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Senate Study Bill 1116 - IntroducedA Bill ForAn Act 1relating to the health and well-being of children and
2families including provisions for maternal support and
3fatherhood initiatives, regional centers of excellence, a
4state-funded family medicine obstetrics fellowship program,
5self-administered hormonal contraceptives, state employee
6parental leave, adoption expenses under the adoption subsidy
7program, and accessibility to the all Iowa scholarship
8program; making appropriations; and including effective date
9and applicability provisions.
10BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1DIVISION I
2More options for maternal support (MOMS) program — fatherhood
3initiatives
4 Section 1. Section 217.41C, subsection 1, paragraph c, Code
52023, is amended to read as follows:
6c. For the purposes of this section, “pregnancy support
7services” means those nonmedical services that promote
8childbirth by providing information, counseling, and support
9services that assist pregnant women or women who believe they
10may be pregnant and men who are involved or who think they
11might be involved in a pregnancy to choose childbirth and to
12make informed decisions regarding the choice of adoption or
13parenting with respect to their children.
14 Sec. 2. Section 217.41C, Code 2023, is amended by adding the
15following new subsections:
16 NEW SUBSECTION. 8. The department shall develop and
17maintain a virtual clearinghouse of pregnancy support
18services and resources including but not limited to all of the
19following:
20a. Pregnancy resource center and maternity home information
21including contact information, location, and services provided.
22b. Assistance in accessing public assistance including but
23not limited to the special supplemental nutrition program for
24women, infants, and children and the supplemental nutrition
25assistance program.
26c. Educational resources.
27d. Housing assistance.
28e. Recovery and mental health services.
29f. Family planning education.
30g. Adoption and foster care information and services.
31h. Healing and support services for abortion survivors and
32their families.
33 NEW SUBSECTION. 9. Beginning July 1, 2023, and thereafter,
34funding for the program may be used for all of the following
35purposes:
-1- 1a. Fatherhood engagement grants. The department may
2award grants to nonprofit, community-based organizations to
3address the needs of fathers by assisting fathers in finding
4employment, managing child support obligations, transitioning
5from a period of incarceration, accessing health care,
6understanding child development, and enhancing parenting skills
7using evidence-based parenting education. Priority in the
8awarding of grants shall be based on the demonstrated need
9in a geographic area and the prevalence of the population to
10be served as indicated by factors including but not limited
11to the service area’s unemployment rate, incarceration rate,
12number of public assistance recipients, number of single-parent
13households, level of housing instability, and graduation rates.
14b. Fatherhood communications initiative. The department
15shall administer a communications initiative on responsible
16fatherhood including but not limited to a public internet site
17that provides access to resources on effective parenting and
18assistance in receiving parenting support and services.
19c. Mentoring school-aged males grant program. The
20department may award three-year renewable grants to nonprofit
21organizations that provide mentorship, social and academic
22support, and life skills development to school-aged males.
23Priority in the awarding of grants shall be based on the
24demonstrated need in a geographic area and the prevalence of
25the population to be served as indicated by factors including
26but not limited to the service area’s unemployment rate,
27incarceration rate, number of public assistance recipients,
28number of single-parent households, level of housing
29instability, and graduation rates. The department shall
30provide technical assistance to grantees to ensure program
31sustainability following the end of the three-year grant
32period.
33 Sec. 3. MORE OPTIONS FOR MATERNAL SUPPORT PROGRAM —
34APPROPRIATION. There is appropriated from the general fund of
35the state to the department of health and human services for
-2-1the fiscal year beginning July 1, 2023, and ending June 30,
22024, the following amount, or so much thereof as is necessary,
3to be used for the purposes designated:
.................................................. $42,000,000
5To be used for the purposes of the more options for maternal
6support program created in section 217.41C, including for
7program administration, the provision of services, and for
8funding of fatherhood engagement grants, the fatherhood
9communications initiative, and the mentoring school-aged males
10grant program.
11 Sec. 4. 2022 Iowa Acts, chapter 1131, section 28, subsection
128, is amended to read as follows:
138. Of the funds appropriated under this section, $500,000
14shall be used for the purposes of program administration and
15provision of pregnancy support services through the more
16options for maternal support program created in this Act.
17Notwithstanding section 8.33, moneys appropriated in this
18subsection that remain unencumbered or unobligated at the close
19of the fiscal year shall not revert but shall remain available
20for the purposes designated until the close of the succeeding
21fiscal year.
22 Sec. 5. EFFECTIVE DATE. The following, being deemed of
23immediate importance, takes effect upon enactment:
24The section of this division of this Act amending 2022 Iowa
25Acts, chapter 1131, section 28, subsection 8.
26DIVISION II
27Regional centers of excellence grant program
28 Sec. 6. REGIONAL CENTERS OF EXCELLENCE PROGRAM — GRANTS —
29APPROPRIATION. There is appropriated from the general fund of
30the state to the department of health and human services for
31the fiscal year beginning July 1, 2023, and ending June 30,
322024, the following amount, or so much thereof as is necessary,
33to be used for the purposes designated:
.................................................. $341,000,000
35The funds appropriated in this section shall be used for
-3-1the continuation of a center of excellence program to award
2four grants to encourage innovation and collaboration among
3regional health care providers in a rural area based upon the
4results of a regional community needs assessment to transform
5health care delivery in order to provide quality, sustainable
6care that meets the needs of the local communities. An
7applicant for the grant funds shall specify how the funds will
8be expended to accomplish the goals of the program and shall
9provide a detailed five-year sustainability plan prior to being
10awarded any funding. Following the receipt of grant funding,
11a recipient shall submit periodic reports as specified by the
12department to the governor and the general assembly regarding
13the recipient’s expenditure of the funds and progress in
14accomplishing the program’s goals.
15DIVISION III
16state-funded family medicine obstetrics fellowship program
17 Sec. 7. NEW SECTION. 135.182 State-funded family medicine
18obstetrics fellowship program — fund.
191. The department shall establish a family medicine
20obstetrics fellowship program to increase access to family
21medicine obstetrics practitioners in rural and underserved
22areas of the state. A person who has completed an
23accreditation council for graduate medical education residency
24program in family medicine is eligible for participation
25in the fellowship program. Participating fellows shall
26enter into a program agreement with a participating teaching
27hospital which, at a minimum, requires the fellow to complete a
28one-year fellowship and to engage in full-time family medicine
29obstetrics practice in a rural or underserved area of the
30state for a period of at least five years within nine months
31following completion of the fellowship and receipt of a license
32to practice medicine in the state.
332. Each fellow participating in the program shall be
34eligible for a salary and benefits including a stipend as
35determined by the participating teaching hospital which shall
-4-1be funded through the family medicine obstetrics fellowship
2program fund.
33. The department shall adopt rules pursuant to chapter
417A to administer the program, including defining rural and
5underserved areas for the purpose of the required full-time
6practice of a person following completion of the fellowship.
74. a. A family medicine obstetrics fellowship program
8fund is created in the state treasury consisting of the moneys
9appropriated or credited to the fund by law. Notwithstanding
10section 8.33, moneys in the fund at the end of each fiscal year
11shall not revert to any other fund but shall remain in the fund
12for use in subsequent fiscal years. Moneys in the fund are
13appropriated to the department to be used to fund fellowship
14positions as provided in this section.
15b. For the fiscal year beginning July 1, 2023, and each
16fiscal year beginning July 1 thereafter, there is appropriated
17from the general fund of the state to the family medicine
18obstetrics fellowship program fund an amount sufficient to
19support the creation of four fellowship positions as provided
20in this section.
215. The department and the participating teaching hospitals
22shall regularly evaluate and document their experiences
23including identifying ways the program may be modified or
24expanded to facilitate increased access to family medicine
25obstetrics practitioners in rural and underserved areas of the
26state. The department shall submit an annual report to the
27general assembly by January 1. The report shall include the
28number of fellowships funded to date and any other information
29identified by the department and the participating teaching
30hospitals as indicators of outcomes and the effectiveness of
31the program.
326. For the purposes of this section, “teaching hospital”
33means a hospital or medical center that provides medical
34education to prospective and current health professionals.
35 Sec. 8. STATE-FUNDED FAMILY MEDICINE OBSTETRICS FELLOWSHIP
-5-1PROGRAM AND FUND — APPROPRIATION. There is appropriated from
2the general fund of the state to the department of health and
3human services for the fiscal year beginning July 1, 2023, and
4ending June 30, 2024, the following amount, or so much thereof
5as is necessary, to be used for the purposes designated:
.................................................. $6560,000
7For deposit in the family medicine obstetrics fellowship
8program fund to be utilized in creating and providing for four
9family medicine obstetrics fellowship positions during the
10fiscal year in accordance with the family medicine obstetrics
11fellowship program created in this division of this Act.
12DIVISION IV
13SELF-ADMINISTERED Hormonal contraceptives
14 Sec. 9. Section 155A.3, Code 2023, is amended by adding the
15following new subsections:
16 NEW SUBSECTION. 10A. “Department” means the department of
17health and human services.
18 NEW SUBSECTION. 45A. “Self-administered hormonal
19contraceptive” means a self-administered hormonal contraceptive
20that is approved by the United States food and drug
21administration to prevent pregnancy. “Self-administered
22hormonal contraceptive” includes an oral hormonal contraceptive,
23a hormonal vaginal ring, and a hormonal contraceptive patch,
24but does not include any drug intended to induce an abortion as
25defined in section 146.1.
