House Study Bill 91 - Introduced SENATE/HOUSE FILE _____ BY (PROPOSED GOVERNOR BILL) A BILL FOR An Act relating to the health and well-being of children and 1 families including provisions for rural emergency hospitals, 2 regional centers of excellence, noneconomic damage awards 3 against health care providers, a state-funded family 4 medicine obstetrical fellowship program, self-administered 5 hormonal contraceptives, review and approval of and public 6 policy considerations relating to insurance benefits, 7 maternal support and fatherhood initiatives, state employee 8 parental leave, modification of property tax provisions for 9 certain commercial child care properties, adoption expenses 10 under the adoption subsidy program, and accessibility to the 11 all Iowa scholarship program; providing for appropriations, 12 fines, and penalties; and including effective date and 13 applicability and retroactive applicability provisions. 14 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 15 TLSB 1511XL (14) 90 pf/rh

S.F. _____ H.F. _____ DIVISION I 1 RURAL EMERGENCY HOSPITALS 2 Section 1. Section 135B.1, Code 2023, is amended by adding 3 the following new subsections: 4 NEW SUBSECTION . 5. “Rural emergency hospital” means a 5 facility that provides rural emergency hospital services in 6 the facility twenty-four hours per day, seven days per week; 7 does not provide any acute care inpatient services with the 8 exception of any distinct part of the facility licensed as a 9 skilled nursing facility providing posthospital extended care 10 services; and meets the criteria specified in section 135B.1A 11 and the federal Consolidated Appropriations Act, Pub. L. No. 12 116-260, §125. 13 NEW SUBSECTION . 6. “Rural emergency hospital services” 14 means the following services provided by a rural emergency 15 hospital that do not exceed an annual per patient average of 16 twenty-four hours in such a rural emergency hospital: 17 a. Emergency department services and observation care. 18 For purposes of providing emergency department services, an 19 emergency department of a rural emergency hospital shall 20 be considered staffed if a physician, nurse practitioner, 21 clinical nurse specialist, or physician assistant is available 22 to furnish rural emergency hospital services in the facility 23 twenty-four hours per day. 24 b. At the election of the rural emergency hospital, with 25 respect to services furnished on an outpatient basis, other 26 medical and health services as specified in regulations adopted 27 by the United States secretary of health and human services. 28 Sec. 2. Section 135B.2, Code 2023, is amended to read as 29 follows: 30 135B.2 Purpose. 31 The purpose of this chapter is to provide for the 32 development, establishment and enforcement of basic standards 33 for the care and treatment of individuals in hospitals and 34 rural emergency hospitals and for the construction, maintenance 35 -1- LSB 1511XL (14) 90 pf/rh 1/ 44

S.F. _____ H.F. _____ and operation of such hospitals, which, in the light of 1 existing knowledge, will promote safe and adequate treatment 2 of such individuals in such hospitals, in the interest of the 3 health, welfare and safety of the public. 4 Sec. 3. Section 135B.3, Code 2023, is amended to read as 5 follows: 6 135B.3 Licensure. 7 No person or governmental unit, acting severally or jointly 8 with any other person or governmental unit shall establish, 9 conduct or maintain a hospital or rural emergency hospital in 10 this state without a license. 11 Sec. 4. NEW SECTION . 135B.3A Rural emergency hospital 12 licensure. 13 1. The department shall adopt rules pursuant to chapter 14 17A to establish minimum standards for the licensure of rural 15 emergency hospitals consistent with the federal Consolidated 16 Appropriations Act, Pub. L. No. 116-260, §125, and with 17 regulations issued by the United States secretary of health and 18 human services for rural emergency hospitals. 19 2. To be eligible for a rural emergency hospital license, a 20 facility shall have been, on or before December 27, 2020, one 21 of the following: 22 a. A licensed critical access hospital. 23 b. A general hospital with not more than fifty licensed 24 beds located in a county in a rural area as defined in section 25 1886(d)(2)(D) of the federal Social Security Act. 26 c. A general hospital with no more than fifty licensed beds 27 that is deemed as being located in a rural area pursuant to 28 section 1886(d)(8)(E) of the federal Social Security Act. 29 Sec. 5. Section 135B.4, Code 2023, is amended to read as 30 follows: 31 135B.4 Application for license. 32 Licenses shall be obtained from the department. 33 Applications shall be upon forms and shall contain information 34 as the department may reasonably require, which may include 35 -2- LSB 1511XL (14) 90 pf/rh 2/ 44

