Bill Text: IA SF463 | 2015-2016 | 86th General Assembly | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: A bill for an act relating to the redesign of mental health and disabilities services administered by regions comprised of counties. (Formerly SSB 1181.) Effective 7-1-15.

Sponsorship: Committee Bill

Status: (Passed) 2015-04-24 - Signed by Governor. S.J. 932. [SF463 Detail]

Download: Iowa-2015-SF463-Introduced.html

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Senate File 463 - Introduced




                                 SENATE FILE       
                                 BY  COMMITTEE ON HUMAN
                                     RESOURCES

                                 (SUCCESSOR TO SSB
                                     1181)

                                      A BILL FOR

  1 An Act relating to the redesign of mental health and
  2    disabilities services administered by regions comprised of
  3    counties.
  4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
    TLSB 2062SV (3) 86
    rh/rj

PAG LIN



  1  1    Section 1.  Section 135.180, subsection 3, Code 2015, is
  1  2 amended to read as follows:
  1  3    3.  The program shall provide stipends to support
  1  4 psychiatrist positions with an emphasis on securing and
  1  5 retaining medical directors at community mental health
  1  6 centers, providers of mental health services to county
  1  7 residents pursuant to a waiver approved under section 225C.7,
  1  8 subsection 3, Code 2011, designated under chapter 230A and
  1  9 hospital psychiatric units that are located in mental health
  1 10 professional shortage areas.
  1 11    Sec. 2.  Section 222.1, Code 2015, is amended to read as
  1 12 follows:
  1 13    222.1  Purpose of chapter ==== state resource centers ==== special
  1 14 unit at state mental health institute.
  1 15    1.  This chapter addresses the public and private services
  1 16 available in this state to meet the needs of persons with an
  1 17 intellectual disability.  The responsibility of the mental
  1 18 health and disability services regions formed by counties and
  1 19 of the state for the costs and administration of publicly
  1 20 funded services shall be as set out in section 222.60 and other
  1 21 pertinent sections of this chapter.
  1 22    1.  2.  The Glenwood state resource center and the Woodward
  1 23 state resource center are established and shall be maintained
  1 24 as the state's regional resource centers for the purpose of
  1 25 providing treatment, training, instruction, care, habilitation,
  1 26 and support of persons with an intellectual disability or other
  1 27 disabilities in this state, and providing facilities, services,
  1 28 and other support to the communities located in the region
  1 29 being served by a state resource center. In addition, the
  1 30 state resource centers are encouraged to serve as a training
  1 31 resource for community=based program staff, medical students,
  1 32 and other participants in professional education programs. A
  1 33 resource center may request the approval of the council on
  1 34 human services to change the name of the resource center for
  1 35 use in communication with the public, in signage, and in other
  2  1 forms of communication.
  2  2    2.  3.  A special intellectual disability unit may be
  2  3 maintained at one of the state mental health institutes for the
  2  4 purposes set forth in sections 222.88 to 222.91.
  2  5    Sec. 3.  Section 222.2, subsection 3, Code 2015, is amended
  2  6 by striking the subsection.
  2  7    Sec. 4.  Section 222.2, Code 2015, is amended by adding the
  2  8 following new subsections:
  2  9    NEW SUBSECTION.  5A.  "Mental health and disability services
  2 10 region" means a mental health and disability services region
  2 11 formed in accordance with section 331.389.
  2 12    NEW SUBSECTION.  5B.  "Regional administrator" means the
  2 13 regional administrator of a mental health and disability
  2 14 services region, as defined in section 331.388.
  2 15    Sec. 5.  Section 222.6, Code 2015, is amended to read as
  2 16 follows:
  2 17    222.6  State districts.
  2 18    The administrator shall divide the state into two districts
  2 19 in such manner that one of the resource centers shall be
  2 20 located within each of the districts. Such districts may
  2 21 from time to time be changed. After such districts have been
  2 22 established, the administrator shall notify all boards of
  2 23 supervisors, county auditors, regional administrators of the
  2 24 mental health and disability services regions, and clerks of
  2 25 the district courts of the action. Thereafter, unless the
  2 26 administrator otherwise orders, all admissions of persons with
  2 27 an intellectual disability from a district shall be to the
  2 28 resource center located within such district.
  2 29    Sec. 6.  Section 222.12, subsection 2, Code 2015, is amended
  2 30 to read as follows:
  2 31    2.  Notice of the death of the patient, and the cause
  2 32 of death, shall be sent to the county board of supervisors
  2 33  regional administrator of the mental health and disability
  2 34 services region of the patient's county of residence. The
  2 35 fact of death with the time, place, and alleged cause shall be
  3  1 entered upon the docket of the court.
  3  2    Sec. 7.  Section 222.13, Code 2015, is amended to read as
  3  3 follows:
  3  4    222.13  Voluntary admissions.
  3  5    1.  If an adult person is believed to be a person with
  3  6 an intellectual disability, the adult person or the adult
  3  7 person's guardian may submit a request in writing through the
  3  8 central point of coordination process for the county board
  3  9 of supervisors of the adult person's county of residence to
  3 10  apply to the department and the superintendent of any state
  3 11 resource center for the voluntary admission of the adult person
  3 12 either as an inpatient or an outpatient of the resource center.
  3 13 The board of supervisors shall, on forms prescribed by the
  3 14 department's administrator, apply to the superintendent of
  3 15 the resource center in the district for the admission of the
  3 16 adult person to the resource center.  If the expenses of the
  3 17 person's admission or placement are payable in whole or in
  3 18 part by the person's county of residence, application for the
  3 19 admission shall be made through the regional administrator.  An
  3 20 application for admission to a special unit of any adult person
  3 21 believed to be in need of any of the services provided by the
  3 22 special unit under section 222.88 may be made in the same
  3 23 manner, upon request of the adult person or the adult person's
  3 24 guardian. The superintendent shall accept the application if
  3 25 a preadmission diagnostic evaluation, performed through the
  3 26 central point of coordination process, confirms or establishes
  3 27 the need for admission, except that an application shall not be
  3 28 accepted if the institution does not have adequate facilities
  3 29 available or if the acceptance will result in an overcrowded
  3 30 condition.
  3 31    2.  If the resource center has no does not have an
  3 32  appropriate program for the treatment of an adult or minor
  3 33 person with an intellectual disability applying under this
  3 34 section or section 222.13A, the board of supervisors regional
  3 35 administrator for the person's county of residence or the
  4  1 department, as applicable, shall arrange for the placement of
  4  2 the person in any public or private facility within or without
  4  3 the state, approved by the director of the department of human
  4  4 services, which offers appropriate services for the person, as
  4  5 determined through the central point of coordination process.
  4  6 If the expenses of the placement are payable in whole or in
  4  7 part by a county, the placement shall be made by the regional
  4  8 administrator for the county.
  4  9    3.  Upon applying for admission If the expenses of an
  4 10 admission of an adult or minor person to a resource center, or
  4 11 a special unit, or upon arranging for of the placement of the
  4 12 person in a public or private facility are payable in whole
  4 13 or in part by a mental health and disability services region,
  4 14 the board of supervisors regional administrator shall make a
  4 15 full investigation into the financial circumstances of that the
  4 16  person and those liable for that the person's support under
  4 17 section 222.78 to determine whether or not any of them are able
  4 18 to pay the expenses arising out of the admission of the person
  4 19 to a resource center, special treatment unit, or public or
  4 20 private facility. If the board regional administrator finds
  4 21 that the person or those legally responsible for the person are
  4 22 presently unable to pay the expenses, the board shall direct
  4 23 that regional administrator shall pay the expenses be paid by
  4 24 the county. The board regional administrator may review its
  4 25  such a finding at any subsequent time while the person remains
  4 26 at the resource center, or is otherwise receiving care or
  4 27 treatment for which this chapter obligates the county region
  4 28  to pay. If the board regional administrator finds upon review
  4 29 that the person or those legally responsible for the person
  4 30 are presently able to pay the expenses, the finding shall
  4 31 apply only to the charges incurred during the period beginning
  4 32 on the date of the review and continuing thereafter, unless
  4 33 and until the board regional administrator again changes its
  4 34  such a finding. If the board regional administrator finds
  4 35 that the person or those legally responsible for the person
  5  1 are able to pay the expenses, the board shall direct that
  5  2  regional administrator shall collect the charges be so paid to
  5  3 the extent required by section 222.78, and the county auditor
  5  4  regional administrator shall be responsible for the collection
  5  5  payment of the remaining charges.
  5  6    Sec. 8.  Section 222.13A, Code 2015, is amended to read as
  5  7 follows:
  5  8    222.13A  Voluntary admissions ==== minors.
  5  9    1.  If a minor is believed to be a person with an
  5 10 intellectual disability, the minor's parent, guardian, or
  5 11 custodian may request the county board of supervisors to
  5 12  apply to the department for admission of the minor as a
  5 13 voluntary patient in a state resource center. If the resource
  5 14 center does not have appropriate services for the minor's
  5 15 treatment, the board of supervisors department may arrange for
  5 16 the admission of the minor in a public or private facility
  5 17 within or without the state, approved by the director of human
  5 18 services, which offers appropriate services for the minor's
  5 19 treatment.
  5 20    2.  Upon receipt of an application for voluntary admission of
  5 21 a minor, the board of supervisors department shall provide for
  5 22 a preadmission diagnostic evaluation of the minor to confirm
  5 23 or establish the need for the admission. The preadmission
  5 24 diagnostic evaluation shall be performed by a person who meets
  5 25 the qualifications of a qualified intellectual disability
  5 26 professional who is designated through the central point of
  5 27 coordination process by the department.
  5 28    3.  During the preadmission diagnostic evaluation, the
  5 29 minor shall be informed both orally and in writing that the
  5 30 minor has the right to object to the voluntary admission. If
  5 31 the preadmission diagnostic evaluation determines that the
  5 32 voluntary admission is appropriate but the minor objects to
  5 33 the admission, the minor shall not be admitted to the state
  5 34 resource center unless the court approves of the admission. A
  5 35 petition for approval of the minor's admission may be submitted
  6  1 to the juvenile court by the minor's parent, guardian, or
  6  2 custodian.
  6  3    4.  As soon as practicable after the filing of a petition for
  6  4 approval of the voluntary admission, the court shall determine
  6  5 whether the minor has an attorney to represent the minor in the
  6  6 proceeding. If the minor does not have an attorney, the court
  6  7 shall assign to the minor an attorney. If the minor is unable
  6  8 to pay for an attorney, the attorney shall be compensated
  6  9 by the county mental health and disability services region
  6 10  at an hourly rate to be established by the county board of
  6 11 supervisors regional administrator in substantially the same
  6 12 manner as provided in section 815.7.
  6 13    5.  The court shall order the admission of a minor who
  6 14 objects to the admission, only after a hearing in which it
  6 15 is shown by clear and convincing evidence that both of the
  6 16 following circumstances exist:
  6 17    a.  The minor needs and will substantially benefit from
  6 18 treatment or habilitation.
  6 19    b.  A placement which involves less restriction of the
  6 20 minor's liberties for the purposes of treatment or habilitation
  6 21 is not feasible.
  6 22    Sec. 9.  Section 222.14, Code 2015, is amended to read as
  6 23 follows:
  6 24    222.14  Care by county region pending admission.
  6 25    If the institution is unable to receive a patient, the
  6 26 superintendent shall notify the county board of supervisors
  6 27 of regional administrator for the county from which the
  6 28 application in behalf of residence of the prospective patient
  6 29 was made of the time when such person may be received.
