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PAG LIN 1 1 Section 1. NEW SECTION. 231D.1 DEFINITIONS. 1 2 For the purposes of this chapter, unless the context 1 3 otherwise requires: 1 4 1. "Adult day services", "adult day services program", or 1 5 "program" means an organized program providing a variety of 1 6 health, social, and related support services for sixteen hours 1 7 or less in a twenty-four-hour period to persons with a 1 8 functional impairment on a regularly scheduled, contractual 1 9 basis. 1 10 2. "Functional impairment" means a psychological, 1 11 cognitive, or physical impairment creating the inability to 1 12 perform personal and instrumental activities of daily living 1 13 and associated tasks necessitating some form of supervision or 1 14 assistance or both. 1 15 3. "Governmental unit" means the state, or any county, 1 16 municipality, or other political subdivision or any 1 17 department, division, board, or other agency of any of these 1 18 entities. 1 19 4. "Nursing care" means services which are required to be 1 20 provided only under the direction of a registered nurse or a 1 21 licensed practical nurse. 1 22 5. "Recognized accrediting entity" means a nationally 1 23 recognized accrediting entity that the department of elder 1 24 affairs, in cooperation with the department of inspections and 1 25 appeals, recognizes as having specific adult day services 1 26 program standards equivalent to the standards established by 1 27 the department of elder affairs, in cooperation with the 1 28 department of inspections and appeals, for adult day services. 1 29 6. "Social services" means services relating to the 1 30 psychological and social needs of the individual in adjusting 1 31 to participating in an adult day services program, and 1 32 minimizing the stress arising from that circumstance. 1 33 7. "Supervision" means direct oversight and inspection of 1 34 the act of accomplishing a function or activity. 1 35 Sec. 2. NEW SECTION. 231D.2 PURPOSE – RULES – SPECIAL 2 1 CLASSIFICATIONS. 2 2 1. The purpose of this chapter is to promote and encourage 2 3 adequate and safe care for adults with functional impairments. 2 4 2. The department of elder affairs, in cooperation with 2 5 the department of inspections and appeals, shall establish, by 2 6 rule in accordance with chapter 17A, a program for 2 7 certification and monitoring of and complaint investigations 2 8 related to adult day services programs. The department of 2 9 elder affairs, in cooperation with the department of 2 10 inspections and appeals, in establishing standards for adult 2 11 day services programs, may adopt by rule in accordance with 2 12 chapter 17A, nationally recognized standards for adult day 2 13 services programs. The rules shall include specification of 2 14 recognized accrediting entities. The rules and standards 2 15 adopted shall be formulated in consultation with affected 2 16 industry, professional, and consumer groups and shall be 2 17 designed to accomplish the purpose of this chapter. 2 18 3. The department of elder affairs, in cooperation with 2 19 the department of inspections and appeals, may establish by 2 20 administrative rule special classifications for adult day 2 21 services providers. The department of inspections and appeals 2 22 shall issue separate certificates for each special 2 23 classification for which a provider is certified. 2 24 Sec. 3. NEW SECTION. 231D.3 CERTIFICATION REQUIRED. 2 25 1. A person or governmental unit acting severally or 2 26 jointly with any other person or governmental unit shall not 2 27 establish or operate an adult day services program and shall 2 28 not represent an adult day services program to the public as 2 29 certified unless and until the program is certified pursuant 2 30 to this chapter. If an adult day services program is 2 31 voluntarily accredited by a recognized accrediting entity with 2 32 specific adult day services standards, the department of 2 33 inspections and appeals shall accept voluntary accreditation 2 34 as the basis for certification by the department. The owner 2 35 or manager of a certified adult day services program shall 3 1 comply with the rules adopted by the department of elder 3 2 affairs, in cooperation with the department of inspections and 3 3 appeals, for an adult day services program. 3 4 2. An adult day services program may provide any type of 3 5 adult day services for which the program is certified, 3 6 including any special classification of adult day services. 3 7 An adult day services program shall provide services and 3 8 supervision commensurate with the needs of the recipients. An 3 9 adult day services program shall not provide services to 3 10 individuals requiring a level or type of services for which 3 11 the program is not certified and services provided shall not 3 12 exceed the level or type of services for which the program is 3 13 certified. 3 14 3. An adult day services program that has been certified 3 15 by the department of inspections and appeals shall not alter 3 16 the program, operation, or adult day services for which the 3 17 program is certified in a manner that affects continuing 3 18 certification without prior approval of the department of 3 19 inspections and appeals. The department of inspections and 3 20 appeals shall specify, by rule, alterations that are subject 3 21 to prior approval. 3 22 4. A department, agency, or officer of this state or of 3 23 any political subdivision shall not pay or approve for payment 3 24 from public funds any amount to an adult day services program 3 25 for an actual or perspective recipient, unless the program 3 26 holds a current certificate issued by the department of 3 27 inspections and appeals and meets all current requirements for 3 28 certification. 3 29 5. An adult day services program shall not conduct or 3 30 operate another business or activity within the program 3 31 without the prior approval of the department of inspections 3 32 and appeals, if the business or activity serves primarily 3 33 nonrecipients of adult day services. The department of elder 3 34 affairs, in cooperation with the department of inspections and 3 35 appeals, and in accordance with chapter 17A, shall adopt rules 4 1 which establish criteria for approval of a business or 4 2 activity to be conducted or operated within the program. The 4 3 rules shall be developed in consultation with affected 4 4 industry, professional, and consumer groups. 