S.F. _____ H.F. _____ Section 1. Section 135B.34, subsection 2, paragraph b, 1 subparagraph (2), Code 2014, is amended to read as follows: 2 (2) Subparagraph (1) applies to a crime that is a simple 3 misdemeanor offense under section 123.47 or chapter 321 , and 4 to a crime that is a first offense of operating a motor vehicle 5 while intoxicated under section 321J.2, subsection 1 . 6 Sec. 2. Section 135C.10, subsection 9, Code 2014, is amended 7 to read as follows: 8 9. In the case of an application by an existing licensee 9 for a new or newly acquired facility, continuing or repeated 10 failure of the licensee to operate any previously licensed 11 facility or facilities in compliance with the provisions of 12 this chapter or of , the rules adopted pursuant to it this 13 chapter, or equivalent provisions that the facility is subject 14 to in this state or any other state . 15 Sec. 3. Section 135C.10, Code 2014, is amended by adding the 16 following new subsection: 17 NEW SUBSECTION . 11. Impeding the department’s ability to 18 ensure the facility’s compliance with this chapter or with 19 rules adopted pursuant to this chapter. 20 Sec. 4. Section 135C.11, subsection 2, Code 2014, is amended 21 to read as follows: 22 2. The procedure governing hearings authorized by this 23 section shall be in accordance with the rules promulgated by 24 the department. A full and complete record shall be kept 25 of all proceedings, and all testimony shall be reported but 26 need not be transcribed unless judicial review is sought 27 pursuant to section 135C.13 . Copies of the transcript may be 28 obtained by an interested party upon payment of the cost of 29 preparing the copies. Witnesses may be subpoenaed by either 30 party and shall be allowed fees at a rate prescribed by the 31 department’s rules. The director may, after advising the 32 certified volunteer long-term care ombudsman a representative 33 of the office of long-term care ombudsman , either proceed in 34 accordance with section 135C.30 , or remove all residents and 35 -1- LSB 5304XD (4) 85 ad/nh 1/ 14

S.F. _____ H.F. _____ suspend the license or licenses of any health care facility, 1 prior to a hearing, when the director finds that the health 2 or safety of residents of the health care facility requires 3 such action on an emergency basis. The fact that a certified 4 volunteer long-term care ombudsman has not been appointed for a 5 particular facility shall not bar the director from exercising 6 the emergency powers granted by this subsection with respect 7 to that facility. 8 Sec. 5. Section 135C.13, Code 2014, is amended to read as 9 follows: 10 135C.13 Judicial review. 11 Judicial review of any action of the director may be sought 12 in accordance with the terms of the Iowa administrative 13 procedure Act, chapter 17A . Notwithstanding the terms of 14 chapter 17A , petitions for judicial review may be filed in the 15 district court of the county where the facility or proposed 16 facility is located, and pending final disposition of the 17 matter the status quo of the applicant or licensee shall be 18 preserved except when the director, with the advice and consent 19 after advising a representative of the certified volunteer 20 office of long-term care ombudsman, determines that the health, 21 safety , or welfare of the residents of the facility is in 22 immediate danger, in which case the director may order the 23 immediate removal of such residents. The fact that a certified 24 volunteer long-term care ombudsman has not been appointed for a 25 particular facility shall not bar the director from exercising 26 the emergency powers granted by this section with respect to 27 that facility. 28 Sec. 6. Section 135C.14, subsection 8, paragraph d, Code 29 2014, is amended to read as follows: 30 d. The notification of certified volunteer the office 31 of long-term care ombudsmen ombudsman by the department of 32 all complaints relating to health care facilities and the 33 involvement of the certified volunteer office of long-term care 34 ombudsmen ombudsman in resolution of the complaints. 35 -2- LSB 5304XD (4) 85 ad/nh 2/ 14

