Branstad signs mental health care reform bill

Local delivery, regional administration of services 'meets the needs'

Surrounded by Democratic and Republican legislators, Gov. Terry Branstad praised a bipartisan effort to overhaul Iowa’s mental health system Friday as he signed a bill implementing the changes.

“Unfortunately, in this day and age, we don’t see a lot of things done on a bipartisan basis,” Branstad said during the bill signing ceremony outside the Black Hawk-Grundy Mental Health Center. Many legislators making up the Cedar Valley contingent in the Iowa House and Senate attended the ceremony, along with the bill’s floor managers, Sen. Jack Hatch, D-Des Moines, and Rep. Renee Schulte, R-Cedar Rapids.

The bill redesigns Iowa’s county-based mental health and disability system so services are delivered locally but administered regionally — an approach that is already in place for Black Hawk County and its neighbors. The result will be a more economical approach that will better “meet the needs of our people,” said Branstad.

“This redesign is about putting the needs of patients first,” he added. “This bill creates a system that balances availability, affordability and quality of care.”

Under the new law, counties will maintain their property tax levy that generates about $125 million annually for mental health services. Every county will levy the equivalent of $41.28 per person in property taxes for mental health services, an amount that will be reduced over five years with dollar-for-dollar property tax relief from the state.

Some counties will have to increase their levies while others will reduce them to that per-person amount. It will cost the state an estimated $17.3 million to bring all counties below the amount up to the target.

“This region is a leader for the state of Iowa and we hope the model for how mental health and developmental services will be delivered across our state,” Branstad said during the ceremony.

Area counties piloted the approach in the spring of 2008 and “formally combined” into a region on Jan. 1, 2009, said Bob Lincoln, who coordinates Black Hawk County’s human services programs. “The region started with five counties,” he noted. “As of yesterday, we are 13 counties.”

Lincoln credited the elected supervisors in those counties for making the “political decision” to form and join the region. “Being connected is the best way to deliver services,” he said.

He cited the region’s 10-bed crisis stabilization center, which works closely with psychiatric hospitals. It allows a place for patients who don’t need hospitalization but need time to become “medically stable” and get the necessary support in place at home.

The current approach means each county has its own administrative expenses, which increases costs. As a result, the county-by-county system can be “financially unsustainable and unpredictable for families,” said Branstad. “This bill will advance care and accountability. This bill is an investment in our state’s future.”

“Basically, we had 99 different systems,” said Hatch, until now. He noted Van Buren County in southern Iowa has “no structured mental health delivery system,” which means residents are not assured of receiving services. “Why shouldn’t all Iowans get a core set of services?”

Schulte said Branstad’s signature on the bill is the first of many milestones as the state transitions to the regional system over the next four to five years.The change is a “true grassroots movement,” she said, that involved listening a wide range of stakeholders. “It took a very long time to get here.”

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