House File 754 - Introduced HOUSE FILE 754 BY COMMITTEE ON HEALTH AND HUMAN SERVICES (SUCCESSOR TO HSB 191) A BILL FOR An Act relating to health care including a funding model for 1 the rural health care system; the elimination of several 2 health care-related award, grant, residency, and fellowship 3 programs; establishment of a health care professional 4 incentive program; Medicaid graduate medical education; the 5 health facilities council; and the Iowa health information 6 network, making appropriations, and including effective date 7 provisions. 8 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 9 TLSB 1555HV (3) 91 lh/ko

H.F. 754 DIVISION I 1 HEALTH CARE HUB-AND-SPOKE PARTNERSHIP FUNDING MODEL 2 Section 1. HEALTH CARE HUB-AND-SPOKE PARTNERSHIP FUNDING 3 MODEL APPROVAL. The department of health and human services 4 shall submit to the centers for Medicare and Medicaid services 5 of the United States department of health and human services 6 a request for approval for a health care hub-and-spoke 7 partnership funding model for the purpose of improving Iowa’s 8 rural health system to establish sufficient financial support 9 for collaboration among regional health care providers in rural 10 areas to transform health care delivery to provide quality and 11 sustainable care. 12 Sec. 2. EFFECTIVE DATE. This division of this Act, being 13 deemed of immediate importance, takes effect upon enactment. 14 DIVISION II 15 ELIMINATION OF PRIMECARRE PROGRAMS —— DEPARTMENT OF HEALTH AND 16 HUMAN SERVICES 17 Sec. 3. Section 135.107, subsection 1, Code 2025, is amended 18 by adding the following new paragraph: 19 NEW PARAGRAPH . f. Coordinate with the college student aid 20 commission to administer the health professional incentive 21 program created in section 256.222. 22 Sec. 4. Section 135.107, subsections 2 and 3, Code 2025, are 23 amended by striking the subsections. 24 Sec. 5. Section 135B.33, subsection 3, Code 2025, is amended 25 to read as follows: 26 3. The health facilities may seek technical assistance 27 or apply for matching grant funds for the plan development. 28 The department shall require compliance with subsection 1 , 29 paragraphs “a” through “h” , when the facility applies for 30 matching grant funds. 31 Sec. 6. TRANSITION PROVISIONS —— ACCOUNT. 32 1. The department of health and human services shall make 33 loan repayments pursuant to a loan repayment program contract, 34 including a United States department of health and human 35 -1- LSB 1555HV (3) 91 lh/ko 1/ 40

H.F. 754 services state loan repayment program contract, executed on 1 or before December 31, 2025, under the primary care provider 2 loan repayment program in section 135.107, Code 2025, if the 3 recipient remains in compliance with all obligations under the 4 loan repayment program contract. 5 2. a. The department of health and human services shall 6 create an account for deposit of any moneys encumbered or 7 obligated pursuant to a loan repayment program contract as 8 specified in subsection 1. The department shall ensure that 9 the encumbered and obligated moneys remain available for the 10 duration of the loan repayment program contract. Moneys in the 11 account are appropriated to the department for the purposes of 12 this section. 13 b. Notwithstanding section 8.33, any balance in the account 14 shall not revert but shall remain available for the duration of 15 such loan repayment program contracts. Notwithstanding section 16 12C.7, subsection 2, interest or earnings on moneys deposited 17 in the account shall be credited to the account. 18 c. Upon expiration of all loan repayment program contract 19 periods and the expenditure of all moneys encumbered and 20 obligated under such loan repayment contracts, any unencumbered 21 or unobligated moneys remaining in the account created under 22 this section shall be deposited in the health care professional 23 incentive program fund created in section 256.222, as enacted 24 by this Act. 25 DIVISION III 26 ELIMINATION OF HEALTH CARE-RELATED LOAN REPAYMENT AND FINANCIAL 27 AWARD PROGRAMS —— COLLEGE STUDENT AID COMMISSION 28 Sec. 7. REPEAL. Sections 256.221, 256.223, 256.224, and 29 256.225, Code 2025, are repealed. 30 Sec. 8. TRANSITION PROVISIONS. 31 1. The college student aid commission shall make loan 32 repayments pursuant to a program agreement entered into on or 33 before June 30, 2025, by an eligible student and the commission 34 under the rural Iowa primary care loan repayment program 35 -2- LSB 1555HV (3) 91 lh/ko 2/ 40

