Print
Senate File 75 - ReprintedA Bill ForAn Act 1relating to certain health facilities including
2ambulatory surgical centers and rural emergency hospitals,
3including licensing requirements and fees, providing
4penalties and making penalties applicable, providing
5emergency rulemaking authority, and including applicability
6and effective date provisions.
7BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1DIVISION I
2rural emergency hospitals
3 Section 1. Section 135B.1, Code 2023, is amended by adding
4the following new subsections:
5 NEW SUBSECTION. 5. “Rural emergency hospital” means a
6facility that provides rural emergency hospital services in
7the facility twenty-four hours per day, seven days per week;
8does not provide any acute care inpatient services with the
9exception of any distinct part of the facility licensed as a
10skilled nursing facility providing posthospital extended care
11services; and meets the criteria specified in section 135B.1A
12and the federal Consolidated Appropriations Act, Pub.L.No.
13116-260, §125.
14 NEW SUBSECTION. 6. “Rural emergency hospital services”
15means the following services provided by a rural emergency
16hospital that do not exceed an annual per patient average of
17twenty-four hours in such a rural emergency hospital:
18a. Emergency department services and observation care.
19For purposes of providing emergency department services, an
20emergency department of a rural emergency hospital shall be
21considered staffed if a physician, advanced registered nurse
22practitioner, or physician assistant is available to furnish
23rural emergency hospital services in the facility twenty-four
24hours per day.
25b. At the election of the rural emergency hospital, with
26respect to services furnished on an outpatient basis, other
27medical and health services as specified in regulations adopted
28by the United States secretary of health and human services.
29 Sec. 2. Section 135B.2, Code 2023, is amended to read as
30follows:
31135B.2 Purpose.
32The purpose of this chapter is to provide for the
33development, establishment and enforcement of basic standards
34for the care and treatment of individuals in hospitals and
35rural emergency hospitals and for the construction, maintenance
-1-1and operation of such hospitals, which, in the light of
2existing knowledge, will promote safe and adequate treatment
3of such individuals in such hospitals, in the interest of the
4health, welfare and safety of the public.
5 Sec. 3. Section 135B.3, Code 2023, is amended to read as
6follows:
7135B.3 Licensure.
8No person or governmental unit, acting severally or jointly
9with any other person or governmental unit shall establish,
10conduct or maintain a hospital or rural emergency hospital in
11this state without a license.
12 Sec. 4. NEW SECTION. 135B.3A Rural emergency hospital
13licensure.
141. The department shall adopt rules pursuant to chapter
1517A to establish minimum standards for the licensure of rural
16emergency hospitals consistent with the federal Consolidated
17Appropriations Act, Pub.L.No.116-260, §125, and with
18regulations issued by the United States secretary of health and
19human services for rural emergency hospitals.
202. To be eligible for a rural emergency hospital license, a
21facility shall have been, on or before December 27, 2020, one
22of the following:
23a. A licensed critical access hospital.
24b. A general hospital with not more than fifty licensed
25beds located in a county in a rural area as defined in section
261886(d)(2)(D) of the federal Social Security Act.
27c. A general hospital with no more than fifty licensed beds
28that is deemed as being located in a rural area pursuant to
29section 1886(d)(8)(E) of the federal Social Security Act.
30 Sec. 5. Section 135B.4, Code 2023, is amended to read as
31follows:
32135B.4 Application for license.
33Licenses shall be obtained from the department.
34Applications shall be upon forms and shall contain information
35as the department may reasonably require, which may include
-2-1affirmative evidence of ability to comply with reasonable
2standards and rules prescribed under this chapter. Each
3application for license shall be accompanied by the license
4fee, which shall be refunded to the applicant if the license
5is denied and which shall be deposited into the state treasury
6and credited to the general fund if the license is issued.
7Hospitals and rural emergency hospitals having fifty beds or
8less shall pay an initial license fee of fifteen dollars;
9hospitals of more than fifty beds and not more than one hundred
10beds shall pay an initial license fee of twenty-five dollars;
11all other hospitals shall pay an initial license fee of fifty
12dollars.
13 Sec. 6. Section 135B.5, subsection 1, Code 2023, is amended
14to read as follows:
151. Upon receipt of an application for license and the
16license fee, the department shall issue a license if the
17applicant and hospital facilities comply with this chapter,
18chapter 135, and the rules of the department. Each licensee
19shall receive annual reapproval upon payment of five hundred
20dollars and upon filing of an application form which is
21available from the department. The annual licensure fee shall
22be dedicated to support and provide educational programs on
23regulatory issues for hospitals and rural emergency hospitals
24 licensed under this chapter. Licenses shall be either general
25or restricted in form. Each license shall be issued only
26for the premises and persons or governmental units named in
27the application and is not transferable or assignable except
28with the written approval of the department. Licenses shall
29be posted in a conspicuous place on the licensed premises as
30prescribed by rule of the department.
