Bill Text: IA SF2354 | 2023-2024 | 90th General Assembly | Introduced

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Bill Title: A bill for an act relating to the transition of behavioral health services from a mental health and disability services system to a behavioral health service system, and the transfer of disability services to the division of aging and disability services of the department of health and human services, making appropriations, and including effective date provisions.(Formerly SSB 3146; See SF 2420.)

Spectrum: Committee Bill

Status: (Introduced - Dead) 2024-03-28 - Committee report approving bill, renumbered as SF 2420. S.J. 668. [SF2354 Detail]

Download: Iowa-2023-SF2354-Introduced.html

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Senate File 2354 - Introduced
SENATE FILE 2354
BY COMMITTEE ON HEALTH AND
HUMAN SERVICES
(SUCCESSOR TO SSB 3146)
(COMPANION TO HF 2509 BY
COMMITTEE ON HEALTH AND HUMAN
SERVICES)
A BILL FOR
An Act relating to the transition of behavioral health services
from a mental health and disability services system to
a behavioral health service system, and the transfer of
disability services to the division of aging and disability
services of the department of health and human services,
making appropriations, and including effective date
provisions.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
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DIVISION I
BEHAVIORAL HEALTH SERVICE SYSTEM
Section 1. NEW SECTION . 225A.1 Definitions.
As used in this chapter unless the context otherwise
requires:
1. “Administrative services organization” means an entity
designated by the department pursuant to section 225A.4, to
develop and perform planning and administrative services in
accordance with a district behavioral health service system
plan.
2. “Behavioral health condition” means a substantial
limitation in major life activities due to a mental,
behavioral, or addictive disorder or condition diagnosed in
accordance with the criteria provided in the most current
edition of the diagnostic and statistical manual of mental
disorders, published by the American psychiatric association.
3. “Behavioral health district” or “district” means a
geographic, multicounty, sub-state area as designated by the
department under section 225A.4.
4. “Behavioral health provider” or “provider” means an
individual, firm, corporation, association, or institution
that, pursuant to this chapter, is providing or has been
approved by the department to provide services to an individual
with a behavioral health condition.
5. “Behavioral health service system” means the behavioral
health service system established in section 225A.3.
6. “Caregiver” means an adult family member, or other
individual, who is providing care to a person outside of a
formal program.
7. “Department” means the department of health and human
services.
8. “Director” means the director of the department of health
and human services.
9. “District behavioral health advisory council” or
“advisory council” means a council established by an
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administrative services organization under section 225A.5, to
identify opportunities, address challenges, and advise the
administrative services organization in accordance with section
225A.5.
10. “District behavioral health service system plan” or
“district behavioral health plan” means a plan developed by
an administrative services organization and approved by the
department to outline the services intended to be provided
within the administrative services organization’s behavioral
health district.
11. “Indicated prevention” means prevention activities
designed to prevent the onset of substance use disorders in
individuals who do not meet the medical criteria for addiction,
but who show early signs of developing a substance use disorder
in the future.
12. “Selective prevention” means prevention activities
designed to target subsets of the total population who are
considered at-risk for a substance use disorder by virtue of
their membership in a particular segment of the population.
Selective prevention targets the entire subgroup, regardless of
the degree of risk of any individual within the group.
13. “State behavioral health service system plan” or
“state behavioral health plan” means the plan developed by the
department that describes the key components of the state’s
behavioral health service system.
14. “Universal prevention” means prevention activities
designed to address an entire population class for the purpose
of preventing or delaying the use of alcohol, tobacco, and
other drugs. Population classes include but are not limited
to the national population, local populations, community
populations, school populations, and neighborhood populations.
Sec. 2. NEW SECTION . 225A.2 State mental health authority
—— state agency for substance abuse.
1. The department is designated as the state mental health
authority as defined in 42 U.S.C. §201(m) for the purpose of
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directing benefits from the federal community mental health
services block grant, 42 U.S.C. §300x et seq., and the state
authority designated for the purpose of directing benefits
from the federal substance abuse prevention and treatment
block grant, 42 U.S.C. §300x-21 et seq. This designation
does not preclude the state board of regents from authorizing
or directing any institution under the board of regents’
jurisdiction to carry out educational, prevention, and research
activities in the areas of mental health and intellectual
disability.
2. The department is designated as the single state agency
for substance abuse for the purposes of 42 U.S.C. §1396a et
seq.
3. For the purposes of effectuating the department’s roles
designated in this section, the department shall have the
following powers and the authority to take all the following
actions:
a. Plan, establish, and maintain prevention, education,
early intervention, treatment, recovery support, and crisis
services programs as necessary or desirable in accordance with
a comprehensive behavioral health service system.
b. Develop and submit a state plan as required by 42 U.S.C.
§300x-1, in accordance with 42 C.F.R. §431.10.
c. Review and approve district behavioral health service
system plans developed in accordance with the state behavioral
health service system plan.
d. Perform all necessary acts to cooperate with any state
agency, political subdivision, or federal government agency to
apply for grants.
e. Solicit and accept for use any gift of money or property
by will or otherwise, and any grant of money, services,
or property from the federal government, the state, or any
political subdivision thereof or any private source.
f. Collect and maintain records, engage in studies and
analyses, and gather relevant statistics.
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g. Take any other actions as necessary to execute the
duties granted to the department in this chapter, or that
are otherwise required to maintain compliance with federal
requirements related to the department’s roles established in
this section.
Sec. 3. NEW SECTION . 225A.3 Behavioral health service
system —— department powers and duties.
1. A behavioral health service system is established
under the control of the department for the purposes of
implementing a statewide system of prevention, education, early
intervention, treatment, recovery support, and crisis services
related to mental health, substance use, tobacco use, and
problem gambling.
2. To the extent funding is available, the department
shall perform all of the following duties to administer the
behavioral health service system:
a. Consistent with the department’s agency strategic plan
adopted pursuant to section 8E.206, prepare and administer
the state behavioral health service system plan. The state
behavioral health service system plan shall identify strategies
and targeted outcomes for the behavioral health service system
to continuously improve the provision of all of the following:
(1) Universal prevention, selective prevention, and
indicated prevention.
(2) Evidence-based and evidence-informed early intervention
and treatment services.
(3) Comprehensive recovery support services with a focus on
community-based services that avoid, divert, or offset the need
for acute inpatient services, long-term services provided in
large institutional settings, law enforcement involvement, and
incarceration.
(4) Crisis services with a focus on reducing escalation
of crisis situations, relieving the immediate distress of
individuals experiencing a crisis situation, reducing the
risk that individuals in a crisis situation harm themselves
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or others, and promoting timely access to behavioral health
services for those who require ongoing treatment.
b. Administer and distribute state appropriations, federal
aid, and grants deposited into the behavioral health fund
established in section 225A.7.
c. Oversee, provide technical assistance to, and
monitor administrative services organizations to ensure the
administrative services organizations’ compliance with district
behavioral health plans.
d. Oversee behavioral health provider licensure,
accreditation, and certification, and issue determinations
to approve, deny, revoke, or suspend a behavioral health
provider’s licensure, accreditation, or certification status.
e. Establish and maintain a data collection and management
information system to identify, collect, and analyze service
outcome and performance data to address the needs of patients,
providers, the department, and programs operating within the
behavioral health service system.
f. Collect, monitor, and utilize information including but
not limited to behavioral health service system patient records
and syndromic surveillance data to understand emerging needs,
and to swiftly deploy information, resources, and technical
assistance in response.
g. Adopt rules pursuant to chapter 17A to administer this
chapter. Such rules shall include but not be limited to rules
that provide for all of the following:
(1) Minimum access standards to ensure equitable access to
services provided through the behavioral health service system
including but not limited to when services are available, who
is eligible for services, and where services are available.
(2) Methods to ensure each individual receives an
uninterrupted continuum of care for prevention, education,
early intervention, treatment, recovery support, and crisis
services.
(3) Standards for the implementation and maintenance
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of behavioral health programs and services offered by the
behavioral health service system, and by each administrative
services organization.
(4) Procedures for the management and oversight of
behavioral health providers to ensure provider compliance with
the terms of the behavioral health providers’ contracts and
with state and federal law and rules.
(5) Procedures for the termination of an administrative
services organization’s designation as an administrative
services organization.
(6) Procedures for the collection, utilization, and
maintenance of the data necessary to establish a central data
repository in accordance with section 225A.6.
(7) Any other requirements the department deems necessary
to ensure that an administrative services organization
fulfills the administrative services organization’s duties
as established in this chapter, and as established in the
administrative services organization’s district behavioral
health plan.
Sec. 4. NEW SECTION . 225A.4 Behavioral health service
system —— districts and administrative services organizations.
1. a. The department shall divide the entirety of the state
into designated behavioral health districts. Behavioral health
prevention, education, early intervention, treatment, recovery
support, and crisis services shall be made available through
each behavioral health district in a manner consistent with
directives each district receives from the department.
b. For the purpose of providing equitable access to all
services provided through the behavioral health service
system, the department shall consider all of the following when
designating behavioral health districts:
(1) City and county lines.
(2) The maximum population size that behavioral health
services available in an area are able to effectively serve.
(3) Areas of high need for behavioral health services.
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(4) Patterns various populations exhibit when accessing or
receiving behavioral health services.
c. Notwithstanding chapter 17A, the manner in which the
department designates behavioral health districts including but
not limited to the determination of the boundaries for each
district shall not be subject to judicial review.
2. a. The department shall designate an administrative
services organization for each behavioral health district to
oversee and organize each district and the behavioral health
services associated with the district. The department shall
issue requests for proposals for administrative services
organization candidates.
b. At the department’s discretion, the department may
designate any of the following as an administrative services
organization:
(1) A mental health and disability services regional
administrator formed prior to July 1, 2025.
(2) A public or private agency in a behavioral health
district, or any separate organizational unit within the
public or private agency, that has the capabilities to engage
in the planning or provision of a broad range of behavioral
health prevention, education, early intervention, treatment,
recovery support, and crisis services only as directed by the
department.
c. The department shall consider all of the following
factors in determining whether to designate an entity as an
administrative services organization:
(1) Whether the entity has demonstrated the capacity to
manage and utilize available resources in a manner required of
an administrative services organization.
(2) Whether the entity has demonstrated the ability to
ensure the delivery of behavioral health services within the
district as required by the department by rule.
(3) Whether the entity has demonstrated the ability to
fulfill the monitoring, oversight, and provider compliance
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responsibilities as required by the department by rule.
3. a. Upon designation by the department, an administrative
services organization shall be considered an instrumentality of
the state and shall adhere to all state and federal mandates
and prohibitions applicable to an instrumentality of the state.
b. The designation as an administrative services
organization shall continue until the designation is removed
by the department, the administrative services organization
withdraws, or a change in state or federal law necessitates the
removal of the designation.
4. Each administrative services organization shall function
as a subrecipient for the purposes of the federal community
mental health services block grant, 42 U.S.C. §300x et seq.,
and the federal substance abuse prevention and treatment block
grant, 42 U.S.C. §300x-21 et seq., and shall comply with all
federal requirements applicable to subrecipients under the
block grants.
5. Each administrative services organization shall perform
all of the following duties:
a. Develop and administer a district behavioral health
plan as approved by the department, and in accordance with the
standards adopted by the department by rule.
b. Coordinate the administration of the district behavioral
health plan with federal, state, and local resources in order
to develop a comprehensive and coordinated local behavioral
health service system.
c. Enter into contracts necessary to provide services under
the district behavioral health plan.
d. Oversee, provide technical assistance to, and monitor
the compliance of providers contracted by the administrative
services organization to provide behavioral health services in
accordance with the district behavioral health plan.
e. Establish a district behavioral health advisory council
pursuant to section 225A.5.
Sec. 5. NEW SECTION . 225A.5 District behavioral health
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advisory councils.
1. Each administrative services organization shall
establish a district behavioral health advisory council that
shall do all of the following:
a. Identify opportunities and address challenges based on
updates received from the administrative services organization
regarding the implementation of the district behavioral health
plan.
b. Advise the administrative services organization while
the administrative services organization is developing a
comprehensive behavioral health policy.
c. Advise the administrative services organization on how to
best provide access to behavioral health prevention, education,
early intervention, treatment, recovery support, and crisis
services throughout the district as directed by the department.
2. An advisory council shall consist of nine members.
Members shall be appointed by the administrative services
organization subject to the following requirements:
a. Three members shall be elected public officials
currently holding office, or the public official’s designated
representative. However, if the number of elected public
officials available and willing to serve is less than three
members, this requirement shall be waived until an elected
public official currently holding office is willing to serve.
b. Three members shall be chosen in accordance with
procedures established by the administrative services
organization to ensure representation of the populations served
within the behavioral health district.
c. Three members shall be chosen who have experience
or education related to core behavioral health functions,
essential behavioral health services, behavioral health
prevention, behavioral health treatment, population-based
behavioral health services, or community-based behavioral
health initiatives.
Sec. 6. NEW SECTION . 225A.6 Behavioral health service
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system —— data collection and use.
1. The department shall take all of the following actions
for data related to the behavioral health service system:
a. Collect and analyze the data, including but not
limited to Medicaid and community services network data, as
necessary to issue cost estimates for serving populations,
providing treatment, making and receiving payments, conducting
operations, and performing duties related to the behavioral
health service system. In doing so, the department shall
maintain compliance with applicable federal and state
privacy laws to ensure the confidentiality and integrity
of individually identifiable data. The department may
periodically assess the status of the department’s compliance
to ensure that data collected by and stored with the department
is protected.
b. Establish and administer a central data repository for
collecting and analyzing state, behavioral health district, and
contracted behavioral health provider data.
c. Establish a record for each individual receiving publicly
funded services from an administrative services organization.
Each record shall include a unique client identifier for the
purposes of identifying and tracking the individual’s record.
d. Consult with administrative services organizations,
behavioral health service providers, and other behavioral
health service system stakeholders on an ongoing basis to
implement and maintain the central data repository.
e. Engage with all entities that maintain information the
department is required to collect pursuant to this section in
order to integrate all data concerning individuals receiving
services within the behavioral health service system.
f. Engage with all entities that maintain general population
data relating to behavioral health in order to develop action
plans, create projections relating to a population’s behavioral
health needs, develop policies concerning behavioral health,
and otherwise perform acts as necessary to enhance the state’s
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overall behavioral health.
2. Administrative services organizations shall report all
data required to be maintained in the central data repository
to the department in a manner as established by the department
by rule. For the purpose of making such data reports, an
administrative services organization shall do one of the
following:
a. Utilize a data system that integrates with the data
systems used by the department.
b. Utilize a data system that has the capacity to securely
exchange information with the department, other behavioral
health districts, contractors, and other entities involved with
the behavioral health service system who are authorized to
access the central data repository.
