135.63 - CERTIFICATE OF NEED REQUIRED -- EXCLUSIONS.

        135.63  CERTIFICATE OF NEED REQUIRED -- EXCLUSIONS.
         1.  A new institutional health service or changed institutional
      health service shall not be offered or developed in this state
      without prior application to the department for and receipt of a
      certificate of need, pursuant to this division.  The application
      shall be made upon forms furnished or prescribed by the department
      and shall contain such information as the department may require
      under this division.  The application shall be accompanied by a fee
      equivalent to three-tenths of one percent of the anticipated cost of
      the project with a minimum fee of six hundred dollars and a maximum
      fee of twenty-one thousand dollars.  The fee shall be remitted by the
      department to the treasurer of state, who shall place it in the
      general fund of the state.  If an application is voluntarily
      withdrawn within thirty calendar days after submission, seventy-five
      percent of the application fee shall be refunded; if the application
      is voluntarily withdrawn more than thirty but within sixty days after
      submission, fifty percent of the application fee shall be refunded;
      if the application is withdrawn voluntarily more than sixty days
      after submission, twenty-five percent of the application fee shall be
      refunded.  Notwithstanding the required payment of an application fee
      under this subsection, an applicant for a new institutional health
      service or a changed institutional health service offered or
      developed by an intermediate care facility for persons with mental
      retardation or an intermediate care facility for persons with mental
      illness as defined pursuant to section 135C.1 is exempt from payment
      of the application fee.
         2.  This division shall not be construed to augment, limit,
      contravene, or repeal in any manner any other statute of this state
      which may authorize or relate to licensure, regulation, supervision,
      or control of, nor to be applicable to:
         a.  Private offices and private clinics of an individual
      physician, dentist, or other practitioner or group of health care
      providers, except as provided by section 135.61, subsection 18,
      paragraphs "g", "h", and "m", and subsections 20 and 21.

         b.  Dispensaries and first aid stations, located within
      schools, businesses, or industrial establishments, which are
      maintained solely for the use of students or employees of those
      establishments and which do not contain inpatient or resident beds
      that are customarily occupied by the same individual for more than
      twenty-four consecutive hours.
         c.  Establishments such as motels, hotels, and boarding houses
      which provide medical, nursing personnel, and other health related
      services as an incident to their primary business or function.
         d.  The remedial care or treatment of residents or patients in
      any home or institution conducted only for those who rely solely upon
      treatment by prayer or spiritual means in accordance with the creed
      or tenets of any recognized church or religious denomination.
         e.  A health maintenance organization or combination of health
      maintenance organizations or an institutional health facility
      controlled directly or indirectly by a health maintenance
      organization or combination of health maintenance organizations,
      except when the health maintenance organization or combination of
      health maintenance organizations does any of the following:
         (1)  Constructs, develops, renovates, relocates, or otherwise
      establishes an institutional health facility.
         (2)  Acquires major medical equipment as provided by section
      135.61, subsection 18, paragraphs "i" and "j".
         f.  A residential care facility, as defined in section 135C.1,
      including a residential care facility for persons with mental
      retardation, notwithstanding any provision in this division to the
      contrary.
         g. (1)  A reduction in bed capacity of an institutional health
      facility, notwithstanding any provision in this division to the
      contrary, if all of the following conditions exist:
         (a)  The institutional health facility reports to the department
      the number and type of beds reduced on a form prescribed by the
      department at least thirty days before the reduction.  In the case of
      a health care facility, the new bed total must be consistent with the
      number of licensed beds at the facility.  In the case of a hospital,
      the number of beds must be consistent with bed totals reported to the
      department of inspections and appeals for purposes of licensure and
      certification.
         (b)  The institutional health facility reports the new bed total
      on its next annual report to the department.
         (2)  If these conditions are not met, the institutional health
      facility is subject to review as a "new institutional health
      service" or "changed institutional health service" under
      section 135.61, subsection 18, paragraph "d", and subject to
      sanctions under section 135.73.  If the institutional health facility
      reestablishes the deleted beds at a later time, review as a "new
      institutional health service" or "changed institutional health
      service" is required pursuant to section 135.61, subsection 18,
      paragraph "d".
         h. (1)  The deletion of one or more health services,
      previously offered on a regular basis by an institutional health
      facility or health maintenance organization, notwithstanding any
      provision of this division to the contrary, if all of the following
      conditions exist:
         (a)  The institutional health facility or health maintenance
      organization reports to the department the deletion of the service or
      services at least thirty days before the deletion on a form
      prescribed by the department.
         (b)  The institutional health facility or health maintenance
      organization reports the deletion of the service or services on its
      next annual report to the department.
         (2)  If these conditions are not met, the institutional health
      facility or health maintenance organization is subject to review as a
      "new institutional health service" or "changed institutional
      health service" under section 135.61, subsection 18, paragraph
      "f", and subject to sanctions under section 135.73.
