House Study Bill 691 - Introduced HOUSE FILE _____ BY (PROPOSED COMMITTEE ON HEALTH AND HUMAN SERVICES BILL BY CHAIRPERSON MEYER) A BILL FOR An Act relating to health care facilities, including joint 1 training sessions and review of certain citations for 2 nursing facilities, and exceptions to on-site inspections of 3 health care facilities following complaints. 4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 5 TLSB 6308YC (7) 90 pf/ko

H.F. _____ Section 1. NEW SECTION . 135C.35C Nursing facilities —— 1 joint training sessions. 2 The department shall semiannually provide joint training 3 sessions for inspectors and nursing facilities to review at 4 least three of the ten most frequently issued federal citations 5 in the state during the immediately preceding calendar year. 6 The department shall develop a protocol to identify regional 7 citation patterns relating to complaints, standards, and 8 outcomes in the nursing facility inspection process. The 9 department shall include the state long-term care ombudsman, 10 or the state long-term care ombudsman’s designee, and 11 representatives of each nursing facility provider association 12 in the state in the planning process for the joint training 13 sessions. 14 Sec. 2. Section 135C.38, subsection 1, paragraph a, 15 unnumbered paragraph 1, Code 2024, is amended to read as 16 follows: 17 Upon receipt of a complaint made in accordance with section 18 135C.37 , the department shall make a preliminary review of 19 the complaint. Unless the department concludes that the 20 complaint is intended to harass a facility or a licensee , or 21 is without reasonable basis, involves an issue that is either 22 the same subject of an incident self-reported by a facility 23 or of a complaint otherwise reported within the immediately 24 preceding ninety calendar days, or is a complaint that may 25 be investigated by the department off site through access 26 to electronic records and via telephonic interviews, the 27 department shall make or cause to be made an on-site inspection 28 of the health care facility which is the subject of the 29 complaint within the time period determined pursuant to the 30 following guidelines, which period shall commence on the date 31 of receipt of the complaint: 32 Sec. 3. Section 135C.40, subsection 1, Code 2024, is amended 33 by adding the following new paragraph: 34 NEW PARAGRAPH . d. (1) The department shall establish and 35 -1- LSB 6308YC (7) 90 pf/ko 1/ 3

H.F. _____ maintain a process to review each citation issued for immediate 1 jeopardy or substandard quality of care prior to issuance of 2 final findings under section 135C.40A. Representatives of the 3 nursing facility issued such a citation may participate in 4 the review to provide context and evidence for the department 5 to consider in determining if a final finding of immediate 6 jeopardy or substandard quality of care should be issued. The 7 review shall ensure consistent and accurate application of 8 federal and state inspection protocols and defined regulatory 9 standards. 10 (2) For the purposes of this paragraph: 11 (a) “Immediate jeopardy” means a situation in which the 12 provider’s noncompliance with one or more requirements of 13 participation has caused, or is likely to cause, serious 14 injury, harm, impairment, or death to a resident. 15 (b) “Likely” means probable and reasonably to be expected, 16 and suggests a greater degree of probability than a mere risk, 17 potential, or possibility that a particular event will cause 18 serious injury, harm, impairment, or death to a resident. 19 (c) “Substandard quality of care” means the same as defined 20 in 42 C.F.R. §488.301. 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 relates to health care facility regulation, 25 including inspections and review of citations. 26 The bill requires the department of inspections, appeals, 27 and licensing (DIAL) to semiannually provide joint training 28 sessions for inspectors and nursing facilities to review at 29 least three of the 10 most frequently issued federal citations 30 in the state during the immediately preceding calendar year. 31 DIAL shall develop a protocol to identify regional citation 32 patterns relating to complaints, standards, and outcomes in 33 the nursing facility inspection process, and shall include the 34 state long-term care ombudsman or designee, and representatives 35 -2- LSB 6308YC (7) 90 pf/ko 2/ 3

H.F. _____ of each nursing facility provider association in the state in 1 the planning process for the joint training sessions. 2 Under Code section 135C.38(1), DIAL, upon receipt of 3 a complaint regarding a health care facility shall make a 4 preliminary review of the complaint and unless DIAL concludes 5 the complaint is intended to harass a facility or licensee or 6 is without a reasonable basis, shall make or cause to be made 7 an on-site inspection of the health care facility. The bill 8 adds additional exceptions to the required on-site inspection 9 including if DIAL concludes that the complaint involves 10 an issue that is either the same subject of an incident 11 self-reported by a health care facility or otherwise reported 12 within the previous 90 calendar days, or is a complaint 13 that may be investigated by DIAL off site through access to 14 electronic records and telephonic interviews. 15 The bill requires DIAL to establish and maintain a process 16 to review each citation issued for immediate jeopardy or 17 substandard quality of care prior to issuance of final findings 18 of an investigation or inspection. Representatives of the 19 nursing facility issued such citation may participate in the 20 review to provide context and evidence for DIAL to consider 21 in determining if a final finding of immediate jeopardy or 22 substandard quality of care should be issued. The review shall 23 ensure consistent and accurate application of federal and state 24 inspection protocols and defined regulatory standards. The 25 bill defines “immediate jeopardy”, “likely”, and “substandard 26 quality of care”. 27 -3- LSB 6308YC (7) 90 pf/ko 3/ 3