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House
File
2220
-
Introduced
HOUSE
FILE
2220
BY
MOHR
and
A.
MEYER
A
BILL
FOR
An
Act
relating
to
mental
health
care,
including
subacute
1
mental
health
care
facility
requirements;
admission
to
and
2
discharge
from
a
subacute
mental
health
care
facility;
3
employment
requirements
at
a
subacute
mental
health
care
4
facility;
insurance
coverage
for
subacute
mental
health
5
care;
and
the
establishment
of
a
psychiatric
medical
6
institution
for
children
bed
tracking
system,
and
providing
7
penalties
and
including
effective
date
provisions.
8
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
9
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Section
1.
Section
135G.1,
Code
2026,
is
amended
by
adding
1
the
following
new
subsection:
2
NEW
SUBSECTION
.
3A.
“Health
carrier”
means
the
same
as
3
defined
in
section
514J.102.
4
Sec.
2.
Section
135G.1,
subsection
12,
paragraph
c,
Code
5
2026,
is
amended
by
striking
the
paragraph.
6
Sec.
3.
Section
135G.3,
Code
2026,
is
amended
to
read
as
7
follows:
8
135G.3
Nature
of
care
——
seclusion
room
——
admissions
——
9
discharge
.
10
1.
a.
A
subacute
care
facility
shall
utilize
a
team
of
11
professionals
to
direct
an
organized
program
of
diagnostic
12
services,
subacute
mental
health
services,
social
services,
13
and
rehabilitative
services
to
meet
the
needs
of
residents
14
in
accordance
with
a
treatment
care
plan
developed
for
each
15
resident
under
the
supervision
of
a
mental
health
professional.
16
b.
The
goal
of
a
treatment
care
plan
is
to
transition
17
residents
to
a
less
restrictive
environment,
including
a
18
home-based
community
setting.
Social
and
rehabilitative
19
services
shall
also
be
provided
under
the
direction
of
a
mental
20
health
professional.
21
c.
Within
twenty-four
hours
of
a
resident’s
admission
to
22
a
subacute
care
facility,
the
subacute
care
facility
shall
23
develop
a
written
treatment
care
plan
with
the
resident.
24
2.
a.
Prior
authorization
shall
not
be
required
for
an
25
individual’s
admission
to
a
subacute
care
facility
or
for
26
the
first
fifteen
consecutive
calendar
days
of
a
resident’s
27
treatment.
28
b.
Starting
from
a
resident’s
first
day
of
treatment,
on
or
29
after
a
resident’s
forty-fifth
consecutive
day
of
treatment,
30
a
managed
care
organization
may
review
the
medical
necessity
31
of
the
resident’s
treatment.
After
the
initial
review
of
a
32
resident’s
treatment,
a
managed
care
organization
may
only
33
review
the
medical
necessity
of
the
resident’s
treatment
a
34
maximum
of
one
time
within
any
consecutive
thirty-calendar-day
35
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period.
1
2.
3.
The
mental
health
professional
providing
supervision
2
of
the
subacute
care
facility’s
treatment
care
plans
shall
3
evaluate
the
condition
of
each
resident
as
medically
necessary
,
4
and
shall
be
available
to
residents
of
the
facility
on
an
5
on-call
basis
at
all
other
times.
Additional
evaluation
and
6
treatment
may
be
provided
by
a
mental
health
professional.
The
7
subacute
care
facility
may
employ
a
seclusion
room
meeting
the
8
conditions
described
in
42
C.F.R.
§483.364(b)
with
approval
9
of
a
licensed
psychiatrist
,
or
by
order
of
the
resident’s
10
physician,
a
physician
assistant,
or
an
advanced
registered
11
nurse
practitioner.
12
4.
A
managed
care
organization
shall
not
require
a
resident
13
to
be
discharged
from
a
subacute
care
facility
until
the
mental
14
health
professional
providing
supervision
of
the
resident’s
15
treatment
care
plan
has
determined
that
there
are
proper
16
supports
in
place
prior
to
the
resident’s
discharge
to
mitigate
17
the
risk
of
self-harm
by
the
resident,
or
harm
to
another
18
individual
by
the
resident.
