House File 2248 S-5065 Amend House File 2248, as passed by the House, as follows: 1 1. Page 1, before line 1 by inserting: 2 < DIVISION I 3 AMBULATORY SURGICAL CENTER —— INFORMATION AND REFERRAL > 4 2. Page 2, after line 20 by inserting: 5 < DIVISION ___ 6 CERTIFICATE OF NEED 7 Sec. ___. Section 135.61, Code 2022, is amended by adding 8 the following new subsections: 9 NEW SUBSECTION . 2A. “Birthing hospital” means the same as 10 defined in section 135.131. 11 NEW SUBSECTION . 15A. “Mental health services” means 12 services provided by a mental health professional as defined in 13 section 228.1 operating within the scope of the professional’s 14 practice which address mental, emotional, medical, or 15 behavioral problems. 16 NEW SUBSECTION . 18A. “Nursing facility” means the same as 17 defined in section 135C.1. 18 NEW SUBSECTION . 21A. “Psychiatric services” means services 19 provided under the direction of a physician which address 20 mental, emotional, medical, or behavioral problems. 21 Sec. ___. Section 135.61, subsections 12, 14, and 18, Code 22 2022, are amended to read as follows: 23 12. “Health services” means clinically related diagnostic, 24 curative, or rehabilitative services, and includes but does not 25 include alcoholism services , drug abuse substance use disorder 26 services , and mental health services, psychiatric services, or 27 obstetrical and gynecological services. 28 14. “Institutional health facility” means any of the 29 following, without regard to whether the facilities referred 30 to are publicly or privately owned or are organized for profit 31 or not or whether the facilities are part of or sponsored by a 32 health maintenance organization: 33 a. A hospital. 34 b. A health care facility. 35 -1- HF 2248.3819 (3) 89 pf/rh 1/ 18 #1. #2.

c. An organized outpatient health facility. 1 d. An outpatient surgical facility. 2 e. A community mental health facility. 3 f. A birth center. 4 18. “New institutional health service” or “changed 5 institutional health service” means any of the following: 6 a. (1) The construction, development , or other 7 establishment of a new institutional health facility other than 8 a nursing facility regardless of ownership with a value in 9 excess of five million dollars . 10 (2) The construction, development, or other establishment 11 of a nursing facility regardless of ownership. 12 b. Relocation of an institutional health facility. 13 c. (1) Any capital expenditure, lease, or donation by or on 14 behalf of an institutional health facility other than a nursing 15 facility in excess of one five million five hundred thousand 16 dollars within a twelve-month period. 17 (2) Any capital expenditure, lease, or donation by or on 18 behalf of a nursing facility in excess of one million five 19 hundred thousand dollars within a twelve-month period. 20 d. A permanent change in the bed capacity, as determined 21 by the department, of an institutional health facility. For 22 purposes of this paragraph, a change is permanent if it is 23 intended to be effective for one year or more. 24 e. (1) Any expenditure in excess of five hundred thousand 25 million dollars by or on behalf of an institutional health 26 facility other than a nursing facility for health services 27 which are or will be offered in or through an institutional 28 health facility at a specific time but which were not offered 29 on a regular basis in or through that institutional health 30 facility within the twelve-month period prior to that time. 31 (2) Any expenditure in excess of five hundred thousand 32 dollars by or on behalf of a nursing facility for health 33 services which are or will be offered in or through a nursing 34 facility at a specific time but which were not offered on a 35 -2- HF 2248.3819 (3) 89 pf/rh 2/ 18

regular basis in or through that nursing facility within the 1 twelve-month period prior to that time. 2 f. The deletion of one or more health services, previously 3 offered on a regular basis by an institutional health facility 4 or health maintenance organization or the relocation of one or 5 more health services from one physical facility to another. 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 three 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 three 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. (1) Any acquisition by or on behalf of an institutional 21 health facility other than a nursing facility or a health 22 maintenance organization of any piece of replacement equipment 23 with a value in excess of one three million five hundred 24 thousand dollars, whether acquired by purchase, lease, or 25 donation. 26 (2) Any acquisition by or on behalf of a nursing facility of 27 any piece of replacement equipment with a value in excess of 28 one million five hundred thousand dollars, whether acquired by 29 purchase, lease, or donation. 30 j. (1) Any acquisition by or on behalf of an institutional 31 health facility other than a nursing facility or health 32 maintenance organization of any piece of equipment with a value 33 in excess of one three million five hundred thousand dollars, 34 whether acquired by purchase, lease, or donation, which 35 -3- HF 2248.3819 (3) 89 pf/rh 3/ 18

