S.F. _____ H.F. _____ Section 1. Section 261.2, subsection 8, Code 2017, is 1 amended to read as follows: 2 8. Submit by January 15 annually a report to the general 3 assembly which provides, by program, the number of individuals 4 who received loan forgiveness or loan repayment in the previous 5 fiscal year, the amount amounts paid to or on behalf of 6 individuals under sections 261.73 , 261.112 , and 261.116 , and 7 the institutions from which individuals graduated, and that 8 includes any proposed statutory changes and the commission’s 9 findings and recommendations. 10 Sec. 2. Section 261.114, subsection 3, unnumbered paragraph 11 1, Code 2017, is amended to read as follows: 12 A program agreement shall be entered into by an eligible 13 student and the commission when the eligible student begins 14 the final year of study in an academic program leading to 15 eligibility for licensure as a nurse practitioner or physician 16 assistant. The commission shall not enter into any new 17 program agreement under this section on or after July 1, 2017. 18 Under the agreement, to receive loan repayments pursuant to 19 subsection 5 , an eligible student shall agree to and shall 20 fulfill all of the following requirements: 21 Sec. 3. Section 261.114, subsection 8, Code 2017, is amended 22 by striking the subsection. 23 Sec. 4. Section 261.114, subsection 9, Code 2017, is amended 24 to read as follows: 25 9. Postponement and satisfaction Satisfaction of service 26 obligation. 27 a. The obligation to engage in practice in accordance with 28 subsection 3 shall be postponed for the following purposes: 29 (1) Active duty status in the armed forces, the armed forces 30 military reserve, or the national guard. 31 (2) Service in volunteers in service to America. 32 (3) Service in the federal peace corps. 33 (4) A period of service commitment to the United States 34 public health service commissioned corps. 35 -1- LSB 1193DP (11) 87 kh/rj/jh 1/ 9

S.F. _____ H.F. _____ (5) A period of religious missionary work conducted by an 1 organization exempt from federal income taxation pursuant to 2 section 501(c)(3) of the Internal Revenue Code . 3 (6) Any period of temporary medical incapacity during which 4 the person obligated is unable, due to a medical condition, to 5 engage in full-time practice as required under subsection 3 . 6 b. Except for a postponement under paragraph “a” , 7 subparagraph (6), an obligation to engage in practice under an 8 agreement entered into pursuant to subsection 3 , shall not be 9 postponed for more than two years from the time the full-time 10 practice was to have commenced under the agreement. 11 c. a. An obligation to engage in full-time practice under 12 an agreement entered into pursuant to subsection 3 shall be 13 considered satisfied when any of the following conditions are 14 met: 15 (1) The terms of the agreement are completed. 16 (2) The person who entered into the agreement dies. 17 (3) The person who entered into the agreement, due to a 18 permanent disability, is unable to practice as an advanced 19 registered nurse practitioner or physician assistant. 20 d. b. If a loan repayment recipient fails to fulfill 21 the obligation to engage in practice in accordance with 22 subsection 3 , the recipient shall be subject to repayment to 23 the commission of the loan amount plus interest as specified 24 by rule. A loan repayment recipient who fails to meet the 25 requirements of the obligation to engage in practice in 26 accordance with subsection 3 may also be subject to repayment 27 of moneys advanced by the service commitment area as provided 28 in any agreement with the service commitment area. 29 Sec. 5. Section 261.114, subsection 10, Code 2017, is 30 amended to read as follows: 31 10. Trust fund established. A rural Iowa advanced 32 registered nurse practitioner and physician assistant trust 33 fund is created in the state treasury as a separate fund under 34 the control of the commission. The commission shall remit all 35 -2- LSB 1193DP (11) 87 kh/rj/jh 2/ 9

S.F. _____ H.F. _____ repayments made pursuant to this section to the rural Iowa 1 advanced registered nurse practitioner and physician assistant 2 trust fund. All moneys deposited or paid into the trust fund 3 are appropriated and made available to the commission to be 4 used for meeting the requirements of this section . Moneys in 5 the fund up to the total amount that an eligible student may 6 receive for an eligible loan in accordance with this section 7 and upon fulfilling the requirements of subsection 3 shall be 8 considered encumbered for the duration of the agreement entered 9 into pursuant to subsection 3 . Notwithstanding section 8.33 , 10 any balance in the fund on June 30 of each fiscal year shall not 11 revert to the general fund of the state, but shall be available 12 for purposes of this section in subsequent fiscal years. 13 Notwithstanding section 8.33, any balance in the fund on June 14 30, 2023, shall not revert to the general fund of the state but 15 shall be transferred to the health care loan repayment fund 16 established pursuant to section 261.116 to be used for purposes 17 of the health care loan repayment program. 18 Sec. 6. Section 261.114, Code 2017, is amended by adding the 19 following new subsection: 20 NEW SUBSECTION . 10A. This section is repealed July 1, 2023. 21 Sec. 7. Section 261.116, Code 2017, is amended to read as 22 follows: 23 261.116 Registered nurse and nurse educator Health care loan 24 forgiveness repayment program. 25 1. Definitions. For purposes of this section, unless the 26 context otherwise requires: 27 a. “Advanced registered nurse practitioner” means a person 28 licensed as a registered nurse under chapter 152 or 152E who 29 is licensed by the board of nursing as an advanced registered 30 nurse practitioner. 31 b. “Nurse educator” means a registered nurse who holds 32 a master’s degree or doctorate degree and is employed by a 33 community college, an accredited private institution, or an 34 institution of higher education governed by the state board 35 -3- LSB 1193DP (11) 87 kh/rj/jh 3/ 9

