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Senate File 75 - IntroducedA Bill ForAn Act 1relating to rural emergency hospitals, including
2licensing requirements and fees, making penalties
3applicable, providing emergency rulemaking authority, and
4including applicability and effective date provisions.
5BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1 Section 1. Section 135B.1, Code 2023, is amended by adding
2the following new subsections:
3 NEW SUBSECTION. 5. “Rural emergency hospital” means a
4facility that provides rural emergency hospital services in
5the facility twenty-four hours per day, seven days per week;
6does not provide any acute care inpatient services with the
7exception of any distinct part of the facility licensed as a
8skilled nursing facility providing posthospital extended care
9services; and meets the criteria specified in section 135B.1A
10and the federal Consolidated Appropriations Act, Pub.L.No.
11116-260, §125.
12 NEW SUBSECTION. 6. “Rural emergency hospital services”
13means the following services provided by a rural emergency
14hospital that do not exceed an annual per patient average of
15twenty-four hours in such a rural emergency hospital:
16a. Emergency department services and observation care.
17For purposes of providing emergency department services, an
18emergency department of a rural emergency hospital shall
19be considered staffed if a physician, nurse practitioner,
20clinical nurse specialist, or physician assistant is available
21to furnish rural emergency hospital services in the facility
22twenty-four hours per day.
23b. At the election of the rural emergency hospital, with
24respect to services furnished on an outpatient basis, other
25medical and health services as specified in regulations adopted
26by the United States secretary of health and human services.
27 Sec. 2. Section 135B.2, Code 2023, is amended to read as
28follows:
29135B.2 Purpose.
30The purpose of this chapter is to provide for the
31development, establishment and enforcement of basic standards
32for the care and treatment of individuals in hospitals and
33rural emergency hospitals and for the construction, maintenance
34and operation of such hospitals, which, in the light of
35existing knowledge, will promote safe and adequate treatment
-1-1of such individuals in such hospitals, in the interest of the
2health, welfare and safety of the public.
3 Sec. 3. Section 135B.3, Code 2023, is amended to read as
4follows:
5135B.3 Licensure.
6No person or governmental unit, acting severally or jointly
7with any other person or governmental unit shall establish,
8conduct or maintain a hospital or rural emergency hospital in
9this state without a license.
10 Sec. 4. NEW SECTION. 135B.3A Rural emergency hospital
11licensure.
121. The department shall adopt rules pursuant to chapter
1317A to establish minimum standards for the licensure of rural
14emergency hospitals consistent with the federal Consolidated
15Appropriations Act, Pub.L.No.116-260, §125, and with
16regulations issued by the United States secretary of health and
17human services for rural emergency hospitals.
182. To be eligible for a rural emergency hospital license, a
19facility shall have been, on or before December 27, 2020, one
20of the following:
21a. A licensed critical access hospital.
22b. A general hospital with not more than fifty licensed
23beds located in a county in a rural area as defined in section
241886(d)(2)(D) of the federal Social Security Act.
25c. A general hospital with no more than fifty licensed beds
26that is deemed as being located in a rural area pursuant to
27section 1886(d)(8)(E) of the federal Social Security Act.
28 Sec. 5. Section 135B.4, Code 2023, is amended to read as
29follows:
30135B.4 Application for license.
31Licenses shall be obtained from the department.
32Applications shall be upon forms and shall contain information
33as the department may reasonably require, which may include
34affirmative evidence of ability to comply with reasonable
35standards and rules prescribed under this chapter. Each
-2-1application for license shall be accompanied by the license
2fee, which shall be refunded to the applicant if the license
3is denied and which shall be deposited into the state treasury
4and credited to the general fund if the license is issued.
5Hospitals and rural emergency hospitals having fifty beds or
6less shall pay an initial license fee of fifteen dollars;
7hospitals of more than fifty beds and not more than one hundred
8beds shall pay an initial license fee of twenty-five dollars;
9all other hospitals shall pay an initial license fee of fifty
10dollars.
