General Assembly: 75 (1994 Regular GA) - Chapter 1168 - Health care providers — rural health and primary care


Published: 1994-05-10

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CH. 1167 LA WS OF THE SEVENTY -FIFTH G.A., 1994 SESSION 410

Sec. 118. Section 554.9206, subsection 1, Code 1993, is amended to read as follows: 1. Subject to any statute or decision which establishes a different rule for buyers or lessees

of consumer goods, an agreement by a buyer or lessee that the buyer or lessee will not assert against an assignee any claim or defense which the buyer or lessee may have against the seller or lessor is enforceable by an assignee who takes that assignee's assignment for value, in good faith and without notice of a claim or defense, except as to defenses of a type which may be asserted against a holder in due course of a negotiable instrument under the Article on G6m- mercial PapeI' Negotiable Instruments (Article 3). A buyer who as part of one transaction signs both a negotiable instrument and a security agreement makes such an agreement.

Sec. 119. NEW SECTION. 668.16 APPLICABILITY OF THIS CHAPTER. This chapter does not apply to Article 3 or 4 of chapter 554.

Sec. 120. DIRECTION TO CODE EDITOR. The Code editor, in cooperation with the legislative service bureau and in conformity with

the policies of the legislative council, is directed to renumber sections in this Act in confor- mance with the numbering system included in the model Act as recommended by the Ameri- can law institute and national conference of commissioners on uniform state laws, and to cor- rect internal references as necessary.

Sec. 121. REPEALS. 1. Sections 554.3101 through 554.3806, Code 1993, are repealed. 2. Section 554.4109, Code 1993, is repealed.

Sec. 122. EFFECTIVE DATE. This Act takes effect July 1, 1995.

Approved May 10, 1994

CHAPTER 1168 HEALTH CARE PROVIDERS - RURAL HEALTH AND PRIMARY CARE

H.F.2422

AN ACT relating to health care providers and to the establishment of a primary care provider recruitment and retention endeavor and providing an appropriation.

Be It Enacted by the General Assembly of the State of Iowa:

Section 1. LEGISLATIVE FINDINGS. The general assembly finds that a significant num- ber of rural Iowans face increasing difficulty accessing necessary primary care health ser- vices. The inequities of the current medical services reimbursement system, the closure of rural hospitals and clinics, the inability of small communities to attract new primary care providers, and the professional isolation that current primary care providers face in their prac- tices contribute to the access problems experienced by Iowa's rural residents. Health care reform will significantly change the environment in which primary care is provided in Iowa. Rural communities must be supported in their strategies to ensure access to the benefits of affordable, accessible, and quality health care. New and innovative programs to assist these rural communities with this task must be promoted.

It is therefore the intent of the general assembly to create a comprehensive primary health care initiative to respond to these health needs. The purposes of the primary care provider recruitment and retention endeavor shall be the following:

1. To establish a student loan repayment program for health professionals who choose to establish practices in provider-shortage areas.

411 LA WS OF THE SEVENTY -FIFTH G.A., 1994 SE.-'-S-'-SI----'O'---N ___ --'C""H. 1168

2. To establish a community scholarship program to provide students with assistance with their professional education in exchange for a commitment to return to the community and provide primary health care.

3. To initiate a collaborative effort to establish area health education centers. 4. To enable the center for rural health and primary care to help local communities identify

current and evolving health care needs as well as innovative and collaborative options using local, state, and federal resources to help resolve those needs.

5. To provide for an appropriation by the general assembly that, when matched with fed- eral, local, and other private funds, make possible the implementation of a comprehensive primary health care initiative as set out in this Act.

