House File 427 - Introduced
HOUSE FILE 427
BY COMMITTEE ON HEALTH AND
HUMAN SERVICES
(SUCCESSOR TO HSB 91)
A BILL FOR
1 An Act relating to the health and well-being of children
2 and families including provisions for regional centers of
3 excellence, a state-funded family medicine obstetrical
4 fellowship program, self-administered hormonal
5 contraceptives, maternal support and fatherhood initiatives,
6 adoption expenses under the adoption subsidy program,
7 and accessibility to the all Iowa scholarship program;
8 making appropriations; and including effective date and
9 applicability provisions.
10 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
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1 DIVISION I
2 REGIONAL CENTERS OF EXCELLENCE GRANT PROGRAM
3 Section 1. REGIONAL CENTERS OF EXCELLENCE PROGRAM —— GRANTS
4 —— APPROPRIATION. There is appropriated from the general fund
5 of the state to the department of health and human services for
6 the fiscal year beginning July 1, 2023, and ending June 30,
7 2024, the following amount, or so much thereof as is necessary,
8 to be used for the purposes designated:
9 .................................................. $ 1,000,000
10 The funds appropriated in this section shall be used for
11 the continuation of a center of excellence program to award
12 four grants to encourage innovation and collaboration among
13 regional health care providers in a rural area based upon the
14 results of a regional community needs assessment to transform
15 health care delivery in order to provide quality, sustainable
16 care that meets the needs of the local communities. An
17 applicant for the grant funds shall specify how the funds will
18 be expended to accomplish the goals of the program and shall
19 provide a detailed five-year sustainability plan prior to being
20 awarded any funding. Following the receipt of grant funding,
21 a recipient shall submit periodic reports as specified by the
22 department to the governor and the general assembly regarding
23 the recipient’s expenditure of the funds and progress in
24 accomplishing the program’s goals.
25 DIVISION II
26 STATE-FUNDED FAMILY MEDICINE OBSTETRICS FELLOWSHIP PROGRAM
27 Sec. 2. NEW SECTION. 135.182 State-funded family medicine
28 obstetrics fellowship program —— fund.
29 1. The department shall establish a family medicine
30 obstetrics fellowship program to increase access to family
31 medicine obstetrics practitioners in rural and underserved
32 areas of the state. A person who has completed an
33 accreditation council for graduate medical education residency
34 program in family medicine is eligible for participation
35 in the fellowship program. Participating fellows shall
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1 enter into a program agreement with a participating teaching
2 hospital which, at a minimum, requires the fellow to complete a
3 one-year fellowship and to engage in full-time family medicine
4 obstetrics practice in a rural or underserved area of the
5 state for a period of at least five years within nine months
6 following completion of the fellowship and receipt of a license
7 to practice medicine in the state.
8 2. Each fellow participating in the program shall be
9 eligible for a salary and benefits including a stipend as
10 determined by the participating teaching hospital which shall
11 be funded through the family medicine obstetrics fellowship
12 program fund.
13 3. The department shall adopt rules pursuant to chapter
14 17A to administer the program, including defining rural and
15 underserved areas for the purpose of the required full-time
16 practice of a person following completion of the fellowship.
17 4. a. A family medicine obstetrics fellowship program
18 fund is created in the state treasury consisting of the moneys
19 appropriated or credited to the fund by law. Notwithstanding
20 section 8.33, moneys in the fund at the end of each fiscal year
21 shall not revert to any other fund but shall remain in the fund
22 for use in subsequent fiscal years. Moneys in the fund are
23 appropriated to the department to be used to fund fellowship
24 positions as provided in this section.
25 b. For the fiscal year beginning July 1, 2023, and each
26 fiscal year beginning July 1 thereafter, there is appropriated
27 from the general fund of the state to the family medicine
28 obstetrics fellowship program fund an amount sufficient to
29 support the creation of four fellowship positions as provided
30 in this section.
31 5. The department and the participating teaching hospitals
32 shall regularly evaluate and document their experiences
33 including identifying ways the program may be modified or
34 expanded to facilitate increased access to family medicine
35 obstetrics practitioners in rural and underserved areas of the
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1 state. The department shall submit an annual report to the
2 general assembly by January 1. The report shall include the
3 number of fellowships funded to date and any other information
4 identified by the department and the participating teaching
5 hospitals as indicators of outcomes and the effectiveness of
6 the program.
7 6. For the purposes of this section, “teaching hospital”
8 means a hospital or medical center that provides medical
9 education to prospective and current health professionals.
