House
Amendment
to
Senate
File
296
S-3210
Amend
Senate
File
296,
as
amended,
passed,
and
1
reprinted
by
the
Senate,
as
follows:
2
1.
By
striking
everything
after
the
enacting
clause
3
and
inserting:
4
<
DIVISION
I
5
HEALTHY
IOWA
PLAN
6
Section
1.
NEW
SECTION
.
249N.1
Title.
7
This
chapter
shall
be
known
and
may
be
cited
as
the
8
“Healthy
Iowa
Plan”
.
9
Sec.
2.
NEW
SECTION
.
249N.2
Definitions.
10
As
used
in
this
chapter,
unless
the
context
11
otherwise
requires:
12
1.
“Accountable
care
organization”
means
a
13
risk-bearing,
integrated
health
care
organization
14
characterized
by
a
payment
and
care
delivery
model
that
15
ties
provider
reimbursement
to
quality
metrics
and
16
reductions
in
the
total
cost
of
care
for
an
attributed
17
population
of
patients.
18
2.
“Affordable
Care
Act”
or
“federal
Act”
means
the
19
federal
Patient
Protection
and
Affordable
Care
Act,
20
Pub.
L.
No.
111-148
as
amended
by
the
federal
Health
21
Care
and
Education
Reconciliation
Act
of
2010,
Pub.
L.
22
No.
111-152.
23
3.
“Clean
claim”
means
a
claim
submitted
by
a
24
healthy
Iowa
plan
provider
that
may
be
adjudicated
as
25
paid
or
denied.
26
4.
“Covered
benefits”
means
reimbursable
health
27
care
services
as
specified
in
section
249N.6.
28
5.
“Department”
means
the
department
of
human
29
services.
30
6.
“Director”
means
the
director
of
human
services.
31
7.
“Essential
health
benefits”
means
essential
32
health
benefits
as
defined
in
section
1302
of
the
33
Affordable
Care
Act,
that
include
at
least
the
general
34
categories
and
the
items
and
services
covered
within
35
the
categories
of
ambulatory
patient
services;
36
emergency
services;
hospitalization;
maternity
and
37
newborn
care;
mental
health
and
substance
use
disorder
38
services,
including
behavioral
health
treatment;
39
prescription
drugs;
rehabilitative
and
habilitative
40
services
and
devices;
laboratory
services;
preventive
41
and
wellness
services
and
chronic
disease
management;
42
and
pediatric
services,
including
oral
and
vision
care.
43
8.
“Federal
approval”
means
approval
by
the
centers
44
for
Medicare
and
Medicaid
services
of
the
United
States
45
department
of
health
and
human
services.
46
9.
“Federal
poverty
level”
means
the
most
recently
47
revised
poverty
income
guidelines
published
by
the
48
United
States
department
of
health
and
human
services.
49
10.
“Full
benefits
recipient”
means
an
adult
who
is
50
-1-
SF296.2082.H
(1)
85
md
1/
21
#1.
eligible
for
full
medical
assistance
benefits
pursuant
1
to
chapter
249A
under
any
category
of
eligibility.
2
11.
“Healthy
Iowa
plan”
or
“plan”
means
the
healthy
3
Iowa
plan
established
under
this
chapter.
4
12.
“Healthy
Iowa
plan
provider”
means
any
provider
5
enrolled
in
the
medical
assistance
program
or
any
6
participating
accountable
care
organization.
7
13.
“Healthy
Iowa
plan
provider
network”
means
the
8
health
care
delivery
network
approved
by
the
department
9
for
healthy
Iowa
plan
members.
10
14.
“Medical
assistance
program”
or
“Medicaid”
means
11
the
program
paying
all
or
part
of
the
costs
of
care
and
12
services
provided
to
an
individual
pursuant
to
chapter
13
249A
and
Tit.
XIX
of
the
federal
Social
Security
Act.
14
15.
“Medicare”
means
the
federal
Medicare
program
15
established
pursuant
to
Tit.
XVIII
of
the
federal
16
Social
Security
Act.
17
16.
“Member”
means
an
individual
who
meets
the
18
eligibility
requirements
of
section
249N.5
and
is
19
enrolled
in
the
healthy
Iowa
plan.
20
17.
“My
health
rewards
account”
means
an
account
21
established
by
the
department
pursuant
to
section
22
249N.9
on
behalf
of
a
member
to
contain
contributions
23
from
the
member,
financial
incentives
earned
by
the
24
member,
and
other
payments
made
by
the
plan,
to
be
used
25
by
the
member
for
payment
of
required
contributions,
26
cost-sharing,
and
health
improvements.
27
18.
“Participating
accountable
care
organization”
28
means
an
accountable
care
organization
approved
by
the
29
department
to
participate
in
the
healthy
Iowa
plan
30
provider
network.
31
19.
“Preventive
care
services”
means
care
that
is
32
provided
to
an
individual
to
promote
health,
prevent
33
disease,
or
diagnose
disease.
34
20.
“Primary
medical
provider”
means
the
primary
35
care
provider
chosen
by
a
member
or
to
whom
a
member
36
is
assigned
to
provide
and
manage
the
member’s
primary
37
care
and
to
provide
referrals,
as
necessary
and
38
required
by
the
healthy
Iowa
plan,
to
other
healthy
39
Iowa
plan
providers.
40
21.
“Value-based
reimbursement”
means
a
payment
41
methodology
that
links
provider
reimbursement
to
42
improved
performance
by
health
care
providers
by
43
holding
health
care
providers
accountable
for
both
the
44
cost
and
quality
of
care
provided.
45
Sec.
3.
NEW
SECTION
.
249N.3
Purpose
——
46
establishment
of
healthy
Iowa
plan.
47
1.
The
purpose
of
this
chapter
is
to
establish
and
48
administer
a
healthy
Iowa
plan
to
promote
increased
49
access
to
health
care,
quality
health
care
outcomes,
50
-2-
SF296.2082.H
(1)
85
md
2/
21
and
the
use
of
personal
responsibility
mechanisms
that
1
encourage
individuals
with
incomes
at
or
below
one
2
hundred
percent
of
the
federal
poverty
level
to
be
3
cost-conscious
consumers
of
health
care
and
to
exhibit
4
healthy
behaviors.
5
2.
The
healthy
Iowa
plan
is
established
within
the
6
medical
assistance
program
and
shall
be
administered
by
7
the
department.
Except
as
otherwise
specified
in
this
8
chapter,
the
rules
applicable
to
the
medical
assistance
9
program
pursuant
to
chapter
249A
shall
be
applicable
10
to
the
healthy
Iowa
plan.
11
3.
The
department
may
contract
with
a
third-party
12
administrator
to
provide
eligibility
determination
13
support,
and
to
administer
enrollment,
member
14
outreach,
my
health
rewards
account
services,
and
other
15
components
of
the
healthy
Iowa
plan.
16
Sec.
4.
NEW
SECTION
.
249N.4
Federal
financial
17
participation
——
limitations
of
program.
18
1.
This
chapter
shall
be
implemented
only
to
the
19
extent
that
federal
matching
funds
are
available
for
20
nonfederal
expenditures
under
this
chapter.
Except
as
21
otherwise
provided
in
section
249N.11,
the
department
22
shall
not
expend
funds
under
this
chapter,
including
23
but
not
limited
to
expenditures
for
reimbursement
of
24
providers
and
program
administration,
if
appropriated
25
nonfederal
funds
are
not
matched
by
federal
financial
26
participation.
27
2.
Enrollment
in
the
healthy
Iowa
plan
may
be
28
limited,
closed,
or
reduced
and
the
scope
and
duration
29
of
services
provided
under
the
healthy
Iowa
plan
may
30
be
limited,
reduced,
or
terminated
if
the
department
31
determines
that
federal
financial
participation
or
32
appropriated
nonfederal
funds
will
not
be
available
to
33
pay
for
existing
or
additional
enrollment
costs.
