S.F. 506 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. 35 -1- SF 506 (7) 90 pf/rh/mb 1/ 17

S.F. 506 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. c. 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 35 -2- SF 506 (7) 90 pf/rh/mb 2/ 17

S.F. 506 a new institutional health facility regardless of ownership , in 1 excess of the following amounts, as applicable: 2 (1) Beginning January 1, 2023, three million five hundred 3 thousand dollars. 4 (2) Beginning January 1, 2028, four million dollars. 5 (3) Beginning January 1, 2033, four million five hundred 6 thousand dollars. 7 (4) Beginning January 1, 2038, five million dollars . 8 b. Relocation of an institutional health facility. 9 c. Any capital expenditure, lease, or donation by or on 10 behalf of expenditure or lease by an institutional health 11 facility in excess of one million five hundred thousand dollars 12 the following amounts, as applicable, within a twelve-month 13 period . : 14 (1) Beginning January 1, 2023, three million five hundred 15 thousand dollars. 16 (2) Beginning January 1, 2028, four million dollars. 17 (3) Beginning January 1, 2033, four million five hundred 18 thousand dollars. 19 (4) Beginning January 1, 2038, five million dollars. 20 d. A permanent change in the bed capacity, as determined 21 by the department, of an institutional health facility. For 22 purposes of this paragraph, a change is permanent if it is 23 intended to be effective for one year or more. 24 e. Any expenditure in excess of five hundred thousand 25 dollars by or on behalf of an institutional health facility for 26 health services which are or will be offered in or through an 27 institutional health facility at a specific time but which were 28 not offered on a regular basis in or through that institutional 29 health facility within the twelve-month period prior to that 30 time. 31 f. The deletion of one or more health services, previously 32 offered on a regular basis by an institutional health facility 33 or health maintenance organization or the relocation of one or 34 more health services from one physical facility to another. 35 -3- SF 506 (7) 90 pf/rh/mb 3/ 17

S.F. 506 g. Any acquisition by or on behalf of a health care provider 1 or a group of health care providers of any piece of replacement 2 equipment with a value in excess of one million five hundred 3 thousand dollars, whether acquired by purchase, lease, or 4 donation. 5 h. Any acquisition by or on behalf of a health care provider 6 or group of health care providers of any piece of equipment 7 with a value in excess of one million five hundred thousand 8 dollars, whether acquired by purchase, lease, or donation, 9 which results in the offering or development of a health 10 service not previously provided. A mobile service provided 11 on a contract basis is not considered to have been previously 12 provided by a health care provider or group of health care 13 providers. 14 i. Any acquisition by or on behalf of an institutional 15 health facility or a health maintenance organization of any 16 piece of replacement equipment with a value in excess of one 17 million five hundred thousand dollars, whether acquired by 18 purchase, lease, or donation. 19 j. Any acquisition by or on behalf of an institutional 20 health facility or health maintenance organization of any 21 piece of equipment with a value in excess of one million five 22 hundred thousand dollars, whether acquired by purchase, lease, 23 or donation, which results in the offering or development of 24 a health service not previously provided. A mobile service 25 provided on a contract basis is not considered to have been 26 previously provided by an institutional health facility. 27 k. Any air transportation service for transportation of 28 patients or medical personnel offered through an institutional 29 health facility at a specific time but which was not offered 30 on a regular basis in or through that institutional health 31 facility within the twelve-month period prior to the specific 32 time. 33 l. Any mobile health service with a value in excess of one 34 million five hundred thousand dollars. 35 -4- SF 506 (7) 90 pf/rh/mb 4/ 17