S.F. _____ H.F. _____ affirmative evidence of ability to comply with reasonable 1 standards and rules prescribed under this chapter . Each 2 application for license shall be accompanied by the license 3 fee, which shall be refunded to the applicant if the license 4 is denied and which shall be deposited into the state treasury 5 and credited to the general fund if the license is issued. 6 Hospitals and rural emergency hospitals having fifty beds or 7 less shall pay an initial license fee of fifteen dollars; 8 hospitals of more than fifty beds and not more than one hundred 9 beds shall pay an initial license fee of twenty-five dollars; 10 all other hospitals shall pay an initial license fee of fifty 11 dollars. 12 Sec. 6. Section 135B.5, subsection 1, Code 2023, is amended 13 to read as follows: 14 1. Upon receipt of an application for license and the 15 license fee, the department shall issue a license if the 16 applicant and hospital facilities comply with this chapter , 17 chapter 135 , and the rules of the department. Each licensee 18 shall receive annual reapproval upon payment of five hundred 19 dollars and upon filing of an application form which is 20 available from the department. The annual licensure fee shall 21 be dedicated to support and provide educational programs on 22 regulatory issues for hospitals and rural emergency hospitals 23 licensed under this chapter . Licenses shall be either general 24 or restricted in form. Each license shall be issued only 25 for the premises and persons or governmental units named in 26 the application and is not transferable or assignable except 27 with the written approval of the department. Licenses shall 28 be posted in a conspicuous place on the licensed premises as 29 prescribed by rule of the department. 30 Sec. 7. Section 135B.5A, Code 2023, is amended to read as 31 follows: 32 135B.5A Conversion of a hospital relative to certain 33 hospitals . 34 1. A conversion of a long-term acute care hospital, 35 -3- LSB 1511XL (14) 90 pf/rh 3/ 44

S.F. _____ H.F. _____ rehabilitation hospital, or psychiatric hospital as defined by 1 federal regulations to a general hospital or to a specialty 2 hospital of a different type is a permanent change in bed 3 capacity and shall require a certificate of need pursuant to 4 section 135.63 . 5 2. A conversion of a critical access hospital or general 6 hospital to a rural emergency hospital or a conversion of a 7 rural emergency hospital to a critical access hospital or 8 general hospital shall not require a certificate of need 9 pursuant to section 135.63. 10 Sec. 8. Section 135B.7, Code 2023, is amended to read as 11 follows: 12 135B.7 Rules and enforcement. 13 1. a. The department, with the approval of the state 14 board of health, shall adopt rules setting out the standards 15 for the different types of hospitals and for rural emergency 16 hospitals to be licensed under this chapter . The department 17 shall enforce the rules. 18 b. Rules or standards shall not be adopted or enforced 19 which would have the effect of denying a license to a hospital , 20 rural emergency hospital, or other institution required to be 21 licensed, solely by reason of the school or system of practice 22 employed or permitted to be employed by physicians in the 23 hospital, rural emergency hospital, or other institution if the 24 school or system of practice is recognized by the laws of this 25 state. 26 2. a. The rules shall state that a hospital or rural 27 emergency hospital shall not deny clinical privileges to 28 physicians and surgeons, podiatric physicians, osteopathic 29 physicians and surgeons, dentists, certified health service 30 providers in psychology, physician assistants, or advanced 31 registered nurse practitioners licensed under chapter 148 , 32 148C , 149 , 152 , or 153 , or section 154B.7 , solely by reason of 33 the license held by the practitioner or solely by reason of 34 the school or institution in which the practitioner received 35 -4- LSB 1511XL (14) 90 pf/rh 4/ 44