Sec. 2. Section 135.13, Code 1993, is amended to read as follows: 135.13 OFFICE GF CENTER FOR RURAL HEALTH AND PRIMARY CARE ESTAB-

LISHED - DUTIES. 1. The 6ffiee 6f center for rural health and primar)' care is established within the depart-

ment. There is established an advisory committee to the mtiee 6f center for rural health and primary care consisting of one representative, approved by the respective agency, of each of the following agencies: the depaFtment 6f ffiI.mafl seFviees, the department of agriculture and land stewardship, the Iowa department of public health, the department of inspections and appeals, the national institute for rural health policy, the rural health resource center, the insti- tute of agricultural medicine and occupational health, and the Iowa state association of coun- ties, aDd the health peliey eOFpoFation 6f Wwft. The governor shall appoint two representa- tives ()! consumer groups active iQ rural health issues and a representative of each of two farm organizations active within the state, a representative of an agricultural business in the state, a practicing rural family physician, <l: practicing rural physician assistant, <l: practicing rural advanced registered nurs~ practitioner, and a rural health practitioner who is not a physician, physician assistant, or advanced registered nurse practitioner, as members of the advisory committee. 'l'we s-tate senatoFs appointed by the pFesident 6f the senate, aft.ep eonsultation with the majoFity leadff aDd the minoFity leadff 6f the senate, aDd t-we s-tate FepFesentatives appointed by the spealwF 6f the lwuse 6f FepFesentatives sflalI- als6 be membeFs 6f the advi- sery eommittee. ill the membeFs appointed by the pFesident 6f the senate, aft.ep eonsultation with the majoFity leadff aDd the minoFity leadff 6f the senate, aDd the speakeF 6f the fleu.se 6f FepFesentatives, n% I'IillFe tfta.ft 6fie from eaeft lwuse sflalI- be a membeF 6f the same politieal p-aFty-. The advisory committee shall also incl~~ as members two ~tate representatives, one appointed by the speaker ()! the house ()! representatives and one bX ~~ minority leader Q! the house, and two ~tate senators, one appointed by the majority l~der of the senate and one by the minority leader of the senate.

The advisory committee shall regularly meet with the administrative head of the 6ffiee center as well as the director of the center for agricultural health and safety established under sec- tion 262.78. The head of the office and the director of the center shall consult with the advi- sory committee and provide the committee with relevant information regarding their agencies.

2. The 6ffiee 6f center for rural health and primary care shall do all of the following: a. Provide technical planning assistance gI'fHlts to rural communities and counties explor-

ing altemative innovative means of delivering rural health services through community health services assessment, planning, and implementation, including but not limited to hospital con- versions, cooperative agreements among hospitals, physician and health practitioner support, recruitment and retention ()! primary health care providers, public health services, emergency medical services, medical assistance facilities, rural health care clinics, and alternative means which may be included in the long-term community health services assessment and develop- mental plan developed UfldeF. this paFagFaph OF in a long teFm plan developed thFough the I'Uffil health tFansition gra-nt pFogFam pUFsuant 16 the fe6eral Omnibus Budget Reeoneiliation Acl 6f W8'7-, Pu-b. b N&. 100 203, § 400&{e}. The mtiee 6f center for rural health and primary care shall encourage collaborative efforts ()! the local boards of health, aDd hospital governing boards!

CH. 1168 LA WS OF THE SEVENTY -FIFTH G.A., 1994 SESSION 412

and other public and private entities located !Q rural communities to adopt a long-term com- munity health services assessment and developmental plan as provided in secl-ien 1:UiB.33 pur- suant to rules adopted by the department and perform the duties required of the Iowa depart- ment of public health in section 135B.33.

D. Provide eompetitive researeh ~ to be aVlarded hy- the advisory eommittee, to een- ducl eeonomie analyses ef the effecl.s. ef bea+tb eare restrueturing mOOels en- RtI'al eommuni ties, ineluding but- net limited to the employment effecl.s. en- the eommunity ef redireeting lunGs to new areas ef serviee, the o-ver-all effecl.s. ef redireetion ef the lunGs en- the number ef bea+tb eare 00lla-rs eJfpended wtthin the RtI'al eommunity, ami the benefit to the bea+tb ef patients ef redireeting the fuHds..

eo 'l'fle efHre ef l'ffi'iH health shall make 11; report to the general assembly regarding the impaet ef the euffeftt eompensation strueture uru:le¥ medieare en- l'ffi'iH hospitals ami other health eare providers, shall provide information regarding the euffeftt eompensation system to ffiwa's een- gressional delegation, ami shall make reeommendations to the general assembly regarding reeommendations to be ma-ae to ffiwa's eongressional delegation to improve the eompensation strueture.

