Bill Text: IA SF2315 | 2011-2012 | 84th General Assembly | Enrolled
Bill Title: A bill for an act relating to redesign of publicly funded mental health and disability services by requiring certain core services and addressing other services and providing for establishment of regions, revising related property tax levy provisions, and including effective date and applicability provisions. (Formerly SSB 3152.) Various effective dates; see sections 21, 65, 130, and 139 of bill.
Spectrum: Committee Bill
Status: (Passed) 2012-05-25 - Signed by Governor. S.J. 950. [SF2315 Detail]
Download: Iowa-2011-SF2315-Enrolled.html
Senate
File
2315
AN
ACT
RELATING
TO
REDESIGN
OF
PUBLICLY
FUNDED
MENTAL
HEALTH
AND
DISABILITY
SERVICES
BY
REQUIRING
CERTAIN
CORE
SERVICES
AND
ADDRESSING
OTHER
SERVICES
AND
PROVIDING
FOR
ESTABLISHMENT
OF
REGIONS,
REVISING
RELATED
PROPERTY
TAX
LEVY
PROVISIONS,
AND
INCLUDING
EFFECTIVE
DATE
AND
APPLICABILITY
PROVISIONS.
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
DIVISION
I
CORE
SERVICES
Section
1.
Section
225C.2,
Code
2011,
is
amended
by
adding
the
following
new
subsections:
NEW
SUBSECTION
.
7A.
“Mental
health
and
disability
services
region”
means
a
mental
health
and
disability
services
region
formed
in
accordance
with
section
331.438B.
NEW
SUBSECTION
.
7B.
“Mental
health
and
disability
services
regional
service
system”
means
the
mental
health
and
disability
service
system
for
a
mental
health
and
disability
services
region.
NEW
SUBSECTION
.
9.
“Regional
administrator”
means
the
same
as
defined
in
section
331.438A.
Sec.
2.
Section
225C.4,
subsection
1,
paragraphs
a,
b,
c,
f,
h,
j,
q,
and
s,
Code
2011,
are
amended
to
read
as
follows:
a.
Prepare
and
administer
the
comprehensive
mental
health
and
disability
services
plan
as
provided
in
section
225C.6B
,
including
state
mental
health
and
mental
retardation
plans
for
the
provision
of
disability
services
within
the
state
and
the
state
developmental
disabilities
plan.
The
administrator
shall
consult
with
take
into
account
any
related
planning
activities
implemented
by
the
Iowa
department
of
public
health,
the
state
board
of
regents
or
a
body
designated
by
the
board
for
that
Senate
File
2315,
p.
2
purpose,
the
department
of
management
or
a
body
designated
by
the
director
of
the
department
for
that
purpose,
the
department
of
education,
the
department
of
workforce
development
and
any
other
appropriate
governmental
body,
in
order
to
facilitate
coordination
of
disability
services
provided
in
this
state.
The
state
mental
health
and
mental
retardation
plans
shall
be
consistent
with
the
state
health
plan,
and
shall
incorporate
county
disability
services
take
into
account
mental
health
and
disability
services
regional
service
system
management
plans.
b.
Assist
county
boards
of
supervisors
and
mental
health
and
developmental
disabilities
regional
planning
councils
mental
health
and
disability
services
region
governing
boards
and
regional
administrators
in
planning
for
community-based
disability
services.
c.
Emphasize
the
provision
of
evidence-based
outpatient
and
community
support
services
by
community
mental
health
centers
and
local
mental
retardation
providers
as
a
preferable
alternative
to
acute
inpatient
hospital
services
and
services
provided
in
large
institutional
settings
.
f.
Promote
coordination
of
Coordinate
community-based
services
with
those
of
the
state
mental
health
institutes
and
state
resource
centers.
h.
Administer
and
distribute
state
appropriations
to
in
connection
with
the
mental
health
and
developmental
disabilities
community
disability
regional
services
fund
established
by
section
225C.7
225C.7A
.
j.
Establish
and
maintain
a
data
collection
and
management
information
system
oriented
to
the
needs
of
patients,
providers,
the
department,
and
other
programs
or
facilities.
The
system
shall
be
used
to
identify,
collect,
and
analyze
service
outcome
data
in
order
to
assess
the
effects
of
the
services
on
the
persons
utilizing
the
services.
The
administrator
shall
annually
submit
to
the
commission
information
collected
by
the
department
indicating
the
changes
and
trends
in
the
disability
services
system.
The
administrator
shall
make
the
outcome
data
available
to
the
public.
q.
In
cooperation
with
the
department
of
inspections
and
appeals,
recommend
minimum
standards
under
section
227.4
for
the
care
of
and
services
to
persons
with
mental
illness
and
or
mental
retardation
residing
in
county
care
facilities.
The
administrator
shall
also
cooperate
with
the
department
of
inspections
and
appeals
in
recommending
minimum
standards
for
Senate
File
2315,
p.
3
care
of
and
services
provided
to
persons
with
mental
illness
or
an
intellectual
disability
living
in
a
residential
care
facility
regulated
under
chapter
135C.
s.
Provide
technical
assistance
concerning
disability
services
and
funding
to
counties
and
mental
health
and
developmental
disabilities
regional
planning
councils
mental
health
and
disability
services
region
governing
boards
and
regional
administrators
.
Sec.
3.
Section
225C.4,
subsection
1,
Code
2011,
is
amended
by
adding
the
following
new
paragraphs:
NEW
PARAGRAPH
.
u.
Enter
into
performance-based
contracts
with
regional
administrators
as
described
in
section
331.438C.
A
performance-based
contract
shall
require
a
regional
administrator
to
fulfill
the
statutory
and
regulatory
requirements
of
the
regional
service
system
under
this
chapter
and
chapter
331.
A
failure
to
fulfill
the
requirements
may
be
addressed
by
remedies
specified
in
the
contract,
including
but
not
limited
to
suspension
of
contract
payments
or
cancellation
of
the
contract.
The
contract
provisions
may
include
but
are
not
limited
to
requirements
for
the
regional
service
system
to
attain
outcomes
within
a
specified
range
of
acceptable
performance
in
any
of
the
following
categories:
(1)
Access
standards
for
the
required
core
services.
(2)
Penetration
rates
for
serving
the
number
of
persons
expected
to
be
served.
(3)
Utilization
rates
for
inpatient
and
residential
treatment.
(4)
Readmission
rates
for
inpatient
and
residential
treatment.
(5)
Employment
of
the
persons
receiving
services.
(6)
Administrative
costs.
(7)
Data
reporting.
(8)
Timely
and
accurate
claims
processing.
NEW
PARAGRAPH
.
v.
Provide
information
through
the
internet
concerning
waiting
lists
for
services
implemented
by
mental
health
and
disability
services
regions.
Sec.
4.
Section
225C.6,
subsection
1,
paragraph
b,
Code
Supplement
2011,
is
amended
to
read
as
follows:
b.
Adopt
Pursuant
to
recommendations
made
for
this
purpose
by
the
administrator,
adopt
necessary
rules
pursuant
to
chapter
17A
which
relate
to
disability
programs
and
services,
including
but
not
limited
to
definitions
of
each
disability
included
within
the
term
“disability
services”
as
necessary
for
Senate
File
2315,
p.
4
purposes
of
state,
county,
and
regional
planning,
programs,
and
services.
Sec.
5.
Section
225C.6,
subsection
1,
paragraph
l,
Code
Supplement
2011,
is
amended
by
striking
the
paragraph
and
inserting
in
lieu
thereof
the
following:
l.
Pursuant
to
a
recommendation
made
by
the
administrator,
identify
basic
financial
eligibility
standards
for
the
disability
services
provided
by
a
mental
health
and
disability
services
region.
The
initial
standards
shall
be
as
specified
in
chapter
331.
Sec.
6.
Section
225C.6A,
unnumbered
paragraph
1,
Code
2011,
is
amended
to
read
as
follows:
1.
The
commission
department
shall
do
the
following
relating
to
redesign
of
the
data
concerning
the
disability
services
system
in
the
state:
Sec.
7.
Section
225C.6A,
subsections
1
through
3,
Code
2011,
are
amended
to
read
as
follows:
1.
Identify
sources
of
revenue
to
support
statewide
delivery
of
core
disability
services
to
eligible
disability
populations.
2.
Ensure
there
is
a
continuous
improvement
process
for
development
and
maintenance
of
the
disability
services
system
for
adults
and
children.
The
process
shall
include
but
is
not
limited
to
data
collection
and
reporting
provisions.
3.
a.
Plan,
collect,
and
analyze
data
as
necessary
to
issue
cost
estimates
for
serving
additional
populations
and
providing
core
disability
services
statewide.
The
department
shall
maintain
compliance
with
applicable
federal
and
state
privacy
laws
to
ensure
the
confidentiality
and
integrity
of
individually
identifiable
disability
services
data.
The
department
shall
regularly
may
periodically
assess
the
status
of
the
compliance
in
order
to
assure
that
data
security
is
protected.
b.
In
implementing
a
system
under
this
subsection
section
for
collecting
and
analyzing
state,
county
and
region
,
and
private
contractor
data,
the
department
shall
establish
a
client
identifier
for
the
individuals
receiving
services.
The
client
identifier
shall
be
used
in
lieu
of
the
individual’s
name
or
social
security
number.
The
client
identifier
shall
consist
of
the
last
four
digits
of
an
individual’s
social
security
number,
the
first
three
letters
of
the
individual’s
last
name,
the
individual’s
date
of
birth,
and
the
individual’s
gender
in
an
order
determined
by
the
department.
Senate
File
2315,
p.
5
c.
2.
Each
county
regional
administrator
shall
regularly
report
to
the
department
annually
on
or
before
December
1,
for
the
preceding
fiscal
year
the
following
information
for
each
individual
served:
demographic
information,
expenditure
data,
and
data
concerning
the
services
and
other
support
provided
to
each
individual,
as
specified
in
administrative
rule
adopted
by
the
commission
department
.
Sec.
8.
Section
225C.6B,
Code
2011,
is
amended
by
adding
the
following
new
subsection:
NEW
SUBSECTION
.
3.
State
and
regional
disability
service
systems.
The
publicly
financed
disability
services
for
persons
with
mental
illness,
intellectual
disability
or
other
developmental
disability,
or
brain
injury
in
this
state
shall
be
provided
by
the
department
and
the
counties
operating
together
as
regions.
The
financial
and
administrative
responsibility
for
such
services
is
as
follows:
a.
Disability
services
for
children
and
adults
that
are
covered
under
the
medical
assistance
program
pursuant
to
chapter
249A
are
the
responsibility
of
the
state.
b.
Adult
mental
health
and
intellectual
disability
services
that
are
not
covered
under
the
medical
assistance
program
are
the
responsibility
of
the
county-based
regional
service
system.
Sec.
9.
NEW
SECTION
.
225C.7A
Mental
health
and
disability
regional
services
fund.
1.
A
mental
health
and
disability
regional
services
fund
is
created
in
the
office
of
the
treasurer
of
state
under
the
authority
of
the
department,
which
shall
consist
of
the
amounts
appropriated
to
the
fund
by
the
general
assembly
for
each
fiscal
year.
Before
completion
of
the
department’s
budget
estimate
as
required
by
section
8.23,
the
director
of
human
services,
in
consultation
with
the
commission,
shall
determine
and
include
in
the
estimate
the
amount
which
in
order
to
address
the
increase
in
the
costs
of
providing
services
should
be
appropriated
to
the
fund
for
the
succeeding
fiscal
year.
2.
The
department
shall
distribute
the
moneys
appropriated
from
the
fund
to
mental
health
and
disability
services
regions
for
funding
of
disability
services
in
accordance
with
performance-based
contracts
with
the
regions
and
in
the
manner
provided
in
the
appropriations.
If
the
allocation
methodology
includes
a
population
factor,
the
definition
of
“population”
in
section
331.438A
shall
be
applied.
Sec.
10.
Section
331.439,
subsection
1,
paragraph
a,
Code
Supplement
2011,
is
amended
to
read
as
follows:
Senate
File
2315,
p.
6
a.
The
county
accurately
reported
by
December
1
the
county’s
expenditures
for
mental
health,
mental
retardation,
and
developmental
disabilities
services
and
the
information
required
under
section
225C.6A,
subsection
3
,
paragraph
“c”
2
,
for
the
previous
fiscal
year
in
accordance
with
rules
adopted
by
the
state
commission.
The
information
reported
shall
conform
with
the
cost
principles
for
state,
local,
and
Indian
tribal
governments
issued
by
the
United
States
office
of
management
and
budget.
The
information
shall
also
segregate
expenditures
for
administration,
purchase
of
service,
and
enterprise
costs
in
which
the
county
is
a
service
provider
or
is
directly
billing
and
collecting
payments
and
shall
be
submitted
on
forms
prescribed
by
the
department
of
management.
If
the
department
of
human
services
determines
good
cause
exists,
the
department
may
extend
a
deadline
otherwise
imposed
under
this
chapter
,
chapter
225C
,
or
chapter
426B
for
a
county’s
reporting
concerning
mental
health,
mental
retardation,
or
developmental
disabilities
services
or
related
revenues
and
expenditures.
Sec.
11.
Section
331.439,
Code
Supplement
2011,
is
amended
by
adding
the
following
new
subsection:
NEW
SUBSECTION
.
9A.
a.
Commencing
during
the
fiscal
year
beginning
July
1,
2012,
the
county
management
plan
for
mental
health
services
shall
provide
that
an
individual’s
eligibility
for
individualized
services
shall
be
determined
by
a
standardized
functional
assessment
methodology
approved
for
this
purpose
by
the
director
of
human
services.
b.
Commencing
during
the
fiscal
year
beginning
July
1,
2012,
the
county
management
plan
for
intellectual
disability
services
shall
provide
that
an
individual’s
eligibility
for
individualized
services
shall
be
determined
by
a
standardized
functional
assessment
methodology
approved
for
this
purpose
by
the
director
of
human
services.
c.
Commencing
during
the
fiscal
year
beginning
July
1,
2012,
if
a
county
management
plan
provides
for
brain
injury
services
the
plan
shall
provide
that
an
individual’s
eligibility
for
individualized
services
shall
be
determined
by
a
standardized
functional
assessment
methodology
approved
for
this
purpose
by
the
director
of
human
services.
Sec.
12.
NEW
SECTION
.
331.439A
Regional
service
system
management
plan.
1.
The
mental
health
and
disability
services
provided
by
counties
operating
as
a
region
shall
be
delivered
in
Senate
File
2315,
p.
7
accordance
with
a
regional
service
system
management
plan
approved
by
the
region’s
governing
board
and
implemented
by
the
regional
administrator
in
accordance
with
this
section.
The
requirements
for
a
regional
service
system
management
plan
and
plan
format
shall
be
specified
in
rule
adopted
by
the
state
commission
pursuant
to
a
recommendation
made
by
the
department.
A
regional
management
plan
shall
include
an
annual
service
and
budget
plan,
a
policies
and
procedures
manual,
and
an
annual
report.
Each
region’s
initial
plan
shall
be
submitted
to
the
department
by
April
1,
2014.
2.
Each
region
shall
submit
to
the
department
an
annual
service
and
budget
plan
approved
by
the
region’s
governing
board
and
subject
to
approval
by
the
director
of
human
services.
Provisions
for
the
director
of
human
services’
approval
of
the
annual
service
and
budget
plan,
and
any
amendments
to
the
plan,
and
other
requirements
shall
be
specified
in
rule
adopted
by
the
state
commission.
The
provisions
addressed
in
the
annual
plan
shall
include
but
are
not
limited
to
all
of
the
following:
a.
The
region’s
budget
and
financing
provisions
for
the
next
fiscal
year.
The
provisions
shall
address
how
county,
regional,
state,
and
other
funding
sources
will
be
used
to
meet
the
service
needs
within
the
region.
b.
The
scope
of
services
included
in
addition
to
the
required
core
services.
Each
service
included
shall
be
described
and
projection
of
need
and
the
funding
necessary
to
meet
the
need
shall
be
included.
c.
The
location
of
the
local
access
points
for
services.
d.
The
plan
for
assuring
effective
crisis
prevention,
response,
and
resolution.
e.
The
provider
reimbursement
provisions.
A
region’s
use
of
provider
reimbursement
approaches
in
addition
to
fee-for-service
reimbursement
and
for
compensating
the
providers
engaged
in
a
systems
of
care
approach
and
other
nontraditional
providers
shall
be
encouraged.
A
region
also
shall
be
encouraged
to
use
and
the
department
shall
approve
funding
approaches
that
identify
and
incorporate
all
services
and
sources
of
funding
used
by
persons
receiving
services,
including
medical
assistance
program
funding.
f.
Financial
forecasting
measures.
g.
The
targeted
case
managers
designated
for
the
region.
3.
Each
region
shall
submit
an
annual
report
to
the
department
on
or
before
December
1.
The
annual
report
shall
Senate
File
2315,
p.
8
provide
information
on
the
actual
numbers
of
persons
served,
moneys
expended,
and
outcomes
achieved.
4.
The
region
shall
have
in
effect
a
policies
and
procedures
manual
for
the
regional
service
system.
The
manual
shall
be
approved
by
the
region’s
governing
board
and
is
subject
to
approval
by
the
director
of
human
services.
An
approved
manual
shall
remain
in
effect
subject
to
amendment.
An
amendment
to
the
manual
shall
be
submitted
to
the
department
at
least
forty-five
days
prior
to
the
date
of
implementation
of
the
amendment.
Prior
to
implementation
of
an
amendment
to
the
manual,
the
amendment
must
be
approved
by
the
director
of
human
services
in
consultation
with
the
state
commission.
The
manual
shall
include
but
is
not
limited
to
all
of
the
following:
a.
A
description
of
the
region’s
policies
and
procedures
for
financing
and
delivering
the
services
included
in
the
annual
service
and
budget
plan.
b.
The
enrollment
and
eligibility
process.
c.
The
method
of
annual
service
and
budget
plan
administration.
d.
The
process
for
managing
utilization
and
access
to
services
and
other
assistance.
The
process
shall
also
describe
how
coordination
between
the
services
included
in
the
annual
service
and
budget
plan
and
the
disability
services
administered
by
the
state
and
others
will
be
managed.
e.
The
quality
management
and
improvement
processes.
f.
The
risk
management
provisions
and
fiscal
viability
of
the
annual
service
and
budget
plan,
if
the
region
contracts
with
a
private
entity.
g.
The
requirements
for
designation
of
targeted
case
management
providers
and
for
implementation
of
evidence-based
models
of
case
management.
The
requirements
shall
be
designed
to
provide
the
person
receiving
the
case
management
with
a
choice
of
providers,
allow
a
service
provider
to
be
the
case
manager
but
prohibit
the
provider
from
referring
a
person
receiving
the
case
management
only
to
services
administered
by
the
provider,
and
include
other
provisions
to
ensure
compliance
with
but
not
exceed
federal
requirements
for
conflict-free
case
management.
The
qualifications
of
targeted
case
managers
and
other
persons
providing
service
coordination
under
the
management
plan
shall
be
specified
in
the
rules.
The
rules
shall
also
include
but
are
not
limited
to
all
of
the
following
relating
to
targeted
case
management
and
service
coordination
services:
Senate
File
2315,
p.
9
(1)
Performance
and
outcome
measures
relating
to
the
health,
safety,
work
performance,
and
community
residency
of
the
persons
receiving
the
services.
(2)
Standards
for
delivery
of
the
services,
including
but
not
limited
to
social
history,
assessment,
service
planning,
incident
reporting,
crisis
planning,
coordination,
and
monitoring
for
persons
receiving
the
services.
(3)
Methodologies
for
complying
with
the
requirements
of
this
paragraph
“g”
which
may
include
the
use
of
electronic
recordkeeping
and
remote
or
internet-based
training.
h.
A
plan
for
a
systems
of
care
approach
in
which
multiple
public
and
private
agencies
partner
with
families
and
communities
to
address
the
multiple
needs
of
the
persons
and
their
families
involved
with
the
regional
service
system.
i.
Measures
to
provide
services
in
a
decentralized
manner
that
utilize
the
strengths
and
assets
of
the
administrators
and
service
providers
within
and
available
to
the
region.
j.
A
plan
for
provider
network
formation
and
management.
k.
Service
provider
payment
provisions.
l.
A
process
for
resolving
grievances.
m.
Measures
for
implementing
interagency
and
multisystem
collaboration
and
care
coordination.
5.
The
provisions
of
a
regional
service
system
management
plan
shall
include
measures
to
address
the
needs
of
persons
who
have
two
or
more
co-occurring
mental
health,
intellectual
or
other
developmental
disability,
brain
injury,
or
substance-related
disorders
and
individuals
with
specialized
needs.
Implementation
of
measures
to
meet
the
needs
of
persons
with
a
developmental
disability
other
than
intellectual
disability,
brain
injury,
or
substance-related
disorders
is
contingent
upon
identification
of
a
funding
source
to
meet
those
needs
and
implementation
of
provisions
to
engage
the
entity
under
contract
with
the
state
to
provide
services
to
address
substance-related
disorders
within
the
regional
service
system.
6.
If
a
county
has
been
exempted
pursuant
to
section
331.438B
from
the
requirement
to
enter
into
a
regional
service
system,
the
county
and
the
county’s
board
of
supervisors
shall
fulfill
all
requirements
under
this
chapter
for
a
regional
service
system,
regional
service
system
management
plan,
regional
governing
board,
and
regional
administrator,
and
any
other
provisions
applicable
to
a
region
of
counties
providing
local
mental
health
and
disability
services.
Senate
File
2315,
p.
10
7.
The
region
may
either
directly
implement
a
system
of
service
management
and
contract
with
service
providers,
or
contract
with
a
private
entity
to
manage
the
regional
service
system,
provided
all
requirements
of
this
section
are
met
by
the
private
entity.
The
regional
service
system
shall
incorporate
service
management
and
functional
assessment
processes
developed
in
accordance
with
applicable
requirements.
8.
A
region
may
provide
assistance
to
service
populations
with
disabilities
to
which
the
counties
comprising
the
region
have
historically
provided
assistance
but
who
are
not
included
in
the
core
services
required
under
section
331.439D,
subject
to
the
availability
of
funding.
9.
If
a
region
determines
that
the
region
cannot
provide
services
for
the
fiscal
year
in
accordance
with
the
regional
plan
and
remain
in
compliance
with
applicable
budgeting
requirements,
the
region
may
implement
a
waiting
list
for
the
services.
The
procedures
for
establishing
and
applying
a
waiting
list
shall
be
specified
in
the
regional
plan.
If
a
region
implements
a
waiting
list
for
services,
the
region
shall
notify
the
department
of
human
services.
The
department
shall
maintain
on
the
department’s
internet
site
an
up-to-date
listing
of
the
regions
that
have
implemented
a
waiting
list
and
the
services
affected
by
each
waiting
list.
10.
The
director’s
approval
of
a
regional
plan
shall
not
be
construed
to
constitute
certification
of
the
respective
county
budgets
or
of
the
region’s
budget.
Sec.
13.
NEW
SECTION
.
331.439B
Financial
eligibility
requirements.
A
person
must
comply
with
all
of
the
following
financial
eligibility
requirements
to
be
eligible
for
services
under
the
regional
service
system:
1.
