Bill Text: IA HF690 | 2019-2020 | 88th General Assembly | Enrolled

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Bill Title: A bill for an act relating to mental health and disability services, including the establishment of a children's behavioral health system and a children's behavioral health system state board, and requiring certain children's behavioral health core services. (Formerly HSB 206.) Effective 7-1-19.

Spectrum: Committee Bill

Status: (Passed) 2019-05-01 - Signed by Governor. H.J. 1083. [HF690 Detail]

Download: Iowa-2019-HF690-Enrolled.html

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House File 690 - Enrolled
House File 690
AN ACT
RELATING TO MENTAL HEALTH AND DISABILITY SERVICES, INCLUDING
THE ESTABLISHMENT OF A CHILDREN’S BEHAVIORAL HEALTH SYSTEM
AND A CHILDREN’S BEHAVIORAL HEALTH SYSTEM STATE BOARD,
AND REQUIRING CERTAIN CHILDREN’S BEHAVIORAL HEALTH CORE
SERVICES.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
Section 1. Section 225C.2, Code 2019, is amended by adding
the following new subsections:
NEW SUBSECTION . 1A. “Child” or “children” means a person or
persons under eighteen years of age.
NEW SUBSECTION . 1B. “Children’s behavioral health
services” means services for children with a serious emotional
disturbance.
NEW SUBSECTION . 1C. “Children’s behavioral health system” or
“children’s system” means the behavioral health service system
for children implemented pursuant to this subchapter.
NEW SUBSECTION . 11. “Serious emotional disturbance” means
a diagnosable mental, behavioral, or emotional disorder of
sufficient duration to meet diagnostic criteria specified
within the most current diagnostic and statistical manual
of mental disorders published by the American psychiatric
association that results in a functional impairment. “Serious
emotional disturbance” does not include substance use and
developmental disorders unless such disorders co-occur with
such a diagnosable mental, behavioral, or emotional disorder.

House File 690, p. 2
NEW SUBSECTION . 12. “State board” means the children’s
behavioral health system state board created in section
225C.51.
Sec. 2. Section 225C.2, subsection 9, Code 2019, is amended
by striking the subsection.
Sec. 3. Section 225C.4, subsection 1, Code 2019, is amended
by adding the following new paragraph:
NEW PARAGRAPH . 0c. Assist the state board in planning for
community-based children’s behavioral health services.
Sec. 4. Section 225C.4, subsection 1, paragraphs d and j,
Code 2019, are amended to read as follows:
d. Encourage and facilitate coordination of mental health
and disability services with the objective of developing and
maintaining in the state a mental health and disability service
delivery system to provide disability services to all persons
in this state who need the services, regardless of the place
of residence or economic circumstances of those persons. The
administrator shall work with the commission and other state
agencies, including but not limited to the departments of
corrections, education, and public health and the state board
of regents, to develop and implement a strategic plan to expand
access to qualified mental health workers across the state.
j. Establish and maintain a data collection and management
information system oriented to the needs of patients,
providers, the department, and other programs or facilities in
accordance with section 225C.6A . The system shall be used to
identify, collect, and analyze service outcome and performance
measures data in order to assess the effects of the services on
the persons utilizing the services. The administrator shall
annually submit to the commission information collected by the
department indicating the changes and trends in the mental
health and disability services system. The administrator shall
make the outcome data available to the public.
Sec. 5. Section 225C.4, subsection 1, Code 2019, is amended
by adding the following new paragraphs:
NEW PARAGRAPH . 0k. Encourage and facilitate coordination
of children’s behavioral health services with the objective of
developing and maintaining in the state a children’s behavioral
health system to provide behavioral health services to all

House File 690, p. 3
children in this state who need the services, regardless of the
place of residence or economic circumstances of those children.
The administrator shall work with the state board and other
state agencies including but not limited to the department of
education and the department of public health to develop and
implement a strategic plan to expand access to qualified mental
health workers across the state.
NEW PARAGRAPH . 00k. Establish and maintain a data
collection and management information system oriented to the
needs of children utilizing the children’s behavioral health
system, providers, the department, and other programs or
facilities in accordance with section 225C.6A. The system
shall be used to identify, collect, and analyze service
outcome and performance measures data in order to assess the
effects of the services on the children utilizing the services.
The administrator shall annually submit to the state board
information collected by the department indicating the changes
and trends in the children’s behavioral health system. The
administrator shall make the outcome data available to the
public.
Sec. 6. Section 225C.4, subsection 1, paragraph u, Code
2019, is amended by adding the following new subparagraph:
NEW SUBPARAGRAPH . (9) School attendance.
Sec. 7. Section 225C.6B, subsection 3, Code 2019, is amended
by adding the following new paragraph:
NEW PARAGRAPH . c. Children’s behavioral health services
provided to eligible children that are not covered under the
medical assistance program or other third-party payor are the
responsibility of the county-based regional service system.
Sec. 8. NEW SECTION . 225C.51 Children’s behavioral health
system state board.
1. A children’s behavioral health system state board
is created as the state body to provide guidance on the
implementation and management of a children’s behavioral health
system for the provision of services to children with a serious
emotional disturbance. The state board’s public voting members
shall be appointed to four-year staggered terms by the governor
and are subject to confirmation by the senate. All other
state board voting members shall be appointed to four-year