34
3.
The
provisions
of
this
chapter
shall
not
be
35
construed,
are
not
intended
as,
and
shall
not
imply
a
36
grant
of
entitlement
to
services
for
individuals
who
37
are
eligible
for
covered
benefits
under
this
chapter
38
or
for
utilization
of
services
that
do
not
exist
or
39
are
not
otherwise
available
under
this
chapter.
Any
40
state
obligation
to
provide
covered
benefits
pursuant
41
to
this
chapter
is
limited
to
the
extent
of
the
funds
42
appropriated
or
distributed
for
the
purposes
of
this
43
chapter.
44
4.
The
provisions
of
this
chapter
shall
not
be
45
construed
and
are
not
intended
to
affect
the
provision
46
of
services
to
medical
assistance
program
recipients
47
existing
on
January
1,
2014.
48
Sec.
5.
NEW
SECTION
.
249N.5
Healthy
Iowa
plan
——
49
eligibility.
50
-3-
SF296.2082.H
(1)
85
md
3/
21
1.
Except
as
otherwise
provided
in
this
chapter,
1
an
individual
nineteen
through
sixty-four
years
of
age
2
shall
be
eligible
for
covered
benefits
specified
in
3
this
chapter
when
provided
through
the
healthy
Iowa
4
plan
provider
network
as
described
in
this
chapter,
if
5
the
individual
meets
all
of
the
following
conditions:
6
a.
The
individual
meets
the
citizenship
or
alienage
7
requirements
of
the
medical
assistance
program,
is
a
8
resident
of
Iowa,
and
provides
a
social
security
number
9
upon
application
for
the
plan.
10
b.
The
individual
has
household
income
at
or
below
11
one
hundred
percent
of
the
federal
poverty
level.
12
Household
income
shall
be
determined
using
the
modified
13
adjusted
gross
income
methodology
pursuant
to
section
14
2002
of
the
Affordable
Care
Act.
15
c.
The
individual
fulfills
all
other
conditions
16
of
participation
in
the
healthy
Iowa
plan,
including
17
member
financial
participation
pursuant
to
section
18
249N.8.
19
2.
The
following
individuals
are
not
eligible
for
20
the
healthy
Iowa
plan:
21
a.
An
individual
eligible
as
a
full
benefits
22
recipient
under
the
medical
assistance
program.
23
b.
An
individual
who
is
entitled
to
or
enrolled
24
for
Medicare
benefits
under
part
A,
or
is
enrolled
for
25
Medicare
benefits
under
part
B,
of
Tit.
XVIII
of
the
26
federal
Social
Security
Act.
27
c.
An
individual
who
is
pregnant
and
otherwise
28
eligible
for
the
medical
assistance
program
pursuant
to
29
section
249A.3.
30
d.
An
individual
who
has
access
to
affordable
31
employer-sponsored
health
care
coverage,
as
defined
by
32
rule
of
the
department
to
align
with
rules
adopted
by
33
the
federal
internal
revenue
service
under
the
federal
34
Affordable
Care
Act.
35
3.
a.
Each
applicant
for
the
healthy
Iowa
36
plan
shall
provide
to
the
department
all
insurance
37
information
required
by
the
health
insurance
premium
38
payment
program
in
accordance
with
rules
adopted
by
the
39
department.
40
b.
The
department
may
elect
to
pay
the
41
cost
of
premiums
for
applicants
with
access
42
to
employer-sponsored
health
care
coverage
if
43
the
department
determines
such
payment
to
be
44
cost-effective.
45
c.
Eligibility
for
the
healthy
Iowa
plan
is
a
46
qualifying
event
under
the
federal
Health
Insurance
47
Portability
and
Accountability
Act
of
1996,
Pub.
L.
No.
48
104-191.
49
d.
If
premium
payment
is
provided
under
this
50
-4-
SF296.2082.H
(1)
85
md
4/
21
subsection
for
employer-sponsored
health
care
coverage,
1
the
healthy
Iowa
plan
shall
supplement
such
coverage
2
as
necessary
to
provide
the
covered
benefits
specified
3
under
section
249N.6.
4
4.
The
department
shall
implement
the
healthy
Iowa
5
plan
in
a
manner
that
ensures
that
the
healthy
Iowa
6
plan
is
the
payor
of
last
resort.
7
5.
A
member
is
eligible
for
coverage
effective
8
the
first
day
of
the
month
following
the
month
of
9
application
for
enrollment.
10
6.
Following
initial
enrollment,
a
member
is
11
eligible
for
covered
benefits
for
twelve
months,
12
subject
to
program
termination
and
other
limitations
13
otherwise
specified
in
this
chapter.
The
department
14
shall
review
the
member’s
eligibility
on
at
least
an
15
annual
basis.
16
Sec.
6.
NEW
SECTION
.
249N.6
Healthy
Iowa
plan
——
17
covered
benefits.
18
Members
shall
receive
coverage
for
benefits
pursuant
19
to
42
U.S.C.
§
1396u-7(b)(1)(B),
adjusted
as
necessary
20
to
provide
the
essential
health
benefits
required
21
pursuant
to
section
1302
of
the
federal
Act,
and
22
including
habilitation
services
consistent
with
the
23
state
medical
assistance
program
section
1915I
waiver.
24
Sec.
7.
NEW
SECTION
.
249N.7
Healthy
Iowa
plan
25
provider
network.
26
1.
The
department
shall
develop
a
regionalized
27
healthy
Iowa
plan
provider
network
statewide.
28
2.
The
healthy
Iowa
plan
provider
network
shall
29
include
all
providers
enrolled
in
the
medical
30
assistance
program
and
participating
accountable
care
31
organizations.
Reimbursement
under
this
chapter
shall
32
only
be
made
to
such
healthy
Iowa
plan
providers
for
33
covered
benefits.
34
3.
a.
Upon
enrollment,
a
member
shall
choose
a
35
primary
medical
provider
within
the
healthy
Iowa
plan
36
provider
network.
37
b.
If
the
member
does
not
choose
a
primary
medical
38
provider,
the
department
shall
assign
the
member
to
39
a
primary
medical
provider
in
accordance
with
the
40
mandatory
enrollment
provisions
specified
in
rules
41
adopted
by
the
department
pursuant
to
chapter
249A
42
and
in
accordance
with
quality
data
available
to
the
43
department.
44
c.
The
department
shall
develop
a
mechanism
for
45
primary
medical
providers
and
participating
accountable
46
care
organizations
within
a
region
to
jointly
47
facilitate
member
care
coordination.
48
4.
a.
The
healthy
Iowa
plan
provider
network
shall
49
include
at
least
one
participating
accountable
care
50
-5-
SF296.2082.H
(1)
85
md
5/
21
organization
per
region
with
which
the
department
shall
1
contract
to
ensure
the
coordination
and
management
2
of
the
health
of
the
members
within
the
region,
to
3
produce
improved
health
care
quality,
and
to
control
4
overall
cost.
The
department
shall
contract
with
the
5
acute
care
teaching
hospital
located
in
a
county
with
6
a
population
over
three
hundred
fifty
thousand
to
act
7
as
a
participating
accountable
care
organization
within
8
the
region
specified
by
the
department.
9
b.
The
department
shall
establish
the
10
qualifications,
contracting
processes,
and
11
contract
terms
for
a
participating
accountable
care
12
organization.
The
department
shall
also
establish
13
a
methodology
for
attribution
of
a
specified
member
14
population
to
the
participating
accountable
care
15
organization.
16
c.
A
participating
accountable
care
organization
17
contract
shall
establish
accountability
based
on
18
quality
performance
and
total
cost
of
care
metrics
for
19
the
attributed
population.
The
metrics
shall
include
20
but
are
not
limited
to
risk
sharing,
including
both
21
shared
savings
and
shared
costs,
between
the
state
and
22
the
participating
accountable
care
organization.
