S.F. 372 Section 1. Section 147.1, subsections 3 and 6, Code 2015, 1 are amended to read as follows: 2 3. “Licensed” or “certified” , when applied to a physician 3 and surgeon, podiatric physician, osteopathic physician and 4 surgeon, physician assistant, psychologist, chiropractor, 5 nurse, dentist, dental hygienist, dental assistant, 6 optometrist, speech pathologist, audiologist, pharmacist, 7 physical therapist, physical therapist assistant, occupational 8 therapist, occupational therapy assistant, orthotist, 9 prosthetist, pedorthist, respiratory care practitioner, 10 practitioner of cosmetology arts and sciences, practitioner 11 of barbering, funeral director, dietitian, marital and family 12 therapist, mental health counselor, social worker, massage 13 therapist, athletic trainer, acupuncturist, nursing home 14 administrator, hearing aid dispenser, durable medical equipment 15 provider, or sign language interpreter or transliterator means 16 a person licensed under this subtitle . 17 6. “Profession” means medicine and surgery, podiatry, 18 osteopathic medicine and surgery, practice as a physician 19 assistant, psychology, chiropractic, nursing, dentistry, 20 dental hygiene, dental assisting, optometry, speech pathology, 21 audiology, pharmacy, physical therapy, physical therapist 22 assisting, occupational therapy, occupational therapy 23 assisting, respiratory care, cosmetology arts and sciences, 24 barbering, mortuary science, marital and family therapy, mental 25 health counseling, social work, dietetics, massage therapy, 26 athletic training, acupuncture, nursing home administration, 27 hearing aid dispensing, durable medical equipment providing, 28 sign language interpreting or transliterating, orthotics, 29 prosthetics, or pedorthics. 30 Sec. 2. Section 147.2, subsection 1, Code 2015, is amended 31 to read as follows: 32 1. A person shall not engage in the practice of medicine 33 and surgery, podiatry, osteopathic medicine and surgery, 34 psychology, chiropractic, physical therapy, physical 35 -1- LSB 1109SV (2) 86 tr/nh 1/ 19

S.F. 372 therapist assisting, nursing, dentistry, dental hygiene, 1 dental assisting, optometry, speech pathology, audiology, 2 occupational therapy, occupational therapy assisting, 3 orthotics, prosthetics, pedorthics, respiratory care, 4 pharmacy, cosmetology arts and sciences, barbering, social 5 work, dietetics, marital and family therapy or mental health 6 counseling, massage therapy, mortuary science, athletic 7 training, acupuncture, nursing home administration, hearing 8 aid dispensing, durable medical equipment providing, or sign 9 language interpreting or transliterating, or shall not practice 10 as a physician assistant, unless the person has obtained a 11 license for that purpose from the board for the profession. 12 Sec. 3. Section 147.13, Code 2015, is amended by adding the 13 following new subsection: 14 NEW SUBSECTION . 25. For durable medical equipment 15 providers, the board of durable medical equipment providers. 16 Sec. 4. Section 147.14, subsection 1, Code 2015, is amended 17 by adding the following new paragraph: 18 NEW PARAGRAPH . x. For durable medical equipment providers, 19 seven licensed durable medical equipment providers. 20 Sec. 5. NEW SECTION . 154G.1 Definitions. 21 For purposes of this chapter: 22 1. “Accrediting organization” means any organization 23 recognized by the centers for Medicare and Medicaid services of 24 the United States department of health and human services as an 25 accreditation body for durable medical equipment providers. 26 2. “Affiliated person” means any person who directly or 27 indirectly manages, controls, or oversees the operation of 28 a corporation or other business entity that is a licensee, 29 regardless of whether such person is a partner, shareholder, 30 owner, officer, director, agent, or employee of the entity. 31 3. “Applicant” means an individual applicant in the case of 32 a sole proprietorship or any officer, director, agent, managing 33 employee, general manager, or affiliated person or any partner 34 or shareholder having an ownership interest equal to five 35 -2- LSB 1109SV (2) 86 tr/nh 2/ 19

