Iowa Senate Bill SF618 Latest Draft

                            Senate File 618 - Introduced   SENATE FILE 618   BY COMMITTEE ON APPROPRIATIONS   (SUCCESSOR TO SF 575)   (SUCCESSOR TO SSB 1163)   (COMPANION TO HF 972 BY   COMMITTEE ON APPROPRIATIONS)   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 1555SZ (2) 91   lh/ko  

  S.F. 618   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 1555SZ (2) 91   lh/ko 1/ 41             

  S.F. 618   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 1555SZ (2) 91   lh/ko 2/ 41  

  S.F. 618   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 1555SZ (2) 91   lh/ko 3/ 41  

  S.F. 618   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 1555SZ (2) 91   lh/ko 4/ 41   

  S.F. 618   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 at least two 28   thousand eighty hours of work in a calendar year, including all 29   paid 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 at least one 32   thousand five hundred sixty hours of work in a calendar year, 33   including all paid holidays, vacations, sick time, and other 34   paid leave, an eligible health care professional must practice 35   -5-   LSB 1555SZ (2) 91   lh/ko 5/ 41  

  S.F. 618   for seven 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 1555SZ (2) 91   lh/ko 6/ 41  

  S.F. 618   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. The commission shall give priority to an applicant 4   fulfilling a full-time employment obligation. 5   c. If selected for an award, the eligible health care 6   professional and the commission shall execute a program 7   agreement that specifies all of the following: 8   (1) The date the eligible health care professionals 9   employment obligation begins, which shall be no later than six 10   months from the date the program agreement is executed. 11   (2) The date the health care professionals employment 12   obligation terminates. 13   (3) Whether the award is a loan repayment or an income 14   bonus, and the terms and conditions related to the award, 15   including the aggregate award amount that the eligible health 16   care professional will receive. 17   (4) Requirements regarding the eligible health care 18   professionals license to practice in this state while 19   participating in the program. 20   (5) All other terms and conditions agreed to by the eligible 21   health care professional and the commission. 22   6. Awards. 23   a. Upon verifying the eligible health care professional is 24   in compliance with all terms of the program agreement executed 25   pursuant to subsection 5, paragraph c , the commission shall 26   pay the eligible health care professionals award annually as 27   follows:   28   (1) For a full-time employment obligation, the award shall 29   be paid as follows: 30   (a) An amount equal to twenty percent of the aggregate award 31   shall be paid to the eligible health care professional after 32   the completion of the first year of the eligible health care 33   professionals employment obligation. 34   (b) An amount equal to fifteen percent of the aggregate 35   -7-   LSB 1555SZ (2) 91   lh/ko 7/ 41  

  S.F. 618   award shall be paid to the eligible health care professional 1   after the completion of the second year, the third year, and 2   the fourth year of the eligible health care professionals 3   employment obligation. 4   (c) An amount equal to thirty-five percent of the aggregate 5   award shall be paid to the eligible health care professional 6   after the completion of the fifth year of the eligible health 7   care professionals employment obligation. 8   (2) For a part-time employment obligation, the aggregate 9   award shall be prorated by the commission. 10   b. A minimum of every five years, the commission, in 11   consultation with the department, shall establish a list of 12   eligible health care professions and the aggregate award amount 13   for each eligible health care profession. The aggregate award 14   amount shall not exceed two hundred thousand dollars. 15   c. An individual who executed a program agreement under 16   subsection 5, paragraph c , prior to the exclusion of the 17   individuals health care profession from the list established 18   under paragraph b shall remain eligible for the program per 19   the terms of the individuals program agreement. 20   7. Health care professional incentive program fund. A 21   health care professional incentive program fund is created in 22   the state treasury under the control of the commission. All 23   moneys deposited or paid into the fund are appropriated to the 24   commission to be used for awards as provided in this section. 25   Notwithstanding section 8.33, moneys in the fund that remain 26   unencumbered or unobligated at the close of each fiscal year 27   shall not revert but shall remain available for expenditure. 28   Notwithstanding section 12C.7, subsection 2, interest or 29   earnings on moneys in the fund shall be credited to the fund 30   and may be utilized by the commission for administrative costs. 31   8. Rules. The commission, in coordination with the   32   department, shall adopt rules pursuant to chapter 17A to 33   administer this section.   34   Sec. 12. EFFECTIVE DATE. This division of this Act, being 35   -8-   LSB 1555SZ (2) 91   lh/ko 8/ 41  

  S.F. 618   deemed of immediate importance, takes effect upon enactment. 1   DIVISION V 2   GRADUATE MEDICAL EDUCATION  MEDICAID SUPPLEMENTAL ENHANCED 3   PAYMENT 4   Sec. 13. GRADUATE MEDICAL EDUCATION  MEDICAID 5   SUPPLEMENTAL ENHANCED PAYMENT. The department of health and 6   human services shall submit to the centers for Medicare and 7   Medicaid services of the United States department of health 8   and human services a request for approval for a Medicaid 9   supplemental enhanced payment for the purposes of maximizing 10   federal funding opportunities for graduate medical education, 11   and to increase the number of medical residencies in the state. 12   Upon receipt of federal approval, the department of health and 13   human services shall notify the general assembly and the Code 14   editor. 15   Sec. 14. EFFECTIVE DATE. This division of this Act, being 16   deemed of immediate importance, takes effect upon enactment. 17   DIVISION VI 18   ELIMINATION OF HEALTH CARE-RELATED GRANT, RESIDENCY, AND 19   FELLOWSHIP PROGRAMS  DEPARTMENT OF HEALTH AND HUMAN SERVICES 20   Sec. 15. Section 135.179, subsection 2, Code 2025, is 21   amended to read as follows: 22   2. Funding for the program may be provided through the   23   health care workforce shortage fund or the fulfilling Iowas 24   need for dentists matching grant program account created in 25   section 135.175 . The purpose of the program is to establish, 26   expand, or support the placement of dentists in dental or rural 27   shortage areas across the state by providing education loan 28   repayments. 29   Sec. 16. Section 249M.4, subsection 2, Code 2025, is amended 30   to read as follows: 31   2. Moneys in the trust fund shall be used, subject to 32   their appropriation by the general assembly, by the department 33   to reimburse participating hospitals the medical assistance 34   program upper payment limit for inpatient and outpatient 35   -9-   LSB 1555SZ (2) 91   lh/ko 9/ 41       

  S.F. 618   hospital services as calculated in this section . Following 1   payment of such upper payment limit to participating hospitals, 2   any remaining funds in the trust fund on an annual basis may be 3   used for any of the following purposes: 4   a. To support medical assistance program utilization 5   shortfalls. 6   b. To maintain the states capacity to provide access to and 7   delivery of services for vulnerable Iowans. 8   c.   To fund the health care workforce support initiative 9   created pursuant to section 135.175 . 10   d.   c. To support access to health care services for 11   uninsured Iowans. 12   e. d. To support Iowa hospital programs and services which 13   expand access to health care services for Iowans. 14   Sec. 17. REPEAL. Sections 135.175, 135.176, 135.178, and 15   135.193, Code 2025, are repealed. 16   Sec. 18. TRANSITION PROVISIONS. 17   1. a. The department of health and human services shall 18   provide matching state funding to a sponsor awarded on or 19   before June 30, 2025, under the medical residency training 20   state matching grants program in section 135.176, Code 2025, 21   until all residents in the funded residencies have completed or 22   left the program. 23   b. The department of health and human services shall provide 24   matching state funding to a sponsor for medical residency 25   training program liability costs awarded on or before June 26   30, 2025, under the medical residency training state matching 27   grants program in section 135.176, Code 2025, until June 30, 28   2026. 29   2. The department of health and human services shall provide 30   matching state funding to a sponsor awarded on or before June 31   30, 2025, under the nurse residency state matching grants 32   program in section 135.178, Code 2025, until all residents have 33   completed or left the nurse residency programs. 34   3. The department of health and human services shall fund 35   -10-   LSB 1555SZ (2) 91   lh/ko 10/ 41            

