S.F. _____ Section 1. Section 135C.33, subsection 5, paragraph a, Code 1 2011, is amended by adding the following new subparagraph: 2 NEW SUBPARAGRAPH . (6) An employee of an ambulatory surgical 3 center licensed under chapter 135P. 4 Sec. 2. NEW SECTION . 135P.1 Definitions. 5 1. “Ambulatory surgical center” means any distinct facility 6 that operates exclusively for the purpose of providing surgical 7 services to patients not requiring hospitalization and in which 8 the expected duration of services would not exceed twenty-four 9 hours following an admission. 10 2. “Department” means the department of inspections and 11 appeals. 12 3. “Governmental unit” means the state, or any county, 13 municipality, or other political subdivision, or any 14 department, division, board, or other agency of any of the 15 foregoing. 16 Sec. 3. NEW SECTION . 135P.2 Purpose. 17 The purpose of this chapter is to protect the public 18 health, safety, and welfare by providing for the development, 19 establishment, and enforcement of basic standards for the 20 operation, construction, and maintenance of ambulatory surgical 21 centers. 22 Sec. 4. NEW SECTION . 135P.3 Licensure. 23 No person or governmental unit, acting severally or jointly 24 with any other person or governmental unit, shall establish, 25 operate, or maintain an ambulatory surgical center in this 26 state without obtaining a license as provided under this 27 chapter. 28 Sec. 5. NEW SECTION . 135P.4 Application for license —— fee. 29 An ambulatory surgical center license shall be obtained from 30 the department. Applications for a license shall be upon such 31 forms and shall include such information as the department may 32 reasonably require, which may include affirmative evidence 33 of compliance with this chapter, other statutes, and rules 34 as may be applicable. Each application for license shall be 35 -1- LSB 5348XC (6) 84 ad/nh 1/ 8

S.F. _____ accompanied by the required license fee which shall be credited 1 to the general fund of the state. The initial and annual 2 license fee shall be five hundred dollars. 3 Sec. 6. NEW SECTION . 135P.5 Issuance and renewal of 4 license. 5 1. Upon receipt of an application for license and the 6 license fee, the department shall issue a license if the 7 applicant and the ambulatory surgical center comply with this 8 chapter and the rules of the department. The department shall 9 renew a license upon payment of the five hundred dollar annual 10 license fee and filing of an application form available from 11 the department. 12 2. A license shall be either general or restricted in form. 13 A license shall be issued only for the premises and persons 14 or governmental units named in the application and is not 15 transferable or assignable except with the written approval of 16 the department. A license shall be posted in a conspicuous 17 place on the licensed premises as prescribed by rule of the 18 department. 19 Sec. 7. NEW SECTION . 135P.6 Denial, suspension, or 20 revocation of license —— hearings and review. 21 1. The department may deny, suspend, or revoke a license 22 in any case where it finds that there has been a substantial 23 failure to comply with this chapter or the rules or minimum 24 standards adopted pursuant to this chapter. 25 2. The procedure governing notice and hearing to deny 26 an application or suspend or revoke a license shall be in 27 accordance with the rules adopted by the department. A full 28 and complete record shall be kept of the proceedings and of 29 any testimony. The record of any proceeding pursuant to this 30 section need not be transcribed unless judicial review is 31 sought. A copy or copies of the transcript may be obtained by 32 an interested party on payment of the cost of preparing the 33 copy or copies. 34 Sec. 8. NEW SECTION . 135P.7 Rules. 35 -2- LSB 5348XC (6) 84 ad/nh 2/ 8

S.F. _____ 1. The department shall adopt rules setting out the 1 standards for ambulatory surgical centers to be licensed under 2 this chapter. The rules shall state, at a minimum, that an 3 ambulatory surgical center shall meet the federal requirements 4 for conditions of participation in the federal Medicare program 5 for ambulatory surgical centers under 42 C.F.R. pt. 416. 6 2. The department shall adopt rules to govern the notice 7 and hearing procedure when a license is denied, suspended, or 8 revoked. 9 3. The rules shall require ambulatory surgical centers 10 to report ambulatory data to the department of public health 11 or the designated intermediary for the purpose of public 12 dissemination of health data as initially authorized in 1996 13 Iowa Acts, chapter 1212, section 5, subsection 1, paragraph “a” , 14 subparagraph (4). 15 4. An ambulatory surgical center which is in operation at 16 the time of promulgation of any applicable rules or minimum 17 standards under this chapter shall be given a reasonable time, 18 not to exceed one year from the date of promulgation, within 19 which to comply with such rules and minimum standards. 20 5. The department shall enforce the rules. 21 Sec. 9. NEW SECTION . 135P.8 Inspections. 22 1. The department shall make or cause to be made inspections 23 or complaint investigations of ambulatory surgical centers as 24 the department deems necessary in order to determine compliance 25 with this chapter and applicable rules. 26 2. A department inspector shall not participate in an 27 inspection or complaint investigation of an ambulatory surgical 28 center in which the inspector or a member of the inspector’s 29 immediate family works or has worked within the last two years 30 or in which the inspector or the inspector’s immediate family 31 has a financial ownership interest. For the purposes of this 32 section, “immediate family member” means a spouse, natural or 33 adoptive parent or grandparent, child, grandchild, sibling, 34 stepparent, stepchild, or stepsibling. 35 -3- LSB 5348XC (6) 84 ad/nh 3/ 8

