Iowa 2023 2023-2024 Regular Session

Iowa Senate Bill SF75 Introduced / Bill

Filed 01/12/2023

                    Senate File 75 - Introduced   SENATE FILE 75   BY REICHMAN   A BILL FOR   An Act relating to rural emergency hospitals, including 1   licensing requirements and fees, making penalties 2   applicable, providing emergency rulemaking authority, and 3   including applicability and effective date provisions. 4   BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 5   TLSB 1084XS (6) 90   pf/rh  

  S.F. 75   Section 1. Section 135B.1, Code 2023, is amended by adding 1   the following new subsections: 2   NEW SUBSECTION   . 5. Rural emergency hospital means a 3   facility that provides rural emergency hospital services in 4   the facility twenty-four hours per day, seven days per week; 5   does not provide any acute care inpatient services with the 6   exception of any distinct part of the facility licensed as a 7   skilled nursing facility providing posthospital extended care 8   services; and meets the criteria specified in section 135B.1A 9   and the federal Consolidated Appropriations Act, Pub. L. No. 10   116-260, 125. 11   NEW SUBSECTION   . 6. Rural emergency hospital services 12   means the following services provided by a rural emergency 13   hospital that do not exceed an annual per patient average of 14   twenty-four hours in such a rural emergency hospital: 15   a. Emergency department services and observation care. 16   For purposes of providing emergency department services, an 17   emergency department of a rural emergency hospital shall 18   be considered staffed if a physician, nurse practitioner, 19   clinical nurse specialist, or physician assistant is available 20   to furnish rural emergency hospital services in the facility 21   twenty-four hours per day. 22   b. At the election of the rural emergency hospital, with 23   respect to services furnished on an outpatient basis, other 24   medical and health services as specified in regulations adopted 25   by the United States secretary of health and human services. 26   Sec. 2. Section 135B.2, Code 2023, is amended to read as   27   follows: 28   135B.2 Purpose. 29   The purpose of this chapter is to provide for the 30   development, establishment and enforcement of basic standards 31   for the care and treatment of individuals in hospitals and 32   rural emergency hospitals and   for the construction, maintenance 33   and operation of such hospitals, which, in the light of 34   existing knowledge, will promote safe and adequate treatment 35   -1-   LSB 1084XS (6) 90   pf/rh   1/ 11     

  S.F. 75   of such individuals in such hospitals, in the interest of the 1   health, welfare and safety of the public. 2   Sec. 3. Section 135B.3, Code 2023, is amended to read as 3   follows: 4   135B.3 Licensure. 5   No person or governmental unit, acting severally or jointly 6   with any other person or governmental unit shall establish, 7   conduct or maintain a hospital or rural emergency hospital   in 8   this state without a license. 9   Sec. 4. NEW SECTION   . 135B.3A Rural emergency hospital 10   licensure. 11   1. The department shall adopt rules pursuant to chapter 12   17A to establish minimum standards for the licensure of rural 13   emergency hospitals consistent with the federal Consolidated 14   Appropriations Act, Pub. L. No. 116-260, 125, and with 15   regulations issued by the United States secretary of health and 16   human services for rural emergency hospitals. 17   2. To be eligible for a rural emergency hospital license, a 18   facility shall have been, on or before December 27, 2020, one 19   of the following: 20   a. A licensed critical access hospital. 21   b. A general hospital with not more than fifty licensed 22   beds located in a county in a rural area as defined in section 23   1886(d)(2)(D) of the federal Social Security Act. 24   c. A general hospital with no more than fifty licensed beds 25   that is deemed as being located in a rural area pursuant to 26   section 1886(d)(8)(E) of the federal Social Security Act. 27   Sec. 5. Section 135B.4, Code 2023, is amended to read as   28   follows:   29   135B.4 Application for license. 30   Licenses shall be obtained from the department. 31   Applications shall be upon forms and shall contain information 32   as the department may reasonably require, which may include 33   affirmative evidence of ability to comply with reasonable 34   standards and rules prescribed under this chapter . Each 35   -2-   LSB 1084XS (6) 90   pf/rh   2/ 11     