S.F. 372 percent or greater in the corporation or other business entity. 1 4. “Board” means the board of durable medical equipment 2 providers. 3 5. “Consumer” or “patient” means a person who uses durable 4 medical equipment in the person’s residence. 5 6. “Durable medical equipment” means any product reimbursed 6 under Medicare part B durable medical equipment benefits and 7 any product as defined by the federal Food, Drug, and Cosmetic 8 Act or reimbursable under Medicaid as provided by the board by 9 rule. “Durable medical equipment” includes but is not limited 10 to hospital beds, oxygen, walkers, continuous positive airway 11 pressure machines, customized wheelchairs, and related seating 12 and positioning devices, but does not include prosthetics 13 or orthotics or any splints, braces, or aids custom-fit or 14 custom-fabricated by a licensed health care practitioner or 15 commercially available noncustomized splints, braces, or aids 16 prescribed by a licensed health care practitioner. 17 7. “Durable medical equipment provider” means a person or 18 entity that sells or rents, or offers to sell or rent, to or 19 for a consumer any durable medical equipment or durable medical 20 equipment services. 21 8. “Durable medical equipment provider personnel” means 22 persons who are employed by or under contract with a durable 23 medical equipment provider. 24 9. “Durable medical equipment services” means equipment 25 management and consumer instruction, including selection, 26 delivery, setup, and maintenance of equipment and other related 27 services for the use of durable medical equipment in the 28 consumer’s regular or temporary residence. 29 10. “General manager” means the individual who has the 30 general administrative charge of the premises of a licensed 31 durable medical equipment provider. 32 11. “Licensed health care practitioner” means a person 33 licensed in this state engaging in a profession or occupation 34 included in section 147.1, subsections 3 and 6. 35 -3- LSB 1109SV (2) 86 tr/nh 3/ 19

S.F. 372 12. “Licensee” means the person or entity to whom a license 1 to operate as a durable medical equipment provider is issued 2 by the board. 3 13. “Moratorium” means a mandated temporary cessation or 4 suspension of the sale, rental, or offering of durable medical 5 equipment, except that services related to durable medical 6 equipment sold or rented prior to the moratorium shall be 7 continued without interruption, unless ordered otherwise by the 8 board. 9 14. “Premises” means those buildings and equipment which 10 are located at the address of the licensed durable medical 11 equipment provider for the provision of durable medical 12 equipment services which are in such reasonable proximity as to 13 appear to the public to be a single provider location. 14 15. “Residence” means a consumer’s home or place of 15 residence, which may include a nursing home as defined in 16 section 155.1, assisted living program as defined in section 17 231C.2, elder group home as defined in section 231B.1, 18 transitional living facility, or other congregate residential 19 facility. 20 16. “Retail sale” means a sale or rental of durable medical 21 equipment directly to a consumer which does not require a 22 prescription or billing of Medicare, Medicaid, or any other 23 third-party insurance. 24 Sec. 6. NEW SECTION . 154G.2 License required —— exemptions. 25 1. A person shall not do any of the following without 26 obtaining a license from the board under this chapter: 27 a. Hold oneself out to the public as providing durable 28 medical equipment or durable medical equipment services or 29 accept physician orders for durable medical equipment or 30 durable medical equipment services. 31 b. Hold oneself out to the public as providing durable 32 medical equipment that typically requires durable medical 33 equipment services. 34 c. Provide durable medical equipment or durable medical 35 -4- LSB 1109SV (2) 86 tr/nh 4/ 19

