H.F. 246 Section 1. NEW SECTION . 135Q.1 Short title. 1 This chapter shall be known and may be cited as the 2 “Immunization Informed Consent Protection Act” . 3 Sec. 2. NEW SECTION . 135Q.2 Definitions. 4 As used in this chapter, unless the content otherwise 5 requires: 6 1. “Department” means the department of public health. 7 2. “Health care facility” means the same as defined in 8 section 135C.1. 9 3. “Health care provider” means a person licensed or 10 certified by and subject to the authority of a board as defined 11 in section 147.2 who provides professional health care services 12 to a patient during that patient’s medical care, treatment, or 13 confinement. 14 4. “Hospital” means the same as defined in section 135B.1. 15 5. “Informed consent” means the right of a patient to 16 be fully informed about the risks and benefits of a medical 17 intervention and to make a voluntary decision regarding the 18 intervention without being coerced, threatened, or punished for 19 the decision. 20 6. “Insurer” means an entity providing a plan of health 21 insurance, health care benefits, or health care services, or 22 an entity subject to the jurisdiction of the commissioner 23 of insurance performing utilization review, including an 24 insurance company offering sickness and accident plans, a 25 health maintenance organization, a nonprofit health service 26 corporation, a plan established pursuant to chapter 509A 27 for public employees, or any other entity providing a plan 28 of health insurance, health care benefits, or health care 29 services. 30 7. “Patient” means a person who has received or is receiving 31 professional health care services from a health care facility, 32 health care provider, or hospital. 33 Sec. 3. NEW SECTION . 135Q.3 Immunizations —— prohibited 34 discrimination —— civil remedies. 35 -1- LSB 1619HH (16) 88 pf/rh 1/ 10

H.F. 246 1. A hospital or health care facility shall not do any of 1 the following: 2 a. Discriminate against or terminate the employment or 3 contract of a health care provider, staff member, employee, 4 contractor, subcontractor, or applicant for one of these 5 positions based on the person’s refusal to receive an 6 immunization. 7 b. Discriminate against or terminate the employment or 8 contract of a health care provider, staff member, employee, 9 contractor or subcontractor based on the person’s willingness 10 to participate in the immunization of patients. 11 c. Discriminate against or prohibit or terminate 12 participation by a volunteer based upon the person’s refusal 13 to receive an immunization or the person’s willingness to 14 participate in the immunization of patients. 15 2. A hospital, health care facility, or educational 16 institution providing clinical experience to satisfy the 17 professional degree requirements of a student, intern, or 18 resident shall not discriminate against the student, intern, or 19 resident, or prohibit admission, enrollment, or employment as a 20 student, intern, or resident based on the immunization status 21 of the student, intern, or resident. 22 3. A person aggrieved under this section may petition the 23 district court in the county where the hospital, health care 24 facility, or educational institution is located for any of the 25 following, as applicable: 26 a. Injunctive relief against any further violation. 27 b. Affirmative relief, including reinstatement of employment 28 with back pay and interest, or any other equitable relief the 29 court deems appropriate. 30 c. Other appropriate relief necessary to ensure compliance 31 with this section. 32 Sec. 4. NEW SECTION . 135Q.4 Immunization —— health care 33 provider licensing authorities. 34 1. The licensing authority for a health care provider shall 35 -2- LSB 1619HH (16) 88 pf/rh 2/ 10

