Section 1. Section 100.1, subsection 6, Code 2003, is amended to read as follows:

6. To adopt rules designating a fee to be assessed to each

building, structure, or facility for which a fire safety

inspection or plan review by the state fire marshal is

required as a condition of licensureby law. The fee

designated by rule shall be set in an amount that is

reasonably related to the costs of conducting the applicable

inspection or plan review. The fees collected by the state

fire marshal shall be deposited in the general fund of the

state.

Sec. 2. Section 135C.33, subsection 5, paragraph e, Code 2003, is amended to read as follows:

e. An employee of an assisted living facilityprogram

certified or voluntarily accredited under chapter 231C, if the

employee provides direct services to consumers.

Sec. 3. Section 231B.1, subsection 4, Code 2003, is amended to read as follows:

4. "Elder group home" means a single-family residence that

is a residence ofoperated by a person who is providing room,

board, and personal care to three through five elders who are

not related to the person providing the service within the

third degree of consanguinity or affinity.

Sec. 4. Section 231B.2, subsection 2, paragraph c, Code 2003, is amended to read as follows:

c. An elder group home shall be owner-occupied, or owned

by a nonprofit corporation and occupied by a resident manager

staffed by an on-site manager twenty-four hours per day, seven

days per week. A resident manager shall reside in and provide

services for no more than one elder group home.

Sec. 5. Section 231B.2, subsections 3 and 5, Code 2003, are amended to read as follows:

3. An elder group home established pursuant to this

chapter shall be certified by the department of inspections

and appeals.

5. Inspections and certification services shall be

provided by the department of inspections and appeals.

However, beginning July 1, 1994, the department may enter into

contracts with the area agencies on aging to provide these

services.

Sec. 6. Section 231B.3, subsection 2, Code 2003, is amended to read as follows:

2. A person who has knowledge that an elder group home is

operating without certification shall report the name and

address of the home to the department of inspections and

appeals. The department of inspections and appeals shall

investigate a report made pursuant to this section.

Sec. 7. Section 231C.1, Code 2003, is amended to read as follows:

231C.1 FINDINGS,AND PURPOSE, AND INTENT.

1. The general assembly finds that assisted living is an

important part of the long-term care system in this state.

Assisted living emphasizes the independence and dignity of the

individual while providing services in a cost-effective

manner.

2. The purposes of establishing an assisted living program

include all of the following:

a. To encourage the establishment and maintenance of a

safe and homelike environment for individuals of all income

levels who require assistance to live independently but who do

not require health-related care on a continuous twenty-four

hour per day basis.

b. To establish standards for assisted living programs

that allow flexibility in design which promotes a social model

of service delivery by focusing on individual independence,

individual needs and desires, and consumer-driven quality of

service.

c. To encourage general public participation in the

development of assisted living programs for individuals of all

income levels.

3. It is the intent of the general assembly that the

department of elder affairs establish policy for assisted

living programs and that the department of inspections and

appeals enforce this chapter.

Sec. 8. Section 231C.2, subsections 1 and 6, Code 2003, are amended to read as follows:

1. "Assisted living" means provision of housing with

services which may include but are not limited to health-

related care, personal care, and assistance with instrumental

activities of daily living to sixthree or more tenants in a

physical structure which provides a homelike environment.

"Assisted living" also includes encouragement of family

involvement, tenant self-direction, and tenant participation

in decisions that emphasize choice, dignity, privacy,

individuality, shared risk, and independence. "Assisted

living" includes the provision of housing and assistance with

instrumental activities of daily living only if personal care

or health-related care is also included.

6. "Tenant" means an individual who receives assisted

living services through a certified or accredited assisted

living program.

Sec. 9. Section 231C.2, Code 2003, is amended by adding the following new subsections:

NEW SUBSECTION 2A. "Governmental unit" means the state,

or any county, municipality, or other political subdivision or

any department, division, board, or other agency of any of

these entities.

NEW SUBSECTION 4A. "Legal representative" means a person

appointed by the court to act on behalf of the tenant, or a

person acting pursuant to a power of attorney.

