Senate File 2286 - Introduced SENATE FILE 2286 BY COMMITTEE ON JUDICIARY (SUCCESSOR TO SSB 3006) A BILL FOR An Act relating to protections for health care institutions, 1 health care payors, and medical practitioners including 2 those related to the exercise of a right of conscience, 3 whistleblower activities, and free speech, and providing 4 penalties. 5 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 6 TLSB 5640SV (3) 90 pf/ko
S.F. 2286 Section 1. NEW SECTION . 135S.1 Definitions. 1 As used in this chapter, unless the context otherwise 2 requires: 3 1. Adverse action includes termination of employment; 4 transfer or demotion from a current position; an adverse 5 administrative action; reassignment to a different shift or 6 job title; increased administrative duties; denial of staff 7 privileges; denial of board certification; loss of career 8 specialty; reduction of wages, benefits, or privileges; refusal 9 to award a grant, contract, or other funding opportunity; 10 refusal to provide residency training opportunities; denial, 11 deprivation, or disqualification of licensure; withholding 12 or disqualifying from financial aid and other assistance; 13 impediment of the establishment or improvement of a health care 14 institution or health care payor; impediment of the acquisition 15 or merger of a health care institution or health care payor; 16 or any other penalty, discipline, or retaliatory action. 17 Adverse action does not include the negotiation or purchase of 18 insurance by a nongovernmental entity. 19 2. a. Conscience means the ethical, moral, or religious 20 beliefs or principles held by a medical practitioner, health 21 care institution, or health care payor. 22 b. With respect to persons who are institutions, 23 corporations, or other legal entities, conscience is 24 determined by reference to that entitys governing documents 25 including but not limited to published ethical, moral, or 26 religious guidelines or directives, mission statements, 27 constitutions, articles of incorporation, bylaws, policies, or 28 regulations. 29 3. Discrimination means an adverse action taken against, 30 or a threat of adverse action communicated to, a medical 31 practitioner, health care institution, or health care payor as 32 a result of the refusal of the medical practitioner, health 33 care institution, or health care payor to participate in a 34 health care service on the basis of conscience. 35 -1- LSB 5640SV (3) 90 pf/ko 1/ 11
S.F. 2286 4. Health care institution means a hospital, an 1 outpatient primary care location, a medical center, a physician 2 organization, a professional association, an ambulatory 3 surgical center, a private office of a medical practitioner, a 4 pharmacy, a health care facility, a medical or nursing school, 5 a medical training facility, or any other entity or location 6 in which health care services are performed. Health care 7 institution includes but is not limited to organizations, 8 corporations, partnerships, associations, agencies, networks, 9 sole proprietorships, and joint ventures. 10 5. Health care payor means an employer, a health plan, 11 an insurer, a management services organization, or any other 12 entity that pays for or arranges for payment, in whole or in 13 part, for a health care service. 14 6. Health care service means medical research and medical 15 care provided to a patient or client at any time during the 16 patients or clients course of treatment, including but 17 not limited to initial examination, testing, diagnosis, or 18 referral; dispensing or administration of a drug, medication, 19 or device; psychological therapy or counseling; research, 20 prognosis, therapy, recordmaking, notes related to treatment, 21 set up, or performance of a surgery or procedure; or any 22 other care or service performed or provided by a medical 23 practitioner. 24 7. Insurer means any entity, including a health 25 service corporation, health maintenance organization, or any 26 similar corporation or organization, or an employer offering 27 self-insurance, that provides a health benefit plan. 28 8. Medical practitioner means a person who facilitates 29 or participates, or who is asked to facilitate or participate 30 in a health care service, including but not limited to a 31 health-related professional licensed by a board designated in 32 section 147.13, and any other person licensed, certified, or 33 otherwise authorized or permitted by the laws of this state 34 to administer a health care service in the ordinary course 35 -2- LSB 5640SV (3) 90 pf/ko 2/ 11
S.F. 2286 of business or in the practice of a profession. Medical 1 practitioner includes any student enrolled in an educational 2 institution who is a prospective medical practitioner. 3 9. Participate in a health care service means to provide, 4 perform, assist with, facilitate, refer for, provide counseling 5 for, advise with regard to, admit for the purposes of 6 providing, or take part in a health care service in any way. 7 10. Person means the same as defined in section 4.1. 8 Sec. 2. NEW SECTION . 135S.2 Exercise of conscience for 9 health care institutions, health care payors, and medical 10 practitioners immunity exception. 11 1. a. A health care institution or health care payor shall 12 not be required to participate in or pay for a health care 13 service that violates the health care institutions or health 14 care payors conscience, including by permitting the use of the 15 health care institutions or health care payors facilities. 