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

NOTE: There are more recent revisions of this legislation. Read Latest Draft
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-Introduced.html
House File 690 - Introduced HOUSE FILE 690 BY COMMITTEE ON HUMAN RESOURCES (SUCCESSOR TO HSB 206) A BILL FOR An Act relating to mental health and disability services, 1 including the establishment of a children’s behavioral 2 health system and a children’s behavioral health system 3 state board, and requiring certain children’s behavioral 4 health core services. 5 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 6 TLSB 1827HV (3) 88 hb/rh
H.F. 690 Section 1. Section 225C.2, Code 2019, is amended by adding 1 the following new subsections: 2 NEW SUBSECTION . 1A. “Child” or “children” means a person or 3 persons under eighteen years of age. 4 NEW SUBSECTION . 1B. “Children’s behavioral health 5 services” means services for children with a serious emotional 6 disturbance. 7 NEW SUBSECTION . 1C. “Children’s behavioral health system” or 8 “children’s system” means the behavioral health service system 9 for children implemented pursuant to this subchapter. 10 NEW SUBSECTION . 11. “Serious emotional disturbance” means 11 a diagnosable mental, behavioral, or emotional disorder of 12 sufficient duration to meet diagnostic criteria specified 13 within the most current diagnostic and statistical manual 14 of mental disorders published by the American psychiatric 15 association that results in a functional impairment. “Serious 16 emotional disturbance” does not include substance use and 17 developmental disorders unless such disorders co-occur with 18 such a diagnosable mental, behavioral, or emotional disorder. 19 NEW SUBSECTION . 12. “State board” means the children’s 20 behavioral health system state board created in section 21 225C.51. 22 Sec. 2. Section 225C.2, subsection 9, Code 2019, is amended 23 by striking the subsection. 24 Sec. 3. Section 225C.4, subsection 1, Code 2019, is amended 25 by adding the following new paragraph: 26 NEW PARAGRAPH . 0c. Assist the state board in planning for 27 community-based children’s behavioral health services. 28 Sec. 4. Section 225C.4, subsection 1, paragraphs d and j, 29 Code 2019, are amended to read as follows: 30 d. Encourage and facilitate coordination of mental health 31 and disability services with the objective of developing and 32 maintaining in the state a mental health and disability service 33 delivery system to provide disability services to all persons 34 in this state who need the services, regardless of the place 35 -1- LSB 1827HV (3) 88 hb/rh 1/ 18
H.F. 690 of residence or economic circumstances of those persons. The 1 administrator shall work with the commission and other state 2 agencies, including but not limited to the departments of 3 corrections, education, and public health and the state board 4 of regents, to develop and implement a strategic plan to expand 5 access to qualified mental health workers across the state. 6 j. Establish and maintain a data collection and management 7 information system oriented to the needs of patients, 8 providers, the department, and other programs or facilities in 9 accordance with section 225C.6A . The system shall be used to 10 identify, collect, and analyze service outcome and performance 11 measures data in order to assess the effects of the services on 12 the persons utilizing the services. The administrator shall 13 annually submit to the commission information collected by the 14 department indicating the changes and trends in the mental 15 health and disability services system. The administrator shall 16 make the outcome data available to the public. 17 Sec. 5. Section 225C.4, subsection 1, Code 2019, is amended 18 by adding the following new paragraphs: 19 NEW PARAGRAPH . 0k. Encourage and facilitate coordination 20 of children’s behavioral health services with the objective of 21 developing and maintaining in the state a children’s behavioral 22 health system to provide behavioral health services to all 23 children in this state who need the services, regardless of the 24 place of residence or economic circumstances of those children. 25 The administrator shall work with the state board and other 26 state agencies including but not limited to the department of 27 education and the department of public health to develop and 28 implement a strategic plan to expand access to qualified mental 29 health workers across the state. 30 NEW PARAGRAPH . 00k. Establish and maintain a data 31 collection and management information system oriented to the 32 needs of children utilizing the children’s behavioral health 33 system, providers, the department, and other programs or 34 facilities in accordance with section 225C.6A. The system 35 -2- LSB 1827HV (3) 88 hb/rh 2/ 18
