Bill Text: IA SF2304 | 2023-2024 | 90th General Assembly | Introduced
Bill Title: A bill for an act relating to oversight for long-term care facilities, providing penalties, making an appropriation, and including effective date and retroactive applicability provisions.
Spectrum: Partisan Bill (Democrat 15-0)
Status: (Introduced - Dead) 2024-02-15 - Subcommittee: Edler, Rowley, and Trone Garriott. S.J. 307. [SF2304 Detail]
Download: Iowa-2023-SF2304-Introduced.html
Senate
File
2304
-
Introduced
SENATE
FILE
2304
BY
CELSI
,
DONAHUE
,
DOTZLER
,
BISIGNANO
,
BOULTON
,
T.
TAYLOR
,
PETERSEN
,
WEINER
,
QUIRMBACH
,
JOCHUM
,
TRONE
GARRIOTT
,
WINCKLER
,
KNOX
,
WAHLS
,
and
BENNETT
A
BILL
FOR
An
Act
relating
to
oversight
for
long-term
care
facilities,
1
providing
penalties,
making
an
appropriation,
and
including
2
effective
date
and
retroactive
applicability
provisions.
3
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
4
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Section
1.
NEW
SECTION
.
10A.904
Definitions.
1
As
used
in
this
subchapter,
unless
the
context
otherwise
2
requires:
3
1.
“Assisted
living
program”
or
“program”
means
the
same
as
4
defined
in
section
231C.2.
5
2.
“Health
care
facility”
means
the
same
as
defined
in
6
section
135C.1.
7
3.
“Long-term
care
facility”
means
a
health
care
facility
8
or
an
assisted
living
program.
9
4.
“Long-term
care
facility
safety
council”
or
“safety
10
council”
means
the
long-term
care
facility
safety
council
11
created
in
section
10A.905.
12
5.
“Resident”
means
the
same
as
defined
in
section
135C.1.
13
6.
“Tenant”
means
the
same
as
defined
in
section
231C.2.
14
Sec.
2.
NEW
SECTION
.
10A.905
Long-term
care
facility
safety
15
council
——
membership
——
duties
——
meetings.
16
1.
A
long-term
care
facility
safety
council
is
created.
17
a.
The
safety
council
shall
include
the
following
voting
18
members:
19
(1)
The
director
of
health
and
human
services,
or
the
20
director’s
designee.
21
(2)
The
state
long-term
care
ombudsman,
or
the
state
22
long-term
care
ombudsman’s
designee.
23
(3)
The
director
of
an
area
agency
on
aging,
or
the
24
director’s
designee.
25
(4)
The
state
director
of
AARP,
or
the
state
director’s
26
designee.
27
(5)
Three
public
members
appointed
by
the
governor,
and
28
subject
to
confirmation
by
the
senate,
who
are
consumers
or
29
members
of
consumer
groups
or
consumer
organizations.
30
b.
The
safety
council
shall
also
include
the
director
or
the
31
director’s
designee
as
a
nonvoting
member.
32
2.
The
long-term
care
facility
safety
council
shall
do
all
33
of
the
following:
34
a.
Determine
and
approve
standards,
including
those
relating
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to
health
and
safety,
for
long-term
care
facilities.
1
b.
Conduct
informal
conferences
and
reviews
of
health
care
2
facility
applicants
and
licensees,
and
assisted
living
program
3
applicants
and
certificate
holders,
and
make
recommendations
4
for
departmental
action
pursuant
to
sections
135C.10A
and
5
231C.11B.
6
c.
Review
and
make
recommendations
to
the
department
7
regarding
violations
and
penalties
under
chapters
135C
and
8
231C.
9
d.
Make
recommendations
to
the
department
regarding
the
10
adoption
or
amendment
of
administrative
rules.
11
e.
Review
the
operation
of
long-term
care
facilities
for
12
which
the
department
has
referred
a
complaint
received
by
the
13
department
to
the
office
of
long-term
care
ombudsman.
14
f.
Receive
recommendations
from
the
state
long-term
care
15
ombudsman
regarding
inspections
of
specific
long-term
care
16
facilities,
and
changes
in
administrative
rules
regarding
the
17
health,
safety,
welfare,
and
rights
of
residents
and
tenants.
18
g.
Submit
an
annual
report
to
the
general
assembly
by
19
October
31
for
the
immediately
preceding
fiscal
year,
including
20
any
recommendations
for
changes
in
law
to
better
protect
21
residents
and
tenants,
and
a
summary
of
all
recommendations
22
made
by
long-term
care
facilities
during
informal
conferences.
23
3.
The
members
shall
elect
a
public
member
as
the
24
chairperson
of
the
safety
council
annually.
25
4.
