S.F. _____ H.F. _____ DIVISION I 1 ORGANIZED DELIVERY SYSTEMS 2 Section 1. Section 135H.3, subsection 2, Code 2013, is 3 amended to read as follows: 4 2. If a child is diagnosed with a biologically based mental 5 illness as defined in section 514C.22 and meets the medical 6 assistance program criteria for admission to a psychiatric 7 medical institution for children, the child shall be deemed 8 to meet the acuity criteria for medically necessary inpatient 9 benefits under a group policy, contract, or plan providing 10 for third-party payment or prepayment of health, medical, and 11 surgical coverage benefits issued by a carrier, as defined in 12 section 513B.2 , or by an organized delivery system authorized 13 under 1993 Iowa Acts, ch. 158, that is subject to section 14 514C.22 . Such medically necessary benefits shall not be 15 excluded or denied as care that is substantially custodial in 16 nature under section 514C.22, subsection 8 , paragraph “b” . 17 Sec. 2. Section 505.32, subsection 2, paragraph i, Code 18 2013, is amended by striking the paragraph. 19 Sec. 3. Section 507B.4, subsection 1, Code 2013, is amended 20 to read as follows: 21 1. For purposes of subsection 3 , paragraph “p” , “insurer” 22 means an entity providing a plan of health insurance, health 23 care benefits, or health care services, or an entity subject 24 to the jurisdiction of the commissioner performing utilization 25 review, including an insurance company offering sickness and 26 accident plans, a health maintenance organization, an organized 27 delivery system authorized under 1993 Iowa Acts, ch. 158 , and 28 licensed by the department of public health, a nonprofit health 29 service corporation, a plan established pursuant to chapter 30 509A for public employees, or any other entity providing a 31 plan of health insurance, health care benefits, or health care 32 services. However, “insurer” does not include an entity that 33 sells disability income or long-term care insurance. 34 Sec. 4. Section 507B.4A, subsection 2, paragraph a, Code 35 -1- LSB 1252DP (18) 85 pf/nh 1/ 17

S.F. _____ H.F. _____ 2013, is amended to read as follows: 1 a. An insurer providing accident and sickness insurance 2 under chapter 509 , 514 , or 514A ; a health maintenance 3 organization; an organized delivery system authorized under 4 1993 Iowa Acts, ch. 158, and licensed by the department of 5 public health; or another entity providing health insurance or 6 health benefits subject to state insurance regulation shall 7 either accept and pay or deny a clean claim. 8 Sec. 5. Section 509.3A, subsection 11, Code 2013, is amended 9 by striking the subsection. 10 Sec. 6. Section 509.19, subsection 2, paragraph d, Code 11 2013, is amended by striking the paragraph. 12 Sec. 7. Section 513B.2, subsection 8, paragraph k, Code 13 2013, is amended by striking the paragraph. 14 Sec. 8. Section 513B.7, subsection 3, Code 2013, is amended 15 to read as follows: 16 3. A small employer carrier or organized delivery system 17 shall make the information and documentation described in 18 subsection 1 available to the commissioner or the director of 19 public health upon request. The information is not a public 20 record or otherwise subject to disclosure under chapter 22 , 21 and is considered proprietary and trade secret information 22 and is not subject to disclosure by the commissioner or the 23 director of public health to persons outside of the division or 24 department except as agreed to by the small employer carrier or 25 organized delivery system or as ordered by a court of competent 26 jurisdiction. 27 Sec. 9. Section 513B.10, subsection 1, paragraph b, 28 subparagraph (2), unnumbered paragraph 1, Code 2013, is amended 29 to read as follows: 30 Deny such coverage to such employers within the service area 31 of such plan if the carrier or organized delivery system has 32 demonstrated to the applicable state authority commissioner 33 both of the following: 34 Sec. 10. Section 513B.10, subsection 3, paragraph c, Code 35 -2- LSB 1252DP (18) 85 pf/nh 2/ 17

