H.F. 570 Section 1. Section 135C.41, subsection 2, Code 2013, is 1 amended to read as follows: 2 2. Notify the director that the facility desires to 3 contest the citation and request an informal conference with 4 a representative of the department an independent reviewer 5 pursuant to section 135C.42 . 6 Sec. 2. Section 135C.42, Code 2013, is amended to read as 7 follows: 8 135C.42 Informal conference on contested citation. 9 1. The director shall assign a representative of the 10 department, other than the inspector upon whose inspection the 11 contested citation is based, provide an independent reviewer 12 to hold an informal conference with the facility within ten 13 working days after receipt of a request made under section 14 135C.41, subsection 2 . At the conclusion of the conference the 15 representative independent reviewer may affirm or may modify or 16 dismiss the citation. In the latter case, the representative 17 The independent reviewer shall state in writing the specific 18 reasons for the affirmation, modification , or dismissal and 19 immediately transmit copies of the statement to the director, 20 and to the facility. If the facility does not desire to 21 further contest an affirmed or modified citation, it shall 22 within five working days after the informal conference, or 23 after receipt of the written explanation of the representative 24 independent reviewer , as the case may be, comply with section 25 135C.41, subsection 1 . 26 2. An independent reviewer shall be licensed as an attorney 27 in the state of Iowa and shall not be employed or have been 28 employed by the department in the past eight years or have 29 appeared in front of the department on behalf of a health care 30 facility in the past eight years. Preference shall be given to 31 an attorney with background knowledge, experience, or training 32 in long-term care. The department may issue a request for 33 proposals to enter into a contract for the purpose of providing 34 one or more independent reviewers for informal conferences. 35 -1- LSB 1705HV (3) 85 ad/nh 1/ 6

H.F. 570 3. The department shall hold the informal conference, 1 as required in this section, concurrently with any informal 2 dispute resolution held pursuant to 42 C.F.R. § 488.331 for 3 those health care facilities certified under Medicare or the 4 medical assistance program. 5 Sec. 3. Section 135C.43, subsection 1, Code 2013, is amended 6 to read as follows: 7 1. A facility which that desires to further contest an 8 affirmed or modified citation for a Class I, Class II, or Class 9 III violation, may do so in the manner provided by chapter 17A 10 for contested cases. Notice of intent to formally contest a 11 citation shall be given the department in writing within five 12 days after the informal conference or after receipt of the 13 written explanation of the representative delegated independent 14 reviewer provided to hold the informal conference, whichever is 15 applicable, in the case of an affirmed or modified citation. 16 A facility which has exhausted all adequate administrative 17 remedies and is aggrieved by the final action of the department 18 may petition for judicial review in the manner provided by 19 chapter 17A . 20 Sec. 4. Section 231C.8, Code 2013, is amended by striking 21 the section and inserting in lieu thereof the following: 22 231C.8 Exit interview —— issuance of findings. 23 1. The department shall provide an assisted living program 24 an exit interview at the conclusion of a monitoring evaluation 25 or complaint investigation, and the department shall inform the 26 program’s representative of all issues and areas of concern 27 related to the insufficient practices. The department may 28 conduct the exit interview in person or by telephone, and 29 the department shall provide a second exit interview if any 30 additional issues or areas of concern are identified. The 31 program shall have two working days from the date of the exit 32 interview to submit additional or rebuttal information to the 33 department. 34 2. The department shall issue the final findings of a 35 -2- LSB 1705HV (3) 85 ad/nh 2/ 6

H.F. 570 monitoring evaluation or complaint investigation within 1 ten working days after completion of the on-site monitoring 2 evaluation or complaint investigation. The final findings 3 shall be served upon the program personally, by electronic 4 mail, or by certified mail. 5 Sec. 5. Section 231C.9, Code 2013, is amended to read as 6 follows: 7 231C.9 Public disclosure of findings. 8 Upon completion of a monitoring evaluation or complaint 9 investigation of an assisted living program by the department 10 pursuant to this chapter , including the conclusion of informal 11 review, the department’s final findings with respect to 12 compliance by the assisted living program with requirements 13 for certification shall be made available to the public 14 in a readily available form and place. Other information 15 relating to an assisted living program that is obtained by 16 the department which does not constitute the department’s 17 final findings from a monitoring evaluation or complaint 18 investigation of the assisted living program shall not be made 19 available to the public except in proceedings involving the 20 denial, suspension, or revocation of a certificate under this 21 chapter . 22 Sec. 6. NEW SECTION . 231C.9A Informal conference —— formal 23 contest —— judicial review. 24 1. Within twenty business days after issuance of the final 25 findings, the assisted living program shall notify the director 26 if the program desires to contest the findings and request an 27 informal conference. 28 2. The department shall provide an independent reviewer to 29 hold an informal conference with an assisted living program 30 within ten working days after receiving a request from the 31 program pursuant to subsection 1. At the conclusion of the 32 informal conference, the independent reviewer may affirm, 33 modify, or dismiss a contested regulatory insufficiency. The 34 independent reviewer shall state in writing the specific 35 -3- LSB 1705HV (3) 85 ad/nh 3/ 6