11 Sec. 6. Section 135B.5, subsection 1, Code 2023, is amended
12to read as follows:
131. Upon receipt of an application for license and the
14license fee, the department shall issue a license if the
15applicant and hospital facilities comply with this chapter,
16chapter 135, and the rules of the department. Each licensee
17shall receive annual reapproval upon payment of five hundred
18dollars and upon filing of an application form which is
19available from the department. The annual licensure fee shall
20be dedicated to support and provide educational programs on
21regulatory issues for hospitals and rural emergency hospitals
22 licensed under this chapter. Licenses shall be either general
23or restricted in form. Each license shall be issued only
24for the premises and persons or governmental units named in
25the application and is not transferable or assignable except
26with the written approval of the department. Licenses shall
27be posted in a conspicuous place on the licensed premises as
28prescribed by rule of the department.
29 Sec. 7. Section 135B.5A, Code 2023, is amended to read as
30follows:
31135B.5A Conversion of a hospital relative to certain
32hospitals.
331. A conversion of a long-term acute care hospital,
34rehabilitation hospital, or psychiatric hospital as defined by
35federal regulations to a general hospital or to a specialty
-3-1hospital of a different type is a permanent change in bed
2capacity and shall require a certificate of need pursuant to
3section 135.63.
42. A conversion of a critical access hospital or general
5hospital to a rural emergency hospital or a conversion of a
6rural emergency hospital to a critical access hospital or
7general hospital shall not require a certificate of need
8pursuant to section 135.63.
9 Sec. 8. Section 135B.7, Code 2023, is amended to read as
10follows:
11135B.7 Rules and enforcement.
121. a. The department, with the approval of the state
13board of health, shall adopt rules setting out the standards
14for the different types of hospitals and for rural emergency
15hospitals to be licensed under this chapter. The department
16shall enforce the rules.
17b. Rules or standards shall not be adopted or enforced
18which would have the effect of denying a license to a hospital,
19rural emergency hospital, or other institution required to be
20licensed, solely by reason of the school or system of practice
21employed or permitted to be employed by physicians in the
22hospital, rural emergency hospital, or other institution if the
23school or system of practice is recognized by the laws of this
24state.
252. a. The rules shall state that a hospital or rural
26emergency hospital shall not deny clinical privileges to
27physicians and surgeons, podiatric physicians, osteopathic
28physicians and surgeons, dentists, certified health service
29providers in psychology, physician assistants, or advanced
30registered nurse practitioners licensed under chapter 148,
31148C, 149, 152, or 153, or section 154B.7, solely by reason of
32the license held by the practitioner or solely by reason of
33the school or institution in which the practitioner received
34medical schooling or postgraduate training if the medical
35schooling or postgraduate training was accredited by an
-4-1organization recognized by the council on higher education
2accreditation or an accrediting group recognized by the United
3States department of education.
4b. A hospital or rural emergency hospital may establish
5procedures for interaction between a patient and a
6practitioner. The rules shall not prohibit a hospital or
7rural emergency hospital from limiting, restricting, or
8revoking clinical privileges of a practitioner for violation
9of hospital rules, regulations, or procedures established
10under this paragraph, when applied in good faith and in a
11nondiscriminatory manner.
12c. This subsection shall not require a hospital or rural
13emergency hospital to expand the hospital’s current scope of
14service delivery solely to offer the services of a class of
15providers not currently providing services at the hospital
16or rural emergency hospital. This section shall not be
17construed to require a hospital or rural emergency hospital
18 to establish rules which are inconsistent with the scope of
19practice established for licensure of practitioners to whom
20this subsection applies.
21d. This section shall not be construed to authorize the
22denial of clinical privileges to a practitioner or class of
23practitioners solely because a hospital or rural emergency
24hospital has as employees of the hospital or rural emergency
25hospital identically licensed practitioners providing the same
26or similar services.
273. The rules shall require that a hospital or rural
28emergency hospital establish and implement written criteria
29for the granting of clinical privileges. The written criteria
30shall include but are not limited to consideration of all of
31the following:
32a. The ability of an applicant for privileges to provide
33patient care services independently and appropriately in the
34hospital or rural emergency hospital.
35b. The license held by the applicant to practice.
-5- 1c. The training, experience, and competence of the
2applicant.
3d. The relationship between the applicant’s request for the
4granting of privileges and the hospital’s or rural emergency
5hospital’s current scope of patient care services, as well as
6the hospital’s or rural emergency hospital’s determination of
7the necessity to grant privileges to a practitioner authorized
8to provide comprehensive, appropriate, and cost-effective
9services.