23
d.
The
department
shall
ensure
that
payments
made
24
to
participating
accountable
care
organizations
do
not
25
exceed
available
funds
in
the
healthy
Iowa
account
26
created
in
section
249N.11.
27
e.
The
participating
accountable
care
organization
28
shall
provide
access
by
members
to
primary
medical
29
providers
within
thirty
miles
or
thirty
minutes
of
a
30
member’s
residence,
unless
such
access
is
technically
31
infeasible.
32
5.
To
the
extent
possible,
members
shall
have
33
a
choice
of
providers
within
the
healthy
Iowa
plan
34
provider
network,
subject
to
the
results
of
attribution
35
under
this
section
and
subject
to
all
of
the
following:
36
a.
Member
choice
may
be
limited
by
the
37
participating
accountable
care
organization,
with
prior
38
approval
of
the
department,
if
the
member’s
health
39
condition
would
benefit
from
limiting
the
member’s
40
choice
of
a
healthy
Iowa
plan
provider
to
ensure
41
coordination
of
services,
or
due
to
overutilization
of
42
covered
benefits.
The
participating
accountable
care
43
organization
shall
provide
thirty
days’
notice
to
the
44
member
prior
to
limitation
of
such
choice.
45
b.
The
department
may
require
that
access
to
46
services
not
provided
through
the
participating
47
accountable
care
organization
be
subject
to
prior
48
authorization
by
the
participating
accountable
care
49
organization,
if
such
prior
authorization
is
projected
50
-6-
SF296.2082.H
(1)
85
md
6/
21
to
improve
health
care
delivery
in
the
region.
1
6.
a.
A
healthy
Iowa
plan
provider
shall
submit
2
clean
claims
within
twenty
days
of
the
date
of
3
provision
of
a
covered
benefit
to
a
member.
4
b.
A
healthy
Iowa
plan
provider
shall
be
reimbursed
5
for
covered
benefits
under
the
healthy
Iowa
plan
6
utilizing
the
same
reimbursement
methodology
as
7
that
applicable
to
individuals
eligible
for
medical
8
assistance
under
section
249A.3,
subsection
1.
9
c.
Notwithstanding
paragraph
“b”
,
a
participating
10
accountable
care
organization
under
contract
with
the
11
department
shall
be
reimbursed
utilizing
a
value-based
12
reimbursement
methodology.
13
7.
a.
Healthy
Iowa
plan
providers
shall
exchange
14
member
health
information
as
provided
by
rule
to
15
facilitate
coordination
and
management
of
care,
16
improved
health
outcomes,
and
reduction
in
costs.
17
b.
The
department
shall
provide
the
health
care
18
claims
data
of
attributed
members
to
a
member’s
19
participating
accountable
care
organization
on
a
20
timeframe
established
by
rule
of
the
department.
21
Sec.
8.
NEW
SECTION
.
249N.8
Member
financial
22
participation.
23
1.
Membership
in
the
healthy
Iowa
plan
shall
24
require
payment
of
a
monthly
contribution
and
25
cost-sharing
amounts,
annually,
that
align
with
the
26
cost-sharing
limitations
requirements
for
American
27
health
benefit
exchanges
under
the
Affordable
Care
28
Act.
Copayments
under
the
healthy
Iowa
plan
shall
29
be
applicable
only
to
nonemergency
use
of
a
hospital
30
emergency
department.
Contribution
and
cost-sharing
31
amounts,
including
an
annual
deductible,
shall
be
32
established
by
rule
of
the
department.
33
2.
a.
Even
though
a
member
is
eligible
for
34
coverage
effective
the
first
day
of
the
month
following
35
the
month
of
application
for
enrollment,
claims
for
36
covered
benefits
shall
not
be
paid
until
the
initial
37
monthly
contribution
payment
is
made
by
the
member.
38
If
the
initial
monthly
contribution
payment
is
made
39
within
sixty
days
of
the
eligibility
date,
claims
for
40
covered
benefits
are
payable
from
the
effective
date
41
of
eligibility.
42
b.
Timely
payment
of
monthly
contributions,
43
within
sixty
days
of
the
date
the
payment
is
due,
is
44
a
condition
of
membership.
A
member
who
does
not
45
make
such
timely
payment
is
subject
to
disenrollment
46
from
the
plan,
following
notice
from
the
department.
47
Following
such
disenrollment,
an
individual
is
not
48
eligible
for
reapplication
for
membership
in
the
plan
49
for
twelve
months
from
the
date
of
disenrollment.
50
-7-
SF296.2082.H
(1)
85
md
7/
21
c.
A
member
may
request
a
hardship
exemption
if
1
a
hardship
would
accrue
from
imposing
payment
of
the
2
monthly
contribution.
Information
regarding
the
3
contribution
obligation
and
the
hardship
exemption,
4
including
the
process
by
which
a
prospective
member
may
5
apply
for
the
hardship
exemption,
shall
be
provided
to
6
a
prospective
member
at
the
time
of
application
for
7
enrollment.
8
3.
Any
required
member
contributions
or
9
cost-sharing
that
are
unpaid
are
a
debt
owed
the
state.
10
Sec.
9.
NEW
SECTION
.
249N.9
My
health
rewards
11
accounts.
12
1.
The
department
shall
establish
a
my
health
13
rewards
account
for
each
healthy
Iowa
plan
member.
14
2.
The
plan
shall
deposit
all
of
the
following
in
a
15
member’s
health
rewards
account:
16
a.
All
member
contributions
collected
under
section
17
249N.8.
18
b.
Financial
incentive
payments
paid
by
the
plan,
19
annually,
for
the
member’s
completion
of
a
health
risk
20
assessment,
completion
of
an
annual
physical,
receipt
21
of
preventive
services
specified
by
the
plan,
or
the
22
entering
into
by
a
member
of
a
health
responsibility
23
and
self-sufficiency
agreement,
as
specified
by
rule
of
24
the
department.
25
c.
A
payment
paid
by
the
plan
upon
initial
26
enrollment
and
annually
thereafter,
of
an
amount
that
27
is
the
difference
between
the
sum
of
the
required
28
contributions
made
by
the
member
plus
the
financial
29
incentive
amounts
paid
by
the
plan,
and
the
total
30
annual
deductible
for
the
member
as
established
by
31
rule.
32
3.
The
moneys
in
a
member’s
account
shall
only
be
33
distributed
from
the
account
and
used
to
improve
the
34
health
of
the
member
as
specified
by
rule
based
on
best
35
practices.
Such
uses
may
include
but
are
not
limited
36
to
payment
for
smoking
cessation
services
or
nutrition
37
counseling,
or
payment
of
required
contributions
or
38
cost-sharing
amounts,
exclusive
of
copayments
for
39
nonemergency
use
of
a
hospital
emergency
department.
40
A
member’s
deductible
amount
under
the
plan
shall
be
41
debited
against
the
member’s
account
annually.
42
4.
If
a
member
demonstrates
an
established
pattern
43
of
failure
to
pay
required
contribution
or
cost-sharing
44
amounts,
or
a
pattern
of
inappropriate
use
of
emergency
45
department
or
covered
benefits,
the
member
may
be
46
subject
to
forfeiture
of
the
funds
in
the
account,
47
following
notice
from
the
department.
48
5.
Any
funds
remaining
in
a
member’s
my
health
49
rewards
account
annually
at
the
end
of
a
twelve-month
50
-8-
SF296.2082.H
(1)
85
md
8/
21
enrollment
period
are
subject
to
the
following:
1
a.
If
the
member
renews
enrollment,
the
funds
2
shall
remain
in
the
account
to
be
used
to
defray
the
3
costs
of
the
member’s
contributions
and
cost-sharing
4
requirements
in
the
subsequent
enrollment
period.
