Bill Text: IA SF2304 | 2023-2024 | 90th General Assembly | Introduced

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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) 2024-02-15 - Subcommittee: Edler, Rowley, and Trone Garriott. S.J. 307. [SF2304 Detail]

Download: Iowa-2023-SF2304-Introduced.html

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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,
providing penalties, making an appropriation, and including
effective date and retroactive applicability provisions.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
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Section 1. NEW SECTION . 10A.904 Definitions.
As used in this subchapter, unless the context otherwise
requires:
1. “Assisted living program” or “program” means the same as
defined in section 231C.2.
2. “Health care facility” means the same as defined in
section 135C.1.
3. “Long-term care facility” means a health care facility
or an assisted living program.
4. “Long-term care facility safety council” or “safety
council” means the long-term care facility safety council
created in section 10A.905.
5. “Resident” means the same as defined in section 135C.1.
6. “Tenant” means the same as defined in section 231C.2.
Sec. 2. NEW SECTION . 10A.905 Long-term care facility safety
council —— membership —— duties —— meetings.
1. A long-term care facility safety council is created.
a. The safety council shall include the following voting
members:
(1) The director of health and human services, or the
director’s designee.
(2) The state long-term care ombudsman, or the state
long-term care ombudsman’s designee.
(3) The director of an area agency on aging, or the
director’s designee.
(4) The state director of AARP, or the state director’s
designee.
(5) Three public members appointed by the governor, and
subject to confirmation by the senate, who are consumers or
members of consumer groups or consumer organizations.
b. The safety council shall also include the director or the
director’s designee as a nonvoting member.
2. The long-term care facility safety council shall do all
of the following:
a. Determine and approve standards, including those relating
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to health and safety, for long-term care facilities.
b. Conduct informal conferences and reviews of health care
facility applicants and licensees, and assisted living program
applicants and certificate holders, and make recommendations
for departmental action pursuant to sections 135C.10A and
231C.11B.
c. Review and make recommendations to the department
regarding violations and penalties under chapters 135C and
231C.
d. Make recommendations to the department regarding the
adoption or amendment of administrative rules.
e. Review the operation of long-term care facilities for
which the department has referred a complaint received by the
department to the office of long-term care ombudsman.
f. Receive recommendations from the state long-term care
ombudsman regarding inspections of specific long-term care
facilities, and changes in administrative rules regarding the
health, safety, welfare, and rights of residents and tenants.
g. Submit an annual report to the general assembly by
October 31 for the immediately preceding fiscal year, including
any recommendations for changes in law to better protect
residents and tenants, and a summary of all recommendations
made by long-term care facilities during informal conferences.
3. The members shall elect a public member as the
chairperson of the safety council annually.
4. The safety council shall hold an organizational meeting
in July each year, and meetings shall be held as necessary
to enable the safety council to expeditiously discharge its
duties. Meeting dates shall be set upon adjournment or by call
of the chairperson upon five days’ notice to the other members.
Sec. 3. Section 135C.1, Code 2024, is amended by adding the
following new subsection:
NEW SUBSECTION . 12A. “Long-term care facility safety
council” or “safety council” means the long-term care facility
safety council created pursuant to section 10A.905.
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Sec. 4. Section 135C.10, unnumbered paragraph 1, Code 2024,
is amended to read as follows:
The department shall have the authority to deny, suspend, or
revoke a license in any case where the department finds that
there has been repeated failure on the part of the a facility
to comply with the provisions of this chapter or the rules or
minimum standards promulgated hereunder under this chapter , or
for any of the following reasons:
Sec. 5. Section 135C.10, Code 2024, is amended by adding the
following new subsection:
NEW SUBSECTION . 12. The facility is issued three or more
class I or federal immediate jeopardy violations within a
twelve-month period for which a penalty was assessed.
Sec. 6. NEW SECTION . 135C.10A Multiple violations
within a twelve-month period —— informal conference and review
by long-term care facility safety council —— recommended
departmental actions.