S.F. _____ H.F. _____ medical schooling or postgraduate training if the medical 1 schooling or postgraduate training was accredited by an 2 organization recognized by the council on higher education 3 accreditation or an accrediting group recognized by the United 4 States department of education. 5 b. A hospital or rural emergency hospital may establish 6 procedures for interaction between a patient and a 7 practitioner. The rules shall not prohibit a hospital or 8 rural emergency hospital from limiting, restricting, or 9 revoking clinical privileges of a practitioner for violation 10 of hospital rules, regulations, or procedures established 11 under this paragraph, when applied in good faith and in a 12 nondiscriminatory manner. 13 c. This subsection shall not require a hospital or rural 14 emergency hospital to expand the hospital’s current scope of 15 service delivery solely to offer the services of a class of 16 providers not currently providing services at the hospital 17 or rural emergency hospital . This section shall not be 18 construed to require a hospital or rural emergency hospital 19 to establish rules which are inconsistent with the scope of 20 practice established for licensure of practitioners to whom 21 this subsection applies. 22 d. This section shall not be construed to authorize the 23 denial of clinical privileges to a practitioner or class of 24 practitioners solely because a hospital or rural emergency 25 hospital has as employees of the hospital or rural emergency 26 hospital identically licensed practitioners providing the same 27 or similar services. 28 3. The rules shall require that a hospital or rural 29 emergency hospital establish and implement written criteria 30 for the granting of clinical privileges. The written criteria 31 shall include but are not limited to consideration of all of 32 the following: 33 a. The ability of an applicant for privileges to provide 34 patient care services independently and appropriately in the 35 -5- LSB 1511XL (14) 90 pf/rh 5/ 44

S.F. _____ H.F. _____ hospital or rural emergency hospital . 1 b. The license held by the applicant to practice. 2 c. The training, experience, and competence of the 3 applicant. 4 d. The relationship between the applicant’s request for the 5 granting of privileges and the hospital’s or rural emergency 6 hospital’s current scope of patient care services, as well as 7 the hospital’s or rural emergency hospital’s determination of 8 the necessity to grant privileges to a practitioner authorized 9 to provide comprehensive, appropriate, and cost-effective 10 services. 11 4. The department shall also adopt rules requiring 12 hospitals and rural emergency hospitals to establish and 13 implement protocols for responding to the needs of patients who 14 are victims of domestic abuse, as defined in section 236.2 . 15 5. The department shall also adopt rules requiring 16 hospitals and rural emergency hospitals to establish and 17 implement protocols for responding to the needs of patients who 18 are victims of elder abuse, as defined in section 235F.1 . 19 Sec. 9. Section 135B.7A, Code 2023, is amended to read as 20 follows: 21 135B.7A Procedures —— orders. 22 The department shall adopt rules that require hospitals 23 and rural emergency hospitals to establish procedures for 24 authentication of all verbal orders by a practitioner within 25 a period not to exceed thirty days following a patient’s 26 discharge. 27 Sec. 10. Section 135B.8, Code 2023, is amended to read as 28 follows: 29 135B.8 Effective date of rules. 30 Any hospital or rural emergency hospital which is in 31 operation at the time of promulgation of any applicable 32 rules or minimum standards under this chapter shall be given 33 a reasonable time, not to exceed one year from the date of 34 such promulgation, within which to comply with such rules and 35 -6- LSB 1511XL (14) 90 pf/rh 6/ 44

S.F. _____ H.F. _____ minimum standards. 1 Sec. 11. Section 135B.9, Code 2023, is amended to read as 2 follows: 3 135B.9 Inspections and qualifications for hospital and rural 4 emergency hospital inspectors —— protection and advocacy agency 5 investigations. 6 1. The department shall make or cause to be made inspections 7 as it deems necessary in order to determine compliance with 8 applicable rules. Hospital and rural emergency hospital 9 inspectors shall meet the following qualifications: 10 a. Be free of conflicts of interest. A hospital or rural 11 emergency hospital inspector shall not participate in an 12 inspection or complaint investigation of a hospital or rural 13 emergency hospital in which the inspector or a member of the 14 inspector’s immediate family works or has worked within the 15 last two years. For purposes of this paragraph, “immediate 16 family member” means a spouse; natural or adoptive parent, 17 child, or sibling; or stepparent, stepchild, or stepsibling. 18 b. Complete a yearly conflict of interest disclosure 19 statement. 20 c. Biennially, complete a minimum of ten hours of continuing 21 education pertaining to hospital or rural emergency hospital 22 operations including but not limited to quality and process 23 improvement standards, trauma system standards, and regulatory 24 requirements. 25 2. In the state resource centers and state mental health 26 institutes operated by the department of human services, the 27 designated protection and advocacy agency as provided in 28 section 135C.2, subsection 4 , shall have the authority to 29 investigate all complaints of abuse and neglect of persons 30 with developmental disabilities or mental illnesses if the 31 complaints are reported to the protection and advocacy agency 32 or if there is probable cause to believe that the abuse has 33 occurred. Such authority shall include the examination of all 34 records pertaining to the care provided to the residents and 35 -7- LSB 1511XL (14) 90 pf/rh 7/ 44

