H.F. 2079 Section 1. Section 135C.33, subsection 5, paragraph a, 1 subparagraph (5), Code Supplement 2009, is amended to read as 2 follows: 3 (5) An employee of an assisted living program or assisted 4 living care agency certified under chapter 231C, if the 5 employee provides direct services to consumers. 6 Sec. 2. Section 144C.3, subsection 4, Code Supplement 2009, 7 is amended to read as follows: 8 4. A funeral director, an attorney, or any agent, owner, or 9 employee of a funeral establishment, cremation establishment, 10 cemetery, elder group home, assisted living program, assisted 11 living care agency, adult day services program, or licensed 12 hospice program shall not serve as a designee unless related to 13 the declarant within the third degree of consanguinity. 14 Sec. 3. Section 231C.2, Code Supplement 2009, is amended by 15 adding the following new subsections: 16 NEW SUBSECTION . 2A. “Assisted living care agency” means 17 a health care or other agency that provides assisted living 18 services, with the exception of provision of housing, to three 19 or more dependent persons who reside in one or more group or 20 age-restricted facilities, including facilities regulated under 21 chapter 523D. 22 NEW SUBSECTION . 2B. “Client” means an individual who 23 receives services through a certified assisted living care 24 agency. 25 NEW SUBSECTION . 2C. “Client’s legal representative” means a 26 person appointed by the court to act on behalf of a client or a 27 person acting pursuant to a power of attorney. 28 Sec. 4. Section 231C.3A, subsection 1, Code Supplement 29 2009, is amended to read as follows: 30 1. Any of the following circumstances disqualifies a 31 monitor from inspecting a particular assisted living program or 32 assisted living care agency under this chapter: 33 a. The monitor currently works or, within the past two 34 years, has worked as an employee or employment agency staff at 35 -1- LSB 5110HH (4) 83 jr/nh 1/ 10

H.F. 2079 the program or agency , or as an officer, consultant, or agent 1 for the program or agency to be monitored. 2 b. The monitor has any financial interest or any ownership 3 interest in the program or agency . For purposes of this 4 paragraph, indirect ownership, such as through a broad-based 5 mutual fund, does not constitute financial or ownership 6 interest. 7 c. The monitor has an immediate family member who has 8 a relationship with the program or agency as described in 9 paragraph “a” or “b” . 10 d. The monitor has an immediate family member who currently 11 resides in the program or obtains services from the agency . 12 Sec. 5. NEW SECTION . 231C.3B Certification of assisted 13 living care agencies —— fee. 14 1. The department shall establish by rule minimum standards 15 for certification and monitoring of assisted living care 16 agencies. 17 2. Each assisted living care agency shall be certified by 18 the department. 19 3. The owner or manager of an assisted living care agency 20 shall comply with the rules adopted by the department. 21 4. The department shall have full access to all records and 22 other materials pertaining to the provision of services and 23 care to the clients of an assisted living care agency during 24 certification, monitoring, and complaint investigations. 25 5. Certification of an assisted living care agency shall be 26 for two years unless certification is revoked for good cause 27 by the department. 28 6. The department shall establish and collect certification 29 fees by rule. Fees collected and retained pursuant to this 30 section shall be deposited in the general fund of the state. 31 7. A department, agency, or officer of this state or of 32 any governmental unit shall not pay or approve for payment 33 from public funds any amount to an assisted living care agency 34 for an actual or prospective client, unless the agency holds 35 -2- LSB 5110HH (4) 83 jr/nh 2/ 10

