H.F. 581 Section 1. NEW SECTION . 135P.1 Definitions. 1 As used in this chapter, unless the context otherwise 2 requires: 3 1. “Ambulatory surgical center” means a distinct facility 4 that operates exclusively for the purpose of providing surgical 5 services to patients not requiring hospitalization and in which 6 the expected duration of services does not exceed twenty-four 7 hours following an admission. “Ambulatory surgical center” does 8 not include individual or group practice offices of private 9 physicians or podiatrists that do not contain a distinct area 10 used for outpatient surgical treatment on a regular basis, or 11 that only provide surgery routinely provided in a physician’s 12 or podiatrist’s office using local anesthesia or conscious 13 sedation; individual or group practice offices of private 14 dentists; or a portion of a licensed hospital designated for 15 outpatient surgical treatment. 16 2. “Department” means the department of inspections and 17 appeals. 18 Sec. 2. NEW SECTION . 135P.2 Purpose. 19 The purpose of this chapter is to protect the public 20 health, safety, and welfare by providing for the licensing and 21 regulation of ambulatory surgical centers. 22 Sec. 3. NEW SECTION . 135P.3 Licensure. 23 A person, acting severally or jointly with any other person, 24 shall not establish, operate, or maintain an ambulatory 25 surgical center in this state without obtaining a license as 26 provided under this chapter. 27 Sec. 4. NEW SECTION . 135P.4 Application for license —— fee. 28 1. An applicant for an ambulatory surgical center license 29 shall submit an application to the department. Applications 30 shall be upon such forms and shall include such information 31 as the department may reasonably require, which may include 32 affirmative evidence of ability to comply with reasonable rules 33 and standards prescribed under this chapter. 34 2. a. An application for an initial license for 35 -1- LSB 1638HV (2) 85 pf/nh 1/ 16

H.F. 581 an ambulatory surgical center that is in existence and 1 Medicare-certified prior to July 1, 2014, shall be accompanied 2 by a fee of fifty dollars. 3 b. An application for an initial license for an ambulatory 4 surgical center established on or after July 1, 2014, shall 5 be accompanied by a fee sufficient to cover the costs of 6 performing the inspection required in section 135P.8 in an 7 amount as provided in rules adopted by the department. 8 3. The fees collected under this section shall be considered 9 repayment receipts as defined in section 8.2 and shall be used 10 by the department to administer this chapter. 11 Sec. 5. NEW SECTION . 135P.5 Issuance and renewal of 12 license. 13 1. Upon receipt of an application for license and the 14 license fee, the department shall issue a license if the 15 applicant and the ambulatory surgical center meet the 16 requirements of this chapter and the rules adopted by the 17 department. 18 2. A license shall be issued only for the premises and 19 persons named in the application. 20 3. A license is not transferable or assignable except with 21 the written approval of the department. 22 4. A license shall be posted in a conspicuous place on the 23 licensed premises as prescribed by rule of the department. 24 5. Separate licenses are not required for ambulatory 25 surgical center facilities that are maintained on the same 26 physical site and that have the same ownership or control. 27 Multiple buildings located on the same physical site under the 28 same ownership or control shall be considered one ambulatory 29 surgical center facility for purposes of this chapter and 30 section 135.61, subsection 21, and may operate under one 31 license. 32 6. A license, unless sooner suspended or revoked, shall 33 expire on June 30 of each year and shall be renewed annually. 34 The department shall renew a license upon payment of a five 35 -2- LSB 1638HV (2) 85 pf/nh 2/ 16

H.F. 581 hundred dollar annual license renewal fee and filing of an 1 application for renewal at least thirty days prior to the 2 expiration of the existing license. The annual licensure fee 3 shall be considered a repayment receipt as defined in section 4 8.2 and dedicated to support the staffing necessary to conduct 5 the inspections and investigations provided in section 135P.8. 6 Sec. 6. NEW SECTION . 135P.6 Denial, suspension, or 7 revocation of license —— hearings and review. 8 1. The department may deny, suspend, or revoke a license in 9 any case where it finds there has been a substantial failure 10 to comply with this chapter or the rules and standards adopted 11 under this chapter. 12 2. The denial, suspension, or revocation of a license by 13 the department and appeal from that action are governed by the 14 procedures for a contested case hearing under chapter 17A. 15 3. a. If the department finds, after providing notice of 16 noncompliance and a reasonable time for corrective action, that 17 an ambulatory surgical center is in repeated noncompliance with 18 this chapter or the department’s rules but that noncompliance 19 does not endanger public health or safety, the department may 20 issue a conditional license to the ambulatory surgical center 21 as an alternative to suspending or revoking the ambulatory 22 surgical center’s license. 23 b. The department shall provide notice of its intent to 24 issue a conditional license to the ambulatory surgical center 25 and of the items of noncompliance not less than ten days before 26 the date the conditional license is issued. 27 c. The department shall designate a period of not more 28 than one year during which the ambulatory surgical center may 29 operate under a conditional license. 30 d. During the period an ambulatory surgical center is 31 operating under a conditional license, the ambulatory surgical 32 center shall correct the items that are in noncompliance and 33 report the corrections to the department for approval. 34 4. The department may suspend or revoke the license of an 35 -3- LSB 1638HV (2) 85 pf/nh 3/ 16

