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. Effective 7-1-19

“Children’s system” or “children’s behavioral health system” is defined as the behavioral health services system for children created in the bill. CHILDREN’S BEHAVIORAL HEALTH SYSTEM STATE BOARD. The bill establishes a children’s behavioral health system state board (state board) as the state body to provide guidance on the implementation and management of the children’s behavioral health system and for the provision of services to children with a serious emotional disturbance. The bill specifies the membership of the board and provides that the state board’s public voting members shall be appointed to four-year staggered terms by the governor and are subject to confirmation by the senate. All other state board voting members shall be appointed to four-year terms and are not subject to senate confirmation. A member shall not be appointed for more than two consecutive four-year terms. State board members shall be appointed on the basis of interest and experience in the fields of children’s behavioral health to ensure representation from persons with life experiences and persons knowledgeable about children’s behavioral health services. The state board shall be co-chaired by the director of the department of human services (DHS) and the director of the department of education, or their designees. In addition to the voting members, the membership shall include four members of the general assembly to serve in a nonvoting, ex officio capacity on the board. The bill requires the DHS to provide support to the state board and the state board may utilize staff support and other assistance provided to the state board by other persons. The state board is required to meet a minimum of four times per year. The state board is required to advise the administrator of the division of mental health and disability services of DHS on the administration of the children’s behavioral health system, provide consultation services to agencies regarding the development of administrative rules for the children’s behavioral health system, identify behavioral health outcomes and indicators for eligible children with a serious emotional disturbance to promote children living with their own families and in the community; and submit a written report on or before December of each year to the governor and the general assembly. ELIGIBILITY REQUIREMENTS —— CHILDREN’S BEHAVIORAL HEALTH SERVICES. Under current law, a person who is years of age, is a resident of Iowa, and is receiving publicly funded children’s mental health services may be considered eligible for mental health services through the adult mental health and disability services regional service system during the three-month period preceding the person’s 18th birthday in order to provide a smooth transition from children’s services to adult services. The bill strikes this provision and provides that a child shall be eligible for behavioral health services under the children’s behavioral health system if the child is under years of age, a resident of Iowa, has been diagnosed with a serious emotional disturbance, and the child’s family has a household income equal to or less than 500 percent of the federal poverty level, except that a child’s family whose household income is between 150 percent but not more than 500 percent of the federal poverty level shall be eligible for behavioral health services subject to a copayment, a single statewide sliding fee scale, or other cost-sharing requirements approved by DHS. The bill does not apply to intellectual disability services or brain injury services for children under the children’s behavioral health system. CHILDREN’S BEHAVIORAL HEALTH SYSTEM —— CORE SERVICES. The bill provides that, subject to available appropriations, the director of DHS shall ensure that the children’s behavioral health core service domains, as specified in the bill, are covered services for the medical assistance program under Code chapter 249A to the greatest extent allowable under federal regulations. The bill provides the medical assistance program shall reimburse Medicaid enrolled providers for Medicaid covered services when the services are medically necessary, the Medicaid enrolled provider submits an appropriate claim for such services, and no other third-party payor is responsible for reimbursement of such services. Within the funds available, each mental health and disability services region is required to pay for such services for eligible children when payment through the medical assistance program or another third-party payment is not available, unless a child is on a waiting list for such payment or it has been determined that the child does not meet the eligibility criteria for any such service. The bill provides that until funding is designed for other service populations, eligibility for the core services shall be limited to such children who are in need of behavioral health services. The bill requires DHS to adopt rules pursuant to recommendations made by the state board to define the services included in the core domains. The rules shall provide service definitions, service provider standards, service access standards, and service implementation dates, and shall also provide consistency, to the extent possible, with similar service definitions under the medical assistance program. The bill requires each mental health and disability services region to submit to DHS plans to implement children’s behavioral health services no later than April 1, 2020. MENTAL HEALTH AND DISABILITY SERVICES —— ADMINISTRATOR’S DUTIES. The bill requires the administrator of the division of mental health and disability services of DHS to assist the state board in planning for community-based children’s behavioral health services and to encourage and facilitate coordination of children’s behavioral health services with the objective of developing and maintaining in the state a children’s behavioral health system to provide behavioral health services to all children in this state who need the services, regardless of the place of residence or economic circumstances of those children. The administrator shall work with the state board and other state agencies, including but not limited to the departments of education and public health, to develop and implement a strategic plan to expand access to qualified mental health workers across the state.6A. The system shall be used to identify, collect, and analyze service outcome and performance measures data in order to assess the effects of the services on the children utilizing the services. The administrator shall annually submit to the state board information collected by DHS indicating the changes and trends in the children’s behavioral health system. The administrator shall make the outcome data available to the public. Current law requires the administrator to enter into performance-based contracts with mental health and disability services regional administrators which may include requirements for the regional service system to attain outcomes within a specified range of acceptable performance in certain categories. The bill expands the categories to include a school attendance category. STATE AND REGIONAL DISABILITY SERVICE SYSTEMS. Current law provides that the publicly financed disability services for persons with mental illness, intellectual disability or other developmental disability, or brain injury in Iowa shall be provided by DHS and the counties operating together as regions and provides for financial and administrative responsibility for such services. The bill provides that children’s behavioral health services provided to eligible children that are not covered under the medical assistance program or other third-party payor are the responsibility of the mental health and disabilities regional service system. MENTAL HEALTH AND DISABILITY SERVICES REGIONS. The bill makes changes to the mental health and disability services regional governing board (governing board). The governing board membership shall consist of at least one board of supervisors member from each county comprising the region who shall be a voting member; one adult person who utilizes mental health and disability services or is an actively involved relative of such an adult person designated by the regional advisory committee formed by the governing board; one member representing adult service providers in the region designated by the regional advisory committee formed by the governing board, who shall serve in a nonvoting, ex officio capacity; one member representing children’s behavioral health service providers in the region designated by the regional children’s advisory committee formed by the governing board, who shall serve in a nonvoting, ex officio capacity; one member representing area education agency administrators in the region designated by the regional children’s advisory committee formed by the governing board; and one member who is a parent of a child who utilizes children’s behavioral health services or actively involved relatives of such children designated by the regional children’s advisory committee. The membership of the governing board shall not include employees of DHS or an unelected employee of a county. The bill adds to the regional administrator staff one or more coordinators of children’s behavioral health services. The bill requires a mental health and disability region to include provisions relating to eligibility requirements for children’s behavioral health core services under the children’s behavioral health system and performance and outcome measures relating to education in a region’s annual service and budget plan. RULES. The bill requires DHS to submit a notice of intended action to the administrative rules coordinator and the Iowa administrative code editor not later than January 1, 2020, for the adoption of rules to implement the bill. MISCELLANEOUS CODE CHANGES.4 to include mental health services in references to disability services in that Code section. REPEALS.54.52 with new content in the bill.