The
person
must
have
an
income
equal
to
or
less
than
one
hundred
fifty
percent
of
the
federal
poverty
level,
as
defined
by
the
most
recently
revised
poverty
income
guidelines
published
by
the
United
States
department
of
health
and
human
services,
to
be
eligible
for
regional
service
system
public
funding.
It
is
the
intent
of
the
general
assembly
to
consider
increasing
this
income
eligibility
provision
to
two
hundred
percent
of
the
federal
poverty
level.
2.
a.
A
region
or
a
service
provider
contracting
with
the
region
shall
not
apply
a
copayment,
sliding
fee
scale,
or
other
cost
sharing
requirement
for
a
particular
service
to
a
person
with
an
income
equal
to
or
less
than
one
hundred
fifty
percent
Senate
File
2315,
p.
11
of
the
federal
poverty
level.
b.
Notwithstanding
subsection
1,
a
person
with
an
income
above
one
hundred
fifty
percent
of
the
federal
poverty
level
may
be
eligible
for
services
subject
to
a
copayment,
sliding
fee
scale,
or
other
cost-sharing
requirement
approved
by
the
department.
c.
A
provider
under
the
regional
service
system
of
a
service
that
is
not
funded
by
the
medical
assistance
program
under
chapter
249A
may
waive
the
copayment
or
other
cost-sharing
arrangement
if
the
provider
is
not
reimbursed
for
the
cost
with
public
funds.
3.
A
person
who
is
eligible
for
federally
funded
services
and
other
support
must
apply
for
such
services
and
support.
4.
The
person
is
in
compliance
with
resource
limitations
identified
in
rule
adopted
by
the
state
commission.
The
limitation
shall
be
derived
from
the
federal
supplemental
security
income
program
resource
limitations.
A
person
with
resources
above
the
federal
supplemental
security
income
program
resource
limitations
may
be
eligible
subject
to
limitations
adopted
in
rule
by
the
state
commission
pursuant
to
a
recommendation
made
by
the
department.
If
a
person
does
not
qualify
for
federally
funded
services
and
other
support
but
meets
income,
resource,
and
functional
eligibility
requirements
for
regional
services,
the
following
types
of
resources
shall
be
disregarded:
a.
A
retirement
account
that
is
in
the
accumulation
stage.
b.
A
burial,
medical
savings,
or
assistive
technology
account.
Sec.
14.
NEW
SECTION
.
331.439C
Diagnosis
——
functional
assessment.
1.
A
person
must
comply
with
all
of
the
following
requirements
to
be
eligible
for
mental
health
services
under
the
regional
service
system:
a.
The
person
complies
with
financial
eligibility
requirements
under
section
331.439B.
b.
The
person
is
at
least
eighteen
years
of
age
and
is
a
resident
of
this
state.
However,
a
person
who
is
seventeen
years
of
age,
is
a
resident
of
this
state,
and
is
receiving
publicly
funded
children’s
services
may
be
considered
eligible
for
services
through
the
regional
service
system
during
the
three-month
period
preceding
the
person’s
eighteenth
birthday
in
order
to
provide
a
smooth
transition
from
children’s
to
adult
services.
Senate
File
2315,
p.
12
c.
The
person
has
had
at
any
time
during
the
preceding
twelve-month
period
a
mental
health,
behavioral,
or
emotional
disorder
or,
in
the
opinion
of
a
mental
health
professional,
may
now
have
such
a
diagnosable
disorder.
The
diagnosis
shall
be
made
in
accordance
with
the
criteria
provided
in
the
diagnostic
and
statistical
manual
of
mental
disorders,
fourth
edition
text
revised,
published
by
the
American
psychiatric
association,
and
shall
not
include
the
manual’s
“V”
codes
identifying
conditions
other
than
a
disease
or
injury.
The
diagnosis
shall
also
not
include
substance-related
disorders,
dementia,
antisocial
personality,
or
developmental
disabilities,
unless
co-occurring
with
another
diagnosable
mental
illness.
d.
The
person’s
eligibility
for
individualized
services
shall
be
determined
in
accordance
with
the
standardized
functional
assessment
methodology
approved
for
mental
health
services
by
the
director
of
human
services
in
consultation
with
the
state
commission.
2.
A
person
must
comply
with
all
of
the
following
requirements
to
be
eligible
for
intellectual
disability
services
under
the
regional
service
system:
a.
The
person
complies
with
financial
eligibility
requirements
under
section
331.439B.
b.
The
person
is
at
least
eighteen
years
of
age
and
is
a
resident
of
this
state.
However,
a
person
who
is
seventeen
years
of
age,
is
a
resident
of
this
state,
and
is
receiving
publicly
funded
children’s
services
may
be
considered
eligible
for
services
through
the
regional
service
system
during
the
three-month
period
preceding
the
person’s
eighteenth
birthday
in
order
to
provide
a
smooth
transition
from
children’s
to
adult
services.
c.
The
person
has
a
diagnosis
of
intellectual
disability.
d.
The
person’s
eligibility
for
individualized
services
shall
be
determined
in
accordance
with
the
standardized
functional
assessment
methodology
approved
for
intellectual
disability
and
developmental
disability
services
by
the
director
of
human
services.
3.
A
person
must
comply
with
all
of
the
following
requirements
to
be
eligible
for
brain
injury
services
under
the
regional
service
system:
a.
The
person
complies
with
financial
eligibility
requirements
under
section
331.439B.
b.
The
person
is
at
least
eighteen
years
of
age
and
is
a
Senate
File
2315,
p.
13
resident
of
this
state.
However,
a
person
who
is
seventeen
years
of
age,
is
a
resident
of
this
state,
and
is
receiving
publicly
funded
children’s
services
may
be
considered
eligible
for
services
through
the
regional
service
system
during
the
three-month
period
preceding
the
person’s
eighteenth
birthday
in
order
to
provide
a
smooth
transition
from
children’s
to
adult
services.
c.
The
person
has
a
diagnosis
of
brain
injury.
d.
The
person’s
eligibility
for
individualized
services
shall
be
determined
in
accordance
with
a
standardized
functional
assessment
methodology
approved
for
this
purpose
by
the
director
of
human
services.
Sec.
15.
NEW
SECTION
.
331.439D
Regional
core
services.
1.
For
the
purposes
of
this
section,
unless
the
context
otherwise
requires,
“domain”
means
a
set
of
similar
services
that
can
be
provided
depending
upon
a
person’s
service
needs.
2.
a.
(1)
A
region
shall
work
with
service
providers
to
ensure
that
services
are
available
to
residents
of
the
region,
regardless
of
potential
payment
source
for
the
services.
(2)
Subject
to
the
available
appropriations,
the
director
of
human
services
shall
ensure
the
initial
core
service
domains
listed
in
subsection
4
are
covered
services
for
the
medical
assistance
program
under
chapter
249A
to
the
greatest
extent
allowable
under
federal
regulations.
Within
funds
available,
the
region
shall
pay
for
such
services
for
eligible
persons
when
payment
through
the
medical
assistance
program
or
another
third-party
payment
is
not
available,
unless
the
person
is
on
a
waiting
list
for
such
payment
or
it
has
been
determined
that
the
person
does
not
meet
the
eligibility
criteria
for
any
such
service.
b.
Until
funding
is
designated
for
other
service
populations,
eligibility
for
the
service
domains
listed
in
this
section
shall
be
limited
to
such
persons
who
are
in
need
of
mental
health
or
intellectual
disability
services.
However,
if
a
county
in
a
region
was
providing
services
to
an
individual
person
with
a
developmental
disability
other
than
intellectual
disability
or
a
brain
injury
prior
to
formation
of
the
region,
the
individual
person
shall
remain
eligible
for
the
services
provided
when
the
region
is
formed,
provided
that
funds
are
available
to
continue
such
services.
c.
It
is
the
intent
of
the
general
assembly
to
address
the
need
for
funding
so
that
the
availability
of
the
service
domains
listed
in
this
section
may
be
expanded
to
include
such
Senate
File
2315,
p.
14
persons
who
are
in
need
of
developmental
disability
or
brain
injury
services.
3.
Pursuant
to
recommendations
made
by
the
director
of
human
services,
the
state
commission
shall
adopt
rules
as
required
by
section
225C.6
to
define
the
services
included
in
the
initial
and
additional
core
service
domains
listed
in
this
section.
The
rules
shall
provide
consistency,
to
the
extent
possible,
with
similar
service
definitions
under
the
medical
assistance
program.
The
rules
relating
to
the
credentialing
of
a
person
directly
providing
services
shall
require
all
of
the
following:
a.
The
person
shall
provide
services
and
represent
the
person
as
competent
only
within
the
boundaries
of
the
person’s
education,
training,
license,
certification,
consultation
received,
supervised
experience,
or
other
relevant
professional
experience.
b.
The
person
shall
provide
services
in
substantive
areas
or
use
intervention
techniques
or
approaches
that
are
new
only
after
engaging
in
appropriate
study,
training,
consultation,
and
supervision
from
a
person
who
is
competent
in
those
areas,
techniques,
or
approaches.
c.
If
generally
recognized
standards
do
not
exist
with
respect
to
an
emerging
area
of
practice,
the
person
shall
exercise
careful
judgment
and
take
responsible
steps,
including
obtaining
appropriate
education,
research,
training,
consultation,
and
supervision,
in
order
to
ensure
competence
and
to
protect
from
harm
the
persons
receiving
the
services
in
the
emerging
area
of
practice.
4.
The
initial
core
service
domains
shall
include
the
following:
a.
Treatment
designed
to
ameliorate
a
person’s
condition,
including
but
not
limited
to
all
of
the
following:
(1)
Assessment
and
evaluation.
(2)
Mental
health
outpatient
therapy.
(3)
Medication
prescribing
and
management.
(4)
Mental
health
inpatient
treatment.
b.
Basic
crisis
response
provisions,
including
but
not
limited
to
all
of
the
following:
(1)
Twenty-four-hour
access
to
crisis
response.
(2)
Evaluation.
(3)
Personal
emergency
response
system.
c.
Support
for
community
living,
including
but
not
limited
to
all
of
the
following:
(1)
Home
health
aide.
Senate
File
2315,
p.
15
(2)
Home
and
vehicle
modifications.
(3)
Respite.
(4)
Supportive
community
living.
d.
Support
for
employment,
including
but
not
limited
to
all
of
the
following:
(1)
Day
habilitation.
(2)
Job
development.
(3)
Supported
employment.
(4)
Prevocational
services.
e.
Recovery
services,
including
but
not
limited
to
all
of
the
following:
(1)
Family
support.
(2)
Peer
support.
f.
Service
coordination
including
coordinating
physical
health
and
primary
care,
including
but
not
limited
to
all
of
the
following:
(1)
Case
management.
(2)
Health
homes.
5.
A
region
shall
ensure
that
access
is
available
to
providers
of
core
services
that
demonstrate
competencies
necessary
for
all
of
the
following:
a.
Serving
persons
with
co-occurring
conditions.
b.
Providing
evidence-based
services.
c.
Providing
trauma-informed
care
that
recognizes
the
presence
of
trauma
symptoms
in
persons
receiving
services.
6.
A
region
shall
ensure
that
services
within
the
following
additional
core
service
domains
are
available
to
persons
not
eligible
for
the
medical
assistance
program
under
chapter
249A
or
receiving
other
third-party
payment
for
the
services,
when
public
funds
are
made
available
for
such
services:
a.
Comprehensive
facility
and
community-based
crisis
services,
including
but
not
limited
to
all
of
the
following:
(1)
Twenty-four-hour
crisis
hotline.
(2)
Mobile
response.
(3)
Twenty-three-hour
crisis
observation
and
holding,
and
crisis
stabilization
facility
and
community-based
services.
(4)
Crisis
residential
services.
b.
Subacute
services
provided
in
facility
and
community-based
settings.
c.
Justice
system-involved
services,
including
but
not
limited
to
all
of
the
following:
(1)
Jail
diversion.
(2)
Crisis
intervention
training.
Senate
File
2315,
p.
16
(3)
Civil
commitment
prescreening.
d.
Advances
in
the
use
of
evidence-based
treatment,
including
but
not
limited
to
all
of
the
following:
(1)
Positive
behavior
support.
(2)
Assertive
community
treatment.
(3)
Peer
self-help
drop-in
centers.
7.
A
regional
service
system
may
provide
funding
for
other
appropriate
services
or
other
support.
In
considering
whether
to
provide
such
funding,
a
region
may
consider
the
following
criteria:
a.
Applying
a
person-centered
planning
process
to
identify
the
need
for
the
services
or
other
support.
b.
The
efficacy
of
the
services
or
other
support
is
recognized
as
an
evidence-based
practice,
is
deemed
to
be
an
emerging
and
promising
practice,
or
providing
the
services
is
part
of
a
demonstration
and
will
supply
evidence
as
to
the
services’
effectiveness.
c.
A
determination
that
the
services
or
other
support
provides
an
effective
alternative
to
existing
services
that
have
been
shown
by
the
evidence
base
to
be
ineffective,
to
not
yield
the
desired
outcome,
or
to
not
support
the
principles
outlined
in
Olmstead
v.
L.C.,
527
U.S.
581
(1999).
Sec.
16.
NEW
SECTION
.
331.440B
Regional
service
system
financing.
1.
The
financing
of
a
regional
mental
health
and
disability
service
system
is
limited
to
a
fixed
budget
amount.
The
fixed
budget
amount
shall
be
the
amount
identified
in
a
regional
service
system
management
plan
and
budget
for
the
fiscal
year.
A
region
shall
receive
state
funding
for
growth
in
non-Medicaid
expenditures
through
the
mental
health
and
disability
regional
services
fund
created
in
section
225C.7A
to
address
increased
service
costs,
additional
service
populations,
additional
core
service
domains,
and
increased
numbers
of
persons
receiving
services.
2.
A
region
shall
implement
its
regional
service
system
management
plan
in
a
manner
so
as
to
provide
adequate
funding
of
services
for
the
entire
fiscal
year
by
budgeting
for
ninety-nine
percent
of
the
funding
anticipated
to
be
available
for
the
regional
plan
for
the
fiscal
year.
A
region
may
expend
all
of
the
funding
anticipated
to
be
available
for
the
regional
plan.
Sec.
17.
IMPLEMENTATION
OF
ACT.
Section
25B.2,
subsection
3,
shall
not
apply
to
this
division
of
this
Act.
Senate
File
2315,
p.
17
Sec.
18.
CODE
EDITOR.
The
Code
editor
may
codify
the
provisions
of
this
division
of
this
Act
and
any
other
provisions
of
this
Act
involving
chapter
331
as
one
or
more
new
parts
of
chapter
331,
division
III.
Sec.
19.
APPLICABILITY.
The
provisions
of
this
division
of
this
Act
enacting
new
Code
sections
331.439A
through
331.439D,
and
section
331.440B
apply
beginning
on
July
1,
2013.
Sec.
20.
APPLICABILITY.
The
provisions
of
this
division
of
this
Act
amending
chapter
225C
are
applicable
prior
to
July
1,
2013,
for
purposes
of
adopting
rules
to
be
effective
on
or
after
July
1,
2013.
Sec.
21.
EFFECTIVE
DATE.
The
following
provisions
of
this
Act
take
effect
July
1,
2013:
1.
The
sections
of
this
division
of
this
Act
amending
chapter
225C.
DIVISION
II
REDESIGN
PLANNING,
SUPPORT,
AND
IMPLEMENTATION
Sec.
22.
REDESIGN
SUPPORT.
1.
The
department
of
human
services
shall
work
with
the
Iowa
state
association
of
counties
in
providing
training,
support,
and
technical
assistance
to
counties
in
developing
the
mental
health
and
disability
services
regional
services
system
as
provided
in
this
Act
and
in
evaluating
whether
any
barriers
exist
that
would
prevent
or
restrict
the
community
services
network
developed
by
the
association
from
being
used
as
the
data
system
for
the
service
system.
2.
The
department
of
human
services
shall
identify
third-party
coverage
sources
and
develop
estimates
and
financing
options
for
maximizing
the
use
of
the
third-party
coverage
sources
in
adding
eligibility
for
core
services
under
the
mental
health
and
disability
services
regional
service
system
for
adults
with
a
developmental
disability
other
than
intellectual
disability
and
for
adults
with
brain
injury.
The
estimates
and
financing
options
shall
be
submitted
to
the
governor
and
general
assembly
on
or
before
December
14,
2012.
3.
a.
The
department
of
human
services
shall
create
a
transition
committee
of
appropriate
stakeholders
with
whom
to
consult
on
the
transition
from
the
current
mental
health
and
disability
services
system
to
the
regional
service
system
as
provided
in
this
Act.
In
addition,
the
transition
committee
shall
consider
the
data
collected
for
the
current
system
and
for
the
new
regional
system
and
whether
improvements
are
warranted.
Senate
File
2315,
p.
18
b.
In
designating
the
committee
members,
the
director
of
human
services
shall
consult
with
the
chairpersons
and
ranking
members
of
the
committees
on
human
resources
of
the
senate
and
house
of
representatives
and
other
members
of
the
general
assembly
identified
by
the
majority
or
minority
leader
of
the
senate
or
the
speaker
or
minority
leader
of
the
house
of
representatives.
In
addition,
the
membership
shall
include
four
members
of
the
general
assembly,
with
one
each
appointed
by
the
majority
and
minority
leader
of
the
senate
and
the
speaker
and
minority
leader
of
the
house
of
representatives.
Sec.
23.
MENTAL
HEALTH
AND
DISABILITY
SERVICES
REDESIGN
TRANSITION
FUND.
1.
A
mental
health
and
disability
services
redesign
transition
fund
is
created
under
the
authority
of
the
department
of
human
services
for
the
fiscal
year
beginning
July
1,
2012,
and
ending
June
30,
2013.
Moneys
credited
to
the
fund
shall
be
used
as
provided
in
appropriations
made
from
the
fund,
to
be
enacted
by
the
general
assembly,
for
allocation
by
the
department
to
counties
for
one-time
assistance
for
continuation
of
current
core
county
mental
health
and
disability
services
to
targeted
populations
that
are
not
funded
by
the
Medicaid
program.
2.
The
eligibility
provisions
for
a
county
to
receive
moneys
from
the
fund
shall
include
but
are
not
limited
to
all
of
the
following:
a.
The
application
and
application
materials
submitted
are
approved
by
the
county
board
of
supervisors.
b.
The
county
levy
certified
for
the
county’s
services
fund
under
section
331.424A
for
the
fiscal
year
is
the
maximum
amount
authorized
by
law.
c.
The
county
financial
information
provided
with
the
application
is
independently
verified.
The
financial
information
to
be
provided
shall
be
specified
by
the
department
and
may
include
actual
and
projected
cash
and
accrued
fund
balances,
detailed
accounts
receivable
and
payable
information,
budgeted
revenues
and
expenditures,
identification
of
the
need
for
the
amount
requested,
and
costs
for
the
county’s
services
administration.
d.
The
required
county
service
information
is
provided
with
the
application.
The
county
service
information
to
be
provided
shall
be
specified
by
the
department
and
may
include
the
following:
(1)
The
type,
amount,
and
scope
of
services
provided
by
the
Senate
File
2315,
p.
19
county
as
compared
with
other
counties.
(2)
The
extent
to
which
the
county
subsidizes
the
services
directly
provided
or
authorized
by
the
county.
(3)
The
extent
to
which
the
services
funded
by
the
county
are
included
in
the
county’s
management
plan
approved
under
section
331.439.
(4)
The
extent
to
which
services
are
provided
to
persons
other
than
adults
with
an
intellectual
disability
or
mental
illness
with
income
that
is
at
or
below
150
percent
of
the
federal
poverty
level.
e.
The
application
contains
a
sustainability
plan
in
accordance
with
the
requirements
specified
by
the
department.
The
requirements
shall
include
but
are
not
limited
to
explanation
as
to
how
the
moneys
requested
will
be
used
during
this
transition
year
to
provide
services
in
a
manner
that
will
allow
the
county
to
remain
within
the
funding
available
to
the
county
under
per
capita
funding
provisions,
applicable
to
the
county
as
enacted
by
this
Act,
commencing
with
the
fiscal
year
beginning
July
1,
2013.
f.
The
application
is
submitted
on
or
before
the
specified
application
date.
The
initial
application
date
specified
shall
be
on
or
after
October
15,
2012.
The
department
shall
complete
the
application
process
and
make
a
recommendation
by
December
1,
2012,
to
the
governor
and
general
assembly
for
an
appropriate
amount
of
funding
to
meet
the
need
for
assistance
under
this
section
as
determined
by
the
department’s
analysis
of
the
applications,
which
amount
may
be
addressed
by
an
appropriation
by
the
Eighty-fifth
General
Assembly,
2013
Regular
Session.
g.
Other
items
specified
by
rule.
The
department
shall
consult
with
the
transition
committee
created
by
this
division
of
this
Act
in
recommending
the
adoption
of
rules
by
the
mental
health
and
disability
services
commission
delineating
the
requirements
for
funding
under
this
section.
3.
The
department
may
provide
for
distribution
provisions
in
which
the
amount
awarded
is
distributed
in
more
than
one
payment
based
upon
actual
expenditures
and
submission
of
required
information.
4.
The
mental
health
and
disability
services
commission
may
adopt
administrative
rules
under
section
17A.4,
subsection
3,
and
section
17A.5,
subsection
2,
paragraph
“b”,
to
implement
the
provisions
of
this
section,
and
the
rules
shall
become
effective
immediately
upon
filing
or
on
a
later
effective
date
Senate
File
2315,
p.
20
specified
in
the
rules,
unless
the
effective
date
is
delayed
by
the
administrative
rules
review
committee.
Any
rules
adopted
in
accordance
with
this
subsection
shall
not
take
effect
before
the
rules
are
reviewed
by
the
administrative
rules
review
committee.
The
delay
authority
provided
to
the
administrative
rules
review
committee
under
section
17A.4,
subsection
7,
and
section
17A.8,
subsection
9,
shall
be
applicable
to
a
delay
imposed
under
this
subsection,
notwithstanding
a
provision
in
those
sections
making
them
inapplicable
to
section
17A.5,
subsection
2,
paragraph
“b”.
Any
rules
adopted
in
accordance
with
the
provisions
of
this
subsection
shall
also
be
published
as
notice
of
intended
action
as
provided
in
section
17A.4.
Sec.
24.
MENTAL
HEALTH
AND
DISABILITY
SERVICES
WORKFORCE
DEVELOPMENT
WORKGROUP.
1.
The
department
of
public
health
shall
create
and
provide
support
to
a
mental
health
and
disability
services
workforce
development
workgroup
to
address
issues
in
connection
with
assuring
that
an
adequate
workforce
is
available
in
the
state
to
provide
mental
health
and
disability
services.
The
membership
of
the
workgroup
shall
include
the
other
state
agencies
involved
with
the
services
and
other
appropriate
stakeholders
designated
by
the
director
of
public
health
in
consultation
with
the
chairpersons
and
ranking
members
of
the
committees
on
human
resources
of
the
senate
and
house
of
representatives
and
other
members
of
the
general
assembly
identified
by
the
majority
or
minority
leader
of
the
senate
or
the
speaker
or
minority
leader
of
the
house
of
representatives.
In
addition,
the
membership
shall
include
four
members
of
the
general
assembly
with
one
each
appointed
by
the
majority
and
minority
leader
of
the
senate
and
the
speaker
and
minority
leader
of
the
house
of
representatives.
