House Study Bill 521



                                    HOUSE FILE       
                                    BY  (PROPOSED COMMITTEE ON
                                        STATE GOVERNMENT BILL
                                        BY CHAIRPERSON COWNIE)

                                         A BILL FOR

     1 An Act relating to the licensure of ambulatory surgical
     2    centers, providing fees and penalties, and including
     3    effective date provisions.
     4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
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PAG LIN



  1  1    Section 1.  Section 135C.33, subsection 5, paragraph a, Code
  1  2 2011, is amended by adding the following new subparagraph:
  1  3    NEW SUBPARAGRAPH.  (6)  An employee of an ambulatory surgical
  1  4 center licensed under chapter 135P.
  1  5    Sec. 2.  NEW SECTION.  135P.1  Definitions.
  1  6    1.  "Ambulatory surgical center" means any distinct facility
  1  7 that operates exclusively for the purpose of providing surgical
  1  8 services to patients not requiring hospitalization and in which
  1  9 the expected duration of services would not exceed twenty=four
  1 10 hours following an admission.
  1 11    2.  "Department" means the department of inspections and
  1 12 appeals.
  1 13    3.  "Governmental unit" means the state, or any county,
  1 14 municipality, or other political subdivision, or any
  1 15 department, division, board, or other agency of any of the
  1 16 foregoing.
  1 17    Sec. 3.  NEW SECTION.  135P.2  Purpose.
  1 18    The purpose of this chapter is to protect the public
  1 19 health, safety, and welfare by providing for the development,
  1 20 establishment, and enforcement of basic standards for the
  1 21 operation, construction, and maintenance of ambulatory surgical
  1 22 centers.
  1 23    Sec. 4.  NEW SECTION.  135P.3  Licensure.
  1 24    No person or governmental unit, acting severally or jointly
  1 25 with any other person or governmental unit, shall establish,
  1 26 operate, or maintain an ambulatory surgical center in this
  1 27 state without obtaining a license as provided under this
  1 28 chapter.
  1 29    Sec. 5.  NEW SECTION.  135P.4  Application for license ==== fee.
  1 30    An ambulatory surgical center license shall be obtained from
  1 31 the department.  Applications for a license shall be upon such
  1 32 forms and shall include such information as the department may
  1 33 reasonably require, which may include affirmative evidence
  1 34 of compliance with this chapter, other statutes, and rules
  1 35 as may be applicable.  Each application for license shall be
  2  1 accompanied by the required license fee which shall be credited
  2  2 to the general fund of the state.  The initial and annual
  2  3 license fee shall be five hundred dollars.
  2  4    Sec. 6.  NEW SECTION.  135P.5  Issuance and renewal of
  2  5 license.
  2  6    1.  Upon receipt of an application for license and the
  2  7 license fee, the department shall issue a license if the
  2  8 applicant and the ambulatory surgical center comply with this
  2  9 chapter and the rules of the department.  The department shall
  2 10 renew a license upon payment of the five hundred dollar annual
  2 11 license fee and filing of an application form available from
  2 12 the department.
  2 13    2.  A license shall be either general or restricted in form.
  2 14 A license shall be issued only for the premises and persons
  2 15 or governmental units named in the application and is not
  2 16 transferable or assignable except with the written approval of
  2 17 the department.  A license shall be posted in a conspicuous
  2 18 place on the licensed premises as prescribed by rule of the
  2 19 department.
  2 20    Sec. 7.  NEW SECTION.  135P.6  Denial, suspension, or
  2 21 revocation of license ==== hearings and review.
  2 22    1.  The department may deny, suspend, or revoke a license
  2 23 in any case where it finds that there has been a substantial
  2 24 failure to comply with this chapter or the rules or minimum
  2 25 standards adopted pursuant to this chapter.
