Bill Text: IA SF75 | 2023-2024 | 90th General Assembly | Enrolled

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Bill Title: A bill for an act relating to certain health facilities including ambulatory surgical centers and rural emergency hospitals, including licensing requirements and fees, providing penalties and making penalties applicable, providing emergency rulemaking authority, and including applicability and effective date provisions. Effective date: 03/28/2023, 07/01/2023. Contingent applicability date.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Passed) 2023-03-28 - Signed by Governor. S.J. 719. [SF75 Detail]

Download: Iowa-2023-SF75-Enrolled.html

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Senate File 75 - Enrolled
Senate File 75
AN ACT
RELATING TO CERTAIN HEALTH FACILITIES INCLUDING AMBULATORY
SURGICAL CENTERS AND RURAL EMERGENCY HOSPITALS, INCLUDING
LICENSING REQUIREMENTS AND FEES, PROVIDING PENALTIES AND
MAKING PENALTIES APPLICABLE, PROVIDING EMERGENCY RULEMAKING
AUTHORITY, AND INCLUDING APPLICABILITY AND EFFECTIVE DATE
PROVISIONS.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
DIVISION I
RURAL EMERGENCY HOSPITALS
Section 1. Section 135B.1, Code 2023, is amended by adding
the following new subsections:
NEW SUBSECTION . 5. “Rural emergency hospital” means a
facility that provides rural emergency hospital services in
the facility twenty-four hours per day, seven days per week;
does not provide any acute care inpatient services with the
exception of any distinct part of the facility licensed as a
skilled nursing facility providing posthospital extended care
services; and meets the criteria specified in section 135B.1A
and the federal Consolidated Appropriations Act, Pub. L. No.
116-260, §125.
NEW SUBSECTION . 6. “Rural emergency hospital services”
means the following services provided by a rural emergency
hospital that do not exceed an annual per patient average of
twenty-four hours in such a rural emergency hospital:

Senate File 75, p. 2
a. Emergency department services and observation care.
For purposes of providing emergency department services, an
emergency department of a rural emergency hospital shall be
considered staffed if a physician, advanced registered nurse
practitioner, or physician assistant is available to furnish
rural emergency hospital services in the facility twenty-four
hours per day.
b. At the election of the rural emergency hospital, with
respect to services furnished on an outpatient basis, other
medical and health services as specified in regulations adopted
by the United States secretary of health and human services.
Sec. 2. Section 135B.2, Code 2023, is amended to read as
follows:
135B.2 Purpose.
The purpose of this chapter is to provide for the
development, establishment and enforcement of basic standards
for the care and treatment of individuals in hospitals and
rural emergency hospitals and for the construction, maintenance
and operation of such hospitals, which, in the light of
existing knowledge, will promote safe and adequate treatment
of such individuals in such hospitals, in the interest of the
health, welfare and safety of the public.
Sec. 3. Section 135B.3, Code 2023, is amended to read as
follows:
135B.3 Licensure.
No person or governmental unit, acting severally or jointly
with any other person or governmental unit shall establish,
conduct or maintain a hospital or rural emergency hospital in
this state without a license.
Sec. 4. NEW SECTION . 135B.3A Rural emergency hospital
licensure.
1. The department shall adopt rules pursuant to chapter
17A to establish minimum standards for the licensure of rural
emergency hospitals consistent with the federal Consolidated
Appropriations Act, Pub. L. No. 116-260, §125, and with
regulations issued by the United States secretary of health and
human services for rural emergency hospitals.
2. To be eligible for a rural emergency hospital license, a
facility shall have been, on or before December 27, 2020, one

