Senate Study Bill 3006 - Introduced SENATE FILE _____ BY (PROPOSED COMMITTEE ON JUDICIARY BILL BY CHAIRPERSON ZAUN) A BILL FOR An Act relating to protections for health care institutions, 1 health care payors, and medical practitioners including 2 those related to the exercise of a right of conscience, 3 whistleblower activities, and free speech, and providing 4 penalties. 5 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 6 TLSB 5640XC (4) 90 pf/ko

S.F. _____ Section 1. NEW SECTION . 135S.1 Definitions. 1 As used in this chapter, unless the context otherwise 2 requires: 3 1. “Adverse action” includes termination of employment; 4 transfer or demotion from a current position; an adverse 5 administrative action; reassignment to a different shift or 6 job title; increased administrative duties; denial of staff 7 privileges; denial of board certification; loss of career 8 specialty; reduction of wages, benefits, or privileges; refusal 9 to award a grant, contract, or other funding opportunity; 10 refusal to provide residency training opportunities; denial, 11 deprivation, or disqualification of licensure; withholding 12 or disqualifying from financial aid and other assistance; 13 impediment of the establishment or improvement of a health care 14 institution or health care payor; impediment of the acquisition 15 or merger of a health care institution or health care payor; or 16 any other penalty, discipline, or retaliatory action. 17 2. a. “Conscience” means the ethical, moral, or religious 18 beliefs or principles held by a medical practitioner, health 19 care institution, or health care payor. 20 b. With respect to persons who are institutions, 21 corporations, or other legal entities, “conscience” is 22 determined by reference to that entity’s governing documents 23 including but not limited to published ethical, moral, or 24 religious guidelines or directives, mission statements, 25 constitutions, articles of incorporation, bylaws, policies, or 26 regulations. 27 3. “Discrimination” means an adverse action taken against, 28 or a threat of adverse action communicated to, a medical 29 practitioner, health care institution, or health care payor as 30 a result of the refusal of the medical practitioner, health 31 care institution, or health care payor to participate in a 32 health care service on the basis of conscience. 33 4. “Health care institution” means a hospital, an 34 outpatient primary care location, a medical center, a physician 35 -1- LSB 5640XC (4) 90 pf/ko 1/ 11

S.F. _____ organization, a professional association, an ambulatory 1 surgical center, a private office of a medical practitioner, a 2 pharmacy, a health care facility, a medical or nursing school, 3 a medical training facility, or any other entity or location 4 in which health care services are performed. “Health care 5 institution” includes but is not limited to organizations, 6 corporations, partnerships, associations, agencies, networks, 7 sole proprietorships, and joint ventures. 8 5. “Health care payor” means an employer, a health plan, 9 an insurer, a management services organization, or any other 10 entity that pays for or arranges for payment, in whole or in 11 part, for a health care service. 12 6. “Health care service” means medical care provided to a 13 patient at any time during the patient’s course of treatment, 14 including but not limited to initial examination, testing, 15 diagnosis, or referral; dispensing or administration of a drug, 16 medication, or device; psychological therapy or counseling; 17 research, prognosis, therapy, recordmaking, notes related to 18 treatment, set up, or performance of a surgery or procedure; or 19 any other care or service performed or provided by a medical 20 practitioner. 21 7. “Insurer” means any entity, including a health 22 service corporation, health maintenance organization, or any 23 similar corporation or organization, or an employer offering 24 self-insurance, that provides a health benefit plan, but does 25 not include an entity that provides public coverage. 26 8. “Medical practitioner” means a person who facilitates 27 or participates, or who is asked to facilitate or participate 28 in a health care service, including but not limited to a 29 health-related professional licensed by a board designated in 30 section 147.13, and any other person licensed, certified, or 31 otherwise authorized or permitted by the laws of this state 32 to administer a health care service in the ordinary course of 33 business or in the practice of a profession. 34 9. “Participate in a health care service” means to provide, 35 -2- LSB 5640XC (4) 90 pf/ko 2/ 11