S.F. 372 equipment services to consumers in this state. 1 2. A separate license is required for all durable medical 2 equipment providers operating on separate premises, even if 3 the providers are operating under the same management. For 4 each location a provider operates, an initial inspection by the 5 board pursuant to section 154G.9 shall be required to obtain 6 a license. 7 3. The following persons are exempt from durable medical 8 equipment provider licensure unless the person operates a 9 separate company, corporation, or division that is in the 10 business of providing durable medical equipment and services 11 for sale or rent to consumers at their regular or temporary 12 place of residence pursuant to the provisions of this chapter: 13 a. Durable medical equipment providers operated by the 14 federal government. 15 b. Nursing homes as defined in section 155.1. 16 c. Assisted living programs as defined in section 231C.2. 17 d. Home health agencies as defined in 42 C.F.R. pt. 484. 18 e. Hospice programs as defined in section 135J.1. 19 f. Intermediate care facilities for persons with 20 intellectual disabilities or mental illnesses as defined in 21 section 135C.1. 22 g. Homes for special services. 23 h. Transitional living facilities. 24 i. Hospitals licensed pursuant to chapter 135B. 25 j. Ambulatory surgical centers. 26 k. Manufacturers and wholesale distributors when not selling 27 directly to consumers. 28 l. Licensed health care practitioners who utilize durable 29 medical equipment in the course of their practice. 30 m. Pharmacies licensed pursuant to chapter 155A. 31 n. Any durable medical equipment provider who only provides 32 items for retail sale. 33 4. A person shall not offer or advertise durable medical 34 equipment or durable medical equipment services to the public 35 -5- LSB 1109SV (2) 86 tr/nh 5/ 19

S.F. 372 unless such person has a valid license under this chapter or is 1 exempted from licensure under subsection 3. A person holding 2 a license issued under this chapter shall not advertise or 3 indicate to the public that the person holds a durable medical 4 equipment provider license other than the license the person 5 has been issued. 6 Sec. 7. NEW SECTION . 154G.3 Principal place of business 7 out of state. 8 A durable medical equipment provider that provides durable 9 medical equipment or durable medical equipment services 10 to persons in this state and that has a principal place of 11 business outside this state shall maintain an office or place 12 of business within this state unless the principal place of 13 business is located in a bordering state, is within fifty miles 14 of a border with this state, and meets the other requirements 15 of this chapter. 16 Sec. 8. NEW SECTION . 154G.4 Accreditation. 17 A durable medical equipment provider accredited by an 18 accrediting organization may submit documents to the board 19 evidencing current accreditation and shall be presumed to 20 comply with the licensing requirements of this chapter. 21 Licensing of a durable medical equipment provider that has 22 been accredited by an accrediting organization shall become 23 effective upon written notification from the board that the 24 accreditation meets the standards set out in rules adopted by 25 the board. 26 Sec. 9. NEW SECTION . 154G.5 License application —— renewal 27 —— duplicates —— fees. 28 1. An application for an initial license or for renewal of 29 an existing license shall be made under oath to the board on 30 forms furnished by the board and must be accompanied by the 31 appropriate license fee as established by the board by rule. 32 2. The applicant shall file with the application 33 information demonstrating that the applicant is in compliance 34 with this chapter and applicable rules. Such information shall 35 -6- LSB 1109SV (2) 86 tr/nh 6/ 19

S.F. 372 include the following: 1 a. A report specifying by category the durable medical 2 equipment to be provided and indicating the durable medical 3 equipment offered either directly by the applicant or through 4 contractual arrangements with existing durable medical 5 equipment providers. Categories of equipment include but are 6 not limited to the following: 7 (1) Respiratory modalities. 8 (2) Ambulation aids. 9 (3) Mobility aids. 10 (4) Sickroom setup. 11 (5) Disposables. 12 b. A report specifying by category the durable medical 13 equipment services to be provided and indicating those offered 14 either directly by the applicant or through contractual 15 arrangements with existing providers. Categories of services 16 include but are not limited to the following: 17 (1) Intake. 18 (2) Equipment selection. 19 (3) Delivery. 20 (4) Setup and installation. 21 (5) Patient training. 22 (6) Ongoing service and maintenance. 23 (7) Retrieval. 24 c. A list of those persons with whom the applicant contracts 25 to provide durable medical equipment or durable medical 26 equipment services to its consumers and those persons for whom 27 the applicant provides durable medical equipment or durable 28 medical equipment services. 29 d. A description and explanation of any exclusions, 30 permanent suspensions, or terminations of the applicant 31 from the Medicare or medical assistance program. Proof 32 of compliance with the disclosure of ownership and control 33 interest requirements of the Medicare or medical assistance 34 program shall be accepted in lieu of this submission. 35 -7- LSB 1109SV (2) 86 tr/nh 7/ 19

