H.F. 2045 Section 1. NEW SECTION . 35E.1 Definitions. 1 As used in this chapter, unless the context otherwise 2 requires: 3 1. “Department” means the Iowa department of veterans 4 affairs created in section 35A.4. 5 2. “Health care practitioner” means a practitioner as 6 defined in section 155A.3. 7 3. “Hyperbaric oxygen treatment” means treatment, including 8 diagnostic testing and other related medical treatments, for 9 traumatic brain injury or post-traumatic stress disorder 10 prescribed by a health care practitioner that utilizes, as part 11 of the treatment, any of the following: 12 a. A hyperbaric chamber approved by the United States food 13 and drug administration. 14 b. A hyperbaric oxygen device that is approved by the United 15 States food and drug administration for investigational use 16 under the direction of an institutional review board with a 17 national clinical trial number. 18 4. “Pilot program” means the veterans recovery pilot program 19 established under this chapter. 20 5. “Traumatic brain injury” means an acquired injury to the 21 brain. “Traumatic brain injury” does not mean brain dysfunction 22 caused by congenital or degenerative disorders or birth trauma. 23 6. “Treatment facility” means a hospital as defined in 24 section 135B.1, an organized outpatient health facility as 25 defined in section 135.61, or any other facility that is 26 authorized by the department of inspections and appeals to 27 provide hyperbaric oxygen treatment under this chapter. 28 7. “Veteran” means a veteran as defined in section 35.1, a 29 member of the national guard or reserve forces of the United 30 States, and a former member of the national guard or reserve 31 forces of the United States who was discharged under honorable 32 conditions. 33 8. “Veterans recovery fund” means the veterans recovery fund 34 created in section 35E.3. 35 -1- LSB 5363YH (4) 87 ec/rn 1/ 8

H.F. 2045 Sec. 2. NEW SECTION . 35E.2 Veterans recovery pilot program 1 —— establishment —— reports —— rules. 2 1. The department shall establish a veterans recovery pilot 3 program, subject to sufficient funds in the veterans recovery 4 fund to operate the pilot program, to provide hyperbaric oxygen 5 treatment and support services to eligible veterans who have 6 been diagnosed with a post-traumatic stress disorder or a 7 traumatic brain injury pursuant to the requirements of this 8 chapter. 9 2. The department, and the department of inspections and 10 appeals, shall adopt rules to implement and administer this 11 chapter. 12 3. By October 1 of each odd-numbered year, the department 13 and the department of inspections and appeals shall submit a 14 biennial report regarding the pilot program that includes an 15 evaluation of the effectiveness of the pilot program and the 16 number of veterans and treatment facilities participating in 17 the pilot program. 18 Sec. 3. NEW SECTION . 35E.3 Veterans recovery fund. 19 1. A veterans recovery fund is created in the state treasury 20 under the control of the department. 21 2. The fund shall consist of moneys appropriated for 22 purposes of the pilot program, and any other devise, gift, 23 bequest, donation, federal or other grant, reimbursement of 24 payments made by any responsible third-party payor, repayment, 25 judgment, transfer, or payment intended to be used for the 26 purposes of the fund. 27 3. Moneys in the fund are appropriated to the department 28 and may be expended by the department for any of the following 29 purposes: 30 a. Expenses incurred by the department and the department of 31 inspections and appeals in administering the pilot program. 32 b. Expenses authorized pursuant to a treatment plan approved 33 pursuant to section 35E.4 for hyperbaric oxygen treatment of a 34 veteran under the pilot program. 35 -2- LSB 5363YH (4) 87 ec/rn 2/ 8

H.F. 2045 c. Expenses authorized pursuant to a treatment plan approved 1 pursuant to section 35E.4 for any necessary travel and living 2 expenses of a veteran required to travel to obtain hyperbaric 3 oxygen treatment under the pilot program. 4 4. Notwithstanding section 12C.7, subsection 2, interest or 5 earnings on moneys in the fund shall be credited to the fund. 6 Moneys in the fund may be used for cash flow purposes during a 7 fiscal year provided that any moneys so allocated are returned 8 to the fund by the end of that fiscal year. 9 5. For purposes of section 8.33, unencumbered or 10 unobligated moneys in the fund shall not revert but shall 11 remain available for expenditure for the purposes designated 12 until June 30, 2024. Any unencumbered or unobligated moneys 13 remaining in the fund as of June 30, 2024, shall not revert but 14 shall be transferred for deposit in the veterans trust fund 15 created in section 35A.13. 16 Sec. 4. NEW SECTION . 35E.4 Hyperbaric oxygen treatment —— 17 treatment plan. 18 1. A treatment facility seeking reimbursement for providing 19 hyperbaric oxygen treatment to a veteran under the pilot 20 program shall, prior to providing such treatment, submit a 21 proposed treatment plan to the department of inspections 22 and appeals in a manner as prescribed by the department of 23 inspections and appeals. 24 2. The proposed treatment plan shall include the following 25 information: 26 a. A prescription order for hyperbaric oxygen treatment 27 issued by a health care practitioner. 28 b. Information verifying the eligibility of the veteran to 29 receive treatment and that the treatment facility is authorized 30 to provide hyperbaric oxygen treatment. 31 c. An estimate of the costs for providing hyperbaric oxygen 32 treatment by the treatment facility. 33 d. An estimate of cost for reimbursing any necessary travel 34 and living expenses of the veteran required to travel to obtain 35 -3- LSB 5363YH (4) 87 ec/rn 3/ 8