H.F. 754 in section 256.221, Code 2025, if the student remains in 1 compliance with all obligations under the program agreement. 2 2. The college student aid commission shall make loan 3 repayments pursuant to a contract entered into on or before 4 June 30, 2025, by a health care professional and the commission 5 under the health care professional recruitment program in 6 section 256.223, Code 2025, if the health care professional 7 remains in compliance with all obligations under the contract. 8 3. The college student aid commission shall provide the 9 annual award to a recipient selected on or before June 30, 10 2025, for an award under the health care award program in 11 section 256.224, Code 2025. 12 4. The college student aid commission shall make loan 13 repayments pursuant to a program agreement entered into on or 14 before June 30, 2025, by a mental health professional and the 15 commission under the mental health professional loan repayment 16 program in section 256.225, Code 2025, if the mental health 17 professional remains in compliance with all obligations under 18 the program agreement. 19 Sec. 9. TRANSFER OF MONEYS. On the effective date of this 20 division of this Act, any unencumbered and unobligated moneys 21 remaining in the following funds shall be transferred to the 22 health care professional incentive program fund created in 23 section 256.222, as enacted in this Act: 24 1. The rural Iowa primary care trust fund created in section 25 256.221, subsection 12, Code 2025. 26 2. The health care professional recruitment fund created in 27 section 256.223, subsection 4, Code 2025. 28 3. The health care award fund created in section 256.224, 29 subsection 6, Code 2025. 30 4. The mental health professional loan repayment fund 31 created in section 256.225, subsection 7, Code 2025. 32 Sec. 10. TRANSITION —— ACCOUNTS. 33 1. The college student aid commission shall create 34 individual accounts for the deposit of any moneys encumbered or 35 -3- LSB 1555HV (3) 91 lh/ko 3/ 40

H.F. 754 obligated relating to a loan repayment or award funded under 1 each of the following programs: 2 a. The rural Iowa primary care loan repayment program under 3 section 256.221, Code 2025. 4 b. The health care professional recruitment program under 5 section 256.223, Code 2025. 6 c. The health care award program under section 256.224, Code 7 2025. 8 d. The mental health professional loan repayment program 9 under section 256.225, Code 2025. 10 2. Notwithstanding section 8.33, any balance in any of 11 the accounts created under subsection 1 shall not revert but 12 shall remain available for the duration of all applicable 13 loan repayments and awards. Notwithstanding section 12C.7, 14 subsection 2, interest or earnings on moneys deposited in each 15 account shall be credited to the respective account. 16 3. Upon expiration of all program agreement, contract, 17 and award disbursement periods and the expenditure of all 18 moneys encumbered and obligated under such program agreements, 19 contracts, and awards, any unencumbered or unobligated moneys 20 remaining in the accounts created under this section shall be 21 deposited in the health care professional incentive program 22 fund created in section 256.222, as enacted by this Act. 23 DIVISION IV 24 HEALTH CARE PROFESSIONAL INCENTIVE PROGRAM ESTABLISHED 25 Sec. 11. NEW SECTION . 256.222 Health care professional 26 incentive program —— fund. 27 1. Definitions. For purposes of this section, unless the 28 context otherwise requires: 29 a. “Award” means either of the following: 30 (1) A loan repayment made on behalf of an eligible health 31 care professional on the total amount owed, including principal 32 and interest, by the eligible health care professional on any 33 of the following: 34 (a) A federally guaranteed Stafford loan under the federal 35 -4- LSB 1555HV (3) 91 lh/ko 4/ 40

H.F. 754 family education loan program or the federal direct loan 1 program. 2 (b) A federal grad plus loan. 3 (c) A consolidated federally guaranteed Stafford loan under 4 the federal family education loan program or the federal direct 5 loan program. 6 (d) A consolidated federal grad plus loan. 7 (2) An income bonus paid to an eligible health care 8 professional. 9 b. “Commission” means the college student aid commission. 10 c. “Department” means the department of health and human 11 services. 12 d. “Eligible health care profession” means health care 13 occupational categories that are in high demand, as determined 14 and maintained on a list by the department, and may include but 15 are not limited to physicians, physician assistants, registered 16 nurses, nurse practitioners, nurse educators, and mental health 17 professionals. 18 e. “Eligible health care professional” means an individual 19 currently employed, or who will be employed, in an eligible 20 health care profession that is located in an eligible practice 21 area. 22 f. “Eligible practice area” means a geographic region 23 or county in this state that has a shortage of health care 24 professionals as determined by the department. 25 g. “Employment obligation” means the number of consecutive 26 years an eligible health care professional must practice. 27 (1) If practicing full-time, which means two thousand 28 eighty hours of work in a calendar year, including all paid 29 holidays, vacations, sick time, and other paid leave, an 30 eligible health care professional must practice for five years. 31 (2) If practicing part-time, which means one thousand five 32 hundred sixty hours of work in a calendar year, including all 33 paid holidays, vacations, sick time, and other paid leave, 34 an eligible health care professional must practice for seven 35 -5- LSB 1555HV (3) 91 lh/ko 5/ 40

