Bill Text: IA HF2327 | 2017-2018 | 87th General Assembly | Introduced
Bill Title: A bill for an act relating to behavioral health, including provisions relating to involuntary commitments and hospitalizations, the disclosure of mental health information to law enforcement professionals, and mental health and disability services. (See HF 2456.)
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2018-02-27 - Withdrawn. H.J. 425. [HF2327 Detail]
Download: Iowa-2017-HF2327-Introduced.html
House File 2327 - Introduced HOUSE FILE BY LUNDGREN A BILL FOR 1 An Act relating to behavioral health, including provisions 2 relating to involuntary commitments and hospitalizations, 3 the disclosure of mental health information to law 4 enforcement professionals, and mental health and disability 5 services. 6 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: TLSB 6024YH (12) 87 hb/rh PAG LIN 1 1 Section 1. Section 125.80, subsection 3, Code 2018, is 1 2 amended to read as follows: 1 3 3. If the report of a court=designated licensed physician 1 4 or mental health professional is to the effect that the 1 5 respondent is not a person with a substance=related disorder, 1 6 the court, without taking further action,mayshall terminate 1 7 the proceeding and dismiss the application on its own motion 1 8 and without notice. 1 9 Sec. 2. Section 125.81, Code 2018, is amended by adding the 1 10 following new subsection: 1 11 NEW SUBSECTION. 2A. A respondent shall be released from 1 12 detention prior to the commitment hearing if a licensed 1 13 physician or mental health professional examines the respondent 1 14 and determines the respondent no longer meets the criteria for 1 15 detention under subsection 1 and provides notification to the 1 16 court. 1 17 Sec. 3. Section 135G.6, Code 2018, is amended by striking 1 18 the section and inserting in lieu thereof the following: 1 19 135G.6 Inspection ==== conditions for issuance. 1 20 The department shall issue a license to an applicant under 1 21 this chapter if the department has ascertained that the 1 22 applicant's facilities and staff are adequate to provide the 1 23 care and services required of a subacute care facility. 1 24 Sec. 4. Section 228.1, Code 2018, is amended by adding the 1 25 following new subsection: 1 26 NEW SUBSECTION. 3A. "Law enforcement professional" means 1 27 a law enforcement officer as defined in section 80B.3, county 1 28 attorney as defined in section 331.101, probation or parole 1 29 officer, or jailer. 1 30 Sec. 5. NEW SECTION. 228.7A Disclosures to law enforcement 1 31 professionals. 1 32 1. Mental health information relating to an individual 1 33 shall be disclosed by a mental health professional, at the 1 34 minimum consistent with applicable laws and standards of 1 35 ethical conduct, to a law enforcement professional if all of 2 1 the following apply: 2 2 a. The disclosure is made in good faith. 2 3 b. The disclosure is necessary to prevent or lessen a 2 4 serious and imminent threat to the health or safety of the 2 5 individual or to a clearly identifiable victim or victims. 2 6 c. The individual has the apparent intent and ability to 2 7 carry out the threat. 2 8 2. A mental health professional shall not be held criminally 2 9 or civilly liable for failure to disclose mental health 2 10 information relating to an individual to a law enforcement 2 11 professional except in circumstances where the individual has 2 12 communicated to the mental health professional an imminent 2 13 threat of physical violence against the individual's self or 2 14 against a clearly identifiable victim or victims. 2 15 3. A mental health professional discharges the 2 16 professional's duty to disclose pursuant to subsection 1 by 2 17 making reasonable efforts to communicate the threat to a law 2 18 enforcement professional. 2 19 Sec. 6. Section 229.10, subsection 3, Code 2018, is amended 2 20 to read as follows: 2 21 3. If the report of one or more of the court=designated 2 22 physicians or mental health professionals is to the effect 2 23 that the individual is not seriously mentally impaired, the 2 24 courtmayshall without taking further action terminate the 2 25 proceeding and dismiss the application on its own motion and 2 26 without notice. 2 27 Sec. 7. Section 229.11, Code 2018, is amended by adding the 2 28 following new subsection: 2 29 NEW SUBSECTION. 1A. A respondent shall be released from 2 30 detention prior to the hospitalization hearing if a licensed 2 31 physician or mental health professional examines the respondent 2 32 and determines the respondent no longer meets the criteria for 2 33 detention under subsection 1 and provides notification to the 2 34 court. 2 35 Sec. 8. Section 229.12, subsection 3, paragraph a, Code 3 1 2018, is amended to read as follows: 3 2 a. The respondent's welfare shall be paramount and the 3 3 hearing shall be conducted in as informal a manner as may be 3 4 consistent with orderly procedure, but consistent therewith 3 5 the issue shall be tried as a civil matter. The hearing may 3 6 be held by video conference at the discretion of the court. 3 7 Such discovery as is permitted under the Iowa rules of civil 3 8 procedure shall be available to the respondent. The court 3 9 shall receive all relevant and material evidence which may be 3 10 offered and need not be bound by the rules of evidence. There 3 11 shall be a presumption in favor of the respondent, and the 3 12 burden of evidence in support of the contentions made in the 3 13 application shall be upon the applicant. 3 14 Sec. 9. Section 229.22, subsection 2, paragraph b, Code 3 15 2018, is amended to read as follows: 3 16 b. If the magistrate orders that the person be detained, 3 17 the magistrate shall, by the close of business on the next 3 18 working day, file a written order with the clerk in the county 3 19 where it is anticipated that an application may be filed 3 20 under section 229.6. The order may be filed by facsimile if 3 21 necessary. A peace officer from the law enforcement agency 3 22 that took the person into custody, if no request was made 3 23 under paragraph "a", may inform the magistrate that an arrest 3 24 warrant has been issued for or charges are pending against the 3 25 person and request that any written order issued under this 3 26 paragraph require the facility or hospital to notify the law 3 27 enforcement agency about the discharge of the person prior to 3 28 discharge. The order shall state the circumstances under which 3 29 the person was taken into custody or otherwise brought to a 3 30 facility or hospital, and the grounds supporting the finding 3 31 of probable cause to believe that the person is seriously 3 32 mentally impaired