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House File 427 - IntroducedA Bill ForAn Act 1relating to the health and well-being of children
2and families including provisions for regional centers of
3excellence, a state-funded family medicine obstetrical
4fellowship program, self-administered hormonal
5contraceptives, maternal support and fatherhood initiatives,
6adoption expenses under the adoption subsidy program,
7and accessibility to the all Iowa scholarship program;
8making appropriations; and including effective date and
9applicability provisions.
10BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1DIVISION I
2Regional centers of excellence grant program
3 Section 1. REGIONAL CENTERS OF EXCELLENCE PROGRAM — GRANTS
4— APPROPRIATION. There is appropriated from the general fund
5of the state to the department of health and human services for
6the fiscal year beginning July 1, 2023, and ending June 30,
72024, the following amount, or so much thereof as is necessary,
8to be used for the purposes designated:
.................................................. $91,000,000
10The funds appropriated in this section shall be used for
11the continuation of a center of excellence program to award
12four grants to encourage innovation and collaboration among
13regional health care providers in a rural area based upon the
14results of a regional community needs assessment to transform
15health care delivery in order to provide quality, sustainable
16care that meets the needs of the local communities. An
17applicant for the grant funds shall specify how the funds will
18be expended to accomplish the goals of the program and shall
19provide a detailed five-year sustainability plan prior to being
20awarded any funding. Following the receipt of grant funding,
21a recipient shall submit periodic reports as specified by the
22department to the governor and the general assembly regarding
23the recipient’s expenditure of the funds and progress in
24accomplishing the program’s goals.
25DIVISION II
26state-funded family medicine obstetrics fellowship program
27 Sec. 2. NEW SECTION. 135.182 State-funded family medicine
28obstetrics fellowship program — fund.
291. The department shall establish a family medicine
30obstetrics fellowship program to increase access to family
31medicine obstetrics practitioners in rural and underserved
32areas of the state. A person who has completed an
33accreditation council for graduate medical education residency
34program in family medicine is eligible for participation
35in the fellowship program. Participating fellows shall
-1-1enter into a program agreement with a participating teaching
2hospital which, at a minimum, requires the fellow to complete a
3one-year fellowship and to engage in full-time family medicine
4obstetrics practice in a rural or underserved area of the
5state for a period of at least five years within nine months
6following completion of the fellowship and receipt of a license
7to practice medicine in the state.
82. Each fellow participating in the program shall be
9eligible for a salary and benefits including a stipend as
10determined by the participating teaching hospital which shall
11be funded through the family medicine obstetrics fellowship
12program fund.
133. The department shall adopt rules pursuant to chapter
1417A to administer the program, including defining rural and
15underserved areas for the purpose of the required full-time
16practice of a person following completion of the fellowship.
174. a. A family medicine obstetrics fellowship program
18fund is created in the state treasury consisting of the moneys
19appropriated or credited to the fund by law. Notwithstanding
20section 8.33, moneys in the fund at the end of each fiscal year
21shall not revert to any other fund but shall remain in the fund
22for use in subsequent fiscal years. Moneys in the fund are
23appropriated to the department to be used to fund fellowship
24positions as provided in this section.
25b. For the fiscal year beginning July 1, 2023, and each
26fiscal year beginning July 1 thereafter, there is appropriated
27from the general fund of the state to the family medicine
28obstetrics fellowship program fund an amount sufficient to
29support the creation of four fellowship positions as provided
30in this section.
315. The department and the participating teaching hospitals
32shall regularly evaluate and document their experiences
33including identifying ways the program may be modified or
34expanded to facilitate increased access to family medicine
35obstetrics practitioners in rural and underserved areas of the
-2-1state. The department shall submit an annual report to the
2general assembly by January 1. The report shall include the
3number of fellowships funded to date and any other information
4identified by the department and the participating teaching
5hospitals as indicators of outcomes and the effectiveness of
6the program.
76. For the purposes of this section, “teaching hospital”
8means a hospital or medical center that provides medical
9education to prospective and current health professionals.
10 Sec. 3. STATE-FUNDED FAMILY MEDICINE OBSTETRICS FELLOWSHIP
11PROGRAM AND FUND — APPROPRIATION. There is appropriated from
12the general fund of the state to the department of health and
13human services for the fiscal year beginning July 1, 2023, and
14ending June 30, 2024, the following amount, or so much thereof
15as is necessary, to be used for the purposes designated:
.................................................. $16560,000
17For deposit in the family medicine obstetrics fellowship
18program fund to be utilized in creating and providing for four
19family medicine obstetrics fellowship positions during the
20fiscal year in accordance with the family medicine obstetrics
21fellowship program created in this division of this Act.
22DIVISION III
23SELF-ADMINISTERED Hormonal contraceptives
24 Sec. 4. Section 155A.3, Code 2023, is amended by adding the
25following new subsections:
26 NEW SUBSECTION. 10A. “Department” means the department of
27health and human services.
28 NEW SUBSECTION. 45A. “Self-administered hormonal
29contraceptive” means a self-administered hormonal contraceptive
30that is approved by the United States food and drug
31administration to prevent pregnancy. “Self-administered
32hormonal contraceptive” includes an oral hormonal contraceptive,
33a hormonal vaginal ring, and a hormonal contraceptive patch,
34but does not include any drug intended to induce an abortion as
35defined in section 146.1.
-3-1 NEW SUBSECTION. 45B. “Standing order” means a preauthorized
2medication order with specific instructions from the medical
3director of the department to dispense a medication under
4clearly defined circumstances.
5 Sec. 5. NEW SECTION. 155A.49 Pharmacist dispensing of
6self-administered hormonal contraceptives — standing order —
7requirements — limitations of liability.
81. a. Notwithstanding any provision of law to the contrary,
9a pharmacist may dispense a self-administered hormonal
10contraceptive to a patient who is at least eighteen years of
11age, pursuant to a standing order established by the medical
12director of the department in accordance with this section.
13b. In dispensing a self-administered hormonal contraceptive
14to a patient under this section, a pharmacist shall comply with
15all of the following:
16(1) For an initial dispensing of a self-administered
17hormonal contraceptive, the pharmacist may dispense only up
18to a three-month supply at one time of the self-administered
19hormonal contraceptive.
20(2) For any subsequent dispensing of the same
21self-administered hormonal contraceptive, the pharmacist
22may dispense up to a twelve-month supply at one time of the
23self-administered hormonal contraceptive.
242. A pharmacist who dispenses a self-administered hormonal
25contraceptive in accordance with this section shall not
26require any other prescription drug order authorized by a
27practitioner prior to dispensing the self-administered hormonal
28contraceptive to a patient.
293. The medical director of the department may establish a
30standing order authorizing the dispensing of self-administered
31hormonal contraceptives by a pharmacist who does all of the
32following:
33a. Complies with the standing order established pursuant to
34this section.
35b. Retains a record of each patient to whom a
-4-1self-administered hormonal contraceptive is dispensed under
2this section and submits the record to the department.
34. The standing order shall require a pharmacist who
4dispenses self-administered hormonal contraceptives under this
5section to do all of the following:
6a. Complete a standardized training program and continuing
7education requirements approved by the board in consultation
8with the board of medicine and the department that are related
9to prescribing self-administered hormonal contraceptives and
10include education regarding all contraceptive methods approved
11by the United States food and drug administration.
12b. Obtain a completed self-screening risk assessment,
13approved by the department in collaboration with the board and
14the board of medicine, from each patient, verify the identity
15and age of each patient, and perform a blood pressure screening
16on each patient prior to dispensing the self-administered
17hormonal contraceptive to the patient.
18c. Provide the patient with all of the following:
19(1) Written information regarding all of the following:
20(a) The importance of completing an appointment with the
21patient’s primary care or women’s health care practitioner
22to obtain preventative care, including but not limited to
23recommended tests and screenings.
24(b) The effectiveness and availability of long-acting
25reversible contraceptives as an alternative to
26self-administered hormonal contraceptives.
27(2) A copy of the record of the pharmacist’s encounter with
28the patient that includes all of the following:
29(a) The patient’s completed self-screening risk assessment.
30(b) A description of the contraceptive dispensed, or the
31basis for not dispensing a contraceptive.
32(3) Patient counseling regarding all of the following:
33(a) The appropriate administration and storage of the
34self-administered hormonal contraceptive.
35(b) Potential side effects and risks of the
-5-1self-administered hormonal contraceptive.
2(c) The need for backup contraception.
3(d) When to seek emergency medical attention.
4(e) The risk of contracting a sexually transmitted
5infection or disease, and ways to reduce such a risk.
65. The standing order established pursuant to this section
7shall prohibit a pharmacist who dispenses a self-administered
8hormonal contraceptive under this section from doing any of the
9following:
10a. Requiring a patient to schedule an appointment with
11the pharmacist for the prescribing or dispensing of a
12self-administered hormonal contraceptive.
