HF 2053 (LSB 5060YH (7) 90)

HOUSE FILE 2053

BY  JACOBY

A BILL FOR

An Act relating to the cardiac health of children, and providing for licensee discipline and civil penalties.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  NEW SECTION.  147.165  Definitions.
   As used in sections 147.166 through 147.168:
   1.  “Health care provider” means an individual licensed under chapter 148 to practice medicine and surgery or osteopathic medicine and surgery, a physician assistant licensed under chapter 148C, a chiropractor licensed under chapter 151, an advanced registered nurse practitioner licensed under chapter 152, or an advanced practice registered nurse under chapter 152E.
   2.  “Nonpublic school” means any school, other than a public school, which is accredited pursuant to section 256.11.
   3.  “Public school” means any school directly supported in whole or in part by taxation.
    Sec. 2.  NEW SECTION.  147.166  Child cardiac health —— development of child cardiac health evaluation form, childhood cardiac screening professional development training module, and child cardiac health education pamphlet.
   1.  No later than October 1, 2024, the department of health and human services in collaboration with the department of education shall do all of the following:
   a.  Develop a child cardiac health evaluation form that incorporates all of the following:
   (1)  The questions that evaluate a child’s family history related to cardiac conditions contained in the Iowa preparticipation physical evaluation form that is based on the most recent edition of the preparticipation physical evaluation developed jointly by the American academy of family physicians, American academy of pediatrics, American college of sports medicine, American medical society for sports medicine, American orthopedic society for sports medicine, and American osteopathic academy of sports medicine.
   (2)  The questions included in the American heart association’s fourteen point screening for heart disease in the young.
   (3)  Questions regarding the biologic heart health history of the child including the history of any biological parent.
   (4)  The four questions recommended by the American academy of pediatrics to identify children who may be at risk for sudden cardiac arrest or sudden cardiac death as published in the July 2021 issue of “Pediatrics”.
   b.  Develop a childhood cardiac screening professional development training module for health care providers.
   (1)  The module shall be developed by the department of health and human services and the department of education in consultation with representatives of the Iowa chapter of the American academy of pediatrics, the Iowa academy of family physicians, the American heart association, and the Iowa chapter of the American college of cardiology.
   (2)  The module shall include but is not limited to all of the following:
   (a)  How to complete and review a detailed medical history with an emphasis on cardiovascular family history and personal reports of symptoms.
   (b)  Identifying symptoms of sudden cardiac arrest that may require follow up with a cardiologist.
   (c)  Recognizing normal structural changes of the athletic heart.
   (d)  Recognizing prodromal symptoms that precede sudden cardiac arrest.
   (e)  Performing the cardiovascular physical examination.
   (f)  Reviewing the major etiologies of sudden unexplained cardiac death with an emphasis on structural abnormalities and acquired conditions.
   (g)  When to refer a child to a cardiologist for further assessment.
   (3)  The module shall require a health care provider to read the child cardiac health education pamphlet developed under paragraph “c” every four years, or more frequently following revision of the pamphlet as prescribed by rule.
   c.  Develop a child cardiac health education pamphlet for health care providers, students, parents, and guardians.
   (1)  The department of health and human services and the department of education shall develop the pamphlet in consultation with the American heart association and the Iowa chapter of the American academy of pediatrics.
   (2)  The pamphlet shall provide information about the causes of sudden cardiac arrest in children, and shall include an explanation of sudden cardiac arrest, its incidence, a description of early warning signs, and an overview of the options that are available to screen for cardiac conditions that may lead to sudden cardiac arrest, including a statement about the limitations of these options.
   (3)  The department of health and human services and the department of education shall update the pamphlet as necessary to include the most current best practices, and shall distribute the pamphlet at no charge to all public schools and nonpublic schools throughout the state for subsequent distribution to students and parents or guardians.
    Sec. 3.  NEW SECTION.  147.167  Child cardiac health —— annual well-child visit examinations and child cardiac health evaluation form —— required professional development —— license requirements.
