House Amendment to Senate File 477 S-5075 Amend Senate File 477, as amended, passed, and reprinted by 1 the Senate, as follows: 2 1. By striking everything after the enacting clause and 3 inserting: 4 < DIVISION I 5 LICENSURE OF INTERNATIONALLY TRAINED PHYSICIANS 6 Section 1. NEW SECTION . 148J.1 Definitions. 7 For the purposes of this chapter: 8 1. “Board” means the board of medicine established pursuant 9 to chapter 147. 10 2. “Health care facility” means all of the following: 11 a. A facility as defined in section 514J.102. 12 b. A facility licensed pursuant to chapter 135B. 13 c. A facility licensed pursuant to chapter 135C. 14 3. “International medical program” means a medical school, 15 residency program, medical internship program, or entity that 16 provides physicians with a medical education or training 17 outside of the United States that is substantially similar to 18 the practice of medicine and surgery or osteopathic medicine 19 and surgery in Iowa and that has been evaluated by the 20 educational commission on foreign medical graduates. 21 4. “International physician” means an individual who meets 22 all of the following requirements: 23 a. Has a medical doctorate or substantially similar degree 24 issued by an international medical program in good standing. 25 b. Has been in good standing with the medical licensing or 26 regulatory institution of the individual’s resident country 27 during the immediately preceding five years and has no pending 28 discipline before the licensing or regulatory institution. 29 c. Has completed a residency or substantially similar 30 postgraduate medical training in the individual’s resident 31 country. 32 d. Has practiced medicine and surgery or osteopathic 33 medicine and surgery as a licensed physician for five years 34 following the completion of a residency or substantially 35 -1- SF 477.3749.H (1) 90 md 1/ 5 #1.

similar postgraduate medical training. 1 e. Possesses basic fluency in the English language. 2 Sec. 2. NEW SECTION . 148J.2 International physicians —— 3 provisional licenses. 4 1. a. The board shall grant a provisional license to 5 practice medicine and surgery or osteopathic medicine and 6 surgery in this state to an international physician with an 7 offer for employment as a physician at a health care facility 8 in this state. However, the board shall not grant a license 9 pursuant to this subsection to an international physician who 10 does not possess a federal immigration status allowing the 11 international medical graduate to practice as a physician 12 in the United States, or to an international physician who 13 fails to obtain a passing score on the United States medical 14 licensing examination. 15 b. A provisional license granted pursuant to paragraph “a” 16 may be converted to a full license to practice medicine and 17 surgery or osteopathic medicine and surgery after three years, 18 unless the license has been revoked pursuant to subsection 2 19 or surrendered by the licensee. 20 2. a. The board may revoke a provisional license granted 21 pursuant to subsection 1, paragraph “a” , if the board finds by 22 clear and compelling evidence that the licensee has violated 23 a provision of section 148.6. A licensee may appeal a 24 revocation pursuant to this subsection in a court of competent 25 jurisdiction within one hundred twenty days of the date of 26 revocation. 27 b. The board may revoke a provisional license granted 28 pursuant to subsection 1, paragraph “a” , if the international 29 physician is not employed by a health care facility in this 30 state during the entirety of the provisional licensing period. 31 3. This section does not require the board to grant a 32 provisional license or full license pursuant to subsection 1 to 33 an individual that does not do all of the following: 34 a. Complete training substantially similar to a physician 35 -2- SF 477.3749.H (1) 90 md 2/ 5

