Senate Study Bill 1197 - Introduced SENATE/HOUSE FILE _____ BY (PROPOSED GOVERNOR BILL) A BILL FOR An Act relating to mental health and disability services, 1 including the establishment of a children’s behavioral 2 health system and a children’s behavioral health system 3 state board, and requiring certain children’s behavioral 4 health core services. 5 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 6 TLSB 1827XL (7) 88 hb/rh

S.F. _____ H.F. _____ Section 1. Section 225C.2, Code 2019, is amended by adding 1 the following new subsections: 2 NEW SUBSECTION . 1A. “Child” or “children” means a person or 3 persons under eighteen years of age. 4 NEW SUBSECTION . 1B. “Children’s behavioral health 5 services” means services for children with a serious emotional 6 disturbance. 7 NEW SUBSECTION . 1C. “Children’s behavioral health system” or 8 “children’s system” means the behavioral health service system 9 for children implemented pursuant to this subchapter. 10 NEW SUBSECTION . 11. “Serious emotional disturbance” means 11 a diagnosable mental, behavioral, or emotional disorder of 12 sufficient duration to meet diagnostic criteria specified 13 within the most current diagnostic and statistical manual 14 of mental disorders published by the American psychiatric 15 association that results in a functional impairment. “Serious 16 emotional disturbance” does not include substance use and 17 developmental disorders unless such disorders co-occur with 18 such a diagnosable mental, behavioral, or emotional disorder. 19 NEW SUBSECTION . 12. “State board” means the children’s 20 behavioral health system state board created in section 21 225C.51. 22 Sec. 2. Section 225C.2, subsection 9, Code 2019, is amended 23 by striking the subsection. 24 Sec. 3. Section 225C.4, subsection 1, Code 2019, is amended 25 by adding the following new paragraph: 26 NEW PARAGRAPH . 0c. Assist the state board in planning for 27 community-based children’s behavioral health services. 28 Sec. 4. Section 225C.4, subsection 1, paragraphs d and j, 29 Code 2019, are amended to read as follows: 30 d. Encourage and facilitate coordination of mental health 31 and disability services with the objective of developing and 32 maintaining in the state a mental health and disability service 33 delivery system to provide disability services to all persons 34 in this state who need the services, regardless of the place 35 -1- LSB 1827XL (7) 88 hb/rh 1/ 18

S.F. _____ H.F. _____ of residence or economic circumstances of those persons. The 1 administrator shall work with the commission and other state 2 agencies, including but not limited to the departments of 3 corrections, education, and public health and the state board 4 of regents, to develop and implement a strategic plan to expand 5 access to qualified mental health workers across the state. 6 j. Establish and maintain a data collection and management 7 information system oriented to the needs of patients, 8 providers, the department, and other programs or facilities in 9 accordance with section 225C.6A . The system shall be used to 10 identify, collect, and analyze service outcome and performance 11 measures data in order to assess the effects of the services on 12 the persons utilizing the services. The administrator shall 13 annually submit to the commission information collected by the 14 department indicating the changes and trends in the mental 15 health and disability services system. The administrator shall 16 make the outcome data available to the public. 17 Sec. 5. Section 225C.4, subsection 1, Code 2019, is amended 18 by adding the following new paragraphs: 19 NEW PARAGRAPH . 0k. Encourage and facilitate coordination 20 of children’s behavioral health services with the objective of 21 developing and maintaining in the state a children’s behavioral 22 health system to provide behavioral health services to all 23 children in this state who need the services, regardless of the 24 place of residence or economic circumstances of those children. 25 The administrator shall work with the state board and other 26 state agencies including but not limited to the department of 27 education and the department of public health to develop and 28 implement a strategic plan to expand access to qualified mental 29 health workers across the state. 30 NEW PARAGRAPH . 00k. Establish and maintain a data 31 collection and management information system oriented to the 32 needs of children utilizing the children’s behavioral health 33 system, providers, the department, and other programs or 34 facilities in accordance with section 225C.6A. The system 35 -2- LSB 1827XL (7) 88 hb/rh 2/ 18

