S.F. _____ H.F. _____ Section 1. Section 135C.10, subsection 9, Code 2015, is 1 amended to read as follows: 2 9. In the case of an application by an existing licensee 3 for a new or newly acquired facility, continuing or repeated 4 failure of the licensee to operate any previously licensed 5 facility or facilities in compliance with the provisions of 6 this chapter , the rules adopted pursuant to this chapter , or 7 equivalent provisions that the facility is subject to in this 8 state or any other state. 9 Sec. 2. Section 135C.19, Code 2015, is amended to read as 10 follows: 11 135C.19 Public disclosure Disclosure of inspection findings 12 —— posting of citations. 13 1. Following an inspection of a health care facility by 14 the department pursuant to this chapter , the department’s 15 final findings with respect to compliance by the facility 16 with requirements for licensing shall be made available to 17 the public in a readily available form and place. Other 18 information relating to a health care facility obtained by the 19 department which does not constitute the department’s findings 20 from an inspection of the facility shall not be made available 21 to the public or to the health care facility except in formal 22 administrative proceedings pursuant to chapter 17A involving 23 the citation of a facility for a violation under section 24 135C.40 , or the denial, suspension, or revocation of a license 25 under this chapter . The name of a person who files a complaint 26 with the department shall be confidential. 27 2. a. A citation for a class I or class II violation 28 which is issued to a health care facility and which has become 29 final, or a copy of the citation, shall be prominently posted 30 as prescribed in rules, until the violation is corrected to 31 the department’s satisfaction. The citation or copy shall 32 be posted in a place in plain view of the residents of the 33 facility cited, persons visiting the residents, and persons 34 inquiring about placement in the facility. 35 -1- LSB 1329XD (13) 86 rh/nh 1/ 15

S.F. _____ H.F. _____ b. A copy of each citation required to be posted by this 1 subsection shall be sent by the department to the department 2 of human services, to the designated protection and advocacy 3 agency if the facility has one or more residents with 4 developmental disabilities or mental illness, and to the office 5 of long-term care ombudsman if the facility is a nursing 6 facility or residential care facility. 7 3. If the facility cited subsequently advises the 8 department of human services that the violation has been 9 corrected to the satisfaction of the department of inspections 10 and appeals, the department of human services shall maintain 11 this advisory in the same file with the copy of the citation. 12 The department of human services shall not disseminate to 13 the public any information regarding citations issued by the 14 department of inspections and appeals, but shall forward or 15 refer inquiries to the department of inspections and appeals. 16 Sec. 3. Section 135C.36, subsection 4, Code 2015, is amended 17 to read as follows: 18 4. Any state penalty, including a fine or citation, issued 19 as a result of the federal survey and certification process 20 following a state licensure and federal certification survey or 21 investigation shall be dismissed if the corresponding federal 22 deficiency or citation is dismissed or removed. Any state 23 penalty, including a fine or citation, shall be retained or 24 reinstated if the federal deficiency is retained or reinstated. 25 Sec. 4. Section 135C.41, subsection 2, Code 2015, is amended 26 to read as follows: 27 2. If the facility desires to contest the citation, notify 28 the director that the facility desires to contest the citation 29 and request do either of the following: 30 a. Request an informal conference with an independent 31 reviewer pursuant to section 135C.42 . Upon the conclusion of 32 an informal conference, in the case of an affirmed or modified 33 citation, the facility may request a contested case hearing 34 in writing within five days after receipt of the written 35 -2- LSB 1329XD (13) 86 rh/nh 2/ 15

