S.F. _____ 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 specify by rules adopted pursuant 11 to chapter 17A, the criteria for designation of a hospital as 12 a comprehensive stroke center, a primary stroke center, or an 13 acute stroke-ready hospital. A hospital seeking a designation 14 shall apply to the department for such designation, and if the 15 department determines that the hospital meets the applicable 16 criteria for the requested designation, the department shall 17 certify the hospital accordingly. 18 2. The department shall recognize, in lieu of the 19 criteria established by the department, accreditation by 20 the American heart association, the joint commission on the 21 accreditation of health care organizations, or other nationally 22 recognized organization that provides such accreditation, for 23 certification of a hospital as a comprehensive stroke center, 24 a primary stroke center, or an acute stroke-ready hospital, 25 as applicable, if the hospital is in good standing with and 26 maintains certification through such national organization. 27 3. The department may suspend or revoke a hospital's 28 certification as a comprehensive stroke center, primary stroke 29 center, or acute stroke-ready hospital, after notice and 30 hearing, if the department determines that the hospital is not 31 in compliance with the requirements of this section or the 32 rules adopted under this section. 33 4. Comprehensive stroke centers and primary stroke centers 34 are encouraged to coordinate efforts, through coordinated 35 -1- LSB 2504XC (4) 87 pf/nh 1/ 6

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

S.F. _____ licensed emergency medical services providers. Such protocols 1 shall include the development and implementation of plans 2 for the triage and transport of acute stroke patients to the 3 closest comprehensive stroke center, primary stroke center, or, 4 when appropriate, to an acute stroke-ready hospital, within a 5 specified time relative to the onset of a patient’s symptoms. 6 4. All licensed emergency medical services providers 7 in the state shall establish, as part of current training 8 requirements, protocols to assure that licensed emergency 9 medical services providers and 911 dispatch personnel receive 10 regular training on the assessment and treatment of stroke 11 patients. 12 5. All data reported under this section shall be made 13 available to the department and to any other agency that 14 has responsibility for the management and administration of 15 emergency medical services throughout the state. 16 6. This section shall not be construed to require disclosure 17 of any confidential information or other data in violation of 18 the federal Health Insurance Portability and Accountability Act 19 of 1996, Pub. L. No. 104-191. 20 Sec. 4. NEW SECTION . 147A.33 Continuous quality improvement 21 for persons with stroke. 22 1. The department shall establish and implement a plan for 23 achieving continuous quality improvement in the care provided 24 under a statewide system for stroke response and treatment. 25 In implementing the plan, the department shall do all of the 26 following: 27 a. Maintain a statewide stroke database that compiles 28 information and statistics on stroke care that align with 29 the stroke consensus metrics developed and approved by the 30 American heart association and the American stroke association. 31 The department shall utilize the “get with the guidelines – 32 stroke” or another nationally recognized data set platform with 33 confidentiality standards no less secure than those utilized 34 by the department for the statewide stroke database. To the 35 -3- LSB 2504XC (4) 87 pf/nh 3/ 6

S.F. _____ extent possible, the department shall coordinate with national 1 voluntary health organizations involved in stroke quality 2 improvement to avoid duplication and redundancy. 3 b. Require comprehensive stroke centers and primary 4 stroke centers and encourage acute stroke-ready hospitals and 5 emergency medical services providers to report data consistent 6 with nationally recognized guidelines on the treatment of 7 individuals with confirmed stroke within the state. 8 2. All data reported under this section shall be made 9 available to the department and to any other agencies that 10 have responsibility for the management and administration of 11 emergency medical services throughout the state. 12 3. Beginning September 1, 2017, and by each September 1, 13 thereafter, the department shall provide a summary report of 14 the data collected under this section to the governor and the 15 general assembly summarizing the progress made in improving 16 quality of care and patient outcomes for individuals with 17 stroke. All data shall be reported in the aggregate form and 18 shall be posted on the department’s internet site. 19 EXPLANATION 20 The inclusion of this explanation does not constitute agreement with 21 the explanation’s substance by the members of the general assembly. 22 This bill relates to stroke care quality improvement. 23 The bill provides for designation of hospitals in the state 24 as comprehensive stroke centers, primary stroke centers, or 25 acute stroke-ready hospitals. A hospital seeking a designation 26 shall apply to the department of public health (DPH) for 27 designation, and if the department determines the hospital 28 meets the applicable criteria for the requested designation, 29 the department shall certify the hospital accordingly. The 30 bill directs DPH to recognize, in lieu of the criteria 31 established by the department, accreditation by nationally 32 recognized organizations that provide accreditation, for 33 certification of a hospital as a comprehensive stroke center, 34 a primary stroke center, or an acute stroke-ready hospital, 35 -4- LSB 2504XC (4) 87 pf/nh 4/ 6

