Bill Text: IA SSB1133 | 2023-2024 | 90th General Assembly | Introduced

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Bill Title: A bill for an act relating to the health and well-being of children and families including provisions for rural emergency hospitals, regional centers of excellence, noneconomic damage awards against health care providers, a state-funded family medicine obstetrical fellowship program, self-administered hormonal contraceptives, review and approval of and public policy considerations relating to insurance benefits, maternal support and fatherhood initiatives, state employee parental leave, modification of property tax provisions for certain commercial child care properties, adoption expenses under the adoption subsidy program, and accessibility to the all Iowa scholarship program; providing for appropriations, fines, and penalties; and including effective date and applicability and retroactive applicability provisions.

Spectrum: Committee Bill

Status: (Introduced - Dead) 2023-02-06 - Subcommittee: Edler, Evans, and Trone Garriott. [SSB1133 Detail]

Download: Iowa-2023-SSB1133-Introduced.html

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Senate Study Bill 1133 - Introduced
SENATE/HOUSE FILE _____
BY (PROPOSED GOVERNOR BILL)
A BILL FOR
An Act relating to the health and well-being of children and
families including provisions for rural emergency hospitals,
regional centers of excellence, noneconomic damage awards
against health care providers, a state-funded family
medicine obstetrical fellowship program, self-administered
hormonal contraceptives, review and approval of and public
policy considerations relating to insurance benefits,
maternal support and fatherhood initiatives, state employee
parental leave, modification of property tax provisions for
certain commercial child care properties, adoption expenses
under the adoption subsidy program, and accessibility to the
all Iowa scholarship program; providing for appropriations,
fines, and penalties; and including effective date and
applicability and retroactive applicability provisions.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
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DIVISION I
RURAL EMERGENCY HOSPITALS
Section 1. Section 135B.1, Code 2023, is amended by adding
the following new subsections:
NEW SUBSECTION . 5. “Rural emergency hospital” means a
facility that provides rural emergency hospital services in
the facility twenty-four hours per day, seven days per week;
does not provide any acute care inpatient services with the
exception of any distinct part of the facility licensed as a
skilled nursing facility providing posthospital extended care
services; and meets the criteria specified in section 135B.1A
and the federal Consolidated Appropriations Act, Pub. L. No.
116-260, §125.
NEW SUBSECTION . 6. “Rural emergency hospital services”
means the following services provided by a rural emergency
hospital that do not exceed an annual per patient average of
twenty-four hours in such a rural emergency hospital:
a. Emergency department services and observation care.
For purposes of providing emergency department services, an
emergency department of a rural emergency hospital shall
be considered staffed if a physician, nurse practitioner,
clinical nurse specialist, or physician assistant is available
to furnish rural emergency hospital services in the facility
twenty-four hours per day.
b. At the election of the rural emergency hospital, with
respect to services furnished on an outpatient basis, other
medical and health services as specified in regulations adopted
by the United States secretary of health and human services.
Sec. 2. Section 135B.2, Code 2023, is amended to read as
follows:
135B.2 Purpose.
The purpose of this chapter is to provide for the
development, establishment and enforcement of basic standards
for the care and treatment of individuals in hospitals and
rural emergency hospitals and for the construction, maintenance
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and operation of such hospitals, which, in the light of
existing knowledge, will promote safe and adequate treatment
of such individuals in such hospitals, in the interest of the
health, welfare and safety of the public.
Sec. 3. Section 135B.3, Code 2023, is amended to read as
follows:
135B.3 Licensure.
No person or governmental unit, acting severally or jointly
with any other person or governmental unit shall establish,
conduct or maintain a hospital or rural emergency hospital in
this state without a license.
Sec. 4. NEW SECTION . 135B.3A Rural emergency hospital
licensure.
1. The department shall adopt rules pursuant to chapter
17A to establish minimum standards for the licensure of rural
emergency hospitals consistent with the federal Consolidated
Appropriations Act, Pub. L. No. 116-260, §125, and with
regulations issued by the United States secretary of health and
human services for rural emergency hospitals.
2. To be eligible for a rural emergency hospital license, a
facility shall have been, on or before December 27, 2020, one
of the following:
a. A licensed critical access hospital.
b. A general hospital with not more than fifty licensed
beds located in a county in a rural area as defined in section
1886(d)(2)(D) of the federal Social Security Act.
c. A general hospital with no more than fifty licensed beds
that is deemed as being located in a rural area pursuant to
section 1886(d)(8)(E) of the federal Social Security Act.
Sec. 5. Section 135B.4, Code 2023, is amended to read as
follows:
135B.4 Application for license.
Licenses shall be obtained from the department.
Applications shall be upon forms and shall contain information
as the department may reasonably require, which may include
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affirmative evidence of ability to comply with reasonable
standards and rules prescribed under this chapter . Each
application for license shall be accompanied by the license
fee, which shall be refunded to the applicant if the license
is denied and which shall be deposited into the state treasury
and credited to the general fund if the license is issued.
Hospitals and rural emergency hospitals having fifty beds or
less shall pay an initial license fee of fifteen dollars;
hospitals of more than fifty beds and not more than one hundred
beds shall pay an initial license fee of twenty-five dollars;
all other hospitals shall pay an initial license fee of fifty
dollars.
Sec. 6. Section 135B.5, subsection 1, Code 2023, is amended
to read as follows:
1. Upon receipt of an application for license and the
license fee, the department shall issue a license if the
applicant and hospital facilities comply with this chapter ,
chapter 135 , and the rules of the department. Each licensee
shall receive annual reapproval upon payment of five hundred
dollars and upon filing of an application form which is
available from the department. The annual licensure fee shall
be dedicated to support and provide educational programs on
regulatory issues for hospitals and rural emergency hospitals
licensed under this chapter . Licenses shall be either general
or restricted in form. Each license shall be issued only
for the premises and persons or governmental units named in
the application and is not transferable or assignable except
with the written approval of the department. Licenses shall
be posted in a conspicuous place on the licensed premises as
prescribed by rule of the department.
Sec. 7. Section 135B.5A, Code 2023, is amended to read as
follows:
135B.5A Conversion of a hospital relative to certain
hospitals .
1. A conversion of a long-term acute care hospital,
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rehabilitation hospital, or psychiatric hospital as defined by
federal regulations to a general hospital or to a specialty
hospital of a different type is a permanent change in bed
capacity and shall require a certificate of need pursuant to
section 135.63 .
2. A conversion of a critical access hospital or general
hospital to a rural emergency hospital or a conversion of a
rural emergency hospital to a critical access hospital or
general hospital shall not require a certificate of need
pursuant to section 135.63.
Sec. 8. Section 135B.7, Code 2023, is amended to read as
follows:
135B.7 Rules and enforcement.
1. a. The department, with the approval of the state
board of health, shall adopt rules setting out the standards
for the different types of hospitals and for rural emergency
hospitals to be licensed under this chapter . The department
shall enforce the rules.
b. Rules or standards shall not be adopted or enforced
which would have the effect of denying a license to a hospital ,
rural emergency hospital, or other institution required to be
licensed, solely by reason of the school or system of practice
employed or permitted to be employed by physicians in the
hospital, rural emergency hospital, or other institution if the
school or system of practice is recognized by the laws of this
state.
2. a. The rules shall state that a hospital or rural
emergency hospital shall not deny clinical privileges to
physicians and surgeons, podiatric physicians, osteopathic
physicians and surgeons, dentists, certified health service
providers in psychology, physician assistants, or advanced
registered nurse practitioners licensed under chapter 148 ,
148C , 149 , 152 , or 153 , or section 154B.7 , solely by reason of
the license held by the practitioner or solely by reason of
the school or institution in which the practitioner received
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medical schooling or postgraduate training if the medical
schooling or postgraduate training was accredited by an
organization recognized by the council on higher education
accreditation or an accrediting group recognized by the United
States department of education.
b. A hospital or rural emergency hospital may establish
procedures for interaction between a patient and a
practitioner. The rules shall not prohibit a hospital or
rural emergency hospital from limiting, restricting, or
revoking clinical privileges of a practitioner for violation
of hospital rules, regulations, or procedures established
under this paragraph, when applied in good faith and in a
nondiscriminatory manner.
c. This subsection shall not require a hospital or rural
emergency hospital to expand the hospital’s current scope of
service delivery solely to offer the services of a class of
providers not currently providing services at the hospital
or rural emergency hospital . This section shall not be
construed to require a hospital or rural emergency hospital
to establish rules which are inconsistent with the scope of
practice established for licensure of practitioners to whom
this subsection applies.
d. This section shall not be construed to authorize the
denial of clinical privileges to a practitioner or class of
practitioners solely because a hospital or rural emergency
hospital has as employees of the hospital or rural emergency
hospital identically licensed practitioners providing the same
or similar services.
