S.F. 1 Section 1. Section 68B.35, subsection 2, paragraph e, Code 1 2023, is amended to read as follows: 2 e. Members of the state banking council, the Iowa ethics 3 and campaign disclosure board, the credit union review board, 4 the economic development authority, the employment appeal 5 board, the environmental protection commission, the health 6 facilities council, the Iowa finance authority, the Iowa public 7 employees’ retirement system investment board, the board of 8 the Iowa lottery authority, the natural resource commission, 9 the board of parole, the petroleum underground storage tank 10 fund board, the public employment relations board, the state 11 racing and gaming commission, the state board of regents, the 12 transportation commission, the office of consumer advocate, the 13 utilities board, the Iowa telecommunications and technology 14 commission, and any full-time members of other boards and 15 commissions as defined under section 7E.4 who receive an annual 16 salary for their service on the board or commission. The Iowa 17 ethics and campaign disclosure board shall conduct an annual 18 review to determine if members of any other board, commission, 19 or authority should file a statement and shall require the 20 filing of a statement pursuant to rules adopted pursuant to 21 chapter 17A . 22 Sec. 2. Section 97B.1A, subsection 8, paragraph a, 23 subparagraph (8), Code 2023, is amended to read as follows: 24 (8) Members of the state transportation commission , and the 25 board of parole , and the state health facilities council . 26 Sec. 3. Section 135.131, subsection 1, paragraph a, Code 27 2023, is amended to read as follows: 28 a. “Birth center” means birth center as defined in section 29 135.61 a facility or institution, which is not an ambulatory 30 surgical center or a hospital or in a hospital, in which 31 births are planned to occur following a normal, uncomplicated, 32 low-risk pregnancy . 33 Sec. 4. Section 135C.2, subsection 5, unnumbered paragraph 34 1, Code 2023, is amended to read as follows: 35 -1- LSB 1297XS (2) 90 pf/rh 1/ 7

S.F. 1 The department shall establish a special classification 1 within the residential care facility category in order to 2 foster the development of residential care facilities which 3 serve persons with an intellectual disability, chronic mental 4 illness, a developmental disability, or brain injury, as 5 described under section 225C.26 , and which contain five or 6 fewer residents. A facility within the special classification 7 established pursuant to this subsection is exempt from the 8 requirements of section 135.63 . The department shall adopt 9 rules which are consistent with rules previously developed 10 for the waiver demonstration project pursuant to 1986 Iowa 11 Acts, ch. 1246, §206 , and which include all of the following 12 provisions: 13 Sec. 5. Section 135H.6, subsection 1, Code 2023, is amended 14 to read as follows: 15 1. The department shall issue a license to an applicant 16 under this chapter if all the following conditions exist: 17 a. The department has ascertained that the applicant’s 18 medical facilities and staff are adequate to provide the care 19 and services required of a psychiatric institution. 20 b. The proposed psychiatric institution is accredited 21 by the joint commission on the accreditation of health 22 care organizations, the commission on accreditation of 23 rehabilitation facilities, the council on accreditation of 24 services for families and children, or by any other recognized 25 accrediting organization with comparable standards acceptable 26 under federal regulation. 27 c. The applicant complies with applicable state rules 28 and standards for a psychiatric institution adopted by the 29 department in accordance with federal requirements under 42 30 C.F.R. §441.150 – 441.156. 31 d. The applicant has been awarded a certificate of need 32 pursuant to chapter 135 , unless exempt as provided in this 33 section . 34 e. d. The department of health and human services has 35 -2- LSB 1297XS (2) 90 pf/rh 2/ 7

S.F. 1 submitted written approval of the application based on the 1 department of health and human services’ determination of need. 2 The department of health and human services shall identify the 3 location and number of children in the state who require the 4 services of a psychiatric medical institution for children. 5 Approval of an application shall be based upon the location 6 of the proposed psychiatric institution relative to the need 7 for services identified by the department of health and human 8 services and an analysis of the applicant’s ability to provide 9 services and support consistent with requirements under chapter 10 232 , particularly regarding community-based treatment. If 11 the proposed psychiatric institution is not freestanding from 12 a facility licensed under chapter 135B or 135C , approval 13 under this paragraph shall not be given unless the department 14 of health and human services certifies that the proposed 15 psychiatric institution is capable of providing a resident with 16 a living environment similar to the living environment provided 17 by a licensee which is freestanding from a facility licensed 18 under chapter 135B or 135C . 19 f. e. The proposed psychiatric institution is under 20 the direction of an agency which has operated a facility 21 licensed under section 237.3, subsection 2 , paragraph “a” , as 22 a comprehensive residential facility for children for three 23 years or of an agency which has operated a facility for three 24 years providing psychiatric services exclusively to children or 25 adolescents and the facility meets or exceeds requirements for 26 licensure under section 237.3, subsection 2 , paragraph “a” , as a 27 comprehensive residential facility for children. 28 g. f. If a child has an emotional, behavioral, or mental 29 health disorder, the psychiatric institution does not require 30 court proceedings to be initiated or that a child’s parent, 31 guardian, or custodian must terminate parental rights over 32 or transfer legal custody of the child for the purpose of 33 obtaining treatment from the psychiatric institution for the 34 child. Relinquishment of a child’s custody shall not be a 35 -3- LSB 1297XS (2) 90 pf/rh 3/ 7

