H.F. 2053 Section 1. NEW SECTION . 147.165 Definitions. 1 As used in sections 147.166 through 147.168: 2 1. “Health care provider” means an individual licensed under 3 chapter 148 to practice medicine and surgery or osteopathic 4 medicine and surgery, a physician assistant licensed under 5 chapter 148C, a chiropractor licensed under chapter 151, an 6 advanced registered nurse practitioner licensed under chapter 7 152, or an advanced practice registered nurse under chapter 8 152E. 9 2. “Nonpublic school” means any school, other than a public 10 school, which is accredited pursuant to section 256.11. 11 3. “Public school” means any school directly supported in 12 whole or in part by taxation. 13 Sec. 2. NEW SECTION . 147.166 Child cardiac health —— 14 development of child cardiac health evaluation form, childhood 15 cardiac screening professional development training module, and 16 child cardiac health education pamphlet. 17 1. No later than October 1, 2024, the department of health 18 and human services in collaboration with the department of 19 education shall do all of the following: 20 a. Develop a child cardiac health evaluation form that 21 incorporates all of the following: 22 (1) The questions that evaluate a child’s family 23 history related to cardiac conditions contained in the Iowa 24 preparticipation physical evaluation form that is based on 25 the most recent edition of the preparticipation physical 26 evaluation developed jointly by the American academy of family 27 physicians, American academy of pediatrics, American college of 28 sports medicine, American medical society for sports medicine, 29 American orthopedic society for sports medicine, and American 30 osteopathic academy of sports medicine. 31 (2) The questions included in the American heart 32 association’s fourteen point screening for heart disease in the 33 young. 34 (3) Questions regarding the biologic heart health history 35 -1- LSB 5060YH (7) 90 pf/ko 1/ 10

H.F. 2053 of the child including the history of any biological parent. 1 (4) The four questions recommended by the American academy 2 of pediatrics to identify children who may be at risk for 3 sudden cardiac arrest or sudden cardiac death as published in 4 the July 2021 issue of “Pediatrics”. 5 b. Develop a childhood cardiac screening professional 6 development training module for health care providers. 7 (1) The module shall be developed by the department of 8 health and human services and the department of education in 9 consultation with representatives of the Iowa chapter of the 10 American academy of pediatrics, the Iowa academy of family 11 physicians, the American heart association, and the Iowa 12 chapter of the American college of cardiology. 13 (2) The module shall include but is not limited to all of 14 the following: 15 (a) How to complete and review a detailed medical history 16 with an emphasis on cardiovascular family history and personal 17 reports of symptoms. 18 (b) Identifying symptoms of sudden cardiac arrest that may 19 require follow up with a cardiologist. 20 (c) Recognizing normal structural changes of the athletic 21 heart. 22 (d) Recognizing prodromal symptoms that precede sudden 23 cardiac arrest. 24 (e) Performing the cardiovascular physical examination. 25 (f) Reviewing the major etiologies of sudden unexplained 26 cardiac death with an emphasis on structural abnormalities and 27 acquired conditions. 28 (g) When to refer a child to a cardiologist for further 29 assessment. 30 (3) The module shall require a health care provider to read 31 the child cardiac health education pamphlet developed under 32 paragraph “c” every four years, or more frequently following 33 revision of the pamphlet as prescribed by rule. 34 c. Develop a child cardiac health education pamphlet for 35 -2- LSB 5060YH (7) 90 pf/ko 2/ 10

