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Senate
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532
-
Introduced
SENATE
FILE
532
BY
CELSI
A
BILL
FOR
An
Act
relating
to
health
care
facilities,
providing
penalties,
1
making
an
appropriation,
and
including
effective
date
and
2
retroactive
applicability
provisions.
3
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
4
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Section
1.
Section
135C.14,
subsection
5,
Code
2025,
is
1
amended
to
read
as
follows:
2
5.
Equipment
essential
to
the
health
and
welfare
of
the
3
resident.
The
rules
shall
require
a
health
care
facility
4
that
accepts
state
funding
to
annually
adopt
and
provide
to
5
the
department
the
health
care
facility’s
policies
regarding
6
competitive
procurement
for
supplies
and
equipment
including
7
transactions
and
associated
reimbursement
structures
with
any
8
related
party
as
defined
in
section
135C.7A.
9
Sec.
2.
Section
135C.14,
subsection
8,
Code
2025,
is
amended
10
by
adding
the
following
new
paragraph:
11
NEW
PARAGRAPH
.
g.
Facility
policies
and
procedures
12
regarding
the
use
of
arbitration
agreements.
The
rules
and
13
standards
shall
prohibit
any
health
care
facility
that
accepts
14
state
funding
from
offering
a
resident,
or
requiring
a
resident
15
to
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
Sec.
3.
Section
135C.16,
subsection
1,
Code
2025,
is
amended
19
to
read
as
follows:
20
1.
In
addition
to
the
inspections
required
by
sections
21
135C.9
and
135C.38
,
the
department
shall
make
or
cause
to
be
22
made
such
further
unannounced
inspections
as
it
deems
necessary
23
to
adequately
enforce
this
chapter
.
At
On
average,
at
least
24
one
general
unannounced
inspection
shall
be
conducted
for
each
25
health
care
facility
within
a
thirty-month
twelve-month
period
,
26
not
to
exceed
a
period
of
fifteen
months
.
The
inspector
shall
27
show
identification
to
the
person
in
charge
of
the
facility
28
and
state
that
an
inspection
is
to
be
made
before
beginning
29
the
inspection.
An
employee
of
the
department
who
gives
30
unauthorized
advance
notice
of
an
inspection
made
or
planned
31
to
be
made
under
this
subsection
or
section
135C.38
shall
be
32
disciplined
as
determined
by
the
director,
except
that
if
the
33
employee
is
employed
pursuant
to
the
merit
system
provisions
of
34
chapter
8A,
subchapter
IV
,
the
discipline
shall
not
exceed
the
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discipline
authorized
pursuant
to
that
subchapter.
1
Sec.
4.
Section
135C.36,
subsection
1,
Code
2025,
is
amended
2
to
read
as
follows:
3
1.
A
class
I
violation
is
one
which
presents
an
imminent
4
danger
or
a
substantial
probability
of
resultant
death
or
5
physical
harm
to
the
residents
of
the
facility
in
which
6
the
violation
occurs.
A
physical
condition
or
one
or
more
7
practices
in
a
facility
may
constitute
a
class
I
violation.
A
8
class
I
violation
shall
be
abated
or
eliminated
immediately
9
unless
the
department
determines
that
a
stated
period
of
time,
10
specified
in
the
citation
issued
under
section
135C.40
,
is
11
required
to
correct
the
violation.
A
licensee
is
subject
to
12
a
penalty
of
not
less
than
two
five
thousand
nor
more
than
13
ten
thousand
dollars
for
each
class
I
violation
for
which
the
14
licensee’s
facility
is
cited.
15
Sec.
5.
Section
135C.36,
Code
2025,
is
amended
by
adding
the
16
following
new
subsection:
17
NEW
SUBSECTION
.
1A.
A
class
I
violation
includes
any
18
confirmed
instance
of
a
facility
retaliating
against
a
resident
19
or
employee
for
filing
a
complaint
or
otherwise
cooperating
20
with
the
department
or
the
office
of
long-term
care
ombudsman.
21
Sec.
6.
Section
135C.38,
subsection
1,
paragraph
a,
Code
22
2025,
is
amended
to
read
as
follows:
23
a.
