House File 2673 - Reprinted HOUSE FILE 2673 BY COMMITTEE ON APPROPRIATIONS (SUCCESSOR TO HF 2509) (SUCCESSOR TO HSB 653) (As Amended and Passed by the House April 2, 2024 ) 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 HF 2673 (8) 90 dg/ko/md
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- HF 2673 (8) 90 dg/ko/md 1/ 95
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- HF 2673 (8) 90 dg/ko/md 2/ 95
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- HF 2673 (8) 90 dg/ko/md 3/ 95
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- HF 2673 (8) 90 dg/ko/md 4/ 95
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- HF 2673 (8) 90 dg/ko/md 5/ 95
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- HF 2673 (8) 90 dg/ko/md 6/ 95
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- HF 2673 (8) 90 dg/ko/md 7/ 95
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- HF 2673 (8) 90 dg/ko/md 8/ 95
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 agency located in a behavioral 10 health district, or any separate organizational unit within the 11 public or private agency, that has the capabilities to engage 12 in the planning or provision of a broad range of behavioral 13 health prevention, education, early intervention, treatment, 14 recovery support, and crisis services related to mental health 15 and addictive disorders, including but not limited to alcohol 16 use, substance use, tobacco use, and problem gambling, only as 17 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- HF 2673 (8) 90 dg/ko/md 9/ 95
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- HF 2673 (8) 90 dg/ko/md 10/ 95
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- HF 2673 (8) 90 dg/ko/md 11/ 95
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- HF 2673 (8) 90 dg/ko/md 12/ 95
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- HF 2673 (8) 90 dg/ko/md 13/ 95
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- HF 2673 (8) 90 dg/ko/md 14/ 95
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. 15 3. For the fiscal year beginning July 1, 2025, there 16 is transferred from the general fund of the state to the 17 behavioral health fund an amount equal to forty-two dollars 18 multiplied by the states population for the fiscal year. 19 4. For the fiscal year beginning July 1, 2026, and each 20 succeeding fiscal year, there is transferred from the general 21 fund of the state to the behavioral health fund an amount equal 22 to the states population for the fiscal year multiplied by 23 the sum of the dollar amount used to calculate the transfer 24 from the general fund to the behavioral health fund for the 25 immediately preceding fiscal year, plus the state growth factor 26 for the fiscal year for which the transfer is being made. 27 5. For each fiscal year, an administrative services 28 organization shall not spend on administrative costs an amount 29 more than seven percent of the total amount distributed to the 30 administrative services organization through this section and 31 all other appropriations for the same fiscal year. 32 6. Moneys in the behavioral health fund may be used by the 33 department for cash flow purposes, provided that any moneys so 34 allocated are returned to the behavioral health fund by the end 35 -15- HF 2673 (8) 90 dg/ko/md 15/ 95
H.F. 2673 of each fiscal year. 1 7. Notwithstanding section 12C.7, subsection 2, interest 2 or earnings on moneys deposited in the behavioral health fund 3 shall be credited to the behavioral health fund. 4 8. Notwithstanding section 8.33, moneys appropriated in 5 this section that remain unencumbered or unobligated at the 6 close of the fiscal year shall not revert but shall remain 7 available for expenditure for the purposes designated. 8 Sec. 8. NEW SECTION . 225A.8 Addictive disorders prevention 9 prohibitions. 10 1. For purposes of this section, entity means a 11 manufacturer, distributor, wholesaler, retailer, or 12 distributing agent, or an agent of a manufacturer, distributor, 13 wholesaler, retailer, or distributing agent as those terms are 14 defined in section 453A.1. 15 2. To promote comprehensive tobacco use prevention and 16 control initiatives outlined in the state behavioral health 17 service system plan, an entity shall not perform any of the 18 following acts: 19 a. Give away cigarettes or tobacco products. 20 b. Provide free articles, products, commodities, gifts, or 21 concessions in any exchange for the purchase of cigarettes or 22 tobacco products. 23 3. The prohibitions in this section shall not apply to 24 transactions between manufacturers, distributors, wholesalers, 25 or retailers as those terms are defined in section 453A.1. 26 Sec. 9. NEW SECTION . 225A.9 Application for services 27 minors. 28 A minor who is twelve years of age or older shall have 29 the legal capacity to act and give consent to the provision 30 of tobacco cessation coaching services pursuant to a tobacco 31 cessation telephone and internet-based program approved by 32 the department through the behavioral health service system 33 established in section 225A.3. Consent shall not be subject to 34 later disaffirmance by reason of such minority. The consent of 35 -16- HF 2673 (8) 90 dg/ko/md 16/ 95
H.F. 2673 another person, including but not limited to the consent of a 1 spouse, parent, custodian, or guardian, shall not be necessary. 2 Sec. 10. CODE EDITOR DIRECTIVE. The Code editor is directed 3 to do all of the following: 4 1. Designate sections 225A.1 through 225A.9, as enacted 5 in this division of this Act, as Code chapter 225A entitled 6 Department of Health and Human Services Behavioral Health 7 Service System. 8 2. 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. 11. EFFECTIVE DATE. This division of this Act takes 12 effect July 1, 2025. 13 DIVISION II 14 BEHAVIORAL HEALTH SERVICE SYSTEM CONFORMING CHANGES 15 Sec. 12. Section 11.6, subsection 1, paragraph b, Code 2024, 16 is amended to read as follows: 17 b. The financial condition and transactions of community 18 mental health centers organized under chapter 230A , substance 19 use disorder programs organized licensed under chapter 125 , and 20 community action agencies organized under chapter 216A , shall 21 be audited at least once each year. 22 Sec. 13. Section 97B.1A, subsection 8, paragraph a, 23 subparagraph (13), Code 2024, is amended by striking the 24 subparagraph. 25 Sec. 14. Section 123.17, subsection 5, Code 2024, is amended 26 to read as follows: 27 5. After any transfer provided for in subsection 3 is made, 28 the department shall transfer into a special revenue account 29 in the general fund of the state, a sum of money at least equal 30 to seven percent of the gross amount of sales made by the 31 department from the beer and liquor control fund on a monthly 32 basis but not less than nine million dollars annually. Of 33 the amounts transferred, two three million dollars, plus an 34 additional amount determined by the general assembly, shall be 35 -17- HF 2673 (8) 90 dg/ko/md 17/ 95
H.F. 2673 appropriated to the department of health and human services for 1 use by the staff who administer the comprehensive substance use 2 disorder program under chapter 125 for substance use disorder 3 treatment and prevention programs shall be transferred to the 4 behavioral health fund established under section 225A.7 . Any 5 amounts received in excess of the amounts appropriated to the 6 department of health and human services for use by the staff 7 who administer the comprehensive substance use disorder program 8 under chapter 125 transferred to the behavioral health fund 9 shall be considered part of the general fund balance. 10 Sec. 15. Section 123.17, subsection 8, Code 2024, is amended 11 by striking the subsection. 12 Sec. 16. Section 123.17, subsection 9, Code 2024, is amended 13 to read as follows: 14 9. After any transfers provided for in subsections 3, 5, 15 6, and 7 , and 8 are made, and before any other transfer to the 16 general fund, the department shall transfer to the economic 17 development authority from the beer and liquor control fund the 18 lesser of two hundred fifty thousand dollars or one percent of 19 the gross sales of native distilled spirits by all class A 20 native distilled spirits license holders made by the department 21 for the purposes of promoting Iowa wine, beer, and spirits. 22 Sec. 17. Section 124.409, subsection 2, Code 2024, is 23 amended by striking the subsection. 24 Sec. 18. Section 125.2, subsections 4, 5, and 10, Code 2024, 25 are amended by striking the subsections. 26 Sec. 19. Section 125.91, subsection 1, Code 2024, is amended 27 to read as follows: 28 1. The procedure prescribed by this section shall only 29 be used for a person with a substance use disorder due to 30 intoxication or substance-induced incapacitation who has 31 threatened, attempted, or inflicted physical self-harm or harm 32 on another, and is likely to inflict physical self-harm or harm 33 on another unless immediately detained, or who is incapacitated 34 by a chemical substance, if an application has not been filed 35 -18- HF 2673 (8) 90 dg/ko/md 18/ 95
H.F. 2673 naming the person as the respondent pursuant to section 125.75 1 and the person cannot be ordered into immediate custody and 2 detained pursuant to section 125.81 . 3 Sec. 20. Section 125.93, Code 2024, is amended to read as 4 follows: 5 125.93 Commitment records confidentiality. 6 Records of the identity, diagnosis, prognosis, or treatment 7 of a person which are maintained in connection with the 8 provision of substance use disorder treatment services are 9 confidential, consistent with the requirements of section 10 125.37 , and with the federal confidentiality regulations 11 authorized by the federal Drug Abuse Office and Treatment Act , 12 42 U.S.C. 290ee and the federal Comprehensive Alcohol Abuse 13 and Alcoholism Prevention, Treatment and Rehabilitation Act, 42 14 U.S.C. 290dd-2. However, such records may be disclosed to an 15 employee of the department of corrections, if authorized by the 16 director of the department of corrections, or to an employee 17 of a judicial district department of correctional services, if 18 authorized by the director of the judicial district department 19 of correctional services. 20 Sec. 21. Section 135.11, subsection 11, Code 2024, is 21 amended to read as follows: 22 11. Administer chapters 125, 136A , 136C , 139A , 142 , 142A , 23 144 , and 147A . 24 Sec. 22. Section 135C.2, subsection 5, unnumbered paragraph 25 1, Code 2024, is amended to read as follows: 26 The department shall establish a special classification 27 within the residential care facility category in order to 28 foster the development of residential care facilities which 29 serve persons with an intellectual disability, chronic mental 30 illness, a developmental disability, or brain injury, as 31 described under section 225C.26 , and which contain five or 32 fewer residents. A facility within the special classification 33 established pursuant to this subsection is exempt from the 34 requirements of section 10A.713 . The department shall adopt 35 -19- HF 2673 (8) 90 dg/ko/md 19/ 95
H.F. 2673 rules which are consistent with rules previously developed for 1 the waiver demonstration waiver project pursuant to 1986 Iowa 2 Acts, ch. 1246, 206 , and which include all of the following 3 provisions: 4 Sec. 23. Section 135C.6, subsection 1, Code 2024, is amended 5 to read as follows: 6 1. A person or governmental unit acting severally or 7 jointly with any other person or governmental unit shall not 8 establish or operate a health care facility in this state 9 without a license for the facility. A supported community 10 living service, as defined in section 225C.21 249A.38A , is not 11 required to be licensed under this chapter , but is subject to 12 approval under section 225C.21 249A.38A in order to receive 13 public funding. 14 Sec. 24. Section 135C.23, subsection 1, unnumbered 15 paragraph 1, Code 2024, is amended to read as follows: 16 Each resident shall be covered by a contract executed 17 by the resident, or the residents legal representative, 18 and the health care facility at or prior to the time of the 19 residents admission or prior thereto by the resident, or the 20 legal representative, and the health care facility, except as 21 otherwise provided by subsection 5 with respect to residents 22 admitted at public expense to a county care facility operated 23 under chapter 347B . Each party to the contract shall be 24 entitled to a duplicate of the original thereof contract , and 25 the health care facility shall keep on file all contracts 26 which it has with residents and shall not destroy or otherwise 27 dispose of any such contract for at least one year after its 28 expiration. Each such contract shall expressly set forth: 29 Sec. 25. Section 135C.23, subsection 2, paragraph b, Code 30 2024, is amended to read as follows: 31 b. This section does not prohibit the admission of a 32 patient with a history of dangerous or disturbing behavior to 33 an intermediate care facility for persons with mental illness, 34 intermediate care facility for persons with an intellectual 35 -20- HF 2673 (8) 90 dg/ko/md 20/ 95
H.F. 2673 disability, or nursing facility , or county care facility when 1 the 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 has a 4 program which has received prior approval from the department 5 to properly care for and manage the patient. An intermediate 6 care facility for persons with mental illness, intermediate 7 care facility for persons with an intellectual disability, 8 or nursing facility , or county care facility is required to 9 transfer or discharge a resident with dangerous or disturbing 10 behavior when the intermediate care facility for persons with 11 mental illness, intermediate care facility for persons with an 12 intellectual disability, or nursing facility , or county care 13 facility cannot control the residents dangerous or disturbing 14 behavior. The department , in coordination with the state 15 mental health and disability services commission created in 16 section 225C.5 , shall adopt rules pursuant to chapter 17A for 17 programs to be required in intermediate care facilities for 18 persons with mental illness, intermediate care facilities 19 for persons with an intellectual disability, and nursing 20 facilities , and county care facilities that admit patients 21 or have residents with histories of dangerous or disturbing 22 behavior. 23 Sec. 26. Section 135C.23, subsection 5, Code 2024, is 24 amended by striking the subsection. 25 Sec. 27. Section 135C.24, subsection 5, Code 2024, is 26 amended by striking the subsection. 27 Sec. 28. Section 135G.1, subsection 12, Code 2024, is 28 amended to read as follows: 29 12. a. Subacute mental health services means the same 30 as defined in section 225C.6 services that provide all of the 31 following: 32 (1) A comprehensive set of wraparound services for a 33 person who has had, or is at imminent risk of having, acute or 34 crisis mental health symptoms that do not permit the person to 35 -21- HF 2673 (8) 90 dg/ko/md 21/ 95
H.F. 2673 remain in or threatens removal of the person from the persons 1 home and community, but who has been determined by a mental 2 health professional and a licensed health care professional, 3 subject to the professionals scope of practice, not to need 4 inpatient acute hospital services. For the purposes of this 5 subparagraph, licensed health care professional means a person 6 licensed under chapter 148, an advanced registered nurse 7 practitioner, or a physician assistant. 8 (2) Intensive, recovery-oriented treatment and monitoring 9 of a person. Treatment may be provided directly or remotely 10 by a licensed psychiatrist or an advanced registered nurse 11 practitioner. 12 (3) An outcome-focused, interdisciplinary approach designed 13 to return a person to living successfully in the community. 14 b. Subacute mental health services may include services 15 provided in a wide array of settings ranging from a persons 16 home to a specialized facility with restricted means of egress. 17 c. Subacute mental health services shall be limited to a 18 period not to exceed ten calendar days or another time period 19 determined in accordance with rules adopted by the department 20 for this purpose, whichever is longer . 21 Sec. 29. Section 142.1, Code 2024, is amended to read as 22 follows: 23 142.1 Delivery of bodies. 24 The body of every person dying who died in a public asylum, 25 hospital, county care facility, penitentiary, or reformatory 26 in this state, or found dead within the state, or which who 27 is to be buried at public expense in this state, except those 28 buried under the provisions of chapter 144C or 249 , and which 29 is suitable for scientific purposes, shall be delivered to the 30 medical college of the state university, or some osteopathic 31 or chiropractic college or school located in this state, which 32 has been approved under the law regulating the practice of 33 osteopathic medicine or chiropractic; but no such body shall 34 be delivered to any such college or school if the deceased 35 -22- HF 2673 (8) 90 dg/ko/md 22/ 95
H.F. 2673 person expressed a desire during the persons last illness 1 that the persons body should be buried or cremated, nor if 2 such is the desire of the persons relatives. Such bodies 3 shall be equitably distributed among said colleges and schools 4 according to their needs for teaching anatomy in accordance 5 with such rules as may be adopted by the department of health 6 and human services. The expense of transporting said bodies to 7 such college or school shall be paid by the college or school 8 receiving the same. If the deceased person has not expressed 9 a desire during the persons last illness that the persons 10 body should be buried or cremated and no person authorized to 11 control the deceased persons remains under section 144C.5 12 requests the persons body for burial or cremation, and if a 13 friend objects to the use of the deceased persons body for 14 scientific purposes, said deceased persons body shall be 15 forthwith delivered to such friend for burial or cremation at 16 no expense to the state or county. Unless such friend provides 17 for burial and burial expenses within five days, the body shall 18 be used for scientific purposes under this chapter . 19 Sec. 30. Section 142.3, Code 2024, is amended to read as 20 follows: 21 142.3 Notification of department. 22 Every county medical examiner, funeral director or embalmer, 23 and the managing officer of every public asylum, hospital, 24 county care facility, penitentiary, or reformatory, as soon as 25 any dead body shall come into the persons custody which may be 26 used for scientific purposes as provided in sections 142.1 and 27 142.2 , shall at once notify the nearest relative or friend of 28 the deceased, if known, and the department of health and human 29 services, and hold such body unburied for forty-eight hours. 30 Upon receipt of notification, the department shall issue verbal 31 or written instructions relative to the disposition to be made 32 of said body. Complete jurisdiction over said bodies is vested 33 exclusively in the department of health and human services. No 34 autopsy or post mortem, except as are legally ordered by county 35 -23- HF 2673 (8) 90 dg/ko/md 23/ 95
H.F. 2673 medical examiners, shall be performed on any of said bodies 1 prior to their delivery to the medical schools. 2 Sec. 31. NEW SECTION . 217.17 State health improvement plan. 3 1. The department shall develop, implement, and administer 4 a state health improvement plan to identify health priorities, 5 goals, and measurable objectives, and outline strategies to 6 improve health statewide. 7 2. The state health improvement plan shall be developed 8 and updated in collaboration and in coordination with other 9 state departments, stakeholders, and statewide organizations 10 the department determines to be relevant. 11 3. The state health improvement plan may be updated by the 12 department at the departments discretion. 13 Sec. 32. NEW SECTION . 217.37 Recovery of payment 14 assignment of liens county attorney to enforce. 15 1. For purposes of this section, assistance means all of 16 the following: 17 a. A payment by the state for services rendered through 18 the behavioral health service system established under section 19 225A.3. 20 b. A payment by the state for aging and disability services 21 rendered in accordance with chapter 231. 22 2. The department shall have the authority to investigate if 23 a person is eligible to have assistance paid on the persons 24 behalf and whether payment of assistance was proper. 25 3. Notwithstanding any provision of law to the contrary, 26 assistance shall not be recoverable unless the department 27 finds that the assistance was paid for the benefit of a person 28 who was not entitled to have assistance paid on the persons 29 behalf. 30 4. Assistance paid for the benefit of a person who was 31 not entitled to have assistance paid on the persons behalf 32 shall be recoverable from the entity to which the assistance 33 was paid, from the person on whose behalf assistance was paid, 34 or from a third party who is liable for the persons debts or 35 -24- HF 2673 (8) 90 dg/ko/md 24/ 95