House File 690, p. 4
staggered terms and are not subject to confirmation by the
senate. State board members shall be appointed on the basis of
interest and experience in the fields of children’s behavioral
health to ensure adequate representation from persons with life
experiences and from persons knowledgeable about children’s
behavioral health services. The department shall provide
support to the state board, and the board may utilize staff
support and other assistance provided to the state board by
other persons. The state board shall meet at least four times
per year. The membership of the state board shall consist of
the following persons who, at the time of appointment to the
state board, are active members of the indicated groups:
a. The director of the department or the director’s
designee.
b. The director of the department of education or the
director’s designee.
c. The director of the department of public health or the
director’s designee.
d. The director of workforce development or the director’s
designee.
e. One member shall be selected from nominees submitted by
the state court administrator.
f. One member shall be selected from nominees submitted
by the early childhood Iowa office in the department of
management.
g. One member shall be a member of the mental health and
disability services commission.
h. One member shall be a board member or an employee of a
provider of mental health services to children.
i. One member shall be a board member or an employee of a
provider of child welfare services.
j. One member shall be an administrator of an area education
agency.
k. One member shall be an educator, counselor, or
administrator of a school district.
l. One member shall be a representative of an established
advocacy organization whose mission or purpose it is, in part,
to further goals related to children’s mental health.
m. One member shall be a parent or guardian of a child

House File 690, p. 5
currently utilizing or who has utilized behavioral health
services.
n. One member shall be a sheriff.
o. One member shall be a pediatrician.
p. One member shall be a representative from a health care
system.
q. One member shall be a chief executive officer of a mental
health and disability services region.
r. In addition to the voting members, the membership shall
include four members of the general assembly with one member
designated by each of the following: the majority leader of
the senate, the minority leader of the senate, the speaker of
the house of representatives, and the minority leader of the
house of representatives. A legislative member serves for a
term as provided in section 69.16B in a nonvoting, ex officio
capacity and is not eligible for per diem and expenses as
provided in section 2.10.
2. The four-year terms shall begin and end as provided in
section 69.19. Vacancies on the state board shall be filled as
provided in section 2.32. A member shall not be appointed for
more than two consecutive four-year terms.
3. The director and the director of the department of
education, or their designees, shall serve as co-chairpersons
of the state board. Board members shall not be entitled to a
per diem as specified in section 7E.6 and shall not be entitled
to actual and necessary expenses incurred while engaged in
their official duties.
Sec. 9. NEW SECTION . 225C.52 Children’s behavioral health
system state board —— duties.
To the extent funding is available, the state board shall
perform the following duties:
1. Advise the administrator on the administration of the
children’s behavioral health system.
2. Provide consultation services to agencies regarding
the development of administrative rules for the children’s
behavioral health system.
3. Identify behavioral health outcomes and indicators for
eligible children with a serious emotional disturbance to
promote children living with their own families and in the

House File 690, p. 6
community.
4. Submit a written report on or before December 1 of each
year to the governor and the general assembly. At a minimum,
the report shall include a summary of all activities undertaken
by the state board, a summary of state board activities,
and results from identified behavioral health outcomes and
indicators for the children’s behavioral health system.
Sec. 10. Section 331.388, Code 2019, is amended by adding
the following new subsections:
NEW SUBSECTION . 01. “Children’s behavioral health services”
means the same as defined in section 225C.2.
NEW SUBSECTION . 4A. “Serious emotional disturbance” means
the same as defined in section 225C.2.
NEW SUBSECTION . 4B. “State board” means the children’s
system state board created in section 225C.51.
Sec. 11. Section 331.390, subsection 2, Code 2019, is
amended by striking the subsection and inserting in lieu
thereof the following:
2. The governing board shall comply with all of the
following requirements:
a. The voting membership of the governing board shall
consist of at least one board of supervisors member from each
county comprising the region or their designees.
b. The membership of the governing board shall also include
one adult person who utilizes mental health and disability
services or is an actively involved relative of such an adult
person. This member shall be designated by the regional
advisory committee formed by the governing board pursuant to
paragraph “h” .
c. The membership of the governing board shall not include
employees of the department of human services or an unelected
employee of a county.
d. The membership of the governing board shall also consist
of one member representing adult service providers in the
region. This member shall be designated by the regional
advisory committee formed by the governing board pursuant to
paragraph “h” . The member designated in accordance with this
paragraph shall serve in a nonvoting, ex officio capacity.
e. The membership of the governing board shall also