  2 26    2.  The procedure governing notice and hearing to deny
  2 27 an application or suspend or revoke a license shall be in
  2 28 accordance with the rules adopted by the department.  A full
  2 29 and complete record shall be kept of the proceedings and of
  2 30 any testimony.  The record of any proceeding pursuant to this
  2 31 section need not be transcribed unless judicial review is
  2 32 sought.  A copy or copies of the transcript may be obtained by
  2 33 an interested party on payment of the cost of preparing the
  2 34 copy or copies.
  2 35    Sec. 8.  NEW SECTION.  135P.7  Rules.
  3  1    1.  The department shall adopt rules setting out the
  3  2 standards for ambulatory surgical centers to be licensed under
  3  3 this chapter.  The rules shall state, at a minimum, that an
  3  4 ambulatory surgical center shall meet the federal requirements
  3  5 for conditions of participation in the federal Medicare program
  3  6 for ambulatory surgical centers under 42 C.F.R. pt. 416.
  3  7    2.  The department shall adopt rules to govern the notice
  3  8 and hearing procedure when a license is denied, suspended, or
  3  9 revoked.
  3 10    3.  The rules shall require ambulatory surgical centers
  3 11 to report ambulatory data to the department of public health
  3 12 or the designated intermediary for the purpose of public
  3 13 dissemination of health data as initially authorized in 1996
  3 14 Iowa Acts, chapter 1212, section 5, subsection 1, paragraph "a",
  3 15 subparagraph (4).
  3 16    4.  An ambulatory surgical center which is in operation at
  3 17 the time of promulgation of any applicable rules or minimum
  3 18 standards under this chapter shall be given a reasonable time,
  3 19 not to exceed one year from the date of promulgation, within
  3 20 which to comply with such rules and minimum standards.
  3 21    5.  The department shall enforce the rules.
  3 22    Sec. 9.  NEW SECTION.  135P.8  Inspections.
  3 23    1.  The department shall make or cause to be made inspections
  3 24 or complaint investigations of ambulatory surgical centers as
  3 25 the department deems necessary in order to determine compliance
  3 26 with this chapter and applicable rules.
  3 27    2.  A department inspector shall not participate in an
  3 28 inspection or complaint investigation of an ambulatory surgical
  3 29 center in which the inspector or a member of the inspector's
  3 30 immediate family works or has worked within the last two years
  3 31 or in which the inspector or the inspector's immediate family
  3 32 has a financial ownership interest.  For the purposes of this
  3 33 section, "immediate family member" means a spouse, natural or
  3 34 adoptive parent or grandparent, child, grandchild, sibling,
  3 35 stepparent, stepchild, or stepsibling.
  4  1    Sec. 10.  NEW SECTION.  135P.9  Employee background checks.
  4  2    1.  An ambulatory surgical center shall comply with child or
  4  3 dependent adult abuse information and criminal record checks
  4  4 and evaluations as provided in section 135C.33.
  4  5    2.  An ambulatory surgical center licensed in this state
  4  6 may access the single contact repository established by the
  4  7 department pursuant to section 135C.33 as necessary for the
  4  8 ambulatory surgical center to perform record checks of persons
  4  9 employed or being considered for employment by the ambulatory
  4 10 surgical center.
  4 11    Sec. 11.  NEW SECTION.  135P.10  Confidentiality.
  4 12    The department's final inspection or investigation findings
  4 13 or the final survey findings of an accrediting body, authorized
  4 14 by the department in rule, with respect to compliance by an
  4 15 ambulatory surgical center with requirements for licensing
  4 16 or accreditation shall be made available to the public in a
  4 17 readily available form and place.  Other information relating
  4 18 to an ambulatory surgical center obtained by the department
  4 19 which does not constitute the department's findings from an
  4 20 inspection or investigation of the ambulatory surgical center
  4 21 or the final survey findings of the accrediting body shall
  4 22 not be made available to the public, except in proceedings
  4 23 involving the denial, suspension, or revocation of a license
  4 24 under this chapter.  The name of a person who files a complaint
  4 25 with the department shall remain confidential and shall not
  4 26 be subject to discovery, subpoena, or other means of legal
  4 27 compulsion for its release to a person other than department
  4 28 employees or agents involved in the investigation of the
  4 29 complaint.
