S-5065

   Amend House File 2248, as passed by the House, as follows:
   1.  Page 1, before line 1 by inserting: 
<DIVISION I
AMBULATORY SURGICAL CENTER —— INFORMATION AND REFERRAL>
   2.  Page 2, after line 20 by inserting: 
<DIVISION ___
CERTIFICATE OF NEED

   Sec. ___.  Section 135.61, Code 2022, is amended by adding the following new subsections:
   NEW SUBSECTION.  2A.  “Birthing hospital” means the same as defined in section 135.131.
   NEW SUBSECTION.  15A.  “Mental health services” means services provided by a mental health professional as defined in section 228.1 operating within the scope of the professional’s practice which address mental, emotional, medical, or behavioral problems.
   NEW SUBSECTION.  18A.  “Nursing facility” means the same as defined in section 135C.1.
   NEW SUBSECTION.  21A.  “Psychiatric services” means services provided under the direction of a physician which address mental, emotional, medical, or behavioral problems.
   Sec. ___.  Section 135.61, subsections 12, 14, and 18, Code 2022, are amended to read as follows:
   12.  “Health services” means clinically related diagnostic, curative, or rehabilitative services, and includes but does not include alcoholism services, drug abuse substance use disorder services, and mental health services, psychiatric services, or obstetrical and gynecological services.
   14.  “Institutional health facility” means any of the following, without regard to whether the facilities referred to are publicly or privately owned or are organized for profit or not or whether the facilities are part of or sponsored by a health maintenance organization:
   a.  A hospital.
   b.  A health care facility.
   c.  An organized outpatient health facility.
   d.  An outpatient surgical facility.
   e.  A community mental health facility.
   f.  A birth center.
   18.  “New institutional health service” or “changed institutional health service” means any of the following:
   a.  (1)  The construction, development, or other establishment of a new institutional health facility other than a nursing facility regardless of ownership with a value in excess of five million dollars.
   (2)  The construction, development, or other establishment of a nursing facility regardless of ownership.
   b.  Relocation of an institutional health facility.
   c.  (1)  Any capital expenditure, lease, or donation by or on behalf of an institutional health facility other than a nursing facility in excess of one five million five hundred thousand dollars within a twelve-month period.
   (2)  Any capital expenditure, lease, or donation by or on behalf of a nursing facility in excess of one million five hundred thousand dollars within a twelve-month period.
   d.  A permanent change in the bed capacity, as determined by the department, of an institutional health facility. For purposes of this paragraph, a change is permanent if it is intended to be effective for one year or more.
   e.  (1)  Any expenditure in excess of five hundred thousand million dollars by or on behalf of an institutional health facility other than a nursing facility for health services which are or will be offered in or through an institutional health facility at a specific time but which were not offered on a regular basis in or through that institutional health facility within the twelve-month period prior to that time.
   (2)  Any expenditure in excess of five hundred thousand dollars by or on behalf of a nursing facility for health services which are or will be offered in or through a nursing facility at a specific time but which were not offered on a regular basis in or through that nursing facility within the twelve-month period prior to that time.
   f.  The deletion of one or more health services, previously offered on a regular basis by an institutional health facility or health maintenance organization or the relocation of one or more health services from one physical facility to another.
   g.  Any acquisition by or on behalf of a health care provider or a group of health care providers of any piece of replacement equipment with a value in excess of one three million five hundred thousand dollars, whether acquired by purchase, lease, or donation.
   h.  Any acquisition by or on behalf of a health care provider or group of health care providers of any piece of equipment with a value in excess of one three million five hundred thousand dollars, whether acquired by purchase, lease, or donation, which results in the offering or development of a health service not previously provided. A mobile service provided on a contract basis is not considered to have been previously provided by a health care provider or group of health care providers.
   i.  (1)  Any acquisition by or on behalf of an institutional health facility other than a nursing facility or a health maintenance organization of any piece of replacement equipment with a value in excess of one three million five hundred thousand dollars, whether acquired by purchase, lease, or donation.