H.F. 690 shall be used to identify, collect, and analyze service 1 outcome and performance measures data in order to assess the 2 effects of the services on the children utilizing the services. 3 The administrator shall annually submit to the state board 4 information collected by the department indicating the changes 5 and trends in the children’s behavioral health system. The 6 administrator shall make the outcome data available to the 7 public. 8 Sec. 6. Section 225C.4, subsection 1, paragraph u, Code 9 2019, is amended by adding the following new subparagraph: 10 NEW SUBPARAGRAPH . (9) School attendance. 11 Sec. 7. Section 225C.6B, subsection 3, Code 2019, is amended 12 by adding the following new paragraph: 13 NEW PARAGRAPH . c. Children’s behavioral health services 14 provided to eligible children that are not covered under the 15 medical assistance program or other third-party payor are the 16 responsibility of the county-based regional service system. 17 Sec. 8. NEW SECTION . 225C.51 Children’s behavioral health 18 system state board. 19 1. A children’s behavioral health system state board 20 is created as the state body to provide guidance on the 21 implementation and management of a children’s behavioral health 22 system for the provision of services to children with a serious 23 emotional disturbance. The state board’s public voting members 24 shall be appointed to four-year staggered terms by the governor 25 and are subject to confirmation by the senate. All other 26 state board voting members shall be appointed to four-year 27 staggered terms and are not subject to confirmation by the 28 senate. State board members shall be appointed on the basis of 29 interest and experience in the fields of children’s behavioral 30 health to ensure adequate representation from persons with life 31 experiences and from persons knowledgeable about children’s 32 behavioral health services. The department shall provide 33 support to the state board, and the board may utilize staff 34 support and other assistance provided to the state board by 35 -3- LSB 1827HV (3) 88 hb/rh 3/ 18
H.F. 690 other persons. The state board shall meet at least four times 1 per year. The membership of the state board shall consist of 2 the following persons who, at the time of appointment to the 3 state board, are active members of the indicated groups: 4 a. The director of the department or the director’s 5 designee. 6 b. The director of the department of education or the 7 director’s designee. 8 c. The director of the department of public health or the 9 director’s designee. 10 d. The director of workforce development or the director’s 11 designee. 12 e. One member shall be selected from nominees submitted by 13 the state court administrator. 14 f. One member shall be selected from nominees submitted 15 by the early childhood Iowa office in the department of 16 management. 17 g. One member shall be a member of the mental health and 18 disability services commission. 19 h. One member shall be a board member or an employee of a 20 provider of mental health services to children. 21 i. One member shall be a board member or an employee of a 22 provider of child welfare services. 23 j. One member shall be an administrator of an area education 24 agency. 25 k. One member shall be an educator, counselor, or 26 administrator of a school district. 27 l. One member shall be a representative of an established 28 advocacy organization whose mission or purpose it is, in part, 29 to further goals related to children’s mental health. 30 m. One member shall be a parent or guardian of a child 31 currently utilizing or who has utilized behavioral health 32 services. 33 n. One member shall be a sheriff. 34 o. One member shall be a pediatrician. 35 -4- LSB 1827HV (3) 88 hb/rh 4/ 18