S.F. _____ H.F. _____ 2013, is amended to read as follows: 1 c. A carrier or organized delivery system shall waive 2 any waiting period applicable to a preexisting condition 3 exclusion or limitation period with respect to particular 4 services under health insurance coverage for the period 5 of time an individual was covered by creditable coverage, 6 provided that the creditable coverage was continuous to a 7 date not more than sixty-three days prior to the effective 8 date of the new coverage. Any period that an individual 9 is in a waiting period for any coverage under group health 10 insurance coverage, or is in an affiliation period, shall not 11 be taken into account in determining the period of continuous 12 coverage. A health maintenance organization that does not 13 use preexisting condition limitations in any of its health 14 insurance coverage may impose an affiliation period. For 15 purposes of this section , “affiliation period” means a period 16 of time not to exceed sixty days for new entrants and not to 17 exceed ninety days for late enrollees during which no premium 18 shall be collected and coverage issued is not effective, so 19 long as the affiliation period is applied uniformly, without 20 regard to any health status-related factors. This paragraph 21 does not preclude application of a waiting period applicable 22 to all new enrollees under the health insurance coverage, 23 provided that any carrier or organized delivery system-imposed 24 carrier-imposed waiting period is no longer than sixty days and 25 is used in lieu of a preexisting condition exclusion. 26 Sec. 11. Section 513C.3, subsection 5, Code 2013, is amended 27 to read as follows: 28 5. “Carrier” means any entity that provides individual 29 health benefit plans in this state. For purposes of this 30 chapter , carrier includes an insurance company, a group 31 hospital or medical service corporation, a fraternal benefit 32 society, a health maintenance organization, and any other 33 entity providing an individual plan of health insurance 34 or health benefits subject to state insurance regulation. 35 -3- LSB 1252DP (18) 85 pf/nh 3/ 17

S.F. _____ H.F. _____ “Carrier” does not include an organized delivery system. 1 Sec. 12. Section 513C.3, subsection 7, Code 2013, is amended 2 by striking the subsection. 3 Sec. 13. Section 513C.3, subsection 9, Code 2013, is amended 4 to read as follows: 5 9. “Established service area” means a geographic area, 6 as approved by the commissioner and based upon the carrier’s 7 certificate of authority to transact business in this state, 8 within which the carrier is authorized to provide coverage or 9 a geographic area, as approved by the director and based upon 10 the organized delivery system’s license to transact business 11 in this state, within which the organized delivery system is 12 authorized to provide coverage . 13 Sec. 14. Section 513C.3, subsection 12, Code 2013, is 14 amended by striking the subsection. 15 Sec. 15. Section 513C.3, subsection 15, paragraph a, 16 subparagraph (3), Code 2013, is amended by striking the 17 subparagraph. 18 Sec. 16. Section 513C.7, subsection 1, paragraph b, Code 19 2013, is amended by striking the paragraph. 20 Sec. 17. Section 513C.10, subsection 10, paragraph b, Code 21 2013, is amended by striking the paragraph. 22 Sec. 18. Section 514A.3B, subsection 3, paragraph k, Code 23 2013, is amended by striking the paragraph. 24 Sec. 19. Section 514B.25A, subsection 1, Code 2013, is 25 amended to read as follows: 26 1. Upon a health maintenance organization or organized 27 delivery system authorized to do business in this state and 28 licensed by the director of public health being declared 29 insolvent by the district court, the commissioner may levy an 30 assessment on each health maintenance organization or organized 31 delivery system doing business in this state and licensed by 32 the director of public health, as applicable, to pay claims 33 for uncovered expenditures for enrollees. The commissioner 34 shall not assess an amount in any one calendar year which is 35 -4- LSB 1252DP (18) 85 pf/nh 4/ 17

S.F. _____ H.F. _____ more than two percent of the aggregate premium written by each 1 health maintenance organization or organized delivery system . 2 Sec. 20. Section 514C.10, subsection 2, paragraph e, Code 3 2013, is amended by striking the paragraph. 4 Sec. 21. Section 514C.11, Code 2013, is amended to read as 5 follows: 6 514C.11 Services provided by licensed physician assistants 7 and licensed advanced registered nurse practitioners. 8 Notwithstanding section 514C.6 , a policy or contract 9 providing for third-party payment or prepayment of health or 10 medical expenses shall include a provision for the payment 11 of necessary medical or surgical care and treatment provided 12 by a physician assistant licensed pursuant to chapter 148C , 13 or provided by an advanced registered nurse practitioner 14 licensed pursuant to chapter 152 and performed within the 15 scope of the license of the licensed physician assistant or 16 the licensed advanced registered nurse practitioner if the 17 policy or contract would pay for the care and treatment if 18 the care and treatment were provided by a person engaged in 19 the practice of medicine and surgery or osteopathic medicine 20 and surgery under chapter 148 . The policy or contract shall 21 provide that policyholders and subscribers under the policy 22 or contract may reject the coverage for services which may 23 be provided by a licensed physician assistant or licensed 24 advanced registered nurse practitioner if the coverage is 25 rejected for all providers of similar services. A policy or 26 contract subject to this section shall not impose a practice 27 or supervision restriction which is inconsistent with or more 28 restrictive than the restriction already imposed by law. This 29 section applies to services provided under a policy or contract 30 delivered, issued for delivery, continued, or renewed in this 31 state on or after July 1, 1996, and to an existing policy or 32 contract, on the policy’s or contract’s anniversary or renewal 33 date, or upon the expiration of the applicable collective 34 bargaining contract, if any, whichever is later. This section 35 -5- LSB 1252DP (18) 85 pf/nh 5/ 17

