H.F. 2263 Section 1. Section 135.61, subsection 18, paragraphs c, g, 1 h, i, j, and l, Code 2018, are amended to read as follows: 2 c. Any capital expenditure, lease, or donation by or 3 on behalf of an institutional health facility in excess 4 of one five million five hundred thousand dollars within a 5 twelve-month period. 6 g. Any acquisition by or on behalf of a health care provider 7 or a group of health care providers of any piece of replacement 8 equipment with a value in excess of one five million five 9 hundred thousand dollars, whether acquired by purchase, lease, 10 or donation. 11 h. Any acquisition by or on behalf of a health care 12 provider or group of health care providers of any piece of 13 equipment with a value in excess of one five million five 14 hundred thousand dollars, whether acquired by purchase, lease, 15 or donation, which results in the offering or development of 16 a health service not previously provided. A mobile service 17 provided on a contract basis is not considered to have been 18 previously provided by a health care provider or group of 19 health care providers. 20 i. Any acquisition by or on behalf of an institutional 21 health facility or a health maintenance organization of any 22 piece of replacement equipment with a value in excess of one 23 five million five hundred thousand dollars, whether acquired by 24 purchase, lease, or donation. 25 j. Any acquisition by or on behalf of an institutional 26 health facility or health maintenance organization of any piece 27 of equipment with a value in excess of one five million five 28 hundred thousand dollars, whether acquired by purchase, lease, 29 or donation, which results in the offering or development of 30 a health service not previously provided. A mobile service 31 provided on a contract basis is not considered to have been 32 previously provided by an institutional health facility. 33 l. Any mobile health service with a value in excess of one 34 million five hundred thousand million dollars. 35 -1- LSB 5434YH (9) 87 pf/rh 1/ 3

H.F. 2263 Sec. 2. Section 135.61, subsection 21, Code 2018, is amended 1 to read as follows: 2 21. “Outpatient surgical facility” means a facility which 3 as its primary function provides, through an organized medical 4 staff and on an outpatient basis to patients who are generally 5 ambulatory, surgical procedures not ordinarily performed in 6 a private physician’s office, but not requiring twenty-four 7 hour hospitalization, and which is neither a part of a hospital 8 nor the private office of a health care provider who there 9 engages in the lawful practice of surgery. “Outpatient surgical 10 facility” includes a facility certified or seeking certification 11 as an ambulatory surgical center, under the federal Medicare 12 program or under the medical assistance program established 13 pursuant to chapter 249A . “Outpatient surgical facility” does 14 not include an outpatient surgical facility, located in a 15 county with a population over thirty thousand, that is offered 16 or developed, and owned by, a group of health care providers. 17 EXPLANATION 18 The inclusion of this explanation does not constitute agreement with 19 the explanation’s substance by the members of the general assembly. 20 This bill relates to the certificate of need process under 21 Code chapter 135 relative to the planning and delivery of 22 health services. The bill increases the threshold amount 23 applicable to new institutional health services or changed 24 institutional health services that must be met to be subject to 25 the certificate of need process from $1.5 million to $5 million 26 for all of the following: 27 1. Any capital expenditure, lease, or donation by or on 28 behalf of an institutional health facility in excess of such 29 amount within a 12-month period. 30 2. Any acquisition by or on behalf of a health care provider 31 or a group of health care providers of any piece of replacement 32 equipment with a value in excess of such amount whether 33 acquired by purchase, lease, or donation. 34 3. Any acquisition by or on behalf of a health care provider 35 -2- LSB 5434YH (9) 87 pf/rh 2/ 3

H.F. 2263 or group of health care providers of any piece of equipment 1 with a value in excess of such amount, whether acquired by 2 purchase, lease, or donation, which results in the offering or 3 development of a health service not previously provided. A 4 mobile service provided on a contract basis is not considered 5 to have been previously provided by a health care provider or 6 group of health care providers. 7 4. Any acquisition by or on behalf of an institutional health 8 facility or a health maintenance organization of any piece of 9 replacement equipment with a value in excess of such amount, 10 whether acquired by purchase, lease, or donation. 11 5. Any acquisition by or on behalf of an institutional 12 health facility or health maintenance organization of any piece 13 of equipment with a value in excess of such amount, whether 14 acquired by purchase, lease, or donation, which results in the 15 offering or development of a health service not previously 16 provided. A mobile service provided on a contract basis is not 17 considered to have been previously provided by an institutional 18 health facility. 19 6. Any mobile health service with a value in excess of such 20 amount. 21 The bill also amends the definition of outpatient surgical 22 facility by excluding from the definition an outpatient 23 surgical facility, located in a county with a population over 24 30,000, that is offered or developed, and owned by, a group 25 of health care providers, thereby exempting these specific 26 outpatient surgical facilities from the certificate of need 27 process. 28 -3- LSB 5434YH (9) 87 pf/rh 3/ 3