Amendment S-5140 to HF 2305

Filed March 30, 2026 in the Senate by Sen. Mark Costello (R)

What it changes

1. By striking everything after the enacting clause and inserting: “Section
2. Section 135J.1, Code 2026, is amended to read as follows: 135J.1 Definitions. For the purposes of this chapter unless otherwise defined:
3. “Attending physician provider ” means a physician licensed pursuant to chapter 148 or a physician assistant licensed pursuant to chapter 148C , physician assistant, or an advanced registered nurse practitioner who is licensed in this state .
4. “Attorney in fact” means the same as defined in section 144B.1.
6. “Core services” means physician services, nursing services, medical social services, counseling services, and volunteer services provided by volunteers . These core services, as well as others deemed necessary by the hospice in delivering safe and appropriate care to its case load the hospice’s hospice patients , can be provided through either direct or indirect arrangement by the hospice.
8. “Department” means the department of inspections, appeals, and licensing.
9. “Guardian” means the same as defined in section 633.3.
11. “Hospice patient” or “patient” means a diagnosed terminally ill person an individual with an anticipated life expectancy of six months or less, as certified by the attending physician provider , who , alone or in conjunction with a unit of care as defined in subsection 9, has voluntarily requested and received admission into the a hospice program. If the patient is unable to request admission, a family member the may voluntarily request and receive admission on the patient’s behalf. An individual may make this request in conjunction with a unit of care, the individual’s attorney in fact, the individual’s guardian, or the majority of the guardians if the individual has more than one guardian with equal responsibilities appointed.
13. “Hospice patient’s family” means the immediate kin of the a hospice patient, including a spouse, parent, stepparent, brother, sister, stepbrother, stepsister, child, or stepchild. Additional relatives or individuals with significant personal ties to the hospice patient may be included in the hospice patient’s family.
15. “Hospice program” means a centrally coordinated program of home and inpatient care provided directly or through an agreement under the direction of an identifiable hospice administration providing palliative care directed at symptom management and supportive medical and other health services to terminally ill hospice patients and their families. A licensed hospice program shall utilize a medically directed interdisciplinary team and provide care to meet the physical, emotional, social, spiritual, and other special needs which are experienced during the final stages of illness, dying, and bereavement. Hospice care shall be available twenty-four hours a day, seven days a week.
17. “Interdisciplinary team” means the hospice patient and the hospice patient’s family, the attending physician provider , and all of the following individuals trained to serve with a licensed hospice program: a. A licensed physician pursuant to chapter 148 . b. A licensed registered nurse pursuant to chapter 152 . c. An individual with at least a baccalaureate degree in the field of social work providing medical-social services. d. Trained hospice volunteers Volunteers . e. As deemed appropriate by the hospice, physician assistants, providers of special services including but not limited to a spiritual counselor, a pharmacist pharmacists , or professionals in the fields of mental health may be included on the interdisciplinary team.
19. “Palliative care” means specialized medical care directed at managing symptoms experienced by the hospice provided to a patient , as well as addressing related needs of the patient and family as they experience the stress of the dying process who has been diagnosed by the patient’s attending provider with a serious illness. Palliative care is stress and symptom management care, based on the needs of the patient rather than the patient’s diagnosis, provided by an interdisciplinary team . The intent of palliative care is to enhance the quality of life for the hospice patient and family unit , and is not treatment directed at cure of the terminal illness . Palliative care may be provided at any stage of a patient’s serious illness, regardless of the patient’s age, and may be provided in conjunction with curative treatment for the serious illness.
20. “Serious illness” means a health condition that carries a high risk of mortality and either negatively impacts an individual’s daily functioning or quality of life, or excessively strains the individual’s caregivers.
21. “Terminal condition” means the same as defined in section 144A.2.
23. “Unit of care” means the a hospice patient and the a hospice patient’s family within a hospice program.
25. “Volunteer services” “Volunteer” means the services provided by individuals an individual who have has successfully completed a training program developed by a licensed hospice program and who provides services . Sec.
