What changed in HF 2543

2 passages reworded, 22 added and 31 removed; 8 of 63 unchanged.

Removed AddedIntroduced textText as passedAmendments

Compares wording only. The printed bills also mark changes to existing law with strikes and underlines, which aren’t shown here.

Section 1. Section 135G.1, subsection 12, paragraph c, Code 2026, is amended by adding striking the following new subsection: paragraph.

NEW SUBSECTION. 3A. “Health carrier” means the same as defined in section 514J.102.

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2. Section 135G.3, Code 2026, is amended by adding the following new subsection:

2. Section 135G.1, subsection 12, paragraph c, Code 2026, is amended by striking the paragraph.

NEW SUBSECTION. 1A. Within twenty-four hours of a resident’s admission to a subacute care facility, the subacute care facility shall develop an initial treatment plan with the resident.

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3. Section 135G.3, Code 2026, is amended to read as follows: 135G.3 Nature of care —— seclusion room —— admissions —— discharge.

1.

a. A subacute care facility shall utilize a team of professionals to direct an organized program of diagnostic services, subacute mental health services, social services, and rehabilitative services to meet the needs of residents in accordance with a treatment care plan developed for each resident under the supervision of a mental health professional.

b. The goal of a treatment care plan is to transition residents to a less restrictive environment, including a home-based community setting. Social and rehabilitative services shall also be provided under the direction of a mental health professional.

c. Within twenty-four hours of a resident’s admission to a subacute care facility, the subacute care facility shall develop a written treatment care plan with the resident.

2.

3.

a. Prior authorization shall not be required for an individual’s admission to a subacute care facility or for the first fifteen consecutive calendar days of a resident’s treatment.

NEW SECTION. 135G.3A Insurance authorization.

b. Starting from a resident’s first day of treatment, on or after a resident’s forty-fifth consecutive day of treatment, a managed care organization may review the medical necessity of the resident’s treatment. After the initial review of a resident’s treatment, a managed care organization may only review the medical necessity of the resident’s treatment a maximum of one time within any consecutive thirty-calendar-day period.

1. If a mental health professional submits an electronic request through an internet portal designated by the department of health and human services for prior authorization for insurance coverage for an individual’s subacute mental health care service under chapter 249A or chapter 249N, the department of health and human services or the managed care organization responsible for administering the individual’s medical assistance shall provide a determination to the mental health professional for the preauthorization request as follows:

2.

a. Within forty-eight hours after the date of receipt of an urgent preauthorization request.

3. The mental health professional providing supervision of the subacute care facility’s treatment care plans shall evaluate the condition of each resident as medically necessary, and shall be available to residents of the facility on an on-call basis at all other times. Additional evaluation and treatment may be provided by a mental health professional. The subacute care facility may employ a seclusion room meeting the conditions described in 42 C.F.R. §483.364(b) with approval of a licensed psychiatrist, or by order of the resident’s physician, a physician assistant, or an advanced registered nurse practitioner.

b. Within five calendar days after the date of receipt of a nonurgent preauthorization request.

4. A managed care organization shall not require a resident to be discharged from a subacute care facility until the mental health professional providing supervision of the resident’s treatment care plan has determined that there are proper supports in place prior to the resident’s discharge to mitigate the risk of self-harm by the resident, or harm to another individual by the resident.

c. Within ten calendar days after the date of receipt of a nonurgent preauthorization request involving complex or unique circumstances.

5. Pursuant to section 505.36, a health carrier shall provide coverage for subacute mental health services provided by a subacute care facility.

2. The director of health and human services shall adopt rules pursuant to chapter 17A as necessary to administer this section.

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5.

NEW SECTION. 505.36 Health carriers —— subacute mental health care services.

1. For purposes of this section:

a. “Health carrier” means the same as defined in section 514J.102.

b. “Subacute care facility” means the same as defined in section 135G.1.

c. “Subacute mental health services” means the same as defined in section 135G.1.

2. A health carrier shall provide coverage for subacute mental health services provided by a subacute care facility. A health carrier that violates this section shall be subject to penalties pursuant to section 505.7A.

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6. DEPARTMENTS OF HEALTH AND HUMAN SERVICES AND INSPECTIONS, APPEALS, AND LICENSING —— ADMINISTRATIVE RULE REVIEW. The department of health and human services and the department of inspections, appeals, and licensing shall collaborate to review each department’s administrative rules adopted pursuant to section 135G.10 and eliminate any rule the departments determine impedes any of the following goals without providing an equal or greater benefit:

1. Establishment of new subacute mental health care facilities and services.

2. Expansion of existing subacute mental health care facilities and services.

5. DEPARTMENTS OF INSPECTIONS, APPEALS, AND LICENSING AND HEALTH AND HUMAN SERVICES —— ADMINISTRATIVE RULE REVIEW. The department of inspections, appeals, and licensing and the department of health and human services shall do all of the following:

3. Ease of access to subacute mental health care facilities and services.

1. Collaborate to review each department’s administrative rules adopted pursuant to section 135G.10 and eliminate any rule the departments determine impedes any of the following goals without providing an equal or greater benefit:

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a. Establishment of new subacute mental health care facilities and services.

7. DEPARTMENT OF INSPECTIONS, APPEALS, AND LICENSING —— SUBACUTE MENTAL HEALTH CARE FACILITIES —— BED CAPACITY —— FACILITY AND EMPLOYEE REQUIREMENTS. The department of inspections, appeals, and licensing shall adopt rules pursuant to chapter 17A to do the following:

b. Expansion of existing subacute mental health care facilities and services.

1. Increase the maximum number of beds a subacute care facility may have without the subacute care facility being defined as a state mental health institute.

c. Ease of access to subacute mental health care facilities and services.

2. Provide that requirements applicable to a subacute mental health care facility, and subacute mental health care facility employees, are less stringent than comparable requirements that apply to a state mental health institute or a state mental health institute’s employees.

2. Modify the departments’ respective rules so that the requirements to employ an individual at a subacute mental health care facility are less stringent than the requirements for the same employment at a state mental health institute.

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6. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— SUBACUTE MENTAL HEALTH CARE SERVICES.

1.

a. The department of health and human services shall review the state’s capability to establish subacute mental health care services, and additional psychiatric inpatient services at the state mental health institute at Independence, beginning on July 1, 2027.

b. At a minimum, the department’s review shall assess the operational costs, bed capacity, staffing capabilities, necessary infrastructure improvements, and reasonable implementation time frames.

c. The department’s review shall investigate the possibility of partnering with private operators to provide subacute mental health care services at the state mental health institute at Independence.

d. The department shall submit a report on the department’s findings to the chairpersons of the house of representatives committee on health and human services, the senate committee on health and human services, the house committee on appropriations, and the senate committee on appropriations no later than January 4, 2027.

8. EMERGENCY RULES. The department of health and human services and the department of inspections, appeals, and licensing may adopt emergency rules under section 17A.4, subsection 3, and section 17A.5, subsection 2, paragraph “b”, to implement the provisions of this Act and shall submit such rules to the administrative rules coordinator and the administrative code editor pursuant to section 17A.5, subsection 1, within the same period. The rules shall be effective immediately upon filing unless a later date is specified in the rules. Any rules adopted in accordance with this section shall also be published as a notice of intended action as provided in section 17A.4.

2. Following the review under subsection 1, if the director of health and human services determines on or after July 1, 2026, that the department can provide subacute mental health care services at the state mental health institute at Independence within the department’s budget, the department may provide such services until the general assembly directs otherwise.

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9. 7. EFFECTIVE DATE. This Act, being deemed of immediate importance, takes effect upon enactment.