Bill Text: IA SF440 | 2013-2014 | 85th General Assembly | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: A bill for an act relating to human services involving mental health and disability services and children's services, making appropriations, and including effective dates. (Formerly SSB 1199 and SF 415.)

Spectrum: Committee Bill

Status: (Engrossed - Dead) 2013-12-31 - END OF 2013 ACTIONS [SF440 Detail]

Download: Iowa-2013-SF440-Introduced.html
Senate File 440 - Introduced SENATE FILE 440 BY COMMITTEE ON APPROPRIATIONS (SUCCESSOR TO SF 415) (SUCCESSOR TO SSB 1199) A BILL FOR An Act relating to human services involving mental health 1 and disability services and children’s services, making 2 appropriations, and including effective dates. 3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 4 TLSB 1663SZ (2) 85 jp/rj
S.F. 440 DIVISION I 1 SYSTEM REDESIGN —— IMPLEMENTATION 2 RESEARCH-BASED PRACTICE 3 Section 1. Section 331.388, Code 2013, is amended by adding 4 the following new subsection: 5 NEW SUBSECTION . 4A. “Research-based practice” means a 6 service or other support in which the efficacy of the service 7 or other support is recognized as an evidence-based practice, 8 or is deemed to be an emerging and promising practice, or which 9 is part of a demonstration and will supply evidence as to the 10 effectiveness of the service or other support. 11 Sec. 2. Section 331.393, subsection 4, paragraph g, 12 unnumbered paragraph 1, Code 2013, is amended to read as 13 follows: 14 The requirements for designation of targeted case management 15 providers and for implementation of evidence-based models 16 of case management that apply research-based practice . The 17 requirements shall be designed to provide the person receiving 18 the case management with a choice of providers, allow a 19 service provider to be the case manager but prohibit the 20 provider from referring a person receiving the case management 21 only to services administered by the provider, and include 22 other provisions to ensure compliance with but not exceed 23 federal requirements for conflict-free case management. The 24 qualifications of targeted case managers and other persons 25 providing service coordination under the management plan shall 26 be specified in the rules. The rules shall also include but 27 are not limited to all of the following relating to targeted 28 case management and service coordination services: 29 Sec. 3. Section 331.397, subsection 5, paragraph b, Code 30 2013, is amended to read as follows: 31 b. Providing evidence-based services that apply 32 research-based practice . 33 Sec. 4. Section 331.397, subsection 6, paragraph d, Code 34 2013, is amended to read as follows: 35 -1- LSB 1663SZ (2) 85 jp/rj 1/ 25
S.F. 440 d. Advances in the use of evidence-based treatment applying 1 research-based practice , including but not limited to all of 2 the following: 3 (1) Positive behavior support. 4 (2) Assertive community treatment. 5 (3) Peer self-help drop-in centers. 6 Sec. 5. Section 331.397, subsection 7, paragraphs b and c, 7 Code 2013, are amended to read as follows: 8 b. The efficacy of the services or other support is are 9 recognized as an evidence-based a research-based practice , is 10 deemed to be an emerging and promising practice, or providing 11 the services is part of a demonstration and will supply 12 evidence as to the services’ effectiveness . 13 c. A determination that the services or other support 14 provides an effective alternative to existing services 15 that have been shown by the evidence research base to be 16 ineffective, to not yield the desired outcome, or to not 17 support the principles outlined in Olmstead v. L.C., 527 U.S. 18 581 (1999). 19 COMMUNITY CORRECTIONS SYSTEM ACCESS TO REGIONAL SERVICES 20 Sec. 6. Section 331.395, Code 2013, is amended by adding the 21 following new subsection: 22 NEW SUBSECTION . 5. If adequate funding is provided through 23 a state appropriation made for purposes of paying for services 24 authorized pursuant to this subsection, a person with an income 25 within the level specified in subsection 1 who is housed by or 26 supervised by a judicial district department of correctional 27 services established under chapter 905 shall be deemed to 28 have met the income and resource eligibility requirements for 29 services under the regional service system. 30 ELIGIBILITY MAINTENANCE 31 Sec. 7. Section 331.396, subsection 1, paragraph b, Code 32 2013, is amended to read as follows: 33 b. The person is at least eighteen years of age and is a 34 resident of this state. However, a person who is seventeen 35 -2- LSB 1663SZ (2) 85 jp/rj 2/ 25
S.F. 440 years of age, is a resident of this state, and is receiving 1 publicly funded children’s services may be considered eligible 2 for services through the regional service system during the 3 three-month period preceding the person’s eighteenth birthday 4 in order to provide a smooth transition from children’s 5 to adult services. In addition, a person who is less than 6 eighteen years of age and a resident of this state may be 7 eligible, as determined by the region, for those mental health 8 services made available to all or a portion of the residents 9 of the region of the same age and eligibility class under the 10 county management plan of one or more counties of the region 11 applicable prior to formation of the region. 12 Sec. 8. Section 331.396, subsection 2, paragraph b, Code 13 2013, is amended to read as follows: 14 b. The person is at least eighteen years of age and is a 15 resident of this state. However, a person who is seventeen 16 years of age, is a resident of this state, and is receiving 17 publicly funded children’s services may be considered eligible 18 for services through the regional service system during the 19 three-month period preceding the person’s eighteenth birthday 20 in order to provide a smooth transition from children’s 21 to adult services. In addition, a person who is less than 22 eighteen years of age and a resident of this state may be 23 eligible, as determined by the region, for those intellectual 24 disability services made available to all or a portion of the 25 residents of the region of the same age and eligibility class 26 under the county management plan of one or more counties of the 27 region applicable prior to formation of the region. 28 Sec. 9. Section 331.397, subsection 2, paragraph b, Code 29 2013, is amended to read as follows: 30 b. Until funding is designated for other service 31 populations, eligibility for the service domains listed in this 32 section shall be limited to such persons who are in need of 33 mental health or intellectual disability services. However, if 34 a county in a region was providing services to an individual 35 -3- LSB 1663SZ (2) 85 jp/rj 3/ 25
