Bill Text: IA HF2673 | 2023-2024 | 90th General Assembly | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: A bill for an act related to state behavioral health, disability, and addictive disorder services and related programs, including the transition of behavioral health services from a mental health and disability services system to a behavioral health service system, the transfer of disability services to the division of aging and disability services of the department of health and human services, the elimination of the commission on aging, the elimination of special intellectual disability units at state mental health institutes, making appropriations, and including effective date provisions. (Formerly HF 2509, HSB 653.) Effective date: 05/15/2024, 07/01/2024, 07/01/2025.

Spectrum: Committee Bill

Status: (Passed) 2024-05-24 - NOBA: Final [HF2673 Detail]

Download: Iowa-2023-HF2673-Amended.html

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House File 2673 - Reprinted
HOUSE FILE 2673
BY COMMITTEE ON APPROPRIATIONS
(SUCCESSOR TO HF 2509)
(SUCCESSOR TO HSB 653)
(As Amended and Passed by the House April 2, 2024 )
A BILL FOR
An Act related to state behavioral health, disability, and
addictive disorder services and related programs, including
the transition of behavioral health services from a mental
health and disability services system to a behavioral health
service system, the transfer of disability services to the
division of aging and disability services of the department
of health and human services, the elimination of the
commission on aging, the elimination of special intellectual
disability units at state mental health institutes, making
appropriations, and including effective date provisions.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
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DIVISION I
BEHAVIORAL HEALTH SERVICE SYSTEM
Section 1. NEW SECTION . 225A.1 Definitions.
As used in this chapter unless the context otherwise
requires:
1. “Administrative services organization” means an entity
designated by the department pursuant to section 225A.4, to
develop and perform planning and administrative services in
accordance with a district behavioral health service system
plan.
2. “Behavioral health condition” means a substantial
limitation in major life activities due to a mental,
behavioral, or addictive disorder or condition diagnosed in
accordance with the criteria provided in the most current
edition of the diagnostic and statistical manual of mental
disorders, published by the American psychiatric association.
3. “Behavioral health district” or “district” means a
geographic, multicounty, sub-state area as designated by the
department under section 225A.4.
4. “Behavioral health provider” or “provider” means an
individual, firm, corporation, association, or institution
that, pursuant to this chapter, is providing or has been
approved by the department to provide services to an individual
with a behavioral health condition.
5. “Behavioral health service system” means the behavioral
health service system established in section 225A.3.
6. “Caregiver” means an adult family member, or other
individual, who is providing care to a person outside of a
formal program.
7. “Community mental health center” means an entity
designated by the department to address the mental health needs
of one or more counties.
8. “Department” means the department of health and human
services.
9. “Director” means the director of the department of health
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and human services.
10. “District behavioral health advisory council”
or “advisory council” means a council established by an
administrative services organization under section 225A.5, to
identify opportunities, address challenges, and advise the
administrative services organization in accordance with section
225A.5.
11. “District behavioral health service system plan” or
“district behavioral health plan” means a plan developed by
an administrative services organization and approved by the
department to outline the services intended to be provided
within the administrative services organization’s behavioral
health district.
12. “Indicated prevention” means prevention activities
designed to prevent the onset of substance use disorders in
individuals who do not meet the medical criteria for addiction,
but who show early signs of developing a substance use disorder
in the future.
13. “Selective prevention” means prevention activities
designed to target subsets of the total population who are
considered at-risk for a substance use disorder by virtue of
their membership in a particular segment of the population.
Selective prevention targets the entire subgroup, regardless of
the degree of risk of any individual within the group.
14. “State behavioral health service system plan” or
“state behavioral health plan” means the plan developed by the
department that describes the key components of the state’s
behavioral health service system.
15. “Universal prevention” means prevention activities
designed to address an entire population class for the purpose
of preventing or delaying the use of alcohol, tobacco, and
other drugs. Population classes include but are not limited
to the national population, local populations, community
populations, school populations, and neighborhood populations.
Sec. 2. NEW SECTION . 225A.2 State mental health authority
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—— state agency for substance abuse.
1. The department is designated as the state mental health
authority as defined in 42 U.S.C. §201(m) for the purpose of
directing benefits from the federal community mental health
services block grant, 42 U.S.C. §300x et seq., and the state
authority designated for the purpose of directing benefits
from the federal substance abuse prevention and treatment
block grant, 42 U.S.C. §300x-21 et seq. This designation
does not preclude the state board of regents from authorizing
or directing any institution under the board of regents’
jurisdiction to carry out educational, prevention, and research
activities in the areas of mental health and intellectual
disability.
2. The department is designated as the single state agency
for substance abuse for the purposes of 42 U.S.C. §1396a et
seq.
3. For the purposes of effectuating the department’s roles
designated in this section, the department shall have the
following powers and the authority to take all of the following
actions:
a. Plan, establish, and maintain prevention, education,
early intervention, treatment, recovery support, and crisis
services programs as necessary or desirable for the behavioral
health service system established in section 225A.3.
b. Develop and submit a state plan as required by, and in
accordance with, 42 U.S.C. §300x-1.
c. Review and approve district behavioral health service
system plans developed in accordance with the state behavioral
health service system plan.
d. Perform all necessary acts to cooperate with any state
agency, political subdivision, or federal government agency to
apply for grants.
e. Solicit and accept for use any gift of money by will or
otherwise, and any grant of money or services from the federal
government, the state, or any political subdivision thereof,
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or any private source.
f. Collect and maintain records, engage in studies and
analyses, and gather relevant statistics.
g. Take any other actions as necessary to execute the
duties granted to the department in this chapter, or that
are otherwise required to maintain compliance with federal
requirements related to the department’s roles as designated in
this section.
Sec. 3. NEW SECTION . 225A.3 Behavioral health service
system —— department powers and duties.
1. a. A behavioral health service system is established
under the control of the department for the purposes of
implementing a statewide system of prevention, education, early
intervention, treatment, recovery support, and crisis services
related to mental health and addictive disorders, including but
not limited to alcohol use, substance use, tobacco use, and
problem gambling.
b. The behavioral health service system shall support
equitable statewide access to all services offered through
the behavioral health service system and offer specialized
services with a focus on at-risk populations including but not
limited to children, youth, young adults, individuals with
disabilities, pregnant and parenting women, older adults, and
people with limited access to financial resources.
c. Services offered through the behavioral health service
system shall, at a minimum, include all of the following:
(1) Prevention intervention services and education
programs designed to reduce and mitigate behavioral health
conditions and future behavioral health conditions. Prevention
intervention programs shall incorporate indicated prevention,
selective prevention, and universal prevention activities.
(2) Evidence-based and evidence-informed early intervention
and treatment services.
(3) Comprehensive recovery support services with a focus on
community-based services that avoid, divert, or offset the need
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for long-term inpatient services, law enforcement involvement,
or incarceration.
(4) Crisis services with a focus on reducing the escalation
of crisis situations, relieving the immediate distress of
individuals experiencing a crisis situation, and reducing the
risk that individuals in a crisis situation harm themselves.
2. To the extent funding is available, the department shall
perform all of the following duties to develop and administer
the behavioral health service system:
a. (1) Develop a state behavioral health service system
plan that accomplishes all of the following:
(a) Identifies the goals, objectives, and targeted outcomes
for the behavioral health service system.
(b) Identifies the strategies to meet system objectives and
ensure equitable access statewide to prevention, education,
early intervention, treatment, recovery support, and crisis
services.
(c) Is consistent with the state health improvement plan
developed under section 217.17.
(d) Is consistent with the department’s agency strategic
plan adopted pursuant to section 8E.206.
(2) The department shall do all of the following when
developing the state behavioral health service system plan:
(a) Collaborate with stakeholders including but not limited
to county supervisors and other local elected officials,
experienced behavioral health providers, and organizations that
represent populations, including but not limited to children,
served by the behavioral health service system.
(b) Publish the proposed state behavioral health service
system plan on the department’s internet site and allow the
public to review and comment on the proposed state behavioral
health system plan prior to the adoption of the proposed state
behavioral health plan.
b. Administer and distribute state appropriations, federal
aid, and grants that have been deposited into the behavioral
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health fund established in section 225A.7.
c. Oversee, provide technical assistance to, and
monitor administrative services organizations to ensure the
administrative services organizations’ compliance with district
behavioral health plans.
d. Collaborate with the department of inspections, appeals,
and licensing on the accreditation, certification, and
licensure of behavioral health providers including but not
limited to the approval, denial, revocation, or suspension of
a behavioral health provider’s accreditation, certification,
or licensure.
e. Develop and adopt minimum accreditation standards for
the maintenance and operation of community mental health
centers to ensure that each community mental health center,
and each entity that provides services under contract with a
community mental health center, furnishes high-quality mental
health services to the community that the community mental
health center serves in accordance with rules adopted by the
department.
f. Designate community mental health centers.
g. Conduct formal accreditation reviews of community mental
health centers based on minimum accreditation standards adopted
by the department pursuant to paragraph “e” .
h. Establish and maintain a data collection and management
information system to identify, collect, and analyze service
outcome and performance data to address the needs of patients,
providers, the department, and programs operating within the
behavioral health service system.
i. Collect, monitor, and utilize information including but
not limited to behavioral health service system patient records
and syndromic surveillance data to understand emerging needs,
and to deploy information, resources, and technical assistance
in response.
j. Adopt rules pursuant to chapter 17A to administer this
chapter. Such rules shall include but not be limited to rules
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that provide for all of the following:
(1) Minimum access standards to ensure equitable access to
services provided through the behavioral health service system
including but not limited to when services are available, who
is eligible for services, and where services are available.
(2) Methods to ensure each individual who is eligible
for services receives an uninterrupted continuum of care for
prevention, education, early intervention, treatment, recovery
support, and crisis services.
(3) Standards for the implementation and maintenance
of behavioral health programs and services offered by the
behavioral health service system, and by each administrative
services organization.
(4) Procedures for the management and oversight of
behavioral health providers to ensure compliance with the terms
of the behavioral health providers’ contracts relating to the
behavioral health service system, and with state and federal
law and rules.
(5) Procedures for the suspension of an administrative
services organization’s services due to the administrative
services organization’s failure to comply with the terms and
conditions of its contract with the department.
(6) Procedures for the reallocation of funds from
an administrative services organization that is not in
compliance with the terms of its contract with the department
to an alternative administrative services organization or
a behavioral health provider to provide for services the
noncompliant administrative services organization failed to
provide.
(7) Procedures for the termination of an administrative
services organization’s designation as an administrative
services organization.
(8) Procedures for the collection, utilization, and
maintenance of the data necessary to establish a central data
repository in accordance with section 225A.6.
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(9) Any other requirements the department deems necessary
to ensure that an administrative services organization
fulfills the administrative services organization’s duties
as established in this chapter, and as established in the
administrative services organization’s district behavioral
health plan.
Sec. 4. NEW SECTION . 225A.4 Behavioral health service
system —— districts and administrative services organizations.
1. a. The department shall divide the entirety of the
state into designated behavioral health districts. Behavioral
health prevention, education, early intervention, treatment,
recovery support, and crisis services related to mental health
and addictive disorders, including but not limited to alcohol
use, substance use, tobacco use, and problem gambling, shall
be made available through each behavioral health district in a
manner consistent with directives each district receives from
the department.
b. For the purpose of providing equitable access to all
services provided through the behavioral health service
system, the department shall consider all of the following when
designating behavioral health districts:
(1) City and county lines.
(2) The maximum population size that behavioral health
services available in an area are able to effectively serve.
(3) Areas of high need for behavioral health services.
(4) Patterns various populations exhibit when accessing or
receiving behavioral health services.
c. Notwithstanding chapter 17A, the manner in which the
department designates behavioral health districts including but
not limited to the determination of the boundaries for each
district shall not be subject to judicial review.
2. a. The department shall designate an administrative
services organization for each behavioral health district to
oversee and organize each district and the behavioral health
services associated with the district. The department shall
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issue requests for proposals for administrative services
organization candidates.
b. At the department’s discretion, the department may
designate any of the following entities as an administrative
services organization:
(1) An organization that coordinated administrative
services or mental health and disability services for a mental
health and disability services region formed on or before June
30, 2024.
(2) A public or private agency located in a behavioral
health district, or any separate organizational unit within the
public or private agency, that has the capabilities to engage
in the planning or provision of a broad range of behavioral
health prevention, education, early intervention, treatment,
recovery support, and crisis services related to mental health
and addictive disorders, including but not limited to alcohol
use, substance use, tobacco use, and problem gambling, only as
directed by the department.
c. The department shall consider all of the following
factors in determining whether to designate an entity as an
administrative services organization:
(1) Whether the entity has demonstrated the capacity to
manage and utilize available resources in a manner required of
an administrative services organization.
(2) Whether the entity has demonstrated the ability to
ensure the delivery of behavioral health services within the
district as required by the department by rule.
(3) Whether the entity has demonstrated the ability to
fulfill the monitoring, oversight, and provider compliance
responsibilities as required by the department by rule.
(4) Whether the entity has demonstrated the capacity to
function as a subrecipient for the purposes of the federal
community mental health services block grant, 42 U.S.C.
§300x et seq., and the federal substance abuse prevention and
treatment block grant, 42 U.S.C. §300x-21 et seq., and the
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ability to comply with all federal requirements applicable to
subrecipients under the block grants.
3. a. Upon designation by the department, an administrative
services organization shall be considered an instrumentality of
the state and shall adhere to all state and federal mandates
and prohibitions applicable to an instrumentality of the state.
b. An entity’s designation as an administrative services
organization shall continue until the designation is removed
by the department, the administrative services organization
withdraws, or a change in state or federal law necessitates the
removal of the designation.
4. Each administrative services organization shall function
as a subrecipient for the purposes of the federal community
mental health services block grant, 42 U.S.C. §300x et seq.,
and the federal substance abuse prevention and treatment block
grant, 42 U.S.C. §300x-21 et seq., and shall comply with all
federal requirements applicable to subrecipients under the
block grants.
5. Each administrative services organization shall perform
all of the following duties:
a. Develop and administer a district behavioral health plan
in accordance with the standards adopted by the department by
rule.
b. Coordinate the administration of the district behavioral
health plan with federal, state, and local resources in order
to develop a comprehensive and coordinated local behavioral
health service system.
c. Enter into contracts necessary to provide services under
the district behavioral health plan.
d. Oversee, provide technical assistance to, and monitor
the compliance of providers contracted by the administrative
services organization to provide behavioral health services in
accordance with the district behavioral health plan.
e. Establish a district behavioral health advisory council
pursuant to section 225A.5.
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Sec. 5. NEW SECTION . 225A.5 District behavioral health
advisory councils.
1. Each administrative services organization shall
establish a district behavioral health advisory council that
shall do all of the following:
a. Identify opportunities and address challenges based on
updates received from the administrative services organization
regarding the implementation of the district behavioral health
plan.
b. Advise the administrative services organization while the
administrative services organization is developing behavioral
health policies.
c. Advise the administrative services organization on
how to best provide access to behavioral health prevention,
education, early intervention, treatment, recovery support,
and crisis services related to mental health and addictive
disorders, including but not limited to alcohol use, substance
use, tobacco use, and problem gambling, throughout the district
as directed by the department.
2. An advisory council shall consist of ten members.
Members shall be appointed by the administrative services
organization subject to the following requirements:
a. Three members shall be local elected public officials
currently holding office within the behavioral health district,
or the public official’s designated representative.
b. Three members shall be chosen in accordance with
procedures established by the administrative services
organization to ensure representation of the populations
served within the behavioral health district. At least one
member chosen under this paragraph shall represent child and
adolescent persons.
c. Three members shall be chosen who have experience
or education related to core behavioral health functions,
essential behavioral health services, behavioral health
prevention, behavioral health treatment, population-based
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behavioral health services, or community-based behavioral
health initiatives.
d. One member shall be a law enforcement representative from
within the behavioral health district.
3. An advisory council shall perform the duties required
under this section regardless of whether any seat on the
advisory council is vacant.
Sec. 6. NEW SECTION . 225A.6 Behavioral health service
system —— data collection and use.
1. The department shall take all of the following actions
for data related to the behavioral health service system:
a. Collect and analyze the data, including but not
limited to Medicaid and community services network data, as
necessary to issue cost estimates for serving populations,
providing treatment, making and receiving payments, conducting
operations, and performing prevention and health promotion
activities. In doing so, the department shall maintain
compliance with applicable federal and state privacy laws
to ensure the confidentiality and integrity of individually
identifiable data. The department shall periodically assess
the status of the department’s compliance to ensure that data
collected by and stored with the department is protected.
b. Establish and administer a central data repository for
collecting and analyzing state, behavioral health district, and
contracted behavioral health provider data.
c. Establish a record for each individual receiving publicly
funded services from an administrative services organization.
Each record shall include a unique client identifier for the
purposes of identifying and tracking the individual’s record.
d. Consult with administrative services organizations,
behavioral health service providers, and other behavioral
health service system stakeholders on an ongoing basis to
implement and maintain the central data repository.
e. Engage with all entities that maintain information the
department is required to collect pursuant to this section in
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order to integrate all data concerning individuals receiving
services within the behavioral health service system.
f. Engage with all entities that maintain general population
data relating to behavioral health in order to develop action
plans, create projections relating to a population’s behavioral
health needs, develop policies concerning behavioral health,
and otherwise perform acts as necessary to enhance the state’s
overall behavioral health.