results in the offering or development of a health service not 1 previously provided. A mobile service provided on a contract 2 basis is not considered to have been previously provided by an 3 institutional health facility. 4 (2) Any acquisition by or on behalf of a nursing facility 5 of any piece of equipment with a value in excess of one 6 million five hundred thousand dollars, whether acquired by 7 purchase, lease, or donation, which results in the offering or 8 development of a health service not previously provided. 9 k. Any air transportation service for transportation of 10 patients or medical personnel offered through an institutional 11 health facility at a specific time but which was not offered 12 on a regular basis in or through that institutional health 13 facility within the twelve-month period prior to the specific 14 time. 15 l. k. Any mobile health service with a value in excess of 16 one three million five hundred thousand dollars. 17 m. l. Any of the following services with a value in excess 18 of five million dollars : 19 (1) Cardiac catheterization service. 20 (2) Open heart surgical service. 21 (3) Organ transplantation service. 22 (4) Radiation therapy service applying ionizing radiation 23 for the treatment of malignant disease using megavoltage 24 external beam equipment. 25 Sec. ___. Section 135.63, subsection 1, Code 2022, is 26 amended to read as follows: 27 1. A new institutional health service or changed 28 institutional health service shall not be offered or developed 29 in this state without prior application to the department 30 for and receipt of a certificate of need, pursuant to 31 this subchapter . The application shall be made upon forms 32 furnished or prescribed by the department and shall contain 33 such information as the department may require under this 34 subchapter . The application shall be accompanied by a fee 35 -4- HF 2248.3819 (3) 89 pf/rh 4/ 18

equivalent to three-tenths of one percent of the anticipated 1 cost of the project with a minimum fee of six hundred dollars 2 and a maximum fee of twenty-one thousand dollars. The fee 3 shall be remitted by the department to the treasurer of 4 state, who shall place it in the general fund of the state. 5 If an application is voluntarily withdrawn within thirty 6 calendar days after submission, seventy-five percent of the 7 application fee shall be refunded; if the application is 8 voluntarily withdrawn more than thirty but within sixty days 9 after submission, fifty percent of the application fee shall 10 be refunded; if the application is withdrawn voluntarily more 11 than sixty days after submission, twenty-five percent of 12 the application fee shall be refunded. Notwithstanding the 13 required payment of an application fee under this subsection , 14 an applicant for a new institutional health service or a 15 changed institutional health service offered or developed by 16 an intermediate care facility for persons with an intellectual 17 disability or an intermediate care facility for persons with 18 mental illness as defined pursuant to section 135C.1 is exempt 19 from payment of the application fee. 20 Sec. ___. Section 135.63, subsection 2, paragraph a, Code 21 2022, is amended to read as follows: 22 a. Private offices and private clinics of an individual 23 physician, dentist, or other practitioner or group of 24 health care providers, except as provided by section 135.61, 25 subsection 18 , paragraphs “g” , “h” , and “m” “l” , and section 26 135.61, subsections 20 and 21 . 27 Sec. ___. Section 135.63, subsection 2, paragraph e, 28 subparagraph (1), Code 2022, is amended to read as follows: 29 (1) Constructs, develops, renovates, relocates, or 30 otherwise establishes an institutional health facility as 31 specified under section 135.61, subsection 18 . 32 Sec. ___. Section 135.63, subsection 2, Code 2022, is 33 amended by adding the following new paragraphs: 34 NEW PARAGRAPH . q. An institutional health facility that is 35 -5- HF 2248.3819 (3) 89 pf/rh 5/ 18

