Text: HF477            Text: HF479
Complete Bill History


House File 478

HOUSE FILE BY HEDDENS, WESSEL=KROESCHELL, PETERSEN, STECKMAN, THEDE, WINCKLER, ABDUL=SAMAD, and MASCHER A BILL FOR 1 An Act relating to state and county responsibilities for 2 adult mental health, mental retardation, and developmental 3 disabilities services and including effective date 4 provisions. 5 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: TLSB 2160YH (9) 84 jp/nh PAG LIN 1 1 DIVISION I 1 2 MENTAL HEALTH COMMITMENT AND FACILITY COSTS 1 3 Section 1. Section 218.44, Code 2011, is amended to read as 1 4 follows: 1 5 218.44 Wages paid to dependent ==== deposits. 1 6 If such wage be wages are paid to a resident, the 1 7 administrator in control of such the institution in which 1 8 the resident is placed may pay all or any part of the same 1 9 wages directly to any dependent of such the resident, or may 1 10 deposit such the wage to the account of such the resident, or 1 11 may so deposit part thereof of the wage and allow the resident 1 12 a portion part for the resident's own personal use, or may 1 13 pay to the county of commitment state all or any part of the 1 14 resident's care, treatment, or subsistence while at said the 1 15 institution from any credit balance accruing to the account of 1 16 said the resident. 1 17 Sec. 2. Section 218.99, Code 2011, is amended to read as 1 18 follows: 1 19 218.99 Counties Department to be notified of patients' 1 20 personal accounts. 1 21 The administrator in control of a state institution shall 1 22 direct the business manager of each institution under the 1 23 administrator's jurisdiction which is mentioned in section 1 24 331.424, subsection 1, paragraph "a", subparagraphs (1) 1 25 and (2), and for which services are paid under section 1 26 331.424A, to quarterly inform the county of legal settlement's 1 27 entity designated to perform the county's central point 1 28 of coordination process to quarterly inform the department 1 29 of human services of any patient or resident who has an 1 30 amount in excess of two hundred dollars on account in the 1 31 patients' personal deposit fund and the amount on deposit. The 1 32 administrators shall direct the business manager to further 1 33 notify the entity designated to perform the county's central 1 34 point of coordination process department at least fifteen days 1 35 before the release of funds in excess of two hundred dollars 2 1 or upon the death of the patient or resident. If the patient 2 2 or resident has no county of legal settlement, notice shall be 2 3 made to the director of human services and the administrator in 2 4 control of the institution involved. 2 5 Sec. 3. Section 226.9C, subsection 1, paragraph a, Code 2 6 2011, is amended to read as follows: 2 7 a. Moneys received by the state from billings to counties 2 8 under section 230.20. 2 9 Sec. 4. Section 226.45, Code 2011, is amended to read as 2 10 follows: 2 11 226.45 Reimbursement to county or state. 2 12 If a patient is not receiving medical assistance under 2 13 chapter 249A and the amount to the account of any patient 2 14 in the patients' personal deposit fund exceeds two hundred 2 15 dollars, the business manager of the hospital may apply any of 2 16 the excess to reimburse the county of legal settlement or the 2 17 state in a case where no legal settlement exists, as applicable 2 18 as provided by section 230.1, for liability incurred by the 2 19 county or the state for the payment of care, support, and 2 20 maintenance of the patient, when billed by the county of legal 2 21 settlement or by the administrator for a patient having no 2 22 legal settlement at the state mental health institute. 2 23 Sec. 5. Section 230.1, Code 2011, is amended to read as 2 24 follows: 2 25 230.1 Liability of county and state. 2 26 1. The necessary and legal costs and expenses attending 2 27 the taking into custody, care, investigation, admission, 2 28 commitment, and support of a person resident of this state 2 29 with mental illness admitted or committed to a federal, state, 2 30 county, or private hospital or facility on or after July 1, 2 31 2012, shall be paid by a county or by the state. as follows: 2 32 a. By the county in which such person has a legal 2 33 settlement, if the person is eighteen years of age or older. 2 34 b. By the state when such person has no legal settlement in 2 35 this state, when the person's legal settlement is unknown, or 3 1 if the person is under eighteen years of age. 3 2 2. The legal settlement of any person found mentally ill who 3 3 is a patient of any state institution shall be that existing 3 4 at the time of admission thereto. The necessary and legal 3 5 costs and expenses attending the taking into custody, care, 3 6 investigation, admission, commitment, and support of a resident 3 7 of this state with mental illness admitted or committed to 3 8 a federal, state, county, or private hospital or facility 3 9 before July 1, 2012, which were incurred prior to July 1, 2012, 3 10 shall be paid by the state or a county in accordance with this 3 11 chapter, Code 2011, as applicable. Such costs and expenses 3 12 incurred on or after July 1, 2012, shall be paid by the state as 3 13 provided in subsection 1. 3 14 3. A county of legal settlement is not liable for costs 3 15 and expenses associated with a person with mental illness 3 16 unless the costs and expenses are for services and other 3 17 support authorized for the person through the central point 3 18 of coordination process. For the purposes of this chapter, 3 19 "central point of coordination process" means the same as 3 20 defined in section 331.440. 