SSB 1116 (LSB 2014XC (3) 90)

SENATE FILE _____ 

BY  (PROPOSED COMMITTEE ON HEALTH AND HUMAN SERVICES BILL BY CHAIRPERSON EDLER)

A BILL FOR

An Act relating to the health and well-being of children and families including provisions for maternal support and fatherhood initiatives, regional centers of excellence, a state-funded family medicine obstetrics fellowship program, self-administered hormonal contraceptives, state employee parental leave, adoption expenses under the adoption subsidy program, and accessibility to the all Iowa scholarship program; making appropriations; and including effective date and applicability provisions.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

DIVISION I
MORE OPTIONS FOR MATERNAL SUPPORT (MOMS) PROGRAM —— FATHERHOOD INITIATIVES

    Section 1.  Section 217.41C, subsection 1, paragraph c, Code 2023, is amended to read as follows:
   c.  For the purposes of this section, “pregnancy support services” means those nonmedical services that promote childbirth by providing information, counseling, and support services that assist pregnant women or women who believe they may be pregnant and men who are involved or who think they might be involved in a pregnancy to choose childbirth and to make informed decisions regarding the choice of adoption or parenting with respect to their children.
    Sec. 2.  Section 217.41C, Code 2023, is amended by adding the following new subsections:
   NEW SUBSECTION.  8.  The department shall develop and maintain a virtual clearinghouse of pregnancy support services and resources including but not limited to all of the following:
   a.  Pregnancy resource center and maternity home information including contact information, location, and services provided.
   b.  Assistance in accessing public assistance including but not limited to the special supplemental nutrition program for women, infants, and children and the supplemental nutrition assistance program.
   c.  Educational resources.
   d.  Housing assistance.
   e.  Recovery and mental health services. 
   f.  Family planning education.
   g.  Adoption and foster care information and services.
   h.  Healing and support services for abortion survivors and their families. 
   NEW SUBSECTION.  9.  Beginning July 1, 2023, and thereafter, funding for the program may be used for all of the following purposes:
   a.  Fatherhood engagement grants.  The department may award grants to nonprofit, community-based organizations to address the needs of fathers by assisting fathers in finding employment, managing child support obligations, transitioning from a period of incarceration, accessing health care, understanding child development, and enhancing parenting skills using evidence-based parenting education. Priority in the awarding of grants shall be based on the demonstrated need in a geographic area and the prevalence of the population to be served as indicated by factors including but not limited to the service area’s unemployment rate, incarceration rate, number of public assistance recipients, number of single-parent households, level of housing instability, and graduation rates.
   b.  Fatherhood communications initiative.  The department shall administer a communications initiative on responsible fatherhood including but not limited to a public internet site that provides access to resources on effective parenting and assistance in receiving parenting support and services.
   c.  Mentoring school-aged males grant program.  The department may award three-year renewable grants to nonprofit organizations that provide mentorship, social and academic support, and life skills development to school-aged males. Priority in the awarding of grants shall be based on the demonstrated need in a geographic area and the prevalence of the population to be served as indicated by factors including but not limited to the service area’s unemployment rate, incarceration rate, number of public assistance recipients, number of single-parent households, level of housing instability, and graduation rates. The department shall provide technical assistance to grantees to ensure program sustainability following the end of the three-year grant period.
    Sec. 3.  MORE OPTIONS FOR MATERNAL SUPPORT PROGRAM —— APPROPRIATION.  There is appropriated from the general fund of the state to the department of health and human services for the fiscal year beginning July 1, 2023, and ending June 30, 2024, the following amount, or so much thereof as is necessary, to be used for the purposes designated:
   ...................................................................... $  2,000,000

   To be used for the purposes of the more options for maternal support program created in section 217.41C, including for program administration, the provision of services, and for funding of fatherhood engagement grants, the fatherhood communications initiative, and the mentoring school-aged males grant program. 
    Sec. 4.  2022 Iowa Acts, chapter 1131, section 28, subsection 8, is amended to read as follows:
   8.  Of the funds appropriated under this section, $500,000 shall be used for the purposes of program administration and provision of pregnancy support services through the more options for maternal support program created in this Act.  Notwithstanding section 8.33, moneys appropriated in this subsection that remain unencumbered or unobligated at the close of the fiscal year shall not revert but shall remain available for the purposes designated until the close of the succeeding fiscal year.
    Sec. 5.  EFFECTIVE DATE.  The following, being deemed of immediate importance, takes effect upon enactment:
   The section of this division of this Act amending 2022 Iowa Acts, chapter 1131, section 28, subsection 8.
DIVISION II
REGIONAL CENTERS OF EXCELLENCE GRANT PROGRAM

