H.F. 2317 Section 1. NEW SECTION . 135C.49 Definitions. 1 As used in this subchapter, unless the context otherwise 2 requires: 3 1. “Electronic monitoring” means the placement and use 4 of an electronic monitoring device by a resident or resident 5 representative in the resident’s room in accordance with this 6 subchapter. 7 2. “Electronic monitoring device” means a video camera that 8 livestream broadcasts video only that is placed in a resident’s 9 room and is used to monitor the resident or activities in the 10 room. “Electronic monitoring device” does not include video 11 phone calls or video conferencing where a resident either 12 initiates or joins a call or conference. 13 3. “Resident” means an individual admitted to a nursing 14 facility in a manner prescribed in section 135C.23. 15 4. “Resident representative” means one of the following in 16 the order of priority listed, to the extent the person may 17 reasonably be identified and located: 18 a. The guardian of the resident if one has been appointed 19 pursuant to chapter 633. 20 b. The attorney in fact designated to make treatment 21 decisions for the resident in accordance with chapter 144B. 22 Sec. 2. NEW SECTION . 135C.50 Electronic monitoring. 23 1. A resident, or a resident representative when acting 24 on behalf of a resident, may conduct electronic monitoring 25 of the resident’s room through the use of an electronic 26 monitoring device placed in the resident’s room pursuant to 27 this subchapter. 28 2. A nursing facility or resident of the nursing facility 29 shall not engage in electronic monitoring or the use of 30 electronic monitoring devices in a resident’s room without the 31 written permission of the nursing facility and the written 32 consent of the resident or resident representative when 33 consenting on behalf of a resident. 34 3. Nothing in this section precludes the use of electronic 35 -1- LSB 1746HV (3) 90 pf/ko 1/ 12

H.F. 2317 monitoring otherwise allowed by law. 1 Sec. 3. NEW SECTION . 135C.51 Consent to electronic 2 monitoring. 3 1. Except as otherwise provided in this subchapter, 4 a resident must consent to electronic monitoring in the 5 resident’s room in writing on a notification and consent 6 form prescribed by the department. If the resident has 7 not affirmatively objected to electronic monitoring and 8 the resident’s health care professional determines that the 9 resident lacks the ability to understand and appreciate the 10 nature and consequences of electronic monitoring, the resident 11 representative may consent on behalf of the resident. For 12 purposes of this subsection, a resident affirmatively objects 13 when the resident orally, visually, or through the use of 14 auxiliary aids or services declines electronic monitoring. The 15 resident’s response shall be documented on the notification and 16 consent form. 17 2. Prior to a resident representative consenting on behalf 18 of a resident, the resident shall be asked if the resident 19 wants electronic monitoring to be conducted. The resident 20 representative shall explain all of the following to the 21 resident: 22 a. The type of electronic monitoring device to be used. 23 b. The standard conditions or restrictions that may be 24 placed on the electronic monitoring device’s use including as 25 specified in the list of standard conditions or restrictions 26 contained in the notification and consent form completed by the 27 resident as provided in section 135C.55. 28 c. The resident’s ability to decline all electronic 29 monitoring. 30 3. A resident, or resident representative when consenting 31 on behalf of the resident, shall consent to electronic 32 monitoring with the standard conditions or restrictions 33 contained in the notification and consent form completed by the 34 resident as provided in section 135C.55. 35 -2- LSB 1746HV (3) 90 pf/ko 2/ 12