3 21 Sec. 6. Section 230.15, unnumbered paragraph 1, Code 2011, 3 22 is amended to read as follows: 3 23 A person with mental illness and a person legally liable 3 24 for the person's support remain liable for the support of 3 25 the person with mental illness as provided in this section. 3 26 Persons legally liable for the support of a person with mental 3 27 illness include the spouse of the person, any person bound 3 28 by contract for support of the person, and, with respect to 3 29 persons with mental illness under eighteen years of age only, 3 30 the father and mother of the person. The county auditor, 3 31 subject to the direction of the board of supervisors, shall 3 32 enforce the obligation created in this section as to all 3 33 sums advanced by the county. The liability to the state or 3 34 county incurred by a person with mental illness or a person 3 35 legally liable for the person's support under this section 4 1 is limited to an amount equal to one hundred percent of the 4 2 cost of care and treatment of the person with mental illness 4 3 at a state mental health institute for one hundred twenty days 4 4 of hospitalization. This limit of liability may be reached 4 5 by payment of equal to the cost of care and treatment of the 4 6 person with mental illness subsequent to a single admission 4 7 or multiple admissions to a state mental health institute or, 4 8 if the person is not discharged as cured, subsequent to a 4 9 single transfer or multiple transfers to a county care facility 4 10 pursuant to section 227.11. If the person is discharged 4 11 from a state mental health institute or other inpatient 4 12 placement and the limit of liability has not been reached, the 4 13 liability extends to costs provided for outpatient treatment. 4 14 After reaching this limit of liability, a person with mental 4 15 illness or a person legally liable for the person's support 4 16 is liable to the state or county, as applicable, for the care 4 17 and treatment of the person with mental illness at a state 4 18 mental health institute or other inpatient placement, or, if 4 19 transferred but not discharged as cured, at a county care 4 20 facility or from an outpatient treatment provider in an amount 4 21 not in excess of the average minimum cost of the maintenance 4 22 of an individual who is physically and mentally healthy 4 23 residing in the individual's own home, which standard shall 4 24 be established and may from time to time be revised by the 4 25 department of human services. A lien imposed by section 230.25 4 26 shall not exceed the amount of the liability which may be 4 27 incurred under this section on account of a person with mental 4 28 illness. 4 29 Sec. 7. Section 230.16, Code 2011, is amended to read as 4 30 follows: 4 31 230.16 Presumption. 4 32 In actions to enforce the liability imposed by section 4 33 230.15, the certificate from the superintendent to the or the 4 34 county auditor stating the sums charged in such cases, shall be 4 35 presumptively correct. 5 1 Sec. 8. Section 230.17, Code 2011, is amended to read as 5 2 follows: 5 3 230.17 Board or department may compromise lien. 5 4 1. The board of supervisors is hereby empowered to may 5 5 compromise any and all liabilities to the county, created by 5 6 this chapter, when such compromise is deemed to be for the best 5 7 interests of the county. 5 8 2. The department of human services may compromise any and 5 9 all liabilities to the state created by this chapter, when such 5 10 compromise is deemed to be for the best interests of the state. 5 11 Sec. 9. Section 230.18, Code 2011, is amended to read as 5 12 follows: 5 13 230.18 Expense in county or private hospitals. 5 14 The estates of persons with mental illness who may be treated 5 15 or confined in any county hospital or home, or in any private 5 16 hospital or sanatorium, or receive outpatient services, and 5 17 the estates of persons legally bound for their support, shall 5 18 be liable to the county or state, as applicable, for the 5 19 reasonable cost of such support paid by the county or state. 5 20 Sec. 10. Section 230.20, subsections 1, 2, 3, 4, and 5, Code 5 21 2011, are amended by striking the subsections. 5 22 Sec. 11. Section 230.20, subsections 6, 7, and 8, Code 2011, 5 23 are amended to read as follows: 5 24 6. All or any reasonable portion of the charges incurred 5 25 for services provided to a patient, to the most recent date for 5 26 which the charges have been computed, may be paid at any time 5 27 by the patient or by any other person on the patient's behalf. 5 28 Any payment made by the patient or other person, and any 5 29 federal financial assistance received pursuant to Tit. XVIII or 5 30 XIX of the federal Social Security Act for services rendered 5 31 to a patient, shall be credited against the patient's account 5 32 and, if the charges paid as described in this subsection have 5 33 previously been billed to a county, reflected in the mental 5 34 health institute's next general statement to that county. 