FISCAL YEAR 2015 HEALTH AND HUMAN SERVICES BUDGET

Bill: HF 2463 Committee: Appropriations Date: April 8, 2014 Floor Manager: Representative Dave Heaton Staff: Carrie Kobrinetz (5-2063) FISCAL YEAR 2015 HEALTH AND HUMAN SERVICES BUDGET The House bill appropriates a total of $1,858.4 million from the General Fund to the Department on Aging (IDA), the Department of Public Health (DPH), the Department of Human Services (DHS), the Department of Veterans Affairs (IVA), and the Iowa Veterans Home (IVH). This is an increase of $107.4 million and a decrease of 77.2 FTE positions compared to estimated FY 2014. Summary of Action House HHS Budget Subcommittee Passed HSB 685 on April 2 (5-4). House Appropriations Committee Passed HSB 685 on April 3 (14-11). DIVISION I DEPARTMENT ON AGING SECTION 1 - Department on Aging $10,606,066 $10,931,066 $10,606,066 0 This section allows the Department on Aging to provide citizens of Iowa who are 60 years of age and older with case management, adult day services, respite care, and for salaries, support, and administration. The Department on Aging appropriates $10.6 million and 28 FTE positions. This is no change in funding and an increase of 2.9 FTE positions compared to FY 2014. DIVISION II OFFICE OF LONG-TERM CARE OMBUDSMAN SECTION 2 Office of Long-Term Care Ombudsman

$1,021,707 $929,315 $821,707-200,000 The decrease of $200,000 reflects the Governor s veto of two additional Long-Term Care Ombudsmen from the FY 2014 budget. DIVISION III DEPARTMENT OF PUBLIC HEALTH SECTION 3 - Department of Public Health $58,030,568 $58,973,924 $58,696,686 $666,118 Addictive Disorders $27,163,690 $27,088,690 $27,088,690-75,000 This budget unit provides funding for services directed toward reducing the use of tobacco, alcohol and other drugs, and treating Iowans with addictive disorders. This is a decrease of $75,000 compared to FY 2014. The House concurred with the Governor s proposed decreases. Changes include: A decrease of $50,000 for tobacco social media funding. A decrease of $25,000 for tobacco education materials. Healthy Children and Families $3,653,559 $3,628,559 $3,671,602 $18,043 This budget unit provides funding for programs that promote the health status of children and adults. Among the services funded by this area is the Healthy Opportunities to Experience Success (HOPES) program, assistance for voluntary dental care, childhood obesity prevention, and audiology services to children. This is a net increase of $18,043 compared to FY 2014. Changes include: An increase of $43,043 for a donated dental services program for elderly and disabled people. A decrease of $25,000 to the Audiological Services for Kids Program. Chronic Conditions $5,080,692 $5,040,692 $5,040,692-40,000 This budget unit funds activities and services that are provided to Iowans suffering from chronic conditions or special health care needs. This includes money for the child health specialty clinics, comprehensive cancer control, and cervical and colon cancer screening. This is a reduction of $40,000. Changes include: A decrease of $40,000 for the Medical Home Advisory Council. This council is charged with developing and implementing a prevention and chronic care management state initiative. Their base allocation is $175,263. 2

Community Capacity $8,562,617 $9,562,617 $9,192,336 $629,719 This budget unit funds activities by the Department of Public Health that are designed to strengthen the local public health system. Community Capacity has a net increase of $629,719 compared to FY 2014. Changes include: An increase of $293 for the FIND program. This program provides dental education. An increase of $7,900 due to the passage of House File 2378. This bill created a provisional license in psychology. A decrease of $378,474 to eliminate the allocation for free clinics to assist patients in finding an appropriate medical home. An increase of $1,000,000 for the Medical Residency Training Program. This program is a $2 million initiative that was started last year by Governor Branstad. He requested an additional $1 million for the program this year that the House agreed to. Healthy Aging $7,297,142 $7,297,142 $7,297,142 $0 The budget unit funds activities and services provided to persons over the age of 55 which are intended to optimize the health status of Iowa seniors. The budget unit is funded at the FY 2014 level. Environmental Hazards $803,870 $803,870 $853,870 $50,000 The budget unit funds activities intended to reduce exposure to hazards in the environment, primarily chemical hazards. Changes include: An increase of $50,000 for community water fluoride education. This is a new allocation. Infectious Diseases $1,335,155 $1,335,155 $1,335,155 $0 The budget unit funds state activities designed to reduce the incidence of communicable diseases. The budget unit is funded at the FY 2014 level. Public Protection $3,278,771 $3,297,127 $3,297,127 $18,356 3

