House Study Bill 83 - Introduced SENATE/HOUSE FILE _____ BY (PROPOSED DEPARTMENT OF PUBLIC HEALTH BILL) A BILL FOR An Act relating to programs and services under the purview 1 of the department of public health including the board of 2 hearing aid dispensers and the medical residency training 3 matching grants program and including effective date and 4 retroactive applicability provisions. 5 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 6 TLSB 1222XD (10) 86 pf/nh

S.F. _____ H.F. _____ DIVISION I 1 HEARING AID SPECIALISTS 2 Section 1. Section 147.1, subsections 3 and 6, Code 2015, 3 are amended to read as follows: 4 3. “Licensed” or “certified” , when applied to a physician 5 and surgeon, podiatric physician, osteopathic physician and 6 surgeon, physician assistant, psychologist, chiropractor, 7 nurse, dentist, dental hygienist, dental assistant, 8 optometrist, speech pathologist, audiologist, pharmacist, 9 physical therapist, physical therapist assistant, occupational 10 therapist, occupational therapy assistant, orthotist, 11 prosthetist, pedorthist, respiratory care practitioner, 12 practitioner of cosmetology arts and sciences, practitioner 13 of barbering, funeral director, dietitian, marital and family 14 therapist, mental health counselor, social worker, massage 15 therapist, athletic trainer, acupuncturist, nursing home 16 administrator, hearing aid dispenser specialist , or sign 17 language interpreter or transliterator means a person licensed 18 under this subtitle . 19 6. “Profession” means medicine and surgery, podiatry, 20 osteopathic medicine and surgery, practice as a physician 21 assistant, psychology, chiropractic, nursing, dentistry, 22 dental hygiene, dental assisting, optometry, speech pathology, 23 audiology, pharmacy, physical therapy, physical therapist 24 assisting, occupational therapy, occupational therapy 25 assisting, respiratory care, cosmetology arts and sciences, 26 barbering, mortuary science, marital and family therapy, mental 27 health counseling, social work, dietetics, massage therapy, 28 athletic training, acupuncture, nursing home administration, 29 practice as a hearing aid dispensing specialist , sign language 30 interpreting or transliterating, orthotics, prosthetics, or 31 pedorthics. 32 Sec. 2. Section 147.2, subsection 1, Code 2015, is amended 33 to read as follows: 34 1. A person shall not engage in the practice of medicine 35 -1- LSB 1222XD (10) 86 pf/nh 1/ 17

S.F. _____ H.F. _____ and surgery, podiatry, osteopathic medicine and surgery, 1 psychology, chiropractic, physical therapy, physical 2 therapist assisting, nursing, dentistry, dental hygiene, 3 dental assisting, optometry, speech pathology, audiology, 4 occupational therapy, occupational therapy assisting, 5 orthotics, prosthetics, pedorthics, respiratory care, 6 pharmacy, cosmetology arts and sciences, barbering, social 7 work, dietetics, marital and family therapy or mental health 8 counseling, massage therapy, mortuary science, athletic 9 training, acupuncture, nursing home administration, hearing aid 10 dispensing, or sign language interpreting or transliterating, 11 or shall not practice as a physician assistant or a hearing aid 12 specialist , unless the person has obtained a license for that 13 purpose from the board for the profession. 14 Sec. 3. Section 147.13, subsection 22, Code 2015, is amended 15 to read as follows: 16 22. For hearing aid dispensing specialists , the board of 17 hearing aid dispensers specialists . 18 Sec. 4. Section 147.14, subsection 1, paragraph v, Code 19 2015, is amended to read as follows: 20 v. For hearing aid dispensers specialists , three licensed 21 hearing aid dispensers specialists and two members who are not 22 licensed hearing aid dispensers specialists who shall represent 23 the general public. No more than two members of the board 24 shall be employees of, or dispensers specialists principally 25 for, the same hearing aid manufacturer. 26 Sec. 5. Section 154A.1, subsections 1, 3, 6, 7, and 9, Code 27 2015, are amended to read as follows: 28 1. “Board” means the board of hearing aid dispensers 29 specialists . 30 3. “Dispense” or “sell” means a transfer of title or of 31 the right to use by lease, bailment, or any other means, 32 but excludes a wholesale transaction with a distributor or 33 dispenser hearing aid specialist , and excludes the temporary, 34 charitable loan or educational loan of a hearing aid without 35 -2- LSB 1222XD (10) 86 pf/nh 2/ 17

