SSB 1133

This bill relates to the health and well-being of children and families. The bill is constructed in divisions. DIVISION I —— RURAL EMERGENCY HOSPITALS. This division provides for state licensure of rural emergency hospitals (REHs). Under the federal Consolidated Appropriations Act of 2021 (federal Act), REHs were established as a new provider type. Effective January 1, 2023, REHs are eligible to enroll in Medicare and to receive an enhanced reimbursement rate for eligible services consisting of the outpatient prospective payment system rate plus a percent add-on and a fixed monthly payment. In order to be classified as an REH under the federal Act, a facility must meet certain requirements, including applicable state licensing requirements. The division provides a process for such licensure. The division provides emergency rulemaking authority to implement the division. _____ takes effect upon enactment. DIVISION II —— REGIONAL CENTERS OF EXCELLENCE GRANT PROGRAM. This division appropriates $1 million from the general fund of the state to the department of health and human services (HHS) for fiscal year 2023-2024 for continuation of a regional center of excellence program to award four grants to encourage innovation and collaboration among regional health care providers in a rural area based upon the results of a regional community needs assessment to transform health care delivery in order to provide quality, sustainable care that meets the needs of the local communities. An applicant for the grant funds shall specify how the funds will be expended to accomplish the goals of the program and shall provide a detailed five-year sustainability plan prior to being awarded any funding. Following the receipt of grant funding, a recipient shall submit periodic reports as specified by HHS to the governor and the general assembly regarding the recipient’s expenditure of the funds and progress in accomplishing the program goals. DIVISION III —— NONECONOMIC DAMAGE AWARDS AGAINST HEALTH CARE PROVIDERS. This division of the bill relates to noneconomic damage awards against health care providers. Current law provides that in a civil action brought against a health care provider, the maximum amount of noneconomic damages that a patient may recover for personal injury or death is $250,000, unless the jury determines that there is a substantial or permanent loss or impairment of a bodily function, substantial disfigurement, or death, which warrants a finding that imposition of such a limitation would deprive the plaintiff of just compensation for the injuries sustained. In such a case, there is no cap on the amount of noneconomic damages that a patient may recover. The bill makes two changes to current law. _____ adult. Instead, such damages are economic damages. Second, the bill provides a $1 million cap on noneconomic damages when the jury finds that there is substantial or permanent loss or impairment of a bodily function, substantial disfigurement, or death which warrants exceeding the $250,000 cap. The bill does not amend the current exception to the cap for cases in which the defendant’s actions constitute actual malice. The division of the bill takes effect upon enactment and applies to causes of action accrued on or after that date. DIVISION IV —— STATE-FUNDED FAMILY MEDICINE OBSTETRICS FELLOWSHIP PROGRAM AND FUND. This division requires HHS to establish a family medicine obstetrics fellowship program to increase access to family medicine obstetrics practitioners in rural and underserved areas of the state. A person who has completed an accreditation council for graduate medical education residency program in family medicine is eligible for participation in the fellowship program. Participating fellows shall enter into a program agreement with a participating teaching hospital which, at a minimum, requires the fellow to complete a one-year fellowship and to engage in full-time family medicine obstetrics practice in a rural or underserved area of the state for a period of at least five years within nine months following completion of the fellowship and receipt of a license to practice medicine in the state. Each fellow participating in the program shall be eligible for salary and benefits including a stipend as determined by the participating teaching hospital and funded through the family medicine obstetrics fellowship program fund. The division requires HHS to adopt administrative rules to administer the program, including defining rural and underserved areas for the purpose of the required full-time practice of a person following completion of the fellowship. The division creates a family medicine obstetrics fellowship program fund in the state treasury consisting of the moneys appropriated or credited to the fund by law. _____ fund at the end of each fiscal year shall not revert to any other fund but shall remain in the fund for use in subsequent fiscal years. Moneys in the fund are appropriated to HHS to be used to fund fellowship positions as provided in the division. The division appropriates a sufficient amount from the general fund of the state to the fund annually to support the creation of four fellowship positions. The division provides an appropriation for deposit in the fund for fiscal year 2023-2024. The division requires HHS and the participating teaching hospitals to regularly evaluate and document their experiences including identifying ways the program may be modified or expanded to facilitate increased access to family medicine obstetrics practitioners in rural and underserved areas of the state. The department shall submit an annual report to the general assembly by January 1. The report shall include the number of fellowships funded to date and any other information identified by HHS and the participating teaching hospitals as indicators of outcomes and the effectiveness of the program. DIVISION V —— SELF-ADMINISTERED HORMONAL CONTRACEPTIVES. This division relates to the dispensing of self-administered hormonal contraceptives by a pharmacist. The division defines “self-administered hormonal contraceptive” as a self-administered hormonal contraceptive that is approved by the United States food and drug administration to prevent pregnancy, including an oral hormonal contraceptive, a hormonal vaginal ring, and a hormonal contraceptive patch, but not including any drug intended to induce an abortion. The division provides that notwithstanding any provision