SENATE FILE 2060

BY  BOLKCOM

(COMPANION TO 5527HH BY HEDDENS)

A BILL FOR

An Act relating to services provided by assisted living programs and requiring the adoption of rules.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  Section 231C.1, subsection 2, paragraph b, Code 2011, is amended to read as follows:
   b.  To establish standards for assisted living programs that allow flexibility in design which promotes a social model of service delivery by focusing on independence, individual needs and desires, and consumer-driven quality of service, and that provide consumer protections to ensure program transparency, oversight, and accountability.
    Sec. 2.  Section 231C.1, subsection 3, Code 2011, is amended to read as follows:
   3.  It is the intent of the general assembly that the department promote a social model for assisted living programs, provide consistent standards and oversight to ensure protection of consumers, and
 
utilize a consultative process to assist with compliance by assisted living programs.
    Sec. 3.  Section 231C.2, subsection 2, Code Supplement 2011, is amended to read as follows:
   2.
  a.  “Assisted living” means
 
the provision
 
to three or more tenants of
 
a social model of housing with
 
in a physical structure which provides a homelike environment and balances individual privacy with the benefits of social interaction and provides associated services which may.
   b.  The social model shall provide an environment that supports each tenant in maximizing the tenant’s highest practicable level of well-being through individualized, stimulating, and purposeful activities, connections to and interaction with the outside community, and other interventions that assist a tenant in maintaining optimal independence while delaying further decline from any existing health, cognitive, mental health, or functional condition.
   c.  The services offered shall
 
include but are not limited to health-related
 
the following:
   (1)  Health-related
 
care,
 
or personal care, and assistance with instrumental activities of daily living to three or more tenants in a physical structure which provides a homelike environment.
   (2)  “Assisted living” also includes
 
The encouragement of family involvement, tenant self-direction, and tenant participation in decisions that emphasize choice, dignity, privacy, individuality, shared risk, and independence
 
in a manner commensurate with the tenant’s health, cognitive, mental health, and functional status. “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. “Assisted living” includes
   (3)  Access to awake staff
 
twenty-four hours per day response staff to meet
 
a tenant’s scheduled and unscheduled or unpredictable needs
 
commensurate with the tenant’s health, cognitive, mental health, and functional status, in a manner that promotes maximum dignity and independence and provides supervision, safety, and security.
   d.  Services may include assistance with instrumental activities of daily living.
    Sec. 4.  Section 231C.3, subsection 1, paragraphs c and d, Code 2011, are amended to read as follows:
   c.  Standards for tenant evaluation or assessment,
 
which evaluate each prospective tenant’s health, cognitive, mental health, and functional status prior to the tenant’s signing the occupancy agreement and
 
taking occupancy of a dwelling unit in order to determine the tenant’s eligibility for a program, including whether the personal or health-related services are available. The standards shall provide that each program shall use one or two of the standard assessment tools selected by the department.
   d.  Standards for tenant
 
service plans, which may vary in accordance with the nature of the services provided or the status of the
 
a tenant.

The standards shall provide that daily activities based on a tenant’s abilities, personal interests, and individual assessment shall be planned for a tenant who is unable to plan the tenant’s own activities. The standards shall state that a service plan must include the level of staff needed to provide personal or health-related care. When a tenant needs personal care or health-related care, the service plan shall be updated within thirty days of occupancy and as needed with significant change, but not less than annually.
   d.

e.  Provisions for granting short-term waivers for tenants who exceed occupancy criteria.
    Sec. 5.  Section 231C.3, subsection 1, Code 2011, is amended by adding the following new paragraphs:
   NEW PARAGRAPH.  f.  Standards for food service at a program that ensure that the nutritional needs of each tenant is met as reflected in the tenant’s service plan. The standards shall state that the program shall provide, at minimum, one hot meal per day to all tenants and up to three meals per day for tenants who require the food service.
   NEW PARAGRAPH.  g.  Standards for employment of a program manager. The standards shall provide that programs employing a new program manager on and after January 1, 2013, shall require the manager to have, at minimum, a combination of three years of study or experience related to older adults and to complete, within six months of initial employment as a program manager, an assisted living management class whose curriculum includes at least six hours of training specifically related to Iowa rules and laws on assisted living programs.
    Sec. 6.  Section 231C.5, subsection 2, paragraph a, Code Supplement 2011, is amended to read as follows:
   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. 
 