H.F. 581 ambulatory surgical center that does not correct items that 1 are in noncompliance or that does not comply with this chapter 2 or the rules adopted under this chapter within the applicable 3 period. 4 5. The department may issue an emergency order to suspend 5 a license issued under this chapter if the department has 6 reasonable cause to believe that the conduct of the ambulatory 7 surgical center creates an immediate danger to the public 8 health and safety. An emergency suspension is effective 9 immediately without a hearing or notice to the licensee. On 10 written request of the licensee, the department shall conduct 11 a hearing not earlier than the tenth day or later than the 12 thirtieth day after the date the hearing request is received 13 to determine if the emergency suspension is to be continued, 14 modified, or rescinded. The hearing and any appeal are 15 governed by the department’s rules for a contested case hearing 16 and chapter 17A. 17 Sec. 7. NEW SECTION . 135P.7 Rules. 18 1. The department, with the advice and approval of the state 19 board of health, shall adopt rules specifying the standards for 20 ambulatory surgical centers to be licensed under this chapter. 21 The rules shall be consistent with and shall not exceed the 22 requirements of this chapter and the conditions for coverage in 23 the federal Medicare program for ambulatory surgical centers 24 under 42 C.F.R. pt. 416. 25 2. The department shall adopt rules as the department deems 26 necessary to implement the provisions of this chapter relating 27 to the issuance, renewal, denial, suspension, and revocation 28 of a license to establish, operate, and maintain an ambulatory 29 surgical center. 30 3. An ambulatory surgical center which is in operation at 31 the time of adoption of any applicable rules or standards under 32 this chapter shall be given a reasonable time, not to exceed 33 one year from the date of adoption, within which to comply with 34 such rules and standards. 35 -4- LSB 1638HV (2) 85 pf/nh 4/ 16

H.F. 581 4. The department shall enforce the rules. 1 Sec. 8. NEW SECTION . 135P.8 Inspections. 2 1. The department shall make or cause to be made inspections 3 or investigations of ambulatory surgical centers to determine 4 compliance with this chapter and applicable rules and 5 standards. The department shall perform inspections on a 6 schedule that is of the same frequency required for inspections 7 of Medicare-certified ambulatory surgical centers. 8 2. The department shall recognize, in lieu of its own 9 licensure inspection, the comparable inspection and inspection 10 findings of a Medicare conditions for coverage survey completed 11 by the department or an accrediting organization authorized by 12 the centers for Medicare and Medicaid services with deeming 13 authority. 14 3. A department inspector shall not participate in an 15 inspection or investigation of an ambulatory surgical center in 16 which the inspector or a member of the inspector’s immediate 17 family works or has worked within the last two years or in 18 which the inspector or the inspector’s immediate family has 19 a financial ownership interest. For the purposes of this 20 section, “immediate family member” means a spouse, natural or 21 adoptive parent or grandparent, child, grandchild, sibling, 22 stepparent, stepchild, or stepsibling. 23 Sec. 9. NEW SECTION . 135P.9 Employee background checks. 24 1. a. Prior to employment of a person in an ambulatory 25 surgical center, the ambulatory surgical center shall request 26 that the department of public safety perform a criminal 27 history check and the department of human services perform 28 child and dependent adult abuse record checks of the person 29 in this state. An ambulatory surgical center shall inform 30 all persons prior to employment regarding the performance of 31 the record checks and shall obtain from the persons a signed 32 acknowledgment of the receipt of the information. 33 b. An ambulatory surgical center shall include the following 34 inquiry in an application for employment: 35 -5- LSB 1638HV (2) 85 pf/nh 5/ 16