a health care facility, a hospital or portion of a hospital, 1 or any other facility that is engaged primarily in providing 2 mental health services or psychiatric services including but 3 not limited to an intermediate care facility for persons with 4 mental illness as defined in section 135C.1, a psychiatric 5 medical institution for children licensed pursuant to chapter 6 135H, a community mental health center organized under chapter 7 230A or other community mental health facility, or a state 8 mental health institute designated by chapter 226. 9 NEW PARAGRAPH . r. A birth center or a birthing hospital. 10 Sec. ___. Section 135H.6, Code 2022, is amended to read as 11 follows: 12 135H.6 Inspection —— conditions for issuance. 13 1. The department shall issue a license to an applicant 14 under this chapter if all the following conditions exist: 15 a. The department has ascertained that the applicant’s 16 medical facilities and staff are adequate to provide the care 17 and services required of a psychiatric institution. 18 b. The proposed psychiatric institution is accredited 19 by the joint commission on the accreditation of health 20 care organizations, the commission on accreditation of 21 rehabilitation facilities, the council on accreditation of 22 services for families and children, or by any other recognized 23 accrediting organization with comparable standards acceptable 24 under federal regulation. 25 c. The applicant complies with applicable state rules 26 and standards for a psychiatric institution adopted by the 27 department in accordance with federal requirements under 42 28 C.F.R. §441.150 – 441.156. 29 d. The applicant has been awarded a certificate of need 30 pursuant to chapter 135 , unless exempt as provided in this 31 section . 32 e. d. The department of human services has submitted 33 written approval of the application based on the department of 34 human services’ determination of need. The department of human 35 -6- HF 2248.3819 (3) 89 pf/rh 6/ 18

services shall identify the location and number of children in 1 the state who require the services of a psychiatric medical 2 institution for children. Approval of an application shall be 3 based upon the location of the proposed psychiatric institution 4 relative to the need for services identified by the department 5 of human services and an analysis of the applicant’s ability to 6 provide services and support consistent with requirements under 7 chapter 232 , particularly regarding community-based treatment. 8 If the proposed psychiatric institution is not freestanding 9 from a facility licensed under chapter 135B or 135C , approval 10 under this paragraph shall not be given unless the department 11 of human services certifies that the proposed psychiatric 12 institution is capable of providing a resident with a living 13 environment similar to the living environment provided by a 14 licensee which is freestanding from a facility licensed under 15 chapter 135B or 135C . 16 f. e. The proposed psychiatric institution is under 17 the direction of an agency which has operated a facility 18 licensed under section 237.3, subsection 2 , paragraph “a” , as 19 a comprehensive residential facility for children for three 20 years or of an agency which has operated a facility for three 21 years providing psychiatric services exclusively to children or 22 adolescents and the facility meets or exceeds requirements for 23 licensure under section 237.3, subsection 2 , paragraph “a” , as a 24 comprehensive residential facility for children. 25 g. f. If a child has an emotional, behavioral, or mental 26 health disorder, the psychiatric institution does not require 27 court proceedings to be initiated or that a child’s parent, 28 guardian, or custodian must terminate parental rights over 29 or transfer legal custody of the child for the purpose of 30 obtaining treatment from the psychiatric institution for the 31 child. Relinquishment of a child’s custody shall not be a 32 condition of the child receiving services. 33 2. The department of human services shall not give approval 34 to an application which would cause the total number of beds 35 -7- HF 2248.3819 (3) 89 pf/rh 7/ 18

licensed under this chapter for services reimbursed by the 1 medical assistance program under chapter 249A to exceed four 2 hundred thirty beds. 3 3. In addition to the beds authorized under subsection 2 , 4 the department of human services may establish not more than 5 thirty beds licensed under this chapter at the state mental 6 health institute at Independence. The beds shall be exempt 7 from the certificate of need requirement under subsection 1 , 8 paragraph “d” . 9 4. The department of human services may give approval to 10 conversion of beds approved under subsection 2 , to beds which 11 are specialized to provide substance abuse treatment. However, 12 the total number of beds approved under subsection 2 and this 13 subsection shall not exceed four hundred thirty. Conversion 14 of beds under this subsection shall not require a revision of 15 the certificate of need issued for the psychiatric institution 16 making the conversion. Beds for children who do not reside 17 in this state and whose service costs are not paid by public 18 funds in this state are not subject to the limitations on the 19 number of beds and certificate of need requirements otherwise 20 applicable under this section . 21 5. A psychiatric institution licensed prior to July 1, 1999, 22 may exceed the number of beds authorized under subsection 2 23 if the excess beds are used to provide services funded from a 24 source other than the medical assistance program under chapter 25 249A . Notwithstanding subsection 1 , paragraphs paragraph “d” 26 and “e” , and subsection 2 , the provision of services using those 27 excess beds does not require a certificate of need or a review 28 by the department of human services. 29 6. A psychiatric institution shall be exempt from the 30 certificate of need requirements pursuant to section 135.63. 31 Sec. ___. ADMINISTRATIVE RULES. The department of public 32 health, in accordance with section 135.72, may adopt rules 33 pursuant to chapter 17A to administer this division of this 34 Act. 35 -8- HF 2248.3819 (3) 89 pf/rh 8/ 18