H.F. 690 p. One member shall be a representative from the health care 1 system. 2 q. One member shall be a chief executive officer of a mental 3 health and disability services region. 4 r. In addition to the voting members, the membership shall 5 include four members of the general assembly with one member 6 designated by each of the following: the majority leader of 7 the senate, the minority leader of the senate, the speaker of 8 the house of representatives, and the minority leader of the 9 house of representatives. A legislative member serves for a 10 term as provided in section 69.16B in a nonvoting, ex officio 11 capacity and is not eligible for per diem and expenses as 12 provided in section 2.10. 13 2. The four-year terms shall begin and end as provided in 14 section 69.19. Vacancies on the state board shall be filled as 15 provided in section 2.32. A member shall not be appointed for 16 more than two consecutive four-year terms. 17 3. The director and the director of the department of 18 education, or their designees, shall serve as co-chairpersons 19 of the state board. Board members shall not be entitled to a 20 per diem as specified in section 7E.6 and shall not be entitled 21 to actual and necessary expenses incurred while engaged in 22 their official duties. 23 Sec. 9. NEW SECTION . 225C.52 Children’s behavioral health 24 system state board —— duties. 25 1. To the extent funding is available, the state board shall 26 perform the following duties: 27 a. Advise the administrator on the administration of the 28 children’s behavioral health system. 29 b. Provide consultation services to agencies regarding 30 the development of administrative rules for the children’s 31 behavioral health system. 32 c. Identify behavioral health outcomes and indicators for 33 eligible children with a serious emotional disturbance to 34 promote children living with their own families and in the 35 -5- LSB 1827HV (3) 88 hb/rh 5/ 18
H.F. 690 community. 1 d. Submit a written report on or before December 1 of each 2 year to the governor and the general assembly. At a minimum, 3 the report shall include a summary of all activities undertaken 4 by the state board, a summary of state board activities, 5 and results from identified behavioral health outcomes and 6 indicators for the children’s behavioral health system. 7 Sec. 10. Section 331.388, Code 2019, is amended by adding 8 the following new subsections: 9 NEW SUBSECTION . 01. “Children’s behavioral health services” 10 means the same as defined in section 225C.2. 11 NEW SUBSECTION . 4A. “Serious emotional disturbance” means 12 the same as defined in section 225C.2. 13 NEW SUBSECTION . 4B. “State board” means the children’s 14 system state board created in section 225C.51. 15 Sec. 11. Section 331.390, subsection 2, Code 2019, is 16 amended by striking the subsection and inserting in lieu 17 thereof the following: 18 2. The governing board shall comply with all of the 19 following requirements: 20 a. The voting membership of the governing board shall 21 consist of at least one board of supervisors member from each 22 county comprising the region or their designees. 23 b. The membership of the governing board shall also include 24 one adult person who utilizes mental health and disability 25 services or is an actively involved relative of such an adult 26 person. This member shall be designated by the regional 27 advisory committee formed by the governing board pursuant to 28 paragraph “h” . 29 c. The membership of the governing board shall not include 30 employees of the department of human services or an unelected 31 employee of a county. 32 d. The membership of the governing board shall also consist 33 of one member representing adult service providers in the 34 region. This member shall be designated by the regional 35 -6- LSB 1827HV (3) 88 hb/rh 6/ 18
H.F. 690 advisory committee formed by the governing board pursuant to 1 paragraph “h” . The member designated in accordance with this 2 paragraph shall serve in a nonvoting, ex officio capacity. 3 e. The membership of the governing board shall also 4 consist of one member representing children’s behavioral 5 health services providers in the region. This member shall be 6 designated by the regional children’s advisory committee formed 7 by the governing board pursuant to paragraph “i” . The member 8 designated in accordance with this paragraph shall serve in a 9 nonvoting, ex officio capacity. 10 f. The membership of the governing board shall also consist 11 of one member representing area education agency administrators 12 in the region. This member shall be designated by the regional 13 children’s advisory committee formed by the governing board 14 pursuant to paragraph “i” . 15 g. The membership of the governing board shall also 16 consist of one member who is a parent of a child who utilizes 17 children’s behavioral health services or actively involved 18 relatives of such children. This member shall be designated 19 by the regional children’s advisory committee formed by the 20 governing board pursuant to paragraph “i” . 