Senate Study Bill 1116 - Introduced SENATE FILE _____ BY (PROPOSED COMMITTEE ON HEALTH AND HUMAN SERVICES BILL BY CHAIRPERSON EDLER) A BILL FOR An Act relating to the health and well-being of children and 1 families including provisions for maternal support and 2 fatherhood initiatives, regional centers of excellence, a 3 state-funded family medicine obstetrics fellowship program, 4 self-administered hormonal contraceptives, state employee 5 parental leave, adoption expenses under the adoption subsidy 6 program, and accessibility to the all Iowa scholarship 7 program; making appropriations; and including effective date 8 and applicability provisions. 9 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 10 TLSB 2014XC (3) 90 pf/rh

S.F. _____ DIVISION I 1 MORE OPTIONS FOR MATERNAL SUPPORT (MOMS) PROGRAM —— FATHERHOOD 2 INITIATIVES 3 Section 1. Section 217.41C, subsection 1, paragraph c, Code 4 2023, is amended to read as follows: 5 c. For the purposes of this section , “pregnancy support 6 services” means those nonmedical services that promote 7 childbirth by providing information, counseling, and support 8 services that assist pregnant women or women who believe they 9 may be pregnant and men who are involved or who think they 10 might be involved in a pregnancy to choose childbirth and to 11 make informed decisions regarding the choice of adoption or 12 parenting with respect to their children. 13 Sec. 2. Section 217.41C, Code 2023, is amended by adding the 14 following new subsections: 15 NEW SUBSECTION . 8. The department shall develop and 16 maintain a virtual clearinghouse of pregnancy support 17 services and resources including but not limited to all of the 18 following: 19 a. Pregnancy resource center and maternity home information 20 including contact information, location, and services provided. 21 b. Assistance in accessing public assistance including but 22 not limited to the special supplemental nutrition program for 23 women, infants, and children and the supplemental nutrition 24 assistance program. 25 c. Educational resources. 26 d. Housing assistance. 27 e. Recovery and mental health services. 28 f. Family planning education. 29 g. Adoption and foster care information and services. 30 h. Healing and support services for abortion survivors and 31 their families. 32 NEW SUBSECTION . 9. Beginning July 1, 2023, and thereafter, 33 funding for the program may be used for all of the following 34 purposes: 35 -1- LSB 2014XC (3) 90 pf/rh 1/ 23

S.F. _____ a. Fatherhood engagement grants. The department may 1 award grants to nonprofit, community-based organizations to 2 address the needs of fathers by assisting fathers in finding 3 employment, managing child support obligations, transitioning 4 from a period of incarceration, accessing health care, 5 understanding child development, and enhancing parenting skills 6 using evidence-based parenting education. Priority in the 7 awarding of grants shall be based on the demonstrated need 8 in a geographic area and the prevalence of the population to 9 be served as indicated by factors including but not limited 10 to the service area’s unemployment rate, incarceration rate, 11 number of public assistance recipients, number of single-parent 12 households, level of housing instability, and graduation rates. 13 b. Fatherhood communications initiative. The department 14 shall administer a communications initiative on responsible 15 fatherhood including but not limited to a public internet site 16 that provides access to resources on effective parenting and 17 assistance in receiving parenting support and services. 18 c. Mentoring school-aged males grant program. The 19 department may award three-year renewable grants to nonprofit 20 organizations that provide mentorship, social and academic 21 support, and life skills development to school-aged males. 22 Priority in the awarding of grants shall be based on the 23 demonstrated need in a geographic area and the prevalence of 24 the population to be served as indicated by factors including 25 but not limited to the service area’s unemployment rate, 26 incarceration rate, number of public assistance recipients, 27 number of single-parent households, level of housing 28 instability, and graduation rates. The department shall 29 provide technical assistance to grantees to ensure program 30 sustainability following the end of the three-year grant 31 period. 32 Sec. 3. MORE OPTIONS FOR MATERNAL SUPPORT PROGRAM —— 33 APPROPRIATION. There is appropriated from the general fund of 34 the state to the department of health and human services for 35 -2- LSB 2014XC (3) 90 pf/rh 2/ 23

