H.F. 549 DIVISION I 1 IOWA COLLABORATIVE SAFETY NET PROVIDER NETWORK 2 Section 1. Section 135.24, subsection 7, paragraph e, Code 3 2019, is amended to read as follows: 4 e. “Specialty health care provider office” means the 5 private office or clinic of an individual specialty health 6 care provider or group of specialty health care providers as 7 referred by the Iowa collaborative safety net provider network 8 established in section 135.153 , but does not include a field 9 dental clinic, a free clinic, or a hospital. 10 Sec. 2. Section 135.159, subsection 1, paragraph h, Code 11 2019, is amended by striking the paragraph. 12 Sec. 3. REPEAL. Section 135.153, Code 2019, is repealed. 13 DIVISION II 14 HOSPITAL HEALTH CARE ACCESS TRUST FUND BOARD 15 Sec. 4. Section 249M.4, Code 2019, is amended to read as 16 follows: 17 249M.4 Hospital health care access trust fund —— board . 18 1. A hospital health care access trust fund is created 19 in the state treasury under the authority of the department. 20 Moneys received through the collection of the hospital health 21 care access assessment imposed under this chapter and any 22 other moneys specified for deposit in the trust fund shall be 23 deposited in the trust fund. 24 2. Moneys in the trust fund shall be used, subject to 25 their appropriation by the general assembly, by the department 26 to reimburse participating hospitals the medical assistance 27 program upper payment limit for inpatient and outpatient 28 hospital services as calculated in this section . Following 29 payment of such upper payment limit to participating hospitals, 30 any remaining funds in the trust fund on an annual basis may be 31 used for any of the following purposes: 32 a. To support medical assistance program utilization 33 shortfalls. 34 b. To maintain the state’s capacity to provide access to and 35 -1- LSB 2076YH (11) 88 pf/rh 1/ 15

H.F. 549 delivery of services for vulnerable Iowans. 1 c. To fund the health care workforce support initiative 2 created pursuant to section 135.175 . 3 d. To support access to health care services for uninsured 4 Iowans. 5 e. To support Iowa hospital programs and services which 6 expand access to health care services for Iowans. 7 3. The trust fund shall be separate from the general fund 8 of the state and shall not be considered part of the general 9 fund. The moneys in the trust fund shall not be considered 10 revenue of the state, but rather shall be funds of the hospital 11 health care access assessment program. The moneys deposited 12 in the trust fund are not subject to section 8.33 and shall not 13 be transferred, used, obligated, appropriated, or otherwise 14 encumbered, except to provide for the purposes of this chapter . 15 Notwithstanding section 12C.7, subsection 2 , interest or 16 earnings on moneys deposited in the trust fund shall be 17 credited to the trust fund. 18 4. The department shall adopt rules pursuant to chapter 19 17A to administer the trust fund and reimbursements and 20 expenditures as specified in this chapter made from the trust 21 fund. 22 5. a. Beginning July 1, 2010, or the implementation date 23 of the hospital health care access assessment program as 24 determined by receipt of approval from the centers for Medicare 25 and Medicaid services of the United States department of health 26 and human services, whichever is later, the department shall 27 increase the diagnostic related groups and ambulatory patient 28 classifications base rates to provide payments to participating 29 hospitals at the Medicare upper payment limit for the fiscal 30 year beginning July 1, 2010, calculated as of July 31, 2010. 31 Each participating hospital shall receive the same percentage 32 increase, but the percentage may differ depending on whether 33 the basis for the base rate increase is the diagnostic related 34 groups or ambulatory patient classifications. 35 -2- LSB 2076YH (11) 88 pf/rh 2/ 15