13b. Dispensing self-administered hormonal contraceptives
14to a patient for more than twenty-seven months after the
15date a self-administered hormonal contraceptive is initially
16dispensed to the patient, if the patient has not consulted with
17a primary care or women’s health care practitioner during the
18preceding twenty-seven months, in which case the pharmacist
19shall refer the patient to a primary care or women’s health
20care practitioner.
21c. Dispensing a self-administered hormonal contraceptive to
22a patient if the results of the self-screening risk assessment
23completed by a patient pursuant to subsection 4, paragraph
24“b”, indicate it is unsafe for the pharmacist to dispense the
25self-administered hormonal contraceptive to the patient, in
26which case the pharmacist shall refer the patient to a primary
27care or women’s health care practitioner.
286. A pharmacist who dispenses a self-administered hormonal
29contraceptive and the medical director of the department who
30establishes a standing order in compliance with this section
31shall be immune from criminal and civil liability arising
32from any damages caused by the dispensing, administering,
33or use of a self-administered hormonal contraceptive or the
34establishment of the standing order. The medical director of
35the department shall be considered to be acting within the
-6-1scope of the medical director’s office and employment for
2purposes of chapter 669 in the establishment of a standing
3order in compliance with this section.
47. The department, in collaboration with the board and
5the board of medicine, and in consideration of the guidelines
6established by the American congress of obstetricians and
7gynecologists, shall adopt rules pursuant to chapter 17A to
8administer this chapter.
9 Sec. 6. Section 514C.19, Code 2023, is amended to read as
10follows:
11514C.19 Prescription contraceptive coverage.
121. Notwithstanding the uniformity of treatment requirements
13of section 514C.6, a group policy, or contract, or plan
14 providing for third-party payment or prepayment of health or
15medical expenses shall not do either of the following comply
16as follows:
17a. Exclude Such policy, contract, or plan shall not
18exclude or restrict benefits for prescription contraceptive
19drugs or prescription contraceptive devices which prevent
20conception and which are approved by the United States
21food and drug administration, or generic equivalents
22approved as substitutable by the United States food and
23drug administration, if such policy, or contract, or plan
24 provides benefits for other outpatient prescription drugs
25or devices. However, such policy, contract, or plan shall
26specifically provide for payment of a self-administered
27hormonal contraceptive, as prescribed by a practitioner as
28defined in section 155A.3, or as prescribed by standing order
29and dispensed by a pharmacist pursuant to section 155A.49,
30including payment for up to an initial three-month supply
31of a self-administered hormonal contraceptive dispensed at
32one time and for up to a twelve-month supply of the same
33self-administered hormonal contraceptive subsequently dispensed
34at one time.
35b. Exclude Such policy, contract, or plan shall not exclude
-7-1 or restrict benefits for outpatient contraceptive services
2which are provided for the purpose of preventing conception if
3such policy, or contract, or plan provides benefits for other
4outpatient services provided by a health care professional.
52. A person who provides a group policy, or contract, or
6plan providing for third-party payment or prepayment of health
7or medical expenses which is subject to subsection 1 shall not
8do any of the following:
9a. Deny to an individual eligibility, or continued
10eligibility, to enroll in or to renew coverage under the terms
11of the policy, or contract, or plan because of the individual’s
12use or potential use of such prescription contraceptive drugs
13or devices, or use or potential use of outpatient contraceptive
14services.
15b. Provide a monetary payment or rebate to a covered
16individual to encourage such individual to accept less than the
17minimum benefits provided for under subsection 1.
18c. Penalize or otherwise reduce or limit the reimbursement
19of a health care professional because such professional
20prescribes contraceptive drugs or devices, or provides
21contraceptive services.
22d. Provide incentives, monetary or otherwise, to a health
23care professional to induce such professional to withhold
24from a covered individual contraceptive drugs or devices, or
25contraceptive services.
263. This section shall not be construed to prevent a
27third-party payor from including deductibles, coinsurance, or
28copayments under the policy, or contract, or plan as follows:
29a. A deductible, coinsurance, or copayment for benefits
30for prescription contraceptive drugs shall not be greater than
31such deductible, coinsurance, or copayment for any outpatient
32prescription drug for which coverage under the policy, or
33 contract, or plan is provided.
34b. A deductible, coinsurance, or copayment for benefits for
35prescription contraceptive devices shall not be greater than
-8-1such deductible, coinsurance, or copayment for any outpatient
2prescription device for which coverage under the policy, or
3 contract, or plan is provided.
4c. A deductible, coinsurance, or copayment for benefits for
5outpatient contraceptive services shall not be greater than
6such deductible, coinsurance, or copayment for any outpatient
7health care services for which coverage under the policy, or
8 contract, or plan is provided.
94. This section shall not be construed to require a
10third-party payor under a policy, or contract, or plan
11 to provide benefits for experimental or investigational
12contraceptive drugs or devices, or experimental or
13investigational contraceptive services, except to the extent
14that such policy, or contract, or plan provides coverage for
15other experimental or investigational outpatient prescription
16drugs or devices, or experimental or investigational outpatient
17health care services.
185. This section shall not be construed to limit or otherwise
19discourage the use of generic equivalent drugs approved by the
20United States food and drug administration, whenever available
21and appropriate. This section, when a brand name drug is
22requested by a covered individual and a suitable generic
23equivalent is available and appropriate, shall not be construed
24to prohibit a third-party payor from requiring the covered
25individual to pay a deductible, coinsurance, or copayment
26consistent with subsection 3, in addition to the difference of
27the cost of the brand name drug less the maximum covered amount
28for a generic equivalent.
296. A person who provides an individual policy, or contract,
30or plan providing for third-party payment or prepayment of
31health or medical expenses shall make available a coverage
32provision that satisfies the requirements in subsections
331 through 5 in the same manner as such requirements are
34applicable to a group policy, or contract, or plan under those
35subsections. The policy, or contract, or plan shall provide
-9-1that the individual policyholder may reject the coverage
2provision at the option of the policyholder.
37. a. This section applies to the following classes of
4third-party payment provider contracts, or policies, or plans
5 delivered, issued for delivery, continued, or renewed in this
6state on or after July 1, 2000 January 1, 2024:
7(1) Individual or group accident and sickness insurance
8providing coverage on an expense-incurred basis.
9(2) An individual or group hospital or medical service
10contract issued pursuant to chapter 509, 514, or 514A.
11(3) An individual or group health maintenance organization
12contract regulated under chapter 514B.
13(4) Any other entity engaged in the business of insurance,
14risk transfer, or risk retention, which is subject to the
15jurisdiction of the commissioner.
16(5) A plan established pursuant to chapter 509A for public
17employees.
18b. This section shall not apply to accident-only,
19specified disease, short-term hospital or medical, hospital
20confinement indemnity, credit, dental, vision, Medicare
21supplement, long-term care, basic hospital and medical-surgical
22expense coverage as defined by the commissioner, disability
23income insurance coverage, coverage issued as a supplement
24to liability insurance, workers’ compensation or similar
25insurance, or automobile medical payment insurance.
268. This section shall not be construed to require a
27third-party payor to provide payment to a practitioner for the
28dispensing of a self-administered hormonal contraceptive to
29replace a self-administered hormonal contraceptive that has
30been dispensed to a covered person and that has been misplaced,
31stolen, or destroyed. This section shall not be construed to
32require a third-party payor to replace covered prescriptions
33that are misplaced, stolen, or destroyed.
349. For the purposes of this section, “self-administered
35hormonal contraceptive” and “standing order” mean the same as
-10-1defined in section 155A.3.
2 Sec. 7. INFORMATION PROGRAM FOR DRUG PRESCRIBING AND
3DISPENSING — SELF-ADMINISTERED HORMONAL CONTRACEPTIVES. The
4board of pharmacy in collaboration with the board of medicine
5and the department of health and human services shall expand
6the information program for drug prescribing and dispensing
7established pursuant to section 124.551, to collect from
8pharmacists information relating to the dispensing of
9self-administered hormonal contraceptives as provided pursuant
10to section 155A.49. The board of pharmacy shall adopt
11rules pursuant to chapter 17A related to registration of
12participating pharmacists, the information to be reported by a
13pharmacist to the information program, access to information
14from the program, and other rules necessary to carry out the
15purposes and to enforce the provisions of this section.
16 Sec. 8. APPLICATION TO MEDICAID PROGRAM. This division
17of this Act shall apply to the Medicaid program including a
18managed care organization acting pursuant to a contract with
19the department of health and human services to administer
20the Medicaid program under chapter 249A. However, if it is
21determined that any provision of this division of this Act
22would cause denial of federal funds under Tit.XVIII or XIX
23of the federal Social Security Act, or would otherwise be
24inconsistent or conflict with the requirements of federal law
25or regulation, such provision shall be suspended, but only to
26the extent necessary to prevent denial of such funds or to
27eliminate the inconsistency or conflict with the requirements
28of federal law or regulation.
