S.F. 238 Section 1. NEW SECTION . 135Q.1 Short title. 1 This chapter shall be known and may be cited as the 2 “Immunization Safety and Right of Refusal Act” . 3 Sec. 2. NEW SECTION . 135Q.2 Definitions. 4 As used in this chapter, unless the content otherwise 5 requires: 6 1. “Health care facility” means the same as defined in 7 section 135C.1. 8 2. “Health care provider” means a person licensed or 9 certified by and subject to the authority of a board as defined 10 in section 147.2 who provides professional health care services 11 to a patient during that patient’s medical care, treatment, or 12 confinement. 13 3. “Hospital” means the same as defined in section 135B.1. 14 4. “Insurer” means an entity providing a plan of health 15 insurance, health care benefits, or health care services, or 16 an entity subject to the jurisdiction of the commissioner 17 of insurance performing utilization review, including an 18 insurance company offering sickness and accident plans, a 19 health maintenance organization, a nonprofit health service 20 corporation, a plan established pursuant to chapter 509A 21 for public employees, or any other entity providing a plan 22 of health insurance, health care benefits, or health care 23 services. 24 5. “Patient” means a person who has received or is receiving 25 professional health care services from a health care facility, 26 health care provider, or hospital. 27 Sec. 3. NEW SECTION . 135Q.3 Immunizations —— prohibited 28 discrimination —— civil remedies. 29 1. A hospital or health care facility shall not do any of 30 the following: 31 a. Discriminate against or terminate the employment of a 32 health care provider, staff member, employee, or applicant for 33 one of these positions based on the person’s refusal to receive 34 an immunization. 35 -1- LSB 1770XS (4) 88 pf/rh 1/ 5

S.F. 238 b. Discriminate against or terminate the employment of a 1 health care provider, staff member, or employee based on the 2 person’s willingness to participate in the immunization of 3 patients. 4 2. A hospital or health care facility or a health care 5 provider, staff member, or employee of a hospital or health 6 care facility shall not discriminate against or terminate 7 treatment of a patient based upon the patient’s refusal to 8 receive an immunization. 9 3. A hospital, health care facility, or educational 10 institution providing clinical experience to satisfy the 11 professional degree requirements of a student, intern, or 12 resident shall not discriminate against the student, intern, or 13 resident, or prohibit admission, enrollment, or employment as a 14 student, intern, or resident based on the immunization status 15 of the student, intern, or resident. 16 4. A person aggrieved under this section may petition the 17 district court in the county where the hospital, health care 18 facility, or educational institution is located for any of the 19 following: 20 a. Injunctive relief against any further violation. 21 b. Affirmative relief, including reinstatement of employment 22 with back pay and interest, or any other equitable relief the 23 court deems appropriate. 24 c. Other appropriate relief necessary to ensure compliance 25 with this section. 26 Sec. 4. NEW SECTION . 135Q.4 Immunization —— health care 27 providers —— prohibited discrimination. 28 1. The licensing authority for a health care provider shall 29 not deny an applicant for a license or suspend, revoke, or 30 refuse to renew a license, and shall not take disciplinary 31 action against a licensee based on the applicant’s or 32 licensee’s immunization history or refusal to submit to or 33 administer an immunization. 34 2. The licensing authority for a health care provider shall 35 -2- LSB 1770XS (4) 88 pf/rh 2/ 5

