Senate
File
506
-
Introduced
SENATE
FILE
506
BY
COMMITTEE
ON
HEALTH
AND
HUMAN
SERVICES
(SUCCESSOR
TO
SSB
1117)
A
BILL
FOR
An
Act
relating
to
health
facilities
and
health
services
1
including
licensing
and
the
certificate
of
need
process,
and
2
including
effective
date
provisions.
3
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
4
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DIVISION
I
1
CERTIFICATE
OF
NEED
——
HEALTH
FACILITIES
COUNCIL
2
Section
1.
Section
68B.35,
subsection
2,
paragraph
e,
Code
3
2023,
is
amended
to
read
as
follows:
4
e.
Members
of
the
state
banking
council,
the
Iowa
ethics
5
and
campaign
disclosure
board,
the
credit
union
review
board,
6
the
economic
development
authority,
the
employment
appeal
7
board,
the
environmental
protection
commission,
the
health
8
facilities
council,
the
Iowa
finance
authority,
the
Iowa
public
9
employees’
retirement
system
investment
board,
the
board
of
10
the
Iowa
lottery
authority,
the
natural
resource
commission,
11
the
board
of
parole,
the
petroleum
underground
storage
tank
12
fund
board,
the
public
employment
relations
board,
the
state
13
racing
and
gaming
commission,
the
state
board
of
regents,
the
14
transportation
commission,
the
office
of
consumer
advocate,
the
15
utilities
board,
the
Iowa
telecommunications
and
technology
16
commission,
and
any
full-time
members
of
other
boards
and
17
commissions
as
defined
under
section
7E.4
who
receive
an
annual
18
salary
for
their
service
on
the
board
or
commission.
The
Iowa
19
ethics
and
campaign
disclosure
board
shall
conduct
an
annual
20
review
to
determine
if
members
of
any
other
board,
commission,
21
or
authority
should
file
a
statement
and
shall
require
the
22
filing
of
a
statement
pursuant
to
rules
adopted
pursuant
to
23
chapter
17A
.
24
Sec.
2.
Section
97B.1A,
subsection
8,
paragraph
a,
25
subparagraph
(8),
Code
2023,
is
amended
to
read
as
follows:
26
(8)
Members
of
the
state
transportation
commission
,
and
the
27
board
of
parole
,
and
the
state
health
facilities
council
.
28
Sec.
3.
Section
135.61,
subsections
1,
14,
15,
and
18,
Code
29
2023,
are
amended
to
read
as
follows:
30
1.
“Affected
persons”
means,
with
respect
to
an
application
31
for
a
certificate
of
need:
32
a.
The
person
submitting
the
application.
33
b.
Consumers
who
would
be
served
by
the
new
institutional
34
health
service
proposed
in
the
application.
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c.
Each
institutional
health
facility
or
health
maintenance
1
organization
which
is
located
in
the
geographic
area
which
2
would
appropriately
be
served
by
the
new
institutional
3
health
service
proposed
in
the
application.
The
appropriate
4
geographic
service
area
of
each
institutional
health
facility
5
or
health
maintenance
organization
shall
be
determined
on
a
6
uniform
basis
in
accordance
with
criteria
established
in
rules
7
adopted
by
the
department.
8
d.
Each
institutional
health
facility
or
health
maintenance
9
organization
which,
prior
to
receipt
of
the
application
by
10
the
department,
has
formally
indicated
to
the
department
11
pursuant
to
this
subchapter
an
intent
to
furnish
in
the
future
12
institutional
health
services
similar
to
the
new
institutional
13
health
service
proposed
in
the
application.
14
e.
Any
other
person
designated
as
an
affected
person
by
15
rules
of
the
department.
16
f.
Any
payer
or
third-party
payer
for
health
services.
17
14.
“Institutional
health
facility”
means
any
of
the
18
following,
without
regard
to
whether
the
facilities
referred
19
to
are
publicly
or
privately
owned
or
are
organized
for
profit
20
or
not
or
whether
the
facilities
are
part
of
or
sponsored
by
a
21
health
maintenance
organization:
22
a.
A
hospital.
23
b.
A
health
care
facility.
24
c.
An
organized
outpatient
health
facility.
25
d.
An
outpatient
surgical
facility.
26
e.
A
community
mental
health
facility.
27
f.
A
birth
center.
28
15.
“Institutional
health
service”
means
any
health
service
29
furnished
in
or
through
institutional
health
facilities
or
30
health
maintenance
organizations
,
including
mobile
health
31
services
.
32
18.
“New
institutional
health
service”
or
“changed
33
institutional
health
service”
means
any
of
the
following:
34
a.
The
construction,
development
,
or
other
establishment
of
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a
new
institutional
health
facility
regardless
of
ownership.
1
b.
Relocation
of
an
institutional
health
facility.
2
c.
Any
capital
expenditure,
lease,
or
donation
by
or
on
3
behalf
of
an
institutional
health
facility
in
excess
of
one
4
million
five
hundred
thousand
dollars
the
following
amounts,
as
5
applicable,
within
a
twelve-month
period
.
:
6
(1)
Beginning
January
1,
2023,
three
million
five
hundred
7
thousand
dollars.
8
(2)
Beginning
January
1,
2028,
four
million
dollars.
9
(3)
Beginning
January
1,
2033,
four
million
five
hundred
10
thousand
dollars.
11
(4)
Beginning
January
1,
2038,
five
million
dollars.
12
d.
A
permanent
change
in
the
bed
capacity,
as
determined
13
by
the
department,
of
an
institutional
health
facility.
For
14
purposes
of
this
paragraph,
a
change
is
permanent
if
it
is
15
intended
to
be
effective
for
one
year
or
more.
