House File 571 - Reprinted HOUSE FILE 571 BY COMMITTEE ON JUDICIARY (SUCCESSOR TO HSB 139) (As Amended and Passed by the House March 26, 2025 ) A BILL FOR An Act relating to protections for medical practitioners, 1 health care institutions, and health care payors including 2 those related to the exercise of conscience, whistleblower 3 activities, and free speech, and providing penalties. 4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 5 HF 571 (2) 91 lh/ko/md

H.F. 571 Section 1. SHORT TITLE. This Act shall be known and may be 1 cited as the “Medical Ethics Defense Act”. 2 Sec. 2. NEW SECTION . 135S.1 Definitions. 3 As used in this chapter, unless the context otherwise 4 requires: 5 1. a. “Conscience” means the ethical, moral, or religious 6 beliefs or principles held by a medical practitioner, health 7 care institution, or health care payor. 8 b. With respect to persons who are institutions, 9 corporations, or other legal entities, “conscience” is 10 determined by reference to that entity’s governing documents 11 including but not limited to published ethical, moral, or 12 religious guidelines or directives, mission statements, 13 constitutions, articles of incorporation, bylaws, policies, or 14 regulations. 15 2. “Discrimination” means an adverse action, including but 16 not limited to any penalty, disciplinary, or retaliatory action 17 taken against, or a threat of adverse action communicated to, a 18 medical practitioner, health care institution, or health care 19 payor as a result of the refusal of the medical practitioner, 20 health care institution, or health care payor to participate 21 in a health care service on the basis of conscience. 22 “ Discrimination” not does include the negotiation or purchase of 23 insurance or a health care service by a nongovernmental entity 24 or individual, the refusal to use or purchase insurance or a 25 health care service by a nongovernmental entity or individual, 26 or a health care institution’s good-faith effort to accommodate 27 a medical practitioner’s, health care institution’s, or health 28 care payor’s exercise of conscience. 29 3. “Health care institution” means an organization, 30 corporation, partnership, association, agency, network, sole 31 proprietorship, joint venture, or other entity that provides 32 a health care service. 33 4. “Health care payor” means an employer; a health plan; 34 a management services organization; any entity, including a 35 -1- HF 571 (2) 91 lh/ko/md 1/ 7

H.F. 571 health service corporation, health maintenance organization, 1 or any similar corporation or organization, or an employer 2 offering self-insurance, that provides a health benefit plan; 3 or any other entity that pays for or arranges for payment, in 4 whole or in part, for a health care service. 5 5. “Health care service” means medical research and medical 6 care provided to a patient or client at any time during the 7 patient’s or client’s course of treatment, including but 8 not limited to testing; diagnosis; record making; referral; 9 prescribing, dispensing, or administering any drug, medication, 10 or device; therapy or counseling; and preparation or 11 arrangement for a surgical procedure. 12 6. “Medical practitioner” means a person who facilitates 13 or participates, or who is asked to facilitate or participate 14 in a health care service, including but not limited to a 15 health-related professional licensed by a board designated in 16 section 147.13, and any other person licensed, certified, or 17 otherwise authorized or permitted by the laws of this state 18 to administer a health care service in the ordinary course 19 of business or in the practice of a profession. “Medical 20 practitioner” includes any student enrolled in an educational 21 institution who is a prospective medical practitioner. 22 8. “Participate in a health care service” means to provide, 23 perform, assist with, facilitate, refer for, provide counseling 24 for, advise with regard to, admit for the purposes of 25 providing, or take part in a health care service in any way. 26 Sec. 3. NEW SECTION . 135S.2 Exercise of conscience for 27 health care institutions, health care payors, and medical 28 practitioners —— exception. 29 1. a. A medical practitioner, health care institution, 30 or health care payor has the right not to participate in 31 or pay for a health care service that violates the medical 32 practitioner’s, health care institution’s, or health care 33 payor’s conscience. This paragraph shall not be construed to 34 waive or modify a duty a medical practitioner, health care 35 -2- HF 571 (2) 91 lh/ko/md 2/ 7

