Senate File 372 - Introduced
SENATE FILE
BY COMMITTEE ON STATE
GOVERNMENT
(SUCCESSOR TO SSB
1172)
A BILL FOR
1 An Act relating to licensure of durable medical equipment
2 providers, providing penalties, and including effective date
3 and implementation provisions.
4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
TLSB 1109SV (2) 86
tr/nh
PAG LIN
1 1 Section 1. Section 147.1, subsections 3 and 6, Code 2015,
1 2 are amended to read as follows:
1 3 3. "Licensed" or "certified", when applied to a physician
1 4 and surgeon, podiatric physician, osteopathic physician and
1 5 surgeon, physician assistant, psychologist, chiropractor,
1 6 nurse, dentist, dental hygienist, dental assistant,
1 7 optometrist, speech pathologist, audiologist, pharmacist,
1 8 physical therapist, physical therapist assistant, occupational
1 9 therapist, occupational therapy assistant, orthotist,
1 10 prosthetist, pedorthist, respiratory care practitioner,
1 11 practitioner of cosmetology arts and sciences, practitioner
1 12 of barbering, funeral director, dietitian, marital and family
1 13 therapist, mental health counselor, social worker, massage
1 14 therapist, athletic trainer, acupuncturist, nursing home
1 15 administrator, hearing aid dispenser, durable medical equipment
1 16 provider, or sign language interpreter or transliterator means
1 17 a person licensed under this subtitle.
1 18 6. "Profession" means medicine and surgery, podiatry,
1 19 osteopathic medicine and surgery, practice as a physician
1 20 assistant, psychology, chiropractic, nursing, dentistry,
1 21 dental hygiene, dental assisting, optometry, speech pathology,
1 22 audiology, pharmacy, physical therapy, physical therapist
1 23 assisting, occupational therapy, occupational therapy
1 24 assisting, respiratory care, cosmetology arts and sciences,
1 25 barbering, mortuary science, marital and family therapy, mental
1 26 health counseling, social work, dietetics, massage therapy,
1 27 athletic training, acupuncture, nursing home administration,
1 28 hearing aid dispensing, durable medical equipment providing,
1 29 sign language interpreting or transliterating, orthotics,
1 30 prosthetics, or pedorthics.
1 31 Sec. 2. Section 147.2, subsection 1, Code 2015, is amended
1 32 to read as follows:
1 33 1. A person shall not engage in the practice of medicine
1 34 and surgery, podiatry, osteopathic medicine and surgery,
1 35 psychology, chiropractic, physical therapy, physical
2 1 therapist assisting, nursing, dentistry, dental hygiene,
2 2 dental assisting, optometry, speech pathology, audiology,
2 3 occupational therapy, occupational therapy assisting,
2 4 orthotics, prosthetics, pedorthics, respiratory care,
2 5 pharmacy, cosmetology arts and sciences, barbering, social
2 6 work, dietetics, marital and family therapy or mental health
2 7 counseling, massage therapy, mortuary science, athletic
2 8 training, acupuncture, nursing home administration, hearing
2 9 aid dispensing, durable medical equipment providing, or sign
2 10 language interpreting or transliterating, or shall not practice
2 11 as a physician assistant, unless the person has obtained a
2 12 license for that purpose from the board for the profession.
2 13 Sec. 3. Section 147.13, Code 2015, is amended by adding the
2 14 following new subsection:
2 15 NEW SUBSECTION. 25. For durable medical equipment
2 16 providers, the board of durable medical equipment providers.
2 17 Sec. 4. Section 147.14, subsection 1, Code 2015, is amended
2 18 by adding the following new paragraph:
2 19 NEW PARAGRAPH. x. For durable medical equipment providers,
2 20 seven licensed durable medical equipment providers.
2 21 Sec. 5. NEW SECTION. 154G.1 Definitions.
2 22 For purposes of this chapter:
2 23 1. "Accrediting organization" means any organization
2 24 recognized by the centers for Medicare and Medicaid services of
2 25 the United States department of health and human services as an
2 26 accreditation body for durable medical equipment providers.