d. Fer the purposes ef this seetioB-;- "medieare" means the program ef health insuranee estab- fts.bee: uru:le¥ 'l'itle X-¥m ef the fedeffiI &cia! 8e eurity Aet.

e Q. Provide technical assistance to assist rural communities in improving medicare reim- bursements through the establishment of rural health clinics, defined pursuant to 42 U.S.C. § 1395(x), and distinct part skilled nursing facility beds.

f~. Coordinate services to provide research for the following items: (1) Examination of the prevalence of rural occupational health injuries in the state. (2) Assessment of training and continuing education available through local hospitals and

others relating to diagnosis and treatment of diseases associated with rural occupational health hazards.

(3) Determination of continuing education support necessary for rural health practitioners to diagnose and treat illnesses caused by exposure to rural occupational health hazards.

(4) Determination of the types of actions that can help prevent agricultural accidents. (5) Surveillance and reporting of disabilities suffered by persons engaged in agriculture result-

ing from diseases or injuries, including identifying the amount and severity of agricultural- related injuries and diseases in the state, identifying causal factors associated with agricultural- related injuries and diseases, and indicating the effectiveness of intervention programs designed to reduce injuries and diseases.

g <!. Cooperate with the center for agricultural health and safety established under section 262.78, the center for health effects of environmental contamination established under section 263.17, and the department of agriculture and land stewardship. The agencies shall coordinate programs to the extent practicable. ~ Administer grants for farm safety education efforts directed to rural families for the pur-

pose of preventing farm-related injuries to children. ~ The center for rural health and primary care shall establish !! primary care provider recruit-

ment and retention endeavor, to be known as PRIME CARRE. The endeavor shall include a ---- ------ ------ community grant program, a primary care provider loan repayment program, !! primary care provider community scholarship program, and the establishment ()! area health education centers. The endeavor shall be developed and implemented in !! manner to promote and accom- modate local creativity !Q efforts to recruit and retain health care professionals to provide ser- vices !Q the locality. The focus ()! the endeavor shall be to promote and assist local efforts !Q developing health care provider recruitment and retention programs. Eligibility under any ()! the programs established under the primary care provider recruitment and retention endeavor shall be based upon !! community health services assessment completed under sub- section g, paragraph "a". ~ community or region, as applicable, shall !,ubmit !! letter of intent to conduc!!! community health services assessment and to 1l1l.P!l for assistance under this sub- section. The letter :,hal! be !Q!! form and contain information as determined by the center. ~

413 LA WS OF THE SEVENTY -FIFTH G.A., 1994 SESSION CH. 1168

letter Q! intent shall be submitted to the center Qy January! preceding the fiscal year for which an application for assistance ~ to Q~ made. Assistance under this subseCt10Il shall not be granted until such time as the community or region making application has completed the community health services assessment and adopted lliong-term community health services assessment and developmental plan. In addition to ani: other requirements, II developmental plan shall include II clear commitment to informing high school students of the health care oppor- tunities which !!!llY be available to such students.

The center for rural health and primary care shall seek additional assistance and I'~s()lIrc()s from other state departments and agencies, federal agencies and grant programs, private organi- zations, and any other person, as appropriate. The center ~ authorized and directed to accept on behalf Q! the state any grant or contribution, federal or otherwise, made to assist, iQ meet- iQg the cost Q! carrying out the purpose Q! this subsection. All federal grants to and the fed- eral receipts Q! the center are appropriated for the purpose set forth iQ such federal grants or receipts. Funds appropriated by the general assembly to the center for implementation of this subsection shall first be used for securing any available federal funds requiring a state match, with remaining funds being used for the community grant program.