H.F. 581 Do you have a record of founded child or dependent adult abuse 1 or have you ever been convicted of a crime, in this state or any 2 other state? 3 2. a. If it is determined that a person being considered 4 for employment in an ambulatory surgical center has been 5 convicted of a crime, the department of public safety shall 6 notify the ambulatory surgical center that upon the request 7 of the ambulatory surgical center the department of human 8 services will perform an evaluation to determine whether the 9 crime warrants prohibition of the person’s employment in the 10 ambulatory surgical center. 11 b. If a department of human services child or dependent 12 adult abuse record check shows that the person has a record of 13 founded child or dependent adult abuse, the department of human 14 services shall notify the ambulatory surgical center that upon 15 the request of the ambulatory surgical center the department of 16 human services will perform an evaluation to determine whether 17 the founded child or dependent adult abuse warrants prohibition 18 of the person’s employment in the ambulatory surgical center. 19 c. An evaluation performed under this subsection shall 20 be performed in accordance with procedures adopted for this 21 purpose by the department of human services. 22 d. (1) If a person owns or operates more than one 23 ambulatory surgical center, and an employee of one of such 24 ambulatory surgical centers is transferred to another such 25 ambulatory surgical center without a lapse in employment, 26 the ambulatory surgical center is not required to request 27 additional criminal and child and dependent adult abuse record 28 checks of that employee. 29 (2) If the ownership of an ambulatory surgical center is 30 transferred, at the time of transfer the record checks required 31 by this section shall be performed for each employee for whom 32 there is no documentation that such record checks have been 33 performed. The ambulatory surgical center may continue to 34 employ such employee pending the performance of the record 35 -6- LSB 1638HV (2) 85 pf/nh 6/ 16

H.F. 581 checks and any related evaluation. 1 3. In an evaluation, the department of human services 2 shall consider the nature and seriousness of the crime 3 or founded child or dependent adult abuse in relation to 4 the position sought or held, the time elapsed since the 5 commission of the crime or founded child or dependent adult 6 abuse, the circumstances under which the crime or founded 7 child or dependent adult abuse was committed, the degree of 8 rehabilitation, the likelihood that the person will commit 9 the crime or founded child or dependent adult abuse again, 10 and the number of crimes or founded child or dependent adult 11 abuses committed by the person involved. If the department of 12 human services performs an evaluation for the purposes of this 13 section, the department of human services has final authority 14 in determining whether prohibition of the person’s employment 15 is warranted. 16 4. a. Except as provided in paragraph “b” and subsection 2, 17 a person who has been convicted of a crime or has a record of 18 founded child or dependent adult abuse shall not be employed 19 in an ambulatory surgical center licensed under this chapter 20 unless an evaluation has been performed by the department of 21 human services. 22 b. A person with a criminal or abuse record who is or was 23 employed by an ambulatory surgical center licensed under this 24 chapter and is hired by an employer who is another licensee 25 without a lapse in employment shall be subject to the criminal 26 history and abuse record checks required pursuant to subsection 27 1. However, if an evaluation was previously performed by the 28 department of human services concerning the person’s criminal 29 or abuse record and it was determined that the record did not 30 warrant prohibition of the person’s employment and the latest 31 record checks do not indicate a crime was committed or founded 32 abuse record was entered subsequent to that evaluation, the 33 person may commence employment with the other licensee in 34 accordance with the department of human services’ evaluation 35 -7- LSB 1638HV (2) 85 pf/nh 7/ 16

H.F. 581 and an exemption from the requirements in paragraph “a” for 1 reevaluation of the latest record checks is authorized. 2 Otherwise, the requirements of paragraph “a” remain applicable 3 to the person’s employment. Authorization of an exemption 4 under this lettered paragraph “b” from requirements for 5 reevaluation of the latest record checks by the department of 6 human services is subject to all of the following provisions: 7 (1) The position with the subsequent employer is 8 substantially the same or has the same job responsibilities as 9 the position for which the previous evaluation was performed. 10 (2) Any restrictions placed on the person’s employment in 11 the previous evaluation by the department of human services 12 shall remain applicable in the person’s subsequent employment. 13 (3) The person subject to the record checks has maintained a 14 copy of the previous evaluation and provides the evaluation to 15 the subsequent employer or the previous licensee provides the 16 previous evaluation from the person’s personnel file pursuant 17 to the person’s authorization. If a physical copy of the 18 previous evaluation is not provided to the subsequent employer 19 the record checks shall be reevaluated. 20 (4) Although an exemption under this lettered paragraph “b” 21 may be authorized, the subsequent employer may instead request 22 a reevaluation of the record checks and may employ the person 23 while the reevaluation is being performed. 24 5. a. If a person employed by an ambulatory surgical center 25 licensed under this chapter is convicted of a crime or has a 26 record of founded child or dependent adult abuse entered in the 27 abuse registry after the person’s employment application date, 28 the person shall inform the ambulatory surgical center of such 29 information within forty-eight hours of the criminal conviction 30 or entry of the record of founded child or dependent adult 31 abuse. The ambulatory surgical center shall act to verify 32 the information within forty-eight hours of notification. If 33 the information is verified, the requirements of subsections 34 2, 3, and 4 regarding employability and evaluations shall 35 -8- LSB 1638HV (2) 85 pf/nh 8/ 16