S.F. _____ H.F. _____ remuneration. 1 6. “Hearing aid fitting” means the measurement of 2 human hearing by any means for the purpose of selections, 3 adaptations, and sales of hearing aids, and the instruction and 4 counseling pertaining thereto to the selections, adaptations, 5 and sales of hearing aids , and demonstration of techniques in 6 the use of hearing aids, and the making of earmold impressions 7 as part of the fitting of hearing aids. 8 7. “License” means a license issued by the state under this 9 chapter to a hearing aid dispensers specialist . 10 9. “Temporary permit” means a permit issued while the 11 applicant is in training to become a licensed hearing aid 12 dispenser specialist . 13 Sec. 6. Section 154A.1, subsection 5, Code 2015, is amended 14 by striking the subsection. 15 Sec. 7. Section 154A.1, Code 2015, is amended by adding the 16 following new subsection: 17 NEW SUBSECTION . 6A. “Hearing aid specialist” means any 18 person engaged in the fitting, dispensing, and sale of hearing 19 aids and providing hearing aid services or maintenance, by 20 means of procedures stipulated by this chapter or the board. 21 Sec. 8. Section 154A.13, Code 2015, is amended to read as 22 follows: 23 154A.13 Temporary permit. 24 A person who has not been licensed as a hearing aid dispenser 25 specialist may obtain a temporary permit from the department 26 upon completion of the application accompanied by the written 27 verification of employment from a licensed hearing aid 28 dispenser specialist . The department shall issue a temporary 29 permit for one year which shall not be renewed or reissued. 30 The fee for issuance of the temporary permit shall be set by 31 the board in accordance with the provisions for establishment 32 of fees in section 147.80 . The temporary permit entitles an 33 applicant to engage in the fitting or selection and sale of 34 hearing aids under the supervision of a person holding a valid 35 -3- LSB 1222XD (10) 86 pf/nh 3/ 17

S.F. _____ H.F. _____ license. 1 Sec. 9. Section 154A.19, Code 2015, is amended to read as 2 follows: 3 154A.19 Exceptions. 4 1. This chapter shall not prohibit a corporation, 5 partnership, trust, association, or other organization 6 maintaining an established business address from engaging in 7 the business of selling or offering for sale hearing aids at 8 retail without a license if it employs only licensed hearing 9 aid dispensers specialists in the direct fitting or selection 10 and sale of hearing aids. Such an organization shall file 11 annually with the board a list of all licensed hearing aid 12 dispensers specialists and persons holding temporary permits 13 directly or indirectly employed by it. Such an organization 14 shall also file with the board a statement on a form approved 15 by the board that the organization submits itself to the rules 16 and regulations of the board and the provisions of this chapter 17 which the department deems applicable. 18 2. This chapter shall not apply to a person who engages 19 in the practices covered by this chapter if this activity is 20 part of the academic curriculum of an accredited institution of 21 higher education, or part of a program conducted by a public 22 or charitable institution, or nonprofit organization, unless 23 the institution or organization also dispenses or sells hearing 24 aids. 25 3. This chapter shall not prevent any person from engaging 26 in practices covered by this chapter , provided the person, or 27 organization employing the person, does not dispense or sell 28 hearing aids. 29 Sec. 10. Section 154A.20, Code 2015, is amended to read as 30 follows: 31 154A.20 Rights of purchaser. 32 1. A hearing aid dispenser specialist shall deliver, to 33 each person supplied with a hearing aid, a receipt which 34 contains the licensee’s signature and shows the licensee’s 35 -4- LSB 1222XD (10) 86 pf/nh 4/ 17