1. At the time the department effects delivery of notice on
an applicant or licensee under section 135C.11, based on the
department’s authority under section 135C.10, subsection 12, to
deny, suspend, or revoke a license, the department shall also
notify the long-term care facility safety council.
2. a. The safety council shall hold an informal conference
with the applicant or licensee within ten working days of
the mailing or service of notice to review the applicant’s
or licensee’s history of violations for which a penalty was
assessed under this chapter, and the response by the applicant
or licensee in correcting such violations.
b. Following the informal conference and review, the safety
council shall report its findings to the department, including
any recommendations for departmental action as authorized under
this chapter. The department shall proceed in accordance with
the recommendations of the safety council. A health care
facility may subsequently request a formal hearing and proceed
under section 135C.11.
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Sec. 7. Section 135C.14, unnumbered paragraph 1, Code 2024,
is amended to read as follows:
The department shall, in accordance with chapter 17A and
with the approval of the council on health and human services
long-term care facility safety council , adopt and enforce
rules setting minimum standards for health care facilities.
In so doing, the department, with the approval of the council
on health and human services long-term care facility safety
council , may adopt by reference, with or without amendment,
nationally recognized standards and rules, which shall be
specified by title and edition, date of publication, or similar
information. The rules and standards required by this section
shall be formulated in consultation with the director of
health and human services or the director of health and human
services’ designee, with the director, with the state long-term
care ombudsman, and with affected industry, professional,
and consumer groups, and shall be designed to further the
accomplishment of the purposes of this chapter and shall relate
to:
Sec. 8. Section 135C.14, subsection 5, Code 2024, is amended
to read as follows:
5. Equipment essential to the health and welfare of the
resident. The rules shall require a health care facility
that accepts state funding to annually adopt and provide to
the department the health care facility’s policies regarding
competitive procurement for supplies and equipment including
transactions and associated reimbursement structures with any
related party as defined in section 135C.7A.
Sec. 9. Section 135C.14, subsection 8, Code 2024, is amended
by adding the following new paragraph:
NEW PARAGRAPH . g. Facility policies and procedures
regarding the use of arbitration agreements. The rules and
standards shall prohibit any health care facility that accepts
state funding from offering a resident, or requiring a resident
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
a precondition for being admitted to the facility.
Sec. 10. Section 135C.16, subsection 1, Code 2024, is
amended to read as follows:
1. In addition to the inspections required by sections
135C.9 and 135C.38 , the department shall make or cause to be
made such further unannounced inspections as it deems necessary
to adequately enforce this chapter . At On average, at least
one general unannounced inspection shall be conducted for each
health care facility within a thirty-month twelve-month period ,
not to exceed a period of fifteen months . The inspector shall
show identification to the person in charge of the facility
and state that an inspection is to be made before beginning
the inspection. An employee of the department who gives
unauthorized advance notice of an inspection made or planned
to be made under this subsection or section 135C.38 shall be
disciplined as determined by the director, except that if the
employee is employed pursuant to the merit system provisions of
chapter 8A, subchapter IV , the discipline shall not exceed the
discipline authorized pursuant to that subchapter.
Sec. 11. Section 135C.36, subsection 1, Code 2024, is
amended to read as follows:
1. A class I violation is one which presents an imminent
danger or a substantial probability of resultant death or
physical harm to the residents of the facility in which
the violation occurs. A physical condition or one or more
practices in a facility may constitute a class I violation. A
class I violation shall be abated or eliminated immediately
unless the department determines that a stated period of time,
specified in the citation issued under section 135C.40 , is
required to correct the violation. A licensee is subject to
a penalty of not less than two five thousand nor more than
ten thousand dollars for each class I violation for which the
licensee’s facility is cited.
Sec. 12. Section 135C.36, Code 2024, is amended by adding
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the following new subsection:
NEW SUBSECTION . 1A. A class I violation includes any
confirmed instance of a facility retaliating against a resident
or employee for filing a complaint or otherwise cooperating
with the department or the office of long-term care ombudsman.
