H.F. 2133 Section 1. Section 135.61, subsection 21, Code 2009, is 1 amended to read as follows: 2 21. “Outpatient surgical facility” means a all of the 3 following: 4 a. A facility which as its primary function provides, 5 through an organized medical staff and on an outpatient basis 6 to patients who are generally ambulatory, surgical procedures 7 not ordinarily performed in a private physician’s office, but 8 not requiring twenty-four hour hospitalization, and which is 9 neither not a part of a hospital nor is owned wholly or in part 10 by a hospital, nor is it the private office of a health care 11 provider who there engages in the lawful practice of surgery. 12 “Outpatient surgical facility” includes a 13 b. A facility certified or seeking certification as an 14 ambulatory surgical center, under the federal Medicare program 15 or under the medical assistance program established pursuant to 16 chapter 249A. 17 c. A facility that provides for the performing or inducing 18 of any second or third trimester abortions or five or more 19 first trimester abortions per month. 20 Sec. 2. NEW SECTION . 135P.1 Definitions. 21 As used in this chapter, unless the context otherwise 22 requires: 23 1. “Ambulatory surgical center” means an outpatient surgical 24 facility as defined in section 135.61 or an ambulatory surgical 25 facility as defined in section 514.5. 26 2. “Department” means the department of inspections and 27 appeals. 28 Sec. 3. NEW SECTION . 135P.2 Licenses —— fees —— criteria. 29 1. A person shall not operate an ambulatory surgical center 30 in this state without first obtaining a license from the 31 department after meeting the requirements of this chapter. The 32 application shall be on a form prescribed by the department and 33 shall require information the department deems necessary. Each 34 application for license shall be accompanied by a nonrefundable 35 -1- LSB 5687YH (1) 83 pf/nh 1/ 4

H.F. 2133 biennial license fee determined by the department. 1 2. The ambulatory surgical center shall meet the 2 requirements of 42 C.F.R. § 416 before a license is issued. 3 The department of inspections and appeals shall provide the 4 necessary personnel to inspect the ambulatory surgical center 5 to determine if the ambulatory surgical center complies with 6 necessary requirements before a license is issued. Ambulatory 7 surgical centers that are certified under the federal Medicare 8 program and thereby meet the requirements of 42 C.F.R. § 416 9 shall be licensed without inspection by the department of 10 inspections and appeals. 11 Sec. 4. NEW SECTION . 135P.3 Denial, suspension, or 12 revocation of license. 13 The department may deny, suspend, or revoke a license if 14 the department determines an ambulatory surgical center fails 15 to comply with this chapter or the rules adopted under this 16 chapter. A denial, suspension, or revocation may be appealed 17 under chapter 17A. The department may reissue a license 18 following a suspension or revocation after the ambulatory 19 surgical center corrects the conditions upon which the 20 suspension or revocation was based. 21 Sec. 5. NEW SECTION . 135P.4 Limitation, expiration, and 22 renewal of license. 23 A license for an ambulatory surgical center shall be issued 24 only for the premises, person, or facility named in the 25 application and is not transferable or assignable. A license, 26 unless sooner suspended or revoked, shall expire two years 27 after the date of issuance and shall be renewed biennially 28 upon an application by the licensee. Application for renewal 29 shall be made in writing to the department at least thirty days 30 prior to the expiration of the license. The fee for a license 31 renewal shall be determined by the department. 32 Sec. 6. NEW SECTION . 135P.5 Rules. 33 Except as otherwise provided in this chapter, the department 34 shall adopt rules pursuant to chapter 17A necessary to 35 -2- LSB 5687YH (1) 83 pf/nh 2/ 4

H.F. 2133 implement this chapter, subject to approval of the state board 1 of health. Formulation of the rules shall include consultation 2 with persons affected by this chapter. 3 Sec. 7. Section 514.5, Code 2009, is amended to read as 4 follows: 5 514.5 Contracts for service. 6 1. A hospital service corporation organized under 7 chapter 504, Code 1989, or current chapter 504 may enter 8 into contracts for the rendering of hospital service to any 9 of its subscribers with hospitals maintained and operated by 10 the state or any of its political subdivisions, or by any 11 corporation, association, or individual. Such hospital service 12 corporation may also contract with an ambulatory surgical 13 facility to provide surgical services to the corporation’s 14 subscribers. Hospital service is meant to include bed and 15 board, general nursing care, use of the operating room, use of 16 the delivery room, ordinary medications and dressings and other 17 customary routine care. “Ambulatory surgical facility” means 18 a facility constructed and operated for the specific purpose 19 of providing surgery to patients admitted to and discharged 20 from the facility within the same day or an “outpatient surgical 21 facility” as defined in section 135.61 . 22 2. A medical service corporation organized under this 23 chapter may enter into contracts with subscribers to furnish 24 health care service through physicians and surgeons, dentists, 25 podiatric physicians, osteopathic physicians, osteopathic 26 physicians and surgeons, or chiropractors. 27 3. Any pharmaceutical or optometric service corporation 28 organized under the provisions of said chapter may enter 29 into contracts for the rendering of pharmaceutical or 30 optometric service to any of its subscribers. Membership in 31 any pharmaceutical service corporation shall be open to all 32 pharmacies licensed under chapter 155A. 33 4. A hospital service corporation or medical service 34 corporation organized under this chapter may enter into 35 -3- LSB 5687YH (1) 83 pf/nh 3/ 4

H.F. 2133 contracts with subscribers and providers to furnish health care 1 services not otherwise allocated by this section. 2 EXPLANATION 3 This bill defines an outpatient surgical facility or 4 ambulatory surgical center to include any facility that 5 provides for performing or inducing any second or third 6 trimester abortions or five or more first trimester abortions 7 per month, thereby making these establishments subject 8 to certificate of need requirements and other regulatory 9 provisions to which outpatient surgical facilities or 10 ambulatory surgical centers are subject. The bill also amends 11 the definition of an outpatient surgical facility to exclude 12 facilities that are owned wholly or in part by a hospital. 13 The bill also requires that ambulatory surgical centers be 14 licensed and meet the requirements of the centers for Medicare 15 and Medicaid services of the United States department of health 16 and human services for ambulatory surgical centers. 17 -4- LSB 5687YH (1) 83 pf/nh 4/ 4