  S.F. 618   a fellowship position pursuant to a program agreement entered 1   into on or before June 30, 2025, by a participating teaching 2   hospital and a participating fellow under the state-funded 3   family medicine obstetrics fellowship program in section 4   135.193, Code 2025, if the participating fellow remains in 5   compliance with all obligations under the program agreement. 6   4. The department of health and human services shall fund 7   a rural psychiatric residency for a resident selected on or 8   before June 30, 2025, until all residents have completed 9   or left the rural psychiatric residencies, pursuant to 10   appropriations as provided in the following: 11   a. 2024 Iowa Acts, chapter 1157, section 5, subsection 3, 12   and 2024 Iowa Acts, chapter 1157, section 22, subsection 5. 13   b. 2023 Iowa Acts, chapter 112, section 5, subsection 4, 14   paragraph j, as amended by 2024 Iowa Acts, chapter 1157, 15   section 29. 16   c. 2022 Iowa Acts, chapter 1131, section 3, subsection 4, 17   paragraph j, as amended by 2024 Iowa Acts, chapter 1157, 18   section 23. 19   d. 2021 Iowa Acts, chapter 182, section 3, subsection 4, 20   paragraph j. 21   e. 2019 Iowa Acts, chapter 85, section 3, subsection 4, 22   paragraph j, as amended by 2020 Iowa Acts, chapter 1121, 23   section 19. 24   Sec. 19. TRANSFER OF MONEYS. Notwithstanding section 8.33 25   or any other provision to the contrary, any unobligated or 26   unencumbered moneys in any of the following accounts or funds 27   or constituting any specified appropriation, shall not revert 28   but are appropriated to the department of health and human 29   services to fund Medicaid graduate medical education efforts. 30   1. The health care workforce shortage fund created in 31   section 135.175, subsection 1, paragraph b, Code 2025. 32   2. The medical residency training account created in 33   section 135.175, subsection 5, paragraph a, Code 2025. 34   3. The nurse residency state matching grants program 35   -11-   LSB 1555SZ (2) 91   lh/ko 11/ 41  

  S.F. 618   account created in section 135.175, subsection 5, paragraph 1   b, Code 2025. 2   4. The health care workforce shortage national initiatives 3   account created in section 135.175, subsection 5, paragraph 4   c, Code 2025. 5   5. The family medicine obstetrics fellowship program fund 6   created in section 135.193, Code 2025. 7   6. Moneys appropriated to the department of health and human 8   services for rural psychiatric residencies to fund psychiatric 9   residents to provide mental health services in underserved 10   areas of the state as described in the following: 11   a. 2024 Iowa Acts, chapter 1157, section 5, subsection 3, 12   and 2024 Iowa Acts, chapter 1157, section 22, subsection 5. 13   b. 2023 Iowa Acts, chapter 112, section 5, subsection 4, 14   paragraph j, as amended by 2024 Iowa Acts, chapter 1157, 15   section 29. 16   c. 2022 Iowa Acts, chapter 1131, section 3, subsection 4, 17   paragraph j, as amended by 2024 Iowa Acts, chapter 1157, 18   section 23. 19   d. 2021 Iowa Acts, chapter 182, section 3, subsection 4, 20   paragraph j. 21   e. 2019 Iowa Acts, chapter 85, section 3, subsection 4, 22   paragraph j, as amended by 2020 Iowa Acts, chapter 1121, 23   section 19. 24   Sec. 20. TRANSITION  ACCOUNTS. 25   1. The department of health and human services shall create 26   individual accounts for the deposit of any moneys encumbered 27   or obligated relating to a grant awarded, or residency or 28   fellowship funded, under each of the following programs: 29   a. The medical residency training state matching grants 30   program under section 135.176, Code 2025. 31   b. The nurse residency state matching grants program under 32   section 135.178, Code 2025. 33   c. The state-funded family medicine obstetrics fellowship 34   program under section 135.193, Code 2025. 35   -12-   LSB 1555SZ (2) 91   lh/ko 12/ 41  

  S.F. 618   d. Rural psychiatric residencies as described in the 1   following: 2   (1) 2024 Iowa Acts, chapter 1157, section 5, subsection 3, 3   and 2024 Iowa Acts, chapter 1157, section 22, subsection 5. 4   (2) 2023 Iowa Acts, chapter 112, section 5, subsection 4, 5   paragraph j, as amended by 2024 Iowa Acts, chapter 1157, 6   section 29. 7   (3) 2022 Iowa Acts, chapter 1131, section 3, subsection 8   4, paragraph j, as amended by 2024 Iowa Acts, chapter 1157, 9   section 23. 10   (4) 2021 Iowa Acts, chapter 182, section 3, subsection 4, 11   paragraph j. 12   (5) 2019 Iowa Acts, chapter 85, section 3, subsection 4, 13   paragraph j, as amended by 2020 Iowa Acts, chapter 1121, 14   section 19. 15   2. Notwithstanding section 8.33, any balance in any of the 16   accounts created under subsection 1 shall not revert but shall 17   remain available for the duration of all applicable grants, 18   residencies, and fellowships. Notwithstanding section 12C.7, 19   subsection 2, interest or earnings on moneys deposited in each 20   account shall be credited to the respective account. 21   3. Upon expiration of all grant, residency, and fellowship 22   periods and the expenditure of all moneys encumbered under 23   such grants, residencies, and fellowships, any unencumbered or 24   unobligated moneys remaining in any of the accounts created 25   under subsection 1 are appropriated to the department of health 26   and human services for Medicaid graduate medical education 27   efforts.   28   Sec. 21. CONTINGENT EFFECTIVE DATE. This division of   29   this Act takes effect upon the date that the department of 30   health and human services notifies the general assembly and the 31   Code editor of the receipt of federal approval for a Medicaid 32   supplemental enhanced payment for the purposes of maximizing 33   federal funding opportunities for graduate medical education, 34   and to increase the number of medical residencies in the state. 35   -13-   LSB 1555SZ (2) 91   lh/ko 13/ 41  

  S.F. 618   DIVISION VII 1   ELIMINATION OF THE STATE-FUNDED PSYCHIATRY RESIDENCY AND 2   FELLOWSHIP POSITIONS  UNIVERSITY OF IOWA HOSPITALS AND 3   CLINICS 4   Sec. 22. REPEAL. Section 135.180, Code 2025, is repealed. 5   Sec. 23. TRANSITION PROVISIONS. The board of regents 6   shall direct the university of Iowa hospitals and clinics to 7   distribute moneys for state-funded psychiatry residency and 8   fellowship positions approved and awarded on or before June 9   30, 2025, under the state-funded psychiatry residency and 10   fellowship positions in section 135.180, Code 2025, until all 11   residents and fellows have completed or left the state-funded 12   psychiatry residency or fellowship positions. 13   Sec. 24. TRANSITION  ACCOUNT. 14   1. The board of regents shall direct the university of Iowa 15   hospitals and clinics to create an account for the deposit 16   of moneys encumbered or obligated relating to residency and 17   fellowship positions funded under the state-funded psychiatry 18   residency and fellowship positions under section 135.180, Code 19   2025. 20   2. Notwithstanding section 8.33, any balance in the account 21   created under subsection 1 shall not revert but shall remain 22   available for the duration of all applicable residencies and 23   fellowships. Notwithstanding section 12C.7, subsection 2, 24   interest or earnings on moneys deposited in the account shall 25   be credited to the account. 26   3. Upon expiration of all residency and fellowship periods 27   and the expenditure of all moneys encumbered under such 28   residencies and fellowships, any unencumbered or unobligated 29   moneys remaining in the account created under subsection 1 are 30   appropriated to the department of health and human services for 31   Medicaid graduate medical education efforts. 32   Sec. 25. TRANSFER OF MONEYS. Notwithstanding section 8.33 33   or any other provision to the contrary, any unobligated or 34   unencumbered moneys in the psychiatry residency and fellowship 35   -14-   LSB 1555SZ (2) 91   lh/ko 14/ 41  

