Senate File 463 - Reprinted
SENATE FILE
BY COMMITTEE ON HUMAN
RESOURCES
(SUCCESSOR TO SSB
1181)
(As Amended and Passed by the Senate March 18, 2015)
A BILL FOR
1 An Act relating to the redesign of mental health and
2 disabilities services administered by regions comprised of
3 counties.
4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
SF 463 (5) 86
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PAG LIN
1 1 Section 1. Section 135.180, subsection 3, Code 2015, is
1 2 amended to read as follows:
1 3 3. The program shall provide stipends to support
1 4 psychiatrist positions with an emphasis on securing and
1 5 retaining medical directors at community mental health
1 6 centers, providers of mental health services to county
1 7 residents pursuant to a waiver approved under section 225C.7,
1 8 subsection 3, Code 2011, designated under chapter 230A and
1 9 hospital psychiatric units that are located in mental health
1 10 professional shortage areas.
1 11 Sec. 2. Section 222.1, Code 2015, is amended to read as
1 12 follows:
1 13 222.1 Purpose of chapter ==== state resource centers ==== special
1 14 unit at state mental health institute.
1 15 1. This chapter addresses the public and private services
1 16 available in this state to meet the needs of persons with an
1 17 intellectual disability. The responsibility of the mental
1 18 health and disability services regions formed by counties and
1 19 of the state for the costs and administration of publicly
1 20 funded services shall be as set out in section 222.60 and other
1 21 pertinent sections of this chapter.
1 22 1. 2. The Glenwood state resource center and the Woodward
1 23 state resource center are established and shall be maintained
1 24 as the state's regional resource centers for the purpose of
1 25 providing treatment, training, instruction, care, habilitation,
1 26 and support of persons with an intellectual disability or other
1 27 disabilities in this state, and providing facilities, services,
1 28 and other support to the communities located in the region
1 29 being served by a state resource center. In addition, the
1 30 state resource centers are encouraged to serve as a training
1 31 resource for community=based program staff, medical students,
1 32 and other participants in professional education programs. A
1 33 resource center may request the approval of the council on
1 34 human services to change the name of the resource center for
1 35 use in communication with the public, in signage, and in other
2 1 forms of communication.
2 2 2. 3. A special intellectual disability unit may be
2 3 maintained at one of the state mental health institutes for the
2 4 purposes set forth in sections 222.88 to 222.91.
2 5 Sec. 3. Section 222.2, subsection 3, Code 2015, is amended
2 6 by striking the subsection.
2 7 Sec. 4. Section 222.2, Code 2015, is amended by adding the
2 8 following new subsections:
2 9 NEW SUBSECTION. 5A. "Mental health and disability services
2 10 region" means a mental health and disability services region
2 11 formed in accordance with section 331.389.
2 12 NEW SUBSECTION. 5B. "Regional administrator" means the
2 13 regional administrator of a mental health and disability
2 14 services region, as defined in section 331.388.
2 15 Sec. 5. Section 222.6, Code 2015, is amended to read as
2 16 follows:
2 17 222.6 State districts.
2 18 The administrator shall divide the state into two districts
2 19 in such manner that one of the resource centers shall be
2 20 located within each of the districts. Such districts may
2 21 from time to time be changed. After such districts have been
2 22 established, the administrator shall notify all boards of
2 23 supervisors, county auditors, regional administrators of the
2 24 mental health and disability services regions, and clerks of
2 25 the district courts of the action. Thereafter, unless the
2 26 administrator otherwise orders, all admissions of persons with
2 27 an intellectual disability from a district shall be to the
2 28 resource center located within such district.
2 29 Sec. 6. Section 222.12, subsection 2, Code 2015, is amended
2 30 to read as follows:
2 31 2. Notice of the death of the patient, and the cause
2 32 of death, shall be sent to the county board of supervisors
2 33 regional administrator of the mental health and disability
2 34 services region of the patient's county of residence. The
2 35 fact of death with the time, place, and alleged cause shall be
3 1 entered upon the docket of the court.
3 2 Sec. 7. Section 222.13, Code 2015, is amended to read as
3 3 follows:
3 4 222.13 Voluntary admissions.
3 5 1. If an adult person is believed to be a person with
3 6 an intellectual disability, the adult person or the adult
3 7 person's guardian may submit a request in writing through the
3 8 central point of coordination process for the county board
3 9 of supervisors of the adult person's county of residence to
3 10 apply to the department and the superintendent of any state
3 11 resource center for the voluntary admission of the adult person
3 12 either as an inpatient or an outpatient of the resource center.
3 13 The board of supervisors shall, on forms prescribed by the
3 14 department's administrator, apply to the superintendent of
3 15 the resource center in the district for the admission of the
3 16 adult person to the resource center. If the expenses of the
3 17 person's admission or placement are payable in whole or in
3 18 part by the person's county of residence, application for the
3 19 admission shall be made through the regional administrator. An
3 20 application for admission to a special unit of any adult person
3 21 believed to be in need of any of the services provided by the
3 22 special unit under section 222.88 may be made in the same
3 23 manner, upon request of the adult person or the adult person's
3 24 guardian. The superintendent shall accept the application if
3 25 a preadmission diagnostic evaluation, performed through the
3 26 central point of coordination process, confirms or establishes
3 27 the need for admission, except that an application shall not be
3 28 accepted if the institution does not have adequate facilities
3 29 available or if the acceptance will result in an overcrowded
3 30 condition.
3 31 2. If the resource center has no does not have an
3 32 appropriate program for the treatment of an adult or minor
3 33 person with an intellectual disability applying under this
3 34 section or section 222.13A, the board of supervisors regional
3 35 administrator for the person's county of residence or the
4 1 department, as applicable, shall arrange for the placement of
4 2 the person in any public or private facility within or without
4 3 the state, approved by the director of the department of human
4 4 services, which offers appropriate services for the person, as
4 5 determined through the central point of coordination process.
4 6 If the expenses of the placement are payable in whole or in
4 7 part by a county, the placement shall be made by the regional
4 8 administrator for the county.
4 9 3. Upon applying for admission If the expenses of an
4 10 admission of an adult or minor person to a resource center, or
4 11 a special unit, or upon arranging for of the placement of the
4 12 person in a public or private facility are payable in whole
4 13 or in part by a mental health and disability services region,
4 14 the board of supervisors regional administrator shall make a
4 15 full investigation into the financial circumstances of that the
4 16 person and those liable for that the person's support under
4 17 section 222.78 to determine whether or not any of them are able
4 18 to pay the expenses arising out of the admission of the person
4 19 to a resource center, special treatment unit, or public or
4 20 private facility. If the board regional administrator finds
4 21 that the person or those legally responsible for the person are
4 22 presently unable to pay the expenses, the board shall direct
4 23 that regional administrator shall pay the expenses be paid by
4 24 the county. The board regional administrator may review its
4 25 such a finding at any subsequent time while the person remains
4 26 at the resource center, or is otherwise receiving care or
4 27 treatment for which this chapter obligates the county region
4 28 to pay. If the board regional administrator finds upon review
4 29 that the person or those legally responsible for the person
4 30 are presently able to pay the expenses, the finding shall
4 31 apply only to the charges incurred during the period beginning
4 32 on the date of the review and continuing thereafter, unless
4 33 and until the board regional administrator again changes its
4 34 such a finding. If the board regional administrator finds
4 35 that the person or those legally responsible for the person
5 1 are able to pay the expenses, the board shall direct that
5 2 regional administrator shall collect the charges be so paid to
5 3 the extent required by section 222.78, and the county auditor
5 4 regional administrator shall be responsible for the collection
5 5 payment of the remaining charges.
5 6 Sec. 8. Section 222.13A, Code 2015, is amended to read as
5 7 follows:
5 8 222.13A Voluntary admissions ==== minors.
5 9 1. If a minor is believed to be a person with an
5 10 intellectual disability, the minor's parent, guardian, or
5 11 custodian may request the county board of supervisors to
5 12 apply to the department for admission of the minor as a
5 13 voluntary patient in a state resource center. If the resource
5 14 center does not have appropriate services for the minor's
5 15 treatment, the board of supervisors department may arrange for
5 16 the admission of the minor in a public or private facility
5 17 within or without the state, approved by the director of human
5 18 services, which offers appropriate services for the minor's
5 19 treatment.
5 20 2. Upon receipt of an application for voluntary admission of
5 21 a minor, the board of supervisors department shall provide for
5 22 a preadmission diagnostic evaluation of the minor to confirm
5 23 or establish the need for the admission. The preadmission
5 24 diagnostic evaluation shall be performed by a person who meets
5 25 the qualifications of a qualified intellectual disability
5 26 professional who is designated through the central point of
5 27 coordination process by the department.
