House File 427 - Introduced HOUSE FILE 427 BY COMMITTEE ON HEALTH AND HUMAN SERVICES (SUCCESSOR TO HSB 91) A BILL FOR An Act relating to the health and well-being of children 1 and families including provisions for regional centers of 2 excellence, a state-funded family medicine obstetrical 3 fellowship program, self-administered hormonal 4 contraceptives, maternal support and fatherhood initiatives, 5 adoption expenses under the adoption subsidy program, 6 and accessibility to the all Iowa scholarship program; 7 making appropriations; and including effective date and 8 applicability provisions. 9 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 10 TLSB 1511HV (2) 90 pf/rh

H.F. 427 DIVISION I 1 REGIONAL CENTERS OF EXCELLENCE GRANT PROGRAM 2 Section 1. REGIONAL CENTERS OF EXCELLENCE PROGRAM —— GRANTS 3 —— APPROPRIATION. There is appropriated from the general fund 4 of the state to the department of health and human services for 5 the fiscal year beginning July 1, 2023, and ending June 30, 6 2024, the following amount, or so much thereof as is necessary, 7 to be used for the purposes designated: 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,000,000 9 The funds appropriated in this section shall be used for 10 the continuation of a center of excellence program to award 11 four grants to encourage innovation and collaboration among 12 regional health care providers in a rural area based upon the 13 results of a regional community needs assessment to transform 14 health care delivery in order to provide quality, sustainable 15 care that meets the needs of the local communities. An 16 applicant for the grant funds shall specify how the funds will 17 be expended to accomplish the goals of the program and shall 18 provide a detailed five-year sustainability plan prior to being 19 awarded any funding. Following the receipt of grant funding, 20 a recipient shall submit periodic reports as specified by the 21 department to the governor and the general assembly regarding 22 the recipient’s expenditure of the funds and progress in 23 accomplishing the program’s goals. 24 DIVISION II 25 STATE-FUNDED FAMILY MEDICINE OBSTETRICS FELLOWSHIP PROGRAM 26 Sec. 2. NEW SECTION . 135.182 State-funded family medicine 27 obstetrics fellowship program —— fund. 28 1. The department shall establish a family medicine 29 obstetrics fellowship program to increase access to family 30 medicine obstetrics practitioners in rural and underserved 31 areas of the state. A person who has completed an 32 accreditation council for graduate medical education residency 33 program in family medicine is eligible for participation 34 in the fellowship program. Participating fellows shall 35 -1- LSB 1511HV (2) 90 pf/rh 1/ 22

H.F. 427 enter into a program agreement with a participating teaching 1 hospital which, at a minimum, requires the fellow to complete a 2 one-year fellowship and to engage in full-time family medicine 3 obstetrics practice in a rural or underserved area of the 4 state for a period of at least five years within nine months 5 following completion of the fellowship and receipt of a license 6 to practice medicine in the state. 7 2. Each fellow participating in the program shall be 8 eligible for a salary and benefits including a stipend as 9 determined by the participating teaching hospital which shall 10 be funded through the family medicine obstetrics fellowship 11 program fund. 12 3. The department shall adopt rules pursuant to chapter 13 17A to administer the program, including defining rural and 14 underserved areas for the purpose of the required full-time 15 practice of a person following completion of the fellowship. 16 4. a. A family medicine obstetrics fellowship program 17 fund is created in the state treasury consisting of the moneys 18 appropriated or credited to the fund by law. Notwithstanding 19 section 8.33, moneys in the fund at the end of each fiscal year 20 shall not revert to any other fund but shall remain in the fund 21 for use in subsequent fiscal years. Moneys in the fund are 22 appropriated to the department to be used to fund fellowship 23 positions as provided in this section. 24 b. For the fiscal year beginning July 1, 2023, and each 25 fiscal year beginning July 1 thereafter, there is appropriated 26 from the general fund of the state to the family medicine 27 obstetrics fellowship program fund an amount sufficient to 28 support the creation of four fellowship positions as provided 29 in this section. 30 5. The department and the participating teaching hospitals 31 shall regularly evaluate and document their experiences 32 including identifying ways the program may be modified or 33 expanded to facilitate increased access to family medicine 34 obstetrics practitioners in rural and underserved areas of the 35 -2- LSB 1511HV (2) 90 pf/rh 2/ 22