The
safety
council
shall
hold
an
organizational
meeting
26
in
July
each
year,
and
meetings
shall
be
held
as
necessary
27
to
enable
the
safety
council
to
expeditiously
discharge
its
28
duties.
Meeting
dates
shall
be
set
upon
adjournment
or
by
call
29
of
the
chairperson
upon
five
days’
notice
to
the
other
members.
30
Sec.
3.
Section
135C.1,
Code
2024,
is
amended
by
adding
the
31
following
new
subsection:
32
NEW
SUBSECTION
.
12A.
“Long-term
care
facility
safety
33
council”
or
“safety
council”
means
the
long-term
care
facility
34
safety
council
created
pursuant
to
section
10A.905.
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Sec.
4.
Section
135C.10,
unnumbered
paragraph
1,
Code
2024,
1
is
amended
to
read
as
follows:
2
The
department
shall
have
the
authority
to
deny,
suspend,
or
3
revoke
a
license
in
any
case
where
the
department
finds
that
4
there
has
been
repeated
failure
on
the
part
of
the
a
facility
5
to
comply
with
the
provisions
of
this
chapter
or
the
rules
or
6
minimum
standards
promulgated
hereunder
under
this
chapter
,
or
7
for
any
of
the
following
reasons:
8
Sec.
5.
Section
135C.10,
Code
2024,
is
amended
by
adding
the
9
following
new
subsection:
10
NEW
SUBSECTION
.
12.
The
facility
is
issued
three
or
more
11
class
I
or
federal
immediate
jeopardy
violations
within
a
12
twelve-month
period
for
which
a
penalty
was
assessed.
13
Sec.
6.
NEW
SECTION
.
135C.10A
Multiple
violations
14
within
a
twelve-month
period
——
informal
conference
and
review
15
by
long-term
care
facility
safety
council
——
recommended
16
departmental
actions.
17
1.
At
the
time
the
department
effects
delivery
of
notice
on
18
an
applicant
or
licensee
under
section
135C.11,
based
on
the
19
department’s
authority
under
section
135C.10,
subsection
12,
to
20
deny,
suspend,
or
revoke
a
license,
the
department
shall
also
21
notify
the
long-term
care
facility
safety
council.
22
2.
a.
The
safety
council
shall
hold
an
informal
conference
23
with
the
applicant
or
licensee
within
ten
working
days
of
24
the
mailing
or
service
of
notice
to
review
the
applicant’s
25
or
licensee’s
history
of
violations
for
which
a
penalty
was
26
assessed
under
this
chapter,
and
the
response
by
the
applicant
27
or
licensee
in
correcting
such
violations.
28
b.
Following
the
informal
conference
and
review,
the
safety
29
council
shall
report
its
findings
to
the
department,
including
30
any
recommendations
for
departmental
action
as
authorized
under
31
this
chapter.
The
department
shall
proceed
in
accordance
with
32
the
recommendations
of
the
safety
council.
A
health
care
33
facility
may
subsequently
request
a
formal
hearing
and
proceed
34
under
section
135C.11.
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Sec.
7.
Section
135C.14,
unnumbered
paragraph
1,
Code
2024,
1
is
amended
to
read
as
follows:
2
The
department
shall,
in
accordance
with
chapter
17A
and
3
with
the
approval
of
the
council
on
health
and
human
services
4
long-term
care
facility
safety
council
,
adopt
and
enforce
5
rules
setting
minimum
standards
for
health
care
facilities.
6
In
so
doing,
the
department,
with
the
approval
of
the
council
7
on
health
and
human
services
long-term
care
facility
safety
8
council
,
may
adopt
by
reference,
with
or
without
amendment,
9
nationally
recognized
standards
and
rules,
which
shall
be
10
specified
by
title
and
edition,
date
of
publication,
or
similar
11
information.
The
rules
and
standards
required
by
this
section
12
shall
be
formulated
in
consultation
with
the
director
of
13
health
and
human
services
or
the
director
of
health
and
human
14
services’
designee,
with
the
director,
with
the
state
long-term
15
care
ombudsman,
and
with
affected
industry,
professional,
16
and
consumer
groups,
and
shall
be
designed
to
further
the
17
accomplishment
of
the
purposes
of
this
chapter
and
shall
relate
18
to:
19
Sec.
8.
Section
135C.14,
subsection
5,
Code
2024,
is
amended
20
to
read
as
follows:
21
5.
Equipment
essential
to
the
health
and
welfare
of
the
22
resident.
The
rules
shall
require
a
health
care
facility
23
that
accepts
state
funding
to
annually
adopt
and
provide
to
24
the
department
the
health
care
facility’s
policies
regarding
25
competitive
procurement
for
supplies
and
equipment
including
26
transactions
and
associated
reimbursement
structures
with
any
27
related
party
as
defined
in
section
135C.7A.