and likely to injure the person's self or 3 33 others if not immediately detained. The order shall also 3 34 include any law enforcement agency notification requirements if 3 35 applicable. The order shall confirm the oral order authorizing 4 1 the person's detention including any order given to transport 4 2 the person to an appropriate facility or hospital. A peace 4 3 officer from the law enforcement agency that took the person 4 4 into custody may also request an order, separate from the 4 5 written order, requiring the facility or hospital to notify the 4 6 law enforcement agency about the discharge of the person prior 4 7 to discharge. The clerk shall provide a copy of the written 4 8 order or any separate order to the chief medical officer of the 4 9 facility or hospital to which the person was originally taken, 4 10 to any subsequent facility to which the person was transported, 4 11 and to any law enforcement department,orambulance service, 4 12 or transportation service under contract with a mental health 4 13 and disability services region that transported the person 4 14 pursuant to the magistrate's order. A transportation service 4 15 that contracts with a mental health and disability services 4 16 region for purposes of this paragraph shall provide a secure 4 17 transportation vehicle and shall employ staff that has received 4 18 or is receiving mental health training. 4 19 Sec. 10. Section 331.397, Code 2018, is amended to read as 4 20 follows: 4 21 331.397 Regional core services. 4 22 1. For the purposes of this section, unless the context 4 23 otherwise requires, "domain" means a set of similar services 4 24 that can be provided depending upon a person's service needs. 4 25 2. a. (1) A region shall work with service providers to 4 26 ensure that services in the required core service domains in 4 27 subsections 4 and 5 are available to residents of the region, 4 28 regardless of potential payment source for the services. 4 29 (2) Subject to the available appropriations, the director 4 30 of human services shall ensure theinitialcore service domains 4 31 listed insubsectionsubsections 4 and 5 are covered services 4 32 for the medical assistance program under chapter 249A to the 4 33 greatest extent allowable under federal regulations. The 4 34 medical assistance program shall reimburse Medicaid enrolled 4 35 providers for Medicaid covered services under subsections 4 5 1 and 5 when the services are medically necessary, the Medicaid 5 2 enrolled provider submits an appropriate claim for such 5 3 services, and no other third=party payer is responsible for 5 4 reimbursement of such services. Within funds available, the 5 5 region shall pay for such services for eligible persons when 5 6 payment through the medical assistance program or another 5 7 third=party payment is not available, unless the person is on a 5 8 waiting list for such payment or it has been determined that 5 9 the person does not meet the eligibility criteria for any such 5 10 service. 5 11 b. Until funding is designated for other service 5 12 populations, eligibility for the service domains listed in this 5 13 section shall be limited to such persons who are in need of 5 14 mental health or intellectual disability services. However, if 5 15 a county in a region was providing services to an eligibility 5 16 class of persons with a developmental disability other than 5 17 intellectual disability or a brain injury prior to formation of 5 18 the region, the class of persons shall remain eligible for the 5 19 services provided when the regioniswas formed, provided that 5 20 funds are available to continue such services without limiting 5 21 or reducing core services. 5 22 c. It is the intent of the general assembly to address 5 23 the need for funding so that the availability of the service 5 24 domains listed in this section may be expanded to include such 5 25 persons who are in need of developmental disability or brain 5 26 injury services. 5 27 3. Pursuant to recommendations made by the director of human 5 28 services, the state commission shall adopt rules as required by 5 29 section 225C.6 to define the services included in theinitial 5 30 and additionalcore service domains listed in this section. 5 31 The rules shall provide service definitions, service provider 5 32 standards, service access standards, and service implementation 5 33 dates, and shall provide consistency, to the extent possible, 5 34 with similar service definitions under the medical assistance 5 35 program. 6 1 a. The rules relating to the credentialing of a person 6 2 directly providing services shall require all of the following: 6 3a.(1) The person shall provide services and represent the 6 4 person as competent only within the boundaries of the person's 6 5 education, training, license, certification, consultation 6 6 received, supervised experience, or other relevant professional 6 7 experience. 6 8b.(2) The person shall provide services in substantive 6 9 areas or use intervention techniques or approaches that 6 10 are new only after engaging in appropriate study, training, 6 11 consultation, and supervision from a person who is competent in 6 12 those areas, techniques, or approaches. 6 13c.(3) If generally recognized standards do not exist 6 14 with respect to an emerging area of practice, the person 6 15 shall exercise careful judgment and take responsible steps, 6 16 including obtaining appropriate education, research, training, 6 17 consultation, and supervision, in order to ensure competence 6 18 and to protect from harm the persons receiving the services in 6 19 the emerging area of practice. 6 20 b. The rules relating to the availability of services shall 6 21 provide for all of the following: 6 22 (1) Twenty=two assertive community treatment teams. 6 23 (2) Six access centers. 6 24 (3) Intensive residential service homes that provide 6 25 services to up to one hundred twenty persons statewide. 6 26 4. Theinitialcore service domains shall include the 6 27 following: 6 28 a. Treatment designed to ameliorate a person's condition, 6 29 including but not limited to all of the following: 6 30 (1) Assessment and evaluation. 6 31 (2) Mental health outpatient therapy. 6 32 (3) Medication prescribing and management. 6 33 (4) Mental health inpatient treatment. 6 34 b. Basic crisis response provisions, including but not 6 35 limited to all of the following: 7 1 (1) Twenty=four=hour access to crisis response. 7 2 (2) Evaluation. 7 3 (3) Personal emergency response system. 7 4 c. Support for community living, including but not limited 7 5 to all of the following: 7 6 (1) Home health aide. 7 7 (2) Home and vehicle modifications. 7 8 (3) Respite. 