S.F. _____ H.F. _____ DIVISION I 1 IOWA HEALTH WORKFORCE CENTER 2 Section 1. Section 135.11, subsection 27, Code 2011, is 3 amended by striking the subsection. 4 Sec. 2. NEW SECTION . 135.179 Iowa health workforce center 5 —— established —— duties. 6 1. An Iowa health workforce center is established within the 7 division of health promotion and chronic disease prevention of 8 the department. 9 2. The center shall do all of the following: 10 a. Coordinate public and private efforts to develop and 11 maintain an appropriate health care delivery infrastructure and 12 a stable, well-qualified, diverse, and sustainable health care 13 workforce in this state. 14 b. Develop a biennial strategic plan for health care 15 delivery infrastructure and health care workforce resources in 16 this state. 17 c. Provide for the continuous collection of data to provide 18 a basis for health care strategic planning and health care 19 policymaking. 20 d. Make recommendations regarding the health care delivery 21 infrastructure and the health care workforce that assist 22 in monitoring current needs, predicting future trends, and 23 informing policymaking. 24 e. Leverage federal, state, and local resources to support 25 programs under the purview of the center. 26 DIVISION II 27 TOBACCO ENFORCEMENT 28 Sec. 3. Section 142A.4, subsection 14, Code 2011, is amended 29 by striking the subsection. 30 Sec. 4. Section 142A.5, subsection 1, paragraph e, Code 31 2011, is amended to read as follows: 32 e. Enter into contracts with the alcoholic beverages 33 division of the department of commerce, to provide enforcement 34 of tobacco laws and regulations. Such contracts shall require 35 -1- LSB 1230DP (15) 84 pf/nh 1/ 15

S.F. _____ H.F. _____ Ensure that enforcement efforts to enforce tobacco laws and 1 regulations include training of local authorities who issue 2 retailer permits and education of retailers. 3 DIVISION III 4 COMMUNICABLE AND INFECTIOUS DISEASES AND POISONINGS 5 Sec. 5. Section 139A.2, subsections 5 and 8, Code 2011, are 6 amended to read as follows: 7 5. “Contagious or infectious disease” means hepatitis in any 8 form, meningococcal disease, AIDS or HIV as defined in section 9 141A.1, tuberculosis, and any other disease , with the exception 10 of AIDS or HIV infection as defined in section 141A.1 , 11 determined to be life-threatening to a person exposed to the 12 disease as established by rules adopted by the department, 13 based upon a determination by the state epidemiologist and in 14 accordance with guidelines of the centers for disease control 15 and prevention of the United States department of health and 16 human services. 17 8. “Exposure” means the risk of contracting disease as 18 determined by the centers for disease control and prevention 19 of the United States department of health and human services 20 and adopted by rule of the department a specific eye, mouth, 21 other mucous membrane, nonintact skin, or parenteral contact 22 with blood or other potentially infectious bodily fluids . 23 Sec. 6. Section 139A.2, Code 2011, is amended by adding the 24 following new subsection: 25 NEW SUBSECTION . 23A. “Significant exposure” means a 26 situation in which there is a risk of contracting disease 27 through exposure to a person’s infectious bodily fluids 28 in a manner capable of transmitting an infectious agent as 29 determined by the centers for disease control and prevention of 30 the United States department of health and human services and 31 adopted by rule of the department. 32 Sec. 7. Section 139A.19, Code 2011, is amended to read as 33 follows: 34 139A.19 Care provider notification. 35 -2- LSB 1230DP (15) 84 pf/nh 2/ 15

