HF 690 — 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.

3 children in ththis isstate s ta te who need the services, regardless of the place of residence or economic circumstances of those children.

The admadministrator inistratorshall sh a ll work with the sstate ta te board and other sstate ta te agencies including but not limlimited ited to the department of education and the department of public health to develop and implement a strastrategic te g ic plan to expand access to qqualified u alified mental health workers across the sstate. ta te .

NEW PARAGRAPH.PARAGRAPH .

OOk.00k.

EEstablish stablish and maintain a data cocollection llectio n and management information system oriented to the needs of children uutilizing tiliz in g the chchildren’s ild ren 's behavioral health system, providers, the department, and other programs or ffacilities a c ilitie s in accordance with section 225C.6A.

The system shshall a ll be used to ididentify, encollect, tify , c o lle c t, and analyze service outcome and performance measures data in order to assess the effects of the services on the children uutilizing tiliz in g the servicesservices. .

The admadministrator inistratorshall sh a ll annually submit to the sstate ta te board information collected by the department indicating the changes and trends in the chchildren’s ild ren 's behavioral health system.

The admadministrator inistratorshall sh a ll make the outcome data available to the public.

NEW SUBPARAGRAPH.SUBPARAGRAPH .

NEW PARAGRAPH.PARAGRAPH .

CChildren’s hildren's behavioral health services provided to eeligible lig ib le children ththat at are not covered under the medical assistance program or other ththird-party ird -p arty payor are the respresponsibility o n sib ility of the county-based regional service system.

225C.Sl225C.51 Children'sChildren’s behavioral health system stastate te board.

A chchildren’s ild ren 's behavioral health system sstate ta te board is created as the sstate ta te body to provide guidance on the implementation and management of a chchildren’s ild ren 's behavioral health system for the provision of services to children with a serious emotional disturbance.

The sstate taboard’s te board's public voting members shshall a ll be appointed to four-year staggered terms by the governor and are subject to confirmconfirmation ation by the senate.

All other sstate ta te board voting members shshall all be appointed to four-year House FFile ile 690, pp. .

4 staggered terms and are not subject to confirmconfirmation ation by the senate.

SState tate board members shshall a ll be appointed on the basis of ininterest te re st and experience in the fiefields ld s of chchildren’s ild ren 's behavioral health to ensure adequate representation from persons with llife i f e experiences and from persons knowledgeable about chchildren’s ild ren 's behavioral health services.

The department shshall a ll provide support to the sstate ta te board, and the board may uutilize tilizstaff e s ta ff support and other assistance provided to the sstate ta te board by other persons.

The sstate ta te board shshall a ll meet aat tleast le a st four times per year.

The membership of the sstate ta te board shshall a ll consist of the following persons who, aat t the time of appointment to the sstate ta te board, are active members of the indicated groups:

The ddirector irecto r of the department or the ddirector’s ire c to r's designee.

bb. .

The ddirector irecto r of the department of education or the ddirector’s ire c to r's designee.

The ddirector irecto r of the department of public health or the ddirector’s ire c to r's designee.

The ddirector irecto r of workforce development or the ddirector’s ire c to r's designee.

One member shshall a ll be selected from nominees submitted by the sstate ta te court admadministrator. inistrator.

One member shshall all be selected from nominees submitted by the early childhood Iowa ooffice ffice in the department of management.

One member shshall a ll be a member of the mental health and ddisability is a b ility services commission.

hh. .

One member shshall all be a board member or an employee of a provider of mental health services to children.

ii. .

One member shshall a ll be a board member or an employee of a provider of child welfare services.

jj. .

One member shshall a ll be an admadministrator inistrator of an area education agency.

One member shshall a ll be an educator, counselor, or admadministrator inistrator of a school ddistrict. is tr ic t.

1.l.

One member shshall all be a representative of an established advocacy organization whose mission or purpose iit tis, is , in ppart, a rt, to further goals related to cchildren’s h ild re n 's mental health.

One member shshall a ll be a parent or guardian of a child House FFile ile 690, pp. .

