This rulemaking proposes the repromulgation of Chapter 51. This rulemaking implements Iowa Code chapter 135B as amended by 2023 Iowa Acts, Senate File 75, in accordance with the goals and directives of Executive Order 10 (January 10, 2023). Iowa Code chapter 135B requires that the Department, with approval by the Council on Health and Human Services, adopt rules setting forth standards for the different types of hospitals to be licensed under Iowa Code chapter 135B. Iowa Code section 135B.7 specifically requires that the rules state that a hospital or rural emergency hospital shall not deny clinical privileges to practitioners solely by reason of the license held by the practitioner or school or institution in which the practitioner received training; a hospital or rural emergency hospital establish and implement written criteria for the granting of clinical privileges, including delineation of specified factors; and the Department adopt rules requiring hospitals and rural emergency hospitals to establish and implement protocols for responding to the needs of patients who are victims of domestic abuse and elder abuse.

Pursuant to Iowa Code section 135B.3A, the Department is also required to adopt rules to establish minimum standards for the licensure of rural emergency hospitals consistent with the federal Consolidated Appropriations Act, Pub. L. No. 116-260, §125, and with regulations issued by the United States Secretary of Health and Human Services for rural emergency hospitals. Iowa Code section 135B.7A also requires the Department to adopt rules that require hospitals and rural emergency hospitals to establish procedures for authentication of all verbal orders by a practitioner within a period not to exceed 30 days following a patient’s discharge.

 The proposed rules establish basic standards for patient care, including standards related to medical, nursing, and additional staff who provide services in hospitals; hospital response to abuse; hospital delivery of adequate nursing, surgical, anesthesia, emergency, obstetric, neonatal, and pediatric services; implementation of science-based infection control practices; delivery of services for medication administration, pharmacy, pathology  and laboratory, and radiological services; organ and tissue procurement; maintenance of patient records; food protection and nutritional services; maintenance and use of patient equipment; and safe standards of construction.

A regulatory analysis related to this rulemaking was published in the Iowa Administrative Bulletin on November 29, 2023, and a public hearing on the regulatory analysis was held on December 20, 2023. The department received two public comments specifically supportive of the rules, including a comment opining that the rules are “appropriate for the chapter’s purpose and are the most effective and efficient implementation of Iowa Code chapter 135B.” The department also received public comments identifying the need for rural emergency hospitals in their communities, but without substantive comment on the rules. In response to comments from the Administrative Rule Review Committee at its hearing on the regulatory analysis, a minor and non-substantive change was made to proposed rule 51.24 to make that rule easier for laypersons to read.