  6 30 Until such time as the patient is able to be received by the
  6 31 institution, or when application has been made for admission
  6 32 to a public or private facility as provided in section 222.13
  6 33 and the application is pending, the care of said person the
  6 34 patient shall be provided as arranged by the county board of
  6 35 supervisors regional administrator.
  7  1    Sec. 10.  Section 222.59, subsection 1, unnumbered paragraph
  7  2 1, Code 2015, is amended to read as follows:
  7  3    Upon receiving a request from an authorized requester, the
  7  4 superintendent of a state resource center shall coordinate
  7  5 with the central point of coordination process regional
  7  6 administrator for the person's county of residence or
  7  7 the department, as applicable, in assisting the requester
  7  8 in identifying available community=based services as an
  7  9 alternative to continued placement of a patient in the state
  7 10 resource center. For the purposes of this section, "authorized
  7 11 requester" means the parent, guardian, or custodian of a minor
  7 12 patient, the guardian of an adult patient, or an adult patient
  7 13 who does not have a guardian. The assistance shall identify
  7 14 alternatives to continued placement which are appropriate to
  7 15 the patient's needs and shall include but are not limited to
  7 16 any of the following:
  7 17    Sec. 11.  Section 222.60, subsections 1 and 2, Code 2015, are
  7 18 amended to read as follows:
  7 19    1.  All necessary and legal expenses for the cost of
  7 20 admission or for the treatment, training, instruction, care,
  7 21 habilitation, support, and transportation of persons with
  7 22 an intellectual disability, as provided for in the county
  7 23  applicable regional service system management plan provisions
  7 24  implemented pursuant to section 331.439, subsection 1, 331.393
  7 25  in a state resource center, or in a special unit, or any public
  7 26 or private facility within or without the state, approved by
  7 27 the director of human services, shall be paid by either:
  7 28    a.  The regional administrator for the person's county of
  7 29 residence.
  7 30    b.  The state when the person is a resident in another state
  7 31 or in a foreign country, or when the person's residence is
  7 32 unknown. The payment responsibility shall be deemed to be a
  7 33 state case.
  7 34    2.  a.  Prior to the regional administrator for a county of
  7 35 residence approving the payment of expenses for a person under
  8  1 this section, the county regional administrator may require
  8  2 that the person be diagnosed to determine if the person has
  8  3 an intellectual disability or that the person be evaluated to
  8  4 determine the appropriate level of services required to meet
  8  5 the person's needs relating to an intellectual disability. The
  8  6 diagnosis and the evaluation may be performed concurrently and
  8  7 shall be performed by an individual or individuals approved
  8  8 by the regional administrator for the person's county who
  8  9 are qualified to perform the diagnosis or the evaluation.
  8 10 Following the initial approval for payment of expenses, the
  8 11 county regional administrator may require that an evaluation be
  8 12 performed at reasonable time periods.
  8 13    b.  The cost of a county=required regional
  8 14 administrator=required diagnosis and an evaluation is
  8 15 at the county's mental health and disability services region's
  8 16  expense. For a state case, the state may apply the diagnosis
  8 17 and evaluation provisions of this subsection at the state's
  8 18 expense.
  8 19    c.  A diagnosis or an evaluation under this section may be
  8 20 part of a county's central point of coordination process under
  8 21 section 331.440, diagnosis and assessment process implemented
  8 22 by the applicable regional administrator, provided that a
  8 23 diagnosis is performed only by an individual qualified as
  8 24 provided in this section.
  8 25    Sec. 12.  Section 222.61, Code 2015, is amended to read as
  8 26 follows:
  8 27    222.61   Residency determined.
  8 28    When a county receives an application on behalf of any person
  8 29 for admission to a resource center or a special unit, the board
  8 30 of supervisors application shall refer the determination of
  8 31 residency be forwarded to the central point of coordination
  8 32 process regionaladministrator for the county to determine and
  8 33 certify that the residence of the person is in one of the
  8 34 following:
  8 35    1.  In the county in which the application is received.
  9  1    2.  In some other county of the state.
  9  2    3.  In another state or in a foreign country.
  9  3    4.  Unknown.
  9  4    Sec. 13.  Section 222.62, Code 2015, is amended to read as
  9  5 follows:
  9  6    222.62  Residency in another county.
  9  7    When the board of supervisors determines through the central
  9  8 point of coordination process regional administrator for the
  9  9 county determines that the residency of the person is other
  9 10 than in the county in which the application is received, the
  9 11 determination shall be certified to the superintendent of
  9 12 the resource center or the special unit where the person is
  9 13 a patient. The certification shall be accompanied by a copy
  9 14 of the evidence supporting the determination. The If the
  9 15 person is not eligible for the medical assistance program, the
  9 16  superintendent shall charge the expenses already incurred and
  9 17 unadjusted, and all future expenses of the patient, to the
  9 18 county certified to be mental health and disability services
  9 19 region for the county of the person's residency.
  9 20    Sec. 14.  Section 222.63, Code 2015, is amended to read as
  9 21 follows:
  9 22    222.63  Finding of residency ==== objection.
  9 23    A board of supervisors' certification utilizing the
  9 24 central point of coordination process through the regional
  9 25 administrator for a county that a person's residency is
  9 26 in another county shall be sent to the auditor of regional
  9 27 administrator for the county of residence. The certification
  9 28 shall be accompanied by a copy of the evidence supporting the
  9 29 determination. The auditor of regional administrator for the
  9 30 county of residence shall submit the certification to the board
  9 31 of supervisors of the auditor's regional administrator for the
  9 32  county and it shall be conclusively presumed that the patient
  9 33 has residency in that county unless the regional administrator
  9 34 for that county disputes the determination of residency as
  9 35 provided in section 331.394.
 10  1    Sec. 15.  Section 222.64, Code 2015, is amended to read as
 10  2 follows:
 10  3    222.64  Foreign state or country or unknown residency.
 10  4    If the residency of the person is determined by a regional
 10  5 administrator on behalf of a county or by the state to be in
 10  6 a foreign state or country or is determined to be unknown,
 10  7 the county regional administrator or the state shall certify
 10  8 the determination to the administrator. The certification
 10  9 shall be accompanied by a copy of the evidence supporting the
 10 10 determination. The care of the person shall be as arranged by
 10 11 the county regional administrator or the state. Application
 10 12 for admission may be made pending investigation by the
 10 13 administrator.
 10 14    Sec. 16.  Section 222.73, subsection 2, paragraph a,
 10 15 subparagraph (6), Code 2015, is amended to read as follows:
 10 16    (6)  A county mental health and disability services region
 10 17  shall not be billed for the cost of a patient unless the
 10 18 patient's admission is authorized through the applicable
 10 19 central point of coordination process regional administrator.
 10 20 The state resource center and the county regional administrator
 10 21  shall work together to locate appropriate alternative
 10 22 placements and services, and to educate patients and the family
 10 23 members of patients regarding such alternatives.
 10 24    Sec. 17.  Section 222.73, subsection 2, paragraph b, Code
 10 25 2015, is amended to read as follows:
 10 26    b.  The per diem costs billed to each county mental health
 10 27 and disability services region shall not exceed the per diem
 10 28 costs billed to the county in the fiscal year beginning July
 10 29 1, 1996. However, the per diem costs billed to a county may
 10 30 be adjusted in for a fiscal year to reflect increased costs to
 10 31 the extent of the percentage increase in the total of county
 10 32 fixed budgets pursuant to the allowed growth factor adjustment
 10 33 authorized statewide per capita expenditure target amount,
 10 34 if any per capita growth amount is authorized by the general
 10 35 assembly for that fiscal year in accordance with section
 11  1 331.439 331.424A.
 11  2    Sec. 18.  Section 222.92, subsection 3, paragraph a, Code
 11  3 2015, is amended to read as follows:
 11  4    a.  Moneys received by the state from billings to counties
 11  5 and regional administrators for the counties.
 11  6    Sec. 19.  Section 225.1, Code 2015, is amended to read as
 11  7 follows:
 11  8    225.1  Establishment ==== definitions.
 11  9    1.  There shall be established a The state psychiatric
 11 10 hospital, is established. The hospital shall be especially
 11 11 designed, kept, and administered for the care, observation,
 11 12 and treatment of those persons who are afflicted with abnormal
 11 13 mental conditions.
 11 14    2.  For the purposes of this chapter, unless the context
 11 15 otherwise requires:
 11 16    a.  "Mental health and disability services region" means
 11 17 a mental health and disability services region approved in
 11 18 accordance with section 331.389.
 11 19    b.  "Regional administrator" means the administrator of a
 11 20 mental health and disability services region, as defined in
 11 21 section 331.388.
 11 22    Sec. 20.  Section 225.10, unnumbered paragraph 1, Code 2015,
 11 23 is amended to read as follows:
 11 24    Persons suffering from mental diseases may be admitted to
 11 25 the state psychiatric hospital as voluntary public patients
 11 26 if a physician authorized to practice medicine or osteopathic
 11 27 medicine in the state of Iowa files information with the board
 11 28 of supervisors regional administrator of the person's county
 11 29 of residence or the board's designee, stating all of the
 11 30 following:
 11 31    Sec. 21.  Section 225.11, Code 2015, is amended to read as
 11 32 follows:
 11 33    225.11  Initiating commitment procedures.
 11 34    When a court finds upon completion of a hearing held pursuant
 11 35 to section 229.12 that the contention that a respondent is
 12  1 seriously mentally impaired has been sustained by clear and
 12  2 convincing evidence, and the application filed under section
 12  3 229.6 also contends or the court otherwise concludes that it
 12  4 would be appropriate to refer the respondent to the state
 12  5 psychiatric hospital for a complete psychiatric evaluation and
 12  6 appropriate treatment pursuant to section 229.13, the judge
 12  7 may order that a financial investigation be made in the manner
 12  8 prescribed by section 225.13. If the costs of a respondent's
 12  9 evaluation or treatment are payable in whole or in part by
 12 10 a county, an order under this section shall be for referral
 12 11 of the respondent through the central point of coordination
 12 12 process regional administrator for the respondent's county of
 12 13 residence for an evaluation and referral of the respondent
 12 14 to an appropriate placement or service, which may include
 12 15 the state psychiatric hospital for additional evaluation or
 12 16 treatment. For purposes of this chapter, "central point of
 12 17 coordination process" means the same as defined in section
 12 18 331.440.
 12 19    Sec. 22.  Section 225.12, Code 2015, is amended to read as
 12 20 follows:
 12 21    225.12  Voluntary public patient ==== physician's report.
 12 22    A physician filing information under section 225.10 shall
 12 23 include a written report to the county board of supervisors
 12 24 or the board's designee regional administrator for the
 12 25 county of residence of the person named in the information,
 12 26 giving a history of the case as will be likely to aid in the
 12 27 observation, treatment, and hospital care of the person named
 12 28 in the information and describing the history in detail.
 12 29    Sec. 23.  Section 225.13, Code 2015, is amended to read as
 12 30 follows:
 12 31    225.13  Financial condition.
 12 32    The county board of supervisors or the board's designee
 12 33  regional administrator of the county of residence of a person
 12 34 being admitted to the state psychiatric hospital is responsible
 12 35 for investigating the financial condition of a person being
 13  1 admitted to the state psychiatric hospital the person and of
 13  2 those legally responsible for the person's support.
