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STATE OF IOWA
KIM REYNOLDS
GOVERNOR
May 1,2025
The Honorable Paul Pate
Secretary of State of Iowa
State Capitol
Des Moines, Iowa 50319
Dear Mr. Secretary,
I hereby transmit:
House File 919, an Act relating to children's specialty hospital designations for certain
nonprofit organizations, and including effective date provisions.
The above House File is hereby approved on this date.
Sincerely,
KinlReynolds
Governor of low^
cc: Secretary of the Senate
Clerk of the House
STATE CAPITOL DES MOINES, IOWA 50319 515.281.5211 FAX 515.725.3527 WWW.GOVERNOR.IOWA.GOV
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House File 919
AN ACT
RELATING TO CHILDREN'S SPECIALTY HOSPITAL DESIGNATIONS FOR
CERTAIN NONPROFIT ORGANIZATIONS, AND INCLUDING EFFECTIVE
DATE PROVISIONS.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
Section 1. Section 135B.1, Code 2025, is amended by adding
the following new subsection:
NEW SUBSECTION. 7. ^Children's specialty hospital" means a
hospital described by all of the following:
a. The hospital is owned and operated by a nonprofit
organization.
b. The hospital only serves individuals thirty years of age
and younger.
c. More than sixty percent of the individuals served by the
hospital receive medical assistance under chapter 249A.
d. The hospital specializes in pediatric rehabilitation and
treating children with a behavioral health condition or complex
medical needs.
e. The hospital has no more than two hundred inpatient beds.
f. The hospital provides outpatient services.
g. The hospital met the definition of a special population
nursing facility, as promulgated by rule by the department of
health and human services, prior to July 1, 2025.
Sec. 2. NEW SECTION. 1353.40 Children's specialty
hospitals.
House File 919, p. 2
1. The department may adopt rules pursuant to chapter 17A
to establish minimum standards for the licensure of children's
specialty hospitals. Rules adopted pursuant to this section
shall be formulated in consultation with the director of
health and human services or the director's designee, and with
affected industry, professional, and consumer groups.
2. A children's specialty hospital shall establish formal
criteria based on objective medical standards for patient
admission, discharge, and continuation of care.
Sec. 3, DEPARTMENT OF INSPECTIONS, APPEALS, AND LICENSING
DEPARTMENT OF HEALTH AND HUMAN SERVICES CHILDREN'S
SPECIALTY HOSPITALS.
1. For purposes of this section, ^^licensed entity" means
an entity granted a provisional children's specialty hospital
license under subsection 2, paragraph ^'a".
2. The department of inspections, appeals, and licensing
shall do all of the following:
a. Within thirty calendar days of the effective date of
this Act, grant a provisional children's specialty hospital
license to an entity that requests such provisional licensure
provided that the entity meets the definition of children's
specialty hospital under section 135B.1. A provisional license
granted under this paragraph shall be valid for no more than
twenty-four consecutive months from the date the provisional
license is granted. A licensed entity may seek federal
certification and participation in federal reimbursement
programs that require hospital licensure.
b. Grant reasonable waivers from state hospital rules to
permit a licensed entity to maintain the licensed entity's
operations as provided prior to the effective date of this
Act, until the date the licensed entity obtains federal
certification or the ability to participate in federal
reimbursement programs that require hospital licensure. After
a licensed entity obtains federal certification or the ability
to participate in federal reimbursement programs that require
hospital licensure, the department of inspections, appeals, and
licensing and the department of health and human services shall
grant the necessary waivers to the licensed entity to ensure
the licensed entity's compliance with the requirements of the
House File 919, p. 3
federal certification or the federal reimbursement programs.
Waivers granted under this paragraph shall specifically include
a waiver from state rules that require a licensed entity to
maintain, or to have available, laboratory and pathology
services and facilities, other than laboratory and pathology
services and facilities that the licensed entity maintained
prior to the effective date of this Act, and a waiver from
state rules that require the provision of emergency services,
other than emergency services that the licensed entity provided
prior to the"effective date of this Act. Each waiver granted
to a licensed entity under this paragraph shall be valid for
no more than twenty-four consecutive months from the date the
licensed entity was granted a provisional children's specialty
hospital license under paragraph ^^a", or until the date the
licensed entity obtains a permanent children's specialty
hospital license, whichever date is earlier.
c. Collaborate with the department of health and human
services and a licensed entity to assist the licensed entity
in seeking federal certification or participation in federal
reimbursement programs requiring hospital licensure.
3. A licensed entity may operate under the minimum physical
standards for nursing facilities in 481 lAC 61 under which
the licensed entity operated prior to the effective date of
this Act, and shall be exempt from all other construction
standards applicable only to hospitals and off-site premises.
The exemption under this paragraph shall include the exemption
from the standards set forth in the guidelines for design
and construction of hospitals as published by the facility
guidelines institute.
4. The department of health and human services shall set
reimbursement rates for inpatient care and outpatient care
provided by the licensed entity. Reimbursement rates under
this subsection shall be based on the following:
a. For inpatient care, prospective average allowable
per diem costs adjusted for inflation pursuant to 441 lAC
79.1(5)(k).
b. For outpatient care, the licensed entity's
cost-to-charge ratio, as defined by the department of health
and human services, with retrospectively adjusted prospective
House File 919, p. 4
reimbursements as provided in 441 lAC 79.1(1)(g).
5, A licensed entity shall be exempt from certificate of
need requirements under chapter lOA, subchapter VII, part 2,
to the extent that the licensed entity is implementing a new
institutional health service, or a changed institutional health
service, for the purpose of converting the licensed entity to a
children's specialty hospital, or to revert the licensed entity
to a nursing facility. The exemption under this subsection
shall continue until the earlier of the following occurs:
a. The date the licensed entity obtains a permanent
children's specialty hospital license.
b. Twenty-four consecutive months from the date the
licensed entity was granted a provisional children's specialty
hospital license.
Sec. 4, EMERGENCY RULES. The department of inspections,
appeals, and licensing may adopt emergency rules under section
17A.4, subsection 3, and section 17A.5, subsection 2, paragraph
^^b", to implement the provisions of this Act and the rules
shall be effective immediately upon filing unless a later date
is specified in the rules. Any rules adopted in accordance
with this section shall also be published as a notice of
intended action as provided in section 17A.4,
Sec. 5. EFFECTIVE DATE, This Act, being deemed of immediate
importance, takes effect upon enactment.
PAT GRASSLE7 AMY SINCLAIR
Speaker of the House President of the Senate
I hereby certify that this bill originated in the House and
is known as House Pile 919, Ninety-first General Assembly.
meg; iN NELSON
Chij : Clerk/^f the HouseChu : cierjy-ot the House
Approved
NOLDS
Governor
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