S.F. 440 person eligibility class of persons with a developmental 1 disability other than intellectual disability or a brain injury 2 prior to formation of the region, the individual person class 3 of persons shall remain eligible for the services provided when 4 the region is formed, provided that funds are available to 5 continue such services. 6 CORE SERVICES 7 Sec. 10. Section 331.397, subsection 4, paragraphs c and d, 8 Code 2013, are amended to read as follows: 9 c. Support for community living and other living 10 arrangements , including but not limited to all of the 11 following: 12 (1) Home health aide. 13 (2) Home and vehicle modifications. 14 (3) Respite. 15 (4) Supportive community living. 16 (5) Residential care facility living arrangements. 17 d. Support for employment and work activity , including but 18 not limited to all of the following: 19 (1) Day habilitation. 20 (2) Job development. 21 (3) Supported employment. 22 (4) Prevocational services. 23 (5) Other work activity services. 24 STATE PAYMENTS TO REGION 25 Sec. 11. Section 426B.3, subsection 4, as enacted by 2012 26 Iowa Acts, chapter 1120, section 137, is amended to read as 27 follows: 28 4. a. For the fiscal years beginning July 1, 2013, and 29 July 1, 2014, a county with a county population expenditure 30 target amount that exceeds the amount of the county’s base year 31 expenditures for mental health and disabilities services shall 32 receive an equalization payment for the difference. 33 b. The equalization payments determined in accordance 34 with this subsection shall be made by the department of human 35 -4- LSB 1663SZ (2) 85 jp/rj 4/ 25
S.F. 440 services for each fiscal year as provided in appropriations 1 made from the property tax relief fund for this purpose. If 2 the county is part of a region that has been approved by the 3 department in accordance with section 331.389, to commence 4 partial or full operations, the county’s equalization payment 5 shall be remitted to the region for expenditure as approved by 6 the region’s governing board. 7 STRATEGIC PLAN REQUIREMENT FOR FY 2013-2014 8 Sec. 12. 2012 Iowa Acts, chapter 1128, section 8, is amended 9 to read as follows: 10 SEC. 8. COUNTY MENTAL HEALTH, MENTAL RETARDATION 11 INTELLECTUAL DISABILITY , AND DEVELOPMENTAL DISABILITIES 12 SERVICES MANAGEMENT PLAN —— STRATEGIC PLAN. Notwithstanding 13 section 331.439, subsection 1 , paragraph “b”, subparagraph (3), 14 counties are not required to submit a three-year strategic 15 plan by April 1, 2012, to the department of human services. A 16 county’s strategic plan in effect as of the effective date of 17 this section shall remain in effect until the regional service 18 system management plan for the region to which the county 19 belongs is approved in accordance with section 331.393 , subject 20 to modification before that date as necessary to conform with 21 statutory changes affecting the plan and any amendments to the 22 plan that are adopted in accordance with law . 23 RISK POOL DISTRIBUTIONS 24 Sec. 13. 2012 Iowa Acts, chapter 1128, section 6, 25 subsections 5 and 6, as amended by 2012 Iowa Acts, chapter 26 1133, section 67, are amended to read as follows: 27 5. If moneys from a distribution made under this section are 28 not expended by a county by June 30, 2013 2015 , for services 29 provided by that date under the applicable service management 30 plan , the county shall reimburse the unexpended moneys to the 31 department by August 30, 2013 2015 , and the moneys reimbursed 32 shall be credited to the risk pool in the property tax relief 33 fund. 34 6. The risk pool board shall submit annual reports to the 35 -5- LSB 1663SZ (2) 85 jp/rj 5/ 25
S.F. 440 governor and general assembly on or before December 31 , 2012 1 and 2013, regarding the expenditure of funds distributed under 2 this section. The final annual report shall be submitted on or 3 before December 31, 2015. 4 TRANSITION FUND —— SERVICES MAINTENANCE 5 Sec. 14. TRANSITION FUND —— SERVICES MAINTENANCE. A county 6 receiving an allocation of funding from the mental health and 7 disability services redesign transition fund created in 2012 8 Iowa Acts, chapter 1120, section 23, shall utilize the funding 9 received by the county as necessary for the services covered 10 in accordance with the county’s approved management plan in 11 effect as of June 30, 2012, for the fiscal year beginning July 12 1, 2012, and ending June 30, 2013. 13 REDESIGN EQUALIZATION PAYMENTS AND RISK POOL 14 Sec. 15. EQUALIZATION PAYMENTS AND RISK POOL. 15 1. There is transferred from the general fund of the state 16 to the property tax relief fund created in section 426B.1 17 for the fiscal year beginning July 1, 2012, and ending June 18 30, 2013, the following amount to be used for the purposes 19 designated: 20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 29,820,478 21 2. The moneys credited to the property tax relief fund in 22 accordance with this section are appropriated to the department 23 of human services for the fiscal year beginning July 1, 2013, 24 and ending June 30, 2014, for distribution to counties and 25 regions in accordance with this section. If a county is 26 part of a region that has been approved by the department to 27 commence partial or full operations in accordance with section 28 331.389 for the fiscal year, the county’s payment made pursuant 29 to this section shall be remitted to the region for expenditure 30 as approved by the region’s governing board. The payments made 31 under this section are in lieu of equalization payments for the 32 fiscal year beginning July 1, 2013, otherwise required under 33 section 426B.3, as amended by 2012 Iowa Acts, section 137. 34 3. Of the amount appropriated in this section, $18,373,854 35 -6- LSB 1663SZ (2) 85 jp/rj 6/ 25
