Fiscal Note
Fiscal Services Division
SF 471 – Health and Human Services Omnibus (LSB1183SV)
Staff Contact: Eric Richardson (515.281.6767) eric.richardson@legis.iowa.gov
Fiscal Note Version – New
Description
Senate File 471 relates to Mental Health and Disability Services (MHDS), judicial procedures,
adoptions, and confinement of incompetent persons. Figure 1 summarizes the fiscal impact of
the various Bill divisions and is at the end of this Fiscal Note.
Division I — State Mental Health Institutes — Specialization
Description and Background
The Bill removes persons who solely have a substance abuse problem as a population eligible
to receive treatment, training, care, habilitation, and support at a State mental health institute
(MHI). The Bill designates the MHI located in Independence for specialized treatment of
behaviorally complex youth and designates the State MHI located in Cherokee for specialized
treatment and security of adults ordered by a court into the custody of the State.
Iowa Code section 226.1 details the services provided by a State MHI, including treatment and
care of persons with mental illness, facilities and services to the communities in the region being
served by the MHI, and a unit for the civil commitment of sexually violent predators committed to
the custody of the Director of the Department of Health and Human Services (HHS). Currently,
the Independence MHI contains beds for 16 youths and 40 adults, while the Cherokee MHI
contains beds for 12 youths and 24 adults.
Assumptions/Fiscal Impact (Division I)
The estimated fiscal impacts for Division I are outlined below:
• FY 2024 — An increase of $160,000 and 3.0 full-time equivalent (FTE) positions to the
Independence MHI, including assigning up to 36 youth beds (an 8-bed increase for youth)
and chronic adult beds to Independence, and an increase of $340,000 and 13.0 FTE
positions to the Cherokee MHI, including assigning all acute adult and forensic adult beds to
Cherokee. The total number of beds in each facility is expected to remain the same.
• FY 2025 — An increase of $300,000 for the Independence MHI, and an increase of
$922,000 for the Cherokee MHI, along with an annualization of all FTE positions.
Division II — Child in Need of Assistance — Safety Plans — Temporary Removal
Description and Background
The Bill allows a child’s guardian to enter into a safety plan and prohibits a safety plan from
being construed as a child’s removal from a guardian absent a court order.
To have a court hold a hearing to review a removal order within six months of the order, Division
II references Iowa Code section 232.95(2), which allows a court to, after a hearing to determine
whether the child should be temporarily removed from a home, return the child to a person with
legal custody of the child, remove a child from a home and place the child with a parent pending
a final court order, and remove a child from a home and place custody of the child with the HHS.
1
Assumptions/Fiscal Impact (Division II)
Division II has little to no fiscal impact.
Division III — Mental Health and Disability Services Regions — Governance — Core
Services — Report
Description and Background
The Bill makes changes to the regional governance of MHDS governing boards, adds outpatient
competency restoration as a core service for both adult and children’s MHDS Regions, and
changes requirements for reporting to the General Assembly to annually from quarterly.
Outpatient competency restoration (OCR) services were created to treat incompetent to stand
trial (IST) defendants who do not require hospital-level care and who can be safely treated
within the community, and not in an inpatient setting, such as a jail or an institution. Iowa Code
sections 331.397 and 331.397A outline regional core services and children’s behavioral core
services that would be altered under the Bill.
Assumptions/Fiscal Impact (Division III)
According to the HHS, the cost of adding OCR services is unknown but will be absorbed within
current regional resources.
According to the State of Washington, at approximately $200 per day for 100 days (below U.S.
norms of 111 days) for OCR program costs (prior to IST defendants being found restored or
unrestorable), the cost of maintaining a defendant would be approximately $20,000. However,
federal reimbursement for numerous services eligible for Medicare and Medicaid would lower
costs to the State for each IST defendant. Nevertheless, a study on Washington, D.C., OCR
defendants found that OCR costs were approximately 68.2% less than costs for inpatient
competency restoration services, and have the potential to reduce expenditures for the State
Department of Corrections (DOC).
Division IV — Adoption Notices — Hearings
Description and Background
The Bill requires a petitioner in an adoption proceeding to provide notice by mail of an order
setting an adoption hearing to a sibling of a person to be adopted at least 20 days prior to the
adoption hearing if there is either an existing relationship between the siblings or a court finds
that ongoing contact with the person to be adopted is in the best interests of each sibling. The
Bill allows a copy of the order to be sent by ordinary mail. The Bill does not require a copy of
the order to be sent to parents whose rights have been terminated or siblings under certain
circumstances.
Iowa Code section 600.11(2) referenced in the Bill currently requires petitioners to give a copy
of a petition for adoption at least 20 days before an adoption hearing to certain stakeholders,
including a guardian or person in a parent-child relationship with the person to be adopted, a
potential adult adoptee, an investigator, any person required to consent under Iowa Code
section 600.7, a person granted visitation rights with a child to be adopted, any person paying
financial support for a child, and any siblings of the person to be adopted under certain
circumstances.
