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Senate
File
2459
-
Introduced
SENATE
FILE
2459
BY
COMMITTEE
ON
HEALTH
AND
HUMAN
SERVICES
(SUCCESSOR
TO
SSB
3084)
A
BILL
FOR
An
Act
relating
to
the
certificate
of
need
process.
1
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
2
TLSB
5717SV
(3)
91
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S.F.
2459
Section
1.
Section
135.61,
subsection
1,
paragraphs
d
and
f,
1
Code
2026,
are
amended
by
striking
the
paragraphs.
2
Sec.
2.
Section
135.61,
subsection
12,
paragraph
e,
Code
3
2026,
is
amended
by
striking
the
paragraph.
4
Sec.
3.
Section
135.61,
subsection
16,
Code
2026,
is
amended
5
to
read
as
follows:
6
16.
“New
institutional
health
service”
or
“changed
7
institutional
health
service”
means
any
of
the
following:
8
a.
(1)
The
construction,
development
,
or
other
9
establishment
of
a
new
institutional
health
facility
regardless
10
of
ownership
if
completing
the
construction,
development,
or
11
other
establishment
requires
more
than
the
following
amount:
12
(a)
Beginning
on
or
after
January
1,
2027,
and
before
13
December
31,
2031,
four
million
dollars
.
14
(b)
Beginning
on
or
after
January
1,
2032,
and
before
15
December
31,
2036,
four
million
five
hundred
thousand
dollars.
16
(c)
Beginning
on
or
after
January
1,
2037,
five
million
17
dollars.
18
(2)
If
the
new
institutional
health
facility
involves
19
the
use
of
a
leased
building,
the
market
value
of
the
leased
20
building
shall
be
used
when
calculating
the
value
of
completing
21
construction,
development,
or
other
establishment
under
22
subparagraph
(1).
23
b.
Relocation
of
an
institutional
health
facility.
24
c.
Any
A
capital
expenditure
,
or
lease
,
or
donation
by
or
25
on
behalf
of
an
institutional
health
facility
in
excess
of
one
26
million
five
hundred
thousand
dollars
the
following
amount
27
within
a
consecutive
twelve-month
period
:
28
(1)
Beginning
on
or
after
January
1,
2027,
and
before
29
December
31,
2031,
four
million
dollars.
30
(2)
Beginning
on
or
after
January
1,
2032,
and
before
31
December
31,
2036,
four
million
five
hundred
thousand
dollars.
32
(3)
Beginning
on
or
after
January
1,
2037,
five
million
33
dollars
.
34
d.
A
permanent
change
in
the
bed
capacity,
as
determined
35
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by
the
department,
of
an
institutional
health
facility.
For
1
purposes
of
this
paragraph,
a
change
is
permanent
if
it
is
2
intended
to
be
effective
for
one
year
or
more.
3
e.
Any
expenditure
in
excess
of
five
hundred
thousand
4
dollars
by
or
on
behalf
of
an
institutional
health
facility
for
5
health
services
which
are
or
will
be
offered
in
or
through
an
6
institutional
health
facility
at
a
specific
time
but
which
were
7
not
offered
on
a
regular
basis
in
or
through
that
institutional
8
health
facility
within
the
twelve-month
period
prior
to
that
9
time.
10
f.
The
deletion
of
one
or
more
health
services,
previously
11
offered
on
a
regular
basis
by
an
institutional
health
facility
12
or
health
maintenance
organization
or
the
relocation
of
one
or
13
more
health
services
from
one
physical
facility
to
another.
14
g.
Any
acquisition
by
or
on
behalf
of
a
health
care
provider
15
or
a
group
of
health
care
providers
of
any
piece
of
replacement
16
equipment
with
a
value
in
excess
of
one
million
five
hundred
17
thousand
dollars,
whether
acquired
by
purchase,
lease,
or
18
donation.
19
h.
e.
(1)
Any
acquisition
by
or
on
behalf
of
a
health
20
care
provider
or
group
of
health
care
providers
of
any
piece
of
21
equipment
with
a
value
in
excess
of
one
million
five
hundred
22
thousand
dollars
,
whether
acquired
by
purchase
,
or
lease,
or
23
donation,
which
results
in
the
offering
or
development
of
a
24
health
service
not
previously
provided
that
has
a
value
in
25
excess
of
the
following
amount:
26
(a)
Beginning
on
or
after
January
1,
2027,
and
before
27
December
31,
2031,
four
million
dollars
.
28
(b)
Beginning
on
or
after
January
1,
2032,
and
before
29
December
31,
2036,
four
million
five
hundred
thousand
dollars.