S.F. _____ H.F. _____ explanation of the independent reviewer. 1 b. Request a contested case hearing in the manner provided 2 by chapter 17A for contested cases. The formal hearing shall 3 be conducted in accordance with chapter 17A and rules adopted 4 by the department. 5 Sec. 5. Section 135C.42, subsection 1, Code 2015, is amended 6 to read as follows: 7 1. The director shall provide an independent reviewer 8 to hold an informal conference with the facility within ten 9 working days after receipt of a request made under section 10 135C.41, subsection 2 , paragraph “a” . At the conclusion of the 11 conference the independent reviewer may affirm or may modify or 12 dismiss the citation. The independent reviewer shall state in 13 writing the specific reasons for the affirmation, modification, 14 or dismissal and immediately transmit copies of the statement 15 to the director, and to the facility. If the facility does not 16 desire to further contest an affirmed or modified citation, it 17 shall comply with section 135C.41, subsection 1, within five 18 working days after the informal conference, or after receipt 19 of the written explanation of the independent reviewer , as the 20 case may be, comply with section 135C.41, subsection 1 . 21 Sec. 6. Section 135C.42, Code 2015, is amended by adding the 22 following new subsection: 23 NEW SUBSECTION . 4. The following provisions shall apply to 24 an informal conference: 25 a. Legal counsel shall not be permitted. 26 b. The health care facility shall not have access to 27 department documents other than the department’s final findings 28 issued to the health care facility. 29 c. Testimony from witnesses employed outside of the health 30 care facility, the entity that owns the facility, or the 31 department shall not be permitted. 32 Sec. 7. Section 135C.43, Code 2015, is amended to read as 33 follows: 34 135C.43 Formal contest —— judicial Judicial review. 35 -3- LSB 1329XD (13) 86 rh/nh 3/ 15

S.F. _____ H.F. _____ 1. A facility that desires to further contest an affirmed 1 or modified citation for a class I, class II, or class III 2 violation may do so in the manner provided by chapter 17A 3 for contested cases. Notice of intent to formally contest a 4 citation shall be given the department in writing within five 5 days after the informal conference or after receipt of the 6 written explanation of the independent reviewer provided to 7 hold the informal conference, whichever is applicable, in the 8 case of an affirmed or modified citation. A facility which has 9 exhausted all adequate administrative remedies and is aggrieved 10 by the final action of the department may petition for judicial 11 review in the manner provided by chapter 17A . 12 2. Hearings on petitions for judicial review brought under 13 this section shall be set for trial at the earliest possible 14 date and shall take precedence on the court calendar over 15 all other cases except matters to which equal or superior 16 precedence is specifically granted by law. The times for 17 pleadings and for hearings in such actions shall be set by the 18 judge of the court with the object of securing a decision in 19 the matter at the earliest possible time. 20 Sec. 8. Section 135C.43A, Code 2015, is amended to read as 21 follows: 22 135C.43A Reduction of penalty amount. 23 If a facility has been assessed a penalty, does not request a 24 formal hearing pursuant to section 135C.43 135C.41, subsection 25 2, paragraph “b” , or withdraws its request for a formal hearing 26 within thirty days of the date that the penalty was assessed, 27 and the penalty is paid within thirty days of the receipt of 28 notice or service, the amount of the penalty shall be reduced 29 by thirty-five percent. The citation which includes the civil 30 penalty shall include a statement to this effect. 31 Sec. 9. Section 231B.9, Code 2015, is amended to read as 32 follows: 33 231B.9 Public disclosure Disclosure of findings. 34 Upon completion of a monitoring evaluation or complaint 35 -4- LSB 1329XD (13) 86 rh/nh 4/ 15

S.F. _____ H.F. _____ investigation of an elder group home by the department pursuant 1 to this chapter , the department’s final findings with respect 2 to compliance by the elder group home with requirements for 3 certification shall be made available to the public in a 4 readily available form and place. Other information relating 5 to an elder group home that is obtained by the department which 6 does not constitute the department’s final findings from a 7 monitoring evaluation or complaint investigation of the elder 8 group home shall not be made available to the public or to the 9 elder group home except in formal administrative proceedings 10 pursuant to chapter 17A involving the assessment of a civil 11 penalty pursuant to section 231B.14 or the denial, suspension, 12 or revocation of a certificate under this chapter . 13 Sec. 10. Section 231B.9A, Code 2015, is amended to read as 14 follows: 15 231B.9A Informal conference —— formal contest —— judicial 16 review. 17 1. Within twenty business days after issuance of the final 18 findings, the elder group home shall notify the director if the 19 home desires to contest the findings and request do either of 20 the following: 21 a. Request an informal conference with an independent 22 reviewer pursuant to subsection 2 . Upon the conclusion of an 23 informal conference, if the elder group home desires to further 24 contest an affirmed or modified regulatory insufficiency, 25 it may do so by giving notice of intent to formally contest 26 the regulatory insufficiency, in writing, to the department 27 within five days after receipt of the written decision of the 28 independent reviewer. 29 b. Request a contested case hearing in the manner provided 30 by chapter 17A for contested cases. The formal hearing shall 31 be conducted in accordance with chapter 17A and rules adopted 32 by the department. 33 2. a. The department shall provide an independent reviewer 34 to hold an informal conference with an elder group home within 35 -5- LSB 1329XD (13) 86 rh/nh 5/ 15