5 currently uutilizing tiliz in g or who has uutilized tiliz e d behavioral health services.

One member shshall a ll be a ssheriff. h e riff.

One member shshall a ll be a ppediatrician. ed iatrician .

One member shshall a ll be a representative from a health care system.

One member shshall a ll be a chief executive oofficer fficer of a mental health and ddisability is a b ility services region.

In addition to the voting members, the membership shshall a ll include four members of the general assembly with one member designated by each of the following:

the mmajority ajority leader of the senate, the mminority inority leader of the senate, the speaker of the house of representatives, and the mminority inority leader of the house of representatives.

A lelegislative g isla tiv e member serves for a term as provided in section 69.16B in a nonvoting, ex oofficio ffic io capacity and is not eeligible lig ib le for per diem and expenses as provided in section 2.10.

The four-year terms shshall a ll begin and end as provided in section 69.19.

Vacancies on the sstate ta te board shshall a ll be fillefilled d as provided in section 2.32.

A member shshall a ll not be appointed for more than two consecutive four-year terms.

The ddirector irecto r and the ddirector irecto r of the department of education, or ththeir e ir designees, shshall a ll serve as co-chairpersons of the sstate ta te board.

Board members shshall all not be eentitled n title d to a per diem as specified in section 7E.6 and shshall all not be eentitled n title d to actual and necessary expenses incurred while engaged in ththeir eofficial irduties. o ffic ia l d u ties.

225C.52 Children'sChildren’s behavioral health system stastate te board ~—— duties.

To the extent funding is avavailable, ailab le, the sstate ta te board shshall a ll perform the following dduties: u ties:

Advise the admadministrator inistrator on the admadministration inistration of the cchildren’s h ild re n 's behavioral health system.

Provide consultation services to agencies regarding the development of admadministrative inistrative rules for the chchildren’s ild ren 's behavioral health system.

Identify behavioral health outcomes and indicators for eeligible lig ib le children with a serious emotional disturbance to promote children livliving in g with ththeir e ir own famfamilies ilies and in the House FFile ile690, 690p. , p .

6 communitycommunity. .

Submit a wrwritten ireport tte n re p o rt on or bbefore e fo re December 1 oof f each year to ththe e governor and ththe egeneral gassembly. e n e ra l assem bly.

At a minimum, ththe ereport reshall pinclude o rt s h a ll in clu d e a summary oof fall aactivities l l a c t i v i t i e s undertaken by ththe estate sboard, t a t e b o ard , a summary oof fstate s t a t e board aactivities, c t i v i t i e s , and rresults e s u lts from ididentified ebehavioral nhealth tif ie d b e h a v io ra l h e a lth outcomes and inindicators dfor icthe achildren’s tobehavioral rshealth fosystem. r th e c h ild r e n 's b e h a v io ra l h e a lth system .

SSection e c tio n 331.388, Code 2019, iis s amended by adding ththe efollowing follow ing new susubsections: b se c tio n s:

NEW SUBSECTION.SUBSECTION .

~Children's“Children’s behavioral health servicesservices” means ththe e same as ddefined efin ed in ssection e c tio n 225C.2.

NEW SUBSECTION.SUBSECTION .

~Serious“Serious emotional disturbance-disturbance” means ththe e same as ddefined efin ed in ssection e c tio n 225C.2.

NEW SUBSECTION.SUBSECTION .

~State“State board-board” means ththe echildren’s c h ild r e n 's system sstate t a t e board ccreated re a te d in ssection e c tio n 225C.51.

SSection e c tio n 331.390, susubsection b se c tio n 2, Code 2019, iis s amended by sstriking trthe iksubsection in g th e su b se c tio n and ininserting s e r tin g in lielieu uthereof ththe efollowing: re o f th e fo llo w in g :

The governing board sshall h a ll comply wwith ithall aof lthe lfollowing orequirements: f th e fo llo w in g req u irem en ts:

The vvoting o tin g membership oof fthe th e governing board sshall hconsist aof llat cleast o n s is t o f a t l e a s t one board oof fsupervisors su p e rv iso rs member from each county comcomprising prisingthe thregion eor regtheir iodesignees. n o r th e ir d e sig n e e s.

bb. .