28
Sec.
9.
Section
135C.14,
subsection
8,
Code
2024,
is
amended
29
by
adding
the
following
new
paragraph:
30
NEW
PARAGRAPH
.
g.
Facility
policies
and
procedures
31
regarding
the
use
of
arbitration
agreements.
The
rules
and
32
standards
shall
prohibit
any
health
care
facility
that
accepts
33
state
funding
from
offering
a
resident,
or
requiring
a
resident
34
to
sign,
an
arbitration
agreement
that
limits
the
resident’s
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inalienable
right
to
seek
full
judicial
review
of
a
dispute
as
1
a
precondition
for
being
admitted
to
the
facility.
2
Sec.
10.
Section
135C.16,
subsection
1,
Code
2024,
is
3
amended
to
read
as
follows:
4
1.
In
addition
to
the
inspections
required
by
sections
5
135C.9
and
135C.38
,
the
department
shall
make
or
cause
to
be
6
made
such
further
unannounced
inspections
as
it
deems
necessary
7
to
adequately
enforce
this
chapter
.
At
On
average,
at
least
8
one
general
unannounced
inspection
shall
be
conducted
for
each
9
health
care
facility
within
a
thirty-month
twelve-month
period
,
10
not
to
exceed
a
period
of
fifteen
months
.
The
inspector
shall
11
show
identification
to
the
person
in
charge
of
the
facility
12
and
state
that
an
inspection
is
to
be
made
before
beginning
13
the
inspection.
An
employee
of
the
department
who
gives
14
unauthorized
advance
notice
of
an
inspection
made
or
planned
15
to
be
made
under
this
subsection
or
section
135C.38
shall
be
16
disciplined
as
determined
by
the
director,
except
that
if
the
17
employee
is
employed
pursuant
to
the
merit
system
provisions
of
18
chapter
8A,
subchapter
IV
,
the
discipline
shall
not
exceed
the
19
discipline
authorized
pursuant
to
that
subchapter.
20
Sec.
11.
Section
135C.36,
subsection
1,
Code
2024,
is
21
amended
to
read
as
follows:
22
1.
A
class
I
violation
is
one
which
presents
an
imminent
23
danger
or
a
substantial
probability
of
resultant
death
or
24
physical
harm
to
the
residents
of
the
facility
in
which
25
the
violation
occurs.
A
physical
condition
or
one
or
more
26
practices
in
a
facility
may
constitute
a
class
I
violation.
A
27
class
I
violation
shall
be
abated
or
eliminated
immediately
28
unless
the
department
determines
that
a
stated
period
of
time,
29
specified
in
the
citation
issued
under
section
135C.40
,
is
30
required
to
correct
the
violation.
A
licensee
is
subject
to
31
a
penalty
of
not
less
than
two
five
thousand
nor
more
than
32
ten
thousand
dollars
for
each
class
I
violation
for
which
the
33
licensee’s
facility
is
cited.
34
Sec.
12.
Section
135C.36,
Code
2024,
is
amended
by
adding
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the
following
new
subsection:
1
NEW
SUBSECTION
.
1A.
A
class
I
violation
includes
any
2
confirmed
instance
of
a
facility
retaliating
against
a
resident
3
or
employee
for
filing
a
complaint
or
otherwise
cooperating
4
with
the
department
or
the
office
of
long-term
care
ombudsman.
5
Sec.
13.
Section
135C.38,
subsection
1,
paragraph
a,
Code
6
2024,
is
amended
to
read
as
follows:
7
a.
Upon
receipt
of
a
complaint
made
in
accordance
with
8
section
135C.37
,
the
department
shall
make
a
preliminary
review
9
of
the
complaint.
Unless
the
department
concludes
that
the
10
complaint
is
intended
to
harass
a
facility
or
a
licensee
or
is
11
without
reasonable
basis,
the
department
shall
make
or
cause
12
to
be
made
an
on-site
inspection
of
the
health
care
facility
13
which
is
the
subject
of
the
complaint
within
the
time
period
14
determined
pursuant
to
the
following
guidelines,
which
period
15
shall
commence
on
the
date
of
receipt
of
the
complaint:
16
(1)
For
nursing
facilities,
an
on-site
inspection
shall
be
17
initiated
as
follows:
18
(a)
Within
two
one
working
days
day
for
a
complaint
19
determined
by
the
department
to
be
an
alleged
immediate
20
jeopardy
situation.
21
(b)
Within
ten
five
working
days
for
a
complaint
determined
22
by
the
department
to
be
an
alleged
high-level,
nonimmediate
23
jeopardy
situation.