  S.F. 75   application for license shall be accompanied by the license 1   fee, which shall be refunded to the applicant if the license 2   is denied and which shall be deposited into the state treasury 3   and credited to the general fund if the license is issued. 4   Hospitals and rural emergency hospitals having fifty beds or 5   less shall pay an initial license fee of fifteen dollars; 6   hospitals of more than fifty beds and not more than one hundred 7   beds shall pay an initial license fee of twenty-five dollars; 8   all other hospitals shall pay an initial license fee of fifty 9   dollars. 10   Sec. 6. Section 135B.5, subsection 1, Code 2023, is amended 11   to read as follows: 12   1. Upon receipt of an application for license and the 13   license fee, the department shall issue a license if the 14   applicant and hospital facilities comply with this chapter , 15   chapter 135 , and the rules of the department. Each licensee 16   shall receive annual reapproval upon payment of five hundred 17   dollars and upon filing of an application form which is 18   available from the department. The annual licensure fee shall 19   be dedicated to support and provide educational programs on 20   regulatory issues for hospitals and rural emergency hospitals   21   licensed under this chapter . Licenses shall be either general 22   or restricted in form. Each license shall be issued only 23   for the premises and persons or governmental units named in 24   the application and is not transferable or assignable except 25   with the written approval of the department. Licenses shall 26   be posted in a conspicuous place on the licensed premises as 27   prescribed by rule of the department. 28   Sec. 7. Section 135B.5A, Code 2023, is amended to read as 29   follows:   30   135B.5A Conversion of a hospital   relative to certain 31   hospitals   . 32   1. A conversion of a long-term acute care hospital, 33   rehabilitation hospital, or psychiatric hospital as defined by 34   federal regulations to a general hospital or to a specialty 35   -3-   LSB 1084XS (6) 90   pf/rh   3/ 11        

  S.F. 75   hospital of a different type is a permanent change in bed 1   capacity and shall require a certificate of need pursuant to 2   section 135.63 . 3   2.   A conversion of a critical access hospital or general 4   hospital to a rural emergency hospital or a conversion of a   5   rural emergency hospital to a critical access hospital or   6   general hospital shall not require a certificate of need 7   pursuant to section 135.63. 8   Sec. 8. Section 135B.7, Code 2023, is amended to read as 9   follows: 10   135B.7 Rules and enforcement. 11   1. a. The department, with the approval of the state 12   board of health, shall adopt rules setting out the standards 13   for the different types of hospitals and for rural emergency   14   hospitals to be licensed under this chapter . The department 15   shall enforce the rules. 16   b. Rules or standards shall not be adopted or enforced 17   which would have the effect of denying a license to a hospital ,   18   rural emergency hospital,   or other institution required to be 19   licensed, solely by reason of the school or system of practice 20   employed or permitted to be employed by physicians in the 21   hospital, rural emergency hospital, or other institution   if the 22   school or system of practice is recognized by the laws of this 23   state. 24   2. a. The rules shall state that a hospital or rural   25   emergency hospital shall not deny clinical privileges to 26   physicians and surgeons, podiatric physicians, osteopathic 27   physicians and surgeons, dentists, certified health service 28   providers in psychology, physician assistants, or advanced 29   registered nurse practitioners licensed under chapter 148 , 30   148C , 149 , 152 , or 153 , or section 154B.7 , solely by reason of 31   the license held by the practitioner or solely by reason of 32   the school or institution in which the practitioner received 33   medical schooling or postgraduate training if the medical 34   schooling or postgraduate training was accredited by an 35   -4-   LSB 1084XS (6) 90   pf/rh   4/ 11                

  S.F. 75   organization recognized by the council on higher education 1   accreditation or an accrediting group recognized by the United 2   States department of education. 3   b. A hospital or rural emergency hospital   may establish 4   procedures for interaction between a patient and a 5   practitioner. The rules shall not prohibit a hospital or 6   rural emergency hospital from limiting, restricting, or 7   revoking clinical privileges of a practitioner for violation 8   of hospital rules, regulations, or procedures established 9   under this paragraph, when applied in good faith and in a 10   nondiscriminatory manner. 11   c. This subsection shall not require a hospital or rural   12   emergency hospital to expand the hospitals current scope of 13   service delivery solely to offer the services of a class of 14   providers not currently providing services at the hospital 15   or rural emergency hospital   . This section shall not be 16   construed to require a hospital or rural emergency hospital 17   to establish rules which are inconsistent with the scope of 18   practice established for licensure of practitioners to whom 19   this subsection applies. 20   d. This section shall not be construed to authorize the 21   denial of clinical privileges to a practitioner or class of 22   practitioners solely because a hospital or rural emergency   23   hospital has as employees of the hospital or rural emergency 24   hospital identically licensed practitioners providing the same 25   or similar services. 26   3. The rules shall require that a hospital or rural 27   emergency hospital establish and implement written criteria 28   for the granting of clinical privileges. The written criteria 29   shall include but are not limited to consideration of all of   30   the following: 31   a. The ability of an applicant for privileges to provide 32   patient care services independently and appropriately in the 33   hospital or rural emergency hospital   . 34   b. The license held by the applicant to practice. 35   -5-   LSB 1084XS (6) 90   pf/rh   5/ 11                 

