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Amendments › HF 2676

Amendment S-5173 to HF 2676

Relating to health-related matters, including health-related professions, nutrition, medication, and education, and including effective date and applicability provisions

Adopted · April 8, 2026Strike everything: replaces the whole bill

Filed April 8, 2026 in the Senate by Sen. Kara Warme (R)

What it changes

  1. By striking everything after the enacting clause and inserting: “DIVISION I SHORT TITLE Section
  2. SHORT TITLE. This Act shall be known and may be cited as the “Iowa Make America Healthy Again Act”. DIVISION II CONTINUING EDUCATION REQUIREMENTS —— NUTRITION AND METABOLIC HEALTH Sec.
  3. Section 148.3, Code 2026, is amended by adding the following new subsection: NEW SUBSECTION .
  4. The board shall adopt rules pursuant to chapter 17A requiring a licensee practicing family medicine, internal medicine, pediatrics, psychiatry, endocrinology, gastroenterology, cardiology, oncology, rheumatology, neurology, nephrology, dermatology, pulmonology, surgery, immunology, hematology, obstetrics, or gynecology to complete a minimum of one hour of continuing education on nutrition and metabolic health every four years as a condition of license renewal. Sec.
  5. Section 148C.3, subsection 1, paragraph c, Code 2026, is amended to read as follows: c. Hours of continuing medical education necessary to become or remain licensed. The board shall adopt rules pursuant to chapter 17A requiring a licensee practicing family medicine, internal medicine, pediatrics, psychiatry, endocrinology, gastroenterology, cardiology, oncology, rheumatology, neurology, nephrology, dermatology, pulmonology, surgery, immunology, hematology, obstetrics, or gynecology to complete a minimum of one hour of continuing education on nutrition and metabolic health every four years as a condition of license renewal. DIVISION III MEDICAL SCHOOL GRADUATION REQUIREMENT —— NUTRITION Sec.
  6. NEW SECTION . 148.15 Medical school graduation requirement —— nutrition. Beginning July 1, 2028, a medical school or college of osteopathic medicine and surgery in this state shall require as a condition of graduation that each student complete at least forty hours of coursework on nutrition and metabolic health. DIVISION IV SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM —— SUMMER ELECTRONIC BENEFITS TRANSFER FOR CHILDREN PROGRAM Sec.
  7. Section 234.1, Code 2026, is amended by adding the following new subsection: NEW SUBSECTION . 4A. “Summer electronic benefits transfer for children program” or “summer EBT program” means the summer electronic benefits transfer for children program established in 42 U.S.C. §1762. Sec.
  8. NEW SECTION . 234.12B Supplemental nutrition assistance program —— summer electronic benefits transfer for children program.
  9. The department shall do all of the following: a. Implement a SNAP waiver upon receipt of approval by the United States department of agriculture, food and nutrition service, and continuously maintain state participation in SNAP in accordance with waiver guidelines specifying that eligible foods pursuant to 7 C.F.R. §271.2 are healthy foods as defined by the director or the director’s designee. b. Contingent upon the availability of federal funding, ensure that the provision of SNAP benefits to recipients is uninterrupted in accordance with federal law, regardless of whether the United States department of agriculture, food and nutrition service, approves state participation utilizing only eligible foods as described in paragraph “a” .
  10. The department may participate in the summer EBT program subject to federally approved eligible foods for the summer EBT program being consistent with eligible foods as described in subsection 1, paragraph “a” . DIVISION V SCHOOL FOODS AND BEVERAGES Sec.
  11. Section 256E.7, subsection 2, Code 2026, is amended by adding the following new paragraph: NEW PARAGRAPH . 0t. Be subject to and comply with the requirements of section 283A.6 relating to the preparation of meals provided to students, and prohibited ingredients in meals provided to students, in the same manner as a school district, if the charter school provides a breakfast or lunch program through the national school lunch program or the school breakfast program administered by the food and nutrition service of the United States department of agriculture. Sec.
  12. Section 256F.4, subsection 2, Code 2026, is amended by adding the following new paragraph: NEW PARAGRAPH . v. Be subject to and comply with the requirements of section 283A.6 relating to the preparation of meals provided to students, and prohibited ingredients in meals provided to students, in the same manner as a school district, if the charter school or innovation zone school provides a breakfast or lunch program. Sec.