5 35 7. A superintendent of a mental health institute may request 6 1 that the director of human services enter into a contract 6 2 with a person for the mental health institute to provide 6 3 consultation or treatment services or for fulfilling other 6 4 purposes which are consistent with the purposes stated in 6 5 section 226.1. The contract provisions shall include charges 6 6 which reflect the actual cost of providing the services or 6 7 fulfilling the other purposes. Any income from a contract 6 8 authorized under this subsection may be retained by the 6 9 mental health institute to defray the costs of providing the 6 10 services. Except for a contract voluntarily entered into by a 6 11 county under this subsection, the costs or income associated 6 12 with a contract authorized under this subsection shall not 6 13 be considered in computing charges and per diem costs in 6 14 accordance with the provisions of subsections 1 through 6 of 6 15 this section. 6 16 8. The department shall provide a county with information, 6 17 which is not otherwise confidential under law, in the 6 18 department's possession concerning a patient whose cost of 6 19 care provided outside a state mental health institute or other 6 20 inpatient setting is chargeable to the county, including but 6 21 not limited to the information specified in section 229.24, 6 22 subsection 3. 6 23 Sec. 12. Section 331.424A, subsection 2, Code 2011, is 6 24 amended to read as follows: 6 25 2. For the fiscal year beginning July 1, 1996, and 6 26 succeeding fiscal years, county revenues from taxes and other 6 27 sources designated for mental health, mental retardation, 6 28 and developmental disabilities services shall be credited 6 29 to the mental health, mental retardation, and developmental 6 30 disabilities services fund of the county. The board shall 6 31 make appropriations from the fund for payment of services 6 32 provided under the county management plan approved pursuant 6 33 to section 331.439. The county may pay for the services in 6 34 cooperation with other counties by pooling appropriations 6 35 from the fund with other counties or through county regional 7 1 entities including but not limited to the county's mental 7 2 health and developmental disabilities regional planning council 7 3 created pursuant to section 225C.18. The costs of placement, 7 4 treatment, or other service ordered under chapter 812 shall not 7 5 be paid from the fund. 7 6 Sec. 13. REPEAL. Sections 230.2, 230.3, 230.4, 230.5, 7 7 230.6, 230.9, 230.10, 230.11, 230.12, and 230.22, Code 2011, 7 8 are repealed. 7 9 Sec. 14. EFFECTIVE DATE. This division of this Act takes 7 10 effect July 1, 2012. 7 11 DIVISION II 7 12 STATE RESOURCE CENTERS 7 13 Sec. 15. Section 222.13, Code 2011, is amended to read as 7 14 follows: 7 15 222.13 Voluntary admissions. 7 16 1. If an adult person is believed to be a person with mental 7 17 retardation, the adult person or the adult person's guardian 7 18 may submit a request through the central point of coordination 7 19 process for the county board of supervisors to apply to the 7 20 superintendent of any state resource center for the voluntary 7 21 admission of the adult person either as an inpatient or an 7 22 outpatient of the resource center. After determining the legal 7 23 settlement of the adult person as provided by this chapter, 7 24 the board of supervisors shall, on forms prescribed by the 7 25 administrator, apply to the superintendent of the resource 7 26 center in the district for the admission of the adult person to 7 27 the resource center. An application for admission to a special 7 28 unit of any adult person believed to be in need of any of the 7 29 services provided by the special unit under section 222.88 may 7 30 be made in the same manner, upon request of the adult person or 7 31 the adult person's guardian. The superintendent shall accept 7 32 the application providing a preadmission diagnostic evaluation, 7 33 performed through the central point of coordination process, 7 34 confirms or establishes the need for admission, except that an 7 35 application may not be accepted if the institution does not 8 1 have adequate facilities available or if the acceptance will 8 2 result in an overcrowded condition. 8 3 2. If the resource center has no appropriate program for the 8 4 treatment of an adult or minor person with mental retardation 8 5 applying under this section or section 222.13A, the board of 8 6 supervisors central point of coordination for the person's 8 7 county of residence shall arrange for the placement of the 8 8 person in any public or private facility within or without the 8 9 state, approved by the director of the department of human 8 10 services, which offers appropriate services for the person, as 8 11 determined through the central point of coordination process. 8 12 3. Upon applying application for admission of an 8 13 adult or minor person to a resource center, or a special 8 14 unit, or upon arranging arrangement for the placement of 8 15 the person in a public or private facility, the board of 8 16 supervisors superintendent or the department shall make a 8 17 full investigation into the financial circumstances of that 8 18 person and those liable for that person's support under section 8 19 222.78 to determine whether or not any of them are able to pay 8 20 the expenses arising out of the admission of the person to a 8 21 resource center, special treatment unit, or public or private 8 22 facility. If the board superintendent or the department finds 8 23 that the person or those legally responsible for the person are 8 24 presently unable to pay the expenses, the board shall direct 8 25 that the expenses shall be paid by the county department. The 8 26 board superintendent or the department may review its the 8 27 finding at any subsequent time while the person remains at the 8 28 resource center, or is otherwise receiving care or treatment 8 29 for which this chapter obligates the county to pay. If the 8 30 board superintendent or the department finds upon review that 8 31 the person or those legally responsible for the person are 8 32 presently able to pay the expenses, the finding shall apply 8 33 only to the charges incurred during the period beginning on the 8 34 date of the review and continuing thereafter, unless and until 8 35 the board superintendent or the department again changes its 9 1 the finding. If the board superintendent or the department 9 2 finds that the person or those legally responsible for the 9 3 person are able to pay the expenses, the board superintendent 9 4 or the department shall direct that the charges be so paid to 9 5 the extent required by section 222.78, and the county auditor 9 6 shall be responsible for the collection of the charges. 