The
workgroup
shall
report
to
the
governor
and
general
assembly
providing
findings
and
recommendations
and
financing
information
concerning
the
findings
and
recommendations.
A
preliminary
report
shall
be
submitted
on
or
before
December
14,
2012,
and
a
final
report
on
or
before
December
16,
2013.
2.
The
workgroup
shall
consider
the
recommendations
of
the
direct
care
worker
task
force
created
pursuant
to
2005
Iowa
Acts,
chapter
88,
and
the
direct
care
worker
advisory
council
created
pursuant
to
2008
Iowa
Acts,
chapter
69,
regarding
training,
level
of
competency,
core
curricula,
and
certification,
including
but
not
limited
to
those
provisions
relating
to
the
use
of
the
college
of
direct
support
and
other
Senate
File
2315,
p.
21
internet-based
training.
Sec.
25.
REGIONAL
SERVICE
SYSTEM
——
OUTCOMES
AND
PERFORMANCE
MEASURES
COMMITTEE.
1.
The
department
of
human
services
shall
establish
an
outcomes
and
performance
measures
committee
to
make
recommendations
for
specific
outcomes
and
performance
measures
to
be
utilized
by
the
mental
health
and
disability
services
regional
service
system.
The
membership
of
the
committee
shall
include
appropriate
stakeholders
designated
by
the
director
of
human
services
in
consultation
with
the
chairpersons
and
ranking
members
of
the
committees
on
human
resources
of
the
senate
and
house
of
representatives
and
other
members
of
the
general
assembly
identified
by
the
majority
or
minority
leader
of
the
senate
or
the
speaker
or
minority
leader
of
the
house
of
representatives.
In
addition,
the
membership
shall
include
four
members
of
the
general
assembly
with
one
each
appointed
by
the
majority
and
minority
leader
of
the
senate
and
the
speaker
and
minority
leader
of
the
house
of
representatives.
2.
The
committee’s
recommendations
shall
incorporate
the
outcome
measurement
methodologies
previously
developed
by
the
mental
health
and
disability
services
commission.
To
the
extent
possible,
the
committee
shall
seek
to
provide
outcome
and
performance
measures
recommendations
that
are
consistent
across
the
mental
health
and
disability
services
populations
addressed.
The
committee
shall
also
evaluate
data
collection
requirements
utilized
in
the
mental
health
and
disability
regional
service
system
to
identify
the
requirements
that
could
be
eliminated
or
revised
due
to
the
administrative
burden
involved
or
the
low
degree
of
relevance
to
outcomes
or
other
reporting
requirements.
3.
The
committee
recommendations
shall
be
submitted
to
the
governor,
general
assembly,
and
policymaking
bodies.
Initial
recommendations
shall
be
submitted
on
or
before
December
14,
2012,
and
final
recommendations
on
or
before
December
16,
2013.
The
mental
health
and
disability
services
commission
and
other
policymaking
bodies
shall
consider
the
recommendations
in
eliminating
or
otherwise
revising
data
collection
requirements.
Sec.
26.
CHILDREN’S
DISABILITY
SERVICES
WORKGROUP.
The
December
2012
report
of
the
workgroup
created
by
the
department
of
human
services
pursuant
to
2011
Iowa
Acts,
chapter
121,
section
1,
to
develop
a
proposal
for
publicly
funded
children’s
disability
services
shall
include
an
analysis
of
service
and
cost
effects
of
transitioning
the
behavioral
health
Senate
File
2315,
p.
22
intervention
services
formerly
known
as
remedial
services
and
the
psychiatric
medical
institution
for
children
services
to
the
Iowa
plan.
The
report
shall
also
provide
a
specific
proposal
for
developing
services
in
this
state
to
meet
the
needs
of
children
who
are
placed
out-of-state
due
to
the
lack
of
treatment
services
in
this
state.
The
workgroup
membership
shall
be
expanded
to
include
up
to
four
legislators,
with
one
each
appointed
by
the
majority
leader
and
the
minority
leader
of
the
senate
and
the
speaker
and
the
minority
leader
of
the
house
of
representatives.
Sec.
27.
DISPUTED
BILLINGS.
1.
To
the
extent
allowable
under
federal
law
or
regulation,
if
the
costs
of
a
service
are
payable
in
whole
or
in
part
by
a
county
in
accordance
with
a
chapter
of
the
Code
listed
in
this
section,
the
service
was
rendered
prior
to
July
1,
2011,
and
the
county
that
would
be
obligated
to
pay
for
the
costs
of
the
service
has
not
been
billed
for
the
service
or
has
disputed
the
billing
prior
to
the
effective
date
of
this
section,
or
the
state
has
fully
charged
off
the
cost
of
the
service
or
has
not
provided
information
to
appropriately
document
the
basis
for
the
billing,
the
county
shall
have
no
obligation
to
pay
for
the
service.
2.
This
section
is
applicable
to
service
costs
that
are
a
county
obligation
for
services
provided
under
any
of
the
following
chapters
of
the
Code:
a.
Chapter
221.
b.
Chapter
222.
c.
Chapter
229.
d.
Chapter
230.
e.
Chapter
233B.
f.
Chapter
249A.
g.
Chapter
812.
Sec.
28.
NEW
SECTION
.
225C.6E
Regional
service
system
——
regulatory
requirements.
1.
The
departments
of
inspections
and
appeals,
human
services,
and
public
health
shall
comply
with
the
requirements
of
this
section
in
their
efforts
to
improve
the
regulatory
requirements
applied
to
the
mental
health
and
disability
regional
service
system
administration
and
service
providers.
2.
The
three
departments
shall
work
together
to
establish
a
process
to
streamline
accreditation,
certification,
and
licensing
standards
applied
to
the
regional
service
system
administration
and
service
providers.
Senate
File
2315,
p.
23
3.
The
departments
of
human
services
and
inspections
and
appeals
shall
jointly
review
the
standards
and
inspection
process
applicable
to
residential
care
facilities.
4.
The
three
departments
shall
do
all
of
the
following
in
developing
regulatory
requirements
applicable
to
the
regional
service
system
administration
and
service
providers:
a.
Consider
the
costs
to
administrators
and
providers
in
the
development
of
quality
monitoring
efforts.
b.
Implement
the
use
of
uniform,
streamlined,
and
statewide
cost
reporting
standards
and
tools
by
the
regional
service
system
and
the
department
of
human
services.
c.
Make
quality
monitoring
information,
including
services,
quality,
and
location
information,
easily
available
and
understandable
to
all
citizens.
d.
Establish
standards
that
are
clearly
understood
and
are
accompanied
by
interpretive
guidelines
to
support
understanding
by
those
responsible
for
applying
the
standards.
e.
Develop
a
partnership
with
providers
in
order
to
improve
the
quality
of
services
and
develop
mechanisms
for
the
provision
of
technical
assistance.
f.
Develop
consistent
data
collection
efforts
based
on
statewide
standards
and
make
information
available
to
all
providers.
The
efforts
under
this
paragraph
shall
be
made
with
representatives
of
the
Iowa
state
association
of
counties.
g.
Evaluate
existing
provider
qualification
and
monitoring
efforts
to
identify
duplication
and
gaps,
and
align
the
efforts
with
valued
outcomes.
h.
Streamline
and
enhance
existing
standards.
i.
Consider
allowing
providers
to
seek
accreditation
from
a
national
accrediting
body
in
lieu
of
state
accreditation
or
certification.
DIVISION
III
COMMUNITY
MENTAL
HEALTH
CENTER
AMENDMENTS
Sec.
29.
Section
230A.110,
subsection
1,
as
enacted
by
2011
Iowa
Acts,
chapter
121,
section
20,
is
amended
to
read
as
follows:
1.
The
division
shall
recommend
and
the
commission
shall
adopt
standards
for
designated
community
mental
health
centers
and
comprehensive
community
mental
health
programs,
with
the
overall
objective
of
ensuring
that
each
center
and
each
affiliate
providing
services
under
contract
with
a
center
furnishes
high-quality
mental
health
services
within
a
framework
of
accountability
to
the
community
it
serves.
Senate
File
2315,
p.
24
The
standards
adopted
shall
conform
with
federal
standards
applicable
to
community
mental
health
centers
and
shall
be
in
substantial
conformity
with
the
applicable
behavioral
health
standards
adopted
by
the
joint
commission,
formerly
known
as
the
joint
commission
on
accreditation
of
health
care
organizations,
and
or
other
recognized
national
standards
for
evaluation
of
psychiatric
facilities
unless
in
the
judgment
of
the
division,
with
approval
of
the
commission,
there
are
sound
reasons
for
departing
from
the
standards.
DIVISION
IV
REGIONAL
SERVICE
SYSTEM
Sec.
30.
Section
97B.1A,
subsection
8,
paragraph
a,
Code
Supplement
2011,
is
amended
by
adding
the
following
new
subparagraph:
NEW
SUBPARAGRAPH
.
(13)
Employees
of
a
regional
administrator
formed
in
accordance
with
section
331.438E,
determined
to
be
an
instrumentality
of
the
political
subdivision
forming
the
regional
administrator.
Sec.
31.
NEW
SECTION
.
331.438A
Definitions.
As
used
in
this
part,
unless
the
context
otherwise
requires:
1.
“Department”
means
the
department
of
human
services.
2.
“Disability
services”
means
the
same
as
defined
in
section
225C.2.
3.
“Population”
means
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.
4.
“Regional
administrator”
means
the
administrative
office,
organization,
or
entity
formed
by
agreement
of
the
counties
participating
in
a
region
to
function
on
behalf
of
those
counties
in
accordance
with
this
part.
5.
“State
commission”
means
the
mental
health
and
disability
services
commission
created
in
section
225C.5.
Sec.
32.
NEW
SECTION
.
331.438B
Mental
health
and
disability
services
regions
——
criteria.
1.
a.
Local
access
to
mental
health
and
disability
services
for
adults
shall
be
provided
either
by
counties
organized
into
a
regional
service
system
or
by
individual
counties
that
are
exempted
as
provided
by
this
subsection.
The
department
of
human
services
shall
encourage
counties
to
enter
into
a
regional
system
when
the
regional
approach
is
likely
to
increase
the
availability
of
services
to
residents
of
the
state
who
need
the
services.
It
is
the
intent
of
the
Senate
File
2315,
p.
25
general
assembly
that
the
adult
residents
of
this
state
should
have
access
to
needed
mental
health
and
disability
services
regardless
of
the
location
of
their
residence.
b.
(1)
The
director
of
human
services
shall
exempt
a
county
from
being
required
to
enter
into
a
regional
service
system
if
the
county
furnishes
evidence
that
the
county
complies
with
the
requirements
in
subsection
3,
paragraphs
“c”
,
“d”
,
“e”
,
and
“f”
,
and
is
able
to
provide
the
core
services
required
by
law
to
the
county’s
residents
in
a
manner
that
is
as
cost
effective
and
with
outcomes
that
are
at
least
equal
to
what
could
be
provided
to
the
residents
if
the
county
would
provide
the
services
through
a
regional
service
system.
The
director
shall
identify
criteria
for
evaluating
the
evidence
provided
by
counties
applying
for
the
exemption.
The
criteria
identified
shall
be
specified
in
rule
adopted
by
the
state
commission.
(2)
To
be
considered
for
an
exemption
under
subparagraph
(1),
a
county
must
file
a
written
statement
of
intent
to
apply
for
an
exemption
with
the
department
on
or
before
May
1,
2013,
and
the
county’s
exemption
application
must
be
filed
with
the
department
on
or
before
June
30,
2013.
The
director
of
human
services
shall
issue
a
decision
on
the
application
within
forty-five
days
of
receiving
the
application.
This
subparagraph
is
repealed
July
1,
2013.
c.
If
a
county
has
been
exempted
pursuant
to
this
subsection
from
the
requirement
to
enter
into
a
regional
service
system,
the
county
and
the
county’s
board
of
supervisors
shall
fulfill
all
requirements
under
this
chapter
and
chapter
225C
for
a
regional
service
system,
regional
service
system
management
plan,
regional
governing
board,
and
regional
administrator,
and
any
other
provisions
applicable
to
a
region
of
counties
providing
local
mental
health
and
disability
services.
2.
The
director
of
human
services
shall
approve
any
region
meeting
the
requirements
of
subsection
3.
However,
the
director
of
human
services,
in
consultation
with
the
state
commission,
may
grant
a
waiver
from
the
requirement
relating
to
the
minimum
number
of
counties
if
there
is
convincing
evidence
that
compliance
with
such
requirement
is
not
workable.
3.
Each
county
in
the
state
shall
participate
in
an
approved
mental
health
and
disability
services
region,
unless
exempted
pursuant
to
subsection
1.
A
mental
health
and
disability
services
region
shall
comply
with
all
of
the
following
requirements:
a.
The
counties
comprising
the
region
are
contiguous.
Senate
File
2315,
p.
26
b.
The
region
has
at
least
three
counties.
c.
The
region
has
the
capacity
to
provide
required
core
services
and
perform
required
functions.
d.
At
least
one
community
mental
health
center
or
a
federally
qualified
health
center
with
providers
qualified
to
provide
psychiatric
services,
either
directly
or
through
contractual
arrangements
with
mental
health
professionals
qualified
to
provide
psychiatric
services,
is
located
within
the
region,
has
the
capacity
to
provide
outpatient
services
for
the
region,
and
is
either
under
contract
with
the
region
or
has
provided
documentation
of
intent
to
contract
with
the
region
to
provide
the
services.
e.
A
hospital
with
an
inpatient
psychiatric
unit
or
a
state
mental
health
institute
is
located
in
or
within
reasonably
close
proximity
to
the
region,
has
the
capability
to
provide
inpatient
services
for
the
region,
and
is
either
under
contract
with
the
region
or
has
provided
documentation
of
intent
to
contract
with
the
region
to
provide
the
services.
f.
The
regional
administrator
structure
proposed
for
or
utilized
by
the
region
has
clear
lines
of
accountability
and
the
regional
administrator
functions
as
a
lead
agency
utilizing
shared
county
staff
or
other
means
of
limiting
administrative
costs.
4.
County
formation
of
a
mental
health
and
disability
services
region
is
subject
to
all
of
the
following:
a.
On
or
before
April
1,
2013,
counties
voluntarily
participating
in
a
region
have
complied
with
all
of
the
following
formation
criteria:
(1)
The
counties
forming
the
region
have
been
identified
and
the
board
of
supervisors
of
the
counties
have
approved
a
written
letter
of
intent
to
join
together
to
form
the
region.
(2)
The
proposed
region
complies
with
the
requirements
in
subsection
3.
(3)
The
department
provides
written
notice
to
the
boards
of
supervisors
of
the
counties
identified
for
the
region
in
the
letter
of
intent
that
the
counties
have
complied
with
the
requirements
in
subsection
3.
b.
Upon
compliance
with
the
provisions
of
paragraph
“a”
,
the
participating
counties
are
eligible
for
technical
assistance
provided
by
the
department.
c.
During
the
period
of
April
2,
2013,
through
July
1,
2013,
the
department
shall
work
with
any
county
that
has
not
agreed
to
be
part
of
a
region
in
accordance
with
paragraph
Senate
File
2315,
p.
27
“a”
and
with
the
regions
forming
around
the
county
to
resolve
issues
preventing
the
county
from
joining
a
region.
By
July
1,
2013,
a
county
that
has
not
agreed
to
be
part
of
a
region
in
accordance
with
paragraph
“a”
shall
be
assigned
by
the
department
to
a
region,
unless
exempted
pursuant
to
subsection
1.
d.
On
or
before
December
31,
2013,
all
counties
shall
be
part
of
a
region
that
is
in
compliance
with
the
provisions
of
paragraph
“a”
other
than
meeting
the
April
1,
2013,
date.
e.
On
or
before
June
30,
2014,
unless
exempted
pursuant
to
subsection
1,
all
counties
shall
be
in
compliance
with
all
of
the
following
mental
health
and
disability
services
region
implementation
criteria:
(1)
The
board
of
supervisors
of
each
county
participating
in
the
region
has
voted
to
approve
a
chapter
28E
agreement.
(2)
The
duly
authorized
representatives
of
all
the
counties
participating
in
the
region
have
signed
the
chapter
28E
agreement
that
is
in
compliance
with
section
331.438C.
(3)
The
county
board
of
supervisors’
or
supervisors’
designee
members
and
other
members
of
the
region’s
governing
board
have
been
appointed
in
accordance
with
section
331.438C.
(4)
Executive
staff
for
the
region’s
regional
administrator
have
been
identified
or
engaged.
(5)
An
initial
draft
of
a
regional
service
management
transition
plan
has
been
developed
which
identifies
the
steps
to
be
taken
by
the
region
to
do
all
of
the
following:
(a)
Designate
local
access
points
for
the
disability
services
administered
by
the
region.
(b)
Designate
the
region’s
targeted
case
manager
providers
funded
by
the
medical
assistance
program.
(c)
Identify
the
service
provider
network
for
the
region.
(d)
Define
the
service
access
and
service
authorization
process
to
be
utilized
for
the
region.
(e)
Identify
the
information
technology
and
data
management
capacity
to
be
employed
to
support
regional
functions.
(f)
Establish
business
functions,
funds
accounting
procedures,
and
other
administrative
processes.
(g)
Comply
with
data
reporting
and
other
information
technology
requirements
identified
by
the
department.
(6)
The
department
has
approved
the
region’s
chapter
28E
agreement
and
the
initial
draft
of
the
regional
management
transition
plan.
f.
If
the
department,
in
consultation
with
the
state
Senate
File
2315,
p.
28
commission,
determines
that
a
region
is
in
substantial
compliance
with
the
implementation
criteria
in
paragraph
“e”
and
has
sufficient
operating
capacity
to
begin
operations,
the
region
may
commence
partial
or
full
operations
prior
to
July
2014.
5.
If
the
department
determines
that
a
region
or
an
exempted
county
is
not
adequately
fulfilling
the
requirements
under
this
chapter
for
a
regional
service
system,
the
department
shall
address
the
region
or
county
in
the
following
order:
a.
Require
compliance
with
a
corrective
action
plan.
b.
Reduce
the
amount
of
the
annual
state
funding
provided
for
the
regional
service
system,
not
to
exceed
fifteen
percent
of
the
amount.
c.
Withdraw
approval
for
the
region
or
for
the
county
exemption,
as
applicable.
Sec.
33.
NEW
SECTION
.
331.438C
Regional
governance
structure.
1.
The
counties
comprising
a
mental
health
and
disability
services
region
shall
enter
into
an
agreement
under
chapter
28E
to
form
a
regional
administrator
under
the
control
of
a
governing
board
to
function
on
behalf
of
those
counties.
2.
The
governing
board
shall
comply
with
all
of
the
following
requirements:
a.
The
voting
membership
of
the
governing
board
shall
consist
of
at
least
one
board
of
supervisors
member
from
each
county
comprising
the
regions
or
their
designees.
b.
The
membership
of
the
governing
board
shall
also
include
one
individual
who
utilizes
mental
health
and
disability
services
or
is
an
actively
involved
relative
of
such
an
individual.
This
member
shall
be
designated
by
the
advisory
committee
or
committees
formed
by
the
governing
board
pursuant
to
this
section.
The
member
designated
in
accordance
with
this
paragraph
shall
serve
in
a
nonvoting,
ex
officio
capacity.
c.
The
membership
of
the
governing
board
shall
not
include
employees
of
the
department
of
human
services.
d.
The
membership
of
the
governing
board
shall
also
consist
of
one
member
representing
service
providers
in
the
region.
This
member
shall
be
designated
by
the
advisory
committee
or
committees
formed
by
the
governing
board
pursuant
to
this
section.
The
member
designated
in
accordance
with
this
paragraph
shall
serve
in
a
nonvoting,
ex
officio
capacity.
e.
The
governing
board
shall
have
a
regional
advisory
committee
consisting
of
individuals
who
utilize
services
or
Senate
File
2315,
p.
29
actively
involved
relatives
of
such
individuals,
service
providers,
and
regional
governing
board
members.
3.
a.
The
regional
administrator
shall
be
under
the
control
of
the
governing
board.
The
regional
administrator
shall
enter
into
performance-based
contracts
with
the
department
in
accordance
with
section
225C.4,
subsection
1,
paragraph
“u”
for
the
regional
administrator
to
manage,
on
behalf
of
the
counties
comprising
the
region,
the
mental
health
and
disability
services
that
are
not
funded
by
the
medical
assistance
program
under
chapter
249A
and
for
coordinating
with
the
department
the
provision
of
mental
health
and
disability
services
that
are
funded
under
the
medical
assistance
program.
b.
The
regional
administrator
staff
shall
include
one
or
more
coordinators
of
disability
services.
A
coordinator
shall
possess
a
bachelor’s
or
higher
level
degree
in
a
human
services-related
or
administrative-related
field,
including
but
not
limited
to
social
work,
psychology,
nursing,
or
public
or
business
administration,
from
an
accredited
college
or
university.
However,
in
lieu
of
a
degree
in
public
or
business
administration,
a
coordinator
may
provide
documentation
of
relevant
management
experience.
An
action
of
a
coordinator
involving
a
clinical
decision
shall
be
made
in
conjunction
with
a
professional
who
is
trained
in
the
delivery
of
the
mental
health
or
disability
service
addressed
by
the
clinical
decision.
The
regional
administrator
shall
determine
whether
referral
to
a
coordinator
of
disability
services
is
required
for
a
person
seeking
to
access
a
service
through
a
local
access
point
of
the
regional
service
system.
Sec.
34.
NEW
SECTION
.
331.438D
Regional
finances.
1.
The
funding
under
the
control
of
the
governing
board
shall
be
maintained
in
a
combined
account,
in
separate
county
accounts
that
are
under
the
control
of
the
governing
board,
or
pursuant
to
other
arrangements
authorized
by
law
that
limit
the
administrative
burden
of
such
control
while
facilitating
public
scrutiny
of
financial
processes.
2.
The
accounting
system
and
financial
reporting
to
the
department
shall
conform
with
the
cost
principles
for
state,
local,
and
Indian
tribal
governments
issued
by
the
United
States
office
of
management
and
budget.
The
information
shall
segregate
expenditures
for
administration,
purchase
of
service,
and
enterprise
costs
for
which
the
region
is
a
service
provider
or
is
directly
billing
and
collecting
payments
and
shall
be
identified
along
with
other
financial
information
in
Senate
File
2315,
p.
30
a
uniform
chart
of
accounts
prescribed
by
the
department
of
management.
Following
periodic
review
of
administrative
costs,
the
department
shall
make
recommendations,
in
consultation
with
the
legislative
services
agency,
for
standards
defining
region
administrative
costs
and
the
methodology
for
calculating
a
region’s
administrative
load.
Such
standards
shall
be
specified
in
rule
adopted
by
the
state
commission.
3.
The
funding
provided
pursuant
to
appropriations
from
the
mental
health
and
disability
regional
services
fund
created
in
section
225C.7A
and
from
performance-based
contracts
with
the
department
shall
be
credited
to
the
account
or
accounts
under
the
control
of
the
governing
board.
Sec.
35.
NEW
SECTION
.
331.438E
Regional
governance
agreements.
1.
In
addition
to
compliance
with
the
applicable
provisions
of
chapter
28E,
the
chapter
28E
agreement
entered
into
by
the
counties
comprising
a
mental
health
and
disability
services
region
in
forming
the
regional
administrator
to
function
on
behalf
of
the
counties
shall
comply
with
the
requirements
of
this
section.