30
(c)
Beginning
on
or
after
January
1,
2037,
five
million
31
dollars.
32
(2)
A
mobile
health
service
provided
on
a
contract
basis
33
is
not
considered
to
have
been
previously
provided
by
a
health
34
care
provider
or
group
of
health
care
providers.
35
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i.
Any
acquisition
by
or
on
behalf
of
an
institutional
1
health
facility
or
a
health
maintenance
organization
of
any
2
piece
of
replacement
equipment
with
a
value
in
excess
of
one
3
million
five
hundred
thousand
dollars,
whether
acquired
by
4
purchase,
lease,
or
donation.
5
j.
f.
(1)
Any
acquisition
by
or
on
behalf
of
an
6
institutional
health
facility
or
health
maintenance
7
organization
of
any
piece
of
equipment
with
a
value
in
excess
8
of
one
million
five
hundred
thousand
dollars
,
whether
acquired
9
by
purchase
,
or
lease,
or
donation,
which
results
in
the
10
offering
or
development
of
a
health
service
not
previously
11
provided
that
has
a
value
in
excess
of
the
following
amount:
12
(a)
Beginning
on
or
after
January
1,
2027,
and
before
13
December
31,
2031,
four
million
dollars
.
14
(b)
Beginning
on
or
after
January
1,
2032,
and
before
15
December
31,
2036,
four
million
five
hundred
thousand
dollars.
16
(c)
Beginning
on
or
after
January
1,
2037,
five
million
17
dollars.
18
(2)
A
mobile
health
service
provided
on
a
contract
basis
19
is
not
considered
to
have
been
previously
provided
by
an
20
institutional
health
facility.
21
k.
Any
air
transportation
service
for
transportation
of
22
patients
or
medical
personnel
offered
through
an
institutional
23
health
facility
at
a
specific
time
but
which
was
not
offered
24
on
a
regular
basis
in
or
through
that
institutional
health
25
facility
within
the
twelve-month
period
prior
to
the
specific
26
time.
27
l.
g.
Any
A
mobile
health
service
with
a
value
in
excess
of
28
one
four
million
five
hundred
thousand
dollars.
29
m.
Any
of
the
following:
30
(1)
Cardiac
catheterization
service.
31
(2)
Open
heart
surgical
service.
32
(3)
Organ
transplantation
service.
33
(4)
Radiation
therapy
service
applying
ionizing
radiation
34
for
the
treatment
of
malignant
disease
using
megavoltage
35
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external
beam
equipment.
1
Sec.
4.
Section
135.62,
subsection
1,
Code
2026,
is
amended
2
to
read
as
follows:
3
1.
a.
A
new
institutional
health
service
or
changed
4
institutional
health
service
shall
not
be
offered
or
developed
5
in
this
state
without
prior
application
to
the
department
6
for
,
and
receipt
of
,
a
certificate
of
need,
pursuant
to
this
7
subchapter
.
8
b.
The
application
shall
be
made
upon
on
forms
furnished
or
9
prescribed
by
the
department
and
shall
contain
such
information
10
as
required
by
the
department
may
require
under
this
subchapter
11
by
rule
adopted
pursuant
to
chapter
17A
.
12
c.
(1)
The
application
shall
be
accompanied
by
a
fee
13
equivalent
to
three-tenths
of
one
percent
of
the
anticipated
14
cost
of
the
project
with
a
minimum
fee
of
six
hundred
dollars
15
and
a
maximum
fee
of
twenty-one
thousand
dollars.
The
fee
16
shall
be
remitted
by
the
department
to
the
treasurer
of
state
,
17
who
shall
place
it
for
deposit
in
the
general
fund
of
the
18
state.
An
applicant
for
a
new
institutional
health
service
or
19
a
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
each
of
those
terms
are
defined
in
section
23
135C.1,
shall
not
be
required
to
pay
the
application
fee.
24
(2)
If
an
application
is
voluntarily
withdrawn
within
25
thirty
calendar
days
after
submission,
seventy-five
percent
26
of
the
application
fee
shall
be
refunded
;
if
the
application
27
is
voluntarily
withdrawn
more
than
thirty
but
within
sixty
28
days
after
submission,
fifty
percent
of
the
application
fee
29
shall
be
refunded;
if
the
application
is
withdrawn
voluntarily
30
more
than
sixty
days
after
submission,
twenty-five
percent
of
31
the
application
fee
shall
be
refunded
.
