S.F. 91 Section 1. Section 29C.6, subsection 1, Code 2023, is 1 amended to read as follows: 2 1. a. After finding a disaster exists or is threatened, 3 proclaim a state of disaster emergency. This proclamation 4 shall be in writing, indicate the area affected and the facts 5 upon which it is based, be signed by the governor, and be 6 filed with the secretary of state. If the state of disaster 7 emergency specifically constitutes a public health disaster 8 as defined in section 135.140 , the written proclamation shall 9 include a statement to that effect. A state of disaster 10 emergency shall continue for thirty sixty days, unless sooner 11 terminated or rescinded, extended in writing , or amended by 12 the governor general assembly . The general assembly may, 13 by concurrent resolution, rescind , extend, or amend this 14 proclamation. Any initial extension of this proclamation by 15 the general assembly shall not exceed sixty days, and any 16 subsequent extension shall not exceed sixty-day increments. 17 If the general assembly is not in session, the legislative 18 council may, by majority vote, rescind , extend, or amend this 19 proclamation only once and any extension shall not exceed 20 sixty days . Rescission Following any rescission, extension, 21 or amendment of this proclamation by the legislative council, 22 any additional action may only be taken by the general 23 assembly. Any rescission, extension, or amendment shall be 24 effective upon the filing of the concurrent resolution or 25 resolution of the legislative council with the secretary of 26 state. A proclamation of disaster emergency shall activate the 27 disaster response and recovery aspect of the state, local, and 28 interjurisdictional disaster emergency plans applicable to the 29 political subdivision or area in question and be authority for 30 the deployment and use of any forces to which the plan applies, 31 and for use or distribution of any supplies, equipment, and 32 materials and facilities assembled, stockpiled, or arranged to 33 be made available. 34 b. A measure dictated in a state of disaster emergency 35 -1- LSB 1617XS (4) 90 pf/rh 1/ 10

S.F. 91 proclamation shall not do any of the following: 1 (1) Infringe on a fundamental constitutionally protected 2 right unless the measure is justified by a compelling state 3 interest, is narrowly tailored to achieve its specific purpose, 4 and is achieved by the least restrictive means possible. 5 (2) Restrict rights, interests, or activities in a manner 6 that is not neutral or generally applicable. 7 (3) Prohibit in-person interactions between religious 8 leaders or individuals who are related by consanguinity or 9 affinity with patients or residents of hospitals or health care 10 facilities. 11 (4) Authorize the use of mobile, cellular, or any other 12 digital technologies to track or surveil persons without 13 providing prior notice to and receiving consent from such 14 persons. 15 (5) Authorize the use of any drones, unmanned 16 aerial vehicles, advanced robotics, or any artificial 17 intelligence-based systems to enforce the proclamation. 18 (6) Restrict the practice of a person holding a valid 19 license to practice a health-related profession regulated 20 by a board designated pursuant to section 147.13 or by the 21 department of health and human services, or restrict the scope 22 of service delivery of a hospital, clinic, or health care 23 professional if the person or entity is otherwise practicing 24 within the scope of a valid license. 25 (7) Allow a board designated pursuant to section 147.13 to 26 restrict the prescribing authority of a licensed health-related 27 professional in a way that acts as a deterrent for a prescriber 28 to use a medication or treatment in accordance with the 29 prescriber’s best professional judgment. 30 (8) Require identification and monitoring of persons 31 who may be at risk of contracting a contagious or infectious 32 disease by virtue of contact with a contagious person 33 in a manner consistent with known or suspected modes 34 of transmission; require a person to comply with such 35 -2- LSB 1617XS (4) 90 pf/rh 2/ 10