H.F. 581 be applied by the ambulatory surgical center to determine 1 whether or not the person’s employment is continued. The 2 ambulatory surgical center may continue to employ the person 3 pending the performance of an evaluation by the department 4 of human services to determine whether prohibition of the 5 person’s employment is warranted. A person who is required by 6 this subsection to inform the ambulatory surgical center of 7 a conviction or entry of an abuse record and fails to do so 8 within the required period commits a serious misdemeanor. 9 b. If an ambulatory surgical center receives credible 10 information, as determined by the ambulatory surgical center, 11 that a person employed by the ambulatory surgical center has 12 been convicted of a crime or a record of founded child or 13 dependent adult abuse has been entered in the abuse registry 14 after employment from a person other than the employee and the 15 employee has not informed the ambulatory surgical center of 16 such information within the period required under paragraph 17 “a” , the ambulatory surgical center shall act to verify the 18 credible information within forty-eight hours of receipt of 19 the credible information. If the information is verified, the 20 requirements of subsections 2, 3, and 4 regarding employability 21 and evaluations shall be applied by the ambulatory surgical 22 center to determine whether or not the person’s employment is 23 continued. 24 c. The ambulatory surgical center may notify the county 25 attorney for the county where the ambulatory surgical center is 26 located of any violation or failure by an employee to notify 27 the ambulatory surgical center of a criminal conviction or 28 entry of an abuse record within the period required under 29 paragraph “a” . 30 6. An ambulatory surgical center licensed under this 31 chapter may access the single contact repository established by 32 the department pursuant to section 135C.33 as necessary for the 33 ambulatory surgical center to perform record checks of persons 34 employed or being considered for employment by the ambulatory 35 -9- LSB 1638HV (2) 85 pf/nh 9/ 16

H.F. 581 surgical center. 1 Sec. 10. NEW SECTION . 135P.10 Confidentiality. 2 The department’s final findings with respect to compliance 3 by an ambulatory surgical center with requirements for 4 licensing shall be made available to the public in a readily 5 available form and place. Other information relating to 6 an ambulatory surgical center obtained by the department 7 which does not constitute the department’s findings from an 8 inspection of the ambulatory surgical center shall not be made 9 available to the public, except in proceedings involving the 10 denial, suspension, or revocation of a license under this 11 chapter. The name of a person who files a complaint with the 12 department shall remain confidential and shall not be subject 13 to discovery, subpoena, or other means of legal compulsion for 14 its release to a person other than department employees or 15 agents involved in the investigation of the complaint. 16 Sec. 11. NEW SECTION . 135P.11 Injunction. 17 Notwithstanding the existence or pursuit of any other 18 remedy, the department may, in the manner provided by law, 19 maintain an action in the name of the state for injunction 20 or other process against any person to restrain or prevent 21 the establishment, operation, or maintenance of an ambulatory 22 surgical center without a license. 23 Sec. 12. NEW SECTION . 135P.12 Judicial review. 24 Judicial review of an action of the department may be sought 25 in accordance with chapter 17A. Notwithstanding the provisions 26 of chapter 17A, petitions for judicial review may be filed 27 in the district court of the county in which the ambulatory 28 surgical center is located or is to be located and the status 29 quo of the petitioner or licensee shall be preserved pending 30 final disposition of the judicial review matter. 31 Sec. 13. NEW SECTION . 135P.13 Penalties. 32 Any person establishing, operating, or maintaining any 33 ambulatory surgical center without a license commits a serious 34 misdemeanor, and each day of continuing violation after 35 -10- LSB 1638HV (2) 85 pf/nh 10/ 16