S.F. _____ perform, assist with, facilitate, refer for, provide counseling 1 for, advise with regard to, admit for the purposes of 2 providing, or take part in a health care service in any way. 3 10. “Person” means the same as defined in section 4.1. 4 Sec. 2. NEW SECTION . 135S.2 Exercise of conscience for 5 health care institutions, health care payors, and medical 6 practitioners —— immunity —— exception. 7 1. a. A health care institution or health care payor shall 8 not be required to participate in or pay for a health care 9 service that violates the health care institution’s or health 10 care payor’s conscience, including by permitting the use of the 11 health care institution’s or health care payor’s facilities. 12 b. A health care payor shall list any health care service 13 the health care payor refuses to pay for on the basis of their 14 right of conscience in the health care payor’s policies, plans, 15 contracts, or other agreements. 16 c. Except as provided in subsection 4, a health care 17 institution or health care payor that refuses to participate in 18 or pay for a health care service under this section is immune 19 from liability for damages allegedly arising from the refusal, 20 and such refusal shall not be the basis for any discrimination 21 against the health care institution or health care payor. 22 2. a. A medical practitioner has the right not to 23 participate in a health care service that violates the medical 24 practitioner’s conscience. 25 b. A health care institution may require a medical 26 practitioner who is employed, contracted, or granted admitting 27 privileges by the health care institution and who is seeking to 28 exercise their conscience by not participating in a health care 29 service, to submit to the health care institution a written 30 refusal signed by the medical practitioner. A written refusal 31 made under this paragraph shall refer only generally to the 32 grounds of conscience. Except as provided in subsection 4, 33 a health care institution is immune from liability for the 34 exercise of conscience by a medical practitioner. 35 -3- LSB 5640XC (4) 90 pf/ko 3/ 11

S.F. _____ c. A medical practitioner who refuses to participate in a 1 health care service under this section is immune from liability 2 for damages allegedly arising from the refusal, and such 3 refusal shall not be the basis for any discrimination against 4 the medical practitioner. 5 3. This section shall not be construed to relieve a health 6 care institution of the requirement to provide emergency 7 medical services to all patients as required under 42 U.S.C. 8 §1395dd. 9 4. The immunity provisions of this section shall not apply 10 to a health care institution or a health care payor owned or 11 operated by the state or a political subdivision of the state. 12 Sec. 3. NEW SECTION . 135S.3 Exercise of conscience not 13 grounds for loss of privileges, immunities, or public benefits. 14 The exercise of conscience by a health care institution, 15 health care payor, or medical practitioner not to participate 16 in a health care service shall not be grounds for loss of any 17 privileges, immunities, or public benefits under state law. 18 Sec. 4. NEW SECTION . 135S.4 Whistleblower protections. 19 1. A medical practitioner or health care institution shall 20 not be discriminated against because the medical practitioner 21 or health care institution does any of the following: 22 a. Provides, causes to be provided, or intends to provide 23 or cause to be provided information relating to a suspected 24 violation of this chapter to the medical practitioner or health 25 care institution’s employer, the attorney general, any agency 26 charged with protecting health care rights of conscience, 27 the United States department of health and human services, 28 the United States commission on civil rights, or any other 29 federal agency charged with protecting health care rights of 30 conscience. 31 b. Testifies or intends to testify in a proceeding 32 concerning a violation of this chapter. 33 c. Assists or participates, or intends to assist or 34 participate, in a proceeding under this chapter. 35 -4- LSB 5640XC (4) 90 pf/ko 4/ 11

S.F. _____ 2. It shall be unlawful to discriminate against a medical 1 practitioner because the medical practitioner discloses 2 information to appropriate government, regulatory, or law 3 enforcement entities that the medical practitioner reasonably 4 believes evidences any of the following: 5 a. A violation of any law or rule. 6 b. A violation of any standard of care or ethical guidelines 7 for the provision of any health care service. 8 c. Gross mismanagement, a gross waste of funds, an abuse 9 of authority, practices, or methods of treatment that may put 10 patient health at risk, or a substantial and specific danger to 11 public health or safety. 12 3. This section shall not be construed to exempt a 13 person from the requirements of the federal Health Insurance 14 Portability and Accountability Act of 1996, Pub. L. No. 15 104-191, including amendments thereto and regulations 16 promulgated thereunder, or any other applicable confidentiality 17 and patient privacy requirements. 18 Sec. 5. NEW SECTION . 135S.5 Free speech protections —— 19 notification of complaints —— penalty. 20 1. The department of health and human services, a licensing 21 board designated under chapter 147, or any other licensing 22 or certifying entity of a medical practitioner shall not 23 reprimand, sanction, or revoke or threaten to revoke a license 24 or certification of a medical practitioner who is licensed 25 or certified by the department, licensing board, or other 26 licensing or certifying entity for engaging in speech or 27 expressive activity protected under the first amendment to 28 the Constitution of the United States, unless the department, 29 licensing board, or other licensing or certifying entity 30 demonstrates beyond a reasonable doubt that the medical 31 practitioner’s speech was the direct cause of physical harm 32 to a person with whom the medical practitioner had a medical 33 practitioner-patient relationship within the three years 34 immediately preceding the incident of physical harm. 35 -5- LSB 5640XC (4) 90 pf/ko 5/ 11

