SSB 1133 (LSB 1511XL (14) 90)

SENATE/HOUSE FILE _____

BY  (PROPOSED GOVERNOR BILL)

A BILL FOR

An Act relating to the health and well-being of children and families including provisions for rural emergency hospitals, regional centers of excellence, noneconomic damage awards against health care providers, a state-funded family medicine obstetrical fellowship program, self-administered hormonal contraceptives, review and approval of and public policy considerations relating to insurance benefits, maternal support and fatherhood initiatives, state employee parental leave, modification of property tax provisions for certain commercial child care properties, adoption expenses under the adoption subsidy program, and accessibility to the all Iowa scholarship program; providing for appropriations, fines, and penalties; and including effective date and applicability and retroactive applicability provisions.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

DIVISION I
RURAL EMERGENCY HOSPITALS

    Section 1.  Section 135B.1, Code 2023, is amended by adding the following new subsections:
   NEW SUBSECTION.  5.  “Rural emergency hospital” means a facility that provides rural emergency hospital services in the facility twenty-four hours per day, seven days per week; does not provide any acute care inpatient services with the exception of any distinct part of the facility licensed as a skilled nursing facility providing posthospital extended care services; and meets the criteria specified in section 135B.1A and the federal Consolidated Appropriations Act, Pub. L. No. 116-260, §125.
   NEW SUBSECTION.  6.  “Rural emergency hospital services” means the following services provided by a rural emergency hospital that do not exceed an annual per patient average of twenty-four hours in such a rural emergency hospital:
   a.  Emergency department services and observation care. For purposes of providing emergency department services, an emergency department of a rural emergency hospital shall be considered staffed if a physician, nurse practitioner, clinical nurse specialist, or physician assistant is available to furnish rural emergency hospital services in the facility twenty-four hours per day.
   b.  At the election of the rural emergency hospital, with respect to services furnished on an outpatient basis, other medical and health services as specified in regulations adopted by the United States secretary of health and human services.
    Sec. 2.  Section 135B.2, Code 2023, is amended to read as follows:
   135B.2  Purpose.
   The purpose of this chapter is to provide for the development, establishment and enforcement of basic standards for the care and treatment of individuals in hospitals and rural emergency hospitals and for the construction, maintenance and operation of such hospitals, which, in the light of existing knowledge, will promote safe and adequate treatment of such individuals in such hospitals, in the interest of the health, welfare and safety of the public.
    Sec. 3.  Section 135B.3, Code 2023, is amended to read as follows:
   135B.3  Licensure.
   No person or governmental unit, acting severally or jointly with any other person or governmental unit shall establish, conduct or maintain a hospital or rural emergency hospital in this state without a license.
    Sec. 4.  NEW SECTION.  135B.3A  Rural emergency hospital licensure.
   1.  The department shall adopt rules pursuant to chapter 17A to establish minimum standards for the licensure of rural emergency hospitals consistent with the federal Consolidated Appropriations Act, Pub. L. No. 116-260, §125, and with regulations issued by the United States secretary of health and human services for rural emergency hospitals.
   2.  To be eligible for a rural emergency hospital license, a facility shall have been, on or before December 27, 2020, one of the following:
   a.  A licensed critical access hospital.
   b.  A general hospital with not more than fifty licensed beds located in a county in a rural area as defined in section 1886(d)(2)(D) of the federal Social Security Act.
   c.  A general hospital with no more than fifty licensed beds that is deemed as being located in a rural area pursuant to section 1886(d)(8)(E) of the federal Social Security Act.
    Sec. 5.  Section 135B.4, Code 2023, is amended to read as follows:
   135B.4  Application for license.
   Licenses shall be obtained from the department. Applications shall be upon forms and shall contain information as the department may reasonably require, which may include affirmative evidence of ability to comply with reasonable standards and rules prescribed under this chapter. Each application for license shall be accompanied by the license fee, which shall be refunded to the applicant if the license is denied and which shall be deposited into the state treasury and credited to the general fund if the license is issued. Hospitals and rural emergency hospitals having fifty beds or less shall pay an initial license fee of fifteen dollars; hospitals of more than fifty beds and not more than one hundred beds shall pay an initial license fee of twenty-five dollars; all other hospitals shall pay an initial license fee of fifty dollars.
    Sec. 6.  Section 135B.5, subsection 1, Code 2023, is amended to read as follows:
   1.  Upon receipt of an application for license and the license fee, the department shall issue a license if the applicant and hospital facilities comply with this chapter, chapter 135, and the rules of the department. Each licensee shall receive annual reapproval upon payment of five hundred dollars and upon filing of an application form which is available from the department. The annual licensure fee shall be dedicated to support and provide educational programs on regulatory issues for hospitals and rural emergency hospitals licensed under this chapter. Licenses shall be either general or restricted in form. Each license shall be issued only for the premises and persons or governmental units named in the application and is not transferable or assignable except with the written approval of the department. Licenses shall be posted in a conspicuous place on the licensed premises as prescribed by rule of the department.
    Sec. 7.  Section 135B.5A, Code 2023, is amended to read as follows:
   135B.5A  Conversion of a hospital relative to certain hospitals.
   1.  A conversion of a long-term acute care hospital, rehabilitation hospital, or psychiatric hospital as defined by federal regulations to a general hospital or to a specialty hospital of a different type is a permanent change in bed capacity and shall require a certificate of need pursuant to section 135.63.
   2.  A conversion of a critical access hospital or general hospital to a rural emergency hospital or a conversion of a rural emergency hospital to a critical access hospital or general hospital shall not require a certificate of need pursuant to section 135.63.
    Sec. 8.  Section 135B.7, Code 2023, is amended to read as follows:
   135B.7  Rules and enforcement.
   1.  a.  The department, with the approval of the state board of health, shall adopt rules setting out the standards for the different types of hospitals and for rural emergency hospitals to be licensed under this chapter. The department shall enforce the rules.
   b.  Rules or standards shall not be adopted or enforced which would have the effect of denying a license to a hospital, rural emergency hospital, or other institution required to be licensed, solely by reason of the school or system of practice employed or permitted to be employed by physicians in the hospital, rural emergency hospital, or other institution if the school or system of practice is recognized by the laws of this state.
   2.  a.  The rules shall state that a hospital or rural emergency hospital shall not deny clinical privileges to physicians and surgeons, podiatric physicians, osteopathic physicians and surgeons, dentists, certified health service providers in psychology, physician assistants, or advanced registered nurse practitioners licensed under chapter 148, 148C, 149, 152, or 153, or section 154B.7, solely by reason of the license held by the practitioner or solely by reason of the school or institution in which the practitioner received medical schooling or postgraduate training if the medical schooling or postgraduate training was accredited by an organization recognized by the council on higher education accreditation or an accrediting group recognized by the United States department of education.
   b.  A hospital or rural emergency hospital may establish procedures for interaction between a patient and a practitioner. The rules shall not prohibit a hospital or rural emergency hospital from limiting, restricting, or revoking clinical privileges of a practitioner for violation of hospital rules, regulations, or procedures established under this paragraph, when applied in good faith and in a nondiscriminatory manner.
   c.  This subsection shall not require a hospital or rural emergency hospital to expand the hospital’s current scope of service delivery solely to offer the services of a class of providers not currently providing services at the hospital or rural emergency hospital. This section shall not be construed to require a hospital or rural emergency hospital to establish rules which are inconsistent with the scope of practice established for licensure of practitioners to whom this subsection applies.
   d.  This section shall not be construed to authorize the denial of clinical privileges to a practitioner or class of practitioners solely because a hospital or rural emergency hospital has as employees of the hospital or rural emergency hospital identically licensed practitioners providing the same or similar services.
   3.  The rules shall require that a hospital or rural emergency hospital establish and implement written criteria for the granting of clinical privileges. The written criteria shall include but are not limited to consideration of all of the following:
   a.  The ability of an applicant for privileges to provide patient care services independently and appropriately in the hospital or rural emergency hospital.
   b.  The license held by the applicant to practice.
   c.  The training, experience, and competence of the applicant.
   d.  The relationship between the applicant’s request for the granting of privileges and the hospital’s or rural emergency hospital’s current scope of patient care services, as well as the hospital’s or rural emergency hospital’s determination of the necessity to grant privileges to a practitioner authorized to provide comprehensive, appropriate, and cost-effective services.
   4.  The department shall also adopt rules requiring hospitals and rural emergency hospitals to establish and implement protocols for responding to the needs of patients who are victims of domestic abuse, as defined in section 236.2.
   5.  The department shall also adopt rules requiring hospitals and rural emergency hospitals to establish and implement protocols for responding to the needs of patients who are victims of elder abuse, as defined in section 235F.1.
    Sec. 9.  Section 135B.7A, Code 2023, is amended to read as follows:
   135B.7A  Procedures —— orders.
   The department shall adopt rules that require hospitals and rural emergency hospitals to establish procedures for authentication of all verbal orders by a practitioner within a period not to exceed thirty days following a patient’s discharge.
    Sec. 10.  Section 135B.8, Code 2023, is amended to read as follows:
   135B.8  Effective date of rules.
   Any hospital or rural emergency hospital which is in operation at the time of promulgation of any applicable rules or minimum standards under this chapter shall be given a reasonable time, not to exceed one year from the date of such promulgation, within which to comply with such rules and minimum standards.
    Sec. 11.  Section 135B.9, Code 2023, is amended to read as follows:
   135B.9  Inspections and qualifications for hospital and rural emergency hospital inspectors —— protection and advocacy agency investigations.
   1.  The department shall make or cause to be made inspections as it deems necessary in order to determine compliance with applicable rules. Hospital and rural emergency hospital inspectors shall meet the following qualifications:
   a.  Be free of conflicts of interest. A hospital or rural emergency hospital inspector shall not participate in an inspection or complaint investigation of a hospital or rural emergency hospital in which the inspector or a member of the inspector’s immediate family works or has worked within the last two years. For purposes of this paragraph, “immediate family member” means a spouse; natural or adoptive parent, child, or sibling; or stepparent, stepchild, or stepsibling.
   b.  Complete a yearly conflict of interest disclosure statement.
   c.  Biennially, complete a minimum of ten hours of continuing education pertaining to hospital or rural emergency hospital operations including but not limited to quality and process improvement standards, trauma system standards, and regulatory requirements.
   2.  In the state resource centers and state mental health institutes operated by the department of human services, the designated protection and advocacy agency as provided in section 135C.2, subsection 4, shall have the authority to investigate all complaints of abuse and neglect of persons with developmental disabilities or mental illnesses if the complaints are reported to the protection and advocacy agency or if there is probable cause to believe that the abuse has occurred. Such authority shall include the examination of all records pertaining to the care provided to the residents and contact or interview with any resident, employee, or any other person who might have knowledge about the operation of the institution.
    Sec. 12.  Section 135B.12, Code 2023, is amended to read as follows:
   135B.12  Confidentiality.
   The department’s final findings or the final survey findings of the joint commission on the accreditation of health care organizations or the American osteopathic association with respect to compliance by a hospital or rural emergency hospital with requirements for licensing or accreditation shall be made available to the public in a readily available form and place. Other information relating to a hospital or rural emergency hospital obtained by the department which does not constitute the department’s findings from an inspection of the hospital or rural emergency hospital or the final survey findings of the joint commission on the accreditation of health care organizations or the American osteopathic association shall not be made available to the public, except in proceedings involving the denial, suspension, or revocation of a license under this chapter. The name of a person who files a complaint with the department shall remain confidential and shall not be subject to discovery, subpoena, or other means of legal compulsion for its release to a person other than department employees or agents involved in the investigation of the complaint.
    Sec. 13.  Section 135B.14, Code 2023, is amended to read as follows:
   135B.14  Judicial review.
   Judicial review of the action of the department may be sought in accordance with chapter 17A. Notwithstanding the terms of chapter 17A, the Iowa administrative procedure Act, petitions for judicial review may be filed in the district court of the county in which the hospital or rural emergency hospital is located or to be located, and the status quo of the petitioner or licensee shall be preserved pending final disposition of the matter in the courts.
    Sec. 14.  Section 135B.15, Code 2023, is amended to read as follows:
   135B.15  Penalties.
   Any person establishing, conducting, managing, or operating any hospital or rural emergency hospital without a license shall be guilty of a serious misdemeanor, and each day of continuing violation after conviction shall be considered a separate offense.
    Sec. 15.  Section 135B.16, Code 2023, is amended to read as follows:
   135B.16  Injunction.
   Notwithstanding the existence or pursuit of any other remedy, the department may, in the manner provided by law, maintain an action in the name of the state for injunction or other process against any person or governmental unit to restrain or prevent the establishment, conduct, management or operation of a hospital or rural emergency hospital without a license.
    Sec. 16.  Section 135B.20, subsection 3, Code 2023, is amended to read as follows:
   3.  “Hospital” shall mean means all hospitals and rural emergency hospitals licensed under this chapter.
    Sec. 17.  Section 135B.33, subsection 1, unnumbered paragraph 1, Code 2023, is amended to read as follows:
   Subject to availability of funds, the Iowa department of public health shall provide technical planning assistance to local boards of health and hospital or rural emergency hospital governing boards to ensure access to hospital such services in rural areas. The department shall encourage the local boards of health and hospital or rural emergency hospital governing boards to adopt a long-term community health services and developmental plan including the following:
    Sec. 18.  Section 135B.34, subsection 7, Code 2023, is amended to read as follows:
   7.  For the purposes of this section, “comprehensive preliminary background check”: 
   a.  “Comprehensive preliminary background check” means the same as defined in section 135C.1.
   b.  “Hospital” means a hospital or rural emergency hospital licensed under this chapter.
    Sec. 19.  EMERGENCY RULEMAKING AUTHORITY.  The department of inspections and appeals may adopt emergency rules under section 17A.4, subsection 3, and section 17A.5, subsection 2, paragraph “b”, to implement the provisions of this division of this Act and the rules shall be effective immediately upon filing unless a later date is specified in the rules. Any rules adopted in accordance with this section shall also be published as a notice of intended action as provided in section 17A.4.
    Sec. 20.  EFFECTIVE DATE.  This division of this Act, being deemed of immediate importance, takes effect upon enactment.
DIVISION II
REGIONAL CENTERS OF EXCELLENCE GRANT PROGRAM