9 7 Sec. 16. Section 222.13A, subsections 1 and 2, Code 2011, 9 8 are amended to read as follows: 9 9 1. If a minor is believed to be a person with mental 9 10 retardation, the minor's parent, guardian, or custodian may 9 11 request the county board of supervisors to apply for admission 9 12 of the minor as a voluntary patient in a state resource center. 9 13 If the resource center does not have appropriate services for 9 14 the minor's treatment, the board of supervisors central point 9 15 of coordination for the minor's county of residence may arrange 9 16 for the admission of the minor in a public or private facility 9 17 within or without the state, approved by the director of human 9 18 services, which offers appropriate services for the minor's 9 19 treatment. 9 20 2. Upon receipt of an application for voluntary admission 9 21 of a minor, the board of supervisors state resource center 9 22 shall provide for a preadmission diagnostic evaluation of the 9 23 minor to confirm or establish the need for the admission. 9 24 The preadmission diagnostic evaluation shall be performed by 9 25 a person who meets the qualifications of a qualified mental 9 26 retardation professional who is designated through the central 9 27 point of coordination process. 9 28 Sec. 17. Section 222.31, subsection 1, paragraph b, Code 9 29 2011, is amended to read as follows: 9 30 b. (1) Commit the person to the state resource center 9 31 designated by the administrator to serve the county in which 9 32 the hearing is being held, or to a special unit. The court 9 33 shall, prior to issuing an order of commitment, request 9 34 that a diagnostic evaluation of the person be made by the 9 35 superintendent of the resource center or the special unit, or 10 1 the superintendent's qualified designee. The evaluation shall 10 2 be conducted at a place as the superintendent may direct. The 10 3 cost of the evaluation shall be defrayed by the county of legal 10 4 settlement department unless otherwise ordered by the court. 10 5 The cost may be equal to but shall not exceed the actual cost 10 6 of the evaluation. Persons referred by a court to a resource 10 7 center or the special unit for diagnostic evaluation shall be 10 8 considered as outpatients of the institution. No An order of 10 9 commitment shall not be issued unless the superintendent of the 10 10 institution recommends that the order be issued, and advises 10 11 the court that adequate facilities for the care of the person 10 12 are available at the state resource center. 10 13 (2) The court shall examine the report of the county 10 14 attorney filed pursuant to section 222.13, and if the report 10 15 shows that neither the person nor those liable for the person's 10 16 support under section 222.78 are presently able to pay the 10 17 charges rising out of the person's care in a resource center, 10 18 or special treatment unit, shall enter an order stating that 10 19 finding and directing that the charges be paid by the person's 10 20 county of residence department. The court may, upon request 10 21 of the board of supervisors department, review its finding at 10 22 any subsequent time while the person remains at the resource 10 23 center, or is otherwise receiving care or treatment for which 10 24 this chapter obligates the county to pay. If the court finds 10 25 upon review that the person or those legally responsible for 10 26 the person are presently able to pay the expenses, that finding 10 27 shall apply only to the charges incurred during the period 10 28 beginning on the date of the board's department's request for 10 29 the review and continuing thereafter, unless and until the 10 30 court again changes its finding. If the court finds that the 10 31 person, or those liable for the person's support, are able 10 32 to pay the charges, the court shall enter an order directing 10 33 that the charges be so paid to the extent required by section 10 34 222.78. 10 35 Sec. 18. Section 222.49, Code 2011, is amended to read as 11 1 follows: 11 2 222.49 Costs paid. 11 3 1. The Except as provided in subsection 2, the costs of 11 4 proceedings for placement of a person at a state resource 11 5 center shall be defrayed from the county treasury paid by the 11 6 department unless otherwise ordered by the court. 11 7 2. The costs of proceedings for placement of a person at a 11 8 state resource center which commenced prior to July 1, 2012, 11 9 shall be paid by the person's county of legal settlement unless 11 10 otherwise ordered by the court. Such costs shall be paid in 11 11 accordance with this chapter, Code 2011, as applicable. 