    Sec. 6.  REGIONAL CENTERS OF EXCELLENCE PROGRAM —— GRANTS —— APPROPRIATION.  There is appropriated from the general fund of the state to the department of health and human services for the fiscal year beginning July 1, 2023, and ending June 30, 2024, the following amount, or so much thereof as is necessary, to be used for the purposes designated:
   ...................................................................... $  1,000,000

   The funds appropriated in this section shall be used for the continuation of a center of excellence program to award four grants to encourage innovation and collaboration among regional health care providers in a rural area based upon the results of a regional community needs assessment to transform health care delivery in order to provide quality, sustainable care that meets the needs of the local communities. An applicant for the grant funds shall specify how the funds will be expended to accomplish the goals of the program and shall provide a detailed five-year sustainability plan prior to being awarded any funding. Following the receipt of grant funding, a recipient shall submit periodic reports as specified by the department to the governor and the general assembly regarding the recipient’s expenditure of the funds and progress in accomplishing the program’s goals.
DIVISION III
STATE-FUNDED FAMILY MEDICINE OBSTETRICS FELLOWSHIP PROGRAM

    Sec. 7.  NEW SECTION.  135.182  State-funded family medicine obstetrics fellowship program —— fund.
   1.  The department shall establish a family medicine obstetrics fellowship program to increase access to family medicine obstetrics practitioners in rural and underserved areas of the state. A person who has completed an accreditation council for graduate medical education residency program in family medicine is eligible for participation in the fellowship program. Participating fellows shall enter into a program agreement with a participating teaching hospital which, at a minimum, requires the fellow to complete a one-year fellowship and to engage in full-time family medicine obstetrics practice in a rural or underserved area of the state for a period of at least five years within nine months following completion of the fellowship and receipt of a license to practice medicine in the state.
   2.  Each fellow participating in the program shall be eligible for a salary and benefits including a stipend as determined by the participating teaching hospital which shall be funded through the family medicine obstetrics fellowship program fund.
   3.  The department shall adopt rules pursuant to chapter 17A to administer the program, including defining rural and underserved areas for the purpose of the required full-time practice of a person following completion of the fellowship.
   4.  a.  A family medicine obstetrics fellowship program fund is created in the state treasury consisting of the moneys appropriated or credited to the fund by law. Notwithstanding section 8.33, moneys in the fund at the end of each fiscal year shall not revert to any other fund but shall remain in the fund for use in subsequent fiscal years. Moneys in the fund are appropriated to the department to be used to fund fellowship positions as provided in this section.
   b.  For the fiscal year beginning July 1, 2023, and each fiscal year beginning July 1 thereafter, there is appropriated from the general fund of the state to the family medicine obstetrics fellowship program fund an amount sufficient to support the creation of four fellowship positions as provided in this section.
   5.  The department and the participating teaching hospitals shall regularly evaluate and document their experiences including identifying ways the program may be modified or expanded to facilitate increased access to family medicine obstetrics practitioners in rural and underserved areas of the state. The department shall submit an annual report to the general assembly by January 1. The report shall include the number of fellowships funded to date and any other information identified by the department and the participating teaching hospitals as indicators of outcomes and the effectiveness of the program.
   6.  For the purposes of this section, “teaching hospital” means a hospital or medical center that provides medical education to prospective and current health professionals.
    Sec. 8.  STATE-FUNDED FAMILY MEDICINE OBSTETRICS FELLOWSHIP PROGRAM AND FUND —— APPROPRIATION.  There is appropriated from the general fund of the state to the department of health and human services for the fiscal year beginning July 1, 2023, and ending June 30, 2024, the following amount, or so much thereof as is necessary, to be used for the purposes designated:
   ...................................................................... $    560,000

   For deposit in the family medicine obstetrics fellowship program fund to be utilized in creating and providing for four family medicine obstetrics fellowship positions during the fiscal year in accordance with the family medicine obstetrics fellowship program created in this division of this Act. 
DIVISION IV
SELF-ADMINISTERED HORMONAL CONTRACEPTIVES

