H.F. _____ Section 1. Section 144.1, Code 2020, is amended by adding 1 the following new subsections: 2 NEW SUBSECTION . 1A. “Bodily remains” means the physical 3 remains, corpse, or body parts of a dead fetus, which remains 4 were expelled or extracted following a fetal death. “Bodily 5 remains” does not include medical waste. 6 NEW SUBSECTION . 9A. “Induced termination of pregnancy” 7 means a termination of pregnancy by any means of a woman known 8 to be pregnant with the intent other than to produce a live 9 birth or to remove a dead fetus. 10 NEW SUBSECTION . 9B. “Induces a termination of pregnancy” 11 means the use of any means to terminate the pregnancy of a 12 woman known to be pregnant with the intent other than to 13 produce a live birth or to remove a dead fetus. 14 NEW SUBSECTION . 11A. “Medical facility” means the same as 15 defined in section 146B.1. 16 NEW SUBSECTION . 11B. “Medical waste” means discarded 17 biologic product such as blood, tissue, or body parts removed 18 from medical facilities as well as bedding, bandages, syringes, 19 and similar materials that have been used in treating patients, 20 but does not include bodily remains. 21 NEW SUBSECTION . 12A. “Spontaneous termination of pregnancy” 22 means an unintended termination of pregnancy at any time during 23 the period from conception to twenty weeks gestation. 24 NEW SUBSECTION . 13A. “Stillbirth” means an unintended fetal 25 death occurring after a gestation period of twenty completed 26 weeks, or an unintended fetal death of a fetus with a weight of 27 three hundred fifty or more grams. 28 Sec. 2. Section 144.29, subsection 1, Code 2020, is amended 29 to read as follows: 30 1. A fetal death certificate for each fetal death which 31 occurs in this state after a gestation period of twenty twelve 32 completed weeks or greater , or for a fetus with a weight of 33 three hundred fifty grams or more shall be filed as directed 34 by the state registrar within three days after delivery and 35 -1- LSB 6297YC (3) 88 pf/rh 1/ 6

H.F. _____ prior to final disposition of the fetus bodily remains . The 1 certificate shall be registered if it has been completed and 2 filed in accordance with this chapter . 3 Sec. 3. Section 144.29A, subsection 7, Code 2020, is amended 4 to read as follows: 5 7. For the purposes of this section : 6 a. “Health care provider” , “health care provider” means an 7 individual licensed under chapter 148 , 148C , 148D , or 152 , 8 or any individual who provides medical services under the 9 authorization of the licensee. 10 b. “Inducing a termination of pregnancy” means the use of 11 any means to terminate the pregnancy of a woman known to be 12 pregnant with the intent other than to produce a live birth or 13 to remove a dead fetus. 14 c. “Spontaneous termination of pregnancy” means the 15 occurrence of an unintended termination of pregnancy at 16 any time during the period from conception to twenty weeks 17 gestation and which is not a spontaneous termination of 18 pregnancy at any time during the period from twenty weeks or 19 greater which is reported to the department as a fetal death 20 under this chapter . 21 Sec. 4. NEW SECTION . 144.29B Final disposition of bodily 22 remains after fetal death. 23 1. When a fetal death occurs in an institution or medical 24 facility, the individual in charge of the institution or 25 medical facility shall inform the woman that the woman may 26 determine the final disposition of the bodily remains. A 27 determination request by the woman under this subsection may 28 be made within the time frame established by rule of the 29 department. 30 2. a. The individual in charge of the institution or 31 medical facility where the bodily remains were expelled or 32 extracted shall obtain from the woman a written authorization 33 for final disposition on a form prescribed and furnished or 34 approved by the department. 35 -2- LSB 6297YC (3) 88 pf/rh 2/ 6

H.F. _____ b. The authorization may allow final disposition to be by 1 the individual in charge of the institution or medical facility 2 where the bodily remains were expelled or extracted or another 3 person assuming responsibility for the final disposition of the 4 bodily remains. 5 c. The woman may direct, in the written authorization, that 6 the final disposition of the bodily remains be completed as 7 follows: 8 (1) Only by burial, interment, or cremation when the bodily 9 remains are the result of an induced termination of pregnancy, 10 a spontaneous termination of pregnancy, or a stillbirth. 11 (2) In addition to the means specified in subparagraph 12 (1), when the bodily remains are the result of a spontaneous 13 termination of pregnancy or a stillbirth, by means in 14 compliance with chapter 142C. 15 d. When the bodily remains are the result of an induced 16 termination of pregnancy and the pregnant woman is a minor, the 17 institution or medical facility shall obtain parental consent 18 for the authorization of final disposition of the bodily 19 remains, unless the minor has received a waiver of notification 20 pursuant to chapter 135L. 21 e. The written authorization provided under paragraph 22 “c” shall allow the woman to waive direction of the final 23 disposition of the bodily remains and instead authorize the 24 institution or medical facility to select the manner of final 25 disposition by burial, interment, or cremation. 26 f. The individual in charge of the institution or medical 27 facility where the bodily remains were expelled or extracted or 28 the person assuming responsibility for the final disposition 29 of the bodily remains shall ensure that the final disposition 30 of the bodily remains is performed in compliance with the 31 authorization for final disposition and shall retain the 32 authorization as specified by rule of the department. 33 3. If the woman chooses a location of final disposition 34 other than the location of final disposition that is usual and 35 -3- LSB 6297YC (3) 88 pf/rh 3/ 6