5 28 3. During the preadmission diagnostic evaluation, the
5 29 minor shall be informed both orally and in writing that the
5 30 minor has the right to object to the voluntary admission. If
5 31 the preadmission diagnostic evaluation determines that the
5 32 voluntary admission is appropriate but the minor objects to
5 33 the admission, the minor shall not be admitted to the state
5 34 resource center unless the court approves of the admission. A
5 35 petition for approval of the minor's admission may be submitted
6 1 to the juvenile court by the minor's parent, guardian, or
6 2 custodian.
6 3 4. As soon as practicable after the filing of a petition for
6 4 approval of the voluntary admission, the court shall determine
6 5 whether the minor has an attorney to represent the minor in the
6 6 proceeding. If the minor does not have an attorney, the court
6 7 shall assign to the minor an attorney. If the minor is unable
6 8 to pay for an attorney, the attorney shall be compensated
6 9 by the county mental health and disability services region
6 10 at an hourly rate to be established by the county board of
6 11 supervisors regional administrator in substantially the same
6 12 manner as provided in section 815.7.
6 13 5. The court shall order the admission of a minor who
6 14 objects to the admission, only after a hearing in which it
6 15 is shown by clear and convincing evidence that both of the
6 16 following circumstances exist:
6 17 a. The minor needs and will substantially benefit from
6 18 treatment or habilitation.
6 19 b. A placement which involves less restriction of the
6 20 minor's liberties for the purposes of treatment or habilitation
6 21 is not feasible.
6 22 Sec. 9. Section 222.14, Code 2015, is amended to read as
6 23 follows:
6 24 222.14 Care by county region pending admission.
6 25 If the institution is unable to receive a patient, the
6 26 superintendent shall notify the county board of supervisors
6 27 of regional administrator for the county from which the
6 28 application in behalf of residence of the prospective patient
6 29 was made of the time when such person may be received.
6 30 Until such time as the patient is able to be received by the
6 31 institution, or when application has been made for admission
6 32 to a public or private facility as provided in section 222.13
6 33 and the application is pending, the care of said person the
6 34 patient shall be provided as arranged by the county board of
6 35 supervisors regional administrator.
7 1 Sec. 10. Section 222.59, subsection 1, unnumbered paragraph
7 2 1, Code 2015, is amended to read as follows:
7 3 Upon receiving a request from an authorized requester, the
7 4 superintendent of a state resource center shall coordinate
7 5 with the central point of coordination process regional
7 6 administrator for the person's county of residence or
7 7 the department, as applicable, in assisting the requester
7 8 in identifying available community=based services as an
7 9 alternative to continued placement of a patient in the state
7 10 resource center. For the purposes of this section, "authorized
7 11 requester" means the parent, guardian, or custodian of a minor
7 12 patient, the guardian of an adult patient, or an adult patient
7 13 who does not have a guardian. The assistance shall identify
7 14 alternatives to continued placement which are appropriate to
7 15 the patient's needs and shall include but are not limited to
7 16 any of the following:
7 17 Sec. 11. Section 222.60, subsections 1 and 2, Code 2015, are
7 18 amended to read as follows:
7 19 1. All necessary and legal expenses for the cost of
7 20 admission or for the treatment, training, instruction, care,
7 21 habilitation, support, and transportation of persons with
7 22 an intellectual disability, as provided for in the county
7 23 applicable regional service system management plan provisions
7 24 implemented pursuant to section 331.439, subsection 1, 331.393
7 25 in a state resource center, or in a special unit, or any public
7 26 or private facility within or without the state, approved by
7 27 the director of human services, shall be paid by either:
7 28 a. The regional administrator for the person's county of
7 29 residence.
7 30 b. The state when the person is a resident in another state
7 31 or in a foreign country, or when the person's residence is
7 32 unknown. The payment responsibility shall be deemed to be a
7 33 state case.
7 34 2. a. Prior to the regional administrator for a county of
7 35 residence approving the payment of expenses for a person under
8 1 this section, the county regional administrator may require
8 2 that the person be diagnosed to determine if the person has
8 3 an intellectual disability or that the person be evaluated to
8 4 determine the appropriate level of services required to meet
8 5 the person's needs relating to an intellectual disability. The
8 6 diagnosis and the evaluation may be performed concurrently and
8 7 shall be performed by an individual or individuals approved
8 8 by the regional administrator for the person's county who
8 9 are qualified to perform the diagnosis or the evaluation.
8 10 Following the initial approval for payment of expenses, the
8 11 county regional administrator may require that an evaluation be
8 12 performed at reasonable time periods.
8 13 b. The cost of a county=required regional
8 14 administrator=required diagnosis and an evaluation is
8 15 at the county's mental health and disability services region's
8 16 expense. For a state case, the state may apply the diagnosis
8 17 and evaluation provisions of this subsection at the state's
8 18 expense.
8 19 c. A diagnosis or an evaluation under this section may be
8 20 part of a county's central point of coordination process under
8 21 section 331.440, diagnosis and assessment process implemented
8 22 by the applicable regional administrator, provided that a
8 23 diagnosis is performed only by an individual qualified as
8 24 provided in this section.
8 25 Sec. 12. Section 222.61, Code 2015, is amended to read as
8 26 follows:
8 27 222.61 Residency determined.
8 28 When a county receives an application on behalf of any person
8 29 for admission to a resource center or a special unit, the board
8 30 of supervisors application shall refer the determination of
8 31 residency be forwarded to the central point of coordination
8 32 process regionaladministrator for the county to determine and
8 33 certify that the residence of the person is in one of the
8 34 following:
8 35 1. In the county in which the application is received.
9 1 2. In some other county of the state.
9 2 3. In another state or in a foreign country.
9 3 4. Unknown.
9 4 Sec. 13. Section 222.62, Code 2015, is amended to read as
9 5 follows:
9 6 222.62 Residency in another county.
9 7 When the board of supervisors determines through the central
9 8 point of coordination process regional administrator for the
9 9 county determines that the residency of the person is other
9 10 than in the county in which the application is received, the
9 11 determination shall be certified to the superintendent of
9 12 the resource center or the special unit where the person is
9 13 a patient. The certification shall be accompanied by a copy
9 14 of the evidence supporting the determination. The If the
9 15 person is not eligible for the medical assistance program, the
9 16 superintendent shall charge the expenses already incurred and
9 17 unadjusted, and all future expenses of the patient, to the
9 18 county certified to be mental health and disability services
9 19 region for the county of the person's residency.
9 20 Sec. 14. Section 222.63, Code 2015, is amended to read as
9 21 follows:
9 22 222.63 Finding of residency ==== objection.
9 23 A board of supervisors' certification utilizing the
9 24 central point of coordination process through the regional
9 25 administrator for a county that a person's residency is
9 26 in another county shall be sent to the auditor of regional
9 27 administrator for the county of residence. The certification
9 28 shall be accompanied by a copy of the evidence supporting the
9 29 determination. The auditor of regional administrator for the
9 30 county of residence shall submit the certification to the board
9 31 of supervisors of the auditor's regional administrator for the
9 32 county and it shall be conclusively presumed that the patient
9 33 has residency in that county unless the regional administrator
9 34 for that county disputes the determination of residency as
9 35 provided in section 331.394.
10 1 Sec. 15. Section 222.64, Code 2015, is amended to read as
10 2 follows:
10 3 222.64 Foreign state or country or unknown residency.
10 4 If the residency of the person is determined by a regional
10 5 administrator on behalf of a county or by the state to be in
10 6 a foreign state or country or is determined to be unknown,
10 7 the county regional administrator or the state shall certify
10 8 the determination to the administrator. The certification
10 9 shall be accompanied by a copy of the evidence supporting the
10 10 determination. The care of the person shall be as arranged by
10 11 the county regional administrator or the state. Application
10 12 for admission may be made pending investigation by the
10 13 administrator.
10 14 Sec. 16. Section 222.73, subsection 2, paragraph a,
10 15 subparagraph (6), Code 2015, is amended to read as follows:
10 16 (6) A county mental health and disability services region
10 17 shall not be billed for the cost of a patient unless the
10 18 patient's admission is authorized through the applicable
10 19 central point of coordination process regional administrator.
10 20 The state resource center and the county regional administrator
10 21 shall work together to locate appropriate alternative
10 22 placements and services, and to educate patients and the family
10 23 members of patients regarding such alternatives.
10 24 Sec. 17. Section 222.73, subsection 2, paragraph b, Code
10 25 2015, is amended to read as follows:
10 26 b. The per diem costs billed to each county mental health
10 27 and disability services region shall not exceed the per diem
10 28 costs billed to the county in the fiscal year beginning July
10 29 1, 1996. However, the per diem costs billed to a county may
10 30 be adjusted in for a fiscal year to reflect increased costs to
10 31 the extent of the percentage increase in the total of county
10 32 fixed budgets pursuant to the allowed growth factor adjustment
10 33 authorized statewide per capita expenditure target amount,
10 34 if any per capita growth amount is authorized by the general
10 35 assembly for that fiscal year in accordance with section
11 1 331.439 331.424A.
11 2 Sec. 18. Section 222.92, subsection 3, paragraph a, Code
11 3 2015, is amended to read as follows:
11 4 a. Moneys received by the state from billings to counties
11 5 and regional administrators for the counties.
