H.F. 224 Section 1. Section 135.131, subsection 1, paragraph a, Code 1 2025, is amended to read as follows: 2 a. “Birth center” means birth center as defined in section 3 10A.711 a facility or institution, which is not an ambulatory 4 surgical center or a hospital or in a hospital in which 5 births are planned to occur following a normal, uncomplicated, 6 low-risk pregnancy . 7 Sec. 2. Section 135C.2, subsection 5, unnumbered paragraph 8 1, Code 2025, is amended to read as follows: 9 The department shall establish a special classification 10 within the residential care facility category in order to 11 foster the development of residential care facilities which 12 serve persons with an intellectual disability, chronic mental 13 illness, a developmental disability, or brain injury, as 14 described under section 225C.26 , and which contain five or 15 fewer residents. A facility within the special classification 16 established pursuant to this subsection is exempt from the 17 requirements of section 10A.713 . The department shall adopt 18 rules which are consistent with rules previously developed 19 for the waiver demonstration project pursuant to 1986 Iowa 20 Acts, ch. 1246, §206 , and which include all of the following 21 provisions: 22 Sec. 3. Section 135P.1, subsection 3, Code 2025, is amended 23 to read as follows: 24 3. “Health facility” means an institutional health facility 25 as defined in section 10A.711 , a hospice licensed under chapter 26 135J , a home health agency as defined in section 144D.1 , an 27 assisted living program certified under chapter 231C , a clinic, 28 a community health center, or the university of Iowa hospitals 29 and clinics, and includes any corporation, professional 30 corporation, partnership, limited liability company, limited 31 liability partnership, or other entity comprised of such health 32 facilities. For purposes of this subsection, institutional 33 health facility includes any of the following, without regard 34 to whether the facilities referred to are publicly or privately 35 -1- LSB 1650YH (3) 91 dg/ko 1/ 4

H.F. 224 owned or are organized for profit or not or whether the 1 facilities are part of or sponsored by a health maintenance 2 organization: 3 a. A hospital. 4 b. A health care facility. 5 c. An organized outpatient health facility. 6 d. An ambulatory surgical center. 7 e. A community mental health facility. 8 f. A birth center. 9 Sec. 4. Section 231C.3, subsection 2, Code 2025, is amended 10 to read as follows: 11 2. Each assisted living program operating in this state 12 shall be certified by the department. If an assisted living 13 program is voluntarily accredited by a recognized accrediting 14 entity, the department shall certify the assisted living 15 program on the basis of the voluntary accreditation. An 16 assisted living program that is certified by the department on 17 the basis of voluntary accreditation shall not be subject to 18 payment of the certification fee prescribed in section 231C.18 , 19 but shall be subject to an administrative fee as prescribed by 20 rule. An assisted living program certified under this section 21 is exempt from the requirements of section 10A.713 relating to 22 certificate of need requirements. 23 Sec. 5. Section 249K.2, subsection 5, Code 2025, is amended 24 to read as follows: 25 5. “New construction” means the construction of a new 26 nursing facility which does not replace an existing licensed 27 and certified facility and requires the provider to obtain a 28 certificate of need pursuant to chapter 10A, subchapter VII . 29 Sec. 6. Section 505.27, subsection 5, paragraph a, Code 30 2025, is amended to read as follows: 31 a. “Health care provider” means the same as defined in 32 section 10A.711 , a any of the following: 33 (1) A person licensed or certified under chapter 147, 148, 34 148A, 148C, 149, 151, 152, 153, 154, 154B, 154F, or 155A to 35 -2- LSB 1650YH (3) 91 dg/ko 2/ 4

H.F. 224 provide in this state professional health care service to an 1 individual during that individual’s medical care, treatment, 2 or confinement. 3 (2) A hospital licensed pursuant to chapter 135B , or a . 4 (3) A health care facility licensed pursuant to chapter 5 135C . 6 Sec. 7. Section 708.3A, subsection 5, paragraph d, Code 7 2025, is amended to read as follows: 8 d. “Health care provider” means an emergency medical care 9 provider as defined in chapter 147A or a person licensed 10 or registered under chapter 148 , 148C , 148D , or 152 who is 11 providing or who is attempting to provide emergency medical 12 services, as defined in section 147A.1 , or who is providing 13 or who is attempting to provide health services as defined in 14 section 10A.711 clinically related diagnostic, curative, or 15 rehabilitative services, including substance use disorder and 16 mental health services, in a hospital. A person who commits an 17 assault under this section against a health care provider in 18 a hospital, or at the scene or during out-of-hospital patient 19 transportation in an ambulance, is presumed to know that the 20 person against whom the assault is committed is a health care 21 provider. 22 Sec. 8. REPEAL. Sections 10A.711, 10A.712, 10A.713, 23 10A.714, 10A.715, 10A.716, 10A.717, 10A.718, 10A.719, 10A.720, 24 10A.721, 10A.722, 10A.723, and 135B.5A, Code 2025, are 25 repealed. 26 EXPLANATION 27 The inclusion of this explanation does not constitute agreement with 28 the explanation’s substance by the members of the general assembly. 29 This bill eliminates certificate of need (CON) requirements 30 and the state health facilities council (council). 31 Under current law, certain health care providers are 32 required to obtain a CON from the department of inspections, 33 appeals, and licensing (DIAL) prior to creating or expanding a 34 medical facility or introducing certain medical services within 35 -3- LSB 1650YH (3) 91 dg/ko 3/ 4

H.F. 224 a specific area. To obtain a CON, a health care provider 1 must proceed through an application process implemented and 2 administered by DIAL and the council. 3 The bill makes conforming changes to Code sections 4 135.131 (universal newborn and infant hearing screening), 5 135C.2 (health care facilities —— purpose —— rules —— 6 special classifications —— protection and advocacy agency), 7 135P.1 (adverse health care incidents —— definitions), 8 231C.3 (certification of assisted living programs), 249K.2 9 (nursing facility construction or expansion), 505.27 (medical 10 malpractice insurance —— annual claims reports required), and 11 708.3A (assaults on persons engaged in certain occupations). 12 -4- LSB 1650YH (3) 91 dg/ko 4/ 4