H.F. 2673 support. 1 5. Upon the death of a person who was not entitled to 2 have assistance paid on the persons behalf, the department 3 shall have a lien equivalent in priority to liens described 4 in section 633.425, subsection 6, against the persons estate 5 for the portion of the assistance improperly paid which the 6 department had not recovered at the time of the persons death. 7 6. The department may waive all or a portion of improperly 8 paid assistance, or a lien created under subsection 5, if 9 the department finds that collection would result in undue 10 hardship. 11 7. The department shall adopt rules pursuant to chapter 17A 12 to implement and administer this section. 13 Sec. 33. Section 218.30, Code 2024, is amended to read as 14 follows: 15 218.30 Investigation of other facilities. 16 The director may investigate or cause the investigation of 17 charges of abuse, neglect, or mismanagement on the part of an 18 officer or employee of a private facility which is subject to 19 the directors supervision or control. The director shall also 20 investigate or cause the investigation of charges concerning 21 county care facilities in which persons with mental illness are 22 served. 23 Sec. 34. Section 218.78, subsection 1, Code 2024, is amended 24 to read as follows: 25 1. All institutional receipts of the department, including 26 funds received from client participation at the state resource 27 centers under section 222.78 and at the state mental health 28 institutes under section 230.20 , shall be deposited in the 29 general fund except for reimbursements for services provided 30 to another institution or state agency, for receipts deposited 31 in the revolving farm fund under section 904.706 , for deposits 32 into the medical assistance fund under section 249A.11 , and for 33 rentals charged to employees or others for room, apartment, or 34 house and meals, which shall be available to the institutions. 35 -25- HF 2673 (8) 90 dg/ko/md 25/ 95
H.F. 2673 Sec. 35. Section 222.1, subsection 1, Code 2024, is amended 1 to read as follows: 2 1. This chapter addresses the public and private services 3 available in this state to meet the needs of persons with an 4 intellectual disability. The responsibility of the mental 5 health and disability services regions formed by counties and 6 of the state for the costs and administration of publicly 7 funded services shall be as set out in section 222.60 and other 8 pertinent sections of this chapter . 9 Sec. 36. Section 222.2, Code 2024, is amended by adding the 10 following new subsection: 11 NEW SUBSECTION . 01. Administrative services organization 12 means the same as defined in section 225A.1. 13 Sec. 37. Section 222.2, subsections 6 and 7, Code 2024, are 14 amended by striking the subsections. 15 Sec. 38. Section 222.12, subsection 2, Code 2024, is amended 16 by striking the subsection. 17 Sec. 39. Section 222.13, Code 2024, is amended to read as 18 follows: 19 222.13 Voluntary admissions. 20 1. If an adult person is believed to be a person with an 21 intellectual disability, the adult person or the adult persons 22 guardian may apply to the department and the superintendent of 23 any state resource center for the voluntary admission of the 24 adult person either as an inpatient or an outpatient of the 25 resource center. If the expenses of the persons admission 26 or placement are payable in whole or in part by the persons 27 county of residence, application for the admission shall be 28 made through the regional administrator. An application for 29 admission to a special unit of any adult person believed to be 30 in need of any of the services provided by the special unit 31 under section 222.88 may be made in the same manner. The 32 superintendent shall accept the application if a preadmission 33 diagnostic evaluation confirms or establishes the need for 34 admission, except that an application shall not be accepted if 35 -26- HF 2673 (8) 90 dg/ko/md 26/ 95
H.F. 2673 the institution does not have adequate facilities available or 1 if the acceptance will result in an overcrowded condition. 2 2. If the resource center does not have an appropriate 3 program for the treatment of an adult or minor person with an 4 intellectual disability applying under this section or section 5 222.13A , the regional administrator for the persons county 6 of residence or the department , as applicable, shall arrange 7 for the placement of the person in any public or private 8 facility within or without outside of the state, approved by 9 the director, which offers appropriate services for the person. 10 If the expenses of the placement are payable in whole or in 11 part by a county, the placement shall be made by the regional 12 administrator for the county. 13 3. If the expenses of an admission of an adult to a resource 14 center or a special unit, or of the placement of the person 15 in a public or private facility are payable in whole or in 16 part by a mental health and disability services region, the 17 regional administrator shall make a full investigation into 18 the financial circumstances of the person and those liable for 19 the persons support under section 222.78 to determine whether 20 or not any of them are able to pay the expenses arising out of 21 the admission of the person to a resource center, special unit, 22 or public or private facility. If the regional administrator 23 finds that the person or those legally responsible for 24 the person are presently unable to pay the expenses, the 25 regional administrator shall pay the expenses. The regional 26 administrator may review such a finding at any subsequent 27 time while the person remains at the resource center, or is 28 otherwise receiving care or treatment for which this chapter 29 obligates the region to pay. If the regional administrator 30 finds upon review that the person or those legally responsible 31 for the person are presently able to pay the expenses, the 32 finding shall apply only to the charges incurred during the 33 period beginning on the date of the review and continuing 34 thereafter, unless and until the regional administrator again 35 -27- HF 2673 (8) 90 dg/ko/md 27/ 95
H.F. 2673 changes such a finding. If the regional administrator finds 1 that the person or those legally responsible for the person 2 are able to pay the expenses, the regional administrator shall 3 collect the charges to the extent required by section 222.78 , 4 and the regional administrator shall be responsible for the 5 payment of the remaining charges. 6 Sec. 40. Section 222.13A, subsections 3 and 4, Code 2024, 7 are amended to read as follows: 8 3. During the preadmission diagnostic evaluation, the 9 minor shall be informed both orally and in writing that the 10 minor has the right to object to the voluntary admission. If 11 Notwithstanding section 222.33, if the preadmission diagnostic 12 evaluation determines that the voluntary admission is 13 appropriate but the minor objects to the admission, the minor 14 shall not be admitted to the state resource center unless the 15 court approves of the admission. A petition for approval of 16 the minors admission may be submitted to the juvenile court by 17 the minors parent, guardian, or custodian. 18 4. As soon as practicable after the filing of a petition for 19 approval of the voluntary admission, the court shall determine 20 whether the minor has an attorney to represent the minor in the 21 proceeding. If the minor does not have an attorney, the court 22 shall assign an attorney to the minor an attorney . If the 23 minor is unable to pay for an attorney, the attorney shall be 24 compensated by the mental health and disability services region 25 an administrative services organization at an hourly rate to be 26 established by the regional administrator in substantially the 27 same manner as provided in section 815.7 . 28 Sec. 41. Section 222.14, Code 2024, is amended to read as 29 follows: 30 222.14 Care by region pending admission. 31 If the institution is unable to receive a patient, the 32 superintendent shall notify the regional administrator 33 for the county of residence of the prospective patient an 34 administrative services organization . Until such time as the 35 -28- HF 2673 (8) 90 dg/ko/md 28/ 95
H.F. 2673 patient is able to be received by the institution, or when 1 application has been made for admission to a public or private 2 facility as provided in section 222.13 and the application 3 is pending, the care of the patient shall be provided as 4 arranged by the regional administrator administrative services 5 organization . 6 Sec. 42. NEW SECTION . 222.33 State resource center 7 admissions and discharge. 8 1. The department shall make all final determinations 9 concerning whether a person may be admitted to a state resource 10 center. 11 2. If a patient is admitted to a state resource center 12 pursuant to section 222.13 or 222.13A, and the patient 13 wishes to be placed outside of the state resource center, the 14 discharge of the patient shall be made in accordance with 15 section 222.15. 16 Sec. 43. NEW SECTION . 222.35 State payor of last resort. 17 The department shall implement services and adopt rules 18 pursuant to chapter 17A in a manner that ensures that the state 19 is the payor of last resort, and that the department shall not 20 make any payments for services that have been provided until 21 the department has determined that the services provided are 22 not payable by a third-party source. 23 Sec. 44. Section 222.73, subsections 2 and 4, Code 2024, are 24 amended by striking the subsections. 25 Sec. 45. Section 222.77, Code 2024, is amended to read as 26 follows: 27 222.77 Patients on leave. 28 The cost of support of patients placed on convalescent leave 29 or removed as a habilitation measure from a resource center, 30 or a special unit, except when living in the home of a person 31 legally bound for the support of the patient, shall be paid by 32 the county of residence or the state as provided in section 33 222.60 . 34 Sec. 46. Section 222.78, subsection 1, Code 2024, is amended 35 -29- HF 2673 (8) 90 dg/ko/md 29/ 95
H.F. 2673 to read as follows: 1 1. The father and mother of any patient admitted to a 2 resource center or to a special unit , as either an inpatient 3 or an outpatient, and any person, firm, or corporation bound 4 by contract made for support of the patient , are liable for 5 the support of the patient. The patient and those legally 6 bound for the support of the patient shall be liable to 7 the county or state , as applicable, for all sums advanced 8 in accordance with the provisions of sections 222.60 and 9 222.77 relating to reasonable attorney fees and court costs for 10 the patients admission to the resource center, and for the 11 treatment, training, instruction, care, habilitation, support, 12 transportation, or other expenditures made on behalf of the 13 patient pursuant to this chapter . 14 Sec. 47. Section 222.79, Code 2024, is amended to read as 15 follows: 16 222.79 Certification statement presumed correct. 17 In actions to enforce the liability imposed by section 18 222.78 , the superintendent or the county of residence, as 19 applicable, shall submit a certification statement stating 20 the sums charged, and the certification statement shall be 21 considered presumptively correct. 22 Sec. 48. Section 222.80, Code 2024, is amended to read as 23 follows: 24 222.80 Liability to county or state. 25 A person admitted to a county institution or home or admitted 26 at county or state expense to a private hospital, sanitarium, 27 or other facility for treatment, training, instruction, care, 28 habilitation, and support as a patient with an intellectual 29 disability shall be liable to the county or state , as 30 applicable, for the reasonable cost of the support as provided 31 in section 222.78 . 32 Sec. 49. Section 222.82, Code 2024, is amended to read as 33 follows: 34 222.82 Collection of liabilities and claims. 35 -30- HF 2673 (8) 90 dg/ko/md 30/ 95
H.F. 2673 If liabilities and claims exist as provided in section 1 222.78 or any other provision of this chapter , the county of 2 residence or the state , as applicable, may proceed as provided 3 in this section . If the liabilities and claims are owed to 4 a county of residence, the countys board of supervisors may 5 direct the county attorney to proceed with the collection of 6 the liabilities and claims as a part of the duties of the 7 county attorneys office when the board of supervisors deems 8 such action advisable. If the liabilities and claims are owed 9 to the state, the state shall proceed with the collection. 10 The board of supervisors or the state , as applicable, may 11 compromise any and all liabilities to the county or state 12 arising under this chapter when such compromise is deemed to be 13 in the best interests of the county or state. Any collections 14 and liens shall be limited in conformance to section 614.1, 15 subsection 4 . 16 Sec. 50. Section 222.85, subsection 2, Code 2024, is amended 17 to read as follows: 18 2. Moneys paid to a resource center from any source other 19 than state appropriated funds and intended to pay all or a 20 portion of the cost of care of a patient, which cost would 21 otherwise be paid from state or county funds or from the 22 patients own funds, shall not be deemed funds belonging to a 23 patient for the purposes of this section . 24 Sec. 51. Section 222.86, Code 2024, is amended to read as 25 follows: 26 222.86 Payment for care from fund. 27 If a patient is not receiving medical assistance under 28 chapter 249A and the amount in the account of any patient 29 in the patients personal deposit fund exceeds two hundred 30 dollars, the department may apply any amount of the excess to 31 reimburse the county of residence or the state for liability 32 incurred by the county or the state for the payment of care, 33 support, and maintenance of the patient , when billed by the 34 county or state , as applicable . 35 -31- HF 2673 (8) 90 dg/ko/md 31/ 95
H.F. 2673 Sec. 52. Section 222.92, subsection 1, Code 2024, is amended 1 to read as follows: 2 1. The department shall operate the state resource centers 3 on the basis of net appropriations from the general fund of 4 the state. The appropriation amounts shall be the net amounts 5 of state moneys projected to be needed for the state resource 6 centers for the fiscal year of the appropriations. The purpose 7 of utilizing net appropriations is to encourage the state 8 resource centers to operate with increased self-sufficiency, to 9 improve quality and efficiency, and to support collaborative 10 efforts between the state resource centers and counties and 11 other providers of funding for the services available from 12 the state resource centers. The state resource centers shall 13 not be operated under the net appropriations in a manner that 14 results in a cost increase to the state or in cost shifting 15 between the state, the medical assistance program, counties, or 16 other sources of funding for the state resource centers. 17 Sec. 53. Section 222.92, subsection 3, paragraph a, Code 18 2024, is amended by striking the paragraph. 19 Sec. 54. Section 225.1, subsection 2, Code 2024, is amended 20 to read as follows: 21 2. For the purposes of this chapter , unless the context 22 otherwise requires: 23 a. Mental health and disability services region means 24 a mental health and disability services region approved in 25 accordance with section 225C.56 . Administrative services 26 organization means the same as defined in section 225A.1. 27 b. Regional administrator means the administrator of a 28 mental health and disability services region, as defined in 29 section 225C.55 . Department means the department of health 30 and human services. 31 c. Respondent means the same as defined in section 229.1 . 32 Sec. 55. NEW SECTION . 225.4 State psychiatric hospital 33 admissions. 34 The department shall make all final determinations 35 -32- HF 2673 (8) 90 dg/ko/md 32/ 95
H.F. 2673 concerning whether a person may be admitted to the state 1 psychiatric hospital. 2 Sec. 56. Section 225.11, Code 2024, is amended to read as 3 follows: 4 225.11 Initiating commitment procedures. 5 When a court finds upon completion of a hearing held pursuant 6 to section 229.12 that the contention that a respondent is 7 seriously mentally impaired has been sustained by clear and 8 convincing evidence, and the application filed under section 9 229.6 also contends or the court otherwise concludes that it 10 would be appropriate to refer the respondent to the state 11 psychiatric hospital for a complete psychiatric evaluation and 12 appropriate treatment pursuant to section 229.13 , the judge 13 may order that a financial investigation be made in the manner 14 prescribed by section 225.13 . If the costs of a respondents 15 evaluation or treatment are payable in whole or in part by a 16 county an administrative services organization , an order under 17 this section shall be for referral of the respondent through 18 the regional administrator for the respondents county of 19 residence by an administrative services organization for an 20 evaluation and referral of the respondent to an appropriate 21 placement or service, which may include the state psychiatric 22 hospital for additional evaluation or treatment. 23 Sec. 57. Section 225.12, Code 2024, is amended to read as 24 follows: 25 225.12 Voluntary public patient physicians or physician 26 assistants report. 27 A physician or a physician assistant who meets the 28 qualifications set forth in the definition of a mental health 29 professional in section 228.1 filing information under 30 section 225.10 shall include a written report to the regional 31 administrator for the county of residence of the person named 32 in the information, giving shall submit a detailed history of 33 the case to an administrative services organization as will be 34 likely to aid in the observation, treatment, and hospital care 35 -33- HF 2673 (8) 90 dg/ko/md 33/ 95
H.F. 2673 of the person and describing the history in detail . 1 Sec. 58. Section 225.13, Code 2024, is amended to read as 2 follows: 3 225.13 Financial condition. 4 The regional administrator for the county of residence of 5 a person being admitted to the state psychiatric hospital is 6 Administrative services organizations shall be responsible for 7 investigating the financial condition of the a person and of 8 those legally responsible for the persons support. 9 Sec. 59. Section 225.15, Code 2024, is amended to read as 10 follows: 11 225.15 Examination and treatment. 12 1. When a respondent arrives at the state psychiatric 13 hospital, the admitting physician, or a physician assistant 14 who meets the qualifications set forth in the definition of a 15 mental health professional in section 228.1 , shall examine the 16 respondent and determine whether or not, in the physicians 17 or physician assistants judgment, the respondent is a fit 18 subject for observation, treatment, and hospital care. If, 19 upon examination, the physician or physician assistant who 20 meets the qualifications set forth in the definition of a 21 mental health professional in section 228.1 decides that the 22 respondent should be admitted to the hospital, the respondent 23 shall be provided a proper bed in the hospital. The physician 24 or physician assistant who meets the qualifications set forth 25 in the definition of a mental health professional in section 26 228.1 who has charge of the respondent shall proceed with 27 observation, medical treatment, and hospital care as in the 28 physicians or physician assistants judgment are proper and 29 necessary, in compliance with sections 229.13 , 229.14 , this 30 section , and section 229.16 . After the respondents admission, 31 the observation, medical treatment, and hospital care of the 32 respondent may be provided by a mental health professional, 33 as defined in section 228.1 , who is licensed as a physician, 34 advanced registered nurse practitioner, or physician assistant. 35 -34- HF 2673 (8) 90 dg/ko/md 34/ 95
