Relating to discharge of involuntarily committed persons from a facility or a hospital

Description

House File 385 modifies a mental health treatment facility’s obligations with regard to the discharge of a person committed by court order. Prior to the discharge of a person that was committed for a substance use disorder or hospitalized for inpatient care for a serious mental impairment, the facility treating the person must refer the person to an administrative services organization (ASO) that will provide evaluation, system navigation, and postdischarge services. In addition to the referral to an ASO, the facility must do the following:

• Assess the person for suicide risk.
• Provide the person with a 15-day supply of all medications prescribed for the person before or during treatment. If payment for medication is not covered by insurance or the medical assistance program, the facility may make a request for reimbursement from an ASO for the cost of the medication.
• Provide the person or the person’s legal representative with a discharge report.
• Notify the ASO being referred and the person’s legal guardian.

The Bill requires an ASO to coordinate the discharged person’s postdischarge care by contacting them to ensure they attend scheduled appointments and receive necessary care and services and following up with the discharged person in a timely manner. An ASO may delegate these requirements to a managed care organization (MCO) acting pursuant to a contract with the Department of Health and Human Services (HHS) if the respondent referred to the ASO qualified for the medical assistance program. Each ASO will be required to make quarterly reports to the HHS. An ASO’s quarterly report is considered a confidential record and must comply with the federal Health Insurance Portability and Accountability Act of 1996. The HHS is required to develop educational materials for distribution to facilities for a facility to provide with the person’s discharge report, and to adopt administrative rules to implement and administer the Bill.

Background

Under current law, following a committed person’s discharge from a facility or from treatment, the administrator of the facility must immediately report that fact to the court that ordered the respondent’s commitment or treatment. The court must issue an order confirming the respondent’s discharge from the facility or from treatment and must terminate the proceedings pursuant to which the order was issued. Copies of the order are then sent by regular mail to the facility and the respondent. These discharge requirements are established in Iowa Code sections 125.85 and 229.16.

Currently, committed persons discharged from the HHS mental health institutes (MHIs) are provided prescriptions for medications. In limited cases, a three-day supply of medications may be provided. In FY 2024, 381 individuals were discharged from the MHIs.

Assumptions

• There are over 300 discharges annually from the MHIs.
• The average cost per 15 days for a psychotropic medication prescription at the MHIs is estimated to be between $550 and $800.
• House File 385 requires a 15-day supply of any prescribed medications, either psychotropic or nonpsychotropic, at the time of discharge.
• The amount a facility will be reimbursed by insurance, the medical assistance program, or an ASO is unknown.

Fiscal Impact

The total fiscal impact of HF 385 cannot be determined, but may be significant. If a 15-day supply of psychotropic medications is provided to all individuals discharged from the MHIs, the fiscal impact may be up to $211,000 to $286,000 per year.

The fiscal impact of HF 385 requiring the MHIs to provide a 15-day supply of prescription nonpsychotropic medications at the time of discharge cannot be determined as the cost, quantity, and types of medications are unknown.

Source

• Department of Health and Human Services