4 5 Sec. 4. NEW SECTION. 231D.4 APPLICATION AND FEES. 4 6 1. Certificates for adult day services programs shall be 4 7 obtained from the department of inspections and appeals. 4 8 Applications shall be upon such forms and shall include such 4 9 information as the department of inspections and appeals may 4 10 reasonably require, which may include affirmative evidence of 4 11 compliance with applicable statutes and local ordinances. 4 12 Each application for certification shall be accompanied by the 4 13 appropriate fee, subject to refund to the applicant if the 4 14 certification is denied. 4 15 2. The department of elder affairs, in cooperation with 4 16 the department of inspections and appeals, shall establish 4 17 certification fees by rule in accordance with chapter 17A. 4 18 The department of inspections and appeals shall collect and 4 19 retain adult day services certification fees. The fees shall 4 20 be deposited in an adult day services program fund created in 4 21 the state treasury under the authority of the department of 4 22 inspections and appeals and are appropriated to the department 4 23 of inspections and appeals to carry out the purposes of this 4 24 chapter. Amounts deposited in the fund shall not be 4 25 transferred, used, obligated, appropriated, or otherwise 4 26 encumbered except as provided in this section. 4 27 Notwithstanding section 12C.7, subsection 2, interest or 4 28 earnings on moneys deposited into the fund shall be credited 4 29 to the fund. Notwithstanding section 8.33, amounts deposited 4 30 in the fund that remain unexpended or unencumbered at the 4 31 close of the fiscal year shall remain in the fund for 4 32 utilization as provided in this section for the following 4 33 fiscal year. 4 34 Sec. 5. NEW SECTION. 231D.5 DENIAL, SUSPENSION, OR 4 35 REVOCATION. 5 1 1. The department of inspections and appeals may deny, 5 2 suspend, or revoke certification if the department of 5 3 inspections and appeals finds that there has been a 5 4 substantial or repeated failure on the part of the adult day 5 5 services program to comply with this chapter or the rules or 5 6 minimum standards adopted pursuant to this chapter, or for any 5 7 of the following reasons: 5 8 a. Cruelty or indifference to adult day services program 5 9 service recipients. 5 10 b. Appropriation or conversion of the property of an adult 5 11 day services programs service recipient without the 5 12 recipient's written consent or the written consent of the 5 13 service recipient's legal guardian. 5 14 c. Permitting, aiding, or abetting the commission of any 5 15 illegal act in the adult day services program. 5 16 d. Obtaining or attempting to obtain or retain 5 17 certification by fraudulent means, misrepresentation, or by 5 18 submitting false information. 5 19 e. Habitual intoxication or addiction to the use of drugs 5 20 by the applicant, owner, manager, or supervisor of the adult 5 21 day services program. 5 22 f. Securing the devise or bequest of the property of a 5 23 recipient of services of an adult day services program by 5 24 undue influence. 5 25 g. Failure or neglect to maintain a continuing education 5 26 and training program for all personnel employed in the adult 5 27 day services program. 5 28 h. Founded dependent adult abuse as defined in section 5 29 235B.2. 5 30 i. For any other reason as provided by law or 5 31 administrative rule. 5 32 2. In the case of an application by an existing 5 33 certificate holder for a new or newly acquired adult day 5 34 services program, continuing or repeated failure of the 5 35 certificate holder to operate any previously certified adult 6 1 day services program in compliance with this chapter or of the 6 2 rules adopted pursuant to this chapter. 6 3 3. In the case of a certificate applicant or existing 6 4 certificate holder which is an entity other than an 6 5 individual, the department of inspections and appeals may 6 6 deny, suspend, or revoke a certificate if any individual who 6 7 is in a position of control or is an officer of the entity 6 8 engages in any act or omission proscribed by this section. 6 9 Sec. 6. NEW SECTION. 231D.6 NOTICE – APPEAL – 6 10 EMERGENCY PROVISIONS. 6 11 1. The denial, suspension, or revocation of a certificate 6 12 shall be effected by delivering to the applicant or 6 13 certificate holder by restricted certified mail or by personal 6 14 service a notice setting forth the particular reasons for the 6 15 action. The denial, suspension, or revocation shall become 6 16 effective thirty days after the mailing or service of the 6 17 notice, unless the applicant or certificate holder, within the 6 18 thirty-day period, requests a hearing, in writing, of the 6 19 department of inspections and appeals, in which case the 6 20 notice shall be deemed to be suspended. 6 21 2. The denial, suspension, or revocation of a certificate 6 22 may be appealed in accordance with rules adopted by the 6 23 department of inspections and appeals. 6 24 3. When the department of inspections and appeals finds 6 25 that an immediate danger to the health or safety of recipients 6 26 of services from an adult day services program exists which 6 27 requires action on an emergency basis, the department of 6 28 inspections and appeals may direct the removal of all 6 29 recipients of services from an adult day services program and 6 30 suspend the certificate prior to a hearing. 6 31 Sec. 7. NEW SECTION. 231D.7 CONDITIONAL OPERATION. 6 32 The department of inspections and appeals may, as an 6 33 alternative to denial, suspension, or revocation of 6 34 certification under section 231D.5, conditionally issue or 6 35 continue certification dependent upon the performance by the 7 1 adult day services program of reasonable conditions within a 7 2 reasonable period of time as prescribed by the department of 7 3 inspections and appeals so as to permit the program to 7 4 commence or continue the operation of the program pending full 7 5 compliance with this chapter or the rules adopted pursuant to 7 6 this chapter. If the adult day services program does not make 7 7 diligent efforts to comply with the conditions prescribed, the 7 8 department of inspections and appeals may, under the 7 9 proceedings prescribed by this chapter, suspend or revoke the 7 10 certificate. An adult day services program shall not be 7 11 operated under conditional certification for more than one 7 12 year. 7 13 Sec. 8. NEW SECTION. 231D.8 DIRECTOR NOTIFIED OF 7 14 CASUALTIES. 