3. Data and information maintained by and exchanged between
an administrative services organization and the department
shall be labeled consistently, share the same definitions,
utilize the same common coding and nomenclature, and be in a
form and format as required by the department by rule.
4. Administrative services organizations shall report,
to the department in a manner specified by the department,
information including but not limited to demographic
information, expenditure data, and data concerning the
behavioral health services and other support provided to
individuals in the administrative service organization’s
district.
5. The department shall ensure that administrative services
organizations, behavioral health providers, and contracting
entities operating within the behavioral health service system
maintain uniform methods for keeping statistical information
relating to behavioral health service system outcomes and
performance.
6. The department shall develop and implement a means to
provide key outcome and performance data to the public and to
persons involved with the behavioral health service system.
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Sec. 7. NEW SECTION . 225A.7 Behavioral health fund.
1. For purposes of this section:
a. “Population” means, as of July 1 of the fiscal year
preceding the fiscal year in which the population figure is
applied, the population shown by the latest preceding certified
federal census or the latest applicable population estimate
issued by the United States census bureau, whichever is most
recent.
b. “State growth factor” for a fiscal year means an amount
equal to the dollar amount used to calculate the appropriation
under this section for the immediately preceding fiscal year
multiplied by the percent increase, if any, in the amount of
sales tax revenue deposited into the general fund of the state
under section 423.2A, subsection 1, paragraph “a” , less the
transfers required under section 423.2A, subsection 2, between
the fiscal year beginning three years prior to the applicable
fiscal year and the fiscal year beginning two years prior
to the applicable year, but not to exceed one and one-half
percent.
2. A behavioral health fund is established in the state
treasury under the control of the department. The fund shall
consist of moneys deposited into the fund pursuant to this
section and section 426B.1, gifts of money or property accepted
by the state or the department to support any services under
this chapter or chapter 231, and moneys otherwise appropriated
by the general assembly. Moneys in the fund are appropriated
to the department to implement and administer the behavioral
health service system and related programs including but not
limited to all of the following:
a. Distributions to administrative services organizations
to provide services as outlined in the organizations’ district
behavioral health plan.
b. Distributions to providers of tobacco use services,
substance use disorder services, and problem gambling services.
c. Funding of disability services pursuant to chapter 231.
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d. Payment of administrative costs associated with services
described under paragraphs “a” , “b” , and “c” .
3. For the fiscal year beginning July 1, 2025, there
is transferred from the general fund of the state to the
behavioral health fund an amount equal to forty-two dollars
multiplied by the state’s population for the fiscal year.
4. For the fiscal year beginning July 1, 2026, and each
succeeding fiscal year, there is transferred from the general
fund of the state to the behavioral health fund an amount equal
to the state’s population for the fiscal year multiplied by
the sum of the dollar amount used to calculate the transfer
from the general fund to the behavioral health fund for the
immediately preceding fiscal year, plus the state growth factor
for the fiscal year for which the transfer is being made.
5. For each fiscal year, an administrative services
organization shall not spend on administrative costs an amount
more than seven percent of the total amount distributed to the
administrative services organization through this section and
other appropriations for that fiscal year.
6. Moneys in the behavioral health fund may be used by the
department for cash flow purposes, provided that any moneys so
allocated are returned to the behavioral health fund by the end
of each fiscal year.
7. Notwithstanding section 12C.7, subsection 2, interest
or earnings on moneys deposited in the behavioral health fund
shall be credited to the behavioral health fund.
8. Notwithstanding section 8.33, moneys appropriated in
this section that remain unencumbered or unobligated at the
close of the fiscal year shall not revert but shall remain
available for expenditure for the purposes designated until the
close of the succeeding fiscal year.
Sec. 8. CODE EDITOR DIRECTIVE. The Code editor is directed
to do all of the following:
1. Designate sections 225A.1 through 225A.7, as enacted
in this division of this Act, as Code chapter 225A entitled
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“Department of Health and Human Services —— Behavioral Health
Service System”.
2. Correct internal references in the Code and in any
enacted legislation as necessary due to the enactment of this
division of this Act.
Sec. 9. EFFECTIVE DATE. This division of this Act takes
effect July 1, 2025.
DIVISION II
BEHAVIORAL HEALTH SERVICE SYSTEM —— CONFORMING CHANGES
Sec. 10. Section 11.6, subsection 1, paragraph b, Code 2024,
is amended to read as follows:
b. The financial condition and transactions of community
mental health centers organized under chapter 230A , substance
use disorder programs organized licensed under chapter 125 , and
community action agencies organized under chapter 216A , shall
be audited at least once each year.
Sec. 11. Section 35D.9, Code 2024, is amended to read as
follows:
35D.9 County of residence upon discharge.
1. A member of the home does not acquire residency in
the county in which the home is located unless the member is
voluntarily or involuntarily discharged from the home and the
member meets county of residence requirements.
2. For purposes of this section , “county of residence”
means the same as defined in section 225C.61 the county in
this state in which, at the time a person applies for or
receives services, the person is living and has established
an ongoing presence with the declared, good faith intention
of living for a permanent or indefinite period of time . The
county of residence of a homeless person is the county in
which the homeless person usually sleeps. A person maintains
residency in the county or state in which the person last
resided during the time period that the person is present in
a different county or state receiving services in a hospital,
a correctional facility, a halfway house for community-based
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corrections or substance use disorder treatment, a nursing
facility, an intermediate care facility for persons with an
intellectual disability, a residential care facility, or for
the purpose of attending a college or university.
3. a. The dispute resolution process in this subsection
shall apply to county of residence disputes. The dispute
resolution process shall not be applicable to any of the
following:
(1) Disputes involving persons committed to a state
facility pursuant to chapter 812.
(2) Disputes involving Iowa rule of criminal procedure
2.22(8)(b), commitment for evaluation.
(3) Disputes involving chapter 12 of Iowa court rules, rules
for involuntary hospitalization of mentally ill persons.
b. If a county objects to a billing for services or a
residency determination and asserts that either the person
has residency in a different county or the person is not a
resident of this state, the person’s county of residence
shall be determined as provided in this subsection. If the
county asserts that the person has residency in a different
county in this state, the county shall notify that county in
writing within one hundred twenty calendar days of receiving
the billing for services or of the county of residence
determination.
c. The county that receives the notification under paragraph
“b” shall respond in writing to the county that provided the
notification within forty-five calendar days of receiving the
notification. If the parties cannot agree as to the person’s
county of residence within ninety calendar days of the date of
notification, on motion of either of the parties, the matter
shall be referred to the administrative hearings division of
the department of inspections, appeals, and licensing for
a contested case proceeding under chapter 17A, before an
administrative law judge assigned in accordance with section
10A.801, to determine the person’s county of residence.
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d. (1) Notwithstanding section 17A.15, the administrative
law judge’s determination of a person’s county of residence
shall be considered final agency action. Judicial review of
the determination may be sought in accordance with section
17A.19.
(2) If following the determination of a person’s county of
residence under this subsection additional evidence becomes
available that merits a change in the determination of the
person’s county of residence, the affected parties may change
the determination of county of residence by mutual agreement.
Otherwise, a party may move that the matter be reconsidered
by the county, or by an administrative law judge assigned in
accordance with section 10A.801.
e. Unless a petition is filed for judicial review, the
administrative law judge’s determination of the person’s county
of residence shall result in one of the following:
(1) If a county is determined to be the person’s county
of residence, that county shall pay any amounts due and shall
reimburse the other county for any amounts paid for services
provided to the person by the other county prior to the county
of residence determination.
(2) If it is determined that the person is not a resident of
this state, neither the state nor either county shall be liable
for payment of amounts due for services provided to the person
prior to the determination of the person’s county of residence.
f. (1) The party that does not prevail in a contested
case proceeding or a subsequent judicial review pursuant to
this subsection shall be liable for costs associated with
the proceeding or judicial review, including reimbursement
of the administrative hearings division of the department of
inspections, appeals, and licensing’s actual costs associated
with the administrative proceeding, court costs, and reasonable
attorney fees.
(2) A payment or reimbursement pursuant to this subsection
shall be remitted within forty-five calendar days of the
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date the county of residence determination is issued by the
administrative law judge or the date the court files an order
determining the person’s county of residence, whichever is
later. After forty-five calendar days, the prevailing party
may add a penalty of up to one percent per month to any amounts
due.
Sec. 12. Section 97B.1A, subsection 8, paragraph a,
subparagraph (13), Code 2024, is amended by striking the
subparagraph.
Sec. 13. Section 123.17, subsections 5 and 8, Code 2024, are
amended to read as follows:
5. After any transfer provided for in subsection 3 is
made, the department shall transfer into a special revenue
account in the general fund of the state, a sum of money at
least equal to seven percent of the gross amount of sales
made by the department from the beer and liquor control fund
on a monthly basis but not less than nine million dollars
annually. Of the amounts transferred, two million dollars,
plus an additional amount determined by the general assembly,
shall be appropriated to the department of health and human
services for use by the staff who administer the comprehensive
substance use disorder program under chapter 125 for substance
use disorder treatment and prevention programs the purposes of
planning, establishing, and maintaining prevention, education,
early intervention, treatment, and recovery support services
programs for substance use . Any amounts received in excess of
the amounts appropriated to the department of health and human
services for use by the staff who administer the comprehensive
substance use disorder program under chapter 125 the purposes
of planning, establishing, and maintaining prevention,
education, early intervention, treatment, and recovery support
services programs for substance use shall be considered part of
the general fund balance.
8. After any transfers provided for in subsections 3, 5,
6, and 7 , and before any other transfer to the general fund,
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the department shall transfer from the beer and liquor control
fund one million dollars to the department of health and human
services for distribution pursuant to section 125.59 behavioral
health fund established under section 225A.7 .
Sec. 14. Section 124.409, subsection 2, Code 2024, is
amended by striking the subsection.
Sec. 15. Section 125.2, subsections 4, 5, and 10, Code 2024,
are amended by striking the subsections.
Sec. 16. Section 125.91, subsection 1, Code 2024, is amended
to read as follows:
1. The procedure prescribed by this section shall only
be used for a person with a substance use disorder due to
intoxication or substance-induced incapacitation who has
threatened, attempted, or inflicted physical self-harm or harm
on another, and is likely to inflict physical self-harm or harm
on another unless immediately detained, or who is incapacitated
by a chemical substance, if an application has not been filed
naming the person as the respondent pursuant to section 125.75
and the person cannot be ordered into immediate custody and
detained pursuant to section 125.81 .
Sec. 17. Section 125.93, Code 2024, is amended to read as
follows:
125.93 Commitment records —— confidentiality.
Records of the identity, diagnosis, prognosis, or treatment
of a person which are maintained in connection with the
provision of substance use disorder treatment services are
confidential, consistent with the requirements of section
125.37 , and with the federal confidentiality regulations
authorized by the federal Drug Abuse Office and Treatment Act ,
42 U.S.C. §290ee and the federal Comprehensive Alcohol Abuse
and Alcoholism Prevention, Treatment and Rehabilitation Act, 42
U.S.C. §290dd-2. However, such records may be disclosed to an
employee of the department of corrections, if authorized by the
director of the department of corrections, or to an employee
of a judicial district department of correctional services, if
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authorized by the director of the judicial district department
of correctional services.
Sec. 18. Section 135.11, subsection 11, Code 2024, is
amended to read as follows:
11. Administer chapters 125, 136A , 136C , 139A , 142 , 142A ,
144 , and 147A .
Sec. 19. Section 135C.2, subsection 5, unnumbered paragraph
1, Code 2024, is amended to read as follows:
The department shall establish a special classification
within the residential care facility category in order to
foster the development of residential care facilities which
serve persons with an intellectual disability, chronic mental
illness, a developmental disability, or brain injury, as
described under section 225C.26 , and which contain five or
fewer residents. A facility within the special classification
established pursuant to this subsection is exempt from the
requirements of section 10A.713 . The department shall adopt
rules which are consistent with rules previously developed for
the waiver demonstration waiver project pursuant to 1986 Iowa
Acts, ch. 1246, §206 , and which include all of the following
provisions:
Sec. 20. Section 135C.6, subsection 1, Code 2024, is amended
to read as follows:
1. A person or governmental unit acting severally or
jointly with any other person or governmental unit shall not
establish or operate a health care facility in this state
without a license for the facility. A supported community
living service, as defined in section 225C.21 249A.38A , is not
required to be licensed under this chapter , but is subject to
approval under section 225C.21 249A.38A in order to receive
public funding.
Sec. 21. Section 135C.23, subsection 1, unnumbered
paragraph 1, Code 2024, is amended to read as follows:
Each resident shall be covered by a contract executed at
the time of admission or prior thereto by the resident, or the
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resident’s legal representative, and the health care facility ,
except as otherwise provided by subsection 5 with respect to
residents admitted at public expense to a county care facility
operated under chapter 347B . Each party to the contract shall
be entitled to a duplicate original thereof, and the health
care facility shall keep on file all contracts which it has
with residents and shall not destroy or otherwise dispose of
any such contract for at least one year after its expiration.
Each such contract shall expressly set forth:
Sec. 22. Section 135C.23, subsection 2, paragraph b, Code
2024, is amended to read as follows:
b. This section does not prohibit the admission of a
patient with a history of dangerous or disturbing behavior to
an intermediate care facility for persons with mental illness,
intermediate care facility for persons with an intellectual
disability, or nursing facility , or county care facility when
the intermediate care facility for persons with mental illness,
intermediate care facility for persons with an intellectual
disability, or nursing facility , or county care facility has a
program which has received prior approval from the department
to properly care for and manage the patient. An intermediate
care facility for persons with mental illness, intermediate
care facility for persons with an intellectual disability,
or nursing facility , or county care facility is required to
transfer or discharge a resident with dangerous or disturbing
behavior when the intermediate care facility for persons with
mental illness, intermediate care facility for persons with an
intellectual disability, or nursing facility , or county care
facility cannot control the resident’s dangerous or disturbing
behavior. The department , in coordination with the state
mental health and disability services commission created in
section 225C.5 , shall adopt rules pursuant to chapter 17A for
programs to be required in intermediate care facilities for
persons with mental illness, intermediate care facilities
for persons with an intellectual disability, and nursing
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facilities , and county care facilities that admit patients
or have residents with histories of dangerous or disturbing
behavior.
Sec. 23. Section 135C.23, subsection 5, Code 2024, is
amended by striking the subsection.
Sec. 24. Section 135C.24, subsection 5, Code 2024, is
amended by striking the subsection.
