Text: S05088                            Text: S05090
Text: S05000 - S05099                   Text: S Index
Bills and Amendments: General Index     Bill History: General Index

Senate Amendment 5089

Amendment Text

PAG LIN
  1  1    Amend Senate File 2102 as follows:
  1  2    #1.  By striking everything after the enacting
  1  3 clause and inserting the following:
  1  4    "Section 1.  Section 135.61, Code 1995, is amended
  1  5 to read as follows:
  1  6    135.61  DEFINITIONS.
  1  7    As used in this division, unless the context
  1  8 otherwise requires:
  1  9    1.  "Affected persons" means, with respect to an
  1 10 application for a certificate of need:
  1 11    a.  The person submitting the application.
  1 12    b.  Consumers who would be served by the new
  1 13 institutional health service proposed in the
  1 14 application.
  1 15    c.  Each institutional health facility or health
  1 16 maintenance organization which is located in the
  1 17 geographic area which would appropriately be served by
  1 18 the new institutional health service proposed in the
  1 19 application.  The appropriate geographic service area
  1 20 of each institutional health facility or health
  1 21 maintenance organization shall be determined on a
  1 22 uniform basis in accordance with criteria established
  1 23 in rules adopted by the department.
  1 24    d.  Each institutional health facility or health
  1 25 maintenance organization which, prior to receipt of
  1 26 the application by the department, has formally
  1 27 indicated to the department pursuant to this division
  1 28 an intent to furnish in the future institutional
  1 29 health services similar to the new institutional
  1 30 health service proposed in the application.
  1 31    e.  Any other person designated as an affected
  1 32 person by rules of the department.
  1 33    f.  Any payer or third-party payer for health
  1 34 services.
  1 35    2.  "Birth center" means birth center as defined in
  1 36 section 135G.2.
  1 37    3. 2.  "Consumer" means any individual whose
  1 38 occupation is other than health services, who has no
  1 39 fiduciary obligation to an institutional health
  1 40 facility, health maintenance organization or other
  1 41 facility primarily engaged in delivery of services
  1 42 provided by persons in health service occupations, and
  1 43 who has no material financial interest in the
  1 44 providing of any health services.
  1 45    4. 3.  "Council" means the state health facilities
  1 46 council established by this division.
  1 47    5. 4.  "Department" means the Iowa department of
  1 48 public health.
  1 49    6. 5.  "Develop", when used in connection with
  1 50 health services, means to undertake those activities
  2  1 which on their completion will result in the offer of
  2  2 a new institutional health service or the incurring of
  2  3 a financial obligation in relation to the offering of
  2  4 such a service.
  2  5    7. 6.  "Director" means the director of public
  2  6 health, or the director's designee.
  2  7    8. 7.  "Financial reporting" means reporting by
  2  8 which hospitals and health care facilities shall
  2  9 respectively record their revenues, expenses, other
  2 10 income, other outlays, assets and liabilities, and
  2 11 units of services.
  2 12    9. 8.  "Health care facility" means health care
  2 13 facility as defined in section 135C.1.
  2 14    10. 9.  "Health care provider" means a person
  2 15 licensed or certified under chapter 147, 148, 148A,
  2 16 148C, 149, 150, 150A, 151, 152, 153, 154, 154B, or
  2 17 155A to provide in this state professional health care
  2 18 service to an individual during that individual's
  2 19 medical care, treatment or confinement.
  2 20    11. 10.  "Health maintenance organization" means
  2 21 health maintenance organization as defined in section
  2 22 514B.1, subsection 6.
  2 23    12. 11.  "Health services" means clinically related
  2 24 diagnostic, curative, or rehabilitative services, and
  2 25 includes alcoholism, drug abuse, and mental health
  2 26 services.
  2 27    13.  "Hospital" means hospital as defined in
  2 28 section 135B.1, subsection 3.
  2 29    14. 12.  "Institutional health facility" means any
  2 30 of the following a health care facility, without
  2 31 regard to whether the facilities referred to are
  2 32 facility is publicly or privately owned or are is
  2 33 organized for profit or not or whether the facilities
  2 34 are facility is part of or sponsored by a health
  2 35 maintenance organization:
  2 36    a.  A hospital.