H.F. 427 state. The department shall submit an annual report to the 1 general assembly by January 1. The report shall include the 2 number of fellowships funded to date and any other information 3 identified by the department and the participating teaching 4 hospitals as indicators of outcomes and the effectiveness of 5 the program. 6 6. For the purposes of this section, “teaching hospital” 7 means a hospital or medical center that provides medical 8 education to prospective and current health professionals. 9 Sec. 3. STATE-FUNDED FAMILY MEDICINE OBSTETRICS FELLOWSHIP 10 PROGRAM AND FUND —— APPROPRIATION. There is appropriated from 11 the general fund of the state to the department of health and 12 human services for the fiscal year beginning July 1, 2023, and 13 ending June 30, 2024, the following amount, or so much thereof 14 as is necessary, to be used for the purposes designated: 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 560,000 16 For deposit in the family medicine obstetrics fellowship 17 program fund to be utilized in creating and providing for four 18 family medicine obstetrics fellowship positions during the 19 fiscal year in accordance with the family medicine obstetrics 20 fellowship program created in this division of this Act. 21 DIVISION III 22 SELF-ADMINISTERED HORMONAL CONTRACEPTIVES 23 Sec. 4. Section 155A.3, Code 2023, is amended by adding the 24 following new subsections: 25 NEW SUBSECTION . 10A. “Department” means the department of 26 health and human services. 27 NEW SUBSECTION . 45A. “Self-administered hormonal 28 contraceptive” means a self-administered hormonal contraceptive 29 that is approved by the United States food and drug 30 administration to prevent pregnancy. “Self-administered 31 hormonal contraceptive” includes an oral hormonal contraceptive, 32 a hormonal vaginal ring, and a hormonal contraceptive patch, 33 but does not include any drug intended to induce an abortion as 34 defined in section 146.1. 35 -3- LSB 1511HV (2) 90 pf/rh 3/ 22

H.F. 427 NEW SUBSECTION . 45B. “Standing order” means a preauthorized 1 medication order with specific instructions from the medical 2 director of the department to dispense a medication under 3 clearly defined circumstances. 4 Sec. 5. NEW SECTION . 155A.49 Pharmacist dispensing of 5 self-administered hormonal contraceptives —— standing order —— 6 requirements —— limitations of liability. 7 1. a. Notwithstanding any provision of law to the contrary, 8 a pharmacist may dispense a self-administered hormonal 9 contraceptive to a patient who is at least eighteen years of 10 age, pursuant to a standing order established by the medical 11 director of the department in accordance with this section. 12 b. In dispensing a self-administered hormonal contraceptive 13 to a patient under this section, a pharmacist shall comply with 14 all of the following: 15 (1) For an initial dispensing of a self-administered 16 hormonal contraceptive, the pharmacist may dispense only up 17 to a three-month supply at one time of the self-administered 18 hormonal contraceptive. 19 (2) For any subsequent dispensing of the same 20 self-administered hormonal contraceptive, the pharmacist 21 may dispense up to a twelve-month supply at one time of the 22 self-administered hormonal contraceptive. 23 2. A pharmacist who dispenses a self-administered hormonal 24 contraceptive in accordance with this section shall not 25 require any other prescription drug order authorized by a 26 practitioner prior to dispensing the self-administered hormonal 27 contraceptive to a patient. 28 3. The medical director of the department may establish a 29 standing order authorizing the dispensing of self-administered 30 hormonal contraceptives by a pharmacist who does all of the 31 following: 32 a. Complies with the standing order established pursuant to 33 this section. 34 b. Retains a record of each patient to whom a 35 -4- LSB 1511HV (2) 90 pf/rh 4/ 22

