Behavioral Health and Disability Services Frequently Asked Questions (FAQ)

Yes! You can find information about the Behavioral Health Service System at https://hhs.iowa.gov/initiatives/system-alignment/behavioral-health-service-system.  

The law guiding Iowa’s Behavioral Health Service System transition requires feedback from the public. The Behavioral Health Feedback Form is one opportunity available to submit questions and comments. Those questions help create this FAQ as well as feed into the development of materials for monthly Behavioral Health Town Halls. Previously recorded town halls and links for upcoming town halls can be found here.

Assessment and planning at the state and district levels are intended to ensure that Iowa’s behavioral health service system is both guided by data and attuned to stakeholder feedback. Iowa’s behavioral health service system statewide plan has been in development and the final draft will be posted for public comment in February 2025. 

Each behavioral health district will have a District Advisory Committee to provide feedback and help advise the Behavioral Health Administrative Service Organization on ensuring access to behavioral health prevention, early intervention, treatment, recovery support, and crisis services throughout the district. You can apply to be a part of a District Advisory Council here.

No. House File 2673 transfers the management of disability services from the local Mental Health and Disability Services (MHDS) Regions to the Division of Aging & Disability Services (ADS). To focus on systems of support, care, and connection for all Iowans and families with disability-related needs, management activities will include identifying additional organizations to participate in the Aging and Disability Resource Center (ADRC) network and the creation of a disability services system. 

Iowa HHS has requested individual service level information (plans and services authorizations) from MHDS Regions to ensure continuity of care. Information will be used by Iowa HHS’ Behavioral Health and Aging and Disability Services teams to authorize individual services and ensure care continuity. 

Will there still be training, continuous quality improvement, and best practices for brain injury? 

Yes. Mental health and substance use disorder assessments will continue to include screening for brain injury.  

Incorporation of brain injury awareness, screening, and training into behavioral health work has brought important benefits and will continue. The opportunity to leverage combined resources to invest in training, evidence-based practices, and continuous quality improvement in alignment with the priorities identified through assessment and planning is one of the significant areas of positive impact associated to building Iowa’s behavioral health and disability service systems. 

The BH-ASO will support a strong safety net of behavioral health providers in each behavioral health district. They will work with behavioral health providers and partners to simplify administrative processes, remove duplication and create consistent, centralized functions. The BH-ASO will build on local partnerships to establish access points throughout the district and install accessible system navigation to help all Iowans connect quickly with the help and support they need. This will:

• Ensure equitable access to comprehensive prevention, early intervention, treatment, recovery, and crisis services for behavioral health.
• Connect and collaborate with local leaders and systems like schools, law enforcement, and public health to meet behavioral health needs. 
• Provide information, referrals, and support to help Iowans navigate the behavioral health system.

The application to be considered for the District Advisory Council can be found here.

If so, is it only for parents/caregivers of children under 18? 

We are interested in including all kinds of lived experiences in the make-up of the advisory councils. Please submit your application to us either way.

In person, online and telephonic support for problem solving and navigation of the services and supports available. Behavioral health is important for overall health, and untreated behavioral health problems can lead to serious, chronic health issues. Behavioral health system navigation is available to anyone with no eligibility requirements.   

System navigators ensure individuals and families who encounter barriers in accessing services and support can navigate healthcare, social services, and legal systems. They can help people identify their needs and provide understandable information about available services and supports. 

Navigators help connect people to the right provider, including help with scheduling appointments and can connect to resources such as support groups. System navigators can also support people applying for benefits or can connect them with additional specialized supports and resources.  

Yes. The Iowa PCA envisions that they will initially hire and train system navigators, but the work and the navigators will be embedded alongside providers and at access points throughout the districts. Community Health Worker training will be leveraged for consistency in System Navigator training. 

There are entities that help people with applications for social security and receive specialized training and funding to address specific needs. System Navigators can support individuals and families by sharing information about options, assisting with understanding and completing applications and making connections to specialized supports such as SSI/SSDI Outreach, Access, and Recovery and Ticket to Work or resources available through Aging and Disability Resource Centers (ADRCs), or Senior Health Insurance Information Program (SHIIP). 