  4 30    Sec. 12.  NEW SECTION.  135P.11  Judicial review.
  4 31    Judicial review of an action of the department may be sought
  4 32 in accordance with chapter 17A.  Notwithstanding the provisions
  4 33 of chapter 17A, petitions for judicial review may be filed
  4 34 in the district court of the county in which the ambulatory
  4 35 surgical center is located or to be located and the status quo
  5  1 of the petitioner or licensee shall be preserved pending final
  5  2 disposition of the judicial review matter.
  5  3    Sec. 13.  NEW SECTION.  135P.12  Penalty.
  5  4    Any person establishing, conducting, managing, or operating
  5  5 any ambulatory surgical center without a license commits a
  5  6 serious misdemeanor, and each day of continuing violation after
  5  7 conviction shall be considered a separate offense.
  5  8    Sec. 14.  NEW SECTION.  135P.13  Injunction.
  5  9    Notwithstanding the existence or pursuit of any other
  5 10 remedy, the department may, in the manner provided by law,
  5 11 maintain an action in the name of the state for injunction
  5 12 or other process against any person or governmental unit to
  5 13 restrain or prevent the establishment, conduct, management, or
  5 14 operation of an ambulatory surgical center without a license.
  5 15    Sec. 15.  EFFECTIVE DATE.  This Act takes effect July 1,
  5 16 2013.
  5 17                           EXPLANATION
  5 18    This bill relates to ambulatory surgical centers.  The bill
  5 19 defines "ambulatory surgical center" using the definition
  5 20 provided by Medicare.  The bill states the purpose of new Code
  5 21 chapter 135P is to protect public health, safety, and welfare
  5 22 by providing basic standards for operating, constructing, and
  5 23 maintaining an ambulatory surgical center.
  5 24    The bill requires that any person or governmental unit
  5 25 acting separately or together that establishes, conducts, or
  5 26 maintains an ambulatory surgical center must have a license as
  5 27 provided under the Code chapter.  The person or governmental
  5 28 unit shall obtain a license from the department of inspections
  5 29 and appeals (DIA).  The application shall include information
  5 30 that the DIA may reasonably require including affirmative
  5 31 evidence of compliance with new Code chapter 135P, other
  5 32 statutes, and rules.  An application must be accompanied by the
  5 33 required initial license fee of $500.  An annual license fee is
  5 34 also $500.  The license fees are to be credited to the state's
  5 35 general fund.  The bill also provides that the DIA shall issue
  6  1 a license upon receiving an application if the applicant
  6  2 and the ambulatory surgical center comply with Code chapter
  6  3 135P and the rules of the department.  A licensee receives
  6  4 reapproval upon payment of the $500 license fee and filing
  6  5 an application form available from the DIA.  Licenses are
  6  6 general or restricted in form.  A license will be issued only
  6  7 for a premises and persons or governmental units named in the
  6  8 application and the license is not transferable or assignable
  6  9 without written approval of the DIA.  The bill requires that
  6 10 a license be posted in a conspicuous place on the licensed
  6 11 premises as prescribed by department rules.
  6 12    The bill states that the DIA may deny, suspend, or revoke a
  6 13 license when it finds the licensee or applicant substantially
  6 14 failed to comply with Code chapter 135P or rules or minimum
  6 15 standards adopted pursuant to the Code chapter.  The bill
  6 16 states that the DIA rules will govern the procedure for notice
  6 17 and hearing to deny an application for a license or to revoke
  6 18 or suspend a license.  The bill states a full and complete
  6 19 record of the proceedings shall be kept, but the record does
  6 20 not need to be transcribed unless judicial review is sought.  A
  6 21 transcript of the proceeding may be obtained by an interested
  6 22 party on payment of the cost of preparing the copy or copies.