S.F. _____ H.F. _____ ten working days after receiving a request from the home 1 pursuant to subsection 1 , paragraph “a” . At the conclusion of 2 the informal conference, the independent reviewer may affirm, 3 modify, or dismiss a contested regulatory insufficiency. The 4 independent reviewer shall state in writing the specific 5 reasons for the affirmation, modification, or dismissal and 6 immediately transmit copies of the statement to the department 7 and to the home. 8 3. b. An independent reviewer shall be licensed as an 9 attorney in the state of Iowa and shall not be employed or have 10 been employed by the department in the past eight years or have 11 appeared in front of the department on behalf of an elder group 12 home in the past eight years. Preference shall be given to an 13 attorney with background knowledge, experience, or training 14 in long-term care. The department may issue a request for 15 proposals to enter into a contract for the purpose of providing 16 one or more independent reviewers for informal conferences. 17 c. The following provisions shall apply to an informal 18 conference: 19 (1) Legal counsel shall not be permitted. 20 (2) The elder group home shall not have access to department 21 documents other than the department’s final findings issued to 22 the elder group home. 23 (3) Testimony from witnesses employed outside of the elder 24 group home, the corporation that owns the elder group home, or 25 the department shall not be permitted. 26 4. An elder group home that desires to further contest an 27 affirmed or modified regulatory insufficiency may do so in the 28 manner provided by chapter 17A for contested cases. The home 29 shall give notice of intent to formally contest a regulatory 30 insufficiency, in writing, to the department within five days 31 after receipt of the written decision of the independent 32 reviewer. The formal hearing shall be conducted in accordance 33 with chapter 17A and rules adopted by the department. 34 5. 3. An elder group home that has exhausted all adequate 35 -6- LSB 1329XD (13) 86 rh/nh 6/ 15

S.F. _____ H.F. _____ administrative remedies and is aggrieved by the final action of 1 the department may petition for judicial review in the manner 2 provided by chapter 17A . 3 Sec. 11. Section 231B.10, subsection 1, paragraphs f and i, 4 Code 2015, are amended to read as follows: 5 f. Founded dependent adult abuse as defined in section 6 235B.2 235E.1 . 7 i. In the case of an application by an existing certificate 8 holder for a new or newly acquired elder group home, continuing 9 or repeated failure of the certificate holder to operate any 10 previously certified elder group home or homes in compliance 11 with the provisions of this chapter , the rules adopted pursuant 12 to this chapter , or equivalent provisions that the elder group 13 home is subject to in this state or any other state. 14 Sec. 12. Section 231C.9, Code 2015, is amended to read as 15 follows: 16 231C.9 Public disclosure Disclosure of findings. 17 Upon completion of a monitoring evaluation or complaint 18 investigation of an assisted living program by the department 19 pursuant to this chapter , the department’s final findings 20 with respect to compliance by the assisted living program 21 with requirements for certification shall be made available 22 to the public in a readily available form and place. Other 23 information relating to an assisted living program that is 24 obtained by the department which does not constitute the 25 department’s final findings from a monitoring evaluation or 26 complaint investigation of the assisted living program shall 27 not be made available to the public or to the assisted living 28 program except in formal administrative proceedings pursuant 29 to chapter 17A involving the assessment of a civil penalty 30 pursuant to section 231C.14 or the denial, suspension, or 31 revocation of a certificate under this chapter . 32 Sec. 13. Section 231C.9A, Code 2015, is amended to read as 33 follows: 34 231C.9A Informal conference —— formal contest —— judicial 35 -7- LSB 1329XD (13) 86 rh/nh 7/ 15