   1.  Beginning January 1, 2025, all of the following shall apply:
   a.  A health care provider who performs annual well-child visit examinations of children nineteen years of age or younger shall include as part of the examination completion of the child cardiac health evaluation form developed pursuant to section 147.166.
   b.  A health care provider who performs annual well-child visit examinations or Iowa preparticipation physical evaluations of children nineteen years of age or younger shall complete the childhood cardiac screening professional development training module developed pursuant to section 147.166.
   c.  A health care provider who is under contract with a public school or nonpublic school to provide medical care to children nineteen years of age or younger shall complete and sign a certificate as part of the contract attesting to completion of the childhood cardiac screening professional development training module.
   d.  A health care provider who completes the childhood cardiac screening professional development training module as required under this section shall retain the original signed certificate of completion and shall make a copy of the signed certificate of completion available to the department upon request.
   2.  Beginning July 1, 2025, the license of a health care provider who performs annual well-child visit examinations or Iowa preparticipation physical evaluations of children nineteen years of age or younger, shall not be issued or renewed unless the health care provider completes and attests to completion of the childhood cardiac screening professional development training module.
    Sec. 4.  NEW SECTION.  147.168  Database —— report.
   1.  A health care provider who performs annual well-child examinations for children nineteen years of age or younger, including the required completion of the child cardiac health evaluation form, shall report annually to the department the number of such examinations performed and the number of children referred to a cardiologist as the result of such examinations. The department shall maintain the data for ten years following each annual report.
   2.  The department shall report annually to the governor and the general assembly on the outcomes of the requirements of sections 147.166 and 147.167, and shall post the annual report on the department’s internet site.
    Sec. 5.  NEW SECTION.  147.169  Childhood cardiac health requirements for health care providers —— civil penalties —— licensee discipline —— Medicaid reimbursement.
   1.  A health care provider required to complete the childhood cardiac screening professional development training module under section 147.166 who fails to produce a certificate of completion of the module upon request by the department is subject to a civil penalty established by the department by rule.
   2.  A health care provider required to complete the childhood cardiac screening professional development training module under section 147.166 who fails to do so is subject to professional discipline.
   3.  A health care provider shall not be eligible as an enrolled Medicaid provider and entitled to reimbursement for completion of a well-child visit examination or an Iowa preparticipation physical evaluation for a child nineteen years of age or younger unless the health care provider has completed the childhood cardiac screening professional development training module as required under section 147.166.
    Sec. 6.  NEW SECTION.  147.170  Administrative rules.
   The department, in consultation with the departments of health and human services and education, shall adopt rules pursuant to chapter 17A to administer sections 147.165 through 147.169.
    Sec. 7.  NEW SECTION.  280.13D  Child cardiac health policies.
   1.  The department of education in consultation with the department of health and human services shall ensure that the Iowa preparticipation physical evaluation form utilized beginning with the 2025-2026 school year be expanded to include all of the following information and be made available to all public and nonpublic schools:
   a.  All of the information included in the Iowa preparticipation physical evaluation form as updated for the 2022-2023 school year.
   b.  The questions included in the American heart association’s fourteen point screening for heart disease in the young.
   c.  Questions regarding the biologic heart health history of the child including the history of any biological parent.
   d.  The four questions recommended by the American academy of pediatrics to identify children who may be at risk for sudden cardiac arrest or sudden cardiac death as published in the July 2021 issue of “Pediatrics”.
   e.  A certificate form to be completed by the health care provider attesting that the health care provider has completed the childhood cardiac screening professional development training module as required pursuant to section 147.167.
   2.  Beginning with the 2025-2026 school year, and in each subsequent school year, all of the following shall apply:
   a.  Prior to participating, all students enrolled in kindergarten through grade twelve who participate in an interscholastic activity or intramural activity shall complete and present to the superintendent of the public school district or the authorities in charge of the nonpublic school a completed Iowa preparticipation physical evaluation form.
   b.  Each public school and nonpublic school shall distribute the child cardiac health education pamphlet developed pursuant to section 147.166 to each student who completes the Iowa preparticipation physical evaluation form and to each student’s parent or guardian.
   c.  A health care provider who performs an Iowa preparticipation physical evaluation shall sign the certificate included in the Iowa preparticipation physical evaluation form attesting to completion of the childhood cardiac screening professional development training module, and shall provide a copy of the signed certificate to the student’s school district or accredited nonpublic school. The school district or accredited nonpublic school shall retain the copy of the signed certificate and the health care provider shall retain the original signed certificate in the health care provider’s records.
