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.

No. The District Advisory Council will not make funding decisions.  The Councils serve in an advisory role to the BH-ASO.   

Per Iowa Code 225.A.5. the responsibilities of the District Advisory Councils include the following: 

1. Identify opportunities and address challenges based on updates received from the ASO regarding the implementation of the district behavioral health plan. 
2. Advise the ASO while the ASO is developing behavioral health policies. 
3. Advise the ASO on how to best provide access to behavioral health prevention, education, early intervention, treatment, recovery support, and crisis services related to mental health and addictive disorders, including but not limited to alcohol use, substance use, tobacco use, and problem gambling, throughout the district.   

Are we continuing with IBHRS but expanding it?   

There will be no significant changes to IBHRS data collection on July 1, 2025. Licensed substance use providers will continue to report information that cannot be captured through claims into IBHRS. Iowa HHS is reviewing required data sets and systems across the behavioral health service system to determine the best direction for data collection in the future.  

Iowa HHS has held several town hall, public comment, and roundtable conversations related to Iowa's Behavioral Health Service System alignment. During these conversations, we’ve received feedback from providers about the heavy administrative burden and other challenges they encounter related to data collection and reporting.  We hope that providers will share their experiences, both successes and challenges, regarding the current state of data collection and reporting in future conversations.  HHS knows that although there is value in data collection to inform our work, the most important work our providers do is with the people they serve. Our goal is to ensure data are collected in efficient and low-burden ways to ensure services are available to Iowans and timely payment is made to providers. 

Iowa HHS does not recommend investment in further changes or enhancements in your current systems related to IBHRS data collection and reporting at this time. 

Will it move into this model of system navigation?  

Integrated Health Homes (IHH) are authorized under a Medicaid State Plan Amendment (SPA) and operate as delegates for Medicaid Managed Care Organizations (MCOs). The intensive case management components of IHH are linked to long term services and supports (LTSS) for people receiving 1915(i) Habilitation Services and 1915(c) Children’s Mental Health waiver services. Non-intensive IHH is similar to the coordination required of Certified Community Behavioral Health Clinics (CCBHCs) but, more constrained in its’ coverage as IHH is focused on adults with severe mental illness (SMI) and children with a serious emotional disturbance (SED). IHH also has some similarities to System Navigation, though IHH is more constrained in its scope and function. IHH is not a requirement or component of the behavioral health service system and does not fulfill the scope of System Navigation. 

Iowa HHS posted a request for proposals for Behavioral Health Administrative Service Organizations (BH-ASO) in the fall of 2024. Multiple proposals were received for each of the seven behavioral health districts in Iowa. Each proposal was reviewed and evaluated by a committee of evaluators. In the evaluation process, the Iowa Primary Care Association (Iowa PCA) proposal was chosen unanimously as the winning proposal in each of the seven districts. The proposal from the Iowa PCA was noted by evaluators to have put forward a clear vision for the future alongside a robust plan for continuity of care through the system transition. The Iowa PCA proposal can be reviewed here.  

A "safety net provider" is a healthcare provider, like a community mental health center (CMHC), community health center (CHC), or public hospital, that primarily serves low-income and uninsured patients, often relying on government funding to provide care regardless of ability to pay. "Private practice" is a healthcare provider independently owned and operated, typically billing patients directly for services based on their insurance or ability to pay, with more flexibility in patient selection compared to a safety net provider.  

• Patient population: Safety net providers focus on serving a large proportion of uninsured and low-income patients, while private practices can choose their patient population with more flexibility.  
• Funding source: Safety net providers heavily rely on government funding like Medicaid and Medicare, while private practices primarily rely on patient payments and private insurance billing.  
• Financial constraints: Safety net providers have limitations on charging patients due to their requirements to provide care to those with limited means, whereas private practices have more flexibility in setting fees.  

Iowa HHS' Substance Use and Problem Gambling Services Integrated Provider Network (IPN) is a statewide, community-based, resiliency and recovery-oriented system of care for substance use and problem gambling prevention, early intervention, treatment, and recovery support. The IPN was formed and maintained by contract. The structure was not designed within Iowa Code or administrative rule. IPN contracts are ending on 6/30/2025 and will not be reprocured, however the services provided through this network will be continued within the new system with some payments being made directly by Iowa HHS via claims and by the BH-ASO for services not billable through claims.  