H.F. 2317 4. A nursing facility employee may be present to witness 1 the completion of the written notification and consent form 2 and to answer any questions relating to conducting electronic 3 monitoring in a resident’s room. 4 Sec. 4. NEW SECTION . 135C.52 Consent to electronic 5 monitoring —— shared room. 6 1. If a resident resides in a shared room, all of the 7 following shall apply: 8 a. The resident, or resident representative, as applicable, 9 shall request and obtain the written consent on the 10 notification and consent form of any existing roommate residing 11 in the shared room, prior to initiating electronic monitoring 12 in the resident’s room. 13 b. The resident, or resident representative, as applicable, 14 who is currently conducting electronic monitoring in the 15 resident’s room, shall immediately remove or disable an 16 electronic monitoring device prior to a new roommate moving 17 into a shared room, and shall not resume electronic monitoring 18 unless the resident or resident representative requests 19 and obtains written consent on the notification and consent 20 form, of the new roommate or the new roommate’s resident 21 representative. 22 2. a. An existing or new roommate, or the roommate’s 23 resident representative, as applicable, shall have thirty 24 calendar days from receipt of the request for consent to 25 electronic monitoring to complete the notification and consent 26 form. 27 b. Failure of an existing or new roommate, or the roommate’s 28 resident representative, to complete the notification and 29 consent form within the thirty-calendar-day period, shall 30 be considered an affirmative objection to the initiating 31 or resuming of electronic monitoring, and the resident 32 or resident’s representative shall not initiate or resume 33 electronic monitoring in the resident’s room. 34 3. After obtaining an existing or new roommate’s, or the 35 -3- LSB 1746HV (3) 90 pf/ko 3/ 12

H.F. 2317 roommate’s resident representative’s signed notification 1 and consent form and submitting the form to the nursing 2 facility as required under section 135C.54, the resident or 3 resident representative may initiate or resume electronic 4 monitoring of the resident’s room only after the expiration of 5 a thirty-calendar-day waiting period commencing on the date 6 the signed notification and consent form is submitted to the 7 nursing facility. 8 4. The resident, the existing or new roommate, the 9 resident’s resident representative, or the roommate’s resident 10 representative, as applicable, may withdraw consent to 11 electronic monitoring at any time and the withdrawal of consent 12 shall be documented on the original notification and consent 13 form. 14 Sec. 5. NEW SECTION . 135C.53 Refusal of roommate to consent 15 —— accommodations. 16 1. If a resident is residing in a shared room, and the 17 resident or resident representative, when acting on behalf of 18 the resident, wants to initiate or resume electronic monitoring 19 but an existing or new roommate refuses to consent to the 20 electronic monitoring as required under section 135C.52, the 21 nursing facility shall make a reasonable attempt to accommodate 22 the resident or resident representative who wants to conduct 23 electronic monitoring. 24 2. A nursing facility has met the requirement to make 25 a reasonable attempt to accommodate a resident or resident 26 representative who wants to initiate or resume electronic 27 monitoring under subsection 1 when, upon notification of the 28 nursing facility by a resident or resident representative 29 that an existing or new roommate has refused to consent to 30 electronic monitoring in the shared room, the nursing facility 31 offers to move the resident or roommate to another shared room 32 that is available at the time of the request that accommodates 33 the resident or roommate. 34 3. If a resident chooses to reside in a private room in 35 -4- LSB 1746HV (3) 90 pf/ko 4/ 12

H.F. 2317 order to accommodate the use of an electronic monitoring 1 device, the resident shall be subject to the private room rate. 2 4. If a nursing facility is unable to accommodate a 3 resident’s request to conduct electronic monitoring under this 4 section, the nursing facility shall reevaluate the request 5 periodically until the request is fulfilled. 6 Sec. 6. NEW SECTION . 135C.54 Notice and consent form 7 submitted to nursing facility. 8 1. Electronic monitoring of a resident’s room may be 9 conducted only after all of the following conditions are met: 10 a. (1) If the resident resides in a private room, the 11 resident, or the resident representative when acting on behalf 12 of the resident, completes a notification and consent form and 13 submits the signed and completed form to the nursing facility. 14 (2) If the resident resides in a shared room, the resident 15 or the resident representative when acting on behalf of 16 the resident, and any roommate or the roommate’s resident 17 representative, completes notification and consent forms and 18 submit the signed and completed forms to the nursing facility. 19 b. Any required waiting period prior to the initiating or 20 resuming of electronic monitoring has expired. 21 2. Upon receipt of any required, completed notification 22 and consent form, the nursing facility shall place a copy of 23 the form in the resident’s file and a copy of the form in any 24 roommate’s file. The nursing facility shall provide a copy 25 of any notification and consent form received to the resident 26 and the resident’s roommate, or to the resident’s resident 27 representative or the roommate’s resident representative, as 28 applicable. 29 3. If a resident or roommate, or the resident representative 30 or roommate’s resident representative if the representative 31 is consenting on behalf of the resident or roommate, chooses 32 to withdraw consent to electronic monitoring, the nursing 33 facility shall make available the original notification and 34 consent form so that the original form may be updated. Upon 35 -5- LSB 1746HV (3) 90 pf/ko 5/ 12

