H.F. 236 DIVISION I 1 STATE FAMILY PLANNING SERVICES PROGRAM 2 Section 1. STATE FAMILY PLANNING SERVICES PROGRAM —— 3 ESTABLISHMENT —— DISCONTINUATION OF MEDICAID FAMILY PLANNING 4 NETWORK WAIVER. 5 1. The department of human services shall discontinue the 6 Medicaid family planning network waiver effective July 1, 2017, 7 and shall instead establish a state family planning services 8 program. The state program shall replicate the eligibility 9 requirements and other provisions included in the Medicaid 10 family planning network waiver as approved by the centers for 11 Medicare and Medicaid services of the United States department 12 of health and human services in effect on June 30, 2017, but 13 shall provide for distribution of the family planning services 14 program funds in accordance with this section. 15 2. Distribution of family planning services program funds 16 shall be made to eligible applicants in the following order of 17 priority: 18 a. Public entities that provide family planning services 19 including state, county, or local community health clinics and 20 federally qualified health centers. 21 b. Nonpublic entities that, in addition to family planning 22 services, provide required primary health services as described 23 in 42 U.S.C. §254b(b)(1)(A). 24 c. Nonpublic entities that provide family planning 25 services but do not provide required primary health services as 26 described in 42 U.S.C. §254b(b)(1)(A). 27 3. Distribution of family planning services program funds 28 under this section shall be made in a manner that continues 29 access to family planning services. 30 4. Distribution of family planning services program funds 31 shall not be made to any entity that performs abortions or that 32 maintains or operates a facility where abortions are performed. 33 For the purposes of this section, “abortion” does not include 34 any of the following: 35 -1- LSB 1117YH (24) 87 pf/rn/rj 1/ 8

H.F. 236 a. The treatment of a woman for a physical disorder, 1 physical injury, or physical illness, including a 2 life-endangering physical condition caused by or arising from 3 the pregnancy itself, that would, as certified by a physician, 4 place the woman in danger of death. 5 b. The treatment of a woman for a spontaneous abortion, 6 commonly known as a miscarriage. 7 5. Family planning services program funds distributed in 8 accordance with this section shall not be used for direct or 9 indirect costs, including but not limited to administrative 10 costs or expenses, overhead, employee salaries, rent, and 11 telephone and other utility costs, related to providing 12 abortions as specified in subsection 4. 13 6. The department of human services shall submit a report to 14 the governor and the general assembly, annually by January 1, 15 listing any entities that received funds pursuant to subsection 16 2, paragraph “c”, and the amount and type of funds received by 17 such entities during the preceding calendar year. The report 18 shall provide a detailed explanation of how the department 19 determined that distribution of family planning services 20 program funds to such an entity, instead of to an entity 21 described in subsection 2, paragraph “a” or “b”, was necessary 22 to prevent severe limitation or elimination of access to family 23 planning services in the region of the state where the entity 24 is located. 25 Sec. 2. EFFECTIVE UPON ENACTMENT. This division of this 26 Act, being deemed of immediate importance, takes effect upon 27 enactment. 28 DIVISION II 29 DISTRIBUTION OF FEDERAL FUNDS —— RESTRICTIONS —— ABORTION 30 Sec. 3. DISTRIBUTION OF FEDERAL PUBLIC HEALTH SERVICES ACT 31 FUNDS FOR FAMILY PLANNING. 32 1. The department of public health shall annually apply 33 to the United States department of health and human services 34 for grant funding under Tit. X of the federal Public Health 35 -2- LSB 1117YH (24) 87 pf/rn/rj 2/ 8