Iowa HHS envisions strengthened local connections with key partners like our Community Action Agencies. There are some Community Action Agencies that will continue contracts through the BH-ASO to provide behavioral health services such as prevention and early intervention activities. Community Action Agencies will also serve as key local partners connecting people in need to Behavioral Health providers and System Navigators and collaborating to provide direct assistance for individuals who are navigating economic difficulties. 

Will telehealth access for emergency room crisis assessment and evaluation continue to be available? Will funding for Access Centers still be available? 

Crisis services will be funded because they are a key part of the behavioral health service array and a requirement of the new law. Crisis services are unique as they often operate 24/7/365 and require significant investment beyond fee for service payments to sustain and maintain access to services. The BH-ASO will help ensure system sustainability for crisis services through contracts with crisis service providers. Crisis service providers will continue to be expected to submit claims for billable services to Medicaid for Medicaid enrollees and will begin to submit claims to Iowa HHS for individuals who are not enrolled in Medicaid on 7/1/2025. BH-ASO contracts will outline expectations and access funds to support consistent access to crisis services.  Access funds support safety net providers to enhance service delivery, maintain access to services, and fund other necessary expenses that fall outside of the scope and payment structures of other available funding.

• Each district will have an advisory council made up of local providers, elected officials, and other partners to identify opportunities, tackle challenges, and advise the district Disability Access Point (DAP). 
• System partners and individuals with lived experience will also be asked to help write the state Disability Services System Plan. 

Currently all Mental Health and Disability Services (MHDS) Regions coordinate disability services across Iowa. 

Service navigation is provided by ADRCs. Service navigation means providing individuals, their families, and caregivers access to information to help them make informed decisions about long-term services and supports (LTSS). Service navigation includes: 

• Information and Assistance. 
• Options Counseling. 
• Connection to local providers for needed supports and services (e.g., case management, home modification, etc.). 

People that contact a DAP will receive person-centered support in navigating disability services including, at a minimum, Information and Assistance and Options Counseling. They will be able to call, text, or chat with a DAP staff person about the services and supports available in their community.  

Information and Assistance provides individuals with current information about opportunities and services available within their community. This includes: 

• Identifying the individual’s needs. 
• Ensuring that the individual is aware of the opportunities and services available. 
• Linking the individual to appropriate opportunities and services. 
• Ensuring that the individual receives services. 
• Providing information about assistive technology (as needed).

Options Counseling is an interactive process where individuals receive guidance to make informed choices about long-term supports. The process is directed by the individual and may include others whom the individual chooses or those who are legally authorized to represent the individual. 

An ADRC is a person-centered, community navigation and coordination organization. ADRCs blend service delivery activities and funding to ensure supports and services that contribute to a consumer’s ability to remain at home in their community, are available. 

Yes, a Disability Access Point serves as an Aging and Disability Resource Center (ADRC) and will help Iowans connect with local providers in their community, provide Information and Assistance, and provide Options Counseling. 

Iowa’s Aging and Disability Resource Center (ADRC) Network ensures equitable access to aging and disability services statewide. The ADRC Network consists of ADRC member organizations and the ADRC Technical Assistance and Call Center. Member organizations provide ADRC Information and Assistance and person-centered services at the local level. ADRC member organizations are selected by HHS and include, at a minimum, Disability Access Points and Area Agencies on Aging (AAAs). The ADRC Technical Assistance and Call Center operates the statewide aging and disability services call center and provides training and technical assistance to ADRC member organizations. 

Prevention is now part of the law. HF 2673 marks the first time that Iowa has broadly committed, in statute, to funding behavioral health prevention, early intervention and recovery support efforts. Iowa HHS will use statewide and district level assessment and planning to coordinate efforts and inform future investment. The model is bult on shared responsibility and reliant on active participation and effort. Iowa’s Behavioral Health Service System Statewide Plan information can be found here and the draft strategies and tactics were based on feedback from Iowans. The strategies outlined for prevention efforts address key priorities including consistency, building mental health promotion, making prevention effort visible, and advancing prevention efforts, including building and supporting a statewide prevention workforce

Yes. Iowa HHS has been engaged in assessment across HHS delivery systems, including a range of prevention efforts and activities. HHS System Alignment efforts, including the initial assessment of strengths, gaps and recommendations completed by Health Management Associates (HMA) can be found here. Based on the assessment and recommendations, Governor Reynolds proposed and Iowa legislators, with significant bi-partisan support, passed House File 2673.