S.F. 372 e. A description and explanation of any felony committed 1 by a member of the board of directors of the applicant, its 2 officers, or any individual owning five percent or more of the 3 applicant. This requirement does not apply to a director of 4 a not-for-profit corporation or organization if the director 5 serves solely in a voluntary capacity for the corporation or 6 organization, does not regularly take part in the day-to-day 7 operational decisions of the corporation or organization, 8 receives no remuneration for such director’s services on the 9 corporation’s or organization’s board of directors, and has 10 no financial interest and no family members with a financial 11 interest in the corporation or organization, provided that the 12 director and the not-for-profit corporation or organization 13 include in the application a statement affirming that the 14 director’s relationship to the corporation satisfies the 15 requirements of this paragraph. 16 3. An applicant for initial licensure shall demonstrate 17 financial ability to operate, which may be accomplished by the 18 submission of a surety bond in the amount of fifty thousand 19 dollars to the board. An existing surety bond for Medicare 20 credentialing held by the applicant shall be sufficient in lieu 21 of an additional bond. 22 4. An applicant for license renewal who has demonstrated 23 financial inability to operate shall demonstrate financial 24 ability to operate before the board may renew the applicant’s 25 license. 26 5. The board shall initiate a criminal background check of 27 the applicant upon receipt of a completed, signed, and dated 28 application. As used in this subsection, “applicant” means the 29 general manager and the financial officer or similarly titled 30 individual who is responsible for the financial operation of 31 the durable medical equipment provider. 32 a. The applicant shall supply fingerprint samples or 33 submit to a criminal history records check to be conducted 34 by the division of criminal investigation of the department 35 -8- LSB 1109SV (2) 86 tr/nh 8/ 19

S.F. 372 of public safety. Any costs incurred by the division of 1 criminal investigation of the department of public safety in 2 conducting such investigation of an applicant shall be paid by 3 the potential licensee. 4 b. The board may require a criminal background check for a 5 member of the board of directors of the potential licensee or 6 an officer or an individual owning five percent or more of the 7 potential licensee if the board has probable cause to believe 8 that such individual has been convicted of a felony. 9 6. The board shall not issue a license to an applicant if 10 the applicant or an administrator or financial officer of the 11 durable medical equipment provider has been found guilty of or 12 has entered a plea of nolo contendere or guilty to any felony. 13 7. Proof of professional and commercial liability insurance 14 shall be submitted with the application. The board shall 15 set the required amounts of liability insurance by rule, 16 but the required amount shall not be less than two hundred 17 fifty thousand dollars per claim. In the case of contracted 18 services, the contractor shall have liability insurance of not 19 less than two hundred fifty thousand dollars per claim. 20 8. Ninety days before the expiration date of a license, the 21 durable medical equipment provider shall submit an application 22 for license renewal to the board under oath on forms furnished 23 by the board. The license shall be renewed if the applicant 24 has met the requirements established under this chapter and 25 applicable rules. The durable medical equipment provider must 26 file with the application satisfactory proof that it is in 27 compliance with this chapter and applicable rules. The durable 28 medical equipment provider must submit satisfactory proof of 29 its financial ability to comply with the requirements of this 30 chapter. 31 9. When a duplicate license is issued, a fee shall be 32 assessed not exceeding the actual cost of duplicating and 33 mailing the duplicate license. 34 10. The license must be displayed in a conspicuous place 35 -9- LSB 1109SV (2) 86 tr/nh 9/ 19

