Bill Text: IA HF653 | 2019-2020 | 88th General Assembly | Introduced
Bill Title: A bill for an act relating to family planning and abortion reduction in the state and including effective date provisions.
Spectrum: Partisan Bill (Democrat 7-0)
Status: (Introduced - Dead) 2019-03-07 - Introduced, referred to Human Resources. H.J. 424. [HF653 Detail]
Download: Iowa-2019-HF653-Introduced.html
House
File
653
-
Introduced
HOUSE
FILE
653
BY
BROWN-POWERS
,
WINCKLER
,
HUNTER
,
LENSING
,
R.
SMITH
,
WOLFE
,
and
BENNETT
A
BILL
FOR
An
Act
relating
to
family
planning
and
abortion
reduction
in
1
the
state
and
including
effective
date
provisions.
2
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
3
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DIVISION
I
1
FAMILY
PLANNING
AND
ABORTION
REDUCTION
POLICY
2
Section
1.
FAMILY
PLANNING
AND
ABORTION
REDUCTION
POLICY.
3
1.
a.
In
2011,
nearly
two
million
eight
hundred
thousand
4
pregnancies,
or
forty-five
percent
of
pregnancies,
were
5
unintended,
meaning
that
the
pregnancy
occurred
when
a
woman
6
wanted
to
become
pregnant
in
the
future
but
not
at
the
time
she
7
became
pregnant,
or
the
woman
became
pregnant
when
she
did
not
8
want
to
become
pregnant
then
or
at
any
time
in
the
future.
9
b.
The
rate
of
unintended
pregnancies
is
higher
among
10
women
with
incomes
below
two
hundred
percent
of
the
federal
11
poverty
level
(FPL),
women
eighteen
to
twenty-four
years
of
12
age,
cohabiting
women,
and
women
of
color,
and
is
lowest
among
13
higher-income
women,
white
women,
college
graduates,
and
14
married
women.
With
respect
to
the
outcome
of
an
unintended
15
pregnancy,
in
2011,
women
with
incomes
below
one
hundred
16
percent
of
the
FPL
had
an
unplanned
birth
rate
nearly
seven
17
times
that
of
women
at
or
above
two
hundred
percent
of
the
FPL.
18
2.
a.
Between
2008
and
2011,
the
unintended
pregnancy
19
rate
in
the
United
States
declined
by
eighteen
percent,
the
20
lowest
level
in
three
decades.
During
this
time,
the
rates
21
of
both
abortion
and
unplanned
births
fell
substantially
by
22
thirteen
percent
and
eighteen
percent,
respectively.
Abortion
23
rates
have
continued
to
decline
and
although
states
enacted
new
24
restrictions
on
abortions
between
2012
and
2014,
these
states
25
only
accounted
for
thirty-eight
percent
of
the
total
abortion
26
rate
decline
between
2011
and
2014.
Conversely,
sixty-two
27
percent
of
the
decline
in
the
abortion
rate
was
attributable
28
to
states
and
jurisdictions
that
did
not
pass
restrictive
29
abortion
laws
during
this
same
time
period.
This
suggests
that
30
the
decline
in
the
abortion
rate
during
both
periods
was
not
31
due
to
an
increase
in
unplanned
births
or
increased
abortion
32
restrictions.
33
b.
During
these
periods,
however,
there
was
improvement
34
in
contraceptive
use,
including
the
use
of
highly
effective
35
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long-acting
reversible
contraceptives.
Based
on
this
data,
1
researchers
have
concluded
that
the
decline
in
abortions
was
2
driven
by
the
steep
decline
in
unintended
pregnancy,
which
in
3
turn
was
most
plausibly
explained
by
improved
contraceptive
4
use,
not
because
fewer
women
decided
to
end
an
unwanted
5
pregnancy.
6
3.
a.
According
to
the
centers
for
disease
control
and
7
prevention
of
the
United
States
department
of
health
and
human
8
services
(CDC),
two
million
three
hundred
thousand
cases
of
9
chlamydia,
gonorrhea,
and
syphilis
were
reported
in
the
United
10
States
in
2017,
the
highest
number
ever,
and
two
hundred
11
thousand
more
than
in
2016.
Of
these
cases,
the
population
12
aged
fifteen
to
twenty-four
accounted
for
more
than
one-half
13
of
all
new
sexually
transmitted
infections
(STIs)
each
year,
14
even
though
that
population
makes
up
only
one-quarter
of
the
15
sexually
active
population.