21 h. The governing board shall have a regional advisory 22 committee consisting of adults who utilize services or actively 23 involved relatives of such adults, service providers, and 24 regional governing board members. 25 i. The governing board shall have a regional children’s 26 advisory committee consisting of parents of children who 27 utilize services or actively involved relatives of such 28 children, an area education agency administrator, an early 29 childhood advocate, a child welfare advocate, a children’s 30 behavioral health service provider, a member of the juvenile 31 court, a pediatrician, a child care provider, a local law 32 enforcement representative, and regional governing board 33 members. 34 Sec. 12. Section 331.390, subsection 3, paragraph b, Code 35 -7- LSB 1827HV (3) 88 hb/rh 7/ 18
H.F. 690 2019, is amended to read as follows: 1 b. The regional administrator staff shall include one or 2 more coordinators of mental health and disability services 3 and one or more coordinators of children’s behavioral 4 health services . A coordinator shall possess a bachelor’s 5 or higher level degree in a human services-related or 6 administration-related field, including but not limited 7 to social work, psychology, nursing, or public or business 8 administration, from an accredited college or university. 9 However, in lieu of a degree in public or business 10 administration, a coordinator may provide documentation of 11 relevant management experience. An action of a coordinator 12 involving a clinical decision shall be made in conjunction with 13 a professional who is trained in the delivery of the mental 14 health or disability service or children’s behavioral health 15 service addressed by the clinical decision. The regional 16 administrator shall determine whether referral to a coordinator 17 of mental health and disability services or children’s 18 behavioral health services is required for a person or child 19 seeking to access a service through a local access point of the 20 regional service system or the children’s behavioral health 21 system . 22 Sec. 13. Section 331.393, subsection 2, Code 2019, is 23 amended by adding the following new paragraphs: 24 NEW PARAGRAPH . i. The scope of children’s behavioral health 25 core services. Each service included shall be described and a 26 projection of need shall be included. 27 NEW PARAGRAPH . j. The eligibility requirements for 28 children’s behavioral health core services under the children’s 29 behavioral health system. 30 Sec. 14. Section 331.393, subsection 4, paragraph g, 31 subparagraph (1), Code 2019, is amended to read as follows: 32 (1) Performance and outcome measures relating to the 33 health, safety, education, work performance, and community 34 residency of the persons receiving the services. 35 -8- LSB 1827HV (3) 88 hb/rh 8/ 18
H.F. 690 Sec. 15. Section 331.396, subsection 1, paragraph b, Code 1 2019, is amended to read as follows: 2 b. The person is at least eighteen years of age and is a 3 resident of this state. However, a person who is seventeen 4 years of age, is a resident of this state, and is receiving 5 publicly funded children’s services may be considered eligible 6 for services through the regional service system during the 7 three-month period preceding the person’s eighteenth birthday 8 in order to provide a smooth transition from children’s to 9 adult services. 10 Sec. 16. Section 331.396, subsection 1, paragraph d, Code 11 2019, is amended by striking the paragraph. 12 Sec. 17. NEW SECTION . 331.396A Eligibility requirements —— 13 children’s behavioral health services. 14 A child shall be eligible for behavioral health services 15 under the children’s behavioral health system if all of the 16 following conditions are met: 17 1. The child is under eighteen years of age and is a 18 resident of this state. 19 2. The child has been diagnosed with a serious emotional 20 disturbance. 21 3. a. The child’s family has a family income equal to or 22 less than five hundred percent of the federal poverty level as 23 defined by the most recently revised poverty income guidelines 24 published by the United States department of health and human 25 services. 26 b. Notwithstanding subparagraph (1), a child’s family whose 27 household income is between one hundred fifty percent but not 28 more than five hundred percent of the federal poverty level 29 shall be eligible for behavioral health services subject to 30 a copayment, a single statewide sliding fee scale, or other 31 cost-sharing requirements approved by the department. 32 Sec. 18. NEW SECTION . 331.397A Children’s behavioral health 33 core services. 34 1. For the purposes of this section, unless the context 35 -9- LSB 1827HV (3) 88 hb/rh 9/ 18