H.F. 2673 2. A proper and competent nurse shall also be assigned to 1 look after and care for the respondent during observation, 2 treatment, and care. Observation, treatment, and hospital 3 care under this section which are payable in whole or in part 4 by a county shall only be provided as determined through 5 the regional administrator for the respondents county of 6 residence. 7 Sec. 60. Section 225.16, subsection 1, Code 2024, is amended 8 to read as follows: 9 1. If the regional administrator for a persons county of 10 residence department finds from the physicians information 11 or from the information of a physician assistant who 12 meets the qualifications set forth in the definition of 13 a mental health professional in section 228.1 which was 14 filed under the provisions of section 225.10 225.12 that it 15 would be appropriate for the person to be admitted to the 16 state psychiatric hospital, and the report of the regional 17 administrator made pursuant to section 225.13 shows the 18 department finds that the person and those who are legally 19 responsible for the person are not able to pay the expenses 20 incurred at the hospital, or are able to pay only a part of 21 the expenses, the person shall be considered to be a voluntary 22 public patient and the regional administrator shall direct that 23 the person shall be sent to the state psychiatric hospital at 24 the state university of Iowa for observation, treatment, and 25 hospital care. 26 Sec. 61. Section 225.17, subsection 2, Code 2024, is amended 27 to read as follows: 28 2. When the respondent arrives at the hospital, the 29 respondent shall receive the same treatment as is provided for 30 committed public patients in section 225.15 , in compliance 31 with sections 229.13 through 229.16 . However, observation, 32 treatment, and hospital care under this section of a respondent 33 whose expenses are payable in whole or in part by a county 34 shall only be provided as determined through the regional 35 -35- HF 2673 (8) 90 dg/ko/md 35/ 95
H.F. 2673 administrator for the respondents county of residence. 1 Sec. 62. Section 225.18, Code 2024, is amended to read as 2 follows: 3 225.18 Attendants. 4 The regional administrator An administrative services 5 organization may appoint an attendant to accompany the 6 committed public patient or the voluntary public patient 7 or the committed private patient from the place where the 8 patient may be to the state psychiatric hospital, or to 9 accompany the patient from the hospital to a place as may 10 be designated by the regional administrator administrative 11 services organization . If a patient is moved pursuant to this 12 section , at least one attendant shall be of the same gender as 13 the patient. 14 Sec. 63. Section 225.22, Code 2024, is amended to read as 15 follows: 16 225.22 Liability of private patients payment. 17 Every committed private patient, if the patient has an 18 estate sufficient for that purpose, or if those legally 19 responsible for the patients support are financially able, 20 shall be liable to the county and state for all expenses paid 21 by them in the state on behalf of such patient. All bills 22 for the care, nursing, observation, treatment, medicine, and 23 maintenance of such patients shall be paid by the director of 24 the department of administrative services in the same manner as 25 those of committed and voluntary public patients as provided in 26 this chapter , unless the patient or those legally responsible 27 for the patient make such settlement with the state psychiatric 28 hospital. 29 Sec. 64. Section 225.24, Code 2024, is amended to read as 30 follows: 31 225.24 Collection of preliminary expense. 32 Unless a committed private patient or those legally 33 responsible for the patients support offer to settle the 34 amount of the claims, the regional administrator for the 35 -36- HF 2673 (8) 90 dg/ko/md 36/ 95
H.F. 2673 persons county of residence department shall collect, by 1 action if necessary, the amount of all claims for per diem and 2 expenses that have been approved by the regional administrator 3 for the county an administrative services organization and 4 paid by the regional administrator as provided under section 5 225.21 administrative services organization . Any amount 6 collected shall be credited to the mental health and disability 7 services region combined account created behavioral health fund 8 established in accordance with section 225C.58 225A.7 . 9 Sec. 65. Section 225.27, Code 2024, is amended to read as 10 follows: 11 225.27 Discharge transfer. 12 The state psychiatric hospital may, at any time, discharge 13 any patient as recovered, as improved, or as not likely to 14 be benefited by further treatment. If the patient being so 15 discharged was involuntarily hospitalized, the hospital shall 16 notify the committing judge or court of the discharge as 17 required by section 229.14 or section 229.16 , whichever is as 18 applicable , and the applicable regional administrator . Upon 19 receiving the notification, the court shall issue an order 20 confirming the patients discharge from the hospital or from 21 care and custody, as the case may be, and shall terminate the 22 proceedings pursuant to which the order was issued. The court 23 or judge shall, if necessary, appoint a person to accompany the 24 discharged patient from the state psychiatric hospital to such 25 place as the hospital or the court may designate, or authorize 26 the hospital to appoint such attendant. 27 Sec. 66. Section 226.1, subsection 4, Code 2024, is amended 28 by adding the following new paragraph: 29 NEW PARAGRAPH . 0a. Administrative services organization 30 means the same as defined in section 225A.1. 31 Sec. 67. Section 226.1, subsection 4, paragraphs d and f, 32 Code 2024, are amended by striking the paragraphs. 33 Sec. 68. Section 226.8, subsection 2, Code 2024, is amended 34 to read as follows: 35 -37- HF 2673 (8) 90 dg/ko/md 37/ 95
H.F. 2673 2. Charges for the care of any person with a diagnosis of 1 an intellectual disability admitted to a state mental health 2 institute shall be made by the institute in the manner provided 3 by chapter 230 , but the liability of any other person to any 4 mental health and disability services region the state for the 5 cost of care of such person with a diagnosis of an intellectual 6 disability shall be as prescribed by section 222.78 . 7 Sec. 69. Section 226.32, Code 2024, is amended to read as 8 follows: 9 226.32 Overcrowded conditions. 10 The director shall order the discharge or removal from the 11 mental health institute of incurable and harmless patients 12 whenever it is necessary to make room for recent cases. If 13 a patient who is to be discharged entered the mental health 14 institute voluntarily, the director shall notify the regional 15 administrator for the county interested at least ten days in 16 advance of the day of actual discharge. 17 Sec. 70. Section 226.34, subsection 2, paragraph d, Code 18 2024, is amended by striking the paragraph. 19 Sec. 71. Section 228.6, subsection 1, Code 2024, is amended 20 to read as follows: 21 1. A mental health professional or an employee of or 22 agent for a mental health facility may disclose mental health 23 information if and to the extent necessary, to meet the 24 requirements of section 229.24 , 229.25 , 230.20 , 230.21 , 230.25 , 25 230.26 , 230A.108 , 232.74 , or 232.147 , or to meet the compulsory 26 reporting or disclosure requirements of other state or federal 27 law relating to the protection of human health and safety. 28 Sec. 72. Section 229.1, Code 2024, is amended by adding the 29 following new subsection: 30 NEW SUBSECTION . 01. Administrative services organization 31 means the same as defined in section 225A.1. 32 Sec. 73. Section 229.1, subsections 11, 18, and 19, Code 33 2024, are amended by striking the subsections. 34 Sec. 74. Section 229.1B, Code 2024, is amended to read as 35 -38- HF 2673 (8) 90 dg/ko/md 38/ 95
H.F. 2673 follows: 1 229.1B Regional administrator Administrative services 2 organization . 3 Notwithstanding any provision of this chapter to the 4 contrary, any person whose hospitalization expenses are 5 payable in whole or in part by a mental health and disability 6 services region an administrative services organization 7 shall be subject to all administrative requirements of the 8 regional administrator for the county administrative services 9 organization . 10 Sec. 75. Section 229.2, subsection 1, paragraph b, 11 subparagraph (3), Code 2024, is amended to read as follows: 12 (3) As soon as is practicable after the filing of a 13 petition for juvenile court approval of the admission of the 14 minor, the juvenile court shall determine whether the minor 15 has an attorney to represent the minor in the hospitalization 16 proceeding, and if not, the court shall assign to the minor 17 an attorney. If the minor is financially unable to pay for 18 an attorney, the attorney shall be compensated by the mental 19 health and disability services region an administrative 20 services organization at an hourly rate to be established 21 by the regional administrator for the county in which the 22 proceeding is held administrative services organization in 23 substantially the same manner as provided in section 815.7 . 24 Sec. 76. Section 229.2, subsection 2, paragraph a, Code 25 2024, is amended to read as follows: 26 a. The chief medical officer of a public hospital shall 27 receive and may admit the person whose admission is sought, 28 subject in cases other than medical emergencies to availability 29 of suitable accommodations and to the provisions of sections 30 section 229.41 and 229.42 . 31 Sec. 77. Section 229.8, subsection 1, Code 2024, is amended 32 to read as follows: 33 1. Determine whether the respondent has an attorney 34 who is able and willing to represent the respondent in the 35 -39- HF 2673 (8) 90 dg/ko/md 39/ 95
H.F. 2673 hospitalization proceeding, and if not, whether the respondent 1 is financially able to employ an attorney and capable of 2 meaningfully assisting in selecting one. In accordance with 3 those determinations, the court shall if necessary allow the 4 respondent to select, or shall assign to the respondent, an 5 attorney. If the respondent is financially unable to pay an 6 attorney, the attorney shall be compensated by the mental 7 health and disability services region an administrative 8 services organization at an hourly rate to be established 9 by the regional administrator for the county in which the 10 proceeding is held administrative services organization in 11 substantially the same manner as provided in section 815.7 . 12 Sec. 78. Section 229.10, subsection 1, paragraph a, Code 13 2024, is amended to read as follows: 14 a. An examination of the respondent shall be conducted by 15 one or more licensed physicians or mental health professionals, 16 as required by the courts order, within a reasonable time. 17 If the respondent is detained pursuant to section 229.11, 18 subsection 1 , paragraph b , the examination shall be conducted 19 within twenty-four hours. If the respondent is detained 20 pursuant to section 229.11, subsection 1 , paragraph a or 21 c , the examination shall be conducted within forty-eight 22 hours. If the respondent so desires, the respondent shall be 23 entitled to a separate examination by a licensed physician or 24 mental health professional of the respondents own choice. The 25 reasonable cost of the examinations shall, if the respondent 26 lacks sufficient funds to pay the cost, be paid by the regional 27 administrator from mental health and disability services region 28 funds an administrative services organization upon order of the 29 court. 30 Sec. 79. Section 229.11, subsection 1, unnumbered paragraph 31 1, Code 2024, is amended to read as follows: 32 If the applicant requests that the respondent be taken into 33 immediate custody and the judge, upon reviewing the application 34 and accompanying documentation, finds probable cause to believe 35 -40- HF 2673 (8) 90 dg/ko/md 40/ 95
H.F. 2673 that the respondent has a serious mental impairment and is 1 likely to injure the respondent or other persons if allowed 2 to remain at liberty, the judge may enter a written order 3 directing that the respondent be taken into immediate custody 4 by the sheriff or the sheriffs deputy and be detained until 5 the hospitalization hearing. The hospitalization hearing shall 6 be held no more than five days after the date of the order, 7 except that if the fifth day after the date of the order is 8 a Saturday, Sunday, or a holiday, the hearing may be held 9 on the next succeeding business day. If the expenses of a 10 respondent are payable in whole or in part by a mental health 11 and disability services region an administrative services 12 organization , for a placement in accordance with paragraph a , 13 the judge shall give notice of the placement to the regional 14 administrator for the county in which the court is located an 15 administrative services organization , and for a placement in 16 accordance with paragraph b or c , the judge shall order 17 the placement in a hospital or facility designated through 18 the regional administrator by an administrative services 19 organization . The judge may order the respondent detained for 20 the period of time until the hearing is held, and no longer, 21 in accordance with paragraph a , if possible, and if not then 22 in accordance with paragraph b , or, only if neither of these 23 alternatives is available, in accordance with paragraph c . 24 Detention may be in any of the following: 25 Sec. 80. Section 229.13, subsection 1, paragraph a, Code 26 2024, is amended to read as follows: 27 a. The court shall order a respondent whose expenses are 28 payable in whole or in part by a mental health and disability 29 services region an administrative services organization 30 placed under the care of an appropriate hospital or facility 31 designated through the regional administrator for the county 32 by an administrative services organization on an inpatient or 33 outpatient basis. 34 Sec. 81. Section 229.13, subsection 7, paragraph b, Code 35 -41- HF 2673 (8) 90 dg/ko/md 41/ 95
H.F. 2673 2024, is amended to read as follows: 1 b. A region An administrative services organization shall 2 contract with mental health professionals to provide the 3 appropriate treatment including treatment by the use of oral 4 medicine or injectable antipsychotic medicine pursuant to this 5 section . 6 Sec. 82. Section 229.14, subsection 2, paragraph a, Code 7 2024, is amended to read as follows: 8 a. For a respondent whose expenses are payable in whole 9 or in part by a mental health and disability services region 10 an administrative services organization , placement as 11 designated through the regional administrator for the county 12 by an administrative services organization in the care of an 13 appropriate hospital or facility on an inpatient or outpatient 14 basis, or other appropriate treatment, or in an appropriate 15 alternative placement. 16 Sec. 83. Section 229.14A, subsections 7 and 9, Code 2024, 17 are amended to read as follows: 18 7. If a respondents expenses are payable in whole or in 19 part by a mental health and disability services region through 20 the regional administrator for the county an administrative 21 services organization , notice of a placement hearing shall be 22 provided to the county attorney and the regional administrator 23 an administrative services organization . At the hearing, the 24 county may present evidence regarding appropriate placement. 25 9. A placement made pursuant to an order entered under 26 section 229.13 or 229.14 or this section shall be considered to 27 be authorized through the regional administrator for the county 28 by an administrative services organization . 29 Sec. 84. Section 229.15, subsection 4, Code 2024, is amended 30 to read as follows: 31 4. When a patient has been placed in an alternative facility 32 other than a hospital pursuant to a report issued under section 33 229.14, subsection 1 , paragraph d , a report on the patients 34 condition and prognosis shall be made to the court which placed 35 -42- HF 2673 (8) 90 dg/ko/md 42/ 95
H.F. 2673 the patient, at least once every six months, unless the court 1 authorizes annual reports. If an evaluation of the patient is 2 performed pursuant to section 227.2, subsection 4 , a copy of 3 the evaluation report shall be submitted to the court within 4 fifteen days of the evaluations completion. The court may in 5 its discretion waive the requirement of an additional report 6 between the annual evaluations. If the department exercises 7 the authority to remove residents or patients from a county 8 care facility or other county or private facility under section 9 227.6 , the department shall promptly notify each court which 10 placed in that facility any resident or patient removed. 11 Sec. 85. Section 229.19, subsection 1, paragraphs a and b, 12 Code 2024, are amended to read as follows: 13 a. In each county the board of supervisors shall appoint 14 an individual who has demonstrated by prior activities an 15 informed concern for the welfare and rehabilitation of persons 16 with mental illness, and who is not an officer or employee of 17 the department , an officer or employee of a region, an officer 18 or employee of a county performing duties for a region, or 19 an officer or employee of any agency or facility providing 20 care or treatment to persons with mental illness, to act as an 21 advocate representing the interests of patients involuntarily 22 hospitalized by the court, in any matter relating to the 23 patients hospitalization or treatment under section 229.14 or 24 229.15 . 25 b. The committing court shall assign the advocate for the 26 county where the patient is located. A county or region may 27 seek reimbursement from the patients county of residence or 28 from the region in which the patients county of residence is 29 located an administrative services organization . 30 Sec. 86. Section 229.19, subsection 4, unnumbered paragraph 31 1, Code 2024, is amended to read as follows: 32 The state mental health and disability services commission 33 created in section 225C.5 department , in consultation with 34 advocates and county and judicial branch representatives, shall 35 -43- HF 2673 (8) 90 dg/ko/md 43/ 95
H.F. 2673 adopt rules pursuant to chapter 17A relating to advocates that 1 include but are not limited to all of the following topics: 2 Sec. 87. Section 229.22, subsection 2, paragraph b, Code 3 2024, is amended to read as follows: 4 b. If the magistrate orders that the person be detained, 5 the magistrate shall, by the close of business on the next 6 working day, file a written order with the clerk in the county 7 where it is anticipated that an application may be filed 8 under section 229.6 . The order may be filed by facsimile if 9 necessary. A peace officer from the law enforcement agency 10 that took the person into custody, if no request was made 11 under paragraph a , may inform the magistrate that an arrest 12 warrant has been issued for or charges are pending against the 13 person and request that any written order issued under this 14 paragraph require the facility or hospital to notify the law 15 enforcement agency about the discharge of the person prior to 16 discharge. The order shall state the circumstances under which 17 the person was taken into custody or otherwise brought to a 18 facility or hospital, and the grounds supporting the finding 19 of probable cause to believe that the person is seriously 20 mentally impaired and likely to injure the persons self or 21 others if not immediately detained. The order shall also 22 include any law enforcement agency notification requirements if 23 applicable. The order shall confirm the oral order authorizing 24 the persons detention including any order given to transport 25 the person to an appropriate facility or hospital. A peace 26 officer from the law enforcement agency that took the person 27 into custody may also request an order, separate from the 28 written order, requiring the facility or hospital to notify the 29 law enforcement agency about the discharge of the person prior 30 to discharge. The clerk shall provide a copy of the written 31 order or any separate order to the chief medical officer of 32 the facility or hospital to which the person was originally 33 taken, to any subsequent facility to which the person was 34 transported, and to any law enforcement department, ambulance 35 -44- HF 2673 (8) 90 dg/ko/md 44/ 95