The membership oof fthe th e governing board sshall halso ainclude ll a ls o in clu d e one aadult d u lt person who uutilizes tmental ihealth l i z e s m ental h e a lth and ddisability iservices sor ais b i l i t y s e rv ic e s o r i s an aactively c tiv e ly involved rrelative eof la tiv e o f such an aadult dperson. u lt p erso n .

TThis his member sshall h a ll be ddesignated e sig n a te d by ththe eregional readvisory gcommittee io n a l ad v iso ry com m ittee formed by ththe e governing board ppursuant u rsu an t to pparagraph arag“h”. rap h ~h-.

The membership oof fthe th e governing board sshall h a ll not ininclude c lu d e employees oof fthe thdepartment eof departm ent o f human sservices e rv ic e s or an uunelected n e le c te d employee oof f a county.

The membership oof fthe th e governing board sshall halso aconsist llof a ls o c o n s is t o f one member rerepresenting padult reservice seproviders n tin g a d u lt s e rv ic e p ro v id e rs in ththe eregion. re g io n .T his member s h a ll be d e sig n a te d by th e re g io n a l ad v iso ry com m ittee formed by th e governing board p u rsu an t to paragraph 'n-.

TheThis member dshall ebe sigdesignated nby athe teregional dadvisory incommittee accordanceformed wby iththe thgoverning isboard paragraphpursuant sto hparagraph a“h”. ll serv e in a nonvoting, ex o f f i c i o c a p a c ity .

The member designated in accordance with this paragraph shall serve in a nonvoting, ex officio capacity.

The membership oof fthe th e governing board sshall halso a ll a ls o House FFile ile690, 690p. , p .

7 consist of one member representing childrenchildren’s ' s behavioral health services providers in the region.

This member shshall all be designated by the regional chchildren’s ild ren 's advisory committee formed ,.'" by the governing board pursuant to paragraph .l•“i”. The member designated in accordance with th is paragraph sh all serve in a nonvoting, ex o ffic io capacity.

The member designated in accordance with this paragraph shall serve in a nonvoting, ex officio capacity.

The membership of the governing board shshall all also consist of one member representing the education system in the region.

This member shshall all be designated by the regional chchildren’s ild ren 's advisory committee formed by the governing board pursuant to paragraph ""i“i”. ".

The membership of the governing board shshall all also consist of one member who is a parent of a child who uutilizes tilizchildren’s e s ch ild ren 's behavioral health services or actively involved relativrelatives es of such children.

This member shshall all be designated by the regional chchildren’s ild ren 's advisory committee formed by the governing board pursuant to paragraph ""i".“i”.

hh. .

The governing board shshall all have a regional advisory committee consisting of adults who uutilize tiliz e services or actively involved relativrelatives es of such adadults, u lts, service providers, and regional governing board members.

ii. .

The governing board shshall all have a regional chchildren’s ild ren 's advisory committee consisting of parents of children who uutilize tiliz e services or actively involved relativrelatives es of such children, a member of the education system, an early childhood advocate, a child welfare advocate, a chchildren’s ild ren 's behavioral health service provider, a member of the juvenile court, a ppediatrician, ed iatrician , a child care provider, a local law enforcement representative, and regional governing board members.

bb. .

The regional admadministrator inistratorstaff sshall ta ff sh all include one or more coordinators of mental health and ddisability isa b ility services and one or more coordinators of chchildren’s ild ren 's behavioral health services.services .

A coordinator shshall all possess a bachelor'sbachelor’s or higher level degree in a human services-related or admadministration-related inistration-relatedfield, fie ld , including but not limlimited ited to social work, psychology, nursing, or public or business admadministration, inistration, from an accredited college or university.

House FFile ile 690, pp. .

