Bill Text: IA SF2286 | 2023-2024 | 90th General Assembly | Introduced
Bill Title: A bill for an act relating to protections for health care institutions, health care payors, and medical practitioners including those related to the exercise of a right of conscience, whistleblower activities, and free speech, and providing penalties.(Formerly SSB 3006.)
Spectrum: Committee Bill
Status: (Introduced - Dead) 2024-03-12 - Amendment S-5059 filed. S.J. 515. [SF2286 Detail]
Download: Iowa-2023-SF2286-Introduced.html
Senate
File
2286
-
Introduced
SENATE
FILE
2286
BY
COMMITTEE
ON
JUDICIARY
(SUCCESSOR
TO
SSB
3006)
A
BILL
FOR
An
Act
relating
to
protections
for
health
care
institutions,
1
health
care
payors,
and
medical
practitioners
including
2
those
related
to
the
exercise
of
a
right
of
conscience,
3
whistleblower
activities,
and
free
speech,
and
providing
4
penalties.
5
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
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Section
1.
NEW
SECTION
.
135S.1
Definitions.
1
As
used
in
this
chapter,
unless
the
context
otherwise
2
requires:
3
1.
“Adverse
action”
includes
termination
of
employment;
4
transfer
or
demotion
from
a
current
position;
an
adverse
5
administrative
action;
reassignment
to
a
different
shift
or
6
job
title;
increased
administrative
duties;
denial
of
staff
7
privileges;
denial
of
board
certification;
loss
of
career
8
specialty;
reduction
of
wages,
benefits,
or
privileges;
refusal
9
to
award
a
grant,
contract,
or
other
funding
opportunity;
10
refusal
to
provide
residency
training
opportunities;
denial,
11
deprivation,
or
disqualification
of
licensure;
withholding
12
or
disqualifying
from
financial
aid
and
other
assistance;
13
impediment
of
the
establishment
or
improvement
of
a
health
care
14
institution
or
health
care
payor;
impediment
of
the
acquisition
15
or
merger
of
a
health
care
institution
or
health
care
payor;
16
or
any
other
penalty,
discipline,
or
retaliatory
action.
17
“Adverse
action”
does
not
include
the
negotiation
or
purchase
of
18
insurance
by
a
nongovernmental
entity.
19
2.
a.
“Conscience”
means
the
ethical,
moral,
or
religious
20
beliefs
or
principles
held
by
a
medical
practitioner,
health
21
care
institution,
or
health
care
payor.
22
b.
With
respect
to
persons
who
are
institutions,
23
corporations,
or
other
legal
entities,
“conscience”
is
24
determined
by
reference
to
that
entity’s
governing
documents
25
including
but
not
limited
to
published
ethical,
moral,
or
26
religious
guidelines
or
directives,
mission
statements,
27
constitutions,
articles
of
incorporation,
bylaws,
policies,
or
28
regulations.
29
3.
“Discrimination”
means
an
adverse
action
taken
against,
30
or
a
threat
of
adverse
action
communicated
to,
a
medical
31
practitioner,
health
care
institution,
or
health
care
payor
as
32
a
result
of
the
refusal
of
the
medical
practitioner,
health
33
care
institution,
or
health
care
payor
to
participate
in
a
34
health
care
service
on
the
basis
of
conscience.
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4.
“Health
care
institution”
means
a
hospital,
an
1
outpatient
primary
care
location,
a
medical
center,
a
physician
2
organization,
a
professional
association,
an
ambulatory
3
surgical
center,
a
private
office
of
a
medical
practitioner,
a
4
pharmacy,
a
health
care
facility,
a
medical
or
nursing
school,
5
a
medical
training
facility,
or
any
other
entity
or
location
6
in
which
health
care
services
are
performed.
“Health
care
7
institution”
includes
but
is
not
limited
to
organizations,
8
corporations,
partnerships,
associations,
agencies,
networks,
9
sole
proprietorships,
and
joint
ventures.
10
5.
“Health
care
payor”
means
an
employer,
a
health
plan,
11
an
insurer,
a
management
services
organization,
or
any
other
12
entity
that
pays
for
or
arranges
for
payment,
in
whole
or
in
13
part,
for
a
health
care
service.