  6 23    The bill provides that the DIA shall adopt rules setting
  6 24 the standards for an ambulatory surgical center to be licensed
  6 25 under the Code chapter.  The rules must require that an
  6 26 ambulatory surgical center shall meet the federal requirements
  6 27 for conditions of participation in the federal Medicare
  6 28 program for ambulatory surgical centers under 42 C.F.R.
  6 29 pt. 416.  The DIA must also establish, by rule, the notice
  6 30 and hearing procedure if a license is denied, revoked, or
  6 31 suspended.  The DIA must also enforce the rules.  The rules
  6 32 established by the DIA shall require ambulatory surgical
  6 33 centers to report ambulatory data to the department of public
  6 34 health or the designated intermediary for purposes of public
  6 35 health dissemination of health data.  The bill states that
  7  1 an ambulatory surgical center in operation at the time of
  7  2 promulgation of applicable rules or standards under Code
  7  3 chapter 135P shall be given a reasonable time, not to exceed
  7  4 one year, to comply with the rules and minimum standards.
  7  5    The bill provides for inspections of ambulatory surgical
  7  6 centers.  The bill requires the DIA to make, or cause to be
  7  7 made, inspections or complaint investigations as the DIA deems
  7  8 necessary to determine compliance with Code chapter 135P and
  7  9 the applicable rules.  The DIA inspectors must not participate
  7 10 in an inspection or complaint investigation of an ambulatory
  7 11 surgical center if the inspector or a member of the inspector's
  7 12 immediate family works or has worked at the ambulatory surgical
  7 13 center within the last two years.  A DIA inspector also must
  7 14 not participate in an inspection or complaint investigation
  7 15 of an ambulatory surgical center in which the inspector or
  7 16 the inspector's immediate family has a financial or ownership
  7 17 interest.
  7 18    The bill provides that an ambulatory surgical center shall
  7 19 comply with abuse and criminal background checks as provided
  7 20 in Code section 135C.33.  The bill also states that a licensed
  7 21 ambulatory surgical center is allowed to access the single
  7 22 contact repository as is necessary to perform record checks of
  7 23 employees or potential employees.
  7 24    The bill provides for the confidentiality of the DIA records
  7 25 of ambulatory surgical centers.  The bill states that the DIA's
  7 26 final inspection or investigation findings, or survey findings
  7 27 of an accredited body authorized by the DIA rules, regarding
  7 28 an ambulatory surgical center's compliance with requirements
  7 29 for licensing or accreditation must be made available to the
  7 30 public in a readily available form and place.  The bill states
  7 31 that other information acquired by the DIA relating to an
  7 32 ambulatory surgical center shall not be made available to the
  7 33 public except in proceedings involving denial, suspension,
  7 34 or revocation of a license.  The bill also provides that the
  7 35 name of a person who files a complaint with the DIA shall
  8  1 remain confidential regardless of means of legal compulsion
  8  2 for its release, other than the release of the name to the DIA
  8  3 employees or agents involved in investigating a complaint.
  8  4    The bill provides that judicial review may be sought
  8  5 pursuant to Code chapter 17A, but petitions for judicial review
  8  6 may be filed in the district court of the county in which the
  8  7 ambulatory surgical center is located or is to be located,
  8  8 notwithstanding the terms of Code chapter 17A.  The bill
  8  9 provides that the status quo of the petitioner or licensee is
  8 10 preserved pending final disposition in court.
  8 11    The bill establishes a penalty for any person establishing,
  8 12 conducting, managing, or operating an ambulatory surgical
  8 13 center without a license.  The person is guilty of a serious
  8 14 misdemeanor and each day of the continuing violation after a
  8 15 conviction is a separate offense.
  8 16    The bill provides that the DIA may maintain an action in
  8 17 the name of the state for an injunction or other process
  8 18 against a person or governmental unit to restrain or prevent
  8 19 the establishment, conduct, management, or operation of an
  8 20 unlicensed ambulatory surgical center.
  8 21    The bill provides that the Act takes effect July 1, 2013.
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