S.F. _____ H.F. _____ does not apply to policyholders or subscribers eligible for 1 coverage under Tit. XVIII of the federal Social Security Act 2 or any similar coverage under a state or federal government 3 plan. For the purposes of this section , third-party payment 4 or prepayment includes an individual or group policy of 5 accident or health insurance or individual or group hospital 6 or health care service contract issued pursuant to chapter 7 509 , 514 , or 514A , an individual or group health maintenance 8 organization contract issued and regulated under chapter 514B , 9 an organized delivery system contract regulated under rules 10 adopted by the director of public health, or a preferred 11 provider organization contract regulated pursuant to chapter 12 514F . Nothing in this section shall be interpreted to require 13 an individual or group health maintenance organization , an 14 organized delivery system, or a preferred provider organization 15 or arrangement to provide payment or prepayment for services 16 provided by a licensed physician assistant or licensed advanced 17 registered nurse practitioner unless the physician assistant’s 18 supervising physician, the physician-physician assistant team, 19 the advanced registered nurse practitioner, or the advanced 20 registered nurse practitioner’s collaborating physician has 21 entered into a contract or other agreement to provide services 22 with the individual or group health maintenance organization , 23 the organized delivery system, or the preferred provider 24 organization or arrangement. 25 Sec. 22. Section 514C.13, subsection 1, paragraph h, Code 26 2013, is amended by striking the paragraph. 27 Sec. 23. Section 514C.14, subsections 1 and 3, Code 2013, 28 are amended to read as follows: 29 1. Except as provided under subsection 2 or 3 , a carrier, 30 as defined in section 513B.2 , an organized delivery system 31 authorized under 1993 Iowa Acts, ch. 158, or a plan established 32 pursuant to chapter 509A for public employees, which terminates 33 its contract with a participating health care provider, 34 shall continue to provide coverage under the contract to a 35 -6- LSB 1252DP (18) 85 pf/nh 6/ 17

S.F. _____ H.F. _____ covered person in the second or third trimester of pregnancy 1 for continued care from such health care provider. Such 2 persons may continue to receive such treatment or care through 3 postpartum care related to the child birth and delivery. 4 Payment for covered benefits and benefit levels shall be 5 according to the terms and conditions of the contract. 6 3. A carrier , organized delivery system, or a plan 7 established under chapter 509A , which terminates the contract 8 of a participating health care provider for cause shall not 9 be liable to pay for health care services provided by the 10 health care provider to a covered person following the date of 11 termination. 12 Sec. 24. Section 514C.15, unnumbered paragraph 1, Code 13 2013, is amended to read as follows: 14 A carrier, as defined in section 513B.2 ; an organized 15 delivery system authorized under 1993 Iowa Acts, ch. 158, 16 and licensed by the director of public health; , or a plan 17 established pursuant to chapter 509A for public employees, 18 shall not prohibit a participating provider from, or penalize a 19 participating provider for, doing either of the following: 20 Sec. 25. Section 514C.16, subsection 1, Code 2013, is 21 amended to read as follows: 22 1. A carrier, as defined in section 513B.2 ; an organized 23 delivery system authorized under 1993 Iowa Acts, ch. 158, 24 and licensed by the director of public health; , or a plan 25 established pursuant to chapter 509A for public employees, 26 which provides coverage for emergency services, is responsible 27 for charges for emergency services provided to a covered 28 individual, including services furnished outside any 29 contractual provider network or preferred provider network. 30 Coverage for emergency services is subject to the terms and 31 conditions of the health benefit plan or contract. 32 Sec. 26. Section 514C.17, subsections 1 and 3, Code 2013, 33 are amended to read as follows: 34 1. Except as provided under subsection 2 or 3 , if a carrier, 35 -7- LSB 1252DP (18) 85 pf/nh 7/ 17

