H.F. 2129 Section 1. NEW SECTION . 147A.30 Definitions. 1 As used in this subchapter, unless the context otherwise 2 requires: 3 1. “Categorization” means a determination by the department 4 that a hospital is capable of acting as a level 1, level 2, 5 or level 3 stroke center in accordance with criteria adopted 6 pursuant to chapter 17A for level 1, level 2, or level 3 stroke 7 care capabilities. 8 2. “Department” means the department of public health. 9 3. “Hospital” means a facility licensed under chapter 135B. 10 4. “Stroke center” means a hospital which provides stroke 11 care and has been verified by the department as having level 1, 12 level 2, or level 3 care capabilities and issued a certificate 13 of verification pursuant to this subchapter. 14 5. “Stroke triage system” means an organized approach to 15 providing personnel, facilities, and equipment for effective 16 and coordinated stroke care. 17 6. “Verification” means a formal process by which the 18 department certifies a hospital to provide stroke care in 19 accordance with criteria established for a level 1, level 2, or 20 level 3 stroke center. 21 Sec. 2. NEW SECTION . 147A.31 Stroke triage plan and system 22 development. 23 1. The department is designated as the lead agency in this 24 state responsible for the development of a statewide stroke 25 triage system. 26 2. The department, in consultation with the EMS advisory 27 council, shall develop, coordinate, and monitor a statewide 28 stroke triage plan and system. 29 a. The plan shall provide for a statewide prehospital 30 and interhospital stroke triage strategy to promote rapid 31 access for stroke patients to appropriate organized stroke 32 care through publication and regular updating of information 33 on resources for stroke care, and publication of generally 34 accepted criteria for stroke triage and appropriate transfer. 35 -1- LSB 5740HH (7) 83 pf/nh 1/ 4

H.F. 2129 b. The system shall include but is not limited to the 1 following: 2 (1) The categorization of all hospitals as stroke centers 3 by the department in accordance with their capacity to provide 4 stroke care. 5 (2) The issuance of a certificate of verification for 6 each categorized hospital from the department at the level 7 demonstrated by the hospital. The standards and verification 8 process shall be established by rule and may vary as 9 appropriate by level of stroke care capability. To the extent 10 possible, the standards and verification process shall be 11 coordinated with other applicable accreditation and licensing 12 standards. 13 (3) Upon verification and the issuance of a certificate of 14 verification, a hospital shall agree to maintain a level of 15 commitment and resources sufficient to meet responsibilities 16 and standards as required by the stroke care criteria 17 established by rule under this subchapter. Verifications are 18 valid for a period of three years or as determined by the 19 department and are renewable. As part of the verification and 20 renewal process, the department may conduct periodic on-site 21 reviews of the services and facilities of the hospital. 22 Sec. 3. NEW SECTION . 147A.32 Statewide stroke registry. 23 1. The department shall maintain a statewide stroke 24 registry to compile information and statistics on stroke care 25 including prevalence, mortality, and performance metrics for 26 acute stroke patients. The purposes of the statewide stroke 27 registry are to monitor, evaluate, and provide guidance to 28 health care quality improvement efforts for the education, 29 diagnosis, and treatment of acute stroke; to facilitate the 30 implementation of quality of stroke care improvements in Iowa 31 hospitals; and to track the progress of Iowa hospitals in 32 meeting national benchmarks for stroke care. 33 2. The data collected by and furnished to the department 34 pursuant to this section are confidential records of the 35 -2- LSB 5740HH (7) 83 pf/nh 2/ 4

H.F. 2129 condition, diagnosis, care, or treatment of patients or former 1 patients, including outpatients, pursuant to section 22.7, 2 subsection 2. Compilations of information prepared for release 3 or dissemination from the data collected are not confidential 4 under section 22.7, subsection 2. However, information which 5 individually identifies patients shall not be disclosed and 6 state and federal law regarding patient confidentiality shall 7 apply. 8 3. To the extent possible, activities under this section 9 shall be coordinated with other health data collection methods. 10 Sec. 4. NEW SECTION . 147A.33 Adoption of rules. 11 The department shall adopt rules to implement the stroke 12 triage system and statewide stroke registry under this 13 subchapter. The rules shall include designating stroke as a 14 reportable disease pursuant to chapter 139A. 15 Sec. 5. DIRECTIVE TO CODE EDITOR. The Code editor shall 16 codify sections 147A.30, 147A.31, 147A.32, and 147A.33, as 17 enacted in this Act, in a new subchapter in chapter 147A 18 entitled the “stroke triage plan and system”. 19 EXPLANATION 20 This bill creates a new subchapter in Code chapter 147A 21 relating to the establishment by the department of public 22 health (DPH) of a stroke triage plan and system. The 23 department is designated as the lead agency responsible 24 for the development of a statewide stroke triage plan and 25 system. The plan is to provide for a statewide prehospital 26 and interhospital stroke triage strategy to promote rapid 27 access for stroke patients to appropriate organized stroke 28 care. The system is to include the categorization of all 29 hospitals as stroke centers by the department in accordance 30 with their capacity to provide stroke care, certification of 31 verification of all categorized hospitals by the department 32 at the level demonstrated by the hospital; and, upon issuance 33 of a certificate of verification, agreement of a hospital to 34 maintain a level of commitment and resources sufficient to meet 35 -3- LSB 5740HH (7) 83 pf/nh 3/ 4

H.F. 2129 responsibilities and standards as required by the stroke care 1 criteria. 2 The bill also directs DPH to maintain a statewide stroke 3 registry to compile information and statistics on stroke care 4 including prevalence, mortality, and performance metrics for 5 acute stroke patients. The purposes of the statewide stroke 6 registry are to monitor, evaluate, and provide guidance to 7 health care quality improvement efforts for the education, 8 diagnosis, and treatment of acute stroke; to facilitate the 9 implementation of quality of stroke care improvements in Iowa 10 hospitals; and to track the progress of Iowa hospitals in 11 meeting national benchmarks for stroke care. 12 The bill directs DPH to adopt rules to implement the stroke 13 triage plan and system and the statewide stroke registry. The 14 rules shall include designating stroke as a reportable disease 15 pursuant to Code chapter 139A. 16 -4- LSB 5740HH (7) 83 pf/nh 4/ 4