H.F. 2427 Section 1. Section 12.51, subsections 1 and 2, Code 2024, 1 are amended to read as follows: 2 1. An opioid settlement fund is created in the office 3 of the treasurer of state. The fund shall be separate from 4 the general fund of the state and the balance in the fund 5 shall not be considered part of the balance of the general 6 fund of the state. The On or after the effective date of 7 this Act, one-half of the state portion of any moneys paid to 8 the state as a result of a national settlement of litigation 9 with entities that manufactured, marketed, sold, distributed, 10 dispensed, or promoted opioids, made in connection with 11 claims arising from the manufacturing, marketing, selling, 12 distributing, dispensing, or promoting of opioids, shall be 13 deposited in the fund. This subsection does not apply to such 14 moneys paid to the state that are earmarked for or otherwise 15 required to be transferred or distributed to counties, cities, 16 or other local governmental entities. 17 2. Moneys in the fund shall not be transferred, used, 18 obligated, appropriated, or otherwise encumbered except as 19 provided in this section . Moneys in the fund shall only be 20 used pursuant to appropriations from the fund by the general 21 assembly for purposes of abating the opioid crisis in this 22 state, which may include but are not limited to the purposes 23 specified in section 135.190A for moneys in the opioid 24 antagonist medication fund and the purposes specified in 25 chapter 123B . Moneys in the fund shall not be used for the 26 purposes specified in chapter 123B after the state has received 27 all moneys from the settlement described in subsection 1. 28 Sec. 2. NEW SECTION . 12.52 Opioid settlement future fund. 29 1. a. An opioid settlement future fund is created in the 30 office of the treasurer of state. The fund shall be separate 31 from the general fund of the state and the balance in the fund 32 shall not be considered part of the balance of the general 33 fund of the state. On or after the effective date of this 34 Act, one-half of the state portion of any moneys paid to 35 -1- LSB 5405YH (7) 90 ss/ko 1/ 11

H.F. 2427 the state as a result of a national settlement of litigation 1 with entities that manufactured, marketed, sold, distributed, 2 dispensed, or promoted opioids, made in connection with 3 claims arising from the manufacturing, marketing, selling, 4 distributing, dispensing, or promoting of opioids, shall be 5 deposited in the fund. This subsection does not apply to such 6 moneys paid to the state that are earmarked for or otherwise 7 required to be transferred or distributed to counties, cities, 8 or other local governmental entities. 9 b. On the effective date of this Act, the treasurer of state 10 shall transfer half of the moneys in the opioid settlement 11 fund, created pursuant to section 12.51, on the effective date 12 of this Act to the opioid settlement future fund. 13 2. Moneys in the fund shall not be transferred, used, 14 obligated, appropriated, or otherwise encumbered except as 15 provided in this section. Interest and earnings in the fund 16 shall only be used pursuant to appropriations from the fund by 17 the general assembly for purposes of abating the opioid crisis 18 in this state, which may include but are not limited to the 19 purposes specified in chapter 123B. 20 3. Notwithstanding section 8.33, moneys in the fund 21 that remain unencumbered or unobligated at the close of a 22 fiscal year shall not revert. Notwithstanding section 12C.7, 23 subsection 2, interest or earnings on moneys in the fund shall 24 be credited to the fund. 25 Sec. 3. NEW SECTION . 123B.1 Opioid epidemic response 26 advisory council. 27 1. a. The opioid epidemic response advisory council is 28 established to develop and implement a comprehensive and 29 effective statewide effort to address the opioid addiction and 30 overdose epidemic in Iowa. The council shall consist of the 31 following members, appointed by the director of the department 32 of health and human services, except as otherwise provided: 33 (1) Two members of the house of representatives, one 34 appointed by the speaker of the house and one appointed by the 35 -2- LSB 5405YH (7) 90 ss/ko 2/ 11