S.F. _____ H.F. _____ business address and the number of the license, together with 1 specifications as to the make, model, and serial number of the 2 hearing aid furnished, and full terms of sale clearly stated, 3 including the date of consummation of the sale of the hearing 4 aid. If a hearing aid is sold which is not new, the receipt and 5 the container must be clearly marked “used” or “reconditioned”, 6 with the terms of guarantee, if any. 7 2. The receipt shall bear the following statement in type no 8 smaller than the largest used in the body copy portion of the 9 receipt: 10 The purchaser has been advised that any examination or 11 representation made by a licensed hearing aid dispenser 12 specialist in connection with the fitting or selection and 13 selling of this hearing aid is not an examination, diagnosis, 14 or prescription by a person licensed to practice medicine in 15 this state and therefore, must not be regarded as medical 16 opinion or advice. 17 3. Whenever any of the following conditions are found to 18 exist either from observations by the licensed hearing aid 19 dispenser specialist or person holding a temporary permit or on 20 the basis of information furnished by a prospective hearing aid 21 user, the hearing aid dispenser specialist or person holding a 22 temporary permit shall, prior to fitting and selling a hearing 23 aid to any individual, suggest to that individual in writing 24 that the individual’s best interests would be served if the 25 individual would consult a licensed physician specializing 26 in diseases of the ear, or if no such licensed physician is 27 available in the community, then a duly licensed physician: 28 a. Visible congenital or traumatic deformity of the ear. 29 b. History of, or active drainage from the ear within the 30 previous ninety days. 31 c. History of sudden or rapidly progressive hearing loss 32 within the previous ninety days. 33 d. Acute or chronic dizziness. 34 e. Unilateral hearing loss of sudden or recent onset within 35 -5- LSB 1222XD (10) 86 pf/nh 5/ 17

S.F. _____ H.F. _____ the previous ninety days. 1 f. Significant air-bone gap (greater greater than or equal 2 to 15dB ANSI 500, 1000 and 2000 Hz. average) average . 3 g. Obstruction of the ear canal, by structures of 4 undetermined origin, such as foreign bodies, impacted cerumen, 5 redness, swelling, or tenderness from localized infections of 6 the otherwise normal ear canal. 7 4. A copy of the written recommendation shall be retained by 8 the licensed hearing aid dispenser specialist for the period 9 of seven years. A person receiving the written recommendation 10 who elects to purchase a hearing aid shall sign a receipt for 11 the same, and the receipt shall be kept with the other papers 12 retained by the licensed hearing aid dispenser specialist for 13 the period of seven years. Nothing in this section required 14 to be performed by a licensed hearing aid dispenser specialist 15 shall mean that the hearing aid dispenser specialist is engaged 16 in the diagnosis of illness or the practice of medicine or any 17 other activity prohibited by this chapter . 18 5. No hearing aid shall be sold by any individual licensed 19 under this chapter to a person twelve years of age or younger, 20 unless within the preceding six months a recommendation for 21 a hearing aid has been made by a physician specializing in 22 otolaryngology. A replacement of an identical hearing aid 23 within one year shall be an exception to this requirement. 24 6. A licensed hearing aid dispenser specialist shall, upon 25 the consummation of a sale of a hearing aid, keep and maintain 26 records in the dispenser’s specialist’s office or place of 27 business at all times and each such record shall be kept 28 and maintained for a seven-year period. These records shall 29 include: 30 a. Results of test techniques as they pertain to fitting of 31 the hearing aids. 32 b. A copy of the written receipt and the written 33 recommendation. 34 Sec. 11. Section 154A.21, Code 2015, is amended to read as 35 -6- LSB 1222XD (10) 86 pf/nh 6/ 17

S.F. _____ H.F. _____ follows: 1 154A.21 Notice of address. 2 1. A licensee or person holding a temporary permit shall 3 notify the department in writing of the address of the place 4 where the licensee or permittee engages or intends to engage in 5 business as a hearing aid dispenser specialist . The department 6 shall keep a record of the place of business of licensees and 7 persons holding temporary permits. 8 2. Any notice required to be given by the department to a 9 licensee shall be adequately served if sent by certified mail 10 to the address of the last place of business recorded. 11 Sec. 12. Section 154A.24, subsection 3, paragraphs e and i, 12 Code 2015, are amended to read as follows: 13 e. Representing that the service or advice of a person 14 licensed to practice medicine, or one who is certificated as 15 a clinical audiologist by the board of speech pathology and 16 audiology or its equivalent, will be used or made available in 17 the fitting or selection, adjustment, maintenance, or repair 18 of hearing aids when that is not true, or using the words 19 “doctor”, “clinic”, “clinical audiologist”, “state approved”, 20 or similar words, abbreviations, or symbols which tend to 21 connote the medical or other professions, except where the 22 title “certified hearing aid audiologist” has been granted 23 by the national hearing aid society, or that the hearing aid 24 dispenser specialist has been recommended by this state or the 25 board when such is not accurate. 26 i. Directly or indirectly giving or offering to give, or 27 permitting or causing to be given, money or anything of value 28 to a person who advises another in a professional capacity, as 29 an inducement to influence the person or cause the person to 30 influence others to purchase or contract to purchase products 31 sold or offered for sale by a hearing aid dispenser specialist , 32 or to influence others to refrain from dealing in the products 33 of competitors. 34 Sec. 13. Section 154A.25, subsection 2, Code 2015, is 35 -7- LSB 1222XD (10) 86 pf/nh 7/ 17