H.F. 246 not deny an applicant for a license or suspend, revoke, or 1 refuse to renew a license, and shall not take disciplinary 2 action against a licensee based on the applicant’s or 3 licensee’s immunization history or refusal to submit to or 4 administer an immunization. 5 2. The licensing authority for a health care provider may 6 deny an applicant a license or suspend, revoke, or refuse to 7 renew a license, and may take disciplinary action against a 8 licensee based on the applicant or licensee having three or 9 more verified failures to comply in one calendar year with the 10 applicable health care provider requirements pursuant to 42 11 U.S.C. §300aa-25 and 42 U.S.C. §300aa-26. 12 Sec. 5. NEW SECTION . 135Q.5 Immunizations —— prohibited 13 actions —— insurers and insurer ratings —— cease and desist 14 orders and penalties. 15 1. An insurer providing a group policy, contract, or plan 16 for health insurance shall not use the immunization status of 17 a person as a basis to reject; deny; limit; cancel; refuse to 18 renew; increase the premiums for; limit the amount, extent, or 19 kind of coverage available to; or otherwise adversely affect 20 eligibility or coverage for the group health policy, contract, 21 or plan for health insurance. 22 2. An insurer providing a group policy, contract, or plan 23 for health insurance shall not use the immunization status of a 24 patient as a qualification or requirement for contracting with 25 the patient’s provider or as a basis for terminating a contract 26 with the patient’s provider. 27 3. The immunization status of a person covered by a group 28 policy, contract, or plan for health insurance shall not be 29 used as a factor in the rating of a group policy, contract, or 30 plan for health insurance in this state. 31 4. An insurer issuing a group policy, contract, or plan 32 for health insurance shall not deny a health care facility, 33 health care provider, or hospital’s participation or decrease 34 reimbursement based on low patient immunization rates or as the 35 -3- LSB 1619HH (16) 88 pf/rh 3/ 10

H.F. 246 result of a health care facility’s, health care provider’s, or 1 hospital’s decision not to immunize a patient. 2 5. An insurer issuing a group policy, contract, or plan for 3 health insurance who violates this section is subject to the 4 summary cease and desist order, cease and desist order, and 5 penalty provisions pursuant to chapter 507B. 6 Sec. 6. NEW SECTION . 135Q.6 Prohibited activities. 7 1. A health care facility, health care provider, or hospital 8 shall not accept an incentive from an insurer or pharmaceutical 9 company in exchange for the immunization of patients. 10 2. A health care facility, health care provider, or hospital 11 shall not require a patient or the parent or guardian of a 12 patient to sign a liability waiver as a condition of receiving 13 medical care if the patient or the patient’s parent or guardian 14 chooses to delay or decline an immunization. 15 3. The department of human services shall not initiate a 16 child abuse investigation against the parent or guardian of a 17 child on the sole basis that the parent or guardian has chosen 18 to delay or decline an immunization for the child. 19 4. A health care facility, health care provider, hospital, 20 or a staff member or employee of a health care facility, health 21 care provider, or hospital shall not discriminate against a 22 patient or the parent or guardian of a patient or terminate 23 treatment of a patient based solely on a patient or a parent 24 or guardian of a patient choosing to delay or decline an 25 immunization. The exercise of a patient’s right to informed 26 consent by delaying or declining immunization shall not be 27 grounds for the dismissal of a patient from a health care 28 provider practice, health care facility, or hospital or for a 29 patient’s loss of medical privileges or benefits. 30 5. A health care facility, health care provider, or hospital 31 shall not harass, coerce, admonish, or threaten a patient 32 or the parent or guardian of a patient for exercising the 33 patient’s right to delay or decline an immunization. 34 Sec. 7. NEW SECTION . 135Q.7 Rights of patients. 35 -4- LSB 1619HH (16) 88 pf/rh 4/ 10

H.F. 246 1. The department shall publish on the department’s 1 publicly accessible internet site a summary of the rights of a 2 patient and the patient’s parent or guardian as specified in 3 this chapter. 4 2. If requested, a health care facility, health care 5 provider, or hospital shall inform a patient and a patient’s 6 parent or guardian of the address and telephone number of 7 each state agency responsible for responding to a patient’s 8 complaints of noncompliance with this chapter. 9 3. A health care facility, health care provider, or hospital 10 shall adopt policies and procedures to ensure that a patient 11 and a patient’s parent or guardian are provided the opportunity 12 to receive information regarding the patient’s rights under 13 this chapter. 14 4. A health care facility, health care provider, or hospital 15 that fails to make the patient’s summary of rights available to 16 a patient or the patient’s parent or guardian as specified in 17 this section shall be subject to the following: 18 a. (1) For a first unintentional violation, completion of a 19 corrective action plan. 20 (2) For a second or subsequent unintentional violation, a 21 fine of not more than one hundred dollars. 22 (3) For a first or subsequent intentional violation, a fine 23 of not more than five hundred dollars, with each intentional 24 violation constituting a separate violation subject to a 25 separate fine. 26 b. In determining the amount of fine to be assessed under 27 paragraph “a” , the following factors shall be considered: 28 (1) The scope and severity of the violation, including the 29 number of patients or parents or guardians of patients found 30 not to have received notice of a patient’s rights, and whether 31 the failure to provide the information was willful. 32 (2) Actions taken by the health care facility, health care 33 provider, or hospital to correct the violation or to remedy a 34 complaint. 35 -5- LSB 1619HH (16) 88 pf/rh 5/ 10

