Iowa House Bill HF2673 Introduced / Bill

                    House File 2673 - Introduced   HOUSE FILE 2673   BY COMMITTEE ON APPROPRIATIONS   (SUCCESSOR TO HF 2509)   (SUCCESSOR TO HSB 653)   A BILL FOR   An Act related to state behavioral health, disability, and 1   addictive disorder services and related programs, including 2   the transition of behavioral health services from a mental 3   health and disability services system to a behavioral health 4   service system, the transfer of disability services to the 5   division of aging and disability services of the department 6   of health and human services, the elimination of the 7   commission on aging, the elimination of special intellectual 8   disability units at state mental health institutes, making 9   appropriations, and including effective date provisions. 10   BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 11   TLSB 5509HZ (7) 90   dg/ko  

  H.F. 2673   DIVISION I 1   BEHAVIORAL HEALTH SERVICE SYSTEM 2   Section 1. NEW SECTION   . 225A.1 Definitions. 3   As used in this chapter unless the context otherwise 4   requires: 5   1. Administrative services organization means an entity 6   designated by the department pursuant to section 225A.4, to 7   develop and perform planning and administrative services in 8   accordance with a district behavioral health service system 9   plan. 10   2. Behavioral health condition means a substantial 11   limitation in major life activities due to a mental, 12   behavioral, or addictive disorder or condition diagnosed in 13   accordance with the criteria provided in the most current 14   edition of the diagnostic and statistical manual of mental 15   disorders, published by the American psychiatric association. 16   3. Behavioral health district or district means a 17   geographic, multicounty, sub-state area as designated by the 18   department under section 225A.4. 19   4. Behavioral health provider or provider means an 20   individual, firm, corporation, association, or institution 21   that, pursuant to this chapter, is providing or has been 22   approved by the department to provide services to an individual 23   with a behavioral health condition. 24   5. Behavioral health service system means the behavioral 25   health service system established in section 225A.3. 26   6. Caregiver means an adult family member, or other 27   individual, who is providing care to a person outside of a 28   formal program. 29   7. Community mental health center means an entity 30   designated by the department to address the mental health needs 31   of one or more counties. 32   8. Department means the department of health and human 33   services.   34   9. Director means the director of the department of health 35   -1-   LSB 5509HZ (7) 90   dg/ko   1/ 101   

  H.F. 2673   and human services. 1   10. District behavioral health advisory council 2   or advisory council means a council established by an 3   administrative services organization under section 225A.5, to 4   identify opportunities, address challenges, and advise the 5   administrative services organization in accordance with section 6   225A.5. 7   11. District behavioral health service system plan or 8   district behavioral health plan means a plan developed by 9   an administrative services organization and approved by the 10   department to outline the services intended to be provided 11   within the administrative services organizations behavioral 12   health district. 13   12. Indicated prevention means prevention activities 14   designed to prevent the onset of substance use disorders in 15   individuals who do not meet the medical criteria for addiction, 16   but who show early signs of developing a substance use disorder 17   in the future. 18   13. Selective prevention means prevention activities 19   designed to target subsets of the total population who are 20   considered at-risk for a substance use disorder by virtue of 21   their membership in a particular segment of the population. 22   Selective prevention targets the entire subgroup, regardless of 23   the degree of risk of any individual within the group. 24   14. State behavioral health service system plan or 25   state behavioral health plan means the plan developed by the 26   department that describes the key components of the states 27   behavioral health service system. 28   15. Universal prevention means prevention activities 29   designed to address an entire population class for the purpose 30   of preventing or delaying the use of alcohol, tobacco, and 31   other drugs. Population classes include but are not limited 32   to the national population, local populations, community 33   populations, school populations, and neighborhood populations. 34   Sec. 2. NEW SECTION   . 225A.2 State mental health authority 35   -2-   LSB 5509HZ (7) 90   dg/ko   2/ 101   

  H.F. 2673    state agency for substance abuse. 1   1. The department is designated as the state mental health 2   authority as defined in 42 U.S.C. 201(m) for the purpose of 3   directing benefits from the federal community mental health 4   services block grant, 42 U.S.C. 300x et seq., and the state 5   authority designated for the purpose of directing benefits 6   from the federal substance abuse prevention and treatment 7   block grant, 42 U.S.C. 300x-21 et seq. This designation 8   does not preclude the state board of regents from authorizing 9   or directing any institution under the board of regents 10   jurisdiction to carry out educational, prevention, and research 11   activities in the areas of mental health and intellectual 12   disability. 13   2. The department is designated as the single state agency 14   for substance abuse for the purposes of 42 U.S.C. 1396a et 15   seq. 16   3. For the purposes of effectuating the departments roles 17   designated in this section, the department shall have the 18   following powers and the authority to take all of the following 19   actions: 20   a. Plan, establish, and maintain prevention, education, 21   early intervention, treatment, recovery support, and crisis 22   services programs as necessary or desirable for the behavioral 23   health service system established in section 225A.3. 24   b. Develop and submit a state plan as required by, and in 25   accordance with, 42 U.S.C. 300x-1. 26   c. Review and approve district behavioral health service 27   system plans developed in accordance with the state behavioral 28   health service system plan. 29   d. Perform all necessary acts to cooperate with any state 30   agency, political subdivision, or federal government agency to 31   apply for grants. 32   e. Solicit and accept for use any gift of money by will or 33   otherwise, and any grant of money or services from the federal 34   government, the state, or any political subdivision thereof, 35   -3-   LSB 5509HZ (7) 90   dg/ko   3/ 101  

  H.F. 2673   or any private source. 1   f. Collect and maintain records, engage in studies and 2   analyses, and gather relevant statistics. 3   g. Take any other actions as necessary to execute the 4   duties granted to the department in this chapter, or that 5   are otherwise required to maintain compliance with federal 6   requirements related to the departments roles as designated in 7   this section. 8   Sec. 3. NEW SECTION   . 225A.3 Behavioral health service 9   system  department powers and duties. 10   1. a. A behavioral health service system is established 11   under the control of the department for the purposes of 12   implementing a statewide system of prevention, education, early 13   intervention, treatment, recovery support, and crisis services 14   related to mental health and addictive disorders, including but 15   not limited to alcohol use, substance use, tobacco use, and 16   problem gambling. 17   b. The behavioral health service system shall support 18   equitable statewide access to all services offered through 19   the behavioral health service system and offer specialized 20   services with a focus on at-risk populations including but not 21   limited to children, youth, young adults, individuals with 22   disabilities, pregnant and parenting women, older adults, and 23   people with limited access to financial resources. 24   c. Services offered through the behavioral health service 25   system shall, at a minimum, include all of the following: 26   (1) Prevention intervention services and education 27   programs designed to reduce and mitigate behavioral health 28   conditions and future behavioral health conditions. Prevention 29   intervention programs shall incorporate indicated prevention, 30   selective prevention, and universal prevention activities. 31   (2) Evidence-based and evidence-informed early intervention 32   and treatment services. 33   (3) Comprehensive recovery support services with a focus on 34   community-based services that avoid, divert, or offset the need 35   -4-   LSB 5509HZ (7) 90   dg/ko   4/ 101   

  H.F. 2673   for long-term inpatient services, law enforcement involvement, 1   or incarceration. 2   (4) Crisis services with a focus on reducing the escalation 3   of crisis situations, relieving the immediate distress of 4   individuals experiencing a crisis situation, and reducing the 5   risk that individuals in a crisis situation harm themselves. 6   2. To the extent funding is available, the department shall 7   perform all of the following duties to develop and administer 8   the behavioral health service system: 9   a. (1) Develop a state behavioral health service system 10   plan that accomplishes all of the following: 11   (a) Identifies the goals, objectives, and targeted outcomes 12   for the behavioral health service system. 13   (b) Identifies the strategies to meet system objectives and 14   ensure equitable access statewide to prevention, education, 15   early intervention, treatment, recovery support, and crisis 16   services. 17   (c) Is consistent with the state health improvement plan 18   developed under section 217.17. 19   (d) Is consistent with the departments agency strategic 20   plan adopted pursuant to section 8E.206. 21   (2) The department shall do all of the following when 22   developing the state behavioral health service system plan: 23   (a) Collaborate with stakeholders including but not limited 24   to county supervisors and other local elected officials, 25   experienced behavioral health providers, and organizations that 26   represent populations, including but not limited to children, 27   served by the behavioral health service system. 28   (b) Publish the proposed state behavioral health service 29   system plan on the departments internet site and allow the 30   public to review and comment on the proposed state behavioral 31   health system plan prior to the adoption of the proposed state 32   behavioral health plan. 33   b. Administer and distribute state appropriations, federal 34   aid, and grants that have been deposited into the behavioral 35   -5-   LSB 5509HZ (7) 90   dg/ko   5/ 101  

  H.F. 2673   health fund established in section 225A.7. 1   c. Oversee, provide technical assistance to, and 2   monitor administrative services organizations to ensure the 3   administrative services organizations compliance with district 4   behavioral health plans. 5   d. Collaborate with the department of inspections, appeals, 6   and licensing on the accreditation, certification, and 7   licensure of behavioral health providers including but not 8   limited to the approval, denial, revocation, or suspension of 9   a behavioral health providers accreditation, certification, 10   or licensure. 11   e. Develop and adopt minimum accreditation standards for 12   the maintenance and operation of community mental health 13   centers to ensure that each community mental health center, 14   and each entity that provides services under contract with a 15   community mental health center, furnishes high-quality mental 16   health services to the community that the community mental 17   health center serves in accordance with rules adopted by the 18   department. 19   f. Designate community mental health centers. 20   g. Conduct formal accreditation reviews of community mental 21   health centers based on minimum accreditation standards adopted 22   by the department pursuant to paragraph e . 23   h. Establish and maintain a data collection and management 24   information system to identify, collect, and analyze service 25   outcome and performance data to address the needs of patients, 26   providers, the department, and programs operating within the 27   behavioral health service system. 28   i. Collect, monitor, and utilize information including but 29   not limited to behavioral health service system patient records 30   and syndromic surveillance data to understand emerging needs, 31   and to deploy information, resources, and technical assistance 32   in response. 33   j. Adopt rules pursuant to chapter 17A to administer this 34   chapter. Such rules shall include but not be limited to rules 35   -6-   LSB 5509HZ (7) 90   dg/ko   6/ 101  

  H.F. 2673   that provide for all of the following: 1   (1) Minimum access standards to ensure equitable access to 2   services provided through the behavioral health service system 3   including but not limited to when services are available, who 4   is eligible for services, and where services are available. 5   (2) Methods to ensure each individual who is eligible 6   for services receives an uninterrupted continuum of care for 7   prevention, education, early intervention, treatment, recovery 8   support, and crisis services. 9   (3) Standards for the implementation and maintenance 10   of behavioral health programs and services offered by the 11   behavioral health service system, and by each administrative 12   services organization. 13   (4) Procedures for the management and oversight of 14   behavioral health providers to ensure compliance with the terms 15   of the behavioral health providers contracts relating to the 16   behavioral health service system, and with state and federal 17   law and rules. 18   (5) Procedures for the suspension of an administrative 19   services organizations services due to the administrative 20   services organizations failure to comply with the terms and 21   conditions of its contract with the department. 22   (6) Procedures for the reallocation of funds from 23   an administrative services organization that is not in 24   compliance with the terms of its contract with the department 25   to an alternative administrative services organization or 26   a behavioral health provider to provide for services the 27   noncompliant administrative services organization failed to 28   provide. 29   (7) Procedures for the termination of an administrative 30   services organizations designation as an administrative 31   services organization. 32   (8) Procedures for the collection, utilization, and 33   maintenance of the data necessary to establish a central data 34   repository in accordance with section 225A.6. 35   -7-   LSB 5509HZ (7) 90   dg/ko   7/ 101  

  H.F. 2673   (9) Any other requirements the department deems necessary 1   to ensure that an administrative services organization 2   fulfills the administrative services organizations duties 3   as established in this chapter, and as established in the 4   administrative services organizations district behavioral 5   health plan. 6   Sec. 4. NEW SECTION   . 225A.4 Behavioral health service 7   system  districts and administrative services organizations. 8   1. a. The department shall divide the entirety of the 9   state into designated behavioral health districts. Behavioral 10   health prevention, education, early intervention, treatment, 11   recovery support, and crisis services related to mental health 12   and addictive disorders, including but not limited to alcohol 13   use, substance use, tobacco use, and problem gambling, shall 14   be made available through each behavioral health district in a 15   manner consistent with directives each district receives from 16   the department. 17   b. For the purpose of providing equitable access to all 18   services provided through the behavioral health service 19   system, the department shall consider all of the following when 20   designating behavioral health districts: 21   (1) City and county lines. 22   (2) The maximum population size that behavioral health 23   services available in an area are able to effectively serve. 24   (3) Areas of high need for behavioral health services. 25   (4) Patterns various populations exhibit when accessing or 26   receiving behavioral health services. 27   c. Notwithstanding chapter 17A, the manner in which the 28   department designates behavioral health districts including but 29   not limited to the determination of the boundaries for each   30   district shall not be subject to judicial review. 31   2. a. The department shall designate an administrative 32   services organization for each behavioral health district to 33   oversee and organize each district and the behavioral health 34   services associated with the district. The department shall 35   -8-   LSB 5509HZ (7) 90   dg/ko   8/ 101   

  H.F. 2673   issue requests for proposals for administrative services 1   organization candidates. 2   b. At the departments discretion, the department may 3   designate any of the following entities as an administrative 4   services organization: 5   (1) An organization that coordinated administrative 6   services or mental health and disability services for a mental 7   health and disability services region formed on or before June 8   30, 2024. 9   (2) A public or private nonprofit agency located in a 10   behavioral health district, or any separate organizational 11   unit within the public or private nonprofit agency, that has 12   the capabilities to engage in the planning or provision of a 13   broad range of behavioral health prevention, education, early 14   intervention, treatment, recovery support, and crisis services 15   related to mental health and addictive disorders, including but 16   not limited to alcohol use, substance use, tobacco use, and 17   problem gambling, only as directed by the department. 18   c. The department shall consider all of the following 19   factors in determining whether to designate an entity as an 20   administrative services organization: 21   (1) Whether the entity has demonstrated the capacity to 22   manage and utilize available resources in a manner required of 23   an administrative services organization. 24   (2) Whether the entity has demonstrated the ability to 25   ensure the delivery of behavioral health services within the 26   district as required by the department by rule. 27   (3) Whether the entity has demonstrated the ability to 28   fulfill the monitoring, oversight, and provider compliance 29   responsibilities as required by the department by rule. 30   (4) Whether the entity has demonstrated the capacity to 31   function as a subrecipient for the purposes of the federal 32   community mental health services block grant, 42 U.S.C. 33   300x et seq., and the federal substance abuse prevention and 34   treatment block grant, 42 U.S.C. 300x-21 et seq., and the 35   -9-   LSB 5509HZ (7) 90   dg/ko   9/ 101  

  H.F. 2673   ability to comply with all federal requirements applicable to 1   subrecipients under the block grants. 2   3. a. Upon designation by the department, an administrative 3   services organization shall be considered an instrumentality of 4   the state and shall adhere to all state and federal mandates 5   and prohibitions applicable to an instrumentality of the state. 6   b. An entitys designation as an administrative services 7   organization shall continue until the designation is removed 8   by the department, the administrative services organization 9   withdraws, or a change in state or federal law necessitates the 10   removal of the designation. 11   4. Each administrative services organization shall function 12   as a subrecipient for the purposes of the federal community 13   mental health services block grant, 42 U.S.C. 300x et seq., 14   and the federal substance abuse prevention and treatment block 15   grant, 42 U.S.C. 300x-21 et seq., and shall comply with all 16   federal requirements applicable to subrecipients under the 17   block grants. 18   5. Each administrative services organization shall perform 19   all of the following duties: 20   a. Develop and administer a district behavioral health plan 21   in accordance with the standards adopted by the department by 22   rule. 23   b. Coordinate the administration of the district behavioral 24   health plan with federal, state, and local resources in order 25   to develop a comprehensive and coordinated local behavioral 26   health service system. 27   c. Enter into contracts necessary to provide services under 28   the district behavioral health plan. 29   d. Oversee, provide technical assistance to, and monitor 30   the compliance of providers contracted by the administrative 31   services organization to provide behavioral health services in 32   accordance with the district behavioral health plan. 33   e. Establish a district behavioral health advisory council 34   pursuant to section 225A.5. 35   -10-   LSB 5509HZ (7) 90   dg/ko   10/ 101  

  H.F. 2673   Sec. 5. NEW SECTION . 225A.5 District behavioral health 1   advisory councils. 2   1. Each administrative services organization shall 3   establish a district behavioral health advisory council that 4   shall do all of the following: 5   a. Identify opportunities and address challenges based on 6   updates received from the administrative services organization 7   regarding the implementation of the district behavioral health 8   plan. 9   b. Advise the administrative services organization while the 10   administrative services organization is developing behavioral 11   health policies. 12   c. Advise the administrative services organization on 13   how to best provide access to behavioral health prevention, 14   education, early intervention, treatment, recovery support, 15   and crisis services related to mental health and addictive 16   disorders, including but not limited to alcohol use, substance 17   use, tobacco use, and problem gambling, throughout the district 18   as directed by the department. 19   2. An advisory council shall consist of ten members. 20   Members shall be appointed by the administrative services 21   organization subject to the following requirements: 22   a. Three members shall be local elected public officials 23   currently holding office within the behavioral health district, 24   or the public officials designated representative. 25   b. Three members shall be chosen in accordance with 26   procedures established by the administrative services 27   organization to ensure representation of the populations 28   served within the behavioral health district. At least one 29   member chosen under this paragraph shall represent child and 30   adolescent persons. 31   c. Three members shall be chosen who have experience 32   or education related to core behavioral health functions, 33   essential behavioral health services, behavioral health   34   prevention, behavioral health treatment, population-based 35   -11-   LSB 5509HZ (7) 90   dg/ko   11/ 101   

  H.F. 2673   behavioral health services, or community-based behavioral 1   health initiatives. 2   d. One member shall be a law enforcement representative from 3   within the behavioral health district. 4   3. An advisory council shall perform the duties required 5   under this section regardless of whether any seat on the 6   advisory council is vacant. 7   Sec. 6. NEW SECTION   . 225A.6 Behavioral health service 8   system  data collection and use. 9   1. The department shall take all of the following actions 10   for data related to the behavioral health service system: 11   a. Collect and analyze the data, including but not 12   limited to Medicaid and community services network data, as 13   necessary to issue cost estimates for serving populations, 14   providing treatment, making and receiving payments, conducting 15   operations, and performing prevention and health promotion 16   activities. In doing so, the department shall maintain 17   compliance with applicable federal and state privacy laws 18   to ensure the confidentiality and integrity of individually 19   identifiable data. The department shall periodically assess 20   the status of the departments compliance to ensure that data 21   collected by and stored with the department is protected. 22   b. Establish and administer a central data repository for 23   collecting and analyzing state, behavioral health district, and 24   contracted behavioral health provider data. 25   c. Establish a record for each individual receiving publicly 26   funded services from an administrative services organization. 27   Each record shall include a unique client identifier for the 28   purposes of identifying and tracking the individuals record. 29   d. Consult with administrative services organizations, 30   behavioral health service providers, and other behavioral 31   health service system stakeholders on an ongoing basis to 32   implement and maintain the central data repository. 33   e. Engage with all entities that maintain information the 34   department is required to collect pursuant to this section in 35   -12-   LSB 5509HZ (7) 90   dg/ko   12/ 101   

  H.F. 2673   order to integrate all data concerning individuals receiving 1   services within the behavioral health service system. 2   f. Engage with all entities that maintain general population 3   data relating to behavioral health in order to develop action 4   plans, create projections relating to a populations behavioral 5   health needs, develop policies concerning behavioral health, 6   and otherwise perform acts as necessary to enhance the states 7   overall behavioral health. 8   2. Administrative services organizations shall report all 9   data required to be maintained in the central data repository 10   to the department in a manner as established by the department 11   by rule. For the purpose of making such data reports, an 12   administrative services organization shall do one of the 13   following: 14   a. Utilize a data system that integrates with the data 15   systems used by the department. 16   b. Utilize a data system that has the capacity to securely 17   exchange information with the department, other behavioral 18   health districts, contractors, and other entities involved with 19   the behavioral health service system who are authorized to 20   access the central data repository. 21   3. Data and information maintained by and exchanged between 22   an administrative services organization and the department 23   shall be labeled consistently, share the same definitions, 24   utilize the same common coding and nomenclature, and be in a 25   form and format as required by the department by rule. 26   4. Administrative services organizations shall report 27   to the department, in a manner specified by the department, 28   information including but not limited to demographic 29   information, expenditure data, and data concerning the 30   behavioral health services and other support provided to 31   individuals in the administrative service organizations 32   district.   33   5. The department shall ensure that public and private 34   agencies, organizations, and individuals that operate within 35   -13-   LSB 5509HZ (7) 90   dg/ko   13/ 101  

