Relating to mental health and disability services provided by the state and judicial procedures relating to child in need of assistance proceedings, adoptions, and the confinement of persons found incompetent to stand trial

Sponsored by the House Health and Human Services Committee

Topics:Courts & civil law Health care Families & human services Mental health & addiction

Same legislation: SSB 1166, HSB 176, SF 471

Write your legislators about itWhat changed before it passed

Official bill page Lobbyist declarations One-pager to print

Where it is now

Done: IntroducedFebruary 20, 2023
Done: SubcommitteeFebruary 20, 2023
Done: House committeeFebruary 23, 2023
Done: Passes the HouseMarch 7, 202398–0
Done: Senate committeeMarch 30, 2023
Done: Passes the SenateApril 26, 202349–0
Done: To the GovernorMay 9, 2023
Done: Signed into lawJune 1, 2023

Signed into law What’s a funnel?

What’s in it

AI summary This bill changes how Iowa handles mental health services, child welfare, and adoptions. It assigns specific roles to state mental health institutes, updates how regional boards are run, and changes rules for safety plans and adoption notices for siblings. Additionally, it adjusts how courts receive progress reports for people receiving mental health treatment while awaiting trial.¹

Read the official explanation

This bill relates to mental health and disability services provided by the state and judicial procedures relating to child in need of assistance proceedings, adoptions, and the confinement of persons found incompetent to stand trial. The bill is organized into divisions. DIVISION I —— STATE MENTAL HEALTH INSTITUTES —— SPECIALIZATION. 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. The bill designates the state mental health institute located in Independence, Iowa, for specialized treatment of behaviorally complex youth, and designates the state mental health institute located in Cherokee, Iowa, for specialized treatment and security of adults ordered by the court into the custody of the state for the purposes of competency restoration, adults who have been acquitted of a crime by reason of insanity, and similarly situated adults. DIVISION II —— CHILD IN NEED OF ASSISTANCE —— SAFETY PLANS —— TEMPORARY REMOVAL. The bill allows, in a child in need of assistance proceeding, 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 placing the child with a person or facility other than the guardian who entered into the safety plan.95(2)(a) relating to hearings concerning the temporary removal of a child in child in need of assistance cases.102(10) relating to transfer of legal custody of a child in a child in need of assistance case for placement and visitation of the child by the child’s grandparents, great-grandparents, and certain other adult relatives. DIVISION III —— MENTAL HEALTH AND DISABILITY SERVICES REGIONS —— GOVERNANCE —— CORE SERVICES —— REPORT. The bill makes changes to the regional governance of mental health and disability services (MHDS) governing boards. The bill allows each member of an MHDS governing board to have a vote, limits the number of representatives county boards of supervisors may have on an MHDS regional governing board to percent of the total governing board membership, and adds a member representing law enforcement and a member representing the judicial system in an MHDS region as representatives on an MHDS governing board. The bill adds outpatient competency restoration as a core service for both adult and children’s MHDS regions. The bill requires the department of health and human services (HHS) to deliver a report on an annual basis to the general assembly that provides a summary of the status of implementing core services in each region, the accessibility of core services in each region, how each region is using the funding provided to MHDS regions, and recommendations for improvements to the MHDS system in order to attain the outcome improvement goals set by HHS. Under current law, HHS is required to give such a report on a quarterly basis. DIVISION IV —— ADOPTION NOTICES —— HEARINGS. The bill requires an adoption petitioner to provide a copy of the order setting the adoption hearing to siblings of a person to be adopted at least days prior to the adoption hearing when there is either an existing relationship or a court finding that ongoing contact with the person to be adopted is in the best interests of each sibling and the person to be adopted was a minor child when the parents of the person to be adopted had their parental rights terminated subsequent to the person to be adopted having been adjudicated a child in need of assistance. The bill allows a copy of the order setting the adoption hearing to be provided to a sibling via ordinary mail if the sibling’s address is known. A copy of an order setting an adoption hearing sent to a sibling under years of age shall be addressed to the sibling’s custodian or guardian. The bill does not require a copy of the order setting the adoption hearing to be provided to a person whose parental rights have been terminated with regard to the person to be adopted; siblings who are placed with the sibling to be adopted at the time the court issued the order setting the adoption hearing; or a previously adopted sibling, unless the siblings were the subjects of child in need of assistance or termination of parental rights proceedings that occurred at the same time. DIVISION V —— CONFINEMENT OF PERSONS FOUND INCOMPETENT TO STAND TRIAL. 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 allows a psychiatrist or licensed doctorate-level psychologist evaluating the progress of a defendant’s outpatient competency restoration treatment, or the director of the facility where the defendant is being held and treated pursuant to a court order, to provide a written status report to the court regarding the defendant’s mental disorder. Under current law, only the psychiatrist or licensed doctorate level psychologist providing the defendant’s treatment or the director of the facility where the defendant is being held and treated can provide the written status report. The bill 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. The bill requires a psychiatrist, psychologist, or director to submit an initial report to the court no later than days after the defendant’s placement by the court for treatment, and subsequent reports every days or less after submission of the initial report until the defendant’s competency is restored or the placement of the defendant is terminated. The bill requires a psychiatrist or licensed doctorate-level psychologist evaluating the progress of a defendant’s outpatient competency restoration treatment, or the director of the facility where the defendant is being held and treated pursuant to a court order, to notify a court if there is a substantial probability or is no substantial probability that a defendant formerly deemed incompetent either has acquired the ability to appreciate the charge against the defendant, understand the proceedings, and effectively assist in the defendant’s defense or will be restored to competency in a reasonable amount of time. Under current law, only the psychiatrist or licensed doctorate-level psychologist providing the defendant’s treatment or the director of the facility where the defendant is being held and treated could provide such notice to a court. DIVISION VI —— CONFORMING CODE CHANGE.25 (therapeutic classroom incentive grant program —— fund). DIVISION VII —— CODE TRANSFERS.69 and directs the Code editor to make conforming changes.

Full bill text · What changed before it passed²

House subcommittee

Named February 20, 2023 (as HSB 176). On February 21, 2023 it recommended passage. Vote Total: 3-0.

Three legislators hear a bill first and recommend what the committee should do; it’s the best time to weigh in. How to take part

Fiscal note

AI summary This bill changes how state mental health institutes operate, updates child safety plans, modifies regional mental health governance, and adjusts adoption notice requirements. Division I is estimated to increase costs for the Independence MHI by $160,000 and 3.0 full-time equivalent positions in fiscal year 2024, and by $300,000 in fiscal year 2025, while the Cherokee MHI is estimated to see an increase of $340,000 and 13.0 full-time equivalent positions in fiscal year 2024, and an increase of $922,000 in fiscal year 2025. The fiscal impacts for the other divisions have little to no effect, and the costs for adding outpatient competency restoration services cannot be estimated.³

Read the fiscal note

Description

House 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

Division I 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 Division 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

Division II 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. 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 (OCR) 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. 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

Division IV 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. Division IV allows a copy of the order to be sent by ordinary mail. Division IV 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 Division IV 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.

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

Division V 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 Division 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.

Division VI — Conforming Code Changes

Description and Background

Division VI 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

Division VII 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 HF 471 Fiscal ImpactsDivision Summary Fiscal Impacts Source of Funding I State Mental Health Institutes —