31 Sec. 7. Section 135B.5A, Code 2023, is amended to read as
32follows:
33135B.5A Conversion of a hospital relative to certain
34hospitals.
351. A conversion of a long-term acute care hospital,
-3-1rehabilitation hospital, or psychiatric hospital as defined by
2federal regulations to a general hospital or to a specialty
3hospital of a different type is a permanent change in bed
4capacity and shall require a certificate of need pursuant to
5section 135.63.
62. A conversion of a critical access hospital or general
7hospital to a rural emergency hospital shall not require a
8certificate of need pursuant 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
7shall adopt emergency rules within six months of the effective
8date of this Act under section 17A.4, subsection 3, and section
917A.5, subsection 2, paragraph “b”, to implement the provisions
10of this division of this Act and the rules shall be effective
11immediately upon filing unless a later date is specified in the
12rules. Any rules adopted in accordance with this section shall
13also be published as a notice of intended action as provided
14in section 17A.4.
15 Sec. 20. APPLICABILITY. This division of this Act applies
16to a facility, or due to change in ownership, a successor
17facility, that was, on or before December 27, 2020, a general
18hospital with no more than fifty licensed beds, located in a
19county in a rural area as specified in section 135B.3A, as
20enacted in this division of this Act, with a population between
21thirty thousand and thirty-five thousand according to the 2020
22federal decennial census, operating under a valid certificate
23of need on and prior to September 1, 2022. Notwithstanding
24any provision to the contrary, and in accordance with section
25135B.5A, as amended in this division of this Act, the reopening
26of a general hospital by a successor facility as specified
27under this section and subsequent conversion to a rural
28emergency hospital under this division of this Act, shall not
29be subject to certificate of need requirements pursuant to
30section 135.63.
31 Sec. 21. EFFECTIVE DATE. This division of this Act, being
32deemed of immediate importance, takes effect upon enactment.
33DIVISION II
34Ambulatory Surgical Centers
35 Sec. 22. NEW SECTION. 135R.1 Definitions.
-10- 1As used in this chapter, unless the context otherwise
2requires:
31. “Ambulatory surgical center” means a distinct facility
4that operates exclusively for the purpose of providing surgical
5services to patients not requiring hospitalization and in which
6the expected duration of services does not exceed twenty-four
7hours following an admission. “Ambulatory surgical center”
8includes a facility certified or seeking certification as an
9ambulatory surgical center under the federal Medicare program
10or under the medical assistance program established pursuant
11to chapter 249A. “Ambulatory surgical center” does not include
12the individual or group practice office of a private physician,
13podiatrist, or dentist who there engages in the lawful practice
14of surgery, or the portion of a licensed hospital designated
15for outpatient surgical treatment.
162. “Department” means the department of inspections and
17appeals.
18 Sec. 23. NEW SECTION. 135R.2 Licensure.
19A person, acting severally or jointly with any other person,
20shall not establish, operate, or maintain an ambulatory
21surgical center in this state without obtaining a license as
22provided under this chapter.
23 Sec. 24. NEW SECTION. 135R.3 Application for license —
24fee.
251. An applicant for an ambulatory surgical center license
26shall submit an application to the department. Applications
27shall be upon such forms and shall include such information
28as the department may reasonably require, which may include
29affirmative evidence of the ability to comply with reasonable
30rules and standards prescribed under this chapter.
312. An application for an initial license for an ambulatory
32surgical center shall be accompanied by a fee of fifty dollars.
333. The fees collected under this section shall be considered
34repayment receipts as defined in section 8.2 and shall be used
35by the department to administer this chapter.
-11-1 Sec. 25. NEW SECTION. 135R.4 Rules.
21. The department, with the advice and approval of the state
3board of health, shall adopt rules specifying the standards for
4ambulatory surgical centers to be licensed under this chapter.
5The rules shall be consistent with and shall not exceed the
6requirements of this chapter and the conditions for coverage in
7the federal Medicare program for ambulatory surgical centers
8under 42 C.F.R. pt.416.