Sec. 25. Section 135G.1, subsection 12, Code 2024, is
amended to read as follows:
12. a. “Subacute mental health services” means the same
as defined in section 225C.6 services that provide all of the
following:
(1) A comprehensive set of wraparound services for a
person who has had, or is at imminent risk of having, acute or
crisis mental health symptoms that do not permit the person to
remain in or threatens removal of the person from the person’s
home and community, but who has been determined by a mental
health professional and a licensed health care professional,
subject to the professional’s scope of practice, not to need
inpatient acute hospital services. For the purposes of this
subparagraph, “licensed health care professional” means a person
licensed under chapter 148, an advanced registered nurse
practitioner, or a physician assistant.
(2) Intensive, recovery-oriented treatment and monitoring
of a person. Treatment may be provided directly or remotely
by a licensed psychiatrist or an advanced registered nurse
practitioner.
(3) An outcome-focused, interdisciplinary approach designed
to return a person to living successfully in the community.
b. Subacute mental health services may include services
provided in a wide array of settings ranging from a person’s
home to a specialized facility with restricted means of egress.
c. Subacute mental health services shall be limited to a
period not to exceed ten calendar days or another time period
determined in accordance with rules adopted by the department
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for this purpose, whichever is longer .
Sec. 26. Section 142.1, Code 2024, is amended to read as
follows:
142.1 Delivery of bodies.
The body of every person dying who died in a public asylum,
hospital, county care facility, penitentiary, or reformatory
in this state, or found dead within the state, or which who
is to be buried at public expense in this state, except those
buried under the provisions of chapter 144C or 249 , and which
is suitable for scientific purposes, shall be delivered to the
medical college of the state university, or some osteopathic
or chiropractic college or school located in this state, which
has been approved under the law regulating the practice of
osteopathic medicine or chiropractic; but no such body shall
be delivered to any such college or school if the deceased
person expressed a desire during the person’s last illness
that the person’s body should be buried or cremated, nor if
such is the desire of the person’s relatives. Such bodies
shall be equitably distributed among said colleges and schools
according to their needs for teaching anatomy in accordance
with such rules as may be adopted by the department of health
and human services. The expense of transporting said bodies to
such college or school shall be paid by the college or school
receiving the same. If the deceased person has not expressed
a desire during the person’s last illness that the person’s
body should be buried or cremated and no person authorized to
control the deceased person’s remains under section 144C.5
requests the person’s body for burial or cremation, and if a
friend objects to the use of the deceased person’s body for
scientific purposes, said deceased person’s body shall be
forthwith delivered to such friend for burial or cremation at
no expense to the state or county. Unless such friend provides
for burial and burial expenses within five days, the body shall
be used for scientific purposes under this chapter .
Sec. 27. Section 142.3, Code 2024, is amended to read as
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follows:
142.3 Notification of department.
Every county medical examiner, funeral director or embalmer,
and the managing officer of every public asylum, hospital,
county care facility, penitentiary, or reformatory, as soon as
any dead body shall come into the person’s custody which may be
used for scientific purposes as provided in sections 142.1 and
142.2 , shall at once notify the nearest relative or friend of
the deceased, if known, and the department of health and human
services, and hold such body unburied for forty-eight hours.
Upon receipt of notification, the department shall issue verbal
or written instructions relative to the disposition to be made
of said body. Complete jurisdiction over said bodies is vested
exclusively in the department of health and human services. No
autopsy or post mortem, except as are legally ordered by county
medical examiners, shall be performed on any of said bodies
prior to their delivery to the medical schools.
Sec. 28. Section 218.30, Code 2024, is amended to read as
follows:
218.30 Investigation of other facilities.
The director may investigate or cause the investigation of
charges of abuse, neglect, or mismanagement on the part of an
officer or employee of a private facility which is subject to
the director’s supervision or control. The director shall also
investigate or cause the investigation of charges concerning
county care facilities in which persons with mental illness are
served.
Sec. 29. Section 218.78, subsection 1, Code 2024, is amended
to read as follows:
1. All institutional receipts of the department, including
funds received from client participation at the state resource
centers under section 222.78 and at the state mental health
institutes under section 230.20 , shall be deposited in the
general fund except for reimbursements for services provided
to another institution or state agency, for receipts deposited
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in the revolving farm fund under section 904.706 , for deposits
into the medical assistance fund under section 249A.11 , and for
rentals charged to employees or others for room, apartment, or
house and meals, which shall be available to the institutions.
Sec. 30. Section 222.1, subsection 1, Code 2024, is amended
to read as follows:
1. This chapter addresses the public and private services
available in this state to meet the needs of persons with an
intellectual disability. The responsibility of the mental
health and disability services regions formed by counties and
of the state for the costs and administration of publicly
funded services shall be as set out in section 222.60 and other
pertinent sections of this chapter .
Sec. 31. Section 222.2, Code 2024, is amended by adding the
following new subsection:
NEW SUBSECTION . 01. “Administrative services organization”
means the same as defined in section 225A.1.
Sec. 32. Section 222.2, subsections 6 and 7, Code 2024, are
amended by striking the subsections.
Sec. 33. Section 222.12, subsection 2, Code 2024, is amended
by striking the subsection.
Sec. 34. Section 222.13, Code 2024, is amended to read as
follows:
222.13 Voluntary admissions.
1. If an adult person is believed to be a person with an
intellectual disability, the adult person or the adult person’s
guardian may apply to the department and the superintendent of
any state resource center for the voluntary admission of the
adult person either as an inpatient or an outpatient of the
resource center. If the expenses of the person’s admission
or placement are payable in whole or in part by the person’s
county of residence, application for the admission shall be
made through the regional administrator. An application for
admission to a special unit of any adult person believed to be
in need of any of the services provided by the special unit
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under section 222.88 may be made in the same manner. The
superintendent shall accept the application if a preadmission
diagnostic evaluation confirms or establishes the need for
admission, except that an application shall not be accepted if
the institution does not have adequate facilities available or
if the acceptance will result in an overcrowded condition.
2. If the resource center does not have an appropriate
program for the treatment of an adult or minor person with an
intellectual disability applying under this section or section
222.13A , the regional administrator for the person’s county
of residence or the department , as applicable, shall arrange
for the placement of the person in any public or private
facility within or without outside of the state, approved by
the director, which offers appropriate services for the person.
If the expenses of the placement are payable in whole or in
part by a county, the placement shall be made by the regional
administrator for the county.
3. If the expenses of an admission of an adult to a resource
center or a special unit, or of the placement of the person
in a public or private facility are payable in whole or in
part by a mental health and disability services region, the
regional administrator shall make a full investigation into
the financial circumstances of the person and those liable for
the person’s support under section 222.78 to determine whether
or not any of them are able to pay the expenses arising out of
the admission of the person to a resource center, special unit,
or public or private facility. If the regional administrator
finds that the person or those legally responsible for
the person are presently unable to pay the expenses, the
regional administrator shall pay the expenses. The regional
administrator may review such a finding at any subsequent
time while the person remains at the resource center, or is
otherwise receiving care or treatment for which this chapter
obligates the region to pay. If the regional administrator
finds upon review that the person or those legally responsible
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for the person are presently able to pay the expenses, the
finding shall apply only to the charges incurred during the
period beginning on the date of the review and continuing
thereafter, unless and until the regional administrator again
changes such a finding. If the regional administrator finds
that the person or those legally responsible for the person
are able to pay the expenses, the regional administrator shall
collect the charges to the extent required by section 222.78 ,
and the regional administrator shall be responsible for the
payment of the remaining charges.
Sec. 35. Section 222.13A, subsections 3 and 4, Code 2024,
are amended to read as follows:
3. During the preadmission diagnostic evaluation, the
minor shall be informed both orally and in writing that the
minor has the right to object to the voluntary admission. If
Notwithstanding section 222.33, if the preadmission diagnostic
evaluation determines that the voluntary admission is
appropriate but the minor objects to the admission, the minor
shall not be admitted to the state resource center unless the
court approves of the admission. A petition for approval of
the minor’s admission may be submitted to the juvenile court by
the minor’s parent, guardian, or custodian.
4. As soon as practicable after the filing of a petition for
approval of the voluntary admission, the court shall determine
whether the minor has an attorney to represent the minor in the
proceeding. If the minor does not have an attorney, the court
shall assign to the minor an attorney. If the minor is unable
to pay for an attorney, the attorney shall be compensated by
the mental health and disability services region applicable
administrative services organization at an hourly rate to be
established by the regional administrator in substantially the
same manner as provided in section 815.7 .
Sec. 36. Section 222.14, Code 2024, is amended to read as
follows:
222.14 Care by region pending admission.
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If the institution is unable to receive a patient, the
superintendent shall notify the regional administrator for
the county of residence of the prospective patient applicable
administrative services organization . Until such time as the
patient is able to be received by the institution, or when
application has been made for admission to a public or private
facility as provided in section 222.13 and the application
is pending, the care of the patient shall be provided as
arranged by the regional administrator administrative services
organization .
Sec. 37. NEW SECTION . 222.33 State resource center and
special units —— admissions and discharge.
1. The department shall make all final determinations
concerning whether a person may be admitted to a state resource
center or to a special unit.
2. If a patient is admitted to a state resource center or a
special unit pursuant to section 222.13, or a state resource
center pursuant to section 222.13A, and the patient wishes to
be placed outside of the state resource center or the special
unit, the discharge of the patient shall be made in accordance
with section 222.15.
Sec. 38. NEW SECTION . 222.35 State —— payor of last resort.
The department shall implement services and adopt rules
pursuant to this chapter in a manner that ensures that the
state is the payor of last resort, and that the department
shall not make any payments for services that have been
provided until the department has determined that the services
provided are not payable by a third-party source.
Sec. 39. Section 222.73, subsections 2 and 4, Code 2024, are
amended by striking the subsections.
Sec. 40. Section 222.77, Code 2024, is amended to read as
follows:
222.77 Patients on leave.
The cost of support of patients placed on convalescent leave
or removed as a habilitation measure from a resource center,
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or a special unit, except when living in the home of a person
legally bound for the support of the patient, shall be paid by
the county of residence or the state as provided in section
222.60 .
Sec. 41. Section 222.78, subsection 1, Code 2024, is amended
to read as follows:
1. The father and mother of any patient admitted to a
resource center or to a special unit, as either an inpatient
or an outpatient, and any person, firm, or corporation bound
by contract made for support of the patient are liable for the
support of the patient. The patient and those legally bound
for the support of the patient shall be liable to the county
or state , as applicable, for all sums advanced in accordance
with the provisions of sections 222.60 and 222.77 relating to
reasonable attorney fees and court costs for the patient’s
admission to the resource center or special unit, and for the
treatment, training, instruction, care, habilitation, support,
transportation, or other expenditures made on behalf of the
patient pursuant to this chapter .
Sec. 42. Section 222.79, Code 2024, is amended to read as
follows:
222.79 Certification statement presumed correct.
In actions to enforce the liability imposed by section
222.78 , the superintendent or the county of residence, as
applicable, shall submit a certification statement stating
the sums charged, and the certification statement shall be
considered presumptively correct.
Sec. 43. Section 222.80, Code 2024, is amended to read as
follows:
222.80 Liability to county or state.
A person admitted to a county institution or home or admitted
at county or state expense to a private hospital, sanitarium,
or other facility for treatment, training, instruction, care,
habilitation, and support as a patient with an intellectual
disability shall be liable to the county or state , as
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applicable, for the reasonable cost of the support as provided
in section 222.78 .
Sec. 44. Section 222.82, Code 2024, is amended to read as
follows:
222.82 Collection of liabilities and claims.
If liabilities and claims exist as provided in section
222.78 or any other provision of this chapter , the county of
residence or the state , as applicable, may proceed as provided
in this section . If the liabilities and claims are owed to
a county of residence, the county’s board of supervisors may
direct the county attorney to proceed with the collection of
the liabilities and claims as a part of the duties of the
county attorney’s office when the board of supervisors deems
such action advisable. If the liabilities and claims are owed
to the state, the state shall proceed with the collection.
The board of supervisors or the state , as applicable, may
compromise any and all liabilities to the county or state
arising under this chapter when such compromise is deemed to be
in the best interests of the county or state. Any collections
and liens shall be limited in conformance to section 614.1,
subsection 4 .
Sec. 45. Section 222.85, subsection 2, Code 2024, is amended
to read as follows:
2. Moneys paid to a resource center from any source other
than state appropriated funds and intended to pay all or a
portion of the cost of care of a patient, which cost would
otherwise be paid from state or county funds or from the
patient’s own funds, shall not be deemed “funds belonging to a
patient” for the purposes of this section .
Sec. 46. Section 222.86, Code 2024, is amended to read as
follows:
222.86 Payment for care from fund.
If a patient is not receiving medical assistance under
chapter 249A and the amount in the account of any patient
in the patients’ personal deposit fund exceeds two hundred
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dollars, the department may apply any amount of the excess to
reimburse the county of residence or the state for liability
incurred by the county or the state for the payment of care,
support, and maintenance of the patient, when billed by the
county or state , as applicable .
Sec. 47. Section 222.92, subsection 1, Code 2024, is amended
to read as follows:
1. The department shall operate the state resource centers
on the basis of net appropriations from the general fund of
the state. The appropriation amounts shall be the net amounts
of state moneys projected to be needed for the state resource
centers for the fiscal year of the appropriations. The purpose
of utilizing net appropriations is to encourage the state
resource centers to operate with increased self-sufficiency, to
improve quality and efficiency, and to support collaborative
efforts between the state resource centers and counties and
other providers of funding for the services available from
the state resource centers. The state resource centers shall
not be operated under the net appropriations in a manner that
results in a cost increase to the state or in cost shifting
between the state, the medical assistance program, counties, or
other sources of funding for the state resource centers.
Sec. 48. Section 222.92, subsection 3, paragraph a, Code
2024, is amended by striking the paragraph.
Sec. 49. Section 225.1, subsection 2, Code 2024, is amended
to read as follows:
2. For the purposes of this chapter , unless the context
otherwise requires:
a. “Mental health and disability services region” means
a mental health and disability services region approved in
accordance with section 225C.56 . “Administrative services
organization” means the same as defined in section 225A.1.
b. “Regional administrator” means the administrator of a
mental health and disability services region, as defined in
section 225C.55 . “Department” means the department of health
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and human services.
c. “Respondent” means the same as defined in section 229.1 .
Sec. 50. NEW SECTION . 225.4 State psychiatric hospital ——
admissions.
The department shall make all final determinations
concerning whether a person may be admitted to the state
psychiatric hospital.