    Sec. 21.  REGIONAL CENTERS OF EXCELLENCE PROGRAM —— GRANTS —— APPROPRIATION.  There is appropriated from the general fund of the state to the department of health and human services for the fiscal year beginning July 1, 2023, and ending June 30, 2024, the following amount, or so much thereof as is necessary, to be used for the purposes designated:
   ...................................................................... $  1,000,000

   The funds appropriated in this section shall be used for the continuation of a center of excellence program to award four grants to encourage innovation and collaboration among regional health care providers in a rural area based upon the results of a regional community needs assessment to transform health care delivery in order to provide quality, sustainable care that meets the needs of the local communities. An applicant for the grant funds shall specify how the funds will be expended to accomplish the goals of the program and shall provide a detailed five-year sustainability plan prior to being awarded any funding. Following the receipt of grant funding, a recipient shall submit periodic reports as specified by the department to the governor and the general assembly regarding the recipient’s expenditure of the funds and progress in accomplishing the program’s goals.
DIVISION III
NONECONOMIC DAMAGE AWARDS AGAINST HEALTH CARE PROVIDERS

    Sec. 22.  Section 147.136A, subsection 1, paragraph b, Code 2023, is amended to read as follows:
   b.  (1)  “Noneconomic damages” means damages arising from pain, suffering, inconvenience, physical impairment, mental anguish, emotional pain and suffering, loss of chance, loss of consortium, or any other nonpecuniary damages.
   (2)  “Noneconomic damages” does not include the loss of dependent care, including the loss of child care, due to the death of or severe injury to a spouse or parent who is the primary caregiver of a child under the age of eighteen or a disabled adult. Such damages shall be considered economic damages.
    Sec. 23.  Section 147.136A, subsection 2, Code 2023, is amended to read as follows:
   2.  The total amount recoverable in any civil action for noneconomic damages for personal injury or death, whether in tort, contract, or otherwise, against a health care provider shall be limited to two hundred fifty thousand dollars for any occurrence resulting in injury or death of a patient regardless of the number of plaintiffs, derivative claims, theories of liability, or defendants in the civil action, shall not exceed two hundred fifty thousand dollars unless the jury determines that there is a substantial or permanent loss or impairment of a bodily function, substantial disfigurement, or death, which warrants a finding that imposition of such a limitation would deprive the plaintiff of just compensation for the injuries sustained, in which case the amount recoverable shall not exceed one million dollars.
    Sec. 24.  EFFECTIVE DATE.  This division of this Act, being deemed of immediate importance, takes effect upon enactment.
    Sec. 25.  APPLICABILITY.  This division of this Act applies to causes of actions accrued on or after the effective date of this Act.
DIVISION IV
STATE-FUNDED FAMILY MEDICINE OBSTETRICS FELLOWSHIP PROGRAM