Notwithstanding
the
32
required
payment
of
an
application
fee
under
this
subsection
,
33
an
applicant
for
a
new
institutional
health
service
or
a
34
changed
institutional
health
service
offered
or
developed
by
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an
intermediate
care
facility
for
persons
with
an
intellectual
1
disability
or
an
intermediate
care
facility
for
persons
with
2
mental
illness
as
defined
pursuant
to
section
135C.1
is
exempt
3
from
payment
of
the
application
fee.
4
Sec.
5.
Section
135.62,
subsection
2,
paragraphs
a
and
e,
5
Code
2026,
are
amended
to
read
as
follows:
6
a.
Private
offices
and
private
clinics
of
an
individual
7
physician,
dentist,
or
other
practitioner
or
group
of
8
health
care
providers,
except
as
provided
by
section
135.61,
9
subsection
16
,
paragraphs
“g”
,
“h”
,
and
“m”
paragraph
“e”
,
and
10
section
135.61,
subsections
2
and
18
.
11
e.
A
health
maintenance
organization
or
combination
of
12
health
maintenance
organizations
or
an
institutional
health
13
facility
controlled
directly
or
indirectly
by
a
health
14
maintenance
organization
or
combination
of
health
maintenance
15
organizations,
except
when
the
health
maintenance
organization
16
or
combination
of
health
maintenance
organizations
does
any
of
17
the
following:
18
(1)
Constructs,
develops,
renovates,
relocates,
or
19
otherwise
establishes
an
institutional
health
facility.
20
(2)
Acquires
major
medical
equipment
as
provided
by
section
21
135.61,
subsection
16,
paragraphs
“i”
and
“j”
paragraph
“f”
.
22
Sec.
6.
Section
135.62,
subsection
2,
paragraph
h,
23
subparagraph
(2),
Code
2026,
is
amended
to
read
as
follows:
24
(2)
If
these
conditions
are
not
met,
the
institutional
25
health
facility
or
health
maintenance
organization
is
subject
26
to
review
as
a
“new
institutional
health
service”
or
“changed
27
institutional
health
service”
under
section
135.61,
subsection
28
16
,
paragraph
“f”
,
and
is
subject
to
sanctions
under
section
29
135.72
.
30
Sec.
7.
Section
135.62,
subsection
2,
Code
2026,
is
amended
31
by
adding
the
following
new
paragraphs:
32
NEW
PARAGRAPH
.
r.
An
organized
outpatient
health
33
facility
that
provides
behavioral
health
services
as
defined
34
by
the
department
by
rule,
including
but
not
limited
to
35
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substitution-based
treatment
centers
for
opiate
addiction.
1
NEW
PARAGRAPH
.
s.
Open
heart
surgical
services.
2
NEW
PARAGRAPH
.
t.
Organ
transplantation
services.
3
NEW
PARAGRAPH
.
u.
Radiation
therapy
services.
4
Sec.
8.
Section
135.63,
subsection
2,
paragraph
b,
Code
5
2026,
is
amended
by
striking
the
paragraph.
6
Sec.
9.
Section
135.65,
subsections
1
and
2,
Code
2026,
are
7
amended
to
read
as
follows:
8
1.
a.
Within
fifteen
business
days
after
receipt
of
the
9
date
the
department
receives
an
application
for
a
certificate
10
of
need,
the
department
shall
examine
the
application
for
form
11
and
completeness
and
accept
or
reject
it.
An
application
12
shall
be
rejected
only
if
it
fails
to
provide
all
information
13
required
by
the
department
pursuant
to
section
135.62,
14
subsection
1
.
The
department
shall
promptly
return
to
the
15
applicant
any
a
rejected
application
,
to
the
applicant
with
an
16
explanation
of
the
reasons
for
its
rejection.
17
b.
Within
thirty
calendar
days
of
the
date
the
department
18
sends
a
rejected
application
to
an
applicant,
the
applicant
may
19
revise
and
resubmit
the
application
once
for
review
without
20
submitting
another
application
fee
under
section
135.62.
21
2.
Upon
acceptance
of
an
application
for
a
certificate
22
of
need,
the
department
shall
promptly
undertake
to
notify
23
all
affected
persons
in
writing
through
electronic
means
24
that
formal
review
of
the
application
has
been
initiated.
25
Notification
to
those
affected
persons
who
are
consumers
26
or
third-party
payers
or
other
payers
for
health
services
27
may
be
provided
by
electronic
distribution
of
the
pertinent
28
information
to
the
news
media
.
29
Sec.
10.
Section
135.65,
subsection
3,
paragraph
b,
Code
30
2026,
is
amended
to
read
as
follows:
31
b.
A
period
for
the
submission
of
written
public
hearing
32
comments
from
affected
persons
on
the
application,
to
be
held
33
scheduled
prior
to
completion
of
the
evaluation
required
by
34
paragraph
“a”
.
