Bill Text: IA HF689 | 2011-2012 | 84th General Assembly | Introduced


Bill Title: A bill for an act relating to mental health and disability services and substance-related disorders and mental illness commitment proceedings, making appropriations, and including effective date provisions. (Formerly HF 626) (Formerly HSB 83)

Spectrum: Committee Bill

Status: (Introduced - Dead) 2012-01-24 - Subcommittee, Raecker, T. Olson, and Wagner. H.J. 125. [HF689 Detail]

Download: Iowa-2011-HF689-Introduced.html
House File 689 - Introduced HOUSE FILE 689 BY COMMITTEE ON APPROPRIATIONS (SUCCESSOR TO HF 626) (SUCCESSOR TO HSB 83) A BILL FOR An Act relating to mental health and disability services and 1 substance-related disorders and mental illness commitment 2 proceedings, making appropriations, and including effective 3 date provisions. 4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 5 TLSB 2002HZ (3) 84 jp/rj
H.F. 689 DIVISION I 1 SERVICES SYSTEM REDESIGN —— FUNDING 2 Section 1. MENTAL HEALTH SERVICES SYSTEM REDESIGN. 3 1. The general assembly intends to implement service system 4 redesign for mental health services in which the department 5 of human services assumes responsibility for administering 6 publicly funded mental health services for children and adults 7 beginning on July 1, 2012. 8 2. The legislative council is requested to authorize 9 a legislative interim committee to meet during the 2011 10 legislative interim to develop a plan for implementing the 11 redesigned mental health services system for children and 12 adults. The plan shall be submitted to the general assembly 13 for consideration and enactment in the 2012 legislative 14 session. The plan shall include but is not limited to all of 15 the following: 16 a. Identifying clear definitions and requirements for the 17 following: 18 (1) Characteristics of the service populations. 19 (2) The array of core services to be delivered by providers 20 in a manner that promotes cost-effectiveness, uniformity, 21 accessibility, and best practices approaches. 22 (3) Outcome measures that focus on consumer needs. 23 (4) Quality assurance measures. 24 (5) Provider accreditation, certification, or licensure 25 requirements. 26 b. A proposal for developing treatment services in this 27 state to meet the needs of children who are placed out of state 28 due to the lack of treatment services in this state. 29 c. A proposal for implementing the delivery of regionally 30 coordinated and community-based information and referral, 31 options counseling, care coordination, and targeted case 32 management services. 33 Sec. 2. DEPARTMENTS OF HUMAN SERVICES AND PUBLIC HEALTH. 34 1. The departments of human services and public health 35 -1- LSB 2002HZ (3) 84 jp/rj 1/ 57
H.F. 689 shall work with appropriate stakeholders designated by the 1 departments to develop the proposals described in subsection 2. 2 Progress on the proposals shall be shared with the legislative 3 interim committee authorized pursuant to this division of this 4 Act and a final report on the proposals shall be submitted to 5 the governor and general assembly on or before December 15, 6 2011. 7 2. The departments shall develop the following proposals: 8 a. A proposal to emphasize service providers addressing 9 co-occurring mental health and substance abuse disorders. 10 b. A proposal to address service provider shortages. In 11 developing the proposal, the departments and appropriate 12 stakeholders shall examine barriers to recruiting providers, 13 including but not limited to variation in health insurance 14 payment provisions for the services provided by different types 15 of providers. 16 Sec. 3. INTELLECTUAL AND OTHER DEVELOPMENTAL DISABILITY AND 17 BRAIN INJURY SERVICES SYSTEM REDESIGN. 18 1. In addition to mental health services, the general 19 assembly intends to implement service system redesign in which 20 the department of human services assumes responsibility for 21 the administration of intellectual and other developmental 22 disability and brain injury services for adults and children at 23 a later time. 24 2. The legislative council is requested to extend the 25 interim committee authorized pursuant to this division of 26 this Act for the 2011 legislative interim or authorize a 27 different legislative interim committee to meet during the 28 2012 legislative interim to develop a plan for implementing 29 the redesigned disability services system for adults and 30 children. The plan shall be submitted to the general assembly 31 for consideration and enactment in the 2013 legislative 32 session. The plan shall include but is not limited to all of 33 the following: 34 a. Identifying clear definitions and requirements for the 35 -2- LSB 2002HZ (3) 84 jp/rj 2/ 57
H.F. 689 following: 1 (1) Characteristics of the service populations. 2 (2) The array of core services to be delivered by providers 3 in a manner that promotes cost-effectiveness, accessibility, 4 and the best practices approaches. 5 (3) Outcome measures. 6 (4) Quality assurance measures. 7 (5) Provider accreditation, certification, or licensure 8 requirements. 9 b. A proposal developed in conjunction with the department 10 of public health to emphasize service providers addressing 11 co-occurring mental health, intellectual disability, or 12 substance abuse disorders. 13 c. A proposal for implementing the delivery of regionally 14 coordinated and community-based information and referral, 15 options counseling, care coordination, and targeted case 16 management services. 17 Sec. 4. CONTINUATION OF WORKGROUP BY JUDICIAL BRANCH 18 AND DEPARTMENT OF HUMAN SERVICES. The judicial branch and 19 department of human services shall continue the workgroup 20 implemented pursuant to 2010 Iowa Acts, chapter 1192, section 21 24, subsection 2, to improve the processes for involuntary 22 commitment for chronic substance abuse under chapter 125 and 23 serious mental illness under chapter 229. The recommendations 24 issued by the workgroup shall address options to the current 25 provision of transportation by the county sheriff; to the role, 26 supervision, and funding of mental health patient advocates; 27 and for civil commitment prescreening. Additional stakeholders 28 shall be added as necessary to facilitate the workgroup 29 efforts. the workgroup shall complete deliberations and submit 30 a final report providing findings and recommendations on or 31 before December 15, 2011. 32 Sec. 5. SERVICE SYSTEM DATA AND STATISTICAL INFORMATION 33 INTEGRATION. The department of human services, department of 34 public health, and the community services affiliate of the Iowa 35 -3- LSB 2002HZ (3) 84 jp/rj 3/ 57
H.F. 689 state association of counties shall agree on implementation 1 provisions for an integrated data and statistical information 2 system for mental health, disability services, and substance 3 abuse services. The departments and affiliate shall report on 4 the integrated system to the governor, the joint appropriations 5 subcommittee on health and human services, and the legislative 6 services agency, providing findings and recommendations, on or 7 before December 15, 2011. 8 Sec. 6. NEW SECTION . 225C.7A Disability services system 9 redesign savings fund. 10 1. A disability services system redesign savings fund 11 is created in the state treasury under the authority of the 12 department. Moneys credited to the fund are not subject to 13 section 8.33. Moneys available in the fund for a fiscal 14 year shall be used in accordance with appropriations made by 15 the general assembly to implement disability services system 16 improvements. 17 2. Notwithstanding section 8.33, appropriations made to the 18 department for disabilities services that remain unencumbered 19 or unobligated at the close of the fiscal year as a result of 20 implementation of disabilities services system efficiencies 21 shall not revert but shall be credited to the disability 22 services system redesign savings fund. 23 DIVISION II 24 APPROPRIATIONS AND CONFORMING PROVISIONS 25 Sec. 7. CONFORMING PROVISIONS. The legislative services 26 agency shall prepare a study bill for consideration by the 27 committees on human resources of the senate and house of 28 representatives for the 2012 legislative session, providing any 29 necessary conforming Code changes for implementation of the 30 system redesign provisions contained in this Act. 31 Sec. 8. PROPERTY TAX RELIEF FUND —— MENTAL HEALTH AND 32 INTELLECTUAL AND OTHER DEVELOPMENTAL DISABILITIES SERVICES 33 SYSTEM REFORM. 34 1. The moneys appropriated and credited to the property 35 -4- LSB 2002HZ (3) 84 jp/rj 4/ 57
H.F. 689 tax relief fund pursuant to 2011 Iowa Acts, Senate File 209, 1 section 21, if enacted, shall be credited to the risk pool 2 within the property tax relief fund, to be distributed as 3 provided in this section. 4 2. The amount credited to the risk pool pursuant to this 5 section is appropriated from the risk pool to the department of 6 human services for distribution as provided in this section. 7 3. a. For the purposes of this section, “services fund” 8 means a county’s mental health, mental retardation, and 9 developmental disabilities services fund created in section 10 331.424A. 11 b. The risk pool board shall implement a process for 12 distribution of the amount appropriated in this section to 13 counties to be used to provide eligibility for services and 14 other support payable from the counties’ services funds for 15 persons who are eligible under county management plans in 16 effect as of December 31, 2010, but due to insufficient funding 17 are on a waiting list for the services and other support. The 18 period addressed by the funding appropriated in this section 19 begins on or after the effective date of this section and ends 20 June 30, 2012. The distribution allocations shall be completed 21 on or before July 1, 2011. 22 c. The general assembly finds that as of the time of 23 enactment of this section, the funding appropriated in this 24 section is sufficient to eliminate the need for continuing, 25 instituting, or reinstituting waiting lists during the 26 period addressed by the appropriation. However, the process 27 implemented by the risk pool board shall ensure there is 28 adequate funding so that a person made eligible for services 29 and other support from the waiting list would not be required 30 to return to the waiting list if a later projection indicates 31 the funding is insufficient to cover for the entire period all 32 individuals removed from the waiting list pursuant to this 33 section. 34 d. The funding provided in this section is intended to 35 -5- LSB 2002HZ (3) 84 jp/rj 5/ 57
H.F. 689 provide necessary services for adults in need of publicly 1 funded mental health and intellectual and other developmental 2 disabilities services until the system reform provisions 3 addressed by this Act are developed and enacted. 4 Sec. 9. IMPLEMENTATION. There is appropriated from the 5 general fund of the state to the department of human services 6 for the fiscal year beginning July 1, 2011, and ending June 30, 7 2012, the following amount, or so much thereof as is necessary, 8 to be used for the purposes designated: 9 For costs associated with implementation of this Act: 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 50,000 11 Sec. 10. EFFECTIVE UPON ENACTMENT. This division of this 12 Act, being deemed of immediate importance, takes effect upon 13 enactment. 14 DIVISION III 15 PSYCHIATRIC MEDICAL INSTITUTIONS FOR CHILDREN 16 Sec. 11. Section 135H.3, subsection 1, Code 2011, is amended 17 to read as follows: 18 1. A psychiatric medical institution for children shall 19 utilize a team of professionals to direct an organized program 20 of diagnostic services, psychiatric services, nursing care, 21 and rehabilitative services to meet the needs of residents 22 in accordance with a medical care plan developed for each 23 resident. The membership of the team of professionals may 24 include but is not limited to an advanced registered nurse 25 practitioner. Social and rehabilitative services shall be 26 provided under the direction of a qualified mental health 27 professional. 28 Sec. 12. Section 135H.6, subsection 8, Code 2011, is amended 29 to read as follows: 30 8. The department of human services may give approval to 31 conversion of beds approved under subsection 6 , to beds which 32 are specialized to provide substance abuse treatment. However, 33 the total number of beds approved under subsection 6 and this 34 subsection shall not exceed four hundred thirty. Conversion 35 -6- LSB 2002HZ (3) 84 jp/rj 6/ 57
H.F. 689 of beds under this subsection shall not require a revision of 1 the certificate of need issued for the psychiatric institution 2 making the conversion. Beds for children who do not reside 3 in this state and whose service costs are not paid by public 4 funds in this state are not subject to the limitations on the 5 number of beds and certificate of need requirements otherwise 6 applicable under this section. 7 Sec. 13. Section 249A.31, subsection 2, Code 2011, is 8 amended to read as follows: 9 2. Effective July 1, 2010 2012 , the department shall apply 10 a cost-based reimbursement methodology for reimbursement 11 of services provided by psychiatric medical institution 12 for children providers shall be reimbursed as determined 13 in accordance with the managed care contract awarded for 14 authorizing payment for such services under the medical 15 assistance program . 16 Sec. 14. PSYCHIATRIC MEDICAL INSTITUTIONS FOR CHILDREN 17 —— MANAGED CARE CONTRACT. The department of human services 18 shall issue a request for proposals to procure a contractor 19 to authorize, reimburse, and manage benefits for psychiatric 20 medical institution for children services reimbursed under 21 the medical assistance program beginning July 1, 2012. The 22 department shall not procure this contract through a sole 23 source contract process or other limited selection process. 24 Sec. 15. PSYCHIATRIC MEDICAL INSTITUTIONS FOR CHILDREN —— 25 LEVEL 2. 26 1. For the purposes of this section, unless the context 27 otherwise requires: 28 a. “Psychiatric institution-level 1” means a psychiatric 29 medical institution for children licensed under chapter 135H 30 and receiving medical assistance program reimbursement. 31 b. “Psychiatric institution-level 2” means a psychiatric 32 medical institution for children licensed under chapter 33 135H and receiving medical assistance program reimbursement 34 and providing more intensive treatment as described in this 35 -7- LSB 2002HZ (3) 84 jp/rj 7/ 57