16
e.
Any
expenditure
in
excess
of
five
hundred
thousand
17
dollars
by
or
on
behalf
of
an
institutional
health
facility
for
18
health
services
which
are
or
will
be
offered
in
or
through
an
19
institutional
health
facility
at
a
specific
time
but
which
were
20
not
offered
on
a
regular
basis
in
or
through
that
institutional
21
health
facility
within
the
twelve-month
period
prior
to
that
22
time.
23
f.
The
deletion
of
one
or
more
health
services,
previously
24
offered
on
a
regular
basis
by
an
institutional
health
facility
25
or
health
maintenance
organization
or
the
relocation
of
one
or
26
more
health
services
from
one
physical
facility
to
another.
27
g.
Any
acquisition
by
or
on
behalf
of
a
health
care
provider
28
or
a
group
of
health
care
providers
of
any
piece
of
replacement
29
equipment
with
a
value
in
excess
of
one
million
five
hundred
30
thousand
dollars,
whether
acquired
by
purchase,
lease,
or
31
donation.
32
h.
Any
acquisition
by
or
on
behalf
of
a
health
care
provider
33
or
group
of
health
care
providers
of
any
piece
of
equipment
34
with
a
value
in
excess
of
one
million
five
hundred
thousand
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dollars,
whether
acquired
by
purchase,
lease,
or
donation,
1
which
results
in
the
offering
or
development
of
a
health
2
service
not
previously
provided.
A
mobile
service
provided
3
on
a
contract
basis
is
not
considered
to
have
been
previously
4
provided
by
a
health
care
provider
or
group
of
health
care
5
providers.
6
i.
Any
acquisition
by
or
on
behalf
of
an
institutional
7
health
facility
or
a
health
maintenance
organization
of
any
8
piece
of
replacement
equipment
with
a
value
in
excess
of
one
9
million
five
hundred
thousand
dollars,
whether
acquired
by
10
purchase,
lease,
or
donation.
11
j.
Any
acquisition
by
or
on
behalf
of
an
institutional
12
health
facility
or
health
maintenance
organization
of
any
13
piece
of
equipment
with
a
value
in
excess
of
one
million
five
14
hundred
thousand
dollars,
whether
acquired
by
purchase,
lease,
15
or
donation,
which
results
in
the
offering
or
development
of
16
a
health
service
not
previously
provided.
A
mobile
service
17
provided
on
a
contract
basis
is
not
considered
to
have
been
18
previously
provided
by
an
institutional
health
facility.
19
k.
Any
air
transportation
service
for
transportation
of
20
patients
or
medical
personnel
offered
through
an
institutional
21
health
facility
at
a
specific
time
but
which
was
not
offered
22
on
a
regular
basis
in
or
through
that
institutional
health
23
facility
within
the
twelve-month
period
prior
to
the
specific
24
time.
25
l.
Any
mobile
health
service
with
a
value
in
excess
of
one
26
million
five
hundred
thousand
dollars.
27
m.
Any
of
the
following:
28
(1)
Cardiac
catheterization
service.
29
(2)
Open
heart
surgical
service.
30
(3)
Organ
transplantation
service.
31
(4)
Radiation
therapy
service
applying
ionizing
radiation
32
for
the
treatment
of
malignant
disease
using
megavoltage
33
external
beam
equipment.
34
Sec.
4.
Section
135.61,
subsections
2,
4,
and
16,
Code
2023,
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are
amended
by
striking
the
subsections.
1
Sec.
5.
Section
135.62,
Code
2023,
is
amended
to
read
as
2
follows:
3
135.62
Department
to
administer
subchapter
——
health
4
facilities
council
established
——
appointments
——
powers
and
5
duties.
6
1.
This
subchapter
shall
be
administered
by
the
department.
7
The
director
shall
employ
or
cause
to
be
employed
the
necessary
8
persons
to
discharge
the
duties
imposed
on
the
department
by
9
this
subchapter
.
10
2.
There
is
established
a
state
health
facilities
council
11
consisting
of
five
persons
appointed
by
the
governor.
The
12
council
shall
be
within
the
department
for
administrative
and
13
budgetary
purposes.
14
a.
Qualifications.
The
members
of
the
council
shall
be
15
chosen
so
that
the
council
as
a
whole
is
broadly
representative
16
of
various
geographical
areas
of
the
state
and
no
more
than
17
three
of
its
members
are
affiliated
with
the
same
political
18
party.
Each
council
member
shall
be
a
person
who
has
19
demonstrated
by
prior
activities
an
informed
concern
for
the
20
planning
and
delivery
of
health
services.
A
member
of
the
21
council
and
any
spouse
of
a
member
shall
not,
during
the
22
time
that
member
is
serving
on
the
council,
do
either
of
the
23
following:
24
(1)
Be
a
health
care
provider
nor
be
otherwise
directly
or
25
indirectly
engaged
in
the
delivery
of
health
care
services
nor
26
have
a
material
financial
interest
in
the
providing
or
delivery
27
of
health
services.
28
(2)
Serve
as
a
member
of
any
board
or
other
policymaking
29
or
advisory
body
of
an
institutional
health
facility,
a
health
30
maintenance
organization,
or
any
health
or
hospital
insurer.
31
b.
Appointments.
Terms
of
council
members
shall
be
six
32
years,
beginning
and
ending
as
provided
in
section
69.19
.
A
33
member
shall
be
appointed
in
each
odd-numbered
year
to
succeed
34
each
member
whose
term
expires
in
that
year.
Vacancies
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shall
be
filled
by
the
governor
for
the
balance
of
the
1
unexpired
term.