7 15 The director of inspections and appeals shall be notified 7 16 within twenty-four hours, by the most expeditious means 7 17 available, of any accident causing substantial injury or 7 18 death, and any substantial fire or natural or other disaster 7 19 occurring at or near an adult day services program. 7 20 Sec. 9. NEW SECTION. 231D.9 COMPLAINTS AND 7 21 CONFIDENTIALITY. 7 22 1. A person with concerns regarding the operations or 7 23 service delivery of an adult day services program may file a 7 24 complaint with the department of inspections and appeals. The 7 25 name of the person who files a complaint with the department 7 26 of inspections and appeals and any personal identifying 7 27 information of the person or any recipient of program services 7 28 identified in the complaint shall be kept confidential and 7 29 shall not be subject to discovery, subpoena, or other means of 7 30 legal compulsion for its release to a person other than 7 31 employees of the department of inspections and appeals 7 32 involved in the investigation of the complaint. 7 33 2. The department of elder affairs, in cooperation with 7 34 the department of inspections and appeals, shall establish 7 35 procedures for the disposition of complaints received in 8 1 accordance with this section. 8 2 Sec. 10. NEW SECTION. 231D.10 PUBLIC DISCLOSURE OF 8 3 FINDINGS. 8 4 Following a monitoring evaluation or complaint 8 5 investigation of an adult day services program by the 8 6 department of inspections and appeals pursuant to this 8 7 chapter, the department's final findings with respect to 8 8 compliance by the adult day services program with requirements 8 9 for certification shall be made available to the public in a 8 10 readily available form and place. Other information relating 8 11 to an adult day services program that is obtained by the 8 12 department of inspections and appeals which does not 8 13 constitute the department's final findings from a monitoring 8 14 evaluation or complaint investigation of the adult day 8 15 services program shall not be made available to the public 8 16 except in proceedings involving the denial, suspension, or 8 17 revocation of a certificate under this chapter. 8 18 Sec. 11. NEW SECTION. 231D.11 PENALTIES. 8 19 1. A person establishing, conducting, managing, or 8 20 operating an adult day services program without a certificate 8 21 is guilty of a serious misdemeanor. Each day of continuing 8 22 violation after conviction or notice from the department of 8 23 inspections and appeals by certified mail of a violation shall 8 24 be considered a separate offense or chargeable offense. A 8 25 person establishing, conducting, managing, or operating a 8 26 adult day services program without a certificate may be 8 27 temporarily or permanently restrained by a court of competent 8 28 jurisdiction from such activity in an action brought by the 8 29 state. 8 30 2. A person who prevents or interferes with or attempts to 8 31 impede in any way any duly authorized representative of the 8 32 department of inspections and appeals in the lawful 8 33 enforcement of this chapter or of the rules adopted pursuant 8 34 to this chapter is guilty of a simple misdemeanor. As used in 8 35 this subsection, lawful enforcement includes but is not 9 1 limited to: 9 2 a. Contacting or interviewing any participant of an adult 9 3 day services program in private at any reasonable hour and 9 4 without advance notice. 9 5 b. Examining any relevant records of an adult day services 9 6 program. 9 7 c. Preserving evidence of any violation of this chapter or 9 8 of the rules adopted pursuant to this chapter. 9 9 3. A civil penalty, as established by rule, may apply in 9 10 any of the following situations: 9 11 a. Program noncompliance with one or more regulatory 9 12 requirements has caused or is likely to cause harm, serious 9 13 injury, threat, or death to a recipient of program services. 9 14 b. Program failure or refusal to comply with regulatory 9 15 requirements within prescribed time frames. 9 16 Sec. 12. NEW SECTION. 231D.12 RETALIATION BY AN ADULT 9 17 DAY SERVICES PROVIDER PROHIBITED. 9 18 1. An adult day services provider shall not discriminate 9 19 or retaliate in any way against a recipient, recipient's 9 20 family, or an employee of the program who has initiated or 9 21 participated in any proceeding authorized by this chapter. An 9 22 adult day services program that violates this section is 9 23 subject to a penalty as established by administrative rule, to 9 24 be assessed and collected by the department of inspections and 9 25 appeals and paid into the state treasury to be credited to the 9 26 general fund of the state, or to immediate revocation of the 9 27 program's certificate. 9 28 2. Any attempt to discharge a recipient from an adult day 9 29 services program by whom or upon whose behalf a complaint has 9 30 been submitted to the department of inspections and appeals 9 31 under section 231D.9, within ninety days after the filing of 9 32 the complaint or the conclusion of any proceeding resulting 9 33 from the complaint, shall raise a rebuttable presumption that 9 34 the action was taken by the program in retaliation for the 9 35 filing of the complaint, except in situations in which the 10 1 recipient is discharged due to changes in health status which 10 2 exceed the level of care offered by the adult day services 10 3 program. 10 4 Sec. 13. NEW SECTION. 231D.13 NURSING ASSISTANT AND 10 5 MEDICATION AIDE – CERTIFICATION. 10 6 The department of inspections and appeals, in cooperation 10 7 with other appropriate agencies, shall establish a procedure 10 8 to allow nursing assistants or medication aides to deem work 10 9 within adult day services programs as credit toward sustaining 10 10 professional certification. 10 11 Sec. 14. NEW SECTION. 231D.14 CRIMINAL RECORDS 10 12 INVESTIGATION CHECK. 10 13 An adult day services program shall comply with section 10 14 135C.33. 10 15 Sec. 15. NEW SECTION. 231D.15 FIRE AND SAFETY STANDARDS. 10 16 The state fire marshal shall adopt rules, in coordination 10 17 with the department of inspections and appeals, relating to 10 18 the certification and monitoring of the fire and safety 10 19 standards of adult day services programs. 10 20 Sec. 16. NEW SECTION. 231D.16 TRANSITION PROVISIONS. 10 21 Adult day service programs existing prior to July 1, 2003, 10 22 shall comply with this chapter by June 30, 2004. 