S.F. 440 shall be distributed to counties as per capita growth payments 1 in accordance with this section. 2 4. A per capita growth amount shall be distributed to each 3 county in two payments. The provisional per capita growth 4 amount for the fiscal year is $6.00, with the final amount 5 determined in accordance with subsection 5. A county’s first 6 per capita growth payment shall be the product of $5.00 of the 7 provisional per capita growth amount times the county’s general 8 population for the fiscal year. 9 5. The moneys transferred to the property tax relief fund 10 for the fiscal year beginning July 1, 2013, from the federal 11 social services block grant pursuant to 2013 Iowa Acts, House 12 File 614, or any other 2013 Iowa Acts, if enacted and from the 13 federal temporary assistance for needy families block grant, 14 totaling $11,251,443, are appropriated to the department of 15 human services for the fiscal year beginning July 1, 2013, to 16 be used for distribution of state payment program remittances 17 to counties for the fiscal year in accordance with this 18 subsection. The state payment program remittance shall be an 19 amount equal to the amount paid to a county of residence under 20 the program for state case services known as the state payment 21 program, implemented pursuant to section 331.440, subsection 5, 22 for the fiscal year beginning July 1, 2011. 23 6. The first per capita growth payment due a county under 24 subsection 4 and any state payment program remittance due a 25 county under subsection 5, shall be combined and remitted to 26 the counties on or before July 15, 2013. 27 7. a. Of the amount appropriated in this section, 28 $11,446,624 shall be distributed to counties as stabilization 29 payments in accordance with this subsection. A stabilization 30 payment shall be distributed to each county for which the 31 amount of net expenditures from the county’s services fund 32 under section 331.424A for the fiscal year beginning July 1, 33 2012, exceeds the sum of the county’s state payment program 34 remittance under subsection 5 plus the dollar amount of the 35 -7- LSB 1663SZ (2) 85 jp/rj 7/ 25
S.F. 440 county’s services fund levies for the fiscal year beginning 1 July 1, 2013. A county’s stabilization payment amount shall 2 be equal to the excess net expenditures amount. To receive a 3 stabilization payment, the county shall submit a request for 4 the payment to the department of human services not later than 5 December 1, 2013, with documentation detailing and verifying 6 the county’s net expenditures from the services fund for the 7 fiscal year beginning July 1, 2012, and certifying the county’s 8 levies for the services fund for the fiscal year beginning July 9 1, 2013. 10 b. If the sum of the total of all eligible counties’ 11 stabilization payments plus the product of $1.00 of the 12 provisional per capita growth payment amount under subsection 13 4 times the state’s general population for the fiscal year is 14 greater or less than the amount of moneys remaining after the 15 first per capita growth payments made pursuant to subsection 16 4 and the amount allocated in this subsection, the department 17 shall identify a final per capita growth amount by adjusting 18 the provisional per capita growth amount as necessary to 19 distribute all of the moneys remaining. If the total of the 20 stabilization payments exceeds the amount allocated in this 21 subsection, the provisional per capita growth amount shall be 22 reduced to provide sufficient funding to address the excess. 23 If the total of the stabilization payments is less than the 24 amount allocated in this subsection, the provisional per 25 capita growth amount shall be increased to address the reduced 26 amount. A county’s second per capita growth payment shall be 27 the product of the remainder of the final per capita growth 28 amount as adjusted by the department times the county’s general 29 population for the fiscal year. 30 c. Each county’s second per capita growth payment shall be 31 combined with any stabilization payment due the county. The 32 payments shall be remitted to the counties on or before January 33 2, 2014. 34 SUBSTANCE-RELATED DISORDER DETOXIFICATION 35 -8- LSB 1663SZ (2) 85 jp/rj 8/ 25
S.F. 440 Sec. 16. COORDINATION OF DETOXIFICATION SERVICES. The 1 department of human services shall review options for the 2 mental health and disability services regions to coordinate 3 detoxification funding provided by counties and other such 4 disorder funding provided by counties in place of county 5 coordination. The department shall report to the governor and 6 general assembly its findings, options, and recommendations on 7 or before October 15, 2013. 8 MEDICAID OBLIGATION COST SETTLEMENT 9 Sec. 17. COUNTY MEDICAL ASSISTANCE NONFEDERAL SHARE —— 10 COST SETTLEMENT. Any county obligation for payment to the 11 department of human services of the nonfederal share of the 12 cost of services provided under the medical assistance program 13 prior to July 1, 2012, pursuant to sections 249A.12 and 14 249A.26, shall remain at the amount agreed upon as of June 30, 15 2013. Beginning July 1, 2013, other than a county payment on 16 the obligation or for a charge when the county is the provider 17 of the service, the department shall be responsible for any 18 adjustment that would otherwise be applied to the amount of the 19 county obligation after that date due to cost settlement of 20 charges or other reasons. 21 COUNTY MENTAL HEALTH AND DISABILITY 22 SERVICES FUND —— FY 2013-2014 23 Sec. 18. SERVICES FUND —— MANAGEMENT PLAN. For the fiscal 24 year beginning July 1, 2013, and ending June 30, 2014, the 25 appropriations made by the county board of supervisors for 26 payment for mental health and disability services pursuant 27 to section 331.424A, subsection 3, as enacted by 2012 Iowa 28 Acts, chapter 1120, section 132, shall be made in accordance 29 with the county’s service management plan approved under 30 section 331.439, Code 2013, until the county management plan is 31 replaced by a regional service system management plan approved 32 under section 331.393. 33 Sec. 19. CONTINUATION OF MENTAL HEALTH AND DISABILITY 34 SERVICES REDESIGN FISCAL VIABILITY STUDY COMMITTEE. The 35 -9- LSB 1663SZ (2) 85 jp/rj 9/ 25
