Iowa General Assembly Daily Bills, Amendments & Study Bills March 17, 2009



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19 33 advanced registered nurse practitioner, and a rural health


19 34 practitioner who is not a physician, physician assistant, or

19 35 advanced registered nurse practitioner, as members of the
Senate File 446 - Introduced continued
20 1 advisory committee. The advisory committee shall also include

20 2 as members two state representatives, one appointed by the

20 3 speaker of the house of representatives and one by the

20 4 minority leader of the house, and two state senators, one

20 5 appointed by the majority leader of the senate and one by the

20 6 minority leader of the senate.

20 7 The advisory committee shall regularly meet with the



20 8 administrative head of the center as well as the director of

20 9 the center for agricultural health and safety established

20 10 under section 262.78. The head of the center and the director

20 11 of the center for agricultural health and safety shall consult

20 12 with the advisory committee and provide the committee with

20 13 relevant information regarding their agencies.

20 14 A simple majority of the membership of the advisory



20 15 committee shall constitute a quorum. Action may be taken by

20 16 the affirmative vote of a majority of the advisory committee


20 17 membership.

20 18 2. The center for rural health and primary care shall do

20 19 all of the following:

20 20 a. Provide technical planning assistance to rural

20 21 communities and counties exploring innovative means of

20 22 delivering rural health services through community health

20 23 services assessment, planning, and implementation, including

20 24 but not limited to hospital conversions, cooperative

20 25 agreements among hospitals, physician and health practitioner

20 26 support, recruitment and retention of primary health care

20 27 providers, public health services, emergency medical services,

20 28 medical assistance facilities, rural health care clinics, and

20 29 alternative means which may be included in the long=term

20 30 community health services assessment and developmental plan.

20 31 The center for rural health and primary care shall encourage

20 32 collaborative efforts of the local boards of health, hospital

20 33 governing boards, and other public and private entities

20 34 located in rural communities to adopt a long=term community

20 35 health services assessment and developmental plan pursuant to

Senate File 446 - Introduced continued
21 1 rules adopted by the department and perform the duties

21 2 required of the Iowa department of public health in section

21 3 135B.33.

21 4 b. Provide technical assistance to assist rural

21 5 communities in improving Medicare reimbursements through the

21 6 establishment of rural health clinics, defined pursuant to 42

21 7 U.S.C. } 1395(x), and distinct part skilled nursing facility

21 8 beds.

21 9 c. Coordinate services to provide research for the

21 10 following items:

21 11 (1) Examination of the prevalence of rural occupational

21 12 health injuries in the state.

21 13 (2) Assessment of training and continuing education

21 14 available through local hospitals and others relating to

21 15 diagnosis and treatment of diseases associated with rural

21 16 occupational health hazards.

21 17 (3) Determination of continuing education support

21 18 necessary for rural health practitioners to diagnose and treat

21 19 illnesses caused by exposure to rural occupational health

21 20 hazards.

21 21 (4) Determination of the types of actions that can help

21 22 prevent agricultural accidents.

21 23 (5) Surveillance and reporting of disabilities suffered by

21 24 persons engaged in agriculture resulting from diseases or

21 25 injuries, including identifying the amount and severity of

21 26 agricultural=related injuries and diseases in the state,

21 27 identifying causal factors associated with

21 28 agricultural=related injuries and diseases, and indicating the

21 29 effectiveness of intervention programs designed to reduce

21 30 injuries and diseases.

21 31 d. Cooperate with the center for agricultural health and

21 32 safety established under section 262.78, the center for health

21 33 effects of environmental contamination established under

21 34 section 263.17, and the department of agriculture and land

21 35 stewardship. The agencies shall coordinate programs to the

Senate File 446 - Introduced continued
22 1 extent practicable.

22 2 e. Administer grants for farm safety education efforts

22 3 directed to rural families for the purpose of preventing

22 4 farm=related injuries to children.

