| 1 | 1 | | House File 754 - Introduced HOUSE FILE 754 BY COMMITTEE ON HEALTH AND HUMAN SERVICES (SUCCESSOR TO HSB 191) A BILL FOR An Act relating to health care including a funding model for 1 the rural health care system; the elimination of several 2 health care-related award, grant, residency, and fellowship 3 programs; establishment of a health care professional 4 incentive program; Medicaid graduate medical education; the 5 health facilities council; and the Iowa health information 6 network, making appropriations, and including effective date 7 provisions. 8 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 9 TLSB 1555HV (3) 91 lh/ko |
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| 3 | 3 | | H.F. 754 DIVISION I 1 HEALTH CARE HUB-AND-SPOKE PARTNERSHIP FUNDING MODEL 2 Section 1. HEALTH CARE HUB-AND-SPOKE PARTNERSHIP FUNDING 3 MODEL APPROVAL. The department of health and human services 4 shall submit to the centers for Medicare and Medicaid services 5 of the United States department of health and human services 6 a request for approval for a health care hub-and-spoke 7 partnership funding model for the purpose of improving Iowas 8 rural health system to establish sufficient financial support 9 for collaboration among regional health care providers in rural 10 areas to transform health care delivery to provide quality and 11 sustainable care. 12 Sec. 2. EFFECTIVE DATE. This division of this Act, being 13 deemed of immediate importance, takes effect upon enactment. 14 DIVISION II 15 ELIMINATION OF PRIMECARRE PROGRAMS DEPARTMENT OF HEALTH AND 16 HUMAN SERVICES 17 Sec. 3. Section 135.107, subsection 1, Code 2025, is amended 18 by adding the following new paragraph: 19 NEW PARAGRAPH . f. Coordinate with the college student aid 20 commission to administer the health professional incentive 21 program created in section 256.222. 22 Sec. 4. Section 135.107, subsections 2 and 3, Code 2025, are 23 amended by striking the subsections. 24 Sec. 5. Section 135B.33, subsection 3, Code 2025, is amended 25 to read as follows: 26 3. The health facilities may seek technical assistance 27 or apply for matching grant funds for the plan development. 28 The department shall require compliance with subsection 1 , 29 paragraphs a through h , when the facility applies for 30 matching grant funds. 31 Sec. 6. TRANSITION PROVISIONS ACCOUNT. 32 1. The department of health and human services shall make 33 loan repayments pursuant to a loan repayment program contract, 34 including a United States department of health and human 35 -1- LSB 1555HV (3) 91 lh/ko 1/ 40 |
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| 5 | 5 | | H.F. 754 services state loan repayment program contract, executed on 1 or before December 31, 2025, under the primary care provider 2 loan repayment program in section 135.107, Code 2025, if the 3 recipient remains in compliance with all obligations under the 4 loan repayment program contract. 5 2. a. The department of health and human services shall 6 create an account for deposit of any moneys encumbered or 7 obligated pursuant to a loan repayment program contract as 8 specified in subsection 1. The department shall ensure that 9 the encumbered and obligated moneys remain available for the 10 duration of the loan repayment program contract. Moneys in the 11 account are appropriated to the department for the purposes of 12 this section. 13 b. Notwithstanding section 8.33, any balance in the account 14 shall not revert but shall remain available for the duration of 15 such loan repayment program contracts. Notwithstanding section 16 12C.7, subsection 2, interest or earnings on moneys deposited 17 in the account shall be credited to the account. 18 c. Upon expiration of all loan repayment program contract 19 periods and the expenditure of all moneys encumbered and 20 obligated under such loan repayment contracts, any unencumbered 21 or unobligated moneys remaining in the account created under 22 this section shall be deposited in the health care professional 23 incentive program fund created in section 256.222, as enacted 24 by this Act. 25 DIVISION III 26 ELIMINATION OF HEALTH CARE-RELATED LOAN REPAYMENT AND FINANCIAL 27 AWARD PROGRAMS COLLEGE STUDENT AID COMMISSION 28 Sec. 7. REPEAL. Sections 256.221, 256.223, 256.224, and 29 256.225, Code 2025, are repealed. 30 Sec. 8. TRANSITION PROVISIONS. 31 1. The college student aid commission shall make loan 32 repayments pursuant to a program agreement entered into on or 33 before June 30, 2025, by an eligible student and the commission 34 under the rural Iowa primary care loan repayment program 35 -2- LSB 1555HV (3) 91 lh/ko 2/ 40 |
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| 7 | 7 | | H.F. 754 in section 256.221, Code 2025, if the student remains in 1 compliance with all obligations under the program agreement. 2 2. The college student aid commission shall make loan 3 repayments pursuant to a contract entered into on or before 4 June 30, 2025, by a health care professional and the commission 5 under the health care professional recruitment program in 6 section 256.223, Code 2025, if the health care professional 7 remains in compliance with all obligations under the contract. 8 3. The college student aid commission shall provide the 9 annual award to a recipient selected on or before June 30, 10 2025, for an award under the health care award program in 11 section 256.224, Code 2025. 12 4. The college student aid commission shall make loan 13 repayments pursuant to a program agreement entered into on or 14 before June 30, 2025, by a mental health professional and the 15 commission under the mental health professional loan repayment 16 program in section 256.225, Code 2025, if the mental health 17 professional remains in compliance with all obligations under 18 the program agreement. 19 Sec. 9. TRANSFER OF MONEYS. On the effective date of this 20 division of this Act, any unencumbered and unobligated moneys 21 remaining in the following funds shall be transferred to the 22 health care professional incentive program fund created in 23 section 256.222, as enacted in this Act: 24 1. The rural Iowa primary care trust fund created in section 25 256.221, subsection 12, Code 2025. 26 2. The health care professional recruitment fund created in 27 section 256.223, subsection 4, Code 2025. 28 3. The health care award fund created in section 256.224, 29 subsection 6, Code 2025. 30 4. The mental health professional loan repayment fund 31 created in section 256.225, subsection 7, Code 2025. 32 Sec. 10. TRANSITION ACCOUNTS. 33 1. The college student aid commission shall create 34 individual accounts for the deposit of any moneys encumbered or 35 -3- LSB 1555HV (3) 91 lh/ko 3/ 40 |
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| 9 | 9 | | H.F. 754 obligated relating to a loan repayment or award funded under 1 each of the following programs: 2 a. The rural Iowa primary care loan repayment program under 3 section 256.221, Code 2025. 4 b. The health care professional recruitment program under 5 section 256.223, Code 2025. 6 c. The health care award program under section 256.224, Code 7 2025. 8 d. The mental health professional loan repayment program 9 under section 256.225, Code 2025. 10 2. Notwithstanding section 8.33, any balance in any of 11 the accounts created under subsection 1 shall not revert but 12 shall remain available for the duration of all applicable 13 loan repayments and awards. Notwithstanding section 12C.7, 14 subsection 2, interest or earnings on moneys deposited in each 15 account shall be credited to the respective account. 16 3. Upon expiration of all program agreement, contract, 17 and award disbursement periods and the expenditure of all 18 moneys encumbered and obligated under such program agreements, 19 contracts, and awards, any unencumbered or unobligated moneys 20 remaining in the accounts created under this section shall be 21 deposited in the health care professional incentive program 22 fund created in section 256.222, as enacted by this Act. 23 DIVISION IV 24 HEALTH CARE PROFESSIONAL INCENTIVE PROGRAM ESTABLISHED 25 Sec. 11. NEW SECTION . 256.222 Health care professional 26 incentive program fund. 27 1. Definitions. For purposes of this section, unless the 28 context otherwise requires: 29 a. Award means either of the following: 30 (1) A loan repayment made on behalf of an eligible health 31 care professional on the total amount owed, including principal 32 and interest, by the eligible health care professional on any 33 of the following: 34 (a) A federally guaranteed Stafford loan under the federal 35 -4- LSB 1555HV (3) 91 lh/ko 4/ 40 |
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| 11 | 11 | | H.F. 754 family education loan program or the federal direct loan 1 program. 2 (b) A federal grad plus loan. 3 (c) A consolidated federally guaranteed Stafford loan under 4 the federal family education loan program or the federal direct 5 loan program. 6 (d) A consolidated federal grad plus loan. 7 (2) An income bonus paid to an eligible health care 8 professional. 9 b. Commission means the college student aid commission. 10 c. Department means the department of health and human 11 services. 12 d. Eligible health care profession means health care 13 occupational categories that are in high demand, as determined 14 and maintained on a list by the department, and may include but 15 are not limited to physicians, physician assistants, registered 16 nurses, nurse practitioners, nurse educators, and mental health 17 professionals. 18 e. Eligible health care professional means an individual 19 currently employed, or who will be employed, in an eligible 20 health care profession that is located in an eligible practice 21 area. 22 f. Eligible practice area means a geographic region 23 or county in this state that has a shortage of health care 24 professionals as determined by the department. 25 g. Employment obligation means the number of consecutive 26 years an eligible health care professional must practice. 27 (1) If practicing full-time, which means two thousand 28 eighty hours of work in a calendar year, including all paid 29 holidays, vacations, sick time, and other paid leave, an 30 eligible health care professional must practice for five years. 31 (2) If practicing part-time, which means one thousand five 32 hundred sixty hours of work in a calendar year, including all 33 paid holidays, vacations, sick time, and other paid leave, 34 an eligible health care professional must practice for seven 35 -5- LSB 1555HV (3) 91 lh/ko 5/ 40 |