H.F. 236 Services Act, 42 U.S.C. §300 et seq. The department shall 1 distribute all grant funding received to applicants in the 2 following order of priority: 3 a. Public entities that provide family planning services 4 including state, county, or local community health clinics and 5 federally qualified health centers. 6 b. Nonpublic entities that, in addition to family planning 7 services, provide required primary health services as described 8 in 42 U.S.C. §254b(b)(1)(A). 9 c. Nonpublic entities that provide family planning 10 services but do not provide required primary health services as 11 described in 42 U.S.C. §254b(b)(1)(A). 12 2. Distribution of funds under this section shall be made in 13 a manner that continues access to family planning services. 14 3. Distribution of funds shall not be made to any entity 15 that performs abortions or that maintains or operates a 16 facility where abortions are performed. For the purposes of 17 this section, “abortion” does not include any of the following: 18 a. The treatment of a woman for a physical disorder, 19 physical injury, or physical illness, including a 20 life-endangering physical condition caused by or arising from 21 the pregnancy itself, that would, as certified by a physician, 22 place the woman in danger of death. 23 b. The treatment of a woman for a spontaneous abortion, 24 commonly known as a miscarriage. 25 4. Funds distributed in accordance with this section shall 26 not be used for direct or indirect costs, including but not 27 limited to administrative costs or expenses, overhead, employee 28 salaries, rent, and telephone and other utility costs, related 29 to providing abortions as specified in this section. 30 5. The department of public health shall submit a report to 31 the governor and the general assembly, annually by January 1, 32 listing any entities that received funds pursuant to subsection 33 1, paragraph “c”, and the amount and type of funds received by 34 such entities during the preceding calendar year. The report 35 -3- LSB 1117YH (24) 87 pf/rn/rj 3/ 8

H.F. 236 shall provide a detailed explanation of how the department 1 determined that distribution of funds to such an entity, 2 instead of to an entity described in subsection 1, paragraph 3 “a” or “b”, was necessary to prevent severe limitation or 4 elimination of access to family planning services in the region 5 of the state where the entity is located. 6 Sec. 4. ADMINISTRATION OF PERSONAL RESPONSIBILITY 7 EDUCATION PROGRAM AND ABSTINENCE EDUCATION GRANT PROGRAM 8 FUNDS. Any contract entered into on or after July 1, 2017, 9 by the department of public health to administer the personal 10 responsibility education program as specified in 42 U.S.C. 11 §713 or to administer the abstinence education grant program 12 authorized pursuant to section 510 of Tit. V of the federal 13 Social Security Act, shall exclude as an eligible applicant any 14 applicant entity that provides abortions, maintains or operates 15 a facility where abortions are performed, or regularly makes 16 referrals to an entity that provides abortions or maintains or 17 operates a facility where abortions are performed. For the 18 purposes of this section, such referrals include but are not 19 limited to referrals made by reference to an internet site or 20 by linking to an internet site maintained by an entity that 21 provides abortions or maintains or operates a facility where 22 abortions are performed. 23 Sec. 5. AWARD OF COMMUNITY ADOLESCENT PREGNANCY PREVENTION 24 AND SERVICES PROGRAM GRANT FUNDS. Any contract entered into on 25 or after July 1, 2017, by the department of human services to 26 award a community adolescent pregnancy prevention and services 27 program grant using federal temporary assistance for needy 28 families block grant funds appropriated to the department 29 shall exclude as an eligible applicant any applicant entity 30 that provides abortions, maintains or operates a facility 31 where abortions are performed, or regularly makes referrals to 32 an entity that provides abortions or maintains or operates a 33 facility where abortions are performed. For the purposes of 34 this section, such referrals include but are not limited to 35 -4- LSB 1117YH (24) 87 pf/rn/rj 4/ 8

H.F. 236 referrals made by reference to an internet site or by linking 1 to an internet site maintained by an entity that provides 2 abortions or maintains or operates a facility where abortions 3 are performed. 4 DIVISION III 5 RIGHT OF INTERVENTION 6 Sec. 6. RIGHT OF INTERVENTION. The sponsor or cosponsors 7 of this Act, as an agent or agents of the state, shall have 8 standing to intervene on behalf of the general assembly as a 9 party in any judicial or administrative proceeding challenging 10 the provisions of this Act. 11 DIVISION IV 12 SEVERABILITY 13 Sec. 7. SEVERABILITY. If any provision of this Act or 14 the application of this Act to any person or circumstances is 15 held invalid, the invalidity shall not affect other provisions 16 or applications of the Act which can be given effect without 17 the invalid provisions or application and, to this end, the 18 provisions of this Act are severable. 19 EXPLANATION 20 The inclusion of this explanation does not constitute agreement with 21 the explanation’s substance by the members of the general assembly. 22 This bill relates to the distribution of certain funds 23 relative to abortions. 24 Division I of the bill establishes a state family planning 25 services program and discontinues the Medicaid family planning 26 network waiver. 27 The division directs the department of human services (DHS) 28 to discontinue the Medicaid family planning network waiver 29 effective July 1, 2017, and to instead establish a state family 30 planning services program. The state program is to replicate 31 the eligibility requirements and other provisions included in 32 the Medicaid family planning network waiver, but the program 33 funds are to be distributed in accordance with a prioritization 34 schedule specified in the division. 35 -5- LSB 1117YH (24) 87 pf/rn/rj 5/ 8

