House File 833 - Introduced HOUSE FILE 833 BY COMMITTEE ON HEALTH AND HUMAN SERVICES (SUCCESSOR TO HSB 153) A BILL FOR An Act relating to services and support for youth, including 1 treatment, physical assessments, and behavioral health 2 evaluations for youth involved in involuntary commitment, 3 juvenile delinquency, child in need of assistance, and 4 family in need of assistance proceedings; the licensing 5 and certification of certain residential facilities; 6 the provision of home and community-based services and 7 habilitation services to certain youth by residential 8 programs; administration and supervision of juvenile court 9 services; and the suspension of Hawki eligibility for 10 inmates of public institutions. 11 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 12 TLSB 1457HV (4) 91 dg/ko
H.F. 833 DIVISION I 1 SERVICES AND SUPPORT FOR CHILDREN AND YOUTH 2 Section 1. Section 125.13, subsection 2, Code 2025, is 3 amended by adding the following new paragraph: 4 NEW PARAGRAPH . k. A psychiatric medical institution for 5 children licensed under chapter 135H. 6 Sec. 2. Section 135H.1, Code 2025, is amended to read as 7 follows: 8 135H.1 Definitions. 9 As used in this chapter , unless the context otherwise 10 requires: 11 1. Approved qualifying organization means any of the 12 following: 13 a. The joint commission. 14 b. The commission on accreditation of rehabilitation 15 facilities. 16 c. The council on accreditation. 17 d. A nationally recognized accrediting organization with 18 standards comparable to the entities listed in paragraphs a 19 through c that are acceptable under federal regulations. 20 e. An entity specified by rule adopted by the department in 21 consultation with the department of health and human services. 22 1. 2. Department means the department of inspections, 23 appeals, and licensing. 24 2. 3. Direction means authoritative policy or procedural 25 guidance for the accomplishment of a function or an activity. 26 3. 4. Licensee means the holder of a license issued to 27 operate a psychiatric medical institution for children. 28 4. 5. Medical care plan means a plan of care and services 29 designed to eliminate the need for inpatient care by improving 30 the condition of a child youth . Services must be based upon a 31 diagnostic evaluation, which includes an examination a physical 32 assessment and behavioral health evaluation of the medical, 33 psychological, social, behavioral, and developmental aspects 34 of the childs youths situation, reflecting the need for 35 -1- LSB 1457HV (4) 91 dg/ko 1/ 38
H.F. 833 inpatient care. 1 6. Mental health disorder means any of the following: 2 a. A mental disorder as defined by the most recent version 3 of the diagnostic and statistical manual of mental disorders 4 published by the American psychiatric association. 5 b. A mental disorder included in the mental, behavioral, or 6 neurodevelopmental disorders chapter in the most recent version 7 of the international classification of diseases published by 8 the world health organization. 9 5. 7. Mental health professional means an individual who 10 has all of the following qualifications: 11 a. The individual holds at least a masters degree in a 12 mental health field, including but not limited to, psychology, 13 counseling and guidance, nursing, and or social work, or the 14 individual is a physician. 15 b. The individual holds a current Iowa license if practicing 16 in a field covered by that requires an Iowa licensure law 17 license . 18 c. The individual has at least two years of post-degree 19 clinical experience, supervised by another mental health 20 professional, in assessing mental health needs and problems and 21 in providing appropriate mental health services. 22 6. 8. Nursing care means services which are provided 23 under the direction of a physician or registered nurse. 24 7. 9. Physician means a person licensed under chapter 25 148 . 26 10. Protective locked environment means a setting that 27 prevents egress from a building or grounds as a protective 28 measure to ensure safety and security. 29 8. 11. Psychiatric medical institution for children or 30 psychiatric institution means an institution providing more 31 than twenty-four hours of continuous care involving long-term 32 psychiatric services to three or more children youth in 33 residence for expected periods of fourteen or more days for an 34 assessment, evaluation, and diagnosis and evaluation or for 35 -2- LSB 1457HV (4) 91 dg/ko 2/ 38
H.F. 833 expected periods of ninety days or more for treatment. 1 9. 12. Psychiatric services means services provided under 2 the direction of a physician which address mental, emotional, 3 medical, or behavioral problems. 4 13. Record check evaluation system means the same as 5 defined in section 135C.1. 6 10. 14. Rehabilitative services means services to 7 encourage and assist restoration of a residents optimum mental 8 and physical capabilities. 9 11. 15. Resident means a person who is less than 10 twenty-one years of age and youth who has been admitted by a 11 physician to a psychiatric medical institution for children. 12 16. Serious emotional disturbance means a diagnosable 13 disorder of sufficient duration to meet diagnostic criteria 14 specified within the most current diagnostic and statistical 15 manual of mental disorders published by the American 16 psychiatric association that results in a functional 17 impairment. Serious emotional disturbance does not include a 18 substance use or developmental disorder unless such disorder 19 co-occurs with such a diagnosable mental, behavioral, or 20 emotional disorder. 21 17. Substance use disorder means the same as defined in 22 section 125.2. 23 12. 18. Supervision means direct oversight and inspection 24 of the an act of accomplishing that accomplishes a function or 25 activity. 26 19. Youth means a person who is less than twenty-one years 27 of age. 28 Sec. 3. Section 135H.3, Code 2025, is amended to read as 29 follows: 30 135H.3 Nature of care. 31 1. a. A psychiatric medical institution for children 32 shall provide shelter, food, supervision, care, assessment, 33 evaluation, diagnosis, treatment, counseling, rehabilitative 34 services, and related professional-directed services to 35 -3- LSB 1457HV (4) 91 dg/ko 3/ 38
H.F. 833 youth who have a serious emotional disturbance, a substance 1 use disorder, or both, with the intention of reducing or 2 ameliorating the disorder, the symptoms of the disorder, or the 3 effects of the disorder. 4 b. A psychiatric medical institution for children shall 5 utilize a team of professionals to direct an organized program 6 of diagnostic services, psychiatric services, nursing care, 7 and rehabilitative services to meet the needs of residents 8 in accordance with a medical care plan developed for each 9 resident. The membership of the team of professionals 10 may include but is not limited to an advanced registered 11 nurse practitioner or a physician assistant. Social and 12 rehabilitative services shall be provided under the direction 13 of a qualified mental health professional. 14 2. If a child youth is diagnosed with a biologically 15 based mental illness as defined in section 514C.22 and meets 16 the medical assistance program criteria for admission to a 17 psychiatric medical institution for children, the child youth 18 shall be deemed to meet the acuity criteria for medically 19 necessary inpatient benefits under a group policy, contract, or 20 plan providing for third-party payment or prepayment of health, 21 medical, and surgical coverage benefits issued by a carrier, as 22 defined in section 513B.2 , that is subject to section 514C.22 . 23 Such medically necessary benefits shall not be excluded or 24 denied as care that is substantially custodial in nature under 25 section 514C.22, subsection 8 , paragraph b . 26 Sec. 4. Section 135H.4, Code 2025, is amended to read as 27 follows: 28 135H.4 Licensure scope of license . 29 1. A person shall not establish, operate, or maintain a 30 psychiatric medical institution for children unless the person 31 obtains a license for the institution under this chapter and 32 either holds a license under section 237.3, subsection 2 , 33 paragraph a , as a comprehensive residential facility for 34 children or holds a license under section 125.13 , if the 35 -4- LSB 1457HV (4) 91 dg/ko 4/ 38
H.F. 833 facility provides substance use disorder treatment . 1 2. A licensee shall only provide serious emotional 2 disturbance or substance use disorder services for which the 3 licensee is licensed under this chapter. 4 Sec. 5. Section 135H.5, Code 2025, is amended to read as 5 follows: 6 135H.5 Application for license initial application and 7 annual fees . 8 1. An application for a license under this chapter shall 9 be submitted on a form requesting information required by 10 the department , which . The application may include require 11 affirmative evidence of the applicants ability to comply with 12 the rules for standards adopted pursuant to this chapter . The 13 application shall require the applicant to specify whether the 14 applicant intends to provide services for serious emotional 15 disturbances, substance use disorders, or both. 16 2. An application for a license shall be accompanied by the 17 required license fee which shall be credited to the general 18 fund of the state. The initial application fee and the annual 19 license fee is twenty-five dollars. 20 Sec. 6. Section 135H.6, subsections 1, 4, and 5, Code 2025, 21 are amended to read as follows: 22 1. The department shall issue a license to an applicant 23 under this chapter if all the following conditions exist: 24 a. The department has ascertained that the applicants 25 medical facilities and staff are adequate to provide the care 26 and services required of a psychiatric medical institution for 27 children . 28 b. The proposed psychiatric institution is accredited 29 by the joint commission on the accreditation of health 30 care organizations, the commission on accreditation of 31 rehabilitation facilities, the council on accreditation of 32 services for families and children, or by any other recognized 33 accrediting organization with comparable standards acceptable 34 under federal regulation an approved qualifying organization . 35 -5- LSB 1457HV (4) 91 dg/ko 5/ 38