H.F. 549 b. The percentage increase shall be calculated by dividing 1 the amount calculated under subparagraph (1) by the amount 2 calculated under subparagraph (2) as follows: 3 (1) The amount under the Medicare upper payment limit for 4 the fiscal year beginning July 1, 2010, for participating 5 hospitals. 6 (2) The projected expenditures for participating hospitals 7 for the fiscal year beginning July 1, 2010, as determined by 8 the fiscal management division of the department, plus the 9 amount calculated under subparagraph (1). 10 6. For the fiscal year beginning July 1, 2011, and for 11 each fiscal year beginning July 1, thereafter, the payments to 12 participating hospitals shall continue to be calculated based 13 on the upper payment limit as calculated for the fiscal year 14 beginning July 1, 2010. 15 7. Reimbursement of participating hospitals shall 16 incorporate the rebasing process for inpatient and outpatient 17 services for state fiscal year 2012. However, the total amount 18 of increased funding available for reimbursement attributable 19 to rebasing shall not exceed four million five hundred thousand 20 dollars for state fiscal year 2012 and six million dollars for 21 state fiscal year 2013. 22 8. Any payments to participating hospitals under this 23 section shall result in budget neutrality to the general fund 24 of the state. 25 9. a. A hospital health care access trust fund board is 26 established consisting of the following members: 27 (1) The co-chairpersons and the ranking members of the joint 28 appropriations subcommittee on health and human services. 29 (2) The Iowa medical assistance program director. 30 (3) Two hospital executives representing the two largest 31 private health care systems in the state. 32 (4) The president of the Iowa hospital association. 33 (5) A representative of a consumer advocacy group, involved 34 in both state and national initiatives, that provides data on 35 -3- LSB 2076YH (11) 88 pf/rh 3/ 15

H.F. 549 key indicators of well-being for children and families in order 1 to inform policymakers to help children and families succeed. 2 b. The board shall do all of the following: 3 (1) Provide oversight of the trust fund. 4 (2) Make recommendations regarding the hospital health care 5 access assessment program, including recommendations regarding 6 the assessment calculation, assessment amounts, payments to 7 participating hospitals, and use of the moneys in the trust 8 fund. 9 (3) Submit an annual report to the governor and the general 10 assembly regarding the use and expenditure of moneys deposited 11 in the trust fund. 12 c. The department shall provide administrative assistance 13 to the board. 14 DIVISION III 15 ADVISORY COUNCIL ON BRAIN INJURIES 16 Sec. 5. Section 135.22A, Code 2019, is amended to read as 17 follows: 18 135.22A Advisory council on Lead agency for brain injuries 19 injury . 20 1. For purposes of this section , unless the context 21 otherwise requires: 22 a. “Brain injury” means a brain injury as defined in section 23 135.22 . 24 b. “Council” means the advisory council on brain injuries. 25 2. The advisory council on brain injuries is established. 26 The following persons or their designees shall serve as ex 27 officio, nonvoting members of the council: 28 a. The director of public health. 29 b. The director of human services and any division 30 administrators of the department of human services so assigned 31 by the director. 32 c. The director of the department of education. 33 d. The chief of the special education bureau of the 34 department of education. 35 -4- LSB 2076YH (11) 88 pf/rh 4/ 15

H.F. 549 e. The administrator of the division of vocational 1 rehabilitation services of the department of education. 2 f. The director of the department for the blind. 3 3. The council shall be composed of a minimum of nine 4 members appointed by the governor in addition to the ex officio 5 members, and the governor may appoint additional members. 6 Insofar as practicable, the council shall include persons with 7 brain injuries; family members of persons with brain injuries; 8 representatives of industry, labor, business, and agriculture; 9 representatives of federal, state, and local government; and 10 representatives of religious, charitable, fraternal, civic, 11 educational, medical, legal, veteran, welfare, and other 12 professional groups and organizations. Members shall be 13 appointed representing every geographic and employment area 14 of the state and shall include members of both sexes. A 15 simple majority of the members appointed by the governor shall 16 constitute a quorum. 17 4. Members of the council appointed by the governor shall 18 be appointed for terms of two years. Vacancies on the council 19 shall be filled for the remainder of the term of the original 20 appointment. Members whose terms expire may be reappointed. 21 5. The voting members of the council shall appoint a 22 chairperson and a vice chairperson and other officers as the 23 council deems necessary. The officers shall serve until their 24 successors are appointed and qualified. Members of the council 25 shall receive actual expenses for their services. Members may 26 also be eligible to receive compensation as provided in section 27 7E.6 . The council shall adopt rules pursuant to chapter 17A . 28 6. 1. a. The council shall do department is designated 29 as Iowa’s lead agency for brain injury. For the purposes of 30 this section, the designation of lead agency authorizes the 31 department to perform or oversee the performance of all of the 32 following: 33 a. (1) Promote Promotion of meetings and programs for 34 the discussion of methods to reduce the debilitating effects 35 -5- LSB 2076YH (11) 88 pf/rh 5/ 15