S.F. _____ the fiscal year beginning July 1, 2023, and ending June 30, 1 2024, the following amount, or so much thereof as is necessary, 2 to be used for the purposes designated: 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2,000,000 4 To be used for the purposes of the more options for maternal 5 support program created in section 217.41C, including for 6 program administration, the provision of services, and for 7 funding of fatherhood engagement grants, the fatherhood 8 communications initiative, and the mentoring school-aged males 9 grant program. 10 Sec. 4. 2022 Iowa Acts, chapter 1131, section 28, subsection 11 8, is amended to read as follows: 12 8. Of the funds appropriated under this section, $500,000 13 shall be used for the purposes of program administration and 14 provision of pregnancy support services through the more 15 options for maternal support program created in this Act. 16 Notwithstanding section 8.33, moneys appropriated in this 17 subsection that remain unencumbered or unobligated at the close 18 of the fiscal year shall not revert but shall remain available 19 for the purposes designated until the close of the succeeding 20 fiscal year. 21 Sec. 5. EFFECTIVE DATE. The following, being deemed of 22 immediate importance, takes effect upon enactment: 23 The section of this division of this Act amending 2022 Iowa 24 Acts, chapter 1131, section 28, subsection 8. 25 DIVISION II 26 REGIONAL CENTERS OF EXCELLENCE GRANT PROGRAM 27 Sec. 6. REGIONAL CENTERS OF EXCELLENCE PROGRAM —— GRANTS —— 28 APPROPRIATION. There is appropriated from the general fund of 29 the state to the department of health and human services for 30 the fiscal year beginning July 1, 2023, and ending June 30, 31 2024, the following amount, or so much thereof as is necessary, 32 to be used for the purposes designated: 33 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,000,000 34 The funds appropriated in this section shall be used for 35 -3- LSB 2014XC (3) 90 pf/rh 3/ 23

S.F. _____ the continuation of a center of excellence program to award 1 four grants to encourage innovation and collaboration among 2 regional health care providers in a rural area based upon the 3 results of a regional community needs assessment to transform 4 health care delivery in order to provide quality, sustainable 5 care that meets the needs of the local communities. An 6 applicant for the grant funds shall specify how the funds will 7 be expended to accomplish the goals of the program and shall 8 provide a detailed five-year sustainability plan prior to being 9 awarded any funding. Following the receipt of grant funding, 10 a recipient shall submit periodic reports as specified by the 11 department to the governor and the general assembly regarding 12 the recipient’s expenditure of the funds and progress in 13 accomplishing the program’s goals. 14 DIVISION III 15 STATE-FUNDED FAMILY MEDICINE OBSTETRICS FELLOWSHIP PROGRAM 16 Sec. 7. NEW SECTION . 135.182 State-funded family medicine 17 obstetrics fellowship program —— fund. 18 1. The department shall establish a family medicine 19 obstetrics fellowship program to increase access to family 20 medicine obstetrics practitioners in rural and underserved 21 areas of the state. A person who has completed an 22 accreditation council for graduate medical education residency 23 program in family medicine is eligible for participation 24 in the fellowship program. Participating fellows shall 25 enter into a program agreement with a participating teaching 26 hospital which, at a minimum, requires the fellow to complete a 27 one-year fellowship and to engage in full-time family medicine 28 obstetrics practice in a rural or underserved area of the 29 state for a period of at least five years within nine months 30 following completion of the fellowship and receipt of a license 31 to practice medicine in the state. 32 2. Each fellow participating in the program shall be 33 eligible for a salary and benefits including a stipend as 34 determined by the participating teaching hospital which shall 35 -4- LSB 2014XC (3) 90 pf/rh 4/ 23

S.F. _____ be funded through the family medicine obstetrics fellowship 1 program fund. 2 3. The department shall adopt rules pursuant to chapter 3 17A to administer the program, including defining rural and 4 underserved areas for the purpose of the required full-time 5 practice of a person following completion of the fellowship. 6 4. a. A family medicine obstetrics fellowship program 7 fund is created in the state treasury consisting of the moneys 8 appropriated or credited to the fund by law. Notwithstanding 9 section 8.33, moneys in the fund at the end of each fiscal year 10 shall not revert to any other fund but shall remain in the fund 11 for use in subsequent fiscal years. Moneys in the fund are 12 appropriated to the department to be used to fund fellowship 13 positions as provided in this section. 14 b. For the fiscal year beginning July 1, 2023, and each 15 fiscal year beginning July 1 thereafter, there is appropriated 16 from the general fund of the state to the family medicine 17 obstetrics fellowship program fund an amount sufficient to 18 support the creation of four fellowship positions as provided 19 in this section. 20 5. The department and the participating teaching hospitals 21 shall regularly evaluate and document their experiences 22 including identifying ways the program may be modified or 23 expanded to facilitate increased access to family medicine 24 obstetrics practitioners in rural and underserved areas of the 25 state. The department shall submit an annual report to the 26 general assembly by January 1. The report shall include the 27 number of fellowships funded to date and any other information 28 identified by the department and the participating teaching 29 hospitals as indicators of outcomes and the effectiveness of 30 the program. 31 6. For the purposes of this section, “teaching hospital” 32 means a hospital or medical center that provides medical 33 education to prospective and current health professionals. 34 Sec. 8. STATE-FUNDED FAMILY MEDICINE OBSTETRICS FELLOWSHIP 35 -5- LSB 2014XC (3) 90 pf/rh 5/ 23