H.F. 689 section. 1 2. The department of human services shall work with the 2 department of inspections and appeals to develop a second level 3 of care for psychiatric medical institutions for children 4 licensed under chapter 135H, to be known as “psychiatric 5 institution-level 2” to address the needs of children in need 6 of more intensive treatment. The number of beds authorized for 7 psychiatric institution-level 2 shall not exceed 60 beds. The 8 number of beds in a level 2 program shall be limited to 12 beds. 9 3. The department of human services shall select providers 10 to be authorized to provide psychiatric institution-level 2 11 beds using a request-for-proposal process. The providers shall 12 be selected and contracts finalized on or before January 1, 13 2012. At least three but not more than five providers shall be 14 selected based upon the following criteria: 15 a. Geographic accessibility. 16 b. Ability to provide needed expertise, including but not 17 limited to psychiatry, nursing, specialized medical care, or 18 specialized programming. 19 c. Ability to meet and report on standardized outcome 20 measures. 21 d. Ability to provide treatment to children whose treatment 22 needs have resulted in an out-of-state placement. 23 e. Ability to transition children from psychiatric 24 institution-level 2 care to psychiatric institution-level 1 25 care. 26 4. a. Notwithstanding any provision of law to the contrary, 27 for the fiscal year beginning July 1, 2011, the reimbursement 28 rate for psychiatric institution-level 1 providers shall be the 29 actual cost of care, not to exceed 103 percent of the statewide 30 average of the costs of psychiatric institution-level 1 31 providers for the fiscal year. The costs shall not incorporate 32 the uniform 5 percent reduction applied to such provider rates 33 in fiscal year 2010-2011. It is the intent of the general 34 assembly that such reimbursement rates in subsequent years be 35 -8- LSB 2002HZ (3) 84 jp/rj 8/ 57
H.F. 689 recalculated annually at the beginning of the fiscal year. 1 The average of the costs limitation shall not apply to the 2 psychiatric medical institution for children located at the 3 state mental health institute at Independence. 4 b. Notwithstanding any provision of law to the contrary, 5 for the fiscal year beginning July 1, 2011, the initial 6 reimbursement rate for psychiatric institution-level 2 7 providers shall be based on a prospective cost of care basis, 8 not to exceed the actual cost of care for the psychiatric 9 medical institution for children located at the state mental 10 health institute at Independence. In subsequent years, it 11 is the intent of the general assembly that the reimbursement 12 rate for psychiatric institution-level 2 providers be the 13 actual cost of care, not to exceed 103 percent of the statewide 14 average of the costs of psychiatric institution-level 2 15 providers for the fiscal year. 16 5. The department of human services shall create an 17 oversight committee comprised of psychiatric institution-level 18 2 providers and representatives of other mental health 19 organizations with expertise in children’s mental health 20 treatment to address the following issues concerning 21 psychiatric institution-level 2 providers and report to the 22 department, governor, and general assembly as needed: 23 a. Identifying the target population to be served by 24 providers. 25 b. Identifying admission and continued state criteria for 26 the providers. 27 c. Reviewing potential changes in licensing standards 28 for psychiatric institution-level 1 providers in order to 29 accommodate the higher acuity level and increased treatment 30 needs of children to be served by psychiatric institution-level 31 2 providers. 32 d. Reviewing the children in out-of-state placements with 33 providers similar to psychiatric medical institutions for 34 children to determine which children could be better served in 35 -9- LSB 2002HZ (3) 84 jp/rj 9/ 57
H.F. 689 this state by a psychiatric institution-level 2 provider. 1 6. The department of human services shall annually report 2 not later than December 15 to the chairpersons and ranking 3 members of the joint appropriations subcommittee on health 4 and human services through 2016 regarding implementation of 5 this section. The report shall include but is not limited 6 to information on children served by both level 1 and level 7 2 providers, the types of locations to which children are 8 discharged after level 1 and level 2 treatment and the 9 community-based services available to such children, and the 10 incidence of readmission for level 1 and level 2 treatment 11 within 12 months of discharge. 12 DIVISION IV 13 MEDICATION THERAPY MANAGEMENT 14 Sec. 16. NEW SECTION . 249A.20B Medication therapy 15 management. 16 1. Beginning July 1, 2011, the department shall utilize a 17 request for proposals process to select an entity to contract 18 beginning July 1, 2012, for the provision of medication therapy 19 management for any medical assistance program recipient who 20 meets any of the following criteria: 21 a. Is an individual who takes prescription drugs to treat or 22 prevent chronic mental illness, or is an individual who takes 23 four or more prescription drugs to treat or prevent two or more 24 chronic medical conditions. 25 b. Is an individual with a prescription drug therapy 26 problem who is identified by the prescribing physician or 27 other appropriate prescriber, and referred to a pharmacist for 28 medication therapy management services. 29 c. Is an individual who meets other criteria established by 30 the department. 31 2. For the initial contract period beginning July 1, 2012, 32 the primary focus shall be provision of medication therapy 33 management services to individuals with chronic mental illness. 34 3. a. The contract shall require the selected entity 35 -10- LSB 2002HZ (3) 84 jp/rj 10/ 57
H.F. 689 to provide annual reports to the general assembly detailing 1 the costs, savings, estimated cost avoidance and return on 2 investment, and patient outcomes related to the medication 3 therapy management services provided. 4 b. The entity shall guarantee demonstrated annual savings, 5 including any savings associated with cost avoidance at least 6 equal to the medication therapy management services program’s 7 costs with any shortfall amount refunded to the state. 8 c. As a proof of concept in the program for the initial year 9 of the contract, the entity shall offer a dollar-for-dollar 10 guarantee for drug product costs savings alone. 11 d. Prior to entering into a contract with an entity, the 12 department and the entity shall agree on the terms, conditions, 13 and applicable measurement standards associated with the 14 demonstration of savings. The department shall verify that the 15 demonstrated savings reported by the entity was performed in 16 accordance with the agreed upon measurement standards. 17 e. The entity shall contract with Iowa licensed pharmacies, 18 pharmacists, or physicians to provide the medication therapy 19 management services. 20 4. The fees for pharmacist-delivered medication therapy 21 management services shall be separate from the reimbursement 22 for prescription drug product or dispensing services; shall 23 be determined under the terms of the contract; and must be 24 reasonable based on the resources and time required to provide 25 the services. 26 5. A fee shall be established for physician reimbursement 27 for services delivered for medication therapy management 28 as determined under the terms of the contract, and must be 29 reasonable based on the resources and time required to provide 30 the services. 31 6. If any part of the medication therapy management 32 plan developed by a pharmacist incorporates services which 33 are outside the pharmacist’s independent scope of practice, 34 including the initiation of therapy, modification of dosages, 35 -11- LSB 2002HZ (3) 84 jp/rj 11/ 57
H.F. 689 therapeutic interchange, or changes in drug therapy, the 1 express authorization of the individual’s physician or other 2 appropriate prescriber is required. 3 7. For the purposes of this section, “medication therapy 4 management” means a systematic process performed by a licensed 5 pharmacist, designed to optimize therapeutic outcomes through 6 improved medication use and reduced risk of adverse drug events 7 in order to reduce overall health care costs, including all of 8 the following services: 9 a. A medication therapy review and in-person consultation 10 relating to all medications, vitamins, and herbal supplements 11 currently being taken by an eligible individual. 12 b. A medication action plan, subject to the limitations 13 specified in this section, communicated to the individual and 14 the individual’s primary care physician or other appropriate 15 prescriber to address safety issues, inconsistencies, 16 duplicative therapy, omissions, and medication costs. The 17 medication action plan may include recommendations to the 18 prescriber for changes in drug therapy. 19 c. Documentation and followup to ensure consistent levels of 20 pharmacy services and positive outcomes. 21 Sec. 17. EFFECTIVE UPON ENACTMENT. This division of this 22 Act, being deemed of immediate importance, takes effect upon 23 enactment. 24 DIVISION V 25 COMMUNITY MENTAL HEALTH CENTERS 26 COMMUNITY MENTAL HEALTH CENTERS —— CATCHMENT AREAS 27 Sec. 18. NEW SECTION . 230A.101 Services system roles. 28 1. The role of the department of human services, through 29 the division of the department designated as the state 30 mental health authority with responsibility for state policy 31 concerning mental health and disability services, is to develop 32 and maintain policies for the mental health and disability 33 services system. The policies shall address the service needs 34 of individuals of all ages with disabilities in this state, 35 -12- LSB 2002HZ (3) 84 jp/rj 12/ 57
H.F. 689 regardless of the individuals’ places of residence or economic 1 circumstances, and shall be consistent with the requirements of 2 chapter 225C and other applicable law. 3 2. The role of community mental health centers in the 4 mental health and disability services system is to provide 5 an organized set of services in order to adequately meet the 6 mental health needs of this state’s citizens based on organized 7 catchment areas. 8 Sec. 19. NEW SECTION . 230A.102 Definitions. 9 As used in this chapter, unless the context otherwise 10 requires: 11 1. “Administrator” , “commission” , “department” , “disability 12 services” , and “division” mean the same as defined in section 13 225C.2. 14 2. “Catchment area” means a community mental health center 15 catchment area identified in accordance with this chapter. 16 3. “Community mental health center” or “center” means a 17 community mental health center designated in accordance with 18 this chapter. 19 Sec. 20. NEW SECTION . 230A.103 Designation of community 20 mental health centers. 21 1. The division, subject to agreement by any community 22 mental health center that would provide services for the 23 catchment area and approval by the commission, shall designate 24 at least one community mental health center under this chapter 25 to serve as lead agency for addressing the mental health needs 26 of the county or counties comprising the catchment area. The 27 designation process shall provide for the input of potential 28 service providers regarding designation of the initial 29 catchment area or a change in the designation. 30 2. The division shall utilize objective criteria for 31 designating a community mental health center to serve a 32 catchment area and for withdrawing such designation. The 33 commission shall adopt rules outlining the criteria. The 34 criteria shall include but are not limited to provisions for 35 -13- LSB 2002HZ (3) 84 jp/rj 13/ 57
H.F. 689 meeting all of the following requirements: 1 a. An appropriate means shall be used for determining which 2 prospective designee is best able to serve all ages of the 3 targeted population within the catchment area with minimal or 4 no service denials. 5 b. An effective means shall be used for determining the 6 relative ability of a prospective designee to appropriately 7 provide mental health services and other support to consumers 8 residing within a catchment area as well as consumers residing 9 outside the catchment area. The criteria shall address the 10 duty for a prospective designee to arrange placements outside 11 the catchment area when such placements best meet consumer 12 needs and to provide services within the catchment area to 13 consumers who reside outside the catchment area when the 14 services are necessary and appropriate. 15 3. The board of directors for a designated community mental 16 health center shall enter into an agreement with the division. 17 The terms of the agreement shall include but are not limited 18 to all of the following: 19 a. The period of time the agreement will be in force. 20 b. The services and other support the center will offer or 21 provide for the residents of the catchment area. 22 c. The standards to be followed by the center in determining 23 whether and to what extent the persons seeking services from 24 the center shall be considered to be able to pay the costs of 25 the services. 26 d. The policies regarding availability of the services 27 offered by the center to the residents of the catchment area as 28 well as consumers residing outside the catchment area. 29 e. The requirements for preparation and submission to the 30 division of annual audits, cost reports, program reports, 31 performance measures, and other financial and service 32 accountability information. 33 4. This section does not limit the authority of the board or 34 the boards of supervisors of any county or group of counties to 35 -14- LSB 2002HZ (3) 84 jp/rj 14/ 57