H.F. 2673 service, or transportation service under contract with a 1 mental health and disability services region an administrative 2 services organization that transported the person pursuant 3 to the magistrates order. A transportation service that 4 contracts with a mental health and disability services region 5 an administrative services organization for purposes of this 6 paragraph shall provide a secure transportation vehicle and 7 shall employ staff that has received or is receiving mental 8 health training. 9 Sec. 88. Section 229.24, subsection 3, unnumbered paragraph 10 1, Code 2024, is amended to read as follows: 11 If all or part of the costs associated with hospitalization 12 of an individual under this chapter are chargeable to a county 13 of residence an administrative services organization , the 14 clerk of the district court shall provide to the regional 15 administrator for the county of residence and to the regional 16 administrator for the county in which the hospitalization 17 order is entered an administrative services organization the 18 following information pertaining to the individual which would 19 be confidential under subsection 1 : 20 Sec. 89. Section 229.38, Code 2024, is amended to read as 21 follows: 22 229.38 Cruelty or official misconduct. 23 If any person having the care of a person with mental illness 24 who has voluntarily entered a hospital or other facility for 25 treatment or care, or who is responsible for psychiatric 26 examination care, treatment, and maintenance of any person 27 involuntarily hospitalized under sections 229.6 through 229.15 , 28 whether in a hospital or elsewhere, with or without proper 29 authority, shall treat such patient with unnecessary severity, 30 harshness, or cruelty, or in any way abuse the patient or if 31 any person unlawfully detains or deprives of liberty any person 32 with mental illness or any person who is alleged to have mental 33 illness, or if any officer required by the provisions of this 34 chapter and chapters chapter 226 and 227 , to perform any act 35 -45- HF 2673 (8) 90 dg/ko/md 45/ 95
H.F. 2673 shall willfully refuse or neglect to perform the same, the 1 offending person shall, unless otherwise provided, be guilty of 2 a serious misdemeanor. 3 Sec. 90. Section 230.1, Code 2024, is amended by adding the 4 following new subsection: 5 NEW SUBSECTION . 01. Administrative service organization 6 means the same as defined in section 225A.1. 7 Sec. 91. Section 230.1, subsections 4 and 5, Code 2024, are 8 amended by striking the subsections. 9 Sec. 92. Section 230.10, Code 2024, is amended to read as 10 follows: 11 230.10 Payment of costs. 12 All legal costs and expenses for the taking into custody, 13 care, investigation, and admission or commitment of a person to 14 a state mental health institute under a finding that the person 15 has residency in another county of this state shall be charged 16 against the regional administrator of the persons county of 17 residence to an administrative services organization . 18 Sec. 93. Section 230.11, Code 2024, is amended to read as 19 follows: 20 230.11 Recovery of costs from state. 21 Costs and expenses for the taking into custody, care, and 22 investigation of a person who has been admitted or committed 23 to a state mental health institute, United States department 24 of veterans affairs hospital, or other agency of the United 25 States government, for persons with mental illness and 26 who has no residence in this state or whose residence is 27 unknown, including cost of commitment, if any, shall be paid 28 as approved by the department. The amount of the costs and 29 expenses approved by the department is appropriated to the 30 department from any moneys in the state treasury not otherwise 31 appropriated. Payment shall be made by the department on 32 itemized vouchers executed by the regional administrator of 33 the persons county which has paid them, and approved by the 34 department. 35 -46- HF 2673 (8) 90 dg/ko/md 46/ 95
H.F. 2673 Sec. 94. Section 230.15, subsections 1 and 2, Code 2024, are 1 amended to read as follows: 2 1. A person with mental illness and a person legally liable 3 for the persons support remain liable for the support of 4 the person with mental illness as provided in this section . 5 Persons legally liable for the support of a person with mental 6 illness include the spouse of the person, and any person 7 bound by contract for support of the person. The regional 8 administrator of the persons county of residence, subject to 9 the direction of the regions governing board, shall enforce 10 the obligation created in this section as to all sums advanced 11 by the regional administrator. The liability to the regional 12 administrator incurred by a person with mental illness or a 13 person legally liable for the persons support under this 14 section is limited to an amount equal to one hundred percent 15 of the cost of care and treatment of the person with mental 16 illness at a state mental health institute for one hundred 17 twenty days of hospitalization. This limit of liability may 18 be reached by payment of the cost of care and treatment of the 19 person with mental illness subsequent to a single admission 20 or multiple admissions to a state mental health institute or, 21 if the person is not discharged as cured, subsequent to a 22 single transfer or multiple transfers to a county care facility 23 pursuant to section 227.11 . After reaching this limit of 24 liability, a person with mental illness or a person legally 25 liable for the persons support is liable to the regional 26 administrator state for the care and treatment of the person 27 with mental illness at a state mental health institute or, 28 if transferred but not discharged as cured, at a county care 29 facility in an amount not in excess of to exceed the average 30 minimum cost of the maintenance of an individual who is 31 physically and mentally healthy residing in the individuals 32 own home , which standard shall be as established and may be 33 revised by the department by rule . A lien imposed by section 34 230.25 shall not exceed the amount of the liability which may 35 -47- HF 2673 (8) 90 dg/ko/md 47/ 95
H.F. 2673 be incurred under this section on account of a person with 1 mental illness. 2 2. A person with a substance use disorder is legally 3 liable for the total amount of the cost of providing care, 4 maintenance, and treatment for the person with a substance 5 use disorder while a voluntary or committed patient. When 6 a portion of the cost is paid by a county an administrative 7 services organization , the person with a substance use disorder 8 is legally liable to the county administrative services 9 organization for the amount paid. The person with a substance 10 use disorder shall assign any claim for reimbursement under any 11 contract of indemnity, by insurance or otherwise, providing 12 for the persons care, maintenance, and treatment in a state 13 mental health institute to the state. Any payments received 14 by the state from or on behalf of a person with a substance use 15 disorder shall be in part credited to the county in proportion 16 to the share of the costs paid by the county. 17 Sec. 95. NEW SECTION . 230.23 State payor of last resort. 18 The department shall implement services and adopt rules 19 pursuant to chapter 17A in a manner that ensures that the state 20 is the payor of last resort, and that the department does not 21 make any payments for services that have been provided until 22 the department has determined that the services provided are 23 not payable by a third-party source. 24 Sec. 96. Section 230.30, Code 2024, is amended to read as 25 follows: 26 230.30 Claim against estate. 27 On the death of a person receiving or who has received 28 assistance under the provisions of this chapter , and whom the 29 board department has previously found , under section 230.25 , 30 is able to pay , there shall be allowed against the estate of 31 such decedent a claim of the sixth class for that portion of 32 the total amount paid for that persons care which exceeds 33 the total amount of all claims of the first through the fifth 34 classes, inclusive, as defined in section 633.425 , which are 35 -48- HF 2673 (8) 90 dg/ko/md 48/ 95
H.F. 2673 allowed against that estate. 1 Sec. 97. Section 232.78, subsection 5, unnumbered paragraph 2 1, Code 2024, is amended to read as follows: 3 The juvenile court, before or after the filing of a petition 4 under this chapter , may enter an ex parte order authorizing 5 a physician or physician assistant or hospital to conduct an 6 outpatient physical examination or authorizing a physician or 7 physician assistant, a psychologist certified under section 8 154B.7, or a community mental health center accredited pursuant 9 to chapter 230A section 225A.3 to conduct an outpatient mental 10 examination of a child if necessary to identify the nature, 11 extent, and cause of injuries to the child as required by 12 section 232.71B , provided all of the following apply: 13 Sec. 98. Section 232.83, subsection 2, unnumbered paragraph 14 1, Code 2024, is amended to read as follows: 15 Anyone authorized to conduct a preliminary investigation in 16 response to a complaint may apply for, or the court on its own 17 motion may enter, an ex parte order authorizing a physician 18 or physician assistant or hospital to conduct an outpatient 19 physical examination or authorizing a physician or physician 20 assistant, a psychologist certified under section 154B.7, or a 21 community mental health center accredited pursuant to chapter 22 230A section 225A.3 to conduct an outpatient mental examination 23 of a child if necessary to identify the nature, extent, and 24 causes of any injuries, emotional damage, or other such needs 25 of a child as specified in section 232.96A, subsection 3, 5, or 26 6 , provided that all of the following apply: 27 Sec. 99. Section 235.7, subsection 2, Code 2024, is amended 28 to read as follows: 29 2. Membership. The department may authorize the governance 30 boards of decategorization of child welfare and juvenile 31 justice funding projects established under section 232.188 to 32 appoint the transition committee membership and may utilize 33 the boundaries of decategorization projects to establish 34 the service areas for transition committees. The committee 35 -49- HF 2673 (8) 90 dg/ko/md 49/ 95
H.F. 2673 membership may include but is not limited to department staff 1 involved with foster care, child welfare, and adult services, 2 juvenile court services staff, staff involved with county 3 general assistance or emergency relief under chapter 251 or 4 252, or a regional administrator of the county mental health 5 and disability services region, as defined in section 225C.55, 6 in the area, school district and area education agency staff 7 involved with special education, and a childs court appointed 8 special advocate, guardian ad litem, service providers, and 9 other persons knowledgeable about the child. 10 Sec. 100. Section 235A.15, subsection 2, paragraph c, 11 subparagraphs (5) and (8), Code 2024, are amended by striking 12 the subparagraphs. 13 Sec. 101. Section 249A.4, subsection 15, Code 2024, is 14 amended by striking the subsection. 15 Sec. 102. Section 249A.12, subsection 4, Code 2024, is 16 amended by striking the subsection. 17 Sec. 103. NEW SECTION . 249A.38A Supported community living 18 services. 19 1. As used in this section, supported community living 20 service means a service provided in a noninstitutional 21 setting to adult persons with mental illness, an intellectual 22 disability, or developmental disabilities to meet the persons 23 daily living needs. 24 2. The department shall adopt rules pursuant to chapter 17A 25 establishing minimum standards for supported community living 26 services. 27 3. The department shall determine whether to grant, deny, or 28 revoke approval for any supported community living service. 29 4. Approved supported community living services may receive 30 funding from the state, federal and state social services block 31 grant funds, and other appropriate funding sources, consistent 32 with state legislation and federal regulations. The funding 33 may be provided on a per diem, per hour, or grant basis, as 34 appropriate. 35 -50- HF 2673 (8) 90 dg/ko/md 50/ 95
H.F. 2673 Sec. 104. Section 249N.8, Code 2024, is amended by striking 1 the section and inserting in lieu thereof the following: 2 249N.8 Behavioral health services reports. 3 The department shall annually submit a report to the 4 governor and the general assembly with details related to the 5 departments review of the funds administered by, and the 6 outcomes and effectiveness of, the behavioral health services 7 provided by, the behavioral health service system established 8 in section 225A.3. 9 Sec. 105. Section 252.24, subsections 1 and 3, Code 2024, 10 are amended to read as follows: 11 1. The county of residence, as defined in section 225C.61 12 331.190 , shall be liable to the county granting assistance for 13 all reasonable charges and expenses incurred in the assistance 14 and care of a poor person. 15 3. This section shall apply to assistance or maintenance 16 provided by a county through the countys mental health 17 and disability services behavioral health service system 18 implemented under chapter 225C established in section 225A.3 . 19 Sec. 106. Section 256.25, subsections 2 and 3, Code 2024, 20 are amended to read as follows: 21 2. A school district, which may collaborate and partner 22 with one or more school districts, area education agencies, 23 accredited nonpublic schools, nonprofit agencies, and 24 institutions that provide childrens mental health services, 25 located in mental health and disability services regions 26 providing childrens behavioral health services in accordance 27 with chapter 225C, subchapter VII operating within the states 28 behavioral health service system under chapter 225A , may apply 29 for a grant under this program to establish a therapeutic 30 classroom in the school district in accordance with this 31 section . 32 3. The department shall develop a grant application 33 and selection and evaluation criteria. Selection criteria 34 shall include a method for prioritizing grant applications 35 -51- HF 2673 (8) 90 dg/ko/md 51/ 95
H.F. 2673 submitted by school districts. First priority shall be 1 given to applications submitted by school districts that 2 submitted an application pursuant to this section for the 3 previous immediately preceding fiscal year. Second priority 4 shall be given to applications submitted by school districts 5 that, pursuant to subsection 2 , are collaborating and 6 partnering with one or more school districts, area education 7 agencies, accredited nonpublic schools, nonprofit agencies, 8 or institutions that provide mental health services for 9 children. Third priority shall be given to applications 10 submitted by school districts located in mental health and 11 disability services regions behavioral health districts as 12 defined in section 225A.1, and that are providing behavioral 13 health services for children in accordance with chapter 225C, 14 subchapter VII 225A . Grant awards shall be distributed as 15 equitably as possible among small, medium, and large school 16 districts. For purposes of this subsection , a small school 17 district is a district with an actual enrollment of fewer than 18 six hundred pupils; a medium school district is a district 19 with an actual enrollment that is at least six hundred pupils, 20 but less than two thousand five hundred pupils; and a large 21 school district is a district with an actual enrollment of two 22 thousand five hundred or more pupils. 23 Sec. 107. Section 321.189, subsection 10, Code 2024, is 24 amended to read as follows: 25 10. Autism spectrum disorder status. A licensee who has 26 autism spectrum disorder, as defined in section 514C.28 , may 27 request that the license be marked to reflect the licensees 28 autism spectrum disorder status on the face of the license 29 when the licensee applies for the issuance or renewal of a 30 license. The department may adopt rules pursuant to chapter 31 17A establishing criteria under which a license may be marked, 32 including requiring the licensee to submit medical proof of the 33 licensees autism spectrum disorder status. When a drivers 34 license is so marked, the licensees autism spectrum disorder 35 -52- HF 2673 (8) 90 dg/ko/md 52/ 95
H.F. 2673 status shall be noted in the electronic database used by 1 the department and law enforcement to access registration, 2 titling, and drivers license information. The department, in 3 consultation with the mental health and disability services 4 commission department of health and human services , shall 5 develop educational media to raise awareness of a licensees 6 ability to request the license be marked to reflect the 7 licensees autism spectrum disorder status. 8 Sec. 108. Section 321.190, subsection 1, paragraph b, 9 subparagraph (6), Code 2024, is amended to read as follows: 10 (6) An applicant for a nonoperators identification 11 card who has autism spectrum disorder, as defined in section 12 514C.28 , may request that the card be marked to reflect 13 the applicants autism spectrum disorder status on the face 14 of the card when the applicant applies for the issuance or 15 renewal of a card. The department may adopt rules pursuant to 16 chapter 17A establishing criteria under which a card may be 17 marked, including requiring the applicant to submit medical 18 proof of the applicants autism spectrum disorder status. 19 The department, in consultation with the mental health and 20 disability services commission department of health and human 21 services , shall develop educational media to raise awareness of 22 an applicants ability to request the card be marked to reflect 23 the applicants autism spectrum disorder status. 24 Sec. 109. Section 321J.25, subsection 1, paragraph b, Code 25 2024, is amended to read as follows: 26 b. Program means a substance use disorder awareness 27 program , licensed under chapter 125, and provided under a 28 contract entered into between the provider and the department 29 of health and human services under chapter 125 or an 30 administrative services organization as defined in section 31 225A.1 . 32 Sec. 110. Section 321J.25, subsection 2, unnumbered 33 paragraph 1, Code 2024, is amended to read as follows: 34 A substance use disorder awareness program is established 35 -53- HF 2673 (8) 90 dg/ko/md 53/ 95