Sec. 13. Section 135C.38, subsection 1, paragraph a, Code
2024, is amended to read as follows:
a. Upon receipt of a complaint made in accordance with
section 135C.37 , the department shall make a preliminary review
of the complaint. Unless the department concludes that the
complaint is intended to harass a facility or a licensee or is
without reasonable basis, the department shall make or cause
to be made an on-site inspection of the health care facility
which is the subject of the complaint within the time period
determined pursuant to the following guidelines, which period
shall commence on the date of receipt of the complaint:
(1) For nursing facilities, an on-site inspection shall be
initiated as follows:
(a) Within two one working days day for a complaint
determined by the department to be an alleged immediate
jeopardy situation.
(b) Within ten five working days for a complaint determined
by the department to be an alleged high-level, nonimmediate
jeopardy situation.
(c) Within forty-five calendar days for a complaint
determined by the department to be an alleged nonimmediate
jeopardy situation, other than a high-level situation.
(2) For all other types of health care facilities, an
on-site inspection shall be initiated as follows:
(a) Within two one working days day for a complaint
determined by the department to be an alleged immediate
jeopardy situation.
(b) Within twenty five working days for a complaint
determined by the department to be an alleged high-level,
nonimmediate jeopardy situation.
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(c) Within forty-five calendar days for a complaint
determined by the department to be an alleged nonimmediate
jeopardy situation, other than a high-level situation.
Sec. 14. Section 135C.44, Code 2024, is amended to read as
follows:
135C.44 Treble Additional fines for repeated violations.
The penalties authorized by section 135C.36 shall be trebled
quadrupled for a second or subsequent class I or violation and
tripled for a second or subsequent class II violation occurring
within any twelve-month period if a citation was issued for the
same class I or class II violation occurring within that period
and a penalty was assessed therefor for the violation .
Sec. 15. NEW SECTION . 135C.49 Improper influence.
1. A member of the general assembly or an employee of
the legislative or executive branch shall not attempt to
influence a decision of the department during the course of an
investigation, inspection, or appeal under this chapter.
2. An allegation of a violation of this section shall
be investigated by the office of ombudsman established
under section 2C.2. If the office of ombudsman determines a
violation of this section has occurred, the office shall report
the recommendations, including disciplinary action, pursuant to
sections 2C.16 and 2C.19.
3. A person who is recommended for disciplinary action for
a violation of this section is subject to a civil penalty of
up to five thousand dollars per violation. A civil penalty
collected pursuant to this section shall be credited to the
department, shall be considered repayment receipts as defined
in section 8.2, and shall be used by the department to enforce
this chapter.
4. a. A civil penalty for violations committed by an
employee of the executive branch shall be assessed by the
department.
b. A civil penalty for violations committed by a member or
employee of the general assembly shall be assessed pursuant to
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a resolution approved by a majority of the house in which the
member serves or by which the employee is employed. If the
general assembly is not in session at the time a recommendation
is received from the office of ombudsman, a civil penalty shall
be assessed by a majority vote of the legislative council.
Sec. 16. Section 231.42, subsection 2, Code 2024, is amended
by adding the following new paragraph:
NEW PARAGRAPH . f. Make recommendations to the long-term
care facility safety council created in section 10A.905
regarding inspections of specific health care facilities and
assisted living programs, and changes in administrative rules
regarding the health, safety, welfare, and rights of residents
of health care facilities and tenants of assisted living
programs.
Sec. 17. Section 231C.2, Code 2024, is amended by adding the
following new subsection:
NEW SUBSECTION . 7A. “Long-term care facility safety council”
or “safety council” means the long-term care facility safety
council created in section 10A.905.
Sec. 18. NEW SECTION . 231C.11B Multiple violations
within a twelve-month period —— informal conference and review
by long-term care facility safety council —— recommended
departmental actions.
1. At the time the department effects delivery of notice
on an applicant or certificate holder under section 231C.11,
based on the assisted living program having been issued notice
of three violations in a twelve-month period which presented
imminent danger or a substantial probability of resultant
death or physical harm to a tenant and for which a penalty
was assessed under section 231C.14, the department shall also
notify the long-term care facility safety council.