   (2)  Any acquisition by or on behalf of a nursing facility of any piece of replacement equipment with a value in excess of one million five hundred thousand dollars, whether acquired by purchase, lease, or donation.
   j.  (1)  Any acquisition by or on behalf of an institutional health facility other than a nursing facility or health maintenance organization of any piece of equipment with a value in excess of one three million five hundred thousand dollars, whether acquired by purchase, lease, or donation, which results in the offering or development of a health service not previously provided. A mobile service provided on a contract basis is not considered to have been previously provided by an institutional health facility.
   (2)  Any acquisition by or on behalf of a nursing facility of any piece of equipment with a value in excess of one million five hundred thousand dollars, whether acquired by purchase, lease, or donation, which results in the offering or development of a health service not previously provided.
   k.  Any air transportation service for transportation of patients or medical personnel offered through an institutional health facility at a specific time but which was not offered on a regular basis in or through that institutional health facility within the twelve-month period prior to the specific time.
   l.  k.  Any mobile health service with a value in excess of one three million five hundred thousand dollars.
   m.  l.  Any of the following services with a value in excess of five million dollars:
   (1)  Cardiac catheterization service.
   (2)  Open heart surgical service.
   (3)  Organ transplantation service.
   (4)  Radiation therapy service applying ionizing radiation for the treatment of malignant disease using megavoltage external beam equipment.
   Sec. ___.  Section 135.63, subsection 1, Code 2022, is amended to read as follows:
   1.  A new institutional health service or changed institutional health service shall not be offered or developed in this state without prior application to the department for and receipt of a certificate of need, pursuant to this subchapter. The application shall be made upon forms furnished or prescribed by the department and shall contain such information as the department may require under this subchapter. The application shall be accompanied by a fee equivalent to three-tenths of one percent of the anticipated cost of the project with a minimum fee of six hundred dollars and a maximum fee of twenty-one thousand dollars. The fee shall be remitted by the department to the treasurer of state, who shall place it in the general fund of the state. If an application is voluntarily withdrawn within thirty calendar days after submission, seventy-five percent of the application fee shall be refunded; if the application is voluntarily withdrawn more than thirty but within sixty days after submission, fifty percent of the application fee shall be refunded; if the application is withdrawn voluntarily more than sixty days after submission, twenty-five percent of the application fee shall be refunded. Notwithstanding the required payment of an application fee under this subsection, an applicant for a new institutional health service or a changed institutional health service offered or developed by an intermediate care facility for persons with an intellectual disability or an intermediate care facility for persons with mental illness as defined pursuant to section 135C.1 is exempt from payment of the application fee.
   Sec. ___.  Section 135.63, subsection 2, paragraph a, Code 2022, is amended to read as follows:
   a.  Private offices and private clinics of an individual physician, dentist, or other practitioner or group of health care providers, except as provided by section 135.61, subsection 18, paragraphs “g”, “h”, and “m” “l”, and section 135.61, subsections 20 and 21.
   Sec. ___.  Section 135.63, subsection 2, paragraph e, subparagraph (1), Code 2022, is amended to read as follows:
   (1)  Constructs, develops, renovates, relocates, or otherwise establishes an institutional health facility as specified under section 135.61, subsection 18.
   Sec. ___.  Section 135.63, subsection 2, Code 2022, is amended by adding the following new paragraphs:
   NEW PARAGRAPH.  q.  An institutional health facility that is a health care facility, a hospital or portion of a hospital, or any other facility that is engaged primarily in providing mental health services or psychiatric services including but not limited to an intermediate care facility for persons with mental illness as defined in section 135C.1, a psychiatric medical institution for children licensed pursuant to chapter 135H, a community mental health center organized under chapter 230A or other community mental health facility, or a state mental health institute designated by chapter 226.
   NEW PARAGRAPH.  r.  A birth center or a birthing hospital.
   Sec. ___.  Section 135H.6, Code 2022, is amended to read as follows:
   135H.6  Inspection —— conditions for issuance.