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| 13 | 13 | | H.F. 754 years. 1 h. Program means the health care professional incentive 2 program established in this section. 3 2. Program established. The health care professional 4 incentive program is established and shall be administered 5 by the commission, in coordination with the department, for 6 the purpose of offering awards to recruit and retain eligible 7 health care professionals for employment in eligible practice 8 areas. For the fiscal year beginning July 1, 2025, and 9 each fiscal year thereafter, the commission, in coordination 10 with the department, shall determine the number of awards 11 available for each eligible health care profession prior to the 12 commencement of the fiscal year. 13 3. Legislative intent. It is the intent of the general 14 assembly that the program shall not interfere with local 15 community investments to recruit and retain health care 16 professionals. 17 4. Exceptions. An eligible health care professional shall 18 be ineligible for the program if the eligible health care 19 professional is currently participating in, or has participated 20 in, any of the following: 21 a. The primary care provider loan repayment program pursuant 22 to section 135.107, Code 2025. 23 b. The rural Iowa primary care loan repayment program 24 pursuant to section 256.221, Code 2025. 25 c. The health care professional recruitment program pursuant 26 to section 256.223, Code 2025. 27 d. The health care award program pursuant to section 28 256.224, Code 2025. 29 e. The mental health professional loan repayment program 30 pursuant to section 256.225, Code 2025. 31 5. Program requirements. 32 a. An eligible health care professional may submit an 33 application for the program to the commission in the form and 34 manner prescribed by the commission. The applicant shall 35 -6- LSB 1555HV (3) 91 lh/ko 6/ 40 |
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| 15 | 15 | | H.F. 754 elect to receive an award as either a loan repayment or an 1 income bonus if selected for the program, and shall submit any 2 additional information requested by the commission. 3 b. If selected for an award, the eligible health care 4 professional and the commission shall execute a program 5 agreement that specifies all of the following: 6 (1) The date the eligible health care professionals 7 employment obligation begins, which shall be no later than six 8 months from the date the program agreement is executed. 9 (2) The date the health care professionals employment 10 obligation terminates. 11 (3) Whether the award is a loan repayment or an income 12 bonus, and the terms and conditions related to the award, 13 including the aggregate award amount that the eligible health 14 care professional will receive. 15 (4) Requirements regarding the eligible health care 16 professionals license to practice in this state while 17 participating in the program. 18 (5) All other terms and conditions agreed to by the eligible 19 health care professional and the commission. 20 6. Awards. 21 a. Upon verifying the eligible health care professional is 22 in compliance with all terms of the program agreement executed 23 pursuant to subsection 5, paragraph b , the commission shall 24 pay the eligible health care professionals award annually as 25 follows: 26 (1) For a full-time employment obligation, the award shall 27 be paid as follows: 28 (a) An amount equal to twenty percent of the aggregate award 29 shall be paid to the eligible health care professional after 30 the completion of the first year of the eligible health care 31 professionals employment obligation. 32 (b) An amount equal to fifteen percent of the aggregate 33 award shall be paid to the eligible health care professional 34 after the completion of the second year, the third year, and 35 -7- LSB 1555HV (3) 91 lh/ko 7/ 40 |
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| 17 | 17 | | H.F. 754 the fourth year of the eligible health care professionals 1 employment obligation. 2 (c) An amount equal to thirty-five percent of the aggregate 3 award shall be paid to the eligible health care professional 4 after the completion of the fifth year of the eligible health 5 care professionals employment obligation. 6 (2) For a part-time employment obligation, the aggregate 7 award shall be prorated by the commission. 8 b. A minimum of every five years, the commission, in 9 consultation with the department, shall establish a list of the 10 eligible health care professions and the aggregate award amount 11 for each eligible health care profession. The aggregate award 12 amount shall not exceed two hundred thousand dollars. 13 c. An individual who executed a program agreement under 14 subsection 5, paragraph b , prior to the exclusion of an 15 eligible health care professional from the list established 16 under paragraph b shall remain eligible for the program per 17 the terms of the individuals program agreement. 18 7. Health care professional incentive program fund. A 19 health care professional incentive program fund is created in 20 the state treasury under the control of the commission. All 21 moneys deposited or paid into the fund are appropriated to the 22 commission to be used for awards as provided in this section. 23 Notwithstanding section 8.33, moneys in the fund that remain 24 unencumbered or unobligated at the close of each fiscal year 25 shall not revert but shall remain available for expenditure. 26 Notwithstanding section 12C.7, subsection 2, interest or 27 earnings on moneys in the fund shall be credited to the fund 28 and may be utilized by the commission for administrative costs. 29 8. Rules. The commission, in coordination with the 30 department, shall adopt rules pursuant to chapter 17A to 31 administer this section. 32 Sec. 12. EFFECTIVE DATE. This division of this Act, being 33 deemed of immediate importance, takes effect upon enactment. 34 DIVISION V 35 -8- LSB 1555HV (3) 91 lh/ko 8/ 40 |
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| 19 | 19 | | H.F. 754 ELIMINATION OF HEALTH CARE-RELATED GRANT, RESIDENCY, AND 1 FELLOWSHIP PROGRAMS DEPARTMENT OF HEALTH AND HUMAN SERVICES 2 Sec. 13. Section 135.179, subsection 2, Code 2025, is 3 amended to read as follows: 4 2. Funding for the program may be provided through the 5 health care workforce shortage fund or the fulfilling Iowas 6 need for dentists matching grant program account created in 7 section 135.175 . The purpose of the program is to establish, 8 expand, or support the placement of dentists in dental or rural 9 shortage areas across the state by providing education loan 10 repayments. 11 Sec. 14. Section 249M.4, subsection 2, Code 2025, is amended 12 to read as follows: 13 2. Moneys in the trust fund shall be used, subject to 14 their appropriation by the general assembly, by the department 15 to reimburse participating hospitals the medical assistance 16 program upper payment limit for inpatient and outpatient 17 hospital services as calculated in this section . Following 18 payment of such upper payment limit to participating hospitals, 19 any remaining funds in the trust fund on an annual basis may be 20 used for any of the following purposes: 21 a. To support medical assistance program utilization 22 shortfalls. 23 b. To maintain the states capacity to provide access to and 24 delivery of services for vulnerable Iowans. 25 c. To fund the health care workforce support initiative 26 created pursuant to section 135.175 . 27 d. c. To support access to health care services for 28 uninsured Iowans. 29 e. d. To support Iowa hospital programs and services which 30 expand access to health care services for Iowans. 31 Sec. 15. REPEAL. Sections 135.175, 135.176, 135.178, and 32 135.193, Code 2025, are repealed. 33 Sec. 16. TRANSITION PROVISIONS. 34 1. a. The department of health and human services shall 35 -9- LSB 1555HV (3) 91 lh/ko 9/ 40 |
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| 21 | 21 | | H.F. 754 provide matching state funding to a sponsor awarded on or 1 before June 30, 2025, under the medical residency training 2 state matching grants program in section 135.176, Code 2025, 3 until all residents in the funded residencies have completed or 4 left the program. 5 b. The department of health and human services shall provide 6 matching state funding to a sponsor for medical residency 7 training program liability costs awarded on or before June 8 30, 2025, under the medical residency training state matching 9 grants program in section 135.176, Code 2025, until June 30, 10 2026. 11 2. The department of health and human services shall provide 12 matching state funding to a sponsor awarded on or before June 13 30, 2025, under the nurse residency state matching grants 14 program in section 135.178, Code 2025, until all residents have 15 completed or left the nurse residency programs. 16 3. The department of health and human services shall fund 17 a fellowship position pursuant to a program agreement entered 18 into on or before June 30, 2025, by a participating teaching 19 hospital and a participating fellow under the state-funded 20 family medicine obstetrics fellowship program in section 21 135.193, Code 2025, if the participating fellow remains in 22 compliance with all obligations under the program agreement. 23 4. The department of health and human services shall fund 24 a rural psychiatric residency for a resident selected on or 25 before June 30, 2025, until all residents have completed 26 or left the rural psychiatric residencies, pursuant to 27 appropriations as provided in the following: 28 a. 2024 Iowa Acts, chapter 1157, section 5, subsection 3, 29 and 2024 Iowa Acts, chapter 1157, section 22, subsection 5. 30 b. 2023 Iowa Acts, chapter 112, section 5, subsection 4, 31 paragraph j, as amended by 2024 Iowa Acts, chapter 1157, 32 section 29. 33 c. 2022 Iowa Acts, chapter 1131, section 3, subsection 4, 34 paragraph j, as amended by 2024 Iowa Acts, chapter 1157, 35 -10- LSB 1555HV (3) 91 lh/ko 10/ 40 |