H.F. 690 otherwise requires, “domain” means a set of similar behavioral 1 health services that can be provided depending on a child’s 2 service needs. 3 2. a. (1) A region shall work with children’s behavioral 4 health service providers to ensure that services in the 5 required behavioral health core service domains in subsection 6 4 are available to children who are residents of the region, 7 regardless of any potential payment source for the services. 8 (2) Subject to the available appropriations, the director 9 of human services shall ensure the behavioral health core 10 service domains listed in subsection 4 are covered services 11 for the medical assistance program under chapter 249A to the 12 greatest extent allowable under federal regulations. The 13 medical assistance program shall reimburse Medicaid enrolled 14 providers for Medicaid covered services under subsection 4 when 15 the services are medically necessary, the Medicaid enrolled 16 provider submits an appropriate claim for such services, and 17 no other third-party payor is responsible for reimbursement 18 of such services. Within the funds available, the region 19 shall pay for such services for eligible children when payment 20 through the medical assistance program or another third-party 21 payment is not available, unless the child is on a waiting list 22 for such payment or it has been determined that the child does 23 not meet the eligibility criteria for any such service. 24 b. Until funding is designed for other service populations, 25 eligibility for the service domains listed in this section 26 shall be limited to such children who are in need of behavioral 27 health services. 28 3. Pursuant to recommendations made by the state board, the 29 department of human services shall adopt rules to define the 30 services included in the core domains listed in this section. 31 The rules shall provide service definitions, service provider 32 standards, service access standards, and service implementation 33 dates, and shall provide consistency, to the extent possible, 34 with similar service definitions under the medical assistance 35 -10- LSB 1827HV (3) 88 hb/rh 10/ 18
H.F. 690 program. 1 4. The children’s behavioral health core service domains 2 shall include all of the following: 3 a. Treatment designed to ameliorate a child’s serious 4 emotional disturbance, including but not limited to all of the 5 following: 6 (1) Prevention, early identification, early intervention, 7 and education. 8 (2) Assessment and evaluation relating to eligibility for 9 services. 10 (3) Medication prescribing and management. 11 (4) Behavioral health outpatient therapy. 12 b. Comprehensive facility and community-based crisis 13 services regardless of a diagnosis of a serious emotional 14 disturbance, including all of the following: 15 (1) Mobile response. 16 (2) Crisis stabilization community-based services. 17 (3) Crisis stabilization residential services. 18 (4) Behavioral health inpatient treatment. 19 (5) A statewide twenty-four-hour crisis hotline. 20 5. A region shall ensure that services within the following 21 additional core service domains are available to children not 22 eligible for the medical assistance program under chapter 249A 23 or receiving other third-party payment for the services, when 24 public funds are made available for such services: 25 a. Treatment designed to ameliorate a child’s serious 26 emotional disturbance including but not limited to behavioral 27 health school-based therapy. 28 b. Support for community living including but not limited 29 to all of the following: 30 (1) Family support. 31 (2) Peer support. 32 (3) Therapeutic foster care. 33 (4) Respite care. 34 c. Transition services for children to the adult mental 35 -11- LSB 1827HV (3) 88 hb/rh 11/ 18
H.F. 690 health system providing an appropriate match with a child’s 1 abilities based upon informed, person-centered choices made 2 from an array of options including but not limited to all of 3 the following: 4 (1) Day habilitation. 5 (2) Job development. 6 (3) Supported employment. 7 (4) Prevocational services. 8 (5) Educational services. 9 d. Service coordination including physical health and 10 primary care that follow the principles of the system of care 11 including but not limited to all of the following: 12 (1) Care coordination. 13 (2) Health homes. 14 Sec. 19. MENTAL HEALTH AND DISABILITY SERVICES REGION 15 —— CHILDREN’S BEHAVIORAL HEALTH SERVICES IMPLEMENTATION 16 PLAN. Each mental health and disability services region shall 17 submit to the department of human services an implementation 18 plan to implement children’s behavioral health services 19 described under section 331.397A, as enacted in this Act, no 20 later than April 1, 2020. 