  2 37    b.  A health care facility.
  2 38    c.  A kidney disease treatment center, including
  2 39 any freestanding hemodialysis unit but not including
  2 40 any home hemodialysis unit.
  2 41    d.  An organized outpatient health facility.
  2 42    e.  An outpatient surgical facility.
  2 43    f.  A community mental health facility.
  2 44    g.  A birth center.
  2 45    15. 13.  "Institutional health service" means any
  2 46 health service furnished in or through institutional
  2 47 health facilities or health maintenance organizations,
  2 48 including mobile health services.
  2 49    16. 14.  "Mobile health service" means equipment
  2 50 used to provide a health service that can be
  3  1 transported from one delivery site to another.
  3  2    17. 15.  "Modernization" means the alteration,
  3  3 repair, remodeling, replacement or renovation of
  3  4 existing buildings or of the equipment previously
  3  5 installed therein, or both.
  3  6    18. 16.  "New institutional health service" or
  3  7 "changed institutional health service" means any of
  3  8 the following:
  3  9    a.  The construction, development or other
  3 10 establishment of a new institutional health facility
  3 11 regardless of ownership.
  3 12    b.  Relocation of an institutional health facility.
  3 13    c.  Any capital expenditure, lease, or donation by
  3 14 or on behalf of an institutional health facility in
  3 15 excess of eight hundred thousand dollars within a
  3 16 twelve-month period.
  3 17    d.  A permanent change in the bed capacity, as
  3 18 determined by the department, of an institutional
  3 19 health facility.  For purposes of this paragraph, a
  3 20 change is permanent if it is intended to be effective
  3 21 for one year or more.
  3 22    e.  Any expenditure in excess of three hundred
  3 23 thousand dollars by or on behalf of an institutional
  3 24 health facility for health services which are or will
  3 25 be offered in or through an institutional health
  3 26 facility at a specific time but which were not offered
  3 27 on a regular basis in or through that institutional
  3 28 health facility within the twelve-month period prior
  3 29 to that time.
  3 30    f.  The deletion of one or more health services,
  3 31 previously offered on a regular basis by an
  3 32 institutional health facility or health maintenance
  3 33 organization or the relocation of one or more health
  3 34 services from one physical facility to another.
  3 35    g.  Any acquisition by or on behalf of a health
  3 36 care provider or a group of health care providers of
  3 37 any piece of replacement equipment with a value in
  3 38 excess of four hundred thousand dollars, whether
  3 39 acquired by purchase, lease, or donation.
  3 40    h.  Any acquisition by or on behalf of a health
  3 41 care provider or group of health care providers of any
  3 42 piece of equipment with a value in excess of three
  3 43 hundred thousand dollars, whether acquired by
  3 44 purchase, lease, or donation, which results in the
  3 45 offering or development of a health service not
  3 46 previously provided.  A mobile service provided on a
  3 47 contract basis is not considered to have been
  3 48 previously provided by a health care provider or group
  3 49 of health care providers.
  3 50    i.  Any acquisition by or on behalf of an
  4  1 institutional health facility or a health maintenance
  4  2 organization of any piece of replacement equipment
  4  3 with a value in excess of four hundred thousand
  4  4 dollars, whether acquired by purchase, lease, or
  4  5 donation.
  4  6    j.  Any acquisition by or on behalf of an
  4  7 institutional health facility or health maintenance
  4  8 organization of any piece of equipment with a value in
  4  9 excess of three hundred thousand dollars, whether
  4 10 acquired by purchase, lease, or donation, which
  4 11 results in the offering or development of a health
  4 12 service not previously provided.  A mobile service
  4 13 provided on a contract basis is not considered to have
  4 14 been previously provided by an institutional health
  4 15 facility.
  4 16    k.  Any air transportation system for
  4 17 transportation of patients or medical personnel.
  4 18    l.  Any mobile health service with a value in
  4 19 excess of three hundred thousand dollars.
  4 20    m.  Any of the following:
  4 21    (1)  Cardiac catheterization service.
  4 22    (2)  Open heart surgical service.
  4 23    (3)  Organ transplantation service.