Sexually
transmitted
infections
16
are
disproportionately
more
common
in
young
and
marginalized
17
people.
18
b.
If
left
undiagnosed
and
untreated,
STIs
can
have
serious
19
health
consequences,
resulting
in
infertility,
life-threatening
20
ectopic
pregnancies,
stillbirths
in
infants,
and
miscarriages,
21
and
an
increased
risk
for
human
immunodeficiency
virus
22
transmission.
Additionally,
STIs
may
result
in
adverse
23
pregnancy
outcomes
including
preterm
birth,
low-birth
24
weight,
and
children
with
physical
and
mental
developmental
25
disabilities.
26
c.
The
CDC
identifies
budgetary
cuts
in
STI
prevention
27
efforts,
societal
stigma,
insufficient
awareness
of
the
28
importance
of
screening
among
some
health
care
providers,
lack
29
of
comprehensive
sex
education,
and
barriers
to
health
care
30
services
as
playing
roles
in
the
increase
in
STIs.
31
4.
a.
The
CDC
and
the
United
States
office
of
population
32
affairs
recommend
that
family
planning
services
include
33
providing
contraception
to
help
men
and
women
plan
and
space
34
births,
prevent
unintended
pregnancies,
and
reduce
the
number
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of
abortions;
offer
pregnancy
testing
and
counseling;
help
1
clients
who
want
to
conceive;
provide
basic
infertility
2
services;
provide
preconception
health
service
to
improve
3
infant
and
maternal
outcomes,
and
improve
women’s
and
men’s
4
health;
and
provide
STI
screening
and
treatment
services
to
5
prevent
tubal
infertility
and
improve
the
health
of
women,
men,
6
and
infants.
7
b.
In
2014,
of
the
sixty-seven
million
women
of
reproductive
8
age,
ages
thirteen
to
forty-four,
thirty-eight
million
were
in
9
need
of
contraceptive
care,
and
twenty
million
were
in
need
of
10
publicly
funded
services
and
supplies
due
to
being
low-income
11
or
being
younger
than
twenty
years
of
age.
12
c.
In
2015,
public
expenditures
for
family
planning
client
13
services
totaled
two
billion
one
hundred
million
dollars
14
with
Medicaid
accounting
for
seventy-five
percent,
state
15
appropriations
accounting
for
twelve
percent,
and
funding
16
through
Title
X
of
the
federal
Public
Health
Services
Act
17
(Title
X)
accounting
for
ten
percent.
Title
X
subsidizes
18
services
for
men
and
women
who
do
not
meet
the
eligibility
19
requirements
for
Medicaid,
maintains
the
national
network
of
20
family
planning
centers,
and
sets
the
standards
for
provision
21
of
family
planning
services.
22
d.
Although
total
public
funding
for
family
planning
in
23
actual
dollars
increased
by
more
than
one
billion
seven
hundred
24
million
dollars
between
1980
and
2015,
after
adjusting
for
25
inflation,
funding
levels
were
essentially
the
same
in
2015
as
26
in
1980.
27
e.
In
2010,
every
one
dollar
invested
in
publicly
funded
28
family
planning
services
saved
over
seven
dollars
in
Medicaid
29
expenditures
that
would
otherwise
have
been
necessary
to
pay
30
the
medical
costs
of
pregnancy,
delivery,
and
early
childhood
31
care;
and
the
nationwide
public
investment
in
family
planning
32
services
resulted
in
over
thirteen
billion
dollars
in
net
33
savings,
helping
women
avoid
unintended
pregnancies
and
a
range
34
of
other
negative
reproductive
health
outcomes.
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f.
In
2014,
publicly
funded
family
planning
services
helped
1
women
to
avoid
two
million
unintended
pregnancies,
which
would
2
potentially
have
resulted
in
nearly
nine
hundred
thousand
3
unplanned
births
and
nearly
seven
hundred
thousand
abortions.
4
g.
Publicly
funded
family
planning
has
well-documented
5
health
benefits
for
women,
newborns,
families,
and
communities.
6
The
ability
to
delay
and
space
out
childbearing
is
crucial
to
7
women’s
social
and
economic
advancement.
A
woman’s
ability
to
8
obtain
and
effectively
use
contraceptives
has
a
positive
impact
9
on
their
education
and
workforce
participation,
as
well
as
on
10
subsequent
outcomes
related
to
income,
family
stability,
mental
11
health
and
happiness,
and
children’s
well-being.