S.F. _____ H.F. _____ amended to read as follows: 1 2. Purchase or procure by barter a license or temporary 2 permit with intent to use it as evidence of the holder’s 3 qualifications to engage in business as a hearing aid dispenser 4 specialist . 5 Sec. 14. Section 154F.2, subsection 1, paragraph b, Code 6 2015, is amended to read as follows: 7 b. Hearing aid fitting, the dispensing or sale of hearing 8 aids, and the providing of hearing aid service and maintenance 9 by a hearing aid dispenser specialist or holder of a temporary 10 permit as defined and licensed under chapter 154A . 11 Sec. 15. Section 154F.2, subsection 2, Code 2015, is amended 12 to read as follows: 13 2. A person exempted from the provisions of this chapter by 14 this section shall not use the title “speech pathologist” or 15 “audiologist” or any title or device indicating or representing 16 in any manner that the person is a speech pathologist or is 17 an audiologist; provided, a hearing aid dispenser specialist 18 licensed under chapter 154A may use the title “certified 19 hearing aid audiologist” when granted by the national hearing 20 aid society; and provided, persons who meet the requirements 21 of section 154F.3, subsection 1 , who are certified by the 22 department of education as speech clinicians may use the title 23 “speech pathologist” and persons who meet the requirements 24 of section 154F.3, subsection 2 , who are certified by the 25 department of education as hearing clinicians may use the 26 title “audiologist”, while acting within the scope of their 27 employment. 28 Sec. 16. Section 216E.7, Code 2015, is amended to read as 29 follows: 30 216E.7 Exemptions. 31 This chapter does not apply to a hearing aid sold, leased, 32 or transferred to a consumer by an audiologist licensed under 33 chapter 154F , or a hearing aid dispenser specialist licensed 34 under chapter 154A , if the audiologist or dispenser specialist 35 -8- LSB 1222XD (10) 86 pf/nh 8/ 17

S.F. _____ H.F. _____ provides either an express warranty for the hearing aid or 1 provides for service and replacement of the hearing aid. 2 Sec. 17. Section 272C.1, subsection 6, paragraph v, Code 3 2015, is amended to read as follows: 4 v. The board of hearing aid dispensers specialists , created 5 pursuant to chapter 154A . 6 DIVISION II 7 MEDICAL RESIDENCY TRAINING STATE MATCHING GRANTS PROGRAM —— 8 REENACTMENT 9 Sec. 18. NEW SECTION . 135.176 Medical residency training 10 state matching grants program. 11 1. The department shall establish a medical residency 12 training state matching grants program to provide matching 13 state funding to sponsors of accredited graduate medical 14 education residency programs in this state to establish, 15 expand, or support medical residency training programs. 16 Funding for the program may be provided through the health 17 care workforce shortage fund or the medical residency training 18 account created in section 135.175. For the purposes of this 19 section, unless the context otherwise requires, “accredited” 20 means a graduate medical education program approved by the 21 accreditation council for graduate medical education or the 22 American osteopathic association. The grant funds may be 23 used to support medical residency programs through any of the 24 following: 25 a. The establishment of new or alternative campus accredited 26 medical residency training programs. For the purposes of 27 this paragraph, “new or alternative campus accredited medical 28 residency training program” means a program that is accredited 29 by a recognized entity approved for such purpose by the 30 accreditation council for graduate medical education or the 31 American osteopathic association with the exception that 32 a new medical residency training program that, by reason 33 of an insufficient period of operation is not eligible for 34 accreditation on or before the date of submission of an 35 -9- LSB 1222XD (10) 86 pf/nh 9/ 17

