House File 634 - Reprinted HOUSE FILE 634 BY COMMITTEE ON APPROPRIATIONS (SUCCESSOR TO HF 595) (SUCCESSOR TO HSB 79) (As Amended and Passed by the House April 18, 2017 ) A BILL FOR An Act relating to educational assistance programs administered 1 by the department of public health or the college student 2 aid commission for nurses, physician assistants, advanced 3 registered nurse practitioners, and nurse educators. 4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 5 HF 634 (2) 87 kh/rj/jh/md

H.F. 634 Section 1. NEW SECTION . 135.175A Iowa needs nurses now 1 initiative —— fund. 2 1. Nurse educator incentive payment program. 3 a. The department shall establish a nurse educator incentive 4 payment program. For the purposes of this subsection , “nurse 5 educator” means a registered nurse who holds a master’s degree 6 or doctorate degree and is employed as a faculty member who 7 teaches nursing in a nursing education program as provided in 8 rules adopted by the board of nursing at a community college, 9 an accredited private institution, or an institution of higher 10 education governed by the state board of regents. 11 b. The program shall consist of incentive payments to 12 recruit and retain nurse educators. The program shall provide 13 for incentive payments of up to twenty thousand dollars for a 14 nurse educator who remains teaching in a qualifying teaching 15 position for a period of not less than four consecutive 16 academic years. 17 c. The nurse educator and the department shall enter into an 18 agreement specifying the obligations of the nurse educator and 19 the department. If the nurse educator leaves the qualifying 20 teaching position prior to teaching for four consecutive 21 academic years, the nurse educator shall be liable to repay 22 the incentive payment amount to the state, plus interest as 23 specified by rule. However, if the nurse educator leaves 24 the qualifying teaching position involuntarily, the nurse 25 educator shall be liable to repay only a pro rata amount of the 26 incentive payment based on incompleted years of service. 27 d. The department, in consultation with the board of 28 nursing, the department of education, and the Iowa nurses 29 association, shall adopt rules pursuant to chapter 17A relating 30 to the establishment and administration of the nurse educator 31 incentive payment program. The rules shall include provisions 32 specifying what constitutes a qualifying teaching position. 33 2. Nursing faculty fellowship program. 34 a. The department shall establish a nursing faculty 35 -1- HF 634 (2) 87 kh/rj/jh/md 1/ 11

H.F. 634 fellowship program to provide funds to nursing schools in the 1 state, including but not limited to nursing schools located at 2 community colleges, for fellowships for individuals employed in 3 qualifying positions on the nursing faculty. The program shall 4 be designed to assist nursing schools in filling vacancies in 5 qualifying positions throughout the state. 6 b. The department, in consultation with the board of 7 nursing, the department of education, and the Iowa nurses 8 association, and in cooperation with nursing schools throughout 9 the state, shall develop a distribution formula which shall 10 provide that no more than thirty percent of the available 11 moneys are awarded to a single nursing school. Additionally, 12 the program shall limit funding for a qualifying position in a 13 nursing school to no more than ten thousand dollars per year 14 for up to three years. 15 c. The department, in consultation with the board of 16 nursing, the department of education, and the Iowa nurses 17 association, shall adopt rules pursuant to chapter 17A to 18 administer the program. The rules shall include provisions 19 specifying what constitutes a qualifying position at a nursing 20 school. 21 d. In determining eligibility for a fellowship, the 22 department shall consider all of the following: 23 (1) The length of time a qualifying position has gone 24 unfilled at a nursing school. 25 (2) Documented recruiting efforts by a nursing school. 26 (3) The geographic location of a nursing school. 27 (4) The type of nursing program offered at the nursing 28 school, including associate, bachelor’s, master’s, or doctoral 29 degrees in nursing, and the need for the specific nursing 30 program in the state. 31 3. Nurse educator scholarship program. 32 a. The department shall establish a nurse educator 33 scholarship program. The goal of the nurse educator 34 scholarship program is to address the waiting list of qualified 35 -2- HF 634 (2) 87 kh/rj/jh/md 2/ 11