S.F. 440 legislative council is requested to continue for the 2014 1 legislative interim the mental health and disability services 2 redesign fiscal viability study committee initially created by 3 the legislative council in 2013. The legislative council is 4 requested to add at least four citizen members to the study 5 committee to provide representation for service consumers, 6 service providers, county supervisors, and the community 7 services affiliate of the Iowa state association of counties. 8 In addition to monitoring implementation of the mental health 9 and disability services redesign and receiving reports from 10 stakeholder groups engaged in implementation of the redesign, 11 the study committee shall be directed to propose a permanent 12 approach for state, county, and regional financing of the 13 redesign. 14 Sec. 20. EFFECTIVE UPON ENACTMENT. This division of this 15 Act, being deemed of immediate importance, takes effect upon 16 enactment. 17 DIVISION II 18 DATA AND STATISTICAL INFORMATION AND OUTCOME AND PERFORMANCE 19 MEASURES 20 Sec. 21. Section 225C.4, subsection 1, paragraph j, Code 21 2013, is amended to read as follows: 22 j. Establish and maintain a data collection and management 23 information system oriented to the needs of patients, 24 providers, the department, and other programs or facilities in 25 accordance with section 225C.6A . The system shall be used to 26 identify, collect, and analyze service outcome and performance 27 measures data in order to assess the effects of the services on 28 the persons utilizing the services. The administrator shall 29 annually submit to the commission information collected by the 30 department indicating the changes and trends in the disability 31 services system. The administrator shall make the outcome data 32 available to the public. 33 Sec. 22. Section 225C.6A, Code 2013, is amended to read as 34 follows: 35 -10- LSB 1663SZ (2) 85 jp/rj 10/ 25
S.F. 440 225C.6A Disability services system redesign central data 1 repository . 2 1. The commission department shall do the following 3 relating to redesign of data concerning the disability services 4 system in the state: 5 1. Identify sources of revenue to support statewide 6 delivery of core disability services to eligible disability 7 populations. 8 2. Ensure there is a continuous improvement process for 9 development and maintenance of the disability services system 10 for adults and children. The process shall include but is not 11 limited to data collection and reporting provisions. 12 3. a. Plan, collect, and analyze data as necessary to 13 issue cost estimates for serving additional populations and 14 providing core disability services statewide. The department 15 shall maintain compliance with applicable federal and state 16 privacy laws to ensure the confidentiality and integrity of 17 individually identifiable disability services data. The 18 department shall regularly may periodically assess the status 19 of the compliance in order to assure that data security is 20 protected. 21 b. In implementing Implement a system central data 22 repository under this subsection section for collecting and 23 analyzing state, county and region , and private contractor 24 data , the . The department shall establish a client identifier 25 for the individuals receiving services. The client identifier 26 shall be used in lieu of the individual’s name or social 27 security number. The client identifier shall consist of the 28 last four digits of an individual’s social security number, 29 the first three letters of the individual’s last name, the 30 individual’s date of birth, and the individual’s gender in an 31 order determined by the department. 32 c. Consult on an ongoing basis with regional administrators, 33 service providers, and other stakeholders in implementing the 34 central data repository and operations of the repository. The 35 -11- LSB 1663SZ (2) 85 jp/rj 11/ 25
S.F. 440 consultation shall focus on minimizing the state and local 1 costs associated with operating the repository. 2 d. Engage with other state and local government and 3 nongovernmental entities operating the Iowa health information 4 network under chapter 135 and other data systems that maintain 5 information relating to individuals with information in the 6 central data repository in order to integrate data concerning 7 individuals. 8 c. 2. A county or region shall not be required to utilize a 9 uniform data operational or transactional system. However, the 10 system utilized shall have the capacity to exchange information 11 with the department, counties and regions, contractors, and 12 others involved with services to persons with a disability 13 who have authorized access to the central data repository. 14 The information exchanged shall be labeled consistently 15 and share the same definitions. Each county regional 16 administrator shall regularly report to the department annually 17 on or before December 1, for the preceding fiscal year the 18 following information for each individual served: demographic 19 information, expenditure data, and data concerning the services 20 and other support provided to each individual, as specified 21 in administrative rule adopted by the commission by the 22 department . 23 4. Work with county representatives and other qualified 24 persons to develop an implementation plan for replacing the 25 county of legal settlement approach to determining service 26 system funding responsibilities with an approach based upon 27 residency. The plan shall address a statewide standard for 28 proof of residency, outline a plan for establishing a data 29 system for identifying residency of eligible individuals, 30 address residency issues for individuals who began residing in 31 a county due to a court order or criminal sentence or to obtain 32 services in that county, recommend an approach for contesting 33 a residency determination, and address other implementation 34 issues. 35 -12- LSB 1663SZ (2) 85 jp/rj 12/ 25