H.F. 754 years. 1 h. “Program” means the health care professional incentive 2 program established in this section. 3 2. Program established. The health care professional 4 incentive program is established and shall be administered 5 by the commission, in coordination with the department, for 6 the purpose of offering awards to recruit and retain eligible 7 health care professionals for employment in eligible practice 8 areas. For the fiscal year beginning July 1, 2025, and 9 each fiscal year thereafter, the commission, in coordination 10 with the department, shall determine the number of awards 11 available for each eligible health care profession prior to the 12 commencement of the fiscal year. 13 3. Legislative intent. It is the intent of the general 14 assembly that the program shall not interfere with local 15 community investments to recruit and retain health care 16 professionals. 17 4. Exceptions. An eligible health care professional shall 18 be ineligible for the program if the eligible health care 19 professional is currently participating in, or has participated 20 in, any of the following: 21 a. The primary care provider loan repayment program pursuant 22 to section 135.107, Code 2025. 23 b. The rural Iowa primary care loan repayment program 24 pursuant to section 256.221, Code 2025. 25 c. The health care professional recruitment program pursuant 26 to section 256.223, Code 2025. 27 d. The health care award program pursuant to section 28 256.224, Code 2025. 29 e. The mental health professional loan repayment program 30 pursuant to section 256.225, Code 2025. 31 5. Program requirements. 32 a. An eligible health care professional may submit an 33 application for the program to the commission in the form and 34 manner prescribed by the commission. The applicant shall 35 -6- LSB 1555HV (3) 91 lh/ko 6/ 40

H.F. 754 elect to receive an award as either a loan repayment or an 1 income bonus if selected for the program, and shall submit any 2 additional information requested by the commission. 3 b. If selected for an award, the eligible health care 4 professional and the commission shall execute a program 5 agreement that specifies all of the following: 6 (1) The date the eligible health care professional’s 7 employment obligation begins, which shall be no later than six 8 months from the date the program agreement is executed. 9 (2) The date the health care professional’s employment 10 obligation terminates. 11 (3) Whether the award is a loan repayment or an income 12 bonus, and the terms and conditions related to the award, 13 including the aggregate award amount that the eligible health 14 care professional will receive. 15 (4) Requirements regarding the eligible health care 16 professional’s license to practice in this state while 17 participating in the program. 18 (5) All other terms and conditions agreed to by the eligible 19 health care professional and the commission. 20 6. Awards. 21 a. Upon verifying the eligible health care professional is 22 in compliance with all terms of the program agreement executed 23 pursuant to subsection 5, paragraph “b” , the commission shall 24 pay the eligible health care professional’s award annually as 25 follows: 26 (1) For a full-time employment obligation, the award shall 27 be paid as follows: 28 (a) An amount equal to twenty percent of the aggregate award 29 shall be paid to the eligible health care professional after 30 the completion of the first year of the eligible health care 31 professional’s employment obligation. 32 (b) An amount equal to fifteen percent of the aggregate 33 award shall be paid to the eligible health care professional 34 after the completion of the second year, the third year, and 35 -7- LSB 1555HV (3) 91 lh/ko 7/ 40

H.F. 754 the fourth year of the eligible health care professional’s 1 employment obligation. 2 (c) An amount equal to thirty-five percent of the aggregate 3 award shall be paid to the eligible health care professional 4 after the completion of the fifth year of the eligible health 5 care professional’s employment obligation. 6 (2) For a part-time employment obligation, the aggregate 7 award shall be prorated by the commission. 8 b. A minimum of every five years, the commission, in 9 consultation with the department, shall establish a list of the 10 eligible health care professions and the aggregate award amount 11 for each eligible health care profession. The aggregate award 12 amount shall not exceed two hundred thousand dollars. 13 c. An individual who executed a program agreement under 14 subsection 5, paragraph “b” , prior to the exclusion of an 15 eligible health care professional from the list established 16 under paragraph “b” shall remain eligible for the program per 17 the terms of the individual’s program agreement. 18 7. Health care professional incentive program fund. A 19 health care professional incentive program fund is created in 20 the state treasury under the control of the commission. All 21 moneys deposited or paid into the fund are appropriated to the 22 commission to be used for awards as provided in this section. 23 Notwithstanding section 8.33, moneys in the fund that remain 24 unencumbered or unobligated at the close of each fiscal year 25 shall not revert but shall remain available for expenditure. 26 Notwithstanding section 12C.7, subsection 2, interest or 27 earnings on moneys in the fund shall be credited to the fund 28 and may be utilized by the commission for administrative costs. 29 8. Rules. The commission, in coordination with the 30 department, shall adopt rules pursuant to chapter 17A to 31 administer this section. 32 Sec. 12. EFFECTIVE DATE. This division of this Act, being 33 deemed of immediate importance, takes effect upon enactment. 34 DIVISION V 35 -8- LSB 1555HV (3) 91 lh/ko 8/ 40

