H.F. 2328 Section 1. Section 135C.37, Code 2009, is amended to read 1 as follows: 2 135C.37 Complaints alleging violations —— confidentiality. 3 A person may request an inspection of a health care facility 4 by filing with the department, resident advocate committee 5 of the facility, or the office of long-term care resident’s 6 advocate as established pursuant to section 231.42, a complaint 7 of an alleged violation of applicable requirements of this 8 chapter or the rules adopted pursuant to this chapter. A 9 person alleging abuse or neglect of a resident with a 10 developmental disability or with mental illness may also file a 11 complaint with the protection and advocacy agency designated 12 pursuant to section 135B.9 or section 135C.2. A copy of a 13 complaint filed with the resident advocate committee or the 14 office of long-term care resident’s advocate shall be forwarded 15 to the department. The complaint shall state in a reasonably 16 specific manner the basis of the complaint, and a statement 17 of the nature of the complaint shall be delivered to the 18 facility involved at the time of the inspection. The name of 19 the person who files a complaint with the department, resident 20 advocate committee, or the office of long-term care resident’s 21 advocate shall be kept confidential and shall not be subject to 22 discovery, subpoena, or other means of legal compulsion for its 23 release to a person other than department employees involved in 24 the investigation of the complaint. 25 Sec. 2. Section 135C.38, subsection 2, paragraph d, Code 26 2009, is amended to read as follows: 27 d. A person who is dissatisfied with any aspect of the 28 department’s handling of the complaint may contact the office 29 of long-term care resident’s advocate, established pursuant 30 to section 231.42, or may contact the protection and advocacy 31 agency designated pursuant to section 135C.2 if the complaint 32 relates to a resident with a developmental disability or a 33 mental illness. 34 Sec. 3. Section 231.4, Code Supplement 2009, is amended by 35 -1- LSB 5280HV (2) 83 pf/nh 1/ 10

H.F. 2328 adding the following new subsections: 1 NEW SUBSECTION . 1A. “Assisted living program” means a 2 program which provides assisted living as defined pursuant to 3 section 231C.2 and which is certified under chapter 231C. 4 NEW SUBSECTION . 4A. “Elder group home” means elder group 5 home as defined in section 231B.1 which is certified under 6 chapter 231B. 7 NEW SUBSECTION . 7A. “Legal representative” means a tenant’s 8 legal representative as defined in section 231B.1 or 231C.2, or 9 a guardian, conservator, or attorney in fact of a resident. 10 NEW SUBSECTION . 9A. “Resident” means a resident or tenant 11 of a long-term care facility, assisted living program, or elder 12 group home, excluding facilities licensed primarily to serve 13 persons with mental retardation or mental illness. 14 Sec. 4. Section 231.4, subsection 10, Code Supplement 2009, 15 is amended by striking the subsection. 16 Sec. 5. Section 231.23A, subsection 7, Code Supplement 17 2009, is amended to read as follows: 18 7. Administration relating to the office of long-term care 19 resident’s advocate program and training for resident advocate 20 committees. 21 Sec. 6. Section 231.41, Code Supplement 2009, is amended to 22 read as follows: 23 231.41 Purpose. 24 The purpose of this subchapter is to establish the office 25 of long-term care resident’s advocate program operated 26 by within the Iowa commission on aging department in accordance 27 with the requirements of the federal Act, and to adopt 28 the supporting federal regulations and guidelines for its 29 implementation operation . In accordance with chapter 17A , 30 the commission on aging shall adopt and enforce rules for the 31 implementation of this subchapter . 32 Sec. 7. Section 231.42, Code Supplement 2009, is amended 33 by striking the section and inserting in lieu thereof the 34 following: 35 -2- LSB 5280HV (2) 83 pf/nh 2/ 10