104. The department shall also adopt rules requiring
11hospitals and rural emergency hospitals to establish and
12implement protocols for responding to the needs of patients who
13are victims of domestic abuse, as defined in section 236.2.
145. The department shall also adopt rules requiring
15hospitals and rural emergency hospitals to establish and
16implement protocols for responding to the needs of patients who
17are victims of elder abuse, as defined in section 235F.1.
18 Sec. 9. Section 135B.7A, Code 2023, is amended to read as
19follows:
20135B.7A Procedures — orders.
21The department shall adopt rules that require hospitals
22and rural emergency hospitals to establish procedures for
23authentication of all verbal orders by a practitioner within
24a period not to exceed thirty days following a patient’s
25discharge.
26 Sec. 10. Section 135B.8, Code 2023, is amended to read as
27follows:
28135B.8 Effective date of rules.
29Any hospital or rural emergency hospital which is in
30operation at the time of promulgation of any applicable
31rules or minimum standards under this chapter shall be given
32a reasonable time, not to exceed one year from the date of
33such promulgation, within which to comply with such rules and
34minimum standards.
35 Sec. 11. Section 135B.9, Code 2023, is amended to read as
-6-1follows:
2135B.9 Inspections and qualifications for hospital and rural
3emergency hospital inspectors — protection and advocacy agency
4investigations.
51. The department shall make or cause to be made inspections
6as it deems necessary in order to determine compliance with
7applicable rules. Hospital and rural emergency hospital
8 inspectors shall meet the following qualifications:
9a. Be free of conflicts of interest. A hospital or rural
10emergency hospital inspector shall not participate in an
11inspection or complaint investigation of a hospital or rural
12emergency hospital in which the inspector or a member of the
13inspector’s immediate family works or has worked within the
14last two years. For purposes of this paragraph, “immediate
15family member” means a spouse; natural or adoptive parent,
16child, or sibling; or stepparent, stepchild, or stepsibling.
17b. Complete a yearly conflict of interest disclosure
18statement.
19c. Biennially, complete a minimum of ten hours of continuing
20education pertaining to hospital or rural emergency hospital
21 operations including but not limited to quality and process
22improvement standards, trauma system standards, and regulatory
23requirements.
242. In the state resource centers and state mental health
25institutes operated by the department of human services, the
26designated protection and advocacy agency as provided in
27section 135C.2, subsection 4, shall have the authority to
28investigate all complaints of abuse and neglect of persons
29with developmental disabilities or mental illnesses if the
30complaints are reported to the protection and advocacy agency
31or if there is probable cause to believe that the abuse has
32occurred. Such authority shall include the examination of all
33records pertaining to the care provided to the residents and
34contact or interview with any resident, employee, or any other
35person who might have knowledge about the operation of the
-7-1institution.
2 Sec. 12. Section 135B.12, Code 2023, is amended to read as
3follows:
4135B.12 Confidentiality.
5The department’s final findings or the final survey findings
6of the joint commission on the accreditation of health care
7organizations or the American osteopathic association with
8respect to compliance by a hospital or rural emergency hospital
9 with requirements for licensing or accreditation shall be made
10available to the public in a readily available form and place.
11Other information relating to a hospital or rural emergency
12hospital obtained by the department which does not constitute
13the department’s findings from an inspection of the hospital
14or rural emergency hospital or the final survey findings of
15the joint commission on the accreditation of health care
16organizations or the American osteopathic association shall
17not be made available to the public, except in proceedings
18involving the denial, suspension, or revocation of a license
19under this chapter. The name of a person who files a complaint
20with the department shall remain confidential and shall not
21be subject to discovery, subpoena, or other means of legal
22compulsion for its release to a person other than department
23employees or agents involved in the investigation of the
24complaint.
25 Sec. 13. Section 135B.14, Code 2023, is amended to read as
26follows:
27135B.14 Judicial review.
28Judicial review of the action of the department may be sought
29in accordance with chapter 17A.Notwithstanding the terms of
30chapter 17A, the Iowa administrative procedure Act, petitions
31for judicial review may be filed in the district court of the
32county in which the hospital or rural emergency hospital is
33located or to be located, and the status quo of the petitioner
34or licensee shall be preserved pending final disposition of the
35matter in the courts.