Senate File 75, p. 3
of the following:
a. A licensed critical access hospital.
b. A general hospital with not more than fifty licensed
beds located in a county in a rural area as defined in section
1886(d)(2)(D) of the federal Social Security Act.
c. A general hospital with no more than fifty licensed beds
that is deemed as being located in a rural area pursuant to
section 1886(d)(8)(E) of the federal Social Security Act.
Sec. 5. Section 135B.4, Code 2023, is amended to read as
follows:
135B.4 Application for license.
Licenses shall be obtained from the department.
Applications shall be upon forms and shall contain information
as the department may reasonably require, which may include
affirmative evidence of ability to comply with reasonable
standards and rules prescribed under this chapter . Each
application for license shall be accompanied by the license
fee, which shall be refunded to the applicant if the license
is denied and which shall be deposited into the state treasury
and credited to the general fund if the license is issued.
Hospitals and rural emergency hospitals having fifty beds or
less shall pay an initial license fee of fifteen dollars;
hospitals of more than fifty beds and not more than one hundred
beds shall pay an initial license fee of twenty-five dollars;
all other hospitals shall pay an initial license fee of fifty
dollars.
Sec. 6. Section 135B.5, subsection 1, Code 2023, is amended
to read as follows:
1. Upon receipt of an application for license and the
license fee, the department shall issue a license if the
applicant and hospital facilities comply with this chapter ,
chapter 135 , and the rules of the department. Each licensee
shall receive annual reapproval upon payment of five hundred
dollars and upon filing of an application form which is
available from the department. The annual licensure fee shall
be dedicated to support and provide educational programs on
regulatory issues for hospitals and rural emergency hospitals
licensed under this chapter . Licenses shall be either general
or restricted in form. Each license shall be issued only

Senate File 75, p. 4
for the premises and persons or governmental units named in
the application and is not transferable or assignable except
with the written approval of the department. Licenses shall
be posted in a conspicuous place on the licensed premises as
prescribed by rule of the department.
Sec. 7. Section 135B.5A, Code 2023, is amended to read as
follows:
135B.5A Conversion of a hospital relative to certain
hospitals .
1. A conversion of a long-term acute care hospital,
rehabilitation hospital, or psychiatric hospital as defined by
federal regulations to a general hospital or to a specialty
hospital of a different type is a permanent change in bed
capacity and shall require a certificate of need pursuant to
section 135.63 .
2. A conversion of a critical access hospital or general
hospital to a rural emergency hospital shall not require a
certificate of need pursuant to section 135.63.
3. Any change of a rural emergency hospital in licensure,
organizational structure, or type of institutional health
facility shall require a certificate of need pursuant to
section 135.63.
Sec. 8. Section 135B.7, Code 2023, is amended to read as
follows:
135B.7 Rules and enforcement.
1. a. The department, with the approval of the state
board of health, shall adopt rules setting out the standards
for the different types of hospitals and for rural emergency
hospitals to be licensed under this chapter . The department
shall enforce the rules.
b. Rules or standards shall not be adopted or enforced
which would have the effect of denying a license to a hospital ,
rural emergency hospital, or other institution required to be
licensed, solely by reason of the school or system of practice
employed or permitted to be employed by physicians in the
hospital, rural emergency hospital, or other institution if the
school or system of practice is recognized by the laws of this
state.
2. a. The rules shall state that a hospital or rural

Senate File 75, p. 5
emergency hospital shall not deny clinical privileges to
physicians and surgeons, podiatric physicians, osteopathic
physicians and surgeons, dentists, certified health service
providers in psychology, physician assistants, or advanced
registered nurse practitioners licensed under chapter 148 ,
148C , 149 , 152 , or 153 , or section 154B.7 , solely by reason of
the license held by the practitioner or solely by reason of
the school or institution in which the practitioner received
medical schooling or postgraduate training if the medical
schooling or postgraduate training was accredited by an
organization recognized by the council on higher education
accreditation or an accrediting group recognized by the United
States department of education.
b. A hospital or rural emergency hospital may establish
procedures for interaction between a patient and a
practitioner. The rules shall not prohibit a hospital or
rural emergency hospital from limiting, restricting, or
revoking clinical privileges of a practitioner for violation
of hospital rules, regulations, or procedures established
under this paragraph, when applied in good faith and in a
nondiscriminatory manner.
c. This subsection shall not require a hospital or rural
emergency hospital to expand the hospital’s current scope of
service delivery solely to offer the services of a class of
providers not currently providing services at the hospital
or rural emergency hospital . This section shall not be
construed to require a hospital or rural emergency hospital
to establish rules which are inconsistent with the scope of
practice established for licensure of practitioners to whom
this subsection applies.
d. This section shall not be construed to authorize the
denial of clinical privileges to a practitioner or class of
practitioners solely because a hospital or rural emergency
hospital has as employees of the hospital or rural emergency
hospital identically licensed practitioners providing the same
or similar services.
3. The rules shall require that a hospital or rural
emergency hospital establish and implement written criteria
for the granting of clinical privileges. The written criteria

