H.F. 2471 DIVISION I 1 ELECTRONIC MONITORING IN HEALTH CARE FACILITIES 2 Section 1. Section 135C.1, Code 2026, is amended by adding 3 the following new subsection: 4 NEW SUBSECTION . 6A. “Electronic monitoring device” means a 5 device capable of any combination of capturing, recording, or 6 transmitting audio, visual, or audio-visual information. 7 Sec. 2. NEW SECTION . 135C.35D Electronic monitoring 8 devices. 9 1. For purposes of this section, “roommate” means a resident 10 who resides in the same room as another resident. 11 2. Subject to subsection 3, each facility shall permit a 12 resident, or the resident’s legal representative, to install 13 and operate an electronic monitoring device in the resident’s 14 room. 15 3. a. Each facility shall require a resident, or the 16 resident’s legal representative, to obtain written consent from 17 each of the resident’s roommates, or each roommate’s legal 18 representative, prior to installing an electronic monitoring 19 device in the resident’s room. 20 b. If a resident requested written consent under paragraph 21 “a” , and one or more of the resident’s roommates or the 22 roommate’s legal representative refuses to provide written 23 consent, the facility shall, to the extent practicable, 24 transfer the resident to a different room that can accommodate 25 installation of an electronic monitoring device. 26 4. A health care facility shall not refuse admission to, 27 discharge, or otherwise retaliate against a resident who elects 28 to use an electronic monitoring device. 29 5. Each health care facility shall make reasonable physical 30 accommodations for the placement of electronic monitoring 31 devices, including but not limited to access to a power source. 32 6. If an electronic monitoring device is being used in 33 a resident’s room, the facility shall post a notice at the 34 entrance of the room that states the room is subject to 35 -1- LSB 5254YH (6) 91 dg/ko 1/ 13

H.F. 2471 electronic monitoring. 1 7. A resident, or the resident’s legal representative, 2 shall pay for all costs associated with the purchase, 3 installation, maintenance, and removal of each electronic 4 monitoring device the resident, or the resident’s legal 5 representative, installs in the resident’s room. 6 DIVISION II 7 HEALTH CARE FACILITY VIOLATIONS 8 Sec. 3. Section 135C.10, Code 2026, is amended to read as 9 follows: 10 135C.10 Denial, suspension, or revocation. 11 1. The department shall have the authority to deny, suspend, 12 or revoke a license in any case where the department finds that 13 there has been repeated failure on the part of the facility 14 to comply with the provisions of this chapter or the rules or 15 minimum standards promulgated hereunder, or for any of the 16 following reasons: 17 1. a. Cruelty or indifference to health care facility 18 residents. 19 2. b. Appropriation or conversion of the property of a 20 health care facility resident without the resident’s written 21 consent or the written consent of the resident’s legal 22 guardian. 23 3. c. Permitting, aiding, or abetting the commission of any 24 illegal act in the health care facility. 25 4. d. Inability or failure to operate and conduct the 26 health care facility in accordance with the requirements 27 of this chapter and the minimum standards and rules issued 28 pursuant thereto. 29 5. e. Obtaining or attempting to obtain or retain a license 30 by fraudulent means, misrepresentation, or by submitting false 31 information. 32 6. f. Habitual intoxication or addiction to the use of 33 drugs by the applicant , or the manager or supervisor of the 34 health care facility. 35 -2- LSB 5254YH (6) 91 dg/ko 2/ 13

H.F. 2471 7. g. Securing the devise or bequest of the property of a 1 resident of a health care facility by undue influence. 2 8. h. Willful failure or neglect to maintain a continuing 3 in-service education and training program for all personnel 4 employed in the facility. 5 9. i. In the case of an application for a new or newly 6 acquired facility, continuing or repeated failure of the 7 licensee to operate any previously licensed facility or 8 facilities in compliance with the provisions of this chapter , 9 the rules adopted pursuant to this chapter , or equivalent 10 provisions that the facility is subject to in this state or any 11 other state. 12 10. j. In the case of a license applicant or existing 13 licensee which is an entity other than an individual, the 14 department may deny, suspend, or revoke a license if any 15 individual, who is in a position of control or is an officer of 16 the entity, engages in any act or omission proscribed by this 17 section . 18 11. k. Intentionally preventing or interfering with 19 or attempting to prevent or interfere in any way with the 20 performance by any duly authorized representative of the 21 department of the lawful enforcement of this chapter or of 22 the rules adopted pursuant to this chapter . As used in this 23 subsection , “lawful enforcement” includes but is not limited to 24 the following: 25 a. (1) Contacting or interviewing any resident of a health 26 care facility in private at any reasonable hour and without 27 advance notice. 28 b. (2) Examining any relevant books or records of a health 29 care facility unless otherwise protected from disclosure by 30 operation of law. 31 c. (3) Preserving evidence of any violation of this chapter 32 or of the rules adopted pursuant to this chapter . 33 2. The department shall either suspend or revoke a health 34 care facility’s license if the department finds the facility 35 -3- LSB 5254YH (6) 91 dg/ko 3/ 13