  S.F. 618   positions fund created in section 135.180, Code 2025, shall 1   not revert but are appropriated to the department of health 2   and human services to fund Medicaid graduate medical education 3   efforts. 4   Sec. 26. CONTINGENT EFFECTIVE DATE. This division of 5   this Act takes effect upon the date that the department of 6   health and human services notifies the general assembly and the 7   Code editor of the receipt of federal approval for a Medicaid 8   supplemental enhanced payment for the purposes of maximizing 9   federal funding opportunities for graduate medical education, 10   and to increase the number of medical residencies in the state. 11   DIVISION VIII 12   ELIMINATION OF THE HEALTH FACILITIES COUNCIL 13   Sec. 27. Section 10A.711, subsection 5, Code 2025, is 14   amended by striking the subsection and inserting in lieu 15   thereof the following: 16   5. Department means the department of health and human 17   services. 18   Sec. 28. Section 10A.713, subsection 4, unnumbered 19   paragraph 1, Code 2025, is amended to read as follows: 20   A copy of the application shall be sent to the department   21   of health and human services at the time the application is 22   submitted to the department.   The department shall not process 23   applications for and the council shall not an intermediate 24   care facility for persons with an intellectual disability, or 25   consider a new or changed institutional health service for an 26   intermediate care facility for persons with an intellectual 27   disability , unless both of the following conditions are met: 28   Sec. 29. Section 10A.714, subsection 1, unnumbered 29   paragraph 1, Code 2025, is amended to read as follows: 30   In determining whether a certificate of need shall be 31   issued, the department and council   shall consider the 32   following: 33   Sec. 30. Section 10A.714, subsection 1, paragraph r, Code 34   2025, is amended to read as follows: 35   -15-   LSB 1555SZ (2) 91   lh/ko 15/ 41          

  S.F. 618   r. The recommendations of staff personnel of the department 1   assigned to the area of certificate of need, concerning the 2   application , if requested by the council   . 3   Sec. 31. Section 10A.714, subsection 2, unnumbered 4   paragraph 1, Code 2025, is amended to read as follows: 5   In addition to the findings required with respect to any 6   of the criteria listed in subsection 1 of this section , the 7   council department shall grant a certificate of need for a new 8   institutional health service or changed institutional health 9   service only if it   the department finds in writing, on the 10   basis of data submitted to it by the department   , that: 11   Sec. 32. Section 10A.716, subsection 3, Code 2025, is 12   amended to read as follows: 13   3. Each application accepted by the department shall be 14   formally reviewed for the purpose of furnishing to the council   15   the information necessary to enable it the department to 16   determine whether or not to grant the certificate of need. A 17   formal review shall consist ,   at a minimum , of the following 18   steps: 19   a. Evaluation of the application against the criteria 20   specified in section 10A.714   135.63 . 21   b. A public hearing on the application, to be held prior to 22   completion of the evaluation required by paragraph a , shall be   23   conducted by the council . 24   Sec. 33. Section 10A.719, Code 2025, is amended to read as 25   follows: 26   10A.719 Council Department to make final decision. 27   1. The department shall complete its formal review of 28   the application within ninety days after acceptance of the 29   application, except as otherwise provided by section 10A.722   30   135.71 , subsection 4 . Upon completion of the formal review, 31   the council   department shall approve or deny the application. 32   The council department shall issue written findings stating the 33   basis for its decision on the application ,   and the department 34   shall send copies of the councils decision and the written 35   -16-   LSB 1555SZ (2) 91   lh/ko 16/ 41                             

  S.F. 618   findings supporting the decision to the applicant and to any 1   other person who so requests. 2   2. Failure by the council   department to issue a written 3   decision on an application for a certificate of need within the 4   time required by this section shall constitute denial of and 5   final administrative action on the application. 6   Sec. 34. Section 10A.720, Code 2025, is amended to read as 7   follows: 8   10A.720 Appeal of certificate of need decisions. 9   The councils   departments decision on an application for 10   certificate of need, when announced pursuant to section 10A.719   11   135.68 , is shall be a final decision. Any dissatisfied party 12   who is an affected person with respect to the application, 13   and who participated or sought unsuccessfully to participate 14   in the formal review procedure prescribed by section 10A.716   15   135.65 , may request a rehearing in accordance with chapter 17A 16   and rules of the department. If a rehearing is not requested 17   or an affected party remains dissatisfied after the request for 18   rehearing, an appeal may be taken in the manner provided by 19   chapter 17A . Notwithstanding the Iowa administrative procedure 20   Act, chapter 17A , a request for rehearing is not required ,   21   prior to appeal under section 17A.19 . 22   Sec. 35. Section 10A.721, Code 2025, is amended to read as 23   follows: 24   10A.721 Period for which certificate is valid  extension 25   or revocation. 26   1. A certificate of need shall be valid for a maximum of   27   one year from the date of issuance. Upon the expiration of the 28   certificate, or at any earlier time while the certificate is 29   valid ,   the holder thereof of the certificate shall provide the 30   department such information on the development of the project 31   covered by the certificate as the department may request. 32   The council   department shall determine at the end of the 33   certification period whether sufficient progress is being made 34   on the development of the project. The certificate of need may 35   -17-   LSB 1555SZ (2) 91   lh/ko 17/ 41                   

  S.F. 618   be extended by the council department for additional periods 1   of time as are reasonably necessary to expeditiously complete 2   the project, but may be revoked by the council   department at 3   the end of the first or any subsequent certification period for 4   insufficient progress in developing the project. 5   2. Upon expiration of a certificate of need, and prior to 6   extension thereof of the certificate of need , any affected 7   person shall have the right to submit to the department 8   information which may be relevant to the question of granting 9   an extension. The department may call a public hearing for 10   this purpose. 11   Sec. 36. Section 10A.722, unnumbered paragraph 1, Code 12   2025, is amended to read as follows: 13   The department shall adopt , with approval of the council,   14   such administrative rules as are necessary to enable it to 15   implement this part subchapter . These rules shall include: 16   Sec. 37. Section 10A.723, subsection 2, paragraph a, Code 17   2025, is amended to read as follows: 18   a. A class I violation is one in which a party offers a 19   new institutional health service or changed institutional 20   health service modernization or acquisition without review and 21   approval by the council   department . A party in violation is 22   subject to a penalty of three hundred dollars for each day of a 23   class I violation. The department may seek injunctive relief 24   which shall include restraining the commission or continuance 25   of an act which would violate the provisions of this paragraph. 26   Notice and opportunity to be heard shall be provided to a party 27   pursuant to rule of civil procedure 1.1507 and contested case 28   procedures in accordance with chapter 17A . The department may 29   reduce, alter, or waive a penalty upon the party showing good 30   faith compliance with the departments request to immediately 31   cease and desist from conduct in violation of this section .   32   Sec. 38. Section 68B.35, subsection 2, paragraph e, Code 33   2025, is amended to read as follows: 34   e. Members of the state banking council, the Iowa ethics and 35   -18-   LSB 1555SZ (2) 91   lh/ko 18/ 41              