H.F. 2328 231.42 Office of long-term care resident’s advocate —— 1 duties —— penalties for violations. 2 1. Office established. The office of long-term care 3 resident’s advocate is established within the department, in 4 accordance with section 712 of the federal Act, as codified 5 at 42 U.S.C. § 3058g. The office shall consist of the state 6 long-term care resident’s advocate and any local long-term care 7 resident’s advocates. 8 2. State long-term care resident’s advocate. The director 9 of the department shall appoint the state long-term care 10 resident’s advocate who shall do all of the following: 11 a. Establish and implement a statewide confidential 12 uniform reporting system for receiving, analyzing, referring, 13 investigating, and resolving complaints about administrative 14 actions and the health, safety, welfare, and rights of 15 residents or tenants of long-term care facilities, assisted 16 living programs, and elder group homes, excluding facilities 17 licensed primarily to serve persons with mental retardation or 18 mental illness. 19 b. Publicize the office of long-term care resident’s 20 advocate and provide information and education to consumers, 21 the public, and other agencies about issues related to 22 long-term care in Iowa. 23 c. Monitor the development and implementation of federal, 24 state, and local laws, regulations, and policies that relate to 25 long-term care in Iowa. 26 d. Annually report to the governor and general assembly 27 on the activities of the office and make recommendations for 28 improving the health, safety, welfare, and rights of residents 29 and tenants of long-term care facilities, assisted living 30 programs, and elder group homes. 31 e. Cooperate with persons and public or private agencies 32 with regard to, and participate in, inquiries, meetings, 33 or studies that may lead to improvements in the health, 34 safety, welfare, and rights of residents and tenants and the 35 -3- LSB 5280HV (2) 83 pf/nh 3/ 10

H.F. 2328 functioning of long-term care facilities, assisted living 1 programs, and elder group homes. 2 f. Recruit, train, educate, support, and monitor volunteers 3 associated with the office. 4 3. Local long-term care resident’s advocates. The local 5 long-term care resident’s advocates established pursuant to 6 this section shall do all of the following: 7 a. Accept, investigate, verify, and work to resolve 8 complaints, whether reported to or initiated by a long-term 9 care resident’s advocate, relating to any action or inaction 10 that may adversely affect the health, safety, welfare, or 11 rights of residents or tenants of a long-term care facility, 12 assisted living program, or elder group home. 13 b. Provide information about long-term care, the rights of 14 residents and tenants, payment sources for care, and selection 15 of a long-term care facility, assisted living program, or elder 16 group home to providers, consumers, family members, volunteers, 17 and the public. 18 c. Make referrals to appropriate licensing, certifying, and 19 enforcement agencies to assure appropriate investigation of 20 abuse complaints and corrective actions. 21 d. Assist in the recruitment, training, education, support, 22 and monitoring of volunteers associated with the office of the 23 long-term care resident’s advocate. 24 e. Make noncomplaint-related visits to long-term care 25 facilities, assisted living programs, and elder group homes 26 to observe daily routines, meals, and activities, and work to 27 resolve complaints if any are identified during these visits. 28 4. Referrals of abuse, neglect, or exploitation. 29 a. If abuse, neglect, or exploitation of a resident or 30 tenant of a long-term care facility, assisted living program, 31 or elder group home is suspected, the state or a local 32 long-term care resident’s advocate shall, with the permission 33 of the resident or tenant as applicable under federal law, 34 make an immediate referral to the department of inspections 35 -4- LSB 5280HV (2) 83 pf/nh 4/ 10

H.F. 2328 and appeals or the department of human services as applicable, 1 and to the appropriate law enforcement agency. The state or 2 a local long-term care resident’s advocate shall cooperate, 3 if requested, with the department of inspections and appeals, 4 department of human services, or any law enforcement agency 5 pursuant to any investigation of such abuse, neglect, or 6 exploitation. 7 b. If the department of inspections and appeals responds 8 to a complaint referred by the state or a local long-term 9 care resident’s advocate against a long-term care facility, 10 assisted living program, elder group home, or an employee of 11 such entity, copies of related inspection reports, plans of 12 correction, and notice of any citations and sanctions levied 13 against the facility, program, or home shall be forwarded to 14 the office of the long-term care resident’s advocate. 15 5. Access to facility, program, or home. The state or a 16 local long-term care resident’s advocate or a trained volunteer 17 may enter any long-term care facility, assisted living program, 18 or elder group home at any time with or without prior notice 19 or complaint and shall be granted access to residents and 20 tenants at all times for the purpose of carrying out the duties 21 specified in this section. As used in this section, “access” 22 means the right to do all of the following: 23 a. Enter any long-term care facility, assisted living 24 program, or elder group home and provide identification. 25 b. Seek consent to communicate privately and without 26 restriction with any resident or tenant. 27 c. Communicate privately and without restriction with any 28 resident, tenant, legal representative, or other representative 29 who consents to communication. 30 d. Review the clinical or other records of a resident or 31 tenant. 32 e. Observe all resident or tenant areas of a facility, 33 program, or housing establishment except the living area of any 34 resident or tenant who protests the observation. 35 -5- LSB 5280HV (2) 83 pf/nh 5/ 10