S.F. _____ as applicable, if the hospital is in good standing with and 1 maintains certification through such national organization. 2 The bill provides for suspension or revocation of a 3 hospital’s certification as a comprehensive stroke center, 4 primary stroke center, or acute stroke-ready hospital, after 5 notice and hearing, if the department determines that the 6 hospital is not in compliance with the requirements of the bill 7 or the rules adopted under the bill. 8 The bill encourages comprehensive stroke centers and primary 9 stroke centers to coordinate efforts, through coordinated 10 stroke care agreements, with acute stroke-ready hospitals 11 throughout the state, to provide appropriate access to care 12 for acute stroke patients. The coordinating stroke care 13 agreement shall be in writing and shall include, at a minimum, 14 transfer agreements between acute stroke-ready hospitals 15 and comprehensive stroke centers or primary stroke centers 16 and communication criteria and protocols with the acute 17 stroke-ready hospital. 18 The bill requires that by January 15, annually, DPH shall 19 forward the current list of the designated comprehensive 20 stroke centers, primary stroke centers, and acute stroke-ready 21 hospitals, to the medical director of each licensed emergency 22 medical services provider in the state, maintain a copy of the 23 list, and post the list on the department’s internet site. 24 The department shall specify by rule a nationally recognized 25 standardized sample stroke triage assessment tool, distribute 26 the tool to each licensed emergency medical services provider 27 and post the tool on the department’s internet site. Each 28 licensed emergency medical services provider shall use the 29 sample tool or, alternatively, a stroke triage assessment tool 30 that is substantially similar to the sample tool as part of the 31 state stroke triage process. 32 The bill requires all licensed emergency medical services 33 providers in the state to establish prehospital care protocols 34 related to the assessment, treatment, and transport of stroke 35 -5- LSB 2504XC (4) 87 pf/nh 5/ 6

S.F. _____ patients. 1 All licensed emergency medical services providers are 2 also required to establish, as part of current training 3 requirements, protocols to assure that licensed emergency 4 medical services providers and 911 dispatch personnel receive 5 regular training on the assessment and treatment of stroke 6 patients. 7 The bill requires DPH to establish and implement a plan 8 for achieving continuous quality improvement in the care 9 provided under a statewide system for stroke response and 10 treatment. In implementing the plan, the department shall: 11 maintain a statewide stroke database that compiles information 12 and statistics on stroke care; and require comprehensive 13 stroke centers and primary stroke centers and encourage acute 14 stroke-ready hospitals and emergency medical services providers 15 to report data consistent with nationally recognized guidelines 16 on the treatment of individuals with confirmed stroke within 17 the state. 18 The bill requires that beginning September 1, 2017, and 19 by each September 1, thereafter, DPH shall provide a summary 20 report of the data collected to the governor and the general 21 assembly summarizing the progress made in improving quality of 22 care and patient outcomes for individuals with stroke. All 23 data shall be reported in the aggregate form and shall be 24 posted on the department’s internet site. 25 -6- LSB 2504XC (4) 87 pf/nh 6/ 6