7 9 (4) Supportive community living. 7 10 d. Support for employment or for activities leading to 7 11 employment providing an appropriate match with an individual's 7 12 abilities based upon informed, person=centered choices made 7 13 from an array of options, including but not limited to all of 7 14 the following: 7 15 (1) Day habilitation. 7 16 (2) Job development. 7 17 (3) Supported employment. 7 18 (4) Prevocational services. 7 19 e. Recovery services, including but not limited to all of 7 20 the following: 7 21 (1) Family support. 7 22 (2) Peer support. 7 23 f. Service coordination including coordinating physical 7 24 health and primary care, including but not limited to all of 7 25 the following: 7 26 (1) Case management. 7 27 (2) Health homes. 7 28 5. a. To the extent federal matching funds are available 7 29 under the Iowa health and wellness plan pursuant to chapter 7 30 249N, the following intensive mental health services in 7 31 strategic locations throughout the state shall be provided 7 32 within the following core service domains: 7 33 (1) Access centers that are located in crisis residential 7 34 and subacute residential settings with sixteen beds or fewer 7 35 that provide immediate, short=term assessments for persons with 8 1 serious mental illness or substance use disorders who do not 8 2 need inpatient psychiatric hospital treatment, but who do need 8 3 significant amounts of supports and services not available in 8 4 the persons' homes or communities. 8 5 (2) Assertive community treatment services. 8 6 (3) Comprehensive facility and community=based crisis 8 7 services, including all of the following: 8 8 (a) Mobile response. 8 9 (b) Twenty=three=hour crisis observation and holding. 8 10 (c) Crisis stabilization community=based services. 8 11 (d) Crisis stabilization residential services. 8 12 (4) Subacute services provided in facility and 8 13 community=based settings. 8 14 (5) Intensive residential service homes for persons 8 15 with severe and persistent mental illness in scattered site 8 16 community=based residential settings that provide intensive 8 17 services and that operate twenty=four hours a day. 8 18 b. The department shall accept arrangements between multiple 8 19 regions sharing intensive mental health services under this 8 20 subsection. 8 215.6. A region shall ensure that access is available 8 22 to providers of core services that demonstrate competencies 8 23 necessary for all of the following: 8 24 a. Serving persons with co=occurring conditions. 8 25 b. Providing evidence=based services. 8 26 c. Providing trauma=informed care that recognizes the 8 27 presence of trauma symptoms in persons receiving services. 8 286.7. A region shall ensure that services within the 8 29 following additional core service domains are available 8 30 to persons not eligible for the medical assistance program 8 31 under chapter 249A or receiving other third=party payment for 8 32 the services, when public funds are made available for such 8 33 services: 8 34a. Comprehensive facility and community=based crisis 8 35 services, including but not limited to all of the following:9 1(1) Twenty=four=hour crisis hotline.9 2(2) Mobile response.9 3(3) Twenty=three=hour crisis observation and holding, and 9 4 crisis stabilization facility and community=based services.9 5(4) Crisis residential services.9 6b. Subacute services provided in facility and 9 7 community=based settings.9 8c.a. Justice system=involved services, including but not 9 9 limited to all of the following: 9 10 (1) Jail diversion. 9 11 (2) Crisis intervention training. 9 12 (3) Civil commitment prescreening. 9 13d.b. Advances in the use of evidence=based treatment, 9 14 including but not limited to all of the following: 9 15 (1) Positive behavior support. 9 16(2) Assertive community treatment.9 17(3)(2) Peer self=help drop=in centers. 9 187.8. A regional service system may provide funding for 9 19 other appropriate services or other support and may implement 9 20 demonstration projects for an initial period of up to three 9 21 years to model the use of research=based practices. In 9 22 considering whether to provide such funding, a region may 9 23 consider the following criteria for research=based practices: 9 24 a. Applying a person=centered planning process to identify 9 25 the need for the services or other support. 9 26 b. The efficacy of the services or other support is 9 27 recognized as an evidence=based practice, is deemed to be an 9 28 emerging and promising practice, or providing the services is 9 29 part of a demonstration and will supply evidence as to the 9 30 services' effectiveness. 9 31 c. A determination that the services or other support 9 32 provides an effective alternative to existing services that 9 33 have been shown by the evidence base to be ineffective, to not 9 34 yield the desired outcome, or to not support the principles 9 35 outlined in Olmstead v. L.C., 527 U.S. 581 (1999). 10 1 Sec. 11. Section 331.424A, subsection 9, Code 2018, is 10 2 amended to read as follows: 10 3 9. a. For the fiscal year beginning July 1, 2017, and each 10 4 subsequent fiscal year, the county budgeted amount determined 10 5 for each county shall be the amount necessary to meet the 10 6 county's financial obligations for the payment of services 10 7 provided under the regional service system management plan 10 8 approved pursuant to section 331.393, not to exceed an amount 10 9 equal to the product of the regional per capita expenditure 10 10 target amount multiplied by the county's population, and, for 10 11 fiscal years beginning on or after July 1, 2021, reduced by 10 12 the amount of the county's cash flow reduction amount for the 10 13 fiscal year calculated under subsection 4, if applicable. 10 14 b. If a county officially joins a different region, the 10 15 county's budgeted amount shall be the amount necessary to meet 10 16 the county's financial obligations for payment of services 10 17 provided under the new region's regional service system 10 18 management plan approved pursuant to section 331.393, not to 10 19 exceed an amount equal to the product of the new region's 10 20 regional per capita expenditure target amount multiplied by the 10 21 county's population. 10 22 Sec. 12. DEPARTMENT OF HUMAN SERVICES ==== CIVIL COMMITMENT 10 23 PRESCREENING ASSESSMENTS ==== RULES. The department of human 10 24 services, in coordination with the mental health and disability 10 25 services commission, shall adopt rules pursuant to chapter 17A 10 26 relating to civil commitment prescreening assessments provided 10 27 by a mental health and disability services region or an entity 10 28 contracting with a mental health and disability service region. 