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Senate
File
85
-
Introduced
SENATE
FILE
85
BY
PETERSEN
A
BILL
FOR
An
Act
creating
a
health
equity
program
and
fund,
and
providing
1
an
appropriation.
2
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
3
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Section
1.
NEW
SECTION
.
135.196
Health
equity
program
——
1
fund
——
standing
appropriation.
2
1.
The
department
shall
establish
a
health
equity
program
3
to
improve
menstrual
and
post-menstrual
health
by
providing
4
for
reimbursement
of
the
costs
associated
with
the
provision
5
of
covered
services
and
treatments
related
to
menstrual
and
6
post-menstrual
health
conditions
not
otherwise
covered
by
a
7
third-party
payor.
The
department
shall
promote
the
program
8
statewide
and
shall
limit
program
administrative
costs
to
9
no
more
than
four
percent
of
the
funds
appropriated
for
the
10
program
on
an
annual
basis.
11
2.
a.
The
department
shall
adopt
rules
pursuant
to
chapter
12
17A
to
administer
the
program
and
to
specify
the
types
of
13
services
and
treatments
covered
under
the
program,
informed
by
14
evidence-based
data
from
menstrual
and
post-menstrual
health
15
experts
including
but
not
limited
to
those
who
practice
in
16
the
fields
of
obstetrics
and
gynecology,
family
practice,
17
internal
medicine,
and
urology.
The
covered
services
and
18
treatments
shall
include
but
are
not
limited
to
hormone
19
treatments,
urinary
tract
treatments,
vaginal
estrogens,
nerve
20
therapies,
and
other
services
and
treatments
that
alleviate
21
illness,
injury,
conditions,
diseases
or
symptoms
related
to
22
periods,
fibroids,
endometriosis,
perimenopause,
menopause,
23
incontinence,
atrophic
vaginitis,
and
other
hormone-related
24
conditions.
25
b.
Covered
services
and
treatments
shall
include
health
26
care
services,
treatments,
supplies,
and
drugs
needed
to
treat
27
a
menstrual
or
post-menstrual
illness,
injury,
condition,
28
disease,
or
its
symptoms
that
meet
any
of
the
following
29
criteria:
30
(1)
Comply
with
standard
medical
practice.
31
(2)
Are
approved
by
the
United
States
food
and
drug
32
administration
including
for
off-label
use
when
supported
by
33
appropriate
medical
records.
34
(3)
Are
recommended
or
preferred
by
the
patient’s
provider
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and
supported
by
appropriate
medical
records.
1
3.
The
department
shall
establish
a
process
for
2
registration
of
participating
providers
eligible
to
receive
3
reimbursement
through
the
health
equity
program
fund.
A
4
health
care
provider
shall
be
eligible
for
participation
if
5
the
provider
is
deemed
qualified
and
in
good
standing
by
the
6
provider’s
respective
health-related
profession
board.
7
4.
A
participating
provider
shall
be
reimbursed
for
a
8
covered
service
or
treatment
through
the
health
equity
program
9
fund
within
ten
days
of
submission
of
a
billing
statement.
10
If
applicable,
the
billing
statement
shall
confirm
that
the
11
patient
is
uninsured
or
that
the
service
or
treatment
is
not
12
covered
by
the
patient’s
insurer.
13
5.
The
amount
billed
by
the
participating
provider
shall
14
not
exceed
the
actual
cost
incurred
by
the
provider
in
15
delivering
the
covered
service
or
treatment.
Reimbursement
for
16
a
covered
service
or
treatment
shall
be
paid
directly
to
the
17
participating
provider
and
such
payment
shall
be
considered
18
payment
in
full.
The
health
equity
program
shall
be
the
payor
19
of
last
resort.
20
6.
If
sufficient
program
funds
are
not
available
to
21
reimburse
all
billings
submitted
by
participating
providers,
22
the
department
shall
place
a
participating
provider
on
a
23
reimbursement
waiting
list
in
the
order
the
participating
24
provider’s
billing
statement
was
received.
25
7.
This
section
shall
not
be
construed
as
granting
an
26
entitlement
to
reimbursement
for
any
covered
service
or
27
treatment
provided
by
a
participating
provider.
28
8.
a.
A
health
equity
program
fund
is
created
in
the
29
state
treasury
under
the
control
of
the
department.
The
fund
30
includes
but
is
not
limited
to
amounts
appropriated
by
the
31
general
assembly
and
other
moneys
available
from
federal
or
32
private
sources
which
are
to
be
used
for
purposes
of
this
33
section.
Notwithstanding
section
8.33,
funds
remaining
in
34
the
fund
at
the
end
of
each
fiscal
year
shall
not
revert
to
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the
general
fund
of
the
state
but
shall
remain
in
the
health
1
equity
program
fund.
Moneys
in
the
fund
are
appropriated
to
2
the
department
for
purposes
of
the
health
equity
program.
3
b.
There
is
appropriated
from
the
general
fund
of
the
4
state
to
the
health
equity
program
fund
a
sum
which
reflects
5
the
total
equivalent
of
all
state
revenue
expended
for
6
genitourinary
agents
for
state
employees
under
the
group
7
insurance
plan
for
public
employees
pursuant
to
chapter
509A,
8
between
July
1,
2002,
and
June
30,
2022.
9
c.