H.F. 833 c. The applicant complies with applicable state rules 1 and standards for a psychiatric institution adopted by the 2 department in accordance with federal requirements under 42 3 C.F.R. 441.150 441.156. 4 d. The department of health and human services has submitted 5 written approval of the application based on the department 6 of health and human services determination of need. The 7 department of health and human services shall identify the 8 location and number of children youth in the state who require 9 the services of a psychiatric medical institution for children. 10 Approval of an application shall be based upon the location 11 of the proposed psychiatric institution relative to the need 12 for services identified by the department of health and human 13 services and an analysis of the applicants ability to provide 14 services and support consistent with requirements under chapter 15 232 , particularly regarding specifically community-based 16 treatment. If the proposed psychiatric institution is not 17 freestanding from a facility licensed under chapter 135B or 18 135C , approval under this paragraph shall not be given unless 19 the department of health and human services certifies that 20 the proposed psychiatric institution is capable of providing 21 a resident with a living environment similar to the living 22 environment provided by a licensee which is freestanding from a 23 facility licensed under chapter 135B or 135C . 24 e. The proposed psychiatric institution is under the 25 direction of an agency which has operated a facility licensed 26 under section 237.3, subsection 2 , paragraph a , as a 27 comprehensive residential facility for children for three years 28 or of an agency which has operated a facility for three years 29 providing psychiatric services exclusively to children or 30 adolescents and the facility meets or exceeds requirements for 31 licensure under section 237.3, subsection 2 , paragraph a , as a 32 comprehensive residential facility for children. 33 f. e. If a child youth has an a serious emotional , 34 behavioral, or mental health disorder disturbance , the 35 -6- LSB 1457HV (4) 91 dg/ko 6/ 38
H.F. 833 psychiatric institution does not require court any of the 1 following as a condition for the youth to obtain treatment: 2 (1) Court proceedings to be initiated or that a childs . 3 (2) For the youths parent, guardian, or custodian must 4 to terminate parental rights over , or transfer legal custody 5 of , the child for the purposes of obtaining treatment from the 6 psychiatric institution for the child youth . 7 (3) Relinquishment of a childs the youths custody shall 8 not be a condition of the child receiving services . 9 4. The department of health and human services may give 10 approval to approve a conversion of beds approved under 11 subsection 2 , to if the beds which are specialized to provide 12 substance use disorder treatment. However, the total number of 13 beds approved under subsection 2 and this subsection shall not 14 exceed four hundred thirty , unless approved for good cause by 15 the director pursuant to subsection 2 . Beds The limitations 16 on the number of beds under this section shall not apply to 17 beds for children youth who do not reside in this state and 18 whose service costs are not paid by public funds in this state 19 are not subject to the limitations on the number of beds 20 requirements otherwise applicable under this section . 21 5. A psychiatric institution licensed prior to July 1, 1999, 22 may exceed the number of beds authorized under subsection 2 23 if the excess beds are used to provide services funded from 24 a source other than the medical assistance program under 25 chapter 249A . Notwithstanding subsection 1 , paragraph d , and 26 subsection 2 , the provision of services using those excess beds 27 does not require a review by the department of health and human 28 services. 29 Sec. 7. Section 135H.7, subsection 2, paragraph a, Code 30 2025, is amended to read as follows: 31 a. If a person who has been convicted of a crime or has a 32 record of founded child abuse is being considered for licensure 33 under this chapter , or for employment with a psychiatric 34 institution involving direct responsibility for a child youth 35 -7- LSB 1457HV (4) 91 dg/ko 7/ 38
H.F. 833 or with access to a child youth when the child youth is alone, 1 by a licensed psychiatric institution, or if a person will 2 reside residence in a facility utilized by a licensee, and if 3 the person has been convicted of a crime or has a record of 4 founded child abuse, the record check evaluation system and 5 the licensee for an employee of the licensee considering the 6 person for employment shall perform an evaluation to determine 7 whether the crime or founded child abuse warrants prohibition 8 of licensure, employment, or residence in the facility utilized 9 by a licensee . The record check evaluation system of the 10 department of health and human services shall conduct criminal 11 and child abuse record checks in this state and may conduct 12 these checks in other states. The record check evaluation 13 shall be performed in accordance with procedures adopted for 14 this purpose by the department of health and human services. 15 Sec. 8. NEW SECTION . 135H.7A Protective locked environment 16 rules. 17 The department, in cooperation with the department of health 18 and human services, shall adopt rules pursuant to chapter 17A 19 relating to the application of a protective locked environment 20 in a psychiatric medial institution for children. 21 Sec. 9. Section 135H.10, subsection 2, Code 2025, is amended 22 to read as follows: 23 2. This chapter shall not be construed as prohibiting 24 the use of to prohibit funds appropriated for foster care to 25 from being used to provide payment to a psychiatric medical 26 institution for children for the financial participation 27 required of a child youth whose foster care placement is in a 28 psychiatric medical institution for children. In accordance 29 with established policies and procedures for foster care, the 30 department of health and human services shall act to recover 31 any such payment for financial participation, apply to be named 32 payee for the childs youths unearned income, and recommend 33 parental liability for the costs of a court-ordered foster care 34 placement in a psychiatric medical institution. 35 -8- LSB 1457HV (4) 91 dg/ko 8/ 38
H.F. 833 Sec. 10. Section 135H.13, subsection 1, Code 2025, is 1 amended to read as follows: 2 1. The departments final findings and the survey findings 3 of the joint commission on the accreditation of health care 4 organizations an approved qualifying organization regarding 5 licensure or program accreditation shall be made available 6 to the public in a readily available form and place. Other 7 information relating to the psychiatric institution is 8 confidential and shall not be made available to the public 9 except in proceedings a proceeding involving licensure, a 10 civil suit involving a resident, or an administrative action 11 involving a resident. 12 Sec. 11. Section 229.13, subsection 1, paragraph c, Code 13 2025, is amended to read as follows: 14 c. (1) If the court orders evaluation and treatment of 15 the respondent on an inpatient basis under this section , the 16 court may order the respondent placed under the care of an 17 appropriate subacute care facility licensed under chapter 135G . 18 (2) If the court orders evaluation and treatment of a minor 19 respondent on an inpatient basis under this section, the court 20 may order the minor respondent placed under the care of an 21 appropriate public hospital. 22 Sec. 12. Section 229.13, subsection 5, Code 2025, is amended 23 to read as follows: 24 5. a. (1) The chief medical officer of the hospital or 25 facility at which the respondent is placed shall report to the 26 court and make a recommendation for disposition of the matter 27 no more than fifteen days after the date the respondent is 28 placed , making a recommendation for disposition of the matter 29 at the hospital or facility . An 30 (2) If the respondent is a minor and is placed under the 31 care of a public hospital pursuant to subsection 1, paragraph 32 c , subparagraph (2), the chief medical officer of the public 33 hospital shall report to the court and make a recommendation 34 for disposition no later than thirty calendar days after the 35 -9- LSB 1457HV (4) 91 dg/ko 9/ 38