11 12 3. When If the person alleged to be mentally retarded have 11 13 mental retardation is found not to be mentally retarded have 11 14 mental retardation, the court shall render judgment for such 11 15 costs against the person filing the petition except when the 11 16 petition is filed by order of court. 11 17 Sec. 19. Section 222.50, Code 2011, is amended to read as 11 18 follows: 11 19 222.50 County of legal settlement to pay Payment 11 20 responsibility. 11 21 1. When the Except as provided in subsection 2, if the costs 11 22 of proceedings for placement of a person at a state resource 11 23 center are not paid by the petitioner, the costs shall be paid 11 24 by the department. 11 25 2. If proceedings for placement of a person at a state 11 26 resource center commenced prior to July 1, 2012, and the 11 27 proceedings are were instituted in a county in which the person 11 28 who is alleged to have mental retardation was found resided but 11 29 which is not the county of legal settlement of the person, and 11 30 the costs are not taxed to the petitioner, the county which is 11 31 the legal settlement of the person shall, on presentation of 11 32 a properly itemized bill for such costs, repay the costs to 11 33 the former county. When If the person's legal settlement is 11 34 was outside the state or is unknown, the costs shall be paid 11 35 out of money in the state treasury not otherwise appropriated, 12 1 itemized on vouchers executed by the auditor of the county 12 2 which paid the costs, and approved by the administrator. 12 3 Sec. 20. Section 222.60, subsection 1, Code 2011, is amended 12 4 to read as follows: 12 5 1. All necessary and legal expenses for the cost of 12 6 admission or commitment or for the treatment, training, 12 7 instruction, care, habilitation, support and transportation 12 8 of persons with mental retardation, as provided for in the 12 9 county management plan provisions implemented pursuant to 12 10 section 331.439, subsection 1, in a state resource center, or 12 11 in a special unit, or any public or private facility within or 12 12 without the state, approved by the director of the department 12 13 of human services, shall be paid by either: 12 14 a. The county in which such person has legal settlement as 12 15 defined in section 252.16, when the person received services at 12 16 a state resource center prior to July 1, 2012. Such expenses 12 17 relating to services received at a state resource center prior 12 18 to July 1, 2012, shall be paid in accordance with this chapter, 12 19 Code 2011, as applicable. 12 20 b. The state when such person has no legal settlement or 12 21 when such settlement is unknown, or when the person receives 12 22 services at a state resource center on or after July 1, 2012. 12 23 Sec. 21. Section 222.63, Code 2011, is amended to read as 12 24 follows: 12 25 222.63 Finding of settlement ==== objection. 12 26 A If payment for a person's necessary and legal expenses 12 27 is a county responsibility under section 222.60, a board of 12 28 supervisors' certification utilizing the central point of 12 29 coordination process that a the person's legal settlement is in 12 30 another county shall be sent by the board of supervisors to the 12 31 auditor of the county of legal settlement. The certification 12 32 shall be accompanied by a copy of the evidence supporting the 12 33 determination. The auditor of the county of legal settlement 12 34 shall submit the certification to the board of supervisors of 12 35 the auditor's county and it shall be conclusively presumed 13 1 that the patient has a legal settlement in that county unless 13 2 that county disputes the determination of legal settlement as 13 3 provided in section 225C.8. 13 4 Sec. 22. Section 222.64, Code 2011, is amended to read as 13 5 follows: 13 6 222.64 Foreign state or country or unknown State case legal 13 7 settlement. 13 8 If the legal settlement of the person is determined by the 13 9 board of supervisors through the central point of coordination 13 10 process to be in a foreign state or country or is determined 13 11 to be unknown responsibility under section 222.60, the 13 12 board of supervisors shall certify the determination to the 13 13 administrator. The certification shall be accompanied by a 13 14 copy of the evidence supporting the determination. The care of 13 15 the person shall be as arranged by the board of supervisors or 13 16 by an order as the court may enter. Application for admission 13 17 or order of commitment may be made pending investigation by the 13 18 administrator. 13 19 Sec. 23. Section 222.70, Code 2011, is amended to read as 13 20 follows: 13 21 222.70 Legal settlement disputes. 13 22 If a dispute arises between counties or between the 13 23 department and a county as to the legal settlement of a person 13 24 admitted or committed to a resource center, a special unit, or 13 25 a community=based service, the dispute shall be resolved as 13 26 provided in section 225C.8. 13 27 Sec. 24. Section 222.78, Code 2011, is amended to read as 13 28 follows: 13 29 222.78 Parents and others liable for support. 