NEW SUBSECTION 4B. "Occupancy agreement" means a written

agreement entered into between an assisted living program and

a tenant that clearly describes the rights and

responsibilities of the assisted living program and a tenant,

and other information required by rule. "Occupancy agreement"

may include a separate signed lease and signed service

agreement.

NEW SUBSECTION 5A. "Recognized accrediting entity" means

a nationally recognized accrediting entity that the department

recognizes as having specific assisted living program

standards equivalent to the standards established by the

department for assisted living programs.

NEW SUBSECTION 6A. "Tenant advocate" means the office of

long-term care resident's advocate established in section

231.42.

NEW SUBSECTION 7. "Tenant's representative" means a

tenant's legal representative or any representative authorized

by the tenant to act on behalf of the tenant.

Sec. 10. Section 231C.3, Code 2003, is amended by striking the section and inserting in lieu thereof the following:

1. The department shall establish by rule in accordance

with chapter 17A, a program for certification and monitoring

of assisted living programs. The department may adopt by

reference with or without amendment, nationally recognized

standards and rules for assisted living programs. The rules

shall include specification of recognized accrediting entities

and provisions related to dementia-specific programs. The

standards and rules shall be formulated in consultation with

the department of inspections and appeals, and affected

industry, professional, and consumer groups and shall be

designed to accomplish the purposes of this chapter and shall

include but are not limited to rules relating to all of the

following:

a. Provisions to ensure, to the greatest extent possible,

the health, safety, and well-being and appropriate treatment

of tenants.

b. Requirements that assisted living programs furnish the

department of elder affairs and the department of inspections

and appeals with specified information necessary to administer

this chapter.

c. Standards for tenant evaluation or assessment, which

may vary in accordance with the nature of the services

provided or the status of the tenant.

d. Provisions for granting short-term waivers for tenants

who exceed occupancy criteria.

2. In addition to the adoption of standards and rules for

assisted living programs, the department in consultation with

the department of inspections and appeals and affected

industry, professional, and consumer groups, shall issue

interpretive guidelines, including the expectations of program

certification monitors, to provide direction to assisted

living programs in complying with certification requirements.

3. Each assisted living program operating in this state

shall be certified by the department of inspections and

appeals. If an assisted living program is voluntarily

accredited by a recognized accrediting entity, the department

of inspections and appeals shall certify the assisted living

program on the basis of the voluntary accreditation. An

assisted living program that is certified by the department of

inspections and appeals on the basis of voluntary

accreditation shall not be subject to payment of the

certification fee prescribed in section 231C.18, but shall be

subject to an administrative fee as prescribed by rule. An

assisted living program certified under this section is exempt

from the requirements of section 135.63 relating to

certificate of need requirements.

4. The owner or manager of a certified assisted living

program shall comply with the rules adopted by the department

for an assisted living program. A person including a

governmental unit shall not represent an assisted living

program to the public as an assisted living program or as a

certified assisted living program unless and until the program

is certified pursuant to this chapter.

5.

a. Services provided by a certified assisted living

program may be provided directly by staff of the assisted

living program, by individuals contracting with the assisted

living program to provide services, or by individuals employed

by the tenant or with whom the tenant contracts if the tenant

agrees to assume the responsibility and risk of the employment

or the contractual relationship.

b. If a tenant is terminally ill and has elected to

receive hospice services under the federal Medicare program

from a Medicare-certified hospice program, the assisted living

program and the Medicare-certified hospice program shall enter

into a written agreement under which the hospice program

retains professional management responsibility for those

services.

6. The department of inspections and appeals may enter

into contracts to provide certification and monitoring of

assisted living programs. The department of inspections and

appeals shall:

a. Have full access at reasonable times to all records,

materials, and common areas pertaining to the provision of

services and care to the tenants of a program during

certification, monitoring, and complaint investigations of

programs seeking certification, currently certified, or

alleged to be uncertified.

b. With the consent of the tenant, visit the tenant's

unit.

c. Require that the recognized accrediting entity

providing accreditation for a program provide copies to the

department of all materials related to the accreditation,

monitoring, and complaint process.

