231D.17  Written contractual agreement required.
  1.  An adult day services program shall not operate in this state unless a written contractual agreement is executed between the adult day services program and each participant or the participant’s legal representative prior to the participant’s admission to the program, and unless the adult day services program operates in accordance with the terms of the written contractual agreement. The adult day services program shall deliver to the participant or the participant’s legal representative a complete copy of the written contractual agreement and all supporting documents and attachments, prior to the participant’s admission to the program, and shall also deliver a written copy of changes to the written contractual agreement, if any changes to the copy originally delivered are subsequently made, at least thirty days prior to any changes, unless otherwise provided in this section.
  2.  An adult day services program written contractual agreement shall clearly describe the rights and responsibilities of the participant and the program. The written contractual agreement shall also include but is not limited to inclusion of all of the following information in the body of the agreement or in the supporting documents and attachments:
  a.  A description of all fees, charges, and rates describing admission and basic services covered, and any additional and optional services and their related costs.
  b.  A statement regarding the impact of the fee structure on third-party payments, and whether third-party payments and resources are accepted by the adult day services program.
  c.  The procedure followed for nonpayment of fees.
  d.  Identification of the party responsible for payment of fees and identification of the participant’s legal representative, if any.
  e.  The term of the written contractual agreement.
  f.  A statement that the adult day services program shall notify the participant or the participant’s legal representative, as applicable, in writing at least thirty days prior to any change being made in the written contractual agreement, with the following exceptions:
  (1)  When the participant’s health status or behavior constitutes a substantial threat to the health or safety of the participant, other participants, or others, including when the participant refuses to consent to discharge.
  (2)  When an emergency or a significant change in the participant’s condition results in the need for the provision of services that exceed the type or level of services included in the written contractual agreement and the necessary services cannot be safely provided by the adult day services program.
  g.  A statement that all participant information shall be maintained in a confidential manner to the extent required under state and federal law.
  h.  Discharge, involuntary transfer, and transfer criteria and procedures, which ensure a safe and orderly transfer.
  i.  The internal appeals process provided relative to an involuntary transfer.
  j.  The program’s policies and procedures for addressing grievances between the adult day services program and the participants, including grievances relating to transfer and occupancy.
  k.  A statement of the prohibition against retaliation as prescribed in section 231D.12.
  l.  The emergency response policy.
  m.  The staffing policy which specifies staff is available during all times of program operation, if nurse delegation will be used, and how staffing will be adapted to meet changing participant needs.
  n.  In dementia-specific adult day services programs, a description of the services and programming provided to meet the life skills and social activities of participants.
  o.  The refund policy.
  p.  A statement regarding billing and payment procedures.
  3.  Written contractual agreements and related documents executed by each participant or participant’s legal representative shall be maintained by the adult day services program in program files from the date of execution until three years from the date the written contractual agreement is terminated. A copy of the most current written contractual agreement shall be provided to members of the general public, upon request. Written contractual agreements and related documents shall be made available for on-site inspection to the department upon request and at reasonable times.
2005 Acts, ch 61, §15, 17; 2007 Acts, ch 215, §203