  H.F. 2673   the behavioral health service system, or that make formal 1   requests for the release of data collected by the department, 2   maintain uniform methods for keeping statistical information 3   relating to behavioral health service system outcomes and 4   performance. 5   6. The department shall develop and implement a 6   communication plan that details how outcome and performance 7   data will be shared with stakeholders including but not limited 8   to the public, persons involved with the behavioral health 9   service system, and the general assembly. 10   Sec. 7. NEW SECTION   . 225A.7 Behavioral health fund. 11   1. For purposes of this section: 12   a. Population means, as of July 1 of the fiscal year 13   preceding the fiscal year in which the population figure is 14   applied, the population shown by the latest preceding certified 15   federal census or the latest applicable population estimate 16   issued by the United States census bureau, whichever is most 17   recent. 18   b. State growth factor for a fiscal year means an amount 19   equal to the dollar amount used to calculate the appropriation 20   under this section for the immediately preceding fiscal year 21   multiplied by the percent increase, if any, in the amount of 22   sales tax revenue deposited into the general fund of the state 23   under section 423.2A, subsection 1, paragraph a , less the 24   transfers required under section 423.2A, subsection 2, between 25   the fiscal year beginning three years prior to the applicable 26   fiscal year and the fiscal year beginning two years prior 27   to the applicable year, but not to exceed one and one-half 28   percent. 29   2. A behavioral health fund is established in the state 30   treasury under the control of the department. The fund shall 31   consist of moneys deposited into the fund pursuant to this 32   section and section 426B.1, gifts of money or property accepted 33   by the state or the department to support any services under 34   this chapter or chapter 231, and moneys otherwise appropriated 35   -14-   LSB 5509HZ (7) 90   dg/ko   14/ 101   

  H.F. 2673   by the general assembly. Moneys in the fund are appropriated 1   to the department to implement and administer the behavioral 2   health service system and related programs including but not 3   limited to all of the following: 4   a. Distributions to administrative services organizations 5   to provide services as outlined in the organizations district 6   behavioral health plan. 7   b. Distributions to providers of mental health services 8   and addictive disorder services, including but not limited to 9   tobacco use services, substance use disorder services, and 10   problem gambling services. 11   c. Funding of disability services pursuant to chapter 231. 12   This paragraph is repealed July 1, 2028. 13   d. Administrative costs associated with services described 14   under this subsection. The department shall not use more than 15   five percent of the moneys in the behavioral health fund at the 16   beginning of each fiscal year for purposes of administrative 17   costs. 18   3. For the fiscal year beginning July 1, 2025, there 19   is transferred from the general fund of the state to the 20   behavioral health fund an amount equal to forty-two dollars 21   multiplied by the states population for the fiscal year. 22   4. For the fiscal year beginning July 1, 2026, and each 23   succeeding fiscal year, there is transferred from the general 24   fund of the state to the behavioral health fund an amount equal 25   to the states population for the fiscal year multiplied by 26   the sum of the dollar amount used to calculate the transfer   27   from the general fund to the behavioral health fund for the 28   immediately preceding fiscal year, plus the state growth factor 29   for the fiscal year for which the transfer is being made. 30   5. For each fiscal year, an administrative services 31   organization shall not spend on administrative costs an amount 32   more than seven percent of the total amount distributed to the 33   administrative services organization through this section and 34   all other appropriations for the same fiscal year. 35   -15-   LSB 5509HZ (7) 90   dg/ko   15/ 101  

  H.F. 2673   6. Moneys in the behavioral health fund may be used by the 1   department for cash flow purposes, provided that any moneys so 2   allocated are returned to the behavioral health fund by the end 3   of each fiscal year. 4   7. Notwithstanding section 12C.7, subsection 2, interest 5   or earnings on moneys deposited in the behavioral health fund 6   shall be credited to the behavioral health fund. 7   8. Notwithstanding section 8.33, moneys appropriated in 8   this section that remain unencumbered or unobligated at the 9   close of the fiscal year shall not revert but shall remain 10   available for expenditure for the purposes designated. 11   Sec. 8. NEW SECTION   . 225A.8 Addictive disorders prevention 12    prohibitions. 13   1. For purposes of this section, entity means a 14   manufacturer, distributor, wholesaler, retailer, or 15   distributing agent, or an agent of a manufacturer, distributor, 16   wholesaler, retailer, or distributing agent as those terms are 17   defined in section 453A.1. 18   2. To promote comprehensive tobacco use prevention and 19   control initiatives outlined in the state behavioral health 20   service system plan, an entity shall not perform any of the 21   following acts: 22   a. Give away cigarettes or tobacco products. 23   b. Provide free articles, products, commodities, gifts, or 24   concessions in any exchange for the purchase of cigarettes or 25   tobacco products. 26   3. The prohibitions in this section shall not apply to 27   transactions between manufacturers, distributors, wholesalers,   28   or retailers as those terms are defined in section 453A.1.   29   Sec. 9. NEW SECTION   . 225A.9 Application for services  30   minors. 31   A minor who is twelve years of age or older shall have 32   the legal capacity to act and give consent to the provision 33   of tobacco cessation coaching services pursuant to a tobacco 34   cessation telephone and internet-based program approved by 35   -16-   LSB 5509HZ (7) 90   dg/ko   16/ 101    

  H.F. 2673   the department through the behavioral health service system 1   established in section 225A.3. Consent shall not be subject to 2   later disaffirmance by reason of such minority. The consent of 3   another person, including but not limited to the consent of a 4   spouse, parent, custodian, or guardian, shall not be necessary. 5   Sec. 10. CODE EDITOR DIRECTIVE. The Code editor is directed 6   to do all of the following: 7   1. Designate sections 225A.1 through 225A.9, as enacted 8   in this division of this Act, as Code chapter 225A entitled 9   Department of Health and Human Services  Behavioral Health 10   Service System. 11   2. Correct internal references in the Code and in any 12   enacted legislation as necessary due to the enactment of this 13   division of this Act. 14   Sec. 11. EFFECTIVE DATE. This division of this Act takes 15   effect July 1, 2025. 16   DIVISION II 17   BEHAVIORAL HEALTH SERVICE SYSTEM  CONFORMING CHANGES 18   Sec. 12. Section 11.6, subsection 1, paragraph b, Code 2024, 19   is amended to read as follows: 20   b. The financial condition and transactions of community   21   mental health centers organized under chapter 230A , substance 22   use disorder programs organized   licensed under chapter 125 , and 23   community action agencies organized under chapter 216A , shall 24   be audited at least once each year. 25   Sec. 13. Section 97B.1A, subsection 8, paragraph a, 26   subparagraph (13), Code 2024, is amended by striking the 27   subparagraph. 28   Sec. 14. Section 123.17, subsection 5, Code 2024, is amended   29   to read as follows: 30   5. After any transfer provided for in subsection 3 is made, 31   the department shall transfer into a special revenue account 32   in the general fund of the state, a sum of money at least equal 33   to seven percent of the gross amount of sales made by the 34   department from the beer and liquor control fund on a monthly 35   -17-   LSB 5509HZ (7) 90   dg/ko   17/ 101          

  H.F. 2673   basis but not less than nine million dollars annually. Of 1   the amounts transferred, two   three million dollars, plus an 2   additional amount determined by the general assembly, shall be 3   appropriated to the department of health and human services for 4   use by the staff who administer the comprehensive substance use   5   disorder program under chapter 125 for substance use disorder   6   treatment and prevention programs shall be transferred to the 7   behavioral health fund established under section 225A.7 . Any 8   amounts received in excess of the amounts appropriated to the   9   department of health and human services for use by the staff 10   who administer the comprehensive substance use disorder program   11   under chapter 125 transferred to the behavioral health fund 12   shall be considered part of the general fund balance. 13   Sec. 15. Section 123.17, subsection 8, Code 2024, is amended 14   by striking the subsection. 15   Sec. 16. Section 123.17, subsection 9, Code 2024, is amended 16   to read as follows: 17   9. After any transfers provided for in subsections 3, 5, 18   6, and   7 , and 8 are made, and before any other transfer to the 19   general fund, the department shall transfer to the economic 20   development authority from the beer and liquor control fund the 21   lesser of two hundred fifty thousand dollars or one percent of 22   the gross sales of native distilled spirits by all class A 23   native distilled spirits license holders made by the department 24   for the purposes of promoting Iowa wine, beer, and spirits. 25   Sec. 17. Section 124.409, subsection 2, Code 2024, is 26   amended by striking the subsection. 27   Sec. 18. Section 125.2, subsections 4, 5, and 10, Code 2024,   28   are amended by striking the subsections. 29   Sec. 19. Section 125.91, subsection 1, Code 2024, is amended 30   to read as follows: 31   1. The procedure prescribed by this section shall only 32   be used for a person with a substance use disorder due to 33   intoxication or substance-induced incapacitation who has 34   threatened, attempted, or inflicted physical self-harm or harm 35   -18-   LSB 5509HZ (7) 90   dg/ko   18/ 101                   

  H.F. 2673   on another, and is likely to inflict physical self-harm or harm 1   on another unless immediately detained, or who is incapacitated 2   by a chemical   substance, if an application has not been filed 3   naming the person as the respondent pursuant to section 125.75 4   and the person cannot be ordered into immediate custody and 5   detained pursuant to section 125.81 . 6   Sec. 20. Section 125.93, Code 2024, is amended to read as 7   follows: 8   125.93 Commitment records  confidentiality. 9   Records of the identity, diagnosis, prognosis, or treatment 10   of a person which are maintained in connection with the 11   provision of substance use disorder treatment services are 12   confidential, consistent with the requirements of   section 13   125.37   , and with the federal confidentiality regulations 14   authorized by the federal Drug Abuse Office and Treatment Act , 15   42 U.S.C. 290ee and the federal Comprehensive Alcohol Abuse 16   and Alcoholism Prevention, Treatment and Rehabilitation Act, 42 17   U.S.C. 290dd-2. However, such records may be disclosed to an 18   employee of the department of corrections, if authorized by the 19   director of the department of corrections, or to an employee 20   of a judicial district department of correctional services, if 21   authorized by the director of the judicial district department 22   of correctional services. 23   Sec. 21. Section 135.11, subsection 11, Code 2024, is 24   amended to read as follows: 25   11. Administer chapters 125, 136A , 136C , 139A , 142 , 142A   , 26   144 , and 147A .   27   Sec. 22. Section 135C.2, subsection 5, unnumbered paragraph 28   1, Code 2024, is amended to read as follows:   29   The department shall establish a special classification 30   within the residential care facility category in order to 31   foster the development of residential care facilities which 32   serve persons with an intellectual disability, chronic mental 33   illness, a developmental disability, or brain injury, as   34   described under section 225C.26 , and which contain five or 35   -19-   LSB 5509HZ (7) 90   dg/ko   19/ 101                 

  H.F. 2673   fewer residents. A facility within the special classification 1   established pursuant to this subsection is exempt from the 2   requirements of section 10A.713 . The department shall adopt 3   rules which are consistent with rules previously developed for 4   the waiver demonstration waiver project pursuant to 1986 Iowa 5   Acts, ch. 1246, 206 , and which include all of the following 6   provisions: 7   Sec. 23. Section 135C.6, subsection 1, Code 2024, is amended 8   to read as follows: 9   1. A person or governmental unit acting severally or 10   jointly with any other person or governmental unit shall not 11   establish or operate a health care facility in this state 12   without a license for the facility. A supported community 13   living service, as defined in section 225C.21   249A.38A , is not 14   required to be licensed under this chapter , but is subject to 15   approval under section 225C.21 249A.38A in order to receive 16   public funding. 17   Sec. 24. Section 135C.23, subsection 1, unnumbered 18   paragraph 1, Code 2024, is amended to read as follows: 19   Each resident shall be covered by a contract executed 20   by the resident, or the residents legal representative,   21   and the health care facility at or prior to the time of the 22   residents   admission or prior thereto by the resident, or the 23   legal representative, and the health care facility, except as 24   otherwise provided by subsection 5 with respect to residents 25   admitted at public expense to a county care facility operated 26   under chapter 347B . Each party to the contract shall be 27   entitled to a duplicate of the original thereof contract , and 28   the health care facility shall keep on file all contracts 29   which it has with residents and shall not destroy or otherwise 30   dispose of any such contract for at least one year after its 31   expiration. Each such contract shall expressly set forth: 32   Sec. 25. Section 135C.23, subsection 2, paragraph b, Code 33   2024, is amended to read as follows:   34   b. This section does not prohibit the admission of a 35   -20-   LSB 5509HZ (7) 90   dg/ko   20/ 101                        

  H.F. 2673   patient with a history of dangerous or disturbing behavior to 1   an intermediate care facility for persons with mental illness, 2   intermediate care facility for persons with an intellectual 3   disability, or   nursing facility , or county care facility when 4   the intermediate care facility for persons with mental illness, 5   intermediate care facility for persons with an intellectual 6   disability, or nursing facility , or county care facility has a 7   program which has received prior approval from the department 8   to properly care for and manage the patient. An intermediate 9   care facility for persons with mental illness, intermediate 10   care facility for persons with an intellectual disability, 11   or   nursing facility , or county care facility is required to 12   transfer or discharge a resident with dangerous or disturbing 13   behavior when the intermediate care facility for persons with 14   mental illness, intermediate care facility for persons with an 15   intellectual disability, or   nursing facility , or county care 16   facility cannot control the residents dangerous or disturbing 17   behavior. The department , in coordination with the state   18   mental health and disability services commission created in   19   section 225C.5 , shall adopt rules pursuant to chapter 17A for 20   programs to be required in intermediate care facilities for 21   persons with mental illness, intermediate care facilities 22   for persons with an intellectual disability, and   nursing 23   facilities , and county care facilities that admit patients 24   or have residents with histories of dangerous or disturbing 25   behavior. 26   Sec. 26. Section 135C.23, subsection 5, Code 2024, is   27   amended by striking the subsection. 28   Sec. 27. Section 135C.24, subsection 5, Code 2024, is   29   amended by striking the subsection. 30   Sec. 28. Section 135G.1, subsection 12, Code 2024, is 31   amended to read as follows: 32   12. a.   Subacute mental health services means the same 33   as defined in   section 225C.6 services that provide all of the 34   following: 35   -21-   LSB 5509HZ (7) 90   dg/ko   21/ 101                       

  H.F. 2673   (1) A comprehensive set of wraparound services for a 1   person who has had, or is at imminent risk of having, acute or   2   crisis mental health symptoms that do not permit the person to 3   remain in or threatens removal of the person from the persons 4   home and community, but who has been determined by a mental   5   health professional and a licensed health care professional,   6   subject to the professionals scope of practice, not to need 7   inpatient acute hospital services. For the purposes of this 8   subparagraph,   licensed health care professional means a person 9   licensed under chapter 148, an advanced registered nurse 10   practitioner, or a physician assistant.   11   (2) Intensive, recovery-oriented treatment and monitoring 12   of a person. Treatment may be provided directly or remotely 13   by a licensed psychiatrist or an advanced registered nurse   14   practitioner. 15   (3) An outcome-focused, interdisciplinary approach designed 16   to return a person to living successfully in the community. 17   b.   Subacute mental health services may include services 18   provided in a wide array of settings ranging from a persons   19   home to a specialized facility with restricted means of egress. 20   c.   Subacute mental health services shall be limited to a 21   period not to exceed ten calendar days or another time period 22   determined in accordance with rules adopted by the department   23   for this purpose, whichever is longer . 24   Sec. 29. Section 142.1, Code 2024, is amended to read as 25   follows: 26   142.1 Delivery of bodies. 27   The body of every person dying who died in a public asylum, 28   hospital, county care facility, penitentiary, or reformatory 29   in this state, or found dead within the state, or which   who 30   is to be buried at public expense in this state, except those 31   buried under the provisions of chapter 144C or 249 , and which 32   is suitable for scientific purposes, shall be delivered to the 33   medical college of the state university, or some osteopathic 34   or chiropractic college or school located in this state, which 35   -22-   LSB 5509HZ (7) 90   dg/ko   22/ 101                                           

  H.F. 2673   has been approved under the law regulating the practice of 1   osteopathic medicine or chiropractic; but no such body shall 2   be delivered to any such college or school if the deceased 3   person expressed a desire during the persons last illness 4   that the persons body should be buried or cremated, nor if 5   such is the desire of the persons relatives. Such bodies 6   shall be equitably distributed among said colleges and schools 7   according to their needs for teaching anatomy in accordance 8   with such rules as may be adopted by the department of health 9   and human services. The expense of transporting said bodies to 10   such college or school shall be paid by the college or school 11   receiving the same. If the deceased person has not expressed 12   a desire during the persons last illness that the persons 13   body should be buried or cremated and no person authorized to 14   control the deceased persons remains under section 144C.5 15   requests the persons body for burial or cremation, and if a 16   friend objects to the use of the deceased persons body for 17   scientific purposes, said deceased persons body shall be 18   forthwith   delivered to such friend for burial or cremation at 19   no expense to the state or county. Unless such friend provides 20   for burial and burial expenses within five days, the body shall 21   be used for scientific purposes under this chapter . 22   Sec. 30. Section 142.3, Code 2024, is amended to read as 23   follows: 24   142.3 Notification of department. 25   Every county medical examiner, funeral director or embalmer, 26   and the managing officer of every public asylum, hospital, 27   county care facility,   penitentiary, or reformatory, as soon as 28   any dead body shall come into the persons custody which may be 29   used for scientific purposes as provided in sections 142.1 and 30   142.2 , shall at once notify the nearest relative or friend of 31   the deceased, if known, and the department of health and human 32   services, and hold such body unburied for forty-eight hours. 33   Upon receipt of notification, the department shall issue verbal 34   or written instructions relative to the disposition to be made 35   -23-   LSB 5509HZ (7) 90   dg/ko   23/ 101    

  H.F. 2673   of said body. Complete jurisdiction over said bodies is vested 1   exclusively in the department of health and human services. No 2   autopsy or post mortem, except as are legally ordered by county 3   medical examiners, shall be performed on any of said bodies 4   prior to their delivery to the medical schools. 5   Sec. 31. NEW SECTION   . 217.17 State health improvement plan. 6   1. The department shall develop, implement, and administer 7   a state health improvement plan to identify health priorities, 8   goals, and measurable objectives, and outline strategies to 9   improve health statewide. 10   2. The state health improvement plan shall be developed 11   and updated in collaboration and in coordination with other 12   state departments, stakeholders, and statewide organizations 13   the department determines to be relevant. 14   3. The state health improvement plan may be updated by the 15   department at the departments discretion. 16   Sec. 32. NEW SECTION   . 217.37 Recovery of payment    17   assignment of liens  county attorney to enforce. 18   1. For purposes of this section, assistance means all of 19   the following: 20   a. A payment by the state for services rendered through 21   the behavioral health service system established under section 22   225A.3. 23   b. A payment by the state for aging and disability services 24   rendered in accordance with chapter 231. 25   2. The department shall have the authority to investigate if 26   a person is eligible to have assistance paid on the persons 27   behalf and whether payment of assistance was proper. 28   3. Notwithstanding any provision of law to the contrary, 29   assistance shall not be recoverable unless the department 30   finds that the assistance was paid for the benefit of a person 31   who was not entitled to have assistance paid on the persons 32   behalf. 33   4. Assistance paid for the benefit of a person who was 34   not entitled to have assistance paid on the persons behalf 35   -24-   LSB 5509HZ (7) 90   dg/ko   24/ 101    

  H.F. 2673   shall be recoverable from the entity to which the assistance 1   was paid, from the person on whose behalf assistance was paid, 2   or from a third party who is liable for the persons debts or 3   support. 4   5. Upon the death of a person who was not entitled to 5   have assistance paid on the persons behalf, the department 6   shall have a lien equivalent in priority to liens described 7   in section 633.425, subsection 6, against the persons estate 8   for the portion of the assistance improperly paid which the 9   department had not recovered at the time of the persons death. 10   6. The department may waive all or a portion of improperly 11   paid assistance, or a lien created under subsection 5, if 12   the department finds that collection would result in undue 13   hardship. 14   7. The department shall adopt rules pursuant to chapter 17A 15   to implement and administer this section. 16   Sec. 33. Section 218.30, Code 2024, is amended to read as 17   follows: 18   218.30 Investigation of other facilities. 19   The director may investigate or cause the investigation of 20   charges of abuse, neglect, or mismanagement on the part of an 21   officer or employee of a private facility which is subject to 22   the directors supervision or control. The director shall also   23   investigate or cause the investigation of charges concerning 24   county care facilities in which persons with mental illness are 25   served. 26   Sec. 34. Section 218.78, subsection 1, Code 2024, is amended   27   to read as follows: 28   1. All institutional receipts of the department, including 29   funds received from client participation at the state resource 30   centers under section 222.78 and at the state mental health   31   institutes under   section 230.20 , shall be deposited in the 32   general fund except for reimbursements for services provided 33   to another institution or state agency, for receipts deposited 34   in the revolving farm fund under section 904.706 , for deposits 35   -25-   LSB 5509HZ (7) 90   dg/ko   25/ 101         

  H.F. 2673   into the medical assistance fund under section 249A.11 , and for 1   rentals charged to employees or others for room, apartment, or 2   house and meals, which shall be available to the institutions. 3   Sec. 35. Section 222.1, subsection 1, Code 2024, is amended 4   to read as follows: 5   1. This chapter addresses the public and private services 6   available in this state to meet the needs of persons with an 7   intellectual disability. The responsibility of the mental   8   health and disability services regions formed by counties and   9   of the state for the costs and administration of publicly 10   funded services shall be as set out in   section 222.60 and other 11   pertinent sections of this chapter . 12   Sec. 36. Section 222.2, Code 2024, is amended by adding the 13   following new subsection: 14   NEW SUBSECTION   . 01. Administrative services organization 15   means the same as defined in section 225A.1. 16   Sec. 37. Section 222.2, subsections 6 and 7, Code 2024, are 17   amended by striking the subsections. 18   Sec. 38. Section 222.12, subsection 2, Code 2024, is amended 19   by striking the subsection. 20   Sec. 39. Section 222.13, Code 2024, is amended to read as 21   follows: 22   222.13 Voluntary admissions. 23   1. If an adult person is believed to be a person with an 24   intellectual disability, the adult person or the adult persons 25   guardian may apply to the department and the superintendent of 26   any state resource center for the voluntary admission of the 27   adult person either as an inpatient or an outpatient of the 28   resource center. If the expenses of the persons admission   29   or placement are payable in whole or in part by the persons   30   county of residence, application for the admission shall be 31   made through the regional administrator. An application for   32   admission to a special unit of any adult person believed to be 33   in need of any of the services provided by the special unit   34   under section 222.88 may be made in the same manner. The 35   -26-   LSB 5509HZ (7) 90   dg/ko   26/ 101                     