H.F. 549 of brain injuries, and disseminate the dissemination of 1 information in cooperation with any other department, agency, 2 or entity on the prevention, evaluation, care, treatment, and 3 rehabilitation of persons affected by brain injuries. 4 b. (2) Study The study and review of current prevention, 5 evaluation, care, treatment, and rehabilitation technologies 6 and recommend appropriate preparation, training, retraining, 7 and distribution of personnel and resources in the provision 8 of services to persons with brain injuries through private 9 and public residential facilities, day programs, and other 10 specialized services. 11 c. (3) Participate Participation in developing the 12 development and disseminating dissemination of criteria and 13 standards which may be required for future funding or licensing 14 of facilities, day programs, and other specialized services for 15 persons with brain injuries in this state. 16 d. (4) Make The making of recommendations to the governor 17 for developing the development and administering administration 18 of a state plan to provide services for persons with brain 19 injuries. 20 e. Meet at least quarterly. 21 7. The department is designated as Iowa’s lead agency 22 for brain injury. For the purposes of this section , the 23 designation of lead agency authorizes the department to perform 24 or oversee the performance of those functions specified in 25 subsection 6 , paragraphs “a” through “c” . The council is 26 assigned to the department for administrative purposes. 27 b. The director shall be responsible for budgeting, program 28 coordination, and related management functions under this 29 section . 30 8. 2. The council department may receive gifts, grants, 31 or donations made for any of the purposes of its programs this 32 section and disburse and administer them in accordance with 33 their terms and under the direction of the director. 34 Sec. 6. Section 135.22B, subsection 2, paragraphs b and c, 35 -6- LSB 2076YH (11) 88 pf/rh 6/ 15

H.F. 549 Code 2019, are amended to read as follows: 1 b. The duties of the division of the department assigned to 2 administer the advisory council on brain injuries under section 3 135.22A shall be the program administrator. The division 4 duties shall include but are not limited to serving as the 5 fiscal agent and contract administrator for the program and 6 providing program oversight. 7 c. The division shall consult with the advisory council 8 on brain injuries, established pursuant to section 135.22A , 9 regarding the program and shall report to the council 10 department concerning the program at least quarterly. The 11 council division shall make recommendations to the department 12 concerning the program’s operation. 13 DIVISION IV 14 ADVISORY COMMITTEE TO THE CENTER FOR RURAL HEALTH AND PRIMARY 15 CARE 16 Sec. 7. Section 135.107, subsection 5, Code 2019, is amended 17 by striking the subsection. 18 Sec. 8. Section 262.78, subsection 3, Code 2019, is amended 19 to read as follows: 20 3. The president of the university of Iowa, in consultation 21 with the president of Iowa state university of science and 22 technology, shall employ a full-time director of the center. 23 The center may employ staff to carry out the center’s purpose. 24 The director shall coordinate the agricultural health and 25 safety programs of the center. The director shall regularly 26 meet and consult with the advisory committee to the center for 27 rural health and primary care. The director shall provide 28 the board of regents with relevant information regarding the 29 center. 30 DIVISION V 31 DOMESTIC ABUSE DEATH REVIEW TEAM 32 Sec. 9. Section 216A.133A, subsection 3, paragraph a, 33 subparagraph (8), Code 2019, is amended to read as follows: 34 (8) Best practices related to the Iowa child death review 35 -7- LSB 2076YH (11) 88 pf/rh 7/ 15

