S.F. 532 Section 1. Section 135C.14, subsection 5, Code 2025, is 1 amended to read as follows: 2 5. Equipment essential to the health and welfare of the 3 resident. The rules shall require a health care facility 4 that accepts state funding to annually adopt and provide to 5 the department the health care facility’s policies regarding 6 competitive procurement for supplies and equipment including 7 transactions and associated reimbursement structures with any 8 related party as defined in section 135C.7A. 9 Sec. 2. Section 135C.14, subsection 8, Code 2025, is amended 10 by adding the following new paragraph: 11 NEW PARAGRAPH . g. Facility policies and procedures 12 regarding the use of arbitration agreements. The rules and 13 standards shall prohibit any health care facility that accepts 14 state funding from offering a resident, or requiring a resident 15 to sign, an arbitration agreement that limits the resident’s 16 inalienable right to seek full judicial review of a dispute as 17 a precondition for being admitted to the facility. 18 Sec. 3. Section 135C.16, subsection 1, Code 2025, is amended 19 to read as follows: 20 1. In addition to the inspections required by sections 21 135C.9 and 135C.38 , the department shall make or cause to be 22 made such further unannounced inspections as it deems necessary 23 to adequately enforce this chapter . At On average, at least 24 one general unannounced inspection shall be conducted for each 25 health care facility within a thirty-month twelve-month period , 26 not to exceed a period of fifteen months . The inspector shall 27 show identification to the person in charge of the facility 28 and state that an inspection is to be made before beginning 29 the inspection. An employee of the department who gives 30 unauthorized advance notice of an inspection made or planned 31 to be made under this subsection or section 135C.38 shall be 32 disciplined as determined by the director, except that if the 33 employee is employed pursuant to the merit system provisions of 34 chapter 8A, subchapter IV , the discipline shall not exceed the 35 -1- LSB 1473XS (4) 91 lh/ko 1/ 8

S.F. 532 discipline authorized pursuant to that subchapter. 1 Sec. 4. Section 135C.36, subsection 1, Code 2025, is amended 2 to read as follows: 3 1. A class I violation is one which presents an imminent 4 danger or a substantial probability of resultant death or 5 physical harm to the residents of the facility in which 6 the violation occurs. A physical condition or one or more 7 practices in a facility may constitute a class I violation. A 8 class I violation shall be abated or eliminated immediately 9 unless the department determines that a stated period of time, 10 specified in the citation issued under section 135C.40 , is 11 required to correct the violation. A licensee is subject to 12 a penalty of not less than two five thousand nor more than 13 ten thousand dollars for each class I violation for which the 14 licensee’s facility is cited. 15 Sec. 5. Section 135C.36, Code 2025, is amended by adding the 16 following new subsection: 17 NEW SUBSECTION . 1A. A class I violation includes any 18 confirmed instance of a facility retaliating against a resident 19 or employee for filing a complaint or otherwise cooperating 20 with the department or the office of long-term care ombudsman. 21 Sec. 6. Section 135C.38, subsection 1, paragraph a, Code 22 2025, is amended to read as follows: 23 a. Upon receipt of a complaint made in accordance with 24 section 135C.37 , the department shall make a preliminary review 25 of the complaint. Unless the department concludes that the 26 complaint is intended to harass a facility or a licensee or is 27 without reasonable basis, the department shall make or cause 28 to be made an on-site inspection of the health care facility 29 which is the subject of the complaint within the time period 30 determined pursuant to the following guidelines, which period 31 shall commence on the date of receipt of the complaint: 32 (1) For nursing facilities, an on-site inspection shall be 33 initiated as follows: 34 (a) Within two one working days day for a complaint 35 -2- LSB 1473XS (4) 91 lh/ko 2/ 8