S.F. _____ H.F. _____ as defined in section 513B.2 , an organized delivery system 1 authorized under 1993 Iowa Acts, ch. 158, or a plan established 2 pursuant to chapter 509A for public employees, terminates its 3 contract with a participating health care provider, a covered 4 individual who is undergoing a specified course of treatment 5 for a terminal illness or a related condition, with the 6 recommendation of the covered individual’s treating physician 7 licensed under chapter 148 may continue to receive coverage for 8 treatment received from the covered individual’s physician for 9 the terminal illness or a related condition, for a period of 10 up to ninety days. Payment for covered benefits and benefit 11 levels shall be according to the terms and conditions of the 12 contract. 13 3. Notwithstanding subsections 1 and 2 , a carrier , 14 organized delivery system, or a plan established under chapter 15 509A which terminates the contract of a participating health 16 care provider for cause shall not be required to cover health 17 care services provided by the health care provider to a covered 18 person following the date of termination. 19 Sec. 27. Section 514C.18, subsection 2, paragraph a, 20 subparagraph (6), Code 2013, is amended by striking the 21 subparagraph. 22 Sec. 28. Section 514C.19, subsection 7, paragraph a, 23 subparagraph (6), Code 2013, is amended by striking the 24 subparagraph. 25 Sec. 29. Section 514C.20, subsection 3, paragraph f, Code 26 2013, is amended by striking the paragraph. 27 Sec. 30. Section 514C.21, subsection 2, paragraph d, Code 28 2013, is amended by striking the paragraph. 29 Sec. 31. Section 514C.22, subsection 1, unnumbered 30 paragraph 1, Code 2013, is amended to read as follows: 31 Notwithstanding the uniformity of treatment requirements of 32 section 514C.6 , a group policy, contract, or plan providing 33 for third-party payment or prepayment of health, medical, and 34 surgical coverage benefits issued by a carrier, as defined in 35 -8- LSB 1252DP (18) 85 pf/nh 8/ 17

S.F. _____ H.F. _____ section 513B.2 , or by an organized delivery system authorized 1 under 1993 Iowa Acts, ch. 158, shall provide coverage benefits 2 for treatment of a biologically based mental illness if either 3 of the following is satisfied: 4 Sec. 32. Section 514C.25, subsection 2, paragraph a, 5 subparagraph (5), Code 2013, is amended by striking the 6 subparagraph. 7 Sec. 33. Section 514C.26, subsection 5, paragraph a, 8 subparagraph (6), Code 2013, is amended by striking the 9 subparagraph. 10 Sec. 34. Section 514C.27, subsection 1, unnumbered 11 paragraph 1, Code 2013, is amended to read as follows: 12 Notwithstanding the uniformity of treatment requirements 13 of section 514C.6 , a group policy or contract providing for 14 third-party payment or prepayment of health or medical expenses 15 issued by a carrier, as defined in section 513B.2 , or by an 16 organized delivery system authorized under 1993 Iowa Acts, 17 chapter 158 , shall provide coverage benefits to an insured who 18 is a veteran for treatment of mental illness and substance 19 abuse if either of the following is satisfied: 20 Sec. 35. Section 514C.29, subsection 2, paragraph e, Code 21 2013, is amended by striking the paragraph. 22 Sec. 36. Section 514E.1, subsection 6, paragraph k, Code 23 2013, is amended by striking the paragraph. 24 Sec. 37. Section 514E.1, subsection 17, Code 2013, is 25 amended by striking the subsection. 26 Sec. 38. Section 514E.2, subsection 1, paragraph a, Code 27 2013, is amended to read as follows: 28 a. All carriers and all organized delivery systems licensed 29 by the director of public health providing health insurance or 30 health care services in Iowa, whether on an individual or group 31 basis, and all other insurers designated by the association’s 32 board of directors and approved by the commissioner shall be 33 members of the association. 34 Sec. 39. Section 514F.5, Code 2013, is amended to read as 35 -9- LSB 1252DP (18) 85 pf/nh 9/ 17