   1.  The department shall issue a license to an applicant under this chapter if all the following conditions exist:
   a.  The department has ascertained that the applicant’s medical facilities and staff are adequate to provide the care and services required of a psychiatric institution.
   b.  The proposed psychiatric institution is accredited by the joint commission on the accreditation of health care organizations, the commission on accreditation of rehabilitation facilities, the council on accreditation of services for families and children, or by any other recognized accrediting organization with comparable standards acceptable under federal regulation.
   c.  The applicant complies with applicable state rules and standards for a psychiatric institution adopted by the department in accordance with federal requirements under 42 C.F.R. §441.150 – 441.156.
   d.  The applicant has been awarded a certificate of need pursuant to chapter 135, unless exempt as provided in this section.
   e.  d.  The department of human services has submitted written approval of the application based on the department of human services’ determination of need. The department of human services shall identify the location and number of children in the state who require the services of a psychiatric medical institution for children. Approval of an application shall be based upon the location of the proposed psychiatric institution relative to the need for services identified by the department of human services and an analysis of the applicant’s ability to provide services and support consistent with requirements under chapter 232, particularly regarding community-based treatment. If the proposed psychiatric institution is not freestanding from a facility licensed under chapter 135B or 135C, approval under this paragraph shall not be given unless the department of human services certifies that the proposed psychiatric institution is capable of providing a resident with a living environment similar to the living environment provided by a licensee which is freestanding from a facility licensed under chapter 135B or 135C.
   f.  e.  The proposed psychiatric institution is under the direction of an agency which has operated a facility licensed under section 237.3, subsection 2, paragraph “a”, as a comprehensive residential facility for children for three years or of an agency which has operated a facility for three years providing psychiatric services exclusively to children or adolescents and the facility meets or exceeds requirements for licensure under section 237.3, subsection 2, paragraph “a”, as a comprehensive residential facility for children.
   g.  f.  If a child has an emotional, behavioral, or mental health disorder, the psychiatric institution does not require court proceedings to be initiated or that a child’s parent, guardian, or custodian must terminate parental rights over or transfer legal custody of the child for the purpose of obtaining treatment from the psychiatric institution for the child. Relinquishment of a child’s custody shall not be a condition of the child receiving services.
   2.  The department of human services shall not give approval to an application which would cause the total number of beds licensed under this chapter for services reimbursed by the medical assistance program under chapter 249A to exceed four hundred thirty beds.
   3.  In addition to the beds authorized under subsection 2, the department of human services may establish not more than thirty beds licensed under this chapter at the state mental health institute at Independence. The beds shall be exempt from the certificate of need requirement under subsection 1, paragraph “d”.
   4.  The department of human services may give approval to conversion of beds approved under subsection 2, to beds which are specialized to provide substance abuse treatment. However, the total number of beds approved under subsection 2 and this subsection shall not exceed four hundred thirty. Conversion of beds under this subsection shall not require a revision of the certificate of need issued for the psychiatric institution making the conversion. Beds for children who do not reside in this state and whose service costs are not paid by public funds in this state are not subject to the limitations on the number of beds and certificate of need requirements otherwise applicable under this section.
   5.  A psychiatric institution licensed prior to July 1, 1999, may exceed the number of beds authorized under subsection 2 if the excess beds are used to provide services funded from a source other than the medical assistance program under chapter 249A. Notwithstanding subsection 1, paragraphs paragraph “d” and “e”, and subsection 2, the provision of services using those excess beds does not require a certificate of need or a review by the department of human services.
   6.  A psychiatric institution shall be exempt from the certificate of need requirements pursuant to section 135.63.
   Sec. ___.  ADMINISTRATIVE RULES.  The department of public health, in accordance with section 135.72, may adopt rules pursuant to chapter 17A to administer this division of this Act.
DIVISION ___
RURAL EMERGENCY HOSPITALS

   Sec. ___.  Section 135B.1, Code 2022, is amended by adding the following new subsections:
   NEW SUBSECTION.  5.  “Rural emergency hospital” means a facility that provides rural emergency hospital services in the facility twenty-four hours per day, seven days per week; does not provide any acute care inpatient services with the exception of any distinct part of the facility licensed as a skilled nursing facility providing posthospital extended care services; and meets the criteria specified in section 135B.1A and the federal Consolidated Appropriations Act, Pub. L. No. 116-260, §125.
   NEW SUBSECTION.  6.  “Rural emergency hospital services” means the following services provided by a rural emergency hospital that do not exceed an annual per patient average of twenty-four hours in such a rural emergency hospital:
   a.  Emergency department services and observation care. For purposes of providing emergency department services, an emergency department of a rural emergency hospital shall be considered staffed if a physician, nurse practitioner, clinical nurse specialist, or physician assistant is available to furnish rural emergency hospital services in the facility twenty-four hours per day.
   b.  At the election of the rural emergency hospital, with respect to services furnished on an outpatient basis, other medical and health services as specified in regulations adopted by the United States secretary of health and human services.