7. The department may also establish by rule in accordance

with chapter 17A a special classification for affordable

assisted living programs. The rules shall be formulated in

consultation with the department of inspections and appeals

and affected industry, professional, and consumer groups.

8. A department, agency, or officer of this state or of

any governmental unit shall not pay or approve for payment

from public funds any amount to an assisted living program for

an actual or prospective tenant, unless the program holds a

current certificate issued by the department of inspections

and appeals and meets all current requirements for

certification.

9. The department shall adopt rules regarding the

conducting or operating of another business or activity in the

distinct part of the physical structure in which the assisted

living program is provided, if the business or activity serves

nontenants. The rules shall be developed in consultation with

the department of inspections and appeals and affected

industry, professional, and consumer groups.

10. An assisted living program shall comply with section

135C.33.

Sec. 11. Section 231C.4, Code 2003, is amended to read as follows:

The state fire marshal shall adopt rules, in coordination

with the department of elder affairs and the department of

inspections and appeals, relating to the certification or

voluntary accreditation and monitoring of the fire and safety

standards of certified or voluntarily accredited assisted

living programs.

Sec. 12. Section 231C.5, Code 2003, is amended by striking the section and inserting in lieu thereof the following:

1. An assisted living program shall not operate in this

state unless a written occupancy agreement, as prescribed in

subsection 2, is executed between the assisted living program

and each tenant or tenant's representative, prior to the

tenant's occupancy, and unless the assisted living program

operates in accordance with the terms of the occupancy

agreement. The assisted living program shall deliver to the

tenant or tenant's representative a complete copy of the

occupancy agreement and all supporting documents and

attachments and shall deliver, at least thirty days prior to

any changes, a written copy of changes to the occupancy

agreement if any changes to the copy originally delivered are

subsequently made.

2. An assisted living program occupancy agreement shall

clearly describe the rights and responsibilities of the tenant

and the program. The occupancy 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 tenancy 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 assisted living program.

c. The procedure followed for nonpayment of fees.

d. Identification of the party responsible for payment of

fees and identification of the tenant's representative, if

any.

e. The term of the occupancy agreement.

f. A statement that the assisted living program shall

notify the tenant or the tenant's representative, as

applicable, in writing at least thirty days prior to any

change being made in the occupancy agreement with the

following exceptions:

(1) When the tenant's health status or behavior

constitutes a substantial threat to the health or safety of

the tenant, other tenants, or others, including when the

tenant refuses to consent to relocation.

(2) When an emergency or a significant change in the

tenant's condition results in the need for the provision of

services that exceed the type or level of services included in

the occupancy agreement and the necessary services cannot be

safely provided by the assisted living program.

g. A statement that all tenant information shall be

maintained in a confidential manner to the extent required

under state and federal law.

h. Occupancy, involuntary transfer, and transfer criteria

and procedures, which ensure a safe and orderly transfer. The

internal appeals process provided relative to an involuntary

transfer.

i. The program's policies and procedures for addressing

grievances between the assisted living program and the

tenants, including grievances relating to transfer and

occupancy.

j. A statement of the prohibition against retaliation as

prescribed in section 231C.13.

k. The emergency response policy.

l. The staffing policy which specifies if the staff is

available twenty-four hours per day, if nurse delegation will

be used, and how staffing will be adapted to meet changing

tenant needs.

m. In dementia-specific assisted living programs, a

description of the services and programming provided to meet

the life skills and social activities of tenants.

n. The refund policy.

o. A statement regarding billing and payment procedures.

3. Occupancy agreements and related documents executed by

each tenant or tenant's representative shall be maintained by

the assisted living program in program files from the date of

execution until three years from the date the occupancy

agreement is terminated. A copy of the most current occupancy

agreement shall be provided to members of the general public,

upon request. Occupancy agreements and related documents

shall be made available for on-site inspection to the

department of inspections and appeals upon request and at

reasonable times.

