Senate File 506 H-8210 Amend Senate File 506, as amended, passed, and reprinted by 1 the Senate, as follows: 2 1. By striking everything after the enacting clause and 3 inserting: 4 < DIVISION I 5 CERTIFICATE OF NEED 6 Section 1. Section 10A.711, subsection 3, Code 2024, is 7 amended by striking the subsection. 8 Sec. 2. Section 10A.711, subsections 13 and 17, Code 2024, 9 are amended to read as follows: 10 13. “Institutional health facility” means any of the 11 following, without regard to whether the facilities referred 12 to are publicly or privately owned or are organized for profit 13 or not or whether the facilities are part of or sponsored by a 14 health maintenance organization: 15 a. A hospital. 16 b. A health care facility. 17 c. An organized outpatient health facility. 18 d. An ambulatory surgical center. 19 e. A community mental health facility. 20 f. A birth center. 21 17. “New institutional health service” or “changed 22 institutional health service” means any of the following: 23 a. The construction, development or other establishment of a 24 new institutional health facility regardless of ownership. 25 b. Relocation of an institutional health facility. 26 c. Any capital expenditure, lease, or donation by or on 27 behalf of an institutional health facility in excess of one 28 million five hundred thousand dollars the following amounts, as 29 applicable, within a twelve-month period . : 30 (1) Beginning July 1, 2024, three million five hundred 31 thousand dollars. 32 (2) Beginning July 1, 2029, four million dollars. 33 (3) Beginning July 1, 2034, four million five hundred 34 thousand dollars. 35 -1- SF 506.3648 (2) 90 pf/ko 1/ 7 #1.
(4) Beginning July 1, 2039, five million dollars. 1 d. A permanent change in the bed capacity, as determined 2 by the department, of an institutional health facility. For 3 purposes of this paragraph, a change is permanent if it is 4 intended to be effective for one year or more. 5 e. Any expenditure in excess of five hundred thousand 6 dollars by or on behalf of an institutional health facility for 7 health services which are or will be offered in or through an 8 institutional health facility at a specific time but which were 9 not offered on a regular basis in or through that institutional 10 health facility within the twelve-month period prior to that 11 time. 12 f. The deletion of one or more health services, previously 13 offered on a regular basis by an institutional health facility 14 or health maintenance organization or the relocation of one or 15 more health services from one physical facility to another. 16 g. Any acquisition by or on behalf of a health care provider 17 or a group of health care providers of any piece of replacement 18 equipment with a value in excess of one million five hundred 19 thousand dollars, whether acquired by purchase, lease, or 20 donation. 21 h. e. (1) Any acquisition by or on behalf of a health 22 care provider or group of health care providers of any piece of 23 equipment with a value in excess of one million five hundred 24 thousand dollars the following amounts, as applicable , whether 25 acquired by purchase, lease, or donation, which results in the 26 offering or development of a health service not previously 27 provided . : 28 (a) Beginning July 1, 2024, three million five hundred 29 thousand dollars. 30 (b) Beginning July 1, 2029, four million dollars. 31 (c) Beginning July 1, 2034, four million five hundred 32 thousand dollars. 33 (d) Beginning July 1, 2039, five million dollars. 34 (2) A mobile service provided on a contract basis is not 35 -2- SF 506.3648 (2) 90 pf/ko 2/ 7
considered to have been previously provided by a health care 1 provider or group of health care providers. 2 i. Any acquisition by or on behalf of an institutional 3 health facility or a health maintenance organization of any 4 piece of replacement equipment with a value in excess of one 5 million five hundred thousand dollars, whether acquired by 6 purchase, lease, or donation. 7 j. f. (1) Any acquisition by or on behalf of an 8 institutional health facility or health maintenance 9 organization of any piece of equipment with a value in excess 10 of one million five hundred thousand dollars the following 11 amounts, as applicable , whether acquired by purchase, lease, 12 or donation, which results in the offering or development of a 13 health service not previously provided . : 14 (a) Beginning July 1, 2024, three million five hundred 15 thousand dollars. 16 (b) Beginning July 1, 2029, four million dollars. 17 (c) Beginning July 1, 2034, four million five hundred 18 thousand dollars. 19 (d) Beginning July 1, 2039, five million dollars. 20 (2) A mobile service provided on a contract basis is not 21 considered to have been previously provided by an institutional 22 health facility. 23 k. Any air transportation service for transportation of 24 patients or medical personnel offered through an institutional 25 health facility at a specific time but which was not offered 26 on a regular basis in or through that institutional health 27 facility within the twelve-month period prior to the specific 28 time. 29 l. g. Any mobile health service with a value in excess 30 of one million five hundred thousand dollars. the following 31 amounts, as applicable: 32 (1) Beginning July 1, 2024, three million five hundred 33 thousand dollars. 34 (2) Beginning July 1, 2029, four million dollars. 35 -3- SF 506.3648 (2) 90 pf/ko 3/ 7