H.F. 2673 in each of the regions established by the director of health 1 and human services pursuant to section 125.12 behavioral 2 health district designated pursuant to section 225A.4 . The 3 program shall consist of an insight class and a substance 4 use disorder evaluation, which shall be attended by the 5 participant, to discuss issues related to the potential 6 consequences of substance use disorder. The parent or parents 7 of the participant shall also be encouraged to participate 8 in the program. The program provider shall consult with the 9 participant or the parents of the participant in the program 10 to determine the timing and appropriate level of participation 11 for the participant and any participation by the participants 12 parents. The program may also include a supervised educational 13 tour by the participant to any or all of the following: 14 Sec. 111. Section 331.321, subsection 1, paragraph e, Code 15 2024, is amended by striking the paragraph. 16 Sec. 112. Section 331.323, subsection 1, paragraph a, 17 subparagraph (7), Code 2024, is amended by striking the 18 subparagraph. 19 Sec. 113. Section 331.381, subsections 4 and 5, Code 2024, 20 are amended to read as follows: 21 4. Comply with chapter 222 , including but not limited to 22 sections 222.13 , 222.14 , 222.59 through 222.70 , 222.73 through 23 222.75 , and 222.77 through 222.82 , in regard to the care of 24 persons with an intellectual disability. 25 5. Comply with chapters 227, 229 and 230 , including but not 26 limited to sections 227.11 , 227.14 , 229.42 , 230.25 , 230.27 , and 27 230.35 , in regard to the care of persons with mental illness. 28 Sec. 114. Section 331.382, subsection 1, paragraphs e, f, 29 and g, Code 2024, are amended by striking the paragraphs. 30 Sec. 115. Section 331.382, subsection 3, Code 2024, is 31 amended by striking the subsection. 32 Sec. 116. Section 331.432, subsection 3, Code 2024, is 33 amended by striking the subsection. 34 Sec. 117. Section 331.502, subsection 10, Code 2024, is 35 -54- HF 2673 (8) 90 dg/ko/md 54/ 95
H.F. 2673 amended by striking the subsection. 1 Sec. 118. Section 331.502, subsection 12, Code 2024, is 2 amended to read as follows: 3 12. Carry out duties relating to the hospitalization and 4 support of persons with mental illness as provided in sections 5 229.42, 230.3 , 230.11 , and 230.15 , 230.21 , 230.22 , 230.25 , and 6 230.26 . 7 Sec. 119. Section 331.552, subsection 13, Code 2024, is 8 amended by striking the subsection. 9 Sec. 120. Section 331.756, subsections 25, 38, and 41, Code 10 2024, are amended by striking the subsections. 11 Sec. 121. Section 331.910, subsection 2, Code 2024, is 12 amended by adding the following new paragraph: 13 NEW PARAGRAPH . 0a. Administrative services organization 14 means the same as defined in section 225A.1. 15 Sec. 122. Section 331.910, subsection 2, paragraph d, Code 16 2024, is amended by striking the paragraph. 17 Sec. 123. Section 331.910, subsection 3, paragraphs a and c, 18 Code 2024, are amended to read as follows: 19 a. A region An administrative services organization may 20 contract with a receiving agency in a bordering state to secure 21 substance use disorder or mental health care and treatment 22 under this subsection for persons who receive substance use 23 disorder or mental health care and treatment pursuant to 24 section 125.33, 125.91 , 229.2 , or 229.22 through a region . 25 c. A region An administrative services organization may 26 contract with a sending agency in a bordering state to provide 27 care and treatment under this subsection for residents of 28 the bordering state in approved substance use disorder and 29 mental health care and treatment hospitals, centers, and 30 facilities in this state, except that care and treatment shall 31 not be provided for residents of the bordering state who are 32 involved in criminal proceedings substantially similar to the 33 involvement described in paragraph b . 34 Sec. 124. Section 347.16, subsection 3, Code 2024, is 35 -55- HF 2673 (8) 90 dg/ko/md 55/ 95
H.F. 2673 amended to read as follows: 1 3. Care and treatment may be furnished in a county public 2 hospital to any sick or injured person who has residence 3 outside the county which maintains the hospital, subject to 4 such policies and rules as the board of hospital trustees 5 may adopt. If care and treatment is provided under this 6 subsection to a person who is indigent, the persons county of 7 residence, as defined in section 225C.61 331.190 , shall pay to 8 the board of hospital trustees the fair and reasonable cost of 9 the care and treatment provided by the county public hospital 10 unless the cost of the indigent persons care and treatment is 11 otherwise provided for. If care and treatment is provided to 12 an indigent person under this subsection , the county public 13 hospital furnishing the care and treatment shall immediately 14 notify, by regular mail, the auditor of the county of residence 15 of the indigent person of the provision of care and treatment 16 to the indigent person including care and treatment provided 17 by a county through the countys mental health and disability 18 services system implemented under chapter 225C behavioral 19 health service system established in section 225A.3 . 20 Sec. 125. Section 423.3, subsection 18, paragraph d, Code 21 2024, is amended to read as follows: 22 d. Community mental health centers accredited by the 23 department of health and human services pursuant to chapter 24 225C section 225A.3 . 25 Sec. 126. Section 426B.1, subsection 2, Code 2024, is 26 amended to read as follows: 27 2. Moneys shall be distributed from the property tax relief 28 fund to the mental health and disability services regional 29 service system for mental health and disability services, 30 behavioral health fund established in section 225A.7 in 31 accordance with the appropriations made to the fund and other 32 statutory requirements. 33 Sec. 127. Section 437A.8, subsection 4, paragraph d, Code 34 2024, is amended to read as follows: 35 -56- HF 2673 (8) 90 dg/ko/md 56/ 95
H.F. 2673 d. (1) Notwithstanding paragraph a , a taxpayer who owns 1 or leases a new electric power generating plant and who has 2 no other operating property in the state of Iowa except for 3 operating property directly serving the new electric power 4 generating plant as described in section 437A.16 shall pay 5 the replacement generation tax associated with the allocation 6 of the local amount to the county treasurer of the county in 7 which the local amount is located and shall remit the remaining 8 replacement generation tax, if any, to the director according 9 to paragraph a for remittance of the tax to county treasurers. 10 The director shall notify each taxpayer on or before August 31 11 following a tax year of its remaining replacement generation 12 tax to be remitted to the director. All remaining replacement 13 generation tax revenues received by the director shall be 14 deposited in the property tax relief fund created in section 15 426B.1 , and shall be distributed as provided in section 426B.2 . 16 (2) If a taxpayer has paid an amount of replacement tax, 17 penalty, or interest which was deposited into the property tax 18 relief fund and which was not due, all of the provisions of 19 section 437A.14, subsection 1 , paragraph b , shall apply with 20 regard to any claim for refund or credit filed by the taxpayer. 21 The director shall have sole discretion as to whether the 22 erroneous payment will be refunded to the taxpayer or credited 23 against any replacement tax due, or to become due, from the 24 taxpayer that would be subject to deposit in the property tax 25 relief fund. 26 Sec. 128. Section 437A.15, subsection 3, paragraph f, Code 27 2024, is amended to read as follows: 28 f. Notwithstanding the provisions of this section , if 29 a taxpayer is a municipal utility or a municipal owner of 30 an electric power facility financed under the provisions 31 of chapter 28F or 476A , the assessed value, other than the 32 local amount, of a new electric power generating plant shall 33 be allocated to each taxing district in which the municipal 34 utility or municipal owner is serving customers and has 35 -57- HF 2673 (8) 90 dg/ko/md 57/ 95
H.F. 2673 electric meters in operation in the ratio that the number of 1 operating electric meters of the municipal utility or municipal 2 owner located in the taxing district bears to the total number 3 of operating electric meters of the municipal utility or 4 municipal owner in the state as of January 1 of the tax year. 5 If the municipal utility or municipal owner of an electric 6 power facility financed under the provisions of chapter 28F 7 or 476A has a new electric power generating plant but the 8 municipal utility or municipal owner has no operating electric 9 meters in this state, the municipal utility or municipal owner 10 shall pay the replacement generation tax associated with the 11 new electric power generating plant allocation of the local 12 amount to the county treasurer of the county in which the local 13 amount is located and shall remit the remaining replacement 14 generation tax, if any, to the director at the times contained 15 in section 437A.8, subsection 4 , for remittance of the tax to 16 the county treasurers. All remaining replacement generation 17 tax revenues received by the director shall be deposited in the 18 property tax relief behavioral health fund created established 19 in section 426B.1, and shall be distributed as provided in 20 section 426B.2 225A.7 . 21 Sec. 129. Section 483A.24, subsection 7, Code 2024, is 22 amended to read as follows: 23 7. A license shall not be required of minor pupils of the 24 Iowa school for the deaf or of minor residents of other state 25 institutions under the control of the department of health 26 and human services. In addition, a person who is on active 27 duty with the armed forces of the United States, on authorized 28 leave from a duty station located outside of this state, and 29 a resident of the state of Iowa shall not be required to 30 have a license to hunt or fish in this state. The military 31 person shall carry the persons leave papers and a copy of 32 the persons current earnings statement showing a deduction 33 for Iowa income taxes while hunting or fishing. In lieu of 34 carrying the persons earnings statement, the military person 35 -58- HF 2673 (8) 90 dg/ko/md 58/ 95
H.F. 2673 may also claim residency if the person is registered to vote 1 in this state. If a deer or wild turkey is taken, the military 2 person shall immediately contact a state conservation officer 3 to obtain an appropriate tag to transport the animal. A 4 license shall not be required of residents of county care 5 facilities or any person who is receiving supplementary 6 assistance under chapter 249 . 7 Sec. 130. Section 602.8102, subsection 39, Code 2024, is 8 amended to read as follows: 9 39. Refer persons applying for voluntary admission to a 10 community mental health center accredited by the department 11 of health and human services under section 225A.3, for a 12 preliminary diagnostic evaluation as provided in section 13 225C.16, subsection 2 . 14 Sec. 131. Section 714.8, subsection 12, Code 2024, is 15 amended to read as follows: 16 12. Knowingly transfers or assigns a legal or equitable 17 interest in property, as defined in section 702.14 , for less 18 than fair consideration, with the intent to obtain public 19 assistance under chapters 16 , 35B , and 35D , and 347B , or Title 20 VI, subtitles 2 through 6 , or accepts a transfer of or an 21 assignment of a legal or equitable interest in property, as 22 defined in section 702.14 , for less than fair consideration, 23 with the intent of enabling the party transferring the property 24 to obtain public assistance under chapters 16 , 35B , and 35D , 25 and 347B , or Title VI, subtitles 2 through 6 . A transfer or 26 assignment of property for less than fair consideration within 27 one year prior to an application for public assistance benefits 28 shall be evidence of intent to transfer or assign the property 29 in order to obtain public assistance for which a person is 30 not eligible by reason of the amount of the persons assets. 31 If a person is found guilty of a fraudulent practice in the 32 transfer or assignment of property under this subsection the 33 maximum sentence shall be the penalty established for a serious 34 misdemeanor and sections 714.9 , 714.10 , and 714.11 shall not 35 -59- HF 2673 (8) 90 dg/ko/md 59/ 95
H.F. 2673 apply. 1 Sec. 132. Section 812.6, subsection 1, Code 2024, is amended 2 to read as follows: 3 1. If the court finds the defendant does not pose a danger 4 to the public peace and safety, is otherwise qualified for 5 pretrial release, and is willing to cooperate with treatment, 6 the court shall order, as a condition of pretrial release, 7 that the defendant obtain mental health treatment designed to 8 restore the defendant to competency. The costs of treatment 9 pursuant to this subsection shall be paid by the mental 10 health and disability services region for the county of the 11 defendants residency pursuant to chapter 225C regardless of 12 whether the defendant meets financial eligibility requirements 13 under section 225C.62 or 225C.66 an administrative services 14 organization designated pursuant to section 225A.4 . 15 Sec. 133. Section 904.201, subsection 8, Code 2024, is 16 amended to read as follows: 17 8. Chapter 230 governs the determination of costs and 18 charges for the care and treatment of persons with mental 19 illness admitted to the forensic psychiatric hospital , 20 except that charges for the care and treatment of any person 21 transferred to the forensic psychiatric hospital from an adult 22 correctional institution or from a state training school shall 23 be paid entirely from state funds . Charges for all other 24 persons at the forensic psychiatric hospital shall be billed to 25 the respective counties at the same ratio as for patients at 26 state mental health institutes under section 230.20. 27 Sec. 134. REPEAL. Chapters 142A, 225C, 227, 230A, and 347B, 28 Code 2024, are repealed. 29 Sec. 135. REPEAL. Sections 125.1, 125.3, 125.7, 125.9, 30 125.10, 125.12, 125.25, 125.32A, 125.34, 125.37, 125.38, 31 125.39, 125.40, 125.41, 125.42, 125.43, 125.43A, 125.46, 32 125.48, 125.54, 125.55, 125.58, 125.59, 125.60, 135B.18, 33 218.99, 222.59, 222.60, 222.61, 222.62, 222.63, 222.64, 222.65, 34 222.66, 222.67, 222.68, 222.69, 222.70, 222.74, 222.75, 225.10, 35 -60- HF 2673 (8) 90 dg/ko/md 60/ 95
H.F. 2673 225.19, 225.21, 226.45, 229.42, 230.1A, 230.2, 230.3, 230.4, 1 230.5, 230.6, 230.9, 230.12, 230.16, 230.17, 230.18, 230.19, 2 230.20, 230.21, 230.22, 230.25, 230.26, 230.27, 426B.2, 426B.4, 3 and 426B.5, Code 2024, are repealed. 4 Sec. 136. CODE EDITOR DIRECTIVE. The Code editor is 5 directed to correct internal references in the Code and in any 6 enacted legislation as necessary due to the enactment of this 7 division of this Act. 8 Sec. 137. EFFECTIVE DATE. This division of this Act takes 9 effect July 1, 2025. 10 DIVISION III 11 AGING AND DISABILITY 12 Sec. 138. Section 231.3, Code 2024, is amended to read as 13 follows: 14 231.3 State policy and objectives. 15 1. The general assembly declares that it is the policy of 16 the state to work toward attainment of the following objectives 17 for Iowas older individuals and individuals with disabilities : 18 1. a. An adequate income. 19 2. b. Access to physical and mental health care and 20 long-term living and community support services without regard 21 to economic status. 22 3. c. Suitable and affordable housing that reflects the 23 needs of older individuals. 24 4. d. Access to comprehensive information and a community 25 navigation system providing all available options related to 26 long-term living and community support services that assist 27 older individuals in the preservation of personal assets and 28 the ability to entirely avoid or significantly delay reliance 29 on entitlement programs. 30 5. e. Full restorative services for those who require 31 institutional care, and a comprehensive array of long-term 32 living and community support services adequate to sustain older 33 people in their communities and, whenever possible, in their 34 homes, including support for caregivers. 35 -61- HF 2673 (8) 90 dg/ko/md 61/ 95
H.F. 2673 6. f. Pursuit of meaningful activity within the widest 1 range of civic, cultural, educational, recreational, and 2 employment opportunities. 3 7. g. Suitable community transportation systems to assist 4 in the attainment of independent movement. 5 8. h. Freedom, independence, and the free exercise of 6 individual initiative in planning and managing their own lives. 7 9. i. Freedom from abuse, neglect, and exploitation. 8 2. The general assembly declares that the state of Iowa 9 recognizes a brain injury as a disability, and each agency and 10 subdivision of this state shall recognize a brain injury as a 11 distinct disability. 12 3. It is the policy of this state that each state agency 13 shall make reasonable efforts to identify those persons with 14 brain injuries among the persons served by the state agency. 15 Sec. 139. Section 231.4, subsection 1, Code 2024, is amended 16 by adding the following new paragraph: 17 NEW PARAGRAPH . 0c. Brain injury means the same as defined 18 in section 135.22. 19 Sec. 140. Section 231.4, subsection 1, paragraph d, Code 20 2024, is amended to read as follows: 21 d. Commission means the commission on aging. Council 22 means the council on health and human services created in 23 section 217.2. 24 Sec. 141. Section 231.14, Code 2024, is amended to read as 25 follows: 26 231.14 Commission Council duties and authority. 27 1. The commission is the policymaking body of the sole state 28 agency responsible for administration of the federal Act. The 29 commission council shall do all of the following : 30 a. 1. Approve Make recommendations to the department 31 regarding approval of the state plan on aging developed under 32 section 231.31 and area plans on aging , developed under section 33 231.33 . 34 b. 2. Adopt Recommend policies to coordinate state 35 -62- HF 2673 (8) 90 dg/ko/md 62/ 95
H.F. 2673 activities related to the purposes of this chapter . 1 c. 3. Serve as an effective and visible advocate for older 2 individuals and individuals with disabilities by establishing 3 recommending policies for reviewing and commenting upon 4 all state plans, budgets, and policies which affect older 5 individuals and for providing technical assistance to any 6 agency, organization, association, or individual representing 7 the needs of older individuals with disabilities . 8 d. Divide the state into distinct planning and service 9 areas after considering the geographical distribution of 10 older individuals in the state, the incidence of the need 11 for supportive services, nutrition services, multipurpose 12 senior centers, and legal services, the distribution of older 13 individuals who have low incomes residing in such areas, the 14 distribution of resources available to provide such services 15 or centers, the boundaries of existing areas within the 16 state which are drawn for the planning or administration of 17 supportive services programs, the location of units of general 18 purpose, local government within the state, and any other 19 relevant factors. 20 e. Designate for each planning and service area a public or 21 private nonprofit agency or organization as the area agency on 22 aging for that area. The commission may revoke the designation 23 of an area agency on aging pursuant to section 231.32 . 24 f. 4. Adopt policies to assure Make recommendations to 25 ensure that the department will take into account the views 26 of older individuals and individuals with disabilities in the 27 development of policy. 28 g. Adopt a method for the distribution of federal 29 Act and state funds taking into account, to the maximum 30 extent feasible, the best available data on the geographic 31 distribution of older individuals in the state, and publish the 32 method for review and comment. 33 h. 5. Adopt Recommend policies and measures to assure 34 ensure that preference will be given to providing services to 35 -63- HF 2673 (8) 90 dg/ko/md 63/ 95
H.F. 2673 older individuals and individuals with disabilities with the 1 greatest economic or social needs, with particular attention to 2 low-income minority older individuals, older individuals with 3 limited English proficiency, and older individuals residing in 4 rural areas. 5 i. 6. Adopt Recommend policies to administer state programs 6 authorized by this chapter . 7 j. 7. Adopt Recommend policies and administrative rules 8 pursuant to chapter 17A that support the capabilities of the 9 area agencies on aging and the aging and disabilities resource 10 centers to serve older individuals and persons individuals 11 with disabilities experiencing Alzheimers disease or related 12 dementias. 13 2. The commission shall adopt administrative rules pursuant 14 to chapter 17A to administer the duties specified in this 15 chapter and in all other chapters under the departments 16 jurisdiction. 17 Sec. 142. Section 231.21, Code 2024, is amended to read as 18 follows: 19 231.21 Administration of chapter department of health and 20 human services. 21 The department of health and human services shall administer 22 this chapter under the policy direction of the commission 23 on aging consider the recommendations of the council when 24 administering this chapter . 25 Sec. 143. Section 231.23, Code 2024, is amended to read as 26 follows: 27 231.23 Department duties and authority. 28 The department shall: 29 1. Develop and administer a Administer the state plan on 30 aging developed pursuant to section 231.31 . 31 2. Assist the commission in the review and approval of 32 Review and approve area plans developed under section 231.33 . 33 3. Pursuant to commission policy, coordinate Coordinate 34 state activities related to the purposes of this chapter 35 -64- HF 2673 (8) 90 dg/ko/md 64/ 95