H.F. 634 applicants to Iowa’s nursing schools by providing incentives 1 for the training of additional nursing educators. For the 2 purposes of this subsection , “nurse educator” means a registered 3 nurse who holds a master’s degree or doctorate degree and is 4 employed as a faculty member who teaches nursing in a nursing 5 education program as provided in rules adopted by the board 6 of nursing at a community college, an accredited private 7 institution, or an institution of higher education governed by 8 the state board of regents. 9 b. The program shall consist of scholarships to further 10 advance the education of nurses to become nurse educators. The 11 program shall provide for scholarship payments in an amount 12 established by rule for students who are preparing to teach in 13 qualifying teaching positions. 14 c. The department, in consultation with the board of 15 nursing, the department of education, and the Iowa nurses 16 association, shall adopt rules pursuant to chapter 17A relating 17 to the establishment and administration of the nurse educator 18 scholarship program. The rules shall include provisions 19 specifying what constitutes a qualifying teaching position and 20 the amount of any scholarship. 21 4. Nurse educator scholarship-in-exchange-for-service 22 program. 23 a. The department shall establish a nurse educator 24 scholarship-in-exchange-for-service program. The goal of the 25 nurse educator scholarship-in-exchange-for-service program is 26 to address the waiting list of qualified applicants to Iowa’s 27 nursing schools by providing incentives for the education 28 of additional nursing educators. For the purposes of this 29 subsection , “nurse educator” means a registered nurse who holds 30 a master’s degree or doctorate degree and is employed as a 31 faculty member who teaches nursing in a nursing education 32 program as provided in rules adopted by the board of nursing 33 at a community college, an accredited private institution, or 34 an institution of higher education governed by the state board 35 -3- HF 634 (2) 87 kh/rj/jh/md 3/ 11

H.F. 634 of regents. 1 b. The program shall consist of scholarships to further 2 advance the education of nurses to become nurse educators. The 3 program shall provide for scholarship-in-exchange-for-service 4 payments in an amount established by rule for students who 5 are preparing to teach in qualifying teaching positions for a 6 period of not less than four consecutive academic years. 7 c. The scholarship-in-exchange-for-service recipient 8 and the department shall enter into an agreement specifying 9 the obligations of the applicant and the department. 10 If the nurse educator leaves the qualifying teaching 11 position prior to teaching for four consecutive academic 12 years, the nurse educator shall be liable to repay the 13 scholarship-in-exchange-for-service amount to the state plus 14 interest as specified by rule. However, if the nurse educator 15 leaves the qualified teaching position involuntarily, the nurse 16 educator shall be liable to repay only a pro rata amount of the 17 scholarship based on incomplete years of service. 18 d. The receipt of a nurse educator 19 scholarship-in-exchange-for-service shall not impact 20 eligibility of an individual for other financial incentives 21 including but not limited to loan forgiveness programs. 22 e. The department, in consultation with the board of 23 nursing, the department of education, and the Iowa nurses 24 association, shall adopt rules pursuant to chapter 17A 25 relating to the establishment and administration of the 26 nurse educator scholarship-in-exchange-for-service program. 27 The rules shall include the provisions specifying what 28 constitutes a qualifying teaching position and the amount of 29 any scholarship-in-exchange-for-service. 30 5. Iowa needs nurses now initiative fund established. An 31 Iowa needs nurses now initiative fund is created in the state 32 treasury as a separate fund under the control of the department 33 for deposit of moneys appropriated to or received by the 34 department for use under the initiative. Notwithstanding 35 -4- HF 634 (2) 87 kh/rj/jh/md 4/ 11