The public protection budget unit funds activities related to protecting public health and safety through the establishment of standards and enforcement of regulations. This is a net increase of $18,356 compared to FY 2014. Changes include: A decrease of $28,644 due to the Governor s veto of the EMS task force in SF 446. A decrease of $28,000 due to one-time funding in FY 2014 for transitioning the licensing of orthotists, prosthetists, and pedorthists to a fee-supported model. An increase of $75,000 for an EMS BIS trauma assessment. Allocates $598,751 for the Poison Control Center. This is the same amount of money they received last year. However, the bill instructs DHS to implement a new initiative under CHIP to provide funding for the Center. This will allow the Center to transfer as much of their state funding as needed to draw down federal funds. It is projected this will raise the Poison Control Center appropriation to $1.2 million total state and federal funds for FY 2015. Resource Management $855,072 $920,072 $920,072 $65,000 This budget unit prohibits the UIHC from receiving indirect cost reimbursement from General Fund appropriations to DPH. It also requires the UIHC to submit billings to the DPH on a quarterly basis each year. This is an increase of $65,000 from FY 2014. Changes include: $65,000 is allocated to Emergency Medical Services software maintenance. SECTION 4 - Department of Veterans Affairs DIVISION IV VETERANS AFFAIRS $11,280,947 $12,180,947 $12,180,947 $900,000 General Administration $1,095,951 $1,095,951 $1,095,951 $0 This budget unit goes toward salaries, support, and maintenance of the Department of Veterans Affairs. There is no change compared to FY 2014. Iowa Veterans Home $7,594,996 $7,594,996 $7,594,996 $0 The section provides funding for the operation of the Iowa Veterans Home, which operates on net budgeting. Thus, the appropriation provides only the state funds required to operate the facility. There is no change compared to FY 2014. 4

Home Ownership Assistance Program $1,600,000 $2,500,000 $2,500,000 $900,000 The section funds the Home Ownership Assistance Program for veterans. This is an increase of $900,000 compared to FY 2014. The Governor requested this increase in his budget and the House bill concurs. SECTION 5 Limitation of County Commission of Veterans Affairs Fund Standing Appropriation $990,000 $990,000 $990,000 $0 The section provides county veteran programs with a matching grant. This year, the funding for the grant is $10,000 per county, which is same as the FY 2015 level. The money must be used for the administration and maintenance of the County Commission of Veterans Affairs office. The funds are used for office supplies, office rent, personnel, and state and national training. DIVISION V DEPARTMENT OF HUMAN SERVICES SECTION 6 - Temporary Assistance for Needy Families Block Grant - This section appropriates the TANF money received by the state and unused TANF funds from previous years. TANF is a federal block grant that allows states flexibility in using funds to: help needy families care for children, end dependence on public benefits by promoting work, reduce out-of-wedlock pregnancies, and encourage the formation of two parent families. Iowa s federal grant remains the same each year: $131,524,959. The allocations for FY 2015 are: TANF Allocation Amount Family Investment Program Account $9,879,488 PROMISE JOBS $11,091,911 Family Development and Self-Sufficiency (FaDSS) $2,898,980 Field Operations $31,296,232 General Administration $3,744,000 State Child Care Assistance $34,947,110 Mental Health and Disability Services State Cases $4,894,052 Child and Family Services $32,084,430 Child Abuse Prevention $125,000 Pregnancy Prevention grants $1,930,067 TANF Technology grants $1,037,186 Integrated eligibility determination system (FIP) $6,549,549 SECTION 7 - Family Investment Program Account 5