Findings outlined that prevention has been conducted in pockets and separate systems that too often failed to share or leverage successes. Champions have invested significant effort but, that effort has often been hyper-local, constrained by funding limitations and disconnected. In some areas, there have been duplicative or even conflicting efforts. Successes that were highlighted included community partnership and youth engagement models been built up in Iowa’s tobacco prevention programs and the incorporation of the Strategic Prevention Framework as a foundation to guide substance use prevention activities.

Local prevention experts and Iowa HHS behavioral health prevention team members were key contributors to the creation the initial draft of system-level strategies and tactics. You can review the initial draft, including the details around how joint efforts will address foundational prevention strategies, here.  If you’d like to share your thoughts, feel free to share those here. The BH-ASO model will provide key linkage between state and local efforts to better support prevention experts and prevention activities throughout the state. 

There were no substantive changes made to the role of Mental Health Advocates as outlined in Iowa Code 229.  

As amended through conforming changes in HF 2673, under Iowa Code 229, counties continue to hold appointment authority and responsibility for mental health advocates. Counties “may seek reimbursement from an administrative services organization.”

There were no substantial changes made to Iowa Code 229. Conforming changes to Iowa Code 229 are laid out in HF 2673.

People with serious mental illness who struggle to manage their basic needs or need support for self-care will continue to be able to access long term services and supports, such as home-based habilitation or similar services. They will continue to be supported through connection with their Medicaid MCO case managers and, for those not enrolled in Medicaid, through their local disability access points. 

In addition, Iowa’s Certified Community Behavioral Health Clinic (CCBHC) demonstration will launch on July 1, 2025, providing access to enhanced behavioral health care with a focus on individuals with serious mental illness, substance use disorders, and co-occurring disorders. CCBHCs are a new type of outpatient care provider required to serve anyone in their clinic regardless of diagnosis, where they live, or their ability to pay. CCBHCs are also required to provide nine core services, including case management, to help ensure the people served through the CCBHC are receiving high quality, coordinated care. 

Through system navigation, the BH-ASO will offer additional support and connection to behavioral healthcare including supporting people with information, connection and referral to a wide range of resources. System navigators are flexible and are not constrained by eligibility requirements. They can help connect individuals leaving incarceration to follow up behavioral healthcare, such as an appointment at their nearest CCBHC, and with supportive resources such as Recovery Housing. 

Unfortunately, no system can deliver the entire answer to the challenges around housing and incarceration for people with serious mental illnesses and substance use disorders. However, building connections to thoughtfully support navigation of the service landscape and strengthening safety net care delivery are essential to maximizing current resources.

The services and supports offered by some MHDS Regions for individuals who are justice-involved have lacked consistent definition. Access and use have significant variance. Iowa HHS has been actively engaged in reviewing and understanding these supports to ensure the behavioral health service system is built in a way that is consistent, sustainable, and focused on the requirements of the law. Iowa HHS leadership will continue to engage with stakeholders, including law enforcement and local decision makers, to ensure understanding and connection at the local level and make sure that all pathways to care, including pathways for justice-involved individuals, are clear and consistent. 

A significant focus of the Behavioral Health Service System Statewide Plan is building and leveraging Iowa’s behavioral health workforce. However, we can’t create more people. Throughout our stakeholder feedback sessions, Iowa HHS challenged contributors to assist in the development of realistic tactics to achieve common goals and Iowans delivered! Tactics identified include removal of administrative and regulatory burdens, improved connections to primary care, enhanced training, and use of non-traditional providers to improve access across the continuum of behavioral health services. The initial draft of system-level strategies and tactics for the statewide plan reviewed during district-level advisory meetings in October can be found here. Further building out this work is likely to be a top priority across all of Iowa’s behavioral health districts.

Through assessment, feedback, and the development of strategies and tactics for Iowa’s Behavioral Health Service System Statewide Plan, Iowans have consistently identified prioritization of workforce a key priority. Iowa HHS incorporated this work into the draft strategies and tactics. Collaborating to build our behavioral health workforce will be a key area of focused work.