2. Administrative services organizations shall report all
data required to be maintained in the central data repository
to the department in a manner as established by the department
by rule. For the purpose of making such data reports, an
administrative services organization shall do one of the
following:
a. Utilize a data system that integrates with the data
systems used by the department.
b. Utilize a data system that has the capacity to securely
exchange information with the department, other behavioral
health districts, contractors, and other entities involved with
the behavioral health service system who are authorized to
access the central data repository.
3. Data and information maintained by and exchanged between
an administrative services organization and the department
shall be labeled consistently, share the same definitions,
utilize the same common coding and nomenclature, and be in a
form and format as required by the department by rule.
4. Administrative services organizations shall report
to the department, in a manner specified by the department,
information including but not limited to demographic
information, expenditure data, and data concerning the
behavioral health services and other support provided to
individuals in the administrative service organization’s
district.
5. The department shall ensure that public and private
agencies, organizations, and individuals that operate within
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the behavioral health service system, or that make formal
requests for the release of data collected by the department,
maintain uniform methods for keeping statistical information
relating to behavioral health service system outcomes and
performance.
6. The department shall develop and implement a
communication plan that details how outcome and performance
data will be shared with stakeholders including but not limited
to the public, persons involved with the behavioral health
service system, and the general assembly.
Sec. 7. NEW SECTION . 225A.7 Behavioral health fund.
1. For purposes of this section:
a. “Population” means, as of July 1 of the fiscal year
preceding the fiscal year in which the population figure is
applied, the population shown by the latest preceding certified
federal census or the latest applicable population estimate
issued by the United States census bureau, whichever is most
recent.
b. “State growth factor” for a fiscal year means an amount
equal to the dollar amount used to calculate the appropriation
under this section for the immediately preceding fiscal year
multiplied by the percent increase, if any, in the amount of
sales tax revenue deposited into the general fund of the state
under section 423.2A, subsection 1, paragraph “a” , less the
transfers required under section 423.2A, subsection 2, between
the fiscal year beginning three years prior to the applicable
fiscal year and the fiscal year beginning two years prior
to the applicable year, but not to exceed one and one-half
percent.
2. A behavioral health fund is established in the state
treasury under the control of the department. The fund shall
consist of moneys deposited into the fund pursuant to this
section and section 426B.1, gifts of money or property accepted
by the state or the department to support any services under
this chapter or chapter 231, and moneys otherwise appropriated
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by the general assembly. Moneys in the fund are appropriated
to the department to implement and administer the behavioral
health service system and related programs including but not
limited to all of the following:
a. Distributions to administrative services organizations
to provide services as outlined in the organizations’ district
behavioral health plan.
b. Distributions to providers of mental health services
and addictive disorder services, including but not limited to
tobacco use services, substance use disorder services, and
problem gambling services.
c. Funding of disability services pursuant to chapter 231.
This paragraph is repealed July 1, 2028.
d. Administrative costs associated with services described
under this subsection.
3. For the fiscal year beginning July 1, 2025, there
is transferred from the general fund of the state to the
behavioral health fund an amount equal to forty-two dollars
multiplied by the state’s population for the fiscal year.
4. For the fiscal year beginning July 1, 2026, and each
succeeding fiscal year, there is transferred from the general
fund of the state to the behavioral health fund an amount equal
to the state’s population for the fiscal year multiplied by
the sum of the dollar amount used to calculate the transfer
from the general fund to the behavioral health fund for the
immediately preceding fiscal year, plus the state growth factor
for the fiscal year for which the transfer is being made.
5. For each fiscal year, an administrative services
organization shall not spend on administrative costs an amount
more than seven percent of the total amount distributed to the
administrative services organization through this section and
all other appropriations for the same fiscal year.
6. Moneys in the behavioral health fund may be used by the
department for cash flow purposes, provided that any moneys so
allocated are returned to the behavioral health fund by the end
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of each fiscal year.
7. Notwithstanding section 12C.7, subsection 2, interest
or earnings on moneys deposited in the behavioral health fund
shall be credited to the behavioral health fund.
8. Notwithstanding section 8.33, moneys appropriated in
this section that remain unencumbered or unobligated at the
close of the fiscal year shall not revert but shall remain
available for expenditure for the purposes designated.
Sec. 8. NEW SECTION . 225A.8 Addictive disorders prevention
—— prohibitions.
1. For purposes of this section, “entity” means a
manufacturer, distributor, wholesaler, retailer, or
distributing agent, or an agent of a manufacturer, distributor,
wholesaler, retailer, or distributing agent as those terms are
defined in section 453A.1.
2. To promote comprehensive tobacco use prevention and
control initiatives outlined in the state behavioral health
service system plan, an entity shall not perform any of the
following acts:
a. Give away cigarettes or tobacco products.
b. Provide free articles, products, commodities, gifts, or
concessions in any exchange for the purchase of cigarettes or
tobacco products.
3. The prohibitions in this section shall not apply to
transactions between manufacturers, distributors, wholesalers,
or retailers as those terms are defined in section 453A.1.
Sec. 9. NEW SECTION . 225A.9 Application for services ——
minors.
A minor who is twelve years of age or older shall have
the legal capacity to act and give consent to the provision
of tobacco cessation coaching services pursuant to a tobacco
cessation telephone and internet-based program approved by
the department through the behavioral health service system
established in section 225A.3. Consent shall not be subject to
later disaffirmance by reason of such minority. The consent of
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another person, including but not limited to the consent of a
spouse, parent, custodian, or guardian, shall not be necessary.
Sec. 10. CODE EDITOR DIRECTIVE. The Code editor is directed
to do all of the following:
1. Designate sections 225A.1 through 225A.9, as enacted
in this division of this Act, as Code chapter 225A entitled
“Department of Health and Human Services —— Behavioral Health
Service System”.
2. Correct internal references in the Code and in any
enacted legislation as necessary due to the enactment of this
division of this Act.
Sec. 11. EFFECTIVE DATE. This division of this Act takes
effect July 1, 2025.
DIVISION II
BEHAVIORAL HEALTH SERVICE SYSTEM —— CONFORMING CHANGES
Sec. 12. Section 11.6, subsection 1, paragraph b, Code 2024,
is amended to read as follows:
b. The financial condition and transactions of community
mental health centers organized under chapter 230A , substance
use disorder programs organized licensed under chapter 125 , and
community action agencies organized under chapter 216A , shall
be audited at least once each year.
Sec. 13. Section 97B.1A, subsection 8, paragraph a,
subparagraph (13), Code 2024, is amended by striking the
subparagraph.
Sec. 14. Section 123.17, subsection 5, Code 2024, is amended
to read as follows:
5. After any transfer provided for in subsection 3 is made,
the department shall transfer into a special revenue account
in the general fund of the state, a sum of money at least equal
to seven percent of the gross amount of sales made by the
department from the beer and liquor control fund on a monthly
basis but not less than nine million dollars annually. Of
the amounts transferred, two three million dollars, plus an
additional amount determined by the general assembly, shall be
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appropriated to the department of health and human services for
use by the staff who administer the comprehensive substance use
disorder program under chapter 125 for substance use disorder
treatment and prevention programs shall be transferred to the
behavioral health fund established under section 225A.7 . Any
amounts received in excess of the amounts appropriated to the
department of health and human services for use by the staff
who administer the comprehensive substance use disorder program
under chapter 125 transferred to the behavioral health fund
shall be considered part of the general fund balance.
Sec. 15. Section 123.17, subsection 8, Code 2024, is amended
by striking the subsection.
Sec. 16. Section 123.17, subsection 9, Code 2024, is amended
to read as follows:
9. After any transfers provided for in subsections 3, 5,
6, and 7 , and 8 are made, and before any other transfer to the
general fund, the department shall transfer to the economic
development authority from the beer and liquor control fund the
lesser of two hundred fifty thousand dollars or one percent of
the gross sales of native distilled spirits by all class “A”
native distilled spirits license holders made by the department
for the purposes of promoting Iowa wine, beer, and spirits.
Sec. 17. Section 124.409, subsection 2, Code 2024, is
amended by striking the subsection.
Sec. 18. Section 125.2, subsections 4, 5, and 10, Code 2024,
are amended by striking the subsections.
Sec. 19. Section 125.91, subsection 1, Code 2024, is amended
to read as follows:
1. The procedure prescribed by this section shall only
be used for a person with a substance use disorder due to
intoxication or substance-induced incapacitation who has
threatened, attempted, or inflicted physical self-harm or harm
on another, and is likely to inflict physical self-harm or harm
on another unless immediately detained, or who is incapacitated
by a chemical substance, if an application has not been filed
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naming the person as the respondent pursuant to section 125.75
and the person cannot be ordered into immediate custody and
detained pursuant to section 125.81 .
Sec. 20. Section 125.93, Code 2024, is amended to read as
follows:
125.93 Commitment records —— confidentiality.
Records of the identity, diagnosis, prognosis, or treatment
of a person which are maintained in connection with the
provision of substance use disorder treatment services are
confidential, consistent with the requirements of section
125.37 , and with the federal confidentiality regulations
authorized by the federal Drug Abuse Office and Treatment Act ,
42 U.S.C. §290ee and the federal Comprehensive Alcohol Abuse
and Alcoholism Prevention, Treatment and Rehabilitation Act, 42
U.S.C. §290dd-2. However, such records may be disclosed to an
employee of the department of corrections, if authorized by the
director of the department of corrections, or to an employee
of a judicial district department of correctional services, if
authorized by the director of the judicial district department
of correctional services.
Sec. 21. Section 135.11, subsection 11, Code 2024, is
amended to read as follows:
11. Administer chapters 125, 136A , 136C , 139A , 142 , 142A ,
144 , and 147A .
Sec. 22. Section 135C.2, subsection 5, unnumbered paragraph
1, Code 2024, is amended to read as follows:
The department shall establish a special classification
within the residential care facility category in order to
foster the development of residential care facilities which
serve persons with an intellectual disability, chronic mental
illness, a developmental disability, or brain injury, as
described under section 225C.26 , and which contain five or
fewer residents. A facility within the special classification
established pursuant to this subsection is exempt from the
requirements of section 10A.713 . The department shall adopt
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rules which are consistent with rules previously developed for
the waiver demonstration waiver project pursuant to 1986 Iowa
Acts, ch. 1246, §206 , and which include all of the following
provisions:
Sec. 23. Section 135C.6, subsection 1, Code 2024, is amended
to read as follows:
1. A person or governmental unit acting severally or
jointly with any other person or governmental unit shall not
establish or operate a health care facility in this state
without a license for the facility. A supported community
living service, as defined in section 225C.21 249A.38A , is not
required to be licensed under this chapter , but is subject to
approval under section 225C.21 249A.38A in order to receive
public funding.
Sec. 24. Section 135C.23, subsection 1, unnumbered
paragraph 1, Code 2024, is amended to read as follows:
Each resident shall be covered by a contract executed
by the resident, or the resident’s legal representative,
and the health care facility at or prior to the time of the
resident’s admission or prior thereto by the resident, or the
legal representative, and the health care facility, except as
otherwise provided by subsection 5 with respect to residents
admitted at public expense to a county care facility operated
under chapter 347B . Each party to the contract shall be
entitled to a duplicate of the original thereof contract , and
the health care facility shall keep on file all contracts
which it has with residents and shall not destroy or otherwise
dispose of any such contract for at least one year after its
expiration. Each such contract shall expressly set forth:
Sec. 25. Section 135C.23, subsection 2, paragraph b, Code
2024, is amended to read as follows:
b. This section does not prohibit the admission of a
patient with a history of dangerous or disturbing behavior to
an intermediate care facility for persons with mental illness,
intermediate care facility for persons with an intellectual
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disability, or nursing facility , or county care facility when
the intermediate care facility for persons with mental illness,
intermediate care facility for persons with an intellectual
disability, or nursing facility , or county care facility has a
program which has received prior approval from the department
to properly care for and manage the patient. An intermediate
care facility for persons with mental illness, intermediate
care facility for persons with an intellectual disability,
or nursing facility , or county care facility is required to
transfer or discharge a resident with dangerous or disturbing
behavior when the intermediate care facility for persons with
mental illness, intermediate care facility for persons with an
intellectual disability, or nursing facility , or county care
facility cannot control the resident’s dangerous or disturbing
behavior. The department , in coordination with the state
mental health and disability services commission created in
section 225C.5 , shall adopt rules pursuant to chapter 17A for
programs to be required in intermediate care facilities for
persons with mental illness, intermediate care facilities
for persons with an intellectual disability, and nursing
facilities , and county care facilities that admit patients
or have residents with histories of dangerous or disturbing
behavior.
Sec. 26. Section 135C.23, subsection 5, Code 2024, is
amended by striking the subsection.
Sec. 27. Section 135C.24, subsection 5, Code 2024, is
amended by striking the subsection.
Sec. 28. Section 135G.1, subsection 12, Code 2024, is
amended to read as follows:
12. a. “Subacute mental health services” means the same
as defined in section 225C.6 services that provide all of the
following:
(1) A comprehensive set of wraparound services for a
person who has had, or is at imminent risk of having, acute or
crisis mental health symptoms that do not permit the person to
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remain in or threatens removal of the person from the person’s
home and community, but who has been determined by a mental
health professional and a licensed health care professional,
subject to the professional’s scope of practice, not to need
inpatient acute hospital services. For the purposes of this
subparagraph, “licensed health care professional” means a person
licensed under chapter 148, an advanced registered nurse
practitioner, or a physician assistant.
(2) Intensive, recovery-oriented treatment and monitoring
of a person. Treatment may be provided directly or remotely
by a licensed psychiatrist or an advanced registered nurse
practitioner.
(3) An outcome-focused, interdisciplinary approach designed
to return a person to living successfully in the community.
b. Subacute mental health services may include services
provided in a wide array of settings ranging from a person’s
home to a specialized facility with restricted means of egress.
c. Subacute mental health services shall be limited to a
period not to exceed ten calendar days or another time period
determined in accordance with rules adopted by the department
for this purpose, whichever is longer .
Sec. 29. Section 142.1, Code 2024, is amended to read as
follows:
142.1 Delivery of bodies.
The body of every person dying who died in a public asylum,
hospital, county care facility, penitentiary, or reformatory
in this state, or found dead within the state, or which who
is to be buried at public expense in this state, except those
buried under the provisions of chapter 144C or 249 , and which
is suitable for scientific purposes, shall be delivered to the
medical college of the state university, or some osteopathic
or chiropractic college or school located in this state, which
has been approved under the law regulating the practice of
osteopathic medicine or chiropractic; but no such body shall
be delivered to any such college or school if the deceased
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person expressed a desire during the person’s last illness
that the person’s body should be buried or cremated, nor if
such is the desire of the person’s relatives. Such bodies
shall be equitably distributed among said colleges and schools
according to their needs for teaching anatomy in accordance
with such rules as may be adopted by the department of health
and human services. The expense of transporting said bodies to
such college or school shall be paid by the college or school
receiving the same. If the deceased person has not expressed
a desire during the person’s last illness that the person’s
body should be buried or cremated and no person authorized to
control the deceased person’s remains under section 144C.5
requests the person’s body for burial or cremation, and if a
friend objects to the use of the deceased person’s body for
scientific purposes, said deceased person’s body shall be
forthwith delivered to such friend for burial or cremation at
no expense to the state or county. Unless such friend provides
for burial and burial expenses within five days, the body shall
be used for scientific purposes under this chapter .
Sec. 30. Section 142.3, Code 2024, is amended to read as
follows:
142.3 Notification of department.
Every county medical examiner, funeral director or embalmer,
and the managing officer of every public asylum, hospital,
county care facility, penitentiary, or reformatory, as soon as
any dead body shall come into the person’s custody which may be
used for scientific purposes as provided in sections 142.1 and
142.2 , shall at once notify the nearest relative or friend of
the deceased, if known, and the department of health and human
services, and hold such body unburied for forty-eight hours.
Upon receipt of notification, the department shall issue verbal
or written instructions relative to the disposition to be made
of said body. Complete jurisdiction over said bodies is vested
exclusively in the department of health and human services. No
autopsy or post mortem, except as are legally ordered by county
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medical examiners, shall be performed on any of said bodies
prior to their delivery to the medical schools.
Sec. 31. NEW SECTION . 217.17 State health improvement plan.
1. The department shall develop, implement, and administer
a state health improvement plan to identify health priorities,
goals, and measurable objectives, and outline strategies to
improve health statewide.
2. The state health improvement plan shall be developed
and updated in collaboration and in coordination with other
state departments, stakeholders, and statewide organizations
the department determines to be relevant.
3. The state health improvement plan may be updated by the
department at the department’s discretion.
Sec. 32. NEW SECTION . 217.37 Recovery of payment ——
assignment of liens —— county attorney to enforce.
1. For purposes of this section, “assistance” means all of
the following:
a. A payment by the state for services rendered through
the behavioral health service system established under section
225A.3.
b. A payment by the state for aging and disability services
rendered in accordance with chapter 231.
2. The department shall have the authority to investigate if
a person is eligible to have assistance paid on the person’s
behalf and whether payment of assistance was proper.