DIVISION ___ 1 RURAL EMERGENCY HOSPITALS 2 Sec. ___. Section 135B.1, Code 2022, is amended by adding 3 the following new subsections: 4 NEW SUBSECTION . 5. “Rural emergency hospital” means a 5 facility that provides rural emergency hospital services in 6 the facility twenty-four hours per day, seven days per week; 7 does not provide any acute care inpatient services with the 8 exception of any distinct part of the facility licensed as a 9 skilled nursing facility providing posthospital extended care 10 services; and meets the criteria specified in section 135B.1A 11 and the federal Consolidated Appropriations Act, Pub. L. No. 12 116-260, §125. 13 NEW SUBSECTION . 6. “Rural emergency hospital services” 14 means the following services provided by a rural emergency 15 hospital that do not exceed an annual per patient average of 16 twenty-four hours in such a rural emergency hospital: 17 a. Emergency department services and observation care. 18 For purposes of providing emergency department services, an 19 emergency department of a rural emergency hospital shall 20 be considered staffed if a physician, nurse practitioner, 21 clinical nurse specialist, or physician assistant is available 22 to furnish rural emergency hospital services in the facility 23 twenty-four hours per day. 24 b. At the election of the rural emergency hospital, with 25 respect to services furnished on an outpatient basis, other 26 medical and health services as specified in regulations adopted 27 by the United States secretary of health and human services. 28 Sec. ___. NEW SECTION . 135B.1A Rural emergency hospital 29 licensure. 30 1. The department shall adopt rules pursuant to chapter 31 17A to establish minimum standards for the licensure of rural 32 emergency hospitals consistent with the federal Consolidated 33 Appropriations Act, Pub. L. No. 116-260, §125, and with 34 regulations issued by the United States secretary of health and 35 -9- HF 2248.3819 (3) 89 pf/rh 9/ 18

human services for rural emergency hospitals. 1 2. To be eligible for a rural emergency hospital license, a 2 facility shall have been, on or before December 27, 2020, one 3 of the following: 4 a. A licensed critical access hospital. 5 b. A general hospital with not more than fifty licensed 6 beds located in a county in a rural area as defined in section 7 1886(d)(2)(D) of the federal Social Security Act. 8 c. A general hospital with no more than fifty licensed beds 9 that is deemed as being located in a rural area pursuant to 10 section 1886(d)(8)(E) of the federal Social Security Act. 11 Sec. ___. Section 135B.2, Code 2022, is amended to read as 12 follows: 13 135B.2 Purpose. 14 The purpose of this chapter is to provide for the 15 development, establishment and enforcement of basic standards 16 for the care and treatment of individuals in hospitals and 17 rural emergency hospitals and for the construction, maintenance 18 and operation of such hospitals, which, in the light of 19 existing knowledge, will promote safe and adequate treatment 20 of such individuals in such hospitals, in the interest of the 21 health, welfare and safety of the public. 22 Sec. ___. Section 135B.3, Code 2022, is amended to read as 23 follows: 24 135B.3 Licensure. 25 No person or governmental unit, acting severally or jointly 26 with any other person or governmental unit shall establish, 27 conduct or maintain a hospital or rural emergency hospital in 28 this state without a license. 29 Sec. ___. Section 135B.4, Code 2022, is amended to read as 30 follows: 31 135B.4 Application for license. 32 Licenses shall be obtained from the department. 33 Applications shall be upon forms and shall contain information 34 as the department may reasonably require, which may include 35 -10- HF 2248.3819 (3) 89 pf/rh 10/ 18