11 6 Sec. 19. Section 225.1, Code 2015, is amended to read as
11 7 follows:
11 8 225.1 Establishment ==== definitions.
11 9 1. There shall be established a The state psychiatric
11 10 hospital, is established. The hospital shall be especially
11 11 designed, kept, and administered for the care, observation,
11 12 and treatment of those persons who are afflicted with abnormal
11 13 mental conditions.
11 14 2. For the purposes of this chapter, unless the context
11 15 otherwise requires:
11 16 a. "Mental health and disability services region" means
11 17 a mental health and disability services region approved in
11 18 accordance with section 331.389.
11 19 b. "Regional administrator" means the administrator of a
11 20 mental health and disability services region, as defined in
11 21 section 331.388.
11 22 Sec. 20. Section 225.10, unnumbered paragraph 1, Code 2015,
11 23 is amended to read as follows:
11 24 Persons suffering from mental diseases may be admitted to
11 25 the state psychiatric hospital as voluntary public patients
11 26 if a physician authorized to practice medicine or osteopathic
11 27 medicine in the state of Iowa files information with the board
11 28 of supervisors regional administrator of the person's county
11 29 of residence or the board's designee, stating all of the
11 30 following:
11 31 Sec. 21. Section 225.11, Code 2015, is amended to read as
11 32 follows:
11 33 225.11 Initiating commitment procedures.
11 34 When a court finds upon completion of a hearing held pursuant
11 35 to section 229.12 that the contention that a respondent is
12 1 seriously mentally impaired has been sustained by clear and
12 2 convincing evidence, and the application filed under section
12 3 229.6 also contends or the court otherwise concludes that it
12 4 would be appropriate to refer the respondent to the state
12 5 psychiatric hospital for a complete psychiatric evaluation and
12 6 appropriate treatment pursuant to section 229.13, the judge
12 7 may order that a financial investigation be made in the manner
12 8 prescribed by section 225.13. If the costs of a respondent's
12 9 evaluation or treatment are payable in whole or in part by
12 10 a county, an order under this section shall be for referral
12 11 of the respondent through the central point of coordination
12 12 process regional administrator for the respondent's county of
12 13 residence for an evaluation and referral of the respondent
12 14 to an appropriate placement or service, which may include
12 15 the state psychiatric hospital for additional evaluation or
12 16 treatment. For purposes of this chapter, "central point of
12 17 coordination process" means the same as defined in section
12 18 331.440.
12 19 Sec. 22. Section 225.12, Code 2015, is amended to read as
12 20 follows:
12 21 225.12 Voluntary public patient ==== physician's report.
12 22 A physician filing information under section 225.10 shall
12 23 include a written report to the county board of supervisors
12 24 or the board's designee regional administrator for the
12 25 county of residence of the person named in the information,
12 26 giving a history of the case as will be likely to aid in the
12 27 observation, treatment, and hospital care of the person named
12 28 in the information and describing the history in detail.
12 29 Sec. 23. Section 225.13, Code 2015, is amended to read as
12 30 follows:
12 31 225.13 Financial condition.
12 32 The county board of supervisors or the board's designee
12 33 regional administrator of the county of residence of a person
12 34 being admitted to the state psychiatric hospital is responsible
12 35 for investigating the financial condition of a person being
13 1 admitted to the state psychiatric hospital the person and of
13 2 those legally responsible for the person's support.
13 3 Sec. 24. Section 225.15, Code 2015, is amended to read as
13 4 follows:
13 5 225.15 Examination and treatment.
13 6 1. When a respondent arrives at the state psychiatric
13 7 hospital, the admitting physician shall examine the respondent
13 8 and determine whether or not, in the physician's judgment, the
13 9 respondent is a fit subject for observation, treatment, and
13 10 hospital care. If, upon examination, the physician decides
13 11 that the respondent should be admitted to the hospital, the
13 12 respondent shall be provided a proper bed in the hospital. The
13 13 physician who has charge of the respondent shall proceed with
13 14 observation, medical treatment, and hospital care as in the
13 15 physician's judgment are proper and necessary, in compliance
13 16 with sections 229.13 to 229.16. After the respondent's
13 17 admission, the observation, medical treatment, and hospital
13 18 care of the respondent may be provided by a mental health
13 19 professional, as defined in section 228.1, who is licensed as a
13 20 physician, advanced registered nurse practitioner, or physician
13 21 assistant.
13 22 2. A proper and competent nurse shall also be assigned to
13 23 look after and care for the respondent during observation,
13 24 treatment, and care. Observation, treatment, and hospital care
13 25 under this section which are payable in whole or in part by a
13 26 county shall only be provided as determined through the central
13 27 point of coordination process regional administrator of the
13 28 respondent's county of residence.
13 29 Sec. 25. Section 225.16, subsection 1, Code 2015, is amended
13 30 to read as follows:
13 31 1. If the county board of supervisors or the board's
13 32 designee regional administrator for a person's county of
13 33 residence finds from the physician's information which was
13 34 filed under the provisions of section 225.10 that it would
13 35 be appropriate for the person to be admitted to the state
14 1 psychiatric hospital, and the report of the county board of
14 2 supervisors or the board's designee regional administrator made
14 3 pursuant to section 225.13 shows that the person and those who
14 4 are legally responsible for the person are not able to pay the
14 5 expenses incurred at the hospital, or are able to pay only a
14 6 part of the expenses, the person shall be considered to be a
14 7 voluntary public patient and the board of supervisors regional
14 8 administrator shall direct that the person shall be sent to the
14 9 state psychiatric hospital at the state university of Iowa for
14 10 observation, treatment, and hospital care.
14 11 Sec. 26. Section 225.17, subsection 2, Code 2015, is amended
14 12 to read as follows:
14 13 2. When the respondent arrives at the hospital, the
14 14 respondent shall receive the same treatment as is provided for
14 15 committed public patients in section 225.15, in compliance with
14 16 sections 229.13 to 229.16. However, observation, treatment,
14 17 and hospital care under this section of a respondent whose
14 18 expenses are payable in whole or in part by a county shall
14 19 only be provided as determined through the central point of
14 20 coordination process regional administrator of the respondent's
14 21 county of residence.
14 22 Sec. 27. Section 225.18, Code 2015, is amended to read as
14 23 follows:
14 24 225.18 Attendants.
14 25 The county board of supervisors or the board's designee
14 26 regional administrator may appoint a person an attendant to
14 27 accompany the committed public patient or the voluntary public
14 28 patient or the committed private patient from the place where
14 29 the patient may be to the state psychiatric hospital, or to
14 30 accompany the patient from the hospital to a place as may be
14 31 designated by the county regional administrator. If a patient
14 32 is moved pursuant to this section, at least one attendant shall
14 33 be of the same gender as the patient.
14 34 Sec. 28. Section 225.19, Code 2015, is amended to read as
14 35 follows:
15 1 225.19 Compensation for attendant.
15 2 An individual appointed by the county board of supervisors
15 3 or the board's designee regional administrator in accordance
15 4 with section 225.18 to accompany a person to or from the
15 5 hospital or to make an investigation and report on any question
15 6 involved in the matter shall receive three dollars per day for
15 7 the time actually spent in making the investigation and actual
15 8 necessary expenses incurred in making the investigation or
15 9 trip. This section does not apply to an appointee who receives
15 10 fixed compensation or a salary.
15 11 Sec. 29. Section 225.21, Code 2015, is amended to read as
15 12 follows:
15 13 225.21 Compensation claims ==== filing ==== approval.
15 14 The person making claim to compensation under section 225.19
15 15 shall file the claim in the office of the county auditor
15 16 regional administrator for the person's county of residence.
15 17 The claim is subject to review and approval by the board of
15 18 supervisors or the board's designee regional administrator for
15 19 the county.
15 20 Sec. 30. Section 225.24, Code 2015, is amended to read as
15 21 follows:
15 22 225.24 Collection of preliminary expense.
15 23 Unless a committed private patient or those legally
15 24 responsible for the patient's support offer to settle
15 25 the amount of the claims, the county auditor of regional
15 26 administrator for the person's county of residence shall
15 27 collect, by action if necessary, the amount of all claims
15 28 for per diem and expenses that have been approved by the
15 29 county board of supervisors or the board's designee regional
15 30 administrator for the county and paid by the county regional
15 31 administrator as provided under section 225.21. Any amount
15 32 collected shall be credited to the county treasury mental
15 33 health and disabilities services fund created in accordance
15 34 with section 331.424A.
15 35 Sec. 31. Section 225.27, Code 2015, is amended to read as
16 1 follows:
16 2 225.27 Discharge ==== transfer.