H.F. 2053 health care providers, students, parents, and guardians. 1 (1) The department of health and human services and 2 the department of education shall develop the pamphlet in 3 consultation with the American heart association and the Iowa 4 chapter of the American academy of pediatrics. 5 (2) The pamphlet shall provide information about the 6 causes of sudden cardiac arrest in children, and shall include 7 an explanation of sudden cardiac arrest, its incidence, a 8 description of early warning signs, and an overview of the 9 options that are available to screen for cardiac conditions 10 that may lead to sudden cardiac arrest, including a statement 11 about the limitations of these options. 12 (3) The department of health and human services and 13 the department of education shall update the pamphlet as 14 necessary to include the most current best practices, and shall 15 distribute the pamphlet at no charge to all public schools 16 and nonpublic schools throughout the state for subsequent 17 distribution to students and parents or guardians. 18 Sec. 3. NEW SECTION . 147.167 Child cardiac health —— 19 annual well-child visit examinations and child cardiac health 20 evaluation form —— required professional development —— license 21 requirements. 22 1. Beginning January 1, 2025, all of the following shall 23 apply: 24 a. A health care provider who performs annual well-child 25 visit examinations of children nineteen years of age or younger 26 shall include as part of the examination completion of the 27 child cardiac health evaluation form developed pursuant to 28 section 147.166. 29 b. A health care provider who performs annual well-child 30 visit examinations or Iowa preparticipation physical 31 evaluations of children nineteen years of age or younger 32 shall complete the childhood cardiac screening professional 33 development training module developed pursuant to section 34 147.166. 35 -3- LSB 5060YH (7) 90 pf/ko 3/ 10

H.F. 2053 c. A health care provider who is under contract with a 1 public school or nonpublic school to provide medical care 2 to children nineteen years of age or younger shall complete 3 and sign a certificate as part of the contract attesting to 4 completion of the childhood cardiac screening professional 5 development training module. 6 d. A health care provider who completes the childhood 7 cardiac screening professional development training module as 8 required under this section shall retain the original signed 9 certificate of completion and shall make a copy of the signed 10 certificate of completion available to the department upon 11 request. 12 2. Beginning July 1, 2025, the license of a health care 13 provider who performs annual well-child visit examinations or 14 Iowa preparticipation physical evaluations of children nineteen 15 years of age or younger, shall not be issued or renewed unless 16 the health care provider completes and attests to completion 17 of the childhood cardiac screening professional development 18 training module. 19 Sec. 4. NEW SECTION . 147.168 Database —— report. 20 1. A health care provider who performs annual well-child 21 examinations for children nineteen years of age or younger, 22 including the required completion of the child cardiac health 23 evaluation form, shall report annually to the department 24 the number of such examinations performed and the number of 25 children referred to a cardiologist as the result of such 26 examinations. The department shall maintain the data for ten 27 years following each annual report. 28 2. The department shall report annually to the governor and 29 the general assembly on the outcomes of the requirements of 30 sections 147.166 and 147.167, and shall post the annual report 31 on the department’s internet site. 32 Sec. 5. NEW SECTION . 147.169 Childhood cardiac health 33 requirements for health care providers —— civil penalties —— 34 licensee discipline —— Medicaid reimbursement. 35 -4- LSB 5060YH (7) 90 pf/ko 4/ 10

H.F. 2053 1. A health care provider required to complete the childhood 1 cardiac screening professional development training module 2 under section 147.166 who fails to produce a certificate of 3 completion of the module upon request by the department is 4 subject to a civil penalty established by the department by 5 rule. 6 2. A health care provider required to complete the 7 childhood cardiac screening professional development training 8 module under section 147.166 who fails to do so is subject to 9 professional discipline. 10 3. A health care provider shall not be eligible as an 11 enrolled Medicaid provider and entitled to reimbursement 12 for completion of a well-child visit examination or an Iowa 13 preparticipation physical evaluation for a child nineteen years 14 of age or younger unless the health care provider has completed 15 the childhood cardiac screening professional development 16 training module as required under section 147.166. 17 Sec. 6. NEW SECTION . 147.170 Administrative rules. 18 The department, in consultation with the departments of 19 health and human services and education, shall adopt rules 20 pursuant to chapter 17A to administer sections 147.165 through 21 147.169. 22 Sec. 7. NEW SECTION . 280.13D Child cardiac health policies. 23 1. The department of education in consultation with the 24 department of health and human services shall ensure that 25 the Iowa preparticipation physical evaluation form utilized 26 beginning with the 2025-2026 school year be expanded to include 27 all of the following information and be made available to all 28 public and nonpublic schools: 29 a. All of the information included in the Iowa 30 preparticipation physical evaluation form as updated for the 31 2022-2023 school year. 32 b. The questions included in the American heart 33 association’s fourteen point screening for heart disease in the 34 young. 35 -5- LSB 5060YH (7) 90 pf/ko 5/ 10

