H.F. 151 Section 1. Section 261.117, Code 2023, is amended by 1 striking the section and inserting in lieu thereof the 2 following: 3 261.117 Mental health practitioner loan repayment program —— 4 trust fund —— appropriation of moneys in fund. 5 1. Program established. The commission shall establish 6 a mental health practitioner loan repayment program for the 7 purposes of providing annual loan repayments for mental health 8 practitioners who agree to practice in service commitment areas 9 for at least five years and who meet the requirements of this 10 section. 11 2. Eligibility. An individual is eligible to apply to enter 12 into a program agreement with the commission if the individual 13 is enrolled full-time in a curriculum leading to employment as 14 a mental health practitioner. A recipient of a loan repayment 15 award under section 261.113, 261.114, 261.115, or 261.116 shall 16 not be eligible for a loan repayment award under this chapter. 17 3. Program agreements. A program agreement shall be 18 entered into by an eligible student and the commission when 19 the eligible student begins the final year of study in an 20 academic program leading to eligibility for employment as a 21 mental health practitioner. Under the agreement, to receive 22 annual loan repayments pursuant to subsection 5, an eligible 23 student shall agree to and shall fulfill all of the following 24 requirements: 25 a. Receive a graduate-level credential qualifying the 26 credential recipient for employment as a mental health 27 practitioner. 28 b. Receive a license to practice in this state. 29 c. Within nine months of meeting the requirements of a 30 mental health practitioner, engage in full-time practice as 31 a mental health practitioner for a period of five years in a 32 service commitment area. 33 4. Priorities in making awards. In making awards under this 34 section, the commission shall give priority to: 35 -1- LSB 1107HV (3) 90 pf/rh 1/ 11

H.F. 151 a. Eligible students who are residents of Iowa upon 1 enrolling in a university, who attended and earned an 2 undergraduate degree from an Iowa college or university, or who 3 attended and earned a medical degree from a medical school in 4 Iowa, and who agree to practice in a service commitment area 5 located in a mental health professional shortage area. 6 b. Service commitment areas that are located in mental 7 health professional shortage areas. 8 c. Eligible students who, during the five-year period of 9 full-time practice, are enrolled and actively participating in 10 the Medicaid program as evidenced by accepting assignment of 11 Medicaid for at least twenty-five percent of the patients in 12 their practice. 13 5. Loan repayment amounts. 14 a. The amount of loan repayment an eligible student who 15 enters into an agreement pursuant to subsection 3 shall receive 16 if in compliance with obligations under the agreement shall be 17 as follows: 18 (1) For a psychiatrist, forty thousand dollars annually 19 with a maximum of two hundred thousand dollars for an eligible 20 loan, not to exceed the total loan amount. 21 (2) For a psychologist or a mental health professional, 22 eight thousand dollars annually with a maximum of forty 23 thousand dollars for an eligible loan, not to exceed the total 24 loan amount. 25 (3) For a physician assistant practicing under the 26 supervision of a psychiatrist, or for a psychiatric advanced 27 registered nurse practitioner, ten thousand dollars annually 28 with a maximum of fifty thousand dollars, not to exceed the 29 total loan amount. 30 b. If the total amount of the eligible student’s loan 31 upon graduation is less than the maximum amount specified, 32 the commission shall divide the total amount of the eligible 33 student’s eligible loan by five to determine the annual amount 34 of loan repayment the loan recipient is eligible to receive. 35 -2- LSB 1107HV (3) 90 pf/rh 2/ 11

H.F. 151 c. Payments under this section may be made for each year of 1 eligible practice during a period of five consecutive years, 2 unless the agreement is amended to allow part-time practice 3 pursuant to subsection 10. 4 d. If the agreement is amended to allow part-time practice 5 pursuant to subsection 10, after the completion of one year 6 of part-time practice, the annual amount of loan repayment 7 the commission may make to a mental health practitioner who 8 enters into a program agreement pursuant to subsection 3, 9 if the mental health practitioner is in compliance with the 10 obligations under the agreement, shall be the same amount of 11 loan repayment the commission may make pursuant to paragraph 12 “a” , as prorated based on the number of hours of practice in the 13 mental health practitioner’s workweek. 14 6. Refinanced loans. A loan repayment recipient who 15 refinances an eligible loan by obtaining a private educational 16 loan may continue to receive loan repayment under this section 17 if the amount of loan repayment does not exceed the lesser of 18 the amount specified in subsection 5 or the balance of the loan 19 repayment amount the loan repayment recipient qualified to 20 receive with the eligible loan. 21 7. Program agreement limitation. The commission shall by 22 rule determine the number of agreements entered into annually 23 based upon the funding available. 24 8. Selection of service commitment area. A loan repayment 25 recipient shall notify the commission of the recipient’s 26 service commitment area prior to beginning practice in the area 27 in accordance with subsection 3, paragraph “c” . Priority shall 28 be given to recipients who select service commitment areas 29 located in mental health professional shortage areas. The 30 commission may waive the requirement that the loan repayment 31 recipient practice in the same service commitment area for all 32 five years. 33 9. Rules for additional loan repayment. The commission 34 shall adopt rules to provide, in addition to loan repayment 35 -3- LSB 1107HV (3) 90 pf/rh 3/ 11