S.F. _____ H.F. _____ follows: 1 514F.5 Experimental treatment review. 2 1. A carrier, as defined in section 513B.2 , an organized 3 delivery system authorized under 1993 Iowa Acts, ch. 158, or a 4 plan established pursuant to chapter 509A for public employees, 5 that limits coverage for experimental medical treatment, drugs, 6 or devices, shall develop and implement a procedure to evaluate 7 experimental medical treatments and shall submit a description 8 of the procedure to the division of insurance. The procedure 9 shall be in writing and must describe the process used to 10 determine whether the carrier , organized delivery system, 11 or chapter 509A plan will provide coverage for new medical 12 technologies and new uses of existing technologies. The 13 procedure, at a minimum, shall require a review of information 14 from appropriate government regulatory agencies and published 15 scientific literature concerning new medical technologies, new 16 uses of existing technologies, and the use of external experts 17 in making decisions. A carrier , organized delivery system, 18 or chapter 509A plan shall include appropriately licensed 19 or qualified professionals in the evaluation process. The 20 procedure shall provide a process for a person covered under 21 a plan or contract to request a review of a denial of coverage 22 because the proposed treatment is experimental. A review of 23 a particular treatment need not be reviewed more than once a 24 year. 25 2. A carrier , organized delivery system, or chapter 509A 26 plan that limits coverage for experimental treatment, drugs, or 27 devices shall clearly disclose such limitations in a contract, 28 policy, or certificate of coverage. 29 Sec. 40. Section 514I.2, subsection 10, Code 2013, is 30 amended to read as follows: 31 10. “Participating insurer” means any entity licensed by the 32 division of insurance of the department of commerce to provide 33 health insurance in Iowa or an organized delivery system 34 licensed by the director of public health that has contracted 35 -10- LSB 1252DP (18) 85 pf/nh 10/ 17

S.F. _____ H.F. _____ with the department to provide health insurance coverage to 1 eligible children under this chapter . 2 Sec. 41. Section 514J.102, subsection 23, Code 2013, is 3 amended to read as follows: 4 23. “Health carrier” means an entity subject to the 5 insurance laws and regulations of this state, or subject 6 to the jurisdiction of the commissioner, including an 7 insurance company offering sickness and accident plans, a 8 health maintenance organization, a nonprofit health service 9 corporation, a plan established pursuant to chapter 509A 10 for public employees, or any other entity providing a plan 11 of health insurance, health care benefits, or health care 12 services. “Health carrier” includes, for purposes of this 13 chapter , an organized delivery system. 14 Sec. 42. Section 514J.102, subsection 28, Code 2013, is 15 amended by striking the subsection. 16 Sec. 43. Section 514L.1, subsection 3, Code 2013, is amended 17 to read as follows: 18 3. “Provider of third-party payment or prepayment of 19 prescription drug expenses” or “provider” means a provider of an 20 individual or group policy of accident or health insurance or 21 an individual or group hospital or health care service contract 22 issued pursuant to chapter 509 , 514 , or 514A , a provider of a 23 plan established pursuant to chapter 509A for public employees, 24 a provider of an individual or group health maintenance 25 organization contract issued and regulated under chapter 514B , 26 a provider of an organized delivery system contract regulated 27 under rules adopted by the director of public health, a 28 provider of a preferred provider contract issued pursuant to 29 chapter 514F , a provider of a self-insured multiple employer 30 welfare arrangement, and any other entity providing health 31 insurance or health benefits which provide for payment or 32 prepayment of prescription drug expenses coverage subject to 33 state insurance regulation. 34 Sec. 44. Section 514L.2, subsection 1, paragraph a, 35 -11- LSB 1252DP (18) 85 pf/nh 11/ 17