  S.F. 618   campaign disclosure board, the credit union review board, the 1   economic development authority, the employment appeal board, 2   the environmental protection commission, the health facilities   3   council, the Iowa finance authority, the Iowa public employees 4   retirement system investment board, the Iowa lottery commission 5   created in section 99G.8 , the natural resource commission, the 6   board of parole, the state racing and gaming commission, the 7   state board of regents, the transportation commission, the 8   office of consumer advocate, the utilities commission, the Iowa 9   telecommunications and technology commission, and any full-time 10   members of other boards and commissions as defined under 11   section 7E.4 who receive an annual salary for their service 12   on the board or commission. The Iowa ethics and campaign 13   disclosure board shall conduct an annual review to determine 14   if members of any other board, commission, or authority should 15   file a statement and shall require the filing of a statement 16   pursuant to rules adopted pursuant to chapter 17A . 17   Sec. 39. Section 97B.1A, subsection 8, paragraph a, 18   subparagraph (8), Code 2025, is amended to read as follows: 19   (8) Members of the state transportation commission ,   and the 20   board of parole , and the state health facilities council   . 21   Sec. 40. CODE EDITOR DIRECTIVE. 22   1. The Code editor is directed to make the following 23   transfers: 24   a. Section 10A.711 to section 135.61. 25   b. Section 10A.713 to section 135.62. 26   c. Section 10A.714 to section 135.63. 27   d. Section 10A.715 to section 135.64. 28   e. Section 10A.716 to section 135.65. 29   f. Section 10A.717 to section 135.66. 30   g. Section 10A.718 to section 135.67. 31   h. Section 10A.719 to section 135.68. 32   i. Section 10A.720 to section 135.69. 33   j. Section 10A.721 to section 135.70. 34   k. Section 10A.722 to section 135.71. 35   -19-   LSB 1555SZ (2) 91   lh/ko 19/ 41       

  S.F. 618   l. Section 10A.723 to section 135.72. 1   m. Section 10A.724 to section 135.73. 2   n. Section 10A.725 to section 135.74. 3   o. Section 10A.726 to section 135.75. 4   p. Section 10A.727 to section 135.76. 5   q. Section 10A.728 to section 135.77. 6   r. Section 10A.729 to section 135.78. 7   2. The Code editor is directed to rename and retitle 8   subchapter VI of chapter 135 as HEALTH FACILITIES and include 9   sections 135.61 through 135.78. 10   3. The Code editor shall correct internal references in the 11   Code and in any enacted legislation as is necessary due to the 12   enactment of this division. 13   Sec. 41. REPEAL. Section 10A.712, Code 2025, is repealed. 14   DIVISION IX 15   CONFORMING CHANGES  ELIMINATION OF THE HEALTH FACILITIES 16   COUNCIL 17   Sec. 42. Section 10A.711, unnumbered paragraph 1, Code 18   2025, is amended to read as follows: 19   As used in this part   subchapter , unless the context 20   otherwise requires: 21   Sec. 43. Section 10A.711, subsection 1, paragraph d, Code 22   2025, is amended to read as follows: 23   d. Each institutional health facility or health maintenance 24   organization which, prior to receipt of the application by the 25   department, has formally indicated to the department pursuant 26   to this part   subchapter an intent to furnish in the future 27   institutional health services similar to the new institutional   28   health service proposed in the application. 29   Sec. 44. Section 10A.713, subsection 1, Code 2025, is 30   amended to read as follows: 31   1. A new institutional health service or changed 32   institutional health service shall not be offered or developed 33   in this state without prior application to the department 34   for and receipt of a certificate of need, pursuant to this 35   -20-   LSB 1555SZ (2) 91   lh/ko 20/ 41      

  S.F. 618   part subchapter . The application shall be made upon forms 1   furnished or prescribed by the department and shall contain 2   such information as the department may require under this part   3   subchapter . The application shall be accompanied by a fee 4   equivalent to three-tenths of one percent of the anticipated 5   cost of the project with a minimum fee of six hundred dollars 6   and a maximum fee of twenty-one thousand dollars. The fee 7   shall be remitted by the department to the treasurer of 8   state, who shall place it in the general fund of the state. 9   If an application is voluntarily withdrawn within thirty 10   calendar days after submission, seventy-five percent of the 11   application fee shall be refunded; if the application is 12   voluntarily withdrawn more than thirty but within sixty days 13   after submission, fifty percent of the application fee shall 14   be refunded; if the application is withdrawn voluntarily more 15   than sixty days after submission, twenty-five percent of 16   the application fee shall be refunded. Notwithstanding the 17   required payment of an application fee under this subsection , 18   an applicant for a new institutional health service or a 19   changed institutional health service offered or developed by 20   an intermediate care facility for persons with an intellectual 21   disability or an intermediate care facility for persons with 22   mental illness as defined pursuant to section 135C.1 is exempt 23   from payment of the application fee. 24   Sec. 45. Section 10A.713, subsection 2, unnumbered 25   paragraph 1, Code 2025, is amended to read as follows: 26   This part   subchapter shall not be construed to augment, 27   limit, contravene, or repeal in any manner any other statute 28   of this state which may authorize or relate to licensure, 29   regulation, supervision, or control of, nor to be applicable 30   to:   31   Sec. 46. Section 10A.713, subsection 2, paragraphs a, f, h, 32   j, k, m, and n, Code 2025, are amended to read as follows: 33   a. Private offices and private clinics of an individual 34   physician, dentist, or other practitioner or group of health 35   -21-   LSB 1555SZ (2) 91   lh/ko 21/ 41        

  S.F. 618   care providers, except as provided by section 10A.711 135.61 , 1   subsection 17 , paragraphs g , h , and m , and section 10A.711   2   135.61 , subsections 2 and 19 . 3   f. A residential care facility, as defined in section 4   135C.1 , including a residential care facility for persons with 5   an intellectual disability, notwithstanding any provision in 6   this part subchapter to the contrary. 7   h. (1) The deletion of one or more health services, 8   previously offered on a regular basis by an institutional 9   health facility or health maintenance organization, 10   notwithstanding any provision of this part   subchapter to the 11   contrary, if all of the following conditions exist: 12   (a) The institutional health facility or health maintenance 13   organization reports to the department the deletion of the 14   service or services at least thirty days before the deletion on 15   a form prescribed by the department. 16   (b) The institutional health facility or health maintenance 17   organization reports the deletion of the service or services on 18   its next annual report to the department. 19   (2) If these conditions are not met, the institutional 20   health facility or health maintenance organization is subject 21   to review as a new institutional health service or changed 22   institutional health service under section 10A.711   135.61 , 23   subsection 17 , paragraph f , and is subject to sanctions under 24   section 10A.723 135.72 . 25   (3) If the institutional health facility or health 26   maintenance organization reestablishes the deleted service 27   or services at a later time, review as a new institutional 28   health service or changed institutional health service may 29   be required pursuant to section 10A.711   135.61 , subsection 17 . 30   j. The construction, modification, or replacement of 31   nonpatient care services, including parking facilities, 32   heating, ventilation and air conditioning systems, computers, 33   telephone systems, medical office buildings, and other projects 34   of a similar nature, notwithstanding any provision in this part   35   -22-   LSB 1555SZ (2) 91   lh/ko 22/ 41                 

  S.F. 618   subchapter to the contrary. 1   k. (1) The redistribution of beds by a hospital within 2   the acute care category of bed usage, notwithstanding any 3   provision in this part   subchapter to the contrary, if all of 4   the following conditions exist: 5   (a) The hospital reports to the department the number and 6   type of beds to be redistributed on a form prescribed by the 7   department at least thirty days before the redistribution. 8   (b) The hospital reports the new distribution of beds on its 9   next annual report to the department. 10   (2) If these conditions are not met, the redistribution 11   of beds by the hospital is subject to review as a new 12   institutional health service or changed institutional health 13   service pursuant to section 10A.711   135.61 , subsection 17 , 14   paragraph d , and is subject to sanctions under section 10A.723 15   135.72 . 16   m. Hemodialysis services provided by a hospital or 17   freestanding facility, notwithstanding any provision in this 18   part   subchapter to the contrary. 19   n. Hospice services provided by a hospital, notwithstanding 20   any provision in this part   subchapter to the contrary. 21   Sec. 47. Section 10A.713, subsection 2, paragraph e, 22   subparagraph (2), Code 2025, is amended to read as follows: 23   (2) Acquires major medical equipment as provided by section 24   10A.711   135.61 , subsection 17 , paragraphs i and j . 25   Sec. 48. Section 10A.713, subsection 2, paragraph g, 26   subparagraph (1), unnumbered paragraph 1, Code 2025, is amended 27   to read as follows: 28   A reduction in bed capacity of an institutional health 29   facility, notwithstanding any provision in this part   subchapter 30   to the contrary, if all of the following conditions exist: 31   Sec. 49. Section 10A.713, subsection 2, paragraph g, 32   subparagraph (2), Code 2025, is amended to read as follows: 33   (2) If these conditions are not met, the institutional 34   health facility is subject to review as a new institutional 35   -23-   LSB 1555SZ (2) 91   lh/ko 23/ 41                 