H.F. _____ customary for the institution or medical facility, the woman is 1 responsible for the costs related to the final disposition of 2 the bodily remains at the chosen location. 3 4. The final disposition of the bodily remains shall not be 4 by simultaneous cremation. 5 5. The bodily remains shall not be treated as medical waste. 6 6. The bodily remains may be moved from the place where the 7 bodily remains were expelled or extracted to be prepared for 8 final disposition with the consent of the person who certified 9 the death. 10 7. The final disposition of the bodily remains under 11 this section shall comply with all other requirements for 12 disposition of bodily remains under this chapter and other 13 applicable law. 14 8. The department shall adopt rules pursuant to chapter 17A 15 to administer this section. 16 Sec. 5. Section 144.31A, subsection 1, Code 2020, is amended 17 to read as follows: 18 1. As used in this section : 19 a. “Certificate of birth resulting in stillbirth” , 20 “certificate of birth resulting in stillbirth” means a document 21 issued based upon a properly filed fetal death certificate to 22 record the birth of a stillborn fetus. 23 b. “Stillbirth” means stillbirth as defined in section 24 136A.2 . 25 Sec. 6. Section 144.52, subsection 7, Code 2020, is amended 26 to read as follows: 27 7. Knowingly violates a provision of section 144.29A or 28 144.29B . 29 EXPLANATION 30 The inclusion of this explanation does not constitute agreement with 31 the explanation’s substance by the members of the general assembly. 32 This bill relates to fetal deaths, fetal death certificates, 33 and disposition of bodily remains. 34 FETAL DEATHS AND DISPOSITION OF BODILY REMAINS. The bill 35 -4- LSB 6297YC (3) 88 pf/rh 4/ 6

H.F. _____ amends provisions in Code chapter 144 (vital statistics) to 1 establish a process for a woman to direct the final disposition 2 of bodily remains following a fetal death. The bill provides 3 definitions for the purposes of the bill. The bill provides 4 that when a fetal death occurs in an institution or medical 5 facility, the individual in charge of the institution or 6 medical facility shall inform the woman that the woman may 7 determine the final disposition of the bodily remains. A 8 determination request by the woman may be made within the time 9 frame established by rule of the department of public health 10 (DPH). The individual in charge of the institution or medical 11 facility where the bodily remains were expelled or extracted 12 shall obtain from the woman a written authorization for final 13 disposition on a form prescribed and furnished or approved by 14 DPH. 15 The authorization may allow final disposition to be 16 by the individual in charge of the institution or medical 17 facility or another person assuming responsibility for the 18 final disposition of the bodily remains. In the written 19 authorization, the woman may provide for disposition of the 20 bodily remains as specified in the bill. When the bodily 21 remains are the result of an induced termination of pregnancy, 22 a spontaneous termination of pregnancy, or a stillbirth, 23 disposition may be only by burial, interment, or cremation. 24 When the bodily remains are the result of a spontaneous 25 termination of pregnancy or a stillbirth, disposition may also 26 be made in compliance with Code chapter 142C (the revised 27 uniform anatomical gift Act). When the bodily remains are 28 the result of an induced termination of pregnancy and the 29 pregnant woman is a minor, the institution or medical facility 30 shall obtain parental consent for the authorization of final 31 disposition of the bodily remains, unless the minor has 32 received a waiver of notification pursuant to Code chapter 135L 33 (notification requirements regarding pregnant minors). 34 The individual in charge of the institution or medical 35 -5- LSB 6297YC (3) 88 pf/rh 5/ 6

H.F. _____ facility where the bodily remains were expelled or extracted or 1 the person assuming responsibility for the final disposition 2 of the bodily remains shall ensure that the final disposition 3 of the bodily remains is performed in compliance with the 4 authorization for final disposition, and such person shall 5 retain the authorization as specified by rule of DPH. 6 If the woman chooses a location of final disposition other 7 than the location of final disposition that is usual and 8 customary for the institution or medical facility, the woman is 9 responsible for the costs related to the final disposition of 10 the bodily remains at the chosen location. 11 The final disposition of the bodily remains shall not be 12 by simultaneous cremation. The bodily remains shall not be 13 treated as medical waste. 14 The bodily remains may be moved from the place where the 15 bodily remains were expelled or extracted to be prepared for 16 final disposition with the consent of the person who certified 17 the death. The final disposition of the bodily remains 18 under the bill shall comply with all other requirements for 19 disposition of bodily remains under Code chapter 144 and other 20 applicable laws. 21 A person who knowingly violates a provision of the bill 22 relating to the final disposition of bodily remains after a 23 fetal death is guilty of a serious misdemeanor. A serious 24 misdemeanor is punishable by confinement for no more than one 25 year and a fine of at least $315 but not more than $1,875. 26 FILING OF FETAL DEATH CERTIFICATE. The bill requires a fetal 27 death certificate to be filed for each fetal death which occurs 28 in the state after a gestation period of 12 completed weeks or 29 greater. Current law requires a fetal death certificate to 30 be filed for each fetal death which occurs in the state after 31 a gestation period of 20 completed weeks or greater or for a 32 fetus with a weight of 350 grams or more. 33 -6- LSB 6297YC (3) 88 pf/rh 6/ 6