S.F. 238 not deny an applicant a license or suspend, revoke, or refuse 1 to renew a license, and shall not take disciplinary action 2 against a licensee based on the applicant or licensee having 3 three or more verified failures to comply in one calendar year 4 with the applicable health care provider requirements pursuant 5 to 42 U.S.C. §300aa-25 and 42 U.S.C. §300aa-26. 6 Sec. 5. NEW SECTION . 135Q.5 Immunizations —— prohibited 7 actions —— insurers and insurer ratings —— cease and desist 8 orders and penalties. 9 1. An insurer providing a group policy, contract, or plan 10 for health insurance shall not use the immunization status of 11 a person as a basis to reject; deny; limit; cancel; refuse to 12 renew; increase the premiums for; limit the amount, extent, or 13 kind of coverage available to; or otherwise adversely affect 14 eligibility or coverage for the group health policy, contract, 15 or plan for health insurance. 16 2. An insurer providing a group policy, contract, or plan 17 for health insurance shall not use the immunization status of 18 patient as a qualification or requirement for contracting with 19 the patient’s provider or as a basis for terminating a contract 20 with the patient’s provider. 21 3. The immunization status of a person covered by a group 22 policy, contract, or plan for health insurance shall not be 23 used as a factor in the rating of a group policy, contract, or 24 plan for health insurance in this state. 25 4. An insurer issuing a group policy, contract, or plan for 26 health insurance who violates this section is subject to the 27 summary cease and desist order, cease and desist order, and 28 penalty provisions pursuant to chapter 507B. 29 EXPLANATION 30 The inclusion of this explanation does not constitute agreement with 31 the explanation’s substance by the members of the general assembly. 32 This bill creates the “Vaccination Safety and Right of 33 Refusal Act”. The bill provides definitions used in the Code 34 chapter. 35 -3- LSB 1770XS (4) 88 pf/rh 3/ 5

S.F. 238 The bill prohibits a hospital or health care facility from 1 discriminating against or terminating the employment of a 2 health care provider, staff member, employee, or applicant 3 for one of these positions, based on the person’s refusal to 4 receive an immunization, and from discriminating against or 5 terminating the employment of a health care provider, staff 6 member, or employee based on the person’s willingness to 7 participate in the immunization of patients. The bill also 8 prohibits a hospital, health care facility, or a health care 9 provider, staff member, or employee of a hospital or health 10 care facility from discriminating against or terminating 11 treatment of a patient based upon the patient’s refusal to 12 receive an immunization. Under the bill, a hospital, health 13 care facility, or educational institution providing clinical 14 experience to satisfy the professional degree requirements of a 15 student, intern, or resident is prohibited from discriminating 16 against the student, intern, or resident, or prohibiting 17 admission, enrollment, or employment as a student, intern, 18 or resident based on the immunization status of the student, 19 intern, or resident. A person aggrieved under this portion of 20 the bill may petition the district court in the county where 21 the hospital, health care facility, or educational institution 22 is located for injunctive relief; affirmative relief, including 23 reinstatement of employment with back pay and interest or any 24 other equitable relief the court deems appropriate; or other 25 appropriate relief necessary to ensure compliance with this 26 portion of the bill. 27 The bill also prohibits a health care provider licensing 28 authority from denying an applicant for a license or 29 suspending, revoking, or refusing to renew a license, or 30 from taking disciplinary action against a licensee based on 31 an applicant’s or licensee’s immunization history or refusal 32 to submit to or administer an immunization. A health care 33 provider licensing authority is also prohibited from denying 34 an applicant a license; suspending, revoking, or refusing to 35 -4- LSB 1770XS (4) 88 pf/rh 4/ 5

S.F. 238 renew a license; or from taking disciplinary action against a 1 licensee based on the applicant or licensee having three or 2 more verified failures to comply in one calendar year with 3 the applicable health care provider requirements relative to 4 the recording and reporting of vaccine information and the 5 provision of vaccine information to patients under federal law. 6 The bill prohibits an insurer providing a group policy, 7 contract, or plan for health insurance from using the 8 immunization status of a person as a basis to reject; deny; 9 limit; cancel; refuse to renew; increase the premiums for; 10 limit the amount, extent, or kind of coverage available 11 to; or otherwise adversely affect eligibility or coverage 12 for the group health policy, contract, or plan for health 13 insurance. The bill also prohibits an insurer providing a 14 group policy, contract, or plan for health insurance from 15 using the immunization status of a patient as a qualification 16 or requirement for contracting with the patient’s provider 17 or as a basis for terminating a contract with the patient’s 18 provider. Finally, the bill prohibits the immunization status 19 of a person covered by a group policy, contract, or plan for 20 health insurance from being used as a factor in the rating of a 21 group policy, contract, or plan for health insurance in Iowa. 22 An insurer issuing a group policy, contract, or plan for health 23 insurance who violates any of these provisions of the bill is 24 subject to the summary cease and desist order, cease and desist 25 order, and penalty provisions pursuant to Code chapter 507B 26 (insurance trade practices). 27 -5- LSB 1770XS (4) 88 pf/rh 5/ 5