S.F. 65 Section 1. NEW SECTION . 135.193 Health equity program —— 1 fund —— standing appropriation. 2 1. The department shall establish a health equity program 3 to improve menstrual and post-menstrual health by providing 4 for reimbursement of the costs associated with the provision 5 of covered services and treatments related to menstrual and 6 post-menstrual health conditions not otherwise covered by a 7 third-party payor. The department shall promote the program 8 statewide and shall limit program administrative costs to 9 no more than four percent of the funds appropriated for the 10 program on an annual basis. 11 2. a. The department shall adopt rules pursuant to chapter 12 17A to administer the program and to specify the types of 13 services and treatments covered under the program, informed by 14 evidence-based data from menstrual and post-menstrual health 15 experts including but not limited to those who practice in 16 the fields of obstetrics and gynecology, family practice, 17 internal medicine, and urology. The covered services and 18 treatments shall include but are not limited to hormone 19 treatments, urinary tract treatments, vaginal estrogens, nerve 20 therapies, and other services and treatments that alleviate 21 illness, injury, conditions, diseases or symptoms related to 22 periods, fibroids, endometriosis, perimenopause, menopause, 23 incontinence, atrophic vaginitis, and other hormone-related 24 conditions. 25 b. Covered services and treatments shall include health 26 care services, treatments, supplies, and drugs needed to treat 27 a menstrual or post-menstrual illness, injury, condition, 28 disease, or its symptoms that meet any of the following 29 criteria: 30 (1) Comply with standard medical practice. 31 (2) Are approved by the United States food and drug 32 administration including for off-label use when supported by 33 appropriate medical records. 34 (3) Are recommended or preferred by the patient’s provider 35 -1- LSB 1501XS (3) 90 pf/rh 1/ 5

S.F. 65 and supported by appropriate medical records. 1 3. The department shall establish a process for 2 registration of participating providers eligible to receive 3 reimbursement through the health equity program fund. A 4 health care provider shall be eligible for participation if 5 the provider is deemed qualified and in good standing by the 6 provider’s respective health-related profession board. 7 4. A participating provider shall be reimbursed for a 8 covered service or treatment through the health equity program 9 fund within ten days of submission of a billing statement. 10 If applicable, the billing statement shall confirm that the 11 patient is uninsured or that the service or treatment is not 12 covered by the patient’s insurer. 13 5. The amount billed by the participating provider shall 14 not exceed the actual cost incurred by the provider in 15 delivering the covered service or treatment. Reimbursement for 16 a covered service or treatment shall be paid directly to the 17 participating provider and such payment shall be considered 18 payment in full. The health equity program shall be the payor 19 of last resort. 20 6. If sufficient program funds are not available to 21 reimburse all billings submitted by participating providers, 22 the department shall place a participating provider on a 23 reimbursement waiting list in the order the participating 24 provider’s billing statement was received. 25 7. This section shall not be construed as granting an 26 entitlement to reimbursement for any covered service or 27 treatment provided by a participating provider. 28 8. a. A health equity program fund is created in the 29 state treasury under the control of the department. The fund 30 includes but is not limited to amounts appropriated by the 31 general assembly and other moneys available from federal or 32 private sources which are to be used for purposes of this 33 section. Notwithstanding section 8.33, funds remaining in 34 the fund at the end of each fiscal year shall not revert to 35 -2- LSB 1501XS (3) 90 pf/rh 2/ 5

