H.F. 2280 Section 1. Section 280.16, Code 2022, is amended to read as 1 follows: 2 280.16 Self-administration of respiratory distress, asthma , 3 or other airway constricting disease medication , or epinephrine 4 auto-injectors , bronchodilator canisters, or bronchodilator 5 canisters and spacers . 6 1. Definitions. For purposes of this section : 7 a. “Bronchodilator” means a bronchodilator as recommended by 8 the department of public health for treatment of a student’s 9 respiratory distress, asthma, or other airway constricting 10 disease. 11 b. “Bronchodilator canister” means a portable drug 12 delivery device packaged with multiple premeasured doses of a 13 bronchodilator. 14 a. c. “Epinephrine auto-injector” means a device for 15 immediate self-administration or administration by another 16 trained individual of a measured dose of epinephrine to a 17 person at risk of anaphylaxis. 18 b. d. “ Licensed health care professional” means a person 19 licensed under chapter 148 to practice medicine and surgery or 20 osteopathic medicine and surgery, an advanced registered nurse 21 practitioner licensed under chapter 152 or 152E and registered 22 with the board of nursing, or a physician assistant licensed to 23 practice under the supervision of a physician as authorized in 24 chapters 147 and 148C . 25 c. e. “Medication” means a drug that meets the definition 26 provided in section 126.2, subsection 8 , has an individual 27 prescription label, is prescribed by a licensed health care 28 professional for a student, and pertains to the student’s 29 respiratory distress, asthma , or other airway constricting 30 disease , or risk of anaphylaxis , and includes but is not 31 limited to a bronchodilator . 32 d. f. “Self-administration” means a student’s discretionary 33 use of medication prescribed by a licensed health care 34 professional for the student. 35 -1- LSB 5236HV (2) 89 pf/rh 1/ 8

H.F. 2280 g. “Spacer” means a holding chamber that is used to optimize 1 the delivery of a bronchodilator to a person’s lungs. 2 2. The board of directors of a school district and the 3 authorities in charge of an accredited nonpublic school shall 4 permit the self-administration of medication or the use of a 5 bronchodilator canister or bronchodilator canister and spacer 6 by a student with respiratory distress, asthma , or other airway 7 constricting disease or the use of an epinephrine auto-injector 8 by a student with a risk of anaphylaxis if the following 9 conditions are met: 10 a. The student’s parent or guardian provides to the 11 school written authorization for the self-administration 12 of medication , for the use of a bronchodilator canister or 13 bronchodilator canister and spacer, or for the use of an 14 epinephrine auto-injector. 15 b. The student’s parent or guardian provides to the school 16 a written statement from the student’s licensed health care 17 professional containing the following information: 18 (1) The name and purpose of the medication , bronchodilator 19 canister, bronchodilator canister and spacer, or epinephrine 20 auto-injector. 21 (2) The prescribed dosage. 22 (3) The times at which or the special circumstances under 23 which the medication , bronchodilator canister, bronchodilator 24 canister and spacer, or epinephrine auto-injector is to be 25 administered. 26 c. The parent or guardian and the school meet the 27 requirements of subsection 3 . 28 3. The school district or accredited nonpublic school 29 shall notify the parent or guardian of the student, in 30 writing, that the school district or accredited nonpublic 31 school and its employees are to incur no liability, except 32 for gross negligence, as a result of any injury arising from 33 self-administration of medication , use of a bronchodilator 34 canister or bronchodilator canister and spacer, or use of 35 -2- LSB 5236HV (2) 89 pf/rh 2/ 8

H.F. 2280 an epinephrine auto-injector by the student. The parent or 1 guardian of the student shall sign a statement acknowledging 2 that the school district or nonpublic school is to incur 3 no liability, except for gross negligence, as a result of 4 self-administration of medication , use of a bronchodilator 5 canister or bronchodilator canister and spacer, or use 6 of an epinephrine auto-injector by the student. A school 7 district or accredited nonpublic school and its employees 8 acting reasonably and in good faith shall incur no liability 9 for any improper use of medication , use of a bronchodilator 10 canister or bronchodilator canister and spacer, or an 11 epinephrine auto-injector as defined in this section or for 12 supervising, monitoring, or interfering with a student’s 13 self-administration of medication , use of a bronchodilator 14 canister or bronchodilator canister and spacer, or use of an 15 epinephrine auto-injector as defined in this section . 16 4. The permission for self-administration of medication 17 or , for the use of a bronchodilator canister or bronchodilator 18 canister and spacer, or for the use of an epinephrine 19 auto-injector is effective for the school year for which it is 20 granted and shall be renewed each subsequent school year upon 21 fulfillment of the requirements of this section . However, the 22 parent or guardian shall immediately notify the school of any 23 changes in the conditions listed under subsection 2 . 24 5. Provided that the requirements of this section are 25 fulfilled, a student with respiratory distress, asthma , or 26 other airway constricting disease may possess and use the 27 student’s medication and a student with a written statement 28 from a licensed health care professional on file pursuant to 29 subsection 2 , paragraph “a” , may use a bronchodilator canister, 30 a bronchodilator canister and spacer, or an epinephrine 31 auto-injector while in school, at school-sponsored activities, 32 under the supervision of school personnel, and before or after 33 normal school activities, such as while in before-school or 34 after-school care on school-operated property. If the student 35 -3- LSB 5236HV (2) 89 pf/rh 3/ 8