S.F. _____ H.F. _____ shall be used to identify, collect, and analyze service 1 outcome and performance measures data in order to assess the 2 effects of the services on the children utilizing the services. 3 The administrator shall annually submit to the state board 4 information collected by the department indicating the changes 5 and trends in the children’s behavioral health system. The 6 administrator shall make the outcome data available to the 7 public. 8 Sec. 6. Section 225C.4, subsection 1, paragraph u, Code 9 2019, is amended by adding the following new subparagraph: 10 NEW SUBPARAGRAPH . (9) School attendance. 11 Sec. 7. Section 225C.6B, subsection 3, Code 2019, is amended 12 by adding the following new paragraph: 13 NEW PARAGRAPH . c. Children’s behavioral health services 14 provided to eligible children that are not covered under the 15 medical assistance program or other third-party payor are the 16 responsibility of the county-based regional service system. 17 Sec. 8. NEW SECTION . 225C.51 Children’s behavioral health 18 system state board. 19 1. A children’s behavioral health system state board 20 is created as the state body to provide guidance on the 21 implementation and management of a children’s behavioral health 22 system for the provision of services to children with a serious 23 emotional disturbance. The state board’s public voting members 24 shall be appointed to four-year staggered terms by the governor 25 and are subject to confirmation by the senate. All other 26 state board voting members shall be appointed to four-year 27 staggered terms and are not subject to confirmation by the 28 senate. State board members shall be appointed on the basis of 29 interest and experience in the fields of children’s behavioral 30 health to ensure adequate representation from persons with life 31 experiences and from persons knowledgeable about children’s 32 behavioral health services. The department shall provide 33 support to the state board, and the board may utilize staff 34 support and other assistance provided to the state board by 35 -3- LSB 1827XL (7) 88 hb/rh 3/ 18

S.F. _____ H.F. _____ other persons. The state board shall meet at least four times 1 per year. The membership of the state board shall consist of 2 the following persons who, at the time of appointment to the 3 state board, are active members of the indicated groups: 4 a. The director of the department or the director’s 5 designee. 6 b. The director of the department of education or the 7 director’s designee. 8 c. The director of the department of public health or the 9 director’s designee. 10 d. The director of workforce development or the director’s 11 designee. 12 e. One member shall be selected from nominees submitted by 13 the state court administrator. 14 f. One member shall be selected from nominees submitted 15 by the early childhood Iowa office in the department of 16 management. 17 g. One member shall be a member of the mental health and 18 disability services commission. 19 h. One member shall be a board member or an employee of a 20 provider of mental health services to children. 21 i. One member shall be a board member or an employee of a 22 provider of child welfare services. 23 j. One member shall be an administrator of an area education 24 agency. 25 k. One member shall be an educator, counselor, or 26 administrator of a school district. 27 l. One member shall be a representative of an established 28 advocacy organization whose mission or purpose it is, in part, 29 to further goals related to children’s mental health. 30 m. One member shall be a parent or guardian of a child 31 utilizing behavioral health services. 32 n. One member shall be a chief executive officer of a mental 33 health and disability services region. 34 o. In addition to the voting members, the membership shall 35 -4- LSB 1827XL (7) 88 hb/rh 4/ 18

S.F. _____ H.F. _____ include four members of the general assembly with one member 1 designated by each of the following: the majority leader of 2 the senate, the minority leader of the senate, the speaker of 3 the house of representatives, and the minority leader of the 4 house of representatives. A legislative member serves for a 5 term as provided in section 69.16B in a nonvoting, ex officio 6 capacity and is not eligible for per diem and expenses as 7 provided in section 2.10. 8 2. The four-year terms shall begin and end as provided in 9 section 69.19. Vacancies on the state board shall be filled as 10 provided in section 2.32. A member shall not be appointed for 11 more than two consecutive four-year terms. 12 3. The director and the director of the department of 13 education, or their designees, shall serve as co-chairpersons 14 of the state board. Board members shall not be entitled to a 15 per diem as specified in section 7E.6 and shall not be entitled 16 to actual and necessary expenses incurred while engaged in 17 their official duties. 18 Sec. 9. NEW SECTION . 225C.52 Children’s behavioral health 19 system state board —— duties. 20 1. To the extent funding is available, the state board shall 21 perform the following duties: 22 a. Advise the administrator on the administration of the 23 children’s behavioral health system. 24 b. Provide consultation services to agencies regarding 25 the development of administrative rules for the children’s 26 behavioral health system. 27 c. Identify behavioral health outcomes and indicators for 28 eligible children with a serious emotional disturbance to 29 promote children living with their own families and in the 30 community. 31 d. Submit a written report on or before December 1 of each 32 year to the governor and the general assembly. At a minimum, 33 the report shall include a summary of all activities undertaken 34 by the state board, a summary of state board activities, 35 -5- LSB 1827XL (7) 88 hb/rh 5/ 18