S.F. 91 identification and monitoring efforts including efforts that 1 infringe on a person’s freedom of association; or establish, 2 authorize, or enforce penalties for a person’s refusal to 3 participate in the identification and monitoring efforts. 4 Sec. 2. Section 135.144, subsections 3, 5, 6, 7, and 8, Code 5 2023, are amended to read as follows: 6 3. Take reasonable measures as necessary to prevent 7 the transmission of infectious disease and to ensure that 8 all cases of communicable disease are properly identified, 9 controlled, and treated. However, such reasonable measures 10 shall not include requiring identification and monitoring of 11 persons who may be at risk of contracting a contagious or 12 infectious disease by virtue of contact with a contagious 13 person in a manner consistent with known or suspected modes 14 of transmission; requiring a person to comply with such 15 identification and monitoring efforts including efforts that 16 infringe on a person’s freedom of association; or establishing, 17 authorizing, or enforcing penalties for a person’s refusal 18 to participate in the identification and monitoring efforts 19 including efforts that infringe on a person’s freedom of 20 association. 21 5. Order Recommend physical examinations and tests and 22 collect the collection of specimens as necessary for the 23 diagnosis or treatment of individuals, to be performed by 24 any qualified person authorized to do so by the department. 25 An examination or test shall not be performed or ordered 26 recommended if the examination or test is reasonably likely 27 to lead to serious harm to the affected individual. The 28 department may isolate or quarantine , pursuant to chapter 139A 29 and the rules implementing chapter 139A and this subchapter , 30 any infected individual whose refusal of medical examination or 31 testing results in uncertainty regarding whether the individual 32 has been exposed to or is infected with a communicable or 33 potentially communicable disease or otherwise poses a danger 34 to public health. 35 -3- LSB 1617XS (4) 90 pf/rh 3/ 10

S.F. 91 6. a. Vaccinate or order Recommend that individuals be 1 vaccinated with a vaccine approved by the United States food 2 and drug administration against an infectious disease and to 3 prevent the spread of communicable or potentially communicable 4 disease. Vaccinations shall be administered by any qualified 5 person authorized to do so by the department. Prior to 6 administration of a vaccine, an adult or the parent or legal 7 representative of a minor receiving the vaccine shall be 8 provided with the federal vaccine information statement for 9 the vaccine and verbally informed of the known and potential 10 benefits and risks of the vaccine. The vaccination shall 11 not be provided or ordered recommended if it is reasonably 12 likely to lead to serious harm to the affected individual. To 13 prevent the spread of communicable or potentially communicable 14 disease, the department may isolate or quarantine , pursuant to 15 chapter 139A and the rules implementing chapter 139A and this 16 subchapter , any infected person who is unable or unwilling to 17 undergo vaccination pursuant to this subsection . 18 b. Notwithstanding any provision to the contrary in 19 paragraph “a” , a vaccination shall not be recommended for a 20 person pursuant to this subsection and the department shall 21 not isolate an infected person who is unable or unwilling to 22 undergo vaccination pursuant to this subsection if either of 23 the following applies: 24 (1) The person, or if the person is a minor, the person’s 25 parent or legal guardian, submits to the department a statement 26 signed by a physician, advanced registered nurse practitioner, 27 or physician assistant who is licensed by the board of 28 medicine, board of nursing, or board of physician assistants 29 that the vaccination would be injurious to the health and 30 well-being of the person or any member of the person’s family. 31 (2) The person, or if the person is a minor, the person’s 32 parent or legal guardian, submits to the department an 33 affidavit signed by the person, or if the person is a minor, 34 the person’s parent or legal guardian, stating that the 35 -4- LSB 1617XS (4) 90 pf/rh 4/ 10

S.F. 91 vaccination conflicts with the sincerely held religious beliefs 1 of the applicant, or if the applicant is a minor, of the 2 applicant’s parent or legal guardian. 3 7. Treat or order Recommend that individuals exposed to 4 or infected with disease receive treatment or prophylaxis. 5 Treatment or prophylaxis shall be administered by any qualified 6 person authorized to do so by the department. Treatment or 7 prophylaxis shall not be provided or ordered recommended if 8 the treatment or prophylaxis is reasonably likely to lead 9 to serious harm to the affected individual. To prevent the 10 spread of communicable or potentially communicable disease, the 11 department may isolate or quarantine , pursuant to chapter 139A 12 and the rules implementing chapter 139A and this subchapter , 13 any infected individual who is unable or unwilling to undergo 14 treatment or prophylaxis pursuant to this section . 15 8. Isolate or quarantine infected individuals or groups of 16 individuals pursuant to chapter 139A and the rules implementing 17 chapter 139A and this subchapter . 18 Sec. 3. Section 135.144, Code 2023, is amended by adding the 19 following new subsection: 20 NEW SUBSECTION . 14. Provide a link on the department’s 21 internet website for qualified individuals to submit 22 evidence-based information regarding a public health emergency 23 or public health disaster and for members of the public to 24 share their experiences. The department shall adopt rules 25 pursuant to chapter 17A to administer this subsection, 26 including the criteria a qualified individual must meet to 27 participate. 28 Sec. 4. Section 139A.8, subsection 4, paragraph a, 29 subparagraph (2), Code 2023, is amended to read as follows: 30 (2) The applicant, or if the applicant is a minor, the 31 applicant’s parent or legal guardian, submits an affidavit 32 signed by the applicant, or if the applicant is a minor, 33 the applicant’s parent or legal guardian, stating that the 34 immunization conflicts with the tenets and practices of a 35 -5- LSB 1617XS (4) 90 pf/rh 5/ 10