Each
appointment
to
the
council
is
subject
to
2
confirmation
by
the
senate.
A
council
member
is
ineligible
3
for
appointment
to
a
second
consecutive
term,
unless
first
4
appointed
to
an
unexpired
term
of
three
years
or
less.
5
c.
Chairperson.
The
governor
shall
designate
one
of
6
the
council
members
as
chairperson.
That
designation
may
7
be
changed
not
later
than
July
1
of
any
odd-numbered
year,
8
effective
on
the
date
of
the
organizational
meeting
held
in
9
that
year
under
paragraph
“d”
.
10
d.
Meetings.
The
council
shall
hold
an
organizational
11
meeting
in
July
of
each
odd-numbered
year,
or
as
soon
12
thereafter
as
the
new
appointee
or
appointees
are
confirmed
13
and
have
qualified.
Other
meetings
shall
be
held
as
necessary
14
to
enable
the
council
to
expeditiously
discharge
its
duties.
15
Meeting
dates
shall
be
set
upon
adjournment
or
by
call
of
the
16
chairperson
upon
five
days’
notice
to
the
other
members.
17
e.
2.
Duties.
The
council
department
shall
do
all
of
the
18
following:
19
(1)
a.
Make
the
final
decision,
as
required
by
section
20
135.69
,
with
respect
to
each
application
for
a
certificate
of
21
need
accepted
by
the
department.
22
(2)
b.
Determine
and
adopt
such
policies
as
are
authorized
23
by
law
and
are
deemed
necessary
to
the
efficient
discharge
of
24
its
the
department’s
duties
under
this
subchapter
.
25
(3)
c.
Have
authority
to
direct
staff
personnel
of
the
26
department
assigned
to
conduct
formal
or
summary
reviews
of
27
applications
for
certificates
of
need.
28
(4)
d.
Advise
and
counsel
with
the
director
concerning
the
29
provisions
of
this
subchapter
and
the
policies
and
procedures
30
adopted
by
the
department
pursuant
to
this
subchapter
.
31
(5)
Review
and
approve,
prior
to
promulgation,
all
rules
32
adopted
by
the
department
under
this
subchapter
.
33
Sec.
6.
Section
135.63,
subsection
1,
Code
2023,
is
amended
34
to
read
as
follows:
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1.
A
new
institutional
health
service
or
changed
1
institutional
health
service
shall
not
be
offered
or
developed
2
in
this
state
without
prior
application
to
the
department
3
for
and
receipt
of
a
certificate
of
need,
pursuant
to
4
this
subchapter
.
The
application
shall
be
made
upon
forms
5
furnished
or
prescribed
by
the
department
and
shall
contain
6
such
information
as
the
department
may
require
under
this
7
subchapter
.
The
application
shall
be
accompanied
by
an
8
economic
impact
statement
that
includes
information
specified
9
by
rule
to
assist
the
department
in
the
evaluation
of
the
10
application
pursuant
to
section
135.64.
The
application
shall
11
be
accompanied
by
a
fee
equivalent
to
three-tenths
of
one
12
percent
of
the
anticipated
cost
of
the
project
with
a
minimum
13
fee
of
six
hundred
dollars
and
a
maximum
fee
of
twenty-one
14
thousand
dollars.
The
fee
shall
be
remitted
by
the
department
15
to
the
treasurer
of
state,
who
shall
place
it
in
the
general
16
fund
of
the
state.
If
an
application
is
voluntarily
withdrawn
17
within
thirty
calendar
days
after
submission,
seventy-five
18
percent
of
the
application
fee
shall
be
refunded;
if
the
19
application
is
voluntarily
withdrawn
more
than
thirty
but
20
within
sixty
days
after
submission,
fifty
percent
of
the
21
application
fee
shall
be
refunded;
if
the
application
is
22
withdrawn
voluntarily
more
than
sixty
days
after
submission,
23
twenty-five
percent
of
the
application
fee
shall
be
refunded.
24
Notwithstanding
the
required
payment
of
an
application
fee
25
under
this
subsection
,
an
applicant
for
a
new
institutional
26
health
service
or
a
changed
institutional
health
service
27
offered
or
developed
by
an
intermediate
care
facility
for
28
persons
with
an
intellectual
disability
or
an
intermediate
care
29
facility
for
persons
with
mental
illness
as
defined
pursuant
to
30
section
135C.1
is
exempt
from
payment
of
the
application
fee.
31
Sec.
7.
Section
135.63,
subsection
2,
paragraphs
a
and
e,
32
Code
2023,
are
amended
to
read
as
follows:
33
a.
Private
offices
and
private
clinics
of
an
individual
34
physician,
dentist,
or
other
practitioner
or
group
of
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health
care
providers,
except
as
provided
by
section
135.61,
1
subsection
18
,
paragraphs
“g”
,
“h”
,
and
“m”
,
and
section
135.61,
2
subsections
20
and
21
.
3
e.
A
health
maintenance
organization
or
combination
of
4
health
maintenance
organizations
or
an
institutional
health
5
facility
controlled
directly
or
indirectly
by
a
health
6
maintenance
organization
or
combination
of
health
maintenance
7
organizations,
except
when
the
health
maintenance
organization
8
or
combination
of
health
maintenance
organizations
does
any
of
9
the
following:
10
(1)
Constructs
constructs
,
develops,
renovates,
relocates,
11
or
otherwise
establishes
an
institutional
health
facility.
12
(2)
Acquires
major
medical
equipment
as
provided
by
section
13
135.61,
subsection
18
,
paragraphs
“i”
and
“j”
.
14
Sec.
8.