 13  3    Sec. 24.  Section 225.15, Code 2015, is amended to read as
 13  4 follows:
 13  5    225.15  Examination and treatment.
 13  6    1.  When a respondent arrives at the state psychiatric
 13  7 hospital, the admitting physician shall examine the respondent
 13  8 and determine whether or not, in the physician's judgment, the
 13  9 respondent is a fit subject for observation, treatment, and
 13 10 hospital care. If, upon examination, the physician decides
 13 11 that the respondent should be admitted to the hospital, the
 13 12 respondent shall be provided a proper bed in the hospital. The
 13 13 physician who has charge of the respondent shall proceed with
 13 14 observation, medical treatment, and hospital care as in the
 13 15 physician's judgment are proper and necessary, in compliance
 13 16 with sections 229.13 to 229.16. After the respondent's
 13 17 admission, the observation, medical treatment, and hospital
 13 18 care of the respondent may be provided by a mental health
 13 19 professional, as defined in section 228.1, who is licensed as a
 13 20 physician, advanced registered nurse practitioner, or physician
 13 21 assistant.
 13 22    2.  A proper and competent nurse shall also be assigned to
 13 23 look after and care for the respondent during observation,
 13 24 treatment, and care. Observation, treatment, and hospital care
 13 25 under this section which are payable in whole or in part by a
 13 26 county shall only be provided as determined through the central
 13 27 point of coordination process regional administrator of the
 13 28 respondent's county of residence.
 13 29    Sec. 25.  Section 225.16, subsection 1, Code 2015, is amended
 13 30 to read as follows:
 13 31    1.  If the county board of supervisors or the board's
 13 32 designee regional administrator for a person's county of
 13 33 residence finds from the physician's information which was
 13 34 filed under the provisions of section 225.10 that it would
 13 35 be appropriate for the person to be admitted to the state
 14  1 psychiatric hospital, and the report of the county board of
 14  2 supervisors or the board's designee regional administrator made
 14  3 pursuant to section 225.13 shows that the person and those who
 14  4 are legally responsible for the person are not able to pay the
 14  5 expenses incurred at the hospital, or are able to pay only a
 14  6 part of the expenses, the person shall be considered to be a
 14  7 voluntary public patient and the board of supervisors regional
 14  8 administrator shall direct that the person shall be sent to the
 14  9 state psychiatric hospital at the state university of Iowa for
 14 10 observation, treatment, and hospital care.
 14 11    Sec. 26.  Section 225.17, subsection 2, Code 2015, is amended
 14 12 to read as follows:
 14 13    2.  When the respondent arrives at the hospital, the
 14 14 respondent shall receive the same treatment as is provided for
 14 15 committed public patients in section 225.15, in compliance with
 14 16 sections 229.13 to 229.16. However, observation, treatment,
 14 17 and hospital care under this section of a respondent whose
 14 18 expenses are payable in whole or in part by a county shall
 14 19 only be provided as determined through the central point of
 14 20 coordination process regional administrator of the respondent's
 14 21 county of residence.
 14 22    Sec. 27.  Section 225.18, Code 2015, is amended to read as
 14 23 follows:
 14 24    225.18  Attendants.
 14 25    The county board of supervisors or the board's designee
 14 26  regional administrator may appoint a person an attendant to
 14 27 accompany the committed public patient or the voluntary public
 14 28 patient or the committed private patient from the place where
 14 29 the patient may be to the state psychiatric hospital, or to
 14 30 accompany the patient from the hospital to a place as may be
 14 31 designated by the county regional administrator. If a patient
 14 32 is moved pursuant to this section, at least one attendant shall
 14 33 be of the same gender as the patient.
 14 34    Sec. 28.  Section 225.19, Code 2015, is amended to read as
 14 35 follows:
 15  1    225.19  Compensation for attendant.
 15  2    An individual appointed by the county board of supervisors
 15  3 or the board's designee regional administrator in accordance
 15  4 with section 225.18 to accompany a person to or from the
 15  5 hospital or to make an investigation and report on any question
 15  6 involved in the matter shall receive three dollars per day for
 15  7 the time actually spent in making the investigation and actual
 15  8 necessary expenses incurred in making the investigation or
 15  9 trip. This section does not apply to an appointee who receives
 15 10 fixed compensation or a salary.
 15 11    Sec. 29.  Section 225.21, Code 2015, is amended to read as
 15 12 follows:
 15 13    225.21  Compensation claims ==== filing ==== approval.
 15 14    The person making claim to compensation under section 225.19
 15 15 shall file the claim in the office of the county auditor
 15 16  regional administrator for the person's county of residence.
 15 17 The claim is subject to review and approval by the board of
 15 18 supervisors or the board's designee regional administrator for
 15 19 the county.
 15 20    Sec. 30.  Section 225.24, Code 2015, is amended to read as
 15 21 follows:
 15 22    225.24  Collection of preliminary expense.
 15 23    Unless a committed private patient or those legally
 15 24 responsible for the patient's support offer to settle
 15 25 the amount of the claims, the county auditor of regional
 15 26 administrator for the person's county of residence shall
 15 27 collect, by action if necessary, the amount of all claims
 15 28 for per diem and expenses that have been approved by the
 15 29 county board of supervisors or the board's designee regional
 15 30 administrator for the county and paid by the county regional
 15 31 administrator as provided under section 225.21. Any amount
 15 32 collected shall be credited to the county treasury mental
 15 33 health and disabilities services fund created in accordance
 15 34 with section 331.424A.
 15 35    Sec. 31.  Section 225.27, Code 2015, is amended to read as
 16  1 follows:
 16  2    225.27  Discharge ==== transfer.
 16  3    The state psychiatric hospital may, at any time, discharge
 16  4 any patient as recovered, as improved, or as not likely to
 16  5 be benefited by further treatment. If the patient being so
 16  6 discharged was involuntarily hospitalized, the hospital shall
 16  7 notify the committing judge or court of the discharge as
 16  8 required by section 229.14 or section 229.16, whichever is
 16  9 applicable, and the applicable regional administrator. Upon
 16 10 receiving the notification, the court shall issue an order
 16 11 confirming the patient's discharge from the hospital or from
 16 12 care and custody, as the case may be, and shall terminate the
 16 13 proceedings pursuant to which the order was issued. The court
 16 14 or judge shall, if necessary, appoint a person to accompany the
 16 15 discharged patient from the state psychiatric hospital to such
 16 16 place as the hospital or the court may designate, or authorize
 16 17 the hospital to appoint such attendant.
 16 18    Sec. 32.  Section 225C.2, subsection 2, Code 2015, is amended
 16 19 by striking the subsection.
 16 20    Sec. 33.  Section 225C.5, subsection 1, paragraph f, Code
 16 21 2015, is amended to read as follows:
 16 22    f.  Two members shall be staff members of regional
 16 23  administrators of the central point of coordination process
 16 24 established in accordance with section 331.440 selected from
 16 25 nominees submitted by the community services affiliate of the
 16 26 Iowa state association of counties.
 16 27    Sec. 34.  Section 225C.6, subsection 1, paragraph i,
 16 28 subparagraph (1), Code 2015, is amended to read as follows:
 16 29    (1)  The extent to which services to persons with
 16 30 disabilities are actually available to persons in each county
 16 31 and mental health and disability services region in the state
 16 32 and the quality of those services.
 16 33    Sec. 35.  Section 225C.6, subsection 1, paragraph m, Code
 16 34 2015, is amended to read as follows:
 16 35    m.  Identify disability services outcomes and indicators to
 17  1 support the ability of eligible persons with a disability to
 17  2 live, learn, work, and recreate in communities of the persons'
 17  3 choice. The identification duty includes but is not limited to
 17  4 responsibility for identifying, collecting, and analyzing data
 17  5 as necessary to issue reports on outcomes and indicators at the
 17  6 county, region, and state levels.
 17  7    Sec. 36.  Section 225C.13, subsection 1, Code 2015, is
 17  8 amended to read as follows:
 17  9    1.  The administrator assigned, in accordance with section
 17 10 218.1, to control the state mental health institutes and
 17 11 the state resource centers may enter into agreements under
 17 12 which a facility or portion of a facility administered by the
 17 13 administrator is leased to a department or division of state
 17 14 government, a county or group of counties, a mental health and
 17 15 disability services region, or a private nonprofit corporation
 17 16 organized under chapter 504. A lease executed under this
 17 17 section shall require that the lessee use the leased premises
 17 18 to deliver either disability services or other services
 17 19 normally delivered by the lessee.
 17 20    Sec. 37.  Section 225C.14, Code 2015, is amended to read as
 17 21 follows:
 17 22    225C.14  Preliminary diagnostic evaluation.
 17 23    1.  Except in cases of medical emergency, a person shall be
 17 24 admitted to a state mental health institute as an inpatient
 17 25 only after a preliminary diagnostic evaluation performed
 17 26 through the central point of coordination process regional
 17 27 administrator of the person's county of residence has confirmed
 17 28 that the admission is appropriate to the person's mental health
 17 29 needs, and that no suitable alternative method of providing the
 17 30 needed services in a less restrictive setting or in or nearer
 17 31 to the person's home community is currently available. If
 17 32 provided for through the central point of coordination process
 17 33  regional administrator, the evaluation may be performed by a
 17 34 community mental health center or by an alternative diagnostic
 17 35 facility. The policy established by this section shall be
 18  1 implemented in the manner and to the extent prescribed by
 18  2 sections 225C.15, 225C.16 and 225C.17.
 18  3    2.  As used in this section and sections 225C.15, 225C.16
 18  4 and 225C.17, the term "medical emergency" means a situation
 18  5 in which a prospective patient is received at a state mental
 18  6 health institute in a condition which, in the opinion of the
 18  7 chief medical officer, or that officer's physician designee,
 18  8 requires the immediate admission of the person notwithstanding
 18  9 the policy stated in subsection 1.
 18 10    Sec. 38.  Section 225C.15, Code 2015, is amended to read as
 18 11 follows:
 18 12    225C.15  County implementation of evaluations.
 18 13    The board of supervisors of regional administrator for a
 18 14 county shall, no later than July 1, 1982, require that the
 18 15 policy stated in section 225C.14 be followed with respect
 18 16 to admission of persons from that county to a state mental
 18 17 health institute. A community mental health center which is
 18 18 supported, directly or in affiliation with other counties, by
 18 19 that county may perform the preliminary diagnostic evaluations
 18 20 for that county, unless the performance of the evaluations
 18 21 is not covered by the agreement entered into by the county
 18 22  regional administrator and the center, and the center's
 18 23 director certifies to the board of supervisors regional
 18 24 administrator that the center does not have the capacity to
 18 25 perform the evaluations, in which case the board of supervisors
 18 26  regional administrator shall proceed under section 225C.17.
 18 27    Sec. 39.  Section 225C.16, Code 2015, is amended to read as
 18 28 follows:
 18 29    225C.16  Referrals for evaluation.
 18 30    1.  The chief medical officer of a state mental health
 18 31 institute, or that officer's physician designee, shall advise
 18 32 a person residing in that county who applies for voluntary
 18 33 admission, or a person applying for the voluntary admission
 18 34 of another person who resides in that county, in accordance
 18 35 with section 229.41, that the board of supervisors regional
 19  1 administrator for the county has implemented the policy
 19  2 stated in section 225C.14, and shall advise that a preliminary
 19  3 diagnostic evaluation of the prospective patient be sought,
 19  4 if that has not already been done. This subsection does not
 19  5 apply when voluntary admission is sought in accordance with
 19  6 section 229.41 under circumstances which, in the opinion of the
 19  7 chief medical officer or that officer's physician designee,
 19  8 constitute a medical emergency.