16 3 The state psychiatric hospital may, at any time, discharge
16 4 any patient as recovered, as improved, or as not likely to
16 5 be benefited by further treatment. If the patient being so
16 6 discharged was involuntarily hospitalized, the hospital shall
16 7 notify the committing judge or court of the discharge as
16 8 required by section 229.14 or section 229.16, whichever is
16 9 applicable, and the applicable regional administrator. Upon
16 10 receiving the notification, the court shall issue an order
16 11 confirming the patient's discharge from the hospital or from
16 12 care and custody, as the case may be, and shall terminate the
16 13 proceedings pursuant to which the order was issued. The court
16 14 or judge shall, if necessary, appoint a person to accompany the
16 15 discharged patient from the state psychiatric hospital to such
16 16 place as the hospital or the court may designate, or authorize
16 17 the hospital to appoint such attendant.
16 18 Sec. 32. Section 225C.2, subsection 2, Code 2015, is amended
16 19 by striking the subsection.
16 20 Sec. 33. Section 225C.5, subsection 1, paragraph f, Code
16 21 2015, is amended to read as follows:
16 22 f. Two members shall be staff members of regional
16 23 administrators of the central point of coordination process
16 24 established in accordance with section 331.440 selected from
16 25 nominees submitted by the community services affiliate of the
16 26 Iowa state association of counties.
16 27 Sec. 34. Section 225C.6, subsection 1, paragraph i,
16 28 subparagraph (1), Code 2015, is amended to read as follows:
16 29 (1) The extent to which services to persons with
16 30 disabilities are actually available to persons in each county
16 31 and mental health and disability services region in the state
16 32 and the quality of those services.
16 33 Sec. 35. Section 225C.6, subsection 1, paragraph m, Code
16 34 2015, is amended to read as follows:
16 35 m. Identify disability services outcomes and indicators to
17 1 support the ability of eligible persons with a disability to
17 2 live, learn, work, and recreate in communities of the persons'
17 3 choice. The identification duty includes but is not limited to
17 4 responsibility for identifying, collecting, and analyzing data
17 5 as necessary to issue reports on outcomes and indicators at the
17 6 county, region, and state levels.
17 7 Sec. 36. Section 225C.13, subsection 1, Code 2015, is
17 8 amended to read as follows:
17 9 1. The administrator assigned, in accordance with section
17 10 218.1, to control the state mental health institutes and
17 11 the state resource centers may enter into agreements under
17 12 which a facility or portion of a facility administered by the
17 13 administrator is leased to a department or division of state
17 14 government, a county or group of counties, a mental health and
17 15 disability services region, or a private nonprofit corporation
17 16 organized under chapter 504. A lease executed under this
17 17 section shall require that the lessee use the leased premises
17 18 to deliver either disability services or other services
17 19 normally delivered by the lessee.
17 20 Sec. 37. Section 225C.14, Code 2015, is amended to read as
17 21 follows:
17 22 225C.14 Preliminary diagnostic evaluation.
17 23 1. Except in cases of medical emergency, a person shall be
17 24 admitted to a state mental health institute as an inpatient
17 25 only after a preliminary diagnostic evaluation performed
17 26 through the central point of coordination process regional
17 27 administrator of the person's county of residence has confirmed
17 28 that the admission is appropriate to the person's mental health
17 29 needs, and that no suitable alternative method of providing the
17 30 needed services in a less restrictive setting or in or nearer
17 31 to the person's home community is currently available. If
17 32 provided for through the central point of coordination process
17 33 regional administrator, the evaluation may be performed by a
17 34 community mental health center or by an alternative diagnostic
17 35 facility. The policy established by this section shall be
18 1 implemented in the manner and to the extent prescribed by
18 2 sections 225C.15, 225C.16 and 225C.17.
18 3 2. As used in this section and sections 225C.15, 225C.16
18 4 and 225C.17, the term "medical emergency" means a situation
18 5 in which a prospective patient is received at a state mental
18 6 health institute in a condition which, in the opinion of the
18 7 chief medical officer, or that officer's physician designee,
18 8 requires the immediate admission of the person notwithstanding
18 9 the policy stated in subsection 1.
18 10 Sec. 38. Section 225C.15, Code 2015, is amended to read as
18 11 follows:
18 12 225C.15 County implementation of evaluations.
18 13 The board of supervisors of regional administrator for a
18 14 county shall, no later than July 1, 1982, require that the
18 15 policy stated in section 225C.14 be followed with respect
18 16 to admission of persons from that county to a state mental
18 17 health institute. A community mental health center which is
18 18 supported, directly or in affiliation with other counties, by
18 19 that county may perform the preliminary diagnostic evaluations
18 20 for that county, unless the performance of the evaluations
18 21 is not covered by the agreement entered into by the county
18 22 regional administrator and the center, and the center's
18 23 director certifies to the board of supervisors regional
18 24 administrator that the center does not have the capacity to
18 25 perform the evaluations, in which case the board of supervisors
18 26 regional administrator shall proceed under section 225C.17.
18 27 Sec. 39. Section 225C.16, Code 2015, is amended to read as
18 28 follows:
18 29 225C.16 Referrals for evaluation.
18 30 1. The chief medical officer of a state mental health
18 31 institute, or that officer's physician designee, shall advise
18 32 a person residing in that county who applies for voluntary
18 33 admission, or a person applying for the voluntary admission
18 34 of another person who resides in that county, in accordance
18 35 with section 229.41, that the board of supervisors regional
19 1 administrator for the county has implemented the policy
19 2 stated in section 225C.14, and shall advise that a preliminary
19 3 diagnostic evaluation of the prospective patient be sought,
19 4 if that has not already been done. This subsection does not
19 5 apply when voluntary admission is sought in accordance with
19 6 section 229.41 under circumstances which, in the opinion of the
19 7 chief medical officer or that officer's physician designee,
19 8 constitute a medical emergency.
19 9 2. The clerk of the district court in that county shall
19 10 refer a person applying for authorization for voluntary
19 11 admission, or for authorization for voluntary admission of
19 12 another person, in accordance with section 229.42, to the
19 13 appropriate entity designated through the central point of
19 14 coordination process regional administrator of the person's
19 15 county of residence under section 225C.14 for the preliminary
19 16 diagnostic evaluation unless the applicant furnishes a written
19 17 statement from the appropriate entity which indicates that the
19 18 evaluation has been performed and that the person's admission
19 19 to a state mental health institute is appropriate. This
19 20 subsection does not apply when authorization for voluntary
19 21 admission is sought under circumstances which, in the opinion
19 22 of the chief medical officer or that officer's physician
19 23 designee, constitute a medical emergency.
19 24 3. Judges of the district court in that county or the
19 25 judicial hospitalization referee appointed for that county
19 26 shall so far as possible arrange for the entity designated
19 27 through the central point of coordination process regional
19 28 administrator under section 225C.14 to perform a prehearing
19 29 examination of a respondent required under section 229.8,
19 30 subsection 3, paragraph "b".
19 31 4. The chief medical officer of a state mental health
19 32 institute shall promptly submit to the appropriate entity
19 33 designated through the central point of coordination process
19 34 regional administrator under section 225C.14 a report of the
19 35 voluntary admission of a patient under the medical emergency
20 1 clauses provisions of subsections 1 and 2. The report shall
20 2 explain the nature of the emergency which necessitated the
20 3 admission of the patient without a preliminary diagnostic
20 4 evaluation by the designated entity.
20 5 Sec. 40. Section 225C.17, Code 2015, is amended to read as
20 6 follows:
20 7 225C.17 Alternative diagnostic facility.
20 8 If a county is not served by a community mental health
20 9 center having the capacity to perform the required preliminary
20 10 diagnostic evaluations, the board of supervisors regional
20 11 administrator for the county shall arrange for the evaluations
20 12 to be performed by an alternative diagnostic facility for
20 13 the period until the county is served by a community mental
20 14 health center with the capacity to provide that service. An
20 15 alternative diagnostic facility may be the outpatient service
20 16 of a state mental health institute or any other mental health
20 17 facility or service able to furnish the requisite professional
20 18 skills to properly perform a preliminary diagnostic evaluation
20 19 of a person whose admission to a state mental health institute
20 20 is being sought or considered on either a voluntary or an
20 21 involuntary basis.
20 22 Sec. 41. Section 225C.19, subsection 3, paragraphs a, b, and
20 23 c, Code 2015, are amended to read as follows:
20 24 a. Standards for accrediting or approving emergency mental
20 25 health crisis services providers. Such providers may include
20 26 but are not limited to a community mental health center
20 27 designated under chapter 230A, a provider approved in a waiver
20 28 adopted by the commission to provide services to a county
20 29 in lieu of a community mental health center, a unit of the
20 30 department or other state agency, a county, a mental health
20 31 and disability services region, or any other public or private
20 32 provider who meets the accreditation or approval standards for
20 33 an emergency mental health crisis services provider.
20 34 b. Identification by the division of geographic regions,
20 35 groupings of mental health and disability services regions,
21 1 service areas, or other means of distributing and organizing
21 2 the emergency mental health crisis services system to ensure
21 3 statewide availability of the services.
21 4 c. Coordination of emergency mental health crisis services
21 5 with all of the following:
21 6 (1) The district and juvenile courts.