H.F. 754 ELIMINATION OF HEALTH CARE-RELATED GRANT, RESIDENCY, AND 1 FELLOWSHIP PROGRAMS —— DEPARTMENT OF HEALTH AND HUMAN SERVICES 2 Sec. 13. Section 135.179, subsection 2, Code 2025, is 3 amended to read as follows: 4 2. Funding for the program may be provided through the 5 health care workforce shortage fund or the fulfilling Iowa’s 6 need for dentists matching grant program account created in 7 section 135.175 . The purpose of the program is to establish, 8 expand, or support the placement of dentists in dental or rural 9 shortage areas across the state by providing education loan 10 repayments. 11 Sec. 14. Section 249M.4, subsection 2, Code 2025, is amended 12 to read as follows: 13 2. Moneys in the trust fund shall be used, subject to 14 their appropriation by the general assembly, by the department 15 to reimburse participating hospitals the medical assistance 16 program upper payment limit for inpatient and outpatient 17 hospital services as calculated in this section . Following 18 payment of such upper payment limit to participating hospitals, 19 any remaining funds in the trust fund on an annual basis may be 20 used for any of the following purposes: 21 a. To support medical assistance program utilization 22 shortfalls. 23 b. To maintain the state’s capacity to provide access to and 24 delivery of services for vulnerable Iowans. 25 c. To fund the health care workforce support initiative 26 created pursuant to section 135.175 . 27 d. c. To support access to health care services for 28 uninsured Iowans. 29 e. d. To support Iowa hospital programs and services which 30 expand access to health care services for Iowans. 31 Sec. 15. REPEAL. Sections 135.175, 135.176, 135.178, and 32 135.193, Code 2025, are repealed. 33 Sec. 16. TRANSITION PROVISIONS. 34 1. a. The department of health and human services shall 35 -9- LSB 1555HV (3) 91 lh/ko 9/ 40

H.F. 754 provide matching state funding to a sponsor awarded on or 1 before June 30, 2025, under the medical residency training 2 state matching grants program in section 135.176, Code 2025, 3 until all residents in the funded residencies have completed or 4 left the program. 5 b. The department of health and human services shall provide 6 matching state funding to a sponsor for medical residency 7 training program liability costs awarded on or before June 8 30, 2025, under the medical residency training state matching 9 grants program in section 135.176, Code 2025, until June 30, 10 2026. 11 2. The department of health and human services shall provide 12 matching state funding to a sponsor awarded on or before June 13 30, 2025, under the nurse residency state matching grants 14 program in section 135.178, Code 2025, until all residents have 15 completed or left the nurse residency programs. 16 3. The department of health and human services shall fund 17 a fellowship position pursuant to a program agreement entered 18 into on or before June 30, 2025, by a participating teaching 19 hospital and a participating fellow under the state-funded 20 family medicine obstetrics fellowship program in section 21 135.193, Code 2025, if the participating fellow remains in 22 compliance with all obligations under the program agreement. 23 4. The department of health and human services shall fund 24 a rural psychiatric residency for a resident selected on or 25 before June 30, 2025, until all residents have completed 26 or left the rural psychiatric residencies, pursuant to 27 appropriations as provided in the following: 28 a. 2024 Iowa Acts, chapter 1157, section 5, subsection 3, 29 and 2024 Iowa Acts, chapter 1157, section 22, subsection 5. 30 b. 2023 Iowa Acts, chapter 112, section 5, subsection 4, 31 paragraph “j”, as amended by 2024 Iowa Acts, chapter 1157, 32 section 29. 33 c. 2022 Iowa Acts, chapter 1131, section 3, subsection 4, 34 paragraph “j”, as amended by 2024 Iowa Acts, chapter 1157, 35 -10- LSB 1555HV (3) 91 lh/ko 10/ 40