10 23 Sec. 17. Section 100.1, subsection 6, Code 2003, is 10 24 amended to read as follows: 10 25 6. To adopt rules designating a fee to be assessed to each 10 26 building, structure, or facility for which a fire safety 10 27 inspection or plan review by the state fire marshal is 10 28 requiredas a condition of licensureby law. The fee 10 29 designated by rule shall be set in an amount that is 10 30 reasonably related to the costs of conducting the applicable 10 31 inspection or plan review. The fees collected by the state 10 32 fire marshal shall be retained by the state fire marshal and 10 33 deposited inthe generala separate fundofcreated in the 10 34 state treasury under the authority of the state fire marshal 10 35 and are appropriated to the state fire marshal to carry out 11 1 the purpose of this subsection. Amounts deposited in the fund 11 2 shall not be transferred, used, obligated, appropriated, or 11 3 otherwise encumbered, except as provided in this subsection. 11 4 Notwithstanding section 12C.7, subsection 2, interest or 11 5 earnings on moneys deposited in the fund shall be credited to 11 6 the fund. Notwithstanding section 8.33, amounts deposited in 11 7 the fund that remain unexpended or unencumbered at the close 11 8 of the fiscal year shall remain in the fund for utilization as 11 9 provided in this subsection for the following fiscal year. 11 10 Sec. 18. Section 135C.1, subsection 1, Code 2003, is 11 11 amended to read as follows: 11 12 1. "Adult day services" means adult day services as 11 13 defined in section231.61231D.1 that are provided in a 11 14 licensed health care facility. 11 15 Sec. 19. Section 231B.1, subsection 2, Code 2003, is 11 16 amended by striking the subsection. 11 17 Sec. 20. Section 231B.2, subsection 1, Code 2003, is 11 18 amended to read as follows: 11 19 1. The department of elder affairs, in cooperation with 11 20 the department of inspections and appeals, shall establish by 11 21 rule in accordance with chapter 17A a special classification 11 22 for elder group homes. An elder group home established 11 23 pursuant to this subsection is exempt from the requirements of 11 24 section 135.63. 11 25 Sec. 21. Section 231B.2, subsection 2, unnumbered 11 26 paragraph 1, Code 2003, is amended to read as follows: 11 27 The department of elder affairs, in cooperation with the 11 28 department of inspections and appeals, shall adopt rules to 11 29 establish requirements for certification of elder group homes. 11 30 The requirements shall include but are not limited to all of 11 31 the following: 11 32 Sec. 22. Section 231B.2, subsections 3 through 5, Code 11 33 2003, are amended to read as follows: 11 34 3. An elder group home established pursuant to this 11 35 chapter shall be certified by the department of inspections 12 1 and appeals. 12 2 4. A provider under the special classification shall 12 3 comply with the rules adopted by the department of elder 12 4 affairs, in cooperation with the department of inspections and 12 5 appeals, for an elder group home. 12 6 5. Inspections and certification services shall be 12 7 provided by the department of inspections and appeals. 12 8However, beginning July 1, 1994, the department may enter into12 9contracts with the area agencies on aging to provide these12 10services.12 11 Sec. 23. Section 231B.3, subsection 2, Code 2003, is 12 12 amended to read as follows: 12 13 2. A person who has knowledge that an elder group home is 12 14 operating without certification shall report the name and 12 15 address of the home to the department of inspections and 12 16 appeals. The department of inspections and appeals shall 12 17 investigate a report made pursuant to this section. 12 18 Sec. 24. Section 231B.4, Code 2003, is amended to read as 12 19 follows: 12 20 231B.4 APPLICABILITY. 12 21 1. This chapter shall not be construed to require that a 12 22 facility, currently licensed or licensed as a different type 12 23 of facility and serving persons sixty years of age or older, 12 24 also comply with the requirements of this chapter. 12 25 2. This chapter shall apply only to those elder group 12 26 homes certified by the department of elder affairs prior to 12 27 July 1, 2003. Applications for certification as an elder 12 28 group home shall not be accepted on or after July 1, 2003. 12 29 Sec. 25. Section 231C.2, subsection 1, Code 2003, is 12 30 amended to read as follows: 12 31 1. "Assisted living" means provision of housing with 12 32 services which may include but are not limited to health- 12 33 related care, personal care, and assistance with instrumental 12 34 activities of daily living tosixthree or more tenants in a 12 35 physical structure which provides a homelike environment. 13 1 "Assisted living" also includes encouragement of family 13 2 involvement, tenant self-direction, and tenant participation 13 3 in decisions that emphasize choice, dignity, privacy, 13 4 individuality, shared risk, and independence. "Assisted 13 5 living" includes the provision of housing and assistance with 13 6 instrumental activities of daily living only if personal care 13 7 or health-related care is also included. 13 8 Sec. 26. Section 231C.2, subsection 2, Code 2003, is 13 9 amended by striking the subsection. 13 10 Sec. 27. Section 231C.2, Code 2003, is amended by adding 13 11 the following new subsections: 13 12 NEW SUBSECTION. 0A. "Adult day services" means adult day 13 13 services as defined in section 231D.1. 13 14 NEW SUBSECTION. 2A. "Elder group home" means an elder 13 15 group home as defined in section 231B.1. 13 16 NEW SUBSECTION. 2B. "Governmental unit" means the state, 13 17 or any county, municipality, or other political subdivision or 13 18 any department, division, board, or other agency of any of 13 19 these entities. 13 20 NEW SUBSECTION. 5A. "Recognized accrediting entity" means 13 21 a nationally recognized accrediting entity that the department 13 22 of elder affairs, in cooperation with the department of 13 23 inspections and appeals, recognizes as having specific 13 24 assisted living program standards equivalent to the standards 13 25 established by the department of elder affairs, in cooperation 13 26 with the department of inspections and appeals, for assisted 13 27 living programs. 13 28 Sec. 28. Section 231C.3, Code 2003, is amended by striking 13 29 the section and inserting in lieu thereof the following: 13 30 231C.3 CERTIFICATION OF ASSISTED LIVING PROGRAMS. 