H.F. 2593 Section 1. SHORT TITLE. This Act shall be known and may be 1 cited as “The Amir Act”. 2 Sec. 2. NEW SECTION . 135E.1 Legislative findings and 3 intent. 4 1. The general assembly finds all of the following: 5 a. Infant and maternal mortality remain critical public 6 health concerns in this state. 7 b. Preventable harm and death can occur when patient and 8 caregiver concerns, particularly concerns raised by mothers, 9 are dismissed, delayed, or not adequately escalated within 10 medical settings. 11 c. Parents and guardians are often the first to recognize 12 signs of distress or decline in an infant. 13 d. Health care systems must ensure that concerns raised 14 by patients, caregivers, parents, and guardians are taken 15 seriously, documented, and promptly evaluated. 16 2. The general assembly intends for this chapter to 17 accomplish all of the following: 18 a. Strengthen protections for infants and mothers. 19 b. Ensure timely medical response when a patient, caregiver, 20 parent, or guardian expresses concerns regarding the condition 21 of an infant or the infant’s mother. 22 c. Establish clear accountability and escalation protocols 23 in health care facilities. 24 d. Reduce preventable infant and maternal morbidity and 25 mortality. 26 Sec. 3. NEW SECTION . 135E.2 Definitions. 27 For purposes of this chapter, unless the context otherwise 28 requires: 29 1. “Caregiver” means a parent, legal guardian, legal 30 custodian, or primary caregiver for an infant. 31 2. “Caregiver concern” means a verbal or written expression 32 by a caregiver indicating the belief that an infant or the 33 infant’s mother is experiencing distress, deterioration, or 34 abnormal symptoms. 35 -1- LSB 5426YH (4) 91 dg/ko 1/ 6

H.F. 2593 3. “Department” means the department of health and human 1 services. 2 4. “Escalation protocol” means a formal process requiring 3 review by a clinician in a supervisory position or a care team. 4 5. “Health care facility” means any of the following: 5 a. A hospital as defined in section 135B.1. 6 b. A birth center as defined in section 135.131. 7 c. A birthing hospital as defined in section 135.131. 8 d. Other medical facilities licensed to provide infant or 9 maternal care in this state. 10 6. “Infant” means a child under one year of age. 11 7. “Infant rapid response process” means a series of actions 12 a health care facility must immediately take to evaluate the 13 condition of an infant, determine whether the infant’s care 14 needs to be altered, and execute the altered care if necessary. 15 Sec. 4. NEW SECTION . 135E.3 Caregiver concern —— escalation 16 protocols. 17 1. Each health care facility shall adopt and implement a 18 caregiver concern escalation protocol for infant and maternal 19 patients. 20 2. When a health care facility receives a caregiver concern, 21 the health care facility shall do all of the following: 22 a. Provide the individual who expressed the caregiver 23 concern an acknowledgment that the health care facility has 24 received and will act on the caregiver concern as soon as 25 practicable. 26 b. Document the caregiver concern in the medical record for 27 the infant or mother to whom the caregiver concern relates. 28 c. Conduct an assessment of the caregiver concern as soon 29 as practicable. 30 d. Refer the caregiver concern to a physician in a 31 supervisory position, a neonatal specialist, or a rapid 32 response team if any of the following occurs: 33 (1) The caregiver that expressed the caregiver concern 34 believes the issue that gave rise to the caregiver concern 35 -2- LSB 5426YH (4) 91 dg/ko 2/ 6

H.F. 2593 remains unresolved after the health care facility assessed the 1 infant or mother. 2 (2) Upon request by the caregiver that expressed the 3 caregiver concern. 4 3. A health care facility or health care provider shall not 5 do any of the following in response to a caregiver concern: 6 a. Retaliate against the caregiver, the caregiver’s infant, 7 or the mother who is the subject of the caregiver concern. 8 b. Discharge the caregiver’s infant or the mother who is the 9 subject of the caregiver concern from the health care facility 10 or the health care provider’s care. 11 c. Dismiss the caregiver concern without taking action. 12 Sec. 5. NEW SECTION . 135E.4 Infant rapid response process. 13 1. A health care facility that provides care to infants 14 shall maintain an infant rapid response process that may be 15 initiated by any of the following: 16 a. Medical staff attending an infant. 17 b. A caregiver when the caregiver believes the condition of 18 the caregiver’s infant is worsening. 19 2. When the infant rapid response process is initiated, 20 a physician shall immediately evaluate the condition of the 21 infant who is the subject of the infant rapid response process. 22 Sec. 6. NEW SECTION . 135E.5 Family and patient advocacy 23 notice. 24 1. Each health care facility shall provide a written and 25 verbal notice to an infant’s caregivers when the infant is 26 brought to the health care facility to receive treatment. 27 The written and verbal notice shall include a statement that 28 the caregiver is entitled to the following rights under this 29 chapter: 30 a. The right to make and have caregiver concerns documented. 31 b. The right to request a higher acuity of care for the 32 caregiver’s infant or the infant’s mother, as applicable. 33 c. The right to initiate an infant rapid response process. 34 2. Each health care facility where infants receive 35 -3- LSB 5426YH (4) 91 dg/ko 3/ 6

