S.F. 2229 Section 1. Section 135C.1, Code 2020, is amended by adding 1 the following new subsections: 2 NEW SUBSECTION . 5A. “Electronic monitoring” means the 3 placement and use of an electronic monitoring device by 4 a resident in the resident’s room in accordance with this 5 subchapter. 6 NEW SUBSECTION . 5B. “Electronic monitoring device” means a 7 camera or other device that captures, records, or broadcasts 8 audio, video, or both, that is placed in a resident’s room and 9 is used to monitor the resident or activities in the room. 10 NEW SUBSECTION . 20A. “Resident representative” means one of 11 the following in the order of priority listed, to the extent 12 the person may reasonably be identified and located: 13 a. The attorney in fact designated to make treatment 14 decisions for the resident in accordance with chapter 144B. 15 b. The guardian of the resident if one has been appointed 16 pursuant to chapter 633. 17 c. The resident’s spouse. 18 d. An adult child of the resident or, if the resident has 19 more than one adult child, a majority of the adult children who 20 are reasonably available. 21 e. A parent of the resident, or parents if both are 22 reasonably available. 23 f. An adult sibling of the resident. 24 Sec. 2. NEW SECTION . 135C.49 Electronic monitoring. 25 1. A resident or a resident representative may conduct 26 electronic monitoring of the resident’s room through the use of 27 an electronic monitoring device placed in the resident’s room 28 pursuant to this subchapter. 29 2. Nothing in this section precludes the use of electronic 30 monitoring otherwise allowed by law. 31 Sec. 3. NEW SECTION . 135C.50 Consent to electronic 32 monitoring. 33 1. Except as otherwise provided in this subchapter, 34 a resident must consent to electronic monitoring in the 35 -1- LSB 6256XS (7) 88 pf/rh 1/ 11

S.F. 2229 resident’s room in writing on a notification and consent 1 form prescribed by the department. If the resident has 2 not affirmatively objected to electronic monitoring and the 3 resident’s medical professional determines that the resident 4 lacks the ability to understand and appreciate the nature 5 and consequences of electronic monitoring, the resident 6 representative may consent on behalf of the resident. For 7 purposes of this subsection, a resident affirmatively objects 8 when the resident orally, visually, or through the use of 9 auxiliary aids or services declines electronic monitoring. The 10 resident’s response shall be documented on the notification and 11 consent form. 12 2. Prior to a resident representative consenting on behalf 13 of a resident, the resident shall be asked if the resident 14 wants electronic monitoring to be conducted. The resident 15 representative shall explain all of the following to the 16 resident: 17 a. The type of electronic monitoring device to be used. 18 b. The standard conditions or restrictions that may be 19 placed on the electronic monitoring device’s use including as 20 specified in the list of standard conditions or restrictions 21 provided in section 135C.53. 22 c. The dissemination and use of any recording under section 23 135C.57 or 135C.58. 24 d. The resident’s ability to decline all recordings. 25 3. A resident, or resident representative when consenting 26 on behalf of the resident, may consent to electronic monitoring 27 with any conditions or restrictions of the resident’s or 28 resident representative’s choosing, including the list of 29 standard conditions or restrictions provided in section 30 135C.53. A resident, or resident representative when 31 consenting on behalf of the resident, may request that the 32 electronic monitoring device be turned off or the visual or 33 audio recording component of the electronic monitoring device 34 be blocked at any time. 35 -2- LSB 6256XS (7) 88 pf/rh 2/ 11

S.F. 2229 4. Prior to implementing electronic monitoring, a resident, 1 or resident representative when acting on behalf of the 2 resident, shall obtain the written consent on the notification 3 and consent form of any other resident who is a roommate 4 residing in the shared room. A roommate’s or roommate’s 5 resident representative’s written consent shall comply with 6 the requirements of this section. Consent by a roommate or 7 a roommate’s resident representative under this subsection 8 authorizes the resident’s use of any recording obtained under 9 this section as provided under sections 135C.57 and 135C.58. 10 5. Any resident conducting electronic monitoring shall 11 immediately remove or disable an electronic monitoring device 12 prior to a new resident who will be a roommate moving into 13 a shared room, unless the resident conducting electronic 14 monitoring obtains the new roommate’s or new roommate’s 15 resident representative’s written consent as provided under 16 this section prior to the new roommate moving into the shared 17 room. Upon obtaining the new roommate’s or new roommate’s 18 resident representative’s signed notification and consent form 19 and submitting the form to the nursing facility as required 20 under section 135C.52, the resident may resume electronic 21 monitoring. 22 6. The resident or roommate, or the resident representative 23 or roommate’s resident representative if the representative is 24 consenting on behalf of the resident or roommate, may withdraw 25 consent at any time and the withdrawal of consent shall be 26 documented on the original consent form as provided under 27 section 135C.52. 28 Sec. 4. NEW SECTION . 135C.51 Refusal of roommate to 29 consent. 30 If a resident of a nursing facility who is residing in a 31 shared room, or the resident representative of such a resident 32 when acting on behalf of the resident, wants to conduct 33 electronic monitoring and another resident living in or moving 34 into the same shared room refuses to consent to the use of an 35 -3- LSB 6256XS (7) 88 pf/rh 3/ 11