H.F. 2673 and all other chapters under the departments jurisdiction . 1 State activities shall include, at a minimum, home and 2 community-based services such as employment support, community 3 living, and service coordination. 4 4. Advocate for older individuals and individuals with 5 disabilities by reviewing and commenting upon all state plans, 6 budgets, laws, rules, regulations, and policies which affect 7 older individuals or individuals with disabilities and by 8 providing technical assistance to any agency, organization, 9 association, or individual representing the needs of older 10 individuals or individuals with disabilities . 11 5. Assist the commission in dividing Divide the state into 12 distinct planning and service areas after considering the 13 geographical distribution of older individuals and individuals 14 with disabilities in the state, the incidence of the need 15 for supportive services, nutrition services, multipurpose 16 senior centers, and legal services, the distribution of older 17 individuals and individuals with disabilities with low income 18 residing in such areas, the distribution of resources available 19 to provide such services or centers, the boundaries of existing 20 areas within the state which are drawn for the planning or 21 administration of supportive services programs, the location of 22 units of general purpose, local government within the state, 23 and any other relevant factors . 24 6. Assist the commission in designating Designate for each 25 area a public or private nonprofit agency or organization as 26 the area agency on aging for that area. The department may 27 revoke the designation of an area agency on aging pursuant to 28 section 231.32. 29 7. Pursuant to commission policy, take Take into account the 30 views of older Iowans and Iowans with disabilities . 31 8. Assist the commission in adopting Adopt a method for 32 the distribution of funds available from the federal Act 33 and state appropriations and allocations that takes into 34 account, to the extent feasible, the best available data on the 35 -65- HF 2673 (8) 90 dg/ko/md 65/ 95
H.F. 2673 geographic distribution of older individuals and individuals 1 with disabilities in the state . 2 9. Assist the commission in assuring Adopt policies and 3 measures to ensure that preference will be given to providing 4 services to older individuals and individuals with disabilities 5 with the greatest economic or social needs, with particular 6 attention to low-income minority older individuals, older 7 individuals with limited English proficiency, and older 8 individuals residing in rural areas. 9 10. Assist the commission in developing, adopting, and 10 enforcing Develop, adopt, and enforce administrative rules, 11 including by issuing necessary forms and procedures , to 12 administer the duties specified in this chapter . 13 11. Apply for, receive, and administer grants, devises, 14 donations, and gifts , or bequests of real or personal property 15 from any source to conduct projects consistent with the 16 purposes of the department. Notwithstanding section 8.33 , 17 moneys received by the department pursuant to this section are 18 not subject to reversion to the general fund of the state. 19 12. Administer state authorized programs. 20 13. Establish a procedure for an area agency on aging to 21 use in selection of members of the agencys board of directors. 22 The selection procedure shall be incorporated into the bylaws 23 of the board of directors. 24 14. Adopt rules pursuant to chapter 17A that support the 25 capabilities of the area agencies on aging, and aging and 26 disabilities resource centers, to serve older individuals and 27 individuals with disabilities. 28 Sec. 144. Section 231.23A, subsections 1 and 3, Code 2024, 29 are amended to read as follows: 30 1. Services for older individuals, persons with 31 disabilities eighteen years of age and older, family 32 caregivers, and veterans as defined by the department in the 33 most current version of the departments reporting manual and 34 pursuant to the federal Act and regulations. 35 -66- HF 2673 (8) 90 dg/ko/md 66/ 95
H.F. 2673 3. The aging Aging and disability resource center centers . 1 Sec. 145. Section 231.23A, Code 2024, is amended by adding 2 the following new subsection: 3 NEW SUBSECTION . 7A. Services and supports available to 4 individuals with disabilities including but not limited to 5 individuals with mental illness, an intellectual disability or 6 other developmental disability, or a brain injury. 7 Sec. 146. Section 231.31, Code 2024, is amended to read as 8 follows: 9 231.31 State plan on aging. 10 The department shall develop , and submit to the commission 11 on aging for approval, a multiyear state plan on aging. 12 The state plan on aging shall meet all applicable federal 13 requirements. 14 Sec. 147. Section 231.32, Code 2024, is amended to read as 15 follows: 16 231.32 Criteria for designation of area agencies on aging. 17 1. The commission department shall designate an area 18 agency on aging for each planning and service area. The 19 commission shall continue the designation shall continue until 20 an area agency on agings designation is removed for cause as 21 determined by the commission department , until the time of 22 renewal or the annual update of an area plan, until the agency 23 voluntarily withdraws as an area agency on aging, or until a 24 change in the designation of planning and service areas or area 25 agencies on aging is required by state or federal law. In that 26 event, the commission department shall proceed in accordance 27 with subsections 2, 3, and 4 . Designated area agencies on 28 aging shall comply with the requirements of the federal Act. 29 2. The commission department shall designate an area 30 agency on aging to serve each planning and service area, after 31 consideration of the views offered by units of general purpose 32 local government. An area agency on aging may be: 33 a. An established office of aging which is operating within 34 a planning and service area designated by the commission 35 -67- HF 2673 (8) 90 dg/ko/md 67/ 95
H.F. 2673 department . 1 b. Any office or agency of a unit of general purpose local 2 government, which is designated to function only for the 3 purpose of serving as an area agency on aging by the chief 4 elected official of such unit. 5 c. Any office or agency designated by the appropriate 6 chief elected officials of any combination of units of 7 general purpose local government to act only on behalf of such 8 combination for such purpose. 9 d. Any public or nonprofit private agency in a planning and 10 service area or any separate organizational unit within such 11 agency which is under the supervision or direction for this 12 purpose of the department and which can and will engage only in 13 the planning or provision of a broad range of long-term living 14 and community support services or nutrition services within the 15 planning and service area. 16 3. When the commission department designates a new area 17 agency on aging , the commission department shall give the right 18 of first refusal to a unit of general purpose local government 19 if: 20 a. Such unit can meet the requirements of subsection 1 . 21 b. The boundaries of such a unit and the boundaries of the 22 area are reasonably contiguous. 23 4. Each area agency on aging shall provide assurance, 24 determined adequate by the commission department , that the 25 area agency on aging has the ability to develop an area plan 26 and to carry out, directly or through contractual or other 27 arrangements, a program in accordance with the plan within the 28 planning and service area. In designating an area agency on 29 aging within the planning and service area, the commission 30 department shall give preference to an established office of 31 aging, unless the commission department finds that no such 32 office within the planning and service area has the capacity to 33 carry out the area plan. 34 5. Upon designation, an area agency on aging shall be 35 -68- HF 2673 (8) 90 dg/ko/md 68/ 95
H.F. 2673 considered an instrumentality of the state and shall adhere to 1 all state and federal mandates applicable to an instrumentality 2 of the state. 3 Sec. 148. Section 231.33, subsections 1 and 13, Code 2024, 4 are amended to read as follows: 5 1. Develop and administer an area plan on aging approved by 6 the commission department . 7 13. Submit all fiscal and performance reports in accordance 8 with the policies of the commission department . 9 Sec. 149. Section 231.56, Code 2024, is amended to read as 10 follows: 11 231.56 Services and programs. 12 The department shall administer long-term living and 13 community support services and programs that allow older 14 individuals and individuals with disabilities to secure and 15 maintain maximum independence and dignity in a home environment 16 that provides for self-care with appropriate supportive 17 services, assist in removing individual and social barriers 18 to economic and personal independence for older individuals 19 and individuals with disabilities , and provide a continuum of 20 care for older individuals and individuals with disabilities. 21 Funds appropriated for this purpose shall be allocated based 22 on administrative rules adopted by the commission department 23 pursuant to chapter 17A . The department shall require such 24 records as needed adopt rules pursuant to chapter 17A that 25 allow the department to collect information as necessary from 26 long-term living and community support services, program 27 providers, and patients to administer this section . 28 Sec. 150. Section 231.57, Code 2024, is amended to read as 29 follows: 30 231.57 Coordination of advocacy. 31 The department shall administer a program for the 32 coordination of information and assistance provided within 33 the state to assist older individuals and individuals with 34 disabilities, and their caregivers , in obtaining and protecting 35 -69- HF 2673 (8) 90 dg/ko/md 69/ 95
H.F. 2673 their rights and benefits. State and local agencies providing 1 information and assistance to older individuals and individuals 2 with disabilities, and their caregivers , in seeking their 3 rights and benefits shall cooperate with the department in 4 administering this program. 5 Sec. 151. Section 231.58, Code 2024, is amended to read as 6 follows: 7 231.58 Long-term living coordination. 8 The director may convene meetings, as necessary, of the 9 director and the director of inspections, appeals, and 10 licensing, to assist in the coordination of policy, service 11 delivery, and long-range planning relating to the long-term 12 living system and older Iowans and Iowans with disabilities 13 in the state. The group may consult with individuals, 14 institutions, and entities with expertise in the area of the 15 long-term living system and older Iowans and Iowans with 16 disabilities , as necessary, to facilitate the groups efforts. 17 Sec. 152. Section 231.64, Code 2024, is amended to read as 18 follows: 19 231.64 Aging and disability resource center centers . 20 1. The aging and disability resource center shall be 21 administered by the department consistent with the federal 22 Act . The department shall designate area agencies on aging and 23 disability resource centers to establish, in consultation with 24 other stakeholders including organizations representing the 25 disability community, a coordinated local aging and disability 26 service system for providing . In addition to services required 27 by the department by rules adopted pursuant to chapter 17A, 28 aging and disability resource centers shall provide for all of 29 the following: 30 a. Comprehensive information, referral, and assistance 31 regarding the full range of available public and private 32 long-term living and community support services, options, 33 service providers, and resources within a community, including 34 information on the availability of integrated long-term care. 35 -70- HF 2673 (8) 90 dg/ko/md 70/ 95
H.F. 2673 b. Options counseling to assist individuals in assessing 1 their existing or anticipated long-term care needs and 2 developing and implementing a plan for long-term living and 3 community support services designed to meet their specific 4 needs and circumstances. The plan for long-term living 5 and community support services may include support with 6 person-centered care transitions to assist consumers and family 7 caregivers with transitions between home and care settings. 8 c. Consumer access to the range of publicly-supported 9 long-term living and community support services for which 10 consumers may be eligible, by serving as a convenient point 11 of entry for such services. The aging Aging and disability 12 resource center centers shall offer information online and 13 be available via a toll-free telephone number, electronic 14 communications, and in person. 15 2. The following entities shall be eligible to be designated 16 as an aging and disability resource center by the department: 17 a. An area agency on aging established on or before June 30, 18 2024. 19 b. A public or private nonprofit agency, or any separate 20 organizational unit within the public or private nonprofit 21 agency, that has the capabilities to engage in the planning or 22 provision of aging and disability services only as directed by 23 the department. 24 2. 3. The aging Aging and disability resource center 25 centers shall assist older individuals, persons individuals 26 with disabilities age eighteen or older , family caregivers, 27 and people who inquire about or request assistance on behalf 28 of members of these groups, as they seek long-term living and 29 community support services. 30 4. The department shall adopt rules pursuant to chapter 17A 31 to implement this section. 32 Sec. 153. NEW SECTION . 231.75 Scope. 33 The service quality standards and rights in this subchapter 34 VII shall apply to any person with an intellectual disability, 35 -71- HF 2673 (8) 90 dg/ko/md 71/ 95
H.F. 2673 a developmental disability, brain injury, or chronic mental 1 illness who receives services which are funded in whole or in 2 part by public funds, or services which are permitted under 3 Iowa law. 4 Sec. 154. NEW SECTION . 231.76 Service quality standards. 5 As the state participates more fully in funding services 6 and other support for persons with an intellectual disability, 7 developmental disability, brain injury, or chronic mental 8 illness, it is the intent of the general assembly that the 9 state shall seek to attain the following quality standards in 10 the provision of services and other supports: 11 1. Provide comprehensive evaluation and diagnosis adapted 12 to the cultural background, primary language, and ethnic origin 13 of a person. 14 2. Provide an individual treatment, habilitation, and 15 program services plan. 16 3. Provide treatment, habilitation, and program services 17 that are individualized, flexible, cost-effective, and produce 18 results. 19 4. Provide periodic review of an individuals treatment, 20 habilitation, and program services plan. 21 5. Provide for the least restrictive environment, and 22 age-appropriate services. 23 6. Provide appropriate training and employment 24 opportunities so that a persons ability to contribute to, and 25 participate in, the community is maximized. 26 7. Provide an ongoing process to determine the degree of 27 access to, and the effectiveness of, the services and other 28 supports in achieving the disability service outcomes and 29 indicators identified by the department. 30 Sec. 155. NEW SECTION . 231.77 Rights. 31 All of the following rights shall apply to a person with an 32 intellectual disability, a developmental disability, a brain 33 injury, or a chronic mental illness: 34 1. Wage protection. A person engaged in a work program 35 -72- HF 2673 (8) 90 dg/ko/md 72/ 95
H.F. 2673 shall be paid wages commensurate with the going rate for 1 comparable work and productivity. 2 2. Insurance protection. Pursuant to section 507B.4, 3 subsection 3, paragraph g , a person or designated group 4 of persons shall not be unfairly discriminated against for 5 purposes of insurance coverage. 6 3. Citizenship. A person retains the right to citizenship 7 in accordance with the laws of the state. 8 4. Participation in planning activities. A person has 9 the right to participate in the formulation of an individual 10 treatment, habilitation, and program plan developed for the 11 person. 12 Sec. 156. NEW SECTION . 231.78 Compliance. 13 1. A persons sole remedy for a violation of a rule adopted 14 by the department to implement sections 231.75 through 231.77 15 shall be to initiate a proceeding with the department by 16 request pursuant to chapter 17A. 17 a. Any decision of the department shall be in accordance 18 with due process of law. A person or party who is aggrieved or 19 adversely affected by the departments action may seek judicial 20 review pursuant to section 17A.19. A person or party who is 21 aggrieved or adversely affected by a final judgment of the 22 district court may appeal under section 17A.20. 23 b. Either the department or a party in interest may apply 24 to the Iowa district court for an order to enforce a final 25 decision of the department. 26 2. Any rules adopted by the department to implement sections 27 231.76 and 231.77 shall not create any right, entitlement, 28 property or liberty right or interest, or private cause of 29 action for damages against the state or a political subdivision 30 of the state, or for which the state or a political subdivision 31 of the state would be responsible. 32 3. Notwithstanding subsection 1, any violation of section 33 231.77, subsection 2, shall be subject to enforcement by the 34 commissioner of insurance pursuant to chapter 507B. 35 -73- HF 2673 (8) 90 dg/ko/md 73/ 95
H.F. 2673 Sec. 157. NEW SECTION . 231.79 Appeals process. 1 The department shall establish an appeals process by which a 2 person or the persons representative may appeal a decision of 3 the department concerning the provision or denial of aging or 4 disability services to the person. 5 Sec. 158. Section 231E.3, Code 2024, is amended to read as 6 follows: 7 231E.3 Definitions. 8 As used in this chapter , unless the context otherwise 9 requires: 10 1. Client means an individual for whom a representative 11 payee is appointed. 12 2. Commission means the commission on aging. 13 3. 2. Conservator means conservator as defined in section 14 633.3 . 15 4. 3. Court means court as defined in section 633.3 . 16 5. 4. Department means the department of health and human 17 services. 18 6. 5. Director means the director of health and human 19 services. 20 7. 6. Guardian means guardian as defined in section 21 633.3 . 22 8. 7. Incompetent means incompetent as defined in section 23 633.3 . 24 9. 8. Local office means a local office of public 25 guardian. 26 10. 9. Local public guardian means an individual under 27 contract with the department to act as a guardian, conservator, 28 or representative payee. 29 11. 10. Public guardian means the state public guardian 30 or a local public guardian. 31 12. 11. Public guardianship services means guardianship, 32 conservatorship, or representative payee services provided by 33 the state public guardian or a local public guardian. 34 13. 12. Representative payee means an individual 35 -74- HF 2673 (8) 90 dg/ko/md 74/ 95