10 Sec. 3. STATE-FUNDED FAMILY MEDICINE OBSTETRICS FELLOWSHIP
11 PROGRAM AND FUND —— APPROPRIATION. There is appropriated from
12 the general fund of the state to the department of health and
13 human services for the fiscal year beginning July 1, 2023, and
14 ending June 30, 2024, the following amount, or so much thereof
15 as is necessary, to be used for the purposes designated:
16 .................................................. $ 560,000
17 For deposit in the family medicine obstetrics fellowship
18 program fund to be utilized in creating and providing for four
19 family medicine obstetrics fellowship positions during the
20 fiscal year in accordance with the family medicine obstetrics
21 fellowship program created in this division of this Act.
22 DIVISION III
23 SELF-ADMINISTERED HORMONAL CONTRACEPTIVES
24 Sec. 4. Section 155A.3, Code 2023, is amended by adding the
25 following new subsections:
26 NEW SUBSECTION. 10A. “Department” means the department of
27 health and human services.
28 NEW SUBSECTION. 45A. “Self-administered hormonal
29 contraceptive” means a self-administered hormonal contraceptive
30 that is approved by the United States food and drug
31 administration to prevent pregnancy. “Self-administered
32 hormonal contraceptive” includes an oral hormonal contraceptive,
33 a hormonal vaginal ring, and a hormonal contraceptive patch,
34 but does not include any drug intended to induce an abortion as
35 defined in section 146.1.
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1 NEW SUBSECTION. 45B. “Standing order” means a preauthorized
2 medication order with specific instructions from the medical
3 director of the department to dispense a medication under
4 clearly defined circumstances.
5 Sec. 5. NEW SECTION. 155A.49 Pharmacist dispensing of
6 self-administered hormonal contraceptives —— standing order ——
7 requirements —— limitations of liability.
8 1. a. Notwithstanding any provision of law to the contrary,
9 a pharmacist may dispense a self-administered hormonal
10 contraceptive to a patient who is at least eighteen years of
11 age, pursuant to a standing order established by the medical
12 director of the department in accordance with this section.
13 b. In dispensing a self-administered hormonal contraceptive
14 to a patient under this section, a pharmacist shall comply with
15 all of the following:
16 (1) For an initial dispensing of a self-administered
17 hormonal contraceptive, the pharmacist may dispense only up
18 to a three-month supply at one time of the self-administered
19 hormonal contraceptive.
20 (2) For any subsequent dispensing of the same
21 self-administered hormonal contraceptive, the pharmacist
22 may dispense up to a twelve-month supply at one time of the
23 self-administered hormonal contraceptive.
24 2. A pharmacist who dispenses a self-administered hormonal
25 contraceptive in accordance with this section shall not
26 require any other prescription drug order authorized by a
27 practitioner prior to dispensing the self-administered hormonal
28 contraceptive to a patient.
29 3. The medical director of the department may establish a
30 standing order authorizing the dispensing of self-administered
31 hormonal contraceptives by a pharmacist who does all of the
32 following:
33 a. Complies with the standing order established pursuant to
34 this section.
35 b. Retains a record of each patient to whom a
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1 self-administered hormonal contraceptive is dispensed under
2 this section and submits the record to the department.
3 4. The standing order shall require a pharmacist who
4 dispenses self-administered hormonal contraceptives under this
5 section to do all of the following:
6 a. Complete a standardized training program and continuing
7 education requirements approved by the board in consultation
8 with the board of medicine and the department that are related
9 to prescribing self-administered hormonal contraceptives and
10 include education regarding all contraceptive methods approved
11 by the United States food and drug administration.
12 b. Obtain a completed self-screening risk assessment,
13 approved by the department in collaboration with the board and
14 the board of medicine, from each patient, verify the identity
15 and age of each patient, and perform a blood pressure screening
16 on each patient prior to dispensing the self-administered
17 hormonal contraceptive to the patient.
18 c. Provide the patient with all of the following:
19 (1) Written information regarding all of the following:
20 (a) The importance of completing an appointment with the
21 patient’s primary care or women’s health care practitioner
22 to obtain preventative care, including but not limited to
23 recommended tests and screenings.
24 (b) The effectiveness and availability of long-acting
25 reversible contraceptives as an alternative to
26 self-administered hormonal contraceptives.
27 (2) A copy of the record of the pharmacist’s encounter with
28 the patient that includes all of the following:
29 (a) The patient’s completed self-screening risk assessment.
30 (b) A description of the contraceptive dispensed, or the
31 basis for not dispensing a contraceptive.