14
6.
“Health
care
service”
means
medical
research
and
medical
15
care
provided
to
a
patient
or
client
at
any
time
during
the
16
patient’s
or
client’s
course
of
treatment,
including
but
17
not
limited
to
initial
examination,
testing,
diagnosis,
or
18
referral;
dispensing
or
administration
of
a
drug,
medication,
19
or
device;
psychological
therapy
or
counseling;
research,
20
prognosis,
therapy,
recordmaking,
notes
related
to
treatment,
21
set
up,
or
performance
of
a
surgery
or
procedure;
or
any
22
other
care
or
service
performed
or
provided
by
a
medical
23
practitioner.
24
7.
“Insurer”
means
any
entity,
including
a
health
25
service
corporation,
health
maintenance
organization,
or
any
26
similar
corporation
or
organization,
or
an
employer
offering
27
self-insurance,
that
provides
a
health
benefit
plan.
28
8.
“Medical
practitioner”
means
a
person
who
facilitates
29
or
participates,
or
who
is
asked
to
facilitate
or
participate
30
in
a
health
care
service,
including
but
not
limited
to
a
31
health-related
professional
licensed
by
a
board
designated
in
32
section
147.13,
and
any
other
person
licensed,
certified,
or
33
otherwise
authorized
or
permitted
by
the
laws
of
this
state
34
to
administer
a
health
care
service
in
the
ordinary
course
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of
business
or
in
the
practice
of
a
profession.
“Medical
1
practitioner”
includes
any
student
enrolled
in
an
educational
2
institution
who
is
a
prospective
medical
practitioner.
3
9.
“Participate
in
a
health
care
service”
means
to
provide,
4
perform,
assist
with,
facilitate,
refer
for,
provide
counseling
5
for,
advise
with
regard
to,
admit
for
the
purposes
of
6
providing,
or
take
part
in
a
health
care
service
in
any
way.
7
10.
“Person”
means
the
same
as
defined
in
section
4.1.
8
Sec.
2.
NEW
SECTION
.
135S.2
Exercise
of
conscience
for
9
health
care
institutions,
health
care
payors,
and
medical
10
practitioners
——
immunity
——
exception.
11
1.
a.
A
health
care
institution
or
health
care
payor
shall
12
not
be
required
to
participate
in
or
pay
for
a
health
care
13
service
that
violates
the
health
care
institution’s
or
health
14
care
payor’s
conscience,
including
by
permitting
the
use
of
the
15
health
care
institution’s
or
health
care
payor’s
facilities.
16
b.
An
insurer
shall
list
any
health
care
service
the
insurer
17
refuses
to
pay
for
on
the
basis
of
the
insurer’s
right
of
18
conscience
in
the
insurer’s
policies,
plans,
contracts,
or
19
other
agreements.
20
c.
Except
as
provided
in
subsection
4,
a
health
care
21
institution
or
health
care
payor
that
refuses
to
participate
in
22
or
pay
for
a
health
care
service
under
this
section
is
immune
23
from
liability
for
damages
allegedly
arising
from
the
refusal,
24
and
such
refusal
shall
not
be
the
basis
for
any
discrimination
25
against
the
health
care
institution
or
health
care
payor,
or
26
any
personnel,
agent,
or
governing
board
of
the
health
care
27
institution
or
health
care
payor.
28
2.
a.
A
medical
practitioner
has
the
right
not
to
29
participate
in
a
health
care
service
that
violates
the
medical
30
practitioner’s
conscience.
31
b.
A
health
care
institution
may
require
a
medical
32
practitioner
who
is
employed,
contracted,
or
granted
admitting
33
privileges
by
the
health
care
institution
and
who
is
seeking
34
to
exercise
their
conscience
by
not
participating
in
a
health
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care
service,
to
submit
to
the
health
care
institution
a
1
written
refusal
signed
by
the
medical
practitioner.
A
written
2
refusal
made
under
this
paragraph
may
refer
only
generally
to
3
the
grounds
of
conscience.
Except
as
provided
in
subsection
4
4,
a
health
care
institution
is
immune
from
liability
for
the
5
exercise
of
conscience
by
a
medical
practitioner.
6
c.