2 27 2. "Affiliated person" means any person who directly or
2 28 indirectly manages, controls, or oversees the operation of
2 29 a corporation or other business entity that is a licensee,
2 30 regardless of whether such person is a partner, shareholder,
2 31 owner, officer, director, agent, or employee of the entity.
2 32 3. "Applicant" means an individual applicant in the case of
2 33 a sole proprietorship or any officer, director, agent, managing
2 34 employee, general manager, or affiliated person or any partner
2 35 or shareholder having an ownership interest equal to five
3 1 percent or greater in the corporation or other business entity.
3 2 4. "Board" means the board of durable medical equipment
3 3 providers.
3 4 5. "Consumer" or "patient" means a person who uses durable
3 5 medical equipment in the person's residence.
3 6 6. "Durable medical equipment" means any product reimbursed
3 7 under Medicare part B durable medical equipment benefits and
3 8 any product as defined by the federal Food, Drug, and Cosmetic
3 9 Act or reimbursable under Medicaid as provided by the board by
3 10 rule. "Durable medical equipment" includes but is not limited
3 11 to hospital beds, oxygen, walkers, continuous positive airway
3 12 pressure machines, customized wheelchairs, and related seating
3 13 and positioning devices, but does not include prosthetics
3 14 or orthotics or any splints, braces, or aids custom=fit or
3 15 custom=fabricated by a licensed health care practitioner or
3 16 commercially available noncustomized splints, braces, or aids
3 17 prescribed by a licensed health care practitioner.
3 18 7. "Durable medical equipment provider" means a person or
3 19 entity that sells or rents, or offers to sell or rent, to or
3 20 for a consumer any durable medical equipment or durable medical
3 21 equipment services.
3 22 8. "Durable medical equipment provider personnel" means
3 23 persons who are employed by or under contract with a durable
3 24 medical equipment provider.
3 25 9. "Durable medical equipment services" means equipment
3 26 management and consumer instruction, including selection,
3 27 delivery, setup, and maintenance of equipment and other related
3 28 services for the use of durable medical equipment in the
3 29 consumer's regular or temporary residence.
3 30 10. "General manager" means the individual who has the
3 31 general administrative charge of the premises of a licensed
3 32 durable medical equipment provider.
3 33 11. "Licensed health care practitioner" means a person
3 34 licensed in this state engaging in a profession or occupation
3 35 included in section 147.1, subsections 3 and 6.
4 1 12. "Licensee" means the person or entity to whom a license
4 2 to operate as a durable medical equipment provider is issued
4 3 by the board.
4 4 13. "Moratorium" means a mandated temporary cessation or
4 5 suspension of the sale, rental, or offering of durable medical
4 6 equipment, except that services related to durable medical
4 7 equipment sold or rented prior to the moratorium shall be
4 8 continued without interruption, unless ordered otherwise by the
4 9 board.
4 10 14. "Premises" means those buildings and equipment which
4 11 are located at the address of the licensed durable medical
4 12 equipment provider for the provision of durable medical
4 13 equipment services which are in such reasonable proximity as to
4 14 appear to the public to be a single provider location.
4 15 15. "Residence" means a consumer's home or place of
4 16 residence, which may include a nursing home as defined in
4 17 section 155.1, assisted living program as defined in section
4 18 231C.2, elder group home as defined in section 231B.1,
4 19 transitional living facility, or other congregate residential
4 20 facility.
4 21 16. "Retail sale" means a sale or rental of durable medical
4 22 equipment directly to a consumer which does not require a
4 23 prescription or billing of Medicare, Medicaid, or any other
4 24 third=party insurance.
4 25 Sec. 6. NEW SECTION. 154G.2 License required == exemptions.
4 26 1. A person shall not do any of the following without
4 27 obtaining a license from the board under this chapter:
4 28 a. Hold oneself out to the public as providing durable
4 29 medical equipment or durable medical equipment services or
4 30 accept physician orders for durable medical equipment or
4 31 durable medical equipment services.
4 32 b. Hold oneself out to the public as providing durable
4 33 medical equipment that typically requires durable medical
4 34 equipment services.
4 35 c. Provide durable medical equipment or durable medical
5 1 equipment services to consumers in this state.