The center for rural health and primary care may, to further the purpos~s Q! this subsec- tion, provide financial assistance iQ the form of grants to support the effort Q! II community which ~ clearly part Q! the community's long-term community health services assessment and developmental plan. Efforts for which such grants may be awarded include, but are not limited to, the procurement Q! clinical equipment, clinical facilities, and telecommunications facilities, and the support Q! locum tenens arrangements and primary care provider mentor programs.

ll: COMMUNITY GRANT PROGRAM. The center for rural health and primary care shall adopt rules establishing an application process to be used QX the center to establish II grant assistance program as provided in this paragraph, and establishing the criteria to be used iQ evaluating the applications. Selection criteria shall include II method for prioritizing grant appli- cations based on illustrated efforts to meet the health care provider needs Qf the locality and surrounding area. Such assistance may be iQ the form Q! II forgivable loan, grant, or other non- financial assistance as deemed appropriate by the center. An application submitted shall con- tain II commitment of at least II dollar-for-dollar match Q! the grant assistance. Application may be made for assistance by II single community or ~ Qf communities.

Grants awarded under the program shall be subject to the following limitations: (1) Ten thousand dollars for II single community or region with II population of ten thousand

or les~ An award shall not be made under this program to II community with II population of more than ten thousand. - (2) An amount not to exceed one dollar ~ capita for II region iQ which the population exceeds ten thousand. For purposes Q! determining the amount of II grant for II region, the population of the region shall not include the population of any community with II P<>.P!I.lation Q! more than ten thousand located in the region.

b. PRIMARY CARE PROVIDER LOAN REPAYMENT PROGRAM. (1) ~ primary care provider loan repayment program ~ established to increase the number

Qf health professionals practicing primary care iQ federally designated health professional short- ~ areas Q! the state. Under the program, loan repayment may be made to II recipient for educational expenses incurred while completing an accredited health education program directly related to obtaining credentials necessary to P.I'llctic~ the recipient's health profession.

(2) The center for rural health and primary care shall adopt rules relating to the establish- ment and administration of the primary care provider loan repayment program. Rules adopted pursuant to this paragraph shall provide, at II minimum, for all of the following:

(a) Determination of eligibility requirements and qualifications Q! an applicant to receive loan repayment under the program, including but not limited to years Qf obligated service which shall be for II minimum of ten years unless federal requirements for the program require differ- ently, clinical practice requirements, and residency requirements. Loan repayment under the program shall not be approved for II health provider whose license or certification ~ restricted by II medical regulatory authority Q! any jurisdiction Q! the United States, other nations! or territories.

CH. 1168 LA WS OF THE SEVENTY -FIFTH G.A., 1994 SESSION 414

(b) Identification of federally designated health professional shortage areas Q! the state and prioritization of such areas according to need.

(c) Determination Q! the amount and duration Q! the loan repayment an applicant may receive, giving consideration to the availability Q! funds under the program, and the applicant's out- standing educational loans and professional credentials.

(d) Determination of the conditions Q! loan repayment applicable to an applicant. (e) Enforcement of the state's rights under ~ loan repayment program contract, including

the commencement Q! any court action. (f) Cancellation Q! ~ loan repayment program contract for reasonable cause. (g) Participation in federal programs supporting repayment Q! loans Q! health care providers

and acceptance Q! gifts, grants, and other aid or amounts from any person, association, founda- tion, trust, corporation, governmental agency, or other entity for the purposes Q! the program.

(h) Upon availability of state funds, determine eligibility criteria and qualifications for par- ticipating communities and applicants not located it! federally designated shortage areas.

ill Other rules as necessary. (3) The center for rural health and primary care may enter into an agreement under chap-

ter 28E with the college student aid commission for the administration Q! this program. c. PRIMARY CARE PROVIDER COMMUNITY SCHOLARSHIP PROGRAM. (1) ~ primary care provider community scholarship program ~ established to recruit and

to provide scholarships to train primary health care practitioners it! federally designated health professional shortage areas Q! the state. Under the program, scholarships may be awarded to ~ recipient for educational expenses incurred while completing an accredited health educa- tion program directly related to obtaining the credentials necessary to practice the recipient's health profession.

(2) The department shall adopt rules relating to the establishment and administration Q! the primary care provider community scholarship program. Rules adopted pursuant to this paragraph shall provide, at ~ minimum, for all Q! the following:

(a) Determination of eligibility requirements and qualifications of an applicant to receive scholarships under the program, including but not limited to years of obligated service which shall be for ~ minimum Q! ten years unless federal requirements for the program require differ- ently, clinical practice requirements, and residency requirements.