26 NEW SUBSECTION. 45B. “Standing order” means a preauthorized
27medication order with specific instructions from the medical
28director of the department to dispense a medication under
29clearly defined circumstances.
30 Sec. 10. NEW SECTION. 155A.49 Pharmacist dispensing of
31self-administered hormonal contraceptives — standing order —
32requirements — limitations of liability.
331. a. Notwithstanding any provision of law to the contrary,
34a pharmacist may dispense a self-administered hormonal
35contraceptive to a patient who is at least eighteen years of
-6-1age, pursuant to a standing order established by the medical
2director of the department in accordance with this section.
3b. In dispensing a self-administered hormonal contraceptive
4to a patient under this section, a pharmacist shall comply with
5all of the following:
6(1) For an initial dispensing of a self-administered
7hormonal contraceptive, the pharmacist may dispense only up
8to a three-month supply at one time of the self-administered
9hormonal contraceptive.
10(2) For any subsequent dispensing of the same
11self-administered hormonal contraceptive, the pharmacist
12may dispense up to a twelve-month supply at one time of the
13self-administered hormonal contraceptive.
142. A pharmacist who dispenses a self-administered hormonal
15contraceptive in accordance with this section shall not
16require any other prescription drug order authorized by a
17practitioner prior to dispensing the self-administered hormonal
18contraceptive to a patient.
193. The medical director of the department may establish a
20standing order authorizing the dispensing of self-administered
21hormonal contraceptives by a pharmacist who does all of the
22following:
23a. Complies with the standing order established pursuant to
24this section.
25b. Retains a record of each patient to whom a
26self-administered hormonal contraceptive is dispensed under
27this section and submits the record to the department.
284. The standing order shall require a pharmacist who
29dispenses self-administered hormonal contraceptives under this
30section to do all of the following:
31a. Complete a standardized training program and continuing
32education requirements approved by the board in consultation
33with the board of medicine and the department that are related
34to prescribing self-administered hormonal contraceptives and
35include education regarding all contraceptive methods approved
-7-1by the United States food and drug administration.
2b. Obtain a completed self-screening risk assessment,
3approved by the department in collaboration with the board and
4the board of medicine, from each patient, verify the identity
5and age of each patient, and perform a blood pressure screening
6on each patient prior to dispensing the self-administered
7hormonal contraceptive to the patient.
8c. Provide the patient with all of the following:
9(1) Written information regarding all of the following:
10(a) The importance of completing an appointment with the
11patient’s primary care or women’s health care practitioner
12to obtain preventative care, including but not limited to
13recommended tests and screenings.
14(b) The effectiveness and availability of long-acting
15reversible contraceptives as an alternative to
16self-administered hormonal contraceptives.
17(2) A copy of the record of the pharmacist’s encounter with
18the patient that includes all of the following:
19(a) The patient’s completed self-screening risk assessment.
20(b) A description of the contraceptive dispensed, or the
21basis for not dispensing a contraceptive.
22(3) Patient counseling regarding all of the following:
23(a) The appropriate administration and storage of the
24self-administered hormonal contraceptive.
25(b) Potential side effects and risks of the
26self-administered hormonal contraceptive.
27(c) The need for backup contraception.
28(d) When to seek emergency medical attention.
29(e) The risk of contracting a sexually transmitted
30infection or disease, and ways to reduce such a risk.
315. The standing order established pursuant to this section
32shall prohibit a pharmacist who dispenses a self-administered
33hormonal contraceptive under this section from doing any of the
34following:
35a. Requiring a patient to schedule an appointment with
-8-1the pharmacist for the prescribing or dispensing of a
2self-administered hormonal contraceptive.
3b. Dispensing self-administered hormonal contraceptives
4to a patient for more than twenty-seven months after the
5date a self-administered hormonal contraceptive is initially
6dispensed to the patient, if the patient has not consulted with
7a primary care or women’s health care practitioner during the
8preceding twenty-seven months, in which case the pharmacist
9shall refer the patient to a primary care or women’s health
10care practitioner.
11c. Dispensing a self-administered hormonal contraceptive to
12a patient if the results of the self-screening risk assessment
13completed by a patient pursuant to subsection 4, paragraph
14“b”, indicate it is unsafe for the pharmacist to dispense the
15self-administered hormonal contraceptive to the patient, in
16which case the pharmacist shall refer the patient to a primary
17care or women’s health care practitioner.
186. A pharmacist who dispenses a self-administered hormonal
19contraceptive and the medical director of the department who
20establishes a standing order in compliance with this section
21shall be immune from criminal and civil liability arising
22from any damages caused by the dispensing, administering,
23or use of a self-administered hormonal contraceptive or the
24establishment of the standing order. The medical director of
25the department shall be considered to be acting within the
26scope of the medical director’s office and employment for
27purposes of chapter 669 in the establishment of a standing
28order in compliance with this section.
297. The department, in collaboration with the board and
30the board of medicine, and in consideration of the guidelines
31established by the American congress of obstetricians and
32gynecologists, shall adopt rules pursuant to chapter 17A to
33administer this chapter.
34 Sec. 11. Section 514C.19, Code 2023, is amended to read as
35follows:
-9- 1514C.19 Prescription contraceptive coverage.
21. Notwithstanding the uniformity of treatment requirements
3of section 514C.6, a group policy, or contract, or plan
4 providing for third-party payment or prepayment of health or
5medical expenses shall not do either of the following comply
6as follows:
7a. Exclude Such policy, contract, or plan shall not
8exclude or restrict benefits for prescription contraceptive
9drugs or prescription contraceptive devices which prevent
10conception and which are approved by the United States
11food and drug administration, or generic equivalents
12approved as substitutable by the United States food and
13drug administration, if such policy, or contract, or plan
14 provides benefits for other outpatient prescription drugs
15or devices. However, such policy, contract, or plan shall
16specifically provide for payment of a self-administered
17hormonal contraceptive, as prescribed by a practitioner as
18defined in section 155A.3, or as prescribed by standing order
19and dispensed by a pharmacist pursuant to section 155A.49,
20including payment for up to an initial three-month supply
21of a self-administered hormonal contraceptive dispensed at
22one time and for up to a twelve-month supply of the same
23self-administered hormonal contraceptive subsequently dispensed
24at one time.
25b. Exclude Such policy, contract, or plan shall not exclude
26 or restrict benefits for outpatient contraceptive services
27which are provided for the purpose of preventing conception if
28such policy, or contract, or plan provides benefits for other
29outpatient services provided by a health care professional.
302. A person who provides a group policy, or contract, or
31plan providing for third-party payment or prepayment of health
32or medical expenses which is subject to subsection 1 shall not
33do any of the following:
34a. Deny to an individual eligibility, or continued
35eligibility, to enroll in or to renew coverage under the terms
-10-1of the policy, or contract, or plan because of the individual’s
2use or potential use of such prescription contraceptive drugs
3or devices, or use or potential use of outpatient contraceptive
4services.
5b. Provide a monetary payment or rebate to a covered
6individual to encourage such individual to accept less than the
7minimum benefits provided for under subsection 1.
8c. Penalize or otherwise reduce or limit the reimbursement
9of a health care professional because such professional
10prescribes contraceptive drugs or devices, or provides
11contraceptive services.
12d. Provide incentives, monetary or otherwise, to a health
13care professional to induce such professional to withhold
14from a covered individual contraceptive drugs or devices, or
15contraceptive services.
163. This section shall not be construed to prevent a
17third-party payor from including deductibles, coinsurance, or
18copayments under the policy, or contract, or plan as follows:
19a. A deductible, coinsurance, or copayment for benefits
20for prescription contraceptive drugs shall not be greater than
21such deductible, coinsurance, or copayment for any outpatient
22prescription drug for which coverage under the policy, or
23 contract, or plan is provided.
24b. A deductible, coinsurance, or copayment for benefits for
25prescription contraceptive devices shall not be greater than
26such deductible, coinsurance, or copayment for any outpatient
27prescription device for which coverage under the policy, or
28 contract, or plan is provided.
29c. A deductible, coinsurance, or copayment for benefits for
30outpatient contraceptive services shall not be greater than
31such deductible, coinsurance, or copayment for any outpatient
32health care services for which coverage under the policy, or
33 contract, or plan is provided.
344. This section shall not be construed to require a
35third-party payor under a policy, or contract, or plan
-11-1 to provide benefits for experimental or investigational
2contraceptive drugs or devices, or experimental or
3investigational contraceptive services, except to the extent
4that such policy, or contract, or plan provides coverage for
5other experimental or investigational outpatient prescription
6drugs or devices, or experimental or investigational outpatient
7health care services.
85. This section shall not be construed to limit or otherwise
9discourage the use of generic equivalent drugs approved by the
10United States food and drug administration, whenever available
11and appropriate. This section, when a brand name drug is
12requested by a covered individual and a suitable generic
13equivalent is available and appropriate, shall not be construed
14to prohibit a third-party payor from requiring the covered
15individual to pay a deductible, coinsurance, or copayment
16consistent with subsection 3, in addition to the difference of
17the cost of the brand name drug less the maximum covered amount
18for a generic equivalent.