H.F. 246 (3) Any previous violations under this chapter by a health 1 care facility, health care provider, or hospital. 2 Sec. 8. NEW SECTION . 135Q.8 Penalties. 3 1. A health care facility, health care provider, hospital, 4 or insurer, as applicable, that violates a provision of this 5 chapter, is subject to the following as determined by the 6 appropriate licensing authority: 7 a. For a first violation, a fine in the amount of one 8 thousand dollars. 9 b. For a second or subsequent violation, licensee discipline 10 as applicable to the health care facility, health care 11 provider, hospital, or insurer. 12 2. In addition to the penalties specified in subsection 13 1, a health care facility, health care provider, hospital, 14 or insurer, as applicable, that violates this chapter may be 15 subject to the following, as determined by the department or 16 the commissioner of insurance, as applicable: 17 a. A fine of not more than five thousand dollars for an 18 unintentional violation. 19 b. A fine of not more than twenty-five thousand dollars 20 for an intentional violation, with each intentional violation 21 constituting a separate violation subject to a separate fine. 22 EXPLANATION 23 The inclusion of this explanation does not constitute agreement with 24 the explanation’s substance by the members of the general assembly. 25 This bill creates the “Immunization Informed Consent 26 Protection Act”. The bill provides definitions used in the 27 bill. 28 The bill prohibits a hospital or health care facility 29 from discriminating against or terminating the employment or 30 contract of a health care provider, staff member, employee, 31 contractor, subcontractor, or applicant for one of these 32 positions based on the person’s refusal to receive an 33 immunization; and from discriminating against or terminating 34 the employment or contract of a health care provider, staff 35 -6- LSB 1619HH (16) 88 pf/rh 6/ 10

H.F. 246 member, employee, contractor, or subcontractor based on 1 the person’s willingness to participate in the immunization 2 of patients. The bill also prohibits a hospital or health 3 care facility from discriminating against or prohibiting 4 or terminating participation by a volunteer based upon the 5 person’s refusal to receive an immunization or the person’s 6 willingness to participate in the immunization of patients. 7 Additionally, a hospital, health care facility, or educational 8 institution providing clinical experience to satisfy the 9 professional degree requirements of a student, intern, or 10 resident is prohibited from discriminating against the student, 11 intern, or resident, or prohibit admission, enrollment, or 12 employment as a student, intern, or resident based on the 13 immunization status of the student, intern, or resident. The 14 bill provides that a person aggrieved under this portion of 15 the bill may petition the district court for injunctive relief 16 against any further violation; affirmative relief, including 17 reinstatement of employment with back pay and interest; any 18 other equitable relief the court deems appropriate; or other 19 appropriate relief necessary to ensure compliance with this 20 portion of the bill. 21 With respect to health care provider licensees, the bill 22 prohibits the licensing authority for a health care provider 23 from denying an applicant for a license or from suspending, 24 revoking, or refusing to renew a license, and from taking 25 disciplinary action against a licensee based on the applicant’s 26 or licensee’s immunization history or refusal to submit to or 27 administer an immunization. However, the licensing authority 28 may deny an applicant a license or suspend, revoke, or refuse 29 to renew a license, or take disciplinary action against a 30 licensee based on the applicant or licensee having three or 31 more verified failures to comply in one calendar year with the 32 applicable federal health care provider requirements relative 33 to the recording and reporting of immunization information and 34 the provision of immunization information to patients under 35 -7- LSB 1619HH (16) 88 pf/rh 7/ 10