This section describes how funds deposited in the Family Investment Program (FIP) account will be allocated and disbursed by the Department of Human Services. The Family Investment Program (FIP) is Iowa's TANF program. SECTION 8 - Family Investment Program General Fund $48,503,875 $48,503,875 $48,503,875 $0 Iowa s Family Investment Program is a cash assistance program to support low income families with children and to provide services for them to become self-sufficient. The FIP appropriation funds the Promise Jobs Program, the Family Self-Sufficiency Grant, and FaDSS. There is no net change compared to FY 2014. Notable changes include: An increase of $3,502,157 for FIP to shift funding to the General Fund. An increase of $774,528 for Promise Jobs to shift additional funding to the General Fund. An increase of $422,157 for operational and maintenance costs for a new eligibility system. A decrease of $1,196,685 due to a reduction in Promise Jobs caseloads. A decrease of $3,502,157 due to a reduction of FIP caseloads. SECTION 9 - Child Support Recovery $14,215,081 $14,911,230 $14,911,230 $696,149 The section funds child support enforcement efforts in Iowa. This is an increase of $696,149 compared to FY 2014. Changes include: An increase of $483,963 to replace lost federal incentives and other one-time funding. An increase of $212,186 due to increased costs of service. SECTION 10 Health Care Trust Fund Medical Assistance This section states that funds deposited in the Health Care Trust Fund for FY 2015 will be appropriated to DHS to supplement the Medicaid appropriations. SECTION 11 Medicaid Reimbursement Medical Assistance $1,484,193,203 $1,595,141,383 $1,5894,676,229 $110,483,026 The chart below shows Iowa Medicaid enrollment and spending by enrollment category: 6

Medical Assistance provides medically necessary healthcare coverage for financially needy parents with children, children, people with disabilities, elderly people, and pregnant women. Notable changes include: An increase of $4,847,559 to reduce the number of people on the HCBS Waiver waiting list. An increase of $35,139,094 to replace federal funds due to a reduction in the FMAP rate. An increase of $38,192,881 to replace a funding shortfall in FY 2014. An increase of $16,191,074 to replace one-time and expiring revenue sources. An increase of $13,366,589 due to program growth for mental health services, enrollment, and FMAP. An increase of $7,385,771 to replace Carryforward from FY 2014. An increase of $252,000 due to an increase in eligibility for Miller Trusts. A decrease of $8,715,473 to reflect the Governor s veto of the HCBS waiver waiting list buydown in FY 2014. This section also includes the same abortion language that was in the HHS bill for FY 2014 (Medicaid reimbursement for abortions must be approved by the Governor s office). SECTION 12 Cost Containment This section prohibits DHS from implementing the cost containment strategy from last year that requires Consumer Directed Attendant Care providers to transition to agency provided personal care services. SECTION 13 Cost Containment Report This section requires DHS to report on the implementation of the cost containment strategies on a quarterly basis to LSA and DOM. SECTION 14 This section adds the following language to the bill: Specifies that the $4.8 million that will buy down the HCBS waiver waiting list will add an equal number of waiver waiting list slots to each waiver. Requires DHS to perform an analysis of the Medicaid pharmacy benefit in the managed care organization plan for Medicaid members. SECTION 15 - Medical Contracts $12,320,048 $16,323,366 $17,323,366 $5,003,318 7

This provides the money for DHS to contract out with several entities to carry out programs to support the Medicaid program. Staff performs policy functions; they also manage Medicaid vendors to assure member access, cost effectiveness, and value. This is an increase of $5,003,318 compared to FY 2014. Notable changes include: An increase of $1,597,515 due to increased administrative costs of the Iowa Health and Wellness Plan. An increase of $1,223,367 due to increased IT costs. An increase of $1,000,000 for the Autism Treatment Program. The Autism Treatment Program was created last year to provide payment for Applied Behavioral Analysis treatment for eligible children. SECTION 16 - State Supplementary Assistance $16,516,858 $14,121,154 $14,121,154 $-2,395,704 State Supplementary Assistance helps low-income elderly or disabled Iowans meet basic needs and reduces state spending for Medicaid. Changes include: A $2.3 million decrease due to lower caseloads. SECTION 17 - Children s Health Insurance Program (CHIP) $36,817,261 $45,877,998 $45,877,998 $9,060,737 This section appropriates money for the Healthy and Well Kids in Iowa (HAWK-i) program. Notable changes include: An increase of $3,063,803 due to caseload growth. An increase of $1,482,307 due to increases in premiums. An increase of $1,433,789 due to a decrease in the federal FMAP rate. SECTION 18 - Child Care Assistance $62,735,563 $57,925,206 $45,622,828 $-17,112,735 The Child Care Assistance program supports low income families with working parents, parents gaining working skills, or parents going to school. In addition to paying for child care, this appropriation supports the regulation of child care providers. Because of the federal budget deal passed earlier this year, sequester cuts to the Child Care Block Grant were restored, providing the state with additional federal funds. Notable changes include: A decrease of $5,302,378 due to carryforward for projected FY 2014 unused funds A decrease of $2,866,414 due to available federal surplus funds in FY 2014. SECTION 19 - Juvenile Institutions State Training School at Eldora $11,268,202 $11,500,098 $11,500,098 $231,896 8