16 b. An insurer shall list any health care service the insurer 17 refuses to pay for on the basis of the insurers right of 18 conscience in the insurers policies, plans, contracts, or 19 other agreements. 20 c. Except as provided in subsection 4, a health care 21 institution or health care payor that refuses to participate in 22 or pay for a health care service under this section is immune 23 from liability for damages allegedly arising from the refusal, 24 and such refusal shall not be the basis for any discrimination 25 against the health care institution or health care payor, or 26 any personnel, agent, or governing board of the health care 27 institution or health care payor. 28 2. a. A medical practitioner has the right not to 29 participate in a health care service that violates the medical 30 practitioners conscience. 31 b. A health care institution may require a medical 32 practitioner who is employed, contracted, or granted admitting 33 privileges by the health care institution and who is seeking 34 to exercise their conscience by not participating in a health 35 -3- LSB 5640SV (3) 90 pf/ko 3/ 11
S.F. 2286 care service, to submit to the health care institution a 1 written refusal signed by the medical practitioner. A written 2 refusal made under this paragraph may refer only generally to 3 the grounds of conscience. Except as provided in subsection 4 4, a health care institution is immune from liability for the 5 exercise of conscience by a medical practitioner. 6 c. A medical practitioner who refuses to participate in a 7 health care service under this section is immune from liability 8 for damages allegedly arising from the refusal, and such 9 refusal shall not be the basis for any discrimination against 10 the medical practitioner. 11 3. This section shall not be construed to relieve a health 12 care institution of the requirement to provide emergency 13 medical services to all individuals as required under 42 U.S.C. 14 1395dd. 15 4. The immunity provisions of this section shall not apply 16 to a health care institution or a health care payor owned or 17 operated by the state or a political subdivision of the state. 18 5. Notwithstanding any other provision of this chapter to 19 the contrary, a medical practitioner, health care institution, 20 or health care payor that holds itself out to the public as 21 religion-based, states in the entitys governing documents 22 that the entity has a religious purpose or mission, and that 23 has internal operating policies or procedures that implement 24 the entitys religious beliefs, shall have the right to make 25 employment, staffing, contracting, and admitting privilege 26 decisions consistent with the entitys religious beliefs. 27 Sec. 3. NEW SECTION . 135S.3 Exercise of conscience not 28 grounds for loss of privileges, immunities, or public benefits. 29 The exercise of conscience by a health care institution, 30 health care payor, or medical practitioner not to participate 31 in a health care service shall not be grounds for loss of any 32 privileges, immunities, or public benefits under state law. 33 Sec. 4. NEW SECTION . 135S.4 Whistleblower protections. 34 1. A medical practitioner or health care institution shall 35 -4- LSB 5640SV (3) 90 pf/ko 4/ 11
S.F. 2286 not be discriminated against because the medical practitioner 1 or health care institution does any of the following: 2 a. Provides, causes to be provided, or intends to provide 3 or cause to be provided information relating to a suspected 4 violation of this chapter to the medical practitioner or health 5 care institutions employer, the attorney general, any agency 6 charged with protecting health care rights of conscience, 7 the United States department of health and human services, 8 the United States commission on civil rights, or any other 9 federal agency charged with protecting health care rights of 10 conscience. 11 b. Testifies or intends to testify in a proceeding 12 concerning a violation of this chapter. 13 c. Assists or participates, or intends to assist or 14 participate, in a proceeding under this chapter. 15 2. It shall be unlawful to discriminate against a medical 16 practitioner because the medical practitioner discloses 17 information that the medical practitioner reasonably believes 18 evidences any of the following: 19 a. A violation of any law or rule. 20 b. A violation of any standard of care or ethical guidelines 21 for the provision of any health care service. 22 c. Gross mismanagement, a gross waste of funds, an abuse 23 of authority, practices, or methods of treatment that may put 24 patient or client health at risk, or a substantial and specific 25 danger to public health or safety. 26 3. This section shall not be construed to exempt a 27 person from the requirements of the federal Health Insurance 28 Portability and Accountability Act of 1996, Pub. L. No. 29 104-191, including amendments thereto and regulations 30 promulgated thereunder, or any other applicable confidentiality 31 and patient or client privacy requirements. 32 Sec. 5. NEW SECTION . 135S.5 Free speech protections 33 notification of complaints penalty. 34 1. The department of health and human services, a licensing 35 -5- LSB 5640SV (3) 90 pf/ko 5/ 11