Senate File 75, p. 6
shall include but are not limited to consideration of all of
the following:
a. The ability of an applicant for privileges to provide
patient care services independently and appropriately in the
hospital or rural emergency hospital .
b. The license held by the applicant to practice.
c. The training, experience, and competence of the
applicant.
d. The relationship between the applicant’s request for the
granting of privileges and the hospital’s or rural emergency
hospital’s current scope of patient care services, as well as
the hospital’s or rural emergency hospital’s determination of
the necessity to grant privileges to a practitioner authorized
to provide comprehensive, appropriate, and cost-effective
services.
4. The department shall also adopt rules requiring
hospitals and rural emergency hospitals to establish and
implement protocols for responding to the needs of patients who
are victims of domestic abuse, as defined in section 236.2 .
5. The department shall also adopt rules requiring
hospitals and rural emergency hospitals to establish and
implement protocols for responding to the needs of patients who
are victims of elder abuse, as defined in section 235F.1 .
Sec. 9. Section 135B.7A, Code 2023, is amended to read as
follows:
135B.7A Procedures —— orders.
The department shall adopt rules that require hospitals
and rural emergency hospitals to establish procedures for
authentication of all verbal orders by a practitioner within
a period not to exceed thirty days following a patient’s
discharge.
Sec. 10. Section 135B.8, Code 2023, is amended to read as
follows:
135B.8 Effective date of rules.
Any hospital or rural emergency hospital which is in
operation at the time of promulgation of any applicable
rules or minimum standards under this chapter shall be given
a reasonable time, not to exceed one year from the date of
such promulgation, within which to comply with such rules and

Senate File 75, p. 7
minimum standards.
Sec. 11. Section 135B.9, Code 2023, is amended to read as
follows:
135B.9 Inspections and qualifications for hospital and rural
emergency hospital inspectors —— protection and advocacy agency
investigations.
1. The department shall make or cause to be made inspections
as it deems necessary in order to determine compliance with
applicable rules. Hospital and rural emergency hospital
inspectors shall meet the following qualifications:
a. Be free of conflicts of interest. A hospital or rural
emergency hospital inspector shall not participate in an
inspection or complaint investigation of a hospital or rural
emergency hospital in which the inspector or a member of the
inspector’s immediate family works or has worked within the
last two years. For purposes of this paragraph, “immediate
family member” means a spouse; natural or adoptive parent,
child, or sibling; or stepparent, stepchild, or stepsibling.
b. Complete a yearly conflict of interest disclosure
statement.
c. Biennially, complete a minimum of ten hours of continuing
education pertaining to hospital or rural emergency hospital
operations including but not limited to quality and process
improvement standards, trauma system standards, and regulatory
requirements.
2. In the state resource centers and state mental health
institutes operated by the department of human services, the
designated protection and advocacy agency as provided in
section 135C.2, subsection 4 , shall have the authority to
investigate all complaints of abuse and neglect of persons
with developmental disabilities or mental illnesses if the
complaints are reported to the protection and advocacy agency
or if there is probable cause to believe that the abuse has
occurred. Such authority shall include the examination of all
records pertaining to the care provided to the residents and
contact or interview with any resident, employee, or any other
person who might have knowledge about the operation of the
institution.
Sec. 12. Section 135B.12, Code 2023, is amended to read as