13 31 1. The department of elder affairs, in cooperation with 13 32 the department of inspections and appeals, shall establish by 13 33 rule in accordance with chapter 17A, a program for 13 34 certification and monitoring of and complaint investigations 13 35 related to assisted living programs. The rules shall be 14 1 formulated in consultation with affected industry, 14 2 professional, and consumer groups. In establishing the 14 3 certification and monitoring program, the department of elder 14 4 affairs, in cooperation with the department of inspections and 14 5 appeals, may adopt by reference any portion of nationally 14 6 recognized standards and rules for assisted living programs. 14 7 The rules shall include specification of recognized 14 8 accrediting agencies. 14 9 2. A person or governmental unit acting severally or 14 10 jointly with any other person or governmental unit shall not 14 11 establish or operate an assisted living program and shall not 14 12 represent an assisted living program to the public as 14 13 certified in this state unless and until the program is 14 14 certified pursuant to this chapter. If an assisted living 14 15 program is voluntarily accredited by a recognized accrediting 14 16 entity, the department of inspections and appeals shall accept 14 17 voluntary accreditation as the basis for certification by the 14 18 department of inspections and appeals. An owner or manager of 14 19 a certified assisted living program shall comply with the 14 20 rules adopted for an assisted living program. An assisted 14 21 living program certified under this section is exempt from the 14 22 requirements of section 135.63 relating to certificate of need 14 23 requirements. 14 24 3. a. Services provided by a certified assisted living 14 25 program may be provided directly by staff of the assisted 14 26 living program, by individuals contracting with the assisted 14 27 living program, or by individuals employed by the tenant or 14 28 with whom the tenant contracts if the tenant agrees to assume 14 29 the responsibility and risk of the employment or the 14 30 contractual relationship. 14 31 b. If a tenant is terminally ill and has elected to 14 32 receive hospice services under the federal Medicare program 14 33 from a Medicare certified hospice program, the certified 14 34 assisted living program shall enter into a written agreement 14 35 with the Medicare certified hospice program under which the 15 1 hospice program assumes full responsibility for the 15 2 professional management of the tenant's hospice care. 15 3 4. The department of inspections and appeals may enter 15 4 into contracts to provide certification and monitoring of 15 5 assisted living programs. The department of inspections and 15 6 appeals shall have full access at any reasonable time to all 15 7 records, materials, and common areas pertaining to the 15 8 provision of services to the tenants of a program during 15 9 certification and monitoring of programs seeking certification 15 10 or currently certified. The department of elder affairs, in 15 11 cooperation with the department of inspections and appeals, 15 12 shall adopt rules in accordance with chapter 17A that require 15 13 recognized accrediting entities to provide the department of 15 14 inspections and appeals with all records and documents 15 15 pertaining to the accrediting, monitoring, and complaint 15 16 process. 15 17 5. The department of elder affairs, in cooperation with 15 18 the department of inspections and appeals, may also establish 15 19 by rule in accordance with chapter 17A special classifications 15 20 for assisted living programs. The rules shall be formulated 15 21 in consultation with affected industry, professional, and 15 22 consumer groups. The special classifications established may 15 23 include a special classification that allows a portion of the 15 24 tenants who require more than part-time or intermittent 15 25 nursing care the opportunity to extend their tenancy in the 15 26 assisted living program. 15 27 6. A department, agency, or officer of this state or of 15 28 any political subdivision shall not pay or approve for payment 15 29 from public funds any amount to an assisted living program for 15 30 an actual or prospective tenant, unless the program holds a 15 31 current certificate issued by the department of inspections 15 32 and appeals and meets all current requirements for 15 33 certification. 15 34 7. An assisted living program shall not conduct or operate 15 35 another business or activity in the program without the prior 16 1 approval of the department of inspections and appeals, if the 16 2 business or activity serves primarily nontenants. The 16 3 department of elder affairs, in cooperation with the 16 4 department of inspections and appeals, and in accordance with 16 5 chapter 17A, shall adopt rules which establish criteria for 16 6 approval of a business or activity to be conducted or operated 16 7 within the program. The rules shall be developed in 16 8 consultation with affected industry, professional, and 16 9 consumer groups. 16 10 8. An assisted living program shall comply with section 16 11 135C.33. 16 12 Sec. 29. Section 231C.4, Code 2003, is amended to read as 16 13 follows: 16 14 231C.4 FIRE AND SAFETY STANDARDS. 16 15 The state fire marshal shall adopt rules, in coordination 16 16 with the department of elder affairs and the department of 16 17 inspections and appeals, relating to the certificationor16 18voluntary accreditationand monitoring of the fire and safety 16 19 standards of certifiedor voluntarily accreditedassisted 16 20 living programs. 16 21 Sec. 30. Section 231C.5, Code 2003, is amended to read as 16 22 follows: 16 23 231C.5 COORDINATION OF THE LONG-TERM CARE SYSTEM – 16 24 TRANSITIONAL PROVISIONS. 16 251. Any person representing a program to the public as an16 26assisted living program prior to July 1, 1996, shall be16 27granted a temporary certification by the department or shall16 28be voluntarily accredited and shall meet the requirements of16 29this chapter within one year of the issuance of the temporary16 30certification or voluntary accreditation to receive subsequent16 31certification or voluntary accreditation.16 32 1. An elder group home certified under chapter 231B prior 16 33 to July 1, 2003, shall be exempt from the requirements of this 16 34 chapter. If an elder group home certified under chapter 231B 16 35 prior to July 1, 2003, seeks certification as an assisted 17 1 living program on or after July 1, 2003, the elder group home 17 2 shall be granted a conditional assisted living program 17 3 certification by the department of inspections and appeals for 17 4 a period of one year from the date the conditional certificate 17 5 is issued. At the end of the one-year period, the elder group 17 6 home shall meet the requirements of this chapter to receive 17 7 subsequent certification as an assisted living program. 