-8-1 Sec. 14. Section 135B.15, Code 2023, is amended to read as
2follows:
3135B.15 Penalties.
4Any person establishing, conducting, managing, or operating
5any hospital or rural emergency hospital without a license
6shall be guilty of a serious misdemeanor, and each day of
7continuing violation after conviction shall be considered a
8separate offense.
9 Sec. 15. Section 135B.16, Code 2023, is amended to read as
10follows:
11135B.16 Injunction.
12Notwithstanding the existence or pursuit of any other
13remedy, the department may, in the manner provided by law,
14maintain an action in the name of the state for injunction
15or other process against any person or governmental unit to
16restrain or prevent the establishment, conduct, management or
17operation of a hospital or rural emergency hospital without a
18license.
19 Sec. 16. Section 135B.20, subsection 3, Code 2023, is
20amended to read as follows:
213. “Hospital” shall mean means all hospitals and rural
22emergency hospitals licensed under this chapter.
23 Sec. 17. Section 135B.33, subsection 1, unnumbered
24paragraph 1, Code 2023, is amended to read as follows:
25Subject to availability of funds, the Iowa department of
26public health shall provide technical planning assistance to
27local boards of health and hospital or rural emergency hospital
28 governing boards to ensure access to hospital such services in
29rural areas. The department shall encourage the local boards
30of health and hospital or rural emergency hospital governing
31boards to adopt a long-term community health services and
32developmental plan including the following:
33 Sec. 18. Section 135B.34, subsection 7, Code 2023, is
34amended to read as follows:
357. For the purposes of this section, “comprehensive
-9-1preliminary background check”:
2a. “Comprehensive preliminary background check”means the
3same as defined in section 135C.1.
4b. “Hospital” means a hospital or rural emergency hospital
5licensed under this chapter.
6 Sec. 19. EMERGENCY RULEMAKING AUTHORITY. The department
7may adopt emergency rules under section 17A.4, subsection 3,
8and section 17A.5, subsection 2, paragraph “b”, to implement
9the provisions of this Act and the rules shall be effective
10immediately upon filing unless a later date is specified in the
11rules. Any rules adopted in accordance with this section shall
12also be published as a notice of intended action as provided
13in section 17A.4.
14 Sec. 20. APPLICABILITY. This Act applies to a facility
15that was, on or before December 27, 2020, a general hospital
16with no more than fifty licensed beds, located in a county in a
17rural area as specified in section 135B.3A, as enacted in this
18Act, with a population between thirty thousand and thirty-five
19thousand according to the 2020 federal decennial census,
20operating under a valid certificate of need on and prior to
21September 1, 2022. Notwithstanding any provision to the
22contrary, and in accordance with section 135B.5A, as amended
23in this Act, the conversion of a general hospital as specified
24under this section to a rural emergency hospital under this
25Act shall not be subject to certificate of need requirements
26pursuant to section 135.63.
27 Sec. 21. EFFECTIVE DATE. This Act, being deemed of
28immediate importance, takes effect upon enactment.
29EXPLANATION
30The inclusion of this explanation does not constitute agreement with
31the explanation’s substance by the members of the general assembly.
32This bill provides for state licensure of rural emergency
33hospitals. Under the federal Consolidated Appropriations Act
34of 2021 (federal Act), rural emergency hospitals (REHs) were
35established as a new provider type. Effective January 1, 2023,
-10-1REHs will be eligible to enroll in Medicare and to receive an
2enhanced reimbursement rate for eligible services consisting
3of the outpatient prospective payment system rate plus a 5
4percent add-on and a fixed monthly payment. In order to be
5classified as an REH under the federal Act, a facility must
6meet certain requirements, including applicable state licensing
7requirements. The bill provides a process for such licensure.
8The bill provides emergency rulemaking authority to
9implement the bill.
10The bill includes applicability provisions. The bill
11applies to a facility that was, on or before December 27, 2020,
12a general hospital with no more than 50 licensed beds, located
13in a county in a rural area as specified in the bill with a
14population between 30,000 and 35,000 according to the 2020
15federal decennial census, operating under a valid certificate
16of need on and prior to September 1, 2022. Notwithstanding
17any provision to the contrary, the conversion of the specified
18general hospital to a rural emergency hospital shall not be
19subject to certificate of need requirements.