H.F. 2427 minority leader of the house, who shall serve as ex officio, 1 nonvoting members. 2 (2) Two members of the senate, one appointed by the 3 president of the senate and one appointed by the minority 4 leader of the senate, who shall serve as ex officio, nonvoting 5 members. 6 (3) One member appointed by the board of pharmacy. 7 (4) One member who is a physician and surgeon or 8 osteopathic physician and surgeon appointed by the Iowa medical 9 association. 10 (5) One member who represents an opioid treatment program, 11 sober living program, or substance use disorder program. 12 (6) One member appointed by the Iowa association of 13 addiction professionals who is a psychiatrist specializing in 14 the treatment of addiction. 15 (7) One member appointed by the commissioner of the 16 department of public safety. 17 (8) One member who represents nonprofit organizations 18 conducting initiatives to address the opioid epidemic. 19 (9) One member appointed by the Iowa emergency medical 20 services association who is serving with an ambulance service 21 as an emergency medical care provider. 22 (10) One member who represents the Iowa courts who is a 23 judge. 24 (11) One member who is a resident of this state and who is 25 in opioid addiction recovery. 26 (12) One member appointed by the director of the office of 27 drug control policy. 28 (13) One member who is a mental health advocate. 29 (14) One member who represents the Iowa hospital 30 association. 31 (15) One member who represents a local health department. 32 (16) The directors of the departments of health and human 33 services, corrections, and management, the attorney general, 34 and the state public defender, or their designees, who shall 35 -3- LSB 5405YH (7) 90 ss/ko 3/ 11

H.F. 2427 serve as ex officio, nonvoting members. 1 b. The director of the department of health and human 2 services shall coordinate the director’s appointments to 3 provide, to the extent practicable, geographic, racial, and 4 gender diversity. 5 c. The council shall annually elect a chair. 6 d. The chair shall convene the council at least quarterly, 7 and the chair may convene the council at other times as 8 necessary. The chair shall convene meetings at different 9 locations in the state to provide geographic access and may 10 conduct all meetings, other than one meeting per year, remotely 11 by electronic means. 12 e. The department of health and human services shall provide 13 staffing and administrative support to the council. 14 f. The director of the department of health and human 15 services shall convene the first meeting of the council no 16 later than August 1, 2024. 17 g. An advisory council member shall disclose to the council, 18 refrain from participating in discussions, and abstain from 19 voting on any matter before the council if the member has a 20 conflict of interest. For the purposes of this paragraph, a 21 conflict of interest is a financial association that has the 22 potential to bias or have the appearance of biasing a council 23 member’s decision related to council activities under this 24 chapter. 25 2. The council shall focus on all of the following: 26 a. Primary prevention, secondary prevention, early 27 intervention, and education, including public education and 28 awareness for adults and youth, prescriber education, the 29 development and sustainability of opioid overdose prevention 30 and education programs, and the role of adult protective 31 services in prevention and response. 32 b. Training on the treatment of opioid addiction, including 33 the use of all approved opioid addiction medications, 34 detoxification, relapse prevention, patient assessment, 35 -4- LSB 5405YH (7) 90 ss/ko 4/ 11

H.F. 2427 individual treatment planning, counseling, recovery supports, 1 diversion control, and other best practices. 2 c. The expansion and enhancement of a continuum of care 3 for opioid-related substance use disorders, including primary 4 prevention, early intervention, treatment, recovery, and 5 aftercare services. 6 d. Supporting efforts to prevent or reduce deaths from 7 opioid overdoses or other opioid-related harms, including 8 through increasing the availability or distribution of naloxone 9 or other opioid antagonists for use by a family member, friend, 10 caregiver, health care provider, employee of a substance abuse 11 treatment facility, school employee, or other person who may be 12 in a place to render aid to a person at risk of experiencing an 13 opioid-related overdose. 14 3. The council shall do all of the following: 15 a. Review local, state, and federal initiatives and 16 activities related to education, prevention, treatment, and 17 services for individuals and families experiencing and affected 18 by opioid use disorder. 19 b. Establish priorities to address the state’s opioid 20 epidemic for the purposes of recommending initiatives to fund. 21 c. Recommend to the legislative council specific projects 22 and initiatives to be funded. 23 (1) Until such time as all opioid settlement moneys have 24 been received by the state, the council shall recommend grants 25 to be appropriated from the opioid settlement fund created 26 in section 12.51. The council shall not recommend grants in 27 excess of the balance of the opioid settlement fund. 28 (2) After all settlement moneys have been received by the 29 state, the council shall recommend grants to be appropriated 30 from the opioid settlement future fund created in section 31 12.52. The council shall not recommend grants in excess of the 32 interest held in the opioid settlement future fund. 33 d. Ensure that available funding is allocated to align with 34 other local, state, and federal funding to achieve the greatest 35 -5- LSB 5405YH (7) 90 ss/ko 5/ 11