21 7 (2) Law enforcement.
21 8 (3) Judicial district departments of correctional services.
21 9 (4) County central point of coordination processes Mental
21 10 health and disability services regions.
21 11 (5) Other mental health, substance abuse, and co=occurring
21 12 mental illness and substance abuse services available through
21 13 the state and counties to serve both children and adults.
21 14 Sec. 42. Section 225C.20, Code 2015, is amended to read as
21 15 follows:
21 16 225C.20 Responsibilities of counties mental health and
21 17 disabilities services regions for individual case management
21 18 services.
21 19 Individual case management services funded under medical
21 20 assistance shall be provided by the department except when
21 21 a county or a consortium of counties contracts with the
21 22 department to provide the services. A county or consortium
21 23 of counties regional administrator may contract for one or
21 24 more counties of the region to be the provider at any time
21 25 and the department shall agree to the contract so long as
21 26 the contract meets the standards for case management adopted
21 27 by the department. The county or consortium of counties
21 28 regional administrator may subcontract for the provision
21 29 of case management services so long as the subcontract
21 30 meets the same standards. A county board of supervisors
21 31 regional administrator may change the provider of individual
21 32 case management services at any time. If the current or
21 33 proposed contract is with the department, the county board
21 34 of supervisors regional administrator shall provide written
21 35 notification of a change at least ninety days before the date
22 1 the change will take effect.
22 2 Sec. 43. Section 225C.54, subsection 1, Code 2015, is
22 3 amended to read as follows:
22 4 1. The mental health services system for children and youth
22 5 shall be initially implemented by the division commencing
22 6 with the fiscal year beginning July 1, 2008. The division
22 7 shall begin implementation by utilizing a competitive bidding
22 8 process to allocate state block grants to develop services
22 9 through existing community mental health centers, providers
22 10 approved in a waiver adopted by the commission to provide
22 11 services to a county in lieu of a community mental health
22 12 center, designated under chapter 230A and other local service
22 13 partners. The implementation shall be limited to the extent of
22 14 the appropriations provided for the children's system.
22 15 Sec. 44. Section 226.1, Code 2015, is amended by adding the
22 16 following new subsection:
22 17 NEW SUBSECTION. 4. For the purposes of this chapter, unless
22 18 the context otherwise requires:
22 19 a. "Administrator" means the person assigned by the
22 20 director of human services to control the state mental health
22 21 institutes.
22 22 b. "Department" means the department of human services.
22 23 c. "Mental health and disability services region" means
22 24 a mental health and disability services region formed in
22 25 accordance with section 331.389.
22 26 d. "Regional administrator" means the regional administrator
22 27 of a mental health and disability services region, as defined
22 28 in section 331.388.
22 29 Sec. 45. Section 226.9C, subsection 2, paragraphs a and c,
22 30 Code 2015, are amended to read as follows:
22 31 a. A county may split the The charges payable by a
22 32 county may be split between the county's mental health and
22 33 disabilities services fund created pursuant to section 331.424A
22 34 and the county's budget for substance abuse substance=related
22 35 disorder expenditures.
23 1 c. (1) Prior to an individual's admission for dual
23 2 diagnosis treatment, the individual shall have been
23 3 prescreened. The person performing the prescreening shall
23 4 be either the mental health professional, as defined in
23 5 section 228.1, who is contracting with the county central
23 6 point of coordination process regional administrator for the
23 7 county's mental health and disability services region to
23 8 provide the prescreening or a mental health professional with
23 9 the requisite qualifications. A mental health professional
23 10 with the requisite qualifications shall meet all of the
23 11 following qualifications: is a mental health professional as
23 12 defined in section 228.1, is an alcohol and drug counselor
23 13 certified by the nongovernmental Iowa board of substance abuse
23 14 certification, and is employed by or providing services for a
23 15 facility, as defined in section 125.2.
23 16 (2) Prior to an individual's admission for dual diagnosis
23 17 treatment, the individual shall have been screened through a
23 18 county's central point of coordination process implemented
23 19 pursuant to section 331.440 regional administrator to determine
23 20 the appropriateness of the treatment.
23 21 Sec. 46. Section 226.32, Code 2015, is amended to read as
23 22 follows:
23 23 226.32 Overcrowded conditions.
23 24 The administrator shall order the discharge or removal
23 25 from the hospital of incurable and harmless patients whenever
23 26 it is necessary to make room for recent cases. If a patient
23 27 who is to be so discharged entered the hospital voluntarily,
23 28 the administrator shall notify the auditor of regional
23 29 administrator for the county interested at least ten days in
23 30 advance of the day of actual discharge.
23 31 Sec. 47. Section 226.34, subsection 2, Code 2015, is amended
23 32 to read as follows:
23 33 2. If a patient in a mental health institute dies from any
23 34 cause, the superintendent of the institute shall within three
23 35 days of the date of death, send by certified mail a written
24 1 notice of death to all of the following:
24 2 a. The decedent's nearest relative.
24 3 b. The clerk of the district court of the county from which
24 4 the patient was committed.
24 5 c. The sheriff of the county from which the patient was
24 6 committed.
24 7 d. The regional administrator for the county from which the
24 8 patient was committed.
24 9 Sec. 48. Section 227.1, Code 2015, is amended to read as
24 10 follows:
24 11 227.1 Supervision Definitions ==== supervision.
24 12 1. For the purposes of this chapter, unless the context
24 13 otherwise requires:
24 14 a. "Administrator" means the person assigned by the director
24 15 of human services in the appropriate division of the department
24 16 to administer mental health and disability services.
24 17 b. "Department" means the department of human services.
24 18 c. "Mental health and disability services region" means
24 19 a mental health and disability services region formed in
24 20 accordance with section 331.389.
24 21 d. "Regional administrator" means the regional administrator
24 22 of a mental health and disability services region, as defined
24 23 in section 331.388.
24 24 2. All The regulatory requirements for county and private
24 25 institutions wherein where persons with mental illness or an
24 26 intellectual disability are kept admitted, committed, or placed
24 27 shall be under the supervision of the administrator.
24 28 Sec. 49. Section 227.2, subsection 1, unnumbered paragraph
24 29 1, Code 2015, is amended to read as follows:
24 30 The director of inspections and appeals shall make, or cause
24 31 to be made, at least one licensure inspection each year of
24 32 every county care facility. Either the administrator of the
24 33 division or the director of the department of inspections and
24 34 appeals, in cooperation with each other, upon receipt of a
24 35 complaint or for good cause, may make, or cause to be made,
25 1 a review of a county care facility or of any other private
25 2 or county institution where persons with mental illness or
25 3 an intellectual disability reside. A licensure inspection
25 4 or a review shall be made by a competent and disinterested
25 5 person who is acquainted with and interested in the care of
25 6 persons with mental illness and persons with an intellectual
25 7 disability. The objective of a licensure inspection or a
25 8 review shall be an evaluation of the programming and treatment
25 9 provided by the facility. After each licensure inspection of a
25 10 county care facility, the person who made the inspection shall
25 11 consult with the county authorities regional administrator
25 12 for the county in which the facility is located on plans and
25 13 practices that will improve the care given patients and. The
25 14 person shall also make recommendations to the administrator of
25 15 the division and the director of public health for coordinating
25 16 and improving the relationships between the administrators of
25 17 county care facilities, the administrator of the division,
25 18 the director of public health, the superintendents of state
25 19 mental health institutes and resource centers, community
25 20 mental health centers, mental health and disability services
25 21 regions, and other cooperating agencies, to cause improved
25 22 and more satisfactory care of patients. A written report of
25 23 each licensure inspection of a county care facility under this
25 24 section shall be filed by the person with the administrator
25 25 of the division and the director of public health and shall
25 26 include:
25 27 Sec. 50. Section 227.2, subsection 1, paragraph f, Code
25 28 2015, is amended to read as follows:
25 29 f. The recommendations given to and received from county
25 30 authorities the regional administrator on methods and practices
25 31 that will improve the conditions under which the county care
25 32 facility is operated.
25 33 Sec. 51. Section 227.2, subsection 2, Code 2015, is amended
25 34 to read as follows:
25 35 2. A copy of the written report prescribed by subsection
26 1 1 shall be furnished to the county board of supervisors,
26 2 to the county mental health and intellectual disability
26 3 coordinating board or to its advisory board if the county board
26 4 of supervisors constitutes ex officio the coordinating board
26 5 regional administrator for the county, to the administrator
26 6 of the county care facility inspected and to its certified
26 7 volunteer long=term care ombudsman, and to the department on
26 8 aging.
26 9 Sec. 52. Section 227.4, Code 2015, is amended to read as
26 10 follows:
26 11 227.4 Standards for care of persons with mental illness or an
26 12 intellectual disability in county care facilities.