A
medical
practitioner
who
refuses
to
participate
in
a
7
health
care
service
under
this
section
is
immune
from
liability
8
for
damages
allegedly
arising
from
the
refusal,
and
such
9
refusal
shall
not
be
the
basis
for
any
discrimination
against
10
the
medical
practitioner.
11
3.
This
section
shall
not
be
construed
to
relieve
a
health
12
care
institution
of
the
requirement
to
provide
emergency
13
medical
services
to
all
individuals
as
required
under
42
U.S.C.
14
§1395dd.
15
4.
The
immunity
provisions
of
this
section
shall
not
apply
16
to
a
health
care
institution
or
a
health
care
payor
owned
or
17
operated
by
the
state
or
a
political
subdivision
of
the
state.
18
5.
Notwithstanding
any
other
provision
of
this
chapter
to
19
the
contrary,
a
medical
practitioner,
health
care
institution,
20
or
health
care
payor
that
holds
itself
out
to
the
public
as
21
religion-based,
states
in
the
entity’s
governing
documents
22
that
the
entity
has
a
religious
purpose
or
mission,
and
that
23
has
internal
operating
policies
or
procedures
that
implement
24
the
entity’s
religious
beliefs,
shall
have
the
right
to
make
25
employment,
staffing,
contracting,
and
admitting
privilege
26
decisions
consistent
with
the
entity’s
religious
beliefs.
27
Sec.
3.
NEW
SECTION
.
135S.3
Exercise
of
conscience
not
28
grounds
for
loss
of
privileges,
immunities,
or
public
benefits.
29
The
exercise
of
conscience
by
a
health
care
institution,
30
health
care
payor,
or
medical
practitioner
not
to
participate
31
in
a
health
care
service
shall
not
be
grounds
for
loss
of
any
32
privileges,
immunities,
or
public
benefits
under
state
law.
33
Sec.
4.
NEW
SECTION
.
135S.4
Whistleblower
protections.
34
1.
A
medical
practitioner
or
health
care
institution
shall
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not
be
discriminated
against
because
the
medical
practitioner
1
or
health
care
institution
does
any
of
the
following:
2
a.
Provides,
causes
to
be
provided,
or
intends
to
provide
3
or
cause
to
be
provided
information
relating
to
a
suspected
4
violation
of
this
chapter
to
the
medical
practitioner
or
health
5
care
institution’s
employer,
the
attorney
general,
any
agency
6
charged
with
protecting
health
care
rights
of
conscience,
7
the
United
States
department
of
health
and
human
services,
8
the
United
States
commission
on
civil
rights,
or
any
other
9
federal
agency
charged
with
protecting
health
care
rights
of
10
conscience.
11
b.
Testifies
or
intends
to
testify
in
a
proceeding
12
concerning
a
violation
of
this
chapter.
13
c.
Assists
or
participates,
or
intends
to
assist
or
14
participate,
in
a
proceeding
under
this
chapter.
15
2.
It
shall
be
unlawful
to
discriminate
against
a
medical
16
practitioner
because
the
medical
practitioner
discloses
17
information
that
the
medical
practitioner
reasonably
believes
18
evidences
any
of
the
following:
19
a.
A
violation
of
any
law
or
rule.
20
b.
A
violation
of
any
standard
of
care
or
ethical
guidelines
21
for
the
provision
of
any
health
care
service.
22
c.
Gross
mismanagement,
a
gross
waste
of
funds,
an
abuse
23
of
authority,
practices,
or
methods
of
treatment
that
may
put
24
patient
or
client
health
at
risk,
or
a
substantial
and
specific
25
danger
to
public
health
or
safety.
26
3.
This
section
shall
not
be
construed
to
exempt
a
27
person
from
the
requirements
of
the
federal
Health
Insurance
28
Portability
and
Accountability
Act
of
1996,
Pub.
L.
No.
29
104-191,
including
amendments
thereto
and
regulations
30
promulgated
thereunder,
or
any
other
applicable
confidentiality
31
and
patient
or
client
privacy
requirements.
32
Sec.
5.
NEW
SECTION
.
135S.5
Free
speech
protections
——
33
notification
of
complaints
——
penalty.
34
1.