H.F. 581 conviction shall be considered a separate offense. 1 Sec. 14. Section 135.11, Code 2013, is amended by adding the 2 following new subsection: 3 NEW SUBSECTION . 32. Adopt rules requiring ambulatory 4 surgical centers to report quality data to the department of 5 public health that is consistent with the data required to be 6 reported to the centers for Medicare and Medicaid services 7 of the United States department of health and human services 8 as authorized by the Medicare Improvements and Extension Act 9 of 2006 under Title I of the Tax Relief and Health Care Act 10 of 2006, Pub. L. No. 109-432, and the regulations adopted 11 under such Acts. Notwithstanding any provision of law to 12 the contrary, nothing in this subsection shall require an 13 ambulatory surgical center to provide health data to the 14 department of public health or any other public or private 15 entity that is in addition to, different than, or exceeds 16 the quality data required to be reported to the centers for 17 Medicare and Medicaid services of the United States department 18 of health and human services. 19 Sec. 15. Section 135.61, Code 2013, is amended by adding the 20 following new subsection: 21 NEW SUBSECTION . 1A. “Ambulatory surgical center” means 22 ambulatory surgical center as defined in section 135P.1. 23 Sec. 16. Section 135.61, subsection 14, paragraph d, Code 24 2013, is amended to read as follows: 25 d. An outpatient ambulatory surgical facility center . 26 Sec. 17. Section 135.61, subsection 21, Code 2013, is 27 amended by striking the subsection. 28 Sec. 18. EFFECTIVE DATE. This Act takes effect July 1, 29 2014. 30 EXPLANATION 31 This bill creates a new Code chapter to provide for the 32 licensing and regulation of ambulatory surgical centers. 33 The bill defines “ambulatory surgical center” as a distinct 34 facility that operates exclusively for the purpose of providing 35 -11- LSB 1638HV (2) 85 pf/nh 11/ 16

H.F. 581 surgical services to patients not requiring hospitalization 1 and in which the expected duration of services does not 2 exceed 24 hours following an admission. “Ambulatory surgical 3 center” does not include individual or group practice offices 4 of private physicians or podiatrists that do not contain a 5 distinct area used for outpatient surgical treatment on a 6 regular basis, or that only provide surgery routinely provided 7 in a physician’s or podiatrist’s office using local anesthesia 8 or conscious sedation; individual or group practice offices of 9 dentists; or a portion of a licensed hospital designated for 10 outpatient surgical treatment. The department of inspections 11 and appeals is designated to enforce the regulations. 12 The bill provides that the purpose of the new Code chapter is 13 to protect the public health, safety, and welfare by providing 14 for the licensing and regulation of ambulatory surgical 15 centers. The bill prohibits the establishment, operation, 16 or maintenance of an ambulatory surgical center in the state 17 without obtaining a license. 18 The bill provides the process for application for licensure. 19 An application for an initial license for an ambulatory 20 surgical center that is in existence and Medicare-certified 21 prior to July 1, 2014, is required to be accompanied by a 22 fee of $50. An application for an initial license for an 23 ambulatory surgical center established on or after July 1, 24 2014, is required to be accompanied by a fee sufficient to 25 cover the costs of performing the required inspection in an 26 amount provided in rules adopted by the department. The fees 27 collected are repayment receipts and are to be used by the 28 department to administer the chapter. 29 The bill provides for the issuance and renewal of licenses. 30 A license is to be issued only for the premises and persons 31 named in the application; is not transferable or assignable 32 except with the written approval of the department; and is 33 required to be posted in a conspicuous place on the licensed 34 premises as prescribed by rule of the department. The bill 35 -12- LSB 1638HV (2) 85 pf/nh 12/ 16

