House File 972 - Enrolled House File 972 AN ACT RELATING TO HEALTH CARE INCLUDING A FUNDING MODEL FOR THE RURAL HEALTH CARE SYSTEM; THE ELIMINATION OF SEVERAL HEALTH CARE-RELATED AWARD, GRANT, RESIDENCY, AND FELLOWSHIP PROGRAMS; ESTABLISHMENT OF A HEALTH CARE PROFESSIONAL INCENTIVE PROGRAM; MEDICAID GRADUATE MEDICAL EDUCATION; THE HEALTH FACILITIES COUNCIL; AND THE IOWA HEALTH INFORMATION NETWORK, MAKING APPROPRIATIONS, AND INCLUDING EFFECTIVE DATE PROVISIONS. BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

House File 972, p. 2 DIVISION I HEALTH CARE HUB-AND-SPOKE PARTNERSHIP FUNDING MODEL Section 1. HEALTH CARE HUB-AND-SPOKE PARTNERSHIP FUNDING MODEL APPROVAL. The department of health and human services shall submit to the centers for Medicare and Medicaid services of the United States department of health and human services a request for approval for a health care hub-and-spoke partnership funding model for the purpose of improving Iowa’s rural health system to establish sufficient financial support for collaboration among regional health care providers in rural areas to transform health care delivery to provide quality and sustainable care. Sec. 2. EFFECTIVE DATE. This division of this Act, being deemed of immediate importance, takes effect upon enactment. DIVISION II ELIMINATION OF PRIMECARRE PROGRAMS —— DEPARTMENT OF HEALTH AND HUMAN SERVICES Sec. 3. Section 135.107, subsection 1, Code 2025, is amended by adding the following new paragraph: NEW PARAGRAPH . f. Coordinate with the college student aid commission to administer the health professional incentive program created in section 256.222. Sec. 4. Section 135.107, subsections 2 and 3, Code 2025, are amended by striking the subsections. Sec. 5. Section 135B.33, subsection 3, Code 2025, is amended to read as follows: 3. The health facilities may seek technical assistance or apply for matching grant funds for the plan development. The department shall require compliance with subsection 1 , paragraphs “a” through “h” , when the facility applies for matching grant funds. Sec. 6. TRANSITION PROVISIONS —— ACCOUNT. 1. The department of health and human services shall make loan repayments pursuant to a loan repayment program contract, including a United States department of health and human services state loan repayment program contract, executed on or before December 31, 2025, under the primary care provider loan repayment program in section 135.107, Code 2025, if the recipient remains in compliance with all obligations under the

House File 972, p. 3 loan repayment program contract. 2. a. The department of health and human services shall create an account for deposit of any moneys encumbered or obligated pursuant to a loan repayment program contract as specified in subsection 1. The department shall ensure that the encumbered and obligated moneys remain available for the duration of the loan repayment program contract. Moneys in the account are appropriated to the department for the purposes of this section. b. Notwithstanding section 8.33, any balance in the account shall not revert but shall remain available for the duration of such loan repayment program contracts. Notwithstanding section 12C.7, subsection 2, interest or earnings on moneys deposited in the account shall be credited to the account. c. Upon expiration of all loan repayment program contract periods and the expenditure of all moneys encumbered and obligated under such loan repayment contracts, any unencumbered or unobligated moneys remaining in the account created under this section shall be deposited in the health care professional incentive program fund created in section 256.222, as enacted by this Act. DIVISION III ELIMINATION OF HEALTH CARE-RELATED LOAN REPAYMENT AND FINANCIAL AWARD PROGRAMS —— COLLEGE STUDENT AID COMMISSION Sec. 7. REPEAL. Sections 256.221, 256.223, 256.224, and 256.225, Code 2025, are repealed. Sec. 8. TRANSITION PROVISIONS. 1. The college student aid commission shall make loan repayments pursuant to a program agreement entered into on or before June 30, 2025, by an eligible student and the commission under the rural Iowa primary care loan repayment program in section 256.221, Code 2025, if the student remains in compliance with all obligations under the program agreement. 2. The college student aid commission shall make loan repayments pursuant to a contract entered into on or before June 30, 2025, by a health care professional and the commission under the health care professional recruitment program in section 256.223, Code 2025, if the health care professional remains in compliance with all obligations under the contract.