S.F. _____ H.F. _____ 1. a. Notwithstanding any provision of this chapter to the 1 contrary, if a care provider sustains an a significant exposure 2 from an individual while rendering health care services or 3 other services, the individual to whom the care provider was 4 exposed is deemed to consent to a test to determine if the 5 individual has a contagious or infectious disease and is deemed 6 to consent to notification of the care provider of the results 7 of the test, upon submission of an a significant exposure 8 report by the care provider to the hospital , clinic, other 9 health facility, or other person specified in this section 10 to whom the individual is delivered by the care provider 11 as determined by rule . The exposure report form may be 12 incorporated into the Iowa prehospital care report, the Iowa 13 prehospital advanced care report, or a similar report used 14 by an ambulance, rescue, or first response service or law 15 enforcement agency. 16 b. The hospital , clinic, or other health facility in which 17 the significant exposure occurred or other person specified in 18 this section to whom the individual is delivered shall conduct 19 the test. If the individual is delivered by the care provider 20 to an institution administered by the Iowa department of 21 corrections, the test shall be conducted by the staff physician 22 of the institution. If the individual is delivered by the 23 care provider to a jail, the test shall be conducted by the 24 attending physician of the jail or the county medical examiner. 25 The sample and test results shall only be identified by a 26 number and shall not otherwise identify the individual tested . 27 c. A hospital, clinic, or other health facility, 28 institutions administered by the department of corrections, 29 and jails shall have written policies and procedures for 30 notification of a care provider under this section . The 31 policies and procedures shall include designation of a 32 representative of the care provider to whom notification shall 33 be provided and who shall, in turn, notify the care provider. 34 The identity of the designated representative of the care 35 -3- LSB 1230DP (15) 84 pf/nh 3/ 15

S.F. _____ H.F. _____ provider shall not be revealed to the individual tested. 1 The designated representative shall inform the hospital, 2 clinic, or other health facility, institution administered 3 by the department of corrections, or jail of those parties 4 who received the notification, and following receipt of 5 this information and upon request of the individual tested, 6 the hospital, clinic, or other health facility, institution 7 administered by the department of corrections, or jail shall 8 inform the individual of the parties to whom notification was 9 provided. 10 d. Notwithstanding any other provision of law to the 11 contrary, a care provider may transmit cautions regarding 12 contagious or infectious disease information , with the 13 exception of AIDS or HIV pursuant to section 80.9B, in the 14 course of the care provider’s duties over the police radio 15 broadcasting system under chapter 693 or any other radio-based 16 communications system if the information transmitted does not 17 personally identify an individual. 18 2. a. If the test results are positive, the hospital, 19 clinic, other health facility, or other person performing the 20 test shall notify the subject of the test and make any required 21 reports to the department pursuant to sections 139A.3 and 22 141A.6. The report to the department shall include the name of 23 the individual tested. 24 b. If the individual tested is diagnosed or confirmed 25 as having a contagious or infectious disease, the hospital , 26 clinic, other health facility, or other person conducting 27 the test shall notify the care provider or the designated 28 representative of the care provider who shall then notify the 29 care provider. 30 3. The notification to the care provider shall advise the 31 care provider of possible exposure to a particular contagious 32 or infectious disease and recommend that the care provider seek 33 medical attention. 34 c. The notification to the care provider shall be provided 35 -4- LSB 1230DP (15) 84 pf/nh 4/ 15

S.F. _____ H.F. _____ as soon as is reasonably possible following determination 1 that the individual subject of the test has a contagious or 2 infectious disease. The notification shall not include the 3 name of the individual tested for the contagious or infectious 4 disease unless the individual consents. If the care provider 5 who sustained an a significant exposure determines the identity 6 of the individual diagnosed or confirmed as having a contagious 7 or infectious disease, the identity of the individual shall be 8 confidential information and shall not be disclosed by the care 9 provider to any other person unless a specific written release 10 is obtained from the individual diagnosed with or confirmed as 11 having a contagious or infectious disease. 12 4. This section does not require or permit, unless otherwise 13 provided, a hospital, health care provider, or other person to 14 administer a test for the express purpose of determining the 15 presence of a contagious or infectious disease, except that 16 testing may be performed if the individual consents and if the 17 requirements of this section are satisfied. 18 5. 3. This section does not preclude a hospital , clinic, 19 other health facility, or a health care provider from providing 20 notification to a care provider under circumstances in 21 which the hospital’s , clinic’s, other health facility’s, or 22 health care provider’s policy provides for notification of 23 the hospital’s , clinics, other health facility’s, or health 24 care provider’s own employees of exposure to a contagious or 25 infectious disease that is not life-threatening if the notice 26 does not reveal a patient’s name, unless the patient consents. 27 6. 4. A hospital, clinic, other health facility, or health 28 care provider, or other person participating in good faith in 29 complying with provisions authorized or required under this 30 section is immune from any liability, civil or criminal, which 31 might otherwise be incurred or imposed. 32 7. 5. A hospital’s , clinic’s, other health facility’s, or 33 health care provider’s duty of notification to notify under 34 this section is not continuing but is limited to a diagnosis 35 -5- LSB 1230DP (15) 84 pf/nh 5/ 15

