S.F. 457 Section 1. NEW SECTION . 147A.30 Definitions. 1 As used in this subchapter, unless the context otherwise 2 requires: 3 1. “Department” means the department of public health. 4 2. “Emergency medical services” or “EMS” means as defined 5 in section 147A.1. 6 3. “Emergency medical services medical director” means as 7 defined in section 147A.1. 8 Sec. 2. NEW SECTION . 147A.31 Designations —— level of care 9 relating to stroke. 10 1. The department shall recognize accreditation by the 11 American heart association, the joint commission on the 12 accreditation of health care organizations, or other nationally 13 recognized organization that provides such accreditation, for 14 certification of a hospital as a comprehensive stroke center, 15 a primary stroke center, or an acute stroke-ready hospital, 16 as applicable, if the hospital is in good standing with and 17 maintains certification through such national organization. 18 2. The department may suspend or revoke a hospital's 19 certification as a comprehensive stroke center, primary stroke 20 center, or acute stroke-ready hospital, after notice and 21 hearing, if the department determines that the hospital is not 22 in compliance with the requirements of this section or the 23 rules adopted under this section. 24 3. Comprehensive stroke centers and primary stroke centers 25 are encouraged to coordinate efforts, through coordinated 26 stroke care agreements with acute stroke-ready hospitals 27 throughout the state, to provide appropriate access to care for 28 acute stroke patients. The coordinating stroke care agreement 29 shall be in writing and shall include, at a minimum, all of the 30 following: 31 a. Transfer agreements for the transport of a stroke patient 32 from an acute stroke-ready hospital to a comprehensive stroke 33 center or primary stroke center for the purpose of stroke 34 treatment therapies which the acute stroke-ready hospital is 35 -1- LSB 2504SV (3) 87 pf/nh 1/ 6

S.F. 457 not capable of providing. 1 b. Communication criteria and protocols with the acute 2 stroke-ready hospital. 3 Sec. 3. NEW SECTION . 147A.32 Stroke triage assessment. 4 1. By January 15, annually, the department shall forward the 5 current list of the designated comprehensive stroke centers, 6 primary stroke centers, and acute stroke-ready hospitals, 7 to the medical director of each licensed emergency medical 8 services provider in the state. The department shall maintain 9 a copy of the list in the bureau of emergency and trauma 10 services within the department and shall post the list on the 11 department’s internet site. 12 2. The department shall specify by rules adopted pursuant to 13 chapter 17A a nationally recognized standardized sample stroke 14 triage assessment tool. The department shall distribute the 15 sample stroke triage assessment tool to each licensed emergency 16 medical services provider and shall post the tool on the 17 department’s internet site. Each licensed emergency medical 18 services provider shall use the sample stroke triage assessment 19 tool adopted by rules of the department or, alternatively, a 20 stroke triage assessment tool that is substantially similar to 21 the sample stroke triage assessment tool as part of the state 22 stroke triage process. 23 3. All licensed emergency medical services providers in the 24 state shall establish prehospital care protocols related to 25 the assessment, treatment, and transport of stroke patients by 26 licensed emergency medical services providers. Such protocols 27 shall include the development and implementation of plans 28 for the triage and transport of acute stroke patients to the 29 closest comprehensive stroke center, primary stroke center, or, 30 when appropriate, to an acute stroke-ready hospital, within a 31 specified time relative to the onset of a patient’s symptoms. 32 4. All licensed emergency medical services providers 33 in the state shall establish, as part of current training 34 requirements, protocols to assure that licensed emergency 35 -2- LSB 2504SV (3) 87 pf/nh 2/ 6

S.F. 457 medical services providers and 911 dispatch personnel receive 1 regular training on the assessment and treatment of stroke 2 patients. 3 5. All data reported under this section shall be made 4 available to the department and to any other agency that 5 has responsibility for the management and administration of 6 emergency medical services throughout the state. 7 6. This section shall not be construed to require disclosure 8 of any confidential information or other data in violation of 9 the federal Health Insurance Portability and Accountability Act 10 of 1996, Pub. L. No. 104-191. 11 Sec. 4. NEW SECTION . 147A.33 Continuous quality improvement 12 for persons with stroke. 13 1. The department shall establish and implement a plan for 14 achieving continuous quality improvement in the care provided 15 under a statewide system for stroke response and treatment. 16 In implementing the plan, the department shall do all of the 17 following: 18 a. Maintain a statewide stroke database that compiles 19 information and statistics on stroke care that align with 20 the stroke consensus metrics developed and approved by the 21 American heart association and the American stroke association. 22 The department shall utilize the “get with the guidelines – 23 stroke” or another nationally recognized data set platform with 24 confidentiality standards no less secure than those utilized 25 by the department for the statewide stroke database. To the 26 extent possible, the department shall coordinate with national 27 voluntary health organizations involved in stroke quality 28 improvement to avoid duplication and redundancy. 29 b. Require comprehensive stroke centers and primary 30 stroke centers and encourage acute stroke-ready hospitals and 31 emergency medical services providers to report data consistent 32 with nationally recognized guidelines on the treatment of 33 individuals with confirmed stroke within the state. 34 2. All data reported under this section shall be made 35 -3- LSB 2504SV (3) 87 pf/nh 3/ 6