S.F. _____ H.F. _____ application for a grant, may be deemed accredited if the 1 accreditation council for graduate medical education or the 2 American osteopathic association finds, after consultation with 3 the appropriate accreditation entity, that there is reasonable 4 assurance that the program will meet the accreditation 5 standards of the entity prior to the date of graduation of the 6 initial class in the program. 7 b. The provision of new residency positions within existing 8 accredited medical residency or fellowship training programs. 9 c. The funding of residency positions which are in excess of 10 the federal residency cap. For the purposes of this paragraph, 11 “in excess of the federal residency cap” means a residency 12 position for which no federal Medicare funding is available 13 because the residency position is a position beyond the cap for 14 residency positions established by the federal Balanced Budget 15 Act of 1997, Pub. L. No. 105-33. 16 2. The department shall adopt rules pursuant to chapter 17A 17 to provide for all of the following: 18 a. Eligibility requirements for and qualifications 19 of a sponsor of an accredited graduate medical education 20 residency program to receive a grant. The requirements and 21 qualifications shall include but are not limited to all of the 22 following: 23 (1) Only a sponsor that establishes a dedicated fund to 24 support a residency program that meets the specifications of 25 this section shall be eligible to receive a matching grant. A 26 sponsor funding residency positions in excess of the federal 27 residency cap, as defined in subsection 1, paragraph “c” , 28 exclusive of funds provided under the medical residency 29 training state matching grants program established in this 30 section, is deemed to have satisfied this requirement and 31 shall be eligible for a matching grant equal to the amount of 32 funds expended for such residency positions, subject to the 33 limitation on the maximum award of grant funds specified in 34 paragraph “e” . 35 -10- LSB 1222XD (10) 86 pf/nh 10/ 17

S.F. _____ H.F. _____ (2) A sponsor shall demonstrate, through documented 1 financial information as prescribed by rule of the department, 2 that funds have been reserved and will be expended by the 3 sponsor in the amount required to provide matching funds for 4 each residency proposed in the request for state matching 5 funds. 6 (3) A sponsor shall demonstrate, through objective evidence 7 as prescribed by rule of the department, a need for such 8 residency program in the state. 9 b. The application process for the grant. 10 c. Criteria for preference in awarding of the grants, 11 including preference in the residency specialty. 12 d. Determination of the amount of a grant. The total amount 13 of a grant awarded to a sponsor shall be limited to no more 14 than twenty-five percent of the amount that the sponsor has 15 demonstrated through documented financial information has been 16 reserved and will be expended by the sponsor for each residency 17 sponsored for the purpose of the residency program. 18 e. The maximum award of grant funds to a particular 19 individual sponsor per year. An individual sponsor shall not 20 receive more than twenty-five percent of the state matching 21 funds available each year to support the program. However, 22 if less than ninety-five percent of the available funds has 23 been awarded in a given year, a sponsor may receive more than 24 twenty-five percent of the state matching funds available 25 if total funds awarded do not exceed ninety-five percent of 26 the available funds. If more than one sponsor meets the 27 requirements of this section and has established, expanded, 28 or supported a graduate medical residency training program, 29 as specified in subsection 1, in excess of the sponsor’s 30 twenty-five percent maximum share of state matching funds, the 31 state matching funds shall be divided proportionately among 32 such sponsors. 33 f. Use of the funds awarded. Funds may be used to pay the 34 costs of establishing, expanding, or supporting an accredited 35 -11- LSB 1222XD (10) 86 pf/nh 11/ 17