S.F. _____ H.F. _____ Sec. 7. Section 135C.16, subsection 3, Code 2014, is amended 1 to read as follows: 2 3. An inspector authorized representative of the department 3 may enter any licensed health care facility without a 4 warrant, and may examine all records pertaining to the care 5 provided residents of the facility. An inspector authorized 6 representative of the department may contact or interview 7 any resident, employee, or any other person who might have 8 knowledge about the operation of a health care facility. 9 An inspector authorized representative of the department 10 of human services shall have the same right with respect 11 to any facility where one or more residents are cared for 12 entirely or partially at public expense, and an investigator 13 authorized representative of the designated protection and 14 advocacy agency shall have the same right with respect to 15 any facility where one or more residents have developmental 16 disabilities or mental illnesses, and the state fire marshal 17 or a deputy appointed pursuant to section 135C.9, subsection 18 1 , paragraph “b” , shall have the same right of entry into any 19 facility and the right to inspect any records pertinent to 20 fire safety practices and conditions within that facility , and 21 an authorized representative of the office of long-term care 22 ombudsman shall have the same right with respect to any nursing 23 facility or residential care facility . If any such inspector 24 authorized representative has probable cause to believe that 25 any institution, building, or agency not licensed as a health 26 care facility is in fact a health care facility as defined 27 by this chapter , and upon producing identification that the 28 individual is an inspector authorized representative is denied 29 entry thereto for the purpose of making an inspection, the 30 inspector authorized representative may, with the assistance 31 of the county attorney of the county in which the purported 32 health care facility is located, apply to the district court 33 for an order requiring the owner or occupant to permit entry 34 and inspection of the premises to determine whether there have 35 -3- LSB 5304XD (4) 85 ad/nh 3/ 14

S.F. _____ H.F. _____ been any violations of this chapter . 1 Sec. 8. Section 135C.17, Code 2014, is amended to read as 2 follows: 3 135C.17 Duties of other departments. 4 It shall be the duty of the department of human services, 5 state fire marshal, office of long-term care ombudsman, and 6 the officers and agents of other state and local governmental 7 units, and the designated protection and advocacy agency to 8 assist the department in carrying out the provisions of this 9 chapter , insofar as the functions of these respective offices 10 and departments are concerned with the health, welfare, and 11 safety of any resident of any health care facility. It shall 12 be the duty of the department to cooperate with the protection 13 and advocacy agency and the office of long-term care ombudsman 14 by responding to all reasonable requests for assistance and 15 information as required by federal law and this chapter . 16 Sec. 9. Section 135C.19, subsection 2, paragraph b, Code 17 2014, is amended to read as follows: 18 b. A copy of each citation required to be posted by this 19 subsection shall be sent by the department to the department 20 of human services and , to the designated protection and 21 advocacy agency if the facility has one or more residents 22 with developmental disabilities or mental illness , and to the 23 office of long-term care ombudsman if the facility is a nursing 24 facility or residential care facility . 25 Sec. 10. Section 135C.33, subsection 2, paragraph b, 26 subparagraph (2), Code 2014, is amended to read as follows: 27 (2) Subparagraph (1) applies to a crime that is a simple 28 misdemeanor offense under section 123.47 or chapter 321 , and 29 to a crime that is a first offense of operating a motor vehicle 30 while intoxicated under section 321J.2, subsection 1 . 31 Sec. 11. Section 135C.33, subsection 8, paragraph d, 32 subparagraph (2), Code 2014, is amended to read as follows: 33 (2) Subparagraph (1) applies to a crime that is a simple 34 misdemeanor offense under section 123.47 or chapter 321 , and 35 -4- LSB 5304XD (4) 85 ad/nh 4/ 14