    Sec. 9.  Section 155A.3, Code 2023, is amended by adding the following new subsections:
   NEW SUBSECTION.  10A.  “Department” means the department of health and human services.
   NEW SUBSECTION.  45A.  “Self-administered hormonal contraceptive” means a self-administered hormonal contraceptive that is approved by the United States food and drug administration to prevent pregnancy. “Self-administered hormonal contraceptive” includes an oral hormonal contraceptive, a hormonal vaginal ring, and a hormonal contraceptive patch, but does not include any drug intended to induce an abortion as defined in section 146.1.
   NEW SUBSECTION.  45B.  “Standing order” means a preauthorized medication order with specific instructions from the medical director of the department to dispense a medication under clearly defined circumstances.
    Sec. 10.  NEW SECTION.  155A.49  Pharmacist dispensing of self-administered hormonal contraceptives —— standing order —— requirements —— limitations of liability.
   1.  a.  Notwithstanding any provision of law to the contrary, a pharmacist may dispense a self-administered hormonal contraceptive to a patient who is at least eighteen years of age, pursuant to a standing order established by the medical director of the department in accordance with this section.
   b.  In dispensing a self-administered hormonal contraceptive to a patient under this section, a pharmacist shall comply with all of the following:
   (1)  For an initial dispensing of a self-administered hormonal contraceptive, the pharmacist may dispense only up to a three-month supply at one time of the self-administered hormonal contraceptive.
   (2)  For any subsequent dispensing of the same self-administered hormonal contraceptive, the pharmacist may dispense up to a twelve-month supply at one time of the self-administered hormonal contraceptive.
   2.  A pharmacist who dispenses a self-administered hormonal contraceptive in accordance with this section shall not require any other prescription drug order authorized by a practitioner prior to dispensing the self-administered hormonal contraceptive to a patient.
   3.  The medical director of the department may establish a standing order authorizing the dispensing of self-administered hormonal contraceptives by a pharmacist who does all of the following: 
   a.  Complies with the standing order established pursuant to this section.
   b.  Retains a record of each patient to whom a self-administered hormonal contraceptive is dispensed under this section and submits the record to the department.
   4.  The standing order shall require a pharmacist who dispenses self-administered hormonal contraceptives under this section to do all of the following:
   a.  Complete a standardized training program and continuing education requirements approved by the board in consultation with the board of medicine and the department that are related to prescribing self-administered hormonal contraceptives and include education regarding all contraceptive methods approved by the United States food and drug administration.
   b.  Obtain a completed self-screening risk assessment, approved by the department in collaboration with the board and the board of medicine, from each patient, verify the identity and age of each patient, and perform a blood pressure screening on each patient prior to dispensing the self-administered hormonal contraceptive to the patient. 
   c.  Provide the patient with all of the following:
   (1)  Written information regarding all of the following: 
   (a)  The importance of completing an appointment with the patient’s primary care or women’s health care practitioner to obtain preventative care, including but not limited to recommended tests and screenings.
   (b)  The effectiveness and availability of long-acting reversible contraceptives as an alternative to self-administered hormonal contraceptives.
   (2)  A copy of the record of the pharmacist’s encounter with the patient that includes all of the following: 
   (a)  The patient’s completed self-screening risk assessment. 
   (b)  A description of the contraceptive dispensed, or the basis for not dispensing a contraceptive.
   (3)  Patient counseling regarding all of the following: 
   (a)  The appropriate administration and storage of the self-administered hormonal contraceptive. 
   (b)  Potential side effects and risks of the self-administered hormonal contraceptive. 
   (c)  The need for backup contraception. 
   (d)  When to seek emergency medical attention.
   (e)  The risk of contracting a sexually transmitted infection or disease, and ways to reduce such a risk. 
   5.  The standing order established pursuant to this section shall prohibit a pharmacist who dispenses a self-administered hormonal contraceptive under this section from doing any of the following: 
   a.  Requiring a patient to schedule an appointment with the pharmacist for the prescribing or dispensing of a self-administered hormonal contraceptive.
   b.  Dispensing self-administered hormonal contraceptives to a patient for more than twenty-seven months after the date a self-administered hormonal contraceptive is initially dispensed to the patient, if the patient has not consulted with a primary care or women’s health care practitioner during the preceding twenty-seven months, in which case the pharmacist shall refer the patient to a primary care or women’s health care practitioner.
   c.  Dispensing a self-administered hormonal contraceptive to a patient if the results of the self-screening risk assessment completed by a patient pursuant to subsection 4, paragraph “b”, indicate it is unsafe for the pharmacist to dispense the self-administered hormonal contraceptive to the patient, in which case the pharmacist shall refer the patient to a primary care or women’s health care practitioner. 
   6.  A pharmacist who dispenses a self-administered hormonal contraceptive and the medical director of the department who establishes a standing order in compliance with this section shall be immune from criminal and civil liability arising from any damages caused by the dispensing, administering, or use of a self-administered hormonal contraceptive or the establishment of the standing order. The medical director of the department shall be considered to be acting within the scope of the medical director’s office and employment for purposes of chapter 669 in the establishment of a standing order in compliance with this section. 
   7.  The department, in collaboration with the board and the board of medicine, and in consideration of the guidelines established by the American congress of obstetricians and gynecologists, shall adopt rules pursuant to chapter 17A to administer this chapter. 
    Sec. 11.  Section 514C.19, Code 2023, is amended to read as follows:
   514C.19  Prescription contraceptive coverage.
   1.  Notwithstanding the uniformity of treatment requirements of section 514C.6, a group policy, or contract, or plan providing for third-party payment or prepayment of health or medical expenses shall not do either of the following comply as follows:
   a.  Exclude Such policy, contract, or plan shall not exclude or restrict benefits for prescription contraceptive drugs or prescription contraceptive devices which prevent conception and which are approved by the United States food and drug administration, or generic equivalents approved as substitutable by the United States food and drug administration, if such policy, or contract, or plan provides benefits for other outpatient prescription drugs or devices.  However, such policy, contract, or plan shall specifically provide for payment of a self-administered hormonal contraceptive, as prescribed by a practitioner as defined in section 155A.3, or as prescribed by standing order and dispensed by a pharmacist pursuant to section 155A.49, including payment for up to an initial three-month supply of a self-administered hormonal contraceptive dispensed at one time and for up to a twelve-month supply of the same self-administered hormonal contraceptive subsequently dispensed at one time.