2.
The
organizational
provisions
of
the
agreement
shall
include
all
of
the
following:
a.
A
statement
of
purpose,
goals,
and
objectives
of
entering
into
the
agreement.
b.
Identification
of
the
governing
board
membership
and
the
terms,
methods
of
appointment,
voting
procedures,
and
other
provisions
applicable
to
the
operation
of
the
governing
board.
The
voting
procedures
may
provide
for
a
weighted
vote
on
decisions
identified
by
the
governing
board.
A
weighted
vote
may
provide
for
assignment
of
a
number
of
votes
to
each
of
the
counties
comprising
the
region
equal
to
its
population
within
the
region,
may
require
at
least
three-fourths
of
the
total
votes
cast
for
approval
of
a
decision,
or
may
provide
for
another
weighted
vote
option
determined
by
the
governing
board.
c.
The
identification
of
the
process
for
selecting
the
executive
staff
of
the
regional
administrator
serving
as
the
single
point
of
accountability
for
the
region.
d.
The
counties
participating
in
the
agreement.
e.
The
time
period
of
the
agreement
and
terms
for
termination
or
renewal
of
the
agreement.
f.
The
circumstances
under
which
additional
counties
may
join
the
region.
g.
Methods
for
dispute
resolution
and
mediation.
Senate
File
2315,
p.
31
h.
Methods
for
termination
of
a
county’s
participation
in
the
region.
i.
Provisions
for
formation
and
assigned
responsibilities
for
one
or
more
advisory
committees
consisting
of
individuals
who
utilize
services
or
actively
involved
relatives
of
such
individuals,
service
providers,
governing
board
members,
and
other
interests
identified
in
the
agreement.
3.
The
administrative
provisions
of
the
agreement
shall
include
all
of
the
following:
a.
Responsibility
of
the
governing
board
in
appointing
and
evaluating
the
performance
of
the
chief
executive
officer
of
the
regional
administrator.
b.
A
general
list
of
the
functions
and
responsibilities
of
the
regional
administrator’s
chief
executive
officer
and
other
administrative
staff.
c.
Specification
of
the
functions
to
be
carried
out
by
each
party
to
the
agreement
and
by
any
subcontractor
of
a
party
to
the
agreement.
A
contract
with
a
provider
network
shall
be
separately
addressed.
4.
The
financial
provisions
of
the
agreement
shall
include
all
of
the
following:
a.
Methods
for
pooling,
management,
and
expenditure
of
the
funding
under
the
control
of
the
regional
administrator.
If
the
agreement
does
not
provide
for
pooling
of
the
participating
county
moneys
in
a
single
fund,
the
agreement
shall
specify
how
the
participating
county
moneys
will
be
subject
to
the
control
of
the
regional
administrator.
b.
Methods
for
allocating
administrative
funding
and
resources.
c.
Contributions
and
uses
of
initial
funding
or
related
contributions
made
by
the
counties
participating
in
the
region
for
purposes
of
commencing
operations
by
the
regional
administrator.
d.
Methods
for
acquiring
or
disposing
of
real
property.
e.
A
process
for
determining
the
use
of
savings
for
reinvestment.
f.
A
process
for
performance
of
an
annual
independent
audit
of
the
regional
administrator.
5.
If
implementation
of
a
region’s
regional
administrator
results
in
a
change
in
the
employer
of
county
employees
assigned
to
the
central
point
of
coordination
administrator
under
section
331.440,
Code
Supplement
2011,
to
another
public
employer
and
the
employees
were
covered
under
a
collective
Senate
File
2315,
p.
32
bargaining
agreement,
such
employees
shall
be
retained
and
the
agreement
shall
be
continued
by
the
successor
employer
as
though
there
had
not
been
a
change
in
employer.
Sec.
36.
NEW
SECTION
.
331.438F
County
of
residence
——
services
to
residents
——
service
authorization
appeals
——
disputes
between
counties
or
regions
and
the
department.
1.
For
the
purposes
of
this
section,
unless
the
context
otherwise
requires:
a.
“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
in
the
county
for
a
permanent
or
indefinite
period
of
time.
The
county
of
residence
of
a
person
who
is
a
homeless
person
is
the
county
where
the
homeless
person
usually
sleeps.
A
person
maintains
residency
in
the
county
in
which
the
person
last
resided
while
the
person
is
present
in
another
county
receiving
services
in
a
hospital,
a
correctional
facility,
a
halfway
house
for
community-based
corrections
or
substance-related
treatment,
a
nursing
facility,
an
intermediate
care
facility
for
persons
with
an
intellectual
disability,
or
a
residential
care
facility,
or
for
the
purpose
of
attending
a
college
or
university.
b.
“Homeless
person”
means
the
same
as
defined
in
section
48A.2.
c.
“Mental
health
professional”
means
the
same
as
defined
in
section
228.1.
d.
“Person”
means
a
person
who
is
a
United
States
citizen
or
a
qualified
alien
as
defined
in
8
U.S.C.
§
1641.
2.
If
a
person
appeals
a
decision
regarding
a
service
authorization
or
other
services-related
decision
made
by
a
regional
administrator
that
cannot
be
resolved
informally,
the
appeal
shall
be
heard
in
a
contested
case
proceeding
by
a
state
administrative
law
judge.
The
administrative
law
judge’s
decision
shall
be
considered
final
agency
action
under
chapter
17A.
3.
If
a
service
authorization
or
other
services-related
decision
made
by
a
regional
administrator
concerning
a
person
varies
from
the
type
and
amount
of
service
identified
to
be
necessary
for
the
person
in
a
clinical
determination
made
by
a
mental
health
professional
and
the
mental
health
professional
believes
that
failure
to
provide
the
type
and
amount
of
service
identified
could
cause
an
immediate
danger
to
the
person’s
Senate
File
2315,
p.
33
health
or
safety,
the
person
may
request
an
expedited
review
of
the
regional
administrator’s
decision
to
be
made
by
the
department
of
human
services.
An
expedited
review
held
in
accordance
with
this
subsection
is
subject
to
the
following
procedures:
a.
The
request
for
the
expedited
review
shall
be
filed
within
five
business
days
of
receiving
the
notice
of
decision
by
the
regional
administrator.
The
request
must
be
in
writing,
plainly
state
the
request
for
an
expedited
review
in
the
caption
and
body
of
the
request,
and
be
supported
by
written
documentation
from
the
mental
health
professional
who
made
the
clinical
determination
stating
how
the
notice
of
decision
on
services
could
cause
an
immediate
danger
to
the
person’s
health
or
safety.
b.
The
expedited
review
shall
be
performed
by
a
mental
health
professional,
who
is
either
the
administrator
of
the
division
of
mental
health
and
disability
services
of
the
department
of
human
services
or
the
administrator’s
designee.
If
the
administrator
is
not
a
mental
health
professional,
the
expedited
review
shall
be
performed
by
a
designee
of
the
administrator
who
is
a
mental
health
professional
and
is
free
of
any
conflict
of
interest
to
perform
the
expedited
review.
The
expedited
review
shall
be
performed
within
two
business
days
of
the
time
the
request
is
filed.
If
the
reviewer
determines
the
information
submitted
in
connection
with
the
request
is
inadequate
to
perform
the
review,
the
reviewer
shall
request
the
submission
of
additional
information
and
the
review
shall
be
performed
within
two
business
days
of
the
time
that
adequate
information
is
submitted.
The
regional
administrator
and
the
person,
with
the
assistance
of
the
mental
health
professional
who
made
the
clinical
determination
shall
each
provide
a
brief
statement
of
facts,
conclusions,
and
reasons
for
the
decision
made.
Supporting
clinical
information
shall
also
be
attached.
All
information
related
to
the
proceedings
and
any
related
filings
shall
be
considered
to
be
mental
health
information
subject
to
chapter
228.
c.
The
administrator
or
designee
shall
issue
an
order,
including
a
brief
statement
of
findings
of
fact,
conclusions
of
law,
and
policy
reasons
for
the
order,
to
justify
the
decision
made
concerning
the
expedited
review.
If
the
decision
concurs
with
the
contention
that
there
is
an
immediate
danger
to
the
person’s
health
or
safety,
the
order
shall
identify
the
type
and
amount
of
service
which
shall
be
provided
for
the
person.
Senate
File
2315,
p.
34
The
administrator
or
designee
shall
give
such
notice
as
is
practicable
to
persons
who
are
required
to
comply
with
the
order.
The
order
is
effective
when
issued.
d.
The
decision
of
the
administrator
or
designee
shall
be
considered
a
final
agency
action
and
is
subject
to
judicial
review
in
accordance
with
section
17A.19.
The
record
for
judicial
review
consists
of
any
documents
regarding
the
matter
that
were
considered
or
prepared
by
the
administrator
or
designee.
The
administrator
or
designee
shall
maintain
these
documents
as
the
official
record
of
the
decision.
If
the
matter
is
appealed
to
the
district
court,
the
record
shall
be
filed
as
confidential.
4.
If
a
county
of
residence
is
part
of
a
mental
health
and
disability
services
region
that
has
agreed
to
pool
funding
and
liability
for
services,
the
responsibilities
of
the
county
under
law
regarding
such
services
shall
be
performed
on
behalf
of
the
county
by
the
regional
administrator.
The
county
of
residence
or
the
county’s
mental
health
and
disability
services
region,
as
applicable,
is
responsible
for
paying
the
public
costs
of
the
mental
health
and
disability
services
that
are
not
covered
by
the
medical
assistance
program
under
chapter
249A
and
are
provided
in
accordance
with
the
region’s
approved
service
management
plan
to
persons
who
are
residents
of
the
county
or
region.
5.
a.
The
dispute
resolution
process
implemented
in
accordance
with
this
subsection
applies
to
residency
disputes.
The
dispute
resolution
process
is
not
applicable
to
disputes
involving
persons
committed
to
a
state
facility
pursuant
to
chapter
812
or
rule
of
criminal
procedure
2.22,
Iowa
court
rules,
or
to
disputes
involving
service
authorization
decisions
made
by
a
region.
b.
If
a
county,
region,
or
the
department,
as
applicable,
receives
a
billing
for
services
provided
to
a
resident
in
another
county
or
region,
or
objects
to
a
residency
determination
certified
by
the
department
or
another
county’s
or
region’s
regional
administrator
and
asserts
either
that
the
person
has
residency
in
another
county
or
region
or
the
person
is
not
a
resident
of
this
state
or
the
person’s
residency
is
unknown
so
that
the
person
is
deemed
a
state
case,
the
person’s
residency
status
shall
be
determined
as
provided
in
this
subsection.
The
county
or
region
shall
notify
the
department
of
the
county’s
or
region’s
assertion
within
one
hundred
twenty
days
of
receiving
the
billing.
If
the
county
or
Senate
File
2315,
p.
35
region
asserts
that
the
person
has
residency
in
another
county
or
region,
that
county
or
region
shall
be
notified
at
the
same
time
as
the
department.
If
the
department
disputes
a
residency
determination
certification
made
by
a
regional
administrator,
the
department
shall
notify
the
affected
counties
or
regions
of
the
department’s
assertion.
c.
The
department,
county,
or
region
that
received
the
notification,
as
applicable,
shall
respond
to
the
party
that
provided
the
notification
within
forty-five
days
of
receiving
the
notification.
If
the
parties
cannot
agree
to
a
settlement
as
to
the
person’s
residency
status
within
ninety
days
of
the
date
of
notification,
on
motion
of
any
of
the
parties,
the
matter
shall
be
referred
to
the
department
of
inspections
and
appeals
for
a
contested
case
hearing
under
chapter
17A
before
an
administrative
law
judge
assigned
in
accordance
with
section
10A.801
to
determine
the
person’s
residency
status.
d.
(1)
The
administrative
law
judge’s
determination
of
the
person’s
residency
status
shall
be
considered
final
agency
action,
notwithstanding
contrary
provisions
of
section
17A.15.
The
party
that
does
not
prevail
in
the
determination
or
subsequent
judicial
review
is
liable
for
costs
associated
with
the
proceeding,
including
reimbursement
of
the
department
of
inspections
and
appeals’
actual
costs
associated
with
the
administrative
proceeding.
Judicial
review
of
the
determination
may
be
sought
in
accordance
with
section
17A.19.
(2)
If
following
the
determination
of
a
person’s
residency
status
in
accordance
with
this
subsection,
additional
evidence
becomes
available
that
merits
a
change
in
that
determination,
the
parties
affected
may
change
the
determination
by
mutual
agreement.
Otherwise,
a
party
may
move
that
the
matter
be
reconsidered
by
the
department,
county,
or
region,
or
by
the
administrative
law
judge.
e.
(1)
Unless
a
petition
is
filed
for
judicial
review,
the
administrative
law
judge’s
determination
of
the
person’s
residency
status
shall
result
in
one
of
the
following:
(a)
If
a
county
or
region
is
determined
to
be
the
person’s
residence,
the
county
or
region
shall
pay
the
amounts
due
and
shall
reimburse
any
other
amounts
paid
for
services
provided
by
the
other
county
or
region
or
the
department
on
the
person’s
behalf
prior
to
the
determination.
(b)
If
it
is
determined
that
the
person
is
not
a
resident
of
this
state
or
the
person’s
residency
is
unknown
so
that
the
person
is
deemed
to
be
a
state
case,
the
department
shall
pay
Senate
File
2315,
p.
36
the
amounts
due
and
shall
reimburse
the
county
or
region,
as
applicable,
for
any
payment
made
on
behalf
of
the
person
prior
to
the
determination.
(2)
The
payment
or
reimbursement
shall
be
remitted
within
forty-five
days
of
the
date
the
determination
was
issued.
After
the
forty-five-day
period,
a
penalty
of
not
greater
than
one
percent
per
month
may
be
added
to
the
amount
due.
6.
a.
The
dispute
resolution
process
implemented
in
accordance
with
this
subsection
applies
beginning
July
1,
2012,
to
billing
disputes
between
the
state
and
a
county
or
region,
other
than
residency
disputes
or
other
dispute
processes
under
this
section,
involving
the
responsibility
for
service
costs
for
services
provided
on
or
after
July
1,
2011,
under
any
of
the
following:
(1)
Chapter
221.
(2)
Chapter
222.
(3)
Chapter
229.
(4)
Chapter
230.
(5)
Chapter
249A.
(6)
Chapter
812.
b.
If
a
county,
region,
or
the
department,
as
applicable,
disputes
a
billing
for
service
costs
listed
in
paragraph
“a”
,
the
dispute
shall
be
resolved
as
provided
in
this
subsection.
The
county
or
region
shall
notify
the
department
of
the
county’s
or
region’s
assertion
within
ninety
days
of
receiving
the
billing.
However,
for
services
provided
on
or
after
July
1,
2011,
for
which
a
county
has
received
the
billing
as
of
July
1,
2012,
the
county
shall
notify
the
department
of
the
county’s
assertion
on
or
before
October
1,
2012.
If
the
department
disputes
such
a
billing
of
a
regional
administrator,
the
department
shall
notify
the
affected
counties
or
regions
of
the
department’s
assertion.
c.
The
department,
county,
or
region
that
received
the
notification,
as
applicable,
shall
respond
to
the
party
that
provided
the
notification
within
forty-five
days
of
receiving
the
notification.
If
the
parties
cannot
agree
to
a
settlement
as
to
the
dispute
within
ninety
days
of
the
date
of
notification,
on
motion
of
any
of
the
parties,
the
matter
shall
be
referred
to
the
department
of
inspections
and
appeals
for
a
contested
case
hearing
under
chapter
17A
before
an
administrative
law
judge
assigned
in
accordance
with
section
10A.801
to
determine
facts
and
issue
a
decision
to
resolve
the
dispute.
Senate
File
2315,
p.
37
d.
(1)
The
administrative
law
judge’s
decision
is
a
final
agency
action,
notwithstanding
contrary
provisions
of
section
17A.15.
The
party
that
does
not
prevail
in
the
decision
or
subsequent
judicial
review
is
liable
for
costs
associated
with
the
proceeding,
including
reimbursement
of
the
department
of
inspections
and
appeals’
actual
costs
associated
with
the
administrative
proceeding.
Judicial
review
of
the
decision
may
be
sought
in
accordance
with
section
17A.19.
(2)
If
following
the
decision
regarding
a
dispute
in
accordance
with
this
subsection,
additional
evidence
becomes
available
that
merits
a
change
in
that
decision,
the
parties
affected
may
change
the
decision
by
mutual
agreement.
Otherwise,
a
party
may
move
that
the
matter
be
reconsidered
by
the
department,
county,
or
region,
or
by
the
administrative
law
judge.
e.
(1)
Unless
a
petition
is
filed
for
judicial
review,
the
administrative
law
judge’s
decision
regarding
a
disputed
billing
shall
result
in
one
of
the
following:
(a)
If
a
county
or
region
is
determined
to
be
responsible
for
the
disputed
amounts,
the
county
or
region
shall
pay
the
amounts
due
and
shall
reimburse
any
other
amounts
paid
for
services
provided
by
the
other
county
or
region
or
the
department
on
the
person’s
behalf
prior
to
the
decision.
(b)
If
it
is
determined
that
the
state
is
responsible
for
the
disputed
amounts,
the
state
shall
pay
the
amounts
due
and
shall
reimburse
the
county
or
region,
as
applicable,
for
any
payment
made
on
behalf
of
the
person
prior
to
the
decision.
(2)
The
payment
or
reimbursement
shall
be
remitted
within
forty-five
days
of
the
date
the
decision
was
issued.
After
the
forty-five-day
period,
a
penalty
of
not
greater
than
one
percent
per
month
may
be
added
to
the
amount
due.
Sec.
37.
CODE
EDITOR.
The
Code
editor
may
codify
the
provisions
of
this
division
of
this
Act
and
any
other
provisions
of
this
Act
involving
chapter
331
as
one
or
more
new
parts
of
chapter
331,
division
III.
Sec.
38.
EMERGENCY
RULES.
The
mental
health
and
disability
services
commission
may
adopt
administrative
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
enacting
section
331.438B,
that
relate
to
criteria
for
evaluation
of
an
application
for
an
exemption
from
regionalization,
and
the
rules
shall
become
effective
immediately
upon
filing
or
on
a
later
effective
date
specified
Senate
File
2315,
p.
38
in
the
rules,
unless
the
effective
date
is
delayed
by
the
administrative
rules
review
committee.
Any
rules
adopted
in
accordance
with
this
section
shall
not
take
effect
before
the
rules
are
reviewed
by
the
administrative
rules
review
committee.
The
delay
authority
provided
to
the
administrative
rules
review
committee
under
section
17A.4,
subsection
7,
and
section
17A.8,
subsection
9,
shall
be
applicable
to
a
delay
imposed
under
this
section,
notwithstanding
a
provision
in
those
sections
making
them
inapplicable
to
section
17A.5,
subsection
2,
paragraph
“b”.
Any
rules
adopted
in
accordance
with
the
provisions
of
this
section
shall
also
be
published
as
notice
of
intended
action
as
provided
in
section
17A.4.
Sec.
39.
APPLICABILITY.
The
provisions
of
this
division
of
this
Act
enacting
new
sections
in
chapter
331,
except
as
specifically
provided
by
the
provisions,
are
applicable
beginning
July
1,
2013.
DIVISION
V
SUBACUTE
CARE
FACILITIES
FOR
PERSONS
WITH
SERIOUS
AND
PERSISTENT
MENTAL
ILLNESS
Sec.
40.
NEW
SECTION
.
135P.1
Definitions.
As
used
in
this
chapter,
unless
the
context
otherwise
requires:
1.
“Advanced
registered
nurse
practitioner”
means
a
person
currently
licensed
as
a
registered
nurse
under
chapter
152
or
152E
who
is
registered
with
the
board
of
nursing
as
an
advanced
registered
nurse
practitioner.
2.
“Department”
means
the
department
of
inspections
and
appeals.
3.
“Direction”
means
authoritative
policy
or
procedural
guidance
for
the
accomplishment
of
a
function
or
an
activity.
4.
“Licensee”
means
the
holder
of
a
license
issued
to
operate
a
subacute
care
facility
for
persons
with
serious
and
persistent
mental
illness.
5.
“Mental
health
professional”
means
the
same
as
defined
in
section
228.1.
6.
“Mental
health
services”
means
services
provided
by
a
mental
health
professional
operating
within
the
scope
of
the
professional’s
practice
which
address
mental,
emotional,
medical,
or
behavioral
problems.
7.
“Physician”
means
a
person
licensed
under
chapter
148.
8.
“Physician
assistant”
means
a
person
licensed
to
practice
under
the
supervision
of
a
physician
as
authorized
in
chapters
147
and
148C.
Senate
File
2315,
p.
39
9.
“Rehabilitative
services”
means
services
to
encourage
and
assist
restoration
of
a
resident’s
optimum
mental
and
physical
capabilities.
10.
“Resident”
means
a
person
who
is
eighteen
years
of
age
or
older
and
has
been
determined
by
a
mental
health
professional
to
need
subacute
mental
health
services.
11.
“Subacute
care
facility
for
persons
with
serious
and
persistent
mental
illness”
or
“subacute
care
facility”
means
an
institution,
place,
building,
or
agency
with
restricted
means
of
egress
providing
subacute
mental
health
services
for
a
period
exceeding
twenty-four
consecutive
hours
to
persons
in
need
of
the
services.
12.
“Subacute
mental
health
services”
means
the
same
as
defined
in
section
225C.6.
13.
“Supervision”
means
direct
oversight
and
inspection
of
the
act
of
accomplishing
a
function
or
activity.
14.
“Treatment
care
plan”
means
a
plan
of
care
and
services
designed
to
eliminate
the
need
for
acute
care
by
improving
the
condition
of
a
person
with
serious
and
persistent
mental
illness.
Services
must
be
based
upon
a
diagnostic
evaluation,
which
includes
an
examination
of
the
medical,
psychological,
social,
behavioral,
and
developmental
aspects
of
the
person’s
situation,
reflecting
the
need
for
inpatient
care.
Sec.
41.
NEW
SECTION
.
135P.2
Purpose.
The
purpose
of
this
chapter
is
to
provide
for
the
development,
establishment,
and
enforcement
of
basic
standards
for
the
operation,
construction,
and
maintenance
of
a
subacute
care
facility
which
will
ensure
the
safe
and
adequate
diagnosis,
evaluation,
and
treatment
of
persons
with
serious
and
persistent
mental
illness
so
that
the
persons
are
able
to
experience
recovery
and
live
successfully
in
the
community.
Sec.
42.
NEW
SECTION
.
135P.3
Nature
of
care
——
seclusion
room
——
admissions.
1.
A
subacute
care
facility
shall
utilize
a
team
of
professionals
to
direct
an
organized
program
of
diagnostic
services,
subacute
mental
health
services,
and
rehabilitative
services
to
meet
the
needs
of
residents
in
accordance
with
a
treatment
care
plan
developed
for
each
resident
under
the
supervision
of
a
licensed
psychiatrist.
The
goal
of
a
treatment
care
plan
is
to
transition
residents
to
a
less
restrictive
environment,
including
a
home-based
community
setting.
Social
and
rehabilitative
services
shall
be
provided
under
the
direction
of
a
mental
health
professional.
Senate
File
2315,
p.
40
2.
