H.F. 2388 Section 1. NEW SECTION . 135Q.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 admission. “ Ambulatory surgical center” 8 includes a facility certified or seeking certification as an 9 ambulatory surgical center under the federal Medicare program 10 or under the medical assistance program established pursuant 11 to chapter 249A. “Ambulatory surgical center” does not include 12 the individual or group practice office of a private physician, 13 podiatrist, or dentist who there engages in the lawful practice 14 of surgery, or the portion of a licensed hospital designated 15 for outpatient surgical treatment. 16 2. “Department” means the department of inspections and 17 appeals. 18 Sec. 2. NEW SECTION . 135Q.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 . 135Q.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 . 135Q.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. An application for an initial license for an ambulatory 35 -1- LSB 5832HV (3) 89 pf/rh 1/ 15

H.F. 2388 surgical center shall be accompanied by a fee of fifty dollars. 1 3. The fees collected under this section shall be considered 2 repayment receipts as defined in section 8.2 and shall be used 3 by the department to administer this chapter. 4 Sec. 5. NEW SECTION . 135Q.5 Issuance and renewal of 5 license. 6 1. Upon receipt of an application for license and the 7 license fee, the department shall issue a license if the 8 applicant and the ambulatory surgical center meet the 9 requirements of this chapter and the rules adopted by the 10 department. 11 2. A license shall be issued only for the premises and 12 persons named in the application. 13 3. A license is not transferable or assignable except with 14 the written approval of the department. 15 4. A license shall be posted in a conspicuous place on the 16 licensed premises as prescribed by rule of the department. 17 5. Separate licenses are not required for ambulatory 18 surgical center facilities that are maintained on the same 19 physical site and that have the same ownership or control. 20 Multiple buildings located on the same physical site under the 21 same ownership or control shall be considered one ambulatory 22 surgical center facility for purposes of this chapter and 23 section 135.61, and may operate under one license. 24 6. A license, unless sooner suspended or revoked, shall 25 expire on June 30 of each year and shall be renewed annually. 26 The department shall renew a license upon payment of a five 27 hundred dollar annual license renewal fee and filing of an 28 application for renewal at least thirty days prior to the 29 expiration of the existing license. The annual licensure fee 30 shall be considered a repayment receipt as defined in section 31 8.2 and dedicated to support the staffing necessary to conduct 32 the inspections and investigations provided in section 135Q.8. 33 Sec. 6. NEW SECTION . 135Q.6 Denial, suspension, or 34 revocation of license —— hearings and review. 35 -2- LSB 5832HV (3) 89 pf/rh 2/ 15

H.F. 2388 1. The department may deny, suspend, or revoke a license in 1 any case where it finds there has been a substantial failure 2 to comply with this chapter or the rules and standards adopted 3 under this chapter. 4 2. The denial, suspension, or revocation of a license by 5 the department and appeal from that action are governed by the 6 procedures for a contested case hearing under chapter 17A. 7 3. a. If the department finds, after providing notice of 8 noncompliance and a reasonable time for corrective action, that 9 an ambulatory surgical center is in repeated noncompliance with 10 this chapter or the department’s rules but that noncompliance 11 does not endanger public health or safety, the department may 12 issue a conditional license to the ambulatory surgical center 13 as an alternative to suspending or revoking the ambulatory 14 surgical center’s license. 15 b. The department shall provide notice of its intent to 16 issue a conditional license to the ambulatory surgical center 17 and of the items of noncompliance not less than ten days before 18 the date the conditional license is issued. 19 c. The department shall designate a period of not more 20 than one year during which the ambulatory surgical center may 21 operate under a conditional license. 22 d. During the period an ambulatory surgical center is 23 operating under a conditional license, the ambulatory surgical 24 center shall correct the items that are in noncompliance and 25 report the corrections to the department for approval. 26 4. The department may suspend or revoke the license of an 27 ambulatory surgical center that does not correct items that 28 are in noncompliance or that does not comply with this chapter 29 or the rules adopted under this chapter within the applicable 30 period. 31 5. The department may issue an emergency order to suspend 32 a license issued under this chapter if the department has 33 reasonable cause to believe that the conduct of the ambulatory 34 surgical center creates an immediate danger to the public 35 -3- LSB 5832HV (3) 89 pf/rh 3/ 15