H.F. 2079 a current certificate issued by the department and meets all 1 current requirements for certification. 2 8. An assisted living care agency shall comply with section 3 135C.33. 4 9. The department shall conduct training sessions for 5 personnel responsible for conducting monitoring evaluations and 6 complaint investigations of assisted living care agencies. 7 Sec. 6. Section 231C.7, subsection 1, Code 2009, is amended 8 to read as follows: 9 1. Any person with concerns regarding the operations 10 or service delivery of an assisted living program or an 11 assisted living care agency may file a complaint with the 12 department. The name of the person who files a complaint with 13 the department and any personal identifying information of the 14 person or any tenant identified in the complaint shall be kept 15 confidential and shall not be subject to discovery, subpoena, 16 or other means of legal compulsion for its release to a person 17 other than department employees involved with the complaint. 18 Sec. 7. Section 231C.8, Code 2009, is amended to read as 19 follows: 20 231C.8 Informal review. 21 1. If an assisted living program or an assisted living 22 care agency contests the regulatory insufficiencies of a 23 monitoring evaluation or complaint investigation, the program 24 or agency shall submit written information, demonstrating that 25 the program or agency was in compliance with the applicable 26 requirement at the time of the monitoring evaluation or 27 complaint investigation, in support of the contesting of the 28 regulatory insufficiencies, to the department for review. 29 2. The department shall review the written information 30 submitted within ten working days of the receipt of the 31 information. At the conclusion of the review, the department 32 may affirm, modify, or dismiss the regulatory insufficiencies. 33 The department shall notify the program or agency in writing 34 of the decision to affirm, modify, or dismiss the regulatory 35 -3- LSB 5110HH (4) 83 jr/nh 3/ 10

H.F. 2079 insufficiencies, and the reasons for the decision. 1 3. In the case of a complaint investigation, the department 2 shall also notify the complainant, if known, of the decision 3 and the reasons for the decision. 4 Sec. 8. Section 231C.9, Code 2009, is amended to read as 5 follows: 6 231C.9 Public disclosure of findings. 7 Upon completion of a monitoring evaluation or complaint 8 investigation of an assisted living program or an assisted 9 living care agency by the department pursuant to this chapter, 10 including the conclusion of informal review, the department’s 11 final findings with respect to compliance by the assisted 12 living program or agency with requirements for certification 13 shall be made available to the public in a readily available 14 form and place. Other information relating to an assisted 15 living program or agency that is obtained by the department 16 which does not constitute the department’s final findings from 17 a monitoring evaluation or complaint investigation of the 18 assisted living program or agency shall not be made available 19 to the public except in proceedings involving the denial, 20 suspension, or revocation of a certificate under this chapter. 21 Sec. 9. Section 231C.10, Code Supplement 2009, is amended 22 to read as follows: 23 231C.10 Denial, suspension, or revocation —— conditional 24 operation. 25 1. The department may deny, suspend, or revoke a certificate 26 in any case where the department finds that there has been a 27 substantial or repeated failure on the part of the assisted 28 living program or assisted living care agency to comply with 29 this chapter or the rules, or minimum standards adopted under 30 this chapter, or for any of the following reasons: 31 a. Appropriation or conversion of the property of an 32 assisted living program tenant or an assisted living care 33 agency client without the tenant’s or client’s written consent 34 or the written consent of the tenant’s or client’s legal 35 -4- LSB 5110HH (4) 83 jr/nh 4/ 10

H.F. 2079 representative. 1 b. Permitting, aiding, or abetting the commission of any 2 illegal act in the assisted living program or by the agency . 3 c. Obtaining or attempting to obtain or retain a certificate 4 by fraudulent means, misrepresentation, or by submitting false 5 information. 6 d. Habitual intoxication or addiction to the use of drugs by 7 the applicant, administrator, executive director, manager, or 8 supervisor of the assisted living program or assisted living 9 care agency . 10 e. Securing the devise or bequest of the property of a 11 tenant of an assisted living program or a client of an assisted 12 living care agency by undue influence. 13 f. Failure to protect tenants or clients from dependent 14 adult abuse as defined in section 235E.1. 15 g. In the case of any officer, member of the board of 16 directors, trustee, or designated manager of the program or 17 agency or any stockholder, partner, or individual who has 18 greater than a five percent equity interest in the program 19 or agency , having or having had an ownership interest in 20 an assisted living program, adult day services program, 21 elder group home, home health agency, assisted living care 22 agency, residential care facility, or licensed nursing facility 23 in any state which has been closed due to removal of program, 24 agency, or facility licensure or certification or involuntary 25 termination from participation in either the medical assistance 26 or Medicare programs, or having been found to have failed 27 to provide adequate protection or services for tenants or 28 clients to prevent abuse or neglect. 29 h. In the case of a certificate applicant or an existing 30 certified owner or operator who is an entity other than an 31 individual, the person is in a position of control or is an 32 officer of the entity and engages in any act or omission 33 proscribed by this chapter. 34 i. For any other reason as provided by law or administrative 35 -5- LSB 5110HH (4) 83 jr/nh 5/ 10