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Sec.
11.
Section
135.65,
subsection
4,
Code
2026,
is
amended
1
by
striking
the
subsection.
2
Sec.
12.
Section
135.66,
subsection
1,
Code
2026,
is
amended
3
to
read
as
follows:
4
1.
The
department
may
waive
the
letter
of
intent
procedures
5
prescribed
by
section
135.64
and
substitute
conduct
a
summary
6
review
procedure,
which
shall
be
established
by
rules
of
7
adopted
by
the
department,
when
it
the
department
accepts
an
8
application
for
a
certificate
of
need
for
a
project
which
that
9
meets
any
of
the
following
criteria
in
paragraphs
“a”
through
10
“e”
:
11
a.
A
project
which
is
limited
to
repair
or
replacement
of
a
12
facility
or
equipment
damaged
or
destroyed
by
a
disaster,
and
13
which
will
not
expand
the
facility
nor
increase
the
services
14
provided
beyond
the
level
existing
prior
to
the
disaster.
15
b.
A
project
necessary
to
enable
the
facility
or
service
to
16
achieve
or
maintain
compliance
with
federal,
state,
or
other
17
appropriate
licensing,
certification,
or
safety
requirements.
18
c.
A
project
which
will
not
change
the
existing
bed
capacity
19
of
the
applicant’s
facility
or
service,
as
determined
by
the
20
department,
by
more
than
ten
percent
or
ten
beds,
whichever
is
21
less,
over
a
two-year
period.
22
d.
A
project
the
total
cost
of
which
will
not
exceed
one
23
hundred
fifty
thousand
dollars.
24
e.
d.
Any
other
project
for
which
the
applicant
proposes
25
and
the
department
agrees
to
summary
review.
26
Sec.
13.
Section
135.70,
subsection
2,
Code
2026,
is
amended
27
to
read
as
follows:
28
2.
Upon
expiration
of
a
certificate
of
need,
and
prior
to
29
extension
of
the
certificate
of
need,
any
affected
person
shall
30
have
the
right
to
submit
to
the
department
information
which
31
may
be
relevant
to
the
question
of
granting
an
extension.
The
32
department
may
call
a
public
hearing
for
this
purpose.
33
Sec.
14.
Section
135.71,
subsection
4,
Code
2026,
is
amended
34
to
read
as
follows:
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4.
Criteria
for
determining
when
it
is
not
feasible
to
1
complete
formal
review
of
an
application
for
a
certificate
of
2
need
within
the
time
limits
limit
specified
in
section
135.68
.
3
The
rules
adopted
under
this
subsection
shall
include
criteria
4
for
determining
whether
an
application
proposes
introduction
5
of
technologically
innovative
equipment,
and
if
so,
procedures
6
to
be
followed
in
reviewing
the
application.
However,
a
rule
7
adopted
under
this
subsection
shall
not
permit
a
deferral
of
8
more
than
sixty
thirty
calendar
days
beyond
the
time
when
a
9
decision
is
required
under
section
135.68
,
unless
both
the
10
applicant
and
the
department
agree
to
a
longer
deferment.
11
Sec.
15.
Section
135P.1,
subsection
3,
Code
2026,
is
amended
12
to
read
as
follows:
13
3.
“Health
facility”
means
an
any
of
the
following:
14
a.
An
institutional
health
facility
as
defined
in
section
15
135.61
,
a
.
16
b.
A
birth
center
as
defined
in
section
135.131
,
a
.
17
c.
A
hospice
licensed
under
chapter
135J
,
a
.
18
d.
A
home
health
agency
as
defined
in
section
144D.1
,
an
.
19
e.
An
assisted
living
program
certified
under
chapter
231C
,
20
a
.
21
f.
A
clinic
,
a
.
22
g.
A
community
health
center
,
or
the
.
23
h.
The
university
of
Iowa
hospitals
and
clinics
,
and
24
includes
any
.
25
i.
A
corporation,
professional
corporation,
partnership,
26
limited
liability
company,
limited
liability
partnership,
or
27
other
entity
comprised
of
such
health
facilities.
28
Sec.
16.
Section
135P.1,
Code
2026,
is
amended
by
adding
the
29
following
new
subsection:
30
NEW
SUBSECTION
.
3A.
“Institutional
health
facility”
means
31
any
of
the
following
without
regard
to
whether
the
facility
is
32
publicly
or
privately
owned,
organized
for
profit,
or
is
part
33
of
or
sponsored
by
a
health
maintenance
organization:
34
a.
A
hospital
as
defined
in
section
135B.1.