S.F. _____ H.F. _____ unnumbered paragraph 1, Code 2013, is amended to read as 1 follows: 2 A provider of third-party payment or prepayment of 3 prescription drug expenses, including the provider’s agents or 4 contractors and pharmacy benefits managers, that issues a card 5 or other technology for claims processing and an administrator 6 of the payor, excluding administrators of self-funded employer 7 sponsored health benefit plans qualified under the federal 8 Employee Retirement Income Security Act of 1974, shall issue 9 to its insureds a card or other technology containing uniform 10 prescription drug information. The commissioner of insurance 11 shall adopt rules for the uniform prescription drug information 12 card or technology applicable to those entities subject to 13 regulation by the commissioner of insurance. The director of 14 public health shall adopt rules for the uniform prescription 15 drug information card or technology applicable to organized 16 delivery systems. The rules shall require at least both of the 17 following regarding the card or technology: 18 Sec. 45. Section 521F.2, subsection 7, Code 2013, is amended 19 to read as follows: 20 7. “Health organization” means a health maintenance 21 organization, limited service organization, dental or vision 22 plan, hospital, medical and dental indemnity or service 23 corporation or other managed care organization licensed under 24 chapter 514 , or 514B , or 1993 Iowa Acts, ch. 158, or any other 25 entity engaged in the business of insurance, risk transfer, 26 or risk retention, that is subject to the jurisdiction of the 27 commissioner of insurance or the director of public health . 28 “Health organization” does not include an insurance company 29 licensed to transact the business of insurance under chapter 30 508 , 515 , or 520 , and which is otherwise subject to chapter 31 521E . 32 Sec. 46. 1993 Iowa Acts, chapter 158, section 4, is amended 33 to read as follows: 34 SEC. 4. EMERGENCY RULES. Pursuant to sections 1 , and 2 , and 35 -12- LSB 1252DP (18) 85 pf/nh 12/ 17

S.F. _____ H.F. _____ 3 of this Act, the commissioner of insurance or the director of 1 public health shall adopt administrative rules under section 2 17A.4, subsection 2, and section 17A.5, subsection 2, paragraph 3 “b”, to implement the provisions of this Act and the rules 4 shall become effective immediately upon filing, unless a later 5 effective date is specified in the rules. Any rules adopted in 6 accordance with the provisions of this section shall also be 7 published as notice of intended action as provided in section 8 17A.4. 9 Sec. 47. REPEAL. Section 135.120, Code 2013, is repealed. 10 Sec. 48. REPEAL. 1993 Iowa Acts, chapter 158, section 3, 11 is repealed. 12 Sec. 49. CODE EDITOR DIRECTIVE —— ORGANIZED DELIVERY 13 SYSTEMS. 14 1. Sections 505.32, 509A.6, 513B.5, 513B.6, 513B.7, 15 513B.9A, 513B.10, 513C.3, 513C.6, 513C.7, 513C.9, 513C.10, 16 514B.25A, 514C.13, 514C.15, 514C.22, 514C.27, 514E.2, 514E.7, 17 514E.9, 514E.11, 514K.1, Code 2013, are amended as follows: 18 a. By striking from the sections “organized delivery 19 system”. 20 b. By striking from the sections “organized delivery 21 systems”. 22 c. By striking from the sections “organized delivery 23 system’s”. 24 d. By striking from the sections “system”. 25 2. Sections 513B.5, 513B.7, 513B.10, 513C.5, 513C.6, 26 513C.10, 514E.9, and 514K.1, Code 2013, are amended as follows: 27 a. By striking from the sections “director of public 28 health”. 29 b. By striking from the sections “director”. 30 DIVISION II 31 TRAUMA SYSTEM QUALITY IMPROVEMENT 32 Sec. 50. Section 147A.25, subsection 1, paragraph h, Code 33 2013, is amended to read as follows: 34 h. Iowa foundation of medical care director A representative 35 -13- LSB 1252DP (18) 85 pf/nh 13/ 17

S.F. _____ H.F. _____ of the state’s Medicare quality improvement organization . 1 DIVISION III 2 REIMBURSEMENT FOR CERTAIN AUTOPSIES 3 Sec. 51. Section 331.802, subsection 2, paragraph c, Code 4 2013, is amended to read as follows: 5 c. The fee and expenses of the county medical examiner who 6 performs an autopsy or conducts an investigation of a person 7 who dies after being brought into this state for emergency 8 medical treatment by or at the direction of an out-of-state 9 law enforcement officer or public authority shall be paid by 10 the state. A claim for payment shall be filed with the Iowa 11 department of public health. If moneys are not appropriated 12 to the Iowa department of public health for the payment of 13 autopsies under this paragraph, claims for payment shall be 14 forwarded to the state appeal board and, if authorized by the 15 board, shall be paid out of moneys in the general fund of the 16 state not otherwise appropriated. 17 Sec. 52. Section 331.802, subsection 4, Code 2013, is 18 amended to read as follows: 19 4. The county medical examiner shall conduct the 20 investigation in the manner required by the state medical 21 examiner and shall determine whether the public interest 22 requires an autopsy or other special investigation. However, 23 if the death occurred in the manner specified in subsection 24 3 , paragraph “j”, the county medical examiner shall order 25 an autopsy, claims for the expense payment of which shall 26 be reimbursed by the Iowa department of public health filed 27 with the state appeal board and, if authorized by the board, 28 shall be paid out of moneys in the general fund of the state 29 not otherwise appropriated . In determining the need for an 30 autopsy, the county medical examiner may consider the request 31 for an autopsy from a public official or private person, but 32 the state medical examiner or the county attorney of the county 33 where the death occurred may require an autopsy. 34 DIVISION IV 35 -14- LSB 1252DP (18) 85 pf/nh 14/ 17