21 Sec. 20. DEPARTMENT OF HUMAN SERVICES —— RULES. The 22 department of human services shall submit a notice of intended 23 action to the administrative rules coordinator and the 24 Iowa administrative code editor pursuant to section 17A.4, 25 subsection 1, paragraph “a”, not later than January 1, 2020, 26 for the adoption of rules to implement this Act. 27 Sec. 21. REPEAL. Sections 225C.51, 225C.52, 225C.53, and 28 225C.54, Code 2019, are repealed. 29 Sec. 22. CODE EDITOR’S DIRECTIVES. The Code editor may 30 change the current subchapter title of chapter 225C, subchapter 31 VI, to “CHILDREN’S BEHAVIORAL HEALTH SYSTEM”. 32 The Code editor may change the current subchapter title of 33 chapter 331, part 6, to “MENTAL HEALTH AND DISABILITY SERVICES 34 —— REGIONAL SERVICE SYSTEM —— CHILDREN’S BEHAVIORAL HEALTH 35 -12- LSB 1827HV (3) 88 hb/rh 12/ 18
H.F. 690 SYSTEM”. 1 EXPLANATION 2 The inclusion of this explanation does not constitute agreement with 3 the explanation’s substance by the members of the general assembly. 4 This bill relates to mental health and disability services 5 including the establishment of a children’s behavioral health 6 system and a children’s behavioral health system state board, 7 and requiring certain children’s behavioral health core 8 services. 9 DEFINITIONS. The bill provides definitions for the 10 children’s behavioral health system. “Child” or “children” 11 is defined as a person or persons under 18 years of age. 12 “Children’s behavioral health services” is defined as services 13 for children with a “serious emotional disturbance” defined 14 as a diagnosable mental, behavioral, or emotional disorder 15 of sufficient duration to meet diagnostic criteria specified 16 within the most current diagnostic and statistical manual 17 of mental disorders published by the American psychiatric 18 association that results in a functional impairment, but 19 does not include substance use and developmental disorders 20 unless such disorders co-occur with such a diagnosable mental, 21 behavioral, or emotional disorder. “Children’s system” 22 or “children’s behavioral health system” is defined as the 23 behavioral health services system for children created in the 24 bill. 25 CHILDREN’S BEHAVIORAL HEALTH SYSTEM STATE BOARD. The bill 26 establishes a children’s behavioral health system state board 27 (state board) as the state body to provide guidance on the 28 implementation and management of the children’s behavioral 29 health system and for the provision of services to children 30 with a serious emotional disturbance. 31 The bill specifies the membership of the board and provides 32 that the state board’s public voting members shall be appointed 33 to four-year staggered terms by the governor and are subject 34 to confirmation by the senate. All other state board voting 35 -13- LSB 1827HV (3) 88 hb/rh 13/ 18
H.F. 690 members shall be appointed to four-year terms and are not 1 subject to senate confirmation. A member shall not be 2 appointed for more than two consecutive four-year terms. State 3 board members shall be appointed on the basis of interest 4 and experience in the fields of children’s behavioral health 5 to ensure representation from persons with life experiences 6 and persons knowledgeable about children’s behavioral health 7 services. The state board shall be co-chaired by the director 8 of the department of human services (DHS) and the director of 9 the department of education, or their designees. In addition 10 to the voting members, the membership shall include four 11 members of the general assembly to serve in a nonvoting, ex 12 officio capacity on the board. 13 The bill requires the DHS to provide support to the state 14 board and the state board may utilize staff support and other 15 assistance provided to the state board by other persons. The 16 state board is required to meet a minimum of four times per 17 year. 18 The state board is required to advise the administrator 19 of the division of mental health and disability services of 20 DHS on the administration of the children’s behavioral health 21 system, provide consultation services to agencies regarding 22 the development of administrative rules for the children’s 23 behavioral health system, identify behavioral health outcomes 24 and indicators for eligible children with a serious emotional 25 disturbance to promote children living with their own families 26 and in the community; and submit a written report on or 27 before December 1 of each year to the governor and the general 28 assembly. 29 ELIGIBILITY REQUIREMENTS —— CHILDREN’S BEHAVIORAL HEALTH 30 SERVICES. Under current law, a person who is 17 years of 31 age, is a resident of Iowa, and is receiving publicly funded 32 children’s mental health services may be considered eligible 33 for mental health services through the adult mental health 34 and disability services regional service system during the 35 -14- LSB 1827HV (3) 88 hb/rh 14/ 18