Section
135.63,
subsection
2,
paragraph
h,
Code
15
2023,
is
amended
by
striking
the
paragraph.
16
Sec.
9.
Section
135.63,
subsection
4,
unnumbered
paragraph
17
1,
Code
2023,
is
amended
to
read
as
follows:
18
A
copy
of
the
application
shall
be
sent
to
the
department
19
of
human
services
at
the
time
the
application
is
submitted
to
20
the
Iowa
department
of
public
health.
The
department
shall
not
21
process
applications
for
and
the
council
shall
not
consider
a
22
new
or
changed
institutional
health
service
for
an
intermediate
23
care
facility
for
persons
with
an
intellectual
disability
24
unless
both
of
the
following
conditions
are
met:
25
Sec.
10.
Section
135.64,
subsection
1,
unnumbered
paragraph
26
1,
Code
2023,
is
amended
to
read
as
follows:
27
In
determining
whether
a
certificate
of
need
shall
be
28
issued,
the
department
and
council
shall
consider
the
29
following:
30
Sec.
11.
Section
135.64,
subsection
1,
paragraph
r,
Code
31
2023,
is
amended
to
read
as
follows:
32
r.
The
recommendations
of
staff
personnel
of
the
department
33
assigned
to
the
area
of
certificate
of
need,
concerning
the
34
application
,
if
requested
by
the
council
.
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Sec.
12.
Section
135.64,
subsection
2,
unnumbered
paragraph
1
1,
Code
2023,
is
amended
to
read
as
follows:
2
In
addition
to
the
findings
required
with
respect
to
any
3
of
the
criteria
listed
in
subsection
1
of
this
section
,
the
4
council
department
shall
grant
a
certificate
of
need
for
a
new
5
institutional
health
service
or
changed
institutional
health
6
service
only
if
it
the
department
finds
in
writing,
on
the
7
basis
of
data
submitted
to
it
by
the
department
,
that:
8
Sec.
13.
Section
135.66,
Code
2023,
is
amended
to
read
as
9
follows:
10
135.66
Procedure
upon
receipt
of
application
——
public
11
notification.
12
1.
a.
Within
fifteen
business
days
after
receipt
of
an
13
application
for
a
certificate
of
need,
the
department
shall
14
examine
the
application
for
form
and
completeness
and
accept
15
or
reject
it.
An
application
shall
be
rejected
only
if
it
16
fails
to
provide
all
information
required
by
the
department
17
pursuant
to
section
135.63,
subsection
1
.
The
department
shall
18
promptly
return
to
the
applicant
any
rejected
application,
with
19
an
explanation
of
the
reasons
for
its
rejection.
20
b.
Within
thirty
days
after
notifying
the
applicant
of
21
rejection
of
the
application,
the
applicant
may
resubmit
a
22
revised
application
for
review
under
this
subsection
and
shall
23
not
be
subject
to
payment
of
another
required
application
24
fee
pursuant
to
section
135.63.
If
a
subsequent
rejection
25
is
issued,
the
applicant
shall
resubmit
the
application
in
26
accordance
with
and
shall
be
subject
to
the
procedure
and
27
requirements
for
an
initial
application.
28
2.
Upon
acceptance
of
an
application
for
a
certificate
29
of
need,
the
department
shall
promptly
undertake
to
notify
30
all
affected
persons
in
writing
that
formal
review
of
the
31
application
has
been
initiated.
Notification
to
those
affected
32
persons
who
are
consumers
or
third-party
payers
or
other
33
payers
for
health
services
may
be
provided
by
distribution
of
34
the
pertinent
information
to
the
news
media
by
an
electronic
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distribution
method
available
to
the
department
.
1
3.
Each
application
accepted
by
the
department
shall
2
be
formally
reviewed
for
the
purpose
of
furnishing
to
the
3
council
department
the
information
necessary
to
enable
it
the
4
department
to
determine
whether
or
not
to
grant
the
certificate
5
of
need.
A
formal
review
shall
consist
at
a
minimum
of
the
6
following
steps:
7
a.
Evaluation
of
the
application
against
the
criteria
8
specified
in
section
135.64
.
9
b.
A
public
hearing
on
the
application,
to
be
held
prior
to
10
completion
of
the
evaluation
required
by
paragraph
“a”
,
shall
be
11
conducted
by
the
council
department
.
12
4.
When
a
hearing
is
to
be
held
pursuant
to
subsection
13
3
,
paragraph
“b”
,
the
department
shall
give
at
least
ten
14
days’
notice
of
the
time
and
place
of
the
hearing.
At
the
15
hearing,
any
Any
affected
person
or
that
person’s
designated
16
representative
shall
have
the
opportunity
to
present
testimony
17
may
submit
written
testimony
in
a
manner
prescribed
by
the
18
department,
beginning
on
the
day
the
notice
of
the
hearing
is
19
given
until
the
day
prior
to
the
date
fixed
for
the
hearing
.
20
Sec.
14.
Section
135.67,
subsection
1,
Code
2023,
is
amended
21
to
read
as
follows:
22
1.
The
department
may
waive
the
letter
of
intent
procedures
23
prescribed
by
section
135.65
and
substitute
conduct
a
summary
24
review
procedure,
which
shall
be
established
by
rules
of
the
25
department,
when
it
accepts
an
application
for
a
certificate
of
26
need
for
a
project
which
meets
any
of
the
following
criteria
27
in
paragraphs
“a”
through
“e”
:
28
a.
A
project
which
is
limited
to
repair
or
replacement
of
a
29
facility
or
equipment
damaged
or
destroyed
by
a
disaster,
and
30
which
will
not
expand
the
facility
nor
increase
the
services
31
provided
beyond
the
level
existing
prior
to
the
disaster.