of law to the contrary, a pharmacist may dispense a self-administered hormonal contraceptive to a patient who is at least years of age pursuant to a standing order established by the medical director of HHS (medical director). _____ hormonal contraceptive, and for any subsequent dispensing of the same self-administered hormonal contraceptive, a 12-month supply at one time. Additionally, the division prohibits a pharmacist who dispenses a self-administered hormonal contraceptive in accordance with the division from requiring any other prescription drug order authorized by a practitioner prior to dispensing the self-administered hormonal contraceptive. The division authorizes the medical director to establish a standing order authorizing the dispensing of self-administered hormonal contraceptives by any pharmacist who complies with the standing order and retains and submits the patient’s record to HHS. The standing order includes requiring a pharmacist who dispenses a self-administered hormonal contraceptive under the division to: complete a standardized training program and continuing education requirements related to prescribing the hormonal contraceptives; obtain a completed self-screening risk assessment from each patient, verify the identity and age of each patient, and perform a blood pressure screening on each patient before dispensing the hormonal contraceptives; provide the patient with certain written information; provide the patient with a copy of the record of the pharmacist’s encounter with the patient; and provide patient counseling. _____ to the patient, in which case the pharmacist shall refer the patient to a practitioner. The division provides immunity for a pharmacist who dispenses a self-administered hormonal contraceptive and for the medical director who establishes a standing order in compliance with the division from criminal and civil liability arising from any damages caused by the dispensing, administering, or use of a self-administered hormonal contraceptive or the establishment of the standing order. Additionally, the medical director shall be considered to be acting within the scope of the medical director’s office and employment for purposes of Code chapter 669 (Iowa tort claims Act) in the establishment of a standing order in compliance with the division. The division requires HHS, in collaboration with the boards of pharmacy and medicine, and in consideration of the guidelines established by the American congress of obstetricians and gynecologists, to adopt administrative rules to administer the provisions of the division. The division amends prescription contraceptive coverage provisions to require that a group policy, contract, or plan delivered, issued for delivery, continued, or renewed in the state on or after January 1, 2024, providing for third-party payment or prepayment of health or medical expenses, shall specifically provide for payment of self-administered hormonal contraceptives, prescribed and dispensed as specified in the division, including those dispensed at one time. The division provides, however, that the provisions relating to coverage are not to be construed to require a third-party payor to provide payment to a practitioner for dispensing a self-administered hormonal contraceptive to replace a self-administered hormonal contraceptive that has been dispensed to a covered person and that has been misplaced, stolen, or destroyed. _____ misplaced, stolen, or destroyed. The division also requires the board of pharmacy in collaboration with the board of medicine and HHS to expand the information program for drug prescribing to collect from pharmacists information relating to the dispensing of self-administered hormonal contraceptives as provided in the division. The division applies to the Medicaid program as specified in the bill. DIVISION VI —— INSURANCE BENEFITS —— REVIEW AND APPROVAL —— PUBLIC POLICY CONSIDERATIONS. This division prohibits a policy or policy form (form) in connection with a group accident or health insurance policy (group policy) that is issued in this state from containing a provision that is unjust, unfair, inequitable, misleading, deceptive, encourages misrepresentation, or that is otherwise contrary to public policy (contrary to policy). The division makes it unlawful for a carrier to issue a policy or to use a form in connection with any group policy after notice from the commissioner of insurance (commissioner) that the policy or form violates the prohibition. A carrier has days after receipt of the notice to request a hearing to contest the commissioner’s notice. The hearing shall be conducted pursuant to Code chapter 17A and if it results in a decision that affirms the commissioner’s notice, the decision shall be provided to the carrier in writing and specify the reasons for the decision. A group policy of insurance against loss or expense from sickness, or from the bodily injury or death by accident of the insured (accident and health policy), shall not be issued or delivered in this state by a carrier until a copy of the policy has been filed with, and approved by, the commissioner. Applications, riders, or endorsements shall not be used in connection with the accident and health policy until a copy of the policy form has been filed with, and approved by, the commissioner. _____ disapproved by the commissioner within days. If upon review of a form the commissioner finds that the benefits provided are unreasonable in relation to the premium charged, or that the form contains a provision contrary to public policy, the commissioner shall provide notice to the carrier that advises the carrier as detailed in the bill. The carrier has days after receipt of the notice to request a hearing, to be conducted pursuant to Code chapter 17A. The division permits the commissioner, after opportunity for hearing, to withdraw the commissioner’s previous approval of a form in circumstances detailed in the division. A carrier is prohibited from issuing a form, or from using a form in connection with any group policy, on or after the effective date of the commissioner’s withdrawal of the previous approval. If a hearing results in a decision to withdraw a previous approval, the decision shall be provided to the carrier in writing. DIVISION VII —— MORE OPTIONS FOR MATERNAL SUPPORT (MOMS) PROGRAM —— FATHERHOOD INITIATIVES. This division relates to the more options for maternal support (MOMS) program. The bill adds as