Senate File 506 H-8217 Amend the amendment, H-8210, to Senate File 506, as amended, 1 passed, and reprinted by the Senate, as follows: 2 1. Page 7, after line 1 by inserting: 3 < DIVISION ___ 4 NURSING FACILITY TRAINING AND CITATION REVIEWS 5 Sec. ___. NEW SECTION . 135C.35C Nursing facilities —— joint 6 training sessions. 7 The department shall semiannually provide joint training 8 sessions for inspectors and nursing facilities to review at 9 least three of the ten most frequently issued federal citations 10 in the state during the immediately preceding calendar year. 11 The department shall develop a protocol to identify regional 12 citation patterns relating to complaints, standards, and 13 outcomes in the nursing facility inspection process. The 14 department shall include the state long-term care ombudsman, 15 or the state long-term care ombudsman’s designee, and 16 representatives of each nursing facility provider association 17 in the state in the planning process for the joint training 18 sessions. 19 Sec. ___. Section 135C.40, subsection 1, Code 2024, is 20 amended by adding the following new paragraph: 21 NEW PARAGRAPH . d. (1) The department shall establish and 22 maintain a process to review each citation issued for immediate 23 jeopardy or substandard quality of care prior to issuance of 24 final findings under section 135C.40A. Representatives of the 25 nursing facility issued such a citation may participate in 26 the review to provide context and evidence for the department 27 to consider in determining if a final finding of immediate 28 jeopardy or substandard quality of care should be issued. The 29 review shall ensure consistent and accurate application of 30 federal and state inspection protocols and defined regulatory 31 standards. 32 (2) For the purposes of this paragraph: 33 (a) “Immediate jeopardy” means a situation in which the 34 provider’s noncompliance with one or more requirements of 35 -1- H 8210.3752 (2) 90 pf/ko 1/ 8 #1.

participation has caused, or is likely to cause, serious 1 injury, harm, impairment, or death to a resident. 2 (b) “Likely” means probable and reasonably to be expected, 3 and suggests a greater degree of probability than a mere risk, 4 potential, or possibility that a particular event will cause 5 serious injury, harm, impairment, or death to a resident. 6 (c) “Substandard quality of care” means the same as defined 7 in 42 C.F.R. §488.301. 8 DIVISION ___ 9 HEALTH CARE EMPLOYMENT AGENCIES AND AGENCY WORKERS 10 Sec. ___. Section 135Q.1, Code 2024, is amended to read as 11 follows: 12 135Q.1 Definitions. 13 As used in this chapter , unless the context otherwise 14 requires: 15 1. “Department” means the department of inspections, 16 appeals, and licensing. 17 2. “Health care employment agency” or “agency” means an any 18 of the following: 19 a. An agency that contracts with a health care entity 20 in this state to provide agency workers for temporary or 21 temporary-to-hire employee placements. 22 b. A health care technology platform. 23 3. “Health care employment agency worker” or “agency worker” 24 means an individual who contracts with or is employed by a 25 health care employment agency to provide nursing services to 26 health care entity consumers. 27 4. “Health care entity” means a facility, agency, or program 28 licensed or certified by the department or by the centers for 29 Medicare and Medicaid services of the United States department 30 of health and human services. 31 5. “Health care technology platform” or “platform” includes 32 an individual, a trust, a partnership, a corporation, a limited 33 liability partnership or company, or any other business entity 34 that develops and operates, offers, or maintains a system or 35 -2- H 8210.3752 (2) 90 pf/ko 2/ 8