92. The department shall adopt rules as the department deems
10necessary to administer the provisions of this chapter relating
11to the issuance, renewal, denial, suspension, and revocation
12of a license to establish, operate, and maintain an ambulatory
13surgical center.
143. An ambulatory surgical center which is in operation at
15the time of adoption of any applicable rules or standards under
16this chapter shall be given a reasonable time, not to exceed
17one year from the date of adoption, within which to comply with
18such rules and standards.
194. The department shall enforce the rules.
20 Sec. 26. NEW SECTION. 135R.5 Inspections or investigations.
211. The department shall make or cause to be made inspections
22or investigations of ambulatory surgical centers to determine
23compliance with this chapter and applicable rules and
24standards. The department shall perform inspections on a
25schedule that is of the same frequency required for inspections
26of Medicare-certified ambulatory surgical centers.
272. The department shall recognize, in lieu of its own
28licensure inspection, the comparable inspection and inspection
29findings of a Medicare conditions for coverage survey completed
30by the department or an accrediting organization with deeming
31authority authorized by the centers for Medicare and Medicaid
32services of the United States department of health and human
33services.
343. A department inspector shall not participate in an
35inspection or investigation of an ambulatory surgical center in
-12-1which the inspector or a member of the inspector’s immediate
2family works or has worked within the last two years or in
3which the inspector or the inspector’s immediate family has
4a financial ownership interest. For the purposes of this
5section, “immediate family member” means a spouse, natural or
6adoptive parent or grandparent, child, grandchild, sibling,
7stepparent, stepchild, or stepsibling.
8 Sec. 27. NEW SECTION. 135R.6 Confidentiality.
9The department’s final findings with respect to compliance
10by an ambulatory surgical center with requirements for
11licensing shall be made available to the public in a readily
12available form and place. Other information relating to
13an ambulatory surgical center obtained by the department
14which does not constitute the department’s findings from an
15inspection of the ambulatory surgical center shall not be made
16available to the public, except in proceedings involving the
17denial, suspension, or revocation of a license under this
18chapter. The name of a person who files a complaint with the
19department shall remain confidential and shall not be subject
20to discovery, subpoena, or other means of legal compulsion for
21its release to a person other than department employees or
22agents involved in the investigation of the complaint.
23 Sec. 28. NEW SECTION. 135R.7 Injunction.
24Notwithstanding the existence or pursuit of any other
25remedy, the department may, in the manner provided by law,
26maintain an action in the name of the state for injunction
27or other process against any person to restrain or prevent
28the establishment, operation, or maintenance of an ambulatory
29surgical center without a license.
30 Sec. 29. NEW SECTION. 135R.8 Judicial review.
31Judicial review of an action of the department may be sought
32in accordance with chapter 17A. Notwithstanding the provisions
33of chapter 17A, petitions for judicial review may be filed
34in the district court of the county in which the ambulatory
35surgical center is located or is to be located and the status
-13-1quo of the petitioner or licensee shall be preserved pending
2final disposition of the judicial review matter.
3 Sec. 30. NEW SECTION. 135R.9 Penalties.
4Any person establishing, operating, or maintaining any
5ambulatory surgical center without a license commits a serious
6misdemeanor, and each day of continuing violation after
7conviction shall be considered a separate offense.
8 Sec. 31. Section 135.11, Code 2023, is amended by adding the
9following new subsection:
10 NEW SUBSECTION. 29. Adopt rules requiring ambulatory
11surgical centers to report quality data to the department
12of health and human services that is consistent with the
13data required to be reported to the centers for Medicare and
14Medicaid services of the United States department of health and
15human services as authorized by the Medicare Improvements and
16Extension Act of 2006 under Tit.I of the Tax Relief and Health
17Care Act of 2006, Pub.L. No.109-432, and the regulations
18adopted under such Acts. Notwithstanding any provision of
19law to the contrary, nothing in this subsection shall require
20an ambulatory surgical center to provide health data to the
21department of health and human services or any other public
22or private entity that is in addition to, different than,
23or exceeds the quality data required to be reported to the
24centers for Medicare and Medicaid services of the United States
25department of health and human services.
26 Sec. 32. Section 135.61, Code 2023, is amended by adding the
27following new subsection:
28 NEW SUBSECTION. 1A. “Ambulatory surgical center” means
29ambulatory surgical center as defined in section 135R.1.
30 Sec. 33. Section 135.61, subsection 14, paragraph d, Code
312023, is amended to read as follows:
32d. An outpatient ambulatory surgical facility center.