H.F. 2280 misuses this privilege, the privilege may be withdrawn. A 1 school district or nonpublic school shall notify a student’s 2 parent or guardian before withdrawing the privilege to use a 3 bronchodilator canister, a bronchodilator canister and spacer, 4 or an epinephrine auto-injector. 5 6. Information provided to the school under subsection 2 6 shall be kept on file in the office of the school nurse or, in 7 the absence of a school nurse, the school’s administrator. 8 7. The Iowa braille and sight saving school, the Iowa school 9 for the deaf, and the institutions under the control of the 10 department of human services as provided in section 218.1 are 11 exempt from the provisions of this section . 12 Sec. 2. Section 280.16A, Code 2022, is amended to read as 13 follows: 14 280.16A Epinephrine auto-injector , bronchodilator canister, 15 and bronchodilator canister and spacer supply. 16 1. For purposes of this section , unless the context 17 otherwise requires: 18 a. “Bronchodilator” means the same as defined in section 19 280.16. 20 b. “Bronchodilator canister” means the same as defined in 21 section 280.16. 22 a. c. “Epinephrine auto-injector” means the same as 23 provided in section 280.16 . 24 b. d. “Licensed health care professional” means the same as 25 provided in section 280.16 . 26 c. e. “Personnel authorized to administer epinephrine 27 or a bronchodilator ” means a school nurse or other employee 28 of a school district or accredited nonpublic school trained 29 and authorized to administer an epinephrine auto-injector , 30 a bronchodilator canister, or a bronchodilator canister and 31 spacer . 32 f. “School nurse” means a registered nurse holding current 33 licensure recognized by the board of nursing who practices in 34 the school setting to promote and protect the health of the 35 -4- LSB 5236HV (2) 89 pf/rh 4/ 8

H.F. 2280 school population by using knowledge from the nursing, social, 1 and public health sciences. 2 g. “Spacer” means the same as defined in section 280.16. 3 2. Notwithstanding any other provision of law to the 4 contrary, a licensed health care professional may prescribe 5 epinephrine auto-injectors , bronchodilator canisters, and 6 bronchodilator canisters and spacers in the name of a school 7 district or accredited nonpublic school to be maintained for 8 use as provided in this section . 9 3. The board of directors in charge of each school 10 district and the authorities in charge of each accredited 11 nonpublic school may obtain a prescription for epinephrine 12 auto-injectors , bronchodilator canisters, and bronchodilator 13 canisters and spacers and maintain a supply of such epinephrine 14 auto-injectors , bronchodilator canisters, and bronchodilator 15 canisters and spacers in a secure location at each school for 16 use as provided in this section . The board and the authorities 17 shall replace epinephrine auto-injectors , bronchodilator 18 canisters, and bronchodilator canisters and spacers in 19 the supply upon use or expiration. Personnel authorized 20 to administer epinephrine or a bronchodilator may possess 21 and administer epinephrine auto-injectors , bronchodilator 22 canisters, or bronchodilator canisters and spacers, as 23 applicable, from the supply as provided in this section . 24 4. Personnel authorized to administer epinephrine or 25 a bronchodilator may provide or administer an epinephrine 26 auto-injector , a bronchodilator canister, or a bronchodilator 27 canister and spacer, as applicable, from the school’s supply to 28 a student or other individual if such personnel reasonably and 29 in good faith believe the student or other individual is having 30 an anaphylactic reaction or requires treatment for respiratory 31 distress, asthma, or other airway constricting disease . 32 5. The following persons, provided they have acted 33 reasonably and in good faith, shall not be liable for 34 any injury arising from the provision, administration, 35 -5- LSB 5236HV (2) 89 pf/rh 5/ 8