Yes. Individuals who are not eligible for Medicaid may be eligible for funding for behavioral health safety net services. Eligibility is defined by rule which outlines need-based and financial eligibility criteria. Adults with income equal to or less than 200% of the federal poverty level (FPL) can qualify for services. This same 200% of FPL threshold applies to household income for children. Additionally, applicants must not have resources over $2,000 in value for an individual or $3,000 in value for a multi-person household.  

There are many services and activities considered to be part of the behavioral health service system that have no financial eligibility threshold. These include crisis services, receiving some forms of recovery support such as peer or recovery community centers, System Navigation, and many prevention-focused activities.

Yes.  Administrative rules require access to an array of crisis services, including Access Centers.  Crisis services are a “firehouse model” which may be eligible for access funds to operate 24/7/365. To receive access funds a service provider must demonstrate meeting basic requirements, such as ensuring access.  For Access Centers, rules require that Iowans have access to services within 60 minutes or 60 miles of their residence.

Or can they provide services for selected counties?

Expectations regarding service provision will be negotiated during the contracting process with the Iowa PCA.

Prevention is now part of the law. House File 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 to support prevention efforts and workforce. 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 public feedback.

Yes. Provider have been embedded into each step of system assessment and are always the most frequent responders to inquiries, surveys, Town Hall, and Public Comment period. Iowa HHS anticipates that providers will continue to play an important role in any assessment going forward but, we are also focused on ensuring that the voices of people and communities who rely on services are not overshadowed by the voices of those who have traditionally had an easier time finding their ‘seat at the table’. To ensure provider specific information is cascading clearly, Iowa PCA will be providing a survey for the district assessment, and it is posted here.

Yes. The goal is to expand the use of warm hand-offs and ensure that people receive easier access to support and care. Ease of access is essential to building a true ‘no wrong door’ approach for Iowans. THRIVE Iowa will connect across a wide spectrum of HHS including Community Access, ADRCs, Disability Access Points, Area Agencies on Aging, and BH-ASO to strengthen the collaboration needed for fulsome system navigation and ensure people are able to access what they need. 

Or will there be an option for an outside of Medicaid fee-for-service?

LTSS services will be billable through a Mangement Information System, similar to Medicaid’s current Mangement Information System (MMIS). Providers can anticipate the release of a fee schedule for LTSS rates and a similar billing process that will go through Iowa HHS for payment. Providers of LTSS services will be expected to be Medicaid enrolled providers. Provider Enrollment | Health & Human Services

made it into the rules or the BHSS. Where will those services be picked up and not lost?

These services are Long-term Services and Supports (LTSS) and are part of the Disability Services System and administrative rules. The services will be accessed through the Disability Access Points (DAPs). Service Coordination for LTSS will be available to plan for these services, as will providing short-term services and supports. Individuals will be supported to access services and supports that they are eligible for and meet their desired goals and needs. 

Town hall meetings are posted underneath Behavioral Health Town Halls on the Iowa Behavioral Health Service System page on the Iowa HHS website. There are three additional town halls scheduled (March 27th, April 24th and May 22nd and you can sign up for them here.

To maintain system stability, 70% of Iowa’s Mental Health Block Grant is anticipated to be allocated to Community Mental Health Centers (CMHC) for FY26. Block grant funds will flow through the BH-ASO contracts with the CMHC. Prior to approval, CMHCs are required to ensure their block grant plans are aligned with both the Behavioral Health Services System statewide plan and the Behavioral Health district plan. 

They have been funded in part in the past by MHDS Regions. 

Most education programs and support groups will continue through the continuity of care period, through contracts with the BH-ASO. During that time, the Iowa PCA will assess programs for long-term fit with each district’s service system plan. 

Treatment for gambling disorder will be reimbursed through a fee-for-service rate. 

• 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. 