H.F. 754 section 23. 1 d. 2021 Iowa Acts, chapter 182, section 3, subsection 4, 2 paragraph “j”. 3 e. 2019 Iowa Acts, chapter 85, section 3, subsection 4, 4 paragraph “j”, as amended by 2020 Iowa Acts, chapter 1121, 5 section 19. 6 Sec. 17. TRANSFER OF MONEYS. Notwithstanding section 8.33 7 or any other provision to the contrary, any unobligated or 8 unencumbered moneys in any of the following accounts or funds 9 or constituting any specified appropriation, shall not revert 10 but are appropriated to the department of health and human 11 services to fund Medicaid graduate medical education efforts. 12 1. The health care workforce shortage fund created in 13 section 135.175, subsection 1, paragraph “b”, Code 2025. 14 2. The medical residency training account created in 15 section 135.175, subsection 5, paragraph “a”, Code 2025. 16 3. The nurse residency state matching grants program 17 account created in section 135.175, subsection 5, paragraph 18 “b”, Code 2025. 19 4. The health care workforce shortage national initiatives 20 account created in section 135.175, subsection 5, paragraph 21 “c”, Code 2025. 22 5. The family medicine obstetrics fellowship program fund 23 created in section 135.193, Code 2025. 24 6. Moneys appropriated to the department of health and human 25 services for rural psychiatric residencies to fund psychiatric 26 residents to provide mental health services in underserved 27 areas of the state as described in the following: 28 a. 2024 Iowa Acts, chapter 1157, section 5, subsection 3, 29 and 2024 Iowa Acts, chapter 1157, section 22, subsection 5. 30 b. 2023 Iowa Acts, chapter 112, section 5, subsection 4, 31 paragraph “j”, as amended by 2024 Iowa Acts, chapter 1157, 32 section 29. 33 c. 2022 Iowa Acts, chapter 1131, section 3, subsection 4, 34 paragraph “j”, as amended by 2024 Iowa Acts, chapter 1157, 35 -11- LSB 1555HV (3) 91 lh/ko 11/ 40

H.F. 754 section 23. 1 d. 2021 Iowa Acts, chapter 182, section 3, subsection 4, 2 paragraph “j”. 3 e. 2019 Iowa Acts, chapter 85, section 3, subsection 4, 4 paragraph “j”, as amended by 2020 Iowa Acts, chapter 1121, 5 section 19. 6 Sec. 18. TRANSITION —— ACCOUNTS. 7 1. The department of health and human services shall create 8 individual accounts for the deposit of any moneys encumbered 9 or obligated relating to a grant awarded, or residency or 10 fellowship funded, under each of the following programs: 11 a. The medical residency training state matching grants 12 program under section 135.176, Code 2025. 13 b. The nurse residency state matching grants program under 14 section 135.178, Code 2025. 15 c. The state-funded family medicine obstetrics fellowship 16 program under section 135.193, Code 2025. 17 d. Rural psychiatric residencies as described in the 18 following: 19 (1) 2024 Iowa Acts, chapter 1157, section 5, subsection 3, 20 and 2024 Iowa Acts, chapter 1157, section 22, subsection 5. 21 (2) 2023 Iowa Acts, chapter 112, section 5, subsection 4, 22 paragraph “j”, as amended by 2024 Iowa Acts, chapter 1157, 23 section 29. 24 (3) 2022 Iowa Acts, chapter 1131, section 3, subsection 25 4, paragraph “j”, as amended by 2024 Iowa Acts, chapter 1157, 26 section 23. 27 (4) 2021 Iowa Acts, chapter 182, section 3, subsection 4, 28 paragraph “j”. 29 (5) 2019 Iowa Acts, chapter 85, section 3, subsection 4, 30 paragraph “j”, as amended by 2020 Iowa Acts, chapter 1121, 31 section 19. 32 2. Notwithstanding section 8.33, any balance in any of the 33 accounts created under subsection 1 shall not revert but shall 34 remain available for the duration of all applicable grants, 35 -12- LSB 1555HV (3) 91 lh/ko 12/ 40