    Sec. 26.  NEW SECTION.  135.182  State-funded family medicine obstetrics fellowship program —— fund.
   1.  The department shall establish a family medicine obstetrics fellowship program to increase access to family medicine obstetrics practitioners in rural and underserved areas of the state. A person who has completed an accreditation council for graduate medical education residency program in family medicine is eligible for participation in the fellowship program. Participating fellows shall enter into a program agreement with a participating teaching hospital which, at a minimum, requires the fellow to complete a one-year fellowship and to engage in full-time family medicine obstetrics practice in a rural or underserved area of the state for a period of at least five years within nine months following completion of the fellowship and receipt of a license to practice medicine in the state.
   2.  Each fellow participating in the program shall be eligible for a salary and benefits including a stipend as determined by the participating teaching hospital which shall be funded through the family medicine obstetrics fellowship program fund.
   3.  The department shall adopt rules pursuant to chapter 17A to administer the program, including defining rural and underserved areas for the purpose of the required full-time practice of a person following completion of the fellowship.
   4.  a.  A family medicine obstetrics fellowship program fund is created in the state treasury consisting of the moneys appropriated or credited to the fund by law. Notwithstanding section 8.33, moneys in the fund at the end of each fiscal year shall not revert to any other fund but shall remain in the fund for use in subsequent fiscal years. Moneys in the fund are appropriated to the department to be used to fund fellowship positions as provided in this section.
   b.  For the fiscal year beginning July 1, 2023, and each fiscal year beginning July 1 thereafter, there is appropriated from the general fund of the state to the family medicine obstetrics fellowship program fund an amount sufficient to support the creation of four fellowship positions as provided in this section.
   5.  The department and the participating teaching hospitals shall regularly evaluate and document their experiences including identifying ways the program may be modified or expanded to facilitate increased access to family medicine obstetrics practitioners in rural and underserved areas of the state. The department shall submit an annual report to the general assembly by January 1. The report shall include the number of fellowships funded to date and any other information identified by the department and the participating teaching hospitals as indicators of outcomes and the effectiveness of the program.
   6.  For the purposes of this section, “teaching hospital” means a hospital or medical center that provides medical education to prospective and current health professionals.
    Sec. 27.  STATE-FUNDED FAMILY MEDICINE OBSTETRICS FELLOWSHIP PROGRAM AND FUND —— APPROPRIATION.  There is appropriated from the general fund of the state to the department of health and human services for the fiscal year beginning July 1, 2023, and ending June 30, 2024, the following amount, or so much thereof as is necessary, to be used for the purposes designated:
   ...................................................................... $    560,000

   For deposit in the family medicine obstetrics fellowship program fund to be utilized in creating and providing for four family medicine obstetrics fellowship positions during the fiscal year in accordance with the family medicine obstetrics fellowship program created in this division of this Act. 
DIVISION V
SELF-ADMINISTERED HORMONAL CONTRACEPTIVES