S.F. _____ H.F. _____ and results from identified behavioral health outcomes and 1 indicators for the children’s behavioral health system. 2 Sec. 10. Section 331.388, Code 2019, is amended by adding 3 the following new subsections: 4 NEW SUBSECTION . 01. “Children’s behavioral health services” 5 means the same as defined in section 225C.2. 6 NEW SUBSECTION . 4A. “Serious emotional disturbance” means 7 the same as defined in section 225C.2. 8 NEW SUBSECTION . 4B. “State board” means the children’s 9 system state board created in section 225C.51. 10 Sec. 11. Section 331.390, subsection 2, Code 2019, is 11 amended by striking the subsection and inserting in lieu 12 thereof the following: 13 2. The governing board shall comply with all of the 14 following requirements: 15 a. The voting membership of the governing board shall 16 consist of at least one board of supervisors member from each 17 county comprising the region or their designees. 18 b. The membership of the governing board shall also include 19 one adult person who utilizes mental health and disability 20 services or is an actively involved relative of such an adult 21 person. This member shall be designated by the regional 22 advisory committee formed by the governing board pursuant to 23 paragraph “h” . 24 c. The membership of the governing board shall not include 25 employees of the department of human services or an unelected 26 employee of a county. 27 d. The membership of the governing board shall also consist 28 of one member representing adult service providers in the 29 region. This member shall be designated by the regional 30 advisory committee formed by the governing board pursuant to 31 paragraph “h” . The member designated in accordance with this 32 paragraph shall serve in a nonvoting, ex officio capacity. 33 e. The membership of the governing board shall also 34 consist of one member representing children’s behavioral 35 -6- LSB 1827XL (7) 88 hb/rh 6/ 18

S.F. _____ H.F. _____ health services providers in the region. This member shall be 1 designated by the regional children’s advisory committee formed 2 by the governing board pursuant to paragraph “i” . The member 3 designated in accordance with this paragraph shall serve in a 4 nonvoting, ex officio capacity. 5 f. The membership of the governing board shall also consist 6 of one member representing area education agency administrators 7 in the region. This member shall be designated by the regional 8 children’s advisory committee formed by the governing board 9 pursuant to paragraph “i” . 10 g. The membership of the governing board shall also 11 consist of one member who is a parent of a child who utilizes 12 children’s behavioral health services or actively involved 13 relatives of such children. This member shall be designated 14 by the regional children’s advisory committee formed by the 15 governing board pursuant to paragraph “i” . 16 h. The governing board shall have a regional advisory 17 committee consisting of adults who utilize services or actively 18 involved relatives of such adults, service providers, and 19 regional governing board members. 20 i. The governing board shall have a regional children’s 21 advisory committee consisting of parents of children who 22 utilize services or actively involved relatives of such 23 children, an area education agency administrator, an early 24 childhood advocate, a child welfare advocate, a children’s 25 behavioral health service provider, a member of the juvenile 26 court, a pediatrician, a child care provider, a local law 27 enforcement representative, and regional governing board 28 members. 29 Sec. 12. Section 331.390, subsection 3, paragraph b, Code 30 2019, is amended to read as follows: 31 b. The regional administrator staff shall include one or 32 more coordinators of mental health and disability services 33 and one or more coordinators of children’s behavioral 34 health services . A coordinator shall possess a bachelor’s 35 -7- LSB 1827XL (7) 88 hb/rh 7/ 18