  H.F. 2673   superintendent shall accept the application if a preadmission 1   diagnostic evaluation confirms or establishes the need for 2   admission, except that an application shall not be accepted if 3   the institution does not have adequate facilities available or 4   if the acceptance will result in an overcrowded condition. 5   2. If the resource center does not have an appropriate 6   program for the treatment of an adult or minor person with an 7   intellectual disability applying under this section or section 8   222.13A , the regional administrator for the persons county   9   of residence or the department , as applicable, shall arrange 10   for the placement of the person in any public or private 11   facility within or without   outside of the state, approved by 12   the director, which offers appropriate services for the person. 13   If the expenses of the placement are payable in whole or in   14   part by a county, the placement shall be made by the regional 15   administrator for the county. 16   3. If the expenses of an admission of an adult to a resource 17   center or a special unit, or of the placement of the person   18   in a public or private facility are payable in whole or in   19   part by a mental health and disability services region, the 20   regional administrator shall make a full investigation into   21   the financial circumstances of the person and those liable for 22   the persons support under   section 222.78 to determine whether 23   or not any of them are able to pay the expenses arising out of 24   the admission of the person to a resource center, special unit, 25   or public or private facility. If the regional administrator 26   finds that the person or those legally responsible for 27   the person are presently unable to pay the expenses, the   28   regional administrator shall pay the expenses. The regional 29   administrator may review such a finding at any subsequent   30   time while the person remains at the resource center, or is 31   otherwise receiving care or treatment for which   this chapter 32   obligates the region to pay. If the regional administrator 33   finds upon review that the person or those legally responsible   34   for the person are presently able to pay the expenses, the   35   -27-   LSB 5509HZ (7) 90   dg/ko   27/ 101                                  

  H.F. 2673   finding shall apply only to the charges incurred during the 1   period beginning on the date of the review and continuing   2   thereafter, unless and until the regional administrator again 3   changes such a finding. If the regional administrator finds 4   that the person or those legally responsible for the person   5   are able to pay the expenses, the regional administrator shall   6   collect the charges to the extent required by section 222.78 , 7   and the regional administrator shall be responsible for the 8   payment of the remaining charges.   9   Sec. 40. Section 222.13A, subsections 3 and 4, Code 2024, 10   are amended to read as follows: 11   3. During the preadmission diagnostic evaluation, the 12   minor shall be informed both orally and in writing that the 13   minor has the right to object to the voluntary admission. If   14   Notwithstanding section 222.33, if the preadmission diagnostic 15   evaluation determines that the voluntary admission is 16   appropriate but the minor objects to the admission, the minor 17   shall not be admitted to the state resource center unless the 18   court approves of the admission. A petition for approval of 19   the minors admission may be submitted to the juvenile court by 20   the minors parent, guardian, or custodian. 21   4. As soon as practicable after the filing of a petition for 22   approval of the voluntary admission, the court shall determine 23   whether the minor has an attorney to represent the minor in the 24   proceeding. If the minor does not have an attorney, the court 25   shall assign an attorney   to the minor an attorney . If the 26   minor is unable to pay for an attorney, the attorney shall be 27   compensated by the mental health and disability services region 28   an administrative services organization at an hourly rate to be 29   established by the regional administrator   in substantially the 30   same manner as provided in section 815.7 . 31   Sec. 41. Section 222.14, Code 2024, is amended to read as   32   follows:   33   222.14 Care by region   pending admission. 34   If the institution is unable to receive a patient, the 35   -28-   LSB 5509HZ (7) 90   dg/ko   28/ 101                     

  H.F. 2673   superintendent shall notify the regional administrator 1   for the county of residence of the prospective patient   an 2   administrative services organization . Until such time as the 3   patient is able to be received by the institution, or when 4   application has been made for admission to a public or private 5   facility as provided in section 222.13 and the application 6   is pending, the care of the patient shall be provided as 7   arranged by the regional administrator administrative services 8   organization   . 9   Sec. 42. NEW SECTION . 222.33 State resource center  10   admissions and discharge. 11   1. The department shall make all final determinations 12   concerning whether a person may be admitted to a state resource 13   center. 14   2. If a patient is admitted to a state resource center 15   pursuant to section 222.13 or 222.13A, and the patient 16   wishes to be placed outside of the state resource center, the 17   discharge of the patient shall be made in accordance with 18   section 222.15. 19   Sec. 43. NEW SECTION   . 222.35 State  payor of last resort. 20   The department shall implement services and adopt rules 21   pursuant to chapter 17A in a manner that ensures that the state 22   is the payor of last resort, and that the department shall not 23   make any payments for services that have been provided until 24   the department has determined that the services provided are 25   not payable by a third-party source. 26   Sec. 44. Section 222.73, subsections 2 and 4, Code 2024, are 27   amended by striking the subsections. 28   Sec. 45. Section 222.77, Code 2024, is amended to read as   29   follows:   30   222.77 Patients on leave. 31   The cost of support of patients placed on convalescent leave 32   or removed as a habilitation measure from a resource center,   33   or a special unit,   except when living in the home of a person 34   legally bound for the support of the patient, shall be paid by 35   -29-   LSB 5509HZ (7) 90   dg/ko   29/ 101            

  H.F. 2673   the county of residence or the state as provided in section 1   222.60   . 2   Sec. 46. Section 222.78, subsection 1, Code 2024, is amended 3   to read as follows: 4   1. The father and mother of any patient admitted to a 5   resource center or to a special unit , as either an inpatient 6   or an outpatient, and any person, firm, or corporation bound 7   by contract made for support of the patient , are liable for 8   the support of the patient. The patient and those legally 9   bound for the support of the patient shall be liable to the 10   county or   state , as applicable, for all sums advanced in 11   accordance with the provisions of sections 222.60 and 222.77 12   relating to reasonable attorney fees and court costs for 13   the patients admission to the resource center, and for the   14   treatment, training, instruction, care, habilitation, support, 15   transportation, or other expenditures made on behalf of the 16   patient pursuant to this chapter . 17   Sec. 47. Section 222.79, Code 2024, is amended to read as 18   follows: 19   222.79 Certification statement presumed correct. 20   In actions to enforce the liability imposed by section 21   222.78 , the superintendent or the county of residence, as   22   applicable,   shall submit a certification statement stating 23   the sums charged, and the certification statement shall be 24   considered presumptively correct. 25   Sec. 48. Section 222.80, Code 2024, is amended to read as 26   follows:   27   222.80 Liability to county or   state. 28   A person admitted to a county institution or home or admitted 29   at county or   state expense to a private hospital, sanitarium, 30   or other facility for treatment, training, instruction, care, 31   habilitation, and support as a patient with an intellectual 32   disability shall be liable to the county or   state , as 33   applicable,   for the reasonable cost of the support as provided 34   in section 222.78 . 35   -30-   LSB 5509HZ (7) 90   dg/ko   30/ 101                            

  H.F. 2673   Sec. 49. Section 222.82, Code 2024, is amended to read as 1   follows: 2   222.82 Collection of liabilities and claims. 3   If liabilities and claims exist as provided in section 4   222.78 or any other provision of this chapter , the county of 5   residence or   the state , as applicable, may proceed as provided 6   in this section . If the liabilities and claims are owed to 7   a county of residence, the countys board of supervisors may 8   direct the county attorney to proceed with the collection of   9   the liabilities and claims as a part of the duties of the 10   county attorneys office when the board of supervisors deems   11   such action advisable. If the liabilities and claims are owed 12   to the state, the state shall proceed with the collection. 13   The board of supervisors or the   state , as applicable, may 14   compromise any and all liabilities to the county or state 15   arising under this chapter when such compromise is deemed to be 16   in the best interests of the county or state. Any collections 17   and liens shall be limited in conformance to section 614.1, 18   subsection 4 . 19   Sec. 50. Section 222.85, subsection 2, Code 2024, is amended 20   to read as follows: 21   2. Moneys paid to a resource center from any source other 22   than state appropriated funds and intended to pay all or a 23   portion of the cost of care of a patient, which cost would 24   otherwise be paid from state or county   funds or from the 25   patients own funds, shall not be deemed funds belonging to a 26   patient for the purposes of this section . 27   Sec. 51. Section 222.86, Code 2024, is amended to read as   28   follows:   29   222.86 Payment for care from fund. 30   If a patient is not receiving medical assistance under 31   chapter 249A and the amount in the account of any patient 32   in the patients personal deposit fund exceeds two hundred 33   dollars, the department may apply any amount of the excess to 34   reimburse the county of residence or the   state for liability 35   -31-   LSB 5509HZ (7) 90   dg/ko   31/ 101                   

  H.F. 2673   incurred by the county or the state for the payment of care, 1   support, and maintenance of the patient ,   when billed by the 2   county or state , as applicable . 3   Sec. 52. Section 222.92, subsection 1, Code 2024, is amended 4   to read as follows: 5   1. The department shall operate the state resource centers 6   on the basis of net appropriations from the general fund of 7   the state. The appropriation amounts shall be the net amounts 8   of state moneys projected to be needed for the state resource 9   centers for the fiscal year of the appropriations. The purpose 10   of utilizing net appropriations is to encourage the state 11   resource centers to operate with increased self-sufficiency, to 12   improve quality and efficiency, and to support collaborative 13   efforts between the state resource centers and counties and   14   other providers of funding for the services available from 15   the state resource centers. The state resource centers shall 16   not be operated under the net appropriations in a manner that 17   results in a cost increase to the state or in cost shifting 18   between the state, the medical assistance program, counties,   or 19   other sources of funding for the state resource centers. 20   Sec. 53. Section 222.92, subsection 3, paragraph a, Code 21   2024, is amended by striking the paragraph. 22   Sec. 54. Section 225.1, subsection 2, Code 2024, is amended 23   to read as follows: 24   2. For the purposes of this chapter , unless the context 25   otherwise requires: 26   a. Mental health and disability services region   means 27   a mental health and disability services region approved in 28   accordance with section 225C.56 . Administrative services 29   organization   means the same as defined in section 225A.1. 30   b. Regional administrator   means the administrator of a 31   mental health and disability services region, as defined in   32   section 225C.55 . Department means the department of health 33   and human services.   34   c. Respondent means the same as defined in section 229.1 . 35   -32-   LSB 5509HZ (7) 90   dg/ko   32/ 101                          

  H.F. 2673   Sec. 55. NEW SECTION . 225.4 State psychiatric hospital  1   admissions. 2   The department shall make all final determinations 3   concerning whether a person may be admitted to the state 4   psychiatric hospital. 5   Sec. 56. Section 225.11, Code 2024, is amended to read as 6   follows: 7   225.11 Initiating commitment procedures. 8   When a court finds upon completion of a hearing held pursuant 9   to section 229.12 that the contention that a respondent is 10   seriously mentally impaired has been sustained by clear and 11   convincing evidence, and the application filed under section 12   229.6 also contends or the court otherwise concludes that it 13   would be appropriate to refer the respondent to the state 14   psychiatric hospital for a complete psychiatric evaluation and 15   appropriate treatment pursuant to section 229.13 , the judge 16   may order that a financial investigation be made in the manner 17   prescribed by section 225.13 . If the costs of a respondents 18   evaluation or treatment are payable in whole or in part by a   19   county an administrative services organization , an order under 20   this section shall be for referral of the respondent through   21   the regional administrator for the respondents county of 22   residence   by an administrative services organization for an 23   evaluation and referral of the respondent to an appropriate 24   placement or service, which may include the state psychiatric 25   hospital for additional evaluation or treatment. 26   Sec. 57. Section 225.12, Code 2024, is amended to read as   27   follows: 28   225.12 Voluntary public patient  physicians or physician 29   assistants report. 30   A physician or a physician assistant who meets the 31   qualifications set forth in the definition of a mental health 32   professional in section 228.1 filing information under   33   section 225.10   shall include a written report to the regional 34   administrator for the county of residence of the person named 35   -33-   LSB 5509HZ (7) 90   dg/ko   33/ 101              

  H.F. 2673   in the information, giving shall submit a detailed history of 1   the case to an administrative services organization   as will be 2   likely to aid in the observation, treatment, and hospital care 3   of the person and describing the history in detail . 4   Sec. 58. Section 225.13, Code 2024, is amended to read as 5   follows: 6   225.13 Financial condition. 7   The regional administrator for the county of residence of 8   a person being admitted to the state psychiatric hospital is   9   Administrative services organizations shall be responsible for 10   investigating the financial condition of the   a person and of 11   those legally responsible for the persons support. 12   Sec. 59. Section 225.15, Code 2024, is amended to read as 13   follows: 14   225.15 Examination and treatment. 15   1.   When a respondent arrives at the state psychiatric 16   hospital, the admitting physician, or a physician assistant 17   who meets the qualifications set forth in the definition of a 18   mental health professional in section 228.1 , shall examine the 19   respondent and determine whether or not, in the physicians 20   or physician assistants judgment, the respondent is a fit 21   subject for observation, treatment, and hospital care. If, 22   upon examination, the physician or physician assistant who 23   meets the qualifications set forth in the definition of a 24   mental health professional in section 228.1 decides that the 25   respondent should be admitted to the hospital, the respondent 26   shall be provided a proper bed in the hospital. The physician 27   or physician assistant who meets the qualifications set forth 28   in the definition of a mental health professional in section 29   228.1 who has charge of the respondent shall proceed with 30   observation, medical treatment, and hospital care as in the 31   physicians or physician assistants judgment are proper and 32   necessary, in compliance with sections 229.13 , 229.14 , this 33   section , and section 229.16 . After the respondents admission, 34   the observation, medical treatment, and hospital care of the 35   -34-   LSB 5509HZ (7) 90   dg/ko   34/ 101             

  H.F. 2673   respondent may be provided by a mental health professional, 1   as defined in section 228.1 , who is licensed as a physician, 2   advanced registered nurse practitioner, or physician assistant. 3   2.   A proper and competent nurse shall also be assigned to 4   look after and care for the respondent during observation,   5   treatment, and care. Observation, treatment, and hospital   6   care under this section which are payable in whole or in part 7   by a county shall only be provided as determined through 8   the regional administrator for the respondents county of   9   residence. 10   Sec. 60. Section 225.16, subsection 1, Code 2024, is amended 11   to read as follows: 12   1. If the regional administrator for a persons county of   13   residence   department finds from the physicians information 14   or from the information of a physician assistant who 15   meets the qualifications set forth in the definition of 16   a mental health professional in section 228.1 which was 17   filed under the provisions of section 225.10   225.12 that it 18   would be appropriate for the person to be admitted to the 19   state psychiatric hospital, and the report of the regional   20   administrator made pursuant to   section 225.13 shows the 21   department finds that the person and those who are legally 22   responsible for the person are not able to pay the expenses 23   incurred at the hospital, or are able to pay only a part of 24   the expenses, the person shall be considered to be a voluntary 25   public patient and the regional administrator shall direct that   26   the person shall be sent to the state psychiatric hospital at 27   the state university of Iowa for observation, treatment, and 28   hospital care. 29   Sec. 61. Section 225.17, subsection 2, Code 2024, is amended   30   to read as follows: 31   2. When the respondent arrives at the hospital, the 32   respondent shall receive the same treatment as is provided for 33   committed public patients in section 225.15 , in compliance 34   with sections 229.13 through 229.16 . However, observation,   35   -35-   LSB 5509HZ (7) 90   dg/ko   35/ 101                             

  H.F. 2673   treatment, and hospital care under this section of a respondent 1   whose expenses are payable in whole or in part by a county   2   shall only be provided as determined through the regional 3   administrator for the respondents county of residence. 4   Sec. 62. Section 225.18, Code 2024, is amended to read as 5   follows: 6   225.18 Attendants. 7   The regional administrator An administrative services 8   organization   may appoint an attendant to accompany the 9   committed public patient or the voluntary public patient 10   or the committed private patient from the place where the 11   patient may be to the state psychiatric hospital, or to 12   accompany the patient from the hospital to a place as may 13   be designated by the regional administrator   administrative 14   services organization . If a patient is moved pursuant to this 15   section , at least one attendant shall be of the same gender as 16   the patient. 17   Sec. 63. Section 225.22, Code 2024, is amended to read as 18   follows: 19   225.22 Liability of private patients  payment. 20   Every committed private patient, if the patient has an 21   estate sufficient for that purpose, or if those legally 22   responsible for the patients support are financially able, 23   shall be liable to the county and   state for all expenses paid 24   by them in the state on behalf of such patient. All bills 25   for the care, nursing, observation, treatment, medicine, and 26   maintenance of such patients shall be paid by the director of 27   the department of administrative services in the same manner as 28   those of committed and voluntary public patients as provided in 29   this chapter , unless the patient or those legally responsible 30   for the patient make such settlement with the state psychiatric 31   hospital. 32   Sec. 64. Section 225.24, Code 2024, is amended to read as 33   follows:   34   225.24 Collection of preliminary expense. 35   -36-   LSB 5509HZ (7) 90   dg/ko   36/ 101                 

  H.F. 2673   Unless a committed private patient or those legally 1   responsible for the patients support offer to settle the 2   amount of the claims, the regional administrator for the   3   persons county of residence department shall collect, by 4   action if necessary, the amount of all claims for per diem and 5   expenses that have been approved by the regional administrator 6   for the county an administrative services organization and 7   paid by the regional administrator as provided under section 8   225.21   administrative services organization . Any amount 9   collected shall be credited to the mental health and disability 10   services region combined account created   behavioral health fund 11   established in accordance with section 225C.58 225A.7 . 12   Sec. 65. Section 225.27, Code 2024, is amended to read as 13   follows: 14   225.27 Discharge  transfer. 15   The state psychiatric hospital may, at any time, discharge 16   any patient as recovered, as improved, or as not likely to 17   be benefited by further treatment. If the patient being so 18   discharged was involuntarily hospitalized, the hospital shall 19   notify the committing judge or court of the discharge as 20   required by section 229.14 or section 229.16 , whichever is   as 21   applicable , and the applicable regional administrator . Upon 22   receiving the notification, the court shall issue an order 23   confirming the patients discharge from the hospital or from 24   care and custody, as the case may be, and shall terminate the 25   proceedings pursuant to which the order was issued. The court 26   or judge shall, if necessary, appoint a person to accompany the 27   discharged patient from the state psychiatric hospital to such 28   place as the hospital or the court may designate, or authorize 29   the hospital to appoint such attendant. 30   Sec. 66. Section 226.1, subsection 4, Code 2024, is amended 31   by adding the following new paragraph: 32   NEW PARAGRAPH   . 0a. Administrative services organization 33   means the same as defined in section 225A.1.   34   Sec. 67. Section 226.1, subsection 4, paragraphs d and f, 35   -37-   LSB 5509HZ (7) 90   dg/ko   37/ 101                       

  H.F. 2673   Code 2024, are amended by striking the paragraphs. 1   Sec. 68. Section 226.8, subsection 2, Code 2024, is amended 2   to read as follows: 3   2. Charges for the care of any person with a diagnosis of 4   an intellectual disability admitted to a state mental health 5   institute shall be made by the institute in the manner provided 6   by chapter 230 , but the liability of any other person to any   7   mental health and disability services region the state for the 8   cost of care of such person with a diagnosis of an intellectual 9   disability shall be as prescribed by section 222.78 . 10   Sec. 69. Section 226.32, Code 2024, is amended to read as 11   follows: 12   226.32 Overcrowded conditions. 13   The director shall order the discharge or removal from the 14   mental health institute of incurable and harmless patients 15   whenever it is necessary to make room for recent cases. If   16   a patient who is to be discharged entered the mental health 17   institute voluntarily, the director shall notify the regional   18   administrator for the county interested at least ten days in   19   advance of the day of actual discharge. 20   Sec. 70. Section 226.34, subsection 2, paragraph d, Code 21   2024, is amended by striking the paragraph. 22   Sec. 71. Section 228.6, subsection 1, Code 2024, is amended 23   to read as follows: 24   1. A mental health professional or an employee of or 25   agent for a mental health facility may disclose mental health 26   information if and to the extent necessary, to meet the 27   requirements of section 229.24 , 229.25 , 230.20   , 230.21 , 230.25 , 28   230.26 , 230A.108 , 232.74 , or 232.147 , or to meet the compulsory 29   reporting or disclosure requirements of other state or federal 30   law relating to the protection of human health and safety. 31   Sec. 72. Section 229.1, Code 2024, is amended by adding the 32   following new subsection: 33   NEW SUBSECTION   . 01. Administrative services organization 34   means the same as defined in section 225A.1.   35   -38-   LSB 5509HZ (7) 90   dg/ko   38/ 101                   