H.F. 2593 treatment shall display a written notice that contains the 1 information in subsection 1, paragraphs “a” through “c” , in a 2 prominent location. 3 Sec. 7. NEW SECTION . 135E.6 Training requirements. 4 All health care facility staff who provide, or assist in 5 the provision of, infant or maternal care shall receive annual 6 training on all of the following: 7 1. Implicit bias and patient communication. 8 2. Recognizing caregiver-reported warning signs. 9 3. Proper use of escalation protocols and infant rapid 10 response processes. 11 Sec. 8. NEW SECTION . 135E.7 Rules. 12 1. The department shall adopt rules pursuant to chapter 17A 13 to do all of the following: 14 a. Implement and administer section 135E.5, including but 15 not limited to all of the following: 16 (1) Rules establishing minimum hours of annual training. 17 (2) Rules establishing which classes and training programs 18 qualify for credit. 19 (3) Other rules related to training that the department 20 deems relevant to effectuate the intent of this chapter. 21 b. Require each health care facility to provide data 22 relating to all incidents with adverse outcomes when a 23 caregiver requested a higher acuity of care for the caregiver’s 24 infant or when an infant rapid response process was initiated. 25 2. The department of inspections, appeals, and licensing 26 shall adopt rules pursuant to chapter 17A to implement, 27 administer, and enforce this chapter. Rules relating to 28 enforcement shall include the corrective action plans, 29 administrative penalties, or licensure review for a person 30 found in violation of this chapter. 31 EXPLANATION 32 The inclusion of this explanation does not constitute agreement with 33 the explanation’s substance by the members of the general assembly. 34 This bill relates to infant and maternal care at a health 35 -4- LSB 5426YH (4) 91 dg/ko 4/ 6

H.F. 2593 care facility (facility). 1 The bill shall be known and may be cited as “The Amir Act”. 2 The bill states several legislative findings and the intent of 3 the bill. 4 The bill defines “caregiver” as a parent, legal guardian, 5 legal custodian, or primary caregiver for an infant. 6 The bill defines “caregiver concern” as a verbal or written 7 expression by a caregiver indicating the belief that an infant 8 or the infant’s mother is experiencing distress, deterioration, 9 or abnormal symptoms. 10 The bill defines “escalation protocol” as a formal process 11 requiring review by a clinician in a supervisory position or a 12 care team. 13 The bill defines “health care facility” (facility) as a 14 hospital, a birth center, a birthing hospital, or other medical 15 facilities licensed to provide infant or maternal care in this 16 state. 17 The bill defines “infant rapid response process” as a series 18 of actions a facility must immediately take to evaluate the 19 condition of an infant, determine whether the infant’s care 20 needs to be altered, and execute the altered care if necessary. 21 The bill also defines “department” and “infant”. 22 The bill requires each facility to adopt and implement a 23 caregiver concern escalation protocol for infant and maternal 24 patients, and requires a facility to take certain actions 25 specified in the bill when the facility receives a caregiver 26 concern. 27 The bill prohibits a facility or health care provider from 28 retaliating against a caregiver, an infant, or a mother, or 29 discharging an infant or a mother, due to the fact a caregiver 30 expressed a caregiver concern. The bill also prohibits a 31 facility from dismissing a caregiver concern without taking 32 action. 33 The bill requires a facility that provides care to infants to 34 maintain an infant rapid response process that may be initiated 35 -5- LSB 5426YH (4) 91 dg/ko 5/ 6

H.F. 2593 by medical staff attending an infant, or a caregiver when the 1 caregiver believes the condition of the caregiver’s infant is 2 worsening. When an infant rapid response process is initiated, 3 a physician shall immediately evaluate the infant’s condition. 4 The bill requires a facility to provide written and verbal 5 notice to an infant’s caregivers when the infant is brought 6 to the facility to receive treatment. The written and verbal 7 notice shall include a statement that the caregiver is entitled 8 to certain rights under the bill, and the written notice must 9 be displayed in a prominent location where infants receive 10 treatment. 11 The bill requires all facility staff who provide, or assist 12 in the provision of, infant or maternal care to receive annual 13 training as specified in the bill. 14 The bill requires the department of health and human 15 services to adopt rules relating to facility staff training 16 and requiring each facility to provide data relating to all 17 incidents with adverse outcomes when a caregiver requested a 18 higher acuity of care for the caregiver’s infant, or when an 19 infant rapid response process was initiated. 20 The bill requires the department of inspections, appeals, 21 and licensing to adopt rules to implement, administer, and 22 enforce the bill. Rules relating to enforcement must include 23 corrective action plans, administrative penalties, or licensure 24 review for a person found in violation of the bill. 25 -6- LSB 5426YH (4) 91 dg/ko 6/ 6