H.F. 2471 has committed three or more class I violations under section 1 135C.36 within a period of twenty-four consecutive months. 2 Sec. 4. Section 135C.19, subsection 2, Code 2026, is amended 3 to read as follows: 4 2. a. A citation for a class I or class II violation which 5 is issued to a health care facility and which has become final, 6 or a copy of the citation, shall be prominently posted as 7 prescribed in rules, until from the date the department serves 8 the citation on the facility until twelve months from the date 9 the department confirms the violation is has been corrected 10 to the department’s satisfaction. The citation or copy shall 11 be posted in a place in plain view of the residents of the 12 facility cited, persons visiting the residents, and persons 13 inquiring about placement in the facility. 14 b. A copy of each citation required to be posted by this 15 subsection shall be sent by the department to the department 16 of health and human services, to the designated protection 17 and advocacy agency if the facility has one or more residents 18 with developmental disabilities or mental illness, and to the 19 office of long-term care ombudsman if the facility is a nursing 20 facility or residential care facility. 21 c. A health care facility shall provide a copy of each 22 citation required to be posted by this subsection to each 23 resident of the facility and mail a copy of the citation to 24 each legal representative of a resident of the facility. 25 Sec. 5. Section 135C.36, Code 2026, is amended to read as 26 follows: 27 135C.36 Violations classified —— penalties. 28 1. Every violation by a health care facility of any 29 provision of this chapter or of the rules adopted pursuant 30 to it this chapter shall be classified by the department in 31 accordance with this section . The department shall adopt and 32 may from time to time modify, in accordance with chapter 17A , 33 rules setting forth so far as feasible the specific violations 34 included in each classification and stating criteria for the 35 -4- LSB 5254YH (6) 91 dg/ko 4/ 13

H.F. 2471 classification of any violation not so listed. 1 1. 2. a. (1) A class I violation is one which presents 2 an imminent danger or a substantial probability of resultant a 3 violation that is substantially likely to cause a resident’s 4 death or physical harm to the residents of the facility in 5 which the violation occurs. A physical condition or one 6 or more practices in a facility may constitute a class I 7 violation . Based on the circumstances, the department may find 8 either of the following is a class I violation: 9 (a) A violation of a rule adopted pursuant to section 10 135C.14, subsection 8. 11 (b) A violation of section 135C.31. 12 (2) A class I violation shall be abated or eliminated 13 immediately unless the department determines that a stated 14 period of time, specified in the citation issued under section 15 135C.40 , is required to correct the violation . 16 (3) A licensee is subject to a penalty of not less than two 17 ten thousand nor dollars but not more than ten fifty thousand 18 dollars for each calendar day a class I violation for which the 19 licensee’s facility is cited exists beginning from the date the 20 department serves a citation on the licensee for the violation . 21 2. b. (1) A class II violation is one which a violation 22 that has a direct or immediate relationship to an impact on 23 the health, safety, or security of residents of a health 24 care facility , but which presents no imminent danger nor 25 substantial probability of that is not substantially likely to 26 cause a resident’s death or physical harm to them. A physical 27 condition or one or more practices within a facility, including 28 either physical abuse of any resident or failure to treat any 29 resident with consideration, respect, and full recognition of 30 the resident’s dignity and individuality, in violation of a 31 specific rule adopted by the department, may constitute a class 32 II violation . 33 (2) A violation of a rule adopted pursuant to section 34 135C.14, subsection 8 , or section 135C.31 and rules or a rule 35 -5- LSB 5254YH (6) 91 dg/ko 5/ 13