10 29 The rules shall provide for all of the following: 10 30 1. The provision of civil commitment prescreening 10 31 assessments by a licensed physician or mental health 10 32 professional within four hours of an emergency detention of 10 33 an individual believed to be mentally ill to determine if 10 34 inpatient psychiatric hospitalization is necessary. 10 35 2. The coordination of appropriate levels of care 11 1 to include securing an inpatient psychiatric bed when 11 2 inpatient psychiatric hospitalization is needed and 11 3 utilizing community=based resources and services such as 11 4 crisis observation and crisis stabilization services and 11 5 subacute care and detoxification centers and facilitating 11 6 outpatient treatment appointments when inpatient psychiatric 11 7 hospitalization is not needed. 11 8 3. The provision of ongoing consultations by a licensed 11 9 physician or mental health professional while the individual 11 10 remains in the emergency room. 11 11 4. Requiring appropriate documentation and reports to be 11 12 submitted by a licensed physician or mental health professional 11 13 to a treating hospital and the court as necessary. 11 14 Sec. 13. PROGRAM IMPLEMENTATION == ADOPTION OF 11 15 ADMINISTRATIVE RULES. 11 16 1. The core services specified in this Act shall be 11 17 implemented and the department of human services shall adopt 11 18 rules pursuant to chapter 17A relating to the administration of 11 19 such core services no later than October 1, 2018. 11 20 2. The provisions of this Act and rules adopted in 11 21 accordance with this Act shall not be interpreted to delay 11 22 or disrupt services or plans for the implementation of such 11 23 services in effect on July 1, 2018. 11 24 3. The rules adopted by the department relating to access 11 25 centers shall provide for all of the following: 11 26 a. The access centers shall meet all of the following 11 27 criteria: 11 28 (1) An access center shall serve individuals with a 11 29 serious mental health or substance use disorder need who are 11 30 otherwise medically stable, who are not in need of an inpatient 11 31 psychiatric level of care, and who do not have alternative, 11 32 safe, effective services immediately available. 11 33 (2) Access center services shall be provided on a no reject, 11 34 no eject basis. 11 35 (3) An access center shall accept and serve individuals who 12 1 are court=ordered to participate in mental health or substance 12 2 use disorder treatment. 12 3 (4) Access center providers shall be accredited under 441 12 4 IAC 24 to provide crisis stabilization residential services and 12 5 shall be licensed to provide subacute mental health services as 12 6 defined in section 135G.1 12 7 (5) An access center shall be licensed as a substance abuse 12 8 treatment program pursuant to chapter 125 or have a cooperative 12 9 agreement with and immediate access to licensed substance abuse 12 10 treatment services or medical care that incorporates withdrawal 12 11 management. 12 12 (6) An access center shall provide person=centered mental 12 13 health and substance use disorder assessments by appropriately 12 14 licensed or credentialed professionals and peer support 12 15 services based on a comprehensive assessment. 12 16 (7) An access center shall provide or arrange to provide 12 17 necessary physical health services. 12 18 (8) An access center shall ensure short stays by providing 12 19 individuals with care coordination that provides successful 12 20 navigation and warm handoffs to the next service provider 12 21 as well as linkages to needed services including housing, 12 22 employment, and shelter services. 12 23 b. The rules shall include access center designation 12 24 criteria and standards that allow and encourage multiple 12 25 mental health and disability services regions to strategically 12 26 locate and share access center services, including bill=back 12 27 provisions to provide for reimbursement of a region when the 12 28 resident of another region utilizes an access center located 12 29 in that region. 12 30 c. The rules shall direct Medicaid managed care 12 31 organizations, mental health and disability services regions, 12 32 and law enforcement to jointly select, develop, and implement 12 33 six access centers strategically located throughout the state 12 34 by December 31, 2019. Regions may enter into chapter 28E 12 35 agreements to provide such services. 13 1 d. The rules shall require that Medicaid managed care 13 2 organizations reimburse Medicaid services provided at access 13 3 centers by Medicaid providers based on the reimbursement rate 13 4 floor established for the covered Medicaid service. The rules 13 5 shall also require mental health and disability services 13 6 regions to provide start=up funding for the establishment of 13 7 access centers jointly selected by mental health and disability 13 8 services regions and Medicaid managed care organizations and 13 9 to provide funding for non=Medicaid covered services provided 13 10 by the access centers. 13 11 4. The rules relating to assertive community treatment 13 12 (ACT) shall provide for all of the following: 13 13 a. The department shall establish uniform, statewide 13 14 accreditation standards for ACT based on national accreditation 13 15 standards, including allowances for nationally recognized small 13 16 team standards. The statewide standards shall require that ACT 13 17 teams meet fidelity to practice nationally recognized standards 13 18 as determined by an independent review of each team that 13 19 includes peer review. The rules shall provide that Medicaid 13 20 managed care organization utilization management requirements 13 21 do not exceed the accreditation standards developed by the 13 22 department and that Medicaid managed care organizations 13 23 reimburse ACT teams for each day of care provided including for 13 24 admissions and ongoing treatment provided on weekends. 13 25 b. The rules shall require mental health and disability 13 26 services regions and Medicaid managed care organizations to 13 27 jointly agree on all of the following: 13 28 (1) Strategically located geographic areas in which ACT 13 29 teams should be developed upon consideration of all of the 13 30 following: 13 31 (a) Recommendations for locations included in the complex 13 32 service needs workgroup report published by the department of 13 33 human services on December 15, 2017. 13 34 (b) A review of known individuals with diagnoses that would 13 35 benefit from ACT. 14 1 (c) Hospital inpatient psychiatric readmission rates. 14 2 (d) The interest and readiness of a provider and community 14 3 partners to form ACT. 14 4 (e) The availability of psychiatric providers interested 14 5 in the model. 