H.F. 2045 the hyperbaric oxygen treatment. 1 e. Any other information required by the department of 2 inspections and appeals. 3 3. Upon receipt of a proposed treatment plan, the department 4 of inspections and appeals shall approve or disapprove the 5 treatment plan within a reasonable time as established by rule. 6 The department shall not approve the treatment plan if there is 7 not sufficient money in the veterans recovery fund to reimburse 8 the estimate of costs and expenses provided in the proposed 9 treatment plan. The department of inspections and appeals 10 shall notify the treatment facility whether the treatment plan 11 was approved or disapproved. 12 4. A treatment facility may, following approval of a 13 proposed treatment plan, submit a modified treatment plan 14 if actual expenses are anticipated to exceed the estimated 15 costs approved in the initial treatment plan. The department 16 of inspections and appeals shall approve or disapprove the 17 modified treatment plan, subject to sufficient moneys in the 18 veterans recovery fund for the increased expenses, and shall 19 notify the treatment facility within a reasonable time as 20 established by rule whether the modified treatment plan was 21 approved or disapproved within a reasonable time as established 22 by rule. 23 Sec. 5. NEW SECTION . 35E.5 Provision of treatment —— 24 reimbursement of expenses. 25 1. A treatment facility shall receive reimbursement of 26 expenses incurred in providing hyperbaric oxygen treatment 27 under the pilot program to a veteran if the department of 28 inspections and appeals has approved a treatment plan under 29 section 35E.4 for the veteran. 30 2. A treatment facility that elects to provide hyperbaric 31 oxygen treatment to a veteran under the pilot program shall 32 provide the treatment without charge to the veteran. A veteran 33 receiving treatment under the pilot program is not liable for 34 the cost of treatment or expenses incurred under the pilot 35 -4- LSB 5363YH (4) 87 ec/rn 4/ 8

H.F. 2045 program. 1 3. A treatment facility that elects to provide treatment 2 under the pilot program shall submit to the department 3 of inspections and appeals regular reports, in the form 4 prescribed by the department, of the veteran’s measured health 5 improvements under the treatment plan and whether treatments 6 are continuing or have concluded. If hyperbaric oxygen 7 treatment has concluded, the treatment facility shall indicate 8 the date the treatment concluded. 9 4. A treatment facility providing hyperbaric oxygen 10 treatment under the pilot program may submit a request for 11 reimbursement of expenses incurred by the treatment facility to 12 the department of inspections and appeals. The department of 13 inspections and appeals shall approve the request and notify 14 the department to reimburse the expenses from the veterans 15 recovery fund if all of the following criteria are met: 16 a. The hyperbaric oxygen treatment was provided according 17 to the treatment plan or modified treatment plan approved by 18 the commission. 19 b. The expenses do not exceed the estimated cost of the 20 hyperbaric oxygen treatment as provided in the approved 21 treatment plan or modified treatment plan. 22 c. The treatment facility demonstrates in the reports 23 submitted to the department of inspections and appeals 24 as required by subsection 3 that the veteran is making 25 measured health improvements or that continuing treatment is 26 recommended. 27 5. The department shall reimburse a veteran from moneys in 28 the veterans recovery fund for any travel and living expenses 29 incurred by the veteran receiving hyperbaric oxygen treatment 30 under the pilot program if the amount requested does not exceed 31 the estimated cost of travel and living expenses as provided in 32 the approved treatment plan or modified treatment plan. 33 6. After six months from the date specified in the reports 34 submitted to the department of inspections and appeals 35 -5- LSB 5363YH (4) 87 ec/rn 5/ 8