H.F. 2471 adopted under those sections pursuant to that section, shall 1 be at least a class II violation and may be if the department 2 determines the violation does not constitute a class I 3 violation. 4 (3) A class II violation shall be corrected within a stated 5 period of time determined by the department and specified 6 in the citation issued under section 135C.40 . The stated 7 department may modify the period of time specified in the 8 citation may subsequently be modified by the department for 9 good cause shown if the facility subject to the citation 10 provides evidence that it cannot correct the violation within 11 the period of time specified in the citation through no fault 12 of the facility’s own . 13 (4) A licensee is subject to a penalty of not less than 14 one hundred nor five thousand dollars but not more than five 15 hundred twenty-five thousand dollars for each calendar day a 16 class II violation for which the licensee’s facility is cited; 17 however the continues after the period of time specified by the 18 department under subparagraph (3) or the date a modification 19 granted by the department under subparagraph (3) terminates. 20 (5) The director may, upon written request of the a 21 facility, waive the a penalty assessed on the facility for a 22 class II violation if the violation is corrected within the 23 time specified in the citation. The department shall adopt 24 rules in accordance with chapter 17A establishing criteria for 25 the granting or denial of denying a waiver request under this 26 subparagraph . 27 3. c. (1) A class III violation is any violation of this 28 chapter , or of the rules adopted pursuant to it which violation 29 this chapter, that is not classified in by the department’s 30 rules nor classifiable under the criteria stated in those rules 31 as a class I or a class II violation. 32 (2) A class III violation shall be corrected within a 33 period of time determined by the department and specified in 34 the citation issued under section 135C.40. The department may 35 -6- LSB 5254YH (6) 91 dg/ko 6/ 13

H.F. 2471 modify the period of time specified in the citation for good 1 cause shown. 2 (3) A licensee shall not be is subject to a penalty for 3 each calendar day a class III violation , except as provided 4 by section 135C.40, subsection 1 , for failure to correct the 5 violation within a reasonable time specified by the department 6 in the notice of the violation continues after any period 7 of time specified by the department under subparagraph (2) 8 or a date a modification granted by the department under 9 subparagraph (2) terminates . 10 (4) The director may, upon written request of a facility, 11 waive a penalty assessed upon the facility for a class III 12 violation if the violation is corrected within the time 13 specified in the citation. The department shall adopt rules in 14 accordance with chapter 17A to establish criteria for granting 15 or denying a waiver request under this subparagraph. 16 4. 3. Any state penalty, including a fine or citation, 17 issued following a state licensure and federal certification 18 survey or investigation shall be dismissed if the corresponding 19 federal deficiency is dismissed or removed. Any state penalty, 20 including a fine or citation, shall be retained or reinstated 21 if the federal deficiency is retained or reinstated. 22 5. 4. If a facility self-identifies a deficient practice 23 prior to an on-site visit inspection, there has been no 24 complaint filed with the department related to that specific 25 deficient practice, and the facility corrects such practice 26 prior to an inspection, no citation shall be issued or fine 27 penalty assessed pursuant to subsection 2 or 3 except for those 28 penalties arising pursuant to section 135C.33 ; 481 IAC 57.11(3) 29 and (7), 481 IAC 57.16(3) , 481 IAC 57.32 , 481 IAC 57.34(1) , 30 481 IAC 58.11(3), 481 IAC 58.14(5) , 481 IAC 58.19(2)(a) , 481 31 IAC 58.19(2)(h), 481 IAC 58.28(1)(a) , 481 IAC 58.43 , 481 IAC 32 63.8(3), 481 IAC 63.27 , 481 IAC 63.29(1) , 481 IAC 64.4(9) , 481 33 IAC 64.33(2), 481 IAC 64.34 , 481 IAC 65.9(5) , 481 IAC 65.15 , 34 or 481 IAC 65.25(3) and (4) , or the successor to any of such 35 -7- LSB 5254YH (6) 91 dg/ko 7/ 13