  4 24    19. 17.  "Offer", when used in connection with
  4 25 health services, means that an institutional health
  4 26 facility, health maintenance organization, health care
  4 27 provider, or group of health care providers holds
  4 28 itself out as capable of providing, or as having the
  4 29 means to provide, specified health services.
  4 30    20.  "Organized outpatient health facility" means a
  4 31 facility, not part of a hospital, organized and
  4 32 operated to provide health care to
  4 33 noninstitutionalized and nonhomebound persons on an
  4 34 outpatient basis; it does not include private offices
  4 35 or clinics of individual physicians, dentists or other
  4 36 practitioners, or groups of practitioners, who are
  4 37 health care providers.
  4 38    21.  "Outpatient surgical facility" means a
  4 39 facility which as its primary function provides,
  4 40 through an organized medical staff and on an
  4 41 outpatient basis to patients who are generally
  4 42 ambulatory, surgical procedures not ordinarily
  4 43 performed in a private physician's office, but not
  4 44 requiring twenty-four hour hospitalization, and which
  4 45 is neither a part of a hospital nor the private office
  4 46 of a health care provider who there engages in the
  4 47 lawful practice of surgery.  "Outpatient surgical
  4 48 facility" includes a facility certified or seeking
  4 49 certification as an ambulatory surgical center, under
  4 50 the federal Medicare program or under the medical
  5  1 assistance program established pursuant to chapter
  5  2 249A.
  5  3    22. 18.  "Technologically innovative equipment"
  5  4 means equipment potentially useful for diagnostic or
  5  5 therapeutic purposes which introduces new technology
  5  6 in the diagnosis or treatment of disease, the
  5  7 usefulness of which is not well enough established to
  5  8 permit a specific plan of need to be developed for the
  5  9 state.
  5 10    Sec. 2.  Section 135.63, subsection 2, Code
  5 11 Supplement 1995, is amended to read as follows:
  5 12    2.  This division shall not be construed to
  5 13 augment, limit, contravene, or repeal in any manner
  5 14 any other statute of this state which may authorize or
  5 15 relate to licensure, regulation, supervision, or
  5 16 control of, nor to be applicable to:
  5 17    a.  Private offices and private clinics of an
  5 18 individual physician, dentist or other practitioner or
  5 19 group of health care providers, except as provided by
  5 20 section 135.61, subsection 18, paragraphs "g" and "h",
  5 21 and subsections 20 and 21.
  5 22    b.  Dispensaries and first aid stations, located
  5 23 within schools, businesses or industrial
  5 24 establishments, which are maintained solely for the
  5 25 use of students or employees of those establishments
  5 26 and which do not contain inpatient or resident beds
  5 27 that are customarily occupied by the same individual
  5 28 for more than twenty-four consecutive hours.
  5 29    c. a.  Establishments such as motels, hotels, and
  5 30 boarding houses which provide medical, nursing
  5 31 personnel, and other health related services as an
  5 32 incident to their primary business or function.
  5 33    d. b.  The remedial care or treatment of residents
  5 34 or patients in any home or institution conducted only
  5 35 for those who rely solely upon treatment by prayer or
  5 36 spiritual means in accordance with the creed or tenets
  5 37 of any recognized church or religious denomination.
  5 38    e. c.  A health maintenance organization or
  5 39 combination of health maintenance organizations or an
  5 40 institutional health facility controlled directly or
  5 41 indirectly by a health maintenance organization or
  5 42 combination of health maintenance organizations,
  5 43 except when the health maintenance organization or
  5 44 combination of health maintenance organizations does
  5 45 any of the following:
  5 46    (1)  Constructs, develops, renovates, relocates, or
  5 47 otherwise establishes an institutional health
  5 48 facility.
  5 49    (2)  Acquires major medical equipment as provided
  5 50 by section 135.61, subsection 18 16, paragraphs "i"
  6  1 and "j".
  6  2    f. d.  A residential care facility, as defined in
  6  3 section 135C.1, including a residential care facility
  6  4 for the mentally retarded, notwithstanding any
  6  5 provision in this division to the contrary.
