What changed in HF 919

6 passages reworded, 17 added and 17 removed; 10 of 50 unchanged.

Removed AddedIntroduced textText as passedAmendments

Compares wording only. The printed bills also mark changes to existing law with strikes and underlines, which aren’t shown here.

Section 1. Section 135B.1, Code 2025, is amended by adding the following new subsection:

NEW SUBSECTION.

7. “Specialty “Children’s specialty hospital” means a hospital described by all of the following:

a. The hospital is owned and operated by a nonprofit organization.

d. The hospital specializes in pediatric rehabilitation and treating children with a behavioral health condition or complex medical needs.

e. The hospital has no more than one two hundred inpatient beds.

f. The hospital provides outpatient services.

g. The hospital was a licensed nursing facility under section 135C.1, prior to July 1, 2025.

g. The hospital met the definition of a special population nursing facility, as promulgated by rule by the department of health and human services, prior to July 1, 2025.

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2.

NEW SECTION. 135B.40 Specialty Children’s specialty hospitals.

1. A specialty hospital shall establish formal criteria based on objective medical standards for patient admission, discharge, and continuation of care.

2. The department shall adopt rules pursuant to chapter 17A relating to the application of criteria established under subsection 1 when reviewing patient discharges from a specialty hospital.

1. The department may adopt rules pursuant to chapter 17A to establish minimum standards for the licensure of children’s specialty hospitals. Rules adopted pursuant to this section shall be formulated in consultation with the director of health and human services or the director’s designee, and with affected industry, professional, and consumer groups.

3. The department of health and human services shall provide notice to a specialty hospital of a significant change in federal Medicaid reimbursement to hospitals which would negatively impact the specialty hospital. To the extent permitted by law, the department of health and human services shall collaborate with the specialty hospital to mitigate the negative effects of a significant change in federal Medicaid reimbursement to hospitals.

2. A children’s specialty hospital shall establish formal criteria based on objective medical standards for patient admission, discharge, and continuation of care.

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3. DEPARTMENT OF INSPECTIONS, APPEALS, AND LICENSING —— DEPARTMENT OF HEALTH AND HUMAN SERVICES —— CHILDREN’S SPECIALTY HOSPITALS.

1. For purposes of this section, “licensed entity” means an entity granted a provisional general hospital license with a children’s specialty hospital designation license under subsection 2, paragraph “a”.

2. On or before July 1, 2025, the The department of inspections, appeals, and licensing shall, to the extent not prohibited by federal law, shall do all of the following:

a. Within thirty calendar days of the effective date of this Act, grant a provisional children’s specialty hospital license to an entity that requests such provisional licensure provided that the entity meets the definition of children’s specialty hospital under section 135B.1. A provisional license granted under this paragraph shall be valid for no more than twenty-four consecutive months from the date the provisional license is granted. A licensed entity may seek federal certification and participation in federal reimbursement programs that require hospital licensure.

a. Grant a provisional general hospital license with a specialty hospital designation to an entity that meets the definition of a specialty hospital under section 135B.1. A provisional license granted under this paragraph shall enable the licensed entity to participate in hospital-based enhanced reimbursement.

b. Grant reasonable waivers from state hospital rules to permit a licensed entity to maintain the licensed entity’s operations as provided prior to the effective date of this Act, until the date the licensed entity obtains federal certification or the ability to participate in federal reimbursement programs that require hospital licensure. After a licensed entity obtains federal certification or the ability to participate in federal reimbursement programs that require hospital licensure, the department of inspections, appeals, and licensing and the department of health and human services shall grant the necessary waivers to the licensed entity to ensure the licensed entity’s compliance with the requirements of the federal certification or the federal reimbursement programs. Waivers granted under this paragraph shall specifically include a waiver from state rules that require a licensed entity to maintain, or to have available, laboratory and pathology services and facilities, other than laboratory and pathology services and facilities that the licensed entity maintained prior to the effective date of this Act, and a waiver from state rules that require the provision of emergency services, other than emergency services that the licensed entity provided prior to the effective date of this Act. Each waiver granted to a licensed entity under this paragraph shall be valid for no more than twenty-four consecutive months from the date the licensed entity was granted a provisional children’s specialty hospital license under paragraph “a”, or until the date the licensed entity obtains a permanent children’s specialty hospital license, whichever date is earlier.

b. Approve a licensed entity to obtain accreditation from an accrediting organization approved by the federal centers for Medicare and Medicaid services.

c. Collaborate with the department of health and human services and a licensed entity to assist the licensed entity in seeking federal certification or participation in federal reimbursement programs requiring hospital licensure.