196. A person who provides an individual policy, or contract,
20or plan providing for third-party payment or prepayment of
21health or medical expenses shall make available a coverage
22provision that satisfies the requirements in subsections
231 through 5 in the same manner as such requirements are
24applicable to a group policy, or contract, or plan under those
25subsections. The policy, or contract, or plan shall provide
26that the individual policyholder may reject the coverage
27provision at the option of the policyholder.
287. a. This section applies to the following classes of
29third-party payment provider contracts, or policies, or plans
30 delivered, issued for delivery, continued, or renewed in this
31state on or after July 1, 2000 January 1, 2024:
32(1) Individual or group accident and sickness insurance
33providing coverage on an expense-incurred basis.
34(2) An individual or group hospital or medical service
35contract issued pursuant to chapter 509, 514, or 514A.
-12- 1(3) An individual or group health maintenance organization
2contract regulated under chapter 514B.
3(4) Any other entity engaged in the business of insurance,
4risk transfer, or risk retention, which is subject to the
5jurisdiction of the commissioner.
6(5) A plan established pursuant to chapter 509A for public
7employees.
8b. This section shall not apply to accident-only,
9specified disease, short-term hospital or medical, hospital
10confinement indemnity, credit, dental, vision, Medicare
11supplement, long-term care, basic hospital and medical-surgical
12expense coverage as defined by the commissioner, disability
13income insurance coverage, coverage issued as a supplement
14to liability insurance, workers’ compensation or similar
15insurance, or automobile medical payment insurance.
168. This section shall not be construed to require a
17third-party payor to provide payment to a practitioner for the
18dispensing of a self-administered hormonal contraceptive to
19replace a self-administered hormonal contraceptive that has
20been dispensed to a covered person and that has been misplaced,
21stolen, or destroyed. This section shall not be construed to
22require a third-party payor to replace covered prescriptions
23that are misplaced, stolen, or destroyed.
249. For the purposes of this section, “self-administered
25hormonal contraceptive” and “standing order” mean the same as
26defined in section 155A.3.
27 Sec. 12. INFORMATION PROGRAM FOR DRUG PRESCRIBING AND
28DISPENSING — SELF-ADMINISTERED HORMONAL CONTRACEPTIVES. The
29board of pharmacy in collaboration with the board of medicine
30and the department of health and human services shall expand
31the information program for drug prescribing and dispensing
32established pursuant to section 124.551, to collect from
33pharmacists information relating to the dispensing of
34self-administered hormonal contraceptives as provided pursuant
35to section 155A.49. The board of pharmacy shall adopt
-13-1rules pursuant to chapter 17A related to registration of
2participating pharmacists, the information to be reported by a
3pharmacist to the information program, access to information
4from the program, and other rules necessary to carry out the
5purposes and to enforce the provisions of this section.
6 Sec. 13. APPLICATION TO MEDICAID PROGRAM. This division
7of this Act shall apply to the Medicaid program including a
8managed care organization acting pursuant to a contract with
9the department of health and human services to administer
10the Medicaid program under chapter 249A. However, if it is
11determined that any provision of this division of this Act
12would cause denial of federal funds under Tit.XVIII or XIX
13of the federal Social Security Act, or would otherwise be
14inconsistent or conflict with the requirements of federal law
15or regulation, such provision shall be suspended, but only to
16the extent necessary to prevent denial of such funds or to
17eliminate the inconsistency or conflict with the requirements
18of federal law or regulation.
19DIVISION V
20State employee paid parental leave benefit
21 Sec. 14. NEW SECTION. 70A.31 Paid parental leave.
221. A state employee entitled to leave under the federal
23Family and Medical Leave Act of 1993 shall be provided paid
24leave for such time as specified in this section for the birth
25or placement for adoption with the employee of a child if the
26leave is taken within twelve months following any such birth
27or adoption.
282. a. For the birth of a child, a state employee parent who
29gave birth shall be entitled to up to four weeks of paid leave
30and a state employee parent who did not give birth shall be
31entitled to up to one week of paid leave.
32b. For the placement for adoption of a child, a state
33employee parent shall be entitled to up to four weeks of paid
34leave.
353. The department of administrative services shall adopt
-14-1rules to implement this section.
2DIVISION VI
3Nonrecurring ADOPTION EXPENSES — adoption subsidy program
4 Sec. 15. NEW SECTION. 234.48 Adoption subsidy —
5nonrecurring adoption expenses.
6Notwithstanding any provision to the contrary, the maximum
7reimbursement provided to an adoptive parent under the
8adoption subsidy program for nonrecurring adoption expenses
9is one thousand dollars. For the purposes of this section,
10“nonrecurring adoption expenses” means the same as defined in 45
11C.F.R. §1356.41. The department shall adopt rules pursuant to
12chapter 17A to administer this section.
13 Sec. 16. REPEAL. 2010 Iowa Acts, chapter 1031, section 408,
14is repealed.
15DIVISION VII
16All Iowa opportunity scholarship PROGRAM
17 Sec. 17. Section 261.87, subsection 1, paragraph b,
18unnumbered paragraph 1, Code 2023, is amended to read as
19follows:
20“Eligible foster care student” means a person under
21twenty-six years of age who has a high school diploma or a high
22school equivalency diploma under chapter 259A and is described
23by any of the following:
24 Sec. 18. Section 261.87, subsection 2, paragraph f, Code
252023, is amended to read as follows:
26f. (1) Begins Except as provided in subparagraph (2),
27begins enrollment at an eligible institution within two
28academic years of graduation from high school or receipt of
29a high school equivalency diploma under chapter 259A and
30continuously receives awards as a full-time or part-time
31student to maintain eligibility. However, the student may
32defer or suspend participation in the program for up to two
33years in order to pursue obligations that meet conditions
34established by the commission by rule or to fulfill military
35obligations.
-15- 1(2) The requirements of subparagraph (1) do not apply to an
2eligible foster care student.
3 Sec. 19. APPLICABILITY. This division of this Act applies
4to applications submitted under the all Iowa opportunity
5scholarship program established pursuant to section 261.87
6before, on, or after the effective date of this division of
7this Act.
8EXPLANATION
9The inclusion of this explanation does not constitute agreement with
10the explanation’s substance by the members of the general assembly.
11This bill relates to the health and well-being of children
12and families. The bill is constructed in divisions.
13DIVISION I — MORE OPTIONS FOR MATERNAL SUPPORT (MOMS)
14PROGRAM — FATHERHOOD INITIATIVES. This division relates to
15the more options for maternal support (MOMS) program. The
16bill adds as part of the definition of “pregnancy support
17services” services to men who are involved or think they might
18be involved in a pregnancy. As part of the MOMS program,
19the division requires HHS to develop and maintain a virtual
20clearinghouse of pregnancy support services and resources. The
21services and resources include but are not limited to pregnancy
22resource center and maternity home information; assistance in
23accessing public assistance including but not limited to the
24special supplemental nutrition program for women, infants, and
25children program and the supplemental nutrition assistance
26program; educational resources; housing assistance; recovery
27and mental health services; family planning education; adoption
28and foster care information and services; and healing and
29support services for abortion survivors and their families.
30As part of the MOMS program, beginning July 1, 2023, and
31thereafter, funding for the program may be used for fatherhood
32engagement grants to nonprofit, community-based organizations
33to address the needs of fathers by assisting fathers in
34finding employment, managing child support obligations,
35transitioning from a period of incarceration, accessing health
-16-1care, understanding child development, and enhancing parenting
2skills using evidence-based parenting education; a fatherhood
3communications initiative administered by HHS, including but
4not limited to a public internet site that provides access to
5resources on effective parenting and assistance in receiving
6parenting support and services; and a mentoring school-aged
7males grant program to provide mentorship, social and academic
8support, and life skills development to school-aged males.
9The division also appropriates $2 million from the general
10fund of the state to HHS for fiscal year 2023-2024 to be used
11for the MOMS program including for program administration, the
12provision of services, and for funding of fatherhood engagement
13grants, the fatherhood communications initiative, and the
14mentoring school-aged males grant program.
15The division provides that the funding appropriated for the
16MOMS program for fiscal year 2022-2023 is not to revert, but
17is to remain available for the MOMS program for fiscal year
182023-2024. This provision takes effect upon enactment.
19DIVISION II — REGIONAL CENTERS OF EXCELLENCE GRANT PROGRAM.
20 This division appropriates $1 million from the general fund
21of the state to the department of health and human services
22(HHS) for fiscal year 2023-2024 for continuation of a regional
23center of excellence program to award four grants to encourage
24innovation and collaboration among regional health care
25providers in a rural area based upon the results of a regional
26community needs assessment to transform health care delivery in
27order to provide quality, sustainable care that meets the needs
28of the local communities. An applicant for the grant funds
29shall specify how the funds will be expended to accomplish the
30goals of the program and shall provide a detailed five-year
31sustainability plan prior to being awarded any funding.
32Following the receipt of grant funding, a recipient shall
33submit periodic reports as specified by HHS to the governor and
34the general assembly regarding the recipient’s expenditure of
35the funds and progress in accomplishing the program goals.
