S.F. 2069 Section 1. NEW SECTION . 135.193 Health equity program —— 1 fund —— standing appropriation. 2 1. The department shall establish a health equity program 3 to improve menstrual and post-menstrual health by providing 4 for reimbursement of the costs associated with the provision 5 of covered services and treatments related to menstrual and 6 post-menstrual health conditions not otherwise covered by a 7 third-party payor. The department shall promote the program 8 statewide and shall limit program administrative costs to 9 no more than four percent of the funds appropriated for the 10 program on an annual basis. 11 2. a. The department shall adopt rules pursuant to chapter 12 17A to administer the program and to specify the types of 13 services and treatments covered under the program, informed by 14 evidence-based data from menstrual and post-menstrual health 15 experts including but not limited to those who practice in 16 the fields of obstetrics and gynecology, family practice, 17 internal medicine, and urology. The covered services and 18 treatments shall include but are not limited to hormone 19 treatments, urinary tract treatments, vaginal estrogens, nerve 20 therapies, and other services and treatments that alleviate 21 illness, injury, conditions, diseases or symptoms related to 22 periods, fibroids, endometriosis, perimenopause, menopause, 23 incontinence, atrophic vaginitis, and other hormone-related 24 conditions. 25 b. Covered services and treatments shall include health 26 care services, treatments, supplies, and drugs needed to treat 27 a menstrual or post-menstrual illness, injury, condition, 28 disease, or its symptoms that meet any of the following 29 criteria: 30 (1) Comply with standard medical practice. 31 (2) Are approved by the United States food and drug 32 administration including for off-label use when supported by 33 appropriate medical records. 34 (3) Are recommended or preferred by the patient’s provider 35 -1- LSB 5618XS (7) 89 pf/rh 1/ 5

S.F. 2069 and supported by appropriate medical records. 1 3. The department shall establish a process for 2 registration of participating providers eligible to receive 3 reimbursement through the health equity program fund. A 4 health care provider shall be eligible for participation if 5 the provider is deemed qualified and in good standing by the 6 provider’s respective health-related profession board. 7 4. A participating provider shall be reimbursed for a 8 covered service or treatment through the health equity program 9 fund within ten days of submission of a billing statement. 10 If applicable, the billing statement shall confirm that the 11 patient is uninsured or that the service or treatment is not 12 covered by the patient’s insurer. 13 5. The amount billed by the participating provider shall 14 not exceed the actual cost incurred by the provider in 15 delivering the covered service or treatment. Reimbursement for 16 a covered service or treatment shall be paid directly to the 17 participating provider and such payment shall be considered 18 payment in full. The health equity program shall be the payor 19 of last resort. 20 6. If sufficient program funds are not available to 21 reimburse all billings submitted by participating providers, 22 the department shall place a participating provider on a 23 reimbursement waiting list in the order the participating 24 provider’s billing statement was received. This section 25 shall not be construed as granting an entitlement to 26 reimbursement for any covered service or treatment provided by 27 a participating provider. 28 7. a. A health equity program fund is created in the 29 state treasury under the control of the department. The fund 30 includes but is not limited to amounts appropriated by the 31 general assembly and other moneys available from federal or 32 private sources which are to be used for purposes of this 33 section. Notwithstanding section 8.33, funds remaining in 34 the fund at the end of each fiscal year shall not revert to 35 -2- LSB 5618XS (7) 89 pf/rh 2/ 5