Sec. 13. Section 231C.6, Code 2003, is amended by striking the section and inserting in lieu thereof the following:

1. If an assisted living program initiates the involuntary

transfer of a tenant and the action is not a result of a

monitoring evaluation or complaint investigation by the

department of inspections and appeals, and if the tenant or

tenant's representative contests the transfer, the following

procedure shall apply:

a. The assisted living program shall notify the tenant or

tenant's representative, in accordance with the occupancy

agreement, of the need to transfer, the reason for the

transfer, and the contact information of the tenant advocate.

b. The assisted living program shall provide the tenant

advocate with a copy of the notification to the tenant.

c. The tenant advocate shall offer the notified tenant or

tenant's representative assistance with the program's internal

appeals process. The tenant is not required to accept the

assistance of the tenant advocate.

d. If, following the internal appeals process, the

assisted living program upholds the transfer decision, the

tenant may utilize other remedies authorized by law to contest

the transfer.

2. The department, in consultation with the department of

inspections and appeals and affected industry, professional,

and consumer groups, shall establish, by rule in accordance

with chapter 17A, procedures to be followed, including the

opportunity for hearing, when the transfer of a tenant results

from a monitoring evaluation or complaint investigation

conducted by the department of inspections and appeals.

Sec. 14. NEW SECTION 231C.7 COMPLAINTS.

1. Any person with concerns regarding the operations or

service delivery of an assisted living program may file a

complaint with the department of inspections and appeals. The

name of the person who files a complaint with the department

of inspections and appeals and any personal identifying

information of the person or any tenant identified in the

complaint shall be kept confidential and shall not be subject

to discovery, subpoena, or other means of legal compulsion for

its release to a person other than department of inspections

and appeals' employees involved with the complaint.

2. The department, in cooperation with the department of

inspections and appeals, shall establish procedures for the

disposition of complaints received in accordance with this

section.

Sec. 15. NEW SECTION 231C.8 INFORMAL REVIEW.

If an assisted living program contests the regulatory

insufficiencies of a monitoring evaluation or complaint

investigation, the program shall submit written information,

demonstrating that the program was in compliance with the

applicable requirement at the time of the monitoring

evaluation or complaint investigation, in support of the

contesting of the regulatory insufficiencies, to the

department of inspections and appeals for review. The

department of inspections and appeals shall review the written

information submitted within ten working days of the receipt

of the information. At the conclusion of the review, the

department of inspections and appeals may affirm, modify, or

dismiss the regulatory insufficiencies. The department of

inspections and appeals shall notify the program in writing of

the decision to affirm, modify, or dismiss the regulatory

insufficiencies, and the reasons for the decision. In the

case of a complaint investigation, the department of

inspections and appeals shall also notify the complainant, if

known, of the decision and the reasons for the decision.

Sec. 16. NEW SECTION 231C.9 PUBLIC DISCLOSURE OF FINDINGS.

Following a monitoring evaluation or complaint

investigation of an assisted living program by the department

of inspections and appeals pursuant to this chapter, the

department of inspections and appeals' final findings with

respect to compliance by the assisted living program with

requirements for certification shall be made available to the

public in a readily available form and place. Other

information relating to an assisted living program that is

obtained by the department of inspections and appeals which

does not constitute the department of inspections and appeals'

final findings from a monitoring evaluation or complaint

investigation of the assisted living program shall not be made

available to the public except in proceedings involving the

denial, suspension, or revocation of a certificate under this

chapter.

Sec. 17. NEW SECTION 231C.10 DENIAL, SUSPENSION, OR REVOCATION — CONDITIONAL OPERATION.

1. The department of inspections and appeals may deny,

suspend, or revoke a certificate in any case where the

department of inspections and appeals finds that there has

been a substantial or repeated failure on the part of the

assisted living program to comply with this chapter or the

rules, or minimum standards adopted under this chapter, or for

any of the following reasons:

a. Cruelty or indifference to assisted living program

tenants.

b. Appropriation or conversion of the property of an

assisted living program tenant without the tenant's written

consent or the written consent of the tenant's legal guardian.

c. Permitting, aiding, or abetting the commission of any

illegal act in the assisted living program.

d. Obtaining or attempting to obtain or retain a

certificate by fraudulent means, misrepresentation, or by

submitting false information.