S.F. _____ PROGRAM AND FUND —— APPROPRIATION. There is appropriated from 1 the general fund of the state to the department of health and 2 human services for the fiscal year beginning July 1, 2023, and 3 ending June 30, 2024, the following amount, or so much thereof 4 as is necessary, to be used for the purposes designated: 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 560,000 6 For deposit in the family medicine obstetrics fellowship 7 program fund to be utilized in creating and providing for four 8 family medicine obstetrics fellowship positions during the 9 fiscal year in accordance with the family medicine obstetrics 10 fellowship program created in this division of this Act. 11 DIVISION IV 12 SELF-ADMINISTERED HORMONAL CONTRACEPTIVES 13 Sec. 9. Section 155A.3, Code 2023, is amended by adding the 14 following new subsections: 15 NEW SUBSECTION . 10A. “Department” means the department of 16 health and human services. 17 NEW SUBSECTION . 45A. “Self-administered hormonal 18 contraceptive” means a self-administered hormonal contraceptive 19 that is approved by the United States food and drug 20 administration to prevent pregnancy. “Self-administered 21 hormonal contraceptive” includes an oral hormonal contraceptive, 22 a hormonal vaginal ring, and a hormonal contraceptive patch, 23 but does not include any drug intended to induce an abortion as 24 defined in section 146.1. 25 NEW SUBSECTION . 45B. “Standing order” means a preauthorized 26 medication order with specific instructions from the medical 27 director of the department to dispense a medication under 28 clearly defined circumstances. 29 Sec. 10. NEW SECTION . 155A.49 Pharmacist dispensing of 30 self-administered hormonal contraceptives —— standing order —— 31 requirements —— limitations of liability. 32 1. a. Notwithstanding any provision of law to the contrary, 33 a pharmacist may dispense a self-administered hormonal 34 contraceptive to a patient who is at least eighteen years of 35 -6- LSB 2014XC (3) 90 pf/rh 6/ 23

S.F. _____ age, pursuant to a standing order established by the medical 1 director of the department in accordance with this section. 2 b. In dispensing a self-administered hormonal contraceptive 3 to a patient under this section, a pharmacist shall comply with 4 all of the following: 5 (1) For an initial dispensing of a self-administered 6 hormonal contraceptive, the pharmacist may dispense only up 7 to a three-month supply at one time of the self-administered 8 hormonal contraceptive. 9 (2) For any subsequent dispensing of the same 10 self-administered hormonal contraceptive, the pharmacist 11 may dispense up to a twelve-month supply at one time of the 12 self-administered hormonal contraceptive. 13 2. A pharmacist who dispenses a self-administered hormonal 14 contraceptive in accordance with this section shall not 15 require any other prescription drug order authorized by a 16 practitioner prior to dispensing the self-administered hormonal 17 contraceptive to a patient. 18 3. The medical director of the department may establish a 19 standing order authorizing the dispensing of self-administered 20 hormonal contraceptives by a pharmacist who does all of the 21 following: 22 a. Complies with the standing order established pursuant to 23 this section. 24 b. Retains a record of each patient to whom a 25 self-administered hormonal contraceptive is dispensed under 26 this section and submits the record to the department. 27 4. The standing order shall require a pharmacist who 28 dispenses self-administered hormonal contraceptives under this 29 section to do all of the following: 30 a. Complete a standardized training program and continuing 31 education requirements approved by the board in consultation 32 with the board of medicine and the department that are related 33 to prescribing self-administered hormonal contraceptives and 34 include education regarding all contraceptive methods approved 35 -7- LSB 2014XC (3) 90 pf/rh 7/ 23

