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Lawmakers approve overhaul of Iowa’s mental health system. Here’s what it would do.
Iowa’s 32 mental health and substance use regions would be combined into seven behavioral health districts
Tom Barton
Apr. 18, 2024 3:08 pm, Updated: Apr. 19, 2024 9:30 am
DES MOINES — A plan to overhaul and combine Iowa’s delivery system for mental and behavioral health services — which advocates hope will improve access for patients — is headed to the governor to be signed into law.
Earlier this year, Gov. Kim Reynolds proposed streamlining and eliminating redundancies in Iowa’s mental health and addiction treatment programs.
House File 2673 passed the House, 88-8, after being amended by the Senate.
It combines Iowa’s 32 mental health and substance use regions into seven unified behavioral health districts.
“Iowa has made significant progress in behavioral health care in recent years, from expanding adult services to establishing the first children’s mental health system and increasing funding,” Reynolds said in a statement.
“But more must be done to align services, making it easier for Iowans to get the help they need and for providers to better coordinate their care. This legislation takes the next step to strengthen the system by aligning services statewide.”
The legislation states the new behavioral health services system shall provide equitable statewide access to all services and offer specialized services with a focus on at-risk populations. That includes children, young adults, individuals with disabilities, pregnant women, older Iowans and those with limited access to financial resources.
“I have worked on a variety of different pieces related to mental health and substance abuse for over my last 14 years here, and this is a great opportunity for the state of Iowa to be able to see these two worlds merged, and to have a system statewide that I believe will benefit Iowans in some pretty dramatic ways,” said Rep. Joel Fry, R-Osceola, the bill’s floor manager.
Some worry the proposal does not go far enough to address underlying issues that hinder access to treatment and services in the state, including lowa Medicaid reimbursement rates.
Questions remain
Mental health and substance abuse advocates also have requested more details as to how services such as mental health access centers — like those in Linn and Johnson counties — would be affected. The centers provide care and a place where adults experiencing a mental health or substance use disorder crisis can go or be brought by police, rather than going to an emergency room or to jail.
Numerous groups were registered undecided on the bill. The National Alliance on Mental Illness of Iowa and Iowa Mental Health Advocacy were registered in support.
"Change can yield good things, but with change always comes challenges. And there are still a lot of unanswered questions,“ said Sen. Sarah Trone-Garriott, a Democrat from Waukee.
“What will the final map of regions look like? … Will rural areas be able to hold onto their services in their area? Or will all resources, all attention and all people in need be driven to metro areas?”
She also questioned what steps would be taken to keep people “from falling through the cracks” during the transition.
“I still have these concerns, while knowing that there is good that can come from this legislation,” Trone-Garriott said. “And the biggest concern of all that I have is that we are rearranging but once again not investing the resources that Iowans clearly need. There is no new money for mental health.”
What would the bill do?
The state would contract with local administrative service organizations to carry out their services in each of the seven behavioral health districts. The state would solicit proposals from existing agencies that oversee mental health regions, or another public or nonprofit entity in the district, to administer the seven new regions.
Lawmakers amended the bill by striking House language that would have allowed for-profit groups to serve as the governing entity for a district. Only public or private nonprofits would be selected.
The bill specifies the new behavioral health districts be created on or before Aug. 1, and organizations selected by Dec. 31 to administer services.
The districts would handle prevention, education, early intervention, treatment, recovery and crisis services related to both mental health and substance use disorders. Funding would be similar to block grants, with a goal to target funding to measurable outcomes rather than services.
Each district would be overseen by an advisory board of local providers and government officials to “identify opportunities, address challenges and advise the administrative services organization.”
The bill also would:
- Eliminate the Commission on Tobacco Use Prevention and Control and its advisory council.
- Move disability services provided by the state’s Mental Health and Disability Service network to the state’s Department of Health and Human Services division of Aging and Disability Services.
- Change the body that oversees Aging and Disability Services from the Commission on Aging to a new Council on Health and Human Services.
- Recognize a brain injury as a distinct disability in the state.
- Provide $3 million from the Regional Incentive Fund to supplement the 988 suicide and crisis hotline.
- Provide $1 million in administrative costs to the Department of Health and Human Services to manage the transition. It also requires the department report to the Legislature explaining the administrative costs and ongoing support needed to implement the changes in the bill.
The bill specifies the state’s transition to a unified behavioral health system be completed by July 1, 2025.
Children’s mental health
House lawmakers also passed and sent to Gov. Reynolds legislation that would provide enhanced Medicaid reimbursement rates to licensed psychiatric medical institutions for children, or PMICs.
House File 2402 requires the HHS to review benefits and address coverage of additional autism treatments through the Healthy and Well Kids in Iowa (Hawki) program, as well as an expansion of services provided by a children’s psychiatric medical care provider.
It would allow a previously licensed PMIC with capacity to increase its licensed capacity to include additional beds without further review, including by the Health Facilities Council, so long as additional beds meet all other licensing and state fire marshal requirements.
Supporters of the bill, including Republicans and Democrats, say it will help address a shortage of youth mental health services in Iowa.
“As of November of 2023, there were 43 children that left the state of Iowa away from their families to seek help with high-acuity need. This bill will bring them back home,” said Rep. Hans Wilz, the bill’s floor manager and a Republican from Ottumwa.
“… This bill helps keep families in Iowa together. This bill is about Iowa's children who need our help. This bill is about Iowa's families and keeping them together.”
Comments: (319) 398-8499; tom.barton@thegazette.com