  13. NEW SECTION . 283A.6 School district breakfast and lunch programs —— food and beverages provided to students —— prohibited ingredients.
  14. a. A school district shall not serve a meal to students as part of the school district’s breakfast or lunch program that contains any of the following ingredients: (1) Blue dye
  15. (2) Blue dye
  16. (3) Green dye
  17. (4) Potassium bromate. (5) Propylparaben. (6) Red dye
  18. (7) Yellow dye
  19. (8) Yellow dye
  20. b. Paragraph “a” does not apply to food and beverages received as part of a direct delivery from the foods in schools program of the United States department of agriculture.
  21. An employee or contracted vendor of a school district shall not provide any food or beverages that contain an ingredient described in subsection 1 to a student enrolled in the school district during the school day.
  22. A school district shall not permit the sale to students of any foods or beverages that contain an ingredient described in subsection 1 on the school campus, as school campus is defined in 7 C.F.R. §210.11 as of January 1, 2026, unless the sale takes place outside of the school day, as school day is defined in 7 C.F.R. §210.11 as of January 1,
  23. Sec.
  24. Section 283A.10, Code 2026, is amended to read as follows: 283A.10 School breakfast or lunch in nonpublic schools. The authorities in charge of nonpublic schools may operate or provide for the operation of school breakfast or lunch programs in schools under their jurisdiction and may use funds appropriated to them by the general assembly, gifts, funds received from sale of school breakfasts or lunches under such programs, and any other funds available to the nonpublic school. However, school breakfast or lunch programs shall not be required in nonpublic schools. The department of education shall direct the disbursement of state funds to nonpublic schools for school breakfast or lunch programs in the same manner as state funds are disbursed to public schools. If a nonpublic school receives state funds for the operation of a school breakfast or lunch program, meals served under the program shall be nutritionally adequate meals, as defined in section 283A.1 , and shall comply with the requirements of section 283A.6 . Sec.
  25. APPLICABILITY. This division of this Act applies to school years beginning on or after July 1,
  26. DIVISION VI EPINEPHRINE DELIVERY SYSTEMS Sec.
  27. Section 135.185, Code 2026, is amended to read as follows: 135.185 Epinephrine auto-injector delivery system supply.
  28. For purposes of this section , unless the context otherwise requires: a. “Epinephrine auto-injector delivery system ” means the same as provided in section 280.16 . b. “Facility” means a food establishment as defined in section 137F.1 , a carnival as defined in section 88A.1 , a recreational camp, a youth sports facility, or a sports arena. c. “Licensed health care professional” means the same as provided in section 280.16 . d. “Personnel authorized to administer epinephrine” means an employee or agent of a facility who is trained and authorized to administer an epinephrine auto-injector delivery system .
  29. Notwithstanding any other provision of law to the contrary, a licensed health care professional may prescribe epinephrine auto-injectors delivery systems in the name of a facility to be maintained for use as provided in this section .
  30. A facility may obtain a prescription for epinephrine auto-injectors delivery systems and maintain a supply of such auto-injectors delivery systems in a secure location at each location where a member of the public may be present for use as provided in this section . A facility that obtains such a prescription shall replace epinephrine auto-injectors delivery systems in the supply upon use or expiration. Personnel authorized to administer epinephrine may possess and administer epinephrine auto-injectors delivery systems from the supply as provided in this section .
  31. Personnel authorized to administer epinephrine may provide or administer an epinephrine auto-injector delivery system from the facility’s supply to an individual present at the facility if such personnel reasonably and in good faith believe the individual is having an anaphylactic reaction.
  32. The following persons, provided they have acted reasonably and in good faith, shall not be liable for any injury arising from the provision, administration, or assistance in the administration of an epinephrine auto-injector delivery system as provided in this section : a. Any personnel authorized to administer epinephrine who provide, administer, or assist in the administration of an epinephrine auto-injector delivery system to an individual present at the facility who such personnel believe to be having an anaphylactic reaction. b. The owner or operator of the facility. c. The prescriber of the epinephrine auto-injector delivery system .