S.F. 506 m. Any of the following: 1 (1) Cardiac catheterization service. 2 (2) Open heart surgical service. 3 (3) Organ transplantation service. 4 (4) Radiation therapy service applying ionizing radiation 5 for the treatment of malignant disease using megavoltage 6 external beam equipment. 7 Sec. 4. Section 135.61, subsections 2, 4, 5, 7, 16, and 20, 8 Code 2023, are amended by striking the subsections. 9 Sec. 5. Section 135.62, Code 2023, is amended to read as 10 follows: 11 135.62 Department to administer subchapter —— health 12 facilities council established —— appointments —— powers and 13 duties. 14 1. This subchapter shall be administered by the department. 15 The director shall employ or cause to be employed the necessary 16 persons to discharge the duties imposed on the department by 17 this subchapter . 18 2. There is established a state health facilities council 19 consisting of five persons appointed by the governor. The 20 council shall be within the department for administrative and 21 budgetary purposes. 22 a. Qualifications. The members of the council shall be 23 chosen so that the council as a whole is broadly representative 24 of various geographical areas of the state and no more than 25 three of its members are affiliated with the same political 26 party. Each council member shall be a person who has 27 demonstrated by prior activities an informed concern for the 28 planning and delivery of health services. A member of the 29 council and any spouse of a member shall not, during the 30 time that member is serving on the council, do either of the 31 following: 32 (1) Be a health care provider nor be otherwise directly or 33 indirectly engaged in the delivery of health care services nor 34 have a material financial interest in the providing or delivery 35 -5- SF 506 (7) 90 pf/rh/mb 5/ 17

S.F. 506 of health services. 1 (2) Serve as a member of any board or other policymaking 2 or advisory body of an institutional health facility, a health 3 maintenance organization, or any health or hospital insurer. 4 b. Appointments. Terms of council members shall be six 5 years, beginning and ending as provided in section 69.19 . A 6 member shall be appointed in each odd-numbered year to succeed 7 each member whose term expires in that year. Vacancies 8 shall be filled by the governor for the balance of the 9 unexpired term. Each appointment to the council is subject to 10 confirmation by the senate. A council member is ineligible 11 for appointment to a second consecutive term, unless first 12 appointed to an unexpired term of three years or less. 13 c. Chairperson. The governor shall designate one of 14 the council members as chairperson. That designation may 15 be changed not later than July 1 of any odd-numbered year, 16 effective on the date of the organizational meeting held in 17 that year under paragraph “d” . 18 d. Meetings. The council shall hold an organizational 19 meeting in July of each odd-numbered year, or as soon 20 thereafter as the new appointee or appointees are confirmed 21 and have qualified. Other meetings shall be held as necessary 22 to enable the council to expeditiously discharge its duties. 23 Meeting dates shall be set upon adjournment or by call of the 24 chairperson upon five days’ notice to the other members. 25 e. 2. Duties. The council department shall do all of the 26 following: 27 (1) a. Make the final decision, as required by section 28 135.69 , with respect to each application for a certificate of 29 need accepted by the department. 30 (2) b. Determine and adopt such policies as are authorized 31 by law and are deemed necessary to the efficient discharge of 32 its the department’s duties under this subchapter . 33 (3) c. Have authority to direct staff personnel of the 34 department assigned to conduct formal or summary reviews of 35 -6- SF 506 (7) 90 pf/rh/mb 6/ 17

S.F. 506 applications for certificates of need. 1 (4) d. Advise and counsel with the director concerning the 2 provisions of this subchapter and the policies and procedures 3 adopted by the department pursuant to this subchapter . 4 (5) Review and approve, prior to promulgation, all rules 5 adopted by the department under this subchapter . 6 Sec. 6. Section 135.63, subsection 1, Code 2023, is amended 7 to read as follows: 8 1. A new institutional health service or changed 9 institutional health service shall not be offered or developed 10 in this state without prior application to the department 11 for and receipt of a certificate of need, pursuant to 12 this subchapter . The application shall be made upon forms 13 furnished or prescribed by the department and shall contain 14 such information as the department may require under this 15 subchapter . The application shall be accompanied by an 16 economic impact statement that includes information specified 17 by rule to assist the department in the evaluation of the 18 application pursuant to section 135.64. The application shall 19 be accompanied by a fee equivalent to three-tenths of one 20 percent of the anticipated cost of the project with a minimum 21 fee of six hundred dollars and a maximum fee of twenty-one 22 thousand dollars. The fee shall be remitted by the department 23 to the treasurer of state, who shall place it in the general 24 fund of the state. If an application is voluntarily withdrawn 25 within thirty calendar days after submission, seventy-five 26 percent of the application fee shall be refunded; if the 27 application is voluntarily withdrawn more than thirty but 28 within sixty days after submission, fifty percent of the 29 application fee shall be refunded; if the application is 30 withdrawn voluntarily more than sixty days after submission, 31 twenty-five percent of the application fee shall be refunded. 32 Notwithstanding the required payment of an application fee 33 under this subsection , an applicant for a new institutional 34 health service or a changed institutional health service 35 -7- SF 506 (7) 90 pf/rh/mb 7/ 17