22 5 3. The center for rural health and primary care shall

22 6 establish a primary care provider recruitment and retention

22 7 endeavor, to be known as PRIMECARRE. The endeavor shall

22 8 include a community grant program, a primary care provider

22 9 loan repayment program, and a primary care provider community

22 10 scholarship program. The endeavor shall be developed and

22 11 implemented in a manner to promote and accommodate local

22 12 creativity in efforts to recruit and retain health care

22 13 professionals to provide services in the locality. The focus

22 14 of the endeavor shall be to promote and assist local efforts

22 15 in developing health care provider recruitment and retention

22 16 programs. Eligibility under any of the programs established



22 17 under the primary care provider recruitment and retention

22 18 endeavor shall be based upon a community health services

22 19 assessment completed under subsection 2, paragraph "a". A


22 20 community or region, as applicable, shall submit a letter of

22 21 intent to conduct a community health services assessment and

22 22 to apply for assistance under this subsection. The letter

22 23 shall be in a form and contain information as determined by

22 24 the center. A letter of intent shall be submitted to the

22 25 center by January 1 preceding the fiscal year for which an

22 26 application for assistance is to be made. Assistance under

22 27 this subsection shall not be granted until such time as the

22 28 community or region making application has completed the

22 29 community health services assessment and adopted a long=term

22 30 community health services assessment and developmental plan.

22 31 In addition to any other requirements, a developmental plan

22 32 shall include a clear commitment to informing high school

22 33 students of the health care opportunities which may be

22 34 available to such students.

22 35 The center for rural health and primary care shall seek

Senate File 446 - Introduced continued
23 1 additional assistance and resources from other state

23 2 departments and agencies, federal agencies and grant programs,

23 3 private organizations, and any other person, as appropriate.

23 4 The center is authorized and directed to accept on behalf of

23 5 the state any grant or contribution, federal or otherwise,

23 6 made to assist in meeting the cost of carrying out the purpose

23 7 of this subsection. All federal grants to and the federal

23 8 receipts of the center are appropriated for the purpose set

23 9 forth in such federal grants or receipts. Funds appropriated

23 10 by the general assembly to the center for implementation of

23 11 this subsection shall first be used for securing any available

23 12 federal funds requiring a state match, with remaining funds

23 13 being used for the community grant program.

23 14 The center for rural health and primary care may, to



23 15 further the purposes of this subsection, provide financial

23 16 assistance in the form of grants to support the effort of a

23 17 community which is clearly part of the community's long=term

23 18 community health services assessment and developmental plan.

23 19 Efforts for which such grants may be awarded include, but are

23 20 not limited to, the procurement of clinical equipment,

23 21 clinical facilities, and telecommunications facilities, and

23 22 the support of locum tenens arrangements and primary care

23 23 provider mentor programs.

23 24 a. COMMUNITY GRANT PROGRAM.

23 25 (1) The center for rural health and primary care shall

23 26 adopt rules establishing an application process to be used by

23 27 the center to establish a grant assistance program as provided

23 28 in this paragraph, and establishing the criteria to be used in

23 29 evaluating the applications. Selection criteria shall include

23 30 a method for prioritizing grant applications based on

23 31 illustrated efforts to meet the health care provider needs of

23 32 the locality and surrounding area. Such assistance may be in

23 33 the form of a forgivable loan, grant, or other nonfinancial

23 34 assistance as deemed appropriate by the center. An

23 35 application submitted shall contain a commitment of at least a
Senate File 446 - Introduced continued
24 1 dollar=for=dollar match of the grant assistance. Application

24 2 may be made for assistance by a single community or group of

24 3 communities.

24 4 (2) Grants awarded under the program shall be subject to

24 5 the following limitations:

24 6 (1) (a) Ten thousand dollars for a single community or

24 7 region with a population of ten thousand or less. An award

24 8 shall not be made under this program to a community with a

24 9 population of more than ten thousand.

24 10 (2) (b) An amount not to exceed one dollar per capita for

24 11 a region in which the population exceeds ten thousand. For

24 12 purposes of determining the amount of a grant for a region,

24 13 the population of the region shall not include the population

24 14 of any community with a population of more than ten thousand

24 15 located in the region.

24 16 b. PRIMARY CARE PROVIDER LOAN REPAYMENT PROGRAM.