The
department
of
health
and
human
services,
a
licensing
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board
designated
under
chapter
147,
or
any
other
licensing
1
or
certifying
entity
of
a
medical
practitioner
shall
not
2
reprimand,
sanction,
or
revoke
or
threaten
to
revoke
a
license
3
or
certification
of
a
medical
practitioner
who
is
licensed
4
or
certified
by
the
department,
licensing
board,
or
other
5
licensing
or
certifying
entity
for
engaging
in
speech
or
6
expressive
activity
protected
under
the
first
amendment
to
7
the
Constitution
of
the
United
States,
unless
the
department,
8
licensing
board,
or
other
licensing
or
certifying
entity
9
demonstrates
beyond
a
reasonable
doubt
that
the
medical
10
practitioner’s
speech
was
the
direct
cause
of
physical
11
harm
to
a
person
with
whom
the
medical
practitioner
had
a
12
medical
practitioner-patient
or
medical
practitioner-client
13
relationship
within
the
three
years
immediately
preceding
the
14
incident
of
physical
harm.
15
2.
a.
Within
fourteen
days
of
receiving
a
complaint
that
16
alleges
a
violation
of
speech
or
expressive
activity
protected
17
under
subsection
1
that
may
result
in
revocation
of
a
medical
18
practitioner’s
license,
the
department,
licensing
board,
or
19
other
licensing
or
certifying
entity
shall
provide
the
medical
20
practitioner
with
a
copy
of
the
complaint.
21
b.
If
the
department,
licensing
board,
or
other
licensing
or
22
certifying
entity
fails
to
provide
a
copy
of
the
complaint
to
23
the
medical
practitioner
within
fourteen
days
of
receipt,
the
24
department,
licensing
board,
or
other
certifying
entity
shall
25
pay
the
medical
practitioner
an
administrative
penalty
of
five
26
hundred
dollars
for
each
week
of
noncompliance.
27
Sec.
6.
NEW
SECTION
.
135S.6
Unlawful
interference
——
28
relief.
29
1.
It
is
unlawful
for
a
person
to
interfere
or
attempt
to
30
interfere
with
the
exercise
of
conscience
not
to
participate
in
31
a
health
care
service,
or
in
the
whistleblower
or
free
speech
32
rights
and
protections
under
this
chapter,
whether
by
duress,
33
coercion,
or
any
other
means.
34
2.
A
health
care
institution,
health
care
payor,
or
medical
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practitioner
that
alleges
injury
by
unlawful
interference
1
by
a
person
under
this
chapter
may
bring
a
civil
action
in
2
a
court
of
competent
jurisdiction.
If
a
court
of
competent
3
jurisdiction
finds
a
person
liable
under
this
section,
the
4
court
may
order
any
of
the
following:
5
a.
Injunctive
relief,
when
appropriate,
including
but
not
6
limited
to
reinstatement
of
a
medical
practitioner
to
the
7
medical
practitioner’s
previous
position,
or
reinstatement
8
or
reactivation
of
licensure
or
certification
of
a
medical
9
practitioner,
or
reactivation
or
reinstatement
of
licensure
of
10
a
health
care
institution
or
a
health
care
payor.
11
b.
Monetary
damages
for
injuries
suffered.
12
c.
Reasonable
costs
and
attorney
fees.
13
Sec.
7.
NEW
SECTION
.
135S.7
Relationship
to
rights
and
14
remedies
relating
to
abortion.
15
This
chapter
shall
not
be
construed
to
modify
or
limit
the
16
rights
and
remedies
provided
under
chapter
146.
17
Sec.
8.
NEW
SECTION
.
135S.8
Severability.
18
If
any
provision
of
this
chapter
or
its
application
to
any
19
person
or
circumstance
is
held
invalid,
the
invalidity
shall
20
not
affect
other
provisions
or
applications
of
this
chapter
21
which
can
be
given
effect
without
the
invalid
provision
or
22
application,
and
to
this
end
the
provisions
of
this
chapter
are
23
severable.
24
Sec.
9.
APPLICABILITY.
This
Act
applies
to
a
health
care
25
payor
policy,
contract,
plan,
or
other
agreement
delivered,
26
issued
for
delivery,
continued,
or
renewed
in
this
state
on
or
27
after
January
1,
2025.