H.F. 690 three-month period preceding the person’s 18th birthday in 1 order to provide a smooth transition from children’s services 2 to adult services. The bill strikes this provision and 3 provides that a child shall be eligible for behavioral health 4 services under the children’s behavioral health system if the 5 child is under 18 years of age, a resident of Iowa, has been 6 diagnosed with a serious emotional disturbance, and the child’s 7 family has a household income equal to or less than 500 percent 8 of the federal poverty level, except that a child’s family 9 whose household income is between 150 percent but not more than 10 500 percent of the federal poverty level shall be eligible for 11 behavioral health services subject to a copayment, a single 12 statewide sliding fee scale, or other cost-sharing requirements 13 approved by DHS. The bill does not apply to intellectual 14 disability services or brain injury services for children under 15 the children’s behavioral health system. 16 CHILDREN’S BEHAVIORAL HEALTH SYSTEM —— CORE SERVICES. The 17 bill provides that, subject to available appropriations, the 18 director of DHS shall ensure that the children’s behavioral 19 health core service domains, as specified in the bill, are 20 covered services for the medical assistance program under Code 21 chapter 249A to the greatest extent allowable under federal 22 regulations. The bill provides the medical assistance program 23 shall reimburse Medicaid enrolled providers for Medicaid 24 covered services when the services are medically necessary, the 25 Medicaid enrolled provider submits an appropriate claim for 26 such services, and no other third-party payor is responsible 27 for reimbursement of such services. Within the funds 28 available, each mental health and disability services region 29 is required to pay for such services for eligible children 30 when payment through the medical assistance program or another 31 third-party payment is not available, unless a child is on a 32 waiting list for such payment or it has been determined that 33 the child does not meet the eligibility criteria for any such 34 service. 35 -15- LSB 1827HV (3) 88 hb/rh 15/ 18
H.F. 690 The bill provides that until funding is designed for other 1 service populations, eligibility for the core services shall be 2 limited to such children who are in need of behavioral health 3 services. 4 The bill requires DHS to adopt rules pursuant to 5 recommendations made by the state board to define the services 6 included in the core domains. The rules shall provide service 7 definitions, service provider standards, service access 8 standards, and service implementation dates, and shall also 9 provide consistency, to the extent possible, with similar 10 service definitions under the medical assistance program. 11 The bill requires each mental health and disability 12 services region to submit to DHS plans to implement children’s 13 behavioral health services no later than April 1, 2020. 14 MENTAL HEALTH AND DISABILITY SERVICES —— ADMINISTRATOR’S 15 DUTIES. The bill requires the administrator of the division 16 of mental health and disability services of DHS to assist 17 the state board in planning for community-based children’s 18 behavioral health services and to encourage and facilitate 19 coordination of children’s behavioral health services with 20 the objective of developing and maintaining in the state a 21 children’s behavioral health system to provide behavioral 22 health services to all children in this state who need the 23 services, regardless of the place of residence or economic 24 circumstances of those children. The administrator shall work 25 with the state board and other state agencies, including but 26 not limited to the departments of education and public health, 27 to develop and implement a strategic plan to expand access to 28 qualified mental health workers across the state. 29 The bill requires the administrator to establish and 30 maintain a data collection and management information system 31 oriented to the needs of children utilizing the children’s 32 behavioral health system, providers, DHS, and other programs or 33 facilities in accordance with the disability services system 34 data repository established in Code section 225C.6A. The 35 -16- LSB 1827HV (3) 88 hb/rh 16/ 18