33 Sec. 34. Section 135.61, subsection 21, Code 2023, is
34amended by striking the subsection.
pf/rh/mb
2ambulatory surgical centers and rural emergency hospitals,
3including licensing requirements and fees, providing
4penalties and making penalties applicable, providing
5emergency rulemaking authority, and including applicability
6and effective date provisions.
7BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1DIVISION I
2rural emergency hospitals
3 Section 1. Section 135B.1, Code 2023, is amended by adding
4the following new subsections:
5 NEW SUBSECTION. 5. “Rural emergency hospital” means a
6facility that provides rural emergency hospital services in
7the facility twenty-four hours per day, seven days per week;
8does not provide any acute care inpatient services with the
9exception of any distinct part of the facility licensed as a
10skilled nursing facility providing posthospital extended care
11services; and meets the criteria specified in section 135B.1A
12and the federal Consolidated Appropriations Act, Pub.L.No.
13116-260, §125.
14 NEW SUBSECTION. 6. “Rural emergency hospital services”
15means the following services provided by a rural emergency
16hospital that do not exceed an annual per patient average of
17twenty-four hours in such a rural emergency hospital:
18a. Emergency department services and observation care.
19For purposes of providing emergency department services, an
20emergency department of a rural emergency hospital shall be
21considered staffed if a physician, advanced registered nurse
22practitioner, or physician assistant is available to furnish
23rural emergency hospital services in the facility twenty-four
24hours per day.
25b. At the election of the rural emergency hospital, with
26respect to services furnished on an outpatient basis, other
27medical and health services as specified in regulations adopted
28by the United States secretary of health and human services.
29 Sec. 2. Section 135B.2, Code 2023, is amended to read as
30follows:
31135B.2 Purpose.
32The purpose of this chapter is to provide for the
33development, establishment and enforcement of basic standards
34for the care and treatment of individuals in hospitals and
35rural emergency hospitals and for the construction, maintenance
-1-1and operation of such hospitals, which, in the light of
2existing knowledge, will promote safe and adequate treatment
3of such individuals in such hospitals, in the interest of the
4health, welfare and safety of the public.
5 Sec. 3. Section 135B.3, Code 2023, is amended to read as
6follows:
7135B.3 Licensure.
8No person or governmental unit, acting severally or jointly
9with any other person or governmental unit shall establish,
10conduct or maintain a hospital or rural emergency hospital in
11this state without a license.
12 Sec. 4. NEW SECTION. 135B.3A Rural emergency hospital
13licensure.
141. The department shall adopt rules pursuant to chapter
1517A to establish minimum standards for the licensure of rural
16emergency hospitals consistent with the federal Consolidated
17Appropriations Act, Pub.L.No.116-260, §125, and with
18regulations issued by the United States secretary of health and
19human services for rural emergency hospitals.
202. To be eligible for a rural emergency hospital license, a
21facility shall have been, on or before December 27, 2020, one
22of the following:
23a. A licensed critical access hospital.
24b. A general hospital with not more than fifty licensed
25beds located in a county in a rural area as defined in section
261886(d)(2)(D) of the federal Social Security Act.
27c. A general hospital with no more than fifty licensed beds
28that is deemed as being located in a rural area pursuant to
29section 1886(d)(8)(E) of the federal Social Security Act.
30 Sec. 5. Section 135B.4, Code 2023, is amended to read as
31follows:
32135B.4 Application for license.
33Licenses shall be obtained from the department.
34Applications shall be upon forms and shall contain information
35as the department may reasonably require, which may include
-2-1affirmative evidence of ability to comply with reasonable
2standards and rules prescribed under this chapter. Each
3application for license shall be accompanied by the license
4fee, which shall be refunded to the applicant if the license
5is denied and which shall be deposited into the state treasury
6and credited to the general fund if the license is issued.
7Hospitals and rural emergency hospitals having fifty beds or
8less shall pay an initial license fee of fifteen dollars;
9hospitals of more than fifty beds and not more than one hundred
10beds shall pay an initial license fee of twenty-five dollars;
11all other hospitals shall pay an initial license fee of fifty
12dollars.
13 Sec. 6. Section 135B.5, subsection 1, Code 2023, is amended
14to read as follows:
151. Upon receipt of an application for license and the
16license fee, the department shall issue a license if the
17applicant and hospital facilities comply with this chapter,
18chapter 135, and the rules of the department. Each licensee
19shall receive annual reapproval upon payment of five hundred
20dollars and upon filing of an application form which is
21available from the department. The annual licensure fee shall
22be dedicated to support and provide educational programs on
23regulatory issues for hospitals and rural emergency hospitals
24 licensed under this chapter. Licenses shall be either general
25or restricted in form. Each license shall be issued only
26for the premises and persons or governmental units named in
27the application and is not transferable or assignable except
28with the written approval of the department. Licenses shall
29be posted in a conspicuous place on the licensed premises as
30prescribed by rule of the department.