S.F. 440 3. The outcome and performance measures applied to the 1 regional disability services system shall utilize measurement 2 domains. The department may identify other measurement domains 3 in consultation with system stakeholders to be utilized in 4 addition to the following initial set of measurement domains: 5 a. Access to services. 6 b. Life in the community. 7 c. Person-centeredness. 8 d. Health and wellness. 9 e. Quality of life and safety. 10 f. Family and natural supports. 11 4. a. The processes used for collecting outcome and 12 performance measures data shall include but are not limited 13 to direct surveys of the individuals and families receiving 14 services and the providers of the services. The department 15 shall involve a workgroup of persons who are knowledgeable 16 about both the regional service system and survey techniques 17 to implement and maintain the processes. The workgroup shall 18 conduct an ongoing evaluation for the purpose of eliminating 19 the collection of information that is not utilized. The 20 surveys shall be conducted with a conflict-free approach in 21 which someone other than a provider of services surveys an 22 individual receiving the services. 23 b. The outcome and performance measures data shall encompass 24 and provide a means to evaluate both the regional services and 25 the services funded by the medical assistance program provided 26 to the same service populations. 27 c. The department shall develop and implement an 28 internet-based approach with graphical display of information 29 to provide outcome and performance measures data to the public 30 and those engaged with the regional service system. 31 d. The department shall include any significant costs for 32 collecting and interpreting outcome and performance measures 33 and other data in the department’s operating budget. 34 Sec. 23. REPEAL. The amendment to section 225C.4, 35 -13- LSB 1663SZ (2) 85 jp/rj 13/ 25
S.F. 440 subsection 1, paragraph j, in 2012 Iowa Acts, chapter 1120, 1 section 2, is repealed. 2 Sec. 24. REPEAL. The amendments to section 225C.6A, in 2012 3 Iowa Acts, chapter 1120, sections 6, 7, and 95, are repealed. 4 DIVISION III 5 CHILDREN’S CABINET 6 Sec. 25. NEW SECTION . 242.1 Findings. 7 The general assembly finds there is a need for a 8 state-level children’s cabinet to provide guidance, oversight, 9 problem-solving, and long-term strategy development, and to 10 foster collaboration among state and local efforts to build a 11 comprehensive, coordinated system of care in order to promote 12 the well-being of the children in this state. The system of 13 care should address all domains of child physical, mental, 14 intellectual, developmental, and social health and meet the 15 particular needs of children for family-centered mental health 16 and disability services and for other appropriate specialized 17 services. 18 Sec. 26. NEW SECTION . 242.2 Children’s cabinet established. 19 There is established within the department of human services 20 a children’s cabinet. 21 1. The voting members of the children’s cabinet shall 22 consist of the following: 23 a. The director of the department of education or the 24 director’s designee. 25 b. The director of the department of human services or the 26 director’s designee. This member shall be chairperson of the 27 cabinet. 28 c. The director of the department of inspections and appeals 29 or the director’s designee. 30 d. The director of the department of public health or the 31 director’s designee. 32 e. A parent of a child with a severe emotional disturbance 33 or a disability who is the primary caregiver for that child, 34 appointed by the governor. 35 -14- LSB 1663SZ (2) 85 jp/rj 14/ 25
S.F. 440 f. A juvenile court judge or juvenile court officer 1 appointed by the chief justice of the supreme court. 2 g. A community-based provider of child welfare, health, 3 or juvenile justice services to children, appointed by the 4 director of human services. 5 h. A member of the early childhood Iowa state board or the 6 early childhood stakeholders alliance, appointed by the state 7 board. 8 i. A community stakeholder who is not affiliated with a 9 provider of services, appointed by the governor. 10 j. A member of a child advocacy organization approved by the 11 members of the children’s cabinet. 12 k. A member of the Iowa chapter of the American academy 13 of pediatrics who has expertise in pediatric health care and 14 addressing the needs of children with special needs, designated 15 by the Iowa chapter. 16 l. Not more than three other members designated by 17 the cabinet chairperson to ensure adequate representation 18 of the persons and interests who may be affected by the 19 recommendations made by the cabinet. 20 2. In addition to the voting members, there shall be four ex 21 officio, nonvoting members of the children’s cabinet. These 22 members shall be two state representatives, one appointed by 23 the speaker of the house of representatives and one by the 24 minority leader of the house of representatives, and two state 25 senators, one appointed by the majority leader of the senate 26 and one by the minority leader of the senate. 27 3. a. The voting members, other than department directors 28 and their designees, shall be appointed for four-year terms. 29 The terms of such members begin on May 1 in the year of 30 appointment and expire on April 30 in the year of expiration. 31 b. Vacancies shall be filled in the same manner as original 32 appointments. A vacancy shall be filled for the unexpired 33 term. 34 c. The voting members shall receive actual and necessary 35 -15- LSB 1663SZ (2) 85 jp/rj 15/ 25
S.F. 440 expenses incurred in the performance of their duties and 1 legislative members shall be compensated as provided in section 2 2.32A. 3 4. Staffing services for the children’s cabinet shall be 4 provided by the department of human services. 5 Sec. 27. NEW SECTION . 242.3 Duties. 6 The children’s cabinet shall perform the following duties 7 in making recommendations to the agencies and organizations 8 represented on the cabinet, the governor, the general assembly, 9 and the judicial branch to address the needs of children and 10 families in this state: 11 1. Recommend operating provisions for health homes for 12 children implemented by the department of human services. The 13 provisions shall include but are not limited to all of the 14 following: 15 a. Identification of quality metrics. 16 b. Identification of performance criteria. 17 c. Provisions for monitoring the implementation of 18 specialized health homes. 19 d. Identification of system of care principles and values 20 based on the recommendations of the workgroup for redesign of 21 publicly funded children’s disability services implemented by 22 the department of human services in accordance with 2011 Iowa 23 Acts, chapter 121, section 1, subsection 4, paragraph “i” . 24 2. Gather information and improve the understanding of 25 policymakers and the public of how the various service systems 26 intended to meet the needs of children and families operate at 27 the local level. 28 3. Address areas of overlap, gaps, and conflict between 29 service systems. 30 4. Support the evolution of service systems in implementing 31 new services and enhancing existing services to address the 32 needs of children and families through process improvement 33 methodologies. 34 5. Assist policymakers and service system users in 35 -16- LSB 1663SZ (2) 85 jp/rj 16/ 25
