S.F. 526 Section 1. Section 135C.2, Code 2025, is amended by adding 1 the following new subsection: 2 NEW SUBSECTION . 8. The department shall adopt rules to 3 implement section 135C.6, subsection 11. 4 Sec. 2. Section 135C.6, Code 2025, is amended by adding the 5 following new subsection: 6 NEW SUBSECTION . 11. a. Beginning January 1, 2026, the 7 department shall not approve a new license or renew a license 8 issued under this chapter for a nursing facility unless the 9 nursing facility meets all of the following requirements: 10 (1) Each calendar year, the nursing facility spends an 11 amount equal to or greater than seventy percent of the nursing 12 facility’s gross revenue for the immediately preceding calendar 13 year for goods and services directly related to resident care 14 including but not limited to nursing staff salaries, physician 15 services, medications, and necessary resident care supplies. 16 (2) Each calendar year, the nursing facility spends an 17 amount equal to or greater than forty percent of the nursing 18 facility’s gross revenue for the immediately preceding calendar 19 year on salaries for nursing facility staff that directly 20 interact with and provide care to the nursing facility’s 21 residents. Expenditures on salaries for nursing facility staff 22 under this subparagraph shall count toward the requirements of 23 subparagraph (1). 24 (3) (a) If the nursing facility has gross revenue for a 25 calendar year in excess of one hundred five percent of the 26 nursing facility’s expenses, the nursing facility remits the 27 gross revenue that is in excess of one hundred five percent of 28 the nursing facility’s expenses to the department. 29 (b) An aging Iowans care fund is created in the state 30 treasury. The department shall deposit all moneys received 31 under subparagraph subdivision (a) into the aging Iowans 32 care fund. The general assembly may appropriate moneys from 33 the aging Iowans care fund as the general assembly deems 34 appropriate. 35 -1- LSB 1485XS (3) 91 dg/ko 1/ 3

S.F. 526 b. (1) A nursing facility may apply with the department, 1 and the office of the long-term care ombudsman established 2 in section 231.42, for a waiver of the requirements under 3 paragraph “a” due to unexpected or exceptional circumstances 4 which prevent the nursing facility from complying with 5 paragraph “a” . Upon receipt of an application, the department 6 and the office of the long-term care ombudsman shall make a 7 determination whether the nursing facility experienced an 8 unexpected or exceptional circumstance as alleged in the 9 nursing facility’s application for a waiver. 10 (2) (a) If the department and the office of the long-term 11 care ombudsman determine that the nursing facility experienced 12 an unexpected or exceptional circumstance which prevented 13 the nursing facility from complying with paragraph “a” , the 14 department shall waive the requirements of paragraph “a” to 15 the extent that the unexpected or exceptional circumstances 16 prevented the nursing facility’s compliance. 17 (b) If the department, the office of the long-term care 18 ombudsman, or both, determine that the nursing facility has not 19 experienced an unexpected or exceptional circumstance which 20 prevents the nursing facility from complying with paragraph 21 “a” , the department shall not waive the requirements of 22 paragraph “a” . 23 EXPLANATION 24 The inclusion of this explanation does not constitute agreement with 25 the explanation’s substance by the members of the general assembly. 26 This bill relates to nursing facility revenue requirements. 27 Beginning January 1, 2026, the bill prohibits the department 28 of inspections, appeals, and licensing (DIAL) from approving a 29 new license or renewing a license for a nursing facility unless 30 the nursing facility spends a certain percentage of the nursing 31 facility’s gross revenue for the immediately preceding calendar 32 year on goods and services directly related to resident care as 33 detailed in the bill, and remits the nursing facility’s gross 34 revenue in excess of 105 percent of its expenditures to DIAL. 35 -2- LSB 1485XS (3) 91 dg/ko 2/ 3

S.F. 526 The bill creates an aging Iowans care fund (fund) and requires 1 DIAL to deposit all moneys received under the bill into the 2 fund. The general assembly may appropriate moneys from the 3 fund as the general assembly deems appropriate. 4 The bill allows a nursing facility to apply with DIAL and the 5 office of the long-term care ombudsman (ombudsman) for a waiver 6 of the bill’s requirements due to an unexpected or exceptional 7 circumstance which prevents the nursing facility from complying 8 with the bill (exceptional circumstances). The bill requires 9 DIAL and the ombudsman to make a determination if exceptional 10 circumstances exist as alleged by the nursing facility. If 11 both DIAL and the ombudsman determine exceptional circumstances 12 exist, DIAL must grant the nursing facility a waiver of the 13 bill’s requirements to the extent the exceptional circumstances 14 prevented the nursing facility’s compliance. If DIAL, the 15 ombudsman, or both, determine that exceptional circumstances 16 do not exist, DIAL shall not grant a waiver to the nursing 17 facility. 18 The bill requires DIAL to adopt rules to implement the bill. 19 -3- LSB 1485XS (3) 91 dg/ko 3/ 3