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| 23 | 23 | | H.F. 754 section 23. 1 d. 2021 Iowa Acts, chapter 182, section 3, subsection 4, 2 paragraph j. 3 e. 2019 Iowa Acts, chapter 85, section 3, subsection 4, 4 paragraph j, as amended by 2020 Iowa Acts, chapter 1121, 5 section 19. 6 Sec. 17. TRANSFER OF MONEYS. Notwithstanding section 8.33 7 or any other provision to the contrary, any unobligated or 8 unencumbered moneys in any of the following accounts or funds 9 or constituting any specified appropriation, shall not revert 10 but are appropriated to the department of health and human 11 services to fund Medicaid graduate medical education efforts. 12 1. The health care workforce shortage fund created in 13 section 135.175, subsection 1, paragraph b, Code 2025. 14 2. The medical residency training account created in 15 section 135.175, subsection 5, paragraph a, Code 2025. 16 3. The nurse residency state matching grants program 17 account created in section 135.175, subsection 5, paragraph 18 b, Code 2025. 19 4. The health care workforce shortage national initiatives 20 account created in section 135.175, subsection 5, paragraph 21 c, Code 2025. 22 5. The family medicine obstetrics fellowship program fund 23 created in section 135.193, Code 2025. 24 6. Moneys appropriated to the department of health and human 25 services for rural psychiatric residencies to fund psychiatric 26 residents to provide mental health services in underserved 27 areas of the state as described in the following: 28 a. 2024 Iowa Acts, chapter 1157, section 5, subsection 3, 29 and 2024 Iowa Acts, chapter 1157, section 22, subsection 5. 30 b. 2023 Iowa Acts, chapter 112, section 5, subsection 4, 31 paragraph j, as amended by 2024 Iowa Acts, chapter 1157, 32 section 29. 33 c. 2022 Iowa Acts, chapter 1131, section 3, subsection 4, 34 paragraph j, as amended by 2024 Iowa Acts, chapter 1157, 35 -11- LSB 1555HV (3) 91 lh/ko 11/ 40 |
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| 25 | 25 | | H.F. 754 section 23. 1 d. 2021 Iowa Acts, chapter 182, section 3, subsection 4, 2 paragraph j. 3 e. 2019 Iowa Acts, chapter 85, section 3, subsection 4, 4 paragraph j, as amended by 2020 Iowa Acts, chapter 1121, 5 section 19. 6 Sec. 18. TRANSITION ACCOUNTS. 7 1. The department of health and human services shall create 8 individual accounts for the deposit of any moneys encumbered 9 or obligated relating to a grant awarded, or residency or 10 fellowship funded, under each of the following programs: 11 a. The medical residency training state matching grants 12 program under section 135.176, Code 2025. 13 b. The nurse residency state matching grants program under 14 section 135.178, Code 2025. 15 c. The state-funded family medicine obstetrics fellowship 16 program under section 135.193, Code 2025. 17 d. Rural psychiatric residencies as described in the 18 following: 19 (1) 2024 Iowa Acts, chapter 1157, section 5, subsection 3, 20 and 2024 Iowa Acts, chapter 1157, section 22, subsection 5. 21 (2) 2023 Iowa Acts, chapter 112, section 5, subsection 4, 22 paragraph j, as amended by 2024 Iowa Acts, chapter 1157, 23 section 29. 24 (3) 2022 Iowa Acts, chapter 1131, section 3, subsection 25 4, paragraph j, as amended by 2024 Iowa Acts, chapter 1157, 26 section 23. 27 (4) 2021 Iowa Acts, chapter 182, section 3, subsection 4, 28 paragraph j. 29 (5) 2019 Iowa Acts, chapter 85, section 3, subsection 4, 30 paragraph j, as amended by 2020 Iowa Acts, chapter 1121, 31 section 19. 32 2. Notwithstanding section 8.33, any balance in any of the 33 accounts created under subsection 1 shall not revert but shall 34 remain available for the duration of all applicable grants, 35 -12- LSB 1555HV (3) 91 lh/ko 12/ 40 |
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| 27 | 27 | | H.F. 754 residencies, and fellowships. Notwithstanding section 12C.7, 1 subsection 2, interest or earnings on moneys deposited in each 2 account shall be credited to the respective account. 3 3. Upon expiration of all grant, residency, and fellowship 4 periods and the expenditure of all moneys encumbered under 5 such grants, residencies, and fellowships, any unencumbered or 6 unobligated moneys remaining in any of the accounts created 7 under subsection 1 are appropriated to the department of health 8 and human services for Medicaid graduate medical education 9 efforts. 10 DIVISION VI 11 ELIMINATION OF THE STATE-FUNDED PSYCHIATRY RESIDENCY AND 12 FELLOWSHIP POSITIONS UNIVERSITY OF IOWA HOSPITALS AND 13 CLINICS 14 Sec. 19. REPEAL. Section 135.180, Code 2025, is repealed. 15 Sec. 20. TRANSITION PROVISIONS. The board of regents 16 shall direct the university of Iowa hospitals and clinics to 17 distribute moneys for state-funded psychiatry residency and 18 fellowship positions approved and awarded on or before June 19 30, 2025, under the state-funded psychiatry residency and 20 fellowship positions in section 135.180, Code 2025, until all 21 residents and fellows have completed or left the state-funded 22 psychiatry residency or fellowship positions. 23 Sec. 21. TRANSITION ACCOUNT. 24 1. The board of regents shall direct the university of Iowa 25 hospitals and clinics to create an account for the deposit 26 of moneys encumbered or obligated relating to residency and 27 fellowship positions funded under the state-funded psychiatry 28 residency and fellowship positions under section 135.180, Code 29 2025. 30 2. Notwithstanding section 8.33, any balance in the account 31 created under subsection 1 shall not revert but shall remain 32 available for the duration of all applicable residencies and 33 fellowships. Notwithstanding section 12C.7, subsection 2, 34 interest or earnings on moneys deposited in the account shall 35 -13- LSB 1555HV (3) 91 lh/ko 13/ 40 |
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| 29 | 29 | | H.F. 754 be credited to the account. 1 3. Upon expiration of all residency and fellowship periods 2 and the expenditure of all moneys encumbered under such 3 residencies and fellowships, any unencumbered or unobligated 4 moneys remaining in the account created under subsection 1 are 5 appropriated to the department of health and human services for 6 Medicaid graduate medical education efforts. 7 Sec. 22. TRANSFER OF MONEYS. Notwithstanding section 8.33 8 or any other provision to the contrary, any unobligated or 9 unencumbered moneys in the psychiatry residency and fellowship 10 positions fund created in section 135.180, Code 2025, shall 11 not revert but are appropriated to the department of health 12 and human services to fund Medicaid graduate medical education 13 efforts. 14 DIVISION VII 15 ELIMINATION OF THE HEALTH FACILITIES COUNCIL 16 Sec. 23. Section 10A.711, subsection 5, Code 2025, is 17 amended by striking the subsection and inserting in lieu 18 thereof the following: 19 5. Department means the department of health and human 20 services. 21 Sec. 24. Section 10A.713, subsection 4, unnumbered 22 paragraph 1, Code 2025, is amended to read as follows: 23 A copy of the application shall be sent to the department 24 of health and human services at the time the application is 25 submitted to the department. The department shall not process 26 applications for and the council shall not an intermediate 27 care facility for persons with an intellectual disability, or 28 consider a new or changed institutional health service for an 29 intermediate care facility for persons with an intellectual 30 disability , unless both of the following conditions are met: 31 Sec. 25. Section 10A.714, subsection 1, unnumbered 32 paragraph 1, Code 2025, is amended to read as follows: 33 In determining whether a certificate of need shall be 34 issued, the department and council shall consider the 35 -14- LSB 1555HV (3) 91 lh/ko 14/ 40 |
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| 31 | 31 | | H.F. 754 following: 1 Sec. 26. Section 10A.714, subsection 1, paragraph r, Code 2 2025, is amended to read as follows: 3 r. The recommendations of staff personnel of the department 4 assigned to the area of certificate of need, concerning the 5 application , if requested by the council . 6 Sec. 27. Section 10A.714, subsection 2, unnumbered 7 paragraph 1, Code 2025, is amended to read as follows: 8 In addition to the findings required with respect to any 9 of the criteria listed in subsection 1 of this section , the 10 council department shall grant a certificate of need for a new 11 institutional health service or changed institutional health 12 service only if it the department finds in writing, on the 13 basis of data submitted to it by the department , that: 14 Sec. 28. Section 10A.716, subsection 3, Code 2025, is 15 amended to read as follows: 16 3. Each application accepted by the department shall be 17 formally reviewed for the purpose of furnishing to the council 18 the information necessary to enable it the department to 19 determine whether or not to grant the certificate of need. A 20 formal review shall consist , at a minimum , of the following 21 steps: 22 a. Evaluation of the application against the criteria 23 specified in section 10A.714 135.63 . 24 b. A public hearing on the application, to be held prior to 25 completion of the evaluation required by paragraph a , shall be 26 conducted by the council . 27 Sec. 29. Section 10A.719, Code 2025, is amended to read as 28 follows: 29 10A.719 Council Department to make final decision. 30 1. The department shall complete its formal review of 31 the application within ninety days after acceptance of the 32 application, except as otherwise provided by section 10A.722 33 135.71 , subsection 4 . Upon completion of the formal review, 34 the council department shall approve or deny the application. 35 -15- LSB 1555HV (3) 91 lh/ko 15/ 40 |
