H.F. 2324 Section 1. Section 10A.711, subsection 2, Code 2024, is 1 amended to read as follows: 2 2. “Ambulatory surgical center” means ambulatory surgical 3 center as defined in section 135R.1 a distinct facility that 4 operates primarily 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 an 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 Sec. 2. Section 10A.713, subsection 2, Code 2024, is amended 17 by adding the following new paragraph: 18 NEW PARAGRAPH . q. Cosmetic, reconstructive, or plastic 19 surgery services provided in an ambulatory surgical center 20 licensed under chapter 135R. 21 Sec. 3. Section 135R.3, subsection 1, Code 2024, is amended 22 to read as follows: 23 1. An applicant for an ambulatory surgical center license 24 shall submit an application to the department. Applications 25 shall be upon such forms and shall include such information 26 as the department may reasonably require, which may include 27 affirmative evidence of the ability to comply with reasonable 28 rules and standards prescribed under this chapter but which 29 shall not exceed either the requirements for applications 30 required by Medicare , or an accreditation standard for the 31 joint commission, the American association for accreditation of 32 ambulatory surgical facilities, the accreditation association 33 for ambulatory health care, or an accrediting organization with 34 deeming authority authorized by the centers for Medicare and 35 -1- LSB 5792HV (2) 90 pf/ko 1/ 4

H.F. 2324 Medicaid services of the United States department of health and 1 human services. 2 Sec. 4. Section 135R.4, subsection 1, Code 2024, is amended 3 to read as follows: 4 1. The department, with the advice and approval of the 5 council on health and human services, shall adopt rules 6 specifying the standards for ambulatory surgical centers to be 7 licensed under this chapter . The rules shall be consistent 8 with and shall not exceed the requirements of this chapter and 9 the conditions for coverage in the federal Medicare program 10 for ambulatory surgical centers under 42 C.F.R. pt. 416 , 11 or an accreditation standard for the joint commission, the 12 American association for accreditation of ambulatory surgical 13 facilities, the accreditation association for ambulatory health 14 care, or an accrediting organization with deeming authority 15 authorized by the centers for Medicare and Medicaid services of 16 the United States department of health and human services . 17 Sec. 5. Section 135R.5, subsection 2, Code 2024, is amended 18 to read as follows: 19 2. The department shall recognize, in lieu of its own 20 licensure inspection, the comparable inspection and inspection 21 findings of a Medicare conditions for coverage survey completed 22 by the department or an accrediting organization survey from an 23 accrediting organization with deeming authority authorized by 24 the centers for Medicare and Medicaid services of the United 25 States department of health and human services. An ambulatory 26 surgical center utilizing an accrediting organization survey 27 to satisfy the requirements of this section shall submit an 28 accreditation certificate to the department within thirty days 29 of completion of each accrediting organization survey. 30 EXPLANATION 31 The inclusion of this explanation does not constitute agreement with 32 the explanation’s substance by the members of the general assembly. 33 This bill relates to ambulatory surgical centers (ASCs). 34 The bill defines “ambulatory surgical center” differently 35 -2- LSB 5792HV (2) 90 pf/ko 2/ 4

H.F. 2324 for the purposes of Code chapter 10A (department of 1 inspections, appeals, and licensing) relative to the health 2 facilities council and certificate of need as compared with 3 Code chapter 135R (ambulatory surgical centers). Under Code 4 section 10A.711, “ambulatory surgical center” does not include 5 the individual or group practice office of a private physician, 6 podiatrist, or dentist who there engages in the lawful practice 7 of surgery, or the portion of a licensed hospital designated 8 for outpatient surgical treatment. Under Code section 135R.1, 9 “ambulatory surgical center” does not include the individual or 10 group practice office of a private physician, podiatrist, or 11 dentist who there engages in the lawful practice of surgery, 12 not including cosmetic, reconstructive, or plastic surgery, or 13 the portion of a licensed hospital designated for outpatient 14 surgical treatment. 15 The bill also exempts from the applicability of certificate 16 of need requirements, cosmetic, reconstructive, or plastic 17 surgery services provided in an ambulatory surgical center as 18 defined in Code section 135R.1, and as licensed pursuant to 19 Code chapter 135R. 20 The bill amends Code section 135R.3(1) and Code section 21 135R.4(1) to provide that the application requirements for an 22 ASC license and the rules adopted specifying standards for an 23 ASC shall not exceed, as applicable, either the requirements 24 for applications or the conditions for coverage required 25 by Medicare, or an accreditation standard for the joint 26 commission, the American association for accreditation of 27 ambulatory surgical facilities, the accreditation association 28 for ambulatory health care, or an accrediting organization with 29 deeming authority authorized by the centers for Medicare and 30 Medicaid services (CMS) of the United States department of 31 health and human services. 32 Code section 135R.5(2) provides that the department of 33 inspections, appeals, and licensing (DIAL) shall recognize, in 34 lieu of its own licensure inspection, the comparable inspection 35 -3- LSB 5792HV (2) 90 pf/ko 3/ 4

H.F. 2324 and inspections findings of a Medicare conditions survey 1 completed by DIAL or an accrediting organization with deeming 2 authority authorized by CMS. The bill provides instead that 3 DIAL shall recognize the comparable inspection and inspections 4 findings of a Medicare conditions survey completed by DIAL 5 or an accrediting organization survey from an accrediting 6 organization with deeming authority authorized by CMS. An ASC 7 utilizing an accrediting organization survey as specified shall 8 submit an accreditation certificate to DIAL within 30 days of 9 completion of each accrediting organization survey. 10 -4- LSB 5792HV (2) 90 pf/ko 4/ 4