H.F. 427 self-administered hormonal contraceptive is dispensed under 1 this section and submits the record to the department. 2 4. The standing order shall require a pharmacist who 3 dispenses self-administered hormonal contraceptives under this 4 section to do all of the following: 5 a. Complete a standardized training program and continuing 6 education requirements approved by the board in consultation 7 with the board of medicine and the department that are related 8 to prescribing self-administered hormonal contraceptives and 9 include education regarding all contraceptive methods approved 10 by the United States food and drug administration. 11 b. Obtain a completed self-screening risk assessment, 12 approved by the department in collaboration with the board and 13 the board of medicine, from each patient, verify the identity 14 and age of each patient, and perform a blood pressure screening 15 on each patient prior to dispensing the self-administered 16 hormonal contraceptive to the patient. 17 c. Provide the patient with all of the following: 18 (1) Written information regarding all of the following: 19 (a) The importance of completing an appointment with the 20 patient’s primary care or women’s health care practitioner 21 to obtain preventative care, including but not limited to 22 recommended tests and screenings. 23 (b) The effectiveness and availability of long-acting 24 reversible contraceptives as an alternative to 25 self-administered hormonal contraceptives. 26 (2) A copy of the record of the pharmacist’s encounter with 27 the patient that includes all of the following: 28 (a) The patient’s completed self-screening risk assessment. 29 (b) A description of the contraceptive dispensed, or the 30 basis for not dispensing a contraceptive. 31 (3) Patient counseling regarding all of the following: 32 (a) The appropriate administration and storage of the 33 self-administered hormonal contraceptive. 34 (b) Potential side effects and risks of the 35 -5- LSB 1511HV (2) 90 pf/rh 5/ 22

H.F. 427 self-administered hormonal contraceptive. 1 (c) The need for backup contraception. 2 (d) When to seek emergency medical attention. 3 (e) The risk of contracting a sexually transmitted 4 infection or disease, and ways to reduce such a risk. 5 5. The standing order established pursuant to this section 6 shall prohibit a pharmacist who dispenses a self-administered 7 hormonal contraceptive under this section from doing any of the 8 following: 9 a. Requiring a patient to schedule an appointment with 10 the pharmacist for the prescribing or dispensing of a 11 self-administered hormonal contraceptive. 12 b. Dispensing self-administered hormonal contraceptives 13 to a patient for more than twenty-seven months after the 14 date a self-administered hormonal contraceptive is initially 15 dispensed to the patient, if the patient has not consulted with 16 a primary care or women’s health care practitioner during the 17 preceding twenty-seven months, in which case the pharmacist 18 shall refer the patient to a primary care or women’s health 19 care practitioner. 20 c. Dispensing a self-administered hormonal contraceptive to 21 a patient if the results of the self-screening risk assessment 22 completed by a patient pursuant to subsection 4, paragraph 23 “b” , indicate it is unsafe for the pharmacist to dispense the 24 self-administered hormonal contraceptive to the patient, in 25 which case the pharmacist shall refer the patient to a primary 26 care or women’s health care practitioner. 27 6. A pharmacist who dispenses a self-administered hormonal 28 contraceptive and the medical director of the department who 29 establishes a standing order in compliance with this section 30 shall be immune from criminal and civil liability arising 31 from any damages caused by the dispensing, administering, 32 or use of a self-administered hormonal contraceptive or the 33 establishment of the standing order. The medical director of 34 the department shall be considered to be acting within the 35 -6- LSB 1511HV (2) 90 pf/rh 6/ 22

H.F. 427 scope of the medical director’s office and employment for 1 purposes of chapter 669 in the establishment of a standing 2 order in compliance with this section. 3 7. The department, in collaboration with the board and 4 the board of medicine, and in consideration of the guidelines 5 established by the American congress of obstetricians and 6 gynecologists, shall adopt rules pursuant to chapter 17A to 7 administer this chapter. 8 Sec. 6. Section 514C.19, Code 2023, is amended to read as 9 follows: 10 514C.19 Prescription contraceptive coverage. 11 1. Notwithstanding the uniformity of treatment requirements 12 of section 514C.6 , a group policy , or contract , or plan 13 providing for third-party payment or prepayment of health or 14 medical expenses shall not do either of the following comply 15 as follows : 16 a. Exclude Such policy, contract, or plan shall not 17 exclude or restrict benefits for prescription contraceptive 18 drugs or prescription contraceptive devices which prevent 19 conception and which are approved by the United States 20 food and drug administration, or generic equivalents 21 approved as substitutable by the United States food and 22 drug administration, if such policy , or contract , or plan 23 provides benefits for other outpatient prescription drugs 24 or devices. However, such policy, contract, or plan shall 25 specifically provide for payment of a self-administered 26 hormonal contraceptive, as prescribed by a practitioner as 27 defined in section 155A.3, or as prescribed by standing order 28 and dispensed by a pharmacist pursuant to section 155A.49, 29 including payment for up to an initial three-month supply 30 of a self-administered hormonal contraceptive dispensed at 31 one time and for up to a twelve-month supply of the same 32 self-administered hormonal contraceptive subsequently dispensed 33 at one time. 34 b. Exclude Such policy, contract, or plan shall not exclude 35 -7- LSB 1511HV (2) 90 pf/rh 7/ 22

