Senate File 474 - Introduced SENATE FILE 474 BY COMMITTEE ON HEALTH AND HUMAN SERVICES (SUCCESSOR TO SSB 1120) 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 1457SV (6) 91 dg/ko
S.F. 474 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 1457SV (6) 91 dg/ko 1/ 39
S.F. 474 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 1457SV (6) 91 dg/ko 2/ 39
S.F. 474 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 mental, behavioral, or emotional disorder of sufficient 14 duration to meet diagnostic criteria specified within the most 15 current diagnostic and statistical manual of mental disorders 16 published by the American psychiatric association that results 17 in a functional impairment. Serious emotional disturbance 18 does not include a substance use disorder or developmental 19 disorder unless such disorder co-occurs with such a diagnosable 20 mental, behavioral, or 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 1457SV (6) 91 dg/ko 3/ 39
S.F. 474 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 1457SV (6) 91 dg/ko 4/ 39
S.F. 474 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 1457SV (6) 91 dg/ko 5/ 39
S.F. 474 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 1457SV (6) 91 dg/ko 6/ 39
S.F. 474 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 f. (1) If the applicant will provide serious emotional 10 disturbance services, the applicant meets or exceeds the 11 requirements for a license under section 237.3, subsection 2, 12 paragraph a , as a comprehensive residential facility for 13 children. 14 (2) If the applicant will provide substance use disorder 15 services, the applicant meets or exceeds the requirements for a 16 license under section 125.13. 17 4. The department of health and human services may give 18 approval to approve a conversion of beds approved under 19 subsection 2 , to if the beds which are specialized to provide 20 substance use disorder treatment. However, the total number of 21 beds approved under subsection 2 and this subsection shall not 22 exceed four hundred thirty , unless approved for good cause by 23 the director pursuant to subsection 2 . Beds The limitations 24 on the number of beds under this section shall not apply to 25 beds for children youth who do not reside in this state and 26 whose service costs are not paid by public funds in this state 27 are not subject to the limitations on the number of beds 28 requirements otherwise applicable under this section . 29 5. A psychiatric institution licensed prior to July 1, 1999, 30 may exceed the number of beds authorized under subsection 2 31 if the excess beds are used to provide services funded from 32 a source other than the medical assistance program under 33 chapter 249A . Notwithstanding subsection 1 , paragraph d , and 34 subsection 2 , the provision of services using those excess beds 35 -7- LSB 1457SV (6) 91 dg/ko 7/ 39
S.F. 474 does not require a review by the department of health and human 1 services. 2 Sec. 7. Section 135H.7, subsection 2, paragraph a, Code 3 2025, is amended to read as follows: 4 a. If a person who has been convicted of a crime or has a 5 record of founded child abuse is being considered for licensure 6 under this chapter , or for employment with a psychiatric 7 institution involving direct responsibility for a child youth 8 or with access to a child youth when the child youth is alone, 9 by a licensed psychiatric institution, or if a person will 10 reside residence in a facility utilized by a licensee, and if 11 the person has been convicted of a crime or has a record of 12 founded child abuse, the record check evaluation system and 13 the licensee for an employee of the licensee considering the 14 person for employment shall perform an evaluation to determine 15 whether the crime or founded child abuse warrants prohibition 16 of licensure, employment, or residence in the facility utilized 17 by a licensee . The record check evaluation system of the 18 department of health and human services shall conduct criminal 19 and child abuse record checks in this state and may conduct 20 these checks in other states. The record check evaluation 21 shall be performed in accordance with procedures adopted for 22 this purpose by the department of health and human services. 23 Sec. 8. NEW SECTION . 135H.7A Protective locked environment 24 rules. 25 The department, in cooperation with the department of health 26 and human services, shall adopt rules pursuant to chapter 17A 27 relating to the application of a protective locked environment 28 in a psychiatric medical institution for children. 29 Sec. 9. Section 135H.10, subsection 2, Code 2025, is amended 30 to read as follows: 31 2. This chapter shall not be construed as prohibiting 32 the use of to prohibit funds appropriated for foster care to 33 from being used to provide payment to a psychiatric medical 34 institution for children for the financial participation 35 -8- LSB 1457SV (6) 91 dg/ko 8/ 39
S.F. 474 required of a child youth whose foster care placement is in a 1 psychiatric medical institution for children. In accordance 2 with established policies and procedures for foster care, the 3 department of health and human services shall act to recover 4 any such payment for financial participation, apply to be named 5 payee for the childs youths unearned income, and recommend 6 parental liability for the costs of a court-ordered foster care 7 placement in a psychiatric medical institution. 8 Sec. 10. Section 135H.13, subsection 1, Code 2025, is 9 amended to read as follows: 10 1. The departments final findings and the survey findings 11 of the joint commission on the accreditation of health care 12 organizations an approved qualifying organization regarding 13 licensure or program accreditation shall be made available 14 to the public in a readily available form and place. Other 15 information relating to the psychiatric institution is 16 confidential and shall not be made available to the public 17 except in proceedings a proceeding involving licensure, a 18 civil suit involving a resident, or an administrative action 19 involving a resident. 20 Sec. 11. Section 229.13, subsection 1, paragraph c, Code 21 2025, is amended to read as follows: 22 c. (1) If the court orders evaluation and treatment of 23 the respondent on an inpatient basis under this section , the 24 court may order the respondent placed under the care of an 25 appropriate subacute care facility licensed under chapter 135G . 26 (2) If the court orders evaluation and treatment of a minor 27 respondent on an inpatient basis under this section, the court 28 may order the minor respondent placed under the care of an 29 appropriate public hospital. 30 Sec. 12. Section 229.13, subsection 5, Code 2025, is amended 31 to read as follows: 32 5. a. (1) The chief medical officer of the hospital or 33 facility at which the respondent is placed shall report to the 34 court and make a recommendation for disposition of the matter 35 -9- LSB 1457SV (6) 91 dg/ko 9/ 39
S.F. 474 no more than fifteen days after the date the respondent is 1 placed , making a recommendation for disposition of the matter 2 at the hospital or facility . An 3 (2) If the respondent is a minor and is placed under the 4 care of a public hospital pursuant to subsection 1, paragraph 5 c , subparagraph (2), the chief medical officer of the public 6 hospital shall report to the court and make a recommendation 7 for disposition no later than thirty calendar days after the 8 date the minor respondent is placed under the care of the 9 public hospital. 10 b. A copy of the chief medical officers report shall be 11 sent to the respondents attorney. 12 c. (1) Upon request, the court may grant the chief medical 13 officer an extension of time may be granted , not to exceed 14 seven days , upon a showing of cause. A copy of the report shall 15 be sent to the The respondents attorney , who may contest the 16 need for an extension of time if one is requested . An 17 (2) The court shall grant an extension of time shall be 18 granted upon request unless the request is contested, in which 19 case the court shall make such inquiry as it deems appropriate 20 and may either order the respondents release from the hospital 21 or facility , or grant an extension of time for psychiatric 22 evaluation. 23 d. If the chief medical officer fails to report to the 24 court within fifteen days after the individual is placed under 25 the care of the hospital or facility the time specified in 26 paragraph a , and an extension of time has not been requested 27 granted , the chief medical officer is guilty of contempt 28 and shall be punished under chapter 665. The court shall 29 order a rehearing on the application to determine whether the 30 respondent should continue to be detained at or placed under 31 the care of the hospital or facility. 32 Sec. 13. Section 229.14, subsection 2, paragraph e, Code 33 2025, is amended to read as follows: 34 e. (1) If the court orders placement and treatment of the 35 -10- LSB 1457SV (6) 91 dg/ko 10/ 39