-17- 1DIVISION III — STATE-FUNDED FAMILY MEDICINE OBSTETRICS
2FELLOWSHIP PROGRAM AND FUND. This division requires HHS to
3establish a family medicine obstetrics fellowship program to
4increase access to family medicine obstetrics practitioners
5in rural and underserved areas of the state. A person who
6has completed an accreditation council for graduate medical
7education residency program in family medicine is eligible for
8participation in the fellowship program. Participating fellows
9shall enter into a program agreement with a participating
10teaching hospital which, at a minimum, requires the fellow
11to complete a one-year fellowship and to engage in full-time
12family medicine obstetrics practice in a rural or underserved
13area of the state for a period of at least five years within
14nine months following completion of the fellowship and receipt
15of a license to practice medicine in the state. Each fellow
16participating in the program shall be eligible for salary and
17benefits including a stipend as determined by the participating
18teaching hospital and funded through the family medicine
19obstetrics fellowship program fund.
20The division requires HHS to adopt administrative rules
21to administer the program, including defining rural and
22underserved areas for the purpose of the required full-time
23practice of a person following completion of the fellowship.
24The division creates a family medicine obstetrics fellowship
25program fund in the state treasury consisting of the moneys
26appropriated or credited to the fund by law. Moneys in the
27fund at the end of each fiscal year shall not revert to any
28other fund but shall remain in the fund for use in subsequent
29fiscal years. Moneys in the fund are appropriated to HHS
30to be used to fund fellowship positions as provided in the
31division. The division appropriates a sufficient amount from
32the general fund of the state to the fund annually to support
33the creation of four fellowship positions. The division
34provides an appropriation for deposit in the fund for fiscal
35year 2023-2024.
-18- 1The division requires HHS and the participating teaching
2hospitals to regularly evaluate and document their experiences
3including identifying ways the program may be modified or
4expanded to facilitate increased access to family medicine
5obstetrics practitioners in rural and underserved areas of the
6state. The department shall submit an annual report to the
7general assembly by January 1. The report shall include the
8number of fellowships funded to date and any other information
9identified by HHS and the participating teaching hospitals as
10indicators of outcomes and the effectiveness of the program.
11DIVISION IV — SELF-ADMINISTERED HORMONAL CONTRACEPTIVES.
12 This division relates to the dispensing of self-administered
13hormonal contraceptives by a pharmacist. The division
14defines “self-administered hormonal contraceptive” as a
15self-administered hormonal contraceptive that is approved by
16the United States food and drug administration to prevent
17pregnancy, including an oral hormonal contraceptive, a hormonal
18vaginal ring, and a hormonal contraceptive patch, but not
19including any drug intended to induce an abortion.
20The division provides that notwithstanding any provision
21of law to the contrary, a pharmacist may dispense a
22self-administered hormonal contraceptive to a patient who
23is at least 18 years of age pursuant to a standing order
24established by the medical director of HHS (medical director).
25For an initial dispensing, a pharmacist may dispense only up
26to a three-month supply at one time of the self-administered
27hormonal contraceptive, and for any subsequent dispensing
28of the same self-administered hormonal contraceptive, a
2912-month supply at one time. Additionally, the division
30prohibits a pharmacist who dispenses a self-administered
31hormonal contraceptive in accordance with the division from
32requiring any other prescription drug order authorized by a
33practitioner prior to dispensing the self-administered hormonal
34contraceptive.
35The division authorizes the medical director to establish a
-19-1standing order authorizing the dispensing of self-administered
2hormonal contraceptives by any pharmacist who complies with the
3standing order and retains and submits the patient’s record to
4HHS.
5The standing order includes requiring a pharmacist who
6dispenses a self-administered hormonal contraceptive under the
7division to: complete a standardized training program and
8continuing education requirements related to prescribing the
9hormonal contraceptives; obtain a completed self-screening risk
10assessment from each patient, verify the identity and age of
11each patient, and perform a blood pressure screening on each
12patient before dispensing the hormonal contraceptives; provide
13the patient with certain written information; provide the
14patient with a copy of the record of the pharmacist’s encounter
15with the patient; and provide patient counseling.
16The standing order would prohibit a pharmacist who dispenses
17hormonal contraceptives under the division from requiring a
18patient to schedule an appointment with the pharmacist for
19the prescribing or dispensing of the hormonal contraceptive;
20dispensing the hormonal contraceptives to a patient for more
21than 27 months after the date initially dispensed without the
22patient’s attestation that the patient has consulted with a
23practitioner during the preceding 27 months; and dispensing
24the hormonal contraceptives to a patient if the results of the
25patient’s self-screening risk assessment indicate it is unsafe
26for the pharmacist to dispense the hormonal contraceptives
27to the patient, in which case the pharmacist shall refer the
28patient to a practitioner.
29The division provides immunity for a pharmacist who
30dispenses a self-administered hormonal contraceptive and
31for the medical director who establishes a standing order
32in compliance with the division from criminal and civil
33liability arising from any damages caused by the dispensing,
34administering, or use of a self-administered hormonal
35contraceptive or the establishment of the standing order.
-20-1Additionally, the medical director shall be considered to be
2acting within the scope of the medical director’s office and
3employment for purposes of Code chapter 669 (Iowa tort claims
4Act) in the establishment of a standing order in compliance
5with the division.
6The division requires HHS, in collaboration with the
7boards of pharmacy and medicine, and in consideration of
8the guidelines established by the American congress of
9obstetricians and gynecologists, to adopt administrative rules
10to administer the provisions of the division.
11The division amends prescription contraceptive coverage
12provisions to require that a group policy, contract, or plan
13delivered, issued for delivery, continued, or renewed in the
14state on or after January 1, 2024, providing for third-party
15payment or prepayment of health or medical expenses, shall
16specifically provide for payment of self-administered hormonal
17contraceptives, prescribed and dispensed as specified in the
18division, including those dispensed at one time. The division
19provides, however, that the provisions relating to coverage are
20not to be construed to require a third-party payor to provide
21payment to a practitioner for dispensing a self-administered
22hormonal contraceptive to replace a self-administered
23hormonal contraceptive that has been dispensed to a covered
24person and that has been misplaced, stolen, or destroyed.
25These provisions are also not to be construed to require a
26third-party payor to replace covered prescriptions that are
27misplaced, stolen, or destroyed.
28The division also requires the board of pharmacy in
29collaboration with the board of medicine and HHS to expand
30the information program for drug prescribing to collect
31from pharmacists information relating to the dispensing of
32self-administered hormonal contraceptives as provided in the
33division.
34The division applies to the Medicaid program as specified in
35the bill.
-21- 1DIVISION V — STATE EMPLOYEE PAID PARENTAL LEAVE BENEFIT.
2 This division provides that a state employee entitled to leave
3under the federal Family and Medical Leave Act of 1993 shall
4be provided paid leave for the birth or adoption of a child if
5the leave is taken within 12 months following any such birth or
6adoption. The division provides that a state employee parent
7who gives birth or adopts a child shall be entitled to up to
8four weeks of paid leave while a state employee parent of a
9child who did not give birth shall be entitled to up to one
10week of paid leave. The division requires the department of
11administrative services to adopt rules to implement this paid
12parental leave benefit.
13DIVISION VI — NONRECURRING ADOPTION EXPENSES — ADOPTION
14SUBSIDY PROGRAM. This division provides that the maximum
15reimbursement provided to an adoptive parent under the adoption
16subsidy program for nonrecurring adoption expenses is $1,000.
17The division defines “nonrecurring adoption expenses” as the
18reasonable and necessary adoption fees, court costs, attorney
19fees, and other expenses which are directly related to the
20legal adoption of a child with special needs which are not
21incurred in violation of state, tribal, or federal law, and
22which have not been reimbursed from other sources or other
23funds. Under federal regulation, “other expenses which
24are directly related to the legal adoption of a child with
25special needs” means the costs of the adoption incurred by
26or on behalf of the parents and for which parents carry the
27ultimate liability for payment. Such costs may include the
28adoption study, including health and psychological examination,
29supervision of the placement prior to adoption, transportation,
30and the reasonable costs of lodging and food for the child or
31the adoptive parents when necessary to complete the placement
32or adoption process. The department of health and human
33services shall adopt administrative rules to administer the
34division. The division also repeals a provision in 2010 Iowa
35Acts which limited the nonrecurring adoption expenses to $500
-22-1and prohibited additional amounts for court costs and other
2related legal expenses.
3DIVISION VII — ALL IOWA OPPORTUNITY SCHOLARSHIP PROGRAM.
4 This division relates to the all Iowa opportunity scholarship
5program (program), which provides scholarships to Iowa
6students who graduate from high school or receive a high
7school equivalency diploma to help such students attend a
8community college in this state or an institution of higher
9learning governed by the state board of regents. The program
10prioritizes awarding scholarships to certain students,
11including eligible foster care students. Eligible foster care
12students are students who age out of Iowa’s foster care system,
13age out of the state training school, or are adopted from
14Iowa’s foster care system after reaching 16 years of age.
15Current law requires that, in order to be eligible to
16receive a scholarship under the program, the student must begin
17enrollment at a community college or institution of higher
18learning governed by the state board of regents within two
19academic years of graduation from high school or receipt of a
20high school equivalency diploma and continuously receive awards
21as a full-time or part-time student to maintain eligibility.
22The division strikes these requirements for eligible foster
23care students. The division also provides that, for purposes
24of the program, “eligible foster care student” does not include
25a person who is 26 years of age or older.
26The division applies to applications submitted under
27the program before, on, or after the effective date of the
28division.