H.F. 754 residencies, and fellowships. Notwithstanding section 12C.7, 1 subsection 2, interest or earnings on moneys deposited in each 2 account shall be credited to the respective account. 3 3. Upon expiration of all grant, residency, and fellowship 4 periods and the expenditure of all moneys encumbered under 5 such grants, residencies, and fellowships, any unencumbered or 6 unobligated moneys remaining in any of the accounts created 7 under subsection 1 are appropriated to the department of health 8 and human services for Medicaid graduate medical education 9 efforts. 10 DIVISION VI 11 ELIMINATION OF THE STATE-FUNDED PSYCHIATRY RESIDENCY AND 12 FELLOWSHIP POSITIONS —— UNIVERSITY OF IOWA HOSPITALS AND 13 CLINICS 14 Sec. 19. REPEAL. Section 135.180, Code 2025, is repealed. 15 Sec. 20. TRANSITION PROVISIONS. The board of regents 16 shall direct the university of Iowa hospitals and clinics to 17 distribute moneys for state-funded psychiatry residency and 18 fellowship positions approved and awarded on or before June 19 30, 2025, under the state-funded psychiatry residency and 20 fellowship positions in section 135.180, Code 2025, until all 21 residents and fellows have completed or left the state-funded 22 psychiatry residency or fellowship positions. 23 Sec. 21. TRANSITION —— ACCOUNT. 24 1. The board of regents shall direct the university of Iowa 25 hospitals and clinics to create an account for the deposit 26 of moneys encumbered or obligated relating to residency and 27 fellowship positions funded under the state-funded psychiatry 28 residency and fellowship positions under section 135.180, Code 29 2025. 30 2. Notwithstanding section 8.33, any balance in the account 31 created under subsection 1 shall not revert but shall remain 32 available for the duration of all applicable residencies and 33 fellowships. Notwithstanding section 12C.7, subsection 2, 34 interest or earnings on moneys deposited in the account shall 35 -13- LSB 1555HV (3) 91 lh/ko 13/ 40

H.F. 754 be credited to the account. 1 3. Upon expiration of all residency and fellowship periods 2 and the expenditure of all moneys encumbered under such 3 residencies and fellowships, any unencumbered or unobligated 4 moneys remaining in the account created under subsection 1 are 5 appropriated to the department of health and human services for 6 Medicaid graduate medical education efforts. 7 Sec. 22. TRANSFER OF MONEYS. Notwithstanding section 8.33 8 or any other provision to the contrary, any unobligated or 9 unencumbered moneys in the psychiatry residency and fellowship 10 positions fund created in section 135.180, Code 2025, shall 11 not revert but are appropriated to the department of health 12 and human services to fund Medicaid graduate medical education 13 efforts. 14 DIVISION VII 15 ELIMINATION OF THE HEALTH FACILITIES COUNCIL 16 Sec. 23. Section 10A.711, subsection 5, Code 2025, is 17 amended by striking the subsection and inserting in lieu 18 thereof the following: 19 5. “Department” means the department of health and human 20 services. 21 Sec. 24. Section 10A.713, subsection 4, unnumbered 22 paragraph 1, Code 2025, is amended to read as follows: 23 A copy of the application shall be sent to the department 24 of health and human services at the time the application is 25 submitted to the department. The department shall not process 26 applications for and the council shall not an intermediate 27 care facility for persons with an intellectual disability, or 28 consider a new or changed institutional health service for an 29 intermediate care facility for persons with an intellectual 30 disability , unless both of the following conditions are met: 31 Sec. 25. Section 10A.714, subsection 1, unnumbered 32 paragraph 1, Code 2025, is amended to read as follows: 33 In determining whether a certificate of need shall be 34 issued, the department and council shall consider the 35 -14- LSB 1555HV (3) 91 lh/ko 14/ 40

H.F. 754 following: 1 Sec. 26. Section 10A.714, subsection 1, paragraph r, Code 2 2025, is amended to read as follows: 3 r. The recommendations of staff personnel of the department 4 assigned to the area of certificate of need, concerning the 5 application , if requested by the council . 6 Sec. 27. Section 10A.714, subsection 2, unnumbered 7 paragraph 1, Code 2025, is amended to read as follows: 8 In addition to the findings required with respect to any 9 of the criteria listed in subsection 1 of this section , the 10 council department shall grant a certificate of need for a new 11 institutional health service or changed institutional health 12 service only if it the department finds in writing, on the 13 basis of data submitted to it by the department , that: 14 Sec. 28. Section 10A.716, subsection 3, Code 2025, is 15 amended to read as follows: 16 3. Each application accepted by the department shall be 17 formally reviewed for the purpose of furnishing to the council 18 the information necessary to enable it the department to 19 determine whether or not to grant the certificate of need. A 20 formal review shall consist , at a minimum , of the following 21 steps: 22 a. Evaluation of the application against the criteria 23 specified in section 10A.714 135.63 . 24 b. A public hearing on the application, to be held prior to 25 completion of the evaluation required by paragraph “a” , shall be 26 conducted by the council . 27 Sec. 29. Section 10A.719, Code 2025, is amended to read as 28 follows: 29 10A.719 Council Department to make final decision. 30 1. The department shall complete its formal review of 31 the application within ninety days after acceptance of the 32 application, except as otherwise provided by section 10A.722 33 135.71 , subsection 4 . Upon completion of the formal review, 34 the council department shall approve or deny the application. 35 -15- LSB 1555HV (3) 91 lh/ko 15/ 40