Senate File 75, p. 8
follows:
135B.12 Confidentiality.
The department’s final findings or the final survey findings
of the joint commission on the accreditation of health care
organizations or the American osteopathic association with
respect to compliance by a hospital or rural emergency hospital
with requirements for licensing or accreditation shall be made
available to the public in a readily available form and place.
Other information relating to a hospital or rural emergency
hospital obtained by the department which does not constitute
the department’s findings from an inspection of the hospital
or rural emergency hospital or the final survey findings of
the joint commission on the accreditation of health care
organizations or the American osteopathic association shall
not be made available to the public, except in proceedings
involving the denial, suspension, or revocation of a license
under this chapter . The name of a person who files a complaint
with the department shall remain confidential and shall not
be subject to discovery, subpoena, or other means of legal
compulsion for its release to a person other than department
employees or agents involved in the investigation of the
complaint.
Sec. 13. Section 135B.14, Code 2023, is amended to read as
follows:
135B.14 Judicial review.
Judicial review of the action of the department may be sought
in accordance with chapter 17A . Notwithstanding the terms of
chapter 17A , the Iowa administrative procedure Act, petitions
for judicial review may be filed in the district court of the
county in which the hospital or rural emergency hospital is
located or to be located, and the status quo of the petitioner
or licensee shall be preserved pending final disposition of the
matter in the courts.
Sec. 14. Section 135B.15, Code 2023, is amended to read as
follows:
135B.15 Penalties.
Any person establishing, conducting, managing, or operating
any hospital or rural emergency hospital without a license
shall be guilty of a serious misdemeanor, and each day of

Senate File 75, p. 9
continuing violation after conviction shall be considered a
separate offense.
Sec. 15. Section 135B.16, Code 2023, is amended to read as
follows:
135B.16 Injunction.
Notwithstanding the existence or pursuit of any other
remedy, the department may, in the manner provided by law,
maintain an action in the name of the state for injunction
or other process against any person or governmental unit to
restrain or prevent the establishment, conduct, management or
operation of a hospital or rural emergency hospital without a
license.
Sec. 16. Section 135B.20, subsection 3, Code 2023, is
amended to read as follows:
3. “Hospital” shall mean means all hospitals and rural
emergency hospitals licensed under this chapter .
Sec. 17. Section 135B.33, subsection 1, unnumbered
paragraph 1, Code 2023, is amended to read as follows:
Subject to availability of funds, the Iowa department of
public health shall provide technical planning assistance to
local boards of health and hospital or rural emergency hospital
governing boards to ensure access to hospital such services in
rural areas. The department shall encourage the local boards
of health and hospital or rural emergency hospital governing
boards to adopt a long-term community health services and
developmental plan including the following:
Sec. 18. Section 135B.34, subsection 7, Code 2023, is
amended to read as follows:
7. For the purposes of this section , “comprehensive
preliminary background check” :
a. “Comprehensive preliminary background check” means the
same as defined in section 135C.1 .
b. “Hospital” means a hospital or rural emergency hospital
licensed under this chapter.
Sec. 19. EMERGENCY RULEMAKING AUTHORITY. The department
shall adopt emergency rules under section 17A.4, subsection 3,
and section 17A.5, subsection 2, paragraph “b”, to implement
the provisions of this division of this Act within six months
of the effective date of this division of this Act and shall