Upon
receipt
of
a
complaint
made
in
accordance
with
24
section
135C.37
,
the
department
shall
make
a
preliminary
review
25
of
the
complaint.
Unless
the
department
concludes
that
the
26
complaint
is
intended
to
harass
a
facility
or
a
licensee
or
is
27
without
reasonable
basis,
the
department
shall
make
or
cause
28
to
be
made
an
on-site
inspection
of
the
health
care
facility
29
which
is
the
subject
of
the
complaint
within
the
time
period
30
determined
pursuant
to
the
following
guidelines,
which
period
31
shall
commence
on
the
date
of
receipt
of
the
complaint:
32
(1)
For
nursing
facilities,
an
on-site
inspection
shall
be
33
initiated
as
follows:
34
(a)
Within
two
one
working
days
day
for
a
complaint
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determined
by
the
department
to
be
an
alleged
immediate
1
jeopardy
situation.
2
(b)
Within
ten
five
working
days
for
a
complaint
determined
3
by
the
department
to
be
an
alleged
high-level,
nonimmediate
4
jeopardy
situation.
5
(c)
Within
forty-five
calendar
days
for
a
complaint
6
determined
by
the
department
to
be
an
alleged
nonimmediate
7
jeopardy
situation,
other
than
a
high-level
situation.
8
(2)
For
all
other
types
of
health
care
facilities,
an
9
on-site
inspection
shall
be
initiated
as
follows:
10
(a)
Within
two
one
working
days
day
for
a
complaint
11
determined
by
the
department
to
be
an
alleged
immediate
12
jeopardy
situation.
13
(b)
Within
twenty
five
working
days
for
a
complaint
14
determined
by
the
department
to
be
an
alleged
high-level,
15
nonimmediate
jeopardy
situation.
16
(c)
Within
forty-five
calendar
days
for
a
complaint
17
determined
by
the
department
to
be
an
alleged
nonimmediate
18
jeopardy
situation,
other
than
a
high-level
situation.
19
Sec.
7.
Section
135C.44,
Code
2025,
is
amended
to
read
as
20
follows:
21
135C.44
Treble
Additional
fines
for
repeated
violations.
22
The
penalties
authorized
by
section
135C.36
shall
be
trebled
23
quadrupled
for
a
second
or
subsequent
class
I
or
violation
and
24
tripled
for
a
second
or
subsequent
class
II
violation
occurring
25
within
any
twelve-month
period
if
a
citation
was
issued
for
the
26
same
class
I
or
class
II
violation
occurring
within
that
period
27
and
a
penalty
was
assessed
therefor
for
the
violation
.
28
Sec.
8.
NEW
SECTION
.
135C.49
Improper
influence.
29
1.
A
member
of
the
general
assembly
or
an
employee
of
30
the
legislative
or
executive
branch
shall
not
attempt
to
31
influence
a
decision
of
the
department
during
the
course
of
an
32
investigation,
inspection,
or
appeal
under
this
chapter.
33
2.
An
allegation
of
a
violation
of
this
section
shall
34
be
investigated
by
the
office
of
ombudsman
established
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under
section
2C.2.
If
the
office
of
ombudsman
determines
a
1
violation
of
this
section
has
occurred,
the
office
shall
report
2
the
recommendations,
including
disciplinary
action,
pursuant
to
3
sections
2C.16
and
2C.19.
4
3.
A
person
who
is
recommended
for
disciplinary
action
for
5
a
violation
of
this
section
is
subject
to
a
civil
penalty
of
6
up
to
five
thousand
dollars
per
violation.
A
civil
penalty
7
collected
pursuant
to
this
section
shall
be
credited
to
the
8
department,
shall
be
considered
appropriated
receipts
as
9
defined
in
section
8.2,
and
shall
be
used
by
the
department
to
10
enforce
this
chapter.
11
4.
a.
A
civil
penalty
for
violations
committed
by
an
12
employee
of
the
executive
branch
shall
be
assessed
by
the
13
department.
14
b.
A
civil
penalty
for
violations
committed
by
a
member
or
15
employee
of
the
general
assembly
shall
be
assessed
pursuant
to
16
a
resolution
approved
by
a
majority
of
the
house
in
which
the
17
member
serves
or
by
which
the
employee
is
employed.
