Iowa House sends narrower subacute mental health care bill to governor

The Iowa House unanimously approved legislation aimed at improving subacute mental health care access in Iowa — though lawmakers of both parties expressed disappointment with changes made by the Iowa Senate.

The Senate’s version of the bill removed some provisions setting new insurance and Managed Care Organizations requirements related to this care.

House File 2543 aims to address problems brought up by family members and advocates at a January study committee meeting about difficulty accessing or getting coverage for subacute mental health care in Iowa — in-person mental health treatment programs for individuals that require intensive care, but do not need emergency hospitalization.

When the bill was first passed by the House in March, it would have eliminated a provision in Iowa Code that set a 10-day limit for individuals to receive subacute mental health care, unless a longer period is approved by the state Department of Health and Human Services. The measure also would have banned preauthorization requirements for an individual to be admitted or receive care for the first 15 days of treatment at subacute mental health care facilities, and restricted periods when MCOs could review the “medical necessity” of treatment, alongside other changes which state officials told lawmakers in January could be placing barriers in people’s attempts to receive subacute mental health care.

But when the Senate took up the measure, legislators in the chamber voted to make significant changes to the proposal, eliminating the specific restrictions on insurers and MCOs related to preauthorization and oversight of a treatment’s “necessity.” Instead, it sets new requirements on Iowa HHS to respond to insurance authorization requests. The state department or MCOs overseeing a patient would be required to provide a determination on a preauthorization request within 48 hours for an “urgent” preauthorization request, within five days for a “nonurgent” request and within 10 days for requests “involving complex or unique circumstances.”

Rep. Beth Wessel-Kroeschell, D-Ames, recommended her colleagues vote in favor of the amendment, despite saying the Senate amendment leans “in favor of private insurance and the MCOs” rather than the needs of people seeking subacute mental health care.

“This is better than current law, I will admit that, but it just simply isn’t as good as what we passed out of the House,” Wessel-Kroeschell said. “I realize that we have to compromise to get out of here. I just wish the compromise would have favored those who need the care.”

During subcommittee meetings on the bill, lobbyists representing insurance companies and MCOs said their data found that preauthorization requests were not causing issues with access to subacute mental health care. Lynh Patterson, representing the MCO Wellpoint Iowa, said in February the insurer had approved 100% of prior authorization requests in 2025.

Rep. Ann Meyer, R-Fort Dodge, said she agreed with Wessel-Koreschell, preferring the House version of the bill. However, she also added that she had reached out to private insurance companies and MCOs to ensure that the issues identified by lawmakers have been addressed.

“We’ll be watching and have the providers watching over the interim, and we will definitely make changes if those promises are not kept,” Meyer said.

The amended bill also requires Iowa HHS provide a review and report to the Legislature about the possibility of offering subacute and other inpatient mental health services at the Independence Mental Health Institute. If deemed feasible within the existing budget, the Iowa HHS director could permit the Independence MHI to begin providing these services July 1, 2027.

The measure heads to the governor for final approval.