3. Notwithstanding any provision of law to the contrary,
assistance shall not be recoverable unless the department
finds that the assistance was paid for the benefit of a person
who was not entitled to have assistance paid on the person’s
behalf.
4. Assistance paid for the benefit of a person who was
not entitled to have assistance paid on the person’s behalf
shall be recoverable from the entity to which the assistance
was paid, from the person on whose behalf assistance was paid,
or from a third party who is liable for the person’s debts or
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support.
5. Upon the death of a person who was not entitled to
have assistance paid on the person’s behalf, the department
shall have a lien equivalent in priority to liens described
in section 633.425, subsection 6, against the person’s estate
for the portion of the assistance improperly paid which the
department had not recovered at the time of the person’s death.
6. The department may waive all or a portion of improperly
paid assistance, or a lien created under subsection 5, if
the department finds that collection would result in undue
hardship.
7. The department shall adopt rules pursuant to chapter 17A
to implement and administer this section.
Sec. 33. Section 218.30, Code 2024, is amended to read as
follows:
218.30 Investigation of other facilities.
The director may investigate or cause the investigation of
charges of abuse, neglect, or mismanagement on the part of an
officer or employee of a private facility which is subject to
the director’s supervision or control. The director shall also
investigate or cause the investigation of charges concerning
county care facilities in which persons with mental illness are
served.
Sec. 34. Section 218.78, subsection 1, Code 2024, is amended
to read as follows:
1. All institutional receipts of the department, including
funds received from client participation at the state resource
centers under section 222.78 and at the state mental health
institutes under section 230.20 , shall be deposited in the
general fund except for reimbursements for services provided
to another institution or state agency, for receipts deposited
in the revolving farm fund under section 904.706 , for deposits
into the medical assistance fund under section 249A.11 , and for
rentals charged to employees or others for room, apartment, or
house and meals, which shall be available to the institutions.
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Sec. 35. Section 222.1, subsection 1, Code 2024, is amended
to read as follows:
1. This chapter addresses the public and private services
available in this state to meet the needs of persons with an
intellectual disability. The responsibility of the mental
health and disability services regions formed by counties and
of the state for the costs and administration of publicly
funded services shall be as set out in section 222.60 and other
pertinent sections of this chapter .
Sec. 36. Section 222.2, Code 2024, is amended by adding the
following new subsection:
NEW SUBSECTION . 01. “Administrative services organization”
means the same as defined in section 225A.1.
Sec. 37. Section 222.2, subsections 6 and 7, Code 2024, are
amended by striking the subsections.
Sec. 38. Section 222.12, subsection 2, Code 2024, is amended
by striking the subsection.
Sec. 39. Section 222.13, Code 2024, is amended to read as
follows:
222.13 Voluntary admissions.
1. If an adult person is believed to be a person with an
intellectual disability, the adult person or the adult person’s
guardian may apply to the department and the superintendent of
any state resource center for the voluntary admission of the
adult person either as an inpatient or an outpatient of the
resource center. If the expenses of the person’s admission
or placement are payable in whole or in part by the person’s
county of residence, application for the admission shall be
made through the regional administrator. An application for
admission to a special unit of any adult person believed to be
in need of any of the services provided by the special unit
under section 222.88 may be made in the same manner. The
superintendent shall accept the application if a preadmission
diagnostic evaluation confirms or establishes the need for
admission, except that an application shall not be accepted if
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the institution does not have adequate facilities available or
if the acceptance will result in an overcrowded condition.
2. If the resource center does not have an appropriate
program for the treatment of an adult or minor person with an
intellectual disability applying under this section or section
222.13A , the regional administrator for the person’s county
of residence or the department , as applicable, shall arrange
for the placement of the person in any public or private
facility within or without outside of the state, approved by
the director, which offers appropriate services for the person.
If the expenses of the placement are payable in whole or in
part by a county, the placement shall be made by the regional
administrator for the county.
3. If the expenses of an admission of an adult to a resource
center or a special unit, or of the placement of the person
in a public or private facility are payable in whole or in
part by a mental health and disability services region, the
regional administrator shall make a full investigation into
the financial circumstances of the person and those liable for
the person’s support under section 222.78 to determine whether
or not any of them are able to pay the expenses arising out of
the admission of the person to a resource center, special unit,
or public or private facility. If the regional administrator
finds that the person or those legally responsible for
the person are presently unable to pay the expenses, the
regional administrator shall pay the expenses. The regional
administrator may review such a finding at any subsequent
time while the person remains at the resource center, or is
otherwise receiving care or treatment for which this chapter
obligates the region to pay. If the regional administrator
finds upon review that the person or those legally responsible
for the person are presently able to pay the expenses, the
finding shall apply only to the charges incurred during the
period beginning on the date of the review and continuing
thereafter, unless and until the regional administrator again
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changes such a finding. If the regional administrator finds
that the person or those legally responsible for the person
are able to pay the expenses, the regional administrator shall
collect the charges to the extent required by section 222.78 ,
and the regional administrator shall be responsible for the
payment of the remaining charges.
Sec. 40. Section 222.13A, subsections 3 and 4, Code 2024,
are amended to read as follows:
3. During the preadmission diagnostic evaluation, the
minor shall be informed both orally and in writing that the
minor has the right to object to the voluntary admission. If
Notwithstanding section 222.33, if the preadmission diagnostic
evaluation determines that the voluntary admission is
appropriate but the minor objects to the admission, the minor
shall not be admitted to the state resource center unless the
court approves of the admission. A petition for approval of
the minor’s admission may be submitted to the juvenile court by
the minor’s parent, guardian, or custodian.
4. As soon as practicable after the filing of a petition for
approval of the voluntary admission, the court shall determine
whether the minor has an attorney to represent the minor in the
proceeding. If the minor does not have an attorney, the court
shall assign an attorney to the minor an attorney . If the
minor is unable to pay for an attorney, the attorney shall be
compensated by the mental health and disability services region
an administrative services organization at an hourly rate to be
established by the regional administrator in substantially the
same manner as provided in section 815.7 .
Sec. 41. Section 222.14, Code 2024, is amended to read as
follows:
222.14 Care by region pending admission.
If the institution is unable to receive a patient, the
superintendent shall notify the regional administrator
for the county of residence of the prospective patient an
administrative services organization . Until such time as the
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patient is able to be received by the institution, or when
application has been made for admission to a public or private
facility as provided in section 222.13 and the application
is pending, the care of the patient shall be provided as
arranged by the regional administrator administrative services
organization .
Sec. 42. NEW SECTION . 222.33 State resource center ——
admissions and discharge.
1. The department shall make all final determinations
concerning whether a person may be admitted to a state resource
center.
2. If a patient is admitted to a state resource center
pursuant to section 222.13 or 222.13A, and the patient
wishes to be placed outside of the state resource center, the
discharge of the patient shall be made in accordance with
section 222.15.
Sec. 43. NEW SECTION . 222.35 State —— payor of last resort.
The department shall implement services and adopt rules
pursuant to chapter 17A in a manner that ensures that the state
is the payor of last resort, and that the department shall not
make any payments for services that have been provided until
the department has determined that the services provided are
not payable by a third-party source.
Sec. 44. Section 222.73, subsections 2 and 4, Code 2024, are
amended by striking the subsections.
Sec. 45. Section 222.77, Code 2024, is amended to read as
follows:
222.77 Patients on leave.
The cost of support of patients placed on convalescent leave
or removed as a habilitation measure from a resource center,
or a special unit, except when living in the home of a person
legally bound for the support of the patient, shall be paid by
the county of residence or the state as provided in section
222.60 .
Sec. 46. Section 222.78, subsection 1, Code 2024, is amended
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to read as follows:
1. The father and mother of any patient admitted to a
resource center or to a special unit , as either an inpatient
or an outpatient, and any person, firm, or corporation bound
by contract made for support of the patient , are liable for
the support of the patient. The patient and those legally
bound for the support of the patient shall be liable to
the county or state , as applicable, for all sums advanced
in accordance with the provisions of sections 222.60 and
222.77 relating to reasonable attorney fees and court costs for
the patient’s admission to the resource center, and for the
treatment, training, instruction, care, habilitation, support,
transportation, or other expenditures made on behalf of the
patient pursuant to this chapter .
Sec. 47. Section 222.79, Code 2024, is amended to read as
follows:
222.79 Certification statement presumed correct.
In actions to enforce the liability imposed by section
222.78 , the superintendent or the county of residence, as
applicable, shall submit a certification statement stating
the sums charged, and the certification statement shall be
considered presumptively correct.
Sec. 48. Section 222.80, Code 2024, is amended to read as
follows:
222.80 Liability to county or state.
A person admitted to a county institution or home or admitted
at county or state expense to a private hospital, sanitarium,
or other facility for treatment, training, instruction, care,
habilitation, and support as a patient with an intellectual
disability shall be liable to the county or state , as
applicable, for the reasonable cost of the support as provided
in section 222.78 .
Sec. 49. Section 222.82, Code 2024, is amended to read as
follows:
222.82 Collection of liabilities and claims.
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If liabilities and claims exist as provided in section
222.78 or any other provision of this chapter , the county of
residence or the state , as applicable, may proceed as provided
in this section . If the liabilities and claims are owed to
a county of residence, the county’s board of supervisors may
direct the county attorney to proceed with the collection of
the liabilities and claims as a part of the duties of the
county attorney’s office when the board of supervisors deems
such action advisable. If the liabilities and claims are owed
to the state, the state shall proceed with the collection.
The board of supervisors or the state , as applicable, may
compromise any and all liabilities to the county or state
arising under this chapter when such compromise is deemed to be
in the best interests of the county or state. Any collections
and liens shall be limited in conformance to section 614.1,
subsection 4 .
Sec. 50. Section 222.85, subsection 2, Code 2024, is amended
to read as follows:
2. Moneys paid to a resource center from any source other
than state appropriated funds and intended to pay all or a
portion of the cost of care of a patient, which cost would
otherwise be paid from state or county funds or from the
patient’s own funds, shall not be deemed “funds belonging to a
patient” for the purposes of this section .
Sec. 51. Section 222.86, Code 2024, is amended to read as
follows:
222.86 Payment for care from fund.
If a patient is not receiving medical assistance under
chapter 249A and the amount in the account of any patient
in the patients’ personal deposit fund exceeds two hundred
dollars, the department may apply any amount of the excess to
reimburse the county of residence or the state for liability
incurred by the county or the state for the payment of care,
support, and maintenance of the patient , when billed by the
county or state , as applicable .
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Sec. 52. Section 222.92, subsection 1, Code 2024, is amended
to read as follows:
1. The department shall operate the state resource centers
on the basis of net appropriations from the general fund of
the state. The appropriation amounts shall be the net amounts
of state moneys projected to be needed for the state resource
centers for the fiscal year of the appropriations. The purpose
of utilizing net appropriations is to encourage the state
resource centers to operate with increased self-sufficiency, to
improve quality and efficiency, and to support collaborative
efforts between the state resource centers and counties and
other providers of funding for the services available from
the state resource centers. The state resource centers shall
not be operated under the net appropriations in a manner that
results in a cost increase to the state or in cost shifting
between the state, the medical assistance program, counties, or
other sources of funding for the state resource centers.
Sec. 53. Section 222.92, subsection 3, paragraph a, Code
2024, is amended by striking the paragraph.
Sec. 54. Section 225.1, subsection 2, Code 2024, is amended
to read as follows:
2. For the purposes of this chapter , unless the context
otherwise requires:
a. “Mental health and disability services region” means
a mental health and disability services region approved in
accordance with section 225C.56 . “Administrative services
organization” means the same as defined in section 225A.1.
b. “Regional administrator” means the administrator of a
mental health and disability services region, as defined in
section 225C.55 . “Department” means the department of health
and human services.
c. “Respondent” means the same as defined in section 229.1 .
Sec. 55. NEW SECTION . 225.4 State psychiatric hospital ——
admissions.
The department shall make all final determinations
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concerning whether a person may be admitted to the state
psychiatric hospital.
Sec. 56. Section 225.11, Code 2024, is amended to read as
follows:
225.11 Initiating commitment procedures.
When a court finds upon completion of a hearing held pursuant
to section 229.12 that the contention that a respondent is
seriously mentally impaired has been sustained by clear and
convincing evidence, and the application filed under section
229.6 also contends or the court otherwise concludes that it
would be appropriate to refer the respondent to the state
psychiatric hospital for a complete psychiatric evaluation and
appropriate treatment pursuant to section 229.13 , the judge
may order that a financial investigation be made in the manner
prescribed by section 225.13 . If the costs of a respondent’s
evaluation or treatment are payable in whole or in part by a
county an administrative services organization , an order under
this section shall be for referral of the respondent through
the regional administrator for the respondent’s county of
residence by an administrative services organization for an
evaluation and referral of the respondent to an appropriate
placement or service, which may include the state psychiatric
hospital for additional evaluation or treatment.
Sec. 57. Section 225.12, Code 2024, is amended to read as
follows:
225.12 Voluntary public patient —— physician’s or physician
assistant’s report.
A physician or a physician assistant who meets the
qualifications set forth in the definition of a mental health
professional in section 228.1 filing information under
section 225.10 shall include a written report to the regional
administrator for the county of residence of the person named
in the information, giving shall submit a detailed history of
the case to an administrative services organization as will be
likely to aid in the observation, treatment, and hospital care
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of the person and describing the history in detail .
Sec. 58. Section 225.13, Code 2024, is amended to read as
follows:
225.13 Financial condition.
The regional administrator for the county of residence of
a person being admitted to the state psychiatric hospital is
Administrative services organizations shall be responsible for
investigating the financial condition of the a person and of
those legally responsible for the person’s support.
Sec. 59. Section 225.15, Code 2024, is amended to read as
follows:
225.15 Examination and treatment.
1. When a respondent arrives at the state psychiatric
hospital, the admitting physician, or a physician assistant
who meets the qualifications set forth in the definition of a
mental health professional in section 228.1 , shall examine the
respondent and determine whether or not, in the physician’s
or physician assistant’s judgment, the respondent is a fit
subject for observation, treatment, and hospital care. If,
upon examination, the physician or physician assistant who
meets the qualifications set forth in the definition of a
mental health professional in section 228.1 decides that the
respondent should be admitted to the hospital, the respondent
shall be provided a proper bed in the hospital. The physician
or physician assistant who meets the qualifications set forth
in the definition of a mental health professional in section
228.1 who has charge of the respondent shall proceed with
observation, medical treatment, and hospital care as in the
physician’s or physician assistant’s judgment are proper and
necessary, in compliance with sections 229.13 , 229.14 , this
section , and section 229.16 . After the respondent’s admission,
the observation, medical treatment, and hospital care of the
respondent may be provided by a mental health professional,
as defined in section 228.1 , who is licensed as a physician,
advanced registered nurse practitioner, or physician assistant.
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2. A proper and competent nurse shall also be assigned to
look after and care for the respondent during observation,
treatment, and care. Observation, treatment, and hospital
care under this section which are payable in whole or in part
by a county shall only be provided as determined through
the regional administrator for the respondent’s county of
residence.
Sec. 60. Section 225.16, subsection 1, Code 2024, is amended
to read as follows:
1. If the regional administrator for a person’s county of
residence department finds from the physician’s information
or from the information of a physician assistant who
meets the qualifications set forth in the definition of
a mental health professional in section 228.1 which was
filed under the provisions of section 225.10 225.12 that it
would be appropriate for the person to be admitted to the
state psychiatric hospital, and the report of the regional
administrator made pursuant to section 225.13 shows the
department finds that the person and those who are legally
responsible for the person are not able to pay the expenses
incurred at the hospital, or are able to pay only a part of
the expenses, the person shall be considered to be a voluntary
public patient and the regional administrator shall direct that
the person shall be sent to the state psychiatric hospital at
the state university of Iowa for observation, treatment, and
hospital care.
Sec. 61. Section 225.17, subsection 2, Code 2024, is amended
to read as follows:
2. When the respondent arrives at the hospital, the
respondent shall receive the same treatment as is provided for
committed public patients in section 225.15 , in compliance
with sections 229.13 through 229.16 . However, observation,
treatment, and hospital care under this section of a respondent
whose expenses are payable in whole or in part by a county
shall only be provided as determined through the regional
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administrator for the respondent’s county of residence.
Sec. 62. Section 225.18, Code 2024, is amended to read as
follows:
225.18 Attendants.
The regional administrator An administrative services
organization may appoint an attendant to accompany the
committed public patient or the voluntary public patient
or the committed private patient from the place where the
patient may be to the state psychiatric hospital, or to
accompany the patient from the hospital to a place as may
be designated by the regional administrator administrative
services organization . If a patient is moved pursuant to this
section , at least one attendant shall be of the same gender as
the patient.
Sec. 63. Section 225.22, Code 2024, is amended to read as
follows:
225.22 Liability of private patients —— payment.
Every committed private patient, if the patient has an
estate sufficient for that purpose, or if those legally
responsible for the patient’s support are financially able,
shall be liable to the county and state for all expenses paid
by them in the state on behalf of such patient. All bills
for the care, nursing, observation, treatment, medicine, and
maintenance of such patients shall be paid by the director of
the department of administrative services in the same manner as
those of committed and voluntary public patients as provided in
this chapter , unless the patient or those legally responsible
for the patient make such settlement with the state psychiatric
hospital.