S.F. 2286 board designated under chapter 147, or any other licensing 1 or certifying entity of a medical practitioner shall not 2 reprimand, sanction, or revoke or threaten to revoke a license 3 or certification of a medical practitioner who is licensed 4 or certified by the department, licensing board, or other 5 licensing or certifying entity for engaging in speech or 6 expressive activity protected under the first amendment to 7 the Constitution of the United States, unless the department, 8 licensing board, or other licensing or certifying entity 9 demonstrates beyond a reasonable doubt that the medical 10 practitioners speech was the direct cause of physical 11 harm to a person with whom the medical practitioner had a 12 medical practitioner-patient or medical practitioner-client 13 relationship within the three years immediately preceding the 14 incident of physical harm. 15 2. a. Within fourteen days of receiving a complaint that 16 alleges a violation of speech or expressive activity protected 17 under subsection 1 that may result in revocation of a medical 18 practitioners license, the department, licensing board, or 19 other licensing or certifying entity shall provide the medical 20 practitioner with a copy of the complaint. 21 b. If the department, licensing board, or other licensing or 22 certifying entity fails to provide a copy of the complaint to 23 the medical practitioner within fourteen days of receipt, the 24 department, licensing board, or other certifying entity shall 25 pay the medical practitioner an administrative penalty of five 26 hundred dollars for each week of noncompliance. 27 Sec. 6. NEW SECTION . 135S.6 Unlawful interference 28 relief. 29 1. It is unlawful for a person to interfere or attempt to 30 interfere with the exercise of conscience not to participate in 31 a health care service, or in the whistleblower or free speech 32 rights and protections under this chapter, whether by duress, 33 coercion, or any other means. 34 2. A health care institution, health care payor, or medical 35 -6- LSB 5640SV (3) 90 pf/ko 6/ 11
S.F. 2286 practitioner that alleges injury by unlawful interference 1 by a person under this chapter may bring a civil action in 2 a court of competent jurisdiction. If a court of competent 3 jurisdiction finds a person liable under this section, the 4 court may order any of the following: 5 a. Injunctive relief, when appropriate, including but not 6 limited to reinstatement of a medical practitioner to the 7 medical practitioners previous position, or reinstatement 8 or reactivation of licensure or certification of a medical 9 practitioner, or reactivation or reinstatement of licensure of 10 a health care institution or a health care payor. 11 b. Monetary damages for injuries suffered. 12 c. Reasonable costs and attorney fees. 13 Sec. 7. NEW SECTION . 135S.7 Relationship to rights and 14 remedies relating to abortion. 15 This chapter shall not be construed to modify or limit the 16 rights and remedies provided under chapter 146. 17 Sec. 8. NEW SECTION . 135S.8 Severability. 18 If any provision of this chapter or its application to any 19 person or circumstance is held invalid, the invalidity shall 20 not affect other provisions or applications of this chapter 21 which can be given effect without the invalid provision or 22 application, and to this end the provisions of this chapter are 23 severable. 24 Sec. 9. APPLICABILITY. This Act applies to a health care 25 payor policy, contract, plan, or other agreement delivered, 26 issued for delivery, continued, or renewed in this state on or 27 after January 1, 2025. 28 EXPLANATION 29 The inclusion of this explanation does not constitute agreement with 30 the explanations substance by the members of the general assembly. 31 This bill relates to protections for health care 32 institutions, health care payors, and medical practitioners 33 involving a right of conscience, whistleblower activities, and 34 free speech. 35 -7- LSB 5640SV (3) 90 pf/ko 7/ 11
S.F. 2286 The bill provides definitions used in the bill including for 1 conscience, health care institution, health care payor, 2 health care service, and medical practitioner. 3 The bill provides that a health care institution or health 4 care payor shall not be required to participate in or pay for a 5 health care service that violates the health care institutions 6 or health care payors conscience. An insurer shall list any 7 health care service the insurer refuses to pay for on the basis 8 of the insurers conscience in the insurers policies, plans, 9 contracts, or other agreements. 10 A health care institution or health care payor that refuses 11 to participate in or pay for a health care service is immune 12 from liability for damages allegedly arising from the refusal, 13 and such refusal shall not be the basis for any discrimination 14 against the health care institution or health care payor, or 15 any personnel, agent, or governing board of the health care 16 institution or health care payor. 17 The bill also provides that a medical practitioner has 18 the right not to participate in a health care service that 19 violates the medical practitioners conscience. A health care 20 institution may require a medical practitioner who is employed, 21 contracted, or granted admitting privileges by the health care 22 institution and who is seeking to exercise their conscience 23 by not participating in a health care service, to submit to 24 the health care institution a written refusal signed by the 25 medical practitioner. A health care institution is immune from 26 liability for the exercise of conscience not to participate in 27 a health care service by a medical practitioner. A medical 28 practitioner who refuses to participate in a health care 29 service due to exercise of conscience is immune from liability 30 for damages allegedly arising from the refusal, and such 31 refusal shall not be the basis for any discrimination against 32 the medical practitioner. 33 These provisions are not to be construed to relieve a 34 health care institution of the requirement under federal law 35 -8- LSB 5640SV (3) 90 pf/ko 8/ 11