  33. The department, the board of medicine, the board of nursing, and the board of pharmacy shall adopt rules pursuant to chapter 17A to implement and administer this section , including but not limited to standards and procedures for the prescription, distribution, storage, replacement, and administration of epinephrine auto-injectors delivery systems , and for training and authorization to be required for personnel authorized to administer epinephrine. Sec.
  34. Section 280.16, Code 2026, is amended to read as follows: 280.16 Self-administration of respiratory distress, asthma, or other airway constricting disease medication, epinephrine auto-injectors delivery systems , bronchodilator canisters, or bronchodilator canisters and spacers.
  35. Definitions. For purposes of this section : a. “Bronchodilator” means a bronchodilator as recommended by the department of health and human services for treatment of a student’s respiratory distress, asthma, or other airway constricting disease. b. “Bronchodilator canister” means a portable drug delivery device packaged with multiple premeasured doses of a bronchodilator. c. “Epinephrine auto-injector delivery system ” means a device for immediate self-administration or administration by another trained individual of a measured dose of epinephrine to a person at risk of anaphylaxis , including epinephrine auto-injectors and epinephrine nasal sprays . d. “ Licensed health care professional” means a person licensed under chapter 148 to practice medicine and surgery or osteopathic medicine and surgery, an advanced registered nurse practitioner licensed under chapter 152 or 152E and registered with the board of nursing, or a physician assistant licensed under chapter 148C . e. “Medication” means a drug that meets the definition provided in section 126.2, subsection 8 , has an individual prescription label, is prescribed by a licensed health care professional for a student, and pertains to the student’s respiratory distress, asthma, or other airway constricting disease, or risk of anaphylaxis, and includes but is not limited to a bronchodilator. f. “Self-administration” means a student’s discretionary use of medication prescribed by a licensed health care professional for the student. g. “Spacer” means a holding chamber that is used to optimize the delivery of a bronchodilator to a person’s lungs.
  36. The board of directors of a school district and the authorities in charge of an accredited nonpublic school shall permit the self-administration of medication or the use of a bronchodilator canister or bronchodilator canister and spacer by a student with respiratory distress, asthma, or other airway constricting disease or the use of an epinephrine auto-injector delivery system by a student with a risk of anaphylaxis if the following conditions are met: a. The student’s parent or guardian provides to the school written authorization for the self-administration of medication, for the use of a bronchodilator canister or a bronchodilator canister and spacer, or for the use of an epinephrine auto-injector delivery system . b. The student’s parent or guardian provides to the school a written statement from the student’s licensed health care professional containing the following information: (1) The name and purpose of the medication, bronchodilator canister, bronchodilator canister and spacer, or epinephrine auto-injector delivery system . (2) The prescribed dosage. (3) The times at which or the special circumstances under which the medication, bronchodilator canister, bronchodilator canister and spacer, or epinephrine auto-injector delivery system is to be administered. c. The parent or guardian and the school meet the requirements of subsection 3 .
  37. The school district or accredited nonpublic school shall notify the parent or guardian of the student, in writing, that the school district or accredited nonpublic school and its employees are to incur no liability, except for gross negligence, as a result of any injury arising from self-administration of medication, use of a bronchodilator canister or a bronchodilator canister and spacer, or use of an epinephrine auto-injector delivery system by the student. The parent or guardian of the student shall sign a statement acknowledging that the school district or nonpublic school is to incur no liability, except for gross negligence, as a result of self-administration of medication, use of a bronchodilator canister or a bronchodilator canister and spacer, or use of an epinephrine auto-injector delivery system by the student. A school district or accredited nonpublic school and its employees acting reasonably and in good faith shall incur no liability for any improper use of medication, a bronchodilator canister, a bronchodilator canister and spacer, or an epinephrine auto-injector delivery system as defined in this section or for supervising, monitoring, or interfering with a student’s self-administration of medication, use of a bronchodilator canister or a bronchodilator canister and spacer, or use of an epinephrine auto-injector delivery system as defined in this section .