S.F. _____ by the United States food and drug administration. 1 b. Obtain a completed self-screening risk assessment, 2 approved by the department in collaboration with the board and 3 the board of medicine, from each patient, verify the identity 4 and age of each patient, and perform a blood pressure screening 5 on each patient prior to dispensing the self-administered 6 hormonal contraceptive to the patient. 7 c. Provide the patient with all of the following: 8 (1) Written information regarding all of the following: 9 (a) The importance of completing an appointment with the 10 patient’s primary care or women’s health care practitioner 11 to obtain preventative care, including but not limited to 12 recommended tests and screenings. 13 (b) The effectiveness and availability of long-acting 14 reversible contraceptives as an alternative to 15 self-administered hormonal contraceptives. 16 (2) A copy of the record of the pharmacist’s encounter with 17 the patient that includes all of the following: 18 (a) The patient’s completed self-screening risk assessment. 19 (b) A description of the contraceptive dispensed, or the 20 basis for not dispensing a contraceptive. 21 (3) Patient counseling regarding all of the following: 22 (a) The appropriate administration and storage of the 23 self-administered hormonal contraceptive. 24 (b) Potential side effects and risks of the 25 self-administered hormonal contraceptive. 26 (c) The need for backup contraception. 27 (d) When to seek emergency medical attention. 28 (e) The risk of contracting a sexually transmitted 29 infection or disease, and ways to reduce such a risk. 30 5. The standing order established pursuant to this section 31 shall prohibit a pharmacist who dispenses a self-administered 32 hormonal contraceptive under this section from doing any of the 33 following: 34 a. Requiring a patient to schedule an appointment with 35 -8- LSB 2014XC (3) 90 pf/rh 8/ 23

S.F. _____ the pharmacist for the prescribing or dispensing of a 1 self-administered hormonal contraceptive. 2 b. Dispensing self-administered hormonal contraceptives 3 to a patient for more than twenty-seven months after the 4 date a self-administered hormonal contraceptive is initially 5 dispensed to the patient, if the patient has not consulted with 6 a primary care or women’s health care practitioner during the 7 preceding twenty-seven months, in which case the pharmacist 8 shall refer the patient to a primary care or women’s health 9 care practitioner. 10 c. Dispensing a self-administered hormonal contraceptive to 11 a patient if the results of the self-screening risk assessment 12 completed by a patient pursuant to subsection 4, paragraph 13 “b” , indicate it is unsafe for the pharmacist to dispense the 14 self-administered hormonal contraceptive to the patient, in 15 which case the pharmacist shall refer the patient to a primary 16 care or women’s health care practitioner. 17 6. A pharmacist who dispenses a self-administered hormonal 18 contraceptive and the medical director of the department who 19 establishes a standing order in compliance with this section 20 shall be immune from criminal and civil liability arising 21 from any damages caused by the dispensing, administering, 22 or use of a self-administered hormonal contraceptive or the 23 establishment of the standing order. The medical director of 24 the department shall be considered to be acting within the 25 scope of the medical director’s office and employment for 26 purposes of chapter 669 in the establishment of a standing 27 order in compliance with this section. 28 7. The department, in collaboration with the board and 29 the board of medicine, and in consideration of the guidelines 30 established by the American congress of obstetricians and 31 gynecologists, shall adopt rules pursuant to chapter 17A to 32 administer this chapter. 33 Sec. 11. Section 514C.19, Code 2023, is amended to read as 34 follows: 35 -9- LSB 2014XC (3) 90 pf/rh 9/ 23

S.F. _____ 514C.19 Prescription contraceptive coverage. 1 1. Notwithstanding the uniformity of treatment requirements 2 of section 514C.6 , a group policy , or contract , or plan 3 providing for third-party payment or prepayment of health or 4 medical expenses shall not do either of the following comply 5 as follows : 6 a. Exclude Such policy, contract, or plan shall not 7 exclude or restrict benefits for prescription contraceptive 8 drugs or prescription contraceptive devices which prevent 9 conception and which are approved by the United States 10 food and drug administration, or generic equivalents 11 approved as substitutable by the United States food and 12 drug administration, if such policy , or contract , or plan 13 provides benefits for other outpatient prescription drugs 14 or devices. However, such policy, contract, or plan shall 15 specifically provide for payment of a self-administered 16 hormonal contraceptive, as prescribed by a practitioner as 17 defined in section 155A.3, or as prescribed by standing order 18 and dispensed by a pharmacist pursuant to section 155A.49, 19 including payment for up to an initial three-month supply 20 of a self-administered hormonal contraceptive dispensed at 21 one time and for up to a twelve-month supply of the same 22 self-administered hormonal contraceptive subsequently dispensed 23 at one time. 24 b. Exclude Such policy, contract, or plan shall not exclude 25 or restrict benefits for outpatient contraceptive services 26 which are provided for the purpose of preventing conception if 27 such policy , or contract , or plan provides benefits for other 28 outpatient services provided by a health care professional. 29 2. A person who provides a group policy , or contract , or 30 plan providing for third-party payment or prepayment of health 31 or medical expenses which is subject to subsection 1 shall not 32 do any of the following: 33 a. Deny to an individual eligibility, or continued 34 eligibility, to enroll in or to renew coverage under the terms 35 -10- LSB 2014XC (3) 90 pf/rh 10/ 23

