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 TLSB 5055XS (17) 90 pf/ko
S.F. 2304 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 directors designee. 21 (2) The state long-term care ombudsman, or the state 22 long-term care ombudsmans designee. 23 (3) The director of an area agency on aging, or the 24 directors designee. 25 (4) The state director of AARP, or the state directors 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 directors 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 35 -1- LSB 5055XS (17) 90 pf/ko 1/ 16
S.F. 2304 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. 35 -2- LSB 5055XS (17) 90 pf/ko 2/ 16
S.F. 2304 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 departments 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 applicants 25 or licensees 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. 35 -3- LSB 5055XS (17) 90 pf/ko 3/ 16
S.F. 2304 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 facilitys 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 residents 35 -4- LSB 5055XS (17) 90 pf/ko 4/ 16
S.F. 2304 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 licensees facility is cited. 34 Sec. 12. Section 135C.36, Code 2024, is amended by adding 35 -5- LSB 5055XS (17) 90 pf/ko 5/ 16
S.F. 2304 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. 35 -6- LSB 5055XS (17) 90 pf/ko 6/ 16
S.F. 2304 (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 -7- LSB 5055XS (17) 90 pf/ko 7/ 16
S.F. 2304 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 applicants or certificate holders history of violations 35 -8- LSB 5055XS (17) 90 pf/ko 8/ 16
S.F. 2304 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 departments 22 development efforts to revise the departments 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 -9- LSB 5055XS (17) 90 pf/ko 9/ 16
S.F. 2304 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 departments 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 -10- LSB 5055XS (17) 90 pf/ko 10/ 16
S.F. 2304 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 explanations 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 35 -11- LSB 5055XS (17) 90 pf/ko 11/ 16
S.F. 2304 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 directors designee; the state long-term care 22 ombudsman, or the ombudsmans designee; the director of an 23 area agency on aging, or the directors designee; the state 24 director of AARP, or the state directors 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 directors 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, 35 -12- LSB 5055XS (17) 90 pf/ko 12/ 16
S.F. 2304 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 applicants or licensees 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 applicants 24 or certificate holders 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 35 -13- LSB 5055XS (17) 90 pf/ko 13/ 16
S.F. 2304 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 facilitys 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 residents 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 -14- LSB 5055XS (17) 90 pf/ko 14/ 16
S.F. 2304 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 -15- LSB 5055XS (17) 90 pf/ko 15/ 16
S.F. 2304 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. 30 -16- LSB 5055XS (17) 90 pf/ko 16/ 16