8 However, in lieu of a degree iin n public or business admadministration, inistration, a coordinator may provide documentation of relevant management experience.

An action of a coordinator involving a cclinical lin ic a l decision shshall all be made in conjunction with a professional who is trained in the delivery of the mental health or ddisability isa b ility service or chchildren’s ild ren 's behavioral health service addressed by the cclinical lin ic a l decision.

The regional admadministrator inistratorshall sh all determine whether rereferral fe rra l to a coordinator of mental health and ddisability isa b ility services or chchildren’s ild ren 's behavioral health services is required for a person or child seeking to access a service through a local access point of the regional service system or the chchildren’s ild ren 's behavioral health system.system .

NEW PARAGRAPH.PARAGRAPH .

ii. .

The scope of chchildren’s ild ren 's behavioral health core services.

Each service included shshall all be described and a projection of need shshall all be included.

NEW PARAGRAPH.PARAGRAPH .

jj. .

The eeligibility lig ib ility requirements for chchildren’s ild ren 's behavioral health core services under the chchildren’s ild ren 's behavioral health system.

(1) Performance and outcome measures relatinrelating g to the health, safety, education, work performance, and community residency of the persons receiving the services.

The person is aat tleast le a st eighteen years of age and is a resident of ththis isstate. s ta te .However, a person who is seventeen years of age, is a resident of th is s ta te , and is receiving publicly funded ch ild ren 's services may be considered e lig ib le for services through the regional service system during the three menth period preceding the person's eighteenth birthday in order to provide a smooth tra n sitio n from ch ild ren 's to adult services.

However, a person who is seventeen years of age, is a resident of this state, and is receiving publicly funded children’s services may be considered eligible for services through the regional service system during the three-month period preceding the person’s eighteenth birthday in order to provide a smooth transition from children’s to adult services.

Section 331.396, subsection 1, paragraph d, Code 2019, is amended by strikstriking in g the paragraph.

331.396A EEligibility ligrequirements ib—— ilitrequirements~ House FFile ile 690, p.

9 children'schildren’s behavioral health services.

A child shshall all be eeligible lig ib le for behavioral health services under the regional service system if aall ll of the following conditions are met:

The child is under eighteen years of age and is a resident of ththis isstate. s ta te .

The cchild’s h ild 's family has a family income equal to or less than five hundred percent of the federal poverty level as defined by the most recently revised poverty income guidelines published by the United States department of health and human services.

Notwithstanding paragraph ''an,a“a”, ca hchild’s ild 's family whose household income is between one hundred ffifty if ty percent but not more than five hundred percent of the federal poverty level shshall a ll be eeligible lig ib le for behavioral health services subject to a copayment, a single statewide slidsliding in g fee scale, or other cost-sharing requirements approved by the department.

331.397A Children'sChildren’s behavioral health core services.

For the purposes of ththis is section, unless the context otherwise requires, ~domain#“domain” means a seset t of simsimilar ilar behavioral health services ththat at can be provided depending on a cchild’s h ild 's service needs.

(1) A region shshall all work with chchildren’s ild ren 's behavioral health service providers to ensure that services in the required behavioral health core service domains in subsection 4 are available to children who are residents of the region, regardless of any ppotential o ten tial payment source for the services.

(2) Subject to the available appropriations, the director of human services shshall all ensure the behavioral health core service domains lislisted te d in subsection 4 are covered services for the medical assistance program under chapter 249A to the ggreatest reatest extent allowable under federal regulations.

The medical assistance program shshall all reimburse Medicaid enrolled providers for Medicaid covered services under subsection 4 when the services are medically necessary, the Medicaid enrolled provider submits an appropriate claim for such services, and House FFile ile 690, p.

10 no other ththird-party ird -p arty payor is responsible for reimbursement of such services.

Within the funds avavailable, ailab le, the region shshall a ll pay for such services for eeligible lig ib le children when payment through the medical assistance program or another ththird-party ird -p arty payment is not avavailable, ailab le, unless the child is on a waiting llist i s t for such payment or iit t has been determined ththat at the child does not meet the eeligibility ligcriteria ib ility c r ite r ia for any such service.