S.F. _____ H.F. _____ contact or interview with any resident, employee, or any other 1 person who might have knowledge about the operation of the 2 institution. 3 Sec. 12. Section 135B.12, Code 2023, is amended to read as 4 follows: 5 135B.12 Confidentiality. 6 The department’s final findings or the final survey findings 7 of the joint commission on the accreditation of health care 8 organizations or the American osteopathic association with 9 respect to compliance by a hospital or rural emergency hospital 10 with requirements for licensing or accreditation shall be made 11 available to the public in a readily available form and place. 12 Other information relating to a hospital or rural emergency 13 hospital obtained by the department which does not constitute 14 the department’s findings from an inspection of the hospital 15 or rural emergency hospital or the final survey findings of 16 the joint commission on the accreditation of health care 17 organizations or the American osteopathic association shall 18 not be made available to the public, except in proceedings 19 involving the denial, suspension, or revocation of a license 20 under this chapter . The name of a person who files a complaint 21 with the department shall remain confidential and shall not 22 be subject to discovery, subpoena, or other means of legal 23 compulsion for its release to a person other than department 24 employees or agents involved in the investigation of the 25 complaint. 26 Sec. 13. Section 135B.14, Code 2023, is amended to read as 27 follows: 28 135B.14 Judicial review. 29 Judicial review of the action of the department may be sought 30 in accordance with chapter 17A . Notwithstanding the terms of 31 chapter 17A , the Iowa administrative procedure Act, petitions 32 for judicial review may be filed in the district court of the 33 county in which the hospital or rural emergency hospital is 34 located or to be located, and the status quo of the petitioner 35 -8- LSB 1511XL (14) 90 pf/rh 8/ 44

S.F. _____ H.F. _____ or licensee shall be preserved pending final disposition of the 1 matter in the courts. 2 Sec. 14. Section 135B.15, Code 2023, is amended to read as 3 follows: 4 135B.15 Penalties. 5 Any person establishing, conducting, managing, or operating 6 any hospital or rural emergency hospital without a license 7 shall be guilty of a serious misdemeanor, and each day of 8 continuing violation after conviction shall be considered a 9 separate offense. 10 Sec. 15. Section 135B.16, Code 2023, is amended to read as 11 follows: 12 135B.16 Injunction. 13 Notwithstanding the existence or pursuit of any other 14 remedy, the department may, in the manner provided by law, 15 maintain an action in the name of the state for injunction 16 or other process against any person or governmental unit to 17 restrain or prevent the establishment, conduct, management or 18 operation of a hospital or rural emergency hospital without a 19 license. 20 Sec. 16. Section 135B.20, subsection 3, Code 2023, is 21 amended to read as follows: 22 3. “Hospital” shall mean means all hospitals and rural 23 emergency hospitals licensed under this chapter . 24 Sec. 17. Section 135B.33, subsection 1, unnumbered 25 paragraph 1, Code 2023, is amended to read as follows: 26 Subject to availability of funds, the Iowa department of 27 public health shall provide technical planning assistance to 28 local boards of health and hospital or rural emergency hospital 29 governing boards to ensure access to hospital such services in 30 rural areas. The department shall encourage the local boards 31 of health and hospital or rural emergency hospital governing 32 boards to adopt a long-term community health services and 33 developmental plan including the following: 34 Sec. 18. Section 135B.34, subsection 7, Code 2023, is 35 -9- LSB 1511XL (14) 90 pf/rh 9/ 44