S.F. _____ H.F. _____ of a contagious or infectious disease made in the course of 1 admission, care, and treatment following the rendering of 2 health care services or other services to which notification 3 under this section applies the individual who was the source of 4 the significant exposure . 5 6. Notwithstanding subsection 5, the hospital, clinic, or 6 other health facility may provide a procedure for notifying 7 the exposed care provider if, following discharge from or 8 completion of care or treatment by the hospital, clinic, or 9 other health facility, the individual who was the source of 10 the significant exposure, and for whom a significant exposure 11 report was submitted that did not result in notification of the 12 exposed care provider, wishes to provide information regarding 13 the source individual’s contagious or infectious disease status 14 to the exposed care provider. 15 8. 7. A hospital, clinic, other health facility, health 16 care provider, or other person who is authorized to perform a 17 test under this section who performs the test in compliance 18 with this section or who fails to perform the test authorized 19 under this section , is immune from any liability, civil or 20 criminal, which might otherwise be incurred or imposed. 21 9. 8. A hospital, clinic, other health facility, health 22 care provider, or other person who is authorized to perform 23 a test under this section has no duty to perform the test 24 authorized. 25 10. 9. The department shall adopt rules pursuant to chapter 26 17A to administer this section . The department may determine 27 by rule the contagious or infectious diseases for which testing 28 is reasonable and appropriate and which may be administered 29 under this section . 30 11. 10. The employer of a care provider who sustained 31 an a significant exposure under this section shall pay the 32 costs of testing for the individual who is the source of the 33 significant exposure and of the testing of the care provider, 34 if the significant exposure was sustained during the course 35 -6- LSB 1230DP (15) 84 pf/nh 6/ 15

S.F. _____ H.F. _____ of employment. However, the department shall pay the costs 1 of testing for the assist an individual who is the source 2 of the significant exposure and in finding resources to pay 3 for the costs of the testing of the and shall assist a care 4 provider who renders direct aid without compensation in finding 5 resources to pay for the cost of the test . 6 Sec. 8. Section 139A.33, Code 2011, is amended to read as 7 follows: 8 139A.33 Determination of source —— partner notification 9 program . 10 The local board or the department shall use every available 11 means to determine the source and spread of any infectious case 12 of sexually transmitted disease or infection which is reported. 13 1. The department shall maintain a partner notification 14 program for persons known to have tested positive for a 15 reportable sexually transmitted disease or infection. 16 2. In administering the program, the department shall 17 provide for all of the following: 18 a. A person who voluntarily participates in the program 19 shall receive post-test counseling during which time the person 20 shall be encouraged to refer for counseling and testing any 21 person with whom the person has had sexual relations or has 22 shared drug injecting equipment. 23 b. The physician or other health care provider attending the 24 person may provide to the department any relevant information 25 provided by the person regarding any person with whom the 26 tested person has had sexual relations or has shared drug 27 injecting equipment. 28 3. The department may delegate its partner notification 29 duties under this section to local health authorities or a 30 physician or other health care provider, as provided by rules 31 adopted by the department. 32 4. In making contact with sexual or drug equipment-sharing 33 partners, the department or its designee shall not disclose the 34 identity of the person who provided the names of the persons 35 -7- LSB 1230DP (15) 84 pf/nh 7/ 15