   b.  Exclude Such policy, contract, or plan shall not exclude or restrict benefits for outpatient contraceptive services which are provided for the purpose of preventing conception if such policy, or contract, or plan provides benefits for other outpatient services provided by a health care professional.
   2.  A person who provides a group policy, or contract, or plan providing for third-party payment or prepayment of health or medical expenses which is subject to subsection 1 shall not do any of the following:
   a.  Deny to an individual eligibility, or continued eligibility, to enroll in or to renew coverage under the terms of the policy, or contract, or plan because of the individual’s use or potential use of such prescription contraceptive drugs or devices, or use or potential use of outpatient contraceptive services.
   b.  Provide a monetary payment or rebate to a covered individual to encourage such individual to accept less than the minimum benefits provided for under subsection 1.
   c.  Penalize or otherwise reduce or limit the reimbursement of a health care professional because such professional prescribes contraceptive drugs or devices, or provides contraceptive services.
   d.  Provide incentives, monetary or otherwise, to a health care professional to induce such professional to withhold from a covered individual contraceptive drugs or devices, or contraceptive services.
   3.  This section shall not be construed to prevent a third-party payor from including deductibles, coinsurance, or copayments under the policy, or contract, or plan as follows:
   a.  A deductible, coinsurance, or copayment for benefits for prescription contraceptive drugs shall not be greater than such deductible, coinsurance, or copayment for any outpatient prescription drug for which coverage under the policy, or contract, or plan is provided.
   b.  A deductible, coinsurance, or copayment for benefits for prescription contraceptive devices shall not be greater than such deductible, coinsurance, or copayment for any outpatient prescription device for which coverage under the policy, or contract, or plan is provided.
   c.  A deductible, coinsurance, or copayment for benefits for outpatient contraceptive services shall not be greater than such deductible, coinsurance, or copayment for any outpatient health care services for which coverage under the policy, or contract, or plan is provided.
   4.  This section shall not be construed to require a third-party payor under a policy, or contract, or plan to provide benefits for experimental or investigational contraceptive drugs or devices, or experimental or investigational contraceptive services, except to the extent that such policy, or contract, or plan provides coverage for other experimental or investigational outpatient prescription drugs or devices, or experimental or investigational outpatient health care services.
   5.  This section shall not be construed to limit or otherwise discourage the use of generic equivalent drugs approved by the United States food and drug administration, whenever available and appropriate. This section, when a brand name drug is requested by a covered individual and a suitable generic equivalent is available and appropriate, shall not be construed to prohibit a third-party payor from requiring the covered individual to pay a deductible, coinsurance, or copayment consistent with subsection 3, in addition to the difference of the cost of the brand name drug less the maximum covered amount for a generic equivalent.
   6.  A person who provides an individual policy, or contract, or plan providing for third-party payment or prepayment of health or medical expenses shall make available a coverage provision that satisfies the requirements in subsections 1 through 5 in the same manner as such requirements are applicable to a group policy, or contract, or plan under those subsections. The policy, or contract, or plan shall provide that the individual policyholder may reject the coverage provision at the option of the policyholder.
   7.  a.  This section applies to the following classes of third-party payment provider contracts, or policies, or plans delivered, issued for delivery, continued, or renewed in this state on or after July 1, 2000 January 1, 2024:
   (1)  Individual or group accident and sickness insurance providing coverage on an expense-incurred basis.
   (2)  An individual or group hospital or medical service contract issued pursuant to chapter 509, 514, or 514A.
   (3)  An individual or group health maintenance organization contract regulated under chapter 514B.
   (4)  Any other entity engaged in the business of insurance, risk transfer, or risk retention, which is subject to the jurisdiction of the commissioner.
   (5)  A plan established pursuant to chapter 509A for public employees.
   b.  This section shall not apply to accident-only, specified disease, short-term hospital or medical, hospital confinement indemnity, credit, dental, vision, Medicare supplement, long-term care, basic hospital and medical-surgical expense coverage as defined by the commissioner, disability income insurance coverage, coverage issued as a supplement to liability insurance, workers’ compensation or similar insurance, or automobile medical payment insurance.
   8.  This section shall not be construed to require a third-party payor to provide payment to a practitioner for the dispensing of a self-administered hormonal contraceptive to replace a self-administered hormonal contraceptive that has been dispensed to a covered person and that has been misplaced, stolen, or destroyed. This section shall not be construed to require a third-party payor to replace covered prescriptions that are misplaced, stolen, or destroyed. 
   9.  For the purposes of this section, “self-administered hormonal contraceptive” and “standing order” mean the same as defined in section 155A.3.
    Sec. 12.  INFORMATION PROGRAM FOR DRUG PRESCRIBING AND DISPENSING —— SELF-ADMINISTERED HORMONAL CONTRACEPTIVES.  The board of pharmacy in collaboration with the board of medicine and the department of health and human services shall expand the information program for drug prescribing and dispensing established pursuant to section 124.551, to collect from pharmacists information relating to the dispensing of self-administered hormonal contraceptives as provided pursuant to section 155A.49. The board of pharmacy shall adopt rules pursuant to chapter 17A related to registration of participating pharmacists, the information to be reported by a pharmacist to the information program, access to information from the program, and other rules necessary to carry out the purposes and to enforce the provisions of this section.
    Sec. 13.  APPLICATION TO MEDICAID PROGRAM.  This division of this Act shall apply to the Medicaid program including a managed care organization acting pursuant to a contract with the department of health and human services to administer the Medicaid program under chapter 249A. However, if it is determined that any provision of this division of this Act would cause denial of federal funds under Tit. XVIII or XIX of the federal Social Security Act, or would otherwise be inconsistent or conflict with the requirements of federal law or regulation, such provision shall be suspended, but only to the extent necessary to prevent denial of such funds or to eliminate the inconsistency or conflict with the requirements of federal law or regulation.
DIVISION V
STATE EMPLOYEE PAID PARENTAL LEAVE BENEFIT