29DIVISION IV
30More options for maternal support (MOMS) program — fatherhood
31initiatives
32 Sec. 9. Section 217.41C, subsection 1, paragraph c, Code
332023, is amended to read as follows:
34c. For the purposes of this section, “pregnancy support
35services” means those nonmedical services that promote
-11-1childbirth by providing information, counseling, and support
2services that assist pregnant women or women who believe they
3may be pregnant and men who are involved or who think they
4might be involved in a pregnancy to choose childbirth and to
5make informed decisions regarding the choice of adoption or
6parenting with respect to their children.
7 Sec. 10. Section 217.41C, Code 2023, is amended by adding
8the following new subsections:
9 NEW SUBSECTION. 8. The department shall develop and
10maintain a virtual clearinghouse of pregnancy support
11services and resources including but not limited to all of the
12following:
13a. Pregnancy resource center and maternity home information
14including contact information, location, and services provided.
15b. Assistance in accessing public assistance including but
16not limited to the special supplemental nutrition program for
17women, infants, and children and the supplemental nutrition
18assistance program.
19c. Educational resources.
20d. Housing assistance.
21e. Recovery and mental health services.
22f. Family planning education.
23g. Adoption and foster care information and services.
24h. Healing and support services for abortion survivors and
25their families.
26 NEW SUBSECTION. 9. Beginning July 1, 2023, and thereafter,
27funding for the program may be used for all of the following
28purposes:
29a. Fatherhood engagement grants. The department may
30award grants to nonprofit, community-based organizations to
31address the needs of fathers by assisting fathers in finding
32employment, managing child support obligations, transitioning
33from a period of incarceration, accessing health care,
34understanding child development, and enhancing parenting skills
35using evidence-based parenting education. Priority in the
-12-1awarding of grants shall be based on the demonstrated need
2in a geographic area and the prevalence of the population to
3be served as indicated by factors including but not limited
4to the service area’s unemployment rate, incarceration rate,
5number of public assistance recipients, number of single-parent
6households, level of housing instability, and graduation rates.
7b. Fatherhood communications initiative. The department
8shall administer a communications initiative on responsible
9fatherhood including but not limited to a public internet site
10that provides access to resources on effective parenting and
11assistance in receiving parenting support and services.
12c. Mentoring school-aged males grant program. The
13department may award three-year renewable grants to nonprofit
14organizations that provide mentorship, social and academic
15support, and life skills development to school-aged males.
16Priority in the awarding of grants shall be based on the
17demonstrated need in a geographic area and the prevalence of
18the population to be served as indicated by factors including
19but not limited to the service area’s unemployment rate,
20incarceration rate, number of public assistance recipients,
21number of single-parent households, level of housing
22instability, and graduation rates. The department shall
23provide technical assistance to grantees to ensure program
24sustainability following the end of the three-year grant
25period.
26 Sec. 11. MORE OPTIONS FOR MATERNAL SUPPORT PROGRAM —
27APPROPRIATION. There is appropriated from the general fund of
28the state to the department of health and human services for
29the fiscal year beginning July 1, 2023, and ending June 30,
302024, the following amount, or so much thereof as is necessary,
31to be used for the purposes designated:
.................................................. $322,000,000
33To be used for the purposes of the more options for maternal
34support program created in section 217.41C, including for
35program administration, the provision of services, and for
-13-1funding of fatherhood engagement grants, the fatherhood
2communications initiative, and the mentoring school-aged males
3grant program.
4 Sec. 12. 2022 Iowa Acts, chapter 1131, section 28,
5subsection 8, is amended to read as follows:
68. Of the funds appropriated under this section, $500,000
7shall be used for the purposes of program administration and
8provision of pregnancy support services through the more
9options for maternal support program created in this Act.
10Notwithstanding section 8.33, moneys appropriated in this
11subsection that remain unencumbered or unobligated at the close
12of the fiscal year shall not revert but shall remain available
13for the purposes designated until the close of the succeeding
14fiscal year.
15 Sec. 13. EFFECTIVE DATE. The following, being deemed of
16immediate importance, takes effect upon enactment:
17The section of this division of this Act amending 2022 Iowa
18Acts, chapter 1131, section 28, subsection 8.
19DIVISION V
20Nonrecurring ADOPTION EXPENSES — adoption subsidy program
21 Sec. 14. NEW SECTION. 234.48 Adoption subsidy —
22nonrecurring adoption expenses.
23Notwithstanding any provision to the contrary, the maximum
24reimbursement provided to an adoptive parent under the
25adoption subsidy program for nonrecurring adoption expenses
26is one thousand dollars. For the purposes of this section,
27“nonrecurring adoption expenses” means the same as defined in 45
28C.F.R. §1356.41. The department shall adopt rules pursuant to
29chapter 17A to administer this section.
30 Sec. 15. REPEAL. 2010 Iowa Acts, chapter 1031, section 408,
31is repealed.
32DIVISION VI
33All Iowa opportunity scholarship PROGRAM
34 Sec. 16. Section 261.87, subsection 1, paragraph b,
35unnumbered paragraph 1, Code 2023, is amended to read as
-14-1follows:
2“Eligible foster care student” means a person under
3twenty-six years of age who has a high school diploma or a high
4school equivalency diploma under chapter 259A and is described
5by any of the following:
6 Sec. 17. Section 261.87, subsection 2, paragraph f, Code
72023, is amended to read as follows:
8f. (1) Begins Except as provided in subparagraph (2),
9begins enrollment at an eligible institution within two
10academic years of graduation from high school or receipt of
11a high school equivalency diploma under chapter 259A and
12continuously receives awards as a full-time or part-time
13student to maintain eligibility. However, the student may
14defer or suspend participation in the program for up to two
15years in order to pursue obligations that meet conditions
16established by the commission by rule or to fulfill military
17obligations.
18(2) The requirements of subparagraph (1) do not apply to an
19eligible foster care student.
20 Sec. 18. APPLICABILITY. This division of this Act applies
21to applications submitted under the all Iowa opportunity
22scholarship program established pursuant to section 261.87
23before, on, or after the effective date of this division of
24this Act.
25EXPLANATION
26The inclusion of this explanation does not constitute agreement with
27the explanation’s substance by the members of the general assembly.
28This bill relates to the health and well-being of children
29and families. The bill is constructed in divisions.
30DIVISION I — REGIONAL CENTERS OF EXCELLENCE GRANT PROGRAM.
31 This division appropriates $1 million from the general fund
32of the state to the department of health and human services
33(HHS) for fiscal year 2023-2024 for continuation of a regional
34center of excellence program to award four grants to encourage
35innovation and collaboration among regional health care
-15-1providers in a rural area based upon the results of a regional
2community needs assessment to transform health care delivery in
3order to provide quality, sustainable care that meets the needs
4of the local communities. An applicant for the grant funds
5shall specify how the funds will be expended to accomplish the
6goals of the program and shall provide a detailed five-year
7sustainability plan prior to being awarded any funding.
8Following the receipt of grant funding, a recipient shall
9submit periodic reports as specified by HHS to the governor and
10the general assembly regarding the recipient’s expenditure of
11the funds and progress in accomplishing the program goals.
12DIVISION II — STATE-FUNDED FAMILY MEDICINE OBSTETRICS
13FELLOWSHIP PROGRAM AND FUND. This division requires HHS to
14establish a family medicine obstetrics fellowship program to
15increase access to family medicine obstetrics practitioners
16in rural and underserved areas of the state. A person who
17has completed an accreditation council for graduate medical
18education residency program in family medicine is eligible for
19participation in the fellowship program. Participating fellows
20shall enter into a program agreement with a participating
21teaching hospital which, at a minimum, requires the fellow
22to complete a one-year fellowship and to engage in full-time
23family medicine obstetrics practice in a rural or underserved
24area of the state for a period of at least five years within
25nine months following completion of the fellowship and receipt
26of a license to practice medicine in the state. Each fellow
27participating in the program shall be eligible for salary and
28benefits including a stipend as determined by the participating
29teaching hospital and funded through the family medicine
30obstetrics fellowship program fund.
31The division requires HHS to adopt administrative rules
32to administer the program, including defining rural and
33underserved areas for the purpose of the required full-time
34practice of a person following completion of the fellowship.
35The division creates a family medicine obstetrics fellowship
-16-1program fund in the state treasury consisting of the moneys
2appropriated or credited to the fund by law. Moneys in the
3fund at the end of each fiscal year shall not revert to any
4other fund but shall remain in the fund for use in subsequent
5fiscal years. Moneys in the fund are appropriated to HHS
6to be used to fund fellowship positions as provided in the
7division. The division appropriates a sufficient amount from
8the general fund of the state to the fund annually to support
9the creation of four fellowship positions. The division
10provides an appropriation for deposit in the fund for fiscal
11year 2023-2024.
12The division requires HHS and the participating teaching
13hospitals to regularly evaluate and document their experiences
14including identifying ways the program may be modified or
15expanded to facilitate increased access to family medicine
16obstetrics practitioners in rural and underserved areas of the
17state. The department shall submit an annual report to the
18general assembly by January 1. The report shall include the
19number of fellowships funded to date and any other information
20identified by HHS and the participating teaching hospitals as
21indicators of outcomes and the effectiveness of the program.