UUntil ntil funding is designed for other service populations, eeligibility lig ib ility for the service domains lislisted te d in ththis is section shshall a ll be limlimited ited to such children who are in need of behavioral health services.

Pursuant to recommendations made by the sstate ta te board, the department of human services shshall a ll adopt rules to define the services included in the core domains lislisted te d in ththis is section.

The rules shshall a ll provide service ddefinitions, e fin itio n s, service provider standards, service access standards, and service implementation dates, and shshall a ll provide consistency, to the extent possible, with simsimilar ilar service ddefinitions efin itio n s under the medical assistance program.

The chchildren’s ild ren 's behavioral health core service domains shshall a ll include aall l l of the following:

Treatment designed to amameliorate eliorate a cchild’s h ild 's serious emotional disturbance, including but not limlimited ited to aall l l of the following:

(1) Prevention, early ididentification, e n tific a tio n , early intervention, and education.

(2) Assessment and evaluation relatinrelating g to eeligibility lig ib ility for services.

Comprehensive fafacility c ility and community-based ccrisis ris is services regardless of a diagnosis of a serious emotional disturbance, including aall l l of the following:

(2) CCrisis risisstabilization sta b iliz a tio n community-based services.

(3) CCrisis risisstabilization staresidential b iliz a tio n re sid e n tia l services.

(4) Behavioral health ininpatient ptreatment. atien t treatm ent.

A region shshall all ensure ththat at services wwithin ithin the following additional core service domains are available to children not House FFile i le 690, pp. .

11 eeligible ligfor ibthe lmedical eassistance fo r th e m edical as s is ta n c program under chchapter ap ter 249A or rereceiving cother ethird-party ivpayment infor gothe thservices, e r th ir d - p a r tpayment fo r th e s e r v ic e s , when ppublic u b lc funds aare re made aavailable vfor a ila b le fo r such sservices: erv ic e s :

TreatmTreatment ent designed to aameliorate m e lio ra te a cchild’s hserious iemotional ldisturbance dincluding 'sbut e rio u s em otional d istu rb a n c e in c lu d in gbut not limlimited ite d to bbehavioral ehealth hschool-based atherapy. v io ra l h e a lth sch o o l-b ased th e ra p y .

Support fofor r community livliving inincluding g in c lu d in g but not limlimited ite d to aall l l of ththe efollowing: fo llo w in g :

(1) FamFamily ilysupport. su p p o rt.

(2) Peer susupport. p p o rt.

(3) TTherapeutic hfoster erapcare. eu tic f o s te rc a re .

(4) RRespite espcare. ite c a re .

TTransition raservices nfor schildren itio n s e rv ic e sfo r c h ild re n to ththe eadult amental dhealth u ltm ental h e a lth system pproviding roan vappropriate idmatch inwith gan a pchild’s pabilities robased p ria tematch w ith a c h i l d 's a b i l i t i ebased upon informinformed, ed,person-centered pchoices e rso n -c e n te re d c h o ices made from an aarray rraof yoptions oincluding fbut o p tio n s in clu d in g bu t not limlimited ite d to aall lof lthe ofollowing: f th e fo llo w in g :

(1) Day hhabilitation. a b ilita tio n .

(2) Job devdevelopment. elopm ent.

(3) SuppSupported orted employment.

(4) PPrevocational reservices. v o c a tio n as e rv ic e s .

(5) EEducational dservices. u catio n al se rv ic e s .

SService ervcoordination iceincluding cphysical ohealth o d in a tio n in c lu d in gp h y sic a lh e a lth and primprimary arycare cathat re th a t follow ththe eprinciples pof rthe in c ip le so f th e system oof fcare cincluding a re in c lu d in g but not limlimited ite d to aall lof lthe ofollowing: f th e fo llo w in g :

(1) Care ccoordination. o o rd in a tio.n (2) H ealth homes.

(2) Health homes.

