Relating to oversight for long-term care facilities, providing penalties, making an appropriation, and including effective date and retroactive applicability provisions

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, 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 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 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 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 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 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 working days for a complaint determined by DIAL to be an alleged high-level, nonimmediate jeopardy situation. Under 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 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.0 additional full-time equivalent positions.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.