H.F. 2442 Section 1. Section 280.13C, Code 2018, is amended by 1 striking the section and inserting in lieu thereof the 2 following: 3 280.13C Concussion and brain injury policies. 4 1. Legislative findings. The general assembly finds and 5 declares all of the following: 6 a. Concussions are one of the most commonly reported 7 injuries in children and adolescents who participate in sports 8 and recreational activities. A concussion is caused by a blow 9 or motion to the head or body that causes the brain to move 10 rapidly inside the skull. The risk of catastrophic injuries or 11 death is significant when a concussion or head injury is not 12 properly evaluated and managed. 13 b. Concussions are a type of brain injury that can range 14 from mild to severe and can disrupt the way the brain normally 15 works. Concussions can occur in any organized or unorganized 16 sport or recreational activity and can result from a fall or 17 from players colliding with each other, the ground, or with 18 obstacles. Concussions can occur with or without loss of 19 consciousness, but the vast majority of concussions occur 20 without loss of consciousness. 21 c. Continuing to play with a concussion or symptoms of a 22 brain injury leaves a young athlete especially vulnerable to 23 greater injury and even death. The general assembly recognizes 24 that, despite having generally recognized return-to-play 25 standards for concussions and head injuries, some affected 26 youth athletes are prematurely returned to play or expected 27 to learn at full capability, resulting in prolonged symptoms, 28 actual or potential physical injury, or death to youth athletes 29 in this state. 30 d. A concussion can impair not only the physical abilities 31 of a student athlete, but can also affect how a student athlete 32 thinks, acts, feels, and learns. A student athlete who has 33 sustained a concussion may need informal or formal adjustments, 34 accommodations, modifications of curriculum, and monitoring 35 -1- LSB 5331HV (4) 87 je/rj 1/ 9

H.F. 2442 by medical or educational staff until the student is fully 1 recovered. To that end, the department of public health, in 2 coordination with the Iowa high school athletic association 3 and the Iowa girls high school athletic union, shall establish 4 and disseminate to all schools in this state a return-to-learn 5 protocol that is based on peer-reviewed scientific evidence 6 consistent with federal guidelines. Furthermore, all schools 7 in this state shall adopt such protocols. 8 2. Definitions. For the purposes of this section: 9 a. “Contest” means an interscholastic athletic game or 10 competition. 11 b. “Contest official” means a referee, umpire, judge, or 12 other official in an athletic contest. 13 c. “Extracurricular interscholastic activity” means any 14 extracurricular interscholastic activity, contest, or practice, 15 including sports, dance, or cheerleading. 16 d. “Licensed health care provider” means a physician, 17 physician assistant, chiropractor, advanced registered nurse 18 practitioner, nurse, physical therapist, or athletic trainer 19 licensed by a board designated under section 147.13. 20 3. Training. 21 a. The department of public health, Iowa high school 22 athletic association, and the Iowa girls high school athletic 23 union shall work together to develop training materials and 24 courses regarding concussions and brain injuries, including 25 training regarding evaluation, prevention, symptoms, risks, 26 and long-term effects of concussions and brain injuries. Each 27 coach or contest official shall complete such training at least 28 every two years. 29 b. Individuals required to complete training pursuant to 30 this subsection shall submit proof of such completion to the 31 board of directors of the school district or the authorities in 32 charge of the accredited nonpublic school within thirty days 33 of such completion. 34 4. Guidelines and information sheet. 35 -2- LSB 5331HV (4) 87 je/rj 2/ 9

H.F. 2442 a. The department of public health, Iowa high school 1 athletic association, and the Iowa girls high school athletic 2 union shall work together to distribute the centers for 3 disease control and prevention guidelines and other pertinent 4 information to inform and educate coaches, students, and 5 the parents and guardians of students of the risks, signs, 6 symptoms, and behaviors consistent with a concussion or brain 7 injury, including the danger of continuing to participate in 8 extracurricular interscholastic activities after suffering a 9 concussion or brain injury and their responsibility to report 10 such signs, symptoms, and behaviors if they occur. 11 b. Annually, each school district and nonpublic school 12 shall provide to the parent or guardian of each student a 13 concussion and brain injury information sheet, as provided by 14 the department of public health, the Iowa high school athletic 15 association, and the Iowa girls high school athletic union. 16 The student and the student’s parent or guardian shall sign and 17 return a copy of the concussion and brain injury information 18 sheet to the student’s school prior to the student’s 19 participation in any extracurricular interscholastic activity. 20 5. Removal from participation. 21 a. If a student’s coach, contest official, or licensed 22 health care provider observes signs, symptoms, or behaviors 23 consistent with a concussion or brain injury in an 24 extracurricular interscholastic activity, the student shall be 25 immediately removed from participation. 26 b. A student who has been removed from participation shall 27 not recommence such participation until the student has been 28 evaluated by a licensed health care provider trained in the 29 evaluation and management of concussions and other brain 30 injuries and the student has received written clearance to 31 return to participation from the licensed health care provider. 32 6. Return-to-play and return-to-learn protocols. The 33 department of public health, the department of education, the 34 Iowa high school athletic association, and the Iowa girls 35 -3- LSB 5331HV (4) 87 je/rj 3/ 9