    Sec. 14.  NEW SECTION.  70A.31  Paid parental leave.
   1.  A state employee entitled to leave under the federal Family and Medical Leave Act of 1993 shall be provided paid leave for such time as specified in this section for the birth or placement for adoption with the employee of a child if the leave is taken within twelve months following any such birth or adoption.
   2.  a.  For the birth of a child, a state employee parent who gave birth shall be entitled to up to four weeks of paid leave and a state employee parent who did not give birth shall be entitled to up to one week of paid leave.
   b.  For the placement for adoption of a child, a state employee parent shall be entitled to up to four weeks of paid leave.
   3.  The department of administrative services shall adopt rules to implement this section.
DIVISION VI
NONRECURRING ADOPTION EXPENSES —— ADOPTION SUBSIDY PROGRAM

    Sec. 15.  NEW SECTION.  234.48  Adoption subsidy —— nonrecurring adoption expenses.
   Notwithstanding any provision to the contrary, the maximum reimbursement provided to an adoptive parent under the adoption subsidy program for nonrecurring adoption expenses is one thousand dollars. For the purposes of this section, “nonrecurring adoption expenses” means the same as defined in 45 C.F.R. §1356.41. The department shall adopt rules pursuant to chapter 17A to administer this section.
    Sec. 16.  REPEAL.  2010 Iowa Acts, chapter 1031, section 408, is repealed.
DIVISION VII
ALL IOWA OPPORTUNITY SCHOLARSHIP PROGRAM