e. Habitual intoxication or addiction to the use of drugs

by the applicant, administrator, executive director, manager,

or supervisor of the assisted living program.

f. Securing the devise or bequest of the property of a

tenant of an assisted living program by undue influence.

g. Founded dependent adult abuse as defined in section

235B.2.

h. In the case of any officer, member of the board of

directors, trustee, or designated manager of the program or

any stockholder, partner, or individual who has greater than a

ten percent equity interest in the program, who has or has had

an ownership interest in an assisted living program, home

health agency, residential care facility, or licensed nursing

facility in any state which has been closed due to removal of

program, agency, or facility licensure or certification or

involuntary termination from participation in either the

medical assistance or Medicare programs, or who has been found

to have failed to provide adequate protection or services for

tenants to prevent abuse or neglect.

i. In the case of a certificate applicant or an existing

certified owner or operator who is an entity other than an

individual, the person is in a position of control or is an

officer of the entity and engages in any act or omission

proscribed by this chapter.

j. For any other reason as provided by law or

administrative rule.

2. The department of inspections and appeals may as an

alternative to denial, suspension, or revocation conditionally

issue or continue a certificate dependent upon the performance

by the assisted living program of reasonable conditions within

a reasonable period of time as set by the department of

inspections and appeals so as to permit the program to

commence or continue the operation of the program pending full

compliance with this chapter or the rules adopted pursuant to

this chapter. If the assisted living program does not make

diligent efforts to comply with the conditions prescribed, the

department of inspections and appeals may, under the

proceedings prescribed by this chapter, suspend, or revoke the

certificate. An assisted living program shall not be operated

on a conditional certificate for more than one year.

Sec. 18. NEW SECTION 231C.11 NOTICE — APPEAL — EMERGENCY PROVISIONS.

1. The denial, suspension, or revocation of a certificate

shall be effected by delivering to the applicant or

certificate holder by restricted certified mail or by personal

service a notice setting forth the particular reasons for such

action. Such denial, suspension, or revocation shall become

effective thirty days after the mailing or service of the

notice, unless the applicant or certificate holder, within

such thirty-day period, requests a hearing, in writing, of the

department of inspections and appeals, in which case the

notice shall be deemed to be suspended.

2. The denial, suspension, or revocation of a certificate

may be appealed in accordance with rules adopted by the

department of inspections and appeals in accordance with

chapter 17A.

3. When the department of inspections and appeals finds

that an imminent danger to the health or safety of tenants of

an assisted living program exists which requires action on an

emergency basis, the department of inspections and appeals may

direct removal of all tenants of an assisted living program

and suspend the certificate prior to a hearing.

Sec. 19. NEW SECTION 231C.12 DEPARTMENT NOTIFIED OF CASUALTIES.

The department of inspections and appeals shall be notified

within twenty-four hours, by the most expeditious means

available, of any accident causing substantial injury or

death, and any substantial fire or natural or other disaster

occurring at or near an assisted living program.

Sec. 20.

NEW SECTION. 231C.13 RETALIATION BY ASSISTED

LIVING PROGRAM PROHIBITED.

An assisted living program shall not discriminate or

retaliate in any way against a tenant, tenant's family, or an

employee of the program who has initiated or participated in

any proceeding authorized by this chapter. An assisted living

program that violates this section is subject to a penalty as

established by administrative rule in accordance with chapter

17A and to be assessed and collected by the department of

inspections and appeals and paid into the state treasury to be

credited to the general fund of the state.

Sec. 21. NEW SECTION 231C.14 CIVIL PENALTIES.

The department may establish by rule, in accordance with

chapter 17A, civil penalties for the following violations by

an assisted living program:

1. Noncompliance with any regulatory requirements which

presents an imminent danger or a substantial probability of

resultant death or physical harm to a tenant.

2. Following receipt of notice from the department of

inspections and appeals, continued failure or refusal to

comply within a prescribed time frame with regulatory

requirements that have a direct relationship to the health,

safety, or security of program tenants.

Sec. 22. NEW SECTION 231C.15 CRIMINAL PENALTIES AND INJUNCTIVE RELIEF.

