S.F. 250 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 2011, is amended 16 to read as follows: 17 2. a. “Assisted living” means the provision of a social 18 model of housing with services to three or more tenants in 19 which may : 20 (1) The services offered include but are not limited to , at 21 a minimum, health-related care , or personal care, or both, and 22 may include assistance with instrumental activities of daily 23 living to three or more tenants . However, “assisted living” 24 does not include the provision of housing and assistance with 25 instrumental activities of daily living unless personal care or 26 health-related care is also offered. 27 (2) The housing is provided in a physical structure which 28 provides offers a homelike environment that balances individual 29 privacy with the benefits of social interaction . 30 (3) The social model provides an environment that supports 31 each tenant in maximizing the tenant’s highest practicable 32 level of well-being through individualized, stimulating, and 33 purposeful activities; connections to and interaction with the 34 outside community; and other interventions that assist a tenant 35 -1- LSB 1530XS (3) 84 pf/nh 1/ 16

S.F. 250 in maintaining optimal independence while delaying further 1 decline from any existing medical, cognitive, or functional 2 condition. 3 b. “Assisted living” also includes encouragement of family 4 involvement, tenant self-direction, and tenant participation 5 in decisions that emphasize choice, dignity, privacy, 6 individuality, shared risk, and independence , commensurate 7 with the tenant’s medical, cognitive, and functional status . 8 “Assisted living” includes the provision of housing and 9 assistance with instrumental activities of daily living only if 10 personal care or health-related care is also included. 11 c. “Assisted living” includes twenty-four hours per day 12 response staff to meet a tenant’s scheduled and unscheduled or 13 unpredictable needs , commensurate with the tenant’s medical, 14 cognitive, and functional status, in a manner that promotes 15 maximum dignity and independence and provides supervision, 16 safety, and security. 17 d. “Assisted living” includes any entity that meets the 18 definition of assisted living under this subsection, whether 19 or not the entity represents the entity to the public as an 20 assisted living program or as a certified assisted living 21 program, including an entity that decertifies a program 22 but continues to provide housing and continues to be or 23 subsequently becomes the sole provider of assistance with 24 instrumental activities of daily living, personal care, or 25 health-related care, by whatever means employed or contracted, 26 including through a subsidiary, parent, or related corporation. 27 Sec. 4. Section 231C.2, Code 2011, is amended by adding the 28 following new subsection: 29 NEW SUBSECTION . 2A. “Assisted living program” or “program” 30 means an entity that provides assisted living. 31 Sec. 5. Section 231C.3, subsection 1, paragraphs a and c, 32 Code 2011, are amended to read as follows: 33 a. Provisions to ensure, to the greatest extent possible, 34 the health, safety, and well-being and appropriate treatment 35 -2- LSB 1530XS (3) 84 pf/nh 2/ 16

S.F. 250 of tenants. The rules shall establish quality and level of 1 care criteria and standards to ensure adequate and appropriate 2 care for tenants and consistent application of the criteria 3 and standards by programs. The criteria and standards shall 4 specify the types and levels of care that are required and 5 shall identify the specific medical, cognitive, and functional 6 needs of a tenant that are beyond the capacity of an assisted 7 living program level of care. 8 c. Standards for tenant initial and ongoing evaluation or 9 assessment , of and service plans , which may vary in accordance 10 with for tenants. The service plan shall specify the nature of 11 the services to be provided or to meet the individual needs of 12 the tenant as determined by the evaluation and assessment of 13 the medical, cognitive, and functional status of the tenant. 14 When a tenant needs personal care or health-related care, the A 15 preliminary service plan shall be developed prior to a tenant’s 16 occupancy and updated within thirty days of occupancy and as 17 needed with necessitated by significant change, but not less 18 than annually. 19 Sec. 6. Section 231C.3, subsection 1, Code 2011, is amended 20 by adding the following new paragraphs: 21 NEW PARAGRAPH . e. (1) A uniform consumer disclosure 22 statement. The purpose of the uniform consumer disclosure 23 statement is to empower consumers, through a uniform 24 description of the policies, environments, staffing, and 25 services of assisted living programs, to effectively compare 26 programs. 27 (2) The rules shall require that, at a minimum, the uniform 28 consumer disclosure statement provide all of the following 29 information: contact information for the program; the sources 30 of payment accepted; the types and level of care and services 31 provided by the program and specific criteria including 32 conditions that prohibit occupancy; the services provided 33 including but not limited to assistance with instrumental 34 activities of daily living, health-related care, personal 35 -3- LSB 1530XS (3) 84 pf/nh 3/ 16