31 Sec. 7. Section 135B.5A, Code 2023, is amended to read as
32follows:
33135B.5A Conversion of a hospital relative to certain
34hospitals.
351. A conversion of a long-term acute care hospital,
-3-1rehabilitation hospital, or psychiatric hospital as defined by
2federal regulations to a general hospital or to a specialty
3hospital of a different type is a permanent change in bed
4capacity and shall require a certificate of need pursuant to
5section 135.63.
62. A conversion of a critical access hospital or general
7hospital to a rural emergency hospital shall not require a
8certificate of need pursuant 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
7shall adopt emergency rules within six months of the effective
8date of this Act under section 17A.4, subsection 3, and section
917A.5, subsection 2, paragraph “b”, to implement the provisions
10of this division of this Act and the rules shall be effective
11immediately upon filing unless a later date is specified in the
12rules. Any rules adopted in accordance with this section shall
13also be published as a notice of intended action as provided
14in section 17A.4.
15 Sec. 20. APPLICABILITY. This division of this Act applies
16to a facility, or due to change in ownership, a successor
17facility, that was, on or before December 27, 2020, a general
18hospital with no more than fifty licensed beds, located in a
19county in a rural area as specified in section 135B.3A, as
20enacted in this division of this Act, with a population between
21thirty thousand and thirty-five thousand according to the 2020
22federal decennial census, operating under a valid certificate
23of need on and prior to September 1, 2022. Notwithstanding
24any provision to the contrary, and in accordance with section
25135B.5A, as amended in this division of this Act, the reopening
26of a general hospital by a successor facility as specified
27under this section and subsequent conversion to a rural
28emergency hospital under this division of this Act, shall not
29be subject to certificate of need requirements pursuant to
30section 135.63.
31 Sec. 21. EFFECTIVE DATE. This division of this Act, being
32deemed of immediate importance, takes effect upon enactment.
33DIVISION II
34Ambulatory Surgical Centers
35 Sec. 22. NEW SECTION. 135R.1 Definitions.
-10- 1As used in this chapter, unless the context otherwise
2requires:
31. “Ambulatory surgical center” means a distinct facility
4that operates exclusively for the purpose of providing surgical
5services to patients not requiring hospitalization and in which
6the expected duration of services does not exceed twenty-four
7hours following an admission. “Ambulatory surgical center”
8includes a facility certified or seeking certification as an
9ambulatory surgical center under the federal Medicare program
10or under the medical assistance program established pursuant
11to chapter 249A. “Ambulatory surgical center” does not include
12the individual or group practice office of a private physician,
13podiatrist, or dentist who there engages in the lawful practice
14of surgery, or the portion of a licensed hospital designated
15for outpatient surgical treatment.
162. “Department” means the department of inspections and
17appeals.
18 Sec. 23. NEW SECTION. 135R.2 Licensure.
19A person, acting severally or jointly with any other person,
20shall not establish, operate, or maintain an ambulatory
21surgical center in this state without obtaining a license as
22provided under this chapter.
23 Sec. 24. NEW SECTION. 135R.3 Application for license —
24fee.
251. An applicant for an ambulatory surgical center license
26shall submit an application to the department. Applications
27shall be upon such forms and shall include such information
28as the department may reasonably require, which may include
29affirmative evidence of the ability to comply with reasonable
30rules and standards prescribed under this chapter.
312. An application for an initial license for an ambulatory
32surgical center shall be accompanied by a fee of fifty dollars.
333. The fees collected under this section shall be considered
34repayment receipts as defined in section 8.2 and shall be used
35by the department to administer this chapter.
-11-1 Sec. 25. NEW SECTION. 135R.4 Rules.
21. The department, with the advice and approval of the state
3board of health, shall adopt rules specifying the standards for
4ambulatory surgical centers to be licensed under this chapter.
5The rules shall be consistent with and shall not exceed the
6requirements of this chapter and the conditions for coverage in
7the federal Medicare program for ambulatory surgical centers
8under 42 C.F.R. pt.416.
92. The department shall adopt rules as the department deems
10necessary to administer the provisions of this chapter relating
11to the issuance, renewal, denial, suspension, and revocation
12of a license to establish, operate, and maintain an ambulatory
13surgical center.