S.F. 91 recognized sincerely held religious denomination beliefs 1 of which the applicant is an adherent or member , or if the 2 applicant is a minor, of the applicant’s parent or legal 3 guardian . 4 Sec. 5. Section 139A.8, subsection 4, paragraph b, Code 5 2023, is amended to read as follows: 6 b. The exemptions under this subsection do not apply in 7 times of emergency or epidemic as determined by the state board 8 of counsel on health and human services and as declared by the 9 director of public health and human services . 10 EXPLANATION 11 The inclusion of this explanation does not constitute agreement with 12 the explanation’s substance by the members of the general assembly. 13 This bill relates to duties and powers relative to emergency 14 situations including a state of disaster emergency and public 15 health disasters. 16 The bill amends provisions relating to the proclamation of 17 a state of disaster emergency by the governor. Current law 18 provides that a state of disaster emergency shall continue for 19 30 days unless sooner terminated or extended by the governor 20 and that the general assembly, by concurrent resolution when 21 in session or through the legislative council by majority vote 22 if not in session, may rescind the proclamation. Under the 23 bill, a state of disaster emergency shall continue for 60 days 24 unless sooner rescinded, extended, or amended by the general 25 assembly, not the governor, and that any initial extension of 26 the proclamation by the general assembly shall not exceed 60 27 days, and any subsequent extension shall not exceed 60-day 28 increments. Any rescission, extension, or amendment by the 29 general assembly shall be effective upon the filing of the 30 concurrent resolution or resolution of the legislative council 31 with the secretary of state. The bill also provides that 32 if the general assembly is not in session, the legislative 33 council may, by majority vote, rescind, extend, or amend this 34 proclamation only once and any extension shall not exceed 60 35 -6- LSB 1617XS (4) 90 pf/rh 6/ 10

S.F. 91 days. Following any rescission, extension, or amendment of the 1 proclamation by the legislative council, any additional action 2 may only be taken by the general assembly. 3 The bill also provides that a measure dictated in a state 4 of disaster emergency proclamation shall not do any of the 5 following: infringe on a fundamental constitutionally 6 protected right unless the measure is justified by a compelling 7 state interest, is narrowly tailored to achieve its specific 8 purpose, and is achieved by the least restrictive means 9 possible; restrict rights, interests, or activities in a manner 10 that is not neutral or generally applicable; prohibit in-person 11 interactions between religious leaders or individuals who are 12 related by consanguinity or affinity with patients or residents 13 of hospitals or health care facilities; authorize the use of 14 mobile, cellular, or any other digital technologies to track or 15 surveil persons without providing prior notice to and receiving 16 consent from such persons; authorize the use of any drones, 17 unmanned aerial vehicles, advanced robotics, or any artificial 18 intelligence-based systems to enforce the proclamation; 19 restrict the practice of a person holding a valid license to 20 practice a health-related profession, or restrict the scope 21 of service delivery of a hospital, clinic, or health care 22 professional if the person or entity is otherwise practicing 23 within the scope of a valid license; allow a health-related 24 professional board to restrict the prescribing authority of a 25 licensed health-related professional in a way that acts as a 26 deterrent for a prescriber to use a medication or treatment in 27 accordance with the prescriber’s best professional judgment; 28 or require identification and monitoring of persons who may 29 be at risk of contracting a contagious or infectious disease 30 by virtue of contact with a contagious person in a manner 31 consistent with known or suspected modes of transmission, 32 require a person to comply with such identification and 33 monitoring efforts including efforts that infringe on a 34 person’s freedom of association, or establish, authorize, or 35 -7- LSB 1617XS (4) 90 pf/rh 7/ 10