3. The rules shall require that a hospital or rural
emergency hospital establish and implement written criteria
for the granting of clinical privileges. The written criteria
shall include but are not limited to consideration of all of
the following:
a. The ability of an applicant for privileges to provide
patient care services independently and appropriately in the
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hospital or rural emergency hospital .
b. The license held by the applicant to practice.
c. The training, experience, and competence of the
applicant.
d. The relationship between the applicant’s request for the
granting of privileges and the hospital’s or rural emergency
hospital’s current scope of patient care services, as well as
the hospital’s or rural emergency hospital’s determination of
the necessity to grant privileges to a practitioner authorized
to provide comprehensive, appropriate, and cost-effective
services.
4. The department shall also adopt rules requiring
hospitals and rural emergency hospitals to establish and
implement protocols for responding to the needs of patients who
are victims of domestic abuse, as defined in section 236.2 .
5. The department shall also adopt rules requiring
hospitals and rural emergency hospitals to establish and
implement protocols for responding to the needs of patients who
are victims of elder abuse, as defined in section 235F.1 .
Sec. 9. Section 135B.7A, Code 2023, is amended to read as
follows:
135B.7A Procedures —— orders.
The department shall adopt rules that require hospitals
and rural emergency hospitals to establish procedures for
authentication of all verbal orders by a practitioner within
a period not to exceed thirty days following a patient’s
discharge.
Sec. 10. Section 135B.8, Code 2023, is amended to read as
follows:
135B.8 Effective date of rules.
Any hospital or rural emergency hospital which is in
operation at the time of promulgation of any applicable
rules or minimum standards under this chapter shall be given
a reasonable time, not to exceed one year from the date of
such promulgation, within which to comply with such rules and
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minimum standards.
Sec. 11. Section 135B.9, Code 2023, is amended to read as
follows:
135B.9 Inspections and qualifications for hospital and rural
emergency hospital inspectors —— protection and advocacy agency
investigations.
1. The department shall make or cause to be made inspections
as it deems necessary in order to determine compliance with
applicable rules. Hospital and rural emergency hospital
inspectors shall meet the following qualifications:
a. Be free of conflicts of interest. A hospital or rural
emergency hospital inspector shall not participate in an
inspection or complaint investigation of a hospital or rural
emergency hospital in which the inspector or a member of the
inspector’s immediate family works or has worked within the
last two years. For purposes of this paragraph, “immediate
family member” means a spouse; natural or adoptive parent,
child, or sibling; or stepparent, stepchild, or stepsibling.
b. Complete a yearly conflict of interest disclosure
statement.
c. Biennially, complete a minimum of ten hours of continuing
education pertaining to hospital or rural emergency hospital
operations including but not limited to quality and process
improvement standards, trauma system standards, and regulatory
requirements.
2. In the state resource centers and state mental health
institutes operated by the department of human services, the
designated protection and advocacy agency as provided in
section 135C.2, subsection 4 , shall have the authority to
investigate all complaints of abuse and neglect of persons
with developmental disabilities or mental illnesses if the
complaints are reported to the protection and advocacy agency
or if there is probable cause to believe that the abuse has
occurred. Such authority shall include the examination of all
records pertaining to the care provided to the residents and
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contact or interview with any resident, employee, or any other
person who might have knowledge about the operation of the
institution.
Sec. 12. Section 135B.12, Code 2023, is amended to read as
follows:
135B.12 Confidentiality.
The department’s final findings or the final survey findings
of the joint commission on the accreditation of health care
organizations or the American osteopathic association with
respect to compliance by a hospital or rural emergency hospital
with requirements for licensing or accreditation shall be made
available to the public in a readily available form and place.
Other information relating to a hospital or rural emergency
hospital obtained by the department which does not constitute
the department’s findings from an inspection of the hospital
or rural emergency hospital or the final survey findings of
the joint commission on the accreditation of health care
organizations or the American osteopathic association shall
not be made available to the public, except in proceedings
involving the denial, suspension, or revocation of a license
under this chapter . The name of a person who files a complaint
with the department shall remain confidential and shall not
be subject to discovery, subpoena, or other means of legal
compulsion for its release to a person other than department
employees or agents involved in the investigation of the
complaint.
Sec. 13. Section 135B.14, Code 2023, is amended to read as
follows:
135B.14 Judicial review.
Judicial review of the action of the department may be sought
in accordance with chapter 17A . Notwithstanding the terms of
chapter 17A , the Iowa administrative procedure Act, petitions
for judicial review may be filed in the district court of the
county in which the hospital or rural emergency hospital is
located or to be located, and the status quo of the petitioner
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or licensee shall be preserved pending final disposition of the
matter in the courts.
Sec. 14. Section 135B.15, Code 2023, is amended to read as
follows:
135B.15 Penalties.
Any person establishing, conducting, managing, or operating
any hospital or rural emergency hospital without a license
shall be guilty of a serious misdemeanor, and each day of
continuing violation after conviction shall be considered a
separate offense.
Sec. 15. Section 135B.16, Code 2023, is amended to read as
follows:
135B.16 Injunction.
Notwithstanding the existence or pursuit of any other
remedy, the department may, in the manner provided by law,
maintain an action in the name of the state for injunction
or other process against any person or governmental unit to
restrain or prevent the establishment, conduct, management or
operation of a hospital or rural emergency hospital without a
license.
Sec. 16. Section 135B.20, subsection 3, Code 2023, is
amended to read as follows:
3. “Hospital” shall mean means all hospitals and rural
emergency hospitals licensed under this chapter .
Sec. 17. Section 135B.33, subsection 1, unnumbered
paragraph 1, Code 2023, is amended to read as follows:
Subject to availability of funds, the Iowa department of
public health shall provide technical planning assistance to
local boards of health and hospital or rural emergency hospital
governing boards to ensure access to hospital such services in
rural areas. The department shall encourage the local boards
of health and hospital or rural emergency hospital governing
boards to adopt a long-term community health services and
developmental plan including the following:
Sec. 18. Section 135B.34, subsection 7, Code 2023, is
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amended to read as follows:
7. For the purposes of this section , “comprehensive
preliminary background check” :
a. “Comprehensive preliminary background check” means the
same as defined in section 135C.1 .
b. “Hospital” means a hospital or rural emergency hospital
licensed under this chapter.
Sec. 19. EMERGENCY RULEMAKING AUTHORITY. The department of
inspections and appeals may adopt emergency rules under section
17A.4, subsection 3, and section 17A.5, subsection 2, paragraph
“b”, to implement the provisions of this division of this Act
and the rules shall be effective immediately upon filing unless
a later date is specified in the rules. Any rules adopted
in accordance with this section shall also be published as a
notice of intended action as provided in section 17A.4.
Sec. 20. EFFECTIVE DATE. This division of this Act, being
deemed of immediate importance, takes effect upon enactment.
DIVISION II
REGIONAL CENTERS OF EXCELLENCE GRANT PROGRAM
Sec. 21. REGIONAL CENTERS OF EXCELLENCE PROGRAM —— GRANTS ——
APPROPRIATION. There is appropriated from the general fund of
the state to the department of health and human services for
the fiscal year beginning July 1, 2023, and ending June 30,
2024, the following amount, or so much thereof as is necessary,
to be used for the purposes designated:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,000,000
The funds appropriated in this section shall be used for
the continuation of a center of excellence program to award
four grants to encourage innovation and collaboration among
regional health care providers in a rural area based upon the
results of a regional community needs assessment to transform
health care delivery in order to provide quality, sustainable
care that meets the needs of the local communities. An
applicant for the grant funds shall specify how the funds will
be expended to accomplish the goals of the program and shall
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provide a detailed five-year sustainability plan prior to being
awarded any funding. Following the receipt of grant funding,
a recipient shall submit periodic reports as specified by the
department to the governor and the general assembly regarding
the recipient’s expenditure of the funds and progress in
accomplishing the program’s goals.
DIVISION III
NONECONOMIC DAMAGE AWARDS AGAINST HEALTH CARE PROVIDERS
Sec. 22. Section 147.136A, subsection 1, paragraph b, Code
2023, is amended to read as follows:
b. (1) “Noneconomic damages” means damages arising from
pain, suffering, inconvenience, physical impairment, mental
anguish, emotional pain and suffering, loss of chance, loss of
consortium, or any other nonpecuniary damages.