S.F. _____ H.F. _____ to a crime that is a first offense of operating a motor vehicle 1 while intoxicated under section 321J.2, subsection 1 . 2 Sec. 12. Section 135C.38, subsection 1, paragraphs a and c, 3 Code 2014, are amended to read as follows: 4 a. Upon receipt of a complaint made in accordance with 5 section 135C.37 , the department or certified volunteer 6 long-term care ombudsman shall make a preliminary review of 7 the complaint. Unless the department or certified volunteer 8 long-term care ombudsman concludes that the complaint is 9 intended to harass a facility or a licensee or is without 10 reasonable basis, the department or certified volunteer 11 long-term care ombudsman shall make or cause to be made an 12 on-site inspection of the health care facility which is the 13 subject of the complaint within the time period determined 14 pursuant to the following guidelines, which period shall 15 commence on the date of receipt of the complaint: 16 (1) For nursing facilities, an on-site inspection shall be 17 initiated as follows: 18 (a) Within two working days for a complaint determined by 19 the department or certified volunteer long-term care ombudsman 20 to be an alleged immediate jeopardy situation. 21 (b) Within ten working days for a complaint determined by 22 the department or certified volunteer long-term care ombudsman 23 to be an alleged high-level, nonimmediate jeopardy situation. 24 (c) Within forty-five calendar days for a complaint 25 determined by the department or certified volunteer long-term 26 care ombudsman to be an alleged nonimmediate jeopardy 27 situation, other than a high-level situation. 28 (2) For all other types of health care facilities, an 29 on-site inspection shall be initiated as follows: 30 (a) Within two working days for a complaint determined by 31 the department or certified volunteer long-term care ombudsman 32 to be an alleged immediate jeopardy situation. 33 (b) Within twenty working days for a complaint determined by 34 the department or certified volunteer long-term care ombudsman 35 -5- LSB 5304XD (4) 85 ad/nh 5/ 14

S.F. _____ H.F. _____ to be an alleged high-level, nonimmediate jeopardy situation. 1 (c) Within forty-five calendar days for a complaint 2 determined by the department or certified volunteer long-term 3 care ombudsman to be an alleged nonimmediate jeopardy 4 situation, other than a high-level situation. 5 c. The department may refer to the certified volunteer a 6 representative of the office of long-term care ombudsman of a 7 facility any complaint received by the department regarding 8 that a facility, for initial evaluation and appropriate action 9 by the certified volunteer office of long-term care ombudsman. 10 Sec. 13. Section 135C.38, subsection 2, paragraph a, Code 11 2014, is amended to read as follows: 12 a. The complainant shall be promptly informed of the result 13 of any action taken by the department or certified volunteer 14 the office of long-term care ombudsman in the matter. The 15 complainant shall also be notified of the name, address, and 16 telephone number of the designated protection and advocacy 17 agency if the alleged violation involves a facility with one 18 or more residents with developmental disabilities or mental 19 illness. 20 Sec. 14. Section 135C.38, subsection 3, Code 2014, is 21 amended to read as follows: 22 3. An inspection made pursuant to a complaint filed under 23 section 135C.37 need not be limited to the matter or matters 24 included in the complaint. However, the inspection shall 25 not be a general inspection unless the complaint inspection 26 coincides with a scheduled general inspection or unless in the 27 course of the complaint investigation a violation is evident to 28 the inspector. Upon arrival at the facility to be inspected, 29 the inspector shall show identification to the person in 30 charge of the facility and state that an inspection is to be 31 made, before beginning the inspection. Upon request of either 32 the complainant or the department or certified volunteer a 33 representative of the office of long-term care ombudsman, the 34 complainant or the complainant’s representative or both may 35 -6- LSB 5304XD (4) 85 ad/nh 6/ 14

S.F. _____ H.F. _____ be allowed the privilege of accompanying the inspector during 1 any on-site inspection made pursuant to this section . The 2 inspector may cancel the privilege at any time if the inspector 3 determines that the privacy of any resident of the facility to 4 be inspected would otherwise be violated. The protection and 5 dignity of the resident shall be given first priority by the 6 inspector and others. 7 Sec. 15. Section 135C.38, subsection 4, Code 2014, is 8 amended by striking the subsection. 9 Sec. 16. Section 231B.8, Code 2014, is amended by striking 10 the section and inserting in lieu thereof the following: 11 231B.8 Exit interview —— issuance of findings. 12 1. The department shall provide an elder group home an 13 exit interview at the conclusion of a monitoring evaluation 14 or complaint investigation, and the department shall inform 15 the home’s representative of all issues and areas of concern 16 related to the insufficient practices. The department may 17 conduct the exit interview in person or by telephone, and 18 the department shall provide a second exit interview if any 19 additional issues or areas of concern are identified. The home 20 shall have two working days from the date of the exit interview 21 to submit additional or rebuttal information to the department. 22 2. The department shall issue the final findings of a 23 monitoring evaluation or complaint investigation within 24 ten working days after completion of the on-site monitoring 25 evaluation or complaint investigation. The final findings 26 shall be served upon the home personally, by electronic mail, 27 or by certified mail. 28 Sec. 17. Section 231B.9, Code 2014, is amended to read as 29 follows: 30 231B.9 Public disclosure of findings. 31 Upon completion of a monitoring evaluation or complaint 32 investigation of an elder group home by the department pursuant 33 to this chapter , including the conclusion of informal review, 34 the department’s final findings with respect to compliance by 35 -7- LSB 5304XD (4) 85 ad/nh 7/ 14