  H.F. 2673   Sec. 73. Section 229.1, subsections 11, 18, and 19, Code 1   2024, are amended by striking the subsections. 2   Sec. 74. Section 229.1B, Code 2024, is amended to read as 3   follows: 4   229.1B Regional administrator Administrative services 5   organization   . 6   Notwithstanding any provision of this chapter to the 7   contrary, any person whose hospitalization expenses are 8   payable in whole or in part by a mental health and disability   9   services region an administrative services organization 10   shall be subject to all administrative requirements of the 11   regional administrator for the county   administrative services 12   organization . 13   Sec. 75. Section 229.2, subsection 1, paragraph b, 14   subparagraph (3), Code 2024, is amended to read as follows: 15   (3) As soon as is practicable after the filing of a 16   petition for juvenile court approval of the admission of the 17   minor, the juvenile court shall determine whether the minor 18   has an attorney to represent the minor in the hospitalization 19   proceeding, and if not, the court shall assign to the minor 20   an attorney. If the minor is financially unable to pay for 21   an attorney, the attorney shall be compensated by the mental   22   health and disability services region   an administrative 23   services organization at an hourly rate to be established 24   by the regional administrator for the county in which the 25   proceeding is held administrative services organization in 26   substantially the same manner as provided in section 815.7 . 27   Sec. 76. Section 229.2, subsection 2, paragraph a, Code 28   2024, is amended to read as follows: 29   a. The chief medical officer of a public hospital shall 30   receive and may admit the person whose admission is sought, 31   subject in cases other than medical emergencies to availability 32   of suitable accommodations and to the provisions of sections   33   section   229.41 and 229.42 .   34   Sec. 77. Section 229.8, subsection 1, Code 2024, is amended   35   -39-   LSB 5509HZ (7) 90   dg/ko   39/ 101                      

  H.F. 2673   to read as follows: 1   1. Determine whether the respondent has an attorney 2   who is able and willing to represent the respondent in the 3   hospitalization proceeding, and if not, whether the respondent 4   is financially able to employ an attorney and capable of 5   meaningfully assisting in selecting one. In accordance with 6   those determinations, the court shall if necessary allow the 7   respondent to select, or shall assign to the respondent, an 8   attorney. If the respondent is financially unable to pay an 9   attorney, the attorney shall be compensated by the mental   10   health and disability services region   an administrative 11   services organization at an hourly rate to be established 12   by the regional administrator for the county in which the 13   proceeding is held   administrative services organization in 14   substantially the same manner as provided in section 815.7 . 15   Sec. 78. Section 229.10, subsection 1, paragraph a, Code 16   2024, is amended to read as follows: 17   a. An examination of the respondent shall be conducted by 18   one or more licensed physicians or mental health professionals, 19   as required by the courts order, within a reasonable time. 20   If the respondent is detained pursuant to section 229.11, 21   subsection 1 , paragraph b , the examination shall be conducted 22   within twenty-four hours. If the respondent is detained 23   pursuant to section 229.11, subsection 1 , paragraph a or 24   c , the examination shall be conducted within forty-eight 25   hours. If the respondent so desires, the respondent shall be 26   entitled to a separate examination by a licensed physician or 27   mental health professional of the respondents own choice. The 28   reasonable cost of the examinations shall, if the respondent 29   lacks sufficient funds to pay the cost, be paid by the regional   30   administrator from mental health and disability services region 31   funds   an administrative services organization upon order of the 32   court.   33   Sec. 79. Section 229.11, subsection 1, unnumbered paragraph 34   1, Code 2024, is amended to read as follows: 35   -40-   LSB 5509HZ (7) 90   dg/ko   40/ 101             

  H.F. 2673   If the applicant requests that the respondent be taken into 1   immediate custody and the judge, upon reviewing the application 2   and accompanying documentation, finds probable cause to believe 3   that the respondent has a serious mental impairment and is 4   likely to injure the respondent or other persons if allowed 5   to remain at liberty, the judge may enter a written order 6   directing that the respondent be taken into immediate custody 7   by the sheriff or the sheriffs deputy and be detained until 8   the hospitalization hearing. The hospitalization hearing shall 9   be held no more than five days after the date of the order, 10   except that if the fifth day after the date of the order is 11   a Saturday, Sunday, or a holiday, the hearing may be held 12   on the next succeeding business day. If the expenses of a 13   respondent are payable in whole or in part by a mental health   14   and disability services region an administrative services 15   organization , for a placement in accordance with paragraph a , 16   the judge shall give notice of the placement to the regional 17   administrator for the county in which the court is located   an 18   administrative services organization   , and for a placement in 19   accordance with paragraph b or c , the judge shall order 20   the placement in a hospital or facility designated through   21   the regional administrator by an administrative services 22   organization   . The judge may order the respondent detained for 23   the period of time until the hearing is held, and no longer, 24   in accordance with paragraph a , if possible, and if not then 25   in accordance with paragraph b , or, only if neither of these 26   alternatives is available, in accordance with paragraph c . 27   Detention may be in any of the following: 28   Sec. 80. Section 229.13, subsection 1, paragraph a, Code 29   2024, is amended to read as follows:   30   a. The court shall order a respondent whose expenses are 31   payable in whole or in part by a mental health and disability   32   services region an administrative services organization 33   placed under the care of an appropriate hospital or facility 34   designated through the regional administrator for the county   35   -41-   LSB 5509HZ (7) 90   dg/ko   41/ 101                  

  H.F. 2673   by an administrative services organization on an inpatient or 1   outpatient basis. 2   Sec. 81. Section 229.13, subsection 7, paragraph b, Code 3   2024, is amended to read as follows: 4   b. A region An administrative services organization shall 5   contract with mental health professionals to provide the 6   appropriate treatment including treatment by the use of oral 7   medicine or injectable antipsychotic medicine pursuant to this 8   section . 9   Sec. 82. Section 229.14, subsection 2, paragraph a, Code 10   2024, is amended to read as follows: 11   a. For a respondent whose expenses are payable in whole 12   or in part by a mental health and disability services region   13   an administrative services organization   , placement as 14   designated through the regional administrator for the county 15   by an administrative services organization in the care of an 16   appropriate hospital or facility on an inpatient or outpatient 17   basis, or other appropriate treatment, or in an appropriate 18   alternative placement. 19   Sec. 83. Section 229.14A, subsections 7 and 9, Code 2024, 20   are amended to read as follows: 21   7. If a respondents expenses are payable in whole or in 22   part by a mental health and disability services region through   23   the regional administrator for the county an administrative 24   services organization , notice of a placement hearing shall be 25   provided to the county attorney and the regional administrator 26   an administrative services organization . At the hearing, the 27   county may present evidence regarding appropriate placement. 28   9. A placement made pursuant to an order entered under 29   section 229.13 or 229.14 or this section shall be considered to   30   be authorized through the regional administrator for the county   31   by an administrative services organization   . 32   Sec. 84. Section 229.15, subsection 4, Code 2024, is amended   33   to read as follows: 34   4. When a patient has been placed in an alternative facility 35   -42-   LSB 5509HZ (7) 90   dg/ko   42/ 101                 

  H.F. 2673   other than a hospital pursuant to a report issued under section 1   229.14, subsection 1 , paragraph d , a report on the patients 2   condition and prognosis shall be made to the court which placed 3   the patient, at least once every six months, unless the court 4   authorizes annual reports. If an evaluation of the patient is 5   performed pursuant to   section 227.2, subsection 4 , a copy of 6   the evaluation report shall be submitted to the court within 7   fifteen days of the evaluations completion. The court may in 8   its discretion waive the requirement of an additional report   9   between the annual evaluations. If the department exercises 10   the authority to remove residents or patients from a county   11   care facility or other county or private facility under section 12   227.6 , the department shall promptly notify each court which 13   placed in that facility any resident or patient removed.   14   Sec. 85. Section 229.19, subsection 1, paragraphs a and b, 15   Code 2024, are amended to read as follows: 16   a. In each county the board of supervisors shall appoint 17   an individual who has demonstrated by prior activities an 18   informed concern for the welfare and rehabilitation of persons 19   with mental illness, and who is not an officer or employee of 20   the department , an officer or employee of a region, an officer   21   or employee of a county performing duties for a region, or 22   an officer or employee of any agency or facility providing 23   care or treatment to persons with mental illness, to act as an 24   advocate representing the interests of patients involuntarily 25   hospitalized by the court, in any matter relating to the 26   patients hospitalization or treatment under section 229.14 or 27   229.15 .   28   b. The committing court shall assign the advocate for the 29   county where the patient is located. A county or region   may 30   seek reimbursement from the patients county of residence or   31   from the region in which the patients county of residence is   32   located an administrative services organization . 33   Sec. 86. Section 229.19, subsection 4, unnumbered paragraph 34   1, Code 2024, is amended to read as follows:   35   -43-   LSB 5509HZ (7) 90   dg/ko   43/ 101                       

  H.F. 2673   The state mental health and disability services commission 1   created in section 225C.5   department , in consultation with 2   advocates and county and judicial branch representatives, shall 3   adopt rules pursuant to chapter 17A relating to advocates that 4   include but are not limited to all of the following topics: 5   Sec. 87. Section 229.22, subsection 2, paragraph b, Code 6   2024, is amended to read as follows: 7   b. If the magistrate orders that the person be detained, 8   the magistrate shall, by the close of business on the next 9   working day, file a written order with the clerk in the county 10   where it is anticipated that an application may be filed 11   under section 229.6 . The order may be filed by facsimile if 12   necessary. A peace officer from the law enforcement agency 13   that took the person into custody, if no request was made 14   under paragraph a , may inform the magistrate that an arrest 15   warrant has been issued for or charges are pending against the 16   person and request that any written order issued under this 17   paragraph require the facility or hospital to notify the law 18   enforcement agency about the discharge of the person prior to 19   discharge. The order shall state the circumstances under which 20   the person was taken into custody or otherwise brought to a 21   facility or hospital, and the grounds supporting the finding 22   of probable cause to believe that the person is seriously 23   mentally impaired and likely to injure the persons self or 24   others if not immediately detained. The order shall also 25   include any law enforcement agency notification requirements if 26   applicable. The order shall confirm the oral order authorizing 27   the persons detention including any order given to transport 28   the person to an appropriate facility or hospital. A peace 29   officer from the law enforcement agency that took the person 30   into custody may also request an order, separate from the 31   written order, requiring the facility or hospital to notify the 32   law enforcement agency about the discharge of the person prior 33   to discharge. The clerk shall provide a copy of the written 34   order or any separate order to the chief medical officer of 35   -44-   LSB 5509HZ (7) 90   dg/ko   44/ 101     

  H.F. 2673   the facility or hospital to which the person was originally 1   taken, to any subsequent facility to which the person was 2   transported, and to any law enforcement department, ambulance 3   service, or transportation service under contract with a   4   mental health and disability services region   an administrative 5   services organization   that transported the person pursuant 6   to the magistrates order. A transportation service that 7   contracts with a mental health and disability services region 8   an administrative services organization   for purposes of this 9   paragraph shall provide a secure transportation vehicle and 10   shall employ staff that has received or is receiving mental 11   health training. 12   Sec. 88. Section 229.24, subsection 3, unnumbered paragraph 13   1, Code 2024, is amended to read as follows: 14   If all or part of the costs associated with hospitalization 15   of an individual under this chapter are chargeable to a county   16   of residence an administrative services organization , the 17   clerk of the district court shall provide to the regional   18   administrator for the county of residence and to the regional   19   administrator for the county in which the hospitalization 20   order is entered   an administrative services organization the 21   following information pertaining to the individual which would 22   be confidential under subsection 1 : 23   Sec. 89. Section 229.38, Code 2024, is amended to read as 24   follows: 25   229.38 Cruelty or official misconduct. 26   If any person having the care of a person with mental illness 27   who has voluntarily entered a hospital or other facility for 28   treatment or care, or who is responsible for psychiatric 29   examination care, treatment, and maintenance of any person 30   involuntarily hospitalized under sections 229.6 through 229.15 , 31   whether in a hospital or elsewhere, with or without proper 32   authority, shall treat such patient with unnecessary severity, 33   harshness, or cruelty, or in any way abuse the patient or if 34   any person unlawfully detains or deprives of liberty any person 35   -45-   LSB 5509HZ (7) 90   dg/ko   45/ 101                

  H.F. 2673   with mental illness or any person who is alleged to have mental 1   illness, or if any officer required by the provisions of this 2   chapter and chapters   chapter 226 and 227 , to perform any act 3   shall willfully refuse or neglect to perform the same, the 4   offending person shall, unless otherwise provided, be guilty of 5   a serious misdemeanor. 6   Sec. 90. Section 230.1, Code 2024, is amended by adding the 7   following new subsection: 8   NEW SUBSECTION   . 01. Administrative service organization 9   means the same as defined in section 225A.1. 10   Sec. 91. Section 230.1, subsections 4 and 5, Code 2024, are 11   amended by striking the subsections. 12   Sec. 92. Section 230.10, Code 2024, is amended to read as 13   follows: 14   230.10 Payment of costs.   15   All legal costs and expenses for the taking into custody, 16   care, investigation, and admission or commitment of a person to 17   a state mental health institute under a finding that the person   18   has residency in another county of this state   shall be charged 19   against the regional administrator of the persons county of 20   residence   to an administrative services organization . 21   Sec. 93. Section 230.11, Code 2024, is amended to read as 22   follows: 23   230.11 Recovery of costs from state. 24   Costs and expenses for the taking into custody, care, and 25   investigation of a person who has been admitted or committed 26   to a state mental health institute, United States department 27   of veterans affairs hospital, or other agency of the United 28   States government, for persons with mental illness and 29   who has no residence in this state or whose residence is   30   unknown, including cost of commitment, if any, shall be paid 31   as approved by the department. The amount of the costs and 32   expenses approved by the department is appropriated to the 33   department from any moneys in the state treasury not otherwise 34   appropriated. Payment shall be made by the department on   35   -46-   LSB 5509HZ (7) 90   dg/ko   46/ 101             

  H.F. 2673   itemized vouchers executed by the regional administrator of 1   the persons county which has paid them, and approved by the   2   department. 3   Sec. 94. Section 230.15, subsections 1 and 2, Code 2024, are 4   amended to read as follows: 5   1. A person with mental illness and a person legally liable 6   for the persons support remain liable for the support of 7   the person with mental illness as provided in this section . 8   Persons legally liable for the support of a person with mental 9   illness include the spouse of the person, and any person 10   bound by contract for support of the person. The regional   11   administrator of the persons county of residence, subject to 12   the direction of the regions governing board, shall enforce 13   the obligation created in   this section as to all sums advanced 14   by the regional administrator. The liability to the regional 15   administrator incurred by a person with mental illness or a 16   person legally liable for the persons support under this 17   section is limited to an amount equal to one hundred percent 18   of the cost of care and treatment of the person with mental 19   illness at a state mental health institute for one hundred 20   twenty days of hospitalization. This limit of liability may 21   be reached by payment of the cost of care and treatment of the 22   person with mental illness subsequent to a single admission 23   or multiple admissions to a state mental health institute or,   24   if the person is not discharged as cured, subsequent to a 25   single transfer or multiple transfers to a county care facility 26   pursuant to section 227.11 . After reaching this limit of 27   liability, a person with mental illness or a person legally 28   liable for the persons support is liable to the regional 29   administrator   state for the care and treatment of the person 30   with mental illness at a state mental health institute or, 31   if transferred but not discharged as cured, at a county care   32   facility in an amount not in excess of to exceed the average 33   minimum cost of the maintenance of an individual who is   34   physically and mentally healthy residing in the individuals 35   -47-   LSB 5509HZ (7) 90   dg/ko   47/ 101                           

  H.F. 2673   own home , which standard shall be as established and may be 1   revised   by the department by rule . A lien imposed by section 2   230.25 shall not exceed the amount of the liability which may 3   be incurred under this section on account of a person with 4   mental illness.   5   2. A person with a substance use disorder is legally 6   liable for the total amount of the cost of providing care, 7   maintenance, and treatment for the person with a substance 8   use disorder while a voluntary or committed patient. When 9   a portion of the cost is paid by a county   an administrative 10   services organization   , the person with a substance use disorder 11   is legally liable to the county administrative services 12   organization for the amount paid. The person with a substance 13   use disorder shall assign any claim for reimbursement under any 14   contract of indemnity, by insurance or otherwise, providing 15   for the persons care, maintenance, and treatment in a state 16   mental health institute to the state. Any payments received   17   by the state from or on behalf of a person with a substance use   18   disorder shall be in part credited to the county in proportion   19   to the share of the costs paid by the county. 20   Sec. 95. NEW SECTION   . 230.23 State  payor of last resort. 21   The department shall implement services and adopt rules 22   pursuant to chapter 17A in a manner that ensures that the state 23   is the payor of last resort, and that the department does not 24   make any payments for services that have been provided until 25   the department has determined that the services provided are 26   not payable by a third-party source. 27   Sec. 96. Section 230.30, Code 2024, is amended to read as 28   follows:   29   230.30 Claim against estate. 30   On the death of a person receiving or who has received 31   assistance under the provisions of this chapter , and whom the 32   board   department has previously found , under section 230.25 , 33   is able to pay ,   there shall be allowed against the estate of 34   such decedent a claim of the sixth class for that portion of 35   -48-   LSB 5509HZ (7) 90   dg/ko   48/ 101                                

  H.F. 2673   the total amount paid for that persons care which exceeds 1   the total amount of all claims of the first through the fifth 2   classes, inclusive, as defined in section 633.425 , which are 3   allowed against that estate. 4   Sec. 97. Section 232.78, subsection 5, unnumbered paragraph 5   1, Code 2024, is amended to read as follows: 6   The juvenile court, before or after the filing of a petition 7   under this chapter , may enter an ex parte order authorizing 8   a physician or physician assistant or hospital to conduct an 9   outpatient physical examination or authorizing a physician or 10   physician assistant, a psychologist certified under section 11   154B.7, or a community mental health center accredited pursuant 12   to chapter 230A   section 225A.3 to conduct an outpatient mental 13   examination of a child if necessary to identify the nature, 14   extent, and cause of injuries to the child as required by 15   section 232.71B , provided all of the following apply: 16   Sec. 98. Section 232.83, subsection 2, unnumbered paragraph 17   1, Code 2024, is amended to read as follows: 18   Anyone authorized to conduct a preliminary investigation in 19   response to a complaint may apply for, or the court on its own 20   motion may enter, an ex parte order authorizing a physician 21   or physician assistant or hospital to conduct an outpatient 22   physical examination or authorizing a physician or physician 23   assistant, a psychologist certified under section 154B.7, or a 24   community mental health center accredited pursuant to chapter   25   230A section 225A.3 to conduct an outpatient mental examination 26   of a child if necessary to identify the nature, extent, and 27   causes of any injuries, emotional damage, or other such needs 28   of a child as specified in section 232.96A, subsection 3, 5, or 29   6 , provided that all of the following apply: 30   Sec. 99. Section 235.7, subsection 2, Code 2024, is amended 31   to read as follows: 32   2. Membership. The department may authorize the governance 33   boards of decategorization of child welfare and juvenile 34   justice funding projects established under section 232.188 to 35   -49-   LSB 5509HZ (7) 90   dg/ko   49/ 101       

  H.F. 2673   appoint the transition committee membership and may utilize 1   the boundaries of decategorization projects to establish 2   the service areas for transition committees. The committee 3   membership may include but is not limited to department staff 4   involved with foster care, child welfare, and adult services, 5   juvenile court services staff, staff involved with county 6   general assistance or emergency relief under chapter 251 or 7   252, or a regional administrator of the county mental health   8   and disability services region, as defined in section 225C.55,   9   in the area, school district and area education agency staff 10   involved with special education, and a childs court appointed 11   special advocate, guardian ad litem, service providers, and 12   other persons knowledgeable about the child. 13   Sec. 100. Section 235A.15, subsection 2, paragraph c, 14   subparagraphs (5) and (8), Code 2024, are amended by striking 15   the subparagraphs. 16   Sec. 101. Section 249A.4, subsection 15, Code 2024, is 17   amended by striking the subsection. 18   Sec. 102. Section 249A.12, subsection 4, Code 2024, is 19   amended by striking the subsection. 20   Sec. 103. NEW SECTION   . 249A.38A Supported community living 21   services. 22   1. As used in this section, supported community living 23   service means a service provided in a noninstitutional 24   setting to adult persons with mental illness, an intellectual 25   disability, or developmental disabilities to meet the persons 26   daily living needs. 27   2. The department shall adopt rules pursuant to chapter 17A 28   establishing minimum standards for supported community living 29   services. 30   3. The department shall determine whether to grant, deny, or 31   revoke approval for any supported community living service. 32   4. Approved supported community living services may receive 33   funding from the state, federal and state social services block 34   grant funds, and other appropriate funding sources, consistent 35   -50-   LSB 5509HZ (7) 90   dg/ko   50/ 101      

  H.F. 2673   with state legislation and federal regulations. The funding 1   may be provided on a per diem, per hour, or grant basis, as 2   appropriate. 3   Sec. 104. Section 249N.8, Code 2024, is amended by striking 4   the section and inserting in lieu thereof the following: 5   249N.8 Behavioral health services reports. 6   The department shall annually submit a report to the 7   governor and the general assembly with details related to the 8   departments review of the funds administered by, and the 9   outcomes and effectiveness of, the behavioral health services 10   provided by, the behavioral health service system established 11   in section 225A.3. 12   Sec. 105. Section 252.24, subsections 1 and 3, Code 2024, 13   are amended to read as follows: 14   1. The county of residence, as defined in section 225C.61   15   331.190 , shall be liable to the county granting assistance for 16   all reasonable charges and expenses incurred in the assistance 17   and care of a poor person. 18   3. This section shall apply to assistance or maintenance 19   provided by a county   through the countys mental health 20   and disability services   behavioral health service system 21   implemented under chapter 225C established in section 225A.3 . 22   Sec. 106. Section 256.25, subsections 2 and 3, Code 2024, 23   are amended to read as follows: 24   2. A school district, which may collaborate and partner 25   with one or more school districts, area education agencies, 26   accredited nonpublic schools, nonprofit agencies, and 27   institutions that provide childrens mental health services, 28   located in mental health and disability services regions   29   providing childrens behavioral health services in accordance   30   with   chapter 225C, subchapter VII operating within the states 31   behavioral health service system under chapter 225A   , may apply 32   for a grant under this program to establish a therapeutic 33   classroom in the school district in accordance with this   34   section .   35   -51-   LSB 5509HZ (7) 90   dg/ko   51/ 101                 