2
Assumptions/Fiscal Impact (Division IV)
Division IV has little to no fiscal impact.
Division V — Confinement of Persons Found Incompetent to Stand Trial
Description and Background
The Bill requires the MHDS region for the county of a defendant’s residency to pay for the costs
of mental health treatment the defendant receives as a condition of pretrial release. The Bill
also:
• Allows doctors or facility directors where the defendant is held to provide a written status
report to a court regarding a defendant’s mental disorder. This statement is required to
notify the court if a defendant formerly deemed incompetent has either acquired the ability to
appreciate the charges against them, or has no substantial probability of acquiring that
ability.
• Requires a written status report prepared for an incompetent defendant to include the
methods used to restore competency to the defendant, the defendant’s current abilities
related to competency, and whether it appears the defendant’s competency can be restored
within a reasonable amount of time.
Iowa Code chapter 225C regarding the costs of mental health treatment for residents in a
county is referenced in the Bill and codifies the Mental Health and Disability Services
Commission, which is tasked as the State policy-making body for the provision of services to
persons with mental illness. The Iowa Mental Health Planning and Advisory Council is
established in 42 U.S.C. §300x-3.
2021 Iowa Acts, Senate File 619 (Taxation and Other Provisions Act), changed the way MHDS
is funded, from a system based on county property taxes to a 100.0% State-funded system.
The previous MHDS system was a regional system managed by the counties, with State
oversight. Counties financed a portion of the system with a county property tax levy that was
capped at a per capita dollar amount for each of the 14 MHDS Regions. The State currently
finances the majority of the services provided through the Medicaid Program. For a complete
funding history of the MHDS system back to 1995, please see the related Issue Review.
Per Capita State Appropriations. Senate File 619 created a new MHDS Regional Services
Fund and established a General Fund standing appropriation to the HHS for distribution to the
MHDS Regions based on performance-based contracts using the following per capita amounts:
• $15.86 for FY 2022
• $38.00 for FY 2023
• $40.00 for FY 2024
• $42.00 for FY 2025
• Beginning in FY 2026 and beyond, the previous year’s appropriation is multiplied by a
growth factor indexed to sales tax growth for the preceding fiscal year, not to exceed 1.5%.
In FY 2023, $121.2 million was appropriated to the HHS for distribution to the MHDS Regions.
Assumptions/Fiscal Impact (Division V)
According to the HHS and as identified in the fiscal impact for Division III, MHDS regional costs
for covering OCR services are to be utilized for OCR services, and regional costs may increase
within the existing State appropriation with a reduction in State costs to the DOC. However, the
HHS expects a period of time to pass before services are fully available for the new program, as
the Department will need to build out the proper services for IST defendants. Costs in FY 2024
and FY 2025 cannot be estimated due to lack of data.
3
Division VI — Conforming Code Changes
Description and Background
The Bill makes a conforming change to Iowa Code section 256.25 which deals with the
Therapeutic Classroom Incentive Grant Program and Fund.
Assumptions/Fiscal Impact (Division VI)
Division VI has little to no fiscal impact.
Division VII — Code Transfers
Description and Background
The Bill transfers Iowa Code sections 331.388 through 331.400 (MHDS — Regional Service
System — Children’s Behavioral Health System) to Iowa Code sections 225C.55 through
225C.69 and makes conforming changes.
Assumptions/Fiscal Impact (Division VII)
Division VII has little to no fiscal impact.
Overall Fiscal Impact — State General Fund Appropriations
Figure 1 provides a summary of the projected changes in General Fund revenue by Bill
provision.
Figure 1 — Summary of SF 471 Fiscal Impacts
Division Summary Fiscal Impacts Source of Funding
Up to 16.0 FTE
State Mental Health Institutes — Cost to State General
I FY 2024 - $500,000
Specialization Fund
FY 2025 - $1.2 million
Child in Need of Assistance — Safety
II No Fiscal Impact N/A
Plans
Average cost of $20,000 per
Majority Federal Funds;
OCR patient and will be
MHDS Regional Governance — Core Some State MHDS
III absorbed within current
Services Appropriations; State
regional resources. State DOC
General Fund
costs may decrease.
IV Adoption Notices — Hearing No Fiscal Impact N/A
MHDS regional costs may
V Confinement of Persons Found IST increase, but State DOC costs State General Fund
may decrease
VI Conforming Code Changes No Fiscal Impact N/A
VII Code Transfers No Fiscal Impact N/A
4
Sources
Department of Health and Human Services
Mental Health and Disability Services Commission
State of Washington Department of Social and Health Services
National Board of Medicine
Legislative Services Agency
/s/ Jennifer Acton
March 7, 2023
Doc ID 1370540
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
5


Statutes affected:
Introduced: 226.1, 232.79B, 232.102, 331.397, 331.397A, 225C.7A, 600.11, 812.6, 225C.62