H.F. 689 continue to expend money to support operation of a center. 1 Sec. 21. NEW SECTION . 230A.104 Catchment areas. 2 1. The division shall collaborate with affected counties in 3 identifying community mental health center catchment areas in 4 accordance with this section. 5 2. a. Unless the division has determined that exceptional 6 circumstances exist, a catchment area shall be served by one 7 community mental health center. The purpose of this general 8 limitation is to clearly designate the center responsible and 9 accountable for providing core mental health services to the 10 target population in the catchment area and to protect the 11 financial viability of the centers comprising the mental health 12 services system in the state. 13 b. A formal review process shall be used in determining 14 whether exceptional circumstances exist that justify 15 designating more than one center to serve a catchment area. 16 The criteria for the review process shall include but are not 17 limited to a means of determining whether the catchment area 18 can support more than one center. 19 c. Criteria shall be provided that would allow the 20 designation of more than one center for all or a portion of a 21 catchment area if designation or approval for more than one 22 center was provided by the division as of October 1, 2010. The 23 criteria shall require a determination that all such centers 24 would be financially viable if designation is provided for all. 25 Sec. 22. NEW SECTION . 230A.105 Target population —— 26 eligibility. 27 1. The target population residing in a catchment area to be 28 served by a community mental health center shall include but is 29 not limited to all of the following: 30 a. Individuals of any age who are experiencing a mental 31 health crisis. 32 b. Individuals of any age who have a mental health disorder. 33 c. Adults who have a serious mental illness or chronic 34 mental illness. 35 -15- LSB 2002HZ (3) 84 jp/rj 15/ 57
H.F. 689 d. Children and youth who are experiencing a serious 1 emotional disturbance. 2 e. Individuals described in paragraph “a” , “b” , “c” , 3 or “d” who have a co-occurring disorder, including but not 4 limited to substance abuse, mental retardation, a developmental 5 disability, brain injury, autism spectrum disorder, or another 6 disability or special health care need. 7 2. Specific eligibility criteria for members of the target 8 population shall be identified in administrative rules adopted 9 by the commission. The eligibility criteria shall address both 10 clinical and financial eligibility. 11 Sec. 23. NEW SECTION . 230A.106 Services offered. 12 1. A community mental health center designated in 13 accordance with this chapter shall offer core services and 14 support addressing the basic mental health and safety needs of 15 the target population and other residents of the catchment area 16 served by the center and may offer other services and support. 17 The core services shall be identified in administrative rules 18 adopted by the commission for this purpose. 19 2. The initial core services identified shall include all 20 of the following: 21 a. Outpatient services. Outpatient services shall consist 22 of evaluation and treatment services provided on an ambulatory 23 basis for the target population. Outpatient services include 24 psychiatric evaluations, medication management, and individual, 25 family, and group therapy. In addition, outpatient services 26 shall include specialized outpatient services directed to 27 the following segments of the target population: children, 28 elderly, individuals who have serious and persistent mental 29 illness, and residents of the service area who have been 30 discharged from inpatient treatment at a mental health 31 facility. Outpatient services shall provide elements of 32 diagnosis, treatment, and appropriate follow-up. The provision 33 of only screening and referral services does not constitute 34 outpatient services. 35 -16- LSB 2002HZ (3) 84 jp/rj 16/ 57
H.F. 689 b. Twenty-four-hour emergency services. 1 Twenty-four-hour emergency services shall be provided through 2 a system that provides access to a clinician and appropriate 3 disposition with follow-up documentation of the emergency 4 service provided. A patient shall have access to evaluation 5 and stabilization services after normal business hours. The 6 range of emergency services that shall be available to a 7 patient may include but are not limited to direct contact with 8 a clinician, medication evaluation, and hospitalization. The 9 emergency services may be provided directly by the center 10 or in collaboration or affiliation with other appropriately 11 accredited providers. 12 c. Day treatment, partial hospitalization, or psychosocial 13 rehabilitation services. Such services shall be provided as 14 structured day programs in segments of less than twenty-four 15 hours using a multidisciplinary team approach to develop 16 treatment plans that vary in intensity of services and the 17 frequency and duration of services based on the needs of the 18 patient. These services may be provided directly by the center 19 or in collaboration or affiliation with other appropriately 20 accredited providers. 21 d. Admission screening for voluntary patients. 22 Admission screening services shall be available for patients 23 considered for voluntary admission to a state mental health 24 institute to determine the patient’s appropriateness for 25 admission. 26 e. Community support services. Community support services 27 shall consist of support and treatment services focused 28 on enhancing independent functioning and assisting persons 29 in the target population who have a serious and persistent 30 mental illness to live and work in their community setting, by 31 reducing or managing mental illness symptoms and the associated 32 functional disabilities that negatively impact such persons’ 33 community integration and stability. 34 f. Consultation services. Consultation services may include 35 -17- LSB 2002HZ (3) 84 jp/rj 17/ 57
H.F. 689 provision of professional assistance and information about 1 mental health and mental illness to individuals, service 2 providers, or groups to increase such persons’ effectiveness 3 in carrying out their responsibilities for providing services. 4 Consultations may be case-specific or program-specific. 5 g. Education services. Education services may include 6 information and referral services regarding available 7 resources and information and training concerning mental 8 health, mental illness, availability of services and other 9 support, the promotion of mental health, and the prevention 10 of mental illness. Education services may be made available 11 to individuals, groups, organizations, and the community in 12 general. 13 3. A community mental health center shall be responsible 14 for coordinating with associated services provided by other 15 unaffiliated agencies to members of the target population in 16 the catchment area and to integrate services in the community 17 with services provided to the target population in residential 18 or inpatient settings. 19 Sec. 24. NEW SECTION . 230A.107 Form of organization. 20 1. Except as authorized in subsection 2, a community mental 21 health center designated in accordance with this chapter shall 22 be organized and administered as a nonprofit corporation. 23 2. A for-profit corporation, nonprofit corporation, or 24 county hospital providing mental health services to county 25 residents pursuant to a waiver approved under section 225C.7, 26 subsection 3, Code 2011, as of October 1, 2010, may also be 27 designated as a community mental health center. 28 Sec. 25. NEW SECTION . 230A.108 Administrative, diagnostic, 29 and demographic information. 30 Release of administrative and diagnostic information, as 31 defined in section 228.1, and demographic information necessary 32 for aggregated reporting to meet the data requirements 33 established by the division, relating to an individual who 34 receives services from a community mental health center, may be 35 -18- LSB 2002HZ (3) 84 jp/rj 18/ 57
H.F. 689 made a condition of support of that center by the division. 1 Sec. 26. NEW SECTION . 230A.109 Funding —— legislative 2 intent. 3 1. It is the intent of the general assembly that public 4 funding for community mental health centers designated in 5 accordance with this chapter shall be provided as a combination 6 of federal and state funding. 7 2. It is the intent of the general assembly that the state 8 funding provided to centers be a sufficient amount for the core 9 services and support addressing the basic mental health and 10 safety needs of the residents of the catchment area served by 11 each center to be provided regardless of individual ability to 12 pay for the services and support. 13 3. While a community mental health center must comply with 14 the core services requirements and other standards associated 15 with designation, provision of services is subject to the 16 availability of a payment source for the services. 17 Sec. 27. NEW SECTION . 230A.110 Standards. 18 1. The division shall recommend and the commission shall 19 adopt standards for designated community mental health centers 20 and comprehensive community mental health programs, with 21 the overall objective of ensuring that each center and each 22 affiliate providing services under contract with a center 23 furnishes high-quality mental health services within a 24 framework of accountability to the community it serves. The 25 standards adopted shall be in substantial conformity with 26 the applicable behavioral health standards adopted by the 27 joint commission, formerly known as the joint commission 28 on accreditation of health care organizations, and other 29 recognized national standards for evaluation of psychiatric 30 facilities unless in the judgment of the division, with 31 approval of the commission, there are sound reasons for 32 departing from the standards. 33 2. When recommending standards under this section, the 34 division shall designate an advisory committee representing 35 -19- LSB 2002HZ (3) 84 jp/rj 19/ 57
H.F. 689 boards of directors and professional staff of designated 1 community mental health centers to assist in the formulation 2 or revision of standards. The membership of the advisory 3 committee shall include representatives of professional and 4 nonprofessional staff and other appropriate individuals. 5 3. The standards recommended under this section shall 6 include requirements that each community mental health center 7 designated under this chapter do all of the following: 8 a. Maintain and make available to the public a written 9 statement of the services the center offers to residents of 10 the catchment area being served. The center shall employ or 11 contract for services with affiliates to employ staff who are 12 appropriately credentialed or meet other qualifications in 13 order to provide services. 14 b. If organized as a nonprofit corporation, be governed by 15 a board of directors which adequately represents interested 16 professions, consumers of the center’s services, socioeconomic, 17 cultural, and age groups, and various geographical areas in 18 the catchment area served by the center. If organized as a 19 for-profit corporation, the corporation’s policy structure 20 shall incorporate such representation. 21 c. Arrange for the financial condition and transactions of 22 the community mental health center to be audited once each year 23 by the auditor of state. However, in lieu of an audit by state 24 accountants, the local governing body of a community mental 25 health center organized under this chapter may contract with 26 or employ certified public accountants to conduct the audit, 27 pursuant to the applicable terms and conditions prescribed by 28 sections 11.6 and 11.19 and audit format prescribed by the 29 auditor of state. Copies of each audit shall be furnished by 30 the accountant to the administrator of the division of mental 31 health and disability services. 32 d. Comply with the accreditation standards applicable to the 33 center. 34 Sec. 28. NEW SECTION . 230A.111 Review and evaluation. 35 -20- LSB 2002HZ (3) 84 jp/rj 20/ 57
H.F. 689 1. The review and evaluation of designated centers shall 1 be performed through a formal accreditation review process as 2 recommended by the division and approved by the commission. 3 The accreditation process shall include all of the following: 4 a. Specific time intervals for full accreditation reviews 5 based upon levels of accreditation. 6 b. Use of random or complaint-specific, on-site limited 7 accreditation reviews in the interim between full accreditation 8 reviews, as a quality review approach. The results of such 9 reviews shall be presented to the commission. 10 c. Use of center accreditation self-assessment tools to 11 gather data regarding quality of care and outcomes, whether 12 used during full or limited reviews or at other times. 13 2. The accreditation process shall include but is not 14 limited to addressing all of the following: 15 a. Measures to address centers that do not meet standards, 16 including authority to revoke accreditation. 17 b. Measures to address noncompliant centers that do not 18 develop a corrective action plan or fail to implement steps 19 included in a corrective action plan accepted by the division. 20 c. Measures to appropriately recognize centers that 21 successfully complete a corrective action plan. 22 d. Criteria to determine when a center’s accreditation 23 should be denied, revoked, suspended, or made provisional. 24 Sec. 29. REPEAL. Sections 230A.1 through 230A.18, Code 25 2011, are repealed. 26 Sec. 30. IMPLEMENTATION —— EFFECTIVE DATE. 27 1. Community mental health centers operating under 28 the provisions of chapter 230A, Code 2011, and associated 29 standards, rules, and other requirements as of June 30, 2012, 30 may continue to operate under such requirements until the 31 department of human services, division of mental health and 32 disability services, and the mental health and disability 33 services commission have completed the rules adoption process 34 to implement the amendments to chapter 230A enacted by this 35 -21- LSB 2002HZ (3) 84 jp/rj 21/ 57
H.F. 689 Act, identified catchment areas, and completed designations of 1 centers. 2 2. The division and the commission shall complete the rules 3 adoption process and other requirements addressed in subsection 4 1 on or before June 30, 2012. 5 3. Except for this section, which shall take effect July 1, 6 2011, this division of this Act takes effect July 1, 2012. 7 DIVISION VI 8 PERSONS WITH SUBSTANCE-RELATED DISORDERS 9 AND PERSONS WITH MENTAL ILLNESS 10 Sec. 31. Section 125.1, subsection 1, Code 2011, is amended 11 to read as follows: 12 1. That substance abusers and persons suffering from 13 chemical dependency persons with substance-related disorders 14 be afforded the opportunity to receive quality treatment and 15 directed into rehabilitation services which will help them 16 resume a socially acceptable and productive role in society. 17 Sec. 32. Section 125.2, subsection 2, Code 2011, is amended 18 by striking the subsection. 19 Sec. 33. Section 125.2, subsection 5, Code 2011, is amended 20 by striking the subsection and inserting in lieu thereof the 21 following: 22 5. “Substance-related disorder” means a diagnosable 23 substance abuse disorder of sufficient duration to meet 24 diagnostic criteria specified within the most current 25 diagnostic and statistical manual of mental disorders published 26 by the American psychiatric association that results in a 27 functional impairment. 28 Sec. 34. Section 125.2, subsection 9, Code 2011, is amended 29 to read as follows: 30 9. “Facility” means an institution, a detoxification center, 31 or an installation providing care, maintenance and treatment 32 for substance abusers persons with substance-related disorders 33 licensed by the department under section 125.13 , hospitals 34 licensed under chapter 135B , or the state mental health 35 -22- LSB 2002HZ (3) 84 jp/rj 22/ 57