2. a. The safety council shall hold an informal conference
with the applicant or certificate holder within ten working
days of the mailing or service of notice to review the
applicant’s or certificate holder’s history of violations
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for which a penalty was assessed under this chapter, and the
response by the applicant or certificate holder in correcting
such violations.
b. Following the informal conference and review, the safety
council shall report its findings to the department, including
any recommendations for departmental action as authorized under
this chapter. The department shall proceed in accordance with
the recommendations of the safety council. An assisted living
program may subsequently request a contested case hearing and
proceed under section 231C.9A.
Sec. 19. 2023 Iowa Acts, chapter 108, section 7, subsection
4, is amended to read as follows:
4. HEALTH FACILITIES
a. For salaries, support, maintenance, and miscellaneous
purposes, and for not more than the following full-time
equivalent positions:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 4,862,971
6,262,971
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 115.00
145.00
b. The department shall make all of the following
information available to the public as part of the department’s
development efforts to revise the department’s internet site:
(1) The number of inspections of health facilities
conducted by the department annually by type of service
provider and type of inspection.
(2) The total annual operations budget for the department
that is associated with health facilities regulation, including
general fund appropriations and federal contract dollars
received by type of service provider inspected.
(3) The total number of full-time equivalent positions
in the department that are associated with health facilities
regulation, to include the number of full-time equivalent
positions serving in a supervisory capacity, and serving as
surveyors, inspectors, or monitors in the field by type of
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service provider inspected.
(4) Identification of state and federal survey trends,
cited regulations, the scope and severity of deficiencies
identified, and federal and state fines assessed and collected
concerning nursing and assisted living facilities and programs.
c. It is the intent of the general assembly that the
department continuously solicit input from health facilities
regulated by the department to assess and improve the
department’s level of collaboration and to identify new
opportunities for cooperation.
d. Of the funds appropriated in this subsection, $2,400,000
shall be used to employ additional nursing facility inspectors
and assisted living program monitors to perform additional
safety inspections.
Sec. 20. STUDY AND RECOMMENDATIONS —— SPECIAL FOCUS LIST FOR
LONG-TERM CARE FACILITIES. The long-term care facility safety
council created in section 10A.905, as enacted in this Act,
shall study the feasibility of creating a special focus list
for long-term care facilities in the state based on a review
of special focus lists in other states. Following completion
of the study, the safety council shall submit a report to
the general assembly by February 1, 2025, including specific
descriptions of successful special focus lists in other states,
and recommendations for the creation of a special focus list
in Iowa including necessary Code changes and the potential
framework for the special focus list.
Sec. 21. OFFICE OF LONG-TERM CARE OMBUDSMAN ——
APPROPRIATION.
1. There is appropriated from the general fund of the state
to the office of long-term care ombudsman for the fiscal year
beginning July 1, 2024, and ending June 30, 2025, the following
amount, or so much thereof as is necessary, to be used for the
purposes designated:
To increase the number of local long-term care ombudsmen,
including for salaries, support, administration, maintenance,
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and miscellaneous purposes:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 300,000
2. The funding appropriated in this section is in addition
to any other funds appropriated from the general fund of the
state and any other full-time equivalent positions authorized
for local long-term care ombudsmen during the same fiscal
year. The funding shall be used to support local ombudsmen in
fulfilling their duties pursuant to section 231.42 including
to provide the resources necessary to complete site visits and
to carry out other duties to protect and improve the health,
safety, welfare, and rights of residents and tenants.
Sec. 22. CODE EDITOR DIRECTIVE. The Code editor is directed
to create a new subchapter X in chapter 10A as follows:
subchapter X shall be entitled “Long-term Care Facility Safety
Council” and shall include sections 10A.904 and 10A.905.
Sec. 23. EFFECTIVE DATE. The following, being deemed of
immediate importance, takes effect upon enactment:
The section of this Act amending 2023 Iowa Acts, chapter 108,
section 7, subsection 4, relating to health facilities.