If
the
18
general
assembly
is
not
in
session
at
the
time
a
recommendation
19
is
received
from
the
office
of
ombudsman,
a
civil
penalty
shall
20
be
assessed
by
a
majority
vote
of
the
legislative
council.
21
Sec.
9.
2023
Iowa
Acts,
chapter
108,
section
7,
subsection
22
4,
is
amended
to
read
as
follows:
23
4.
HEALTH
FACILITIES
24
a.
For
salaries,
support,
maintenance,
and
miscellaneous
25
purposes,
and
for
not
more
than
the
following
full-time
26
equivalent
positions:
27
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
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.
.
.
.
.
.
.
.
.
.
.
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.
.
.
.
.
.
$
4,862,971
28
5,462,971
29
.
.
.
.
.
.
.
.
.
.
.
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.
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.
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.
.
.
.
.
.
FTEs
115.00
30
145.00
31
b.
The
department
shall
make
all
of
the
following
32
information
available
to
the
public
as
part
of
the
department’s
33
development
efforts
to
revise
the
department’s
internet
site:
34
(1)
The
number
of
inspections
of
health
facilities
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conducted
by
the
department
annually
by
type
of
service
1
provider
and
type
of
inspection.
2
(2)
The
total
annual
operations
budget
for
the
department
3
that
is
associated
with
health
facilities
regulation,
including
4
general
fund
appropriations
and
federal
contract
dollars
5
received
by
type
of
service
provider
inspected.
6
(3)
The
total
number
of
full-time
equivalent
positions
7
in
the
department
that
are
associated
with
health
facilities
8
regulation,
to
include
the
number
of
full-time
equivalent
9
positions
serving
in
a
supervisory
capacity,
and
serving
as
10
surveyors,
inspectors,
or
monitors
in
the
field
by
type
of
11
service
provider
inspected.
12
(4)
Identification
of
state
and
federal
survey
trends,
13
cited
regulations,
the
scope
and
severity
of
deficiencies
14
identified,
and
federal
and
state
fines
assessed
and
collected
15
concerning
nursing
and
assisted
living
facilities
and
programs.
16
c.
It
is
the
intent
of
the
general
assembly
that
the
17
department
continuously
solicit
input
from
health
facilities
18
regulated
by
the
department
to
assess
and
improve
the
19
department’s
level
of
collaboration
and
to
identify
new
20
opportunities
for
cooperation.
21
d.
Of
the
funds
appropriated
in
this
subsection,
$600,000,
22
in
addition
to
federal
matching
funds,
shall
be
used
to
employ
23
additional
nursing
facility
inspectors
and
assisted
living
24
program
monitors
to
perform
additional
safety
inspections.
25
Sec.
10.
EFFECTIVE
DATE.
The
following,
being
deemed
of
26
immediate
importance,
takes
effect
upon
enactment:
27
The
section
of
this
Act
amending
2023
Iowa
Acts,
chapter
108,
28
section
7,
subsection
4.
29
Sec.
11.
RETROACTIVE
APPLICABILITY.
The
following
applies
30
retroactively
to
July
1,
2023:
31
The
section
of
this
Act
amending
2023
Iowa
Acts,
chapter
108,
32
section
7,
subsection
4.
33
EXPLANATION
34
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
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the
explanation’s
substance
by
the
members
of
the
general
assembly.
1
This
bill
relates
to
health
care
facilities
and
the
2
department
of
inspections,
appeals,
and
licensing
(DIAL).
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
a
facility
that
receives
state
funding
7
annually
adopt
and
provide
to
the
department
the
facility’s
8
policies
regarding
competitive
procurement
for
supplies
and
9
equipment.
Additionally,
the
rules
and
standards
shall
include
10
policies
and
procedures
regarding
the
use
of
arbitration
11
agreements.
Specifically,
the
rules
shall
prohibit
any
12
facility
that
accepts
state
funding
from
offering
a
resident,
13
or
requiring
a
resident
to
sign,
an
arbitration
agreement
that
14
limits
the
resident’s
inalienable
right
to
seek
full
judicial
15
review
of
a
dispute
as
a
precondition
for
being
admitted
to
the
16
facility.