S.F. 506 offered or developed by an intermediate care facility for 1 persons with an intellectual disability or an intermediate care 2 facility for persons with mental illness as defined pursuant to 3 section 135C.1 is exempt from payment of the application fee. 4 Sec. 7. Section 135.63, subsection 2, paragraphs a and e, 5 Code 2023, are amended to read as follows: 6 a. Private offices and private clinics of an individual 7 physician, dentist, or other practitioner or group of 8 health care providers, except as provided by section 135.61, 9 subsection 18 , paragraphs “g” , “h” , and “m” , and section 135.61, 10 subsections 20 and 21 . 11 e. A health maintenance organization or combination of 12 health maintenance organizations or an institutional health 13 facility controlled directly or indirectly by a health 14 maintenance organization or combination of health maintenance 15 organizations, except when the health maintenance organization 16 or combination of health maintenance organizations does any of 17 the following: 18 (1) Constructs constructs , develops, renovates, relocates, 19 or otherwise establishes an institutional health facility. 20 (2) Acquires major medical equipment as provided by section 21 135.61, subsection 18 , paragraphs “i” and “j” . 22 Sec. 8. Section 135.63, subsection 2, paragraph h, Code 23 2023, is amended by striking the paragraph. 24 Sec. 9. Section 135.63, subsection 4, unnumbered paragraph 25 1, Code 2023, is amended to read as follows: 26 A copy of the application shall be sent to the department 27 of human services at the time the application is submitted to 28 the Iowa department of public health. The department shall not 29 process applications for and the council shall not consider a 30 new or changed institutional health service for an intermediate 31 care facility for persons with an intellectual disability 32 unless both of the following conditions are met: 33 Sec. 10. Section 135.64, subsection 1, unnumbered paragraph 34 1, Code 2023, is amended to read as follows: 35 -8- SF 506 (7) 90 pf/rh/mb 8/ 17

S.F. 506 In determining whether a certificate of need shall be 1 issued, the department and council shall consider the 2 following: 3 Sec. 11. Section 135.64, subsection 1, paragraph r, Code 4 2023, is amended to read as follows: 5 r. The recommendations of staff personnel of the department 6 assigned to the area of certificate of need, concerning the 7 application , if requested by the council . 8 Sec. 12. Section 135.64, subsection 2, unnumbered paragraph 9 1, Code 2023, is amended to read as follows: 10 In addition to the findings required with respect to any 11 of the criteria listed in subsection 1 of this section , the 12 council department shall grant a certificate of need for a new 13 institutional health service or changed institutional health 14 service only if it the department finds in writing, on the 15 basis of data submitted to it by the department , that: 16 Sec. 13. Section 135.66, Code 2023, is amended to read as 17 follows: 18 135.66 Procedure upon receipt of application —— public 19 notification. 20 1. a. Within fifteen business days after receipt of an 21 application for a certificate of need, the department shall 22 examine the application for form and completeness and accept 23 or reject it. An application shall be rejected only if it 24 fails to provide all information required by the department 25 pursuant to section 135.63, subsection 1 . The department shall 26 promptly return to the applicant any rejected application, with 27 an explanation of the reasons for its rejection. 28 b. Within thirty days after notifying the applicant of 29 rejection of the application, the applicant may resubmit a 30 revised application for review under this subsection and shall 31 not be subject to payment of another required application 32 fee pursuant to section 135.63. If a subsequent rejection 33 is issued, the applicant shall resubmit the application in 34 accordance with and shall be subject to the procedure and 35 -9- SF 506 (7) 90 pf/rh/mb 9/ 17