1. A person establishing, conducting, managing, or

operating any assisted living program without a certificate is

guilty of a serious misdemeanor. Each day of continuing

violation after conviction or notice from the department of

inspections and appeals by certified mail of a violation shall

be considered a separate offense or chargeable offense. A

person establishing, conducting, managing, or operating an

assisted living program without a certificate may be

temporarily or permanently restrained by a court of competent

jurisdiction from such activity in an action brought by the

state.

2. A person who prevents or interferes with or attempts to

impede in any way any duly authorized representative of the

department of inspections and appeals in the lawful

enforcement of this chapter or of the rules adopted pursuant

to this chapter is guilty of a simple misdemeanor. As used in

this subsection, lawful enforcement includes but is not

limited to:

a. Contacting or interviewing any tenant of an assisted

living program in private at any reasonable hour and without

advance notice.

b. Examining any relevant records of an assisted living

program.

c. Preserving evidence of any violation of this chapter or

of the rules adopted pursuant to this chapter.

Sec. 23. NEW SECTION 231C.16 NURSING ASSISTANT AND MEDICATION AIDE — CERTIFICATION.

The department of inspections and appeals, in cooperation

with other appropriate agencies, shall establish a procedure

to allow nursing assistants or medication aides to claim work

within an assisted living program as credit toward sustaining

the nursing assistant's or medication aide's certification.

Sec. 24. NEW SECTION 231C.17 COORDINATION OF THE LONG- TERM CARE SYSTEM — TRANSITIONAL PROVISIONS.

1. A hospital licensed pursuant to chapter 135B or a

health care facility licensed pursuant to chapter 135C may

operate an assisted living program, located in a distinct part

of or separate structure under the control of the hospital or

health care facility, if certified pursuant to this chapter.

2. This chapter shall not be construed to require that a

facility licensed as a different type of facility also comply

with the requirements of this chapter, unless the facility is

represented to the public as a certified assisted living

program.

3. A certified assisted living program that complies with

the requirements of this chapter shall not be required to be

licensed as a health care facility pursuant to chapter 135C,

unless the facility is represented to the public as a licensed

health care facility.

4. A continuing care retirement community that is in

compliance with chapter 523D shall not be held in violation of

this chapter if the continuing care retirement community

provides services to its independent living residents.

Sec. 25. NEW SECTION 231C.18 IOWA ASSISTED LIVING FEES.

1. The department of inspections and appeals shall collect

assisted living program certification and related fees. An

assisted living program that is certified by the department of

inspections and appeals on the basis of voluntary

accreditation by a recognized accrediting entity shall not be

subject to payment of the certification fee, but shall be

subject to an administrative fee as prescribed by rule. Fees

collected and retained pursuant to this section shall be

deposited in the general fund of the state.

2. The following certification and related fees shall

apply to assisted living programs:

a. For a two-year initial certification, seven hundred

fifty dollars.

b. For a two-year recertification, one thousand dollars.

c. For a blueprint plan review, nine hundred dollars.

d. For an optional preliminary plan review, five hundred

dollars.

Sec. 26. NEW SECTION 231C.19 APPLICATION OF LANDLORD AND TENANT ACT.

Chapter 562A, the uniform residential landlord and tenant

Act, shall apply to assisted living programs under this

chapter.

Sec. 27. Section 235B.3, subsection 2, paragraph d, Code 2003, is amended to read as follows:

d. A person who performs inspections of elder group homes

for the department of elder affairsinspections and appeals

and a resident advocate committee member assigned to an elder

group home pursuant to chapter 231B.

Sec. 28.

Chapter 231A, Code 2003, is repealed.

Sec. 29.

TRANSITION OF STAFF.

All employees of the

department of elder affairs performing functions related to

certification and monitoring of or complaint investigations

related to assisted living programs as of June 30, 2003, shall

become employees of the department of inspections and appeals

without loss of classification, pay, or benefits, effective

July 1, 2003. All employees of the department of elder

affairs performing functions related to affordable assisted

living as of June 30, 2003, shall become employees of the Iowa

finance authority without loss of classification, pay, or

benefits, effective July 1, 2003.