S.F. _____ H.F. _____ graduate medical education program as specified in this 1 section, including but not limited to the costs associated with 2 residency stipends and physician faculty stipends. 3 Sec. 19. EFFECTIVE DATE. This division of this Act, being 4 deemed of immediate importance, takes effect upon enactment. 5 Sec. 20. APPLICABILITY. This division of this Act applies 6 retroactively to June 30, 2014. 7 DIVISION III 8 MEDICAL RESIDENCY TRAINING STATE MATCHING GRANTS PROGRAM —— 9 AMENDMENTS 10 Sec. 21. Section 135.176, as enacted in this Act, is amended 11 to read as follows: 12 135.176 Medical residency training state matching grants 13 program. 14 1. The department shall establish a medical residency 15 training state matching grants program to provide matching 16 state funding to sponsors of accredited graduate medical 17 education residency programs in this state to establish, 18 expand, or support medical residency training programs. 19 Funding for the program may be provided through the health 20 care workforce shortage fund or the medical residency training 21 account created in section 135.175. For the purposes of this 22 section, unless the context otherwise requires, “accredited” 23 means a graduate medical education program approved by the 24 accreditation council for graduate medical education or the 25 American osteopathic association. The grant funds may be 26 used to support medical residency programs through any of the 27 following: 28 a. The establishment of new or alternative campus accredited 29 medical residency training programs. For the purposes of 30 this paragraph, “new or alternative campus accredited medical 31 residency training program” means a program that is accredited 32 by a recognized entity approved for such purpose by the 33 accreditation council for graduate medical education or the 34 American osteopathic association with the exception that 35 -12- LSB 1222XD (10) 86 pf/nh 12/ 17

S.F. _____ H.F. _____ a new medical residency training program that, by reason 1 of an insufficient period of operation is not eligible for 2 accreditation on or before the date of submission of an 3 application for a grant, may be deemed accredited if the 4 accreditation council for graduate medical education or the 5 American osteopathic association finds, after consultation with 6 the appropriate accreditation entity, that there is reasonable 7 assurance that the program will meet the accreditation 8 standards of the entity prior to the date of graduation of the 9 initial class in the program. 10 b. The provision of new residency positions within existing 11 accredited medical residency or fellowship training programs. 12 c. The funding of residency positions which are in excess of 13 the federal residency cap. For the purposes of this paragraph, 14 “in excess of the federal residency cap” means a residency 15 position for which no federal Medicare funding is available 16 because the residency position is a position beyond the cap for 17 residency positions established by the federal Balanced Budget 18 Act of 1997, Pub. L. No. 105-33. 19 2. The department shall adopt rules pursuant to chapter 17A 20 to provide for all of the following: 21 a. Eligibility requirements for and qualifications 22 of a sponsor of an accredited graduate medical education 23 residency program to receive a grant. The requirements and 24 qualifications shall include but are not limited to all of the 25 following: 26 (1) Only a sponsor that establishes a dedicated fund to 27 support a residency program that meets the specifications of 28 this section shall be eligible to receive a matching grant. A 29 sponsor funding residency positions in excess of the federal 30 residency cap, as defined in subsection 1, paragraph “c” , 31 exclusive of funds provided under the medical residency 32 training state matching grants program established in this 33 section, is deemed to have satisfied this requirement and 34 shall be eligible for a matching grant equal to the amount of 35 -13- LSB 1222XD (10) 86 pf/nh 13/ 17

S.F. _____ H.F. _____ funds expended for such residency positions, subject to the 1 limitation on the maximum award of grant funds specified in 2 paragraph “e” . 3 (2) A sponsor shall demonstrate , through documented 4 financial information as prescribed by rule of the department, 5 that funds have been reserved budgeted and will be expended by 6 the sponsor in the amount required to provide matching funds 7 for each residency proposed in the request for state matching 8 funds. 9 (3) (2) A sponsor shall demonstrate, through objective 10 evidence as prescribed by rule of the department, a need for 11 such residency program in the state. 12 b. The application process for the grant. 13 c. Criteria for preference in awarding of the grants, 14 including preference in the residency specialty. 15 d. Determination of the amount of a grant. The total amount 16 of a grant awarded to a sponsor proposing the establishment 17 of a new or alternative campus accredited medical residency 18 training program as defined in subsection 1, paragraph “a” , 19 shall be limited to no more than twenty-five one hundred 20 percent of the amount the sponsor has budgeted as demonstrated 21 under paragraph “a” . The total amount of a grant awarded to 22 a sponsor proposing the provision of a new residency position 23 within an existing accredited medical residency or fellowship 24 training program as specified in subsection 1, paragraph “b” 25 or the funding of residency positions which are in excess of 26 the federal residency cap as defined in subsection 1, paragraph 27 “c” , shall be limited to no more than twenty-five percent of 28 the amount that the sponsor has demonstrated through documented 29 financial information has been reserved and will be expended by 30 the sponsor budgeted for each residency position sponsored for 31 the purpose of the residency program. 32 e. The maximum award of grant funds to a particular 33 individual sponsor per year. An individual sponsor that 34 establishes a new or alternative campus accredited medical 35 -14- LSB 1222XD (10) 86 pf/nh 14/ 17