S.F. _____ H.F. _____ or higher level degree in a human services-related or 1 administration-related field, including but not limited 2 to social work, psychology, nursing, or public or business 3 administration, from an accredited college or university. 4 However, in lieu of a degree in public or business 5 administration, a coordinator may provide documentation of 6 relevant management experience. An action of a coordinator 7 involving a clinical decision shall be made in conjunction with 8 a professional who is trained in the delivery of the mental 9 health or disability service or children’s behavioral health 10 service addressed by the clinical decision. The regional 11 administrator shall determine whether referral to a coordinator 12 of mental health and disability services or children’s 13 behavioral health services is required for a person or child 14 seeking to access a service through a local access point of the 15 regional service system or the children’s behavioral health 16 system . 17 Sec. 13. Section 331.393, subsection 2, Code 2019, is 18 amended by adding the following new paragraphs: 19 NEW PARAGRAPH . i. The scope of children’s behavioral health 20 core services. Each service included shall be described and a 21 projection of need shall be included. 22 NEW PARAGRAPH . j. The eligibility requirements for 23 children’s behavioral health core services under the children’s 24 behavioral health system. 25 Sec. 14. Section 331.393, subsection 4, paragraph g, 26 subparagraph (1), Code 2019, is amended to read as follows: 27 (1) Performance and outcome measures relating to the 28 health, safety, education, work performance, and community 29 residency of the persons receiving the services. 30 Sec. 15. Section 331.396, subsection 1, paragraph b, Code 31 2019, is amended to read as follows: 32 b. The person is at least eighteen years of age and is a 33 resident of this state. However, a person who is seventeen 34 years of age, is a resident of this state, and is receiving 35 -8- LSB 1827XL (7) 88 hb/rh 8/ 18

S.F. _____ H.F. _____ publicly funded children’s services may be considered eligible 1 for services through the regional service system during the 2 three-month period preceding the person’s eighteenth birthday 3 in order to provide a smooth transition from children’s to 4 adult services. 5 Sec. 16. Section 331.396, subsection 1, paragraph d, Code 6 2019, is amended by striking the paragraph. 7 Sec. 17. NEW SECTION . 331.396A Eligibility requirements —— 8 children’s behavioral health services. 9 1. A child shall be eligible for behavioral health services 10 under the children’s behavioral health system if all of the 11 following conditions are met: 12 a. The child is under eighteen years of age and is a 13 resident of this state. 14 b. The child has been diagnosed with a serious emotional 15 disturbance. 16 c. (1) The child’s family has a family income equal to or 17 less than five hundred percent of the federal poverty level as 18 defined by the most recently revised poverty income guidelines 19 published by the United States department of health and human 20 services. 21 (2) Notwithstanding subparagraph (1), a child’s family 22 whose household income is between one hundred fifty percent 23 but not more than five hundred percent of the federal poverty 24 level shall be eligible for behavioral health services subject 25 to a copayment, a single statewide sliding fee scale, or other 26 cost-sharing requirements approved by the department. 27 Sec. 18. NEW SECTION . 331.397A Children’s behavioral health 28 core services. 29 1. For the purposes of this section, unless the context 30 otherwise requires, “domain” means a set of similar behavioral 31 health services that can be provided depending on a child’s 32 service needs. 33 2. a. (1) A region shall work with children’s behavioral 34 health service providers to ensure that services in the 35 -9- LSB 1827XL (7) 88 hb/rh 9/ 18

S.F. _____ H.F. _____ required behavioral health core service domains in subsection 1 4 are available to children who are residents of the region, 2 regardless of any potential payment source for the services. 3 (2) Subject to the available appropriations, the director 4 of human services shall ensure the behavioral health core 5 service domains listed in subsection 4 are covered services 6 for the medical assistance program under chapter 249A to the 7 greatest extent allowable under federal regulations. The 8 medical assistance program shall reimburse Medicaid enrolled 9 providers for Medicaid covered services under subsection 4 when 10 the services are medically necessary, the Medicaid enrolled 11 provider submits an appropriate claim for such services, and 12 no other third-party payor is responsible for reimbursement 13 of such services. Within the funds available, the region 14 shall pay for such services for eligible children when payment 15 through the medical assistance program or another third-party 16 payment is not available, unless the child is on a waiting list 17 for such payment or it has been determined that the child does 18 not meet the eligibility criteria for any such service. 19 b. Until funding is designed for other service populations, 20 eligibility for the service domains listed in this section 21 shall be limited to such children who are in need of behavioral 22 health services. 23 3. Pursuant to recommendations made by the state board, the 24 department of human services shall adopt rules to define the 25 services included in the core domains listed in this section. 26 The rules shall provide service definitions, service provider 27 standards, service access standards, and service implementation 28 dates, and shall provide consistency, to the extent possible, 29 with similar service definitions under the medical assistance 30 program. 31 4. The children’s behavioral health core service domains 32 shall include all of the following: 33 a. Treatment designed to ameliorate a child’s serious 34 emotional disturbance, including but not limited to all of the 35 -10- LSB 1827XL (7) 88 hb/rh 10/ 18