We are excited you want to work with us to build Iowa’s Behavioral Health Service System! Information about jobs with Iowa HHS is updated here as positions are available. Similarly, you can also view jobs with the BH-ASO as the Iowa PCA has begun to post positions here. Once new systems are operational, Iowa HHS hopes to partner with the BH-ASO, local providers, and partners to build district-level job posting boards to elevate behavioral health career openings around the state. 

If you are currently an IPERS covered employee, reach out directly to IPERS to understand your ability to collect benefits. The Iowa PCA is not an IPERS covered entity. 

The enabling code that created Iowa’s MHDS Regions will sunset on June 30, 2025. MHDS Regions employ staff who serve a variety of functions, and, at times, those functions are split between region and county responsibilities. Regional Administrators are working with county supervisors to plan for closing out of system functions that sunset with the law as well as assess any ongoing county-level needs.

Iowa HHS has requested, and MHDS Regions are compiling and sharing, all contracts. Once all contracts are received, Iowa HHS will review and compile the information to share with the team at the Iowa PCA. Information about contracting was provided in the January Behavioral Health Town Hall and there will be a progress update shared in the February Behavioral Health Town Hall. 

Iowa HHS will share all current MHDS Regional contracts with the Iowa PCA team. The Iowa PCA will contract to fulfill specific behavioral health service system requirements as of July 1, 2025. They will offer providers who are currently providing those required services and activities the ‘right of first refusal’ to contract in the same area(s) in which they provide coverage today. Contracts will also be shared with the Iowa HHS Aging and Disability Services division for disability and related services.

Iowa HHS will establish a statewide fee schedule, effective July 1, 2025, to pay for behavioral health safety net treatment services for eligible individuals using consistent, fee for service claims payment. Services that will be paid through claims include behavioral health inpatient, outpatient, crisis and residential treatment services. Providers must be Medicaid enrolled to receive reimbursement for these services and Iowa HHS will not execute contracts or establish individual provider rates for behavioral health safety net services.

No. Service coordination typically refers to individualized support provided to eligible populations for long-term services and supports. It is not included in the framework of the Behavioral Health Service System. Service coordination is typically found and will remain part of Iowa’s Disability Services System. Iowa HHS is focused on transitioning the systemic function of service coordination to be the responsibility of the Division of Aging & Disability Services.

The Iowa PCA’s system navigators will work in partnership with behavioral health safety net service providers and partners statewide to provide an evidence-based approach to improving access. 

Iowa HHS and its’ behavioral health administrative services organization (BH-ASO) plan to extend to current behavioral health service system contractors a “right of first refusal” for new contracts when providers or partners are contracted and in good standing for work or activities that meet the requirements outlined in statute (225A) and corresponding rule in so much as the work or specific activities will continue effective July 1, 2025. Right of first refusal will apply to contractors based on current coverage or service areas from MHDS regional contracts or Iowa HHS contracts for activities within the Integrated Provider Network (IPN) and Tobacco Community Partnerships (TCP).

Right of first refusal does not mean that a current provider’s entire contract will be adopted and remain as it is. It doesn’t mean that having a contract in place guarantees the same contract effective on July 1, 2025 and it does not guarantee the same reimbursement structure. 

Right of first refusal means that current contractors get to review contract opportunities and terms first and they can then decide if they wish to continue their contractual activities under the new contract structures. If a provider refuses or if there is no current contract coverage, the BH-ASO will look to other contractors to take over and fulfill the requirements in the area. If there are any gaps in the network either due to no current coverage or due to provider contract refusal Iowa HHS and the BH-ASO will partner to identify barriers and close network gaps.

Iowa HHS is finalizing the statewide service system plan. Once the statewide plan is complete, district planning and budgeting will be developed. Iowa HHS is also analyzing expenditure history to share district-level budget information alongside existing contracts with the BH-ASO to aid in the establishment of simplified contract modeling. The BH-ASO will work with providers to establish new contracts based on the requirements of the law, priorities identified in the state and district plans, and budget available for investment. 

Iowa HHS will also use expenditure history to establish a statewide fee schedule to enable payment by claims for individual billable treatment and crisis services for eligible individuals. To receive reimbursement through the claims system, providers must be enrolled Iowa Medicaid providers. Iowa HHS will not execute contracts or negotiate individual provider rates for fee schedule services.