The State Training School at Eldora provides treatment and educational services to assist youth who are adjudicated delinquent. Changes include: An increase to meet new federal sexual harassment and abuse prevention standards. Cost increases. Iowa Juvenile Home at Toledo $8,867,121 $788,531 $788,531 $-8,078,590 Prior to its closure, the Iowa Juvenile Home and the State Training School for Girls at Toledo provided treatment and educational services within a structured setting to assist girls who are adjudicated delinquent and children in need of assistance (CINA). This is a decrease of $8,078,590 compared to FY 2014. However, some of this money will still remain in the system. These children will still receive almost $4 million for placements (see section 20 below). Changes include: A decrease of $8,859,355 and 99 FTE positions to close the facility. An increase of $780,765 to maintain the facility grounds, security, maintenance, and utilities. SECTION 20 Children Adjudicated as Delinquent or CINA Iowa Juvenile Home $0 $5,110,534 $5,110,534 5,110,534 This is a new appropriation for FY 2015 as a result of the closure of the Iowa Juvenile Home. Changes include: An increase of $3,892,534 for placements of female children adjudicated as delinquent and male and female CINA children. An increase of $1,218,000 for compensatory education of children placed at IJH from October 7 through December 20, 2013. This is a one-time appropriation, not an annual appropriation. The bill language also requires DHS to submit a report to the Governor and LSA concerning the status of juvenile delinquent girls in out-of-home placements. The report must include placement history, education, treatment, and recommendations for legislation. SECTION 21 - Child and Family Services $91,329,427 $91,762,511 $95,920,906 $4,591,479 The section appropriates money for various child welfare and juvenile justice programs. Notable changes include: An increase of $4,158,395 to bring group foster care providers to the 80% equalization rate. Group foster care reimbursement rates had not been rebased since the mid-1990s. This money will help to equalize the rates across all three levels of care. No facilities will have their rates decrease as a result of this proposal. an increase of $433,084 due to the reduction in Iowa s federal FMAP rate. A decrease of $250,000 to the Circle of Care grant. This money was a duplication because of the new Integrated Health Home program in DHS. 9

SECTION 22 - Adoption Subsidy $40,729,282 $42,580,749 $42,580,749 $1,851,467 This section provides the FY 2015 funding for the subsidized adoption program. The increase is due to caseload growth and a reduction in FMAP. SECTION 23 - Family Support Subsidy Program $1,093,288 $1,079,739 $1,079,739 $-13,549 This program helps keep families together by defraying some of the special costs of caring at home for a child with disabilities. The decrease includes a reduction in expenses because children are aging out of the program. SECTION 24 - Conner Decree The section states that the Department of Human Services is to provide training in accord with the consent decree in Conner v. Branstad. The money is used for building community capacity. The appropriation is the same as last year. SECTION 25 - Mental Health Institutes This section sets out the funding for the state s four mental health institutes. All facilities received an increase due to higher costs of food, pharmaceuticals, transportation, and utilities. Cherokee Mental Health Institute $5,964,737 $6,031,934 $6,031,934 $67,197 Clarinda Mental Health Institute $6,757,689 $6,787,309 $6,787,309 $29,620 Independence Mental Health Institute $10,334,082 $10,484,386 $10,484,386 $150,304 Mount Pleasant Mental Health Institute $1,374,061 $1,417,796 $1,417,796 $43,735 SECTION 26 - State Resource Centers 10