S.F. 250 care, environmental and social aspects of the program, dietary 1 services, medication-related services, and specialized care 2 or services; privacy options for dwelling units; the specific 3 criteria for discharge or transfer; staffing patterns and staff 4 qualifications and training requirements; and information about 5 tenants’ rights. 6 (3) The rules shall require an assisted living program 7 to provide the disclosure statement to the department, to a 8 consumer upon request, and to a prospective tenant prior to 9 execution of an occupancy agreement. 10 (4) The rules shall require that any marketing materials 11 accurately reflect the information provided in the uniform 12 consumer disclosure statement. 13 NEW PARAGRAPH . f. Staffing requirements including but 14 not limited to staff qualifications such as appropriate 15 professional licensure, education, skills, training, and 16 experience; requirements for and sources of initial and 17 continuing staff training; minimum age requirements for direct 18 care staff; and requirements to provide sufficient direct care 19 staff in number and qualifications to support each tenant’s 20 needs as identified in the tenant’s evaluation, occupancy 21 agreement, and service plan and to meet the twenty-four-hour 22 scheduled and unscheduled or unpredictable needs of all 23 tenants. The staffing requirements shall also provide that 24 direct care staff shall be trained or certified, as applicable 25 to the skill, in emergency procedures, basic first aid, 26 cardiopulmonary resuscitation, and the Heimlich maneuver. 27 NEW PARAGRAPH . g. Prohibition of guarantor agreements. 28 NEW PARAGRAPH . h. Prohibition of transfer, involuntary 29 transfer, or termination of tenancy based solely on source of 30 payment, if the program accepts third-party payment. 31 NEW PARAGRAPH . i. Requirements regarding fees, costs, and 32 charges, which shall require that fees, costs, and charges be 33 reasonable; that periodic or annual automatic increases are 34 prohibited; and that prior to any increase in fees, costs, 35 -4- LSB 1530XS (3) 84 pf/nh 4/ 16

S.F. 250 or charges the program must provide notice and specific, 1 documented justification for the increase to the tenant. 2 Sec. 7. Section 231C.3, subsection 3, Code 2011, is amended 3 to read as follows: 4 3. a. The owner or manager of a certified assisted living 5 program shall comply with the rules adopted by the department 6 for an assisted living program. 7 b. A person, including a governmental unit, that meets 8 the definition of assisted living pursuant to section 231C.2 9 shall be considered an assisted living program whether or not 10 the person represents the person to the public as an assisted 11 living program or as a certified assisted living program, and 12 shall not operate in this state unless and until the assisted 13 living program is certified pursuant to this chapter. 14 c. A person , including a governmental unit , shall not 15 represent an assisted living program to the public as an 16 assisted living program or as a certified assisted living 17 program unless and until the program is certified pursuant to 18 this chapter . 19 Sec. 8. Section 231C.3, subsection 4, paragraph a, Code 20 2011, is amended to read as follows: 21 a. Services provided by a certified assisted living program 22 to an individual tenant as specified in the occupancy agreement 23 and service plan may be provided directly by staff of the 24 assisted living program , or by individuals contracting with the 25 assisted living program to provide services , or by individuals 26 employed by the . A tenant or with whom the tenant contracts 27 may employ or contract with individuals to provide services 28 not specified in the occupancy agreement or service plan if 29 the services provided do not result in the tenant exceeding 30 occupancy criteria, the provision of services does not affect 31 the health or safety of other tenants, and the tenant agrees 32 to assume the responsibility and risk of the employment or the 33 contractual relationship. 34 Sec. 9. Section 231C.5, Code 2011, is amended to read as 35 -5- LSB 1530XS (3) 84 pf/nh 5/ 16