For
the
purposes
of
this
subsection:
10
(1)
“Genitourinary
agents”
means
medicines
used
to
treat
11
conditions
of
the
reproductive
organs
and
excretory
system
or
12
urinary
tract.
13
(2)
“Period
products”
includes
but
is
not
limited
to
14
tampons,
period
pads,
and
period
cups
for
use
in
connection
15
with
the
menstrual
cycle.
16
8.
The
department
shall
submit
an
annual
report
to
the
17
governor
and
the
general
assembly
regarding
the
status
of
the
18
program
and
fund
including
the
balance
remaining
in
the
fund,
19
the
number
of
participating
providers,
the
total
amount
billed
20
per
participating
provider,
the
covered
services
and
treatments
21
for
which
reimbursement
was
provided
in
the
previous
year,
and
22
any
recommendations
for
changes
to
the
program
or
fund.
23
Sec.
2.
CODE
EDITOR
DIRECTIVE.
The
Code
editor
may
24
designate
section
135.196,
as
enacted
in
this
Act,
as
a
new
25
subchapter
within
chapter
135,
entitled
“HEALTH
EQUITY
PROGRAM
26
AND
FUND”.
27
EXPLANATION
28
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
29
the
explanation’s
substance
by
the
members
of
the
general
assembly.
30
This
bill
requires
the
department
of
health
and
human
31
services
(HHS)
to
establish
a
health
equity
program
(program)
32
to
improve
menstrual
and
post-menstrual
health
by
providing
33
for
reimbursement
of
the
costs
associated
with
the
provision
34
of
covered
services
and
treatments
related
to
menstrual
and
35
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85
post-menstrual
health
conditions
not
otherwise
covered
by
a
1
third-party
payor.
The
department
shall
promote
the
program
2
statewide
and
limit
program
administrative
costs
to
no
more
3
than
4
percent
of
the
funds
appropriated
for
the
program
on
an
4
annual
basis.
5
The
bill
requires
HHS
to
adopt
administrative
rules
to
6
administer
the
program
and
specify
the
types
of
services
and
7
treatments
covered
under
the
program,
and
requires
that
the
8
covered
services
and
treatments
shall
include
health
care
9
services,
treatments,
supplies,
and
drugs
needed
to
treat
10
a
menstrual
or
post-menstrual
illness,
injury,
condition,
11
disease,
or
its
symptoms
that
comply
with
standard
medical
12
practice,
or
are
approved
by
the
United
States
food
and
drug
13
administration
or
are
recommended
or
preferred
by
the
patient’s
14
provider
and
supported
by
appropriate
medical
records.
15
The
department
shall
establish
a
process
for
the
16
registration
of
participating
providers
eligible
to
receive
17
reimbursement
through
the
program.
A
participating
provider
18
shall
be
reimbursed
for
a
covered
service
or
treatment
through
19
the
program
fund
within
10
days
of
submission
of
a
billing
20
statement,
and
if
applicable,
the
billing
statement
shall
21
confirm
that
the
patient
is
uninsured
or
that
the
service
or
22
treatment
is
not
covered
by
the
patient’s
insurer.
The
amount
23
billed
by
the
participating
provider
shall
not
exceed
the
24
actual
cost
incurred
by
the
provider
in
delivering
the
covered
25
service
or
treatment.
Reimbursement
shall
be
paid
directly
to
26
the
participating
provider
and
such
payment
shall
be
considered
27
payment
in
full.
The
program
shall
be
the
payor
of
last
28
resort.
If
sufficient
program
funds
are
not
available
to
cover
29
all
of
the
billings
submitted,
HHS
shall
place
a
participating
30
provider
on
a
reimbursement
waiting
list
in
the
order
the
31
participating
provider’s
billing
statement
was
received.
32
The
provisions
of
the
bill
are
not
to
be
construed
as
33
granting
an
entitlement
to
reimbursement
for
any
covered
34
service
or
treatment
provided
by
a
participating
provider.
35
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The
bill
creates
a
health
equity
program
fund
under
the
1
control
of
HHS.
The
fund
includes
amounts
appropriated
by
the
2
general
assembly
and
other
moneys
available
from
federal
or
3
private
sources.
Moneys
in
the
fund
at
the
end
of
each
fiscal
4
year
shall
not
revert
but
remain
in
the
fund.
Moneys
in
the
5
fund
are
appropriated
to
HHS
for
the
purposes
of
the
program.
6
There
is
appropriated
from
the
general
fund
of
the
state
to
7
the
program
fund
a
sum
which
reflects
the
total
equivalent
of
8
all
state
revenue
expended
for
genitourinary
agents
for
state
9
employees
under
the
group
insurance
plan
for
public
employees
10
pursuant
to
Code
chapter
509A,
for
the
fiscal
period
between
11
July
1,
2002,
and
June
30,
2022.
The
department
shall
submit
12
an
annual
report
to
the
governor
and
the
general
assembly
13
regarding
the
status
of
the
program
and
fund
including
the
14
balance
remaining
in
the
fund,
the
number
of
participating
15
providers,
the
total
amount
billed
per
participating
provider,
16
the
covered
services
and
treatments
for
which
reimbursement
17
was
provided
in
the
previous
year,
and
any
recommendations
for
18
changes
to
the
program
or
fund.
19
The
bill
defines
“genitourinary
agents”
and
“period
20
products”.
21
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