H.F. 2132 Section 1. Section 231C.1, subsection 2, paragraph b, Code 1 2011, is amended to read as follows: 2 b. To establish standards for assisted living programs that 3 allow flexibility in design which promotes a social model of 4 service delivery by focusing on independence, individual needs 5 and desires, and consumer-driven quality of service , and that 6 provide consumer protections to ensure program transparency, 7 oversight, and accountability . 8 Sec. 2. Section 231C.1, subsection 3, Code 2011, is amended 9 to read as follows: 10 3. It is the intent of the general assembly that the 11 department promote a social model for assisted living programs , 12 provide consistent standards and oversight to ensure protection 13 of consumers, and utilize a consultative process to assist with 14 compliance by assisted living programs. 15 Sec. 3. Section 231C.2, subsection 2, Code Supplement 2011, 16 is amended to read as follows: 17 2. a. “Assisted living” means the provision to three or 18 more tenants of a social model of housing with in a physical 19 structure which provides a homelike environment and balances 20 individual privacy with the benefits of social interaction and 21 provides associated services which may . 22 b. The social model shall provide an environment that 23 supports each tenant in maximizing the tenant’s highest 24 practicable level of well-being through individualized, 25 stimulating, and purposeful activities, connections to and 26 interaction with the outside community, and other interventions 27 that assist a tenant in maintaining optimal independence while 28 delaying further decline from any existing health, cognitive, 29 mental health, or functional condition. 30 c. The services offered shall include but are not limited to 31 health-related the following: 32 (1) Health-related care , or personal care , and assistance 33 with instrumental activities of daily living to three or more 34 tenants in a physical structure which provides a homelike 35 -1- LSB 5527HH (4) 84 ad/rj 1/ 6

H.F. 2132 environment . 1 (2) “Assisted living” also includes The encouragement 2 of family involvement, tenant self-direction, and tenant 3 participation in decisions that emphasize choice, dignity, 4 privacy, individuality, shared risk, and independence in a 5 manner commensurate with the tenant’s health, cognitive, 6 mental health, and functional status . “Assisted living” 7 includes the provision of housing and assistance with 8 instrumental activities of daily living only if personal care 9 or health-related care is also included. “Assisted living” 10 includes 11 (3) Access to awake staff twenty-four hours per day 12 response staff to meet a tenant’s scheduled and unscheduled 13 or unpredictable needs commensurate with the tenant’s health, 14 cognitive, mental health, and functional status, in a manner 15 that promotes maximum dignity and independence and provides 16 supervision, safety, and security. 17 d. Services may include assistance with instrumental 18 activities of daily living. 19 Sec. 4. Section 231C.3, subsection 1, paragraphs c and d, 20 Code 2011, are amended to read as follows: 21 c. Standards for tenant evaluation or assessment , which 22 evaluate each prospective tenant’s health, cognitive, mental 23 health, and functional status prior to the tenant’s signing the 24 occupancy agreement and taking occupancy of a dwelling unit 25 in order to determine the tenant’s eligibility for a program, 26 including whether the personal or health-related services are 27 available. The standards shall provide that each program shall 28 use one or two of the standard assessment tools selected by the 29 department. 30 d. Standards for tenant service plans, which may vary in 31 accordance with the nature of the services provided or the 32 status of the a tenant. The standards shall provide that daily 33 activities based on a tenant’s abilities, personal interests, 34 and individual assessment shall be planned for a tenant who 35 -2- LSB 5527HH (4) 84 ad/rj 2/ 6

H.F. 2132 is unable to plan the tenant’s own activities. The standards 1 shall state that a service plan must include the level of staff 2 needed to provide personal or health-related care. When a 3 tenant needs personal care or health-related care, the service 4 plan shall be updated within thirty days of occupancy and as 5 needed with significant change, but not less than annually. 6 d. e. Provisions for granting short-term waivers for 7 tenants who exceed occupancy criteria. 8 Sec. 5. Section 231C.3, subsection 1, Code 2011, is amended 9 by adding the following new paragraphs: 10 NEW PARAGRAPH . f. Standards for food service at a program 11 that ensure that the nutritional needs of each tenant is met as 12 reflected in the tenant’s service plan. The standards shall 13 state that the program shall provide, at minimum, one hot meal 14 per day to all tenants and up to three meals per day for tenants 15 who require the food service. 16 NEW PARAGRAPH . g. Standards for employment of a program 17 manager. The standards shall provide that programs employing a 18 new program manager on and after January 1, 2013, shall require 19 the manager to have, at minimum, a combination of three years 20 of study or experience related to older adults and to complete, 21 within six months of initial employment as a program manager, 22 an assisted living management class whose curriculum includes 23 at least six hours of training specifically related to Iowa 24 rules and laws on assisted living programs. 25 Sec. 6. Section 231C.5, subsection 2, paragraph a, Code 26 Supplement 2011, is amended to read as follows: 27 a. A description of all fees, charges, and rates describing 28 tenancy and basic services covered, and any additional and 29 optional services and their related costs. The occupancy 30 agreement shall also include the circumstances under which 31 fees, charges, or rates are subject to change, and the process 32 by which such change is made including but not limited to a 33 provision of timely notice of such change. 34 Sec. 7. Section 231C.5, subsection 2, Code Supplement 2011, 35 -3- LSB 5527HH (4) 84 ad/rj 3/ 6