House File 972, p. 4 3. The college student aid commission shall provide the annual award to a recipient selected on or before June 30, 2025, for an award under the health care award program in section 256.224, Code 2025. 4. The college student aid commission shall make loan repayments pursuant to a program agreement entered into on or before June 30, 2025, by a mental health professional and the commission under the mental health professional loan repayment program in section 256.225, Code 2025, if the mental health professional remains in compliance with all obligations under the program agreement. Sec. 9. TRANSFER OF MONEYS. On the effective date of this division of this Act, any unencumbered and unobligated moneys remaining in the following funds shall be transferred to the health care professional incentive program fund created in section 256.222, as enacted in this Act: 1. The rural Iowa primary care trust fund created in section 256.221, subsection 12, Code 2025. 2. The health care professional recruitment fund created in section 256.223, subsection 4, Code 2025. 3. The health care award fund created in section 256.224, subsection 6, Code 2025. 4. The mental health professional loan repayment fund created in section 256.225, subsection 7, Code 2025. Sec. 10. TRANSITION —— ACCOUNTS. 1. The college student aid commission shall create individual accounts for the deposit of any moneys encumbered or obligated relating to a loan repayment or award funded under each of the following programs: a. The rural Iowa primary care loan repayment program under section 256.221, Code 2025. b. The health care professional recruitment program under section 256.223, Code 2025. c. The health care award program under section 256.224, Code 2025. d. The mental health professional loan repayment program under section 256.225, Code 2025. 2. Notwithstanding section 8.33, any balance in any of the accounts created under subsection 1 shall not revert but

House File 972, p. 5 shall remain available for the duration of all applicable loan repayments and awards. Notwithstanding section 12C.7, subsection 2, interest or earnings on moneys deposited in each account shall be credited to the respective account. 3. Upon expiration of all program agreement, contract, and award disbursement periods and the expenditure of all moneys encumbered and obligated under such program agreements, contracts, and awards, any unencumbered or unobligated moneys remaining in the accounts created under this section shall be deposited in the health care professional incentive program fund created in section 256.222, as enacted by this Act. DIVISION IV HEALTH CARE PROFESSIONAL INCENTIVE PROGRAM ESTABLISHED Sec. 11. NEW SECTION . 256.222 Health care professional incentive program —— fund. 1. Definitions. For purposes of this section, unless the context otherwise requires: a. “Award” means either of the following: (1) A loan repayment made on behalf of an eligible health care professional on the total amount owed, including principal and interest, by the eligible health care professional on any of the following: (a) A federally guaranteed Stafford loan under the federal family education loan program or the federal direct loan program. (b) A federal grad plus loan. (c) A consolidated federally guaranteed Stafford loan under the federal family education loan program or the federal direct loan program. (d) A consolidated federal grad plus loan. (2) An income bonus paid to an eligible health care professional. b. “Commission” means the college student aid commission. c. “Department” means the department of health and human services. d. “Eligible health care profession” means health care occupational categories that are in high demand, as determined and maintained on a list by the department, and may include but are not limited to physicians, physician assistants, registered

House File 972, p. 6 nurses, nurse practitioners, nurse educators, and mental health professionals. e. “Eligible health care professional” means an individual currently employed, or who will be employed, in an eligible health care profession that is located in an eligible practice area. f. “Eligible practice area” means a geographic region or county in this state that has a shortage of health care professionals as determined by the department. g. “Employment obligation” means the number of consecutive years an eligible health care professional must practice. (1) If practicing full-time, which means at least two thousand eighty hours of work in a calendar year, including all paid holidays, vacations, sick time, and other paid leave, an eligible health care professional must practice for five years. (2) If practicing part-time, which means at least one thousand five hundred sixty hours of work in a calendar year, including all paid holidays, vacations, sick time, and other paid leave, an eligible health care professional must practice for seven years. h. “Program” means the health care professional incentive program established in this section. 2. Program established. The health care professional incentive program is established and shall be administered by the commission, in coordination with the department, for the purpose of offering awards to recruit and retain eligible health care professionals for employment in eligible practice areas. For the fiscal year beginning July 1, 2025, and each fiscal year thereafter, the commission, in coordination with the department, shall determine the number of awards available for each eligible health care profession prior to the commencement of the fiscal year. 3. Legislative intent. It is the intent of the general assembly that the program shall not interfere with local community investments to recruit and retain health care professionals. 4. Exceptions. An eligible health care professional shall be ineligible for the program if the eligible health care professional is currently participating in, or has participated