technology that provides an internet-based or application-based 1 marketplace through which an individual as an independent 2 contractor, and in the individual’s sole discretion, chooses 3 when and how often to utilize the platform to bid on or select 4 open shifts posted by a health care entity to provide nursing 5 services to a health care entity. 6 5. 6. “Managing entity” means a business entity, 7 owner, ownership group, chief executive officer, program 8 administrator, director, or other decision maker whose 9 responsibilities include directing the management or policies 10 of a health care employment agency. “Managing entity” includes 11 an individual who, directly or indirectly, holds a beneficial 12 interest in a corporation, partnership, or other business 13 entity that constitutes a managing entity. 14 6. 7. “Nursing services” means those services which may be 15 provided only by or under the supervision of a nurse. “Nursing 16 services” includes services performed by a registered nurse, a 17 licensed practical nurse, a certified nurse aide, a certified 18 medication aide, a home health aide, a medication manager, or 19 by noncertified or nonlicensed staff providing personal care 20 as defined in section 231C.2 . “Nursing services” does not 21 include the practice of nursing by an advanced registered nurse 22 practitioner or an advanced practice registered nurse licensed 23 under chapter 152 or 152E . 24 Sec. ___. Section 135Q.2, Code 2024, is amended to read as 25 follows: 26 135Q.2 Health care employment agency requirements —— 27 registration —— liability —— penalties . 28 1. a. A health care employment agency operating in the 29 state shall register annually with the department. Each 30 separate location of a health care employment agency shall 31 register annually with and pay an annual registration fee of 32 five hundred dollars to the department. The department shall 33 issue each location a separate certification of registration 34 upon approval of registration and payment of the fee. The 35 -3- H 8210.3752 (2) 90 pf/ko 3/ 8

annual registration fees shall be retained by the department as 1 repayment receipts as defined in section 8.2 . 2 b. A health care employment agency that fails to register 3 with the department as required under this section is 4 prohibited from contracting with a health care entity in this 5 state. 6 2. A health care employment agency shall do all of the 7 following: 8 a. Ensure that agency workers comply with all applicable 9 requirements relating to the health requirements and 10 qualifications of personnel in health care entity settings. 11 b. Document that each agency worker meets the minimum 12 licensing, certification, training, and health requirements 13 and the continuing education standards for the agency worker’s 14 position in the health care entity setting. 15 c. Maintain records for each agency worker and report, 16 file, or otherwise provide any required documentation to 17 external parties or regulators which would otherwise be the 18 responsibility of the health care entity if the agency worker 19 was employed by the health care entity. 20 d. Maintain professional and general liability insurance 21 coverage with minimum per occurrence coverage of one million 22 dollars and aggregate coverage of three million dollars to 23 insure against loss, damage, or expense incident to a claim 24 arising out of the death or injury of any person as the result 25 of negligence or malpractice in the provision of services by 26 the agency or an agency worker. 27 3. a. A health care employment agency shall not do any of 28 the following: 29 (1) Restrict in any manner the employment opportunities 30 of an agency worker by including a non-compete clause in any 31 contract with an agency worker or health care entity. 32 (2) In any contract with an agency worker or health care 33 entity, require payment of liquidated damages, employment fees, 34 or other compensation if the agency worker is subsequently 35 -4- H 8210.3752 (2) 90 pf/ko 4/ 8

hired as a permanent employee of the health care entity. 1 b. This subsection shall not apply to a contract between 2 a health care employment agency and an agency worker or a 3 health care entity if the contract meets all of the following 4 criteria: 5 (1) The contract is entered into for the purpose of placing 6 an agency worker the health care employment agency assisted in 7 obtaining authorization to work in the United States. 8 (2) The contract contains an initial duration term of 9 not less than twenty-four months and a total duration term, 10 including any renewals or extensions, of not more than 11 thirty-six months. 12 (3) The contract requires the agency worker to work for 13 a single health care entity for the entire duration of the 14 contract. 15 c. Any contract that violates this subsection shall be 16 unenforceable in court. 17 4. A health care employment agency shall submit a report to 18 the department on a quarterly basis for each health care entity 19 participating in Medicare or Medicaid with whom the agency 20 contracts that includes all of the following by provider type: 21 a. A detailed list of the average amount charged to the 22 health care entity for each individual agency worker category. 23 b. A detailed list of the average amount paid by the agency 24 to agency workers in each individual agency worker category. 25 5. a. A health care employment agency that violates 26 subsection 1 or subsection 2 is subject to denial or revocation 27 of registration for a period of one year and a monetary penalty 28 of five hundred dollars for a first offense and five thousand 29 dollars for each offense thereafter. 30 b. A health care employment agency that violates subsection 31 3 or that knowingly provides an agency worker who has an 32 illegally or fraudulently obtained or issued diploma, 33 registration, license, certification, or background check to 34 a health care entity is subject to immediate revocation of 35 -5- H 8210.3752 (2) 90 pf/ko 5/ 8