 19  9    2.  The clerk of the district court in that county shall
 19 10 refer a person applying for authorization for voluntary
 19 11 admission, or for authorization for voluntary admission of
 19 12 another person, in accordance with section 229.42, to the
 19 13 appropriate entity designated through the central point of
 19 14 coordination process regional administrator of the person's
 19 15 county of residence under section 225C.14 for the preliminary
 19 16 diagnostic evaluation unless the applicant furnishes a written
 19 17 statement from the appropriate entity which indicates that the
 19 18 evaluation has been performed and that the person's admission
 19 19 to a state mental health institute is appropriate. This
 19 20 subsection does not apply when authorization for voluntary
 19 21 admission is sought under circumstances which, in the opinion
 19 22 of the chief medical officer or that officer's physician
 19 23 designee, constitute a medical emergency.
 19 24    3.  Judges of the district court in that county or the
 19 25 judicial hospitalization referee appointed for that county
 19 26 shall so far as possible arrange for the entity designated
 19 27 through the central point of coordination process regional
 19 28 administrator under section 225C.14 to perform a prehearing
 19 29 examination of a respondent required under section 229.8,
 19 30 subsection 3, paragraph "b".
 19 31    4.  The chief medical officer of a state mental health
 19 32 institute shall promptly submit to the appropriate entity
 19 33 designated through the central point of coordination process
 19 34  regional administrator under section 225C.14 a report of the
 19 35 voluntary admission of a patient under the medical emergency
 20  1 clauses provisions of subsections 1 and 2. The report shall
 20  2 explain the nature of the emergency which necessitated the
 20  3 admission of the patient without a preliminary diagnostic
 20  4 evaluation by the designated entity.
 20  5    Sec. 40.  Section 225C.17, Code 2015, is amended to read as
 20  6 follows:
 20  7    225C.17  Alternative diagnostic facility.
 20  8    If a county is not served by a community mental health
 20  9 center having the capacity to perform the required preliminary
 20 10 diagnostic evaluations, the board of supervisors regional
 20 11 administrator for the county shall arrange for the evaluations
 20 12 to be performed by an alternative diagnostic facility for
 20 13 the period until the county is served by a community mental
 20 14 health center with the capacity to provide that service. An
 20 15 alternative diagnostic facility may be the outpatient service
 20 16 of a state mental health institute or any other mental health
 20 17 facility or service able to furnish the requisite professional
 20 18 skills to properly perform a preliminary diagnostic evaluation
 20 19 of a person whose admission to a state mental health institute
 20 20 is being sought or considered on either a voluntary or an
 20 21 involuntary basis.
 20 22    Sec. 41.  Section 225C.19, subsection 3, paragraphs a, b, and
 20 23 c, Code 2015, are amended to read as follows:
 20 24    a.  Standards for accrediting or approving emergency mental
 20 25 health crisis services providers. Such providers may include
 20 26 but are not limited to a community mental health center
 20 27 designated under chapter 230A, a provider approved in a waiver
 20 28 adopted by the commission to provide services to a county
 20 29 in lieu of a community mental health center, a unit of the
 20 30 department or other state agency, a county, a mental health
 20 31 and disability services region, or any other public or private
 20 32 provider who meets the accreditation or approval standards for
 20 33 an emergency mental health crisis services provider.
 20 34    b.  Identification by the division of geographic regions,
 20 35 groupings of mental health and disability services regions,
 21  1  service areas, or other means of distributing and organizing
 21  2 the emergency mental health crisis services system to ensure
 21  3 statewide availability of the services.
 21  4    c.  Coordination of emergency mental health crisis services
 21  5 with all of the following:
 21  6    (1)  The district and juvenile courts.
 21  7    (2)  Law enforcement.
 21  8    (3)  Judicial district departments of correctional services.
 21  9    (4)  County central point of coordination processes Mental
 21 10 health and disability services regions.
 21 11    (5)  Other mental health, substance abuse, and co=occurring
 21 12 mental illness and substance abuse services available through
 21 13 the state and counties to serve both children and adults.
 21 14    Sec. 42.  Section 225C.20, Code 2015, is amended to read as
 21 15 follows:
 21 16    225C.20  Responsibilities of counties mental health and
 21 17 disabilities services regions for individual case management
 21 18 services.
 21 19    Individual case management services funded under medical
 21 20 assistance shall be provided by the department except when
 21 21 a county or a consortium of counties contracts with the
 21 22 department to provide the services. A county or consortium
 21 23 of counties regional administrator may contract for one or
 21 24 more counties of the region to be the provider at any time
 21 25 and the department shall agree to the contract so long as
 21 26 the contract meets the standards for case management adopted
 21 27 by the department. The county or consortium of counties
 21 28  regional administrator may subcontract for the provision
 21 29 of case management services so long as the subcontract
 21 30 meets the same standards. A county board of supervisors
 21 31  regional administrator may change the provider of individual
 21 32 case management services at any time. If the current or
 21 33 proposed contract is with the department, the county board
 21 34 of supervisors regional administrator shall provide written
 21 35 notification of a change at least ninety days before the date
 22  1 the change will take effect.
 22  2    Sec. 43.  Section 225C.54, subsection 1, Code 2015, is
 22  3 amended to read as follows:
 22  4    1.  The mental health services system for children and youth
 22  5 shall be initially implemented by the division commencing
 22  6 with the fiscal year beginning July 1, 2008. The division
 22  7 shall begin implementation by utilizing a competitive bidding
 22  8 process to allocate state block grants to develop services
 22  9 through existing community mental health centers, providers
 22 10 approved in a waiver adopted by the commission to provide
 22 11 services to a county in lieu of a community mental health
 22 12 center, designated under chapter 230A and other local service
 22 13 partners. The implementation shall be limited to the extent of
 22 14 the appropriations provided for the children's system.
 22 15    Sec. 44.  Section 226.1, Code 2015, is amended by adding the
 22 16 following new subsection:
 22 17    NEW SUBSECTION.  4.  For the purposes of this chapter, unless
 22 18 the context otherwise requires:
 22 19    a.  "Administrator" means the person assigned by the
 22 20 director of human services to control the state mental health
 22 21 institutes.
 22 22    b.  "Department" means the department of human services.
 22 23    c.  "Mental health and disability services region" means
 22 24 a mental health and disability services region formed in
 22 25 accordance with section 331.389.
 22 26    d.  "Regional administrator" means the regional administrator
 22 27 of a mental health and disability services region, as defined
 22 28 in section 331.388.
 22 29    Sec. 45.  Section 226.9C, subsection 2, paragraphs a and c,
 22 30 Code 2015, are amended to read as follows:
 22 31    a.  A county may split the The charges payable by a
 22 32 county may be split between the county's mental health and
 22 33 disabilities services fund created pursuant to section 331.424A
 22 34 and the county's budget for substance abuse substance=related
 22 35 disorder expenditures.
 23  1    c.  (1)  Prior to an individual's admission for dual
 23  2 diagnosis treatment, the individual shall have been
 23  3 prescreened. The person performing the prescreening shall
 23  4 be either the mental health professional, as defined in
 23  5 section 228.1, who is contracting with the county central
 23  6 point of coordination process regional administrator for the
 23  7 county's mental health and disability services region to
 23  8 provide the prescreening or a mental health professional with
 23  9 the requisite qualifications. A mental health professional
 23 10 with the requisite qualifications shall meet all of the
 23 11 following qualifications: is a mental health professional as
 23 12 defined in section 228.1, is an alcohol and drug counselor
 23 13 certified by the nongovernmental Iowa board of substance abuse
 23 14 certification, and is employed by or providing services for a
 23 15 facility, as defined in section 125.2.
 23 16    (2)  Prior to an individual's admission for dual diagnosis
 23 17 treatment, the individual shall have been screened through a
 23 18 county's central point of coordination process implemented
 23 19 pursuant to section 331.440 regional administrator to determine
 23 20 the appropriateness of the treatment.
 23 21    Sec. 46.  Section 226.32, Code 2015, is amended to read as
 23 22 follows:
 23 23    226.32  Overcrowded conditions.
 23 24    The administrator shall order the discharge or removal
 23 25 from the hospital of incurable and harmless patients whenever
 23 26 it is necessary to make room for recent cases. If a patient
 23 27 who is to be so discharged entered the hospital voluntarily,
 23 28 the administrator shall notify the auditor of regional
 23 29 administrator for the county interested at least ten days in
 23 30 advance of the day of actual discharge.
 23 31    Sec. 47.  Section 226.34, subsection 2, Code 2015, is amended
 23 32 to read as follows:
 23 33    2.  If a patient in a mental health institute dies from any
 23 34 cause, the superintendent of the institute shall within three
 23 35 days of the date of death, send by certified mail a written
 24  1 notice of death to all of the following:
 24  2    a.  The decedent's nearest relative.
 24  3    b.  The clerk of the district court of the county from which
 24  4 the patient was committed.
 24  5    c.  The sheriff of the county from which the patient was
 24  6 committed.
 24  7    d.  The regional administrator for the county from which the
 24  8 patient was committed.
 24  9    Sec. 48.  Section 227.1, Code 2015, is amended to read as
 24 10 follows:
 24 11    227.1  Supervision Definitions ==== supervision.
 24 12    1.  For the purposes of this chapter, unless the context
 24 13 otherwise requires:
 24 14    a.  "Administrator" means the person assigned by the director
 24 15 of human services in the appropriate division of the department
 24 16 to administer mental health and disability services.
 24 17    b.  "Department" means the department of human services.
 24 18    c.  "Mental health and disability services region" means
 24 19 a mental health and disability services region formed in
 24 20 accordance with section 331.389.
 24 21    d.  "Regional administrator" means the regional administrator
 24 22 of a mental health and disability services region, as defined
 24 23 in section 331.388.
 24 24    2.  All The regulatory requirements for county and private
 24 25 institutions wherein where persons with mental illness or an
 24 26 intellectual disability are kept admitted, committed, or placed
 24 27  shall be under the supervision of the administrator.
 24 28    Sec. 49.  Section 227.2, subsection 1, unnumbered paragraph
 24 29 1, Code 2015, is amended to read as follows:
 24 30    The director of inspections and appeals shall make, or cause
 24 31 to be made, at least one licensure inspection each year of
 24 32 every county care facility. Either the administrator of the
 24 33 division or the director of the department of inspections and
 24 34 appeals, in cooperation with each other, upon receipt of a
 24 35 complaint or for good cause, may make, or cause to be made,
 25  1 a review of a county care facility or of any other private
 25  2 or county institution where persons with mental illness or
 25  3 an intellectual disability reside. A licensure inspection
 25  4 or a review shall be made by a competent and disinterested
 25  5 person who is acquainted with and interested in the care of
 25  6 persons with mental illness and persons with an intellectual
 25  7 disability. The objective of a licensure inspection or a
 25  8 review shall be an evaluation of the programming and treatment
 25  9 provided by the facility. After each licensure inspection of a
 25 10 county care facility, the person who made the inspection shall
 25 11 consult with the county authorities regional administrator
 25 12 for the county in which the facility is located on plans and
 25 13 practices that will improve the care given patients and. The
 25 14 person shall also make recommendations to the administrator of
 25 15 the division and the director of public health for coordinating
 25 16 and improving the relationships between the administrators of
 25 17 county care facilities, the administrator of the division,
 25 18 the director of public health, the superintendents of state
 25 19 mental health institutes and resource centers, community
 25 20 mental health centers, mental health and disability services
 25 21 regions, and other cooperating agencies, to cause improved
 25 22 and more satisfactory care of patients. A written report of
 25 23 each licensure inspection of a county care facility under this
 25 24 section shall be filed by the person with the administrator
 25 25 of the division and the director of public health and shall
 25 26 include:
 25 27    Sec. 50.  Section 227.2, subsection 1, paragraph f, Code
 25 28 2015, is amended to read as follows:
 25 29    f.  The recommendations given to and received from county
 25 30 authorities the regional administrator on methods and practices
 25 31 that will improve the conditions under which the county care
 25 32 facility is operated.