H.F. 571 institution, or health care payor may have to participate in or 1 pay for a health care service that does not violate the medical 2 practitioner’s conscience. 3 b. A medical practitioner, health care institution, or 4 health care payor who refuses to participate in a health care 5 service under this section shall not be discriminated against 6 for the medical practitioner’s, health care institution’s, or 7 health care payor’s exercise of conscience. 8 2. A health care payor shall not decline to pay for a health 9 care service due to a medical practitioner’s, health care 10 institution’s, or health care payor’s refusal to participate 11 in a health care service under this section if the health care 12 payor is contractually obligated to pay for the health care 13 service. 14 3. This section shall not be construed to relieve a health 15 care institution of the requirement to provide emergency 16 medical services to individuals as required under 42 U.S.C. 17 §1395dd. 18 4. Notwithstanding any other provision of this chapter to 19 the contrary, a medical practitioner, health care institution, 20 or health care payor that holds itself out to the public as 21 religion-based, states in the entity’s governing documents 22 that the entity has a religious purpose or mission, and that 23 has internal operating policies or procedures that implement 24 the entity’s religious beliefs, shall have the right to make 25 employment, staffing, contracting, and admitting privilege 26 decisions consistent with the entity’s religious beliefs. 27 Sec. 4. NEW SECTION . 135S.3 Exercise of conscience —— 28 immunity. 29 1. A medical practitioner, health care institution, 30 or health care payor shall not be civilly, criminally, or 31 administratively liable for the medical practitioner’s, health 32 care institution’s, or health care payor’s good faith exercise 33 of conscience. 34 2. A health care institution shall not be civilly, 35 -3- HF 571 (2) 91 lh/ko/md 3/ 7

H.F. 571 criminally, or administratively liable for the good faith 1 exercise of conscience by a medical practitioner employed, 2 contracted, or granted admitting privileges by the health care 3 institution. 4 Sec. 5. NEW SECTION . 135S.4 Whistleblower protections. 5 1. A medical practitioner, health care institution, or 6 health care payor shall not be discriminated against because 7 the medical practitioner, health care institution, or health 8 care payor does any of the following: 9 a. Provides, causes to be provided, or intends to provide 10 or cause to be provided information relating to a suspected 11 violation of this chapter to the medical practitioner’s, 12 health care institution’s, or health care payor’s employer, 13 the attorney general, any state agency charged with protecting 14 health care rights of conscience, the United States department 15 of health and human services, the United States commission 16 on civil rights, or any other federal agency charged with 17 protecting health care rights of conscience. 18 b. Testifies or intends to testify in a proceeding 19 concerning a violation of this chapter. 20 c. Assists or participates, or intends to assist or 21 participate, in a proceeding under this chapter. 22 2. It shall be unlawful to discriminate against a medical 23 practitioner, health care institution, or health care payor 24 because the medical practitioner, health care institution, 25 or health care payor discloses information that the medical 26 practitioner, health care institution, or health care payor 27 reasonably believes evidences any of the following: 28 a. A violation of any law or rule. 29 b. A violation of any standard of care or ethical guidelines 30 for the provision of any health care service. 31 c. Gross mismanagement, a gross waste of funds, an abuse 32 of authority, practices or methods of treatment that may put 33 patient or client health at risk, or a substantial and specific 34 danger to public health or safety. 35 -4- HF 571 (2) 91 lh/ko/md 4/ 7

H.F. 571 3. This section shall not be construed to exempt a 1 person from the requirements of the federal Health Insurance 2 Portability and Accountability Act of 1996, Pub. L. No. 3 104-191, including amendments thereto and regulations 4 promulgated thereunder, or any other applicable confidentiality 5 and patient or client privacy requirements. 6 Sec. 6. NEW SECTION . 135S.5 Free speech protections —— 7 notification of complaints —— penalty. 8 1. The department of health and human services, a licensing 9 board designated under chapter 147, or any other state 10 licensing or certifying entity of a medical practitioner shall 11 not reprimand, sanction, or revoke or threaten to revoke a 12 license or certification of a medical practitioner, health care 13 institution, or health care payor who is licensed or certified 14 by the department, licensing board, or other licensing or 15 certifying entity, for engaging in speech, expressive activity, 16 or association protected under the first amendment to the 17 Constitution of the United States, unless the department, 18 licensing board, or other licensing or certifying entity 19 demonstrates by clear and convincing evidence that the medical 20 practitioner’s, health care institution’s, or health care 21 payor’s speech, expressive activity, or association was the 22 direct cause of physical harm to a person with whom the medical 23 practitioner, health care institution, or health care payor had 24 a medical practitioner-patient or medical practitioner-client 25 relationship within the three years immediately preceding the 26 incident of physical harm. 27 2. a. Within twenty-one days of receipt of a complaint 28 that alleges a violation of speech, expressive activity, or 29 association protected under subsection 1 that may result 30 in revocation of a medical practitioner’s, health care 31 institution’s, or health care payor’s license, certification, 32 or registration, the department, licensing board, or other 33 licensing or certifying entity shall provide the medical 34 practitioner, health care institution, or health care payor 35 -5- HF 571 (2) 91 lh/ko/md 5/ 7

