S.F. _____ DIVISION I 1 CONTINUING EDUCATION REQUIREMENTS —— NUTRITION AND METABOLIC 2 HEALTH 3 Section 1. Section 148.3, Code 2026, is amended by adding 4 the following new subsection: 5 NEW SUBSECTION . 5. The board shall adopt rules pursuant to 6 chapter 17A requiring a licensee practicing family medicine, 7 internal medicine, pediatrics, psychiatry, endocrinology, 8 gastroenterology, cardiology, oncology, rheumatology, 9 neurology, nephrology, dermatology, pulmonology, surgery, 10 immunology, hematology, obstetrics, or gynecology to complete a 11 minimum of one hour of continuing education on nutrition and 12 metabolic health every four years as a condition of license 13 renewal. 14 Sec. 2. Section 148C.3, subsection 1, paragraph c, Code 15 2026, is amended to read as follows: 16 c. Hours of continuing medical education necessary to become 17 or remain licensed. The board shall adopt rules pursuant to 18 chapter 17A requiring a licensee practicing family medicine, 19 internal medicine, pediatrics, psychiatry, endocrinology, 20 gastroenterology, cardiology, oncology, rheumatology, 21 neurology, nephrology, dermatology, pulmonology, surgery, 22 immunology, hematology, obstetrics, or gynecology to complete a 23 minimum of one hour of continuing education on nutrition and 24 metabolic health every four years as a condition of license 25 renewal. 26 DIVISION II 27 CERTIFICATE OF NEED 28 Sec. 3. Section 135.61, subsection 16, paragraphs e, g, i, 29 and k, Code 2026, are amended by striking the paragraphs. 30 Sec. 4. Section 135.61, subsection 16, paragraph m, 31 subparagraphs (2) and (3), Code 2026, are amended by striking 32 the subparagraphs. 33 Sec. 5. Section 135.62, subsection 2, paragraph a, Code 34 2026, is amended to read as follows: 35 -1- LSB 6564XC (2) 91 dg/ko 1/ 9

S.F. _____ a. Private offices and private clinics of an individual 1 physician, dentist, or other practitioner or group of 2 health care providers, except as provided by section 135.61, 3 subsection 16 , paragraphs “g” , “h” , and “m” , and section 135.61, 4 subsections 2 and 18 . 5 Sec. 6. Section 135.62, subsection 2, paragraph e, 6 subparagraph (2), Code 2026, is amended to read as follows: 7 (2) Acquires major medical equipment as provided by section 8 135.61, subsection 16 , paragraphs “i” and paragraph “j” . 9 Sec. 7. Section 135.62, subsection 2, paragraph g, 10 subparagraph (1), unnumbered paragraph 1, Code 2026, is amended 11 to read as follows: 12 A reduction in bed capacity of an institutional health 13 facility, notwithstanding any provision in this subchapter to 14 the contrary, except where a provision expressly exempts such a 15 reduction, if all of the following conditions exist: 16 Sec. 8. Section 135.62, subsection 2, paragraph k, 17 subparagraph (1), unnumbered paragraph 1, Code 2026, is amended 18 to read as follows: 19 The redistribution of beds by a hospital within the acute 20 care category of bed usage, notwithstanding any provision in 21 this subchapter to the contrary, except where a provision 22 expressly exempts such a redistribution of skilled nursing 23 facility or swing beds by a hospital, if all of the following 24 conditions exist: 25 Sec. 9. Section 135.62, subsection 2, paragraph p, Code 26 2026, is amended by striking the paragraph. 27 Sec. 10. Section 135.62, subsection 2, Code 2026, is amended 28 by adding the following new paragraphs: 29 NEW PARAGRAPH . r. An outpatient facility that provides 30 behavioral health services, as defined by rule by the 31 department, to individuals on an outpatient basis, including 32 but not limited to substitution-based treatment centers for 33 opiate addiction. 34 NEW PARAGRAPH . s. Open heart surgical services. 35 -2- LSB 6564XC (2) 91 dg/ko 2/ 9