The
licensed
psychiatrist
providing
supervision
of
the
subacute
care
facility
shall
evaluate
the
condition
of
each
resident
as
medically
necessary
and
shall
be
available
to
residents
of
the
facility
on
an
on-call
basis
at
all
other
times.
Additional
evaluation
and
treatment
may
be
provided
by
a
mental
health
professional.
The
subacute
care
facility
may
employ
a
seclusion
room
meeting
the
conditions
described
in
42
C.F.R.
§
483.364(b)
with
approval
of
the
licensed
psychiatrist
of
the
facility
or
by
order
of
the
resident’s
physician,
a
physician
assistant,
or
an
advanced
registered
nurse
practitioner.
Sec.
43.
NEW
SECTION
.
135P.4
Licensure.
1.
A
person
shall
not
establish,
operate,
or
maintain
a
subacute
care
facility
unless
the
person
obtains
a
license
for
the
subacute
care
facility
under
this
chapter.
2.
An
intermediate
care
facility
for
persons
with
mental
illness
licensed
under
chapter
135C
may
convert
to
a
subacute
care
facility
by
providing
written
notice
to
the
department
that
the
facility
has
employed
a
full-time
psychiatrist
and
desires
to
make
the
conversion.
Sec.
44.
NEW
SECTION
.
135P.5
Application
for
license.
An
application
for
a
license
under
this
chapter
shall
be
submitted
on
a
form
requesting
information
required
by
the
department,
which
may
include
affirmative
evidence
of
the
applicant’s
ability
to
comply
with
the
rules
for
standards
adopted
pursuant
to
this
chapter.
An
application
for
a
license
shall
be
accompanied
by
the
required
license
fee
which
shall
be
credited
to
the
general
fund
of
the
state.
The
initial
and
annual
license
fee
is
twenty-five
dollars.
Sec.
45.
NEW
SECTION
.
135P.6
Inspection
——
conditions
for
issuance.
The
department
shall
issue
a
license
to
an
applicant
under
this
chapter
if
the
following
conditions
exist:
1.
The
department
has
ascertained
that
the
applicant’s
facilities
and
staff
are
adequate
to
provide
the
care
and
services
required
of
a
subacute
care
facility.
2.
a.
The
department
of
human
services
has
submitted
written
approval
of
the
application
based
upon
the
process
used
by
the
department
of
human
services
to
identify
the
best
qualified
providers.
The
department
of
human
services
shall
utilize
a
request
for
proposals
process
to
identify
the
best
qualified
providers,
limit
the
number
of
subacute
care
facility
beds,
and
ensure
the
geographic
dispersion
of
subacute
mental
Senate
File
2315,
p.
41
health
services.
b.
The
department
of
human
services
shall
not
give
approval
to
an
application
which
would
cause
the
number
of
publicly
funded
subacute
care
facility
beds
licensed
under
this
chapter
to
exceed
fifty
beds.
c.
The
subacute
care
facility
beds
identified
by
the
request
for
proposals
process
shall
be
existing
beds
which
have
been
awarded
a
certificate
of
need
pursuant
to
chapter
135.
Such
beds
shall
not
be
required
to
obtain
an
additional
certificate
of
need
upon
conversion
to
licensed
subacute
care
facility
beds.
Sec.
46.
NEW
SECTION
.
135P.7
Denial,
suspension,
or
revocation
of
license.
The
department
may
deny
an
application
or
suspend
or
revoke
a
license
if
the
department
finds
that
an
applicant
or
licensee
has
failed
or
is
unable
to
comply
with
this
chapter
or
the
rules
establishing
minimum
standards
pursuant
to
this
chapter
or
if
any
of
the
following
conditions
apply:
1.
It
is
shown
that
a
resident
is
a
victim
of
cruelty
or
neglect
due
to
the
acts
or
omissions
of
the
licensee.
2.
The
licensee
has
permitted,
aided,
or
abetted
in
the
commission
of
an
illegal
act
in
the
subacute
care
facility.
3.
An
applicant
or
licensee
acted
to
obtain
or
to
retain
a
license
by
fraudulent
means,
misrepresentation,
or
submitting
false
information.
4.
The
licensee
has
willfully
failed
or
neglected
to
maintain
a
continuing
in-service
education
and
training
program
for
persons
employed
by
the
subacute
care
facility.
5.
The
application
involves
a
person
who
has
failed
to
operate
a
subacute
care
facility
in
compliance
with
the
provisions
of
this
chapter.
Sec.
47.
NEW
SECTION
.
135P.8
Provisional
license.
The
department
may
issue
a
provisional
license,
effective
for
not
more
than
one
year,
to
a
licensee
whose
subacute
care
facility
does
not
meet
the
requirements
of
this
chapter
if,
prior
to
issuance
of
the
license,
the
applicant
submits
written
plans
to
achieve
compliance
with
the
applicable
requirements
and
the
plans
are
approved
by
the
department.
The
plans
shall
specify
the
deadline
for
achieving
compliance.
Sec.
48.
NEW
SECTION
.
135P.9
Notice
and
hearings.
The
procedure
governing
notice
and
hearing
to
deny
an
application
or
suspend
or
revoke
a
license
shall
be
in
accordance
with
rules
adopted
by
the
department
pursuant
to
Senate
File
2315,
p.
42
chapter
17A.
A
full
and
complete
record
shall
be
kept
of
the
proceedings
and
of
any
testimony.
The
record
need
not
be
transcribed
unless
judicial
review
is
sought.
A
copy
or
copies
of
a
transcript
may
be
obtained
by
an
interested
party
upon
payment
of
the
cost
of
preparing
the
transcript
or
copies.
Sec.
49.
NEW
SECTION
.
135P.10
Rules.
1.
The
department
of
inspections
and
appeals
and
the
department
of
human
services
shall
collaborate
in
establishing
standards
for
licensing
of
subacute
care
facilities
to
achieve
all
of
the
following
objectives:
a.
Subacute
mental
health
services
are
provided
based
on
sound,
proven
clinical
practice.
b.
Subacute
mental
health
services
are
established
in
a
manner
that
allows
the
services
to
be
included
in
the
federal
medical
assistance
state
plan.
2.
It
is
the
intent
of
the
general
assembly
that
subacute
mental
health
services
be
included
in
the
Medicaid
state
plan
adopted
for
the
implementation
of
the
federal
Patient
Protection
and
Affordable
Care
Act,
benchmark
plan.
3.
The
department
of
inspections
and
appeals,
in
consultation
with
the
department
of
human
services
and
affected
professional
groups,
shall
adopt
and
enforce
rules
setting
out
the
standards
for
a
subacute
care
facility
and
the
rights
of
the
residents
admitted
to
a
subacute
care
facility.
The
department
of
inspections
and
appeals
and
the
department
of
human
services
shall
coordinate
the
adoption
of
rules
and
the
enforcement
of
the
rules
in
order
to
prevent
duplication
of
effort
by
the
departments
and
of
requirements
of
the
licensee.
Sec.
50.
NEW
SECTION
.
135P.11
Complaints
alleging
violations.
1.
A
person
may
request
an
inspection
of
a
subacute
care
facility
by
filing
with
the
department
a
complaint
of
an
alleged
violation
of
an
applicable
requirement
of
this
chapter
or
a
rule
adopted
pursuant
to
this
chapter.
The
complaint
shall
state
in
a
reasonably
specific
manner
the
basis
of
the
complaint.
A
statement
of
the
nature
of
the
complaint
shall
be
delivered
to
the
subacute
care
facility
involved
at
the
time
of
or
prior
to
the
inspection.
2.
Upon
receipt
of
a
complaint
made
in
accordance
with
subsection
1,
the
department
shall
make
a
preliminary
review
of
the
complaint.
Unless
the
department
concludes
that
the
complaint
is
intended
to
harass
a
subacute
care
facility
or
a
licensee
or
is
without
reasonable
basis,
it
shall
within
twenty
Senate
File
2315,
p.
43
working
days
of
receipt
of
the
complaint
make
or
cause
to
be
made
an
on-site
inspection
of
the
subacute
care
facility
which
is
the
subject
of
the
complaint.
The
department
of
inspections
and
appeals
may
refer
to
the
department
of
human
services
any
complaint
received
by
the
department
of
inspections
and
appeals
if
the
complaint
applies
to
rules
adopted
by
the
department
of
human
services.
The
complainant
shall
also
be
notified
of
the
name,
address,
and
telephone
number
of
the
designated
protection
and
advocacy
agency
if
the
alleged
violation
involves
a
facility
with
one
or
more
residents
with
a
developmental
disability
or
mental
illness.
In
any
case,
the
complainant
shall
be
promptly
informed
of
the
result
of
any
action
taken
by
the
department
in
the
matter.
3.
An
inspection
made
pursuant
to
a
complaint
filed
under
subsection
1
need
not
be
limited
to
the
matter
or
matters
referred
to
in
the
complaint;
however,
the
inspection
shall
not
be
a
general
inspection
unless
the
complaint
inspection
coincides
with
a
scheduled
general
inspection.
Upon
arrival
at
the
subacute
care
facility
to
be
inspected,
the
inspector
shall
show
identification
to
the
person
in
charge
of
the
subacute
care
facility
and
state
that
an
inspection
is
to
be
made,
before
beginning
the
inspection.
Upon
request
of
either
the
complainant
or
the
department,
the
complainant
or
the
complainant’s
representative
or
both
may
be
allowed
the
privilege
of
accompanying
the
inspector
during
any
on-site
inspection
made
pursuant
to
this
section.
The
inspector
may
cancel
the
privilege
at
any
time
if
the
inspector
determines
that
the
privacy
of
a
resident
of
the
subacute
care
facility
to
be
inspected
would
be
violated.
The
dignity
of
the
resident
shall
be
given
first
priority
by
the
inspector
and
others.
Sec.
51.
NEW
SECTION
.
135P.12
Information
confidential.
1.
The
department’s
final
findings
regarding
licensure
shall
be
made
available
to
the
public
in
a
readily
available
form
and
place.
Other
information
relating
to
the
subacute
care
facility
is
confidential
and
shall
not
be
made
available
to
the
public
except
in
proceedings
involving
licensure,
a
civil
suit
involving
a
resident,
or
an
administrative
action
involving
a
resident.
2.
The
name
of
a
person
who
files
a
complaint
with
the
department
shall
remain
confidential
and
is
not
subject
to
discovery,
subpoena,
or
any
other
means
of
legal
compulsion
for
release
to
a
person
other
than
an
employee
of
the
department
or
an
agent
involved
in
the
investigation
of
the
complaint.
Senate
File
2315,
p.
44
3.
Information
regarding
a
resident
who
has
received
or
is
receiving
care
shall
not
be
disclosed
directly
or
indirectly
except
as
authorized
under
section
217.30.
Sec.
52.
NEW
SECTION
.
135P.13
Judicial
review.
Judicial
review
of
the
action
of
the
department
may
be
sought
pursuant
to
the
Iowa
administrative
procedure
Act,
chapter
17A.
Notwithstanding
chapter
17A,
a
petition
for
judicial
review
of
the
department’s
actions
under
this
chapter
may
be
filed
in
the
district
court
of
the
county
in
which
the
related
subacute
care
facility
is
located
or
is
proposed
to
be
located.
The
status
of
the
petitioner
or
the
licensee
shall
be
preserved
pending
final
disposition
of
the
judicial
review.
Sec.
53.
NEW
SECTION
.
135P.14
Penalty.
A
person
who
establishes,
operates,
or
manages
a
subacute
care
facility
without
obtaining
a
license
under
this
chapter
commits
a
serious
misdemeanor.
Each
day
of
continuing
violation
following
conviction
shall
be
considered
a
separate
offense.
Sec.
54.
NEW
SECTION
.
135P.15
Injunction.
Notwithstanding
the
existence
or
pursuit
of
another
remedy,
the
department
may
maintain
an
action
for
injunction
or
other
process
to
restrain
or
prevent
the
establishment,
operation,
or
management
of
a
subacute
care
facility
without
a
license.
Sec.
55.
Section
225.15,
unnumbered
paragraph
1,
Code
2011,
is
amended
to
read
as
follows:
When
a
respondent
arrives
at
the
state
psychiatric
hospital,
the
admitting
physician
shall
examine
the
respondent
and
determine
whether
or
not,
in
the
physician’s
judgment,
the
respondent
is
a
fit
subject
for
observation,
treatment,
and
hospital
care.
If,
upon
examination,
the
physician
decides
that
the
respondent
should
be
admitted
to
the
hospital,
the
respondent
shall
be
provided
a
proper
bed
in
the
hospital
;
and
the
.
The
physician
who
has
charge
of
the
respondent
shall
proceed
with
observation,
medical
treatment,
and
hospital
care
as
in
the
physician’s
judgment
are
proper
and
necessary,
in
compliance
with
sections
229.13
to
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.
Sec.
56.
Section
225C.6,
Code
Supplement
2011,
is
amended
by
adding
the
following
new
subsection:
Senate
File
2315,
p.
45
NEW
SUBSECTION
.
4.
a.
The
department
shall
coordinate
with
the
department
of
inspections
and
appeals
in
the
establishment
of
facility-based
and
community-based,
subacute
mental
health
services.
b.
A
person
shall
not
provide
community-based,
subacute
mental
health
services
unless
the
person
has
been
accredited
to
provide
the
services.
The
commission
shall
adopt
standards
for
subacute
mental
health
services
and
for
accreditation
of
providers
of
community-based,
subacute
mental
health
services.
c.
As
used
in
this
subsection,
“subacute
mental
health
services”
means
all
of
the
following:
(1)
A
comprehensive
set
of
wraparound
services
for
persons
who
have
had
or
are
at
imminent
risk
of
having
acute
or
crisis
mental
health
symptoms
that
do
not
permit
the
persons
to
remain
in
or
threatens
removal
of
the
persons
from
their
home
and
community,
but
who
have
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,
“mental
health
professional”
means
the
same
as
defined
in
section
228.1
and
“licensed
health
care
professional”
means
a
person
licensed
under
chapter
148
to
practice
medicine
and
surgery
or
osteopathic
medicine
and
surgery,
an
advanced
registered
nurse
practitioner
licensed
under
chapter
152
or
152E
and
registered
with
the
board
of
nursing,
or
a
physician
assistant
licensed
to
practice
under
the
supervision
of
a
physician
as
authorized
in
chapters
147
and
148C.
(2)
Intensive,
recovery-oriented
treatment
and
monitoring
of
the
person
with
direct
or
remote
access
to
a
psychiatrist
or
advanced
registered
nurse
practitioner.
(3)
An
outcome-focused,
interdisciplinary
approach
designed
to
return
the
person
to
living
successfully
in
the
community.
(4)
Services
that
may
be
provided
in
a
wide
array
of
settings
ranging
from
the
person’s
home
to
a
facility
providing
subacute
mental
health
services.
(5)
Services
that
are
time
limited
to
not
more
than
ten
days
or
another
time
period
determined
in
accordance
with
rules
adopted
for
this
purpose.
d.
Subacute
mental
health
services
and
the
standards
for
the
services
shall
be
established
in
a
manner
that
allows
for
accessing
federal
Medicaid
funding.
Sec.
57.
SUBACUTE
CARE
FACILITY
——
REIMBURSEMENT
METHODOLOGY.
The
department
of
human
services
shall
develop
Senate
File
2315,
p.
46
a
reimbursement
methodology
for
subacute
care
facility
for
persons
with
serious
and
persistent
mental
illness
services,
as
defined
in
this
division
of
this
Act.
It
is
the
intent
of
the
general
assembly
that
the
reimbursement
methodology
will
take
effect
during
the
fiscal
year
beginning
July
1,
2012,
and
result
in
an
initial
reimbursement
rate
in
the
range
of
$400
to
$500
per
day.
Such
rate
shall
be
subject
to
annual
adjustment
as
provided
by
law.
Sec.
58.
STUDY
OF
SUBACUTE
FACILITIES.
The
department
of
human
services
shall
conduct
a
feasibility
study
and
cost
analysis
of
providing
institutional
subacute
services
utilizing
facilities
available
at
one
or
more
of
the
state
mental
health
institutes
or
the
Iowa
veterans
home,
and
shall
submit
a
report
of
the
study
containing
findings
and
recommendations
to
the
governor
and
general
assembly
on
or
before
December
1,
2012.
Sec.
59.
STATE
AGENCY
ACTIVITIES
CONCERNING
SUBACUTE,
CRISIS
STABILIZATION,
AND
RESIDENTIAL
CARE
FACILITY
SERVICES.
1.
The
department
of
human
services
shall
work
with
the
departments
of
public
health
and
inspections
and
appeals
and
other
relevant
stakeholders
to
identify
appropriate
definitions
and
other
regulatory
provisions
to
address
residential
care
facilities
and
both
facility
and
nonfacility
subacute
and
crisis
stabilization
services.
The
department
shall
consider
the
experience
of
the
crisis
stabilization
program
pilot
project
authorized
by
this
division
of
this
Act
in
identifying
regulatory
provisions
for
such
programs.
The
appropriate
department
shall
adopt
rules
to
implement
the
provisions
identified.
2.
It
is
the
intent
of
the
general
assembly
that
the
Medicaid
state
plan
adopted
for
the
implementation
of
the
federal
Patient
Protection
and
Affordable
Care
Act,
Pub.
L.
No.
111-148,
will
include
coverage
of
both
facility
and
nonfacility
subacute
and
crisis
stabilization
services.
3.
The
department
of
human
services
shall
work
with
the
entity
under
contract
with
the
department
to
provide
mental
health
managed
care
under
the
medical
assistance
program
to
ensure
there
is
adequate
reimbursement
of
both
facility
and
nonfacility
subacute
and
crisis
stabilization
services.
Sec.
60.
CRISIS
STABILIZATION
PROGRAM
PILOT
PROJECT.
1.
The
department
of
human
services
shall
authorize
a
facility-based,
crisis
stabilization
program
pilot
project
implemented
by
the
regional
service
network
initiated
pursuant
to
2008
Iowa
Acts,
chapter
1187,
section
59,
subsection
9.
The
Senate
File
2315,
p.
47
facility
operated
by
the
program
shall
not
be
required
to
be
licensed
under
chapter
135B,
135C,
or
231C.
The
purpose
of
the
pilot
project
is
to
provide
a
prototype
for
the
departments
of
human
services,
inspections
and
appeals,
and
public
health
to
develop
regulatory
standards
for
such
programs
and
facilities.
The
pilot
project
shall
comply
with
appropriate
standards
associated
with
funding
of
the
services
provided
by
the
project
that
are
identified
by
the
department
of
human
services.
The
facility
shall
be
limited
to
not
more
than
10
beds
and
shall
be
authorized
to
operate
through
June
30,
2013.
2.
The
network,
in
cooperation
with
the
departments
of
human
services,
inspections
and
appeals,
and
public
health,
shall
report
to
the
governor,
the
general
assembly,
and
the
legislative
services
agency
concerning
the
pilot
project
on
or
before
December
14,
2012,
providing
findings
and
recommendations.
The
report
shall
include
recommendations
for
criteria
concerning
admissions,
staff
qualifications,
staffing
levels,
exclusion
and
inclusion
of
service
recipients,
lengths
of
stays,
transition
between
services,
and
facility
requirements,
and
for
goals
and
objectives
for
such
programs
and
facilities.
Sec.
61.
IMPLEMENTATION
OF
ACT.
Section
25B.2,
subsection
3,
shall
not
apply
to
this
division
of
this
Act.
DIVISION
VI
CO-OCCURRING
CONDITIONS
Sec.
62.
Section
125.10,
subsection
3,
Code
Supplement
2011,
is
amended
to
read
as
follows:
3.
Coordinate
the
efforts
and
enlist
the
assistance
of
all
public
and
private
agencies,
organizations
and
individuals
interested
in
the
prevention
of
substance
abuse
and
the
treatment
of
substance
abusers,
chronic
substance
abusers,
and
intoxicated
persons.
The
director’s
actions
to
implement
this
subsection
shall
also
address
the
treatment
needs
of
persons
who
have
a
mental
illness,
an
intellectual
disability,
brain
injury,
or
other
co-occurring
condition
in
addition
to
a
substance-related
disorder.
Sec.
63.
Section
125.12,
subsection
3,
Code
Supplement
2011,
is
amended
to
read
as
follows:
3.
The
director
shall
provide
for
adequate
and
appropriate
treatment
for
substance
abusers,
chronic
substance
abusers,
intoxicated
persons,
and
concerned
family
members
admitted
under
sections
125.33
and
125.34
,
or
under
section
125.75
,
125.81
,
or
125.91
.
Treatment
shall
not
be
provided
at
a
Senate
File
2315,
p.
48
correctional
institution
except
for
inmates.
A
mental
health
professional,
as
defined
in
section
228.1,
who
is
employed
by
a
treatment
provider
under
the
program
may
provide
treatment
to
a
person
with
co-occurring
substance-related
and
mental
health
disorder.
Such
treatment
may
also
be
provided
by
a
person
employed
by
such
a
treatment
provider
who
is
receiving
the
supervision
required
to
meet
the
definition
of
mental
health
professional
but
has
not
completed
the
supervision
component.
Sec.
64.
Section
226.10,
Code
2011,
is
amended
to
read
as
follows:
226.10
Equal
treatment.
The
several
patients
of
the
state
mental
health
institutes
,
according
to
their
different
conditions
of
mind
and
body,
and
their
respective
needs,
shall
be
provided
for
and
treated
with
equal
care.
If
in
addition
to
mental
illness
a
patient
has
a
co-occurring
intellectual
disability,
brain
injury,
or
substance
abuse
disorder,
the
care
provided
shall
also
address
the
co-occurring
needs.
Sec.
65.
EFFECTIVE
UPON
ENACTMENT.
The
following
provision
or
provisions
of
this
Act,
being
deemed
of
immediate
importance,
take
effect
upon
enactment:
1.
The
section
of
this
Act
authorizing
a
crisis
stabilization
program
pilot
project.
DIVISION
VII
BRAIN
INJURY
DEFINITION
Sec.
66.
Section
135.22,
subsection
1,
paragraph
a,
Code
2011,
is
amended
to
read
as
follows:
a.
“Brain
injury”
means
the
occurrence
of
injury
clinically
evident
damage
to
the
head
brain
resulting
directly
or
indirectly
from
trauma,
infection,
anoxia,
vascular
lesions,
or
tumor
of
the
brain,
not
primarily
related
to
a
degenerative
disease
or
aging
process
that
is
documented
in
a
medical
record
with
one
or
more
of
the
following
conditions
attributed
to
the
head
injury:
(1)
An
observed
or
self-reported
decreased
level
of
consciousness.
(2)
Amnesia.
(3)
A
skull
fracture.
(4)
An
objective
neurological
or
neuropsychological
abnormality.
(5)
A
diagnosed
intracranial
lesion
,
which
temporarily
or
permanently
impairs
a
person’s
physical,
cognitive,
or
behavioral
functions,
and
is
diagnosed
by
a
physician.
The
Senate
File
2315,
p.
49
diagnoses
of
clinically
evident
damage
to
the
brain
used
for
a
diagnosis
of
brain
injury
shall
be
the
same
as
specified
by
rule
for
eligibility
for
the
home
and
community-based
services
waiver
for
persons
with
brain
injury
under
the
medical
assistance
program.
Sec.
67.
Section
225C.23,
subsection
2,
Code
2011,
is
amended
to
read
as
follows:
2.