S.F. _____ 2. a. Within fourteen days of receiving a complaint that 1 alleges a medical practitioner’s speech was the direct cause of 2 physical harm to a person with whom the medical practitioner 3 had a medical practitioner-patient relationship that may 4 result in revocation of a medical practitioner’s license, the 5 department, licensing board, or other licensing or certifying 6 entity shall provide the medical practitioner with a copy of 7 the complaint. 8 b. If the department, licensing board, or other licensing or 9 certifying entity fails to provide a copy of the complaint to 10 the medical practitioner within fourteen days of receipt, the 11 department, licensing board, or other certifying entity shall 12 pay the medical practitioner an administrative penalty of five 13 hundred dollars for each week of noncompliance. 14 Sec. 6. NEW SECTION . 135S.6 Unlawful interference —— 15 relief. 16 1. It is unlawful for a person to interfere or attempt to 17 interfere with the exercise of conscience not to participate in 18 a health care service, or in the whistleblower or free speech 19 rights and protections under this chapter, whether by duress, 20 coercion, or any other means. 21 2. A health care institution, health care payor, or medical 22 practitioner that alleges injury by unlawful interference 23 by a person under this chapter may bring a civil action in 24 a court of competent jurisdiction. If a court of competent 25 jurisdiction finds a person liable under this section, the 26 court may order any of the following: 27 a. Injunctive relief, when appropriate, including but not 28 limited to reinstatement of a medical practitioner to the 29 medical practitioner’s previous position, or reinstatement 30 or reactivation of licensure or certification of a medical 31 practitioner, or reactivation or reinstatement of licensure of 32 a health care institution or a health care payor. 33 b. Monetary damages for injuries suffered. 34 c. Reasonable costs and attorney fees. 35 -6- LSB 5640XC (4) 90 pf/ko 6/ 11

S.F. _____ Sec. 7. NEW SECTION . 135S.7 Relationship to rights and 1 remedies relating to abortion. 2 This chapter shall not be construed to modify or limit the 3 rights and remedies provided under chapter 146. 4 Sec. 8. Section 146.1, Code 2024, is amended to read as 5 follows: 6 146.1 Liability of persons relating to performance of 7 abortions —— written affirmative consent required . 8 1. An individual who may lawfully perform, facilitate, 9 assist, refer for, or otherwise participate in medical 10 procedures which will result in an abortion shall not be 11 required against that individual’s religious beliefs or moral 12 convictions to perform, facilitate, assist, refer for, or 13 otherwise participate in such procedures. 14 2. A person shall not discriminate against any individual in 15 any way, including but not limited to employment, promotion, 16 advancement, transfer, licensing, education, training or the 17 granting of hospital privileges or staff appointments, because 18 of the individual’s participation in or refusal to participate 19 in recommending, performing, or assisting in an abortion 20 procedure as described in subsection 1 . 21 3. An individual shall not be scheduled, assigned, or 22 requested to directly or indirectly perform, facilitate, 23 assist, refer for, or otherwise participate in an abortion 24 unless the individual first affirmatively consents in writing 25 to perform, facilitate, refer for, or otherwise participate in 26 the abortion. 27 4. For the purposes of this chapter , “abortion” means the 28 termination of a human pregnancy with the intent other than to 29 produce a live birth or to remove a dead fetus. Abortion does 30 not include medical care which has as its primary purpose the 31 treatment of a serious physical condition requiring emergency 32 medical treatment necessary to save the life of a mother. 33 Sec. 9. APPLICABILITY. This Act applies to a health care 34 payor policy, contract, plan, or other agreement delivered, 35 -7- LSB 5640XC (4) 90 pf/ko 7/ 11

S.F. _____ issued for delivery, continued, or renewed in this state on or 1 after January 1, 2025. 2 EXPLANATION 3 The inclusion of this explanation does not constitute agreement with 4 the explanation’s substance by the members of the general assembly. 5 This bill relates to protections for health care 6 institutions, health care payors, and medical practitioners 7 involving a right of conscience, whistleblower activities, and 8 free speech. 9 The bill provides definitions used in the bill including for 10 “conscience”, “health care institution”, “health care payor”, 11 “health care service”, and “medical practitioner”. 12 The bill provides that a health care institution or health 13 care payor shall not be required to participate in or pay for a 14 health care service that violates the health care institution’s 15 or health care payor’s conscience. A health care payor shall 16 list any health care service the health care payor refuses to 17 pay for on the basis of their conscience in the health care 18 payor’s policies, plans, contracts, or other agreements. 19 A health care institution or health care payor that refuses 20 to participate in or pay for a health care service is immune 21 from liability for damages allegedly arising from the refusal, 22 and such refusal shall not be the basis for any discrimination 23 against the health care institution or health care payor. 24 The bill also provides that a medical practitioner has 25 the right not to participate in a health care service that 26 violates the medical practitioner’s conscience. A health care 27 institution may require a medical practitioner who is employed, 28 contracted, or granted admitting privileges by the health care 29 institution and who is seeking to exercise their conscience 30 by not participating in a health care service, to submit to 31 the health care institution a written refusal signed by the 32 medical practitioner. A health care institution is immune from 33 liability for the exercise of conscience not to participate in 34 a health care service by a medical practitioner. A medical 35 -8- LSB 5640XC (4) 90 pf/ko 8/ 11