-23-pf/rh
2families including provisions for maternal support and
3fatherhood initiatives, regional centers of excellence, a
4state-funded family medicine obstetrics fellowship program,
5self-administered hormonal contraceptives, state employee
6parental leave, adoption expenses under the adoption subsidy
7program, and accessibility to the all Iowa scholarship
8program; making appropriations; and including effective date
9and applicability provisions.
10BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1DIVISION I
2More options for maternal support (MOMS) program — fatherhood
3initiatives
4 Section 1. Section 217.41C, subsection 1, paragraph c, Code
52023, is amended to read as follows:
6c. For the purposes of this section, “pregnancy support
7services” means those nonmedical services that promote
8childbirth by providing information, counseling, and support
9services that assist pregnant women or women who believe they
10may be pregnant and men who are involved or who think they
11might be involved in a pregnancy to choose childbirth and to
12make informed decisions regarding the choice of adoption or
13parenting with respect to their children.
14 Sec. 2. Section 217.41C, Code 2023, is amended by adding the
15following new subsections:
16 NEW SUBSECTION. 8. The department shall develop and
17maintain a virtual clearinghouse of pregnancy support
18services and resources including but not limited to all of the
19following:
20a. Pregnancy resource center and maternity home information
21including contact information, location, and services provided.
22b. Assistance in accessing public assistance including but
23not limited to the special supplemental nutrition program for
24women, infants, and children and the supplemental nutrition
25assistance program.
26c. Educational resources.
27d. Housing assistance.
28e. Recovery and mental health services.
29f. Family planning education.
30g. Adoption and foster care information and services.
31h. Healing and support services for abortion survivors and
32their families.
33 NEW SUBSECTION. 9. Beginning July 1, 2023, and thereafter,
34funding for the program may be used for all of the following
35purposes:
-1- 1a. Fatherhood engagement grants. The department may
2award grants to nonprofit, community-based organizations to
3address the needs of fathers by assisting fathers in finding
4employment, managing child support obligations, transitioning
5from a period of incarceration, accessing health care,
6understanding child development, and enhancing parenting skills
7using evidence-based parenting education. Priority in the
8awarding of grants shall be based on the demonstrated need
9in a geographic area and the prevalence of the population to
10be served as indicated by factors including but not limited
11to the service area’s unemployment rate, incarceration rate,
12number of public assistance recipients, number of single-parent
13households, level of housing instability, and graduation rates.
14b. Fatherhood communications initiative. The department
15shall administer a communications initiative on responsible
16fatherhood including but not limited to a public internet site
17that provides access to resources on effective parenting and
18assistance in receiving parenting support and services.
19c. Mentoring school-aged males grant program. The
20department may award three-year renewable grants to nonprofit
21organizations that provide mentorship, social and academic
22support, and life skills development to school-aged males.
23Priority in the awarding of grants shall be based on the
24demonstrated need in a geographic area and the prevalence of
25the population to be served as indicated by factors including
26but not limited to the service area’s unemployment rate,
27incarceration rate, number of public assistance recipients,
28number of single-parent households, level of housing
29instability, and graduation rates. The department shall
30provide technical assistance to grantees to ensure program
31sustainability following the end of the three-year grant
32period.
33 Sec. 3. MORE OPTIONS FOR MATERNAL SUPPORT PROGRAM —
34APPROPRIATION. There is appropriated from the general fund of
35the state to the department of health and human services for
-2-1the fiscal year beginning July 1, 2023, and ending June 30,
22024, the following amount, or so much thereof as is necessary,
3to be used for the purposes designated:
.................................................. $42,000,000
5To be used for the purposes of the more options for maternal
6support program created in section 217.41C, including for
7program administration, the provision of services, and for
8funding of fatherhood engagement grants, the fatherhood
9communications initiative, and the mentoring school-aged males
10grant program.
11 Sec. 4. 2022 Iowa Acts, chapter 1131, section 28, subsection
128, is amended to read as follows:
138. Of the funds appropriated under this section, $500,000
14shall be used for the purposes of program administration and
15provision of pregnancy support services through the more
16options for maternal support program created in this Act.
17Notwithstanding section 8.33, moneys appropriated in this
18subsection that remain unencumbered or unobligated at the close
19of the fiscal year shall not revert but shall remain available
20for the purposes designated until the close of the succeeding
21fiscal year.
22 Sec. 5. EFFECTIVE DATE. The following, being deemed of
23immediate importance, takes effect upon enactment:
24The section of this division of this Act amending 2022 Iowa
25Acts, chapter 1131, section 28, subsection 8.
26DIVISION II
27Regional centers of excellence grant program
28 Sec. 6. REGIONAL CENTERS OF EXCELLENCE PROGRAM — GRANTS —
29APPROPRIATION. There is appropriated from the general fund of
30the state to the department of health and human services for
31the fiscal year beginning July 1, 2023, and ending June 30,
322024, the following amount, or so much thereof as is necessary,
33to be used for the purposes designated:
.................................................. $341,000,000
35The funds appropriated in this section shall be used for
-3-1the continuation of a center of excellence program to award
2four grants to encourage innovation and collaboration among
3regional health care providers in a rural area based upon the
4results of a regional community needs assessment to transform
5health care delivery in order to provide quality, sustainable
6care that meets the needs of the local communities. An
7applicant for the grant funds shall specify how the funds will
8be expended to accomplish the goals of the program and shall
9provide a detailed five-year sustainability plan prior to being
10awarded any funding. Following the receipt of grant funding,
11a recipient shall submit periodic reports as specified by the
12department to the governor and the general assembly regarding
13the recipient’s expenditure of the funds and progress in
14accomplishing the program’s goals.
15DIVISION III
16state-funded family medicine obstetrics fellowship program
17 Sec. 7. NEW SECTION. 135.182 State-funded family medicine
18obstetrics fellowship program — fund.
191. The department shall establish a family medicine
20obstetrics fellowship program to increase access to family
21medicine obstetrics practitioners in rural and underserved
22areas of the state. A person who has completed an
23accreditation council for graduate medical education residency
24program in family medicine is eligible for participation
25in the fellowship program. Participating fellows shall
26enter into a program agreement with a participating teaching
27hospital which, at a minimum, requires the fellow to complete a
28one-year fellowship and to engage in full-time family medicine
29obstetrics practice in a rural or underserved area of the
30state for a period of at least five years within nine months
31following completion of the fellowship and receipt of a license
32to practice medicine in the state.
332. Each fellow participating in the program shall be
34eligible for a salary and benefits including a stipend as
35determined by the participating teaching hospital which shall
-4-1be funded through the family medicine obstetrics fellowship
2program fund.
33. The department shall adopt rules pursuant to chapter
417A to administer the program, including defining rural and
5underserved areas for the purpose of the required full-time
6practice of a person following completion of the fellowship.
74. a. A family medicine obstetrics fellowship program
8fund is created in the state treasury consisting of the moneys
9appropriated or credited to the fund by law. Notwithstanding
10section 8.33, moneys in the fund at the end of each fiscal year
11shall not revert to any other fund but shall remain in the fund
12for use in subsequent fiscal years. Moneys in the fund are
13appropriated to the department to be used to fund fellowship
14positions as provided in this section.
15b. For the fiscal year beginning July 1, 2023, and each
16fiscal year beginning July 1 thereafter, there is appropriated
17from the general fund of the state to the family medicine
18obstetrics fellowship program fund an amount sufficient to
19support the creation of four fellowship positions as provided
20in this section.
215. The department and the participating teaching hospitals
22shall regularly evaluate and document their experiences
23including identifying ways the program may be modified or
24expanded to facilitate increased access to family medicine
25obstetrics practitioners in rural and underserved areas of the
26state. The department shall submit an annual report to the
27general assembly by January 1. The report shall include the
28number of fellowships funded to date and any other information
29identified by the department and the participating teaching
30hospitals as indicators of outcomes and the effectiveness of
31the program.
326. For the purposes of this section, “teaching hospital”
33means a hospital or medical center that provides medical
34education to prospective and current health professionals.
35 Sec. 8. STATE-FUNDED FAMILY MEDICINE OBSTETRICS FELLOWSHIP
-5-1PROGRAM AND FUND — APPROPRIATION. There is appropriated from
2the general fund of the state to the department of health and
3human services for the fiscal year beginning July 1, 2023, and
4ending June 30, 2024, the following amount, or so much thereof
5as is necessary, to be used for the purposes designated:
.................................................. $6560,000
7For deposit in the family medicine obstetrics fellowship
8program fund to be utilized in creating and providing for four
9family medicine obstetrics fellowship positions during the
10fiscal year in accordance with the family medicine obstetrics
11fellowship program created in this division of this Act.
12DIVISION IV
13SELF-ADMINISTERED Hormonal contraceptives
14 Sec. 9. Section 155A.3, Code 2023, is amended by adding the
15following new subsections:
16 NEW SUBSECTION. 10A. “Department” means the department of
17health and human services.
18 NEW SUBSECTION. 45A. “Self-administered hormonal
19contraceptive” means a self-administered hormonal contraceptive
20that is approved by the United States food and drug
21administration to prevent pregnancy. “Self-administered
22hormonal contraceptive” includes an oral hormonal contraceptive,
23a hormonal vaginal ring, and a hormonal contraceptive patch,
24but does not include any drug intended to induce an abortion as
25defined in section 146.1.