S.F. _____ H.F. _____ review. 1 1. Within twenty business days after issuance of the final 2 findings, the assisted living program shall notify the director 3 if the program desires to contest the findings and request do 4 either of the following: 5 a. Request an informal conference with an independent 6 reviewer pursuant to subsection 2 . Upon the conclusion 7 of an informal conference, if the assisted living program 8 desires to further contest an affirmed or modified regulatory 9 insufficiency, it may do so by giving notice of intent to 10 formally contest the regulatory insufficiency, in writing, to 11 the department within five days after receipt of the written 12 decision of the independent reviewer. 13 b. Request a contested case hearing in the manner provided 14 by chapter 17A for contested cases. The formal hearing shall 15 be conducted in accordance with chapter 17A and rules adopted 16 by the department. 17 2. a. The department shall provide an independent reviewer 18 to hold an informal conference with an assisted living 19 program within ten working days after receiving a request 20 from the program pursuant to subsection 1 , paragraph “a” . At 21 the conclusion of the informal conference, the independent 22 reviewer may affirm, modify, or dismiss a contested regulatory 23 insufficiency. The independent reviewer shall state in writing 24 the specific reasons for the affirmation, modification, or 25 dismissal and immediately transmit copies of the statement to 26 the department and to the program. 27 3. b. An independent reviewer shall be licensed as an 28 attorney in the state of Iowa and shall not be employed or have 29 been employed by the department in the past eight years or have 30 appeared in front of the department on behalf of an assisted 31 living program in the past eight years. Preference shall be 32 given to an attorney with background knowledge, experience, 33 or training in long-term care. The department may issue a 34 request for proposals to enter into a contract for the purpose 35 -8- LSB 1329XD (13) 86 rh/nh 8/ 15

S.F. _____ H.F. _____ of providing one or more independent reviewers for informal 1 conferences. 2 c. The following provisions shall apply to an informal 3 conference: 4 (1) Legal counsel shall not be permitted. 5 (2) The assisted living program shall not have access to 6 department documents other than the department’s final findings 7 issued to the assisted living program. 8 (3) Testimony from witnesses employed outside of the 9 assisted living program, the corporation that owns the assisted 10 living program, or the department shall not be permitted. 11 4. An assisted living program that desires to further 12 contest an affirmed or modified regulatory insufficiency may do 13 so in the manner provided by chapter 17A for contested cases. 14 The program shall give notice of intent to formally contest 15 a regulatory insufficiency, in writing, to the department 16 within five days after receipt of the written decision of the 17 independent reviewer. The formal hearing shall be conducted 18 in accordance with chapter 17A and rules adopted by the 19 department. 20 5. 3. An assisted living program that has exhausted all 21 adequate administrative remedies and is aggrieved by the final 22 action of the department may petition for judicial review in 23 the manner provided by chapter 17A . 24 Sec. 14. Section 231C.10, subsection 1, paragraph i, Code 25 2015, is amended to read as follows: 26 i. In the case of an application by an existing certificate 27 holder for a new or newly acquired assisted living program, 28 continuing or repeated failure of the certificate holder to 29 operate any previously certified assisted living program or 30 programs in compliance with the provisions of this chapter , 31 the rules adopted pursuant to this chapter , or equivalent 32 provisions that the assisted living program is subject to in 33 this state or any other state. 34 Sec. 15. Section 231D.5, subsection 1, paragraphs g and k, 35 -9- LSB 1329XD (13) 86 rh/nh 9/ 15

S.F. _____ H.F. _____ Code 2015, are amended to read as follows: 1 g. Founded dependent adult abuse as defined in section 2 235B.2 235E.1 . 3 k. In the case of an application by an existing certificate 4 holder for a new or newly acquired adult day services program, 5 continuing or repeated failure of the certificate holder to 6 operate any previously certified adult day services program or 7 programs in compliance with the provisions of this chapter , 8 the rules adopted pursuant to this chapter , or equivalent 9 provisions that the adult day services program is subject to in 10 this state or any other state. 11 Sec. 16. Section 231D.10, Code 2015, is amended to read as 12 follows: 13 231D.10 Public disclosure Disclosure of findings. 14 Upon completion of a monitoring evaluation or complaint 15 investigation of an adult day services program by the 16 department pursuant to this chapter , the department’s final 17 findings with respect to compliance by the adult day services 18 program with requirements for certification shall be made 19 available to the public in a readily available form and place. 20 Other information relating to an adult day services program 21 that is obtained by the department which does not constitute 22 the department’s final findings from a monitoring evaluation 23 or complaint investigation of the adult day services program 24 shall not be made available to the public or to the adult day 25 services program except in formal administrative proceedings 26 pursuant to chapter 17A involving the assessment of a civil 27 penalty pursuant to section 231D.11 or the denial, suspension, 28 or revocation of a certificate under this chapter . 29 Sec. 17. Section 231D.10A, Code 2015, is amended to read as 30 follows: 31 231D.10A Informal conference —— formal contest —— judicial 32 review. 33 1. Within twenty business days after issuance of the final 34 findings, the adult day services program shall notify the 35 -10- LSB 1329XD (13) 86 rh/nh 10/ 15