5 2 2. A separate license is required for all durable medical
5 3 equipment providers operating on separate premises, even if
5 4 the providers are operating under the same management. For
5 5 each location a provider operates, an initial inspection by the
5 6 board pursuant to section 154G.9 shall be required to obtain
5 7 a license.
5 8 3. The following persons are exempt from durable medical
5 9 equipment provider licensure unless the person operates a
5 10 separate company, corporation, or division that is in the
5 11 business of providing durable medical equipment and services
5 12 for sale or rent to consumers at their regular or temporary
5 13 place of residence pursuant to the provisions of this chapter:
5 14 a. Durable medical equipment providers operated by the
5 15 federal government.
5 16 b. Nursing homes as defined in section 155.1.
5 17 c. Assisted living programs as defined in section 231C.2.
5 18 d. Home health agencies as defined in 42 C.F.R. pt. 484.
5 19 e. Hospice programs as defined in section 135J.1.
5 20 f. Intermediate care facilities for persons with
5 21 intellectual disabilities or mental illnesses as defined in
5 22 section 135C.1.
5 23 g. Homes for special services.
5 24 h. Transitional living facilities.
5 25 i. Hospitals licensed pursuant to chapter 135B.
5 26 j. Ambulatory surgical centers.
5 27 k. Manufacturers and wholesale distributors when not selling
5 28 directly to consumers.
5 29 l. Licensed health care practitioners who utilize durable
5 30 medical equipment in the course of their practice.
5 31 m. Pharmacies licensed pursuant to chapter 155A.
5 32 n. Any durable medical equipment provider who only provides
5 33 items for retail sale.
5 34 4. A person shall not offer or advertise durable medical
5 35 equipment or durable medical equipment services to the public
6 1 unless such person has a valid license under this chapter or is
6 2 exempted from licensure under subsection 3. A person holding
6 3 a license issued under this chapter shall not advertise or
6 4 indicate to the public that the person holds a durable medical
6 5 equipment provider license other than the license the person
6 6 has been issued.
6 7 Sec. 7. NEW SECTION. 154G.3 Principal place of business
6 8 out of state.
6 9 A durable medical equipment provider that provides durable
6 10 medical equipment or durable medical equipment services
6 11 to persons in this state and that has a principal place of
6 12 business outside this state shall maintain an office or place
6 13 of business within this state unless the principal place of
6 14 business is located in a bordering state, is within fifty miles
6 15 of a border with this state, and meets the other requirements
6 16 of this chapter.
6 17 Sec. 8. NEW SECTION. 154G.4 Accreditation.
6 18 A durable medical equipment provider accredited by an
6 19 accrediting organization may submit documents to the board
6 20 evidencing current accreditation and shall be presumed to
6 21 comply with the licensing requirements of this chapter.
6 22 Licensing of a durable medical equipment provider that has
6 23 been accredited by an accrediting organization shall become
6 24 effective upon written notification from the board that the
6 25 accreditation meets the standards set out in rules adopted by
6 26 the board.
6 27 Sec. 9. NEW SECTION. 154G.5 License application == renewal
6 28 == duplicates == fees.
6 29 1. An application for an initial license or for renewal of
6 30 an existing license shall be made under oath to the board on
6 31 forms furnished by the board and must be accompanied by the
6 32 appropriate license fee as established by the board by rule.
6 33 2. The applicant shall file with the application
6 34 information demonstrating that the applicant is in compliance
6 35 with this chapter and applicable rules. Such information shall
7 1 include the following:
7 2 a. A report specifying by category the durable medical
7 3 equipment to be provided and indicating the durable medical
7 4 equipment offered either directly by the applicant or through
7 5 contractual arrangements with existing durable medical
7 6 equipment providers. Categories of equipment include but are
7 7 not limited to the following:
7 8 (1) Respiratory modalities.
7 9 (2) Ambulation aids.
7 10 (3) Mobility aids.
7 11 (4) Sickroom setup.
7 12 (5) Disposables.
7 13 b. A report specifying by category the durable medical
7 14 equipment services to be provided and indicating those offered
7 15 either directly by the applicant or through contractual
7 16 arrangements with existing providers. Categories of services
7 17 include but are not limited to the following:
7 18 (1) Intake.
7 19 (2) Equipment selection.