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| 33 | 33 | | H.F. 754 The council department shall issue written findings stating the 1 basis for its decision on the application , and the department 2 shall send copies of the councils decision and the written 3 findings supporting the decision to the applicant and to any 4 other person who so requests. 5 2. Failure by the council department to issue a written 6 decision on an application for a certificate of need within the 7 time required by this section shall constitute denial of and 8 final administrative action on the application. 9 Sec. 30. Section 10A.720, Code 2025, is amended to read as 10 follows: 11 10A.720 Appeal of certificate of need decisions. 12 The councils departments decision on an application for 13 certificate of need, when announced pursuant to section 10A.719 14 135.68 , is shall be a final decision. Any dissatisfied party 15 who is an affected person with respect to the application, 16 and who participated or sought unsuccessfully to participate 17 in the formal review procedure prescribed by section 10A.716 18 135.65 , may request a rehearing in accordance with chapter 17A 19 and rules of the department. If a rehearing is not requested 20 or an affected party remains dissatisfied after the request for 21 rehearing, an appeal may be taken in the manner provided by 22 chapter 17A . Notwithstanding the Iowa administrative procedure 23 Act, chapter 17A , a request for rehearing is not required , 24 prior to appeal under section 17A.19 . 25 Sec. 31. Section 10A.721, Code 2025, is amended to read as 26 follows: 27 10A.721 Period for which certificate is valid extension 28 or revocation. 29 1. A certificate of need shall be valid for a maximum of 30 one year from the date of issuance. Upon the expiration of the 31 certificate, or at any earlier time while the certificate is 32 valid , the holder thereof of the certificate shall provide the 33 department such information on the development of the project 34 covered by the certificate as the department may request. 35 -16- LSB 1555HV (3) 91 lh/ko 16/ 40 |
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| 35 | 35 | | H.F. 754 The council department shall determine at the end of the 1 certification period whether sufficient progress is being made 2 on the development of the project. The certificate of need may 3 be extended by the council department for additional periods 4 of time as are reasonably necessary to expeditiously complete 5 the project, but may be revoked by the council department at 6 the end of the first or any subsequent certification period for 7 insufficient progress in developing the project. 8 2. Upon expiration of a certificate of need, and prior to 9 extension thereof of the certificate of need , any affected 10 person shall have the right to submit to the department 11 information which may be relevant to the question of granting 12 an extension. The department may call a public hearing for 13 this purpose. 14 Sec. 32. Section 10A.722, unnumbered paragraph 1, Code 15 2025, is amended to read as follows: 16 The department shall adopt , with approval of the council, 17 such administrative rules as are necessary to enable it to 18 implement this part subchapter . These rules shall include: 19 Sec. 33. Section 10A.723, subsection 2, paragraph a, Code 20 2025, is amended to read as follows: 21 a. A class I violation is one in which a party offers a 22 new institutional health service or changed institutional 23 health service modernization or acquisition without review and 24 approval by the council department . A party in violation is 25 subject to a penalty of three hundred dollars for each day of a 26 class I violation. The department may seek injunctive relief 27 which shall include restraining the commission or continuance 28 of an act which would violate the provisions of this paragraph. 29 Notice and opportunity to be heard shall be provided to a party 30 pursuant to rule of civil procedure 1.1507 and contested case 31 procedures in accordance with chapter 17A . The department may 32 reduce, alter, or waive a penalty upon the party showing good 33 faith compliance with the departments request to immediately 34 cease and desist from conduct in violation of this section . 35 -17- LSB 1555HV (3) 91 lh/ko 17/ 40 |
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| 37 | 37 | | H.F. 754 Sec. 34. Section 68B.35, subsection 2, paragraph e, Code 1 2025, is amended to read as follows: 2 e. Members of the state banking council, the Iowa ethics and 3 campaign disclosure board, the credit union review board, the 4 economic development authority, the employment appeal board, 5 the environmental protection commission, the health facilities 6 council, the Iowa finance authority, the Iowa public employees 7 retirement system investment board, the Iowa lottery commission 8 created in section 99G.8 , the natural resource commission, the 9 board of parole, the state racing and gaming commission, the 10 state board of regents, the transportation commission, the 11 office of consumer advocate, the utilities commission, the Iowa 12 telecommunications and technology commission, and any full-time 13 members of other boards and commissions as defined under 14 section 7E.4 who receive an annual salary for their service 15 on the board or commission. The Iowa ethics and campaign 16 disclosure board shall conduct an annual review to determine 17 if members of any other board, commission, or authority should 18 file a statement and shall require the filing of a statement 19 pursuant to rules adopted pursuant to chapter 17A . 20 Sec. 35. Section 97B.1A, subsection 8, paragraph a, 21 subparagraph (8), Code 2025, is amended to read as follows: 22 (8) Members of the state transportation commission , and the 23 board of parole , and the state health facilities council . 24 Sec. 36. CODE EDITOR DIRECTIVE. 25 1. The Code editor is directed to make the following 26 transfers: 27 a. Section 10A.711 to section 135.61. 28 b. Section 10A.713 to section 135.62. 29 c. Section 10A.714 to section 135.63. 30 d. Section 10A.715 to section 135.64. 31 e. Section 10A.716 to section 135.65. 32 f. Section 10A.717 to section 135.66. 33 g. Section 10A.718 to section 135.67. 34 h. Section 10A.719 to section 135.68. 35 -18- LSB 1555HV (3) 91 lh/ko 18/ 40 |
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| 38 | 38 | | |
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| 39 | 39 | | H.F. 754 i. Section 10A.720 to section 135.69. 1 j. Section 10A.721 to section 135.70. 2 k. Section 10A.722 to section 135.71. 3 l. Section 10A.723 to section 135.72. 4 m. Section 10A.724 to section 135.73. 5 n. Section 10A.725 to section 135.74. 6 o. Section 10A.726 to section 135.75. 7 p. Section 10A.727 to section 135.76. 8 q. Section 10A.728 to section 135.77. 9 r. Section 10A.729 to section 135.78. 10 2. The Code editor is directed to rename and retitle 11 subchapter VI of chapter 135 as HEALTH FACILITIES and include 12 sections 135.61 through 135.78. 13 3. The Code editor shall correct internal references in the 14 Code and in any enacted legislation as is necessary due to the 15 enactment of this division. 16 Sec. 37. REPEAL. Section 10A.712, Code 2025, is repealed. 17 DIVISION VIII 18 CONFORMING CHANGES ELIMINATION OF THE HEALTH FACILITIES 19 COUNCIL 20 Sec. 38. Section 10A.711, unnumbered paragraph 1, Code 21 2025, is amended to read as follows: 22 As used in this part subchapter , unless the context 23 otherwise requires: 24 Sec. 39. Section 10A.711, subsection 1, paragraph d, Code 25 2025, is amended to read as follows: 26 d. Each institutional health facility or health maintenance 27 organization which, prior to receipt of the application by the 28 department, has formally indicated to the department pursuant 29 to this part subchapter an intent to furnish in the future 30 institutional health services similar to the new institutional 31 health service proposed in the application. 32 Sec. 40. Section 10A.713, subsection 1, Code 2025, is 33 amended to read as follows: 34 1. A new institutional health service or changed 35 -19- LSB 1555HV (3) 91 lh/ko 19/ 40 |
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| 40 | 40 | | |
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| 41 | 41 | | H.F. 754 institutional health service shall not be offered or developed 1 in this state without prior application to the department 2 for and receipt of a certificate of need, pursuant to this 3 part subchapter . The application shall be made upon forms 4 furnished or prescribed by the department and shall contain 5 such information as the department may require under this part 6 subchapter . The application shall be accompanied by a fee 7 equivalent to three-tenths of one percent of the anticipated 8 cost of the project with a minimum fee of six hundred dollars 9 and a maximum fee of twenty-one thousand dollars. The fee 10 shall be remitted by the department to the treasurer of 11 state, who shall place it in the general fund of the state. 12 If an application is voluntarily withdrawn within thirty 13 calendar days after submission, seventy-five percent of the 14 application fee shall be refunded; if the application is 15 voluntarily withdrawn more than thirty but within sixty days 16 after submission, fifty percent of the application fee shall 17 be refunded; if the application is withdrawn voluntarily more 18 than sixty days after submission, twenty-five percent of 19 the application fee shall be refunded. Notwithstanding the 20 required payment of an application fee under this subsection , 21 an applicant for a new institutional health service or a 22 changed institutional health service offered or developed by 23 an intermediate care facility for persons with an intellectual 24 disability or an intermediate care facility for persons with 25 mental illness as defined pursuant to section 135C.1 is exempt 26 from payment of the application fee. 27 Sec. 41. Section 10A.713, subsection 2, unnumbered 28 paragraph 1, Code 2025, is amended to read as follows: 29 This part subchapter shall not be construed to augment, 30 limit, contravene, or repeal in any manner any other statute 31 of this state which may authorize or relate to licensure, 32 regulation, supervision, or control of, nor to be applicable 33 to: 34 Sec. 42. Section 10A.713, subsection 2, paragraphs a, f, h, 35 -20- LSB 1555HV (3) 91 lh/ko 20/ 40 |
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| 42 | 42 | | |