   Sec. ___.  NEW SECTION.  135B.1A  Rural emergency hospital licensure.
   1.  The department shall adopt rules pursuant to chapter 17A to establish minimum standards for the licensure of rural emergency hospitals consistent with the federal Consolidated Appropriations Act, Pub. L. No. 116-260, §125, and with regulations issued by the United States secretary of health and human services for rural emergency hospitals.
   2.  To be eligible for a rural emergency hospital license, a facility shall have been, on or before December 27, 2020, one of the following:
   a.  A licensed critical access hospital.
   b.  A general hospital with not more than fifty licensed beds located in a county in a rural area as defined in section 1886(d)(2)(D) of the federal Social Security Act.
   c.  A general hospital with no more than fifty licensed beds that is deemed as being located in a rural area pursuant to section 1886(d)(8)(E) of the federal Social Security Act.
   Sec. ___.  Section 135B.2, Code 2022, is amended to read as follows:
   135B.2  Purpose.
   The purpose of this chapter is to provide for the development, establishment and enforcement of basic standards for the care and treatment of individuals in hospitals and rural emergency hospitals and for the construction, maintenance and operation of such hospitals, which, in the light of existing knowledge, will promote safe and adequate treatment of such individuals in such hospitals, in the interest of the health, welfare and safety of the public.
   Sec. ___.  Section 135B.3, Code 2022, is amended to read as follows:
   135B.3  Licensure.
   No person or governmental unit, acting severally or jointly with any other person or governmental unit shall establish, conduct or maintain a hospital or rural emergency hospital in this state without a license.
   Sec. ___.  Section 135B.4, Code 2022, is amended to read as follows:
   135B.4  Application for license.
   Licenses shall be obtained from the department. Applications shall be upon forms and shall contain information as the department may reasonably require, which may include affirmative evidence of ability to comply with reasonable standards and rules prescribed under this chapter. Each application for license shall be accompanied by the license fee, which shall be refunded to the applicant if the license is denied and which shall be deposited into the state treasury and credited to the general fund if the license is issued. Hospitals and rural emergency hospitals having fifty beds or less shall pay an initial license fee of fifteen dollars; hospitals of more than fifty beds and not more than one hundred beds shall pay an initial license fee of twenty-five dollars; all other hospitals shall pay an initial license fee of fifty dollars.
   Sec. ___.  Section 135B.5, subsection 1, Code 2022, is amended to read as follows:
   1.  Upon receipt of an application for license and the license fee, the department shall issue a license if the applicant and hospital facilities comply with this chapter, chapter 135, and the rules of the department. Each licensee shall receive annual reapproval upon payment of five hundred dollars and upon filing of an application form which is available from the department. The annual licensure fee shall be dedicated to support and provide educational programs on regulatory issues for hospitals and rural emergency hospitals licensed under this chapter. Licenses shall be either general or restricted in form. Each license shall be issued only for the premises and persons or governmental units named in the application and is not transferable or assignable except with the written approval of the department. Licenses shall be posted in a conspicuous place on the licensed premises as prescribed by rule of the department.
   Sec. ___.  Section 135B.5A, Code 2022, is amended to read as follows:
   135B.5A  Conversion of a hospital relative to certain hospitals.
   1.  A conversion of a long-term acute care hospital, rehabilitation hospital, or psychiatric hospital as defined by federal regulations to a general hospital or to a specialty hospital of a different type is a permanent change in bed capacity and shall require a certificate of need pursuant to section 135.63.
   2.  A conversion of a critical access hospital or general hospital to a rural emergency hospital or a conversion of a rural emergency hospital to a critical access hospital or general hospital shall not require a certificate of need pursuant to section 135.63.
   Sec. ___.  Section 135B.7, Code 2022, is amended to read as follows:
   135B.7  Rules and enforcement.
   1.  a.  The department, with the approval of the state board of health, shall adopt rules setting out the standards for the different types of hospitals and for rural emergency hospitals to be licensed under this chapter. The department shall enforce the rules.
   b.  Rules or standards shall not be adopted or enforced which would have the effect of denying a license to a hospital, rural emergency hospital, or other institution required to be licensed, solely by reason of the school or system of practice employed or permitted to be employed by physicians in the hospital, rural emergency hospital, or other institution if the school or system of practice is recognized by the laws of this state.