  6  6    g. e.  A reduction in bed capacity of an
  6  7 institutional health facility, notwithstanding any
  6  8 provision in this division to the contrary, if all of
  6  9 the following conditions exist:
  6 10    (1)  The institutional health facility reports to
  6 11 the department the number and type of beds reduced on
  6 12 a form prescribed by the department at least thirty
  6 13 days before the reduction.  In the case of a health
  6 14 care facility, the new bed total must be consistent
  6 15 with the number of licensed beds at the facility.  In
  6 16 the case of a hospital, the number of beds must be
  6 17 consistent with bed totals reported to the department
  6 18 of inspections and appeals for purposes of licensure
  6 19 and certification.
  6 20    (2)  The institutional health facility reports the
  6 21 new bed total on its next annual report to the
  6 22 department.
  6 23    If these conditions are not met, the institutional
  6 24 health facility is subject to review as a "new
  6 25 institutional health service" or "changed
  6 26 institutional health service" under section 135.61,
  6 27 subsection 18 16, paragraph "d", and subject to
  6 28 sanctions under section 135.73.  If the institutional
  6 29 health facility reestablishes the deleted beds at a
  6 30 later time, review as a "new institutional health
  6 31 service" or "changed institutional health service" is
  6 32 required pursuant to section 135.61, subsection 18 16,
  6 33 paragraph "d".  
  6 34    h. f.  The deletion of one or more health services,
  6 35 previously offered on a regular basis by an
  6 36 institutional health facility or health maintenance
  6 37 organization, notwithstanding any provision of this
  6 38 division to the contrary, if all of the following
  6 39 conditions exist:
  6 40    (1)  The institutional health facility or health
  6 41 maintenance organization reports to the department the
  6 42 deletion of the service or services at least thirty
  6 43 days before the deletion on a form prescribed by the
  6 44 department.
  6 45    (2)  The institutional health facility or health
  6 46 maintenance organization reports the deletion of the
  6 47 service or services on its next annual report to the
  6 48 department.
  6 49    If these conditions are not met, the institutional
  6 50 health facility or health maintenance organization is
  7  1 subject to review as a "new institutional health
  7  2 service" or "changed institutional health service"
  7  3 under section 135.61, subsection 18 16, paragraph "f",
  7  4 and subject to sanctions under section 135.73.
  7  5    If the institutional health facility or health
  7  6 maintenance organization reestablishes the deleted
  7  7 service or services at a later time, review as a "new
  7  8 institutional health service" or "changed
  7  9 institutional health service" may be required pursuant
  7 10 to section 135.61, subsection 18 16.
  7 11    i.  A residential program exempt from licensing as
  7 12 a health care facility under chapter 135C in
  7 13 accordance with section 135C.6, subsection 8.
  7 14    Sec. 3.  Section 135.64, subsection 3, Code 1995,
  7 15 is amended by striking the subsection.
  7 16    Sec. 4.  Section 135.74, Code 1995, is amended to
  7 17 read as follows:
  7 18    135.74  UNIFORM FINANCIAL REPORTING.
  7 19    1.  The department, after study and in consultation
  7 20 with any advisory committees which may be established
  7 21 pursuant to law, shall promulgate by rule pursuant to
  7 22 chapter 17A uniform methods of financial reporting,
  7 23 including such allocation methods as may be
  7 24 prescribed, by which hospitals and health care
  7 25 facilities shall respectively record their revenues,
  7 26 expenses, other income, other outlays, assets and
  7 27 liabilities, and units of service, according to
  7 28 functional activity center.  These uniform methods of
  7 29 financial reporting shall not preclude a hospital or
  7 30 health care facility from using any accounting methods
  7 31 for its own purposes provided these accounting methods
  7 32 can be reconciled to the uniform methods of financial
  7 33 reporting prescribed by the department and can be
  7 34 audited for validity and completeness.  Each hospital
  7 35 and each health care facility shall adopt the
  7 36 appropriate system for its fiscal year, effective upon
  7 37 such date as the department shall direct.  In
  7 38 determining the effective date for reporting
  7 39 requirements, the department shall consider both the
  7 40 immediate need for uniform reporting of information to
  7 41 effectuate the purposes of this division and the
  7 42 administrative and economic difficulties which
  7 43 hospitals and health care facilities may encounter in
  7 44 complying with the uniform financial reporting
  7 45 requirement, but the effective date shall not be later
  7 46 than January 1, 1980.