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| 43 | 43 | | H.F. 754 j, k, m, and n, Code 2025, are amended to read as follows: 1 a. Private offices and private clinics of an individual 2 physician, dentist, or other practitioner or group of health 3 care providers, except as provided by section 10A.711 135.61 , 4 subsection 17 , paragraphs g , h , and m , and section 10A.711 5 135.61 , subsections 2 and 19 . 6 f. A residential care facility, as defined in section 7 135C.1 , including a residential care facility for persons with 8 an intellectual disability, notwithstanding any provision in 9 this part subchapter to the contrary. 10 h. (1) The deletion of one or more health services, 11 previously offered on a regular basis by an institutional 12 health facility or health maintenance organization, 13 notwithstanding any provision of this part subchapter to the 14 contrary, if all of the following conditions exist: 15 (a) The institutional health facility or health maintenance 16 organization reports to the department the deletion of the 17 service or services at least thirty days before the deletion on 18 a form prescribed by the department. 19 (b) The institutional health facility or health maintenance 20 organization reports the deletion of the service or services on 21 its next annual report to the department. 22 (2) If these conditions are not met, the institutional 23 health facility or health maintenance organization is subject 24 to review as a new institutional health service or changed 25 institutional health service under section 10A.711 135.61 , 26 subsection 17 , paragraph f , and is subject to sanctions under 27 section 10A.723 135.72 . 28 (3) If the institutional health facility or health 29 maintenance organization reestablishes the deleted service 30 or services at a later time, review as a new institutional 31 health service or changed institutional health service may 32 be required pursuant to section 10A.711 135.61 , subsection 17 . 33 j. The construction, modification, or replacement of 34 nonpatient care services, including parking facilities, 35 -21- LSB 1555HV (3) 91 lh/ko 21/ 40 |
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| 44 | 44 | | |
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| 45 | 45 | | H.F. 754 heating, ventilation and air conditioning systems, computers, 1 telephone systems, medical office buildings, and other projects 2 of a similar nature, notwithstanding any provision in this part 3 subchapter to the contrary. 4 k. (1) The redistribution of beds by a hospital within 5 the acute care category of bed usage, notwithstanding any 6 provision in this part subchapter to the contrary, if all of 7 the following conditions exist: 8 (a) The hospital reports to the department the number and 9 type of beds to be redistributed on a form prescribed by the 10 department at least thirty days before the redistribution. 11 (b) The hospital reports the new distribution of beds on its 12 next annual report to the department. 13 (2) If these conditions are not met, the redistribution 14 of beds by the hospital is subject to review as a new 15 institutional health service or changed institutional health 16 service pursuant to section 10A.711 135.61 , subsection 17 , 17 paragraph d , and is subject to sanctions under section 10A.723 18 135.72 . 19 m. Hemodialysis services provided by a hospital or 20 freestanding facility, notwithstanding any provision in this 21 part subchapter to the contrary. 22 n. Hospice services provided by a hospital, notwithstanding 23 any provision in this part subchapter to the contrary. 24 Sec. 43. Section 10A.713, subsection 2, paragraph e, 25 subparagraph (2), Code 2025, is amended to read as follows: 26 (2) Acquires major medical equipment as provided by section 27 10A.711 135.61 , subsection 17 , paragraphs i and j . 28 Sec. 44. Section 10A.713, subsection 2, paragraph g, 29 subparagraph (1), unnumbered paragraph 1, Code 2025, is amended 30 to read as follows: 31 A reduction in bed capacity of an institutional health 32 facility, notwithstanding any provision in this part subchapter 33 to the contrary, if all of the following conditions exist: 34 Sec. 45. Section 10A.713, subsection 2, paragraph g, 35 -22- LSB 1555HV (3) 91 lh/ko 22/ 40 |
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| 46 | 46 | | |
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| 47 | 47 | | H.F. 754 subparagraph (2), Code 2025, is amended to read as follows: 1 (2) If these conditions are not met, the institutional 2 health facility is subject to review as a new institutional 3 health service or changed institutional health service under 4 section 10A.711 135.61 , subsection 17 , paragraph d , and is 5 subject to sanctions under section 10A.723 135.72 . If the 6 institutional health facility reestablishes the deleted beds at 7 a later time, review as a new institutional health service or 8 changed institutional health service is required pursuant to 9 section 10A.711 135.61 , subsection 17 , paragraph d . 10 Sec. 46. Section 10A.713, subsection 2, paragraph l, 11 unnumbered paragraph 1, Code 2025, is amended to read as 12 follows: 13 The replacement or modernization of any institutional 14 health facility if the replacement or modernization does 15 not add new health services or additional bed capacity for 16 existing health services, notwithstanding any provision in this 17 part subchapter to the contrary. With respect to a nursing 18 facility, replacement means establishing a new facility within 19 the same county as the prior facility to be closed. With 20 reference to a hospital, replacement means establishing a new 21 hospital that demonstrates compliance with all of the following 22 criteria through evidence submitted to the department: 23 Sec. 47. Section 10A.713, subsection 2, paragraph p, 24 unnumbered paragraph 1, Code 2025, is amended to read as 25 follows: 26 The conversion of an existing number of beds by an 27 intermediate care facility for persons with an intellectual 28 disability to a smaller facility environment, including but not 29 limited to a community-based environment which does not result 30 in an increased number of beds, notwithstanding any provision 31 in this part subchapter to the contrary, including subsection 32 4 , if all of the following conditions exist: 33 Sec. 48. Section 10A.713, subsection 3, Code 2025, is 34 amended to read as follows: 35 -23- LSB 1555HV (3) 91 lh/ko 23/ 40 |
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| 48 | 48 | | |
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| 49 | 49 | | H.F. 754 3. This part subchapter shall not be construed to be 1 applicable to a health care facility operated by and for the 2 exclusive use of members of a religious order, which does 3 not admit more than two individuals to the facility from the 4 general public, and which was in operation prior to July 1, 5 1986. However, this part subchapter is applicable to such 6 a facility if the facility is involved in the offering or 7 developing of a new or changed institutional health service on 8 or after July 1, 1986. 9 Sec. 49. Section 10A.714, subsection 3, Code 2025, is 10 amended to read as follows: 11 3. In the evaluation of applications for certificates 12 of need submitted by the university of Iowa hospitals and 13 clinics, the unique features of that institution relating to 14 statewide tertiary health care, health science education, and 15 clinical research shall be given due consideration. Further, 16 in administering this part subchapter , the unique capacity of 17 university hospitals for the evaluation of technologically 18 innovative equipment and other new health services shall be 19 utilized. 20 Sec. 50. Section 10A.715, subsection 2, Code 2025, is 21 amended to read as follows: 22 2. Upon request of the sponsor of the proposed new or 23 changed service, the department shall make a preliminary review 24 of the letter for the purpose of informing the sponsor of 25 the project of any factors which may appear likely to result 26 in denial of a certificate of need, based on the criteria 27 for evaluation of applications in section 10A.714 135.63 . 28 A comment by the department under this section shall not 29 constitute a final decision. 30 Sec. 51. Section 10A.716, subsection 1, Code 2025, is 31 amended to read as follows: 32 1. Within fifteen business days after receipt of an 33 application for a certificate of need, the department shall 34 examine the application for form and completeness and accept or 35 -24- LSB 1555HV (3) 91 lh/ko 24/ 40 |
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| 50 | 50 | | |
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| 51 | 51 | | H.F. 754 reject it. An application shall be rejected only if it fails 1 to provide all information required by the department pursuant 2 to section 10A.713 135.62 , subsection 1 . The department shall 3 promptly return to the applicant any rejected application, with 4 an explanation of the reasons for its rejection. 5 Sec. 52. Section 10A.717, subsection 1, unnumbered 6 paragraph 1, Code 2025, is amended to read as follows: 7 The department may waive the letter of intent procedures 8 prescribed by section 10A.715 135.64 and substitute a summary 9 review procedure, which shall be established by rules of the 10 department, when it accepts an application for a certificate 11 of need for a project which meets any of the criteria in 12 paragraphs a through e : 13 Sec. 53. Section 10A.722, subsections 2, 3, and 4, Code 14 2025, are amended to read as follows: 15 2. Uniform procedures for variations in application of 16 criteria specified by section 10A.714 135.63 for use in formal 17 review of applications for certificates of need, when such 18 variations are appropriate to the purpose of a particular 19 review or to the type of institutional health service proposed 20 in the application being reviewed. 21 3. Uniform procedures for summary reviews conducted under 22 section 10A.717 135.66 . 23 4. Criteria for determining when it is not feasible to 24 complete formal review of an application for a certificate 25 of need within the time limits specified in section 10A.719 26 135.68 . The rules adopted under this subsection shall include 27 criteria for determining whether an application proposes 28 introduction of technologically innovative equipment, and if 29 so, procedures to be followed in reviewing the application. 30 However, a rule adopted under this subsection shall not permit 31 a deferral of more than sixty days beyond the time when a 32 decision is required under section 10A.719 135.68 , unless both 33 the applicant and the department agree to a longer deferment. 34 Sec. 54. Section 10A.723, subsections 1 and 3, Code 2025, 35 -25- LSB 1555HV (3) 91 lh/ko 25/ 40 |