The section appropriates money to the State Resources Centers in Glenwood and Woodward. Additional funds are provided to cover the reduction in the federal FMAP rate. Glenwood State Resource Center $20,349,122 $21,695,266 $21,695,266 $1,346,144 Woodward State Resource Center $14,286,191 $14,855,693 $14,855,693 $569,502 SECTION 27 - Sexually Violent Predators $9,425,568 $9,923,563 $9,923,563 $497,995 The section makes the FY 2015 appropriation to the Civil Commitment Unit for Sexual Offenders. Notable changes include: An increase of $312,469 for five additional court-ordered sex offenders. An increase of 8 FTE positions to staff the increase in offenders. SECTION 28 - Field Operations $66,670,976 $66,670,976 $66,670,976 $0 The section sets the FY 2015 appropriation for local DHS offices and service area offices. There is no change. SECTION 29 - General Administration $16,329,602 $16,079,602 $16,304,602 $-25,000 This section funds the central office activities of DHS. The section provides that any funds not spent shall be carried forward for use in FY 2015. The reduction is due to the elimination of a one-time Prevention of Disabilities Council. SECTION 30 Volunteers The section sets the FY 2015 appropriation at $84,686 for the development and coordination of volunteer services, which is the same as FY 2014. SECTION 31 Reimbursement Rates for Nursing Homes This section sets forth the reimbursement rates for DHS service providers in FY 2015. The section establishes the expenditure cap for Medicaid nursing home services and instructs the Department to undertake nursing facility case-mix rebasing within this amount. There is no additional funding for nursing home reimbursement rates in this bill. 11

SECTION 32 Pharmacy Dispensing This section adds language requested by DHS. The federal formula for calculating dispensing fees is changing. This language ensures that dispensing fees will not be increased. The change is budget neutral. SECTION 33 This is a technical change. It removes the current Community Mental Health Center (CMHC) language from the bill (new language is inserted in the next section). SECTION 34 Community Mental Health Centers This language allows CMHCs to choose between two methods of reimbursement. This was formerly a bill that passed the Human Resources committee this year. SECTION 35 This is a technical change. It removes the current foster care group rate language from the bill (new language is inserted in the next section). SECTION 36 Foster Care Group Rate This section allows group foster care providers to receive the weighted state-wide 80% average equalization rate increase for FY 2015. The current rates have not been changed since the mid-1990s. SECTION 37 ICF/ID This section requires DHS to calculate reimbursement rates for Intermediate Care Facilities for persons with Intellectual Disabilities (ICF/ID) at the 80 th percentile using the Consumer Price Index. SECTION 38 Emergency Rules This section permits DHS and the Mental Health and Disabilities Services Commission to adopt emergency rules. SECTION 39 Reports This section requires all reports to be submitted to the Chairs and Ranking Members of the HHS Budget Subcomittee. DIVISION VI HEALTH CARE ACCOUNTS AND FUNDS SECTION 40 Pharmaceutical Settlement Account The section appropriates the funds received in the pharmaceutical settlement account to the Department of Human Services for the Medical Contracts line item. This year s amount is $5,467,564. SECTION 41 Quality Assurance Trust Fund For FY 2015, $29,195,653 will be appropriated from the quality assurance trust fund to DHS for Medicaid. DIVISION VII PERSONNEL SETTLEMENT AGREEMENTS SECTION 42 Personnel Settlement Agreement Payments 12