  S.F. 618   health service or changed institutional health service under 1   section 10A.711   135.61 , subsection 17 , paragraph d , and is 2   subject to sanctions under section 10A.723 135.72 . If the 3   institutional health facility reestablishes the deleted beds at 4   a later time, review as a new institutional health service or 5   changed institutional health service is required pursuant to 6   section 10A.711 135.61 , subsection 17 , paragraph d . 7   Sec. 50. Section 10A.713, subsection 2, paragraph l, 8   unnumbered paragraph 1, Code 2025, is amended to read as 9   follows: 10   The replacement or modernization of any institutional 11   health facility if the replacement or modernization does 12   not add new health services or additional bed capacity for 13   existing health services, notwithstanding any provision in this 14   part   subchapter to the contrary. With respect to a nursing 15   facility, replacement means establishing a new facility within 16   the same county as the prior facility to be closed. With 17   reference to a hospital, replacement means establishing a new 18   hospital that demonstrates compliance with all of the following 19   criteria through evidence submitted to the department: 20   Sec. 51. Section 10A.713, subsection 2, paragraph p, 21   unnumbered paragraph 1, Code 2025, is amended to read as 22   follows: 23   The conversion of an existing number of beds by an 24   intermediate care facility for persons with an intellectual 25   disability to a smaller facility environment, including but not 26   limited to a community-based environment which does not result 27   in an increased number of beds, notwithstanding any provision 28   in this part   subchapter to the contrary, including subsection 29   4 , if all of the following conditions exist: 30   Sec. 52. Section 10A.713, subsection 3, Code 2025, is 31   amended to read as follows: 32   3. This part   subchapter shall not be construed to be 33   applicable to a health care facility operated by and for the 34   exclusive use of members of a religious order, which does 35   -24-   LSB 1555SZ (2) 91   lh/ko 24/ 41              

  S.F. 618   not admit more than two individuals to the facility from the 1   general public, and which was in operation prior to July 1, 2   1986. However, this part   subchapter is applicable to such 3   a facility if the facility is involved in the offering or 4   developing of a new or changed institutional health service on 5   or after July 1, 1986. 6   Sec. 53. Section 10A.714, subsection 3, Code 2025, is 7   amended to read as follows: 8   3. In the evaluation of applications for certificates 9   of need submitted by the university of Iowa hospitals and 10   clinics, the unique features of that institution relating to 11   statewide tertiary health care, health science education, and 12   clinical research shall be given due consideration. Further, 13   in administering this part   subchapter , the unique capacity of 14   university hospitals for the evaluation of technologically 15   innovative equipment and other new health services shall be 16   utilized. 17   Sec. 54. Section 10A.715, subsection 2, Code 2025, is 18   amended to read as follows: 19   2. Upon request of the sponsor of the proposed new or 20   changed service, the department shall make a preliminary review 21   of the letter for the purpose of informing the sponsor of 22   the project of any factors which may appear likely to result 23   in denial of a certificate of need, based on the criteria 24   for evaluation of applications in section 10A.714   135.63 . 25   A comment by the department under this section shall not 26   constitute a final decision.   27   Sec. 55. Section 10A.716, subsection 1, Code 2025, is 28   amended to read as follows: 29   1. Within fifteen business days after receipt of an 30   application for a certificate of need, the department shall 31   examine the application for form and completeness and accept or 32   reject it. An application shall be rejected only if it fails 33   to provide all information required by the department pursuant 34   to section 10A.713   135.62 , subsection 1 . The department shall 35   -25-   LSB 1555SZ (2) 91   lh/ko 25/ 41          

  S.F. 618   promptly return to the applicant any rejected application, with 1   an explanation of the reasons for its rejection. 2   Sec. 56. Section 10A.717, subsection 1, unnumbered 3   paragraph 1, Code 2025, is amended to read as follows: 4   The department may waive the letter of intent procedures 5   prescribed by section 10A.715   135.64 and substitute a summary 6   review procedure, which shall be established by rules of the 7   department, when it accepts an application for a certificate 8   of need for a project which meets any of the criteria in 9   paragraphs a through e : 10   Sec. 57. Section 10A.722, subsections 2, 3, and 4, Code 11   2025, are amended to read as follows: 12   2. Uniform procedures for variations in application of 13   criteria specified by section 10A.714   135.63 for use in formal 14   review of applications for certificates of need, when such 15   variations are appropriate to the purpose of a particular 16   review or to the type of institutional health service proposed 17   in the application being reviewed. 18   3. Uniform procedures for summary reviews conducted under 19   section 10A.717   135.66 . 20   4. Criteria for determining when it is not feasible to 21   complete formal review of an application for a certificate 22   of need within the time limits specified in section 10A.719   23   135.68 . The rules adopted under this subsection shall include 24   criteria for determining whether an application proposes 25   introduction of technologically innovative equipment, and if 26   so, procedures to be followed in reviewing the application. 27   However, a rule adopted under this subsection shall not permit 28   a deferral of more than sixty days beyond the time when a 29   decision is required under section 10A.719   135.68 , unless both 30   the applicant and the department agree to a longer deferment. 31   Sec. 58. Section 10A.723, subsections 1 and 3, Code 2025,   32   are amended to read as follows: 33   1. Any party constructing a new institutional health 34   facility or an addition to or renovation of an existing 35   -26-   LSB 1555SZ (2) 91   lh/ko 26/ 41            

  S.F. 618   institutional health facility without first obtaining a 1   certificate of need or, in the case of a mobile health 2   service, ascertaining that the mobile health service has 3   received certificate of need approval, as required by this part   4   subchapter   , shall be denied licensure or change of licensure by 5   the appropriate responsible licensing agency of this state. 6   3. Notwithstanding any other sanction imposed pursuant 7   to this section , a party offering or developing any new 8   institutional health service or changed institutional health 9   service without first obtaining a certificate of need as 10   required by this part   subchapter, may be temporarily or 11   permanently restrained from doing so by any court of competent 12   jurisdiction in any action brought by the state, any of its 13   political subdivisions, or any other interested person. 14   Sec. 59. Section 10A.723, subsection 2, unnumbered 15   paragraph 1, Code 2025, is amended to read as follows: 16   A party violating this part   subchapter shall be subject 17   to penalties in accordance with this section . The 18   department shall adopt rules setting forth the violations by 19   classification, the criteria for the classification of any 20   violation not listed, and procedures for implementing this 21   subsection . 22   Sec. 60. Section 10A.724, subsection 3, Code 2025, is 23   amended to read as follows: 24   3. The department shall, where appropriate, provide 25   for modification, consistent with the purposes of this part   26   subchapter , of reporting requirements to correctly reflect the 27   differences among hospitals and among health care facilities 28   referred to in subsection 2 , and to avoid otherwise unduly 29   burdensome costs in meeting the requirements of uniform methods 30   of financial reporting. 31   Sec. 61. Section 10A.725, subsection 2, Code 2025, is   32   amended to read as follows: 33   2. Where more than one licensed hospital or health 34   care facility is operated by the reporting organization, 35   -27-   LSB 1555SZ (2) 91   lh/ko 27/ 41          