Senate File 75, p. 10
submit such rules to the administrative rules coordinator and
the administrative code editor pursuant to section 17A.5,
subsection 1, within the same period. The rules shall be
effective immediately upon filing unless a later date is
specified in the rules. Any rules adopted in accordance with
this section shall also be published as a notice of intended
action as provided in section 17A.4.
Sec. 20. APPLICABILITY. This division of this Act also
applies to a facility, or due to change in ownership, a
successor facility, that was, on or before December 27, 2020, a
general hospital with no more than fifty licensed beds, located
in a county in a rural area as specified in section 135B.3A, as
enacted in this division of this Act, with a population between
thirty thousand and thirty-five thousand according to the 2020
federal decennial census, operating under a valid certificate
of need on and prior to September 1, 2022. Notwithstanding
any provision to the contrary, and in accordance with section
135B.5A, as amended in this division of this Act, the reopening
of a general hospital by a successor facility as specified
under this section and subsequent conversion to a rural
emergency hospital under this division of this Act, shall not
be subject to certificate of need requirements pursuant to
section 135.63.
Sec. 21. EFFECTIVE DATE. This division of this Act, being
deemed of immediate importance, takes effect upon enactment.
DIVISION II
AMBULATORY SURGICAL CENTERS
Sec. 22. NEW SECTION . 135R.1 Definitions.
As used in this chapter, unless the context otherwise
requires:
1. “Ambulatory surgical center” means a distinct facility
that operates primarily for the purpose of providing surgical
services to patients not requiring hospitalization and in which
the expected duration of services does not exceed twenty-four
hours following an admission. “Ambulatory surgical center”
includes a facility certified or seeking certification as an
ambulatory surgical center under the federal Medicare program
or under the medical assistance program established pursuant
to chapter 249A. “Ambulatory surgical center” does not include

Senate File 75, p. 11
the individual or group practice office of a private physician,
podiatrist, or dentist who there engages in the lawful practice
of surgery, not including cosmetic, reconstructive, or plastic
surgery, or the portion of a licensed hospital designated for
outpatient surgical treatment.
2. “Department” means the department of inspections and
appeals.
Sec. 23. NEW SECTION . 135R.2 Licensure.
A person, acting severally or jointly with any other person,
shall not establish, operate, or maintain an ambulatory
surgical center in this state without obtaining a license as
provided under this chapter.
Sec. 24. NEW SECTION . 135R.3 Application for license ——
fee.
1. An applicant for an ambulatory surgical center license
shall submit an application to the department. Applications
shall be upon such forms and shall include such information
as the department may reasonably require, which may include
affirmative evidence of the ability to comply with reasonable
rules and standards prescribed under this chapter but which
shall not exceed the requirements for applications required by
Medicare or an accrediting organization with deeming authority
authorized by the centers for Medicare and Medicaid of the
United States department of health and human services.
2. An applicant for an initial ambulatory surgical center
license that has been certified by Medicare or an accrediting
organization with deeming authority authorized by the centers
for Medicare and Medicaid of the United States department of
health and human services shall be granted an initial license.
3. An application for an initial license for an ambulatory
surgical center shall be accompanied by a fee of fifty dollars.
4. The fees collected under this section shall be considered
repayment receipts as defined in section 8.2 and shall be used
by the department to administer this chapter.
Sec. 25. NEW SECTION . 135R.4 Rules.
1. The department, with the advice and approval of the state
board of health, shall adopt rules specifying the standards for
ambulatory surgical centers to be licensed under this chapter.
The rules shall be consistent with and shall not exceed the

Senate File 75, p. 12
requirements of this chapter and the conditions for coverage in
the federal Medicare program for ambulatory surgical centers
under 42 C.F.R. pt. 416.
2. The department shall adopt rules as the department deems
necessary to administer the provisions of this chapter relating
to the issuance, renewal, denial, suspension, and revocation
of a license to establish, operate, and maintain an ambulatory
surgical center.
3. An ambulatory surgical center which is in operation at
the time of adoption of any applicable rules or standards under
this chapter shall be given a reasonable time, not to exceed
one year from the date of adoption, within which to comply with
such rules and standards.
4. The department shall enforce the rules.
Sec. 26. NEW SECTION . 135R.5 Inspections or investigations.
1. The department shall make or cause to be made inspections
or investigations of ambulatory surgical centers to determine
compliance with this chapter and applicable rules and
standards. The department shall perform inspections on a
schedule that is of the same frequency required for inspections
of Medicare-certified ambulatory surgical centers.
2. The department shall recognize, in lieu of its own
licensure inspection, the comparable inspection and inspection
findings of a Medicare conditions for coverage survey completed
by the department or an accrediting organization with deeming
authority authorized by the centers for Medicare and Medicaid
services of the United States department of health and human
services.
3. A department inspector shall not participate in an
inspection or investigation of an ambulatory surgical center in
which the inspector or a member of the inspector’s immediate
family works or has worked within the last two years or in
which the inspector or the inspector’s immediate family has
a financial ownership interest. For the purposes of this
section, “immediate family member” means a spouse, natural or
adoptive parent or grandparent, child, grandchild, sibling,
stepparent, stepchild, or stepsibling.
Sec. 27. NEW SECTION . 135R.6 Confidentiality.
The department’s final findings with respect to compliance