    Sec. 17.  Section 261.87, subsection 1, paragraph b, unnumbered paragraph 1, Code 2023, is amended to read as follows:
   “Eligible foster care student” means a person under twenty-six years of age who has a high school diploma or a high school equivalency diploma under chapter 259A and is described by any of the following:
    Sec. 18.  Section 261.87, subsection 2, paragraph f, Code 2023, is amended to read as follows:
   f.  (1)  Begins Except as provided in subparagraph (2), begins enrollment at an eligible institution within two academic years of graduation from high school or receipt of a high school equivalency diploma under chapter 259A and continuously receives awards as a full-time or part-time student to maintain eligibility. However, the student may defer or suspend participation in the program for up to two years in order to pursue obligations that meet conditions established by the commission by rule or to fulfill military obligations.
   (2)  The requirements of subparagraph (1) do not apply to an eligible foster care student.
    Sec. 19.  APPLICABILITY.  This division of this Act applies to applications submitted under the all Iowa opportunity scholarship program established pursuant to section 261.87 before, on, or after the effective date of this division of this Act.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill relates to the health and well-being of children and families. The bill is constructed in divisions.
   DIVISION I —— MORE OPTIONS FOR MATERNAL SUPPORT (MOMS) PROGRAM —— FATHERHOOD INITIATIVES. This division relates to the more options for maternal support (MOMS) program. The bill adds as part of the definition of “pregnancy support services” services to men who are involved or think they might be involved in a pregnancy. As part of the MOMS program, the division requires HHS to develop and maintain a virtual clearinghouse of pregnancy support services and resources. The services and resources include but are not limited to pregnancy resource center and maternity home information; assistance in accessing public assistance including but not limited to the special supplemental nutrition program for women, infants, and children program and the supplemental nutrition assistance program; educational resources; housing assistance; recovery and mental health services; family planning education; adoption and foster care information and services; and healing and support services for abortion survivors and their families.
   As part of the MOMS program, beginning July 1, 2023, and thereafter, funding for the program may be used for fatherhood engagement grants to nonprofit, community-based organizations to address the needs of fathers by assisting fathers in finding employment, managing child support obligations, transitioning from a period of incarceration, accessing health care, understanding child development, and enhancing parenting skills using evidence-based parenting education; a fatherhood communications initiative administered by HHS, including but not limited to a public internet site that provides access to resources on effective parenting and assistance in receiving parenting support and services; and a mentoring school-aged males grant program to provide mentorship, social and academic support, and life skills development to school-aged males.
   The division also appropriates $2 million from the general fund of the state to HHS for fiscal year 2023-2024 to be used for the MOMS program including for program administration, the provision of services, and for funding of fatherhood engagement grants, the fatherhood communications initiative, and the mentoring school-aged males grant program.
   The division provides that the funding appropriated for the MOMS program for fiscal year 2022-2023 is not to revert, but is to remain available for the MOMS program for fiscal year 2023-2024. This provision takes effect upon enactment. 
   DIVISION II —— REGIONAL CENTERS OF EXCELLENCE GRANT PROGRAM.  This division appropriates $1 million from the general fund of the state to the department of health and human services (HHS) for fiscal year 2023-2024 for continuation of a regional center of excellence program to award four grants to encourage innovation and collaboration among regional health care providers in a rural area based upon the results of a regional community needs assessment to transform health care delivery in order to provide quality, sustainable care that meets the needs of the local communities. An applicant for the grant funds shall specify how the funds will be expended to accomplish the goals of the program and shall provide a detailed five-year sustainability plan prior to being awarded any funding. Following the receipt of grant funding, a recipient shall submit periodic reports as specified by HHS to the governor and the general assembly regarding the recipient’s expenditure of the funds and progress in accomplishing the program goals.
   DIVISION III —— STATE-FUNDED FAMILY MEDICINE OBSTETRICS FELLOWSHIP PROGRAM AND FUND. This division requires HHS to establish a family medicine obstetrics fellowship program to increase access to family medicine obstetrics practitioners in rural and underserved areas of the state. A person who has completed an accreditation council for graduate medical education residency program in family medicine is eligible for participation in the fellowship program. Participating fellows shall enter into a program agreement with a participating teaching hospital which, at a minimum, requires the fellow to complete a one-year fellowship and to engage in full-time family medicine obstetrics practice in a rural or underserved area of the state for a period of at least five years within nine months following completion of the fellowship and receipt of a license to practice medicine in the state. Each fellow participating in the program shall be eligible for salary and benefits including a stipend as determined by the participating teaching hospital and funded through the family medicine obstetrics fellowship program fund.