House File 972, p. 7 in, any of the following: a. The primary care provider loan repayment program pursuant to section 135.107, Code 2025. b. The rural Iowa primary care loan repayment program pursuant to section 256.221, Code 2025. c. The health care professional recruitment program pursuant to section 256.223, Code 2025. d. The health care award program pursuant to section 256.224, Code 2025. e. The mental health professional loan repayment program pursuant to section 256.225, Code 2025. 5. Program requirements. a. An eligible health care professional may submit an application for the program to the commission in the form and manner prescribed by the commission. The applicant shall elect to receive an award as either a loan repayment or an income bonus if selected for the program, and shall submit any additional information requested by the commission. b. The commission shall give priority to an applicant fulfilling a full-time employment obligation. c. If selected for an award, the eligible health care professional and the commission shall execute a program agreement that specifies all of the following: (1) The date the eligible health care professional’s employment obligation begins, which shall be no later than six months from the date the program agreement is executed. (2) The date the health care professional’s employment obligation terminates. (3) Whether the award is a loan repayment or an income bonus, and the terms and conditions related to the award, including the aggregate award amount that the eligible health care professional will receive. (4) Requirements regarding the eligible health care professional’s license to practice in this state while participating in the program. (5) All other terms and conditions agreed to by the eligible health care professional and the commission. 6. Awards. a. Upon verifying the eligible health care professional is

House File 972, p. 8 in compliance with all terms of the program agreement executed pursuant to subsection 5, paragraph “c” , the commission shall pay the eligible health care professional’s award annually as follows: (1) For a full-time employment obligation, the award shall be paid as follows: (a) An amount equal to twenty percent of the aggregate award shall be paid to the eligible health care professional after the completion of the first year of the eligible health care professional’s employment obligation. (b) An amount equal to fifteen percent of the aggregate award shall be paid to the eligible health care professional after the completion of the second year, the third year, and the fourth year of the eligible health care professional’s employment obligation. (c) An amount equal to thirty-five percent of the aggregate award shall be paid to the eligible health care professional after the completion of the fifth year of the eligible health care professional’s employment obligation. (2) For a part-time employment obligation, the aggregate award shall be prorated by the commission. b. A minimum of every five years, the commission, in consultation with the department, shall establish a list of eligible health care professions and the aggregate award amount for each eligible health care profession. The aggregate award amount shall not exceed two hundred thousand dollars. c. An individual who executed a program agreement under subsection 5, paragraph “c” , prior to the exclusion of the individual’s health care profession from the list established under paragraph “b” shall remain eligible for the program per the terms of the individual’s program agreement. 7. Health care professional incentive program fund. A health care professional incentive program fund is created in the state treasury under the control of the commission. All moneys deposited or paid into the fund are appropriated to the commission to be used for awards as provided in this section. Notwithstanding section 8.33, moneys in the fund that remain unencumbered or unobligated at the close of each fiscal year shall not revert but shall remain available for expenditure.

House File 972, p. 9 Notwithstanding section 12C.7, subsection 2, interest or earnings on moneys in the fund shall be credited to the fund and may be utilized by the commission for administrative costs. 8. Rules. The commission, in coordination with the department, shall adopt rules pursuant to chapter 17A to administer this section. Sec. 12. EFFECTIVE DATE. This division of this Act, being deemed of immediate importance, takes effect upon enactment. DIVISION V GRADUATE MEDICAL EDUCATION —— MEDICAID SUPPLEMENTAL ENHANCED PAYMENT Sec. 13. GRADUATE MEDICAL EDUCATION —— MEDICAID SUPPLEMENTAL ENHANCED PAYMENT. The department of health and human services shall submit to the centers for Medicare and Medicaid services of the United States department of health and human services a request for approval for a Medicaid supplemental enhanced payment for the purposes of maximizing federal funding opportunities for graduate medical education, and to increase the number of medical residencies in the state. Upon receipt of federal approval, the department of health and human services shall notify the general assembly and the Code editor. Sec. 14. EFFECTIVE DATE. This division of this Act, being deemed of immediate importance, takes effect upon enactment. DIVISION VI ELIMINATION OF HEALTH CARE-RELATED GRANT, RESIDENCY, AND FELLOWSHIP PROGRAMS —— DEPARTMENT OF HEALTH AND HUMAN SERVICES Sec. 15. Section 135.179, subsection 2, Code 2025, is amended to read as follows: 2. Funding for the program may be provided through the health care workforce shortage fund or the fulfilling Iowa’s need for dentists matching grant program account created in section 135.175 . The purpose of the program is to establish, expand, or support the placement of dentists in dental or rural shortage areas across the state by providing education loan repayments. Sec. 16. Section 249M.4, subsection 2, Code 2025, is amended to read as follows: 2. Moneys in the trust fund shall be used, subject to