S.F. 474 a respondent on an inpatient basis under this section , the 1 court may order the respondent placed under the care of an 2 appropriate subacute care facility licensed under chapter 135G . 3 (2) If the court orders placement and treatment of a minor 4 respondent on an inpatient basis under this section, the court 5 may order the minor respondent placed under the care of an 6 appropriate public hospital. 7 Sec. 14. Section 232.2, Code 2025, is amended by adding the 8 following new subsections: 9 NEW SUBSECTION . 3A. Behavioral health condition means 10 a serious emotional disturbance, a mental health disorder, 11 a substance abuse disorder, life stressors and crises, and 12 stress-related physical symptoms. 13 NEW SUBSECTION . 3B. Behavioral health evaluation means a 14 process used to assess an individuals behavioral health status 15 and functioning for purposes including but not limited to the 16 diagnosis of a behavioral health condition or to determine the 17 need for treatment or intervention. 18 NEW SUBSECTION . 38A. Mental health disorder means the 19 same as defined in section 135H.1. 20 NEW SUBSECTION . 48A. Physical assessment means 21 direct physical touching, viewing, and medically necessary 22 manipulation of any area of a childs body by a physician 23 licensed under chapter 148. 24 NEW SUBSECTION . 58A. Serious emotional disturbance means 25 the same as defined in section 135H.1. 26 NEW SUBSECTION . 64A. Substance use disorder means the 27 same as defined in section 125.2. 28 Sec. 15. Section 232.2, subsections 34 and 58, Code 2025, 29 are amended to read as follows: 30 34. Juvenile court social records or social records means 31 all records , other than official records, made with respect to 32 a child in connection with proceedings over which the court has 33 jurisdiction under this chapter other than official records and 34 includes but is not limited to the records made and compiled 35 -11- LSB 1457SV (6) 91 dg/ko 11/ 39
S.F. 474 by intake officers, predisposition reports, and reports of 1 physical assessments and mental examinations behavioral health 2 evaluations . 3 58. Secure facility means a physically restricting 4 facility in which children adjudicated to have committed 5 a delinquent act a child may be placed pursuant to a 6 dispositional order of the court. 7 Sec. 16. Section 232.8, subsection 4, Code 2025, is amended 8 to read as follows: 9 4. In a proceeding concerning a child who is alleged to 10 have committed a second delinquent act or a second violation 11 excluded from the jurisdiction of the juvenile court, the court 12 or the juvenile court shall determine whether there is reason 13 to believe that the child regularly abuses alcohol or other 14 controlled substance has a behavioral health condition and may 15 be in need of treatment. If the court so determines, the court 16 shall advise appropriate juvenile authorities and refer such 17 offenders to the juvenile court for disposition pursuant to 18 section 232.52A . 19 Sec. 17. Section 232.49, Code 2025, is amended to read as 20 follows: 21 232.49 Physical assessments and mental examinations 22 behavioral health evaluations juvenile delinquency . 23 1. a. Following Any time after the entry of an order 24 of adjudication under section 232.47 , the court may, after 25 a hearing which may be simultaneous with the adjudicatory 26 hearing , order a physical assessment or mental examination 27 behavioral health evaluation of a child if it the court finds 28 that an examination a physical assessment or a behavioral 29 health evaluation is necessary to determine the childs 30 physical condition or mental to determine if the child has a 31 behavioral health condition. 32 b. The court may consider chemical dependency as either 33 a physical condition or mental behavioral health condition 34 and may consider a chemical dependency evaluation as either a 35 -12- LSB 1457SV (6) 91 dg/ko 12/ 39
S.F. 474 physical assessment or mental examination behavioral health 1 evaluation . If the examination 2 c. A hearing to order a physical assessment or behavioral 3 health evaluation may be held at the same time as the 4 adjudicatory hearing. 5 2. Unless otherwise ordered by the court, if a physical 6 assessment or behavioral health evaluation indicates the child 7 has behaved in a manner that threatened the safety of another 8 person, has committed a violent act causing bodily injury to 9 another person, or has been a victim or perpetrator of sexual 10 abuse, unless otherwise ordered by the court, the childs 11 parent, guardian, or foster parent , or other person with 12 custody of the child shall be provided with that information. 13 2. 3. a. When possible an examination , a physical 14 assessment or behavioral health evaluation shall be conducted 15 on an outpatient basis , but . However, if deemed necessary by 16 the court, the court may , if it deems necessary commit order 17 the child to a suitable hospital, facility , or institution for 18 the purpose of examination an inpatient physical assessment or 19 an inpatient behavioral health evaluation . 20 b. Commitment for examination An inpatient physical 21 assessment or an inpatient behavioral health evaluation shall 22 not exceed thirty days and the civil commitment provisions of 23 chapter 229 shall not apply . 24 3. 4. a. At any Any time after the filing of a delinquency 25 petition , the court may order a physical assessment or mental 26 examination behavioral health evaluation of the child if all of 27 the following circumstances apply: 28 (1) The court finds such examination a physical assessment 29 or a behavioral health evaluation to be in the best interest 30 of the child ; and . 31 (2) The parent, guardian, or custodian and the childs 32 counsel agree to the physical assessment or behavioral health 33 evaluation . 34 b. (1) An examination A physical assessment or behavioral 35 -13- LSB 1457SV (6) 91 dg/ko 13/ 39
S.F. 474 health evaluation shall be conducted on an outpatient basis 1 unless the court, the childs counsel, and the childs 2 parent, guardian, or custodian agree that it is necessary the 3 child should be committed ordered to a suitable hospital, 4 facility, or institution for the purpose of examination an 5 inpatient physical assessment or an inpatient behavioral health 6 evaluation . Commitment for examination 7 (2) An inpatient physical assessment or inpatient 8 behavioral health evaluation shall not exceed thirty days and 9 the civil commitment provisions of chapter 229 shall not apply . 10 Sec. 18. Section 232.52A, subsection 1, Code 2025, is 11 amended to read as follows: 12 1. In addition to any other order of the juvenile court, 13 a person under age eighteen, child who may be in need of 14 treatment , as determined under section 232.8 , may be ordered 15 to participate in an alcohol or controlled substance education 16 or a physical assessment or behavioral health evaluation 17 program approved by the juvenile court. If recommended after 18 evaluation, the The court may also order the person child to 19 participate in a treatment program approved by the court if the 20 treatment program is recommended after the childs physical 21 assessment or behavioral health evaluation . The juvenile court 22 may also require the custodial parent or parents , or other 23 legal guardian , to participate in an educational program with 24 the person under age eighteen child if the court determines 25 that such participation is in the best interests of the person 26 under age eighteen child . 27 Sec. 19. Section 232.68, subsection 3, unnumbered paragraph 28 1, Code 2025, is amended to read as follows: 29 Confidential access to a child means access to a child, 30 during an assessment of an alleged act of child abuse, who is 31 alleged to be the victim of the child abuse , during a child 32 abuse assessment . The access may be accomplished by interview, 33 observation, or examination physical assessment of the child. 34 As used in this subsection and this part: 35 -14- LSB 1457SV (6) 91 dg/ko 14/ 39