S.F. 2229 electronic monitoring device, the nursing facility shall make 1 a reasonable attempt to accommodate the resident who wants to 2 conduct electronic monitoring. A nursing facility has met 3 the requirement to make a reasonable attempt to accommodate 4 a resident or resident representative who wants to conduct 5 electronic monitoring when, upon notification that a roommate 6 has not consented to the use of an electronic monitoring device 7 in the resident’s room, the nursing facility offers to move one 8 of the residents to another shared room that is available at 9 the time of the request that accommodates the resident. If 10 a resident chooses to reside in a private room in order to 11 accommodate the use of an electronic monitoring device, the 12 resident shall be subject to a private room rate. If a nursing 13 facility is unable to accommodate a resident due to lack of 14 space, the nursing facility shall reevaluate the request 15 periodically until the request is fulfilled. 16 Sec. 5. NEW SECTION . 135C.52 Notice and consent submitted 17 to nursing facility. 18 1. Electronic monitoring may begin only after the resident 19 or resident representative who intends to place an electronic 20 monitoring device in the resident’s room and any roommate or 21 roommate’s resident representative completes a notification and 22 consent form and submits the form to the nursing facility. 23 2. Upon receipt of the required, completed notification and 24 consent form, the nursing facility shall place the original 25 form in the resident’s file, and a copy of the form in any 26 roommate’s file. The nursing facility shall provide a copy to 27 the resident and the resident’s roommate, as applicable. 28 3. If a resident or roommate, or the resident representative 29 or roommate’s resident representative if the representative 30 is consenting on behalf of the resident or roommate, chooses 31 to alter the conditions under which consent to electronic 32 monitoring is given or chooses to withdraw consent to 33 electronic monitoring, the nursing facility shall make 34 available the original notification and consent form so that 35 -4- LSB 6256XS (7) 88 pf/rh 4/ 11

S.F. 2229 the original form may be updated. Upon receipt of the updated 1 original form, the nursing facility shall place the updated 2 original form in the resident’s file. The nursing facility 3 shall provide a copy of the updated form to the resident and 4 the resident’s roommate, as applicable. 5 4. If a new roommate, or the new roommate’s resident 6 representative when consenting on behalf of the new roommate, 7 does not consent to electronic monitoring and submit a 8 completed notification and consent form to the nursing 9 facility, and the resident conducting the electronic monitoring 10 does not remove or disable an existing electronic monitoring 11 device, the nursing facility shall remove the electronic 12 monitoring device. 13 5. If a roommate, or the roommate’s resident representative 14 when withdrawing consent on behalf of the roommate, submits 15 an updated notification and consent form withdrawing consent 16 and the resident conducting electronic monitoring does not 17 remove or disable the electronic monitoring device, the nursing 18 facility shall remove the electronic monitoring device. 19 Sec. 6. NEW SECTION . 135C.53 Notification and consent form 20 requirements. 21 1. The notification and consent form completed by the 22 resident shall include, at a minimum, all of the following 23 information: 24 a. The resident’s signed consent to electronic monitoring or 25 the signature of the resident representative, if applicable. 26 If a resident representative signs the consent form, the form 27 shall document all of the following: 28 (1) The date the resident was asked if the resident wants 29 electronic monitoring to be conducted. 30 (2) Any person present when the resident was asked. 31 (3) An acknowledgment that the resident did not 32 affirmatively object. 33 (4) The source of authority allowing the resident 34 representative to sign the notification and consent form on the 35 -5- LSB 6256XS (7) 88 pf/rh 5/ 11