32 (3) Patient counseling regarding all of the following:
33 (a) The appropriate administration and storage of the
34 self-administered hormonal contraceptive.
35 (b) Potential side effects and risks of the
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1 self-administered hormonal contraceptive.
2 (c) The need for backup contraception.
3 (d) When to seek emergency medical attention.
4 (e) The risk of contracting a sexually transmitted
5 infection or disease, and ways to reduce such a risk.
6 5. The standing order established pursuant to this section
7 shall prohibit a pharmacist who dispenses a self-administered
8 hormonal contraceptive under this section from doing any of the
9 following:
10 a. Requiring a patient to schedule an appointment with
11 the pharmacist for the prescribing or dispensing of a
12 self-administered hormonal contraceptive.
13 b. Dispensing self-administered hormonal contraceptives
14 to a patient for more than twenty-seven months after the
15 date a self-administered hormonal contraceptive is initially
16 dispensed to the patient, if the patient has not consulted with
17 a primary care or women’s health care practitioner during the
18 preceding twenty-seven months, in which case the pharmacist
19 shall refer the patient to a primary care or women’s health
20 care practitioner.
21 c. Dispensing a self-administered hormonal contraceptive to
22 a patient if the results of the self-screening risk assessment
23 completed by a patient pursuant to subsection 4, paragraph
24 “b”, indicate it is unsafe for the pharmacist to dispense the
25 self-administered hormonal contraceptive to the patient, in
26 which case the pharmacist shall refer the patient to a primary
27 care or women’s health care practitioner.
28 6. A pharmacist who dispenses a self-administered hormonal
29 contraceptive and the medical director of the department who
30 establishes a standing order in compliance with this section
31 shall be immune from criminal and civil liability arising
32 from any damages caused by the dispensing, administering,
33 or use of a self-administered hormonal contraceptive or the
34 establishment of the standing order. The medical director of
35 the department shall be considered to be acting within the
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1 scope of the medical director’s office and employment for
2 purposes of chapter 669 in the establishment of a standing
3 order in compliance with this section.
4 7. The department, in collaboration with the board and
5 the board of medicine, and in consideration of the guidelines
6 established by the American congress of obstetricians and
7 gynecologists, shall adopt rules pursuant to chapter 17A to
8 administer this chapter.
9 Sec. 6. Section 514C.19, Code 2023, is amended to read as
10 follows:
11 514C.19 Prescription contraceptive coverage.
12 1. Notwithstanding the uniformity of treatment requirements
13 of section 514C.6, a group policy, or contract, or plan
14 providing for third-party payment or prepayment of health or
15 medical expenses shall not do either of the following comply
16 as follows:
17 a. Exclude Such policy, contract, or plan shall not
18 exclude or restrict benefits for prescription contraceptive
19 drugs or prescription contraceptive devices which prevent
20 conception and which are approved by the United States
21 food and drug administration, or generic equivalents
22 approved as substitutable by the United States food and
23 drug administration, if such policy, or contract, or plan
24 provides benefits for other outpatient prescription drugs
25 or devices. However, such policy, contract, or plan shall
26 specifically provide for payment of a self-administered
27 hormonal contraceptive, as prescribed by a practitioner as
28 defined in section 155A.3, or as prescribed by standing order
29 and dispensed by a pharmacist pursuant to section 155A.49,
30 including payment for up to an initial three-month supply
31 of a self-administered hormonal contraceptive dispensed at
32 one time and for up to a twelve-month supply of the same
33 self-administered hormonal contraceptive subsequently dispensed
34 at one time.
35 b. Exclude Such policy, contract, or plan shall not exclude
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1 or restrict benefits for outpatient contraceptive services
2 which are provided for the purpose of preventing conception if
3 such policy, or contract, or plan provides benefits for other
4 outpatient services provided by a health care professional.
5 2. A person who provides a group policy, or contract, or
6 plan providing for third-party payment or prepayment of health
7 or medical expenses which is subject to subsection 1 shall not
8 do any of the following:
9 a. Deny to an individual eligibility, or continued
10 eligibility, to enroll in or to renew coverage under the terms
11 of the policy, or contract, or plan because of the individual’s
12 use or potential use of such prescription contraceptive drugs
13 or devices, or use or potential use of outpatient contraceptive
14 services.
15 b. Provide a monetary payment or rebate to a covered
16 individual to encourage such individual to accept less than the
17 minimum benefits provided for under subsection 1.
18 c. Penalize or otherwise reduce or limit the reimbursement
19 of a health care professional because such professional
20 prescribes contraceptive drugs or devices, or provides
21 contraceptive services.
22