H.F. 2388 health and safety. An emergency suspension is effective 1 immediately without a hearing or notice to the licensee. On 2 written request of the licensee, the department shall conduct 3 a hearing not earlier than the tenth day or later than the 4 thirtieth day after the date the hearing request is received 5 to determine if the emergency suspension is to be continued, 6 modified, or rescinded. The hearing and any appeal are 7 governed by the department’s rules for a contested case hearing 8 and chapter 17A. 9 Sec. 7. NEW SECTION . 135Q.7 Rules. 10 1. The department, with the advice and approval of the state 11 board of health, shall adopt rules specifying the standards for 12 ambulatory surgical centers to be licensed under this chapter. 13 The rules shall be consistent with and shall not exceed the 14 requirements of this chapter and the conditions for coverage in 15 the federal Medicare program for ambulatory surgical centers 16 under 42 C.F.R. pt. 416. 17 2. The department shall adopt rules as the department deems 18 necessary to implement the provisions of this chapter relating 19 to the issuance, renewal, denial, suspension, and revocation 20 of a license to establish, operate, and maintain an ambulatory 21 surgical center. 22 3. An ambulatory surgical center which is in operation at 23 the time of adoption of any applicable rules or standards under 24 this chapter shall be given a reasonable time, not to exceed 25 one year from the date of adoption, within which to comply with 26 such rules and standards. 27 4. The department shall enforce the rules. 28 Sec. 8. NEW SECTION . 135Q.8 Inspections. 29 1. The department shall make or cause to be made inspections 30 or investigations of ambulatory surgical centers to determine 31 compliance with this chapter and applicable rules and 32 standards. The department shall perform inspections on a 33 schedule that is of the same frequency required for inspections 34 of Medicare-certified ambulatory surgical centers. 35 -4- LSB 5832HV (3) 89 pf/rh 4/ 15

H.F. 2388 2. The department shall recognize, in lieu of its own 1 licensure inspection, the comparable inspection and inspection 2 findings of a Medicare conditions for coverage survey completed 3 by the department or an accrediting organization authorized by 4 the centers for Medicare and Medicaid services with deeming 5 authority. 6 3. A department inspector shall not participate in an 7 inspection or investigation of an ambulatory surgical center in 8 which the inspector or a member of the inspector’s immediate 9 family works or has worked within the last two years or in 10 which the inspector or the inspector’s immediate family has 11 a financial ownership interest. For the purposes of this 12 section, “immediate family member” means a spouse, natural or 13 adoptive parent or grandparent, child, grandchild, sibling, 14 stepparent, stepchild, or stepsibling. 15 Sec. 9. NEW SECTION . 135Q.9 Employee background checks 16 penalty. 17 1. a. Prior to employment of a person in an ambulatory 18 surgical center, the ambulatory surgical center shall request 19 that the department of public safety perform a criminal 20 history check and the department of human services perform 21 child and dependent adult abuse record checks of the person 22 in this state. An ambulatory surgical center shall inform 23 all persons prior to employment regarding the performance of 24 the record checks and shall obtain from the persons a signed 25 acknowledgment of the receipt of the information. 26 b. An ambulatory surgical center shall include the following 27 inquiry in an application for employment: 28 Do you have a record of founded child or dependent adult abuse 29 or have you ever been convicted of a crime, in this state or any 30 other state? 31 2. a. If it is determined that a person being considered 32 for employment in an ambulatory surgical center has been 33 convicted of a crime, the department of public safety shall 34 notify the ambulatory surgical center that upon the request 35 -5- LSB 5832HV (3) 89 pf/rh 5/ 15