Sec. 64. Section 225.24, Code 2024, is amended to read as
follows:
225.24 Collection of preliminary expense.
Unless a committed private patient or those legally
responsible for the patient’s support offer to settle the
amount of the claims, the regional administrator for the
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person’s county of residence department shall collect, by
action if necessary, the amount of all claims for per diem and
expenses that have been approved by the regional administrator
for the county an administrative services organization and
paid by the regional administrator as provided under section
225.21 administrative services organization . Any amount
collected shall be credited to the mental health and disability
services region combined account created behavioral health fund
established in accordance with section 225C.58 225A.7 .
Sec. 65. Section 225.27, Code 2024, is amended to read as
follows:
225.27 Discharge —— transfer.
The state psychiatric hospital may, at any time, discharge
any patient as recovered, as improved, or as not likely to
be benefited by further treatment. If the patient being so
discharged was involuntarily hospitalized, the hospital shall
notify the committing judge or court of the discharge as
required by section 229.14 or section 229.16 , whichever is as
applicable , and the applicable regional administrator . Upon
receiving the notification, the court shall issue an order
confirming the patient’s discharge from the hospital or from
care and custody, as the case may be, and shall terminate the
proceedings pursuant to which the order was issued. The court
or judge shall, if necessary, appoint a person to accompany the
discharged patient from the state psychiatric hospital to such
place as the hospital or the court may designate, or authorize
the hospital to appoint such attendant.
Sec. 66. Section 226.1, subsection 4, Code 2024, is amended
by adding the following new paragraph:
NEW PARAGRAPH . 0a. “Administrative services organization”
means the same as defined in section 225A.1.
Sec. 67. Section 226.1, subsection 4, paragraphs d and f,
Code 2024, are amended by striking the paragraphs.
Sec. 68. Section 226.8, subsection 2, Code 2024, is amended
to read as follows:
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2. Charges for the care of any person with a diagnosis of
an intellectual disability admitted to a state mental health
institute shall be made by the institute in the manner provided
by chapter 230 , but the liability of any other person to any
mental health and disability services region the state for the
cost of care of such person with a diagnosis of an intellectual
disability shall be as prescribed by section 222.78 .
Sec. 69. Section 226.32, Code 2024, is amended to read as
follows:
226.32 Overcrowded conditions.
The director shall order the discharge or removal from the
mental health institute of incurable and harmless patients
whenever it is necessary to make room for recent cases. If
a patient who is to be discharged entered the mental health
institute voluntarily, the director shall notify the regional
administrator for the county interested at least ten days in
advance of the day of actual discharge.
Sec. 70. Section 226.34, subsection 2, paragraph d, Code
2024, is amended by striking the paragraph.
Sec. 71. Section 228.6, subsection 1, Code 2024, is amended
to read as follows:
1. A mental health professional or an employee of or
agent for a mental health facility may disclose mental health
information if and to the extent necessary, to meet the
requirements of section 229.24 , 229.25 , 230.20 , 230.21 , 230.25 ,
230.26 , 230A.108 , 232.74 , or 232.147 , or to meet the compulsory
reporting or disclosure requirements of other state or federal
law relating to the protection of human health and safety.
Sec. 72. Section 229.1, Code 2024, is amended by adding the
following new subsection:
NEW SUBSECTION . 01. “Administrative services organization”
means the same as defined in section 225A.1.
Sec. 73. Section 229.1, subsections 11, 18, and 19, Code
2024, are amended by striking the subsections.
Sec. 74. Section 229.1B, Code 2024, is amended to read as
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follows:
229.1B Regional administrator Administrative services
organization .
Notwithstanding any provision of this chapter to the
contrary, any person whose hospitalization expenses are
payable in whole or in part by a mental health and disability
services region an administrative services organization
shall be subject to all administrative requirements of the
regional administrator for the county administrative services
organization .
Sec. 75. Section 229.2, subsection 1, paragraph b,
subparagraph (3), Code 2024, is amended to read as follows:
(3) As soon as is practicable after the filing of a
petition for juvenile court approval of the admission of the
minor, the juvenile court shall determine whether the minor
has an attorney to represent the minor in the hospitalization
proceeding, and if not, the court shall assign to the minor
an attorney. If the minor is financially unable to pay for
an attorney, the attorney shall be compensated by the mental
health and disability services region an administrative
services organization at an hourly rate to be established
by the regional administrator for the county in which the
proceeding is held administrative services organization in
substantially the same manner as provided in section 815.7 .
Sec. 76. Section 229.2, subsection 2, paragraph a, Code
2024, is amended to read as follows:
a. The chief medical officer of a public hospital shall
receive and may admit the person whose admission is sought,
subject in cases other than medical emergencies to availability
of suitable accommodations and to the provisions of sections
section 229.41 and 229.42 .
Sec. 77. Section 229.8, subsection 1, Code 2024, is amended
to read as follows:
1. Determine whether the respondent has an attorney
who is able and willing to represent the respondent in the
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hospitalization proceeding, and if not, whether the respondent
is financially able to employ an attorney and capable of
meaningfully assisting in selecting one. In accordance with
those determinations, the court shall if necessary allow the
respondent to select, or shall assign to the respondent, an
attorney. If the respondent is financially unable to pay an
attorney, the attorney shall be compensated by the mental
health and disability services region an administrative
services organization at an hourly rate to be established
by the regional administrator for the county in which the
proceeding is held administrative services organization in
substantially the same manner as provided in section 815.7 .
Sec. 78. Section 229.10, subsection 1, paragraph a, Code
2024, is amended to read as follows:
a. An examination of the respondent shall be conducted by
one or more licensed physicians or mental health professionals,
as required by the court’s order, within a reasonable time.
If the respondent is detained pursuant to section 229.11,
subsection 1 , paragraph “b” , the examination shall be conducted
within twenty-four hours. If the respondent is detained
pursuant to section 229.11, subsection 1 , paragraph “a” or
“c” , the examination shall be conducted within forty-eight
hours. If the respondent so desires, the respondent shall be
entitled to a separate examination by a licensed physician or
mental health professional of the respondent’s own choice. The
reasonable cost of the examinations shall, if the respondent
lacks sufficient funds to pay the cost, be paid by the regional
administrator from mental health and disability services region
funds an administrative services organization upon order of the
court.
Sec. 79. Section 229.11, subsection 1, unnumbered paragraph
1, Code 2024, is amended to read as follows:
If the applicant requests that the respondent be taken into
immediate custody and the judge, upon reviewing the application
and accompanying documentation, finds probable cause to believe
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that the respondent has a serious mental impairment and is
likely to injure the respondent or other persons if allowed
to remain at liberty, the judge may enter a written order
directing that the respondent be taken into immediate custody
by the sheriff or the sheriff’s deputy and be detained until
the hospitalization hearing. The hospitalization hearing shall
be held no more than five days after the date of the order,
except that if the fifth day after the date of the order is
a Saturday, Sunday, or a holiday, the hearing may be held
on the next succeeding business day. If the expenses of a
respondent are payable in whole or in part by a mental health
and disability services region an administrative services
organization , for a placement in accordance with paragraph “a” ,
the judge shall give notice of the placement to the regional
administrator for the county in which the court is located an
administrative services organization , and for a placement in
accordance with paragraph “b” or “c” , the judge shall order
the placement in a hospital or facility designated through
the regional administrator by an administrative services
organization . The judge may order the respondent detained for
the period of time until the hearing is held, and no longer,
in accordance with paragraph “a” , if possible, and if not then
in accordance with paragraph “b” , or, only if neither of these
alternatives is available, in accordance with paragraph “c” .
Detention may be in any of the following:
Sec. 80. Section 229.13, subsection 1, paragraph a, Code
2024, is amended to read as follows:
a. The court shall order a respondent whose expenses are
payable in whole or in part by a mental health and disability
services region an administrative services organization
placed under the care of an appropriate hospital or facility
designated through the regional administrator for the county
by an administrative services organization on an inpatient or
outpatient basis.
Sec. 81. Section 229.13, subsection 7, paragraph b, Code
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2024, is amended to read as follows:
b. A region An administrative services organization shall
contract with mental health professionals to provide the
appropriate treatment including treatment by the use of oral
medicine or injectable antipsychotic medicine pursuant to this
section .
Sec. 82. Section 229.14, subsection 2, paragraph a, Code
2024, is amended to read as follows:
a. For a respondent whose expenses are payable in whole
or in part by a mental health and disability services region
an administrative services organization , placement as
designated through the regional administrator for the county
by an administrative services organization in the care of an
appropriate hospital or facility on an inpatient or outpatient
basis, or other appropriate treatment, or in an appropriate
alternative placement.
Sec. 83. Section 229.14A, subsections 7 and 9, Code 2024,
are amended to read as follows:
7. If a respondent’s expenses are payable in whole or in
part by a mental health and disability services region through
the regional administrator for the county an administrative
services organization , notice of a placement hearing shall be
provided to the county attorney and the regional administrator
an administrative services organization . At the hearing, the
county may present evidence regarding appropriate placement.
9. A placement made pursuant to an order entered under
section 229.13 or 229.14 or this section shall be considered to
be authorized through the regional administrator for the county
by an administrative services organization .
Sec. 84. Section 229.15, subsection 4, Code 2024, is amended
to read as follows:
4. When a patient has been placed in an alternative facility
other than a hospital pursuant to a report issued under section
229.14, subsection 1 , paragraph “d” , a report on the patient’s
condition and prognosis shall be made to the court which placed
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the patient, at least once every six months, unless the court
authorizes annual reports. If an evaluation of the patient is
performed pursuant to section 227.2, subsection 4 , a copy of
the evaluation report shall be submitted to the court within
fifteen days of the evaluation’s completion. The court may in
its discretion waive the requirement of an additional report
between the annual evaluations. If the department exercises
the authority to remove residents or patients from a county
care facility or other county or private facility under section
227.6 , the department shall promptly notify each court which
placed in that facility any resident or patient removed.
Sec. 85. Section 229.19, subsection 1, paragraphs a and b,
Code 2024, are amended to read as follows:
a. In each county the board of supervisors shall appoint
an individual who has demonstrated by prior activities an
informed concern for the welfare and rehabilitation of persons
with mental illness, and who is not an officer or employee of
the department , an officer or employee of a region, an officer
or employee of a county performing duties for a region, or
an officer or employee of any agency or facility providing
care or treatment to persons with mental illness, to act as an
advocate representing the interests of patients involuntarily
hospitalized by the court, in any matter relating to the
patients’ hospitalization or treatment under section 229.14 or
229.15 .
b. The committing court shall assign the advocate for the
county where the patient is located. A county or region may
seek reimbursement from the patient’s county of residence or
from the region in which the patient’s county of residence is
located an administrative services organization .
Sec. 86. Section 229.19, subsection 4, unnumbered paragraph
1, Code 2024, is amended to read as follows:
The state mental health and disability services commission
created in section 225C.5 department , in consultation with
advocates and county and judicial branch representatives, shall
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adopt rules pursuant to chapter 17A relating to advocates that
include but are not limited to all of the following topics:
Sec. 87. Section 229.22, subsection 2, paragraph b, Code
2024, is amended to read as follows:
b. If the magistrate orders that the person be detained,
the magistrate shall, by the close of business on the next
working day, file a written order with the clerk in the county
where it is anticipated that an application may be filed
under section 229.6 . The order may be filed by facsimile if
necessary. A peace officer from the law enforcement agency
that took the person into custody, if no request was made
under paragraph “a” , may inform the magistrate that an arrest
warrant has been issued for or charges are pending against the
person and request that any written order issued under this
paragraph require the facility or hospital to notify the law
enforcement agency about the discharge of the person prior to
discharge. The order shall state the circumstances under which
the person was taken into custody or otherwise brought to a
facility or hospital, and the grounds supporting the finding
of probable cause to believe that the person is seriously
mentally impaired and likely to injure the person’s self or
others if not immediately detained. The order shall also
include any law enforcement agency notification requirements if
applicable. The order shall confirm the oral order authorizing
the person’s detention including any order given to transport
the person to an appropriate facility or hospital. A peace
officer from the law enforcement agency that took the person
into custody may also request an order, separate from the
written order, requiring the facility or hospital to notify the
law enforcement agency about the discharge of the person prior
to discharge. The clerk shall provide a copy of the written
order or any separate order to the chief medical officer of
the facility or hospital to which the person was originally
taken, to any subsequent facility to which the person was
transported, and to any law enforcement department, ambulance
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service, or transportation service under contract with a
mental health and disability services region an administrative
services organization that transported the person pursuant
to the magistrate’s order. A transportation service that
contracts with a mental health and disability services region
an administrative services organization for purposes of this
paragraph shall provide a secure transportation vehicle and
shall employ staff that has received or is receiving mental
health training.
Sec. 88. Section 229.24, subsection 3, unnumbered paragraph
1, Code 2024, is amended to read as follows:
If all or part of the costs associated with hospitalization
of an individual under this chapter are chargeable to a county
of residence an administrative services organization , the
clerk of the district court shall provide to the regional
administrator for the county of residence and to the regional
administrator for the county in which the hospitalization
order is entered an administrative services organization the
following information pertaining to the individual which would
be confidential under subsection 1 :
Sec. 89. Section 229.38, Code 2024, is amended to read as
follows:
229.38 Cruelty or official misconduct.
If any person having the care of a person with mental illness
who has voluntarily entered a hospital or other facility for
treatment or care, or who is responsible for psychiatric
examination care, treatment, and maintenance of any person
involuntarily hospitalized under sections 229.6 through 229.15 ,
whether in a hospital or elsewhere, with or without proper
authority, shall treat such patient with unnecessary severity,
harshness, or cruelty, or in any way abuse the patient or if
any person unlawfully detains or deprives of liberty any person
with mental illness or any person who is alleged to have mental
illness, or if any officer required by the provisions of this
chapter and chapters chapter 226 and 227 , to perform any act
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shall willfully refuse or neglect to perform the same, the
offending person shall, unless otherwise provided, be guilty of
a serious misdemeanor.
Sec. 90. Section 230.1, Code 2024, is amended by adding the
following new subsection:
NEW SUBSECTION . 01. “Administrative service organization”
means the same as defined in section 225A.1.
Sec. 91. Section 230.1, subsections 4 and 5, Code 2024, are
amended by striking the subsections.
Sec. 92. Section 230.10, Code 2024, is amended to read as
follows:
230.10 Payment of costs.
All legal costs and expenses for the taking into custody,
care, investigation, and admission or commitment of a person to
a state mental health institute under a finding that the person
has residency in another county of this state shall be charged
against the regional administrator of the person’s county of
residence to an administrative services organization .
Sec. 93. Section 230.11, Code 2024, is amended to read as
follows:
230.11 Recovery of costs from state.
Costs and expenses for the taking into custody, care, and
investigation of a person who has been admitted or committed
to a state mental health institute, United States department
of veterans affairs hospital, or other agency of the United
States government, for persons with mental illness and
who has no residence in this state or whose residence is
unknown, including cost of commitment, if any, shall be paid
as approved by the department. The amount of the costs and
expenses approved by the department is appropriated to the
department from any moneys in the state treasury not otherwise
appropriated. Payment shall be made by the department on
itemized vouchers executed by the regional administrator of
the person’s county which has paid them, and approved by the
department.
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Sec. 94. Section 230.15, subsections 1 and 2, Code 2024, are
amended to read as follows:
1. A person with mental illness and a person legally liable
for the person’s support remain liable for the support of
the person with mental illness as provided in this section .
Persons legally liable for the support of a person with mental
illness include the spouse of the person, and any person
bound by contract for support of the person. The regional
administrator of the person’s county of residence, subject to
the direction of the region’s governing board, shall enforce
the obligation created in this section as to all sums advanced
by the regional administrator. The liability to the regional
administrator incurred by a person with mental illness or a
person legally liable for the person’s support under this
section is limited to an amount equal to one hundred percent
of the cost of care and treatment of the person with mental
illness at a state mental health institute for one hundred
twenty days of hospitalization. This limit of liability may
be reached by payment of the cost of care and treatment of the
person with mental illness subsequent to a single admission
or multiple admissions to a state mental health institute or,
if the person is not discharged as cured, subsequent to a
single transfer or multiple transfers to a county care facility
pursuant to section 227.11 . After reaching this limit of
liability, a person with mental illness or a person legally
liable for the person’s support is liable to the regional
administrator state for the care and treatment of the person
with mental illness at a state mental health institute or,
if transferred but not discharged as cured, at a county care
facility in an amount not in excess of to exceed the average
minimum cost of the maintenance of an individual who is
physically and mentally healthy residing in the individual’s
own home , which standard shall be as established and may be
revised by the department by rule . A lien imposed by section
230.25 shall not exceed the amount of the liability which may
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be incurred under this section on account of a person with
mental illness.