Sec. 24. RETROACTIVE APPLICABILITY. The following applies
retroactively to July 1, 2023:
The section of this Act amending 2023 Iowa Acts, chapter 108,
section 7, subsection 4, relating to health facilities.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
This bill provides for oversight for long-term care
facilities (facilities).
The bill creates a long-term care facility safety council
(safety council) under the department of inspections, appeals,
and licensing (DIAL) to: determine and approve standards,
including those relating to health and safety, for long-term
care facilities; conduct informal conferences and reviews of
health care facility applicants and licensees that have been
issued three or more class I violations (a violation which
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presents an imminent danger or a substantial probability
of death or physical harm to the residents of the facility
in which the violation occurs) within a 12-month period
for which a penalty was assessed, and of assisted living
program applicants or certificate holders that have been
issued notice of three violations in a 12-month period which
presented imminent danger or a substantial probability of
resultant death or physical harm to a tenant and for which
a penalty was assessed, and make recommendations to DIAL for
departmental action; review and make recommendations to DIAL
regarding violations and penalties; make recommendations to
DIAL regarding the adoption or amendment of administrative
rules; review the operation of long-term care facilities for
which the department has referred a complaint received by
the department to the office of long-term care ombudsman;
receive recommendations from the state long-term care ombudsman
and submit an annual report to the general assembly with
recommendations for changes in law to better protect residents
and tenants, and a summary of recommendations made by long-term
care facilities in informal conferences. The voting members
of the safety council include the director of health and human
services, or the director’s designee; the state long-term care
ombudsman, or the ombudsman’s designee; the director of an
area agency on aging, or the director’s designee; the state
director of AARP, or the state director’s designee; and three
public members, appointed by the governor, and subject to
confirmation by the senate. The safety council also includes
the director of DIAL, or the director’s designee as a nonvoting
member. The members shall annually elect a public member as
the chairperson of the council. The safety council shall
hold an organizational meeting in July each year and hold
other meetings as necessary to enable the safety council to
expeditiously discharge its duties.
The bill provides that at the time DIAL serves notice on an
applicant or licensee of a health care facility for denial,
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suspension, or revocation of a license, because the health
care facility has been issued three or more class I violations
within a 12-month period for which a penalty was assessed, DIAL
shall also notify the safety council. The safety council shall
hold an informal conference with the applicant or licensee
within 10 working days of the mailing or service of notice to
review the applicant’s or licensee’s history of violations for
which a penalty was assessed, and the response by the applicant
or licensee in correcting such violations. Following the
informal conference and review, the council shall report its
findings to DIAL including recommendations for departmental
action, in accordance with which DIAL shall proceed. A
facility may subsequently request a formal hearing.
The bill also requires that at the time DIAL effects
delivery of notice on an assisted living program applicant or
certificate holder, based on the assisted living program having
been issued notice of three violations in a 12-month period
which presented imminent danger or a substantial probability
of resultant death or physical harm to a tenant, and for which
a penalty was assessed, DIAL shall also notify the long-term
care facility safety council. As with health care facilities,
the safety council shall hold an informal conference with the
applicant or certificate holder within 10 working days of
the mailing or service of notice to review the applicant’s
or certificate holder’s history of violations for which a
penalty was assessed, and the response by the applicant or
certificate holder in correcting such violations. Following
the informal conference and review, the safety council shall
report its findings to DIAL, including any recommendations
for departmental action, with which DIAL shall proceed. An
assisted living program may subsequently request a contested
case hearing.
The bill also requires DIAL to adopt and enforce
administrative rules that set minimum standards for facilities
with the approval of the safety council, rather than the
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approval of the council on health and human services.
Additionally, the rules and standards must be formulated in
consultation with the state long-term care ombudsman.