H.F. 2388 of the ambulatory surgical center the department of human 1 services will perform an evaluation to determine whether the 2 crime warrants prohibition of the person’s employment in the 3 ambulatory surgical center. 4 b. If a department of human services child or dependent 5 adult abuse record check shows that the person has a record of 6 founded child or dependent adult abuse, the department of human 7 services shall notify the ambulatory surgical center that upon 8 the request of the ambulatory surgical center the department of 9 human services will perform an evaluation to determine whether 10 the founded child or dependent adult abuse warrants prohibition 11 of the person’s employment in the ambulatory surgical center. 12 c. An evaluation performed under this subsection shall 13 be performed in accordance with procedures adopted for this 14 purpose by the department of human services. 15 d. (1) If a person owns or operates more than one 16 ambulatory surgical center, and an employee of one of such 17 ambulatory surgical centers is transferred to another such 18 ambulatory surgical center without a lapse in employment, 19 the ambulatory surgical center is not required to request 20 additional criminal and child and dependent adult abuse record 21 checks of that employee. 22 (2) If the ownership of an ambulatory surgical center is 23 transferred, at the time of transfer the record checks required 24 by this section shall be performed for each employee for whom 25 there is no documentation that such record checks have been 26 performed. The ambulatory surgical center may continue to 27 employ such employee pending the performance of the record 28 checks and any related evaluation. 29 3. In an evaluation, the department of human services 30 shall consider the nature and seriousness of the crime 31 or founded child or dependent adult abuse in relation to 32 the position sought or held, the time elapsed since the 33 commission of the crime or founded child or dependent adult 34 abuse, the circumstances under which the crime or founded 35 -6- LSB 5832HV (3) 89 pf/rh 6/ 15

H.F. 2388 child or dependent adult abuse was committed, the degree of 1 rehabilitation, the likelihood that the person will commit 2 the crime or founded child or dependent adult abuse again, 3 and the number of crimes or founded child or dependent adult 4 abuses committed by the person involved. If the department of 5 human services performs an evaluation for the purposes of this 6 section, the department of human services has final authority 7 in determining whether prohibition of the person’s employment 8 is warranted. 9 4. a. Except as provided in paragraph “b” and subsection 2, 10 a person who has been convicted of a crime or has a record of 11 founded child or dependent adult abuse shall not be employed 12 in an ambulatory surgical center licensed under this chapter 13 unless an evaluation has been performed by the department of 14 human services. 15 b. A person with a criminal or abuse record who is or was 16 employed by an ambulatory surgical center licensed under this 17 chapter and is hired by an employer who is another licensee 18 without a lapse in employment shall be subject to the criminal 19 history and abuse record checks required pursuant to subsection 20 1. However, if an evaluation was previously performed by the 21 department of human services concerning the person’s criminal 22 or abuse record and it was determined that the record did not 23 warrant prohibition of the person’s employment and the latest 24 record checks do not indicate a crime was committed or founded 25 abuse record was entered subsequent to that evaluation, the 26 person may commence employment with the other licensee in 27 accordance with the department of human services’ evaluation 28 and an exemption from the requirements in paragraph “a” for 29 reevaluation of the latest record checks is authorized. 30 Otherwise, the requirements of paragraph “a” remain applicable 31 to the person’s employment. Authorization of an exemption 32 under this lettered paragraph “b” from requirements for 33 reevaluation of the latest record checks by the department of 34 human services is subject to all of the following provisions: 35 -7- LSB 5832HV (3) 89 pf/rh 7/ 15