2. A person with a substance use disorder is legally
liable for the total amount of the cost of providing care,
maintenance, and treatment for the person with a substance
use disorder while a voluntary or committed patient. When
a portion of the cost is paid by a county an administrative
services organization , the person with a substance use disorder
is legally liable to the county administrative services
organization for the amount paid. The person with a substance
use disorder shall assign any claim for reimbursement under any
contract of indemnity, by insurance or otherwise, providing
for the person’s care, maintenance, and treatment in a state
mental health institute to the state. Any payments received
by the state from or on behalf of a person with a substance use
disorder shall be in part credited to the county in proportion
to the share of the costs paid by the county.
Sec. 95. NEW SECTION . 230.23 State —— payor of last resort.
The department shall implement services and adopt rules
pursuant to chapter 17A in a manner that ensures that the state
is the payor of last resort, and that the department does not
make any payments for services that have been provided until
the department has determined that the services provided are
not payable by a third-party source.
Sec. 96. Section 230.30, Code 2024, is amended to read as
follows:
230.30 Claim against estate.
On the death of a person receiving or who has received
assistance under the provisions of this chapter , and whom the
board department has previously found , under section 230.25 ,
is able to pay , there shall be allowed against the estate of
such decedent a claim of the sixth class for that portion of
the total amount paid for that person’s care which exceeds
the total amount of all claims of the first through the fifth
classes, inclusive, as defined in section 633.425 , which are
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allowed against that estate.
Sec. 97. Section 232.78, subsection 5, unnumbered paragraph
1, Code 2024, is amended to read as follows:
The juvenile court, before or after the filing of a petition
under this chapter , may enter an ex parte order authorizing
a physician or physician assistant or hospital to conduct an
outpatient physical examination or authorizing a physician or
physician assistant, a psychologist certified under section
154B.7, or a community mental health center accredited pursuant
to chapter 230A section 225A.3 to conduct an outpatient mental
examination of a child if necessary to identify the nature,
extent, and cause of injuries to the child as required by
section 232.71B , provided all of the following apply:
Sec. 98. Section 232.83, subsection 2, unnumbered paragraph
1, Code 2024, is amended to read as follows:
Anyone authorized to conduct a preliminary investigation in
response to a complaint may apply for, or the court on its own
motion may enter, an ex parte order authorizing a physician
or physician assistant or hospital to conduct an outpatient
physical examination or authorizing a physician or physician
assistant, a psychologist certified under section 154B.7, or a
community mental health center accredited pursuant to chapter
230A section 225A.3 to conduct an outpatient mental examination
of a child if necessary to identify the nature, extent, and
causes of any injuries, emotional damage, or other such needs
of a child as specified in section 232.96A, subsection 3, 5, or
6 , provided that all of the following apply:
Sec. 99. Section 235.7, subsection 2, Code 2024, is amended
to read as follows:
2. Membership. The department may authorize the governance
boards of decategorization of child welfare and juvenile
justice funding projects established under section 232.188 to
appoint the transition committee membership and may utilize
the boundaries of decategorization projects to establish
the service areas for transition committees. The committee
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membership may include but is not limited to department staff
involved with foster care, child welfare, and adult services,
juvenile court services staff, staff involved with county
general assistance or emergency relief under chapter 251 or
252, or a regional administrator of the county mental health
and disability services region, as defined in section 225C.55,
in the area, school district and area education agency staff
involved with special education, and a child’s court appointed
special advocate, guardian ad litem, service providers, and
other persons knowledgeable about the child.
Sec. 100. Section 235A.15, subsection 2, paragraph c,
subparagraphs (5) and (8), Code 2024, are amended by striking
the subparagraphs.
Sec. 101. Section 249A.4, subsection 15, Code 2024, is
amended by striking the subsection.
Sec. 102. Section 249A.12, subsection 4, Code 2024, is
amended by striking the subsection.
Sec. 103. NEW SECTION . 249A.38A Supported community living
services.
1. As used in this section, “supported community living
service” means a service provided in a noninstitutional
setting to adult persons with mental illness, an intellectual
disability, or developmental disabilities to meet the persons’
daily living needs.
2. The department shall adopt rules pursuant to chapter 17A
establishing minimum standards for supported community living
services.
3. The department shall determine whether to grant, deny, or
revoke approval for any supported community living service.
4. Approved supported community living services may receive
funding from the state, federal and state social services block
grant funds, and other appropriate funding sources, consistent
with state legislation and federal regulations. The funding
may be provided on a per diem, per hour, or grant basis, as
appropriate.
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Sec. 104. Section 249N.8, Code 2024, is amended by striking
the section and inserting in lieu thereof the following:
249N.8 Behavioral health services reports.
The department shall annually submit a report to the
governor and the general assembly with details related to the
department’s review of the funds administered by, and the
outcomes and effectiveness of, the behavioral health services
provided by, the behavioral health service system established
in section 225A.3.
Sec. 105. Section 252.24, subsections 1 and 3, Code 2024,
are amended to read as follows:
1. The county of residence, as defined in section 225C.61
331.190 , shall be liable to the county granting assistance for
all reasonable charges and expenses incurred in the assistance
and care of a poor person.
3. This section shall apply to assistance or maintenance
provided by a county through the county’s mental health
and disability services behavioral health service system
implemented under chapter 225C established in section 225A.3 .
Sec. 106. Section 256.25, subsections 2 and 3, Code 2024,
are amended to read as follows:
2. A school district, which may collaborate and partner
with one or more school districts, area education agencies,
accredited nonpublic schools, nonprofit agencies, and
institutions that provide children’s mental health services,
located in mental health and disability services regions
providing children’s behavioral health services in accordance
with chapter 225C, subchapter VII operating within the state’s
behavioral health service system under chapter 225A , may apply
for a grant under this program to establish a therapeutic
classroom in the school district in accordance with this
section .
3. The department shall develop a grant application
and selection and evaluation criteria. Selection criteria
shall include a method for prioritizing grant applications
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submitted by school districts. First priority shall be
given to applications submitted by school districts that
submitted an application pursuant to this section for the
previous immediately preceding fiscal year. Second priority
shall be given to applications submitted by school districts
that, pursuant to subsection 2 , are collaborating and
partnering with one or more school districts, area education
agencies, accredited nonpublic schools, nonprofit agencies,
or institutions that provide mental health services for
children. Third priority shall be given to applications
submitted by school districts located in mental health and
disability services regions behavioral health districts as
defined in section 225A.1, and that are providing behavioral
health services for children in accordance with chapter 225C,
subchapter VII 225A . Grant awards shall be distributed as
equitably as possible among small, medium, and large school
districts. For purposes of this subsection , a small school
district is a district with an actual enrollment of fewer than
six hundred pupils; a medium school district is a district
with an actual enrollment that is at least six hundred pupils,
but less than two thousand five hundred pupils; and a large
school district is a district with an actual enrollment of two
thousand five hundred or more pupils.
Sec. 107. Section 321.189, subsection 10, Code 2024, is
amended to read as follows:
10. Autism spectrum disorder status. A licensee who has
autism spectrum disorder, as defined in section 514C.28 , may
request that the license be marked to reflect the licensee’s
autism spectrum disorder status on the face of the license
when the licensee applies for the issuance or renewal of a
license. The department may adopt rules pursuant to chapter
17A establishing criteria under which a license may be marked,
including requiring the licensee to submit medical proof of the
licensee’s autism spectrum disorder status. When a driver’s
license is so marked, the licensee’s autism spectrum disorder
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status shall be noted in the electronic database used by
the department and law enforcement to access registration,
titling, and driver’s license information. The department, in
consultation with the mental health and disability services
commission department of health and human services , shall
develop educational media to raise awareness of a licensee’s
ability to request the license be marked to reflect the
licensee’s autism spectrum disorder status.
Sec. 108. Section 321.190, subsection 1, paragraph b,
subparagraph (6), Code 2024, is amended to read as follows:
(6) An applicant for a nonoperator’s identification
card who has autism spectrum disorder, as defined in section
514C.28 , may request that the card be marked to reflect
the applicant’s autism spectrum disorder status on the face
of the card when the applicant applies for the issuance or
renewal of a card. The department may adopt rules pursuant to
chapter 17A establishing criteria under which a card may be
marked, including requiring the applicant to submit medical
proof of the applicant’s autism spectrum disorder status.
The department, in consultation with the mental health and
disability services commission department of health and human
services , shall develop educational media to raise awareness of
an applicant’s ability to request the card be marked to reflect
the applicant’s autism spectrum disorder status.
Sec. 109. Section 321J.25, subsection 1, paragraph b, Code
2024, is amended to read as follows:
b. “Program” means a substance use disorder awareness
program , licensed under chapter 125, and provided under a
contract entered into between the provider and the department
of health and human services under chapter 125 or an
administrative services organization as defined in section
225A.1 .
Sec. 110. Section 321J.25, subsection 2, unnumbered
paragraph 1, Code 2024, is amended to read as follows:
A substance use disorder awareness program is established
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in each of the regions established by the director of health
and human services pursuant to section 125.12 behavioral
health district designated pursuant to section 225A.4 . The
program shall consist of an insight class and a substance
use disorder evaluation, which shall be attended by the
participant, to discuss issues related to the potential
consequences of substance use disorder. The parent or parents
of the participant shall also be encouraged to participate
in the program. The program provider shall consult with the
participant or the parents of the participant in the program
to determine the timing and appropriate level of participation
for the participant and any participation by the participant’s
parents. The program may also include a supervised educational
tour by the participant to any or all of the following:
Sec. 111. Section 331.321, subsection 1, paragraph e, Code
2024, is amended by striking the paragraph.
Sec. 112. Section 331.323, subsection 1, paragraph a,
subparagraph (7), Code 2024, is amended by striking the
subparagraph.
Sec. 113. Section 331.381, subsections 4 and 5, Code 2024,
are amended to read as follows:
4. Comply with chapter 222 , including but not limited to
sections 222.13 , 222.14 , 222.59 through 222.70 , 222.73 through
222.75 , and 222.77 through 222.82 , in regard to the care of
persons with an intellectual disability.
5. Comply with chapters 227, 229 and 230 , including but not
limited to sections 227.11 , 227.14 , 229.42 , 230.25 , 230.27 , and
230.35 , in regard to the care of persons with mental illness.
Sec. 114. Section 331.382, subsection 1, paragraphs e, f,
and g, Code 2024, are amended by striking the paragraphs.
Sec. 115. Section 331.382, subsection 3, Code 2024, is
amended by striking the subsection.
Sec. 116. Section 331.432, subsection 3, Code 2024, is
amended by striking the subsection.
Sec. 117. Section 331.502, subsection 10, Code 2024, is
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amended by striking the subsection.
Sec. 118. Section 331.502, subsection 12, Code 2024, is
amended to read as follows:
12. Carry out duties relating to the hospitalization and
support of persons with mental illness as provided in sections
229.42, 230.3 , 230.11 , and 230.15 , 230.21 , 230.22 , 230.25 , and
230.26 .
Sec. 119. Section 331.552, subsection 13, Code 2024, is
amended by striking the subsection.
Sec. 120. Section 331.756, subsections 25, 38, and 41, Code
2024, are amended by striking the subsections.
Sec. 121. Section 331.910, subsection 2, Code 2024, is
amended by adding the following new paragraph:
NEW PARAGRAPH . 0a. “Administrative services organization”
means the same as defined in section 225A.1.
Sec. 122. Section 331.910, subsection 2, paragraph d, Code
2024, is amended by striking the paragraph.
Sec. 123. Section 331.910, subsection 3, paragraphs a and c,
Code 2024, are amended to read as follows:
a. A region An administrative services organization may
contract with a receiving agency in a bordering state to secure
substance use disorder or mental health care and treatment
under this subsection for persons who receive substance use
disorder or mental health care and treatment pursuant to
section 125.33, 125.91 , 229.2 , or 229.22 through a region .
c. A region An administrative services organization may
contract with a sending agency in a bordering state to provide
care and treatment under this subsection for residents of
the bordering state in approved substance use disorder and
mental health care and treatment hospitals, centers, and
facilities in this state, except that care and treatment shall
not be provided for residents of the bordering state who are
involved in criminal proceedings substantially similar to the
involvement described in paragraph “b” .
Sec. 124. Section 347.16, subsection 3, Code 2024, is
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amended to read as follows:
3. Care and treatment may be furnished in a county public
hospital to any sick or injured person who has residence
outside the county which maintains the hospital, subject to
such policies and rules as the board of hospital trustees
may adopt. If care and treatment is provided under this
subsection to a person who is indigent, the person’s county of
residence, as defined in section 225C.61 331.190 , shall pay to
the board of hospital trustees the fair and reasonable cost of
the care and treatment provided by the county public hospital
unless the cost of the indigent person’s care and treatment is
otherwise provided for. If care and treatment is provided to
an indigent person under this subsection , the county public
hospital furnishing the care and treatment shall immediately
notify, by regular mail, the auditor of the county of residence
of the indigent person of the provision of care and treatment
to the indigent person including care and treatment provided
by a county through the county’s mental health and disability
services system implemented under chapter 225C behavioral
health service system established in section 225A.3 .
Sec. 125. Section 423.3, subsection 18, paragraph d, Code
2024, is amended to read as follows:
d. Community mental health centers accredited by the
department of health and human services pursuant to chapter
225C section 225A.3 .
Sec. 126. Section 426B.1, subsection 2, Code 2024, is
amended to read as follows:
2. Moneys shall be distributed from the property tax relief
fund to the mental health and disability services regional
service system for mental health and disability services,
behavioral health fund established in section 225A.7 in
accordance with the appropriations made to the fund and other
statutory requirements.
Sec. 127. Section 437A.8, subsection 4, paragraph d, Code
2024, is amended to read as follows:
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d. (1) Notwithstanding paragraph “a” , a taxpayer who owns
or leases a new electric power generating plant and who has
no other operating property in the state of Iowa except for
operating property directly serving the new electric power
generating plant as described in section 437A.16 shall pay
the replacement generation tax associated with the allocation
of the local amount to the county treasurer of the county in
which the local amount is located and shall remit the remaining
replacement generation tax, if any, to the director according
to paragraph “a” for remittance of the tax to county treasurers.
The director shall notify each taxpayer on or before August 31
following a tax year of its remaining replacement generation
tax to be remitted to the director. All remaining replacement
generation tax revenues received by the director shall be
deposited in the property tax relief fund created in section
426B.1 , and shall be distributed as provided in section 426B.2 .
(2) If a taxpayer has paid an amount of replacement tax,
penalty, or interest which was deposited into the property tax
relief fund and which was not due, all of the provisions of
section 437A.14, subsection 1 , paragraph “b” , shall apply with
regard to any claim for refund or credit filed by the taxpayer.
The director shall have sole discretion as to whether the
erroneous payment will be refunded to the taxpayer or credited
against any replacement tax due, or to become due, from the
taxpayer that would be subject to deposit in the property tax
relief fund.
Sec. 128. Section 437A.15, subsection 3, paragraph f, Code
2024, is amended to read as follows:
f. Notwithstanding the provisions of this section , if
a taxpayer is a municipal utility or a municipal owner of
an electric power facility financed under the provisions
of chapter 28F or 476A , the assessed value, other than the
local amount, of a new electric power generating plant shall
be allocated to each taxing district in which the municipal
utility or municipal owner is serving customers and has
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electric meters in operation in the ratio that the number of
operating electric meters of the municipal utility or municipal
owner located in the taxing district bears to the total number
of operating electric meters of the municipal utility or
municipal owner in the state as of January 1 of the tax year.
If the municipal utility or municipal owner of an electric
power facility financed under the provisions of chapter 28F
or 476A has a new electric power generating plant but the
municipal utility or municipal owner has no operating electric
meters in this state, the municipal utility or municipal owner
shall pay the replacement generation tax associated with the
new electric power generating plant allocation of the local
amount to the county treasurer of the county in which the local
amount is located and shall remit the remaining replacement
generation tax, if any, to the director at the times contained
in section 437A.8, subsection 4 , for remittance of the tax to
the county treasurers. All remaining replacement generation
tax revenues received by the director shall be deposited in the
property tax relief behavioral health fund created established
in section 426B.1, and shall be distributed as provided in
section 426B.2 225A.7 .
Sec. 129. Section 483A.24, subsection 7, Code 2024, is
amended to read as follows:
7. A license shall not be required of minor pupils of the
Iowa school for the deaf or of minor residents of other state
institutions under the control of the department of health
and human services. In addition, a person who is on active
duty with the armed forces of the United States, on authorized
leave from a duty station located outside of this state, and
a resident of the state of Iowa shall not be required to
have a license to hunt or fish in this state. The military
person shall carry the person’s leave papers and a copy of
the person’s current earnings statement showing a deduction
for Iowa income taxes while hunting or fishing. In lieu of
carrying the person’s earnings statement, the military person
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may also claim residency if the person is registered to vote
in this state. If a deer or wild turkey is taken, the military
person shall immediately contact a state conservation officer
to obtain an appropriate tag to transport the animal. A
license shall not be required of residents of county care
facilities or any person who is receiving supplementary
assistance under chapter 249 .
Sec. 130. Section 602.8102, subsection 39, Code 2024, is
amended to read as follows:
39. Refer persons applying for voluntary admission to a
community mental health center accredited by the department
of health and human services under section 225A.3, for a
preliminary diagnostic evaluation as provided in section
225C.16, subsection 2 .