H.F. 427 or restrict benefits for outpatient contraceptive services 1 which are provided for the purpose of preventing conception if 2 such policy , or contract , or plan provides benefits for other 3 outpatient services provided by a health care professional. 4 2. A person who provides a group policy , or contract , or 5 plan providing for third-party payment or prepayment of health 6 or medical expenses which is subject to subsection 1 shall not 7 do any of the following: 8 a. Deny to an individual eligibility, or continued 9 eligibility, to enroll in or to renew coverage under the terms 10 of the policy , or contract , or plan because of the individual’s 11 use or potential use of such prescription contraceptive drugs 12 or devices, or use or potential use of outpatient contraceptive 13 services. 14 b. Provide a monetary payment or rebate to a covered 15 individual to encourage such individual to accept less than the 16 minimum benefits provided for under subsection 1 . 17 c. Penalize or otherwise reduce or limit the reimbursement 18 of a health care professional because such professional 19 prescribes contraceptive drugs or devices, or provides 20 contraceptive services. 21 d. Provide incentives, monetary or otherwise, to a health 22 care professional to induce such professional to withhold 23 from a covered individual contraceptive drugs or devices, or 24 contraceptive services. 25 3. This section shall not be construed to prevent a 26 third-party payor from including deductibles, coinsurance, or 27 copayments under the policy , or contract, or plan as follows: 28 a. A deductible, coinsurance, or copayment for benefits 29 for prescription contraceptive drugs shall not be greater than 30 such deductible, coinsurance, or copayment for any outpatient 31 prescription drug for which coverage under the policy , or 32 contract , or plan is provided. 33 b. A deductible, coinsurance, or copayment for benefits for 34 prescription contraceptive devices shall not be greater than 35 -8- LSB 1511HV (2) 90 pf/rh 8/ 22

H.F. 427 such deductible, coinsurance, or copayment for any outpatient 1 prescription device for which coverage under the policy , or 2 contract , or plan is provided. 3 c. A deductible, coinsurance, or copayment for benefits for 4 outpatient contraceptive services shall not be greater than 5 such deductible, coinsurance, or copayment for any outpatient 6 health care services for which coverage under the policy , or 7 contract , or plan is provided. 8 4. This section shall not be construed to require a 9 third-party payor under a policy , or contract , or plan 10 to provide benefits for experimental or investigational 11 contraceptive drugs or devices, or experimental or 12 investigational contraceptive services, except to the extent 13 that such policy , or contract , or plan provides coverage for 14 other experimental or investigational outpatient prescription 15 drugs or devices, or experimental or investigational outpatient 16 health care services. 17 5. This section shall not be construed to limit or otherwise 18 discourage the use of generic equivalent drugs approved by the 19 United States food and drug administration, whenever available 20 and appropriate. This section , when a brand name drug is 21 requested by a covered individual and a suitable generic 22 equivalent is available and appropriate, shall not be construed 23 to prohibit a third-party payor from requiring the covered 24 individual to pay a deductible, coinsurance, or copayment 25 consistent with subsection 3 , in addition to the difference of 26 the cost of the brand name drug less the maximum covered amount 27 for a generic equivalent. 28 6. A person who provides an individual policy , or contract , 29 or plan providing for third-party payment or prepayment of 30 health or medical expenses shall make available a coverage 31 provision that satisfies the requirements in subsections 32 1 through 5 in the same manner as such requirements are 33 applicable to a group policy , or contract , or plan under those 34 subsections. The policy , or contract , or plan shall provide 35 -9- LSB 1511HV (2) 90 pf/rh 9/ 22