24
(c)
Within
forty-five
calendar
days
for
a
complaint
25
determined
by
the
department
to
be
an
alleged
nonimmediate
26
jeopardy
situation,
other
than
a
high-level
situation.
27
(2)
For
all
other
types
of
health
care
facilities,
an
28
on-site
inspection
shall
be
initiated
as
follows:
29
(a)
Within
two
one
working
days
day
for
a
complaint
30
determined
by
the
department
to
be
an
alleged
immediate
31
jeopardy
situation.
32
(b)
Within
twenty
five
working
days
for
a
complaint
33
determined
by
the
department
to
be
an
alleged
high-level,
34
nonimmediate
jeopardy
situation.
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(c)
Within
forty-five
calendar
days
for
a
complaint
1
determined
by
the
department
to
be
an
alleged
nonimmediate
2
jeopardy
situation,
other
than
a
high-level
situation.
3
Sec.
14.
Section
135C.44,
Code
2024,
is
amended
to
read
as
4
follows:
5
135C.44
Treble
Additional
fines
for
repeated
violations.
6
The
penalties
authorized
by
section
135C.36
shall
be
trebled
7
quadrupled
for
a
second
or
subsequent
class
I
or
violation
and
8
tripled
for
a
second
or
subsequent
class
II
violation
occurring
9
within
any
twelve-month
period
if
a
citation
was
issued
for
the
10
same
class
I
or
class
II
violation
occurring
within
that
period
11
and
a
penalty
was
assessed
therefor
for
the
violation
.
12
Sec.
15.
NEW
SECTION
.
135C.49
Improper
influence.
13
1.
A
member
of
the
general
assembly
or
an
employee
of
14
the
legislative
or
executive
branch
shall
not
attempt
to
15
influence
a
decision
of
the
department
during
the
course
of
an
16
investigation,
inspection,
or
appeal
under
this
chapter.
17
2.
An
allegation
of
a
violation
of
this
section
shall
18
be
investigated
by
the
office
of
ombudsman
established
19
under
section
2C.2.
If
the
office
of
ombudsman
determines
a
20
violation
of
this
section
has
occurred,
the
office
shall
report
21
the
recommendations,
including
disciplinary
action,
pursuant
to
22
sections
2C.16
and
2C.19.
23
3.
A
person
who
is
recommended
for
disciplinary
action
for
24
a
violation
of
this
section
is
subject
to
a
civil
penalty
of
25
up
to
five
thousand
dollars
per
violation.
A
civil
penalty
26
collected
pursuant
to
this
section
shall
be
credited
to
the
27
department,
shall
be
considered
repayment
receipts
as
defined
28
in
section
8.2,
and
shall
be
used
by
the
department
to
enforce
29
this
chapter.
30
4.
a.
A
civil
penalty
for
violations
committed
by
an
31
employee
of
the
executive
branch
shall
be
assessed
by
the
32
department.
33
b.
A
civil
penalty
for
violations
committed
by
a
member
or
34
employee
of
the
general
assembly
shall
be
assessed
pursuant
to
35
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a
resolution
approved
by
a
majority
of
the
house
in
which
the
1
member
serves
or
by
which
the
employee
is
employed.
If
the
2
general
assembly
is
not
in
session
at
the
time
a
recommendation
3
is
received
from
the
office
of
ombudsman,
a
civil
penalty
shall
4
be
assessed
by
a
majority
vote
of
the
legislative
council.
5
Sec.
16.
Section
231.42,
subsection
2,
Code
2024,
is
amended
6
by
adding
the
following
new
paragraph:
7
NEW
PARAGRAPH
.
f.
Make
recommendations
to
the
long-term
8
care
facility
safety
council
created
in
section
10A.905
9
regarding
inspections
of
specific
health
care
facilities
and
10
assisted
living
programs,
and
changes
in
administrative
rules
11
regarding
the
health,
safety,
welfare,
and
rights
of
residents
12
of
health
care
facilities
and
tenants
of
assisted
living
13
programs.
14
Sec.
17.
Section
231C.2,
Code
2024,
is
amended
by
adding
the
15
following
new
subsection:
16
NEW
SUBSECTION
.
7A.
“Long-term
care
facility
safety
council”
17
or
“safety
council”
means
the
long-term
care
facility
safety
18
council
created
in
section
10A.905.
19
Sec.
18.
NEW
SECTION
.
231C.11B
Multiple
violations
20
within
a
twelve-month
period
——
informal
conference
and
review
21
by
long-term
care
facility
safety
council
——
recommended
22
departmental
actions.
23
1.