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| 52 | 52 | | |
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| 53 | 53 | | H.F. 754 are amended to read as follows: 1 1. Any party constructing a new institutional health 2 facility or an addition to or renovation of an existing 3 institutional health facility without first obtaining a 4 certificate of need or, in the case of a mobile health 5 service, ascertaining that the mobile health service has 6 received certificate of need approval, as required by this part 7 subchapter , shall be denied licensure or change of licensure by 8 the appropriate responsible licensing agency of this state. 9 3. Notwithstanding any other sanction imposed pursuant 10 to this section , a party offering or developing any new 11 institutional health service or changed institutional health 12 service without first obtaining a certificate of need as 13 required by this part subchapter, may be temporarily or 14 permanently restrained from doing so by any court of competent 15 jurisdiction in any action brought by the state, any of its 16 political subdivisions, or any other interested person. 17 Sec. 55. Section 10A.723, subsection 2, unnumbered 18 paragraph 1, Code 2025, is amended to read as follows: 19 A party violating this part subchapter shall be subject 20 to penalties in accordance with this section . The 21 department shall adopt rules setting forth the violations by 22 classification, the criteria for the classification of any 23 violation not listed, and procedures for implementing this 24 subsection . 25 Sec. 56. Section 10A.724, subsection 3, Code 2025, is 26 amended to read as follows: 27 3. The department shall, where appropriate, provide 28 for modification, consistent with the purposes of this part 29 subchapter , of reporting requirements to correctly reflect the 30 differences among hospitals and among health care facilities 31 referred to in subsection 2 , and to avoid otherwise unduly 32 burdensome costs in meeting the requirements of uniform methods 33 of financial reporting. 34 Sec. 57. Section 10A.725, subsection 2, Code 2025, is 35 -26- LSB 1555HV (3) 91 lh/ko 26/ 40 |
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| 54 | 54 | | |
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| 55 | 55 | | H.F. 754 amended to read as follows: 1 2. Where more than one licensed hospital or health 2 care facility is operated by the reporting organization, 3 the information required by this section shall be reported 4 separately for each licensed hospital or health care facility. 5 The department shall require preparation of specified financial 6 reports by a certified public accountant, and may require 7 attestation of responsible officials of the reporting hospital 8 or health care facility that the reports submitted are to the 9 best of their knowledge and belief prepared in accordance with 10 the prescribed methods of reporting. The department shall 11 have the right to inspect the books, audits and records of any 12 hospital or health care facility as reasonably necessary to 13 verify reports submitted pursuant to this part subchapter . 14 Sec. 58. Section 10A.726, subsection 1, Code 2025, is 15 amended to read as follows: 16 1. The department shall from time to time undertake analyses 17 and studies relating to hospital and health care facility 18 costs and to the financial status of hospitals or health care 19 facilities, or both, which are subject to the provisions of 20 this part subchapter . It shall further require the filing 21 of information concerning the total financial needs of each 22 individual hospital or health care facility and the resources 23 currently or prospectively available to meet these needs, 24 including the effect of proposals made by health systems 25 agencies. The department shall also prepare and file such 26 summaries and compilations or other supplementary reports based 27 on the information filed with it as will, in its judgment, 28 advance the purposes of this part subchapter . 29 Sec. 59. Section 10A.727, Code 2025, is amended to read as 30 follows: 31 10A.727 Data to be compiled. 32 The department shall compile all relevant financial and 33 utilization data in order to have available the statistical 34 information necessary to properly monitor hospital and health 35 -27- LSB 1555HV (3) 91 lh/ko 27/ 40 |
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| 56 | 56 | | |
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| 57 | 57 | | H.F. 754 care facility charges and costs. Such data shall include 1 necessary operating expenses, appropriate expenses incurred for 2 rendering services to patients who cannot or do not pay, all 3 properly incurred interest charges, and reasonable depreciation 4 expenses based on the expected useful life of the property 5 and equipment involved. The department shall also obtain 6 from each hospital and health care facility a current rate 7 schedule as well as any subsequent amendments or modifications 8 of that schedule as it may require. In collection of the data 9 required by this section and sections 10A.724 135.73 through 10 10A.726 135.75 , the department and other state agencies shall 11 coordinate their reporting requirements. 12 Sec. 60. Section 10A.728, Code 2025, is amended to read as 13 follows: 14 10A.728 Civil penalty. 15 Any hospital or health care facility which fails to file 16 with the department the financial reports required by sections 17 10A.724 135.73 through 10A.727 135.76 is subject to a civil 18 penalty of not to exceed five hundred dollars for each offense. 19 Sec. 61. Section 10A.729, Code 2025, is amended to read as 20 follows: 21 10A.729 Contracts for assistance with analyses, studies, and 22 data. 23 In furtherance of the departments responsibilities under 24 sections 10A.726 135.75 and 10A.727 135.76 , the director may 25 contract with the Iowa hospital association and third-party 26 payers, the Iowa health care facilities association and 27 third-party payers, or leading age Iowa and third-party 28 payers for the establishment of pilot programs dealing with 29 prospective rate review in hospitals or health care facilities, 30 or both. Such contract shall be subject to the approval of 31 the executive council and shall provide for an equitable 32 representation of health care providers, third-party payers, 33 and health care consumers in the determination of criteria 34 for rate review. No third-party payer shall be excluded from 35 -28- LSB 1555HV (3) 91 lh/ko 28/ 40 |
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| 58 | 58 | | |
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| 59 | 59 | | H.F. 754 positive financial incentives based upon volume of gross 1 patient revenues. No state or federal funds appropriated or 2 available to the department shall be used for any such pilot 3 program. 4 Sec. 62. Section 135.131, subsection 1, paragraph a, Code 5 2025, is amended to read as follows: 6 a. Birth center means birth center as defined in section 7 10A.711 135.61 . 8 Sec. 63. Section 135B.5A, Code 2025, is amended to read as 9 follows: 10 135B.5A Conversion relative to certain hospitals. 11 1. A conversion of a long-term acute care hospital, 12 rehabilitation hospital, or psychiatric hospital as defined by 13 federal regulations to a general hospital or to a specialty 14 hospital of a different type is a permanent change in bed 15 capacity and shall require a certificate of need pursuant to 16 section 10A.713 135.62 . 17 2. A conversion of a critical access hospital or general 18 hospital to a rural emergency hospital shall not require a 19 certificate of need pursuant to section 10A.713 135.62 . 20 3. Any change of a rural emergency hospital in licensure, 21 organizational structure, or type of institutional health 22 facility shall require a certificate of need pursuant to 23 section 10A.713 135.62 . 24 Sec. 64. Section 135C.2, subsection 5, unnumbered paragraph 25 1, Code 2025, is amended to read as follows: 26 The department shall establish a special classification 27 within the residential care facility category in order to 28 foster the development of residential care facilities which 29 serve persons with an intellectual disability, chronic mental 30 illness, a developmental disability, or brain injury, as 31 described under section 225C.26 , and which contain five or 32 fewer residents. A facility within the special classification 33 established pursuant to this subsection is exempt from the 34 requirements of section 10A.713 135.62 . The department 35 -29- LSB 1555HV (3) 91 lh/ko 29/ 40 |
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| 60 | 60 | | |
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| 61 | 61 | | H.F. 754 shall adopt rules which are consistent with rules previously 1 developed for the waiver demonstration project pursuant to 2 1986 Iowa Acts, ch. 1246, 206 , and which include all of the 3 following provisions: 4 Sec. 65. Section 135P.1, subsection 3, Code 2025, is amended 5 to read as follows: 6 3. Health facility means an institutional health facility 7 as defined in section 10A.711 135.61 , a hospice licensed under 8 chapter 135J , a home health agency as defined in section 9 144D.1 , an assisted living program certified under chapter 10 231C , a clinic, a community health center, or the university 11 of Iowa hospitals and clinics, and includes any corporation, 12 professional corporation, partnership, limited liability 13 company, limited liability partnership, or other entity 14 comprised of such health facilities. 15 Sec. 66. Section 231C.3, subsection 2, Code 2025, is amended 16 to read as follows: 17 2. Each assisted living program operating in this state 18 shall be certified by the department. If an assisted living 19 program is voluntarily accredited by a recognized accrediting 20 entity, the department shall certify the assisted living 21 program on the basis of the voluntary accreditation. An 22 assisted living program that is certified by the department on 23 the basis of voluntary accreditation shall not be subject to 24 payment of the certification fee prescribed in section 231C.18 , 25 but shall be subject to an administrative fee as prescribed by 26 rule. An assisted living program certified under this section 27 is exempt from the requirements of section 10A.713 135.62 28 relating to certificate of need requirements. 29 Sec. 67. Section 505.27, subsection 5, paragraph a, Code 30 2025, is amended to read as follows: 31 a. Health care provider means the same as defined in 32 section 10A.711 135.61 , a hospital licensed pursuant to chapter 33 135B , or a health care facility licensed pursuant to chapter 34 135C . 35 -30- LSB 1555HV (3) 91 lh/ko 30/ 40 |