13 30 The father and mother of any patient admitted or committed to 13 31 a resource center or to a special unit, as either an inpatient 13 32 or an outpatient, and any person, firm, or corporation bound 13 33 by contract made for support of the patient are liable for the 13 34 support of the patient. The patient and those legally bound 13 35 for the support of the patient shall be liable to the county 14 1 for all sums advanced by the county to or the state under the 14 2 provisions of sections 222.60 and 222.77. The liability of 14 3 any person, other than the patient, who is legally bound for 14 4 the support of a patient who is under eighteen years of age 14 5 in a resource center or a special unit shall not exceed the 14 6 average minimum cost of the care of a normally intelligent 14 7 minor without a disability of the same age and sex as the 14 8 minor patient. The administrator shall establish the scale 14 9 for this purpose but the scale shall not exceed the standards 14 10 for personal allowances established by the state division 14 11 under the family investment program. The father or mother 14 12 shall incur liability only during any period when the father 14 13 or mother either individually or jointly receive a net income 14 14 from whatever source, commensurate with that upon which they 14 15 would be liable to make an income tax payment to this state. 14 16 The father or mother of a patient shall not be liable for the 14 17 support of the patient upon the patient attaining eighteen 14 18 years of age. Nothing in this section shall be construed to 14 19 prevent a relative or other person from voluntarily paying the 14 20 full actual cost as established by the administrator for caring 14 21 for the patient with mental retardation. 14 22 Sec. 25. Section 222.79, Code 2011, is amended to read as 14 23 follows: 14 24 222.79 Certification statement presumed correct. 14 25 In actions to enforce the liability imposed by section 14 26 222.78, the a certification statement sent from the 14 27 superintendent to the county auditor pursuant to section 222.74 14 28 stating the sums charged in such cases shall be considered to 14 29 be presumptively correct. 14 30 Sec. 26. Section 222.86, Code 2011, is amended to read as 14 31 follows: 14 32 222.86 Payment for care from fund. 14 33 If a patient is not receiving medical assistance under 14 34 chapter 249A and the amount in the account of any patient 14 35 in the patients' personal deposit fund established pursuant 15 1 to section 222.84 exceeds two hundred dollars, the business 15 2 manager of the resource center or special unit may apply 15 3 any amount of the excess to reimburse the county of legal 15 4 settlement or the state in a case where no legal settlement 15 5 exists, as applicable in accordance with section 222.60, for 15 6 liability incurred by the county or the state for the payment 15 7 of care, support, and maintenance of the patient, when billed 15 8 by the county of legal settlement or by the administrator for a 15 9 patient having no legal settlement at a state resource center. 15 10 Sec. 27. Section 222.92, subsection 1, Code 2011, is amended 15 11 to read as follows: 15 12 1. The department shall operate the state resource centers 15 13 on the basis of net appropriations from the general fund of 15 14 the state. The appropriation amounts shall be the net amounts 15 15 of state moneys projected to be needed for the state resource 15 16 centers for the fiscal year of the appropriations. The purpose 15 17 of utilizing net appropriations is to encourage the state 15 18 resource centers to operate with increased self=sufficiency, to 15 19 improve quality and efficiency, and to support collaborative 15 20 efforts between the state resource centers and counties and 15 21 other providers of funding for the services available from 15 22 the state resource centers. The state resource centers shall 15 23 not be operated under the net appropriations in a manner that 15 24 results in a cost increase to the state or in cost shifting 15 25 between the state, the medical assistance program, counties, or 15 26 other sources of funding for the state resource centers. 15 27 Sec. 28. Section 222.92, subsection 3, paragraph a, Code 15 28 2011, is amended by striking the paragraph. 15 29 Sec. 29. REPEAL. Sections 222.61, 222.62, 222.65, 222.67, 15 30 222.68, 222.69, 222.73, 222.74, and 222.75, Code 2011, are 15 31 repealed. 15 32 Sec. 30. EFFECTIVE DATE. This division of this Act takes 15 33 effect July 1, 2012. 15 34 DIVISION III 15 35 LEGISLATIVE INTENT AND EFFECTIVE DATES 16 1 Sec. 31. LEGISLATIVE INTENT ==== PLANNING. 16 2 1. The general assembly intends to assign the 16 3 responsibilities of the state and counties for the costs of 16 4 services as follows: 16 5 a. The necessary and legal nonfederal costs and expenses 16 6 attending the taking into custody, care, investigation, 16 7 admission, commitment, and support of a person with mental 16 8 illness admitted or committed to a federal, state, county, or 16 9 private hospital or facility on or after July 1, 2012, shall be 16 10 paid by the state. 16 11 b. The costs of community=based mental health services for 16 12 adults on or after July 1, 2012, shall be paid by counties. 16 13 c. The nonfederal share of the costs of state resource 16 14 centers on or after July 1, 2012, shall be paid by the state. 16 15 d. The nonfederal share of costs for services, other than 16 16 those associated with the state resource centers, provided to 16 17 adults with mental retardation or intellectual disabilities on 16 18 or after July 1, 2012, shall be paid by counties. 16 19 e. The costs associated with court=ordered commitments of 16 20 persons with mental retardation under chapter 222 on or after 16 21 July 1, 2012, shall be paid by the state. 