(2) “Noneconomic damages” does not include the loss of
dependent care, including the loss of child care, due to the
death of or severe injury to a spouse or parent who is the
primary caregiver of a child under the age of eighteen or a
disabled adult. Such damages shall be considered economic
damages.
Sec. 23. Section 147.136A, subsection 2, Code 2023, is
amended to read as follows:
2. The total amount recoverable in any civil action for
noneconomic damages for personal injury or death, whether in
tort, contract, or otherwise, against a health care provider
shall be limited to two hundred fifty thousand dollars for any
occurrence resulting in injury or death of a patient regardless
of the number of plaintiffs, derivative claims, theories of
liability, or defendants in the civil action, shall not exceed
two hundred fifty thousand dollars unless the jury determines
that there is a substantial or permanent loss or impairment of
a bodily function, substantial disfigurement, or death, which
warrants a finding that imposition of such a limitation would
deprive the plaintiff of just compensation for the injuries
sustained , in which case the amount recoverable shall not
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exceed one million dollars .
Sec. 24. EFFECTIVE DATE. This division of this Act, being
deemed of immediate importance, takes effect upon enactment.
Sec. 25. APPLICABILITY. This division of this Act applies
to causes of actions accrued on or after the effective date of
this Act.
DIVISION IV
STATE-FUNDED FAMILY MEDICINE OBSTETRICS FELLOWSHIP PROGRAM
Sec. 26. NEW SECTION . 135.182 State-funded family medicine
obstetrics fellowship program —— fund.
1. The department shall establish a family medicine
obstetrics fellowship program to increase access to family
medicine obstetrics practitioners in rural and underserved
areas of the state. A person who has completed an
accreditation council for graduate medical education residency
program in family medicine is eligible for participation
in the fellowship program. Participating fellows shall
enter into a program agreement with a participating teaching
hospital which, at a minimum, requires the fellow to complete a
one-year fellowship and to engage in full-time family medicine
obstetrics practice in a rural or underserved area of the
state for a period of at least five years within nine months
following completion of the fellowship and receipt of a license
to practice medicine in the state.
2. Each fellow participating in the program shall be
eligible for a salary and benefits including a stipend as
determined by the participating teaching hospital which shall
be funded through the family medicine obstetrics fellowship
program fund.
3. The department shall adopt rules pursuant to chapter
17A to administer the program, including defining rural and
underserved areas for the purpose of the required full-time
practice of a person following completion of the fellowship.
4. a. A family medicine obstetrics fellowship program
fund is created in the state treasury consisting of the moneys
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appropriated or credited to the fund by law. Notwithstanding
section 8.33, moneys in the fund at the end of each fiscal year
shall not revert to any other fund but shall remain in the fund
for use in subsequent fiscal years. Moneys in the fund are
appropriated to the department to be used to fund fellowship
positions as provided in this section.
b. For the fiscal year beginning July 1, 2023, and each
fiscal year beginning July 1 thereafter, there is appropriated
from the general fund of the state to the family medicine
obstetrics fellowship program fund an amount sufficient to
support the creation of four fellowship positions as provided
in this section.
5. The department and the participating teaching hospitals
shall regularly evaluate and document their experiences
including identifying ways the program may be modified or
expanded to facilitate increased access to family medicine
obstetrics practitioners in rural and underserved areas of the
state. The department shall submit an annual report to the
general assembly by January 1. The report shall include the
number of fellowships funded to date and any other information
identified by the department and the participating teaching
hospitals as indicators of outcomes and the effectiveness of
the program.
6. For the purposes of this section, “teaching hospital”
means a hospital or medical center that provides medical
education to prospective and current health professionals.
Sec. 27. STATE-FUNDED FAMILY MEDICINE OBSTETRICS FELLOWSHIP
PROGRAM AND FUND —— APPROPRIATION. There is appropriated from
the general fund of the state to the department of health and
human services for the fiscal year beginning July 1, 2023, and
ending June 30, 2024, the following amount, or so much thereof
as is necessary, to be used for the purposes designated:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 560,000
For deposit in the family medicine obstetrics fellowship
program fund to be utilized in creating and providing for four
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family medicine obstetrics fellowship positions during the
fiscal year in accordance with the family medicine obstetrics
fellowship program created in this division of this Act.
DIVISION V
SELF-ADMINISTERED HORMONAL CONTRACEPTIVES
Sec. 28. Section 155A.3, Code 2023, is amended by adding the
following new subsections:
NEW SUBSECTION . 10A. “Department” means the department of
health and human services.
NEW SUBSECTION . 45A. “Self-administered hormonal
contraceptive” means a self-administered hormonal contraceptive
that is approved by the United States food and drug
administration to prevent pregnancy. “Self-administered
hormonal contraceptive” includes an oral hormonal contraceptive,
a hormonal vaginal ring, and a hormonal contraceptive patch,
but does not include any drug intended to induce an abortion as
defined in section 146.1.
NEW SUBSECTION . 45B. “Standing order” means a preauthorized
medication order with specific instructions from the medical
director of the department to dispense a medication under
clearly defined circumstances.
Sec. 29. NEW SECTION . 155A.49 Pharmacist dispensing of
self-administered hormonal contraceptives —— standing order ——
requirements —— limitations of liability.
1. a. Notwithstanding any provision of law to the contrary,
a pharmacist may dispense a self-administered hormonal
contraceptive to a patient who is at least eighteen years of
age, pursuant to a standing order established by the medical
director of the department in accordance with this section.
b. In dispensing a self-administered hormonal contraceptive
to a patient under this section, a pharmacist shall comply with
all of the following:
(1) For an initial dispensing of a self-administered
hormonal contraceptive, the pharmacist may dispense only up
to a three-month supply at one time of the self-administered
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hormonal contraceptive.
(2) For any subsequent dispensing of the same
self-administered hormonal contraceptive, the pharmacist
may dispense up to a twelve-month supply at one time of the
self-administered hormonal contraceptive.
2. A pharmacist who dispenses a self-administered hormonal
contraceptive in accordance with this section shall not
require any other prescription drug order authorized by a
practitioner prior to dispensing the self-administered hormonal
contraceptive to a patient.
3. The medical director of the department may establish a
standing order authorizing the dispensing of self-administered
hormonal contraceptives by a pharmacist who does all of the
following:
a. Complies with the standing order established pursuant to
this section.
b. Retains a record of each patient to whom a
self-administered hormonal contraceptive is dispensed under
this section and submits the record to the department.
4. The standing order shall require a pharmacist who
dispenses self-administered hormonal contraceptives under this
section to do all of the following:
a. Complete a standardized training program and continuing
education requirements approved by the board in consultation
with the board of medicine and the department that are related
to prescribing self-administered hormonal contraceptives and
include education regarding all contraceptive methods approved
by the United States food and drug administration.
b. Obtain a completed self-screening risk assessment,
approved by the department in collaboration with the board and
the board of medicine, from each patient, verify the identity
and age of each patient, and perform a blood pressure screening
on each patient prior to dispensing the self-administered
hormonal contraceptive to the patient.
c. Provide the patient with all of the following:
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(1) Written information regarding all of the following:
(a) The importance of completing an appointment with the
patient’s primary care or women’s health care practitioner
to obtain preventative care, including but not limited to
recommended tests and screenings.
(b) The effectiveness and availability of long-acting
reversible contraceptives as an alternative to
self-administered hormonal contraceptives.
(2) A copy of the record of the pharmacist’s encounter with
the patient that includes all of the following:
(a) The patient’s completed self-screening risk assessment.
(b) A description of the contraceptive dispensed, or the
basis for not dispensing a contraceptive.
(3) Patient counseling regarding all of the following:
(a) The appropriate administration and storage of the
self-administered hormonal contraceptive.
(b) Potential side effects and risks of the
self-administered hormonal contraceptive.
(c) The need for backup contraception.
(d) When to seek emergency medical attention.
(e) The risk of contracting a sexually transmitted
infection or disease, and ways to reduce such a risk.