 25 33    Sec. 51.  Section 227.2, subsection 2, Code 2015, is amended
 25 34 to read as follows:
 25 35    2.  A copy of the written report prescribed by subsection
 26  1 1 shall be furnished to the county board of supervisors,
 26  2 to the county mental health and intellectual disability
 26  3 coordinating board or to its advisory board if the county board
 26  4 of supervisors constitutes ex officio the coordinating board
 26  5  regional administrator for the county, to the administrator
 26  6 of the county care facility inspected and to its certified
 26  7 volunteer long=term care ombudsman, and to the department on
 26  8 aging.
 26  9    Sec. 52.  Section 227.4, Code 2015, is amended to read as
 26 10 follows:
 26 11    227.4  Standards for care of persons with mental illness or an
 26 12 intellectual disability in county care facilities.
 26 13    The administrator, in cooperation with the department of
 26 14 inspections and appeals, shall recommend and the mental health
 26 15 and disability services commission created in section 225C.5
 26 16 shall adopt, or amend and adopt, standards for the care of and
 26 17 services to persons with mental illness or an intellectual
 26 18 disability residing in county care facilities. The standards
 26 19 shall be enforced by the department of inspections and appeals
 26 20 as a part of the licensure inspection conducted pursuant to
 26 21 chapter 135C.  The objective of the standards is to ensure
 26 22 that persons with mental illness or an intellectual disability
 26 23 who are residents of county care facilities are not only
 26 24 adequately fed, clothed, and housed, but are also offered
 26 25 reasonable opportunities for productive work and recreational
 26 26 activities suited to their physical and mental abilities and
 26 27 offering both a constructive outlet for their energies and, if
 26 28 possible, therapeutic benefit. When recommending standards
 26 29 under this section, the administrator shall designate an
 26 30 advisory committee representing administrators of county care
 26 31 facilities, county mental health and developmental disabilities
 26 32 regional planning councils regional administrators, mental
 26 33 health and disability services region governing boards,
 26 34  and county care facility certified volunteer long=term care
 26 35 ombudsmen to assist in the establishment of standards.
 27  1    Sec. 53.  Section 227.10, Code 2015, is amended to read as
 27  2 follows:
 27  3    227.10  Transfers from county or private institutions.
 27  4    Patients who have been admitted at public expense to
 27  5 any institution to which this chapter is applicable may be
 27  6 involuntarily transferred to the proper state hospital for
 27  7 persons with mental illness in the manner prescribed by
 27  8 sections 229.6 to 229.13. The application required by section
 27  9 229.6 may be filed by the administrator of the division or
 27 10 the administrator's designee, or by the administrator of the
 27 11 institution where the patient is then being maintained or
 27 12 treated. If the patient was admitted to that institution
 27 13 involuntarily, the administrator of the division may arrange
 27 14 and complete the transfer, and shall report it as required
 27 15 of a chief medical officer under section 229.15, subsection
 27 16 5. The transfer shall be made at county the mental health
 27 17 and disabilities services region's expense, and the expense
 27 18 recovered, as provided in section 227.7. However, transfer
 27 19 under this section of a patient whose expenses are payable in
 27 20 whole or in part by a county the mental health and disabilities
 27 21 services region is subject to an authorization for the transfer
 27 22 through the central point of coordination process regional
 27 23 administrator for the patient's county of residence.
 27 24    Sec. 54.  Section 227.11, Code 2015, is amended to read as
 27 25 follows:
 27 26    227.11  Transfers from state hospitals.
 27 27    A regional administrator for the county chargeable with
 27 28 the expense of a patient in a state hospital for persons with
 27 29 mental illness shall transfer the patient to a county or
 27 30 private institution for persons with mental illness that is in
 27 31 compliance with the applicable rules when the administrator
 27 32 of the division or the administrator's designee orders the
 27 33 transfer on a finding that the patient is suffering from
 27 34 chronic mental illness or from senility a serious mental
 27 35 illness and will receive equal benefit by being so transferred.
 28  1 A county mental health and disability services region shall
 28  2 transfer to its a county care facility any patient in a state
 28  3 hospital for persons with mental illness upon request of the
 28  4 superintendent of the state hospital in which the patient is
 28  5 confined pursuant to the superintendent's authority under
 28  6 section 229.15, subsection 5, and approval by the board of
 28  7 supervisors of regional administrator for the county of the
 28  8 patient's residence. In no case shall a patient be thus
 28  9 transferred except upon compliance with section 229.14A or
 28 10 without the written consent of a relative, friend, or guardian
 28 11 if such relative, friend, or guardian pays the expense of
 28 12 the care of such patient in a state hospital. Patients
 28 13 transferred to a public or private facility under this
 28 14 section may subsequently be placed on convalescent or limited
 28 15 leave or transferred to a different facility for continued
 28 16 full=time custody, care, and treatment when, in the opinion
 28 17 of the attending physician or the chief medical officer of
 28 18 the hospital from which the patient was so transferred, the
 28 19 best interest of the patient would be served by such leave or
 28 20 transfer. For any patient who is involuntarily committed, any
 28 21 transfer made under this section is subject to the placement
 28 22 hearing requirements of section 229.14A.
 28 23    Sec. 55.  Section 227.12, Code 2015, is amended to read as
 28 24 follows:
 28 25    227.12  Difference of opinion.
 28 26    When a difference of opinion exists between the
 28 27 administrator of the division and the authorities in charge
 28 28 of any private or county hospital in regard to the removal
 28 29  transfer of a patient or patients as herein provided in
 28 30 sections 227.10 and 227.11, the matter shall be submitted to
 28 31 the district court of the county in which such hospital is
 28 32 situated and shall be summarily tried as an equitable action,
 28 33 and the judgment of the district court shall be final.
 28 34    Sec. 56.  Section 227.14, Code 2015, is amended to read as
 28 35 follows:
 29  1    227.14  Caring for persons with mental illness from other
 29  2 counties.
 29  3    Boards of supervisors of counties having no The regional
 29  4 administrator for a county that does not have proper facilities
 29  5 for caring for persons with mental illness may, with the
 29  6 consent of the administrator of the division, provide for
 29  7 such care at the expense of the county mental health and
 29  8 disabilities services region in any convenient and proper
 29  9 county or private institution for persons with mental illness
 29 10 which is willing to receive them the persons.
 29 11    Sec. 57.  Section 229.1, subsection 3, Code 2015, is amended
 29 12 by striking the subsection.
 29 13    Sec. 58.  Section 229.1, Code 2015, is amended by adding the
 29 14 following new subsections:
 29 15    NEW SUBSECTION.  8A.  "Mental health and disability services
 29 16 region" means a mental health and disability services region
 29 17 formed in accordance with section 331.389.
 29 18    NEW SUBSECTION.  14A.  "Regional administrator" means the
 29 19 regional administrator of a mental health and disability
 29 20 services region, as defined in section 331.388.
 29 21    Sec. 59.  Section 229.1B, Code 2015, is amended to read as
 29 22 follows:
 29 23    229.1B  Central point of coordination process Regional
 29 24 administrator.
 29 25    Notwithstanding any provision of this chapter to the
 29 26 contrary, any person whose hospitalization expenses are payable
 29 27 in whole or in part by a county mental health and disabilities
 29 28 services region shall be subject to all administrative
 29 29  requirements of the central point of coordination process
 29 30  regional administrator for the county.
 29 31    Sec. 60.  Section 229.2, subsection 1, paragraph b,
 29 32 subparagraph (3), Code 2015, is amended to read as follows:
 29 33    (3)  As soon as is practicable after the filing of a
 29 34 petition for juvenile court approval of the admission of the
 29 35 minor, the juvenile court shall determine whether the minor
 30  1 has an attorney to represent the minor in the hospitalization
 30  2 proceeding, and if not, the court shall assign to the minor
 30  3 an attorney. If the minor is financially unable to pay for
 30  4 an attorney, the attorney shall be compensated by the county
 30  5  mental health and disabilities services region at an hourly
 30  6 rate to be established by the county board of supervisors
 30  7  regional administrator for the county in which the proceeding
 30  8 is held in substantially the same manner as provided in section
 30  9 815.7.
 30 10    Sec. 61.  Section 229.8, subsection 1, Code 2015, is amended
 30 11 to read as follows:
 30 12    1.  Determine whether the respondent has an attorney
 30 13 who is able and willing to represent the respondent in the
 30 14 hospitalization proceeding, and if not, whether the respondent
 30 15 is financially able to employ an attorney and capable of
 30 16 meaningfully assisting in selecting one. In accordance with
 30 17 those determinations, the court shall if necessary allow the
 30 18 respondent to select, or shall assign to the respondent, an
 30 19 attorney. If the respondent is financially unable to pay an
 30 20 attorney, the attorney shall be compensated by the county
 30 21  mental health and disabilities services region at an hourly
 30 22 rate to be established by the county board of supervisors
 30 23  regional administrator for the county in which the proceeding
 30 24 is held in substantially the same manner as provided in section
 30 25 815.7.
 30 26    Sec. 62.  Section 229.10, subsection 1, paragraph a, Code
 30 27 2015, is amended to read as follows:
 30 28    a.  An examination of the respondent shall be conducted by
 30 29 one or more licensed physicians, as required by the court's
 30 30 order, within a reasonable time. If the respondent is detained
 30 31 pursuant to section 229.11, subsection 1, paragraph "b",
 30 32 the examination shall be conducted within twenty=four hours.
 30 33 If the respondent is detained pursuant to section 229.11,
 30 34 subsection 1, paragraph "a" or "c", the examination shall
 30 35 be conducted within forty=eight hours. If the respondent
 31  1 so desires, the respondent shall be entitled to a separate
 31  2 examination by a licensed physician of the respondent's own
 31  3 choice. The reasonable cost of the examinations shall, if the
 31  4 respondent lacks sufficient funds to pay the cost, be paid
 31  5 by the regional administrator from county mental health and
 31  6 disabilities services region funds upon order of the court.