Evidence
12
suggests
that
the
most
disadvantaged
women
in
the
United
States
13
do
not
fully
share
in
these
benefits
which
is
why
unintended
14
pregnancy
prevention
efforts
should
be
grounded
in
broader
15
anti-poverty
and
social
justice
efforts.
16
h.
Publicly
funded
family
planning
services
help
women
to
17
avoid
pregnancies
they
do
not
want
and
to
plan
pregnancies
they
18
do.
Supporting
and
expanding
women’s
access
to
family
planning
19
services
not
only
protects
women’s
health,
it
also
reduces
20
abortion
rates.
The
clear
implication
for
policymakers
who
21
wish
to
see
fewer
abortions
occur
is
to
focus
on
making
family
22
planning
services
and
contraceptive
care
more
available
and
23
increasing
funding
to
these
services.
24
DIVISION
II
25
MEDICAID
——
IOWA
FAMILY
PLANNING
NETWORK
26
Sec.
2.
MEDICAID
——
IOWA
FAMILY
PLANNING
NETWORK.
27
1.
The
Medicaid
1115
demonstration
waiver
provided
family
28
planning
services,
at
various
time
periods,
from
February
2006
29
through
June
2017,
to
men
and
women
ages
twelve
to
fifty-four
30
with
incomes
not
exceeding
three
hundred
percent
of
the
federal
31
poverty
level,
through
the
Iowa
family
planning
network.
32
Services
provided
by
the
Iowa
family
planning
network
during
33
this
time
did
all
of
the
following:
34
a.
Resulted
in
an
estimated
midpoint
number
of
averted
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births,
including
by
extension
the
reduction
in
unintended
or
1
unwanted
pregnancies
and
repeat
teen
births,
of
thirty-six
2
thousand
one
hundred
sixty-nine.
3
b.
Resulted
in
an
estimated
midpoint
reduction
in
Medicaid
4
costs
attributable
to
costs
avoided
for
each
averted
birth
5
including
costs
for
deliveries,
births,
and
first
years
of
life
6
of
four
hundred
eighty-five
million
dollars,
not
including
the
7
continuing
costs
for
children
who
remain
on
Medicaid
beyond
8
their
first
birthday.
Approximately
forty
percent
of
children
9
who
had
a
Medicaid-paid
birth
will
remain
on
Medicaid
for
five
10
or
more
years.
11
c.
Resulted
in
a
total
estimated
net
savings
in
Medicaid
12
costs
of
over
four
hundred
seventy-six
million
dollars.
13
d.
Provided
a
cost-effective
mechanism
to
allow
men
and
14
women
access
to
family
planning
services
which
resulted
in
15
averted
births
and
reduced
costs
to
the
state
with
the
ninety
16
percent
federal
match
for
such
services.
17
2.
Conversely,
data
reported
regarding
the
state
family
18
planning
program
established
July
1,
2017,
and
funded
19
exclusively
with
state
general
fund
moneys,
indicates
that
from
20
April
through
June
of
2018,
there
was
a
seventy-three
percent
21
decline
in
services
compared
with
April
through
June
2017,
the
22
last
three
months
of
the
Iowa
family
planning
network,
and
23
patient
enrollment
in
the
new
program
fell
by
more
than
half.
24
3.
If
family
planning
services
were
once
again
provided
25
under
the
Medicaid
program
through
a
Medicaid
state
plan
26
amendment,
with
the
same
benefits,
eligibility
requirements,
27
and
other
provisions
included
in
the
former
Iowa
family
28
planning
network
demonstration
waiver,
the
state
would
be
able
29
to
do
all
of
the
following:
30
a.
Utilize
the
additional
state
funds
available
to
31
expand
efforts
to
continue
to
reduce
abortions
and
improve
32
reproductive
and
overall
health
for
men
and
women
in
the
state
33
through
broad-based
family
planning
services,
age-appropriate
34
sexual
health
education
efforts
such
as
the
personal
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responsibility
and
education
program,
programs
for
pregnant
and
1
parenting
teens,
increased
access
to
family
planning
services
2
including
contraceptives
to
men
and
women,
Medicaid-enhanced
3
prenatal
services
for
members
determined
to
be
at
high
risk,
4
and
the
Title
X
family
planning
program.
5
b.