H.F. 549 team established in section 135.43 and the Iowa domestic abuse 1 death review team established in section 135.109 . 2 Sec. 10. REPEAL. Sections 135.108, 135.109, 135.110, 3 135.111, and 135.112, Code 2019, are repealed. 4 DIVISION VI 5 GOVERNMENTAL PUBLIC HEALTH ADVISORY COUNCIL 6 Sec. 11. Section 135A.2, subsection 2, Code 2019, is amended 7 by striking the subsection. 8 Sec. 12. Section 135A.9, subsection 1, Code 2019, is amended 9 by striking the subsection. 10 Sec. 13. REPEAL. Section 135A.4, Code 2019, is repealed. 11 DIVISION VII 12 PATIENT-CENTERED HEALTH ADVISORY COUNCIL 13 Sec. 14. REPEAL. Section 135.159, Code 2019, is repealed. 14 DIVISION VIII 15 COMBINING STATE MEDICAL EXAMINER ADVISORY COUNCIL WITH THE 16 INTERAGENCY COORDINATING COUNCIL 17 Sec. 15. Section 691.6B, Code 2019, is amended to read as 18 follows: 19 691.6B Interagency coordinating council. 20 1. An interagency coordinating council is created to advise 21 do all of the following: 22 a. Advise and consult with the state medical examiner on a 23 range of issues affecting the organization and functions of the 24 office of the state medical examiner and the effectiveness of 25 the medical examiner system in the state. 26 b. Advise the state medical examiner concerning the 27 assurance of effective coordination of the functions and 28 operations of the office of the state medical examiner with the 29 needs and interests of the departments of public safety and 30 public health. 31 2. Members of the interagency coordinating council shall 32 include the all of the following: 33 a. The state medical examiner, or when the state medical 34 examiner is not available, the deputy state medical examiner ; 35 -8- LSB 2076YH (11) 88 pf/rh 8/ 15

H.F. 549 the . 1 b. The commissioner of public safety or the commissioner’s 2 designee ; the . 3 c. The director of public health or the director’s designee ; 4 and the . 5 d. The governor or the governor’s designee. 6 e. Representatives from the office of the attorney general, 7 the Iowa county attorneys association, the Iowa medical 8 society, the Iowa association of pathologists, the Iowa 9 association of medical examiners, the statewide emergency 10 medical system, and the Iowa funeral directors association. 11 3. The interagency coordinating council shall meet on 12 a regular basis , and shall be organized and function as 13 established by the state medical examiner by rule . 14 Sec. 16. REPEAL. Section 691.6C, Code 2019, is repealed. 15 DIVISION IX 16 TOBACCO USE PREVENTION AND CONTROL COMMISSION —— MEMBERSHIP —— 17 MEETINGS —— EXPENSES 18 Sec. 17. Section 142A.3, subsection 3, Code 2019, is amended 19 to read as follows: 20 3. The membership of the commission shall include the 21 following voting members who shall serve three-year, staggered 22 terms: 23 a. Members, at least one of whom is a member of a racial 24 minority, to be appointed by the governor, subject to 25 confirmation by the senate pursuant to sections 2.32 and 69.19 , 26 and consisting of the following: 27 (1) Three Two members who are active with nonprofit health 28 organizations that emphasize tobacco use prevention or who are 29 active as health services providers, at the local level. 30 (2) Three Two members who are active with health promotion 31 activities at the local level in youth education, nonprofit 32 services, or other activities relating to tobacco use 33 prevention and control. 34 b. Three voting members, to be selected by the participants 35 -9- LSB 2076YH (11) 88 pf/rh 9/ 15

H.F. 549 in the annual statewide youth summit of the initiative’s youth 1 program, who shall not be subject to section 69.16 or 69.16A . 2 However, the selection process shall provide for diversity 3 among the members and at least one of the youth members shall 4 be a female. 5 Sec. 18. Section 142A.3, subsection 6, Code 2019, is amended 6 to read as follows: 7 6. Citizen members shall be reimbursed for actual and 8 necessary expenses incurred in performance of their duties. 9 Citizen members shall be paid a per diem as specified in 10 section 7E.6 . Legislative members are eligible for per diem 11 and expenses as provided in section 2.10 . 12 Sec. 19. Section 142A.3, subsection 9, Code 2019, is amended 13 to read as follows: 14 9. The commission shall elect a chairperson from among its 15 voting members and may select other officers from among its 16 voting members, as determined necessary by the commission. 17 The commission shall meet regularly no more than quarterly as 18 determined by the commission, upon the call of the chairperson, 19 or upon the call of a majority of the voting members. 20 Sec. 20. TRANSITION PROVISIONS. Notwithstanding any 21 provision of section 142A.3, subsection 8, to the contrary: 22 1. If the term of a voting member of the tobacco use 23 prevention and control commission appointed pursuant to section 24 142A.3, subsection 3, paragraph “a”, expires on April 30, 25 2020, or April 30, 2021, the member shall continue serving 26 until the expiration of that member’s term or until a vacancy 27 occurs prior to the expiration of the applicable term, and such 28 vacancy shall only be filled to the extent consistent with 29 section 142A.3, subsection 3, as amended in this Act. 30 2. If the term of a voting member of the tobacco use 31 prevention and control commission appointed pursuant to section 32 142A.3, subsection 3, paragraph “a”, expires on April 30, 2019, 33 or June 30, 2019, such vacancy shall only be filled to the 34 extent consistent with section 142A.3, subsection 3, as amended 35 -10- LSB 2076YH (11) 88 pf/rh 10/ 15