32
b.
A
project
necessary
to
enable
the
facility
or
service
to
33
achieve
or
maintain
compliance
with
federal,
state,
or
other
34
appropriate
licensing,
certification,
or
safety
requirements.
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c.
A
project
which
will
not
change
the
existing
bed
capacity
1
of
the
applicant’s
facility
or
service,
as
determined
by
the
2
department,
by
more
than
ten
percent
or
ten
beds,
whichever
is
3
less,
over
a
two-year
period.
4
d.
A
project
the
total
cost
of
which
will
not
exceed
one
5
hundred
fifty
thousand
dollars.
6
e.
d.
Any
other
project
for
which
the
applicant
proposes
7
and
the
department
agrees
to
summary
review.
8
Sec.
15.
Section
135.69,
Code
2023,
is
amended
to
read
as
9
follows:
10
135.69
Council
Department
to
make
final
decision.
11
1.
The
department
shall
complete
its
formal
review
of
12
the
application
within
ninety
days
after
acceptance
of
the
13
application,
except
as
otherwise
provided
by
section
135.72,
14
subsection
4
.
Upon
completion
of
the
formal
review,
the
15
council
department
shall
approve
or
deny
the
application.
The
16
council
department
shall
issue
written
findings
stating
the
17
basis
for
its
the
department’s
decision
on
the
application,
and
18
the
department
shall
send
copies
of
the
council’s
decision
and
19
the
written
findings
supporting
the
decision
to
the
applicant
20
and
to
any
other
person
who
so
requests.
21
2.
Failure
by
the
council
department
to
issue
a
written
22
decision
on
an
application
for
a
certificate
of
need
within
the
23
time
required
by
this
section
shall
constitute
denial
approval
24
of
and
final
administrative
action
on
the
application.
25
Sec.
16.
Section
135.70,
Code
2023,
is
amended
to
read
as
26
follows:
27
135.70
Appeal
of
certificate
of
need
decisions.
28
The
council’s
department’s
decision
on
an
application
for
29
certificate
of
need,
when
announced
pursuant
to
section
135.69
,
30
is
a
final
decision.
Any
dissatisfied
party
who
is
an
affected
31
person
with
respect
to
the
application,
and
who
participated
32
or
sought
unsuccessfully
to
participate
in
the
formal
review
33
procedure
prescribed
by
section
135.66
,
may
request
a
rehearing
34
in
accordance
with
chapter
17A
and
rules
of
the
department.
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If
a
rehearing
is
not
requested
or
an
affected
party
remains
1
dissatisfied
after
the
request
for
rehearing,
an
appeal
may
be
2
taken
in
the
manner
provided
by
chapter
17A
.
Notwithstanding
3
the
Iowa
administrative
procedure
Act,
chapter
17A
,
a
request
4
for
rehearing
is
not
required,
prior
to
appeal
under
section
5
17A.19
.
6
Sec.
17.
Section
135.71,
subsection
1,
Code
2023,
is
amended
7
to
read
as
follows:
8
1.
A
certificate
of
need
shall
be
valid
for
a
maximum
of
9
one
year
from
the
date
of
issuance.
Upon
the
expiration
of
10
the
certificate,
or
at
any
earlier
time
while
the
certificate
11
is
valid
the
holder
thereof
shall
provide
the
department
such
12
information
on
the
development
of
the
project
covered
by
13
the
certificate
as
the
department
may
request.
The
council
14
department
shall
determine
at
the
end
of
the
certification
15
period
whether
sufficient
progress
is
being
made
on
the
16
development
of
the
project.
The
certificate
of
need
may
be
17
extended
by
the
council
department
for
additional
periods
of
18
time
as
are
reasonably
necessary
to
expeditiously
complete
the
19
project,
but
may
be
revoked
by
the
council
department
at
the
20
end
of
the
first
or
any
subsequent
certification
period
for
21
insufficient
progress
in
developing
the
project.
22
Sec.
18.
Section
135.72,
unnumbered
paragraph
1,
Code
2023,
23
is
amended
to
read
as
follows:
24
The
department
shall
adopt
,
with
approval
of
the
council,
25
such
administrative
rules
as
are
necessary
to
enable
it
the
26
department
to
implement
this
subchapter
.
These
rules
shall
27
include:
28
Sec.
19.
Section
135.72,
subsection
4,
Code
2023,
is
amended
29
to
read
as
follows:
30
4.
Criteria
for
determining
when
it
is
not
feasible
to
31
complete
formal
review
of
an
application
for
a
certificate
of
32
need
within
the
time
limits
specified
in
section
135.69
.
The
33
rules
adopted
under
this
subsection
shall
include
criteria
for
34
determining
whether
an
application
proposes
introduction
of
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technologically
innovative
equipment,
and
if
so,
procedures
1
to
be
followed
in
reviewing
the
application.
However,
a
rule
2
adopted
under
this
subsection
shall
not
permit
a
deferral
of
3
more
than
sixty
thirty
days
beyond
the
time
when
a
decision
is
4
required
under
section
135.69
,
unless
both
the
applicant
and
5
the
department
agree
to
a
longer
deferment.
6
Sec.
20.
Section
135.73,
subsection
1,
Code
2023,
is
amended
7
to
read
as
follows:
8
1.
Any
party
constructing
a
new
institutional
health
9
facility
or
an
addition
to
or
renovation
of
an
existing
10
institutional
health
facility
without
first
obtaining
a
11
certificate
of
need
or,
in
the
case
of
a
mobile
health
service,
12
ascertaining
that
the
mobile
health
service
has
received
13
certificate
of
need
approval,
as
required
by
this
subchapter
,
14
shall
be
denied
licensure
or
change
of
licensure
by
the
15
appropriate
responsible
licensing
agency
of
this
state.