7 20 (3) Delivery.
7 21 (4) Setup and installation.
7 22 (5) Patient training.
7 23 (6) Ongoing service and maintenance.
7 24 (7) Retrieval.
7 25 c. A list of those persons with whom the applicant contracts
7 26 to provide durable medical equipment or durable medical
7 27 equipment services to its consumers and those persons for whom
7 28 the applicant provides durable medical equipment or durable
7 29 medical equipment services.
7 30 d. A description and explanation of any exclusions,
7 31 permanent suspensions, or terminations of the applicant
7 32 from the Medicare or medical assistance program. Proof
7 33 of compliance with the disclosure of ownership and control
7 34 interest requirements of the Medicare or medical assistance
7 35 program shall be accepted in lieu of this submission.
8 1 e. A description and explanation of any felony committed
8 2 by a member of the board of directors of the applicant, its
8 3 officers, or any individual owning five percent or more of the
8 4 applicant. This requirement does not apply to a director of
8 5 a not=for=profit corporation or organization if the director
8 6 serves solely in a voluntary capacity for the corporation or
8 7 organization, does not regularly take part in the day=to=day
8 8 operational decisions of the corporation or organization,
8 9 receives no remuneration for such director's services on the
8 10 corporation's or organization's board of directors, and has
8 11 no financial interest and no family members with a financial
8 12 interest in the corporation or organization, provided that the
8 13 director and the not=for=profit corporation or organization
8 14 include in the application a statement affirming that the
8 15 director's relationship to the corporation satisfies the
8 16 requirements of this paragraph.
8 17 3. An applicant for initial licensure shall demonstrate
8 18 financial ability to operate, which may be accomplished by the
8 19 submission of a surety bond in the amount of fifty thousand
8 20 dollars to the board. An existing surety bond for Medicare
8 21 credentialing held by the applicant shall be sufficient in lieu
8 22 of an additional bond.
8 23 4. An applicant for license renewal who has demonstrated
8 24 financial inability to operate shall demonstrate financial
8 25 ability to operate before the board may renew the applicant's
8 26 license.
8 27 5. The board shall initiate a criminal background check of
8 28 the applicant upon receipt of a completed, signed, and dated
8 29 application. As used in this subsection, "applicant" means the
8 30 general manager and the financial officer or similarly titled
8 31 individual who is responsible for the financial operation of
8 32 the durable medical equipment provider.
8 33 a. The applicant shall supply fingerprint samples or
8 34 submit to a criminal history records check to be conducted
8 35 by the division of criminal investigation of the department
9 1 of public safety. Any costs incurred by the division of
9 2 criminal investigation of the department of public safety in
9 3 conducting such investigation of an applicant shall be paid by
9 4 the potential licensee.
9 5 b. The board may require a criminal background check for a
9 6 member of the board of directors of the potential licensee or
9 7 an officer or an individual owning five percent or more of the
9 8 potential licensee if the board has probable cause to believe
9 9 that such individual has been convicted of a felony.
9 10 6. The board shall not issue a license to an applicant if
9 11 the applicant or an administrator or financial officer of the
9 12 durable medical equipment provider has been found guilty of or
9 13 has entered a plea of nolo contendere or guilty to any felony.
9 14 7. Proof of professional and commercial liability insurance
9 15 shall be submitted with the application. The board shall
9 16 set the required amounts of liability insurance by rule,
9 17 but the required amount shall not be less than two hundred
9 18 fifty thousand dollars per claim. In the case of contracted
9 19 services, the contractor shall have liability insurance of not
9 20 less than two hundred fifty thousand dollars per claim.
9 21 8. Ninety days before the expiration date of a license, the
9 22 durable medical equipment provider shall submit an application
9 23 for license renewal to the board under oath on forms furnished
9 24 by the board. The license shall be renewed if the applicant
9 25 has met the requirements established under this chapter and
9 26 applicable rules. The durable medical equipment provider must
9 27 file with the application satisfactory proof that it is in
9 28 compliance with this chapter and applicable rules. The durable
9 29 medical equipment provider must submit satisfactory proof of
9 30 its financial ability to comply with the requirements of this
9 31 chapter.