S.F. _____ of the policy , or contract , or plan because of the individual’s 1 use or potential use of such prescription contraceptive drugs 2 or devices, or use or potential use of outpatient contraceptive 3 services. 4 b. Provide a monetary payment or rebate to a covered 5 individual to encourage such individual to accept less than the 6 minimum benefits provided for under subsection 1 . 7 c. Penalize or otherwise reduce or limit the reimbursement 8 of a health care professional because such professional 9 prescribes contraceptive drugs or devices, or provides 10 contraceptive services. 11 d. Provide incentives, monetary or otherwise, to a health 12 care professional to induce such professional to withhold 13 from a covered individual contraceptive drugs or devices, or 14 contraceptive services. 15 3. This section shall not be construed to prevent a 16 third-party payor from including deductibles, coinsurance, or 17 copayments under the policy , or contract, or plan as follows: 18 a. A deductible, coinsurance, or copayment for benefits 19 for prescription contraceptive drugs shall not be greater than 20 such deductible, coinsurance, or copayment for any outpatient 21 prescription drug for which coverage under the policy , or 22 contract , or plan is provided. 23 b. A deductible, coinsurance, or copayment for benefits for 24 prescription contraceptive devices shall not be greater than 25 such deductible, coinsurance, or copayment for any outpatient 26 prescription device for which coverage under the policy , or 27 contract , or plan is provided. 28 c. A deductible, coinsurance, or copayment for benefits for 29 outpatient contraceptive services shall not be greater than 30 such deductible, coinsurance, or copayment for any outpatient 31 health care services for which coverage under the policy , or 32 contract , or plan is provided. 33 4. This section shall not be construed to require a 34 third-party payor under a policy , or contract , or plan 35 -11- LSB 2014XC (3) 90 pf/rh 11/ 23

S.F. _____ to provide benefits for experimental or investigational 1 contraceptive drugs or devices, or experimental or 2 investigational contraceptive services, except to the extent 3 that such policy , or contract , or plan provides coverage for 4 other experimental or investigational outpatient prescription 5 drugs or devices, or experimental or investigational outpatient 6 health care services. 7 5. This section shall not be construed to limit or otherwise 8 discourage the use of generic equivalent drugs approved by the 9 United States food and drug administration, whenever available 10 and appropriate. This section , when a brand name drug is 11 requested by a covered individual and a suitable generic 12 equivalent is available and appropriate, shall not be construed 13 to prohibit a third-party payor from requiring the covered 14 individual to pay a deductible, coinsurance, or copayment 15 consistent with subsection 3 , in addition to the difference of 16 the cost of the brand name drug less the maximum covered amount 17 for a generic equivalent. 18 6. A person who provides an individual policy , or contract , 19 or plan providing for third-party payment or prepayment of 20 health or medical expenses shall make available a coverage 21 provision that satisfies the requirements in subsections 22 1 through 5 in the same manner as such requirements are 23 applicable to a group policy , or contract , or plan under those 24 subsections. The policy , or contract , or plan shall provide 25 that the individual policyholder may reject the coverage 26 provision at the option of the policyholder. 27 7. a. This section applies to the following classes of 28 third-party payment provider contracts , or policies , or plans 29 delivered, issued for delivery, continued, or renewed in this 30 state on or after July 1, 2000 January 1, 2024 : 31 (1) Individual or group accident and sickness insurance 32 providing coverage on an expense-incurred basis. 33 (2) An individual or group hospital or medical service 34 contract issued pursuant to chapter 509 , 514 , or 514A . 35 -12- LSB 2014XC (3) 90 pf/rh 12/ 23