S.F. 2229 resident’s behalf. 1 b. The resident’s roommate’s signed consent or the signature 2 of the roommate’s resident representative, if applicable. If a 3 roommate’s resident representative signs the consent form, the 4 form shall document all of the following: 5 (1) The date the roommate was asked if the roommate wants 6 electronic monitoring to be conducted. 7 (2) Any person present when the roommate was asked. 8 (3) An acknowledgment that the roommate did not 9 affirmatively object. 10 (4) The source of authority allowing the resident 11 representative to sign the notification and consent form on the 12 roommate’s behalf. 13 c. The type of electronic monitoring device to be used. 14 d. Any installation needs, such as mounting of a device to 15 a wall or ceiling. 16 e. The proposed date of installation for scheduling 17 purposes. 18 f. A copy of any contract for maintenance of the electronic 19 monitoring device by a commercial entity. 20 g. A list of standard conditions or restrictions that the 21 resident or a roommate may elect to place on the use of the 22 electronic monitoring device including but not limited to all 23 of the following: 24 (1) Prohibiting audio recording. 25 (2) Prohibiting video recording. 26 (3) Prohibiting broadcasting of audio or video. 27 (4) Turning off the electronic monitoring device or 28 blocking the visual recording component of the electronic 29 monitoring device for the duration of an exam or procedure by a 30 health care professional. 31 (5) Turning off the electronic monitoring device or 32 blocking the visual recording component of the electronic 33 monitoring device while dressing or bathing is performed. 34 (6) Turning off the electronic monitoring device for 35 -6- LSB 6256XS (7) 88 pf/rh 6/ 11

S.F. 2229 the duration of a visit with a spiritual adviser, ombudsman, 1 attorney, financial planner, intimate partner, or other 2 visitor. 3 h. Any other condition or restriction elected by the 4 resident or roommate on the use of an electronic monitoring 5 device. 6 i. A statement of the circumstances under which a recording 7 may be disseminated under section 135C.57. 8 j. A signature box to document if the resident or roommate 9 withdraws consent. 10 2. A nursing facility shall make the notification and 11 consent form available to the residents and inform residents of 12 the option to conduct electronic monitoring of the resident’s 13 room. 14 Sec. 7. NEW SECTION . 135C.54 Cost and installation. 15 1. A resident who chooses to conduct electronic monitoring 16 shall do so at the resident’s own expense, including payment of 17 any purchase, installation, maintenance, and removal costs. 18 2. If a resident chooses to place an electronic monitoring 19 device that uses internet technology for visual or audio 20 monitoring, the resident may be responsible for contracting 21 with an internet service provider. 22 3. The nursing facility shall make a reasonable attempt 23 to accommodate the resident’s installation needs, including 24 allowing access to the nursing facility’s public-use internet 25 or wi-fi systems when available for other public uses. 26 4. All electronic monitoring device installations and 27 supporting services shall comply with the requirements of the 28 national fire protection association 101 life safety code. 29 5. A nursing facility shall not charge a resident a fee 30 for the costs of electricity used by the electronic monitoring 31 device. 32 Sec. 8. NEW SECTION . 135C.55 Notice to visitors. 33 1. A nursing facility shall post a sign at each nursing 34 facility entrance accessible to visitors that states 35 -7- LSB 6256XS (7) 88 pf/rh 7/ 11

S.F. 2229 “Electronic monitoring devices may be present in the rooms of 1 residents to record persons and activities”. 2 2. A nursing facility shall post a sign clearly and 3 conspicuously at the entrance to a resident’s room where 4 electronic monitoring is being conducted. The notice shall 5 state “This room is electronically monitored”. 6 3. The nursing facility is responsible for installing and 7 maintaining the signage required in this section. 8 Sec. 9. NEW SECTION . 135C.56 Obstruction of electronic 9 monitoring devices. 10 1. A person shall not knowingly hamper, obstruct, tamper 11 with, or destroy an electronic monitoring device placed in 12 a resident’s room without the permission of the resident or 13 resident representative. 14 2. A person shall not knowingly hamper, obstruct, tamper 15 with, or destroy a video or audio recording obtained through 16 the use of an electronic monitoring device in accordance with 17 this subchapter. 18 3. It is not a violation of this section for a person to 19 turn off the electronic monitoring device or block the visual 20 recording component of the electronic monitoring device at the 21 direction of the resident or resident representative, or if 22 consent has been withdrawn. 23 4. A person who violates this section is guilty of a serious 24 misdemeanor. 25 Sec. 10. NEW SECTION . 135C.57 Dissemination of recordings. 26 1. A person shall not access any video or audio recording 27 created through electronic monitoring under this subchapter 28 without the written consent of the resident or resident 29 representative. 30 2. Except as otherwise required by law, a recording or copy 31 of a recording created as provided in this subchapter may only 32 be disseminated for the purpose of addressing health, safety, 33 or welfare concerns of a resident. 34 3. A person accessing or disseminating a recording or copy 35 -8- LSB 6256XS (7) 88 pf/rh 8/ 11