H.F. 2471 rules; or 42 C.F.R. §483.420(d) , 42 C.F.R. §483.460(c)(4) , or 1 42 C.F.R. §483.470(j), or the successor to any of such federal 2 regulations. 3 Sec. 6. Section 135C.40, subsection 1, unnumbered paragraph 4 1, Code 2026, is amended to read as follows: 5 If the director determines, based on the findings of an 6 inspection or investigation of a health care facility, that the 7 facility is in violation of this chapter or rules adopted under 8 this chapter , the director within five working business days 9 after making the determination, may issue a written citation to 10 the facility. The citation shall be served upon the facility 11 personally, by electronic mail, or by certified mail , except 12 that a citation for a class III violation may be sent by 13 ordinary mail . Each citation shall specifically describe the 14 nature of the violation, identifying identify the Code section 15 or subsection or the rule or standard violated, and identify 16 the classification of the violation under section 135C.36 . 17 Where appropriate, the citation shall also state the period 18 of time allowed for correction of the violation, which shall 19 in each case be the shortest period of time the department 20 deems feasible. Failure to correct a violation within the time 21 specified, unless the licensee shows that the failure was due 22 to circumstances beyond the licensee’s control, shall subject 23 the facility to a further penalty of fifty dollars for each 24 day that the violation continues after the time specified for 25 correction. 26 Sec. 7. Section 135C.44, Code 2026, is amended to read as 27 follows: 28 135C.44 Treble Enhanced fines for repeated violations. 29 1. The penalties authorized by section 135C.36 shall 30 be trebled for a second or subsequent class I or class II 31 increased by fifty percent for a violation occurring within any 32 twelve-month consecutive twenty-four-month period if a citation 33 was issued for the same class I or class II violation occurring 34 within that consecutive twenty-four-month period and a penalty 35 -8- LSB 5254YH (6) 91 dg/ko 8/ 13

H.F. 2471 was assessed therefor . 1 2. If a facility was assessed an enhanced penalty under 2 subsection 1, the penalty for each subsequent citation for the 3 same violation shall be increased by one hundred percent of 4 the most recent penalty assessed on the facility for that same 5 violation. 6 Sec. 8. NEW SECTION . 135C.49 Resident protection fund. 7 1. A resident protection fund is created in the state 8 treasury under the control of the department of health and 9 human services. 10 2. The resident protection fund shall consist of moneys 11 collected by the department as penalties for violations of this 12 chapter, moneys appropriated by the general assembly, and other 13 moneys received by the department of health and human services 14 for deposit in the fund. 15 3. Moneys in the resident protection fund are appropriated 16 to the department of health and human services for the 17 purpose of remedying harm caused by violations of this 18 chapter, increasing the quality of care provided to residents, 19 and supporting the office of the long-term care ombudsman 20 established in section 231.42. 21 4. Notwithstanding section 8.33, moneys appropriated in 22 this section that remain unencumbered or unobligated at the 23 close of a fiscal year shall not revert but shall remain 24 available for expenditure for the purposes designated. 25 Notwithstanding section 12C.7, subsection 2, interest and 26 earnings on moneys in the resident protection fund shall be 27 credited to the resident protection fund. 28 EXPLANATION 29 The inclusion of this explanation does not constitute agreement with 30 the explanation’s substance by the members of the general assembly. 31 This bill relates to health care facilities (facilities), 32 including electronic monitoring device (device) requirements 33 and facility violations. 34 DIVISION I —— ELECTRONIC MONITORING IN HEALTH CARE 35 -9- LSB 5254YH (6) 91 dg/ko 9/ 13

H.F. 2471 FACILITIES. Code chapter 135C (health care facilities) defines 1 a health care facility as a residential care facility, nursing 2 facility, intermediate care facility for persons with a mental 3 illness, or an intermediate care facility for persons with an 4 intellectual disability. 5 The bill defines “electronic monitoring device” as a 6 device capable of any combination of capturing, recording, or 7 transmitting audio, visual, or audio-visual information. 8 The bill defines “roommate” as a resident who resides in the 9 same room as another resident. For purposes of Code chapter 10 135C, a resident is an individual admitted to a facility. 11 The bill requires each facility to permit a resident, or 12 the resident’s legal representative (representative), to 13 install and operate a device in the resident’s room. The 14 bill also requires each facility to require a resident, or 15 the resident’s representative, to obtain written consent from 16 each of the resident’s roommates or their representative 17 prior to installing a device in the resident’s room. If a 18 resident requests permission from a roommate or the roommate’s 19 representative to install a device, and the roommate or 20 roommate’s representative refuses to provide written consent, 21 the facility where the resident resides must, to the extent 22 practicable, transfer the resident to a different room to 23 accommodate the installation of a device. 24 The bill prohibits a facility from refusing admission to, 25 discharging, or otherwise retaliating against a resident who 26 elects to use a device. 27 The bill requires each facility to make reasonable physical 28 accommodations for the placement of a device, including but not 29 limited to access to a power source. 30 The bill requires each facility to post a notice at the 31 entrance of a resident’s room that states that the room is 32 subject to electronic monitoring if a device is in use in the 33 resident’s room. 34 The bill requires a resident, or the resident’s 35 -10- LSB 5254YH (6) 91 dg/ko 10/ 13