H.F. 2388 (1) The position with the subsequent employer is 1 substantially the same or has the same job responsibilities as 2 the position for which the previous evaluation was performed. 3 (2) Any restrictions placed on the person’s employment in 4 the previous evaluation by the department of human services 5 shall remain applicable in the person’s subsequent employment. 6 (3) The person subject to the record checks has maintained a 7 copy of the previous evaluation and provides the evaluation to 8 the subsequent employer or the previous licensee provides the 9 previous evaluation from the person’s personnel file pursuant 10 to the person’s authorization. If a physical copy of the 11 previous evaluation is not provided to the subsequent employer 12 the record checks shall be reevaluated. 13 (4) Although an exemption under this lettered paragraph “b” 14 may be authorized, the subsequent employer may instead request 15 a reevaluation of the record checks and may employ the person 16 while the reevaluation is being performed. 17 5. a. If a person employed by an ambulatory surgical center 18 licensed under this chapter is convicted of a crime or has a 19 record of founded child or dependent adult abuse entered in the 20 abuse registry after the person’s employment application date, 21 the person shall inform the ambulatory surgical center of such 22 information within forty-eight hours of the criminal conviction 23 or entry of the record of founded child or dependent adult 24 abuse. The ambulatory surgical center shall act to verify 25 the information within forty-eight hours of notification. If 26 the information is verified, the requirements of subsections 27 2, 3, and 4 regarding employability and evaluations shall 28 be applied by the ambulatory surgical center to determine 29 whether or not the person’s employment is continued. The 30 ambulatory surgical center may continue to employ the person 31 pending the performance of an evaluation by the department 32 of human services to determine whether prohibition of the 33 person’s employment is warranted. A person who is required by 34 this subsection to inform the ambulatory surgical center of 35 -8- LSB 5832HV (3) 89 pf/rh 8/ 15

H.F. 2388 a conviction or entry of an abuse record and fails to do so 1 within the required period commits a serious misdemeanor. 2 b. If an ambulatory surgical center receives credible 3 information, as determined by the ambulatory surgical center, 4 that a person employed by the ambulatory surgical center has 5 been convicted of a crime or a record of founded child or 6 dependent adult abuse has been entered in the abuse registry 7 after employment from a person other than the employee and the 8 employee has not informed the ambulatory surgical center of 9 such information within the period required under paragraph 10 “a” , the ambulatory surgical center shall act to verify the 11 credible information within forty-eight hours of receipt of 12 the credible information. If the information is verified, the 13 requirements of subsections 2, 3, and 4 regarding employability 14 and evaluations shall be applied by the ambulatory surgical 15 center to determine whether or not the person’s employment is 16 continued. 17 c. The ambulatory surgical center may notify the county 18 attorney for the county where the ambulatory surgical center is 19 located of any violation or failure by an employee to notify 20 the ambulatory surgical center of a criminal conviction or 21 entry of an abuse record within the period required under 22 paragraph “a” . 23 6. An ambulatory surgical center licensed under this 24 chapter may access the single contact repository established by 25 the department pursuant to section 135C.33 as necessary for the 26 ambulatory surgical center to perform record checks of persons 27 employed or being considered for employment by the ambulatory 28 surgical center. 29 Sec. 10. NEW SECTION . 135Q.10 Confidentiality. 30 The department’s final findings with respect to compliance 31 by an ambulatory surgical center with requirements for 32 licensing shall be made available to the public in a readily 33 available form and place. Other information relating to 34 an ambulatory surgical center obtained by the department 35 -9- LSB 5832HV (3) 89 pf/rh 9/ 15

H.F. 2388 which does not constitute the department’s findings from an 1 inspection of the ambulatory surgical center shall not be made 2 available to the public, except in proceedings involving the 3 denial, suspension, or revocation of a license under this 4 chapter. The name of a person who files a complaint with the 5 department shall remain confidential and shall not be subject 6 to discovery, subpoena, or other means of legal compulsion for 7 its release to a person other than department employees or 8 agents involved in the investigation of the complaint. 9 Sec. 11. NEW SECTION . 135Q.11 Injunction. 10 Notwithstanding the existence or pursuit of any other 11 remedy, the department may, in the manner provided by law, 12 maintain an action in the name of the state for injunction 13 or other process against any person to restrain or prevent 14 the establishment, operation, or maintenance of an ambulatory 15 surgical center without a license. 16 Sec. 12. NEW SECTION . 135Q.12 Judicial review. 17 Judicial review of an action of the department may be sought 18 in accordance with chapter 17A. Notwithstanding the provisions 19 of chapter 17A, petitions for judicial review may be filed 20 in the district court of the county in which the ambulatory 21 surgical center is located or is to be located and the status 22 quo of the petitioner or licensee shall be preserved pending 23 final disposition of the judicial review matter. 24 Sec. 13. NEW SECTION . 135Q.13 Penalties. 25 Any person establishing, operating, or maintaining any 26 ambulatory surgical center without a license commits a serious 27 misdemeanor, and each day of continuing violation after 28 conviction shall be considered a separate offense. 29 Sec. 14. Section 135.11, Code 2022, is amended by adding the 30 following new subsection: 31 NEW SUBSECTION . 29. Adopt rules requiring ambulatory 32 surgical centers to report quality data to the department of 33 public health that is consistent with the data required to be 34 reported to the centers for Medicare and Medicaid services 35 -10- LSB 5832HV (3) 89 pf/rh 10/ 15