H.F. 2317 receipt of the updated original form, the nursing facility 1 shall place a copy of the updated form in the resident’s file. 2 The nursing facility shall provide a copy of the updated form 3 to the resident and the resident’s roommate or to the resident 4 representative or roommate’s resident representative, as 5 applicable. 6 4. If a new roommate, or the new roommate’s resident 7 representative when consenting on behalf of the new roommate, 8 does not consent to electronic monitoring and submit a 9 completed notification and consent form to the nursing 10 facility, and the resident or resident representative 11 conducting the electronic monitoring does not remove or disable 12 an existing electronic monitoring device, the nursing facility 13 shall provide the resident or the resident representative, as 14 applicable, a twenty-four-hour notice to remove or disable the 15 electronic monitoring device. If the device is not removed 16 or disabled within twenty-four hours of notification to the 17 resident or resident representative, the nursing facility may 18 disable or remove the electronic monitoring device. 19 5. If an existing roommate, or the existing roommate’s 20 resident representative when withdrawing consent on behalf of 21 the existing roommate, submits an updated notification and 22 consent form withdrawing consent and the resident or resident 23 representative conducting electronic monitoring does not remove 24 or disable the electronic monitoring device, the nursing 25 facility shall provide the resident or resident representative 26 a twenty-four-hour notice to remove or disable the electronic 27 monitoring device. If the device is not removed or disabled 28 within twenty-four hours of notification to the resident or 29 resident representative, the nursing facility may disable or 30 remove the electronic monitoring device. 31 Sec. 7. NEW SECTION . 135C.55 Notification and consent form 32 requirements. 33 1. The notification and consent form completed by the 34 resident shall include, at a minimum, all of the following 35 -6- LSB 1746HV (3) 90 pf/ko 6/ 12

H.F. 2317 information: 1 a. The resident’s signed consent to electronic monitoring or 2 the signature of the resident representative, if applicable. 3 If a resident representative signs the notification and consent 4 form, the form shall document all of the following: 5 (1) The date the resident was asked if the resident wants 6 electronic monitoring to be conducted. 7 (2) The name of any person present when the resident was 8 asked. 9 (3) An acknowledgment that the resident did not 10 affirmatively object. 11 (4) The source of authority allowing the resident 12 representative to sign the notification and consent form on the 13 resident’s behalf, including any court order, as applicable. 14 b. The resident’s roommate’s signed consent or the signature 15 of the roommate’s resident representative, if applicable. If a 16 roommate’s resident representative signs the notification and 17 consent form, the form shall document all of the following: 18 (1) The date the roommate was asked if the roommate wants 19 electronic monitoring to be conducted. 20 (2) The name of any person present when the roommate was 21 asked. 22 (3) An acknowledgment that the roommate did not 23 affirmatively object. 24 (4) The source of authority allowing the resident 25 representative to sign the notification and consent form on the 26 roommate’s behalf, including any court order, as applicable. 27 c. The type of electronic monitoring device to be used. 28 d. Any installation needs, such as mounting a device to a 29 wall or ceiling, and the costs associated with installation 30 and use, which are to be paid by the resident or the resident 31 representative, and the resident’s liability for potential 32 damage and repairs due to installation. 33 e. Fourteen days’ notice of the proposed date of 34 installation for scheduling purposes. 35 -7- LSB 1746HV (3) 90 pf/ko 7/ 12