H.F. 634 section 8.33, moneys deposited in the fund shall not revert 1 to any fund of the state at the end of any fiscal year but 2 shall remain in the Iowa needs nurses now initiative fund and 3 be continuously available for the purposes of the initiative. 4 Notwithstanding section 12C.7, subsection 2, interest or 5 earnings on moneys deposited in the fund shall be credited to 6 the fund. 7 Sec. 2. Section 261.2, subsection 8, Code 2017, is amended 8 to read as follows: 9 8. Submit by January 15 annually a report to the general 10 assembly which provides, by program, the number of individuals 11 who received loan forgiveness or loan repayment in the previous 12 fiscal year, the amount amounts paid to or on behalf of 13 individuals under sections 261.73 , 261.112 , and 261.116 , and 14 the institutions from which individuals graduated, and that 15 includes any proposed statutory changes and the commission’s 16 findings and recommendations. 17 Sec. 3. Section 261.114, subsection 3, unnumbered paragraph 18 1, Code 2017, is amended to read as follows: 19 A program agreement shall be entered into by an eligible 20 student and the commission when the eligible student begins 21 the final year of study in an academic program leading to 22 eligibility for licensure as a nurse practitioner or physician 23 assistant. The commission shall not enter into any new 24 program agreement under this section on or after July 1, 2017. 25 Under the agreement, to receive loan repayments pursuant to 26 subsection 5 , an eligible student shall agree to and shall 27 fulfill all of the following requirements: 28 Sec. 4. Section 261.114, subsection 8, Code 2017, is amended 29 by striking the subsection. 30 Sec. 5. Section 261.114, subsection 9, Code 2017, is amended 31 to read as follows: 32 9. Postponement and satisfaction Satisfaction of service 33 obligation. 34 a. The obligation to engage in practice in accordance with 35 -5- HF 634 (2) 87 kh/rj/jh/md 5/ 11

H.F. 634 subsection 3 shall be postponed for the following purposes: 1 (1) Active duty status in the armed forces, the armed forces 2 military reserve, or the national guard. 3 (2) Service in volunteers in service to America. 4 (3) Service in the federal peace corps. 5 (4) A period of service commitment to the United States 6 public health service commissioned corps. 7 (5) A period of religious missionary work conducted by an 8 organization exempt from federal income taxation pursuant to 9 section 501(c)(3) of the Internal Revenue Code . 10 (6) Any period of temporary medical incapacity during which 11 the person obligated is unable, due to a medical condition, to 12 engage in full-time practice as required under subsection 3 . 13 b. Except for a postponement under paragraph “a” , 14 subparagraph (6), an obligation to engage in practice under an 15 agreement entered into pursuant to subsection 3 , shall not be 16 postponed for more than two years from the time the full-time 17 practice was to have commenced under the agreement. 18 c. a. An obligation to engage in full-time practice under 19 an agreement entered into pursuant to subsection 3 shall be 20 considered satisfied when any of the following conditions are 21 met: 22 (1) The terms of the agreement are completed. 23 (2) The person who entered into the agreement dies. 24 (3) The person who entered into the agreement, due to a 25 permanent disability, is unable to practice as an advanced 26 registered nurse practitioner or physician assistant. 27 d. b. If a loan repayment recipient fails to fulfill 28 the obligation to engage in practice in accordance with 29 subsection 3 , the recipient shall be subject to repayment to 30 the commission of the loan amount plus interest as specified 31 by rule. A loan repayment recipient who fails to meet the 32 requirements of the obligation to engage in practice in 33 accordance with subsection 3 may also be subject to repayment 34 of moneys advanced by the service commitment area as provided 35 -6- HF 634 (2) 87 kh/rj/jh/md 6/ 11

