Mental Health reform an area of agreement for Iowa lawmakers

DES MOINES - Lawmakers believe the best chance for bipartisan accord in this election-year session will come as they work to revamp the mental health service delivery system in Iowa.

"We all know the system is unsustainable the way it is now," Sen. Jack Hatch, D-Des Moines, said.

He was co-leader of an interim panel that tackled the task of establishing a funding mechanism that will enable policy makers to redesign the current county-based mental health system into a statewide effort where services are administered regionally and delivered locally beginning July 1, 2013.

[pullout_quote credit="Rep. Renee Schulte, R-Cedar Rapids" align="left"]"It is a priority of both chambers as well as the governor's office to get something done, and it's not very often that the stars align where everybody's priority is this," [/pullout_quote]Hatch and Rep. Renee Schulte, R-Cedar Rapids, the other leader of the Legislature's Mental Health and Disability Services Study Committee, said they have asked their leaders to appoint a joint House-Senate panel that will draft legislation early in the session for both chambers to consider.

"I have great hope we're going to get something done this session," said Schulte, who expected the system overhaul could become this year's "signature" piece of bipartisan work.

"It is a priority of both chambers as well as the governor's office to get something done, and it's not very often that the stars align where everybody's priority is this," she said.

The impetus for the reform effort was legislation approved by the General Assembly and signed by Gov. Terry Branstad that established a "sunset" of the current mental health system in two years and directed state Department of Human Services officials to engage Iowans in discussions about core services, outcomes, delivery and funding with an expectation that lawmakers would craft legislation in their 2012 session that will spell out the particulars of the new system.

"It appears we're going to have broad-based bipartisan support for a statewide system, which we've never had before," Branstad said in an interview. "I think it can be a better-managed system, provide better services, and also help us manage and control the costs in the long term."

The governor expected the transition would be done in phases over a five-year implementation period. Initial DHS estimates call for the state to invest $42 million in the effort, with that growing to $133 million once fully implemented in fiscal 2017. The county share from property tax levies would stay at about $125 million each year.

Recommendations from DHS-led working groups called for the creation of up to 15 regions - made up of three counties or more - serving targeted populations between 200,000 to 700,000 people. Each region will have a governing board made up of elected supervisors or their designees from each participating county along with at least three consumer or family representatives.

The regions would be made up of contiguous counties that enter into partnering arrangements and utilize a single "checking account" where federal, state and county funds would be deposited and spent as a way to bring consistency and equity to a service-delivery system currently carved up 99 different ways.

"I think this is the right direction, and you don't make this kind of significant change in how things are done without it being a major undertaking," DHS Director Charles Palmer said.

"Right now what you get depends on where you live, and what people pay for services depends on which county is negotiating which rates, which makes it difficult for providers that serve multiple counties. The set of core services that is proposed is an enrichment of what is out there today."

Initial discussions have pointed toward the establishment of a governance board likely dominated by elected county supervisors from around Iowa that will oversee a new process of directing the $1.3 billion in federal, state and county funds throughout the new regions, he added.

Bill Peterson, executive director of the Iowa State Association of Counties, said there are a lot of unanswered questions that county officials have as the modernization moves forward.

Mental health care currently is largely the responsibility of counties, with much of the funding coming from local property taxes. Palmer said that arrangement leads to a wide variance in quality and availability of service.

If the legislature approves the plan this session, Palmer said counties could begin voluntarily forming the regional groupings early next year. Also, he would begin negotiating performance-based contracts with providers in each of the new service regions.