S.F. 474 Sec. 20. Section 232.68, subsection 3, paragraph c, Code 1 2025, is amended by striking the paragraph. 2 Sec. 21. Section 232.69, subsection 3, paragraph b, Code 3 2025, is amended to read as follows: 4 b. A person required to make a report under subsection 1, 5 other than a physician whose professional practice does not 6 regularly involve providing primary health care to children, 7 shall complete the core training curriculum relating to 8 the identification and reporting of child abuse within six 9 months of initial employment or self-employment involving 10 the examination physical assessments or behavioral health 11 evaluations , or attending, counseling, or treatment of treating 12 children on a regular basis. Within one month of initial 13 employment or self-employment, the person shall obtain a 14 statement of the abuse reporting requirements from the persons 15 employer or, if self-employed, from the department. The person 16 shall complete the core training curriculum relating to the 17 identification and reporting of child abuse every three years. 18 Sec. 22. Section 232.71B, subsection 10, Code 2025, is 19 amended to read as follows: 20 10. Physical examination assessment . If the department 21 refers a child to a physician or physician assistant for a 22 physical examination assessment , the department shall contact 23 the physician or physician assistant regarding the examination 24 physical assessment within twenty-four hours of making the 25 referral. If the physician or physician assistant who performs 26 the examination upon referral by the department physical 27 assessment reasonably believes the child has been abused, the 28 physician or physician assistant shall report to the department 29 within twenty-four hours of performing the examination physical 30 assessment . 31 Sec. 23. Section 232.77, subsection 1, Code 2025, is amended 32 to read as follows: 33 1. a. A person who is required to report suspected 34 child abuse may take or perform, or may cause to be taken or 35 -15- LSB 1457SV (6) 91 dg/ko 15/ 39
S.F. 474 performed , at public expense, photographs, X rays, or other 1 physical examinations assessments, or other tests of a child 2 which would provide medical indication of allegations arising 3 from an assessment. 4 b. A health practitioner may, if medically indicated, 5 cause to be performed a radiological examination, physical 6 examination assessment , or other medical tests test of the 7 child. 8 c. A person who takes any photographs or X rays or 9 performs any physical examinations assessments or other tests 10 pursuant to this section shall notify the department that the 11 photographs or X rays have been taken or the examinations 12 physical assessments or other tests have been performed . The 13 person who made notification , and shall retain the photographs , 14 or X rays , or examination physical assessment or other test 15 findings for a reasonable time following the notification. 16 d. Whenever the person is required to report under section 17 232.69 , in that persons capacity as a member of the staff of 18 a medical or other private or public institution, agency or 19 facility, that person shall immediately notify the person in 20 charge of the institution, agency, or facility or that persons 21 designated delegate of the need for photographs , or X rays or 22 examinations , physical assessments, or other tests. 23 Sec. 24. Section 232.78, subsection 1, paragraph a, Code 24 2025, is amended to read as follows: 25 a. Any of the following circumstances exist: 26 (1) The person responsible for the care of the child 27 consents to the removal. 28 (2) The person responsible for the care of the child is 29 absent , or . 30 (3) The person responsible for the care of the child, though 31 present, was asked and refused to consent to the removal of the 32 child and was informed of an intent to apply for an order under 33 this section , or there . 34 (4) There is reasonable cause to believe that a request for 35 -16- LSB 1457SV (6) 91 dg/ko 16/ 39
S.F. 474 consent would further endanger the child , or there . 1 (5) There is reasonable cause to believe that a request for 2 consent will cause the parent, guardian, or legal custodian 3 person responsible for the care of the child to take flight 4 with the child. 5 Sec. 25. Section 232.78, subsection 1, paragraph c, 6 subparagraph (1), Code 2025, is amended to read as follows: 7 (1) The refusal or failure of the person responsible for 8 the care of the child to comply with the request of a peace 9 officer, juvenile court officer, or child protection worker 10 for such the person to obtain and provide to the requester 11 the results of a physical assessment or mental examination 12 behavioral health evaluation of the child. The request for a 13 physical examination assessment of the child may specify the 14 performance of a medically relevant test. 15 Sec. 26. Section 232.78, subsection 5, Code 2025, is amended 16 to read as follows: 17 5. The juvenile court, before or after the filing of a 18 petition under this chapter , may enter an ex parte order 19 authorizing a physician or physician assistant or hospital to 20 conduct an inpatient or outpatient physical examination or 21 authorizing a physician or physician assistant, a psychologist 22 certified under section 154B.7 , or a community mental health 23 center accredited pursuant to chapter 230A to conduct an 24 outpatient mental examination assessment or an inpatient or 25 outpatient behavioral health evaluation of a child if necessary 26 to identify the nature, extent, and cause of injuries to the 27 child as required by section 232.71B , provided all of the 28 following apply: 29 a. Any of the following circumstances exist: 30 (1) The childs parent, guardian, or custodian consents to 31 the physical assessment or the behavioral health evaluation. 32 (2) The childs parent, guardian, or legal custodian is 33 absent , or . 34 (3) The childs parent, guardian, or custodian, though 35 -17- LSB 1457SV (6) 91 dg/ko 17/ 39
S.F. 474 present, was asked and refused to provide written consent to 1 the examination physical assessment or the behavioral health 2 evaluation . 3 b. The juvenile court has entered an ex parte order 4 directing the removal of the child from the childs home or a 5 child care facility under this section. 6 c. There is not enough time to file a petition and to hold 7 a hearing as provided in section 232.98. 8 Sec. 27. Section 232.79, subsection 5, Code 2025, is amended 9 to read as follows: 10 5. When there has been an emergency removal or keeping of a 11 child without a court order, a physical examination assessment 12 of the child by a licensed medical practitioner shall be 13 performed within twenty-four hours of such the emergency 14 removal or keeping of a child , unless the child is returned 15 to the childs home within twenty-four hours of the emergency 16 removal or keeping of a child . 17 Sec. 28. Section 232.83, subsection 2, Code 2025, is amended 18 to read as follows: 19 2. Anyone authorized to conduct a preliminary investigation 20 in response to a complaint may apply for, or the court on its 21 own motion may enter, an ex parte order authorizing a physician 22 or physician assistant or hospital to conduct an inpatient or 23 outpatient physical examination or authorizing a physician or 24 physician assistant, a psychologist certified under section 25 154B.7 , or a community mental health center accredited pursuant 26 to chapter 230A to conduct an outpatient mental examination 27 of a child if necessary to identify the nature, extent, and 28 causes of any injuries, emotional damage, or other such needs 29 of a child as specified in section 232.96A, subsection 3, 5, or 30 6 , assessment or an inpatient or outpatient behavioral health 31 evaluation provided that all of the following apply: 32 a. Any of the following circumstances exist: 33 (1) The parent, guardian, or custodian consents to the 34 physical assessment or the behavioral health evaluation. 35 -18- LSB 1457SV (6) 91 dg/ko 18/ 39