14 6 (2) How to accomplish independent review of fidelity to 14 7 practice established standards. 14 8 c. The rules shall direct Medicaid managed care 14 9 organizations to enter into contracts with jointly selected ACT 14 10 teams. Reimbursement of ACT teams shall be provided based on 14 11 the reimbursement rate floor established for such services to 14 12 Medicaid covered members who have a demonstrated need for ACT. 14 13 The rules shall allow mental health and disability services 14 14 regions to enter into chapter 28E agreements to provide ACT 14 15 services and shall also include bill=back provisions to allow 14 16 for reimbursement of a region when the resident of another 14 17 region utilizes an ACT team located in that region. 14 18 d. The rules shall require mental health and disability 14 19 services regions to provide start=up funding for the ACT teams 14 20 that are not established prior to July 1, 2018, including for 14 21 assistance in achieving fidelity to practice standards and 14 22 technical assistance. 14 23 e. The rules shall require that mental health and disability 14 24 services regions ensure the efficient and effective operation 14 25 of ACT teams and provide funding for general operations based 14 26 on guidance provided by the department. 14 27 5. The rules relating to intensive residential service 14 28 homes (IRSH) shall provide for all of the following: 14 29 a. That an intensive residential service home be enrolled 14 30 with the Iowa Medicaid enterprise as a section 1915(i) home and 14 31 community=based services habilitation waiver or intellectual 14 32 disability waiver=supported community living provider. 14 33 b. That an intensive residential service home have adequate 14 34 staffing that includes appropriate specialty training including 14 35 applied behavior analysis as appropriate; adequate direct 15 1 care staffing rations; swift access to additional staffing 15 2 if serious incidents occur; and adequate pay and paid time 15 3 off commensurate with the increased intensity of the services 15 4 provided. 15 5 c. Coordination with the individual's clinical 15 6 mental health and physical health treatment including 15 7 ensuring treatment plans are developed by a comprehensive 15 8 interdisciplinary team selected by the individual that develops 15 9 and implements the individual's person=centered plan; ensuring 15 10 access to active medication management and outpatient therapy 15 11 including evidence=based therapy approaches; establishing a 15 12 fully coordinated care plan; accessing assertive community 15 13 treatment if there is a demonstrated need; and developing a 15 14 thorough wellness recovery action plan, as appropriate. 15 15 d. Be licensed as a substance abuse treatment program 15 16 pursuant to chapter 125 or have a cooperative agreement 15 17 with and timely access to licensed substance abuse treatment 15 18 services for those with a demonstrated need. 15 19 e. Accept court=ordered commitments. 15 20 f. Have a high tolerance for serious behavioral issues. 15 21 g. Have a no reject, no eject policy for an individual 15 22 referred to the home based on the severity of the individual's 15 23 mental health or co=occurring needs. 15 24 h. Be smaller in size, preferably providing services to 15 25 four or fewer individuals and no more than sixteen individuals, 15 26 and be located in a neighborhood setting to maximize community 15 27 integration and natural supports. 15 28 i. Determine length of stay based on an individual basis 15 29 using person=centered planning and objective utilization 15 30 review criteria with the goal for the individual to live in 15 31 the most integrated setting practicable. Individuals expected 15 32 to have a longer stay shall be provided the protections of the 15 33 landlord=tenant relationship pursuant to chapter 562A. 15 34 j. Require Medicaid managed care organizations and mental 15 35 health and disability services regions to jointly select and 16 1 mutually agree upon the strategic geographic locations of 16 2 IRSHs. Any existing section 1915(i) home and community=based 16 3 services habilitation waiver or intellectual disability 16 4 waiver=supported community living providers that meet IRSH 16 5 criteria shall be considered in the selection process. 16 6 Medicaid managed care organizations and mental health and 16 7 disability services regions shall also work with the state 16 8 mental health institutes, Broadlawns, the university of Iowa 16 9 hospitals and clinics, and other interested hospitals with 16 10 inpatient psychiatric programs to operate or affiliate with 16 11 one IRSH each as an integral part of the mental health and 16 12 disability services provided by a region. 16 13 k. Direct Medicaid managed care organizations to enter 16 14 into contracts with jointly selected IRSHs. Reimbursement of 16 15 IRSH shall be provided based on the reimbursement rate floor 16 16 established for such services provided to Medicaid covered 16 17 members who have a demonstrated need for IRSH. The rules shall 16 18 allow mental health and disability services regions to enter 16 19 into chapter 28E agreements to provide IRSH services. The 16 20 rules shall also include bill=back provisions to allow for 16 21 reimbursement of a region when the resident of another region 16 22 utilizes an IRSH located in that region. 16 23 l. Require mental health and disability services regions to 16 24 provide start=up funding for an IRSH that is not established 16 25 prior to July 1, 2018. Regions shall also provide funding as 16 26 necessary for non=Medicaid covered services provided by the 16 27 IRSH. 16 28 m. Require contracts entered into between the regions and 16 29 the Medicaid managed care organizations to include objective 16 30 utilization review criteria. 16 31 6. The department of human services and the department of 16 32 public health shall provide a single statewide twenty=four=hour 16 33 crisis hotline that incorporates warmline services which may be 16 34 provided through expansion of the YourLifeIowa platform. 16 35 Sec. 14. COMMITMENT PROCESS REVIEW. The department of 17 1 human services, in cooperation with the department of public 17 2 health, representatives of the mental health institutes, Iowa 17 3 hospital association, Iowa health care association, managed 17 4 care organizations, the national alliance on mental illness, 17 5 and other affected or interested stakeholders shall review 17 6 the commitment processes under chapters 125 and 229 and shall 17 7 report recommendations for improvements in the processes 17 8 and any amendments to law to increase efficiencies and more 17 9 appropriately utilize the array of mental health and disability 17 10 services available based upon an individual's needs to the 17 11 governor and the general assembly by December 31, 2018. 