9 32 9. When a duplicate license is issued, a fee shall be
9 33 assessed not exceeding the actual cost of duplicating and
9 34 mailing the duplicate license.
9 35 10. The license must be displayed in a conspicuous place
10 1 in the administrative office of the durable medical equipment
10 2 provider and is valid only while in the possession of the
10 3 person or entity to which it is issued. The license may
10 4 not be sold, assigned, or otherwise transferred, voluntarily
10 5 or involuntarily, and is valid only for the durable medical
10 6 equipment provider and location for which originally issued.
10 7 11. All license fees required of a durable medical equipment
10 8 provider are nonrefundable. The board shall set license
10 9 renewal fees by rule sufficient to cover its costs in carrying
10 10 out its responsibilities.
10 11 12. State, county, or municipal governments applying for
10 12 licenses under this chapter are exempt from the payment of
10 13 license fees.
10 14 13. An applicant for initial licensure, or following a
10 15 change of ownership as described in section 154G.6, shall pay
10 16 a license processing fee not to exceed three hundred dollars
10 17 and an inspection fee not to exceed four hundred dollars to be
10 18 paid by all applicants except those not subject to licensure
10 19 inspection by the board.
10 20 Sec. 10. NEW SECTION. 154G.6 Provisional licenses == change
10 21 of ownership.
10 22 1. A provisional license shall be issued by the board
10 23 to an approved applicant for initial licensure for a period
10 24 of ninety days. During that time, the board shall conduct
10 25 an investigation to determine substantial compliance, as
10 26 determined by the board, with the requirements of section
10 27 154G.5, including any determination to be made by the board
10 28 pending the outcome of the criminal background check performed
10 29 pursuant to section 154G.5, subsection 5. If substantial
10 30 compliance is demonstrated, a license shall be issued, to
10 31 expire two years after the effective date of the provisional
10 32 license.
10 33 2. A durable medical equipment provider against whom a
10 34 proceeding by the board for revocation or suspension or for
10 35 denial of a renewal application is pending may be issued a
11 1 provisional license effective until final disposition of such
11 2 proceedings. If judicial relief is sought from the final
11 3 disposition, the court that has jurisdiction may direct the
11 4 board to issue a provisional license for the duration of the
11 5 judicial proceeding.
11 6 3. a. When a change of ownership of a durable medical
11 7 equipment provider occurs, the prospective owner shall submit
11 8 an initial application for a license to the board at least
11 9 fifteen days before the effective date of the change of
11 10 ownership. An application for change of ownership of a license
11 11 is required when ownership, a majority of the ownership, or
11 12 controlling interest of a licensed durable medical equipment
11 13 provider is transferred or assigned and when the prospective
11 14 owner agrees to undertake or provide services to the extent
11 15 that legal liability for operation of the durable medical
11 16 equipment provider rests with the prospective owner.
11 17 b. A provisional license shall be issued to the new owner
11 18 for a period of ninety days during which time all required
11 19 documentation must be submitted and an investigation must
11 20 be conducted demonstrating substantial compliance with this
11 21 section. If substantial compliance is demonstrated a license
11 22 shall be issued, to expire two years after the issuance of the
11 23 provisional license.
11 24 4. a. When a change of the general manager of a durable
11 25 medical equipment provider occurs, the licensee shall notify
11 26 the board of the change within forty=five days and shall
11 27 provide evidence of compliance with the background check
11 28 requirements in section 154G.5, subsection 5.
11 29 b. A general manager who has met the standards for the abuse
11 30 registry background check and the criminal background check,
11 31 but for whom background screening results from the division of
11 32 criminal investigation of the department of public safety have
11 33 not yet been received, may be employed pending receipt of the
11 34 division of criminal investigation of the department of public
11 35 safety background screening report.
12 1 5. When a change is reported which requires issuance of a
12 2 license, the board shall assess a fee. The fee must be based on
12 3 the actual cost of processing and issuing the license.
12 4 Sec. 11. NEW SECTION. 154G.7 Standards.
12 5 The following standards shall govern the manner in which a
12 6 licensed durable medical equipment provider operates:
12 7 1. A licensed durable medical equipment provider must be in
12 8 compliance with all applicable federal and state licensure and
12 9 regulatory requirements.