 31  7    Sec. 63.  Section 229.11, subsection 1, unnumbered paragraph
 31  8 1, Code 2015, is amended to read as follows:
 31  9    If the applicant requests that the respondent be taken into
 31 10 immediate custody and the judge, upon reviewing the application
 31 11 and accompanying documentation, finds probable cause to believe
 31 12 that the respondent has a serious mental impairment and is
 31 13 likely to injure the respondent or other persons if allowed
 31 14 to remain at liberty, the judge may enter a written order
 31 15 directing that the respondent be taken into immediate custody
 31 16 by the sheriff or the sheriff's deputy and be detained until
 31 17 the hospitalization hearing. The hospitalization hearing shall
 31 18 be held no more than five days after the date of the order,
 31 19 except that if the fifth day after the date of the order is a
 31 20 Saturday, Sunday, or a holiday, the hearing may be held on the
 31 21 next succeeding business day. If the expenses of a respondent
 31 22 are payable in whole or in part by a county mental health and
 31 23 disabilities services region, for a placement in accordance
 31 24 with paragraph "a", the judge shall give notice of the
 31 25 placement to the central point of coordination process regional
 31 26 administrator for the county in which the court is located,
 31 27 and for a placement in accordance with paragraph "b" or "c",
 31 28 the judge shall order the placement in a hospital or facility
 31 29 designated through the central point of coordination process
 31 30  regional administrator. The judge may order the respondent
 31 31 detained for the period of time until the hearing is held,
 31 32 and no longer, in accordance with paragraph "a", if possible,
 31 33 and if not then in accordance with paragraph "b", or, only if
 31 34 neither of these alternatives is available, in accordance with
 31 35 paragraph "c". Detention may be:
 32  1    Sec. 64.  Section 229.13, subsection 1, paragraph a, Code
 32  2 2015, is amended to read as follows:
 32  3    a.  The court shall order a respondent whose expenses are
 32  4 payable in whole or in part by a county mental health and
 32  5 disabilities services region placed under the care of an
 32  6 appropriate hospital or facility designated through the central
 32  7 point of coordination process county's regional administrator
 32  8  on an inpatient or outpatient basis.
 32  9    Sec. 65.  Section 229.14, subsection 2, paragraph a, Code
 32 10 2015, is amended to read as follows:
 32 11    a.  For a respondent whose expenses are payable in whole or
 32 12 in part by a county mental health and disabilities services
 32 13 region, placement as designated through the central point of
 32 14 coordination process county's regional administrator in the
 32 15 care of an appropriate hospital or facility on an inpatient
 32 16 or outpatient basis, or other appropriate treatment, or in an
 32 17 appropriate alternative placement.
 32 18    Sec. 66.  Section 229.14A, subsections 7 and 9, Code 2015,
 32 19 are amended to read as follows:
 32 20    7.  If a respondent's expenses are payable in whole or in
 32 21 part by a county mental health and disabilities services region
 32 22  through the central point of coordination process county's
 32 23 regional administrator, notice of a placement hearing shall
 32 24 be provided to the county attorney and the county's central
 32 25 point of coordination process regional administrator. At the
 32 26 hearing, the county may present evidence regarding appropriate
 32 27 placement.
 32 28    9.  A placement made pursuant to an order entered under
 32 29 section 229.13 or 229.14 or this section shall be considered to
 32 30 be authorized through the central point of coordination process
 32 31  county's regional administrator.
 32 32    Sec. 67.  Section 229.19, subsection 1, paragraphs a and b,
 32 33 Code 2015, are amended to read as follows:
 32 34    a.  In each county with a population of three hundred
 32 35 thousand or more inhabitants the board of supervisors county's
 33  1 regional administrator shall appoint an individual who has
 33  2 demonstrated by prior activities an informed concern for the
 33  3 welfare and rehabilitation of persons with mental illness,
 33  4 and who is not an officer or employee of the department of
 33  5 human services nor of any agency or facility providing care
 33  6 or treatment to persons with mental illness, to act as an
 33  7 advocate representing the interests of patients involuntarily
 33  8 hospitalized by the court, in any matter relating to the
 33  9 patients' hospitalization or treatment under section 229.14
 33 10 or 229.15. In each county with a population of under three
 33 11 hundred thousand inhabitants, the chief judge of the judicial
 33 12 district encompassing the county shall appoint the advocate.
 33 13    b.  The court or, if the advocate is appointed by the
 33 14 county board of supervisors regional administrator, the board
 33 15  regional administrator shall assign the advocate appointed from
 33 16 a patient's county of residence to represent the interests
 33 17 of the patient. If a patient has no county of residence or
 33 18 the patient is a state case, the court or, if the advocate
 33 19 is appointed by the county board of supervisors regional
 33 20 administrator, the board regional administrator shall assign
 33 21 the advocate appointed from for the county where the hospital
 33 22 or facility is located to represent the interests of the
 33 23 patient.
 33 24    Sec. 68.  Section 229.19, subsection 3, Code 2015, is amended
 33 25 to read as follows:
 33 26    3.  The court or, if the advocate is appointed by the county
 33 27 board of supervisors regional administrator, the board regional
 33 28 administrator shall prescribe reasonable compensation for the
 33 29 services of the advocate. The compensation shall be based
 33 30 upon the reports filed by the advocate with the court. The
 33 31 advocate's compensation shall be paid by the county in which
 33 32 the court is located, either on order of the court or, if
 33 33 the advocate is appointed by the county board of supervisors
 33 34  regional administrator, on the direction of the board regional
 33 35 administrator. If the advocate is appointed by the court, the
 34  1 advocate is an employee of the state for purposes of chapter
 34  2 669. If the advocate is appointed by the county board of
 34  3 supervisors regional administrator, the advocate is an employee
 34  4 of the county for purposes of chapter 670. If the patient or
 34  5 the person who is legally liable for the patient's support is
 34  6 not indigent, the board regional administrator shall recover
 34  7 the costs of compensating the advocate from that person. If
 34  8 that person has an income level as determined pursuant to
 34  9 section 815.9 greater than one hundred percent but not more
 34 10 than one hundred fifty percent of the poverty guidelines, at
 34 11 least one hundred dollars of the advocate's compensation shall
 34 12 be recovered in the manner prescribed by the county board of
 34 13 supervisors regional administrator. If that person has an
 34 14 income level as determined pursuant to section 815.9 greater
 34 15 than one hundred fifty percent of the poverty guidelines, at
 34 16 least two hundred dollars of the advocate's compensation shall
 34 17 be recovered in substantially the same manner prescribed by the
 34 18 county board of supervisors as provided in section 815.9.
 34 19    Sec. 69.  Section 229.24, subsection 3, unnumbered paragraph
 34 20 1, Code 2015, is amended to read as follows:
 34 21    If all or part of the costs associated with hospitalization
 34 22 of an individual under this chapter are chargeable to a county
 34 23 of residence, the clerk of the district court shall provide
 34 24 to the regional administrator for the county of residence and
 34 25 to the regional administrator for the county in which the
 34 26 hospitalization order is entered the following information
 34 27 pertaining to the individual which would be confidential under
 34 28 subsection 1:
 34 29    Sec. 70.  Section 229.42, subsection 1, Code 2015, is amended
 34 30 to read as follows:
 34 31    1.  If a person wishing to make application for voluntary
 34 32 admission to a mental hospital established by chapter 226 is
 34 33 unable to pay the costs of hospitalization or those responsible
 34 34 for the person are unable to pay the costs, application for
 34 35 authorization of voluntary admission must be made through a
 35  1 central point of coordination process regional administrator
 35  2  before application for admission is made to the hospital. The
 35  3 person's county of residence shall be determined through the
 35  4 central point of coordination process regional administrator
 35  5  and if the admission is approved through the central point
 35  6 of coordination process regional administrator, the person's
 35  7 admission to a mental health hospital shall be authorized as
 35  8 a voluntary case. The authorization shall be issued on forms
 35  9 provided by the department of human services' administrator.
 35 10 The costs of the hospitalization shall be paid by the county
 35 11 of residence through the regional administrator to the
 35 12 department of human services and credited to the general
 35 13 fund of the state, provided that the mental health hospital
 35 14 rendering the services has certified to the county auditor of
 35 15 the county of residence and the regional administrator the
 35 16 amount chargeable to the county mental health and disabilities
 35 17 services region and has sent a duplicate statement of the
 35 18 charges to the department of human services. A county mental
 35 19 health and disabilities services region shall not be billed
 35 20 for the cost of a patient unless the patient's admission is
 35 21 authorized through the central point of coordination process
 35 22  regional administrator. The mental health institute and the
 35 23 county regional administrator shall work together to locate
 35 24 appropriate alternative placements and services, and to
 35 25 educate patients and family members of patients regarding such
 35 26 alternatives.
 35 27    Sec. 71.  Section 230.1, subsection 3, Code 2015, is amended
 35 28 to read as follows:
 35 29    3.  A  mental health and disabilities services region or
 35 30  county of residence is not liable for costs and expenses
 35 31 associated with a person with mental illness unless the costs
 35 32 and expenses are for services and other support authorized for
 35 33 the person through the central point of coordination process
 35 34  county's regional administrator. For the purposes of this
 35 35 chapter, "central point of coordination process" "regional
 36  1 administrator" means the same as defined in section 331.440
 36  2  331.388.
 36  3    Sec. 72.  Section 230.3, Code 2015, is amended to read as
 36  4 follows:
 36  5    230.3  Certification of residence.
 36  6    If a person's county of residence is determined by the
 36  7 county's central point of coordination process regional
 36  8 administrator to be in another county of this state, the county
 36  9  regional administrator making the determination shall certify
 36 10 the determination to the superintendent of the hospital to
 36 11 which the person is admitted or committed. The certification
 36 12 shall be accompanied by a copy of the evidence supporting
 36 13 the determination. Upon receiving the certification, the
 36 14 superintendent shall charge the expenses already incurred and
 36 15 unadjusted, and all future expenses of the person, to the
 36 16 regional administrator of the county determined to be the
 36 17 county of residence.
 36 18    Sec. 73.  Section 230.20, subsection 2, paragraph b, Code
 36 19 2015, is amended to read as follows:
 36 20    b.  The per diem costs billed to each county mental health
 36 21 and disabilities services region shall not exceed the per
 36 22 diem costs billed to the county in the fiscal year beginning
 36 23 July 1, 1996. However, the per diem costs billed to a county
 36 24  mental health and disabilities services region may be adjusted
 36 25 annually to reflect increased costs, to the extent of the
 36 26 percentage increase in the total of county fixed budgets
 36 27 pursuant to the allowed growth factor adjustment statewide per
 36 28 capita expenditure target amount, if any per capita growth
 36 29 amount is authorized by the general assembly for the fiscal
 36 30 year in accordance with section 331.439 426B.3.
 36 31    Sec. 74.  Section 232.2, subsection 4, paragraph f,
 36 32 subparagraph (3), Code 2015, is amended to read as follows:
 36 33    (3)  The transition plan shall be developed and reviewed
 36 34 by the department in collaboration with a child=centered
 36 35 transition team. The transition team shall be comprised of
 37  1 the child's caseworker and persons selected by the child,
 37  2 persons who have knowledge of services available to the child,
 37  3 and any person who may reasonably be expected to be a service
 37  4 provider for the child when the child becomes an adult or to
 37  5 become responsible for the costs of services at that time.
 37  6 If the child is reasonably likely to need or be eligible for
 37  7 adult services, the transition team membership shall include
 37  8 representatives from the adult services system. The adult
 37  9 services system representatives may include but are not limited
 37 10 to the administrator of county general relief under chapter
 37 11 251 or 252 or of the central point of coordination process
 37 12 implemented under section 331.440 regional administrator of
 37 13 the county mental health and disability services region, as
 37 14 defined in section 331.388. The membership of the transition
 37 15 team and the meeting dates for the team shall be documented in
 37 16 the transition plan.
