H-8210

   Amend Senate File 506, as amended, passed, and reprinted by the Senate, as follows:
   1.  By striking everything after the enacting clause and inserting: 
<DIVISION I
CERTIFICATE OF NEED

   Section 1.  Section 10A.711, subsection 3, Code 2024, is amended by striking the subsection.
   Sec. 2.  Section 10A.711, subsections 13 and 17, Code 2024, are amended to read as follows:
   13.  “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 ambulatory surgical center.
   e.  A community mental health facility.
   f.  A birth center.
   17.  “New institutional health service” or “changed institutional health service” means any of the following:
   a.  The construction, development or other establishment of a new institutional health facility regardless of ownership.
   b.  Relocation of an institutional health facility.
   c.  Any capital expenditure, lease, or donation by or on behalf of an institutional health facility in excess of one million five hundred thousand dollars the following amounts, as applicable, within a twelve-month period.:
   (1)  Beginning July 1, 2024, three million five hundred thousand dollars.
   (2)  Beginning July 1, 2029, four million dollars.
   (3)  Beginning July 1, 2034, four million five hundred thousand dollars.
   (4)  Beginning July 1, 2039, five million dollars.
   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.  Any expenditure in excess of five hundred thousand dollars by or on behalf of an institutional health 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.
   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 million five hundred thousand dollars, whether acquired by purchase, lease, or donation.
   h.  e.  (1)  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 million five hundred thousand dollars the following amounts, as applicable, whether acquired by purchase, lease, or donation, which results in the offering or development of a health service not previously provided.:
   (a)  Beginning July 1, 2024, three million five hundred thousand dollars.
   (b)  Beginning July 1, 2029, four million dollars.
   (c)  Beginning July 1, 2034, four million five hundred thousand dollars.
   (d)  Beginning July 1, 2039, five million dollars.
   (2)  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.  Any acquisition by or on behalf of an institutional health facility or a health maintenance organization 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.  f.  (1)  Any acquisition by or on behalf of an institutional health facility or health maintenance organization of any piece of equipment with a value in excess of one million five hundred thousand dollars the following amounts, as applicable, whether acquired by purchase, lease, or donation, which results in the offering or development of a health service not previously provided.:
   (a)  Beginning July 1, 2024, three million five hundred thousand dollars.
   (b)  Beginning July 1, 2029, four million dollars.
   (c)  Beginning July 1, 2034, four million five hundred thousand dollars.
   (d)  Beginning July 1, 2039, five million dollars.
   (2)  A mobile service provided on a contract basis is not considered to have been previously provided by an institutional health facility.
   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.  g.  Any mobile health service with a value in excess of one million five hundred thousand dollars. the following amounts, as applicable:
   (1)  Beginning July 1, 2024, three million five hundred thousand dollars.
   (2)  Beginning July 1, 2029, four million dollars.
   (3)  Beginning July 1, 2034, four million five hundred thousand dollars.
   (4)  Beginning July 1, 2039, five million dollars.
   m.  h.  Any of the following:
   (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. 3.  Section 10A.713, subsection 2, paragraph a, Code 2024, 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 10A.711, subsection 17, paragraphs “g”, “e” and “h”, and “m”, and section 10A.711, subsections 2 and 19.
   Sec. 4.  Section 10A.713, subsection 2, paragraph e, subparagraphs (1) and (2), Code 2024, are amended to read as follows:
   (1)  Constructs, develops, renovates, relocates, or otherwise establishes an institutional health facility.
   (2)  Acquires major medical equipment as provided by section 10A.711, subsection 17, paragraphs “i” and “j” paragraph “f”.
   Sec. 5.  Section 10A.713, subsection 2, paragraph h, subparagraphs (2) and (3), Code 2024, are amended to read as follows:
   (2)  If these conditions are not met, the institutional health facility or health maintenance organization is subject to review as a “new institutional health service” or “changed institutional health service” under section 10A.711, subsection 17, paragraph “f”, and subject to sanctions under section 10A.723.
   (3)  If the institutional health facility or health maintenance organization reestablishes the deleted service or services at a later time, review as a “new institutional health service” or “changed institutional health service” may be required pursuant to section 10A.711, subsection 17.
   Sec. 6.  Section 135.131, subsection 1, paragraph a, Code 2024, is amended to read as follows:
   a.  “Birth center” means birth center as defined in section 10A.711 a facility or institution, which is not an ambulatory surgical center or hospital or in a hospital, in which births are planned to occur following a normal, uncomplicated, low-risk pregnancy.
DIVISION II
BIRTH CENTERS

   Sec. 7.  NEW SECTION.  147.165  Birth centers —— civil and criminal liability limitations of health care providers.
   1.  A health care provider accepting the transfer of a patient from a birth center shall not be civilly or criminally liable for any injuries, damages, or outcomes arising from or related to the acts or omissions of the birth center or any of the employees, agents, contractors, or assigns of such birth center.
   2.  For the purposes of this section:
   a.  “Birth center” means the same as defined in section 135.131.
   b.  “Health care provider” means the same as defined in section 147.136A.
   Sec. 8.  BIRTH CENTERS —— PROVISIONAL LICENSURE.  The department of inspections, appeals, and licensing shall develop minimum standards for provisional licensure of a birth center and shall adopt rules pursuant to chapter 17A to administer birth center provisional licensure. The department shall issue a provisional license to a birth center that meets the minimum standards. A provisional license may be granted for a period of no more than one year from the date the specified administrative rules are adopted. A provisional license shall expire at the end of the license term and is not renewable. During the term of a provisional license, a health care provider accepting the transfer of a patient from a provisionally licensed birth center shall not be civilly or criminally liable for any injuries, damages, or outcomes arising from or related to the acts or omissions of the provisionally licensed birth center or any of the employees, agents, contractors, or assigns of such birth center.
   Sec. 9.  EMERGENCY RULES.  The department of inspections, appeals, and licensing shall adopt emergency rules under section 17A.4, subsection 3, and section 17A.5, subsection 2, paragraph “b”, to implement the birth center provisional licensure provisions of this division of this Act, within six months of the effective date of this division of this Act and shall submit such rules to the administrative rules coordinator and the administrative code editor pursuant to section 17A.5, subsection 1, within the same period. The rules shall be effective immediately upon filing unless a later date is specified in the rules. Any rules adopted in accordance with this section shall also be published as a notice of intended action as provided in section 17A.4.
   Sec. 10.  PROPOSED LEGISLATION —— BIRTH CENTER LICENSURE.  The department of inspections, appeals, and licensing shall submit proposed legislation under section 2.16 that provides for state licensure of and inspection requirements for birth centers to be considered by the 2025 session of the general assembly.
   Sec. 11.  DEFINITIONS.  For the purposes of this division of this Act:
   1.  “Birth center” means a facility or institution, which is not an ambulatory surgical center or a hospital or in a hospital, in which births are planned to occur following a normal, uncomplicated, low-risk pregnancy.
   2.  “Health care provider” means the same as defined in section 147.136A.
   Sec. 12.  EFFECTIVE DATE.  This division of this Act, being deemed of immediate importance, takes effect upon enactment.>
   2.  Title page, line 2, after <process,> by inserting <providing civil and criminal liability limitations for health care providers in certain circumstances,>

______________________________
COMMITTEE ON HEALTH AND HUMAN SERVICES

A. MEYER of Webster, Chairperson