H.F. 833 date the minor respondent is placed under the care of the 1 public hospital. 2 b. A copy of the chief medical officers report shall be 3 sent to the respondents attorney. 4 c. (1) Upon request, the court may grant the chief medical 5 officer an extension of time may be granted , not to exceed 6 seven days , upon a showing of cause. A copy of the report shall 7 be sent to the The respondents attorney , who may contest the 8 need for an extension of time if one is requested . An 9 (2) The court shall grant an extension of time shall be 10 granted upon request unless the request is contested, in which 11 case the court shall make such inquiry as it deems appropriate 12 and may either order the respondents release from the hospital 13 or facility , or grant an extension of time for psychiatric 14 evaluation. 15 d. If the chief medical officer fails to report to the 16 court within fifteen days after the individual is placed under 17 the care of the hospital or facility the time specified in 18 paragraph a , and an extension of time has not been requested 19 granted , the chief medical officer is guilty of contempt 20 and shall be punished under chapter 665. The court shall 21 order a rehearing on the application to determine whether the 22 respondent should continue to be detained at or placed under 23 the care of the hospital or facility. 24 Sec. 13. Section 229.14, subsection 2, paragraph e, Code 25 2025, is amended to read as follows: 26 e. (1) If the court orders placement and treatment of the 27 a respondent on an inpatient basis under this section , the 28 court may order the respondent placed under the care of an 29 appropriate subacute care facility licensed under chapter 135G . 30 (2) If the court orders placement and treatment of a minor 31 respondent on an inpatient basis under this section, the court 32 may order the minor respondent placed under the care of an 33 appropriate public hospital. 34 Sec. 14. Section 232.2, Code 2025, is amended by adding the 35 -10- LSB 1457HV (4) 91 dg/ko 10/ 38
H.F. 833 following new subsections: 1 NEW SUBSECTION . 3A. Behavioral health condition means 2 a serious emotional disturbance, a mental health disorder, 3 a substance abuse disorder, life stressors and crises, and 4 stress-related physical symptoms. 5 NEW SUBSECTION . 3B. Behavioral health evaluation means a 6 process used to assess an individuals behavioral health status 7 and functioning for purposes including but not limited to the 8 diagnosis of a behavioral health condition or to determine the 9 need for treatment or intervention. 10 NEW SUBSECTION . 38A. Mental health disorder means the 11 same as defined in section 135H.1. 12 NEW SUBSECTION . 48A. Physical assessment means 13 direct physical touching, viewing, and medically necessary 14 manipulation of any area of a childs body by a physician 15 licensed under chapter 148. 16 NEW SUBSECTION . 58A. Serious emotional disturbance means 17 the same as defined in section 135H.1. 18 NEW SUBSECTION . 64A. Substance use disorder means the 19 same as defined in section 125.2. 20 Sec. 15. Section 232.2, subsections 34 and 58, Code 2025, 21 are amended to read as follows: 22 34. Juvenile court social records or social records means 23 all records , other than official records, made with respect to 24 a child in connection with proceedings over which the court has 25 jurisdiction under this chapter other than official records and 26 includes but is not limited to the records made and compiled 27 by intake officers, predisposition reports, and reports of 28 physical assessments and mental examinations behavioral health 29 evaluations . 30 58. Secure facility means a physically restricting 31 facility in which children adjudicated to have committed 32 a delinquent act a child may be placed pursuant to a 33 dispositional order of the court. 34 Sec. 16. Section 232.8, subsection 4, Code 2025, is amended 35 -11- LSB 1457HV (4) 91 dg/ko 11/ 38
H.F. 833 to read as follows: 1 4. In a proceeding concerning a child who is alleged to 2 have committed a second delinquent act or a second violation 3 excluded from the jurisdiction of the juvenile court, the court 4 or the juvenile court shall determine whether there is reason 5 to believe that the child regularly abuses alcohol or other 6 controlled substance has a behavioral health condition and may 7 be in need of treatment. If the court so determines, the court 8 shall advise appropriate juvenile authorities and refer such 9 offenders to the juvenile court for disposition pursuant to 10 section 232.52A . 11 Sec. 17. Section 232.49, Code 2025, is amended to read as 12 follows: 13 232.49 Physical assessments and mental examinations 14 behavioral health evaluations juvenile delinquency . 15 1. a. Following Any time after the entry of an order 16 of adjudication under section 232.47 , the court may, after 17 a hearing which may be simultaneous with the adjudicatory 18 hearing , order a physical assessment or mental examination 19 behavioral health evaluation of a child if it the court finds 20 that an examination a physical assessment or a behavioral 21 health evaluation is necessary to determine the childs 22 physical condition or mental to determine if the child has a 23 behavioral health condition. 24 b. The court may consider chemical dependency as either 25 a physical condition or mental behavioral health condition 26 and may consider a chemical dependency evaluation as either a 27 physical assessment or mental examination behavioral health 28 evaluation . If the examination 29 c. A hearing to order a physical assessment or behavioral 30 health evaluation may be held at the same time as the 31 adjudicatory hearing. 32 2. Unless otherwise ordered by the court, if a physical 33 assessment or behavioral health evaluation indicates the child 34 has behaved in a manner that threatened the safety of another 35 -12- LSB 1457HV (4) 91 dg/ko 12/ 38
H.F. 833 person, has committed a violent act causing bodily injury to 1 another person, or has been a victim or perpetrator of sexual 2 abuse, unless otherwise ordered by the court, the childs 3 parent, guardian, or foster parent , or other person with 4 custody of the child shall be provided with that information. 5 2. 3. a. When possible an examination , a physical 6 assessment or behavioral health evaluation shall be conducted 7 on an outpatient basis , but . However, if deemed necessary by 8 the court, the court may , if it deems necessary commit order 9 the child to a suitable hospital, facility , or institution for 10 the purpose of examination an inpatient physical assessment or 11 an inpatient behavioral health evaluation . 12 b. Commitment for examination An inpatient physical 13 assessment or an inpatient behavioral health evaluation shall 14 not exceed thirty days and the civil commitment provisions of 15 chapter 229 shall not apply . 16 3. 4. a. At any Any time after the filing of a delinquency 17 petition , the court may order a physical assessment or mental 18 examination behavioral health evaluation of the child if all of 19 the following circumstances apply: 20 (1) The court finds such examination a physical assessment 21 or a behavioral health evaluation to be in the best interest 22 of the child ; and . 23 (2) The parent, guardian, or custodian and the childs 24 counsel agree to the physical assessment or behavioral health 25 evaluation . 26 b. (1) An examination A physical assessment or behavioral 27 health evaluation shall be conducted on an outpatient basis 28 unless the court, the childs counsel, and the childs 29 parent, guardian, or custodian agree that it is necessary the 30 child should be committed ordered to a suitable hospital, 31 facility, or institution for the purpose of examination an 32 inpatient physical assessment or an inpatient behavioral health 33 evaluation . Commitment for examination 34 Sec. 18. Section 232.52A, subsection 1, Code 2025, is 35 -13- LSB 1457HV (4) 91 dg/ko 13/ 38
H.F. 833 amended to read as follows: 1 1. In addition to any other order of the juvenile court, 2 a person under age eighteen, child who may be in need of 3 treatment , as determined under section 232.8 , may be ordered 4 to participate in an alcohol or controlled substance education 5 or a physical assessment or behavioral health evaluation 6 program approved by the juvenile court. If recommended after 7 evaluation, the The court may also order the person child to 8 participate in a treatment program approved by the court if the 9 treatment program is recommended after the childs physical 10 assessment or behavioral health evaluation . The juvenile court 11 may also require the custodial parent or parents , or other 12 legal guardian , to participate in an educational program with 13 the person under age eighteen child if the court determines 14 that such participation is in the best interests of the person 15 under age eighteen child . 16 Sec. 19. Section 232.68, subsection 3, unnumbered paragraph 17 1, Code 2025, is amended to read as follows: 18 Confidential access to a child means access to a child, 19 during an assessment of an alleged act of child abuse, who is 20 alleged to be the victim of the child abuse , during a child 21 abuse assessment . The access may be accomplished by interview, 22 observation, or examination physical assessment of the child. 23 As used in this subsection and this part: 24 Sec. 20. Section 232.68, subsection 3, paragraph c, Code 25 2025, is amended by striking the paragraph. 26 Sec. 21. Section 232.69, subsection 3, paragraph b, Code 27 2025, is amended to read as follows: 28 b. A person required to make a report under subsection 1, 29 other than a physician whose professional practice does not 30 regularly involve providing primary health care to children, 31 shall complete the core training curriculum relating to 32 the identification and reporting of child abuse within six 33 months of initial employment or self-employment involving 34 the examination physical assessments or behavioral health 35 -14- LSB 1457HV (4) 91 dg/ko 14/ 38