S.F. _____ Sec. 10. NEW SECTION . 135P.9 Employee background checks. 1 1. An ambulatory surgical center shall comply with child or 2 dependent adult abuse information and criminal record checks 3 and evaluations as provided in section 135C.33. 4 2. An ambulatory surgical center licensed in this state 5 may access the single contact repository established by the 6 department pursuant to section 135C.33 as necessary for the 7 ambulatory surgical center to perform record checks of persons 8 employed or being considered for employment by the ambulatory 9 surgical center. 10 Sec. 11. NEW SECTION . 135P.10 Confidentiality. 11 The department’s final inspection or investigation findings 12 or the final survey findings of an accrediting body, authorized 13 by the department in rule, with respect to compliance by an 14 ambulatory surgical center with requirements for licensing 15 or accreditation shall be made available to the public in a 16 readily available form and place. Other information relating 17 to an ambulatory surgical center obtained by the department 18 which does not constitute the department’s findings from an 19 inspection or investigation of the ambulatory surgical center 20 or the final survey findings of the accrediting body shall 21 not be made available to the public, except in proceedings 22 involving the denial, suspension, or revocation of a license 23 under this chapter. The name of a person who files a complaint 24 with the department shall remain confidential and shall not 25 be subject to discovery, subpoena, or other means of legal 26 compulsion for its release to a person other than department 27 employees or agents involved in the investigation of the 28 complaint. 29 Sec. 12. NEW SECTION . 135P.11 Judicial review. 30 Judicial review of an action of the department may be sought 31 in accordance with chapter 17A. Notwithstanding the provisions 32 of chapter 17A, petitions for judicial review may be filed 33 in the district court of the county in which the ambulatory 34 surgical center is located or to be located and the status quo 35 -4- LSB 5348XC (6) 84 ad/nh 4/ 8

S.F. _____ of the petitioner or licensee shall be preserved pending final 1 disposition of the judicial review matter. 2 Sec. 13. NEW SECTION . 135P.12 Penalty. 3 Any person establishing, conducting, managing, or operating 4 any ambulatory surgical center without a license commits a 5 serious misdemeanor, and each day of continuing violation after 6 conviction shall be considered a separate offense. 7 Sec. 14. NEW SECTION . 135P.13 Injunction. 8 Notwithstanding the existence or pursuit of any other 9 remedy, the department may, in the manner provided by law, 10 maintain an action in the name of the state for injunction 11 or other process against any person or governmental unit to 12 restrain or prevent the establishment, conduct, management, or 13 operation of an ambulatory surgical center without a license. 14 Sec. 15. EFFECTIVE DATE. This Act takes effect July 1, 15 2013. 16 EXPLANATION 17 This bill relates to ambulatory surgical centers. The bill 18 defines “ambulatory surgical center” using the definition 19 provided by Medicare. The bill states the purpose of new Code 20 chapter 135P is to protect public health, safety, and welfare 21 by providing basic standards for operating, constructing, and 22 maintaining an ambulatory surgical center. 23 The bill requires that any person or governmental unit 24 acting separately or together that establishes, conducts, or 25 maintains an ambulatory surgical center must have a license as 26 provided under the Code chapter. The person or governmental 27 unit shall obtain a license from the department of inspections 28 and appeals (DIA). The application shall include information 29 that the DIA may reasonably require including affirmative 30 evidence of compliance with new Code chapter 135P, other 31 statutes, and rules. An application must be accompanied by the 32 required initial license fee of $500. An annual license fee is 33 also $500. The license fees are to be credited to the state’s 34 general fund. The bill also provides that the DIA shall issue 35 -5- LSB 5348XC (6) 84 ad/nh 5/ 8