H.F. 151 provided to eligible students pursuant to this section and 1 subject to the availability of surplus funds, loan repayment to 2 a psychiatrist, a psychologist, a mental health professional, 3 a physician assistant practicing under the supervision of 4 a psychiatrist, or a psychiatric advanced registered nurse 5 practitioner, who, as provided in subsection 3, received a 6 degree from a university, obtained a license to practice 7 in this state, and is engaged in full-time practice in the 8 respective profession in a service commitment area. 9 10. Part-time practice —— agreement amended. A person who 10 entered into an agreement pursuant to subsection 3 may apply 11 to the commission to amend the agreement to allow the person 12 to engage in less than the full-time practice specified in the 13 agreement and under subsection 3, paragraph “c” . The commission 14 and the person may consent to amend the agreement under which 15 the person shall engage in less than full-time practice in a 16 service commitment area for an extended period of part-time 17 practice determined by the commission to be proportional to 18 the amount of full-time practice remaining under the original 19 agreement. For purposes of this subsection, “less than 20 the full-time practice” means at least seventy percent of a 21 forty-hour workweek. 22 11. Postponement and satisfaction of service obligation. 23 a. The obligation to engage in practice in accordance with 24 subsection 3 shall be postponed for the following purposes: 25 (1) Active duty status in the armed forces, the armed forces 26 military reserve, or the national guard. 27 (2) Service in volunteers in service to America. 28 (3) Service in the federal peace corps. 29 (4) A period of service commitment to the United States 30 public health service commissioned corps. 31 (5) A period of religious missionary work conducted by an 32 organization exempt from federal income taxation pursuant to 33 section 501(c)(3) of the Internal Revenue Code. 34 (6) Any period of temporary medical incapacity during which 35 -4- LSB 1107HV (3) 90 pf/rh 4/ 11

H.F. 151 the person obligated is unable, due to a medical condition, to 1 engage in full-time practice as required under subsection 3, 2 paragraph “c” . 3 b. Except for a postponement under paragraph “a” , 4 subparagraph (6), an obligation to engage in practice under an 5 agreement entered into pursuant to subsection 3 shall not be 6 postponed for more than two years from the time the full-time 7 practice was to have commenced under the agreement. 8 c. An obligation to engage in full-time practice under 9 an agreement entered into pursuant to subsection 3 shall be 10 considered satisfied when any of the following conditions are 11 met: 12 (1) The terms of the agreement are completed. 13 (2) The person who entered into the agreement dies. 14 (3) The person who entered into the agreement, due to a 15 permanent disability, is unable to practice as a mental health 16 practitioner. 17 d. If a loan repayment recipient fails to fulfill the 18 obligation to engage in practice in accordance with subsection 19 3, the commission shall not make additional loan repayments to 20 the mental health practitioner. A loan repayment recipient who 21 fails to meet the requirements of the obligation to engage in 22 practice in accordance with subsection 3 may also be subject to 23 repayment of moneys advanced by the service commitment area as 24 provided in any agreement with the service commitment area. 25 12. Trust fund established. A mental health practitioner 26 loan repayment program trust fund is created in the state 27 treasury as a separate fund under the control of the 28 commission. The commission shall remit all repayments made 29 pursuant to this section to the trust fund. All moneys 30 deposited or paid into the trust fund are appropriated and 31 shall be made available to the commission to be used for 32 meeting the requirements of this section. Moneys in the trust 33 fund up to the total amount that an eligible student may 34 receive for an eligible loan in accordance with this section 35 -5- LSB 1107HV (3) 90 pf/rh 5/ 11

