Bill Text: IA HF653 | 2019-2020 | 88th General Assembly | Introduced

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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

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