S.F. 440 understanding and effectively managing system costs. 1 6. Ensure services offered are evidence-based. 2 7. Issue guidelines to enable the services and other support 3 which is provided by or under the control of state entities and 4 delivered at the local level to have sufficient flexibility to 5 engage local resources and meet unique needs of children and 6 families. 7 8. Integrate efforts of policymakers and service providers 8 to improve the well-being of community members in addition to 9 children and families. 10 9. Implement strategies so that the children and families 11 engaged with the service systems avoid the need for higher 12 level services and other support. 13 10. Oversee the practices utilized by accountable care 14 organizations and other care management entities operating on 15 behalf of the state in the provision of government supported 16 children’s services and systems of care. 17 11. Identify and promote evidence-based practices that may 18 be creatively applied in appropriate settings for prevention 19 and early identification of social, emotional, behavioral, and 20 developmental risk factors for children from birth through age 21 eight. 22 12. Making periodic recommendations to the agencies 23 and organizations represented on the cabinet. An agency or 24 organization receiving such a recommendation shall respond 25 in writing to the children’s cabinet detailing how the 26 recommendation was addressed. The response shall be submitted 27 not later than sixty business days following the date of the 28 receipt of the recommendation. 29 13. Submit a report annually by December 15 to the governor, 30 general assembly, and supreme court providing findings and 31 recommendations and issue other reports as deemed necessary by 32 the cabinet. 33 Sec. 28. INITIAL TERMS. Notwithstanding section 242.2, 34 subsection 3, paragraph “a”, as enacted by this division of 35 -17- LSB 1663SZ (2) 85 jp/rj 17/ 25
S.F. 440 this Act, the appointing authorities for the members of the 1 children’s cabinet created by this division of this Act who are 2 subject to terms of service shall be coordinated so that the 3 initial terms of approximately half of such members are two 4 years and the remainder are for four years and remain staggered 5 thereafter. 6 DIVISION IV 7 CENTER FOR CHILD HEALTH INNOVATION AND EXCELLENCE 8 Sec. 29. Section 135.11, Code 2013, is amended by adding the 9 following new subsection: 10 NEW SUBSECTION . 32. Create and operate, subject to 11 appropriation of funding by the general assembly, a center for 12 child health excellence and innovation. The purpose of the 13 center is to provide a policy forum for efforts to improve 14 child health, including but not limited to improving health 15 quality, demonstrating better health outcomes, and reducing 16 long-term health care costs. 17 a. The center shall engage major providers of child health 18 services and associated groups, including but not limited to 19 representatives of the department, the medical assistance 20 program administrator, child health specialty clinics, the 21 association representing community health centers, the state 22 council created by the department for the department’s project 23 LAUNCH initiative, staff of institutions of higher education 24 with expertise in pediatric health and child health care, the 25 prevention of disabilities policy council in conjunction with 26 the center for disabilities and development of the university 27 of Iowa’s children’s hospital, and others. 28 b. The center shall lead the review and analysis of public 29 policy efforts that are directed toward the purpose of the 30 center. 31 c. The center shall develop community-based initiatives 32 to promote healthy child development, leveraging medical 33 assistance program funding where possible. The initiatives 34 of Iowa shall include but are not limited to the promotion of 35 -18- LSB 1663SZ (2) 85 jp/rj 18/ 25
S.F. 440 demonstration programs within the behavioral health managed 1 care contract and the development of a grant application for 2 federal and foundation funding opportunities that focus upon 3 improving child health through innovation and the diffusion of 4 innovation. 5 d. The center shall develop an early childhood mental health 6 certification for professionals and others engaged in working 7 with young children. 8 e. The center shall draw upon national and state 9 expertise in the field of child health, including experts 10 from Iowa’s institutions of higher education, health provider 11 organizations, and health policy and advocacy organizations. 12 The center shall seek support from the Iowa research 13 community in data report development and analysis of available 14 information from Iowa child health data sources. 15 f. The center shall work with the departments of human 16 services and public health and with the governor and members 17 of the general assembly in child health public policy efforts 18 such as providing medical assistance funding as necessary to 19 expand the department’s initiative to provide for adequate 20 developmental surveillance and screening during a child’s first 21 five years to be available statewide and enabling child care 22 resource and referral service agencies to facilitate provision 23 of child mental health consultation for child care providers. 24 g. The center shall submit a report of its activities and 25 policy recommendations to the general assembly by December 15 26 annually. 27 EXPLANATION 28 This bill relates to mental health and disability services 29 (MH/DS) administered by counties and the regions being formed 30 by counties to provide adult MH/DS that are not covered by the 31 medical assistance (Medicaid) program, children’s services, and 32 makes appropriations. The bill addresses recommendations made 33 to the mental health and disability services redesign fiscal 34 viability study committee by various committees and workgroups 35 -19- LSB 1663SZ (2) 85 jp/rj 19/ 25