H.F. 2388 of the United States department of health and human services 1 as authorized by the Medicare Improvements and Extension Act 2 of 2006 under Title I of the Tax Relief and Health Care Act 3 of 2006, Pub. L. No. 109-432, and the regulations adopted 4 under such Acts. Notwithstanding any provision of law to 5 the contrary, nothing in this subsection shall require an 6 ambulatory surgical center to provide health data to the 7 department of public health or any other public or private 8 entity that is in addition to, different than, or exceeds 9 the quality data required to be reported to the centers for 10 Medicare and Medicaid services of the United States department 11 of health and human services. 12 Sec. 15. Section 135.61, Code 2022, is amended by adding the 13 following new subsection: 14 NEW SUBSECTION . 1A. “Ambulatory surgical center” means 15 ambulatory surgical center as defined in section 135Q.1. 16 Sec. 16. Section 135.61, subsection 14, paragraph d, Code 17 2022, is amended to read as follows: 18 d. An outpatient ambulatory surgical facility center . 19 Sec. 17. Section 135.61, subsection 21, Code 2022, is 20 amended by striking the subsection. 21 EXPLANATION 22 The inclusion of this explanation does not constitute agreement with 23 the explanation’s substance by the members of the general assembly. 24 This bill creates a new Code chapter to provide for the 25 licensing and regulation of ambulatory surgical centers. The 26 department of inspections and appeals (DIA) is designated to 27 enforce the regulations. 28 The bill provides that the purpose of the new Code chapter is 29 to protect the public health, safety, and welfare by providing 30 for the licensing and regulation of ambulatory surgical 31 centers. The bill prohibits the establishment, operation, 32 or maintenance of an ambulatory surgical center in the state 33 without obtaining a license. 34 The bill provides the process for application for licensure. 35 -11- LSB 5832HV (3) 89 pf/rh 11/ 15

H.F. 2388 An application for an initial license is required to be 1 accompanied by a fee of $50. The fees collected are repayment 2 receipts and are to be used by DIA to administer the new Code 3 chapter. 4 The bill provides for the issuance and renewal of licenses. 5 A license is to be issued only for the premises and persons 6 named in the application; is not transferable or assignable 7 except with the written approval of DIA; and is required to 8 be posted in a conspicuous place on the licensed premises as 9 prescribed by rule of DIA. The bill provides that separate 10 licenses are not required for ambulatory surgical center 11 facilities that are maintained on the same physical site and 12 that have the same ownership or control. Multiple buildings 13 located on the same physical site under the same ownership or 14 control are considered one ambulatory surgical center facility 15 for purposes of the new Code chapter and Code chapter 135, 16 division VI, relating to the health facilities council and 17 certificate of need provisions, and are to be permitted to 18 operate under one license. Licenses expire on June 30 of each 19 year and are required to be renewed annually. The bill directs 20 DIA to renew a license upon payment of a $500 annual license 21 renewal fee and the filing of an application for renewal at 22 least 30 days prior to the expiration of the existing license. 23 The annual licensure fee is considered a repayment receipt and 24 is to be dedicated to support the staffing necessary to conduct 25 the inspections and investigations under the new Code chapter. 26 The bill provides for denial, suspension, or revocation of 27 licenses. A license may be denied, suspended, or revoked if 28 DIA finds there has been a substantial failure to comply with 29 the new Code chapter or the rules and standards adopted under 30 the new Code chapter. The denial, suspension, or revocation 31 of a license by DIA and appeal from that action are governed by 32 the procedures for a contested case hearing under Code chapter 33 17A. The bill authorizes DIA, after providing notice of 34 noncompliance and a reasonable time for corrective action, and 35 -12- LSB 5832HV (3) 89 pf/rh 12/ 15