S.F. _____ H.F. _____ to be contacted and shall protect the confidentiality of the 1 persons contacted. 2 5. a. This section shall not be interpreted as creating 3 a duty to warn third parties of the danger of exposure to a 4 sexually transmitted disease or infection through contact with 5 a person who tests positive for a sexually transmitted disease. 6 b. This section shall not be interpreted to require the 7 department to provide partner notification services to all 8 persons who have tested positive for a sexually transmitted 9 disease or infection. 10 DIVISION IV 11 AIDS UPDATE 12 Sec. 9. Section 141A.1, subsections 2, 11, 13, 15, and 18, 13 Code 2011, are amended to read as follows: 14 2. “AIDS-related conditions” means any condition resulting 15 from the human immunodeficiency virus infection that meets the 16 definition of AIDS as established by the centers for disease 17 control and prevention of the United States department of 18 health and human services. 19 11. “HIV-related condition” means any condition resulting 20 from the human immunodeficiency virus infection. 21 13. “Infectious bodily fluids” means bodily fluids capable 22 of transmitting HIV infection as determined by the centers for 23 disease control and prevention of the United States department 24 of health and human services and adopted by rule of the 25 department. 26 15. “Nonblinded epidemiological studies” means studies 27 in which specimens are collected for the express purpose 28 of testing for the HIV infection and persons included in 29 the nonblinded study are selected according to established 30 criteria. 31 18. “Significant exposure” means the a situation in which 32 there is a risk of contracting HIV infection by means of 33 through exposure to a person’s infectious bodily fluids in a 34 manner capable of transmitting HIV infection as determined by 35 -8- LSB 1230DP (15) 84 pf/nh 8/ 15

S.F. _____ H.F. _____ the centers for disease control and prevention of the United 1 States department of health and human services and adopted by 2 rule of the department. 3 Sec. 10. Section 141A.1, Code 2011, is amended by adding the 4 following new subsection: 5 NEW SUBSECTION . 6A. “Exposure” means a specific eye, mouth, 6 other mucous membrane, nonintact skin, or parenteral contact 7 with blood or other potentially infectious bodily fluids. 8 Sec. 11. Section 141A.2, subsection 5, Code 2011, is amended 9 to read as follows: 10 5. The department shall coordinate efforts with local 11 health officers to investigate sources of HIV infection and use 12 every appropriate means to prevent the spread of the infection 13 HIV . 14 Sec. 12. Section 141A.3, subsection 2, paragraph b, Code 15 2011, is amended to read as follows: 16 b. Provide health information to the public regarding HIV 17 infection , including information about how the infection HIV 18 is transmitted and how transmittal can be prevented. The 19 department shall prepare and distribute information regarding 20 HIV infection transmission and prevention. 21 Sec. 13. Section 141A.4, subsection 1, Code 2011, is amended 22 to read as follows: 23 1. HIV testing and education shall be offered to persons who 24 are at risk for HIV infection including all of the following: 25 a. Males who have had sexual relations with other males. 26 b. All persons testing positive for a sexually transmitted 27 disease. 28 b. c. All persons having a history of injecting drug abuse. 29 c. d. Male and female sex workers and those who trade sex 30 for drugs, money, or favors. 31 d. e. Sexual partners of HIV-infected persons. 32 e. f. Persons whose sexual partners are identified in 33 paragraphs “a” through “d” “e” . 34 Sec. 14. Section 141A.5, subsection 2, paragraph c, 35 -9- LSB 1230DP (15) 84 pf/nh 9/ 15