House File 972, p. 10 their appropriation by the general assembly, by the department to reimburse participating hospitals the medical assistance program upper payment limit for inpatient and outpatient hospital services as calculated in this section . Following payment of such upper payment limit to participating hospitals, any remaining funds in the trust fund on an annual basis may be used for any of the following purposes: a. To support medical assistance program utilization shortfalls. b. To maintain the state’s capacity to provide access to and delivery of services for vulnerable Iowans. c. To fund the health care workforce support initiative created pursuant to section 135.175 . d. c. To support access to health care services for uninsured Iowans. e. d. To support Iowa hospital programs and services which expand access to health care services for Iowans. Sec. 17. REPEAL. Sections 135.175, 135.176, 135.178, and 135.193, Code 2025, are repealed. Sec. 18. TRANSITION PROVISIONS. 1. a. The department of health and human services shall provide matching state funding to a sponsor awarded on or before June 30, 2025, under the medical residency training state matching grants program in section 135.176, Code 2025, until all residents in the funded residencies have completed or left the program. b. The department of health and human services shall provide matching state funding to a sponsor for medical residency training program liability costs awarded on or before June 30, 2025, under the medical residency training state matching grants program in section 135.176, Code 2025, until June 30, 2026. 2. The department of health and human services shall provide matching state funding to a sponsor awarded on or before June 30, 2025, under the nurse residency state matching grants program in section 135.178, Code 2025, until all residents have completed or left the nurse residency programs. 3. The department of health and human services shall fund a fellowship position pursuant to a program agreement entered

House File 972, p. 11 into on or before June 30, 2025, by a participating teaching hospital and a participating fellow under the state-funded family medicine obstetrics fellowship program in section 135.193, Code 2025, if the participating fellow remains in compliance with all obligations under the program agreement. 4. The department of health and human services shall fund a rural psychiatric residency for a resident selected on or before June 30, 2025, until all residents have completed or left the rural psychiatric residencies, pursuant to appropriations as provided in the following: a. 2024 Iowa Acts, chapter 1157, section 5, subsection 3, and 2024 Iowa Acts, chapter 1157, section 22, subsection 5. b. 2023 Iowa Acts, chapter 112, section 5, subsection 4, paragraph “j”, as amended by 2024 Iowa Acts, chapter 1157, section 29. c. 2022 Iowa Acts, chapter 1131, section 3, subsection 4, paragraph “j”, as amended by 2024 Iowa Acts, chapter 1157, section 23. d. 2021 Iowa Acts, chapter 182, section 3, subsection 4, paragraph “j”. e. 2019 Iowa Acts, chapter 85, section 3, subsection 4, paragraph “j”, as amended by 2020 Iowa Acts, chapter 1121, section 19. Sec. 19. TRANSFER OF MONEYS. Notwithstanding section 8.33 or any other provision to the contrary, any unobligated or unencumbered moneys in any of the following accounts or funds or constituting any specified appropriation, shall not revert but are appropriated to the department of health and human services to fund Medicaid graduate medical education efforts. 1. The health care workforce shortage fund created in section 135.175, subsection 1, paragraph “b”, Code 2025. 2. The medical residency training account created in section 135.175, subsection 5, paragraph “a”, Code 2025. 3. The nurse residency state matching grants program account created in section 135.175, subsection 5, paragraph “b”, Code 2025. 4. The health care workforce shortage national initiatives account created in section 135.175, subsection 5, paragraph “c”, Code 2025.