H.F. 2328 6. Access to medical and personal records. 1 a. The state or a local long-term care resident’s advocate 2 shall have access to the medical and personal records of an 3 individual who is a resident or tenant of a long-term care 4 facility, assisted living program, or elder group home retained 5 by the facility, program, or home. 6 b. Records may be reproduced by the state or a local 7 long-term care resident’s advocate. 8 c. Upon request of the state or a local long-term care 9 resident’s advocate, a long-term care facility, assisted living 10 program, or elder group home shall provide the name, address, 11 and telephone number of the legal representative or next of kin 12 of any resident or tenant. 13 d. A long-term care facility, assisted living program, or 14 elder group home or personnel of such a facility, program, or 15 home who discloses records in compliance with this section and 16 the procedures adopted pursuant to this section shall not be 17 liable for such disclosure. 18 7. Interference prohibited —— penalties. 19 a. An officer, owner, director, or employee of a long-term 20 care facility, assisted living program, or elder group home who 21 intentionally prevents, interferes with, or attempts to impede 22 the work of the state or a local long-term care resident’s 23 advocate is subject to a penalty imposed by the director of not 24 more than one thousand five hundred dollars for each violation. 25 If the director imposes a penalty for a violation under this 26 paragraph, no other state agency shall impose a penalty for the 27 same interference violation. Any moneys collected pursuant to 28 this subsection shall be deposited in the general fund of the 29 state. 30 b. The office of the long-term care resident’s advocate 31 shall adopt rules specifying procedures for notice and appeal 32 of penalties imposed pursuant to this subsection. 33 c. The director, in consultation with the office of the 34 long-term care resident’s advocate, shall notify the county 35 -6- LSB 5280HV (2) 83 pf/nh 6/ 10

H.F. 2328 attorney of the county in which the long-term care facility, 1 assisted living program, or elder group home is located, or the 2 attorney general, of any violation of this subsection. 3 8. Retaliation prohibited —— penalties. An officer, owner, 4 director, or employee of a long-term care facility, assisted 5 living program, or elder group home shall not retaliate against 6 any person for having filed a complaint with, or provided 7 information to, the state or a local long-term care resident’s 8 advocate. A person who retaliates or discriminates in 9 violation of this subsection is guilty of a simple misdemeanor. 10 9. Change in operations. A long-term care facility, 11 assisted living program, or elder group home shall inform the 12 office of the long-term care resident’s advocate in writing at 13 least thirty days prior to any change in operations, programs, 14 services, licensure, or certification that affects residents or 15 tenants, including but not limited to the intention to close, 16 decertify, or change ownership. In an emergency situation, or 17 when a long-term care facility, assisted living program, or 18 elder group home is evacuated, the department of inspections 19 and appeals shall notify the office of the state long-term care 20 resident’s advocate. 21 10. Immunity. The state or a local long-term care 22 resident’s advocate or any representative of the office 23 participating in the good faith performance of their official 24 duties shall have immunity from any civil or criminal liability 25 that otherwise might result by reason of taking, investigating, 26 or pursuing a complaint under this section. 27 11. Confidentiality. Information relating to any complaint 28 made to or investigation by the state or a local long-term 29 care resident’s advocate that discloses the identity of a 30 complainant, resident, or tenant, or information related to 31 a resident’s or tenant’s personal or medical records, shall 32 remain confidential except as follows: 33 a. If permission is granted by the director in consultation 34 with the state long-term care resident’s advocate. 35 -7- LSB 5280HV (2) 83 pf/nh 7/ 10