Sec. 51. Section 225.11, Code 2024, is amended to read as
follows:
225.11 Initiating commitment procedures.
When a court finds upon completion of a hearing held pursuant
to section 229.12 that the contention that a respondent is
seriously mentally impaired has been sustained by clear and
convincing evidence, and the application filed under section
229.6 also contends or the court otherwise concludes that it
would be appropriate to refer the respondent to the state
psychiatric hospital for a complete psychiatric evaluation and
appropriate treatment pursuant to section 229.13 , the judge
may order that a financial investigation be made in the manner
prescribed by section 225.13 . If the costs of a respondent’s
evaluation or treatment are payable in whole or in part by
a county an administrative services organization , an order
under this section shall be for referral of the respondent
through the regional administrator for the respondent’s county
of residence administrative services organization for an
evaluation and referral of the respondent to an appropriate
placement or service, which may include the state psychiatric
hospital for additional evaluation or treatment.
Sec. 52. Section 225.12, Code 2024, is amended to read as
follows:
225.12 Voluntary public patient —— physician’s or physician
assistant’s report.
A physician or a physician assistant who meets the
qualifications set forth in the definition of a mental health
professional in section 228.1 filing information under
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section 225.10 shall include a written report to the regional
administrator for the county of residence of the person named
in the information, giving shall submit a detailed history of
the case to the applicable administrative services organization
as will be likely to aid in the observation, treatment, and
hospital care of the person and describing the history in
detail .
Sec. 53. Section 225.13, Code 2024, is amended to read as
follows:
225.13 Financial condition.
The regional administrator for the county of residence
applicable administrative services organization of a person
being admitted to the state psychiatric hospital is responsible
for investigating the financial condition of the person and of
those legally responsible for the person’s support.
Sec. 54. Section 225.15, Code 2024, is amended to read as
follows:
225.15 Examination and treatment.
1. When a respondent arrives at the state psychiatric
hospital, the admitting physician, or a physician assistant
who meets the qualifications set forth in the definition of a
mental health professional in section 228.1 , shall examine the
respondent and determine whether or not, in the physician’s
or physician assistant’s judgment, the respondent is a fit
subject for observation, treatment, and hospital care. If,
upon examination, the physician or physician assistant who
meets the qualifications set forth in the definition of a
mental health professional in section 228.1 decides that the
respondent should be admitted to the hospital, the respondent
shall be provided a proper bed in the hospital. The physician
or physician assistant who meets the qualifications set forth
in the definition of a mental health professional in section
228.1 who has charge of the respondent shall proceed with
observation, medical treatment, and hospital care as in the
physician’s or physician assistant’s judgment are proper and
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necessary, in compliance with sections 229.13 , 229.14 , this
section , and section 229.16 . After the respondent’s admission,
the observation, medical treatment, and hospital care of the
respondent may be provided by a mental health professional,
as defined in section 228.1 , who is licensed as a physician,
advanced registered nurse practitioner, or physician assistant.
2. A proper and competent nurse shall also be assigned to
look after and care for the respondent during observation,
treatment, and care. Observation, treatment, and hospital
care under this section which are payable in whole or in part
by a county shall only be provided as determined through
the regional administrator for the respondent’s county of
residence.
Sec. 55. Section 225.16, subsection 1, Code 2024, is amended
to read as follows:
1. If the regional administrator for a person’s county of
residence department finds from the physician’s information
or from the information of a physician assistant who
meets the qualifications set forth in the definition of
a mental health professional in section 228.1 which was
filed under the provisions of section 225.10 225.12 that it
would be appropriate for the person to be admitted to the
state psychiatric hospital, and the report of the regional
administrator made pursuant to section 225.13 shows the
department finds that the person and those who are legally
responsible for the person are not able to pay the expenses
incurred at the hospital, or are able to pay only a part of
the expenses, the person shall be considered to be a voluntary
public patient and the regional administrator shall direct that
the person shall be sent to the state psychiatric hospital at
the state university of Iowa for observation, treatment, and
hospital care.
Sec. 56. Section 225.17, subsection 2, Code 2024, is amended
to read as follows:
2. When the respondent arrives at the hospital, the
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respondent shall receive the same treatment as is provided for
committed public patients in section 225.15 , in compliance
with sections 229.13 through 229.16 . However, observation,
treatment, and hospital care under this section of a respondent
whose expenses are payable in whole or in part by a county
shall only be provided as determined through the regional
administrator for the respondent’s county of residence.
Sec. 57. Section 225.18, Code 2024, is amended to read as
follows:
225.18 Attendants.
The regional administrator An administrative services
organization may appoint an attendant to accompany the
committed public patient or the voluntary public patient
or the committed private patient from the place where the
patient may be to the state psychiatric hospital, or to
accompany the patient from the hospital to a place as may
be designated by the regional administrator administrative
services organization . If a patient is moved pursuant to this
section , at least one attendant shall be of the same gender as
the patient.
Sec. 58. Section 225.22, Code 2024, is amended to read as
follows:
225.22 Liability of private patients —— payment.
Every committed private patient, if the patient has an
estate sufficient for that purpose, or if those legally
responsible for the patient’s support are financially able,
shall be liable to the county and state for all expenses paid
by them in the state on behalf of such patient. All bills
for the care, nursing, observation, treatment, medicine, and
maintenance of such patients shall be paid by the director of
the department of administrative services in the same manner as
those of committed and voluntary public patients as provided in
this chapter , unless the patient or those legally responsible
for the patient make such settlement with the state psychiatric
hospital.
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Sec. 59. Section 225.24, Code 2024, is amended to read as
follows:
225.24 Collection of preliminary expense.
Unless a committed private patient or those legally
responsible for the patient’s support offer to settle the
amount of the claims, the regional administrator for the
person’s county of residence department shall collect, by
action if necessary, the amount of all claims for per diem and
expenses that have been approved by the regional administrator
for the county an administrative services organization and
paid by the regional administrator as provided under section
225.21 administrative services organization . Any amount
collected shall be credited to the mental health and disability
services region combined account created behavioral health fund
established in accordance with section 225C.58 225A.7 .
Sec. 60. Section 225.27, Code 2024, is amended to read as
follows:
225.27 Discharge —— transfer.
The state psychiatric hospital may, at any time, discharge
any patient as recovered, as improved, or as not likely to
be benefited by further treatment. If the patient being so
discharged was involuntarily hospitalized, the hospital shall
notify the committing judge or court of the discharge as
required by section 229.14 or section 229.16 , whichever is as
applicable , and the applicable regional administrator . Upon
receiving the notification, the court shall issue an order
confirming the patient’s discharge from the hospital or from
care and custody, as the case may be, and shall terminate the
proceedings pursuant to which the order was issued. The court
or judge shall, if necessary, appoint a person to accompany the
discharged patient from the state psychiatric hospital to such
place as the hospital or the court may designate, or authorize
the hospital to appoint such attendant.
Sec. 61. Section 226.1, subsection 4, Code 2024, is amended
by adding the following new paragraph:
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NEW PARAGRAPH . 0a. “Administrative services organization”
means the same as defined in section 225A.1.
Sec. 62. Section 226.1, subsection 4, paragraphs d and f,
Code 2024, are amended by striking the paragraphs.
Sec. 63. Section 226.8, subsection 2, Code 2024, is amended
to read as follows:
2. Charges for the care of any person with a diagnosis of
an intellectual disability admitted to a state mental health
institute shall be made by the institute in the manner provided
by chapter 230 , but the liability of any other person to any
mental health and disability services region the state for the
cost of care of such person with a diagnosis of an intellectual
disability shall be as prescribed by section 222.78 .
Sec. 64. Section 226.32, Code 2024, is amended to read as
follows:
226.32 Overcrowded conditions.
The director shall order the discharge or removal from the
mental health institute of incurable and harmless patients
whenever it is necessary to make room for recent cases. If
a patient who is to be discharged entered the mental health
institute voluntarily, the director shall notify the regional
administrator for the county interested at least ten days in
advance of the day of actual discharge.
Sec. 65. Section 226.34, subsection 2, paragraph d, Code
2024, is amended to read as follows:
d. The regional administrator for the county from which
the patient was committed applicable administrative services
organization .
Sec. 66. Section 228.6, subsection 1, Code 2024, is amended
to read as follows:
1. A mental health professional or an employee of or
agent for a mental health facility may disclose mental health
information if and to the extent necessary, to meet the
requirements of section 229.24 , 229.25 , 230.20 , 230.21 , 230.25 ,
230.26 , 230A.108 , 232.74 , or 232.147 , or to meet the compulsory
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reporting or disclosure requirements of other state or federal
law relating to the protection of human health and safety.
Sec. 67. Section 229.1, Code 2024, is amended by adding the
following new subsection:
NEW SUBSECTION . 01. “Administrative services organization”
means the same as defined in section 225A.1.
Sec. 68. Section 229.1, subsections 11, 18, and 19, Code
2024, are amended by striking the subsections.
Sec. 69. Section 229.1B, Code 2024, is amended to read as
follows:
229.1B Regional administrator Administrative services
organization .
Notwithstanding any provision of this chapter to the
contrary, any person whose hospitalization expenses are
payable in whole or in part by a mental health and disability
services region an administrative services organization
shall be subject to all administrative requirements of the
regional administrator for the county administrative services
organization .
Sec. 70. Section 229.2, subsection 1, paragraph b,
subparagraph (3), Code 2024, is amended to read as follows:
(3) As soon as is practicable after the filing of a
petition for juvenile court approval of the admission of the
minor, the juvenile court shall determine whether the minor
has an attorney to represent the minor in the hospitalization
proceeding, and if not, the court shall assign to the minor
an attorney. If the minor is financially unable to pay for
an attorney, the attorney shall be compensated by the mental
health and disability services region administrative services
organization responsible for the minor’s behavioral health
care at an hourly rate to be established by the regional
administrator for the county in which the proceeding is held
administrative services organization in substantially the same
manner as provided in section 815.7 .
Sec. 71. Section 229.2, subsection 2, paragraph a, Code
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2024, is amended to read as follows:
a. The chief medical officer of a public hospital shall
receive and may admit the person whose admission is sought,
subject in cases other than medical emergencies to availability
of suitable accommodations and to the provisions of sections
section 229.41 and 229.42 .
Sec. 72. Section 229.8, subsection 1, Code 2024, is amended
to read as follows:
1. Determine whether the respondent has an attorney
who is able and willing to represent the respondent in the
hospitalization proceeding, and if not, whether the respondent
is financially able to employ an attorney and capable of
meaningfully assisting in selecting one. In accordance with
those determinations, the court shall if necessary allow the
respondent to select, or shall assign to the respondent, an
attorney. If the respondent is financially unable to pay an
attorney, the attorney shall be compensated by the mental
health and disability services region administrative services
organization responsible for the respondent’s behavioral health
care at an hourly rate to be established by the regional
administrator for the county in which the proceeding is held
administrative services organization in substantially the same
manner as provided in section 815.7 .
Sec. 73. Section 229.10, subsection 1, paragraph a, Code
2024, is amended to read as follows:
a. An examination of the respondent shall be conducted by
one or more licensed physicians or mental health professionals,
as required by the court’s order, within a reasonable time.
If the respondent is detained pursuant to section 229.11,
subsection 1 , paragraph “b” , the examination shall be conducted
within twenty-four hours. If the respondent is detained
pursuant to section 229.11, subsection 1 , paragraph “a” or
“c” , the examination shall be conducted within forty-eight
hours. If the respondent so desires, the respondent shall be
entitled to a separate examination by a licensed physician or
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mental health professional of the respondent’s own choice. The
reasonable cost of the examinations shall, if the respondent
lacks sufficient funds to pay the cost, be paid by the regional
administrator from mental health and disability services region
funds an administrative services organization upon order of the
court.
Sec. 74. Section 229.11, subsection 1, unnumbered paragraph
1, Code 2024, is amended to read as follows:
If the applicant requests that the respondent be taken into
immediate custody and the judge, upon reviewing the application
and accompanying documentation, finds probable cause to believe
that the respondent has a serious mental impairment and is
likely to injure the respondent or other persons if allowed
to remain at liberty, the judge may enter a written order
directing that the respondent be taken into immediate custody
by the sheriff or the sheriff’s deputy and be detained until
the hospitalization hearing. The hospitalization hearing shall
be held no more than five days after the date of the order,
except that if the fifth day after the date of the order is
a Saturday, Sunday, or a holiday, the hearing may be held
on the next succeeding business day. If the expenses of a
respondent are payable in whole or in part by a mental health
and disability services region an administrative services
organization , for a placement in accordance with paragraph “a” ,
the judge shall give notice of the placement to the regional
administrator for the county in which the court is located
applicable administrative services organization , and for a
placement in accordance with paragraph “b” or “c” , the judge
shall order the placement in a hospital or facility designated
through by the regional administrator applicable administrative
services organization . The judge may order the respondent
detained for the period of time until the hearing is held,
and no longer, in accordance with paragraph “a” , if possible,
and if not then in accordance with paragraph “b” , or, only if
neither of these alternatives is available, in accordance with
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paragraph “c” . Detention may be in any of the following:
Sec. 75. Section 229.13, subsection 1, paragraph a, Code
2024, is amended to read as follows:
a. The court shall order a respondent whose expenses are
payable in whole or in part by a mental health and disability
services region an administrative services organization
placed under the care of an appropriate hospital or facility
designated through by the regional administrator for the
county administrative services organization on an inpatient or
outpatient basis.
Sec. 76. Section 229.13, subsection 7, paragraph b, Code
2024, is amended to read as follows:
b. A region An administrative services organization shall
contract with mental health professionals to provide the
appropriate treatment including treatment by the use of oral
medicine or injectable antipsychotic medicine pursuant to this
section .
Sec. 77. Section 229.14, subsection 2, paragraph a, Code
2024, is amended to read as follows:
a. For a respondent whose expenses are payable in whole
or in part by a mental health and disability services
region an administrative services organization , placement
as designated through the regional administrator for the
county administrative services organization in the care of an
appropriate hospital or facility on an inpatient or outpatient
basis, or other appropriate treatment, or in an appropriate
alternative placement.
Sec. 78. Section 229.14A, subsections 7 and 9, Code 2024,
are amended to read as follows:
7. If a respondent’s expenses are payable in whole or in
part by a mental health and disability services region through
the regional administrator for the county an administrative
services organization , notice of a placement hearing shall be
provided to the county attorney and the regional administrator
administrative services organization . At the hearing, the
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county may present evidence regarding appropriate placement.
9. A placement made pursuant to an order entered under
section 229.13 or 229.14 or this section shall be considered to
be authorized through the regional administrator for the county
applicable administrative services organization .
Sec. 79. Section 229.15, subsection 4, Code 2024, is amended
to read as follows:
4. When a patient has been placed in an alternative facility
other than a hospital pursuant to a report issued under section
229.14, subsection 1 , paragraph “d” , a report on the patient’s
condition and prognosis shall be made to the court which placed
the patient, at least once every six months, unless the court
authorizes annual reports. If an evaluation of the patient is
performed pursuant to section 227.2, subsection 4 , a copy of
the evaluation report shall be submitted to the court within
fifteen days of the evaluation’s completion. The court may in
its discretion waive the requirement of an additional report
between the annual evaluations. If the department exercises
the authority to remove residents or patients from a county
care facility or other county or private facility under section
227.6 , the department shall promptly notify each court which
placed in that facility any resident or patient removed.