S.F. _____ H.F. _____ following: 1 (1) Prevention, early identification, early intervention, 2 and education. 3 (2) Assessment and evaluation relating to eligibility for 4 services. 5 (3) Medication prescribing and management. 6 (4) Behavioral health outpatient therapy. 7 b. Comprehensive facility and community-based crisis 8 services, including all of the following: 9 (1) Mobile response. 10 (2) Crisis stabilization community-based services. 11 (3) Crisis stabilization residential services. 12 (4) Behavioral health inpatient treatment. 13 5. A region shall ensure that services within the following 14 additional core service domains are available to children not 15 eligible for the medical assistance program under chapter 249A 16 or receiving other third-party payment for the services, when 17 public funds are made available for such services: 18 a. Treatment designed to ameliorate a child’s serious 19 emotional disturbance including but not limited to behavioral 20 health school-based therapy. 21 b. Support for community living including but not limited 22 to all of the following: 23 (1) Family support. 24 (2) Peer support. 25 (3) Therapeutic foster care. 26 (4) Respite care. 27 c. Transition services for children to the adult mental 28 health system providing an appropriate match with a child’s 29 abilities based upon informed, person-centered choices made 30 from an array of options including but not limited to all of 31 the following: 32 (1) Day habilitation. 33 (2) Job development. 34 (3) Supported employment. 35 -11- LSB 1827XL (7) 88 hb/rh 11/ 18

S.F. _____ H.F. _____ (4) Prevocational services. 1 (5) Educational services. 2 d. Service coordination including physical health and 3 primary care that follow the principles of the system of care 4 including but not limited to all of the following: 5 (1) Care coordination. 6 (2) Health homes. 7 Sec. 19. MENTAL HEALTH AND DISABILITY SERVICES REGION 8 —— CHILDREN’S BEHAVIORAL HEALTH SERVICES IMPLEMENTATION 9 PLAN. Each mental health and disability services region shall 10 submit to the department of human services an implementation 11 plan to implement children’s behavioral health services 12 described under section 331.397A, as enacted in this Act, no 13 later than April 1, 2020. 14 Sec. 20. DEPARTMENT OF HUMAN SERVICES —— RULES. The 15 department of human services shall adopt rules pursuant to 16 chapter 17A to administer this Act. 17 Sec. 21. REPEAL. Sections 225C.51, 225C.52, 225C.53, and 18 225C.54, Code 2019, are repealed. 19 Sec. 22. CODE EDITOR’S DIRECTIVES. The Code editor may 20 change the current subchapter title of chapter 225C, subchapter 21 VI, to “CHILDREN’S BEHAVIORAL HEALTH SYSTEM”. 22 The Code editor may change the current subchapter title of 23 chapter 331, part 6, to “MENTAL HEALTH AND DISABILITY SERVICES 24 —— REGIONAL SERVICE SYSTEM —— CHILDREN’S BEHAVIORAL HEALTH 25 SYSTEM”. 26 EXPLANATION 27 The inclusion of this explanation does not constitute agreement with 28 the explanation’s substance by the members of the general assembly. 29 This bill relates to mental health and disability services 30 including the establishment of a children’s behavioral health 31 system and a children’s behavioral health system state board, 32 and requiring certain children’s behavioral health core 33 services. 34 DEFINITIONS. The bill provides definitions for the 35 -12- LSB 1827XL (7) 88 hb/rh 12/ 18

S.F. _____ H.F. _____ children’s behavioral health system. “Child” or “children” 1 is defined as a person or persons under 18 years of age. 2 “Children’s behavioral health services” is defined as services 3 for children with a “serious emotional disturbance” defined 4 as a diagnosable mental, behavioral, or emotional disorder 5 of sufficient duration to meet diagnostic criteria specified 6 within the most current diagnostic and statistical manual 7 of mental disorders published by the American psychiatric 8 association that results in a functional impairment, but 9 does not include substance use and developmental disorders 10 unless such disorders co-occur with such a diagnosable mental, 11 behavioral, or emotional disorder. “Children’s system” 12 or “children’s behavioral health system” is defined as the 13 behavioral health services system for children created in the 14 bill. 15 CHILDREN’S BEHAVIORAL HEALTH SYSTEM STATE BOARD. The bill 16 establishes a children’s behavioral health system state board 17 (state board) as the state body to provide guidance on the 18 implementation and management of the children’s behavioral 19 health system and for the provision of services to children 20 with a serious emotional disturbance. 21 The bill specifies the membership of the board and provides 22 that the state board’s public voting members shall be appointed 23 to four-year staggered terms by the governor and are subject 24 to confirmation by the senate. All other state board voting 25 members shall be appointed to four-year terms and are not 26 subject to senate confirmation. A member shall not be 27 appointed for more than two consecutive four-year terms. State 28 board members shall be appointed on the basis of interest 29 and experience in the fields of children’s behavioral health 30 to ensure representation from persons with life experiences 31 and persons knowledgeable about children’s behavioral health 32 services. The state board shall be co-chaired by the director 33 of the department of human services (DHS) and the director of 34 the department of education, or their designees. In addition 35 -13- LSB 1827XL (7) 88 hb/rh 13/ 18