S.F. 474 (2) The parent, guardian, or legal custodian is absent , or . 1 (3) The parent, guardian, or custodian, though present, 2 was asked and refused to authorize the examination physical 3 assessment or the behavioral health evaluation . 4 b. There is not enough time to file a petition and hold a 5 hearing under this chapter. 6 c. The parent, guardian, or legal custodian has not provided 7 care and treatment related to their the childs alleged 8 victimization. 9 Sec. 29. Section 232.98, Code 2025, is amended to read as 10 follows: 11 232.98 Physical and mental examinations assessments and 12 behavioral health evaluations child in need of assistance . 13 1. a. Except as provided in section 232.78, subsection 5 , 14 a physical assessment or mental examination behavioral health 15 evaluation of the a child may be ordered only after the filing 16 of a petition pursuant to section 232.87 , and after a hearing 17 to determine whether an examination a physical assessment 18 or behavioral health evaluation is necessary to determine 19 the childs physical condition or mental if the child has a 20 behavioral health condition. 21 b. The court may consider chemical dependency as either 22 a physical or mental behavioral health condition and may 23 consider a chemical dependency evaluation as either a physical 24 assessment or mental examination behavioral health evaluation . 25 a. c. The hearing required by this section may be held 26 simultaneously with the adjudicatory hearing. 27 b. d. An examination A physical assessment or a behavioral 28 health evaluation ordered prior to the adjudication shall 29 be conducted on an outpatient basis when possible , but . 30 However, if deemed necessary by the court, the court may 31 commit order the child to a suitable nonsecure hospital, 32 facility, or institution for the purpose of examination an 33 inpatient physical assessment or an inpatient behavioral health 34 evaluation for a period not to exceed fifteen thirty days if 35 -19- LSB 1457SV (6) 91 dg/ko 19/ 39
S.F. 474 all of the following are found to be present circumstances 1 exist : 2 (1) Probable cause exists to believe that the child is 3 a child in need of assistance pursuant to section 232.96A, 4 subsection 5 or 6 . 5 (2) Commitment An inpatient physical assessment or 6 inpatient behavioral health evaluation is necessary to 7 determine whether there is clear and convincing evidence that 8 the child is a child in need of assistance. 9 (3) The childs attorney agrees to the commitment an 10 inpatient physical assessment or inpatient behavioral health 11 evaluation . 12 c. e. An examination A physical assessment or a behavioral 13 health evaluation ordered after the adjudication shall 14 be conducted on an outpatient basis when possible , but . 15 However, if deemed necessary by the court, the court may 16 commit order the child to a suitable nonsecure hospital, 17 facility, or institution for the purpose of examination an 18 inpatient physical assessment or an inpatient behavioral health 19 evaluation for a period not to exceed thirty days. 20 d. f. The childs parent, guardian, or custodian shall 21 be included in counseling sessions offered during the childs 22 stay in a hospital, facility, or institution when feasible, and 23 when in the best interests of the child and the childs parent, 24 guardian, or custodian. If separate counseling sessions are 25 conducted for the child and the childs parent, guardian, or 26 custodian, a joint counseling session shall be offered prior 27 to the release of the child from the hospital, facility, or 28 institution. The court shall require that notice be provided 29 to the childs guardian ad litem of the counseling sessions , 30 and of the counseling session participants , and results the 31 outcomes of the counseling sessions. 32 2. Following an adjudication that a child is a child in 33 need of assistance, the court may , after a hearing , order the 34 a physical assessment or mental examination behavioral health 35 -20- LSB 1457SV (6) 91 dg/ko 20/ 39
S.F. 474 evaluation of the childs parent, guardian, or custodian if 1 that persons ability to care for the child is at issue. 2 Sec. 30. Section 232.102, subsection 5, Code 2025, is 3 amended to read as follows: 4 5. a. The child shall not be placed in the state training 5 school. 6 b. (1) Paragraph a shall not preclude the departments 7 use of the facilities of the state training school for the 8 purposes of conducting a physical assessment, a behavioral 9 health evaluation, or both, as described in section 232.98, of 10 a male child for a period not to exceed thirty days. Such use 11 of the facilities of the state training school shall be subject 12 to the directors authorization and approval for any request to 13 obtain a court order for these purposes. Following review of 14 the authorized and approved departmental request, the court may 15 order such use of the facilities of the state training school. 16 (2) A male child temporarily located at the state training 17 school pursuant to subparagraph (1) shall at all times be 18 separated from children adjudicated to have committed a 19 delinquent act who are placed at the state training school. 20 (3) The department shall adopt rules pursuant to chapter 17A 21 to administer this paragraph. 22 Sec. 31. Section 232.127, subsection 7, Code 2025, is 23 amended to read as follows: 24 7. a. The court may not order the child placed on 25 probation, in a foster home or in a nonsecure facility unless 26 the child requests and agrees to such supervision or placement. 27 In no event shall the 28 b. The court shall not order the child placed in a secure 29 facility or in the state training school or other secure 30 facility . 31 c. (1) Paragraph b shall not preclude the departments 32 use of the facilities of the state training school for the 33 purposes of conducting a physical assessment, a behavioral 34 health evaluation, or both, as described in section 232.98, of 35 -21- LSB 1457SV (6) 91 dg/ko 21/ 39
S.F. 474 a male child for a period not to exceed thirty days. Such use 1 of the facilities of the state training school shall be subject 2 to the directors authorization and approval for any request to 3 obtain a court order for these purposes. Following review of 4 the authorized and approved departmental request, the court may 5 order such use of the facilities of the state training school. 6 (2) A male child temporarily located at the state training 7 school pursuant to subparagraph (1) shall at all times be 8 separated from children adjudicated to have committed a 9 delinquent act who are placed at the state training school. 10 (3) The department shall adopt rules pursuant to chapter 17A 11 to administer this paragraph. 12 Sec. 32. Section 232.141, subsection 1, Code 2025, is 13 amended to read as follows: 14 1. Except as otherwise provided by law, the court shall 15 inquire into the ability of the child or the childs parent 16 to pay expenses incurred pursuant to subsections 2, 4, and 17 8 . After giving the parent a reasonable opportunity to be 18 heard, the court may order the parent to pay all or part of the 19 costs of the childs care, examination physical assessment, 20 behavioral health evaluation , treatment, legal expenses, or 21 other expenses. An order entered under this section does not 22 obligate a parent paying child support under a custody decree, 23 except that part of the monthly support payment may be used to 24 satisfy the obligations imposed by the order entered pursuant 25 to this section . If a parent fails to pay as ordered, without 26 good reason, the court may proceed against the parent for 27 contempt and may inform the county attorney who shall proceed 28 against the parent to collect the unpaid amount. Any payment 29 ordered by the court shall be a judgment against each of the 30 childs parents and a lien as provided in section 624.23 . If 31 all or part of the amount that the parents are ordered to pay is 32 subsequently paid by the county or state, the judgment and lien 33 shall thereafter be against each of the parents in favor of the 34 county to the extent of the countys payments and in favor of 35 -22- LSB 1457SV (6) 91 dg/ko 22/ 39