S.F. 506 requirements for an initial application. 1 2. Upon acceptance of an application for a certificate 2 of need, the department shall promptly undertake to notify 3 all affected persons in writing that formal review of the 4 application has been initiated. Notification to those affected 5 persons who are consumers or third-party payers or other 6 payers for health services may be provided by distribution of 7 the pertinent information to the news media by an electronic 8 distribution method available to the department . 9 3. Each application accepted by the department shall 10 be formally reviewed for the purpose of furnishing to the 11 council department the information necessary to enable it the 12 department to determine whether or not to grant the certificate 13 of need. A formal review shall consist at a minimum of the 14 following steps: 15 a. Evaluation of the application against the criteria 16 specified in section 135.64 . 17 b. A public hearing on the application, to be held prior to 18 completion of the evaluation required by paragraph “a” , shall be 19 conducted by the council department . 20 4. When a hearing is to be held pursuant to subsection 3, 21 paragraph “b” , the department shall give at least ten days’ 22 notice of the time and place of the hearing. At Any affected 23 person or that person’s designated representative may submit 24 written testimony in a manner prescribed by the department 25 beginning on the day the notice of the hearing is given until 26 the day prior to the date fixed for the hearing, or at the 27 hearing , any affected person or that person’s designated 28 representative shall may have the opportunity to present 29 testimony. 30 Sec. 14. Section 135.67, subsection 1, Code 2023, is amended 31 to read as follows: 32 1. The department may waive the letter of intent procedures 33 prescribed by section 135.65 and substitute conduct a summary 34 review procedure, which shall be established by rules of the 35 -10- SF 506 (7) 90 pf/rh/mb 10/ 17

S.F. 506 department, when it accepts an application for a certificate of 1 need for a project which meets any of the following criteria 2 in paragraphs “a” through “e” : 3 a. A project which is limited to repair or replacement of a 4 facility or equipment damaged or destroyed by a disaster, and 5 which will not expand the facility nor increase the services 6 provided beyond the level existing prior to the disaster. 7 b. A project necessary to enable the facility or service to 8 achieve or maintain compliance with federal, state, or other 9 appropriate licensing, certification, or safety requirements. 10 c. A project which will not change the existing bed capacity 11 of the applicant’s facility or service, as determined by the 12 department, by more than ten percent or ten beds, whichever is 13 less, over a two-year period. 14 d. A project the total cost of which will not exceed one 15 hundred fifty thousand dollars. 16 e. d. Any other project for which the applicant proposes 17 and the department agrees to summary review. 18 Sec. 15. Section 135.69, Code 2023, is amended to read as 19 follows: 20 135.69 Council Department to make final decision. 21 1. The department shall complete its formal review of 22 the application within ninety days after acceptance of the 23 application, except as otherwise provided by section 135.72, 24 subsection 4 . Upon completion of the formal review, the 25 council department shall approve or deny the application. The 26 council department shall issue written findings stating the 27 basis for its the department’s decision on the application, and 28 the department shall send copies of the council’s department’s 29 decision and the written findings supporting the decision to 30 the applicant and to any other person who so requests. 31 2. Failure by the council to issue a written decision 32 on an application for a certificate of need within the time 33 required by this section shall constitute denial of and final 34 administrative action on the application. 35 -11- SF 506 (7) 90 pf/rh/mb 11/ 17

S.F. 506 Sec. 16. Section 135.70, Code 2023, is amended to read as 1 follows: 2 135.70 Appeal of certificate of need decisions. 3 The council’s department’s decision on an application for 4 certificate of need, when announced pursuant to section 135.69 , 5 is a final decision. Any dissatisfied party who is an affected 6 person with respect to the application, and who participated 7 or sought unsuccessfully to participate in the formal review 8 procedure prescribed by section 135.66 , may request a rehearing 9 in accordance with chapter 17A and rules of the department. 10 If a rehearing is not requested or an affected party remains 11 dissatisfied after the request for rehearing, an appeal may be 12 taken in the manner provided by chapter 17A . Notwithstanding 13 the Iowa administrative procedure Act, chapter 17A , a request 14 for rehearing is not required, prior to appeal under section 15 17A.19 . 16 Sec. 17. Section 135.71, subsection 1, Code 2023, is amended 17 to read as follows: 18 1. A certificate of need shall be valid for a maximum of 19 one year from the date of issuance. Upon the expiration of 20 the certificate, or at any earlier time while the certificate 21 is valid the holder thereof shall provide the department such 22 information on the development of the project covered by 23 the certificate as the department may request. The council 24 department shall determine at the end of the certification 25 period whether sufficient progress is being made on the 26 development of the project. The certificate of need may be 27 extended by the council department for additional periods of 28 time as are reasonably necessary to expeditiously complete the 29 project, but may be revoked by the council department at the 30 end of the first or any subsequent certification period for 31 insufficient progress in developing the project. 32 Sec. 18. Section 135.72, unnumbered paragraph 1, Code 2023, 33 is amended to read as follows: 34 The department shall adopt , with approval of the council, 35 -12- SF 506 (7) 90 pf/rh/mb 12/ 17