H.F. 427 that the individual policyholder may reject the coverage 1 provision at the option of the policyholder. 2 7. a. This section applies to the following classes of 3 third-party payment provider contracts , or policies , or plans 4 delivered, issued for delivery, continued, or renewed in this 5 state on or after July 1, 2000 January 1, 2024 : 6 (1) Individual or group accident and sickness insurance 7 providing coverage on an expense-incurred basis. 8 (2) An individual or group hospital or medical service 9 contract issued pursuant to chapter 509 , 514 , or 514A . 10 (3) An individual or group health maintenance organization 11 contract regulated under chapter 514B . 12 (4) Any other entity engaged in the business of insurance, 13 risk transfer, or risk retention, which is subject to the 14 jurisdiction of the commissioner. 15 (5) A plan established pursuant to chapter 509A for public 16 employees. 17 b. This section shall not apply to accident-only, 18 specified disease, short-term hospital or medical, hospital 19 confinement indemnity, credit, dental, vision, Medicare 20 supplement, long-term care, basic hospital and medical-surgical 21 expense coverage as defined by the commissioner, disability 22 income insurance coverage, coverage issued as a supplement 23 to liability insurance, workers’ compensation or similar 24 insurance, or automobile medical payment insurance. 25 8. This section shall not be construed to require a 26 third-party payor to provide payment to a practitioner for the 27 dispensing of a self-administered hormonal contraceptive to 28 replace a self-administered hormonal contraceptive that has 29 been dispensed to a covered person and that has been misplaced, 30 stolen, or destroyed. This section shall not be construed to 31 require a third-party payor to replace covered prescriptions 32 that are misplaced, stolen, or destroyed. 33 9. For the purposes of this section, “self-administered 34 hormonal contraceptive” and “standing order” mean the same as 35 -10- LSB 1511HV (2) 90 pf/rh 10/ 22

H.F. 427 defined in section 155A.3. 1 Sec. 7. INFORMATION PROGRAM FOR DRUG PRESCRIBING AND 2 DISPENSING —— SELF-ADMINISTERED HORMONAL CONTRACEPTIVES. The 3 board of pharmacy in collaboration with the board of medicine 4 and the department of health and human services shall expand 5 the information program for drug prescribing and dispensing 6 established pursuant to section 124.551, to collect from 7 pharmacists information relating to the dispensing of 8 self-administered hormonal contraceptives as provided pursuant 9 to section 155A.49. The board of pharmacy shall adopt 10 rules pursuant to chapter 17A related to registration of 11 participating pharmacists, the information to be reported by a 12 pharmacist to the information program, access to information 13 from the program, and other rules necessary to carry out the 14 purposes and to enforce the provisions of this section. 15 Sec. 8. APPLICATION TO MEDICAID PROGRAM. This division 16 of this Act shall apply to the Medicaid program including a 17 managed care organization acting pursuant to a contract with 18 the department of health and human services to administer 19 the Medicaid program under chapter 249A. However, if it is 20 determined that any provision of this division of this Act 21 would cause denial of federal funds under Tit. XVIII or XIX 22 of the federal Social Security Act, or would otherwise be 23 inconsistent or conflict with the requirements of federal law 24 or regulation, such provision shall be suspended, but only to 25 the extent necessary to prevent denial of such funds or to 26 eliminate the inconsistency or conflict with the requirements 27 of federal law or regulation. 28 DIVISION IV 29 MORE OPTIONS FOR MATERNAL SUPPORT (MOMS) PROGRAM —— FATHERHOOD 30 INITIATIVES 31 Sec. 9. Section 217.41C, subsection 1, paragraph c, Code 32 2023, is amended to read as follows: 33 c. For the purposes of this section , “pregnancy support 34 services” means those nonmedical services that promote 35 -11- LSB 1511HV (2) 90 pf/rh 11/ 22

H.F. 427 childbirth by providing information, counseling, and support 1 services that assist pregnant women or women who believe they 2 may be pregnant and men who are involved or who think they 3 might be involved in a pregnancy to choose childbirth and to 4 make informed decisions regarding the choice of adoption or 5 parenting with respect to their children. 6 Sec. 10. Section 217.41C, Code 2023, is amended by adding 7 the following new subsections: 8 NEW SUBSECTION . 8. The department shall develop and 9 maintain a virtual clearinghouse of pregnancy support 10 services and resources including but not limited to all of the 11 following: 12 a. Pregnancy resource center and maternity home information 13 including contact information, location, and services provided. 14 b. Assistance in accessing public assistance including but 15 not limited to the special supplemental nutrition program for 16 women, infants, and children and the supplemental nutrition 17 assistance program. 18 c. Educational resources. 19 d. Housing assistance. 20 e. Recovery and mental health services. 21 f. Family planning education. 22 g. Adoption and foster care information and services. 23 h. Healing and support services for abortion survivors and 24 their families. 25 NEW SUBSECTION . 9. Beginning July 1, 2023, and thereafter, 26 funding for the program may be used for all of the following 27 purposes: 28 a. Fatherhood engagement grants. The department may 29 award grants to nonprofit, community-based organizations to 30 address the needs of fathers by assisting fathers in finding 31 employment, managing child support obligations, transitioning 32 from a period of incarceration, accessing health care, 33 understanding child development, and enhancing parenting skills 34 using evidence-based parenting education. Priority in the 35 -12- LSB 1511HV (2) 90 pf/rh 12/ 22