S.F. 474 the state to the extent of the states payments. 1 Sec. 33. Section 232.141, subsection 4, paragraph b, Code 2 2025, is amended to read as follows: 3 b. Expenses for mental or physical examinations assessments 4 or behavioral health evaluations of a child if ordered by the 5 court. 6 Sec. 34. Section 232.141, subsection 6, Code 2025, is 7 amended to read as follows: 8 6. If a child is given A physical or mental examinations 9 assessment, behavioral health evaluation, or any treatment 10 relating to an assessment performed pursuant to section 11 232.71B , shall be paid by the state if physical assessment, 12 behavioral health evaluation, or other treatment was performed 13 with the consent of the childs parent, guardian, or legal 14 custodian and no other provision of law otherwise requires 15 payment for the costs of the examination and treatment, the 16 costs shall be paid by the state . Reimbursement for The 17 department shall reimburse costs of services described in under 18 this subsection is subject to in accordance with subsection 5 . 19 Sec. 35. Section 237.1, Code 2025, is amended by adding the 20 following new subsection: 21 NEW SUBSECTION . 8A. Protective locked environment means a 22 setting that prevents egress from a building or grounds as a 23 protective measure to ensure safety and security. 24 Sec. 36. Section 237.3, Code 2025, is amended by adding the 25 following new subsection: 26 NEW SUBSECTION . 13. The department shall adopt rules 27 pursuant to chapter 17A relating to the application of a 28 protective locked environment to child foster care licensees. 29 Sec. 37. Section 237.4, Code 2025, is amended by adding the 30 following new subsection: 31 NEW SUBSECTION . 9. A psychiatric medical institution for 32 children licensed under chapter 135H. 33 Sec. 38. Section 237C.1, Code 2025, is amended by adding the 34 following new subsection: 35 -23- LSB 1457SV (6) 91 dg/ko 23/ 39
S.F. 474 NEW SUBSECTION . 5. Protective locked environment means a 1 setting that prevents egress from a building or grounds as a 2 protective measure to ensure safety and security. 3 Sec. 39. Section 237C.4, Code 2025, is amended by adding the 4 following new subsection: 5 NEW SUBSECTION . 6A. Rules governing the application of 6 a protective locked environment to a childrens residential 7 facility shall be adopted by the department. 8 Sec. 40. DEPARTMENT OF HEALTH AND HUMAN SERVICES 9 DEPARTMENT OF INSPECTIONS, APPEALS, AND LICENSING 10 ADMINISTRATIVE RULES. 11 1. The department of health and human services and the 12 department of inspections, appeals, and licensing shall each 13 adopt rules pursuant to chapter 17A to administer this division 14 of this Act. The departments shall coordinate in developing 15 their respective rules to provide continuity for, and maximize 16 utilization of the array of behavioral health services 17 available by, affected individuals. 18 2. a. The department of health and human services and 19 the department of inspections, appeals, and licensing shall 20 review applicable existing rules and shall each adopt rules 21 pursuant to chapter 17A to provide for the following relative 22 to facilities licensed or certified under chapters 135H, 237, 23 and 237C: 24 (1) Consistency to the greatest extent possible regarding 25 the use of restraints and seclusion across these facilities. 26 (2) Adaptation in application of licensing and 27 certification requirements to provide for the unmet residential 28 care needs of affected individuals. 29 b. In reviewing and adopting the rules, the departments 30 shall consider the nature of the services and programming 31 provided by the specific type of facility and applicable 32 federal requirements, including those for psychiatric 33 residential treatment facilities as described in 42 C.F.R. 34 483.352. 35 -24- LSB 1457SV (6) 91 dg/ko 24/ 39
S.F. 474 3. The department of health and human services shall adopt 1 rules pursuant to chapter 17A relating to the application of 2 a protective locked environment to detention and shelter care 3 as defined in section 232.2. For purposes of this subsection, 4 protective locked environment means a setting that prevents 5 egress from a building or grounds as a protective measure to 6 ensure safety and security. 7 Sec. 41. REVIEW OF YOUTH SYSTEMS, SERVICES, AND SUPPORTS. 8 1. The department of health and human services shall convene 9 representatives of the department of health and human services, 10 the courts and practitioners involved in civil commitment and 11 juvenile justice proceedings, law enforcement and corrections, 12 hospital systems, service providers, and individuals with lived 13 experience and their families to review the systems and related 14 services and supports for youth, including but not limited to 15 the civil commitment and treatment provisions under chapters 16 125 and 229, and the juvenile delinquency and child in need of 17 assistance provisions under chapter 232. 18 2. The primary goal of the review is to facilitate and 19 enhance the interplay of the multidimensional aspects of the 20 systems, services, and supports for youth and the work of 21 the relevant stakeholders to ensure accessible and effectual 22 processes, procedures, protections, and services for affected 23 youth. 24 3. The department of health and human services shall report 25 the reviews findings and recommendations to the governor and 26 the general assembly by October 1, 2025. 27 Sec. 42. REPEAL. 2024 Iowa Acts, chapter 1161, sections 97 28 and 98, are repealed. 29 DIVISION II 30 HOME AND COMMUNITY-BASED SERVICES HABILITATION SERVICES 31 PROVIDED BY A RESIDENTIAL PROGRAM EXCLUSION FROM CHILDRENS 32 RESIDENTIAL FACILITY DEFINITION 33 Sec. 43. Section 237C.1, subsection 2, Code 2025, is amended 34 by adding the following new paragraph: 35 -25- LSB 1457SV (6) 91 dg/ko 25/ 39
S.F. 474 NEW PARAGRAPH . j. Care furnished to persons sixteen 1 years of age and older by a residential program to which the 2 department applies accreditation, certification, or standards 3 of review under the provisions of a federally approved medical 4 assistance home and community-based services waiver, or other 5 provision of the medical assistance program. Care furnished 6 to persons under eighteen years of age shall be provided in 7 settings separate from individuals over the age of twenty-one 8 as specified by the department by rule. 9 DIVISION III 10 DIRECTOR OF JUVENILE COURT SERVICES CHIEF JUVENILE COURT 11 OFFICERS 12 Sec. 44. Section 602.1101, Code 2025, is amended by adding 13 the following new subsection: 14 NEW SUBSECTION . 5A. Director of juvenile court services 15 means the same as defined in the Iowa court rules of juvenile 16 court services directed programs as prescribed by the supreme 17 court and includes the deputy director of juvenile court 18 services. 19 Sec. 45. 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 -26- LSB 1457SV (6) 91 dg/ko 26/ 39
S.F. 474 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. 46. 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. 47. Section 602.7202, subsection 1, Code 2025, is 24 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 DIVISION IV 32 HAWKI ELIGIBILITY PUBLIC INSTITUTION INMATES 33 Sec. 48. Section 514I.8, subsection 2, paragraph g, Code 34 2025, is amended to read as follows: 35 -27- LSB 1457SV (6) 91 dg/ko 27/ 39