S.F. 506 such administrative rules as are necessary to enable it the 1 department to implement this subchapter . These rules shall 2 include: 3 Sec. 19. Section 135.72, subsection 4, Code 2023, is amended 4 to read as follows: 5 4. Criteria for determining when it is not feasible to 6 complete formal review of an application for a certificate of 7 need within the time limits specified in section 135.69 . The 8 rules adopted under this subsection shall include criteria for 9 determining whether an application proposes introduction of 10 technologically innovative equipment, and if so, procedures 11 to be followed in reviewing the application. However, a rule 12 adopted under this subsection shall not permit a deferral of 13 more than sixty thirty days beyond the time when a decision is 14 required under section 135.69 , unless both the applicant and 15 the department agree to a longer deferment. 16 Sec. 20. Section 135.73, subsection 1, Code 2023, is amended 17 to read as follows: 18 1. Any party constructing a new institutional health 19 facility or an addition to or renovation of an existing 20 institutional health facility without first obtaining a 21 certificate of need or, in the case of a mobile health service, 22 ascertaining that the mobile health service has received 23 certificate of need approval, as required by this subchapter , 24 shall be denied licensure or change of licensure by the 25 appropriate responsible licensing agency of this state. 26 Sec. 21. Section 135.73, subsection 2, paragraph a, Code 27 2023, is amended to read as follows: 28 a. A class I violation is one in which a party offers a 29 new institutional health service or changed institutional 30 health service modernization or acquisition without review and 31 approval by the council department . A party in violation is 32 subject to a penalty of three hundred dollars for each day of a 33 class I violation. The department may seek injunctive relief 34 which shall include restraining the commission or continuance 35 -13- SF 506 (7) 90 pf/rh/mb 13/ 17

S.F. 506 of an act which would violate the provisions of this paragraph. 1 Notice and opportunity to be heard shall be provided to a party 2 pursuant to rule of civil procedure 1.1507 and contested case 3 procedures in accordance with chapter 17A . The department may 4 reduce, alter, or waive a penalty upon the party showing good 5 faith compliance with the department’s request to immediately 6 cease and desist from conduct in violation of this section . 7 Sec. 22. Section 135.131, subsection 1, paragraph a, Code 8 2023, is amended to read as follows: 9 a. “Birth center” means birth center as defined in section 10 135.61 a facility or institution, which is not an ambulatory 11 surgical center or a hospital or in a hospital, in which 12 births are planned to occur following a normal, uncomplicated, 13 low-risk pregnancy . 14 Sec. 23. Section 135P.1, Code 2023, is amended to read as 15 follows: 16 135P.1 Definitions. 17 For the purposes of this chapter , unless the context 18 otherwise requires: 19 1. “Adverse health care incident” means an objective and 20 definable outcome arising from or related to patient care that 21 results in the death or physical injury of a patient. 22 2. “Health care provider” means a physician or osteopathic 23 physician licensed under chapter 148 , a physician assistant 24 licensed and practicing under a supervising physician pursuant 25 to chapter 148C , a podiatrist licensed under chapter 149 , a 26 chiropractor licensed under chapter 151 , a licensed practical 27 nurse, a registered nurse, or an advanced registered nurse 28 practitioner licensed under chapter 152 or 152E , a dentist 29 licensed under chapter 153 , an optometrist licensed under 30 chapter 154 , a pharmacist licensed under chapter 155A , or 31 any other person who is licensed, certified, or otherwise 32 authorized or permitted by the law of this state to administer 33 health care in the ordinary course of business or in the 34 practice of a profession. 35 -14- SF 506 (7) 90 pf/rh/mb 14/ 17