5
However,
if
the
member
did
not
complete
the
preventive
6
care
services
specified
by
the
plan
during
the
prior
7
enrollment
period,
any
portion
of
the
remaining
amount
8
paid
by
the
plan
shall
not
be
used
to
defray
the
9
costs
of
the
member’s
contributions
or
cost-sharing
10
requirements
in
the
subsequent
enrollment
period.
11
b.
If
an
individual
is
no
longer
eligible
for
12
the
plan,
does
not
reenroll
in
the
plan,
or
is
13
terminated
from
the
plan
for
nonpayment
of
required
14
contributions
or
cost-sharing
amounts,
the
plan
shall
15
refund
a
prorated
amount
of
the
member’s
contributions
16
as
determined
by
rule
of
the
department,
less
any
17
outstanding
contributions
or
cost-sharing
owed
by
the
18
member,
to
the
individual
within
sixty
days
of
such
19
occurrence.
Any
portion
of
the
remaining
amount
in
the
20
account
paid
by
the
plan
shall
revert
to
the
healthy
21
Iowa
account.
22
Sec.
10.
NEW
SECTION
.
249N.10
Funding
——
county
23
and
county
hospital
contributions
——
certified
public
24
expenditures.
25
1.
Notwithstanding
any
provision
to
the
contrary
26
relating
to
the
taxes
levied
by
a
county
pursuant
to
27
section
331.424A
for
which
the
collection
is
performed
28
after
January
1,
2014,
the
county
treasurer
of
each
29
county
shall
distribute
thirty-seven
and
eighty-four
30
hundredths
percent
of
the
maximum
amount
authorized
to
31
be
levied
and
collected
pursuant
to
section
331.424A,
32
to
the
treasurer
of
state
for
deposit
in
the
healthy
33
Iowa
account
created
in
section
249N.11.
One-half
34
of
the
total
amount
specified
under
this
subsection
35
shall
be
distributed
by
each
county
treasurer
to
the
36
treasurer
of
state
by
October
15,
and
one-half
of
the
37
total
amount
shall
be
distributed
to
the
treasurer
of
38
state
by
April
15,
annually.
39
2.
Notwithstanding
any
provision
to
the
contrary,
40
for
the
collection
of
taxes
levied
under
section
347.7,
41
for
which
the
collection
is
performed
after
January
42
1,
2014,
the
county
treasurer
of
a
county
with
a
43
population
over
three
hundred
fifty
thousand
in
which
a
44
publicly
owned
acute
care
teaching
hospital
is
located
45
shall
distribute
the
proceeds
collected
pursuant
to
46
section
347.7,
in
a
total
amount
of
forty-two
million
47
dollars
annually,
which
would
otherwise
be
distributed
48
to
the
county
hospital,
to
the
treasurer
of
state
for
49
deposit
in
the
healthy
Iowa
account
created
in
section
50
-9-
SF296.2082.H
(1)
85
md
9/
21
249N.11
as
follows:
1
a.
The
first
nineteen
million
dollars
in
2
collections
pursuant
to
section
347.7,
between
July
3
1
and
December
31
annually,
shall
be
distributed
to
4
the
treasurer
of
state
for
deposit
in
the
healthy
Iowa
5
account
and
collections
during
this
time
period
in
6
excess
of
nineteen
million
dollars
shall
be
distributed
7
to
the
acute
care
teaching
hospital
identified
in
this
8
subsection.
In
addition,
of
the
collections
during
9
this
time
period
in
excess
of
nineteen
million
dollars
10
received
by
the
acute
care
teaching
hospital,
two
11
million
dollars
shall
be
distributed
by
the
acute
care
12
teaching
hospital
to
the
treasurer
of
state
for
deposit
13
in
the
healthy
Iowa
account
in
the
month
of
January
14
following
the
July
1
through
December
31
period.
15
b.
The
first
nineteen
million
dollars
in
16
collections
pursuant
to
section
347.7,
between
January
17
1
and
June
30
annually,
shall
be
distributed
to
the
18
treasurer
of
state
for
deposit
in
the
healthy
Iowa
19
account
and
collections
during
this
time
period
in
20
excess
of
nineteen
million
dollars
shall
be
distributed
21
to
the
acute
care
teaching
hospital
identified
in
22
this
subsection.
In
addition,
of
the
collections
23
during
this
time
period
in
excess
of
nineteen
million
24
dollars
received
by
the
acute
care
teaching
hospital,
25
two
million
dollars
shall
be
distributed
by
the
acute
26
care
teaching
hospital
to
the
treasurer
of
state
for
27
deposit
in
the
healthy
Iowa
account
in
the
month
of
28
July
following
the
January
1
through
June
30
period.
29
3.
In
addition
to
the
funding
specified
in
this
30
section,
the
university
of
Iowa
hospitals
and
clinics
31
shall
certify
public
expenditures
in
an
amount
equal
to
32
provide
the
nonfederal
share
of
total
expenditures
not
33
to
exceed
thirty
million
dollars
annually.
34
4.
The
distribution
of
county
hospital
funds
to
the
35
treasurer
of
state
required
under
this
section
shall
36
not
be
the
basis
for
an
increase
in
the
amount
levied
37
and
a
county
hospital
shall
not
thereby
increase
the
38
amount
levied
pursuant
to
section
347.7.
39
Sec.
11.
NEW
SECTION
.
249N.11
Healthy
Iowa
40
account.
41
1.
A
healthy
Iowa
account
is
created
in
the
state
42
treasury
under
the
authority
of
the
department.
Moneys
43
appropriated
from
the
general
fund
of
the
state
to
the
44
account,
proceeds
distributed
from
county
treasurers
as
45
specified
in
section
249N.10,
and
moneys
from
any
other
46
source
credited
to
the
account
shall
be
deposited
in
47
the
account.
Moneys
deposited
in
or
credited
to
the
48
account
are
appropriated
to
the
department
of
human
49
services
to
be
used
for
the
purposes
of
the
healthy
50
-10-
SF296.2082.H
(1)
85
md
10/
21
Iowa
plan
including
administration
of
the
plan
and
to
1
provide
nonfederal
matching
funds
for
the
healthy
Iowa
2
plan,
as
specified
in
this
chapter.
An
amount
shall
3
be
appropriated
from
the
account
to
the
county
with
a
4
population
over
three
hundred
fifty
thousand
in
which
a
5
publicly
owned
acute
care
teaching
hospital
is
located,
6
annually,
to
offset
any
difference
between
the
amount
7
of
proceeds
required
to
be
distributed
by
the
county
8
treasurer
to
the
account
and
the
actual
amount
received
9
by
the
hospital
in
reimbursements
through
the
healthy
10
Iowa
plan
in
the
preceding
fiscal
year.
11
2.
The
account
shall
be
separate
from
the
general
12
fund
of
the
state
and
shall
not
be
considered
part
13
of
the
general
fund
of
the
state.
The
moneys
in
14
the
account
shall
not
be
considered
revenue
of
the
15
state,
but
rather
shall
be
funds
of
the
account.
16
The
moneys
in
the
account
are
not
subject
to
17
section
8.33
and
shall
not
be
transferred,
used,
18
obligated,
appropriated,
or
otherwise
encumbered,
19
except
to
provide
for
the
purposes
of
this
chapter.
20
Notwithstanding
section
12C.7,
subsection
2,
interest
21
or
earnings
on
moneys
deposited
in
the
account
shall
22
be
credited
to
the
account.
23
3.
The
department
shall
adopt
rules
pursuant
to
24
chapter
17A
to
administer
the
account.
25
Sec.
12.
NEW
SECTION
.
249N.12
Adoption
of
rules
——
26
sole-source
administration
——
reports.
27
1.
The
department
shall
adopt
rules
pursuant
to
28
chapter
17A
as
necessary
to
administer
this
chapter.