The bill requires that the administrative rules and
standards to be adopted and enforced by DIAL as part of the
rule relating to equipment essential to the health and welfare
of the resident, require that a facility that receives state
funding annually adopt and provide to the department the
facility’s policies regarding competitive procurement for
supplies and equipment including transactions and associated
reimbursement structures with any related party. Additionally,
the rules and standards shall include policies and procedures
regarding the use of arbitration agreements. Specifically,
the rules shall prohibit any facility that accepts state
funding from offering a resident, or requiring a resident to
sign, an arbitration agreement that limits the resident’s
inalienable right to seek full judicial review of a dispute as
a precondition for being admitted to the facility.
The bill increases the monetary amount for the bottom of the
range of the penalty for a class I violation by a health care
facility from $2,000 to $5,000, and maintains the upper part
of the range at $10,000. The bill also increases the penalty
for repeated class I violations in a 12-month period for which
a penalty is assessed by quadrupling rather than tripling the
amount.
The bill adds as a class I violation for a health care
facility any confirmed instance of a facility retaliating
against a resident or employee for filing a complaint or
otherwise cooperating with the department or the office of
long-term care ombudsman.
The bill provides that a member of the general assembly or
an employee of the legislative or executive branch shall not
attempt to influence a decision of DIAL during the course of
an investigation, inspection, or appeal. An allegation of a
violation shall be investigated by the office of ombudsman. If
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the office of ombudsman determines a violation has occurred,
the office shall report the recommendations, including
disciplinary action, to an agency. A person who is recommended
for disciplinary action for a violation is subject to a
civil penalty of up to $5,000 per violation. A civil penalty
collected shall be credited to DIAL, considered repayment
receipts, and used by DIAL to enforce Code chapter 135C. DIAL
shall assess the civil penalty for violations committed by
an employee of the executive branch, and a civil penalty for
violations committed by a member or employee of the general
assembly shall be assessed pursuant to a resolution or by the
legislative council if the general assembly is not in session
at the time a recommendation is received from the office of
ombudsman.
The bill requires the long-term care facility safety council
to study the feasibility of creating a special focus list for
long-term care facilities in the state based on a review of
special focus lists in other states, and to submit a report to
the general assembly by February 1, 2025, including specific
descriptions of successful special focus lists in other states,
and recommendations for the creation of a special focus list
in Iowa including necessary Code changes and the potential
framework for the special focus list.
The bill requires that, on average, DIAL perform at least one
general unannounced inspection of a health care facility within
a 12-month period not to exceed a period of 15 months, rather
than the current 30-month period.
The bill amends the required time period within which DIAL
must respond upon receipt of a complaint. Under the bill, for
nursing facilities, an on-site inspection shall be initiated
within one working day rather than the current two working days
for a complaint determined by DIAL to be an alleged immediate
jeopardy situation; and within five rather than the current
10 working days for a complaint determined by DIAL to be an
alleged high-level, nonimmediate jeopardy situation. Under
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the bill for all other types of health care facilities, an
on-site inspection shall be initiated within one working day
rather than two working days for a complaint determined by
DIAL to be an alleged immediate jeopardy situation; and within
five working days rather than 20 working days for a complaint
determined by DIAL to be an alleged high-level, nonimmediate
jeopardy situation.
The bill includes, as a duty of the state long-term care
ombudsman, making recommendations to the long-term care
facility safety council.
The bill amends the appropriation for FY 2023-2024 to DIAL
for health facilities to provide for an increase of $1.4
million and 30.0 additional full-time equivalent positions.
Of the total appropriation, $2.4 million is to be used for
additional nursing facility inspectors and assisted living
program monitors to perform additional safety inspections.
This provision takes effect upon enactment and is retroactively
applicable to July 1, 2023.
The bill appropriates funds from the general fund of
the state to the office of long-term care ombudsman for FY
2024-2025 to be used to increase the number of local long-term
care ombudsmen. The funding appropriated is in addition to any
other funds appropriated from the general fund of the state and
any other full-time equivalent positions authorized for local
long-term care ombudsmen during the same fiscal year. The
funding shall be used to support local ombudsmen in fulfilling
their required duties including to provide the resources
necessary to complete site visits and to carry out other duties
to protect and improve the health, safety, welfare, and rights
of residents and tenants.
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LSB 5055XS (17) 90
pf/ko 16/ 16