SF 2021 (LSB 5391XS (3) 87)

SENATE FILE 2021

BY  ZAUN

A BILL FOR

An Act relating to the elimination of the certificate of need process relating to the development of a new or changed institutional health service.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  Section 68B.35, subsection 2, paragraph e, Code 2018, is amended to read as follows:
   e.  Members of the state banking council, the Iowa ethics and campaign disclosure board, the credit union review board, the economic development authority, the employment appeal board, the environmental protection commission, the health facilities council, the Iowa finance authority, the Iowa public employees’ retirement system investment board, the board of the Iowa lottery authority, the natural resource commission, the board of parole, the petroleum underground storage tank fund board, the public employment relations board, the state racing and gaming commission, the state board of regents, the transportation commission, the office of consumer advocate, the utilities board, the Iowa telecommunications and technology commission, and any full-time members of other boards and commissions as defined under section 7E.4 who receive an annual salary for their service on the board or commission. The Iowa ethics and campaign disclosure board shall conduct an annual review to determine if members of any other board, commission, or authority should file a statement and shall require the filing of a statement pursuant to rules adopted pursuant to chapter 17A.
    Sec. 2.  Section 97B.1A, subsection 8, paragraph a, subparagraph (8), Code 2018, is amended to read as follows:
   (8)  Members of the state transportation commission, and the board of parole, and the state health facilities council.
    Sec. 3.  Section 135.131, subsection 1, paragraph a, Code 2018, is amended to read as follows:
   a.  “Birth center” means birth center as defined in section 135.61 a facility or institution, which is not an ambulatory surgical center or a hospital or in a hospital, in which births are planned to occur following a normal, uncomplicated, low-risk pregnancy.
    Sec. 4.  Section 135C.2, subsection 5, unnumbered paragraph 1, Code 2018, is amended to read as follows:
   The department shall establish a special classification within the residential care facility category in order to foster the development of residential care facilities which serve persons with an intellectual disability, chronic mental illness, a developmental disability, or brain injury, as described under section 225C.26, and which contain five or fewer residents. A facility within the special classification established pursuant to this subsection is exempt from the requirements of section 135.63. The department shall adopt rules which are consistent with rules previously developed for the waiver demonstration project pursuant to 1986 Iowa Acts, ch. 1246, §206, and which include all of the following provisions:
    Sec. 5.  Section 135H.6, Code 2018, is amended to read as follows:
   135H.6  Inspection —— conditions for issuance.
   The department shall issue a license to an applicant under this chapter if all the following conditions exist:
   1.  The department has ascertained that the applicant’s medical facilities and staff are adequate to provide the care and services required of a psychiatric institution.
   2.  The proposed psychiatric institution is accredited by the joint commission on the accreditation of health care organizations, the commission on accreditation of rehabilitation facilities, the council on accreditation of services for families and children, or by any other recognized accrediting organization with comparable standards acceptable under federal regulation.
   3.  The applicant complies with applicable state rules and standards for a psychiatric institution adopted by the department in accordance with federal requirements under 
42 C.F.R. §441.150 – 441.156
.
   4.  The applicant has been awarded a certificate of need pursuant to chapter 135, unless exempt as provided in this section.
   5.  4.  The department of human services has submitted written approval of the application based on the department of human services’ determination of need. The department of human services shall identify the location and number of children in the state who require the services of a psychiatric medical institution for children. Approval of an application shall be based upon the location of the proposed psychiatric institution relative to the need for services identified by the department of human services and an analysis of the applicant’s ability to provide services and support consistent with requirements under chapter 232, particularly regarding community-based treatment. If the proposed psychiatric institution is not freestanding from a facility licensed under chapter 135B or 135C, approval under this subsection shall not be given unless the department of human services certifies that the proposed psychiatric institution is capable of providing a resident with a living environment similar to the living environment provided by a licensee which is freestanding from a facility licensed under chapter 135B or 135C.
   6.  5.  The department of human services shall not give approval to an application which would cause the total number of beds licensed under this chapter for services reimbursed by the medical assistance program under chapter 249A to exceed four hundred thirty beds.
   7.  6.  In addition to the beds authorized under subsection 6 5, the department of human services may establish not more than thirty beds licensed under this chapter at the state mental health institute at Independence. The beds shall be exempt from the certificate of need requirement under subsection 4.
   8.  7.  The department of human services may give approval to conversion of beds approved under subsection 6 5, to beds which are specialized to provide substance abuse treatment. However, the total number of beds approved under subsection 6 5 and this subsection shall not exceed four hundred thirty. Conversion of beds under this subsection shall not require a revision of the certificate of need issued for the psychiatric institution making the conversion. Beds for children who do not reside in this state and whose service costs are not paid by public funds in this state are not subject to the limitations on the number of beds and certificate of need requirements otherwise applicable under this section.