As a condition of the appropriations in this Act, the money appropriated and any other moneys available shall not be used for payment of a personnel settlement agreement that contains a confidentiality provision intended to prevent public disclosure of the agreement. DIVISION VIII PRIOR YEAR APPROPRIATIONS SECTION 43 Medical Residency This section allows IDPH to use the medical residency training program. It specifies that the grants for new medical residency positions, psychiatric residency positions, and family practice positions have priority. SECTION 44 Cost Containment Repeal This section strikes the cost containment strategy from last year. SECTION 45 Autism This section permits DHS to carryforward any unspent funding for the Autism Treatment Program to FY 2015. SECTION 46 Foster Care Respite This language permits DHS to carryforward any unspent funding from the Iowa Foster Care Respite Pilot Program. SECTION 47 Community MH Center Reimbursement This section strikes CMHC from the reimbursement paragraph. This is a technical change. SECTION 48 Community MH Center Reimbursement This section allows CMHCs to choose between two different methods for reimbursement. SECTION 49 Emergency Rules This section allows DHS to adopt emergency rules to implement the changes in reimbursement for CMHCs. SECTION 50 Effective Upon Enactment This Division that makes changes to the medical residency program, CDAC, autism, foster care respite, and CMHC reimbursement takes effect upon enactment. SECTION 51 Retroactive Applicability The sections relating to CDAC are retroactive to July 1, 2013. SECTION 52 Retroactive Applicability The sections relating to CMHC reimbursement are retroactive to July 1, 2013. DIVISION IX Mental Health and Disability Services SECTION 53 This section provides a FY 2015 GF appropriation to the Property Tax Relief Fund for MHDS equalization payments to counties. This is an increase from last year of $735,345 because of population growth. 13

SECTION 54 State Program Remittance Appropriation This program was to pay for individuals without a county of legal settlement. County of legal settlement has been eliminated and payment is now based on county of residence. This section allocates funding that was previously appropriated to counties. SECTION 55 Vocational Rehabilitation Services Employment This section requires DHS and the Department of Education Vocational Rehabilitation Division to jointly develop protocols and program models to integrate employment services for persons with disabilities through a federal matching fund. The two agencies are to report to LSA and the General Assembly by December 15, 2014. SECTION 56 Bed Availability Tracking System This section requires DHS to expand on a study they did regarding a hospital bed tracking system for psychiatric and substance related placements. SECTION 57 Study of Community-Based Service Options for Persons with Serious Mental Illness This section requires DHS to assemble a group to study community-based placement options for persons with serious mental illness to divert them from being placed in an institution. SECTION 58 This section amends the population definition used to distribute the MHDS equalization payment. SECTION 59 This requires a region to reserve 25% of funds needed to meet projected expenditures if the region is meeting all obligations of their management plan. Any residual funding can be used to expand core services. SECTION 60 This section revises the core services language regarding work activity, by encouraging counties to provide opportunities for employment activities that are an appropriate match with the client s abilities. SECTION 61 This section specifies that county cash reserves are not to exceed 25% of their expenditures. SECTION 62 This section extends the MHDS equalization payment through FY 2016. SECTION 63 Medicaid Offset This section makes changes to the Medicaid offset (or clawback ) of savings due to the shift of funding from the counties to the new Iowa Health and Wellness Plan. Changes include: Requires rules for the offset to include the amount expended by the counties for specific services and support services. The Medicaid offset amounts calculated for the counties are subject to review by the Auditor of State before they can be certified. The offset amount is to be certified by and submitted to the Governor and Legislature every year by December 1. Requires the offset amount certified in FY 2014 to be based on actual expenditures for the second half of the fiscal year subtracted from the actual expenditures from the first half of the fiscal year. SECTION 64 Property Tax Relief Fund 14

This section allows up to $600,000 to be used by DHS for distribution to counties for state case services. this continues current practice. DIVISION X Family Supplementation SECTION 65 This section lowers the nursing facility occupancy rate to 50% to allow families to supplement Medicaid money to allow their loved one to have a private room. DIVISION XI Miscellaneous SECTION 66 Office Space in County This section requires DHS to report annually to the Auditor detailing their costs for office space and supplies. The idea behind this change is to not have the counties spending money on items they do not need each year. SECTION 67 Early Childhood Iowa Boards Currently, ECI Board members are prohibited from providing services to or for the area board. This section requires the state board to adopt criteria to allow for waivers of this restriction. DIVISION XII Medicaid Asset Verification SECTION 68 Medicaid Asset Verification This section requires DHS to contract with a third party vendor to establish an electronic asset, income, and identity eligibility verification system. This will cost money in FY 2015 but cost savings will begin in the second year. This bill passed the House but failed to pass in the Senate. SECTION 69 Effective Upon Enactment This section makes Medicaid asset verification effective upon enactment. DIVISION XIII Interdepartmental Coordination - Individuals Released from Correctional System SECTION 70 Individuals Release from the Correctional System This section requires DHS, DPH, and DOC to implement an interagency collaborative effort to provide an integrated approach to address the medical and psychosocial needs of people released from correctional facilities. The Departments will submit a report to the Legislature. SECTION 71 Definitions DIVISION XIV Departmental Responsibility for Mental Health Advocates 15