S.F. _____ H.F. _____ amended to read as follows: 1 7. For the purposes of this section , “comprehensive 2 preliminary background check” : 3 a. “Comprehensive preliminary background check” means the 4 same as defined in section 135C.1 . 5 b. “Hospital” means a hospital or rural emergency hospital 6 licensed under this chapter. 7 Sec. 19. EMERGENCY RULEMAKING AUTHORITY. The department of 8 inspections and appeals may adopt emergency rules under section 9 17A.4, subsection 3, and section 17A.5, subsection 2, paragraph 10 “b”, to implement the provisions of this division of this Act 11 and the rules shall be effective immediately upon filing unless 12 a later date is specified in the rules. Any rules adopted 13 in accordance with this section shall also be published as a 14 notice of intended action as provided in section 17A.4. 15 Sec. 20. EFFECTIVE DATE. This division of this Act, being 16 deemed of immediate importance, takes effect upon enactment. 17 DIVISION II 18 REGIONAL CENTERS OF EXCELLENCE GRANT PROGRAM 19 Sec. 21. REGIONAL CENTERS OF EXCELLENCE PROGRAM —— GRANTS —— 20 APPROPRIATION. There is appropriated from the general fund of 21 the state to the department of health and human services for 22 the fiscal year beginning July 1, 2023, and ending June 30, 23 2024, the following amount, or so much thereof as is necessary, 24 to be used for the purposes designated: 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,000,000 26 The funds appropriated in this section shall be used for 27 the continuation of a center of excellence program to award 28 four grants to encourage innovation and collaboration among 29 regional health care providers in a rural area based upon the 30 results of a regional community needs assessment to transform 31 health care delivery in order to provide quality, sustainable 32 care that meets the needs of the local communities. An 33 applicant for the grant funds shall specify how the funds will 34 be expended to accomplish the goals of the program and shall 35 -10- LSB 1511XL (14) 90 pf/rh 10/ 44

S.F. _____ H.F. _____ provide a detailed five-year sustainability plan prior to being 1 awarded any funding. Following the receipt of grant funding, 2 a recipient shall submit periodic reports as specified by the 3 department to the governor and the general assembly regarding 4 the recipient’s expenditure of the funds and progress in 5 accomplishing the program’s goals. 6 DIVISION III 7 NONECONOMIC DAMAGE AWARDS AGAINST HEALTH CARE PROVIDERS 8 Sec. 22. Section 147.136A, subsection 1, paragraph b, Code 9 2023, is amended to read as follows: 10 b. (1) “Noneconomic damages” means damages arising from 11 pain, suffering, inconvenience, physical impairment, mental 12 anguish, emotional pain and suffering, loss of chance, loss of 13 consortium, or any other nonpecuniary damages. 14 (2) “Noneconomic damages” does not include the loss of 15 dependent care, including the loss of child care, due to the 16 death of or severe injury to a spouse or parent who is the 17 primary caregiver of a child under the age of eighteen or a 18 disabled adult. Such damages shall be considered economic 19 damages. 20 Sec. 23. Section 147.136A, subsection 2, Code 2023, is 21 amended to read as follows: 22 2. The total amount recoverable in any civil action for 23 noneconomic damages for personal injury or death, whether in 24 tort, contract, or otherwise, against a health care provider 25 shall be limited to two hundred fifty thousand dollars for any 26 occurrence resulting in injury or death of a patient regardless 27 of the number of plaintiffs, derivative claims, theories of 28 liability, or defendants in the civil action, shall not exceed 29 two hundred fifty thousand dollars unless the jury determines 30 that there is a substantial or permanent loss or impairment of 31 a bodily function, substantial disfigurement, or death, which 32 warrants a finding that imposition of such a limitation would 33 deprive the plaintiff of just compensation for the injuries 34 sustained , in which case the amount recoverable shall not 35 -11- LSB 1511XL (14) 90 pf/rh 11/ 44

S.F. _____ H.F. _____ exceed one million dollars . 1 Sec. 24. EFFECTIVE DATE. This division of this Act, being 2 deemed of immediate importance, takes effect upon enactment. 3 Sec. 25. APPLICABILITY. This division of this Act applies 4 to causes of actions accrued on or after the effective date of 5 this Act. 6 DIVISION IV 7 STATE-FUNDED FAMILY MEDICINE OBSTETRICS FELLOWSHIP PROGRAM 8 Sec. 26. NEW SECTION . 135.182 State-funded family medicine 9 obstetrics fellowship program —— fund. 10 1. The department shall establish a family medicine 11 obstetrics fellowship program to increase access to family 12 medicine obstetrics practitioners in rural and underserved 13 areas of the state. A person who has completed an 14 accreditation council for graduate medical education residency 15 program in family medicine is eligible for participation 16 in the fellowship program. Participating fellows shall 17 enter into a program agreement with a participating teaching 18 hospital which, at a minimum, requires the fellow to complete a 19 one-year fellowship and to engage in full-time family medicine 20 obstetrics practice in a rural or underserved area of the 21 state for a period of at least five years within nine months 22 following completion of the fellowship and receipt of a license 23 to practice medicine in the state. 24 2. Each fellow participating in the program shall be 25 eligible for a salary and benefits including a stipend as 26 determined by the participating teaching hospital which shall 27 be funded through the family medicine obstetrics fellowship 28 program fund. 29 3. The department shall adopt rules pursuant to chapter 30 17A to administer the program, including defining rural and 31 underserved areas for the purpose of the required full-time 32 practice of a person following completion of the fellowship. 33 4. a. A family medicine obstetrics fellowship program 34 fund is created in the state treasury consisting of the moneys 35 -12- LSB 1511XL (14) 90 pf/rh 12/ 44