S.F. 372 in the administrative office of the durable medical equipment 1 provider and is valid only while in the possession of the 2 person or entity to which it is issued. The license may 3 not be sold, assigned, or otherwise transferred, voluntarily 4 or involuntarily, and is valid only for the durable medical 5 equipment provider and location for which originally issued. 6 11. All license fees required of a durable medical equipment 7 provider are nonrefundable. The board shall set license 8 renewal fees by rule sufficient to cover its costs in carrying 9 out its responsibilities. 10 12. State, county, or municipal governments applying for 11 licenses under this chapter are exempt from the payment of 12 license fees. 13 13. An applicant for initial licensure, or following a 14 change of ownership as described in section 154G.6, shall pay 15 a license processing fee not to exceed three hundred dollars 16 and an inspection fee not to exceed four hundred dollars to be 17 paid by all applicants except those not subject to licensure 18 inspection by the board. 19 Sec. 10. NEW SECTION . 154G.6 Provisional licenses —— change 20 of ownership. 21 1. A provisional license shall be issued by the board 22 to an approved applicant for initial licensure for a period 23 of ninety days. During that time, the board shall conduct 24 an investigation to determine substantial compliance, as 25 determined by the board, with the requirements of section 26 154G.5, including any determination to be made by the board 27 pending the outcome of the criminal background check performed 28 pursuant to section 154G.5, subsection 5. If substantial 29 compliance is demonstrated, a license shall be issued, to 30 expire two years after the effective date of the provisional 31 license. 32 2. A durable medical equipment provider against whom a 33 proceeding by the board for revocation or suspension or for 34 denial of a renewal application is pending may be issued a 35 -10- LSB 1109SV (2) 86 tr/nh 10/ 19

S.F. 372 provisional license effective until final disposition of such 1 proceedings. If judicial relief is sought from the final 2 disposition, the court that has jurisdiction may direct the 3 board to issue a provisional license for the duration of the 4 judicial proceeding. 5 3. a. When a change of ownership of a durable medical 6 equipment provider occurs, the prospective owner shall submit 7 an initial application for a license to the board at least 8 fifteen days before the effective date of the change of 9 ownership. An application for change of ownership of a license 10 is required when ownership, a majority of the ownership, or 11 controlling interest of a licensed durable medical equipment 12 provider is transferred or assigned and when the prospective 13 owner agrees to undertake or provide services to the extent 14 that legal liability for operation of the durable medical 15 equipment provider rests with the prospective owner. 16 b. A provisional license shall be issued to the new owner 17 for a period of ninety days during which time all required 18 documentation must be submitted and an investigation must 19 be conducted demonstrating substantial compliance with this 20 section. If substantial compliance is demonstrated a license 21 shall be issued, to expire two years after the issuance of the 22 provisional license. 23 4. a. When a change of the general manager of a durable 24 medical equipment provider occurs, the licensee shall notify 25 the board of the change within forty-five days and shall 26 provide evidence of compliance with the background check 27 requirements in section 154G.5, subsection 5. 28 b. A general manager who has met the standards for the abuse 29 registry background check and the criminal background check, 30 but for whom background screening results from the division of 31 criminal investigation of the department of public safety have 32 not yet been received, may be employed pending receipt of the 33 division of criminal investigation of the department of public 34 safety background screening report. 35 -11- LSB 1109SV (2) 86 tr/nh 11/ 19