Utilize
the
entire
family
planning
services
provider
6
network
to
expand
access
to
reach
those
in
need
of
publicly
7
funded
services,
including
those
women
for
whom
rates
of
8
unintended
pregnancies
are
higher
including
low-income,
9
younger,
and
less-formally
educated
women,
and
women
of
color.
10
c.
Continue
to
provide
necessary
family
planning
services
11
that
have
resulted
in
declining
unintended
pregnancies
and
12
fewer
abortions,
and
that
would
result
in
additional
resources
13
being
available
to
enhance
the
quality
of
life
for
children
14
after
they
are
born
including
through
the
head
start
program,
15
prekindergarten
programs,
child
care
assistance,
properly
16
funded
schools,
foster
and
adoptive
programs,
hawk-i,
and
other
17
programs
that
support
and
enrich
the
lives
of
children
and
18
families
in
the
state.
19
Sec.
3.
IOWA
FAMILY
PLANNING
NETWORK
——
MEDICAID
STATE
20
PLAN
AMENDMENT.
The
department
of
human
services
shall
submit
21
a
Medicaid
state
plan
amendment
to
the
centers
for
Medicare
22
and
Medicaid
services
of
the
United
States
department
of
23
health
and
human
services
for
approval
to
establish
the
Iowa
24
family
planning
network
with
the
same
benefits,
eligibility
25
requirements,
and
other
provisions
included
in
the
Medicaid
26
Iowa
family
planning
network
waiver
as
approved
by
the
centers
27
for
Medicare
and
Medicaid
services
of
the
United
States
28
department
of
health
and
human
services
in
effect
on
June
30,
29
2017.
30
Sec.
4.
EFFECTIVE
DATE.
This
division
of
this
Act,
being
31
deemed
of
immediate
importance,
takes
effect
upon
enactment.
32
DIVISION
III
33
REPEAL
OF
STATE
FAMILY
PLANNING
SERVICES
PROGRAM
34
Sec.
5.
REPEAL.
Section
217.41B,
Code
2019,
is
repealed.
35
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Sec.
6.
CONTINGENT
EFFECTIVE
DATE.
The
following
takes
1
effect
upon
receipt
of
approval
by
the
department
of
human
2
services
from
the
centers
for
Medicare
and
Medicaid
services
3
of
the
United
States
department
of
health
and
human
services
4
of
the
Medicaid
state
plan
amendment
submitted
pursuant
to
5
division
II
of
this
Act
to
establish
the
Iowa
family
planning
6
network:
7
The
section
of
this
division
of
this
Act
repealing
section
8
217.41B,
Code
2019.
9
DIVISION
IV
10
SELF-ADMINISTERED
HORMONAL
CONTRACEPTIVES
11
Sec.
7.
Section
155A.3,
Code
2019,
is
amended
by
adding
the
12
following
new
subsections:
13
NEW
SUBSECTION
.
10A.
“Department”
means
the
department
of
14
public
health.
15
NEW
SUBSECTION
.
44A.
“Self-administered
hormonal
16
contraceptive”
means
a
self-administered
hormonal
contraceptive
17
that
is
approved
by
the
United
States
food
and
drug
18
administration
to
prevent
pregnancy.
“Self-administered
19
hormonal
contraceptive”
includes
an
oral
hormonal
contraceptive,
20
a
hormonal
vaginal
ring,
and
a
hormonal
contraceptive
patch,
21
but
does
not
include
any
drug
intended
to
induce
an
abortion
as
22
defined
in
section
146.1.
23
NEW
SUBSECTION
.
44B.
“Standing
order”
means
a
preauthorized
24
medication
order
with
specific
instructions
from
the
medical
25
director
of
the
department
to
dispense
a
medication
under
26
clearly
defined
circumstances.
27
Sec.
8.
NEW
SECTION
.
155A.47
Pharmacist
dispensing
of
28
self-administered
hormonal
contraceptives
——
standing
order
——
29
requirements
——
limitations
of
liability.
30
1.
Notwithstanding
any
provision
of
law
to
the
contrary,
a
31
pharmacist
may
dispense,
at
one
time,
up
to
a
one-year
supply
32
of
a
self-administered
hormonal
contraceptive
to
a
patient,
33
pursuant
to
a
standing
order
established
by
the
medical
34
director
of
the
department
in
accordance
with
this
section.
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2.