12 10 2. A licensed durable medical equipment provider must honor
12 11 all warranties under applicable law.
12 12 3. A licensed durable medical equipment provider must
12 13 maintain a physical facility on an appropriate site and must
12 14 maintain a visible sign with posted hours of operation. The
12 15 location must be accessible to the public and staffed during
12 16 posted hours of business. The location must be at least two
12 17 hundred square feet and contain space for storing records.
12 18 4. A licensed durable medical equipment provider must
12 19 maintain a primary business telephone number listed under
12 20 the name of the business in a local directory or a toll=free
12 21 telephone number available through directory assistance.
12 22 The exclusive use of a beeper, answering machine, answering
12 23 service, or cell phone during posted business hours is
12 24 prohibited.
12 25 5. A licensed durable medical equipment provider shall
12 26 furnish the board any information required under state law.
12 27 6. A licensed durable medical equipment provider must
12 28 notify the accrediting organization for the durable medical
12 29 equipment provider when a new location is opened.
12 30 7. All durable medical equipment provider locations,
12 31 whether owned or subcontracted, must adhere to the standards
12 32 established pursuant to this section and be separately
12 33 accredited in order to comply with licensure requirements.
12 34 8. A licensed durable medical equipment provider must
12 35 disclose to the board upon application for a license all
13 1 products and services, including the addition of new product
13 2 lines for which the durable medical equipment provider is
13 3 seeking accreditation.
13 4 9. A licensed durable medical equipment provider must
13 5 remain open to the public for at least thirty hours per week.
13 6 Sec. 12. NEW SECTION. 154G.8 Duties.
13 7 A licensed durable medical equipment provider shall do all
13 8 of the following:
13 9 1. Offer and provide durable medical equipment to consumers
13 10 and offer and provide durable medical equipment services, as
13 11 necessary, to consumers who purchase or rent equipment that
13 12 requires such services.
13 13 2. Provide at least one category of durable medical
13 14 equipment directly by filling orders from its own inventory.
13 15 3. Respond to orders received for durable medical equipment
13 16 by filling those orders from its own inventory or inventory
13 17 from other companies with which it has contracted to fill such
13 18 orders, or customizing or fitting items for sale from supplies
13 19 purchased under contract.
13 20 4. Maintain trained durable medical equipment provider
13 21 personnel to coordinate order fulfillment and schedule timely
13 22 durable medical equipment and durable medical equipment service
13 23 delivery.
13 24 5. As necessary in relation to the sophistication of
13 25 the durable medical equipment and durable medical equipment
13 26 services being provided:
13 27 a. Ensure that delivery personnel are appropriately
13 28 trained to conduct an environment and equipment compatibility
13 29 assessment.
13 30 b. Appropriately and safely set up the durable medical
13 31 equipment.
13 32 c. Instruct patients and caregivers in the safe operation
13 33 and client maintenance of the durable medical equipment.
13 34 d. Recognize when additional education or follow=up patient
13 35 compliance monitoring is appropriate.
14 1 Sec. 13. NEW SECTION. 154G.9 Inspections.
14 2 1. The board shall make or cause to be made such inspections
14 3 and investigations of a durable medical equipment provider as
14 4 it considers necessary, including:
14 5 a. Licensure inspections.
14 6 b. Inspections directed by the centers for Medicare and
14 7 Medicaid services of the United States department of health and
14 8 human services.
14 9 c. Licensure complaint investigations, including
14 10 full licensure investigations with a review of all
14 11 licensure standards as outlined in rules adopted by the
14 12 board. Complaints received by the board from individuals,
14 13 organizations, or other sources are subject to review and
14 14 investigation by the board.
14 15 2. The board shall accept, in lieu of its own periodic
14 16 inspections for licensure, submission of a survey or inspection
14 17 of an accrediting organization, provided the accreditation
14 18 of the licensed durable medical equipment provider is not
14 19 provisional and provided the licensed durable medical equipment
14 20 provider authorizes release of, and the board receives the
14 21 report of, the accrediting organization.
14 22 Sec. 14. NEW SECTION. 154G.10 License denial, revocation,
14 23 or suspension.