   9.  8.  The proposed psychiatric institution is under the direction of an agency which has operated a facility licensed under section 237.3, subsection 2, paragraph “a”, as a comprehensive residential facility for children for three years or of an agency which has operated a facility for three years providing psychiatric services exclusively to children or adolescents and the facility meets or exceeds requirements for licensure under section 237.3, subsection 2, paragraph “a”, as a comprehensive residential facility for children.
   10.  9.  A psychiatric institution licensed prior to July 1, 1999, may exceed the number of beds authorized under subsection 6 5 if the excess beds are used to provide services funded from a source other than the medical assistance program under chapter 249A. Notwithstanding subsections 4, 5, and 6, the provision of services using those excess beds does not require a certificate of need or a review by the department of human services.
   11.  10.  If a child has an emotional, behavioral, or mental health disorder, the psychiatric institution does not require court proceedings to be initiated or that a child’s parent, guardian, or custodian must terminate parental rights over or transfer legal custody of the child for the purpose of obtaining treatment from the psychiatric institution for the child. Relinquishment of a child’s custody shall not be a condition of the child receiving services.
    Sec. 6.  Section 135P.1, subsection 3, Code 2018, is amended to read as follows:
   3.  “Health facility” means an institutional health facility as defined in section 135.61, hospice licensed under chapter 135J, home health agency as defined in section 144D.1, assisted living program certified under chapter 231C, clinic, or community health center, and includes any corporation, professional corporation, partnership, limited liability company, limited liability partnership, or other entity comprised of such health facilities.
    Sec. 7.  Section 135P.1, Code 2018, is amended by adding the following new subsection:
   NEW SUBSECTION.  3A.  “Institutional health facility” means any of the following, without regard to whether the facilities referred to are publicly or privately owned or are organized for profit or not or whether the facilities are part of or sponsored by a health maintenance organization:
   a.  A hospital.
   b.  A health care facility.
   c.  An organized outpatient health facility.
   d.  An outpatient surgical facility.
   e.  A community mental health facility.
   f.  A birth center.
    Sec. 8.  Section 231C.3, subsection 2, Code 2018, is amended to read as follows:
   2.  Each assisted living program operating in this state shall be certified by the department. If an assisted living program is voluntarily accredited by a recognized accrediting entity, the department shall certify the assisted living program on the basis of the voluntary accreditation. An assisted living program that is certified by the department on the basis of voluntary accreditation shall not be subject to payment of the certification fee prescribed in section 231C.18, but shall be subject to an administrative fee as prescribed by rule. An assisted living program certified under this section is exempt from the requirements of section 135.63 relating to certificate of need requirements.
    Sec. 9.  Section 249K.2, subsection 6, Code 2018, is amended to read as follows:
   6.  “New construction” means the construction of a new nursing facility which does not replace an existing licensed and certified facility and requires the provider to obtain a certificate of need pursuant to chapter 135, division VI.
    Sec. 10.  Section 505.27, subsection 5, paragraph a, Code 2018, is amended to read as follows:
   a.  “Health care provider” means the same as defined in section 135.61, a person licensed or certified under chapter 147, 148, 148A, 148C, 149, 151, 152, 153, 154, 154B, 154F, or 155A to provide in this state professional health care service to an individual during that individual’s medical care, treatment, or confinement; a hospital licensed pursuant to chapter 135B;, or a health care facility licensed pursuant to chapter 135C.
    Sec. 11.  Section 708.3A, subsection 5, paragraph d, Code 2018, is amended to read as follows:
   d.  “Health care provider” means an emergency medical care provider as defined in chapter 147A or a person licensed or registered under chapter 148, 148C, 148D, or 152 who is providing or who is attempting to provide emergency medical services, as defined in section 147A.1, or who is providing or who is attempting to provide health services as defined in section 135.61 in a hospital. A person who commits an assault under this section against a health care provider in a hospital, or at the scene or during out-of-hospital patient transportation in an ambulance, is presumed to know that the person against whom the assault is committed is a health care provider.
    Sec. 12.  Section 708.3A, subsection 5, Code 2018, is amended by adding the following new paragraph:
   NEW PARAGRAPH.  0e.  “Health services” means clinically related diagnostic, curative, or rehabilitative services, and includes alcoholism, drug abuse, and mental health services.
    Sec. 13.  REPEAL.  Sections 135.61 through 135.73, Code 2018, are repealed.
    Sec. 14.  CODE EDITOR DIRECTIVE.  The Code editor is directed to modify the title of chapter 135, division VI, as “Hospital and health care facility reporting, data, analyses, and studies” and to correct internal references in the Code as necessary due to enactment of this Act.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill eliminates the certificate of need (CON) process required prior to the offering or development of a new or changed institutional health service and makes conforming changes throughout the Code.