16 22 2. The department of human services shall work with 16 23 representatives designated by the Iowa state association 16 24 of counties, service providers, and service consumers and 16 25 advocates to develop plans to implement the provisions of 16 26 this Act, including formulating recommendations for statutory 16 27 changes, funding provisions, and other measures to implement 16 28 the intent expressed in subsection 1. In addition, the plans 16 29 and recommendations shall also provide for development and 16 30 funding of a subacute level of care to address behavioral and 16 31 mental health needs of children and adults. The department 16 32 shall report the plans and recommendations to the governor and 16 33 general assembly on or before December 15, 2011. 16 34 3. The office of the citizens' aide shall consult with 16 35 stakeholders in reviewing the role, funding, and appropriate 17 1 administrative entity for mental health advocates currently 17 2 appointed under section 229.19. The office shall submit 17 3 a report with findings and recommendations to the general 17 4 assembly and governor on or before December 15, 2011. 17 5 Sec. 32. EFFECTIVE DATE. This division of this Act takes 17 6 effect upon enactment. 17 7 EXPLANATION 17 8 This bill revises state and county responsibilities for 17 9 adult mental health, mental retardation, and developmental 17 10 disabilities services effective July 1, 2012. The bill is 17 11 organized into divisions. 17 12 MENTAL HEALTH COMMITMENT AND FACILITY COSTS. This division 17 13 provides for the state to pay necessary and legal nonfederal 17 14 costs and expenses attending the taking into custody, care, 17 15 investigation, admission, commitment, and support of a person 17 16 with mental illness admitted or committed to a federal, state, 17 17 county, or private hospital or facility on or after July 17 18 1, 2012. Current law requires counties to pay capped per 17 19 diem rates for the services at the four state mental health 17 20 institutes and the nonfederal share of other noninstitutional 17 21 mental health services provided to adults with legal settlement 17 22 and for the state to pay for children's services and state 17 23 cases for adults with mental illness. 17 24 Provisions in Code chapter 218, relating to the state 17 25 institutions controlled by the department of human services, 17 26 are amended to provide that certain excess moneys from state 17 27 institution patient wages and accounts are to be paid to the 17 28 department instead of counties. A similar provision in Code 17 29 section 226.45 is also amended. 17 30 Code section 226.9C, relating to operation of the dual 17 31 diagnosis mental health and substance abuse program at the 17 32 state mental health institute at Mount Pleasant on a net 17 33 budgeting basis, is amended to strike a reference to a section 17 34 repealed by the bill. 17 35 Code section 230.1, relating to the liability of the state 18 1 and counties for the costs and expenses of adults and children 18 2 with mental illness committed to facilities, is amended to 18 3 provide for the state to pay these costs on or after July 18 4 1, 2012. For costs incurred before that date, the payment 18 5 responsibility is determined by the provisions repealed by the 18 6 bill. These provisions assign the responsibility for persons 18 7 age 18 and older to the county of legal settlement or to the 18 8 state when a person has no legal settlement in this state, when 18 9 the person's legal settlement is unknown, or if the person is 18 10 under 18 years of age. 18 11 Code section 230.15, relating to the liability of a person 18 12 with mental illness and persons liable for that person's 18 13 support and establishing a limitation on that liability, is 18 14 amended to also provide for payment to the state. Code section 18 15 230.16, relating to presumption of accuracy of certificates 18 16 from the superintendent of a state resource center in actions 18 17 relating to liability for services, is also made applicable to 18 18 a statement from a county auditor. 18 19 Code section 230.17, relating to the authority of the county 18 20 auditor to compromise a lien for cost liability when in the 18 21 best interests of the county, is expanded to provide similar 18 22 authority to the department of human services when it is in the 18 23 best interests of the state. 18 24 Code section 230.18, relating to liability of an estate to a 18 25 county for costs of services provided in a county hospital or 18 26 home, or in any private hospital or sanatorium, is also made 18 27 applicable to the state. 18 28 Code section 230.20, relating to billings to counties for 18 29 services provided at a state mental health institute and how 18 30 the billings are computed, is amended to repeal the subsections 18 31 involving the requirement for counties to be billed for 18 32 services provided at a state mental health institute and the 18 33 computation methodology. Subsections relating to crediting of 18 34 federal payment offsets and authorization for a state mental 18 35 health institute to provide other services are amended to 19 1 delete references to county liability for the cost of services. 19 2 Subsection 6, requiring the department to provide information 19 3 possessed by the department to a county, if such information 19 4 is not confidential under law, is modified to apply when the 19 5 county is obligated to pay for services provided outside a 19 6 state mental health institution or other inpatient setting. 19 7 Code section 331.424A, relating to the county mental health, 19 8 mental retardation, and developmental disabilities services 19 9 funds, is amended to prohibit the use of moneys in these funds 19 10 to pay for the costs of placement, treatment, or other service 19 11 ordered by a court under Code chapter 812. This Code chapter 19 12 relates to the confinement of persons accused of a crime who 19 13 may be incompetent to stand trial. 