S.F. _____ H.F. _____ to the voting members, the membership shall include four 1 members of the general assembly to serve in a nonvoting, ex 2 officio capacity on the board. 3 The bill requires the DHS to provide support to the state 4 board and the state board may utilize staff support and other 5 assistance provided to the state board by other persons. The 6 state board is required to meet a minimum of four times per 7 year. 8 The state board is required to advise the administrator 9 of the division of mental health and disability services of 10 DHS on the administration of the children’s behavioral health 11 system, provide consultation services to agencies regarding 12 the development of administrative rules for the children’s 13 behavioral health system, identify behavioral health outcomes 14 and indicators for eligible children with a serious emotional 15 disturbance to promote children living with their own families 16 and in the community; and submit a written report on or 17 before December 1 of each year to the governor and the general 18 assembly. 19 ELIGIBILITY REQUIREMENTS —— CHILDREN’S BEHAVIORAL HEALTH 20 SERVICES. Under current law, a person who is 17 years of 21 age, is a resident of Iowa, and is receiving publicly funded 22 children’s mental health services may be considered eligible 23 for mental health services through the adult mental health 24 and disability services regional service system during the 25 three-month period preceding the person’s 18th birthday in 26 order to provide a smooth transition from children’s services 27 to adult services. The bill strikes this provision and 28 provides that a child shall be eligible for behavioral health 29 services under the children’s behavioral health system if the 30 child is under 18 years of age, a resident of Iowa, has been 31 diagnosed with a serious emotional disturbance, and the child’s 32 family has a household income equal to or less than 500 percent 33 of the federal poverty level, except that a child’s family 34 whose household income is between 150 percent but not more than 35 -14- LSB 1827XL (7) 88 hb/rh 14/ 18

S.F. _____ H.F. _____ 500 percent of the federal poverty level shall be eligible for 1 behavioral health services subject to a copayment, a single 2 statewide sliding fee scale, or other cost-sharing requirements 3 approved by DHS. The bill does not apply to intellectual 4 disability services or brain injury services for children under 5 the children’s behavioral health system. 6 CHILDREN’S BEHAVIORAL HEALTH SYSTEM —— CORE SERVICES. The 7 bill provides that, subject to available appropriations, the 8 director of DHS shall ensure that the children’s behavioral 9 health core service domains, as specified in the bill, are 10 covered services for the medical assistance program under Code 11 chapter 249A to the greatest extent allowable under federal 12 regulations. The bill provides the medical assistance program 13 shall reimburse Medicaid enrolled providers for Medicaid 14 covered services when the services are medically necessary, the 15 Medicaid enrolled provider submits an appropriate claim for 16 such services, and no other third-party payor is responsible 17 for reimbursement of such services. Within the funds 18 available, each mental health and disability services region 19 is required to pay for such services for eligible children 20 when payment through the medical assistance program or another 21 third-party payment is not available, unless a child is on a 22 waiting list for such payment or it has been determined that 23 the child does not meet the eligibility criteria for any such 24 service. 25 The bill provides that until funding is designed for other 26 service populations, eligibility for the core services shall be 27 limited to such children who are in need of behavioral health 28 services. 29 The bill requires DHS to adopt rules pursuant to 30 recommendations made by the state board to define the services 31 included in the core domains. The rules shall provide service 32 definitions, service provider standards, service access 33 standards, and service implementation dates, and shall also 34 provide consistency, to the extent possible, with similar 35 -15- LSB 1827XL (7) 88 hb/rh 15/ 18