and surgeon or osteopathic physician and surgeon. 1 b. Receive a passing score on the United States medical 2 licensing examination. 3 c. Pass a background check as required by the board. 4 d. Complete a licensure application as required by the 5 board. 6 e. Pay all required fees as required by the board. 7 Sec. 3. EFFECTIVE DATE. This division of this Act takes 8 effect January 1, 2025. 9 DIVISION II 10 ELECTRONIC PROTECTED HEALTH INFORMATION 11 Sec. 4. NEW SECTION . 135.194 Electronic protected health 12 information of minor —— disclosure to legal guardian —— option 13 to provide printed copy. 14 1. A health care provider or facility that maintains 15 or transmits electronic protected health information shall 16 disclose to the legal guardian of a minor the minor’s 17 electronic protected health information, with the following 18 exceptions: 19 a. Electronic protected health information that relates 20 to health care for which the minor is legally authorized to 21 consent without the consent of a legal guardian. 22 b. If disclosure of the electronic protected health 23 information to a legal guardian is otherwise prohibited 24 by state law or federal law, including federal statute, 25 regulation, or centers for disease control and prevention 26 guidelines. 27 2. In lieu of disclosing the minor’s electronic protected 28 health information to the legal guardian of a minor as required 29 pursuant to subsection 1, a health care provider or facility 30 may comply with this section by providing a printed copy of the 31 minor’s electronic protected health information, subject to 32 the exceptions prescribed pursuant to subsection 1, and at no 33 charge to the legal guardian of the minor. 34 3. For the purposes of this section: 35 -3- SF 477.3749.H (1) 90 md 3/ 5

a. “Disclosure” means the release, transfer, provision of 1 access to, or divulging in any manner of electronic protected 2 health information outside the entity holding the electronic 3 protected health information. 4 b. “Electronic media” means electronic storage material 5 on which data is or may be recorded electronically and 6 transmission media used to exchange information already in 7 electronic storage media. 8 c. “Electronic protected health information” means protected 9 health information that is transmitted or maintained by or in 10 electronic media. 11 d. “Facility” means a health care delivery system location 12 that provides a range of primary, secondary, and tertiary 13 inpatient, outpatient, and physician services; an institution 14 providing health care services; and any other health care 15 setting including but not limited to a hospital or other 16 licensed inpatient center, ambulatory surgical center 17 or treatment center, skilled nursing center, residential 18 treatment center, diagnostic, laboratory or imaging centers, 19 rehabilitation or other therapeutic health setting, or the 20 private office or clinic of an individual health care provider 21 or group of health care providers. 22 e. “Health care” means care, services, or supplies related 23 to the health of a person and includes but is not limited to: 24 (1) Preventive, diagnostic, therapeutic, rehabilitative, 25 maintenance, or palliative care, and any counseling, service, 26 assessment, or procedure with respect to the physical or mental 27 condition, or functional status of a person, or that affects 28 the structure or function of the body. 29 (2) The sale or dispensing of a drug, device, equipment, or 30 other item in accordance with a prescription. 31 f. “Health care provider” means a physician or osteopathic 32 physician licensed under chapter 148, a physician assistant 33 licensed under chapter 148C, a podiatrist licensed under 34 chapter 149, a chiropractor licensed under chapter 151, a 35 -4- SF 477.3749.H (1) 90 md 4/ 5

licensed practical nurse, a registered nurse, or an advanced 1 registered nurse practitioner licensed under chapter 152 or 2 152E, a dentist licensed under chapter 153, an optometrist 3 licensed under chapter 154, a pharmacist licensed under chapter 4 155A, or any other person who is licensed, certified, or 5 otherwise authorized or permitted by the law of this state to 6 administer health care in the ordinary course of business or in 7 the practice of a profession. 8 g. “Health information” means health information as defined 9 in 45 C.F.R. §160.103 that is maintained or transmitted by a 10 health care provider or facility. 11 h. “Legal guardian” means a person appointed by a court as 12 the guardian of a minor pursuant to chapter 633, or the parent 13 or other person responsible for the care of the minor. 14 i. “Protected health information” means protected health 15 information as defined in 45 C.F.R. §160.103 that is maintained 16 or transmitted by a health care provider or facility. > 17 2. Title page, line 1, after < to > by inserting < health care, 18 including > 19 3. Title page, line 2, after < and > by inserting < electronic 20 protected health information, and > 21 -5- SF 477.3749.H (1) 90 md 5/ 5 #2.