At
the
time
the
department
effects
delivery
of
notice
24
on
an
applicant
or
certificate
holder
under
section
231C.11,
25
based
on
the
assisted
living
program
having
been
issued
notice
26
of
three
violations
in
a
twelve-month
period
which
presented
27
imminent
danger
or
a
substantial
probability
of
resultant
28
death
or
physical
harm
to
a
tenant
and
for
which
a
penalty
29
was
assessed
under
section
231C.14,
the
department
shall
also
30
notify
the
long-term
care
facility
safety
council.
31
2.
a.
The
safety
council
shall
hold
an
informal
conference
32
with
the
applicant
or
certificate
holder
within
ten
working
33
days
of
the
mailing
or
service
of
notice
to
review
the
34
applicant’s
or
certificate
holder’s
history
of
violations
35
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for
which
a
penalty
was
assessed
under
this
chapter,
and
the
1
response
by
the
applicant
or
certificate
holder
in
correcting
2
such
violations.
3
b.
Following
the
informal
conference
and
review,
the
safety
4
council
shall
report
its
findings
to
the
department,
including
5
any
recommendations
for
departmental
action
as
authorized
under
6
this
chapter.
The
department
shall
proceed
in
accordance
with
7
the
recommendations
of
the
safety
council.
An
assisted
living
8
program
may
subsequently
request
a
contested
case
hearing
and
9
proceed
under
section
231C.9A.
10
Sec.
19.
2023
Iowa
Acts,
chapter
108,
section
7,
subsection
11
4,
is
amended
to
read
as
follows:
12
4.
HEALTH
FACILITIES
13
a.
For
salaries,
support,
maintenance,
and
miscellaneous
14
purposes,
and
for
not
more
than
the
following
full-time
15
equivalent
positions:
16
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
$
4,862,971
17
6,262,971
18
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
FTEs
115.00
19
145.00
20
b.
The
department
shall
make
all
of
the
following
21
information
available
to
the
public
as
part
of
the
department’s
22
development
efforts
to
revise
the
department’s
internet
site:
23
(1)
The
number
of
inspections
of
health
facilities
24
conducted
by
the
department
annually
by
type
of
service
25
provider
and
type
of
inspection.
26
(2)
The
total
annual
operations
budget
for
the
department
27
that
is
associated
with
health
facilities
regulation,
including
28
general
fund
appropriations
and
federal
contract
dollars
29
received
by
type
of
service
provider
inspected.
30
(3)
The
total
number
of
full-time
equivalent
positions
31
in
the
department
that
are
associated
with
health
facilities
32
regulation,
to
include
the
number
of
full-time
equivalent
33
positions
serving
in
a
supervisory
capacity,
and
serving
as
34
surveyors,
inspectors,
or
monitors
in
the
field
by
type
of
35
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service
provider
inspected.
1
(4)
Identification
of
state
and
federal
survey
trends,
2
cited
regulations,
the
scope
and
severity
of
deficiencies
3
identified,
and
federal
and
state
fines
assessed
and
collected
4
concerning
nursing
and
assisted
living
facilities
and
programs.
5
c.
It
is
the
intent
of
the
general
assembly
that
the
6
department
continuously
solicit
input
from
health
facilities
7
regulated
by
the
department
to
assess
and
improve
the
8
department’s
level
of
collaboration
and
to
identify
new
9
opportunities
for
cooperation.
10
d.
Of
the
funds
appropriated
in
this
subsection,
$2,400,000
11
shall
be
used
to
employ
additional
nursing
facility
inspectors
12
and
assisted
living
program
monitors
to
perform
additional
13
safety
inspections.
14
Sec.
20.
STUDY
AND
RECOMMENDATIONS
——
SPECIAL
FOCUS
LIST
FOR
15
LONG-TERM
CARE
FACILITIES.
The
long-term
care
facility
safety
16
council
created
in
section
10A.905,
as
enacted
in
this
Act,
17
shall
study
the
feasibility
of
creating
a
special
focus
list
18
for
long-term
care
facilities
in
the
state
based
on
a
review
19
of
special
focus
lists
in
other
states.
Following
completion
20
of
the
study,
the
safety
council
shall
submit
a
report
to
21
the
general
assembly
by
February
1,
2025,
including
specific
22
descriptions
of
successful
special
focus
lists
in
other
states,
23
and
recommendations
for
the
creation
of
a
special
focus
list
24
in
Iowa
including
necessary
Code
changes
and
the
potential
25
framework
for
the
special
focus
list.
26
Sec.
21.
OFFICE
OF
LONG-TERM
CARE
OMBUDSMAN
——
27
APPROPRIATION.
28
1.
There
is
appropriated
from
the
general
fund
of
the
state
29
to
the
office
of
long-term
care
ombudsman
for
the
fiscal
year
30
beginning
July
1,
2024,
and
ending
June
30,
2025,
the
following
31
amount,
or
so
much
thereof
as
is
necessary,
to
be
used
for
the
32
purposes
designated:
33
To
increase
the
number
of
local
long-term
care
ombudsmen,
34
including
for
salaries,
support,
administration,
maintenance,
35
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and
miscellaneous
purposes:
1
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
$
300,000
2
2.
