H.F. 285 Section 1. NEW SECTION . 135.131A Prenatal ultrasound. 1 1. The department shall adopt guidelines that require 2 attending health care providers to offer each pregnant woman 3 as part of the woman’s prenatal care the option of undergoing 4 a minimum of two ultrasounds when medically indicated to 5 maximize the possibility of assessing the risk factors for 6 and preventing premature birth, stillbirth, or other delivery 7 complications. The guidelines adopted shall be consistent 8 with or may adopt by reference the practice guidelines for the 9 performance of obstetric ultrasound examinations as approved 10 and published by the American institute of ultrasound in 11 medicine in conjunction with the American college of radiology 12 and the American college of obstetricians and gynecologists. 13 2. The attending health care provider shall provide the 14 following information to the pregnant woman regarding the 15 ultrasounds: 16 a. That the ultrasounds are voluntary at the discretion of 17 the pregnant woman. 18 b. Upon request of the pregnant woman, the complete results 19 of the ultrasound, including any risks associated with the 20 findings to determine the most effective way to manage the 21 pregnancy, labor, and delivery. 22 c. That health care coverage is provided in accordance with 23 section 514C.30 and through the medical assistance program. 24 3. The attending health care provider shall document the 25 pregnant woman’s declining of an ultrasound in the pregnant 26 woman’s medical record. 27 4. This section shall not be interpreted to limit the number 28 of ultrasounds provided to a woman during pregnancy or to hold 29 a health care provider liable for not providing an ultrasound 30 as specified in this section if the pregnant woman does not 31 seek prenatal care. 32 5. For the purposes of this section “attending health care 33 provider” means a licensed physician, nurse practitioner, 34 certified nurse midwife, physician assistant, or other health 35 -1- LSB 1609YH (3) 85 pf/nh 1/ 8

H.F. 285 care provider who has the primary responsibility for the 1 treatment and care of a pregnant woman. 2 Sec. 2. NEW SECTION . 135.131B Fetal movement education. 3 An attending health care provider, as defined in section 4 135.131A, shall provide to a pregnant woman prior to the 5 third trimester of the pregnancy, educational materials 6 regarding, and an explanation of the procedure to monitor, 7 fetal movement to reduce the risk of fetal death. The center 8 for congenital and inherited disorders shall make the fetal 9 movement educational materials available to attending health 10 care providers upon request. 11 Sec. 3. NEW SECTION . 136A.5A Newborn pulse oximetry 12 screening tests. 13 1. Each newborn born in this state shall receive a pulse 14 oximetry screening test in conjunction with the metabolic 15 screening required pursuant to section 136A.5 in accordance 16 with rules adopted by the department. 17 2. An attending health care provider, as defined in section 18 135.131A, shall ensure that every newborn under the provider’s 19 care receives the pulse oximetry screening test in accordance 20 with rules adopted by the department. 21 3. This section does not apply if a parent objects to 22 the screening. If a parent objects to the screening of a 23 newborn, the attending health care provider shall document the 24 refusal in the newborn’s medical record and shall obtain a 25 written refusal from the parent and report the refusal to the 26 department as provided by rule of the department. 27 4. The results of each newborn’s pulse oximetry screening 28 test shall be reported in a manner consistent with the 29 reporting of the results of metabolic screenings pursuant to 30 section 136A.5, and in accordance with rules adopted by the 31 center for congenital and inherited disorders in collaboration 32 with the department. 33 Sec. 4. NEW SECTION . 514C.30 Prenatal care —— ultrasounds. 34 1. a. Notwithstanding the uniformity of treatment 35 -2- LSB 1609YH (3) 85 pf/nh 2/ 8