H.F. 833 evaluations , or attending, counseling, or treatment of treating 1 children on a regular basis. Within one month of initial 2 employment or self-employment, the person shall obtain a 3 statement of the abuse reporting requirements from the persons 4 employer or, if self-employed, from the department. The person 5 shall complete the core training curriculum relating to the 6 identification and reporting of child abuse every three years. 7 Sec. 22. Section 232.71B, subsection 10, Code 2025, is 8 amended to read as follows: 9 10. Physical examination assessment . If the department 10 refers a child to a physician or physician assistant for a 11 physical examination assessment , the department shall contact 12 the physician or physician assistant regarding the examination 13 physical assessment within twenty-four hours of making the 14 referral. If the physician or physician assistant who performs 15 the examination upon referral by the department physical 16 assessment reasonably believes the child has been abused, the 17 physician or physician assistant shall report to the department 18 within twenty-four hours of performing the examination physical 19 assessment . 20 Sec. 23. Section 232.77, subsection 1, Code 2025, is amended 21 to read as follows: 22 1. a. A person who is required to report suspected 23 child abuse may take or perform, or may cause to be taken or 24 performed , at public expense, photographs, X rays, or other 25 physical examinations assessments, or other tests of a child 26 which would provide medical indication of allegations arising 27 from an assessment. 28 b. A health practitioner may, if medically indicated, 29 cause to be performed a radiological examination, physical 30 examination assessment , or other medical tests test of the 31 child. 32 c. A person who takes any photographs or X rays or 33 performs any physical examinations assessments or other tests 34 pursuant to this section shall notify the department that the 35 -15- LSB 1457HV (4) 91 dg/ko 15/ 38
H.F. 833 photographs or X rays have been taken or the examinations 1 physical assessments or other tests have been performed . The 2 person who made notification , and shall retain the photographs , 3 or X rays , or examination physical assessment or other test 4 findings for a reasonable time following the notification. 5 d. Whenever the person is required to report under section 6 232.69 , in that persons capacity as a member of the staff of 7 a medical or other private or public institution, agency or 8 facility, that person shall immediately notify the person in 9 charge of the institution, agency, or facility or that persons 10 designated delegate of the need for photographs , or X rays or 11 examinations , physical assessments, or other tests. 12 Sec. 24. Section 232.78, subsection 1, paragraph a, Code 13 2025, is amended to read as follows: 14 a. Any of the following circumstances exist: 15 (1) The person responsible for the care of the child 16 consents to the removal. 17 (2) The person responsible for the care of the child is 18 absent , or . 19 (3) The person responsible for the care of the child, though 20 present, was asked and refused to consent to the removal of the 21 child and was informed of an intent to apply for an order under 22 this section , or there . 23 (4) There is reasonable cause to believe that a request for 24 consent would further endanger the child , or there . 25 (5) There is reasonable cause to believe that a request for 26 consent will cause the parent, guardian, or legal custodian 27 person responsible for the care of the child to take flight 28 with the child. 29 Sec. 25. Section 232.78, subsection 1, paragraph c, 30 subparagraph (1), Code 2025, is amended to read as follows: 31 (1) The refusal or failure of the person responsible for 32 the care of the child to comply with the request of a peace 33 officer, juvenile court officer, or child protection worker 34 for such the person to obtain and provide to the requester 35 -16- LSB 1457HV (4) 91 dg/ko 16/ 38
H.F. 833 the results of a physical assessment or mental examination 1 behavioral health evaluation of the child. The request for a 2 physical examination assessment of the child may specify the 3 performance of a medically relevant test. 4 Sec. 26. Section 232.78, subsection 5, Code 2025, is amended 5 to read as follows: 6 5. The juvenile court, before or after the filing of a 7 petition under this chapter , may enter an ex parte order 8 authorizing a physician or physician assistant or hospital to 9 conduct an inpatient or outpatient physical examination or 10 authorizing a physician or physician assistant, a psychologist 11 certified under section 154B.7 , or a community mental health 12 center accredited pursuant to chapter 230A to conduct an 13 outpatient mental examination assessment or an inpatient or 14 outpatient behavioral health evaluation of a child if necessary 15 to identify the nature, extent, and cause of injuries to the 16 child as required by section 232.71B , provided all of the 17 following apply: 18 a. Any of the following circumstances exist: 19 (1) The childs parent, guardian, or custodian consents to 20 the physical assessment or the behavioral health evaluation. 21 (2) The childs parent, guardian, or legal custodian is 22 absent , or . 23 (3) The childs parent, guardian, or custodian, though 24 present, was asked and refused to provide written consent to 25 the examination physical assessment or the behavioral health 26 evaluation . 27 b. The juvenile court has entered an ex parte order 28 directing the removal of the child from the childs home or a 29 child care facility under this section. 30 c. There is not enough time to file a petition and to hold 31 a hearing as provided in section 232.98. 32 Sec. 27. Section 232.79, subsection 5, Code 2025, is amended 33 to read as follows: 34 5. When there has been an emergency removal or keeping of a 35 -17- LSB 1457HV (4) 91 dg/ko 17/ 38
H.F. 833 child without a court order, a physical examination assessment 1 of the child by a licensed medical practitioner shall be 2 performed within twenty-four hours of such the emergency 3 removal or keeping of a child , unless the child is returned 4 to the childs home within twenty-four hours of the emergency 5 removal or keeping of a child . 6 Sec. 28. Section 232.83, subsection 2, Code 2025, is amended 7 to read as follows: 8 2. Anyone authorized to conduct a preliminary investigation 9 in response to a complaint may apply for, or the court on its 10 own motion may enter, an ex parte order authorizing a physician 11 or physician assistant or hospital to conduct an inpatient or 12 outpatient physical examination or authorizing a physician or 13 physician assistant, a psychologist certified under section 14 154B.7 , or a community mental health center accredited pursuant 15 to chapter 230A to conduct an outpatient mental examination 16 of a child if necessary to identify the nature, extent, and 17 causes of any injuries, emotional damage, or other such needs 18 of a child as specified in section 232.96A, subsection 3, 5, or 19 6 , assessment or an inpatient or outpatient behavioral health 20 evaluation provided that all of the following apply: 21 a. Any of the following circumstances exist: 22 (1) The parent, guardian, or custodian consents to the 23 physical assessment or the behavioral health evaluation. 24 (2) The parent, guardian, or legal custodian is absent , or . 25 (3) The parent, guardian, or custodian, though present, 26 was asked and refused to authorize the examination physical 27 assessment or the behavioral health evaluation . 28 b. There is not enough time to file a petition and hold a 29 hearing under this chapter. 30 c. The parent, guardian, or legal custodian has not provided 31 care and treatment related to their the childs alleged 32 victimization. 33 Sec. 29. Section 232.98, Code 2025, is amended to read as 34 follows: 35 -18- LSB 1457HV (4) 91 dg/ko 18/ 38
H.F. 833 232.98 Physical and mental examinations assessments and 1 behavioral health evaluations child in need of assistance . 2 1. a. Except as provided in section 232.78, subsection 5 , 3 a physical assessment or mental examination behavioral health 4 evaluation of the a child may be ordered only after the filing 5 of a petition pursuant to section 232.87 , and after a hearing 6 to determine whether an examination a physical assessment 7 or behavioral health evaluation is necessary to determine 8 the childs physical condition or mental if the child has a 9 behavioral health condition. 10 b. The court may consider chemical dependency as either 11 a physical or mental behavioral health condition and may 12 consider a chemical dependency evaluation as either a physical 13 assessment or mental examination behavioral health evaluation . 14 a. c. The hearing required by this section may be held 15 simultaneously with the adjudicatory hearing. 16 b. d. An examination A physical assessment or a behavioral 17 health evaluation ordered prior to the adjudication shall 18 be conducted on an outpatient basis when possible , but . 19 However, if deemed necessary by the court, the court may 20 commit order the child to a suitable nonsecure hospital, 21 facility, or institution for the purpose of examination an 22 inpatient physical assessment or an inpatient behavioral health 23 evaluation for a period not to exceed fifteen thirty days if 24 all of the following are found to be present circumstances 25 exist : 26 (1) Probable cause exists to believe that the child is 27 a child in need of assistance pursuant to section 232.96A, 28 subsection 5 or 6 . 29 (2) Commitment An inpatient physical assessment or 30 inpatient behavioral health evaluation is necessary to 31 determine whether there is clear and convincing evidence that 32 the child is a child in need of assistance. 33 (3) The childs attorney agrees to the commitment an 34 inpatient physical assessment or inpatient behavioral health 35 -19- LSB 1457HV (4) 91 dg/ko 19/ 38