The
funding
appropriated
in
this
section
is
in
addition
3
to
any
other
funds
appropriated
from
the
general
fund
of
the
4
state
and
any
other
full-time
equivalent
positions
authorized
5
for
local
long-term
care
ombudsmen
during
the
same
fiscal
6
year.
The
funding
shall
be
used
to
support
local
ombudsmen
in
7
fulfilling
their
duties
pursuant
to
section
231.42
including
8
to
provide
the
resources
necessary
to
complete
site
visits
and
9
to
carry
out
other
duties
to
protect
and
improve
the
health,
10
safety,
welfare,
and
rights
of
residents
and
tenants.
11
Sec.
22.
CODE
EDITOR
DIRECTIVE.
The
Code
editor
is
directed
12
to
create
a
new
subchapter
X
in
chapter
10A
as
follows:
13
subchapter
X
shall
be
entitled
“Long-term
Care
Facility
Safety
14
Council”
and
shall
include
sections
10A.904
and
10A.905.
15
Sec.
23.
EFFECTIVE
DATE.
The
following,
being
deemed
of
16
immediate
importance,
takes
effect
upon
enactment:
17
The
section
of
this
Act
amending
2023
Iowa
Acts,
chapter
108,
18
section
7,
subsection
4,
relating
to
health
facilities.
19
Sec.
24.
RETROACTIVE
APPLICABILITY.
The
following
applies
20
retroactively
to
July
1,
2023:
21
The
section
of
this
Act
amending
2023
Iowa
Acts,
chapter
108,
22
section
7,
subsection
4,
relating
to
health
facilities.
23
EXPLANATION
24
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
25
the
explanation’s
substance
by
the
members
of
the
general
assembly.
26
This
bill
provides
for
oversight
for
long-term
care
27
facilities
(facilities).
28
The
bill
creates
a
long-term
care
facility
safety
council
29
(safety
council)
under
the
department
of
inspections,
appeals,
30
and
licensing
(DIAL)
to:
determine
and
approve
standards,
31
including
those
relating
to
health
and
safety,
for
long-term
32
care
facilities;
conduct
informal
conferences
and
reviews
of
33
health
care
facility
applicants
and
licensees
that
have
been
34
issued
three
or
more
class
I
violations
(a
violation
which
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presents
an
imminent
danger
or
a
substantial
probability
1
of
death
or
physical
harm
to
the
residents
of
the
facility
2
in
which
the
violation
occurs)
within
a
12-month
period
3
for
which
a
penalty
was
assessed,
and
of
assisted
living
4
program
applicants
or
certificate
holders
that
have
been
5
issued
notice
of
three
violations
in
a
12-month
period
which
6
presented
imminent
danger
or
a
substantial
probability
of
7
resultant
death
or
physical
harm
to
a
tenant
and
for
which
8
a
penalty
was
assessed,
and
make
recommendations
to
DIAL
for
9
departmental
action;
review
and
make
recommendations
to
DIAL
10
regarding
violations
and
penalties;
make
recommendations
to
11
DIAL
regarding
the
adoption
or
amendment
of
administrative
12
rules;
review
the
operation
of
long-term
care
facilities
for
13
which
the
department
has
referred
a
complaint
received
by
14
the
department
to
the
office
of
long-term
care
ombudsman;
15
receive
recommendations
from
the
state
long-term
care
ombudsman
16
and
submit
an
annual
report
to
the
general
assembly
with
17
recommendations
for
changes
in
law
to
better
protect
residents
18
and
tenants,
and
a
summary
of
recommendations
made
by
long-term
19
care
facilities
in
informal
conferences.
The
voting
members
20
of
the
safety
council
include
the
director
of
health
and
human
21
services,
or
the
director’s
designee;
the
state
long-term
care
22
ombudsman,
or
the
ombudsman’s
designee;
the
director
of
an
23
area
agency
on
aging,
or
the
director’s
designee;
the
state
24
director
of
AARP,
or
the
state
director’s
designee;
and
three
25
public
members,
appointed
by
the
governor,
and
subject
to
26
confirmation
by
the
senate.
The
safety
council
also
includes
27
the
director
of
DIAL,
or
the
director’s
designee
as
a
nonvoting
28
member.
The
members
shall
annually
elect
a
public
member
as
29
the
chairperson
of
the
council.
The
safety
council
shall
30
hold
an
organizational
meeting
in
July
each
year
and
hold
31
other
meetings
as
necessary
to
enable
the
safety
council
to
32
expeditiously
discharge
its
duties.