registration. The department shall notify the agency thirty 1 days in advance of the date of such revocation. 2 c. (1) The managing entity of an agency for which 3 registration has been denied or revoked under this subsection 4 shall not be eligible to apply for or be granted registration 5 for another agency during the two-year period following the 6 date of the denial or revocation. 7 (2) The department shall not approve a new registration 8 or renew an existing registration for any agency for which 9 the managing entity is also the managing entity of an agency 10 for which registration has been denied or revoked during the 11 two-year period in which registration of the violating agency 12 is denied or revoked. 13 6. 5. The department shall establish a system for members 14 of the public to report complaints against an agency or 15 agency worker. The department shall investigate any complaint 16 received and shall report the department’s findings to the 17 complaining party and the agency involved. 18 Sec. ___. NEW SECTION . 135Q.3 Penalties —— enforcement. 19 1. a. A health care employment agency that violates 20 section 135Q.2, subsection 1 or 4, is subject to an initial 21 monetary penalty of five thousand dollars and shall be provided 22 notification and given a thirty-day grace period in which to 23 comply. 24 b. A health care employment agency that fails to comply 25 following the notification and within the thirty-day grace 26 period under paragraph “a” shall be subject to a monetary penalty 27 of twenty-five thousand dollars. 28 c. If a health care employment agency fails to comply 29 with paragraph “b” , the health care employment agency shall 30 be subject to an additional monetary penalty of twenty-five 31 thousand dollars, revocation of registration, and denial of 32 subsequent registration for up to three years. 33 2. a. A health care employment agency that violates section 34 135Q.2, subsection 2, or that knowingly provides an agency 35 -6- H 8210.3752 (2) 90 pf/ko 6/ 8

worker who has an illegally or fraudulently obtained or issued 1 diploma, registration, license, certification, or background 2 check to a health care entity is subject to a monetary penalty 3 of five thousand dollars for each violation. 4 b. If a health care employment agency commits a second or 5 subsequent violation of section 135Q.2, subsection 2, within 6 any three-year period, the health care employment agency shall 7 be subject to immediate revocation of registration. The 8 department shall notify the agency thirty days in advance of 9 the date of such revocation. 10 3. A health care employment agency that violates section 11 135Q.2, subsection 3, is subject to a monetary penalty of 12 twenty-five thousand dollars for the first violation. If 13 a health care employment agency violates section 135Q.2, 14 subsection 3, a second or subsequent time, the health care 15 employment agency shall be subject to immediate revocation of 16 registration, and shall not be eligible to apply for or be 17 granted registration for the three-year period immediately 18 following the date of revocation. 19 4. a. The managing entity of an agency for which 20 registration has been denied or revoked under this section 21 shall not be eligible to apply for or be granted registration 22 for another agency during the three-year period following the 23 date of the denial or revocation. 24 b. The department shall not approve a new registration 25 or renew an existing registration for any agency for which 26 the managing entity is also the managing entity of an agency 27 for which registration has been denied or revoked during the 28 three-year period in which registration of the violating agency 29 is denied or revoked. 30 5. Any monetary penalties collected under this section 31 shall be retained by the department as repayment receipts as 32 defined in section 8.2. 33 6. The attorney general shall enforce the provisions of this 34 chapter. 35 -7- H 8210.3752 (2) 90 pf/ko 7/ 8

Sec. ___. NEW SECTION . 135Q.4 Department annual report. 1 The department shall submit an annual report to the general 2 assembly by January 15, for the immediately preceding fiscal 3 year, that includes a summary of the number of registrations 4 issued and the amount of registration fees collected, the 5 violations of this chapter, the amount of monetary penalties 6 collected, the number of health care employment agencies and 7 managing entities for whom a registration was revoked or 8 denied, and any recommendations for changes to the chapter. 9 Sec. ___. EFFECTIVE DATE. This division of this Act, being 10 deemed of immediate importance, takes effect upon enactment. > 11 2. Page 7, by striking lines 2 through 4 and inserting: 12 < ___. Title page, line 2, after < process, > by inserting 13 < training and citation reviews, and health care employment 14 agencies and agency workers, providing civil and criminal 15 liability limitations under certain circumstances, providing 16 penalties, >> 17 3. By renumbering as necessary. 18 ______________________________ FRY of Clarke -8- H 8210.3752 (2) 90 pf/ko 8/ 8 #2. #3.