331.439 - ELIGIBILITY FOR STATE PAYMENT.

        331.439  ELIGIBILITY FOR STATE PAYMENT.         1.  The state payment to eligible counties under this section      shall be made as provided in sections 331.438 and 426B.2.  A county      is eligible for the state payment, as defined in section 331.438, for      a fiscal year if the director of human services, in consultation with      the state commission, determines for a specific fiscal year that all      of the following conditions are met:         a.  The county accurately reported by December 1 the county's      expenditures for mental health, mental retardation, and developmental      disabilities services and the information required under section      225C.6A, subsection 2, paragraph "c", for the previous fiscal      year on forms prescribed by rules adopted by the state commission.      If the department determines good cause exists, the department may      extend a deadline otherwise imposed under this chapter, chapter 225C,      or chapter 426B for a county's reporting concerning mental health,      mental retardation, or developmental disabilities services or related      revenues and expenditures.         b.  The county developed and implemented a county management      plan for the county's mental health, mental retardation, and      developmental disabilities services in accordance with the provisions      of this paragraph "b".  The plan shall comply with the      administrative rules adopted for this purpose by the state commission      and is subject to the approval of the director of human services in      consultation with the state commission.  The plan shall include a      description of the county's service management provision for mental      health, mental retardation, and developmental disabilities services.      For mental retardation and developmental disabilities service      management, the plan shall describe the county's development and      implementation of a managed system of cost-effective individualized      services and shall comply with the provisions of paragraph "f".      The goal of this part of the plan shall be to assist the individuals      served to be as independent, productive, and integrated into the      community as possible.  The service management provisions for mental      health shall comply with the provisions of paragraph "e".  A      county is subject to all of the following provisions in regard to the      county's management plan and planning process:         (1)  The county shall have in effect an approved policies and      procedures manual for the county's services fund.  The county      management plan shall be defined in the manual.  The manual submitted      by the county as part of the county's management plan for the fiscal      year beginning July 1, 2000, as approved by the director of human      services, shall remain in effect, subject to amendment.  An amendment      to the manual shall be submitted to the department of human services      at least forty-five days prior to the date of implementation.  Prior      to implementation of any amendment to the manual, the amendment must      be approved by the director of human services in consultation with      the state commission.         (2)  For informational purposes, the county shall submit a      management plan review to the department of human services by      December 1 of each year.  The annual review shall incorporate an      analysis of the data associated with the services managed during the      preceding fiscal year by the county or by a managed care entity on      behalf of the county.  The annual review shall also identify      measurable outcomes and results showing the county's progress in      fulfilling the purposes listed in paragraph "c", and in achieving      the disability services outcomes and indicators identified by the      commission pursuant to section 225C.6.         (3)  For informational purposes, every three years the county      shall submit to the department of human services a three-year      strategic plan.  The strategic plan shall describe how the county      will proceed to attain the plan's goals and objectives, and the      measurable outcomes and results necessary for moving the county's      service system toward an individualized, community-based focus in      accordance with paragraph "c".  The three-year strategic plan      shall be submitted by April 1, 2000, and by April 1 of every third      year thereafter.         c.  The county implements its county management plan under      paragraph "b" and other service management functions in a manner      that seeks to achieve all of the following purposes identified in      section 225C.1 for persons who are covered by the plan or are      otherwise subject to the county's service management functions:         (1)  The service system seeks to empower persons to exercise their      own choices about the amounts and types of services and other support      received.         (2)  The service system seeks to empower the persons to accept      responsibility, exercise choices, and take risks.         (3)  The service system seeks to provide services and other      support that are individualized, provided to produce results,      flexible, and cost-effective.         (4)  The service system seeks to provide services and other      supports in a manner which supports the ability of the persons to      live, learn, work, and recreate in communities of their choice.         d.  Commencing with the fiscal year beginning July 1, 2007,      the county management plan under paragraph "c" shall do both of      the following:         (1)  Describe how the county will provide services and other      support that are individualized, provided to produce results,      flexible, and cost-effective in accordance with paragraph "c",      subparagraph (3).         (2)  Describe how the ability of the individuals covered by the      plan to live, learn, work, and recreate in communities of the      individuals' choice will be enhanced as provided in paragraph      "c", subparagraph (4).         e. (1)  For mental health service management, the county may      either directly implement a system of service management and contract      with service providers, or contract with a private entity to manage      the system, provided all requirements of this lettered paragraph are      met by the private entity.  The mental health service management      shall incorporate a central point of coordination and clinical      assessment process developed in accordance with the provisions of      section 331.440.         (2)  A managed care system for mental health proposed by a county      shall include but is not limited to all of the following elements      which shall be specified in administrative rules adopted by the state      commission:         (a)  The enrollment and eligibility process.         (b)  The scope of services included.         (c)  The method of plan administration.         (d)  The process for managing utilization and access to services      and other assistance.         (e)  The quality assurance process.         (f)  The risk management provisions and fiscal viability of the      provisions, if the county contracts with a private managed care      entity.         f.  