S.F. _____ a license upon receiving an application if the applicant 1 and the ambulatory surgical center comply with Code chapter 2 135P and the rules of the department. A licensee receives 3 reapproval upon payment of the $500 license fee and filing 4 an application form available from the DIA. Licenses are 5 general or restricted in form. A license will be issued only 6 for a premises and persons or governmental units named in the 7 application and the license is not transferable or assignable 8 without written approval of the DIA. The bill requires that 9 a license be posted in a conspicuous place on the licensed 10 premises as prescribed by department rules. 11 The bill states that the DIA may deny, suspend, or revoke a 12 license when it finds the licensee or applicant substantially 13 failed to comply with Code chapter 135P or rules or minimum 14 standards adopted pursuant to the Code chapter. The bill 15 states that the DIA rules will govern the procedure for notice 16 and hearing to deny an application for a license or to revoke 17 or suspend a license. The bill states a full and complete 18 record of the proceedings shall be kept, but the record does 19 not need to be transcribed unless judicial review is sought. A 20 transcript of the proceeding may be obtained by an interested 21 party on payment of the cost of preparing the copy or copies. 22 The bill provides that the DIA shall adopt rules setting 23 the standards for an ambulatory surgical center to be licensed 24 under the Code chapter. The rules must require that an 25 ambulatory surgical center shall meet the federal requirements 26 for conditions of participation in the federal Medicare 27 program for ambulatory surgical centers under 42 C.F.R. 28 pt. 416. The DIA must also establish, by rule, the notice 29 and hearing procedure if a license is denied, revoked, or 30 suspended. The DIA must also enforce the rules. The rules 31 established by the DIA shall require ambulatory surgical 32 centers to report ambulatory data to the department of public 33 health or the designated intermediary for purposes of public 34 health dissemination of health data. The bill states that 35 -6- LSB 5348XC (6) 84 ad/nh 6/ 8

S.F. _____ an ambulatory surgical center in operation at the time of 1 promulgation of applicable rules or standards under Code 2 chapter 135P shall be given a reasonable time, not to exceed 3 one year, to comply with the rules and minimum standards. 4 The bill provides for inspections of ambulatory surgical 5 centers. The bill requires the DIA to make, or cause to be 6 made, inspections or complaint investigations as the DIA deems 7 necessary to determine compliance with Code chapter 135P and 8 the applicable rules. The DIA inspectors must not participate 9 in an inspection or complaint investigation of an ambulatory 10 surgical center if the inspector or a member of the inspector’s 11 immediate family works or has worked at the ambulatory surgical 12 center within the last two years. A DIA inspector also must 13 not participate in an inspection or complaint investigation 14 of an ambulatory surgical center in which the inspector or 15 the inspector’s immediate family has a financial or ownership 16 interest. 17 The bill provides that an ambulatory surgical center shall 18 comply with abuse and criminal background checks as provided 19 in Code section 135C.33. The bill also states that a licensed 20 ambulatory surgical center is allowed to access the single 21 contact repository as is necessary to perform record checks of 22 employees or potential employees. 23 The bill provides for the confidentiality of the DIA records 24 of ambulatory surgical centers. The bill states that the DIA’s 25 final inspection or investigation findings, or survey findings 26 of an accredited body authorized by the DIA rules, regarding 27 an ambulatory surgical center’s compliance with requirements 28 for licensing or accreditation must be made available to the 29 public in a readily available form and place. The bill states 30 that other information acquired by the DIA relating to an 31 ambulatory surgical center shall not be made available to the 32 public except in proceedings involving denial, suspension, 33 or revocation of a license. The bill also provides that the 34 name of a person who files a complaint with the DIA shall 35 -7- LSB 5348XC (6) 84 ad/nh 7/ 8

S.F. _____ remain confidential regardless of means of legal compulsion 1 for its release, other than the release of the name to the DIA 2 employees or agents involved in investigating a complaint. 3 The bill provides that judicial review may be sought 4 pursuant to Code chapter 17A, but petitions for judicial review 5 may be filed in the district court of the county in which the 6 ambulatory surgical center is located or is to be located, 7 notwithstanding the terms of Code chapter 17A. The bill 8 provides that the status quo of the petitioner or licensee is 9 preserved pending final disposition in court. 10 The bill establishes a penalty for any person establishing, 11 conducting, managing, or operating an ambulatory surgical 12 center without a license. The person is guilty of a serious 13 misdemeanor and each day of the continuing violation after a 14 conviction is a separate offense. 15 The bill provides that the DIA may maintain an action in 16 the name of the state for an injunction or other process 17 against a person or governmental unit to restrain or prevent 18 the establishment, conduct, management, or operation of an 19 unlicensed ambulatory surgical center. 20 The bill provides that the Act takes effect July 1, 2013. 21 -8- LSB 5348XC (6) 84 ad/nh 8/ 8