H.F. 549 in this Act. 1 Sec. 21. EFFECTIVE DATE. The following, being deemed of 2 immediate importance, takes effect upon enactment: 3 The section of this division of this Act relating to 4 transition provisions for the tobacco use prevention and 5 control commission. 6 Sec. 22. RETROACTIVE APPLICABILITY. The following applies 7 retroactively to April 30, 2019: 8 The section of this division of this Act relating to 9 transition provisions for the tobacco use prevention and 10 control commission. 11 DIVISION X 12 STATE BOARD OF HEALTH —— MEMBERSHIP —— EXPENSES 13 Sec. 23. Section 136.1, subsection 1, Code 2019, is amended 14 to read as follows: 15 1. The state board of health shall consist of the following 16 members: 17 a. Two members One member learned in health-related 18 disciplines. 19 b. Three Two members who have direct experience with public 20 health. 21 c. Two members One member who have has direct experience 22 with substance abuse treatment or prevention. 23 d. Four Three members representing the general public. 24 Sec. 24. REPEAL. Section 136.9, Code 2019, is repealed. 25 Sec. 25. TRANSITION PROVISIONS. Notwithstanding any 26 provision of section 136.2 to the contrary: 27 1. If the term of a member of the state board of health 28 ends on June 30, 2019, such vacancy shall only be filled to the 29 extent consistent with section 136.1, subsection 1, as amended 30 in this Act. 31 2. If the term of a member of the state board of health who 32 is a member on July 1, 2019, expires on April 30, 2020, June 33 30, 2020, or June 30, 2021, the member shall continue serving 34 until the expiration of that member’s term or until a vacancy 35 -11- LSB 2076YH (11) 88 pf/rh 11/ 15

H.F. 549 occurs prior to the expiration of the applicable term, and such 1 vacancy shall only be filled to the extent consistent with 2 section 136.1, subsection 1, as amended in this Act. 3 Sec. 26. EFFECTIVE DATE. The following, being deemed of 4 immediate importance, takes effect upon enactment: 5 The section of this division of this Act relating to 6 transition provisions for the state board of health. 7 Sec. 27. RETROACTIVE APPLICABILITY. The following applies 8 retroactively to June 30, 2019: 9 The section of this division of this Act relating to 10 transition provisions for the state board of health. 11 DIVISION XI 12 TRAUMA SYSTEM ADVISORY COUNCIL 13 Sec. 28. Section 147A.24, subsection 2, Code 2019, is 14 amended to read as follows: 15 2. The council shall consist of seven members to be 16 appointed by the director from the recommendations of 17 the organizations in subsection 1 for terms of two years. 18 Vacancies on the council shall be filled for the remainder of 19 the term of the original appointment. Members whose terms 20 expire may be reappointed. 21 Sec. 29. TRANSITION PROVISIONS. Notwithstanding any 22 provision of section 147A.24, subsection 2, to the contrary, a 23 member of the trauma system advisory council on July 1, 2019, 24 shall continue serving until the expiration of that member’s 25 term or until a vacancy occurs prior to the expiration of the 26 applicable term, and such vacancy shall only be filled to the 27 extent consistent with and necessary to maintain the total 28 number of members of the council specified in section 147A.24, 29 subsection 2, as amended in this Act. 30 DIVISION XII 31 TELECONFERENCE OPTION FOR STATE ENTITIES 32 Sec. 30. NEW SECTION . 135.11B Statutory board, commission, 33 committee, or council of committee —— teleconference option. 34 Any statutorily established board, commission, committee, or 35 -12- LSB 2076YH (11) 88 pf/rh 12/ 15