S.F. _____ H.F. _____ appropriated or credited to the fund by law. Notwithstanding 1 section 8.33, moneys in the fund at the end of each fiscal year 2 shall not revert to any other fund but shall remain in the fund 3 for use in subsequent fiscal years. Moneys in the fund are 4 appropriated to the department to be used to fund fellowship 5 positions as provided in this section. 6 b. For the fiscal year beginning July 1, 2023, and each 7 fiscal year beginning July 1 thereafter, there is appropriated 8 from the general fund of the state to the family medicine 9 obstetrics fellowship program fund an amount sufficient to 10 support the creation of four fellowship positions as provided 11 in this section. 12 5. The department and the participating teaching hospitals 13 shall regularly evaluate and document their experiences 14 including identifying ways the program may be modified or 15 expanded to facilitate increased access to family medicine 16 obstetrics practitioners in rural and underserved areas of the 17 state. The department shall submit an annual report to the 18 general assembly by January 1. The report shall include the 19 number of fellowships funded to date and any other information 20 identified by the department and the participating teaching 21 hospitals as indicators of outcomes and the effectiveness of 22 the program. 23 6. For the purposes of this section, “teaching hospital” 24 means a hospital or medical center that provides medical 25 education to prospective and current health professionals. 26 Sec. 27. STATE-FUNDED FAMILY MEDICINE OBSTETRICS FELLOWSHIP 27 PROGRAM AND FUND —— APPROPRIATION. There is appropriated from 28 the general fund of the state to the department of health and 29 human services for the fiscal year beginning July 1, 2023, and 30 ending June 30, 2024, the following amount, or so much thereof 31 as is necessary, to be used for the purposes designated: 32 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 560,000 33 For deposit in the family medicine obstetrics fellowship 34 program fund to be utilized in creating and providing for four 35 -13- LSB 1511XL (14) 90 pf/rh 13/ 44

S.F. _____ H.F. _____ family medicine obstetrics fellowship positions during the 1 fiscal year in accordance with the family medicine obstetrics 2 fellowship program created in this division of this Act. 3 DIVISION V 4 SELF-ADMINISTERED HORMONAL CONTRACEPTIVES 5 Sec. 28. Section 155A.3, Code 2023, is amended by adding the 6 following new subsections: 7 NEW SUBSECTION . 10A. “Department” means the department of 8 health and human services. 9 NEW SUBSECTION . 45A. “Self-administered hormonal 10 contraceptive” means a self-administered hormonal contraceptive 11 that is approved by the United States food and drug 12 administration to prevent pregnancy. “Self-administered 13 hormonal contraceptive” includes an oral hormonal contraceptive, 14 a hormonal vaginal ring, and a hormonal contraceptive patch, 15 but does not include any drug intended to induce an abortion as 16 defined in section 146.1. 17 NEW SUBSECTION . 45B. “Standing order” means a preauthorized 18 medication order with specific instructions from the medical 19 director of the department to dispense a medication under 20 clearly defined circumstances. 21 Sec. 29. NEW SECTION . 155A.49 Pharmacist dispensing of 22 self-administered hormonal contraceptives —— standing order —— 23 requirements —— limitations of liability. 24 1. a. Notwithstanding any provision of law to the contrary, 25 a pharmacist may dispense a self-administered hormonal 26 contraceptive to a patient who is at least eighteen years of 27 age, pursuant to a standing order established by the medical 28 director of the department in accordance with this section. 29 b. In dispensing a self-administered hormonal contraceptive 30 to a patient under this section, a pharmacist shall comply with 31 all of the following: 32 (1) For an initial dispensing of a self-administered 33 hormonal contraceptive, the pharmacist may dispense only up 34 to a three-month supply at one time of the self-administered 35 -14- LSB 1511XL (14) 90 pf/rh 14/ 44