22DIVISION III — SELF-ADMINISTERED HORMONAL CONTRACEPTIVES.
23 This division relates to the dispensing of self-administered
24hormonal contraceptives by a pharmacist. The division
25defines “self-administered hormonal contraceptive” as a
26self-administered hormonal contraceptive that is approved by
27the United States food and drug administration to prevent
28pregnancy, including an oral hormonal contraceptive, a hormonal
29vaginal ring, and a hormonal contraceptive patch, but not
30including any drug intended to induce an abortion.
31The division provides that notwithstanding any provision
32of law to the contrary, a pharmacist may dispense a
33self-administered hormonal contraceptive to a patient who
34is at least 18 years of age pursuant to a standing order
35established by the medical director of HHS (medical director).
-17-1For an initial dispensing, a pharmacist may dispense only up
2to a three-month supply at one time of the self-administered
3hormonal contraceptive, and for any subsequent dispensing
4of the same self-administered hormonal contraceptive, a
512-month supply at one time. Additionally, the division
6prohibits a pharmacist who dispenses a self-administered
7hormonal contraceptive in accordance with the division from
8requiring any other prescription drug order authorized by a
9practitioner prior to dispensing the self-administered hormonal
10contraceptive.
11The division authorizes the medical director to establish a
12standing order authorizing the dispensing of self-administered
13hormonal contraceptives by any pharmacist who complies with the
14standing order and retains and submits the patient’s record to
15HHS.
16The standing order includes requiring a pharmacist who
17dispenses a self-administered hormonal contraceptive under the
18division to: complete a standardized training program and
19continuing education requirements related to prescribing the
20hormonal contraceptives; obtain a completed self-screening risk
21assessment from each patient, verify the identity and age of
22each patient, and perform a blood pressure screening on each
23patient before dispensing the hormonal contraceptives; provide
24the patient with certain written information; provide the
25patient with a copy of the record of the pharmacist’s encounter
26with the patient; and provide patient counseling.
27The standing order would prohibit a pharmacist who dispenses
28hormonal contraceptives under the division from requiring a
29patient to schedule an appointment with the pharmacist for
30the prescribing or dispensing of the hormonal contraceptive;
31dispensing the hormonal contraceptives to a patient for more
32than 27 months after the date initially dispensed without the
33patient’s attestation that the patient has consulted with a
34practitioner during the preceding 27 months; and dispensing
35the hormonal contraceptives to a patient if the results of the
-18-1patient’s self-screening risk assessment indicate it is unsafe
2for the pharmacist to dispense the hormonal contraceptives
3to the patient, in which case the pharmacist shall refer the
4patient to a practitioner.
5The division provides immunity for a pharmacist who
6dispenses a self-administered hormonal contraceptive and
7for the medical director who establishes a standing order
8in compliance with the division from criminal and civil
9liability arising from any damages caused by the dispensing,
10administering, or use of a self-administered hormonal
11contraceptive or the establishment of the standing order.
12Additionally, the medical director shall be considered to be
13acting within the scope of the medical director’s office and
14employment for purposes of Code chapter 669 (Iowa tort claims
15Act) in the establishment of a standing order in compliance
16with the division.
17The division requires HHS, in collaboration with the
18boards of pharmacy and medicine, and in consideration of
19the guidelines established by the American congress of
20obstetricians and gynecologists, to adopt administrative rules
21to administer the provisions of the division.
22The division amends prescription contraceptive coverage
23provisions to require that a group policy, contract, or plan
24delivered, issued for delivery, continued, or renewed in the
25state on or after January 1, 2024, providing for third-party
26payment or prepayment of health or medical expenses, shall
27specifically provide for payment of self-administered hormonal
28contraceptives, prescribed and dispensed as specified in the
29division, including those dispensed at one time. The division
30provides, however, that the provisions relating to coverage are
31not to be construed to require a third-party payor to provide
32payment to a practitioner for dispensing a self-administered
33hormonal contraceptive to replace a self-administered
34hormonal contraceptive that has been dispensed to a covered
35person and that has been misplaced, stolen, or destroyed.
-19-1These provisions are also not to be construed to require a
2third-party payor to replace covered prescriptions that are
3misplaced, stolen, or destroyed.
4The division also requires the board of pharmacy in
5collaboration with the board of medicine and HHS to expand
6the information program for drug prescribing to collect
7from pharmacists information relating to the dispensing of
8self-administered hormonal contraceptives as provided in the
9division.
10The division applies to the Medicaid program as specified in
11the bill.
12DIVISION IV — MORE OPTIONS FOR MATERNAL SUPPORT (MOMS)
13PROGRAM — FATHERHOOD INITIATIVES. This division relates to
14the more options for maternal support (MOMS) program. The
15bill adds as part of the definition of “pregnancy support
16services” services to men who are involved or think they might
17be involved in a pregnancy. As part of the MOMS program,
18the division requires HHS to develop and maintain a virtual
19clearinghouse of pregnancy support services and resources. The
20services and resources include but are not limited to pregnancy
21resource center and maternity home information; assistance in
22accessing public assistance including but not limited to the
23special supplemental nutrition program for women, infants, and
24children program and the supplemental nutrition assistance
25program; educational resources; housing assistance; recovery
26and mental health services; family planning education; adoption
27and foster care information and services; and healing and
28support services for abortion survivors and their families.
29As part of the MOMS program, beginning July 1, 2023, and
30thereafter, funding for the program may be used for fatherhood
31engagement grants to nonprofit, community-based organizations
32to address the needs of fathers by assisting fathers in
33finding employment, managing child support obligations,
34transitioning from a period of incarceration, accessing health
35care, understanding child development, and enhancing parenting
-20-1skills using evidence-based parenting education; a fatherhood
2communications initiative administered by HHS, including but
3not limited to a public internet site that provides access to
4resources on effective parenting and assistance in receiving
5parenting support and services; and a mentoring school-aged
6males grant program to provide mentorship, social and academic
7support, and life skills development to school-aged males.
8The division also appropriates $2 million from the general
9fund of the state to HHS for fiscal year 2023-2024 to be used
10for the MOMS program including for program administration, the
11provision of services, and for funding of fatherhood engagement
12grants, the fatherhood communications initiative, and the
13mentoring school-aged males grant program.
14The division provides that the funding appropriated for the
15MOMS program for fiscal year 2022-2023 is not to revert, but
16is to remain available for the MOMS program for fiscal year
172023-2024. This provision takes effect upon enactment.
18DIVISION V — NONRECURRING ADOPTION EXPENSES — ADOPTION
19SUBSIDY PROGRAM. This division provides that the maximum
20reimbursement provided to an adoptive parent under the adoption
21subsidy program for nonrecurring adoption expenses is $1,000.
22The division defines “nonrecurring adoption expenses” as the
23reasonable and necessary adoption fees, court costs, attorney
24fees, and other expenses which are directly related to the
25legal adoption of a child with special needs which are not
26incurred in violation of state, tribal, or federal law, and
27which have not been reimbursed from other sources or other
28funds. Under federal regulation, “other expenses which
29are directly related to the legal adoption of a child with
30special needs” means the costs of the adoption incurred by
31or on behalf of the parents and for which parents carry the
32ultimate liability for payment. Such costs may include the
33adoption study, including health and psychological examination,
34supervision of the placement prior to adoption, transportation,
35and the reasonable costs of lodging and food for the child or
-21-1the adoptive parents when necessary to complete the placement
2or adoption process. The department of health and human
3services shall adopt administrative rules to administer the
4division. The division also repeals a provision in 2010 Iowa
5Acts which limited the nonrecurring adoption expenses to $500
6and prohibited additional amounts for court costs and other
7related legal expenses.
8DIVISION VI — ALL IOWA OPPORTUNITY SCHOLARSHIP PROGRAM.
9 This division relates to the all Iowa opportunity scholarship
10program (program), which provides scholarships to Iowa
11students who graduate from high school or receive a high
12school equivalency diploma to help such students attend a
13community college in this state or an institution of higher
14learning governed by the state board of regents. The program
15prioritizes awarding scholarships to certain students,
16including eligible foster care students. Eligible foster care
17students are students who age out of Iowa’s foster care system,
18age out of the state training school, or are adopted from
19Iowa’s foster care system after reaching 16 years of age.
20Current law requires that, in order to be eligible to
21receive a scholarship under the program, the student must begin
22enrollment at a community college or institution of higher
23learning governed by the state board of regents within two
24academic years of graduation from high school or receipt of a
25high school equivalency diploma and continuously receive awards
26as a full-time or part-time student to maintain eligibility.
27The division strikes these requirements for eligible foster
28care students. The division also provides that, for purposes
29of the program, “eligible foster care student” does not include
30a person who is 26 years of age or older.
31The division applies to applications submitted under
32the program before, on, or after the effective date of the
33division.