H.F. 285 requirements of section 514C.6, a policy, contract, or plan 1 providing for third-party payment or prepayment of health or 2 medical expenses shall provide minimum ultrasound benefits 3 coverage for insured pregnant women. The provisions of this 4 section apply to the following classes of third-party payment 5 provider contracts, policies, or plans delivered, issued for 6 delivery, continued, or renewed in this state on or after July 7 1, 2013. 8 (1) Individual or group accident and sickness insurance 9 providing coverage on an expense-incurred basis. 10 (2) An individual or group hospital or medical service 11 contract issued pursuant to chapter 509, 514, or 514A. 12 (3) An individual or group health maintenance organization 13 contract regulated under chapter 514B. 14 (4) A plan established pursuant to chapter 509A for public 15 employees. 16 (5) A plan established by any other entity engaged in the 17 business of insurance, risk transfer, or risk retention, which 18 is subject to the jurisdiction of the commissioner. 19 b. This section shall not apply to accident-only, 20 specified disease, short-term hospital or medical, hospital 21 confinement indemnity, credit, dental, vision, Medicare 22 supplement, long-term care, basic hospital and medical-surgical 23 expense coverage as defined by the commissioner, disability 24 income insurance coverage, coverage issued as a supplement 25 to liability insurance, workers’ compensation or similar 26 insurance, or automobile medical payment insurance. 27 2. As used in this section, “minimum ultrasound benefits 28 coverage” means coverage for benefits which are equal to or 29 greater than a minimum of two ultrasounds as part of a woman’s 30 prenatal care offered at times when medically indicated to 31 maximize the possibility of assessing the risk factors for 32 and preventing premature birth, stillbirth, or other delivery 33 complications as specified under the guidelines adopted by the 34 department of public health pursuant to section 135.131A. 35 -3- LSB 1609YH (3) 85 pf/nh 3/ 8

H.F. 285 3. Notice of availability of the coverage shall be provided 1 to the insured in a summary of benefits and coverage issued to 2 the insured at the time of delivery, continuation, or renewal 3 of the coverage, policy, or plan. The coverage shall provide 4 that the ultrasounds shall be offered to but are voluntary on 5 the part of the pregnant woman. 6 4. This section shall not be interpreted to limit the 7 number of ultrasounds provided to a woman during pregnancy or 8 to hold a health care provider liable for not providing an 9 ultrasound covered under this section if the insured does not 10 seek prenatal care. 11 5. The commissioner of insurance shall adopt rules under 12 chapter 17A necessary to implement this section. 13 Sec. 5. NEW SECTION . 514C.31 Newborn pulse oximetry 14 screening. 15 1. a. Notwithstanding the uniformity of treatment 16 requirements of section 514C.6, a policy, contract, or plan 17 providing for third-party payment or prepayment of health or 18 medical expenses shall provide coverage to an insured for 19 newborn pulse oximetry screening as required to be administered 20 pursuant to section 136A.5A. The provisions of this section 21 apply to the following classes of third-party payment provider 22 contracts, policies, or plans delivered, issued for delivery, 23 continued, or renewed in this state on or after July 1, 2013. 24 (1) Individual or group accident and sickness insurance 25 providing coverage on an expense-incurred basis. 26 (2) An individual or group hospital or medical service 27 contract issued pursuant to chapter 509, 514, or 514A. 28 (3) An individual or group health maintenance organization 29 contract regulated under chapter 514B. 30 (4) A plan established pursuant to chapter 509A for public 31 employees. 32 (5) A plan established by any other entity engaged in the 33 business of insurance, risk transfer, or risk retention, which 34 is subject to the jurisdiction of the commissioner. 35 -4- LSB 1609YH (3) 85 pf/nh 4/ 8

H.F. 285 b. This section shall not apply to accident-only, 1 specified disease, short-term hospital or medical, hospital 2 confinement indemnity, credit, dental, vision, Medicare 3 supplement, long-term care, basic hospital and medical-surgical 4 expense coverage as defined by the commissioner, disability 5 income insurance coverage, coverage issued as a supplement 6 to liability insurance, workers’ compensation or similar 7 insurance, or automobile medical payment insurance. 8 2. Notice of availability of the coverage shall be provided 9 to the insured in a summary of benefits issued to the insured 10 at the time of delivery, continuation, or renewal of the 11 contract, policy, or plan. 12 3. The commissioner of insurance shall adopt rules under 13 chapter 17A necessary to implement this section. 14 Sec. 6. MEDICAL ASSISTANCE PROGRAM —— PRENATAL AND NEWBORN 15 COVERED BENEFITS. The department of human services shall 16 include as covered benefits under the medical assistance 17 program the prenatal ultrasounds as specified pursuant to 18 section 135.131A and the newborn pulse oximetry screening tests 19 as specified pursuant to section 136A.5A. The department 20 shall amend the medical assistance state plan as necessary to 21 implement this provision. 22 Sec. 7. CODE EDITOR DIRECTIVE. The Code editor shall create 23 a new division in chapter 135, following division XV, titled 24 “Prenatal and postpartum information and education” to include 25 sections 135.131A and 135.131B, as enacted in this Act. 26 EXPLANATION 27 This bill relates to health care provided during and after a 28 pregnancy. 29 The bill requires an attending health care provider to offer 30 each pregnant woman the option of undergoing a minimum of two 31 ultrasounds as medically indicated to maximize the possibility 32 of assessing the risk factors for and preventing premature 33 birth, stillbirth, or other delivery complications under 34 guidelines adopted by the department of public health (DPH). 35 -5- LSB 1609YH (3) 85 pf/nh 5/ 8