5. The standing order established pursuant to this section
shall prohibit a pharmacist who dispenses a self-administered
hormonal contraceptive under this section from doing any of the
following:
a. Requiring a patient to schedule an appointment with
the pharmacist for the prescribing or dispensing of a
self-administered hormonal contraceptive.
b. Dispensing self-administered hormonal contraceptives
to a patient for more than twenty-seven months after the
date a self-administered hormonal contraceptive is initially
dispensed to the patient, if the patient has not consulted with
a primary care or women’s health care practitioner during the
preceding twenty-seven months, in which case the pharmacist
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shall refer the patient to a primary care or women’s health
care practitioner.
c. Dispensing a self-administered hormonal contraceptive to
a patient if the results of the self-screening risk assessment
completed by a patient pursuant to subsection 4, paragraph
“b” , indicate it is unsafe for the pharmacist to dispense the
self-administered hormonal contraceptive to the patient, in
which case the pharmacist shall refer the patient to a primary
care or women’s health care practitioner.
6. A pharmacist who dispenses a self-administered hormonal
contraceptive and the medical director of the department who
establishes a standing order in compliance with this section
shall be immune from criminal and civil liability arising
from any damages caused by the dispensing, administering,
or use of a self-administered hormonal contraceptive or the
establishment of the standing order. The medical director of
the department shall be considered to be acting within the
scope of the medical director’s office and employment for
purposes of chapter 669 in the establishment of a standing
order in compliance with this section.
7. The department, in collaboration with the board and
the board of medicine, and in consideration of the guidelines
established by the American congress of obstetricians and
gynecologists, shall adopt rules pursuant to chapter 17A to
administer this chapter.
Sec. 30. Section 514C.19, Code 2023, is amended to read as
follows:
514C.19 Prescription contraceptive coverage.
1. Notwithstanding the uniformity of treatment requirements
of section 514C.6 , a group policy , or contract , or plan
providing for third-party payment or prepayment of health or
medical expenses shall not do either of the following comply
as follows :
a. Exclude Such policy, contract, or plan shall not
exclude or restrict benefits for prescription contraceptive
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drugs or prescription contraceptive devices which prevent
conception and which are approved by the United States
food and drug administration, or generic equivalents
approved as substitutable by the United States food and
drug administration, if such policy , or contract , or plan
provides benefits for other outpatient prescription drugs
or devices. However, such policy, contract, or plan shall
specifically provide for payment of a self-administered
hormonal contraceptive, as prescribed by a practitioner as
defined in section 155A.3, or as prescribed by standing order
and dispensed by a pharmacist pursuant to section 155A.49,
including payment for up to an initial three-month supply
of a self-administered hormonal contraceptive dispensed at
one time and for up to a twelve-month supply of the same
self-administered hormonal contraceptive subsequently dispensed
at one time.
b. Exclude Such policy, contract, or plan shall not exclude
or restrict benefits for outpatient contraceptive services
which are provided for the purpose of preventing conception if
such policy , or contract , or plan provides benefits for other
outpatient services provided by a health care professional.
2. A person who provides a group policy , or contract , or
plan providing for third-party payment or prepayment of health
or medical expenses which is subject to subsection 1 shall not
do any of the following:
a. Deny to an individual eligibility, or continued
eligibility, to enroll in or to renew coverage under the terms
of the policy , or contract , or plan because of the individual’s
use or potential use of such prescription contraceptive drugs
or devices, or use or potential use of outpatient contraceptive
services.
b. Provide a monetary payment or rebate to a covered
individual to encourage such individual to accept less than the
minimum benefits provided for under subsection 1 .
c. Penalize or otherwise reduce or limit the reimbursement
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of a health care professional because such professional
prescribes contraceptive drugs or devices, or provides
contraceptive services.
d. Provide incentives, monetary or otherwise, to a health
care professional to induce such professional to withhold
from a covered individual contraceptive drugs or devices, or
contraceptive services.
3. This section shall not be construed to prevent a
third-party payor from including deductibles, coinsurance, or
copayments under the policy , or contract, or plan as follows:
a. A deductible, coinsurance, or copayment for benefits
for prescription contraceptive drugs shall not be greater than
such deductible, coinsurance, or copayment for any outpatient
prescription drug for which coverage under the policy , or
contract , or plan is provided.
b. A deductible, coinsurance, or copayment for benefits for
prescription contraceptive devices shall not be greater than
such deductible, coinsurance, or copayment for any outpatient
prescription device for which coverage under the policy , or
contract , or plan is provided.
c. A deductible, coinsurance, or copayment for benefits for
outpatient contraceptive services shall not be greater than
such deductible, coinsurance, or copayment for any outpatient
health care services for which coverage under the policy , or
contract , or plan is provided.
4. This section shall not be construed to require a
third-party payor under a policy , or contract , or plan
to provide benefits for experimental or investigational
contraceptive drugs or devices, or experimental or
investigational contraceptive services, except to the extent
that such policy , or contract , or plan provides coverage for
other experimental or investigational outpatient prescription
drugs or devices, or experimental or investigational outpatient
health care services.
5. This section shall not be construed to limit or otherwise
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discourage the use of generic equivalent drugs approved by the
United States food and drug administration, whenever available
and appropriate. This section , when a brand name drug is
requested by a covered individual and a suitable generic
equivalent is available and appropriate, shall not be construed
to prohibit a third-party payor from requiring the covered
individual to pay a deductible, coinsurance, or copayment
consistent with subsection 3 , in addition to the difference of
the cost of the brand name drug less the maximum covered amount
for a generic equivalent.
6. A person who provides an individual policy , or contract ,
or plan providing for third-party payment or prepayment of
health or medical expenses shall make available a coverage
provision that satisfies the requirements in subsections
1 through 5 in the same manner as such requirements are
applicable to a group policy , or contract , or plan under those
subsections. The policy , or contract , or plan shall provide
that the individual policyholder may reject the coverage
provision at the option of the policyholder.
7. a. This section applies to the following classes of
third-party payment provider contracts , or policies , or plans
delivered, issued for delivery, continued, or renewed in this
state on or after July 1, 2000 January 1, 2024 :
(1) Individual or group accident and sickness insurance
providing coverage on an expense-incurred basis.
(2) An individual or group hospital or medical service
contract issued pursuant to chapter 509 , 514 , or 514A .
(3) An individual or group health maintenance organization
contract regulated under chapter 514B .
(4) Any other entity engaged in the business of insurance,
risk transfer, or risk retention, which is subject to the
jurisdiction of the commissioner.
(5) A plan established pursuant to chapter 509A for public
employees.
b. This section shall not apply to accident-only,
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specified disease, short-term hospital or medical, hospital
confinement indemnity, credit, dental, vision, Medicare
supplement, long-term care, basic hospital and medical-surgical
expense coverage as defined by the commissioner, disability
income insurance coverage, coverage issued as a supplement
to liability insurance, workers’ compensation or similar
insurance, or automobile medical payment insurance.
8. This section shall not be construed to require a
third-party payor to provide payment to a practitioner for the
dispensing of a self-administered hormonal contraceptive to
replace a self-administered hormonal contraceptive that has
been dispensed to a covered person and that has been misplaced,
stolen, or destroyed. This section shall not be construed to
require a third-party payor to replace covered prescriptions
that are misplaced, stolen, or destroyed.
9. For the purposes of this section, “self-administered
hormonal contraceptive” and “standing order” mean the same as
defined in section 155A.3.
Sec. 31. INFORMATION PROGRAM FOR DRUG PRESCRIBING AND
DISPENSING —— SELF-ADMINISTERED HORMONAL CONTRACEPTIVES. The
board of pharmacy in collaboration with the board of medicine
and the department of health and human services shall expand
the information program for drug prescribing and dispensing
established pursuant to section 124.551, to collect from
pharmacists information relating to the dispensing of
self-administered hormonal contraceptives as provided pursuant
to section 155A.49. The board of pharmacy shall adopt
rules pursuant to chapter 17A related to registration of
participating pharmacists, the information to be reported by a
pharmacist to the information program, access to information
from the program, and other rules necessary to carry out the
purposes and to enforce the provisions of this section.
Sec. 32. APPLICATION TO MEDICAID PROGRAM. This division
of this Act shall apply to the Medicaid program including a
managed care organization acting pursuant to a contract with
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the department of health and human services to administer
the Medicaid program under chapter 249A. However, if it is
determined that any provision of this division of this Act
would cause denial of federal funds under Tit. XVIII or XIX
of the federal Social Security Act, or would otherwise be
inconsistent or conflict with the requirements of federal law
or regulation, such provision shall be suspended, but only to
the extent necessary to prevent denial of such funds or to
eliminate the inconsistency or conflict with the requirements
of federal law or regulation.