S.F. 2229 of a recording created as provided in this section in violation 1 of this section is guilty of a serious misdemeanor. 2 Sec. 11. NEW SECTION . 135C.58 Admissibility of evidence. 3 Subject to applicable rules of evidence and procedure, any 4 video or audio recording created through electronic monitoring 5 under this subchapter may be admitted into evidence in a civil, 6 criminal, or administrative proceeding if the contents of the 7 recording have not been edited or artificially enhanced and the 8 recording includes the date and time the events occurred. 9 Sec. 12. NEW SECTION . 135C.59 Liability —— penalties. 10 1. A nursing facility is not civilly or criminally liable 11 for the disclosure of a recording by a resident or a person who 12 consents on behalf of a resident for any purpose not authorized 13 by this subchapter. 14 2. A nursing facility is not civilly or criminally liable 15 for a violation of a resident’s right to privacy arising out 16 of any electronic monitoring conducted in accordance and in 17 compliance with this subchapter. 18 3. A nursing facility that knowingly violates this 19 subchapter shall be subject to licensee discipline. 20 Sec. 13. NEW SECTION . 135C.60 Resident protections. 21 1. A nursing facility shall not do any of the following: 22 a. Refuse to admit a potential resident or remove a resident 23 because the nursing facility disagrees with the potential 24 resident’s or the resident’s decisions regarding electronic 25 monitoring, whether the decision is made by a resident or a 26 resident representative acting on behalf of the resident. 27 b. Retaliate or discriminate against any resident for 28 consenting or refusing to consent to electronic monitoring. 29 c. Prevent the placement or use of an electronic monitoring 30 device by a resident who has provided the nursing facility 31 with the notification and consent form as required under this 32 subchapter. 33 2. Any contractual provision prohibiting, limiting, 34 or otherwise modifying the rights and obligations in this 35 -9- LSB 6256XS (7) 88 pf/rh 9/ 11

S.F. 2229 subchapter is contrary to public policy and is void and 1 unenforceable. 2 Sec. 14. NEW SECTION . 135C.61 Report to department. 3 A nursing facility shall report, in a manner prescribed by 4 the department, the number of electronic monitoring device 5 notification and consent forms received by the nursing facility 6 on an annual basis. 7 Sec. 15. DIRECTIVE TO DEPARTMENT OF INSPECTIONS AND 8 APPEALS. The department of inspections and appeals shall 9 prescribe by rule pursuant to chapter 17A the notification and 10 consent form described in this Act, and shall make the form 11 available on the department’s internet site. 12 Sec. 16. CODE EDITOR DIRECTIVE. The Code editor may codify 13 the provisions of this Act as a new subchapter of chapter 135C 14 entitled “Electronic Monitoring”. 15 EXPLANATION 16 The inclusion of this explanation does not constitute agreement with 17 the explanation’s substance by the members of the general assembly. 18 This bill provides for authorized electronic monitoring in 19 nursing facilities. 20 The bill provides that a nursing facility resident or a 21 resident representative may conduct electronic monitoring 22 of the resident’s room through the use of electronic 23 monitoring devices placed in the resident’s room pursuant 24 to the bill. The bill specifies the consents that must be 25 obtained for a resident to conduct electronic monitoring 26 in the resident’s room, including from any roommate; the 27 process to be followed if a roommate refuses to consent; the 28 provision of notice to the nursing facility; the notification 29 and consent form requirements; the responsibility for the 30 cost and installation relating to the electronic monitoring; 31 penalties for obstruction of electronic monitoring devices; 32 the dissemination of recordings created through electronic 33 monitoring; the admissibility of evidence created through 34 electronic monitoring; liability and penalties for violations 35 -10- LSB 6256XS (7) 88 pf/rh 10/ 11