House File 690, p. 7
consist of one member representing children’s behavioral
health services providers in the region. This member shall be
designated by the regional children’s advisory committee formed
by the governing board pursuant to paragraph “i” . The member
designated in accordance with this paragraph shall serve in a
nonvoting, ex officio capacity.
f. The membership of the governing board shall also consist
of one member representing the education system in the region.
This member shall be designated by the regional children’s
advisory committee formed by the governing board pursuant to
paragraph “i” .
g. The membership of the governing board shall also
consist of one member who is a parent of a child who utilizes
children’s behavioral health services or actively involved
relatives of such children. This member shall be designated
by the regional children’s advisory committee formed by the
governing board pursuant to paragraph “i” .
h. The governing board shall have a regional advisory
committee consisting of adults who utilize services or actively
involved relatives of such adults, service providers, and
regional governing board members.
i. The governing board shall have a regional children’s
advisory committee consisting of parents of children who
utilize services or actively involved relatives of such
children, a member of the education system, an early childhood
advocate, a child welfare advocate, a children’s behavioral
health service provider, a member of the juvenile court, a
pediatrician, a child care provider, a local law enforcement
representative, and regional governing board members.
Sec. 12. Section 331.390, subsection 3, paragraph b, Code
2019, is amended to read as follows:
b. The regional administrator staff shall include one or
more coordinators of mental health and disability services
and one or more coordinators of children’s behavioral
health services . A coordinator shall possess a bachelor’s
or higher level degree in a human services-related or
administration-related field, including but not limited
to social work, psychology, nursing, or public or business
administration, from an accredited college or university.

House File 690, p. 8
However, in lieu of a degree in public or business
administration, a coordinator may provide documentation of
relevant management experience. An action of a coordinator
involving a clinical decision shall be made in conjunction with
a professional who is trained in the delivery of the mental
health or disability service or children’s behavioral health
service addressed by the clinical decision. The regional
administrator shall determine whether referral to a coordinator
of mental health and disability services or children’s
behavioral health services is required for a person or child
seeking to access a service through a local access point of the
regional service system or the children’s behavioral health
system .
Sec. 13. Section 331.393, subsection 2, Code 2019, is
amended by adding the following new paragraphs:
NEW PARAGRAPH . i. The scope of children’s behavioral health
core services. Each service included shall be described and a
projection of need shall be included.
NEW PARAGRAPH . j. The eligibility requirements for
children’s behavioral health core services under the children’s
behavioral health system.
Sec. 14. Section 331.393, subsection 4, paragraph g,
subparagraph (1), Code 2019, is amended to read as follows:
(1) Performance and outcome measures relating to the
health, safety, education, work performance, and community
residency of the persons receiving the services.
Sec. 15. Section 331.396, subsection 1, paragraph b, Code
2019, is amended to read as follows:
b. The person is at least eighteen years of age and is a
resident of this state. However, a person who is seventeen
years of age, is a resident of this state, and is receiving
publicly funded children’s services may be considered eligible
for services through the regional service system during the
three-month period preceding the person’s eighteenth birthday
in order to provide a smooth transition from children’s to
adult services.
Sec. 16. Section 331.396, subsection 1, paragraph d, Code
2019, is amended by striking the paragraph.
Sec. 17. NEW SECTION . 331.396A Eligibility requirements ——

House File 690, p. 9
children’s behavioral health services.
A child shall be eligible for behavioral health services
under the regional service system if all of the following
conditions are met:
1. The child is under eighteen years of age and is a
resident of this state.
2. The child has been diagnosed with a serious emotional
disturbance.
3. a. The child’s family has a family income equal to or
less than five hundred percent of the federal poverty level as
defined by the most recently revised poverty income guidelines
published by the United States department of health and human
services.
b. Notwithstanding paragraph “a” , a child’s family whose
household income is between one hundred fifty percent but not
more than five hundred percent of the federal poverty level
shall be eligible for behavioral health services subject to
a copayment, a single statewide sliding fee scale, or other
cost-sharing requirements approved by the department.
Sec. 18. NEW SECTION . 331.397A Children’s behavioral health
core services.
1. For the purposes of this section, unless the context
otherwise requires, “domain” means a set of similar behavioral
health services that can be provided depending on a child’s
service needs.
2. a. (1) A region shall work with children’s behavioral
health service providers to ensure that services in the
required behavioral health core service domains in subsection
4 are available to children who are residents of the region,
regardless of any potential payment source for the services.
(2) Subject to the available appropriations, the director
of human services shall ensure the behavioral health core
service domains listed in subsection 4 are covered services
for the medical assistance program under chapter 249A to the
greatest extent allowable under federal regulations. The
medical assistance program shall reimburse Medicaid enrolled
providers for Medicaid covered services under subsection 4 when
the services are medically necessary, the Medicaid enrolled
provider submits an appropriate claim for such services, and

