Senate File 4 - IntroducedA Bill ForAn Act 1relating to the elimination of the certificate of need
2process relating to the development of a new or changed
3institutional health service.
1   Section 1.  Section 68B.35, subsection 2, paragraph e, Code
22021, is amended to read as follows:
   3e.  Members of the state banking council, the Iowa ethics
4and campaign disclosure board, the credit union review board,
5the economic development authority, the employment appeal
6board, the environmental protection commission, the health
7facilities council,
the Iowa finance authority, the Iowa public
8employees’ retirement system investment board, the board of
9the Iowa lottery authority, the natural resource commission,
10the board of parole, the petroleum underground storage tank
11fund board, the public employment relations board, the state
12racing and gaming commission, the state board of regents, the
13transportation commission, the office of consumer advocate, the
14utilities board, the Iowa telecommunications and technology
15commission, and any full-time members of other boards and
16commissions as defined under section 7E.4 who receive an annual
17salary for their service on the board or commission. The Iowa
18ethics and campaign disclosure board shall conduct an annual
19review to determine if members of any other board, commission,
20or authority should file a statement and shall require the
21filing of a statement pursuant to rules adopted pursuant to
22chapter 17A.
23   Sec. 2.  Section 97B.1A, subsection 8, paragraph a,
24subparagraph (8), Code 2021, is amended to read as follows:
   25(8)  Members of the state transportation commission, and the
26board of parole, and the state health facilities council.
27   Sec. 3.  Section 135.131, subsection 1, paragraph a, Code
282021, is amended to read as follows:
   29a.  “Birth center” means birth center as defined in section
 a facility or institution, which is not an ambulatory
31surgical center or a hospital or in a hospital, in which
32births are planned to occur following a normal, uncomplicated,
33low-risk pregnancy
34   Sec. 4.  Section 135C.2, subsection 5, unnumbered paragraph
351, Code 2021, is amended to read as follows:
-1-   1The department shall establish a special classification
2within the residential care facility category in order to
3foster the development of residential care facilities which
4serve persons with an intellectual disability, chronic mental
5illness, a developmental disability, or brain injury, as
6described under section 225C.26, and which contain five or
7fewer residents. A facility within the special classification
8established pursuant to this subsection is exempt from the
9requirements of section 135.63.
The department shall adopt
10rules which are consistent with rules previously developed
11for the waiver demonstration project pursuant to 1986 Iowa
12Acts, ch.1246, §206, and which include all of the following
14   Sec. 5.  Section 135H.6, subsection 1, Code 2021, is amended
15to read as follows:
   161.  The department shall issue a license to an applicant
17under this chapter if all the following conditions exist:
   18a.  The department has ascertained that the applicant’s
19medical facilities and staff are adequate to provide the care
20and services required of a psychiatric institution.
   21b.  The proposed psychiatric institution is accredited
22by the joint commission on the accreditation of health
23care organizations, the commission on accreditation of
24rehabilitation facilities, the council on accreditation of
25services for families and children, or by any other recognized
26accrediting organization with comparable standards acceptable
27under federal regulation.
   28c.  The applicant complies with applicable state rules
29and standards for a psychiatric institution adopted by the
30department in accordance with federal requirements under 42
31C.F.R. §441.150 – 441.156.
   32d.  The applicant has been awarded a certificate of need
33pursuant to chapter 135, unless exempt as provided in this
   35e.    d.  The department of human services has submitted
-2-1written approval of the application based on the department of
2human services’ determination of need. The department of human
3services shall identify the location and number of children in
4the state who require the services of a psychiatric medical
5institution for children. Approval of an application shall be
6based upon the location of the proposed psychiatric institution
7relative to the need for services identified by the department
8of human services and an analysis of the applicant’s ability to
9provide services and support consistent with requirements under
10chapter 232, particularly regarding community-based treatment.
11If the proposed psychiatric institution is not freestanding
12from a facility licensed under chapter 135B or 135C, approval
13under this paragraph shall not be given unless the department
14of human services certifies that the proposed psychiatric
15institution is capable of providing a resident with a living
16environment similar to the living environment provided by a
17licensee which is freestanding from a facility licensed under
18chapter 135B or 135C.
   19f.    e.  The proposed psychiatric institution is under
20the direction of an agency which has operated a facility
21licensed under section 237.3, subsection 2, paragraph “a”, as
22a comprehensive residential facility for children for three
23years or of an agency which has operated a facility for three
24years providing psychiatric services exclusively to children or
25adolescents and the facility meets or exceeds requirements for
26licensure under section 237.3, subsection 2, paragraph “a”, as a
27comprehensive residential facility for children.
   28g.    f.  If a child has an emotional, behavioral, or mental
29health disorder, the psychiatric institution does not require
30court proceedings to be initiated or that a child’s parent,
31guardian, or custodian must terminate parental rights over
32or transfer legal custody of the child for the purpose of
33obtaining treatment from the psychiatric institution for the
34child. Relinquishment of a child’s custody shall not be a
35condition of the child receiving services.
1   Sec. 6.  Section 135H.6, subsections 3, 4, and 5, Code 2021,
2are amended to read as follows:
   33.  In addition to the beds authorized under subsection 2,
4the department of human services may establish not more than
5thirty beds licensed under this chapter at the state mental
6health institute at Independence. The beds shall be exempt
7from the certificate of need requirement under subsection 1,
8paragraph “d”.