 37 17    Sec. 75.  Section 235.7, subsection 2, Code 2015, is amended
 37 18 to read as follows:
 37 19    2.  Membership.  The department may authorize the governance
 37 20 boards of decategorization of child welfare and juvenile
 37 21 justice funding projects established under section 232.188 to
 37 22 appoint the transition committee membership and may utilize
 37 23 the boundaries of decategorization projects to establish
 37 24 the service areas for transition committees. The committee
 37 25 membership may include but is not limited to department of
 37 26 human services staff involved with foster care, child welfare,
 37 27 and adult services, juvenile court services staff, staff
 37 28 involved with county general relief under chapter 251 or 252,
 37 29 or of the central point of coordination process implemented
 37 30 under section 331.440 a regional administrator of the county
 37 31 mental health and disability services region, as defined
 37 32 in section 331.388, in the area, school district and area
 37 33 education agency staff involved with special education, and a
 37 34 child's court appointed special advocate, guardian ad litem,
 37 35 service providers, and other persons knowledgeable about the
 38  1 child.
 38  2    Sec. 76.  Section 235A.15, subsection 2, paragraph c,
 38  3 subparagraph (9), Code 2015, is amended to read as follows:
 38  4    (9)  To the administrator of an agency providing mental
 38  5 health, intellectual disability, or developmental disability
 38  6 services under a county management plan developed pursuant
 38  7 to section 331.439 regional service system management plan
 38  8 implemented in accordance with section 331.393, if the data
 38  9 concerns a person employed by or being considered by the agency
 38 10 for employment.
 38 11    Sec. 77.  Section 235B.6, subsection 2, paragraph c,
 38 12 subparagraph (6), Code 2015, is amended to read as follows:
 38 13    (6)  To the administrator of an agency providing mental
 38 14 health, intellectual disability, or developmental disability
 38 15 services under a county management plan developed pursuant
 38 16 to section 331.439 regional service system management plan
 38 17 implemented in accordance with section 331.393, if the
 38 18 information concerns a person employed by or being considered
 38 19 by the agency for employment.
 38 20    Sec. 78.  Section 426B.2, subsection 2, Code 2015, is amended
 38 21 to read as follows:
 38 22    2.  As used in this chapter, and in sections 331.438 and
 38 23 331.439 section 331.424A, for purposes of population=based
 38 24 funding calculations, "population" means the population shown
 38 25 by the latest preceding certified federal census or the
 38 26 latest applicable population estimate issued by the federal
 38 27 government, whichever is most recent and available as of July
 38 28 1 of the fiscal year preceding the fiscal year to which the
 38 29 funding calculations apply.
 38 30    Sec. 79.  Section 426B.5, subsection 1, Code 2015, is amended
 38 31 by striking the subsection.
 38 32    Sec. 80.  Section 426B.5, subsections 2 and 3, Code 2015, are
 38 33 amended to read as follows:
 38 34    2.  Risk pool.
 38 35    a.  For the purposes of this subsection section, unless the
 39  1 context otherwise requires, "services fund":
 39  2    (1)  "Mental health and disability services region" means
 39  3 a mental health and disability services region formed in
 39  4 accordance with section 331.389.
 39  5    (2)  "Regional administrator" means the regional
 39  6 administrator of a mental health and disability services
 39  7 region, as defined in section 331.388.
 39  8    (3)  "Services fund" means a county's mental health and
 39  9 disabilities services fund created in section 331.424A.
 39 10    b.  A risk pool is created in the property tax relief fund.
 39 11 The pool shall consist of the moneys credited to the pool by
 39 12 law.
 39 13    c.  A risk pool board is created. The board shall consist
 39 14 of two county supervisors, two county auditors, a member of
 39 15 the mental health and disability services commission who is
 39 16 not a member of a county board of supervisors, a member of
 39 17 the county finance committee created in chapter 333A who is
 39 18 not an elected official, a representative of a provider of
 39 19 mental health or developmental disabilities services selected
 39 20 from nominees submitted by the Iowa association of community
 39 21 providers, and two central point of coordination process
 39 22  staff members of regional administrators of county mental
 39 23 health and disability services, all appointed by the governor,
 39 24 and one member appointed by the director of human services.
 39 25 All members appointed by the governor shall be subject to
 39 26 confirmation by the senate. Members shall serve for three=year
 39 27 terms. A vacancy shall be filled in the same manner as the
 39 28 original appointment. Expenses and other costs of the risk
 39 29 pool board members representing counties shall be paid by the
 39 30 county of origin. Expenses and other costs of risk pool board
 39 31 members who do not represent counties shall be paid from a
 39 32 source determined by the governor. Staff assistance to the
 39 33 board shall be provided by the department of human services and
 39 34 counties. Actuarial expenses and other direct administrative
 39 35 costs shall be charged to the pool.
 40  1    d.  A county regional administrator must apply to the risk
 40  2 pool board for assistance from the risk pool on or before
 40  3 October 31.  The purpose of the assistance shall be to provide
 40  4 financial support for services provided by one or more of the
 40  5 counties comprising the regional administrator's mental health
 40  6 and disability services region. The risk pool board shall
 40  7 make its final decisions on or before December 15 regarding
 40  8 acceptance or rejection of the applications for assistance and
 40  9 the total amount accepted shall be considered obligated.
 40 10    e.  Basic eligibility for risk pool assistance requires that
 40 11 a county mental health and disability services region meet all
 40 12 of the following conditions:
 40 13    (1)  The county mental health and disability services region
 40 14  is in compliance with the regional service system management
 40 15 plan requirements of section 331.439 331.393.
 40 16    (2)  The county counties comprising the mental health and
 40 17 disability services region each levied the maximum amount
 40 18 allowed for the county's services fund under section 331.424A
 40 19 for the fiscal year of application for risk pool assistance.
 40 20    (3)  In the fiscal year that commenced two years prior to the
 40 21 fiscal year of application, the county's ending balance, under
 40 22 generally accepted accounting principles, of the mental health
 40 23 and disability services region's combined services fund ending
 40 24 balance under generally accepted accounting principles funds
 40 25  was equal to or less than twenty percent of the county's actual
 40 26 gross expenditures of the counties comprising the mental health
 40 27 and disability services region for that fiscal year.
 40 28    f.  The board shall review the fiscal year=end financial
 40 29 records for all counties mental health and disability services
 40 30 regions that are granted risk pool assistance. If the board
 40 31 determines a county's mental health and disability services
 40 32 region's actual need for risk pool assistance was less than
 40 33 the amount of risk pool assistance granted to the county
 40 34  mental health and disability services region, the county
 40 35  mental health and disability services region shall refund the
 41  1 difference between the amount of assistance granted and the
 41  2 actual need. The county mental health and disability services
 41  3 region shall submit the refund within thirty days of receiving
 41  4 notice from the board. Refunds shall be credited to the risk
 41  5 pool. The mental health and disability services commission
 41  6 shall adopt rules pursuant to chapter 17A providing criteria
 41  7 for the purposes of this lettered paragraph and as necessary to
 41  8 implement the other provisions of this subsection.
 41  9    g.  The board shall determine application requirements to
 41 10 ensure prudent use of risk pool assistance. The board may
 41 11 accept or reject an application for assistance in whole or in
 41 12 part. The decision of the board is final.
 41 13    h.  The total amount of risk pool assistance shall be limited
 41 14 to the amount available in the risk pool for a fiscal year. Any
 41 15 unobligated balance in the risk pool at the close of a fiscal
 41 16 year shall remain in the risk pool for distribution in the
 41 17 succeeding fiscal year.
 41 18    i.  Risk pool assistance shall only be made available to
 41 19 address one or more of the following circumstances:
 41 20    (1)  Continuing support for mandated services.
 41 21    (2)  Avoiding the need for reduction or elimination of
 41 22 critical services when the reduction or elimination places
 41 23 consumers' health or safety at risk.
 41 24    (3)  Avoiding the need for reduction or elimination of a
 41 25 mobile crisis team or other critical emergency services when
 41 26 the reduction or elimination places the public's health or
 41 27 safety at risk.
 41 28    (4)  Avoiding the need for reduction or elimination of
 41 29 the services or other support provided to entire disability
 41 30 populations.
 41 31    (5)  Avoiding the need for reduction or elimination of
 41 32 services or other support that maintain consumers in a
 41 33 community setting, creating a risk that the consumers would be
 41 34 placed in more restrictive, higher cost settings.
 41 35    j.  Subject to the amount available and obligated from the
 42  1 risk pool for a fiscal year, the department of human services
 42  2 shall annually calculate the amount of moneys due to eligible
 42  3 counties mental health and disability services regions in
 42  4 accordance with the board's decisions and that amount is
 42  5 appropriated from the risk pool to the department for payment
 42  6 of the moneys due. The department shall authorize the issuance
 42  7 of warrants payable to the county treasurer mental health
 42  8 and disability services regions for the amounts due and the
 42  9 warrants shall be issued on or before January 1.
 42 10    k.  On or before March 1 and September 1 of each fiscal year,
 42 11 the department of human services shall provide the risk pool
 42 12 board with a report of the financial condition of each funding
 42 13 source administered by the board. The report shall include
 42 14 but is not limited to an itemization of the funding source's
 42 15 balances, types and amount of revenues credited, and payees
 42 16 and payment amounts for the expenditures made from the funding
 42 17 source during the reporting period.
 42 18    l.  If the board has made its decisions but has determined
 42 19 that there are otherwise qualifying requests for risk pool
 42 20 assistance that are beyond the amount available in the risk
 42 21 pool fund for a fiscal year, the board shall compile a list of
 42 22 such requests and the supporting information for the requests.
 42 23 The list and information shall be submitted to the mental
 42 24 health and disability services commission, the department of
 42 25 human services, and the general assembly.
 42 26    3.  Incentive pool.
 42 27    a.  An incentive pool is created in the property tax relief
 42 28 fund. The incentive pool shall consist of the moneys credited
 42 29 to the incentive pool by law.
 42 30    b.  Moneys available in the incentive pool for a fiscal
 42 31 year shall be distributed to those counties mental health and
 42 32 disability services regions that either meet or show progress
 42 33 toward meeting the purposes and intent described in section
 42 34 331.439, subsection 1, paragraph "c" 225C.1. The moneys
 42 35 received by a county region from the incentive pool shall be
 43  1 used to build community capacity to support individuals covered
 43  2 by the county's region's regional service system management
 43  3 plan approved under section 331.439, 331.393 in meeting such
 43  4 purposes.
 43  5    Sec. 81.  REPEAL.  Section 226.47, Code 2015, is repealed.
 43  6                           EXPLANATION
 43  7 The inclusion of this explanation does not constitute agreement with
 43  8 the explanation's substance by the members of the general assembly.
 43  9    This bill relates to the redesign of mental health and
 43 10 disabilities services (MH/DS) administered by regions comprised
 43 11 of counties.  Under the redesign provisions initially enacted
 43 12 in 2012, each organization of counties as a region is governed
 43 13 by a Code chapter 28E agreement and the region is to have
 43 14 an administrative office, organization, or entity formed by
 43 15 agreement of the counties participating in the region to
 43 16 function on behalf of those counties, known as the regional
 43 17 administrator and defined in Code section 331.388.  The
 43 18 redesign legislation maintained the financial responsibility
 43 19 for MH/DS with each county but provided for the regional
 43 20 administrator and the regional governance board to assume the
 43 21 administrative functions on behalf of the county.  The bill
 43 22 makes conforming Code amendments relating to the redesign
 43 23 legislation.