H.F. 690 system shall be used to identify, collect, and analyze service 1 outcome and performance measures data in order to assess the 2 effects of the services on the children utilizing the services. 3 The administrator shall annually submit to the state board 4 information collected by DHS indicating the changes and trends 5 in the children’s behavioral health system. The administrator 6 shall make the outcome data available to the public. 7 Current law requires the administrator to enter into 8 performance-based contracts with mental health and disability 9 services regional administrators which may include requirements 10 for the regional service system to attain outcomes within 11 a specified range of acceptable performance in certain 12 categories. The bill expands the categories to include a 13 school attendance category. 14 STATE AND REGIONAL DISABILITY SERVICE SYSTEMS. Current law 15 provides that the publicly financed disability services for 16 persons with mental illness, intellectual disability or other 17 developmental disability, or brain injury in Iowa shall be 18 provided by DHS and the counties operating together as regions 19 and provides for financial and administrative responsibility 20 for such services. The bill provides that children’s 21 behavioral health services provided to eligible children that 22 are not covered under the medical assistance program or other 23 third-party payor are the responsibility of the mental health 24 and disabilities regional service system. 25 MENTAL HEALTH AND DISABILITY SERVICES REGIONS. The bill 26 makes changes to the mental health and disability services 27 regional governing board (governing board). The governing 28 board membership shall consist of at least one board of 29 supervisors member from each county comprising the region 30 who shall be a voting member; one adult person who utilizes 31 mental health and disability services or is an actively 32 involved relative of such an adult person designated by the 33 regional advisory committee formed by the governing board; 34 one member representing adult service providers in the region 35 -17- LSB 1827HV (3) 88 hb/rh 17/ 18
H.F. 690 designated by the regional advisory committee formed by the 1 governing board, who shall serve in a nonvoting, ex officio 2 capacity; one member representing children’s behavioral health 3 service providers in the region designated by the regional 4 children’s advisory committee formed by the governing board, 5 who shall serve in a nonvoting, ex officio capacity; one member 6 representing area education agency administrators in the region 7 designated by the regional children’s advisory committee formed 8 by the governing board; and one member who is a parent of a 9 child who utilizes children’s behavioral health services or 10 actively involved relatives of such children designated by the 11 regional children’s advisory committee. The membership of 12 the governing board shall not include employees of DHS or an 13 unelected employee of a county. 14 The bill adds to the regional administrator staff one or more 15 coordinators of children’s behavioral health services. 16 The bill requires a mental health and disability region to 17 include provisions relating to eligibility requirements for 18 children’s behavioral health core services under the children’s 19 behavioral health system and performance and outcome measures 20 relating to education in a region’s annual service and budget 21 plan. 22 RULES. The bill requires DHS to submit a notice of intended 23 action to the administrative rules coordinator and the Iowa 24 administrative code editor not later than January 1, 2020, for 25 the adoption of rules to implement the bill. 26 MISCELLANEOUS CODE CHANGES. The bill makes technical 27 changes to Code section 225C.2(9) by striking the term “person 28 with a disability” as that term is not used in Code chapter 29 225C (mental health and disability services) and to Code 30 section 225C.4 to include mental health services in references 31 to disability services in that Code section. 32 REPEALS. The bill repeals 2019 Code sections 225C.51, 33 225C.52, 225C.53, and 225C.54. The bill replaces 2019 Code 34 sections 225C.51 and 225C.52 with new content in the bill. 35 -18- LSB 1827HV (3) 88 hb/rh 18/ 18
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