    Sec. 28.  Section 155A.3, Code 2023, is amended by adding the following new subsections:
   NEW SUBSECTION.  10A.  “Department” means the department of health and human services.
   NEW SUBSECTION.  45A.  “Self-administered hormonal contraceptive” means a self-administered hormonal contraceptive that is approved by the United States food and drug administration to prevent pregnancy. “Self-administered hormonal contraceptive” includes an oral hormonal contraceptive, a hormonal vaginal ring, and a hormonal contraceptive patch, but does not include any drug intended to induce an abortion as defined in section 146.1.
   NEW SUBSECTION.  45B.  “Standing order” means a preauthorized medication order with specific instructions from the medical director of the department to dispense a medication under clearly defined circumstances.
    Sec. 29.  NEW SECTION.  155A.49  Pharmacist dispensing of self-administered hormonal contraceptives —— standing order —— requirements —— limitations of liability.
   1.  a.  Notwithstanding any provision of law to the contrary, a pharmacist may dispense a self-administered hormonal contraceptive to a patient who is at least eighteen years of age, pursuant to a standing order established by the medical director of the department in accordance with this section.
   b.  In dispensing a self-administered hormonal contraceptive to a patient under this section, a pharmacist shall comply with all of the following:
   (1)  For an initial dispensing of a self-administered hormonal contraceptive, the pharmacist may dispense only up to a three-month supply at one time of the self-administered hormonal contraceptive.
   (2)  For any subsequent dispensing of the same self-administered hormonal contraceptive, the pharmacist may dispense up to a twelve-month supply at one time of the self-administered hormonal contraceptive.
   2.  A pharmacist who dispenses a self-administered hormonal contraceptive in accordance with this section shall not require any other prescription drug order authorized by a practitioner prior to dispensing the self-administered hormonal contraceptive to a patient.
   3.  The medical director of the department may establish a standing order authorizing the dispensing of self-administered hormonal contraceptives by a pharmacist who does all of the following: 
   a.  Complies with the standing order established pursuant to this section.
   b.  Retains a record of each patient to whom a self-administered hormonal contraceptive is dispensed under this section and submits the record to the department.
   4.  The standing order shall require a pharmacist who dispenses self-administered hormonal contraceptives under this section to do all of the following:
   a.  Complete a standardized training program and continuing education requirements approved by the board in consultation with the board of medicine and the department that are related to prescribing self-administered hormonal contraceptives and include education regarding all contraceptive methods approved by the United States food and drug administration.
   b.  Obtain a completed self-screening risk assessment, approved by the department in collaboration with the board and the board of medicine, from each patient, verify the identity and age of each patient, and perform a blood pressure screening on each patient prior to dispensing the self-administered hormonal contraceptive to the patient. 
   c.  Provide the patient with all of the following:
   (1)  Written information regarding all of the following: 
   (a)  The importance of completing an appointment with the patient’s primary care or women’s health care practitioner to obtain preventative care, including but not limited to recommended tests and screenings.
   (b)  The effectiveness and availability of long-acting reversible contraceptives as an alternative to self-administered hormonal contraceptives.
   (2)  A copy of the record of the pharmacist’s encounter with the patient that includes all of the following: 
   (a)  The patient’s completed self-screening risk assessment. 
   (b)  A description of the contraceptive dispensed, or the basis for not dispensing a contraceptive.
   (3)  Patient counseling regarding all of the following: 
   (a)  The appropriate administration and storage of the self-administered hormonal contraceptive. 
   (b)  Potential side effects and risks of the self-administered hormonal contraceptive. 
   (c)  The need for backup contraception. 
   (d)  When to seek emergency medical attention.
   (e)  The risk of contracting a sexually transmitted infection or disease, and ways to reduce such a risk. 
   5.  The standing order established pursuant to this section shall prohibit a pharmacist who dispenses a self-administered hormonal contraceptive under this section from doing any of the following: 
   a.  Requiring a patient to schedule an appointment with the pharmacist for the prescribing or dispensing of a self-administered hormonal contraceptive.
   b.  Dispensing self-administered hormonal contraceptives to a patient for more than twenty-seven months after the date a self-administered hormonal contraceptive is initially dispensed to the patient, if the patient has not consulted with a primary care or women’s health care practitioner during the preceding twenty-seven months, in which case the pharmacist shall refer the patient to a primary care or women’s health care practitioner.
   c.  Dispensing a self-administered hormonal contraceptive to a patient if the results of the self-screening risk assessment completed by a patient pursuant to subsection 4, paragraph “b”, indicate it is unsafe for the pharmacist to dispense the self-administered hormonal contraceptive to the patient, in which case the pharmacist shall refer the patient to a primary care or women’s health care practitioner. 
   6.  A pharmacist who dispenses a self-administered hormonal contraceptive and the medical director of the department who establishes a standing order in compliance with this section shall be immune from criminal and civil liability arising from any damages caused by the dispensing, administering, or use of a self-administered hormonal contraceptive or the establishment of the standing order. The medical director of the department shall be considered to be acting within the scope of the medical director’s office and employment for purposes of chapter 669 in the establishment of a standing order in compliance with this section. 
   7.  The department, in collaboration with the board and the board of medicine, and in consideration of the guidelines established by the American congress of obstetricians and gynecologists, shall adopt rules pursuant to chapter 17A to administer this chapter. 
    Sec. 30.  Section 514C.19, Code 2023, is amended to read as follows:
   514C.19  Prescription contraceptive coverage.
   1.  Notwithstanding the uniformity of treatment requirements of section 514C.6, a group policy, or contract, or plan providing for third-party payment or prepayment of health or medical expenses shall not do either of the following comply as follows:
   a.  Exclude Such policy, contract, or plan shall not exclude or restrict benefits for prescription contraceptive drugs or prescription contraceptive devices which prevent conception and which are approved by the United States food and drug administration, or generic equivalents approved as substitutable by the United States food and drug administration, if such policy, or contract, or plan provides benefits for other outpatient prescription drugs or devices.  However, such policy, contract, or plan shall specifically provide for payment of a self-administered hormonal contraceptive, as prescribed by a practitioner as defined in section 155A.3, or as prescribed by standing order and dispensed by a pharmacist pursuant to section 155A.49, including payment for up to an initial three-month supply of a self-administered hormonal contraceptive dispensed at one time and for up to a twelve-month supply of the same self-administered hormonal contraceptive subsequently dispensed at one time.
   b.  Exclude Such policy, contract, or plan shall not exclude or restrict benefits for outpatient contraceptive services which are provided for the purpose of preventing conception if such policy, or contract, or plan provides benefits for other outpatient services provided by a health care professional.
   2.  A person who provides a group policy, or contract, or plan providing for third-party payment or prepayment of health or medical expenses which is subject to subsection 1 shall not do any of the following:
   a.  Deny to an individual eligibility, or continued eligibility, to enroll in or to renew coverage under the terms of the policy, or contract, or plan because of the individual’s use or potential use of such prescription contraceptive drugs or devices, or use or potential use of outpatient contraceptive services.
   b.  Provide a monetary payment or rebate to a covered individual to encourage such individual to accept less than the minimum benefits provided for under subsection 1.
   c.  Penalize or otherwise reduce or limit the reimbursement of a health care professional because such professional prescribes contraceptive drugs or devices, or provides contraceptive services.
   d.  Provide incentives, monetary or otherwise, to a health care professional to induce such professional to withhold from a covered individual contraceptive drugs or devices, or contraceptive services.
   3.  This section shall not be construed to prevent a third-party payor from including deductibles, coinsurance, or copayments under the policy, or contract, or plan as follows:
   a.  A deductible, coinsurance, or copayment for benefits for prescription contraceptive drugs shall not be greater than such deductible, coinsurance, or copayment for any outpatient prescription drug for which coverage under the policy, or contract, or plan is provided.
   b.  A deductible, coinsurance, or copayment for benefits for prescription contraceptive devices shall not be greater than such deductible, coinsurance, or copayment for any outpatient prescription device for which coverage under the policy, or contract, or plan is provided.
   c.  A deductible, coinsurance, or copayment for benefits for outpatient contraceptive services shall not be greater than such deductible, coinsurance, or copayment for any outpatient health care services for which coverage under the policy, or contract, or plan is provided.
   4.  This section shall not be construed to require a third-party payor under a policy, or contract, or plan to provide benefits for experimental or investigational contraceptive drugs or devices, or experimental or investigational contraceptive services, except to the extent that such policy, or contract, or plan provides coverage for other experimental or investigational outpatient prescription drugs or devices, or experimental or investigational outpatient health care services.
   5.  This section shall not be construed to limit or otherwise discourage the use of generic equivalent drugs approved by the United States food and drug administration, whenever available and appropriate. This section, when a brand name drug is requested by a covered individual and a suitable generic equivalent is available and appropriate, shall not be construed to prohibit a third-party payor from requiring the covered individual to pay a deductible, coinsurance, or copayment consistent with subsection 3, in addition to the difference of the cost of the brand name drug less the maximum covered amount for a generic equivalent.
   6.  A person who provides an individual policy, or contract, or plan providing for third-party payment or prepayment of health or medical expenses shall make available a coverage provision that satisfies the requirements in subsections 1 through 5 in the same manner as such requirements are applicable to a group policy, or contract, or plan under those subsections. The policy, or contract, or plan shall provide that the individual policyholder may reject the coverage provision at the option of the policyholder.
   7.  a.  This section applies to the following classes of third-party payment provider contracts, or policies, or plans delivered, issued for delivery, continued, or renewed in this state on or after July 1, 2000 January 1, 2024:
   (1)  Individual or group accident and sickness insurance providing coverage on an expense-incurred basis.
   (2)  An individual or group hospital or medical service contract issued pursuant to chapter 509, 514, or 514A.
   (3)  An individual or group health maintenance organization contract regulated under chapter 514B.
   (4)  Any other entity engaged in the business of insurance, risk transfer, or risk retention, which is subject to the jurisdiction of the commissioner.
   (5)  A plan established pursuant to chapter 509A for public employees.
   b.  This section shall not apply to accident-only, specified disease, short-term hospital or medical, hospital confinement indemnity, credit, dental, vision, Medicare supplement, long-term care, basic hospital and medical-surgical expense coverage as defined by the commissioner, disability income insurance coverage, coverage issued as a supplement to liability insurance, workers’ compensation or similar insurance, or automobile medical payment insurance.
   8.  This section shall not be construed to require a third-party payor to provide payment to a practitioner for the dispensing of a self-administered hormonal contraceptive to replace a self-administered hormonal contraceptive that has been dispensed to a covered person and that has been misplaced, stolen, or destroyed. This section shall not be construed to require a third-party payor to replace covered prescriptions that are misplaced, stolen, or destroyed. 
   9.  For the purposes of this section, “self-administered hormonal contraceptive” and “standing order” mean the same as defined in section 155A.3.
    Sec. 31.  INFORMATION PROGRAM FOR DRUG PRESCRIBING AND DISPENSING —— SELF-ADMINISTERED HORMONAL CONTRACEPTIVES.  The board of pharmacy in collaboration with the board of medicine and the department of health and human services shall expand the information program for drug prescribing and dispensing established pursuant to section 124.551, to collect from pharmacists information relating to the dispensing of self-administered hormonal contraceptives as provided pursuant to section 155A.49. The board of pharmacy shall adopt rules pursuant to chapter 17A related to registration of participating pharmacists, the information to be reported by a pharmacist to the information program, access to information from the program, and other rules necessary to carry out the purposes and to enforce the provisions of this section.
    Sec. 32.  APPLICATION TO MEDICAID PROGRAM.  This division of this Act shall apply to the Medicaid program including a managed care organization acting pursuant to a contract with the department of health and human services to administer the Medicaid program under chapter 249A. However, if it is determined that any provision of this division of this Act would cause denial of federal funds under Tit. XVIII or XIX of the federal Social Security Act, or would otherwise be inconsistent or conflict with the requirements of federal law or regulation, such provision shall be suspended, but only to the extent necessary to prevent denial of such funds or to eliminate the inconsistency or conflict with the requirements of federal law or regulation.
DIVISION VI
INSURANCE BENEFITS —— REVIEW AND APPROVAL —— PUBLIC POLICY CONSIDERATIONS

