H.F. 2044 Section 1. NEW SECTION . 217.37 Epinephrine auto-injector 1 supply. 2 1. For purposes of this section, unless the context 3 otherwise requires: 4 a. “Epinephrine auto-injector” means the same as provided 5 in section 280.16. 6 b. “Personnel authorized to administer epinephrine” means an 7 employee of a provider trained and authorized to administer an 8 epinephrine auto-injector. 9 c. “Physician” means the same as provided in section 280.16. 10 d. “Provider” means a person who is a service provider who 11 is registered, approved, licensed, or regulated in accordance 12 with rules adopted by the department of human services or who 13 is reimbursed in whole or in part with funding administered by 14 the department. “Provider” includes but is not limited to a 15 child care provider, a family or group foster care provider, 16 a shelter care provider, a hospital, a mental health or 17 substance-related disorder service provider, an institutional 18 or home and community-based services waiver provider or other 19 health care provider that receives Medicaid funding, a regional 20 mental health and disability service system, or a state 21 institution administered by the department. 22 2. Notwithstanding any other provision of law to the 23 contrary, a physician may prescribe epinephrine auto-injectors 24 in the name of a provider to be maintained for use as provided 25 in this section. 26 3. A provider may obtain a prescription for epinephrine 27 auto-injectors and maintain a supply of such auto-injectors 28 in a secure location at each location where an individual 29 receives, treatment, care, or supervision from the provider 30 for use as provided in this section. A provider who obtains 31 such a prescription shall replace epinephrine auto-injectors 32 in the supply upon use or expiration. Personnel authorized to 33 administer epinephrine may possess and administer epinephrine 34 auto-injectors from the supply as provided in this section. 35 -1- LSB 5147YH (3) 85 je/nh 1/ 9

H.F. 2044 4. Personnel authorized to administer epinephrine may 1 provide or administer an epinephrine auto-injector from the 2 provider’s supply to an individual under the treatment, care, 3 or supervision of the provider if such personnel reasonably and 4 in good faith believe the individual is having an anaphylactic 5 reaction. 6 5. Any personnel authorized to administer epinephrine 7 who provide, administer, or assist in the administration 8 of an epinephrine auto-injector to an individual receiving 9 treatment, care, or supervision from the provider who such 10 personnel reasonably and in good faith believe to be having an 11 anaphylactic reaction; a provider employing the personnel; the 12 owner or operator of the provider; or the prescriber of the 13 epinephrine auto-injector, shall incur no liability, except for 14 gross negligence, as a result of any injury arising from the 15 provision, administration, or assistance in the administration 16 of an epinephrine auto-injector as provided in this section. 17 6. The department of human services, the board of medicine, 18 and the board of pharmacy shall adopt rules to implement and 19 administer this section, including but not limited to standards 20 and procedures for the prescription, distribution, storage, 21 replacement, and administration of epinephrine auto-injectors, 22 and for training and authorization to be required for personnel 23 authorized to administer epinephrine. 24 Sec. 2. Section 280.16, Code 2014, is amended to read as 25 follows: 26 280.16 Self-administration of asthma or other airway 27 constricting disease medication certain medications . 28 1. Definitions. For purposes of this section : 29 a. “Epinephrine auto-injector” means a medical device for 30 immediate self-administration of a measured dose of epinephrine 31 by a person at risk of anaphylaxis. 32 a. b. “Medication” means a drug that meets the definition 33 provided in section 126.2, subsection 8 , has an individual 34 prescription label, is prescribed by a physician for a 35 -2- LSB 5147YH (3) 85 je/nh 2/ 9

H.F. 2044 student, and pertains to the student’s asthma or other airway 1 constricting disease. 2 b. c. “Physician” means a person licensed under chapter 3 148 , or a physician’s assistant, advanced registered nurse 4 practitioner, or other person licensed or registered to 5 distribute or dispense a prescription drug or device in the 6 course of professional practice in this state in accordance 7 with section 147.107 , or a person licensed by another state 8 in a health field in which, under Iowa law, licensees in this 9 state may legally prescribe drugs. 10 c. d. “Self-administration” means a student’s discretionary 11 use of medication prescribed by a physician for the student. 12 2. The board of directors of a school district and the 13 authorities in charge of an accredited nonpublic school shall 14 permit the self-administration of medication by a student 15 with asthma or other airway constricting disease or the use 16 of an epinephrine auto-injector by a student if the following 17 conditions are met: 18 a. The student’s parent or guardian provides to the school 19 written authorization for the self-administration of medication 20 or for the use of an epinephrine auto-injector . 21 b. The student’s parent or guardian provides to the school 22 a written statement from the student’s physician containing the 23 following information: 24 (1) The name and purpose of the medication or epinephrine 25 auto-injector . 26 (2) The prescribed dosage. 27 (3) The times at which or the special circumstances under 28 which the medication or epinephrine auto-injector is to be 29 administered. 30 c. The parent or guardian and the school meet the 31 requirements of subsection 3 . 32 3. The school district or accredited nonpublic school 33 shall notify the parent or guardian of the student, in 34 writing, that the school district or accredited nonpublic 35 -3- LSB 5147YH (3) 85 je/nh 3/ 9