For mental retardation and developmental disabilities      services management, the county must either develop and implement a      managed system of care which addresses a full array of appropriate      services and cost-effective delivery of services or contract with a      state-approved managed care contractor or contractors.  Any system or      contract implemented under this paragraph shall incorporate a central      point of coordination and clinical assessment process developed in      accordance with the provisions of section 331.440.  The elements of      the county managed system of care shall be specified in rules      developed by the department of human services in consultation with      and adopted by the state commission.         2.  The county management plan shall address the county's criteria      for serving persons with chronic mental illness, including any      rationale used for decision making regarding this population.         3. a.  For the fiscal year beginning July 1, 1996, and      succeeding fiscal years, the county's mental health, mental      retardation, and developmental disabilities service expenditures for      a fiscal year are limited to a fixed budget amount.  The fixed budget      amount shall be the amount identified in the county's management plan      and budget for the fiscal year.  The county shall be authorized an      allowed growth factor adjustment as established by statute for      services paid from the county's services fund under section 331.424A      which is in accordance with the county's management plan and budget,      implemented pursuant to this section.  The statute establishing the      allowed growth factor adjustment shall establish the adjustment for      the fiscal year which commences two years from the beginning date of      the fiscal year in progress at the time the statute is enacted.         b.  Based upon information contained in county management      plans and budgets and proposals made by representatives of counties,      the state commission shall recommend an allowed growth factor      adjustment to the governor by November 15 for the fiscal year which      commences two years from the beginning date of the fiscal year in      progress at the time the recommendation is made.  The allowed growth      factor adjustment shall address costs associated with new consumers      of service, service cost inflation, and investments for economy and      efficiency.  In developing the service cost inflation recommendation,      the state commission shall consider the cost trends indicated by the      gross expenditure amount reported in the expenditure reports      submitted by counties pursuant to subsection 1, paragraph "a".      The governor shall consider the state commission's recommendation in      developing the governor's recommendation for an allowed growth factor      adjustment for such fiscal year.  The governor's recommendation shall      be submitted at the time the governor's proposed budget for the      succeeding fiscal year is submitted in accordance with chapter 8.         c.  The amount of the appropriation required to fund the      allowed growth factor adjustment for a fiscal year shall be      calculated by applying the adjustment established by statute for that      fiscal year to the sum of the following:         (1)  The total amount of base year expenditures for all counties.         (2)  The total amount of the appropriations for allowed growth      factor adjustments made to all counties in all of the fiscal years      prior to that fiscal year.         4.  A county may provide assistance to service populations with      disabilities to which the county has historically provided assistance      but who are not included in the service management provisions      required under subsection 1, subject to the availability of funding.         5. a.  A county shall implement the county's management plan      in a manner so as to provide adequate funding for the entire fiscal      year by budgeting for ninety-nine percent of the funding anticipated      to be available for the plan.  A county may expend all of the funding      anticipated to be available for the plan.         b.  If a county determines that the county cannot provide      services in accordance with the county's management plan and remain      in compliance with the budgeting requirement of paragraph "a" for      the fiscal year, the county may implement a waiting list for the      services.  The procedures for establishing and applying a waiting      list shall be specified in the county's management plan.  If a county      implements a waiting list for services, the county shall notify the      department of human services.  The department shall maintain on the      department's internet website an up-to-date listing of the counties      that have implemented a waiting list and the services affected by      each waiting list.         6.  The director's approval of a county's mental health, mental      retardation, and developmental disabilities services management plan      shall not be construed to constitute certification of the county's      budget.         7.  A county shall annually report data concerning the services      managed by the county.  At a minimum, the data reported shall      indicate the number of different individuals who utilized services in      a fiscal year and the various types of services.  Data reported under      this subsection shall be submitted with the county's expenditure      report required under subsection 1, paragraph "a".         8.  A county's management plans submitted under this section shall      provide for services to children from community mental health centers      and other mental health service providers accredited under chapter      225C.         9.  The county management plan shall designate at least one      hospital licensed under chapter 135B that the county has contracted      with to provide services covered under the plan.  If the designated      hospital does not have a bed available to provide the services, the      county is responsible for the cost of covered services provided at an      alternate hospital licensed under chapter 135B.  
         Section History: Recent Form
         94 Acts, ch 1163, §3; 95 Acts, ch 206, §15; 96 Acts, ch 1205, §3,      11; 97 Acts, ch 169, § 22--25; 97 Acts, ch 198, § 4; 97 Acts, ch 206,      § 18, 24; 98 Acts, ch 1100, §53, 54; 98 Acts, ch 1181, §18, 20; 99      Acts, ch 160, §13--16; 2002 Acts, ch 1146, §12--17; 2004 Acts, ch      1090, §24--29, 33; 2005 Acts, ch 179, §59; 2006 Acts, ch 1115, §9,      10; 2007 Acts, ch 218, §80, 88, 92; 2008 Acts, ch 1187, § 57         Referred to in § 222.60, 222.73, 225C.6, 230.20, 231.56A, 235A.15,      235B.6, 331.424A, 331.438, 331.440, 426B.2, 426B.5         For specific exceptions to payments, expenditures, and reporting      requirements provided under this section, see appropriations and      other noncodified enactments in the annual Acts of the general      assembly 
         Footnotes
         2007 amendment to subsection 1, paragraph a, takes effect May 29,      2007, and applies retroactively to and after December 1, 2006, for      information collected as of that date; deadline for submission of      data for preceding fiscal year; penalties; report regarding transfer      of funds to county services fund or utilization of nonreversion      authority for decategorization project funding; 2007 Acts, ch 218,      §92, 96