House Study Bill 653 - Introduced
SENATE/HOUSE FILE _____
BY (PROPOSED GOVERNOR BILL)
A BILL FOR
1 An Act relating to the transition of behavioral health services
2 from a mental health and disability services system to
3 a behavioral health service system, and the transfer of
4 disability services to the division of aging and disability
5 services of the department of health and human services,
6 making appropriations, and including effective date
7 provisions.
8 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
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1 DIVISION I
2 BEHAVIORAL HEALTH SERVICE SYSTEM
3 Section 1. NEW SECTION. 225A.1 Definitions.
4 As used in this chapter unless the context otherwise
5 requires:
6 1. “Administrative services organization” means an entity
7 designated by the department pursuant to section 225A.4, to
8 develop and perform planning and administrative services in
9 accordance with a district behavioral health service system
10 plan.
11 2. “Behavioral health condition” means a substantial
12 limitation in major life activities due to a mental,
13 behavioral, or addictive disorder or condition diagnosed in
14 accordance with the criteria provided in the most current
15 edition of the diagnostic and statistical manual of mental
16 disorders, published by the American psychiatric association.
17 3. “Behavioral health district” or “district” means a
18 geographic, multicounty, sub-state area as designated by the
19 department under section 225A.4.
20 4. “Behavioral health provider” or “provider” means an
21 individual, firm, corporation, association, or institution
22 that, pursuant to this chapter, is providing or has been
23 approved by the department to provide services to an individual
24 with a behavioral health condition.
25 5. “Behavioral health service system” means the behavioral
26 health service system established in section 225A.3.
27 6. “Caregiver” means an adult family member, or other
28 individual, who is providing care to a person outside of a
29 formal program.
30 7. “Department” means the department of health and human
31 services.
32 8. “Director” means the director of the department of health
33 and human services.
34 9. “District behavioral health advisory council” or
35 “advisory council” means a council established by an
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1 administrative services organization under section 225A.5, to
2 identify opportunities, address challenges, and advise the
3 administrative services organization in accordance with section
4 225A.5.
5 10. “District behavioral health service system plan” or
6 “district behavioral health plan” means a plan developed by
7 an administrative services organization and approved by the
8 department to outline the services intended to be provided
9 within the administrative services organization’s behavioral
10 health district.
11 11. “Indicated prevention” means prevention activities
12 designed to prevent the onset of substance use disorders in
13 individuals who do not meet the medical criteria for addiction,
14 but who show early signs of developing a substance use disorder
15 in the future.
16 12. “Selective prevention” means prevention activities
17 designed to target subsets of the total population who are
18 considered at-risk for a substance use disorder by virtue of
19 their membership in a particular segment of the population.
20 Selective prevention targets the entire subgroup, regardless of
21 the degree of risk of any individual within the group.
22 13. “State behavioral health service system plan” or
23 “state behavioral health plan” means the plan developed by the
24 department that describes the key components of the state’s
25 behavioral health service system.
26 14. “Universal prevention” means prevention activities
27 designed to address an entire population class for the purpose
28 of preventing or delaying the use of alcohol, tobacco, and
29 other drugs. Population classes include but are not limited
30 to the national population, local populations, community
31 populations, school populations, and neighborhood populations.
32 Sec. 2. NEW SECTION. 225A.2 State mental health authority
33 —— state agency for substance abuse.
34 1. The department is designated as the state mental health
35 authority as defined in 42 U.S.C. §201(m) for the purpose of
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1 directing benefits from the federal community mental health
2 services block grant, 42 U.S.C. §300x et seq., and the state
3 authority designated for the purpose of directing benefits
4 from the federal substance abuse prevention and treatment
5 block grant, 42 U.S.C. §300x-21 et seq. This designation
6 does not preclude the state board of regents from authorizing
7 or directing any institution under the board of regents’
8 jurisdiction to carry out educational, prevention, and research
9 activities in the areas of mental health and intellectual
10 disability.
11 2. The department is designated as the single state agency
12 for substance abuse for the purposes of 42 U.S.C. §1396a et
13 seq.