24 17 (1) A primary care provider loan repayment program is

24 18 established to increase the number of health professionals

24 19 practicing primary care in federally designated health

24 20 professional shortage areas of the state. Under the program,

24 21 loan repayment may be made to a recipient for educational

24 22 expenses incurred while completing an accredited health

24 23 education program directly related to obtaining credentials

24 24 necessary to practice the recipient's health profession.

24 25 (2) The center for rural health and primary care shall

24 26 adopt rules relating to the establishment and administration

24 27 of the primary care provider loan repayment program. Rules

24 28 adopted pursuant to this paragraph shall provide, at a

24 29 minimum, for all of the following:

24 30 (a) Determination of eligibility requirements and

24 31 qualifications of an applicant to receive loan repayment under

24 32 the program, including but not limited to years of obligated

24 33 service, clinical practice requirements, and residency

24 34 requirements. One year of obligated service shall be provided

24 35 by the applicant in exchange for each year of loan repayment,
Senate File 446 - Introduced continued
25 1 unless federal requirements otherwise require. Loan repayment

25 2 under the program shall not be approved for a health provider

25 3 whose license or certification is restricted by a medical

25 4 regulatory authority of any jurisdiction of the United States,

25 5 other nations, or territories.

25 6 (b) Identification of federally designated health

25 7 professional shortage areas of the state and prioritization of

25 8 such areas according to need.

25 9 (c) Determination of the amount and duration of the loan

25 10 repayment an applicant may receive, giving consideration to

25 11 the availability of funds under the program, and the

25 12 applicant's outstanding educational loans and professional

25 13 credentials.

25 14 (d) Determination of the conditions of loan repayment

25 15 applicable to an applicant.

25 16 (e) Enforcement of the state's rights under a loan

25 17 repayment program contract, including the commencement of any

25 18 court action.

25 19 (f) Cancellation of a loan repayment program contract for

25 20 reasonable cause.

25 21 (g) Participation in federal programs supporting repayment

25 22 of loans of health care providers and acceptance of gifts,

25 23 grants, and other aid or amounts from any person, association,

25 24 foundation, trust, corporation, governmental agency, or other

25 25 entity for the purposes of the program.

25 26 (h) Upon availability of state funds, determine

25 27 eligibility criteria and qualifications for participating

25 28 communities and applicants not located in federally designated

25 29 shortage areas.

25 30 (i) Other rules as necessary.

25 31 (3) The center for rural health and primary care may enter

25 32 into an agreement under chapter 28E with the college student

25 33 aid commission for the administration of this program.

25 34 c. PRIMARY CARE PROVIDER COMMUNITY SCHOLARSHIP PROGRAM.

25 35 (1) A primary care provider community scholarship program
Senate File 446 - Introduced continued
26 1 is established to recruit and to provide scholarships to train

26 2 primary health care practitioners in federally designated

26 3 health professional shortage areas of the state. Under the

26 4 program, scholarships may be awarded to a recipient for

26 5 educational expenses incurred while completing an accredited

26 6 health education program directly related to obtaining the

26 7 credentials necessary to practice the recipient's health

26 8 profession.

26 9 (2) The department shall adopt rules relating to the

26 10 establishment and administration of the primary care provider

26 11 community scholarship program. Rules adopted pursuant to this

26 12 paragraph shall provide, at a minimum, for all of the

26 13 following:

26 14 (a) Determination of eligibility requirements and

26 15 qualifications of an applicant to receive scholarships under

26 16 the program, including but not limited to years of obligated

26 17 service, clinical practice requirements, and residency

26 18 requirements. One year of obligated service shall be provided

26 19 by the applicant in exchange for each year of scholarship

26 20 receipt, unless federal requirements otherwise require.

26 21 (b) Identification of federally designated health

26 22 professional shortage areas of the state and prioritization of

26 23 such areas according to need.

26 24 (c) Determination of the amount of the scholarship an

26 25 applicant may receive.

26 26 (d) Determination of the conditions of scholarship to be

26 27 awarded to an applicant.

26 28 (e) Enforcement of the state's rights under a scholarship

26 29 contract, including the commencement of any court action.

