Iowa
I.C.A.T.
IV, Subt. 2, Ch. 135H, Refs & Annos
– Psychiatric Medical Institutions for Children
§135H.1
- Definitions
As used in this chapter,
unless the context otherwise requires:
1. "Department" means the department of
inspections and appeals.
2. "Direction" means authoritative policy or
procedural guidance for the accomplishment of a function or an activity.
3. "Licensee" means the holder of a license
issued to operate a psychiatric medical institution for
children.
4. "Medical care plan" means a plan of care
and services designed to eliminate the need for inpatient care by improving the
condition of a child. Services must be based upon a diagnostic evaluation,
which includes an examination of the medical, psychological, social,
behavioral, and developmental aspects of the child's situation, reflecting the
need for inpatient care.
5. "Mental health professional" means an
individual who has all of the following qualifications:
a. The individual holds at least a master's degree in a mental health
field, including but not limited to, psychology, counseling and guidance,
nursing, and social work, or the individual is a physician.
b. The individual holds a current Iowa license if practicing in a field
covered by an Iowa licensure law.
c. The individual has at least two years of post-degree clinical
experience, supervised by another mental health professional, in assessing
mental health needs and problems and in providing appropriate mental health
services.
6. "Nursing care" means services which are
provided under the direction of a physician or registered nurse.
7. "Physician" means a person licensed under
chapter 148 or 150A.
8. "Psychiatric medical institution for
children" or "psychiatric institution" means an institution
providing more than twenty-four hours of continuous care involving long-term
psychiatric services to three or more children in residence for expected
periods of fourteen or more days for diagnosis and evaluation or for expected
periods of ninety days or more for treatment.
9. "Psychiatric services" means services
provided under the direction of a physician which address mental, emotional,
medical, or behavioral problems.
10. "Rehabilitative services" means services to
encourage and assist restoration of a resident's optimum mental and physical
capabilities.
11. "Resident" means a person who is less
than twenty-one years of age and has been admitted by a physician to a
psychiatric medical institution for children.
12. "Supervision" means direct oversight and
inspection of the act of accomplishing a function or activity.
135H.2. Purpose
The purpose of this chapter is
to provide for the development, establishment, and enforcement of basic
standards for the operation, construction, and maintenance of a psychiatric
medical institution for children which will ensure the safe and adequate
diagnosis and evaluation and treatment of the residents.
135H.3. Nature of care
A psychiatric medical
institution for children shall utilize a team of professionals to direct an
organized program of diagnostic services, psychiatric services, nursing care,
and rehabilitative services to meet the needs of residents in accordance with a
medical care plan developed for each resident. Social and rehabilitative
services shall be provided under the direction of a qualified mental health
professional.
135H.4. Licensure
A person shall not establish, operate, or
maintain a psychiatric medical institution for children unless the person obtains
a license for the institution under this chapter and either holds a license
under section 237.3,
subsection 2, paragraph "a", as a comprehensive
residential facility for children or holds a license under section 125.13, if
the facility provides substance abuse treatment.
135H.5. Application for
license
An application for a license under this
chapter shall be submitted on a form requesting information required by the
department, which may include affirmative evidence of the applicant's ability
to comply with the rules for standards adopted pursuant to this chapter. An
application for a license shall be accompanied by the required license fee
which shall be credited to the general fund of the state. The initial and
annual license fee is twenty-five dollars.
135H.6.
Inspection--conditions for issuance
The department shall issue a license to an
applicant under this chapter if all the following conditions exist:
1. The department has ascertained that the
applicant's medical facilities and staff are adequate to provide the care and
services required of a psychiatric institution.
2. The proposed psychiatric institution is
accredited by the joint commission on the accreditation of health care
organizations, the commission on accreditation of rehabilitation facilities,
the council on accreditation of services for families and children, or by any
other recognized accrediting organization with comparable standards acceptable
under federal regulation.
3. The applicant complies
with applicable state rules and standards for a psychiatric institution adopted
by the department in accordance with federal requirements under 42 C.F.R.