DIVISION VI
INSURANCE BENEFITS —— REVIEW AND APPROVAL —— PUBLIC POLICY
CONSIDERATIONS
Sec. 33. Section 509.3, Code 2023, is amended by adding the
following new subsection:
NEW SUBSECTION . 3. a. A policy or policy form in
connection with a policy of group accident or health insurance,
or combination thereof, that is issued in this state shall
not contain a provision that is unjust, unfair, inequitable,
misleading, deceptive, encourages misrepresentation of the
policy, or that is otherwise contrary to public policy.
b. It shall be unlawful for a carrier to issue a policy, or
to use a policy form in connection with a policy, after notice
from the commissioner of insurance that the policy or policy
form violates paragraph “a” .
c. A carrier shall have twenty days after receipt of a
notice under paragraph “b” to request a hearing to contest
the commissioner’s notice. The hearing shall be conducted
pursuant to chapter 17A. If the hearing results in a decision
that affirms the commissioner’s notice, the decision shall
be provided to the carrier in writing and shall specify the
reasons for the decision.
Sec. 34. NEW SECTION . 513B.4C Filing requirement —— prior
approval.
1. a. A group policy of insurance against loss or expense
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from sickness, or from the bodily injury or death by accident
of the insured, shall not be issued or delivered in this state
by a carrier until a copy of the policy has been filed with, and
approved by, the commissioner.
b. An application, rider, or endorsement shall not be used
in connection with a group policy under paragraph “a” until a
copy of the policy form has been filed with, and approved by,
the commissioner.
2. A filing under subsection 1 shall be deemed approved
unless disapproved by the commissioner within thirty days of
the date the filing is received by the commissioner.
Sec. 35. NEW SECTION . 513B.4D Filing —— disapproval.
1. a. The commissioner shall provide notice to a
carrier that has filed a policy form pursuant to section
513B.4C, subsection 1, if upon review of the policy form the
commissioner finds any of the following:
(1) The benefits provided are unreasonable in relation to
the premium charged.
(2) The policy form contains a provision that is unjust,
unfair, inequitable, misleading, deceptive, encourages
misrepresentation of the policy, or is otherwise contrary to
public policy.
b. The notice under paragraph “a” shall do all of the
following:
(1) Advise the carrier that the policy form does not comply
with this section, or with the rules adopted pursuant to
chapter 17 to implement and administer this section.
(2) Advise the carrier that it shall be unlawful for the
carrier to issue the policy form or to use the policy form in
connection with any policy.
(3) Provide the specific reasons for the commissioner’s
disapproval of the policy form.
2. A carrier shall have twenty days after receipt of a
notice under subsection 1 to request a hearing to contest
the commissioner’s notice. The hearing shall be conducted
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pursuant to chapter 17A. If the hearing results in a decision
that affirms the commissioner’s notice, the decision shall
be provided to the carrier in writing and shall specify the
reasons for the decision.
Sec. 36. NEW SECTION . 513B.4E Withdrawal of approval.
1. The commissioner may, after opportunity for hearing,
withdraw the commissioner’s previous approval of a policy form
under section 513B.4C if the policy form is in violation of
section 513B.4D, subsection 1, paragraph “a” . The hearing shall
be conducted pursuant to chapter 17A. Notice to the carrier
of the hearing shall specify the matters to be considered at
the hearing.
2. It shall be unlawful for a carrier to issue a policy
form, or to use a policy form in connection with any group
policy, on or after the effective date of the commissioner’s
withdrawal of a previous approval of the policy form.
3. If a hearing results in a decision to withdraw a previous
approval of a policy form, the decision shall be provided to
the carrier in writing and shall specify the reasons for the
commissioner’s withdrawal of the prior approval.
DIVISION VII
MORE OPTIONS FOR MATERNAL SUPPORT (MOMS) PROGRAM —— FATHERHOOD
INITIATIVES
Sec. 37. Section 217.41C, subsection 1, paragraph c, Code
2023, is amended to read as follows:
c. For the purposes of this section , “pregnancy support
services” means those nonmedical services that promote
childbirth by providing information, counseling, and support
services that assist pregnant women or women who believe they
may be pregnant and men who are involved or who think they
might be involved in a pregnancy to choose childbirth and to
make informed decisions regarding the choice of adoption or
parenting with respect to their children.
Sec. 38. Section 217.41C, Code 2023, is amended by adding
the following new subsections:
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NEW SUBSECTION . 8. The department shall develop and
maintain a virtual clearinghouse of pregnancy support
services and resources including but not limited to all of the
following:
a. Pregnancy resource center and maternity home information
including contact information, location, and services provided.
b. Assistance in accessing public assistance including but
not limited to the special supplemental nutrition program for
women, infants, and children and the supplemental nutrition
assistance program.
c. Educational resources.
d. Housing assistance.
e. Recovery and mental health services.
f. Family planning education.
g. Adoption and foster care information and services.
h. Healing and support services for abortion survivors and
their families.
NEW SUBSECTION . 9. Beginning July 1, 2023, and thereafter,
funding for the program may be used for all of the following
purposes:
a. Fatherhood engagement grants. The department may
award grants to nonprofit, community-based organizations to
address the needs of fathers by assisting fathers in finding
employment, managing child support obligations, transitioning
from a period of incarceration, accessing health care,
understanding child development, and enhancing parenting skills
using evidence-based parenting education. Priority in the
awarding of grants shall be based on the demonstrated need
in a geographic area and the prevalence of the population to
be served as indicated by factors including but not limited
to the service area’s unemployment rate, incarceration rate,
number of public assistance recipients, number of single-parent
households, level of housing instability, and graduation rates.
b. Fatherhood communications initiative. The department
shall administer a communications initiative on responsible
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fatherhood including but not limited to a public internet site
that provides access to resources on effective parenting and
assistance in receiving parenting support and services.
c. Mentoring school-aged males grant program. The
department may award three-year renewable grants to nonprofit
organizations that provide mentorship, social and academic
support, and life skills development to school-aged males.
Priority in the awarding of grants shall be based on the
demonstrated need in a geographic area and the prevalence of
the population to be served as indicated by factors including
but not limited to the service area’s unemployment rate,
incarceration rate, number of public assistance recipients,
number of single-parent households, level of housing
instability, and graduation rates. The department shall
provide technical assistance to grantees to ensure program
sustainability following the end of the three-year grant
period.
Sec. 39. MORE OPTIONS FOR MATERNAL SUPPORT PROGRAM ——
APPROPRIATION. There is appropriated from the general fund of
the state to the department of health and human services for
the fiscal year beginning July 1, 2023, and ending June 30,
2024, the following amount, or so much thereof as is necessary,
to be used for the purposes designated:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2,000,000
To be used for the purposes of the more options for maternal
support program created in section 217.41C, including for
program administration, the provision of services, and for
funding of fatherhood engagement grants, the fatherhood
communications initiative, and the mentoring school-aged males
grant program.
Sec. 40. 2022 Iowa Acts, chapter 1131, section 28,
subsection 8, is amended to read as follows:
8. Of the funds appropriated under this section, $500,000
shall be used for the purposes of program administration and
provision of pregnancy support services through the more
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options for maternal support program created in this Act.
Notwithstanding section 8.33, moneys appropriated in this
subsection that remain unencumbered or unobligated at the close
of the fiscal year shall not revert but shall remain available
for the purposes designated until the close of the succeeding
fiscal year.
Sec. 41. EFFECTIVE DATE. The following, being deemed of
immediate importance, takes effect upon enactment:
The section of this division of this Act amending 2022 Iowa
Acts, chapter 1131, section 28, subsection 8.
DIVISION VIII
STATE EMPLOYEE PAID PARENTAL LEAVE BENEFIT
Sec. 42. NEW SECTION . 70A.31 Paid parental leave.
1. A state employee entitled to leave under the federal
Family and Medical Leave Act of 1993 shall be provided paid
leave for such time as specified in this section for the birth
or placement for adoption with the employee of a child if the
leave is taken within twelve months following any such birth
or adoption.
2. a. For the birth of a child, a state employee parent who
gave birth shall be entitled to up to four weeks of paid leave
and a state employee parent who did not give birth shall be
entitled to up to one week of paid leave.
b. For the placement for adoption of a child, a state
employee parent shall be entitled to up to four weeks of paid
leave.
3. The department of administrative services shall adopt
rules to implement this section.
