Fiscal Note
Fiscal Services Division
SF 526 – Access Centers (LSB2586SV)
Staff Contact: Jess Benson (515.281.4611) jess.benson@legis.iowa.gov
Fiscal Note Version – New
Description
Senate File 526 amends various sections of the Iowa Code to allow for the emergency detention
of an individual experiencing a mental health or substance use crisis at an access center. The
Bill defines “access center” as the coordinated provision of intake assessment, screening for co-
occurring conditions, care coordination, crisis stabilization residential services, subacute mental
health services, and substance abuse treatment for persons experiencing a mental health or
substance use crisis who do not need inpatient psychiatric hospital treatment, but who do need
significant amounts of supports and services not available in other home and community-based
settings.
Background
Access centers, which were required by HF 2456 (FY 2020 Mental Health Complex Service
Needs Workgroup Report Act), are managed by the 14 Mental Health and Disability Services
(MHDS) Regions. There are currently five access centers in operation and one in development.
They are designed to accept patients 24 hours a day, seven days a week, and provide rapid
assessment, triage, stabilization, and follow-up resources.
Assumptions
The assumptions noted below will be multiplied by the six access centers that are either
currently operating or in development. It is assumed that it will take the first nine months of
FY 2022 to make the necessary upgrades to the access centers and gain proper licensure and
because of this, staff costs would not begin until March 1, 2022.
Accepting individuals for emergency detention, 24 hours a day, seven days a week, would
require the following additional full-time equivalent (FTE) positions at each of the six access
centers:
• 1.0 psychiatrist FTE position on call at $1,300 per day.
• 2.0 additional security staff FTE positions per shift.
• 1.0 pharmacist FTE position on call at $50 per day.
• 1.0 pharmacy tech FTE position.
• 1.0 indirect FTE position at the center per shift such as a psychology technician.
• 1.0 additional nursing FTE position per shift.
• A portion of these cost increases may be offset by Medicaid.
Other ongoing and one-time costs at each of the six access centers would include:
• An additional $50,000 per year for liability insurance.
• A one-time cost of $75,000 for pharmacy equipment.
• One-time costs to remodel or design facilities to have at a minimum an isolation room, a
locked room, and modifications to meet ligature standards.
• Additional staff training would be required depending on licensure.
• Additional licensure would be required.
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Fiscal Impact
Senate File 526 is estimated to cost a minimum of $2.9 million in FY 2022 and $9.0 million in
FY 2023 and subsequent fiscal years. A summary of the costs is listed below. The most
significant unknown cost is the cost to remodel or design access centers to meet ligature
standards to prevent suicide. To meet those standards requires specialty engineering and
hardware to eliminate anything which could be used to attach a cord, rope, or other material.
Other unknown costs include the cost of licensure and meeting those licensure requirements;
and staff training costs which will be at least partially determined based on the licensure
necessary. A portion of the ongoing staff costs may be offset by Medicaid and a decrease in
involuntary holds at inpatient psychiatric hospitals, but access center costs are currently capped
at a per diem rate and would need to be reevaluated based on the new requirements of the Bill.
SF 526 — Summary of Estimated Costs
FY 2022 FY 2023
Six Facilities Six Facilities
Additional Staff Costs Per Facility Statewide Per Facility Statewide
On-Call Psychiatrist $ 118,625 $ 711,750 $ 474,500 $ 2,847,000
Security Staff 96,750 580,500 387,000 2,322,000
On-Call Pharmacist 4,563 27,375 18,250 109,500
Pharmacy Technician 37,775 226,650 151,100 906,600
Indirect Staff 30,225 181,350 120,900 725,400
Nursing staff 75,550 453,300 302,200 1,813,200
Total Additional Staff Costs $ 363,488 $ 2,180,925 $ 1,453,950 $ 8,723,700
Other Costs
Pharmacy Equipment $ 75,000 $ 450,000 $ 0 $ 0
Liability Insurance 50,000 300,000 50,000 300,000
Licensure Costs TBD TBD TBD TBD
Facility Costs TBD TBD 0 0
Training TBD TBD TBD TBD
Total Other Costs $ 125,000 $ 750,000 $ 50,000 $ 300,000
Total Quantifiable Costs $ 488,488 $ 2,930,925 $ 1,503,950 $ 9,023,700
TBD=To be determined based on licensure requirements and the specific needs of each facility.
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Source
Mental Health and Disability Services Regions
Holly M. Lyons
March 23, 2021
Doc ID 1216183
The fiscal note for this Bill was prepared pursuant to Joint Rule 17 and the Iowa Code. Data used in
developing this fiscal note is available from the Fiscal Services Division of the Legislative Services
Agency upon request.
www.legis.iowa.gov
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Statutes affected:
Introduced: 125.34, 125.91, 229.22, 331.388, 331.397