143. An ambulatory surgical center which is in operation at
15the time of adoption of any applicable rules or standards under
16this chapter shall be given a reasonable time, not to exceed
17one year from the date of adoption, within which to comply with
18such rules and standards.
194. The department shall enforce the rules.
20 Sec. 26. NEW SECTION. 135R.5 Inspections or investigations.
211. The department shall make or cause to be made inspections
22or investigations of ambulatory surgical centers to determine
23compliance with this chapter and applicable rules and
24standards. The department shall perform inspections on a
25schedule that is of the same frequency required for inspections
26of Medicare-certified ambulatory surgical centers.
272. The department shall recognize, in lieu of its own
28licensure inspection, the comparable inspection and inspection
29findings of a Medicare conditions for coverage survey completed
30by the department or an accrediting organization with deeming
31authority authorized by the centers for Medicare and Medicaid
32services of the United States department of health and human
33services.
343. A department inspector shall not participate in an
35inspection or investigation of an ambulatory surgical center in
-12-1which the inspector or a member of the inspector’s immediate
2family works or has worked within the last two years or in
3which the inspector or the inspector’s immediate family has
4a financial ownership interest. For the purposes of this
5section, “immediate family member” means a spouse, natural or
6adoptive parent or grandparent, child, grandchild, sibling,
7stepparent, stepchild, or stepsibling.
8 Sec. 27. NEW SECTION. 135R.6 Confidentiality.
9The department’s final findings with respect to compliance
10by an ambulatory surgical center with requirements for
11licensing shall be made available to the public in a readily
12available form and place. Other information relating to
13an ambulatory surgical center obtained by the department
14which does not constitute the department’s findings from an
15inspection of the ambulatory surgical center shall not be made
16available to the public, except in proceedings involving the
17denial, suspension, or revocation of a license under this
18chapter. The name of a person who files a complaint with the
19department shall remain confidential and shall not be subject
20to discovery, subpoena, or other means of legal compulsion for
21its release to a person other than department employees or
22agents involved in the investigation of the complaint.
23 Sec. 28. NEW SECTION. 135R.7 Injunction.
24Notwithstanding the existence or pursuit of any other
25remedy, the department may, in the manner provided by law,
26maintain an action in the name of the state for injunction
27or other process against any person to restrain or prevent
28the establishment, operation, or maintenance of an ambulatory
29surgical center without a license.
30 Sec. 29. NEW SECTION. 135R.8 Judicial review.
31Judicial review of an action of the department may be sought
32in accordance with chapter 17A. Notwithstanding the provisions
33of chapter 17A, petitions for judicial review may be filed
34in the district court of the county in which the ambulatory
35surgical center is located or is to be located and the status
-13-1quo of the petitioner or licensee shall be preserved pending
2final disposition of the judicial review matter.
3 Sec. 30. NEW SECTION. 135R.9 Penalties.
4Any person establishing, operating, or maintaining any
5ambulatory surgical center without a license commits a serious
6misdemeanor, and each day of continuing violation after
7conviction shall be considered a separate offense.
8 Sec. 31. Section 135.11, Code 2023, is amended by adding the
9following new subsection:
10 NEW SUBSECTION. 29. Adopt rules requiring ambulatory
11surgical centers to report quality data to the department
12of health and human services that is consistent with the
13data required to be reported to the centers for Medicare and
14Medicaid services of the United States department of health and
15human services as authorized by the Medicare Improvements and
16Extension Act of 2006 under Tit.I of the Tax Relief and Health
17Care Act of 2006, Pub.L. No.109-432, and the regulations
18adopted under such Acts. Notwithstanding any provision of
19law to the contrary, nothing in this subsection shall require
20an ambulatory surgical center to provide health data to the
21department of health and human services or any other public
22or private entity that is in addition to, different than,
23or exceeds the quality data required to be reported to the
24centers for Medicare and Medicaid services of the United States
25department of health and human services.
26 Sec. 32. Section 135.61, Code 2023, is amended by adding the
27following new subsection:
28 NEW SUBSECTION. 1A. “Ambulatory surgical center” means
29ambulatory surgical center as defined in section 135R.1.
30 Sec. 33. Section 135.61, subsection 14, paragraph d, Code
312023, is amended to read as follows:
32d. An outpatient ambulatory surgical facility center.
33 Sec. 34. Section 135.61, subsection 21, Code 2023, is
34amended by striking the subsection.
pf/rh/mb