17 8 2. A hospital licensed pursuant to chapter 135B or a 17 9 health care facility licensed pursuant to chapter 135C may 17 10 operate an assisted living program, located in a distinct part 17 11 of or separate structure under the control of the hospital or 17 12 health care facility, if certifiedor voluntarily accredited17 13 pursuant to this chapter. 17 14 3. This chapter shall not be construed to require that a 17 15 facility licensed as a different type of facility also comply 17 16 with the requirements of this chapter, unless the facility is 17 17 represented to the public as a certifiedor voluntarily17 18accreditedassisted living program. 17 19 Sec. 31. Section 231C.6, Code 2003, is amended to read as 17 20 follows: 17 21 231C.6 IOWA ASSISTED LIVING FEES. 17 22 The department ofelder affairsinspections and appeals 17 23 shall collect and retain assisted living program certification 17 24 andaccreditationrelated fees as established by rule. Fees 17 25 collected and retained pursuant to this section shall be 17 26 deposited into an assisted living program fund created in the 17 27 state treasury under the authority of the department of 17 28 inspections and appeals and are appropriated to the department 17 29 of inspections and appeals to carry out the purposes of this 17 30 chapter. Amounts deposited in the fund shall not be 17 31 transferred, used, obligated, appropriated, or otherwise 17 32 encumbered except as provided in this section. 17 33 Notwithstanding section 12C.7, subsection 2, interest or 17 34 earnings on moneys deposited into the fund shall be credited 17 35 to the fund.AmountsNotwithstanding section 8.33, amounts 18 1 deposited in the fund that remain unexpended or unencumbered 18 2 at the close of the fiscal year shall remain in the fund for 18 3 utilization as provided in this section for the following 18 4 fiscal year. 18 5 Sec. 32. NEW SECTION. 231C.7 COMPLAINTS. 18 6 1. Any person with concerns regarding the operations or 18 7 service delivery of an assisted living program may file a 18 8 complaint with the department of inspections and appeals. The 18 9 name of the person who files a complaint with the department 18 10 of inspections and appeals and any personal identifying 18 11 information of the person or any tenant identified in the 18 12 complaint shall be kept confidential and shall not be subject 18 13 to discovery, subpoena, or other means of legal compulsion for 18 14 its release to a person other than department's employees 18 15 involved with the complaint. 18 16 2. The department of elder affairs, in cooperation with 18 17 the department of inspections and appeals, shall establish 18 18 procedures for the disposition of complaints received in 18 19 accordance with this section. 18 20 Sec. 33. NEW SECTION. 231C.8 PENALTIES. 18 21 1. A person establishing, conducting, managing, or 18 22 operating any assisted living program without a certificate is 18 23 guilty of a serious misdemeanor. Each day of continuing 18 24 violation after conviction or notice from the department of 18 25 inspections and appeals by certified mail of a violation shall 18 26 be considered a separate offense or chargeable offense. A 18 27 person establishing, conducting, managing, or operating an 18 28 assisted living program without a certificate may be 18 29 temporarily or permanently restrained by a court of competent 18 30 jurisdiction from such activity in an action brought by the 18 31 state. 18 32 2. A person who prevents or interferes with or attempts to 18 33 impede in any way any duly authorized representative of the 18 34 department of inspections and appeals in the lawful 18 35 enforcement of this chapter or of the rules adopted pursuant 19 1 to this chapter is guilty of a simple misdemeanor. As used in 19 2 this subsection, lawful enforcement includes but is not 19 3 limited to: 19 4 a. Contacting or interviewing any tenant of an assisted 19 5 living program in private at any reasonable hour and without 19 6 advance notice. 19 7 b. Examining any relevant records of an assisted living 19 8 program. 19 9 c. Preserving evidence of any violation of this chapter or 19 10 of the rules adopted pursuant to this chapter. 19 11 3. A civil penalty, as established by rule, may apply in 19 12 any of the following situations: 19 13 a. Program noncompliance with one or more regulatory 19 14 requirements has caused or is likely to cause harm, serious 19 15 injury, threat, or death to a tenant. 19 16 b. Program failure or refusal to comply with regulatory 19 17 requirements within prescribed time frames. 19 18 Sec. 34. NEW SECTION. 231C.9 PUBLIC DISCLOSURE OF 19 19 FINDINGS. 19 20 Following a monitoring evaluation or complaint 19 21 investigation of an assisted living program by the department 19 22 of inspections and appeals pursuant to this chapter, the 19 23 department's final findings with respect to compliance by the 19 24 assisted living program with requirements for certification 19 25 shall be made available to the public in a readily available 19 26 form and place. Other information relating to an assisted 19 27 living program that is obtained by the department of 19 28 inspections and appeals which does not constitute the 19 29 department's final findings from a monitoring evaluation or 19 30 complaint investigation of the assisted living program shall 19 31 not be made available to the public except in proceedings 19 32 involving the denial, suspension, or revocation of a 19 33 certificate under this chapter. 19 34 Sec. 35. NEW SECTION. 231C.10 DIRECTOR NOTIFIED OF 19 35 CASUALTIES. 20 1 The director of inspections and appeals shall be notified 20 2 within twenty-four hours, by the most expeditious means 20 3 available, of any accident causing substantial injury or 20 4 death, and any substantial fire or natural or other disaster 20 5 occurring at or near an assisted living program. 20 6 Sec. 36. NEW SECTION. 231C.11 RETALIATION BY ASSISTED 20 7 LIVING PROGRAM PROVIDER PROHIBITED. 