affirmative evidence of ability to comply with reasonable 1 standards and rules prescribed under this chapter . Each 2 application for license shall be accompanied by the license 3 fee, which shall be refunded to the applicant if the license 4 is denied and which shall be deposited into the state treasury 5 and credited to the general fund if the license is issued. 6 Hospitals and rural emergency hospitals having fifty beds or 7 less shall pay an initial license fee of fifteen dollars; 8 hospitals of more than fifty beds and not more than one hundred 9 beds shall pay an initial license fee of twenty-five dollars; 10 all other hospitals shall pay an initial license fee of fifty 11 dollars. 12 Sec. ___. Section 135B.5, subsection 1, Code 2022, is 13 amended to read as follows: 14 1. Upon receipt of an application for license and the 15 license fee, the department shall issue a license if the 16 applicant and hospital facilities comply with this chapter , 17 chapter 135 , and the rules of the department. Each licensee 18 shall receive annual reapproval upon payment of five hundred 19 dollars and upon filing of an application form which is 20 available from the department. The annual licensure fee shall 21 be dedicated to support and provide educational programs on 22 regulatory issues for hospitals and rural emergency hospitals 23 licensed under this chapter . Licenses shall be either general 24 or restricted in form. Each license shall be issued only 25 for the premises and persons or governmental units named in 26 the application and is not transferable or assignable except 27 with the written approval of the department. Licenses shall 28 be posted in a conspicuous place on the licensed premises as 29 prescribed by rule of the department. 30 Sec. ___. Section 135B.5A, Code 2022, is amended to read as 31 follows: 32 135B.5A Conversion of a hospital relative to certain 33 hospitals . 34 1. A conversion of a long-term acute care hospital, 35 -11- HF 2248.3819 (3) 89 pf/rh 11/ 18

rehabilitation hospital, or psychiatric hospital as defined by 1 federal regulations to a general hospital or to a specialty 2 hospital of a different type is a permanent change in bed 3 capacity and shall require a certificate of need pursuant to 4 section 135.63 . 5 2. A conversion of a critical access hospital or general 6 hospital to a rural emergency hospital or a conversion of a 7 rural emergency hospital to a critical access hospital or 8 general hospital shall not require a certificate of need 9 pursuant to section 135.63. 10 Sec. ___. Section 135B.7, Code 2022, is amended to read as 11 follows: 12 135B.7 Rules and enforcement. 13 1. a. The department, with the approval of the state 14 board of health, shall adopt rules setting out the standards 15 for the different types of hospitals and for rural emergency 16 hospitals to be licensed under this chapter . The department 17 shall enforce the rules. 18 b. Rules or standards shall not be adopted or enforced 19 which would have the effect of denying a license to a hospital , 20 rural emergency hospital, or other institution required to be 21 licensed, solely by reason of the school or system of practice 22 employed or permitted to be employed by physicians in the 23 hospital, rural emergency hospital, or other institution if the 24 school or system of practice is recognized by the laws of this 25 state. 26 2. a. The rules shall state that a hospital or rural 27 emergency hospital shall not deny clinical privileges to 28 physicians and surgeons, podiatric physicians, osteopathic 29 physicians and surgeons, dentists, certified health service 30 providers in psychology, physician assistants, or advanced 31 registered nurse practitioners licensed under chapter 148 , 32 148C , 149 , 152 , or 153 , or section 154B.7 , solely by reason of 33 the license held by the practitioner or solely by reason of 34 the school or institution in which the practitioner received 35 -12- HF 2248.3819 (3) 89 pf/rh 12/ 18

medical schooling or postgraduate training if the medical 1 schooling or postgraduate training was accredited by an 2 organization recognized by the council on higher education 3 accreditation or an accrediting group recognized by the United 4 States department of education. 5 b. A hospital or rural emergency hospital may establish 6 procedures for interaction between a patient and a 7 practitioner. The rules shall not prohibit a hospital or 8 rural emergency hospital from limiting, restricting, or 9 revoking clinical privileges of a practitioner for violation 10 of hospital rules, regulations, or procedures established 11 under this paragraph, when applied in good faith and in a 12 nondiscriminatory manner. 13 c. This subsection shall not require a hospital or rural 14 emergency hospital to expand the hospital’s current scope of 15 service delivery solely to offer the services of a class of 16 providers not currently providing services at the hospital 17 or rural emergency hospital . This section shall not be 18 construed to require a hospital or rural emergency hospital 19 to establish rules which are inconsistent with the scope of 20 practice established for licensure of practitioners to whom 21 this subsection applies. 22 d. This section shall not be construed to authorize the 23 denial of clinical privileges to a practitioner or class of 24 practitioners solely because a hospital or rural emergency 25 hospital has as employees of the hospital or rural emergency 26 hospital identically licensed practitioners providing the same 27 or similar services. 28 3. The rules shall require that a hospital or rural 29 emergency hospital establish and implement written criteria 30 for the granting of clinical privileges. The written criteria 31 shall include but are not limited to consideration of all of 32 the following: 33 a. The ability of an applicant for privileges to provide 34 patient care services independently and appropriately in the 35 -13- HF 2248.3819 (3) 89 pf/rh 13/ 18