26 13 The administrator, in cooperation with the department of
26 14 inspections and appeals, shall recommend and the mental health
26 15 and disability services commission created in section 225C.5
26 16 shall adopt, or amend and adopt, standards for the care of and
26 17 services to persons with mental illness or an intellectual
26 18 disability residing in county care facilities. The standards
26 19 shall be enforced by the department of inspections and appeals
26 20 as a part of the licensure inspection conducted pursuant to
26 21 chapter 135C. The objective of the standards is to ensure
26 22 that persons with mental illness or an intellectual disability
26 23 who are residents of county care facilities are not only
26 24 adequately fed, clothed, and housed, but are also offered
26 25 reasonable opportunities for productive work and recreational
26 26 activities suited to their physical and mental abilities and
26 27 offering both a constructive outlet for their energies and, if
26 28 possible, therapeutic benefit. When recommending standards
26 29 under this section, the administrator shall designate an
26 30 advisory committee representing administrators of county care
26 31 facilities, county mental health and developmental disabilities
26 32 regional planning councils regional administrators, mental
26 33 health and disability services region governing boards,
26 34 and county care facility certified volunteer long=term care
26 35 ombudsmen to assist in the establishment of standards.
27 1 Sec. 53. Section 227.10, Code 2015, is amended to read as
27 2 follows:
27 3 227.10 Transfers from county or private institutions.
27 4 Patients who have been admitted at public expense to
27 5 any institution to which this chapter is applicable may be
27 6 involuntarily transferred to the proper state hospital for
27 7 persons with mental illness in the manner prescribed by
27 8 sections 229.6 to 229.13. The application required by section
27 9 229.6 may be filed by the administrator of the division or
27 10 the administrator's designee, or by the administrator of the
27 11 institution where the patient is then being maintained or
27 12 treated. If the patient was admitted to that institution
27 13 involuntarily, the administrator of the division may arrange
27 14 and complete the transfer, and shall report it as required
27 15 of a chief medical officer under section 229.15, subsection
27 16 5. The transfer shall be made at county the mental health
27 17 and disabilities services region's expense, and the expense
27 18 recovered, as provided in section 227.7. However, transfer
27 19 under this section of a patient whose expenses are payable in
27 20 whole or in part by a county the mental health and disabilities
27 21 services region is subject to an authorization for the transfer
27 22 through the central point of coordination process regional
27 23 administrator for the patient's county of residence.
27 24 Sec. 54. Section 227.11, Code 2015, is amended to read as
27 25 follows:
27 26 227.11 Transfers from state hospitals.
27 27 A regional administrator for the county chargeable with
27 28 the expense of a patient in a state hospital for persons with
27 29 mental illness shall transfer the patient to a county or
27 30 private institution for persons with mental illness that is in
27 31 compliance with the applicable rules when the administrator
27 32 of the division or the administrator's designee orders the
27 33 transfer on a finding that the patient is suffering from
27 34 chronic mental illness or from senility a serious mental
27 35 illness and will receive equal benefit by being so transferred.
28 1 A county mental health and disability services region shall
28 2 transfer to its a county care facility any patient in a state
28 3 hospital for persons with mental illness upon request of the
28 4 superintendent of the state hospital in which the patient is
28 5 confined pursuant to the superintendent's authority under
28 6 section 229.15, subsection 5, and approval by the board of
28 7 supervisors of regional administrator for the county of the
28 8 patient's residence. In no case shall a patient be thus
28 9 transferred except upon compliance with section 229.14A or
28 10 without the written consent of a relative, friend, or guardian
28 11 if such relative, friend, or guardian pays the expense of
28 12 the care of such patient in a state hospital. Patients
28 13 transferred to a public or private facility under this
28 14 section may subsequently be placed on convalescent or limited
28 15 leave or transferred to a different facility for continued
28 16 full=time custody, care, and treatment when, in the opinion
28 17 of the attending physician or the chief medical officer of
28 18 the hospital from which the patient was so transferred, the
28 19 best interest of the patient would be served by such leave or
28 20 transfer. For any patient who is involuntarily committed, any
28 21 transfer made under this section is subject to the placement
28 22 hearing requirements of section 229.14A.
28 23 Sec. 55. Section 227.12, Code 2015, is amended to read as
28 24 follows:
28 25 227.12 Difference of opinion.
28 26 When a difference of opinion exists between the
28 27 administrator of the division and the authorities in charge
28 28 of any private or county hospital in regard to the removal
28 29 transfer of a patient or patients as herein provided in
28 30 sections 227.10 and 227.11, the matter shall be submitted to
28 31 the district court of the county in which such hospital is
28 32 situated and shall be summarily tried as an equitable action,
28 33 and the judgment of the district court shall be final.
28 34 Sec. 56. Section 227.14, Code 2015, is amended to read as
28 35 follows:
29 1 227.14 Caring for persons with mental illness from other
29 2 counties.
29 3 Boards of supervisors of counties having no The regional
29 4 administrator for a county that does not have proper facilities
29 5 for caring for persons with mental illness may, with the
29 6 consent of the administrator of the division, provide for
29 7 such care at the expense of the county mental health and
29 8 disabilities services region in any convenient and proper
29 9 county or private institution for persons with mental illness
29 10 which is willing to receive them the persons.
29 11 Sec. 57. Section 229.1, subsection 3, Code 2015, is amended
29 12 by striking the subsection.
29 13 Sec. 58. Section 229.1, Code 2015, is amended by adding the
29 14 following new subsections:
29 15 NEW SUBSECTION. 8A. "Mental health and disability services
29 16 region" means a mental health and disability services region
29 17 formed in accordance with section 331.389.
29 18 NEW SUBSECTION. 14A. "Regional administrator" means the
29 19 regional administrator of a mental health and disability
29 20 services region, as defined in section 331.388.
29 21 Sec. 59. Section 229.1B, Code 2015, is amended to read as
29 22 follows:
29 23 229.1B Central point of coordination process Regional
29 24 administrator.
29 25 Notwithstanding any provision of this chapter to the
29 26 contrary, any person whose hospitalization expenses are payable
29 27 in whole or in part by a county mental health and disabilities
29 28 services region shall be subject to all administrative
29 29 requirements of the central point of coordination process
29 30 regional administrator for the county.
29 31 Sec. 60. Section 229.2, subsection 1, paragraph b,
29 32 subparagraph (3), Code 2015, is amended to read as follows:
29 33 (3) As soon as is practicable after the filing of a
29 34 petition for juvenile court approval of the admission of the
29 35 minor, the juvenile court shall determine whether the minor
30 1 has an attorney to represent the minor in the hospitalization
30 2 proceeding, and if not, the court shall assign to the minor
30 3 an attorney. If the minor is financially unable to pay for
30 4 an attorney, the attorney shall be compensated by the county
30 5 mental health and disabilities services region at an hourly
30 6 rate to be established by the county board of supervisors
30 7 regional administrator for the county in which the proceeding
30 8 is held in substantially the same manner as provided in section
30 9 815.7.
30 10 Sec. 61. Section 229.8, subsection 1, Code 2015, is amended
30 11 to read as follows:
30 12 1. Determine whether the respondent has an attorney
30 13 who is able and willing to represent the respondent in the
30 14 hospitalization proceeding, and if not, whether the respondent
30 15 is financially able to employ an attorney and capable of
30 16 meaningfully assisting in selecting one. In accordance with
30 17 those determinations, the court shall if necessary allow the
30 18 respondent to select, or shall assign to the respondent, an
30 19 attorney. If the respondent is financially unable to pay an
30 20 attorney, the attorney shall be compensated by the county
30 21 mental health and disabilities services region at an hourly
30 22 rate to be established by the county board of supervisors
30 23 regional administrator for the county in which the proceeding
30 24 is held in substantially the same manner as provided in section
30 25 815.7.
30 26 Sec. 62. Section 229.10, subsection 1, paragraph a, Code
30 27 2015, is amended to read as follows:
30 28 a. An examination of the respondent shall be conducted by
30 29 one or more licensed physicians, as required by the court's
30 30 order, within a reasonable time. If the respondent is detained
30 31 pursuant to section 229.11, subsection 1, paragraph "b",
30 32 the examination shall be conducted within twenty=four hours.
30 33 If the respondent is detained pursuant to section 229.11,
30 34 subsection 1, paragraph "a" or "c", the examination shall
30 35 be conducted within forty=eight hours. If the respondent
31 1 so desires, the respondent shall be entitled to a separate
31 2 examination by a licensed physician of the respondent's own
31 3 choice. The reasonable cost of the examinations shall, if the
31 4 respondent lacks sufficient funds to pay the cost, be paid
31 5 by the regional administrator from county mental health and
31 6 disabilities services region funds upon order of the court.