S.F. _____ H.F. _____ director if the program desires to contest the findings and 1 request do either of the following: 2 a. Request an informal conference with an independent 3 reviewer pursuant to subsection 2 . Upon the conclusion of 4 an informal conference, if the adult day services program 5 desires to further contest an affirmed or modified regulatory 6 insufficiency, it may do so by giving notice of intent to 7 formally contest the regulatory insufficiency, in writing, to 8 the department within five days after receipt of the written 9 decision of the independent reviewer. 10 b. Request a contested case hearing in the manner provided 11 by chapter 17A for contested cases. The formal hearing shall 12 be conducted in accordance with chapter 17A and rules adopted 13 by the department. 14 2. a. The department shall provide an independent reviewer 15 to hold an informal conference with an adult day services 16 program within ten working days after receiving a request 17 from the program pursuant to subsection 1 , paragraph “a” . At 18 the conclusion of the informal conference, the independent 19 reviewer may affirm, modify, or dismiss a contested regulatory 20 insufficiency. The independent reviewer shall state in writing 21 the specific reasons for the affirmation, modification, or 22 dismissal and immediately transmit copies of the statement to 23 the department and to the program. 24 3. b. An independent reviewer shall be licensed as an 25 attorney in the state of Iowa and shall not be employed or have 26 been employed by the department in the past eight years or have 27 appeared in front of the department on behalf of an adult day 28 services program in the past eight years. Preference shall be 29 given to an attorney with background knowledge, experience, 30 or training in long-term care. The department may issue a 31 request for proposals to enter into a contract for the purpose 32 of providing one or more independent reviewers for informal 33 conferences. 34 c. The following provisions shall apply to an informal 35 -11- LSB 1329XD (13) 86 rh/nh 11/ 15

S.F. _____ H.F. _____ conference: 1 (1) Legal counsel shall not be permitted. 2 (2) The adult day services program shall not have access to 3 department documents other than the department’s final findings 4 issued to the adult day services program. 5 (3) Testimony from witnesses employed outside of the adult 6 day services program, the corporation that owns the adult day 7 services program, or the department shall not be permitted. 8 4. An adult day services program that desires to further 9 contest an affirmed or modified regulatory insufficiency may do 10 so in the manner provided by chapter 17A for contested cases. 11 The program shall give notice of intent to formally contest 12 a regulatory insufficiency, in writing, to the department 13 within five days after receipt of the written decision of the 14 independent reviewer. The formal hearing shall be conducted 15 in accordance with chapter 17A and rules adopted by the 16 department. 17 5. 3. An adult day services program that has exhausted all 18 adequate administrative remedies and is aggrieved by the final 19 action of the department may petition for judicial review in 20 the manner provided by chapter 17A . 21 Sec. 18. Section 235E.2, subsection 6, paragraph d, Code 22 2015, is amended to read as follows: 23 d. In every case involving dependent adult abuse which is 24 substantiated by the department and which results in a judicial 25 proceeding on behalf of the dependent adult, legal counsel 26 shall be appointed by the court to represent the dependent 27 adult in the proceedings. The court may also appoint a 28 guardian ad litem to represent the dependent adult if necessary 29 to protect the dependent adult’s best interests. The same 30 attorney may shall not be appointed to serve both as legal 31 counsel and as guardian ad litem. Before legal counsel or a 32 guardian ad litem is appointed pursuant to this paragraph, the 33 court shall require the dependent adult and any person legally 34 responsible for the support of the dependent adult to complete 35 -12- LSB 1329XD (13) 86 rh/nh 12/ 15