H.F. 689 institutes designated by chapter 226 . 1 Sec. 35. Section 125.2, subsections 13, 17, and 18, Code 2 2011, are amended by striking the subsections. 3 Sec. 36. Section 125.9, subsections 2 and 4, Code 2011, are 4 amended to read as follows: 5 2. Make contracts necessary or incidental to the 6 performance of the duties and the execution of the powers of 7 the director, including contracts with public and private 8 agencies, organizations and individuals to pay them for 9 services rendered or furnished to substance abusers, chronic 10 substance abusers, or intoxicated persons persons with 11 substance-related disorders . 12 4. Coordinate the activities of the department and 13 cooperate with substance abuse programs in this and other 14 states, and make contracts and other joint or cooperative 15 arrangements with state, local or private agencies in this 16 and other states for the treatment of substance abusers, 17 chronic substance abusers, and intoxicated persons persons with 18 substance-related disorders and for the common advancement of 19 substance abuse programs. 20 Sec. 37. Section 125.10, subsections 2, 3, 4, 5, 7, 8, 9, 21 11, 13, 15, and 17, Code 2011, are amended to read as follows: 22 2. Develop, encourage, and foster statewide, regional 23 and local plans and programs for the prevention of substance 24 abuse misuse and the treatment of substance abusers, chronic 25 substance abusers, and intoxicated persons persons with 26 substance-related disorders in cooperation with public and 27 private agencies, organizations and individuals, and provide 28 technical assistance and consultation services for these 29 purposes. 30 3. Coordinate the efforts and enlist the assistance of all 31 public and private agencies, organizations and individuals 32 interested in the prevention of substance abuse and the 33 treatment of substance abusers, chronic substance abusers, and 34 intoxicated persons persons with substance-related disorders . 35 -23- LSB 2002HZ (3) 84 jp/rj 23/ 57
H.F. 689 4. Cooperate with the department of human services and 1 the Iowa department of public health in establishing and 2 conducting programs to provide treatment for substance abusers, 3 chronic substance abusers, and intoxicated persons persons with 4 substance-related disorders . 5 5. Cooperate with the department of education, boards 6 of education, schools, police departments, courts, and other 7 public and private agencies, organizations, and individuals in 8 establishing programs for the prevention of substance abuse 9 and the treatment of substance abusers, chronic substance 10 abusers, and intoxicated persons persons with substance-related 11 disorders , and in preparing relevant curriculum materials for 12 use at all levels of school education. 13 7. Develop and implement, as an integral part of treatment 14 programs, an educational program for use in the treatment of 15 substance abusers, chronic substance abusers, and intoxicated 16 persons persons with substance-related disorders , which program 17 shall include the dissemination of information concerning the 18 nature and effects of chemical substances. 19 8. Organize and implement, in cooperation with local 20 treatment programs, training programs for all persons engaged 21 in treatment of substance abusers, chronic substance abusers, 22 and intoxicated persons persons with substance-related 23 disorders . 24 9. Sponsor and implement research in cooperation with local 25 treatment programs into the causes and nature of substance 26 abuse misuse and treatment of substance abusers, chronic 27 substance abusers, and intoxicated persons persons with 28 substance-related disorders , and serve as a clearing house for 29 information relating to substance abuse. 30 11. Develop and implement, with the counsel and approval of 31 the board, the comprehensive plan for treatment of substance 32 abusers, chronic substance abusers, and intoxicated persons 33 persons with substance-related disorders in accordance with 34 this chapter . 35 -24- LSB 2002HZ (3) 84 jp/rj 24/ 57
H.F. 689 13. Utilize the support and assistance of interested 1 persons in the community, particularly recovered substance 2 abusers and chronic substance abusers, persons who are 3 recovering from substance-related disorders to encourage 4 substance abusers and chronic substance abusers persons with 5 substance-related disorders to voluntarily undergo treatment. 6 15. Encourage general hospitals and other appropriate 7 health facilities to admit without discrimination substance 8 abusers, chronic substance abusers, and intoxicated persons 9 persons with substance-related disorders and to provide them 10 with adequate and appropriate treatment. The director may 11 negotiate and implement contracts with hospitals and other 12 appropriate health facilities with adequate detoxification 13 facilities. 14 17. Review all state health, welfare, education and 15 treatment proposals to be submitted for federal funding under 16 federal legislation, and advise the governor on provisions to 17 be included relating to substance abuse, substance abusers, 18 chronic substance abusers, and intoxicated persons and persons 19 with substance-related disorders . 20 Sec. 38. Section 125.12, subsections 1 and 3, Code 2011, are 21 amended to read as follows: 22 1. The board shall review the comprehensive substance 23 abuse program implemented by the department for the treatment 24 of substance abusers, chronic substance abusers, intoxicated 25 persons persons with substance-related disorders , and concerned 26 family members. Subject to the review of the board, the 27 director shall divide the state into appropriate regions 28 for the conduct of the program and establish standards for 29 the development of the program on the regional level. In 30 establishing the regions, consideration shall be given to city 31 and county lines, population concentrations, and existing 32 substance abuse treatment services. 33 3. The director shall provide for adequate and appropriate 34 treatment for substance abusers, chronic substance abusers, 35 -25- LSB 2002HZ (3) 84 jp/rj 25/ 57
H.F. 689 intoxicated persons persons with substance-related disorders , 1 and concerned family members admitted under sections 125.33 and 2 125.34 , or under section 125.75 , 125.81 , or 125.91 . Treatment 3 shall not be provided at a correctional institution except for 4 inmates. 5 Sec. 39. Section 125.13, subsection 1, paragraph a, Code 6 2011, is amended to read as follows: 7 a. Except as provided in subsection 2 , a person shall not 8 maintain or conduct any chemical substitutes or antagonists 9 program, residential program, or nonresidential outpatient 10 program, the primary purpose of which is the treatment and 11 rehabilitation of substance abusers or chronic substance 12 abusers persons with substance-related disorders without having 13 first obtained a written license for the program from the 14 department. 15 Sec. 40. Section 125.13, subsection 2, paragraphs a and c, 16 Code 2011, are amended to read as follows: 17 a. A hospital providing care or treatment to substance 18 abusers or chronic substance abusers persons with 19 substance-related disorders licensed under chapter 135B which 20 is accredited by the joint commission on the accreditation of 21 health care organizations, the commission on accreditation 22 of rehabilitation facilities, the American osteopathic 23 association, or another recognized organization approved by the 24 board. All survey reports from the accrediting or licensing 25 body must be sent to the department. 26 c. Private institutions conducted by and for persons who 27 adhere to the faith of any well recognized church or religious 28 denomination for the purpose of providing care, treatment, 29 counseling, or rehabilitation to substance abusers or chronic 30 substance abusers persons with substance-related disorders and 31 who rely solely on prayer or other spiritual means for healing 32 in the practice of religion of such church or denomination. 33 Sec. 41. Section 125.15, Code 2011, is amended to read as 34 follows: 35 -26- LSB 2002HZ (3) 84 jp/rj 26/ 57
H.F. 689 125.15 Inspections. 1 The department may inspect the facilities and review the 2 procedures utilized by any chemical substitutes or antagonists 3 program, residential program, or nonresidential outpatient 4 program that has as a primary purpose the treatment and 5 rehabilitation of substance abusers or chronic substance 6 abusers persons with substance-related disorders , for the 7 purpose of ensuring compliance with this chapter and the rules 8 adopted pursuant to this chapter . The examination and review 9 may include case record audits and interviews with staff and 10 patients, consistent with the confidentiality safeguards of 11 state and federal law. 12 Sec. 42. Section 125.32, unnumbered paragraph 1, Code 2011, 13 is amended to read as follows: 14 The department shall adopt and may amend and repeal rules 15 for acceptance of persons into the treatment program, subject 16 to chapter 17A , considering available treatment resources and 17 facilities, for the purpose of early and effective treatment 18 of substance abusers, chronic substance abusers, intoxicated 19 persons, persons with substance-related disorders and concerned 20 family members. In establishing the rules the department shall 21 be guided by the following standards: 22 Sec. 43. Section 125.33, subsections 1, 3, and 4, Code 2011, 23 are amended to read as follows: 24 1. A substance abuser or chronic substance abuser person 25 with a substance-related disorder may apply for voluntary 26 treatment or rehabilitation services directly to a facility 27 or to a licensed physician and surgeon or osteopathic 28 physician and surgeon. If the proposed patient is a minor 29 or an incompetent person, a parent, a legal guardian or 30 other legal representative may make the application. The 31 licensed physician and surgeon or osteopathic physician and 32 surgeon or any employee or person acting under the direction 33 or supervision of the physician and surgeon or osteopathic 34 physician and surgeon, or the facility shall not report or 35 -27- LSB 2002HZ (3) 84 jp/rj 27/ 57
H.F. 689 disclose the name of the person or the fact that treatment 1 was requested or has been undertaken to any law enforcement 2 officer or law enforcement agency; nor shall such information 3 be admissible as evidence in any court, grand jury, or 4 administrative proceeding unless authorized by the person 5 seeking treatment. If the person seeking such treatment or 6 rehabilitation is a minor who has personally made application 7 for treatment, the fact that the minor sought treatment or 8 rehabilitation or is receiving treatment or rehabilitation 9 services shall not be reported or disclosed to the parents or 10 legal guardian of such minor without the minor’s consent, and 11 the minor may give legal consent to receive such treatment and 12 rehabilitation. 13 3. A substance abuser or chronic substance abuser person 14 with a substance-related disorder seeking treatment or 15 rehabilitation and who is either addicted or dependent on a 16 chemical substance may first be examined and evaluated by a 17 licensed physician and surgeon or osteopathic physician and 18 surgeon who may prescribe a proper course of treatment and 19 medication, if needed. The licensed physician and surgeon 20 or osteopathic physician and surgeon may further prescribe a 21 course of treatment or rehabilitation and authorize another 22 licensed physician and surgeon or osteopathic physician and 23 surgeon or facility to provide the prescribed treatment or 24 rehabilitation services. Treatment or rehabilitation services 25 may be provided to a person individually or in a group. A 26 facility providing or engaging in treatment or rehabilitation 27 shall not report or disclose to a law enforcement officer or 28 law enforcement agency the name of any person receiving or 29 engaged in the treatment or rehabilitation; nor shall a person 30 receiving or participating in treatment or rehabilitation 31 report or disclose the name of any other person engaged in or 32 receiving treatment or rehabilitation or that the program is 33 in existence, to a law enforcement officer or law enforcement 34 agency. Such information shall not be admitted in evidence in 35 -28- LSB 2002HZ (3) 84 jp/rj 28/ 57
H.F. 689 any court, grand jury, or administrative proceeding. However, 1 a person engaged in or receiving treatment or rehabilitation 2 may authorize the disclosure of the person’s name and 3 individual participation. 4 4. If a patient receiving inpatient or residential care 5 leaves a facility, the patient shall be encouraged to consent 6 to appropriate outpatient or halfway house treatment. If it 7 appears to the administrator in charge of the facility that 8 the patient is a substance abuser or chronic substance abuser 9 person with a substance-related disorder who requires help, the 10 director may arrange for assistance in obtaining supportive 11 services. 12 Sec. 44. Section 125.34, Code 2011, is amended to read as 13 follows: 14 125.34 Treatment and services for intoxicated persons and 15 persons incapacitated by alcohol persons with substance-related 16 disorders due to intoxication and substance-induced 17 incapacitation . 18 1. An intoxicated A person with a substance-related 19 disorder due to intoxication or substance-induced 20 incapacitation may come voluntarily to a facility for 21 emergency treatment. A person who appears to be intoxicated or 22 incapacitated by a chemical substance in a public place and in 23 need of help may be taken to a facility by a peace officer under 24 section 125.91 . If the person refuses the proffered help, the 25 person may be arrested and charged with intoxication under 26 section 123.46 , if applicable. 27 2. If no facility is readily available the person may 28 be taken to an emergency medical service customarily used 29 for incapacitated persons. The peace officer in detaining 30 the person and in taking the person to a facility shall make 31 every reasonable effort to protect the person’s health and 32 safety. In detaining the person the detaining officer may take 33 reasonable steps for self-protection. Detaining a person under 34 section 125.91 is not an arrest and no entry or other record 35 -29- LSB 2002HZ (3) 84 jp/rj 29/ 57