-22-pf/rh
2and families including provisions for regional centers of
3excellence, a state-funded family medicine obstetrical
4fellowship program, self-administered hormonal
5contraceptives, maternal support and fatherhood initiatives,
6adoption expenses under the adoption subsidy program,
7and accessibility to the all Iowa scholarship program;
8making appropriations; and including effective date and
9applicability provisions.
10BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1DIVISION I
2Regional centers of excellence grant program
3 Section 1. REGIONAL CENTERS OF EXCELLENCE PROGRAM — GRANTS
4— APPROPRIATION. There is appropriated from the general fund
5of the state to the department of health and human services for
6the fiscal year beginning July 1, 2023, and ending June 30,
72024, the following amount, or so much thereof as is necessary,
8to be used for the purposes designated:
.................................................. $91,000,000
10The funds appropriated in this section shall be used for
11the continuation of a center of excellence program to award
12four grants to encourage innovation and collaboration among
13regional health care providers in a rural area based upon the
14results of a regional community needs assessment to transform
15health care delivery in order to provide quality, sustainable
16care that meets the needs of the local communities. An
17applicant for the grant funds shall specify how the funds will
18be expended to accomplish the goals of the program and shall
19provide a detailed five-year sustainability plan prior to being
20awarded any funding. Following the receipt of grant funding,
21a recipient shall submit periodic reports as specified by the
22department to the governor and the general assembly regarding
23the recipient’s expenditure of the funds and progress in
24accomplishing the program’s goals.
25DIVISION II
26state-funded family medicine obstetrics fellowship program
27 Sec. 2. NEW SECTION. 135.182 State-funded family medicine
28obstetrics fellowship program — fund.
291. The department shall establish a family medicine
30obstetrics fellowship program to increase access to family
31medicine obstetrics practitioners in rural and underserved
32areas of the state. A person who has completed an
33accreditation council for graduate medical education residency
34program in family medicine is eligible for participation
35in the fellowship program. Participating fellows shall
-1-1enter into a program agreement with a participating teaching
2hospital which, at a minimum, requires the fellow to complete a
3one-year fellowship and to engage in full-time family medicine
4obstetrics practice in a rural or underserved area of the
5state for a period of at least five years within nine months
6following completion of the fellowship and receipt of a license
7to practice medicine in the state.
82. Each fellow participating in the program shall be
9eligible for a salary and benefits including a stipend as
10determined by the participating teaching hospital which shall
11be funded through the family medicine obstetrics fellowship
12program fund.
133. The department shall adopt rules pursuant to chapter
1417A to administer the program, including defining rural and
15underserved areas for the purpose of the required full-time
16practice of a person following completion of the fellowship.
174. a. A family medicine obstetrics fellowship program
18fund is created in the state treasury consisting of the moneys
19appropriated or credited to the fund by law. Notwithstanding
20section 8.33, moneys in the fund at the end of each fiscal year
21shall not revert to any other fund but shall remain in the fund
22for use in subsequent fiscal years. Moneys in the fund are
23appropriated to the department to be used to fund fellowship
24positions as provided in this section.
25b. For the fiscal year beginning July 1, 2023, and each
26fiscal year beginning July 1 thereafter, there is appropriated
27from the general fund of the state to the family medicine
28obstetrics fellowship program fund an amount sufficient to
29support the creation of four fellowship positions as provided
30in this section.
315. The department and the participating teaching hospitals
32shall regularly evaluate and document their experiences
33including identifying ways the program may be modified or
34expanded to facilitate increased access to family medicine
35obstetrics practitioners in rural and underserved areas of the
-2-1state. The department shall submit an annual report to the
2general assembly by January 1. The report shall include the
3number of fellowships funded to date and any other information
4identified by the department and the participating teaching
5hospitals as indicators of outcomes and the effectiveness of
6the program.
76. For the purposes of this section, “teaching hospital”
8means a hospital or medical center that provides medical
9education to prospective and current health professionals.
10 Sec. 3. STATE-FUNDED FAMILY MEDICINE OBSTETRICS FELLOWSHIP
11PROGRAM AND FUND — APPROPRIATION. There is appropriated from
12the general fund of the state to the department of health and
13human services for the fiscal year beginning July 1, 2023, and
14ending June 30, 2024, the following amount, or so much thereof
15as is necessary, to be used for the purposes designated:
.................................................. $16560,000
17For deposit in the family medicine obstetrics fellowship
18program fund to be utilized in creating and providing for four
19family medicine obstetrics fellowship positions during the
20fiscal year in accordance with the family medicine obstetrics
21fellowship program created in this division of this Act.
22DIVISION III
23SELF-ADMINISTERED Hormonal contraceptives
24 Sec. 4. Section 155A.3, Code 2023, is amended by adding the
25following new subsections:
26 NEW SUBSECTION. 10A. “Department” means the department of
27health and human services.
28 NEW SUBSECTION. 45A. “Self-administered hormonal
29contraceptive” means a self-administered hormonal contraceptive
30that is approved by the United States food and drug
31administration to prevent pregnancy. “Self-administered
32hormonal contraceptive” includes an oral hormonal contraceptive,
33a hormonal vaginal ring, and a hormonal contraceptive patch,
34but does not include any drug intended to induce an abortion as
35defined in section 146.1.
-3-1 NEW SUBSECTION. 45B. “Standing order” means a preauthorized
2medication order with specific instructions from the medical
3director of the department to dispense a medication under
4clearly defined circumstances.
5 Sec. 5. NEW SECTION. 155A.49 Pharmacist dispensing of
6self-administered hormonal contraceptives — standing order —
7requirements — limitations of liability.
81. a. Notwithstanding any provision of law to the contrary,
9a pharmacist may dispense a self-administered hormonal
10contraceptive to a patient who is at least eighteen years of
11age, pursuant to a standing order established by the medical
12director of the department in accordance with this section.
13b. In dispensing a self-administered hormonal contraceptive
14to a patient under this section, a pharmacist shall comply with
15all of the following:
16(1) For an initial dispensing of a self-administered
17hormonal contraceptive, the pharmacist may dispense only up
18to a three-month supply at one time of the self-administered
19hormonal contraceptive.
20(2) For any subsequent dispensing of the same
21self-administered hormonal contraceptive, the pharmacist
22may dispense up to a twelve-month supply at one time of the
23self-administered hormonal contraceptive.
242. A pharmacist who dispenses a self-administered hormonal
25contraceptive in accordance with this section shall not
26require any other prescription drug order authorized by a
27practitioner prior to dispensing the self-administered hormonal
28contraceptive to a patient.
293. The medical director of the department may establish a
30standing order authorizing the dispensing of self-administered
31hormonal contraceptives by a pharmacist who does all of the
32following:
33a. Complies with the standing order established pursuant to
34this section.
35b. Retains a record of each patient to whom a
-4-1self-administered hormonal contraceptive is dispensed under
2this section and submits the record to the department.
34. The standing order shall require a pharmacist who
4dispenses self-administered hormonal contraceptives under this
5section to do all of the following:
6a. Complete a standardized training program and continuing
7education requirements approved by the board in consultation
8with the board of medicine and the department that are related
9to prescribing self-administered hormonal contraceptives and
10include education regarding all contraceptive methods approved
11by the United States food and drug administration.
12b. Obtain a completed self-screening risk assessment,
13approved by the department in collaboration with the board and
14the board of medicine, from each patient, verify the identity
15and age of each patient, and perform a blood pressure screening
16on each patient prior to dispensing the self-administered
17hormonal contraceptive to the patient.
18c. Provide the patient with all of the following:
19(1) Written information regarding all of the following:
20(a) The importance of completing an appointment with the
21patient’s primary care or women’s health care practitioner
22to obtain preventative care, including but not limited to
23recommended tests and screenings.
24(b) The effectiveness and availability of long-acting
25reversible contraceptives as an alternative to
26self-administered hormonal contraceptives.
27(2) A copy of the record of the pharmacist’s encounter with
28the patient that includes all of the following:
29(a) The patient’s completed self-screening risk assessment.
30(b) A description of the contraceptive dispensed, or the
31basis for not dispensing a contraceptive.
32(3) Patient counseling regarding all of the following:
33(a) The appropriate administration and storage of the
34self-administered hormonal contraceptive.
35(b) Potential side effects and risks of the
-5-1self-administered hormonal contraceptive.
2(c) The need for backup contraception.
3(d) When to seek emergency medical attention.
4(e) The risk of contracting a sexually transmitted
5infection or disease, and ways to reduce such a risk.
65. The standing order established pursuant to this section
7shall prohibit a pharmacist who dispenses a self-administered
8hormonal contraceptive under this section from doing any of the
9following:
10a. Requiring a patient to schedule an appointment with
11the pharmacist for the prescribing or dispensing of a
12self-administered hormonal contraceptive.