    Sec. 33.  Section 509.3, Code 2023, is amended by adding the following new subsection:
   NEW SUBSECTION.  3.  a.  A policy or policy form in connection with a policy of group accident or health insurance, or combination thereof, that is issued in this state shall not contain a provision that is unjust, unfair, inequitable, misleading, deceptive, encourages misrepresentation of the policy, or that is otherwise contrary to public policy.
   b.  It shall be unlawful for a carrier to issue a policy, or to use a policy form in connection with a policy, after notice from the commissioner of insurance that the policy or policy form violates paragraph “a”.
   c.  A carrier shall have twenty days after receipt of a notice under paragraph “b” to request a hearing to contest the commissioner’s notice. The hearing shall be conducted pursuant to chapter 17A. If the hearing results in a decision that affirms the commissioner’s notice, the decision shall be provided to the carrier in writing and shall specify the reasons for the decision.
    Sec. 34.  NEW SECTION.  513B.4C  Filing requirement —— prior approval.
   1.  a.  A group policy of insurance against loss or expense from sickness, or from the bodily injury or death by accident of the insured, shall not be issued or delivered in this state by a carrier until a copy of the policy has been filed with, and approved by, the commissioner.
   b.  An application, rider, or endorsement shall not be used in connection with a group policy under paragraph “a” until a copy of the policy form has been filed with, and approved by, the commissioner.
   2.  A filing under subsection 1 shall be deemed approved unless disapproved by the commissioner within thirty days of the date the filing is received by the commissioner.
    Sec. 35.  NEW SECTION.  513B.4D  Filing —— disapproval.
   1.  a.  The commissioner shall provide notice to a carrier that has filed a policy form pursuant to section 513B.4C, subsection 1, if upon review of the policy form the commissioner finds any of the following:
   (1)  The benefits provided are unreasonable in relation to the premium charged.
   (2)  The policy form contains a provision that is unjust, unfair, inequitable, misleading, deceptive, encourages misrepresentation of the policy, or is otherwise contrary to public policy.
   b.  The notice under paragraph “a” shall do all of the following:
   (1)  Advise the carrier that the policy form does not comply with this section, or with the rules adopted pursuant to chapter 17 to implement and administer this section.
   (2)  Advise the carrier that it shall be unlawful for the carrier to issue the policy form or to use the policy form in connection with any policy.
   (3)  Provide the specific reasons for the commissioner’s disapproval of the policy form.
   2.  A carrier shall have twenty days after receipt of a notice under subsection 1 to request a hearing to contest the commissioner’s notice. The hearing shall be conducted pursuant to chapter 17A. If the hearing results in a decision that affirms the commissioner’s notice, the decision shall be provided to the carrier in writing and shall specify the reasons for the decision.
    Sec. 36.  NEW SECTION.  513B.4E  Withdrawal of approval.
   1.  The commissioner may, after opportunity for hearing, withdraw the commissioner’s previous approval of a policy form under section 513B.4C if the policy form is in violation of section 513B.4D, subsection 1, paragraph “a”. The hearing shall be conducted pursuant to chapter 17A. Notice to the carrier of the hearing shall specify the matters to be considered at the hearing.
   2.  It shall be unlawful for a carrier to issue a policy form, or to use a policy form in connection with any group policy, on or after the effective date of the commissioner’s withdrawal of a previous approval of the policy form.
   3.  If a hearing results in a decision to withdraw a previous approval of a policy form, the decision shall be provided to the carrier in writing and shall specify the reasons for the commissioner’s withdrawal of the prior approval.
DIVISION VII
MORE OPTIONS FOR MATERNAL SUPPORT (MOMS) PROGRAM —— FATHERHOOD INITIATIVES

    Sec. 37.  Section 217.41C, subsection 1, paragraph c, Code 2023, is amended to read as follows:
   c.  For the purposes of this section, “pregnancy support services” means those nonmedical services that promote childbirth by providing information, counseling, and support services that assist pregnant women or women who believe they may be pregnant and men who are involved or who think they might be involved in a pregnancy to choose childbirth and to make informed decisions regarding the choice of adoption or parenting with respect to their children.
    Sec. 38.  Section 217.41C, Code 2023, is amended by adding the following new subsections:
   NEW SUBSECTION.  8.  The department shall develop and maintain a virtual clearinghouse of pregnancy support services and resources including but not limited to all of the following:
   a.  Pregnancy resource center and maternity home information including contact information, location, and services provided.
   b.  Assistance in accessing public assistance including but not limited to the special supplemental nutrition program for women, infants, and children and the supplemental nutrition assistance program.
   c.  Educational resources.
   d.  Housing assistance.
   e.  Recovery and mental health services. 
   f.  Family planning education.
   g.  Adoption and foster care information and services.
   h.  Healing and support services for abortion survivors and their families. 
   NEW SUBSECTION.  9.  Beginning July 1, 2023, and thereafter, funding for the program may be used for all of the following purposes:
   a.  Fatherhood engagement grants.  The department may award grants to nonprofit, community-based organizations to address the needs of fathers by assisting fathers in finding employment, managing child support obligations, transitioning from a period of incarceration, accessing health care, understanding child development, and enhancing parenting skills using evidence-based parenting education. Priority in the awarding of grants shall be based on the demonstrated need in a geographic area and the prevalence of the population to be served as indicated by factors including but not limited to the service area’s unemployment rate, incarceration rate, number of public assistance recipients, number of single-parent households, level of housing instability, and graduation rates.
   b.  Fatherhood communications initiative.  The department shall administer a communications initiative on responsible fatherhood including but not limited to a public internet site that provides access to resources on effective parenting and assistance in receiving parenting support and services.
   c.  Mentoring school-aged males grant program.  The department may award three-year renewable grants to nonprofit organizations that provide mentorship, social and academic support, and life skills development to school-aged males. Priority in the awarding of grants shall be based on the demonstrated need in a geographic area and the prevalence of the population to be served as indicated by factors including but not limited to the service area’s unemployment rate, incarceration rate, number of public assistance recipients, number of single-parent households, level of housing instability, and graduation rates. The department shall provide technical assistance to grantees to ensure program sustainability following the end of the three-year grant period.
    Sec. 39.  MORE OPTIONS FOR MATERNAL SUPPORT PROGRAM —— APPROPRIATION.  There is appropriated from the general fund of the state to the department of health and human services for the fiscal year beginning July 1, 2023, and ending June 30, 2024, the following amount, or so much thereof as is necessary, to be used for the purposes designated:
   ...................................................................... $  2,000,000

   To be used for the purposes of the more options for maternal support program created in section 217.41C, including for program administration, the provision of services, and for funding of fatherhood engagement grants, the fatherhood communications initiative, and the mentoring school-aged males grant program. 
    Sec. 40.  2022 Iowa Acts, chapter 1131, section 28, subsection 8, is amended to read as follows:
   8.  Of the funds appropriated under this section, $500,000 shall be used for the purposes of program administration and provision of pregnancy support services through the more options for maternal support program created in this Act.  Notwithstanding section 8.33, moneys appropriated in this subsection that remain unencumbered or unobligated at the close of the fiscal year shall not revert but shall remain available for the purposes designated until the close of the succeeding fiscal year.
    Sec. 41.  EFFECTIVE DATE.  The following, being deemed of immediate importance, takes effect upon enactment:
   The section of this division of this Act amending 2022 Iowa Acts, chapter 1131, section 28, subsection 8.
DIVISION VIII
STATE EMPLOYEE PAID PARENTAL LEAVE BENEFIT

    Sec. 42.  NEW SECTION.  70A.31  Paid parental leave.
   1.  A state employee entitled to leave under the federal Family and Medical Leave Act of 1993 shall be provided paid leave for such time as specified in this section for the birth or placement for adoption with the employee of a child if the leave is taken within twelve months following any such birth or adoption.
   2.  a.  For the birth of a child, a state employee parent who gave birth shall be entitled to up to four weeks of paid leave and a state employee parent who did not give birth shall be entitled to up to one week of paid leave.
   b.  For the placement for adoption of a child, a state employee parent shall be entitled to up to four weeks of paid leave.
   3.  The department of administrative services shall adopt rules to implement this section.
DIVISION IX
PROPERTY TAX MODIFICATIONS —— LICENSED COMMERCIAL CHILD CARE CENTERS AND CHILD CARE FACILITIES