   3.  For the purposes of this section:
   a.  “Health care provider” means the same as defined in section 147.165.
   b.  “Interscholastic activity” means any dance or cheerleading activity, contest, or practice that is a contact or limited contact activity as identified by the American academy of pediatrics that involves students of different public schools or nonpublic schools.
   c.  “Intramural activity” means any dance or cheerleading activity, contest, or practice that is a contact or limited contact activity as identified by the American academy of pediatrics that involves the students of the same public school or nonpublic school.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill incorporates provisions of the healthy cardiac monitoring Act proposed by the hypertrophic cardiomyopathy association to ensure the cardiovascular health needs of all children, including student athletes, are met and that health care providers are trained to meet those needs.
   The bill defines “health care provider” (provider) to mean a person licensed to practice medicine and surgery or osteopathic medicine and surgery, a licensed physician assistant, a licensed chiropractor, a licensed advanced registered nurse practitioner, or an advanced practice registered nurse. “Nonpublic school” and “public school” are also defined in the bill.
   The bill requires that by October 1, 2024, the department of health and human services (HHS) in collaboration with the department of education (DE) take certain actions relating to child cardiac health. The departments are required to develop a child cardiac health evaluation form that incorporates the questions that evaluate a child’s family history related to cardiac conditions contained in the Iowa preparticipation physical evaluation form; the questions included in the American heart association’s 14 point screening for heart disease in the young; questions regarding the biologic heart health history of the child including the history of any biological parent; and the four questions recommended by the American academy of pediatrics to identify children who may be at risk for sudden cardiac arrest or sudden cardiac death. The departments are also required to develop a childhood cardiac screening professional development training module (module) for providers and a child cardiac health education pamphlet to be included in the module. The pamphlet must also be distributed to public and nonpublic schools for further distribution to students and parents or guardians of students.
   The bill requires that beginning January 1, 2025, a provider who performs an annual well-child visit examination of a child 19 years of age or younger to include as part of that examination completion of the child cardiac health evaluation form; requires a provider who performs an annual well-child visit examination or an Iowa preparticipation physical evaluation (athlete physical) of a child 19 years of age or younger to complete the module; requires a provider who is under contract with a public school or nonpublic school to provide medical care to children 19 years of age or younger to complete and to provide a signed certificate attesting to completion of the module as part of the contract; and requires a provider who completes the required module to retain the signed original of the certificate of completion and to make a copy of the certificate available to the department of inspections, appeals, and licensing (DIAL) upon request. The bill also provides that beginning July 1, 2025, the license of a provider who performs annual well-child visit examinations or athlete physicals of children 19 years of age or younger shall not be issued or renewed unless the provider completes and attests to completion of the module.
   The bill requires a provider who performs annual well-child visit examinations for children 19 years of age or younger, including the required completion of the child cardiac health evaluation form, to annually report to DIAL the number of examinations performed and the number of children referred to a cardiologist. DIAL is required to maintain the data for 10 years following each annual report, to report annually to the governor and the general assembly on the outcomes of the requirements of the bill, and to post the annual report on the department’s internet site.
   The bill provides that a provider required to complete the module who fails to produce a certificate of completion upon request by DIAL is subject to a civil penalty established by DIAL by rule. A provider required to complete the module who fails to do so is also subject to professional discipline. Additionally, a provider shall not be eligible as an enrolled Medicaid provider and entitled to reimbursement for completion of a well-child visit examination or an athlete physical unless the provider has completed the required module.
   The bill also includes child cardiac health policies in Code chapter 280 (uniform school requirements). The bill requires DE, in consultation with HHS, to ensure that the Iowa preparticipation physical evaluation form be expanded to include certain child cardiac health information and be made available to all public and nonpublic schools. The additional required information is detailed in the bill. 
   The bill requires that beginning with the 2025-2026 school year, and in each subsequent school year, prior to participating, all students enrolled in kindergarten through grade 12 who participate in interscholastic activities or intramural activities, as defined in the bill, shall complete and present to the superintendent of the public school district or the authorities in charge of the nonpublic school the completed Iowa preparticipation physical evaluation form; that each public school and nonpublic school distribute the child cardiac health education pamphlet to each student and to each student’s parent or guardian who completes the evaluation form; and that a provider who performs an athlete physical complete the certificate included in the evaluation form attesting to completion of the module and provide a copy of the signed certificate to the student’s school district or accredited nonpublic school. The school district or the accredited nonpublic school must retain the copy of the signed certificate and the provider must retain the original.