Sec. 80. Section 229.19, subsection 1, paragraphs a and b,
Code 2024, are amended to read as follows:
a. In each county the board of supervisors shall appoint
an individual who has demonstrated by prior activities an
informed concern for the welfare and rehabilitation of persons
with mental illness, and who is not an officer or employee of
the department , an officer or employee of a region, an officer
or employee of a county performing duties for a region, or
an officer or employee of any agency or facility providing
care or treatment to persons with mental illness, to act as an
advocate representing the interests of patients involuntarily
hospitalized by the court, in any matter relating to the
patients’ hospitalization or treatment under section 229.14 or
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229.15 .
b. The committing court shall assign the advocate for the
county where the patient is located. A county or region may
seek reimbursement from the patient’s county of residence or
from the region in which the patient’s county of residence is
located applicable administrative services organization .
Sec. 81. Section 229.19, subsection 4, unnumbered paragraph
1, Code 2024, is amended to read as follows:
The state mental health and disability services commission
council on health and human services created in section 225C.5
217.2 , in consultation with advocates and county and judicial
branch representatives, shall adopt rules pursuant to chapter
17A relating to advocates that include but are not limited to
all of the following topics:
Sec. 82. Section 229.22, subsection 2, paragraph b, Code
2024, is amended to read as follows:
b. If the magistrate orders that the person be detained,
the magistrate shall, by the close of business on the next
working day, file a written order with the clerk in the county
where it is anticipated that an application may be filed
under section 229.6 . The order may be filed by facsimile if
necessary. A peace officer from the law enforcement agency
that took the person into custody, if no request was made
under paragraph “a” , may inform the magistrate that an arrest
warrant has been issued for or charges are pending against the
person and request that any written order issued under this
paragraph require the facility or hospital to notify the law
enforcement agency about the discharge of the person prior to
discharge. The order shall state the circumstances under which
the person was taken into custody or otherwise brought to a
facility or hospital, and the grounds supporting the finding
of probable cause to believe that the person is seriously
mentally impaired and likely to injure the person’s self or
others if not immediately detained. The order shall also
include any law enforcement agency notification requirements if
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applicable. The order shall confirm the oral order authorizing
the person’s detention including any order given to transport
the person to an appropriate facility or hospital. A peace
officer from the law enforcement agency that took the person
into custody may also request an order, separate from the
written order, requiring the facility or hospital to notify the
law enforcement agency about the discharge of the person prior
to discharge. The clerk shall provide a copy of the written
order or any separate order to the chief medical officer of
the facility or hospital to which the person was originally
taken, to any subsequent facility to which the person was
transported, and to any law enforcement department, ambulance
service, or transportation service under contract with a
mental health and disability services region an administrative
services organization that transported the person pursuant
to the magistrate’s order. A transportation service that
contracts with a mental health and disability services region
an administrative services organization for purposes of this
paragraph shall provide a secure transportation vehicle and
shall employ staff that has received or is receiving mental
health training.
Sec. 83. Section 229.24, subsection 3, unnumbered paragraph
1, Code 2024, is amended to read as follows:
If all or part of the costs associated with hospitalization
of an individual under this chapter are chargeable to a county
of residence an administrative services organization , the
clerk of the district court shall provide to the regional
administrator for the county of residence and to the regional
administrator for the county in which the hospitalization
order is entered administrative services organization the
following information pertaining to the individual which would
be confidential under subsection 1 :
Sec. 84. Section 229.38, Code 2024, is amended to read as
follows:
229.38 Cruelty or official misconduct.
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If any person having the care of a person with mental illness
who has voluntarily entered a hospital or other facility for
treatment or care, or who is responsible for psychiatric
examination care, treatment, and maintenance of any person
involuntarily hospitalized under sections 229.6 through 229.15 ,
whether in a hospital or elsewhere, with or without proper
authority, shall treat such patient with unnecessary severity,
harshness, or cruelty, or in any way abuse the patient or if
any person unlawfully detains or deprives of liberty any person
with mental illness or any person who is alleged to have mental
illness, or if any officer required by the provisions of this
chapter and chapters chapter 226 and 227 , to perform any act
shall willfully refuse or neglect to perform the same, the
offending person shall, unless otherwise provided, be guilty of
a serious misdemeanor.
Sec. 85. Section 230.1, Code 2024, is amended by adding the
following new subsection:
NEW SUBSECTION . 01. “Administrative service organization”
means the same as defined in section 225A.1.
Sec. 86. Section 230.1, subsections 4 and 5, Code 2024, are
amended by striking the subsections.
Sec. 87. Section 230.10, Code 2024, is amended to read as
follows:
230.10 Payment of costs.
All legal costs and expenses for the taking into custody,
care, investigation, and admission or commitment of a person to
a state mental health institute under a finding that the person
has residency in another county of this state shall be charged
against to the regional administrator of the person’s county of
residence applicable administrative services organization .
Sec. 88. Section 230.11, Code 2024, is amended to read as
follows:
230.11 Recovery of costs from state.
Costs and expenses for the taking into custody, care, and
investigation of a person who has been admitted or committed
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to a state mental health institute, United States department
of veterans affairs hospital, or other agency of the United
States government, for persons with mental illness and
who has no residence in this state or whose residence is
unknown, including cost of commitment, if any, shall be paid
as approved by the department. The amount of the costs and
expenses approved by the department is appropriated to the
department from any moneys in the state treasury not otherwise
appropriated. Payment shall be made by the department on
itemized vouchers executed by the regional administrator of
the person’s county which has paid them, and approved by the
department.
Sec. 89. Section 230.15, subsections 1 and 2, Code 2024, are
amended to read as follows:
1. A person with mental illness and a person legally liable
for the person’s support remain liable for the support of
the person with mental illness as provided in this section .
Persons legally liable for the support of a person with mental
illness include the spouse of the person, and any person
bound by contract for support of the person. The regional
administrator of the person’s county of residence, subject to
the direction of the region’s governing board, shall enforce
the obligation created in this section as to all sums advanced
by the regional administrator. The liability to the regional
administrator incurred by a person with mental illness or a
person legally liable for the person’s support under this
section is limited to an amount equal to one hundred percent
of the cost of care and treatment of the person with mental
illness at a state mental health institute for one hundred
twenty days of hospitalization. This limit of liability may
be reached by payment of the cost of care and treatment of the
person with mental illness subsequent to a single admission
or multiple admissions to a state mental health institute or,
if the person is not discharged as cured, subsequent to a
single transfer or multiple transfers to a county care facility
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pursuant to section 227.11 . After reaching this limit of
liability, a person with mental illness or a person legally
liable for the person’s support is liable to the regional
administrator state for the care and treatment of the person
with mental illness at a state mental health institute or,
if transferred but not discharged as cured, at a county care
facility in an amount not in excess of to exceed the average
minimum cost of the maintenance of an individual who is
physically and mentally healthy residing in the individual’s
own home , which standard shall be as established and may be
revised by the department by rule . A lien imposed by section
230.25 shall not exceed the amount of the liability which may
be incurred under this section on account of a person with
mental illness.
2. A person with a substance use disorder is legally
liable for the total amount of the cost of providing care,
maintenance, and treatment for the person with a substance
use disorder while a voluntary or committed patient. When
a portion of the cost is paid by a county an administrative
services organization , the person with a substance use disorder
is legally liable to the county administrative services
organization for the amount paid. The person with a substance
use disorder shall assign any claim for reimbursement under any
contract of indemnity, by insurance or otherwise, providing
for the person’s care, maintenance, and treatment in a state
mental health institute to the state. Any payments received
by the state from or on behalf of a person with a substance use
disorder shall be in part credited to the county in proportion
to the share of the costs paid by the county.
Sec. 90. NEW SECTION . 230.23 State —— payor of last resort.
The department shall implement services and adopt rules
pursuant to this chapter in a manner that ensures that the
state is the payor of last resort, and that the department
shall not make any payments for services that have been
provided until the department has determined that the services
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provided are not payable by a third-party source.
Sec. 91. Section 230.30, Code 2024, is amended to read as
follows:
230.30 Claim against estate.
On the death of a person receiving or who has received
assistance under the provisions of this chapter , and whom the
board department has previously found , under section 230.25 ,
is able to pay , there shall be allowed against the estate of
such decedent a claim of the sixth class for that portion of
the total amount paid for that person’s care which exceeds
the total amount of all claims of the first through the fifth
classes, inclusive, as defined in section 633.425 , which are
allowed against that estate.
Sec. 92. Section 232.78, subsection 5, unnumbered paragraph
1, Code 2024, is amended to read as follows:
The juvenile court, before or after the filing of a petition
under this chapter , may enter an ex parte order authorizing
a physician or physician assistant or hospital to conduct an
outpatient physical examination or authorizing a physician or
physician assistant, or a psychologist certified under section
154B.7 , or a community mental health center accredited pursuant
to chapter 230A to conduct an outpatient mental examination
of a child if necessary to identify the nature, extent, and
cause of injuries to the child as required by section 232.71B ,
provided all of the following apply:
Sec. 93. Section 232.83, subsection 2, unnumbered paragraph
1, Code 2024, is amended to read as follows:
Anyone authorized to conduct a preliminary investigation in
response to a complaint may apply for, or the court on its own
motion may enter, an ex parte order authorizing a physician
or physician assistant or hospital to conduct an outpatient
physical examination or authorizing a physician or physician
assistant, or a psychologist certified under section 154B.7 , or
a community mental health center accredited pursuant to chapter
230A to conduct an outpatient mental examination of a child if
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necessary to identify the nature, extent, and causes of any
injuries, emotional damage, or other such needs of a child as
specified in section 232.96A, subsection 3, 5, or 6 , provided
that all of the following apply:
Sec. 94. Section 232.141, subsections 7 and 8, Code 2024,
are amended to read as follows:
7. A county charged with the costs and expenses under
subsections 2 and 3 may recover the costs and expenses from
the child’s custodial parent’s county of residence, as defined
in section 225C.61 35D.9 , by filing verified claims which are
payable as are other claims against the county. A detailed
statement of the facts upon which a claim is based shall
accompany the claim.
8. This subsection applies only to placements in a juvenile
shelter care home which is publicly owned, operated as a county
or multicounty shelter care home, organized under a chapter
28E agreement, or operated by a private juvenile shelter care
home. If the actual and allowable costs of a child’s shelter
care placement exceed the amount the department is authorized
to pay, the unpaid costs may be recovered from the child’s
custodial parent’s county of residence. However, the maximum
amount of the unpaid costs which may be recovered under this
subsection is limited to the difference between the amount
the department is authorized to pay and the statewide average
of the actual and allowable rates as reasonably determined
by the department annually. A home may only be reimbursed
for the lesser of the home’s actual and allowable costs or
the statewide average of the actual and allowable rates as
determined by the department in effect on the date the costs
were paid. The unpaid costs are payable pursuant to filing of
verified claims against the child’s custodial parent’s county
of residence. A detailed statement of the facts upon which a
claim is based shall accompany the claim. Any dispute between
counties arising from filings of claims filed pursuant to this
subsection shall be settled in the manner provided to determine
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residency county of residence in section 225C.61 35D.9 .
Sec. 95. Section 235.7, subsection 2, Code 2024, is amended
to read as follows:
2. Membership. The department may authorize the governance
boards of decategorization of child welfare and juvenile
justice funding projects established under section 232.188 to
appoint the transition committee membership and may utilize
the boundaries of decategorization projects to establish
the service areas for transition committees. The committee
membership may include but is not limited to department staff
involved with foster care, child welfare, and adult services,
juvenile court services staff, staff involved with county
general assistance or emergency relief under chapter 251 or
252 , or a regional administrator of the county mental health
and disability services region, as defined in section 225C.55 ,
in the area, school district and area education agency staff
involved with special education, and a child’s court appointed
special advocate, guardian ad litem, service providers, and
other persons knowledgeable about the child .
Sec. 96. Section 235A.15, subsection 2, paragraph c,
subparagraphs (5) and (8), Code 2024, are amended by striking
the subparagraphs.
Sec. 97. Section 235B.6, subsection 2, paragraph d,
subparagraph (6), Code 2024, is amended by striking the
subparagraph.
Sec. 98. Section 249A.4, subsection 15, Code 2024, is
amended by striking the subsection.
Sec. 99. Section 249A.12, subsection 4, paragraph a,
unnumbered paragraph 1, Code 2024, is amended to read as
follows:
The mental health and disability services commission council
on health and human services created pursuant to section 217.2,
shall recommend to the department the actions necessary to
assist in the transition of individuals being served in an
intermediate care facility for persons with an intellectual
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disability, who are appropriate for the transition, to services
funded under a medical assistance home and community-based
services waiver for persons with an intellectual disability in
a manner which maximizes the use of existing public and private
facilities. The actions may include but are not limited to
submitting any of the following or a combination of any of the
following as a request for a revision of the medical assistance
home and community-based services waiver for persons with an
intellectual disability:
Sec. 100. Section 249A.12, subsection 4, paragraph b, Code
2024, is amended to read as follows:
b. In implementing the provisions of this subsection , the
mental health and disability services commission council on
health and human services shall consult with other states. The
waiver revision request or other action necessary to assist
in the transition of service provision from intermediate care
facilities for persons with an intellectual disability to
alternative programs shall be implemented by the department in
a manner that can appropriately meet the needs of individuals
at an overall lower cost to counties, the federal government,
and the state. In addition, the department shall take into
consideration significant federal changes to the medical
assistance program in formulating the department’s actions
under this subsection . The department shall consult with the
mental health and disability services commission council on
health and human services in adopting rules for oversight of
facilities converted pursuant to this subsection . A transition
approach described in paragraph “a” may be modified as necessary
to obtain federal waiver approval.
Sec. 101. NEW SECTION . 249A.38A Supported community living
services.
1. As used in this section, “supported community living
service” means a service provided in a noninstitutional
setting to adult persons with mental illness, an intellectual
disability, or developmental disabilities to meet the persons’
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daily living needs.
2. The department shall adopt rules pursuant to chapter 17A
establishing minimum standards for supported community living
services.
3. The department shall determine whether to grant, deny, or
revoke approval for any supported community living service.
4. Approved supported community living services may receive
funding from the state, federal and state social services block
grant funds, and other appropriate funding sources, consistent
with state legislation and federal regulations. The funding
may be provided on a per diem, per hour, or grant basis, as
appropriate.
Sec. 102. Section 249N.8, Code 2024, is amended by striking
the section and inserting in lieu thereof the following:
249N.8 Behavioral health services reports.
