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Iowa lawmakers advance legislation to strengthen subacute mental health care
‘The overwhelming evidence is that there's a need here,’ Bettendorf Republican Gary Mohr says
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DES MOINES — When Mary Neubauer’s son Sergei died by suicide in 2017, his obituary was read over a million times, she said.
The family received an outpouring of love and support after they spoke out about Sergei’s struggles with mental health and what they had gone through to get him adequate care.
Neubauer and her husband, who both live in Clive, adopted Sergei from Russia in 2009, where he experienced an abusive childhood. After they adopted him, Neubauer said, he struggled with PTSD, depression, anxiety and eventually thoughts of suicide as he grew older. The family tried everything they could to find him long-term care in Iowa, but had to turn to programs in Wisconsin and Arizona after failing to find subacute health care in the state.
Sergei ended up receiving care in an Arizona treatment center for five weeks and completed another three months of step-down care in California. He seemed to be doing well during his first few weeks back in Iowa, but Sergei eventually killed himself in September 2017.
Over the last eight years, Neubauer and her husband have advocated for a stronger and more accessible subacute mental health care system in the state, as they believe there was a gap in treatment options for their son.
“We were just trying to honor our son and be honest about what occurred, but because the story really just grasped attention and made people see that this is real, that if it could happen to our family, it could happen to anyone,” Neubauer told reporters after an Iowa legislative subcommittee meeting Tuesday. “The wheels of change turn so, so slowly. It's way too slow for me as an advocate and someone who cares about these issues, but I also understand that we want to be methodical.”
Neubauer shared her story with lawmakers after urging them to take up the issue during a subcommittee in early January before the 2026 legislative session began. After nearly a decade of work by Neubauer, Iowa state lawmakers are addressing the issue this year.
The Neubauers are just one family that has urged lawmakers to improve and increase access to subacute mental health care, or short-term, intensive treatment to resolve the presence of acute or crisis mental health symptoms.
Facilities that specialize in subacute mental health provide care at a level just under full hospitalization. The treatment is less intensive than inpatient psychiatric care but is more structured than outpatient therapy.
Legislation advancing through the Iowa House and Senate aims to start the conversation, by removing certain administrative barriers around subacute mental health care.
A bill proposed by Republican state Rep. Gary Mohr of Bettendorf, which was advanced unanimously out of a three-member House subcommittee Tuesday, would remove a section in Iowa code created in 2012 suggesting stays at subacute facilities don’t exceed 10 days.
The bill, House File 2220, also:
- Requires a subacute mental health care facility to develop a written treatment care plan with a resident within 24 hours of the resident’s admission to the facility.
- Prohibits a preauthorization requirement for an individual’s admission to a subacute mental health care facility or for the first 15 days of a resident’s treatment. Starting from the date of a resident’s first day of treatment, on or after a resident’s 45th day of treatment, a managed care organization may review the medical necessity of the resident’s treatment.
- Requires the Iowa Department of Health and Human Services to establish an electronic system to track the availability of beds at each psychiatric medical institution for children.
- Requires collaboration between state departments to eliminate rules that departments determine impede establishing and expanding subacute mental health care facilities and services and easing access to the services.
- Makes requirements to employ an individual at a subacute mental health care facility less stringent than requirements for the same employment at a state mental health institute.
- Requires HHS and the Iowa Department of Inspections, Appeals, and Licensing to modify their respective rules to allow a subacute mental health care facility to have more beds to provide subacute mental health care.
A bill in the Iowa Senate, Senate Study Bill 3083, includes similar requirements.
The legislation was advanced out of the Iowa Senate Health and Human Services Committee on Feb. 3, making it eligible for floor debate in the chamber.
Mohr, who proposed the legislation after hearing concerns from Quad-Cities area law enforcement, said he is optimistic about the bill advancing to the full House chamber. He said if both bills pass, lawmakers will sit down and “reconcile” the two bills.
“The overwhelming evidence is that there's a need here, and we're going to stick with it and continue to pursue this,” Mohr told the Gazette-Lee Des Moines Bureau on Tuesday. “It's extremely important we come out of this session with something, and there's time for that negotiation.”
Concerns from managed care organizations
During the House subcommittee meeting, representatives for managed care organizations, or health insurance companies that coordinate care for those enrolled in certain Medicaid programs, argued the bill’s prohibition on preauthorization during an individual’s first 15 days in subacute care is lengthy and unnecessary.
Lynh Patterson, representing Wellpoint, said the provider’s data shows that the prior authorization does not create a barrier to care, noting this issue was not specifically addressed during the January subcommittee.
“Currently, we looked at the amount of requests that we received in prior authorization for 2025, we approved 100 percent of them,” Patterson said.
Rep. Rob Johnson, D-Des Moines, asked Patterson what she believes is the necessary length of time for individuals.
Patterson said the average length of stay for their patients is around eight days.
After the subcommittee, Neubauer told reporters that subacute care treatment time spanning from one to three months is most effective for individuals and is the time span used by other states that have comprehensive treatment systems.
“We're wanting people to really rebuild their lives and build healthy new habits, and it takes about six weeks to form a new habit, good or bad,” Neubauer said.
Legislation receives bipartisan support
House lawmakers on both sides of the aisle agreed that enhancing subacute mental health care is necessary.
Johnson said as a minister, he is doing too many funerals for Iowans who lacked access to mental health care.
“I am doing more funerals than weddings, and some of those services is because someone could not get into the right mental health care and get the right type of opportunity that they needed,” Johnson said. “We have to do something. We are taking up too much time in our ER visits. Our law enforcement officers are not therapists.”
Republican Rep. Craig Johnson of Independence said he “appreciated” the bill coming forward as a friend of his struggled to access similar mental health care in Iowa.
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