DEPARTMENT OF HUMAN SERVICES AND DEPARTMENT OF PUBLIC HEALTH ~—— CRISIS HOTLINEHOTLINE. .

The departmdepartment entof o f human sservices eand rvthe icdepartment e sand th e departm ent of ppublic uhealth bshall licprovide h e a lthsingle, sstatewide htwenty-four-hour acrisis llphotline rothat vincorporates idinformation efor afamilies sof inchildren gwith le , sta te w id e tw en ty -fo u r-h o u rc r i s i h o tlin e th a tserious inemotional cdisturbance owhich rp o ra te sin fo rm atio n fo r fa m ilie s o f c h ild re n w ith a s e rio u s em otional d istu rb a n c ewhic h may be provided through expansion oof fthe thYourLifeIowa eplatform. YourLifeiowa p latfo rm .

MENTAL HEALTH AND DISABILITY SERVICES REGION ~—— CHILDREN'SCHILDREN’S BEHAVIOBEHAVIORAL RAL HEALTH SERVICES IMPLEMENTATION PLAN.

EacEach hmental mhealth ental h e a lth and ddisability iservices sregion ashall bsubmit i l i s e rv ic s reg io n s h a ll subm it to ththe edepartment departmof ent o f human sservices ean rvimplementation icplan e san im plem entation p la n to implement cchildren’s hbehavioral ildhealth rservices e n 'sb e h a v io ra h e a ht s e rv ic e s House FiFile l e 690, pp. .

12 ddescribed escribunder edsection under331.397A, sas eenacted cin tiothis nAct, 331no .later than April 1, 2020.

397A, as enacted in th is A ct, no l a t e r than A p ril 1 , 2020.

DEPARTMENT OF HUMAN SERVICES ~RULES.—— RULES.

The departmdepartment ent of human sservices eshall rvsubmit ic e s s h a llnotice submof it a n o tic e o f intended aaction c tio n to ththe eadministrative arules dcoordinator m in is tra tiv e ru le s c o o rd in a to r and ththe e Iowa aadministrative d m in is tra tiv e code eeditor dpursuant ito r p u rsu an t to ssection e c tio n 17A.4, susubsection b1, se c tio n 1 , paragraph "“a”, a " , not llater a t e r than January 11, , 2020, fofor rthe thadoption eof adrules o p tio n o f ru le s to implement ththis isAct. A ct.

SSections ectio n s 225C.51, 225C.52, 225C.53, and 225C.54, Code 2019, aare rerepealed. re p e a le d .

CODE EDITOR'SEDITOR’S DIRECTIVES.

The Code eeditor d ito r may change ththe ecurrent c u rre n t subchapter ttitle iof tchapter l e o f ch ap ter 225C, subchaptesubchapter r VI, to "CHILDREN'S“CHILDREN’S BEHAVIORAL HEALTH SYSTEM".SYSTEM”.

The Code eeditor d ito r may change ththe ecurrent c u rre n t subchapter ttitle iof tchapter l e o f ch ap ter 331, ppart a r t 6, to "MENTAL“MENTAL HEALTH AND DISABILITY SERVICES ~REGIONAL—— REGIONAL SERVICE SYSTEM ~—— CHILDREN'SCHILDREN’S BEHAVIORAL HEALTH CHARLESSYSTEM”. SCHNEIDER P re sid e n t o f th e Senate I hereby c e r t i f y th a t th is b i l l o rig in a te d in th e House and i s known as House F ile 690, E ig h ty -e ig h th G eneral Assembly.

~______________________________ ~______________________________ CARMINELINDA BOALUPMEYER CCHARLES hiefSCHNEIDER CSpeaker lerkof othe fHouse thPresident eof the Senate I hereby certify that this bill originated in the House Approvedand _-is C;.known as House File 690, Eighty-eighth General Assembly.

,______________________________ *CARMINE ~_BOAL ~-'Chief Clerk of the House Approved _______________, 2019 '______________________________ KIM REYNOLDS Governor