13b. Dispensing self-administered hormonal contraceptives
14to a patient for more than twenty-seven months after the
15date a self-administered hormonal contraceptive is initially
16dispensed to the patient, if the patient has not consulted with
17a primary care or women’s health care practitioner during the
18preceding twenty-seven months, in which case the pharmacist
19shall refer the patient to a primary care or women’s health
20care practitioner.
21c. Dispensing a self-administered hormonal contraceptive to
22a patient if the results of the self-screening risk assessment
23completed by a patient pursuant to subsection 4, paragraph
24“b”, indicate it is unsafe for the pharmacist to dispense the
25self-administered hormonal contraceptive to the patient, in
26which case the pharmacist shall refer the patient to a primary
27care or women’s health care practitioner.
286. A pharmacist who dispenses a self-administered hormonal
29contraceptive and the medical director of the department who
30establishes a standing order in compliance with this section
31shall be immune from criminal and civil liability arising
32from any damages caused by the dispensing, administering,
33or use of a self-administered hormonal contraceptive or the
34establishment of the standing order. The medical director of
35the department shall be considered to be acting within the
-6-1scope of the medical director’s office and employment for
2purposes of chapter 669 in the establishment of a standing
3order in compliance with this section.
47. The department, in collaboration with the board and
5the board of medicine, and in consideration of the guidelines
6established by the American congress of obstetricians and
7gynecologists, shall adopt rules pursuant to chapter 17A to
8administer this chapter.
9 Sec. 6. Section 514C.19, Code 2023, is amended to read as
10follows:
11514C.19 Prescription contraceptive coverage.
121. Notwithstanding the uniformity of treatment requirements
13of section 514C.6, a group policy, or contract, or plan
14 providing for third-party payment or prepayment of health or
15medical expenses shall not do either of the following comply
16as follows:
17a. Exclude Such policy, contract, or plan shall not
18exclude or restrict benefits for prescription contraceptive
19drugs or prescription contraceptive devices which prevent
20conception and which are approved by the United States
21food and drug administration, or generic equivalents
22approved as substitutable by the United States food and
23drug administration, if such policy, or contract, or plan
24 provides benefits for other outpatient prescription drugs
25or devices. However, such policy, contract, or plan shall
26specifically provide for payment of a self-administered
27hormonal contraceptive, as prescribed by a practitioner as
28defined in section 155A.3, or as prescribed by standing order
29and dispensed by a pharmacist pursuant to section 155A.49,
30including payment for up to an initial three-month supply
31of a self-administered hormonal contraceptive dispensed at
32one time and for up to a twelve-month supply of the same
33self-administered hormonal contraceptive subsequently dispensed
34at one time.
35b. Exclude Such policy, contract, or plan shall not exclude
-7-1 or restrict benefits for outpatient contraceptive services
2which are provided for the purpose of preventing conception if
3such policy, or contract, or plan provides benefits for other
4outpatient services provided by a health care professional.
52. A person who provides a group policy, or contract, or
6plan providing for third-party payment or prepayment of health
7or medical expenses which is subject to subsection 1 shall not
8do any of the following:
9a. Deny to an individual eligibility, or continued
10eligibility, to enroll in or to renew coverage under the terms
11of the policy, or contract, or plan because of the individual’s
12use or potential use of such prescription contraceptive drugs
13or devices, or use or potential use of outpatient contraceptive
14services.
15b. Provide a monetary payment or rebate to a covered
16individual to encourage such individual to accept less than the
17minimum benefits provided for under subsection 1.
18c. Penalize or otherwise reduce or limit the reimbursement
19of a health care professional because such professional
20prescribes contraceptive drugs or devices, or provides
21contraceptive services.
22d. Provide incentives, monetary or otherwise, to a health
23care professional to induce such professional to withhold
24from a covered individual contraceptive drugs or devices, or
25contraceptive services.
263. This section shall not be construed to prevent a
27third-party payor from including deductibles, coinsurance, or
28copayments under the policy, or contract, or plan as follows:
29a. A deductible, coinsurance, or copayment for benefits
30for prescription contraceptive drugs shall not be greater than
31such deductible, coinsurance, or copayment for any outpatient
32prescription drug for which coverage under the policy, or
33 contract, or plan is provided.
34b. A deductible, coinsurance, or copayment for benefits for
35prescription contraceptive devices shall not be greater than
-8-1such deductible, coinsurance, or copayment for any outpatient
2prescription device for which coverage under the policy, or
3 contract, or plan is provided.
4c. A deductible, coinsurance, or copayment for benefits for
5outpatient contraceptive services shall not be greater than
6such deductible, coinsurance, or copayment for any outpatient
7health care services for which coverage under the policy, or
8 contract, or plan is provided.
94. This section shall not be construed to require a
10third-party payor under a policy, or contract, or plan
11 to provide benefits for experimental or investigational
12contraceptive drugs or devices, or experimental or
13investigational contraceptive services, except to the extent
14that such policy, or contract, or plan provides coverage for
15other experimental or investigational outpatient prescription
16drugs or devices, or experimental or investigational outpatient
17health care services.
185. This section shall not be construed to limit or otherwise
19discourage the use of generic equivalent drugs approved by the
20United States food and drug administration, whenever available
21and appropriate. This section, when a brand name drug is
22requested by a covered individual and a suitable generic
23equivalent is available and appropriate, shall not be construed
24to prohibit a third-party payor from requiring the covered
25individual to pay a deductible, coinsurance, or copayment
26consistent with subsection 3, in addition to the difference of
27the cost of the brand name drug less the maximum covered amount
28for a generic equivalent.
296. A person who provides an individual policy, or contract,
30or plan providing for third-party payment or prepayment of
31health or medical expenses shall make available a coverage
32provision that satisfies the requirements in subsections
331 through 5 in the same manner as such requirements are
34applicable to a group policy, or contract, or plan under those
35subsections. The policy, or contract, or plan shall provide
-9-1that the individual policyholder may reject the coverage
2provision at the option of the policyholder.
37. a. This section applies to the following classes of
4third-party payment provider contracts, or policies, or plans
5 delivered, issued for delivery, continued, or renewed in this
6state on or after July 1, 2000 January 1, 2024:
7(1) Individual or group accident and sickness insurance
8providing coverage on an expense-incurred basis.
9(2) An individual or group hospital or medical service
10contract issued pursuant to chapter 509, 514, or 514A.
11(3) An individual or group health maintenance organization
12contract regulated under chapter 514B.
13(4) Any other entity engaged in the business of insurance,
14risk transfer, or risk retention, which is subject to the
15jurisdiction of the commissioner.
16(5) A plan established pursuant to chapter 509A for public
17employees.
18b. This section shall not apply to accident-only,
19specified disease, short-term hospital or medical, hospital
20confinement indemnity, credit, dental, vision, Medicare
21supplement, long-term care, basic hospital and medical-surgical
22expense coverage as defined by the commissioner, disability
23income insurance coverage, coverage issued as a supplement
24to liability insurance, workers’ compensation or similar
25insurance, or automobile medical payment insurance.
268. This section shall not be construed to require a
27third-party payor to provide payment to a practitioner for the
28dispensing of a self-administered hormonal contraceptive to
29replace a self-administered hormonal contraceptive that has
30been dispensed to a covered person and that has been misplaced,
31stolen, or destroyed. This section shall not be construed to
32require a third-party payor to replace covered prescriptions
33that are misplaced, stolen, or destroyed.
349. For the purposes of this section, “self-administered
35hormonal contraceptive” and “standing order” mean the same as
-10-1defined in section 155A.3.
2 Sec. 7. INFORMATION PROGRAM FOR DRUG PRESCRIBING AND
3DISPENSING — SELF-ADMINISTERED HORMONAL CONTRACEPTIVES. The
4board of pharmacy in collaboration with the board of medicine
5and the department of health and human services shall expand
6the information program for drug prescribing and dispensing
7established pursuant to section 124.551, to collect from
8pharmacists information relating to the dispensing of
9self-administered hormonal contraceptives as provided pursuant
10to section 155A.49. The board of pharmacy shall adopt
11rules pursuant to chapter 17A related to registration of
12participating pharmacists, the information to be reported by a
13pharmacist to the information program, access to information
14from the program, and other rules necessary to carry out the
15purposes and to enforce the provisions of this section.
16 Sec. 8. APPLICATION TO MEDICAID PROGRAM. This division
17of this Act shall apply to the Medicaid program including a
18managed care organization acting pursuant to a contract with
19the department of health and human services to administer
20the Medicaid program under chapter 249A. However, if it is
21determined that any provision of this division of this Act
22would cause denial of federal funds under Tit.XVIII or XIX
23of the federal Social Security Act, or would otherwise be
24inconsistent or conflict with the requirements of federal law
25or regulation, such provision shall be suspended, but only to
26the extent necessary to prevent denial of such funds or to
27eliminate the inconsistency or conflict with the requirements
28of federal law or regulation.