For
the
purposes
of
this
section
and
section
135.22A
,
“brain
injury”
means
the
occurrence
of
injury
to
the
head
not
primarily
related
to
a
degenerative
disease
or
aging
process
that
is
documented
in
a
medical
record
with
one
or
more
of
the
following
conditions
attributed
to
the
head
injury:
a.
An
observed
or
self-reported
decreased
level
of
consciousness.
b.
Amnesia.
c.
A
skull
fracture.
d.
An
objective
neurological
or
neuropsychological
abnormality.
e.
A
diagnosed
intracranial
lesion
same
as
defined
in
section
135.22
.
DIVISION
VIII
LEGAL
SETTLEMENT
Sec.
68.
Section
218.99,
Code
2011,
is
amended
to
read
as
follows:
218.99
Counties
to
be
notified
of
patients’
personal
accounts.
The
administrator
in
control
of
a
state
institution
shall
direct
the
business
manager
of
each
institution
under
the
administrator’s
jurisdiction
which
is
mentioned
in
section
331.424,
subsection
1
,
paragraph
“a”
,
subparagraphs
(1)
and
(2),
and
for
which
services
are
paid
under
section
331.424A
,
to
quarterly
inform
the
county
of
legal
settlement’s
entity
designated
to
perform
the
county’s
central
point
of
coordination
process
residence
of
any
patient
or
resident
who
has
an
amount
in
excess
of
two
hundred
dollars
on
account
in
the
patients’
personal
deposit
fund
and
the
amount
on
deposit.
The
administrators
shall
direct
the
business
manager
to
further
notify
the
entity
designated
to
perform
the
county’s
central
point
of
coordination
process
county
of
residence
at
least
fifteen
days
before
the
release
of
funds
in
excess
of
two
hundred
dollars
or
upon
the
death
of
the
patient
or
resident.
If
the
patient
or
resident
has
no
county
of
legal
settlement
residency
in
this
state
or
the
person’s
residency
is
unknown
so
Senate
File
2315,
p.
50
that
the
person
is
deemed
to
be
a
state
case
,
notice
shall
be
made
to
the
director
of
human
services
and
the
administrator
in
control
of
the
institution
involved.
Sec.
69.
Section
222.10,
Code
2011,
is
amended
to
read
as
follows:
222.10
Duty
of
peace
officer.
When
any
person
with
mental
retardation
departs
without
proper
authority
from
an
institution
in
another
state
and
is
found
in
this
state,
any
peace
officer
in
any
county
in
which
such
patient
is
found
may
take
and
detain
the
patient
without
warrant
or
order
and
shall
report
such
detention
to
the
administrator.
The
administrator
shall
provide
for
the
return
of
the
patient
to
the
authorities
in
the
state
from
which
the
unauthorized
departure
was
made.
Pending
return,
such
patient
may
be
detained
temporarily
at
one
of
the
institutions
of
this
state
governed
by
the
administrator
or
by
the
administrator
of
the
division
of
child
and
family
services
of
the
department
of
human
services.
The
provisions
of
this
section
relating
to
the
administrator
shall
also
apply
to
the
return
of
other
nonresident
persons
with
mental
retardation
having
legal
settlement
residency
outside
the
state
of
Iowa.
Sec.
70.
Section
222.13,
subsection
1,
Code
2011,
is
amended
to
read
as
follows:
1.
If
an
adult
person
is
believed
to
be
a
person
with
mental
retardation,
the
adult
person
or
the
adult
person’s
guardian
may
submit
a
request
through
the
central
point
of
coordination
process
for
the
county
board
of
supervisors
of
the
adult
person’s
county
of
residence
in
writing
to
apply
to
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.
After
determining
the
legal
settlement
of
the
adult
person
as
provided
by
this
chapter
,
the
The
board
of
supervisors
shall,
on
forms
prescribed
by
the
department’s
administrator,
apply
to
the
superintendent
of
the
resource
center
in
the
district
for
the
admission
of
the
adult
person
to
the
resource
center.
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,
upon
request
of
the
adult
person
or
the
adult
person’s
guardian.
The
superintendent
shall
accept
the
application
providing
if
a
preadmission
diagnostic
evaluation,
performed
through
the
central
point
of
coordination
process,
confirms
or
establishes
Senate
File
2315,
p.
51
the
need
for
admission,
except
that
an
application
may
shall
not
be
accepted
if
the
institution
does
not
have
adequate
facilities
available
or
if
the
acceptance
will
result
in
an
overcrowded
condition.
Sec.
71.
Section
222.31,
subsection
1,
paragraph
b,
subparagraph
(1),
Code
2011,
is
amended
to
read
as
follows:
(1)
Commit
the
person
to
the
state
resource
center
designated
by
the
administrator
to
serve
the
county
in
which
the
hearing
is
being
held,
or
to
a
special
unit.
The
court
shall,
prior
to
issuing
an
order
of
commitment,
request
that
a
diagnostic
evaluation
of
the
person
be
made
by
the
superintendent
of
the
resource
center
or
the
special
unit,
or
the
superintendent’s
qualified
designee
a
person
qualified
to
perform
the
diagnostic
evaluation
.
The
evaluation
shall
be
conducted
at
a
place
as
the
superintendent
may
direct.
The
cost
of
the
evaluation
shall
be
defrayed
by
the
committed
person’s
county
of
legal
settlement
residence
unless
otherwise
ordered
by
the
court.
The
cost
of
the
evaluation
to
be
charged
may
be
equal
to
but
shall
not
exceed
the
actual
cost
of
the
evaluation.
Persons
referred
by
a
court
to
a
resource
center
or
the
special
unit
for
diagnostic
evaluation
shall
be
considered
as
outpatients
of
the
institution.
No
An
order
of
commitment
shall
not
be
issued
unless
the
superintendent
of
the
institution
recommends
that
the
order
be
issued,
and
advises
the
court
that
adequate
facilities
for
the
care
of
the
person
are
available.
Sec.
72.
Section
222.49,
Code
2011,
is
amended
to
read
as
follows:
222.49
Costs
paid.
The
costs
of
proceedings
shall
be
defrayed
from
the
county
treasury
paid
by
the
county
or
the
state,
as
determined
in
accordance
with
section
222.60,
unless
otherwise
ordered
by
the
court.
When
the
person
alleged
to
be
mentally
retarded
is
found
not
to
be
mentally
retarded,
the
court
shall
render
judgment
for
such
costs
against
the
person
filing
the
petition
except
when
the
petition
is
filed
by
order
of
court.
Sec.
73.
Section
222.50,
Code
2011,
is
amended
to
read
as
follows:
222.50
County
of
legal
settlement
residence
or
state
to
pay.
When
the
proceedings
are
instituted
in
a
county
in
which
the
person
who
is
alleged
to
have
mental
retardation
was
found
but
which
is
not
the
county
of
legal
settlement
residence
of
the
person,
and
the
costs
are
not
taxed
to
the
petitioner,
the
Senate
File
2315,
p.
52
person’s
county
which
is
the
legal
settlement
of
the
person
of
residence
or
the
state,
as
determined
in
accordance
with
section
222.60,
shall,
on
presentation
of
a
properly
itemized
bill
for
such
costs,
repay
the
costs
to
the
former
county.
When
the
person’s
legal
settlement
is
outside
the
state
or
is
unknown,
the
costs
shall
be
paid
out
of
money
in
the
state
treasury
not
otherwise
appropriated,
itemized
on
vouchers
executed
by
the
auditor
of
the
county
which
paid
the
costs,
and
approved
by
the
administrator.
Sec.
74.
Section
222.60,
subsection
1,
Code
2011,
is
amended
to
read
as
follows:
1.
All
necessary
and
legal
expenses
for
the
cost
of
admission
or
commitment
or
for
the
treatment,
training,
instruction,
care,
habilitation,
support
and
transportation
of
persons
with
mental
retardation,
as
provided
for
in
the
county
management
plan
provisions
implemented
pursuant
to
section
331.439,
subsection
1
,
in
a
state
resource
center,
or
in
a
special
unit,
or
any
public
or
private
facility
within
or
without
the
state,
approved
by
the
director
of
the
department
of
human
services,
shall
be
paid
by
either:
a.
The
person’s
county
in
which
such
person
has
legal
settlement
as
defined
in
section
252.16
of
residence
.
b.
The
state
when
such
the
person
has
no
legal
settlement
or
when
such
settlement
is
unknown
is
a
resident
in
another
state
or
in
a
foreign
country
or
the
residence
is
unknown
.
The
payment
responsibility
shall
be
deemed
to
be
a
state
case.
Sec.
75.
Section
222.60,
subsection
2,
Code
2011,
is
amended
to
read
as
follows:
2.
a.
Prior
to
a
county
of
legal
settlement
residence
approving
the
payment
of
expenses
for
a
person
under
this
section
,
the
county
may
require
that
the
person
be
diagnosed
to
determine
if
the
person
has
mental
retardation
or
that
the
person
be
evaluated
to
determine
the
appropriate
level
of
services
required
to
meet
the
person’s
needs
relating
to
mental
retardation.
The
diagnosis
and
the
evaluation
may
be
performed
concurrently
and
shall
be
performed
by
an
individual
or
individuals
approved
by
the
county
who
are
qualified
to
perform
the
diagnosis
or
the
evaluation.
Following
the
initial
approval
for
payment
of
expenses,
the
county
of
legal
settlement
may
require
that
an
evaluation
be
performed
at
reasonable
time
periods.
b.
The
cost
of
a
county-required
diagnosis
and
an
evaluation
is
at
the
county’s
expense.
In
the
For
a
state
case
of
a
person
Senate
File
2315,
p.
53
without
legal
settlement
or
whose
legal
settlement
is
unknown
,
the
state
may
apply
the
diagnosis
and
evaluation
provisions
of
this
subsection
at
the
state’s
expense.
c.
A
diagnosis
or
an
evaluation
under
this
section
may
be
part
of
a
county’s
central
point
of
coordination
process
under
section
331.440
,
provided
that
a
diagnosis
is
performed
only
by
an
individual
qualified
as
provided
in
this
section
.
Sec.
76.
Section
222.61,
Code
2011,
is
amended
to
read
as
follows:
222.61
Legal
settlement
Residency
determined.
When
a
county
receives
an
application
on
behalf
of
any
person
for
admission
to
a
resource
center
or
a
special
unit
or
when
a
court
issues
an
order
committing
any
person
to
a
resource
center
or
a
special
unit,
the
board
of
supervisors
shall
utilize
refer
the
determination
of
residency
to
the
central
point
of
coordination
process
to
determine
and
certify
that
the
legal
settlement
residence
of
the
person
is
in
one
of
the
following:
1.
In
the
county
in
which
the
application
is
received
or
in
which
the
court
is
located.
2.
In
some
other
county
of
the
state.
3.
In
another
state
or
in
a
foreign
country.
4.
Unknown.
Sec.
77.
Section
222.62,
Code
2011,
is
amended
to
read
as
follows:
222.62
Settlement
Residency
in
another
county.
When
the
board
of
supervisors
determines
through
the
central
point
of
coordination
process
that
the
legal
settlement
residency
of
the
person
is
other
than
in
the
county
in
which
the
application
is
received,
the
determination
shall
be
certified
to
the
superintendent
of
the
resource
center
or
the
special
unit
where
the
person
is
a
patient.
The
certification
shall
be
accompanied
by
a
copy
of
the
evidence
supporting
the
determination.
The
superintendent
shall
charge
the
expenses
already
incurred
and
unadjusted,
and
all
future
expenses
of
the
patient,
to
the
county
certified
to
be
the
county
of
legal
settlement
residency
.
Sec.
78.
Section
222.63,
Code
2011,
is
amended
to
read
as
follows:
222.63
Finding
of
settlement
residency
——
objection.
A
board
of
supervisors’
certification
utilizing
the
central
point
of
coordination
process
that
a
person’s
legal
settlement
residency
is
in
another
county
shall
be
sent
by
the
board
of
Senate
File
2315,
p.
54
supervisors
to
the
auditor
of
the
county
of
legal
settlement
residence
.
The
certification
shall
be
accompanied
by
a
copy
of
the
evidence
supporting
the
determination.
The
auditor
of
the
county
of
legal
settlement
residence
shall
submit
the
certification
to
the
board
of
supervisors
of
the
auditor’s
county
and
it
shall
be
conclusively
presumed
that
the
patient
has
a
legal
settlement
residency
in
that
county
unless
that
county
disputes
the
determination
of
legal
settlement
residency
as
provided
in
section
225C.8
331.438F
.
Sec.
79.
Section
222.64,
Code
2011,
is
amended
to
read
as
follows:
222.64
Foreign
state
or
country
or
unknown
legal
settlement
residency
.
If
the
legal
settlement
residency
of
the
person
is
determined
by
the
board
of
supervisors
through
the
central
point
of
coordination
process
a
county
or
the
state
to
be
in
a
foreign
state
or
country
or
is
determined
to
be
unknown,
the
board
of
supervisors
county
or
the
state
shall
certify
the
determination
to
the
administrator.
The
certification
shall
be
accompanied
by
a
copy
of
the
evidence
supporting
the
determination.
The
care
of
the
person
shall
be
as
arranged
by
the
board
of
supervisors
county
or
the
state
or
by
an
order
as
the
court
may
enter.
Application
for
admission
or
order
of
commitment
may
be
made
pending
investigation
by
the
administrator.
Sec.
80.
Section
222.65,
Code
2011,
is
amended
to
read
as
follows:
222.65
Investigation.
If
an
application
is
made
for
placement
of
a
person
in
a
state
resource
center
or
special
unit,
the
department’s
administrator
shall
immediately
investigate
the
legal
settlement
residency
of
the
person
and
proceed
as
follows:
1.
If
the
administrator
concurs
with
a
certified
determination
as
to
legal
settlement
residency
of
the
person
so
that
the
person
is
deemed
a
state
case
under
section
222.60
,
the
administrator
shall
cause
the
person
either
to
be
transferred
to
a
resource
center
or
a
special
unit
or
to
be
transferred
to
the
place
of
foreign
settlement
residency
.
2.
If
the
administrator
disputes
a
certified
determination
of
legal
settlement
residency
,
the
administrator
shall
order
the
person
transferred
to
a
state
resource
center
or
a
special
unit
until
the
dispute
is
resolved.
3.
If
the
administrator
disputes
a
certified
determination
Senate
File
2315,
p.
55
of
legal
settlement
residency
,
the
administrator
shall
utilize
the
procedure
provided
in
section
225C.8
331.438F
to
resolve
the
dispute.
A
determination
of
the
person’s
legal
settlement
residency
status
made
pursuant
to
section
225C.8
331.438F
is
conclusive.
Sec.
81.
Section
222.66,
Code
2011,
is
amended
to
read
as
follows:
222.66
Transfers
——
state
cases
——
expenses.
1.
The
transfer
to
a
resource
center
or
a
special
unit
or
to
the
place
of
legal
settlement
residency
of
a
person
with
mental
retardation
who
has
no
legal
settlement
residence
in
this
state
or
whose
legal
settlement
residency
is
unknown,
shall
be
made
in
accordance
with
such
directions
as
shall
be
prescribed
by
the
administrator
and
when
practicable
by
employees
of
the
state
resource
center
or
the
special
unit.
The
actual
and
necessary
expenses
of
such
transfers
shall
be
paid
by
the
department
on
itemized
vouchers
sworn
to
by
the
claimants
and
approved
by
the
administrator
and
the
approved
amount
is
appropriated
to
the
department
from
any
funds
in
the
state
treasury
not
otherwise
appropriated.
2.
The
case
of
a
person
with
an
intellectual
disability
who
is
determined
to
have
no
residence
in
this
state
or
whose
residence
is
unknown
shall
be
considered
a
state
case.
Sec.
82.
Section
222.67,
Code
2011,
is
amended
to
read
as
follows:
222.67
Charge
on
finding
of
settlement
residency
.
If
a
person
has
been
received
into
a
resource
center
or
a
special
unit
as
a
patient
whose
legal
settlement
is
supposedly
outside
the
state
or
residency
is
unknown
and
the
administrator
determines
that
the
legal
settlement
residency
of
the
patient
was
at
the
time
of
admission
or
commitment
in
a
county
of
this
state,
the
administrator
shall
certify
the
determination
and
charge
all
legal
costs
and
expenses
pertaining
to
the
admission
or
commitment
and
support
of
the
patient
to
the
county
of
legal
settlement
residence
.
The
certification
shall
be
sent
to
the
county
of
legal
settlement
residence
.
The
certification
shall
be
accompanied
by
a
copy
of
the
evidence
supporting
the
determination.
If
the
person’s
legal
settlement
residency
status
has
been
determined
in
accordance
with
section
225C.8
331.438F
,
the
legal
costs
and
expenses
shall
be
charged
to
the
county
or
as
a
state
case
in
accordance
with
that
determination.
The
costs
and
expenses
shall
be
collected
as
provided
by
law
in
other
cases.
Senate
File
2315,
p.
56
Sec.
83.
Section
222.68,
Code
2011,
is
amended
to
read
as
follows:
222.68
Costs
paid
in
first
instance.
All
necessary
and
legal
expenses
for
the
cost
of
admission
or
commitment
of
a
person
to
a
resource
center
or
a
special
unit
when
the
person’s
legal
settlement
residency
is
found
to
be
in
another
county
of
this
state
shall
in
the
first
instance
be
paid
by
the
county
from
which
the
person
was
admitted
or
committed.
The
county
of
legal
settlement
residence
shall
reimburse
the
county
which
pays
for
all
such
expenses.
Where
any
If
a
county
fails
to
make
such
reimbursement
within
forty-five
days
following
submission
of
a
properly
itemized
bill
to
the
county
of
legal
settlement
residence
,
a
penalty
of
not
greater
than
one
percent
per
month
on
and
after
forty-five
days
from
submission
of
the
bill
may
be
added
to
the
amount
due.
Sec.
84.
Section
222.69,
Code
2011,
is
amended
to
read
as
follows:
222.69
Payment
by
state.
All
The
amount
necessary
to
pay
the
necessary
and
legal
expenses
for
the
cost
of
admission
or
commitment
of
a
person
to
a
resource
center
or
a
special
unit
when
the
person’s
legal
settlement
residence
is
outside
this
state
or
is
unknown
shall
be
paid
out
of
is
appropriated
to
the
department
from
any
money
in
the
state
treasury
not
otherwise
appropriated.
Such
payments
shall
be
made
by
the
department
on
itemized
vouchers
executed
by
the
auditor
of
the
county
from
which
the
expenses
have
been
paid
and
approved
by
the
administrator.
Sec.
85.
Section
222.70,
Code
2011,
is
amended
to
read
as
follows:
222.70
Legal
settlement
Residency
disputes.
If
a
dispute
arises
between
counties
or
between
the
department
and
a
county
as
to
the
legal
settlement
residency
of
a
person
admitted
or
committed
to
a
resource
center,
a
special
unit,
or
a
community-based
service,
the
dispute
shall
be
resolved
as
provided
in
section
225C.8
331.438F
.
Sec.
86.
Section
222.73,
subsection
2,
paragraph
a,
unnumbered
paragraph
1,
Code
2011,
is
amended
to
read
as
follows:
The
superintendent
shall
certify
to
the
department
the
billings
to
each
county
for
services
provided
to
patients
chargeable
to
the
county
during
the
preceding
calendar
quarter.
The
county
billings
shall
be
based
on
the
average
daily
patient
Senate
File
2315,
p.
57
charge
and
outpatient
treatment
charges
computed
pursuant
to
subsection
1
,
and
the
number
of
inpatient
days
and
outpatient
treatment
service
units
chargeable
to
the
county.
The
billings
to
a
county
of
legal
settlement
residence
are
subject
to
adjustment
for
all
of
the
following
circumstances:
Sec.
87.
Section
222.77,
Code
2011,
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
legal
settlement
residence
or
the
state
as
provided
in
section
222.60
.
If
the
patient
has
no
county
of
legal
settlement,
the
cost
shall
be
paid
from
the
support
fund
of
the
resource
center
or
special
unit
and
charged
on
abstract
in
the
same
manner
as
other
state
inpatients
until
the
patient
becomes
self-supporting
or
qualifies
for
support
under
other
statutes.
Sec.
88.
Section
222.78,
Code
2011,
is
amended
to
read
as
follows:
222.78
Parents
and
others
liable
for
support.
1.
The
father
and
mother
of
any
patient
admitted
or
committed
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
by
the
county
to
the
state
under
in
accordance
with
the
provisions
of
sections
222.60
and
222.77
.
2.
The
liability
of
any
person,
other
than
the
patient,
who
is
legally
bound
for
the
support
of
a
patient
who
is
under
eighteen
years
of
age
in
a
resource
center
or
a
special
unit
shall
not
exceed
the
average
minimum
cost
of
the
care
of
a
normally
intelligent
minor
without
a
disability
of
the
same
age
and
sex
as
the
minor
patient.
The
administrator
shall
establish
the
scale
for
this
purpose
but
the
scale
shall
not
exceed
the
standards
for
personal
allowances
established
by
the
state
division
under
the
family
investment
program.
The
father
or
mother
shall
incur
liability
only
during
any
period
when
the
father
or
mother
either
individually
or
jointly
receive
a
net
income
from
whatever
source,
commensurate
with
Senate
File
2315,
p.
58
that
upon
which
they
would
be
liable
to
make
an
income
tax
payment
to
this
state.
The
father
or
mother
of
a
patient
shall
not
be
liable
for
the
support
of
the
patient
upon
the
patient
attaining
eighteen
years
of
age.
Nothing
in
this
section
shall
be
construed
to
prevent
a
relative
or
other
person
from
voluntarily
paying
the
full
actual
cost
as
established
by
the
administrator
for
caring
for
the
patient
with
mental
retardation.
Sec.
89.
Section
222.79,
Code
2011,
is
amended
to
read
as
follows:
222.79
Certification
statement
presumed
correct.
In
actions
to
enforce
the
liability
imposed
by
section
222.78
,
the
certification
statement
sent
from
the
superintendent
to
the
county
auditor
pursuant
to
section
222.74
or
the
county
of
residence,
as
applicable,
shall
submit
a
certification
statement
stating
the
sums
charged
in
such
cases
and
the
certification
statement
shall
be
considered
presumptively
correct.
Sec.
90.
Section
222.80,
Code
2011,
is
amended
to
read
as
follows:
222.80
Liability
to
county
or
state
.
A
person
admitted
or
committed
to
a
county
institution
or
home
or
admitted
or
committed
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
mental
retardation
shall
be
liable
to
the
county
or
state,
as
applicable,
for
the
reasonable
cost
of
the
support
as
provided
in
section
222.78
.
Sec.
91.
Section
222.82,
Code
2011,
is
amended
to
read
as
follows:
222.82
Collection
of
liabilities
and
claims.
The
If
liabilities
and
claims
exist
as
provided
in
section
222.78
or
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
of
each
county
may
direct
the
county
attorney
to
proceed
with
the
collection
of
said
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
and
is
hereby
empowered
to
compromise
any
Senate
File
2315,
p.
59
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.
92.
Section
222.86,
Code
2011,
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
business
manager
of
the
resource
center
or
special
unit
may
apply
any
amount
of
the
excess
to
reimburse
the
county
of
legal
settlement
or
the
state
in
a
case
where
no
legal
settlement
exists
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
of
legal
settlement
or
by
the
administrator
for
a
patient
having
no
legal
settlement
or
state,
as
applicable
.
Sec.
93.