DIVISION IX
PROPERTY TAX MODIFICATIONS —— LICENSED COMMERCIAL CHILD CARE
CENTERS AND CHILD CARE FACILITIES
Sec. 43. Section 441.21, subsection 5, paragraph b,
subparagraph (2), unnumbered paragraph 1, Code 2023, is amended
to read as follows:
For Except for property subject to subparagraph (3), for
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valuations established for the assessment year beginning
January 1, 2022, and each assessment year thereafter, the
portion of actual value at which each property unit of
commercial property shall be assessed shall be the sum of the
following:
Sec. 44. Section 441.21, subsection 5, paragraph b, Code
2023, is amended by adding the following new subparagraph:
NEW SUBPARAGRAPH . (3) (a) For valuations established
for the assessment year beginning January 1, 2023, and each
assessment year thereafter, the portion of actual value at
which each portion of a property unit of commercial property
that is primarily used as a child care center or child care
facility, as defined in section 237A.1, and for which an
application has been allowed under this subparagraph, shall be
assessed at an amount equal to the product of the assessment
limitation percentage applicable to residential property under
subsection 4 for that assessment year multiplied by the actual
value of the property.
(b) A person who wishes to qualify for the assessment
limitation under this subparagraph shall file an application
with the assessor not later than July 1 of the assessment
year for which the person is first requesting the assessment
limitation on forms provided by the department of revenue.
The application shall describe the property and its location
and include other information required by the department of
revenue. The application shall be accompanied by a copy
of the license to operate as a child care center or child
care facility issued by the department of health and human
services or other proof of eligibility set forth in rule by the
department of revenue. Upon allowance of the application, the
assessment limitation shall be applied to the portion of the
property unit of commercial property that is primarily used as
a child care center or child care facility for successive years
without further filing as long as the portion of the property
unit continues to be classified as commercial property and is
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used for the purposes specified in the application.
(c) Not later than July 6 of each year, the assessor shall
remit the applications for the assessment limitation to the
county auditor with the assessor’s recommendation for allowance
or disallowance. If the assessor recommends disallowance, the
assessor shall submit the reasons for the recommendation, in
writing, to the county auditor.
(d) Not later than July 15 of each year, the county auditor
shall forward the applications for the assessment limitation
to the board of supervisors. The board shall determine the
eligibility for each application on or before September 1 of
each year. If the board disallows a claim, it shall send
written notice, by mail, to the applicant at the applicant’s
last-known address. The notice shall state the reasons for
disallowing the application and shall state the applicant’s
right to appeal the board’s action to the district court under
subparagraph division (f).
(e) All applications that have been allowed by the board of
supervisors shall be certified on or before October 1, in each
year, by the board of supervisors to the county auditor.
(f) Within thirty days following the date of the notice of
disallowance under subparagraph division (d), the applicant may
appeal the disallowance to the district court of the county in
which the property is situated.
(g) If the person ceases to use the property as a child
care center or child care facility, the person shall provide
written notice to the assessor by July 1 following the date on
which the use has changed. If, at any time within thirty-six
months following the date that an application is allowed,
the board determines that the person received an assessment
limitation under this subparagraph that the person is not
entitled to, the treasurer shall collect from the person the
amount of additional tax that would have been assessed on the
property if the property received the assessment limitations
under subparagraph (2), and the amount shall become a lien
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on the property that received the assessment limitation and
shall be collected by the county treasurer in the same manner
as other taxes. Prior to the board’s determination that a
person received an assessment limitation that the person is
not entitled to, the board shall notify the person by mail and
conduct a hearing.
(h) The assessor shall retain a permanent file of current
applications made under this subparagraph. The county recorder
shall give notice to the assessor of each transfer of title
filed in the recorder’s office. The notice from the county
recorder shall describe the property transferred, the name of
the person transferring title to the property, and the name of
the person to whom title to the property has been transferred.
The assessor shall file a notice of transfer of property for
which an application is filed when notice is received from the
office of the county recorder.
(i) The department shall adopt rules to implement and
administer this subparagraph.
Sec. 45. Section 441.21, subsection 5, paragraph e,
subparagraphs (1) and (3), Code 2023, are amended to read as
follows:
(1) For each fiscal year beginning on or after July 1, 2023,
there is appropriated from the general fund of the state to
the department of revenue the sum of one hundred twenty-five
million dollars to be used for payments under this paragraph
calculated as a result of the assessment limitations imposed
under paragraph “b” , subparagraph (2), subparagraph division
(a) ; , and paragraph “c” , subparagraph (2), subparagraph
division (a) ; and paragraph “b” , subparagraph (3), for the
portion of actual value of each property unit subject to the
assessment limitation under paragraph “b” , subparagraph (3),
that is less than or equal to one hundred fifty thousand
dollars .
(3) On or before July 1 of each fiscal year, the assessor
shall report to the county auditor that portion of the total
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actual value of all commercial property and industrial property
in the county that is subject to the assessment limitations
imposed under paragraph “b” , subparagraph (2), subparagraph
division (a) ; , and paragraph “c” , subparagraph (2),
subparagraph division (a) , ; and paragraph “b” , subparagraph
(3), for the portion of actual value of each property unit
subject to the assessment limitation under paragraph “b” ,
subparagraph (3), that is less than or equal to one hundred
fifty thousand dollars, for the assessment year used to
calculate the taxes due and payable in that fiscal year.
Sec. 46. Section 441.21, subsection 5, paragraph e,
subparagraph (4), subparagraph division (a), Code 2023, is
amended to read as follows:
(a) The product of the portion of the total actual value
of all commercial property, industrial property, and property
valued by the department under chapter 434 in the county
that is subject to the assessment limitations imposed under
paragraph “b” , subparagraph (2), subparagraph division (a) ; ,
and paragraph “c” , subparagraph (2), subparagraph division
(a) , ; and paragraph “b” , subparagraph (3), for the portion of
actual value of each property unit subject to the assessment
limitation under paragraph “b” , subparagraph (3), that is less
than or equal to one hundred fifty thousand dollars, for the
applicable assessment year used to calculate taxes which are
due and payable in the applicable fiscal year multiplied by the
difference, stated as a percentage, between ninety percent and
the assessment limitation percentage applicable to residential
property under subsection 4 for the applicable assessment year.
Sec. 47. EFFECTIVE DATE. This division of this Act, being
deemed of immediate importance, takes effect upon enactment.
Sec. 48. RETROACTIVE APPLICABILITY. The following apply
retroactively to assessment years beginning on or after January
1, 2023:
1. The section of this division of this Act amending
section 441.21, subsection 5, paragraph “b”, subparagraph (2),
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unnumbered paragraph 1.
2. The section of this division of this Act enacting section
441.21, subsection 5, paragraph “b”, subparagraph (3).
Sec. 49. APPLICABILITY. The following apply July 1, 2024,
for payments under section 441.21, subsection 5, paragraph “e”,
for fiscal years beginning on or after that date:
1. The section of this division of this Act amending section
441.21, subsection 5, paragraph “e”, subparagraphs (1) and (3).
2. The section of this division of this Act amending
section 441.21, subsection 5, paragraph “e”, subparagraph (4),
subparagraph division (a).
DIVISION X
NONRECURRING ADOPTION EXPENSES —— ADOPTION SUBSIDY PROGRAM
Sec. 50. NEW SECTION . 234.48 Adoption subsidy ——
nonrecurring adoption expenses.
Notwithstanding any provision to the contrary, the maximum
reimbursement provided to an adoptive parent under the
adoption subsidy program for nonrecurring adoption expenses
is one thousand dollars. For the purposes of this section,
“nonrecurring adoption expenses” means the same as defined in 45
C.F.R. §1356.41. The department shall adopt rules pursuant to
chapter 17A to administer this section.
Sec. 51. REPEAL. 2010 Iowa Acts, chapter 1031, section 408,
is repealed.
DIVISION XI
ALL IOWA OPPORTUNITY SCHOLARSHIP PROGRAM
Sec. 52. Section 261.87, subsection 1, paragraph b,
unnumbered paragraph 1, Code 2023, is amended to read as
follows:
“Eligible foster care student” means a person under
twenty-six years of age who has a high school diploma or a high
school equivalency diploma under chapter 259A and is described
by any of the following:
Sec. 53. Section 261.87, subsection 2, paragraph f, Code
2023, is amended to read as follows:
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f. (1) Begins Except as provided in subparagraph (2),
begins enrollment at an eligible institution within two
academic years of graduation from high school or receipt of
a high school equivalency diploma under chapter 259A and
continuously receives awards as a full-time or part-time
student to maintain eligibility. However, the student may
defer or suspend participation in the program for up to two
years in order to pursue obligations that meet conditions
established by the commission by rule or to fulfill military
obligations.
(2) The requirements of subparagraph (1) do not apply to an
eligible foster care student.
Sec. 54. APPLICABILITY. This division of this Act applies
to applications submitted under the all Iowa opportunity
scholarship program established pursuant to section 261.87
before, on, or after the effective date of this division of
this Act.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
This bill relates to the health and well-being of children
and families. The bill is constructed in divisions.