  38. The permission for self-administration of medication, for the use of a bronchodilator canister or a bronchodilator canister and spacer, or for the use of an epinephrine auto-injector delivery system is effective for the school year for which it is granted and shall be renewed each subsequent school year upon fulfillment of the requirements of this section . However, the parent or guardian shall immediately notify the school of any changes in the conditions listed under subsection 2 .
  39. Provided that the requirements of this section are fulfilled, a student with respiratory distress, asthma, or other airway constricting disease may possess and use the student’s medication and a student with a written statement from a licensed health care professional on file pursuant to subsection 2 , paragraph “a” , may use a bronchodilator canister, a bronchodilator canister and spacer, or an epinephrine auto-injector delivery system while in school, at school-sponsored activities, under the supervision of school personnel, and before or after normal school activities, such as while in before-school or after-school care on school-operated property. If the student misuses this privilege, the privilege may be withdrawn. A school district or nonpublic school shall notify a student’s parent or guardian before withdrawing the privilege to use a bronchodilator canister, a bronchodilator canister and spacer, or an epinephrine auto-injector delivery system .
  40. Information provided to the school under subsection 2 shall be kept on file in the office of the school nurse or, in the absence of a school nurse, the school’s administrator.
  41. The Iowa school for the deaf and the institutions under the control of the department of health and human services as provided in section 218.1 are exempt from the provisions of this section . Sec.
  42. Section 280.16A, Code 2026, is amended to read as follows: 280.16A Epinephrine auto-injector delivery system , bronchodilator canister, or bronchodilator canister and spacer supply.
  43. For purposes of this section , unless the context otherwise requires: a. “Bronchodilator” means the same as defined in section 280.16 . b. “Bronchodilator canister” means the same as defined in section 280.16 . c. “Epinephrine auto-injector delivery system ” means the same as provided in section 280.16 . d. “Licensed health care professional” means the same as provided in section 280.16 . e. “Personnel authorized to administer epinephrine or a bronchodilator” means a school nurse or other employee of a school district or accredited nonpublic school trained and authorized to administer an epinephrine auto-injector delivery system , a bronchodilator canister, or a bronchodilator canister and spacer. f. “School nurse” means a registered nurse holding current licensure recognized by the board of nursing who practices in the school setting to promote and protect the health of the school population by using knowledge from the nursing, social, and public health sciences. g. “Spacer” means the same as defined in section 280.16 .
  44. Notwithstanding any other provision of law to the contrary, a licensed health care professional may prescribe epinephrine auto-injectors delivery systems , bronchodilator canisters, and bronchodilator canisters and spacers in the name of a school district or accredited nonpublic school to be maintained for use as provided in this section .
  45. The board of directors in charge of each school district and the authorities in charge of each accredited nonpublic school may obtain a prescription for epinephrine auto-injectors delivery systems , bronchodilator canisters, and bronchodilator canisters and spacers and maintain a supply of such epinephrine auto-injectors delivery systems , bronchodilator canisters, and bronchodilator canisters and spacers in a secure location at each school for use as provided in this section . The board and the authorities shall replace epinephrine auto-injectors delivery systems , bronchodilator canisters, and bronchodilator canisters and spacers in the supply upon use or expiration. Personnel authorized to administer epinephrine or a bronchodilator may possess and administer epinephrine auto-injectors delivery systems , bronchodilator canisters, or bronchodilator canisters and spacers, as applicable, from the supply as provided in this section .
  46. Personnel authorized to administer epinephrine or a bronchodilator may provide or administer an epinephrine auto-injector delivery system , a bronchodilator canister, or a bronchodilator canister and spacer, as applicable, from the school’s supply to a student or other individual if such personnel reasonably and in good faith believe the student or other individual is having an anaphylactic reaction or requires treatment for respiratory distress, asthma, or other airway constricting disease.
  47. The following persons, provided they have acted reasonably and in good faith, shall not be liable for any injury arising from the provision, administration, or assistance in the administration of an epinephrine auto-injector delivery system , a bronchodilator canister, or a bronchodilator canister and spacer as provided in this section : a. Any personnel authorized to administer epinephrine or a bronchodilator who, as applicable, provide, administer, or assist in the administration of an epinephrine auto-injector delivery system to a student or other individual present at the school who such personnel believe to be having an anaphylactic reaction or in the administration of a bronchodilator canister or a bronchodilator canister and spacer to a student or other individual present at the school who such personnel believe to require treatment for respiratory distress, asthma, or other airway constricting disease. b. A school district or accredited nonpublic school employing the personnel. c. The board of directors in charge of the school district or authorities in charge of the accredited nonpublic school. d. The prescriber of the epinephrine auto-injector delivery system , the bronchodilator canister, or the bronchodilator canister and spacer.