H.F. 2442 high school athletic union shall work together to develop 1 a return-to-play protocol and a return-to-learn protocol, 2 based on peer-reviewed scientific evidence consistent with the 3 guidelines of the centers for disease control and prevention 4 of the United States department of health and human services, 5 for a student’s return to participation in an extracurricular 6 interscholastic activity and in the classroom after showing 7 signs, symptoms, or behaviors consistent with a concussion 8 or brain injury. The board of directors of each school 9 district and the authorities in charge of each accredited 10 nonpublic school with enrolled students who participate in an 11 extracurricular interscholastic activity which is a contest in 12 grades seven through twelve shall adopt such protocols. 13 7. Protective gear. For school budget years beginning on 14 or after July 1, 2018, the board of directors of each school 15 district and the authorities in charge of each accredited 16 nonpublic school with enrolled students who participate 17 in an extracurricular interscholastic activity which is a 18 contest in grades seven through twelve shall provide students 19 participating in such contests with any protective gear, 20 including but not limited to helmets and pads required for the 21 activity by law, by the rules for such contests, or by Iowa 22 high school athletic association or Iowa girls high school 23 athletic union guidelines. However, an individual student 24 is responsible for other protective gear that the individual 25 student needs but that is not required for participation in the 26 contest as provided in this subsection. 27 8. Liability. 28 a. A school district or accredited nonpublic school that 29 fully implements the protocols required by this section and 30 provides a licensed health care provider at an extracurricular 31 interscholastic activity shall not be liable for any claim for 32 injuries or damages based upon the actions or inactions of the 33 licensed health care provider present at the extracurricular 34 interscholastic activity at the request of the school district 35 -4- LSB 5331HV (4) 87 je/rj 4/ 9

H.F. 2442 or accredited nonpublic school so long as the licensed health 1 care provider acts reasonably and in good faith and in the best 2 interest of the student athlete and without undue influence of 3 the school district or accredited nonpublic school or coaching 4 staff employed by the school district or accredited nonpublic 5 school. 6 b. A licensed health care provider providing care without 7 compensation for a school district or accredited nonpublic 8 school under this section shall not be liable for any claim for 9 injuries or damages arising out of such care so long as the 10 licensed health care provider acts reasonably and in good faith 11 and in the best interest of the student athlete and without 12 undue influence of the school district or accredited nonpublic 13 school or coaching staff employed by the school district or 14 accredited nonpublic school. 15 9. Recommendations. The advisory council on brain 16 injuries established pursuant to section 135.22A shall make 17 recommendations to the governor on the prevention, diagnosis, 18 and treatment of brain injuries in student athletes, including 19 baseline and post-concussion testing and diagnosis of student 20 athletes, return-to-play and return-to-learn guidelines, 21 training for school educators, coaches, athletic directors, 22 and athletic trainers, delivery of post-concussive management 23 services, and ways to integrate education, training, and 24 diagnostic programs into school programs. 25 Sec. 2. APPLICABILITY. A person required to complete 26 training pursuant to section 280.13C, subsection 3, as enacted 27 by this Act, has until July 1, 2019, to initially complete such 28 training. 29 Sec. 3. STATE MANDATE FUNDING SPECIFIED. In accordance 30 with section 25B.2, subsection 3, the state cost of requiring 31 compliance with any state mandate included in this division 32 of this Act shall be paid by a school district from state 33 school foundation aid received by the school district under 34 section 257.16. This specification of the payment of the state 35 -5- LSB 5331HV (4) 87 je/rj 5/ 9

