Gov. Kim Reynolds’ plan to overhaul Iowa’s “cracked” mental health and disability services system is moving forward at the Iowa State Capitol.
An 80-page bill introduced in Congress last week would restructure the mental health and substance use treatment services provided in Iowa and consolidate 32 rural areas into seven new “unified districts,” Republicans said. The governor’s plan is shown.
House Study Bill 653 It would also move disability services currently overseen by those districts and transfer their management to the Iowa Department of Health and Human Services instead.
Lawmakers and state officials have described the new proposal as the next step in a sweeping state government reorganization that Reynolds signed into law last year.
Rep. Joel Frey, R-Osceola, said during a House subcommittee hearing that the proposed bill “accomplishes our commitment to ensuring that all Iowans have access to the best mental health and disability services.” “It has a lot to do with continued momentum as well as organizational restructuring.” last week.
With the formal consolidation of Iowa state agencies effective, Iowa Department of Health and Human Services Secretary Kelly Garcia said the focus will now shift to the agency divisions that manage the array of services Iowa provides. He said there was.
Why does Kim Reynolds want to overhaul Iowa’s mental health system?
The governor’s office, Health and Human Services, and other supporters of the bill say the integration efforts are necessary to address problems within Iowa’s current system, which separates substance use treatment and mental health services. claims.
Services are inconsistent across the current system, creating disparities in Iowans’ ability to access the care they need, Legislative Liaison and Deputy Chief of Staff in Reynolds’ Office said during a House subcommittee hearing last week. said Officer Molly Severn. As a result, Iowans aren’t able to access behavioral health services “where they live and when they need it,” she said.
Alex Murphy, a spokesperson for the Iowa Department of Health and Human Services, said in a statement that the shift allows the agency to “establish a truly integrated and equitable system of behavioral health care for the first time.”
“Right now, the way mental health and disability services regions are configured allows Iowans to understand which region they live in, what services are funded in their region, and We need to know who our service providers are,” Murphy said. “The newly coordinated system will be better aligned with clear points of access, so Iowans can receive the same behavioral health services across the state, no matter where they live.”
Sen. Jeff Edler, R-State Center, who chaired the subcommittee on the Senate bill, said he supports the bill moving forward, but lawmakers are expected to offer amendments before it goes to the full Senate. He said he hopes to do so.
“I would also like to express my gratitude. This is a continuation of an ongoing journey and we must continue to move forward to close those gaps,” he said. .
more:Gov. Kim Reynolds proposes integrated plan to improve access to mental health in Iowa
How would this proposal change mental health and substance use services in Iowa?
Currently, Iowa has 13 states. Mental Health and Disability Services Region In addition to agencies that oversee mental health and disability services, 19 Integrated provider network Control drug use and problem gambling services.
Reynolds’ proposal would eliminate that system and instead create a new behavioral health services system made up of seven districts that would oversee services for people with mental health conditions and substance use disorders. .
“Twenty-five percent of adults with serious mental health issues also suffer from a substance use disorder,” Reynolds said in a statement, “but right now that system is broken and the people of Iowa are… are not receiving the support they need.” By consolidating these 32 separate regions into seven unified regions, he will be able to better coordinate services and provide better care to Iowans. ”
The governor’s proposal outlines new system mandates, including preventive services. “Evidence-based” early intervention and treatment. Support services designed to avoid the need for emergency treatment or law enforcement. And crisis response focuses on de-escalation.
HHS will maintain a central data repository to track the new system and its impact, and will use that data to track behavioral health needs, develop policy, and otherwise They will be tasked with implementing the necessary measures to strengthen health.
Who will oversee Iowa’s new behavioral health district?
The new bill directs HHS to hire an Administrative Services Organization (ASO) to oversee each of the seven districts and their service clusters.
“The organizational structure of the civil service is key as we move forward. That’s how accountability works,” Garcia said. This is also a place where you can definitely get local input. ”
These ASOs may exist in the form of dedicated “regional managers” or public or private agencies already operating within the scope of the new health district. HHS will seek proposals from potential candidates for these organizational roles.
“The contracts with these organizations will have set budgets and measurable outcomes and performance measures,” Severn told lawmakers.