H.F. 236 The program funds are to be distributed in a manner that 1 continues access to family planning services, but are not to 2 be distributed to any entity that performs abortions or that 3 maintains or operates a facility where abortions are performed. 4 The division makes exceptions to the definition of “abortion” 5 for the purpose of distribution of the funds. 6 The division also specifies that the funds distributed shall 7 not be used for direct or indirect costs, including but not 8 limited to administrative costs or expenses, overhead, employee 9 salaries, rent, and telephone and other utility costs, related 10 to providing abortions. 11 The division requires DHS to submit a report to the governor 12 and the general assembly annually by January 1 listing any 13 entities that received program funds that are in the lowest 14 position of priority described as nonpublic entities that 15 provide family planning services but do not provide required 16 primary health services as defined in federal law, as well as 17 the amount and type of funds received by such entities during 18 the preceding calendar year. The report is also to include a 19 detailed explanation of how DHS determined that distribution of 20 program funds to such an entity was necessary to prevent severe 21 limitation or elimination of access to family planning services 22 in the region of the state where the entity is located. 23 This division of the bill takes effect upon enactment. 24 Division II of the bill relates to the distribution and use 25 of certain federal funds for abortions. The division includes 26 limitations on distribution to certain applicants of federal 27 funds received by the state under Title X of the federal Public 28 Health Services Act, the personal responsibility education 29 program, the abstinence education grant program, and the 30 community adolescent pregnancy prevention grant program. 31 The division directs the department of health (DPH) to 32 distribute all grant funding received through Title X of 33 the federal Public Health Services Act on the basis of a 34 prioritized schedule of applicants. The division prohibits 35 -6- LSB 1117YH (24) 87 pf/rn/rj 6/ 8

H.F. 236 funding to be distributed to any entity that performs abortions 1 or that maintains or operates a facility where abortions are 2 performed. The division also prohibits funds distributed to 3 be used for direct or indirect costs related to providing 4 abortions. The division makes exceptions to the definition 5 of “abortion” for the purpose of distribution of the funds. 6 The division directs DPH to submit a report annually to the 7 governor and the general assembly by January 1, identifying any 8 entities lowest in the prioritization schedule that received 9 public funds instead of an entity higher in the prioritization 10 schedule during the preceding calendar year. The report 11 shall include a detailed explanation of how DPH determined 12 that distribution to such an entity was necessary to prevent 13 limitations in access to family planning services in the region 14 of the state where the entity is located. 15 The division directs DPH, beginning with any contract 16 entered into on or after July 1, 2017, to administer the 17 state personal responsibility education program and the state 18 abstinence education grant program to exclude as an eligible 19 applicant any applicant entity that provides abortions, 20 maintains or operates facilities where abortions are performed, 21 or regularly makes referrals to an entity that provides 22 abortions or maintains or operates a facility where abortions 23 are performed. 24 The division directs the department of human services, 25 beginning with any contract entered into on or after July 1, 26 2017, to exclude from the award of federal temporary assistance 27 for needy families block grant funds appropriated to the 28 department for the community adolescent pregnancy prevention 29 and services program, any applicant entity that provides 30 abortions, maintains or operates a facility where abortions 31 are performed, or regularly makes referrals to an entity that 32 provides abortions or maintains or operates a facility where 33 abortions are performed. 34 Division III of the bill provides for a right of 35 -7- LSB 1117YH (24) 87 pf/rn/rj 7/ 8

H.F. 236 intervention. The bill provides that a sponsor or cosponsors 1 of the bill, as an agent or agents of the state, shall have 2 standing to intervene on behalf of the general assembly as a 3 party in any judicial or administrative proceeding challenging 4 the provisions of the bill. 5 Division IV of the bill provides for severability of any 6 provision or application of the bill that is held invalid from 7 the provisions or applications of the bill which can be given 8 effect without the invalid provisions or application. 9 -8- LSB 1117YH (24) 87 pf/rn/rj 8/ 8