26 NEW SUBSECTION. 45B. “Standing order” means a preauthorized
27medication order with specific instructions from the medical
28director of the department to dispense a medication under
29clearly defined circumstances.
30 Sec. 10. NEW SECTION. 155A.49 Pharmacist dispensing of
31self-administered hormonal contraceptives — standing order —
32requirements — limitations of liability.
331. a. Notwithstanding any provision of law to the contrary,
34a pharmacist may dispense a self-administered hormonal
35contraceptive to a patient who is at least eighteen years of
-6-1age, pursuant to a standing order established by the medical
2director of the department in accordance with this section.
3b. In dispensing a self-administered hormonal contraceptive
4to a patient under this section, a pharmacist shall comply with
5all of the following:
6(1) For an initial dispensing of a self-administered
7hormonal contraceptive, the pharmacist may dispense only up
8to a three-month supply at one time of the self-administered
9hormonal contraceptive.
10(2) For any subsequent dispensing of the same
11self-administered hormonal contraceptive, the pharmacist
12may dispense up to a twelve-month supply at one time of the
13self-administered hormonal contraceptive.
142. A pharmacist who dispenses a self-administered hormonal
15contraceptive in accordance with this section shall not
16require any other prescription drug order authorized by a
17practitioner prior to dispensing the self-administered hormonal
18contraceptive to a patient.
193. The medical director of the department may establish a
20standing order authorizing the dispensing of self-administered
21hormonal contraceptives by a pharmacist who does all of the
22following:
23a. Complies with the standing order established pursuant to
24this section.
25b. Retains a record of each patient to whom a
26self-administered hormonal contraceptive is dispensed under
27this section and submits the record to the department.
284. The standing order shall require a pharmacist who
29dispenses self-administered hormonal contraceptives under this
30section to do all of the following:
31a. Complete a standardized training program and continuing
32education requirements approved by the board in consultation
33with the board of medicine and the department that are related
34to prescribing self-administered hormonal contraceptives and
35include education regarding all contraceptive methods approved
-7-1by the United States food and drug administration.
2b. Obtain a completed self-screening risk assessment,
3approved by the department in collaboration with the board and
4the board of medicine, from each patient, verify the identity
5and age of each patient, and perform a blood pressure screening
6on each patient prior to dispensing the self-administered
7hormonal contraceptive to the patient.
8c. Provide the patient with all of the following:
9(1) Written information regarding all of the following:
10(a) The importance of completing an appointment with the
11patient’s primary care or women’s health care practitioner
12to obtain preventative care, including but not limited to
13recommended tests and screenings.
14(b) The effectiveness and availability of long-acting
15reversible contraceptives as an alternative to
16self-administered hormonal contraceptives.
17(2) A copy of the record of the pharmacist’s encounter with
18the patient that includes all of the following:
19(a) The patient’s completed self-screening risk assessment.
20(b) A description of the contraceptive dispensed, or the
21basis for not dispensing a contraceptive.
22(3) Patient counseling regarding all of the following:
23(a) The appropriate administration and storage of the
24self-administered hormonal contraceptive.
25(b) Potential side effects and risks of the
26self-administered hormonal contraceptive.
27(c) The need for backup contraception.
28(d) When to seek emergency medical attention.
29(e) The risk of contracting a sexually transmitted
30infection or disease, and ways to reduce such a risk.
315. The standing order established pursuant to this section
32shall prohibit a pharmacist who dispenses a self-administered
33hormonal contraceptive under this section from doing any of the
34following:
35a. Requiring a patient to schedule an appointment with
-8-1the pharmacist for the prescribing or dispensing of a
2self-administered hormonal contraceptive.
3b. Dispensing self-administered hormonal contraceptives
4to a patient for more than twenty-seven months after the
5date a self-administered hormonal contraceptive is initially
6dispensed to the patient, if the patient has not consulted with
7a primary care or women’s health care practitioner during the
8preceding twenty-seven months, in which case the pharmacist
9shall refer the patient to a primary care or women’s health
10care practitioner.
11c. Dispensing a self-administered hormonal contraceptive to
12a patient if the results of the self-screening risk assessment
13completed by a patient pursuant to subsection 4, paragraph
14“b”, indicate it is unsafe for the pharmacist to dispense the
15self-administered hormonal contraceptive to the patient, in
16which case the pharmacist shall refer the patient to a primary
17care or women’s health care practitioner.
186. A pharmacist who dispenses a self-administered hormonal
19contraceptive and the medical director of the department who
20establishes a standing order in compliance with this section
21shall be immune from criminal and civil liability arising
22from any damages caused by the dispensing, administering,
23or use of a self-administered hormonal contraceptive or the
24establishment of the standing order. The medical director of
25the department shall be considered to be acting within the
26scope of the medical director’s office and employment for
27purposes of chapter 669 in the establishment of a standing
28order in compliance with this section.
297. The department, in collaboration with the board and
30the board of medicine, and in consideration of the guidelines
31established by the American congress of obstetricians and
32gynecologists, shall adopt rules pursuant to chapter 17A to
33administer this chapter.
34 Sec. 11. Section 514C.19, Code 2023, is amended to read as
35follows:
-9- 1514C.19 Prescription contraceptive coverage.
21. Notwithstanding the uniformity of treatment requirements
3of section 514C.6, a group policy, or contract, or plan
4 providing for third-party payment or prepayment of health or
5medical expenses shall not do either of the following comply
6as follows:
7a. Exclude Such policy, contract, or plan shall not
8exclude or restrict benefits for prescription contraceptive
9drugs or prescription contraceptive devices which prevent
10conception and which are approved by the United States
11food and drug administration, or generic equivalents
12approved as substitutable by the United States food and
13drug administration, if such policy, or contract, or plan
14 provides benefits for other outpatient prescription drugs
15or devices. However, such policy, contract, or plan shall
16specifically provide for payment of a self-administered
17hormonal contraceptive, as prescribed by a practitioner as
18defined in section 155A.3, or as prescribed by standing order
19and dispensed by a pharmacist pursuant to section 155A.49,
20including payment for up to an initial three-month supply
21of a self-administered hormonal contraceptive dispensed at
22one time and for up to a twelve-month supply of the same
23self-administered hormonal contraceptive subsequently dispensed
24at one time.
25b. Exclude Such policy, contract, or plan shall not exclude
26 or restrict benefits for outpatient contraceptive services
27which are provided for the purpose of preventing conception if
28such policy, or contract, or plan provides benefits for other
29outpatient services provided by a health care professional.
302. A person who provides a group policy, or contract, or
31plan providing for third-party payment or prepayment of health
32or medical expenses which is subject to subsection 1 shall not
33do any of the following:
34a. Deny to an individual eligibility, or continued
35eligibility, to enroll in or to renew coverage under the terms
-10-1of the policy, or contract, or plan because of the individual’s
2use or potential use of such prescription contraceptive drugs
3or devices, or use or potential use of outpatient contraceptive
4services.
5b. Provide a monetary payment or rebate to a covered
6individual to encourage such individual to accept less than the
7minimum benefits provided for under subsection 1.
8c. Penalize or otherwise reduce or limit the reimbursement
9of a health care professional because such professional
10prescribes contraceptive drugs or devices, or provides
11contraceptive services.
12d. Provide incentives, monetary or otherwise, to a health
13care professional to induce such professional to withhold
14from a covered individual contraceptive drugs or devices, or
15contraceptive services.
163. This section shall not be construed to prevent a
17third-party payor from including deductibles, coinsurance, or
18copayments under the policy, or contract, or plan as follows:
19a. A deductible, coinsurance, or copayment for benefits
20for prescription contraceptive drugs shall not be greater than
21such deductible, coinsurance, or copayment for any outpatient
22prescription drug for which coverage under the policy, or
23 contract, or plan is provided.
24b. A deductible, coinsurance, or copayment for benefits for
25prescription contraceptive devices shall not be greater than
26such deductible, coinsurance, or copayment for any outpatient
27prescription device for which coverage under the policy, or
28 contract, or plan is provided.
29c. A deductible, coinsurance, or copayment for benefits for
30outpatient contraceptive services shall not be greater than
31such deductible, coinsurance, or copayment for any outpatient
32health care services for which coverage under the policy, or
33 contract, or plan is provided.
344. This section shall not be construed to require a
35third-party payor under a policy, or contract, or plan
-11-1 to provide benefits for experimental or investigational
2contraceptive drugs or devices, or experimental or
3investigational contraceptive services, except to the extent
4that such policy, or contract, or plan provides coverage for
5other experimental or investigational outpatient prescription
6drugs or devices, or experimental or investigational outpatient
7health care services.
85. This section shall not be construed to limit or otherwise
9discourage the use of generic equivalent drugs approved by the
10United States food and drug administration, whenever available
11and appropriate. This section, when a brand name drug is
12requested by a covered individual and a suitable generic
13equivalent is available and appropriate, shall not be construed
14to prohibit a third-party payor from requiring the covered
15individual to pay a deductible, coinsurance, or copayment
16consistent with subsection 3, in addition to the difference of
17the cost of the brand name drug less the maximum covered amount
18for a generic equivalent.