H.F. 570 reasons for the affirmation, modification, or dismissal and 1 immediately transmit copies of the statement to the department 2 and to the program. 3 3. An independent reviewer shall be licensed as an attorney 4 in the state of Iowa and shall not be employed or have been 5 employed by the department in the past eight years or have 6 appeared in front of the department on behalf of an assisted 7 living program in the past eight years. Preference shall be 8 given to an attorney with background knowledge, experience, 9 or training in long-term care. The department may issue a 10 request for proposals to enter into a contract for the purpose 11 of providing one or more independent reviewers for informal 12 conferences. 13 4. An assisted living program that desires to further 14 contest an affirmed or modified regulatory insufficiency may do 15 so in the manner provided by chapter 17A for contested cases. 16 The program shall give notice of intent to formally contest 17 a regulatory insufficiency, in writing, to the department 18 within five days after receipt of the written decision of the 19 independent reviewer. The formal hearing shall be conducted 20 in accordance with chapter 17A and rules adopted by the 21 department. 22 5. An assisted living program that has exhausted all 23 adequate administrative remedies and is aggrieved by the final 24 action of the department may petition for judicial review in 25 the manner provided by chapter 17A. 26 Sec. 7. APPLICABILITY. 27 1. The sections of this Act amending sections 135C.41, 28 135C.42, and 135C.43 apply to an informal conference requested 29 under chapter 135C on or after January 1, 2014. 30 2. The sections of this Act amending sections 231C.8 and 31 231C.9, and adding section 231C.9A, apply to assisted living 32 programs desiring to request an informal conference on or after 33 January 1, 2014. 34 EXPLANATION 35 -4- LSB 1705HV (3) 85 ad/nh 4/ 6

H.F. 570 This bill relates to informal conferences on contested 1 citations in health care facilities or assisted living 2 programs. Currently, the director of the department of 3 inspections and appeals (DIA) assigns a representative of the 4 department who was not involved in the contested citation 5 to hold an informal conference with a health care facility 6 within 10 working days after receipt of a request made by the 7 facility to contest a citation. The bill would require that an 8 independent reviewer hold the informal conference concurrently 9 with any informal dispute resolution required by federal 10 regulations rather than a representative of DIA. The bill 11 provides that the independent reviewer must be an Iowa-licensed 12 attorney that has not appeared in front of DIA on behalf of a 13 health care facility in the past eight years and has not been 14 employed by DIA in the last eight years. Preference for the 15 position of independent reviewer is given to persons who have 16 experience or training in geriatric long-term care. 17 The bill also changes the process for assisted living 18 programs that receive a regulatory insufficiency and wish to 19 contest that finding. Current law allows assisted living 20 programs to request an informal review of contested regulatory 21 insufficiencies, but does not provide for an exit interview or 22 an informal conference. The bill removes the current informal 23 review process and replaces it with an exit interview and 24 informal conference in a manner similar to that provided for 25 health care facilities, as amended in the bill. 26 At the completion of the informal conference, the 27 independent reviewer may affirm, modify, or dismiss the 28 regulatory insufficiency. The reviewer must provide written 29 specific reasons for the decision and immediately transmit 30 copies of the written statement to DIA and to the program. If, 31 after receiving the reviewer’s statement, the program no longer 32 wishes to contest the decision, the program shall comply with 33 the payment of any civil penalty. 34 If an assisted living program wants to further contest the 35 -5- LSB 1705HV (3) 85 ad/nh 5/ 6

H.F. 570 independent reviewer’s affirmation or modification of the 1 regulatory insufficiency, the program may do so pursuant to 2 chapter 17A for contested cases. The program must provide 3 DIA with written notice of the intent to formally contest a 4 regulatory insufficiency within five days of receiving the 5 independent reviewer’s written decision. A formal hearing will 6 be conducted pursuant to Code chapter 17A and rules adopted by 7 DIA. After exhausting administrative remedies, a program may 8 petition for judicial review pursuant to Code chapter 17A. 9 The bill applies to an informal conference requested by 10 a health care facility under Code chapter 135C on or after 11 January 1, 2014, and to assisted living programs desiring to 12 request an informal conference under Code chapter 231C on or 13 after January 1, 2014. 14 -6- LSB 1705HV (3) 85 ad/nh 6/ 6