S.F. 91 enforce penalties for a person’s refusal to participate in the 1 identification and monitoring efforts. 2 The bill amends the duties of the department of health 3 and human services (HHS or the department) relative to a 4 public health disaster. The bill provides that the reasonable 5 measures taken by HHS to prevent the transmission of infectious 6 disease and to ensure that all cases of communicable disease 7 are properly identified, controlled, and treated shall 8 not include requiring identification and monitoring of 9 persons who may be at risk of contracting a contagious or 10 infectious disease by virtue of contact with a contagious 11 person in a manner consistent with known or suspected modes 12 of transmission; requiring a person to comply with such 13 identification and monitoring efforts including efforts that 14 infringe on a person’s freedom of association; or establishing, 15 authorizing, or enforcing penalties for a person’s refusal 16 to participate in the identification and monitoring efforts 17 including efforts that infringe on a person’s freedom of 18 association. The department may recommend, but not order, 19 physical examinations, testing, and the collection of specimens 20 necessary for the diagnosis and treatment of individuals and 21 may isolate only infected individuals who refuse medical 22 examination or testing and who pose a danger to the public 23 health. The department may recommend that individuals be 24 vaccinated with a vaccine approved by the United State food 25 and drug administration, but not vaccinate or order that 26 individuals be vaccinated against an infectious disease or to 27 prevent the spread of communicable or potentially communicable 28 disease. Prior to administration of a vaccine, an adult or 29 the parent or legal representative of a minor receiving the 30 vaccine shall be provided with the federal vaccine information 31 statement for the vaccine and verbally informed of the known 32 and potential benefits and risks of the vaccine. Vaccination 33 shall not be recommended if it is reasonably likely to lead to 34 serious harm to the affected individual. The department may 35 -8- LSB 1617XS (4) 90 pf/rh 8/ 10

S.F. 91 isolate only infected individuals who are unable or unwilling 1 to undergo vaccination. However, the bill provides that 2 a vaccination shall not be recommended for a person under 3 this provision of the bill and that HHS shall not isolate 4 an infected person who is unable or unwilling to undergo 5 vaccination pursuant to the bill if either of the following 6 applies: the person, or if the person is a minor, the person’s 7 parent or legal guardian, submits to HHS a statement signed 8 by a physician, advanced registered nurse practitioner, or 9 physician assistant who is licensed by the board of medicine, 10 board of nursing, or board of physician assistants that the 11 vaccination would be injurious to the health and well-being 12 of the person or any member of the person’s family; or the 13 person, or if the person is a minor, the person’s parent or 14 legal guardian, submits to HHS an affidavit signed by the 15 person, or if the person is a minor, the person’s parent or 16 legal guardian, stating that the vaccination conflicts with 17 the sincerely held religious beliefs of the applicant, or if 18 the applicant is a minor, of the applicant’s parent or legal 19 guardian. 20 The department may recommend, but not treat or order, 21 that individuals infected with disease receive treatment or 22 prophylaxis. Treatment or prophylaxis shall not be recommended 23 if the treatment or prophylaxis is reasonably likely to lead 24 to serious harm to the affected individual. The department 25 may isolate only individuals infected with disease who are 26 unable or unwilling to undergo treatment or prophylaxis and may 27 isolate only infected individuals or groups of individuals. 28 The bill requires the department to provide a link on the 29 department’s internet website for qualified individuals to 30 submit evidence-based information regarding a public health 31 emergency or public health disaster and for members of the 32 public to share their experiences. The department shall adopt 33 rules pursuant to Code chapter 17A to administer the bill, 34 including the criteria a qualified individual must meet to 35 -9- LSB 1617XS (4) 90 pf/rh 9/ 10

S.F. 91 participate. 1 The bill amends provisions relating to the immunization of 2 children to provide that if a child is exempt from vaccination, 3 the exemption applies during times of emergency or epidemic and 4 provides that the religious exemption is based on the sincerely 5 held religious beliefs of the applicant, or if the applicant is 6 a minor, of the applicant’s parent or legal guardian, rather 7 than based on a conflict with the tenets and practices of a 8 recognized religious denomination of which the applicant is an 9 adherent or member. 10 -10- LSB 1617XS (4) 90 pf/rh 10/ 10