A
pharmacist
who
dispenses
a
self-administered
hormonal
1
contraceptive
in
accordance
with
this
section
shall
not
2
require
any
other
prescription
drug
order
authorized
by
a
3
practitioner
prior
to
dispensing
the
self-administered
hormonal
4
contraceptive
to
a
patient.
5
3.
The
medical
director
of
the
department
may
establish
a
6
standing
order
authorizing
the
dispensing
of
self-administered
7
hormonal
contraceptives
by
a
pharmacist
who
does
all
of
the
8
following:
9
a.
Complies
with
the
standing
order
established
pursuant
to
10
this
section.
11
b.
Retains
a
record
of
each
patient
to
whom
a
12
self-administered
hormonal
contraceptive
is
dispensed
under
13
this
section
and
submits
the
record
to
the
department.
14
4.
The
standing
order
shall
require
a
pharmacist
who
15
dispenses
self-administered
hormonal
contraceptives
under
this
16
section
to
do
all
of
the
following:
17
a.
Complete
a
standardized
training
program
and
continuing
18
education
requirements
approved
by
the
board
in
consultation
19
with
the
department
that
are
related
to
prescribing
20
self-administered
hormonal
contraceptives
and
include
education
21
regarding
all
contraceptive
methods
approved
by
the
United
22
States
food
and
drug
administration.
23
b.
Obtain
a
completed
self-screening
risk
assessment,
24
approved
by
the
department
in
collaboration
with
the
board
and
25
the
board
of
medicine,
from
each
patient
prior
to
dispensing
26
the
self-administered
hormonal
contraceptive
to
the
patient.
27
c.
Provide
the
patient
with
all
of
the
following:
28
(1)
Written
information
regarding
all
of
the
following:
29
(a)
The
importance
of
completing
an
appointment
with
the
30
patient’s
primary
care
or
women’s
health
care
practitioner
31
to
obtain
preventative
care,
including
but
not
limited
to
32
recommended
tests
and
screenings.
33
(b)
The
effectiveness
and
availability
of
long-acting
34
reversible
contraceptives
as
an
alternative
to
35
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self-administered
hormonal
contraceptives.
1
(2)
A
copy
of
the
record
of
the
pharmacist’s
encounter
with
2
the
patient
that
includes
all
of
the
following:
3
(a)
The
patient’s
completed
self-screening
risk
assessment.
4
(b)
A
description
of
the
contraceptive
dispensed,
or
the
5
basis
for
not
dispensing
a
contraceptive.
6
(3)
Patient
counseling
regarding
all
of
the
following:
7
(a)
The
appropriate
administration
and
storage
of
the
8
self-administered
hormonal
contraceptive.
9
(b)
Potential
side
effects
and
risks
of
the
10
self-administered
hormonal
contraceptive.
11
(c)
The
need
for
backup
contraception.
12
(d)
When
to
seek
emergency
medical
attention.
13
(e)
The
risk
of
contracting
a
sexually
transmitted
14
infection
or
disease,
and
ways
to
reduce
such
a
risk.
15
5.
The
standing
order
established
pursuant
to
this
section
16
shall
prohibit
a
pharmacist
who
dispenses
a
self-administered
17
hormonal
contraceptive
under
this
section
from
doing
any
of
the
18
following:
19
a.
Requiring
a
patient
to
schedule
an
appointment
with
20
the
pharmacist
for
the
prescribing
or
dispensing
of
a
21
self-administered
hormonal
contraceptive.
22
b.
Dispensing
self-administered
hormonal
contraceptives
to
23
a
patient
for
more
than
twenty-four
months
after
the
date
a
24
self-administered
hormonal
contraceptive
is
initially
dispensed
25
to
the
patient
without
the
patient’s
attestation
that
the
26
patient
has
consulted
with
a
primary
care
or
women’s
health
27
care
practitioner
during
the
preceding
twenty-four
months.
28
c.
Dispensing
a
self-administered
hormonal
contraceptive
to
29
a
patient
if
the
results
of
the
self-screening
risk
assessment
30
completed
by
a
patient
pursuant
to
subsection
4,
paragraph
31
“b”
,
indicate
it
is
unsafe
for
the
pharmacist
to
dispense
the
32
self-administered
hormonal
contraceptive
to
the
patient,
in
33
which
case
the
pharmacist
shall
refer
the
patient
to
a
primary
34
care
or
women’s
health
care
practitioner.
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6.
