S.F. 535 Section 1. Section 135C.7A, subsection 1, unnumbered 1 paragraph 1, Code 2025, is amended to read as follows: 2 In addition to the requirements of section 135C.7 , the 3 change of ownership of a previously licensed nursing facility 4 shall be subject to approval by the department through 5 application for a license. The department shall review each 6 change of ownership application to determine the potential 7 impact on the health, safety, welfare, and rights of the 8 nursing facility’s residents, and to ensure that a new owner 9 will guarantee the safety of and attain the highest practicable 10 physical, mental, and social well-being for each resident. An 11 applicant for a nursing facility license under this section 12 shall submit all of the following information to the department 13 with the license application: 14 Sec. 2. Section 135C.7A, subsection 1, paragraph c, Code 15 2025, is amended by adding the following new subparagraph: 16 NEW SUBPARAGRAPH . (4) Information and documentation that 17 verifies the applicant has sufficient cash or liquid assets to 18 maintain the nursing facility’s operations for a period of not 19 less than twelve months. 20 Sec. 3. Section 135C.7A, subsection 1, paragraph d, Code 21 2025, is amended to read as follows: 22 d. Information and documentation related to the applicant’s 23 regulatory history with any other state , federal, or licensing 24 jurisdiction , including but not limited to state or federal 25 agency actions, as verified by the applicant , which . The 26 information shall include but is not limited to all of the 27 following: 28 (1) Information and documentation related to any complaint, 29 allegation, corrective plan, notice of noncompliance, or 30 investigation concerning the applicant in any other state or 31 licensing jurisdiction . 32 (2) Affirmation that the applicant has not voluntarily 33 surrendered a license while under investigation in any other 34 state or licensing jurisdiction . 35 -1- LSB 1484XS (2) 91 dg/ko 1/ 4

S.F. 535 (3) Supporting documentation regarding the resolution 1 of any disciplinary action or complaint, allegation, or 2 investigation against the applicant in any other state or 3 licensing jurisdiction . 4 (4) Affirmation that no other nursing facility owned or 5 operated by the applicant has been subject to operation by a 6 court-appointed receiver or temporary manager. 7 (5) Information and documentation related to any complaint 8 or citation for a violation of state or federal worker 9 protection laws, any complaint or violation of state or federal 10 antidiscrimination laws, any complaint or violation of 29 11 U.S.C. §201, et seq., or similar laws, or any whistleblower 12 complaints against the applicant. 13 Sec. 4. Section 135C.7A, subsection 1, Code 2025, is amended 14 by adding the following new paragraphs: 15 NEW PARAGRAPH . e. Information and documentation related to 16 any reduction in wages or benefits for health workers employed 17 by the applicant, or by any entity owned at least in part by the 18 applicant, during the thirty-six consecutive months immediately 19 preceding the date the applicant submits the application. 20 NEW PARAGRAPH . f. Information and documentation related 21 to any investigation of the applicant’s violation of state 22 or federal Medicaid or Medicare law, and the outcome of each 23 investigation. 24 NEW PARAGRAPH . g. Information and documentation related to 25 any investigation of insurance or other fraud committed by the 26 applicant and the outcome of each investigation. 27 NEW PARAGRAPH . h. A record of each nursing facility change 28 of ownership in this state or any other state in which the 29 applicant was the seller or purchaser of a nursing facility. 30 NEW PARAGRAPH . i. A list identifying each nursing facility 31 the applicant has closed or sold. The list shall also identify 32 how long the applicant owned each nursing facility prior to its 33 closure or sale. 34 NEW PARAGRAPH . j. Any information and documentation that 35 -2- LSB 1484XS (2) 91 dg/ko 2/ 4

S.F. 535 the department determines is relevant for evaluating the impact 1 the proposed change in ownership will have on the provision of 2 health care, the quality of health care, and the safety of each 3 resident at the nursing facility. 4 Sec. 5. Section 135C.7A, subsection 3, Code 2025, is amended 5 by striking the subsection. 6 Sec. 6. Section 135C.7A, subsection 4, unnumbered paragraph 7 1, Code 2025, is amended to read as follows: 8 The department may require an applicant to create an escrow 9 account sufficient to sustain financial operations of the 10 applicant’s nursing facility for a period of not less than 11 two four months upon consideration of the timing of projected 12 deposits and disbursements during the nursing facility’s 13 initial operating period. 14 Sec. 7. Section 135C.7A, Code 2025, is amended by adding the 15 following new subsections: 16 NEW SUBSECTION . 6A. The department shall review the 17 information provided in subsection 1 to determine whether the 18 terms of the sale or lease of a nursing facility will weaken 19 the nursing facility’s financial state long-term, or present a 20 public health risk. The department shall not approve a change 21 of ownership application that the department determined would 22 weaken the nursing facility’s financial state long-term, or 23 present a public health risk. 24 NEW SUBSECTION . 6B. Upon completion of a review of a change 25 of ownership application, the department shall publish a report 26 on the department’s internet site that explains the rationale 27 for the department’s decision. The report shall, at a minimum, 28 include a comparative analysis of past decisions. 29 EXPLANATION 30 The inclusion of this explanation does not constitute agreement with 31 the explanation’s substance by the members of the general assembly. 32 This bill relates to nursing facility (facility) change of 33 ownership applications. 34 The bill requires the department of inspections, appeals, 35 -3- LSB 1484XS (2) 91 dg/ko 3/ 4

S.F. 535 and licensing (DIAL), during review of an application to change 1 the ownership of a facility, to determine the potential impact 2 on the health, safety, welfare, and rights of the residents, 3 and to ensure that a new owner will guarantee the safety of and 4 attain the highest practicable physical, mental, and social 5 well-being for each resident. 6 The bill requires an applicant for a facility change of 7 ownership (applicant) to provide information and documentation 8 as detailed in the bill to verify the applicant’s financial 9 state and history of compliance with state, federal, and other 10 jurisdictions’ laws and regulations. 11 Under current law, DIAL may require an applicant to create 12 an escrow account sufficient to sustain financial operations 13 of the applicant’s nursing facility for a period of not less 14 than two months. The bill changes this requirement to a period 15 of not less than four months. 16 The bill requires DIAL to review the information provided 17 in an application for change of ownership of a facility to 18 determine whether the terms of the sale or lease of a facility 19 would weaken the facility’s financial state long-term, 20 or present a public health risk. The bill prohibits DIAL 21 from approving to a change of ownership application that 22 DIAL determined would weaken the facility’s financial state 23 long-term, or present a public health risk. 24 The bill requires DIAL, upon completion of a review of a 25 change of ownership application, to publish a report on DIAL’s 26 internet site that explains the rationale for DIAL’s decision. 27 The report must, at a minimum, include a comparative analysis 28 of past decisions. 29 -4- LSB 1484XS (2) 91 dg/ko 4/ 4