H.F. 581 provides that separate licenses are not required for ambulatory 1 surgical center facilities that are maintained on the same 2 physical site and that have the same ownership or control. 3 Multiple buildings located on the same physical site under 4 the same ownership or control are considered one ambulatory 5 surgical center facility for purposes of the new Code chapter 6 and Code chapter 135, division VI, relating to the health 7 facilities council and certificate of need provisions, and 8 are to be permitted to operate under one license. Licenses 9 expire on June 30 of each year and are required to be renewed 10 annually. The bill directs the department to renew a license 11 upon payment of a $500 annual license renewal fee and filing 12 of an application for renewal at least 30 days prior to the 13 expiration of the existing license. The annual licensure fee 14 is considered a repayment receipt and is to be dedicated to 15 support the staffing necessary to conduct the inspections and 16 investigations under the Code chapter. 17 The bill provides for denial, suspension, or revocation of 18 licenses. A license may be denied, suspended, or revoked if 19 the department finds there has been a substantial failure to 20 comply with the Code chapter or the rules and standards adopted 21 under the Code chapter. The denial, suspension, or revocation 22 of a license by the department and appeal from that action are 23 governed by the procedures for a contested case hearing under 24 Code chapter 17A. The bill authorizes the department, after 25 providing notice of noncompliance and a reasonable time for 26 corrective action, and if the noncompliance does not endanger 27 public health or safety, to issue a conditional license to the 28 ambulatory surgical center as an alternative to suspending or 29 revoking its license. 30 The bill also authorizes the department to issue an 31 emergency order to suspend a license if the department has 32 reasonable cause to believe that the conduct of the ambulatory 33 surgical center creates an immediate danger to the public 34 health or safety. On written request of the licensee, the 35 -13- LSB 1638HV (2) 85 pf/nh 13/ 16

H.F. 581 department is required to conduct a hearing to determine if 1 the emergency suspension is to be continued, modified, or 2 rescinded. The hearing and any appeal are governed by the 3 department’s rules for a contested case hearing and Code 4 chapter 17A. 5 The bill directs the department to adopt rules with the 6 advice and approval of the state board of health to specify 7 the standards for ambulatory surgical centers. The rules are 8 required to be consistent with and not exceed the requirements 9 of the Code chapter and the conditions for coverage in the 10 federal Medicare program for ambulatory surgical centers. 11 The department is also directed to adopt rules relating to 12 provisions of the Code chapter relating to the issuance, 13 renewal, denial, suspension, and revocation of a license to 14 establish, operate, and maintain an ambulatory surgical center. 15 If an ambulatory surgical center is in operation at the time of 16 adoption of any applicable rules or standards, the center is 17 to be given a reasonable time, not to exceed one year from the 18 date of adoption, within which to comply with such rules and 19 standards. 20 The bill provides for inspections or investigations of 21 ambulatory surgical centers, and directs that the department 22 shall perform inspections on a schedule that is of the same 23 frequency required for inspections of Medicare-certified 24 ambulatory surgical centers. The bill also requires the 25 department to recognize, in lieu of its own licensure 26 inspection, the comparable inspection and inspection findings 27 of a Medicare conditions for coverage survey. 28 The bill prohibits a department inspector from participating 29 in an inspection or investigation of an ambulatory surgical 30 center in which the inspector or a member of the inspector’s 31 immediate family works or has worked within the last two years 32 or in which the inspector or the inspector’s immediate family 33 has a financial ownership interest. 34 The bill requires an ambulatory surgical center to comply 35 -14- LSB 1638HV (2) 85 pf/nh 14/ 16

H.F. 581 with child and dependent adult abuse information and criminal 1 record checks and evaluations. 2 The bill provides confidentiality provisions relating to 3 ambulatory surgical center information. The final findings 4 with respect to compliance by an ambulatory surgical center 5 are to be made available to the public in a readily available 6 form and place. Other information relating to an ambulatory 7 surgical center shall not be made available to the public, 8 except in proceedings involving the denial, suspension, or 9 revocation of a license. The name of a person who files 10 a complaint with the department is required to remain 11 confidential and not be subject to discovery, subpoena, or 12 other means of legal compulsion. 13 The bill provides for injunctive relief and judicial review. 14 The bill provides that any person establishing, operating, 15 or maintaining an ambulatory surgical center without a license 16 commits a serious misdemeanor, and each day of continuing 17 violation after conviction shall be considered a separate 18 offense. A serious misdemeanor is punishable by confinement 19 for no more than one year and a fine of at least $315 but not 20 more than $1,875. 21 The bill also directs the department of public health 22 to adopt rules requiring ambulatory surgical centers to 23 report quality data to the department of public health that 24 is consistent with the data required to be reported to the 25 centers for Medicare and Medicaid services of the United States 26 department of health and human services. However, the rules 27 are not to require an ambulatory surgical center to provide 28 health data to the department of public health or any other 29 public or private entity that is in addition to, different 30 than, or exceeds the quality data required to be reported to 31 the centers for Medicare and Medicaid services of the United 32 States department of health and human services. 33 The bill makes conforming changes in the Code to reflect the 34 terminology of “ambulatory surgical center”. 35 -15- LSB 1638HV (2) 85 pf/nh 15/ 16