28
EXPLANATION
29
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
30
the
explanation’s
substance
by
the
members
of
the
general
assembly.
31
This
bill
relates
to
protections
for
health
care
32
institutions,
health
care
payors,
and
medical
practitioners
33
involving
a
right
of
conscience,
whistleblower
activities,
and
34
free
speech.
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The
bill
provides
definitions
used
in
the
bill
including
for
1
“conscience”,
“health
care
institution”,
“health
care
payor”,
2
“health
care
service”,
and
“medical
practitioner”.
3
The
bill
provides
that
a
health
care
institution
or
health
4
care
payor
shall
not
be
required
to
participate
in
or
pay
for
a
5
health
care
service
that
violates
the
health
care
institution’s
6
or
health
care
payor’s
conscience.
An
insurer
shall
list
any
7
health
care
service
the
insurer
refuses
to
pay
for
on
the
basis
8
of
the
insurer’s
conscience
in
the
insurer’s
policies,
plans,
9
contracts,
or
other
agreements.
10
A
health
care
institution
or
health
care
payor
that
refuses
11
to
participate
in
or
pay
for
a
health
care
service
is
immune
12
from
liability
for
damages
allegedly
arising
from
the
refusal,
13
and
such
refusal
shall
not
be
the
basis
for
any
discrimination
14
against
the
health
care
institution
or
health
care
payor,
or
15
any
personnel,
agent,
or
governing
board
of
the
health
care
16
institution
or
health
care
payor.
17
The
bill
also
provides
that
a
medical
practitioner
has
18
the
right
not
to
participate
in
a
health
care
service
that
19
violates
the
medical
practitioner’s
conscience.
A
health
care
20
institution
may
require
a
medical
practitioner
who
is
employed,
21
contracted,
or
granted
admitting
privileges
by
the
health
care
22
institution
and
who
is
seeking
to
exercise
their
conscience
23
by
not
participating
in
a
health
care
service,
to
submit
to
24
the
health
care
institution
a
written
refusal
signed
by
the
25
medical
practitioner.
A
health
care
institution
is
immune
from
26
liability
for
the
exercise
of
conscience
not
to
participate
in
27
a
health
care
service
by
a
medical
practitioner.
A
medical
28
practitioner
who
refuses
to
participate
in
a
health
care
29
service
due
to
exercise
of
conscience
is
immune
from
liability
30
for
damages
allegedly
arising
from
the
refusal,
and
such
31
refusal
shall
not
be
the
basis
for
any
discrimination
against
32
the
medical
practitioner.
33
These
provisions
are
not
to
be
construed
to
relieve
a
34
health
care
institution
of
the
requirement
under
federal
law
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to
provide
emergency
medical
services
to
all
individuals.
The
1
immunity
provisions
do
not
apply
to
a
health
care
institution
2
or
health
care
payor
owned
or
operated
by
the
state
or
a
3
political
subdivision
of
the
state.
4
The
bill
provides
that
a
medical
practitioner,
health
care
5
institution,
or
health
care
payor
that
holds
itself
out
to
6
the
public
as
religion-based
states
in
the
entity’s
governing
7
documents
that
the
entity
has
a
religious
purpose
or
mission,
8
and
that
has
internal
operating
policies
or
procedures
that
9
implement
the
entity’s
religious
beliefs,
shall
have
the
right
10
to
make
employment,
staffing,
contracting,
and
admitting
11
privilege
decisions
consistent
with
the
entity’s
religious
12
beliefs.
13
The
bill
provides
that
a
medical
practitioner’s,
health
care
14
institution’s,
or
health
care
payor’s
exercise
of
conscience
15
not
to
participate
in
a
health
care
service
shall
not
be
16
grounds
for
loss
of
any
privileges,
immunities,
or
public
17
benefits
under
state
law.