A
pharmacist
who
dispenses
a
self-administered
hormonal
1
contraceptive
and
the
medical
director
of
the
department
who
2
establishes
a
standing
order
in
compliance
with
this
section
3
shall
be
immune
from
criminal
and
civil
liability
arising
4
from
any
damages
caused
by
the
dispensing,
administering,
5
or
use
of
a
self-administered
hormonal
contraceptive
or
the
6
establishment
of
the
standing
order.
The
medical
director
of
7
the
department
shall
be
considered
to
be
acting
within
the
8
scope
of
the
medical
director’s
office
and
employment
for
9
purposes
of
chapter
669
in
the
establishment
of
a
standing
10
order
in
compliance
with
this
section.
11
7.
The
department,
in
collaboration
with
the
board
and
12
the
board
of
medicine,
and
in
consideration
of
the
guidelines
13
established
by
the
American
congress
of
obstetricians
and
14
gynecologists,
shall
adopt
rules
pursuant
to
chapter
17A
to
15
administer
this
chapter.
16
Sec.
9.
Section
514C.19,
Code
2019,
is
amended
to
read
as
17
follows:
18
514C.19
Prescription
contraceptive
coverage.
19
1.
Notwithstanding
the
uniformity
of
treatment
requirements
20
of
section
514C.6
,
a
group
policy
,
or
contract
,
or
plan
21
providing
for
third-party
payment
or
prepayment
of
health
or
22
medical
expenses
shall
not
do
either
of
the
following
comply
23
as
follows
:
24
a.
Exclude
Such
policy,
contract,
or
plan
shall
not
25
exclude
or
restrict
benefits
for
prescription
contraceptive
26
drugs
or
prescription
contraceptive
devices
which
prevent
27
conception
and
which
are
approved
by
the
United
States
28
food
and
drug
administration,
or
generic
equivalents
29
approved
as
substitutable
by
the
United
States
food
and
drug
30
administration,
if
such
policy
,
or
contract
,
or
plan
provides
31
benefits
for
other
outpatient
prescription
drugs
or
devices.
32
However,
such
policy,
contract,
or
plan
shall
specifically
33
provide
for
payment
of
a
one-year
supply
of
self-administered
34
hormonal
contraceptives,
as
prescribed
by
a
practitioner
as
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defined
in
section
155A.3,
or
as
prescribed
by
standing
order
1
and
dispensed
by
a
pharmacist
pursuant
to
section
155A.47,
2
including
self-administered
hormonal
contraceptives
dispensed
3
at
one
time.
4
b.
Exclude
Such
policy,
contract,
or
plan
shall
not
exclude
5
or
restrict
benefits
for
outpatient
contraceptive
services
6
which
are
provided
for
the
purpose
of
preventing
conception
if
7
such
policy
,
or
contract
,
or
plan
provides
benefits
for
other
8
outpatient
services
provided
by
a
health
care
professional.
9
2.
A
person
who
provides
a
group
policy
,
or
contract
,
or
10
plan
providing
for
third-party
payment
or
prepayment
of
health
11
or
medical
expenses
which
is
subject
to
subsection
1
shall
not
12
do
any
of
the
following:
13
a.
Deny
to
an
individual
eligibility,
or
continued
14
eligibility,
to
enroll
in
or
to
renew
coverage
under
the
terms
15
of
the
policy
,
or
contract
,
or
plan
because
of
the
individual’s
16
use
or
potential
use
of
such
prescription
contraceptive
drugs
17
or
devices,
or
use
or
potential
use
of
outpatient
contraceptive
18
services.
19
b.
Provide
a
monetary
payment
or
rebate
to
a
covered
20
individual
to
encourage
such
individual
to
accept
less
than
the
21
minimum
benefits
provided
for
under
subsection
1
.
22
c.
Penalize
or
otherwise
reduce
or
limit
the
reimbursement
23
of
a
health
care
professional
because
such
professional
24
prescribes
contraceptive
drugs
or
devices,
or
provides
25
contraceptive
services.
26
d.
Provide
incentives,
monetary
or
otherwise,
to
a
health
27
care
professional
to
induce
such
professional
to
withhold
28
from
a
covered
individual
contraceptive
drugs
or
devices,
or
29
contraceptive
services.
30
3.
This
section
shall
not
be
construed
to
prevent
a
31
third-party
payor
from
including
deductibles,
coinsurance,
or
32
copayments
under
the
policy
,
or
contract,
or
plan
as
follows:
33
a.
