H-8217

   Amend  the amendment, H-8210, to Senate File 506, as amended, passed, and reprinted by the Senate, as follows:
   1.  Page 7, after line 1 by inserting: 
<DIVISION ___
NURSING FACILITY TRAINING AND CITATION REVIEWS

   Sec. ___.  NEW SECTION.  135C.35C  Nursing facilities —— joint training sessions.
   The department shall semiannually provide joint training sessions for inspectors and nursing facilities to review at least three of the ten most frequently issued federal citations in the state during the immediately preceding calendar year. The department shall develop a protocol to identify regional citation patterns relating to complaints, standards, and outcomes in the nursing facility inspection process. The department shall include the state long-term care ombudsman, or the state long-term care ombudsman’s designee, and representatives of each nursing facility provider association in the state in the planning process for the joint training sessions.
   Sec. ___.  Section 135C.40, subsection 1, Code 2024, is amended by adding the following new paragraph:
   NEW PARAGRAPH.  d.  (1)  The department shall establish and maintain a process to review each citation issued for immediate jeopardy or substandard quality of care prior to issuance of final findings under section 135C.40A. Representatives of the nursing facility issued such a citation may participate in the review to provide context and evidence for the department to consider in determining if a final finding of immediate jeopardy or substandard quality of care should be issued. The review shall ensure consistent and accurate application of federal and state inspection protocols and defined regulatory standards.
   (2)  For the purposes of this paragraph:
   (a)  “Immediate jeopardy” means a situation in which the provider’s noncompliance with one or more requirements of participation has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident.
   (b)  “Likely” means probable and reasonably to be expected, and suggests a greater degree of probability than a mere risk, potential, or possibility that a particular event will cause serious injury, harm, impairment, or death to a resident.
   (c)  “Substandard quality of care” means the same as defined in 42 C.F.R. §488.301.
DIVISION ___
HEALTH CARE EMPLOYMENT AGENCIES AND AGENCY WORKERS