17
The
bill
requires
that,
on
average,
DIAL
perform
at
least
one
18
general
unannounced
inspection
of
a
health
care
facility
within
19
a
12-month
period
not
to
exceed
a
period
of
15
months,
rather
20
than
the
current
30-month
period.
21
The
bill
increases
the
monetary
amount
for
the
bottom
of
the
22
range
of
the
penalty
for
a
class
I
violation
by
a
health
care
23
facility
from
$2,000
to
$5,000,
and
maintains
the
upper
part
24
of
the
range
at
$10,000.
The
bill
also
increases
the
penalty
25
for
repeated
class
I
violations
in
a
12-month
period
for
which
26
a
penalty
is
assessed
by
quadrupling
rather
than
tripling
the
27
amount.
28
The
bill
adds
as
a
class
I
violation
for
a
health
care
29
facility
any
confirmed
instance
of
a
facility
retaliating
30
against
a
resident
or
employee
for
filing
a
complaint
or
31
otherwise
cooperating
with
the
department
or
the
office
of
32
long-term
care
ombudsman.
33
The
bill
amends
the
required
time
period
within
which
DIAL
34
must
respond
upon
receipt
of
a
complaint.
Under
the
bill,
for
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nursing
facilities,
an
on-site
inspection
shall
be
initiated
1
within
one
working
day
rather
than
the
current
two
working
2
days
if
a
complaint
is
determined
to
be
an
alleged
immediate
3
jeopardy
situation;
and
within
five
rather
than
the
current
4
10
working
days
if
a
complaint
is
determined
to
be
an
alleged
5
high-level,
nonimmediate
jeopardy
situation.
Under
the
bill
6
for
all
other
types
of
health
care
facilities,
an
on-site
7
inspection
shall
be
initiated
within
one
working
day
rather
8
than
two
working
days
if
a
complaint
is
determined
to
be
an
9
alleged
immediate
jeopardy
situation;
and
within
five
working
10
days
rather
than
20
working
days
if
a
complaint
is
determined
11
be
an
alleged
high-level,
nonimmediate
jeopardy
situation.
12
The
bill
provides
that
a
member
of
the
general
assembly
or
13
an
employee
of
the
legislative
or
executive
branch
shall
not
14
attempt
to
influence
a
decision
of
DIAL
during
the
course
of
15
an
investigation,
inspection,
or
appeal.
An
allegation
of
a
16
violation
shall
be
investigated
by
the
office
of
ombudsman.
If
17
the
office
of
ombudsman
determines
a
violation
has
occurred,
18
the
office
shall
report
the
recommendations,
including
19
disciplinary
action,
to
an
agency.
A
person
who
is
recommended
20
for
disciplinary
action
for
a
violation
is
subject
to
a
21
civil
penalty
of
up
to
$5,000
per
violation.
A
civil
penalty
22
collected
shall
be
credited
to
DIAL,
considered
appropriated
23
receipts,
and
used
by
DIAL
to
enforce
Code
chapter
135C.
DIAL
24
shall
assess
the
civil
penalty
for
violations
committed
by
25
an
employee
of
the
executive
branch,
and
a
civil
penalty
for
26
violations
committed
by
a
member
or
employee
of
the
general
27
assembly
shall
be
assessed
pursuant
to
a
resolution
or
by
the
28
legislative
council
if
the
general
assembly
is
not
in
session
29
at
the
time
a
recommendation
is
received
from
the
office
of
30
ombudsman.
31
The
bill
amends
the
appropriation
for
FY
2023-2024
to
DIAL
32
for
health
facilities
to
provide
for
an
increase
of
$600,000
33
and
30.00
additional
full-time
equivalent
positions.
The
34
appropriated
funds,
in
addition
to
the
federal
matching
funds,
35
-7-
LSB
1473XS
(4)
91
lh/ko
7/
8
S.F.
532
shall
be
used
for
additional
nursing
facility
inspectors
and
1
assisted
living
program
monitors
to
perform
additional
safety
2
inspections.
This
provision
takes
effect
upon
enactment
and
is
3
retroactively
applicable
to
July
1,
2023.
4
-8-
LSB
1473XS
(4)
91
lh/ko
8/
8