H.F. 285 The guidelines adopted are to be consistent with the practice 1 guidelines approved and published by the American institute of 2 ultrasound in medicine in conjunction with the American college 3 of radiology and the American college of obstetricians and 4 gynecologists. 5 The bill specifies the information to be provided to the 6 pregnant woman regarding the ultrasound upon request of the 7 pregnant woman, and requires the attending health care provider 8 to document the pregnant woman’s declining of an ultrasound in 9 the pregnant woman’s medical record. The bill provides that 10 the provision is not to be interpreted to limit the number of 11 ultrasounds provided to a woman during pregnancy or to hold a 12 provider liable for not providing an ultrasound as specified 13 under the provision if the pregnant woman does not seek 14 prenatal care. 15 The bill directs an attending health care provider to 16 provide to a pregnant woman prior to the third trimester of the 17 pregnancy, educational materials regarding, and an explanation 18 of the procedure to monitor, fetal movement to reduce the 19 risk of fetal death. The bill specifies that the center for 20 congenital and inherited disorders shall make the educational 21 materials available to attending health care providers upon 22 request. 23 The bill adds to Code chapter 136A (center for congenital 24 and inherited disorders) a requirement that each newborn born 25 in this state receive a pulse oximetry screening test in 26 conjunction with the metabolic screening required under the 27 Code chapter. An attending health care provider is required to 28 ensure that every newborn under the provider’s care receives 29 the pulse oximetry screening test. However, the requirement 30 does not apply if a parent objects to the screening. If a 31 parent objects to the screening, the attending health care 32 provider is required to document the refusal in the newborn’s 33 medical record and to obtain a written refusal from the parent 34 and report the refusal to the department of public health. 35 -6- LSB 1609YH (3) 85 pf/nh 6/ 8

H.F. 285 The results of the screening are to be reported in a manner 1 consistent with the reporting of the results of metabolic 2 screenings and in accordance with rules adopted by the center 3 for congenital and inherited disorders in collaboration with 4 DPH. 5 The bill requires that a policy, contract, or plan providing 6 for third-party payment or prepayment of health or medical 7 expenses provide minimum ultrasound benefits coverage on 8 or after July 1, 2013. The bill specifies the classes of 9 third-party payment provider contracts or policies subject and 10 not subject to the requirement; defines “minimum ultrasound 11 benefits coverage”; and requires that notice of availability 12 and the voluntary nature of the coverage be provided to the 13 insured. The bill provides that the provision is not to be 14 interpreted to limit the number of ultrasounds provided to a 15 woman during pregnancy or to hold a provider liable for not 16 providing an ultrasound covered under the bill if the insured 17 does not seek prenatal care. The bill directs the commissioner 18 of insurance to adopt rules under Code chapter 17A necessary to 19 implement the provision. 20 The bill requires that a policy, contract, or plan providing 21 for third-party payment or prepayment of health or medical 22 expenses provide coverage for the newborn pulse oximetry 23 screening as specified in Code section 136A.5A as enacted 24 in the bill. The bill specifies the classes of third-party 25 payment provider contracts, policies, or plans subject and 26 not subject to the requirement, and requires that notice of 27 availability of the coverage be provided to the insured. The 28 bill directs the commissioner of insurance to adopt rules under 29 Code chapter 17A necessary to implement the provision. 30 The bill also directs the department of human services (DHS) 31 to include as covered benefits under the medical assistance 32 program the prenatal ultrasounds as specified pursuant to Code 33 section 135.131A and the newborn pulse oximetry screening 34 tests as specified pursuant to Code section 136A.5A. The bill 35 -7- LSB 1609YH (3) 85 pf/nh 7/ 8