S.F. 474 g. Is not an inmate of a public institution or a patient in 1 an institution for mental diseases. 2 Sec. 49. NEW SECTION . 514I.8B Inmates of public 3 institutions suspension of medical assistance. 4 1. Following the first thirty days of commitment, the 5 department shall suspend, but not terminate, the eligibility of 6 an eligible child who is an inmate of a public institution as 7 defined in 42 C.F.R. 435.1010, who is enrolled in the medical 8 assistance program under this chapter at the time of commitment 9 to the public institution, and who remains eligible for medical 10 assistance under this chapter except for the eligible childs 11 institutional status, during the entire period of the eligible 12 childs commitment to the public institution. 13 2. To the extent applicable, the public institution and the 14 department shall comply with the reporting requirements and the 15 expediting of the restoration of an eligible childs medical 16 assistance benefits under this chapter upon the eligible 17 childs discharge, consistent with section 249A.38. 18 3. The department shall adopt rules pursuant to chapter 17A 19 to administer this section. 20 DIVISION V 21 CORRECTIVE CHANGES 22 Sec. 50. Section 125.13, subsection 2, paragraphs a, i, and 23 j, Code 2025, are amended to read as follows: 24 a. A hospital providing care or treatment to persons with 25 a substance use disorder licensed under chapter 135B which is 26 accredited by the joint commission on the accreditation of 27 health care organizations , the commission on accreditation 28 of rehabilitation facilities, the American osteopathic 29 association, or another recognized organization approved by 30 the department. All survey reports from the accrediting or 31 licensing body must be sent to the department. 32 i. A substance use disorder treatment program not funded 33 by the department which is accredited or licensed by the joint 34 commission on the accreditation of health care organizations , 35 -28- LSB 1457SV (6) 91 dg/ko 28/ 39
S.F. 474 the commission on the accreditation of rehabilitation 1 facilities, the American osteopathic association, or another 2 recognized organization approved by the department. All survey 3 reports from the accrediting or licensing body must be sent to 4 the department. 5 j. A hospital substance use disorder treatment program 6 that is accredited or licensed by the joint commission on the 7 accreditation of health care organizations , the commission on 8 the accreditation of rehabilitation facilities, the American 9 osteopathic association, or another recognized organization 10 approved by the department. All survey reports for the 11 hospital substance use disorder treatment program from the 12 accrediting or licensing body shall be sent to the department. 13 Sec. 51. Section 125.43A, Code 2025, is amended to read as 14 follows: 15 125.43A Prescreening exception. 16 Except in cases of medical emergency or court-ordered 17 admissions, a person shall be admitted to a state mental 18 health institute for treatment of a substance use disorder 19 only after a preliminary intake and assessment by a 20 department-licensed treatment facility or a hospital providing 21 care or treatment for persons with a substance use disorder 22 licensed under chapter 135B and accredited by the joint 23 commission on the accreditation of health care organizations , 24 the commission on accreditation of rehabilitation facilities, 25 the American osteopathic association, or another recognized 26 organization approved by the department, or by a designee of 27 a department-licensed treatment facility or a hospital other 28 than a state mental health institute, which confirms that the 29 admission is appropriate to the persons substance use disorder 30 service needs. A county board of supervisors may seek an 31 admission of a patient to a state mental health institute who 32 has not been confirmed for appropriate admission and the county 33 shall be responsible for one hundred percent of the cost of 34 treatment and services of the patient. 35 -29- LSB 1457SV (6) 91 dg/ko 29/ 39
S.F. 474 Sec. 52. Section 135B.12, Code 2025, is amended to read as 1 follows: 2 135B.12 Confidentiality. 3 The departments final findings or the final survey findings 4 of the joint commission on the accreditation of health care 5 organizations or the American osteopathic association with 6 respect to compliance by a hospital or rural emergency hospital 7 with requirements for licensing or accreditation shall be made 8 available to the public in a readily available form and place. 9 Other information relating to a hospital or rural emergency 10 hospital obtained by the department which does not constitute 11 the departments findings from an inspection of the hospital 12 or rural emergency hospital or the final survey findings of 13 the joint commission on the accreditation of health care 14 organizations or the American osteopathic association shall 15 not be made available to the public, except in proceedings 16 involving the denial, suspension, or revocation of a license 17 under this chapter . The name of a person who files a complaint 18 with the department shall remain confidential and shall not 19 be subject to discovery, subpoena, or other means of legal 20 compulsion for its release to a person other than department 21 employees or agents involved in the investigation of the 22 complaint. 23 Sec. 53. Section 135B.20, subsection 4, Code 2025, is 24 amended to read as follows: 25 4. Joint conference committee shall mean the joint 26 conference committee as required by the joint commission on 27 accreditation of health care organizations or, in a hospital 28 having no such committee, a similar committee, an equal number 29 of which shall be members of the medical staff selected by the 30 staff and an equal number of which shall be selected by the 31 governing board of the hospital. 32 Sec. 54. Section 135C.2, subsection 7, Code 2025, is amended 33 to read as follows: 34 7. The rules adopted by the department regarding nursing 35 -30- LSB 1457SV (6) 91 dg/ko 30/ 39
S.F. 474 facilities shall provide that a nursing facility may choose 1 to be inspected either by the department or by the joint 2 commission on accreditation of health care organizations . 3 The rules regarding acceptance of inspection by the joint 4 commission on accreditation of health care organizations shall 5 include recognition, in lieu of inspection by the department, 6 of comparable inspections and inspection findings of the joint 7 commission on accreditation of health care organizations , 8 if the department is provided with copies of all requested 9 materials relating to the inspection process. 10 Sec. 55. Section 135C.6, subsection 10, Code 2025, is 11 amended to read as follows: 12 10. Notwithstanding section 135C.9 , nursing facilities 13 which are accredited by the joint commission on accreditation 14 of health care organizations shall be licensed without 15 inspection by the department, if the nursing facility has 16 chosen to be inspected by the joint commission on accreditation 17 of health care organizations in lieu of inspection by the 18 department. 19 Sec. 56. Section 135J.2, subsection 2, Code 2025, is amended 20 to read as follows: 21 2. The hospice program shall meet the criteria pursuant to 22 section 135J.3 before a license is issued. The department is 23 responsible to provide the necessary personnel to inspect the 24 hospice program, the home care and inpatient care provided and 25 the hospital or facility used by the hospice to determine if 26 the hospice complies with necessary standards before a license 27 is issued. Hospices that are certified as Medicare hospice 28 providers by the department , or are accredited as hospices 29 by the joint commission on the accreditation of health care 30 organizations , shall be licensed without inspection by the 31 department. 32 Sec. 57. Section 144F.5, subsection 1, Code 2025, is amended 33 to read as follows: 34 1. The standards for accreditation adopted by the joint 35 -31- LSB 1457SV (6) 91 dg/ko 31/ 39