H.F. 2427 impact and ensure a coordinated state effort. 1 e. Consult with the directors of the departments of health 2 and human services and management to develop measurable 3 outcomes to determine the effectiveness of funds allocated. 4 f. Develop recommendations for an administrative and 5 organizational framework for the allocation, on a sustainable 6 and ongoing basis, of moneys deposited in the opioid settlement 7 fund created pursuant to section 12.51 and the opioid 8 settlement future fund created pursuant to section 12.52 in 9 order to address the opioid abuse and overdose epidemic in Iowa 10 and the areas of focus specified in subsection 2. 11 4. The council, in consultation with the director of the 12 department of health and human services, shall select from the 13 projects awarded grants pursuant to section 123B.2, projects 14 that include promising practices or theory-based activities 15 for which the director of the department of health and human 16 services shall conduct additional research and experimental 17 evaluation. A project selected pursuant to this subsection 18 must be administered to support the research and experimental 19 evaluation, and the grantee must collect and report information 20 that is needed to complete the research and experimental 21 evaluation. 22 5. The council, in consultation with the directors of the 23 departments of health and human services and public safety, 24 shall establish goals related to addressing the opioid epidemic 25 and determine a baseline against which progress shall be 26 monitored and set measurable outcomes, including benchmarks. 27 The goals established must include goals for prevention and 28 public health, access to treatment, and multigenerational 29 impacts. The council shall use existing measures and data 30 collection systems to determine baseline data against which 31 progress shall be measured. The council shall include 32 the proposed goals, the measurable outcomes, and proposed 33 benchmarks in the council’s initial report to the general 34 assembly pursuant to section 123B.3, subsection 1. 35 -6- LSB 5405YH (7) 90 ss/ko 6/ 11

H.F. 2427 Sec. 4. NEW SECTION . 123B.2 Opioid epidemic response 1 grants. 2 1. The legislative council shall award grants from the 3 opioid settlement fund created pursuant to section 12.51 to 4 proposals selected by the advisory council that address the 5 priorities identified in section 123B.1, subsection 2. No more 6 than three percent of each grant awarded shall be used by a 7 grantee for administration. 8 2. The chairperson of the opioid epidemic response advisory 9 council shall submit a report of the grants proposed to be 10 awarded for the upcoming fiscal year by the advisory council 11 to the general assembly by December 1, 2024, and annually by 12 December 1 thereafter. 13 Sec. 5. NEW SECTION . 123B.3 Opioid epidemic response 14 advisory council —— reports. 15 1. The opioid epidemic response advisory council shall 16 annually submit a report to the general assembly by January 17 31, regarding individual projects that received grants and the 18 overall role of the project in addressing the opioid addiction 19 and overdose epidemic in Iowa. The report shall describe the 20 grantees and the activities implemented, along with measurable 21 outcomes as determined by the council in consultation with the 22 director of the department of health and human services. At a 23 minimum, the report shall include information about the number 24 of individuals who received information or treatment, the 25 outcomes individuals achieved and demographic information about 26 the individuals participating in the project; an assessment of 27 the progress toward achieving statewide access to qualified 28 providers and comprehensive treatment and recovery services; 29 and an update on the evaluations implemented by the director of 30 the department of health and human services for the promising 31 practices and theory-based projects that receive funding. 32 2. The director of the department of health and human 33 services, in consultation with the opioid epidemic response 34 advisory council, shall report to the general assembly when 35 -7- LSB 5405YH (7) 90 ss/ko 7/ 11

H.F. 2427 an evaluation described in section 123B.1, subsection 4, is 1 complete. The report shall include demographic information; 2 outcome information for the individuals in the program; the 3 results of the program in promoting recovery, employment, and 4 family reunification; reducing involvement in the criminal 5 justice system; and other relevant outcomes. The report shall 6 include information about the ability of grant programs to be 7 scaled to achieve statewide results. 8 3. The opioid epidemic response advisory council, in 9 its annual report due by January 31, 2030, shall include 10 recommendations on whether appropriations and grants pursuant 11 to this chapter should be continued, adjusted, or discontinued, 12 whether funding should be appropriated for other purposes 13 related to opioid abuse prevention, and on the appropriate 14 level of funding for existing and new uses. 15 Sec. 6. NEW SECTION . 123B.4 Standing appropriation. 16 There is appropriated annually from the opioid settlement 17 fund created pursuant to section 12.51 to the department of 18 health and human services two hundred forty-nine thousand 19 dollars for the provision of administrative services to 20 the opioid epidemic response advisory council and for the 21 administration of grants awarded pursuant to section 123B.2. 22 Sec. 7. OPIOID OVERDOSE PREVENTION —— APPROPRIATION. There 23 is appropriated from the opioid settlement fund created in 24 section 12.51 to the department of health and human services 25 for the fiscal year beginning July 1, 2023, and ending June 30, 26 2024, the following amount, or so much thereof as is necessary, 27 to be used for the purposes designated, except that if this 28 Act is enacted on or before June 30, 2024, the moneys are 29 appropriated for the fiscal year beginning July 1, 2024, and 30 ending June 30, 2025: 31 1. For providing funding for the extension and expansion 32 of an opioid addiction prevention surgery support services 33 agreement entered into by the Iowa attorney general’s office 34 that became effective October 1, 2022, to provide surgery care 35 -8- LSB 5405YH (7) 90 ss/ko 8/ 11