(3) Beginning July 1, 2034, four million five hundred 1 thousand dollars. 2 (4) Beginning July 1, 2039, five million dollars. 3 m. h. Any of the following: 4 (1) Cardiac catheterization service. 5 (2) Open heart surgical service. 6 (3) Organ transplantation service. 7 (4) Radiation therapy service applying ionizing radiation 8 for the treatment of malignant disease using megavoltage 9 external beam equipment. 10 Sec. 3. Section 10A.713, subsection 2, paragraph a, Code 11 2024, is amended to read as follows: 12 a. Private offices and private clinics of an individual 13 physician, dentist, or other practitioner or group of health 14 care providers, except as provided by section 10A.711, 15 subsection 17 , paragraphs “g” , “e” and “h” , and “m” , and section 16 10A.711, subsections 2 and 19 . 17 Sec. 4. Section 10A.713, subsection 2, paragraph e, 18 subparagraphs (1) and (2), Code 2024, are amended to read as 19 follows: 20 (1) Constructs, develops, renovates, relocates, or 21 otherwise establishes an institutional health facility. 22 (2) Acquires major medical equipment as provided by section 23 10A.711, subsection 17 , paragraphs “i” and “j” paragraph “f” . 24 Sec. 5. Section 10A.713, subsection 2, paragraph h, 25 subparagraphs (2) and (3), Code 2024, are amended to read as 26 follows: 27 (2) If these conditions are not met, the institutional 28 health facility or health maintenance organization is subject 29 to review as a “new institutional health service” or “changed 30 institutional health service” under section 10A.711, subsection 31 17 , paragraph “f” , and subject to sanctions under section 32 10A.723 . 33 (3) If the institutional health facility or health 34 maintenance organization reestablishes the deleted service 35 -4- SF 506.3648 (2) 90 pf/ko 4/ 7
or services at a later time, review as a “new institutional 1 health service” or “changed institutional health service” may 2 be required pursuant to section 10A.711, subsection 17 . 3 Sec. 6. Section 135.131, subsection 1, paragraph a, Code 4 2024, is amended to read as follows: 5 a. “Birth center” means birth center as defined in section 6 10A.711 a facility or institution, which is not an ambulatory 7 surgical center or hospital or in a hospital, in which births 8 are planned to occur following a normal, uncomplicated, 9 low-risk pregnancy . 10 DIVISION II 11 BIRTH CENTERS 12 Sec. 7. NEW SECTION . 147.165 Birth centers —— civil and 13 criminal liability limitations of health care providers. 14 1. A health care provider accepting the transfer of a 15 patient from a birth center shall not be civilly or criminally 16 liable for any injuries, damages, or outcomes arising from or 17 related to the acts or omissions of the birth center or any of 18 the employees, agents, contractors, or assigns of such birth 19 center. 20 2. For the purposes of this section: 21 a. “ Birth center” means the same as defined in section 22 135.131. 23 b. “Health care provider” means the same as defined in 24 section 147.136A. 25 Sec. 8. BIRTH CENTERS —— PROVISIONAL LICENSURE. The 26 department of inspections, appeals, and licensing shall develop 27 minimum standards for provisional licensure of a birth center 28 and shall adopt rules pursuant to chapter 17A to administer 29 birth center provisional licensure. The department shall 30 issue a provisional license to a birth center that meets the 31 minimum standards. A provisional license may be granted 32 for a period of no more than one year from the date the 33 specified administrative rules are adopted. A provisional 34 license shall expire at the end of the license term and is 35 -5- SF 506.3648 (2) 90 pf/ko 5/ 7
not renewable. During the term of a provisional license, a 1 health care provider accepting the transfer of a patient from 2 a provisionally licensed birth center shall not be civilly 3 or criminally liable for any injuries, damages, or outcomes 4 arising from or related to the acts or omissions of the 5 provisionally licensed birth center or any of the employees, 6 agents, contractors, or assigns of such birth center. 7 Sec. 9. EMERGENCY RULES. The department of inspections, 8 appeals, and licensing shall adopt emergency rules under 9 section 17A.4, subsection 3, and section 17A.5, subsection 10 2, paragraph “b”, to implement the birth center provisional 11 licensure provisions of this division of this Act, within six 12 months of the effective date of this division of this Act and 13 shall submit such rules to the administrative rules coordinator 14 and the administrative code editor pursuant to section 17A.5, 15 subsection 1, within the same period. The rules shall be 16 effective immediately upon filing unless a later date is 17 specified in the rules. Any rules adopted in accordance with 18 this section shall also be published as a notice of intended 19 action as provided in section 17A.4. 20 Sec. 10. PROPOSED LEGISLATION —— BIRTH CENTER 21 LICENSURE. The department of inspections, appeals, and 22 licensing shall submit proposed legislation under section 23 2.16 that provides for state licensure of and inspection 24 requirements for birth centers to be considered by the 2025 25 session of the general assembly. 26 Sec. 11. DEFINITIONS. For the purposes of this division of 27 this Act: 28 1. “Birth center” means a facility or institution, which 29 is not an ambulatory surgical center or a hospital or in a 30 hospital, in which births are planned to occur following a 31 normal, uncomplicated, low-risk pregnancy. 32 2. “Health care provider” means the same as defined in 33 section 147.136A. 34 Sec. 12. EFFECTIVE DATE. This division of this Act, being 35 -6- SF 506.3648 (2) 90 pf/ko 6/ 7
deemed of immediate importance, takes effect upon enactment. > 1 2. Title page, line 2, after < process, > by inserting 2 < providing civil and criminal liability limitations for health 3 care providers in certain circumstances, > 4 ______________________________ COMMITTEE ON HEALTH AND HUMAN SERVICES A. MEYER of Webster, Chairperson -7- SF 506.3648 (2) 90 pf/ko 7/ 7 #2.