According to the bill, new district boundaries would be determined based on city and county boundaries, high-need areas, populations, and those populations’ patterns in seeking and receiving care.
Each district will also have a nine-member “advisory committee,” whose members will be appointed by the ASO. The Council consists of:
- Three members were elected.
- three behavioral health providers;
- Three individuals receiving or living with behavioral health services.
Severn said these advisory committees will develop individual behavioral health plans for each district based on local needs, and maintaining local autonomy in establishing these core services is key to the new proposal. He added that this is a very important part.
more:Kim Reynolds proposes salary increases, AEA overhaul, and tax cuts for Iowa teachers in annual address
How will these districts be funded?
State officials said HHS will allocate the money to each of the seven districts through a Behavioral Health Fund, which functions similarly to a block grant.
Funding for this fund comes from the state’s general budget and is calculated using the state’s total population.
Currently, mental health and disability service areas rely on state funding, but spending is determined by local government boards. As a result, spending decisions for services to Iowans are inconsistent across the state, creating disparities between patients and providers, Severn said.
“Despite the growing need for behavioral health services, the state estimates that each region has $23 million in unspent funds in their incentive fund balances, with millions more in the next year.” dollar is expected to increase,” Severn said.
more:According to the report, Iowa has the worst number of psychiatric beds in the nation.How the new plan can help
What about disability services?
Under the proposal, disability services currently provided by Iowa’s 13 mental health and disability service regions would be transferred to the state’s Aging and Disability Services under Iowa Health Services.
The agency is directed to establish a coordination system for Aging and Disability Resource Centers to oversee long-term living and community support services for Iowans with disabilities. According to the bill, that includes people with chronic mental illnesses, intellectual disabilities, developmental disabilities and brain injuries.
When will this transition occur?
The new behavioral health services system is expected to be operational by July 1, 2025.
If approved and signed into law, the bill would begin an overhaul of the state’s mental health and disability services system starting July 1 of this year.
How have behavioral health districts in Iowa changed over time?
Reynolds’ plan for this session is not the first time the state has changed how it manages behavioral health services in Iowa.
Services were managed by county until 2014, when they were consolidated into the current system of 32 local areas. Nineteen of these regions specialize in substance use services and 13 provide mental health services.
The system is funded by county property taxes and administered by local governments until 2021, when Reynolds abolished the property tax levy and instead diverted mental health funding from the state. He signed a sweeping tax bill that transferred it to the general fund.
What are Republicans and Democrats saying about this plan?
Republicans praised a proposal to overhaul the state’s mental health and substance use services system, saying the latest bill continues a years-long effort by Iowa’s top officials to improve access to behavioral health care. Stated.
“There is room for improvement and many opportunities, but overall we are listening to what Iowans need and this bill provides the next steps for our mental health and disability services system. I look forward to helping in any way that complements me.” Frye said.
Rep. Ann Meyer (R-Fort Dodge) echoed those comments during a House subcommittee hearing, saying she believes the bill is a “major change.”
“I know there are people in my district who have unmet needs, and I look forward to filling that gap,” Meyer said.
Democrats have so far been more cautious about signing on to the initiative, saying they still have questions about the overhaul.
“This is a big move,” said Rep. Beth Wessel Croschel of Dahms. I plan to continue my activities by joining a group that has yet to be determined. ”
Sen. Sarah Tron Garriott, D-West Des Moines, asked Garcia whether the new plan would allow counties to continue some of the cooperation they currently have. He expressed concern that counties would lack a voice in determining services under the ASO.
“We have plans in place to help ensure that all of these counties have full representation, that they have a voice, and that the services they currently provide are not lost when the transition occurs. mosquito?”
Garcia said the plan is still in draft form and is intended to allow local partnerships to continue if they are successful.
“Maps are tricky because people focus on whether this is a boundary or a boundary or a watershed. But this new system actually shows that there are no barriers or walls, but rather that collaboration is key. “It’s a reminder,” she said.
stephen gruber miller contributed to this report.
Michaela Lamb is a medical officer at the Des Moines Register. You can contact her at: [email protected](319) 339-7354 or on Twitter @Michaela_Ramm
Galen Bakarie covers politics for the Register.please contact him [email protected] or (573) 219-7440 or follow him on Twitter @galenbacharier.