196. A person who provides an individual policy, or contract,
20or plan providing for third-party payment or prepayment of
21health or medical expenses shall make available a coverage
22provision that satisfies the requirements in subsections
231 through 5 in the same manner as such requirements are
24applicable to a group policy, or contract, or plan under those
25subsections. The policy, or contract, or plan shall provide
26that the individual policyholder may reject the coverage
27provision at the option of the policyholder.
287. a. This section applies to the following classes of
29third-party payment provider contracts, or policies, or plans
30 delivered, issued for delivery, continued, or renewed in this
31state on or after July 1, 2000 January 1, 2024:
32(1) Individual or group accident and sickness insurance
33providing coverage on an expense-incurred basis.
34(2) An individual or group hospital or medical service
35contract issued pursuant to chapter 509, 514, or 514A.
-12- 1(3) An individual or group health maintenance organization
2contract regulated under chapter 514B.
3(4) Any other entity engaged in the business of insurance,
4risk transfer, or risk retention, which is subject to the
5jurisdiction of the commissioner.
6(5) A plan established pursuant to chapter 509A for public
7employees.
8b. This section shall not apply to accident-only,
9specified disease, short-term hospital or medical, hospital
10confinement indemnity, credit, dental, vision, Medicare
11supplement, long-term care, basic hospital and medical-surgical
12expense coverage as defined by the commissioner, disability
13income insurance coverage, coverage issued as a supplement
14to liability insurance, workers’ compensation or similar
15insurance, or automobile medical payment insurance.
168. This section shall not be construed to require a
17third-party payor to provide payment to a practitioner for the
18dispensing of a self-administered hormonal contraceptive to
19replace a self-administered hormonal contraceptive that has
20been dispensed to a covered person and that has been misplaced,
21stolen, or destroyed. This section shall not be construed to
22require a third-party payor to replace covered prescriptions
23that are misplaced, stolen, or destroyed.
249. For the purposes of this section, “self-administered
25hormonal contraceptive” and “standing order” mean the same as
26defined in section 155A.3.
27 Sec. 12. INFORMATION PROGRAM FOR DRUG PRESCRIBING AND
28DISPENSING — SELF-ADMINISTERED HORMONAL CONTRACEPTIVES. The
29board of pharmacy in collaboration with the board of medicine
30and the department of health and human services shall expand
31the information program for drug prescribing and dispensing
32established pursuant to section 124.551, to collect from
33pharmacists information relating to the dispensing of
34self-administered hormonal contraceptives as provided pursuant
35to section 155A.49. The board of pharmacy shall adopt
-13-1rules pursuant to chapter 17A related to registration of
2participating pharmacists, the information to be reported by a
3pharmacist to the information program, access to information
4from the program, and other rules necessary to carry out the
5purposes and to enforce the provisions of this section.
6 Sec. 13. APPLICATION TO MEDICAID PROGRAM. This division
7of this Act shall apply to the Medicaid program including a
8managed care organization acting pursuant to a contract with
9the department of health and human services to administer
10the Medicaid program under chapter 249A. However, if it is
11determined that any provision of this division of this Act
12would cause denial of federal funds under Tit.XVIII or XIX
13of the federal Social Security Act, or would otherwise be
14inconsistent or conflict with the requirements of federal law
15or regulation, such provision shall be suspended, but only to
16the extent necessary to prevent denial of such funds or to
17eliminate the inconsistency or conflict with the requirements
18of federal law or regulation.
19DIVISION V
20State employee paid parental leave benefit
21 Sec. 14. NEW SECTION. 70A.31 Paid parental leave.
221. A state employee entitled to leave under the federal
23Family and Medical Leave Act of 1993 shall be provided paid
24leave for such time as specified in this section for the birth
25or placement for adoption with the employee of a child if the
26leave is taken within twelve months following any such birth
27or adoption.
282. a. For the birth of a child, a state employee parent who
29gave birth shall be entitled to up to four weeks of paid leave
30and a state employee parent who did not give birth shall be
31entitled to up to one week of paid leave.
32b. For the placement for adoption of a child, a state
33employee parent shall be entitled to up to four weeks of paid
34leave.
353. The department of administrative services shall adopt
-14-1rules to implement this section.
2DIVISION VI
3Nonrecurring ADOPTION EXPENSES — adoption subsidy program
4 Sec. 15. NEW SECTION. 234.48 Adoption subsidy —
5nonrecurring adoption expenses.
6Notwithstanding any provision to the contrary, the maximum
7reimbursement provided to an adoptive parent under the
8adoption subsidy program for nonrecurring adoption expenses
9is one thousand dollars. For the purposes of this section,
10“nonrecurring adoption expenses” means the same as defined in 45
11C.F.R. §1356.41. The department shall adopt rules pursuant to
12chapter 17A to administer this section.
13 Sec. 16. REPEAL. 2010 Iowa Acts, chapter 1031, section 408,
14is repealed.
15DIVISION VII
16All Iowa opportunity scholarship PROGRAM
17 Sec. 17. Section 261.87, subsection 1, paragraph b,
18unnumbered paragraph 1, Code 2023, is amended to read as
19follows:
20“Eligible foster care student” means a person under
21twenty-six years of age who has a high school diploma or a high
22school equivalency diploma under chapter 259A and is described
23by any of the following:
24 Sec. 18. Section 261.87, subsection 2, paragraph f, Code
252023, is amended to read as follows:
26f. (1) Begins Except as provided in subparagraph (2),
27begins enrollment at an eligible institution within two
28academic years of graduation from high school or receipt of
29a high school equivalency diploma under chapter 259A and
30continuously receives awards as a full-time or part-time
31student to maintain eligibility. However, the student may
32defer or suspend participation in the program for up to two
33years in order to pursue obligations that meet conditions
34established by the commission by rule or to fulfill military
35obligations.
-15- 1(2) The requirements of subparagraph (1) do not apply to an
2eligible foster care student.
3 Sec. 19. APPLICABILITY. This division of this Act applies
4to applications submitted under the all Iowa opportunity
5scholarship program established pursuant to section 261.87
6before, on, or after the effective date of this division of
7this Act.
8EXPLANATION
9The inclusion of this explanation does not constitute agreement with
10the explanation’s substance by the members of the general assembly.
11This bill relates to the health and well-being of children
12and families. The bill is constructed in divisions.
13DIVISION I — MORE OPTIONS FOR MATERNAL SUPPORT (MOMS)
14PROGRAM — FATHERHOOD INITIATIVES. This division relates to
15the more options for maternal support (MOMS) program. The
16bill adds as part of the definition of “pregnancy support
17services” services to men who are involved or think they might
18be involved in a pregnancy. As part of the MOMS program,
19the division requires HHS to develop and maintain a virtual
20clearinghouse of pregnancy support services and resources. The
21services and resources include but are not limited to pregnancy
22resource center and maternity home information; assistance in
23accessing public assistance including but not limited to the
24special supplemental nutrition program for women, infants, and
25children program and the supplemental nutrition assistance
26program; educational resources; housing assistance; recovery
27and mental health services; family planning education; adoption
28and foster care information and services; and healing and
29support services for abortion survivors and their families.
30As part of the MOMS program, beginning July 1, 2023, and
31thereafter, funding for the program may be used for fatherhood
32engagement grants to nonprofit, community-based organizations
33to address the needs of fathers by assisting fathers in
34finding employment, managing child support obligations,
35transitioning from a period of incarceration, accessing health
-16-1care, understanding child development, and enhancing parenting
2skills using evidence-based parenting education; a fatherhood
3communications initiative administered by HHS, including but
4not limited to a public internet site that provides access to
5resources on effective parenting and assistance in receiving
6parenting support and services; and a mentoring school-aged
7males grant program to provide mentorship, social and academic
8support, and life skills development to school-aged males.
9The division also appropriates $2 million from the general
10fund of the state to HHS for fiscal year 2023-2024 to be used
11for the MOMS program including for program administration, the
12provision of services, and for funding of fatherhood engagement
13grants, the fatherhood communications initiative, and the
14mentoring school-aged males grant program.
15The division provides that the funding appropriated for the
16MOMS program for fiscal year 2022-2023 is not to revert, but
17is to remain available for the MOMS program for fiscal year
182023-2024. This provision takes effect upon enactment.
19DIVISION II — REGIONAL CENTERS OF EXCELLENCE GRANT PROGRAM.
20 This division appropriates $1 million from the general fund
21of the state to the department of health and human services
22(HHS) for fiscal year 2023-2024 for continuation of a regional
23center of excellence program to award four grants to encourage
24innovation and collaboration among regional health care
25providers in a rural area based upon the results of a regional
26community needs assessment to transform health care delivery in
27order to provide quality, sustainable care that meets the needs
28of the local communities. An applicant for the grant funds
29shall specify how the funds will be expended to accomplish the
30goals of the program and shall provide a detailed five-year
31sustainability plan prior to being awarded any funding.
32Following the receipt of grant funding, a recipient shall
33submit periodic reports as specified by HHS to the governor and
34the general assembly regarding the recipient’s expenditure of
35the funds and progress in accomplishing the program goals.