S.F. 250 follows: 1 231C.5 Written occupancy agreement required. 2 1. a. An assisted living program shall not operate in this 3 state unless a written occupancy agreement, as prescribed in 4 subsection 2 , is executed between the assisted living program 5 and each tenant or the tenant’s legal representative, prior 6 to the tenant’s occupancy, and unless the assisted living 7 program operates in accordance with the terms of the occupancy 8 agreement. 9 b. The assisted living program shall deliver to the 10 tenant or the tenant’s legal representative a complete copy 11 of the occupancy agreement and all supporting documents and 12 attachments and shall deliver, at least thirty days prior 13 to any changes, a written copy of changes to the occupancy 14 agreement if any changes to the copy originally delivered are 15 subsequently made. 16 2. An assisted living program occupancy agreement shall 17 clearly describe the rights and responsibilities of the tenant 18 and the program. The occupancy agreement shall also include 19 but is not limited to inclusion of all of the following 20 information in the body of the agreement or in the supporting 21 documents and attachments: 22 a. A description of all fees, charges, and rates describing 23 tenancy and basic services covered, and any additional and 24 optional services and their related costs. The occupancy 25 agreement shall also include the circumstances under which 26 fees, charges, or rates are subject to change, and the process 27 by which such changes are made including but not limited to 28 provision of timely notice and documented justification of any 29 such change to the tenants. 30 b. (1) A statement regarding the impact of the fee 31 structure on third-party payments, and whether third-party 32 payments and resources are accepted by the assisted living 33 program. 34 (2) The occupancy agreement shall specifically include a 35 -6- LSB 1530XS (3) 84 pf/nh 6/ 16

S.F. 250 statement regarding each of the following: 1 (a) Whether the program requires disclosure of a tenant’s 2 personal financial information for occupancy or continued 3 occupancy. 4 (b) Whether the program requires private payment for a 5 specified period of time as a prerequisite to acceptance of 6 third-party payment, and the time period so required, if any. 7 Specifically, the occupancy agreement shall include a statement 8 regarding whether the program accepts medical assistance as a 9 payment source for new tenants or existing tenants. 10 (c) The program’s policy regarding retention, transfer, 11 or involuntary transfer of a tenant following exhaustion of 12 private resources. Specifically, the occupancy agreement shall 13 include a statement regarding whether a tenant who exhausts 14 private resources is permitted to continue tenancy with medical 15 assistance as a source of payment. 16 (d) The policy of the program regarding continuation of the 17 tenancy of an individual for whom a third party is responsible 18 for payment, if the program withdraws from participation in a 19 third-party payment program or is otherwise no longer eligible 20 for payment through the third party. 21 (e) Contact information for governmental agencies to assist 22 tenants in accessing third-party payment sources. 23 (f) That if the program accepts third-party payment, 24 the program is prohibited from transferring, involuntarily 25 transferring, or otherwise terminating tenancy based solely on 26 the tenant’s source of payment. 27 c. The procedure followed for nonpayment of fees. 28 d. Identification of the party responsible for payment of 29 fees and identification of the tenant’s legal representative, 30 if any. The occupancy agreement shall include a statement that 31 the program is prohibited from utilizing guarantor agreements. 32 e. The term of the occupancy agreement. 33 f. A statement that the assisted living program shall notify 34 the tenant or the tenant’s legal representative, as applicable, 35 -7- LSB 1530XS (3) 84 pf/nh 7/ 16

S.F. 250 in writing at least thirty days prior to any change being made 1 in the occupancy agreement with the following exceptions: 2 (1) When the tenant’s health status or behavior constitutes 3 a substantial threat to the health or safety of the tenant, 4 other tenants, or others, including when the tenant refuses to 5 consent to relocation. 6 (2) When an emergency or a significant change in the 7 tenant’s condition results in the need for the provision of 8 services that exceed the type or level of services included 9 in the occupancy agreement and the necessary services cannot 10 be safely provided by the assisted living program which the 11 program is certified to provide by law and as specified in the 12 uniform consumer disclosure statement . 13 g. A statement that all tenant information shall be 14 maintained in a confidential manner to the extent required 15 under state and federal law. 16 h. Occupancy, involuntary transfer, and transfer criteria 17 and procedures, which ensure a safe and orderly transfer. 18 The occupancy agreement shall specifically state the type 19 and level of services the program can safely provide and the 20 specific medical, cognitive, or functional conditions that, by 21 law, prohibit initial occupancy or may necessitate subsequent 22 transfer or involuntary transfer. 23 i. The internal appeals process provided relative to an 24 involuntary transfer. 25 j. The program’s policies and procedures for addressing 26 grievances between the assisted living program and the tenants, 27 including grievances relating to transfer and occupancy. 28 k. A statement of the prohibition against retaliation as 29 prescribed in section 231C.13 . 30 l. The emergency response policy. 31 m. (1) Staff qualifications including but not limited 32 to professional licensure, education, skills, training, 33 and experience; requirements for and sources of initial and 34 continuing staff training; and the staffing plan to provide 35 -8- LSB 1530XS (3) 84 pf/nh 8/ 16