S.F. 2069 the general fund of the state but shall remain in the health 1 equity program fund. Moneys in the fund are appropriated to 2 the department for purposes of the health equity program. 3 b. There is appropriated annually from the general fund 4 of the state to the health equity program fund a sum which 5 reflects the total state revenue collected from the sales tax 6 imposed on the sales price from the sales of period products 7 and child and adult diapers whether cloth or disposable, 8 annually, or if a sales tax is not imposed on such products, 9 the amount that reflects the total dollar amount of the sales 10 of such products sold in the state multiplied by the state 11 sales tax rate imposed pursuant to section 423.2. 12 c. For the purposes of this subsection, “period products” 13 includes but is not limited to tampons, period pads, and period 14 cups for use in connection with the menstrual cycle. 15 8. The department shall submit an annual report to the 16 governor and the general assembly regarding the status of the 17 program and fund, including the balance remaining in the fund, 18 the number of participating providers, the total amount billed 19 per participating provider, the covered services and treatments 20 for which reimbursement was provided in the previous year, and 21 any recommendations for changes to the program or fund. 22 Sec. 2. CODE EDITOR DIRECTIVE. The Code editor may 23 designate section 135.193, as enacted in this Act, as a new 24 subchapter within chapter 135, entitled “HEALTH EQUITY PROGRAM 25 AND FUND”. 26 EXPLANATION 27 The inclusion of this explanation does not constitute agreement with 28 the explanation’s substance by the members of the general assembly. 29 This bill requires the department of public health 30 (DPH) to establish a health equity program (program) to 31 improve menstrual and post-menstrual health by providing for 32 reimbursement of the costs associated with the provision of 33 covered services and treatments related to menstrual and 34 post-menstrual health conditions not otherwise covered by a 35 -3- LSB 5618XS (7) 89 pf/rh 3/ 5

S.F. 2069 third-party payor. DPH shall promote the program statewide and 1 limit program administrative costs to no more than 4 percent of 2 the funds appropriated for the program on an annual basis. 3 The bill requires DPH to adopt administrative rules to 4 administer the program and specify the types of services and 5 treatments covered under the program and requires that the 6 covered services and treatments shall include health care 7 services, treatments, supplies, and drugs needed to treat 8 a menstrual or post-menstrual illness, injury, condition, 9 disease, or its symptoms that comply with standard medical 10 practice, or are approved by the United States food and drug 11 administration or are recommended or preferred by the patient’s 12 provider and supported by appropriate medical records. 13 DPH shall establish a process for registration of 14 participating providers eligible to receive reimbursement 15 through the program. A participating provider shall be 16 reimbursed for a covered service or treatment through the 17 program fund within 10 days of submission of a billing 18 statement, and if applicable, the billing statement shall 19 confirm that the patient is uninsured or that the service or 20 treatment is not covered by the patient’s insurer. The amount 21 billed by the participating provider shall not exceed the 22 actual cost incurred by the provider in delivering the covered 23 service or treatment. Reimbursement shall be paid directly to 24 the participating provider and such payment shall be considered 25 payment in full. The program shall be the payor of last 26 resort. If sufficient program funds are not available to cover 27 all of the billings submitted, DPH shall place a participating 28 provider on a reimbursement waiting list in the order the 29 participating provider’s billing statement was received. The 30 provisions of the bill are not to be construed as granting 31 an entitlement to reimbursement for any covered service or 32 treatment provided by a participating provider. 33 The bill creates a program fund under the control of 34 DPH. The fund includes amounts appropriated by the general 35 -4- LSB 5618XS (7) 89 pf/rh 4/ 5

S.F. 2069 assembly and other moneys available from federal or private 1 sources. Moneys in the fund at the end of each fiscal year 2 shall not revert but remain in the fund. Moneys in the fund 3 are appropriated to DPH for the purposes of the program. There 4 is appropriated annually from the general fund of the state to 5 the program fund a sum which reflects the total state revenue 6 collected from the sales tax imposed on the sales price from 7 the sales of period products and child and adult diapers 8 annually, or if a sales tax is not imposed on such products, 9 the amount that reflects the total dollar amount of the sales 10 of such products sold in the state multiplied by the state 11 sales tax rate. DPH shall submit an annual report to the 12 governor and the general assembly regarding the status of the 13 program and fund, including the balance remaining in the fund, 14 the number of participating providers, the total amount billed 15 per participating provider, the covered services and treatments 16 for which reimbursement was provided in the previous year, and 17 any recommendations for changes to the program or fund. The 18 bill defines “period products” to include but not be limited 19 to tampons, period pads, and period cups for use in connection 20 with the menstrual cycle. 21 -5- LSB 5618XS (7) 89 pf/rh 5/ 5