18
The
bill
provides
whistleblower
protections
by
providing
19
that
a
medical
practitioner
or
health
care
institution
shall
20
not
be
discriminated
against
because
the
medical
practitioner
21
or
health
care
institution:
provides,
causes
to
be
provided,
22
or
intends
to
provide
or
cause
to
be
provided
information
23
relating
to
a
suspected
violation
of
the
bill
to
the
medical
24
practitioner
or
health
care
institution’s
employer
or
various
25
other
entities
specified
in
the
bill;
testifies
or
intends
to
26
testify
in
a
proceeding
concerning
a
violation
of
the
bill;
or
27
assists
or
participates,
or
intends
to
assist
or
participate,
28
in
a
proceeding
under
the
bill.
It
is
also
unlawful
under
the
29
bill
to
discriminate
against
a
medical
practitioner
because
30
the
medical
practitioner
discloses
information
to
appropriate
31
government,
regulation,
or
law
enforcement
entities
that
the
32
medical
practitioner
reasonably
believes
evidences
a
violation
33
of
any
law
or
rule;
a
violation
of
any
standard
of
care
or
34
ethical
guidelines
for
the
provision
of
any
health
care
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service;
or
gross
mismanagement,
a
gross
waste
of
funds,
an
1
abuse
of
authority,
practices,
or
methods
of
treatment
that
2
may
put
patient
or
client
health
at
risk,
or
a
substantial
3
and
specific
danger
to
public
health
or
safety.
These
4
provisions
are
not
to
be
construed
to
exempt
a
person
from
the
5
requirements
of
the
federal
Health
Insurance
Portability
and
6
Accountability
Act.
7
The
bill
also
provides
that
the
department
of
health
and
8
human
services
(HHS),
a
health
professional
licensing
board,
9
or
any
other
licensing
or
certifying
entity
of
a
medical
10
practitioner
shall
not
reprimand,
sanction,
or
revoke
or
11
threaten
to
revoke
a
license
or
certification
of
a
medical
12
practitioner
for
engaging
in
speech
or
expressive
activity
13
protected
under
the
first
amendment
to
the
Constitution
of
14
the
United
States,
unless
HHS,
a
licensing
board,
or
other
15
licensing
or
certifying
entity
demonstrates
beyond
a
reasonable
16
doubt
that
the
medical
practitioner’s
speech
was
the
direct
17
cause
of
physical
harm
to
a
person
with
whom
the
medical
18
practitioner
had
a
medical
practitioner-patient
or
medical
19
practitioner-client
relationship
within
the
three
years
20
immediately
preceding
the
incident
of
physical
harm.
Within
14
21
days
of
receiving
a
complaint
alleging
a
violation
of
speech
or
22
expressive
activity
protected
under
the
bill
that
may
result
23
in
revocation
of
a
medical
practitioner’s
license,
HHS,
a
24
licensing
board,
or
other
licensing
or
certifying
entity
shall
25
provide
the
medical
practitioner
with
a
copy
of
the
complaint.
26
If
HHS,
a
licensing
board,
or
other
licensing
or
certifying
27
entity
fails
to
provide
the
complaint
within
14
days
of
28
receipt,
HHS,
the
licensing
board,
or
other
certifying
entity
29
shall
pay
the
medical
practitioner
an
administrative
penalty
of
30
$500
for
each
week
of
noncompliance.
31
The
bill
provides
that
it
is
unlawful
for
a
person
to
32
interfere
or
attempt
to
interfere
with
the
exercise
of
33
conscience
not
to
participate
in
a
health
care
service
or
the
34
whistleblower
or
free
speech
rights
and
protections
authorized
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under
the
bill.
A
health
care
institution,
health
care
payor,
1
or
medical
practitioner
injured
by
unlawful
interference
2
under
the
bill
is
entitled
to
bring
a
civil
action
that,
if
3
successful,
may
result
in
injunctive
relief,
monetary
damages
4
for
injuries
suffered,
and
reasonable
costs
and
attorney
fees.
5
The
provisions
of
the
bill
shall
not
be
construed
as
6
modifying
or
limiting
the
rights
and
remedies
provided
under
7
Code
chapter
146
(abortions
——
refusal
to
perform).
8
The
bill
applies
to
a
health
care
payor
policy,
contract,
9
plan,
or
other
agreement
delivered,
issued
for
delivery,
10
continued,
or
renewed
in
the
state
on
or
after
January
1,
2025.
11
The
bill
includes
a
severability
clause.
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