26 30 (f) Cancellation of a scholarship contract for reasonable

26 31 cause.

26 32 (g) Participation in federal programs supporting

26 33 scholarships for health care providers and acceptance of

26 34 gifts, grants, and other aid or amounts from any person,

26 35 association, foundation, trust, corporation, governmental

Senate File 446 - Introduced continued
27 1 agency, or other entity for the purposes of the program.

27 2 (h) Upon availability of state funds, determination of

27 3 eligibility criteria and qualifications for participating

27 4 communities and applicants not located in federally designated

27 5 shortage areas.

27 6 (i) Other rules as necessary.

27 7 (3) The center for rural health and primary care may enter

27 8 into an agreement under chapter 28E with the college student

27 9 aid commission for the administration of this program.

27 10 4. a. Eligibility under any of the programs established



27 11 under the primary care provider recruitment and retention

27 12 endeavor shall be based upon a community health services

27 13 assessment completed under subsection 2, paragraph "a". A

27 14 community or region, as applicable, shall submit a letter of

27 15 intent to conduct a community health services assessment and

27 16 to apply for assistance under this subsection. The letter

27 17 shall be in a form and contain information as determined by

27 18 the center. A letter of intent shall be submitted to the


27 19 center by January 1 preceding the fiscal year for which an

27 20 application for assistance is to be made.

27 21 b. Assistance under this subsection shall not be granted



27 22 until such time as the community or region making application

27 23 has completed the community health services assessment and

27 24 adopted a long=term community health services assessment and

27 25 developmental plan. In addition to any other requirements, a

27 26 developmental plan shall include a clear commitment to

27 27 informing high school students of the health care

27 28 opportunities which may be available to such students.

27 29 c. The center for rural health and primary care shall seek



27 30 additional assistance and resources from other state

27 31 departments and agencies, federal agencies and grant programs,

27 32 private organizations, and any other person, as appropriate.

27 33 The center is authorized and directed to accept on behalf of

27 34 the state any grant or contribution, federal or otherwise,

27 35 made to assist in meeting the cost of carrying out the purpose

Senate File 446 - Introduced continued

28 1 of this subsection. All federal grants to and the federal

28 2 receipts of the center are appropriated for the purpose set

28 3 forth in such federal grants or receipts. Funds appropriated

28 4 by the general assembly to the center for implementation of

28 5 this subsection shall first be used for securing any available

28 6 federal funds requiring a state match, with remaining funds

28 7 being used for the community grant program.

28 8 d. The center for rural health and primary care may, to



28 9 further the purposes of this subsection, provide financial

28 10 assistance in the form of grants to support the effort of a

28 11 community which is clearly part of the community's long=term

28 12 community health services assessment and developmental plan.

28 13 Efforts for which such grants may be awarded include but are

28 14 not limited to the procurement of clinical equipment, clinical

28 15 facilities, and telecommunications facilities, and the support

28 16 of locum tenens arrangements and primary care provider mentor

28 17 programs.

28 18 5. a. There is established an advisory committee to the


28 19 center for rural health and primary care consisting of one

28 20 representative, approved by the respective agency, of each of

28 21 the following agencies: the department of agriculture and

28 22 land stewardship, the Iowa department of public health, the

28 23 department of inspections and appeals, the national institute

28 24 for rural health policy, the rural health resource center, the

28 25 institute of agricultural medicine and occupational health,

28 26 and the Iowa state association of counties. The governor

28 27 shall appoint two representatives of consumer groups active in

28 28 rural health issues and a representative of each of two farm

28 29 organizations active within the state, a representative of an

28 30 agricultural business in the state, a practicing rural family

28 31 physician, a practicing rural physician assistant, a

28 32 practicing rural advanced registered nurse practitioner, and a

28 33 rural health practitioner who is not a physician, physician

28 34 assistant, or advanced registered nurse practitioner, as

28 35 members of the advisory committee. The advisory committee
Senate File 446 - Introduced continued
29 1 shall also include as members two state representatives, one

29 2 appointed by the speaker of the house of representatives and

29 3 one by the minority leader of the house, and two state




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