The occupancy agreement shall also include the circumstances under which fees, charges, or rates are subject to change, and the process by which such change is made including but not limited to a provision of timely notice of such change.
    Sec. 7.  Section 231C.5, subsection 2, Code Supplement 2011, is amended by adding the following new paragraph:
   NEW PARAGRAPH.  q.  The specific type and level of services the program provides and the specific health, cognitive, mental health, or functional condition that, by law, prohibit initial occupancy or may necessitate subsequent transfer or involuntary transfer.
    Sec. 8.  RULES.  The department of inspections and appeals shall adopt rules to implement the provisions of this Act.
    Sec. 9.  PRIOR PROGRAM MANAGER TRAINING.  The training standards required by section 231C.3, subsection 1, paragraph “g”, as enacted in this Act, shall provide that program managers who have completed similar training prior to January 1, 2013, shall not be required to complete additional training to meet the requirement in section 231C.3, subsection 1, paragraph “g”.
EXPLANATION
   This bill amends Code sections related to assisted living programs. The bill adds that the purpose of establishing an assisted living program includes providing consumer protections to ensure program transparency, oversight, and accountability. The bill provides that it is the intent of the general assembly that the department of inspections and appeals provide consistent standards and oversight to ensure protection of consumers of assisted living programs.
   The bill amends the definition of “assisted living” to mean the provision of a social model of housing in a physical structure with services to three or more tenants. The physical structure must balance individual privacy with the benefits of social interaction. The bill provides that the social model must create an environment that supports the tenant in maximizing the highest practicable level of well-being that assists the tenant in maintaining optimal independence and delaying further decline in any existing health, cognitive, mental health, or functional condition.
   The bill amends the definition of “assisted living” to include as required assisted living services, health-related care, the encouragement of family involvement, tenant self-direction, and tenant participation in a manner commensurate with the tenant’s health, cognitive, mental health, and functional status, and access to awake staff 24 hours per day to meet the tenant’s needs commensurate with the tenant’s health, cognitive, mental health, and functional status. The bill provides that assisted living services may include assistance with instrumental activities of daily living.
   The bill requires the department of inspections and appeals (DIA) to establish rules regarding standards for tenant evaluation or assessment. The rules shall require that each prospective tenant’s health, cognitive, mental health, and functional status be evaluated prior to the tenant’s signing the occupancy agreement and taking occupancy of a dwelling unit. The evaluations must be completed using one or two of the standard assessment tools selected by the department. 
   The bill requires that the DIA’s rules regarding tenant service plans provide that daily activities based on the tenant’s abilities, personal interests, and individual assessment shall be planned for a tenant who is unable to plan the tenant’s own activities. The rules regarding tenant service plans also must include the level of staff needed to provide care.
   The bill requires the DIA to establish rules regarding standards for food service at an assisted living program to ensure that a program meets a tenant’s nutritional needs. These standards shall require that the program, at minimum, provide one hot meal per day to all tenants and up to three meals per day for tenants requiring the service. 
   The bill requires the DIA to establish rules regarding standards for employment of program managers. The standards must require new program managers employed on or after January 1, 2013, to have a minimum of three years of study or experience related to older adults and to complete an assisted living management class within six months of initial employment as a program manager. A program manager does not need to complete additional training if the program manager has completed similar training prior to January 1, 2013. 
   The bill provides that a written occupancy agreement shall include the circumstances under which fees, charges, or rates are subject to change and the process for making the changes including a provision for timely notice. The bill also requires a written occupancy agreement to include the specific type and level of services the program provides and the specific health, cognitive, mental health, or functional conditions that prohibit initial occupancy or may necessitate subsequent transfer.
   The bill requires the DIA to adopt rules to implement the bill.