         (3)  If the institutional health facility or health maintenance
      organization reestablishes the deleted service or services at a later
      time, review as a "new institutional health service" or
      "changed institutional health service" may be required pursuant
      to section 135.61, subsection 18.
         i.  A residential program exempt from licensing as a health
      care facility under chapter 135C in accordance with section 135C.6,
      subsection 8.
         j.  The construction, modification, or replacement of
      nonpatient care services, including parking facilities, heating,
      ventilation and air conditioning systems, computers, telephone
      systems, medical office buildings, and other projects of a similar
      nature, notwithstanding any provision in this division to the
      contrary.
         k. (1)  The redistribution of beds by a hospital within the
      acute care category of bed usage, notwithstanding any provision in
      this division to the contrary, if all of the following conditions
      exist:
         (a)  The hospital reports to the department the number and type of
      beds to be redistributed on a form prescribed by the department at
      least thirty days before the redistribution.
         (b)  The hospital reports the new distribution of beds on its next
      annual report to the department.
         (2)  If these conditions are not met, the redistribution of beds
      by the hospital is subject to review as a new institutional health
      service or changed institutional health service pursuant to section
      135.61, subsection 18, paragraph "d", and is subject to sanctions
      under section 135.73.
         l.  The replacement or modernization of any institutional
      health facility if the replacement or modernization does not add new
      health services or additional bed capacity for existing health
      services, notwithstanding any provision in this division to the
      contrary.  With respect to a nursing facility, "replacement"
      means establishing a new facility within the same county as the prior
      facility to be closed.  With reference to a hospital,
      "replacement" means establishing a new hospital that demonstrates
      compliance with all of the following criteria through evidence
      submitted to the department:
         (1)  Is designated as a critical access hospital pursuant to 42
      U.S.C. § 1395i-4.
         (2)  Serves at least seventy-five percent of the same service area
      that was served by the prior hospital to be closed and replaced by
      the new hospital.
         (3)  Provides at least seventy-five percent of the same services
      that were provided by the prior hospital to be closed and replaced by
      the new hospital.
         (4)  Is staffed by at least seventy-five percent of the same
      staff, including medical staff, contracted staff, and employees, as
      constituted the staff of the prior hospital to be closed and replaced
      by the new hospital.
         m.  Hemodialysis services provided by a hospital or
      freestanding facility, notwithstanding any provision in this division
      to the contrary.
         n.  Hospice services provided by a hospital, notwithstanding
      any provision in this division to the contrary.
         o.  The change in ownership, licensure, organizational
      structure, or designation of the type of institutional health
      facility if the health services offered by the successor
      institutional health facility are unchanged.  This exclusion is
      applicable only if the institutional health facility consents to the
      change in ownership, licensure, organizational structure, or
      designation of the type of institutional health facility and ceases
      offering the health services simultaneously with the initiation of
      the offering of health services by the successor institutional health
      facility.
         p.  The conversion of an existing number of beds by an
      intermediate care facility for persons with mental retardation to a
      smaller facility environment, including but not limited to a
      community-based environment which does not result in an increased
      number of beds, notwithstanding any provision in this division to the
      contrary, including subsection 4, if all of the following conditions
      exist:
         (1)  The intermediate care facility for persons with mental
      retardation reports the number and type of beds to be converted on a
      form prescribed by the department at least thirty days before the
      conversion.
         (2)  The intermediate care facility for persons with mental
      retardation reports the conversion of beds on its next annual report
      to the department.
         3.  This division shall not be construed to be applicable to a
      health care facility operated by and for the exclusive use of members
      of a religious order, which does not admit more than two individuals
      to the facility from the general public, and which was in operation
      prior to July 1, 1986.  However, this division is applicable to such
      a facility if the facility is involved in the offering or developing
      of a new or changed institutional health service on or after July 1,
      1986.
         4.  A copy of the application shall be sent to the department of
      human services at the time the application is submitted to the Iowa
      department of public health.  The department shall not process
      applications for and the council shall not consider a new or changed
      institutional health service for an intermediate care facility for
      persons with mental retardation unless both of the following
      conditions are met:
         a.  The new or changed beds shall not result in an increase in
      the total number of medical assistance certified intermediate care
      facility beds for persons with mental retardation in the state,
      exclusive of those beds at the state resource centers or other state
      institutions, beyond one thousand six hundred thirty-six beds.
         b.  A letter of support for the application is provided by the
      county board of supervisors, or the board's designee, in the county
      in which the beds would be located.  
         Section History: Early Form
         [C79, 81, § 135.63; 82 Acts, ch 1194, § 3] 
         Section History: Recent Form
         86 Acts, ch 1150, § 1; 86 Acts, ch 1245, § 1110; 91 Acts, ch 225,
      § 4; 92 Acts, ch 1043, § 1; 92 Acts, ch 1206, § 1; 95 Acts, ch 120, §
      1; 96 Acts, ch 1129, § 113; 97 Acts, ch 93, §4--8; 2002 Acts, ch
      1120, §10; 2006 Acts, ch 1184, §78; 2008 Acts, ch 1191, §47; 2009
      Acts, ch 184, §38
         Referred to in § 135.66, 135C.2, 231C.3