  H.F. 2673   3. The department shall develop a grant application 1   and selection and evaluation criteria. Selection criteria 2   shall include a method for prioritizing grant applications 3   submitted by school districts. First priority shall be 4   given to applications submitted by school districts that 5   submitted an application pursuant to this section for the 6   previous   immediately preceding fiscal year. Second priority 7   shall be given to applications submitted by school districts 8   that, pursuant to subsection 2 , are collaborating and 9   partnering with one or more school districts, area education 10   agencies, accredited nonpublic schools, nonprofit agencies, 11   or institutions that provide mental health services for 12   children. Third priority shall be given to applications 13   submitted by school districts located in mental health and   14   disability services regions behavioral health districts as 15   defined in section 225A.1, and that are providing behavioral 16   health services for children in accordance with chapter 225C, 17   subchapter VII   225A . Grant awards shall be distributed as 18   equitably as possible among small, medium, and large school 19   districts. For purposes of this subsection , a small school 20   district is a district with an actual enrollment of fewer than 21   six hundred pupils; a medium school district is a district 22   with an actual enrollment that is at least six hundred pupils, 23   but less than two thousand five hundred pupils; and a large 24   school district is a district with an actual enrollment of two 25   thousand five hundred or more pupils. 26   Sec. 107. Section 321.189, subsection 10, Code 2024, is   27   amended to read as follows: 28   10. Autism spectrum disorder status. A licensee who has 29   autism spectrum disorder, as defined in section 514C.28 , may 30   request that the license be marked to reflect the licensees 31   autism spectrum disorder status on the face of the license 32   when the licensee applies for the issuance or renewal of a 33   license. The department may adopt rules pursuant to chapter 34   17A establishing criteria under which a license may be marked, 35   -52-   LSB 5509HZ (7) 90   dg/ko   52/ 101           

  H.F. 2673   including requiring the licensee to submit medical proof of the 1   licensees autism spectrum disorder status. When a drivers 2   license is so marked, the licensees autism spectrum disorder 3   status shall be noted in the electronic database used by 4   the department and law enforcement to access registration, 5   titling, and drivers license information. The department, in 6   consultation with the mental health and disability services   7   commission department of health and human services , shall 8   develop educational media to raise awareness of a licensees 9   ability to request the license be marked to reflect the 10   licensees autism spectrum disorder status. 11   Sec. 108. Section 321.190, subsection 1, paragraph b, 12   subparagraph (6), Code 2024, is amended to read as follows: 13   (6) An applicant for a nonoperators identification 14   card who has autism spectrum disorder, as defined in section 15   514C.28 , may request that the card be marked to reflect 16   the applicants autism spectrum disorder status on the face 17   of the card when the applicant applies for the issuance or 18   renewal of a card. The department may adopt rules pursuant to 19   chapter 17A establishing criteria under which a card may be 20   marked, including requiring the applicant to submit medical 21   proof of the applicants autism spectrum disorder status. 22   The department, in consultation with the mental health and   23   disability services commission department of health and human 24   services , shall develop educational media to raise awareness of 25   an applicants ability to request the card be marked to reflect 26   the applicants autism spectrum disorder status. 27   Sec. 109. Section 321J.25, subsection 1, paragraph b, Code 28   2024, is amended to read as follows: 29   b. Program means a substance use disorder awareness 30   program , licensed under chapter 125, and   provided under a 31   contract entered into between the provider and the department 32   of health and human services under chapter 125   or an 33   administrative services organization as defined in section   34   225A.1 .   35   -53-   LSB 5509HZ (7) 90   dg/ko   53/ 101              

  H.F. 2673   Sec. 110. Section 321J.25, subsection 2, unnumbered 1   paragraph 1, Code 2024, is amended to read as follows: 2   A substance use disorder awareness program is established 3   in each of the regions established by the director of health   4   and human services pursuant to   section 125.12 behavioral 5   health district designated pursuant to section 225A.4   . The 6   program shall consist of an insight class and a substance 7   use disorder evaluation, which shall be attended by the 8   participant, to discuss issues related to the potential 9   consequences of substance use disorder. The parent or parents 10   of the participant shall also be encouraged to participate 11   in the program. The program provider shall consult with the 12   participant or the parents of the participant in the program 13   to determine the timing and appropriate level of participation 14   for the participant and any participation by the participants 15   parents. The program may also include a supervised educational 16   tour by the participant to any or all of the following: 17   Sec. 111. Section 331.321, subsection 1, paragraph e, Code 18   2024, is amended by striking the paragraph. 19   Sec. 112. Section 331.323, subsection 1, paragraph a, 20   subparagraph (7), Code 2024, is amended by striking the 21   subparagraph. 22   Sec. 113. Section 331.381, subsections 4 and 5, Code 2024, 23   are amended to read as follows: 24   4. Comply with chapter 222 , including but not limited to   25   sections 222.13 , 222.14 , 222.59 through 222.70 , 222.73 through 26   222.75 , and 222.77 through 222.82 , in regard to the care of 27   persons with an intellectual disability. 28   5. Comply with chapters 227, 229 and 230 , including but not 29   limited to   sections 227.11 , 227.14 , 229.42 , 230.25 , 230.27 , and 30   230.35 , in regard to the care of persons with mental illness. 31   Sec. 114. Section 331.382, subsection 1, paragraphs e, f, 32   and g, Code 2024, are amended by striking the paragraphs. 33   Sec. 115. Section 331.382, subsection 3, Code 2024, is 34   amended by striking the subsection. 35   -54-   LSB 5509HZ (7) 90   dg/ko   54/ 101                                  

  H.F. 2673   Sec. 116. Section 331.432, subsection 3, Code 2024, is 1   amended by striking the subsection. 2   Sec. 117. Section 331.502, subsection 10, Code 2024, is 3   amended by striking the subsection. 4   Sec. 118. Section 331.502, subsection 12, Code 2024, is 5   amended to read as follows: 6   12. Carry out duties relating to the hospitalization and 7   support of persons with mental illness as provided in sections 8   229.42,   230.3 , 230.11 , and 230.15 , 230.21 , 230.22 , 230.25 , and 9   230.26 . 10   Sec. 119. Section 331.552, subsection 13, Code 2024, is 11   amended by striking the subsection. 12   Sec. 120. Section 331.756, subsections 25, 38, and 41, Code 13   2024, are amended by striking the subsections. 14   Sec. 121. Section 331.910, subsection 2, Code 2024, is 15   amended by adding the following new paragraph: 16   NEW PARAGRAPH   . 0a. Administrative services organization 17   means the same as defined in section 225A.1. 18   Sec. 122. Section 331.910, subsection 2, paragraph d, Code 19   2024, is amended by striking the paragraph. 20   Sec. 123. Section 331.910, subsection 3, paragraphs a and c, 21   Code 2024, are amended to read as follows: 22   a. A region   An administrative services organization may 23   contract with a receiving agency in a bordering state to secure 24   substance use disorder or mental health care and treatment 25   under this subsection for persons who receive substance use 26   disorder or mental health care and treatment pursuant to 27   section 125.33, 125.91 , 229.2 , or 229.22 through a region . 28   c. A region An administrative services organization may 29   contract with a sending agency in a bordering state to provide 30   care and treatment under this subsection for residents of 31   the bordering state in approved substance use disorder and 32   mental health care and treatment hospitals, centers, and 33   facilities in this state, except that care and treatment shall 34   not be provided for residents of the bordering state who are 35   -55-   LSB 5509HZ (7) 90   dg/ko   55/ 101                     

  H.F. 2673   involved in criminal proceedings substantially similar to the 1   involvement described in paragraph b . 2   Sec. 124. Section 347.16, subsection 3, Code 2024, is 3   amended to read as follows: 4   3. Care and treatment may be furnished in a county public 5   hospital to any sick or injured person who has residence 6   outside the county which maintains the hospital, subject to 7   such policies and rules as the board of hospital trustees 8   may adopt. If care and treatment is provided under this 9   subsection to a person who is indigent, the persons county of 10   residence, as defined in section 225C.61   331.190 , shall pay to 11   the board of hospital trustees the fair and reasonable cost of 12   the care and treatment provided by the county public hospital 13   unless the cost of the indigent persons care and treatment is 14   otherwise provided for. If care and treatment is provided to 15   an indigent person under this subsection , the county public 16   hospital furnishing the care and treatment shall immediately 17   notify, by regular mail, the auditor of the county of residence 18   of the indigent person of the provision of care and treatment 19   to the indigent person including care and treatment provided 20   by a county   through the countys mental health and disability 21   services system implemented under chapter 225C behavioral 22   health service system established in section 225A.3   . 23   Sec. 125. Section 423.3, subsection 18, paragraph d, Code 24   2024, is amended to read as follows: 25   d. Community mental health centers accredited by the 26   department of health and human services pursuant to chapter 27   225C section 225A.3 .   28   Sec. 126. Section 426B.1, subsection 2, Code 2024, is   29   amended to read as follows: 30   2. Moneys shall be distributed from the property tax relief 31   fund to the mental health and disability services regional   32   service system for mental health and disability services, 33   behavioral health fund established in section 225A.7   in 34   accordance with the appropriations made to the fund and other 35   -56-   LSB 5509HZ (7) 90   dg/ko   56/ 101               

  H.F. 2673   statutory requirements. 1   Sec. 127. Section 437A.8, subsection 4, paragraph d, Code 2   2024, is amended to read as follows: 3   d. (1)   Notwithstanding paragraph a , a taxpayer who owns 4   or leases a new electric power generating plant and who has 5   no other operating property in the state of Iowa except for 6   operating property directly serving the new electric power 7   generating plant as described in section 437A.16 shall pay 8   the replacement generation tax associated with the allocation 9   of the local amount to the county treasurer of the county in 10   which the local amount is located and shall remit the remaining 11   replacement generation tax, if any, to the director according 12   to paragraph a for remittance of the tax to county treasurers. 13   The director shall notify each taxpayer on or before August 31 14   following a tax year of its remaining replacement generation 15   tax to be remitted to the director. All remaining replacement 16   generation tax revenues received by the director shall be 17   deposited in the property tax relief fund created in section 18   426B.1 , and shall be distributed as provided in section 426B.2   . 19   (2) If a taxpayer has paid an amount of replacement tax, 20   penalty, or interest which was deposited into the property tax 21   relief fund and which was not due, all of the provisions of 22   section 437A.14, subsection 1 , paragraph b , shall apply with 23   regard to any claim for refund or credit filed by the taxpayer. 24   The director shall have sole discretion as to whether the 25   erroneous payment will be refunded to the taxpayer or credited 26   against any replacement tax due, or to become due, from the 27   taxpayer that would be subject to deposit in the property tax 28   relief fund. 29   Sec. 128. Section 437A.15, subsection 3, paragraph f, Code 30   2024, is amended to read as follows: 31   f. Notwithstanding the provisions of this section , if 32   a taxpayer is a municipal utility or a municipal owner of 33   an electric power facility financed under the provisions 34   of chapter 28F or 476A , the assessed value, other than the 35   -57-   LSB 5509HZ (7) 90   dg/ko   57/ 101     

  H.F. 2673   local amount, of a new electric power generating plant shall 1   be allocated to each taxing district in which the municipal 2   utility or municipal owner is serving customers and has 3   electric meters in operation in the ratio that the number of 4   operating electric meters of the municipal utility or municipal 5   owner located in the taxing district bears to the total number 6   of operating electric meters of the municipal utility or 7   municipal owner in the state as of January 1 of the tax year. 8   If the municipal utility or municipal owner of an electric 9   power facility financed under the provisions of chapter 28F 10   or 476A has a new electric power generating plant but the 11   municipal utility or municipal owner has no operating electric 12   meters in this state, the municipal utility or municipal owner 13   shall pay the replacement generation tax associated with the 14   new electric power generating plant allocation of the local 15   amount to the county treasurer of the county in which the local 16   amount is located and shall remit the remaining replacement 17   generation tax, if any, to the director at the times contained 18   in section 437A.8, subsection 4 , for remittance of the tax to 19   the county treasurers. All remaining replacement generation 20   tax revenues received by the director shall be deposited in the 21   property tax relief   behavioral health fund created established 22   in section 426B.1, and shall be distributed as provided in   23   section 426B.2 225A.7 . 24   Sec. 129. Section 483A.24, subsection 7, Code 2024, is 25   amended to read as follows: 26   7. A license shall not be required of minor pupils of the 27   Iowa school for the deaf or of minor residents of other state   28   institutions under the control of the department of health 29   and human services. In addition, a person who is on active 30   duty with the armed forces of the United States, on authorized 31   leave from a duty station located outside of this state, and 32   a resident of the state of Iowa shall not be required to 33   have a license to hunt or fish in this state. The military 34   person shall carry the persons leave papers and a copy of 35   -58-   LSB 5509HZ (7) 90   dg/ko   58/ 101         

  H.F. 2673   the persons current earnings statement showing a deduction 1   for Iowa income taxes while hunting or fishing. In lieu of 2   carrying the persons earnings statement, the military person 3   may also claim residency if the person is registered to vote 4   in this state. If a deer or wild turkey is taken, the military 5   person shall immediately contact a state conservation officer 6   to obtain an appropriate tag to transport the animal. A 7   license shall not be required of residents of county care   8   facilities or   any person who is receiving supplementary 9   assistance under chapter 249 . 10   Sec. 130. Section 602.8102, subsection 39, Code 2024, is 11   amended to read as follows: 12   39. Refer persons applying for voluntary admission to a 13   community mental health center accredited by the department   14   of health and human services under section 225A.3, for a 15   preliminary diagnostic evaluation as provided in section 16   225C.16, subsection 2 . 17   Sec. 131. Section 714.8, subsection 12, Code 2024, is 18   amended to read as follows: 19   12. Knowingly transfers or assigns a legal or equitable 20   interest in property, as defined in section 702.14 , for less 21   than fair consideration, with the intent to obtain public 22   assistance under chapters 16 , 35B , and   35D , and 347B , or Title 23   VI, subtitles 2 through 6 , or accepts a transfer of or an 24   assignment of a legal or equitable interest in property, as 25   defined in section 702.14 , for less than fair consideration, 26   with the intent of enabling the party transferring the property 27   to obtain public assistance under chapters 16 , 35B , and 35D , 28   and 347B , or Title VI, subtitles 2 through 6 . A transfer or 29   assignment of property for less than fair consideration within 30   one year prior to an application for public assistance benefits 31   shall be evidence of intent to transfer or assign the property 32   in order to obtain public assistance for which a person is 33   not eligible by reason of the amount of the persons assets. 34   If a person is found guilty of a fraudulent practice in the 35   -59-   LSB 5509HZ (7) 90   dg/ko   59/ 101                 

  H.F. 2673   transfer or assignment of property under this subsection the 1   maximum sentence shall be the penalty established for a serious 2   misdemeanor and sections 714.9 , 714.10 , and 714.11 shall not 3   apply. 4   Sec. 132. Section 812.6, subsection 1, Code 2024, is amended 5   to read as follows: 6   1. If the court finds the defendant does not pose a danger 7   to the public peace and safety, is otherwise qualified for 8   pretrial release, and is willing to cooperate with treatment, 9   the court shall order, as a condition of pretrial release, 10   that the defendant obtain mental health treatment designed to 11   restore the defendant to competency. The costs of treatment 12   pursuant to this subsection shall be paid by the mental   13   health and disability services region for the county of the   14   defendants residency pursuant to chapter 225C regardless of 15   whether the defendant meets financial eligibility requirements 16   under section 225C.62 or 225C.66 an administrative services 17   organization designated pursuant to section 225A.4   . 18   Sec. 133. Section 904.201, subsection 8, Code 2024, is 19   amended to read as follows: 20   8. Chapter 230 governs the determination of costs and 21   charges for the care and treatment of persons with mental 22   illness admitted to the forensic psychiatric hospital ,   23   except that charges for the care and treatment of any person 24   transferred to the forensic psychiatric hospital from an adult 25   correctional institution or from a state training school shall 26   be paid entirely from state funds . Charges for all other 27   persons at the forensic psychiatric hospital shall be billed to 28   the respective counties at the same ratio as for patients at 29   state mental health institutes under section 230.20.   30   Sec. 134. REPEAL. Chapters 142A, 225C, 227, 230A, and 347B, 31   Code 2024, are repealed. 32   Sec. 135. REPEAL. Sections 125.1, 125.3, 125.7, 125.9,   33   125.10, 125.12, 125.25, 125.32A, 125.34, 125.37, 125.38,   34   125.39, 125.40, 125.41, 125.42, 125.43, 125.43A, 125.46,   35   -60-   LSB 5509HZ (7) 90   dg/ko   60/ 101                  

  H.F. 2673   125.48, 125.54, 125.55, 125.58, 125.59, 125.60, 135B.18, 1   218.99, 222.59, 222.60, 222.61, 222.62, 222.63, 222.64, 222.65, 2   222.66, 222.67, 222.68, 222.69, 222.70, 222.74, 222.75, 225.10, 3   225.19, 225.21, 226.45, 229.42, 230.1A, 230.2, 230.3, 230.4, 4   230.5, 230.6, 230.9, 230.12, 230.16, 230.17, 230.18, 230.19, 5   230.20, 230.21, 230.22, 230.25, 230.26, 230.27, 426B.2, 426B.4, 6   and 426B.5, Code 2024, are repealed. 7   Sec. 136. CODE EDITOR DIRECTIVE. The Code editor is 8   directed to correct internal references in the Code and in any 9   enacted legislation as necessary due to the enactment of this 10   division of this Act. 11   Sec. 137. EFFECTIVE DATE. This division of this Act takes 12   effect July 1, 2025. 13   DIVISION III 14   AGING AND DISABILITY 15   Sec. 138. Section 231.3, Code 2024, is amended to read as 16   follows: 17   231.3 State policy and objectives. 18   1.   The general assembly declares that it is the policy of 19   the state to work toward attainment of the following objectives 20   for Iowas older individuals and individuals with disabilities   : 21   1. a. An adequate income. 22   2.   b. Access to physical and mental health care and 23   long-term living and community support services without regard 24   to economic status. 25   3. c. Suitable and affordable housing that reflects the 26   needs of older individuals.   27   4.   d. Access to comprehensive information and a community 28   navigation system providing all available options related to 29   long-term living and community support services that assist 30   older   individuals in the preservation of personal assets and 31   the ability to entirely avoid or significantly delay reliance 32   on entitlement programs. 33   5.   e. Full restorative services for those who require 34   institutional care, and a comprehensive array of long-term 35   -61-   LSB 5509HZ (7) 90   dg/ko   61/ 101                

  H.F. 2673   living and community support services adequate to sustain older 1   people in their communities and, whenever possible, in their 2   homes, including support for caregivers. 3   6.   f. Pursuit of meaningful activity within the widest 4   range of civic, cultural, educational, recreational, and 5   employment opportunities. 6   7. g. Suitable community transportation systems to assist 7   in the attainment of independent movement. 8   8.   h. Freedom, independence, and the free exercise of 9   individual initiative in planning and managing their own lives. 10   9.   i. Freedom from abuse, neglect, and exploitation. 11   2. The general assembly declares that the state of Iowa 12   recognizes a brain injury as a disability, and each agency and 13   subdivision of this state shall recognize a brain injury as a   14   distinct disability. 15   3. It is the policy of this state that each state agency 16   shall make reasonable efforts to identify those persons with 17   brain injuries among the persons served by the state agency.   18   Sec. 139. Section 231.4, subsection 1, Code 2024, is amended 19   by adding the following new paragraph: 20   NEW PARAGRAPH   . 0c. Brain injury means the same as defined 21   in section 135.22. 22   Sec. 140. Section 231.4, subsection 1, paragraph d, Code 23   2024, is amended to read as follows: 24   d. Commission   means the commission on aging. Council 25   means the council on health and human services created in 26   section 217.2. 27   Sec. 141. Section 231.14, Code 2024, is amended to read as   28   follows:   29   231.14 Commission   Council duties and authority. 30   1. The commission is the policymaking body of the sole state 31   agency responsible for administration of the federal Act.   The 32   commission council shall do all of the following : 33   a.   1. Approve Make recommendations to the department 34   regarding approval of the state plan on aging developed under 35   -62-   LSB 5509HZ (7) 90   dg/ko   62/ 101                                           

  H.F. 2673   section 231.31 and area plans on aging , developed under section 1   231.33   . 2   b. 2. Adopt Recommend policies to coordinate state 3   activities related to the purposes of this chapter . 4   c.   3. Serve as an effective and visible advocate for older 5   individuals and individuals with disabilities   by establishing 6   recommending policies for reviewing and commenting upon 7   all state plans, budgets, and policies which affect older 8   individuals and for providing technical assistance to any   9   agency, organization, association, or individual representing 10   the needs of older   individuals with disabilities . 11   d. Divide the state into distinct planning and service 12   areas after considering the geographical distribution of 13   older individuals in the state, the incidence of the need   14   for supportive services, nutrition services, multipurpose 15   senior centers, and legal services, the distribution of older 16   individuals who have low incomes residing in such areas, the 17   distribution of resources available to provide such services   18   or centers, the boundaries of existing areas within the   19   state which are drawn for the planning or administration of 20   supportive services programs, the location of units of general   21   purpose, local government within the state, and any other 22   relevant factors.   23   e. Designate for each planning and service area a public or 24   private nonprofit agency or organization as the area agency on 25   aging for that area. The commission may revoke the designation 26   of an area agency on aging pursuant to section 231.32 . 27   f. 4. Adopt policies to assure Make recommendations to 28   ensure that the department will take into account the views 29   of older individuals and individuals with disabilities   in the   30   development of policy. 31   g.   Adopt a method for the distribution of federal 32   Act and state funds taking into account, to the maximum 33   extent feasible, the best available data on the geographic   34   distribution of older individuals in the state, and publish the 35   -63-   LSB 5509HZ (7) 90   dg/ko   63/ 101                                                       

