Senate File 2315 (Passed during the 2012 Legislative Session) Movement from a county based mental health system to a regional system

 It is the intent of the General Assembly that the adult residents of this state should have access to needed mental health and disability services regardless of their residence.  Several Workgroups were created: ◦ Transition Committee ◦ Outcomes and Performance Measures ◦ Service System Data and Statistical Information ◦ Judicial Workgroup ◦ Children’s Disability Workgroup

Criteria: ◦ Counties be contiguous ◦ Consist of at least 3 counties ◦ At least 1 CMHC or FQHC ◦ A hospital with an inpatient unit or state mental health institute ◦ Has capacity to provide required core services and other required functions ◦ On September 17, 2012 the Eastern Iowa MH/DS Region was approved. It consists of the following five counties: Cedar, Clinton, Jackson, Muscatine and Scott.

On or before 4/1/13, counties voluntarily participating in a region must have: 1. Identified counties interested 2. Board of Supervisors approve a written letter of intent to form a region 3.Comply with all requirements DHS is expected to provide written notice to the Board of Supervisors that the counties have complied with all requirements.

1.During 4/2/13 and 7/1/13, DHS will work with counties to join and form a region. 2.On 7/1/13, DHS can assign a county to a region if they have not voluntarily joined one. 3.By 12/31/13, all counties shall be part of a region. 4.On or before 6/30/14, all counties shall be in compliance with regionalization criteria.

 Currently, there is one region fully operational: North Central Iowa with 18 counties  There are several more groups of counties who have been talking or who have submitted letters of intent:  One region- 3 counties  Two regions- 4 counties each  Five regions- 5 counties each  Three regions- 7 counties each  One region- 9 counties

1.28E Agreement-Board membership, purpose and goals, terms, governance, staff, finances and scope. 2.Governing Board Members  A.Board of Supervisors  B.A person receiving services/active relative  C.Service Provider 3.Advisory Committee 4.Regional Administrator

Guiding Principles: 1. Region must move forward in the spirit of cooperation with trust amongst all, operating on premise of open communication and respect for differences of opinion 2. Each county’s property tax dollars should be spent on services for their residents 3. Each county has one vote 4. Each county needs to maintain a local presence (local access office) for their residents 5. Each county must provide uniform services while including utilization of an open provider panel 6. The region should not create another layer of government and should maintain administrative costs, not increase them 7. Case management providers are chosen by the county, not the region

 Current Funding FY13: County MH Levy  Ex: Scott County: $3,308,032 MH levy Total Revenue: $3,308,032 million  Future Funding: County MH Levy $47.28 Per Capita  Ex: Scott County: $3,308,032 MH Levy $4,592,220 per capita Total Revenue: $7,900,252 million Not Mandated to Pool Funds

DHS Info for FY14: Populations : 7/1/11 Census Current Levy Amount:Current Per Capita $:New Per Capita ($47.28) Revenue +/-:New Levy Amount: Cedar- 18,400 $968,646Cedar- $52.64($98,694)$869,952 Clinton- 49,015 $2,883,428Clinton- $58.83($565,999)$2,317,429 Jackson- 19,796 $787,145Jackson- $39.76$148,810$935,955 Muscatine- 42,815 $2,055,392Muscatine-$48.01($31,099)$2,024,293 Scott- 167,095 $3,308,032Scott- $19.80$4,592,220$7,900,252

 Senate File 2315: Services are for adults with mental illness and intellectual disabilities only Core Service Domains: Treatment: ◦ Assessment/evaluation ◦ MH Outpatient Therapy ◦ Medication prescribing and management ◦ MH Inpatient treatment Crisis Response : ◦ 24 hour access to crisis response/evaluation ◦ Personal Emergency Response System Supported Community Living : ◦ Home Health Aide ◦ Home and vehicle modification ◦ Respite ◦ Supported Community Living Core Service Domains: Employment : ◦ Day Habilitation ◦ Job Development ◦ Supported Employment ◦ Prevocational Services Recovery: ◦ Recovery Services-Peer/Family Support Service Coordination: ◦ Case Management ◦ Health Homes

1.Regions must ensure access is available to providers of core services. 2.A region shall work with service providers to ensure that services are available to residents in a region, regardless of potential payment source. 3.Providers of core services must:  Serve persons with co-occurring conditions  Provide evidence based services  Provide trauma informed care

 24 Hour Crisis Hotline  Mobile Response  23 Hour Crisis Observation/Stabilization  Crisis Residential Services  Jail Diversion  Crisis Intervention Training  Civil Commitment Prescreening  Positive Behavior Support  Assertive Community Treatment  Peer Self Help Drop In Centers Core plus services will be made available when public funds are available.

1. Development of a 28E Agreement 2. Development of a management plan- annual budget plan, policy and procedure manual, annual report 3. Development of a strategic plan 4. Discussion of historical, cost effective services provided in addition to core services

 Legislature needs to make decisions regarding the final reports from the Judicial Workgroup and the Children’s Disability Workgroup.  Additional funding will be needed.  Iowa Code changes will need to be made.