House File 309 S-3081 Amend House File 309, as passed by the House, as follows: 1 1. Page 1, before line 1 by inserting: 2 < Section 1. Section 135C.16, subsection 1, Code 2025, is 3 amended to read as follows: 4 1. In addition to the inspections required by sections 5 135C.9 and 135C.38 , the department shall make or cause to be 6 made such further unannounced inspections as it deems necessary 7 to adequately enforce this chapter . At On average, at least 8 one general unannounced inspection shall be conducted for each 9 health care facility within a thirty-month twelve-month period , 10 not to exceed a period of fifteen months . The inspector shall 11 show identification to the person in charge of the facility 12 and state that an inspection is to be made before beginning 13 the inspection. An employee of the department who gives 14 unauthorized advance notice of an inspection made or planned 15 to be made under this subsection or section 135C.38 shall be 16 disciplined as determined by the director, except that if the 17 employee is employed pursuant to the merit system provisions of 18 chapter 8A, subchapter IV , the discipline shall not exceed the 19 discipline authorized pursuant to that subchapter. 20 Sec. ___. Section 135C.36, subsection 1, Code 2025, is 21 amended to read as follows: 22 1. A class I violation is one which presents an imminent 23 danger or a substantial probability of resultant death or 24 physical harm to the residents of the facility in which 25 the violation occurs. A physical condition or one or more 26 practices in a facility may constitute a class I violation. A 27 class I violation shall be abated or eliminated immediately 28 unless the department determines that a stated period of time, 29 specified in the citation issued under section 135C.40 , is 30 required to correct the violation. A licensee is subject to 31 a penalty of not less than two five thousand nor more than 32 ten thousand dollars for each class I violation for which the 33 licensee’s facility is cited. 34 Sec. ___. Section 135C.36, Code 2025, is amended by adding 35 -1- HF 309.1429 (2) 91 dg/ko 1/ 4 #1.

the following new subsection: 1 NEW SUBSECTION . 1A. A class I violation includes any 2 confirmed instance of a facility retaliating against a resident 3 or employee for filing a complaint or otherwise cooperating 4 with the department or the office of long-term care ombudsman. 5 Sec. ___. Section 135C.38, subsection 1, paragraph a, Code 6 2025, is amended to read as follows: 7 a. Upon receipt of a complaint made in accordance with 8 section 135C.37 , the department shall make a preliminary review 9 of the complaint. Unless the department concludes that the 10 complaint is intended to harass a facility or a licensee or is 11 without reasonable basis, the department shall make or cause 12 to be made an on-site inspection of the health care facility 13 which is the subject of the complaint within the time period 14 determined pursuant to the following guidelines, which period 15 shall commence on the date of receipt of the complaint: 16 (1) For nursing facilities, an on-site inspection shall be 17 initiated as follows: 18 (a) Within two one working days day for a complaint 19 determined by the department to be an alleged immediate 20 jeopardy situation. 21 (b) Within ten five working days for a complaint determined 22 by the department to be an alleged high-level, nonimmediate 23 jeopardy situation. 24 (c) Within forty-five calendar days for a complaint 25 determined by the department to be an alleged nonimmediate 26 jeopardy situation, other than a high-level situation. 27 (2) For all other types of health care facilities, an 28 on-site inspection shall be initiated as follows: 29 (a) Within two one working days day for a complaint 30 determined by the department to be an alleged immediate 31 jeopardy situation. 32 (b) Within twenty five working days for a complaint 33 determined by the department to be an alleged high-level, 34 nonimmediate jeopardy situation. 35 -2- HF 309.1429 (2) 91 dg/ko 2/ 4

(c) Within forty-five calendar days for a complaint 1 determined by the department to be an alleged nonimmediate 2 jeopardy situation, other than a high-level situation. > 3 2. Page 1, after line 14 by inserting: 4 < Sec. ___. Section 135C.44, Code 2025, is amended to read 5 as follows: 6 135C.44 Treble Additional fines for repeated violations. 7 The penalties authorized by section 135C.36 shall be trebled 8 quadrupled for a second or subsequent class I or violation and 9 tripled for a second or subsequent class II violation occurring 10 within any twelve-month period if a citation was issued for the 11 same class I or class II violation occurring within that period 12 and a penalty was assessed therefor for the violation . 13 Sec. ___. DEPARTMENT OF INSPECTIONS, APPEALS, AND LICENSING 14 —— NURSING FACILITY INSPECTORS AND ASSISTED LIVING PROGRAM 15 MONITORS. 16 1. There is appropriated from the general fund of the state 17 to the department of inspections, appeals, and licensing for 18 the fiscal year beginning July 1, 2025, and ending June 30, 19 2026, the following amount, or so much thereof as is necessary, 20 to be used for the purposes designated: 21 To employ additional nursing facility inspectors and 22 assisted living program monitors to perform additional 23 safety inspections, including salaries, support, maintenance, 24 miscellaneous purposes, and for not more than the following 25 full-time equivalent positions: 26 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 600,000 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 30 28 2. Moneys appropriated in this section of this Act shall be 29 in addition to moneys received from federal matching funds. > 30 3. Title page, by striking lines 1 through 3 and inserting 31 < An Act relating to health care facilities, providing 32 penalties, and making an appropriation. > 33 4. By renumbering as necessary. 34 -3- HF 309.1429 (2) 91 dg/ko 3/ 4 #2. #3.