  S.F. 618   the information required by this section shall be reported 1   separately for each licensed hospital or health care facility. 2   The department shall require preparation of specified financial 3   reports by a certified public accountant, and may require 4   attestation of responsible officials of the reporting hospital 5   or health care facility that the reports submitted are to the 6   best of their knowledge and belief prepared in accordance with 7   the prescribed methods of reporting. The department shall 8   have the right to inspect the books, audits and records of any 9   hospital or health care facility as reasonably necessary to 10   verify reports submitted pursuant to this part   subchapter . 11   Sec. 62. Section 10A.726, subsection 1, Code 2025, is 12   amended to read as follows: 13   1. The department shall from time to time undertake analyses 14   and studies relating to hospital and health care facility 15   costs and to the financial status of hospitals or health care 16   facilities, or both, which are subject to the provisions of 17   this part   subchapter . It shall further require the filing 18   of information concerning the total financial needs of each 19   individual hospital or health care facility and the resources 20   currently or prospectively available to meet these needs, 21   including the effect of proposals made by health systems 22   agencies. The department shall also prepare and file such 23   summaries and compilations or other supplementary reports based 24   on the information filed with it as will, in its judgment, 25   advance the purposes of this part   subchapter . 26   Sec. 63. Section 10A.727, Code 2025, is amended to read as   27   follows: 28   10A.727 Data to be compiled. 29   The department shall compile all relevant financial and 30   utilization data in order to have available the statistical   31   information necessary to properly monitor hospital and health 32   care facility charges and costs. Such data shall include 33   necessary operating expenses, appropriate expenses incurred for 34   rendering services to patients who cannot or do not pay, all 35   -28-   LSB 1555SZ (2) 91   lh/ko 28/ 41        

  S.F. 618   properly incurred interest charges, and reasonable depreciation 1   expenses based on the expected useful life of the property 2   and equipment involved. The department shall also obtain 3   from each hospital and health care facility a current rate 4   schedule as well as any subsequent amendments or modifications 5   of that schedule as it may require. In collection of the data 6   required by this section and sections 10A.724   135.73 through 7   10A.726 135.75 , the department and other state agencies shall 8   coordinate their reporting requirements. 9   Sec. 64. Section 10A.728, Code 2025, is amended to read as 10   follows: 11   10A.728 Civil penalty. 12   Any hospital or health care facility which fails to file 13   with the department the financial reports required by sections 14   10A.724   135.73 through 10A.727 135.76 is subject to a civil 15   penalty of not to exceed five hundred dollars for each offense. 16   Sec. 65. Section 10A.729, Code 2025, is amended to read as 17   follows: 18   10A.729 Contracts for assistance with analyses, studies, and 19   data. 20   In furtherance of the departments responsibilities under 21   sections 10A.726   135.75 and 10A.727 135.76 , the director may 22   contract with the Iowa hospital association and third-party 23   payers, the Iowa health care facilities association and 24   third-party payers, or leading age Iowa and third-party 25   payers for the establishment of pilot programs dealing with 26   prospective rate review in hospitals or health care facilities, 27   or both. Such contract shall be subject to the approval of 28   the executive council and shall provide for an equitable 29   representation of health care providers, third-party payers, 30   and health care consumers in the determination of criteria   31   for rate review. No third-party payer shall be excluded from 32   positive financial incentives based upon volume of gross 33   patient revenues. No state or federal funds appropriated or 34   available to the department shall be used for any such pilot 35   -29-   LSB 1555SZ (2) 91   lh/ko 29/ 41              

  S.F. 618   program. 1   Sec. 66. Section 135.131, subsection 1, paragraph a, Code 2   2025, is amended to read as follows: 3   a. Birth center means birth center as defined in section 4   10A.711 135.61 . 5   Sec. 67. Section 135B.5A, Code 2025, is amended to read as 6   follows: 7   135B.5A Conversion relative to certain hospitals. 8   1. A conversion of a long-term acute care hospital, 9   rehabilitation hospital, or psychiatric hospital as defined by 10   federal regulations to a general hospital or to a specialty 11   hospital of a different type is a permanent change in bed 12   capacity and shall require a certificate of need pursuant to 13   section 10A.713   135.62 . 14   2. A conversion of a critical access hospital or general 15   hospital to a rural emergency hospital shall not require a 16   certificate of need pursuant to section 10A.713 135.62 . 17   3. Any change of a rural emergency hospital in licensure, 18   organizational structure, or type of institutional health 19   facility shall require a certificate of need pursuant to 20   section 10A.713   135.62 . 21   Sec. 68. Section 135C.2, subsection 5, unnumbered paragraph 22   1, Code 2025, is amended to read as follows: 23   The department shall establish a special classification 24   within the residential care facility category in order to 25   foster the development of residential care facilities which 26   serve persons with an intellectual disability, chronic mental 27   illness, a developmental disability, or brain injury, as 28   described under section 225C.26 , and which contain five or 29   fewer residents. A facility within the special classification 30   established pursuant to this subsection is exempt from the 31   requirements of section 10A.713   135.62 . The department 32   shall adopt rules which are consistent with rules previously 33   developed for the waiver demonstration project pursuant to 34   1986 Iowa Acts, ch. 1246, 206 , and which include all of the 35   -30-   LSB 1555SZ (2) 91   lh/ko 30/ 41            

  S.F. 618   following provisions: 1   Sec. 69. Section 135P.1, subsection 3, Code 2025, is amended 2   to read as follows: 3   3. Health facility means an institutional health facility 4   as defined in section 10A.711 135.61 , a hospice licensed under 5   chapter 135J , a home health agency as defined in section 6   144D.1 , an assisted living program certified under chapter 7   231C , a clinic, a community health center, or the university 8   of Iowa hospitals and clinics, and includes any corporation, 9   professional corporation, partnership, limited liability 10   company, limited liability partnership, or other entity 11   comprised of such health facilities. 12   Sec. 70. Section 231C.3, subsection 2, Code 2025, is amended 13   to read as follows: 14   2. Each assisted living program operating in this state 15   shall be certified by the department. If an assisted living 16   program is voluntarily accredited by a recognized accrediting 17   entity, the department shall certify the assisted living 18   program on the basis of the voluntary accreditation. An 19   assisted living program that is certified by the department on 20   the basis of voluntary accreditation shall not be subject to 21   payment of the certification fee prescribed in section 231C.18 , 22   but shall be subject to an administrative fee as prescribed by 23   rule. An assisted living program certified under this section 24   is exempt from the requirements of section 10A.713   135.62 25   relating to certificate of need requirements. 26   Sec. 71. Section 505.27, subsection 5, paragraph a, Code 27   2025, is amended to read as follows:   28   a. Health care provider means the same as defined in 29   section 10A.711   135.61 , a hospital licensed pursuant to chapter 30   135B , or a health care facility licensed pursuant to chapter 31   135C .   32   Sec. 72. Section 708.3A, subsection 5, paragraph d, Code 33   2025, is amended to read as follows: 34   d. Health care provider means an emergency medical care 35   -31-   LSB 1555SZ (2) 91   lh/ko 31/ 41        