3. On or before July 1, 2025, the department of health and human services shall set reimbursement rates for inpatient care provided by a licensed entity. Reimbursement rates under this paragraph shall be equal to the licensed entity’s average allowable per diem costs, and adjusted for inflation.

3. A licensed entity may operate under the minimum physical standards for nursing facilities in 481 IAC 61 under which the licensed entity operated prior to the effective date of this Act, and shall be exempt from all other construction standards applicable only to hospitals and off-site premises. The exemption under this paragraph shall include the exemption from the standards set forth in the guidelines for design and construction of hospitals as published by the facility guidelines institute.

4. On or before July 1, 2025, the department of health and human services and the department of inspections, appeals, and licensing shall, to the extent not prohibited by federal law, do the following:

4. The department of health and human services shall set reimbursement rates for inpatient care and outpatient care provided by the licensed entity. Reimbursement rates under this subsection shall be based on the following:

a. Grant waivers for facility requirements under each department’s rulemaking authority to the extent necessary to allow a licensed entity to operate as a specialty hospital. A waiver granted under this paragraph shall be valid for no more than twenty-four consecutive months from the date of enactment of this Act, or until the licensed entity complies with all facility requirements, whichever is earlier.

a. For inpatient care, prospective average allowable per diem costs adjusted for inflation pursuant to 441 IAC 79.1(5)(k).

b. Collaborate with each other and a licensed entity to obtain necessary federal waivers and approval to allow the licensed entity to operate as a specialty hospital as defined under 42 C.F.R. §411.351.

b. For outpatient care, the licensed entity’s cost-to-charge ratio, as defined by the department of health and human services, with retrospectively adjusted prospective reimbursements as provided in 441 IAC 79.1(1)(g).

c. Exempt a licensed entity from being required to provide emergency services, other than emergency services the licensed entity provided prior to July 1, 2025.

5. A licensed entity shall be exempt from certificate of need requirements under chapter 10A, subchapter VII, part 2, to the extent that the licensed entity is implementing a new institutional health service, or a changed institutional health service, for the purpose of converting the licensed entity to a children’s specialty hospital, or to revert the licensed entity to a nursing facility. The exemption under this subsection shall continue until the earlier of the following occurs:

d. Exempt a licensed entity from being required to maintain, or have available, laboratory and pathology services and facilities, other than laboratory and pathology services and facilities the licensed entity maintained prior to July 1, 2025.

a. The date the licensed entity obtains a permanent children’s specialty hospital license.

e. Exempt a licensed entity from construction standards applicable only to hospitals and off-site premises, other than the construction standards applicable only to hospitals and off-site premises standards that the licensed entity complied with prior to July 1, 2025. The exemption under this paragraph shall include exemption from the standards set forth in the guidelines for design and construction of hospitals as published by the facility guidelines institute.

b. Twenty-four consecutive months from the date the licensed entity was granted a provisional children’s specialty hospital license.

5. On or before July 1, 2025, the department of health and human services, the department of inspections, appeals, and licensing, and the state health facilities council established in section 10A.712 shall, to the extent not prohibited by federal law, do all of the following:

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a. Waive any requirement necessary to allow a licensed entity to redesignate nursing facility beds as specialty hospital beds.

4. EMERGENCY RULES. The department of inspections, appeals, and licensing may adopt emergency rules under section 17A.4, subsection 3, and section 17A.5, subsection 2, paragraph “b”, to implement the provisions of this Act and the rules shall be effective immediately upon filing unless a later date is specified in the rules. Any rules adopted in accordance with this section shall also be published as a notice of intended action as provided in section 17A.4.

b. Waive any requirement necessary to allow a licensed entity to expand up to one hundred specialty hospital beds.

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6. The department of inspections, appeals, and licensing, and the department of health and human services, shall adopt rules pursuant to chapter 17A as necessary to implement this section.

5. EFFECTIVE DATE. This Act, being deemed of immediate importance, takes effect upon enactment.