16
Sec.
21.
Section
135.73,
subsection
2,
paragraph
a,
Code
17
2023,
is
amended
to
read
as
follows:
18
a.
A
class
I
violation
is
one
in
which
a
party
offers
a
19
new
institutional
health
service
or
changed
institutional
20
health
service
modernization
or
acquisition
without
review
and
21
approval
by
the
council
department
.
A
party
in
violation
is
22
subject
to
a
penalty
of
three
hundred
dollars
for
each
day
of
a
23
class
I
violation.
The
department
may
seek
injunctive
relief
24
which
shall
include
restraining
the
commission
or
continuance
25
of
an
act
which
would
violate
the
provisions
of
this
paragraph.
26
Notice
and
opportunity
to
be
heard
shall
be
provided
to
a
party
27
pursuant
to
rule
of
civil
procedure
1.1507
and
contested
case
28
procedures
in
accordance
with
chapter
17A
.
The
department
may
29
reduce,
alter,
or
waive
a
penalty
upon
the
party
showing
good
30
faith
compliance
with
the
department’s
request
to
immediately
31
cease
and
desist
from
conduct
in
violation
of
this
section
.
32
Sec.
22.
Section
135.131,
subsection
1,
paragraph
a,
Code
33
2023,
is
amended
to
read
as
follows:
34
a.
“Birth
center”
means
birth
center
as
defined
in
section
35
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135.61
a
facility
or
institution,
which
is
not
an
ambulatory
1
surgical
center
or
a
hospital
or
in
a
hospital,
in
which
2
births
are
planned
to
occur
following
a
normal,
uncomplicated,
3
low-risk
pregnancy
.
4
Sec.
23.
NEW
SECTION
.
135C.35A
Moratorium
——
new
5
construction
or
permanent
change
in
bed
capacity
——
nursing
6
facilities.
7
1.
Beginning
July
1,
2023,
the
department
may
impose
a
8
temporary
moratorium
on
submission
of
applications
for
new
9
construction
or
a
permanent
change
in
bed
capacity
of
a
10
nursing
facility
for
an
initial
period
of
twelve
months.
The
11
department
may
extend
the
moratorium
in
six-month
increments
12
following
the
conclusion
of
the
initial
twelve-month
period.
13
The
department
shall
document,
in
writing,
the
need
for
each
14
extension
of
the
moratorium.
15
2.
The
department
may
waive
the
moratorium
as
specified
in
16
this
section
if
the
department
determines
there
is
a
need
for
17
specialized
needs
beds.
18
3.
The
department
shall
review
the
moratorium
as
specified
19
in
this
section
during
the
fiscal
year
beginning
July
1,
2026,
20
and
shall
make
a
recommendation
by
February
1,
2027,
to
the
21
general
assembly
regarding
the
continuation
or
repeal
of
the
22
moratorium.
23
Sec.
24.
Section
135P.1,
Code
2023,
is
amended
to
read
as
24
follows:
25
135P.1
Definitions.
26
For
the
purposes
of
this
chapter
,
unless
the
context
27
otherwise
requires:
28
1.
“Adverse
health
care
incident”
means
an
objective
and
29
definable
outcome
arising
from
or
related
to
patient
care
that
30
results
in
the
death
or
physical
injury
of
a
patient.
31
2.
“Health
care
provider”
means
a
physician
or
osteopathic
32
physician
licensed
under
chapter
148
,
a
physician
assistant
33
licensed
and
practicing
under
a
supervising
physician
pursuant
34
to
chapter
148C
,
a
podiatrist
licensed
under
chapter
149
,
a
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chiropractor
licensed
under
chapter
151
,
a
licensed
practical
1
nurse,
a
registered
nurse,
or
an
advanced
registered
nurse
2
practitioner
licensed
under
chapter
152
or
152E
,
a
dentist
3
licensed
under
chapter
153
,
an
optometrist
licensed
under
4
chapter
154
,
a
pharmacist
licensed
under
chapter
155A
,
or
5
any
other
person
who
is
licensed,
certified,
or
otherwise
6
authorized
or
permitted
by
the
law
of
this
state
to
administer
7
health
care
in
the
ordinary
course
of
business
or
in
the
8
practice
of
a
profession.
9
3.
“Health
facility”
means
an
institutional
health
facility
10
as
defined
in
section
135.61
,
a
hospice
licensed
under
chapter
11
135J
,
a
home
health
agency
as
defined
in
section
144D.1
,
an
12
assisted
living
program
certified
under
chapter
231C
,
a
clinic,
13
a
community
health
center,
or
the
university
of
Iowa
hospitals
14
and
clinics,
and
includes
any
corporation,
professional
15
corporation,
partnership,
limited
liability
company,
limited
16
liability
partnership,
or
other
entity
comprised
of
such
health
17
facilities.
18
4.
“Institutional
health
facility”
means
any
of
the
19
following,
without
regard
to
whether
the
facilities
referred
20
to
are
publicly
or
privately
owned
or
are
organized
for
profit
21
or
not,
or
whether
the
facilities
are
part
of
or
sponsored
by
a
22
health
maintenance
organization:
23
a.
A
hospital
as
defined
in
section
135B.1.
24
b.
A
health
care
facility
as
defined
in
section
135C.1.
25
c.
An
organized
outpatient
health
facility
as
defined
in
26
section
135.61.
27
d.
An
outpatient
surgical
facility
as
defined
in
section
28
135.61.