Section
222.92,
subsection
3,
paragraph
a,
Code
2011,
is
amended
to
read
as
follows:
a.
Moneys
received
by
the
state
from
billings
to
counties
under
section
222.73
.
Sec.
94.
Section
225.23,
Code
2011,
is
amended
to
read
as
follows:
225.23
Collection
for
treatment.
If
the
bills
for
a
committed
or
voluntary
private
patient
are
paid
by
the
state,
the
state
psychiatric
hospital
shall
file
a
certified
copy
of
the
claim
for
the
bills
with
the
auditor
of
the
patient’s
county
of
residence
department
of
administrative
services
.
The
county
of
residence
department
shall
proceed
to
collect
the
claim
in
the
name
of
the
state
psychiatric
hospital
and,
when
collected,
pay
the
amount
collected
to
the
director
of
the
department
of
administrative
services
.
The
hospital
shall
also,
at
the
same
time,
forward
a
duplicate
of
the
claim
to
the
director
of
the
department
of
administrative
services.
Sec.
95.
Section
225C.6A,
subsection
4,
Code
2011,
is
amended
by
striking
the
subsection.
Sec.
96.
Section
225C.16,
subsection
2,
Code
2011,
is
amended
to
read
as
follows:
2.
The
clerk
of
the
district
court
in
that
county
shall
refer
a
person
applying
for
authorization
for
voluntary
admission,
or
for
authorization
for
voluntary
admission
of
another
person,
in
accordance
with
section
229.42
,
to
the
Senate
File
2315,
p.
60
appropriate
entity
designated
through
the
central
point
of
coordination
process
of
the
person’s
county
of
residence
under
section
225C.14
for
the
preliminary
diagnostic
evaluation
unless
the
applicant
furnishes
a
written
statement
from
the
appropriate
entity
which
indicates
that
the
evaluation
has
been
performed
and
that
the
person’s
admission
to
a
state
mental
health
institute
is
appropriate.
This
subsection
does
not
apply
when
authorization
for
voluntary
admission
is
sought
under
circumstances
which,
in
the
opinion
of
the
chief
medical
officer
or
that
officer’s
physician
designee,
constitute
a
medical
emergency.
Sec.
97.
Section
226.9C,
subsection
1,
unnumbered
paragraph
1,
Code
Supplement
2011,
is
amended
to
read
as
follows:
The
state
mental
health
institute
at
Mount
Pleasant
shall
operate
the
dual
diagnosis
mental
health
and
substance
abuse
substance-related
disorder
treatment
program
on
a
net
budgeting
basis
in
which
fifty
percent
of
the
actual
per
diem
and
ancillary
services
costs
are
chargeable
to
the
patient’s
county
of
legal
settlement
residence
or
as
a
state
case,
as
appropriate.
Subject
to
the
approval
of
the
department,
revenues
attributable
to
the
dual
diagnosis
program
for
each
fiscal
year
shall
be
deposited
in
the
mental
health
institute’s
account
and
are
appropriated
to
the
department
for
the
dual
diagnosis
program,
including
but
not
limited
to
all
of
the
following
revenues:
Sec.
98.
Section
226.45,
Code
2011,
is
amended
to
read
as
follows:
226.45
Reimbursement
to
county
or
state.
If
a
patient
is
not
receiving
medical
assistance
under
chapter
249A
and
the
amount
to
the
account
of
any
patient
in
the
patients’
personal
deposit
fund
exceeds
two
hundred
dollars,
the
business
manager
of
the
hospital
may
apply
any
of
the
excess
to
reimburse
the
county
of
legal
settlement
residence
or
the
state
in
a
case
where
no
legal
settlement
exists
for
a
state
case
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
of
legal
settlement
residence
or
by
the
administrator
for
a
patient
having
no
legal
settlement
state
case
.
Sec.
99.
Section
229.9A,
Code
2011,
is
amended
to
read
as
follows:
229.9A
Advocate
informed.
The
court
shall
direct
the
clerk
to
furnish
the
advocate
Senate
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p.
61
of
the
respondent’s
county
of
legal
settlement
residence
with
a
copy
of
application
and
any
order
issued
pursuant
to
section
229.8,
subsection
3
.
The
advocate
may
attend
the
hospitalization
hearing
of
any
respondent
for
whom
the
advocate
has
received
notice
of
a
hospitalization
hearing.
Sec.
100.
Section
229.12,
subsection
2,
Code
2011,
is
amended
to
read
as
follows:
2.
All
persons
not
necessary
for
the
conduct
of
the
proceeding
shall
be
excluded,
except
that
the
court
may
admit
persons
having
a
legitimate
interest
in
the
proceeding
and
shall
permit
the
advocate
from
the
respondent’s
county
of
legal
settlement
residence
to
attend
the
hearing.
Upon
motion
of
the
county
attorney,
the
judge
may
exclude
the
respondent
from
the
hearing
during
the
testimony
of
any
particular
witness
if
the
judge
determines
that
witness’s
testimony
is
likely
to
cause
the
respondent
severe
emotional
trauma.
Sec.
101.
Section
229.19,
subsection
1,
paragraph
b,
Code
2011,
is
amended
to
read
as
follows:
b.
The
court
or,
if
the
advocate
is
appointed
by
the
county
board
of
supervisors,
the
board
shall
assign
the
advocate
appointed
from
a
patient’s
county
of
legal
settlement
residence
to
represent
the
interests
of
the
patient.
If
a
patient
has
no
county
of
legal
settlement
residence
or
the
patient
is
a
state
case
,
the
court
or,
if
the
advocate
is
appointed
by
the
county
board
of
supervisors,
the
board
shall
assign
the
advocate
appointed
from
the
county
where
the
hospital
or
facility
is
located
to
represent
the
interests
of
the
patient.
Sec.
102.
Section
229.24,
subsection
3,
unnumbered
paragraph
1,
Code
2011,
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
legal
settlement
residence
,
the
clerk
of
the
district
court
shall
provide
to
the
county
of
legal
settlement
county
of
residence
and
to
the
county
in
which
the
hospitalization
order
is
entered
the
following
information
pertaining
to
the
individual
which
would
be
confidential
under
subsection
1
:
Sec.
103.
Section
229.31,
Code
2011,
is
amended
to
read
as
follows:
229.31
Commission
of
inquiry.
A
sworn
complaint,
alleging
that
a
named
person
is
not
seriously
mentally
impaired
and
is
unjustly
deprived
of
liberty
in
any
hospital
in
the
state,
may
be
filed
by
any
person
with
the
clerk
of
the
district
court
of
the
county
in
which
such
Senate
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p.
62
named
person
is
so
confined,
or
of
the
county
in
which
such
named
person
has
a
legal
settlement,
and
thereupon
a
is
a
resident.
Upon
receiving
the
complaint,
a
judge
of
said
that
court
shall
appoint
a
commission
of
not
more
than
three
persons
to
inquire
into
the
truth
of
said
the
allegations.
One
of
said
the
commissioners
shall
be
a
physician
and
if
additional
commissioners
are
appointed,
one
of
such
the
additional
commissioners
shall
be
a
lawyer.
Sec.
104.
Section
229.42,
Code
2011,
is
amended
to
read
as
follows:
229.42
Costs
paid
by
county.
1.
If
a
person
wishing
to
make
application
for
voluntary
admission
to
a
mental
hospital
established
by
chapter
226
is
unable
to
pay
the
costs
of
hospitalization
or
those
responsible
for
the
person
are
unable
to
pay
the
costs,
application
for
authorization
of
voluntary
admission
must
be
made
through
a
central
point
of
coordination
process
before
application
for
admission
is
made
to
the
hospital.
The
person’s
county
of
legal
settlement
residence
shall
be
determined
through
the
central
point
of
coordination
process
and
if
the
admission
is
approved
through
the
central
point
of
coordination
process,
the
person’s
admission
to
a
mental
health
hospital
shall
be
authorized
as
a
voluntary
case.
The
authorization
shall
be
issued
on
forms
provided
by
the
administrator.
The
costs
of
the
hospitalization
shall
be
paid
by
the
county
of
legal
settlement
residence
to
the
department
of
human
services
and
credited
to
the
general
fund
of
the
state,
provided
that
the
mental
health
hospital
rendering
the
services
has
certified
to
the
county
auditor
of
the
county
of
legal
settlement
residence
the
amount
chargeable
to
the
county
and
has
sent
a
duplicate
statement
of
the
charges
to
the
department
of
human
services.
A
county
shall
not
be
billed
for
the
cost
of
a
patient
unless
the
patient’s
admission
is
authorized
through
the
central
point
of
coordination
process.
The
mental
health
institute
and
the
county
shall
work
together
to
locate
appropriate
alternative
placements
and
services,
and
to
educate
patients
and
family
members
of
patients
regarding
such
alternatives.
2.
All
the
provisions
of
chapter
230
shall
apply
to
such
voluntary
patients
so
far
as
is
applicable.
3.
The
provisions
of
this
section
and
of
section
229.41
shall
apply
to
all
voluntary
inpatients
or
outpatients
receiving
mental
health
services
either
away
from
or
at
the
institution.
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63
4.
If
a
county
fails
to
pay
the
billed
charges
within
forty-five
days
from
the
date
the
county
auditor
received
the
certification
statement
from
the
superintendent,
the
department
of
human
services
shall
charge
the
delinquent
county
the
penalty
of
one
percent
per
month
on
and
after
forty-five
days
from
the
date
the
county
received
the
certification
statement
until
paid.
The
penalties
received
shall
be
credited
to
the
general
fund
of
the
state.
Sec.
105.
Section
229.43,
Code
2011,
is
amended
to
read
as
follows:
229.43
Nonresidents
or
no-settlement
Nonresident
patients.
The
administrator
may
place
patients
of
mental
health
institutes
who
have
no
county
of
legal
settlement,
who
are
nonresidents
,
or
whose
legal
settlement
is
unknown
on
convalescent
leave
to
a
private
sponsor
or
in
a
health
care
facility
licensed
under
chapter
135C
,
when
in
the
opinion
of
the
administrator
the
placement
is
in
the
best
interests
of
the
patient
and
the
state
of
Iowa.
If
the
patient
was
involuntarily
hospitalized,
the
district
court
which
ordered
hospitalization
of
the
patient
must
be
informed
when
the
patient
is
placed
on
convalescent
leave,
as
required
by
section
229.15,
subsection
5
.
Sec.
106.
Section
230.1,
Code
2011,
is
amended
to
read
as
follows:
230.1
Liability
of
county
and
state.
1.
The
necessary
and
legal
costs
and
expenses
attending
the
taking
into
custody,
care,
investigation,
admission,
commitment,
and
support
of
a
person
with
mental
illness
admitted
or
committed
to
a
state
hospital
shall
be
paid
by
a
county
or
by
the
state
as
follows:
a.
By
the
county
in
which
such
person
has
a
legal
settlement,
if
If
the
person
is
eighteen
years
of
age
or
older
,
by
the
person’s
county
of
residence
.
b.
By
the
state
when
as
a
state
case
if
such
person
has
no
legal
settlement
residence
in
this
state,
when
if
the
person’s
legal
settlement
residence
is
unknown,
or
if
the
person
is
under
eighteen
years
of
age.
2.
The
legal
settlement
county
of
residence
of
any
person
found
mentally
ill
with
mental
illness
who
is
a
patient
of
any
state
institution
shall
be
that
the
person’s
county
of
residence
existing
at
the
time
of
admission
thereto
to
the
institution
.
3.
A
county
of
legal
settlement
residence
is
not
liable
Senate
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2315,
p.
64
for
costs
and
expenses
associated
with
a
person
with
mental
illness
unless
the
costs
and
expenses
are
for
services
and
other
support
authorized
for
the
person
through
the
central
point
of
coordination
process.
For
the
purposes
of
this
chapter
,
“central
point
of
coordination
process”
means
the
same
as
defined
in
section
331.440
.
Sec.
107.
Section
230.2,
Code
2011,
is
amended
to
read
as
follows:
230.2
Finding
of
legal
settlement
residence
.
If
a
person’s
legal
settlement
residency
status
is
disputed,
legal
settlement
the
residency
shall
be
determined
in
accordance
with
section
225C.8
331.438F
.
Otherwise,
the
district
court
may,
when
the
person
is
ordered
placed
in
a
hospital
for
psychiatric
examination
and
appropriate
treatment,
or
as
soon
thereafter
as
the
court
obtains
the
proper
information,
determine
and
enter
of
record
whether
the
legal
settlement
residence
of
the
person
is
one
of
the
following
in
a
county
or
the
person
is
deemed
to
be
a
state
case,
as
follows
:
1.
In
the
county
from
which
the
person
was
placed
in
the
hospital
;
.
2.
In
some
other
another
county
of
the
state
;
.
3.
In
some
a
foreign
state
or
country
;
or
and
deemed
to
be
a
state
case.
4.
Unknown
and
deemed
to
be
a
state
case
.
Sec.
108.
Section
230.3,
Code
2011,
is
amended
to
read
as
follows:
230.3
Certification
of
settlement
residence
.
If
a
person’s
legal
settlement
county
of
residence
is
determined
through
by
the
county’s
central
point
of
coordination
process
to
be
in
another
county
of
this
state,
the
county
making
the
determination
shall
certify
the
determination
to
the
superintendent
of
the
hospital
to
which
the
person
is
admitted
or
committed.
The
certification
shall
be
accompanied
by
a
copy
of
the
evidence
supporting
the
determination.
Upon
receiving
the
certification,
the
superintendent
shall
charge
the
expenses
already
incurred
and
unadjusted,
and
all
future
expenses
of
the
person
,
to
the
county
determined
to
be
the
county
of
legal
settlement
residence
.
Sec.
109.
Section
230.4,
Code
2011,
is
amended
to
read
as
follows:
230.4
Certification
to
debtor
county.
A
determination
of
a
person’s
legal
settlement
county
of
residence
made
in
accordance
with
section
230.2
or
230.3
shall
Senate
File
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p.
65
be
sent
by
the
court
or
the
county
to
the
county
auditor
of
the
county
of
legal
settlement
residence
.
The
certification
shall
be
accompanied
by
a
copy
of
the
evidence
supporting
the
determination.
The
auditor
shall
provide
the
certification
to
the
board
of
supervisors
of
the
auditor’s
county,
and
it
shall
be
conclusively
presumed
that
the
person
has
a
legal
settlement
residence
in
the
notified
county
unless
that
county
disputes
the
finding
of
legal
settlement
residence
as
provided
in
section
225C.8
331.438F
.
Sec.
110.
Section
230.5,
Code
2011,
is
amended
to
read
as
follows:
230.5
Nonresidents.
If
a
person’s
legal
settlement
residence
is
determined
in
accordance
with
section
230.2
or
230.3
to
be
in
a
foreign
state
or
country,
or
is
unknown,
the
court
or
the
county
shall
immediately
certify
the
determination
to
the
department’s
administrator.
The
certification
shall
be
accompanied
by
a
copy
of
the
evidence
supporting
the
determination.
A
court
order
issued
pursuant
to
section
229.13
shall
direct
that
the
patient
be
hospitalized
at
the
appropriate
state
hospital
for
persons
with
mental
illness.
Sec.
111.
Section
230.6,
Code
2011,
is
amended
to
read
as
follows:
230.6
Investigation
by
administrator.
The
administrator
shall
immediately
investigate
the
legal
settlement
residency
of
a
patient
and
proceed
as
follows:
1.
If
the
administrator
concurs
with
a
certified
determination
of
legal
settlement
residency
concerning
the
patient,
the
administrator
shall
cause
the
patient
either
to
be
transferred
to
a
state
hospital
for
persons
with
mental
illness
at
the
expense
of
the
state,
or
to
be
transferred,
with
approval
of
the
court
as
required
by
chapter
229
to
the
place
of
foreign
settlement
residence
.
2.
If
the
administrator
disputes
a
certified
legal
settlement
residency
determination,
the
administrator
shall
order
the
patient
to
be
maintained
at
a
state
hospital
for
persons
with
mental
illness
at
the
expense
of
the
state
until
the
dispute
is
resolved.
3.
If
the
administrator
disputes
a
legal
settlement
residency
determination,
the
administrator
shall
utilize
the
procedure
provided
in
section
225C.8
331.438F
to
resolve
the
dispute.
A
determination
of
the
person’s
legal
settlement
residency
status
made
pursuant
to
section
225C.8
331.438F
is
Senate
File
2315,
p.
66
conclusive.
Sec.
112.
Section
230.8,
Code
2011,
is
amended
to
read
as
follows:
230.8
Transfers
of
persons
with
mental
illness
——
expenses.
The
transfer
to
any
state
hospitals
or
to
the
places
of
their
legal
settlement
residence
of
persons
with
mental
illness
who
have
no
legal
settlement
residence
in
this
state
or
whose
legal
settlement
residence
is
unknown
and
deemed
to
be
a
state
case
,
shall
be
made
according
to
the
directions
of
the
administrator,
and
when
practicable
by
employees
of
the
state
hospitals
,
and
the
.
The
actual
and
necessary
expenses
of
such
transfers
shall
be
paid
on
itemized
vouchers
sworn
to
by
the
claimants
and
approved
by
the
administrator,
and
the
amount
of
the
expenses
is
appropriated
to
the
department
from
any
funds
in
the
state
treasury
not
otherwise
appropriated.
Sec.
113.
Section
230.9,
Code
2011,
is
amended
to
read
as
follows:
230.9
Subsequent
discovery
of
residence.
If,
after
a
person
has
been
received
by
a
state
hospital
for
persons
with
mental
illness
as
a
state
case
patient
whose
legal
settlement
residence
is
supposed
to
be
outside
this
state
or
unknown
,
the
administrator
determines
that
the
legal
settlement
residence
of
the
person
was,
at
the
time
of
admission
or
commitment,
in
a
county
of
this
state,
the
administrator
shall
certify
the
determination
and
charge
all
legal
costs
and
expenses
pertaining
to
the
admission
or
commitment
and
support
of
the
person
to
the
county
of
legal
settlement
residence
.
The
certification
shall
be
sent
to
the
county
of
legal
settlement
residence
.
The
certification
shall
be
accompanied
by
a
copy
of
the
evidence
supporting
the
determination.
The
costs
and
expenses
shall
be
collected
as
provided
by
law
in
other
cases.
If
the
person’s
legal
settlement
residency
status
has
been
determined
in
accordance
with
section
225C.8
331.438F
,
the
legal
costs
and
expenses
shall
be
charged
to
the
county
of
residence
or
as
a
state
case
in
accordance
with
that
determination.
Sec.
114.
Section
230.10,
Code
2011,
is
amended
to
read
as
follows:
230.10
Payment
of
costs.
All
legal
costs
and
expenses
attending
the
taking
into
custody,
care,
investigation,
and
admission
or
commitment
of
a
person
to
a
state
hospital
for
persons
with
mental
illness
under
a
finding
that
such
the
person
has
a
legal
settlement
Senate
File
2315,
p.
67
residency
in
another
county
of
this
state
shall
be
charged
against
the
county
of
legal
settlement
residence
.
Sec.
115.
Section
230.11,
Code
2011,
is
amended
to
read
as
follows:
230.11
Recovery
of
costs
from
state.
Costs
and
expenses
attending
the
taking
into
custody,
care,
and
investigation
of
a
person
who
has
been
admitted
or
committed
to
a
state
hospital,
United
States
department
of
veterans
affairs
hospital,
or
other
agency
of
the
United
States
government,
for
persons
with
mental
illness
and
who
has
no
legal
settlement
residence
in
this
state
or
whose
legal
settlement
residence
is
unknown,
including
cost
of
commitment,
if
any,
shall
be
paid
out
of
as
a
state
case
as
approved
by
the
administrator.
The
amount
of
the
costs
and
expenses
approved
by
the
administrator
is
appropriated
to
the
department
from
any
money
in
the
state
treasury
not
otherwise
appropriated,
on
itemized
vouchers
executed
by
the
auditor
of
the
county
which
has
paid
them,
and
approved
by
the
administrator.
Sec.
116.
Section
230.12,
Code
2011,
is
amended
to
read
as
follows:
230.12
Legal
settlement
Residency
disputes.
If
a
dispute
arises
between
different
counties
or
between
the
administrator
and
a
county
as
to
the
legal
settlement
residence
of
a
person
admitted
or
committed
to
a
state
hospital
for
persons
with
mental
illness,
the
dispute
shall
be
resolved
as
provided
in
section
225C.8
331.438F
.
Sec.
117.
Section
230.32,
Code
2011,
is
amended
to
read
as
follows:
230.32
Support
of
nonresident
patients
on
leave.
The
cost
of
support
of
patients
without
legal
settlement
residence
in
this
state,
who
are
placed
on
convalescent
leave
or
removed
from
a
state
mental
institute
to
any
health
care
facility
licensed
under
chapter
135C
for
rehabilitation
purposes,
shall
be
paid
from
the
hospital
support
fund
and
shall
be
charged
on
abstract
in
the
same
manner
as
state
inpatients,
until
such
time
as
the
patient
becomes
self-supporting
or
qualifies
for
support
under
existing
statutes.
Sec.
118.
Section
232.141,
subsection
8,
Code
2011,
is
amended
to
read
as
follows:
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
Senate
File
2315,
p.
68
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
in
accordance
with
law
and
administrative
rule,
the
unpaid
costs
may
be
recovered
from
the
child’s
county
of
legal
settlement.
However,
the
maximum
amount
of
the
unpaid
costs
which
may
be
recovered
under
this
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
in
effect
in
May
of
the
preceding
fiscal
year
for
reimbursement
of
juvenile
shelter
care
homes.
In
no
case
shall
the
home
be
reimbursed
for
more
than
the
home’s
actual
and
allowable
costs.
The
unpaid
costs
are
payable
pursuant
to
filing
of
verified
claims
against
the
county
of
legal
settlement.
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
pursuant
to
this
subsection
shall
be
settled
in
the
manner
provided
to
determine
legal
settlement
residency
in
section
225C.8
331.438F
.
Sec.
119.
Section
249A.12,
subsection
2,
Code
2011,
is
amended
to
read
as
follows:
2.
A
county
shall
reimburse
the
department
on
a
monthly
basis
for
that
portion
of
the
cost
of
assistance
provided
under
this
section
to
a
recipient
with
legal
settlement
in
who
is
a
resident
of
the
county,
which
is
not
paid
from
federal
funds,
if
the
recipient’s
placement
has
been
approved
by
the
appropriate
review
organization
as
medically
necessary
and
appropriate.
The
department’s
goal
for
the
maximum
time
period
for
submission
of
a
claim
to
a
county
is
not
more
than
sixty
days
following
the
submission
of
the
claim
by
the
provider
of
the
service
to
the
department.
The
department’s
goal
for
completion
and
crediting
of
a
county
for
cost
settlement
for
the
actual
costs
of
a
service
under
a
home
and
community-based
services
waiver
is
within
two
hundred
seventy
days
of
the
close
of
a
fiscal
year
for
which
cost
reports
are
due
from
providers.
The
department
shall
place
all
reimbursements
from
counties
in
the
appropriation
for
medical
assistance,
and
may
use
the
reimbursed
funds
in
the
same
manner
and
for
any
purpose
for
which
the
appropriation
for
medical
assistance
may
be
used.
Sec.
120.
Section
249A.12,
subsection
6,
paragraphs
c
and
d,
Code
2011,
are
amended
to
read
as
follows:
c.