§ 441.150-441.156.
4. The applicant has been awarded a
certificate of need pursuant to chapter 135, unless exempt as provided in this
section.
5. The department of human services has
submitted written approval of the application based on the department of human
services' determination of need. The department of human services shall
identify the location and number of children in the state who require the
services of a psychiatric medical institution for children. Approval of an
application shall be based upon the location of the proposed psychiatric
institution relative to the need for services identified by the department of
human services and an analysis of the applicant's ability to provide services
and support consistent with requirements under chapter 232, particularly
regarding community-based treatment. If the proposed psychiatric institution is
not freestanding from a facility licensed under chapter 135B or 135C, approval
under this subsection
shall not be given unless
the department of human services certifies that the proposed psychiatric
institution is capable of providing a resident with a living environment similar
to the living environment provided by a licensee which is freestanding from a
facility licensed under chapter 135B or 135C.
6. The department of human services shall
not give approval to an application which would cause the total number of beds
licensed under this chapter for services reimbursed by the medical assistance
program under chapter 249A to exceed four hundred thirty beds.
7. In addition to the beds authorized under
subsection 6, the department of human services may establish not more than
thirty beds licensed under this chapter at the state mental health institute at
Independence. The beds shall be exempt from the certificate of need requirement
under subsection 4.
8. The department of human services may
give approval to conversion of beds approved under subsection 6, to beds which
are specialized to provide substance
abuse treatment. However,
the total number of beds approved under subsection 6 and this subsection shall
not exceed four hundred thirty. Conversion of beds under this subsection shall
not require a revision of the certificate of need issued for the psychiatric
institution making the conversion.
9. The proposed psychiatric institution is
under the direction of an agency which has operated a facility licensed under section 237.3, subsection 2,
paragraph "a", as a comprehensive residential facility for children
for three years or of an agency which has operated a facility for three years
providing psychiatric services exclusively to children or adolescents and the
facility meets or exceeds requirements for licensure under section 237.3, subsection 2,
paragraph "a", as a comprehensive residential facility for children.
10. A psychiatric institution licensed
prior to July 1, 1999, may exceed the number of beds authorized under subsection
6 if the excess beds are used to provide services funded from a source other
than the medical assistance program under chapter 249A. Notwithstanding
subsections 4, 5, and 6, the provision of services using those excess beds does
not require a certificate of need or a
review by the department
of human services.
135H.7. Personnel
1. A person shall not be allowed to provide
services in a psychiatric institution if the person has a disease which is
transmissible to other persons through required contact in the workplace, which
presents a significant risk of infecting other persons, which presents a
substantial possibility of harming other persons, or for which no reasonable
accommodation can eliminate the risk of infecting other persons.
2. a. If a person is being considered for licensure under this
chapter, or for employment involving direct responsibility for a child or with
access to a child when the child is alone, by a licensed psychiatric
institution, or if a person will reside in a facility utilized by a licensee,
and if the person has been convicted of a crime or has a record of founded
child abuse, the department of human services and the licensee, for an employee
of the licensee, shall perform an evaluation to determine whether the crime or
founded child abuse warrants prohibition of licensure, employment, or residence
in the
facility. The department
of human services shall conduct criminal and child abuse record checks in this
state and may conduct these checks in other states. The evaluation shall be
performed in accordance with procedures adopted for this purpose by the
department of human services.
b. If the department of human services determines that a person has
committed a crime or has a record of founded child abuse and is licensed,
employed by a psychiatric institution licensed under this chapter, or resides
in a licensed facility the department shall notify the program that an
evaluation will be conducted to determine whether prohibition of the person's
licensure, employment, or residence is warranted.
c. In an evaluation, the department of human services and the licensee
for an employee of the licensee shall consider the nature and seriousness of
the crime or founded child abuse in relation to the position sought or held,
the time elapsed since the commission of the crime or founded child abuse, the
circumstances under which the crime or founded child abuse was committed, the
degree of rehabilitation, the likelihood that the person will commit the crime
or founded child abuse
again, and the number of crimes or founded child abuses committed by the person
involved. The department may permit a person who is evaluated to be licensed,
employed, or to reside, or to continue to be licensed, employed, or to reside
in a licensed facility, if the person complies with the department's conditions
relating to the person's licensure, employment, or residence, which may include
completion of additional training. For an employee of a licensee, these
conditional requirements shall be developed with the licensee. The department
of human services has final authority in determining whether prohibition of the
person's licensure, employment, or residence is warranted and in developing any
conditional requirements under this paragraph.