H.F. 833 evaluation . 1 c. e. An examination A physical assessment or a behavioral 2 health evaluation ordered after the adjudication shall 3 be conducted on an outpatient basis when possible , but . 4 However, if deemed necessary by the court, the court may 5 commit order the child to a suitable nonsecure hospital, 6 facility, or institution for the purpose of examination an 7 inpatient physical assessment or an inpatient behavioral health 8 evaluation for a period not to exceed thirty days. 9 d. f. The childs parent, guardian, or custodian shall 10 be included in counseling sessions offered during the childs 11 stay in a hospital, facility, or institution when feasible, and 12 when in the best interests of the child and the childs parent, 13 guardian, or custodian. If separate counseling sessions are 14 conducted for the child and the childs parent, guardian, or 15 custodian, a joint counseling session shall be offered prior 16 to the release of the child from the hospital, facility, or 17 institution. The court shall require that notice be provided 18 to the childs guardian ad litem of the counseling sessions , 19 and of the counseling session participants , and results the 20 outcomes of the counseling sessions. 21 2. Following an adjudication that a child is a child in 22 need of assistance, the court may , after a hearing , order the 23 a physical assessment or mental examination behavioral health 24 evaluation of the childs parent, guardian, or custodian if 25 that persons ability to care for the child is at issue. 26 Sec. 30. Section 232.102, subsection 5, Code 2025, is 27 amended to read as follows: 28 5. a. The child shall not be placed in the state training 29 school. 30 b. (1) Paragraph a shall not preclude the departments 31 use of the facilities of the state training school for the 32 purposes of conducting a physical assessment, a behavioral 33 health evaluation, or both, as described in section 232.98, of 34 a male child for a period not to exceed thirty days. Such use 35 -20- LSB 1457HV (4) 91 dg/ko 20/ 38
H.F. 833 of the facilities of the state training school shall be subject 1 to the directors authorization and approval for any request to 2 obtain a court order for these purposes. Following review of 3 the authorized and approved departmental request, the court may 4 order such use of the facilities of the state training school. 5 (2) A male child temporarily located at the state training 6 school pursuant to subparagraph (1) shall at all times be 7 separated from children adjudicated to have committed a 8 delinquent act who are placed at the state training school. 9 (3) The department shall adopt rules pursuant to chapter 17A 10 to administer this paragraph. 11 Sec. 31. Section 232.127, subsection 7, Code 2025, is 12 amended to read as follows: 13 7. a. The court may not order the child placed on 14 probation, in a foster home or in a nonsecure facility unless 15 the child requests and agrees to such supervision or placement. 16 In no event shall the 17 b. The court shall not order the child placed in a secure 18 facility or in the state training school or other secure 19 facility . 20 c. (1) Paragraph b shall not preclude the departments 21 use of the facilities of the state training school for the 22 purposes of conducting a physical assessment, a behavioral 23 health evaluation, or both, as described in section 232.98, of 24 a male child for a period not to exceed thirty days. Such use 25 of the facilities of the state training school shall be subject 26 to the directors authorization and approval for any request to 27 obtain a court order for these purposes. Following review of 28 the authorized and approved departmental request, the court may 29 order such use of the facilities of the state training school. 30 (2) A male child temporarily located at the state training 31 school pursuant to subparagraph (1) shall at all times be 32 separated from children adjudicated to have committed a 33 delinquent act who are placed at the state training school. 34 (3) The department shall adopt rules pursuant to chapter 17A 35 -21- LSB 1457HV (4) 91 dg/ko 21/ 38
H.F. 833 to administer this paragraph. 1 Sec. 32. Section 232.141, subsection 1, Code 2025, is 2 amended to read as follows: 3 1. Except as otherwise provided by law, the court shall 4 inquire into the ability of the child or the childs parent 5 to pay expenses incurred pursuant to subsections 2, 4, and 6 8 . After giving the parent a reasonable opportunity to be 7 heard, the court may order the parent to pay all or part of the 8 costs of the childs care, examination physical assessment, 9 behavioral health evaluation , treatment, legal expenses, or 10 other expenses. An order entered under this section does not 11 obligate a parent paying child support under a custody decree, 12 except that part of the monthly support payment may be used to 13 satisfy the obligations imposed by the order entered pursuant 14 to this section . If a parent fails to pay as ordered, without 15 good reason, the court may proceed against the parent for 16 contempt and may inform the county attorney who shall proceed 17 against the parent to collect the unpaid amount. Any payment 18 ordered by the court shall be a judgment against each of the 19 childs parents and a lien as provided in section 624.23 . If 20 all or part of the amount that the parents are ordered to pay is 21 subsequently paid by the county or state, the judgment and lien 22 shall thereafter be against each of the parents in favor of the 23 county to the extent of the countys payments and in favor of 24 the state to the extent of the states payments. 25 Sec. 33. Section 232.141, subsection 4, paragraph b, Code 26 2025, is amended to read as follows: 27 b. Expenses for mental or physical examinations assessments 28 or behavioral health evaluations of a child if ordered by the 29 court. 30 Sec. 34. Section 232.141, subsection 6, Code 2025, is 31 amended to read as follows: 32 6. If a child is given A physical or mental examinations 33 assessment, behavioral health evaluation, or any treatment 34 relating to an assessment performed pursuant to section 35 -22- LSB 1457HV (4) 91 dg/ko 22/ 38
H.F. 833 232.71B , shall be paid by the state if physical assessment, 1 behavioral health evaluation, or other treatment was performed 2 with the consent of the childs parent, guardian, or legal 3 custodian and no other provision of law otherwise requires 4 payment for the costs of the examination and treatment, the 5 costs shall be paid by the state . Reimbursement for The 6 department shall reimburse costs of services described in under 7 this subsection is subject to in accordance with subsection 5 . 8 Sec. 35. Section 237.1, Code 2025, is amended by adding the 9 following new subsection: 10 NEW SUBSECTION . 8A. Protective locked environment means a 11 setting that prevents egress from a building or grounds as a 12 protective measure to ensure safety and security. 13 Sec. 36. Section 237.3, Code 2025, is amended by adding the 14 following new subsection: 15 NEW SUBSECTION . 13. The department shall adopt rules 16 pursuant to chapter 17A relating to the application of a 17 protective locked environment to child foster care licensees. 18 Sec. 37. Section 237.4, Code 2025, is amended by adding the 19 following new subsection: 20 NEW SUBSECTION . 9. A psychiatric medical institution for 21 children licensed under chapter 135H. 22 Sec. 38. Section 237C.1, Code 2025, is amended by adding the 23 following new subsection: 24 NEW SUBSECTION . 5. Protective locked environment means a 25 setting that prevents egress from a building or grounds as a 26 protective measure to ensure safety and security. 27 Sec. 39. Section 237C.4, Code 2025, is amended by adding the 28 following new subsection: 29 NEW SUBSECTION . 6A. Rules governing the application of 30 a protective locked environment to a childrens residential 31 facility shall be adopted by the department. 32 Sec. 40. DEPARTMENT OF HEALTH AND HUMAN SERVICES 33 DEPARTMENT OF INSPECTIONS, APPEALS, AND LICENSING 34 ADMINISTRATIVE RULES. 35 -23- LSB 1457HV (4) 91 dg/ko 23/ 38