S.F. _____ H.F. _____ the elder group home with requirements for certification shall 1 be made available to the public in a readily available form 2 and place. Other information relating to an elder group home 3 that is obtained by the department which does not constitute 4 the department’s final findings from a monitoring evaluation or 5 complaint investigation of the elder group home shall not be 6 made available to the public except in proceedings involving 7 the denial, suspension, or revocation of a certificate under 8 this chapter . 9 Sec. 18. NEW SECTION . 231B.9A Informal conference —— formal 10 contest —— judicial review. 11 1. Within twenty business days after issuance of the final 12 findings, the elder group home shall notify the director if the 13 home desires to contest the findings and request an informal 14 conference. 15 2. The department shall provide an independent reviewer to 16 hold an informal conference with an elder group home within 17 ten working days after receiving a request from the home 18 pursuant to subsection 1. At the conclusion of the informal 19 conference, the independent reviewer may affirm, modify, or 20 dismiss a contested regulatory insufficiency. The independent 21 reviewer shall state in writing the specific reasons for 22 the affirmation, modification, or dismissal and immediately 23 transmit copies of the statement to the department and to the 24 home. 25 3. An independent reviewer shall be licensed as an attorney 26 in the state of Iowa and shall not be employed or have been 27 employed by the department in the past eight years or have 28 appeared in front of the department on behalf of an elder group 29 home in the past eight years. Preference shall be given to an 30 attorney with background knowledge, experience, or training 31 in long-term care. The department may issue a request for 32 proposals to enter into a contract for the purpose of providing 33 one or more independent reviewers for informal conferences. 34 4. An elder group home that desires to further contest an 35 -8- LSB 5304XD (4) 85 ad/nh 8/ 14

S.F. _____ H.F. _____ affirmed or modified regulatory insufficiency may do so in the 1 manner provided by chapter 17A for contested cases. The home 2 shall give notice of intent to formally contest a regulatory 3 insufficiency, in writing, to the department within five days 4 after receipt of the written decision of the independent 5 reviewer. The formal hearing shall be conducted in accordance 6 with chapter 17A and rules adopted by the department. 7 5. An elder group home that has exhausted all adequate 8 administrative remedies and is aggrieved by the final action of 9 the department may petition for judicial review in the manner 10 provided by chapter 17A. 11 Sec. 19. Section 231B.10, subsection 1, Code 2014, is 12 amended by adding the following new paragraphs: 13 NEW PARAGRAPH . 0i. In the case of an application by an 14 existing certificate holder for a new or newly acquired elder 15 group home, continuing or repeated failure of the certificate 16 holder to operate any previously certified elder group home 17 or homes in compliance with the provisions of this chapter, 18 the rules adopted pursuant to this chapter, or equivalent 19 provisions that the elder group home is subject to in this 20 state or any other state. 21 NEW PARAGRAPH . 00i. Impeding the department’s ability to 22 ensure the home’s compliance with this chapter or with the 23 rules adopted pursuant to this chapter. 24 Sec. 20. Section 231C.10, subsection 1, Code 2014, is 25 amended by adding the following new paragraphs: 26 NEW PARAGRAPH . 0i. In the case of an application by 27 an existing certificate holder for a new or newly acquired 28 assisted living program, continuing or repeated failure of the 29 certificate holder to operate any previously certified assisted 30 living program or programs in compliance with the provisions 31 of this chapter, the rules adopted pursuant to this chapter, 32 or equivalent provisions that the assisted living program is 33 subject to in this state or any other state. 34 NEW PARAGRAPH . 00i. Impeding the department’s ability to 35 -9- LSB 5304XD (4) 85 ad/nh 9/ 14