    Sec. 43.  Section 441.21, subsection 5, paragraph b, subparagraph (2), unnumbered paragraph 1, Code 2023, is amended to read as follows:
   For Except for property subject to subparagraph (3), for valuations established for the assessment year beginning January 1, 2022, and each assessment year thereafter, the portion of actual value at which each property unit of commercial property shall be assessed shall be the sum of the following:
    Sec. 44.  Section 441.21, subsection 5, paragraph b, Code 2023, is amended by adding the following new subparagraph:
   NEW SUBPARAGRAPH.  (3)  (a)  For valuations established for the assessment year beginning January 1, 2023, and each assessment year thereafter, the portion of actual value at which each portion of a property unit of commercial property that is primarily used as a child care center or child care facility, as defined in section 237A.1, and for which an application has been allowed under this subparagraph, shall be assessed at an amount equal to the product of the assessment limitation percentage applicable to residential property under subsection 4 for that assessment year multiplied by the actual value of the property.
   (b)  A person who wishes to qualify for the assessment limitation under this subparagraph shall file an application with the assessor not later than July 1 of the assessment year for which the person is first requesting the assessment limitation on forms provided by the department of revenue. The application shall describe the property and its location and include other information required by the department of revenue. The application shall be accompanied by a copy of the license to operate as a child care center or child care facility issued by the department of health and human services or other proof of eligibility set forth in rule by the department of revenue. Upon allowance of the application, the assessment limitation shall be applied to the portion of the property unit of commercial property that is primarily used as a child care center or child care facility for successive years without further filing as long as the portion of the property unit continues to be classified as commercial property and is used for the purposes specified in the application.
   (c)  Not later than July 6 of each year, the assessor shall remit the applications for the assessment limitation to the county auditor with the assessor’s recommendation for allowance or disallowance. If the assessor recommends disallowance, the assessor shall submit the reasons for the recommendation, in writing, to the county auditor.
   (d)  Not later than July 15 of each year, the county auditor shall forward the applications for the assessment limitation to the board of supervisors. The board shall determine the eligibility for each application on or before September 1 of each year. If the board disallows a claim, it shall send written notice, by mail, to the applicant at the applicant’s last-known address. The notice shall state the reasons for disallowing the application and shall state the applicant’s right to appeal the board’s action to the district court under subparagraph division (f).
   (e)  All applications that have been allowed by the board of supervisors shall be certified on or before October 1, in each year, by the board of supervisors to the county auditor.
   (f)  Within thirty days following the date of the notice of disallowance under subparagraph division (d), the applicant may appeal the disallowance to the district court of the county in which the property is situated.
   (g)  If the person ceases to use the property as a child care center or child care facility, the person shall provide written notice to the assessor by July 1 following the date on which the use has changed. If, at any time within thirty-six months following the date that an application is allowed, the board determines that the person received an assessment limitation under this subparagraph that the person is not entitled to, the treasurer shall collect from the person the amount of additional tax that would have been assessed on the property if the property received the assessment limitations under subparagraph (2), and the amount shall become a lien on the property that received the assessment limitation and shall be collected by the county treasurer in the same manner as other taxes. Prior to the board’s determination that a person received an assessment limitation that the person is not entitled to, the board shall notify the person by mail and conduct a hearing.
   (h)  The assessor shall retain a permanent file of current applications made under this subparagraph. The county recorder shall give notice to the assessor of each transfer of title filed in the recorder’s office. The notice from the county recorder shall describe the property transferred, the name of the person transferring title to the property, and the name of the person to whom title to the property has been transferred. The assessor shall file a notice of transfer of property for which an application is filed when notice is received from the office of the county recorder.
   (i)  The department shall adopt rules to implement and administer this subparagraph.
    Sec. 45.  Section 441.21, subsection 5, paragraph e, subparagraphs (1) and (3), Code 2023, are amended to read as follows:
   (1)  For each fiscal year beginning on or after July 1, 2023, there is appropriated from the general fund of the state to the department of revenue the sum of one hundred twenty-five million dollars to be used for payments under this paragraph calculated as a result of the assessment limitations imposed under paragraph “b”, subparagraph (2), subparagraph division (a);, and paragraph “c”, subparagraph (2), subparagraph division (a); and paragraph “b”, subparagraph (3), for the portion of actual value of each property unit subject to the assessment limitation under paragraph “b”, subparagraph (3), that is less than or equal to one hundred fifty thousand dollars. 
   (3)  On or before July 1 of each fiscal year, the assessor shall report to the county auditor that portion of the total actual value of all commercial property and industrial property in the county that is subject to the assessment limitations imposed under paragraph “b”, subparagraph (2), subparagraph division (a);, and paragraph “c”, subparagraph (2), subparagraph division (a),; and paragraph “b”, subparagraph (3), for the portion of actual value of each property unit subject to the assessment limitation under paragraph “b”, subparagraph (3), that is less than or equal to one hundred fifty thousand dollars, for the assessment year used to calculate the taxes due and payable in that fiscal year.
    Sec. 46.  Section 441.21, subsection 5, paragraph e, subparagraph (4), subparagraph division (a), Code 2023, is amended to read as follows:
   (a)  The product of the portion of the total actual value of all commercial property, industrial property, and property valued by the department under chapter 434 in the county that is subject to the assessment limitations imposed under paragraph “b”, subparagraph (2), subparagraph division (a);, and paragraph “c”, subparagraph (2), subparagraph division (a),; and paragraph “b”, subparagraph (3), for the portion of actual value of each property unit subject to the assessment limitation under paragraph “b”, subparagraph (3), that is less than or equal to one hundred fifty thousand dollars, for the applicable assessment year used to calculate taxes which are due and payable in the applicable fiscal year multiplied by the difference, stated as a percentage, between ninety percent and the assessment limitation percentage applicable to residential property under subsection 4 for the applicable assessment year. 
    Sec. 47.  EFFECTIVE DATE.  This division of this Act, being deemed of immediate importance, takes effect upon enactment.
    Sec. 48.  RETROACTIVE APPLICABILITY.  The following apply retroactively to assessment years beginning on or after January 1, 2023:
   1.  The section of this division of this Act amending section 441.21, subsection 5, paragraph “b”, subparagraph (2), unnumbered paragraph 1.
   2.  The section of this division of this Act enacting section 441.21, subsection 5, paragraph “b”, subparagraph (3).
    Sec. 49.  APPLICABILITY.  The following apply July 1, 2024, for payments under section 441.21, subsection 5, paragraph “e”, for fiscal years beginning on or after that date:
   1.  The section of this division of this Act amending section 441.21, subsection 5, paragraph “e”, subparagraphs (1) and (3).
   2.  The section of this division of this Act amending section 441.21, subsection 5, paragraph “e”, subparagraph (4), subparagraph division (a).
DIVISION X
NONRECURRING ADOPTION EXPENSES —— ADOPTION SUBSIDY PROGRAM

    Sec. 50.  NEW SECTION.  234.48  Adoption subsidy —— nonrecurring adoption expenses.
   Notwithstanding any provision to the contrary, the maximum reimbursement provided to an adoptive parent under the adoption subsidy program for nonrecurring adoption expenses is one thousand dollars. For the purposes of this section, “nonrecurring adoption expenses” means the same as defined in 45 C.F.R. §1356.41. The department shall adopt rules pursuant to chapter 17A to administer this section.
    Sec. 51.  REPEAL.  2010 Iowa Acts, chapter 1031, section 408, is repealed.
DIVISION XI
ALL IOWA OPPORTUNITY SCHOLARSHIP PROGRAM