H.F. 151 and upon fulfilling the requirements of subsection 3, shall be 1 considered encumbered for the duration of the agreement entered 2 into pursuant to subsection 3. Notwithstanding section 8.33, 3 any balance in the trust fund on June 30 of each fiscal year 4 shall not revert to the general fund of the state, but shall 5 be available for purposes of this section in subsequent fiscal 6 years. 7 13. Report. The commission shall submit in a report to 8 the general assembly by January 1, annually, the number of 9 individuals who received loan repayment pursuant to this 10 section, where the participants practiced, the amount paid to 11 each program participant, and other information identified by 12 the commission as indicators of outcomes of the program. 13 14. Rules. The commission shall adopt rules pursuant to 14 chapter 17A to administer this section. 15 15. Definitions. For purposes of this section: 16 a. “Advanced registered nurse practitioner” means a person 17 licensed as a registered nurse under chapter 152 or 152E who 18 is licensed by the board of nursing as an advanced registered 19 nurse practitioner. 20 b. “Commission” means the college student aid commission. 21 c. “Eligible loan” means the recipient’s total federally 22 guaranteed Stafford loan amount under the federal family 23 education loan program or the federal direct loan program, the 24 recipient’s federal grad plus loans, or the recipient’s federal 25 Perkins loan, including principal and interest. 26 d. “Mental health practitioner” means a psychiatrist, 27 a psychologist, a mental health professional, a physician 28 assistant practicing under the supervision of a psychiatrist, 29 or a psychiatric advanced registered nurse practitioner. 30 e. “Mental health professional” means an individual who 31 meets all of the following qualifications: 32 (1) The individual holds at least a master’s degree in 33 a mental health field, including psychology, counseling and 34 guidance, social work, marriage and family therapy, applied 35 -6- LSB 1107HV (3) 90 pf/rh 6/ 11

H.F. 151 behavior analysis, or mental health counseling. 1 (2) The individual holds a current Iowa license if 2 practicing in a field covered by an Iowa licensure law. 3 (3) The individual has at least two years of postgraduate 4 degree clinical experience, supervised by another individual in 5 the mental health field, in assessing mental health needs and 6 problems and in providing appropriate mental health services. 7 f. “Mental health professional shortage area” means a mental 8 health health professional shortage area designated by the 9 health resources and services administration of the United 10 States department of health and human services. 11 g. “Psychiatric advanced registered nurse practitioner” 12 means an individual currently licensed as a registered nurse 13 under chapter 152 or 152E who holds a national certification in 14 psychiatric mental health care and who is licensed by the board 15 of nursing as an advanced registered nurse practitioner. 16 h. “Service commitment area” means a city in Iowa that 17 provides the following contribution amounts for deposit in the 18 mental health practitioner loan repayment program trust fund 19 for each loan recipient in the community who is participating 20 in the loan repayment program: 21 (1) For a psychiatrist, twenty thousand dollars. 22 (2) For a psychologist or a mental health professional, four 23 thousand dollars. 24 (3) For a physician assistant practicing under the 25 supervision of a psychiatrist, or for a psychiatric advanced 26 registered nurse practitioner, five thousand dollars. 27 16. Prior agreements. All program agreements entered into 28 by the commission prior to July 1, 2023, under the mental 29 health professional loan repayment program pursuant to section 30 261.117, Code 2022, shall remain in full force and effect in 31 accordance with the terms of the agreement. 32 Sec. 2. MENTAL HEALTH PRACTITIONER LOAN REPAYMENT PROGRAM 33 TRUST FUND —— APPROPRIATION. There is appropriated from the 34 general fund of the state to the college student aid commission 35 -7- LSB 1107HV (3) 90 pf/rh 7/ 11

H.F. 151 for the fiscal year beginning July 1, 2023, and ending June 1 30, 2024, the following amounts, or so much thereof as is 2 necessary, to be used for the purposes designated: 3 For deposit in the mental health practitioner loan repayment 4 program trust fund established pursuant to section 261.117, to 5 be used for the purposes of the program: 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,500,000 7 EXPLANATION 8 The inclusion of this explanation does not constitute agreement with 9 the explanation’s substance by the members of the general assembly. 10 This bill repeals the existing mental health professional 11 loan repayment program within the college student aid 12 commission, replaces the program with a mental health 13 practitioner loan repayment program, and provides an 14 appropriation. 15 REPEALED PROGRAM. The mental health professional loan 16 repayment program, enacted in 2022, was established to increase 17 the number of nonprescribing mental health practitioners 18 serving cities within federal mental health shortage areas in 19 the state. The program was designed to provide loan repayment 20 benefits to recipients for up to five consecutive years of 21 full-time service, unless granted a waiver for part-time 22 service. The maximum award under the program was $40,000, paid 23 in annual installments of $8,000, toward outstanding federal 24 Stafford loan, federal grad PLUS loan, and federal Perkins loan 25 balances at the end of each 12-month employment period. If a 26 recipient refinanced a federal loan with a private loan after 27 signing the program contract, the recipient could continue to 28 receive the loan repayment benefit as long as the recipient 29 contacted the college student aid commission and provided the 30 required documentation. 31 In order to be eligible for the program, a person must have 32 graduated from an eligible Iowa college or university with at 33 least a master’s degree in psychology, counseling and guidance, 34 social work, marriage and family therapy, or mental health 35 -8- LSB 1107HV (3) 90 pf/rh 8/ 11