Some, but not all, MHDS Regions have funded housing programs in addition to what has traditionally been available through county-funded general assistance programs. These housing programs have operated with ‘threshold criteria’ that has typically required individuals to have a disability. This work will be brought into the disability access point model for further examination and establishment of a consistent, statewide process.  

Will there be a central point of contact for people who need to ask for intensive case management to help people with complex needs?  

Disability Access Points (DAPs) will be a bright front door and connection point for the collective service system. DAPs will screen, connect, and serve individuals with information and assistance, options counseling, short-term services and supports, service coordination of long-term services and supports.  Individuals must meet eligibility requirements for service coordination, including intensive case management, for long-term services and supports.  

For needs-based eligibility individuals who would be served are those with a diagnosis of intellectual disability, a developmental disability, brain injury, or serious mental illness as defined in Iowa Code section 135.22, or individuals who reside in or are at risk of residing in institutional settings due to their disability.  

Who will make those determinations fund those services?  

The responsibility of service coordination for long-term services and supports is the role of the Disability Access Points. 

Will they be served moving forward through this transition?

Individuals previously served by MHDS Regions will transition to an awarded Disability Access Point. Those entities will assume responsibility for service coordination and payment for authorized services for individuals with individualized care plans and authorized services to ensure service continuity.  DAP entities are responsible for evaluating needs and individual eligibility to maximize opportunities and ensure that there is no supplantation or supplementation of Medicaid services.  

The Disability Services System will fund Long-term Services and Supports (LTSS) activities that honor choice and value support for people with disabilities. This includes facility diversion or facilitated care transitions to community-based services as determined through the DAP processes for eligibility and service determination. LTSS will be outlined in the individual’s service plan between the individual, care team, and DAP. 

By the BH-ASO or the Disability Access Point System?

They will be navigated to the right place. What we’re installing when we think about system navigation is a broad-spectrum space. There will be system navigation if that person enters through a DAP, there will be navigation when we think about the behavioral health work. If people need longer-term services and supports and they’re not currently enrolled under the Medicaid program, any navigator is going to have the ability to get them connected into the right next step. People will be directed to the services they need, no matter where they come into the system. The focus is on meeting needs, not on diagnostic categories; some people will receive services through both components of the system.

Yes. It is one of the requirements for DAPs. They will have an advisory council for each district and be composed of individuals with lived experience, providers and community members.

Disability Access Points are responsible for the Service Coordination of Long-term Services and Supports. Iowa HHS will manage the payment for those services will through an Iowa HHS Management Information System, similar to the way that we pay Medicaid claims today.

When can we expect to hear more?

The Disability Services team will begin engaging in a regular schedule of townhall meetings. FAQs are posted bi-weekly to answer questions from townhalls and those received in between.

Claims from behavioral health providers for services that are billable through the Iowa HHS payment system will be sent to Iowa HHS for payment. Other services allowable under the new behavioral health service system will be paid based upon a contract with the BH-ASO.  Iowa HHS will publish guidance documents with detailed billing information to assist providers. 

Through the district assessment process, the BH-ASO will conduct landscape analysis of current resources. Planning in each District will consider connections, impact, and effectiveness of existing care coordination systems to ensure the installation of System Navigation in each District is customized to deliver results and ensure continuity of supports and services.  

Iowa HHS and the BH-ASO will look at system investments statewide to focus on offering training opportunities that are aligned with needs at the state and district level. The Behavioral Health Service System statewide plan identifies supporting workforce, including peers, as a priority across Iowa. 

The Iowa PCA will be making that information available through a variety of ways, including posting meeting dates on Iowa HHS’s behavioral health page and on the Iowa PCA’s website. Anyone is welcome to attend these meetings, and a virtual option will be provided. 

The proposal the Iowa PCA submitted can be found here, underneath the Behavioral Health Administrative Service Organization section of the Iowa HHS behavioral health website. 

Rates for billable services will be set by Iowa HHS using a fee schedule and will be consistent statewide. The BH-ASO and the Disability Access Points will contract for programs and services within their unique scopes of work at the district level. 

done by a MHDS Region or a contracted provider. Will those contracted providers no longer do that work after July 1?

System navigation and service coordination are different. 