A
deductible,
coinsurance,
or
copayment
for
benefits
34
for
prescription
contraceptive
drugs
shall
not
be
greater
than
35
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such
deductible,
coinsurance,
or
copayment
for
any
outpatient
1
prescription
drug
for
which
coverage
under
the
policy
,
or
2
contract
,
or
plan
is
provided.
3
b.
A
deductible,
coinsurance,
or
copayment
for
benefits
for
4
prescription
contraceptive
devices
shall
not
be
greater
than
5
such
deductible,
coinsurance,
or
copayment
for
any
outpatient
6
prescription
device
for
which
coverage
under
the
policy
,
or
7
contract
,
or
plan
is
provided.
8
c.
A
deductible,
coinsurance,
or
copayment
for
benefits
for
9
outpatient
contraceptive
services
shall
not
be
greater
than
10
such
deductible,
coinsurance,
or
copayment
for
any
outpatient
11
health
care
services
for
which
coverage
under
the
policy
,
or
12
contract
,
or
plan
is
provided.
13
4.
This
section
shall
not
be
construed
to
require
a
14
third-party
payor
under
a
policy
,
or
contract
,
or
plan
15
to
provide
benefits
for
experimental
or
investigational
16
contraceptive
drugs
or
devices,
or
experimental
or
17
investigational
contraceptive
services,
except
to
the
extent
18
that
such
policy
,
or
contract
,
or
plan
provides
coverage
for
19
other
experimental
or
investigational
outpatient
prescription
20
drugs
or
devices,
or
experimental
or
investigational
outpatient
21
health
care
services.
22
5.
This
section
shall
not
be
construed
to
limit
or
otherwise
23
discourage
the
use
of
generic
equivalent
drugs
approved
by
the
24
United
States
food
and
drug
administration,
whenever
available
25
and
appropriate.
This
section
,
when
a
brand
name
drug
is
26
requested
by
a
covered
individual
and
a
suitable
generic
27
equivalent
is
available
and
appropriate,
shall
not
be
construed
28
to
prohibit
a
third-party
payor
from
requiring
the
covered
29
individual
to
pay
a
deductible,
coinsurance,
or
copayment
30
consistent
with
subsection
3
,
in
addition
to
the
difference
of
31
the
cost
of
the
brand
name
drug
less
the
maximum
covered
amount
32
for
a
generic
equivalent.
33
6.
A
person
who
provides
an
individual
policy
,
or
contract
,
34
or
plan
providing
for
third-party
payment
or
prepayment
of
35
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health
or
medical
expenses
shall
make
available
a
coverage
1
provision
that
satisfies
the
requirements
in
subsections
2
1
through
5
in
the
same
manner
as
such
requirements
are
3
applicable
to
a
group
policy
,
or
contract
,
or
plan
under
those
4
subsections.
The
policy
,
or
contract
,
or
plan
shall
provide
5
that
the
individual
policyholder
may
reject
the
coverage
6
provision
at
the
option
of
the
policyholder.
7
7.
a.
This
section
applies
to
the
following
classes
of
8
third-party
payment
provider
contracts
,
or
policies
,
or
plan
9
delivered,
issued
for
delivery,
continued,
or
renewed
in
this
10
state
on
or
after
July
1,
2000
January
1,
2020
:
11
(1)
Individual
or
group
accident
and
sickness
insurance
12
providing
coverage
on
an
expense-incurred
basis.
13
(2)
An
individual
or
group
hospital
or
medical
service
14
contract
issued
pursuant
to
chapter
509
,
514
,
or
514A
.
15
(3)
An
individual
or
group
health
maintenance
organization
16
contract
regulated
under
chapter
514B
.
17
(4)
Any
other
entity
engaged
in
the
business
of
insurance,
18
risk
transfer,
or
risk
retention,
which
is
subject
to
the
19
jurisdiction
of
the
commissioner.
20
(5)
A
plan
established
pursuant
to
chapter
509A
for
public
21
employees.
22
b.
This
section
shall
not
apply
to
accident-only,
23
specified
disease,
short-term
hospital
or
medical,
hospital
24
confinement
indemnity,
credit,
dental,
vision,
Medicare
25
supplement,
long-term
care,
basic
hospital
and
medical-surgical
26
expense
coverage
as
defined
by
the
commissioner,
disability
27
income
insurance
coverage,
coverage
issued
as
a
supplement
28
to
liability
insurance,
workers’
compensation
or
similar
29
insurance,
or
automobile
medical
payment
insurance.