S.F. _____ H.F. _____ subparagraph (1), subparagraph division (a), Code 2011, is 1 amended to read as follows: 2 (a) A physician for the infected person is of the good 3 faith opinion that the nature of the continuing contact poses 4 an imminent danger of HIV infection transmission to the third 5 party. 6 Sec. 15. Section 141A.6, subsection 1, Code 2011, is amended 7 to read as follows: 8 1. Prior to undergoing an a voluntary HIV-related test, 9 information shall be available to the subject of the test 10 concerning testing and any means of obtaining additional 11 information regarding HIV infection transmission and risk 12 reduction. If an individual signs a general consent form for 13 the performance of medical tests or procedures, the signing 14 of an additional consent form for the specific purpose of 15 consenting to an HIV-related test is not required during 16 the time in which the general consent form is in effect. 17 If an individual has not signed a general consent form 18 for the performance of medical tests and procedures or the 19 consent form is no longer in effect, a health care provider 20 shall obtain oral or written consent prior to performing an 21 HIV-related test. If an individual is unable to provide 22 consent, the individual’s legal guardian may provide consent. 23 If the individual’s legal guardian cannot be located or is 24 unavailable, a health care provider may authorize the test 25 when the test results are necessary for diagnostic purposes to 26 provide appropriate urgent medical care. 27 Sec. 16. Section 141A.9, subsection 2, paragraph i, Code 28 2011, is amended to read as follows: 29 i. Pursuant to section sections 915.42 and 915.43 , to a 30 convicted or alleged sexual assault offender; the physician or 31 other health care provider who orders the test of a convicted 32 or alleged offender; the victim; the parent, guardian, or 33 custodian of the victim if the victim is a minor; the physician 34 of the victim if requested by the victim; the victim counselor 35 -10- LSB 1230DP (15) 84 pf/nh 10/ 15

S.F. _____ H.F. _____ or person requested by the victim to provide counseling 1 regarding the HIV-related test and results; the victim’s 2 spouse; persons with whom the victim has engaged in vaginal, 3 anal, or oral intercourse subsequent to the sexual assault; 4 members of the victim’s family within the third degree of 5 consanguinity; and the county attorney who may use the results 6 as evidence in the prosecution of sexual assault under chapter 7 915, subchapter IV , or prosecution of the offense of criminal 8 transmission of HIV under chapter 709C . For the purposes of 9 this paragraph, “victim” means victim as defined in section 10 915.40 . 11 Sec. 17. Section 141A.9, subsection 3, Code 2011, is amended 12 to read as follows: 13 3. Release may be made of medical or epidemiological 14 information for research or statistical purposes in a manner 15 such that no individual person can be identified. 16 Sec. 18. Section 141A.9, Code 2011, is amended by adding the 17 following new subsection: 18 NEW SUBSECTION . 8. Medical information secured pursuant 19 to subsection 1 may be shared with other state or federal 20 agencies, with employees or agents of the department, or 21 with local units of government, who have a need for the 22 information in the performance of their duties related to HIV 23 prevention, disease surveillance, or care of persons with HIV, 24 only as necessary to administer the program for which the 25 information is collected or to administer a program within the 26 other agency. Confidential information transferred to other 27 entities under this subsection shall continue to maintain 28 its confidential status and shall not be rereleased by the 29 receiving entity. 30 Sec. 19. Section 141A.10, subsection 2, Code 2011, is 31 amended to read as follows: 32 2. A health care provider attending a person who tests 33 positive for the HIV infection has no duty to disclose to 34 or to warn third parties of the dangers of exposure to HIV 35 -11- LSB 1230DP (15) 84 pf/nh 11/ 15

S.F. _____ H.F. _____ infection through contact with that person and is immune from 1 any liability, civil or criminal, for failure to disclose to or 2 warn third parties of the condition of that person. 3 Sec. 20. REPEAL. Section 141A.8, Code 2011, is repealed. 4 DIVISION V 5 MISCELLANEOUS PROVISIONS 6 Sec. 21. Section 135.11, subsection 13, Code 2011, is 7 amended to read as follows: 8 13. Administer the statewide public health nursing, 9 homemaker-home health aide, and senior health programs healthy 10 aging and essential public health services by approving grants 11 of state funds to the local boards of health and the county 12 boards of supervisors for the purposes of promoting healthy 13 aging throughout the lifespan and enhancing health promotion 14 and disease prevention services, and by providing guidelines 15 for the approval of the grants and allocation of the state 16 funds. Program direction Guidelines , evaluation requirements , 17 and formula allocation procedures for each of the programs 18 services shall be established by the department by rule. 19 Sec. 22. Section 135A.5, subsection 1, Code 2011, is amended 20 to read as follows: 21 1. A governmental public health evaluation committee 22 is established to develop , and implement , and evaluate the 23 evaluation of the governmental public health system and 24 voluntary accreditation program. The committee shall meet 25 at least quarterly. The committee shall consist of no fewer 26 than eleven members and no more than thirteen members. The 27 members shall be appointed by the director of the department. 28 The director may solicit and consider recommendations from 29 professional organizations, associations, and academic 30 institutions in making appointments to the committee. 31 Sec. 23. REPEAL. Section 135.162, Code 2011, is repealed. 32 EXPLANATION 33 This bill relates to programs and activities under the 34 purview of the department of public health (DPH). 35 -12- LSB 1230DP (15) 84 pf/nh 12/ 15