20The bill takes effect upon enactment.
-11-pf/rh
2licensing requirements and fees, making penalties
3applicable, providing emergency rulemaking authority, and
4including applicability and effective date provisions.
5BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1 Section 1. Section 135B.1, Code 2023, is amended by adding
2the following new subsections:
3 NEW SUBSECTION. 5. “Rural emergency hospital” means a
4facility that provides rural emergency hospital services in
5the facility twenty-four hours per day, seven days per week;
6does not provide any acute care inpatient services with the
7exception of any distinct part of the facility licensed as a
8skilled nursing facility providing posthospital extended care
9services; and meets the criteria specified in section 135B.1A
10and the federal Consolidated Appropriations Act, Pub.L.No.
11116-260, §125.
12 NEW SUBSECTION. 6. “Rural emergency hospital services”
13means the following services provided by a rural emergency
14hospital that do not exceed an annual per patient average of
15twenty-four hours in such a rural emergency hospital:
16a. Emergency department services and observation care.
17For purposes of providing emergency department services, an
18emergency department of a rural emergency hospital shall
19be considered staffed if a physician, nurse practitioner,
20clinical nurse specialist, or physician assistant is available
21to furnish rural emergency hospital services in the facility
22twenty-four hours per day.
23b. At the election of the rural emergency hospital, with
24respect to services furnished on an outpatient basis, other
25medical and health services as specified in regulations adopted
26by the United States secretary of health and human services.
27 Sec. 2. Section 135B.2, Code 2023, is amended to read as
28follows:
29135B.2 Purpose.
30The purpose of this chapter is to provide for the
31development, establishment and enforcement of basic standards
32for the care and treatment of individuals in hospitals and
33rural emergency hospitals and for the construction, maintenance
34and operation of such hospitals, which, in the light of
35existing knowledge, will promote safe and adequate treatment
-1-1of such individuals in such hospitals, in the interest of the
2health, welfare and safety of the public.
3 Sec. 3. Section 135B.3, Code 2023, is amended to read as
4follows:
5135B.3 Licensure.
6No person or governmental unit, acting severally or jointly
7with any other person or governmental unit shall establish,
8conduct or maintain a hospital or rural emergency hospital in
9this state without a license.
10 Sec. 4. NEW SECTION. 135B.3A Rural emergency hospital
11licensure.
121. The department shall adopt rules pursuant to chapter
1317A to establish minimum standards for the licensure of rural
14emergency hospitals consistent with the federal Consolidated
15Appropriations Act, Pub.L.No.116-260, §125, and with
16regulations issued by the United States secretary of health and
17human services for rural emergency hospitals.
182. To be eligible for a rural emergency hospital license, a
19facility shall have been, on or before December 27, 2020, one
20of the following:
21a. A licensed critical access hospital.
22b. A general hospital with not more than fifty licensed
23beds located in a county in a rural area as defined in section
241886(d)(2)(D) of the federal Social Security Act.
25c. A general hospital with no more than fifty licensed beds
26that is deemed as being located in a rural area pursuant to
27section 1886(d)(8)(E) of the federal Social Security Act.
28 Sec. 5. Section 135B.4, Code 2023, is amended to read as
29follows:
30135B.4 Application for license.
31Licenses shall be obtained from the department.
32Applications shall be upon forms and shall contain information
33as the department may reasonably require, which may include
34affirmative evidence of ability to comply with reasonable
35standards and rules prescribed under this chapter. Each
-2-1application for license shall be accompanied by the license
2fee, which shall be refunded to the applicant if the license
3is denied and which shall be deposited into the state treasury
4and credited to the general fund if the license is issued.
5Hospitals and rural emergency hospitals having fifty beds or
6less shall pay an initial license fee of fifteen dollars;
7hospitals of more than fifty beds and not more than one hundred
8beds shall pay an initial license fee of twenty-five dollars;
9all other hospitals shall pay an initial license fee of fifty
10dollars.