S.F. _____ H.F. _____ HIV HOME TEST KITS 1 Sec. 53. REPEAL. Section 126.25, Code 2013, is repealed. 2 DIVISION V 3 TOBACCO CESSATION SERVICES —— MINORS 4 Sec. 54. NEW SECTION . 142A.11 Application for services —— 5 minors. 6 A minor shall have the legal capacity to act and give 7 consent to the provision of tobacco cessation services by 8 a hospital, clinic, health care provider, or other tobacco 9 cessation services provider. Consent shall not be subject to 10 later disaffirmance by reason of such minority. The consent of 11 another person, including but not limited to the consent of a 12 spouse, parent, custodian, or guardian, shall not be necessary. 13 EXPLANATION 14 This bill includes provisions that relate to programs and 15 services under the purview of the department of public health 16 (DPH). The bill is organized in divisions. 17 Division I relates to organized delivery systems that are 18 regulated by DPH. Organized delivery systems were created 19 pursuant to 1993 Iowa Acts, chapter 158. Rules adopted 20 under the provision define an organized delivery system as 21 “an organization with defined governance that is responsible 22 for delivering or arranging to deliver the full range of 23 health care services covered under a standard benefit plan 24 and is accountable to the public for the cost, quality and 25 access of its services and for the effect of its services 26 on their health.” (641 IAC 201.2) An organization operating 27 as an organized delivery system is required to assume risk 28 and be subject to solvency standards. The bill eliminates 29 all references to organized delivery systems in the Code and 30 repeals the provision in the Acts authorizing the establishment 31 of organized delivery systems. The most recent application for 32 licensure was received by DPH in 1998. Since being authorized 33 in 1993, only two entities applied for licensure as organized 34 delivery systems and both of these entities have since ceased 35 -15- LSB 1252DP (18) 85 pf/nh 15/ 17

S.F. _____ H.F. _____ operations. 1 Division II relates to the membership of the system 2 evaluation and quality improvement committee for the trauma 3 system in the state. The bill changes the membership by 4 replacing the specific name of the one membership entity 5 with a general reference to the Medicare quality improvement 6 organization in the state. 7 Division III relates to county reimbursement for 8 investigations and autopsies that are for persons who die after 9 being brought into the state for emergency medical treatment 10 by or at the direction of an out-of-state law enforcement 11 officer or public authority; or for autopsies relating to the 12 death of a child under the age of two years if death results 13 from an unknown cause or if the circumstances surrounding the 14 death indicate that sudden infant death syndrome may be the 15 cause of death. Current law directs that claims for these 16 investigations and autopsies are to be filed by counties 17 initially with DPH, and, if moneys are not appropriated to 18 DPH for this purpose, the claims are to then be forwarded to 19 the state appeal board. Under the bill, claims would not be 20 initially filed with DPH, but would instead be filed directly 21 with the state appeal board for authorization of payment 22 from the general fund of the state from funds not otherwise 23 appropriated. 24 Division IV relates to human immunodeficiency virus 25 (HIV) home test kits. Current law prohibits a person from 26 advertising for sale, offering for sale, or selling an HIV 27 home testing kit for antibody or antigen testing, and provides 28 civil and criminal penalties as well as injunctive relief for 29 violation of the prohibition. The United States food and drug 30 administration approved the use of such kits in July 2012, and 31 the bill repeals the Code provision prohibiting the HIV home 32 test kits in the state. 33 Division V of the bill provides that a minor shall have 34 the legal capacity to act and give consent to the provision 35 -16- LSB 1252DP (18) 85 pf/nh 16/ 17