House File 972, p. 12 5. The family medicine obstetrics fellowship program fund created in section 135.193, Code 2025. 6. Moneys appropriated to the department of health and human services for rural psychiatric residencies to fund psychiatric residents to provide mental health services in underserved areas of the state as described in the following: a. 2024 Iowa Acts, chapter 1157, section 5, subsection 3, and 2024 Iowa Acts, chapter 1157, section 22, subsection 5. b. 2023 Iowa Acts, chapter 112, section 5, subsection 4, paragraph “j”, as amended by 2024 Iowa Acts, chapter 1157, section 29. c. 2022 Iowa Acts, chapter 1131, section 3, subsection 4, paragraph “j”, as amended by 2024 Iowa Acts, chapter 1157, section 23. d. 2021 Iowa Acts, chapter 182, section 3, subsection 4, paragraph “j”. e. 2019 Iowa Acts, chapter 85, section 3, subsection 4, paragraph “j”, as amended by 2020 Iowa Acts, chapter 1121, section 19. Sec. 20. TRANSITION —— ACCOUNTS. 1. The department of health and human services shall create individual accounts for the deposit of any moneys encumbered or obligated relating to a grant awarded, or residency or fellowship funded, under each of the following programs: a. The medical residency training state matching grants program under section 135.176, Code 2025. b. The nurse residency state matching grants program under section 135.178, Code 2025. c. The state-funded family medicine obstetrics fellowship program under section 135.193, Code 2025. d. Rural psychiatric residencies as described in the following: (1) 2024 Iowa Acts, chapter 1157, section 5, subsection 3, and 2024 Iowa Acts, chapter 1157, section 22, subsection 5. (2) 2023 Iowa Acts, chapter 112, section 5, subsection 4, paragraph “j”, as amended by 2024 Iowa Acts, chapter 1157, section 29. (3) 2022 Iowa Acts, chapter 1131, section 3, subsection 4, paragraph “j”, as amended by 2024 Iowa Acts, chapter 1157,

House File 972, p. 13 section 23. (4) 2021 Iowa Acts, chapter 182, section 3, subsection 4, paragraph “j”. (5) 2019 Iowa Acts, chapter 85, section 3, subsection 4, paragraph “j”, as amended by 2020 Iowa Acts, chapter 1121, section 19. 2. Notwithstanding section 8.33, any balance in any of the accounts created under subsection 1 shall not revert but shall remain available for the duration of all applicable grants, residencies, and fellowships. Notwithstanding section 12C.7, subsection 2, interest or earnings on moneys deposited in each account shall be credited to the respective account. 3. Upon expiration of all grant, residency, and fellowship periods and the expenditure of all moneys encumbered under such grants, residencies, and fellowships, any unencumbered or unobligated moneys remaining in any of the accounts created under subsection 1 are appropriated to the department of health and human services for Medicaid graduate medical education efforts. Sec. 21. CONTINGENT EFFECTIVE DATE. This division of this Act takes effect upon the date that the department of health and human services notifies the general assembly and the Code editor of the receipt of federal approval for a Medicaid supplemental enhanced payment for the purposes of maximizing federal funding opportunities for graduate medical education, and to increase the number of medical residencies in the state. DIVISION VII ELIMINATION OF THE STATE-FUNDED PSYCHIATRY RESIDENCY AND FELLOWSHIP POSITIONS —— UNIVERSITY OF IOWA HOSPITALS AND CLINICS Sec. 22. REPEAL. Section 135.180, Code 2025, is repealed. Sec. 23. TRANSITION PROVISIONS. The board of regents shall direct the university of Iowa hospitals and clinics to distribute moneys for state-funded psychiatry residency and fellowship positions approved and awarded on or before June 30, 2025, under the state-funded psychiatry residency and fellowship positions in section 135.180, Code 2025, until all residents and fellows have completed or left the state-funded psychiatry residency or fellowship positions.

House File 972, p. 14 Sec. 24. TRANSITION —— ACCOUNT. 1. The board of regents shall direct the university of Iowa hospitals and clinics to create an account for the deposit of moneys encumbered or obligated relating to residency and fellowship positions funded under the state-funded psychiatry residency and fellowship positions under section 135.180, Code 2025. 2. Notwithstanding section 8.33, any balance in the account created under subsection 1 shall not revert but shall remain available for the duration of all applicable residencies and fellowships. Notwithstanding section 12C.7, subsection 2, interest or earnings on moneys deposited in the account shall be credited to the account. 3. Upon expiration of all residency and fellowship periods and the expenditure of all moneys encumbered under such residencies and fellowships, any unencumbered or unobligated moneys remaining in the account created under subsection 1 are appropriated to the department of health and human services for Medicaid graduate medical education efforts. Sec. 25. TRANSFER OF MONEYS. Notwithstanding section 8.33 or any other provision to the contrary, any unobligated or unencumbered moneys in the psychiatry residency and fellowship positions fund created in section 135.180, Code 2025, shall not revert but are appropriated to the department of health and human services to fund Medicaid graduate medical education efforts. Sec. 26. CONTINGENT EFFECTIVE DATE. This division of this Act takes effect upon the date that the department of health and human services notifies the general assembly and the Code editor of the receipt of federal approval for a Medicaid supplemental enhanced payment for the purposes of maximizing federal funding opportunities for graduate medical education, and to increase the number of medical residencies in the state. DIVISION VIII ELIMINATION OF THE HEALTH FACILITIES COUNCIL Sec. 27. Section 10A.711, subsection 5, Code 2025, is amended by striking the subsection and inserting in lieu thereof the following: 5. “Department” means the department of health and human