    Sec. 52.  Section 261.87, subsection 1, paragraph b, unnumbered paragraph 1, Code 2023, is amended to read as follows:
   “Eligible foster care student” means a person under twenty-six years of age who has a high school diploma or a high school equivalency diploma under chapter 259A and is described by any of the following:
    Sec. 53.  Section 261.87, subsection 2, paragraph f, Code 2023, is amended to read as follows:
   f.  (1)  Begins Except as provided in subparagraph (2), begins enrollment at an eligible institution within two academic years of graduation from high school or receipt of a high school equivalency diploma under chapter 259A and continuously receives awards as a full-time or part-time student to maintain eligibility. However, the student may defer or suspend participation in the program for up to two years in order to pursue obligations that meet conditions established by the commission by rule or to fulfill military obligations.
   (2)  The requirements of subparagraph (1) do not apply to an eligible foster care student.
    Sec. 54.  APPLICABILITY.  This division of this Act applies to applications submitted under the all Iowa opportunity scholarship program established pursuant to section 261.87 before, on, or after the effective date of this division of this Act.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill relates to the health and well-being of children and families. The bill is constructed in divisions.
   DIVISION I —— RURAL EMERGENCY HOSPITALS. This division provides for state licensure of rural emergency hospitals (REHs). Under the federal Consolidated Appropriations Act of 2021 (federal Act), REHs were established as a new provider type. Effective January 1, 2023, REHs are eligible to enroll in Medicare and to receive an enhanced reimbursement rate for eligible services consisting of the outpatient prospective payment system rate plus a 5 percent add-on and a fixed monthly payment. In order to be classified as an REH under the federal Act, a facility must meet certain requirements, including applicable state licensing requirements. The division provides a process for such licensure. The division provides emergency rulemaking authority to implement the division. The division takes effect upon enactment.
   DIVISION II —— REGIONAL CENTERS OF EXCELLENCE GRANT PROGRAM.  This division appropriates $1 million from the general fund of the state to the department of health and human services (HHS) for fiscal year 2023-2024 for continuation of a regional center of excellence program to award four grants to encourage innovation and collaboration among regional health care providers in a rural area based upon the results of a regional community needs assessment to transform health care delivery in order to provide quality, sustainable care that meets the needs of the local communities. An applicant for the grant funds shall specify how the funds will be expended to accomplish the goals of the program and shall provide a detailed five-year sustainability plan prior to being awarded any funding. Following the receipt of grant funding, a recipient shall submit periodic reports as specified by HHS to the governor and the general assembly regarding the recipient’s expenditure of the funds and progress in accomplishing the program goals.
   DIVISION III —— NONECONOMIC DAMAGE AWARDS AGAINST HEALTH CARE PROVIDERS. This division of the bill relates to noneconomic damage awards against health care providers. Current law provides that in a civil action brought against a health care provider, the maximum amount of noneconomic damages that a patient may recover for personal injury or death is $250,000, unless the jury determines that there is a substantial or permanent loss or impairment of a bodily function, substantial disfigurement, or death, which warrants a finding that imposition of such a limitation would deprive the plaintiff of just compensation for the injuries sustained. In such a case, there is no cap on the amount of noneconomic damages that a patient may recover. The bill makes two changes to current law. First, the bill establishes that the definition of noneconomic damages does not include the loss of dependent care due to the death of or severe injury to a spouse or parent who is the primary caregiver of a child or disabled adult. Instead, such damages are economic damages. Second, the bill provides a $1 million cap on noneconomic damages when the jury finds that there is substantial or permanent loss or impairment of a bodily function, substantial disfigurement, or death which warrants exceeding the $250,000 cap. The bill does not amend the current exception to the cap for cases in which the defendant’s actions constitute actual malice.
   The division of the bill takes effect upon enactment and applies to causes of action accrued on or after that date.
   DIVISION IV —— STATE-FUNDED FAMILY MEDICINE OBSTETRICS FELLOWSHIP PROGRAM AND FUND. This division requires HHS to establish a family medicine obstetrics fellowship program to increase access to family medicine obstetrics practitioners in rural and underserved areas of the state. A person who has completed an accreditation council for graduate medical education residency program in family medicine is eligible for participation in the fellowship program. Participating fellows shall enter into a program agreement with a participating teaching hospital which, at a minimum, requires the fellow to complete a one-year fellowship and to engage in full-time family medicine obstetrics practice in a rural or underserved area of the state for a period of at least five years within nine months following completion of the fellowship and receipt of a license to practice medicine in the state. Each fellow participating in the program shall be eligible for salary and benefits including a stipend as determined by the participating teaching hospital and funded through the family medicine obstetrics fellowship program fund.
   The division requires HHS to adopt administrative rules to administer the program, including defining rural and underserved areas for the purpose of the required full-time practice of a person following completion of the fellowship.
   The division creates a family medicine obstetrics fellowship program fund in the state treasury consisting of the moneys appropriated or credited to the fund by law. Moneys in the fund at the end of each fiscal year shall not revert to any other fund but shall remain in the fund for use in subsequent fiscal years. Moneys in the fund are appropriated to HHS to be used to fund fellowship positions as provided in the division. The division appropriates a sufficient amount from the general fund of the state to the fund annually to support the creation of four fellowship positions. The division provides an appropriation for deposit in the fund for fiscal year 2023-2024.
   The division requires HHS and the participating teaching hospitals to regularly evaluate and document their experiences including identifying ways the program may be modified or expanded to facilitate increased access to family medicine obstetrics practitioners in rural and underserved areas of the state. The department shall submit an annual report to the general assembly by January 1. The report shall include the number of fellowships funded to date and any other information identified by HHS and the participating teaching hospitals as indicators of outcomes and the effectiveness of the program.
   DIVISION V —— SELF-ADMINISTERED HORMONAL CONTRACEPTIVES.  This division relates to the dispensing of self-administered hormonal contraceptives by a pharmacist. The division defines “self-administered hormonal contraceptive” as a self-administered hormonal contraceptive that is approved by the United States food and drug administration to prevent pregnancy, including an oral hormonal contraceptive, a hormonal vaginal ring, and a hormonal contraceptive patch, but not including any drug intended to induce an abortion.
   The division provides that notwithstanding any provision of law to the contrary, a pharmacist may dispense a self-administered hormonal contraceptive to a patient who is at least 18 years of age pursuant to a standing order established by the medical director of HHS (medical director). For an initial dispensing, a pharmacist may dispense only up to a three-month supply at one time of the self-administered hormonal contraceptive, and for any subsequent dispensing of the same self-administered hormonal contraceptive, a 12-month supply at one time. Additionally, the division prohibits a pharmacist who dispenses a self-administered hormonal contraceptive in accordance with the division from requiring any other prescription drug order authorized by a practitioner prior to dispensing the self-administered hormonal contraceptive.
   The division authorizes the medical director to establish a standing order authorizing the dispensing of self-administered hormonal contraceptives by any pharmacist who complies with the standing order and retains and submits the patient’s record to HHS.
   The standing order includes requiring a pharmacist who dispenses a self-administered hormonal contraceptive under the division to: complete a standardized training program and continuing education requirements related to prescribing the hormonal contraceptives; obtain a completed self-screening risk assessment from each patient, verify the identity and age of each patient, and perform a blood pressure screening on each patient before dispensing the hormonal contraceptives; provide the patient with certain written information; provide the patient with a copy of the record of the pharmacist’s encounter with the patient; and provide patient counseling. 
   The standing order would prohibit a pharmacist who dispenses hormonal contraceptives under the division from requiring a patient to schedule an appointment with the pharmacist for the prescribing or dispensing of the hormonal contraceptive; dispensing the hormonal contraceptives to a patient for more than 27 months after the date initially dispensed without the patient’s attestation that the patient has consulted with a practitioner during the preceding 27 months; and dispensing the hormonal contraceptives to a patient if the results of the patient’s self-screening risk assessment indicate it is unsafe for the pharmacist to dispense the hormonal contraceptives to the patient, in which case the pharmacist shall refer the patient to a practitioner. 
   The division provides immunity for a pharmacist who dispenses a self-administered hormonal contraceptive and for the medical director who establishes a standing order in compliance with the division from criminal and civil liability arising from any damages caused by the dispensing, administering, or use of a self-administered hormonal contraceptive or the establishment of the standing order. Additionally, the medical director shall be considered to be acting within the scope of the medical director’s office and employment for purposes of Code chapter 669 (Iowa tort claims Act) in the establishment of a standing order in compliance with the division.
   The division requires HHS, in collaboration with the boards of pharmacy and medicine, and in consideration of the guidelines established by the American congress of obstetricians and gynecologists, to adopt administrative rules to administer the provisions of the division.