   2.  a.  The rules shall state that a hospital or rural emergency hospital shall not deny clinical privileges to physicians and surgeons, podiatric physicians, osteopathic physicians and surgeons, dentists, certified health service providers in psychology, physician assistants, or advanced registered nurse practitioners licensed under chapter 148, 148C, 149, 152, or 153, or section 154B.7, solely by reason of the license held by the practitioner or solely by reason of the school or institution in which the practitioner received medical schooling or postgraduate training if the medical schooling or postgraduate training was accredited by an organization recognized by the council on higher education accreditation or an accrediting group recognized by the United States department of education.
   b.  A hospital or rural emergency hospital may establish procedures for interaction between a patient and a practitioner. The rules shall not prohibit a hospital or rural emergency hospital from limiting, restricting, or revoking clinical privileges of a practitioner for violation of hospital rules, regulations, or procedures established under this paragraph, when applied in good faith and in a nondiscriminatory manner.
   c.  This subsection shall not require a hospital or rural emergency hospital to expand the hospital’s current scope of service delivery solely to offer the services of a class of providers not currently providing services at the hospital or rural emergency hospital. This section shall not be construed to require a hospital or rural emergency hospital to establish rules which are inconsistent with the scope of practice established for licensure of practitioners to whom this subsection applies.
   d.  This section shall not be construed to authorize the denial of clinical privileges to a practitioner or class of practitioners solely because a hospital or rural emergency hospital has as employees of the hospital or rural emergency hospital identically licensed practitioners providing the same or similar services.
   3.  The rules shall require that a hospital or rural emergency hospital establish and implement written criteria for the granting of clinical privileges. The written criteria shall include but are not limited to consideration of all of the following:
   a.  The ability of an applicant for privileges to provide patient care services independently and appropriately in the hospital or rural emergency hospital.
   b.  The license held by the applicant to practice.
   c.  The training, experience, and competence of the applicant.
   d.  The relationship between the applicant’s request for the granting of privileges and the hospital’s or rural emergency hospital’s current scope of patient care services, as well as the hospital’s or rural emergency hospital’s determination of the necessity to grant privileges to a practitioner authorized to provide comprehensive, appropriate, and cost-effective services.
   4.  The department shall also adopt rules requiring hospitals and rural emergency hospitals to establish and implement protocols for responding to the needs of patients who are victims of domestic abuse, as defined in section 236.2.
   5.  The department shall also adopt rules requiring hospitals and rural emergency hospitals to establish and implement protocols for responding to the needs of patients who are victims of elder abuse, as defined in section 235F.1.
   Sec. ___.  Section 135B.7A, Code 2022, is amended to read as follows:
   135B.7A  Procedures —— orders.
   The department shall adopt rules that require hospitals and rural emergency hospitals to establish procedures for authentication of all verbal orders by a practitioner within a period not to exceed thirty days following a patient’s discharge.
   Sec. ___.  Section 135B.8, Code 2022, is amended to read as follows:
   135B.8  Effective date of rules.
   Any hospital or rural emergency hospital which is in operation at the time of promulgation of any applicable rules or minimum standards under this chapter shall be given a reasonable time, not to exceed one year from the date of such promulgation, within which to comply with such rules and minimum standards.
   Sec. ___.  Section 135B.9, Code 2022, is amended to read as follows:
   135B.9  Inspections and qualifications for hospital and rural emergency hospital inspectors —— protection and advocacy agency investigations.
   1.  The department shall make or cause to be made inspections as it deems necessary in order to determine compliance with applicable rules. Hospital and rural emergency hospital inspectors shall meet the following qualifications:
   a.  Be free of conflicts of interest. A hospital or rural emergency hospital inspector shall not participate in an inspection or complaint investigation of a hospital or rural emergency hospital in which the inspector or a member of the inspector’s immediate family works or has worked within the last two years. For purposes of this paragraph, “immediate family member” means a spouse; natural or adoptive parent, child, or sibling; or stepparent, stepchild, or stepsibling.
   b.  Complete a yearly conflict of interest disclosure statement.
   c.  Biennially, complete a minimum of ten hours of continuing education pertaining to hospital or rural emergency hospital operations including but not limited to quality and process improvement standards, trauma system standards, and regulatory requirements.