Sec. 131. Section 714.8, subsection 12, Code 2024, is
amended to read as follows:
12. Knowingly transfers or assigns a legal or equitable
interest in property, as defined in section 702.14 , for less
than fair consideration, with the intent to obtain public
assistance under chapters 16 , 35B , and 35D , and 347B , or Title
VI, subtitles 2 through 6 , or accepts a transfer of or an
assignment of a legal or equitable interest in property, as
defined in section 702.14 , for less than fair consideration,
with the intent of enabling the party transferring the property
to obtain public assistance under chapters 16 , 35B , and 35D ,
and 347B , or Title VI, subtitles 2 through 6 . A transfer or
assignment of property for less than fair consideration within
one year prior to an application for public assistance benefits
shall be evidence of intent to transfer or assign the property
in order to obtain public assistance for which a person is
not eligible by reason of the amount of the person’s assets.
If a person is found guilty of a fraudulent practice in the
transfer or assignment of property under this subsection the
maximum sentence shall be the penalty established for a serious
misdemeanor and sections 714.9 , 714.10 , and 714.11 shall not
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apply.
Sec. 132. Section 812.6, subsection 1, Code 2024, is amended
to read as follows:
1. If the court finds the defendant does not pose a danger
to the public peace and safety, is otherwise qualified for
pretrial release, and is willing to cooperate with treatment,
the court shall order, as a condition of pretrial release,
that the defendant obtain mental health treatment designed to
restore the defendant to competency. The costs of treatment
pursuant to this subsection shall be paid by the mental
health and disability services region for the county of the
defendant’s residency pursuant to chapter 225C regardless of
whether the defendant meets financial eligibility requirements
under section 225C.62 or 225C.66 an administrative services
organization designated pursuant to section 225A.4 .
Sec. 133. Section 904.201, subsection 8, Code 2024, is
amended to read as follows:
8. Chapter 230 governs the determination of costs and
charges for the care and treatment of persons with mental
illness admitted to the forensic psychiatric hospital ,
except that charges for the care and treatment of any person
transferred to the forensic psychiatric hospital from an adult
correctional institution or from a state training school shall
be paid entirely from state funds . Charges for all other
persons at the forensic psychiatric hospital shall be billed to
the respective counties at the same ratio as for patients at
state mental health institutes under section 230.20.
Sec. 134. REPEAL. Chapters 142A, 225C, 227, 230A, and 347B,
Code 2024, are repealed.
Sec. 135. REPEAL. Sections 125.1, 125.3, 125.7, 125.9,
125.10, 125.12, 125.25, 125.32A, 125.34, 125.37, 125.38,
125.39, 125.40, 125.41, 125.42, 125.43, 125.43A, 125.46,
125.48, 125.54, 125.55, 125.58, 125.59, 125.60, 135B.18,
218.99, 222.59, 222.60, 222.61, 222.62, 222.63, 222.64, 222.65,
222.66, 222.67, 222.68, 222.69, 222.70, 222.74, 222.75, 225.10,
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225.19, 225.21, 226.45, 229.42, 230.1A, 230.2, 230.3, 230.4,
230.5, 230.6, 230.9, 230.12, 230.16, 230.17, 230.18, 230.19,
230.20, 230.21, 230.22, 230.25, 230.26, 230.27, 426B.2, 426B.4,
and 426B.5, Code 2024, are repealed.
Sec. 136. CODE EDITOR DIRECTIVE. The Code editor is
directed to correct internal references in the Code and in any
enacted legislation as necessary due to the enactment of this
division of this Act.
Sec. 137. EFFECTIVE DATE. This division of this Act takes
effect July 1, 2025.
DIVISION III
AGING AND DISABILITY
Sec. 138. Section 231.3, Code 2024, is amended to read as
follows:
231.3 State policy and objectives.
1. The general assembly declares that it is the policy of
the state to work toward attainment of the following objectives
for Iowa’s older individuals and individuals with disabilities :
1. a. An adequate income.
2. b. Access to physical and mental health care and
long-term living and community support services without regard
to economic status.
3. c. Suitable and affordable housing that reflects the
needs of older individuals.
4. d. Access to comprehensive information and a community
navigation system providing all available options related to
long-term living and community support services that assist
older individuals in the preservation of personal assets and
the ability to entirely avoid or significantly delay reliance
on entitlement programs.
5. e. Full restorative services for those who require
institutional care, and a comprehensive array of long-term
living and community support services adequate to sustain older
people in their communities and, whenever possible, in their
homes, including support for caregivers.
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6. f. Pursuit of meaningful activity within the widest
range of civic, cultural, educational, recreational, and
employment opportunities.
7. g. Suitable community transportation systems to assist
in the attainment of independent movement.
8. h. Freedom, independence, and the free exercise of
individual initiative in planning and managing their own lives.
9. i. Freedom from abuse, neglect, and exploitation.
2. The general assembly declares that the state of Iowa
recognizes a brain injury as a disability, and each agency and
subdivision of this state shall recognize a brain injury as a
distinct disability.
3. It is the policy of this state that each state agency
shall make reasonable efforts to identify those persons with
brain injuries among the persons served by the state agency.
Sec. 139. Section 231.4, subsection 1, Code 2024, is amended
by adding the following new paragraph:
NEW PARAGRAPH . 0c. “Brain injury” means the same as defined
in section 135.22.
Sec. 140. Section 231.4, subsection 1, paragraph d, Code
2024, is amended to read as follows:
d. “Commission” means the commission on aging. “Council”
means the council on health and human services created in
section 217.2.
Sec. 141. Section 231.14, Code 2024, is amended to read as
follows:
231.14 Commission Council duties and authority.
1. The commission is the policymaking body of the sole state
agency responsible for administration of the federal Act. The
commission council shall do all of the following :
a. 1. Approve Make recommendations to the department
regarding approval of the state plan on aging developed under
section 231.31 and area plans on aging , developed under section
231.33 .
b. 2. Adopt Recommend policies to coordinate state
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activities related to the purposes of this chapter .
c. 3. Serve as an effective and visible advocate for older
individuals and individuals with disabilities by establishing
recommending policies for reviewing and commenting upon
all state plans, budgets, and policies which affect older
individuals and for providing technical assistance to any
agency, organization, association, or individual representing
the needs of older individuals with disabilities .
d. Divide the state into distinct planning and service
areas after considering the geographical distribution of
older individuals in the state, the incidence of the need
for supportive services, nutrition services, multipurpose
senior centers, and legal services, the distribution of older
individuals who have low incomes residing in such areas, the
distribution of resources available to provide such services
or centers, the boundaries of existing areas within the
state which are drawn for the planning or administration of
supportive services programs, the location of units of general
purpose, local government within the state, and any other
relevant factors.
e. Designate for each planning and service area a public or
private nonprofit agency or organization as the area agency on
aging for that area. The commission may revoke the designation
of an area agency on aging pursuant to section 231.32 .
f. 4. Adopt policies to assure Make recommendations to
ensure that the department will take into account the views
of older individuals and individuals with disabilities in the
development of policy.
g. Adopt a method for the distribution of federal
Act and state funds taking into account, to the maximum
extent feasible, the best available data on the geographic
distribution of older individuals in the state, and publish the
method for review and comment.
h. 5. Adopt Recommend policies and measures to assure
ensure that preference will be given to providing services to
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older individuals and individuals with disabilities with the
greatest economic or social needs, with particular attention to
low-income minority older individuals, older individuals with
limited English proficiency, and older individuals residing in
rural areas.
i. 6. Adopt Recommend policies to administer state programs
authorized by this chapter .
j. 7. Adopt Recommend policies and administrative rules
pursuant to chapter 17A that support the capabilities of the
area agencies on aging and the aging and disabilities resource
centers to serve older individuals and persons individuals
with disabilities experiencing Alzheimer’s disease or related
dementias.
2. The commission shall adopt administrative rules pursuant
to chapter 17A to administer the duties specified in this
chapter and in all other chapters under the department’s
jurisdiction.
Sec. 142. Section 231.21, Code 2024, is amended to read as
follows:
231.21 Administration of chapter —— department of health and
human services.
The department of health and human services shall administer
this chapter under the policy direction of the commission
on aging consider the recommendations of the council when
administering this chapter .
Sec. 143. Section 231.23, Code 2024, is amended to read as
follows:
231.23 Department —— duties and authority.
The department shall:
1. Develop and administer a Administer the state plan on
aging developed pursuant to section 231.31 .
2. Assist the commission in the review and approval of
Review and approve area plans developed under section 231.33 .
3. Pursuant to commission policy, coordinate Coordinate
state activities related to the purposes of this chapter
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and all other chapters under the department’s jurisdiction .
State activities shall include, at a minimum, home and
community-based services such as employment support, community
living, and service coordination.
4. Advocate for older individuals and individuals with
disabilities by reviewing and commenting upon all state plans,
budgets, laws, rules, regulations, and policies which affect
older individuals or individuals with disabilities and by
providing technical assistance to any agency, organization,
association, or individual representing the needs of older
individuals or individuals with disabilities .
5. Assist the commission in dividing Divide the state into
distinct planning and service areas after considering the
geographical distribution of older individuals and individuals
with disabilities in the state, the incidence of the need
for supportive services, nutrition services, multipurpose
senior centers, and legal services, the distribution of older
individuals and individuals with disabilities with low income
residing in such areas, the distribution of resources available
to provide such services or centers, the boundaries of existing
areas within the state which are drawn for the planning or
administration of supportive services programs, the location of
units of general purpose, local government within the state,
and any other relevant factors .
6. Assist the commission in designating Designate for each
area a public or private nonprofit agency or organization as
the area agency on aging for that area. The department may
revoke the designation of an area agency on aging pursuant to
section 231.32.
7. Pursuant to commission policy, take Take into account the
views of older Iowans and Iowans with disabilities .
8. Assist the commission in adopting Adopt a method for
the distribution of funds available from the federal Act
and state appropriations and allocations that takes into
account, to the extent feasible, the best available data on the
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geographic distribution of older individuals and individuals
with disabilities in the state .
9. Assist the commission in assuring Adopt policies and
measures to ensure that preference will be given to providing
services to older individuals and individuals with disabilities
with the greatest economic or social needs, with particular
attention to low-income minority older individuals, older
individuals with limited English proficiency, and older
individuals residing in rural areas.
10. Assist the commission in developing, adopting, and
enforcing Develop, adopt, and enforce administrative rules,
including by issuing necessary forms and procedures , to
administer the duties specified in this chapter .
11. Apply for, receive, and administer grants, devises,
donations, and gifts , or bequests of real or personal property
from any source to conduct projects consistent with the
purposes of the department. Notwithstanding section 8.33 ,
moneys received by the department pursuant to this section are
not subject to reversion to the general fund of the state.
12. Administer state authorized programs.
13. Establish a procedure for an area agency on aging to
use in selection of members of the agency’s board of directors.
The selection procedure shall be incorporated into the bylaws
of the board of directors.
14. Adopt rules pursuant to chapter 17A that support the
capabilities of the area agencies on aging, and aging and
disabilities resource centers, to serve older individuals and
individuals with disabilities.
Sec. 144. Section 231.23A, subsections 1 and 3, Code 2024,
are amended to read as follows:
1. Services for older individuals, persons with
disabilities eighteen years of age and older, family
caregivers, and veterans as defined by the department in the
most current version of the department’s reporting manual and
pursuant to the federal Act and regulations.
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3. The aging Aging and disability resource center centers .
Sec. 145. Section 231.23A, Code 2024, is amended by adding
the following new subsection:
NEW SUBSECTION . 7A. Services and supports available to
individuals with disabilities including but not limited to
individuals with mental illness, an intellectual disability or
other developmental disability, or a brain injury.
Sec. 146. Section 231.31, Code 2024, is amended to read as
follows:
231.31 State plan on aging.
The department shall develop , and submit to the commission
on aging for approval, a multiyear state plan on aging.
The state plan on aging shall meet all applicable federal
requirements.
Sec. 147. Section 231.32, Code 2024, is amended to read as
follows:
231.32 Criteria for designation of area agencies on aging.
1. The commission department shall designate an area
agency on aging for each planning and service area. The
commission shall continue the designation shall continue until
an area agency on aging’s designation is removed for cause as
determined by the commission department , until the time of
renewal or the annual update of an area plan, until the agency
voluntarily withdraws as an area agency on aging, or until a
change in the designation of planning and service areas or area
agencies on aging is required by state or federal law. In that
event, the commission department shall proceed in accordance
with subsections 2, 3, and 4 . Designated area agencies on
aging shall comply with the requirements of the federal Act.
2. The commission department shall designate an area
agency on aging to serve each planning and service area, after
consideration of the views offered by units of general purpose
local government. An area agency on aging may be:
a. An established office of aging which is operating within
a planning and service area designated by the commission
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department .
b. Any office or agency of a unit of general purpose local
government, which is designated to function only for the
purpose of serving as an area agency on aging by the chief
elected official of such unit.
c. Any office or agency designated by the appropriate
chief elected officials of any combination of units of
general purpose local government to act only on behalf of such
combination for such purpose.
d. Any public or nonprofit private agency in a planning and
service area or any separate organizational unit within such
agency which is under the supervision or direction for this
purpose of the department and which can and will engage only in
the planning or provision of a broad range of long-term living
and community support services or nutrition services within the
planning and service area.
3. When the commission department designates a new area
agency on aging , the commission department shall give the right
of first refusal to a unit of general purpose local government
if:
a. Such unit can meet the requirements of subsection 1 .
b. The boundaries of such a unit and the boundaries of the
area are reasonably contiguous.
4. Each area agency on aging shall provide assurance,
determined adequate by the commission department , that the
area agency on aging has the ability to develop an area plan
and to carry out, directly or through contractual or other
arrangements, a program in accordance with the plan within the
planning and service area. In designating an area agency on
aging within the planning and service area, the commission
department shall give preference to an established office of
aging, unless the commission department finds that no such
office within the planning and service area has the capacity to
carry out the area plan.
5. Upon designation, an area agency on aging shall be
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considered an instrumentality of the state and shall adhere to
all state and federal mandates applicable to an instrumentality
of the state.
Sec. 148. Section 231.33, subsections 1 and 13, Code 2024,
are amended to read as follows:
1. Develop and administer an area plan on aging approved by
the commission department .
13. Submit all fiscal and performance reports in accordance
with the policies of the commission department .
Sec. 149. Section 231.56, Code 2024, is amended to read as
follows:
231.56 Services and programs.
The department shall administer long-term living and
community support services and programs that allow older
individuals and individuals with disabilities to secure and
maintain maximum independence and dignity in a home environment
that provides for self-care with appropriate supportive
services, assist in removing individual and social barriers
to economic and personal independence for older individuals
and individuals with disabilities , and provide a continuum of
care for older individuals and individuals with disabilities.
Funds appropriated for this purpose shall be allocated based
on administrative rules adopted by the commission department
pursuant to chapter 17A . The department shall require such
records as needed adopt rules pursuant to chapter 17A that
allow the department to collect information as necessary from
long-term living and community support services, program
providers, and patients to administer this section .
Sec. 150. Section 231.57, Code 2024, is amended to read as
follows:
231.57 Coordination of advocacy.
The department shall administer a program for the
coordination of information and assistance provided within
the state to assist older individuals and individuals with
disabilities, and their caregivers , in obtaining and protecting
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their rights and benefits. State and local agencies providing
information and assistance to older individuals and individuals
with disabilities, and their caregivers , in seeking their
rights and benefits shall cooperate with the department in
administering this program.
Sec. 151. Section 231.58, Code 2024, is amended to read as
follows:
231.58 Long-term living coordination.
The director may convene meetings, as necessary, of the
director and the director of inspections, appeals, and
licensing, to assist in the coordination of policy, service
delivery, and long-range planning relating to the long-term
living system and older Iowans and Iowans with disabilities
in the state. The group may consult with individuals,
institutions, and entities with expertise in the area of the
long-term living system and older Iowans and Iowans with
disabilities , as necessary, to facilitate the group’s efforts.
Sec. 152. Section 231.64, Code 2024, is amended to read as
follows:
231.64 Aging and disability resource center centers .
1. The aging and disability resource center shall be
administered by the department consistent with the federal
Act . The department shall designate area agencies on aging and
disability resource centers to establish, in consultation with
other stakeholders including organizations representing the
disability community, a coordinated local aging and disability
service system for providing . In addition to services required
by the department by rules adopted pursuant to chapter 17A,
aging and disability resource centers shall provide for all of
the following:
a. Comprehensive information, referral, and assistance
regarding the full range of available public and private
long-term living and community support services, options,
service providers, and resources within a community, including
information on the availability of integrated long-term care.
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b. Options counseling to assist individuals in assessing
their existing or anticipated long-term care needs and
developing and implementing a plan for long-term living and
community support services designed to meet their specific
needs and circumstances. The plan for long-term living
and community support services may include support with
person-centered care transitions to assist consumers and family
caregivers with transitions between home and care settings.
c. Consumer access to the range of publicly-supported
long-term living and community support services for which
consumers may be eligible, by serving as a convenient point
of entry for such services. The aging Aging and disability
resource center centers shall offer information online and
be available via a toll-free telephone number, electronic
communications, and in person.