  7 47    2.  In establishing uniform methods of financial
  7 48 reporting, the department shall consider:
  7 49    a.  The existing systems of accounting and
  7 50 reporting currently utilized by hospitals and health
  8  1 care facilities;
  8  2    b.  Differences among hospitals and health care
  8  3 facilities, respectively, according to size, financial
  8  4 structure, methods of payment for services, and scope,
  8  5 type and method of providing services; and
  8  6    c.  Other pertinent distinguishing factors.
  8  7    3.  The department shall, where appropriate,
  8  8 provide for modification, consistent with the purposes
  8  9 of this division, of reporting requirements to
  8 10 correctly reflect the differences among hospitals and
  8 11 among health care facilities referred to in subsection
  8 12 2, and to avoid otherwise unduly burdensome costs in
  8 13 meeting the requirements of uniform methods of
  8 14 financial reporting.
  8 15    4.  The uniform financial reporting methods, where
  8 16 appropriate, shall be structured so as to establish
  8 17 and differentiate costs incurred for patient-related
  8 18 services rendered by hospitals and health care
  8 19 facilities, as distinguished from those incurred in
  8 20 the course of educational, research and other
  8 21 nonpatient-related activities including but not
  8 22 limited to charitable activities of these hospitals
  8 23 and health care facilities.
  8 24    Sec. 5.  Section 135.75, Code 1995, is amended to
  8 25 read as follows:
  8 26    135.75  ANNUAL REPORTS BY HOSPITALS, HEALTH CARE
  8 27 FACILITIES.
  8 28    1.  Each hospital and each health care facility
  8 29 shall annually, after the close of its fiscal year,
  8 30 file with the department:
  8 31    a.  A balance sheet detailing the assets,
  8 32 liabilities and net worth of the hospital or health
  8 33 care facility;.
  8 34    b.  A statement of its income and expenses; and.
  8 35    c.  Such other reports of the costs incurred in
  8 36 rendering services as the department may prescribe.
  8 37    2.  Where more than one licensed hospital or health
  8 38 care facility is operated by the reporting
  8 39 organization, the information required by this section
  8 40 shall be reported separately for each licensed
  8 41 hospital or health care facility.  The department
  8 42 shall require preparation of specified financial
  8 43 reports by a certified public accountant, and may
  8 44 require attestation of responsible officials of the
  8 45 reporting hospital or health care facility that the
  8 46 reports submitted are to the best of their knowledge
  8 47 and belief prepared in accordance with the prescribed
  8 48 methods of reporting.  The department shall have the
  8 49 right to inspect the books, audits and records of any
  8 50 hospital or health care facility as reasonably
  9  1 necessary to verify reports submitted pursuant to this
  9  2 division.
  9  3    3.  In obtaining the reports required by this
  9  4 section, the department and other state agencies shall
  9  5 co-ordinate their reporting requirements.
  9  6    4.  All reports filed under this section, except
  9  7 privileged medical information, shall be open to
  9  8 public inspection.
  9  9    Sec. 6.  Section 135.76, subsections 1, 2, and 3,
  9 10 Code 1995, are amended to read as follows:
  9 11    1.  The department shall from time to time
  9 12 undertake analyses and studies relating to hospital
  9 13 and health care facility costs and to the financial
  9 14 status of hospitals or health care facilities, or
  9 15 both, which are subject to the provisions of this
  9 16 division.  It shall further require the filing of
  9 17 information concerning the total financial needs of
  9 18 each individual hospital or health care facility and
  9 19 the resources currently or prospectively available to
  9 20 meet these needs, including the effect of proposals
  9 21 made by health systems agencies.  The department shall
  9 22 also prepare and file such summaries and compilations
  9 23 or other supplementary reports based on the
  9 24 information filed with it as will, in its judgment,
  9 25 advance the purposes of this division.
  9 26    2.  The analyses and studies required by this
  9 27 section shall be conducted with the objective of
  9 28 providing a basis for determining whether or not
  9 29 regulation of hospital and health care facility rates
  9 30 and charges by the state of Iowa is necessary to
  9 31 protect the health or welfare of the people of the
  9 32 state.