H.F. 689 shall be made to indicate that the person who is detained has 1 been arrested or charged with a crime. 2 3. A person who arrives at a facility and voluntarily 3 submits to examination shall be examined by a licensed 4 physician as soon as possible after the person arrives at the 5 facility. The person may then be admitted as a patient or 6 referred to another health facility. The referring facility 7 shall arrange for transportation. 8 4. If a person is voluntarily admitted to a facility, the 9 person’s family or next of kin shall be notified as promptly 10 as possible. If an adult patient who is not incapacitated 11 requests that there be no notification, the request shall be 12 respected. 13 5. A peace officer who acts in compliance with this section 14 is acting in the course of the officer’s official duty and is 15 not criminally or civilly liable therefor, unless such acts 16 constitute willful malice or abuse. 17 6. If the physician in charge of the facility determines it 18 is for the patient’s benefit, the patient shall be encouraged 19 to agree to further diagnosis and appropriate voluntary 20 treatment. 21 7. A licensed physician and surgeon or osteopathic 22 physician and surgeon, facility administrator, or an 23 employee or a person acting as or on behalf of the facility 24 administrator, is not criminally or civilly liable for acts 25 in conformity with this chapter , unless the acts constitute 26 willful malice or abuse. 27 Sec. 45. Section 125.43, Code 2011, is amended to read as 28 follows: 29 125.43 Funding at mental health institutes. 30 Chapter 230 governs the determination of the costs and 31 payment for treatment provided to substance abusers or chronic 32 substance abusers persons with substance-related disorders in a 33 mental health institute under the department of human services, 34 except that the charges are not a lien on real estate owned 35 -30- LSB 2002HZ (3) 84 jp/rj 30/ 57
H.F. 689 by persons legally liable for support of the substance abuser 1 or chronic substance abuser person with a substance-related 2 disorder and the daily per diem shall be billed at twenty-five 3 percent. The superintendent of a state hospital shall total 4 only those expenditures which can be attributed to the cost of 5 providing inpatient treatment to substance abusers or chronic 6 substance abusers persons with substance-related disorders for 7 purposes of determining the daily per diem. Section 125.44 8 governs the determination of who is legally liable for the 9 cost of care, maintenance, and treatment of a substance abuser 10 or chronic substance abuser person with a substance-related 11 disorder and of the amount for which the person is liable. 12 Sec. 46. Section 125.43A, Code 2011, is amended to read as 13 follows: 14 125.43A Prescreening —— exception. 15 Except in cases of medical emergency or court-ordered 16 admissions, a person shall be admitted to a state mental 17 health institute for substance abuse treatment only after a 18 preliminary intake and assessment by a department-licensed 19 treatment facility or a hospital providing care or treatment 20 for substance abusers persons with substance-related disorders 21 licensed under chapter 135B and accredited by the joint 22 commission on the accreditation of health care organizations, 23 the commission on accreditation of rehabilitation facilities, 24 the American osteopathic association, or another recognized 25 organization approved by the board, or by a designee of a 26 department-licensed treatment facility or a hospital other 27 than a state mental health institute, which confirms that 28 the admission is appropriate to the person’s substance abuse 29 service needs. A county board of supervisors may seek an 30 admission of a patient to a state mental health institute who 31 has not been confirmed for appropriate admission and the county 32 shall be responsible for one hundred percent of the cost of 33 treatment and services of the patient. 34 Sec. 47. Section 125.44, Code 2011, is amended to read as 35 -31- LSB 2002HZ (3) 84 jp/rj 31/ 57
H.F. 689 follows: 1 125.44 Agreements with facilities —— liability for costs. 2 The director may, consistent with the comprehensive 3 substance abuse program, enter into written agreements with a 4 facility as defined in section 125.2 to pay for one hundred 5 percent of the cost of the care, maintenance, and treatment 6 of substance abusers and chronic substance abusers persons 7 with substance-related disorders , except when section 125.43A 8 applies. All payments for state patients shall be made 9 in accordance with the limitations of this section . Such 10 contracts shall be for a period of no more than one year. 11 The contract may be in the form and contain provisions 12 as agreed upon by the parties. The contract shall provide 13 that the facility shall admit and treat substance abusers 14 and chronic substance abusers persons with substance-related 15 disorders regardless of where they have residence. If one 16 payment for care, maintenance, and treatment is not made 17 by the patient or those legally liable for the patient, 18 the payment shall be made by the department directly to the 19 facility. Payments shall be made each month and shall be 20 based upon the rate of payment for services negotiated between 21 the department and the contracting facility. If a facility 22 projects a temporary cash flow deficit, the department may 23 make cash advances at the beginning of each fiscal year to the 24 facility. The repayment schedule for advances shall be part 25 of the contract between the department and the facility. This 26 section does not pertain to patients treated at the mental 27 health institutes. 28 If the appropriation to the department is insufficient to 29 meet the requirements of this section , the department shall 30 request a transfer of funds and section 8.39 shall apply. 31 The substance abuser or chronic substance abuser person 32 with a substance-related disorder is legally liable to the 33 facility for the total amount of the cost of providing care, 34 maintenance, and treatment for the substance abuser or chronic 35 -32- LSB 2002HZ (3) 84 jp/rj 32/ 57
H.F. 689 substance abuser person with a substance-related disorder while 1 a voluntary or committed patient in a facility. This section 2 does not prohibit any individual from paying any portion of the 3 cost of treatment. 4 The department is liable for the cost of care, treatment, 5 and maintenance of substance abusers and chronic substance 6 abusers persons with substance-related disorders admitted to 7 the facility voluntarily or pursuant to section 125.75 , 125.81 , 8 or 125.91 or section 321J.3 or 124.409 only to those facilities 9 that have a contract with the department under this section , 10 only for the amount computed according to and within the limits 11 of liability prescribed by this section , and only when the 12 substance abuser or chronic substance abuser person with a 13 substance-related disorder is unable to pay the costs and there 14 is no other person, firm, corporation, or insurance company 15 bound to pay the costs. 16 The department’s maximum liability for the costs of care, 17 treatment, and maintenance of substance abusers and chronic 18 substance abusers persons with substance-related disorders in 19 a contracting facility is limited to the total amount agreed 20 upon by the parties and specified in the contract under this 21 section . 22 Sec. 48. Section 125.46, Code 2011, is amended to read as 23 follows: 24 125.46 County of residence determined. 25 The facility shall, when a substance abuser or chronic 26 substance abuser person with a substance-related disorder is 27 admitted, or as soon thereafter as it receives the proper 28 information, determine and enter upon its records the Iowa 29 county of residence of the substance abuser or chronic 30 substance abuser person with a substance-related disorder , or 31 that the person resides in some other state or country, or that 32 the person is unclassified with respect to residence. 33 Sec. 49. Section 125.75, unnumbered paragraph 1, Code 2011, 34 is amended to read as follows: 35 -33- LSB 2002HZ (3) 84 jp/rj 33/ 57
H.F. 689 Proceedings for the involuntary commitment or treatment of 1 a chronic substance abuser person with a substance-related 2 disorder to a facility may be commenced by the county attorney 3 or an interested person by filing a verified application 4 with the clerk of the district court of the county where the 5 respondent is presently located or which is the respondent’s 6 place of residence. The clerk or the clerk’s designee shall 7 assist the applicant in completing the application. The 8 application shall: 9 Sec. 50. Section 125.75, subsection 1, Code 2011, is amended 10 to read as follows: 11 1. State the applicant’s belief that the respondent is 12 a chronic substance abuser person with a substance-related 13 disorder . 14 Sec. 51. Section 125.80, subsections 3 and 4, Code 2011, are 15 amended to read as follows: 16 3. If the report of a court-designated physician is to the 17 effect that the respondent is not a chronic substance abuser 18 person with a substance-related disorder , the court, without 19 taking further action, may terminate the proceeding and dismiss 20 the application on its own motion and without notice. 21 4. If the report of a court-designated physician is to the 22 effect that the respondent is a chronic substance abuser person 23 with a substance-related disorder , the court shall schedule a 24 commitment hearing as soon as possible. The hearing shall be 25 held not more than forty-eight hours after the report is filed, 26 excluding Saturdays, Sundays, and holidays, unless an extension 27 for good cause is requested by the respondent, or as soon 28 thereafter as possible if the court considers that sufficient 29 grounds exist for delaying the hearing. 30 Sec. 52. Section 125.81, subsection 1, Code 2011, is amended 31 to read as follows: 32 1. If a person filing an application requests that a 33 respondent be taken into immediate custody, and the court upon 34 reviewing the application and accompanying documentation, finds 35 -34- LSB 2002HZ (3) 84 jp/rj 34/ 57
H.F. 689 probable cause to believe that the respondent is a chronic 1 substance abuser person with a substance-related disorder who 2 is likely to injure the person or other persons if allowed 3 to remain at liberty, the court may enter a written order 4 directing that the respondent be taken into immediate custody 5 by the sheriff, and be detained until the commitment hearing, 6 which shall be held no more than five days after the date of the 7 order, except that if the fifth day after the date of the order 8 is a Saturday, Sunday, or a holiday, the hearing may be held 9 on the next business day. The court may order the respondent 10 detained for the period of time until the hearing is held, and 11 no longer except as provided in section 125.88 , in accordance 12 with subsection 2 , paragraph “a” , if possible, and if not, then 13 in accordance with subsection 2 , paragraph “b” , or, only if 14 neither of these alternatives is available in accordance with 15 subsection 2 , paragraph “c” . 16 Sec. 53. Section 125.82, subsection 4, Code 2011, is amended 17 to read as follows: 18 4. The respondent’s welfare is paramount, and the hearing 19 shall be tried as a civil matter and conducted in as informal a 20 manner as is consistent with orderly procedure. Discovery as 21 permitted under the Iowa rules of civil procedure is available 22 to the respondent. The court shall receive all relevant and 23 material evidence, but the court is not bound by the rules of 24 evidence. A presumption in favor of the respondent exists, 25 and the burden of evidence and support of the contentions made 26 in the application shall be upon the person who filed the 27 application. If upon completion of the hearing the court finds 28 that the contention that the respondent is a chronic substance 29 abuser person with a substance-related disorder has not been 30 sustained by clear and convincing evidence, the court shall 31 deny the application and terminate the proceeding. 32 Sec. 54. Section 125.83, Code 2011, is amended to read as 33 follows: 34 125.83 Placement for evaluation. 35 -35- LSB 2002HZ (3) 84 jp/rj 35/ 57
H.F. 689 If upon completion of the commitment hearing, the court 1 finds that the contention that the respondent is a chronic 2 substance abuser person with a substance-related disorder 3 has been sustained by clear and convincing evidence, the 4 court shall order the respondent placed at a facility or 5 under the care of a suitable facility on an outpatient basis 6 as expeditiously as possible for a complete evaluation and 7 appropriate treatment. The court shall furnish to the facility 8 at the time of admission or outpatient placement, a written 9 statement of facts setting forth the evidence on which the 10 finding is based. The administrator of the facility shall 11 report to the court no more than fifteen days after the 12 individual is admitted to or placed under the care of the 13 facility, which shall include the chief medical officer’s 14 recommendation concerning substance abuse treatment. An 15 extension of time may be granted for a period not to exceed 16 seven days upon a showing of good cause. A copy of the report 17 shall be sent to the respondent’s attorney who may contest 18 the need for an extension of time if one is requested. If 19 the request is contested, the court shall make an inquiry 20 as it deems appropriate and may either order the respondent 21 released from the facility or grant extension of time for 22 further evaluation. If the administrator fails to report to 23 the court within fifteen days after the individual is admitted 24 to the facility, and no extension of time has been requested, 25 the administrator is guilty of contempt and shall be punished 26 under chapter 665 . The court shall order a rehearing on the 27 application to determine whether the respondent should continue 28 to be held at the facility. 29 Sec. 55. Section 125.83A, subsection 1, Code 2011, is 30 amended to read as follows: 31 1. If upon completion of the commitment hearing, the court 32 finds that the contention that the respondent is a chronic 33 substance abuser person with a substance-related disorder 34 has been sustained by clear and convincing evidence, and the 35 -36- LSB 2002HZ (3) 84 jp/rj 36/ 57