29
The
department
may
adopt
emergency
rules
under
section
30
17A.4,
subsection
3,
and
section
17A.5,
subsection
2,
31
paragraph
“b”
,
as
necessary
for
the
administration
32
of
this
chapter
and
the
rules
shall
become
effective
33
immediately
upon
filing
or
on
a
later
effective
date
34
specified
in
the
rules,
unless
the
effective
date
is
35
delayed
by
the
administrative
rules
review
committee.
36
Any
rules
adopted
in
accordance
with
this
section
37
shall
not
take
effect
before
the
rules
are
reviewed
38
by
the
administrative
rules
review
committee.
The
39
delay
authority
provided
to
the
administrative
rules
40
review
committee
under
section
17A.4,
subsection
7,
and
41
section
17A.8,
subsection
9,
shall
be
applicable
to
a
42
delay
imposed
under
this
section,
notwithstanding
a
43
provision
in
those
sections
making
them
inapplicable
44
to
section
17A.5,
subsection
2,
paragraph
“b”
.
Any
45
rules
adopted
in
accordance
with
the
provisions
of
this
46
section
shall
also
be
published
as
notice
of
intended
47
action
as
provided
in
section
17A.4.
48
2.
Notwithstanding
section
8.47
or
any
other
49
provision
of
law
to
the
contrary,
the
department
may
50
-11-
SF296.2082.H
(1)
85
md
11/
21
utilize
a
sole-source
approach
to
administer
this
1
chapter.
2
3.
The
department
shall
submit
all
of
the
following
3
to
the
governor
and
the
generally
assembly:
4
a.
Biennially,
a
report
of
the
results
of
a
review,
5
by
county
and
region,
of
mental
health
services
6
previously
funded
through
taxes
levied
by
counties
7
pursuant
to
section
331.424A,
that
are
funded
during
8
the
reporting
period
under
the
healthy
Iowa
plan.
9
b.
Annually,
a
report
of
the
results
of
a
review
10
of
the
outcomes
and
effectiveness
of
mental
health
11
services
provided
under
the
healthy
Iowa
plan.
12
c.
Annually,
an
analysis
of
whether
the
amount
13
distributed
by
each
county
to
the
treasurer
of
14
state
pursuant
to
section
249N.10,
subsection
1,
is
15
commensurate
with
the
cost
of
mental
health
services
16
being
provided
under
the
healthy
Iowa
plan.
17
Sec.
13.
Section
249J.26,
subsection
2,
Code
2013,
18
is
amended
to
read
as
follows:
19
2.
This
chapter
is
repealed
October
December
31,
20
2013.
21
Sec.
14.
HEALTHY
IOWA
ACCOUNT
——
APPROPRIATION
FROM
22
GENERAL
FUND
——
FY
2013-2014.
There
is
appropriated
23
from
the
general
fund
of
the
state
to
the
department
of
24
human
services
for
the
fiscal
year
beginning
July
1,
25
2013,
and
ending
June
30,
2014,
the
following
amount
26
or
so
much
thereof
as
is
necessary
for
the
purposes
27
designated:
28
For
deposit
in
the
healthy
Iowa
account
created
in
29
section
249N.11,
as
enacted
in
this
division
of
this
30
Act,
to
be
used
for
the
purposes
of
the
account:
31
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
$
23,000,000
32
Sec.
15.
MEDICAL
ASSISTANCE
APPROPRIATION
33
——
TRANSFER
TO
THE
HEALTHY
IOWA
ACCOUNT
——
FY
34
2013-2014.
Of
the
funds
appropriated
to
the
department
35
of
human
services
from
the
general
fund
of
the
state
36
for
the
fiscal
year
beginning
July
1,
2013,
and
ending
37
June
30,
2014,
for
the
medical
assistance
program,
38
$35,500,000
is
transferred
to
the
healthy
Iowa
account
39
created
in
section
249N.11,
as
enacted
in
this
division
40
of
this
Act,
for
the
purposes
of
the
account.
41
Sec.
16.
DIRECTIVE
TO
DEPARTMENT
OF
HUMAN
42
SERVICES.
Upon
enactment
of
this
division
of
this
43
Act,
the
department
of
human
services
shall
request
44
federal
approval
of
a
medical
assistance
section
1115
45
demonstration
waiver
to
implement
this
division
of
this
46
Act
effective
January
1,
2014.
47
Sec.
17.
EFFECTIVE
UPON
ENACTMENT
AND
CONTINGENT
48
IMPLEMENTATION.
49
1.
This
division
of
this
Act,
being
deemed
of
50
-12-
SF296.2082.H
(1)
85
md
12/
21
immediate
importance,
takes
effect
upon
enactment.
1
However,
the
department
of
human
services
shall
2
implement
this
division
of
this
Act
effective
January
3
1,
2014,
contingent
and
only
upon
receipt
of
federal
4
approval
of
the
waiver
request
submitted
under
this
5
division
of
this
Act.
6
2.
Notwithstanding
subsection
1,
if
any
portion
7
of
the
waiver
is
denied
or
if
federal
approval
or
8
financial
participation
relative
to
any
portion
of
the
9
waiver
is
denied,
the
department
shall
only
implement
10
this
division
of
this
Act
in
accordance
with
both
of
11
the
following:
12
a.
To
the
extent
that
federal
approval
is
received
13
and
federal
financial
participation
is
available.
14
b.
To
the
extent
federal
approval
is
not
required
15
and
federal
participation
is
not
applicable.
16
3.
The
distributions
of
taxes
levied
pursuant
17
to
section
331.424A
and
distributed
by
each
county
18
treasurer
to
the
treasurer
of
state
pursuant
to
19
section
249N.10
and
the
distribution
of
taxes
levied
20
pursuant
to
section
347.7
and
distributed
by
the
county
21
treasurer
of
a
county
with
a
population
over
three
22
hundred
fifty
thousand
in
which
a
publicly
owned
acute
23
care
teaching
hospital
is
located
to
the
treasurer
24
of
state
pursuant
to
section
249N.10,
shall
not
be
25
distributed
until
the
department
of
human
services
26
has
received
federal
approval
of
the
waiver
request
27
submitted
under
this
division
of
this
Act.
28
DIVISION
II
29
MEDICAL
MALPRACTICE
ACTIONS
30
Sec.
18.
Section
147.139,
Code
2013,
is
amended
to
31
read
as
follows:
32
147.139
Expert
witness
testimony
——
standards.
33
1.
If
the
standard
of
care
given
by
a
physician
34
and
surgeon
or
an
osteopathic
physician
and
surgeon
35
licensed
pursuant
to
chapter
148
,
or
a
dentist
licensed
36
pursuant
to
chapter
153
,
is
at
issue,
the
court
shall
37
only
allow
a
person
to
qualify
as
an
expert
witness
and
38
to
testify
on
the
issue
of
the
appropriate
standard
of
39
care
if
the
person’s
medical
or
dental
qualifications
40
relate
directly
to
the
medical
problem
or
problems
at
41
issue
and
the
type
of
treatment
administered
in
the
42
case.
,
breach
of
the
standard
of
care,
or
proximate
43
cause
of
any
damages
or
injury
as
a
result
of
said
44
breach
if
all
of
the
following
qualifications
of
the
45
person
are
established:
46
a.
The
person
is
licensed
to
practice
medicine,
47
osteopathic
medicine,
or
dentistry
and
in
the
five
48
years
preceding
the
allegedly
negligent
act,
was
49
engaged
in
the
active
practice
of
medicine,
osteopathic
50
-13-
SF296.2082.H
(1)
85
md
13/
21
medicine,
or
dentistry,
or
was
a
qualified
instructor
1
at
an
accredited
university
of
medicine
and
surgery,
2
osteopathic
medicine
and
surgery,
or
dentistry.
3
b.
The
person
practices
or
provides
university
4
instruction
in
the
same
or
substantially
similar
5
specialty
as
the
defendant.
6
c.
