Relating to the licensure of ambulatory surgical centers, providing for fees to be considered repayment receipts, and providing penalties

This bill creates a new Code chapter to provide for the licensing and regulation of ambulatory surgical centers. The department of inspections and appeals (DIA) is designated to enforce the regulations. The bill provides that the purpose of the new Code chapter is to protect the public health, safety, and welfare by providing for the licensing and regulation of ambulatory surgical centers. The bill prohibits the establishment, operation, or maintenance of an ambulatory surgical center in the state without obtaining a license. The bill provides the process for application for licensure. An application for an initial license is required to be accompanied by a fee of $50. The fees collected are repayment receipts and are to be used by DIA to administer the new Code chapter. The bill provides for the issuance and renewal of licenses. A license is to be issued only for the premises and persons named in the application; is not transferable or assignable except with the written approval of DIA; and is required to be posted in a conspicuous place on the licensed premises as prescribed by rule of DIA. The bill provides that separate licenses are not required for ambulatory surgical center facilities that are maintained on the same physical site and that have the same ownership or control. Multiple buildings located on the same physical site under the same ownership or control are considered one ambulatory surgical center facility for purposes of the new Code chapter and Code chapter 135, division VI, relating to the health facilities council and certificate of need provisions, and are to be permitted to operate under one license. Licenses expire on June of each year and are required to be renewed annually. The bill directs DIA to renew a license upon payment of a $500 annual license renewal fee and the filing of an application for renewal at least days prior to the expiration of the existing license. The annual licensure fee is considered a repayment receipt and is to be dedicated to support the staffing necessary to conduct the inspections and investigations under the new Code chapter. The bill provides for denial, suspension, or revocation of licenses. A license may be denied, suspended, or revoked if DIA finds there has been a substantial failure to comply with the new Code chapter or the rules and standards adopted under the new Code chapter. The denial, suspension, or revocation of a license by DIA and appeal from that action are governed by the procedures for a contested case hearing under Code chapter 17A. The bill authorizes DIA, after providing notice of noncompliance and a reasonable time for corrective action, and if the noncompliance does not endanger public health or safety, to issue a conditional license to the ambulatory surgical center as an alternative to suspending or revoking its license. The bill also authorizes DIA to issue an emergency order to suspend a license if DIA has reasonable cause to believe that the conduct of the ambulatory surgical center creates an immediate danger to the public health or safety. On written request of the licensee, DIA is required to conduct a hearing to determine if the emergency suspension is to be continued, modified, or rescinded. The hearing and any appeal are governed by DIA’s rules for a contested case hearing and Code chapter 17A. The bill directs DIA to adopt rules with the advice and approval of the state board of health to specify the standards for ambulatory surgical centers. The rules are required to be consistent with and not exceed the requirements of the new Code chapter and the conditions for coverage in the federal Medicare program for ambulatory surgical centers. DIA is also directed to adopt rules relating to provisions of the new Code chapter relating to the issuance, renewal, denial, suspension, and revocation of a license to establish, operate, and maintain an ambulatory surgical center. If an ambulatory surgical center is in operation at the time of adoption of any applicable rules or standards, the center is to be given a reasonable time, not to exceed one year from the date of adoption, within which to comply with such rules and standards. The bill provides for inspections or investigations of ambulatory surgical centers, and directs that DIA shall perform inspections on a schedule that is of the same frequency required for inspections of Medicare-certified ambulatory surgical centers. The bill also requires DIA to recognize, in lieu of its own licensure inspection, the comparable inspection and inspection findings of a Medicare conditions for coverage survey. The bill prohibits a DIA inspector from participating in an inspection or investigation of an ambulatory surgical center in which the inspector or a member of the inspector’s immediate family works or has worked within the last two years or in which the inspector or the inspector’s immediate family has a financial ownership interest. The bill requires an ambulatory surgical center to comply with child and dependent adult abuse information and criminal record checks and evaluations. The bill provides confidentiality provisions relating to ambulatory surgical center information. The final findings with respect to compliance by an ambulatory surgical center are to be made available to the public in a readily available form and place. Other information relating to an ambulatory surgical center shall not be made available to the public, except in proceedings involving the denial, suspension, or revocation of a license. The name of a person who files a complaint with DIA is required to remain confidential and not be subject to discovery, subpoena, or other means of legal compulsion. The bill provides for injunctive relief and judicial review. The bill provides that any person establishing, operating, or maintaining an ambulatory surgical center without a license commits a serious misdemeanor, and each day of continuing violation after conviction shall be considered a separate offense. A serious misdemeanor is punishable by confinement for no more than one year and a fine of at least $430 but not more than $2,560. The bill also directs the department of public health (DPH) to adopt rules requiring ambulatory surgical centers to report quality data to DPH that is consistent with the data required to be reported to the centers for Medicare and Medicaid services of the United States department of health and human services. However, the rules shall not require an ambulatory surgical center to provide health data to DPH or any other public or private entity that is in addition to, different than, or exceeds the quality data required to be reported to the centers for Medicare and Medicaid services of the United States department of health and human services. The bill makes conforming changes in the Code to reflect the terminology of “ambulatory surgical center”.