   Sec. ___.  Section 135Q.1, Code 2024, is amended to read as follows:
   135Q.1  Definitions.
   As used in this chapter, unless the context otherwise requires:
   1.  “Department” means the department of inspections, appeals, and licensing.
   2.  “Health care employment agency” or “agency” means an any of the following:
   a.  An agency that contracts with a health care entity in this state to provide agency workers for temporary or temporary-to-hire employee placements.
   b.  A health care technology platform.
   3.  “Health care employment agency worker” or “agency worker” means an individual who contracts with or is employed by a health care employment agency to provide nursing services to health care entity consumers.
   4.  “Health care entity” means a facility, agency, or program licensed or certified by the department or by the centers for Medicare and Medicaid services of the United States department of health and human services. 
   5.  “Health care technology platform” or “platform” includes an individual, a trust, a partnership, a corporation, a limited liability partnership or company, or any other business entity that develops and operates, offers, or maintains a system or technology that provides an internet-based or application-based marketplace through which an individual as an independent contractor, and in the individual’s sole discretion, chooses when and how often to utilize the platform to bid on or select open shifts posted by a health care entity to provide nursing services to a health care entity.
   5.  6.  “Managing entity” means a business entity, owner, ownership group, chief executive officer, program administrator, director, or other decision maker whose responsibilities include directing the management or policies of a health care employment agency. “Managing entity” includes an individual who, directly or indirectly, holds a beneficial interest in a corporation, partnership, or other business entity that constitutes a managing entity.
   6.  7.  “Nursing services” means those services which may be provided only by or under the supervision of a nurse. “Nursing services” includes services performed by a registered nurse, a licensed practical nurse, a certified nurse aide, a certified medication aide, a home health aide, a medication manager, or by noncertified or nonlicensed staff providing personal care as defined in section 231C.2.  “Nursing services” does not include the practice of nursing by an advanced registered nurse practitioner or an advanced practice registered nurse licensed under chapter 152 or 152E.
   Sec. ___.  Section 135Q.2, Code 2024, is amended to read as follows:
   135Q.2  Health care employment agency requirements —— registration —— liability —— penalties.
   1.  a.  A health care employment agency operating in the state shall register annually with the department. Each separate location of a health care employment agency shall register annually with and pay an annual registration fee of five hundred dollars to the department. The department shall issue each location a separate certification of registration upon approval of registration and payment of the fee. The annual registration fees shall be retained by the department as repayment receipts as defined in section 8.2.
   b.  A health care employment agency that fails to register with the department as required under this section is prohibited from contracting with a health care entity in this state.
   2.  A health care employment agency shall do all of the following:
   a.  Ensure that agency workers comply with all applicable requirements relating to the health requirements and qualifications of personnel in health care entity settings.
   b.  Document that each agency worker meets the minimum licensing, certification, training, and health requirements and the continuing education standards for the agency worker’s position in the health care entity setting.
   c.  Maintain records for each agency worker and report, file, or otherwise provide any required documentation to external parties or regulators which would otherwise be the responsibility of the health care entity if the agency worker was employed by the health care entity.
   d.  Maintain professional and general liability insurance coverage with minimum per occurrence coverage of one million dollars and aggregate coverage of three million dollars to insure against loss, damage, or expense incident to a claim arising out of the death or injury of any person as the result of negligence or malpractice in the provision of services by the agency or an agency worker.
   3.  a.  A health care employment agency shall not do any of the following:
   (1)  Restrict in any manner the employment opportunities of an agency worker by including a non-compete clause in any contract with an agency worker or health care entity.
   (2)  In any contract with an agency worker or health care entity, require payment of liquidated damages, employment fees, or other compensation if the agency worker is subsequently hired as a permanent employee of the health care entity.
   b.  This subsection shall not apply to a contract between a health care employment agency and an agency worker or a health care entity if the contract meets all of the following criteria:
   (1)  The contract is entered into for the purpose of placing an agency worker the health care employment agency assisted in obtaining authorization to work in the United States.
   (2)  The contract contains an initial duration term of not less than twenty-four months and a total duration term, including any renewals or extensions, of not more than thirty-six months.
   (3)  The contract requires the agency worker to work for a single health care entity for the entire duration of the contract.
   c.  Any contract that violates this subsection shall be unenforceable in court.
   4.  A health care employment agency shall submit a report to the department on a quarterly basis for each health care entity participating in Medicare or Medicaid with whom the agency contracts that includes all of the following by provider type:
   a.  A detailed list of the average amount charged to the health care entity for each individual agency worker category.
   b.  A detailed list of the average amount paid by the agency to agency workers in each individual agency worker category.
   5.  a.  A health care employment agency that violates subsection 1 or subsection 2 is subject to denial or revocation of registration for a period of one year and a monetary penalty of five hundred dollars for a first offense and five thousand dollars for each offense thereafter.
   b.  A health care employment agency that violates subsection 3 or that knowingly provides an agency worker who has an illegally or fraudulently obtained or issued diploma, registration, license, certification, or background check to a health care entity is subject to immediate revocation of registration. The department shall notify the agency thirty days in advance of the date of such revocation.
   c.  (1)  The managing entity of an agency for which registration has been denied or revoked under this subsection shall not be eligible to apply for or be granted registration for another agency during the two-year period following the date of the denial or revocation.
   (2)  The department shall not approve a new registration or renew an existing registration for any agency for which the managing entity is also the managing entity of an agency for which registration has been denied or revoked during the two-year period in which registration of the violating agency is denied or revoked.
   6.  5.  The department shall establish a system for members of the public to report complaints against an agency or agency worker. The department shall investigate any complaint received and shall report the department’s findings to the complaining party and the agency involved.
   Sec. ___.  NEW SECTION.  135Q.3  Penalties —— enforcement.
   1.  a.  A health care employment agency that violates section 135Q.2, subsection 1 or 4, is subject to an initial monetary penalty of five thousand dollars and shall be provided notification and given a thirty-day grace period in which to comply.
   b.  A health care employment agency that fails to comply following the notification and within the thirty-day grace period under paragraph “a”shall be subject to a monetary penalty of twenty-five thousand dollars. 
   c.  If a health care employment agency fails to comply with paragraph “b”, the health care employment agency shall be subject to an additional monetary penalty of twenty-five thousand dollars, revocation of registration, and denial of subsequent registration for up to three years.
   2.  a.  A health care employment agency that violates section 135Q.2, subsection 2, or that knowingly provides an agency worker who has an illegally or fraudulently obtained or issued diploma, registration, license, certification, or background check to a health care entity is subject to a monetary penalty of five thousand dollars for each violation.
   b.  If a health care employment agency commits a second or subsequent violation of section 135Q.2, subsection 2, within any three-year period, the health care employment agency shall be subject to immediate revocation of registration. The department shall notify the agency thirty days in advance of the date of such revocation.
   3.  A health care employment agency that violates section 135Q.2, subsection 3, is subject to a monetary penalty of twenty-five thousand dollars for the first violation. If a health care employment agency violates section 135Q.2, subsection 3, a second or subsequent time, the health care employment agency shall be subject to immediate revocation of registration, and shall not be eligible to apply for or be granted registration for the three-year period immediately following the date of revocation. 
   4.  a.  The managing entity of an agency for which registration has been denied or revoked under this section shall not be eligible to apply for or be granted registration for another agency during the three-year period following the date of the denial or revocation.
   b.  The department shall not approve a new registration or renew an existing registration for any agency for which the managing entity is also the managing entity of an agency for which registration has been denied or revoked during the three-year period in which registration of the violating agency is denied or revoked.
   5.  Any monetary penalties collected under this section shall be retained by the department as repayment receipts as defined in section 8.2. 
   6.  The attorney general shall enforce the provisions of this chapter.
   Sec. ___.  NEW SECTION.  135Q.4  Department annual report.
   The department shall submit an annual report to the general assembly by January 15, for the immediately preceding fiscal year, that includes a summary of the number of registrations issued and the amount of registration fees collected, the violations of this chapter, the amount of monetary penalties collected, the number of health care employment agencies and managing entities for whom a registration was revoked or denied, and any recommendations for changes to the chapter. 
   Sec. ___.  EFFECTIVE DATE.  This division of this Act, being deemed of immediate importance, takes effect upon enactment.>
   2.  Page 7, by striking lines 2 through 4 and inserting: 
   <___.  Title page, line 2, after <process,> by inserting <training and citation reviews, and health care employment agencies and agency workers, providing civil and criminal liability limitations under certain circumstances, providing penalties,>>
   3.  By renumbering as necessary.

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FRY of Clarke