14 3. For the purposes of effectuating the department’s roles
15 designated in this section, the department shall have the
16 following powers and the authority to take all the following
17 actions:
18 a. Plan, establish, and maintain prevention, education,
19 early intervention, treatment, recovery support, and crisis
20 services programs as necessary or desirable in accordance with
21 a comprehensive behavioral health service system.
22 b. Develop and submit a state plan as required by 42 U.S.C.
23 §300x-1, in accordance with 42 C.F.R. §431.10.
24 c. Review and approve district behavioral health service
25 system plans developed in accordance with the state behavioral
26 health service system plan.
27 d. Perform all necessary acts to cooperate with any state
28 agency, political subdivision, or federal government agency to
29 apply for grants.
30 e. Solicit and accept for use any gift of money or property
31 by will or otherwise, and any grant of money, services,
32 or property from the federal government, the state, or any
33 political subdivision thereof or any private source.
34 f. Collect and maintain records, engage in studies and
35 analyses, and gather relevant statistics.
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1 g. Take any other actions as necessary to execute the
2 duties granted to the department in this chapter, or that
3 are otherwise required to maintain compliance with federal
4 requirements related to the department’s roles established in
5 this section.
6 Sec. 3. NEW SECTION. 225A.3 Behavioral health service
7 system —— department powers and duties.
8 1. A behavioral health service system is established
9 under the control of the department for the purposes of
10 implementing a statewide system of prevention, education, early
11 intervention, treatment, recovery support, and crisis services
12 related to mental health, substance use, tobacco use, and
13 problem gambling.
14 2. To the extent funding is available, the department
15 shall perform all of the following duties to administer the
16 behavioral health service system:
17 a. Consistent with the department’s agency strategic plan
18 adopted pursuant to section 8E.206, prepare and administer
19 the state behavioral health service system plan. The state
20 behavioral health service system plan shall identify strategies
21 and targeted outcomes for the behavioral health service system
22 to continuously improve the provision of all of the following:
23 (1) Universal prevention, selective prevention, and
24 indicated prevention.
25 (2) Evidence-based and evidence-informed early intervention
26 and treatment services.
27 (3) Comprehensive recovery support services with a focus on
28 community-based services that avoid, divert, or offset the need
29 for acute inpatient services, long-term services provided in
30 large institutional settings, law enforcement involvement, and
31 incarceration.
32 (4) Crisis services with a focus on reducing escalation
33 of crisis situations, relieving the immediate distress of
34 individuals experiencing a crisis situation, reducing the
35 risk that individuals in a crisis situation harm themselves
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1 or others, and promoting timely access to behavioral health
2 services for those who require ongoing treatment.
3 b. Administer and distribute state appropriations, federal
4 aid, and grants deposited into the behavioral health fund
5 established in section 225A.7.
6 c. Oversee, provide technical assistance to, and
7 monitor administrative services organizations to ensure the
8 administrative services organizations’ compliance with district
9 behavioral health plans.
10 d. Oversee behavioral health provider licensure,
11 accreditation, and certification, and issue determinations
12 to approve, deny, revoke, or suspend a behavioral health
13 provider’s licensure, accreditation, or certification status.
14 e. Establish and maintain a data collection and management
15 information system to identify, collect, and analyze service
16 outcome and performance data to address the needs of patients,
17 providers, the department, and programs operating within the
18 behavioral health service system.
19 f. Collect, monitor, and utilize information including but
20 not limited to behavioral health service system patient records
21 and syndromic surveillance data to understand emerging needs,
22 and to swiftly deploy information, resources, and technical
23 assistance in response.
24 g. Adopt rules pursuant to chapter 17A to administer this
25 chapter. Such rules shall include but not be limited to rules
26 that provide for all of the following:
27 (1) Minimum access standards to ensure equitable access to
28 services provided through the behavioral health service system
29 including but not limited to when services are available, who
30 is eligible for services, and where services are available.
31 (2) Methods to ensure each individual receives an
32 uninterrupted continuum of care for prevention, education,
33 early intervention, treatment, recovery support, and crisis
34 services.
35 (3) Standards for the implementation and maintenance
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1 of behavioral health programs and services offered by the
2 behavioral health service system, and by each administrative
3 services organization.