The
person’s
county
of
legal
settlement
residence
shall
pay
for
the
nonfederal
share
of
the
cost
of
services
provided
Senate
File
2315,
p.
69
under
the
waiver,
and
the
state
shall
pay
for
the
nonfederal
share
of
such
costs
if
the
person
has
no
legal
settlement
is
not
a
resident
of
this
state
or
the
legal
settlement
person’s
residency
is
unknown
so
that
the
person
is
deemed
to
be
a
state
case.
d.
The
county
of
legal
settlement
residence
shall
pay
for
one
hundred
percent
of
the
nonfederal
share
of
the
costs
of
care
provided
for
adults
which
is
reimbursed
under
a
home
and
community-based
services
waiver
that
would
otherwise
be
approved
for
provision
in
an
intermediate
care
facility
for
persons
with
mental
retardation
provided
under
the
medical
assistance
program.
Sec.
121.
Section
249A.12,
subsections
7
and
8,
Code
2011,
are
amended
to
read
as
follows:
7.
When
paying
the
necessary
and
legal
expenses
for
intermediate
care
facility
for
persons
with
mental
retardation
services,
the
cost
requirements
of
section
222.60
shall
be
considered
fulfilled
when
payment
is
made
in
accordance
with
the
medical
assistance
payment
rates
established
by
the
department
for
intermediate
care
facilities
for
persons
with
mental
retardation,
and
the
state
or
a
county
of
legal
settlement
residence
shall
not
be
obligated
for
any
amount
in
excess
of
the
rates.
8.
If
a
person
with
mental
retardation
has
no
legal
settlement
residence
in
this
state
or
the
legal
settlement
whose
residency
is
unknown
so
that
the
person
is
deemed
to
be
a
state
case
and
services
associated
with
the
mental
retardation
can
be
covered
under
a
medical
assistance
home
and
community-based
services
waiver
or
other
medical
assistance
program
provision,
the
nonfederal
share
of
the
medical
assistance
program
costs
for
such
coverage
shall
be
paid
from
the
appropriation
made
for
the
medical
assistance
program.
Sec.
122.
Section
249A.26,
subsection
2,
Code
2011,
is
amended
to
read
as
follows:
2.
a.
Except
as
provided
for
disallowed
costs
in
section
249A.27
,
the
county
of
legal
settlement
residence
shall
pay
for
fifty
percent
of
the
nonfederal
share
of
the
cost
and
the
state
shall
have
responsibility
for
the
remaining
fifty
percent
of
the
nonfederal
share
of
the
cost
of
case
management
provided
to
adults,
day
treatment,
and
partial
hospitalization
provided
under
the
medical
assistance
program
for
persons
with
mental
retardation,
a
developmental
disability,
or
chronic
mental
illness.
For
purposes
of
this
section
,
persons
with
mental
Senate
File
2315,
p.
70
disorders
resulting
from
Alzheimer’s
disease
or
substance
abuse
a
substance-related
disorder
shall
not
be
considered
chronically
mentally
ill
to
be
persons
with
chronic
mental
illness
.
To
the
maximum
extent
allowed
under
federal
law
and
regulations,
the
department
shall
consult
with
and
inform
a
person’s
county
of
legal
settlement’s
residence’s
central
point
of
coordination
process,
as
defined
in
section
331.440
,
regarding
the
necessity
for
and
the
provision
of
any
service
for
which
the
county
is
required
to
provide
reimbursement
under
this
subsection
.
b.
The
state
shall
pay
for
one
hundred
percent
of
the
nonfederal
share
of
the
costs
of
case
management
provided
for
adults,
day
treatment,
partial
hospitalization,
and
the
home
and
community-based
services
waiver
services
for
persons
who
have
no
legal
settlement
residence
in
this
state
or
the
legal
settlement
whose
residence
is
unknown
so
that
the
persons
are
deemed
to
be
state
cases.
c.
The
case
management
services
specified
in
this
subsection
shall
be
paid
for
by
a
county
only
if
the
services
are
provided
outside
of
a
managed
care
contract.
Sec.
123.
Section
249A.26,
subsections
3,
4,
7,
and
8,
Code
2011,
are
amended
to
read
as
follows:
3.
To
the
maximum
extent
allowed
under
federal
law
and
regulations,
a
person
with
mental
illness
or
mental
retardation
shall
not
be
eligible
for
any
service
which
is
funded
in
whole
or
in
part
by
a
county
share
of
the
nonfederal
portion
of
medical
assistance
funds
unless
the
person
is
referred
through
the
central
point
of
coordination
process,
as
defined
in
section
331.440
.
However,
to
the
extent
federal
law
allows
referral
of
a
medical
assistance
recipient
to
a
service
without
approval
of
the
central
point
of
coordination
process,
the
county
of
legal
settlement
residence
shall
be
billed
for
the
nonfederal
share
of
costs
for
any
adult
person
for
whom
the
county
would
otherwise
be
responsible.
4.
The
county
of
legal
settlement
residence
shall
pay
for
one
hundred
percent
of
the
nonfederal
share
of
the
cost
of
services
provided
to
adult
persons
with
chronic
mental
illness
who
qualify
for
habilitation
services
in
accordance
with
the
rules
adopted
for
the
services.
The
state
shall
pay
for
one
hundred
percent
of
the
nonfederal
share
of
the
cost
of
such
services
provided
to
such
persons
who
have
no
legal
settlement
residency
in
this
state
or
the
legal
settlement
whose
residency
is
unknown
so
that
the
persons
are
deemed
to
be
state
cases.
Senate
File
2315,
p.
71
7.
Unless
a
county
has
paid
or
is
paying
for
the
nonfederal
share
of
the
costs
of
a
person’s
home
and
community-based
waiver
services
or
placement
in
an
intermediate
care
facility
for
persons
with
mental
retardation
under
the
county’s
mental
health,
mental
retardation,
and
developmental
disabilities
services
fund
created
in
section
331.424A
,
or
unless
a
county
of
legal
settlement
residence
would
become
liable
for
the
costs
of
services
for
a
person
at
the
level
of
care
provided
in
an
intermediate
care
facility
for
persons
with
mental
retardation
due
to
the
person
reaching
the
age
of
majority,
the
state
shall
pay
for
the
nonfederal
share
of
the
costs
of
an
eligible
person’s
services
under
the
home
and
community-based
services
waiver
for
persons
with
brain
injury.
8.
If
a
dispute
arises
between
different
counties
or
between
the
department
and
a
county
as
to
the
legal
settlement
residency
of
a
person
who
receives
medical
assistance
for
which
the
nonfederal
share
is
payable
in
whole
or
in
part
by
a
county
of
legal
settlement
residence
,
and
cannot
be
resolved
by
the
parties,
the
dispute
shall
be
resolved
as
provided
in
section
225C.8
331.438F
.
Sec.
124.
Section
252.23,
Code
2011,
is
amended
to
read
as
follows:
252.23
Legal
settlement
disputes.
If
the
alleged
settlement
is
disputed,
then,
within
thirty
days
after
notice
as
provided
in
section
252.22
,
a
copy
of
the
notices
sent
and
received
shall
be
filed
in
the
office
of
the
clerk
of
the
district
court
of
the
county
against
which
claim
is
made,
and
a
cause
docketed
without
other
pleadings,
and
tried
as
an
ordinary
action,
in
which
the
county
granting
the
assistance
shall
be
plaintiff,
and
the
other
defendant,
and
the
burden
of
proof
shall
be
upon
the
county
granting
the
assistance.
However,
a
legal
settlement
dispute
concerning
the
liability
of
a
person’s
county
of
residence
for
assistance
provided
through
the
county’s
mental
health
and
disability
services
system
implemented
under
chapter
331
in
connection
with
services
initiated
under
chapter
222
,
230
,
or
249A
shall
be
resolved
as
provided
in
section
225C.8
331.438F
.
Sec.
125.
Section
252.24,
Code
2011,
is
amended
to
read
as
follows:
252.24
County
of
settlement
liable.
1.
The
county
where
the
settlement
is
shall
be
liable
to
the
county
granting
assistance
for
all
reasonable
charges
and
expenses
incurred
in
the
assistance
and
care
of
a
poor
person.
Senate
File
2315,
p.
72
2.
When
assistance
is
furnished
by
any
governmental
agency
of
the
county,
township,
or
city,
the
assistance
shall
be
deemed
to
have
been
furnished
by
the
county
in
which
the
agency
is
located
and
the
agency
furnishing
the
assistance
shall
certify
the
correctness
of
the
costs
of
the
assistance
to
the
board
of
supervisors
of
that
county
and
that
county
shall
collect
from
the
county
of
the
person’s
settlement.
The
amounts
collected
by
the
county
where
the
agency
is
located
shall
be
paid
to
the
agency
furnishing
the
assistance.
This
statute
applies
to
services
and
supplies
furnished
as
provided
in
section
139A.18
.
3.
Notwithstanding
subsection
2,
if
assistance
or
maintenance
is
provided
by
a
county
through
the
county’s
mental
health
and
disability
services
system
implemented
under
chapter
331,
liability
for
the
assistance
and
maintenance
is
the
responsibility
of
the
person’s
county
of
residence.
Sec.
126.
Section
331.440,
subsection
2,
paragraph
b,
Code
Supplement
2011,
is
amended
to
read
as
follows:
b.
“County
of
residence”
means
the
county
in
this
state
in
which,
at
the
time
an
adult
person
applies
for
or
receives
services,
the
adult
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
an
adult
person
who
is
a
homeless
person
is
the
county
where
the
homeless
person
usually
sleeps.
A
person
maintains
residency
in
the
county
in
which
the
person
last
resided
while
the
person
is
present
in
another
county
receiving
services
in
a
hospital,
a
correctional
facility,
a
halfway
house
for
community-based
corrections
or
substance-related
treatment,
a
nursing
facility,
an
intermediate
care
facility
for
persons
with
an
intellectual
disability,
or
a
residential
care
facility,
or
for
the
purpose
of
attending
a
college
or
university.
Sec.
127.
Section
331.502,
subsection
11,
Code
2011,
is
amended
to
read
as
follows:
11.
Carry
out
duties
relating
to
the
determination
of
legal
settlement
residency
,
collection
of
funds
due
the
county
,
and
support
of
persons
with
mental
retardation
as
provided
in
sections
222.13
,
222.50
,
222.61
to
222.66
,
222.69
,
and
222.74
.
Sec.
128.
Section
347.16,
subsection
3,
Code
2011,
is
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
legal
settlement
Senate
File
2315,
p.
73
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
county
in
which
that
person
has
legal
settlement
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
legal
settlement
of
the
indigent
person
of
the
provision
of
care
and
treatment
to
the
indigent
person.
However,
if
the
care
and
treatment
is
provided
by
a
county
through
the
county’s
mental
health
and
disability
services
system
implemented
under
chapter
331,
liability
for
the
assistance
and
maintenance
is
the
responsibility
of
the
person’s
county
of
residence.
Sec.
129.
REPEAL.
Section
225C.8,
Code
2011,
is
repealed.
Sec.
130.
EFFECTIVE
DATE.
This
division
of
this
Act
takes
effect
July
1,
2013.
DIVISION
IX
PROPERTY
TAX-RELATED
PROVISIONS
Sec.
131.
MENTAL
HEALTH
AND
DISABILITY
SERVICES
REDESIGN
FISCAL
VIABILITY
ANALYSIS.
The
legislative
council
is
requested
to
authorize
a
study
committee
to
analyze
the
viability
of
the
mental
health
and
disability
services
redesign
financing
provisions
in
this
Act,
during
the
2012
and
2013
legislative
interims.
The
study
committee
may
contract
for
an
independent
analysis
to
be
performed.
The
study
committee
shall
consider
reports
from
the
transition
committee
created
by
this
division
of
this
Act.
Reports
of
the
analysis
containing
findings
and
recommendations
shall
be
submitted
for
consideration
by
the
Eighty-fifth
General
Assembly
during
the
2013
legislative
session.
The
study
committee
may
meet
during
the
2013
legislative
interim
to
consider
and
determine
whether
revisions
to
2013
redesign
financing
enactments
are
warranted
and
to
make
appropriate
recommendations
for
consideration
during
the
2014
legislative
session.
Sec.
132.
Section
331.424A,
Code
Supplement
2011,
is
amended
to
read
as
follows:
331.424A
County
mental
health
,
mental
retardation,
and
developmental
disabilities
services
fund.
Senate
File
2315,
p.
74
1.
For
the
purposes
of
this
chapter
and
chapter
426B
,
unless
the
context
otherwise
requires
,
“services
fund”
means
the
county
mental
health,
mental
retardation,
and
developmental
disabilities
services
fund
created
in
subsection
2
.
The
county
finance
committee
created
in
section
333A.2
shall
consult
with
the
state
commission
in
adopting
rules
and
prescribing
forms
for
administering
the
services
fund.
:
a.
“Base
year
expenditures
for
mental
health
and
disabilities
services”
means
the
same
as
defined
in
section
331.438,
Code
Supplement
2011,
minus
the
amount
the
county
received
from
the
property
tax
relief
fund
pursuant
to
section
426B.1,
Code
2011,
for
the
fiscal
year
beginning
July
1,
2008.
b.
“County
population
expenditure
target
amount”
means
the
product
of
the
statewide
per
capita
expenditure
target
amount
multiplied
by
a
county’s
general
population.
c.
“County
services
fund”
means
a
county
mental
health
and
disabilities
services
fund
created
pursuant
to
this
section.
d.
“Per
capita
growth
amount”
means
the
amount
by
which
the
statewide
per
capita
expenditure
target
amount
may
grow
from
one
year
to
the
next.
e.
“Statewide
per
capita
expenditure
target
amount”
means
the
dollar
amount
of
a
statewide
expenditure
target
per
person
as
established
by
statute.
2.
The
county
finance
committee
created
in
section
333A.2
shall
consult
with
the
department
of
human
services
and
the
department
of
management
in
adopting
rules
and
prescribing
forms
for
administering
the
county
services
funds.
2.
3.
For
the
fiscal
year
beginning
July
1,
1996,
and
succeeding
fiscal
years,
county
County
revenues
from
taxes
and
other
sources
designated
by
a
county
for
mental
health
,
mental
retardation,
and
developmental
disabilities
services
shall
be
credited
to
the
county
mental
health
,
mental
retardation,
and
developmental
disabilities
services
fund
of
which
shall
be
created
by
the
county.
The
board
shall
make
appropriations
from
the
fund
for
payment
of
services
provided
under
the
county
regional
service
system
management
plan
approved
pursuant
to
section
331.439
331.439A
.
The
county
may
pay
for
the
services
in
cooperation
with
other
counties
by
pooling
appropriations
from
the
county
services
fund
with
appropriations
from
the
county
services
fund
of
other
counties
or
through
county
regional
entities
including
but
not
limited
to
the
county’s
mental
health
and
developmental
disabilities
regional
planning
council
created
pursuant
to
section
225C.18
through
the
Senate
File
2315,
p.
75
county’s
regional
administrator,
or
through
another
arrangement
specified
in
the
regional
governance
agreement
entered
into
by
the
county
under
section
331.438E
.
3.
4.
For
the
fiscal
year
beginning
July
1,
1996,
and
succeeding
fiscal
years,
receipts
Receipts
from
the
state
or
federal
government
for
such
the
mental
health
and
disability
services
administered
or
paid
for
by
a
county
shall
be
credited
to
the
county
services
fund,
including
moneys
allotted
distributed
to
the
county
from
the
state
payment
made
pursuant
to
section
331.439
and
moneys
allotted
to
the
county
for
property
tax
relief
pursuant
to
section
426B.1
department
of
human
services
and
moneys
allocated
under
chapter
426B
.
4.
5.
For
the
fiscal
year
beginning
July
1,
1996,
and
for
each
subsequent
fiscal
year,
the
county
shall
certify
a
levy
for
payment
of
services.
For
each
fiscal
year,
county
revenues
from
taxes
imposed
by
the
county
credited
to
the
services
fund
shall
not
exceed
an
amount
equal
to
the
amount
of
base
year
expenditures
for
mental
health
and
disability
services
as
defined
in
section
331.438
,
less
the
amount
of
property
tax
relief
to
be
received
pursuant
to
section
426B.2
,
in
the
fiscal
year
for
which
the
budget
is
certified
.
The
county
auditor
and
the
board
of
supervisors
shall
reduce
the
amount
of
the
levy
certified
for
the
services
fund
by
the
amount
of
property
tax
relief
to
be
received.
A
levy
certified
under
this
section
is
not
subject
to
the
appeal
provisions
of
section
331.426
or
to
any
other
provision
in
law
authorizing
a
county
to
exceed,
increase,
or
appeal
a
property
tax
levy
limit.
5.
6.
Appropriations
specifically
authorized
to
be
made
from
the
mental
health
,
mental
retardation,
and
developmental
disabilities
services
fund
shall
not
be
made
from
any
other
fund
of
the
county.
6.
7.
This
section
is
repealed
July
1,
2013.
Notwithstanding
subsection
5,
for
the
fiscal
years
beginning
July
1,
2013,
and
July
1,
2014,
county
revenues
from
taxes
levied
by
the
county
and
credited
to
the
county
services
fund
shall
not
exceed
the
lower
of
the
following
amounts:
a.
The
amount
of
the
county’s
base
year
expenditures
for
mental
health
and
disabilities
services.
b.
The
amount
equal
to
the
product
of
the
statewide
per
capita
expenditure
target
for
the
fiscal
year
beginning
July
1,
2013,
multiplied
by
the
county’s
general
population
for
the
same
fiscal
year.
Sec.
133.
Section
331.432,
subsection
3,
Code
Supplement
Senate
File
2315,
p.
76
2011,
is
amended
to
read
as
follows:
3.
Except
as
authorized
in
section
331.477
,
transfers
of
moneys
between
the
county
mental
health
,
mental
retardation,
and
developmental
disabilities
services
fund
created
pursuant
to
section
331.424A
and
any
other
fund
are
prohibited.
Sec.
134.
Section
426B.1,
subsection
2,
Code
2011,
is
amended
by
striking
the
subsection
and
inserting
in
lieu
thereof
the
following:
2.
Moneys
shall
be
distributed
from
the
property
tax
relief
fund
to
counties
for
the
mental
health
and
disability
regional
service
system
for
providing
county
base
property
tax
equivalent
equalization
payments
and
the
per
capita
growth
amount
established
pursuant
to
section
426B.3,
in
accordance
with
the
appropriations
made
to
the
fund
and
other
statutory
requirements.
Sec.
135.
Section
426B.2,
subsections
1
and
2,
Code
2011,
are
amended
by
striking
the
subsections.
Sec.
136.
Section
426B.2,
subsection
3,
Code
2011,
is
amended
to
read
as
follows:
3.
a.
The
director
of
human
services
shall
draw
warrants
on
the
property
tax
relief
fund,
payable
to
the
county
treasurer
in
the
amount
due
to
a
county
in
accordance
with
subsection
1
section
426B.3,
and
mail
the
warrants
to
the
county
auditors
in
July
and
January
of
each
year.
b.
Any
replacement
generation
tax
in
the
property
tax
relief
fund
as
of
May
1
shall
be
paid
to
the
county
treasurers
in
July
and
January
of
the
fiscal
year
beginning
the
following
July
1.
The
department
of
management
shall
determine
the
amount
each
county
will
be
paid
pursuant
to
this
lettered
paragraph
for
the
following
fiscal
year.
The
department
shall
reduce
by
the
determined
amount
the
amount
of
each
county’s
certified
budget
to
be
raised
by
property
tax
for
that
fiscal
year
which
is
to
be
expended
for
mental
health,
mental
retardation,
and
developmental
disabilities
services
and
shall
revise
the
rate
of
taxation
as
necessary
to
raise
the
reduced
amount.
The
department
of
management
shall
report
the
reduction
in
the
certified
budget
and
the
revised
rate
of
taxation
to
the
county
auditors
by
June
15.
Sec.
137.
Section
426B.3,
Code
2011,
is
amended
by
striking
the
section
and
inserting
in
lieu
thereof
the
following:
426B.3
Per
capita
funding
for
fiscal
years
2013-2014
and
2014-2015.
1.
For
the
fiscal
years
beginning
July
1,
2013,
and
July
1,
Senate
File
2315,
p.
77
2014,
the
state
and
county
funding
for
the
mental
health
and
disability
services
administered
or
paid
for
by
counties
shall
be
provided
based
on
a
statewide
per
capita
expenditure
target
amount
computed
in
accordance
with
this
section.
2.
The
statewide
per
capita
expenditure
target
amount
shall
consist
of
the
sum
of
the
following:
a.
A
county
base
property
tax
equivalent
to
forty-seven
dollars
and
twenty-eight
cents
per
capita.
Each
per
capita
growth
amount
established
by
statute
as
provided
in
paragraph
“b”
,
shall
be
added
to
this
amount.
b.
A
per
capita
growth
amount,
which
may
be
stated
as
a
percentage
of
the
prior
fiscal
year’s
county
base
property
tax
per
capita
amount,
as
established
by
statute.
3.
The
per
capita
growth
amount
established
by
statute
shall
provide
funding
for
increases
in
non-Medicaid
expenditures
from
county
services
funds
due
to
service
costs,
additional
service
populations,
additional
core
service
domains,
and
numbers
of
persons
receiving
services.
4.
a.
For
the
fiscal
years
beginning
July
1,
2013,
and
July
1,
2014,
a
county
with
a
county
population
expenditure
target
amount
that
exceeds
the
amount
of
the
county’s
base
year
expenditures
for
mental
health
and
disabilities
services
shall
receive
an
equalization
payment
for
the
difference.
b.
The
equalization
payments
determined
in
accordance
with
this
subsection
shall
be
made
by
the
department
of
human
services
for
each
fiscal
year
as
provided
in
appropriations
made
from
the
property
tax
relief
fund
for
this
purpose.
Sec.
138.
REPEAL.
Section
426B.6,
Code
Supplement
2011,
is
repealed.
Sec.
139.
EFFECTIVE
DATE.
The
following
provisions
of
this
division
of
this
Act
take
effect
July
1,
2013:
1.
The
section
of
this
Act
amending
section
331.424A.
2.
The
section
of
this
Act
amending
section
331.432.
3.
The
section
of
this
Act
amending
section
426B.1.
4.
The
sections
of
this
Act
amending
section
426B.2.
5.
The
section
of
this
Act
amending
section
426B.3.
Sec.
140.
APPLICABILITY.
The
following
provisions
of
this
division
of
this
Act
are
applicable
commencing
with
the
budget
and
tax
levy
certification
process
for
the
fiscal
year
beginning
July
1,
2013:
1.
The
section
of
this
Act
amending
section
331.424A.
2.
The
section
of
this
Act
amending
section
426B.1.
3.
The
sections
of
this
Act
amending
section
426B.2.
Senate
File
2315,
p.
78
4.
The
section
of
this
Act
amending
section
426B.3.
______________________________
JOHN
P.
KIBBIE
President
of
the
Senate
______________________________
KRAIG
PAULSEN
Speaker
of
the
House
I
hereby
certify
that
this
bill
originated
in
the
Senate
and
is
known
as
Senate
File
2315,
Eighty-fourth
General
Assembly.
______________________________
MICHAEL
E.
MARSHALL
Secretary
of
the
Senate
Approved
_______________,
2012
______________________________
TERRY
E.
BRANSTAD
Governor