S.F. 65 the general fund of the state but shall remain in the health 1 equity program fund. Moneys in the fund are appropriated to 2 the department for purposes of the health equity program. 3 b. There is appropriated from the general fund of the 4 state to the health equity program fund a sum which reflects 5 the total equivalent of all state revenue expended for 6 genitourinary agents for state employees under the group 7 insurance plan for public employees pursuant to chapter 509A, 8 between July 1, 2002, and June 30, 2022. 9 c. For the purposes of this subsection: 10 (1) “Genitourinary agents” means medicines used to treat 11 conditions of the reproductive organs and excretory system or 12 urinary tract. 13 (2) “Period products” includes but is not limited to 14 tampons, period pads, and period cups for use in connection 15 with the menstrual cycle. 16 8. The department shall submit an annual report to the 17 governor and the general assembly regarding the status of the 18 program and fund including the balance remaining in the fund, 19 the number of participating providers, the total amount billed 20 per participating provider, the covered services and treatments 21 for which reimbursement was provided in the previous year, and 22 any recommendations for changes to the program or fund. 23 Sec. 2. CODE EDITOR DIRECTIVE. The Code editor may 24 designate section 135.193, as enacted in this Act, as a new 25 subchapter within chapter 135, entitled “HEALTH EQUITY PROGRAM 26 AND FUND”. 27 EXPLANATION 28 The inclusion of this explanation does not constitute agreement with 29 the explanation’s substance by the members of the general assembly. 30 This bill requires the department of health and human 31 services (HHS) to establish a health equity program (program) 32 to improve menstrual and post-menstrual health by providing 33 for reimbursement of the costs associated with the provision 34 of covered services and treatments related to menstrual and 35 -3- LSB 1501XS (3) 90 pf/rh 3/ 5

S.F. 65 post-menstrual health conditions not otherwise covered by a 1 third-party payor. The department shall promote the program 2 statewide and limit program administrative costs to no more 3 than 4 percent of the funds appropriated for the program on an 4 annual basis. 5 The bill requires HHS to adopt administrative rules to 6 administer the program and specify the types of services and 7 treatments covered under the program, and requires that the 8 covered services and treatments shall include health care 9 services, treatments, supplies, and drugs needed to treat 10 a menstrual or post-menstrual illness, injury, condition, 11 disease, or its symptoms that comply with standard medical 12 practice, or are approved by the United States food and drug 13 administration or are recommended or preferred by the patient’s 14 provider and supported by appropriate medical records. 15 The department shall establish a process for the 16 registration of participating providers eligible to receive 17 reimbursement through the program. A participating provider 18 shall be reimbursed for a covered service or treatment through 19 the program fund within 10 days of submission of a billing 20 statement, and if applicable, the billing statement shall 21 confirm that the patient is uninsured or that the service or 22 treatment is not covered by the patient’s insurer. The amount 23 billed by the participating provider shall not exceed the 24 actual cost incurred by the provider in delivering the covered 25 service or treatment. Reimbursement shall be paid directly to 26 the participating provider and such payment shall be considered 27 payment in full. The program shall be the payor of last 28 resort. If sufficient program funds are not available to cover 29 all of the billings submitted, HHS shall place a participating 30 provider on a reimbursement waiting list in the order the 31 participating provider’s billing statement was received. 32 The provisions of the bill are not to be construed as 33 granting an entitlement to reimbursement for any covered 34 service or treatment provided by a participating provider. 35 -4- LSB 1501XS (3) 90 pf/rh 4/ 5

S.F. 65 The bill creates a health equity program fund under the 1 control of HHS. The fund includes amounts appropriated by the 2 general assembly and other moneys available from federal or 3 private sources. Moneys in the fund at the end of each fiscal 4 year shall not revert but remain in the fund. Moneys in the 5 fund are appropriated to HHS for the purposes of the program. 6 There is appropriated from the general fund of the state to 7 the program fund a sum which reflects the total equivalent of 8 all state revenue expended for genitourinary agents for state 9 employees under the group insurance plan for public employees 10 pursuant to Code chapter 509A, for the fiscal period between 11 July 1, 2002, and June 30, 2022. The department shall submit 12 an annual report to the governor and the general assembly 13 regarding the status of the program and fund including the 14 balance remaining in the fund, the number of participating 15 providers, the total amount billed per participating provider, 16 the covered services and treatments for which reimbursement 17 was provided in the previous year, and any recommendations for 18 changes to the program or fund. 19 The bill defines “genitourinary agents” and “period 20 products”. 21 -5- LSB 1501XS (3) 90 pf/rh 5/ 5