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b.
A
health
care
facility
as
defined
in
section
135C.1.
1
c.
An
organized
outpatient
health
facility
as
defined
in
2
section
135.61.
3
d.
An
ambulatory
surgical
center
as
defined
in
section
4
135.61.
5
e.
A
community
mental
health
center
as
defined
in
section
6
225A.1.
7
Sec.
17.
REPEAL.
Section
135.64,
Code
2026,
is
repealed.
8
EXPLANATION
9
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
10
the
explanation’s
substance
by
the
members
of
the
general
assembly.
11
This
bill
relates
to
the
certificate
of
need
(CON)
process.
12
The
bill
removes
from
the
definition
of
“affected
person”
an
13
institutional
health
facility
(facility)
or
health
maintenance
14
organization
which,
prior
to
the
department
health
and
human
15
services’
(HHS)
receipt
of
an
application
for
a
CON,
has
16
formally
indicated
to
HHS
an
intent
to
furnish
institutional
17
health
services
as
described
in
the
application.
The
bill
also
18
removes
payers
and
third-party
payers
for
health
services
from
19
the
definition
of
“affected
persons”,
and
“a
community
mental
20
health
facility”
from
the
definition
of
“institutional
health
21
facility”.
22
The
bill
limits
the
circumstances
that
require
a
health
23
care
provider
to
submit
a
CON
application
to
the
following:
24
construction,
development,
or
other
establishment
of
a
new
25
facility
if
completion
requires
more
than
a
monetary
amount
26
as
specified
in
the
bill;
relocation
of
a
facility;
a
capital
27
expenditure
or
lease
by
a
facility
in
excess
of
a
monetary
28
amount
as
specified
in
the
bill;
a
permanent
change
in
the
bed
29
capacity
of
a
facility;
an
acquisition
of
a
piece
of
equipment
30
by
or
on
behalf
of
a
health
care
provider
or
group
of
health
31
care
providers;
an
acquisition
of
a
piece
of
equipment
by
or
32
on
behalf
of
an
institutional
health
facility
or
a
health
33
maintenance
organization;
and
a
mobile
health
service
with
a
34
value
in
excess
of
$4
million.
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For
purposes
of
determining
the
cost
of
the
construction,
1
development,
or
other
establishment
of
a
new
facility
that
2
involves
the
lease
of
a
building,
the
bill
includes
the
market
3
value
of
the
leased
building.
4
The
bill
exempts
an
organized
outpatient
health
facility
5
that
provides
behavioral
health
services,
open
heart
surgical
6
services,
organ
transplantation
services,
and
radiation
therapy
7
services
from
CON
requirements.
8
The
bill
eliminates
the
requirement
that
a
CON
applicant
9
needs
to
show
that
any
existing
facilities
providing
10
institutional
health
services
similar
to
those
being
applied
11
for
are
being
used
in
an
appropriate
and
efficient
manner.
12
The
bill
no
longer
allows
HHS
to
refund
application
fees
13
if
the
CON
application
is
voluntarily
withdrawn
more
than
30
14
calendar
days
after
submission.
15
The
bill
allows
a
CON
applicant
whose
application
is
16
rejected
to
resubmit
a
revised
application
once
without
an
17
additional
application
fee.
18
The
bill
allows
HHS
to
notify
all
affected
persons
of
19
pertinent
information
regarding
a
formal
review
of
a
CON
20
application
through
electronic
means
instead
of
through
the
21
news
media.
22
Under
current
law,
a
formal
review
of
each
CON
application
23
shall
include
a
public
hearing
on
the
application
where
24
affected
persons,
or
their
representatives,
shall
have
the
25
opportunity
to
present
testimony.
The
bill
instead
requires
26
a
period
for
the
submission
of
written
comments
from
affected
27
persons
on
the
application.
28
Under
current
law,
HHS
may
call
a
public
hearing
to
consider
29
whether
to
extend
a
CON.
The
bill
eliminates
HHS’s
ability
to
30
call
such
a
public
hearing.
31
Under
current
law,
HHS
may
defer
approval
or
denial
of
a
CON
32
application
for
up
to
60
days.
The
bill
allows
HHS
to
defer
for
33
a
maximum
of
30
calendar
days
unless
both
the
applicant
and
HHS
34
agree
to
a
longer
deferment.
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The
bill
makes
conforming
changes
to
Code
sections
135.66
1
(summary
review
procedure)
and
135P.1
(adverse
health
care
2
incidents
——
definitions).
3
The
bill
repeals
Code
section
135.64
(letter
of
intent
to
4
precede
application
——
review
and
comment).
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