H.F. 571 with a copy of the complaint. 1 b. If the department, licensing board, or other licensing or 2 certifying entity fails to provide a copy of the complaint to 3 the medical practitioner, health care institution, or health 4 care payor within twenty-one days of receipt, the department, 5 licensing board, or other certifying entity shall pay the 6 medical practitioner, health care institution, or health care 7 payor an administrative penalty of five hundred dollars for 8 each day of noncompliance. 9 3. The state shall not contract with, recognize, approve, 10 or require a medical practitioner, health care institution, 11 or health care payor to obtain a certification or credential 12 issued or approved by the department of health and human 13 services, a licensing board designated under chapter 147, 14 or any other licensing or certifying entity of a medical 15 practitioner, health care institution, or health care payor 16 that revokes or refuses to issue a certification or credential 17 to the medical practitioner, health care institution, or 18 health care payor if the medical practitioner, health care 19 institution, or health care payor is in compliance with this 20 chapter and did not provide medical advice or treatment to a 21 patient or client. 22 Sec. 7. NEW SECTION . 135S.6 Unlawful interference —— 23 relief. 24 1. It is unlawful for a person to interfere or attempt to 25 interfere with the exercise of conscience not to participate in 26 a health care service, or in the whistleblower or free speech 27 rights and protections under this chapter, whether by duress, 28 coercion, or any other means. 29 2. A health care institution, health care payor, or medical 30 practitioner that alleges injury by unlawful interference 31 by a person under this chapter may bring a civil action in 32 a court of competent jurisdiction. If a court of competent 33 jurisdiction finds a person liable under this section, the 34 court may order any of the following: 35 -6- HF 571 (2) 91 lh/ko/md 6/ 7

H.F. 571 a. Injunctive relief, when appropriate, including but not 1 limited to reinstatement of a medical practitioner to the 2 medical practitioner’s previous position, or reinstatement 3 or reactivation of licensure or certification of a medical 4 practitioner, or reactivation or reinstatement of licensure of 5 a health care institution or a health care payor. 6 b. Monetary damages for injuries suffered. 7 c. Reasonable costs and attorney fees. 8 3. The rights, remedies, and prohibitions contained in this 9 chapter shall be in addition to and cumulative of any other 10 right, remedy, or prohibition accorded by common law or state 11 or federal law. This chapter shall not be construed to deny, 12 abrogate, or impair any such common law or statutory right, 13 remedy, or prohibition. 14 4. Any additional burden or expense to another medical 15 practitioner, health care institution, or health care payor 16 arising from the exercise of conscience pursuant to this 17 chapter shall not be a defense to a violation of this chapter. 18 5. A person shall not bring a civil action against a person 19 who declines to use or purchase a health care service from 20 a medical practitioner, health care institution, or health 21 care payor because of the medical practitioner’s, health care 22 institution’s, or health care payor’s exercise of conscience 23 under this chapter. 24 Sec. 8. NEW SECTION . 135S.7 Severability. 25 If any provision of this chapter or its application to any 26 person or circumstance is held invalid, the invalidity shall 27 not affect other provisions or applications of this chapter 28 which can be given effect without the invalid provision or 29 application, and to this end the provisions of this chapter are 30 severable. 31 -7- HF 571 (2) 91 lh/ko/md 7/ 7