S.F. _____ H.F. _____ hormonal contraceptive. 1 (2) For any subsequent dispensing of the same 2 self-administered hormonal contraceptive, the pharmacist 3 may dispense up to a twelve-month supply at one time of the 4 self-administered hormonal contraceptive. 5 2. A pharmacist who dispenses a self-administered hormonal 6 contraceptive in accordance with this section shall not 7 require any other prescription drug order authorized by a 8 practitioner prior to dispensing the self-administered hormonal 9 contraceptive to a patient. 10 3. The medical director of the department may establish a 11 standing order authorizing the dispensing of self-administered 12 hormonal contraceptives by a pharmacist who does all of the 13 following: 14 a. Complies with the standing order established pursuant to 15 this section. 16 b. Retains a record of each patient to whom a 17 self-administered hormonal contraceptive is dispensed under 18 this section and submits the record to the department. 19 4. The standing order shall require a pharmacist who 20 dispenses self-administered hormonal contraceptives under this 21 section to do all of the following: 22 a. Complete a standardized training program and continuing 23 education requirements approved by the board in consultation 24 with the board of medicine and the department that are related 25 to prescribing self-administered hormonal contraceptives and 26 include education regarding all contraceptive methods approved 27 by the United States food and drug administration. 28 b. Obtain a completed self-screening risk assessment, 29 approved by the department in collaboration with the board and 30 the board of medicine, from each patient, verify the identity 31 and age of each patient, and perform a blood pressure screening 32 on each patient prior to dispensing the self-administered 33 hormonal contraceptive to the patient. 34 c. Provide the patient with all of the following: 35 -15- LSB 1511XL (14) 90 pf/rh 15/ 44

S.F. _____ H.F. _____ (1) Written information regarding all of the following: 1 (a) The importance of completing an appointment with the 2 patient’s primary care or women’s health care practitioner 3 to obtain preventative care, including but not limited to 4 recommended tests and screenings. 5 (b) The effectiveness and availability of long-acting 6 reversible contraceptives as an alternative to 7 self-administered hormonal contraceptives. 8 (2) A copy of the record of the pharmacist’s encounter with 9 the patient that includes all of the following: 10 (a) The patient’s completed self-screening risk assessment. 11 (b) A description of the contraceptive dispensed, or the 12 basis for not dispensing a contraceptive. 13 (3) Patient counseling regarding all of the following: 14 (a) The appropriate administration and storage of the 15 self-administered hormonal contraceptive. 16 (b) Potential side effects and risks of the 17 self-administered hormonal contraceptive. 18 (c) The need for backup contraception. 19 (d) When to seek emergency medical attention. 20 (e) The risk of contracting a sexually transmitted 21 infection or disease, and ways to reduce such a risk. 22 5. The standing order established pursuant to this section 23 shall prohibit a pharmacist who dispenses a self-administered 24 hormonal contraceptive under this section from doing any of the 25 following: 26 a. Requiring a patient to schedule an appointment with 27 the pharmacist for the prescribing or dispensing of a 28 self-administered hormonal contraceptive. 29 b. Dispensing self-administered hormonal contraceptives 30 to a patient for more than twenty-seven months after the 31 date a self-administered hormonal contraceptive is initially 32 dispensed to the patient, if the patient has not consulted with 33 a primary care or women’s health care practitioner during the 34 preceding twenty-seven months, in which case the pharmacist 35 -16- LSB 1511XL (14) 90 pf/rh 16/ 44

S.F. _____ H.F. _____ shall refer the patient to a primary care or women’s health 1 care practitioner. 2 c. Dispensing a self-administered hormonal contraceptive to 3 a patient if the results of the self-screening risk assessment 4 completed by a patient pursuant to subsection 4, paragraph 5 “b” , indicate it is unsafe for the pharmacist to dispense the 6 self-administered hormonal contraceptive to the patient, in 7 which case the pharmacist shall refer the patient to a primary 8 care or women’s health care practitioner. 9 6. A pharmacist who dispenses a self-administered hormonal 10 contraceptive and the medical director of the department who 11 establishes a standing order in compliance with this section 12 shall be immune from criminal and civil liability arising 13 from any damages caused by the dispensing, administering, 14 or use of a self-administered hormonal contraceptive or the 15 establishment of the standing order. The medical director of 16 the department shall be considered to be acting within the 17 scope of the medical director’s office and employment for 18 purposes of chapter 669 in the establishment of a standing 19 order in compliance with this section. 20 7. The department, in collaboration with the board and 21 the board of medicine, and in consideration of the guidelines 22 established by the American congress of obstetricians and 23 gynecologists, shall adopt rules pursuant to chapter 17A to 24 administer this chapter. 25 Sec. 30. Section 514C.19, Code 2023, is amended to read as 26 follows: 27 514C.19 Prescription contraceptive coverage. 28 1. Notwithstanding the uniformity of treatment requirements 29 of section 514C.6 , a group policy , or contract , or plan 30 providing for third-party payment or prepayment of health or 31 medical expenses shall not do either of the following comply 32 as follows : 33 a. Exclude Such policy, contract, or plan shall not 34 exclude or restrict benefits for prescription contraceptive 35 -17- LSB 1511XL (14) 90 pf/rh 17/ 44