H.F. 427 awarding of grants shall be based on the demonstrated need 1 in a geographic area and the prevalence of the population to 2 be served as indicated by factors including but not limited 3 to the service area’s unemployment rate, incarceration rate, 4 number of public assistance recipients, number of single-parent 5 households, level of housing instability, and graduation rates. 6 b. Fatherhood communications initiative. The department 7 shall administer a communications initiative on responsible 8 fatherhood including but not limited to a public internet site 9 that provides access to resources on effective parenting and 10 assistance in receiving parenting support and services. 11 c. Mentoring school-aged males grant program. The 12 department may award three-year renewable grants to nonprofit 13 organizations that provide mentorship, social and academic 14 support, and life skills development to school-aged males. 15 Priority in the awarding of grants shall be based on the 16 demonstrated need in a geographic area and the prevalence of 17 the population to be served as indicated by factors including 18 but not limited to the service area’s unemployment rate, 19 incarceration rate, number of public assistance recipients, 20 number of single-parent households, level of housing 21 instability, and graduation rates. The department shall 22 provide technical assistance to grantees to ensure program 23 sustainability following the end of the three-year grant 24 period. 25 Sec. 11. MORE OPTIONS FOR MATERNAL SUPPORT PROGRAM —— 26 APPROPRIATION. There is appropriated from the general fund of 27 the state to the department of health and human services for 28 the fiscal year beginning July 1, 2023, and ending June 30, 29 2024, the following amount, or so much thereof as is necessary, 30 to be used for the purposes designated: 31 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2,000,000 32 To be used for the purposes of the more options for maternal 33 support program created in section 217.41C, including for 34 program administration, the provision of services, and for 35 -13- LSB 1511HV (2) 90 pf/rh 13/ 22

H.F. 427 funding of fatherhood engagement grants, the fatherhood 1 communications initiative, and the mentoring school-aged males 2 grant program. 3 Sec. 12. 2022 Iowa Acts, chapter 1131, section 28, 4 subsection 8, is amended to read as follows: 5 8. Of the funds appropriated under this section, $500,000 6 shall be used for the purposes of program administration and 7 provision of pregnancy support services through the more 8 options for maternal support program created in this Act. 9 Notwithstanding section 8.33, moneys appropriated in this 10 subsection that remain unencumbered or unobligated at the close 11 of the fiscal year shall not revert but shall remain available 12 for the purposes designated until the close of the succeeding 13 fiscal year. 14 Sec. 13. EFFECTIVE DATE. The following, being deemed of 15 immediate importance, takes effect upon enactment: 16 The section of this division of this Act amending 2022 Iowa 17 Acts, chapter 1131, section 28, subsection 8. 18 DIVISION V 19 NONRECURRING ADOPTION EXPENSES —— ADOPTION SUBSIDY PROGRAM 20 Sec. 14. NEW SECTION . 234.48 Adoption subsidy —— 21 nonrecurring adoption expenses. 22 Notwithstanding any provision to the contrary, the maximum 23 reimbursement provided to an adoptive parent under the 24 adoption subsidy program for nonrecurring adoption expenses 25 is one thousand dollars. For the purposes of this section, 26 “nonrecurring adoption expenses” means the same as defined in 45 27 C.F.R. §1356.41. The department shall adopt rules pursuant to 28 chapter 17A to administer this section. 29 Sec. 15. REPEAL. 2010 Iowa Acts, chapter 1031, section 408, 30 is repealed. 31 DIVISION VI 32 ALL IOWA OPPORTUNITY SCHOLARSHIP PROGRAM 33 Sec. 16. Section 261.87, subsection 1, paragraph b, 34 unnumbered paragraph 1, Code 2023, is amended to read as 35 -14- LSB 1511HV (2) 90 pf/rh 14/ 22