H.F. 549 council established under the purview of the department shall 1 provide for a teleconference option for board, commission, 2 committee, or council members to participate in official 3 meetings. 4 DIVISION XIII 5 ELIMINATION OF PAYMENT OF EXPENSES FOR PUBLIC MEMBERS OF 6 CERTAIN STATE ENTITIES 7 Sec. 31. Section 105.3, subsection 6, Code 2019, is amended 8 by striking the subsection. 9 Sec. 32. Section 135.43, subsection 2, unnumbered paragraph 10 1, Code 2019, is amended to read as follows: 11 The membership of the review team is subject to the 12 provisions of sections 69.16 and 69.16A , relating to political 13 affiliation and gender balance. Review team members who 14 are not designated by another appointing authority shall be 15 appointed by the state medical examiner. Membership terms 16 shall be for three years. A membership vacancy shall be filled 17 in the same manner as the original appointment. The review 18 team shall elect a chairperson and other officers as deemed 19 necessary by the review team. The review team shall meet upon 20 the call of the state medical examiner or as determined by 21 the review team. The members of the team are eligible for 22 reimbursement of actual and necessary expenses incurred in the 23 performance of their official duties. The review team shall 24 include the following: 25 Sec. 33. Section 135.62, subsection 2, paragraph e, Code 26 2019, is amended by striking the paragraph. 27 Sec. 34. Section 147A.3, Code 2019, is amended to read as 28 follows: 29 147A.3 Meetings of the council —— quorum —— expenses . 30 Membership, terms of office, and quorum , and expenses shall 31 be determined by the director pursuant to chapter 135 . 32 Sec. 35. Section 256I.3, subsection 3, Code 2019, is amended 33 by striking the subsection. 34 EXPLANATION 35 -13- LSB 2076YH (11) 88 pf/rh 13/ 15

H.F. 549 The inclusion of this explanation does not constitute agreement with 1 the explanation’s substance by the members of the general assembly. 2 This bill eliminates or combines certain health-related 3 entities and makes other changes relating to health-related 4 entities. 5 Division I repeals Code section 135.153 (Iowa collaborative 6 safety net provider network established) thereby eliminating 7 the network. The bill also makes conforming changes to 8 eliminate references to the network in Code section 135.24 9 (volunteer health care provider program established —— 10 immunity from civil liability) and Code section 135.159 11 (patient-centered health advisory council). 12 Division II eliminates the hospital health care access trust 13 fund board by striking the language establishing the board in 14 Code section 249M.4 (hospital health care access trust fund —— 15 board). 16 Division III eliminates the advisory council on brain 17 injuries and amends Code section 135.22A (advisory council on 18 brain injuries) to redistribute the duties of the advisory 19 council to the department of public health and makes other 20 conforming changes. 21 Division IV eliminates the advisory committee to the center 22 for rural health and primary care (Code section 135.107(5)) and 23 makes conforming changes. 24 Division V eliminates the domestic abuse death review team 25 (Code sections 135.108 through 135.112) and makes conforming 26 changes. 27 Division VI eliminates the governmental public health 28 advisory council (Code section 135A.4) and makes conforming 29 changes. 30 Division VII eliminates the patient-centered health advisory 31 council (Code section 135.159). 32 Division VIII combines the state medical examiner advisory 33 council with the interagency coordinating council (Code 34 sections 691.6B and 691.6C). 35 -14- LSB 2076YH (11) 88 pf/rh 14/ 15

H.F. 549 Division IX reduces the voting membership of the tobacco 1 use prevention and control commission from nine members to 2 seven members and includes membership transition provisions, 3 limits the number of meetings of the commission to no more 4 than quarterly, and eliminates reimbursement for the citizen 5 members. 6 Division X reduces the membership of the state board of 7 health from 11 to 7 members, includes membership transition 8 provisions, and eliminates payment of compensation and expenses 9 for members. 10 Division XI limits the membership of the trauma system 11 advisory council to seven members selected from a listing of 12 organizations, and includes membership transition provisions. 13 Division XII requires any statutorily established board, 14 commission, committee, or council under the purview of the 15 department of public health to provide for a teleconference 16 option for board, commission, committee, or council members to 17 participate in official meetings. 18 Division XIII eliminates payment of compensation or 19 expenses, as applicable, of public members of the child 20 death review team, the early childhood Iowa state board, the 21 emergency management services advisory council, the health 22 facilities council, and the plumbing and mechanical systems 23 board. 24 -15- LSB 2076YH (11) 88 pf/rh 15/ 15