H.F. 689 court is furnished evidence that the respondent is eligible 1 for care and treatment in a facility operated by the United 2 States department of veterans affairs or another agency of 3 the United States government and that the facility is willing 4 to receive the respondent, the court may so order. The 5 respondent, when so placed in a facility operated by the United 6 States department of veterans affairs or another agency of 7 the United States government within or outside of this state, 8 shall be subject to the rules of the United States department 9 of veterans affairs or other agency, but shall not lose any 10 procedural rights afforded the respondent by this chapter . 11 The chief officer of the facility shall have, with respect to 12 the respondent so placed, the same powers and duties as the 13 chief medical officer of a hospital in this state would have 14 in regard to submission of reports to the court, retention 15 of custody, transfer, convalescent leave, or discharge. 16 Jurisdiction is retained in the court to maintain surveillance 17 of the respondent’s treatment and care, and at any time to 18 inquire into the respondent’s condition and the need for 19 continued care and custody. 20 Sec. 56. Section 125.84, subsections 2, 3, and 4, Code 2011, 21 are amended to read as follows: 22 2. That the respondent is a chronic substance abuser 23 person with a substance-related disorder who is in need of 24 full-time custody, care, and treatment in a facility, and is 25 considered likely to benefit from treatment. If the report so 26 states, the court shall enter an order which may require the 27 respondent’s continued placement and commitment to a facility 28 for appropriate treatment. 29 3. That the respondent is a chronic substance abuser person 30 with a substance-related disorder who is in need of treatment, 31 but does not require full-time placement in a facility. If the 32 report so states, the report shall include the chief medical 33 officer’s recommendation for treatment of the respondent on 34 an outpatient or other appropriate basis, and the court shall 35 -37- LSB 2002HZ (3) 84 jp/rj 37/ 57
H.F. 689 enter an order which may direct the respondent to submit to the 1 recommended treatment. The order shall provide that if the 2 respondent fails or refuses to submit to treatment, as directed 3 by the court’s order, the court may order that the respondent 4 be taken into immediate custody as provided by section 125.81 5 and, following notice and hearing held in accordance with 6 the procedures of sections 125.77 and 125.82 , may order the 7 respondent treated as a patient requiring full-time custody, 8 care, and treatment as provided in subsection 2 , and may order 9 the respondent involuntarily committed to a facility. 10 4. That the respondent is a chronic substance abuser 11 person with a substance-related disorder who is in need of 12 treatment, but in the opinion of the chief medical officer is 13 not responding to the treatment provided. If the report so 14 states, the report shall include the facility administrator’s 15 recommendation for alternative placement, and the court shall 16 enter an order which may direct the respondent’s transfer 17 to the recommended placement or to another placement after 18 consultation with respondent’s attorney and the facility 19 administrator who made the report under this subsection . 20 Sec. 57. Section 125.91, subsections 1, 2, and 3, Code 2011, 21 are amended to read as follows: 22 1. The procedure prescribed by this section shall only 23 be used for an intoxicated a person with a substance-related 24 disorder due to intoxication or substance-induced 25 incapacitation who has threatened, attempted, or inflicted 26 physical self-harm or harm on another, and is likely to inflict 27 physical self-harm or harm on another unless immediately 28 detained, or who is incapacitated by a chemical substance, 29 if that person cannot be taken into immediate custody under 30 sections 125.75 and 125.81 because immediate access to the 31 court is not possible. 32 2. a. A peace officer who has reasonable grounds to believe 33 that the circumstances described in subsection 1 are applicable 34 may, without a warrant, take or cause that person to be taken 35 -38- LSB 2002HZ (3) 84 jp/rj 38/ 57
H.F. 689 to the nearest available facility referred to in section 1 125.81, subsection 2 , paragraph “b” or “c” . Such an intoxicated 2 or incapacitated a person with a substance-related disorder due 3 to intoxication or substance-induced incapacitation who also 4 demonstrates a significant degree of distress or dysfunction 5 may also be delivered to a facility by someone other than a 6 peace officer upon a showing of reasonable grounds. Upon 7 delivery of the person to a facility under this section , the 8 examining physician may order treatment of the person, but only 9 to the extent necessary to preserve the person’s life or to 10 appropriately control the person’s behavior if the behavior is 11 likely to result in physical injury to the person or others 12 if allowed to continue. The peace officer or other person 13 who delivered the person to the facility shall describe the 14 circumstances of the matter to the examining physician. If the 15 person is a peace officer, the peace officer may do so either 16 in person or by written report. If the examining physician 17 has reasonable grounds to believe that the circumstances in 18 subsection 1 are applicable, the examining physician shall 19 at once communicate with the nearest available magistrate 20 as defined in section 801.4, subsection 10 . The magistrate 21 shall, based upon the circumstances described by the examining 22 physician, give the examining physician oral instructions 23 either directing that the person be released forthwith, or 24 authorizing the person’s detention in an appropriate facility. 25 The magistrate may also give oral instructions and order that 26 the detained person be transported to an appropriate facility. 27 b. If the magistrate orders that the person be detained, 28 the magistrate shall, by the close of business on the next 29 working day, file a written order with the clerk in the county 30 where it is anticipated that an application may be filed 31 under section 125.75 . The order may be filed by facsimile if 32 necessary. The order shall state the circumstances under which 33 the person was taken into custody or otherwise brought to a 34 facility and the grounds supporting the finding of probable 35 -39- LSB 2002HZ (3) 84 jp/rj 39/ 57
H.F. 689 cause to believe that the person is a chronic substance abuser 1 person with a substance-related disorder likely to result in 2 physical injury to the person or others if not detained. The 3 order shall confirm the oral order authorizing the person’s 4 detention including any order given to transport the person 5 to an appropriate facility. The clerk shall provide a copy 6 of that order to the chief medical officer of the facility 7 attending physician, to which the person was originally taken, 8 any subsequent facility to which the person was transported, 9 and to any law enforcement department or ambulance service that 10 transported the person pursuant to the magistrate’s order. 11 3. The chief medical officer of the facility attending 12 physician shall examine and may detain the person pursuant to 13 the magistrate’s order for a period not to exceed forty-eight 14 hours from the time the order is dated, excluding Saturdays, 15 Sundays, and holidays, unless the order is dismissed by a 16 magistrate. The facility may provide treatment which is 17 necessary to preserve the person’s life or to appropriately 18 control the person’s behavior if the behavior is likely to 19 result in physical injury to the person or others if allowed 20 to continue or is otherwise deemed medically necessary by 21 the chief medical officer attending physician , but shall not 22 otherwise provide treatment to the person without the person’s 23 consent. The person shall be discharged from the facility and 24 released from detention no later than the expiration of the 25 forty-eight-hour period, unless an application for involuntary 26 commitment is filed with the clerk pursuant to section 125.75 . 27 The detention of a person by the procedure in this section , and 28 not in excess of the period of time prescribed by this section , 29 shall not render the peace officer, attending physician, or 30 facility detaining the person liable in a criminal or civil 31 action for false arrest or false imprisonment if the peace 32 officer, physician, or facility had reasonable grounds to 33 believe that the circumstances described in subsection 1 were 34 applicable. 35 -40- LSB 2002HZ (3) 84 jp/rj 40/ 57
H.F. 689 Sec. 58. NEW SECTION . 125.95 Advocates —— duties —— 1 compensation —— state and county liability. 2 1. a. In each county with a population of three hundred 3 thousand or more inhabitants, the board of supervisors shall 4 appoint an individual who has demonstrated by prior activities 5 an informed concern for the welfare and rehabilitation of 6 persons with substance-related disorders, and who is not an 7 officer or employee of the department of public health nor 8 of any agency or facility providing care or treatment to 9 persons with substance-related disorders, to act as an advocate 10 representing the interests of persons involuntarily committed 11 by the court, in any matter relating to the persons’ commitment 12 for treatment under section 125.84 or 125.86. In each county 13 with a population of under three hundred thousand inhabitants, 14 the chief judge of the judicial district encompassing the 15 county shall appoint the advocate. 16 b. The court or, if the advocate is appointed by the county 17 board of supervisors, the board shall assign the advocate 18 appointed from the person’s county of legal settlement to 19 represent the interests of the person. If a person has no 20 county of legal settlement, the court or, if the advocate 21 is appointed by the county board of supervisors, the board 22 shall assign the advocate appointed from the county where the 23 treatment facility is located to represent the interests of the 24 person. 25 c. The advocate’s responsibility with respect to any 26 person shall begin at whatever time the attorney employed 27 or appointed to represent that person as respondent in 28 commitment proceedings, conducted under sections 125.75 to 29 125.83, reports to the court that the attorney’s services 30 are no longer required and requests the court’s approval to 31 withdraw as counsel for that person. However, if the person is 32 found to be a person with a substance-related disorder at the 33 commitment hearing, the attorney representing the person shall 34 automatically be relieved of responsibility in the case and an 35 -41- LSB 2002HZ (3) 84 jp/rj 41/ 57
H.F. 689 advocate shall be assigned to the person at the conclusion of 1 the hearing unless the attorney indicates an intent to continue 2 the attorney’s services and the court so directs. If the 3 court directs the attorney to remain on the case, the attorney 4 shall assume all the duties of an advocate. The clerk shall 5 furnish the advocate with a copy of the court’s order approving 6 the withdrawal and shall inform the person of the name of the 7 person’s advocate. 8 d. With regard to each person whose interests the advocate 9 is required to represent pursuant to this section, the 10 advocate’s duties shall include all of the following: 11 (1) To review each report submitted pursuant to sections 12 125.84 and 125.86. 13 (2) If the advocate is not an attorney, to advise the court 14 at any time it appears that the services of an attorney are 15 required to properly safeguard the person’s interests. 16 (3) To be readily accessible to communications from the 17 person and to originate communications with the patient within 18 five days of the person’s commitment. 19 (4) To visit the person within fifteen days of the person’s 20 commitment and periodically thereafter. 21 (5) To communicate with medical personnel treating the 22 person and to review the person’s medical records pursuant to 23 section 125.93. 24 (6) To file with the court quarterly reports, and additional 25 reports as the advocate feels necessary or as required by the 26 court, in a form prescribed by the court. The reports shall 27 state what actions the advocate has taken with respect to each 28 person and the amount of time spent. 29 2. The treatment facility to which a person is committed 30 shall grant all reasonable requests of the advocate to visit 31 the person, to communicate with medical personnel treating the 32 person, and to review the person’s medical records pursuant to 33 section 125.93. An advocate shall not disseminate information 34 from a person’s medical records to any other person unless done 35 -42- LSB 2002HZ (3) 84 jp/rj 42/ 57
H.F. 689 for official purposes in connection with the advocate’s duties 1 pursuant to this chapter or when required by law. 2 3. The court or, if the advocate is appointed by the 3 county board of supervisors, the board shall prescribe 4 reasonable compensation for the services of the advocate. The 5 compensation shall be based upon the reports filed by the 6 advocate with the court. The advocate’s compensation shall 7 be paid by the county in which the court is located, either 8 on order of the court or, if the advocate is appointed by the 9 county board of supervisors, on the direction of the board. 10 If the advocate is appointed by the court, the advocate is an 11 employee of the state for purposes of chapter 669. If the 12 advocate is appointed by the county board of supervisors, the 13 advocate is an employee of the county for purposes of chapter 14 670. If the person or another person who is legally liable for 15 the person’s support is not indigent, the board shall recover 16 the costs of compensating the advocate from that other person. 17 If that other person has an income level as determined pursuant 18 to section 815.9 greater than one hundred percent but not more 19 than one hundred fifty percent of the poverty guidelines, at 20 least one hundred dollars of the advocate’s compensation shall 21 be recovered in the manner prescribed by the county board of 22 supervisors. If that other person has an income level as 23 determined pursuant to section 815.9 greater than one hundred 24 fifty percent of the poverty guidelines, at least two hundred 25 dollars of the advocate’s compensation shall be recovered in 26 substantially the same manner prescribed by the county board of 27 supervisors as provided in section 815.9. 28 Sec. 59. Section 229.1, subsection 14, Code 2011, is amended 29 by striking the subsection and inserting in lieu thereof the 30 following: 31 14. “Mental health professional” means the same as defined 32 in section 228.1. 33 Sec. 60. Section 229.1, subsection 16, Code 2011, is amended 34 to read as follows: 35 -43- LSB 2002HZ (3) 84 jp/rj 43/ 57