H.F. 2427 management services for ten thousand patients to facilitate 1 the reduction of post-surgery opioid use and to optimize 2 therapeutic, humanistic, and economic results from surgery and 3 surgical recovery: 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 6,834,680 5 2. For providing funding to the public safety survivor 6 benefits fund created pursuant to section 80.47: 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 150,000 8 3. For establishment of a youth substance use treatment 9 and recovery campus located in a central Iowa county with 10 a population between ninety-eight thousand and ninety-nine 11 thousand based on the 2020 federal decennial census: 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 3,000,000 13 Sec. 8. EFFECTIVE DATE. This Act, being deemed of immediate 14 importance, takes effect upon enactment. 15 EXPLANATION 16 The inclusion of this explanation does not constitute agreement with 17 the explanation’s substance by the members of the general assembly. 18 This bill relates to the opioid settlement fund, creates 19 the opioid settlement future fund, and establishes the opioid 20 epidemic response advisory council (advisory council). 21 On or after the effective date of the bill, half of the state 22 portion of moneys received as a result of the national opioid 23 settlements is to be paid into the existing opioid settlement 24 fund, and the other half to be paid into the opioid settlement 25 future fund created in the bill. The bill also requires the 26 treasurer of state to transfer half of the moneys currently 27 held in the opioid settlement fund to the opioid settlement 28 future fund on the effective date of the bill. Interest and 29 earnings on moneys in the opioid settlement future fund shall 30 be credited to the fund, and moneys in the fund that remain 31 unencumbered or unobligated at the close of a fiscal year 32 shall not revert. Interest and earnings in the fund shall be 33 appropriated only for purposes of abating the opioid crisis in 34 this state, including for the funding of grants described in 35 -9- LSB 5405YH (7) 90 ss/ko 9/ 11

H.F. 2427 the bill. 1 The bill instructs the advisory council to focus on matters 2 relating to opioid addiction and overdoses, governmental 3 responses to opioid addiction and overdoses, and providing 4 metrics by which such responses can be measured. The bill 5 provides specific membership requirements for the advisory 6 council and requires the department of health and human 7 services (department) to provide staffing and administrative 8 support to the advisory council. 9 The bill requires the advisory council to identify projects 10 related to opioid addiction and overdoses that should be 11 awarded grants from the opioid settlement fund and opioid 12 settlement future fund. The legislative council shall then 13 award grants to the projects that address the priorities 14 identified in the bill. From among those projects awarded 15 grants, the bill requires the advisory council to identify 16 projects that include promising practices or theory-based 17 activities for which the director of the department shall 18 conduct additional research and experimental evaluation. 19 The bill requires the chairperson of the advisory council 20 to annually report to the general assembly regarding grants 21 proposed by the advisory council and the advisory council and 22 the director of the department of management to annually report 23 to the general assembly regarding the efficacy of individual 24 projects and the progress made with respect to the benchmarks 25 established by the advisory council. The annual report due 26 to be submitted by the advisory council by January 31, 2030, 27 shall include the advisory council’s recommendations regarding 28 the continuation of grants and appropriations from the opioid 29 settlement fund. 30 The bill appropriates $249,000 to the department annually 31 from the opioid settlement fund for the provision of 32 administrative services to the advisory council and for the 33 administration of awarded grants. The bill also appropriates 34 $6,834,680 to the department for the extension and expansion 35 -10- LSB 5405YH (7) 90 ss/ko 10/ 11

H.F. 2427 of an opioid addiction prevention surgery support services 1 agreement entered into by the Iowa attorney general’s 2 office, effective as of October 1, 2022, to provide surgery 3 care management services for 10,000 patients to facilitate 4 the reduction of post-surgery opioid use and to optimize 5 therapeutic, humanistic, and economic results from surgery and 6 surgical recovery, $150,000 to the department for providing 7 funding to the first responder fund, and $3 million for the 8 establishment of a youth substance use treatment and recovery 9 campus in a central Iowa county with a population between 10 98,000 and 99,000 based on the 2020 federal decennial census. 11 The bill takes effect upon enactment. 12 -11- LSB 5405YH (7) 90 ss/ko 11/ 11