11 Sec. 6. Section 135B.5, subsection 1, Code 2023, is amended
12to read as follows:
131. Upon receipt of an application for license and the
14license fee, the department shall issue a license if the
15applicant and hospital facilities comply with this chapter,
16chapter 135, and the rules of the department. Each licensee
17shall receive annual reapproval upon payment of five hundred
18dollars and upon filing of an application form which is
19available from the department. The annual licensure fee shall
20be dedicated to support and provide educational programs on
21regulatory issues for hospitals and rural emergency hospitals
22 licensed under this chapter. Licenses shall be either general
23or restricted in form. Each license shall be issued only
24for the premises and persons or governmental units named in
25the application and is not transferable or assignable except
26with the written approval of the department. Licenses shall
27be posted in a conspicuous place on the licensed premises as
28prescribed by rule of the department.
29 Sec. 7. Section 135B.5A, Code 2023, is amended to read as
30follows:
31135B.5A Conversion of a hospital relative to certain
32hospitals.
331. A conversion of a long-term acute care hospital,
34rehabilitation hospital, or psychiatric hospital as defined by
35federal regulations to a general hospital or to a specialty
-3-1hospital of a different type is a permanent change in bed
2capacity and shall require a certificate of need pursuant to
3section 135.63.
42. A conversion of a critical access hospital or general
5hospital to a rural emergency hospital or a conversion of a
6rural emergency hospital to a critical access hospital or
7general hospital shall not require a certificate of need
8pursuant to section 135.63.
9 Sec. 8. Section 135B.7, Code 2023, is amended to read as
10follows:
11135B.7 Rules and enforcement.
121. a. The department, with the approval of the state
13board of health, shall adopt rules setting out the standards
14for the different types of hospitals and for rural emergency
15hospitals to be licensed under this chapter. The department
16shall enforce the rules.
17b. Rules or standards shall not be adopted or enforced
18which would have the effect of denying a license to a hospital,
19rural emergency hospital, or other institution required to be
20licensed, solely by reason of the school or system of practice
21employed or permitted to be employed by physicians in the
22hospital, rural emergency hospital, or other institution if the
23school or system of practice is recognized by the laws of this
24state.
252. a. The rules shall state that a hospital or rural
26emergency hospital shall not deny clinical privileges to
27physicians and surgeons, podiatric physicians, osteopathic
28physicians and surgeons, dentists, certified health service
29providers in psychology, physician assistants, or advanced
30registered nurse practitioners licensed under chapter 148,
31148C, 149, 152, or 153, or section 154B.7, solely by reason of
32the license held by the practitioner or solely by reason of
33the school or institution in which the practitioner received
34medical schooling or postgraduate training if the medical
35schooling or postgraduate training was accredited by an
-4-1organization recognized by the council on higher education
2accreditation or an accrediting group recognized by the United
3States department of education.
4b. A hospital or rural emergency hospital may establish
5procedures for interaction between a patient and a
6practitioner. The rules shall not prohibit a hospital or
7rural emergency hospital from limiting, restricting, or
8revoking clinical privileges of a practitioner for violation
9of hospital rules, regulations, or procedures established
10under this paragraph, when applied in good faith and in a
11nondiscriminatory manner.
12c. This subsection shall not require a hospital or rural
13emergency hospital to expand the hospital’s current scope of
14service delivery solely to offer the services of a class of
15providers not currently providing services at the hospital
16or rural emergency hospital. This section shall not be
17construed to require a hospital or rural emergency hospital
18 to establish rules which are inconsistent with the scope of
19practice established for licensure of practitioners to whom
20this subsection applies.
21d. This section shall not be construed to authorize the
22denial of clinical privileges to a practitioner or class of
23practitioners solely because a hospital or rural emergency
24hospital has as employees of the hospital or rural emergency
25hospital identically licensed practitioners providing the same
26or similar services.
273. The rules shall require that a hospital or rural
28emergency hospital establish and implement written criteria
29for the granting of clinical privileges. The written criteria
30shall include but are not limited to consideration of all of
31the following:
32a. The ability of an applicant for privileges to provide
33patient care services independently and appropriately in the
34hospital or rural emergency hospital.
35b. The license held by the applicant to practice.
-5- 1c. The training, experience, and competence of the
2applicant.
3d. The relationship between the applicant’s request for the
4granting of privileges and the hospital’s or rural emergency
5hospital’s current scope of patient care services, as well as
6the hospital’s or rural emergency hospital’s determination of
7the necessity to grant privileges to a practitioner authorized
8to provide comprehensive, appropriate, and cost-effective
9services.