S.F. 372 5. When a change is reported which requires issuance of a 1 license, the board shall assess a fee. The fee must be based on 2 the actual cost of processing and issuing the license. 3 Sec. 11. NEW SECTION . 154G.7 Standards. 4 The following standards shall govern the manner in which a 5 licensed durable medical equipment provider operates: 6 1. A licensed durable medical equipment provider must be in 7 compliance with all applicable federal and state licensure and 8 regulatory requirements. 9 2. A licensed durable medical equipment provider must honor 10 all warranties under applicable law. 11 3. A licensed durable medical equipment provider must 12 maintain a physical facility on an appropriate site and must 13 maintain a visible sign with posted hours of operation. The 14 location must be accessible to the public and staffed during 15 posted hours of business. The location must be at least two 16 hundred square feet and contain space for storing records. 17 4. A licensed durable medical equipment provider must 18 maintain a primary business telephone number listed under 19 the name of the business in a local directory or a toll-free 20 telephone number available through directory assistance. 21 The exclusive use of a beeper, answering machine, answering 22 service, or cell phone during posted business hours is 23 prohibited. 24 5. A licensed durable medical equipment provider shall 25 furnish the board any information required under state law. 26 6. A licensed durable medical equipment provider must 27 notify the accrediting organization for the durable medical 28 equipment provider when a new location is opened. 29 7. All durable medical equipment provider locations, 30 whether owned or subcontracted, must adhere to the standards 31 established pursuant to this section and be separately 32 accredited in order to comply with licensure requirements. 33 8. A licensed durable medical equipment provider must 34 disclose to the board upon application for a license all 35 -12- LSB 1109SV (2) 86 tr/nh 12/ 19

S.F. 372 products and services, including the addition of new product 1 lines for which the durable medical equipment provider is 2 seeking accreditation. 3 9. A licensed durable medical equipment provider must 4 remain open to the public for at least thirty hours per week. 5 Sec. 12. NEW SECTION . 154G.8 Duties. 6 A licensed durable medical equipment provider shall do all 7 of the following: 8 1. Offer and provide durable medical equipment to consumers 9 and offer and provide durable medical equipment services, as 10 necessary, to consumers who purchase or rent equipment that 11 requires such services. 12 2. Provide at least one category of durable medical 13 equipment directly by filling orders from its own inventory. 14 3. Respond to orders received for durable medical equipment 15 by filling those orders from its own inventory or inventory 16 from other companies with which it has contracted to fill such 17 orders, or customizing or fitting items for sale from supplies 18 purchased under contract. 19 4. Maintain trained durable medical equipment provider 20 personnel to coordinate order fulfillment and schedule timely 21 durable medical equipment and durable medical equipment service 22 delivery. 23 5. As necessary in relation to the sophistication of 24 the durable medical equipment and durable medical equipment 25 services being provided: 26 a. Ensure that delivery personnel are appropriately 27 trained to conduct an environment and equipment compatibility 28 assessment. 29 b. Appropriately and safely set up the durable medical 30 equipment. 31 c. Instruct patients and caregivers in the safe operation 32 and client maintenance of the durable medical equipment. 33 d. Recognize when additional education or follow-up patient 34 compliance monitoring is appropriate. 35 -13- LSB 1109SV (2) 86 tr/nh 13/ 19

S.F. 372 Sec. 13. NEW SECTION . 154G.9 Inspections. 1 1. The board shall make or cause to be made such inspections 2 and investigations of a durable medical equipment provider as 3 it considers necessary, including: 4 a. Licensure inspections. 5 b. Inspections directed by the centers for Medicare and 6 Medicaid services of the United States department of health and 7 human services. 8 c. Licensure complaint investigations, including 9 full licensure investigations with a review of all 10 licensure standards as outlined in rules adopted by the 11 board. Complaints received by the board from individuals, 12 organizations, or other sources are subject to review and 13 investigation by the board. 14 2. The board shall accept, in lieu of its own periodic 15 inspections for licensure, submission of a survey or inspection 16 of an accrediting organization, provided the accreditation 17 of the licensed durable medical equipment provider is not 18 provisional and provided the licensed durable medical equipment 19 provider authorizes release of, and the board receives the 20 report of, the accrediting organization. 21 Sec. 14. NEW SECTION . 154G.10 License denial, revocation, 22 or suspension. 23 1. The board may deny, revoke, or suspend a license, or 24 impose a civil penalty not to exceed five thousand dollars per 25 violation per day in accordance with this section. 26 2. Either of the following actions by a durable medical 27 equipment provider or any of its employees is grounds for 28 administrative action or imposition of civil penalties by the 29 board: 30 a. Violation of this chapter or rules adopted pursuant to 31 this chapter. 32 b. An intentional, reckless, or negligent act that 33 materially affects the health or safety of a patient. 34 3. The board may deny licensure to an applicant or revoke 35 -14- LSB 1109SV (2) 86 tr/nh 14/ 19