   2.  In the state resource centers and state mental health institutes operated by the department of human services, the designated protection and advocacy agency as provided in section 135C.2, subsection 4, shall have the authority to investigate all complaints of abuse and neglect of persons with developmental disabilities or mental illnesses if the complaints are reported to the protection and advocacy agency or if there is probable cause to believe that the abuse has occurred. Such authority shall include the examination of all records pertaining to the care provided to the residents and contact or interview with any resident, employee, or any other person who might have knowledge about the operation of the institution.
   Sec. ___.  Section 135B.12, Code 2022, is amended to read as follows:
   135B.12  Confidentiality.
   The department’s final findings or the final survey findings of the joint commission on the accreditation of health care organizations or the American osteopathic association with respect to compliance by a hospital or rural emergency hospital with requirements for licensing or accreditation shall be made available to the public in a readily available form and place. Other information relating to a hospital or rural emergency hospital obtained by the department which does not constitute the department’s findings from an inspection of the hospital or rural emergency hospital or the final survey findings of the joint commission on the accreditation of health care organizations or the American osteopathic association shall not be made available to the public, except in proceedings involving the denial, suspension, or revocation of a license under this chapter. The name of a person who files a complaint with the department shall remain confidential and shall not be subject to discovery, subpoena, or other means of legal compulsion for its release to a person other than department employees or agents involved in the investigation of the complaint.
   Sec. ___.  Section 135B.14, Code 2022, is amended to read as follows:
   135B.14  Judicial review.
   Judicial review of the action of the department may be sought in accordance with chapter 17A. Notwithstanding the terms of chapter 17A, the Iowa administrative procedure Act, petitions for judicial review may be filed in the district court of the county in which the hospital or rural emergency hospital is located or to be located, and the status quo of the petitioner or licensee shall be preserved pending final disposition of the matter in the courts.
   Sec. ___.  Section 135B.15, Code 2022, is amended to read as follows:
   135B.15  Penalties.
   Any person establishing, conducting, managing, or operating any hospital or rural emergency hospital without a license shall be guilty of a serious misdemeanor, and each day of continuing violation after conviction shall be considered a separate offense.
   Sec. ___.  Section 135B.16, Code 2022, is amended to read as follows:
   135B.16  Injunction.
   Notwithstanding the existence or pursuit of any other remedy, the department may, in the manner provided by law, maintain an action in the name of the state for injunction or other process against any person or governmental unit to restrain or prevent the establishment, conduct, management or operation of a hospital or rural emergency hospital without a license.
   Sec. ___.  Section 135B.20, subsection 3, Code 2022, is amended to read as follows:
   3.  “Hospital” shall mean means all hospitals and rural emergency hospitals licensed under this chapter.
   Sec. ___.  Section 135B.33, subsection 1, unnumbered paragraph 1, Code 2022, is amended to read as follows:
   Subject to availability of funds, the Iowa department of public health shall provide technical planning assistance to local boards of health and hospital or rural emergency hospital governing boards to ensure access to hospital such services in rural areas. The department shall encourage the local boards of health and hospital or rural emergency hospital governing boards to adopt a long-term community health services and developmental plan including the following:
   Sec. ___.  Section 135B.34, subsection 7, Code 2022, is amended to read as follows:
   7.  For the purposes of this section, “comprehensive preliminary background check”:
   a.  “Comprehensive preliminary background check” means the same as defined in section 135C.1.
   b.  “Hospital” means a hospital or rural emergency hospital licensed under this chapter.
   Sec. ___.  EFFECTIVE DATE.  This division of this Act, being deemed of immediate importance, takes effect upon enactment.>
   3.  Title page, line 1, after <relating to> by inserting <health care, health care facilities, and health services including>
   4.  Title page, lines 3 and 4, by striking <and providing for licensee discipline> and inserting <the application of the certificate of need process, and licensure of rural emergency hospitals, providing for licensee discipline, and including effective date provisions.>
   5.  By renumbering as necessary.

______________________________
COMMITTEE ON HUMAN RESOURCES

JEFF EDLER, CHAIRPERSON