2. The following entities shall be eligible to be designated
as an aging and disability resource center by the department:
a. An area agency on aging established on or before June 30,
2024.
b. A public or private nonprofit agency, or any separate
organizational unit within the public or private nonprofit
agency, that has the capabilities to engage in the planning or
provision of aging and disability services only as directed by
the department.
2. 3. The aging Aging and disability resource center
centers shall assist older individuals, persons individuals
with disabilities age eighteen or older , family caregivers,
and people who inquire about or request assistance on behalf
of members of these groups, as they seek long-term living and
community support services.
4. The department shall adopt rules pursuant to chapter 17A
to implement this section.
Sec. 153. NEW SECTION . 231.75 Scope.
The service quality standards and rights in this subchapter
VII shall apply to any person with an intellectual disability,
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a developmental disability, brain injury, or chronic mental
illness who receives services which are funded in whole or in
part by public funds, or services which are permitted under
Iowa law.
Sec. 154. NEW SECTION . 231.76 Service quality standards.
As the state participates more fully in funding services
and other support for persons with an intellectual disability,
developmental disability, brain injury, or chronic mental
illness, it is the intent of the general assembly that the
state shall seek to attain the following quality standards in
the provision of services and other supports:
1. Provide comprehensive evaluation and diagnosis adapted
to the cultural background, primary language, and ethnic origin
of a person.
2. Provide an individual treatment, habilitation, and
program services plan.
3. Provide treatment, habilitation, and program services
that are individualized, flexible, cost-effective, and produce
results.
4. Provide periodic review of an individual’s treatment,
habilitation, and program services plan.
5. Provide for the least restrictive environment, and
age-appropriate services.
6. Provide appropriate training and employment
opportunities so that a person’s ability to contribute to, and
participate in, the community is maximized.
7. Provide an ongoing process to determine the degree of
access to, and the effectiveness of, the services and other
supports in achieving the disability service outcomes and
indicators identified by the department.
Sec. 155. NEW SECTION . 231.77 Rights.
All of the following rights shall apply to a person with an
intellectual disability, a developmental disability, a brain
injury, or a chronic mental illness:
1. Wage protection. A person engaged in a work program
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shall be paid wages commensurate with the going rate for
comparable work and productivity.
2. Insurance protection. Pursuant to section 507B.4,
subsection 3, paragraph “g” , a person or designated group
of persons shall not be unfairly discriminated against for
purposes of insurance coverage.
3. Citizenship. A person retains the right to citizenship
in accordance with the laws of the state.
4. Participation in planning activities. A person has
the right to participate in the formulation of an individual
treatment, habilitation, and program plan developed for the
person.
Sec. 156. NEW SECTION . 231.78 Compliance.
1. A person’s sole remedy for a violation of a rule adopted
by the department to implement sections 231.75 through 231.77
shall be to initiate a proceeding with the department by
request pursuant to chapter 17A.
a. Any decision of the department shall be in accordance
with due process of law. A person or party who is aggrieved or
adversely affected by the department’s action may seek judicial
review pursuant to section 17A.19. A person or party who is
aggrieved or adversely affected by a final judgment of the
district court may appeal under section 17A.20.
b. Either the department or a party in interest may apply
to the Iowa district court for an order to enforce a final
decision of the department.
2. Any rules adopted by the department to implement sections
231.76 and 231.77 shall not create any right, entitlement,
property or liberty right or interest, or private cause of
action for damages against the state or a political subdivision
of the state, or for which the state or a political subdivision
of the state would be responsible.
3. Notwithstanding subsection 1, any violation of section
231.77, subsection 2, shall be subject to enforcement by the
commissioner of insurance pursuant to chapter 507B.
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Sec. 157. NEW SECTION . 231.79 Appeals process.
The department shall establish an appeals process by which a
person or the person’s representative may appeal a decision of
the department concerning the provision or denial of aging or
disability services to the person.
Sec. 158. Section 231E.3, Code 2024, is amended to read as
follows:
231E.3 Definitions.
As used in this chapter , unless the context otherwise
requires:
1. “Client” means an individual for whom a representative
payee is appointed.
2. “Commission” means the commission on aging.
3. 2. “Conservator” means conservator as defined in section
633.3 .
4. 3. “Court” means court as defined in section 633.3 .
5. 4. “Department” means the department of health and human
services.
6. 5. “Director” means the director of health and human
services.
7. 6. “Guardian” means guardian as defined in section
633.3 .
8. 7. “Incompetent” means incompetent as defined in section
633.3 .
9. 8. “Local office” means a local office of public
guardian.
10. 9. “Local public guardian” means an individual under
contract with the department to act as a guardian, conservator,
or representative payee.
11. 10. “Public guardian” means the state public guardian
or a local public guardian.
12. 11. “Public guardianship services” means guardianship,
conservatorship, or representative payee services provided by
the state public guardian or a local public guardian.
13. 12. “Representative payee” means an individual
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appointed by a government entity to receive funds on behalf of
a client pursuant to federal regulation.
14. 13. “State agency” means any executive department,
commission, board, institution, division, bureau, office,
agency, or other executive entity of state government.
15. 14. “State office” means the state office of public
guardian.
16. 15. “State public guardian” means the administrator of
the state office of public guardian.
17. 16. “Ward” means the individual for whom a guardianship
or conservatorship is established.
Sec. 159. REPEAL. Sections 231.11, 231.12, and 231.13, Code
2024, are repealed.
Sec. 160. CODE EDITOR DIRECTIVE. The Code editor is
directed to do all of the following:
1. Entitle Code chapter 231 “Department of Health and Human
Services —— Aging and Disability Services”.
2. Designate sections 231.75 through 231.79, as enacted in
this division of this Act, as subchapter VII entitled “Bill
of Rights and Service Quality Standards for Persons with an
Intellectual Disability, Developmental Disability, Brain
Injury, or Chronic Mental Illness”.
3. Correct internal references in the Code and in any
enacted legislation as necessary due to the enactment of this
division of this Act.
Sec. 161. EFFECTIVE DATE. The following take effect July
1, 2025:
1. The parts of the sections of this division of this Act
amending the following:
a. Section 231.3.
b. Section 231.4, subsection 1.
c. Section 231.23, subsections 4 and 7.
d. Section 231.23A, subsection 1.
e. Sections 231.56, 231.57, and 231.58.
f. Section 231.64, subsection 2.
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2. The parts of the sections of this division of this Act
enacting the following: sections 231.23A, subsection 7A,
231.75, 231.76, 231.77, 231.78, and 231.79.
DIVISION IV
TRANSITION PROVISIONS
Sec. 162. DEPARTMENT OF HEALTH AND HUMAN SERVICES ——
TRANSITION OF MENTAL HEALTH SERVICES, ADDICTIVE DISORDER
SERVICES, AND DISABILITY SERVICES.
1. For purposes of this division:
a. “Administrative services organization” means the same
as defined in section 225A.1, as enacted in division I of this
Act.
b. “Behavioral health district” means the same as defined in
section 225A.1, as enacted in division I of this Act.
c. “Department” means the department of health and human
services.
d. “District behavioral health service system plan” means
the same as defined in section 225A.1, as enacted in division
I of this Act.
e. “Mental health and disability services region” means the
same as defined in section 225C.2, subsection 9.
f. “State behavioral health service system” means the state
behavioral health service system as established in section
225A.3, as enacted in division I of this Act.
g. “State behavioral health service system plan” means the
same as defined in section 225A.1, as enacted in division I of
this Act.
h. “Transition period” means the period beginning on the
date of enactment of this division of this Act and concluding
on June 30, 2025.
2. There is created a behavioral health service system under
the control of the department. For the fiscal year beginning
July 1, 2025, and each succeeding fiscal year, the behavioral
health service system shall be responsible for implementing and
maintaining a statewide system of prevention, education, early
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intervention, treatment, recovery support, and crisis services
related to mental health and addictive disorders, including
but not limited to substance use, tobacco use, and problem
gambling. For the fiscal year beginning July 1, 2025, and each
succeeding fiscal year, the department’s division of aging
and disability services shall be responsible for disability
services.
3. During the transition period, the department may
exercise all policymaking functions and regulatory powers
established in division I of this Act, as necessary to
establish the state behavioral health service system.
4. To ensure the state behavioral health service system
and the division of aging and disability services are able to
operate as intended at the conclusion of the transition period,
the department shall perform all the following duties:
a. Make contracts as necessary to set up services and
administrative functions.
b. Adopt rules as necessary to establish and administer the
state’s behavioral health service system.
c. Establish policies as necessary to ensure efficient
implementation and operation of the behavioral health service
system.
d. Prepare forms necessary for the implementation and
administration of behavioral health services.
e. Prepare a state behavioral health service system plan for
the state behavioral health service system.
f. Designate behavioral health districts on or before
August 1, 2024. The behavioral health district designation
process shall include an opportunity for the public to
review and to comment on proposed behavioral health district
boundaries.
g. Designate an administrative services organization for
each behavioral health district on or before December 31, 2024.
h. Review and approve district behavioral health service
system plans for services related to the behavioral health
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service system.
i. Issue all necessary licenses and certifications.
j. Establish contractual rights, privileges, and
responsibilities as necessary to establish and implement the
state behavioral health service system.
k. Develop and implement a plan to ensure that persons
currently receiving disability services or early intervention,
treatment, recovery support, or crisis services related
to mental health or addictive disorders, including but not
limited to alcohol use, substance use, tobacco use, and problem
gambling, have an uninterrupted continuum of care.
l. Establish a central data repository as described in
section 225A.6, as enacted in division I of this Act.
5. If the department determines that a federal waiver or
authorization is necessary to administer any provision of this
division of this Act or to effectuate the state behavioral
health service system by the conclusion of the transition
period, the department shall timely request the federal waiver
or authorization. Notwithstanding any other effective date to
the contrary, a provision the department determines requires a
federal waiver or authorization shall be effective only upon
receipt of federal approval for the waiver or authorization.
6. a. On or before July 1, 2024, the department shall
publish on the department’s internet site an initial transition
plan for establishing the state behavioral health service
system. The transition plan shall describe, at a minimum, all
of the following:
(1) All tasks that require completion before July 1, 2025.
The description of tasks shall include a description of how the
department will solicit comments from stakeholders, including
employees of the department, persons served by the department,
partners of the department, members of the public, and members
of the general assembly, and a detailed timeline for the
completion of the tasks described.
(2) The proposed organizational structure of the state
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behavioral health service system.
(3) The transition of service delivery sites from locations
where people currently receive behavioral health services to
where the people will receive behavioral health services under
the state behavioral health service system.
(4) Procedures for the transfer and reconciliation of
budgeting and funding between the mental health and disability
services regions and the department.
(5) A description of how responsibilities for disability
services programs will be transferred from current program
administrators to the department’s division of aging and
disability services by the end of the transition period.
(6) Any additional known tasks that may require completion
after the transition on July 1, 2025.
b. The transition plan published under paragraph “a” shall:
(1) Be updated no less than quarterly during the transition
period with the current status of completing the tasks
identified in paragraph “a”, subparagraph (1).
(2) Describe how information regarding any changes in
service delivery will be provided to persons receiving services
from the mental health and disability services regions or
current behavioral health care providers contracted with the
department.
(3) Describe how the transition is being funded, including
how expenses associated with the transition will be managed.
7. a. Before the end of the transition period, the
governing board of each mental health and disability services
region that maintains a combined account pursuant to section
225C.58, subsection 1, shall transfer all unencumbered and
unobligated moneys remaining in the combined account to the
treasurer of state for deposit into the behavioral health fund
as established in section 225A.7 as enacted in division I of
this Act.
b. Before the end of the transition period, each county
which maintains a county mental health and disability services
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fund pursuant to section 225C.58, subsection 1, shall transfer
all unencumbered and unobligated moneys remaining in the mental
health and disability services fund to the treasurer of state
for deposit into the behavioral health fund as established in
section 225A.7 as enacted in division I of this Act.
c. Moneys in the behavioral health fund as established
in section 225A.7 as enacted in division I of this Act are
appropriated to the department for the purposes established in
section 225A.7 as enacted in division I of this Act, and as
otherwise necessary to effectuate this division of this Act.
8. a. All debts, claims, or other liabilities owed to a
county, a mental health and disability services region, or
the state due to services rendered pursuant to chapter 125,
222, 225, 225C, 226, 227, 229, 230, or 230A, Code 2024, at the
conclusion of the transition period shall remain due and owing
after the transition period concludes.
b. After the transition period concludes, each county
auditor shall collect outstanding debts, claims, or other
liabilities owed to the county for services rendered pursuant
to chapter 125, 222, 225, 225C, 226, 227, 229, 230, or 230A,
Code 2024, before the transition period concluded. The county
attorney may bring a judicial action as necessary to collect
the outstanding debts, claims, or other liabilities.
9. With input from appropriate stakeholders, the department
shall identify each contract that will be impacted by mental
health and disability services being transferred to the state
behavioral health service system, or by responsibilities
being transferred to the department’s division of aging and
disabilities, pursuant to this Act. On or before June 30,
2025, a party to a contract identified by the department
under this subsection shall exercise the option, if available
pursuant to the terms of the contract, to terminate the
contract in accordance with the terms of the contract which
provide for termination. Contracts that do not provide for
termination shall not be renewed or extended at the end of the
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current contract term.
10. A mental health and disability services region, a
regional administrator as defined in section 225C.55, and
any subdivision of the state shall not enter into, renew, or
extend any contract for services related to mental health and
disability services or addictive disorder services beyond June
30, 2025.
Sec. 163. DEPARTMENT OF HEALTH AND HUMAN SERVICES ——
TRANSITION FUNDING. Notwithstanding any provision of law to
the contrary, there is appropriated from the region incentive
fund of the mental health and disability services regional
service fund created in section 225C.7A, subsection 8, to the
department of health and human services for the fiscal year
beginning July 1, 2024, and ending June 30, 2025, the following
amount, or so much thereof as is necessary, to be used for the
purposes designated:
For the establishment of a central data repository as
described in section 225A.6, subsection 1, as enacted in
division I of this Act:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 645,179
Notwithstanding section 8.33, moneys appropriated in this
section that remain unencumbered or unobligated at the close
of the fiscal year shall not revert to the credit of the region
incentive fund of the mental health and disability services
regional service fund, but shall be credited to the behavioral
health fund created in section 225A.7, as enacted in division I
of this Act, and are appropriated to the department of health
and human services for expenditure for the purposes of the
behavioral health fund.
Sec. 164. EMERGENCY RULES. The department of health and
human services may adopt emergency rules under section 17A.4,
subsection 3, and section 17A.5, subsection 2, paragraph “b”,
to implement the provisions of this division of this Act and
the rules shall be effective immediately upon filing unless
a later date is specified in the rules. Any rules adopted
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in accordance with this section shall also be published as a
notice of intended action as provided in section 17A.4.
Sec. 165. EFFECTIVE DATE. This division of this Act, being
deemed of immediate importance, takes effect upon enactment.
DIVISION V
ELIMINATION OF SPECIAL INTELLECTUAL DISABILITY UNITS
Sec. 166. Section 222.1, subsection 3, Code 2024, is amended
by striking the subsection.
Sec. 167. Section 222.2, subsection 8, Code 2024, is amended
by striking the subsection.
Sec. 168. Section 222.5, Code 2024, is amended to read as
follows:
222.5 Preadmission diagnostic evaluation.
A person shall not be eligible for admission to a resource
center or a special unit until a preadmission diagnostic
evaluation has been made by a resource center or a special unit
which confirms or establishes the need for admission.
Sec. 169. Section 222.7, unnumbered paragraph 1, Code 2024,
is amended to read as follows:
The department may transfer patients from one state resource
center to the other and may at any time transfer patients from
the resource centers to the hospitals for persons with mental
illness , or transfer patients in the resource centers to a
special unit or vice versa . The department may also transfer
patients from a hospital for persons with mental illness to a
resource center if consent is given or obtained as follows:
Sec. 170. Section 222.8, Code 2024, is amended to read as
follows:
222.8 Communications by patients.
Persons admitted to the resource centers or a special
unit shall have all reasonable opportunity and facility for
communication with their friends. Such persons shall be
permitted to write and send letters, provided the letters
contain nothing of an offensive character. Letters written by
any patient to the director or to any state or county official
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shall be forwarded unopened.
Sec. 171. Section 222.9, Code 2024, is amended to read as
follows:
222.9 Unauthorized departures.
If any person with an intellectual disability shall depart
without proper authorization from a resource center or a
special unit , it shall be the duty of the superintendent
and the superintendent’s assistants and all peace officers
of any county in which such patient may be found to take
and detain the patient without a warrant or order and to
immediately report such detention to the superintendent who
shall immediately provide for the return of such patient to the
resource center or special unit .
Sec. 172. Section 222.12, subsection 1, Code 2024, is
amended to read as follows:
1. Upon the death of a patient of a resource center or
special unit , a preliminary investigation of the death shall be
conducted as required by section 218.64 by the county medical
examiner as provided in section 331.802 . Such a preliminary
investigation shall also be conducted in the event of a sudden
or mysterious death of a patient in a private institution
for persons with an intellectual disability. The chief
administrative officer of any private institution may request
an investigation of the death of any patient by the county
medical examiner.