If
the
defendant
is
board-certified
in
a
7
specialty,
the
person
is
also
certified
in
that
8
specialty
by
a
board
recognized
by
the
American
board
9
of
medical
specialties
or
the
American
osteopathic
10
association
and
is
licensed
and
in
good
standing
in
11
each
state
of
licensure,
and
has
not
had
the
person’s
12
license
revoked
or
suspended
in
the
past
five
years.
13
2.
A
person
who
is
not
licensed
in
this
state
who
14
testifies
pursuant
to
this
section
as
an
expert
against
15
a
defendant,
whether
in
contract
or
tort
arising
out
16
of
the
provision
of
or
failure
to
provide
care,
shall
17
be
deemed
to
hold
a
temporary
license
to
practice
in
18
this
state
for
the
purpose
of
providing
such
testimony
19
and
shall
be
subject
to
the
authority
of
the
applicable
20
licensing
board
in
this
state
including
but
not
limited
21
to
section
147.55.
22
Sec.
19.
NEW
SECTION
.
147.140
Malpractice
review
23
panels.
24
1.
For
the
purpose
of
this
section,
“health
care
25
provider”
means
a
physician
and
surgeon,
osteopathic
26
physician
and
surgeon,
dentist,
podiatric
physician,
27
optometrist,
pharmacist,
chiropractor,
physician
28
assistant,
advanced
registered
nurse
practitioner,
or
29
nurse
licensed
pursuant
to
this
chapter,
a
facility
30
certified
as
an
ambulatory
surgical
center
under
the
31
federal
Medicare
program,
a
hospital
licensed
pursuant
32
to
chapter
135B,
or
a
health
care
facility
licensed
33
pursuant
to
chapter
135C.
34
2.
a.
Immediately
after
the
filing
of
any
action
35
for
personal
injury
or
wrongful
death
against
any
36
health
care
provider
based
upon
the
alleged
negligence
37
of
the
licensee
in
the
practice
of
that
profession
38
or
occupation,
or
upon
the
alleged
negligence
of
a
39
facility
certified
as
an
ambulatory
surgical
center
40
under
the
federal
Medicare
program,
hospital,
or
41
health
care
facility
in
patient
care
and
the
answer
42
thereto
by
all
named
defendants,
the
chief
judge
of
43
the
judicial
district
within
which
the
action
is
filed
44
shall
select
a
person
pursuant
to
subsection
4
to
serve
45
as
chairperson
of
a
malpractice
review
panel
to
review
46
the
validity
of
the
action.
47
b.
Upon
the
selection
of
the
chairperson,
all
legal
48
proceedings
in
the
malpractice
action
shall
be
stayed
49
until
thirty
days
after
the
malpractice
review
panel
50
-14-
SF296.2082.H
(1)
85
md
14/
21
issues
its
findings
under
subsection
13.
1
3.
a.
The
chairperson
selected
pursuant
to
2
subsection
2
shall
serve
as
a
nonvoting
member
of
the
3
malpractice
review
panel.
4
b.
The
chairperson
shall
select
the
members
of
the
5
malpractice
review
panel
pursuant
to
subsection
6.
6
4.
a.
All
of
the
following
persons
shall
be
7
eligible
to
serve
on
a
review
panel:
8
(1)
Retired
judges,
and
senior
judges
and
retired
9
senior
judges
as
defined
in
section
602.9202.
10
(2)
Health
care
providers
and
attorneys
recommended
11
by
their
respective
professions
to
serve
on
malpractice
12
review
panels
pursuant
to
this
section.
As
a
condition
13
of
licensure
as
a
health
care
provider
or
as
an
14
attorney
in
this
state,
a
health
care
provider
or
15
attorney
selected
to
serve
on
a
malpractice
review
16
panel
shall
be
required
to
serve
if
so
selected.
17
(3)
Residents
of
this
state
who
are
neither
18
attorneys
nor
health
care
providers.
19
b.
For
purposes
of
selecting
members
of
a
20
malpractice
review
panel,
the
clerk
of
the
supreme
21
court
shall
maintain
a
list
of
persons
identified
in
22
paragraph
“a”
,
subparagraphs
(1)
and
(2).
Persons
23
identified
in
paragraph
“a”
,
subparagraph
(3),
shall
be
24
selected
from
a
current
jury
pool.
25
5.
a.
The
chairperson
of
the
malpractice
review
26
panel
shall
be
compensated.
If
the
chairperson
is
27
receiving
compensation
for
the
chairperson’s
service
28
on
the
review
panel
pursuant
to
section
602.1612,
the
29
chairperson
shall
not
receive
additional
compensation
30
for
serving
on
the
review
panel.
31
b.
A
resident
of
this
state
who
is
neither
an
32
attorney
nor
a
health
care
provider
who
is
selected
as
33
a
member
of
a
review
panel
shall
receive
fifty
dollars
34
per
day
for
participating
in
hearings
and
deliberations
35
relating
to
service
on
the
review
panel.
36
c.
All
members
of
a
review
panel
shall
be
37
reimbursed
for
travel
expenses.
38
6.
a.
Within
ten
days
of
receipt
of
the
39
notification
of
selection
as
chairperson
of
the
40
malpractice
review
panel,
the
chairperson
shall
select
41
the
following
persons
to
serve
as
members
of
the
42
malpractice
review
panel
for
the
particular
malpractice
43
action
as
follows:
44
(1)
An
attorney
licensed
to
practice
law
in
this
45
state.
46
(2)
A
health
care
provider
licensed
in
this
state.
47
(3)
A
resident
of
this
state
who
is
neither
an
48
attorney
nor
a
health
care
provider.
49
b.
A
person
who
is
not
referred
to
in
paragraph
“a”
50
-15-
SF296.2082.H
(1)
85
md
15/
21
may
be
selected
to
serve
on
the
review
panel
if
agreed
1
to
by
all
parties
to
the
malpractice
action.
2
7.
a.
Within
thirty
days
of
convening
the
3
malpractice
review
panel,
a
party
to
the
proceedings
4
shall
produce
to
all
other
parties
all
medical
and
5
health
care
provider
records
within
the
possession
6
or
control
of
the
party
pertaining
to
the
plaintiff
7
regardless
of
whether
the
party
believes
such
records
8
are
relevant
to
the
proceedings.
9
b.
The
chairperson
may
permit
reasonable
discovery,
10
and
if
so
allowed,
shall
determine
a
timetable
for
any
11
additional
discovery
prior
to
the
hearing
before
the
12
malpractice
review
panel.
Depositions
of
persons
other
13
than
the
parties
and
experts
designated
by
the
parties
14
shall
not
be
taken
except
for
good
cause
shown
by
the
15
party
requesting
the
deposition.
16
c.
The
chairperson
shall
have
the
power
to
issue
17
subpoenas
for
both
discovery
and
compulsion
of
18
testimony
in
the
same
manner
and
method
as
the
district
19
court.
20
d.
The
chairperson
shall
also
determine
a
date
by
21
which
the
plaintiff
must
submit
a
certificate-of-merit
22
affidavit
as
provided
in
subsection
8
for
each
23
defendant
the
plaintiff
intends
to
call
as
a
witness
to
24
testify
with
respect
to
the
issues
of
the
applicable
25
standard
of
care,
breach
of
the
applicable
standard
of
26
care,
or
causation.
27
8.
a.
A
plaintiff
shall
submit
a
separate
28
certificate-of-merit
affidavit
for
each
defendant
named
29
in
the
malpractice
action.
The
affidavit
submitted
30
for
each
defendant
must
be
signed
by
an
expert.
The
31
affidavit
must
certify
under
the
oath
of
the
expert
all
32
of
the
following:
33
(1)
The
expert’s
statement
of
familiarity
with
the
34
applicable
standard
of
care.
35
(2)
The
expert’s
statement
that
the
standard
of
36
care
was
breached
by
the
health
care
provider
named
as
37
the
defendant.