29DIVISION IV
30More options for maternal support (MOMS) program — fatherhood
31initiatives
32 Sec. 9. Section 217.41C, subsection 1, paragraph c, Code
332023, is amended to read as follows:
34c. For the purposes of this section, “pregnancy support
35services” means those nonmedical services that promote
-11-1childbirth by providing information, counseling, and support
2services that assist pregnant women or women who believe they
3may be pregnant and men who are involved or who think they
4might be involved in a pregnancy to choose childbirth and to
5make informed decisions regarding the choice of adoption or
6parenting with respect to their children.
7 Sec. 10. Section 217.41C, Code 2023, is amended by adding
8the following new subsections:
9 NEW SUBSECTION. 8. The department shall develop and
10maintain a virtual clearinghouse of pregnancy support
11services and resources including but not limited to all of the
12following:
13a. Pregnancy resource center and maternity home information
14including contact information, location, and services provided.
15b. Assistance in accessing public assistance including but
16not limited to the special supplemental nutrition program for
17women, infants, and children and the supplemental nutrition
18assistance program.
19c. Educational resources.
20d. Housing assistance.
21e. Recovery and mental health services.
22f. Family planning education.
23g. Adoption and foster care information and services.
24h. Healing and support services for abortion survivors and
25their families.
26 NEW SUBSECTION. 9. Beginning July 1, 2023, and thereafter,
27funding for the program may be used for all of the following
28purposes:
29a. Fatherhood engagement grants. The department may
30award grants to nonprofit, community-based organizations to
31address the needs of fathers by assisting fathers in finding
32employment, managing child support obligations, transitioning
33from a period of incarceration, accessing health care,
34understanding child development, and enhancing parenting skills
35using evidence-based parenting education. Priority in the
-12-1awarding of grants shall be based on the demonstrated need
2in a geographic area and the prevalence of the population to
3be served as indicated by factors including but not limited
4to the service area’s unemployment rate, incarceration rate,
5number of public assistance recipients, number of single-parent
6households, level of housing instability, and graduation rates.
7b. Fatherhood communications initiative. The department
8shall administer a communications initiative on responsible
9fatherhood including but not limited to a public internet site
10that provides access to resources on effective parenting and
11assistance in receiving parenting support and services.
12c. Mentoring school-aged males grant program. The
13department may award three-year renewable grants to nonprofit
14organizations that provide mentorship, social and academic
15support, and life skills development to school-aged males.
16Priority in the awarding of grants shall be based on the
17demonstrated need in a geographic area and the prevalence of
18the population to be served as indicated by factors including
19but not limited to the service area’s unemployment rate,
20incarceration rate, number of public assistance recipients,
21number of single-parent households, level of housing
22instability, and graduation rates. The department shall
23provide technical assistance to grantees to ensure program
24sustainability following the end of the three-year grant
25period.
26 Sec. 11. MORE OPTIONS FOR MATERNAL SUPPORT PROGRAM —
27APPROPRIATION. There is appropriated from the general fund of
28the state to the department of health and human services for
29the fiscal year beginning July 1, 2023, and ending June 30,
302024, the following amount, or so much thereof as is necessary,
31to be used for the purposes designated:
.................................................. $322,000,000
33To be used for the purposes of the more options for maternal
34support program created in section 217.41C, including for
35program administration, the provision of services, and for
-13-1funding of fatherhood engagement grants, the fatherhood
2communications initiative, and the mentoring school-aged males
3grant program.
4 Sec. 12. 2022 Iowa Acts, chapter 1131, section 28,
5subsection 8, is amended to read as follows:
68. Of the funds appropriated under this section, $500,000
7shall be used for the purposes of program administration and
8provision of pregnancy support services through the more
9options for maternal support program created in this Act.
10Notwithstanding section 8.33, moneys appropriated in this
11subsection that remain unencumbered or unobligated at the close
12of the fiscal year shall not revert but shall remain available
13for the purposes designated until the close of the succeeding
14fiscal year.
15 Sec. 13. EFFECTIVE DATE. The following, being deemed of
16immediate importance, takes effect upon enactment:
17The section of this division of this Act amending 2022 Iowa
18Acts, chapter 1131, section 28, subsection 8.
19DIVISION V
20Nonrecurring ADOPTION EXPENSES — adoption subsidy program
21 Sec. 14. NEW SECTION. 234.48 Adoption subsidy —
22nonrecurring adoption expenses.
23Notwithstanding any provision to the contrary, the maximum
24reimbursement provided to an adoptive parent under the
25adoption subsidy program for nonrecurring adoption expenses
26is one thousand dollars. For the purposes of this section,
27“nonrecurring adoption expenses” means the same as defined in 45
28C.F.R. §1356.41. The department shall adopt rules pursuant to
29chapter 17A to administer this section.
30 Sec. 15. REPEAL. 2010 Iowa Acts, chapter 1031, section 408,
31is repealed.
32DIVISION VI
33All Iowa opportunity scholarship PROGRAM
34 Sec. 16. Section 261.87, subsection 1, paragraph b,
35unnumbered paragraph 1, Code 2023, is amended to read as
-14-1follows:
2“Eligible foster care student” means a person under
3twenty-six years of age who has a high school diploma or a high
4school equivalency diploma under chapter 259A and is described
5by any of the following:
6 Sec. 17. Section 261.87, subsection 2, paragraph f, Code
72023, is amended to read as follows:
8f. (1) Begins Except as provided in subparagraph (2),
9begins enrollment at an eligible institution within two
10academic years of graduation from high school or receipt of
11a high school equivalency diploma under chapter 259A and
12continuously receives awards as a full-time or part-time
13student to maintain eligibility. However, the student may
14defer or suspend participation in the program for up to two
15years in order to pursue obligations that meet conditions
16established by the commission by rule or to fulfill military
17obligations.
18(2) The requirements of subparagraph (1) do not apply to an
19eligible foster care student.
20 Sec. 18. APPLICABILITY. This division of this Act applies
21to applications submitted under the all Iowa opportunity
22scholarship program established pursuant to section 261.87
23before, on, or after the effective date of this division of
24this Act.
25EXPLANATION
26The inclusion of this explanation does not constitute agreement with
27the explanation’s substance by the members of the general assembly.
28This bill relates to the health and well-being of children
29and families. The bill is constructed in divisions.
30DIVISION I — REGIONAL CENTERS OF EXCELLENCE GRANT PROGRAM.
31 This division appropriates $1 million from the general fund
32of the state to the department of health and human services
33(HHS) for fiscal year 2023-2024 for continuation of a regional
34center of excellence program to award four grants to encourage
35innovation and collaboration among regional health care
-15-1providers in a rural area based upon the results of a regional
2community needs assessment to transform health care delivery in
3order to provide quality, sustainable care that meets the needs
4of the local communities. An applicant for the grant funds
5shall specify how the funds will be expended to accomplish the
6goals of the program and shall provide a detailed five-year
7sustainability plan prior to being awarded any funding.
8Following the receipt of grant funding, a recipient shall
9submit periodic reports as specified by HHS to the governor and
10the general assembly regarding the recipient’s expenditure of
11the funds and progress in accomplishing the program goals.
12DIVISION II — STATE-FUNDED FAMILY MEDICINE OBSTETRICS
13FELLOWSHIP PROGRAM AND FUND. This division requires HHS to
14establish a family medicine obstetrics fellowship program to
15increase access to family medicine obstetrics practitioners
16in rural and underserved areas of the state. A person who
17has completed an accreditation council for graduate medical
18education residency program in family medicine is eligible for
19participation in the fellowship program. Participating fellows
20shall enter into a program agreement with a participating
21teaching hospital which, at a minimum, requires the fellow
22to complete a one-year fellowship and to engage in full-time
23family medicine obstetrics practice in a rural or underserved
24area of the state for a period of at least five years within
25nine months following completion of the fellowship and receipt
26of a license to practice medicine in the state. Each fellow
27participating in the program shall be eligible for salary and
28benefits including a stipend as determined by the participating
29teaching hospital and funded through the family medicine
30obstetrics fellowship program fund.
31The division requires HHS to adopt administrative rules
32to administer the program, including defining rural and
33underserved areas for the purpose of the required full-time
34practice of a person following completion of the fellowship.
35The division creates a family medicine obstetrics fellowship
-16-1program fund in the state treasury consisting of the moneys
2appropriated or credited to the fund by law. Moneys in the
3fund at the end of each fiscal year shall not revert to any
4other fund but shall remain in the fund for use in subsequent
5fiscal years. Moneys in the fund are appropriated to HHS
6to be used to fund fellowship positions as provided in the
7division. The division appropriates a sufficient amount from
8the general fund of the state to the fund annually to support
9the creation of four fellowship positions. The division
10provides an appropriation for deposit in the fund for fiscal
11year 2023-2024.
12The division requires HHS and the participating teaching
13hospitals to regularly evaluate and document their experiences
14including identifying ways the program may be modified or
15expanded to facilitate increased access to family medicine
16obstetrics practitioners in rural and underserved areas of the
17state. The department shall submit an annual report to the
18general assembly by January 1. The report shall include the
19number of fellowships funded to date and any other information
20identified by HHS and the participating teaching hospitals as
21indicators of outcomes and the effectiveness of the program.