20 8 1. An assisted living program provider shall not 20 9 discriminate or retaliate in any way against a tenant, 20 10 tenant's family, or an employee of the program who has 20 11 initiated or participated in any proceeding authorized by this 20 12 chapter. An assisted living program provider that violates 20 13 this section is subject to a penalty as established by 20 14 administrative rule in accordance with chapter 17A and to be 20 15 assessed and collected by the department of inspections and 20 16 appeals and paid into the state treasury to be credited to the 20 17 general fund of the state, or to immediate revocation of the 20 18 program's certificate. 20 19 2. Any attempt to evict, from an assisted living program, 20 20 a tenant by whom or upon whose behalf a complaint has been 20 21 submitted to the department under section 231C.7, within 20 22 ninety days after the filing of the complaint or the 20 23 conclusion of any proceeding resulting from the complaint, 20 24 raises a rebuttable presumption that the action was taken by 20 25 the program provider in retaliation for the filing of the 20 26 complaint, except in situations in which the tenant is evicted 20 27 due to occupancy and transfer criteria. 20 28 Sec. 37. NEW SECTION. 231C.12 DENIAL, SUSPENSION, OR 20 29 REVOCATION – CONDITIONAL OPERATION. 20 30 1. The department of inspections and appeals may deny, 20 31 suspend, or revoke a certificate in any case where the 20 32 department of inspections and appeals finds that there has 20 33 been a substantial or repeated failure on the part of the 20 34 assisted living program to comply with this chapter or the 20 35 rules, or minimum standards adopted under this chapter, or for 21 1 any of the following reasons: 21 2 a. Cruelty or indifference to assisted living program 21 3 tenants. 21 4 b. Appropriation or conversion of the property of an 21 5 assisted living program tenant without the tenant's written 21 6 consent or the written consent of the tenant's legal guardian. 21 7 c. Permitting, aiding, or abetting the commission of any 21 8 illegal act in the assisted living program. 21 9 d. Obtaining or attempting to obtain or retain a 21 10 certificate by fraudulent means, misrepresentation, or by 21 11 submitting false information. 21 12 e. Habitual intoxication or addiction to the use of drugs 21 13 by the applicant, administrator, executive director, manager, 21 14 or supervisor of the assisted living program. 21 15 f. Securing the devise or bequest of the property of a 21 16 tenant of an assisted living program by undue influence. 21 17 g. Failure or neglect to maintain a continuing education 21 18 and training program for all personnel employed in the program 21 19 assisted living. 21 20 h. Founded dependent adult abuse as defined in section 21 21 235B.2. 21 22 i. For any other reason as provided by law or 21 23 administrative rule. 21 24 2. The department of inspections and appeals may as an 21 25 alternative to denial, suspension, or revocation conditionally 21 26 issue or continue a certificate dependent upon the performance 21 27 by the assisted living program of reasonable conditions within 21 28 a reasonable period of time as set by the department of 21 29 inspections and appeals so as to permit the program to 21 30 commence or continue the operation of the program pending full 21 31 compliance with this chapter or the rules adopted pursuant to 21 32 this chapter. If the assisted living program does not make 21 33 diligent efforts to comply with the conditions prescribed, the 21 34 department of inspections and appeals may, under the 21 35 proceedings prescribed by this chapter, suspend, or revoke the 22 1 certificate. An assisted living program shall not be operated 22 2 on a conditional certificate for more than one year. 22 3 Sec. 38. NEW SECTION. 231C.13 NOTICE – HEARINGS. 22 4 1. The denial, suspension, or revocation of a certificate 22 5 shall be effected by delivering to the applicant or 22 6 certificate holder by restricted certified mail or by personal 22 7 service a notice setting forth the particular reasons for such 22 8 action. Such denial, suspension, or revocation shall become 22 9 effective thirty days after the mailing or service of the 22 10 notice, unless the applicant or certificate holder, within 22 11 such thirty-day period, requests a hearing, in writing, of the 22 12 department of inspections and appeals, in which case the 22 13 notice shall be deemed to be suspended. 22 14 2. The denial, suspension, or revocation of a certificate 22 15 may be appealed in accordance with rules adopted by the 22 16 department of inspections and appeals in accordance with 22 17 chapter 17A. 22 18 3. When the department of inspections and appeals finds 22 19 that an immediate danger to the health or safety of tenants of 22 20 an assisted living program exists which requires action on an 22 21 emergency basis, the department of inspections and appeals may 22 22 direct removal of all tenants of an assisted living program 22 23 and suspend the certificate prior to a hearing. 22 24 Sec. 39. NEW SECTION. 231C.14 NURSING ASSISTANT AND 22 25 MEDICATION AIDE – CERTIFICATION. 22 26 The department of inspections and appeals, in cooperation 22 27 with other appropriate agencies, shall establish a procedure 22 28 to allow nursing assistants or medication aides to deem work 22 29 within an assisted living program as credit toward sustaining 22 30 professional certification. 22 31 Sec. 40. Section 235B.3, subsection 2, paragraph d, Code 22 32 2003, is amended to read as follows: 22 33 d. A person who performs inspections of elder group homes 22 34 for the department ofelder affairsinspections and appeals 22 35 and a resident advocate committee member assigned to an elder 23 1 group home pursuant to chapter 231B. 23 2 Sec. 41. Section 231.61 and chapter 231A, Code 2003, are 23 3 repealed. 23 4 Sec. 42. TRANSITION OF STAFF. All employees of the 23 5 department of elder affairs performing functions related to 23 6 certification and monitoring of or complaint investigations 23 7 related to assisted living programs as of June 30, 2003, shall 23 8 become employees of the department of inspections and appeals 23 9 without loss of classification, pay, or benefits, effective 23 10 July 1, 2003. All employees of the department of elder 23 11 affairs performing functions related to affordable assisted 23 12 living as of June 30, 2003, shall become employees of the Iowa 23 13 finance authority without loss of classification, pay, or 23 14 benefits, effective July 1, 2003. 