S.F. _____ practitioner who refuses to participate in a health care 1 service due to exercise of conscience is immune from liability 2 for damages allegedly arising from the refusal, and such 3 refusal shall not be the basis for any discrimination against 4 the medical practitioner. 5 These provisions are not to be construed to relieve a 6 health care institution of the requirement under federal law 7 to provide emergency medical services to all patients. The 8 immunity provisions do not apply to a health care institution 9 or health care payor owned or operated by the state or a 10 political subdivision of the state. 11 The bill provides that a medical practitioner’s, health care 12 institution’s, or health care payor’s exercise of conscience 13 not to participate in a health care service shall not be 14 grounds for loss of any privileges, immunities, or public 15 benefits under state law. 16 The bill provides whistleblower protections by providing 17 that a medical practitioner or health care institution shall 18 not be discriminated against because the medical practitioner 19 or health care institution: provides, causes to be provided, 20 or intends to provide or cause to be provided information 21 relating to a suspected violation of the bill to the medical 22 practitioner or health care institution’s employer or various 23 other entities specified in the bill; testifies or intends to 24 testify in a proceeding concerning a violation of the bill; or 25 assists or participates, or intends to assist or participate, 26 in a proceeding under the bill. It is also unlawful under the 27 bill to discriminate against a medical practitioner because 28 the medical practitioner discloses information to appropriate 29 government, regulation, or law enforcement entities that the 30 medical practitioner reasonably believes evidences a violation 31 of any law or rule; a violation of any standard of care or 32 ethical guidelines for the provision of any health care 33 service; or gross mismanagement, a gross waste of funds, an 34 abuse of authority, practices, or methods of treatment that 35 -9- LSB 5640XC (4) 90 pf/ko 9/ 11

S.F. _____ may put patient health at risk, or a substantial and specific 1 danger to public health or safety. These provisions are not to 2 be construed to exempt a person from the requirements of the 3 federal Health Insurance Portability and Accountability Act. 4 The bill also provides that the department of health and 5 human services (HHS), a health professional licensing board, 6 or any other licensing or certifying entity of a medical 7 practitioner shall not reprimand, sanction, or revoke or 8 threaten to revoke a license or certification of a medical 9 practitioner for engaging in speech or expressive activity 10 protected under the first amendment to the Constitution of 11 the United States, unless HHS, a licensing board, or other 12 licensing or certifying entity demonstrates beyond a reasonable 13 doubt that the medical practitioner’s speech was the direct 14 cause of physical harm to a person with whom the medical 15 practitioner had a medical practitioner-patient relationship 16 within the three years immediately preceding the incident 17 of physical harm. Within 14 days of receiving a complaint 18 alleging a medical practitioner’s speech was the direct cause 19 of physical harm to a person with whom the medical practitioner 20 had a medical practitioner-patient relationship that may result 21 in revocation of a medical practitioner’s license, HHS, a 22 licensing board, or other licensing or certifying entity shall 23 provide the medical practitioner with a copy of the complaint. 24 If HHS, a licensing board, or other licensing or certifying 25 entity fails to provide the complaint within 14 days of 26 receipt, HHS, the licensing board, or other certifying entity 27 shall pay the medical practitioner an administrative penalty of 28 $500 for each week of noncompliance. 29 The bill provides that it is unlawful for a person to 30 interfere or attempt to interfere with the exercise of 31 conscience not to participate in a health care service or the 32 whistleblower or free speech rights and protections authorized 33 under the bill. A health care institution, health care payor, 34 or medical practitioner injured by unlawful interference 35 -10- LSB 5640XC (4) 90 pf/ko 10/ 11

S.F. _____ under the bill is entitled to bring a civil action that, if 1 successful, may result in injunctive relief, monetary damages 2 for injuries suffered, and reasonable costs and attorney fees. 3 The provisions of the bill shall not be construed as 4 modifying or limiting the rights and remedies provided under 5 Code chapter 146 (abortions —— refusal to perform). 6 The bill also amends Code chapter 146 to provide that an 7 individual shall not be scheduled, assigned, or requested to 8 directly or indirectly perform, facilitate, refer for, or 9 otherwise participate in an abortion unless the individual 10 first affirmatively consents in writing to perform, facilitate, 11 refer for, or otherwise participate in the abortion. 12 The bill applies to a health care payor policy, contract, 13 plan, or other agreement delivered, issued for delivery, 14 continued, or renewed in the state on or after January 1, 2025. 15 -11- LSB 5640XC (4) 90 pf/ko 11/ 11