H.F. 2317 f. A copy of any contract for maintenance of the electronic 1 monitoring device by a commercial entity. 2 g. A list of standard conditions or restrictions for the use 3 of the electronic monitoring device including but not limited 4 to all of the following: 5 (1) Prohibiting audio recording. 6 (2) Prohibiting video recording. 7 (3) Turning off the electronic monitoring device or 8 blocking the lens of the electronic monitoring device for the 9 duration of an exam or procedure by a health care professional. 10 (4) Turning off the electronic monitoring device or 11 blocking the lens of the electronic monitoring device while 12 dressing or bathing is performed. 13 (5) Turning off the electronic monitoring device for 14 the duration of a visit with a spiritual adviser, ombudsman, 15 attorney, financial planner, intimate partner, or other 16 visitor. 17 (6) Prohibiting drop-in video access. 18 (7) Requiring visual verification when the electronic 19 monitoring device is in use. 20 (8) Requiring conspicuously visible placement of the 21 electronic monitoring device inside the resident’s room. 22 (9) Prohibiting the electronic monitoring device from being 23 placed outside the resident’s living quarters. 24 h. A signature box to document if the resident or roommate 25 withdraws consent. 26 2. A nursing facility shall make the notification and 27 consent form available to residents and inform residents of the 28 option to conduct electronic monitoring of the resident’s room. 29 Sec. 8. NEW SECTION . 135C.56 Cost and installation. 30 1. A resident who chooses to conduct electronic monitoring 31 shall do so at the resident’s own expense, including payment 32 of any purchase, installation, maintenance, removal costs, and 33 costs for returning the resident’s room to preinstallation 34 condition. 35 -8- LSB 1746HV (3) 90 pf/ko 8/ 12

H.F. 2317 2. If a resident chooses to place an electronic monitoring 1 device that uses internet technology for visual monitoring, the 2 resident shall be responsible for contracting with an internet 3 service provider. 4 3. The nursing facility shall make a reasonable attempt to 5 accommodate the resident’s installation needs. 6 4. All electronic monitoring device installations and 7 supporting services shall comply with all applicable building 8 codes. 9 5. A nursing facility shall not charge a resident a fee 10 for the costs of electricity used by the electronic monitoring 11 device. 12 Sec. 9. NEW SECTION . 135C.57 Notice to visitors. 13 1. If electronic monitoring is being conducted, a nursing 14 facility shall post a sign at each nursing facility entrance 15 accessible to visitors that states “Electronic monitoring 16 devices may be present in the rooms of residents to observe 17 persons and activities”. 18 2. A nursing facility shall post a sign clearly and 19 conspicuously at the entrance to a resident’s room where 20 electronic monitoring is being conducted. The notice shall 21 state “This room is electronically monitored”. 22 3. The nursing facility is responsible for installing and 23 maintaining the signage required in this section. 24 Sec. 10. NEW SECTION . 135C.58 Obstruction of electronic 25 monitoring devices. 26 A person shall not knowingly hamper, obstruct, tamper 27 with, or destroy an electronic monitoring device placed in 28 a resident’s room without the permission of the resident or 29 resident representative, as applicable. 30 Sec. 11. NEW SECTION . 135C.59 Immunity from liability —— 31 licensee discipline —— inadmissibility of recordings. 32 1. A nursing facility is not civilly or criminally liable 33 for the disclosure of an unlawful recording captured by an 34 electronic monitoring device. 35 -9- LSB 1746HV (3) 90 pf/ko 9/ 12