  48. The department of education, the board of medicine, the board of nursing, and the board of pharmacy shall, in consultation with an organization representing school nurses, adopt rules pursuant to chapter 17A to implement and administer this section , including but not limited to standards and procedures for the prescription, distribution, storage, disposal, replacement, and administration of epinephrine auto-injectors delivery systems , bronchodilator canisters, and bronchodilator canisters and spacers, and for training and authorization to be required for personnel authorized to administer epinephrine or a bronchodilator. DIVISION VII IVERMECTIN —— OVER-THE-COUNTER AVAILABILITY Sec.
  49. NEW SECTION . 126.24 Ivermectin —— prescription drug order not required.
  50. A pharmacist or pharmacy may distribute ivermectin for human consumption as an over-the-counter medicine.
  51. A pharmacist or pharmacy shall not be subject to professional discipline or civil or criminal penalties for the distribution of ivermectin pursuant to this section. DIVISION VIII STUDENT INSTRUCTIONAL TECHNOLOGY STANDARDS Sec.
  52. Section 256E.7, subsection 2, Code 2026, is amended by adding the following new paragraph: NEW PARAGRAPH . 0s. Be subject to and comply with the requirements of section 279.89 relating to student instructional technology standards in the same manner as a school district. Sec.
  53. Section 256F.4, subsection 2, Code 2026, is amended by adding the following new paragraph: NEW PARAGRAPH . w. Be subject to and comply with the requirements of section 279.89 relating to student instructional technology standards in the same manner as a school district. Sec.
  54. NEW SECTION . 279.89 Student instructional technology standards.
  55. As used in this section, unless the context otherwise requires: a. “Digital instruction” means lessons, assignments, assessments, or instructional activities delivered through instructional technology. b. “Instructional technology” means a laptop, tablet, computer, smart device, software platform, or other similar device or platform used for student learning. c. “One-to-one digital device program” means a program through which a school district provides or assigns a digital device to each student for instructional use.
  56. a. For students enrolled in grades kindergarten through five, digital instruction shall not exceed sixty minutes per school day. b. The following uses shall not count toward the daily limit: (1) Use required pursuant to an individualized education program or a plan developed pursuant to section 504 of the federal Rehabilitation Act of
  57. (2) Assistive or adaptive technology used to provide a student access to instruction or to accommodate differing student abilities. (3) Teacher-directed demonstrations using a projector, smartboard, or similar display device when students are not individually operating a digital device. (4) State assessments, screening, progress monitoring, and local diagnostic assessments that require the use of a one-to-one digital device. (5) Dedicated computer science and technology curriculum.
  58. a. The board of directors of each school district shall adopt a written technology use policy applicable to grades kindergarten through five. b. The policy shall include all of the following: (1) The district’s daily digital instruction limits. (2) Notice of a parent’s or guardian’s right to request additional reductions in the parent’s or guardian’s child’s digital instruction. (3) A statement that instructional technology shall support, and not supplant, foundational learning. (4) A prohibition on the use of digital devices during recess. c. The policy shall be published on each elementary school’s internet site.
  59. a. Prior to adopting or renewing a one-to-one digital device program for any grade level, the board of directors of a school district shall complete a technology adoption checklist that documents consideration of all of the following: (1) The instructional purpose of the device. (2) Age appropriateness of the device and associated software. (3) Content-filtering limitations and the district’s capacity to mitigate those limitations. (4) Whether student data is collected, stored, or shared, and the nature of such data practices. b. The checklist shall be retained by the board and made available to the department of education upon request for audit or compliance purposes.
  60. This section shall not apply to students enrolled in an online learning program operating pursuant to section 256.43.

Shortened here; the full amendment is in the official document.

Official amendment (PDF) · In the Bill Book