S.F. 1 condition of the child receiving services. 1 Sec. 6. Section 135H.6, subsections 3, 4, and 5, Code 2023, 2 are amended to read as follows: 3 3. In addition to the beds authorized under subsection 4 2 , the department of health and human services may establish 5 not more than thirty beds licensed under this chapter at the 6 state mental health institute at Independence. The beds shall 7 be exempt from the certificate of need requirement under 8 subsection 1 , paragraph “d” . 9 4. The department of health and human services may give 10 approval to conversion of beds approved under subsection 2 , 11 to beds which are specialized to provide substance abuse 12 treatment. However, the total number of beds approved under 13 subsection 2 and this subsection shall not exceed four hundred 14 thirty. Conversion of beds under this subsection shall not 15 require a revision of the certificate of need issued for 16 the psychiatric institution making the conversion. Beds 17 for children who do not reside in this state and whose 18 service costs are not paid by public funds in this state are 19 not subject to the limitations on the number of beds and 20 certificate of need requirements otherwise applicable under 21 this section . 22 5. A psychiatric institution licensed prior to July 1, 1999, 23 may exceed the number of beds authorized under subsection 2 24 if the excess beds are used to provide services funded from a 25 source other than the medical assistance program under chapter 26 249A . Notwithstanding subsection 1 , paragraphs “d” and “e” 27 paragraph “d” , and subsection 2 , the provision of services using 28 those excess beds does not require a certificate of need or a 29 review by the department of health and human services. 30 Sec. 7. Section 135P.1, subsection 3, Code 2023, is amended 31 to read as follows: 32 3. “Health facility” means an institutional health facility 33 as defined in section 135.61 , a hospice licensed under chapter 34 135J , a home health agency as defined in section 144D.1 , an 35 -4- LSB 1297XS (2) 90 pf/rh 4/ 7

S.F. 1 assisted living program certified under chapter 231C , a clinic, 1 a community health center, or the university of Iowa hospitals 2 and clinics, and includes any corporation, professional 3 corporation, partnership, limited liability company, limited 4 liability partnership, or other entity comprised of such health 5 facilities. 6 Sec. 8. Section 135P.1, Code 2023, is amended by adding the 7 following new subsection: 8 NEW SUBSECTION . 3A. “Institutional health facility” means 9 any of the following, without regard to whether the facilities 10 referred to are publicly or privately owned or are organized 11 for profit or not or whether the facilities are part of or 12 sponsored by a health maintenance organization: 13 a. A hospital. 14 b. A health care facility. 15 c. An organized outpatient health facility. 16 d. An outpatient surgical facility. 17 e. A community mental health facility. 18 f. A birth center. 19 Sec. 9. Section 231C.3, subsection 2, Code 2023, is amended 20 to read as follows: 21 2. Each assisted living program operating in this state 22 shall be certified by the department. If an assisted living 23 program is voluntarily accredited by a recognized accrediting 24 entity, the department shall certify the assisted living 25 program on the basis of the voluntary accreditation. An 26 assisted living program that is certified by the department on 27 the basis of voluntary accreditation shall not be subject to 28 payment of the certification fee prescribed in section 231C.18 , 29 but shall be subject to an administrative fee as prescribed by 30 rule. An assisted living program certified under this section 31 is exempt from the requirements of section 135.63 relating to 32 certificate of need requirements. 33 Sec. 10. Section 249K.2, subsection 6, Code 2023, is amended 34 to read as follows: 35 -5- LSB 1297XS (2) 90 pf/rh 5/ 7

S.F. 1 6. “New construction” means the construction of a new 1 nursing facility which does not replace an existing licensed 2 and certified facility and requires the provider to obtain a 3 certificate of need pursuant to chapter 135, subchapter VI . 4 Sec. 11. Section 505.27, subsection 5, paragraph a, Code 5 2023, is amended to read as follows: 6 a. “Health care provider” means the same as defined in 7 section 135.61 , a person licensed or certified under chapter 8 147, 148, 148A, 148C, 149, 151, 152, 153, 154, 154B, 154F, 9 or 155A to provide in this state professional health care 10 service to an individual during that individual’s medical care, 11 treatment, or confinement; a hospital licensed pursuant to 12 chapter 135B , ; or a health care facility licensed pursuant to 13 chapter 135C . 14 Sec. 12. Section 708.3A, subsection 5, paragraph d, Code 15 2023, is amended to read as follows: 16 d. “Health care provider” means an emergency medical care 17 provider as defined in chapter 147A or a person licensed 18 or registered under chapter 148 , 148C , 148D , or 152 who is 19 providing or who is attempting to provide emergency medical 20 services, as defined in section 147A.1 , or who is providing 21 or who is attempting to provide health services as defined 22 in section 135.61 in a hospital. A person who commits an 23 assault under this section against a health care provider in 24 a hospital, or at the scene or during out-of-hospital patient 25 transportation in an ambulance, is presumed to know that the 26 person against whom the assault is committed is a health care 27 provider. 28 Sec. 13. Section 708.3A, subsection 5, Code 2023, is amended 29 by adding the following new paragraph: 30 NEW PARAGRAPH . 0e. “Health services” means clinically 31 related diagnostic, curative, or rehabilitative services, and 32 includes alcoholism, drug abuse, and mental health services. 33 Sec. 14. REPEAL. Sections 135.61 through 135.73, and 34 section 135B.5A, Code 2023, are repealed. 35 -6- LSB 1297XS (2) 90 pf/rh 6/ 7

S.F. 1 Sec. 15. CODE EDITOR DIRECTIVE. The Code editor is 1 directed to modify the title of chapter 135, division VI, as 2 “Hospital and health care facility reporting, data, analyses, 3 and studies” and to correct internal references in the Code as 4 necessary due to enactment of this Act. 5 EXPLANATION 6 The inclusion of this explanation does not constitute agreement with 7 the explanation’s substance by the members of the general assembly. 8 This bill eliminates the certificate of need (CON) process 9 required prior to the offering or development of a new or 10 changed institutional health service and makes conforming 11 changes throughout the Code. 12 -7- LSB 1297XS (2) 90 pf/rh 7/ 7