H.F. 689 16. “Serious emotional injury” is an injury which does not 1 necessarily exhibit any physical characteristics, but which can 2 be recognized and diagnosed by a licensed physician or other 3 qualified mental health professional and which can be causally 4 connected with the act or omission of a person who is, or is 5 alleged to be, mentally ill. 6 Sec. 61. Section 229.10, subsection 1, paragraphs b and c, 7 Code 2011, are amended to read as follows: 8 b. Any licensed physician conducting an examination pursuant 9 to this section may consult with or request the participation 10 in the examination of any qualified mental health professional, 11 and may include with or attach to the written report of the 12 examination any findings or observations by any qualified 13 mental health professional who has been so consulted or has so 14 participated in the examination. 15 c. If the respondent is not taken into custody under 16 section 229.11 , but the court is subsequently informed that 17 the respondent has declined to be examined by the licensed 18 physician or physicians pursuant to the court order, the 19 court may order such limited detention of that the respondent 20 as is necessary be detained for a period of not more than 21 twenty-three hours to facilitate the examination of the 22 respondent by the licensed physician or physicians or other 23 mental health professionals . The detention period begins upon 24 the respondent’s admission. Except as otherwise provided, the 25 court may also order that payment be made to the appropriate 26 provider for services associated with the detention period 27 under this paragraph. 28 Sec. 62. Section 229.12, subsection 3, paragraph b, Code 29 2011, is amended to read as follows: 30 b. The licensed physician or qualified mental health 31 professional who examined the respondent shall be present at 32 the hearing unless the court for good cause finds that the 33 licensed physician’s or qualified mental health professional’s 34 presence or testimony is not necessary. The applicant, 35 -44- LSB 2002HZ (3) 84 jp/rj 44/ 57
H.F. 689 respondent, and the respondent’s attorney may waive the 1 presence or the telephonic appearance of the licensed physician 2 or qualified mental health professional who examined the 3 respondent and agree to submit as evidence the written 4 report of the licensed physician or qualified mental health 5 professional. The respondent’s attorney shall inform the 6 court if the respondent’s attorney reasonably believes that 7 the respondent, due to diminished capacity, cannot make an 8 adequately considered waiver decision. “Good cause” for finding 9 that the testimony of the licensed physician or qualified 10 mental health professional who examined the respondent is not 11 necessary may include but is not limited to such a waiver. 12 If the court determines that the testimony of the licensed 13 physician or qualified mental health professional is necessary, 14 the court may allow the licensed physician or the qualified 15 mental health professional to testify by telephone. 16 Sec. 63. Section 229.15, subsection 3, paragraph a, Code 17 2011, is amended to read as follows: 18 a. A psychiatric advanced registered nurse practitioner 19 treating a patient previously hospitalized under this chapter 20 may complete periodic reports pursuant to this section on the 21 patient if the patient has been recommended for treatment on 22 an outpatient or other appropriate basis pursuant to section 23 229.14, subsection 1 , paragraph “c” , and if a psychiatrist 24 licensed pursuant to chapter 148 personally evaluates the 25 patient on at least an annual basis . 26 Sec. 64. Section 229.21, subsection 2, Code 2011, is amended 27 to read as follows: 28 2. When an application for involuntary hospitalization 29 under this chapter or an application for involuntary commitment 30 or treatment of chronic substance abusers persons with 31 substance-related disorders under sections 125.75 to 125.94 is 32 filed with the clerk of the district court in any county for 33 which a judicial hospitalization referee has been appointed, 34 and no district judge, district associate judge, or magistrate 35 -45- LSB 2002HZ (3) 84 jp/rj 45/ 57
H.F. 689 who is admitted to the practice of law in this state is 1 accessible, the clerk shall immediately notify the referee in 2 the manner required by section 229.7 or section 125.77 . The 3 referee shall discharge all of the duties imposed upon the 4 court by sections 229.7 to 229.22 or sections 125.75 to 125.94 5 in the proceeding so initiated. Subject to the provisions 6 of subsection 4 , orders issued by a referee, in discharge of 7 duties imposed under this section , shall have the same force 8 and effect as if ordered by a district judge. However, any 9 commitment to a facility regulated and operated under chapter 10 135C , shall be in accordance with section 135C.23 . 11 Sec. 65. Section 229.21, subsection 3, paragraphs a and b, 12 Code 2011, are amended to read as follows: 13 a. Any respondent with respect to whom the magistrate or 14 judicial hospitalization referee has found the contention that 15 the respondent is seriously mentally impaired or a chronic 16 substance abuser person with a substance-related disorder 17 sustained by clear and convincing evidence presented at a 18 hearing held under section 229.12 or section 125.82 , may appeal 19 from the magistrate’s or referee’s finding to a judge of the 20 district court by giving the clerk notice in writing, within 21 ten days after the magistrate’s or referee’s finding is made, 22 that an appeal is taken. The appeal may be signed by the 23 respondent or by the respondent’s next friend, guardian, or 24 attorney. 25 b. An order of a magistrate or judicial hospitalization 26 referee with a finding that the respondent is seriously 27 mentally impaired or a chronic substance abuser person with a 28 substance-related disorder shall include the following notice, 29 located conspicuously on the face of the order: 30 NOTE: The respondent may appeal from this order to a judge of 31 the district court by giving written notice of the appeal to 32 the clerk of the district court within ten days after the date 33 of this order. The appeal may be signed by the respondent or 34 by the respondent’s next friend, guardian, or attorney. For a 35 -46- LSB 2002HZ (3) 84 jp/rj 46/ 57
H.F. 689 more complete description of the respondent’s appeal rights, 1 consult section 229.21 of the Code of Iowa or an attorney. 2 Sec. 66. Section 229.21, subsection 4, Code 2011, is amended 3 to read as follows: 4 4. If the appellant is in custody under the jurisdiction 5 of the district court at the time of service of the notice of 6 appeal, the appellant shall be discharged from custody unless 7 an order that the appellant be taken into immediate custody has 8 previously been issued under section 229.11 or section 125.81 , 9 in which case the appellant shall be detained as provided in 10 that section until the hospitalization or commitment hearing 11 before the district judge. If the appellant is in the custody 12 of a hospital or facility at the time of service of the notice 13 of appeal, the appellant shall be discharged from custody 14 pending disposition of the appeal unless the chief medical 15 officer, not later than the end of the next secular day on 16 which the office of the clerk is open and which follows service 17 of the notice of appeal, files with the clerk a certification 18 that in the chief medical officer’s opinion the appellant 19 is seriously mentally ill or a substance abuser person with 20 a substance-related disorder . In that case, the appellant 21 shall remain in custody of the hospital or facility until the 22 hospitalization or commitment hearing before the district 23 court. 24 Sec. 67. Section 230.15, unnumbered paragraph 2, Code 2011, 25 is amended to read as follows: 26 A substance abuser or chronic substance abuser person 27 with a substance-related disorder is legally liable for the 28 total amount of the cost of providing care, maintenance, and 29 treatment for the substance abuser or chronic substance abuser 30 person with a substance-related disorder while a voluntary or 31 committed patient. When a portion of the cost is paid by a 32 county, the substance abuser or chronic substance abuser person 33 with a substance-related disorder is legally liable to the 34 county for the amount paid. The substance abuser or chronic 35 -47- LSB 2002HZ (3) 84 jp/rj 47/ 57
H.F. 689 substance abuser person with a substance-related disorder 1 shall assign any claim for reimbursement under any contract 2 of indemnity, by insurance or otherwise, providing for the 3 abuser’s person’s care, maintenance, and treatment in a state 4 hospital to the state. Any payments received by the state from 5 or on behalf of a substance abuser or chronic substance abuser 6 person with a substance-related disorder shall be in part 7 credited to the county in proportion to the share of the costs 8 paid by the county. Nothing in this section shall be construed 9 to prevent a relative or other person from voluntarily paying 10 the full actual cost or any portion of the care and treatment 11 of any person with mental illness , substance abuser, or chronic 12 substance abuser or a substance-related disorder as established 13 by the department of human services. 14 Sec. 68. Section 232.116, subsection 1, paragraph l, 15 subparagraph (2), Code 2011, is amended to read as follows: 16 (2) The parent has a severe , chronic substance abuse 17 problem, substance-related disorder and presents a danger to 18 self or others as evidenced by prior acts. 19 Sec. 69. Section 600A.8, subsection 8, paragraph a, Code 20 2011, is amended to read as follows: 21 a. The parent has been determined to be a chronic substance 22 abuser person with a substance-related disorder as defined 23 in section 125.2 and the parent has committed a second or 24 subsequent domestic abuse assault pursuant to section 708.2A . 25 Sec. 70. Section 602.4201, subsection 3, paragraph h, Code 26 2011, is amended to read as follows: 27 h. Involuntary commitment or treatment of substance abusers 28 persons with a substance-related disorders . 29 Sec. 71. CONFORMING PROVISIONS. The legislative services 30 agency shall prepare a study bill for consideration by the 31 committee on human resources of the senate and the house of 32 representatives for the 2012 legislative session, providing any 33 addition necessary conforming Code changes for implementation 34 of the provisions of this division of this Act. 35 -48- LSB 2002HZ (3) 84 jp/rj 48/ 57
H.F. 689 Sec. 72. EFFECTIVE DATE. This division of this Act takes 1 effect July 1, 2012. 2 EXPLANATION 3 This bill relates to mental health and disability services 4 and substance-related disorders and mental illness commitment 5 proceedings and makes appropriations. The bill is organized 6 into divisions. 7 SERVICES SYSTEM REDESIGN —— FUNDING. This division states 8 legislative intent to redesign the services system for mental 9 health, intellectual and other developmental disabilities, and 10 brain injury over the next several years. 11 2011 Iowa Acts, Senate File 209, provides for the repeal of 12 the statutory authority for significant elements of the county 13 administered adult mental health and intellectual and other 14 developmental disability services effective July 1, 2013. 15 The division states legislative intent to implement the 16 redesign by having the department of human services assume 17 responsibility for administering publicly funded mental health 18 services for adults and children beginning on July 1, 2012. 19 The legislative council is requested to authorize a 20 legislative interim committee during the 2011 legislative 21 interim to develop a plan for the mental health services 22 redesign for consideration by the general assembly in the 2012 23 legislative session. The plan is required to identify clear 24 definitions and requirements for core services, outcomes that 25 focus on consumer needs, and various other elements of the 26 system. 27 The departments of human services and public health are 28 required to develop and submit proposals relating to services 29 addressing co-occurring mental health and substance abuse 30 disorders and to address service provider shortages, including 31 barriers to recruiting providers. The departments are required 32 to submit the proposals to the governor and general assembly 33 on or before December 15, 2011. 34 The legislative council is also requested to either 35 -49- LSB 2002HZ (3) 84 jp/rj 49/ 57
H.F. 689 continue the 2011 legislative interim committee or authorize 1 a different legislative interim committee to meet during 2 the 2012 legislative interim to develop a redesign plan for 3 the department of human services to assume responsibility 4 for administration of intellectual and other developmental 5 disabilities and brain injury services. The plan is to include 6 elements similar to the plan for mental health services and is 7 to be submitted for consideration and enactment in the 2013 8 legislative session. 9 A directive is provided for continuation of the judicial 10 branch and department of human services workgroup which met 11 during the 2010 legislative interim to improve the processes 12 for involuntary commitment for substance abuse under Code 13 chapter 125 and serious mental illness under Code chapter 229. 14 Additional recommendation requirements are added along with a 15 requirement to report by December 15, 2011. 16 The departments of human services and public health, and 17 the community services affiliate of the Iowa state association 18 of counties are required to agree on implementation of an 19 integrated data and statistical information system for mental 20 health, disability, and substance abuse services and report to 21 the governor and representatives of the legislative branch by 22 December 15, 2011. 23 New Code section 225C.7A, creates a new disability services 24 system redesign savings fund to which savings resulting from 25 implementation of services system efficiencies are to be 26 credited. Moneys in the fund are required to be appropriated 27 to implement services system improvements. 28 APPROPRIATIONS AND CONFORMING PROVISIONS. This division 29 addresses conforming statutory provisions and provides 30 appropriations. 31 The legislative services agency is required to prepare a 32 study bill for the committees on human resources of the senate 33 and house of representatives for the 2012 legislative session 34 providing any conforming Code changes for implementation of the 35 -50- LSB 2002HZ (3) 84 jp/rj 50/ 57