   94.  The department of human services may give approval to
10conversion of beds approved under subsection 2, to beds which
11are specialized to provide substance abuse treatment. However,
12the total number of beds approved under subsection 2 and this
13subsection shall not exceed four hundred thirty. Conversion
14of beds under this subsection shall not require a revision of
15the certificate of need issued for the psychiatric institution
16making the conversion.
Beds for children who do not reside
17in this state and whose service costs are not paid by public
18funds in this state are not subject to the limitations on the
19number of beds and certificate of need requirements otherwise
20applicable under this section.
   215.  A psychiatric institution licensed prior to July 1, 1999,
22may exceed the number of beds authorized under subsection 2
23if the excess beds are used to provide services funded from a
24source other than the medical assistance program under chapter
25249A. Notwithstanding subsection 1, paragraphs “d” and “e”
 26paragraph “d”, and subsection 2, the provision of services using
27those excess beds does not require a certificate of need or a
28review by the department of human services.
29   Sec. 7.  Section 135P.1, subsection 3, Code 2021, is amended
30to read as follows:
   313.  “Health facility” means an institutional health facility
32as defined in section 135.61, a hospice licensed under chapter
33135J, a home health agency as defined in section 144D.1, an
34assisted living program certified under chapter 231C, a clinic,
35a community health center, or the university of Iowa hospitals
-4-1and clinics, and includes any corporation, professional
2corporation, partnership, limited liability company, limited
3liability partnership, or other entity comprised of such health
5   Sec. 8.  Section 135P.1, Code 2021, is amended by adding the
6following new subsection:
7   NEW SUBSECTION.  3A.  “Institutional health facility” means
8any of the following, without regard to whether the facilities
9referred to are publicly or privately owned or are organized
10for profit or not or whether the facilities are part of or
11sponsored by a health maintenance organization:
   12a.  A hospital.
   13b.  A health care facility.
   14c.  An organized outpatient health facility.
   15d.  An outpatient surgical facility.
   16e.  A community mental health facility.
   17f.  A birth center.
18   Sec. 9.  Section 231C.3, subsection 2, Code 2021, is amended
19to read as follows:
   202.  Each assisted living program operating in this state
21shall be certified by the department. If an assisted living
22program is voluntarily accredited by a recognized accrediting
23entity, the department shall certify the assisted living
24program on the basis of the voluntary accreditation. An
25assisted living program that is certified by the department on
26the basis of voluntary accreditation shall not be subject to
27payment of the certification fee prescribed in section 231C.18,
28but shall be subject to an administrative fee as prescribed by
29rule. An assisted living program certified under this section
30 is exempt from the requirements of section 135.63 relating to
31certificate of need requirements.

32   Sec. 10.  Section 249K.2, subsection 6, Code 2021, is amended
33to read as follows:
   346.  “New construction” means the construction of a new
35nursing facility which does not replace an existing licensed
-5-1and certified facility and requires the provider to obtain a
2certificate of need pursuant to chapter 135, subchapter VI
3   Sec. 11.  Section 505.27, subsection 5, paragraph a, Code
42021, is amended to read as follows:
   5a.  “Health care provider” means the same as defined in
6section 135.61,
 a person licensed or certified under chapter
7147, 148, 148A, 148C, 149, 151, 152, 153, 154, 154B, 154F,
8or 155A to provide in this state professional health care
9service to an individual during that individual’s medical care,
10treatment, or confinement;
a hospital licensed pursuant to
11chapter 135B,; or a health care facility licensed pursuant to
12chapter 135C.
13   Sec. 12.  Section 708.3A, subsection 5, paragraph d, Code
142021, is amended to read as follows:
   15d.  “Health care provider” means an emergency medical care
16provider as defined in chapter 147A or a person licensed
17or registered under chapter 148, 148C, 148D, or 152 who is
18providing or who is attempting to provide emergency medical
19services, as defined in section 147A.1, or who is providing
20or who is attempting to provide health services as defined
21in section 135.61
in a hospital. A person who commits an
22assault under this section against a health care provider in
23a hospital, or at the scene or during out-of-hospital patient
24transportation in an ambulance, is presumed to know that the
25person against whom the assault is committed is a health care
27   Sec. 13.  Section 708.3A, subsection 5, Code 2021, is amended
28by adding the following new paragraph:
29   NEW PARAGRAPH.  0e.  “Health services” means clinically
30related diagnostic, curative, or rehabilitative services, and
31includes alcoholism, drug abuse, and mental health services.
32   Sec. 14.  REPEAL.  Sections 135.61 through 135.73, and
33section 135B.5A, Code 2021, are repealed.
34   Sec. 15.  CODE EDITOR DIRECTIVE.  The Code editor is
35directed to modify the title of chapter 135, division VI, as
-6-1“Hospital and health care facility reporting, data, analyses,
2and studies” and to correct internal references in the Code as
3necessary due to enactment of this Act.
5The inclusion of this explanation does not constitute agreement with
6the explanation’s substance by the members of the general assembly.
   7This bill eliminates the certificate of need (CON) process
8required prior to the offering or development of a new or
9changed institutional health service and makes conforming
10changes throughout the Code.