  S.F. 75   c. The training, experience, and competence of the 1   applicant. 2   d. The relationship between the applicants request for the 3   granting of privileges and the hospitals or rural emergency   4   hospitals   current scope of patient care services, as well as 5   the hospitals or rural emergency hospitals   determination of 6   the necessity to grant privileges to a practitioner authorized 7   to provide comprehensive, appropriate, and cost-effective 8   services. 9   4. The department shall also adopt rules requiring 10   hospitals and rural emergency hospitals   to establish and 11   implement protocols for responding to the needs of patients who 12   are victims of domestic abuse, as defined in section 236.2 . 13   5. The department shall also adopt rules requiring 14   hospitals and rural emergency hospitals   to establish and 15   implement protocols for responding to the needs of patients who 16   are victims of elder abuse, as defined in section 235F.1 . 17   Sec. 9. Section 135B.7A, Code 2023, is amended to read as 18   follows: 19   135B.7A Procedures  orders. 20   The department shall adopt rules that require hospitals 21   and rural emergency hospitals   to establish procedures for 22   authentication of all verbal orders by a practitioner within 23   a period not to exceed thirty days following a patients 24   discharge. 25   Sec. 10. Section 135B.8, Code 2023, is amended to read as 26   follows: 27   135B.8 Effective date of rules. 28   Any hospital or rural emergency hospital   which is in 29   operation at the time of promulgation of any applicable 30   rules or minimum standards under this chapter shall be given 31   a reasonable time, not to exceed one year from the date of 32   such promulgation, within which to comply with such rules and 33   minimum standards. 34   Sec. 11. Section 135B.9, Code 2023, is amended to read as   35   -6-   LSB 1084XS (6) 90   pf/rh   6/ 11         

  S.F. 75   follows: 1   135B.9 Inspections and qualifications for hospital and rural   2   emergency hospital inspectors  protection and advocacy agency 3   investigations. 4   1. The department shall make or cause to be made inspections 5   as it deems necessary in order to determine compliance with 6   applicable rules. Hospital and rural emergency hospital 7   inspectors shall meet the following qualifications: 8   a. Be free of conflicts of interest. A hospital or rural   9   emergency hospital inspector shall not participate in an 10   inspection or complaint investigation of a hospital or rural   11   emergency hospital in which the inspector or a member of the 12   inspectors immediate family works or has worked within the 13   last two years. For purposes of this paragraph, immediate 14   family member means a spouse; natural or adoptive parent, 15   child, or sibling; or stepparent, stepchild, or stepsibling. 16   b. Complete a yearly conflict of interest disclosure 17   statement. 18   c. Biennially, complete a minimum of ten hours of continuing 19   education pertaining to hospital or rural emergency hospital   20   operations including but not limited to quality and process 21   improvement standards, trauma system standards, and regulatory 22   requirements. 23   2. In the state resource centers and state mental health 24   institutes operated by the department of human services, the 25   designated protection and advocacy agency as provided in 26   section 135C.2, subsection 4 , shall have the authority to 27   investigate all complaints of abuse and neglect of persons 28   with developmental disabilities or mental illnesses if the 29   complaints are reported to the protection and advocacy agency 30   or if there is probable cause to believe that the abuse has 31   occurred. Such authority shall include the examination of all 32   records pertaining to the care provided to the residents and 33   contact or interview with any resident, employee, or any other 34   person who might have knowledge about the operation of the 35   -7-   LSB 1084XS (6) 90   pf/rh   7/ 11          

  S.F. 75   institution. 1   Sec. 12. Section 135B.12, Code 2023, is amended to read as 2   follows: 3   135B.12 Confidentiality. 4   The departments final findings or the final survey findings 5   of the joint commission on the accreditation of health care 6   organizations or the American osteopathic association with 7   respect to compliance by a hospital or rural emergency hospital   8   with requirements for licensing or accreditation shall be made 9   available to the public in a readily available form and place. 10   Other information relating to a hospital or rural emergency   11   hospital obtained by the department which does not constitute 12   the departments findings from an inspection of the hospital 13   or rural emergency hospital   or the final survey findings of 14   the joint commission on the accreditation of health care 15   organizations or the American osteopathic association shall 16   not be made available to the public, except in proceedings 17   involving the denial, suspension, or revocation of a license 18   under this chapter . The name of a person who files a complaint 19   with the department shall remain confidential and shall not 20   be subject to discovery, subpoena, or other means of legal 21   compulsion for its release to a person other than department 22   employees or agents involved in the investigation of the 23   complaint. 24   Sec. 13. Section 135B.14, Code 2023, is amended to read as 25   follows: 26   135B.14 Judicial review.   27   Judicial review of the action of the department may be sought 28   in accordance with chapter 17A . Notwithstanding the terms of 29   chapter 17A , the Iowa administrative procedure Act, petitions 30   for judicial review may be filed in the district court of the 31   county in which the hospital or rural emergency hospital   is 32   located or to be located, and the status quo of the petitioner 33   or licensee shall be preserved pending final disposition of the 34   matter in the courts.   35   -8-   LSB 1084XS (6) 90   pf/rh   8/ 11       

