Senate File 75 S-3024 Amend Senate File 75 as follows: 1 1. Page 1, before line 1 by inserting: 2 < DIVISION I 3 RURAL EMERGENCY HOSPITALS > 4 2. Page 10, line 9, after < This > by inserting < division of 5 this > 6 3. Page 10, line 14, after < This > by inserting < division of 7 this > 8 4. Page 10, line 17, after < this > by inserting < division of 9 this > 10 5. Page 10, line 23, after < this > by inserting < division of 11 this > 12 6. Page 10, line 24, after < this > by inserting < division of 13 this > 14 7. Page 10, by striking lines 27 and 28 and inserting: 15 < Sec. ___. EFFECTIVE DATE. This division of this Act, being 16 deemed of immediate importance, takes effect upon enactment. > 17 8. Page 10, before line 29 by inserting: 18 < DIVISION ___ 19 AMBULATORY SURGICAL CENTERS 20 Sec. ___. NEW SECTION . 135R.1 Definitions. 21 As used in this chapter, unless the context otherwise 22 requires: 23 1. “Ambulatory surgical center” means a distinct facility 24 that operates exclusively for the purpose of providing surgical 25 services to patients not requiring hospitalization and in which 26 the expected duration of services does not exceed twenty-four 27 hours following an admission. “Ambulatory surgical center” 28 includes a facility certified or seeking certification as an 29 ambulatory surgical center under the federal Medicare program 30 or under the medical assistance program established pursuant 31 to chapter 249A. “Ambulatory surgical center” does not include 32 the individual or group practice office of a private physician, 33 podiatrist, or dentist who there engages in the lawful practice 34 of surgery, or the portion of a licensed hospital designated 35 -1- SF 75.375 (3) 90 pf/rh 1/ 5 #1. #2. #3. #4. #5. #6. #7. #8.

for outpatient surgical treatment. 1 2. “Department” means the department of inspections and 2 appeals. 3 Sec. ___. NEW SECTION . 135R.2 Licensure. 4 A person, acting severally or jointly with any other person, 5 shall not establish, operate, or maintain an ambulatory 6 surgical center in this state without obtaining a license as 7 provided under this chapter. 8 Sec. ___. NEW SECTION . 135R.3 Application for license —— 9 fee. 10 1. An applicant for an ambulatory surgical center license 11 shall submit an application to the department. Applications 12 shall be upon such forms and shall include such information 13 as the department may reasonably require, which may include 14 affirmative evidence of the ability to comply with reasonable 15 rules and standards prescribed under this chapter. 16 2. An application for an initial license for an ambulatory 17 surgical center shall be accompanied by a fee of fifty dollars. 18 3. The fees collected under this section shall be considered 19 repayment receipts as defined in section 8.2 and shall be used 20 by the department to administer this chapter. 21 Sec. ___. NEW SECTION . 135R.4 Rules. 22 1. The department, with the advice and approval of the state 23 board of health, shall adopt rules specifying the standards for 24 ambulatory surgical centers to be licensed under this chapter. 25 The rules shall be consistent with and shall not exceed the 26 requirements of this chapter and the conditions for coverage in 27 the federal Medicare program for ambulatory surgical centers 28 under 42 C.F.R. pt. 416. 29 2. The department shall adopt rules as the department deems 30 necessary to implement the provisions of this chapter relating 31 to the issuance, renewal, denial, suspension, and revocation 32 of a license to establish, operate, and maintain an ambulatory 33 surgical center. 34 3. An ambulatory surgical center which is in operation at 35 -2- SF 75.375 (3) 90 pf/rh 2/ 5