H.F. 634 in any agreement with the service commitment area. 1 Sec. 6. Section 261.114, subsection 10, Code 2017, is 2 amended to read as follows: 3 10. Trust fund established. A rural Iowa advanced 4 registered nurse practitioner and physician assistant trust 5 fund is created in the state treasury as a separate fund under 6 the control of the commission. The commission shall remit all 7 repayments made pursuant to this section to the rural Iowa 8 advanced registered nurse practitioner and physician assistant 9 trust fund. All moneys deposited or paid into the trust fund 10 are appropriated and made available to the commission to be 11 used for meeting the requirements of this section . Moneys in 12 the fund up to the total amount that an eligible student may 13 receive for an eligible loan in accordance with this section 14 and upon fulfilling the requirements of subsection 3 shall be 15 considered encumbered for the duration of the agreement entered 16 into pursuant to subsection 3 . Notwithstanding section 8.33 , 17 any balance in the fund on June 30 of each fiscal year shall not 18 revert to the general fund of the state, but shall be available 19 for purposes of this section in subsequent fiscal years. 20 Notwithstanding section 8.33, any balance in the fund on June 21 30, 2023, shall not revert to the general fund of the state but 22 shall be transferred to the health care loan repayment fund 23 established pursuant to section 261.116 to be used for purposes 24 of the health care loan repayment program. 25 Sec. 7. Section 261.114, Code 2017, is amended by adding the 26 following new subsection: 27 NEW SUBSECTION . 10A. This section is repealed July 1, 2023. 28 Sec. 8. Section 261.116, Code 2017, is amended to read as 29 follows: 30 261.116 Registered nurse and nurse educator Health care loan 31 forgiveness repayment program. 32 1. Definitions. For purposes of this section, unless the 33 context otherwise requires: 34 a. “Advanced registered nurse practitioner” means a person 35 -7- HF 634 (2) 87 kh/rj/jh/md 7/ 11

H.F. 634 licensed as a registered nurse under chapter 152 or 152E who 1 is licensed by the board of nursing as an advanced registered 2 nurse practitioner. 3 b. “Nurse educator” means a registered nurse who holds 4 a master’s degree or doctorate degree and is employed by a 5 community college, an accredited private institution, or an 6 institution of higher education governed by the state board 7 of regents as a faculty member to teach nursing at a nursing 8 education program approved by the board of nursing pursuant to 9 section 152.5. 10 c. “Physician assistant” means a person licensed as a 11 physician assistant under chapter 148C. 12 d. “Qualified student loan” means a loan that was made, 13 insured, or guaranteed under Tit. IV of the federal Higher 14 Education Act of 1965, as amended, or under Tit. VII or VIII 15 of the federal Public Health Service Act, as amended, directly 16 to the borrower for attendance at an approved postsecondary 17 educational institution. 18 e. “Service commitment area” means a city in Iowa with a 19 population of less than twenty-six thousand that is located 20 more than fifty miles from a city with a population of fifty 21 thousand or more. 22 2. Program established. A registered nurse and nurse 23 educator health care loan forgiveness repayment program is 24 established to be administered by the commission . The program 25 shall consist of loan forgiveness for eligible federally 26 guaranteed for purposes of repaying the qualified student 27 loans for of registered nurses , advanced registered nurse 28 practitioners, physician assistants, and nurse educators who 29 practice full-time in a service commitment area or teach in 30 this state , as appropriate, and who are selected for the 31 program in accordance with this section . For purposes of 32 this section , unless the context otherwise requires, “nurse 33 educator” means a registered nurse who holds a master’s degree 34 or doctorate degree and is employed as a faculty member who 35 -8- HF 634 (2) 87 kh/rj/jh/md 8/ 11