House File 690, p. 10
no other third-party payor is responsible for reimbursement
of such services. Within the funds available, the region
shall pay for such services for eligible children when payment
through the medical assistance program or another third-party
payment is not available, unless the child is on a waiting list
for such payment or it has been determined that the child does
not meet the eligibility criteria for any such service.
b. Until funding is designed for other service populations,
eligibility for the service domains listed in this section
shall be limited to such children who are in need of behavioral
health services.
3. Pursuant to recommendations made by the state board, the
department of human services shall adopt rules to define the
services included in the core domains listed in this section.
The rules shall provide service definitions, service provider
standards, service access standards, and service implementation
dates, and shall provide consistency, to the extent possible,
with similar service definitions under the medical assistance
program.
4. The children’s behavioral health core service domains
shall include all of the following:
a. Treatment designed to ameliorate a child’s serious
emotional disturbance, including but not limited to all of the
following:
(1) Prevention, early identification, early intervention,
and education.
(2) Assessment and evaluation relating to eligibility for
services.
(3) Medication prescribing and management.
(4) Behavioral health outpatient therapy.
b. Comprehensive facility and community-based crisis
services regardless of a diagnosis of a serious emotional
disturbance, including all of the following:
(1) Mobile response.
(2) Crisis stabilization community-based services.
(3) Crisis stabilization residential services.
(4) Behavioral health inpatient treatment.
5. A region shall ensure that services within the following
additional core service domains are available to children not

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eligible for the medical assistance program under chapter 249A
or receiving other third-party payment for the services, when
public funds are made available for such services:
a. Treatment designed to ameliorate a child’s serious
emotional disturbance including but not limited to behavioral
health school-based therapy.
b. Support for community living including but not limited
to all of the following:
(1) Family support.
(2) Peer support.
(3) Therapeutic foster care.
(4) Respite care.
c. Transition services for children to the adult mental
health system providing an appropriate match with a child’s
abilities based upon informed, person-centered choices made
from an array of options including but not limited to all of
the following:
(1) Day habilitation.
(2) Job development.
(3) Supported employment.
(4) Prevocational services.
(5) Educational services.
d. Service coordination including physical health and
primary care that follow the principles of the system of care
including but not limited to all of the following:
(1) Care coordination.
(2) Health homes.
Sec. 19. DEPARTMENT OF HUMAN SERVICES AND DEPARTMENT OF
PUBLIC HEALTH —— CRISIS HOTLINE. The department of human
services and the department of public health shall provide
a single, statewide twenty-four-hour crisis hotline that
incorporates information for families of children with a
serious emotional disturbance which may be provided through
expansion of the YourLifeIowa platform.
Sec. 20. MENTAL HEALTH AND DISABILITY SERVICES REGION
—— CHILDREN’S BEHAVIORAL HEALTH SERVICES IMPLEMENTATION
PLAN. Each mental health and disability services region shall
submit to the department of human services an implementation
plan to implement children’s behavioral health services

House File 690, p. 12
described under section 331.397A, as enacted in this Act, no
later than April 1, 2020.
Sec. 21. DEPARTMENT OF HUMAN SERVICES —— RULES. The
department of human services shall submit a notice of intended
action to the administrative rules coordinator and the
Iowa administrative code editor pursuant to section 17A.4,
subsection 1, paragraph “a”, not later than January 1, 2020,
for the adoption of rules to implement this Act.
Sec. 22. REPEAL. Sections 225C.51, 225C.52, 225C.53, and
225C.54, Code 2019, are repealed.
Sec. 23. CODE EDITOR’S DIRECTIVES. The Code editor may
change the current subchapter title of chapter 225C, subchapter
VI, to “CHILDREN’S BEHAVIORAL HEALTH SYSTEM”.
The Code editor may change the current subchapter title of
chapter 331, part 6, to “MENTAL HEALTH AND DISABILITY SERVICES
—— REGIONAL SERVICE SYSTEM —— CHILDREN’S BEHAVIORAL HEALTH
SYSTEM”.
______________________________ ______________________________
LINDA UPMEYER CHARLES SCHNEIDER
Speaker of the House President of the Senate
I hereby certify that this bill originated in the House and
is known as House File 690, Eighty-eighth General Assembly.
______________________________
CARMINE BOAL
Chief Clerk of the House
Approved _______________, 2019 ______________________________
KIM REYNOLDS
Governor