38
(3)
The
expert’s
statement
of
the
actions
that
the
39
health
care
provider
failed
to
take
or
should
have
40
taken
to
comply
with
the
standard
of
care.
41
(4)
The
expert’s
statement
of
the
manner
by
which
42
the
breach
of
the
standard
of
care
was
the
cause
of
the
43
injury
alleged
in
the
petition.
44
b.
A
single
expert
need
not
certify
all
of
the
45
elements
in
paragraph
“a”
in
regard
to
one
particular
46
defendant,
however,
each
of
the
elements
must
be
47
certified
by
an
expert
in
regard
to
each
defendant.
48
c.
If
a
plaintiff
fails
to
submit
a
49
certificate-of-merit
affidavit
within
the
time
50
-16-
SF296.2082.H
(1)
85
md
16/
21
period
determined
by
the
chairperson,
the
chairperson
1
shall
file
a
motion
with
the
district
court
to
dismiss
2
the
plaintiff’s
malpractice
action
with
regard
to
the
3
defendant
for
which
the
certificate-of-merit
affidavit
4
was
not
submitted.
The
district
court
shall
then
5
dismiss
with
prejudice
the
plaintiff’s
malpractice
6
action
against
the
defendant.
7
9.
a.
Within
six
months
from
the
date
all
members
8
of
the
malpractice
review
panel
were
appointed,
unless
9
the
time
period
has
been
extended
by
the
chairperson
10
for
good
cause
shown
by
a
requesting
party,
the
11
chairperson
of
the
review
panel
shall
hold
a
hearing
of
12
the
full
review
panel
to
review
the
plaintiff’s
claims
13
and
the
defendant’s
defenses.
In
no
event
shall
any
14
extension
cause
the
hearing
to
occur
more
than
one
year
15
after
all
review
panel
members
were
appointed.
16
b.
Except
as
otherwise
provided
in
this
subsection,
17
one
combined
hearing
or
hearings
shall
be
held
for
18
all
claims
under
this
section
arising
out
of
the
19
same
malpractice
action.
If
the
malpractice
action
20
includes
more
than
one
defendant,
the
parties
may,
21
upon
agreement
of
all
parties,
require
that
separate
22
hearings
be
held
for
each
defendant
or
group
of
23
defendants.
The
chairperson
may,
for
good
cause
shown,
24
order
separate
hearings.
25
10.
At
the
hearing
before
the
malpractice
review
26
panel,
all
parties
who
are
natural
persons
shall
be
27
personally
present
and
all
entity
parties
shall
have
28
a
representative
present
with
responsibility
for
the
29
subject
matter
that
is
the
subject
of
the
malpractice
30
action.
If
a
plaintiff
fails
to
appear
at
the
hearing,
31
the
chairperson
shall
file
a
motion
with
the
district
32
court
to
dismiss
the
plaintiff’s
action
with
prejudice,
33
and
the
court
shall
grant
the
motion.
If
the
defendant
34
fails
to
appear
at
the
hearing,
the
defendant
shall
35
be
precluded
from
presenting
any
evidence
or
making
36
any
presentation
before
the
malpractice
review
panel
37
or
at
any
subsequent
trial.
The
absence
of
a
party
38
or
an
entity’s
representative
may
be
excused
by
the
39
chairperson
for
good
cause
shown.
40
11.
At
the
hearing
before
the
malpractice
review
41
panel,
the
plaintiff
shall
present
the
plaintiff’s
42
case
to
the
review
panel
and
each
defendant
shall
43
present
the
defendant’s
case
in
response
to
the
44
plaintiff’s
presentation.
Wide
latitude
shall
be
45
afforded
the
parties
in
the
conduct
of
the
hearing
46
including
but
not
limited
to
the
right
of
examination
47
and
cross-examination
of
witnesses
by
attorneys
for
48
the
parties.
Depositions
allowed
to
be
taken
under
49
subsection
7
shall
be
admissible
regardless
of
whether
50
-17-
SF296.2082.H
(1)
85
md
17/
21
the
person
deposed
is
available
at
the
hearing.
The
1
Iowa
rules
of
civil
procedure
shall
not
apply
at
2
the
hearing,
and
evidence
may
be
admitted
if
such
3
evidence
is
evidence
upon
which
reasonable
persons
are
4
accustomed
to
rely.
The
chairperson
shall
make
all
5
procedural
rulings
and
such
rulings
shall
be
binding
6
and
final.
The
hearing
shall
be
recorded
either
7
electronically
or
by
a
court
reporter.
The
cost
of
8
recording
the
hearing
shall
be
equally
divided
among
9
the
parties.
The
record
of
the
proceedings
and
all
10
documents
presented
as
exhibits
shall
be
confidential
11
except
in
the
following
circumstances:
12
a.
Any
testimony
or
writings
made
under
oath
may
13
be
used
in
subsequent
proceedings
for
purposes
of
14
impeachment.
15
b.
The
party
who
made
a
statement
or
presented
16
evidence
agrees
to
the
submission,
use,
or
disclosure
17
of
the
statement
or
evidence.
18
c.
The
parties
unanimously
agree
upon
disclosure
of
19
any
part
of
the
record
or
proceedings.
20
12.
Upon
the
conclusion
of
the
hearing,
the
21
malpractice
review
panel
may
request
from
any
party
22
additional
evidence,
records,
or
other
information
to
23
be
submitted
in
writing
or
at
a
continuation
of
the
24
hearing.
A
continued
hearing
shall
be
held
as
soon
as
25
possible.
A
continued
hearing
shall
be
attended
by
26
the
same
review
panel
members
and
parties
who
attended
27
the
initial
hearing,
unless
otherwise
agreed
to
by
all
28
parties.
29
13.
The
malpractice
review
panel
shall
issue
its
30
findings
in
writing
within
thirty
days
of
submission
of
31
all
presentations
and
evidence.
32
a.
The
review
panel’s
findings
shall
contain
33
answers
to
all
of
the
following
questions:
34
(1)
Whether
the
acts
or
omissions
complained
of
35
constitute
a
deviation
from
the
applicable
standard
36
of
care
by
the
health
care
provider
charged
with
such
37
care.
38
(2)
If
the
acts
or
omissions
complained
of
are
39
found
to
have
constituted
a
deviation
from
the
40
applicable
standard
of
care,
whether
the
acts
or
41
omissions
complained
of
proximately
caused
the
injury
42
complained
of.
43
(3)
If
negligence
on
the
part
of
a
health
care
44
provider
is
found,
whether
any
negligence
on
the
part
45
of
the
plaintiff
was
equal
to
or
greater
than
the
46
negligence
of
the
health
care
provider.
47
b.
The
review
panel
shall
make
any
affirmative
48
finding
by
a
preponderance
of
the
evidence.
49
c.
With
regard
to
each
question,
the
review
50
-18-
SF296.2082.H
(1)
85
md
18/
21
panel’s
findings
with
regard
to
each
question
shall
be
1
determined
by
a
majority
of
the
panel
members.
The
2
determination
of
the
answer
to
any
question
by
any
3
individual
review
panel
member
shall
be
confidential
4
and
shall
not
be
disclosed
to
any
party
or
other
member
5
of
the
public.
The
findings
shall
reflect
the
number
6
of
review
panel
members
making
a
determination
of
an
7
answer
in
the
affirmative
and
in
making
a
determination
8
of
an
answer
in
the
negative.
The
findings,
including
9
the
cumulative
determinations
in
the
affirmative
and
10
the
negative
for
each
answer,
shall
be
signed
by
all
11
review
panel
members,
with
each
review
panel
member
12
attesting
that
the
written
findings
accurately
reflect
13
the
determinations
made.
14
d.
The
chairperson
of
the
review
panel
shall
serve
15
the
findings
upon
the
parties
within
seven
days
of
16
the
date
of
the
findings.