S.F. 440 created or continued by the MH/DS redesign legislation enacted 1 in 2012 Iowa Acts, chapter 1120 (SF 2315) and chapter 1133 (SF 2 2336). The primary state agency involved with MH/DS is the 3 department of human services (DHS). The bill also includes 4 other provisions. The bill is organized into divisions. 5 Under current law, certain MH/DS redesign requirements 6 for regions specify the use of evidence-based practices 7 or approaches. The bill defines the term, “research-based 8 practice” in Code section 331.388, relating to definitions for 9 the redesign, to mean a service or other support in which the 10 efficacy of the service or other support is recognized as an 11 evidence-based practice, or is deemed to be an emerging or 12 promising practice, or which is part of a demonstration and 13 will supply evidence as to effectiveness. The redesign-related 14 Code requirements for evidence-based practice are changed by 15 the bill to research-based practice in Code section 331.393, 16 relating to the service management plans that must be adopted 17 by regions and requirements for designating targeted case 18 managers, and in Code section 331.397, relating to the core 19 services that must be provided by regions. 20 An appropriation provision in 2012 Iowa Acts providing 21 for risk pool distributions to certain counties, is amended 22 to extend the period of time for a county to expend its 23 distribution from June 30, 2013, to June 30, 2015. 24 Code section 331.395, relating to financial eligibility 25 requirements for the regional service system, is amended to 26 provide eligibility for the regional service system for persons 27 who meet income requirements and are housed by or supervised by 28 community-based correctional services, if a state appropriation 29 is made to cover the service costs. 30 Code section 331.396, relating to diagnosis and functional 31 assessment requirements for eligibility for the regional 32 service system, is amended to allow a child to be eligible, 33 as determined by the region, for those mental health or 34 intellectual disability services provided to residents of 35 -20- LSB 1663SZ (2) 85 jp/rj 20/ 25
S.F. 440 the same age and eligibility class under an approved county 1 management plan of one or more counties of the region prior 2 to formation of the region. The person’s eligibility for 3 individualized services is subject to determination in 4 accordance with a functional assessment. 5 Code section 331.397, relating to the requirements 6 for regional core services, is amended to provide that an 7 eligibility class of persons with a developmental disability or 8 a brain injury who was receiving services prior to formation of 9 a region remains eligible for the services after formation of 10 the region, subject to the availability of funding. 11 Code section 331.397 is also amended to add additional 12 language to the initial set of core services domains. The 13 support for community living domain is amended to refer to 14 other living arrangements generally and residential care 15 facility living arrangements in particular. The support for 16 employment domain is amended to refer to work activity and 17 other work activity services. 18 Code section 426B.3, as amended by SF 2315, relates to 19 eligibility for equalization payments from the state in fiscal 20 years 2013-2014 and 2014-2015 for those counties with a base 21 year levy which is less than a target amount computed by 22 multiplying the county’s general population times a statewide 23 per capita expenditure target amount of $47.28. The bill 24 provides for distribution of moneys for FY 2013-2014 in lieu of 25 equalization payments. 26 Under Code section 331.439, counties are required to submit 27 a three-year strategic plan for MH/DS and the latest plan was 28 due by April 1, 2012. In accordance with 2012 Iowa Acts, 29 chapter 1128, the strategic plan submission was not required 30 and the existing strategic plan remained in effect. The bill 31 provides that a county’s strategic plan remains in effect, 32 unless modified pursuant to statute or amended by the county, 33 until it is replaced by approval of the regional service system 34 management plan for the region to which the county belongs. 35 -21- LSB 1663SZ (2) 85 jp/rj 21/ 25
S.F. 440 If a county receives an allocation of funding from the 1 mental health and disability services redesign transition fund 2 created in SF 2315, the county is required to utilize the 3 funding provided as necessary for the services provided to an 4 individual child or other individual person receiving services 5 in accordance with the county’s approved service management 6 plan in effect as of June 30, 2012. 7 A transfer of approximately $30 million is made from 8 the general fund of the state for FY 2012-2013 to DHS to be 9 credited to the property tax relief fund and is appropriated 10 for DHS to make various distributions to eligible counties for 11 FY 2013-2014. If a county is part of an approved region, the 12 county’s payment is required to be submitted to the region for 13 expenditure. Approximately $18.4 million is allocated for 14 distribution as per capita growth payments. A prospective 15 per capita growth payment amount of $6.00 is specified for 16 distribution in two payments. The first payment is equal to 17 the product of $5.00 times the county’s general population. 18 This payment is to be combined with a state payment program 19 remittance based on the amount the county received from the 20 state payment program in FY 2011-2012. The funding sources for 21 the state payment program remittance are the federal social 22 services block grant and the temporary assistance for needy 23 families block grant and total approximately $11.25 million. 24 The combined payment is required to be remitted to counties on 25 or before July 15, 2013. 26 Approximately $11.5 million is allocated to make 27 stabilization payments to those counties in which the mental 28 health and disabilities services fund net expenditures for FY 29 2012-2013 exceed the sum of the counties’ state payment program 30 remittances plus the services fund levies for FY 2013-2014. 31 However, if the total of the stabilization payments exceeds the 32 allocation amount, DHS is required to reduce the provisional 33 per capita growth payment amount to provide sufficient funding 34 to address the excess. If the total of the stabilization 35 -22- LSB 1663SZ (2) 85 jp/rj 22/ 25