H.F. 754 The council department shall issue written findings stating the 1 basis for its decision on the application , and the department 2 shall send copies of the council’s decision and the written 3 findings supporting the decision to the applicant and to any 4 other person who so requests. 5 2. Failure by the council department to issue a written 6 decision on an application for a certificate of need within the 7 time required by this section shall constitute denial of and 8 final administrative action on the application. 9 Sec. 30. Section 10A.720, Code 2025, is amended to read as 10 follows: 11 10A.720 Appeal of certificate of need decisions. 12 The council’s department’s decision on an application for 13 certificate of need, when announced pursuant to section 10A.719 14 135.68 , is shall be a final decision. Any dissatisfied party 15 who is an affected person with respect to the application, 16 and who participated or sought unsuccessfully to participate 17 in the formal review procedure prescribed by section 10A.716 18 135.65 , may request a rehearing in accordance with chapter 17A 19 and rules of the department. If a rehearing is not requested 20 or an affected party remains dissatisfied after the request for 21 rehearing, an appeal may be taken in the manner provided by 22 chapter 17A . Notwithstanding the Iowa administrative procedure 23 Act, chapter 17A , a request for rehearing is not required , 24 prior to appeal under section 17A.19 . 25 Sec. 31. Section 10A.721, Code 2025, is amended to read as 26 follows: 27 10A.721 Period for which certificate is valid —— extension 28 or revocation. 29 1. A certificate of need shall be valid for a maximum of 30 one year from the date of issuance. Upon the expiration of the 31 certificate, or at any earlier time while the certificate is 32 valid , the holder thereof of the certificate shall provide the 33 department such information on the development of the project 34 covered by the certificate as the department may request. 35 -16- LSB 1555HV (3) 91 lh/ko 16/ 40

H.F. 754 The council department shall determine at the end of the 1 certification period whether sufficient progress is being made 2 on the development of the project. The certificate of need may 3 be extended by the council department for additional periods 4 of time as are reasonably necessary to expeditiously complete 5 the project, but may be revoked by the council department at 6 the end of the first or any subsequent certification period for 7 insufficient progress in developing the project. 8 2. Upon expiration of a certificate of need, and prior to 9 extension thereof of the certificate of need , any affected 10 person shall have the right to submit to the department 11 information which may be relevant to the question of granting 12 an extension. The department may call a public hearing for 13 this purpose. 14 Sec. 32. Section 10A.722, unnumbered paragraph 1, Code 15 2025, is amended to read as follows: 16 The department shall adopt , with approval of the council, 17 such administrative rules as are necessary to enable it to 18 implement this part subchapter . These rules shall include: 19 Sec. 33. Section 10A.723, subsection 2, paragraph a, Code 20 2025, is amended to read as follows: 21 a. A class I violation is one in which a party offers a 22 new institutional health service or changed institutional 23 health service modernization or acquisition without review and 24 approval by the council department . A party in violation is 25 subject to a penalty of three hundred dollars for each day of a 26 class I violation. The department may seek injunctive relief 27 which shall include restraining the commission or continuance 28 of an act which would violate the provisions of this paragraph. 29 Notice and opportunity to be heard shall be provided to a party 30 pursuant to rule of civil procedure 1.1507 and contested case 31 procedures in accordance with chapter 17A . The department may 32 reduce, alter, or waive a penalty upon the party showing good 33 faith compliance with the department’s request to immediately 34 cease and desist from conduct in violation of this section . 35 -17- LSB 1555HV (3) 91 lh/ko 17/ 40

H.F. 754 Sec. 34. Section 68B.35, subsection 2, paragraph e, Code 1 2025, is amended to read as follows: 2 e. Members of the state banking council, the Iowa ethics and 3 campaign disclosure board, the credit union review board, the 4 economic development authority, the employment appeal board, 5 the environmental protection commission, the health facilities 6 council, the Iowa finance authority, the Iowa public employees’ 7 retirement system investment board, the Iowa lottery commission 8 created in section 99G.8 , the natural resource commission, the 9 board of parole, the state racing and gaming commission, the 10 state board of regents, the transportation commission, the 11 office of consumer advocate, the utilities commission, the Iowa 12 telecommunications and technology commission, and any full-time 13 members of other boards and commissions as defined under 14 section 7E.4 who receive an annual salary for their service 15 on the board or commission. The Iowa ethics and campaign 16 disclosure board shall conduct an annual review to determine 17 if members of any other board, commission, or authority should 18 file a statement and shall require the filing of a statement 19 pursuant to rules adopted pursuant to chapter 17A . 20 Sec. 35. Section 97B.1A, subsection 8, paragraph a, 21 subparagraph (8), Code 2025, is amended to read as follows: 22 (8) Members of the state transportation commission , and the 23 board of parole , and the state health facilities council . 24 Sec. 36. CODE EDITOR DIRECTIVE. 25 1. The Code editor is directed to make the following 26 transfers: 27 a. Section 10A.711 to section 135.61. 28 b. Section 10A.713 to section 135.62. 29 c. Section 10A.714 to section 135.63. 30 d. Section 10A.715 to section 135.64. 31 e. Section 10A.716 to section 135.65. 32 f. Section 10A.717 to section 135.66. 33 g. Section 10A.718 to section 135.67. 34 h. Section 10A.719 to section 135.68. 35 -18- LSB 1555HV (3) 91 lh/ko 18/ 40