S.F. _____ H.F. _____ of regents as a faculty member to teach nursing at a nursing 1 education program approved by the board of nursing pursuant to 2 section 152.5. 3 c. “Physician assistant” means a person licensed as a 4 physician assistant under chapter 148C. 5 d. “Qualified student loan” means a loan that was made, 6 insured, or guaranteed under Tit. IV of the federal Higher 7 Education Act of 1965, as amended, or under Tit. VII or VIII 8 of the federal Public Health Service Act, as amended, directly 9 to the borrower for attendance at an approved postsecondary 10 educational institution. 11 e. “Service commitment area” means a city in Iowa with a 12 population of less than twenty-six thousand that is located 13 more than fifty miles from a city with a population of fifty 14 thousand or more. 15 2. Program established. A registered nurse and nurse 16 educator health care loan forgiveness repayment program is 17 established to be administered by the commission . The program 18 shall consist of loan forgiveness for eligible federally 19 guaranteed for purposes of repaying the qualified student 20 loans for of registered nurses , advanced registered nurse 21 practitioners, physician assistants, and nurse educators who 22 practice full-time in a service commitment area or teach in 23 this state , as appropriate, and who are selected for the 24 program in accordance with this section . For purposes of 25 this section , unless the context otherwise requires, “nurse 26 educator” means a registered nurse who holds a master’s degree 27 or doctorate degree and is employed as a faculty member who 28 teaches nursing as provided in 655 IAC 2.6 (152) at a community 29 college, an accredited private institution, or an institution 30 of higher education governed by the state board of regents. An 31 applicant who is a member of the Iowa national guard is exempt 32 from the service commitment area requirement, but shall submit 33 an affidavit verifying the applicant is practicing full-time 34 in this state. 35 -4- LSB 1193DP (11) 87 kh/rj/jh 4/ 9

S.F. _____ H.F. _____ 2. 3. Application requirements. Each applicant for loan 1 forgiveness repayment shall, in accordance with the rules of 2 the commission, do the following: 3 a. Complete and file an application for registered nurse 4 or nurse educator loan forgiveness repayment . The individual 5 shall be responsible for the prompt submission of any 6 information required by the commission. 7 b. File a new application and submit information as 8 required by the commission annually on the basis of which 9 the applicant’s eligibility for the renewed loan forgiveness 10 repayment will be evaluated and determined. 11 c. Complete and return, on a form approved by the 12 commission, an affidavit of practice verifying that the 13 applicant is a registered nurse , an advanced registered nurse 14 practitioner, or a physician assistant who is practicing 15 full-time in a service commitment area in this state or is a 16 nurse educator teaching at a community college, an accredited 17 private institution, or an institution of higher learning 18 governed by the state board of regents who teaches full-time 19 in this state . If practice in a service commitment area is 20 required as a condition of receiving loan repayment, the 21 affidavit shall specify the service commitment area in which 22 the applicant is practicing full-time. 23 3. 4. Loan repayment amounts. 24 a. The annual amount of registered nurse loan forgiveness 25 for a registered nurse who completes a course of study, which 26 leads to a baccalaureate or associate degree of nursing, 27 diploma in nursing, or a graduate or equivalent degree in 28 nursing, and who practices in this state, repayment provided to 29 a recipient under this section shall not exceed the resident 30 tuition rate established for institutions of higher learning 31 governed by the state board of regents for the first year 32 following the registered nurse’s graduation from a nursing 33 education program approved by the board of nursing pursuant to 34 section 152.5 six thousand dollars , or twenty percent of the 35 -5- LSB 1193DP (11) 87 kh/rj/jh 5/ 9

S.F. _____ H.F. _____ registered nurse’s total federally guaranteed Stafford loan 1 amount under the federal family education loan program or the 2 federal direct loan program, including principal and interest 3 recipient’s total qualified student loan , whichever amount is 4 less. A registered nurse shall be recipient is eligible for 5 the loan forgiveness repayment program for not more than five 6 consecutive years. 7 b. The annual amount of nurse educator loan forgiveness 8 shall not exceed the resident tuition rate established for 9 institutions of higher learning governed by the state board 10 of regents for the first year following the nurse educator’s 11 graduation from an advanced formal academic nursing education 12 program approved by the board of nursing pursuant to section 13 152.5 , or twenty percent of the nurse educator’s total 14 federally guaranteed Stafford loan amount under the federal 15 family education loan program or the federal direct loan 16 program, including principal and interest, whichever amount 17 is less. A nurse educator shall be eligible for the loan 18 forgiveness program for not more than five consecutive years. 19 4. 5. Selection criteria. The commission shall establish 20 by rule the evaluation criteria to be used in evaluating 21 applications submitted under this section. Priority shall be 22 given to applicants who are residents of Iowa and, if requested 23 by the adjutant general, to applicants who are members of the 24 Iowa national guard. 25 6. Health care loan repayment fund. A registered nurse and 26 nurse educator health care loan forgiveness repayment fund is 27 created for deposit of moneys appropriated to or received by 28 the commission for use under the program. Notwithstanding 29 section 8.33 , moneys deposited in the health care loan 30 repayment fund shall not revert to any fund of the state 31 at the end of any fiscal year but shall remain in the loan 32 forgiveness repayment fund and be continuously available for 33 loan forgiveness repayment under the program. Notwithstanding 34 section 12C.7, subsection 2 , interest or earnings on moneys 35 -6- LSB 1193DP (11) 87 kh/rj/jh 6/ 9