S.F. 250 direct care staff sufficient in number and qualifications 1 to meet the twenty-four-hour scheduled and unscheduled or 2 unpredictable needs of the tenants and, specifically, to 3 support the needs of each tenant as identified in the tenant’s 4 evaluation and service plan. 5 m. (2) The staffing policy which specifies shall specify if 6 nurse delegation will be used, and how staffing will be adapted 7 to meet changing tenant needs. 8 (3) The staffing policy shall specify that all direct 9 care staff are trained or certified, as applicable to the 10 specific skill, in emergency procedures, basic first aid, 11 cardiopulmonary resuscitation, and the Heimlich maneuver. 12 n. (1) A description of the specific services and 13 programming to be provided to meet the individualized needs of 14 the tenant as determined through the tenant’s evaluation or 15 assessment and to be included in the tenant’s service plan. 16 (2) The statement of services shall address, at a minimum, 17 the areas of instrumental activities of daily living, personal 18 care, and health-related care to be provided to a tenant. 19 (3) The statement of programming shall inform the tenant of 20 the individualized and group activities to be provided; whether 21 the program has a qualified staff person devoted solely to 22 activities; and that the program is required to provide a daily 23 program of planned and spontaneous activities that are based 24 upon a tenant’s abilities and personal interests. 25 n. (4) In dementia-specific assisted living programs, a 26 description of the services and programming provided to meet 27 the life skills and social activities of tenants. 28 o. The refund policy. 29 p. A statement regarding billing and payment procedures. 30 3. Occupancy agreements and related documents executed 31 by each tenant or the tenant’s legal representative shall be 32 maintained by the assisted living program in program files 33 from the date of execution until three years from the date 34 the occupancy agreement is terminated. A copy of the most 35 -9- LSB 1530XS (3) 84 pf/nh 9/ 16

S.F. 250 current occupancy agreement shall be provided to members of the 1 general public, upon request. Occupancy agreements and related 2 documents shall be made available for on-site inspection to the 3 department upon request and at reasonable times. 4 Sec. 10. NEW SECTION . 231C.11A Voluntary cessation of 5 program operations —— decertification. 6 1. The department shall adopt rules regarding the voluntary 7 cessation of program operations of an assisted living 8 program, including decertification. The rules shall address 9 notification of the tenants, tenant legal representatives, the 10 department, and the tenant advocate at least ninety days prior 11 to the anticipated date of cessation of program operations; the 12 requirements for the safe and orderly transfer or transition of 13 all tenants; and monitoring of the program during the process 14 and after cessation of program operations. 15 2. Within seven days following provision of notice of 16 cessation of program operations, the assisted living program 17 shall hold a meeting and invite all tenants, tenant legal 18 representatives, families of tenants, representatives of the 19 department, and the tenant advocate to discuss the pending 20 cessation of the program and to answer any questions. The 21 department and the tenant advocate shall have access to attend 22 the meeting and provide information to the tenants regarding 23 their legal rights. 24 3. The tenant advocate shall monitor the decertification 25 process and shall undertake any investigations necessary to 26 ensure that the rights of tenants are protected during the 27 process and after cessation of program operations. The tenant 28 advocate shall assist tenants during the transition, including 29 assisting tenants in finding necessary and appropriate service 30 providers if the assisted living program is unable to provide 31 such necessary and appropriate services during the transition 32 period. Under such circumstances, the assisted living program 33 shall cooperate with the tenant advocate by providing contact 34 information for service providers within a thirty-mile radius 35 -10- LSB 1530XS (3) 84 pf/nh 10/ 16

