Access Centers. Access to what exactly? After the legislature passed a law adding 6 access centers to core services, the Department of Human Services (DHS) answered the question in the Iowa Administrative Code (IAC), chapter 25.

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While running for the legislature, the top complaint by people in the mental health field focused on distance people had to travel to obtain services. The story is still true today. Sheriffs continue to criticize the system due to time it takes to find a bed and transport people to the location.

Sheriffs and deputies report thousands of dollars and countless numbers of man hours required to transport people across the state for assessments. Hospitals require sheriffs to wait with patients until they are seen. And, often the sheriff returns the patient back to where they came from if not admitted.

The amount of waste in that “system” highlighted a necessary system change.

In addition, using hospital emergency rooms for many people in crisis is not best practice. Many need a counselor or case worker to deal with a current crisis and do not meet criteria for an inpatient hospital bed. People in crisis but not needing a hospital reflect those addressed in this service.

The complex needs workgroup, including sheriffs, recommended that the legislature add a minimum of 6 access centers across Iowa by December 2019. As a result, the complex needs legislation included this recommendation.

What is an Access Center?

The IAC defines access centers as:

“Access center” means the coordinated provision of intake assessment, screening for multi-occurring conditions, care coordination, crisis stabilization residential services, subacute mental health services, and substance abuse treatment for individuals experiencing a mental health or substance use crisis who do not need inpatient psychiatric hospital treatment, but who do need significant amounts of supports and services not available in other home- and community-based settings.

Access Center Standards:

  • No residential facility greater than 16 beds – to insure access to Medicaid payment
  • Accreditation to provide Crisis stabilization residential Services
  • License to provide Mental health services
  • License to provide Substance abuse treatment disorder programming or immediate access to program that provides such assistance
  • No eject-no reject policy
  • Accept court-ordered clients

Additional Key Information

According to the IAC, regions work together to create access centers statewide. The State mandated that services shall be within 120 miles of a person needing services. And, they added that a person shall have access within 120 minutes after decided they need such level of care.

What is No-eject, No-reject?

According to the IAC, No Eject-No Reject means that an individual who otherwise meets the eligibility criteria for a service shall not be denied access to that service or discharged from that service based on the severity or complexity of that individual’s mental health and multi-occurring needs.

Someone still needs to determine that a person needs an access center instead of a hospital. Time will tell if sheriffs change current protocol to use access centers instead of hospital emergency rooms across Iowa.

Why 120 miles/120 minutes?

People may wonder why we can’t have access within a closer range. The answer. Iowa does not have the qualified workforce to build services in rural parts of the state. Also, the population need in some areas do not support these high-level services. Regions requested changes to some initial core service standards due to these challenges.

Next Steps

As these new access centers role out across Iowa, expect additional conversations to occur. First, it will be important for the state to track data of center usage versus typical emergency room usage. Second, watching how the “no eject no reject” policy plays out in real life is also critical. Finally, policy makers must listen to center users to assure appropriate and timely services are bring provided.

Discussion:

How do you think the use of access centers will impact mental health services in Iowa?