4 (4) Procedures for the management and oversight of
5 behavioral health providers to ensure provider compliance with
6 the terms of the behavioral health providers’ contracts and
7 with state and federal law and rules.
8 (5) Procedures for the termination of an administrative
9 services organization’s designation as an administrative
10 services organization.
11 (6) Procedures for the collection, utilization, and
12 maintenance of the data necessary to establish a central data
13 repository in accordance with section 225A.6.
14 (7) Any other requirements the department deems necessary
15 to ensure that an administrative services organization
16 fulfills the administrative services organization’s duties
17 as established in this chapter, and as established in the
18 administrative services organization’s district behavioral
19 health plan.
20 Sec. 4. NEW SECTION. 225A.4 Behavioral health service
21 system —— districts and administrative services organizations.
22 1. a. The department shall divide the entirety of the state
23 into designated behavioral health districts. Behavioral health
24 prevention, education, early intervention, treatment, recovery
25 support, and crisis services shall be made available through
26 each behavioral health district in a manner consistent with
27 directives each district receives from the department.
28 b. For the purpose of providing equitable access to all
29 services provided through the behavioral health service
30 system, the department shall consider all of the following when
31 designating behavioral health districts:
32 (1) City and county lines.
33 (2) The maximum population size that behavioral health
34 services available in an area are able to effectively serve.
35 (3) Areas of high need for behavioral health services.
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1 (4) Patterns various populations exhibit when accessing or
2 receiving behavioral health services.
3 c. Notwithstanding chapter 17A, the manner in which the
4 department designates behavioral health districts including but
5 not limited to the determination of the boundaries for each
6 district shall not be subject to judicial review.
7 2. a. The department shall designate an administrative
8 services organization for each behavioral health district to
9 oversee and organize each district and the behavioral health
10 services associated with the district. The department shall
11 issue requests for proposals for administrative services
12 organization candidates.
13 b. At the department’s discretion, the department may
14 designate any of the following as an administrative services
15 organization:
16 (1) A mental health and disability services regional
17 administrator formed prior to July 1, 2025.
18 (2) A public or private agency in a behavioral health
19 district, or any separate organizational unit within the
20 public or private agency, that has the capabilities to engage
21 in the planning or provision of a broad range of behavioral
22 health prevention, education, early intervention, treatment,
23 recovery support, and crisis services only as directed by the
24 department.
25 c. The department shall consider all of the following
26 factors in determining whether to designate an entity as an
27 administrative services organization:
28 (1) Whether the entity has demonstrated the capacity to
29 manage and utilize available resources in a manner required of
30 an administrative services organization.
31 (2) Whether the entity has demonstrated the ability to
32 ensure the delivery of behavioral health services within the
33 district as required by the department by rule.
34 (3) Whether the entity has demonstrated the ability to
35 fulfill the monitoring, oversight, and provider compliance
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1 responsibilities as required by the department by rule.
2 3. a. Upon designation by the department, an administrative
3 services organization shall be considered an instrumentality of
4 the state and shall adhere to all state and federal mandates
5 and prohibitions applicable to an instrumentality of the state.
6 b. The designation as an administrative services
7 organization shall continue until the designation is removed
8 by the department, the administrative services organization
9 withdraws, or a change in state or federal law necessitates the
10 removal of the designation.
11 4. Each administrative services organization shall function
12 as a subrecipient for the purposes of the federal community
13 mental health services block grant, 42 U.S.C. §300x et seq.,
14 and the federal substance abuse prevention and treatment block
15 grant, 42 U.S.C. §300x-21 et seq., and shall comply with all
16 federal requirements applicable to subrecipients under the
17 block grants.
18 5. Each administrative services organization shall perform
19 all of the following duties:
20 a. Develop and administer a district behavioral health
21 plan as approved by the department, and in accordance with the
22 standards adopted by the department by rule.
23 b. Coordinate the administration of the district behavioral
24 health plan with federal, state, and local resources in order
25 to develop a comprehensive and coordinated local behavioral
26 health service system.
27 c. Enter into contracts necessary to provide services under
28 the district behavioral health plan.
29 d. Oversee, provide technical assistance to, and monitor
30 the compliance of providers contracted by the administrative
31 services organization to provide behavioral health services in
32 accordance with the