  H.F. 2673   method for review and comment. 1   h.   5. Adopt Recommend policies and measures to assure 2   ensure that preference will be given to providing services to 3   older individuals and individuals with disabilities with the 4   greatest economic or social needs, with particular attention to 5   low-income minority older individuals, older individuals with 6   limited English proficiency, and older individuals residing in 7   rural areas. 8   i.   6. Adopt Recommend policies to administer state programs 9   authorized by this chapter . 10   j.   7. Adopt Recommend policies and administrative rules 11   pursuant to chapter 17A that support the capabilities of the 12   area agencies on aging and the aging and disabilities resource 13   centers to serve older individuals and persons   individuals 14   with disabilities experiencing Alzheimers disease or related 15   dementias. 16   2. The commission shall adopt administrative rules pursuant 17   to   chapter 17A to administer the duties specified in this 18   chapter   and in all other chapters under the departments 19   jurisdiction. 20   Sec. 142. Section 231.21, Code 2024, is amended to read as 21   follows: 22   231.21 Administration of chapter  department of health and 23   human services. 24   The department of health and human services shall administer   25   this chapter under the policy direction of the commission 26   on aging consider the recommendations of the council when 27   administering this chapter . 28   Sec. 143. Section 231.23, Code 2024, is amended to read as 29   follows:   30   231.23 Department  duties and authority. 31   The department shall: 32   1. Develop and administer a   Administer the state plan on 33   aging developed pursuant to section 231.31   . 34   2. Assist the commission in the review and approval of 35   -64-   LSB 5509HZ (7) 90   dg/ko   64/ 101                                              

  H.F. 2673   Review and approve area plans developed under section 231.33 . 1   3. Pursuant to commission policy, coordinate   Coordinate 2   state activities related to the purposes of this chapter 3   and all other chapters under the departments jurisdiction . 4   State activities shall include, at a minimum, home and   5   community-based services such as employment support, community   6   living, and service coordination. 7   4. Advocate for older individuals and individuals with 8   disabilities   by reviewing and commenting upon all state plans, 9   budgets, laws, rules, regulations, and policies which affect 10   older individuals or individuals with disabilities   and by 11   providing technical assistance to any agency, organization, 12   association, or individual representing the needs of older 13   individuals or individuals with disabilities   . 14   5. Assist the commission in dividing Divide the state into 15   distinct planning and service areas after considering the 16   geographical distribution of older individuals and individuals 17   with disabilities in the state, the incidence of the need   18   for supportive services, nutrition services, multipurpose   19   senior centers, and legal services, the distribution of older 20   individuals and individuals with disabilities with low income   21   residing in such areas, the distribution of resources available 22   to provide such services or centers, the boundaries of existing   23   areas within the state which are drawn for the planning or 24   administration of supportive services programs, the location of 25   units of general purpose, local government within the state, 26   and any other relevant factors . 27   6. Assist the commission in designating Designate for each 28   area a public or private nonprofit agency or organization as 29   the area agency on aging for that area. The department may   30   revoke the designation of an area agency on aging pursuant to 31   section 231.32.   32   7. Pursuant to commission policy, take Take into account the 33   views of older Iowans and Iowans with disabilities   . 34   8. Assist the commission in adopting Adopt a method for 35   -65-   LSB 5509HZ (7) 90   dg/ko   65/ 101                                       

  H.F. 2673   the distribution of funds available from the federal Act 1   and state appropriations and allocations that takes into   2   account, to the extent feasible, the best available data on the 3   geographic distribution of older individuals and individuals 4   with disabilities in the state   . 5   9. Assist the commission in assuring   Adopt policies and 6   measures to ensure that preference will be given to providing 7   services to older individuals and individuals with disabilities 8   with the greatest economic or social needs, with particular 9   attention to low-income minority older   individuals, older 10   individuals with limited English proficiency, and older   11   individuals residing in rural areas. 12   10. Assist the commission in developing, adopting, and 13   enforcing   Develop, adopt, and enforce administrative rules, 14   including by issuing necessary forms and procedures , to 15   administer the duties specified in this chapter . 16   11. Apply for, receive, and administer grants, devises, 17   donations, and   gifts , or bequests of real or personal property 18   from any source to conduct projects consistent with the 19   purposes of the department. Notwithstanding section 8.33 , 20   moneys received by the department pursuant to this section are 21   not subject to reversion to the general fund of the state. 22   12. Administer state authorized programs. 23   13. Establish a procedure for an area agency on aging to 24   use in selection of members of the agencys board of directors. 25   The selection procedure shall be incorporated into the bylaws 26   of the board of directors.   27   14.   Adopt rules pursuant to chapter 17A that support the 28   capabilities of the area agencies on aging, and aging and 29   disabilities resource centers, to serve older individuals and   30   individuals with disabilities. 31   Sec. 144. Section 231.23A, subsections 1 and 3, Code 2024,   32   are amended to read as follows: 33   1. Services for older individuals, persons with   34   disabilities eighteen years of age and older, family 35   -66-   LSB 5509HZ (7) 90   dg/ko   66/ 101                             

  H.F. 2673   caregivers, and veterans as defined by the department in the 1   most current version of the departments reporting manual and 2   pursuant to the federal Act and regulations. 3   3. The aging   Aging and disability resource center centers . 4   Sec. 145. Section 231.23A, Code 2024, is amended by adding 5   the following new subsection: 6   NEW SUBSECTION . 7A. Services and supports available to 7   individuals with disabilities including but not limited to 8   individuals with mental illness, an intellectual disability or 9   other developmental disability, or a brain injury. 10   Sec. 146. Section 231.31, Code 2024, is amended to read as 11   follows: 12   231.31 State plan on aging. 13   The department shall develop , and submit to the commission   14   on aging for approval, a multiyear state plan on aging. 15   The state plan on aging shall meet all applicable federal 16   requirements. 17   Sec. 147. Section 231.32, Code 2024, is amended to read as 18   follows: 19   231.32 Criteria for designation of area agencies on aging. 20   1. The commission   department shall designate an area 21   agency on aging for each planning and service area. The 22   commission shall continue the   designation shall continue until 23   an area agency on agings designation is removed for cause as 24   determined by the commission department , until the time of 25   renewal or the annual update of an area plan, until the agency 26   voluntarily withdraws as an area agency on aging, or until a 27   change in the designation of planning and service areas or area 28   agencies on aging is required by state or federal law. In that 29   event, the commission   department shall proceed in accordance 30   with subsections 2, 3, and 4 . Designated area agencies on 31   aging shall comply with the requirements of the federal Act. 32   2. The commission   department shall designate an area 33   agency on aging   to serve each planning and service area, after 34   consideration of the views offered by units of general purpose 35   -67-   LSB 5509HZ (7) 90   dg/ko   67/ 101                    

  H.F. 2673   local government. An area agency on aging may be: 1   a. An established office of aging which is operating within 2   a planning and service area designated by the commission   3   department . 4   b. Any office or agency of a unit of general purpose local 5   government, which is designated to function only for the 6   purpose of serving as an area agency on aging by the chief 7   elected official of such unit. 8   c. Any office or agency designated by the appropriate 9   chief elected officials of any combination of units of 10   general purpose local government to act only on behalf of such 11   combination for such purpose. 12   d. Any public or nonprofit private agency in a planning and 13   service area or any separate organizational unit within such 14   agency which is under the supervision or direction for this 15   purpose of the department and which can and will engage only in 16   the planning or provision of a broad range of long-term living 17   and community support services or nutrition services within the 18   planning and service area. 19   3. When the commission   department designates a new area 20   agency on aging ,   the commission department shall give the right 21   of first refusal to a unit of general purpose local government 22   if: 23   a. Such unit can meet the requirements of subsection 1 . 24   b. The boundaries of such a unit and the boundaries of the 25   area are reasonably contiguous. 26   4. Each area agency on aging   shall provide assurance, 27   determined adequate by the commission department , that the 28   area agency on aging has the ability to develop an area plan 29   and to carry out, directly or through contractual or other 30   arrangements, a program in accordance with the plan within the 31   planning and service area. In designating an area agency on 32   aging within the planning and service area, the commission   33   department   shall give preference to an established office of 34   aging, unless the commission department finds that no such 35   -68-   LSB 5509HZ (7) 90   dg/ko   68/ 101                  

  H.F. 2673   office within the planning and service area has the capacity to 1   carry out the area plan. 2   5. Upon designation, an area agency on aging shall be 3   considered an instrumentality of the state and shall adhere to 4   all state and federal mandates applicable to an instrumentality 5   of the state. 6   Sec. 148. Section 231.33, subsections 1 and 13, Code 2024, 7   are amended to read as follows: 8   1. Develop and administer an area plan on aging   approved by 9   the commission department . 10   13. Submit all fiscal and performance reports in accordance 11   with the policies of the commission   department . 12   Sec. 149. Section 231.56, Code 2024, is amended to read as 13   follows: 14   231.56 Services and programs. 15   The department shall administer long-term living and 16   community support services and programs that allow older 17   individuals and individuals with disabilities   to secure and 18   maintain maximum independence and dignity in a home environment 19   that provides for self-care with appropriate supportive 20   services, assist in removing individual and social barriers 21   to economic and personal independence for older individuals 22   and individuals with disabilities   , and provide a continuum of 23   care for older individuals and individuals with disabilities. 24   Funds appropriated for this purpose shall be allocated based 25   on administrative rules adopted by the commission department 26   pursuant to chapter 17A . The department shall require such 27   records as needed   adopt rules pursuant to chapter 17A that 28   allow the department to collect information as necessary from 29   long-term living and community support services, program   30   providers, and patients to administer this section . 31   Sec. 150. Section 231.57, Code 2024, is amended to read as 32   follows:   33   231.57 Coordination of advocacy. 34   The department shall administer a program for the 35   -69-   LSB 5509HZ (7) 90   dg/ko   69/ 101                   

  H.F. 2673   coordination of information and assistance provided within 1   the state to assist older individuals and individuals with   2   disabilities, and their caregivers , in obtaining and protecting 3   their rights and benefits. State and local agencies providing 4   information and assistance to older individuals and individuals   5   with disabilities,   and their caregivers , in seeking their 6   rights and benefits shall cooperate with the department in 7   administering this program. 8   Sec. 151. Section 231.58, Code 2024, is amended to read as 9   follows: 10   231.58 Long-term living coordination. 11   The director may convene meetings, as necessary, of the 12   director and the director of inspections, appeals, and 13   licensing, to assist in the coordination of policy, service 14   delivery, and long-range planning relating to the long-term 15   living system and older Iowans and Iowans with disabilities   16   in the state. The group may consult with individuals, 17   institutions, and entities with expertise in the area of the 18   long-term living system and older Iowans and Iowans with   19   disabilities , as necessary, to facilitate the groups efforts. 20   Sec. 152. Section 231.64, Code 2024, is amended to read as 21   follows: 22   231.64 Aging and disability resource center   centers . 23   1. The aging and disability resource center shall be 24   administered by the department consistent with the federal 25   Act . The department shall designate area agencies on aging and 26   disability resource centers to establish, in consultation with 27   other stakeholders including organizations representing the 28   disability community, a coordinated local aging and disability 29   service   system for providing . In addition to services required 30   by the department by rules adopted pursuant to chapter 17A, 31   aging and disability resource centers shall provide for   all of 32   the following: 33   a. Comprehensive information, referral, and assistance 34   regarding the full range of available public and private 35   -70-   LSB 5509HZ (7) 90   dg/ko   70/ 101                           

  H.F. 2673   long-term living and community support services, options, 1   service providers, and resources within a community, including 2   information on the availability of integrated long-term care. 3   b. Options counseling to assist individuals in assessing 4   their existing or anticipated long-term care needs and 5   developing and implementing a plan for long-term living and 6   community support services designed to meet their specific 7   needs and circumstances. The plan for long-term living 8   and community support services may include support with 9   person-centered care transitions to assist consumers and family 10   caregivers with transitions between home and care settings. 11   c. Consumer access to the range of publicly-supported 12   long-term living and community support services for which 13   consumers may be eligible, by serving as a convenient point 14   of entry for such services. The aging   Aging and disability 15   resource center centers shall offer information online and 16   be available via a toll-free telephone number, electronic 17   communications, and in person. 18   2.   The following entities shall be eligible to be designated 19   as an aging and disability resource center by the department: 20   a.   An area agency on aging established on or before June 30, 21   2024. 22   b.   A public or private nonprofit agency, or any separate 23   organizational unit within the public or private nonprofit 24   agency, that has the capabilities to engage in the planning or 25   provision of aging and disability services only as directed by 26   the department. 27   2. 3. The aging Aging and disability resource center 28   centers shall assist older individuals, persons individuals 29   with disabilities age eighteen or older   , family caregivers, 30   and people who inquire about or request assistance on behalf 31   of members of these groups, as they seek long-term living and 32   community support services. 33   4.   The department shall adopt rules pursuant to chapter 17A 34   to implement this section. 35   -71-   LSB 5509HZ (7) 90   dg/ko   71/ 101                                  

  H.F. 2673   Sec. 153. NEW SECTION . 231.75 Scope. 1   The service quality standards and rights in this subchapter 2   VII shall apply to any person with an intellectual disability, 3   a developmental disability, brain injury, or chronic mental 4   illness who receives services which are funded in whole or in 5   part by public funds, or services which are permitted under 6   Iowa law. 7   Sec. 154. NEW SECTION   . 231.76 Service quality standards. 8   As the state participates more fully in funding services 9   and other support for persons with an intellectual disability, 10   developmental disability, brain injury, or chronic mental 11   illness, it is the intent of the general assembly that the 12   state shall seek to attain the following quality standards in 13   the provision of services and other supports: 14   1. Provide comprehensive evaluation and diagnosis adapted 15   to the cultural background, primary language, and ethnic origin 16   of a person. 17   2. Provide an individual treatment, habilitation, and 18   program services plan. 19   3. Provide treatment, habilitation, and program services 20   that are individualized, flexible, cost-effective, and produce 21   results. 22   4. Provide periodic review of an individuals treatment, 23   habilitation, and program services plan. 24   5. Provide for the least restrictive environment, and 25   age-appropriate services. 26   6. Provide appropriate training and employment 27   opportunities so that a persons ability to contribute to, and 28   participate in, the community is maximized. 29   7. Provide an ongoing process to determine the degree of 30   access to, and the effectiveness of, the services and other   31   supports in achieving the disability service outcomes and 32   indicators identified by the department. 33   Sec. 155. NEW SECTION   . 231.77 Rights. 34   All of the following rights shall apply to a person with an 35   -72-   LSB 5509HZ (7) 90   dg/ko   72/ 101     

  H.F. 2673   intellectual disability, a developmental disability, a brain 1   injury, or a chronic mental illness: 2   1. Wage protection. A person engaged in a work program 3   shall be paid wages commensurate with the going rate for 4   comparable work and productivity. 5   2. Insurance protection. Pursuant to section 507B.4, 6   subsection 3, paragraph g , a person or designated group 7   of persons shall not be unfairly discriminated against for 8   purposes of insurance coverage. 9   3. Citizenship. A person retains the right to citizenship 10   in accordance with the laws of the state. 11   4. Participation in planning activities. A person has 12   the right to participate in the formulation of an individual 13   treatment, habilitation, and program plan developed for the 14   person. 15   Sec. 156. NEW SECTION   . 231.78 Compliance. 16   1. A persons sole remedy for a violation of a rule adopted 17   by the department to implement sections 231.75 through 231.77 18   shall be to initiate a proceeding with the department by 19   request pursuant to chapter 17A. 20   a. Any decision of the department shall be in accordance 21   with due process of law. A person or party who is aggrieved or 22   adversely affected by the departments action may seek judicial 23   review pursuant to section 17A.19. A person or party who is 24   aggrieved or adversely affected by a final judgment of the 25   district court may appeal under section 17A.20. 26   b. Either the department or a party in interest may apply 27   to the Iowa district court for an order to enforce a final   28   decision of the department. 29   2. Any rules adopted by the department to implement sections 30   231.76 and 231.77 shall not create any right, entitlement, 31   property or liberty right or interest, or private cause of 32   action for damages against the state or a political subdivision 33   of the state, or for which the state or a political subdivision 34   of the state would be responsible. 35   -73-   LSB 5509HZ (7) 90   dg/ko   73/ 101   

  H.F. 2673   3. Notwithstanding subsection 1, any violation of section 1   231.77, subsection 2, shall be subject to enforcement by the 2   commissioner of insurance pursuant to chapter 507B. 3   Sec. 157. NEW SECTION   . 231.79 Appeals process. 4   The department shall establish an appeals process by which a 5   person or the persons representative may appeal a decision of 6   the department concerning the provision or denial of aging or 7   disability services to the person. 8   Sec. 158. Section 231E.3, Code 2024, is amended to read as 9   follows: 10   231E.3 Definitions. 11   As used in this chapter , unless the context otherwise 12   requires: 13   1. Client means an individual for whom a representative 14   payee is appointed. 15   2.   Commission means the commission on aging. 16   3. 2. Conservator means conservator as defined in section 17   633.3 . 18   4.   3. Court means court as defined in section 633.3 . 19   5. 4. Department means the department of health and human 20   services. 21   6.   5. Director means the director of health and human 22   services. 23   7.   6. Guardian means guardian as defined in section 24   633.3 . 25   8. 7. Incompetent means incompetent as defined in section 26   633.3 .   27   9.   8. Local office means a local office of public 28   guardian. 29   10.   9. Local public guardian means an individual under 30   contract with the department to act as a guardian, conservator, 31   or representative payee. 32   11.   10. Public guardian means the state public guardian 33   or a local public guardian. 34   12.   11. Public guardianship services means guardianship, 35   -74-   LSB 5509HZ (7) 90   dg/ko   74/ 101                           

  H.F. 2673   conservatorship, or representative payee services provided by 1   the state public guardian or a local public guardian. 2   13.   12. Representative payee means an individual 3   appointed by a government entity to receive funds on behalf of 4   a client pursuant to federal regulation. 5   14. 13. State agency means any executive department, 6   commission, board, institution, division, bureau, office, 7   agency, or other executive entity of state government. 8   15.   14. State office means the state office of public 9   guardian. 10   16.   15. State public guardian means the administrator of 11   the state office of public guardian. 12   17. 16. Ward means the individual for whom a guardianship 13   or conservatorship is established. 14   Sec. 159. REPEAL. Sections 231.11, 231.12, and 231.13, Code 15   2024, are repealed. 16   Sec. 160. CODE EDITOR DIRECTIVE. The Code editor is 17   directed to do all of the following: 18   1. Entitle Code chapter 231 Department of Health and Human 19   Services  Aging and Disability Services. 20   2. Designate sections 231.75 through 231.79, as enacted in 21   this division of this Act, as subchapter VII entitled Bill 22   of Rights and Service Quality Standards for Persons with an 23   Intellectual Disability, Developmental Disability, Brain 24   Injury, or Chronic Mental Illness. 25   3. Correct internal references in the Code and in any 26   enacted legislation as necessary due to the enactment of this 27   division of this Act.   28   Sec. 161. EFFECTIVE DATE. The following take effect July 29   1, 2025: 30   1. The parts of the sections of this division of this Act 31   amending the following: 32   a. Section 231.3.   33   b. Section 231.4, subsection 1.   34   c. Section 231.23, subsections 4 and 7.   35   -75-   LSB 5509HZ (7) 90   dg/ko   75/ 101            

  H.F. 2673   d. Section 231.23A, subsection 1. 1   e. Sections 231.56, 231.57, and 231.58. 2   f. Section 231.64, subsection 2. 3   2. The parts of the sections of this division of this Act 4   enacting the following: sections 231.23A, subsection 7A, 5   231.75, 231.76, 231.77, 231.78, and 231.79. 6   DIVISION IV 7   TRANSITION PROVISIONS 8   Sec. 162. DEPARTMENT OF HEALTH AND HUMAN SERVICES  9   TRANSITION OF MENTAL HEALTH SERVICES, ADDICTIVE DISORDER 10   SERVICES, AND DISABILITY SERVICES. 11   1. For purposes of this division: 12   a. Administrative services organization means the same 13   as defined in section 225A.1, as enacted in division I of this 14   Act. 15   b. Behavioral health district means the same as defined in 16   section 225A.1, as enacted in division I of this Act. 17   c. Department means the department of health and human 18   services. 19   d. District behavioral health service system plan means 20   the same as defined in section 225A.1, as enacted in division 21   I of this Act. 22   e. Mental health and disability services region means the 23   same as defined in section 225C.2, subsection 9. 24   f. State behavioral health service system means the state 25   behavioral health service system as established in section 26   225A.3, as enacted in division I of this Act.   27   g. State behavioral health service system plan means the 28   same as defined in section 225A.1, as enacted in division I of   29   this Act.   30   h. Transition period means the period beginning on the 31   date of enactment of this division of this Act and concluding 32   on June 30, 2025. 33   2. There is created a behavioral health service system under 34   the control of the department. For the fiscal year beginning 35   -76-   LSB 5509HZ (7) 90   dg/ko   76/ 101  