S.F. 532 determined by the department to be an alleged immediate 1 jeopardy situation. 2 (b) Within ten five working days for a complaint determined 3 by the department to be an alleged high-level, nonimmediate 4 jeopardy situation. 5 (c) Within forty-five calendar days for a complaint 6 determined by the department to be an alleged nonimmediate 7 jeopardy situation, other than a high-level situation. 8 (2) For all other types of health care facilities, an 9 on-site inspection shall be initiated as follows: 10 (a) Within two one working days day for a complaint 11 determined by the department to be an alleged immediate 12 jeopardy situation. 13 (b) Within twenty five working days for a complaint 14 determined by the department to be an alleged high-level, 15 nonimmediate jeopardy situation. 16 (c) Within forty-five calendar days for a complaint 17 determined by the department to be an alleged nonimmediate 18 jeopardy situation, other than a high-level situation. 19 Sec. 7. Section 135C.44, Code 2025, is amended to read as 20 follows: 21 135C.44 Treble Additional fines for repeated violations. 22 The penalties authorized by section 135C.36 shall be trebled 23 quadrupled for a second or subsequent class I or violation and 24 tripled for a second or subsequent class II violation occurring 25 within any twelve-month period if a citation was issued for the 26 same class I or class II violation occurring within that period 27 and a penalty was assessed therefor for the violation . 28 Sec. 8. NEW SECTION . 135C.49 Improper influence. 29 1. A member of the general assembly or an employee of 30 the legislative or executive branch shall not attempt to 31 influence a decision of the department during the course of an 32 investigation, inspection, or appeal under this chapter. 33 2. An allegation of a violation of this section shall 34 be investigated by the office of ombudsman established 35 -3- LSB 1473XS (4) 91 lh/ko 3/ 8

S.F. 532 under section 2C.2. If the office of ombudsman determines a 1 violation of this section has occurred, the office shall report 2 the recommendations, including disciplinary action, pursuant to 3 sections 2C.16 and 2C.19. 4 3. A person who is recommended for disciplinary action for 5 a violation of this section is subject to a civil penalty of 6 up to five thousand dollars per violation. A civil penalty 7 collected pursuant to this section shall be credited to the 8 department, shall be considered appropriated receipts as 9 defined in section 8.2, and shall be used by the department to 10 enforce this chapter. 11 4. a. A civil penalty for violations committed by an 12 employee of the executive branch shall be assessed by the 13 department. 14 b. A civil penalty for violations committed by a member or 15 employee of the general assembly shall be assessed pursuant to 16 a resolution approved by a majority of the house in which the 17 member serves or by which the employee is employed. If the 18 general assembly is not in session at the time a recommendation 19 is received from the office of ombudsman, a civil penalty shall 20 be assessed by a majority vote of the legislative council. 21 Sec. 9. 2023 Iowa Acts, chapter 108, section 7, subsection 22 4, is amended to read as follows: 23 4. HEALTH FACILITIES 24 a. For salaries, support, maintenance, and miscellaneous 25 purposes, and for not more than the following full-time 26 equivalent positions: 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 4,862,971 28 5,462,971 29 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 115.00 30 145.00 31 b. The department shall make all of the following 32 information available to the public as part of the department’s 33 development efforts to revise the department’s internet site: 34 (1) The number of inspections of health facilities 35 -4- LSB 1473XS (4) 91 lh/ko 4/ 8

S.F. 532 conducted by the department annually by type of service 1 provider and type of inspection. 2 (2) The total annual operations budget for the department 3 that is associated with health facilities regulation, including 4 general fund appropriations and federal contract dollars 5 received by type of service provider inspected. 6 (3) The total number of full-time equivalent positions 7 in the department that are associated with health facilities 8 regulation, to include the number of full-time equivalent 9 positions serving in a supervisory capacity, and serving as 10 surveyors, inspectors, or monitors in the field by type of 11 service provider inspected. 12 (4) Identification of state and federal survey trends, 13 cited regulations, the scope and severity of deficiencies 14 identified, and federal and state fines assessed and collected 15 concerning nursing and assisted living facilities and programs. 16 c. It is the intent of the general assembly that the 17 department continuously solicit input from health facilities 18 regulated by the department to assess and improve the 19 department’s level of collaboration and to identify new 20 opportunities for cooperation. 21 d. Of the funds appropriated in this subsection, $600,000, 22 in addition to federal matching funds, shall be used to employ 23 additional nursing facility inspectors and assisted living 24 program monitors to perform additional safety inspections. 25 Sec. 10. EFFECTIVE DATE. The following, being deemed of 26 immediate importance, takes effect upon enactment: 27 The section of this Act amending 2023 Iowa Acts, chapter 108, 28 section 7, subsection 4. 29 Sec. 11. RETROACTIVE APPLICABILITY. The following applies 30 retroactively to July 1, 2023: 31 The section of this Act amending 2023 Iowa Acts, chapter 108, 32 section 7, subsection 4. 33 EXPLANATION 34 The inclusion of this explanation does not constitute agreement with 35 -5- LSB 1473XS (4) 91 lh/ko 5/ 8