hospital or rural emergency hospital . 1 b. The license held by the applicant to practice. 2 c. The training, experience, and competence of the 3 applicant. 4 d. The relationship between the applicant’s request for the 5 granting of privileges and the hospital’s or rural emergency 6 hospital’s current scope of patient care services, as well as 7 the hospital’s or rural emergency hospital’s determination of 8 the necessity to grant privileges to a practitioner authorized 9 to provide comprehensive, appropriate, and cost-effective 10 services. 11 4. The department shall also adopt rules requiring 12 hospitals and rural emergency hospitals to establish and 13 implement protocols for responding to the needs of patients who 14 are victims of domestic abuse, as defined in section 236.2 . 15 5. The department shall also adopt rules requiring 16 hospitals and rural emergency hospitals to establish and 17 implement protocols for responding to the needs of patients who 18 are victims of elder abuse, as defined in section 235F.1 . 19 Sec. ___. Section 135B.7A, Code 2022, is amended to read as 20 follows: 21 135B.7A Procedures —— orders. 22 The department shall adopt rules that require hospitals 23 and rural emergency hospitals to establish procedures for 24 authentication of all verbal orders by a practitioner within 25 a period not to exceed thirty days following a patient’s 26 discharge. 27 Sec. ___. Section 135B.8, Code 2022, is amended to read as 28 follows: 29 135B.8 Effective date of rules. 30 Any hospital or rural emergency hospital which is in 31 operation at the time of promulgation of any applicable 32 rules or minimum standards under this chapter shall be given 33 a reasonable time, not to exceed one year from the date of 34 such promulgation, within which to comply with such rules and 35 -14- HF 2248.3819 (3) 89 pf/rh 14/ 18

minimum standards. 1 Sec. ___. Section 135B.9, Code 2022, is amended to read as 2 follows: 3 135B.9 Inspections and qualifications for hospital and rural 4 emergency hospital inspectors —— protection and advocacy agency 5 investigations. 6 1. The department shall make or cause to be made inspections 7 as it deems necessary in order to determine compliance with 8 applicable rules. Hospital and rural emergency hospital 9 inspectors shall meet the following qualifications: 10 a. Be free of conflicts of interest. A hospital or rural 11 emergency hospital inspector shall not participate in an 12 inspection or complaint investigation of a hospital or rural 13 emergency hospital in which the inspector or a member of the 14 inspector’s immediate family works or has worked within the 15 last two years. For purposes of this paragraph, “immediate 16 family member” means a spouse; natural or adoptive parent, 17 child, or sibling; or stepparent, stepchild, or stepsibling. 18 b. Complete a yearly conflict of interest disclosure 19 statement. 20 c. Biennially, complete a minimum of ten hours of continuing 21 education pertaining to hospital or rural emergency hospital 22 operations including but not limited to quality and process 23 improvement standards, trauma system standards, and regulatory 24 requirements. 25 2. In the state resource centers and state mental health 26 institutes operated by the department of human services, the 27 designated protection and advocacy agency as provided in 28 section 135C.2, subsection 4 , shall have the authority to 29 investigate all complaints of abuse and neglect of persons 30 with developmental disabilities or mental illnesses if the 31 complaints are reported to the protection and advocacy agency 32 or if there is probable cause to believe that the abuse has 33 occurred. Such authority shall include the examination of all 34 records pertaining to the care provided to the residents and 35 -15- HF 2248.3819 (3) 89 pf/rh 15/ 18