22DIVISION III — SELF-ADMINISTERED HORMONAL CONTRACEPTIVES.
23 This division relates to the dispensing of self-administered
24hormonal contraceptives by a pharmacist. The division
25defines “self-administered hormonal contraceptive” as a
26self-administered hormonal contraceptive that is approved by
27the United States food and drug administration to prevent
28pregnancy, including an oral hormonal contraceptive, a hormonal
29vaginal ring, and a hormonal contraceptive patch, but not
30including any drug intended to induce an abortion.
31The division provides that notwithstanding any provision
32of law to the contrary, a pharmacist may dispense a
33self-administered hormonal contraceptive to a patient who
34is at least 18 years of age pursuant to a standing order
35established by the medical director of HHS (medical director).
-17-1For an initial dispensing, a pharmacist may dispense only up
2to a three-month supply at one time of the self-administered
3hormonal contraceptive, and for any subsequent dispensing
4of the same self-administered hormonal contraceptive, a
512-month supply at one time. Additionally, the division
6prohibits a pharmacist who dispenses a self-administered
7hormonal contraceptive in accordance with the division from
8requiring any other prescription drug order authorized by a
9practitioner prior to dispensing the self-administered hormonal
10contraceptive.
11The division authorizes the medical director to establish a
12standing order authorizing the dispensing of self-administered
13hormonal contraceptives by any pharmacist who complies with the
14standing order and retains and submits the patient’s record to
15HHS.
16The standing order includes requiring a pharmacist who
17dispenses a self-administered hormonal contraceptive under the
18division to: complete a standardized training program and
19continuing education requirements related to prescribing the
20hormonal contraceptives; obtain a completed self-screening risk
21assessment from each patient, verify the identity and age of
22each patient, and perform a blood pressure screening on each
23patient before dispensing the hormonal contraceptives; provide
24the patient with certain written information; provide the
25patient with a copy of the record of the pharmacist’s encounter
26with the patient; and provide patient counseling.
27The standing order would prohibit a pharmacist who dispenses
28hormonal contraceptives under the division from requiring a
29patient to schedule an appointment with the pharmacist for
30the prescribing or dispensing of the hormonal contraceptive;
31dispensing the hormonal contraceptives to a patient for more
32than 27 months after the date initially dispensed without the
33patient’s attestation that the patient has consulted with a
34practitioner during the preceding 27 months; and dispensing
35the hormonal contraceptives to a patient if the results of the
-18-1patient’s self-screening risk assessment indicate it is unsafe
2for the pharmacist to dispense the hormonal contraceptives
3to the patient, in which case the pharmacist shall refer the
4patient to a practitioner.
5The division provides immunity for a pharmacist who
6dispenses a self-administered hormonal contraceptive and
7for the medical director who establishes a standing order
8in compliance with the division from criminal and civil
9liability arising from any damages caused by the dispensing,
10administering, or use of a self-administered hormonal
11contraceptive or the establishment of the standing order.
12Additionally, the medical director shall be considered to be
13acting within the scope of the medical director’s office and
14employment for purposes of Code chapter 669 (Iowa tort claims
15Act) in the establishment of a standing order in compliance
16with the division.
17The division requires HHS, in collaboration with the
18boards of pharmacy and medicine, and in consideration of
19the guidelines established by the American congress of
20obstetricians and gynecologists, to adopt administrative rules
21to administer the provisions of the division.
22The division amends prescription contraceptive coverage
23provisions to require that a group policy, contract, or plan
24delivered, issued for delivery, continued, or renewed in the
25state on or after January 1, 2024, providing for third-party
26payment or prepayment of health or medical expenses, shall
27specifically provide for payment of self-administered hormonal
28contraceptives, prescribed and dispensed as specified in the
29division, including those dispensed at one time. The division
30provides, however, that the provisions relating to coverage are
31not to be construed to require a third-party payor to provide
32payment to a practitioner for dispensing a self-administered
33hormonal contraceptive to replace a self-administered
34hormonal contraceptive that has been dispensed to a covered
35person and that has been misplaced, stolen, or destroyed.
-19-1These provisions are also not to be construed to require a
2third-party payor to replace covered prescriptions that are
3misplaced, stolen, or destroyed.
4The division also requires the board of pharmacy in
5collaboration with the board of medicine and HHS to expand
6the information program for drug prescribing to collect
7from pharmacists information relating to the dispensing of
8self-administered hormonal contraceptives as provided in the
9division.
10The division applies to the Medicaid program as specified in
11the bill.
12DIVISION IV — MORE OPTIONS FOR MATERNAL SUPPORT (MOMS)
13PROGRAM — FATHERHOOD INITIATIVES. This division relates to
14the more options for maternal support (MOMS) program. The
15bill adds as part of the definition of “pregnancy support
16services” services to men who are involved or think they might
17be involved in a pregnancy. As part of the MOMS program,
18the division requires HHS to develop and maintain a virtual
19clearinghouse of pregnancy support services and resources. The
20services and resources include but are not limited to pregnancy
21resource center and maternity home information; assistance in
22accessing public assistance including but not limited to the
23special supplemental nutrition program for women, infants, and
24children program and the supplemental nutrition assistance
25program; educational resources; housing assistance; recovery
26and mental health services; family planning education; adoption
27and foster care information and services; and healing and
28support services for abortion survivors and their families.
29As part of the MOMS program, beginning July 1, 2023, and
30thereafter, funding for the program may be used for fatherhood
31engagement grants to nonprofit, community-based organizations
32to address the needs of fathers by assisting fathers in
33finding employment, managing child support obligations,
34transitioning from a period of incarceration, accessing health
35care, understanding child development, and enhancing parenting
-20-1skills using evidence-based parenting education; a fatherhood
2communications initiative administered by HHS, including but
3not limited to a public internet site that provides access to
4resources on effective parenting and assistance in receiving
5parenting support and services; and a mentoring school-aged
6males grant program to provide mentorship, social and academic
7support, and life skills development to school-aged males.
8The division also appropriates $2 million from the general
9fund of the state to HHS for fiscal year 2023-2024 to be used
10for the MOMS program including for program administration, the
11provision of services, and for funding of fatherhood engagement
12grants, the fatherhood communications initiative, and the
13mentoring school-aged males grant program.
14The division provides that the funding appropriated for the
15MOMS program for fiscal year 2022-2023 is not to revert, but
16is to remain available for the MOMS program for fiscal year
172023-2024. This provision takes effect upon enactment.
18DIVISION V — NONRECURRING ADOPTION EXPENSES — ADOPTION
19SUBSIDY PROGRAM. This division provides that the maximum
20reimbursement provided to an adoptive parent under the adoption
21subsidy program for nonrecurring adoption expenses is $1,000.
22The division defines “nonrecurring adoption expenses” as the
23reasonable and necessary adoption fees, court costs, attorney
24fees, and other expenses which are directly related to the
25legal adoption of a child with special needs which are not
26incurred in violation of state, tribal, or federal law, and
27which have not been reimbursed from other sources or other
28funds. Under federal regulation, “other expenses which
29are directly related to the legal adoption of a child with
30special needs” means the costs of the adoption incurred by
31or on behalf of the parents and for which parents carry the
32ultimate liability for payment. Such costs may include the
33adoption study, including health and psychological examination,
34supervision of the placement prior to adoption, transportation,
35and the reasonable costs of lodging and food for the child or
-21-1the adoptive parents when necessary to complete the placement
2or adoption process. The department of health and human
3services shall adopt administrative rules to administer the
4division. The division also repeals a provision in 2010 Iowa
5Acts which limited the nonrecurring adoption expenses to $500
6and prohibited additional amounts for court costs and other
7related legal expenses.
8DIVISION VI — ALL IOWA OPPORTUNITY SCHOLARSHIP PROGRAM.
9 This division relates to the all Iowa opportunity scholarship
10program (program), which provides scholarships to Iowa
11students who graduate from high school or receive a high
12school equivalency diploma to help such students attend a
13community college in this state or an institution of higher
14learning governed by the state board of regents. The program
15prioritizes awarding scholarships to certain students,
16including eligible foster care students. Eligible foster care
17students are students who age out of Iowa’s foster care system,
18age out of the state training school, or are adopted from
19Iowa’s foster care system after reaching 16 years of age.
20Current law requires that, in order to be eligible to
21receive a scholarship under the program, the student must begin
22enrollment at a community college or institution of higher
23learning governed by the state board of regents within two
24academic years of graduation from high school or receipt of a
25high school equivalency diploma and continuously receive awards
26as a full-time or part-time student to maintain eligibility.
27The division strikes these requirements for eligible foster
28care students. The division also provides that, for purposes
29of the program, “eligible foster care student” does not include
30a person who is 26 years of age or older.
31The division applies to applications submitted under
32the program before, on, or after the effective date of the
33division.
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