H.F. 2132 is amended by adding the following new paragraph: 1 NEW PARAGRAPH . q. The specific type and level of services 2 the program provides and the specific health, cognitive, mental 3 health, or functional condition that, by law, prohibit initial 4 occupancy or may necessitate subsequent transfer or involuntary 5 transfer. 6 Sec. 8. RULES. The department of inspections and appeals 7 shall adopt rules to implement the provisions of this Act. 8 Sec. 9. PRIOR PROGRAM MANAGER TRAINING. The training 9 standards required by section 231C.3, subsection 1, paragraph 10 “g”, as enacted in this Act, shall provide that program 11 managers who have completed similar training prior to January 12 1, 2013, shall not be required to complete additional training 13 to meet the requirement in section 231C.3, subsection 1, 14 paragraph “g”. 15 EXPLANATION 16 This bill amends Code sections related to assisted living 17 programs. The bill adds that the purpose of establishing an 18 assisted living program includes providing consumer protections 19 to ensure program transparency, oversight, and accountability. 20 The bill provides that it is the intent of the general assembly 21 that the department of inspections and appeals provide 22 consistent standards and oversight to ensure protection of 23 consumers of assisted living programs. 24 The bill amends the definition of “assisted living” to 25 mean the provision of a social model of housing in a physical 26 structure with services to three or more tenants. The physical 27 structure must balance individual privacy with the benefits 28 of social interaction. The bill provides that the social 29 model must create an environment that supports the tenant in 30 maximizing the highest practicable level of well-being that 31 assists the tenant in maintaining optimal independence and 32 delaying further decline in any existing health, cognitive, 33 mental health, or functional condition. 34 The bill amends the definition of “assisted living” to 35 -4- LSB 5527HH (4) 84 ad/rj 4/ 6

H.F. 2132 include as required assisted living services, health-related 1 care, the encouragement of family involvement, tenant 2 self-direction, and tenant participation in a manner 3 commensurate with the tenant’s health, cognitive, mental 4 health, and functional status, and access to awake staff 24 5 hours per day to meet the tenant’s needs commensurate with 6 the tenant’s health, cognitive, mental health, and functional 7 status. The bill provides that assisted living services may 8 include assistance with instrumental activities of daily 9 living. 10 The bill requires the department of inspections and appeals 11 (DIA) to establish rules regarding standards for tenant 12 evaluation or assessment. The rules shall require that each 13 prospective tenant’s health, cognitive, mental health, and 14 functional status be evaluated prior to the tenant’s signing 15 the occupancy agreement and taking occupancy of a dwelling 16 unit. The evaluations must be completed using one or two of 17 the standard assessment tools selected by the department. 18 The bill requires that the DIA’s rules regarding tenant 19 service plans provide that daily activities based on the 20 tenant’s abilities, personal interests, and individual 21 assessment shall be planned for a tenant who is unable to 22 plan the tenant’s own activities. The rules regarding tenant 23 service plans also must include the level of staff needed to 24 provide care. 25 The bill requires the DIA to establish rules regarding 26 standards for food service at an assisted living program to 27 ensure that a program meets a tenant’s nutritional needs. 28 These standards shall require that the program, at minimum, 29 provide one hot meal per day to all tenants and up to three 30 meals per day for tenants requiring the service. 31 The bill requires the DIA to establish rules regarding 32 standards for employment of program managers. The standards 33 must require new program managers employed on or after 34 January 1, 2013, to have a minimum of three years of study 35 -5- LSB 5527HH (4) 84 ad/rj 5/ 6

H.F. 2132 or experience related to older adults and to complete an 1 assisted living management class within six months of initial 2 employment as a program manager. A program manager does not 3 need to complete additional training if the program manager has 4 completed similar training prior to January 1, 2013. 5 The bill provides that a written occupancy agreement 6 shall include the circumstances under which fees, charges, or 7 rates are subject to change and the process for making the 8 changes including a provision for timely notice. The bill 9 also requires a written occupancy agreement to include the 10 specific type and level of services the program provides and 11 the specific health, cognitive, mental health, or functional 12 conditions that prohibit initial occupancy or may necessitate 13 subsequent transfer. 14 The bill requires the DIA to adopt rules to implement the 15 bill. 16 -6- LSB 5527HH (4) 84 ad/rj 6/ 6