3. If the department of human services
determines that the person has committed a crime or has a record of founded
child abuse which warrants prohibition of licensure, employment, or residence,
the person shall not be licensed under this chapter to operate a psychiatric
institution and shall not be employed by a psychiatric institution or reside in
a facility licensed under this chapter.
4. In addition to the
record checks required under subsection 2, the department of human services may
conduct dependent adult abuse record checks in this state and may conduct these
checks in other states, on a random basis. The provisions of subsections 2 and
3, relative to an evaluation following a determination that a person has been
convicted of a crime or has a record of founded child abuse, shall also apply
to a random dependent adult abuse record check conducted under this subsection.
5. Beginning July 1, 1994, a licensee shall
inform all new applicants for employment of the possibility of the performance
of a record check and shall obtain, from the applicant, a signed acknowledgment
of the receipt of the information.
6. On or after July 1, 1994, a licensee
shall include the following inquiry in an application for employment: "Do
you have a record of founded child or dependent adult abuse or have you ever
been convicted of a crime, in this state or any other state?"
135H.8. Denial,
suspension, or revocation of license
The department may deny an application or
suspend or revoke a license if the department finds that an applicant or
licensee has failed or is unable to comply with this chapter or the rules
establishing minimum standards pursuant to this chapter or if any of the
following conditions apply:
1. It is shown that a resident is a victim
of cruelty or neglect due to the acts or omissions of the licensee.
2. The licensee has permitted, aided, or
abetted in the commission of an illegal act in the psychiatric institution.
3. An applicant or licensee acted to obtain
or to retain a license by fraudulent means, misrepresentation, or submitting
false information.
4. The licensee has willfully failed or
neglected to maintain a continuing in- service education and training program
for persons employed by the psychiatric institution.
5. The application involves a person who
has failed to operate a psychiatric institution in compliance with the
provisions of this chapter.
135H.8A. Provisional
license
The department may issue a provisional
license, effective for not more than one year, to a licensee whose psychiatric
institution does not meet the requirements of this chapter, if, prior to
issuance of the license, written plans to achieve compliance with the
applicable requirements are submitted to and approved by the department. The
plans shall specify the deadline for achieving compliance.
135H.9. Notice and
hearings
The procedure governing notice and hearing
to deny an application or suspend or revoke a license shall be in accordance
with rules adopted by the department pursuant to chapter 17A. A full and
complete record shall be kept of the proceedings and of any testimony. The
record need not be transcribed unless judicial review is sought. A copy or
copies of a transcript may be obtained by an interested party upon payment of
the cost of preparing the transcript or copies.
135H.10. Rules
1. The department of inspections and
appeals, in consultation with the department of human services and affected
professional groups, shall adopt and enforce rules setting out the standards
for a psychiatric medical institution for children and the rights of the
residents admitted to a psychiatric institution. The department of inspections
and appeals and the department of human services shall coordinate the adoption
of rules and the enforcement of the rules in order to prevent duplication of
effort by the departments and of requirements of the licensee.
2. This chapter shall not be construed as
prohibiting the use of funds appropriated for foster care to provide payment to
a psychiatric medical institution for children for the financial participation
required of a child whose foster care placement is in a psychiatric medical
institution for children. In accordance with established policies and
procedures for foster care, the department of human services shall act to
recover any such payment
for financial
participation, apply to be named payee for the child's unearned income, and
recommend parental liability for the costs of a court-ordered foster care
placement in a psychiatric medical institution.