S.F. 474 commission on the accreditation of health care organizations 1 or any other nationally recognized hospital accreditation 2 organization. 3 Sec. 58. Section 155A.13, subsection 4, paragraph a, 4 subparagraph (4), Code 2025, is amended to read as follows: 5 (4) Give recognition to the standards of the joint 6 commission on the accreditation of health care organizations 7 and the American osteopathic association , and to the conditions 8 of participation under Medicare. 9 Sec. 59. Section 232.2, subsection 4, paragraph i, Code 10 2025, is amended to read as follows: 11 i. If reasonable efforts to place a child for adoption or 12 with a guardian are made concurrently with reasonable efforts 13 as defined in section 232.102 232.102A , the concurrent goals 14 and timelines may be identified. Concurrent case permanency 15 plan goals for reunification, and for adoption or for other 16 permanent out-of-home placement of a child shall not be 17 considered inconsistent in that the goals reflect divergent 18 possible outcomes for a child in an out-of-home placement. 19 Sec. 60. Section 232.36, subsection 3, paragraph b, 20 subparagraph (3), Code 2025, is amended to read as follows: 21 (3) Legal custodian Custodian of the child. 22 Sec. 61. Section 232.37, subsection 2, Code 2025, is amended 23 to read as follows: 24 2. Notice of the pendency of the case shall be served upon 25 the known parents, guardians, or legal custodians of a child 26 if these persons are not summoned to appear as provided in 27 subsection 1 . Notice shall also be served upon the child and 28 upon the childs guardian ad litem, if any. The notice shall 29 attach a copy of the petition and shall give notification of 30 the right to counsel provided for in section 232.11 . 31 Sec. 62. Section 232.101A, subsection 1, paragraph c, Code 32 2025, is amended to read as follows: 33 c. The parent of the child does not appear at the 34 dispositional hearing, or the parent appears at the 35 -32- LSB 1457SV (6) 91 dg/ko 32/ 39
S.F. 474 dispositional hearing, does not object to the transfer of 1 guardianship, and agrees to waive the requirement for making 2 reasonable efforts as defined in section 232.102 232.102A . 3 Sec. 63. Section 232.102A, subsection 3, Code 2025, is 4 amended to read as follows: 5 3. The performance of reasonable efforts to place a child 6 for adoption or with a guardian may be made concurrently with 7 making reasonable efforts as defined in this section . 8 Sec. 64. Section 232B.5, subsection 19, unnumbered 9 paragraph 1, Code 2025, is amended to read as follows: 10 A party seeking an involuntary foster care placement of 11 or termination of parental rights over an Indian child shall 12 provide evidence to the court that active efforts have been 13 made to provide remedial services and rehabilitative programs 14 designed to prevent the breakup of the Indian family and that 15 these efforts have proved unsuccessful. The court shall not 16 order the placement or termination, unless the evidence of 17 active efforts shows there has been a vigorous and concerted 18 level of casework beyond the level that typically constitutes 19 reasonable efforts as defined in sections 232.57 and 232.102 20 232.102A . Reasonable efforts shall not be construed to be 21 active efforts. The active efforts must be made in a manner 22 that takes into account the prevailing social and cultural 23 values, conditions, and way of life of the Indian childs 24 tribe. Active efforts shall utilize the available resources 25 of the Indian childs extended family, tribe, tribal and 26 other Indian social service agencies, and individual Indian 27 caregivers. Active efforts shall include but are not limited 28 to all of the following: 29 Sec. 65. Section 233.2, subsection 5, Code 2025, is amended 30 to read as follows: 31 5. Reasonable efforts, as defined in section 232.102 32 232.102A , that are made in regard to the newborn infant shall 33 be limited to the efforts made in a timely manner to finalize a 34 permanency plan for the newborn infant. 35 -33- LSB 1457SV (6) 91 dg/ko 33/ 39
S.F. 474 Sec. 66. Section 237.3, subsection 7, Code 2025, is amended 1 to read as follows: 2 7. If an agency is accredited by the joint commission on 3 the accreditation of health care organizations under the joint 4 commissions consolidated standards for residential settings 5 or by the council on accreditation of services for families 6 and children , the department shall modify facility licensure 7 standards applied to the agency in order to avoid duplicating 8 standards applied through accreditation. 9 EXPLANATION 10 The inclusion of this explanation does not constitute agreement with 11 the explanations substance by the members of the general assembly. 12 This bill relates to services and support for youth and is 13 organized by divisions. 14 DIVISION I TREATMENT, PHYSICAL ASSESSMENTS, AND 15 BEHAVIORAL HEALTH EVALUATIONS. Under current law, a 16 psychiatric medical institution for children (PMIC) is an 17 institution providing more than 24 hours of continuous care 18 involving long-term psychiatric services to 3 or more children 19 in residence for expected periods of 14 days or more for 20 diagnosis and evaluation, or for expected periods of 90 days 21 or more for treatment. 22 The bill exempts PMICs from licensing requirements for 23 maintaining or conducting programs with the primary purpose 24 of treating and rehabilitating persons with a substance use 25 disorder. 26 The bill defines approved qualifying organization as 27 the joint commission, the commission on the accreditation of 28 rehabilitation facilities, the council on accreditation, or a 29 nationally recognized accrediting organization with standards 30 comparable to the joint commission and commission on the 31 accreditation of rehabilitation facilities that are acceptable 32 under federal regulations. 33 The bill defines mental health disorder as a mental 34 disorder as defined in the most recent version of the 35 -34- LSB 1457SV (6) 91 dg/ko 34/ 39
S.F. 474 diagnostic and statistical manual of mental disorders published 1 by the American psychiatric association, or a mental disorder 2 as defined in the most recent version of the international 3 classification of diseases published by the world health 4 organization. 5 The bill defines protective locked environment as a 6 setting that prevents egress from a building or grounds as a 7 protective measure to ensure safety and security. 8 The bill defines record check evaluation system as the 9 record check evaluation system of HHS used to perform child and 10 dependent adult abuse record checks and to evaluate criminal 11 history and abuse records. 12 The bill defines serious emotional disturbance as a 13 diagnosable mental, behavioral, or emotional disorder of 14 sufficient duration to meet diagnostic criteria specified 15 within the most current diagnostic and statistical manual 16 of mental disorders published by the American psychiatric 17 association that results in a functional impairment. Serious 18 emotional disturbance does not include a substance use 19 disorder or developmental disorder unless such disorder 20 co-occurs with such diagnosable mental, behavioral, or 21 emotional disorder. 22 The bill defines substance use disorder as a diagnosable 23 substance use disorder of sufficient duration to meet 24 diagnostic criteria specified within the most current 25 diagnostic and statistical manual of mental disorders published 26 by the American psychiatric association that results in a 27 functional impairment. 28 The bill defines youth as a person who is less than 21 29 years of age. 30 The bill describes the nature of care a PMIC must offer youth 31 with a serious emotional disturbance (SED), a substance use 32 disorder (SUD), or both. 33 Under current law, a person who establishes a PMIC must 34 also hold a license under Code chapter 237 (child foster 35 -35- LSB 1457SV (6) 91 dg/ko 35/ 39