H.F. 2471 representative, to pay for all costs associated with the 1 purchase, installation, maintenance, and removal of each device 2 the resident, or the resident’s representative, installs in the 3 resident’s room. 4 DIVISION II —— HEALTH CARE FACILITY VIOLATIONS. The 5 bill requires DIAL to either suspend or revoke a facility’s 6 license if the department finds the facility has committed 7 three or more class I violations within a period of 24 8 consecutive months. A class I violation is a violation that is 9 substantially likely to cause a resident’s death or physical 10 harm. A class II violation has an impact on the health, 11 safety, or security of residents but is not substantially 12 likely to cause a resident’s death or harm. A class III 13 violation is a violation that is not classified as either a 14 class I or II violation. 15 The bill requires a facility to prominently post a copy of 16 each violation issued to the facility from the date DIAL serves 17 the citation on the facility until 12 months from the date 18 DIAL confirms the violation has been corrected, and requires 19 the facility to provide a copy of the citation to each of the 20 facility’s residents and mail a copy to each representative of 21 a resident of the facility. 22 The bill increases the minimum and maximum penalty for class 23 I and class II violations. The bill also creates a minimum and 24 maximum penalty for class III violations. 25 Under current law, a facility is subject to one penalty for 26 each class I or class II violation DIAL determines the facility 27 has committed. The bill instead makes a facility subject to 28 a penalty for each calendar day a class I violation remains 29 uncorrected beginning from the date DIAL serves a citation on 30 the facility for the violation, and for each calendar day a 31 class II or class III violation continues after the period of 32 time specified by DIAL in DIAL’s citation to the facility. 33 Under current law, DIAL may extend the period of time a 34 facility is required to correct a class II violation for good 35 -11- LSB 5254YH (6) 91 dg/ko 11/ 13

H.F. 2471 cause shown. The bill allows DIAL to extend the period of 1 time to correct a class II violation if the facility provides 2 evidence that it cannot correct the violation within the period 3 of time specified in the citation through no fault of the 4 facility’s own. The bill also allows DIAL to extend the period 5 of time a facility is required to correct a class III violation 6 for good cause shown. 7 The bill allows DIAL, upon written request of a facility, 8 to waive a penalty assessed on the facility for a class 9 III violation if the violation is corrected within the time 10 specified in the citation. The bill requires DIAL to adopt 11 rules to establish criteria for such a waiver. 12 Under current law, DIAL may serve a facility a citation for 13 a class III violation by ordinary mail. The bill requires DIAL 14 to serve a facility a citation for a class III violation by 15 electronic or certified mail. 16 Under current law, the penalty for a facility’s violation is 17 increased by three times if the facility had been assessed a 18 penalty for the same violation within the previous 12 months. 19 The bill instead increases Code chapter 135C penalties by 50 20 percent for a violation committed within 24 months of having 21 been issued a citation for the same violation. If the facility 22 has been subject to an enhanced penalty within the 24-month 23 period, each subsequent penalty assessed for the same violation 24 is increased by 100 percent of the most recently assessed 25 penalty. 26 The bill creates a resident protection fund (fund) under 27 the control of the department of health and human services 28 (HHS). The fund consists of moneys collected as penalties for 29 violations of Code chapter 135C, moneys appropriated by the 30 general assembly, and other moneys received by HHS for deposit 31 in the fund. Moneys in the fund are to be distributed by HHS 32 for the purposes of remedying harm caused by violations of 33 Code chapter 135C, increasing the quality of care provided to 34 residents, and supporting the office of the long-term care 35 -12- LSB 5254YH (6) 91 dg/ko 12/ 13