DIVISION I —— RURAL EMERGENCY HOSPITALS. This division
provides for state licensure of rural emergency hospitals
(REHs). Under the federal Consolidated Appropriations Act of
2021 (federal Act), REHs were established as a new provider
type. Effective January 1, 2023, REHs are eligible to enroll
in Medicare and to receive an enhanced reimbursement rate for
eligible services consisting of the outpatient prospective
payment system rate plus a 5 percent add-on and a fixed monthly
payment. In order to be classified as an REH under the federal
Act, a facility must meet certain requirements, including
applicable state licensing requirements. The division provides
a process for such licensure. The division provides emergency
rulemaking authority to implement the division. The division
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takes effect upon enactment.
DIVISION II —— REGIONAL CENTERS OF EXCELLENCE GRANT PROGRAM.
This division appropriates $1 million from the general fund
of the state to the department of health and human services
(HHS) for fiscal year 2023-2024 for continuation of a regional
center of excellence program to award four grants to encourage
innovation and collaboration among regional health care
providers in a rural area based upon the results of a regional
community needs assessment to transform health care delivery in
order to provide quality, sustainable care that meets the needs
of the local communities. An applicant for the grant funds
shall specify how the funds will be expended to accomplish the
goals of the program and shall provide a detailed five-year
sustainability plan prior to being awarded any funding.
Following the receipt of grant funding, a recipient shall
submit periodic reports as specified by HHS to the governor and
the general assembly regarding the recipient’s expenditure of
the funds and progress in accomplishing the program goals.
DIVISION III —— NONECONOMIC DAMAGE AWARDS AGAINST HEALTH
CARE PROVIDERS. This division of the bill relates to
noneconomic damage awards against health care providers.
Current law provides that in a civil action brought against
a health care provider, the maximum amount of noneconomic
damages that a patient may recover for personal injury or
death is $250,000, unless the jury determines that there is
a substantial or permanent loss or impairment of a bodily
function, substantial disfigurement, or death, which warrants
a finding that imposition of such a limitation would deprive
the plaintiff of just compensation for the injuries sustained.
In such a case, there is no cap on the amount of noneconomic
damages that a patient may recover. The bill makes two
changes to current law. First, the bill establishes that the
definition of noneconomic damages does not include the loss of
dependent care due to the death of or severe injury to a spouse
or parent who is the primary caregiver of a child or disabled
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adult. Instead, such damages are economic damages. Second,
the bill provides a $1 million cap on noneconomic damages when
the jury finds that there is substantial or permanent loss or
impairment of a bodily function, substantial disfigurement, or
death which warrants exceeding the $250,000 cap. The bill does
not amend the current exception to the cap for cases in which
the defendant’s actions constitute actual malice.
The division of the bill takes effect upon enactment and
applies to causes of action accrued on or after that date.
DIVISION IV —— STATE-FUNDED FAMILY MEDICINE OBSTETRICS
FELLOWSHIP PROGRAM AND FUND. This division requires HHS to
establish a family medicine obstetrics fellowship program to
increase access to family medicine obstetrics practitioners
in rural and underserved areas of the state. A person who
has completed an accreditation council for graduate medical
education residency program in family medicine is eligible for
participation in the fellowship program. Participating fellows
shall enter into a program agreement with a participating
teaching hospital which, at a minimum, requires the fellow
to complete a one-year fellowship and to engage in full-time
family medicine obstetrics practice in a rural or underserved
area of the state for a period of at least five years within
nine months following completion of the fellowship and receipt
of a license to practice medicine in the state. Each fellow
participating in the program shall be eligible for salary and
benefits including a stipend as determined by the participating
teaching hospital and funded through the family medicine
obstetrics fellowship program fund.
The division requires HHS to adopt administrative rules
to administer the program, including defining rural and
underserved areas for the purpose of the required full-time
practice of a person following completion of the fellowship.
The division creates a family medicine obstetrics fellowship
program fund in the state treasury consisting of the moneys
appropriated or credited to the fund by law. Moneys in the
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fund at the end of each fiscal year shall not revert to any
other fund but shall remain in the fund for use in subsequent
fiscal years. Moneys in the fund are appropriated to HHS
to be used to fund fellowship positions as provided in the
division. The division appropriates a sufficient amount from
the general fund of the state to the fund annually to support
the creation of four fellowship positions. The division
provides an appropriation for deposit in the fund for fiscal
year 2023-2024.
The division requires HHS and the participating teaching
hospitals to regularly evaluate and document their experiences
including identifying ways the program may be modified or
expanded to facilitate increased access to family medicine
obstetrics practitioners in rural and underserved areas of the
state. The department shall submit an annual report to the
general assembly by January 1. The report shall include the
number of fellowships funded to date and any other information
identified by HHS and the participating teaching hospitals as
indicators of outcomes and the effectiveness of the program.
DIVISION V —— SELF-ADMINISTERED HORMONAL CONTRACEPTIVES.
This division relates to the dispensing of self-administered
hormonal contraceptives by a pharmacist. The division
defines “self-administered hormonal contraceptive” as a
self-administered hormonal contraceptive that is approved by
the United States food and drug administration to prevent
pregnancy, including an oral hormonal contraceptive, a hormonal
vaginal ring, and a hormonal contraceptive patch, but not
including any drug intended to induce an abortion.
The division provides that notwithstanding any provision
of law to the contrary, a pharmacist may dispense a
self-administered hormonal contraceptive to a patient who
is at least 18 years of age pursuant to a standing order
established by the medical director of HHS (medical director).
For an initial dispensing, a pharmacist may dispense only up
to a three-month supply at one time of the self-administered
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hormonal contraceptive, and for any subsequent dispensing
of the same self-administered hormonal contraceptive, a
12-month supply at one time. Additionally, the division
prohibits a pharmacist who dispenses a self-administered
hormonal contraceptive in accordance with the division from
requiring any other prescription drug order authorized by a
practitioner prior to dispensing the self-administered hormonal
contraceptive.
The division authorizes the medical director to establish a
standing order authorizing the dispensing of self-administered
hormonal contraceptives by any pharmacist who complies with the
standing order and retains and submits the patient’s record to
HHS.
The standing order includes requiring a pharmacist who
dispenses a self-administered hormonal contraceptive under the
division to: complete a standardized training program and
continuing education requirements related to prescribing the
hormonal contraceptives; obtain a completed self-screening risk
assessment from each patient, verify the identity and age of
each patient, and perform a blood pressure screening on each
patient before dispensing the hormonal contraceptives; provide
the patient with certain written information; provide the
patient with a copy of the record of the pharmacist’s encounter
with the patient; and provide patient counseling.
The standing order would prohibit a pharmacist who dispenses
hormonal contraceptives under the division from requiring a
patient to schedule an appointment with the pharmacist for
the prescribing or dispensing of the hormonal contraceptive;
dispensing the hormonal contraceptives to a patient for more
than 27 months after the date initially dispensed without the
patient’s attestation that the patient has consulted with a
practitioner during the preceding 27 months; and dispensing
the hormonal contraceptives to a patient if the results of the
patient’s self-screening risk assessment indicate it is unsafe
for the pharmacist to dispense the hormonal contraceptives
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to the patient, in which case the pharmacist shall refer the
patient to a practitioner.
The division provides immunity for a pharmacist who
dispenses a self-administered hormonal contraceptive and
for the medical director who establishes a standing order
in compliance with the division from criminal and civil
liability arising from any damages caused by the dispensing,
administering, or use of a self-administered hormonal
contraceptive or the establishment of the standing order.
Additionally, the medical director shall be considered to be
acting within the scope of the medical director’s office and
employment for purposes of Code chapter 669 (Iowa tort claims
Act) in the establishment of a standing order in compliance
with the division.
The division requires HHS, in collaboration with the
boards of pharmacy and medicine, and in consideration of
the guidelines established by the American congress of
obstetricians and gynecologists, to adopt administrative rules
to administer the provisions of the division.
The division amends prescription contraceptive coverage
provisions to require that a group policy, contract, or plan
delivered, issued for delivery, continued, or renewed in the
state on or after January 1, 2024, providing for third-party
payment or prepayment of health or medical expenses, shall
specifically provide for payment of self-administered hormonal
contraceptives, prescribed and dispensed as specified in the
division, including those dispensed at one time. The division
provides, however, that the provisions relating to coverage are
not to be construed to require a third-party payor to provide
payment to a practitioner for dispensing a self-administered
hormonal contraceptive to replace a self-administered
hormonal contraceptive that has been dispensed to a covered
person and that has been misplaced, stolen, or destroyed.