The department shall annually submit a report to the
governor and the general assembly with details related to the
department’s review of the funds administered by, and the
outcomes and effectiveness of the behavioral health services
provided by, the behavioral health service system established
in chapter 225A.
Sec. 103. Section 252.24, subsections 1 and 3, Code 2024,
are amended to read as follows:
1. The county of residence, as defined in section 225C.61
35D.9 , shall be liable to the county granting assistance for
all reasonable charges and expenses incurred in the assistance
and care of a poor person.
3. This section shall apply to assistance or maintenance
provided by a county through the county’s mental health
and disability services behavioral health service system
implemented under established in chapter 225C 225A .
Sec. 104. Section 256.25, subsections 2 and 3, Code 2024,
are amended to read as follows:
2. A school district, which may collaborate and partner
with one or more school districts, area education agencies,
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accredited nonpublic schools, nonprofit agencies, and
institutions that provide children’s mental health services,
located in mental health and disability services regions
providing children’s behavioral health services in accordance
with chapter 225C, subchapter VII operating within the state’s
behavioral health service system under chapter 225A , may apply
for a grant under this program to establish a therapeutic
classroom in the school district in accordance with this
section .
3. The department shall develop a grant application
and selection and evaluation criteria. Selection criteria
shall include a method for prioritizing grant applications
submitted by school districts. First priority shall be
given to applications submitted by school districts that
submitted an application pursuant to this section for the
previous immediately preceding fiscal year. Second priority
shall be given to applications submitted by school districts
that, pursuant to subsection 2 , are collaborating and
partnering with one or more school districts, area education
agencies, accredited nonpublic schools, nonprofit agencies,
or institutions that provide mental health services for
children. Third priority shall be given to applications
submitted by school districts located in mental health and
disability services regions behavioral health districts as
defined in section 225A.1, and that are providing behavioral
health services for children in accordance with chapter 225C,
subchapter VII 225A . Grant awards shall be distributed as
equitably as possible among small, medium, and large school
districts. For purposes of this subsection , a small school
district is a district with an actual enrollment of fewer than
six hundred pupils; a medium school district is a district
with an actual enrollment that is at least six hundred pupils,
but less than two thousand five hundred pupils; and a large
school district is a district with an actual enrollment of two
thousand five hundred or more pupils.
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Sec. 105. Section 321.189, subsection 10, Code 2024, is
amended to read as follows:
10. Autism spectrum disorder status. A licensee who has
autism spectrum disorder, as defined in section 514C.28 , may
request that the license be marked to reflect the licensee’s
autism spectrum disorder status on the face of the license
when the licensee applies for the issuance or renewal of a
license. The department may adopt rules pursuant to chapter
17A establishing criteria under which a license may be marked,
including requiring the licensee to submit medical proof of the
licensee’s autism spectrum disorder status. When a driver’s
license is so marked, the licensee’s autism spectrum disorder
status shall be noted in the electronic database used by
the department and law enforcement to access registration,
titling, and driver’s license information. The department, in
consultation with the mental health and disability services
commission department of health and human services , shall
develop educational media to raise awareness of a licensee’s
ability to request the license be marked to reflect the
licensee’s autism spectrum disorder status.
Sec. 106. Section 321.190, subsection 1, paragraph b,
subparagraph (6), Code 2024, is amended to read as follows:
(6) An applicant for a nonoperator’s identification
card who has autism spectrum disorder, as defined in section
514C.28 , may request that the card be marked to reflect
the applicant’s autism spectrum disorder status on the face
of the card when the applicant applies for the issuance or
renewal of a card. The department may adopt rules pursuant to
chapter 17A establishing criteria under which a card may be
marked, including requiring the applicant to submit medical
proof of the applicant’s autism spectrum disorder status.
The department, in consultation with the mental health and
disability services commission department of health and human
services , shall develop educational media to raise awareness of
an applicant’s ability to request the card be marked to reflect
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the applicant’s autism spectrum disorder status.
Sec. 107. Section 321J.1, Code 2024, is amended by adding
the following new subsection:
NEW SUBSECTION . 01. “Administrative services organization”
means the same as defined in section 225A.1.
Sec. 108. Section 321J.3, subsection 1, paragraph e, Code
2024, is amended to read as follows:
e. A person committed under this section who does not
possess sufficient income or estate to make payment of the
costs of the treatment in whole or in part shall be considered
a state patient and the costs of treatment shall be paid as
provided in section 125.44 by the applicable administrative
services organization .
Sec. 109. Section 321J.3, subsection 2, paragraph c, Code
2024, is amended to read as follows:
c. A person committed under this section who does not
possess sufficient income or estate to make payment of the
costs of the treatment in whole or in part shall be considered
a state patient and the costs of treatment shall be paid as
provided in section 125.44 by the applicable administrative
services organization .
Sec. 110. Section 321J.3, subsection 3, Code 2024, is
amended to read as follows:
3. The state department of transportation, in cooperation
with the judicial branch, shall adopt rules, pursuant to the
procedure in section 125.33 in accordance with procedures
established by the department of health and human services
relating to the voluntary treatment of persons with a substance
use disorder , regarding the assignment of persons ordered under
section 321J.17 to submit to substance use disorder evaluation
and treatment. The rules shall be applicable only to persons
other than those committed to the custody of the director
of the department of corrections under section 321J.2 . The
rules shall be consistent with the practices and procedures
of the judicial branch in sentencing persons to substance
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use disorder evaluation and treatment under section 321J.2 .
The rules shall include the requirement that the treatment
programs utilized by a person pursuant to an order of the
department of transportation meet the licensure standards of
the department of health and human services for substance use
disorder treatment programs under chapter 125 . The rules shall
also include provisions for payment of costs by the offenders,
including insurance reimbursement on behalf of offenders,
or other forms of funding, and shall also address reporting
requirements of the facility, consistent with the provisions of
sections 125.84 and 125.86 . The department of transportation
shall be entitled to treatment information contained in reports
to the department of transportation, notwithstanding any
provision of chapter 125 that would restrict department access
to treatment information and records.
Sec. 111. Section 321J.25, subsection 1, paragraph b, Code
2024, is amended to read as follows:
b. “Program” means a substance use disorder awareness
program , licensed under chapter 125, and provided under a
contract entered into between the provider and the department
of health and human services under chapter 125 .
Sec. 112. Section 321J.25, subsection 2, unnumbered
paragraph 1, Code 2024, is amended to read as follows:
A substance use disorder awareness program is established
in each of the regions established by the director of health
and human services pursuant to section 125.12 behavioral health
district designated pursuant to section 225A, subsection
4 . The program shall consist of an insight class and a
substance use disorder evaluation, which shall be attended by
the participant, to discuss issues related to the potential
consequences of substance use disorder. The parent or parents
of the participant shall also be encouraged to participate
in the program. The program provider shall consult with the
participant or the parents of the participant in the program
to determine the timing and appropriate level of participation
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for the participant and any participation by the participant’s
parents. The program may also include a supervised educational
tour by the participant to any or all of the following:
Sec. 113. Section 331.321, subsection 1, paragraph e, Code
2024, is amended by striking the paragraph.
Sec. 114. Section 331.323, subsection 1, paragraph a,
subparagraph (7), Code 2024, is amended by striking the
subparagraph.
Sec. 115. Section 331.381, subsections 4 and 5, Code 2024,
are amended to read as follows:
4. Comply with chapter 222 , including but not limited to
sections 222.13 , 222.14 , 222.59 through 222.70 , 222.73 through
222.75 , and 222.77 through 222.82 , in regard to the care of
persons with an intellectual disability.
5. Comply with chapters 227, 229 and 230 , including but not
limited to sections 227.11 , 227.14 , 229.42 , 230.25 , 230.27 , and
230.35 , in regard to the care of persons with mental illness.
Sec. 116. Section 331.382, subsection 1, paragraphs e, f,
and g, Code 2024, are amended by striking the paragraphs.
Sec. 117. Section 331.382, subsection 3, Code 2024, is
amended by striking the subsection.
Sec. 118. Section 331.432, subsection 3, Code 2024, is
amended by striking the subsection.
Sec. 119. Section 331.502, subsection 10, Code 2024, is
amended by striking the subsection.
Sec. 120. Section 331.502, subsection 12, Code 2024, is
amended to read as follows:
12. Carry out duties relating to the hospitalization and
support of persons with mental illness as provided in sections
229.42, 230.3 , 230.11 , and 230.15 , 230.21 , 230.22 , 230.25 , and
230.26 .
Sec. 121. Section 331.552, subsection 13, Code 2024, is
amended to read as follows:
13. Make transfer payments to the state for school expenses
for deaf and hard-of-hearing children and support of persons
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with mental illness behavioral health services as provided in
section 230.21 chapter 225A .
Sec. 122. Section 331.756, subsection 25, Code 2024, is
amended by striking the subsection.
Sec. 123. Section 331.756, subsection 38, Code 2024, is
amended to read as follows:
38. Proceed to collect, as requested by the county,
the reasonable costs for the care, treatment, training,
instruction, and support of a person with an intellectual
disability from parents or other persons who are legally liable
for the support of the person with an intellectual disability
as provided in section 222.82 .
Sec. 124. Section 331.756, subsection 41, Code 2024, is
amended to read as follows:
41. Carry out duties relating to the collection of the costs
for the care, treatment, and support of persons with mental
illness as provided in sections 230.25 and section 230.27 .
Sec. 125. Section 331.910, subsection 2, Code 2024, is
amended by adding the following new paragraph:
NEW PARAGRAPH . 0a. “Administrative services organization”
means the same as defined in section 225A.1.
Sec. 126. Section 331.910, subsection 2, paragraph d, Code
2024, is amended by striking the paragraph.
Sec. 127. Section 331.910, subsection 3, paragraphs a and c,
Code 2024, are amended to read as follows:
a. A region An administrative services organization may
contract with a receiving agency in a bordering state to secure
substance use disorder or mental health care and treatment
under this subsection for persons who receive substance use
disorder or mental health care and treatment pursuant to
section 125.33, 125.91 , 229.2 , or 229.22 through a region .
c. A region An administrative services organization may
contract with a sending agency in a bordering state to provide
care and treatment under this subsection for residents of
the bordering state in approved substance use disorder and
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mental health care and treatment hospitals, centers, and
facilities in this state, except that care and treatment shall
not be provided for residents of the bordering state who are
involved in criminal proceedings substantially similar to the
involvement described in paragraph “b” .
Sec. 128. Section 347.16, subsection 3, Code 2024, is
amended to read as follows:
3. Care and treatment may be furnished in a county public
hospital to any sick or injured person who has residence
outside the county which maintains the hospital, subject to
such policies and rules as the board of hospital trustees
may adopt. If care and treatment is provided under this
subsection to a person who is indigent, the person’s county of
residence, as defined in section 225C.61 35D.9 , shall pay to
the board of hospital trustees the fair and reasonable cost of
the care and treatment provided by the county public hospital
unless the cost of the indigent person’s care and treatment is
otherwise provided for. If care and treatment is provided to
an indigent person under this subsection , the county public
hospital furnishing the care and treatment shall immediately
notify, by regular mail, the auditor of the county of residence
of the indigent person of the provision of care and treatment
to the indigent person including care and treatment provided
by a county through the county’s mental health and disability
services system implemented under behavioral health service
system established in chapter 225C 225A .
Sec. 129. Section 423.3, subsection 18, paragraph d, Code
2024, is amended to read as follows:
d. Community mental health centers accredited by the
department of health and human services pursuant to chapter
225C on or before June 30, 2025 .
Sec. 130. Section 426B.1, subsection 2, Code 2024, is
amended to read as follows:
2. Moneys shall be distributed from the property tax relief
fund to the mental health and disability services regional
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service system for mental health and disability services
behavioral health fund established in section 225A.7 , in
accordance with the appropriations made to the fund and other
statutory requirements.
Sec. 131. Section 437A.8, subsection 4, paragraph d, Code
2024, is amended to read as follows:
d. (1) Notwithstanding paragraph “a” , a taxpayer who owns
or leases a new electric power generating plant and who has
no other operating property in the state of Iowa except for
operating property directly serving the new electric power
generating plant as described in section 437A.16 shall pay
the replacement generation tax associated with the allocation
of the local amount to the county treasurer of the county in
which the local amount is located and shall remit the remaining
replacement generation tax, if any, to the director according
to paragraph “a” for remittance of the tax to county treasurers.
The director shall notify each taxpayer on or before August 31
following a tax year of its remaining replacement generation
tax to be remitted to the director. All remaining replacement
generation tax revenues received by the director shall be
deposited in the property tax relief behavioral health fund
created established in section 426B.1, and shall be distributed
as provided in section 426B.2 225A.7 .
(2) If a taxpayer has paid an amount of replacement tax,
penalty, or interest which was deposited into the property tax
relief fund and which was not due, all of the provisions of
section 437A.14, subsection 1 , paragraph “b” , shall apply with
regard to any claim for refund or credit filed by the taxpayer.
The director shall have sole discretion as to whether the
erroneous payment will be refunded to the taxpayer or credited
against any replacement tax due, or to become due, from the
taxpayer that would be subject to deposit in the property tax
relief fund.
Sec. 132. Section 437A.15, subsection 3, paragraph f, Code
2024, is amended to read as follows:
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f. Notwithstanding the provisions of this section , if
a taxpayer is a municipal utility or a municipal owner of
an electric power facility financed under the provisions
of chapter 28F or 476A , the assessed value, other than the
local amount, of a new electric power generating plant shall
be allocated to each taxing district in which the municipal
utility or municipal owner is serving customers and has
electric meters in operation in the ratio that the number of
operating electric meters of the municipal utility or municipal
owner located in the taxing district bears to the total number
of operating electric meters of the municipal utility or
municipal owner in the state as of January 1 of the tax year.
If the municipal utility or municipal owner of an electric
power facility financed under the provisions of chapter 28F
or 476A has a new electric power generating plant but the
municipal utility or municipal owner has no operating electric
meters in this state, the municipal utility or municipal owner
shall pay the replacement generation tax associated with the
new electric power generating plant allocation of the local
amount to the county treasurer of the county in which the local
amount is located and shall remit the remaining replacement
generation tax, if any, to the director at the times contained
in section 437A.8, subsection 4 , for remittance of the tax to
the county treasurers. All remaining replacement generation
tax revenues received by the director shall be deposited in the
property tax relief behavioral health fund created established
in section 426B.1, and shall be distributed as provided in
section 426B.2 225A.7 .
Sec. 133. Section 462A.14, subsection 12, paragraph f, Code
2024, is amended to read as follows:
f. A defendant committed under this section who does not
possess sufficient income or estate to make payment of the
costs of the treatment in whole or in part shall be considered
a state patient and the costs of treatment shall be paid as
provided in section 125.44 by the applicable administrative
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services organization designated pursuant to section 225A.4 .