S.F. _____ H.F. _____ residency training program as defined in subsection 1, 1 paragraph “a” shall not receive more than twenty-five fifty 2 percent of the state matching funds available each year to 3 support the program. However, if less than ninety-five percent 4 of the available funds has been awarded in a given year, a 5 sponsor may receive more than twenty-five percent of the 6 state matching funds available if total funds awarded do not 7 exceed ninety-five percent of the available funds. If more 8 than one sponsor meets the requirements of this section and 9 has established, expanded, or supported a graduate medical 10 residency training program, as specified in subsection 1, in 11 excess of the sponsor’s twenty-five percent maximum share of 12 state matching funds, the state matching funds shall be divided 13 proportionately among such sponsors. An individual sponsor 14 proposing the provision of a new residency position within an 15 existing accredited medical residency or fellowship training 16 program as specified in subsection 1, paragraph “b” or the 17 funding of residency positions which are in excess of the 18 federal residency cap as defined in subsection 1, paragraph “c” , 19 shall not receive more than twenty-five percent of the state 20 matching funds available each year to support the program. 21 f. Use of the funds awarded. Funds may be used to pay the 22 costs of establishing, expanding, or supporting an accredited 23 graduate medical education program as specified in this 24 section, including but not limited to the costs associated with 25 residency stipends and physician faculty stipends. 26 EXPLANATION 27 The inclusion of this explanation does not constitute agreement with 28 the explanation’s substance by the members of the general assembly. 29 This bill relates to programs and services under the purview 30 of the department of public health. 31 Division I of the bill changes references to and relating 32 to “hearing aid dispensers” to “hearing aid specialists”. 33 The bill changes the references to the “board of hearing aid 34 dispensers” to the “board of hearing aid specialists” and makes 35 -15- LSB 1222XD (10) 86 pf/nh 15/ 17

S.F. _____ H.F. _____ other conforming changes throughout the Code. 1 Division II of the bill relates to the medical residency 2 training state matching grants program. The medical residency 3 training state matching grants program (Code section 135.176, 4 Code 2013), that was repealed on June 30, 2014, is reenacted 5 as amended by 2014 Iowa Acts, chapter 1190, section 7. The 6 division takes effect upon enactment and is retroactively 7 applicable to June 30, 2014. 8 Division III of the bill amends the newly reenacted Code 9 section 135.176, to provide that instead of a requirement that 10 a sponsor establish a dedicated fund to support a residency 11 program, a sponsor shall demonstrate that funds have been 12 budgeted in the amount required in the request for matching 13 funds. Additionally, the bill provides that the limit on the 14 total amount of a grant made to a sponsor is based upon the 15 type of residency position to be funded. Under the bill, the 16 limit is no more than 100 percent of the amount the sponsor 17 budgeted if the sponsor is proposing the establishment of 18 a new or alternative campus accredited medical residency 19 training program, and the limit is not more than 25 percent 20 of the amount the sponsor has budgeted if the sponsor is 21 proposing provision of a new residency position within an 22 existing accredited medical residency or fellowship training 23 program or the funding of residency positions which are in 24 excess of the federal residency cap. Under the bill, the 25 maximum award of grant funds to a particular sponsor that 26 establishes a new or alternative campus accredited medical 27 residency training program shall be not more than 50 percent 28 of the state matching funds available each year; and the 29 maximum award to a particular sponsor that is proposing 30 provision of a new residency position within an existing 31 accredited medical residency or fellowship training program 32 or the funding of residency positions which are in excess of 33 the federal residency cap shall not be more than 25 percent of 34 the state matching funds available each year. Under the bill, 35 -16- LSB 1222XD (10) 86 pf/nh 16/ 17