part of the definition of “pregnancy support services” services to men who are involved or think they might be involved in a pregnancy. As part of the MOMS program, the division requires HHS to develop and maintain a virtual clearinghouse of pregnancy support services and resources. The services and resources include but are not limited to pregnancy resource center and maternity home information; assistance in accessing public assistance including but not limited to the special supplemental nutrition program for women, infants, and children program and the supplemental nutrition assistance program; educational resources; housing assistance; recovery and mental health services; family planning education; adoption and foster care information and services; and healing and support services for abortion survivors and their families. _____ engagement grants to nonprofit, community-based organizations to address the needs of fathers by assisting fathers in finding employment, managing child support obligations, transitioning from a period of incarceration, accessing health care, understanding child development, and enhancing parenting skills using evidence-based parenting education; a fatherhood communications initiative administered by HHS, including but not limited to a public internet site that provides access to resources on effective parenting and assistance in receiving parenting support and services; and a mentoring school-aged males grant program to provide mentorship, social and academic support, and life skills development to school-aged males. The division also appropriates $2 million from the general fund of the state to HHS for fiscal year 2023-2024 to be used for the MOMS program including for program administration, the provision of services, and for funding of fatherhood engagement grants, the fatherhood communications initiative, and the mentoring school-aged males grant program. The division provides that the funding appropriated for the MOMS program for fiscal year 2022-2023 is not to revert, but is to remain available for the MOMS program for fiscal year 2023-2024. This provision takes effect upon enactment. DIVISION VIII —— STATE EMPLOYEE PAID PARENTAL LEAVE BENEFIT. This division provides that a state employee entitled to leave under the federal Family and Medical Leave Act of 1993 shall be provided paid leave for the birth or adoption of a child if the leave is taken within months following any such birth or adoption. The division provides that a state employee parent who gives birth or adopts a child shall be entitled to up to four weeks of paid leave while a state employee parent of a child who did not give birth shall be entitled to up to one week of paid leave. The division requires the department of administrative services to adopt rules to implement this paid parental leave benefit. _____ COMMERCIAL CHILD CARE CENTERS AND CHILD CARE FACILITIES. This division relates to property taxation for commercial child care centers and facilities.21(5) determines the amount of actual value of commercial property that is subject to property tax. The amount is the sum of the residential assessment limitation to the portion of the property’s value that does not exceed $150,000 plus percent of the property’s value in excess of $150,000. The division excludes property primarily used as a child care center or child care facility from that determination and instead specifies that for assessment years beginning on or after January 1, 2023, the amount of actual value of such properties that is subject to property tax and for which an application has been allowed is equal to the product of the assessment limitation percentage applicable to residential property multiplied by the actual value of the property.21(5)(e).21(5)(e) for fiscal years beginning on or after July 1, 2024. DIVISION X —— NONRECURRING ADOPTION EXPENSES —— ADOPTION SUBSIDY PROGRAM. This division provides that the maximum reimbursement provided to an adoptive parent under the adoption subsidy program for nonrecurring adoption expenses is $1,000. _____ which have not been reimbursed from other sources or other funds. Under federal regulation, “other expenses which are directly related to the legal adoption of a child with special needs” means the costs of the adoption incurred by or on behalf of the parents and for which parents carry the ultimate liability for payment. Such costs may include the adoption study, including health and psychological examination, supervision of the placement prior to adoption, transportation, and the reasonable costs of lodging and food for the child or the adoptive parents when necessary to complete the placement or adoption process. The department of health and human services shall adopt administrative rules to administer the division. The division also repeals a provision in 2010 Iowa Acts which limited the nonrecurring adoption expenses to $500 and prohibited additional amounts for court costs and other related legal expenses. DIVISION XI —— ALL IOWA OPPORTUNITY SCHOLARSHIP PROGRAM. This division relates to the all Iowa opportunity scholarship program (program), which provides scholarships to Iowa students who graduate from high school or receive a high school equivalency diploma to help such students attend a community college in this state or an institution of higher learning governed by the state board of regents. The program prioritizes awarding scholarships to certain students, including eligible foster care students. Eligible foster care students are students who age out of Iowa’s foster care system, age out of the state training school, or are adopted from Iowa’s foster care system after reaching years of age. Current law requires that, in order to be eligible to receive a scholarship under the program, the student must begin enrollment at a community college or institution of higher learning governed by the state board of regents within two academic years of graduation from high school or receipt of a high school equivalency diploma and continuously receive awards as a full-time or part-time student to maintain eligibility. _____ The division strikes these requirements for eligible foster care students. The division also provides that, for purposes of the program, “eligible foster care student” does not include a person who is years of age or older. The division applies to applications submitted under the program before, on, or after the effective date of the division.