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Friday, Apr. 29, 2016

Supervisors get updated on Mental Health Redesign

Friday, April 6, 2012

Cherokee County Community Services Director Lisa Langlitz gave a program update to the Cherokee County Board of Supervisors on Tuesday.

At issue is the State of Iowa's Mental Health Redesign. Langlitz told the Board that she is still waiting to see what the State will be doing on the issue.

She presented the Board with Iowa Senate File 2315, which is the main mental health redesign bill currently being considered. The bill implements much of the work done last summer and fall by work groups set by the Department of Human Services (DHS) and the legislative interim committee.

Beginning in FY 2014, Iowa's mental health and disability services system would be change by the following actions:

* Transforming the management structure for mental health services from a county-based system to regions.

* Revising the basis for determining financial responsibility from the rule of legal settlement to a determination of residency.

* Establishing core services that will be available throughout the entire state.

The Senate File also defines the State's roll in specifies core services and service management requirements applicable to a regional service system and addresses responsibilities of the DHS in the new system. Some of the major changes include:

* Requiring the DHS to plan, collect, and analyze data as necessary to issue cost estimates for serving additional populations and providing core disability services statewide.

* Requiring the DHS to cover core service domains under Medicaid to the greatest extent allowable under federal regulations. This provision is subject to available appropriations.

* Requires the State Mental Health Institutes to address the needs of individuals with co-occurring conditions.

* Sets income guidelines for services at 150.0 percent of the federal poverty level (FPL) with no co-pay, a co-pay or sliding fee scale for persons with incomes that exceed 150.0 percent of the FPL.

* Specifies a set of new core service domains for Mental Health and Intellectual Disabilities not covered under the Medicaid Program and adds a new set of services (core plus) that may be provided when funding becomes available.

The Senate File also establishes a Mental Health and Disability Services Workforce Development Workgroup. The Workgroup is to address issues connected with assuring there is adequate workforce to provide mental health and disability services in the State. The bill also establishes an Outcomes and Performance Measures Committee for the regional service system. The Committee is to provide recommendations regarding outcomes and performance measures that are consistent across the MH/DS population and review data requirements that could be eliminated or revised due to low relevance to outcomes.

The Senate File also requires the DHS, the Department of Inspections and Appeals, and the Department of Public Health to work together to review and improve regulatory requirements applied to MH/DS administration and providers.

The Bill creates a regional structure for the MH/DS system. The regional structure will be based on a 28E agreement between the counties in the region. A 28E agreement is an agreement between two or more political subdivisions that allows the parties to take on an activity jointly. Some of the major decisions that will be included in the agreement are:

* Regional governance structure.

* Regional finances.

* Regional governance agreements.

The Senate File lay out a timeline for the process of counties joining into regions. All regions are to be formed and begin to organize by July 1, 2013, regions must meet the formation criteria by Dec. 31, 2013 and regions must meet the implementation criteria by June 20, 2014 (House amendment will change to this date).

With the House amendment, counties will be given the option to continue functioning on their own if they choose. They would still be required to meet the service and administrative requirements set for regions. But if a county can do this and wishes to remain on their own, they would be allowed to do so.

All counties would be required to meet certain standards, set by the state. These include:

* Requires financial information submitted to the State by a county to segregate expenditures for purchase of service, administration, and enterprise cost.

* Requires counties to begin using a standardized functional assessment to determine services.

Senate File 2315 also eliminates country of legal settlement and implements county of residence as the determination of financial responsibility.

The State would bear the responsibility of paying the cost of services eligible for Medicaid funding. Regions or individual counties would be responsible for paying non-Medicaid services, with possible support from the state.

Cherokee County has been exploring into entering a regional governance structure with 10 northwest Iowa Counties.

Langlitz also stated to the Board that whatever the changes are going to be, that it may cause cuts in budget and services.

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