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| 62 | 62 | | |
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| 63 | 63 | | H.F. 754 Sec. 68. Section 708.3A, subsection 5, paragraph d, Code 1 2025, is amended to read as follows: 2 d. Health care provider means an emergency medical care 3 provider as defined in chapter 147A or a person licensed 4 or registered under chapter 148 , 148C , 148D , or 152 who is 5 providing or who is attempting to provide emergency medical 6 services, as defined in section 147A.1 , or who is providing 7 or who is attempting to provide health services as defined in 8 section 10A.711 135.61 in a hospital. A person who commits an 9 assault under this section against a health care provider in 10 a hospital, or at the scene or during out-of-hospital patient 11 transportation in an ambulance, is presumed to know that the 12 person against whom the assault is committed is a health care 13 provider. 14 DIVISION IX 15 IOWA HEALTH INFORMATION NETWORK EXCHANGE ADVISORY COMMITTEE 16 CREATED AND BOARD OF DIRECTORS ELIMINATED 17 Sec. 69. Section 135D.2, subsection 1, Code 2025, is amended 18 by striking the subsection. 19 Sec. 70. Section 135D.2, subsection 4, Code 2025, is amended 20 to read as follows: 21 4. Designated entity means the nonprofit corporation 22 designated selected by the department through a competitive 23 process as the entity responsible for administering and 24 governing the Iowa health information network. 25 Sec. 71. Section 135D.2, Code 2025, is amended by adding the 26 following new subsections: 27 NEW SUBSECTION . 4A. Director means the director of health 28 and human services. 29 NEW SUBSECTION . 5A. Exchange advisory committee or 30 advisory committee means the exchange advisory committee 31 appointed by the director pursuant to section 135D.6. 32 Sec. 72. Section 135D.4, subsection 2, paragraph a, Code 33 2025, is amended to read as follows: 34 a. The network, through the designated entity complying with 35 -31- LSB 1555HV (3) 91 lh/ko 31/ 40 |
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| 64 | 64 | | |
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| 65 | 65 | | H.F. 754 chapter 490, 496C, and 504 and reporting as required under this 1 chapter , operates in an entrepreneurial and businesslike manner 2 in which it is accountable to all participants utilizing the 3 networks products and services. 4 Sec. 73. Section 135D.5, subsection 1, Code 2025, is amended 5 to read as follows: 6 1. The Iowa health information network shall be 7 administered and governed by a designated entity selected by 8 the department through a competitive process. The designated 9 entity shall be established as a nonprofit corporation 10 organized under chapter 490, 496C, or 504. Unless otherwise 11 provided in this chapter, the corporation is subject to the 12 provisions of chapter 504. The designated entity shall be 13 established for the purpose of administering and governing the 14 statewide Iowa health information network. Notwithstanding any 15 provision of law to the contrary, the department shall conduct 16 a competitive process to select a designated entity at least 17 every eight years. 18 Sec. 74. Section 135D.5, subsection 3, paragraph d, Code 19 2025, is amended to read as follows: 20 d. The employment of personnel necessary for the efficient 21 performance of the duties assigned to the designated entity. 22 All such personnel shall be considered employees of a private , 23 nonprofit corporation and shall be exempt from the personnel 24 requirements imposed on state agencies, departments, and 25 administrative units. 26 Sec. 75. Section 135D.6, Code 2025, is amended by striking 27 the section and inserting in lieu thereof the following: 28 135D.6 Exchange advisory committee. 29 1. The director shall appoint an exchange advisory 30 committee. 31 2. The advisory committee shall include at least one 32 member who is a consumer of health services, and a majority 33 of the advisory committee members shall be representative of 34 participants in the Iowa health information network. 35 -32- LSB 1555HV (3) 91 lh/ko 32/ 40 |
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| 66 | 66 | | |
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| 67 | 67 | | H.F. 754 3. The exchange advisory committee shall do all of the 1 following: 2 a. Advise the department regarding the needs of participants 3 and nonparticipants relating to the exchange of health 4 information. 5 b. Ensure the department develops, and the designated 6 entity complies with, the standards, requirements, policies, 7 and procedures for access to, use, secondary use, privacy, 8 and security of health information exchanged through the Iowa 9 health information network, consistent with applicable federal 10 and state standards and laws. 11 c. Direct a public and private collaborative effort to 12 promote the adoption and use of health information technology 13 in the state to improve health care quality, increase patient 14 safety, reduce health care costs, enhance public health, 15 and empower individuals and health care professionals with 16 comprehensive, real-time medical information to provide 17 continuity of care and make the best health care decisions. 18 d. Educate the public and the health care sector about 19 the value of health information technology in improving 20 patient care, and methods to promote increased support and 21 collaboration of state and local public health agencies, 22 health care professionals, and consumers in health information 23 technology initiatives. 24 e. Work to align interstate and intrastate interoperability 25 standards in accordance with national health information 26 exchange standards. 27 f. Provide an annual budget and fiscal report for the Iowa 28 health information network to the governor, the department 29 of health and human services, the department of management, 30 and the general assembly. The report shall also include 31 information about the services provided through the network and 32 information on the participant usage of the network. 33 Sec. 76. Section 135D.7, subsection 1, unnumbered paragraph 34 1, Code 2025, is amended to read as follows: 35 -33- LSB 1555HV (3) 91 lh/ko 33/ 40 |
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| 68 | 68 | | |
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| 69 | 69 | | H.F. 754 The board designated entity shall implement 1 industry-accepted security standards, policies, and procedures 2 to protect the transmission and receipt of protected health 3 information exchanged through the Iowa health information 4 network, which shall, at a minimum, comply with HIPAA and shall 5 include all of the following: 6 Sec. 77. Section 135D.7, subsection 1, paragraph c, 7 subparagraph (2), Code 2025, is amended to read as follows: 8 (2) The board designated entity shall provide the means 9 and process by which a patient may decline participation. 10 The means and process utilized shall minimize the burden on 11 patients and health care professionals. 12 Sec. 78. Section 135D.7, subsection 3, Code 2025, is amended 13 to read as follows: 14 3. A participant exchanging health information and data 15 through the Iowa health information network shall grant to 16 other participants of the network a nonexclusive license to 17 retrieve and use that information in accordance with applicable 18 state and federal laws, and the policies and standards 19 established by the board department . 20 Sec. 79. Section 135D.7, subsection 6, paragraph b, Code 21 2025, is amended to read as follows: 22 b. Any health information in the possession of the 23 board designated entity due to its the designated entitys 24 administration of the Iowa health information network. 25 EXPLANATION 26 The inclusion of this explanation does not constitute agreement with 27 the explanations substance by the members of the general assembly. 28 This bill relates to health care including a funding model 29 for Iowas rural health system; health care-related award, 30 grant, residency, and fellowship programs; establishment of 31 a health care incentive program; Medicaid graduate medical 32 education; the health facilities council; and the Iowa health 33 information network. 34 DIVISION I. This division requires the department of health 35 -34- LSB 1555HV (3) 91 lh/ko 34/ 40 |
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| 70 | 70 | | |
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| 71 | 71 | | H.F. 754 and human services (HHS) to submit to the centers for Medicare 1 and Medicaid services of the United States department of health 2 and human services a request for approval for a health care 3 hub-and-spoke partnership funding model for the purpose of 4 improving Iowas rural health system. The division shall take 5 effect upon enactment. 6 DIVISION II. This division eliminates PRIMECARRE and makes 7 conforming changes. The bill requires HHS to coordinate with 8 the college student aid commission (commission) to administer 9 the health professional incentive program. PRIMECARRE includes 10 the health care workforce and community support grant program 11 and the primary care provider loan repayment program to recruit 12 and retain primary care providers in rural communities. 13 Current law requires HHS to encourage local boards to 14 adopt a plan including that health facilities may seek 15 technical assistance or apply for matching grants for the plan 16 development. The bill removes the instruction for health 17 facilities to apply for matching grants for plan development. 18 HHS is required to make loan repayments pursuant to a loan 19 repayment program contract including a United States department 20 of health and human services state loan repayment program 21 contract executed on or before December 31, 2025, under the 22 primary care provider loan repayment program, if a recipient 23 is in compliance with the loan repayment program contract. 24 HHS shall create an account for the deposit of encumbered or 25 obligated moneys relating to the primary care provider loan 26 repayment program. 27 The division takes effect upon enactment. 28 DIVISION III. This division eliminates certain health 29 care-related programs. 30 The rural Iowa primary care loan repayment program (Code 31 section 256.221) is eliminated. The program provides loan 32 repayment for medical students who agree to practice as 33 physicians in certain service areas. 34 The health care professional recruitment program (Code 35 -35- LSB 1555HV (3) 91 lh/ko 35/ 40 |