S.F. _____ H.F. _____ Division I relates to the creation of an Iowa health 1 workforce center. The division eliminates an existing 2 directive to the department to establish and administer a 3 program relating to workforce supply and instead establishes 4 an Iowa health workforce center in the division of health 5 promotion and chronic disease prevention of DPH and specifies 6 its duties. 7 Division II relates to tobacco enforcement by eliminating 8 the requirement that DPH contract with the alcoholic beverages 9 division for enforcement. Instead, the department is directed 10 to ensure that enforcement efforts include training of local 11 authorities who issue retailer permits and education of 12 retailers. 13 Division III relates to communicable and infectious diseases 14 and poisonings. The bill includes AIDS and HIV, which were 15 previously excluded, in the definition of “contagious and 16 infectious disease” under Code chapter 139A (contagious and 17 infectious diseases and poisonings); provides new definitions 18 for “exposure” and “significant exposure”; amends provisions 19 for the notification of care providers who may have had a 20 significant exposure; provides for the reporting of positive 21 test results to the department; authorizes the notification 22 of a care provider after the individual who was the source of 23 a significant exposure is released from a hospital or other 24 health facility if the test did not result in notification 25 of the care provider, but the individual wishes to provide 26 information to the care provider regarding the individual’s 27 contagious or infectious disease status; amends a provision 28 that required DPH to pay the cost of testing of the individual 29 who is the source of a significant exposure and of a care 30 provider who renders direct aid without compensation and 31 instead requires DPH to assist these individuals in finding 32 resources to pay for the testing; and establishes a partner 33 notification program for those persons known to have tested 34 positive for a reportable sexually transmitted disease or 35 -13- LSB 1230DP (15) 84 pf/nh 13/ 15

S.F. _____ H.F. _____ infection. 1 Division IV relates to acquired immunodeficiency syndrome 2 provisions. The division amends definitions of exposure and 3 significant exposure; adds men who have sexual relations with 4 other men to the list of persons who are at risk for HIV and 5 to whom HIV testing and education are to be offered; clarifies 6 that the consent, testing, and reporting requirements are 7 applicable to HIV-related testing that is voluntary; eliminates 8 the care provider notification program since this program is 9 combined with the care provider program for communicable and 10 infectious diseases under Code chapter 139A in division III 11 of the bill; includes a reference to the section relating to 12 the right to HIV testing of a convicted or alleged assailant 13 in the context of confidentiality of information; allows for 14 the release of medical or epidemiological information for 15 the purpose of research as well as statistical purposes; and 16 provides for the sharing of medical information obtained, 17 submitted, or maintained under the chapter with other state 18 or federal agencies or local units of government only as 19 necessary to administer the program for which the information 20 is collected or a program within the other entity, but such 21 information is to maintain its confidential status not be 22 released. 23 Division V includes miscellaneous provisions. One provision 24 relates to healthy aging and updates language to eliminate 25 discontinued programs. The language also eliminates county 26 boards of supervisors as potential recipients of grants to 27 promote healthy aging and limits grants to local boards of 28 health. The bill amends a provision in the Iowa public health 29 modernization Act to clarify that the public health evaluation 30 committee is to develop and implement the evaluation of the 31 governmental public health system, not develop and implement 32 the system itself. The division also eliminates the clinicians 33 advisory panel. Clinical input is being provided directly by 34 physicians participating in the entities the advisory panel 35 -14- LSB 1230DP (15) 84 pf/nh 14/ 15