Senate File 75, p. 13
by an ambulatory surgical center with requirements for
licensing shall be made available to the public in a readily
available form and place. Other information relating to
an ambulatory surgical center obtained by the department
which does not constitute the department’s findings from an
inspection of the ambulatory surgical center shall not be made
available to the public, except in proceedings involving the
denial, suspension, or revocation of a license under this
chapter. The name of a person who files a complaint with the
department shall remain confidential and shall not be subject
to discovery, subpoena, or other means of legal compulsion for
its release to a person other than department employees or
agents involved in the investigation of the complaint.
Sec. 28. NEW SECTION . 135R.7 Injunction.
Notwithstanding the existence or pursuit of any other
remedy, the department may, in the manner provided by law,
maintain an action in the name of the state for injunction
or other process against any person to restrain or prevent
the establishment, operation, or maintenance of an ambulatory
surgical center without a license.
Sec. 29. NEW SECTION . 135R.8 Judicial review.
Judicial review of an action of the department may be sought
in accordance with chapter 17A. Notwithstanding the provisions
of chapter 17A, petitions for judicial review may be filed
in the district court of the county in which the ambulatory
surgical center is located or is to be located and the status
quo of the petitioner or licensee shall be preserved pending
final disposition of the judicial review matter.
Sec. 30. NEW SECTION . 135R.9 Penalties.
Any person establishing, operating, or maintaining any
ambulatory surgical center without a license commits a serious
misdemeanor, and each day of continuing violation after
conviction shall be considered a separate offense.
Sec. 31. Section 135.11, Code 2023, is amended by adding the
following new subsection:
NEW SUBSECTION . 29. Adopt rules requiring ambulatory
surgical centers to report quality data to the department
of health and human services that is consistent with the
data required to be reported to the centers for Medicare and

Senate File 75, p. 14
Medicaid services of the United States department of health and
human services as authorized by the Medicare Improvements and
Extension Act of 2006 under Tit. I of the Tax Relief and Health
Care Act of 2006, Pub. L. No. 109-432, and the regulations
adopted under such Acts. Notwithstanding any provision of
law to the contrary, nothing in this subsection shall require
an ambulatory surgical center to provide health data to the
department of health and human services or any other public
or private entity that is in addition to, different than,
or exceeds the quality data required to be reported to the
centers for Medicare and Medicaid services of the United States
department of health and human services.
Sec. 32. Section 135.61, Code 2023, is amended by adding the
following new subsection:
NEW SUBSECTION . 1A. “Ambulatory surgical center” means
ambulatory surgical center as defined in section 135R.1.
Sec. 33. Section 135.61, subsection 14, paragraph d, Code
2023, is amended to read as follows:
d. An outpatient ambulatory surgical facility center .
Sec. 34. Section 135.61, subsection 21, Code 2023, is
amended by striking the subsection.
______________________________ ______________________________
AMY SINCLAIR PAT GRASSLEY
President of the Senate Speaker of the House
I hereby certify that this bill originated in the Senate and
is known as Senate File 75, Ninetieth General Assembly.
______________________________
W. CHARLES SMITHSON
Secretary of the Senate
Approved _______________, 2023 ______________________________
KIM REYNOLDS
Governor