H.F. 2053 c. Questions regarding the biologic heart health history of 1 the child including the history of any biological parent. 2 d. The four questions recommended by the American academy of 3 pediatrics to identify children who may be at risk for sudden 4 cardiac arrest or sudden cardiac death as published in the July 5 2021 issue of “Pediatrics”. 6 e. A certificate form to be completed by the health care 7 provider attesting that the health care provider has completed 8 the childhood cardiac screening professional development 9 training module as required pursuant to section 147.167. 10 2. Beginning with the 2025-2026 school year, and in each 11 subsequent school year, all of the following shall apply: 12 a. Prior to participating, all students enrolled in 13 kindergarten through grade twelve who participate in an 14 interscholastic activity or intramural activity shall complete 15 and present to the superintendent of the public school 16 district or the authorities in charge of the nonpublic school a 17 completed Iowa preparticipation physical evaluation form. 18 b. Each public school and nonpublic school shall distribute 19 the child cardiac health education pamphlet developed pursuant 20 to section 147.166 to each student who completes the Iowa 21 preparticipation physical evaluation form and to each student’s 22 parent or guardian. 23 c. A health care provider who performs an Iowa 24 preparticipation physical evaluation shall sign the certificate 25 included in the Iowa preparticipation physical evaluation form 26 attesting to completion of the childhood cardiac screening 27 professional development training module, and shall provide 28 a copy of the signed certificate to the student’s school 29 district or accredited nonpublic school. The school district 30 or accredited nonpublic school shall retain the copy of the 31 signed certificate and the health care provider shall retain 32 the original signed certificate in the health care provider’s 33 records. 34 3. For the purposes of this section: 35 -6- LSB 5060YH (7) 90 pf/ko 6/ 10

H.F. 2053 a. “Health care provider” means the same as defined in 1 section 147.165. 2 b. “Interscholastic activity” means any dance or 3 cheerleading activity, contest, or practice that is a contact 4 or limited contact activity as identified by the American 5 academy of pediatrics that involves students of different 6 public schools or nonpublic schools. 7 c. “Intramural activity” means any dance or cheerleading 8 activity, contest, or practice that is a contact or limited 9 contact activity as identified by the American academy of 10 pediatrics that involves the students of the same public school 11 or nonpublic school. 12 EXPLANATION 13 The inclusion of this explanation does not constitute agreement with 14 the explanation’s substance by the members of the general assembly. 15 This bill incorporates provisions of the healthy cardiac 16 monitoring Act proposed by the hypertrophic cardiomyopathy 17 association to ensure the cardiovascular health needs of all 18 children, including student athletes, are met and that health 19 care providers are trained to meet those needs. 20 The bill defines “health care provider” (provider) to mean a 21 person licensed to practice medicine and surgery or osteopathic 22 medicine and surgery, a licensed physician assistant, a 23 licensed chiropractor, a licensed advanced registered nurse 24 practitioner, or an advanced practice registered nurse. 25 “Nonpublic school” and “public school” are also defined in the 26 bill. 27 The bill requires that by October 1, 2024, the department 28 of health and human services (HHS) in collaboration with the 29 department of education (DE) take certain actions relating to 30 child cardiac health. The departments are required to develop 31 a child cardiac health evaluation form that incorporates the 32 questions that evaluate a child’s family history related to 33 cardiac conditions contained in the Iowa preparticipation 34 physical evaluation form; the questions included in the 35 -7- LSB 5060YH (7) 90 pf/ko 7/ 10