 43 24    In general, references throughout the Code to the central
 43 25 point of coordination (CPC) process (codified in Code section
 43 26 331.440, which was repealed effective July 1, 2013, by 2011
 43 27 Iowa Acts, ch. 123) are changed to instead refer to regional
 43 28 administrators; references to the county mental health,
 43 29 intellectual disability, and developmental disabilities
 43 30 services fund are changed to mental health and disabilities
 43 31 services fund (codified in Code section 331.424A, amended by
 43 32 2012 Iowa Acts, ch. 1120, {132); and references to county
 43 33 service management plans (codified in Code section 331.439,
 43 34 repealed effective July 1, 2013, by 2011 Iowa Acts, ch.
 43 35 123) are changed to instead refer to regional service system
 44  1 management plans approved in accordance with Code section
 44  2 331.393.  References throughout the Code to responsibilities
 44  3 for a county to provide or have administrative responsibility
 44  4 for services or other responsibilities in connection with a
 44  5 person in need of mental health or disability services are
 44  6 changed to instead refer to the regional administrator.  Prior
 44  7 to the redesign, MH/DS services in each county were delineated
 44  8 in a service management plan adopted by that county, subject
 44  9 to approval by the department of human services (DHS).  These
 44 10 individual county plans were replaced by a regional service
 44 11 system management plan effective beginning on July 1, 2014.
 44 12 County MH/DS levy authority and spending authority remains
 44 13 in Code section 331.424A.  However, the name of the fund
 44 14 was changed in the redesign legislation but references to
 44 15 the old fund in other Code sections are corrected in the
 44 16 bill.  In addition, related Code changes are reflected in this
 44 17 explanation.
 44 18    References to waivers for providers of mental health
 44 19 services approved under Code section 225C.7 to operate in lieu
 44 20 of a community mental health center are stricken because the
 44 21 Code section was repealed by 2014 Iowa Acts, ch. 1092, {152.
 44 22 Code chapter 230A, relating to community mental health centers,
 44 23 was substantially rewritten by 2011 Iowa Acts, ch. 121, and
 44 24 the revisions took effect July 1, 2012.  In the rewrite,
 44 25 Code section 230A.107, codified the waiver authorization for
 44 26 a for=profit corporation, nonprofit corporation, or county
 44 27 hospital providing mental health services to county residents
 44 28 pursuant to a waiver approved under section 225C.7, subsection
 44 29 3, Code 2011, as of October 1, 2010, to be designated as a
 44 30 community mental health center under Code chapter 230A.  The
 44 31 reference change is applied by the bill in the following Code
 44 32 sections:  135.180, relating to mental health professional
 44 33 shortage area program; 225C.19, relating to emergency mental
 44 34 health crisis services system; and 225C.54, relating to the
 44 35 mental health services system for children and youth.
 45  1 References to the central point of coordination process
 45  2 are changed to instead refer to the regional administrator in
 45  3 the following Code sections:  222.2, providing definitions
 45  4 for Code chapter 222, relating to the state resource centers;
 45  5 222.13, relating to voluntary admissions of persons to a state
 45  6 resource center; 222.59, relating to coordination between a
 45  7 state resource center and county in identifying community=based
 45  8 services for an individual; 222.60, relating to payment
 45  9 of costs by county or state and diagnosis and evaluation
 45 10 requirements; 222.61, relating to determination of a person's
 45 11 residency status; 222.62, relating to the procedure when a
 45 12 person's residency is determined to be another county; 222.63,
 45 13 providing a procedure for a county to object to a residency
 45 14 determination; 222.64, providing a procedure for when a
 45 15 person's residency is determined to be outside of this state or
 45 16 is unknown; 222.73, relating to billing of charges to counties
 45 17 for the state resource centers; 225.11, providing a procedure
 45 18 for commitment of a person to the state psychiatric hospital
 45 19 at the university of Iowa; 225.15, relating to examination and
 45 20 treatment at the state psychiatric hospital; 225.17, relating
 45 21 to examination and treatment of private patients at the state
 45 22 psychiatric hospital when costs are paid by a county; section
 45 23 225C.2, providing definitions for Code chapter 225C; 225C.5,
 45 24 relating to membership of the mental health and disability
 45 25 services commission; section 225C.6, relating to the duties
 45 26 of the MH/DS commission; 225C.14, relating to requirements
 45 27 for a preliminary diagnostic evaluation before a person is
 45 28 admitted to a state mental health institute (MHI); 225C.16,
 45 29 requiring referrals for a preliminary diagnostic or prehearing
 45 30 evaluation for persons desiring voluntary admission to a state
 45 31 MHI; 225C.19, providing requirements for implementation of
 45 32 an emergency mental health crisis services system; 226.9C,
 45 33 relating to the dual diagnosis program at the state mental
 45 34 health institute at Mount Pleasant; 227.10, relating to
 45 35 transfers of patients from county or private facilities
 46  1 for mental health treatment to a state institution; 229.1,
 46  2 providing definitions for the involuntary commitment Code
 46  3 chapter; 229.1B, providing that the CPC process applies to
 46  4 persons who are involuntarily committed; 229.11, relating to
 46  5 immediate custody of a person who is involuntarily committed;
 46  6 229.13, relating to evaluation orders for persons who are
 46  7 involuntarily committed; 229.14, relating to chief medical
 46  8 officer reports; 229.14A, relating to placement orders; 229.42,
 46  9 relating to county payment for a person voluntarily admitted to
 46 10 an MHI; 230.1, relating to the costs and expenses associated
 46 11 with the commitment of a person with mental illness to a state
 46 12 hospital; 230.3, relating to a certification of residence for
 46 13 purposes of charging expenses incurred for a commitment of
 46 14 a person with a mental illness to a state hospital; 232.2,
 46 15 relating to the membership of a transition team for a child
 46 16 adjudicated as a child in need of assistance; 235.7, relating
 46 17 to transition committees to address transition needs of
 46 18 children receiving child welfare services who are age 16 or
 46 19 older; and 426B.5, relating to the membership of the risk pool
 46 20 board.
 46 21    References to county board of supervisors or to a county
 46 22 responsibility are changed to instead refer to the regional
 46 23 administrator or MH/DS region, or to add such a reference in
 46 24 the following Code sections: 222.6, relating to the catchment
 46 25 areas for the two state resource centers; 222.12, relating to
 46 26 investigations of deaths at a state resource center; 222.13,
 46 27 relating to referrals for voluntary admissions of adults to
 46 28 a state resource center; 222.14, relating to care provided
 46 29 pending admission of a person to a state resource center;
 46 30 222.63, relating to determination of residency findings;
 46 31 222.92, relating to the use of net budgeting by the state
 46 32 resource centers; 225.1, providing definitions for the
 46 33 state psychiatric hospital Code chapter; 225.10, relating
 46 34 to voluntary patients at the state psychiatric hospital;
 46 35 225.12, relating to reports concerning voluntary public
 47  1 patients at the state psychiatric hospital; 225.13, relating
 47  2 to investigations of the financial condition of persons being
 47  3 admitted to the state psychiatric hospital; 225.16, relating to
 47  4 admission of voluntary public patients to the state psychiatric
 47  5 hospital; 225.18, relating to appointment of attendants to
 47  6 accompany committed persons to or from the hospital; 225.19,
 47  7 relating to compensation of attendants; 225.21, relating to
 47  8 claims for compensation of attendants; 225.24, relating to
 47  9 county collection of the costs of care provided at the state
 47 10 psychiatric hospital; 225.27, requiring notice of the discharge
 47 11 or transfer of a patient from the state psychiatric hospital;
 47 12 225C.13, authorizing DHS to lease portions of MHIs to certain
 47 13 public and private organizations; 225C.14, 225C.15, 225C.16,
 47 14 and 225C.17, relating to preliminary diagnostic evaluations
 47 15 of persons with respect to admission to an MHI, county policy
 47 16 regarding the evaluations, referral of voluntary patients
 47 17 for the evaluations, and the use of alternative diagnostic
 47 18 facilities for the evaluations; 225C.20, relating to provision
 47 19 of individual case management services under the medical
 47 20 assistance (Medicaid) program by counties; 226.32, requiring
 47 21 notice to a county when a voluntary patient is discharged to
 47 22 relieve overcrowding; 226.34, requiring notice when a patient
 47 23 at an MHI dies; 227.1, relating to supervision of county and
 47 24 private institutions for persons with mental illness or an
 47 25 intellectual disability (often referred to as "county care
 47 26 facilities") is amended to provide definitions for the Code
 47 27 chapter including DHS and the MH/DS regions; 227.2, relating
 47 28 to state inspection of county facilities; 227.4, relating
 47 29 to standards adoption pertaining to county care facilities;
 47 30 227.11, relating to transfers of patients from state hospitals;
 47 31 227.12, relating to civil trials when there is a disagreement
 47 32 between DHS and the authorities in charge of a county care
 47 33 facility as to transfer of patients; 227.14, relating to care
 47 34 provided at a county care facility to patients from another
 47 35 county; 229.2 and 229.8, relating to compensation of attorneys
 48  1 for minors applying for voluntary admission to an MHI and
 48  2 respondents in involuntary commitment proceedings; 229.10,
 48  3 relating to the payment of examinations with county funds;
 48  4 229.19, relating to mental health advocates; 229.24, relating
 48  5 to confidential records in involuntary commitment proceedings;
 48  6 426B.2, relating to property tax relief fund payments; and
 48  7 426B.5, relating to the risk pool and the incentive pool within
 48  8 the property tax relief fund.
 48  9    References to county management plans developed pursuant to
 48 10 repealed Code section 331.439 are changed to regional service
 48 11 system management plans implemented in accordance with Code
 48 12 section 331.393 in the following Code sections:  222.60,
 48 13 relating to payment of costs at a state resource center by
 48 14 county or state and diagnosis and evaluation requirements;
 48 15 222.73, relating to billing of per diem costs at a state
 48 16 resource center; 235A.15 and 235B.6, relating to access to
 48 17 child and dependent adult abuse registry record checks for
 48 18 employment by an agency providing services under a plan;
 48 19 426B.2, relating to property tax relief fund payments; and
 48 20 426B.5, relating to the risk and incentive pools of the
 48 21 property tax relief fund.
 48 22    Current law in Code sections 222.73 and 230.20, limits an
 48 23 increase in the per diem changed to a county for services
 48 24 provided at a state resource center or a state mental health
 48 25 institute to the percentage increase in the allowed growth
 48 26 factor adjustment, a funding formula provision repealed by the
 48 27 redesign. The bill instead references the per capita growth
 48 28 amount, which replaced the repealed allowed growth factor in
 48 29 the redesign legislation.
 48 30    Code sections 222.13 and 222.13A, relating to voluntary
 48 31 admissions to the state resource centers in general and
 48 32 for minors in particular, are amended by providing for the
 48 33 department of human services to assume responsibilities for
 48 34 voluntary admissions of minors instead of counties.  Code
 48 35 section 222.60, relating to financial responsibilities of the
 49  1 state and counties for the cost of admission or commitment or
 49  2 for the treatment, training, instruction, care, habilitation,
 49  3 support, and transportation of persons with an intellectual
 49  4 disability, is amended.  The amendment specifies the county
 49  5 responsibility is present if the person is not eligible for
 49  6 the medical assistance (Medicaid) program and the service is
 49  7 covered by the regional service system management plan and
 49  8 the state is responsible when the person is eligible for the
 49  9 Medicaid program or is a state case.
 49 10    Code section 226.47, a single definition Code section which
 49 11 is replaced in the bill by amending Code section 226.1 to
 49 12 provide a multiple definition Code section, is repealed.
       LSB 2062SV (3) 86
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