H.F. 833 1. The department of health and human services and the 1 department of inspections, appeals, and licensing shall each 2 adopt rules pursuant to chapter 17A to administer this division 3 of this Act. The departments shall coordinate in developing 4 their respective rules to provide continuity for, and maximize 5 utilization of the array of behavioral health services 6 available by, affected individuals. 7 2. a. The department of health and human services and 8 the department of inspections, appeals, and licensing shall 9 review applicable existing rules and shall each adopt rules 10 pursuant to chapter 17A to provide for the following relative 11 to facilities licensed or certified under chapters 135H, 237, 12 and 237C: 13 (1) Consistency to the greatest extent possible regarding 14 the use of restraints and seclusion across these facilities. 15 (2) Adaptation in application of licensing and 16 certification requirements to provide for the unmet residential 17 care needs of affected individuals. 18 b. In reviewing and adopting the rules, the departments 19 shall consider the nature of the services and programming 20 provided by the specific type of facility and applicable 21 federal requirements, including those for psychiatric 22 residential treatment facilities as described in 42 C.F.R. 23 483.352. 24 3. The department of health and human services shall adopt 25 rules pursuant to chapter 17A relating to the application of 26 a protective locked environment to detention and shelter care 27 as defined in section 232.2. For purposes of this subsection, 28 protective locked environment means a setting that prevents 29 egress from a building or grounds as a protective measure to 30 ensure safety and security. 31 Sec. 41. REPEAL. 2024 Iowa Acts, chapter 1161, sections 97 32 and 98, are repealed. 33 DIVISION II 34 HOME AND COMMUNITY-BASED SERVICES HABILITATION SERVICES 35 -24- LSB 1457HV (4) 91 dg/ko 24/ 38
H.F. 833 PROVIDED BY A RESIDENTIAL PROGRAM EXCLUSION FROM CHILDRENS 1 RESIDENTIAL FACILITY DEFINITION 2 Sec. 42. Section 237C.1, subsection 2, Code 2025, is amended 3 by adding the following new paragraph: 4 NEW PARAGRAPH . j. Care furnished to persons sixteen 5 years of age and older by a residential program to which the 6 department applies accreditation, certification, or standards 7 of review under the provisions of a federally approved medical 8 assistance home and community-based services waiver, or other 9 provision of the medical assistance program. 10 DIVISION III 11 DIRECTOR OF JUVENILE COURT SERVICES CHIEF JUVENILE COURT 12 OFFICERS 13 Sec. 43. Section 602.1101, Code 2025, is amended by adding 14 the following new subsection: 15 NEW SUBSECTION . 5A. Director of juvenile court services 16 means the same as defined in the Iowa court rules of juvenile 17 court services directed programs and includes the deputy 18 director of juvenile court services. 19 Sec. 44. Section 602.1217, Code 2025, is amended to read as 20 follows: 21 602.1217 Chief juvenile court officer. 22 1. The chief judge of director of juvenile court services 23 shall appoint a chief juvenile court officer for each judicial 24 district , after consultation with the judges of the judicial 25 district, shall appoint a chief juvenile court officer and may 26 remove the a chief juvenile court officer for cause. 27 2. The chief juvenile court officer is subject to the 28 immediate supervision and direction of the chief judge of the 29 judicial district director of juvenile court services . 30 3. The chief juvenile court officer, in addition to 31 performing the duties of a juvenile court officer, shall 32 supervise juvenile court officers and administer juvenile court 33 services within the judicial district in a uniform manner, 34 under the supervision and direction of the director of juvenile 35 -25- LSB 1457HV (4) 91 dg/ko 25/ 38
H.F. 833 court services, in accordance with law and with the rules, 1 directives, and procedures of the judicial branch and the 2 judicial district. 3 4. The chief juvenile court officer shall assist the state 4 court administrator and the district court administrator 5 director of juvenile court services in implementing the rules, 6 directives, and procedures of the judicial branch and the 7 judicial district. 8 5. A chief juvenile court officer shall have other duties 9 as prescribed by the supreme court or by the chief judge of the 10 judicial district director of juvenile court services . 11 Sec. 45. Section 602.7201, subsections 2 and 3, Code 2025, 12 are amended to read as follows: 13 2. The juvenile court officers and other personnel 14 employed in juvenile court service offices are subject to 15 the supervision of the chief juvenile court officer. The 16 chief juvenile court officer is subject to the supervision and 17 direction of the director of juvenile court services. 18 3. The chief juvenile court officer may employ, shall 19 supervise, and may remove for cause with due process 20 secretarial, clerical, and other staff within juvenile court 21 service offices as authorized by the chief judge director of 22 juvenile court services . 23 Sec. 46. Section 602.7202, subsections 1 and 3, Code 2025, 24 are amended to read as follows: 25 1. Subject to the approval of the chief judge of the 26 judicial district director of juvenile court services , the 27 chief juvenile court officer shall appoint juvenile court 28 officers to serve the juvenile court. Juvenile court officers 29 may be required to serve in two or more counties within the 30 judicial district. 31 3. Juvenile court officers shall have the duties prescribed 32 in chapter 232 , subject to the direction of the judges of the 33 juvenile court director of juvenile court services . A judge 34 of the juvenile court shall not attempt to direct or influence 35 -26- LSB 1457HV (4) 91 dg/ko 26/ 38
H.F. 833 a juvenile court officer in the performance of the officers 1 duties. 2 DIVISION IV 3 HAWKI ELIGIBILITY PUBLIC INSTITUTION INMATES 4 Sec. 47. Section 514I.8, subsection 2, paragraph g, Code 5 2025, is amended to read as follows: 6 g. Is not an inmate of a public institution or a patient in 7 an institution for mental diseases. 8 Sec. 48. NEW SECTION . 514I.8B Inmates of public 9 institutions suspension of medical assistance. 10 1. Following the first thirty days of commitment, the 11 department shall suspend, but not terminate, the eligibility of 12 an eligible child who is an inmate of a public institution as 13 defined in 42 C.F.R. 435.1010, who is enrolled in the medical 14 assistance program under this chapter at the time of commitment 15 to the public institution, and who remains eligible for medical 16 assistance under this chapter except for the eligible childs 17 institutional status, during the entire period of the eligible 18 childs commitment to the public institution. 19 2. To the extent applicable, the public institution and the 20 department shall comply with the reporting requirements and the 21 expediting of the restoration of an eligible childs medical 22 assistance benefits under this chapter upon the eligible 23 childs discharge, consistent with section 249A.38. 24 3. The department shall adopt rules pursuant to chapter 17A 25 to administer this section. 26 DIVISION V 27 CORRECTIVE CHANGES 28 Sec. 49. Section 125.13, subsection 2, paragraphs a, i, and 29 j, Code 2025, are amended to read as follows: 30 a. A hospital providing care or treatment to persons with 31 a substance use disorder licensed under chapter 135B which is 32 accredited by the joint commission on the accreditation of 33 health care organizations , the commission on accreditation 34 of rehabilitation facilities, the American osteopathic 35 -27- LSB 1457HV (4) 91 dg/ko 27/ 38
H.F. 833 association, or another recognized organization approved by 1 the department. All survey reports from the accrediting or 2 licensing body must be sent to the department. 3 i. A substance use disorder treatment program not funded 4 by the department which is accredited or licensed by the joint 5 commission on the accreditation of health care organizations , 6 the commission on the accreditation of rehabilitation 7 facilities, the American osteopathic association, or another 8 recognized organization approved by the department. All survey 9 reports from the accrediting or licensing body must be sent to 10 the department. 11 j. A hospital substance use disorder treatment program 12 that is accredited or licensed by the joint commission on the 13 accreditation of health care organizations , the commission on 14 the accreditation of rehabilitation facilities, the American 15 osteopathic association, or another recognized organization 16 approved by the department. All survey reports for the 17 hospital substance use disorder treatment program from the 18 accrediting or licensing body shall be sent to the department. 19 Sec. 50. Section 125.43A, Code 2025, is amended to read as 20 follows: 21 125.43A Prescreening exception. 22 Except in cases of medical emergency or court-ordered 23 admissions, a person shall be admitted to a state mental 24 health institute for treatment of a substance use disorder 25 only after a preliminary intake and assessment by a 26 department-licensed treatment facility or a hospital providing 27 care or treatment for persons with a substance use disorder 28 licensed under chapter 135B and accredited by the joint 29 commission on the accreditation of health care organizations , 30 the commission on accreditation of rehabilitation facilities, 31 the American osteopathic association, or another recognized 32 organization approved by the department, or by a designee of 33 a department-licensed treatment facility or a hospital other 34 than a state mental health institute, which confirms that the 35 -28- LSB 1457HV (4) 91 dg/ko 28/ 38