14 24 1. The board may deny, revoke, or suspend a license, or
14 25 impose a civil penalty not to exceed five thousand dollars per
14 26 violation per day in accordance with this section.
14 27 2. Either of the following actions by a durable medical
14 28 equipment provider or any of its employees is grounds for
14 29 administrative action or imposition of civil penalties by the
14 30 board:
14 31 a. Violation of this chapter or rules adopted pursuant to
14 32 this chapter.
14 33 b. An intentional, reckless, or negligent act that
14 34 materially affects the health or safety of a patient.
14 35 3. The board may deny licensure to an applicant or revoke
15 1 the license of a licensee who does any of the following:
15 2 a. Makes or previously made a false representation or
15 3 omission of any material fact in an application, including the
15 4 submission of an application that conceals the applicant's
15 5 controlling or ownership interest, or any officer, director,
15 6 agent, managing employee, affiliated person, partner, or
15 7 shareholder who may not be eligible to participate.
15 8 b. Has been previously found by any board created under
15 9 chapter 147 to have violated the standards or conditions
15 10 relating to licensure or certification or the quality of
15 11 services provided.
15 12 c. Has been or is currently excluded, suspended, or
15 13 terminated from, or has involuntarily withdrawn from,
15 14 participation in any state Medicaid program, the Medicare
15 15 program, or any other governmental or private health care or
15 16 health insurance program.
15 17 4. The board may issue an emergency order immediately
15 18 suspending or revoking a license when it determines that any
15 19 condition within the responsibility of the durable medical
15 20 equipment provider presents a clear and present danger to
15 21 public health and safety.
15 22 5. The board may impose an immediate moratorium on the
15 23 license of a licensed durable medical equipment provider
15 24 when the board determines that any condition within the
15 25 responsibility of the durable medical equipment provider
15 26 presents a threat to public health or safety.
15 27 Sec. 15. NEW SECTION. 154G.11 Penalties.
15 28 1. The following penalties shall be imposed for operating as
15 29 a durable medical equipment provider without a license under
15 30 this chapter:
15 31 a. A person who operates as a durable medical equipment
15 32 provider without a license under this chapter commits a class
15 33 "D" felony.
15 34 b. For any person who has received government reimbursement
15 35 for services provided by an unlicensed durable medical
16 1 equipment provider, the board shall make a fraud referral to
16 2 the appropriate government reimbursement program.
16 3 2. If the board discovers that a licensee is concurrently
16 4 operating licensed and unlicensed provider locations, the
16 5 board may impose a civil penalty of not more than five hundred
16 6 dollars per violation or suspend any of the licensee's existing
16 7 licenses.
16 8 3. A durable medical equipment provider found to be
16 9 operating without a license may apply for licensure but shall
16 10 cease operations until a license is issued by the board.
16 11 Sec. 16. Section 272C.1, subsection 6, Code 2015, is amended
16 12 by adding the following new paragraph:
16 13 NEW PARAGRAPH. ag. The board of durable medical equipment
16 14 providers created pursuant to chapter 147.
16 15 Sec. 17. INITIAL APPOINTMENTS. Notwithstanding any
16 16 provision to the contrary in this Act, the initial appointees
16 17 to the board of durable medical equipment providers established
16 18 pursuant to this Act shall hold accreditation from an
16 19 accrediting organization, as defined in section 154G.1, as
16 20 enacted in this Act.
16 21 Sec. 18. EFFECTIVE UPON ENACTMENT. The following
16 22 provision or provisions of this Act, being deemed of immediate
16 23 importance, take effect upon enactment:
16 24 1. The sections of this Act amending sections 147.13,
16 25 147.14, and 272C.1, and the section relating to initial
16 26 appointments to the board of durable medical equipment
16 27 providers.
16 28 Sec. 19. EFFECTIVE DATE AND IMPLEMENTATION. The following
16 29 provision or provisions of this Act take effect January 1,
16 30 2016, except that the board of durable medical equipment
16 31 providers may begin implementation prior to January 1, 2016, to
16 32 the extent necessary to transition to full implementation of
16 33 these provisions of this Act:
16 34 1. The sections of this Act amending sections 147.1 and
16 35 147.2, and enacting sections 154G.1 through 154G.11.