H.F. 2044 school and its employees are to incur no liability, except 1 for gross negligence, as a result of any injury arising from 2 self-administration of medication or use of an epinephrine 3 auto-injector by the student. The parent or guardian of the 4 student shall sign a statement acknowledging that the school 5 district or nonpublic school is to incur no liability, except 6 for gross negligence, as a result of self-administration of 7 medication or use of an epinephrine auto-injector by the 8 student. A school district or accredited nonpublic school 9 and its employees acting reasonably and in good faith shall 10 incur no liability for any improper use of medication or an 11 epinephrine auto-injector as defined in this section or for 12 supervising, monitoring, or interfering with a student’s 13 self-administration of medication or use of an epinephrine 14 auto-injector as defined in this section . 15 4. The permission for self-administration of medication 16 or use of an epinephrine auto-injector is effective for the 17 school year for which it is granted and shall be renewed each 18 subsequent school year upon fulfillment of the requirements 19 of this section . However, the parent or guardian shall 20 immediately notify the school of any changes in the conditions 21 listed under subsection 2 . 22 5. Provided that the requirements of this section are 23 fulfilled, a student with asthma or other airway constricting 24 disease may possess and use the student’s medication and a 25 student with a written statement from a physician on file 26 pursuant to subsection 2, paragraph “a” may use an epinephrine 27 auto-injector while in school, at school-sponsored activities, 28 under the supervision of school personnel, and before or after 29 normal school activities, such as while in before-school or 30 after-school care on school-operated property. If the student 31 misuses this privilege, the privilege may be withdrawn. A 32 school district or nonpublic school shall notify a student’s 33 parent or guardian before withdrawing the privilege to use an 34 epinephrine auto-injector. 35 -4- LSB 5147YH (3) 85 je/nh 4/ 9

H.F. 2044 6. Information provided to the school under subsection 2 1 shall be kept on file in the office of the school nurse or, in 2 the absence of a school nurse, the school’s administrator. 3 7. The Iowa braille and sight saving school, the state 4 school for the deaf, and the institutions under the control of 5 the department of human services as provided in section 218.1 6 are exempt from the provisions of this section . 7 Sec. 3. NEW SECTION . 280.16A Epinephrine auto-injector 8 supply. 9 1. For purposes of this section, unless the context 10 otherwise requires: 11 a. “Epinephrine auto-injector” means the same as provided 12 in section 280.16. 13 b. “Personnel authorized to administer epinephrine” means a 14 school nurse or other employee of a school district trained and 15 authorized to administer an epinephrine auto-injector. 16 c. “Physician” means the same as provided in section 280.16. 17 2. Notwithstanding any other provision of law to the 18 contrary, a physician may prescribe epinephrine auto-injectors 19 in the name of a school district to be maintained for use as 20 provided in this section. 21 3. The board of directors in charge of each school district 22 shall obtain a prescription for epinephrine auto-injectors and 23 maintain a supply of such auto-injectors in a secure location 24 at each school for use as provided in this section. The board 25 shall replace epinephrine auto-injectors in the supply upon use 26 or expiration. Personnel authorized to administer epinephrine 27 may possess and administer epinephrine auto-injectors from the 28 supply as provided in this section. 29 4. Personnel authorized to administer epinephrine may 30 provide or administer an epinephrine auto-injector from 31 the school district’s supply to a student if such personnel 32 reasonably and in good faith believe the student is having an 33 anaphylactic reaction. 34 5. Any personnel authorized to administer epinephrine 35 -5- LSB 5147YH (3) 85 je/nh 5/ 9

H.F. 2044 who provide, administer, or assist in the administration 1 of an epinephrine auto-injector to a student who such 2 personnel reasonably and in good faith believe to be having 3 an anaphylactic reaction; a school district employing the 4 personnel; the board of directors in charge of the school 5 district; or the prescriber of the epinephrine auto-injector, 6 shall incur no liability, except for gross negligence, 7 as a result of any injury arising from the provision, 8 administration, or assistance in the administration of an 9 epinephrine auto-injector as provided in this section. 10 6. The department of education, the board of medicine, 11 and the board of pharmacy shall adopt rules to implement and 12 administer this section, including but not limited to standards 13 and procedures for the prescription, distribution, storage, 14 replacement, and administration of epinephrine auto-injectors, 15 and for training and authorization to be required for personnel 16 authorized to administer epinephrine. 17 Sec. 4. POLICIES ON ANAPHYLAXIS IN A SCHOOL SETTING. The 18 department of education shall develop, in collaboration 19 with the board of medicine and education and health care 20 stakeholders, policies for the recognition and treatment 21 of anaphylaxis in a school setting. The director of the 22 department shall submit a report to the general assembly by 23 January 1, 2015, recommending any legislation necessary to 24 improve recognition and treatment of anaphylaxis in a school 25 setting. 26 Sec. 5. IMPLEMENTATION OF ACT. Section 25B.2, subsection 27 3, shall not apply to this Act. 28 EXPLANATION 29 The inclusion of this explanation does not constitute agreement with 30 the explanation’s substance by the members of the general assembly. 31 This bill requires the board of directors in charge of each 32 school district to maintain in a secure location at each school 33 a supply of epinephrine auto-injectors for use as provided in 34 the bill. The bill requires the board to replace epinephrine 35 -6- LSB 5147YH (3) 85 je/nh 6/ 9