S.F. _____ H.F. _____ ensure the program’s compliance with this chapter or with the 1 rules adopted pursuant to this chapter. 2 Sec. 21. Section 231D.5, subsection 1, Code 2014, is amended 3 by adding the following new paragraphs: 4 NEW PARAGRAPH . 0k. In the case of an application by 5 an existing certificate holder for a new or newly acquired 6 adult day services program, continuing or repeated failure of 7 the certificate holder to operate any previously certified 8 adult day services program or programs in compliance with the 9 provisions of this chapter, the rules adopted pursuant to this 10 chapter, or equivalent provisions that the adult day services 11 program is subject to in this state or any other state. 12 NEW PARAGRAPH . 00k. Impeding the department’s ability to 13 ensure the program’s compliance with this chapter or with the 14 rules adopted pursuant to this chapter. 15 Sec. 22. Section 231D.9A, Code 2014, is amended by striking 16 the section and inserting in lieu thereof the following: 17 231D.9A Exit interview —— issuance of findings. 18 1. The department shall provide an adult day services 19 program an exit interview at the conclusion of a monitoring 20 evaluation or a complaint investigation, and the department 21 shall inform the program’s representative of all issues and 22 areas of concern related to the insufficient practices. The 23 department may conduct the exit interview in person or by 24 telephone, and the department shall provide a second exit 25 interview if any additional issues or areas of concern are 26 identified. The program shall have two working days from the 27 date of the exit interview to submit additional or rebuttal 28 information to the department. 29 2. The department shall issue the final findings of a 30 monitoring evaluation or complaint investigation within 31 ten working days after completion of the on-site monitoring 32 evaluation or complaint investigation. The final findings 33 shall be served upon the program personally, by electronic 34 mail, or by certified mail. 35 -10- LSB 5304XD (4) 85 ad/nh 10/ 14

S.F. _____ H.F. _____ Sec. 23. Section 231D.10, Code 2014, is amended to read as 1 follows: 2 231D.10 Public disclosure of findings. 3 Upon completion of a monitoring evaluation or complaint 4 investigation of an adult day services program by the 5 department pursuant to this chapter , including the conclusion 6 of informal review, the department’s final findings with 7 respect to compliance by the adult day services program with 8 requirements for certification shall be made available to 9 the public in a readily available form and place. Other 10 information relating to an adult day services program that 11 is obtained by the department which does not constitute the 12 department’s final findings from a monitoring evaluation or 13 complaint investigation of the adult day services program shall 14 not be made available to the public except in proceedings 15 involving the denial, suspension, or revocation of a 16 certificate under this chapter . 17 Sec. 24. NEW SECTION . 231D.10A Informal conference —— 18 formal contest —— judicial review. 19 1. Within twenty business days after issuance of the final 20 findings, the adult day services program shall notify the 21 director if the program desires to contest the findings and 22 request an informal conference. 23 2. The department shall provide an independent reviewer 24 to hold an informal conference with an adult day services 25 program within ten working days after receiving a request from 26 the program pursuant to subsection 1. At the conclusion of 27 the informal conference, the independent reviewer may affirm, 28 modify, or dismiss a contested regulatory insufficiency. The 29 independent reviewer shall state in writing the specific 30 reasons for the affirmation, modification, or dismissal and 31 immediately transmit copies of the statement to the department 32 and to the program. 33 3. An independent reviewer shall be licensed as an attorney 34 in the state of Iowa and shall not be employed or have been 35 -11- LSB 5304XD (4) 85 ad/nh 11/ 14