House File 972, p. 15 services. Sec. 28. Section 10A.713, subsection 4, unnumbered paragraph 1, Code 2025, is amended to read as follows: A copy of the application shall be sent to the department of health and human services at the time the application is submitted to the department. The department shall not process applications for and the council shall not an intermediate care facility for persons with an intellectual disability, or consider a new or changed institutional health service for an intermediate care facility for persons with an intellectual disability , unless both of the following conditions are met: Sec. 29. Section 10A.714, subsection 1, unnumbered paragraph 1, Code 2025, is amended to read as follows: In determining whether a certificate of need shall be issued, the department and council shall consider the following: Sec. 30. Section 10A.714, subsection 1, paragraph r, Code 2025, is amended to read as follows: r. The recommendations of staff personnel of the department assigned to the area of certificate of need, concerning the application , if requested by the council . Sec. 31. Section 10A.714, subsection 2, unnumbered paragraph 1, Code 2025, is amended to read as follows: In addition to the findings required with respect to any of the criteria listed in subsection 1 of this section , the council department shall grant a certificate of need for a new institutional health service or changed institutional health service only if it the department finds in writing, on the basis of data submitted to it by the department , that: Sec. 32. Section 10A.716, subsection 3, Code 2025, is amended to read as follows: 3. Each application accepted by the department shall be formally reviewed for the purpose of furnishing to the council the information necessary to enable it the department to determine whether or not to grant the certificate of need. A formal review shall consist , at a minimum , of the following steps: a. Evaluation of the application against the criteria specified in section 10A.714 135.63 .

House File 972, p. 16 b. A public hearing on the application, to be held prior to completion of the evaluation required by paragraph “a” , shall be conducted by the council . Sec. 33. Section 10A.719, Code 2025, is amended to read as follows: 10A.719 Council Department to make final decision. 1. The department shall complete its formal review of the application within ninety days after acceptance of the application, except as otherwise provided by section 10A.722 135.71 , subsection 4 . Upon completion of the formal review, the council department shall approve or deny the application. The council department shall issue written findings stating the basis for its decision on the application , and the department shall send copies of the council’s decision and the written findings supporting the decision to the applicant and to any other person who so requests. 2. Failure by the council department to issue a written decision on an application for a certificate of need within the time required by this section shall constitute denial of and final administrative action on the application. Sec. 34. Section 10A.720, Code 2025, is amended to read as follows: 10A.720 Appeal of certificate of need decisions. The council’s department’s decision on an application for certificate of need, when announced pursuant to section 10A.719 135.68 , is shall be a final decision. Any dissatisfied party who is an affected person with respect to the application, and who participated or sought unsuccessfully to participate in the formal review procedure prescribed by section 10A.716 135.65 , may request a rehearing in accordance with chapter 17A and rules of the department. If a rehearing is not requested or an affected party remains dissatisfied after the request for rehearing, an appeal may be taken in the manner provided by chapter 17A . Notwithstanding the Iowa administrative procedure Act, chapter 17A , a request for rehearing is not required , prior to appeal under section 17A.19 . Sec. 35. Section 10A.721, Code 2025, is amended to read as follows: 10A.721 Period for which certificate is valid —— extension