31 7 Sec. 63. Section 229.11, subsection 1, unnumbered paragraph
31 8 1, Code 2015, is amended to read as follows:
31 9 If the applicant requests that the respondent be taken into
31 10 immediate custody and the judge, upon reviewing the application
31 11 and accompanying documentation, finds probable cause to believe
31 12 that the respondent has a serious mental impairment and is
31 13 likely to injure the respondent or other persons if allowed
31 14 to remain at liberty, the judge may enter a written order
31 15 directing that the respondent be taken into immediate custody
31 16 by the sheriff or the sheriff's deputy and be detained until
31 17 the hospitalization hearing. The hospitalization hearing shall
31 18 be held no more than five days after the date of the order,
31 19 except that if the fifth day after the date of the order is a
31 20 Saturday, Sunday, or a holiday, the hearing may be held on the
31 21 next succeeding business day. If the expenses of a respondent
31 22 are payable in whole or in part by a county mental health and
31 23 disabilities services region, for a placement in accordance
31 24 with paragraph "a", the judge shall give notice of the
31 25 placement to the central point of coordination process regional
31 26 administrator for the county in which the court is located,
31 27 and for a placement in accordance with paragraph "b" or "c",
31 28 the judge shall order the placement in a hospital or facility
31 29 designated through the central point of coordination process
31 30 regional administrator. The judge may order the respondent
31 31 detained for the period of time until the hearing is held,
31 32 and no longer, in accordance with paragraph "a", if possible,
31 33 and if not then in accordance with paragraph "b", or, only if
31 34 neither of these alternatives is available, in accordance with
31 35 paragraph "c". Detention may be:
32 1 Sec. 64. Section 229.13, subsection 1, paragraph a, Code
32 2 2015, is amended to read as follows:
32 3 a. The court shall order a respondent whose expenses are
32 4 payable in whole or in part by a county mental health and
32 5 disabilities services region placed under the care of an
32 6 appropriate hospital or facility designated through the central
32 7 point of coordination process county's regional administrator
32 8 on an inpatient or outpatient basis.
32 9 Sec. 65. Section 229.14, subsection 2, paragraph a, Code
32 10 2015, is amended to read as follows:
32 11 a. For a respondent whose expenses are payable in whole or
32 12 in part by a county mental health and disabilities services
32 13 region, placement as designated through the central point of
32 14 coordination process county's regional administrator in the
32 15 care of an appropriate hospital or facility on an inpatient
32 16 or outpatient basis, or other appropriate treatment, or in an
32 17 appropriate alternative placement.
32 18 Sec. 66. Section 229.14A, subsections 7 and 9, Code 2015,
32 19 are amended to read as follows:
32 20 7. If a respondent's expenses are payable in whole or in
32 21 part by a county mental health and disabilities services region
32 22 through the central point of coordination process county's
32 23 regional administrator, notice of a placement hearing shall
32 24 be provided to the county attorney and the county's central
32 25 point of coordination process regional administrator. At the
32 26 hearing, the county may present evidence regarding appropriate
32 27 placement.
32 28 9. A placement made pursuant to an order entered under
32 29 section 229.13 or 229.14 or this section shall be considered to
32 30 be authorized through the central point of coordination process
32 31 county's regional administrator.
32 32 Sec. 67. Section 229.24, subsection 3, unnumbered paragraph
32 33 1, Code 2015, is amended to read as follows:
32 34 If all or part of the costs associated with hospitalization
32 35 of an individual under this chapter are chargeable to a county
33 1 of residence, the clerk of the district court shall provide
33 2 to the regional administrator for the county of residence and
33 3 to the regional administrator for the county in which the
33 4 hospitalization order is entered the following information
33 5 pertaining to the individual which would be confidential under
33 6 subsection 1:
33 7 Sec. 68. Section 229.42, subsection 1, Code 2015, is amended
33 8 to read as follows:
33 9 1. If a person wishing to make application for voluntary
33 10 admission to a mental hospital established by chapter 226 is
33 11 unable to pay the costs of hospitalization or those responsible
33 12 for the person are unable to pay the costs, application for
33 13 authorization of voluntary admission must be made through a
33 14 central point of coordination process regional administrator
33 15 before application for admission is made to the hospital. The
33 16 person's county of residence shall be determined through the
33 17 central point of coordination process regional administrator
33 18 and if the admission is approved through the central point
33 19 of coordination process regional administrator, the person's
33 20 admission to a mental health hospital shall be authorized as
33 21 a voluntary case. The authorization shall be issued on forms
33 22 provided by the department of human services' administrator.
33 23 The costs of the hospitalization shall be paid by the county
33 24 of residence through the regional administrator to the
33 25 department of human services and credited to the general
33 26 fund of the state, provided that the mental health hospital
33 27 rendering the services has certified to the county auditor of
33 28 the county of residence and the regional administrator the
33 29 amount chargeable to the county mental health and disabilities
33 30 services region and has sent a duplicate statement of the
33 31 charges to the department of human services. A county mental
33 32 health and disabilities services region shall not be billed
33 33 for the cost of a patient unless the patient's admission is
33 34 authorized through the central point of coordination process
33 35 regional administrator. The mental health institute and the
34 1 county regional administrator shall work together to locate
34 2 appropriate alternative placements and services, and to
34 3 educate patients and family members of patients regarding such
34 4 alternatives.
34 5 Sec. 69. Section 230.1, subsection 3, Code 2015, is amended
34 6 to read as follows:
34 7 3. A mental health and disabilities services region or
34 8 county of residence is not liable for costs and expenses
34 9 associated with a person with mental illness unless the costs
34 10 and expenses are for services and other support authorized for
34 11 the person through the central point of coordination process
34 12 county's regional administrator. For the purposes of this
34 13 chapter, "central point of coordination process" "regional
34 14 administrator" means the same as defined in section 331.440
34 15 331.388.
34 16 Sec. 70. Section 230.3, Code 2015, is amended to read as
34 17 follows:
34 18 230.3 Certification of residence.
34 19 If a person's county of residence is determined by the
34 20 county's central point of coordination process regional
34 21 administrator to be in another county of this state, the county
34 22 regional administrator making the determination shall certify
34 23 the determination to the superintendent of the hospital to
34 24 which the person is admitted or committed. The certification
34 25 shall be accompanied by a copy of the evidence supporting
34 26 the determination. Upon receiving the certification, the
34 27 superintendent shall charge the expenses already incurred and
34 28 unadjusted, and all future expenses of the person, to the
34 29 regional administrator of the county determined to be the
34 30 county of residence.
34 31 Sec. 71. Section 230.20, subsection 2, paragraph b, Code
34 32 2015, is amended to read as follows:
34 33 b. The per diem costs billed to each county mental health
34 34 and disabilities services region shall not exceed the per
34 35 diem costs billed to the county in the fiscal year beginning
35 1 July 1, 1996. However, the per diem costs billed to a county
35 2 mental health and disabilities services region may be adjusted
35 3 annually to reflect increased costs, to the extent of the
35 4 percentage increase in the total of county fixed budgets
35 5 pursuant to the allowed growth factor adjustment statewide per
35 6 capita expenditure target amount, if any per capita growth
35 7 amount is authorized by the general assembly for the fiscal
35 8 year in accordance with section 331.439 426B.3.
35 9 Sec. 72. Section 232.2, subsection 4, paragraph f,
35 10 subparagraph (3), Code 2015, is amended to read as follows:
35 11 (3) The transition plan shall be developed and reviewed
35 12 by the department in collaboration with a child=centered
35 13 transition team. The transition team shall be comprised of
35 14 the child's caseworker and persons selected by the child,
35 15 persons who have knowledge of services available to the child,
35 16 and any person who may reasonably be expected to be a service
35 17 provider for the child when the child becomes an adult or to
35 18 become responsible for the costs of services at that time.
35 19 If the child is reasonably likely to need or be eligible for
35 20 adult services, the transition team membership shall include
35 21 representatives from the adult services system. The adult
35 22 services system representatives may include but are not limited
35 23 to the administrator of county general relief under chapter
35 24 251 or 252 or of the central point of coordination process
35 25 implemented under section 331.440 regional administrator of
35 26 the county mental health and disability services region, as
35 27 defined in section 331.388. The membership of the transition
35 28 team and the meeting dates for the team shall be documented in
35 29 the transition plan.
35 30 Sec. 73. Section 235.7, subsection 2, Code 2015, is amended
35 31 to read as follows:
35 32 2. Membership. The department may authorize the governance
35 33 boards of decategorization of child welfare and juvenile
35 34 justice funding projects established under section 232.188 to
35 35 appoint the transition committee membership and may utilize
36 1 the boundaries of decategorization projects to establish
36 2 the service areas for transition committees. The committee
36 3 membership may include but is not limited to department of
36 4 human services staff involved with foster care, child welfare,
36 5 and adult services, juvenile court services staff, staff
36 6 involved with county general relief under chapter 251 or 252,
36 7 or of the central point of coordination process implemented
36 8 under section 331.440 a regional administrator of the county
36 9 mental health and disability services region, as defined
36 10 in section 331.388, in the area, school district and area
36 11 education agency staff involved with special education, and a
36 12 child's court appointed special advocate, guardian ad litem,
36 13 service providers, and other persons knowledgeable about the
36 14 child.