S.F. _____ H.F. _____ service definitions under the medical assistance program. 1 The bill requires each mental health and disability 2 services region to submit to DHS plans to implement children’s 3 behavioral health services no later than April 1, 2020. 4 MENTAL HEALTH AND DISABILITY SERVICES —— ADMINISTRATOR’S 5 DUTIES. The bill requires the administrator of the division 6 of mental health and disability services of DHS to assist 7 the state board in planning for community-based children’s 8 behavioral health services and to encourage and facilitate 9 coordination of children’s behavioral health services with 10 the objective of developing and maintaining in the state a 11 children’s behavioral health system to provide behavioral 12 health services to all children in this state who need the 13 services, regardless of the place of residence or economic 14 circumstances of those children. The administrator shall work 15 with the state board and other state agencies, including but 16 not limited to the departments of education and public health, 17 to develop and implement a strategic plan to expand access to 18 qualified mental health workers across the state. 19 The bill requires the administrator to establish and 20 maintain a data collection and management information system 21 oriented to the needs of children utilizing the children’s 22 behavioral health system, providers, DHS, and other programs or 23 facilities in accordance with the disability services system 24 data repository established in Code section 225C.6A. The 25 system shall be used to identify, collect, and analyze service 26 outcome and performance measures data in order to assess the 27 effects of the services on the children utilizing the services. 28 The administrator shall annually submit to the state board 29 information collected by DHS indicating the changes and trends 30 in the children’s behavioral health system. The administrator 31 shall make the outcome data available to the public. 32 Current law requires the administrator to enter into 33 performance-based contracts with mental health and disability 34 services regional administrators which may include requirements 35 -16- LSB 1827XL (7) 88 hb/rh 16/ 18

S.F. _____ H.F. _____ for the regional service system to attain outcomes within 1 a specified range of acceptable performance in certain 2 categories. The bill expands the categories to include a 3 school attendance category. 4 STATE AND REGIONAL DISABILITY SERVICE SYSTEMS. Current law 5 provides that the publicly financed disability services for 6 persons with mental illness, intellectual disability or other 7 developmental disability, or brain injury in Iowa shall be 8 provided by DHS and the counties operating together as regions 9 and provides for financial and administrative responsibility 10 for such services. The bill provides that children’s 11 behavioral health services provided to eligible children that 12 are not covered under the medical assistance program or other 13 third-party payor are the responsibility of the mental health 14 and disabilities regional service system. 15 MENTAL HEALTH AND DISABILITY SERVICES REGIONS. The bill 16 makes changes to the mental health and disability services 17 regional governing board (governing board). The governing 18 board membership shall consist of at least one board of 19 supervisors member from each county comprising the region 20 who shall be a voting member; one adult person who utilizes 21 mental health and disability services or is an actively 22 involved relative of such an adult person designated by the 23 regional advisory committee formed by the governing board; 24 one member representing adult service providers in the region 25 designated by the regional advisory committee formed by the 26 governing board, who shall serve in a nonvoting, ex officio 27 capacity; one member representing children’s behavioral health 28 service providers in the region designated by the regional 29 children’s advisory committee formed by the governing board, 30 who shall serve in a nonvoting, ex officio capacity; one member 31 representing area education agency administrators in the region 32 designated by the regional children’s advisory committee formed 33 by the governing board; and one member who is a parent of a 34 child who utilizes children’s behavioral health services or 35 -17- LSB 1827XL (7) 88 hb/rh 17/ 18

S.F. _____ H.F. _____ actively involved relatives of such children designated by the 1 regional children’s advisory committee. The membership of 2 the governing board shall not include employees of DHS or an 3 unelected employee of a county. 4 The bill adds to the regional administrator staff one or more 5 coordinators of children’s behavioral health services. 6 The bill requires a mental health and disability region to 7 include provisions relating to eligibility requirements for 8 children’s behavioral health core services under the children’s 9 behavioral health system and performance and outcome measures 10 relating to education in a region’s annual service and budget 11 plan. 12 The bill makes technical changes to Code section 225C.2(9) 13 by striking the term “person with a disability” as that term 14 is not used in Code chapter 225C (mental health and disability 15 services) and to Code section 225C.4 to include mental health 16 services in references to disability services in that Code 17 section. 18 The bill repeals 2019 Code sections 225C.51, 225C.52, 19 225C.53, and 225C.54. The bill replaces 2019 Code sections 20 225C.51 and 225C.52 with new content in the bill. 21 -18- LSB 1827XL (7) 88 hb/rh 18/ 18