contact or interview with any resident, employee, or any other 1 person who might have knowledge about the operation of the 2 institution. 3 Sec. ___. Section 135B.12, Code 2022, is amended to read as 4 follows: 5 135B.12 Confidentiality. 6 The department’s final findings or the final survey findings 7 of the joint commission on the accreditation of health care 8 organizations or the American osteopathic association with 9 respect to compliance by a hospital or rural emergency hospital 10 with requirements for licensing or accreditation shall be made 11 available to the public in a readily available form and place. 12 Other information relating to a hospital or rural emergency 13 hospital obtained by the department which does not constitute 14 the department’s findings from an inspection of the hospital 15 or rural emergency hospital or the final survey findings of 16 the joint commission on the accreditation of health care 17 organizations or the American osteopathic association shall 18 not be made available to the public, except in proceedings 19 involving the denial, suspension, or revocation of a license 20 under this chapter . The name of a person who files a complaint 21 with the department shall remain confidential and shall not 22 be subject to discovery, subpoena, or other means of legal 23 compulsion for its release to a person other than department 24 employees or agents involved in the investigation of the 25 complaint. 26 Sec. ___. Section 135B.14, Code 2022, is amended to read as 27 follows: 28 135B.14 Judicial review. 29 Judicial review of the action of the department may be sought 30 in accordance with chapter 17A . Notwithstanding the terms of 31 chapter 17A , the Iowa administrative procedure Act, petitions 32 for judicial review may be filed in the district court of the 33 county in which the hospital or rural emergency hospital is 34 located or to be located, and the status quo of the petitioner 35 -16- HF 2248.3819 (3) 89 pf/rh 16/ 18

or licensee shall be preserved pending final disposition of the 1 matter in the courts. 2 Sec. ___. Section 135B.15, Code 2022, is amended to read as 3 follows: 4 135B.15 Penalties. 5 Any person establishing, conducting, managing, or operating 6 any hospital or rural emergency hospital without a license 7 shall be guilty of a serious misdemeanor, and each day of 8 continuing violation after conviction shall be considered a 9 separate offense. 10 Sec. ___. Section 135B.16, Code 2022, is amended to read as 11 follows: 12 135B.16 Injunction. 13 Notwithstanding the existence or pursuit of any other 14 remedy, the department may, in the manner provided by law, 15 maintain an action in the name of the state for injunction 16 or other process against any person or governmental unit to 17 restrain or prevent the establishment, conduct, management or 18 operation of a hospital or rural emergency hospital without a 19 license. 20 Sec. ___. Section 135B.20, subsection 3, Code 2022, is 21 amended to read as follows: 22 3. “Hospital” shall mean means all hospitals and rural 23 emergency hospitals licensed under this chapter . 24 Sec. ___. Section 135B.33, subsection 1, unnumbered 25 paragraph 1, Code 2022, is amended to read as follows: 26 Subject to availability of funds, the Iowa department of 27 public health shall provide technical planning assistance to 28 local boards of health and hospital or rural emergency hospital 29 governing boards to ensure access to hospital such services in 30 rural areas. The department shall encourage the local boards 31 of health and hospital or rural emergency hospital governing 32 boards to adopt a long-term community health services and 33 developmental plan including the following: 34 Sec. ___. Section 135B.34, subsection 7, Code 2022, is 35 -17- HF 2248.3819 (3) 89 pf/rh 17/ 18

amended to read as follows: 1 7. For the purposes of this section , “comprehensive 2 preliminary background check” : 3 a. “Comprehensive preliminary background check” means the 4 same as defined in section 135C.1 . 5 b. “Hospital” means a hospital or rural emergency hospital 6 licensed under this chapter. 7 Sec. ___. EFFECTIVE DATE. This division of this Act, being 8 deemed of immediate importance, takes effect upon enactment. > 9 3. Title page, line 1, after < relating to > by inserting 10 < health care, health care facilities, and health services 11 including > 12 4. Title page, lines 3 and 4, by striking < and providing 13 for licensee discipline > and inserting < the application of the 14 certificate of need process, and licensure of rural emergency 15 hospitals, providing for licensee discipline, and including 16 effective date provisions. > 17 5. By renumbering as necessary. 18 ______________________________ COMMITTEE ON HUMAN RESOURCES JEFF EDLER, CHAIRPERSON -18- HF 2248.3819 (3) 89 pf/rh 18/ 18 #3. #4. #5.