SSB 1234

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.

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 CostsAdditional Staff Costs Per Facility

Six Facilities

Statewide Per Facility

Six Facilities

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. FY 2022 FY 2023

Source

• Mental Health and Disability Services Regions
• Holly M. Lyons
• March 23, 2021
• 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.