17 12 Sec. 15. TERTIARY CARE PSYCHIATRIC HOSPITALS. The 17 13 departments of human services and public health and other 17 14 affected or interested stakeholders shall review the role of 17 15 tertiary care psychiatric hospitals in the array of mental 17 16 health services and shall report recommendations for providing 17 17 tertiary psychiatric services to the governor and the general 17 18 assembly by November 30, 2018. The recommendations shall 17 19 address the role and responsibilities of tertiary care 17 20 psychiatric hospitals in the mental health array of services 17 21 in the state, the viability of utilizing the mental health 17 22 institutes as tertiary care psychiatric hospitals, any 17 23 potential sustainable funding, and admissions criteria. 17 24 Sec. 16. DEPARTMENT OF HUMAN SERVICES. The department of 17 25 human services shall adopt rules pursuant to chapter 17A to 17 26 administer this Act. 17 27 EXPLANATION 17 28 The inclusion of this explanation does not constitute agreement with 17 29 the explanation's substance by the members of the general assembly. 17 30 This bill relates to behavioral health, including provisions 17 31 relating to involuntary commitments and hospitalizations, the 17 32 disclosure of mental health information to law enforcement 17 33 professionals, and mental health and disability services. 17 34 Under current law, if the report of a court=designated 17 35 licensed physician or mental health professional indicates 18 1 that a respondent who is the subject of an application 18 2 for involuntary commitment or treatment due to the 18 3 respondent's substance=related disorder is not a person 18 4 with a substance=related disorder, the court, without taking 18 5 further action, may terminate the proceeding and dismiss 18 6 the application on its own motion and without notice. The 18 7 bill amends current law to provide that the court, under the 18 8 same circumstances and without taking further action, shall 18 9 terminate such a proceeding and dismiss the application on its 18 10 own motion and without notice. 18 11 The bill provides that a respondent who is the subject of an 18 12 application for involuntary commitment for a substance=related 18 13 disorder and who is taken into immediate custody shall be 18 14 released from custody prior to a commitment hearing if a 18 15 licensed physician or mental health professional examines the 18 16 respondent and determines that the respondent no longer meets 18 17 the criteria for custody and provides notification to the 18 18 court. 18 19 Under current law, the department of inspections and appeals 18 20 is required to issue a license to an applicant for a subacute 18 21 mental health care facility if the department of inspections 18 22 and appeals has ascertained that the applicant's facilities and 18 23 staff are adequate to provide the care and services required 18 24 of a subacute care facility. The bill strikes additional 18 25 conditions for licensure requiring the department of human 18 26 services to submit written approval of the application based 18 27 upon the process used by the department of human services 18 28 to identify the best qualified providers, prohibiting the 18 29 department of human services from approving an application 18 30 which would cause the number of publicly funded subacute 18 31 care facility beds to exceed 75 beds, and requiring that the 18 32 subacute care facility beds identified be new beds located in 18 33 hospitals and facilities licensed as a subacute care facility 18 34 under Code chapter 135G. 18 35 Under Code chapter 228, a mental health professional, data 19 1 collector, or employee or agent thereof, is prohibited from 19 2 disclosing or allowing the disclosure of an individual's 19 3 mental health information without the individual's consent or 19 4 written authorization. However, disclosure of such mental 19 5 health information without the individual's consent or written 19 6 authorization is allowed under certain circumstances, including 19 7 for certain administrative disclosures to other mental health 19 8 providers for administrative and professional services to 19 9 the individual and to meet certain compulsory disclosure 19 10 requirements pursuant to state or federal law. In addition, 19 11 the disclosure of certain limited mental health information is 19 12 allowed to authorized family members without the individual's 19 13 consent or written authorization in some circumstances. 19 14 The bill provides that a mental health professional shall 19 15 disclose mental health information, at the minimum consistent 19 16 with applicable laws and standards of ethical conduct, relating 19 17 to an individual without the individual's consent or written 19 18 permission to a law enforcement professional if the disclosure 19 19 is made in good faith, is necessary to prevent or lessen a 19 20 serious and imminent threat to the health or safety of the 19 21 individual or to a clearly identifiable victim or victims, 19 22 and the individual has the apparent intent and ability to 19 23 carry out the threat. The bill provides that a mental health 19 24 professional shall not be held criminally or civilly liable 19 25 for failure to disclose mental health information relating 19 26 to an individual to a law enforcement professional except in 19 27 circumstances where the individual has communicated to the 19 28 mental health professional an imminent threat of physical 19 29 violence against the individual's self or against a clearly 19 30 identifiable victim or victims. The bill provides that a 19 31 mental health professional discharges the professional's duty 19 32 to disclose under the bill by making reasonable efforts to 19 33 communicate the threat to a law enforcement professional. 19 34 The bill defines "law enforcement professional" to mean 19 35 a law enforcement officer as defined in Code section 80B.3 20 1 (an officer appointed by the director of the department of 20 2 natural resources, a member of the police force or other 20 3 agency or department of the state, county, city, or tribal 20 4 government regularly employed as such and who is responsible 20 5 for the prevention and detection of crime and the enforcement 20 6 of the criminal laws of this state and all individuals, as 20 7 determined by the council, who by the nature of their duties 20 8 may be required to perform the duties of a peace officer), 20 9 county attorney as defined in Code section 331.101 (the 20 10 county attorney, a deputy county attorney or an assistant 20 11 county attorney designated by the county attorney), probation 20 12 or parole officer, or jailer. "Mental health information" 20 13 is defined in Code section 228.1 to mean oral, written, 20 14 or recorded information which indicates the identity of an 20 15 individual receiving professional services and which relates to 20 16 the diagnosis, course, or treatment of the individual's mental 20 17 or emotional condition. 