H.F. 2673 appointed by a government entity to receive funds on behalf of 1 a client pursuant to federal regulation. 2 14. 13. State agency means any executive department, 3 commission, board, institution, division, bureau, office, 4 agency, or other executive entity of state government. 5 15. 14. State office means the state office of public 6 guardian. 7 16. 15. State public guardian means the administrator of 8 the state office of public guardian. 9 17. 16. Ward means the individual for whom a guardianship 10 or conservatorship is established. 11 Sec. 159. REPEAL. Sections 231.11, 231.12, and 231.13, Code 12 2024, are repealed. 13 Sec. 160. CODE EDITOR DIRECTIVE. The Code editor is 14 directed to do all of the following: 15 1. Entitle Code chapter 231 Department of Health and Human 16 Services Aging and Disability Services. 17 2. Designate sections 231.75 through 231.79, as enacted in 18 this division of this Act, as subchapter VII entitled Bill 19 of Rights and Service Quality Standards for Persons with an 20 Intellectual Disability, Developmental Disability, Brain 21 Injury, or Chronic Mental Illness. 22 3. Correct internal references in the Code and in any 23 enacted legislation as necessary due to the enactment of this 24 division of this Act. 25 Sec. 161. EFFECTIVE DATE. The following take effect July 26 1, 2025: 27 1. The parts of the sections of this division of this Act 28 amending the following: 29 a. Section 231.3. 30 b. Section 231.4, subsection 1. 31 c. Section 231.23, subsections 4 and 7. 32 d. Section 231.23A, subsection 1. 33 e. Sections 231.56, 231.57, and 231.58. 34 f. Section 231.64, subsection 2. 35 -75- HF 2673 (8) 90 dg/ko/md 75/ 95
H.F. 2673 2. The parts of the sections of this division of this Act 1 enacting the following: sections 231.23A, subsection 7A, 2 231.75, 231.76, 231.77, 231.78, and 231.79. 3 DIVISION IV 4 TRANSITION PROVISIONS 5 Sec. 162. DEPARTMENT OF HEALTH AND HUMAN SERVICES 6 TRANSITION OF MENTAL HEALTH SERVICES, ADDICTIVE DISORDER 7 SERVICES, AND DISABILITY SERVICES. 8 1. For purposes of this division: 9 a. Administrative services organization means the same 10 as defined in section 225A.1, as enacted in division I of this 11 Act. 12 b. Behavioral health district means the same as defined in 13 section 225A.1, as enacted in division I of this Act. 14 c. Department means the department of health and human 15 services. 16 d. District behavioral health service system plan means 17 the same as defined in section 225A.1, as enacted in division 18 I of this Act. 19 e. Mental health and disability services region means the 20 same as defined in section 225C.2, subsection 9. 21 f. State behavioral health service system means the state 22 behavioral health service system as established in section 23 225A.3, as enacted in division I of this Act. 24 g. State behavioral health service system plan means the 25 same as defined in section 225A.1, as enacted in division I of 26 this Act. 27 h. Transition period means the period beginning on the 28 date of enactment of this division of this Act and concluding 29 on June 30, 2025. 30 2. There is created a behavioral health service system under 31 the control of the department. For the fiscal year beginning 32 July 1, 2025, and each succeeding fiscal year, the behavioral 33 health service system shall be responsible for implementing and 34 maintaining a statewide system of prevention, education, early 35 -76- HF 2673 (8) 90 dg/ko/md 76/ 95
H.F. 2673 intervention, treatment, recovery support, and crisis services 1 related to mental health and addictive disorders, including 2 but not limited to substance use, tobacco use, and problem 3 gambling. For the fiscal year beginning July 1, 2025, and each 4 succeeding fiscal year, the departments division of aging 5 and disability services shall be responsible for disability 6 services. 7 3. During the transition period, the department may 8 exercise all policymaking functions and regulatory powers 9 established in division I of this Act, as necessary to 10 establish the state behavioral health service system. 11 4. To ensure the state behavioral health service system 12 and the division of aging and disability services are able to 13 operate as intended at the conclusion of the transition period, 14 the department shall perform all the following duties: 15 a. Make contracts as necessary to set up services and 16 administrative functions. 17 b. Adopt rules as necessary to establish and administer the 18 states behavioral health service system. 19 c. Establish policies as necessary to ensure efficient 20 implementation and operation of the behavioral health service 21 system. 22 d. Prepare forms necessary for the implementation and 23 administration of behavioral health services. 24 e. Prepare a state behavioral health service system plan for 25 the state behavioral health service system. 26 f. Designate behavioral health districts on or before 27 August 1, 2024. The behavioral health district designation 28 process shall include an opportunity for the public to 29 review and to comment on proposed behavioral health district 30 boundaries. 31 g. Designate an administrative services organization for 32 each behavioral health district on or before December 31, 2024. 33 h. Review and approve district behavioral health service 34 system plans for services related to the behavioral health 35 -77- HF 2673 (8) 90 dg/ko/md 77/ 95
H.F. 2673 service system. 1 i. Issue all necessary licenses and certifications. 2 j. Establish contractual rights, privileges, and 3 responsibilities as necessary to establish and implement the 4 state behavioral health service system. 5 k. Develop and implement a plan to ensure that persons 6 currently receiving disability services or early intervention, 7 treatment, recovery support, or crisis services related 8 to mental health or addictive disorders, including but not 9 limited to alcohol use, substance use, tobacco use, and problem 10 gambling, have an uninterrupted continuum of care. 11 l. Establish a central data repository as described in 12 section 225A.6, as enacted in division I of this Act. 13 5. If the department determines that a federal waiver or 14 authorization is necessary to administer any provision of this 15 division of this Act or to effectuate the state behavioral 16 health service system by the conclusion of the transition 17 period, the department shall timely request the federal waiver 18 or authorization. Notwithstanding any other effective date to 19 the contrary, a provision the department determines requires a 20 federal waiver or authorization shall be effective only upon 21 receipt of federal approval for the waiver or authorization. 22 6. a. On or before July 1, 2024, the department shall 23 publish on the departments internet site an initial transition 24 plan for establishing the state behavioral health service 25 system. The transition plan shall describe, at a minimum, all 26 of the following: 27 (1) All tasks that require completion before July 1, 2025. 28 The description of tasks shall include a description of how the 29 department will solicit comments from stakeholders, including 30 employees of the department, persons served by the department, 31 partners of the department, members of the public, and members 32 of the general assembly, and a detailed timeline for the 33 completion of the tasks described. 34 (2) The proposed organizational structure of the state 35 -78- HF 2673 (8) 90 dg/ko/md 78/ 95
H.F. 2673 behavioral health service system. 1 (3) The transition of service delivery sites from locations 2 where people currently receive behavioral health services to 3 where the people will receive behavioral health services under 4 the state behavioral health service system. 5 (4) Procedures for the transfer and reconciliation of 6 budgeting and funding between the mental health and disability 7 services regions and the department. 8 (5) A description of how responsibilities for disability 9 services programs will be transferred from current program 10 administrators to the departments division of aging and 11 disability services by the end of the transition period. 12 (6) Any additional known tasks that may require completion 13 after the transition on July 1, 2025. 14 b. The transition plan published under paragraph a shall: 15 (1) Be updated no less than quarterly during the transition 16 period with the current status of completing the tasks 17 identified in paragraph a, subparagraph (1). 18 (2) Describe how information regarding any changes in 19 service delivery will be provided to persons receiving services 20 from the mental health and disability services regions or 21 current behavioral health care providers contracted with the 22 department. 23 (3) Describe how the transition is being funded, including 24 how expenses associated with the transition will be managed. 25 7. a. Before the end of the transition period, the 26 governing board of each mental health and disability services 27 region that maintains a combined account pursuant to section 28 225C.58, subsection 1, shall transfer all unencumbered and 29 unobligated moneys remaining in the combined account to the 30 treasurer of state for deposit into the behavioral health fund 31 as established in section 225A.7 as enacted in division I of 32 this Act. 33 b. Before the end of the transition period, each county 34 which maintains a county mental health and disability services 35 -79- HF 2673 (8) 90 dg/ko/md 79/ 95
H.F. 2673 fund pursuant to section 225C.58, subsection 1, shall transfer 1 all unencumbered and unobligated moneys remaining in the mental 2 health and disability services fund to the treasurer of state 3 for deposit into the behavioral health fund as established in 4 section 225A.7 as enacted in division I of this Act. 5 c. Moneys in the behavioral health fund as established 6 in section 225A.7 as enacted in division I of this Act are 7 appropriated to the department for the purposes established in 8 section 225A.7 as enacted in division I of this Act, and as 9 otherwise necessary to effectuate this division of this Act. 10 8. a. All debts, claims, or other liabilities owed to a 11 county, a mental health and disability services region, or 12 the state due to services rendered pursuant to chapter 125, 13 222, 225, 225C, 226, 227, 229, 230, or 230A, Code 2024, at the 14 conclusion of the transition period shall remain due and owing 15 after the transition period concludes. 16 b. After the transition period concludes, each county 17 auditor shall collect outstanding debts, claims, or other 18 liabilities owed to the county for services rendered pursuant 19 to chapter 125, 222, 225, 225C, 226, 227, 229, 230, or 230A, 20 Code 2024, before the transition period concluded. The county 21 attorney may bring a judicial action as necessary to collect 22 the outstanding debts, claims, or other liabilities. 23 9. With input from appropriate stakeholders, the department 24 shall identify each contract that will be impacted by mental 25 health and disability services being transferred to the state 26 behavioral health service system, or by responsibilities 27 being transferred to the departments division of aging and 28 disabilities, pursuant to this Act. On or before June 30, 29 2025, a party to a contract identified by the department 30 under this subsection shall exercise the option, if available 31 pursuant to the terms of the contract, to terminate the 32 contract in accordance with the terms of the contract which 33 provide for termination. Contracts that do not provide for 34 termination shall not be renewed or extended at the end of the 35 -80- HF 2673 (8) 90 dg/ko/md 80/ 95
H.F. 2673 current contract term. 1 10. A mental health and disability services region, a 2 regional administrator as defined in section 225C.55, and 3 any subdivision of the state shall not enter into, renew, or 4 extend any contract for services related to mental health and 5 disability services or addictive disorder services beyond June 6 30, 2025. 7 Sec. 163. DEPARTMENT OF HEALTH AND HUMAN SERVICES 8 TRANSITION FUNDING. Notwithstanding any provision of law to 9 the contrary, there is appropriated from the region incentive 10 fund of the mental health and disability services regional 11 service fund created in section 225C.7A, subsection 8, to the 12 department of health and human services for the fiscal year 13 beginning July 1, 2024, and ending June 30, 2025, the following 14 amount, or so much thereof as is necessary, to be used for the 15 purposes designated: 16 For the establishment of a central data repository as 17 described in section 225A.6, subsection 1, as enacted in 18 division I of this Act: 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 645,179 20 Notwithstanding section 8.33, moneys appropriated in this 21 section that remain unencumbered or unobligated at the close 22 of the fiscal year shall not revert to the credit of the region 23 incentive fund of the mental health and disability services 24 regional service fund, but shall be credited to the behavioral 25 health fund created in section 225A.7, as enacted in division I 26 of this Act, and are appropriated to the department of health 27 and human services for expenditure for the purposes of the 28 behavioral health fund. 29 Sec. 164. EMERGENCY RULES. The department of health and 30 human services may adopt emergency rules under section 17A.4, 31 subsection 3, and section 17A.5, subsection 2, paragraph b, 32 to implement the provisions of this division of this Act and 33 the rules shall be effective immediately upon filing unless 34 a later date is specified in the rules. Any rules adopted 35 -81- HF 2673 (8) 90 dg/ko/md 81/ 95
H.F. 2673 in accordance with this section shall also be published as a 1 notice of intended action as provided in section 17A.4. 2 Sec. 165. EFFECTIVE DATE. This division of this Act, being 3 deemed of immediate importance, takes effect upon enactment. 4 DIVISION V 5 ELIMINATION OF SPECIAL INTELLECTUAL DISABILITY UNITS 6 Sec. 166. Section 222.1, subsection 3, Code 2024, is amended 7 by striking the subsection. 8 Sec. 167. Section 222.2, subsection 8, Code 2024, is amended 9 by striking the subsection. 10 Sec. 168. Section 222.5, Code 2024, is amended to read as 11 follows: 12 222.5 Preadmission diagnostic evaluation. 13 A person shall not be eligible for admission to a resource 14 center or a special unit until a preadmission diagnostic 15 evaluation has been made by a resource center or a special unit 16 which confirms or establishes the need for admission. 17 Sec. 169. Section 222.7, unnumbered paragraph 1, Code 2024, 18 is amended to read as follows: 19 The department may transfer patients from one state resource 20 center to the other and may at any time transfer patients from 21 the resource centers to the hospitals for persons with mental 22 illness , or transfer patients in the resource centers to a 23 special unit or vice versa . The department may also transfer 24 patients from a hospital for persons with mental illness to a 25 resource center if consent is given or obtained as follows: 26 Sec. 170. Section 222.8, Code 2024, is amended to read as 27 follows: 28 222.8 Communications by patients. 29 Persons admitted to the resource centers or a special 30 unit shall have all reasonable opportunity and facility for 31 communication with their friends. Such persons shall be 32 permitted to write and send letters, provided the letters 33 contain nothing of an offensive character. Letters written by 34 any patient to the director or to any state or county official 35 -82- HF 2673 (8) 90 dg/ko/md 82/ 95
H.F. 2673 shall be forwarded unopened. 1 Sec. 171. Section 222.9, Code 2024, is amended to read as 2 follows: 3 222.9 Unauthorized departures. 4 If any person with an intellectual disability shall depart 5 without proper authorization from a resource center or a 6 special unit , it shall be the duty of the superintendent 7 and the superintendents assistants and all peace officers 8 of any county in which such patient may be found to take 9 and detain the patient without a warrant or order and to 10 immediately report such detention to the superintendent who 11 shall immediately provide for the return of such patient to the 12 resource center or special unit . 13 Sec. 172. Section 222.12, subsection 1, Code 2024, is 14 amended to read as follows: 15 1. Upon the death of a patient of a resource center or 16 special unit , a preliminary investigation of the death shall be 17 conducted as required by section 218.64 by the county medical 18 examiner as provided in section 331.802 . Such a preliminary 19 investigation shall also be conducted in the event of a sudden 20 or mysterious death of a patient in a private institution 21 for persons with an intellectual disability. The chief 22 administrative officer of any private institution may request 23 an investigation of the death of any patient by the county 24 medical examiner. 25 Sec. 173. Section 222.73, subsections 1, 3, and 5, Code 26 2024, are amended to read as follows: 27 1. The superintendent of each resource center and special 28 unit shall compute by February 1 the average daily patient 29 charge and outpatient treatment charges for which each county 30 will be billed for services provided to patients chargeable to 31 the county during the fiscal year beginning the following July 32 1. The department shall certify the amount of the charges and 33 notify the counties of the billing charges. 34 a. The superintendent shall compute the average daily 35 -83- HF 2673 (8) 90 dg/ko/md 83/ 95
H.F. 2673 patient charge for a resource center or special unit for 1 services provided in the following fiscal year, in accordance 2 with generally accepted accounting procedures, by totaling 3 the expenditures of the resource center or special unit for 4 the immediately preceding calendar year, by adjusting the 5 expenditures by a percentage not to exceed the percentage 6 increase in the consumer price index for all urban consumers 7 for the immediately preceding calendar year, and by dividing 8 the adjusted expenditures by the total inpatient days of 9 service provided during the immediately preceding calendar 10 year. 11 b. The department shall compute the outpatient treatment 12 charges, in accordance with generally accepted accounting 13 procedures, on the basis of the actual cost of the outpatient 14 treatment provided during the immediately preceding calendar 15 year. 16 3. 2. The superintendent shall compute in January the 17 actual per-patient-per-day cost for each resource center or 18 special unit for the immediately preceding calendar year, in 19 accordance with generally accepted accounting procedures, by 20 totaling the actual expenditures of the resource center or 21 special unit for the calendar year and by dividing the total 22 actual expenditures by the total inpatient days of service 23 provided during the calendar year. 24 5. 3. A superintendent of a resource center or special 25 unit may request that the director enter into a contract with 26 a person for the resource center or special unit to provide 27 consultation or treatment services or for fulfilling other 28 purposes which are consistent with the purposes stated in 29 section 222.1 . The contract provisions shall include charges 30 which reflect the actual cost of providing the services. Any 31 income from a contract authorized under this subsection may 32 be retained by the resource center or special unit to defray 33 the costs of providing the services or fulfilling the other 34 purposes. Except for a contract voluntarily entered into by a 35 -84- HF 2673 (8) 90 dg/ko/md 84/ 95
H.F. 2673 county under this subsection , the costs or income associated 1 with a contract authorized under this subsection shall not 2 be considered in computing charges and per diem costs in 3 accordance with the provisions of subsections 1 through 4 and 4 2 . 5 Sec. 174. Section 222.83, Code 2024, is amended to read as 6 follows: 7 222.83 Nonresident patients. 8 The estates of all nonresident patients who are provided 9 treatment, training, instruction, care, habilitation, and 10 support in or by a resource center or a special unit , and all 11 persons legally bound for the support of such persons, shall be 12 liable to the state for the reasonable value of such services. 13 The certificate of the superintendent of the resource center 14 or special unit in which any nonresident is or has been a 15 patient, showing the amounts drawn from the state treasury or 16 due therefrom as provided by law on account of such nonresident 17 patient, shall be presumptive evidence of the reasonable value 18 of such services furnished such patient by the resource center 19 or special unit . 20 Sec. 175. Section 222.84, Code 2024, is amended to read as 21 follows: 22 222.84 Patients personal deposit fund. 23 There is established at each resource center and special 24 unit a patients personal deposit fund. In the case of a 25 special unit, the director may direct that the patients 26 personal deposit fund be maintained and administered as a part 27 of the fund established, pursuant to sections 226.43 through 28 226.46 , by the state mental health institute where the special 29 unit is located. 30 Sec. 176. Section 222.85, subsection 1, Code 2024, is 31 amended to read as follows: 32 1. Any funds coming into the possession of the 33 superintendent or any employee of a resource center or special 34 unit belonging to any patient in that institution shall be 35 -85- HF 2673 (8) 90 dg/ko/md 85/ 95