This section establishes a new division of mental health advocates in DIA and specifies the duties of the administrator of the office. The bill provides $250,000 for FY 2015. SECTION 72 Duties of Administrator This section specifies the duties of the administrator of the program. Duties will include: Approving the appointment of persons to serve as advocates They must meet the qualifications to be a mental health advocate (bachelor s degree in social work, counseling, human services, health, nursing, or psychology and one year of experience in the provision of mental health services). Contracting with the state board of regents to employ persons appointed to serve as mental health advocates. Training persons appointed to serve as mental health advocates. SECTION 73 Transition This section allows DIA to adopt emergency rules to implement this program. DIVISION XV Implementation - Mental Health Advocates SECTION 74 - Implementation This section adds mental health advocates to the chapter on Mental Health and Disabilities Services in the Code. The administrator shall provide consultation and technical assistance to mental health advocates in cooperation with the Department of Corrections and DIA. SECTION 75 - Examination by Court - Notice This section requires notice to also be served to the Mental Health Advocate for the patient prior to any proceedings. SECTION 76 - Hospitalization of Persons with Mental Illness-Application for Voluntary Admission-Authority to Receive Voluntary Patients Upon approval of the admission of a minor, the juvenile court shall appoint an individual to act as an advocate representing the interests of the minor in the same manner as a mental health advocate. SECTION 77 - Mental Health Advocate Informed Hearings The court is responsible for directing the clerk to furnish the mental health advocate designated for the court by DIA with a copy of application and any orders issued. The Mental Health Advocate may attend any hearing involving the respondent. SECTION 78 - Hearing Procedure All persons not necessary for the hearing shall be excluded. The Mental Health Advocate will be allowed in court proceedings even when others are excluded. SECTION 79 - Placement Order-Notice and Hearing Adds Mental Health Advocates to the list of persons who are given notice of placement. SECTION 80 This is a technical change. SECTION 81 - Periodic Reports Required 16

A Copy of the court report must be provided to the Mental Health Advocate. SECTION 82 - Mental Health Advocates Duties The advocate s duties shall include: Review reports Advise Courts if an attorney is required for the case Be accessible to communications from the patient. Visit the person committed within 15 days Communicate with medical personnel File quarterly reports Utilize best practices for the duties SECTION 83 - Hospitalization of Persons with Mental Illness - Medical Records to be Confidential - Exceptions Mental Health Advocates appointed to a person can get their medical records. SECTION 84 - Appointment of Mental Health Advocates The person appointed to provide mental health advocate services before July 1, 2015 shall be appointed as a mental health advocate effective July 1, 2015. SECTION 85 - Effective Date This act takes effect July 1, 2015. DIVISION XVI Prior Authorization SECTION 86 - Effective Date - Prior Authorization for Prescription Drug Benefits - Standard Process and Form This section adds definitions to the Code Chapter that deals with the Insurance Division creating a standard process and form for prior authorizations. The bill adds definitions for facility, health plan benefit, health care professional, health care provider, health care services, health carrier, and pharmacy benefits manager to this section. The Insurance Commissioner shall develop, by rule, a standard prior authorization process and form for use by health carriers and pharmacy benefit managers that require prior authorization for prescription drug benefits pursuant to a health benefit plan by January 1, 2015. Before the development of this process, the Commissioner shall hold public hearings to gather input from stakeholders. The prior authorization process shall meet all of the following requirements: 1. Health carriers and pharmacy benefit managers shall allow electronic submission 2. Approval is valid for 180 days 3. The process should allow a health carrier to substitute for a generic drug 4. Information needs to be available on the health carrier and pharmacy benefits manager internet site 5. There shall be a process for health care providers to appeal a prior authorization determination If the pharmacy fails to use or accept the prior authorization form or to respond to the provider s request within 72 hours of submission of the form, the request for prior authorization shall be approved. If the prior authorization request is incomplete, the pharmacy may request the additional information within 72 hours. 17