the time of adoption of any applicable rules or standards under 1 this chapter shall be given a reasonable time, not to exceed 2 one year from the date of adoption, within which to comply with 3 such rules and standards. 4 4. The department shall enforce the rules. 5 Sec. ___. NEW SECTION . 135R.5 Inspections or 6 investigations. 7 1. The department shall make or cause to be made inspections 8 or investigations of ambulatory surgical centers to determine 9 compliance with this chapter and applicable rules and 10 standards. The department shall perform inspections on a 11 schedule that is of the same frequency required for inspections 12 of Medicare-certified ambulatory surgical centers. 13 2. The department shall recognize, in lieu of its own 14 licensure inspection, the comparable inspection and inspection 15 findings of a Medicare conditions for coverage survey completed 16 by the department or an accrediting organization with deeming 17 authority authorized by the centers for Medicare and Medicaid 18 services of the United States department of health and human 19 services. 20 3. A department inspector shall not participate in an 21 inspection or investigation of an ambulatory surgical center in 22 which the inspector or a member of the inspector’s immediate 23 family works or has worked within the last two years or in 24 which the inspector or the inspector’s immediate family has 25 a financial ownership interest. For the purposes of this 26 section, “immediate family member” means a spouse, natural or 27 adoptive parent or grandparent, child, grandchild, sibling, 28 stepparent, stepchild, or stepsibling. 29 Sec. ___. NEW SECTION . 135R.6 Confidentiality. 30 The department’s final findings with respect to compliance 31 by an ambulatory surgical center with requirements for 32 licensing shall be made available to the public in a readily 33 available form and place. Other information relating to 34 an ambulatory surgical center obtained by the department 35 -3- SF 75.375 (3) 90 pf/rh 3/ 5

which does not constitute the department’s findings from an 1 inspection of the ambulatory surgical center shall not be made 2 available to the public, except in proceedings involving the 3 denial, suspension, or revocation of a license under this 4 chapter. The name of a person who files a complaint with the 5 department shall remain confidential and shall not be subject 6 to discovery, subpoena, or other means of legal compulsion for 7 its release to a person other than department employees or 8 agents involved in the investigation of the complaint. 9 Sec. ___. NEW SECTION . 135R.7 Injunction. 10 Notwithstanding the existence or pursuit of any other 11 remedy, the department may, in the manner provided by law, 12 maintain an action in the name of the state for injunction 13 or other process against any person to restrain or prevent 14 the establishment, operation, or maintenance of an ambulatory 15 surgical center without a license. 16 Sec. ___. NEW SECTION . 135R.8 Judicial review. 17 Judicial review of an action of the department may be sought 18 in accordance with chapter 17A. Notwithstanding the provisions 19 of chapter 17A, petitions for judicial review may be filed 20 in the district court of the county in which the ambulatory 21 surgical center is located or is to be located and the status 22 quo of the petitioner or licensee shall be preserved pending 23 final disposition of the judicial review matter. 24 Sec. ___. NEW SECTION . 135R.9 Penalties. 25 Any person establishing, operating, or maintaining any 26 ambulatory surgical center without a license commits a serious 27 misdemeanor, and each day of continuing violation after 28 conviction shall be considered a separate offense. 29 Sec. ___. Section 135.11, Code 2023, is amended by adding 30 the following new subsection: 31 NEW SUBSECTION . 29. Adopt rules requiring ambulatory 32 surgical centers to report quality data to the department of 33 public health that is consistent with the data required to be 34 reported to the centers for Medicare and Medicaid services of 35 -4- SF 75.375 (3) 90 pf/rh 4/ 5

the United States department of health and human services as 1 authorized by the Medicare Improvements and Extension Act of 2 2006 under Tit. I of the Tax Relief and Health Care Act of 2006, 3 Pub. L. No. 109-432, and the regulations adopted under such 4 Acts. Notwithstanding any provision of law to the contrary, 5 nothing in this subsection shall require an ambulatory 6 surgical center to provide health data to the department of 7 public health or any other public or private entity that 8 is in addition to, different than, or exceeds the quality 9 data required to be reported to the centers for Medicare and 10 Medicaid services of the United States department of health and 11 human services. 12 Sec. ___. Section 135.61, Code 2023, is amended by adding 13 the following new subsection: 14 NEW SUBSECTION . 1A. “Ambulatory surgical center” means 15 ambulatory surgical center as defined in section 135R.1. 16 Sec. ___. Section 135.61, subsection 14, paragraph d, Code 17 2023, is amended to read as follows: 18 d. An outpatient ambulatory surgical facility center . 19 Sec. ___. Section 135.61, subsection 21, Code 2023, is 20 amended by striking the subsection. > 21 9. Title page, line 1, after < to > by inserting < certain 22 health facilities including ambulatory surgical centers and > 23 10. Title page, line 2, after < fees, > by inserting 24 < providing penalties and > 25 11. By renumbering as necessary. 26 ______________________________ KEN ROZENBOOM ______________________________ MARK LOFGREN -5- SF 75.375 (3) 90 pf/rh 5/ 5 #9. #10. #11.