H.F. 2673 deposited in the name of the patient in the patients personal 1 deposit fund, except that if a guardian of the property has 2 been appointed for the person, the guardian shall have the 3 right to demand and receive such funds. Funds belonging to a 4 patient deposited in the patients personal deposit fund may 5 be used for the purchase of personal incidentals, desires, and 6 comforts for the patient. 7 Sec. 177. Section 222.87, Code 2024, is amended to read as 8 follows: 9 222.87 Deposit in bank. 10 The department shall deposit the patients personal deposit 11 fund in a commercial account of a bank of reputable standing. 12 When deposits in the commercial account exceed average monthly 13 withdrawals, the department may deposit the excess at interest. 14 The savings account shall be in the name of the patients 15 personal deposit fund and interest paid on the account may be 16 used for recreational purposes for the patients at the resource 17 center or special unit . 18 Sec. 178. REPEAL. Sections 222.88, 222.89, 222.90, and 19 222.91, Code 2024, are repealed. 20 Sec. 179. EFFECTIVE DATE. This division of this Act, being 21 deemed of immediate importance, takes effect upon enactment. 22 DIVISION VI 23 COUNTY OF RESIDENCE DETERMINATIONS 24 Sec. 180. NEW SECTION . 331.190 County of residence 25 dispute resolution. 26 1. County of residence means the county in this state 27 in which, at the time a person applies for or receives 28 services, the person is living and has established an ongoing 29 presence with the declared, good faith intention of living 30 for a permanent or indefinite period of time. The county 31 of residence of a homeless person is the county in which 32 the homeless person usually sleeps. A person maintains 33 residency in the county or state in which the person last 34 resided during the time period that the person is present in 35 -86- HF 2673 (8) 90 dg/ko/md 86/ 95
H.F. 2673 a different county or state receiving services in a hospital, 1 a correctional facility, a halfway house for community-based 2 corrections or substance use disorder treatment, a nursing 3 facility, an intermediate care facility for persons with an 4 intellectual disability, a residential care facility, or for 5 the purpose of attending a college or university. 6 2. a. The dispute resolution process in this subsection 7 shall apply to county of residence disputes. The dispute 8 resolution process shall not be applicable to any of the 9 following: 10 (1) Disputes involving persons committed to a state 11 facility pursuant to chapter 812. 12 (2) Disputes involving Iowa rule of criminal procedure 13 2.22(8)(b), commitment for evaluation. 14 (3) Disputes involving chapter 12 of Iowa court rules, rules 15 for involuntary hospitalization of mentally ill persons. 16 b. If a county objects to a billing for services or a 17 residency determination and asserts that either the person 18 has residency in a different county or the person is not a 19 resident of this state, the persons county of residence 20 shall be determined as provided in this subsection. If the 21 county asserts that the person has residency in a different 22 county in this state, the county shall notify that county in 23 writing within one hundred twenty calendar days of receiving 24 the billing for services or of the county of residence 25 determination. 26 c. The county that receives the notification under paragraph 27 b shall respond in writing to the county that provided the 28 notification within forty-five calendar days of receiving the 29 notification. If the parties cannot agree as to the persons 30 county of residence within ninety calendar days of the date of 31 notification, on motion of either of the parties, the matter 32 shall be referred to the administrative hearings division of 33 the department of inspections, appeals, and licensing for 34 a contested case proceeding under chapter 17A, before an 35 -87- HF 2673 (8) 90 dg/ko/md 87/ 95
H.F. 2673 administrative law judge assigned in accordance with section 1 10A.801, to determine the persons county of residence. 2 d. (1) Notwithstanding section 17A.15, the administrative 3 law judges determination of a persons county of residence 4 shall be considered final agency action. Judicial review of 5 the determination may be sought in accordance with section 6 17A.19. 7 (2) If following the determination of a persons county of 8 residence under this subsection additional evidence becomes 9 available that merits a change in the determination of the 10 persons county of residence, the affected parties may change 11 the determination of county of residence by mutual agreement. 12 Otherwise, a party may move that the matter be reconsidered 13 by the county, or by an administrative law judge assigned in 14 accordance with section 10A.801. 15 e. Unless a petition is filed for judicial review, the 16 administrative law judges determination of the persons county 17 of residence shall result in one of the following: 18 (1) If a county is determined to be the persons county 19 of residence, that county shall pay any amounts due and shall 20 reimburse the other county for any amounts paid for services 21 provided to the person by the other county prior to the county 22 of residence determination. 23 (2) If it is determined that the person is not a resident of 24 this state, neither the state nor either county shall be liable 25 for payment of amounts due for services provided to the person 26 prior to the determination of the persons county of residence. 27 f. (1) The party that does not prevail in a contested 28 case proceeding or a subsequent judicial review pursuant to 29 this subsection shall be liable for costs associated with 30 the proceeding or judicial review, including reimbursement 31 of the administrative hearings division of the department of 32 inspections, appeals, and licensings actual costs associated 33 with the administrative proceeding, court costs, and reasonable 34 attorney fees. 35 -88- HF 2673 (8) 90 dg/ko/md 88/ 95
H.F. 2673 (2) A payment or reimbursement pursuant to this subsection 1 shall be remitted within forty-five calendar days of the 2 date the county of residence determination is issued by the 3 administrative law judge or the date the court files an order 4 determining the persons county of residence, whichever is 5 later. After forty-five calendar days, the prevailing party 6 may add a penalty of up to one percent per month to any amounts 7 due. 8 Sec. 181. Section 35D.9, Code 2024, is amended to read as 9 follows: 10 35D.9 County of residence upon discharge. 11 A member of the home does not acquire residency in the county 12 in which the home is located unless the member is voluntarily 13 or involuntarily discharged from the home and the member 14 meets county of residence requirements. For purposes of this 15 section , county of residence means the same as defined in 16 section 225C.61 331.190 . 17 Sec. 182. Section 232.141, subsections 7 and 8, Code 2024, 18 are amended to read as follows: 19 7. A county charged with the costs and expenses under 20 subsections 2 and 3 may recover the costs and expenses from the 21 childs custodial parents county of residence, as defined in 22 section 225C.61 331.190 , by filing verified claims which are 23 payable as are other claims against the county. A detailed 24 statement of the facts upon which a claim is based shall 25 accompany the claim. 26 8. This subsection applies only to placements in a juvenile 27 shelter care home which is publicly owned, operated as a county 28 or multicounty shelter care home, organized under a chapter 29 28E agreement, or operated by a private juvenile shelter care 30 home. If the actual and allowable costs of a childs shelter 31 care placement exceed the amount the department is authorized 32 to pay, the unpaid costs may be recovered from the childs 33 custodial parents county of residence. However, the maximum 34 amount of the unpaid costs which may be recovered under this 35 -89- HF 2673 (8) 90 dg/ko/md 89/ 95
H.F. 2673 subsection is limited to the difference between the amount 1 the department is authorized to pay and the statewide average 2 of the actual and allowable rates as reasonably determined 3 by the department annually. A home may only be reimbursed 4 for the lesser of the homes actual and allowable costs or 5 the statewide average of the actual and allowable rates as 6 determined by the department in effect on the date the costs 7 were paid. The unpaid costs are payable pursuant to filing of 8 verified claims against the childs custodial parents county 9 of residence. A detailed statement of the facts upon which a 10 claim is based shall accompany the claim. Any dispute between 11 counties arising from filings of claims filed pursuant to this 12 subsection shall be settled in the manner provided to determine 13 residency county of residence in section 225C.61 331.190 . 14 Sec. 183. EFFECTIVE DATE. This division of this Act takes 15 effect July 1, 2025. 16 DIVISION VII 17 CHILDRENS BEHAVIORAL HEALTH PSYCHIATRIC MEDICAL 18 INSTITUTIONS FOR CHILDREN HAWKI PROGRAM BENEFITS 19 Sec. 184. REDUCTION OF REGULATORY BARRIERS AND RESTRICTIONS 20 PSYCHIATRIC MEDICAL INSTITUTIONS FOR CHILDREN. The 21 department of health and human services shall review the 22 departments administrative rules regarding psychiatric medical 23 institutions for children (PMICs) and shall update the rules, 24 informed by the findings of the association of childrens 25 residential centers most recent nationwide survey and scan 26 of psychiatric residential treatment facilities, and the 27 recommendations of the coalition for family and childrens 28 services in Iowa, to do all of the following: 29 1. Allow a physician assistant or advanced registered nurse 30 practitioner to serve as a member of the plan of care team 31 as a member who is experienced in child psychiatry or child 32 psychology pursuant to 481 IAC 41.13(2). 33 2. Allow a physician assistant or advanced registered 34 nurse practitioner to be a member of the team to complete 35 -90- HF 2673 (8) 90 dg/ko/md 90/ 95
H.F. 2673 the certification of need for services for a PMIC placement 1 pursuant to 481 IAC 41.9. 2 3. Remove the reserve bed day limitations for 3 hospitalizations and expand the number of other therapeutic 4 absences beyond thirty days to allow for skill acquisition, 5 stabilization, and continuity of care as deemed necessary by 6 the childs medical providers and in accordance with a childs 7 discharge plan. 8 4. Allow licensed professionals, based on competencies 9 rather than license type, to order the use of restraints 10 or seclusions and to conduct post-restraint or seclusion 11 assessments, including via telehealth, to increase response 12 times and expand access to care. The department of 13 inspections, appeals, and licensing shall adopt rules pursuant 14 to chapter 17A to implement this subsection. 15 5. a. Allow therapy and behavioral health intervention 16 services to be included as billable services provided during 17 a placement at a PMIC to provide continuity of care, maintain 18 established clinical relationships, and avoid disruption in 19 services or delays in reestablishing care post discharge. 20 b. Allow family therapy and family behavioral health 21 intervention services to be included in billable services 22 during the placement of a child in a PMIC without requiring 23 the childs presence for the family to work on targeted skills 24 essential for the childs success and to prepare the family for 25 the childs return home. 26 c. Provide reimbursement codes to cover services beyond 27 those provided outside the PMIC care team as necessary to 28 adequately treat substance use disorder, sexualized behaviors, 29 autism, and other services needed to support the child. 30 6. Standardize all of the following across all managed care 31 organizations as follows: 32 a. Require that authorization for a PMIC placement shall 33 be retroactive to the date the request for authorization is 34 submitted to the managed care organization not the date the 35 -91- HF 2673 (8) 90 dg/ko/md 91/ 95
H.F. 2673 managed care organization responds; or require a managed care 1 organization to respond within five business days from receipt 2 of a request for authorization for a PMIC placement, if the 3 certification of need and independent assessment have been 4 received in a timely manner. 5 b. Prohibit a managed care organization from denying 6 authorization for a PMIC placement based on lack of parental 7 involvement, based on lack of participation in behavioral 8 health intervention services on an outpatient basis, or based 9 on other perceived behavioral issues. 10 c. Allow a managed care organization to authorize an initial 11 PMIC placement of sixty days upon admission with concurrent 12 stay reviews every thirty days thereafter. A PMIC shall submit 13 a care plan to the managed care organization within thirty days 14 of the admission. 15 d. Require concurrent stay reviews to be standardized 16 and limited to a brief description of progress, or lack of 17 progress, toward the childs goals and objectives. 18 e. Require a managed care organization to offer support to 19 families, including assistance with transportation to and from 20 a PMIC to visit a child. 21 7. Notwithstanding any provision of law to the contrary, 22 including certificate of need requirements, allow a previously 23 licensed PMIC that has the capacity to provide up to an 24 additional four intermediate care facility for persons with an 25 intellectual disability beds, and which additional beds meet 26 all other licensing and state fire marshal requirements, to 27 increase their licensed capacity to include the additional 28 beds without further review including by the health facilities 29 council. 30 8. Allow for step-down PMIC placements or supervised 31 apartment living for a child to utilize programming provided 32 in a PMIC while living independently in a smaller residential 33 setting without twenty-four-hour supervision. 34 Sec. 185. HAWKI PROGRAM BENEFITS INCLUDED IN QUALIFIED 35 -92- HF 2673 (8) 90 dg/ko/md 92/ 95
H.F. 2673 CHILD HEALTH PLAN REVIEW. The department of health 1 and human services shall review the benefits included in a 2 qualified child health plan under the Hawki program and shall 3 specifically address the inclusion of applied behavior analysis 4 services as a covered benefit. The department shall report the 5 findings of the review to the general assembly by December 1, 6 2024. 7 DIVISION VIII 8 STATE-FUNDED PSYCHIATRY RESIDENCY AND FELLOWSHIP POSITIONS 9 Sec. 186. Section 135.180, Code 2024, is amended to read as 10 follows: 11 135.180 State-funded psychiatry residency and fellowship 12 program positions fund appropriations. 13 1. a. The university of Iowa hospitals and clinics shall 14 administer a state-funded psychiatry residency and fellowship 15 program positions for up to nine seven residents and up to two 16 fellows, annually. In addition, a county medical center, and 17 a medical center operating for more than one hundred forty 18 years, that are members of separate health systems, administer 19 psychiatry residency programs, and are located in a county with 20 a population over five hundred thousand shall each administer 21 state-funded psychiatry residency positions for one resident, 22 annually. The university of Iowa hospitals and clinics and the 23 specified medical centers shall expand the their psychiatry 24 residency program programs to provide additional residency 25 positions by providing financial support for residency 26 positions which are in excess of the federal residency cap 27 established by the federal Balanced Budget Act of 1997, Pub. 28 L. No. 105-33. 29 b. The university of Iowa hospitals and clinics and the 30 specified medical centers shall cooperate with the state 31 mental health institutes at Independence and Cherokee, the 32 state resource center at Woodward, the state training school 33 at Eldora, and the Iowa medical and classification center 34 at Oakdale in administering the program the positions . 35 -93- HF 2673 (8) 90 dg/ko/md 93/ 95
H.F. 2673 Participating residents and fellows shall complete a portion 1 of their psychiatry training at one of the state mental health 2 institutes, the state resource center, the state training 3 school, or the Iowa medical and classification center at 4 Oakdale. For accreditation-required clinical experiences 5 not available at the state mental health institutes, the 6 state resource center, the state training school, or the Iowa 7 medical and classification center at Oakdale, the residents of 8 the psychiatry residency and fellowship program awarded the 9 residency positions administered by the university of Iowa 10 hospitals and clinics may utilize clinical rotations at the 11 university of Iowa hospitals and clinics and its affiliates 12 across the state and the residents awarded the residency 13 positions administered by the specified medical centers may 14 utilize clinical rotations at affiliates of such medical 15 centers across the state . 16 2. The university of Iowa hospitals and clinics shall apply 17 to the accreditation council for graduate medical education 18 for approval of nine seven additional residency positions 19 for each class of residents and the psychiatry residency and 20 fellowship program shall award the total number of residency 21 positions approved for each class of residents. The university 22 of Iowa hospitals and clinics shall approve and award up to 23 two fellowship positions annually. The specified medical 24 centers shall apply to the accreditation council for graduate 25 medical education for approval of one additional residency 26 position each for each class of residents and shall award the 27 total number of residency positions approved for each class 28 of residents. Preference in the awarding of residency and 29 fellowship positions shall be given to candidates who are 30 residents of Iowa, attended and earned an undergraduate degree 31 from an Iowa college or university, or attended and earned a 32 medical degree from a medical school in Iowa. 33 3. A psychiatry residency and fellowship program positions 34 fund is created in the state treasury consisting of the moneys 35 -94- HF 2673 (8) 90 dg/ko/md 94/ 95
H.F. 2673 appropriated or credited to the fund by law. Notwithstanding 1 section 8.33 , moneys in the fund at the end of each fiscal 2 year shall not revert to any other fund but shall remain in 3 the psychiatry residency and fellowship program positions fund 4 for use in subsequent fiscal years. Moneys in the fund are 5 appropriated to the university of Iowa hospitals and clinics 6 to be used for the purposes of the program this section . For 7 the fiscal years beginning on or after July 1, 2023, there 8 is appropriated from the general fund of the state to the 9 psychiatry residency and fellowship program positions fund one 10 hundred thousand dollars for each residency position approved 11 and awarded under the program and one hundred fifty thousand 12 dollars for each fellowship position approved and awarded under 13 the program this section . Of the amount appropriated annually 14 from the fund to the university of Iowa hospitals and clinics, 15 the university of Iowa hospitals and clinics shall distribute 16 one hundred thousand dollars to each of the specified medical 17 centers for each residency position approved and awarded. 18 -95- HF 2673 (8) 90 dg/ko/md 95/ 95