S.F. 250 of the program. 1 4. The rules shall also require the escrowing of sufficient 2 funds by the assisted living program to cover the cost of 3 housing and services during the tenant’s period of transition 4 and during the individual’s tenancy in a subsequent certified 5 assisted living program, if the assisted living program 6 confirmed in the occupancy agreement or other instrument 7 acceptance of third-party payment or that the program would 8 not discharge a tenant based on source of payment. Such 9 payments shall be made during the transition period and 10 subsequent tenancy until such time as the tenant is eligible 11 for third-party payment as specified by the subsequent assisted 12 living program. 13 5. Following cessation of program operations and 14 decertification, the department shall retain authority to 15 monitor the decertified program to ensure that the entity does 16 not continue to act as an uncertified assisted living program 17 or other unlicensed, uncertified, or unregistered entity 18 otherwise regulated by the state following decertification. 19 If a decertified assisted living program continues to or 20 subsequently acts in a manner that meets the definition of 21 assisted living pursuant to section 231C.2, the decertified 22 program is subject to the criminal penalties and injunctive 23 relief provisions of section 231C.15, and any other penalties 24 applicable by law. 25 Sec. 11. Section 231C.17, subsections 2 and 3, Code 2011, 26 are amended to read as follows: 27 2. This chapter shall not be construed to require that a 28 facility licensed as a different type of facility also comply 29 with the requirements of this chapter , unless the facility 30 is represented to the public as a certified assisted living 31 program , or unless the facility meets the definition of 32 assisted living pursuant to section 231C.2 and the different 33 type of facility for which the facility is licensed provides a 34 less intensive type and level of services and housing . 35 -11- LSB 1530XS (3) 84 pf/nh 11/ 16

S.F. 250 3. A certified assisted living program that complies with 1 the requirements of this chapter shall not be required to be 2 licensed or certified as a different type of facility, unless 3 the facility is represented to the public as another type of 4 facility , or unless the facility meets the definition of the 5 different type of facility and the different type of facility 6 provides a more intensive type and level of services and 7 housing . 8 Sec. 12. RESIDENTIAL CARE CONTINUUM FOR OLDER INDIVIDUALS 9 —— REVIEW AND RECOMMENDATIONS. 10 1. The office of the long-term care resident’s advocate, 11 in cooperation with the university of Iowa center on aging, 12 shall undertake an independent review of the residential care 13 continuum for older individuals, as defined in section 231.4, 14 in the state. The review shall address the specific role of 15 assisted living in the continuum and shall also address the 16 overall design of the current and necessary future residential 17 care continuum for older individuals. 18 2. The independent review shall examine the entire 19 residential care continuum for older individuals, specifically 20 including independent living, assisted living, and nursing 21 facilities. The purposes of the review shall include all of 22 the following: 23 a. To determine the demographics and profile of the current 24 population of older individuals residing in residential care 25 in the state. 26 b. To determine the current composition of the residential 27 care continuum available for older individuals including but 28 not limited to the spectrum of living arrangements, level of 29 care criteria, services, staffing requirements, and degree of 30 regulation. 31 c. To determine if adequate consumer protections exist for 32 older individuals as they move through the residential care 33 continuum, and to make recommendations to improve protections 34 for consumers. 35 -12- LSB 1530XS (3) 84 pf/nh 12/ 16

S.F. 250 d. To determine if the residential care continuum as 1 currently designed will meet the needs of older individuals of 2 all income levels in the future, and to make recommendations 3 for necessary changes to achieve the appropriate continuum. 4 The recommendations shall address the balance between providing 5 the option for older individuals to age in place and the 6 obligation of residential care providers to provide the 7 necessary and appropriate environment, services, and staffing 8 at each level of care. The recommendations shall also include 9 but are not limited to the purpose and targeted population 10 of and the services and support that can appropriately be 11 provided by each residential care option in the continuum; a 12 determination of the specific standards and criteria to provide 13 a consistent means of determining the point of transition 14 between each level of care; specific standards and requirements 15 for direct care and other staff qualifications, education, and 16 training for each level of care; physical environment standards 17 and requirements including fire and safety provisions; and 18 standards for social and functional interventions to assist 19 older individuals in maintaining optimal independence while 20 preventing deterioration from any existing medical, cognitive, 21 or functional conditions. 22 e. To make recommendations for providing affordable 23 residential care options to all older individuals. 24 f. To make recommendations for the broader residential care 25 continuum by addressing the needs of other populations beyond 26 older individuals, including but not limited to persons with 27 neurodegenerative diseases. 28 g. To determine a means of aligning residential care 29 capacity with the location and needs of consumers. The 30 determination shall specifically consider whether assisted 31 living programs should be subject to certificate of need 32 requirements in order to facilitate alignment and ensure that 33 residential care options are available in all geographic areas 34 of the state and to consumers at all income levels. 35 -13- LSB 1530XS (3) 84 pf/nh 13/ 16