17 1 EXPLANATION
17 2 The inclusion of this explanation does not constitute agreement with
17 3 the explanation's substance by the members of the general assembly.
17 4 This bill establishes a licensing procedure and standards of
17 5 practice for durable medical equipment providers.
17 6 The bill creates a new licensing board, the board of durable
17 7 medical equipment providers. The board shall be responsible
17 8 for administering the licensing procedure and regulating
17 9 durable medical equipment providers. The bill makes Code
17 10 chapters 147 and 272C, including penalty and other regulatory
17 11 provisions, applicable to the practice of durable medical
17 12 equipment providing.
17 13 Under the bill, persons or entities who hold themselves out
17 14 to the public as providers of durable medical equipment must
17 15 have a license issued by the board. To operate as a durable
17 16 medical equipment provider, a person or entity must have a
17 17 place of business open to the public at least 30 hours per
17 18 week. If the person or entity has multiple locations, it must
17 19 have a license for each location. If the person or entity's
17 20 principal place of business is located out of state but within
17 21 50 miles of the state and does business in the state, it need
17 22 not maintain a location in Iowa.
17 23 If a durable medical equipment provider is accredited by
17 24 an organization recognized by the centers for Medicare and
17 25 Medicaid services of the United States department of health and
17 26 human services and provides proof of such accreditation to the
17 27 board, the board shall grant the provider a license. Licenses
17 28 shall be issued for two years. An inspection is required
17 29 before a license can be issued. The board shall establish the
17 30 fees for new licenses and for renewals. The bill enumerates
17 31 a list of groups who are not required to meet the licensure
17 32 requirements.
17 33 Any person operating as a durable medical equipment provider
17 34 without a license commits a class "D" felony and shall cease
17 35 operation until a license is issued by the board.
18 1 An applicant for a durable medical equipment provider
18 2 license must complete the form made available by the board.
18 3 The applicant must also provide a report specifying by category
18 4 the equipment and services to be provided and indicating those
18 5 offered either directly by the applicant or through contractual
18 6 arrangements with existing providers. An applicant must
18 7 provide a list of entities with whom it contracts for the
18 8 provision of equipment and services. An initial applicant
18 9 must provide proof of professional and commercial liability
18 10 insurance as well as financial stability in the form of a
18 11 $50,000 surety bond or an existing surety bond for Medicare
18 12 credentialing.
18 13 An applicant's general manager and senior financial officer
18 14 must submit to and pay for the costs of a criminal background
18 15 check conducted by the division of criminal investigation
18 16 of the department of public safety. The board may require
18 17 background checks of any board of director members or of owners
18 18 who hold at least a 5 percent stake in an applicant entity.
18 19 The applicant must disclose information regarding felonies
18 20 committed by a member of the board of directors, its officers,
18 21 or any individual owning 5 percent or more of the applicant
18 22 entity.
18 23 The board may deny, revoke, or suspend a license, or impose
18 24 a civil penalty not to exceed $5,000 per violation per day if
18 25 a durable medical equipment provider or any of its employees
18 26 violates the bill or rules or commits an intentional, reckless,
18 27 or negligent act that materially affects the health or safety
18 28 of a patient. The board may deny or revoke the license of any
18 29 applicant that made a false representation or omission of any
18 30 material fact on its application, has been previously found by
18 31 any professional licensing, certifying, or standards board or
18 32 agency to have violated its standards or conditions, or has
18 33 been excluded, suspended, or terminated or has involuntarily
18 34 withdrawn from participation in any governmental or private
18 35 health care or health insurance program.
19 1 The board may investigate or inspect an applicant or
19 2 licensee as it considers necessary. The board shall accept
19 3 a survey or inspection of an accrediting organization if
19 4 the accreditation of the licensed durable medical equipment
19 5 provider is not provisional and the provider authorizes the
19 6 release of the organization's report, which is received by the
19 7 board.
19 8 The provisions of the bill that create the board, allow for
19 9 initial board appointments, and grant the board rulemaking
19 10 authority shall be effective upon enactment. The remaining
19 11 provisions shall take effect on January 1, 2016.
LSB 1109SV (2) 86
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