33
The
bill
provides
that
at
the
time
DIAL
serves
notice
on
an
34
applicant
or
licensee
of
a
health
care
facility
for
denial,
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suspension,
or
revocation
of
a
license,
because
the
health
1
care
facility
has
been
issued
three
or
more
class
I
violations
2
within
a
12-month
period
for
which
a
penalty
was
assessed,
DIAL
3
shall
also
notify
the
safety
council.
The
safety
council
shall
4
hold
an
informal
conference
with
the
applicant
or
licensee
5
within
10
working
days
of
the
mailing
or
service
of
notice
to
6
review
the
applicant’s
or
licensee’s
history
of
violations
for
7
which
a
penalty
was
assessed,
and
the
response
by
the
applicant
8
or
licensee
in
correcting
such
violations.
Following
the
9
informal
conference
and
review,
the
council
shall
report
its
10
findings
to
DIAL
including
recommendations
for
departmental
11
action,
in
accordance
with
which
DIAL
shall
proceed.
A
12
facility
may
subsequently
request
a
formal
hearing.
13
The
bill
also
requires
that
at
the
time
DIAL
effects
14
delivery
of
notice
on
an
assisted
living
program
applicant
or
15
certificate
holder,
based
on
the
assisted
living
program
having
16
been
issued
notice
of
three
violations
in
a
12-month
period
17
which
presented
imminent
danger
or
a
substantial
probability
18
of
resultant
death
or
physical
harm
to
a
tenant,
and
for
which
19
a
penalty
was
assessed,
DIAL
shall
also
notify
the
long-term
20
care
facility
safety
council.
As
with
health
care
facilities,
21
the
safety
council
shall
hold
an
informal
conference
with
the
22
applicant
or
certificate
holder
within
10
working
days
of
23
the
mailing
or
service
of
notice
to
review
the
applicant’s
24
or
certificate
holder’s
history
of
violations
for
which
a
25
penalty
was
assessed,
and
the
response
by
the
applicant
or
26
certificate
holder
in
correcting
such
violations.
Following
27
the
informal
conference
and
review,
the
safety
council
shall
28
report
its
findings
to
DIAL,
including
any
recommendations
29
for
departmental
action,
with
which
DIAL
shall
proceed.
An
30
assisted
living
program
may
subsequently
request
a
contested
31
case
hearing.
32
The
bill
also
requires
DIAL
to
adopt
and
enforce
33
administrative
rules
that
set
minimum
standards
for
facilities
34
with
the
approval
of
the
safety
council,
rather
than
the
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approval
of
the
council
on
health
and
human
services.
1
Additionally,
the
rules
and
standards
must
be
formulated
in
2
consultation
with
the
state
long-term
care
ombudsman.
3
The
bill
requires
that
the
administrative
rules
and
4
standards
to
be
adopted
and
enforced
by
DIAL
as
part
of
the
5
rule
relating
to
equipment
essential
to
the
health
and
welfare
6
of
the
resident,
require
that
a
facility
that
receives
state
7
funding
annually
adopt
and
provide
to
the
department
the
8
facility’s
policies
regarding
competitive
procurement
for
9
supplies
and
equipment
including
transactions
and
associated
10
reimbursement
structures
with
any
related
party.
Additionally,
11
the
rules
and
standards
shall
include
policies
and
procedures
12
regarding
the
use
of
arbitration
agreements.
Specifically,
13
the
rules
shall
prohibit
any
facility
that
accepts
state
14
funding
from
offering
a
resident,
or
requiring
a
resident
to
15
sign,
an
arbitration
agreement
that
limits
the
resident’s
16
inalienable
right
to
seek
full
judicial
review
of
a
dispute
as
17
a
precondition
for
being
admitted
to
the
facility.
18
The
bill
increases
the
monetary
amount
for
the
bottom
of
the
19
range
of
the
penalty
for
a
class
I
violation
by
a
health
care
20
facility
from
$2,000
to
$5,000,
and
maintains
the
upper
part
21
of
the
range
at
$10,000.
The
bill
also
increases
the
penalty
22
for
repeated
class
I
violations
in
a
12-month
period
for
which
23
a
penalty
is
assessed
by
quadrupling
rather
than
tripling
the
24
amount.
25
The
bill
adds
as
a
class
I
violation
for
a
health
care
26
facility
any
confirmed
instance
of
a
facility
retaliating
27
against
a
resident
or
employee
for
filing
a
complaint
or
28
otherwise
cooperating
with
the
department
or
the
office
of
29
long-term
care
ombudsman.
30
The
bill
provides
that
a
member
of
the
general
assembly
or
31
an
employee
of
the
legislative
or
executive
branch
shall
not
32
attempt
to
influence
a
decision
of
DIAL
during
the
course
of
33
an
investigation,
inspection,
or
appeal.