H.F. 2280 or assistance in the administration of an epinephrine 1 auto-injector , a bronchodilator canister, or a bronchodilator 2 canister and spacer as provided in this section : 3 a. Any personnel authorized to administer epinephrine or 4 a bronchodilator who , as applicable, provide, administer, or 5 assist in the administration of an epinephrine auto-injector 6 to a student or other individual present at the school who 7 such personnel believe to be having an anaphylactic reaction 8 or in the administration of a bronchodilator canister or a 9 bronchodilator canister and spacer to a student or other 10 individual present at the school who such personnel believe to 11 require treatment for respiratory distress, asthma, or other 12 airway constricting disease . 13 b. A school district or accredited nonpublic school 14 employing the personnel. 15 c. The board of directors in charge of the school district 16 or authorities in charge of the accredited nonpublic school. 17 d. The prescriber of the epinephrine auto-injector , 18 bronchodilator canister, or bronchodilator canister and spacer . 19 6. The department of education, the board of medicine, 20 the board of nursing, and the board of pharmacy shall, in 21 consultation with an organization representing school nurses, 22 adopt rules pursuant to chapter 17A to implement and administer 23 this section , including but not limited to standards and 24 procedures for the prescription, distribution, storage, 25 disposal, replacement, and administration of epinephrine 26 auto-injectors , bronchodilator canisters, and bronchodilator 27 canisters and spacers , and for training and authorization to be 28 required for personnel authorized to administer epinephrine or 29 a bronchodilator . 30 EXPLANATION 31 The inclusion of this explanation does not constitute agreement with 32 the explanation’s substance by the members of the general assembly. 33 This bill relates to the self-administration, storage, 34 and supply of bronchodilators, bronchodilator canisters, and 35 -6- LSB 5236HV (2) 89 pf/rh 6/ 8

H.F. 2280 bronchodilator canisters and spacers relative to schools and 1 students. 2 Current law provides for the self-administration by 3 students of asthma or other airway constricting disease 4 medication or epinephrine auto-injectors. The bill adds a 5 bronchodilator specifically to the definition of “medication”, 6 adds respiratory distress as a condition that may be treated 7 by the medication, and adds bronchodilator canisters and 8 bronchodilator canisters and spacers to the list of devices 9 that may be self-administered by students and stored relative 10 to students and schools. The bill includes definitions of 11 “bronchodilator”, “bronchodilator canister”, and “spacer”. 12 The bill requires that the same conditions be met for the 13 board of directors of a school district and the authorities 14 in charge of an accredited nonpublic school to permit the 15 self-administration of medication or the use of bronchodilator 16 canisters and bronchodilator canisters and spacers by a 17 student as are currently required for the self-administration 18 of medication or the use of an epinephrine auto-injector 19 by a student. The bill also applies to a bronchodilator, 20 bronchodilator canisters, and bronchodilator canisters and 21 spacers the same requirements for self-administration and 22 use of medication or epinephrine auto-injectors relating to 23 permissions, the requirements for the provision of written 24 statements from licensed health care professionals, and the 25 maintaining of information provided to the school. 26 The bill expands provisions authorizing a licensed health 27 care professional to prescribe epinephrine auto-injectors 28 in the name of a school district or accredited nonpublic 29 school to be maintained for use at a school to also include 30 bronchodilator canisters and bronchodilator canisters 31 and spacers. The bill also expands current provisions 32 allowing personnel authorized to administer epinephrine to 33 provide or administer an epinephrine auto-injector from the 34 school’s supply to allow personnel authorized to administer 35 -7- LSB 5236HV (2) 89 pf/rh 7/ 8

H.F. 2280 a bronchodilator to provide or administer a bronchodilator 1 canister or bronchodilator canister and spacer from the 2 school’s supply, and provides liability protection for persons 3 who act reasonably and in good faith. The bill expands the 4 requirement that the department of education, the board of 5 medicine, the board of nursing, and the board of pharmacy, in 6 consultation with an organization representing school nurses, 7 adopt rules pursuant to Code chapter 17A to implement and 8 administer the bill relative to bronchodilators, bronchodilator 9 canisters, and bronchodilator canisters and spacers and also 10 to adopt rules for the disposal of epinephrine auto-injectors, 11 bronchodilator canisters, and bronchodilator canisters and 12 spacers. 13 -8- LSB 5236HV (2) 89 pf/rh 8/ 8