S.F. 440 payments is less than the amount allocated, the provisional per 1 capita growth payment amount is to be increased to address the 2 reduced amount. Any sustainability payment is to be combined 3 with the second per capita growth payment and remitted to 4 counties on or before January 2, 2014. 5 DHS is required to review options for the MH/DS regions to 6 coordinate the county funding for detoxification and other 7 such county-provided disorder funding in place of county 8 coordination. DHS is required to report to the governor and 9 general assembly its findings, options, and recommendations on 10 or before October 15, 2013. 11 Any county obligation for payment to DHS of the nonfederal 12 share of the cost of services provided under the Medicaid 13 program prior to July 1, 2012, is required to remain at the 14 amount agreed upon as of June 30, 2013. Beginning July 1, 15 2013, other than a county payment on the obligation or for a 16 charge when the county is the provider of a service, DHS is 17 responsible for any adjustment that would otherwise be applied 18 to the amount of the county obligation after that date due to 19 cost settlement of charges or other reasons. 20 For FY 2013-2014, until the county management plan for MH/DS 21 is replaced with a regional services system management plan, 22 the county management plan remains applicable. 23 The legislative council is requested to continue the general 24 assembly’s MH/DS redesign fiscal viability study committee that 25 met during the 2012 legislative interim for the next interim, 26 to add at least four citizen members, and to direct the study 27 committee to propose a permanent approach for financing the 28 MH/DS redesign. 29 This division takes effect upon enactment. 30 DATA AND STATISTICAL INFORMATION AND OUTCOME AND PERFORMANCE 31 MEASURES. This division addresses recommendations submitted by 32 the data and statistical information integration workgroup and 33 the outcomes and performance measures committee. 34 Current law is amended in Code section 225C.4, relating 35 -23- LSB 1663SZ (2) 85 jp/rj 23/ 25
S.F. 440 to the duties of the DHS MH/DS division administrator, and 1 in Code section 225C.6A, relating to disability services 2 system redesign, to delineate requirements pertaining to 3 MH/DS state collection and management information systems 4 and outcome and performance data. These Code provisions 5 were previously amended by SF 2315. The bill incorporates 6 the SF 2315 amendments and adds new language and repeals 7 the SF 2315 amendments that would otherwise take effect on 8 July 1, 2013. For Code section 225C.4, the bill references 9 in the administrator’s duties the specific new requirements 10 established by the bill in Code section 225C.6A. The new 11 requirements pertain to DHS implementation of a central data 12 repository, information exchange capacity, regular reporting 13 of individual information, data security, consultation with 14 regional staff, providers, and other stakeholders, engaging 15 with other data systems, outcome and performance measure 16 domains, use of surveys, evaluation of both regional and 17 Medicaid services, provision of data to the public via an 18 internet-based approach with graphical information, and 19 inclusion of significant costs associated with the data and 20 measures in the DHS budget. 21 CHILDREN’S CABINET. This division addresses recommendations 22 submitted by the children’s disability workgroup to create a 23 children’s cabinet. 24 New Code section 242.1 lists legislative findings as to the 25 need for a children’s cabinet. 26 New Code section 242.2 provides for appointment of members 27 to the children’s cabinet. The director of DHS or the 28 director’s designee is to be the chairperson of the cabinet and 29 appoint up to three additional members to the cabinet, and DHS 30 is required to staff the cabinet. Various state agencies are 31 identified for membership along with community stakeholders. 32 Four members of the general assembly are required to be 33 appointed to serve in an ex officio, nonvoting capacity. 34 New Code section 242.3 delineates the duties of the 35 -24- LSB 1663SZ (2) 85 jp/rj 24/ 25
S.F. 440 children’s cabinet in making recommendations to the agencies 1 represented on the cabinet and to the governor, general 2 assembly, and judicial branch. The areas of recommendation 3 include proposing operating provisions for health homes 4 for children and the practices utilized by other aspects of 5 the service systems for children. If the cabinet makes a 6 recommendation to an agency or organization represented on the 7 cabinet, the agency or organization must respond within 60 8 business days detailing how the recommendation was addressed. 9 The children’s cabinet is required to report annually by 10 December 15 to the governor, general assembly, and supreme 11 court providing findings and recommendations and issue other 12 reports as deemed necessary by the cabinet. 13 A temporary provision provides for appointment of 14 approximately half of the initial voting members of the 15 children’s cabinet other than department heads to two-year 16 terms in order to stagger the terms. 17 CENTER FOR CHILD HEALTH INNOVATION AND EXCELLENCE. This 18 division requires the department of public health to create a 19 center for child health excellence and innovation. The purpose 20 of the center is to provide a policy forum for efforts to 21 improve child health, including but not limited to improving 22 health quality, demonstrating better health outcomes, and 23 reducing long-term health care costs. The creation and 24 operation of the center is subject to provision of funding by 25 the general assembly. 26 The center is required to engage other departments of state 27 government and child health providers and to perform various 28 duties to further the purpose of the center. 29 -25- LSB 1663SZ (2) 85 jp/rj 25/ 25
feedback