H.F. 2328 b. If disclosure is authorized in writing by the complainant 1 and the resident, tenant, or the individual’s guardian or legal 2 representative. 3 c. If disclosure is necessary for the provision of services 4 to a resident or tenant, or the resident or tenant is unable to 5 express written or oral consent. 6 d. If ordered by a court. 7 12. Posting of state long-term care resident’s advocate 8 information. Every long-term care facility, assisted living 9 program, and elder group home shall post information in 10 a prominent location that includes the name, address, and 11 telephone number, and a brief description of the services 12 provided by the office of the long-term care resident’s 13 advocate. The information posted shall be approved or provided 14 by the office of the long-term care resident’s advocate. 15 Sec. 8. Section 231.44, subsections 1 and 3, Code Supplement 16 2009, are amended to read as follows: 17 1. The resident advocate committee volunteer program is 18 administered by the office of the long-term care resident’s 19 advocate program . The state and any local long-term care 20 resident’s advocate shall provide information, assistance, 21 and support to resident advocate committee program volunteers 22 to the extent possible. If funding becomes insufficient to 23 process applications and new appointments to resident advocate 24 committees can no longer be made, the director shall notify 25 the director of the department of inspections and appeals. A 26 health care facility shall not be found in violation of section 27 135C.25 for not having a resident advocate committee if new 28 appointments cannot be made as documented in accordance with 29 this subsection. 30 3. A An elder group home or long-term care facility 31 shall disclose the names, addresses, and phone numbers of a 32 resident’s family members, if requested, to a resident advocate 33 committee member, unless permission for this disclosure is 34 refused in writing by a family member. 35 -8- LSB 5280HV (2) 83 pf/nh 8/ 10

H.F. 2328 Sec. 9. Section 235B.6, subsection 2, paragraph e, 1 subparagraph (10), Code Supplement 2009, is amended to read as 2 follows: 3 (10) The state or a local long-term care resident’s 4 advocate if the victim resides in a long-term care facility 5 or the alleged perpetrator is an employee of a long-term care 6 facility. 7 Sec. 10. REPEAL. Section 231.43, Code Supplement 2009, is 8 repealed. 9 EXPLANATION 10 This bill provides for the establishment of the office of 11 long-term care resident’s advocate which consists of the state 12 long-term care resident’s advocate and any local long-term care 13 resident’s advocates. The bill provides that the director 14 of the department on aging is to appoint the state long-term 15 care resident’s advocate and specifies the duties of the state 16 and local long-term care resident’s advocates. In addition to 17 residents of long-term care facilities, the duties of the state 18 and local long-term care resident’s advocates under the bill 19 also extend to tenants of elder group homes and assisted living 20 programs. 21 The bill also provides for referrals of reports of 22 suspected abuse, neglect, or exploitation of a resident 23 or tenant by the state or local long-term care resident’s 24 advocate to the department of inspections and appeals or the 25 department of human services, as applicable, and to local 26 law enforcement; provides for access to certain areas of 27 a facility, assisted living program, or elder group home 28 under certain circumstances; provides for access to medical 29 and personal records of residents and tenants and provides 30 protection of confidentiality for information relating to a 31 complaint; establishes penalties for interference with the work 32 of the state or a local long-term care resident’s advocate 33 and for retaliation against a person who assists a resident’s 34 advocate; requires the reporting by a facility, assisted living 35 -9- LSB 5280HV (2) 83 pf/nh 9/ 10

H.F. 2328 program, or elder group home to the office of the long-term 1 care resident’s advocate at least 30 days prior to any change 2 in operations, programs, services, licensure, or certification 3 that affects residents or tenants; provides immunity and 4 confidentiality provisions relating to the duties of the 5 resident’s advocates; provides for the posting of information 6 about the state long-term care resident’s advocate at each 7 facility, program, or home; and makes other conforming changes. 8 -10- LSB 5280HV (2) 83 pf/nh 10/ 10