23 15 Sec. 43. IMPLEMENTATION – CONTINGENCY. This Act takes 23 16 effect only when the general assembly appropriates funding and 23 17 specifically states in the language of the appropriation that 23 18 the funding is sufficient, based upon an estimate on file with 23 19 the house of origin of the Act, for the implementation and 23 20 administration of the Act. The department of elder affairs 23 21 shall notify the Code editor when sufficient funds are 23 22 appropriated to implement and administer this Act. 23 23 EXPLANATION 23 24 This bill establishes regulatory provisions for adult day 23 25 services and assisted living programs. 23 26 Currently, provisions relating to regulation of adult day 23 27 services are included in Code section 231.61, which is 23 28 repealed in the bill. Under that section, regulation of adult 23 29 day services consisted of development of a system of oversight 23 30 by affected state agencies, industry representatives, and 23 31 consumers under the department of elder affairs. 23 32 Under the bill, a new Code chapter, 231D, is created to 23 33 provide for the regulation of adult day services under the 23 34 department of elder affairs with the cooperation of the 23 35 department of inspections and appeals. The bill directs the 24 1 department of elder affairs, with the cooperation of the 24 2 department of inspections and appeals, to establish a program 24 3 for certification and monitoring of and complaint 24 4 investigations related to adult day services. The rules and 24 5 standards are to be formulated in consultation with affected 24 6 industry, professional, and consumer groups. Under the bill, 24 7 all adult day services programs are required to be certified 24 8 by the department of inspections and appeals. The bill 24 9 establishes application and fee requirements; provides a 24 10 procedure for denial, suspension, or revocation of 24 11 certification; provides for the director of inspections and 24 12 appeals to be notified of casualties relative to an adult day 24 13 services program; provides a complaint process; provides for 24 14 disclosure of final findings by the department of inspections 24 15 and appeals related to monitoring evaluations or complaint 24 16 investigations; provides penalties for noncompliance with 24 17 certification requirements and enforcement of the provisions 24 18 of the chapter; prohibits retaliation by a provider of adult 24 19 day services; provides for nursing assistants and medication 24 20 aides to deem work within adult day services programs as 24 21 credit toward professional certification; provides for fire 24 22 and safety standards; and provides transition provisions. 24 23 The bill provides for regulation of assisted living 24 24 programs by directing the department of elder affairs, in 24 25 cooperation with the department of inspections and appeals, to 24 26 establish, by rule, a program for certification and monitoring 24 27 of and complaint investigations related to assisted living 24 28 programs. The rules are to be formulated in consultation with 24 29 affected industry, professional, and consumer groups. If an 24 30 assisted living program is voluntarily accredited by a 24 31 recognized accrediting entity, the department of inspections 24 32 and appeals is directed to accept voluntary accreditation as 24 33 the basis for certification by the department. The bill 24 34 provides specifically that if a tenant of an assisted living 24 35 program is terminally ill and has elected to receive hospice 25 1 services under the federal Medicare program from a Medicare- 25 2 certified hospice program, the certified assisted living 25 3 program is to enter into a written agreement with the hospice 25 4 program under which the hospice program assumes full 25 5 responsibility for the professional management of the tenant's 25 6 hospice care. 25 7 The bill specifically provides for the adoption of rules by 25 8 the department of elder affairs, in cooperation with the 25 9 department of inspections and appeals, to require recognized 25 10 accrediting entities to provide the department of inspections 25 11 and appeals with all records and documents pertaining to the 25 12 accrediting, monitoring, and complaint processes. 25 13 The bill provides that the department of elder affairs, in 25 14 cooperation with the department of inspections and appeals, 25 15 may also establish by rule special classifications for 25 16 assisted living programs, including a special classification 25 17 to allow a portion of the tenants who require more than part- 25 18 time or intermittent nursing care the opportunity to extend 25 19 their tenancy in the assisted living program. 25 20 The bill provides that an elder group home that seeks 25 21 certification as an assisted living program on or after July 25 22 1, 2003, is to be granted conditional certification as an 25 23 assisted living program for one year from the date of issuance 25 24 of the conditional certification. Thereafter, the elder group 25 25 home must meet all requirements of an assisted living program 25 26 to be certified as an assisted living program. The bill 25 27 establishes a complaint procedure; establishes penalties for 25 28 violations of the certification requirements for assisted 25 29 living facilities; provides for public disclosure of final 25 30 findings by the department of inspections and appeals related 25 31 to monitoring evaluations or complaint investigations; 25 32 provides for the notification of the director of inspections 25 33 and appeals of casualties in an assisted living program; 25 34 prohibits retaliation by an assisted living program provider 25 35 against persons who participate in a proceeding under the 26 1 chapter; provides a procedure for the denial, suspension, or 26 2 revocation of certification and for conditional operation; and 26 3 provides for nursing assistants and medication aides to deem 26 4 work within adult day services programs as credit toward 26 5 professional certification. 26 6 The bill also provides that elder group homes certified 26 7 prior to July 1, 2003, are to comply with the provisions under 26 8 Code chapter 231B relating to elder group homes, but that 26 9 beginning July 1, 2003, applications for certification as an 26 10 elder group home are not to be accepted. 26 11 The bill repeals Code chapter 231A, relating to elder 26 12 family homes. 26 13 LSB 1205DP 80 26 14 pf/cl/14.2
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