29
e.
A
community
mental
health
center
as
defined
in
section
30
230A.102.
31
f.
A
birth
center
as
defined
in
section
135.131.
32
4.
5.
“Open
discussion”
means
all
communications
that
are
33
made
under
section
135P.3
,
and
includes
all
memoranda,
work
34
products,
documents,
and
other
materials
that
are
prepared
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for
or
submitted
in
the
course
of
or
in
connection
with
1
communications
under
section
135P.3
.
2
5.
6.
“Patient”
means
a
person
who
receives
medical
care
3
from
a
health
care
provider,
or
if
the
person
is
a
minor,
4
deceased,
or
incapacitated,
the
person’s
legal
representative.
5
Sec.
25.
REPEAL.
Section
135.65,
Code
2023,
is
repealed.
6
DIVISION
II
7
BIRTH
CENTERS
8
Sec.
26.
BIRTH
CENTERS
——
PROVISIONAL
LICENSURE.
The
9
department
of
inspections
and
appeals
shall
develop
minimum
10
standards
for
provisional
licensure
of
a
birth
center
and
11
shall
adopt
rules
pursuant
to
chapter
17A
to
administer
12
birth
center
provisional
licensure.
The
department
shall
13
issue
a
provisional
license
to
a
birth
center
that
meets
the
14
minimum
standards.
A
provisional
license
may
be
granted
for
15
a
period
of
no
more
than
one
year
from
the
date
the
specified
16
administrative
rules
are
adopted.
A
provisional
license
shall
17
expire
at
the
end
of
the
license
terms
and
is
not
renewable.
18
Sec.
27.
EMERGENCY
RULES.
The
department
of
inspections
19
and
appeals
shall
adopt
emergency
rules
under
section
17A.4,
20
subsection
3,
and
section
17A.5,
subsection
2,
paragraph
21
“b”,
to
implement
the
birth
center
provisional
licensure
22
provisions
of
this
division
of
this
Act,
within
six
months
23
of
the
effective
date
of
this
division
of
this
Act
and
shall
24
submit
such
rules
to
the
administrative
rules
coordinator
and
25
the
administrative
code
editor
pursuant
to
section
17A.5,
26
subsection
1,
within
the
same
period.
The
rules
shall
be
27
effective
immediately
upon
filing
unless
a
later
date
is
28
specified
in
the
rules.
Any
rules
adopted
in
accordance
with
29
this
section
shall
also
be
published
as
a
notice
of
intended
30
action
as
provided
in
section
17A.4.
31
Sec.
28.
PROPOSED
LEGISLATION
——
BIRTH
CENTER
32
LICENSURE.
The
department
of
inspections
and
appeals
shall
33
submit
proposed
legislation
under
section
2.16
that
provides
34
for
state
licensure
of
and
inspection
requirements
for
birth
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centers
to
be
considered
by
the
2024
session
of
the
general
1
assembly.
2
Sec.
29.
DEFINITION.
For
the
purposes
of
this
division
3
of
this
Act,
“birth
center”
means
a
facility
or
institution,
4
which
is
not
an
ambulatory
surgical
center
or
a
hospital
or
in
5
a
hospital,
in
which
births
are
planned
to
occur
following
a
6
normal,
uncomplicated,
low-risk
pregnancy.
7
Sec.
30.
EFFECTIVE
DATE.
This
division
of
this
Act,
being
8
deemed
of
immediate
importance,
takes
effect
upon
enactment.
9
EXPLANATION
10
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
11
the
explanation’s
substance
by
the
members
of
the
general
assembly.
12
This
bill
relates
to
health
facilities
and
services
13
including
licensing,
the
health
facilities
council
(HFC),
and
14
the
certificate
of
need
(CON)
process.
15
DIVISION
I
——
CERTIFICATE
OF
NEED
——
HEALTH
FACILITIES
16
COUNCIL.
This
division
of
the
bill
eliminates
the
HFC
and
17
assigns
the
duties
of
the
HFC
to
the
department
of
health
18
and
human
services
(HHS).
The
bill
amends
the
definition
of
19
“affected
person”
with
respect
to
an
application
for
CON
to
20
eliminate
from
inclusion
in
the
definition
each
institutional
21
health
facility
or
health
maintenance
organization
which,
22
prior
to
receipt
of
the
application,
has
formally
indicated
an
23
intent
to
furnish
in
the
future
institutional
health
services
24
similar
to
the
new
institutional
health
service
proposed
in
the
25
application;
any
other
person
designated
as
an
affected
person
26
by
rules
of
the
department;
and
any
payer
or
third-party
payer
27
for
health
services.
28
The
bill
amends
the
definition
of
“institutional
health
29
facility”
by
removing
a
“community
mental
health
facility”
30
and
a
“birth
center”
from
inclusion
in
the
definition,
31
thereby
making
these
facilities
and
centers
exempt
from
CON
32
requirements.
33
The
bill
amends
the
definition
of
“new
institutional
34
health
service”
or
“changed
institutional
health
service”
35
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by
striking
many
of
the
services
included
in
current
Code
1
and
only
including:
the
construction,
development,
or
other
2
establishment
of
a
new
institutional
health
facility
regardless
3
of
ownership;
relocation
of
an
institutional
health
facility;
4
any
capital
expenditure,
lease,
or
donation
by
or
on
behalf
of
5
an
institutional
health
facility
in
excess
of
certain
amounts
6
beginning
with
$3.5
million
on
January
1,
2023,
and
increasing
7
to
$5
million
beginning
January
1,
2038,
within
a
12-month
8
period,
and
a
permanent
change
(effective
for
one
year
or
more)
9
in
the
bed
capacity
of
an
institutional
health
facility.