House File 972, p. 17 or revocation. 1. A certificate of need shall be valid for a maximum of one year from the date of issuance. Upon the expiration of the certificate, or at any earlier time while the certificate is valid , the holder thereof of the certificate shall provide the department such information on the development of the project covered by the certificate as the department may request. The council department shall determine at the end of the certification period whether sufficient progress is being made on the development of the project. The certificate of need may be extended by the council department for additional periods of time as are reasonably necessary to expeditiously complete the project, but may be revoked by the council department at the end of the first or any subsequent certification period for insufficient progress in developing the project. 2. Upon expiration of a certificate of need, and prior to extension thereof of the certificate of need , any affected person shall have the right to submit to the department information which may be relevant to the question of granting an extension. The department may call a public hearing for this purpose. Sec. 36. Section 10A.722, unnumbered paragraph 1, Code 2025, is amended to read as follows: The department shall adopt , with approval of the council, such administrative rules as are necessary to enable it to implement this part subchapter . These rules shall include: Sec. 37. Section 10A.723, subsection 2, paragraph a, Code 2025, is amended to read as follows: a. A class I violation is one in which a party offers a new institutional health service or changed institutional health service modernization or acquisition without review and approval by the council department . A party in violation is subject to a penalty of three hundred dollars for each day of a class I violation. The department may seek injunctive relief which shall include restraining the commission or continuance of an act which would violate the provisions of this paragraph. Notice and opportunity to be heard shall be provided to a party pursuant to rule of civil procedure 1.1507 and contested case procedures in accordance with chapter 17A . The department may

House File 972, p. 18 reduce, alter, or waive a penalty upon the party showing good faith compliance with the department’s request to immediately cease and desist from conduct in violation of this section . Sec. 38. Section 68B.35, subsection 2, paragraph e, Code 2025, is amended to read as follows: e. Members of the state banking council, the Iowa ethics and campaign disclosure board, the credit union review board, the economic development authority, the employment appeal board, the environmental protection commission, the health facilities council, the Iowa finance authority, the Iowa public employees’ retirement system investment board, the Iowa lottery commission created in section 99G.8 , the natural resource commission, the board of parole, the state racing and gaming commission, the state board of regents, the transportation commission, the office of consumer advocate, the utilities commission, the Iowa telecommunications and technology commission, and any full-time members of other boards and commissions as defined under section 7E.4 who receive an annual salary for their service on the board or commission. The Iowa ethics and campaign disclosure board shall conduct an annual review to determine if members of any other board, commission, or authority should file a statement and shall require the filing of a statement pursuant to rules adopted pursuant to chapter 17A . Sec. 39. Section 97B.1A, subsection 8, paragraph a, subparagraph (8), Code 2025, is amended to read as follows: (8) Members of the state transportation commission , and the board of parole , and the state health facilities council . Sec. 40. CODE EDITOR DIRECTIVE. 1. The Code editor is directed to make the following transfers: a. Section 10A.711 to section 135.61. b. Section 10A.713 to section 135.62. c. Section 10A.714 to section 135.63. d. Section 10A.715 to section 135.64. e. Section 10A.716 to section 135.65. f. Section 10A.717 to section 135.66. g. Section 10A.718 to section 135.67. h. Section 10A.719 to section 135.68. i. Section 10A.720 to section 135.69.

House File 972, p. 19 j. Section 10A.721 to section 135.70. k. Section 10A.722 to section 135.71. l. Section 10A.723 to section 135.72. m. Section 10A.724 to section 135.73. n. Section 10A.725 to section 135.74. o. Section 10A.726 to section 135.75. p. Section 10A.727 to section 135.76. q. Section 10A.728 to section 135.77. r. Section 10A.729 to section 135.78. 2. The Code editor is directed to rename and retitle subchapter VI of chapter 135 as HEALTH FACILITIES and include sections 135.61 through 135.78. 3. The Code editor shall correct internal references in the Code and in any enacted legislation as is necessary due to the enactment of this division. Sec. 41. REPEAL. Section 10A.712, Code 2025, is repealed. DIVISION IX CONFORMING CHANGES —— ELIMINATION OF THE HEALTH FACILITIES COUNCIL Sec. 42. Section 10A.711, unnumbered paragraph 1, Code 2025, is amended to read as follows: As used in this part subchapter , unless the context otherwise requires: Sec. 43. Section 10A.711, subsection 1, paragraph d, Code 2025, is amended to read as follows: d. Each institutional health facility or health maintenance organization which, prior to receipt of the application by the department, has formally indicated to the department pursuant to this part subchapter an intent to furnish in the future institutional health services similar to the new institutional health service proposed in the application. Sec. 44. Section 10A.713, subsection 1, Code 2025, 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 part subchapter . The application shall be made upon forms furnished or prescribed by the department and shall contain