S.F. _____ (3) An individual or group health maintenance organization 1 contract regulated under chapter 514B . 2 (4) Any other entity engaged in the business of insurance, 3 risk transfer, or risk retention, which is subject to the 4 jurisdiction of the commissioner. 5 (5) A plan established pursuant to chapter 509A for public 6 employees. 7 b. This section shall not apply to accident-only, 8 specified disease, short-term hospital or medical, hospital 9 confinement indemnity, credit, dental, vision, Medicare 10 supplement, long-term care, basic hospital and medical-surgical 11 expense coverage as defined by the commissioner, disability 12 income insurance coverage, coverage issued as a supplement 13 to liability insurance, workers’ compensation or similar 14 insurance, or automobile medical payment insurance. 15 8. This section shall not be construed to require a 16 third-party payor to provide payment to a practitioner for the 17 dispensing of a self-administered hormonal contraceptive to 18 replace a self-administered hormonal contraceptive that has 19 been dispensed to a covered person and that has been misplaced, 20 stolen, or destroyed. This section shall not be construed to 21 require a third-party payor to replace covered prescriptions 22 that are misplaced, stolen, or destroyed. 23 9. For the purposes of this section, “self-administered 24 hormonal contraceptive” and “standing order” mean the same as 25 defined in section 155A.3. 26 Sec. 12. INFORMATION PROGRAM FOR DRUG PRESCRIBING AND 27 DISPENSING —— SELF-ADMINISTERED HORMONAL CONTRACEPTIVES. The 28 board of pharmacy in collaboration with the board of medicine 29 and the department of health and human services shall expand 30 the information program for drug prescribing and dispensing 31 established pursuant to section 124.551, to collect from 32 pharmacists information relating to the dispensing of 33 self-administered hormonal contraceptives as provided pursuant 34 to section 155A.49. The board of pharmacy shall adopt 35 -13- LSB 2014XC (3) 90 pf/rh 13/ 23

S.F. _____ rules pursuant to chapter 17A related to registration of 1 participating pharmacists, the information to be reported by a 2 pharmacist to the information program, access to information 3 from the program, and other rules necessary to carry out the 4 purposes and to enforce the provisions of this section. 5 Sec. 13. APPLICATION TO MEDICAID PROGRAM. This division 6 of this Act shall apply to the Medicaid program including a 7 managed care organization acting pursuant to a contract with 8 the department of health and human services to administer 9 the Medicaid program under chapter 249A. However, if it is 10 determined that any provision of this division of this Act 11 would cause denial of federal funds under Tit. XVIII or XIX 12 of the federal Social Security Act, or would otherwise be 13 inconsistent or conflict with the requirements of federal law 14 or regulation, such provision shall be suspended, but only to 15 the extent necessary to prevent denial of such funds or to 16 eliminate the inconsistency or conflict with the requirements 17 of federal law or regulation. 18 DIVISION V 19 STATE EMPLOYEE PAID PARENTAL LEAVE BENEFIT 20 Sec. 14. NEW SECTION . 70A.31 Paid parental leave. 21 1. A state employee entitled to leave under the federal 22 Family and Medical Leave Act of 1993 shall be provided paid 23 leave for such time as specified in this section for the birth 24 or placement for adoption with the employee of a child if the 25 leave is taken within twelve months following any such birth 26 or adoption. 27 2. a. For the birth of a child, a state employee parent who 28 gave birth shall be entitled to up to four weeks of paid leave 29 and a state employee parent who did not give birth shall be 30 entitled to up to one week of paid leave. 31 b. For the placement for adoption of a child, a state 32 employee parent shall be entitled to up to four weeks of paid 33 leave. 34 3. The department of administrative services shall adopt 35 -14- LSB 2014XC (3) 90 pf/rh 14/ 23