H.F. 246 federal law. 1 Relative to insurers and insurance, the bill prohibits an 2 insurer providing a group policy, contract, or plan for health 3 insurance from using the immunization status of a person as a 4 basis to reject; deny; limit; cancel; refuse to renew; increase 5 the premiums for; limit the amount, extent, or kind of coverage 6 available to; or otherwise adversely affect eligibility 7 or coverage for the group health policy, contract, or plan 8 for health insurance. An insurer providing a group policy, 9 contract, or plan for health insurance is also prohibited from 10 using the immunization status of a patient as a qualification 11 or requirement for contracting with the patient’s provider 12 or as a basis for terminating a contract with the patient’s 13 provider. The bill prohibits the immunization status of a 14 person covered by a group policy, contract, or plan for health 15 insurance from being used as a factor in the rating of a group 16 policy, contract, or plan for health insurance in this state, 17 and prohibits an insurer issuing a group policy contract or 18 plan for health insurance from denying a health care facility, 19 health care provider, or hospital’s participation or decreasing 20 reimbursement based on low patient immunization rates or the 21 facility’s, provider’s, or hospital’s decision not to immunize 22 a patient. An insurer who violates this portion of the bill is 23 subject to the summary cease and desist order, cease and desist 24 order, and penalty provisions pursuant to Code chapter 507B 25 (insurance trade practices). 26 The bill includes other prohibited activities relative to 27 immunizations. The bill prohibits a health care facility, 28 health care provider, or hospital from accepting an incentive 29 from an insurer or pharmaceutical company in exchange for 30 the immunization of patients; and from requiring a patient 31 or the parent or guardian of a patient to sign a liability 32 waiver as a condition of receiving medical care if the patient 33 or the patient’s parent or guardian chooses to delay or 34 decline an immunization. The bill prohibits the department 35 -8- LSB 1619HH (16) 88 pf/rh 8/ 10

H.F. 246 of human services from initiating a child abuse investigation 1 against the parent or guardian of a child on the sole basis 2 that the parent or guardian has chosen to delay or decline 3 an immunization for the child. Additionally, a health care 4 facility, health care provider, hospital, or a staff member or 5 employee of a health care facility, health care provider, or 6 hospital is prohibited from discriminating against a patient 7 or the parent or guardian of a patient or from terminating 8 treatment of a patient based solely on a patient or a parent 9 or guardian of a patient choosing to delay or decline an 10 immunization. The exercise of a patient’s right to informed 11 consent by delaying or declining an immunization shall not 12 be grounds for the dismissal of a patient from a health care 13 provider practice, health care facility, or hospital or for a 14 patient’s loss of medical privileges or benefits. The bill 15 prohibits a health care facility, health care provider, or 16 hospital from harassing, coercing, admonishing, or threatening 17 a patient or the parent or guardian of a patient for exercising 18 the patient’s right to delay or decline an immunization. 19 The bill requires the department of public health to 20 publish on the department’s publicly accessible internet 21 site a summary of the rights of a patient and the patient’s 22 parent or guardian as specified in the bill. If requested, a 23 health care facility, health care provider, or hospital shall 24 inform a patient and a patient’s parent or guardian of the 25 address and telephone number of each state agency responsible 26 for responding to a patient’s complaints of noncompliance 27 with the provisions of the bill. The bill requires a health 28 care facility, health care provider, and a hospital to 29 adopt policies and procedures to ensure that a patient and 30 a patient’s parent or guardian are provided the opportunity 31 to receive information regarding the patient’s rights under 32 the bill. If a health care facility, health care provider, 33 or hospital fails to make the patient’s summary of rights 34 available to a patient or the patient’s parent or guardian 35 -9- LSB 1619HH (16) 88 pf/rh 9/ 10

H.F. 246 as specified in the bill, the entity is subject to penalties 1 including a corrective action plan for a first unintentional 2 violation; a fine of not more than $100 for a second or 3 subsequent unintentional violation; and a fine of not more 4 than $500 per violation for a first or subsequent intentional 5 violation. The bill provides factors to be considered in 6 determining the amount of fine to be assessed. 7 The bill includes penalties for a health care facility, 8 health care provider, hospital, or insurer, as applicable, that 9 violates a provision of the Code chapter, as determined by the 10 appropriate licensing authority, including licensing discipline 11 and fines ranging from $1,000 to $25,000 per violation. 12 -10- LSB 1619HH (16) 88 pf/rh 10/ 10