H.F. 2442 cost shall be deemed to meet all of the state funding-related 1 requirements of section 25B.2, subsection 3, and no additional 2 state funding shall be necessary for the full implementation of 3 this Act by and enforcement of this Act against all affected 4 school districts. 5 EXPLANATION 6 The inclusion of this explanation does not constitute agreement with 7 the explanation’s substance by the members of the general assembly. 8 This bill strikes current Code section 280.13C relating 9 to concussion and brain injury policies and creates new Code 10 section 280.13C relating to the same subject. 11 The bill requires the department of public health, the Iowa 12 high school athletic association (IHSAA), and the Iowa girls 13 high school athletic union (IGHSAU) to work together to develop 14 training materials and courses regarding concussions and brain 15 injuries. The bill requires each coach or contest official 16 to complete such training at least every two years. The bill 17 requires individuals required to complete training to submit 18 proof of such completion to the school board or authorities in 19 charge of the accredited nonpublic school within 30 days of 20 such completion. The bill provides that a person required to 21 complete such training has until July 1, 2019, to initially 22 complete the training. 23 The bill requires the department of public health, the 24 IHSAA, and the IGHSAU to work together to distribute the 25 centers for disease control and prevention guidelines and other 26 pertinent information to inform and educate coaches, students, 27 and the parents and guardians of students of the risks, signs, 28 symptoms, and behaviors consistent with a concussion or brain 29 injury. The bill requires each school district and nonpublic 30 school to annually provide to the parent or guardian of each 31 student a concussion and brain injury information sheet, as 32 provided by the department of public health, the IHSAA, and the 33 IGHSAU. The bill requires the student and the student’s parent 34 or guardian to sign and return the information sheet to the 35 -6- LSB 5331HV (4) 87 je/rj 6/ 9

H.F. 2442 student’s school prior to the student’s participation in any 1 extracurricular interscholastic activity. 2 The bill requires that a student be immediately removed from 3 participation in an extracurricular interscholastic activity if 4 the student’s coach, contest official, or licensed health care 5 provider observes signs, symptoms, or behaviors consistent with 6 a concussion or brain injury. The bill prohibits a student 7 who has been removed from participation from recommencing 8 such participation until the student has been evaluated by 9 a licensed health care provider trained in the evaluation 10 and management of concussions and other brain injuries and 11 the student has received written clearance to return to 12 participation from the licensed health care provider. 13 The bill requires the department of public health, 14 the department of education, the IHSAA, and the IGHSAU 15 to work together to develop a return-to-play protocol 16 and a return-to-learn protocol for a student’s return to 17 participation in an extracurricular interscholastic activity 18 and in the classroom after showing signs, symptoms, or 19 behaviors consistent with a concussion or brain injury. The 20 bill requires the school board and the authorities in charge 21 of each accredited nonpublic school with enrolled students who 22 participate in an extracurricular interscholastic activity 23 which is a contest in grades 7 through 12 to adopt such 24 protocols. 25 The bill requires the school board and the authorities 26 in charge of each accredited nonpublic school with enrolled 27 students who participate in an extracurricular interscholastic 28 activity which is a contest in grades 7 through 12, for school 29 budget years beginning July 1, 2018, to provide students 30 participating in such contests with any protective gear 31 required for the activity by law, by the rules for such 32 contests, or by IHSAA or IGHSAU guidelines. The bill provides 33 that an individual student is responsible for other protective 34 gear that the individual student needs but that is not required 35 -7- LSB 5331HV (4) 87 je/rj 7/ 9

H.F. 2442 for participation in the contest as provided in the bill. 1 The bill provides that a school district or nonpublic school 2 that fully implements the protocols required by the bill and 3 provides a licensed health care provider at an extracurricular 4 interscholastic activity shall not be liable for any claim for 5 injuries or damages based upon the actions or inactions of the 6 licensed health care provider present at the extracurricular 7 interscholastic activity at the request of the school district 8 or nonpublic school so long as the licensed health care 9 provider acts reasonably and in good faith and in the best 10 interest of the student athlete and without undue influence of 11 the school district or accredited nonpublic school or coaching 12 staff employed by the school district or accredited nonpublic 13 school. 14 The bill provides that a licensed health care provider 15 providing care without compensation for a school district or 16 accredited nonpublic school under the bill shall not be liable 17 for any claim for injuries or damages arising out of such care 18 so long as the licensed health care provider acts reasonably 19 and in good faith and in the best interest of the student 20 athlete and without undue influence of the school district or 21 accredited nonpublic school or coaching staff employed by the 22 school district or accredited nonpublic school. 23 The bill requires the advisory council on brain injuries to 24 make certain recommendations to the governor on the prevention, 25 diagnosis, and treatment of brain injuries in student athletes. 26 The bill provides legislative findings. 27 The bill may include a state mandate as defined in Code 28 section 25B.3. The bill requires that the state cost of 29 any state mandate included in the bill be paid by a school 30 district from state school foundation aid received by the 31 school district under Code section 257.16. The specification 32 is deemed to constitute state compliance with any state mandate 33 funding-related requirements of Code section 25B.2. The 34 inclusion of this specification is intended to reinstate the 35 -8- LSB 5331HV (4) 87 je/rj 8/ 9