H.F. 833 admission is appropriate to the persons substance use disorder 1 service needs. A county board of supervisors may seek an 2 admission of a patient to a state mental health institute who 3 has not been confirmed for appropriate admission and the county 4 shall be responsible for one hundred percent of the cost of 5 treatment and services of the patient. 6 Sec. 51. Section 135B.12, Code 2025, is amended to read as 7 follows: 8 135B.12 Confidentiality. 9 The departments final findings or the final survey findings 10 of the joint commission on the accreditation of health care 11 organizations or the American osteopathic association with 12 respect to compliance by a hospital or rural emergency hospital 13 with requirements for licensing or accreditation shall be made 14 available to the public in a readily available form and place. 15 Other information relating to a hospital or rural emergency 16 hospital obtained by the department which does not constitute 17 the departments findings from an inspection of the hospital 18 or rural emergency hospital or the final survey findings of 19 the joint commission on the accreditation of health care 20 organizations or the American osteopathic association shall 21 not be made available to the public, except in proceedings 22 involving the denial, suspension, or revocation of a license 23 under this chapter . The name of a person who files a complaint 24 with the department shall remain confidential and shall not 25 be subject to discovery, subpoena, or other means of legal 26 compulsion for its release to a person other than department 27 employees or agents involved in the investigation of the 28 complaint. 29 Sec. 52. Section 135B.20, subsection 4, Code 2025, is 30 amended to read as follows: 31 4. Joint conference committee shall mean the joint 32 conference committee as required by the joint commission on 33 accreditation of health care organizations or, in a hospital 34 having no such committee, a similar committee, an equal number 35 -29- LSB 1457HV (4) 91 dg/ko 29/ 38
H.F. 833 of which shall be members of the medical staff selected by the 1 staff and an equal number of which shall be selected by the 2 governing board of the hospital. 3 Sec. 53. Section 135C.2, subsection 7, Code 2025, is amended 4 to read as follows: 5 7. The rules adopted by the department regarding nursing 6 facilities shall provide that a nursing facility may choose 7 to be inspected either by the department or by the joint 8 commission on accreditation of health care organizations . 9 The rules regarding acceptance of inspection by the joint 10 commission on accreditation of health care organizations shall 11 include recognition, in lieu of inspection by the department, 12 of comparable inspections and inspection findings of the joint 13 commission on accreditation of health care organizations , 14 if the department is provided with copies of all requested 15 materials relating to the inspection process. 16 Sec. 54. Section 135C.6, subsection 10, Code 2025, is 17 amended to read as follows: 18 10. Notwithstanding section 135C.9 , nursing facilities 19 which are accredited by the joint commission on accreditation 20 of health care organizations shall be licensed without 21 inspection by the department, if the nursing facility has 22 chosen to be inspected by the joint commission on accreditation 23 of health care organizations in lieu of inspection by the 24 department. 25 Sec. 55. Section 135J.2, subsection 2, Code 2025, is amended 26 to read as follows: 27 2. The hospice program shall meet the criteria pursuant to 28 section 135J.3 before a license is issued. The department is 29 responsible to provide the necessary personnel to inspect the 30 hospice program, the home care and inpatient care provided and 31 the hospital or facility used by the hospice to determine if 32 the hospice complies with necessary standards before a license 33 is issued. Hospices that are certified as Medicare hospice 34 providers by the department , or are accredited as hospices 35 -30- LSB 1457HV (4) 91 dg/ko 30/ 38
H.F. 833 by the joint commission on the accreditation of health care 1 organizations , shall be licensed without inspection by the 2 department. 3 Sec. 56. Section 144F.5, subsection 1, Code 2025, is amended 4 to read as follows: 5 1. The standards for accreditation adopted by the joint 6 commission on the accreditation of health care organizations 7 or any other nationally recognized hospital accreditation 8 organization. 9 Sec. 57. Section 155A.13, subsection 4, paragraph a, 10 subparagraph (4), Code 2025, is amended to read as follows: 11 (4) Give recognition to the standards of the joint 12 commission on the accreditation of health care organizations 13 and the American osteopathic association , and to the conditions 14 of participation under Medicare. 15 Sec. 58. Section 232.2, subsection 4, paragraph i, Code 16 2025, is amended to read as follows: 17 i. If reasonable efforts to place a child for adoption or 18 with a guardian are made concurrently with reasonable efforts 19 as defined in section 232.102 232.102A , the concurrent goals 20 and timelines may be identified. Concurrent case permanency 21 plan goals for reunification, and for adoption or for other 22 permanent out-of-home placement of a child shall not be 23 considered inconsistent in that the goals reflect divergent 24 possible outcomes for a child in an out-of-home placement. 25 Sec. 59. Section 232.36, subsection 3, paragraph b, 26 subparagraph (3), Code 2025, is amended to read as follows: 27 (3) Legal custodian Custodian of the child. 28 Sec. 60. Section 232.37, subsection 2, Code 2025, is amended 29 to read as follows: 30 2. Notice of the pendency of the case shall be served upon 31 the known parents, guardians, or legal custodians of a child 32 if these persons are not summoned to appear as provided in 33 subsection 1 . Notice shall also be served upon the child and 34 upon the childs guardian ad litem, if any. The notice shall 35 -31- LSB 1457HV (4) 91 dg/ko 31/ 38
H.F. 833 attach a copy of the petition and shall give notification of 1 the right to counsel provided for in section 232.11 . 2 Sec. 61. Section 232.101A, subsection 1, paragraph c, Code 3 2025, is amended to read as follows: 4 c. The parent of the child does not appear at the 5 dispositional hearing, or the parent appears at the 6 dispositional hearing, does not object to the transfer of 7 guardianship, and agrees to waive the requirement for making 8 reasonable efforts as defined in section 232.102 232.102A . 9 Sec. 62. Section 232.102A, subsection 3, Code 2025, is 10 amended to read as follows: 11 3. The performance of reasonable efforts to place a child 12 for adoption or with a guardian may be made concurrently with 13 making reasonable efforts as defined in this section . 14 Sec. 63. Section 232B.5, subsection 19, unnumbered 15 paragraph 1, Code 2025, is amended to read as follows: 16 A party seeking an involuntary foster care placement of 17 or termination of parental rights over an Indian child shall 18 provide evidence to the court that active efforts have been 19 made to provide remedial services and rehabilitative programs 20 designed to prevent the breakup of the Indian family and that 21 these efforts have proved unsuccessful. The court shall not 22 order the placement or termination, unless the evidence of 23 active efforts shows there has been a vigorous and concerted 24 level of casework beyond the level that typically constitutes 25 reasonable efforts as defined in sections 232.57 and 232.102 26 232.102A . Reasonable efforts shall not be construed to be 27 active efforts. The active efforts must be made in a manner 28 that takes into account the prevailing social and cultural 29 values, conditions, and way of life of the Indian childs 30 tribe. Active efforts shall utilize the available resources 31 of the Indian childs extended family, tribe, tribal and 32 other Indian social service agencies, and individual Indian 33 caregivers. Active efforts shall include but are not limited 34 to all of the following: 35 -32- LSB 1457HV (4) 91 dg/ko 32/ 38
H.F. 833 Sec. 64. Section 233.2, subsection 5, Code 2025, is amended 1 to read as follows: 2 5. Reasonable efforts, as defined in section 232.102 3 232.102A , that are made in regard to the newborn infant shall 4 be limited to the efforts made in a timely manner to finalize a 5 permanency plan for the newborn infant. 6 Sec. 65. Section 237.3, subsection 7, Code 2025, is amended 7 to read as follows: 8 7. If an agency is accredited by the joint commission on 9 the accreditation of health care organizations under the joint 10 commissions consolidated standards for residential settings 11 or by the council on accreditation of services for families 12 and children , the department shall modify facility licensure 13 standards applied to the agency in order to avoid duplicating 14 standards applied through accreditation. 15 EXPLANATION 16 The inclusion of this explanation does not constitute agreement with 17 the explanations substance by the members of the general assembly. 18 This bill relates to services and support for youth and is 19 organized by divisions. 20 DIVISION I TREATMENT, PHYSICAL ASSESSMENTS, AND 21 BEHAVIORAL HEALTH EVALUATIONS. Under current law, a 22 psychiatric medical institution for children (PMIC) is an 23 institution providing more than 24 hours of continuous care 24 involving long-term psychiatric services to 3 or more children 25 in residence for expected periods of 14 days or more for 26 diagnosis and evaluation, or for expected periods of 90 days 27 or more for treatment. 28 The bill exempts PMICs from licensing requirements for 29 maintaining or conducting programs with the primary purpose 30 of treating and rehabilitating persons with a substance use 31 disorder. 32 The bill defines approved qualifying organization as 33 the joint commission, the commission on the accreditation of 34 rehabilitation facilities, the council on accreditation, or a 35 -33- LSB 1457HV (4) 91 dg/ko 33/ 38