(b) Identification of federally designated health professional shortage areas Q! the state and prioritization of such areas according to need.

(c) Determination of the amount of the scholarship an applicant may receive. (d) Determination of the conditions of scholarship to be awarded to an applicant. (e) Enforcement Q! the state's rights under ~ scholarship contract, including the commence-

ment of any court action. ill Cancellation Q! ~ scholarship contract for reasonable cause. (g) Participation it! federal programs supporting scholarships for health care providers and

acceptance of gifts, grants, and other aid or amounts from any person, association, foundation, trust, corporation, governmental agency, or other entity for the purposes Q! the program.

(h) Upon avail~.bility of ~tate funds, determination of eligibility criteria and qualifications for participating communities and applicants not located it! federally designated shortage areas.

ill Other rules as necessary. (3) The center for rural health and primary care may enter into an agreement under chap-

ter 28E with the college student aid commission for the administration Q! this program. d. AREA HEALTH EDUCATION CENTERS. (1) The Iowa department Q! public health, it! cooperation with ~ primary care collaborative

effort including the university of Iowa college Q! medicine, the university of osteopathic medi- cine and health sciences, and other primary care professional educational institutions in Iowa, shall develop and establish area health education centers. The effort shall involve making ~ cation for ~ federal grant under 42 U.S.C. § 293j, as prescribed by that section.

415 LA WS OF THE SEVENTY -FIFTH G.A., 1994 SESSION CH. 1168

(2) Area health education centers shall, at (I, minimum, do all of the following: (a) Provide initial and continuing education opportunities to primary care providers. (b) Allow health professionals to consult with specialists, scholars, peers, and other health

care professionals. (c) Enable health professionals to access medical libraries and other research resources. (d) Provide for enhanced opportunities for professional student programs, internships and

residencies !!! primary care !!! rural areas. (3) Points Q! access to area health education centers shall be geographically distributed across

the state to improve services to all rural primary health care providers. Area health educa- tion centers shall utilize, to the extent feasible, current university residency programs, exist- i.!!g health care facilities, existing educational institutions, the Iowa communications network, and other appropriate resources to ensure access.

(4) Implementation Q! this lettered paragraph ~ contingent upon the receipt Q! federal funding awarded specifically for the implementation Q! area health education centers.

±: The director Q! public health shall establish (I, primary care collaborative work ~ to coordinate all statewide recruitment and retention activities established pursuant to this sec- tion and to make recommendations to the department and the center for rural health and primary care relating to the implementation Q! subsection ~ Membership of the work ~ shall consist, at (I, minimum, Q! representatives from the university of Iowa college of medi- cine, university Q! osteopathic medicine and health sciences, university Q! Iowa physician assis- tant school, university Q! Iowa nurse practitioner school, university Q! osteopathic medicine and health sciences physician assistant program, Iowa-Nebraska primary care association, Iowa medical society, Iowa osteopathic medical association, Iowa chapter of American college of osteopathic family physicians, Iowa academy Q! familx physicians, nurse practitioner associa- tion, Iowa nurses association, Iowa hospital association, and Iowa physicians assistants association.

iJ..: The department and the center for rural health and primary care shall submit (I, written report annually to the general assembly on or ~efore February 1 concerning the implementa- tion and coordination Q! all efforts Q! the primary care provider recruitment and retention endeavor established in subsection 3.

Sec. 3. CENTER FOR RURAL HEALTH AND PRIMARY CARE. There is appropriated from the general fund of the state to the Iowa department of public health for the fiscal year beginning July 1, 1994, and ending June 30, 1995, the following amount, or so much thereof as is necessary, to be used for the purpose designated:

For the primary care provider recruitment and retention endeavor established in section 135.13, subsection 3: ................................................................ " $ 235,000

Funds appropriated under this section shall first be used to secure any available federal funds requiring a state match, with remaining funds being used for the community grant pro- gram established pursuant to section 135.13, subsection 3.

Approved May 10, 1994