  H.F. 2673   July 1, 2025, and each succeeding fiscal year, the behavioral 1   health service system shall be responsible for implementing and 2   maintaining a statewide system of prevention, education, early 3   intervention, treatment, recovery support, and crisis services 4   related to mental health and addictive disorders, including 5   but not limited to substance use, tobacco use, and problem 6   gambling. For the fiscal year beginning July 1, 2025, and each 7   succeeding fiscal year, the departments division of aging 8   and disability services shall be responsible for disability 9   services. 10   3. During the transition period, the department may 11   exercise all policymaking functions and regulatory powers 12   established in division I of this Act, as necessary to 13   establish the state behavioral health service system. 14   4. To ensure the state behavioral health service system 15   and the division of aging and disability services are able to 16   operate as intended at the conclusion of the transition period, 17   the department shall perform all the following duties: 18   a. Make contracts as necessary to set up services and 19   administrative functions. 20   b. Adopt rules as necessary to establish and administer the 21   states behavioral health service system. 22   c. Establish policies as necessary to ensure efficient 23   implementation and operation of the behavioral health service 24   system. 25   d. Prepare forms necessary for the implementation and 26   administration of behavioral health services.   27   e. Prepare a state behavioral health service system plan for 28   the state behavioral health service system. 29   f. Designate behavioral health districts on or before 30   August 1, 2024. The behavioral health district designation 31   process shall include an opportunity for the public to 32   review and to comment on proposed behavioral health district 33   boundaries. 34   g. Designate an administrative services organization for 35   -77-   LSB 5509HZ (7) 90   dg/ko   77/ 101  

  H.F. 2673   each behavioral health district on or before December 31, 2024. 1   h. Review and approve district behavioral health service 2   system plans for services related to the behavioral health 3   service system. 4   i. Issue all necessary licenses and certifications. 5   j. Establish contractual rights, privileges, and 6   responsibilities as necessary to establish and implement the 7   state behavioral health service system. 8   k. Develop and implement a plan to ensure that persons 9   currently receiving disability services or early intervention, 10   treatment, recovery support, or crisis services related 11   to mental health or addictive disorders, including but not 12   limited to alcohol use, substance use, tobacco use, and problem 13   gambling, have an uninterrupted continuum of care. 14   l. Establish a central data repository as described in 15   section 225A.6, as enacted in division I of this Act. 16   5. If the department determines that a federal waiver or 17   authorization is necessary to administer any provision of this 18   division of this Act or to effectuate the state behavioral 19   health service system by the conclusion of the transition 20   period, the department shall timely request the federal waiver 21   or authorization. Notwithstanding any other effective date to 22   the contrary, a provision the department determines requires a 23   federal waiver or authorization shall be effective only upon 24   receipt of federal approval for the waiver or authorization. 25   6. a. On or before July 1, 2024, the department shall 26   publish on the departments internet site an initial transition 27   plan for establishing the state behavioral health service 28   system. The transition plan shall describe, at a minimum, all 29   of the following: 30   (1) All tasks that require completion before July 1, 2025. 31   The description of tasks shall include a description of how the 32   department will solicit comments from stakeholders, including 33   employees of the department, persons served by the department, 34   partners of the department, members of the public, and members 35   -78-   LSB 5509HZ (7) 90   dg/ko   78/ 101  

  H.F. 2673   of the general assembly, and a detailed timeline for the 1   completion of the tasks described. 2   (2) The proposed organizational structure of the state 3   behavioral health service system. 4   (3) The transition of service delivery sites from locations 5   where people currently receive behavioral health services to 6   where the people will receive behavioral health services under 7   the state behavioral health service system. 8   (4) Procedures for the transfer and reconciliation of 9   budgeting and funding between the mental health and disability 10   services regions and the department. 11   (5) A description of how responsibilities for disability 12   services programs will be transferred from current program 13   administrators to the departments division of aging and 14   disability services by the end of the transition period. 15   (6) Any additional known tasks that may require completion 16   after the transition on July 1, 2025. 17   b. The transition plan published under paragraph a shall: 18   (1) Be updated no less than quarterly during the transition 19   period with the current status of completing the tasks 20   identified in paragraph a, subparagraph (1). 21   (2) Describe how information regarding any changes in 22   service delivery will be provided to persons receiving services 23   from the mental health and disability services regions or 24   current behavioral health care providers contracted with the 25   department. 26   (3) Describe how the transition is being funded, including 27   how expenses associated with the transition will be managed. 28   7. a. Before the end of the transition period, the 29   governing board of each mental health and disability services 30   region that maintains a combined account pursuant to section 31   225C.58, subsection 1, shall transfer all unencumbered and   32   unobligated moneys remaining in the combined account to the 33   treasurer of state for deposit into the behavioral health fund 34   as established in section 225A.7 as enacted in division I of 35   -79-   LSB 5509HZ (7) 90   dg/ko   79/ 101  

  H.F. 2673   this Act. 1   b. Before the end of the transition period, each county 2   which maintains a county mental health and disability services 3   fund pursuant to section 225C.58, subsection 1, shall transfer 4   all unencumbered and unobligated moneys remaining in the mental 5   health and disability services fund to the treasurer of state 6   for deposit into the behavioral health fund as established in 7   section 225A.7 as enacted in division I of this Act. 8   c. Moneys in the behavioral health fund as established 9   in section 225A.7 as enacted in division I of this Act are 10   appropriated to the department for the purposes established in 11   section 225A.7 as enacted in division I of this Act, and as 12   otherwise necessary to effectuate this division of this Act. 13   8. a. All debts, claims, or other liabilities owed to a 14   county, a mental health and disability services region, or 15   the state due to services rendered pursuant to chapter 125, 16   222, 225, 225C, 226, 227, 229, 230, or 230A, Code 2024, at the 17   conclusion of the transition period shall remain due and owing 18   after the transition period concludes. 19   b. After the transition period concludes, each county 20   auditor shall collect outstanding debts, claims, or other 21   liabilities owed to the county for services rendered pursuant 22   to chapter 125, 222, 225, 225C, 226, 227, 229, 230, or 230A, 23   Code 2024, before the transition period concluded. The county 24   attorney may bring a judicial action as necessary to collect 25   the outstanding debts, claims, or other liabilities. 26   9. With input from appropriate stakeholders, the department 27   shall identify each contract that will be impacted by mental 28   health and disability services being transferred to the state 29   behavioral health service system, or by responsibilities 30   being transferred to the departments division of aging and 31   disabilities, pursuant to this Act. On or before June 30, 32   2025, a party to a contract identified by the department 33   under this subsection shall exercise the option, if available 34   pursuant to the terms of the contract, to terminate the 35   -80-   LSB 5509HZ (7) 90   dg/ko   80/ 101  

  H.F. 2673   contract in accordance with the terms of the contract which 1   provide for termination. Contracts that do not provide for 2   termination shall not be renewed or extended at the end of the 3   current contract term. 4   10. A mental health and disability services region, a 5   regional administrator as defined in section 225C.55, and 6   any subdivision of the state shall not enter into, renew, or 7   extend any contract for services related to mental health and 8   disability services or addictive disorder services beyond June 9   30, 2025. 10   Sec. 163. DEPARTMENT OF HEALTH AND HUMAN SERVICES  11   TRANSITION FUNDING. Notwithstanding any provision of law to 12   the contrary, there is appropriated from the region incentive 13   fund of the mental health and disability services regional 14   service fund created in section 225C.7A, subsection 8, to the 15   department of health and human services for the fiscal year 16   beginning July 1, 2024, and ending June 30, 2025, the following 17   amount, or so much thereof as is necessary, to be used for the 18   purposes designated: 19   For the establishment of a central data repository as 20   described in section 225A.6, subsection 1, as enacted in 21   division I of this Act: 22   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 645,179 23   Notwithstanding section 8.33, moneys appropriated in this 24   section that remain unencumbered or unobligated at the close 25   of the fiscal year shall not revert to the credit of the region 26   incentive fund of the mental health and disability services 27   regional service fund, but shall be credited to the behavioral 28   health fund created in section 225A.7, as enacted in division I 29   of this Act, and are appropriated to the department of health 30   and human services for expenditure for the purposes of the 31   behavioral health fund.   32   Sec. 164. EMERGENCY RULES. The department of health and 33   human services may adopt emergency rules under section 17A.4, 34   subsection 3, and section 17A.5, subsection 2, paragraph b, 35   -81-   LSB 5509HZ (7) 90   dg/ko   81/ 101  

  H.F. 2673   to implement the provisions of this division of this Act and 1   the rules shall be effective immediately upon filing unless 2   a later date is specified in the rules. Any rules adopted 3   in accordance with this section shall also be published as a 4   notice of intended action as provided in section 17A.4. 5   Sec. 165. EFFECTIVE DATE. This division of this Act, being 6   deemed of immediate importance, takes effect upon enactment. 7   DIVISION V 8   ELIMINATION OF SPECIAL INTELLECTUAL DISABILITY UNITS 9   Sec. 166. Section 222.1, subsection 3, Code 2024, is amended 10   by striking the subsection. 11   Sec. 167. Section 222.2, subsection 8, Code 2024, is amended 12   by striking the subsection. 13   Sec. 168. Section 222.5, Code 2024, is amended to read as 14   follows: 15   222.5 Preadmission diagnostic evaluation. 16   A person shall not be eligible for admission to a resource 17   center or a special unit   until a preadmission diagnostic 18   evaluation has been made by a resource center or a special unit   19   which confirms or establishes the need for admission. 20   Sec. 169. Section 222.7, unnumbered paragraph 1, Code 2024, 21   is amended to read as follows: 22   The department may transfer patients from one state resource 23   center to the other and may at any time transfer patients from 24   the resource centers to the hospitals for persons with mental 25   illness , or transfer patients in the resource centers to a   26   special unit or vice versa . The department may also transfer 27   patients from a hospital for persons with mental illness to a 28   resource center if consent is given or obtained as follows: 29   Sec. 170. Section 222.8, Code 2024, is amended to read as   30   follows:   31   222.8 Communications by patients. 32   Persons admitted to the resource centers or a special   33   unit   shall have all reasonable opportunity and facility for 34   communication with their friends. Such persons shall be 35   -82-   LSB 5509HZ (7) 90   dg/ko   82/ 101        

  H.F. 2673   permitted to write and send letters, provided the letters 1   contain nothing of an offensive character. Letters written by 2   any patient to the director or to any state or county official 3   shall be forwarded unopened. 4   Sec. 171. Section 222.9, Code 2024, is amended to read as 5   follows: 6   222.9 Unauthorized departures. 7   If any person with an intellectual disability shall depart 8   without proper authorization from a resource center or a   9   special unit , it shall be the duty of the superintendent 10   and the superintendents assistants and all peace officers 11   of any county in which such patient may be found to take 12   and detain the patient without a warrant or order and to 13   immediately report such detention to the superintendent who 14   shall immediately provide for the return of such patient to the 15   resource center or special unit   . 16   Sec. 172. Section 222.12, subsection 1, Code 2024, is 17   amended to read as follows: 18   1. Upon the death of a patient of a resource center or   19   special unit , a preliminary investigation of the death shall be 20   conducted as required by section 218.64 by the county medical 21   examiner as provided in section 331.802 . Such a preliminary 22   investigation shall also be conducted in the event of a sudden 23   or mysterious death of a patient in a private institution 24   for persons with an intellectual disability. The chief 25   administrative officer of any private institution may request 26   an investigation of the death of any patient by the county 27   medical examiner.   28   Sec. 173. Section 222.73, subsections 1, 3, and 5, Code   29   2024, are amended to read as follows: 30   1. The superintendent of each resource center and special   31   unit   shall compute by February 1 the average daily patient 32   charge and outpatient treatment charges for which each county 33   will be billed for services provided to patients chargeable to 34   the county during the fiscal year beginning the following July 35   -83-   LSB 5509HZ (7) 90   dg/ko   83/ 101         

  H.F. 2673   1. The department shall certify the amount of the charges and 1   notify the counties of the billing charges. 2   a. The superintendent shall compute the average daily 3   patient charge for a resource center or special unit   for 4   services provided in the following fiscal year, in accordance 5   with generally accepted accounting procedures, by totaling 6   the expenditures of the resource center or special unit for 7   the immediately preceding calendar year, by adjusting the 8   expenditures by a percentage not to exceed the percentage 9   increase in the consumer price index for all urban consumers 10   for the immediately preceding calendar year, and by dividing 11   the adjusted expenditures by the total inpatient days of 12   service provided during the immediately preceding calendar 13   year. 14   b. The department shall compute the outpatient treatment 15   charges, in accordance with generally accepted accounting 16   procedures, on the basis of the actual cost of the outpatient 17   treatment provided during the immediately preceding calendar 18   year. 19   3.   2. The superintendent shall compute in January the 20   actual per-patient-per-day cost for each resource center or   21   special unit for the immediately preceding calendar year, in 22   accordance with generally accepted accounting procedures, by 23   totaling the actual expenditures of the resource center or   24   special unit for the calendar year and by dividing the total 25   actual expenditures by the total inpatient days of service 26   provided during the calendar year. 27   5. 3. A superintendent of a resource center or special 28   unit may request that the director enter into a contract with 29   a person for the resource center or special unit   to provide 30   consultation or treatment services or for fulfilling other 31   purposes which are consistent with the purposes stated in 32   section 222.1 . The contract provisions shall include charges 33   which reflect the actual cost of providing the services. Any 34   income from a contract authorized under this subsection may 35   -84-   LSB 5509HZ (7) 90   dg/ko   84/ 101               

  H.F. 2673   be retained by the resource center or special unit to defray 1   the costs of providing the services or fulfilling the other 2   purposes. Except for a contract voluntarily entered into by a 3   county under this subsection , the costs or income associated 4   with a contract authorized under this subsection shall not 5   be considered in computing charges and per diem costs in 6   accordance with the provisions of subsections 1 through 4   and 7   2 . 8   Sec. 174. Section 222.83, Code 2024, is amended to read as 9   follows: 10   222.83 Nonresident patients. 11   The estates of all nonresident patients who are provided 12   treatment, training, instruction, care, habilitation, and 13   support in or by a resource center or a special unit   , and all 14   persons legally bound for the support of such persons, shall be 15   liable to the state for the reasonable value of such services. 16   The certificate of the superintendent of the resource center 17   or special unit   in which any nonresident is or has been a 18   patient, showing the amounts drawn from the state treasury or 19   due therefrom as provided by law on account of such nonresident 20   patient, shall be presumptive evidence of the reasonable value 21   of such services furnished such patient by the resource center 22   or special unit   . 23   Sec. 175. Section 222.84, Code 2024, is amended to read as 24   follows: 25   222.84 Patients personal deposit fund. 26   There is established at each resource center and special 27   unit   a patients personal deposit fund. In the case of a 28   special unit, the director may direct that the patients   29   personal deposit fund be maintained and administered as a part   30   of the fund established, pursuant to sections 226.43 through 31   226.46   , by the state mental health institute where the special 32   unit is located. 33   Sec. 176. Section 222.85, subsection 1, Code 2024, is   34   amended to read as follows: 35   -85-   LSB 5509HZ (7) 90   dg/ko   85/ 101                   

  H.F. 2673   1. Any funds coming into the possession of the 1   superintendent or any employee of a resource center or special   2   unit belonging to any patient in that institution shall be 3   deposited in the name of the patient in the patients personal 4   deposit fund, except that if a guardian of the property has 5   been appointed for the person, the guardian shall have the 6   right to demand and receive such funds. Funds belonging to a 7   patient deposited in the patients personal deposit fund may 8   be used for the purchase of personal incidentals, desires, and 9   comforts for the patient. 10   Sec. 177. Section 222.87, Code 2024, is amended to read as 11   follows: 12   222.87 Deposit in bank. 13   The department shall deposit the patients personal deposit 14   fund in a commercial account of a bank of reputable standing. 15   When deposits in the commercial account exceed average monthly 16   withdrawals, the department may deposit the excess at interest. 17   The savings account shall be in the name of the patients 18   personal deposit fund and interest paid on the account may be 19   used for recreational purposes for the patients at the resource 20   center or special unit   . 21   Sec. 178. REPEAL. Sections 222.88, 222.89, 222.90, and 22   222.91, Code 2024, are repealed. 23   Sec. 179. EFFECTIVE DATE. This division of this Act, being 24   deemed of immediate importance, takes effect upon enactment. 25   DIVISION VI 26   COUNTY OF RESIDENCE DETERMINATIONS   27   Sec. 180. NEW SECTION . 331.190 County of residence  28   dispute resolution. 29   1. County of residence means the county in this state 30   in which, at the time a person applies for or receives 31   services, the person is living and has established an ongoing 32   presence with the declared, good faith intention of living 33   for a permanent or indefinite period of time. The county 34   of residence of a homeless person is the county in which 35   -86-   LSB 5509HZ (7) 90   dg/ko   86/ 101      

  H.F. 2673   the homeless person usually sleeps. A person maintains 1   residency in the county or state in which the person last 2   resided during the time period that the person is present in 3   a different county or state receiving services in a hospital, 4   a correctional facility, a halfway house for community-based 5   corrections or substance use disorder treatment, a nursing 6   facility, an intermediate care facility for persons with an 7   intellectual disability, a residential care facility, or for 8   the purpose of attending a college or university. 9   2. a. The dispute resolution process in this subsection 10   shall apply to county of residence disputes. The dispute 11   resolution process shall not be applicable to any of the 12   following: 13   (1) Disputes involving persons committed to a state 14   facility pursuant to chapter 812. 15   (2) Disputes involving Iowa rule of criminal procedure 16   2.22(8)(b), commitment for evaluation. 17   (3) Disputes involving chapter 12 of Iowa court rules, rules 18   for involuntary hospitalization of mentally ill persons. 19   b. If a county objects to a billing for services or a 20   residency determination and asserts that either the person 21   has residency in a different county or the person is not a 22   resident of this state, the persons county of residence 23   shall be determined as provided in this subsection. If the 24   county asserts that the person has residency in a different 25   county in this state, the county shall notify that county in 26   writing within one hundred twenty calendar days of receiving 27   the billing for services or of the county of residence 28   determination. 29   c. The county that receives the notification under paragraph 30   b shall respond in writing to the county that provided the 31   notification within forty-five calendar days of receiving the 32   notification. If the parties cannot agree as to the persons 33   county of residence within ninety calendar days of the date of 34   notification, on motion of either of the parties, the matter 35   -87-   LSB 5509HZ (7) 90   dg/ko   87/ 101  

  H.F. 2673   shall be referred to the administrative hearings division of 1   the department of inspections, appeals, and licensing for 2   a contested case proceeding under chapter 17A, before an 3   administrative law judge assigned in accordance with section 4   10A.801, to determine the persons county of residence. 5   d. (1) Notwithstanding section 17A.15, the administrative 6   law judges determination of a persons county of residence 7   shall be considered final agency action. Judicial review of 8   the determination may be sought in accordance with section 9   17A.19. 10   (2) If following the determination of a persons county of 11   residence under this subsection additional evidence becomes 12   available that merits a change in the determination of the 13   persons county of residence, the affected parties may change 14   the determination of county of residence by mutual agreement. 15   Otherwise, a party may move that the matter be reconsidered 16   by the county, or by an administrative law judge assigned in 17   accordance with section 10A.801. 18   e. Unless a petition is filed for judicial review, the 19   administrative law judges determination of the persons county 20   of residence shall result in one of the following: 21   (1) If a county is determined to be the persons county 22   of residence, that county shall pay any amounts due and shall 23   reimburse the other county for any amounts paid for services 24   provided to the person by the other county prior to the county 25   of residence determination. 26   (2) If it is determined that the person is not a resident of 27   this state, neither the state nor either county shall be liable 28   for payment of amounts due for services provided to the person 29   prior to the determination of the persons county of residence. 30   f. (1) The party that does not prevail in a contested 31   case proceeding or a subsequent judicial review pursuant to 32   this subsection shall be liable for costs associated with   33   the proceeding or judicial review, including reimbursement 34   of the administrative hearings division of the department of 35   -88-   LSB 5509HZ (7) 90   dg/ko   88/ 101  

  H.F. 2673   inspections, appeals, and licensings actual costs associated 1   with the administrative proceeding, court costs, and reasonable 2   attorney fees. 3   (2) A payment or reimbursement pursuant to this subsection 4   shall be remitted within forty-five calendar days of the 5   date the county of residence determination is issued by the 6   administrative law judge or the date the court files an order 7   determining the persons county of residence, whichever is 8   later. After forty-five calendar days, the prevailing party 9   may add a penalty of up to one percent per month to any amounts 10   due. 11   Sec. 181. Section 35D.9, Code 2024, is amended to read as 12   follows: 13   35D.9 County of residence upon discharge. 14   A member of the home does not acquire residency in the county 15   in which the home is located unless the member is voluntarily 16   or involuntarily discharged from the home and the member 17   meets county of residence requirements. For purposes of this 18   section , county of residence means the same as defined in 19   section 225C.61   331.190 . 20   Sec. 182. Section 232.141, subsections 7 and 8, Code 2024, 21   are amended to read as follows: 22   7. A county charged with the costs and expenses under 23   subsections 2 and 3 may recover the costs and expenses from the 24   childs custodial parents county of residence, as defined in 25   section 225C.61   331.190 , by filing verified claims which are 26   payable as are other claims against the county. A detailed 27   statement of the facts upon which a claim is based shall 28   accompany the claim. 29   8. This subsection applies only to placements in a juvenile 30   shelter care home which is publicly owned, operated as a county 31   or multicounty shelter care home, organized under a chapter 32   28E agreement, or operated by a private juvenile shelter care 33   home. If the actual and allowable costs of a childs shelter 34   care placement exceed the amount the department is authorized 35   -89-   LSB 5509HZ (7) 90   dg/ko   89/ 101      