20 18 Under current law, a respondent who is the subject of 20 19 a petition for involuntary hospitalization due to the 20 20 respondent's serious mental impairment shall be examined by 20 21 one or more licensed physician or mental health professionals 20 22 within a reasonable time and a report shall be submitted to the 20 23 court. If the report of one or more of the court=designated 20 24 physicians or mental health professionals indicates that the 20 25 person is not seriously mentally impaired, the court, without 20 26 taking further action, may terminate the proceeding and dismiss 20 27 the application on its own motion and without notice. The 20 28 bill amends current law to provide that the court, under the 20 29 same circumstances and without taking further action, shall 20 30 terminate the proceeding and dismiss the application on its own 20 31 motion and without notice. 20 32 The bill provides that a respondent who is the subject of 20 33 an application for involuntary hospitalization for a serious 20 34 mental impairment and who is taken into immediate custody shall 20 35 be released from custody prior to the hospitalization hearing 21 1 if a licensed physician or mental health professional examines 21 2 the respondent and determines the respondent no longer meets 21 3 the criteria for custody and provides notification to the 21 4 court. 21 5 Under current law, during a hospitalization hearing for a 21 6 respondent with a serious mental impairment, the respondent's 21 7 welfare is paramount and the hearing shall be conducted in as 21 8 informal a manner as may be consistent with orderly procedure. 21 9 The bill provides that such a hearing may be held by video 21 10 conference at the discretion of the court. 21 11 Under current law, if a magistrate orders that a person with 21 12 mental illness be detained, the appropriate clerk of court 21 13 shall provide a copy of the written order or any separate 21 14 order to the chief medical officer of the facility or hospital 21 15 to which the person was originally taken, to any subsequent 21 16 facility to which the person was transported, and to any law 21 17 enforcement department or ambulance service that transported 21 18 the person pursuant to the magistrate's order. The bill 21 19 amends current law to provide that the clerk of court shall 21 20 also provide a copy of the written order or any separate order 21 21 to a transportation service under contract with a mental 21 22 health and disability services region that transported the 21 23 person pursuant to the magistrate's order. The bill provides 21 24 that a transportation service that contracts with a mental 21 25 health and disability services region shall provide a secure 21 26 transportation vehicle and shall employ staff that has received 21 27 or is receiving mental health training. 21 28 Under current law, each mental health and disability 21 29 services region is required to submit an annual report to the 21 30 department of human services on or before December 1. The 21 31 annual report is required to provide information on the actual 21 32 numbers of persons served, moneys expended, and outcomes 21 33 achieved. The bill provides each region shall additionally 21 34 submit a quarterly report to the department. Each quarterly 21 35 report shall provide information on the accessibility of 22 1 core services using forms and procedures established by the 22 2 department. The department shall combine and analyze the 22 3 reports and make the results public within 30 days of receipt 22 4 of all reports. 22 5 Under current law, subject to available appropriations, 22 6 the director of human services shall ensure that a mental 22 7 health and disability services region's core service domains 22 8 are covered services for the medical assistance program 22 9 under Code chapter 249A to the greatest extent allowable 22 10 under federal regulations. The bill provides the medical 22 11 assistance program shall reimburse Medicaid enrolled providers 22 12 for Medicaid covered core services when the services are 22 13 medically necessary, the Medicaid enrolled provider submits an 22 14 appropriate claim for such services, and no other third=party 22 15 payer is responsible for reimbursement of such services. 22 16 The bill provides that the administrative rules of the state 22 17 mental health and disability services commission relating to 22 18 the availability of mental health and disability services 22 19 shall, in addition to other mental health and disability 22 20 service requirements, provide for 22 assertive community 22 21 treatment teams, six access centers, and intensive residential 22 22 service homes that serve up to 120 persons statewide. 22 23 The bill provides that, to the extent matching federal 22 24 funding is available under the Iowa health and wellness plan, 22 25 intensive mental health services placed in strategic locations 22 26 throughout the state shall be provided within certain core 22 27 service domains including access centers that are located 22 28 in crisis residential and subacute residential settings, 22 29 assertive community treatment services, comprehensive facility 22 30 and community=based crisis services, subacute services, and 22 31 intensive residential service homes. 22 32 The bill directs the department of human services, in 22 33 coordination with the mental health and disability services 22 34 commission, to adopt rules pursuant to Code chapter 17A 22 35 relating to civil commitment prescreening assessments provided 23 1 by a mental health and disability services region or an entity 23 2 contracting with a mental health and disability services 23 3 region. The rules shall provide for the provision of civil 23 4 commitment prescreening assessments, ongoing consultations, 23 5 and appropriate documentation and reports by a licensed 23 6 physician or mental health professional and the coordination 23 7 of appropriate levels of care. 23 8 The bill provides the core services specified in the bill 23 9 shall be implemented and the department of human services 23 10 (department) shall adopt rules pursuant to Code chapter 17A 23 11 relating to the administration of such core services no later 23 12 than October 1, 2018. The provisions of the bill and rules 23 13 adopted in accordance with the bill shall not be interpreted to 23 14 delay or disrupt services or plans for the implementation of 23 15 such services in effect on July 1, 2018. 