H.F. 2053 American heart association’s 14 point screening for heart 1 disease in the young; questions regarding the biologic heart 2 health history of the child including the history of any 3 biological parent; and the four questions recommended by the 4 American academy of pediatrics to identify children who may be 5 at risk for sudden cardiac arrest or sudden cardiac death. The 6 departments are also required to develop a childhood cardiac 7 screening professional development training module (module) for 8 providers and a child cardiac health education pamphlet to be 9 included in the module. The pamphlet must also be distributed 10 to public and nonpublic schools for further distribution to 11 students and parents or guardians of students. 12 The bill requires that beginning January 1, 2025, a provider 13 who performs an annual well-child visit examination of a 14 child 19 years of age or younger to include as part of that 15 examination completion of the child cardiac health evaluation 16 form; requires a provider who performs an annual well-child 17 visit examination or an Iowa preparticipation physical 18 evaluation (athlete physical) of a child 19 years of age or 19 younger to complete the module; requires a provider who is 20 under contract with a public school or nonpublic school to 21 provide medical care to children 19 years of age or younger 22 to complete and to provide a signed certificate attesting to 23 completion of the module as part of the contract; and requires 24 a provider who completes the required module to retain the 25 signed original of the certificate of completion and to make 26 a copy of the certificate available to the department of 27 inspections, appeals, and licensing (DIAL) upon request. The 28 bill also provides that beginning July 1, 2025, the license of 29 a provider who performs annual well-child visit examinations 30 or athlete physicals of children 19 years of age or younger 31 shall not be issued or renewed unless the provider completes 32 and attests to completion of the module. 33 The bill requires a provider who performs annual well-child 34 visit examinations for children 19 years of age or younger, 35 -8- LSB 5060YH (7) 90 pf/ko 8/ 10

H.F. 2053 including the required completion of the child cardiac health 1 evaluation form, to annually report to DIAL the number of 2 examinations performed and the number of children referred to 3 a cardiologist. DIAL is required to maintain the data for 4 10 years following each annual report, to report annually to 5 the governor and the general assembly on the outcomes of the 6 requirements of the bill, and to post the annual report on the 7 department’s internet site. 8 The bill provides that a provider required to complete the 9 module who fails to produce a certificate of completion upon 10 request by DIAL is subject to a civil penalty established by 11 DIAL by rule. A provider required to complete the module who 12 fails to do so is also subject to professional discipline. 13 Additionally, a provider shall not be eligible as an enrolled 14 Medicaid provider and entitled to reimbursement for completion 15 of a well-child visit examination or an athlete physical unless 16 the provider has completed the required module. 17 The bill also includes child cardiac health policies in 18 Code chapter 280 (uniform school requirements). The bill 19 requires DE, in consultation with HHS, to ensure that the 20 Iowa preparticipation physical evaluation form be expanded to 21 include certain child cardiac health information and be made 22 available to all public and nonpublic schools. The additional 23 required information is detailed in the bill. 24 The bill requires that beginning with the 2025-2026 25 school year, and in each subsequent school year, prior to 26 participating, all students enrolled in kindergarten through 27 grade 12 who participate in interscholastic activities or 28 intramural activities, as defined in the bill, shall complete 29 and present to the superintendent of the public school district 30 or the authorities in charge of the nonpublic school the 31 completed Iowa preparticipation physical evaluation form; that 32 each public school and nonpublic school distribute the child 33 cardiac health education pamphlet to each student and to each 34 student’s parent or guardian who completes the evaluation form; 35 -9- LSB 5060YH (7) 90 pf/ko 9/ 10

H.F. 2053 and that a provider who performs an athlete physical complete 1 the certificate included in the evaluation form attesting to 2 completion of the module and provide a copy of the signed 3 certificate to the student’s school district or accredited 4 nonpublic school. The school district or the accredited 5 nonpublic school must retain the copy of the signed certificate 6 and the provider must retain the original. 7 -10- LSB 5060YH (7) 90 pf/ko 10/ 10