S.F. 474 care facilities) as a comprehensive residential facility for 1 children, or hold a license under Code chapter 125 (substance 2 use disorders) if the facility provides SUD treatment. The 3 bill eliminates the requirement that a PMIC holds either 4 of these additional licenses, and instead requires that an 5 applicant for a PMIC license specify whether the applicant will 6 provide SED services, SUD services, or both. A PMIC may only 7 provide services for which it is licensed. 8 The bill eliminates the requirement that a proposed PMIC be 9 under the direction of an agency which has previously operated 10 a facility for children or adolescents and meets or exceeds 11 requirements for licensure as a comprehensive residential 12 facility for children. 13 The bill requires the department of inspections, appeals 14 and licensing (DIAL), in cooperation with the department of 15 health and human services (HHS), to adopt rules relating to the 16 application of a protective locked environment in a PMIC. 17 Under current law, following the hospitalization hearing 18 on an involuntary commitment petition, if the court finds 19 by clear and convincing evidence that the respondent has a 20 serious mental impairment, the court shall order the respondent 21 committed for a complete psychiatric evaluation and appropriate 22 treatment. The chief medical officer (CMO) of the hospital or 23 facility at which a respondent is committed must report to the 24 court no more than 15 days after the date the respondent is 25 placed, making a recommendation for disposition of the matter. 26 The bill allows a court to place a minor respondent in a public 27 hospital and allows a CMO of the hospital no more than 30 28 days after the date the minor respondent is placed to make a 29 recommendation for disposition of the matter. 30 The bill defines behavioral health evaluation as a 31 comprehensive evaluation of a persons mental and behavioral 32 health by a person licensed under Code chapter 154B 33 (psychology), 154C (social work), or 154D (behavioral science) 34 for purposes including but not limited to identifying a 35 -36- LSB 1457SV (6) 91 dg/ko 36/ 39
S.F. 474 possible behavioral health condition. 1 The bill defines physical assessment as direct physical 2 touching, viewing, and medically necessary manipulation of any 3 area of a childs body by a licensed physician. 4 The bill replaces several references to a physical or mental 5 examination with references to a physical assessment (PA) or 6 behavioral health evaluation (BHE) and replaces references to a 7 persons abuse of alcohol or other controlled substances with 8 references to the person having a behavioral health condition. 9 Under current law, one of several specific circumstances 10 must exist before a juvenile court has the authority to enter 11 an ex parte order to direct a peace officer or a juvenile court 12 officer to take custody of a child before or after the filing 13 of a petition under Code chapter 232 (juvenile justice). The 14 bill adds the circumstance when the childs parent, guardian, 15 or legal custodian consents to the removal as a condition that 16 would permit a juvenile court to enter such an ex parte order. 17 The bill creates similar provisions for when a juvenile court 18 may enter an ex parte order for a child to undergo an inpatient 19 PA or an inpatient BHE and when a person authorized to conduct 20 a preliminary investigation in response to a complaint 21 may motion to ask the court to order a child to undergo an 22 inpatient PA or an inpatient BHE. 23 The bill authorizes a court, after a dispositional hearing, 24 to order a male child in a child in need of assistance (CINA) 25 proceeding or a family in need of assistance (FINA) proceeding 26 to receive an inpatient PA, an inpatient BHE, or both, at the 27 state training school (STS). A request for the use of the STS 28 for purposes of a PA or BHE must be approved by the director of 29 HHS. A child ordered to the STS pursuant to a CINA proceeding 30 or a FINA proceeding must be separated at all times from 31 children placed in the STS pursuant to a juvenile delinquency 32 proceeding. Under current law, the court in a CINA or FINA 33 proceeding is prohibited from placing a child in the STS for 34 any reason. 35 -37- LSB 1457SV (6) 91 dg/ko 37/ 39
S.F. 474 The bill exempts a PMIC from licensing requirements for 1 child foster care. 2 The bill defines protective locked environment as a 3 setting that prevents egress from a building or grounds as a 4 protective measure to ensure safety and security. The bill 5 directs HHS and DIAL to adopt rules relating to the application 6 of a protective locked environment to child foster care 7 licensees. 8 The bill directs HHS and DIAL to coordinate in developing 9 rules related to this division of the bill. The bill outlines 10 goals and considerations each department must take into account 11 while adopting such rules. 12 The bill requires HHS to convene a committee made of 13 representatives of several different organizations and persons 14 detailed in the bill to review the systems and related services 15 and supports available for youth, including but not limited to 16 systems, services, and supports related to civil commitment and 17 treatment, juvenile delinquency, and CINA. The bill details 18 the goal of the review and requires HHS to report the reviews 19 findings and recommendations to the governor and the general 20 assembly by October 1, 2025. 21 The bill makes conforming changes to Code chapters 135H 22 (psychiatric medical institutions for children) and 232 23 (juvenile justice). The bill repeals 2024 Iowa Acts, chapter 24 1161, sections 97 and 98. 25 DIVISION II HOME AND COMMUNITY-BASED SERVICES 26 HABILITATION SERVICES PROVIDED BY A RESIDENTIAL PROGRAM 27 EXCLUSION FROM CHILDRENS RESIDENTIAL FACILITY DEFINITION. The 28 bill excludes care furnished to persons 16 years of age or 29 older by certain residential programs detailed in the bill from 30 the definition of a childrens residential facility. The bill 31 requires care furnished at a residential program to persons 32 under 18 years of age to be provided in settings separate from 33 individuals over the age of 21. 34 DIVISION III DIRECTOR OF JUVENILE COURT SERVICES 35 -38- LSB 1457SV (6) 91 dg/ko 38/ 39
S.F. 474 CHIEF JUVENILE COURT OFFICERS. Under current law, the chief 1 juvenile court officers are appointed, terminated for cause, 2 and otherwise act under the direction and supervision of the 3 chief judge for the judicial district in which the chief 4 juvenile court officer was appointed. The bill transfers the 5 chief judges authority over chief juvenile court officers to 6 the director of juvenile court services. 7 DIVISION IV HAWKI ELIGIBILITY PUBLIC INSTITUTION 8 INMATES. Current law does not permit a child who is an inmate 9 in a public institution to be eligible for the Hawki program. 10 The bill requires HHS to suspend, but not terminate, Hawki 11 program eligibility for a child in a public institution if the 12 child is otherwise eligible for the Hawki program except for 13 the childs status as an inmate, the child was enrolled in the 14 Hawki program at the time the child was committed to the public 15 institution, and 30 calendar days have elapsed since the date 16 the child was committed to the public institution. A childs 17 suspension of Hawki benefits must continue during the entire 18 period of the childs commitment to a public institution. 19 The bill requires the public institution to which a child 20 is committed and HHS to provide monthly reports and expedite 21 the restoration of the childs Hawki benefits upon the childs 22 discharge from the public institution. The bill requires HHS 23 to adopt rules to administer the bills provisions related to 24 Hawki benefits for children committed to a public institution. 25 DIVISION V CORRECTIVE CHANGES. The bill updates 26 references to certain accrediting organizations through the 27 Code, corrects a reference throughout the Code related to 28 the citation for the definition of reasonable efforts, 29 and changes the term legal custodian to the defined term 30 custodian. 31 -39- LSB 1457SV (6) 91 dg/ko 39/ 39