Sec. 134. Section 462A.14, subsection 13, paragraph c, Code
2024, is amended to read as follows:
c. A defendant committed under this section who does not
possess sufficient income or estate to make payment of the
costs of the treatment in whole or in part shall be considered
a state patient and the costs of treatment shall be paid as
provided in section 125.44 by the applicable administrative
services organization designated pursuant to section 225A.4 .
Sec. 135. Section 483A.24, subsection 7, Code 2024, is
amended to read as follows:
7. A license shall not be required of minor pupils of the
Iowa school for the deaf or of minor residents of other state
institutions under the control of the department of health
and human services. In addition, a person who is on active
duty with the armed forces of the United States, on authorized
leave from a duty station located outside of this state, and
a resident of the state of Iowa shall not be required to
have a license to hunt or fish in this state. The military
person shall carry the person’s leave papers and a copy of
the person’s current earnings statement showing a deduction
for Iowa income taxes while hunting or fishing. In lieu of
carrying the person’s earnings statement, the military person
may also claim residency if the person is registered to vote
in this state. If a deer or wild turkey is taken, the military
person shall immediately contact a state conservation officer
to obtain an appropriate tag to transport the animal. A
license shall not be required of residents of county care
facilities or any person who is receiving supplementary
assistance under chapter 249 .
Sec. 136. Section 602.8102, subsection 39, Code 2024, is
amended to read as follows:
39. Refer persons applying for voluntary admission to a
community mental health center accredited by the department
of health and human services on or before June 30, 2025, for
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a preliminary diagnostic evaluation as provided in section
225C.16, subsection 2 .
Sec. 137. Section 714.8, subsection 12, Code 2024, is
amended to read as follows:
12. Knowingly transfers or assigns a legal or equitable
interest in property, as defined in section 702.14 , for less
than fair consideration, with the intent to obtain public
assistance under chapters 16 , 35B , and 35D , and 347B , or Title
VI, subtitles 2 through 6 , or accepts a transfer of or an
assignment of a legal or equitable interest in property, as
defined in section 702.14 , for less than fair consideration,
with the intent of enabling the party transferring the property
to obtain public assistance under chapters 16 , 35B , and 35D ,
and 347B , or Title VI, subtitles 2 through 6 . A transfer or
assignment of property for less than fair consideration within
one year prior to an application for public assistance benefits
shall be evidence of intent to transfer or assign the property
in order to obtain public assistance for which a person is
not eligible by reason of the amount of the person’s assets.
If a person is found guilty of a fraudulent practice in the
transfer or assignment of property under this subsection the
maximum sentence shall be the penalty established for a serious
misdemeanor and sections 714.9 , 714.10 , and 714.11 shall not
apply.
Sec. 138. Section 812.6, subsection 1, Code 2024, is amended
to read as follows:
1. If the court finds the defendant does not pose a danger
to the public peace and safety, is otherwise qualified for
pretrial release, and is willing to cooperate with treatment,
the court shall order, as a condition of pretrial release,
that the defendant obtain mental health treatment designed to
restore the defendant to competency. The costs of treatment
pursuant to this subsection shall be paid by the mental
health and disability services region for the county of the
defendant’s residency pursuant to chapter 225C applicable
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administrative services organization designated pursuant to
section 225A.4, regardless of whether the defendant meets
financial eligibility requirements under section 225C.62 or
225C.66 .
Sec. 139. Section 904.201, subsection 8, Code 2024, is
amended to read as follows:
8. Chapter 230 governs the determination of costs and
charges for the care and treatment of persons with mental
illness admitted to the forensic psychiatric hospital,
except that charges for the care and treatment of any person
transferred to the forensic psychiatric hospital from an adult
correctional institution or from a state training school shall
be paid entirely from state funds. Charges for all other
persons at the forensic psychiatric hospital shall be billed to
the respective counties at the same ratio as for patients at
state mental health institutes under section 230.20 .
Sec. 140. REPEAL. Chapters 142A, 225C, 227, 230A, and 347B,
Code 2024, are repealed.
Sec. 141. REPEAL. Sections 125.1, 125.3, 125.7, 125.9,
125.10, 125.12, 125.25, 125.32A, 125.33, 125.34, 125.37,
125.38, 125.39, 125.40, 125.41, 125.42, 125.43, 125.43A,
125.44, 125.46, 125.48, 125.54, 125.55, 125.58, 125.59, 125.60,
135B.18, 218.99, 222.59, 222.60, 222.61, 222.62, 222.63,
222.64, 222.65, 222.66, 222.67, 222.68, 222.69, 222.70, 222.74,
222.75, 225.10, 225.19, 225.21, 225.24, 226.45, 227.4, 229.42,
230.1A, 230.2, 230.3, 230.4, 230.5, 230.6, 230.9, 230.12,
230.16, 230.17, 230.18, 230.19, 230.20, 230.21, 230.22, 230.25,
230.26, 426B.2, 426B.4, and 426B.5, Code 2024, are repealed.
Sec. 142. EFFECTIVE DATE. This division of this Act takes
effect July 1, 2025.
DIVISION III
AGING AND DISABILITY
Sec. 143. Section 231.3, Code 2024, is amended to read as
follows:
231.3 State policy and objectives.
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1. The general assembly declares that it is the policy of
the state to work toward attainment of the following objectives
for Iowa’s older individuals and individuals with disabilities :
1. a. An adequate income.
2. b. Access to physical and mental health care and
long-term living and community support services without regard
to economic status.
3. c. Suitable and affordable housing that reflects the
needs of older individuals.
4. d. Access to comprehensive information and a community
navigation system providing all available options related to
long-term living and community support services that assist
older individuals in the preservation of personal assets and
the ability to entirely avoid or significantly delay reliance
on entitlement programs.
5. e. Full restorative services for those who require
institutional care, and a comprehensive array of long-term
living and community support services adequate to sustain older
people in their communities and, whenever possible, in their
homes, including support for caregivers.
6. f. Pursuit of meaningful activity within the widest
range of civic, cultural, educational, recreational, and
employment opportunities.
7. g. Suitable community transportation systems to assist
in the attainment of independent movement.
8. h. Freedom, independence, and the free exercise of
individual initiative in planning and managing their own lives.
9. i. Freedom from abuse, neglect, and exploitation.
2. The general assembly declares that the state of Iowa
recognizes a brain injury as a disability, and each agency and
subdivision of this state shall recognize a brain injury as a
distinct disability.
3. It is the policy of this state that each state agency
shall make reasonable efforts to identify those persons with
brain injuries among the persons served by the state agency.
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Sec. 144. Section 231.4, subsection 1, Code 2024, is amended
by adding the following new paragraph:
NEW PARAGRAPH . 0c. “Brain injury” means the same as defined
in section 135.22.
Sec. 145. Section 231.23, subsections 4, 7, and 9, Code
2024, are amended to read as follows:
4. Advocate for older individuals and individuals with
disabilities by reviewing and commenting upon all state plans,
budgets, laws, rules, regulations, and policies which affect
older individuals and individuals with disabilities, and by
providing technical assistance to any agency, organization,
association, or individual representing the needs of older
individuals and individuals with disabilities .
7. Pursuant to commission department policy, take into
account the views of older Iowans and Iowans with disabilities .
9. Assist the commission in assuring that preference will
be given to providing services to older individuals with the
greatest economic or social needs, with particular attention to
low-income minority older individuals, older individuals with
limited English proficiency, and older individuals residing in
rural areas.
Sec. 146. Section 231.23A, subsections 1 and 3, Code 2024,
are amended to read as follows:
1. Services for older individuals, persons with
disabilities eighteen years of age and older, family
caregivers, and veterans as defined by the department in the
most current version of the department’s reporting manual and
pursuant to the federal Act and regulations.
3. The aging Aging and disability resource center centers .
Sec. 147. Section 231.23A, Code 2024, is amended by adding
the following new subsection:
NEW SUBSECTION . 7A. Services and supports available to
individuals with disabilities including but not limited to
individuals with mental illness, an intellectual disability or
other developmental disability, or a brain injury.
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Sec. 148. Section 231.56, Code 2024, is amended to read as
follows:
231.56 Services and programs.
The department shall administer long-term living and
community support services and programs that allow older
individuals and individuals with disabilities to secure and
maintain maximum independence and dignity in a home environment
that provides for self-care with appropriate supportive
services, assist in removing individual and social barriers
to economic and personal independence for older individuals
and individuals with disabilities , and provide a continuum of
care for older individuals and individuals with disabilities.
Funds appropriated for this purpose shall be allocated based
on administrative rules adopted by the commission department
pursuant to chapter 17A . The department shall require such
records as needed adopt rules pursuant to chapter 17A that
allow the department to collect information as necessary from
long-term living and community support services, program
providers, and patients to administer this section .
Sec. 149. Section 231.57, Code 2024, is amended to read as
follows:
231.57 Coordination of advocacy.
The department shall administer a program for the
coordination of information and assistance provided within
the state to assist older individuals and individuals with
disabilities, and their caregivers , in obtaining and protecting
their rights and benefits. State and local agencies providing
information and assistance to older individuals and individuals
with disabilities, and their caregivers , in seeking their
rights and benefits shall cooperate with the department in
administering this program.
Sec. 150. Section 231.58, Code 2024, is amended to read as
follows:
231.58 Long-term living coordination.
The director may convene meetings, as necessary, of the
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director and the director of inspections, appeals, and
licensing, to assist in the coordination of policy, service
delivery, and long-range planning relating to the long-term
living system and older Iowans and Iowans with disabilities
in the state. The group may consult with individuals,
institutions, and entities with expertise in the area of the
long-term living system and older Iowans and Iowans with
disabilities , as necessary, to facilitate the group’s efforts.
Sec. 151. Section 231.64, Code 2024, is amended to read as
follows:
231.64 Aging and disability resource center centers .
1. The aging Aging and disability resource center centers
shall be administered by the department consistent with the
federal Act. The department shall designate area agencies on
aging aging and disability resource centers to establish, in
consultation with other stakeholders including organizations
representing the disability community, a coordinated system for
providing all of the following:
a. Comprehensive information, referral, and assistance
regarding the full range of available public and private
long-term living and community support services, options,
service providers, and resources within a community, including
information on the availability of integrated long-term care.
b. Options counseling to assist individuals in assessing
their existing or anticipated long-term care needs and
developing and implementing a plan for long-term living and
community support services designed to meet their specific
needs and circumstances. The plan for long-term living
and community support services may include support with
person-centered care transitions to assist consumers and family
caregivers with transitions between home and care settings.
c. Consumer access to the range of publicly-supported
long-term living and community support services for which
consumers may be eligible, by serving as a convenient point
of entry for such services. The aging Aging and disability
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resource center centers shall offer information online and
be available via a toll-free telephone number, electronic
communications, and in person.
2. The aging Aging and disability resource center centers
shall assist older individuals, persons individuals with
disabilities age eighteen or older , family caregivers, and
people who inquire about or request assistance on behalf of
members of these groups, as they seek long-term living and
community support services.
Sec. 152. NEW SECTION . 231.75 Scope.
The service quality standards and rights in this subchapter
VII shall apply to any person with an intellectual disability,
a developmental disability, brain injury, or chronic mental
illness who receives services which are funded in whole or in
part by public funds, or services which are permitted under
Iowa law.
Sec. 153. NEW SECTION . 231.76 Service quality standards.
As the state participates more fully in funding services
and other support for persons with an intellectual disability,
developmental disability, brain injury, or chronic mental
illness, it is the intent of the general assembly that the
state shall seek to attain the following quality standards in
the provision of services and other supports:
1. Provide comprehensive evaluation and diagnosis adapted
to the cultural background, primary language, and ethnic origin
of a person.
2. Provide an individual treatment, habilitation, and
program services plan.
3. Provide treatment, habilitation, and program services
that are individualized, flexible, cost-effective, and produce
results.
4. Provide periodic review of an individual’s treatment,
habilitation, and program services plan.
5. Provide for the least restrictive environment, and
age-appropriate services.
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6. Provide appropriate training and employment
opportunities so that a person’s ability to contribute to, and
participate in, the community is maximized.
7. Provide an ongoing process to determine the degree of
access to, and the effectiveness of, the services and other
supports in achieving the disability service outcomes and
indicators identified by the department.
Sec. 154. NEW SECTION . 231.77 Rights.
All of the following rights shall apply to a person with an
intellectual disability, a developmental disability, a brain
injury, or a chronic mental illness:
1. Wage protection. A person engaged in a work program
shall be paid wages commensurate with the going rate for
comparable work and productivity.
2. Insurance protection. Pursuant to section 507B.4,
subsection 3, paragraph “g” , a person or designated group
of persons shall not be unfairly discriminated against for
purposes of insurance coverage.
3. Citizenship. A person retains the right to citizenship
in accordance with the laws of the state.
4. Participation in planning activities. A person has
the right to participate in the formulation of an individual
treatment, habilitation, and program plan developed for the
person.
Sec. 155. NEW SECTION . 231.78 Compliance.
1. A person’s sole remedy for a violation of a rule
adopted by the council on health and human services to
implement sections 231.75 through 231.77 shall be to initiate a
proceeding with the department by request pursuant to chapter
17A.
a. Any decision of the department shall be in accordance
with due process of law. A person or party who is aggrieved or
adversely affected by the department’s action may seek judicial
review pursuant to section 17A.19. A person or party who is
aggrieved or adversely affected by a final judgment of the
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district court may appeal under section 17A.20.
b. Either the department or a party in interest may apply
to the Iowa district court for an order to enforce a final
decision of the department.
2. Any rules adopted by the council to implement sections
231.76 and 231.77 shall not create any right, entitlement,
property, or liberty right or interest, or private cause of
action for damages against the state or a political subdivision
of the state, or for which the state or a political subdivision
of the state would be responsible.
3. Notwithstanding subsection 1, any violation of section
231.77, subsection 2, shall be subject to enforcement by the
commissioner of insurance pursuant to chapter 507B.
Sec. 156. NEW SECTION . 231.79 Plan appeals process.
1. a. The department shall establish an appeals process by
which an affected party may appeal a decision of a coordinating
board.
b. The department shall establish an appeals process by
which an affected party or a coordinating board may appeal a
decision relating to an appeal under paragraph “a” .
2. For the purposes of this section, “coordinating board”
means a board formed to coordinate mental health, intellectual
disability, and developmental disability services.
Sec. 157. REPEAL. Sections 225C.35, 225C.36, 225C.37,
225C.38, 225C.39, 225C.40, 225C.41, 225C.42, and 225C.45, Code
2024, are repealed.
Sec. 158. CODE EDITOR DIRECTIVE. The Code editor is
directed to do all of the following:
1. Entitle Code chapter 231 “Department of Health and Human
Services —— Aging and Disability Services”.