S.F. 372 the license of a licensee who does any of the following: 1 a. Makes or previously made a false representation or 2 omission of any material fact in an application, including the 3 submission of an application that conceals the applicant’s 4 controlling or ownership interest, or any officer, director, 5 agent, managing employee, affiliated person, partner, or 6 shareholder who may not be eligible to participate. 7 b. Has been previously found by any board created under 8 chapter 147 to have violated the standards or conditions 9 relating to licensure or certification or the quality of 10 services provided. 11 c. Has been or is currently excluded, suspended, or 12 terminated from, or has involuntarily withdrawn from, 13 participation in any state Medicaid program, the Medicare 14 program, or any other governmental or private health care or 15 health insurance program. 16 4. The board may issue an emergency order immediately 17 suspending or revoking a license when it determines that any 18 condition within the responsibility of the durable medical 19 equipment provider presents a clear and present danger to 20 public health and safety. 21 5. The board may impose an immediate moratorium on the 22 license of a licensed durable medical equipment provider 23 when the board determines that any condition within the 24 responsibility of the durable medical equipment provider 25 presents a threat to public health or safety. 26 Sec. 15. NEW SECTION . 154G.11 Penalties. 27 1. The following penalties shall be imposed for operating as 28 a durable medical equipment provider without a license under 29 this chapter: 30 a. A person who operates as a durable medical equipment 31 provider without a license under this chapter commits a class 32 “D” felony. 33 b. For any person who has received government reimbursement 34 for services provided by an unlicensed durable medical 35 -15- LSB 1109SV (2) 86 tr/nh 15/ 19

S.F. 372 equipment provider, the board shall make a fraud referral to 1 the appropriate government reimbursement program. 2 2. If the board discovers that a licensee is concurrently 3 operating licensed and unlicensed provider locations, the 4 board may impose a civil penalty of not more than five hundred 5 dollars per violation or suspend any of the licensee’s existing 6 licenses. 7 3. A durable medical equipment provider found to be 8 operating without a license may apply for licensure but shall 9 cease operations until a license is issued by the board. 10 Sec. 16. Section 272C.1, subsection 6, Code 2015, is amended 11 by adding the following new paragraph: 12 NEW PARAGRAPH . ag. The board of durable medical equipment 13 providers created pursuant to chapter 147. 14 Sec. 17. INITIAL APPOINTMENTS. Notwithstanding any 15 provision to the contrary in this Act, the initial appointees 16 to the board of durable medical equipment providers established 17 pursuant to this Act shall hold accreditation from an 18 accrediting organization, as defined in section 154G.1, as 19 enacted in this Act. 20 Sec. 18. EFFECTIVE UPON ENACTMENT. The following 21 provision or provisions of this Act, being deemed of immediate 22 importance, take effect upon enactment: 23 1. The sections of this Act amending sections 147.13, 24 147.14, and 272C.1, and the section relating to initial 25 appointments to the board of durable medical equipment 26 providers. 27 Sec. 19. EFFECTIVE DATE AND IMPLEMENTATION. The following 28 provision or provisions of this Act take effect January 1, 29 2016, except that the board of durable medical equipment 30 providers may begin implementation prior to January 1, 2016, to 31 the extent necessary to transition to full implementation of 32 these provisions of this Act: 33 1. The sections of this Act amending sections 147.1 and 34 147.2, and enacting sections 154G.1 through 154G.11. 35 -16- LSB 1109SV (2) 86 tr/nh 16/ 19