36 15 Sec. 74. Section 235A.15, subsection 2, paragraph c,
36 16 subparagraph (9), Code 2015, is amended to read as follows:
36 17 (9) To the administrator of an agency providing mental
36 18 health, intellectual disability, or developmental disability
36 19 services under a county management plan developed pursuant
36 20 to section 331.439 regional service system management plan
36 21 implemented in accordance with section 331.393, if the data
36 22 concerns a person employed by or being considered by the agency
36 23 for employment.
36 24 Sec. 75. Section 235B.6, subsection 2, paragraph c,
36 25 subparagraph (6), Code 2015, is amended to read as follows:
36 26 (6) To the administrator of an agency providing mental
36 27 health, intellectual disability, or developmental disability
36 28 services under a county management plan developed pursuant
36 29 to section 331.439 regional service system management plan
36 30 implemented in accordance with section 331.393, if the
36 31 information concerns a person employed by or being considered
36 32 by the agency for employment.
36 33 Sec. 76. Section 426B.2, subsection 2, Code 2015, is amended
36 34 to read as follows:
36 35 2. As used in this chapter, and in sections 331.438 and
37 1 331.439 section 331.424A, for purposes of population=based
37 2 funding calculations, "population" means the population shown
37 3 by the latest preceding certified federal census or the
37 4 latest applicable population estimate issued by the federal
37 5 government, whichever is most recent and available as of July
37 6 1 of the fiscal year preceding the fiscal year to which the
37 7 funding calculations apply.
37 8 Sec. 77. Section 426B.5, subsection 1, Code 2015, is amended
37 9 by striking the subsection.
37 10 Sec. 78. Section 426B.5, subsections 2 and 3, Code 2015, are
37 11 amended to read as follows:
37 12 2. Risk pool.
37 13 a. For the purposes of this subsection section, unless the
37 14 context otherwise requires, "services fund":
37 15 (1) "Mental health and disability services region" means
37 16 a mental health and disability services region formed in
37 17 accordance with section 331.389.
37 18 (2) "Regional administrator" means the regional
37 19 administrator of a mental health and disability services
37 20 region, as defined in section 331.388.
37 21 (3) "Services fund" means a county's mental health and
37 22 disabilities services fund created in section 331.424A.
37 23 b. A risk pool is created in the property tax relief fund.
37 24 The pool shall consist of the moneys credited to the pool by
37 25 law.
37 26 c. A risk pool board is created. The board shall consist
37 27 of two county supervisors, two county auditors, a member of
37 28 the mental health and disability services commission who is
37 29 not a member of a county board of supervisors, a member of
37 30 the county finance committee created in chapter 333A who is
37 31 not an elected official, a representative of a provider of
37 32 mental health or developmental disabilities services selected
37 33 from nominees submitted by the Iowa association of community
37 34 providers, and two central point of coordination process
37 35 staff members of regional administrators of county mental
38 1 health and disability services, all appointed by the governor,
38 2 and one member appointed by the director of human services.
38 3 All members appointed by the governor shall be subject to
38 4 confirmation by the senate. Members shall serve for three=year
38 5 terms. A vacancy shall be filled in the same manner as the
38 6 original appointment. Expenses and other costs of the risk
38 7 pool board members representing counties shall be paid by the
38 8 county of origin. Expenses and other costs of risk pool board
38 9 members who do not represent counties shall be paid from a
38 10 source determined by the governor. Staff assistance to the
38 11 board shall be provided by the department of human services and
38 12 counties. Actuarial expenses and other direct administrative
38 13 costs shall be charged to the pool.
38 14 d. A county regional administrator must apply to the risk
38 15 pool board for assistance from the risk pool on or before
38 16 October 31. The purpose of the assistance shall be to provide
38 17 financial support for services provided by one or more of the
38 18 counties comprising the regional administrator's mental health
38 19 and disability services region. The risk pool board shall
38 20 make its final decisions on or before December 15 regarding
38 21 acceptance or rejection of the applications for assistance and
38 22 the total amount accepted shall be considered obligated.
38 23 e. Basic eligibility for risk pool assistance requires that
38 24 a county mental health and disability services region meet all
38 25 of the following conditions:
38 26 (1) The county mental health and disability services region
38 27 is in compliance with the regional service system management
38 28 plan requirements of section 331.439 331.393.
38 29 (2) The county counties comprising the mental health and
38 30 disability services region each levied the maximum amount
38 31 allowed for the county's services fund under section 331.424A
38 32 for the fiscal year of application for risk pool assistance.
38 33 (3) In the fiscal year that commenced two years prior to the
38 34 fiscal year of application, the county's ending balance, under
38 35 generally accepted accounting principles, of the mental health
39 1 and disability services region's combined services fund ending
39 2 balance under generally accepted accounting principles funds
39 3 was equal to or less than twenty percent of the county's actual
39 4 gross expenditures of the counties comprising the mental health
39 5 and disability services region for that fiscal year.
39 6 f. The board shall review the fiscal year=end financial
39 7 records for all counties mental health and disability services
39 8 regions that are granted risk pool assistance. If the board
39 9 determines a county's mental health and disability services
39 10 region's actual need for risk pool assistance was less than
39 11 the amount of risk pool assistance granted to the county
39 12 mental health and disability services region, the county
39 13 mental health and disability services region shall refund the
39 14 difference between the amount of assistance granted and the
39 15 actual need. The county mental health and disability services
39 16 region shall submit the refund within thirty days of receiving
39 17 notice from the board. Refunds shall be credited to the risk
39 18 pool. The mental health and disability services commission
39 19 shall adopt rules pursuant to chapter 17A providing criteria
39 20 for the purposes of this lettered paragraph and as necessary to
39 21 implement the other provisions of this subsection.
39 22 g. The board shall determine application requirements to
39 23 ensure prudent use of risk pool assistance. The board may
39 24 accept or reject an application for assistance in whole or in
39 25 part. The decision of the board is final.
39 26 h. The total amount of risk pool assistance shall be limited
39 27 to the amount available in the risk pool for a fiscal year. Any
39 28 unobligated balance in the risk pool at the close of a fiscal
39 29 year shall remain in the risk pool for distribution in the
39 30 succeeding fiscal year.
39 31 i. Risk pool assistance shall only be made available to
39 32 address one or more of the following circumstances:
39 33 (1) Continuing support for mandated services.
39 34 (2) Avoiding the need for reduction or elimination of
39 35 critical services when the reduction or elimination places
40 1 consumers' health or safety at risk.
40 2 (3) Avoiding the need for reduction or elimination of a
40 3 mobile crisis team or other critical emergency services when
40 4 the reduction or elimination places the public's health or
40 5 safety at risk.
40 6 (4) Avoiding the need for reduction or elimination of
40 7 the services or other support provided to entire disability
40 8 populations.
40 9 (5) Avoiding the need for reduction or elimination of
40 10 services or other support that maintain consumers in a
40 11 community setting, creating a risk that the consumers would be
40 12 placed in more restrictive, higher cost settings.
40 13 j. Subject to the amount available and obligated from the
40 14 risk pool for a fiscal year, the department of human services
40 15 shall annually calculate the amount of moneys due to eligible
40 16 counties mental health and disability services regions in
40 17 accordance with the board's decisions and that amount is
40 18 appropriated from the risk pool to the department for payment
40 19 of the moneys due. The department shall authorize the issuance
40 20 of warrants payable to the county treasurer mental health
40 21 and disability services regions for the amounts due and the
40 22 warrants shall be issued on or before January 1.
40 23 k. On or before March 1 and September 1 of each fiscal year,
40 24 the department of human services shall provide the risk pool
40 25 board with a report of the financial condition of each funding
40 26 source administered by the board. The report shall include
40 27 but is not limited to an itemization of the funding source's
40 28 balances, types and amount of revenues credited, and payees
40 29 and payment amounts for the expenditures made from the funding
40 30 source during the reporting period.
40 31 l. If the board has made its decisions but has determined
40 32 that there are otherwise qualifying requests for risk pool
40 33 assistance that are beyond the amount available in the risk
40 34 pool fund for a fiscal year, the board shall compile a list of
40 35 such requests and the supporting information for the requests.
41 1 The list and information shall be submitted to the mental
41 2 health and disability services commission, the department of
41 3 human services, and the general assembly.
41 4 3. Incentive pool.
41 5 a. An incentive pool is created in the property tax relief
41 6 fund. The incentive pool shall consist of the moneys credited
41 7 to the incentive pool by law.
41 8 b. Moneys available in the incentive pool for a fiscal
41 9 year shall be distributed to those counties mental health and
41 10 disability services regions that either meet or show progress
41 11 toward meeting the purposes and intent described in section
41 12 331.439, subsection 1, paragraph "c" 225C.1. The moneys
41 13 received by a county region from the incentive pool shall be
41 14 used to build community capacity to support individuals covered
41 15 by the county's region's regional service system management
41 16 plan approved under section 331.439, 331.393 in meeting such
41 17 purposes.
41 18 Sec. 79. REPEAL. Section 226.47, Code 2015, is repealed.
SF 463 (5) 86
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