  S.F. 618   provider as defined in chapter 147A or a person licensed 1   or registered under chapter 148 , 148C , 148D , or 152 who is 2   providing or who is attempting to provide emergency medical 3   services, as defined in section 147A.1 , or who is providing 4   or who is attempting to provide health services as defined in 5   section 10A.711   135.61 in a hospital. A person who commits an 6   assault under this section against a health care provider in 7   a hospital, or at the scene or during out-of-hospital patient 8   transportation in an ambulance, is presumed to know that the 9   person against whom the assault is committed is a health care 10   provider. 11   DIVISION X 12   IOWA HEALTH INFORMATION NETWORK  EXCHANGE ADVISORY COMMITTEE 13   CREATED AND BOARD OF DIRECTORS ELIMINATED 14   Sec. 73. Section 135D.2, subsection 1, Code 2025, is amended 15   by striking the subsection. 16   Sec. 74. Section 135D.2, subsection 4, Code 2025, is amended 17   to read as follows: 18   4. Designated entity means the nonprofit   corporation 19   designated selected by the department through a competitive 20   process as the entity responsible for administering and   21   governing the Iowa health information network. 22   Sec. 75. Section 135D.2, Code 2025, is amended by adding the 23   following new subsections: 24   NEW SUBSECTION   . 4A. Director means the director of health 25   and human services. 26   NEW SUBSECTION . 5A. Exchange advisory committee or 27   advisory committee means the exchange advisory committee 28   appointed by the director pursuant to section 135D.6. 29   Sec. 76. Section 135D.4, subsection 2, paragraph a, Code 30   2025, is amended to read as follows:   31   a. The network, through the designated entity complying with 32   chapter 490, 496C, and   504 and reporting as required under this 33   chapter , operates in an entrepreneurial and businesslike manner 34   in which it is accountable to all participants utilizing the 35   -32-   LSB 1555SZ (2) 91   lh/ko 32/ 41            

  S.F. 618   networks products and services. 1   Sec. 77. Section 135D.5, subsection 1, Code 2025, is amended 2   to read as follows: 3   1. The Iowa health information network shall be 4   administered and governed by a designated entity selected by 5   the department through a competitive process. The designated 6   entity shall be established as a nonprofit   corporation 7   organized under chapter 490, 496C, or 504. Unless otherwise 8   provided in this chapter, the corporation is subject to the   9   provisions of chapter 504. The designated entity shall be 10   established for the purpose of administering and governing   the 11   statewide Iowa health information network. Notwithstanding any 12   provision of law to the contrary, the department shall conduct 13   a competitive process to select a designated entity at least   14   every eight years. 15   Sec. 78. Section 135D.5, subsection 3, paragraph d, Code 16   2025, is amended to read as follows: 17   d. The employment of personnel necessary for the efficient 18   performance of the duties assigned to the designated entity. 19   All such personnel shall be considered employees of a private ,   20   nonprofit   corporation and shall be exempt from the personnel 21   requirements imposed on state agencies, departments, and 22   administrative units. 23   Sec. 79. Section 135D.6, Code 2025, is amended by striking 24   the section and inserting in lieu thereof the following: 25   135D.6 Exchange advisory committee. 26   1. The director shall appoint an exchange advisory 27   committee.   28   2. The advisory committee shall include at least one 29   member who is a consumer of health services, and a majority 30   of the advisory committee members shall be representative of 31   participants in the Iowa health information network. 32   3. The exchange advisory committee shall do all of the 33   following: 34   a. Advise the department regarding the needs of participants 35   -33-   LSB 1555SZ (2) 91   lh/ko 33/ 41               

  S.F. 618   and nonparticipants relating to the exchange of health 1   information. 2   b. Ensure the department develops, and the designated 3   entity complies with, the standards, requirements, policies, 4   and procedures for access to, use, secondary use, privacy, 5   and security of health information exchanged through the Iowa 6   health information network, consistent with applicable federal 7   and state standards and laws. 8   c. Direct a public and private collaborative effort to 9   promote the adoption and use of health information technology 10   in the state to improve health care quality, increase patient 11   safety, reduce health care costs, enhance public health, 12   and empower individuals and health care professionals with 13   comprehensive, real-time medical information to provide 14   continuity of care and make the best health care decisions. 15   d. Educate the public and the health care sector about 16   the value of health information technology in improving 17   patient care, and methods to promote increased support and 18   collaboration of state and local public health agencies, 19   health care professionals, and consumers in health information 20   technology initiatives. 21   e. Work to align interstate and intrastate interoperability 22   standards in accordance with national health information 23   exchange standards. 24   f. Provide an annual budget and fiscal report for the Iowa 25   health information network to the governor, the department 26   of health and human services, the department of management, 27   and the general assembly. The report shall also include 28   information about the services provided through the network and 29   information on the participant usage of the network. 30   Sec. 80. Section 135D.7, subsection 1, unnumbered paragraph 31   1, Code 2025, is amended to read as follows:   32   The board   designated entity shall implement 33   industry-accepted security standards, policies, and procedures 34   to protect the transmission and receipt of protected health 35   -34-   LSB 1555SZ (2) 91   lh/ko 34/ 41    

  S.F. 618   information exchanged through the Iowa health information 1   network, which shall, at a minimum, comply with HIPAA and shall 2   include all of the following: 3   Sec. 81. Section 135D.7, subsection 1, paragraph c, 4   subparagraph (2), Code 2025, is amended to read as follows: 5   (2) The board   designated entity shall provide the means 6   and process by which a patient may decline participation. 7   The means and process utilized shall minimize the burden on 8   patients and health care professionals. 9   Sec. 82. Section 135D.7, subsection 3, Code 2025, is amended 10   to read as follows: 11   3. A participant exchanging health information and data 12   through the Iowa health information network shall grant to 13   other participants of the network a nonexclusive license to 14   retrieve and use that information in accordance with applicable 15   state and federal laws, and the policies and standards 16   established by the board   department . 17   Sec. 83. Section 135D.7, subsection 6, paragraph b, Code 18   2025, is amended to read as follows: 19   b. Any health information in the possession of the 20   board   designated entity due to its the designated entitys 21   administration of the Iowa health information network. 22   EXPLANATION 23   The inclusion of this explanation does not constitute agreement with 24   the explanations substance by the members of the general assembly. 25   This bill relates to health care including a funding model 26   for Iowas rural health system; health care-related award, 27   grant, residency, and fellowship programs; establishment of 28   a health care incentive program; Medicaid graduate medical 29   education; the health facilities council; and the Iowa health   30   information network.   31   DIVISION I. This division requires the department of health 32   and human services (HHS) to submit to the centers for Medicare 33   and Medicaid services of the United States department of health 34   and human services (CMS) a request for approval for a health 35   -35-   LSB 1555SZ (2) 91   lh/ko 35/ 41          

  S.F. 618   care hub-and-spoke partnership funding model for the purpose 1   of improving Iowas rural health system. The division takes 2   effect upon enactment. 3   DIVISION II. This division eliminates the primary care 4   recruitment and retention endeavor (PRIMECARRE) and makes 5   conforming changes. The bill requires HHS to coordinate with 6   the college student aid commission (commission) to administer 7   the health care professional incentive program established in 8   division IV of the bill. PRIMECARRE includes the health care 9   workforce and community support grant program and the primary 10   care provider loan repayment program to recruit and retain 11   primary care providers in rural communities. 12   Current law requires HHS to encourage local boards to adopt 13   a plan including that health facilities may seek technical 14   assistance or apply for matching grants for plan development. 15   The bill removes the instruction for health facilities to apply 16   for matching grants for plan development. 17   HHS is required to make loan repayments pursuant to a loan 18   repayment program contract including a United States department 19   of health and human services state loan repayment program 20   contract executed on or before December 31, 2025, under the 21   primary care provider loan repayment program if a recipient 22   is in compliance with the loan repayment program contract. 23   HHS shall create an account for the deposit of encumbered or 24   obligated moneys relating to the primary care provider loan 25   repayment program as described in the bill. 26   DIVISION III. This division eliminates certain health   27   care-related programs. 28   The rural Iowa primary care loan repayment program (Code 29   section 256.221) is eliminated. The program provides loan 30   repayment for medical students who agree to practice as 31   physicians in certain service areas. 32   The health care professional recruitment program (Code 33   section 256.223) is also eliminated. The program provides loan 34   repayment for students who graduate from a certain institution 35   -36-   LSB 1555SZ (2) 91   lh/ko 36/ 41  