19 14 The following Code sections are repealed by the division: 19 15 section 230.2, relating to finding of legal settlement; section 19 16 230.3, relating to certification of legal settlement; section 19 17 230.4, relating to certification of legal settlement to a 19 18 debtor county; section 230.5, relating to state cases; section 19 19 230.6, relating to investigation of legal settlement by the 19 20 department; section 230.9, relating to changing a state case to 19 21 a county of legal settlement case; section 230.10, requiring 19 22 all legal costs and expenses relating to state hospital 19 23 placements to be charged to the county of legal settlement; 19 24 section 230.11, providing a standing appropriation to repay 19 25 counties for state cases; section 230.12, requiring the state 19 26 and counties to resolve legal settlement disputes using a 19 27 procedure in Code section 225C.8; section 230.20, providing for 19 28 computation of charges and billings to counties for services 19 29 provided at a state mental health institute; and section 19 30 230.22, relating to financial penalties for counties who pay 19 31 the billings late. 19 32 STATE RESOURCE CENTERS. This division provides for the 19 33 state to assume responsibility for the cost of services 19 34 provided at the state resource centers and the costs of 19 35 court=ordered commitments effective July 1, 2012. Current 20 1 law requires counties to pay capped per diem rates for the 20 2 services. Code chapter 222, relating generally to persons with 20 3 mental retardation and the state resource centers specifically, 20 4 is amended. 20 5 References to county responsibility for the cost of services 20 6 at the state resource centers, court=ordered commitments, and 20 7 county of legal settlement determinations are changed to the 20 8 state, revised, or deleted throughout the chapter. Counties 20 9 retain current responsibility for services provided to adults 20 10 with mental retardation outside the state resource centers. 20 11 The change in legal settlement processes and the shift 20 12 in responsibilities involving the state resource centers 20 13 and court=ordered commitments are specifically addressed in 20 14 the following Code sections: section 222.13, relating to 20 15 voluntary admissions of adults; section 222.13A, relating to 20 16 voluntary admissions of children; section 222.31, relating to 20 17 liability of charges for commitments to placements; section 20 18 222.49, relating to responsibility for the costs of commitment 20 19 proceedings; section 222.50, relating to the county of legal 20 20 settlement's responsibilities for service costs; section 20 21 222.60, relating to state and county responsibilities for 20 22 service costs; section 222.63, relating to certifications 20 23 between counties regarding legal settlement determinations; 20 24 section 222.70, relating to resolution of legal settlement 20 25 disputes; section 222.64, relating to state case legal 20 26 settlement determinations; section 222.70, relating to 20 27 resolution of legal settlement disputes; section 222.78, 20 28 relating to the responsibility of parents and others liable for 20 29 the support of persons placed at a resource center; section 20 30 222.79, relating to state certification of resource center 20 31 cost statements; section 222.86, relating to care payments 20 32 from a special patient fund; and section 222.92, relating to 20 33 the operation of the resource centers using a net general fund 20 34 appropriation. 20 35 The following Code sections are repealed by the division: 21 1 sections 222.61, 222.62, 222.65, 222.67, 222.68, and 222.69, 21 2 relating to legal settlement determinations, investigations, 21 3 charges, and payments; and sections 222.73, 222.74, and 222.75, 21 4 providing for computation of charges and billings to counties 21 5 for services provided at a state resource center and financial 21 6 penalties for counties who pay the billings late. 21 7 LEGISLATIVE INTENT AND EFFECTIVE DATES. This division 21 8 states legislative intent as to the change in responsibilities 21 9 between the state and counties and requires the department 21 10 of human services to work with representatives designated by 21 11 the Iowa state association of counties, service providers, 21 12 and service consumers and advocates to develop plans to 21 13 implement the bill and intent expressed, including formulating 21 14 recommendations for statutory changes, funding provisions, and 21 15 other measures. The department is also required to address 21 16 implementation of a subacute level of care for children and 21 17 adults with behavioral and mental health needs. The department 21 18 is required to report the plans and recommendations to the 21 19 governor and general assembly on or before December 15, 2011. 21 20 The office of the citizens' aide is required to review and make 21 21 recommendations regarding the appropriate role, funding, and 21 22 administrative entity for mental health advocates generally 21 23 appointed by the courts and funded by counties. This provision 21 24 takes effect upon enactment and the remainder of the bill takes 21 25 effect July 1, 2012. 21 26 The bill amends numerous Code provisions and other 21 27 amendments of related provisions will be necessary to fully 21 28 implement this bill. LSB 2160YH (9) 84 jp/nh
Text: HF477            Text: HF479 Complete Bill History