  H.F. 2673   to pay, the unpaid costs may be recovered from the childs 1   custodial parents county of residence. However, the maximum 2   amount of the unpaid costs which may be recovered under this 3   subsection is limited to the difference between the amount 4   the department is authorized to pay and the statewide average 5   of the actual and allowable rates as reasonably determined 6   by the department annually. A home may only be reimbursed 7   for the lesser of the homes actual and allowable costs or 8   the statewide average of the actual and allowable rates as 9   determined by the department in effect on the date the costs 10   were paid. The unpaid costs are payable pursuant to filing of 11   verified claims against the childs custodial parents county 12   of residence. A detailed statement of the facts upon which a 13   claim is based shall accompany the claim. Any dispute between 14   counties arising from filings of   claims filed pursuant to this 15   subsection shall be settled in the manner provided to determine 16   residency county of residence in section 225C.61 331.190 . 17   Sec. 183. EFFECTIVE DATE. This division of this Act takes 18   effect July 1, 2025. 19   DIVISION VII 20   CHILDRENS BEHAVIORAL HEALTH  PSYCHIATRIC MEDICAL 21   INSTITUTIONS FOR CHILDREN  HAWKI PROGRAM BENEFITS 22   Sec. 184. REDUCTION OF REGULATORY BARRIERS AND RESTRICTIONS 23    PSYCHIATRIC MEDICAL INSTITUTIONS FOR CHILDREN. The 24   department of health and human services shall review the 25   departments administrative rules regarding psychiatric medical 26   institutions for children (PMICs) and shall update the rules, 27   informed by the findings of the association of childrens 28   residential centers most recent nationwide survey and scan 29   of psychiatric residential treatment facilities, and the 30   recommendations of the coalition for family and childrens 31   services in Iowa, to do all of the following: 32   1. Allow a physician assistant or advanced registered nurse 33   practitioner to serve as a member of the plan of care team 34   as a member who is experienced in child psychiatry or child 35   -90-   LSB 5509HZ (7) 90   dg/ko   90/ 101        

  H.F. 2673   psychology pursuant to 481 IAC 41.13(2). 1   2. Allow a physician assistant or advanced registered 2   nurse practitioner to be a member of the team to complete 3   the certification of need for services for a PMIC placement 4   pursuant to 481 IAC 41.9. 5   3. Remove the reserve bed day limitations for 6   hospitalizations and expand the number of other therapeutic 7   absences beyond thirty days to allow for skill acquisition, 8   stabilization, and continuity of care as deemed necessary by 9   the childs medical providers and in accordance with a childs 10   discharge plan. 11   4. Allow licensed professionals, based on competencies 12   rather than license type, to order the use of restraints 13   or seclusions and to conduct post-restraint or seclusion 14   assessments, including via telehealth, to increase response 15   times and expand access to care. 16   5. a. Allow therapy and behavioral health intervention 17   services to be included as billable services provided during 18   a placement at a PMIC to provide continuity of care, maintain 19   established clinical relationships, and avoid disruption in 20   services or delays in reestablishing care post discharge. 21   b. Allow family therapy and family behavioral health 22   intervention services to be included in billable services 23   during the placement of a child in a PMIC without requiring 24   the childs presence for the family to work on targeted skills 25   essential for the childs success and to prepare the family for 26   the childs return home.   27   c. Provide reimbursement codes to cover services beyond 28   those provided outside the PMIC care team as necessary to 29   adequately treat substance use disorder, sexualized behaviors, 30   autism, and other services needed to support the child. 31   6. Standardize all of the following across all managed care 32   organizations as follows: 33   a. Require that authorization for a PMIC placement shall 34   be retroactive to the date the request for authorization is 35   -91-   LSB 5509HZ (7) 90   dg/ko   91/ 101  

  H.F. 2673   submitted to the managed care organization not the date the 1   managed care organization responds; or require a managed care 2   organization to respond within five business days from receipt 3   of a request for authorization for a PMIC placement, if the 4   certification of need and independent assessment have been 5   received in a timely manner. 6   b. Prohibit a managed care organization from denying 7   authorization for a PMIC placement based on lack of parental 8   involvement, based on lack of participation in behavioral 9   health intervention services on an outpatient basis, or based 10   on other perceived behavioral issues. 11   c. Allow a managed care organization to authorize an initial 12   PMIC placement of sixty days upon admission with concurrent 13   stay reviews every thirty days thereafter. A PMIC shall submit 14   a care plan to the managed care organization within thirty days 15   of the admission. 16   d. Require concurrent stay reviews to be standardized 17   and limited to a brief description of progress, or lack of 18   progress, toward the childs goals and objectives. 19   e. Require a managed care organization to offer support to 20   families, including assistance with transportation to and from 21   a PMIC to visit a child. 22   7. Notwithstanding any provision of law to the contrary, 23   including certificate of need requirements, allow a previously 24   licensed PMIC that has the capacity to provide up to an 25   additional four intermediate care facility for persons with an 26   intellectual disability beds, and which additional beds meet 27   all other licensing and state fire marshal requirements, to 28   increase their licensed capacity to include the additional 29   beds without further review including by the health facilities 30   council. 31   8. Allow for step-down PMIC placements or supervised 32   apartment living for a child to utilize programming provided 33   in a PMIC while living independently in a smaller residential 34   setting without twenty-four-hour supervision. 35   -92-   LSB 5509HZ (7) 90   dg/ko   92/ 101  

  H.F. 2673   Sec. 185. HAWKI PROGRAM  BENEFITS INCLUDED IN QUALIFIED 1   CHILD HEALTH PLAN  REVIEW. The department of health 2   and human services shall review the benefits included in a 3   qualified child health plan under the Hawki program and shall 4   specifically address the inclusion of applied behavior analysis 5   services as a covered benefit. The department shall report the 6   findings of the review to the general assembly by December 1, 7   2024. 8   DIVISION VIII 9   STATE-FUNDED PSYCHIATRY RESIDENCY AND FELLOWSHIP PROGRAM AND 10   PSYCHIATRY RESIDENCY PROGRAM 11   Sec. 186. Section 135.180, Code 2024, is amended to read as 12   follows: 13   135.180 State-funded psychiatry residency and fellowship 14   program and psychiatry residency program    fund  15   appropriations. 16   1. a. The university of Iowa hospitals and clinics shall 17   administer a state-funded psychiatry residency and fellowship 18   program for up to nine   seven residents and up to two fellows, 19   annually. In addition, a county medical center, and a medical 20   center operating for more than one hundred forty years, that   21   are members of separate health systems, administer psychiatry 22   residency programs, and are located in a county with a   23   population of over five hundred thousand shall each annually 24   administer a state-funded psychiatry residency program for one 25   resident. The university of Iowa hospitals and clinics and the 26   specified medical centers shall expand the their psychiatry 27   residency program programs to provide additional residency 28   positions by providing financial support for residency 29   positions which are in excess of the federal residency cap 30   established by the federal Balanced Budget Act of 1997, Pub. 31   L. No. 105-33.   32   b. The university of Iowa hospitals and clinics and the   33   specified medical centers   shall cooperate with the state 34   mental health institutes at Independence and Cherokee, the 35   -93-   LSB 5509HZ (7) 90   dg/ko   93/ 101                    

  H.F. 2673   state resource center at Woodward, the state training school 1   at Eldora, and the Iowa medical and classification center 2   at Oakdale in administering the program   their programs . 3   Participating residents and fellows shall complete a portion 4   of their psychiatry training at one of the state mental health 5   institutes, the state resource center, the state training 6   school, or the Iowa medical and classification center at 7   Oakdale. For accreditation-required clinical experiences not 8   available at the state mental health institutes, the state 9   resource center, the state training school, or the Iowa medical 10   and classification center at Oakdale, the residents of the 11   psychiatry residency and fellowship program administered by the   12   university of Iowa hospitals and clinics may utilize clinical 13   rotations at the university of Iowa hospitals and clinics 14   and its affiliates across the state. The residents of the   15   psychiatry residency program administered by the specified 16   medical centers may utilize clinical rotations at affiliates of 17   such medical centers across the state.   18   2. The university of Iowa hospitals and clinics shall apply 19   to the accreditation council for graduate medical education 20   for approval of nine   seven additional residency positions 21   for each class of residents and the psychiatry residency and 22   fellowship program shall award the total number of residency 23   positions approved for each class of residents. The university 24   of Iowa hospitals and clinics shall approve and award up to 25   two fellowship positions annually. The specified medical   26   centers shall apply to the accreditation council for graduate 27   medical education for approval of one additional residency 28   position each for each class of residents and shall award the 29   total number of residency positions approved for each class   30   of residents. Preference in the awarding of residency and 31   fellowship positions shall be given to candidates who are 32   residents of Iowa, attended and earned an undergraduate degree 33   from an Iowa college or university, or attended and earned a 34   medical degree from a medical school in Iowa. 35   -94-   LSB 5509HZ (7) 90   dg/ko   94/ 101                  

  H.F. 2673   3. A psychiatry residency and fellowship program fund 1   is created in the state treasury consisting of the moneys 2   appropriated or credited to the fund by law. Notwithstanding 3   section 8.33 , moneys in the fund at the end of each fiscal year 4   shall not revert to any other fund but shall remain in the 5   psychiatry residency and fellowship program fund for use in 6   subsequent fiscal years. Moneys in the fund are appropriated 7   to the university of Iowa hospitals and clinics to be used 8   for the purposes of the program. Of the amount appropriated   9   annually to the university of Iowa hospitals and clinics, the 10   university of Iowa hospitals and clinics shall distribute one   11   hundred thousand dollars to each of the specified medical 12   centers for each residency position approved and awarded. For 13   the fiscal years beginning on or after July 1, 2023, there 14   is appropriated from the general fund of the state to the 15   psychiatry residency and fellowship program fund one hundred 16   thousand dollars for each residency position approved and 17   awarded under the program and one hundred fifty thousand 18   dollars for each fellowship position approved and awarded under 19   the program. 20   EXPLANATION 21   The inclusion of this explanation does not constitute agreement with 22   the explanations substance by the members of the general assembly. 23   This bill relates to state behavioral health, disability, 24   and addictive disorder services and related programs, 25   including the transition of behavioral health services from a 26   mental health and disability services system to a behavioral 27   health service system (BHSS), the transfer of disability 28   services to the division of aging and disability services 29   of the department of health and human services (HHS), the 30   elimination of the commission on aging, and the elimination of 31   special intellectual disability units at state mental health 32   institutes. 33   DIVISION I  BEHAVIORAL HEALTH SERVICE SYSTEM. This   34   division relates to the establishment of the BHSS under the   35   -95-   LSB 5509HZ (7) 90   dg/ko   95/ 101       

  H.F. 2673   control of HHS. The division defines terms related to the 1   BHSS. 2   The division designates HHS as the state authority for 3   purposes of directing benefits and providing services relating 4   to certain federal block grants and statutes. 5   The division establishes a BHSS for the purposes of 6   implementing a statewide system of prevention, education, early 7   intervention, treatment, recovery support, and crisis services 8   related to mental health and addictive disorders, including but 9   not limited to alcohol use, substance use, tobacco use, and 10   problem gambling. 11   The division requires HHS to support equitable statewide 12   access to all services offered through the BHSS and offer 13   specialized behavioral health services with a focus on certain 14   at-risk populations. The division sets minimum services that 15   must be offered through the BHSS and outlines HHSs powers and 16   duties in relation to the BHSS. 17   The division requires HHS to divide the entirety of the 18   state into designated behavioral health districts (district). 19   The division requires each district to provide behavioral 20   health prevention, education, early intervention, treatment, 21   recovery support, and crisis services related to mental health 22   and addictive disorders throughout each district in a manner 23   consistent with directives the district receives from HHS. HHS 24   must consider several factors, as detailed in the division, 25   when designating districts. The manner in which HHS designates 26   districts is not subject to judicial review. 27   The division requires HHS to designate an administrative 28   services organization (ASO) to oversee and organize each 29   district and the BHSS services associated with the district.   30   HHS must issue requests for proposals for ASO candidates. 31   The division details which entities may qualify as an ASO. 32   HHS is required to consider several factors outlined in the 33   division when determining whether to designate an entity as an 34   ASO. Upon an entitys designation as an ASO, the entity is 35   -96-   LSB 5509HZ (7) 90   dg/ko   96/ 101  

  H.F. 2673   considered an instrumentality of the state and must adhere to 1   all state and federal mandates and prohibitions applicable to 2   an instrumentality of the state. 3   Each ASO must function as a subrecipient for the purposes 4   of the federal community mental health services block grant 5   and the federal substance abuse prevention and treatment 6   block grant. Duties an ASO must perform are detailed in the 7   division, including the establishment of a district behavioral 8   health advisory council (advisory council). An advisory 9   council must perform duties detailed in the division to assist 10   the ASO in carrying out the ASOs duties. An advisory council 11   must consist of 10 members. Advisory council membership 12   requirements are established in the division. 13   The division requires HHS to take certain actions for data 14   related to the BHSS, and to create a central data repository 15   for collecting and analyzing state, behavioral health district, 16   and contracted behavioral health provider data. The division 17   establishes requirements for HHS and ASOs relating to the 18   collection, maintenance, and distribution of data, and the 19   maintenance and administration of the central data repository. 20   The division establishes a behavioral health fund (fund). 21   For purposes of the fund, the division defines the terms 22   population and state growth factor. Moneys deposited into 23   the fund are appropriated to HHS to implement and administer 24   the BHSS and related programs, including distributions 25   to ASOs for services; distributions to behavioral health 26   providers; funding of disability services pursuant to Code 27   chapter 231 (department of health and human services  28   aging  older Iowans) until June 30, 2028; and payment of 29   administrative costs for services associated with the BHSS.   30   The division prohibits HHS from using more than 5 percent of 31   the moneys in the fund at the beginning of each fiscal year for 32   administrative costs.   33   For FY 2025-2026, the division transfers an amount equal to 34   $42 multiplied by the states population for the fiscal year 35   -97-   LSB 5509HZ (7) 90   dg/ko   97/ 101  

  H.F. 2673   from the general fund of the state to the fund. 1   For fiscal years beginning on or after July 1, 2026, the 2   division transfers an amount from the general fund to the fund 3   equal to the states population for the fiscal year multiplied 4   by the sum of the dollar amount used to calculate the transfer 5   from the general fund to the fund for the immediately preceding 6   fiscal year, plus the state growth factor for the fiscal year 7   for which the transfer is being made. 8   For each fiscal year, the division prohibits an ASO from 9   spending more than 7 percent of the total amount distributed to 10   the ASO from HHS and all other appropriations on administrative 11   costs for the same fiscal year. 12   The division allows moneys in the fund to be used for cash 13   flow purposes, provided that any moneys so allocated are 14   returned to the fund by the end of each fiscal year. Interest 15   and earnings on moneys deposited into the fund are credited to 16   the fund and moneys in the fund that remain unencumbered or 17   unobligated at the close of the fiscal year are to remain in 18   the fund to be used for the purposes designated. 19   The division amends and moves Code sections 142A.6(6) 20   (tobacco use prevention and control) and 142A.11 (application 21   for services  minors) to new Code chapter 225A, as enacted 22   in this division. 23   This division of the bill is effective July 1, 2025. 24   DIVISION II  BEHAVIORAL HEALTH SERVICE SYSTEM  25   CONFORMING CHANGES. This division of the bill makes conforming 26   changes related to the establishment and implementation of the 27   BHSS.   28   The bill repeals Code chapters 142A (tobacco use prevention 29   and control), 225C (mental health and disability services), 227 30   (facilities for persons with mental illness or an intellectual 31   disability), 230A (community mental health centers), and 347B 32   (county care facilities). 33   The bill repeals Code sections 125.1, 125.3, 125.7, 125.9, 34   125.10, 125.12, 125.25, 125.32A, 125.34, 125.37 through 35   -98-   LSB 5509HZ (7) 90   dg/ko   98/ 101  

  H.F. 2673   125.43A, 125.46, 125.48, 125.54, 125.55, 125.58, 125.59, 1   125.60, 135B.18, 218.99, 222.59 through 222.70, 222.74, 222.75, 2   225.10, 225.19, 225.21, 226.45, 229.42, 230.1A, 230.2 through 3   230.6, 230.9, 230.12, 230.16 through 230.22, 230.25, 230.26, 4   230.27, 426B.2, 426B.4, and 426B.5. 5   This division of the bill takes effect July 1, 2025. 6   DIVISION III  AGING AND DISABILITY. This division of the 7   bill relates to aging and disability services. 8   The division transfers services related to individuals with 9   disabilities to Code chapter 231, as amended in this division, 10   eliminates the commission on aging, and transfers commission 11   on aging duties to HHS and the council on health and human 12   services. 13   The division requires HHS to designate aging and disability 14   resource centers (ADRC) to establish a coordinated local aging 15   and disability service system, and details which entities may 16   be ADRCs. 17   Current Code sections 225C.25, 225C.26, 225C.28A, and 18   225C.28B (the bill of rights and service quality standards 19   of persons with an intellectual disability, developmental 20   disabilities, brain injury, or chronic mental illness), are 21   amended and moved to Code sections 231.75 through 231.79. 22   The division repeals Code sections 231.11, 231.12, and 23   231.13. 24   The parts of the sections of the division amending the 25   following Code sections take effect July 1, 2025: 231.3, 26   231.4(1), 231.23(4), 231.23(7), 231.23A(1), 231.56, 231.57, 27   231.58, and 231.64(2). 28   The parts of the sections of the division enacting Code 29   sections 231.23A(7A) and 231.75 through 231.79 take effect July 30   1, 2025.   31   DIVISION IV  TRANSITION PROVISIONS. This division   32   provides a process, grants HHS certain powers, and assigns 33   HHS certain duties during the period beginning on the date of 34   enactment of this division and concluding June 30, 2025, to 35   -99-   LSB 5509HZ (7) 90   dg/ko   99/ 101  

  H.F. 2673   transition the states behavioral health services to the BHSS, 1   and the states disability services to HHSs division of aging 2   and disability services, effective July 1, 2025. 3   The division appropriates $645,179 from the region incentive 4   fund of the mental health and disability services regional 5   service fund to HHS for FY 2024-2025 for the establishment 6   of a central data repository as described in Code section 7   225A.6(1)(b) as enacted in division I. 8   The division allows HHS to adopt emergency rules to 9   implement the division. 10   The division is effective upon enactment. 11   DIVISION V  ELIMINATION OF SPECIAL INTELLECTUAL DISABILITY 12   UNITS. This division eliminates special intellectual 13   disability units at state mental health institutes in Code 14   chapter 222 (persons with an intellectual disability), and is 15   effective upon enactment. 16   DIVISION VI  COUNTY OF RESIDENCE DETERMINATIONS. This 17   division amends and moves language from Code section 225C.61 18   (county of residence  services to residents  service 19   authorization appeals  disputes between counties or regions) 20   to new Code section 331.190, as enacted in this division, which 21   establishes a process for determining a persons county of 22   residence and for resolving disputes related to a persons 23   county of residence. The division makes conforming changes and 24   takes effect July 1, 2025. 25   DIVISION VII  PSYCHIATRIC MEDICAL INSTITUTIONS FOR 26   CHILDREN AND HAWKI PROGRAM BENEFITS. This division relates   27   to childrens behavioral health. The division requires HHS 28   to review and update rules regarding psychiatric medical 29   institutions for children (PMICs) to permit physician 30   assistants and advanced registered nurse practitioners to serve 31   as plan of care team members and to complete the certification 32   of need for services for a PMIC placement; to remove the 33   reserve bed day limitations for hospitalizations and expand 34   the number of other therapeutic absences allowed; to allow 35   -100-   LSB 5509HZ (7) 90   dg/ko   100/ 101  

  H.F. 2673   licensed professionals, based on competencies rather than 1   license type, to order the use of restraints or seclusions and 2   to conduct post-restraint or seclusion assessments, to increase 3   response times and expand access to care; to require therapy 4   and behavioral health intervention services and family therapy 5   and family behavioral health intervention services as required 6   services during a PMIC placement, and to provide reimbursement 7   codes to cover certain services beyond those provided outside 8   the PMIC care team to support the child; to standardize 9   certain activities across all managed care organizations; to 10   allow for certain exceptions for PMICs to increase capacity 11   without further certification of need review; and to allow for 12   step-down PMIC placements or supervised apartment living for a 13   child. 14   The division also directs HHS to review the benefits under 15   the Hawki program, specifically the inclusion of applied 16   behavioral analysis services as a covered benefit, and to 17   report findings to the general assembly by December 1, 2024. 18   DIVISION VIII  STATE-FUNDED PSYCHIATRY RESIDENCY AND 19   FELLOWSHIP PROGRAM AND PSYCHIATRY RESIDENCY PROGRAM. This 20   division amends the state-funded psychiatry residency and 21   fellowship program. The division reduces the number of 22   residents in the program administered by the university of Iowa 23   hospitals and clinics by two residents annually and provides 24   that a county medical center, and a medical center operating 25   for more than 140 years, that are members of separate health 26   systems, administer psychiatry residency programs, and are 27   located in a county with a population of over 500,000 to each 28   annually administer a state-funded psychiatry residency program 29   for one resident. The division makes conforming changes to the 30   existing program to provide for the distribution of funding to 31   the specified medical centers for the two residency positions. 32   -101-   LSB 5509HZ (7) 90   dg/ko   101/ 101