S.F. _____ rules to implement this section. 1 DIVISION VI 2 NONRECURRING ADOPTION EXPENSES —— ADOPTION SUBSIDY PROGRAM 3 Sec. 15. NEW SECTION . 234.48 Adoption subsidy —— 4 nonrecurring adoption expenses. 5 Notwithstanding any provision to the contrary, the maximum 6 reimbursement provided to an adoptive parent under the 7 adoption subsidy program for nonrecurring adoption expenses 8 is one thousand dollars. For the purposes of this section, 9 “nonrecurring adoption expenses” means the same as defined in 45 10 C.F.R. §1356.41. The department shall adopt rules pursuant to 11 chapter 17A to administer this section. 12 Sec. 16. REPEAL. 2010 Iowa Acts, chapter 1031, section 408, 13 is repealed. 14 DIVISION VII 15 ALL IOWA OPPORTUNITY SCHOLARSHIP PROGRAM 16 Sec. 17. Section 261.87, subsection 1, paragraph b, 17 unnumbered paragraph 1, Code 2023, is amended to read as 18 follows: 19 “Eligible foster care student” means a person under 20 twenty-six years of age who has a high school diploma or a high 21 school equivalency diploma under chapter 259A and is described 22 by any of the following: 23 Sec. 18. Section 261.87, subsection 2, paragraph f, Code 24 2023, is amended to read as follows: 25 f. (1) Begins Except as provided in subparagraph (2), 26 begins enrollment at an eligible institution within two 27 academic years of graduation from high school or receipt of 28 a high school equivalency diploma under chapter 259A and 29 continuously receives awards as a full-time or part-time 30 student to maintain eligibility. However, the student may 31 defer or suspend participation in the program for up to two 32 years in order to pursue obligations that meet conditions 33 established by the commission by rule or to fulfill military 34 obligations. 35 -15- LSB 2014XC (3) 90 pf/rh 15/ 23

S.F. _____ (2) The requirements of subparagraph (1) do not apply to an 1 eligible foster care student. 2 Sec. 19. APPLICABILITY. This division of this Act applies 3 to applications submitted under the all Iowa opportunity 4 scholarship program established pursuant to section 261.87 5 before, on, or after the effective date of this division of 6 this Act. 7 EXPLANATION 8 The inclusion of this explanation does not constitute agreement with 9 the explanation’s substance by the members of the general assembly. 10 This bill relates to the health and well-being of children 11 and families. The bill is constructed in divisions. 12 DIVISION I —— MORE OPTIONS FOR MATERNAL SUPPORT (MOMS) 13 PROGRAM —— FATHERHOOD INITIATIVES. This division relates to 14 the more options for maternal support (MOMS) program. The 15 bill adds as part of the definition of “pregnancy support 16 services” services to men who are involved or think they might 17 be involved in a pregnancy. As part of the MOMS program, 18 the division requires HHS to develop and maintain a virtual 19 clearinghouse of pregnancy support services and resources. The 20 services and resources include but are not limited to pregnancy 21 resource center and maternity home information; assistance in 22 accessing public assistance including but not limited to the 23 special supplemental nutrition program for women, infants, and 24 children program and the supplemental nutrition assistance 25 program; educational resources; housing assistance; recovery 26 and mental health services; family planning education; adoption 27 and foster care information and services; and healing and 28 support services for abortion survivors and their families. 29 As part of the MOMS program, beginning July 1, 2023, and 30 thereafter, funding for the program may be used for fatherhood 31 engagement grants to nonprofit, community-based organizations 32 to address the needs of fathers by assisting fathers in 33 finding employment, managing child support obligations, 34 transitioning from a period of incarceration, accessing health 35 -16- LSB 2014XC (3) 90 pf/rh 16/ 23

S.F. _____ care, understanding child development, and enhancing parenting 1 skills using evidence-based parenting education; a fatherhood 2 communications initiative administered by HHS, including but 3 not limited to a public internet site that provides access to 4 resources on effective parenting and assistance in receiving 5 parenting support and services; and a mentoring school-aged 6 males grant program to provide mentorship, social and academic 7 support, and life skills development to school-aged males. 8 The division also appropriates $2 million from the general 9 fund of the state to HHS for fiscal year 2023-2024 to be used 10 for the MOMS program including for program administration, the 11 provision of services, and for funding of fatherhood engagement 12 grants, the fatherhood communications initiative, and the 13 mentoring school-aged males grant program. 14 The division provides that the funding appropriated for the 15 MOMS program for fiscal year 2022-2023 is not to revert, but 16 is to remain available for the MOMS program for fiscal year 17 2023-2024. This provision takes effect upon enactment. 18 DIVISION II —— REGIONAL CENTERS OF EXCELLENCE GRANT PROGRAM. 19 This division appropriates $1 million from the general fund 20 of the state to the department of health and human services 21 (HHS) for fiscal year 2023-2024 for continuation of a regional 22 center of excellence program to award four grants to encourage 23 innovation and collaboration among regional health care 24 providers in a rural area based upon the results of a regional 25 community needs assessment to transform health care delivery in 26 order to provide quality, sustainable care that meets the needs 27 of the local communities. An applicant for the grant funds 28 shall specify how the funds will be expended to accomplish the 29 goals of the program and shall provide a detailed five-year 30 sustainability plan prior to being awarded any funding. 31 Following the receipt of grant funding, a recipient shall 32 submit periodic reports as specified by HHS to the governor and 33 the general assembly regarding the recipient’s expenditure of 34 the funds and progress in accomplishing the program goals. 35 -17- LSB 2014XC (3) 90 pf/rh 17/ 23