3. Except for those psychiatric medical
institutions for children which are specialized to provide substance abuse
treatment, unless expressly authorized in statute, the department of human
services shall not include services provided by psychiatric medical institutions
for children in any managed care contract.
135H.11. Complaints
alleging violations--confidentiality
A person may request an inspection of a
psychiatric medical institution for children by filing with the department a
complaint of an alleged violation of an applicable requirement of this chapter
or a rule adopted pursuant to this chapter. The complaint shall state in a
reasonably specific manner the basis of the complaint. A statement of the
nature of the complaint shall be delivered to the psychiatric institution
involved at the time of or prior to the inspection. The name of the person who
files a complaint with the department shall be kept confidential and shall not
be subject to discovery, subpoena, or other means of legal compulsion for its
release to a person other than department employees involved in the
investigation of the complaint.
135H.12. Inspections upon
complaints
1. Upon receipt of a complaint made in
accordance with section
135H.11, the department shall make a preliminary review of the
complaint. Unless the department concludes that the complaint is intended to
harass a psychiatric institution or a licensee or is without reasonable basis,
it shall within twenty working days of receipt of the complaint make or cause
to be made an on- site inspection of the psychiatric institution which is the
subject of the complaint. The department of inspections and appeals may refer
to the department of human services any complaint received by the department if
the complaint applies to rules adopted by the department of human services. The
complainant shall also be notified of the name, address, and telephone number
of the designated protection and advocacy agency if the alleged violation
involves a facility with one or more residents with developmental disabilities
or mental illness. In any case, the complainant shall be promptly informed of
the result of any action taken by the department in the matter.
2. An inspection made
pursuant to a complaint filed under section 135H.11 need not be limited to the
matter or matters referred to in the complaint; however, the inspection shall
not be a general inspection unless the complaint inspection coincides with a
scheduled general inspection. Upon arrival at the psychiatric institution to be
inspected, the inspector shall show identification to the person in charge of
the psychiatric institution and state that an inspection is to be made, before
beginning the inspection. Upon request of either the complainant or the
department, the complainant or the complainant's representative or both may be
allowed the privilege of accompanying the inspector during any on-site
inspection made pursuant to this section. The inspector may cancel the
privilege at any time if the inspector determines that the privacy of a
resident of the psychiatric institution to be inspected would be violated. The
dignity of the resident shall be given first priority by the inspector and
others.
135H.13. Information
confidential
1. The department's final findings and the
survey findings of the joint commission on the accreditation of health care
organizations regarding licensure or program accreditation shall be made
available to the public in a readily available form and place. Other
information relating to the psychiatric institution is confidential and shall
not be made available to the public except in proceedings involving licensure,
a civil suit involving a resident, or an administrative action involving a
resident.
2. The name of a person who files a
complaint with the department shall remain confidential and is not subject to
discovery, subpoena, or any other means of legal compulsion for release to a
person other than an employee of the department or an agent involved in the
investigation of the complaint.
3. Information regarding a resident who has
received or is receiving care shall
not be disclosed directly
or indirectly except as authorized under section 217.30, 232.69, or 237.21.
135H.14. Judicial review
Judicial review of the action of the
department may be sought pursuant to the Iowa administrative procedure act,
chapter 17A. Notwithstanding the Iowa administrative procedure act, a petition
for judicial review of the department's actions under this chapter may be filed
in the district court of the county in which the related psychiatric medical
institution for children is located or is proposed to be located. The status of
the petitioner or the licensee shall be preserved pending final disposition of
the judicial review.
135H.15. Penalty
A person who establishes, operates, or
manages a psychiatric medical institution for children without obtaining a
license under this chapter commits a serious misdemeanor. Each day of
continuing violation following conviction shall be considered a separate
offense.
135H.16. Injunction
Notwithstanding the existence or pursuit of
another remedy, the department may maintain an action for injunction or other
process to restrain or prevent the establishment, operation, or management of a
psychiatric medical institution for children without a license.