19
5.
Pursuant
to
section
505.36,
a
health
carrier
shall
20
provide
coverage
for
subacute
mental
health
services
provided
21
by
a
subacute
care
facility.
22
Sec.
4.
NEW
SECTION
.
135H.9A
Bed
tracking
system.
23
The
department
of
health
and
human
services
shall
establish
24
an
electronic
system
to
track
the
availability
of
beds
at
each
25
psychiatric
medical
institution
for
children.
26
Sec.
5.
NEW
SECTION
.
505.36
Health
carriers
——
subacute
27
mental
health
care
services.
28
1.
For
purposes
of
this
section:
29
a.
“Health
carrier”
means
the
same
as
defined
in
section
30
514J.102.
31
b.
“Subacute
care
facility”
means
the
same
as
defined
in
32
section
135G.1.
33
c.
“Subacute
mental
health
services”
means
the
same
as
34
defined
in
section
135G.1.
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2.
A
health
carrier
shall
provide
coverage
for
subacute
1
mental
health
services
provided
by
a
subacute
care
facility.
A
2
health
carrier
that
violates
this
section
shall
be
subject
to
3
penalties
pursuant
to
section
505.7A.
4
Sec.
6.
DEPARTMENTS
OF
HEALTH
AND
HUMAN
SERVICES
AND
5
INSPECTIONS,
APPEALS,
AND
LICENSING
——
ADMINISTRATIVE
RULE
6
REVIEW.
The
department
of
health
and
human
services
and
7
the
department
of
inspections,
appeals,
and
licensing
shall
8
collaborate
to
review
each
department’s
administrative
rules
9
adopted
pursuant
to
section
135G.10
and
eliminate
any
rule
10
the
departments
determine
impedes
any
of
the
following
goals
11
without
providing
an
equal
or
greater
benefit:
12
1.
Establishment
of
new
subacute
mental
health
care
13
facilities
and
services.
14
2.
Expansion
of
existing
subacute
mental
health
care
15
facilities
and
services.
16
3.
Ease
of
access
to
subacute
mental
health
care
facilities
17
and
services.
18
Sec.
7.
DEPARTMENT
OF
INSPECTIONS,
APPEALS,
AND
LICENSING
19
——
SUBACUTE
MENTAL
HEALTH
CARE
FACILITIES
——
BED
CAPACITY
20
——
FACILITY
AND
EMPLOYEE
REQUIREMENTS.
The
department
of
21
inspections,
appeals,
and
licensing
shall
adopt
rules
pursuant
22
to
chapter
17A
to
do
the
following:
23
1.
Increase
the
maximum
number
of
beds
a
subacute
care
24
facility
may
have
without
the
subacute
care
facility
being
25
defined
as
a
state
mental
health
institute.
26
2.
Provide
that
requirements
applicable
to
a
subacute
27
mental
health
care
facility,
and
subacute
mental
health
28
care
facility
employees,
are
less
stringent
than
comparable
29
requirements
that
apply
to
a
state
mental
health
institute
or
a
30
state
mental
health
institute’s
employees.
31
Sec.
8.
EMERGENCY
RULES.
The
department
of
health
and
32
human
services
and
the
department
of
inspections,
appeals,
33
and
licensing
may
adopt
emergency
rules
under
section
17A.4,
34
subsection
3,
and
section
17A.5,
subsection
2,
paragraph
“b”,
35
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to
implement
the
provisions
of
this
Act
and
shall
submit
1
such
rules
to
the
administrative
rules
coordinator
and
2
the
administrative
code
editor
pursuant
to
section
17A.5,
3
subsection
1,
within
the
same
period.
The
rules
shall
be
4
effective
immediately
upon
filing
unless
a
later
date
is
5
specified
in
the
rules.