An
allegation
of
a
34
violation
shall
be
investigated
by
the
office
of
ombudsman.
If
35
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the
office
of
ombudsman
determines
a
violation
has
occurred,
1
the
office
shall
report
the
recommendations,
including
2
disciplinary
action,
to
an
agency.
A
person
who
is
recommended
3
for
disciplinary
action
for
a
violation
is
subject
to
a
4
civil
penalty
of
up
to
$5,000
per
violation.
A
civil
penalty
5
collected
shall
be
credited
to
DIAL,
considered
repayment
6
receipts,
and
used
by
DIAL
to
enforce
Code
chapter
135C.
DIAL
7
shall
assess
the
civil
penalty
for
violations
committed
by
8
an
employee
of
the
executive
branch,
and
a
civil
penalty
for
9
violations
committed
by
a
member
or
employee
of
the
general
10
assembly
shall
be
assessed
pursuant
to
a
resolution
or
by
the
11
legislative
council
if
the
general
assembly
is
not
in
session
12
at
the
time
a
recommendation
is
received
from
the
office
of
13
ombudsman.
14
The
bill
requires
the
long-term
care
facility
safety
council
15
to
study
the
feasibility
of
creating
a
special
focus
list
for
16
long-term
care
facilities
in
the
state
based
on
a
review
of
17
special
focus
lists
in
other
states,
and
to
submit
a
report
to
18
the
general
assembly
by
February
1,
2025,
including
specific
19
descriptions
of
successful
special
focus
lists
in
other
states,
20
and
recommendations
for
the
creation
of
a
special
focus
list
21
in
Iowa
including
necessary
Code
changes
and
the
potential
22
framework
for
the
special
focus
list.
23
The
bill
requires
that,
on
average,
DIAL
perform
at
least
one
24
general
unannounced
inspection
of
a
health
care
facility
within
25
a
12-month
period
not
to
exceed
a
period
of
15
months,
rather
26
than
the
current
30-month
period.
27
The
bill
amends
the
required
time
period
within
which
DIAL
28
must
respond
upon
receipt
of
a
complaint.
Under
the
bill,
for
29
nursing
facilities,
an
on-site
inspection
shall
be
initiated
30
within
one
working
day
rather
than
the
current
two
working
days
31
for
a
complaint
determined
by
DIAL
to
be
an
alleged
immediate
32
jeopardy
situation;
and
within
five
rather
than
the
current
33
10
working
days
for
a
complaint
determined
by
DIAL
to
be
an
34
alleged
high-level,
nonimmediate
jeopardy
situation.
Under
35
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the
bill
for
all
other
types
of
health
care
facilities,
an
1
on-site
inspection
shall
be
initiated
within
one
working
day
2
rather
than
two
working
days
for
a
complaint
determined
by
3
DIAL
to
be
an
alleged
immediate
jeopardy
situation;
and
within
4
five
working
days
rather
than
20
working
days
for
a
complaint
5
determined
by
DIAL
to
be
an
alleged
high-level,
nonimmediate
6
jeopardy
situation.
7
The
bill
includes,
as
a
duty
of
the
state
long-term
care
8
ombudsman,
making
recommendations
to
the
long-term
care
9
facility
safety
council.
10
The
bill
amends
the
appropriation
for
FY
2023-2024
to
DIAL
11
for
health
facilities
to
provide
for
an
increase
of
$1.4
12
million
and
30.0
additional
full-time
equivalent
positions.
13
Of
the
total
appropriation,
$2.4
million
is
to
be
used
for
14
additional
nursing
facility
inspectors
and
assisted
living
15
program
monitors
to
perform
additional
safety
inspections.
16
This
provision
takes
effect
upon
enactment
and
is
retroactively
17
applicable
to
July
1,
2023.
18
The
bill
appropriates
funds
from
the
general
fund
of
19
the
state
to
the
office
of
long-term
care
ombudsman
for
FY
20
2024-2025
to
be
used
to
increase
the
number
of
local
long-term
21
care
ombudsmen.
The
funding
appropriated
is
in
addition
to
any
22
other
funds
appropriated
from
the
general
fund
of
the
state
and
23
any
other
full-time
equivalent
positions
authorized
for
local
24
long-term
care
ombudsmen
during
the
same
fiscal
year.
The
25
funding
shall
be
used
to
support
local
ombudsmen
in
fulfilling
26
their
required
duties
including
to
provide
the
resources
27
necessary
to
complete
site
visits
and
to
carry
out
other
duties
28
to
protect
and
improve
the
health,
safety,
welfare,
and
rights
29
of
residents
and
tenants.
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