-17- 1DIVISION III — STATE-FUNDED FAMILY MEDICINE OBSTETRICS
2FELLOWSHIP PROGRAM AND FUND. This division requires HHS to
3establish a family medicine obstetrics fellowship program to
4increase access to family medicine obstetrics practitioners
5in rural and underserved areas of the state. A person who
6has completed an accreditation council for graduate medical
7education residency program in family medicine is eligible for
8participation in the fellowship program. Participating fellows
9shall enter into a program agreement with a participating
10teaching hospital which, at a minimum, requires the fellow
11to complete a one-year fellowship and to engage in full-time
12family medicine obstetrics practice in a rural or underserved
13area of the state for a period of at least five years within
14nine months following completion of the fellowship and receipt
15of a license to practice medicine in the state. Each fellow
16participating in the program shall be eligible for salary and
17benefits including a stipend as determined by the participating
18teaching hospital and funded through the family medicine
19obstetrics fellowship program fund.
20The division requires HHS to adopt administrative rules
21to administer the program, including defining rural and
22underserved areas for the purpose of the required full-time
23practice of a person following completion of the fellowship.
24The division creates a family medicine obstetrics fellowship
25program fund in the state treasury consisting of the moneys
26appropriated or credited to the fund by law. Moneys in the
27fund at the end of each fiscal year shall not revert to any
28other fund but shall remain in the fund for use in subsequent
29fiscal years. Moneys in the fund are appropriated to HHS
30to be used to fund fellowship positions as provided in the
31division. The division appropriates a sufficient amount from
32the general fund of the state to the fund annually to support
33the creation of four fellowship positions. The division
34provides an appropriation for deposit in the fund for fiscal
35year 2023-2024.
-18- 1The division requires HHS and the participating teaching
2hospitals to regularly evaluate and document their experiences
3including identifying ways the program may be modified or
4expanded to facilitate increased access to family medicine
5obstetrics practitioners in rural and underserved areas of the
6state. The department shall submit an annual report to the
7general assembly by January 1. The report shall include the
8number of fellowships funded to date and any other information
9identified by HHS and the participating teaching hospitals as
10indicators of outcomes and the effectiveness of the program.
11DIVISION IV — SELF-ADMINISTERED HORMONAL CONTRACEPTIVES.
12 This division relates to the dispensing of self-administered
13hormonal contraceptives by a pharmacist. The division
14defines “self-administered hormonal contraceptive” as a
15self-administered hormonal contraceptive that is approved by
16the United States food and drug administration to prevent
17pregnancy, including an oral hormonal contraceptive, a hormonal
18vaginal ring, and a hormonal contraceptive patch, but not
19including any drug intended to induce an abortion.
20The division provides that notwithstanding any provision
21of law to the contrary, a pharmacist may dispense a
22self-administered hormonal contraceptive to a patient who
23is at least 18 years of age pursuant to a standing order
24established by the medical director of HHS (medical director).
25For an initial dispensing, a pharmacist may dispense only up
26to a three-month supply at one time of the self-administered
27hormonal contraceptive, and for any subsequent dispensing
28of the same self-administered hormonal contraceptive, a
2912-month supply at one time. Additionally, the division
30prohibits a pharmacist who dispenses a self-administered
31hormonal contraceptive in accordance with the division from
32requiring any other prescription drug order authorized by a
33practitioner prior to dispensing the self-administered hormonal
34contraceptive.
35The division authorizes the medical director to establish a
-19-1standing order authorizing the dispensing of self-administered
2hormonal contraceptives by any pharmacist who complies with the
3standing order and retains and submits the patient’s record to
4HHS.
5The standing order includes requiring a pharmacist who
6dispenses a self-administered hormonal contraceptive under the
7division to: complete a standardized training program and
8continuing education requirements related to prescribing the
9hormonal contraceptives; obtain a completed self-screening risk
10assessment from each patient, verify the identity and age of
11each patient, and perform a blood pressure screening on each
12patient before dispensing the hormonal contraceptives; provide
13the patient with certain written information; provide the
14patient with a copy of the record of the pharmacist’s encounter
15with the patient; and provide patient counseling.
16The standing order would prohibit a pharmacist who dispenses
17hormonal contraceptives under the division from requiring a
18patient to schedule an appointment with the pharmacist for
19the prescribing or dispensing of the hormonal contraceptive;
20dispensing the hormonal contraceptives to a patient for more
21than 27 months after the date initially dispensed without the
22patient’s attestation that the patient has consulted with a
23practitioner during the preceding 27 months; and dispensing
24the hormonal contraceptives to a patient if the results of the
25patient’s self-screening risk assessment indicate it is unsafe
26for the pharmacist to dispense the hormonal contraceptives
27to the patient, in which case the pharmacist shall refer the
28patient to a practitioner.
29The division provides immunity for a pharmacist who
30dispenses a self-administered hormonal contraceptive and
31for the medical director who establishes a standing order
32in compliance with the division from criminal and civil
33liability arising from any damages caused by the dispensing,
34administering, or use of a self-administered hormonal
35contraceptive or the establishment of the standing order.
-20-1Additionally, the medical director shall be considered to be
2acting within the scope of the medical director’s office and
3employment for purposes of Code chapter 669 (Iowa tort claims
4Act) in the establishment of a standing order in compliance
5with the division.
6The division requires HHS, in collaboration with the
7boards of pharmacy and medicine, and in consideration of
8the guidelines established by the American congress of
9obstetricians and gynecologists, to adopt administrative rules
10to administer the provisions of the division.
11The division amends prescription contraceptive coverage
12provisions to require that a group policy, contract, or plan
13delivered, issued for delivery, continued, or renewed in the
14state on or after January 1, 2024, providing for third-party
15payment or prepayment of health or medical expenses, shall
16specifically provide for payment of self-administered hormonal
17contraceptives, prescribed and dispensed as specified in the
18division, including those dispensed at one time. The division
19provides, however, that the provisions relating to coverage are
20not to be construed to require a third-party payor to provide
21payment to a practitioner for dispensing a self-administered
22hormonal contraceptive to replace a self-administered
23hormonal contraceptive that has been dispensed to a covered
24person and that has been misplaced, stolen, or destroyed.
25These provisions are also not to be construed to require a
26third-party payor to replace covered prescriptions that are
27misplaced, stolen, or destroyed.
28The division also requires the board of pharmacy in
29collaboration with the board of medicine and HHS to expand
30the information program for drug prescribing to collect
31from pharmacists information relating to the dispensing of
32self-administered hormonal contraceptives as provided in the
33division.
34The division applies to the Medicaid program as specified in
35the bill.
-21- 1DIVISION V — STATE EMPLOYEE PAID PARENTAL LEAVE BENEFIT.
2 This division provides that a state employee entitled to leave
3under the federal Family and Medical Leave Act of 1993 shall
4be provided paid leave for the birth or adoption of a child if
5the leave is taken within 12 months following any such birth or
6adoption. The division provides that a state employee parent
7who gives birth or adopts a child shall be entitled to up to
8four weeks of paid leave while a state employee parent of a
9child who did not give birth shall be entitled to up to one
10week of paid leave. The division requires the department of
11administrative services to adopt rules to implement this paid
12parental leave benefit.
13DIVISION VI — NONRECURRING ADOPTION EXPENSES — ADOPTION
14SUBSIDY PROGRAM. This division provides that the maximum
15reimbursement provided to an adoptive parent under the adoption
16subsidy program for nonrecurring adoption expenses is $1,000.
17The division defines “nonrecurring adoption expenses” as the
18reasonable and necessary adoption fees, court costs, attorney
19fees, and other expenses which are directly related to the
20legal adoption of a child with special needs which are not
21incurred in violation of state, tribal, or federal law, and
22which have not been reimbursed from other sources or other
23funds. Under federal regulation, “other expenses which
24are directly related to the legal adoption of a child with
25special needs” means the costs of the adoption incurred by
26or on behalf of the parents and for which parents carry the
27ultimate liability for payment. Such costs may include the
28adoption study, including health and psychological examination,
29supervision of the placement prior to adoption, transportation,
30and the reasonable costs of lodging and food for the child or
31the adoptive parents when necessary to complete the placement
32or adoption process. The department of health and human
33services shall adopt administrative rules to administer the
34division. The division also repeals a provision in 2010 Iowa
35Acts which limited the nonrecurring adoption expenses to $500
-22-1and prohibited additional amounts for court costs and other
2related legal expenses.
3DIVISION VII — ALL IOWA OPPORTUNITY SCHOLARSHIP PROGRAM.
4 This division relates to the all Iowa opportunity scholarship
5program (program), which provides scholarships to Iowa
6students who graduate from high school or receive a high
7school equivalency diploma to help such students attend a
8community college in this state or an institution of higher
9learning governed by the state board of regents. The program
10prioritizes awarding scholarships to certain students,
11including eligible foster care students. Eligible foster care
12students are students who age out of Iowa’s foster care system,
13age out of the state training school, or are adopted from
14Iowa’s foster care system after reaching 16 years of age.
15Current law requires that, in order to be eligible to
16receive a scholarship under the program, the student must begin
17enrollment at a community college or institution of higher
18learning governed by the state board of regents within two
19academic years of graduation from high school or receipt of a
20high school equivalency diploma and continuously receive awards
21as a full-time or part-time student to maintain eligibility.
22The division strikes these requirements for eligible foster
23care students. The division also provides that, for purposes
24of the program, “eligible foster care student” does not include
25a person who is 26 years of age or older.
26The division applies to applications submitted under
27the program before, on, or after the effective date of the
28division.
-23-pf/rh