S.F. _____ H.F. _____ deposited in the health care loan fund shall be credited to the 1 fund. 2 5. 7. Report. The commission shall submit in a report 3 to the general assembly by January 1, annually, the number of 4 individuals who received loan forgiveness repayment pursuant to 5 this section , where the participants practiced or taught, the 6 amount paid to each program participant, and other information 7 identified by the commission as indicators of outcomes from of 8 the program. 9 6. 8. Rules. The commission shall adopt rules pursuant to 10 chapter 17A to administer this section . 11 Sec. 8. REPEAL. Section 261.129, Code 2017, is repealed. 12 EXPLANATION 13 The inclusion of this explanation does not constitute agreement with 14 the explanation’s substance by the members of the general assembly. 15 This bill combines and repeals certain educational 16 assistance programs administered by the college student aid 17 commission for the benefit of registered nurses, physician 18 assistants, advanced registered nurse practitioners, and nurse 19 educators. 20 RURAL IOWA ADVANCED REGISTERED NURSE PRACTITIONER AND 21 PHYSICIAN ASSISTANT LOAN REPAYMENT PROGRAM —— FUNDS. The bill 22 modifies the rural Iowa advanced registered nurse practitioner 23 and physician assistant loan repayment program by prohibiting 24 the commission from entering into any new program agreements on 25 or after July 1, 2017; striking a provision to allow a person 26 who entered into a program agreement to practice part-time; 27 striking language relating to the postponement of program 28 obligations; repealing the program July 1, 2023; and providing 29 for the transfer of any balance in the rural Iowa advanced 30 registered nurse practitioner and physician assistant trust 31 fund on June 30, 2023, to the health care loan repayment fund 32 established for purposes of the health care loan repayment 33 program. 34 COMBINED LOAN PROGRAM. The bill expands the current 35 -7- LSB 1193DP (11) 87 kh/rj/jh 7/ 9

S.F. _____ H.F. _____ registered nurse and nurse educator program by adding advanced 1 registered nurse practitioners and physician assistants to the 2 program. The bill changes the name of the program, and of the 3 program fund, to the health care loan repayment program and the 4 health care loan repayment fund. 5 To qualify for the program, applicants who are registered 6 nurses, advanced registered practitioners, or physician 7 assistants must complete and return an affidavit of practice 8 verifying that the applicant is or will be practicing full-time 9 in a service commitment area in this state or is a nurse 10 educator teaching full-time in this state. The affidavit must 11 specify the service commitment area in which the applicant will 12 practice as a condition of receiving loan repayment. Nurse 13 educators are not required to teach in service commitment 14 areas. An applicant who is a member of the Iowa national guard 15 is exempt from the service commitment area requirement, but 16 must submit an affidavit verifying the applicant is practicing 17 in this state. The bill defines a service commitment area as 18 a city in Iowa with a population of less than 26,000 that is 19 located more than 50 miles from a city with a population of 20 50,000 or more. 21 Currently, the annual amount of loan repayment for a 22 registered nurse or nurse educator shall not exceed the 23 resident tuition rate established for regents universities or 24 20 percent of the registered nurse’s total federally determined 25 loan amount, including principal and interest, whichever 26 amount is less. The bill limits the annual amount of loan 27 repayment to a program applicant to $6,000 or 20 percent of 28 the recipient’s total qualified student loan, whichever amount 29 is less. The bill defines qualified student loan as a loan 30 that was made, insured, or guaranteed under Tit. IV of the 31 federal Higher Education Act of 1965, as amended, or under 32 Tit. VII or VIII of the federal Public Health Service Act, as 33 amended, directly to the borrower for attendance at an approved 34 postsecondary educational institution. 35 -8- LSB 1193DP (11) 87 kh/rj/jh 8/ 9

S.F. _____ H.F. _____ The commission is required to establish by rule the criteria 1 to be used in evaluating applications, and to give highest 2 priority to applicants who are residents of Iowa, then, if 3 requested by the adjutant general, to applicants who are 4 members of the Iowa national guard. 5 The bill repeals Code section 261.129, which establishes 6 the Iowa needs nurses now initiative. The initiative never 7 received funding. 8 -9- LSB 1193DP (11) 87 kh/rj/jh 9/ 9