These provisions are also not to be construed to require a
third-party payor to replace covered prescriptions that are
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misplaced, stolen, or destroyed.
The division also requires the board of pharmacy in
collaboration with the board of medicine and HHS to expand
the information program for drug prescribing to collect
from pharmacists information relating to the dispensing of
self-administered hormonal contraceptives as provided in the
division.
The division applies to the Medicaid program as specified in
the bill.
DIVISION VI —— INSURANCE BENEFITS —— REVIEW AND APPROVAL
—— PUBLIC POLICY CONSIDERATIONS. This division prohibits
a policy or policy form (form) in connection with a group
accident or health insurance policy (group policy) that is
issued in this state from containing a provision that is
unjust, unfair, inequitable, misleading, deceptive, encourages
misrepresentation, or that is otherwise contrary to public
policy (contrary to policy). The division makes it unlawful
for a carrier to issue a policy or to use a form in connection
with any group policy after notice from the commissioner of
insurance (commissioner) that the policy or form violates the
prohibition. A carrier has 20 days after receipt of the notice
to request a hearing to contest the commissioner’s notice. The
hearing shall be conducted pursuant to Code chapter 17A and
if it results in a decision that affirms the commissioner’s
notice, the decision shall be provided to the carrier in
writing and specify the reasons for the decision.
A group policy of insurance against loss or expense from
sickness, or from the bodily injury or death by accident of
the insured (accident and health policy), shall not be issued
or delivered in this state by a carrier until a copy of the
policy has been filed with, and approved by, the commissioner.
Applications, riders, or endorsements shall not be used in
connection with the accident and health policy until a copy
of the policy form has been filed with, and approved by,
the commissioner. A filing shall be deemed approved unless
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disapproved by the commissioner within 30 days. If upon review
of a form the commissioner finds that the benefits provided
are unreasonable in relation to the premium charged, or that
the form contains a provision contrary to public policy, the
commissioner shall provide notice to the carrier that advises
the carrier as detailed in the bill. The carrier has 20
days after receipt of the notice to request a hearing, to be
conducted pursuant to Code chapter 17A. The division permits
the commissioner, after opportunity for hearing, to withdraw
the commissioner’s previous approval of a form in circumstances
detailed in the division. A carrier is prohibited from issuing
a form, or from using a form in connection with any group
policy, on or after the effective date of the commissioner’s
withdrawal of the previous approval. If a hearing results in a
decision to withdraw a previous approval, the decision shall be
provided to the carrier in writing.
DIVISION VII —— MORE OPTIONS FOR MATERNAL SUPPORT (MOMS)
PROGRAM —— FATHERHOOD INITIATIVES. This division relates to
the more options for maternal support (MOMS) program. The
bill adds as part of the definition of “pregnancy support
services” services to men who are involved or think they might
be involved in a pregnancy. As part of the MOMS program,
the division requires HHS to develop and maintain a virtual
clearinghouse of pregnancy support services and resources. The
services and resources include but are not limited to pregnancy
resource center and maternity home information; assistance in
accessing public assistance including but not limited to the
special supplemental nutrition program for women, infants, and
children program and the supplemental nutrition assistance
program; educational resources; housing assistance; recovery
and mental health services; family planning education; adoption
and foster care information and services; and healing and
support services for abortion survivors and their families.
As part of the MOMS program, beginning July 1, 2023, and
thereafter, funding for the program may be used for fatherhood
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engagement grants to nonprofit, community-based organizations
to address the needs of fathers by assisting fathers in
finding employment, managing child support obligations,
transitioning from a period of incarceration, accessing health
care, understanding child development, and enhancing parenting
skills using evidence-based parenting education; a fatherhood
communications initiative administered by HHS, including but
not limited to a public internet site that provides access to
resources on effective parenting and assistance in receiving
parenting support and services; and a mentoring school-aged
males grant program to provide mentorship, social and academic
support, and life skills development to school-aged males.
The division also appropriates $2 million from the general
fund of the state to HHS for fiscal year 2023-2024 to be used
for the MOMS program including for program administration, the
provision of services, and for funding of fatherhood engagement
grants, the fatherhood communications initiative, and the
mentoring school-aged males grant program.
The division provides that the funding appropriated for the
MOMS program for fiscal year 2022-2023 is not to revert, but
is to remain available for the MOMS program for fiscal year
2023-2024. This provision takes effect upon enactment.
DIVISION VIII —— STATE EMPLOYEE PAID PARENTAL LEAVE BENEFIT.
This division provides that a state employee entitled to leave
under the federal Family and Medical Leave Act of 1993 shall
be provided paid leave for the birth or adoption of a child if
the leave is taken within 12 months following any such birth or
adoption. The division provides that a state employee parent
who gives birth or adopts a child shall be entitled to up to
four weeks of paid leave while a state employee parent of a
child who did not give birth shall be entitled to up to one
week of paid leave. The division requires the department of
administrative services to adopt rules to implement this paid
parental leave benefit.
DIVISION IX —— PROPERTY TAX MODIFICATIONS —— LICENSED
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COMMERCIAL CHILD CARE CENTERS AND CHILD CARE FACILITIES. This
division relates to property taxation for commercial child care
centers and facilities. Code section 441.21(5) determines the
amount of actual value of commercial property that is subject
to property tax. The amount is the sum of the residential
assessment limitation to the portion of the property’s value
that does not exceed $150,000 plus 90 percent of the property’s
value in excess of $150,000. The division excludes property
primarily used as a child care center or child care facility
from that determination and instead specifies that for
assessment years beginning on or after January 1, 2023, the
amount of actual value of such properties that is subject to
property tax and for which an application has been allowed is
equal to the product of the assessment limitation percentage
applicable to residential property multiplied by the actual
value of the property.
This division establishes an application and approval
procedure for the assessment limitation and amends provisions
relating to the calculation of payments to local governments as
the result of the application of certain assessment limitations
under Code section 441.21(5)(e).
The division takes effect upon enactment, applies
retroactively to assessment years beginning on or after January
1, 2023, and applies to payments to local governments under
Code section 441.21(5)(e) for fiscal years beginning on or
after July 1, 2024.
DIVISION X —— NONRECURRING ADOPTION EXPENSES —— ADOPTION
SUBSIDY PROGRAM. This division provides that the maximum
reimbursement provided to an adoptive parent under the adoption
subsidy program for nonrecurring adoption expenses is $1,000.
The division defines “nonrecurring adoption expenses” as the
reasonable and necessary adoption fees, court costs, attorney
fees, and other expenses which are directly related to the
legal adoption of a child with special needs which are not
incurred in violation of state, tribal, or federal law, and
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which have not been reimbursed from other sources or other
funds. Under federal regulation, “other expenses which
are directly related to the legal adoption of a child with
special needs” means the costs of the adoption incurred by
or on behalf of the parents and for which parents carry the
ultimate liability for payment. Such costs may include the
adoption study, including health and psychological examination,
supervision of the placement prior to adoption, transportation,
and the reasonable costs of lodging and food for the child or
the adoptive parents when necessary to complete the placement
or adoption process. The department of health and human
services shall adopt administrative rules to administer the
division. The division also repeals a provision in 2010 Iowa
Acts which limited the nonrecurring adoption expenses to $500
and prohibited additional amounts for court costs and other
related legal expenses.
DIVISION XI —— ALL IOWA OPPORTUNITY SCHOLARSHIP PROGRAM.
This division relates to the all Iowa opportunity scholarship
program (program), which provides scholarships to Iowa
students who graduate from high school or receive a high
school equivalency diploma to help such students attend a
community college in this state or an institution of higher
learning governed by the state board of regents. The program
prioritizes awarding scholarships to certain students,
including eligible foster care students. Eligible foster care
students are students who age out of Iowa’s foster care system,
age out of the state training school, or are adopted from
Iowa’s foster care system after reaching 16 years of age.
Current law requires that, in order to be eligible to
receive a scholarship under the program, the student must begin
enrollment at a community college or institution of higher
learning governed by the state board of regents within two
academic years of graduation from high school or receipt of a
high school equivalency diploma and continuously receive awards
as a full-time or part-time student to maintain eligibility.
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The division strikes these requirements for eligible foster
care students. The division also provides that, for purposes
of the program, “eligible foster care student” does not include
a person who is 26 years of age or older.
The division applies to applications submitted under
the program before, on, or after the effective date of the
division.
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