S.F. 250 h. To determine financial and other incentives to promote 1 the necessary residential care continuum. 2 3. In undertaking the review, the office of the long-term 3 care resident’s advocate, in cooperation with the university 4 of Iowa center on aging, shall solicit input from consumers 5 and consumer advocates, residential care providers, health 6 care professionals and other residential care staff, and other 7 entities involved in the care and support of older individuals. 8 4. The office of the long-term care resident’s advocate and 9 the university of Iowa center on aging shall submit a report of 10 the independent review to the governor and the general assembly 11 no later than January 16, 2012. 12 EXPLANATION 13 This bill relates to long-term residential living options. 14 The bill addresses provisions relating to assisted living 15 including the purposes of and intent behind assisted living, 16 the definition of assisted living, and rules relating to 17 assisted living. The bill includes in the purposes of assisted 18 living standards, the provision of consumer protections to 19 ensure program transparency, oversight, and accountability. 20 The bill also includes in the intent for assisted living 21 to provide consistent standards and oversight to ensure 22 protection of consumers. The bill amends the definition of 23 “assisted living” to provide that the encouragement of tenant 24 independence and choice shall be commensurate with the tenant’s 25 medical, cognitive, and functional status and to provide that 26 assisted living includes services that at a minimum include 27 either health-related care or personal care, or both, but that 28 assisted living does not include the provision of housing and 29 assistance with instrumental activities of daily living unless 30 personal care or health-related care is also offered. 31 The bill also provides that the definition of “assisted 32 living” includes any entity that meets the definition of 33 assisted living whether or not the entity represents itself 34 to the public as an assisted living program or as a certified 35 -14- LSB 1530XS (3) 84 pf/nh 14/ 16

S.F. 250 assisted living program, including an entity that decertifies a 1 program but continues to provide housing and continues to be 2 or subsequently becomes the sole provider of assistance with 3 instrumental activities of daily living, personal care, or 4 health-related care, by whatever means employed or contracted, 5 including through a subsidiary, parent, or related corporation. 6 The bill directs that assisted living rules are to establish 7 quality and level of care criteria and standards to ensure 8 adequate and appropriate care for tenants and consistent 9 application by assisted living programs; establish standards 10 for evaluation and assessment of tenants and for service plans 11 to meet the individual needs of the tenant; provide for a 12 uniform consumer disclosure statement to empower consumers 13 in effectively comparing programs; staffing requirements; 14 the prohibition of guarantor agreements; the prohibition of 15 transfer, involuntary transfer, or termination of tenancy 16 based solely on the source of payment if the program accepts 17 third-party payment; and requirements regarding notice and 18 information required to be provided applicable to fees, costs, 19 and charges. 20 The bill provides that if a person meets the definition 21 of assisted living, whether or not the person represents 22 the person to the public as an assisted living program or a 23 certified assisted living program, the person is considered an 24 assisted living program and is prohibited from operating in the 25 state unless and until it is certified. 26 The bill also provides that services provided by a certified 27 assisted living program to individual tenants as specified 28 in an occupancy agreement and service plan may be provided 29 directly by staff of the program or by individuals contracting 30 with the program. Additionally, a tenant may employ or 31 contract for services not included in the occupancy agreement 32 and service plan if the services do not result in the tenant 33 exceeding occupancy criteria, the provision of services does 34 not affect the health or safety of other tenants, and the 35 -15- LSB 1530XS (3) 84 pf/nh 15/ 16

S.F. 250 tenant assumes the responsibility and risk of the contractual 1 relationship. 2 The bill specifies information to be included in an 3 occupancy agreement including information relating to fees, 4 charges, and rates; third-party payment; that guarantor 5 agreements are prohibited; specific information regarding 6 occupancy and transfer criteria; and staffing-related 7 information. 8 The bill provides a procedure for voluntary cessation of a 9 program and requires as part of the procedure that the program 10 escrow sufficient funds to assist tenants in the transition to 11 subsequent housing and services. 12 The bill provides for an independent review of the 13 residential care continuum for older individuals and specifies 14 the purposes of the review. The review is to be undertaken 15 by the office of the long-term care resident’s advocate in 16 cooperation with the university of Iowa center on aging, with a 17 final report to be submitted to the governor and the general 18 assembly by January 16, 2012. 19 -16- LSB 1530XS (3) 84 pf/nh 16/ 16