H.F. 2317 2. A nursing facility is not civilly or criminally liable 1 for a violation of a resident’s right to privacy arising out 2 of any electronic monitoring conducted in accordance and in 3 compliance with this subchapter. 4 3. The resident and resident representative, as applicable, 5 are responsible for complying with local, state, and federal 6 privacy laws and for firewall protections to prevent images 7 that may violate obscenity laws from being inadvertently shown 8 on the internet via the electronic monitoring device. 9 4. A nursing facility that knowingly violates this 10 subchapter shall be subject to licensee discipline. 11 5. If a resident fails to comply with the nursing facility 12 policies and residency agreement relating to the use of an 13 electronic monitoring device, nursing facility staff may 14 report the failure to the office of long-term care ombudsman 15 and law enforcement, as applicable. Continued failure by a 16 resident to comply with such nursing facility policies and 17 residency agreement may constitute grounds for termination of a 18 resident’s residency agreement. 19 6. Audio or video recordings obtained in violation of this 20 chapter are inadmissible in a regulatory or other disciplinary 21 proceeding. 22 Sec. 12. NEW SECTION . 135C.60 Resident protections. 23 1. A nursing facility shall not do any of the following: 24 a. Refuse to admit a potential resident or remove a resident 25 because the nursing facility disagrees with the potential 26 resident’s or the resident’s decisions regarding electronic 27 monitoring, whether the decision is made by a resident or a 28 resident representative acting on behalf of the resident. 29 b. Retaliate or discriminate against any resident for 30 consenting or refusing to consent to electronic monitoring. 31 c. Prevent the placement or use of an electronic monitoring 32 device by a resident who has provided the nursing facility 33 with any notification and consent form as required under this 34 subchapter. 35 -10- LSB 1746HV (3) 90 pf/ko 10/ 12

H.F. 2317 2. Any contractual provision prohibiting, limiting, 1 or otherwise modifying the rights and obligations in this 2 subchapter is contrary to public policy and is void and 3 unenforceable. 4 Sec. 13. NEW SECTION . 135C.61 Report to the department. 5 A nursing facility shall report to the department, during 6 the nursing facility’s recertification survey, the number of 7 electronic monitoring device notification and consent forms 8 received by the nursing facility. 9 Sec. 14. Section 633.635, subsection 3, Code 2024, is 10 amended by adding the following new paragraph: 11 NEW PARAGRAPH . d. Consenting to electronic monitoring 12 conducted in accordance with chapter 135C. 13 Sec. 15. DIRECTIVE TO DEPARTMENT OF INSPECTIONS, APPEALS, 14 AND LICENSING. The department of inspections, appeals, and 15 licensing shall prescribe by rule pursuant to chapter 17A the 16 notification and consent form described in this Act, and shall 17 make the form available on the department’s internet site. 18 Sec. 16. CODE EDITOR DIRECTIVE. The Code editor may codify 19 the provisions of this Act as a new subchapter of chapter 135C 20 entitled “Electronic Monitoring”. 21 EXPLANATION 22 The inclusion of this explanation does not constitute agreement with 23 the explanation’s substance by the members of the general assembly. 24 This bill provides for authorized electronic monitoring in 25 nursing facilities. 26 The bill provides that a nursing facility resident or a 27 resident representative, as applicable, may conduct electronic 28 monitoring of the resident’s room through the use of electronic 29 monitoring devices placed in the resident’s room pursuant 30 to the bill. The bill specifies the consents that must be 31 obtained for a resident to conduct electronic monitoring in the 32 resident’s room, including from any roommate; the process to 33 be followed if a roommate refuses to consent; the provision 34 of notification to the nursing facility; the notification and 35 -11- LSB 1746HV (3) 90 pf/ko 11/ 12

H.F. 2317 consent form requirements; the responsibility for costs and 1 installation relating to the electronic monitoring; notice 2 to visitors; prohibited obstruction of electronic monitoring 3 devices; immunity from liability, licensee discipline, and 4 inadmissibility of recordings related to violations of the 5 bill; resident protections; and reporting requirements. The 6 bill also directs the department of inspections and appeals 7 to prescribe the notification and consent form described in 8 the bill and to make the form available on the department’s 9 internet site. 10 -12- LSB 1746HV (3) 90 pf/ko 12/ 12