H.F. 2045 from a treatment facility that treatment has concluded, 1 the department of inspections and appeals shall notify the 2 treatment facility and veteran in writing of the expenses 3 that have been reimbursed and whether the amounts reimbursed 4 are less than the costs authorized to be reimbursed pursuant 5 to an approved treatment plan or modified treatment plan. 6 The written notification shall further notify the treatment 7 facility and the veteran that any requests for reimbursement 8 shall not be authorized if a request for reimbursement is not 9 submitted within ninety days after receiving the notice unless, 10 prior to the ninety days, the treatment facility indicates that 11 treatment has not been completed. 12 Sec. 6. NEW SECTION . 35E.6 Repeal. 13 This chapter is repealed July 1, 2024. 14 Sec. 7. DIRECTIVE TO DEPARTMENTS OF VETERANS AFFAIRS AND 15 INSPECTIONS AND APPEALS. The departments of veterans affairs 16 and inspections and appeals shall each submit a notice of 17 intended action to the administrative rules coordinator and 18 the administrative code editor pursuant to section 17A.4, 19 subsection 1, paragraph “a”, not later than January 1, 2019, 20 for the adoption of rules to implement and administer chapter 21 35E as enacted in this Act. 22 EXPLANATION 23 The inclusion of this explanation does not constitute agreement with 24 the explanation’s substance by the members of the general assembly. 25 This bill establishes a veterans recovery pilot program, 26 administered in part by both the departments of veterans 27 affairs and inspections and appeals, for the reimbursement of 28 expenses related to providing hyperbaric oxygen treatment to 29 eligible veterans. 30 New Code section 35E.1 establishes definitions applicable 31 to the new Code chapter. The bill includes definitions 32 for department, health care practitioner, hyperbaric oxygen 33 treatment, traumatic brain injury, treatment facility, and 34 veteran. Specifically, the bill defines hyperbaric oxygen 35 -6- LSB 5363YH (4) 87 ec/rn 6/ 8

H.F. 2045 treatment as treatment, including diagnostic testing and other 1 related medical treatments, for traumatic brain injury or 2 post-traumatic stress disorder prescribed by a health care 3 practitioner that utilizes a United States food and drug 4 administration-approved hyperbaric chamber or hyperbaric oxygen 5 device. 6 New Code section 35E.2 establishes the veterans recovery 7 pilot program, subject to sufficient funds to operate the 8 program, requires the departments of veterans affairs and 9 inspections and appeals to adopt rules to implement and 10 administer the program, and includes a reporting requirement 11 for each department concerning the operation of the pilot 12 program. 13 New Code section 35E.3 creates a veterans recovery fund 14 in the state treasury under the control of the department of 15 veterans affairs. The new Code section provides that moneys in 16 the fund are appropriated to the department of veterans affairs 17 to be expended for expenses incurred in operating the program 18 and for expenses authorized to be reimbursed for hyperbaric 19 oxygen treatment and any related travel and living expenses 20 incurred by the veteran. The new Code section provides that 21 moneys in the fund shall not revert but shall remain available 22 for use until June 30, 2024. Any moneys remaining in the fund 23 as of June 30, 2024, shall be transferred for deposit in the 24 veterans trust fund. 25 New Code section 35E.4 provides for the process for a 26 treating facility to seek reimbursement from the veterans 27 recovery fund for providing hyperbaric oxygen treatment. The 28 bill provides that a treating facility may submit a proposed 29 treatment plan to the department of inspections and appeals 30 for their approval. The treatment plan shall include the 31 prescription order for the treatment, information verifying 32 the eligibility of the veteran and the treatment facility to 33 provide the treatment, the estimated costs for providing the 34 treatment and for reimbursing the veteran for any associated 35 -7- LSB 5363YH (4) 87 ec/rn 7/ 8

H.F. 2045 travel and living expenses, and any other information required 1 by the department of inspections and appeals. The new Code 2 section provides that the treatment plan shall not be approved 3 if sufficient moneys to reimburse the estimated costs are not 4 available in the veterans recovery fund. The new Code section 5 also establishes a process for submitting a modified treatment 6 plan if the estimated costs for providing the treatment 7 are anticipated to exceed the cost estimate in the initial 8 treatment plan. 9 New Code section 35E.5 provides for requirements relative 10 to providing hyperbaric oxygen treatment and provides for 11 the manner in which treatment-related expenses are to be 12 reimbursed. The Code section provides that a treatment 13 facility shall not be reimbursed for providing treatment 14 unless a treatment plan has been approved. If a treatment 15 facility elects to provide hyperbaric oxygen treatment under 16 the pilot program, the facility shall provide the treatment 17 without charge to a veteran and shall submit regular reports 18 to the department of inspections and appeals concerning the 19 efficacy of the treatment and on whether the treatments have 20 been concluded. The new Code section also provides for a 21 process for a treatment facility and a veteran to receive 22 reimbursement for expenses incurred. The new Code sections 23 require the department of inspections and appeals to provide 24 written notification to the treatment facility and veteran 25 after treatment has concluded, which notice shall indicate when 26 any additional requests for reimbursement may be made. 27 Code section 35E.6 provides that the new Code chapter is 28 repealed July 1, 2024. 29 The bill further directs the departments of veterans 30 affairs and inspections and appeals to each submit a notice of 31 intended action to the administrative rules coordinator and the 32 administrative code editor not later than January 1, 2019, for 33 the adoption of rules necessary to implement and administer the 34 new Code chapter. 35 -8- LSB 5363YH (4) 87 ec/rn 8/ 8