S.F. 372 EXPLANATION 1 The inclusion of this explanation does not constitute agreement with 2 the explanation’s substance by the members of the general assembly. 3 This bill establishes a licensing procedure and standards of 4 practice for durable medical equipment providers. 5 The bill creates a new licensing board, the board of durable 6 medical equipment providers. The board shall be responsible 7 for administering the licensing procedure and regulating 8 durable medical equipment providers. The bill makes Code 9 chapters 147 and 272C, including penalty and other regulatory 10 provisions, applicable to the practice of durable medical 11 equipment providing. 12 Under the bill, persons or entities who hold themselves out 13 to the public as providers of durable medical equipment must 14 have a license issued by the board. To operate as a durable 15 medical equipment provider, a person or entity must have a 16 place of business open to the public at least 30 hours per 17 week. If the person or entity has multiple locations, it must 18 have a license for each location. If the person or entity’s 19 principal place of business is located out of state but within 20 50 miles of the state and does business in the state, it need 21 not maintain a location in Iowa. 22 If a durable medical equipment provider is accredited by 23 an organization recognized by the centers for Medicare and 24 Medicaid services of the United States department of health and 25 human services and provides proof of such accreditation to the 26 board, the board shall grant the provider a license. Licenses 27 shall be issued for two years. An inspection is required 28 before a license can be issued. The board shall establish the 29 fees for new licenses and for renewals. The bill enumerates 30 a list of groups who are not required to meet the licensure 31 requirements. 32 Any person operating as a durable medical equipment provider 33 without a license commits a class “D” felony and shall cease 34 operation until a license is issued by the board. 35 -17- LSB 1109SV (2) 86 tr/nh 17/ 19

S.F. 372 An applicant for a durable medical equipment provider 1 license must complete the form made available by the board. 2 The applicant must also provide a report specifying by category 3 the equipment and services to be provided and indicating those 4 offered either directly by the applicant or through contractual 5 arrangements with existing providers. An applicant must 6 provide a list of entities with whom it contracts for the 7 provision of equipment and services. An initial applicant 8 must provide proof of professional and commercial liability 9 insurance as well as financial stability in the form of a 10 $50,000 surety bond or an existing surety bond for Medicare 11 credentialing. 12 An applicant’s general manager and senior financial officer 13 must submit to and pay for the costs of a criminal background 14 check conducted by the division of criminal investigation 15 of the department of public safety. The board may require 16 background checks of any board of director members or of owners 17 who hold at least a 5 percent stake in an applicant entity. 18 The applicant must disclose information regarding felonies 19 committed by a member of the board of directors, its officers, 20 or any individual owning 5 percent or more of the applicant 21 entity. 22 The board may deny, revoke, or suspend a license, or impose 23 a civil penalty not to exceed $5,000 per violation per day if 24 a durable medical equipment provider or any of its employees 25 violates the bill or rules or commits an intentional, reckless, 26 or negligent act that materially affects the health or safety 27 of a patient. The board may deny or revoke the license of any 28 applicant that made a false representation or omission of any 29 material fact on its application, has been previously found by 30 any professional licensing, certifying, or standards board or 31 agency to have violated its standards or conditions, or has 32 been excluded, suspended, or terminated or has involuntarily 33 withdrawn from participation in any governmental or private 34 health care or health insurance program. 35 -18- LSB 1109SV (2) 86 tr/nh 18/ 19

S.F. 372 The board may investigate or inspect an applicant or 1 licensee as it considers necessary. The board shall accept 2 a survey or inspection of an accrediting organization if 3 the accreditation of the licensed durable medical equipment 4 provider is not provisional and the provider authorizes the 5 release of the organization’s report, which is received by the 6 board. 7 The provisions of the bill that create the board, allow for 8 initial board appointments, and grant the board rulemaking 9 authority shall be effective upon enactment. The remaining 10 provisions shall take effect on January 1, 2016. 11 -19- LSB 1109SV (2) 86 tr/nh 19/ 19