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Senate
File
575
-
Introduced
SENATE
FILE
575
BY
COMMITTEE
ON
HEALTH
AND
HUMAN
SERVICES
(SUCCESSOR
TO
SSB
1163)
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:
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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
Iowa’s
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
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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
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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
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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
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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
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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
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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
professional’s
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
professional’s
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
professional’s
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
“b”
,
the
commission
shall
26
pay
the
eligible
health
care
professional’s
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
professional’s
employment
obligation.
34
(b)
An
amount
equal
to
fifteen
percent
of
the
aggregate
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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
professional’s
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
professional’s
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
“b”
,
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
individual’s
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
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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
Iowa’s
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
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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
state’s
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
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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
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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.
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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.
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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
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91
lh/ko
14/
41
S.F.
575
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
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575
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
council’s
decision
and
the
written
35
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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
council’s
department’s
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
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575
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
department’s
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
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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
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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
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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
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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
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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
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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
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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
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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
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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,
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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
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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
department’s
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
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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
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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
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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,
or
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
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network’s
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
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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
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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
entity’s
21
administration
of
the
Iowa
health
information
network.
22
EXPLANATION
23
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
24
the
explanation’s
substance
by
the
members
of
the
general
assembly.
25
This
bill
relates
to
health
care
including
a
funding
model
26
for
Iowa’s
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
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care
hub-and-spoke
partnership
funding
model
for
the
purpose
1
of
improving
Iowa’s
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
incentive
program
established
in
division
IV
of
8
the
bill.
PRIMECARRE
includes
the
health
care
workforce
and
9
community
support
grant
program
and
the
primary
care
provider
10
loan
repayment
program
to
recruit
and
retain
primary
care
11
providers
in
rural
communities.
12
Current
law
requires
HHS
to
encourage
local
boards
to
13
adopt
a
plan
including
that
health
facilities
may
seek
14
technical
assistance
or
apply
for
matching
grants
for
the
plan
15
development.
The
bill
removes
the
instruction
for
health
16
facilities
to
apply
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
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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
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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
Iowa’s
need
for
28
dentists
matching
grant
program
may
receive
moneys
through
the
29
health
care
workforce
shortage
fund
or
the
fulfilling
Iowa’s
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
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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
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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
council’s
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
board’s
33
administrative
duties
to
the
designated
entity.
Current
law
34
requires
the
designated
entity
to
be
a
nonprofit
corporation.
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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.
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