30
8.
This
section
shall
not
be
construed
to
require
a
31
third-party
payor
to
provide
payment
to
a
practitioner
for
the
32
dispensing
of
a
self-administered
hormonal
contraceptive
to
33
replace
a
self-administered
hormonal
contraceptive
that
has
34
been
dispensed
to
a
covered
person
and
that
has
been
misplaced,
35
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stolen,
or
destroyed.
This
section
shall
not
be
construed
to
1
require
a
third-party
payor
to
replace
covered
prescriptions
2
that
are
misplaced,
stolen,
or
destroyed.
3
9.
For
the
purposes
of
this
section:
4
a.
“Self-administered
hormonal
contraceptive”
means
a
5
self-administered
hormonal
contraceptive
that
is
approved
6
by
the
United
Sates
food
and
drug
administration
to
prevent
7
pregnancy.
“Self-administered
hormonal
contraceptive”
includes
8
an
oral
hormonal
contraceptive,
a
hormonal
vaginal
ring,
and
9
a
hormonal
contraceptive
patch,
but
does
not
include
any
drug
10
intended
to
induce
an
abortion
as
defined
in
section
146.1.
11
b.
“Standing
order”
means
a
preauthorized
medication
order
12
with
specific
instructions
from
the
medical
director
of
the
13
department
of
public
health
to
dispense
a
medication
under
14
clearly
defined
circumstances.
15
EXPLANATION
16
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
17
the
explanation’s
substance
by
the
members
of
the
general
assembly.
18
This
bill
relates
to
state
family
planning
services.
19
Division
I
of
the
bill
provides
a
basis
for
a
family
planning
20
and
abortion
reduction
policy.
21
Division
II
of
the
bill
requires
the
department
of
human
22
services
(DHS)
to
submit
a
Medicaid
state
plan
amendment
to
23
the
centers
for
Medicare
and
Medicaid
services
of
the
United
24
States
department
of
health
and
human
services
(CMS)
for
25
approval
to
establish
the
Iowa
family
planning
network
with
the
26
same
benefits,
eligibility
requirements,
and
other
provisions
27
included
in
the
Medicaid
Iowa
family
planning
network
waiver
28
as
approved
by
CMS
in
effect
on
June
30,
2017.
The
section
of
29
Division
II
of
the
bill
requiring
submission
of
the
state
plan
30
amendment
takes
effect
upon
enactment.
31
Division
III
of
the
bill
repeals
the
state
family
planning
32
services
program.
The
repeal
of
the
program
takes
effect
upon
33
receipt
of
approval
by
DHS
from
CMS
of
the
Medicaid
state
plan
34
amendment
establishing
the
Iowa
family
planning
network.
35
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Division
IV
of
the
bill
relates
to
the
dispensing
of
1
self-administered
hormonal
contraceptives
by
a
pharmacist.
2
The
division
provides
that
notwithstanding
any
provision
3
of
law
to
the
contrary,
a
pharmacist
may
dispense
at
one
4
time,
up
to
a
one-year
supply
of
a
self-administered
hormonal
5
contraceptive
to
a
patient
pursuant
to
a
standing
order
6
established
by
the
medical
director
of
the
department
of
public
7
health
(medical
director).
8
The
division
authorizes
the
medical
director
to
establish
a
9
standing
order
authorizing
the
dispensing
of
self-administered
10
hormonal
contraceptives
by
any
pharmacist
who
complies
with
the
11
standing
order
and
retains
and
submits
the
patient’s
record
to
12
the
department
of
public
health
(DPH).
13
The
division
requires
DPH,
in
collaboration
with
the
14
boards
of
pharmacy
and
medicine,
and
in
consideration
of
15
the
guidelines
established
by
the
American
congress
of
16
obstetricians
and
gynecologists,
to
adopt
administrative
rules
17
to
administer
the
division.
18
The
division
amends
prescription
contraceptive
coverage
19
provisions
to
require
that
a
group
policy,
contract,
or
plan
20
delivered,
issued
for
delivery,
continued,
or
renewed
in
the
21
state
on
or
after
January
1,
2020,
providing
for
third-party
22
payment
or
prepayment
of
health
or
medical
expenses,
shall
23
specifically
provide
for
payment
of
a
one-year
supply
of
24
self-administered
hormonal
contraceptives,
as
prescribed
25
and
dispensed
as
specified
in
the
division,
including
those
26
dispensed
at
one
time.
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