Any
rules
adopted
in
accordance
with
6
this
section
shall
also
be
published
as
a
notice
of
intended
7
action
as
provided
in
section
17A.4.
8
Sec.
9.
EFFECTIVE
DATE.
This
Act,
being
deemed
of
immediate
9
importance,
takes
effect
upon
enactment.
10
EXPLANATION
11
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
12
the
explanation’s
substance
by
the
members
of
the
general
assembly.
13
This
bill
relates
to
mental
health
care.
14
The
bill
eliminates
the
requirement
that
subacute
mental
15
health
care
(SMHC)
must
be
limited
to
a
period
of
10
calendar
16
days
unless
a
longer
period
of
time
is
adopted
by
the
17
department
of
health
and
human
services
(HHS).
18
The
bill
requires
an
SMHC
facility
to
develop
a
written
19
treatment
care
plan
with
a
resident
within
24
hours
of
the
20
resident’s
admission
to
the
SMHC
facility.
21
The
bill
prohibits
a
preauthorization
requirement
for
an
22
individual’s
admission
to
an
SMHC
facility
or
for
the
first
15
23
consecutive
calendar
days
of
a
resident’s
treatment.
Starting
24
from
the
date
of
a
resident’s
first
day
of
treatment,
on
or
25
after
a
resident’s
45th
consecutive
day
of
treatment,
a
managed
26
care
organization
(MCO)
may
review
the
medical
necessity
of
the
27
resident’s
treatment.
After
the
initial
review
of
a
resident’s
28
treatment,
an
MCO
may
only
review
the
medical
necessity
of
29
the
resident’s
treatment
a
maximum
of
one
time
within
any
30
consecutive
30-calendar-day
period.
31
The
bill
prohibits
an
MCO
from
requiring
a
resident’s
32
discharge
until
the
mental
health
professional
providing
33
supervision
of
the
resident’s
treatment
care
plan
has
34
determined
that
there
are
proper
supports
in
place
prior
to
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the
resident’s
discharge
to
mitigate
the
risk
of
the
patient
1
committing
self-harm
or
the
patient
harming
other
individuals.
2
The
bill
defines
“health
carrier”
and
requires
a
health
3
carrier
to
provide
coverage
for
SMHC
services
provided
by
an
4
SMHC
facility.
A
health
carrier
that
violates
the
bill
is
5
subject
to
a
civil
penalty
of
up
to
$1,000
for
each
violation
6
of
the
bill,
up
to
an
aggregate
of
$10,000,
unless
the
7
person
knew
or
reasonably
should
have
known
the
person
was
8
in
violation
of
the
bill,
in
which
case
the
penalty
is
up
to
9
$5,000
for
each
violation,
up
to
an
aggregate
of
$50,000
in
any
10
one
six-month
period.
11
The
bill
requires
HHS
to
establish
an
electronic
system
to
12
track
the
availability
of
beds
at
each
psychiatric
medical
13
institution
for
children.
14
The
bill
directs
HHS
and
the
department
of
inspections,
15
appeals,
and
licensing
(DIAL)
to
collaborate
to
review
each
16
department’s
rules
and
eliminate
any
rule
the
departments
17
determine
impedes
the
establishment
of
new
SMHC
facilities
and
18
services;
expansion
of
existing
SMHC
facilities
and
services;
19
or
ease
of
access
to
SMHC
facilities
and
services.
20
The
bill
directs
DIAL
to
adopt
rules
to
increase
the
maximum
21
number
of
beds
an
SMHC
facility
may
have
without
the
SMHC
22
facility
being
defined
as
a
state
mental
health
institute,
and
23
provide
that
requirements
applicable
to
an
SMHC
facility,
and
24
SMHC
facility
employees,
are
less
stringent
than
comparable
25
requirements
that
apply
to
a
state
mental
health
institute
or
a
26
state
mental
health
institute’s
employees.
27
The
bill
allows
HHS
and
DIAL
to
adopt
emergency
rules
to
28
implement
the
bill.
29
The
bill
takes
effect
upon
enactment.
30
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