  9 33    3.  In conducting its analyses and studies, the
  9 34 department should determine whether:
  9 35    a.  The rates charged and costs incurred by
  9 36 hospitals and health care facilities are reasonably
  9 37 related to the services offered by those respective
  9 38 groups of institutions.
  9 39    b.  Aggregate rates of hospitals and of health care
  9 40 facilities are reasonably related to the aggregate
  9 41 costs incurred by those respective groups of
  9 42 institutions.
  9 43    c.  Rates are set equitably among all purchasers or
  9 44 classes of purchasers of hospital and of health care
  9 45 facility services.
  9 46    d.  The rates for particular services, supplies or
  9 47 materials established by hospitals and by health care
  9 48 facilities are reasonable.  Determination of
  9 49 reasonableness of rates shall include consideration of
  9 50 a fair rate of return to proprietary hospitals and
 10  1 health care facilities.
 10  2    Sec. 7.  Section 135.78, Code 1995, is amended to
 10  3 read as follows:
 10  4    135.78  DATA TO BE COMPILED.
 10  5    Immediately upon July 1, 1978, or as soon
 10  6 thereafter as reasonably possible, the department
 10  7 shall begin to compile all relevant financial and
 10  8 utilization data in order to have available the
 10  9 statistical information necessary to properly monitor
 10 10 hospital and health care facility charges and costs.
 10 11 Such data shall include necessary operating expenses,
 10 12 appropriate expenses incurred for rendering services
 10 13 to patients who cannot or do not pay, all properly
 10 14 incurred interest charges, and reasonable depreciation
 10 15 expenses based on the expected useful life of the
 10 16 property and equipment involved.  The department shall
 10 17 also obtain from each hospital and health care
 10 18 facility a current rate schedule as well as any
 10 19 subsequent amendments or modifications of that
 10 20 schedule as it may require.  In collection of the data
 10 21 required by sections 135.74 to 135.78, the department
 10 22 and other state agencies shall co-ordinate their
 10 23 reporting requirements.
 10 24    Sec. 8.  Section 135.79, Code 1995, is amended to
 10 25 read as follows:
 10 26    135.79  CIVIL PENALTY.
 10 27    Any hospital or health care facility which fails to
 10 28 file with the department the financial reports
 10 29 required by sections 135.74 to 135.78 is subject to a
 10 30 civil penalty of not to exceed five hundred dollars
 10 31 for each offense.
 10 32    Sec. 9.  Section 135.83, Code 1995, is amended to
 10 33 read as follows:
 10 34    135.83  CONTRACTS FOR ASSISTANCE WITH ANALYSES,
 10 35 STUDIES AND DATA.
 10 36    In furtherance of the department's responsibilities
 10 37 under sections 135.76, 135.77 and 135.78, the director
 10 38 may contract with the Iowa hospital association and
 10 39 third party payers, the Iowa health care facilities
 10 40 association and third party payers, or the Iowa
 10 41 association of homes for the aging and third party
 10 42 payers for the establishment of pilot programs dealing
 10 43 with prospective rate review in hospitals or health
 10 44 care facilities, or both.  Such contract shall be
 10 45 subject to the approval of the executive council and
 10 46 shall provide for an equitable representation of
 10 47 health care providers, third party payers, and health
 10 48 care consumers in the determination of criterion for
 10 49 rate review.  No third party payer shall be excluded
 10 50 from positive financial incentives based upon volume
 11  1 of gross patient revenues.  No state or federal funds
 11  2 appropriated or available to the department shall be
 11  3 used for any such pilot program." 
 11  4 
 11  5 
 11  6                              
 11  7 MARY LOU FREEMAN
 11  8 WAYNE D. BENNETT
 11  9 BERL E. PRIEBE
 11 10 WILMER RENSINK
 11 11 H. KAY HEDGE
 11 12 BRAD BANKS
 11 13 DON GETTINGS
 11 14 JOHN W. JENSEN
 11 15 SF 2102.501 76
 11 16 pf/jw
     

Text: S05088                            Text: S05090
Text: S05000 - S05099                   Text: S Index
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