H.F. 2079 rule. 1 2. The department may as an alternative to denial, 2 suspension, or revocation conditionally issue or continue a 3 certificate dependent upon the performance by the assisted 4 living program or assisted living care agency of reasonable 5 conditions within a reasonable period of time as set by the 6 department so as to permit the program or agency to commence 7 or continue the operation of the program or agency pending 8 substantial compliance with this chapter or the rules adopted 9 pursuant to this chapter. If the assisted living program or 10 assisted living care agency does not make diligent efforts to 11 comply with the conditions prescribed, the department may, 12 under the proceedings prescribed by this chapter, suspend or 13 revoke the certificate. An assisted living program or assisted 14 living care agency shall not be operated on a conditional 15 certificate for more than one year. 16 Sec. 10. Section 231C.11, subsection 3, Code 2009, is 17 amended to read as follows: 18 3. When the department finds that an imminent danger to the 19 health or safety of tenants of an assisted living program or 20 clients of an assisted living care agency exists which requires 21 action on an emergency basis, the department may direct 22 the removal of all tenants of an the assisted living program or 23 the cessation of services to all clients of the assisted living 24 care agency and suspend the certificate of the program or the 25 agency prior to a hearing. 26 Sec. 11. Section 231C.13, Code 2009, is amended to read as 27 follows: 28 231C.13 Retaliation by assisted living program prohibited. 29 An assisted living program or an assisted living care 30 agency shall not discriminate or retaliate in any way against a 31 tenant or client , tenant’s or client’s family, or an employee 32 of the program or agency who has initiated or participated 33 in any proceeding authorized by this chapter. An assisted 34 living program or an assisted living care agency that violates 35 -6- LSB 5110HH (4) 83 jr/nh 6/ 10

H.F. 2079 this section is subject to a penalty as established by 1 administrative rule in accordance with chapter 17A, to be 2 assessed and collected by the department, paid into the state 3 treasury, and credited to the general fund of the state. 4 Sec. 12. Section 231C.14, Code Supplement 2009, is amended 5 to read as follows: 6 231C.14 Civil penalties. 7 1. The department may establish by rule, in accordance with 8 chapter 17A, civil penalties for the following violations by an 9 assisted living program or an assisted living care agency : 10 a. Noncompliance with any regulatory requirements which 11 presents an imminent danger or a substantial probability of 12 resultant death or physical harm to a tenant or client . 13 b. Following receipt of notice from the department, 14 continued failure or refusal to comply within a prescribed 15 time frame with regulatory requirements that have a direct 16 relationship to the health, safety, or security of program 17 tenants or agency clients . 18 c. Preventing or interfering with or attempting to impede in 19 any way any duly authorized representative of the department in 20 the lawful enforcement of this chapter or of the rules adopted 21 pursuant to this chapter. As used in this paragraph, “lawful 22 enforcement” includes but is not limited to: 23 (1) Contacting or interviewing any tenant of an assisted 24 living program or client of an assisted living care agency in 25 private at any reasonable hour and without advance notice. 26 (2) Examining any relevant records of an assisted living 27 program or assisted living care agency . 28 (3) Preserving evidence of any violation of this chapter or 29 of the rules adopted pursuant to this chapter. 30 2. If a program or agency assessed a penalty does not 31 request a formal hearing pursuant to chapter 17A or withdraws 32 its request for a formal hearing within thirty days of the 33 date the penalty was assessed, the penalty shall be reduced by 34 thirty-five percent, if the penalty is paid within thirty days 35 -7- LSB 5110HH (4) 83 jr/nh 7/ 10