H.F. 2044 auto-injectors in the supply upon use or expiration. The bill 1 requires the board to obtain a prescription for epinephrine 2 auto-injectors for use as provided in the bill. The bill 3 permits personnel authorized to administer epinephrine to 4 possess and administer epinephrine auto-injectors from the 5 supply as provided in the bill. The bill permits a physician 6 to prescribe epinephrine auto-injectors in the name of a school 7 district to be maintained for use as provided in the bill, 8 notwithstanding any other provision of law to the contrary. 9 The bill permits personnel authorized to administer 10 epinephrine to provide or administer an epinephrine 11 auto-injector from a school district’s supply to a student if 12 such personnel reasonably and in good faith believe the student 13 is having an anaphylactic reaction. 14 The bill provides immunity from legal liability, except for 15 gross negligence, to any personnel authorized to administer 16 epinephrine who provide, administer, or assist in the 17 administration of an epinephrine auto-injector to a student 18 who such personnel reasonably and in good faith believe to be 19 having an anaphylactic reaction; a school district employing 20 the personnel; the board of directors in charge of the school 21 district; or the prescriber of the epinephrine auto-injector, 22 for any injury arising from the provision, administration, 23 or assistance in the administration of an epinephrine 24 auto-injector as provided in the bill. 25 The bill defines “epinephrine auto-injector” as a medical 26 device for immediate self-administration of a measured dose 27 of epinephrine by a person at risk of anaphylaxis. The bill 28 defines “personnel authorized to administer epinephrine” as an 29 employee trained and authorized to administer an epinephrine 30 auto-injector. 31 The bill permits a person who is a service provider who is 32 registered, approved, licensed, or regulated in accordance 33 with rules adopted by the department of human services or who 34 is reimbursed in whole or in part with funding administered 35 -7- LSB 5147YH (3) 85 je/nh 7/ 9

H.F. 2044 by the department to maintain a supply of epinephrine 1 auto-injectors in the same fashion, with the same duties, 2 powers, and immunities relating to maintaining a supply of 3 epinephrine auto-injectors and administering the auto-injectors 4 applying if the provider chooses to do so. The bill specifies 5 that “provider” includes but is not limited to a child care 6 provider, a family or group foster care provider, a shelter 7 care provider, a hospital, a mental health or substance-related 8 disorder service provider, an institutional or home and 9 community-based services waiver provider or other health care 10 provider that receives Medicaid funding, a regional mental 11 health and disability service system, or a state institution 12 administered by the department. 13 The bill requires the department of education, the 14 department of human services, the board of medicine, and the 15 board of pharmacy to adopt rules to implement and administer 16 the bill, including but not limited to standards and procedures 17 for the prescription, distribution, storage, replacement, and 18 administration of epinephrine auto-injectors, and for training 19 and authorization to be required for personnel authorized to 20 administer epinephrine auto-injectors. 21 The bill also adds epinephrine auto-injectors to Code 22 section 280.16, which permits self-administration of medication 23 in public and nonpublic schools by students with asthma. 24 The bill requires school districts and nonpublic schools 25 to allow the use of an epinephrine auto-injector by a student 26 with a written statement from a physician on file if the school 27 receives written authorization and certain medical information 28 from the student’s parent or guardian. 29 The bill permits a student with a written statement 30 from a physician on file to possess and use an epinephrine 31 auto-injector while in school, at school-sponsored activities, 32 under the supervision of school personnel, and before or after 33 normal school activities, such as while in before-school or 34 after-school care on school-operated property. The bill 35 -8- LSB 5147YH (3) 85 je/nh 8/ 9

H.F. 2044 requires a school district or nonpublic school to notify a 1 student’s parent or guardian before withdrawing the privilege 2 to use an epinephrine auto-injector. 3 The bill adds epinephrine auto-injectors to the provisions 4 of Code section 280.16 granting immunity from legal liability 5 to school employees, except for gross negligence, for injuries 6 resulting from the self-administration of medication. Code 7 section 280.16 requires a student’s parent or guardian to 8 receive notice of such immunity. 9 The bill requires the director of the department of 10 education to develop, in collaboration with the board of 11 medicine and education and health care stakeholders, policies 12 for the recognition and treatment of anaphylaxis in a school 13 setting. The bill requires the director to submit a report 14 to the general assembly by January 1, 2015, recommending any 15 legislation necessary to improve recognition and treatment of 16 anaphylaxis in a school setting. 17 The bill may include a state mandate as defined in Code 18 section 25B.3. The bill makes inapplicable Code section 25B.2, 19 subsection 3, which would relieve a political subdivision from 20 complying with a state mandate if funding for the cost of 21 the state mandate is not provided or specified. Therefore, 22 political subdivisions are required to comply with any state 23 mandate included in the bill. 24 -9- LSB 5147YH (3) 85 je/nh 9/ 9