  S.F. 75   Sec. 14. Section 135B.15, Code 2023, is amended to read as 1   follows: 2   135B.15 Penalties. 3   Any person establishing, conducting, managing, or operating 4   any hospital or rural emergency hospital without a license 5   shall be guilty of a serious misdemeanor, and each day of 6   continuing violation after conviction shall be considered a 7   separate offense. 8   Sec. 15. Section 135B.16, Code 2023, is amended to read as 9   follows: 10   135B.16 Injunction. 11   Notwithstanding the existence or pursuit of any other 12   remedy, the department may, in the manner provided by law, 13   maintain an action in the name of the state for injunction 14   or other process against any person or governmental unit to 15   restrain or prevent the establishment, conduct, management or 16   operation of a hospital or rural emergency hospital   without a 17   license. 18   Sec. 16. Section 135B.20, subsection 3, Code 2023, is 19   amended to read as follows: 20   3. Hospital shall mean   means all hospitals and rural 21   emergency hospitals licensed under this chapter . 22   Sec. 17. Section 135B.33, subsection 1, unnumbered 23   paragraph 1, Code 2023, is amended to read as follows: 24   Subject to availability of funds, the Iowa department of 25   public health shall provide technical planning assistance to 26   local boards of health and hospital or rural emergency hospital   27   governing boards to ensure access to hospital such services in 28   rural areas. The department shall encourage the local boards 29   of health and hospital or rural emergency hospital   governing 30   boards to adopt a long-term community health services and 31   developmental plan including the following: 32   Sec. 18. Section 135B.34, subsection 7, Code 2023, is 33   amended to read as follows: 34   7. For the purposes of this section ,   comprehensive 35   -9-   LSB 1084XS (6) 90   pf/rh   9/ 11              

  S.F. 75   preliminary background check : 1   a.   Comprehensive preliminary background check means the 2   same as defined in section 135C.1 . 3   b. Hospital means a hospital or rural emergency hospital 4   licensed under this chapter.   5   Sec. 19. EMERGENCY RULEMAKING AUTHORITY. The department 6   may adopt emergency rules under section 17A.4, subsection 3, 7   and section 17A.5, subsection 2, paragraph b, to implement 8   the provisions of this Act and the rules shall be effective 9   immediately upon filing unless a later date is specified in the 10   rules. Any rules adopted in accordance with this section shall 11   also be published as a notice of intended action as provided 12   in section 17A.4. 13   Sec. 20. APPLICABILITY. This Act applies to a facility 14   that was, on or before December 27, 2020, a general hospital 15   with no more than fifty licensed beds, located in a county in a 16   rural area as specified in section 135B.3A, as enacted in this 17   Act, with a population between thirty thousand and thirty-five 18   thousand according to the 2020 federal decennial census, 19   operating under a valid certificate of need on and prior to 20   September 1, 2022. Notwithstanding any provision to the 21   contrary, and in accordance with section 135B.5A, as amended 22   in this Act, the conversion of a general hospital as specified 23   under this section to a rural emergency hospital under this 24   Act shall not be subject to certificate of need requirements 25   pursuant to section 135.63. 26   Sec. 21. EFFECTIVE DATE. This Act, being deemed of 27   immediate importance, takes effect upon enactment. 28   EXPLANATION 29   The inclusion of this explanation does not constitute agreement with 30   the explanations substance by the members of the general assembly. 31   This bill provides for state licensure of rural emergency 32   hospitals. Under the federal Consolidated Appropriations Act 33   of 2021 (federal Act), rural emergency hospitals (REHs) were 34   established as a new provider type. Effective January 1, 2023, 35   -10-   LSB 1084XS (6) 90   pf/rh   10/ 11            

  S.F. 75   REHs will be eligible to enroll in Medicare and to receive an 1   enhanced reimbursement rate for eligible services consisting 2   of the outpatient prospective payment system rate plus a 5 3   percent add-on and a fixed monthly payment. In order to be 4   classified as an REH under the federal Act, a facility must 5   meet certain requirements, including applicable state licensing 6   requirements. The bill provides a process for such licensure. 7   The bill provides emergency rulemaking authority to 8   implement the bill. 9   The bill includes applicability provisions. The bill 10   applies to a facility that was, on or before December 27, 2020, 11   a general hospital with no more than 50 licensed beds, located 12   in a county in a rural area as specified in the bill with a 13   population between 30,000 and 35,000 according to the 2020 14   federal decennial census, operating under a valid certificate 15   of need on and prior to September 1, 2022. Notwithstanding 16   any provision to the contrary, the conversion of the specified 17   general hospital to a rural emergency hospital shall not be 18   subject to certificate of need requirements. 19   The bill takes effect upon enactment. 20   -11-   LSB 1084XS (6) 90   pf/rh   11/ 11