H.F. 2079 of the issuance of a demand letter issued by the department. 1 The demand letter, which includes the civil penalty, shall 2 include a statement to this effect. 3 Sec. 13. Section 231C.15, Code 2009, is amended to read as 4 follows: 5 231C.15 Criminal penalties and injunctive relief. 6 A person establishing, conducting, managing, or 7 operating any assisted living program or assisted living 8 care agency without a certificate is guilty of a serious 9 misdemeanor. Each day of continuing violation after conviction 10 or notice from the department by certified mail of a violation 11 shall be considered a separate offense or chargeable offense. 12 A person establishing, conducting, managing, or operating 13 an assisted living program or an assisted living care 14 agency without a certificate may be temporarily or permanently 15 restrained by a court of competent jurisdiction from such 16 activity in an action brought by the state. 17 Sec. 14. Section 231C.16, Code 2009, is amended to read as 18 follows: 19 231C.16 Nursing assistant and medication aide —— 20 certification. 21 The department, in cooperation with other appropriate 22 agencies, shall establish a procedure to allow nursing 23 assistants or medication aides to claim work within an assisted 24 living program or with an assisted living care agency as credit 25 toward sustaining the nursing assistant’s or medication aide’s 26 certification. 27 Sec. 15. Section 235E.1, subsection 9, Code 2009, is amended 28 to read as follows: 29 9. “Program” means an elder group home as defined in section 30 231B.1, an assisted living program or assisted living care 31 agency certified under section 231C.3 or 231C.3B , or an adult 32 day services program as defined in section 231D.1. 33 Sec. 16. Section 249H.3, subsection 4, Code Supplement 34 2009, is amended to read as follows: 35 -8- LSB 5110HH (4) 83 jr/nh 8/ 10

H.F. 2079 4. “Long-term care alternatives” means those services 1 specified as services under the medical assistance home and 2 community-based services waiver for elder persons or adults 3 with disabilities, elder group homes certified under chapter 4 231B, assisted-living assisted living programs or assisted 5 living care agencies certified under chapter 231C, and the PACE 6 program. 7 EXPLANATION 8 Code chapter 231C currently directs the department of 9 inspections and appeals (DIA) to certify and monitor assisted 10 living programs. This bill applies similar certification and 11 monitoring requirements to health care or other agencies which 12 provide assisted living services to three or more dependent 13 persons, who reside in one or more group or age-restricted 14 facilities. Each agency is to be certified and monitored by 15 DIA. Certification is for a two-year period, with the fee set 16 by the DIA in rule. 17 The bill requires certain employees of such agencies to 18 undergo background checks; provides for filing and disposition 19 of complaints; provides for an informal review of contests 20 to the results of a monitoring evaluation or complaint 21 investigation; provides for public disclosure of the final 22 findings of a monitoring evaluation or complaint investigation; 23 provides the bases for denial, suspension, or revocation of 24 certification and for conditional operation of an agency; 25 provides for notice, appeal, and emergency provisions relating 26 to a denial, suspension, or revocation of certification; 27 provides for application of civil penalties, as determined by 28 certain violations, and provides for injunctive relief; and 29 provides for nursing assistants and medication aides to claim 30 work for an agency as credit toward their certification. 31 A person establishing, conducting, managing, or operating 32 an agency without a certificate pursuant to Code chapter 231C 33 is guilty of a serious misdemeanor. Each day of continuing 34 violation after conviction or notice from the department 35 -9- LSB 5110HH (4) 83 jr/nh 9/ 10