S.F. _____ H.F. _____ under oath a detailed financial statement. If, on the basis of 1 that financial statement, the court deems that the dependent 2 adult or the legally responsible person is able to bear all 3 or a portion of the cost of the legal counsel or guardian ad 4 litem, the court shall so order. In cases where the dependent 5 adult or the legally responsible person is unable to bear the 6 cost of the legal counsel or guardian ad litem, the expense 7 shall be paid by the county. 8 EXPLANATION 9 The inclusion of this explanation does not constitute agreement with 10 the explanation’s substance by the members of the general assembly. 11 This bill relates to the regulation of health care 12 facilities, elder group homes, assisted living programs, and 13 adult day services programs by the department of inspections 14 and appeals. 15 LICENSE AND CERTIFICATE HOLDER APPLICATIONS. The bill 16 provides that applications for a license or certificate for a 17 new or newly acquired health care facility, elder group home, 18 assisted living program, or adult day services program may be 19 denied to any applicant for continuing or repeated failure 20 to operate in compliance with applicable law and not just to 21 existing licensees or certificate holders. 22 DISCLOSURE OF FINDINGS. The bill provides that information 23 relating to a health care facility, an elder group home, an 24 assisted living program, or an adult day services program 25 obtained by the department which does not constitute 26 the department’s findings from an inspection, monitoring 27 evaluation, or complaint investigation of the facility, home, 28 or program shall not be made available to the facility, home, 29 or program except pursuant to formal administrative proceedings 30 involving the citation of a facility or the denial, suspension, 31 or revocation of a facility, home, or program license or 32 certificate. 33 HEALTH CARE FACILITY VIOLATIONS. The bill provides that 34 any state penalty, including a fine or citation, issued as a 35 -13- LSB 1329XD (13) 86 rh/nh 13/ 15

S.F. _____ H.F. _____ result of a state licensure and federal certification survey or 1 investigation shall be dismissed if the corresponding federal 2 deficiency is dismissed or removed. The bill specifies that 3 any state penalty, including a fine or citation, shall be 4 retained or reinstated if a federal deficiency is retained or 5 reinstated. 6 CONTESTING REGULATORY INSUFFICIENCIES. The bill provides 7 that if a health care facility, elder group home, assisted 8 living program, or adult day services program desires to 9 contest a regulatory insufficiency, the health care facility, 10 elder group home, assisted living program, or adult day 11 services program may either request an informal conference with 12 an independent reviewer or request a contested case hearing in 13 the manner provided by Code chapter 17A for contested cases. 14 Upon the conclusion of an informal conference, if the facility, 15 home, or program desires to further contest an affirmed or 16 modified regulatory insufficiency, it may do so in the manner 17 provided in Code chapter 17A. The bill provides that if the 18 facility, home, or program does not desire to further contest 19 an affirmed or modified citation after an informal conference, 20 the facility, home, or program shall remit the appropriate 21 penalties or correct the violation within five working days 22 after receipt of the written explanation of the independent 23 reviewer. A facility, home, or program that has exhausted all 24 adequate administrative remedies may petition for judicial 25 review pursuant to Code chapter 17A. 26 INFORMAL CONFERENCES. The bill specifies informal 27 conference guidelines for health care facilities, elder 28 group homes, assisted living programs, and adult day services 29 programs contesting regulatory insufficiencies. Legal counsel 30 is not allowed; the facility, home, or program shall not have 31 access to department documents other than the department’s 32 final findings issued to the facility, home, or program; and 33 testimony from certain witnesses is not allowed. 34 DEPENDENT ADULT ABUSE IN FACILITIES AND PROGRAMS. The bill 35 -14- LSB 1329XD (13) 86 rh/nh 14/ 15

S.F. _____ H.F. _____ specifies that an attorney cannot be both legal counsel and a 1 guardian ad litem representing a dependent adult in a dependent 2 adult abuse case. 3 The bill amends a Code reference relating to dependent 4 adult abuse that occurs in elder group homes and adult day 5 services programs to refer to the definition of dependent adult 6 abuse that occurs in facilities and programs rather than the 7 definition of elder abuse that occurs outside facilities and 8 programs. 9 -15- LSB 1329XD (13) 86 rh/nh 15/ 15