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| 72 | 72 | | |
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| 73 | 73 | | H.F. 754 section 256.223) is also eliminated. The program provides loan 1 repayment for students who graduate from a certain institution 2 and become licensed as a health care professional. 3 In addition, the health care award program (Code section 4 256.224) is eliminated. The program provides financial awards 5 to registered nurses, advanced registered nurse practitioners, 6 physician assistants, and nurse educators who practice in 7 certain areas or teach in this state. 8 Finally, the mental health professional loan repayment 9 program (Code section 256.225) is eliminated. The program 10 provides loan repayment for mental health professionals who 11 agree to practice in certain practice areas. 12 For all of the eliminated programs, the commission is 13 required to make loan repayments and provide annual awards 14 pursuant to program agreements and contracts entered into 15 on or before June 30, 2025, as detailed in the bill. All 16 unencumbered and unobligated moneys in the eliminated programs 17 funds shall be transferred to the health care professional 18 incentive program fund (program fund) created in division IV. 19 The commission shall create accounts for the deposit of 20 encumbered and obligated moneys for each eliminated program as 21 detailed in the division. Upon the expiration of all program 22 agreement, contract, and award disbursement periods, any 23 unencumbered and unobligated moneys in the accounts shall be 24 deposited in the program fund created in division IV. 25 DIVISION IV. This division establishes a health care 26 professional incentive program (incentive program) to recruit 27 and retain eligible health care professionals (professionals) 28 in eligible health care professions (profession) in certain 29 areas of the state by offering an award of a loan repayment 30 or an income bonus. The commission, in coordination with 31 HHS, shall administer the incentive program as detailed in 32 the division. A professional is ineligible for the incentive 33 program if the professional is currently participating in or 34 has participated in certain health care-related award programs 35 -36- LSB 1555HV (3) 91 lh/ko 36/ 40 |
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| 74 | 74 | | |
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| 75 | 75 | | H.F. 754 as identified in divisions II and III. The incentive program 1 award shall be distributed annually by the commission as 2 detailed in the division. At least every five years, the 3 commission, in consultation with HHS, shall establish a list 4 of professions and the aggregate award amounts, not to exceed 5 $200,000, for each profession. 6 A program fund is created and moneys in the program fund are 7 appropriated to the commission to be used for the incentive 8 program. The moneys deposited in the program fund shall not 9 revert and shall remain in the program fund at the end of the 10 fiscal year. The commission may use the interest and earnings 11 on the moneys in the fund for administrative costs. All moneys 12 received by HHS or the commission from the health care-related 13 programs eliminated in divisions II and III shall be deposited 14 into the program fund. The commission, in coordination with 15 HHS, shall adopt rules to administer the incentive program. 16 The division shall take effect upon enactment. 17 DIVISION V. This division eliminates certain health 18 care-related grant, residency, and fellowship programs. 19 Current law provides that the fulfilling Iowas need for 20 dentists matching grant program may receive moneys through the 21 health care workforce shortage fund or the fulfilling Iowas 22 need for dentists matching grant program account (Code section 23 135.175). The division eliminates the fund and the account. 24 The health care workforce support initiative (Code section 25 135.175) is eliminated. The initiative provides for the 26 coordination and support of various efforts to address the 27 health care workforce shortage in the state. 28 Additionally, the medical residency training state matching 29 grants program (Code section 135.176) is eliminated. The 30 program provides matching state funding to sponsors of 31 accredited graduate medical education residency programs in 32 the state to establish, expand, or support medical residency 33 training programs. 34 The nurse residency state matching grants program (Code 35 -37- LSB 1555HV (3) 91 lh/ko 37/ 40 |
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| 76 | 76 | | |
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| 77 | 77 | | H.F. 754 section 135.178) is also eliminated. The program provides 1 matching state funding to sponsors of nurse residency programs 2 in the state to establish, expand, or support nurse residency 3 programs. 4 Moreover, the state-funded family medicine obstetrics 5 fellowship program (Code section 135.193) is eliminated. The 6 program provides funding for fellowships to increase access 7 to family medicine obstetrics practitioners in rural and 8 underserved areas of the state. 9 For all of the programs eliminated in the division, HHS is 10 required to provide matching state funding and fund residency 11 and fellowship positions awarded on or before June 30, 2025, as 12 detailed in the bill. All unencumbered and unobligated moneys 13 related to the programs eliminated in the division shall be 14 transferred to HHS to fund Medicaid graduate medical education 15 efforts. 16 HHS shall create accounts for the deposit of encumbered and 17 obligated moneys for each eliminated program as detailed in the 18 division. Upon the expiration of all grant, residency, and 19 fellowship periods, any unencumbered and unobligated moneys in 20 the account shall be appropriated to HHS for Medicaid graduate 21 medical education efforts. 22 DIVISION VI. This division eliminates the state-funded 23 psychiatry residency and fellowship positions (positions) 24 (Code section 135.180) administered by the university of 25 Iowa hospitals and clinics (U of I). The positions provide 26 financial support for up to seven residents and up to two 27 fellows annually. The board of regents (regents) shall direct 28 the U of I to distribute moneys for positions approved and 29 awarded on or before June 30, 2025, until all residents and 30 fellows have completed or left the positions. The regents must 31 also direct the U of I to create an account for the deposit 32 of moneys encumbered and obligated relating to the positions. 33 Upon the expiration of all residency and fellowship periods, 34 any unencumbered and unobligated moneys in the account shall 35 -38- LSB 1555HV (3) 91 lh/ko 38/ 40 |
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| 78 | 78 | | |
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| 79 | 79 | | H.F. 754 be appropriated to HHS for Medicaid graduate medical education 1 efforts. Any unobligated or unencumbered moneys in the 2 psychiatry residency and fellowship positions fund are also 3 appropriated to HHS to fund Medicaid graduate medical education 4 efforts. 5 DIVISION VII. This division eliminates the health 6 facilities council, and transfers the councils duties to HHS. 7 DIVISION VIII. This division makes conforming changes 8 to the Code related to the elimination of health facilities 9 council and the transfer of the applicable Code sections. 10 DIVISION IX. This division eliminates the board of 11 directors (board) that governs and administers the Iowa 12 health information network (network) and transfers the boards 13 administrative duties to the designated entity. Current law 14 requires the designated entity to be a nonprofit corporation. 15 The bill eliminates the requirement that the corporation be 16 nonprofit. The division creates an exchange advisory committee 17 (committee), appointed by the director of HHS, to govern the 18 network and the designated entity. The division requires 19 HHS to conduct a competitive process every eight years to 20 select a designated entity. Current law prohibits a single 21 industry from being disproportionately represented as voting 22 members of the board, and requires the director of HHS and the 23 director of the Medicaid program or the directors designees 24 to act as voting members. The commissioner of insurance is 25 required to serve on the board as a nonvoting member, and 26 individuals serving in a nonvoting capacity on the board are 27 not included in the total number of authorized members on 28 the board. The division strikes these member requirements. 29 Current law requires the board to ensure the designated entity 30 enters into contracts with each state agency necessary for 31 state reporting requirements, and to develop, implement, and 32 enforce a single patient identifier or alternative mechanism to 33 share secure patient information that is utilized by all health 34 care professionals. The division eliminates these duties for 35 -39- LSB 1555HV (3) 91 lh/ko 39/ 40 |
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| 80 | 80 | | |
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| 81 | 81 | | H.F. 754 the committee. The division requires the committee to advise 1 HHS regarding the needs relating to the exchange of health 2 information, and to ensure HHS develops, and the designated 3 entity complies with, the standards, requirements, policies, 4 and procedures related to the network. 5 -40- LSB 1555HV (3) 91 lh/ko 40/ 40 |
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