S.F. _____ NEW PARAGRAPH . t. Organ transplantation services. 1 NEW PARAGRAPH . u. Notwithstanding any provision of this 2 subchapter to the contrary, any acquisition whether acquired 3 by purchase, lease, or donation by or on behalf of a health 4 care provider or a group of health care providers of any piece 5 of replacement equipment with a value in excess of one million 6 five hundred thousand dollars. 7 NEW PARAGRAPH . v. Notwithstanding any provision of 8 this subchapter to the contrary, any acquisition whether 9 acquired by purchase, lease, or donation by or on behalf of 10 an institutional health facility or a health maintenance 11 organization of any piece of replacement equipment with a value 12 in excess of one million five hundred thousand dollars. 13 NEW PARAGRAPH . w. Any air transportation service for 14 transportation of patients or medical personnel offered through 15 an institutional health facility. 16 NEW PARAGRAPH . x. Notwithstanding any provision of 17 this subchapter to the contrary, bed capacity changes by an 18 institutional health facility that constitute a permanent 19 change or reduction in, or a redistribution, deletion, or 20 conversion of, nursing facility beds, skilled nursing facility 21 beds, or swing beds. 22 NEW PARAGRAPH . y. Notwithstanding any provision of 23 this subchapter to the contrary, bed capacity changes 24 that constitute a permanent change or reduction in, or 25 a redistribution, deletion, or conversion of, beds in 26 intermediate care facilities for persons with mental 27 illness, or intermediate care facilities for persons with an 28 intellectual disability. 29 Sec. 11. Section 135.62, subsection 4, Code 2026, is amended 30 to read as follows: 31 4. The department shall not process applications for an 32 intermediate care facility for persons with an intellectual 33 disability, or consider a new or changed institutional health 34 service for an intermediate care facility for persons with 35 -3- LSB 6564XC (2) 91 dg/ko 3/ 9

S.F. _____ an intellectual disability, unless both of the following 1 conditions are met: 2 a. The new or changed beds shall not result in an 3 increase in the total number of medical assistance certified 4 intermediate care facility beds for persons with an 5 intellectual disability in the state, exclusive of those beds 6 at the state resource centers or other state institutions, 7 beyond one thousand six hundred thirty-six beds. 8 b. A a letter of support for the application is provided by 9 the county board of supervisors, or the board’s designee, in 10 the county in which the beds facility is or would be located. 11 Sec. 12. Section 135.65, subsection 3, paragraph b, Code 12 2026, is amended to read as follows: 13 b. A period for the submission of written public hearing 14 comments from affected persons on the application, to be held 15 scheduled prior to completion of the evaluation required by 16 paragraph “a” . 17 Sec. 13. Section 135.65, subsection 4, Code 2026, is amended 18 by striking the subsection. 19 Sec. 14. Section 135.70, subsection 2, Code 2026, is amended 20 to read as follows: 21 2. Upon expiration of a certificate of need, and prior to 22 extension of the certificate of need, any affected person shall 23 have the right to submit to the department information which 24 may be relevant to the question of granting an extension. The 25 department may call a public hearing for this purpose. 26 DIVISION III 27 SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM —— SUMMER ELECTRONIC 28 BENEFITS TRANSFER FOR CHILDREN PROGRAM 29 Sec. 15. Section 234.1, Code 2026, is amended by adding the 30 following new subsection: 31 NEW SUBSECTION . 4A. “Summer electronic benefits transfer 32 for children program” or “summer EBT program” means the summer 33 electronic benefits transfer for children program established 34 in 42 U.S.C. §1762. 35 -4- LSB 6564XC (2) 91 dg/ko 4/ 9