   The division requires HHS to adopt administrative rules to administer the program, including defining rural and underserved areas for the purpose of the required full-time practice of a person following completion of the fellowship.
   The division creates a family medicine obstetrics fellowship program fund in the state treasury consisting of the moneys appropriated or credited to the fund by law. Moneys in the fund at the end of each fiscal year shall not revert to any other fund but shall remain in the fund for use in subsequent fiscal years. Moneys in the fund are appropriated to HHS to be used to fund fellowship positions as provided in the division. The division appropriates a sufficient amount from the general fund of the state to the fund annually to support the creation of four fellowship positions. The division provides an appropriation for deposit in the fund for fiscal year 2023-2024.
   The division requires HHS and the participating teaching hospitals to regularly evaluate and document their experiences including identifying ways the program may be modified or expanded to facilitate increased access to family medicine obstetrics practitioners in rural and underserved areas of the state. The department shall submit an annual report to the general assembly by January 1. The report shall include the number of fellowships funded to date and any other information identified by HHS and the participating teaching hospitals as indicators of outcomes and the effectiveness of the program.
   DIVISION IV —— SELF-ADMINISTERED HORMONAL CONTRACEPTIVES.  This division relates to the dispensing of self-administered hormonal contraceptives by a pharmacist. The division defines “self-administered hormonal contraceptive” as a self-administered hormonal contraceptive that is approved by the United States food and drug administration to prevent pregnancy, including an oral hormonal contraceptive, a hormonal vaginal ring, and a hormonal contraceptive patch, but not including any drug intended to induce an abortion.
   The division provides that notwithstanding any provision of law to the contrary, a pharmacist may dispense a self-administered hormonal contraceptive to a patient who is at least 18 years of age pursuant to a standing order established by the medical director of HHS (medical director). For an initial dispensing, a pharmacist may dispense only up to a three-month supply at one time of the self-administered hormonal contraceptive, and for any subsequent dispensing of the same self-administered hormonal contraceptive, a 12-month supply at one time. Additionally, the division prohibits a pharmacist who dispenses a self-administered hormonal contraceptive in accordance with the division from requiring any other prescription drug order authorized by a practitioner prior to dispensing the self-administered hormonal contraceptive.
   The division authorizes the medical director to establish a standing order authorizing the dispensing of self-administered hormonal contraceptives by any pharmacist who complies with the standing order and retains and submits the patient’s record to HHS.
   The standing order includes requiring a pharmacist who dispenses a self-administered hormonal contraceptive under the division to: complete a standardized training program and continuing education requirements related to prescribing the hormonal contraceptives; obtain a completed self-screening risk assessment from each patient, verify the identity and age of each patient, and perform a blood pressure screening on each patient before dispensing the hormonal contraceptives; provide the patient with certain written information; provide the patient with a copy of the record of the pharmacist’s encounter with the patient; and provide patient counseling. 
   The standing order would prohibit a pharmacist who dispenses hormonal contraceptives under the division from requiring a patient to schedule an appointment with the pharmacist for the prescribing or dispensing of the hormonal contraceptive; dispensing the hormonal contraceptives to a patient for more than 27 months after the date initially dispensed without the patient’s attestation that the patient has consulted with a practitioner during the preceding 27 months; and dispensing the hormonal contraceptives to a patient if the results of the patient’s self-screening risk assessment indicate it is unsafe for the pharmacist to dispense the hormonal contraceptives to the patient, in which case the pharmacist shall refer the patient to a practitioner. 
   The division provides immunity for a pharmacist who dispenses a self-administered hormonal contraceptive and for the medical director who establishes a standing order in compliance with the division from criminal and civil liability arising from any damages caused by the dispensing, administering, or use of a self-administered hormonal contraceptive or the establishment of the standing order. Additionally, the medical director shall be considered to be acting within the scope of the medical director’s office and employment for purposes of Code chapter 669 (Iowa tort claims Act) in the establishment of a standing order in compliance with the division.