  S.F. 618   and become licensed as a health care professional. 1   In addition, the health care award program (Code section 2   256.224) is eliminated. The program provides financial awards 3   to registered nurses, advanced registered nurse practitioners, 4   physician assistants, and nurse educators who practice in 5   certain areas or teach in this state. 6   Finally, the mental health professional loan repayment 7   program (Code section 256.225) is eliminated. The program 8   provides loan repayment for mental health professionals who 9   agree to practice in certain practice areas. 10   For all of the eliminated programs, the college student aid 11   commission (commission) is required to make loan repayments 12   and provide annual awards pursuant to program agreements and 13   contracts entered into on or before June 30, 2025, as detailed 14   in the bill. All unencumbered and unobligated moneys in the 15   eliminated programs funds shall be transferred to the health 16   care professional incentive program fund (program fund) created 17   in division IV. 18   The commission shall create accounts for the deposit of 19   encumbered and obligated moneys for each eliminated program as 20   detailed in the division. Upon the expiration of all program 21   agreement, contract, and award disbursement periods, any 22   unencumbered and unobligated moneys in the accounts shall be 23   deposited in the program fund created in division IV. 24   DIVISION IV. This division establishes a health care 25   professional incentive program (incentive program) to recruit 26   and retain eligible health care professionals (professionals) 27   in eligible health care professions (profession) in certain 28   areas of the state by offering an award of a loan repayment 29   or an income bonus. The commission, in coordination with   30   HHS, shall administer the incentive program as detailed in 31   the division. A professional is ineligible for the incentive 32   program if the professional is currently participating in or 33   has participated in certain health care-related award programs 34   as identified in divisions II and III. The commission shall   35   -37-   LSB 1555SZ (2) 91   lh/ko 37/ 41  

  S.F. 618   give priority to an applicant fulfilling a full-time employment 1   obligation. The incentive program award shall be distributed 2   annually by the commission as detailed in the division. At 3   least every five years, the commission, in consultation with 4   HHS, shall establish a list of professions, and the aggregate 5   award amounts, not to exceed $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 takes effect upon enactment. 17   DIVISION V. This division requires HHS to submit to CMS 18   a request for approval for a Medicaid supplemental enhanced 19   payment for the purposes of maximizing federal funding 20   opportunities for graduate medical education, and to increase 21   the number of medical residencies in the state. Upon receipt 22   of federal approval, HHS shall notify the general assembly and 23   the Code editor. 24   The division takes effect upon enactment. 25   DIVISION VI. This division eliminates certain health 26   care-related grant, residency, and fellowship programs. 27   Current law provides that the fulfilling Iowas need for 28   dentists matching grant program may receive moneys through the 29   health care workforce shortage fund or the fulfilling Iowas 30   need for dentists matching grant program account (Code section 31   135.175). The division eliminates the fund and the account. 32   The health care workforce support initiative (Code section 33   135.175) is eliminated. The initiative provides for the 34   coordination and support of various efforts to address the 35   -38-   LSB 1555SZ (2) 91   lh/ko 38/ 41  

  S.F. 618   health care workforce shortage in the state. 1   Additionally, the medical residency training state matching 2   grants program (Code section 135.176) is eliminated. The 3   program provides matching state funding to sponsors of 4   accredited graduate medical education residency programs in 5   the state to establish, expand, or support medical residency 6   training programs. 7   The nurse residency state matching grants program (Code 8   section 135.178) is also eliminated. The program provides 9   matching state funding to sponsors of nurse residency programs 10   in the state to establish, expand, or support nurse residency 11   programs. 12   Moreover, the state-funded family medicine obstetrics 13   fellowship program (Code section 135.193) is eliminated. The 14   program provides funding for fellowships to increase access 15   to family medicine obstetrics practitioners in rural and 16   underserved areas of the state. 17   For all of the programs eliminated in the division, HHS is 18   required to provide matching state funding and fund residency 19   and fellowship positions awarded on or before June 30, 2025, as 20   detailed in the bill. All unencumbered and unobligated moneys 21   related to the programs eliminated in the division shall be 22   transferred to HHS to fund Medicaid graduate medical education 23   efforts. 24   HHS shall create accounts for the deposit of encumbered and 25   obligated moneys for each eliminated program as detailed in the 26   division. Upon the expiration of all grant, residency, and 27   fellowship periods, any unencumbered and unobligated moneys in 28   the account shall be appropriated to HHS for Medicaid graduate 29   medical education efforts.   30   The division takes effect upon the date that HHS notifies 31   the general assembly and the Code editor of the receipt of 32   federal approval for a Medicaid supplemental enhanced payment 33   for the purposes of maximizing federal funding opportunities 34   for graduate medical education, and to increase the number of 35   -39-   LSB 1555SZ (2) 91   lh/ko 39/ 41  

  S.F. 618   medical residencies in the state. 1   DIVISION VII. This division eliminates the state-funded 2   psychiatry residency and fellowship positions (positions) 3   (Code section 135.180) administered by the university of 4   Iowa hospitals and clinics (U of I). The positions provide 5   financial support for up to seven residents and up to two 6   fellows annually. The board of regents (regents) shall direct 7   the U of I to distribute moneys for positions approved and 8   awarded on or before June 30, 2025, until all residents and 9   fellows have completed or left the positions. The regents must 10   also direct the U of I to create an account for the deposit 11   of moneys encumbered and obligated relating to the positions. 12   Upon the expiration of all residency and fellowship periods, 13   any unencumbered and unobligated moneys in the account shall 14   be appropriated to HHS for Medicaid graduate medical education 15   efforts. Any unobligated or unencumbered moneys in the 16   psychiatry residency and fellowship positions fund are also 17   appropriated to HHS to fund Medicaid graduate medical education 18   efforts. 19   The division takes effect upon the date that HHS notifies 20   the general assembly and the Code editor of the receipt of 21   federal approval for a Medicaid supplemental enhanced payment 22   for the purposes of maximizing federal funding opportunities 23   for graduate medical education, and to increase the number of 24   medical residencies in the state. 25   DIVISION VIII. This division eliminates the health 26   facilities council, and transfers the councils duties to HHS.   27   DIVISION IX. This division makes conforming changes to the 28   Code related to the elimination of health facilities council   29   and the transfer of the applicable Code sections. 30   DIVISION X. This division eliminates the board of 31   directors (board) that governs and administers the Iowa 32   health information network (network) and transfers the boards 33   administrative duties to the designated entity. Current law 34   requires the designated entity to be a nonprofit corporation. 35   -40-   LSB 1555SZ (2) 91   lh/ko 40/ 41  

  S.F. 618   The bill eliminates the requirement that the corporation be 1   nonprofit. The division creates an exchange advisory committee 2   (committee), appointed by the director of HHS, to govern the 3   network and the designated entity. The division requires 4   HHS to conduct a competitive process every eight years to 5   select a designated entity. Current law prohibits a single 6   industry from being disproportionately represented as voting 7   members of the board, and requires the director of HHS and the 8   director of the Medicaid program or the directors designees 9   to act as voting members. The commissioner of insurance is 10   required to serve on the board as a nonvoting member, and 11   individuals serving in a nonvoting capacity on the board are 12   not included in the total number of authorized members on 13   the board. The division strikes these member requirements. 14   Current law requires the board to ensure the designated entity 15   enters into contracts with each state agency necessary for 16   state reporting requirements, and to develop, implement, and 17   enforce a single patient identifier or alternative mechanism to 18   share secure patient information that is utilized by all health 19   care professionals. The division eliminates these duties for 20   the committee. The division requires the committee to advise 21   HHS regarding the needs relating to the exchange of health 22   information, and to ensure HHS develops, and the designated 23   entity complies with, the standards, requirements, policies, 24   and procedures related to the network. 25   -41-   LSB 1555SZ (2) 91   lh/ko 41/ 41