Senate File 2420 - Introduced
SENATE FILE 2420
BY COMMITTEE ON APPROPRIATIONS
(SUCCESSOR TO SF 2354)
(SUCCESSOR TO SSB 3146)
A BILL FOR
1 An Act related to state behavioral health, disability, and
2 addictive disorder services and related programs, including
3 the transition of behavioral health services from a mental
4 health and disability services system to a behavioral health
5 service system, the transfer of disability services to the
6 division of aging and disability services of the department
7 of health and human services, the elimination of the
8 commission on aging, the elimination of special intellectual
9 disability units at state mental health institutes, making
10 appropriations, and including effective date provisions.
11 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. “Community mental health center” means an entity
31 designated by the department to address the mental health needs
32 of one or more counties.
33 8. “Department” means the department of health and human
34 services.
35 9. “Director” means the director of the department of health
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1 and human services.
2 10. “District behavioral health advisory council”
3 or “advisory council” means a council established by an
4 administrative services organization under section 225A.5, to
5 identify opportunities, address challenges, and advise the
6 administrative services organization in accordance with section
7 225A.5.
8 11. “District behavioral health service system plan” or
9 “district behavioral health plan” means a plan developed by
10 an administrative services organization and approved by the
11 department to outline the services intended to be provided
12 within the administrative services organization’s behavioral
13 health district.
14 12. “Indicated prevention” means prevention activities
15 designed to prevent the onset of substance use disorders in
16 individuals who do not meet the medical criteria for addiction,
17 but who show early signs of developing a substance use disorder
18 in the future.
19 13. “Selective prevention” means prevention activities
20 designed to target subsets of the total population who are
21 considered at-risk for a substance use disorder by virtue of
22 their membership in a particular segment of the population.
23 Selective prevention targets the entire subgroup, regardless of
24 the degree of risk of any individual within the group.
25 14. “State behavioral health service system plan” or
26 “state behavioral health plan” means the plan developed by the
27 department that describes the key components of the state’s
28 behavioral health service system.
29 15. “Universal prevention” means prevention activities
30 designed to address an entire population class for the purpose
31 of preventing or delaying the use of alcohol, tobacco, and
32 other drugs. Population classes include but are not limited
33 to the national population, local populations, community
34 populations, school populations, and neighborhood populations.
35 Sec. 2. NEW SECTION. 225A.2 State mental health authority
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1 —— state agency for substance abuse.
2 1. The department is designated as the state mental health
3 authority as defined in 42 U.S.C. §201(m) for the purpose of
4 directing benefits from the federal community mental health
5 services block grant, 42 U.S.C. §300x et seq., and the state
6 authority designated for the purpose of directing benefits
7 from the federal substance abuse prevention and treatment
8 block grant, 42 U.S.C. §300x-21 et seq. This designation
9 does not preclude the state board of regents from authorizing
10 or directing any institution under the board of regents’
11 jurisdiction to carry out educational, prevention, and research
12 activities in the areas of mental health and intellectual
13 disability.
14 2. The department is designated as the single state agency
15 for substance abuse for the purposes of 42 U.S.C. §1396a et
16 seq.
17 3. For the purposes of effectuating the department’s roles
18 designated in this section, the department shall have the
19 following powers and the authority to take all of the following
20 actions:
21 a. Plan, establish, and maintain prevention, education,
22 early intervention, treatment, recovery support, and crisis
23 services programs as necessary or desirable for the behavioral
24 health service system established in section 225A.3.
25 b. Develop and submit a state plan as required by, and in
26 accordance with, 42 U.S.C. §300x-1.
27 c. Review and approve district behavioral health service
28 system plans developed in accordance with the state behavioral
29 health service system plan.
30 d. Perform all necessary acts to cooperate with any state
31 agency, political subdivision, or federal government agency to
32 apply for grants.
33 e. Solicit and accept for use any gift of money by will or
34 otherwise, and any grant of money or services from the federal
35 government, the state, or any political subdivision thereof,
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1 or any private source.
2 f. Collect and maintain records, engage in studies and
3 analyses, and gather relevant statistics.
4 g. Take any other actions as necessary to execute the
5 duties granted to the department in this chapter, or that
6 are otherwise required to maintain compliance with federal
7 requirements related to the department’s roles as designated in
8 this section.
9 Sec. 3. NEW SECTION. 225A.3 Behavioral health service
10 system —— department powers and duties.
11 1. a. A behavioral health service system is established
12 under the control of the department for the purposes of
13 implementing a statewide system of prevention, education, early
14 intervention, treatment, recovery support, and crisis services
15 related to mental health and addictive disorders, including but
16 not limited to alcohol use, substance use, tobacco use, and
17 problem gambling.
18 b. The behavioral health service system shall support
19 equitable statewide access to all services offered through
20 the behavioral health service system and offer specialized
21 services with a focus on at-risk populations including but not
22 limited to children, youth, young adults, individuals with
23 disabilities, pregnant and parenting women, older adults, and
24 people with limited access to financial resources.
25 c. Services offered through the behavioral health service
26 system shall, at a minimum, include all of the following:
27 (1) Prevention intervention services and education
28 programs designed to reduce and mitigate behavioral health
29 conditions and future behavioral health conditions. Prevention
30 intervention programs shall incorporate indicated prevention,
31 selective prevention, and universal prevention activities.
32 (2) Evidence-based and evidence-informed early intervention
33 and treatment services.
34 (3) Comprehensive recovery support services with a focus on
35 community-based services that avoid, divert, or offset the need
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1 for long-term inpatient services, law enforcement involvement,
2 or incarceration.