26. Section 135J.3, Code 2026, is amended to read as follows: 135J.3 Basic requirements. A licensed hospice program shall include:
27. A planned program of hospice care, the medical components of which shall be under the direction of an attending physician provider .
28. Centrally administered, coordinated hospice core services provided in home, outpatient, or institutional settings.
29. A mechanism that assures the rights of the patient and family a unit of care .
30. Palliative care Symptom management provided to a hospice patient and family unit of care under the direction of an attending physician provider .
31. An interdisciplinary team which develops, implements, and evaluates the hospice plan of care for the patient and family a unit of care .
32. Bereavement services.
33. Accessible hospice care twenty-four hours a day, seven days a week in all settings.
34. An ongoing system of quality assurance and utilization review. Sec.
35. NEW SECTION . 135J.3A Patient incapable of making a treatment decision.
36. a. A request for admission and placement in a hospice program for a patient who has a terminal condition, and who is comatose, incompetent, or otherwise physically or mentally incapable of communication, and who has not expressed their desire for palliative care or a hospice program, may be made by the patient’s attorney in fact or the patient’s guardian. If the patient has more than one guardian with equal responsibilities appointed, the decision agreed to by a majority of guardians. If a majority consensus is not achieved by the guardians, a court order shall be required. b. If a patient does not have an attorney in fact or a guardian, the request may be made by an individual, in the same order of priority prescribed in section 144A.7, subsection 1, paragraph “b” , who shall be guided by the express or implied intentions of the patient and who is reasonably available, willing, and competent to make a request.
37. This section shall not apply to a guardian appointed under chapter 232D. Sec.
38. Section 144A.2, Code 2026, is amended to read as follows: 144A.2 Definitions. Except as otherwise provided, as used in this chapter :
39. “Adult” means an individual eighteen years of age or older.
40. “Advanced registered nurse practitioner” means the same as defined in section 152.1.
42. “Attending physician provider ” means the physician selected by, or assigned to, the patient who has primary responsibility for the treatment and care of the patient same as defined in section 135J.1 .
44. “Attending physician assistant” means the physician assistant selected by, or assigned to, the patient who has primary responsibility for the treatment and care of the patient “Attorney in fact” means the same as defined in section 144B.1 .
45. “Close adult friend” means a friend of a patient to whom all of the following apply: a. The individual is at least eighteen years of age. b. The individual has shown special care and concern for the patient. c. The individual maintains regular contact with the patient and is familiar with the patient’s health, activities, and beliefs. d. The individual has provided an affidavit to the patient’s attending provider that states that the individual is willing and able to be involved in the patient’s care.
47. “Declaration” means a document executed in accordance with the requirements of section 144A.3 .
49. “Department” means the department of health and human services.
51. “Emergency medical care provider” means emergency medical care provider as defined in section 147A.1 .
53. “Health care provider” means a person, including an emergency medical care provider, who is licensed, certified, or otherwise authorized or permitted by the law of this state to administer health care in the ordinary course of business or in the practice of a profession.
55. “Hospital” means hospital as defined in section 135B.1 .
57. a. “Life-sustaining procedure” means any medical procedure, treatment, or intervention, including resuscitation, which meets both of the following requirements: (1) Utilizes mechanical or artificial means to sustain, restore, or supplant a spontaneous vital function. (2) When applied to a patient in a terminal condition, would serve only to prolong the dying process. b. “Life-sustaining procedure” does not include the provision of nutrition or hydration except when required to be provided parenterally or through intubation, or the administration of medication or performance of any medical procedure deemed necessary to provide comfort care or to alleviate pain.
59. “Out-of-hospital do-not-resuscitate order” means a written order signed by a physician an attending provider , executed in accordance with the requirements of section 144A.7A and issued consistent with this chapter , that directs the withholding or withdrawal of resuscitation when an adult patient in a terminal condition is outside the hospital.

Shortened here; the full amendment is in the official document.

Official amendment (PDF) · In the Bill Book