S.F. _____ H.F. _____ drugs or prescription contraceptive devices which prevent 1 conception and which are approved by the United States 2 food and drug administration, or generic equivalents 3 approved as substitutable by the United States food and 4 drug administration, if such policy , or contract , or plan 5 provides benefits for other outpatient prescription drugs 6 or devices. However, such policy, contract, or plan shall 7 specifically provide for payment of a self-administered 8 hormonal contraceptive, as prescribed by a practitioner as 9 defined in section 155A.3, or as prescribed by standing order 10 and dispensed by a pharmacist pursuant to section 155A.49, 11 including payment for up to an initial three-month supply 12 of a self-administered hormonal contraceptive dispensed at 13 one time and for up to a twelve-month supply of the same 14 self-administered hormonal contraceptive subsequently dispensed 15 at one time. 16 b. Exclude Such policy, contract, or plan shall not exclude 17 or restrict benefits for outpatient contraceptive services 18 which are provided for the purpose of preventing conception if 19 such policy , or contract , or plan provides benefits for other 20 outpatient services provided by a health care professional. 21 2. A person who provides a group policy , or contract , or 22 plan providing for third-party payment or prepayment of health 23 or medical expenses which is subject to subsection 1 shall not 24 do any of the following: 25 a. Deny to an individual eligibility, or continued 26 eligibility, to enroll in or to renew coverage under the terms 27 of the policy , or contract , or plan because of the individual’s 28 use or potential use of such prescription contraceptive drugs 29 or devices, or use or potential use of outpatient contraceptive 30 services. 31 b. Provide a monetary payment or rebate to a covered 32 individual to encourage such individual to accept less than the 33 minimum benefits provided for under subsection 1 . 34 c. Penalize or otherwise reduce or limit the reimbursement 35 -18- LSB 1511XL (14) 90 pf/rh 18/ 44

S.F. _____ H.F. _____ of a health care professional because such professional 1 prescribes contraceptive drugs or devices, or provides 2 contraceptive services. 3 d. Provide incentives, monetary or otherwise, to a health 4 care professional to induce such professional to withhold 5 from a covered individual contraceptive drugs or devices, or 6 contraceptive services. 7 3. This section shall not be construed to prevent a 8 third-party payor from including deductibles, coinsurance, or 9 copayments under the policy , or contract, or plan as follows: 10 a. A deductible, coinsurance, or copayment for benefits 11 for prescription contraceptive drugs shall not be greater than 12 such deductible, coinsurance, or copayment for any outpatient 13 prescription drug for which coverage under the policy , or 14 contract , or plan is provided. 15 b. A deductible, coinsurance, or copayment for benefits for 16 prescription contraceptive devices shall not be greater than 17 such deductible, coinsurance, or copayment for any outpatient 18 prescription device for which coverage under the policy , or 19 contract , or plan is provided. 20 c. A deductible, coinsurance, or copayment for benefits for 21 outpatient contraceptive services shall not be greater than 22 such deductible, coinsurance, or copayment for any outpatient 23 health care services for which coverage under the policy , or 24 contract , or plan is provided. 25 4. This section shall not be construed to require a 26 third-party payor under a policy , or contract , or plan 27 to provide benefits for experimental or investigational 28 contraceptive drugs or devices, or experimental or 29 investigational contraceptive services, except to the extent 30 that such policy , or contract , or plan provides coverage for 31 other experimental or investigational outpatient prescription 32 drugs or devices, or experimental or investigational outpatient 33 health care services. 34 5. This section shall not be construed to limit or otherwise 35 -19- LSB 1511XL (14) 90 pf/rh 19/ 44