S.F. _____ DIVISION III —— STATE-FUNDED FAMILY MEDICINE OBSTETRICS 1 FELLOWSHIP PROGRAM AND FUND. This division requires HHS to 2 establish a family medicine obstetrics fellowship program to 3 increase access to family medicine obstetrics practitioners 4 in rural and underserved areas of the state. A person who 5 has completed an accreditation council for graduate medical 6 education residency program in family medicine is eligible for 7 participation in the fellowship program. Participating fellows 8 shall enter into a program agreement with a participating 9 teaching hospital which, at a minimum, requires the fellow 10 to complete a one-year fellowship and to engage in full-time 11 family medicine obstetrics practice in a rural or underserved 12 area of the state for a period of at least five years within 13 nine months following completion of the fellowship and receipt 14 of a license to practice medicine in the state. Each fellow 15 participating in the program shall be eligible for salary and 16 benefits including a stipend as determined by the participating 17 teaching hospital and funded through the family medicine 18 obstetrics fellowship program fund. 19 The division requires HHS to adopt administrative rules 20 to administer the program, including defining rural and 21 underserved areas for the purpose of the required full-time 22 practice of a person following completion of the fellowship. 23 The division creates a family medicine obstetrics fellowship 24 program fund in the state treasury consisting of the moneys 25 appropriated or credited to the fund by law. Moneys in the 26 fund at the end of each fiscal year shall not revert to any 27 other fund but shall remain in the fund for use in subsequent 28 fiscal years. Moneys in the fund are appropriated to HHS 29 to be used to fund fellowship positions as provided in the 30 division. The division appropriates a sufficient amount from 31 the general fund of the state to the fund annually to support 32 the creation of four fellowship positions. The division 33 provides an appropriation for deposit in the fund for fiscal 34 year 2023-2024. 35 -18- LSB 2014XC (3) 90 pf/rh 18/ 23

S.F. _____ The division requires HHS and the participating teaching 1 hospitals to regularly evaluate and document their experiences 2 including identifying ways the program may be modified or 3 expanded to facilitate increased access to family medicine 4 obstetrics practitioners in rural and underserved areas of the 5 state. The department shall submit an annual report to the 6 general assembly by January 1. The report shall include the 7 number of fellowships funded to date and any other information 8 identified by HHS and the participating teaching hospitals as 9 indicators of outcomes and the effectiveness of the program. 10 DIVISION IV —— SELF-ADMINISTERED HORMONAL CONTRACEPTIVES. 11 This division relates to the dispensing of self-administered 12 hormonal contraceptives by a pharmacist. The division 13 defines “self-administered hormonal contraceptive” as a 14 self-administered hormonal contraceptive that is approved by 15 the United States food and drug administration to prevent 16 pregnancy, including an oral hormonal contraceptive, a hormonal 17 vaginal ring, and a hormonal contraceptive patch, but not 18 including any drug intended to induce an abortion. 19 The division provides that notwithstanding any provision 20 of law to the contrary, a pharmacist may dispense a 21 self-administered hormonal contraceptive to a patient who 22 is at least 18 years of age pursuant to a standing order 23 established by the medical director of HHS (medical director). 24 For an initial dispensing, a pharmacist may dispense only up 25 to a three-month supply at one time of the self-administered 26 hormonal contraceptive, and for any subsequent dispensing 27 of the same self-administered hormonal contraceptive, a 28 12-month supply at one time. Additionally, the division 29 prohibits a pharmacist who dispenses a self-administered 30 hormonal contraceptive in accordance with the division from 31 requiring any other prescription drug order authorized by a 32 practitioner prior to dispensing the self-administered hormonal 33 contraceptive. 34 The division authorizes the medical director to establish a 35 -19- LSB 2014XC (3) 90 pf/rh 19/ 23