H.F. 2388 if the noncompliance does not endanger public health or safety, 1 to issue a conditional license to the ambulatory surgical 2 center as an alternative to suspending or revoking its license. 3 The bill also authorizes DIA to issue an emergency order 4 to suspend a license if DIA has reasonable cause to believe 5 that the conduct of the ambulatory surgical center creates an 6 immediate danger to the public health or safety. On written 7 request of the licensee, DIA is required to conduct a hearing 8 to determine if the emergency suspension is to be continued, 9 modified, or rescinded. The hearing and any appeal are 10 governed by DIA’s rules for a contested case hearing and Code 11 chapter 17A. 12 The bill directs DIA to adopt rules with the advice and 13 approval of the state board of health to specify the standards 14 for ambulatory surgical centers. The rules are required to be 15 consistent with and not exceed the requirements of the new Code 16 chapter and the conditions for coverage in the federal Medicare 17 program for ambulatory surgical centers. DIA is also directed 18 to adopt rules relating to provisions of the new Code chapter 19 relating to the issuance, renewal, denial, suspension, and 20 revocation of a license to establish, operate, and maintain an 21 ambulatory surgical center. If an ambulatory surgical center 22 is in operation at the time of adoption of any applicable rules 23 or standards, the center is to be given a reasonable time, not 24 to exceed one year from the date of adoption, within which to 25 comply with such rules and standards. 26 The bill provides for inspections or investigations of 27 ambulatory surgical centers, and directs that DIA shall 28 perform inspections on a schedule that is of the same frequency 29 required for inspections of Medicare-certified ambulatory 30 surgical centers. The bill also requires DIA to recognize, in 31 lieu of its own licensure inspection, the comparable inspection 32 and inspection findings of a Medicare conditions for coverage 33 survey. 34 The bill prohibits a DIA inspector from participating in an 35 -13- LSB 5832HV (3) 89 pf/rh 13/ 15

H.F. 2388 inspection or investigation of an ambulatory surgical center in 1 which the inspector or a member of the inspector’s immediate 2 family works or has worked within the last two years or in 3 which the inspector or the inspector’s immediate family has a 4 financial ownership interest. 5 The bill requires an ambulatory surgical center to comply 6 with child and dependent adult abuse information and criminal 7 record checks and evaluations. 8 The bill provides confidentiality provisions relating to 9 ambulatory surgical center information. The final findings 10 with respect to compliance by an ambulatory surgical center 11 are to be made available to the public in a readily available 12 form and place. Other information relating to an ambulatory 13 surgical center shall not be made available to the public, 14 except in proceedings involving the denial, suspension, or 15 revocation of a license. The name of a person who files a 16 complaint with DIA is required to remain confidential and not 17 be subject to discovery, subpoena, or other means of legal 18 compulsion. 19 The bill provides for injunctive relief and judicial review. 20 The bill provides that any person establishing, operating, 21 or maintaining an ambulatory surgical center without a license 22 commits a serious misdemeanor, and each day of continuing 23 violation after conviction shall be considered a separate 24 offense. A serious misdemeanor is punishable by confinement 25 for no more than one year and a fine of at least $430 but not 26 more than $2,560. 27 The bill also directs the department of public health (DPH) 28 to adopt rules requiring ambulatory surgical centers to report 29 quality data to DPH that is consistent with the data required 30 to be reported to the centers for Medicare and Medicaid 31 services of the United States department of health and human 32 services. However, the rules shall not require an ambulatory 33 surgical center to provide health data to DPH or any other 34 public or private entity that is in addition to, different 35 -14- LSB 5832HV (3) 89 pf/rh 14/ 15