System navigation helps individuals and families understand the service system and provide information, education, referral and support.  It is a brief intervention and available to anyone.  System navigation assists in coordinating key transitions in the behavioral health service system, including crisis services and jail-based behavioral health services.  The BH-ASO and DAPs will each establish system navigation at key access points across the districts.  The Iowa PCA is interested in embedding system navigation in provider and community-based organizations. 

Service coordination collaborates and coordinates across multiple providers on a regular, ongoing basis.  The disability service system includes service coordination, and the DAPs will be determining how to establish this service across the districts. The behavioral health system does not include service coordination requirements.  Although many safety net providers and services include service coordination.  The Iowa PCA will be evaluating and determining how to continue to support these services. 

Everyone should continue to work with their MHDS Regions. The Regions are responsible to work both with the new DAPs and with the BH-ASO throughout transition planning.  The Iowa PCA team is meeting in-person with all Regions during the month of March and will begin to have conversations about early transition planning at that time. Once DAPs are through a process of establishing their new contracts, they, too, will be launching into their transition plan efforts. 

Individuals funded for BHIS by an MHDS region will have no interruption to their services as condition of the BH-ASO’s continuity of care period. ASOs in the future however will move towards funding a more evidence-informed, Intensive In-Home and Community Therapeutic Service to correct or improve behavioral health conditions that interfere with a child's functioning.

pay for non-Medicaid services?

Residential care facilities (RCFs) are a service function of the Disability Access Points and funded through the Division of Aging and Disability Services.

Integrated Health Homes (IHH) are authorized under a Medicaid State Plan Amendment (SPA) and operate as delegates for Medicaid Managed Care Organizations (MCOs). IHH is not a requirement or component of the behavioral health service system and does not fulfill the scope of BH-ASO System Navigation.

Yes.

Service Coordination will be a service function of the Disability Access Points and funded through the Division of Aging and Disability Services. No matter the diagnosis of the individual, if the person is needing service coordination as a connection to long-term services and support, this would be accessed through a Disability Access Point and engagement with the Disability Service System.  

Services with standardized procedure codes will be paid by Iowa HHS via a Management Information System. Providers must be Medicaid enrolled to receive reimbursement for these services.

Yes.

The revised Chapter 24. 

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. 

How will the Behavioral Health Districts support first responders?

Partnerships and collaborations between law enforcement, other first responders, and crisis providers will be strengthened through District planning.  Throughout the planning process the BH-ASO will seek input to identify areas of strength and gaps in the crisis system. Statewide behavioral health crisis training for law enforcement and first responders will continue through trainings such as crisis intervention training (CIT) and mental health first aid. 

Services aimed at the assessment, stabilization, treatment, and recovery for a justice involved individual with a mental or substance use disorder can occur anytime from the initial pre-arrest encounter with law enforcement, through the supports necessary to facilitate a successful reentry from prison back into the community.

Co-responder programs are not a required service delivery model in the behavioral health service system.  A law enforcement or county can choose to continue the program, but behavioral health service system funding may not be available.  Through district planning the BH-ASO will facilitate crisis system planning and implement oversight to ensure alignment and coordination with first responders.

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. 

Yes. Iowa HHS will develop provider guidance and forms related to eligibility for behavioral health safety net services for individuals who meet the eligibility criteria outlined in rule.  

Iowa HHS will develop a consistent statewide fee schedule based on analysis including: current Medicaid fee schedule rates, non-Medicaid behavioral health expenditure history, current contracted rates, and available behavioral health service system funding.  

We are trying to prepare to see if we should or should not include these rates and reimbursement.

Most services provided will be paid through an Iowa HHS Management Information System, similar to the way Iowa HHS pays Medicaid claims today. Payment for these services will not require a contract with Iowa HHS, but providers will need to be enrolled as a provider within Iowa Medicaid. Iowa HHS is working to set rates for these services and will share more information with providers in April.   

For the contracts that the BH-ASO will execute that are focused on access and sustainability, we are targeting May and June for contracting after the initial District assessment and planning process is complete. Iowa HHS will provide a budget target for each District to the BH-ASO before contracting can begin.