H.F. 689 sytem redesign provisions contained in the bill. 1 In 2011 Iowa Acts, Senate File 209, an appropriation was made 2 from the general fund of the state for fiscal year 2010-2011 3 to the property tax relief to be distributed in accordance 4 with a later enactment. The bill provides for the Senate File 5 209 appropriation to be credited to the risk pool within the 6 property tax relief fund. The risk pool board is required 7 to implement a distribution process that will ensure there 8 is sufficient funding to eliminate the need for continuing, 9 instituting, or reinstituting waiting lists for services 10 covered under county service management plans through June 30, 11 2012. 12 An appropriation is provided to the department of human 13 services for costs associated with implementation of the 14 division. 15 The division takes effect upon enactment. 16 PSYCHIATRIC MEDICAL INSTITUTIONS FOR CHILDREN. This 17 division relates to psychiatric medical institutions for 18 children (PMICs). 19 Code section 135H.3, relating to the nature of care 20 provided, is amended to provide that the membership of the team 21 of professionals utilized by a PMIC may include an advanced 22 registered nurse practitioner. 23 Code section 135H.6, relating to conditions for issuance of 24 a PMIC license, is amended to provide that the requirement for 25 a certificate of need and the limitation on the number of beds 26 statewide for PMICs does not apply to beds for children who do 27 not reside in this state and whose service costs are not paid 28 by public funds in this state. 29 Code section 249A.31, relating to cost-based reimbursement 30 under the medical assistance (Medicaid) program, is amended to 31 provide that effective July 1, 2012, Medicaid reimbursement for 32 PMIC providers will be provided in accordance with the managed 33 care contract for authorizing PMIC services. 34 The department of human services is required to issue a 35 -51- LSB 2002HZ (3) 84 jp/rj 51/ 57
H.F. 689 request for proposals to procure a contractor to authorize, 1 reimburse, and mange PMIC benefits under the Medicaid program. 2 The department is prohibited from procuring the contract 3 through a sole source or other limited selection process. 4 The department of human services is required to work with the 5 department of inspections and appeals to develop a second level 6 of PMIC care for children in need of more intensive treatment. 7 Limitations on numbers of level 2 beds and providers are 8 applicable. 9 MEDICATION THERAPY MANAGEMENT. This division relates to 10 implementation of medication therapy management provisions 11 under the Medicaid program in new Code section 249A.20B. The 12 department of human services is required to implement the 13 provisions through a request for proposals process to select a 14 contractor beginning July 1, 2012. 15 Criteria for participation by individuals who take a number 16 of prescription drugs, fees and reimbursement provisions, and 17 definitions are included. 18 The division takes effect upon enactment. 19 COMMUNITY MENTAL HEALTH CENTERS. This division relates to 20 the requirements of community mental health centers under Code 21 chapter 230A and repeals and replaces Code chapter 230A which 22 was originally enacted by 1974 Iowa Acts, chapter 1160. 23 The division maintains the requirements under current law 24 for accreditation of community mental health centers to be 25 performed by the department of human services (DHS), division 26 of mental health and disability services, in accordance 27 with standards adopted by the mental health and disability 28 services commission. 2008 Iowa Acts, chapter 1187, required 29 the division to utilize an advisory group to develop a 30 proposal for revising Code chapter 230A and for revising the 31 accreditation process for centers. Until the proposal has been 32 considered and acted upon by the general assembly, the division 33 administrator is authorized to defer consideration of requests 34 for accreditation of a new community mental health center or 35 -52- LSB 2002HZ (3) 84 jp/rj 52/ 57
H.F. 689 for approval of a provider to fill the role of a center. The 1 proposal was submitted to the governor and general assembly 2 April 17, 2009. The division provides for implementation of 3 the proposal. 4 The current Code chapter provides for community mental 5 health centers to either be directly established by a county 6 or counties and administered by a board of trustees or by 7 establishment of a nonprofit corporation operating on the basis 8 of an agreement with a county or counties. Code section 225C.7 9 allows the department of human services to authorize the center 10 services to be provided by an alternative provider. 11 The division of the bill replaces this approach by requiring 12 the mental health and disability services division and 13 commission to identify catchment areas of counties to be served 14 by a center. The general requirement is for one center to be 15 designated to serve a catchment area but more than one can 16 be designated if exceptional circumstances outlined in the 17 division are determined to exist. 18 New Code section 230A.101 describes the regulatory and 19 policy role to be filled by the department and the service 20 provider role of the community mental health centers. 21 New Code section 230A.102 provides definitions. These 22 terms, defined in Code chapter 225C, are adopted by reference: 23 “administrator” (administrator of MH and disability services 24 division), “commission” (mental health and disability services 25 commission), “department” (DHS), “disability services” 26 (services and other support available to a person with mental 27 illness, MR or other developmental disability or brain injury), 28 and “division” (MH and disability services division). In 29 addition, the terms “community mental health center” and 30 “catchment area” are defined to reflect the contents of the 31 division. 32 New Code section 230A.103 provides criteria to be 33 implemented by the division for designation of at least one 34 community mental health center to serve a catchment area 35 -53- LSB 2002HZ (3) 84 jp/rj 53/ 57
H.F. 689 consisting of a county or counties. Various operating and 1 services requirements are to be addressed in the terms of an 2 agreement between the designated center, the division, and the 3 counties comprising the catchment area. 4 New Code section 230A.104 provides for the division to 5 implement objective criteria for identifying catchment areas 6 for centers. A general limitation of one center per catchment 7 area is stated, however, the criteria are to include a formal 8 review process for use in determining whether exceptional 9 circumstances exist for designating more than one center 10 for a catchment area. The other stated criteria involve 11 determinations of financial viability for a center to operate. 12 New Code section 230A.105 lists the characteristics of the 13 target population required to be served by a center. The 14 list includes individuals of any age experiencing a mental 15 health crisis or disorder, adults who have a serious or chronic 16 mental illness, children and youth experiencing a serious 17 emotional disturbance, and listed individuals who also have a 18 co-occurring disorder. The specific clinical and financial 19 eligibility criteria are required to be identified in rules 20 adopted by the commission. 21 New Code section 230A.106 requires each designated center 22 to offer core services and support addressing the basic mental 23 health and safety needs of the target population and other 24 residents of the catchment area. The core services are to be 25 identified in rules adopted by the commission. 26 An initial list of core services is specified to include the 27 following: outpatient services; 24-hour emergency services; 28 day treatment, partial hospitalization, or psychological 29 rehabilitation services; admission screening for voluntary 30 patients; community support services; consultation services; 31 and education services. 32 In addition, a center is responsible for coordinating 33 associated services provided by other unaffiliated agencies to 34 members of the target population and for integrating services 35 -54- LSB 2002HZ (3) 84 jp/rj 54/ 57
H.F. 689 provided to the target population in residential or inpatient 1 settings. 2 New Code section 230A.107 requires a designated center to be 3 organized as a nonprofit corporation. However, a for-profit 4 corporation, nonprofit corporation, or county hospital 5 providing services under a waiver approved as of October 1, 6 2010, may also be designated. 7 New Code section 230A.108 requires release of 8 administrative, diagnostic, and demographic information as a 9 condition of support by any of the counties in the catchment 10 area served by a center. Language with a similar requirement 11 is part of current law in Code section 230A.13, relating to 12 annual budgets of centers. 13 New Code section 230A.109 states legislative intent 14 regarding provision of federal and state funding supporting 15 centers and for the amount of funding to be sufficient for 16 core services to be provided regardless of an individual’s 17 ability to pay for the services. This section also states that 18 provision of services is subject to the availability of payment 19 sources for the services. 20 New Code section 230A.110 provides for accreditation 21 standards for centers to be recommended by the division 22 and adopted by the commission. The standards are to be in 23 substantial conformity with certain national standards. The 24 division is directed to use an advisory committee to assist in 25 standards development. In addition, the standards recommended 26 are required to include various organizational requirements. 27 New Code section 230A.111 addresses how the review and 28 evaluation components of the accreditation process are to be 29 performed. 30 An implementation section authorizes centers operating 31 under current law as of June 30, 2012, to continue operating 32 until the rules are adopted, catchment areas are identified, 33 and centers are designated, as required by the division of the 34 bill. The division and commission are required to complete 35 -55- LSB 2002HZ (3) 84 jp/rj 55/ 57
H.F. 689 those requirements on or before June 30, 2012. 1 Except for the requirement for the division and commission 2 to develop administrative rules, which takes effect July 1, 3 2011, the division takes effect July 1, 2012. 4 PERSONS WITH SUBSTANCE-RELATED DISORDERS AND PERSONS 5 WITH MENTAL ILLNESS. This division makes various changes 6 to Code chapters 125 (chemical substance abuse) and 229 7 (hospitalization of persons with mental illness). 8 Code chapter 125: The division replaces the terms “chemical 9 dependency”, “chronic substance abuser”, and “substance abuser” 10 in Code chapter 125 with the terms “substance-related disorder” 11 or “person with a substance-related disorder”, and makes 12 conforming Code changes. A “substance-related disorder” is 13 defined as a diagnosable substance abuse disorder of sufficient 14 duration to meet diagnostic criteria specified within the 15 most current diagnostic and statistical manual of mental 16 disorders published by the American psychiatric association 17 that results in a functional impairment. The division also 18 replaces the term “intoxicated person” with the term “a 19 person with a substance-related disorder due to intoxication 20 or substance-induced intoxication” and makes conforming Code 21 changes. 22 The division provides that a peace officer who 23 has reasonable grounds to believe that a person with 24 a substance-related disorder due to intoxication or 25 substance-induced incapacitation who has threatened or 26 inflicted physical self-harm or harm on another person in an 27 emergency situation who also demonstrates a significant degree 28 or distress or dysfunction may be delivered to a facility by 29 someone other than a peace officer upon a showing of reasonable 30 grounds. 31 New Code section 125.95 provides for the appointment 32 of an advocate to represent the interests of persons with 33 substance-related disorders in any matter relating to the 34 person’s commitment for treatment, either by the county board 35 -56- LSB 2002HZ (3) 84 jp/rj 56/ 57
H.F. 689 of supervisors or the chief judge of the appropriate judicial 1 district. The advocate’s duties include reviewing reports, 2 visiting the person who has been committed, communicating with 3 medical personnel treating the person, and filing reports with 4 the court. The advocate shall receive reasonable compensation 5 for the advocate’s services. 6 Code chapter 229: The division replaces the term “qualified 7 mental health professional” with the term “mental health 8 professional”, defined as an individual who holds at least a 9 master’s degree in a mental health field, including but not 10 limited to psychology, counseling and guidance, nursing, and 11 social work, or the individual is a physician and surgeon or an 12 osteopathic physician and surgeon, holds a current Iowa license 13 if practicing in a field covered by an Iowa licensure law, and 14 has at least two years of post-degree clinical experience, 15 supervised by another mental health professional, in assessing 16 mental health needs and problems and in providing appropriate 17 mental health services. This definition is the same 18 definition for a mental health professional contained in Code 19 section 228.1 (disclosure of mental health and psychological 20 information). 21 The division provides in Code section 229.10, relating to 22 physician’s examination and report, that a person who is the 23 subject of an application for involuntary hospitalization who 24 has declined to be examined pursuant to court order may be 25 ordered by the court to be detained for not more than a 23-hour 26 period to facilitate the examination. The court may also order 27 that payment be made to the appropriate provider for services 28 associated with the detention. 29 Code section 229.15, relating to periodic reports required 30 by care providers, is amended to eliminate a requirement for 31 patients receiving outpatient treatment from an advanced 32 registered nurse practitioner to have an annual personal 33 evaluation from a psychiatrist. 34 The division takes effect July 1, 2012. 35 -57- LSB 2002HZ (3) 84 jp/rj 57/ 57
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