   The division amends prescription contraceptive coverage provisions to require that a group policy, contract, or plan delivered, issued for delivery, continued, or renewed in the state on or after January 1, 2024, providing for third-party payment or prepayment of health or medical expenses, shall specifically provide for payment of self-administered hormonal contraceptives, prescribed and dispensed as specified in the division, including those dispensed at one time. The division provides, however, that the provisions relating to coverage are not to be construed to require a third-party payor to provide payment to a practitioner for dispensing a self-administered hormonal contraceptive to replace a self-administered hormonal contraceptive that has been dispensed to a covered person and that has been misplaced, stolen, or destroyed. These provisions are also not to be construed to require a third-party payor to replace covered prescriptions that are misplaced, stolen, or destroyed. 
   The division also requires the board of pharmacy in collaboration with the board of medicine and HHS to expand the information program for drug prescribing to collect from pharmacists information relating to the dispensing of self-administered hormonal contraceptives as provided in the division.
   The division applies to the Medicaid program as specified in the bill.
   DIVISION VI —— INSURANCE BENEFITS —— REVIEW AND APPROVAL —— PUBLIC POLICY CONSIDERATIONS. This division prohibits a policy or policy form (form) in connection with a group accident or health insurance policy (group policy) that is issued in this state from containing a provision that is unjust, unfair, inequitable, misleading, deceptive, encourages misrepresentation, or that is otherwise contrary to public policy (contrary to policy). The division makes it unlawful for a carrier to issue a policy or to use a form in connection with any group policy after notice from the commissioner of insurance (commissioner) that the policy or form violates the prohibition. A carrier has 20 days after receipt of the notice to request a hearing to contest the commissioner’s notice. The hearing shall be conducted pursuant to Code chapter 17A and if it results in a decision that affirms the commissioner’s notice, the decision shall be provided to the carrier in writing and specify the reasons for the decision.
   A group policy of insurance against loss or expense from sickness, or from the bodily injury or death by accident of the insured (accident and health policy), shall not be issued or delivered in this state by a carrier until a copy of the policy has been filed with, and approved by, the commissioner. Applications, riders, or endorsements shall not be used in connection with the accident and health policy until a copy of the policy form has been filed with, and approved by, the commissioner. A filing shall be deemed approved unless disapproved by the commissioner within 30 days. If upon review of a form the commissioner finds that the benefits provided are unreasonable in relation to the premium charged, or that the form contains a provision contrary to public policy, the commissioner shall provide notice to the carrier that advises the carrier as detailed in the bill. The carrier has 20 days after receipt of the notice to request a hearing, to be conducted pursuant to Code chapter 17A. The division permits the commissioner, after opportunity for hearing, to withdraw the commissioner’s previous approval of a form in circumstances detailed in the division. A carrier is prohibited from issuing a form, or from using a form in connection with any group policy, on or after the effective date of the commissioner’s withdrawal of the previous approval. If a hearing results in a decision to withdraw a previous approval, the decision shall be provided to the carrier in writing.
   DIVISION VII —— MORE OPTIONS FOR MATERNAL SUPPORT (MOMS) PROGRAM —— FATHERHOOD INITIATIVES. This division relates to the more options for maternal support (MOMS) program. The bill adds as part of the definition of “pregnancy support services” services to men who are involved or think they might be involved in a pregnancy. As part of the MOMS program, the division requires HHS to develop and maintain a virtual clearinghouse of pregnancy support services and resources. The services and resources include but are not limited to pregnancy resource center and maternity home information; assistance in accessing public assistance including but not limited to the special supplemental nutrition program for women, infants, and children program and the supplemental nutrition assistance program; educational resources; housing assistance; recovery and mental health services; family planning education; adoption and foster care information and services; and healing and support services for abortion survivors and their families.
   As part of the MOMS program, beginning July 1, 2023, and thereafter, funding for the program may be used for fatherhood engagement grants to nonprofit, community-based organizations to address the needs of fathers by assisting fathers in finding employment, managing child support obligations, transitioning from a period of incarceration, accessing health care, understanding child development, and enhancing parenting skills using evidence-based parenting education; a fatherhood communications initiative administered by HHS, including but not limited to a public internet site that provides access to resources on effective parenting and assistance in receiving parenting support and services; and a mentoring school-aged males grant program to provide mentorship, social and academic support, and life skills development to school-aged males.
   The division also appropriates $2 million from the general fund of the state to HHS for fiscal year 2023-2024 to be used for the MOMS program including for program administration, the provision of services, and for funding of fatherhood engagement grants, the fatherhood communications initiative, and the mentoring school-aged males grant program.
   The division provides that the funding appropriated for the MOMS program for fiscal year 2022-2023 is not to revert, but is to remain available for the MOMS program for fiscal year 2023-2024. This provision takes effect upon enactment. 
   DIVISION VIII —— STATE EMPLOYEE PAID PARENTAL LEAVE BENEFIT.  This division provides that a state employee entitled to leave under the federal Family and Medical Leave Act of 1993 shall be provided paid leave for the birth or adoption of a child if the leave is taken within 12 months following any such birth or adoption. The division provides that a state employee parent who gives birth or adopts a child shall be entitled to up to four weeks of paid leave while a state employee parent of a child who did not give birth shall be entitled to up to one week of paid leave. The division requires the department of administrative services to adopt rules to implement this paid parental leave benefit.
   DIVISION IX —— PROPERTY TAX MODIFICATIONS —— LICENSED COMMERCIAL CHILD CARE CENTERS AND CHILD CARE FACILITIES. This division relates to property taxation for commercial child care centers and facilities. Code section 441.21(5) determines the amount of actual value of commercial property that is subject to property tax. The amount is the sum of the residential assessment limitation to the portion of the property’s value that does not exceed $150,000 plus 90 percent of the property’s value in excess of $150,000. The division excludes property primarily used as a child care center or child care facility from that determination and instead specifies that for assessment years beginning on or after January 1, 2023, the amount of actual value of such properties that is subject to property tax and for which an application has been allowed is equal to the product of the assessment limitation percentage applicable to residential property multiplied by the actual value of the property. 
   This division establishes an application and approval procedure for the assessment limitation and amends provisions relating to the calculation of payments to local governments as the result of the application of certain assessment limitations under Code section 441.21(5)(e).
   The division takes effect upon enactment, applies retroactively to assessment years beginning on or after January 1, 2023, and applies to payments to local governments under Code section 441.21(5)(e) for fiscal years beginning on or after July 1, 2024.
   DIVISION X —— NONRECURRING ADOPTION EXPENSES —— ADOPTION SUBSIDY PROGRAM. This division provides that the maximum reimbursement provided to an adoptive parent under the adoption subsidy program for nonrecurring adoption expenses is $1,000. The division defines “nonrecurring adoption expenses” as the reasonable and necessary adoption fees, court costs, attorney fees, and other expenses which are directly related to the legal adoption of a child with special needs which are not incurred in violation of state, tribal, or federal law, and which have not been reimbursed from other sources or other funds. Under federal regulation, “other expenses which are directly related to the legal adoption of a child with special needs” means the costs of the adoption incurred by or on behalf of the parents and for which parents carry the ultimate liability for payment. Such costs may include the adoption study, including health and psychological examination, supervision of the placement prior to adoption, transportation, and the reasonable costs of lodging and food for the child or the adoptive parents when necessary to complete the placement or adoption process. The department of health and human services shall adopt administrative rules to administer the division. The division also repeals a provision in 2010 Iowa Acts which limited the nonrecurring adoption expenses to $500 and prohibited additional amounts for court costs and other related legal expenses.
   DIVISION XI —— ALL IOWA OPPORTUNITY SCHOLARSHIP PROGRAM.  This division relates to the all Iowa opportunity scholarship program (program), which provides scholarships to Iowa students who graduate from high school or receive a high school equivalency diploma to help such students attend a community college in this state or an institution of higher learning governed by the state board of regents. The program prioritizes awarding scholarships to certain students, including eligible foster care students. Eligible foster care students are students who age out of Iowa’s foster care system, age out of the state training school, or are adopted from Iowa’s foster care system after reaching 16 years of age.
   Current law requires that, in order to be eligible to receive a scholarship under the program, the student must begin enrollment at a community college or institution of higher learning governed by the state board of regents within two academic years of graduation from high school or receipt of a high school equivalency diploma and continuously receive awards as a full-time or part-time student to maintain eligibility. The division strikes these requirements for eligible foster care students. The division also provides that, for purposes of the program, “eligible foster care student” does not include a person who is 26 years of age or older.
   The division applies to applications submitted under the program before, on, or after the effective date of the division.