2. Designate sections 231.75 through 231.79, as enacted in
this division of this Act, as subchapter VII entitled “Bill
of Rights and Service Quality Standards of Persons with an
Intellectual Disability, Developmental Disability, Brain
Injury, or Chronic Mental Injury”.
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3. Correct internal references in the Code and in any
enacted legislation as necessary due to the enactment of this
division of this Act.
Sec. 159. EFFECTIVE DATE. The following take effect July
1, 2025:
1. The sections of this division of this Act amending the
following:
a. Section 231.3.
b. Section 231.4, subsection 1.
c. Section 231.23, subsections 4 and 7.
d. Section 231.23A, subsections 1 and 7A.
e. Sections 231.56, 231.57, and 231.58.
f. Section 231.64, subsection 2.
2. The sections of this division of this Act enacting
the following: sections 231.75, 231.76, 231.77, 231.78, and
231.79.
DIVISION IV
TRANSITION PROVISIONS
Sec. 160. DEPARTMENT OF HEALTH AND HUMAN SERVICES ——
TRANSITION OF MENTAL HEALTH SERVICES, ADDICTIVE DISORDER
SERVICES, AND DISABILITY SERVICES.
1. For the purposes of this section:
a. “Administrative services organization” means the same
as defined in section 225A.1, as enacted in division I of this
Act.
b. “Behavioral health district” or “district” means the
same as defined in section 225A.1, as enacted in division I of
this Act.
c. “Department” means the department of health and human
services.
d. “District behavioral health service system plan” or
“district behavioral health plan” means the same as defined in
section 225A.1, as enacted in division I of this Act.
e. “Mental health and disability services region” means the
same as defined in section 225C.2, subsection 9.
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f. “State behavioral health service system” means the state
behavioral health service system as established in section
225A.3, as enacted in division I of this Act.
g. “State behavioral health service system plan” or “state
behavioral health plan” means the same as defined in section
225A.1, as enacted in division I of this Act.
h. “Transition period” means the period beginning July 1,
2024, and concluding June 30, 2025.
2. There is created a behavioral health service system under
the control of the department. For the fiscal year beginning
July 1, 2025, and each succeeding fiscal year, the behavioral
health service system shall be responsible for implementing and
maintaining a statewide system of prevention, education, early
intervention, treatment, recovery support, and crisis services
related to mental health, substance use disorders, tobacco
use, and problem gambling. For the fiscal year beginning July
1, 2025, and each succeeding fiscal year, the department’s
division of aging and disability services shall be responsible
for disability services.
3. During the transition period, the department may
exercise all policymaking functions and regulatory powers
established in division I of this Act, as necessary to
establish the behavioral health service system.
4. To ensure the behavioral health service system and the
division of aging and disability services are able to operate
as intended at the conclusion of the transition period, the
department shall perform all the following duties:
a. Make contracts as necessary to set up services and
administrative functions.
b. Adopt rules as necessary to regulate the state’s
behavioral health service system.
c. Establish policies as necessary to ensure efficient
implementation and operation of the behavioral health service
system.
d. Prepare forms necessary for the implementation and
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administration of behavioral health services.
e. Prepare a state behavioral health service system plan for
the state’s behavioral health service system.
f. Designate behavioral health districts on or before April
1, 2025.
g. Designate an administrative services organization for
each behavioral health district on or before April 1, 2025.
h. Review and approve district behavioral health service
system plans for services related to the behavioral health
service system’s purpose.
i. Issue all necessary licenses and certifications.
j. Establish contractual rights, privileges, and
responsibilities as necessary to establish and implement the
behavioral health service system.
5. If the department determines that a federal waiver
or authorization is necessary to administer any provision of
this division of this Act or to effectuate the behavioral
health system by the conclusion of the transition period,
the department shall timely request the federal waiver or
authorization. Notwithstanding any other effective date to
the contrary, a provision the department determines requires a
federal waiver or authorization shall be effective only upon
receipt of federal approval for the waiver or authorization.
6. a. On or before September 30, 2024, the department shall
publish on the department’s internet site an initial transition
plan for establishing the behavioral health service system.
The transition plan shall describe, at a minimum, all of the
following:
(1) All tasks that require completion before July 1, 2025.
The description of tasks shall include a description of how the
department shall solicit comment from stakeholders, including
employees of the department, persons served by the department,
partners of the department, members of the public, and members
of the general assembly, and a detailed timeline for the
completion of the tasks described.
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(2) The proposed organizational structure of the behavioral
health service system.
(3) The transition of service delivery sites from locations
where people currently receive behavioral health services to
where they will receive behavioral health services under the
behavioral health service system.
(4) Procedures for the transfer and reconciliation of
budgeting and funding between the mental health and disability
services regions and the department.
(5) A description of how responsibilities for disability
services programs will be transferred from current program
administrators to the department’s division of aging and
disability services by the end of the transition period.
(6) Any additional known tasks that may require completion
after the transition on July 1, 2025.
b. The transition plan published under paragraph “a” shall:
(1) Be updated quarterly during the transition period.
(2) Describe how information regarding any changes in
service delivery will be provided to persons receiving services
from the mental health and disability services regions or
current behavioral health care providers contracted with the
department.
(3) Describe how the transition is being funded, including
how expenses associated with the transition will be managed.
7. a. Before the end of the transition period, the
governing board of each mental health and disability services
region that maintains a combined account pursuant to section
225C.58, subsection 1, shall transfer all unencumbered and
unobligated moneys remaining in the combined account to the
treasurer of state for deposit into the behavioral health fund
as established in section 225A.7 as enacted in division I of
this Act.
b. Before the end of the transition period, each county
which maintains a county mental health and disability services
fund pursuant to section 225C.58, subsection 1, shall transfer
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all unencumbered and unobligated moneys remaining in the mental
health and disability services fund to the treasurer of state
for deposit into the behavioral health fund as established in
section 225A.7 as enacted in division I of this Act.
c. Moneys in the behavioral health fund as established
in section 225A.7 as enacted in division I of this Act are
appropriated to the department for the purposes established
in section 225A.7 as enacted in division I of this Act, and
as otherwise necessary to effectuate the provisions of this
division of this Act.
8. a. All debts, claims, or other liabilities owed to a
county, a mental health and disability services region, or
the state due to services rendered pursuant to chapter 125,
222, 225, 225C, 226, 227, 229, 230, or 230A, Code 2024, at the
conclusion of the transition period shall remain due and owing
after the transition period concludes.
b. After the transition period concludes, each county
auditor shall collect outstanding debts, claims, or other
liabilities owed to the county for services rendered pursuant
to chapter 125, 222, 225, 225C, 226, 227, 229, 230, or 230A,
Code 2024, before the transition period concluded. The county
attorney may bring a judicial action as necessary to collect
the debts, claims, or other liabilities.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
This bill relates to the transition of behavioral health
services from a mental health and disabilities services system
to a behavioral health service system (BHSS), and the transfer
of disability services to the department of health and human
services’ (HHS) division of aging and disability services.
DIVISION I —— BEHAVIORAL HEALTH SERVICE SYSTEM. This
division relates to the establishment of the BHSS. The
division defines terms related to the BHSS.
The division designates HHS as the state mental health
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authority for the purpose of directing benefits from the
federal community mental health services block grant, and the
state authority for the purpose of directing benefits from the
federal substance abuse prevention and treatment block grant.
The division also designates HHS as the single state agency for
substance abuse for the purposes of 42 U.S.C. §1396a et seq.
The division establishes a BHSS for the purposes of
implementing a statewide system of prevention, education, early
intervention, treatment, recovery support, and crisis services
related to mental health, substance use, tobacco use, and
problem gambling.
The division requires HHS to divide the entirety of the state
into designated behavioral health districts. The division
requires each district to provide behavioral health prevention,
education, early intervention, treatment, recovery support, and
crisis services throughout the district in a manner consistent
with directives the district receives from HHS. HHS must
consider several factors, as detailed in the division, when
designating districts. The manner in which HHS designates
behavioral health districts including but not limited to the
determination of the boundaries for each district is not
subject to judicial review.
The division requires HHS to designate an administrative
services organization (ASO) to oversee and organize each
district and each BHSS service associated with the district.
HHS must issue requests for proposals for ASO candidates. An
ASO may be either a mental health and disability services
system regional administrator formed prior to July 1, 2025, or
a public or private agency in a behavioral health district, or
any separate organizational unit within the public or private
agency, that has the capabilities to engage in the planning or
provision of a broad range of behavioral health prevention,
education, early intervention, treatment, recovery support,
and crisis services only as directed by the department. HHS
is required to consider several factors as outlined in the
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division when determining whether to designate an entity as an
ASO. Upon an entity’s designation as an ASO, the entity is
considered an instrumentality of the state and must adhere to
all state and federal mandates and prohibitions applicable to
an instrumentality of the state.
Each ASO must function as a subrecipient for the purposes
of the federal community mental health services block grant
and the federal substance abuse prevention and treatment
block grant. Duties an ASO must perform are detailed in
the division. The division requires each ASO to establish a
district behavioral health advisory council (advisory council).
An advisory council must perform duties as detailed in the
division to assist the ASO in carrying out the ASO’s duties.
An advisory council must consist of nine members. Three
members must be elected public officials currently holding
office, or the public official’s designated representative;
three members must be chosen in accordance with procedures
established by the ASO to ensure representation of the
populations served within the behavioral health district; and
three members must have experience or education related to
core behavioral health functions, essential behavioral health
services, behavioral health prevention, behavioral health
treatment, population-based behavioral health services, or
community-based behavioral health services.
The division requires HHS to take certain actions for data
related to the BHSS including but not limited to the creation
of a central data repository for collecting and analyzing
state, behavioral health district, and contracted behavioral
health provider data. Each ASO must either utilize a data
system that integrates with the data systems used by HHS
or utilize a data system that has the capacity to securely
exchange information with the department, other behavioral
health districts, contractors, and other entities involved
with the BHSS who are authorized to access the central data
repository. Data and information maintained by and exchanged
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between an ASO and HHS must be labeled consistently, share
the same definitions, utilize the same common coding and
nomenclature, and be in a form and format as required by HHS
by rule. Each ASO is required to report information including
but not limited to demographic information, expenditure data,
and data concerning the services and other support provided
to individuals, to HHS in a manner specified by HHS. HHS is
required to ensure that ASOs, behavioral health providers, and
contracting entities operating within the BHSS maintain uniform
methods for keeping statistical information relating to BHSS
outcomes and performance.
The division establishes a behavioral health fund (BHS
fund). For the purposes of the BHS fund, the division
defines the terms “population” and “state growth factor”.
Moneys deposited into the BHS fund are appropriated to HHS
to implement and administer the BHSS and related programs,
including but not limited to distributions to ASOs for
services; distributions to providers of tobacco use services,
substance use disorder services, and problem gambling services;
funding of disability services pursuant to Code chapter 231
(department of health and human services —— aging —— older
Iowans); and payment of associated administrative costs.
For FY 2025-2026, the division transfers an amount equal to
$42 multiplied by the state’s population for the fiscal year
from the general fund of the state to the BHS fund.
For fiscal years beginning on or after July 1, 2026, the
division transfers an amount from the general fund to the
BHS fund equal to the state’s population for the fiscal year
multiplied by the sum of the dollar amount used to calculate
the transfer from the general fund to the BHS fund for the
immediately preceding fiscal year, plus the state growth factor
for the fiscal year for which the transfer is being made.
For each fiscal year, the bill prohibits an ASO from spending
more than 7 percent of the total amount distributed to the ASO
from HHS and other appropriations on administrative costs.
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The division allows moneys in the BHS fund to be used for
cash flow purposes, provided that any moneys so allocated
are returned to the BHS fund by the end of each fiscal year.
Interest and earnings on moneys deposited into the BHS fund are
to be credited to the BHS fund. Moneys in the BHS fund that
remain unencumbered or unobligated at the close of the fiscal
year are to remain in the BHS fund to be used for the purposes
designated.
This division of the bill is effective July 1, 2025.
DIVISION II —— BEHAVIORAL HEALTH SERVICE SYSTEM ——
CONFORMING CHANGES. This division of the bill makes conforming
changes related to the implementation of the BHSS.
The bill repeals Code chapters 142A (tobacco use prevention
and control), 225C (mental health and disability services), 227
(facilities for persons with mental illness or an intellectual
disability), 230A (community mental health centers), and 347B
(county care facilities).
The bill repeals Code sections 125.1, 125.3, 125.7, 125.9,
125.10, 125.12, 125.25, 125.32A, 125.33, 125.34, 125.37 through
125.44, 125.46, 125.48, 125.54, 125.55, 125.58, 125.59, 125.60,
135B.18, 218.99, 222.59 through 222.70, 222.74, 222.75, 225.10,
225.19, 225.21, 225.24, 226.45, 227.4, 229.42, 230.1A, 230.2
through 230.6, 230.9, 230.12, 230.16 through 230.22, 230.25,
230.26, 426B.2, 426B.4, and 426B.5.
This division of the bill takes effect July 1, 2025.
DIVISION III —— AGING AND DISABILITY. This division of the
bill relates to aging and disability services.
The division adds individuals with disabilities as a class
of individuals the general assembly intends to provide support
for under Code chapter 231 (department of health and human
services —— aging —— older Iowans).
The division declares the general assembly’s recognition
of a brain injury as a disability, and directs each agency
and subdivision of the state to recognize a brain injury as a
distinct disability. The division defines “brain injury” for
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the purposes of Code chapter 231.
The division adds individuals with disabilities as a class
of persons that HHS is required to serve, advocate for, and
consult pursuant to Code chapter 231.
The division requires HHS to designate aging and disability
resource centers to establish a coordinated system of providing
assistance to persons interested in long-term living or
community support services.
Current Code sections 225C.25, 225C.26, 225C.28A, and
225C.28B, “the bill of rights and service quality standards
of persons with an intellectual disability, developmental
disabilities, brain injury, or chronic mental illness”, are
amended and moved to Code sections 231.75 through 231.79.
The division repeals Code sections 225C.35 through 225C.42
(sections related to the family support subsidy) and 225C.45
(public housing program).
The sections of the division amending the following Code
sections take effect July 1, 2025: 231.3, 231.4(1), 231.23(4),
231.23(7), 231.23A(1), 231.23A(7A), 231.56, 231.57, 231.58, and
231.64(2).
The sections of the division enacting Code sections 231.75
through 231.79 take effect July 1, 2025.
DIVISION IV —— TRANSITION PROVISIONS. This division
provides a process during the period beginning July 1, 2024,
and concluding June 30, 2025, to transition the state’s
behavioral health services to the BHSS and the state’s
disability services to HHS’s division of aging and disability
services, effective July 1, 2025.
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