H.F. 754 i. Section 10A.720 to section 135.69. 1 j. Section 10A.721 to section 135.70. 2 k. Section 10A.722 to section 135.71. 3 l. Section 10A.723 to section 135.72. 4 m. Section 10A.724 to section 135.73. 5 n. Section 10A.725 to section 135.74. 6 o. Section 10A.726 to section 135.75. 7 p. Section 10A.727 to section 135.76. 8 q. Section 10A.728 to section 135.77. 9 r. Section 10A.729 to section 135.78. 10 2. The Code editor is directed to rename and retitle 11 subchapter VI of chapter 135 as HEALTH FACILITIES and include 12 sections 135.61 through 135.78. 13 3. The Code editor shall correct internal references in the 14 Code and in any enacted legislation as is necessary due to the 15 enactment of this division. 16 Sec. 37. REPEAL. Section 10A.712, Code 2025, is repealed. 17 DIVISION VIII 18 CONFORMING CHANGES —— ELIMINATION OF THE HEALTH FACILITIES 19 COUNCIL 20 Sec. 38. Section 10A.711, unnumbered paragraph 1, Code 21 2025, is amended to read as follows: 22 As used in this part subchapter , unless the context 23 otherwise requires: 24 Sec. 39. Section 10A.711, subsection 1, paragraph d, Code 25 2025, is amended to read as follows: 26 d. Each institutional health facility or health maintenance 27 organization which, prior to receipt of the application by the 28 department, has formally indicated to the department pursuant 29 to this part subchapter an intent to furnish in the future 30 institutional health services similar to the new institutional 31 health service proposed in the application. 32 Sec. 40. Section 10A.713, subsection 1, Code 2025, is 33 amended to read as follows: 34 1. A new institutional health service or changed 35 -19- LSB 1555HV (3) 91 lh/ko 19/ 40

H.F. 754 institutional health service shall not be offered or developed 1 in this state without prior application to the department 2 for and receipt of a certificate of need, pursuant to this 3 part subchapter . The application shall be made upon forms 4 furnished or prescribed by the department and shall contain 5 such information as the department may require under this part 6 subchapter . The application shall be accompanied by a fee 7 equivalent to three-tenths of one percent of the anticipated 8 cost of the project with a minimum fee of six hundred dollars 9 and a maximum fee of twenty-one thousand dollars. The fee 10 shall be remitted by the department to the treasurer of 11 state, who shall place it in the general fund of the state. 12 If an application is voluntarily withdrawn within thirty 13 calendar days after submission, seventy-five percent of the 14 application fee shall be refunded; if the application is 15 voluntarily withdrawn more than thirty but within sixty days 16 after submission, fifty percent of the application fee shall 17 be refunded; if the application is withdrawn voluntarily more 18 than sixty days after submission, twenty-five percent of 19 the application fee shall be refunded. Notwithstanding the 20 required payment of an application fee under this subsection , 21 an applicant for a new institutional health service or a 22 changed institutional health service offered or developed by 23 an intermediate care facility for persons with an intellectual 24 disability or an intermediate care facility for persons with 25 mental illness as defined pursuant to section 135C.1 is exempt 26 from payment of the application fee. 27 Sec. 41. Section 10A.713, subsection 2, unnumbered 28 paragraph 1, Code 2025, is amended to read as follows: 29 This part subchapter shall not be construed to augment, 30 limit, contravene, or repeal in any manner any other statute 31 of this state which may authorize or relate to licensure, 32 regulation, supervision, or control of, nor to be applicable 33 to: 34 Sec. 42. Section 10A.713, subsection 2, paragraphs a, f, h, 35 -20- LSB 1555HV (3) 91 lh/ko 20/ 40