H.F. 427 follows: 1 “Eligible foster care student” means a person under 2 twenty-six years of age who has a high school diploma or a high 3 school equivalency diploma under chapter 259A and is described 4 by any of the following: 5 Sec. 17. Section 261.87, subsection 2, paragraph f, Code 6 2023, is amended to read as follows: 7 f. (1) Begins Except as provided in subparagraph (2), 8 begins enrollment at an eligible institution within two 9 academic years of graduation from high school or receipt of 10 a high school equivalency diploma under chapter 259A and 11 continuously receives awards as a full-time or part-time 12 student to maintain eligibility. However, the student may 13 defer or suspend participation in the program for up to two 14 years in order to pursue obligations that meet conditions 15 established by the commission by rule or to fulfill military 16 obligations. 17 (2) The requirements of subparagraph (1) do not apply to an 18 eligible foster care student. 19 Sec. 18. APPLICABILITY. This division of this Act applies 20 to applications submitted under the all Iowa opportunity 21 scholarship program established pursuant to section 261.87 22 before, on, or after the effective date of this division of 23 this Act. 24 EXPLANATION 25 The inclusion of this explanation does not constitute agreement with 26 the explanation’s substance by the members of the general assembly. 27 This bill relates to the health and well-being of children 28 and families. The bill is constructed in divisions. 29 DIVISION I —— REGIONAL CENTERS OF EXCELLENCE GRANT PROGRAM. 30 This division appropriates $1 million from the general fund 31 of the state to the department of health and human services 32 (HHS) for fiscal year 2023-2024 for continuation of a regional 33 center of excellence program to award four grants to encourage 34 innovation and collaboration among regional health care 35 -15- LSB 1511HV (2) 90 pf/rh 15/ 22

H.F. 427 providers in a rural area based upon the results of a regional 1 community needs assessment to transform health care delivery in 2 order to provide quality, sustainable care that meets the needs 3 of the local communities. An applicant for the grant funds 4 shall specify how the funds will be expended to accomplish the 5 goals of the program and shall provide a detailed five-year 6 sustainability plan prior to being awarded any funding. 7 Following the receipt of grant funding, a recipient shall 8 submit periodic reports as specified by HHS to the governor and 9 the general assembly regarding the recipient’s expenditure of 10 the funds and progress in accomplishing the program goals. 11 DIVISION II —— STATE-FUNDED FAMILY MEDICINE OBSTETRICS 12 FELLOWSHIP PROGRAM AND FUND. This division requires HHS to 13 establish a family medicine obstetrics fellowship program to 14 increase access to family medicine obstetrics practitioners 15 in rural and underserved areas of the state. A person who 16 has completed an accreditation council for graduate medical 17 education residency program in family medicine is eligible for 18 participation in the fellowship program. Participating fellows 19 shall enter into a program agreement with a participating 20 teaching hospital which, at a minimum, requires the fellow 21 to complete a one-year fellowship and to engage in full-time 22 family medicine obstetrics practice in a rural or underserved 23 area of the state for a period of at least five years within 24 nine months following completion of the fellowship and receipt 25 of a license to practice medicine in the state. Each fellow 26 participating in the program shall be eligible for salary and 27 benefits including a stipend as determined by the participating 28 teaching hospital and funded through the family medicine 29 obstetrics fellowship program fund. 30 The division requires HHS to adopt administrative rules 31 to administer the program, including defining rural and 32 underserved areas for the purpose of the required full-time 33 practice of a person following completion of the fellowship. 34 The division creates a family medicine obstetrics fellowship 35 -16- LSB 1511HV (2) 90 pf/rh 16/ 22

H.F. 427 program fund in the state treasury consisting of the moneys 1 appropriated or credited to the fund by law. Moneys in the 2 fund at the end of each fiscal year shall not revert to any 3 other fund but shall remain in the fund for use in subsequent 4 fiscal years. Moneys in the fund are appropriated to HHS 5 to be used to fund fellowship positions as provided in the 6 division. The division appropriates a sufficient amount from 7 the general fund of the state to the fund annually to support 8 the creation of four fellowship positions. The division 9 provides an appropriation for deposit in the fund for fiscal 10 year 2023-2024. 11 The division requires HHS and the participating teaching 12 hospitals to regularly evaluate and document their experiences 13 including identifying ways the program may be modified or 14 expanded to facilitate increased access to family medicine 15 obstetrics practitioners in rural and underserved areas of the 16 state. The department shall submit an annual report to the 17 general assembly by January 1. The report shall include the 18 number of fellowships funded to date and any other information 19 identified by HHS and the participating teaching hospitals as 20 indicators of outcomes and the effectiveness of the program. 21 DIVISION III —— SELF-ADMINISTERED HORMONAL CONTRACEPTIVES. 22 This division relates to the dispensing of self-administered 23 hormonal contraceptives by a pharmacist. The division 24 defines “self-administered hormonal contraceptive” as a 25 self-administered hormonal contraceptive that is approved by 26 the United States food and drug administration to prevent 27 pregnancy, including an oral hormonal contraceptive, a hormonal 28 vaginal ring, and a hormonal contraceptive patch, but not 29 including any drug intended to induce an abortion. 30 The division provides that notwithstanding any provision 31 of law to the contrary, a pharmacist may dispense a 32 self-administered hormonal contraceptive to a patient who 33 is at least 18 years of age pursuant to a standing order 34 established by the medical director of HHS (medical director). 35 -17- LSB 1511HV (2) 90 pf/rh 17/ 22