104. The department shall also adopt rules requiring
11hospitals and rural emergency hospitals to establish and
12implement protocols for responding to the needs of patients who
13are victims of domestic abuse, as defined in section 236.2.
145. The department shall also adopt rules requiring
15hospitals and rural emergency hospitals to establish and
16implement protocols for responding to the needs of patients who
17are victims of elder abuse, as defined in section 235F.1.
18 Sec. 9. Section 135B.7A, Code 2023, is amended to read as
19follows:
20135B.7A Procedures — orders.
21The department shall adopt rules that require hospitals
22and rural emergency hospitals to establish procedures for
23authentication of all verbal orders by a practitioner within
24a period not to exceed thirty days following a patient’s
25discharge.
26 Sec. 10. Section 135B.8, Code 2023, is amended to read as
27follows:
28135B.8 Effective date of rules.
29Any hospital or rural emergency hospital which is in
30operation at the time of promulgation of any applicable
31rules or minimum standards under this chapter shall be given
32a reasonable time, not to exceed one year from the date of
33such promulgation, within which to comply with such rules and
34minimum standards.
35 Sec. 11. Section 135B.9, Code 2023, is amended to read as
-6-1follows:
2135B.9 Inspections and qualifications for hospital and rural
3emergency hospital inspectors — protection and advocacy agency
4investigations.
51. The department shall make or cause to be made inspections
6as it deems necessary in order to determine compliance with
7applicable rules. Hospital and rural emergency hospital
8 inspectors shall meet the following qualifications:
9a. Be free of conflicts of interest. A hospital or rural
10emergency hospital inspector shall not participate in an
11inspection or complaint investigation of a hospital or rural
12emergency hospital in which the inspector or a member of the
13inspector’s immediate family works or has worked within the
14last two years. For purposes of this paragraph, “immediate
15family member” means a spouse; natural or adoptive parent,
16child, or sibling; or stepparent, stepchild, or stepsibling.
17b. Complete a yearly conflict of interest disclosure
18statement.
19c. Biennially, complete a minimum of ten hours of continuing
20education pertaining to hospital or rural emergency hospital
21 operations including but not limited to quality and process
22improvement standards, trauma system standards, and regulatory
23requirements.
242. In the state resource centers and state mental health
25institutes operated by the department of human services, the
26designated protection and advocacy agency as provided in
27section 135C.2, subsection 4, shall have the authority to
28investigate all complaints of abuse and neglect of persons
29with developmental disabilities or mental illnesses if the
30complaints are reported to the protection and advocacy agency
31or if there is probable cause to believe that the abuse has
32occurred. Such authority shall include the examination of all
33records pertaining to the care provided to the residents and
34contact or interview with any resident, employee, or any other
35person who might have knowledge about the operation of the
-7-1institution.
2 Sec. 12. Section 135B.12, Code 2023, is amended to read as
3follows:
4135B.12 Confidentiality.
5The department’s final findings or the final survey findings
6of the joint commission on the accreditation of health care
7organizations or the American osteopathic association with
8respect to compliance by a hospital or rural emergency hospital
9 with requirements for licensing or accreditation shall be made
10available to the public in a readily available form and place.
11Other information relating to a hospital or rural emergency
12hospital obtained by the department which does not constitute
13the department’s findings from an inspection of the hospital
14or rural emergency hospital or the final survey findings of
15the joint commission on the accreditation of health care
16organizations or the American osteopathic association shall
17not be made available to the public, except in proceedings
18involving the denial, suspension, or revocation of a license
19under this chapter. The name of a person who files a complaint
20with the department shall remain confidential and shall not
21be subject to discovery, subpoena, or other means of legal
22compulsion for its release to a person other than department
23employees or agents involved in the investigation of the
24complaint.
25 Sec. 13. Section 135B.14, Code 2023, is amended to read as
26follows:
27135B.14 Judicial review.
28Judicial review of the action of the department may be sought
29in accordance with chapter 17A.Notwithstanding the terms of
30chapter 17A, the Iowa administrative procedure Act, petitions
31for judicial review may be filed in the district court of the
32county in which the hospital or rural emergency hospital is
33located or to be located, and the status quo of the petitioner
34or licensee shall be preserved pending final disposition of the
35matter in the courts.
-8-1 Sec. 14. Section 135B.15, Code 2023, is amended to read as
2follows:
3135B.15 Penalties.