S.F. 506 3. “Health facility” means an institutional health facility 1 as defined in section 135.61 , a hospice licensed under chapter 2 135J , a home health agency as defined in section 144D.1 , an 3 assisted living program certified under chapter 231C , a clinic, 4 a community health center, or the university of Iowa hospitals 5 and clinics, and includes any corporation, professional 6 corporation, partnership, limited liability company, limited 7 liability partnership, or other entity comprised of such health 8 facilities. 9 4. “Institutional health facility” means any of the 10 following, without regard to whether the facilities referred 11 to are publicly or privately owned or are organized for profit 12 or not, or whether the facilities are part of or sponsored by a 13 health maintenance organization: 14 a. A hospital as defined in section 135B.1. 15 b. A health care facility as defined in section 135C.1. 16 c. An organized outpatient health facility as defined in 17 section 135.61. 18 d. An outpatient surgical facility as defined in section 19 135.61. 20 e. A community mental health center as defined in section 21 230A.102. 22 f. A birth center as defined in section 135.131. 23 4. 5. “Open discussion” means all communications that are 24 made under section 135P.3 , and includes all memoranda, work 25 products, documents, and other materials that are prepared 26 for or submitted in the course of or in connection with 27 communications under section 135P.3 . 28 5. 6. “Patient” means a person who receives medical care 29 from a health care provider, or if the person is a minor, 30 deceased, or incapacitated, the person’s legal representative. 31 Sec. 24. 2023 Iowa Acts, Senate File 514, section 32 1443, subsection 1, if enacted, is amended by striking the 33 subsection. 34 Sec. 25. 2023 Iowa Acts, Senate File 514, section 35 -15- SF 506 (7) 90 pf/rh/mb 15/ 17

S.F. 506 1443, subsection 5, if enacted, is amended by striking the 1 subsection. 2 Sec. 26. 2023 Iowa Acts, Senate File 514, sections 1584 3 through 1609, if enacted, are amended by striking the sections. 4 Sec. 27. REPEAL. Section 135.65, Code 2023, is repealed. 5 DIVISION II 6 BIRTH CENTERS 7 Sec. 28. BIRTH CENTERS —— PROVISIONAL LICENSURE. The 8 department of inspections, appeals, and licensing shall develop 9 minimum standards for provisional licensure of a birth center 10 and shall adopt rules pursuant to chapter 17A to administer 11 birth center provisional licensure. The department shall 12 issue a provisional license to a birth center that meets the 13 minimum standards. A provisional license may be granted 14 for a period of no more than one year from the date the 15 specified administrative rules are adopted. A provisional 16 license shall expire at the end of the license term and is 17 not renewable. During the term of a provisional license, a 18 health care provider accepting the transfer of a patient from 19 a provisionally licensed birth center shall not be subject to 20 civil or criminal liability for outcomes arising from actions 21 of the provisionally licensed birth center or any of the 22 employees, agents, or contractors of such birth center. 23 Sec. 29. EMERGENCY RULES. The department of inspections, 24 appeals, and licensing shall adopt emergency rules under 25 section 17A.4, subsection 3, and section 17A.5, subsection 26 2, paragraph “b”, to implement the birth center provisional 27 licensure provisions of this division of this Act, within six 28 months of the effective date of this division of this Act and 29 shall submit such rules to the administrative rules coordinator 30 and the administrative code editor pursuant to section 17A.5, 31 subsection 1, within the same period. The rules shall be 32 effective immediately upon filing unless a later date is 33 specified in the rules. Any rules adopted in accordance with 34 this section shall also be published as a notice of intended 35 -16- SF 506 (7) 90 pf/rh/mb 16/ 17

S.F. 506 action as provided in section 17A.4. 1 Sec. 30. PROPOSED LEGISLATION —— BIRTH CENTER 2 LICENSURE. The department of inspections, appeals, and 3 licensing shall submit proposed legislation under section 4 2.16 that provides for state licensure of and inspection 5 requirements for birth centers to be considered by the 2024 6 session of the general assembly. 7 Sec. 31. DEFINITIONS. For the purposes of this division of 8 this Act: 9 1. “Birth center” means a facility or institution, which 10 is not an ambulatory surgical center or a hospital or in a 11 hospital, in which births are planned to occur following a 12 normal, uncomplicated, low-risk pregnancy. 13 2. “Health care provider” means the same as defined in 14 section 147.136A. 15 Sec. 32. EFFECTIVE DATE. This division of this Act, being 16 deemed of immediate importance, takes effect upon enactment. 17 -17- SF 506 (7) 90 pf/rh/mb 17/ 17