The
review
panel’s
written
17
findings
shall
be
preserved
until
thirty
days
after
18
final
judgment
or
the
action
is
finally
resolved
after
19
which
time
such
findings
shall
be
destroyed.
All
20
medical
and
health
care
provider
records
shall
be
21
returned
to
the
party
providing
them
to
the
review
22
panel.
23
e.
The
deliberations
and
discussion
of
the
review
24
panel
shall
be
privileged
and
confidential
and
a
review
25
panel
member
shall
not
be
asked
or
compelled
to
testify
26
at
a
later
proceeding
concerning
the
deliberations,
27
discussions,
or
findings
expressed
during
the
review
28
panel’s
deliberations,
except
as
such
deliberation,
29
discussion,
or
findings
may
be
required
to
prove
an
30
allegation
of
intentional
fraud.
All
review
panel
31
members
and
the
chairperson
shall
be
immune
from
32
liability
as
a
result
of
participation
in
or
serving
33
as
a
review
panel
member,
except
for
instances
of
34
intentional
fraud
by
a
panel
member.
35
14.
The
effect
of
the
malpractice
review
panel’s
36
findings
shall
be
as
follows:
37
a.
If
the
review
panel’s
findings
are
unanimous
and
38
unfavorable
to
the
plaintiff
in
such
a
manner
as
would
39
not
permit
recovery
by
the
plaintiff
if
the
answers
40
were
made
at
trial,
all
of
the
following
shall
apply:
41
(1)
The
review
panel’s
findings
are
admissible
42
in
any
subsequent
court
action
for
professional
43
negligence
against
the
health
care
provider
accused
of
44
professional
negligence
by
the
claimant
based
upon
the
45
same
set
of
facts
which
were
considered
reviewed
by
the
46
review
panel.
47
(2)
If
the
malpractice
action
proceeds
and
results
48
in
a
verdict
and
judgment
for
the
defendant,
the
49
plaintiff
shall
be
required
to
pay
all
expert
witness
50
-19-
SF296.2082.H
(1)
85
md
19/
21
fees
and
court
costs
incurred
by
the
defendant.
1
(3)
If
the
malpractice
action
proceeds
and
results
2
in
a
verdict
and
judgment
for
the
plaintiff,
any
3
noneconomic
damages
awarded
to
the
plaintiff
shall
not
4
exceed
two
hundred
fifty
thousand
dollars.
5
b.
If
the
review
panel’s
findings
are
unanimous
and
6
unfavorable
to
the
defendant,
in
such
a
manner
as
would
7
permit
the
plaintiff
to
recover
if
the
defendant’s
8
answers
were
made
at
trial,
all
of
the
following
shall
9
apply:
10
(1)
The
review
panel’s
findings
are
admissible
11
in
any
subsequent
court
action
for
professional
12
negligence
against
the
health
care
provider
accused
of
13
professional
negligence
by
the
claimant
based
upon
the
14
same
set
of
facts
which
were
considered
reviewed
by
the
15
review
panel.
16
(2)
The
defendant
shall
promptly
admit
liability
or
17
enter
into
negotiations
to
pay
the
plaintiff’s
claim
18
for
damages.
19
(3)
If
liability
is
admitted,
the
claim
may
be
20
resubmitted
to
the
review
panel
upon
agreement
of
the
21
plaintiff
and
the
defendant
for
a
determination
of
22
damages.
Any
determination
of
damages
by
the
review
23
panel
shall
be
admissible
in
any
subsequent
malpractice
24
action.
25
(4)
If
liability
is
not
admitted
and
the
parties
26
are
not
able
to
resolve
the
claim
through
settlement
27
negotiations
within
thirty
days
after
service
of
the
28
review
panel’s
findings,
the
plaintiff
may
proceed
with
29
the
malpractice
action.
If
the
plaintiff
obtains
a
30
verdict
or
judgment
in
excess
of
the
plaintiff’s
last
31
formal
demand
in
the
settlement
negotiations
following
32
the
review
panel’s
findings,
the
defendant
shall
be
33
required
to
pay
all
expert
witness
fees
and
court
costs
34
incurred
by
the
plaintiff.
35
15.
a.
Upon
the
selection
of
all
members
of
the
36
malpractice
review
panel,
each
party
shall
pay
to
the
37
clerk
of
the
district
court
a
filing
fee
of
two
hundred
38
fifty
dollars.
39
b.
Any
party
may
apply
to
the
chairperson
of
the
40
malpractice
review
panel
for
a
waiver
of
the
filing
41
fee.
The
chairperson
shall
grant
the
waiver
if
the
42
party
is
indigent.
43
c.
Any
party
who
is
or
was
an
employee
of
another
44
party
at
the
time
of
the
claimed
injury
and
was
acting
45
in
the
course
and
scope
of
employment
with
such
other
46
party
shall
not
be
required
to
pay
a
filing
fee.
47
Sec.
20.
NEW
SECTION
.
622.31A
Evidence-based
48
medical
practice
guidelines
——
affirmative
defense.
49
1.
For
purposes
of
this
section:
50
-20-
SF296.2082.H
(1)
85
md
20/
21
a.
“Evidence-based
medical
practice
guidelines”
1
means
voluntary
medical
practice
parameters
or
2
protocols
established
and
released
through
a
recognized
3
physician
consensus-building
organization
approved
4
by
the
United
States
department
of
health
and
human
5
services,
through
the
American
medical
association’s
6
physician
consortium
for
performance
improvement
or
7
similar
activity,
or
through
a
recognized
national
8
medical
specialty
society.
9
b.
“Health
care
provider”
means
a
physician
and
10
surgeon,
osteopathic
physician
and
surgeon,
physician
11
assistant,
or
advanced
registered
nurse
practitioner.
12
2.
In
any
action
for
personal
injury
or
wrongful
13
death
against
any
health
care
provider
based
upon
the
14
alleged
negligence
of
the
health
care
provider
in
15
patient
care,
the
health
care
provider
may
assert,
16
as
an
affirmative
defense,
that
the
health
care
17
provider
complied
with
evidence-based
medical
practice
18
guidelines
in
the
diagnosis
and
treatment
of
a
patient.
19
3.
A
judge
may
admit
evidence-based
medical
20
practice
guidelines
into
evidence
if
introduced
only
by
21
a
health
care
provider
or
by
the
health
care
provider’s
22
employer
and
if
the
health
care
provider
or
the
health
23
care
provider’s
employer
establishes
foundational
24
evidence
in
support
of
the
evidence-based
medical
25
practice
guidelines
as
well
as
evidence
that
the
health
26
care
provider
complied
with
the
guidelines.
Evidence
27
of
departure
from
an
evidence-based
medical
practice
28
guideline
is
admissible
only
on
the
issue
of
whether
29
the
health
care
provider
is
entitled
to
assert
an
30
affirmative
defense.
31
4.
This
section
shall
not
apply
to
any
of
the
32
following:
33
a.
A
mistaken
determination
by
the
health
care
34
provider
that
the
evidence-based
medical
practice
35
guideline
applied
to
a
particular
patient
where
36
such
mistake
is
caused
by
the
health
care
provider’s
37
negligence
or
intentional
misconduct.
38
b.
The
health
care
provider’s
failure
to
properly
39
follow
the
evidence-based
medical
practice
guideline
40
where
such
failure
is
caused
by
the
health
care
41
provider’s
negligence
or
intentional
misconduct.
There
42
shall
be
no
presumption
of
negligence
if
a
health
care
43
provider
does
not
adhere
to
an
evidence-based
medical
44
practice
guideline.
>
45
2.
Title
page,
by
striking
lines
1
through
5
46
and
inserting
<
An
Act
relating
to
health
care
by
47
establishing
the
healthy
Iowa
plan,
affecting
medical
48
malpractice
actions,
making
appropriations,
providing
49
remedies,
and
including
effective
date
provisions.
>
50
-21-
SF296.2082.H
(1)
85
md
21/
21