H.F. 427 For an initial dispensing, a pharmacist may dispense only up 1 to a three-month supply at one time of the self-administered 2 hormonal contraceptive, and for any subsequent dispensing 3 of the same self-administered hormonal contraceptive, a 4 12-month supply at one time. Additionally, the division 5 prohibits a pharmacist who dispenses a self-administered 6 hormonal contraceptive in accordance with the division from 7 requiring any other prescription drug order authorized by a 8 practitioner prior to dispensing the self-administered hormonal 9 contraceptive. 10 The division authorizes the medical director to establish a 11 standing order authorizing the dispensing of self-administered 12 hormonal contraceptives by any pharmacist who complies with the 13 standing order and retains and submits the patient’s record to 14 HHS. 15 The standing order includes requiring a pharmacist who 16 dispenses a self-administered hormonal contraceptive under the 17 division to: complete a standardized training program and 18 continuing education requirements related to prescribing the 19 hormonal contraceptives; obtain a completed self-screening risk 20 assessment from each patient, verify the identity and age of 21 each patient, and perform a blood pressure screening on each 22 patient before dispensing the hormonal contraceptives; provide 23 the patient with certain written information; provide the 24 patient with a copy of the record of the pharmacist’s encounter 25 with the patient; and provide patient counseling. 26 The standing order would prohibit a pharmacist who dispenses 27 hormonal contraceptives under the division from requiring a 28 patient to schedule an appointment with the pharmacist for 29 the prescribing or dispensing of the hormonal contraceptive; 30 dispensing the hormonal contraceptives to a patient for more 31 than 27 months after the date initially dispensed without the 32 patient’s attestation that the patient has consulted with a 33 practitioner during the preceding 27 months; and dispensing 34 the hormonal contraceptives to a patient if the results of the 35 -18- LSB 1511HV (2) 90 pf/rh 18/ 22

H.F. 427 patient’s self-screening risk assessment indicate it is unsafe 1 for the pharmacist to dispense the hormonal contraceptives 2 to the patient, in which case the pharmacist shall refer the 3 patient to a practitioner. 4 The division provides immunity for a pharmacist who 5 dispenses a self-administered hormonal contraceptive and 6 for the medical director who establishes a standing order 7 in compliance with the division from criminal and civil 8 liability arising from any damages caused by the dispensing, 9 administering, or use of a self-administered hormonal 10 contraceptive or the establishment of the standing order. 11 Additionally, the medical director shall be considered to be 12 acting within the scope of the medical director’s office and 13 employment for purposes of Code chapter 669 (Iowa tort claims 14 Act) in the establishment of a standing order in compliance 15 with the division. 16 The division requires HHS, in collaboration with the 17 boards of pharmacy and medicine, and in consideration of 18 the guidelines established by the American congress of 19 obstetricians and gynecologists, to adopt administrative rules 20 to administer the provisions of the division. 21 The division amends prescription contraceptive coverage 22 provisions to require that a group policy, contract, or plan 23 delivered, issued for delivery, continued, or renewed in the 24 state on or after January 1, 2024, providing for third-party 25 payment or prepayment of health or medical expenses, shall 26 specifically provide for payment of self-administered hormonal 27 contraceptives, prescribed and dispensed as specified in the 28 division, including those dispensed at one time. The division 29 provides, however, that the provisions relating to coverage are 30 not to be construed to require a third-party payor to provide 31 payment to a practitioner for dispensing a self-administered 32 hormonal contraceptive to replace a self-administered 33 hormonal contraceptive that has been dispensed to a covered 34 person and that has been misplaced, stolen, or destroyed. 35 -19- LSB 1511HV (2) 90 pf/rh 19/ 22