4Any person establishing, conducting, managing, or operating
5any hospital or rural emergency hospital without a license
6shall be guilty of a serious misdemeanor, and each day of
7continuing violation after conviction shall be considered a
8separate offense.
9 Sec. 15. Section 135B.16, Code 2023, is amended to read as
10follows:
11135B.16 Injunction.
12Notwithstanding the existence or pursuit of any other
13remedy, the department may, in the manner provided by law,
14maintain an action in the name of the state for injunction
15or other process against any person or governmental unit to
16restrain or prevent the establishment, conduct, management or
17operation of a hospital or rural emergency hospital without a
18license.
19 Sec. 16. Section 135B.20, subsection 3, Code 2023, is
20amended to read as follows:
213. “Hospital” shall mean means all hospitals and rural
22emergency hospitals licensed under this chapter.
23 Sec. 17. Section 135B.33, subsection 1, unnumbered
24paragraph 1, Code 2023, is amended to read as follows:
25Subject to availability of funds, the Iowa department of
26public health shall provide technical planning assistance to
27local boards of health and hospital or rural emergency hospital
28 governing boards to ensure access to hospital such services in
29rural areas. The department shall encourage the local boards
30of health and hospital or rural emergency hospital governing
31boards to adopt a long-term community health services and
32developmental plan including the following:
33 Sec. 18. Section 135B.34, subsection 7, Code 2023, is
34amended to read as follows:
357. For the purposes of this section, “comprehensive
-9-1preliminary background check”:
2a. “Comprehensive preliminary background check”means the
3same as defined in section 135C.1.
4b. “Hospital” means a hospital or rural emergency hospital
5licensed under this chapter.
6 Sec. 19. EMERGENCY RULEMAKING AUTHORITY. The department
7may adopt emergency rules under section 17A.4, subsection 3,
8and section 17A.5, subsection 2, paragraph “b”, to implement
9the provisions of this Act and the rules shall be effective
10immediately upon filing unless a later date is specified in the
11rules. Any rules adopted in accordance with this section shall
12also be published as a notice of intended action as provided
13in section 17A.4.
14 Sec. 20. APPLICABILITY. This Act applies to a facility
15that was, on or before December 27, 2020, a general hospital
16with no more than fifty licensed beds, located in a county in a
17rural area as specified in section 135B.3A, as enacted in this
18Act, with a population between thirty thousand and thirty-five
19thousand according to the 2020 federal decennial census,
20operating under a valid certificate of need on and prior to
21September 1, 2022. Notwithstanding any provision to the
22contrary, and in accordance with section 135B.5A, as amended
23in this Act, the conversion of a general hospital as specified
24under this section to a rural emergency hospital under this
25Act shall not be subject to certificate of need requirements
26pursuant to section 135.63.
27 Sec. 21. EFFECTIVE DATE. This Act, being deemed of
28immediate importance, takes effect upon enactment.
29EXPLANATION
30The inclusion of this explanation does not constitute agreement with
31the explanation’s substance by the members of the general assembly.
32This bill provides for state licensure of rural emergency
33hospitals. Under the federal Consolidated Appropriations Act
34of 2021 (federal Act), rural emergency hospitals (REHs) were
35established as a new provider type. Effective January 1, 2023,
-10-1REHs will be eligible to enroll in Medicare and to receive an
2enhanced reimbursement rate for eligible services consisting
3of the outpatient prospective payment system rate plus a 5
4percent add-on and a fixed monthly payment. In order to be
5classified as an REH under the federal Act, a facility must
6meet certain requirements, including applicable state licensing
7requirements. The bill provides a process for such licensure.
8The bill provides emergency rulemaking authority to
9implement the bill.
10The bill includes applicability provisions. The bill
11applies to a facility that was, on or before December 27, 2020,
12a general hospital with no more than 50 licensed beds, located
13in a county in a rural area as specified in the bill with a
14population between 30,000 and 35,000 according to the 2020
15federal decennial census, operating under a valid certificate
16of need on and prior to September 1, 2022. Notwithstanding
17any provision to the contrary, the conversion of the specified
18general hospital to a rural emergency hospital shall not be
19subject to certificate of need requirements.
20The bill takes effect upon enactment.
-11-pf/rh