3 (4) Crisis services with a focus on reducing the escalation
4 of crisis situations, relieving the immediate distress of
5 individuals experiencing a crisis situation, and reducing the
6 risk that individuals in a crisis situation harm themselves.
7 2. To the extent funding is available, the department shall
8 perform all of the following duties to develop and administer
9 the behavioral health service system:
10 a. (1) Develop a state behavioral health service system
11 plan that accomplishes all of the following:
12 (a) Identifies the goals, objectives, and targeted outcomes
13 for the behavioral health service system.
14 (b) Identifies the strategies to meet system objectives and
15 ensure equitable access statewide to prevention, education,
16 early intervention, treatment, recovery support, and crisis
17 services.
18 (c) Is consistent with the state health improvement plan
19 developed under section 217.17.
20 (d) Is consistent with the department’s agency strategic
21 plan adopted pursuant to section 8E.206.
22 (2) The department shall do all of the following when
23 developing the state behavioral health service system plan:
24 (a) Collaborate with stakeholders including but not limited
25 to county supervisors and other local elected officials,
26 experienced behavioral health providers, and organizations that
27 represent populations, including but not limited to children,
28 served by the behavioral health service system.
29 (b) Publish the proposed state behavioral health service
30 system plan on the department’s internet site and allow the
31 public to review and comment on the proposed state behavioral
32 health system plan prior to the adoption of the proposed state
33 behavioral health plan.
34 b. Administer and distribute state appropriations, federal
35 aid, and grants that have been deposited into the behavioral
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1 health fund established in section 225A.7.
2 c. Oversee, provide technical assistance to, and
3 monitor administrative services organizations to ensure the
4 administrative services organizations’ compliance with district
5 behavioral health plans.
6 d. Collaborate with the department of inspections, appeals,
7 and licensing on the accreditation, certification, and
8 licensure of behavioral health providers including but not
9 limited to the approval, denial, revocation, or suspension of
10 a behavioral health provider’s accreditation, certification,
11 or licensure.
12 e. Develop and adopt minimum accreditation standards for
13 the maintenance and operation of community mental health
14 centers to ensure that each community mental health center,
15 and each entity that provides services under contract with a
16 community mental health center, furnishes high-quality mental
17 health services to the community that the community mental
18 health center serves in accordance with rules adopted by the
19 department.
20 f. Designate community mental health centers.
21 g. Conduct formal accreditation reviews of community mental
22 health centers based on minimum accreditation standards adopted
23 by the department pursuant to paragraph “e”.
24 h. Establish and maintain a data collection and management
25 information system to identify, collect, and analyze service
26 outcome and performance data to address the needs of patients,
27 providers, the department, and programs operating within the
28 behavioral health service system.
29 i. Collect, monitor, and utilize information including but
30 not limited to behavioral health service system patient records
31 and syndromic surveillance data to understand emerging needs,
32 and to deploy information, resources, and technical assistance
33 in response.
34 j. Adopt rules pursuant to chapter 17A to administer this
35 chapter. Such rules shall include but not be limited to rules
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1 that provide for all of the following:
2 (1) Minimum access standards to ensure equitable access to
3 services provided through the behavioral health service system
4 including but not limited to when services are available, who
5 is eligible for services, and where services are available.
6 (2) Methods to ensure each individual who is eligible
7 for services receives an uninterrupted continuum of care for
8 prevention, education, early intervention, treatment, recovery
9 support, and crisis services.
10 (3) Standards for the implementation and maintenance
11 of behavioral health programs and services offered by the
12 behavioral health service system, and by each administrative
13 services organization.
14 (4) Procedures for the management and oversight of
15 behavioral health providers to ensure compliance with the terms
16 of the behavioral health providers’ contracts relating to the
17 behavioral health service system, and with state and federal
18 law and rules.
19 (5) Procedures for the suspension of an administrative
20 services organization’s services due to the administrative
21 services organization’s failure to comply with the terms and
22 conditions of its contract with the department.
23 (6) Procedures for the reallocation of funds from
24 an administrative services organization that is not in
25 compliance with the terms of its contract with the department
26 to an alternative administrative services organization or
27 a behavioral health provider to provide for services the
28 noncompliant administrative services organization failed to
29 provide.
30 (7) Procedures for the termination of an administrative
31 services organization’s designation as an administrative
32 services organization.
33 (8) Procedures for the collection, utilization, and
34 maintenance of the data necessary to establish a central data
35 repository in accordance with section 225A.6.
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1 (9) Any other requirements the department deems necessary
2 to ensure that an administrative services organization
3 fulfills the administrative services organization’s duties
4 as established in this chapter, and as established in the
5 administrative services organization’s district behavioral
6 health plan.
7 Sec. 4. NEW SECTION. 225A.4 Behavioral health service
8 system —— districts and administrative services organizations.
9 1. a. The department shall divide the entirety of the
10 state into designated behavioral health districts. Behavioral
11 health prevention, education, early intervention, treatment,
12 recovery support, and crisis services related to mental health
13 and addictive disorders, including but not limited to alcohol
14 use, substance use, tobacco use, and problem gambling, shall
15 be made available through each behavioral health district in a
16 manner consistent with directives each district receives from
17 the department.
18 b. For the purpose of providing equitable access to all
19 services provided through the behavioral health service
20 system, the department shall consider all of the following when
21 designating behavioral health districts:
22 (1) City and county lines.
23 (2) The maximum population size that behavioral health
24 services available in an area are able to effectively serve.
25 (3) Areas of high need for behavioral health services.
26 (4) Patterns various populations exhibit when acce