23 16 The bill requires rules adopted by the department relating 23 17 to access centers to meet certain criteria; include access 23 18 center designation criteria and standards that allow and 23 19 encourage multiple mental health and disability services 23 20 regions to strategically locate and share access center 23 21 services, including bill=back provisions to provide for 23 22 reimbursement of a region when the resident of another 23 23 region utilizes an access center located in that region; 23 24 direct Medicaid managed care organizations, regions, and law 23 25 enforcement to jointly select, develop, and implement six 23 26 access centers strategically located throughout the state 23 27 by December 31, 2019; require that Medicaid managed care 23 28 organizations reimburse Medicaid services provided at access 23 29 centers by Medicaid providers based on the reimbursement rate 23 30 floor established for the covered Medicaid service; and require 23 31 regions to provide start=up funding for the establishment of 23 32 the access centers jointly selected by the regions and Medicaid 23 33 managed care organizations and funding for non=Medicaid covered 23 34 services provided by the access centers. 23 35 The bill provides rules relating to assertive community 24 1 treatment (ACT) shall provide for certain statewide 24 2 accreditation standards for ACT based on national accreditation 24 3 standards, including allowances for nationally recognized 24 4 small team standards; require regions and Medicaid managed 24 5 care organizations to jointly agree on strategically located 24 6 geographic areas in which ACT teams should be developed upon 24 7 consideration of certain factors; direct Medicaid managed care 24 8 organizations to enter into contracts with jointly selected ACT 24 9 teams; require regions to provide start=up funding for the ACT 24 10 teams that are not established prior to July 1, 2018, including 24 11 for assistance in achieving fidelity to practice standards 24 12 and technical assistance; and require that mental health and 24 13 disability services regions ensure the efficient and effective 24 14 operation of ACT teams and provide funding for general 24 15 operations based on guidance provided by the department. 24 16 The bill provides the rules relating to intensive 24 17 residential service homes (IRSH) shall provide that an 24 18 intensive residential service home be enrolled with the Iowa 24 19 Medicaid enterprise as a 1915(i) home and community=based 24 20 services habilitation waiver or intellectual disability 24 21 waiver=supported community living provider; that an IRSH have 24 22 adequate staffing that includes appropriate specialty training 24 23 including applied behavior analysis as appropriate, adequate 24 24 direct care staffing rations, swift access to additional 24 25 staffing if serious incidents occur, and adequate pay and 24 26 paid time off commensurate with the increased intensity 24 27 of the services provided; coordinate with the individual's 24 28 clinical mental health and physical health treatment including 24 29 ensuring treatment plans are developed by a comprehensive 24 30 interdisciplinary team selected by the individual that develops 24 31 and implements the individual's person=centered plan, ensuring 24 32 access to active medication management and outpatient therapy 24 33 including evidence=based therapy approaches; establishing a 24 34 fully coordinated care plan, accessing assertive community 24 35 treatment if there is a demonstrated need, and developing a 25 1 thorough wellness recovery action plan, as appropriate; be 25 2 licensed as a substance abuse treatment program pursuant to 25 3 Code chapter 125 or have a cooperative agreement with and 25 4 timely access to licensed substance abuse treatment services 25 5 for those with a demonstrated need. 25 6 The bill provides the rules for an IRSH shall require an 25 7 IRSH to accept court=ordered commitments; have a high tolerance 25 8 for serious behavioral issues; have a no reject, no eject 25 9 policy for an individual referred to the home based on the 25 10 severity of the individual's mental health or co=occurring 25 11 needs; be smaller in size; determine length of stay based 25 12 on an individual basis using person=centered planning and 25 13 objective utilization review criteria; require Medicaid managed 25 14 care organizations and regions to jointly select and mutually 25 15 agree upon the strategic geographic locations of IRSHs; direct 25 16 Medicaid managed care organizations to enter into contracts 25 17 with jointly selected IRSHs; require regions to provide the 25 18 start=up funding for an IRSH that is not established prior 25 19 to July 1, 2018; and that contracts entered into between the 25 20 regions and the Medicaid managed care organizations shall 25 21 include objective utilization review criteria. The bill 25 22 also provides that the department of human services and the 25 23 department of public health shall provide a single statewide 25 24 24=hour crisis hotline that incorporates warmline services. 25 25 The bill directs the department of human services, 25 26 in cooperation with the department of public health, 25 27 representatives of the mental health institutes, Iowa hospital 25 28 association, Iowa health care association, managed care 25 29 organizations, the national alliance on mental illness, 25 30 and other affected or interested stakeholders to review the 25 31 commitment processes under Code chapters 125 and 229 and shall 25 32 report recommendations for improvements in the processes 25 33 and any amendments to law to increase efficiencies and more 25 34 appropriately utilize the array of mental health and disability 25 35 services available based upon an individual's needs to the 26 1 governor and the general assembly by December 31, 2018. 26 2 The bill directs the department of human services, 26 3 department of public health, and other affected or interested 26 4 stakeholders to review the role of tertiary care psychiatric 26 5 hospitals in the array of mental health services and shall 26 6 report recommendations for providing tertiary psychiatric 26 7 services to the governor and the general assembly by November 26 8 30, 2018. 26 9 The bill directs the department of human services to adopt 26 10 administrative rules to administer the bill. LSB 6024YH (12) 87 hb/rh