S.F. _____ H.F. _____ employed by the department in the past eight years or have 1 appeared in front of the department on behalf of an adult day 2 services program in the past eight years. Preference shall be 3 given to an attorney with background knowledge, experience, 4 or training in long-term care. The department may issue a 5 request for proposals to enter into a contract for the purpose 6 of providing one or more independent reviewers for informal 7 conferences. 8 4. An adult day services program that desires to further 9 contest an affirmed or modified regulatory insufficiency may do 10 so in the manner provided by chapter 17A for contested cases. 11 The program shall give notice of intent to formally contest 12 a regulatory insufficiency, in writing, to the department 13 within five days after receipt of the written decision of the 14 independent reviewer. The formal hearing shall be conducted 15 in accordance with chapter 17A and rules adopted by the 16 department. 17 5. An adult day services program that has exhausted all 18 adequate administrative remedies and is aggrieved by the final 19 action of the department may petition for judicial review in 20 the manner provided by chapter 17A. 21 Sec. 25. APPLICABILITY. 22 1. The sections of this Act amending sections 231B.8 and 23 231B.9 and adding section 231B.9A apply to an elder group home 24 desiring to request an informal conference under chapter 231B 25 on or after January 1, 2015. 26 2. The sections of this Act amending sections 231D.9A and 27 231D.10 and adding section 231D.10A apply to an adult day 28 services program desiring to request an informal conference 29 under chapter 231D on or after January 1, 2015. 30 EXPLANATION 31 The inclusion of this explanation does not constitute agreement with 32 the explanation’s substance by the members of the general assembly. 33 This bill makes changes to employment background checks, 34 disciplinary procedures, and procedures for contesting 35 -12- LSB 5304XD (4) 85 ad/nh 12/ 14

S.F. _____ H.F. _____ regulatory insufficiencies for certain entities regulated by 1 the department of inspections and appeals (DIA). 2 The bill changes the crimes for which a hospital can 3 temporarily employ a person who committed the crime pending 4 completion of a department of human services evaluation 5 to determine whether the crime warrants prohibition of 6 employment at the hospital or health care facility. The bill 7 disallows such continued employment for simple misdemeanors 8 under the motor vehicles and law of the road chapter. The 9 bill eliminates duplicative language regarding crimes for 10 which a health care facility can temporarily employ a person 11 who committed a crime and crimes for which a student can 12 temporarily continue with a clinical education component. 13 The bill provides that the DIA has the authority to deny, 14 suspend, or revoke the license of a health care facility, elder 15 group home, assisted living program, or adult day services 16 program for the failure to comply with any provisions that the 17 entity is subject to that are equivalent to those provisions in 18 Code chapter 135C, 231B, 231C, or 231D, respectively, and for 19 impeding the DIA’s ability to ensure the facility complies with 20 applicable provisions. 21 The bill replaces references to a certified volunteer 22 long-term care ombudsman with a representative of the office 23 of long-term care ombudsman in certain circumstances including 24 inspecting a facility upon a complaint of alleged violations. 25 The bill also replaces certain references to inspectors and 26 investigators for inspections of health care facilities with 27 references to authorized representatives of DIA, the department 28 of human services, or the office of long-term care ombudsman, 29 as applicable. The bill also provides that the office of 30 long-term care ombudsman is required to assist DIA in carrying 31 out the provisions of the health care facilities Code chapter. 32 The bill replaces the informal review process for contesting 33 regulatory insufficiencies identified through monitoring 34 evaluations or complaint investigations of elder group homes 35 -13- LSB 5304XD (4) 85 ad/nh 13/ 14

S.F. _____ H.F. _____ and adult day services programs with an exit interview, 1 informal conference, formal contest, and judicial review in a 2 process similar to that available for health care facilities 3 and assisted living programs. The informal conference is 4 conducted by an independent reviewer who may affirm, modify, 5 or dismiss the regulatory insufficiency. The reviewer must 6 provide specific written reasons for the decision and transmit 7 copies of that statement to DIA and the elder group home or 8 adult day services program. An elder group home or adult day 9 services program that wants to further contest the independent 10 reviewer’s affirmed or modified regulatory insufficiency may do 11 so pursuant to the provisions in Code chapter 17A for contested 12 cases. After exhausting the administrative remedies, an elder 13 group home or adult day services program may petition for 14 judicial review pursuant to Code chapter 17A. The changes to 15 the informal review process apply to elder group homes and 16 adult day services programs wishing to request an informal 17 conference on or after January 1, 2015. 18 -14- LSB 5304XD (4) 85 ad/nh 14/ 14