S.F. 532 the explanation’s substance by the members of the general assembly. 1 This bill relates to health care facilities and the 2 department of inspections, appeals, and licensing (DIAL). 3 The bill requires that the administrative rules and 4 standards to be adopted and enforced by DIAL as part of the 5 rule relating to equipment essential to the health and welfare 6 of the resident, require a facility that receives state funding 7 annually adopt and provide to the department the facility’s 8 policies regarding competitive procurement for supplies and 9 equipment. Additionally, the rules and standards shall include 10 policies and procedures regarding the use of arbitration 11 agreements. Specifically, the rules shall prohibit any 12 facility that accepts state funding from offering a resident, 13 or requiring a resident to sign, an arbitration agreement that 14 limits the resident’s inalienable right to seek full judicial 15 review of a dispute as a precondition for being admitted to the 16 facility. 17 The bill requires that, on average, DIAL perform at least one 18 general unannounced inspection of a health care facility within 19 a 12-month period not to exceed a period of 15 months, rather 20 than the current 30-month period. 21 The bill increases the monetary amount for the bottom of the 22 range of the penalty for a class I violation by a health care 23 facility from $2,000 to $5,000, and maintains the upper part 24 of the range at $10,000. The bill also increases the penalty 25 for repeated class I violations in a 12-month period for which 26 a penalty is assessed by quadrupling rather than tripling the 27 amount. 28 The bill adds as a class I violation for a health care 29 facility any confirmed instance of a facility retaliating 30 against a resident or employee for filing a complaint or 31 otherwise cooperating with the department or the office of 32 long-term care ombudsman. 33 The bill amends the required time period within which DIAL 34 must respond upon receipt of a complaint. Under the bill, for 35 -6- LSB 1473XS (4) 91 lh/ko 6/ 8

S.F. 532 nursing facilities, an on-site inspection shall be initiated 1 within one working day rather than the current two working 2 days if a complaint is determined to be an alleged immediate 3 jeopardy situation; and within five rather than the current 4 10 working days if a complaint is determined to be an alleged 5 high-level, nonimmediate jeopardy situation. Under the bill 6 for all other types of health care facilities, an on-site 7 inspection shall be initiated within one working day rather 8 than two working days if a complaint is determined to be an 9 alleged immediate jeopardy situation; and within five working 10 days rather than 20 working days if a complaint is determined 11 be an alleged high-level, nonimmediate jeopardy situation. 12 The bill provides that a member of the general assembly or 13 an employee of the legislative or executive branch shall not 14 attempt to influence a decision of DIAL during the course of 15 an investigation, inspection, or appeal. An allegation of a 16 violation shall be investigated by the office of ombudsman. If 17 the office of ombudsman determines a violation has occurred, 18 the office shall report the recommendations, including 19 disciplinary action, to an agency. A person who is recommended 20 for disciplinary action for a violation is subject to a 21 civil penalty of up to $5,000 per violation. A civil penalty 22 collected shall be credited to DIAL, considered appropriated 23 receipts, and used by DIAL to enforce Code chapter 135C. DIAL 24 shall assess the civil penalty for violations committed by 25 an employee of the executive branch, and a civil penalty for 26 violations committed by a member or employee of the general 27 assembly shall be assessed pursuant to a resolution or by the 28 legislative council if the general assembly is not in session 29 at the time a recommendation is received from the office of 30 ombudsman. 31 The bill amends the appropriation for FY 2023-2024 to DIAL 32 for health facilities to provide for an increase of $600,000 33 and 30.00 additional full-time equivalent positions. The 34 appropriated funds, in addition to the federal matching funds, 35 -7- LSB 1473XS (4) 91 lh/ko 7/ 8