S.F. _____ Sec. 16. NEW SECTION . 234.12B Supplemental nutrition 1 assistance program —— summer electronic benefits transfer for 2 children program. 3 1. The department shall do all of the following: 4 a. Continuously maintain state participation in SNAP 5 by administering the program in accordance with guidelines 6 approved by the United States department of agriculture, 7 food and nutrition service, that specify that eligible foods 8 pursuant to 7 C.F.R. §271.2 are healthy foods as defined by the 9 director or the director’s designee. 10 b. Ensure that the provision of SNAP benefits to recipients 11 is uninterrupted. 12 2. The department may participate in the summer EBT program 13 subject to federally approved eligible foods for the summer EBT 14 program being consistent with eligible foods as described in 15 subsection 1, paragraph “a” . 16 DIVISION IV 17 SCHOOL FOODS AND BEVERAGES 18 Sec. 17. Section 256E.7, subsection 2, Code 2026, is amended 19 by adding the following new paragraph: 20 NEW PARAGRAPH . 0t. Be subject to and comply with the 21 requirements of section 283A.6 relating to the preparation 22 of meals provided to students, and prohibited ingredients in 23 meals provided to students, in the same manner as a school 24 district, if the charter school provides a breakfast or lunch 25 program through the national school lunch program or the school 26 breakfast program administered by the food and nutrition 27 service of the United States department of agriculture. 28 Sec. 18. Section 256F.4, subsection 2, Code 2026, is amended 29 by adding the following new paragraph: 30 NEW PARAGRAPH . v. Be subject to and comply with the 31 requirements of section 283A.6 relating to the preparation of 32 meals provided to students, and prohibited ingredients in meals 33 provided to students, in the same manner as a school district, 34 if the charter school or innovation zone school provides a 35 -5- LSB 6564XC (2) 91 dg/ko 5/ 9

S.F. _____ breakfast or lunch program. 1 Sec. 19. NEW SECTION . 283A.6 School district breakfast 2 and lunch programs —— food and beverages provided to students —— 3 prohibited ingredients. 4 1. a. A school district shall not serve a meal to students 5 as part of the school district’s breakfast or lunch program 6 that contains any of the following ingredients: 7 (1) Blue dye 1. 8 (2) Blue dye 2. 9 (3) Green dye 3. 10 (4) Potassium bromate. 11 (5) Propylparaben. 12 (6) Red dye 40. 13 (7) Yellow dye 5. 14 (8) Yellow dye 6. 15 b. Paragraph “a” does not apply to food and beverages 16 received as part of a direct delivery from the foods in schools 17 program of the United States department of agriculture. 18 2. An employee or contracted vendor of a school district 19 shall not provide any food or beverages that contain an 20 ingredient described in subsection 1 to a student enrolled in 21 the school district during the school day. 22 3. A school district shall not permit the sale to students 23 of any foods or beverages that contain an ingredient described 24 in subsection 1 on the school campus, as school campus is 25 defined in 7 C.F.R. §210.11 as of January 1, 2026, unless the 26 sale takes place outside of the school day, as school day is 27 defined in 7 C.F.R. §210.11 as of January 1, 2026. 28 Sec. 20. Section 283A.10, Code 2026, is amended to read as 29 follows: 30 283A.10 School breakfast or lunch in nonpublic schools. 31 The authorities in charge of nonpublic schools may operate 32 or provide for the operation of school breakfast or lunch 33 programs in schools under their jurisdiction and may use funds 34 appropriated to them by the general assembly, gifts, funds 35 -6- LSB 6564XC (2) 91 dg/ko 6/ 9