   The division requires HHS, in collaboration with the boards of pharmacy and medicine, and in consideration of the guidelines established by the American congress of obstetricians and gynecologists, to adopt administrative rules to administer the provisions of the division.
   The division amends prescription contraceptive coverage provisions to require that a group policy, contract, or plan delivered, issued for delivery, continued, or renewed in the state on or after January 1, 2024, providing for third-party payment or prepayment of health or medical expenses, shall specifically provide for payment of self-administered hormonal contraceptives, prescribed and dispensed as specified in the division, including those dispensed at one time. The division provides, however, that the provisions relating to coverage are not to be construed to require a third-party payor to provide payment to a practitioner for dispensing a self-administered hormonal contraceptive to replace a self-administered hormonal contraceptive that has been dispensed to a covered person and that has been misplaced, stolen, or destroyed. These provisions are also not to be construed to require a third-party payor to replace covered prescriptions that are misplaced, stolen, or destroyed. 
   The division also requires the board of pharmacy in collaboration with the board of medicine and HHS to expand the information program for drug prescribing to collect from pharmacists information relating to the dispensing of self-administered hormonal contraceptives as provided in the division.
   The division applies to the Medicaid program as specified in the bill.
   DIVISION V —— STATE EMPLOYEE PAID PARENTAL LEAVE BENEFIT.  This division provides that a state employee entitled to leave under the federal Family and Medical Leave Act of 1993 shall be provided paid leave for the birth or adoption of a child if the leave is taken within 12 months following any such birth or adoption. The division provides that a state employee parent who gives birth or adopts a child shall be entitled to up to four weeks of paid leave while a state employee parent of a child who did not give birth shall be entitled to up to one week of paid leave. The division requires the department of administrative services to adopt rules to implement this paid parental leave benefit.
   DIVISION VI —— NONRECURRING ADOPTION EXPENSES —— ADOPTION SUBSIDY PROGRAM. This division provides that the maximum reimbursement provided to an adoptive parent under the adoption subsidy program for nonrecurring adoption expenses is $1,000. The division defines “nonrecurring adoption expenses” as the reasonable and necessary adoption fees, court costs, attorney fees, and other expenses which are directly related to the legal adoption of a child with special needs which are not incurred in violation of state, tribal, or federal law, and which have not been reimbursed from other sources or other funds. Under federal regulation, “other expenses which are directly related to the legal adoption of a child with special needs” means the costs of the adoption incurred by or on behalf of the parents and for which parents carry the ultimate liability for payment. Such costs may include the adoption study, including health and psychological examination, supervision of the placement prior to adoption, transportation, and the reasonable costs of lodging and food for the child or the adoptive parents when necessary to complete the placement or adoption process. The department of health and human services shall adopt administrative rules to administer the division. The division also repeals a provision in 2010 Iowa Acts which limited the nonrecurring adoption expenses to $500 and prohibited additional amounts for court costs and other related legal expenses.
   DIVISION VII —— ALL IOWA OPPORTUNITY SCHOLARSHIP PROGRAM.  This division relates to the all Iowa opportunity scholarship program (program), which provides scholarships to Iowa students who graduate from high school or receive a high school equivalency diploma to help such students attend a community college in this state or an institution of higher learning governed by the state board of regents. The program prioritizes awarding scholarships to certain students, including eligible foster care students. Eligible foster care students are students who age out of Iowa’s foster care system, age out of the state training school, or are adopted from Iowa’s foster care system after reaching 16 years of age.
   Current law requires that, in order to be eligible to receive a scholarship under the program, the student must begin enrollment at a community college or institution of higher learning governed by the state board of regents within two academic years of graduation from high school or receipt of a high school equivalency diploma and continuously receive awards as a full-time or part-time student to maintain eligibility. The division strikes these requirements for eligible foster care students. The division also provides that, for purposes of the program, “eligible foster care student” does not include a person who is 26 years of age or older.
   The division applies to applications submitted under the program before, on, or after the effective date of the division.