Under
10
the
bill,
only
these
services
included
in
the
definition
are
11
subject
to
CON
requirements.
12
The
bill
eliminates
terms
defined
and
references
to
these
13
terms
in
current
Code
that
are
no
longer
necessary
due
to
14
provisions
of
the
bill
including
the
definitions
of
“birth
15
center”
and
“mobile
health
service”.
16
The
bill
requires
that
an
application
for
CON
be
accompanied
17
by
an
economic
impact
statement
that
includes
information
18
required
by
rule
to
assist
in
evaluation
of
the
application.
19
Due
to
the
combining
of
the
department
of
human
services
20
(DHS)
and
the
department
of
public
health
(DPH)
into
HHS,
the
21
bill
eliminates
the
requirement
that
a
copy
of
the
application
22
for
CON
be
sent
to
DHS
at
the
time
the
application
is
submitted
23
to
DPH.
24
Current
law
provides
that
within
15
business
days
after
25
receipt
of
an
application
for
a
CON,
HHS
shall
examine
the
26
application
and
accept
or
reject
it,
and
that
HHS
shall
27
promptly
return
to
the
applicant
any
rejected
application,
with
28
an
explanation
of
the
reasons
for
its
rejection.
The
bill
adds
29
a
provision
that
within
30
days
after
notifying
the
applicant
30
of
rejection
of
the
application,
the
applicant
may
resubmit
31
a
revised
application
for
review
and
shall
not
be
subject
to
32
payment
of
another
required
application
fee.
Further,
if
a
33
subsequent
rejection
is
issued,
the
applicant
shall
resubmit
34
the
application
in
accordance
with
and
shall
be
subject
to
the
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procedure
and
requirements
for
an
initial
application.
1
Current
law
provides
that
upon
acceptance
of
an
application
2
for
a
CON,
HHS
shall
promptly
notify
all
affected
persons
3
in
writing
that
formal
review
of
the
application
has
been
4
initiated,
and
that
notification
to
those
affected
persons
who
5
are
consumers
or
third-party
payers
or
other
payers
for
health
6
services
may
be
provided
notification
by
distribution
of
the
7
pertinent
information
to
the
news
media.
The
bill
amends
this
8
provision
to
eliminate
the
reference
to
third-party
payers
or
9
other
payers
as
they
are
no
longer
included
in
the
definition
10
of
affected
persons,
and
provides
that
notification
to
affected
11
persons
who
are
consumers
may
be
provided
by
an
electronic
12
distribution
method
available
to
HHS.
The
bill
also
provides
13
that
any
affected
person
or
that
person’s
representative
may
14
submit
written
testimony
as
prescribed
by
HHS
beginning
the
day
15
the
notice
of
the
hearing
is
given
until
the
day
prior
to
the
16
date
of
the
hearing.
17
The
bill
eliminates
the
letter
of
intent
procedure
requiring
18
that
before
applying
for
a
CON,
the
sponsor
of
a
proposed
19
new
institutional
health
service
or
changed
institutional
20
health
service
submit
to
HHS
a
letter
of
intent
to
offer
or
21
develop
a
service
requiring
a
CON,
as
soon
as
possible
after
22
initiation
of
the
applicant’s
planning
process
and
not
less
23
than
30
days
before
applying
for
a
CON
and
before
substantial
24
expenditures
to
offer
or
develop
the
service
are
made.
Under
25
this
provision,
the
letter
must
include
a
brief
description
26
of
the
proposed
new
or
changed
service,
its
location,
and
its
27
estimated
cost.
If
requested
by
the
sponsor,
HHS
was
required
28
to
make
a
preliminary
review
of
the
letter
and
inform
the
29
sponsor
of
any
factors
likely
to
result
in
denial
of
a
CON.
The
30
bill
also
makes
a
conforming
change
to
eliminate
a
reference
to
31
the
letter
of
intent
procedure.
32
The
bill
provides
that
failure
by
HHS
to
issue
a
written
33
decision
on
a
CON
application
within
the
time
required
shall
34
constitute
approval
rather
than
the
current
denial
of
and
final
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administrative
action
on
the
application.
1
The
bill
provides
that
any
administrative
rule
adopted
for
2
determining
when
it
is
not
feasible
to
complete
formal
review
3
of
an
application
for
a
CON
within
the
time
limits
specified
4
for
HHS’s
final
decision
shall
not
permit
a
deferral
of
more
5
than
30
days,
rather
than
the
current
60
days,
beyond
the
time
6
specified
for
a
decision
on
the
final
decision,
unless
both
the
7
applicant
and
HHS
agree
to
a
longer
deferment.
8
The
bill
provides
for
a
moratorium
on
applications
for
new
9
construction
or
a
permanent
change
in
bed
capacity
of
a
nursing
10
facility
for
an
initial
period
of
12
months,
and
provides
for
11
6-month
extensions
of
the
moratorium.
The
department
may
12
waive
the
moratorium
if
the
department
determines
there
is
a
13
need
for
specialized
needs
beds.
The
department
shall
make
a
14
recommendation
to
the
general
assembly
regarding
continuation
15
of
the
moratorium
by
February
1,
2027.
16
DIVISION
II
——
BIRTH
CENTERS.
This
division
of
the
17
bill
provides
for
provisional
licensing
of
birth
centers
18
and
requires
the
department
of
inspections
and
appeals
to
19
propose
legislation
for
state
licensure
of
birth
centers
to
be
20
considered
by
the
2024
session
of
the
general
assembly.
The
21
division
takes
effect
upon
enactment.
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