H.F. 634 teaches nursing as provided in 655 IAC 2.6 (152) at a community 1 college, an accredited private institution, or an institution 2 of higher education governed by the state board of regents. An 3 applicant who is a member of the Iowa national guard is exempt 4 from the service commitment area requirement, but shall submit 5 an affidavit verifying the applicant is practicing full-time 6 in this state. 7 2. 3. Application requirements. Each applicant for loan 8 forgiveness repayment shall, in accordance with the rules of 9 the commission, do the following: 10 a. Complete and file an application for registered nurse 11 or nurse educator loan forgiveness repayment . The individual 12 shall be responsible for the prompt submission of any 13 information required by the commission. 14 b. File a new application and submit information as 15 required by the commission annually on the basis of which 16 the applicant’s eligibility for the renewed loan forgiveness 17 repayment will be evaluated and determined. 18 c. Complete and return, on a form approved by the 19 commission, an affidavit of practice verifying that the 20 applicant is a registered nurse , an advanced registered nurse 21 practitioner, or a physician assistant who is practicing 22 full-time in a service commitment area in this state or is a 23 nurse educator teaching at a community college, an accredited 24 private institution, or an institution of higher learning 25 governed by the state board of regents who teaches full-time 26 in this state . If practice in a service commitment area is 27 required as a condition of receiving loan repayment, the 28 affidavit shall specify the service commitment area in which 29 the applicant is practicing full-time. 30 3. 4. Loan repayment amounts. 31 a. The annual amount of registered nurse loan forgiveness 32 for a registered nurse who completes a course of study, which 33 leads to a baccalaureate or associate degree of nursing, 34 diploma in nursing, or a graduate or equivalent degree in 35 -9- HF 634 (2) 87 kh/rj/jh/md 9/ 11

H.F. 634 nursing, and who practices in this state, repayment provided to 1 a recipient under this section shall not exceed the resident 2 tuition rate established for institutions of higher learning 3 governed by the state board of regents for the first year 4 following the registered nurse’s graduation from a nursing 5 education program approved by the board of nursing pursuant to 6 section 152.5 six thousand dollars , or twenty percent of the 7 registered nurse’s total federally guaranteed Stafford loan 8 amount under the federal family education loan program or the 9 federal direct loan program, including principal and interest 10 recipient’s total qualified student loan , whichever amount is 11 less. A registered nurse shall be recipient is eligible for 12 the loan forgiveness repayment program for not more than five 13 consecutive years. 14 b. The annual amount of nurse educator loan forgiveness 15 shall not exceed the resident tuition rate established for 16 institutions of higher learning governed by the state board 17 of regents for the first year following the nurse educator’s 18 graduation from an advanced formal academic nursing education 19 program approved by the board of nursing pursuant to section 20 152.5 , or twenty percent of the nurse educator’s total 21 federally guaranteed Stafford loan amount under the federal 22 family education loan program or the federal direct loan 23 program, including principal and interest, whichever amount 24 is less. A nurse educator shall be eligible for the loan 25 forgiveness program for not more than five consecutive years. 26 4. 5. Selection criteria. The commission shall establish 27 by rule the evaluation criteria to be used in evaluating 28 applications submitted under this section. Priority shall be 29 given to applicants who are residents of Iowa and, if requested 30 by the adjutant general, to applicants who are members of the 31 Iowa national guard. 32 6. Health care loan repayment fund. A registered nurse and 33 nurse educator health care loan forgiveness repayment fund is 34 created for deposit of moneys appropriated to or received by 35 -10- HF 634 (2) 87 kh/rj/jh/md 10/ 11

H.F. 634 the commission for use under the program. Notwithstanding 1 section 8.33 , moneys deposited in the health care loan 2 repayment fund shall not revert to any fund of the state 3 at the end of any fiscal year but shall remain in the loan 4 forgiveness repayment fund and be continuously available for 5 loan forgiveness repayment under the program. Notwithstanding 6 section 12C.7, subsection 2 , interest or earnings on moneys 7 deposited in the health care loan fund shall be credited to the 8 fund. 9 5. 7. Report. The commission shall submit in a report 10 to the general assembly by January 1, annually, the number of 11 individuals who received loan forgiveness repayment pursuant to 12 this section , where the participants practiced or taught, the 13 amount paid to each program participant, and other information 14 identified by the commission as indicators of outcomes from of 15 the program. 16 6. 8. Rules. The commission shall adopt rules pursuant to 17 chapter 17A to administer this section . 18 Sec. 9. REPEAL. Section 261.129, Code 2017, is repealed. 19 -11- HF 634 (2) 87 kh/rj/jh/md 11/ 11