Sec. 173. Section 222.73, subsections 1, 3, and 5, Code
2024, are amended to read as follows:
1. The superintendent of each resource center and special
unit shall compute by February 1 the average daily patient
charge and outpatient treatment charges for which each county
will be billed for services provided to patients chargeable to
the county during the fiscal year beginning the following July
1. The department shall certify the amount of the charges and
notify the counties of the billing charges.
a. The superintendent shall compute the average daily
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patient charge for a resource center or special unit for
services provided in the following fiscal year, in accordance
with generally accepted accounting procedures, by totaling
the expenditures of the resource center or special unit for
the immediately preceding calendar year, by adjusting the
expenditures by a percentage not to exceed the percentage
increase in the consumer price index for all urban consumers
for the immediately preceding calendar year, and by dividing
the adjusted expenditures by the total inpatient days of
service provided during the immediately preceding calendar
year.
b. The department shall compute the outpatient treatment
charges, in accordance with generally accepted accounting
procedures, on the basis of the actual cost of the outpatient
treatment provided during the immediately preceding calendar
year.
3. 2. The superintendent shall compute in January the
actual per-patient-per-day cost for each resource center or
special unit for the immediately preceding calendar year, in
accordance with generally accepted accounting procedures, by
totaling the actual expenditures of the resource center or
special unit for the calendar year and by dividing the total
actual expenditures by the total inpatient days of service
provided during the calendar year.
5. 3. A superintendent of a resource center or special
unit may request that the director enter into a contract with
a person for the resource center or special unit to provide
consultation or treatment services or for fulfilling other
purposes which are consistent with the purposes stated in
section 222.1 . The contract provisions shall include charges
which reflect the actual cost of providing the services. Any
income from a contract authorized under this subsection may
be retained by the resource center or special unit to defray
the costs of providing the services or fulfilling the other
purposes. Except for a contract voluntarily entered into by a
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county under this subsection , the costs or income associated
with a contract authorized under this subsection shall not
be considered in computing charges and per diem costs in
accordance with the provisions of subsections 1 through 4 and
2 .
Sec. 174. Section 222.83, Code 2024, is amended to read as
follows:
222.83 Nonresident patients.
The estates of all nonresident patients who are provided
treatment, training, instruction, care, habilitation, and
support in or by a resource center or a special unit , and all
persons legally bound for the support of such persons, shall be
liable to the state for the reasonable value of such services.
The certificate of the superintendent of the resource center
or special unit in which any nonresident is or has been a
patient, showing the amounts drawn from the state treasury or
due therefrom as provided by law on account of such nonresident
patient, shall be presumptive evidence of the reasonable value
of such services furnished such patient by the resource center
or special unit .
Sec. 175. Section 222.84, Code 2024, is amended to read as
follows:
222.84 Patients’ personal deposit fund.
There is established at each resource center and special
unit a patients’ personal deposit fund. In the case of a
special unit, the director may direct that the patients’
personal deposit fund be maintained and administered as a part
of the fund established, pursuant to sections 226.43 through
226.46 , by the state mental health institute where the special
unit is located.
Sec. 176. Section 222.85, subsection 1, Code 2024, is
amended to read as follows:
1. Any funds coming into the possession of the
superintendent or any employee of a resource center or special
unit belonging to any patient in that institution shall be
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deposited in the name of the patient in the patients’ personal
deposit fund, except that if a guardian of the property has
been appointed for the person, the guardian shall have the
right to demand and receive such funds. Funds belonging to a
patient deposited in the patients’ personal deposit fund may
be used for the purchase of personal incidentals, desires, and
comforts for the patient.
Sec. 177. Section 222.87, Code 2024, is amended to read as
follows:
222.87 Deposit in bank.
The department shall deposit the patients’ personal deposit
fund in a commercial account of a bank of reputable standing.
When deposits in the commercial account exceed average monthly
withdrawals, the department may deposit the excess at interest.
The savings account shall be in the name of the patients’
personal deposit fund and interest paid on the account may be
used for recreational purposes for the patients at the resource
center or special unit .
Sec. 178. REPEAL. Sections 222.88, 222.89, 222.90, and
222.91, Code 2024, are repealed.
Sec. 179. EFFECTIVE DATE. This division of this Act, being
deemed of immediate importance, takes effect upon enactment.
DIVISION VI
COUNTY OF RESIDENCE DETERMINATIONS
Sec. 180. NEW SECTION . 331.190 County of residence ——
dispute resolution.
1. “County of residence” means the county in this state
in which, at the time a person applies for or receives
services, the person is living and has established an ongoing
presence with the declared, good faith intention of living
for a permanent or indefinite period of time. The county
of residence of a homeless person is the county in which
the homeless person usually sleeps. A person maintains
residency in the county or state in which the person last
resided during the time period that the person is present in
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a different county or state receiving services in a hospital,
a correctional facility, a halfway house for community-based
corrections or substance use disorder treatment, a nursing
facility, an intermediate care facility for persons with an
intellectual disability, a residential care facility, or for
the purpose of attending a college or university.
2. a. The dispute resolution process in this subsection
shall apply to county of residence disputes. The dispute
resolution process shall not be applicable to any of the
following:
(1) Disputes involving persons committed to a state
facility pursuant to chapter 812.
(2) Disputes involving Iowa rule of criminal procedure
2.22(8)(b), commitment for evaluation.
(3) Disputes involving chapter 12 of Iowa court rules, rules
for involuntary hospitalization of mentally ill persons.
b. If a county objects to a billing for services or a
residency determination and asserts that either the person
has residency in a different county or the person is not a
resident of this state, the person’s county of residence
shall be determined as provided in this subsection. If the
county asserts that the person has residency in a different
county in this state, the county shall notify that county in
writing within one hundred twenty calendar days of receiving
the billing for services or of the county of residence
determination.
c. The county that receives the notification under paragraph
“b” shall respond in writing to the county that provided the
notification within forty-five calendar days of receiving the
notification. If the parties cannot agree as to the person’s
county of residence within ninety calendar days of the date of
notification, on motion of either of the parties, the matter
shall be referred to the administrative hearings division of
the department of inspections, appeals, and licensing for
a contested case proceeding under chapter 17A, before an
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administrative law judge assigned in accordance with section
10A.801, to determine the person’s county of residence.
d. (1) Notwithstanding section 17A.15, the administrative
law judge’s determination of a person’s county of residence
shall be considered final agency action. Judicial review of
the determination may be sought in accordance with section
17A.19.
(2) If following the determination of a person’s county of
residence under this subsection additional evidence becomes
available that merits a change in the determination of the
person’s county of residence, the affected parties may change
the determination of county of residence by mutual agreement.
Otherwise, a party may move that the matter be reconsidered
by the county, or by an administrative law judge assigned in
accordance with section 10A.801.
e. Unless a petition is filed for judicial review, the
administrative law judge’s determination of the person’s county
of residence shall result in one of the following:
(1) If a county is determined to be the person’s county
of residence, that county shall pay any amounts due and shall
reimburse the other county for any amounts paid for services
provided to the person by the other county prior to the county
of residence determination.
(2) If it is determined that the person is not a resident of
this state, neither the state nor either county shall be liable
for payment of amounts due for services provided to the person
prior to the determination of the person’s county of residence.
f. (1) The party that does not prevail in a contested
case proceeding or a subsequent judicial review pursuant to
this subsection shall be liable for costs associated with
the proceeding or judicial review, including reimbursement
of the administrative hearings division of the department of
inspections, appeals, and licensing’s actual costs associated
with the administrative proceeding, court costs, and reasonable
attorney fees.
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(2) A payment or reimbursement pursuant to this subsection
shall be remitted within forty-five calendar days of the
date the county of residence determination is issued by the
administrative law judge or the date the court files an order
determining the person’s county of residence, whichever is
later. After forty-five calendar days, the prevailing party
may add a penalty of up to one percent per month to any amounts
due.
Sec. 181. Section 35D.9, Code 2024, is amended to read as
follows:
35D.9 County of residence upon discharge.
A member of the home does not acquire residency in the county
in which the home is located unless the member is voluntarily
or involuntarily discharged from the home and the member
meets county of residence requirements. For purposes of this
section , “county of residence” means the same as defined in
section 225C.61 331.190 .
Sec. 182. Section 232.141, subsections 7 and 8, Code 2024,
are amended to read as follows:
7. A county charged with the costs and expenses under
subsections 2 and 3 may recover the costs and expenses from the
child’s custodial parent’s county of residence, as defined in
section 225C.61 331.190 , by filing verified claims which are
payable as are other claims against the county. A detailed
statement of the facts upon which a claim is based shall
accompany the claim.
8. This subsection applies only to placements in a juvenile
shelter care home which is publicly owned, operated as a county
or multicounty shelter care home, organized under a chapter
28E agreement, or operated by a private juvenile shelter care
home. If the actual and allowable costs of a child’s shelter
care placement exceed the amount the department is authorized
to pay, the unpaid costs may be recovered from the child’s
custodial parent’s county of residence. However, the maximum
amount of the unpaid costs which may be recovered under this
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subsection is limited to the difference between the amount
the department is authorized to pay and the statewide average
of the actual and allowable rates as reasonably determined
by the department annually. A home may only be reimbursed
for the lesser of the home’s actual and allowable costs or
the statewide average of the actual and allowable rates as
determined by the department in effect on the date the costs
were paid. The unpaid costs are payable pursuant to filing of
verified claims against the child’s custodial parent’s county
of residence. A detailed statement of the facts upon which a
claim is based shall accompany the claim. Any dispute between
counties arising from filings of claims filed pursuant to this
subsection shall be settled in the manner provided to determine
residency county of residence in section 225C.61 331.190 .
Sec. 183. EFFECTIVE DATE. This division of this Act takes
effect July 1, 2025.
DIVISION VII
CHILDREN’S BEHAVIORAL HEALTH —— PSYCHIATRIC MEDICAL
INSTITUTIONS FOR CHILDREN —— HAWKI PROGRAM BENEFITS
Sec. 184. REDUCTION OF REGULATORY BARRIERS AND RESTRICTIONS
—— PSYCHIATRIC MEDICAL INSTITUTIONS FOR CHILDREN. The
department of health and human services shall review the
department’s administrative rules regarding psychiatric medical
institutions for children (PMICs) and shall update the rules,
informed by the findings of the association of children’s
residential centers’ most recent nationwide survey and scan
of psychiatric residential treatment facilities, and the
recommendations of the coalition for family and children’s
services in Iowa, to do all of the following:
1. Allow a physician assistant or advanced registered nurse
practitioner to serve as a member of the plan of care team
as a member who is experienced in child psychiatry or child
psychology pursuant to 481 IAC 41.13(2).
2. Allow a physician assistant or advanced registered
nurse practitioner to be a member of the team to complete
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the certification of need for services for a PMIC placement
pursuant to 481 IAC 41.9.
3. Remove the reserve bed day limitations for
hospitalizations and expand the number of other therapeutic
absences beyond thirty days to allow for skill acquisition,
stabilization, and continuity of care as deemed necessary by
the child’s medical providers and in accordance with a child’s
discharge plan.
4. Allow licensed professionals, based on competencies
rather than license type, to order the use of restraints
or seclusions and to conduct post-restraint or seclusion
assessments, including via telehealth, to increase response
times and expand access to care. The department of
inspections, appeals, and licensing shall adopt rules pursuant
to chapter 17A to implement this subsection.
5. a. Allow therapy and behavioral health intervention
services to be included as billable services provided during
a placement at a PMIC to provide continuity of care, maintain
established clinical relationships, and avoid disruption in
services or delays in reestablishing care post discharge.
b. Allow family therapy and family behavioral health
intervention services to be included in billable services
during the placement of a child in a PMIC without requiring
the child’s presence for the family to work on targeted skills
essential for the child’s success and to prepare the family for
the child’s return home.
c. Provide reimbursement codes to cover services beyond
those provided outside the PMIC care team as necessary to
adequately treat substance use disorder, sexualized behaviors,
autism, and other services needed to support the child.
6. Standardize all of the following across all managed care
organizations as follows:
a. Require that authorization for a PMIC placement shall
be retroactive to the date the request for authorization is
submitted to the managed care organization not the date the
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managed care organization responds; or require a managed care
organization to respond within five business days from receipt
of a request for authorization for a PMIC placement, if the
certification of need and independent assessment have been
received in a timely manner.
b. Prohibit a managed care organization from denying
authorization for a PMIC placement based on lack of parental
involvement, based on lack of participation in behavioral
health intervention services on an outpatient basis, or based
on other perceived behavioral issues.
c. Allow a managed care organization to authorize an initial
PMIC placement of sixty days upon admission with concurrent
stay reviews every thirty days thereafter. A PMIC shall submit
a care plan to the managed care organization within thirty days
of the admission.
d. Require concurrent stay reviews to be standardized
and limited to a brief description of progress, or lack of
progress, toward the child’s goals and objectives.
e. Require a managed care organization to offer support to
families, including assistance with transportation to and from
a PMIC to visit a child.
7. Notwithstanding any provision of law to the contrary,
including certificate of need requirements, allow a previously
licensed PMIC that has the capacity to provide up to an
additional four intermediate care facility for persons with an
intellectual disability beds, and which additional beds meet
all other licensing and state fire marshal requirements, to
increase their licensed capacity to include the additional
beds without further review including by the health facilities
council.
8. Allow for step-down PMIC placements or supervised
apartment living for a child to utilize programming provided
in a PMIC while living independently in a smaller residential
setting without twenty-four-hour supervision.
Sec. 185. HAWKI PROGRAM —— BENEFITS INCLUDED IN QUALIFIED
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CHILD HEALTH PLAN —— REVIEW. The department of health
and human services shall review the benefits included in a
qualified child health plan under the Hawki program and shall
specifically address the inclusion of applied behavior analysis
services as a covered benefit. The department shall report the
findings of the review to the general assembly by December 1,
2024.
DIVISION VIII
STATE-FUNDED PSYCHIATRY RESIDENCY AND FELLOWSHIP POSITIONS
Sec. 186. Section 135.180, Code 2024, is amended to read as
follows:
135.180 State-funded psychiatry residency and fellowship
program positions —— fund —— appropriations.
1. a. The university of Iowa hospitals and clinics shall
administer a state-funded psychiatry residency and fellowship
program positions for up to nine seven residents and up to two
fellows, annually. In addition, a county medical center, and
a medical center operating for more than one hundred forty
years, that are members of separate health systems, administer
psychiatry residency programs, and are located in a county with
a population over five hundred thousand shall each administer
state-funded psychiatry residency positions for one resident,
annually. The university of Iowa hospitals and clinics and the
specified medical centers shall expand the their psychiatry
residency program programs to provide additional residency
positions by providing financial support for residency
positions which are in excess of the federal residency cap
established by the federal Balanced Budget Act of 1997, Pub.
L. No. 105-33.
b. The university of Iowa hospitals and clinics and the
specified medical centers shall cooperate with the state
mental health institutes at Independence and Cherokee, the
state resource center at Woodward, the state training school
at Eldora, and the Iowa medical and classification center
at Oakdale in administering the program the positions .
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Participating residents and fellows shall complete a portion
of their psychiatry training at one of the state mental health
institutes, the state resource center, the state training
school, or the Iowa medical and classification center at
Oakdale. For accreditation-required clinical experiences
not available at the state mental health institutes, the
state resource center, the state training school, or the Iowa
medical and classification center at Oakdale, the residents of
the psychiatry residency and fellowship program awarded the
residency positions administered by the university of Iowa
hospitals and clinics may utilize clinical rotations at the
university of Iowa hospitals and clinics and its affiliates
across the state and the residents awarded the residency
positions administered by the specified medical centers may
utilize clinical rotations at affiliates of such medical
centers across the state .
2. The university of Iowa hospitals and clinics shall apply
to the accreditation council for graduate medical education
for approval of nine seven additional residency positions
for each class of residents and the psychiatry residency and
fellowship program shall award the total number of residency
positions approved for each class of residents. The university
of Iowa hospitals and clinics shall approve and award up to
two fellowship positions annually. The specified medical
centers shall apply to the accreditation council for graduate
medical education for approval of one additional residency
position each for each class of residents and shall award the
total number of residency positions approved for each class
of residents. Preference in the awarding of residency and
fellowship positions shall be given to candidates who are
residents of Iowa, attended and earned an undergraduate degree
from an Iowa college or university, or attended and earned a
medical degree from a medical school in Iowa.
3. A psychiatry residency and fellowship program positions
fund is created in the state treasury consisting of the moneys
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appropriated or credited to the fund by law. Notwithstanding
section 8.33 , moneys in the fund at the end of each fiscal
year shall not revert to any other fund but shall remain in
the psychiatry residency and fellowship program positions fund
for use in subsequent fiscal years. Moneys in the fund are
appropriated to the university of Iowa hospitals and clinics
to be used for the purposes of the program this section . For
the fiscal years beginning on or after July 1, 2023, there
is appropriated from the general fund of the state to the
psychiatry residency and fellowship program positions fund one
hundred thousand dollars for each residency position approved
and awarded under the program and one hundred fifty thousand
dollars for each fellowship position approved and awarded under
the program this section . Of the amount appropriated annually
from the fund to the university of Iowa hospitals and clinics,
the university of Iowa hospitals and clinics shall distribute
one hundred thousand dollars to each of the specified medical
centers for each residency position approved and awarded.
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