S.F. 457 available to the department and to any other agencies that 1 have responsibility for the management and administration of 2 emergency medical services throughout the state. 3 3. Beginning September 1, 2017, and by each September 1, 4 thereafter, the department shall provide a summary report of 5 the data collected under this section to the governor and the 6 general assembly summarizing the progress made in improving 7 quality of care and patient outcomes for individuals with 8 stroke. All data shall be reported in the aggregate form and 9 shall be posted on the department’s internet site. 10 EXPLANATION 11 The inclusion of this explanation does not constitute agreement with 12 the explanation’s substance by the members of the general assembly. 13 This bill relates to stroke care quality improvement. 14 The bill provides for recognition by the department of 15 public health of accreditation by nationally recognized 16 organizations that provide accreditation, for certification of 17 a hospital as a comprehensive stroke center, a primary stroke 18 center, or an acute stroke-ready hospital, as applicable, 19 if the hospital is in good standing with and maintains 20 certification through such national organization. 21 The bill provides for suspension or revocation of a 22 hospital’s certification as a comprehensive stroke center, 23 primary stroke center, or acute stroke-ready hospital, after 24 notice and hearing, if the department determines that the 25 hospital is not in compliance with the requirements of the bill 26 or the rules adopted under the bill. 27 The bill encourages comprehensive stroke centers and primary 28 stroke centers to coordinate efforts, through coordinated 29 stroke care agreements, with acute stroke-ready hospitals 30 throughout the state, to provide appropriate access to care 31 for acute stroke patients. The coordinating stroke care 32 agreement shall be in writing and shall include, at a minimum, 33 transfer agreements between acute stroke-ready hospitals 34 and comprehensive stroke centers or primary stroke centers 35 -4- LSB 2504SV (3) 87 pf/nh 4/ 6

S.F. 457 and communication criteria and protocols with the acute 1 stroke-ready hospital. 2 The bill requires that by January 15, annually, DPH shall 3 forward the current list of the designated comprehensive 4 stroke centers, primary stroke centers, and acute stroke-ready 5 hospitals, to the medical director of each licensed emergency 6 medical services provider in the state, maintain a copy of the 7 list, and post the list on the department’s internet site. 8 The department shall specify by rule a nationally recognized 9 standardized sample stroke triage assessment tool, distribute 10 the tool to each licensed emergency medical services provider 11 and post the tool on the department’s internet site. Each 12 licensed emergency medical services provider shall use the 13 sample tool or, alternatively, a stroke triage assessment tool 14 that is substantially similar to the sample tool as part of the 15 state stroke triage process. 16 The bill requires all licensed emergency medical services 17 providers in the state to establish prehospital care protocols 18 related to the assessment, treatment, and transport of stroke 19 patients. 20 All licensed emergency medical services providers are 21 also required to establish, as part of current training 22 requirements, protocols to assure that licensed emergency 23 medical services providers and 911 dispatch personnel receive 24 regular training on the assessment and treatment of stroke 25 patients. 26 The bill requires DPH to establish and implement a plan 27 for achieving continuous quality improvement in the care 28 provided under a statewide system for stroke response and 29 treatment. In implementing the plan, the department shall: 30 maintain a statewide stroke database that compiles information 31 and statistics on stroke care; and require comprehensive 32 stroke centers and primary stroke centers and encourage acute 33 stroke-ready hospitals and emergency medical services providers 34 to report data consistent with nationally recognized guidelines 35 -5- LSB 2504SV (3) 87 pf/nh 5/ 6

S.F. 457 on the treatment of individuals with confirmed stroke within 1 the state. 2 The bill requires that beginning September 1, 2017, and 3 by each September 1, thereafter, DPH shall provide a summary 4 report of the data collected to the governor and the general 5 assembly summarizing the progress made in improving quality of 6 care and patient outcomes for individuals with stroke. All 7 data shall be reported in the aggregate form and shall be 8 posted on the department’s internet site. 9 -6- LSB 2504SV (3) 87 pf/nh 6/ 6