H.F. 833 nationally recognized accrediting organization with standards 1 comparable to the joint commission and commission on the 2 accreditation of rehabilitation facilities that are acceptable 3 under federal regulations. 4 The bill defines mental health disorder as a mental 5 disorder as defined in the most recent version of the 6 diagnostic and statistical manual of mental disorders published 7 by the American psychiatric association, or a mental disorder 8 as defined in the most recent version of the international 9 classification of diseases published by the world health 10 organization. 11 The bill defines protective locked environment as a 12 setting that prevents egress from a building or grounds as a 13 protective measure to ensure safety and security. 14 The bill defines record check evaluation system as the 15 record check evaluation system of HHS used to perform child and 16 dependent adult abuse record checks and to evaluate criminal 17 history and abuse records. 18 The bill defines serious emotional disturbance as a 19 diagnosable disorder of sufficient duration to meet diagnostic 20 criteria specified within the most current diagnostic and 21 statistical manual of mental disorders published by the 22 American psychiatric association that results in a functional 23 impairment. Serious emotional disturbance does not include a 24 substance use disorder or developmental disorder unless such 25 disorder co-occurs with such diagnosable mental, behavioral, 26 or emotional disorder. 27 The bill defines substance use disorder as a diagnosable 28 substance use disorder of sufficient duration to meet 29 diagnostic criteria specified within the most current 30 diagnostic and statistical manual of mental disorders published 31 by the American psychiatric association that results in a 32 functional impairment. 33 The bill defines youth as a person who is less than 21 34 years of age. 35 -34- LSB 1457HV (4) 91 dg/ko 34/ 38
H.F. 833 The bill describes the nature of care a PMIC must offer youth 1 with a serious emotional disturbance (SED), a substance use 2 disorder (SUD), or both. 3 Under current law, a person who establishes a PMIC must 4 also hold a license under Code chapter 237 (child foster 5 care facilities) as a comprehensive residential facility for 6 children, or hold a license under Code chapter 125 (substance 7 use disorders) if the facility provides SUD treatment. The 8 bill eliminates the requirement that a PMIC holds either 9 of these additional licenses, and instead requires that an 10 applicant for a PMIC license specify whether the applicant will 11 provide SED services, SUD services, or both. A PMIC may only 12 provide services for which it is licensed. 13 The bill eliminates the requirement that a proposed PMIC be 14 under the direction of an agency which has previously operated 15 a facility for children or adolescents and meets or exceeds 16 requirements for licensure as a comprehensive residential 17 facility for children. 18 The bill requires the department of inspections, appeals 19 and licensing (DIAL), in cooperation with the department of 20 health and human services (HHS), to adopt rules relating to the 21 application of a protective locked environment in a PMIC. 22 Under current law, following the hospitalization hearing 23 on an involuntary commitment petition, if the court finds 24 by clear and convincing evidence that the respondent has a 25 serious mental impairment, the court shall order the respondent 26 committed for a complete psychiatric evaluation and appropriate 27 treatment. The chief medical officer (CMO) of the hospital or 28 facility at which a respondent is committed must report to the 29 court no more than 15 days after the date the respondent is 30 placed, making a recommendation for disposition of the matter. 31 The bill allows a court to place a minor respondent in a public 32 hospital and allows a CMO of the hospital no more than 30 33 days after the date the minor respondent is placed to make a 34 recommendation for disposition of the matter. 35 -35- LSB 1457HV (4) 91 dg/ko 35/ 38
H.F. 833 The bill defines behavioral health evaluation as a 1 comprehensive evaluation of a persons mental and behavioral 2 health by a person licensed under Code chapter 154B 3 (psychology), 154C (social work), or 154D (behavioral science) 4 for purposes including but not limited to identifying a 5 possible behavioral health condition. 6 The bill defines physical assessment as direct physical 7 touching, viewing, and medically necessary manipulation of any 8 area of a childs body by a licensed physician. 9 The bill replaces several references to a physical or mental 10 examination with references to a physical assessment (PA) or 11 behavioral health evaluation (BHE) and replaces references to a 12 persons abuse of alcohol or other controlled substances with 13 references to the person having a behavioral health condition. 14 Under current law, one of several specific circumstances 15 must exist before a juvenile court has the authority to enter 16 an ex parte order to direct a peace officer or a juvenile court 17 officer to take custody of a child before or after the filing 18 of a petition under Code chapter 232 (juvenile justice). The 19 bill adds the circumstance when the childs parent, guardian, 20 or legal custodian consents to the removal as a condition that 21 would permit a juvenile court to enter such an ex parte order. 22 The bill creates similar provisions for when a juvenile court 23 may enter an ex parte order for a child to undergo an inpatient 24 PA or an inpatient BHE and when a person authorized to conduct 25 a preliminary investigation in response to a complaint 26 may motion to ask the court to order a child to undergo an 27 inpatient PA or an inpatient BHE. 28 The bill authorizes a court, after a dispositional hearing, 29 to order a male child in a child in need of assistance (CINA) 30 proceeding or a family in need of assistance (FINA) proceeding 31 to receive an inpatient PA, an inpatient BHE, or both, at the 32 state training school (STS). A request for the use of the STS 33 for purposes of a PA or BHE must be approved by the director of 34 HHS. A child ordered to the STS pursuant to a CINA proceeding 35 -36- LSB 1457HV (4) 91 dg/ko 36/ 38
H.F. 833 or a FINA proceeding must be separated at all times from 1 children placed in the STS pursuant to a juvenile delinquency 2 proceeding. Under current law, the court in a CINA or FINA 3 proceeding is prohibited from placing a child in the STS for 4 any reason. 5 The bill exempts a PMIC from licensing requirements for 6 child foster care. 7 The bill defines protective locked environment as a 8 setting that prevents egress from a building or grounds as a 9 protective measure to ensure safety and security. The bill 10 directs HHS and DIAL to adopt rules relating to the application 11 of a protective locked environment to child foster care 12 licensees. 13 The bill directs HHS and DIAL to coordinate in developing 14 rules related to this division of the bill. The bill outlines 15 goals and considerations each department must take into account 16 while adopting such rules. 17 The bill makes conforming changes to Code chapters 135H 18 (psychiatric medical institutions for children) and 232 19 (juvenile justice). The bill repeals 2024 Iowa Acts, chapter 20 1161, sections 97 and 98. 21 DIVISION II HOME AND COMMUNITY-BASED SERVICES 22 HABILITATION SERVICES PROVIDED BY A RESIDENTIAL PROGRAM 23 EXCLUSION FROM CHILDRENS RESIDENTIAL FACILITY DEFINITION. The 24 bill excludes care furnished to persons 16 years of age or 25 older by certain residential programs detailed in the bill from 26 the definition of a childrens residential facility. 27 DIVISION III DIRECTOR OF JUVENILE COURT SERVICES 28 CHIEF JUVENILE COURT OFFICERS. Under current law, the chief 29 juvenile court officers are appointed, terminated for cause, 30 and otherwise act under the direction and supervision of the 31 chief judge for the judicial district in which the chief 32 juvenile court officer was appointed. The bill transfers the 33 chief judges authority over chief juvenile court officers to 34 the director of juvenile court services. 35 -37- LSB 1457HV (4) 91 dg/ko 37/ 38
H.F. 833 DIVISION IV HAWKI ELIGIBILITY PUBLIC INSTITUTION 1 INMATES. The bill defines public institution to mean the 2 same as defined in 42 C.F.R. 435.1010. 3 Current law does not permit a child who is an inmate in a 4 public institution to be eligible for the Hawki program. The 5 bill requires HHS to suspend, but not terminate, Hawki program 6 eligibility for a child in a public institution if the child 7 is otherwise eligible for the Hawki program except for the 8 childs status as an inmate, the child was enrolled in the 9 Hawki program at the time the child was committed to the public 10 institution, and 30 calendar days have elapsed since the date 11 the child was committed to the public institution. A childs 12 suspension of Hawki benefits must continue for the duration of 13 the childs commitment to a public institution. 14 The bill requires the public institution to which a child 15 is committed and HHS to provide monthly reports and expedite 16 the restoration of the childs Hawki benefits upon the childs 17 discharge from the public institution. The bill requires HHS 18 to adopt rules to administer the bills provisions related to 19 Hawki benefits for children committed to a public institution. 20 DIVISION V CORRECTIVE CHANGES. The bill updates 21 references to certain accrediting organizations through the 22 Code, corrects a reference throughout the Code related to 23 the citation for the definition of reasonable efforts, 24 and changes the term legal custodian to the defined term 25 custodian. 26 -38- LSB 1457HV (4) 91 dg/ko 38/ 38