S.F. _____ received from sale of school breakfasts or lunches under such 1 programs, and any other funds available to the nonpublic 2 school. However, school breakfast or lunch programs shall not 3 be required in nonpublic schools. The department of education 4 shall direct the disbursement of state funds to nonpublic 5 schools for school breakfast or lunch programs in the same 6 manner as state funds are disbursed to public schools. If 7 a nonpublic school receives state funds for the operation of 8 a school breakfast or lunch program, meals served under the 9 program shall be nutritionally adequate meals, as defined in 10 section 283A.1 , and shall comply with the requirements of 11 section 283A.6 . 12 Sec. 21. APPLICABILITY. This division of this Act applies 13 to school years beginning on or after July 1, 2027. 14 EXPLANATION 15 The inclusion of this explanation does not constitute agreement with 16 the explanation’s substance by the members of the general assembly. 17 This bill relates to the regulation of health-related 18 matters, including health-related professions, certificates of 19 need, and nutrition. The bill is organized in divisions. 20 DIVISION I —— CONTINUING EDUCATION REQUIREMENTS —— NUTRITION 21 AND METABOLIC HEALTH. The bill requires the board of medicine 22 and the board of physician assistants to adopt rules requiring 23 certain licensees to receive continuing education credits 24 regarding nutritional and metabolic health as a condition of 25 license renewal. 26 DIVISION II —— CERTIFICATE OF NEED. The bill changes the 27 definition of “new institutional health service” or “changed 28 institutional health service”. The bill alters the list of 29 items that are excluded from the provisions of Code chapter 30 135 (department of health and human services —— public 31 health), subchapter VI (health facilities). The bill strikes 32 a provision restricting the department of health and human 33 services (HHS) from processing applications for an intermediate 34 care facility for persons with an intellectual disability, or 35 -7- LSB 6564XC (2) 91 dg/ko 7/ 9

S.F. _____ considering a new or changed institutional health service for 1 an intermediate care facility for persons with an intellectual 2 disability, unless the new or changed beds shall not result 3 in an increase in the total number of medical assistance 4 certified intermediate care facility beds for persons with an 5 intellectual disability in the state, exclusive of those beds 6 at the state resource centers or other state institutions, 7 beyond 1,636 beds. 8 The bill replaces a requirement that HHS hold a public 9 hearing on an application for a certificate of need with a 10 requirement that the department provide a period for the 11 submission of written comments from affected persons. The bill 12 strikes an authorization for the department to call a public 13 hearing on the question of whether to grant an extension for an 14 expiring certificate of need. 15 DIVISION III —— SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM —— 16 SUMMER ELECTRONIC BENEFITS TRANSFER FOR CHILDREN PROGRAM. The 17 bill requires HHS to continuously maintain state participation 18 in the federal supplemental nutrition assistance program (SNAP) 19 by administering the program in accordance with guidelines 20 approved by the United States department of agriculture, food 21 and nutrition service, to define “eligible foods” as “healthy 22 foods”, as that term is defined by the department, and to seek 23 any federal approval necessary to ensure that provision of 24 benefits is continuous. The bill requires HHS to ensure that 25 the provision of SNAP benefits to recipients is uninterrupted. 26 The bill also allows HHS to participate in the summer 27 electronic benefits transfer for children program, subject to 28 federal approval of guidelines for eligible foods under the 29 program that are similar to the guidelines for eligible foods 30 under SNAP. 31 DIVISION IV —— SCHOOL FOODS AND BEVERAGES. The bill 32 prohibits school districts, certain charter schools, and 33 innovation zone schools from serving meals to students as 34 part of the school’s breakfast or lunch program that contain 35 -8- LSB 6564XC (2) 91 dg/ko 8/ 9

S.F. _____ blue dye 1, blue dye 2, green dye 3, potassium bromate, 1 propylparaben, red dye 40, yellow dye 5, or yellow dye 6, 2 unless the foods or beverages in the meal were received as 3 part of a direct delivery from the foods in schools program of 4 the United States department of agriculture. The bill also 5 prohibits schools from permitting the sale to students of any 6 foods or beverages that contain such ingredients on school 7 campus unless the sale takes place after the end of the school 8 day. The bill requires nonpublic schools that use moneys 9 appropriated by the general assembly to provide breakfast or 10 lunch to students to ensure that the meals comply with the same 11 prohibition on ingredients as school districts. 12 This division of the bill applies to school years beginning 13 on or after July 1, 2027. 14 -9- LSB 6564XC (2) 91 dg/ko 9/ 9