H.F. 151 counseling; have completed at least two years of post-degree 1 clinical experience in assessing and diagnosing mental health 2 needs and in providing mental health services while under the 3 supervision of another individual in the mental health field; 4 and have held a current, nonprescribing practitioner license. 5 NEW PROGRAM. The bill requires the college student aid 6 commission to establish a mental health practitioner loan 7 repayment program for the purposes of providing loan repayments 8 for mental health practitioners who agree to practice in 9 service commitment areas for at least five years and meet the 10 requirements of the bill. “Mental health practitioner” means 11 a psychiatrist, a psychologist, a mental health professional, 12 a physician assistant practicing under the supervision of 13 a psychiatrist, or a psychiatric advanced registered nurse 14 practitioner. 15 Under the bill, an individual is eligible to apply if the 16 individual is enrolled full-time in a curriculum leading 17 to employment as a mental health practitioner. A program 18 agreement must be entered into when the eligible student begins 19 the final year of study in an academic program leading to 20 eligibility for employment as a mental health practitioner. 21 Under the agreement, an eligible student must agree to receive 22 a graduate-level credential qualifying the credential recipient 23 for employment as a mental health practitioner; receive a 24 license to practice in this state; and within nine months of 25 meeting the requirements of a mental health practitioner engage 26 in full-time practice as a mental health practitioner for a 27 period of five years in a service commitment area. 28 Under the bill, the commission must give priority in making 29 awards to: eligible students who are residents of Iowa 30 upon enrolling in a university, who attended and earned an 31 undergraduate degree from an Iowa college or university, or 32 who attended and earned a medical degree from a medical school 33 in Iowa; and who agree to practice in a service commitment 34 area located in a mental health professional shortage area; to 35 -9- LSB 1107HV (3) 90 pf/rh 9/ 11

H.F. 151 service commitment areas located in mental health professional 1 shortage areas; and to eligible students who, during their 2 five-year full-time practice, are actively participating in the 3 Medicaid program. A service commitment area is defined as a 4 city in Iowa that provides a certain contribution amount, based 5 on the type of practitioner, for deposit in the mental health 6 practitioner loan repayment program trust fund for each loan 7 recipient in the community participating in the program. 8 Under the bill, the loan repayment amount for a psychiatrist 9 is $40,000 annually with a maximum of $200,000 for an eligible 10 loan, not to exceed the total loan amount; for a psychologist 11 or a mental health professional is $8,000 annually with a 12 maximum of $40,000 for an eligible loan, not to exceed the 13 total loan amount; and for a physician assistant practicing 14 under the supervision of a psychiatrist or for a psychiatric 15 advanced registered nurse practitioner is $10,000 annually with 16 a maximum of $50,000, not to exceed the total loan amount. 17 The bill includes provisions similar to those for other 18 loan repayment and loan forgiveness programs for health 19 professionals under Code chapter 261 including eligibility 20 requirements, program agreements, program priorities, loan 21 repayment amounts, refinanced loans, program agreement 22 limitations, the selection of the service commitment area, 23 rules for loan repayment, rules for additional loan repayment, 24 part-time practice agreement amendments and loan repayment 25 adjustments for part-time practice, postponement, and 26 satisfaction of service obligations, the establishment of a 27 trust fund for the program, the submission of annual reports 28 regarding the program, and the adoption of administrative rules 29 for the program. 30 The bill provides definitions for the purposes of the bill 31 and provides for an appropriation from the general fund of the 32 state to the college student aid commission for FY 2023-2024 to 33 be deposited in the mental health practitioner loan repayment 34 program trust fund established under the bill to be used for 35 -10- LSB 1107HV (3) 90 pf/rh 10/ 11