S.F. 2286 to provide emergency medical services to all individuals. The 1 immunity provisions do not apply to a health care institution 2 or health care payor owned or operated by the state or a 3 political subdivision of the state. 4 The bill provides that a medical practitioner, health care 5 institution, or health care payor that holds itself out to 6 the public as religion-based states in the entitys governing 7 documents that the entity has a religious purpose or mission, 8 and that has internal operating policies or procedures that 9 implement the entitys religious beliefs, shall have the right 10 to make employment, staffing, contracting, and admitting 11 privilege decisions consistent with the entitys religious 12 beliefs. 13 The bill provides that a medical practitioners, health care 14 institutions, or health care payors exercise of conscience 15 not to participate in a health care service shall not be 16 grounds for loss of any privileges, immunities, or public 17 benefits under state law. 18 The bill provides whistleblower protections by providing 19 that a medical practitioner or health care institution shall 20 not be discriminated against because the medical practitioner 21 or health care institution: provides, causes to be provided, 22 or intends to provide or cause to be provided information 23 relating to a suspected violation of the bill to the medical 24 practitioner or health care institutions employer or various 25 other entities specified in the bill; testifies or intends to 26 testify in a proceeding concerning a violation of the bill; or 27 assists or participates, or intends to assist or participate, 28 in a proceeding under the bill. It is also unlawful under the 29 bill to discriminate against a medical practitioner because 30 the medical practitioner discloses information to appropriate 31 government, regulation, or law enforcement entities that the 32 medical practitioner reasonably believes evidences a violation 33 of any law or rule; a violation of any standard of care or 34 ethical guidelines for the provision of any health care 35 -9- LSB 5640SV (3) 90 pf/ko 9/ 11
S.F. 2286 service; or gross mismanagement, a gross waste of funds, an 1 abuse of authority, practices, or methods of treatment that 2 may put patient or client health at risk, or a substantial 3 and specific danger to public health or safety. These 4 provisions are not to be construed to exempt a person from the 5 requirements of the federal Health Insurance Portability and 6 Accountability Act. 7 The bill also provides that the department of health and 8 human services (HHS), a health professional licensing board, 9 or any other licensing or certifying entity of a medical 10 practitioner shall not reprimand, sanction, or revoke or 11 threaten to revoke a license or certification of a medical 12 practitioner for engaging in speech or expressive activity 13 protected under the first amendment to the Constitution of 14 the United States, unless HHS, a licensing board, or other 15 licensing or certifying entity demonstrates beyond a reasonable 16 doubt that the medical practitioners speech was the direct 17 cause of physical harm to a person with whom the medical 18 practitioner had a medical practitioner-patient or medical 19 practitioner-client relationship within the three years 20 immediately preceding the incident of physical harm. Within 14 21 days of receiving a complaint alleging a violation of speech or 22 expressive activity protected under the bill that may result 23 in revocation of a medical practitioners license, HHS, a 24 licensing board, or other licensing or certifying entity shall 25 provide the medical practitioner with a copy of the complaint. 26 If HHS, a licensing board, or other licensing or certifying 27 entity fails to provide the complaint within 14 days of 28 receipt, HHS, the licensing board, or other certifying entity 29 shall pay the medical practitioner an administrative penalty of 30 $500 for each week of noncompliance. 31 The bill provides that it is unlawful for a person to 32 interfere or attempt to interfere with the exercise of 33 conscience not to participate in a health care service or the 34 whistleblower or free speech rights and protections authorized 35 -10- LSB 5640SV (3) 90 pf/ko 10/ 11
S.F. 2286 under the bill. A health care institution, health care payor, 1 or medical practitioner injured by unlawful interference 2 under the bill is entitled to bring a civil action that, if 3 successful, may result in injunctive relief, monetary damages 4 for injuries suffered, and reasonable costs and attorney fees. 5 The provisions of the bill shall not be construed as 6 modifying or limiting the rights and remedies provided under 7 Code chapter 146 (abortions refusal to perform). 8 The bill applies to a health care payor policy, contract, 9 plan, or other agreement delivered, issued for delivery, 10 continued, or renewed in the state on or after January 1, 2025. 11 The bill includes a severability clause. 12 -11- LSB 5640SV (3) 90 pf/ko 11/ 11