S.F. 537 Section 1. NEW SECTION . 135C.49 Definitions. 1 As used in this subchapter, unless the context otherwise 2 requires: 3 1. “Electronic monitoring” means the placement and use 4 of an electronic monitoring device by a resident or resident 5 representative in the resident’s room in accordance with this 6 subchapter. 7 2. “Electronic monitoring device” means a video camera that 8 livestream broadcasts video only that is placed in a resident’s 9 room and is used to monitor the resident or activities in the 10 room. “Electronic monitoring device” does not include video 11 phone calls or video conferencing where a resident either 12 initiates or joins a call or conference. 13 3. “Resident” means an individual admitted to a nursing 14 facility in a manner prescribed in section 135C.23. 15 4. “Resident representative” means one of the following in 16 the order of priority listed, to the extent the person may 17 reasonably be identified and located: 18 a. The guardian of the resident if one has been appointed 19 pursuant to chapter 633. 20 b. The attorney in fact designated to make treatment 21 decisions for the resident in accordance with chapter 144B. 22 Sec. 2. NEW SECTION . 135C.50 Electronic monitoring. 23 1. A resident, or a resident representative when acting 24 on behalf of a resident, may conduct electronic monitoring 25 of the resident’s room through the use of an electronic 26 monitoring device placed in the resident’s room pursuant to 27 this subchapter. 28 2. A nursing facility or resident of the nursing facility 29 shall not engage in electronic monitoring or the use of 30 electronic monitoring devices in a resident’s room without the 31 written consent of the resident or resident representative when 32 consenting on behalf of a resident. 33 3. Nothing in this section precludes the use of electronic 34 monitoring otherwise allowed by law. 35 -1- LSB 1847XS (2) 91 lh/ko 1/ 12

S.F. 537 Sec. 3. NEW SECTION . 135C.51 Consent to electronic 1 monitoring. 2 1. Except as otherwise provided in this subchapter, 3 a resident must consent to electronic monitoring in the 4 resident’s room in writing on a notification and consent 5 form prescribed by the department. If the resident has 6 not affirmatively objected to electronic monitoring and 7 the resident’s health care professional determines that the 8 resident lacks the ability to understand and appreciate the 9 nature and consequences of electronic monitoring, the resident 10 representative may consent on behalf of the resident. For 11 purposes of this subsection, a resident affirmatively objects 12 when the resident orally, visually, or through the use of 13 auxiliary aids or services declines electronic monitoring. The 14 resident’s response shall be documented on the notification and 15 consent form. 16 2. Prior to a resident representative consenting on behalf 17 of a resident, the resident shall be asked if the resident 18 wants electronic monitoring to be conducted. The resident 19 representative shall explain all of the following to the 20 resident: 21 a. The type of electronic monitoring device to be used. 22 b. The standard conditions or restrictions that may be 23 placed on the electronic monitoring device’s use including as 24 specified in the list of standard conditions or restrictions 25 contained in the notification and consent form completed by the 26 resident as provided in section 135C.55. 27 c. The resident’s ability to decline all electronic 28 monitoring. 29 3. A resident, or resident representative when consenting 30 on behalf of the resident, shall consent to electronic 31 monitoring with the standard conditions or restrictions 32 contained in the notification and consent form completed by the 33 resident as provided in section 135C.55. 34 4. A nursing facility employee may be present to witness 35 -2- LSB 1847XS (2) 91 lh/ko 2/ 12

S.F. 537 the completion of the written notification and consent form 1 and to answer any questions relating to conducting electronic 2 monitoring in a resident’s room. 3 Sec. 4. NEW SECTION . 135C.52 Consent to electronic 4 monitoring —— shared room. 5 1. If a resident resides in a shared room, all of the 6 following shall apply: 7 a. The resident, or resident representative, as applicable, 8 shall request and obtain the written consent on the 9 notification and consent form of any existing roommate residing 10 in the shared room, prior to initiating electronic monitoring 11 in the resident’s room. 12 b. The resident, or resident representative, as applicable, 13 who is currently conducting electronic monitoring in the 14 resident’s room, shall immediately remove or disable an 15 electronic monitoring device prior to a new roommate moving 16 into a shared room, and shall not resume electronic monitoring 17 unless the resident or resident representative requests 18 and obtains written consent on the notification and consent 19 form, of the new roommate or the new roommate’s resident 20 representative. 21 2. a. An existing or new roommate, or the roommate’s 22 resident representative, as applicable, shall have thirty 23 calendar days from receipt of the request for consent to 24 electronic monitoring to complete the notification and consent 25 form. 26 b. Failure of an existing or new roommate, or the roommate’s 27 resident representative, to complete the notification and 28 consent form within the thirty-calendar-day period, shall 29 be considered an affirmative objection to the initiating 30 or resuming of electronic monitoring, and the resident 31 or resident’s representative shall not initiate or resume 32 electronic monitoring in the resident’s room. 33 3. After obtaining an existing or new roommate’s, or the 34 roommate’s resident representative’s signed notification 35 -3- LSB 1847XS (2) 91 lh/ko 3/ 12

S.F. 537 and consent form and submitting the form to the nursing 1 facility as required under section 135C.54, the resident or 2 resident representative may initiate or resume electronic 3 monitoring of the resident’s room only after the expiration of 4 a thirty-calendar-day waiting period commencing on the date 5 the signed notification and consent form is submitted to the 6 nursing facility. 7 4. The resident, the existing or new roommate, the 8 resident’s resident representative, or the roommate’s resident 9 representative, as applicable, may withdraw consent to 10 electronic monitoring at any time and the withdrawal of consent 11 shall be documented on the original notification and consent 12 form. 13 Sec. 5. NEW SECTION . 135C.53 Refusal of roommate to consent 14 —— accommodations. 15 1. If a resident is residing in a shared room, and the 16 resident or resident representative, when acting on behalf of 17 the resident, wants to initiate or resume electronic monitoring 18 but an existing or new roommate refuses to consent to the 19 electronic monitoring as required under section 135C.52, the 20 nursing facility shall make a reasonable attempt to accommodate 21 the resident or resident representative who wants to conduct 22 electronic monitoring. 23 2. A nursing facility has met the requirement to make 24 a reasonable attempt to accommodate a resident or resident 25 representative who wants to initiate or resume electronic 26 monitoring under subsection 1 when, upon notification of the 27 nursing facility by a resident or resident representative 28 that an existing or new roommate has refused to consent to 29 electronic monitoring in the shared room, the nursing facility 30 offers to move the resident or roommate to another shared room 31 that is available at the time of the request that accommodates 32 the resident or roommate. 33 3. If a resident chooses to reside in a private room in 34 order to accommodate the use of an electronic monitoring 35 -4- LSB 1847XS (2) 91 lh/ko 4/ 12

S.F. 537 device, the resident shall be subject to the private room rate. 1 4. If a nursing facility is unable to accommodate a 2 resident’s request to conduct electronic monitoring under this 3 section, the nursing facility shall reevaluate the request 4 periodically until the request is fulfilled. 5 Sec. 6. NEW SECTION . 135C.54 Notice and consent form 6 submitted to nursing facility. 7 1. Electronic monitoring of a resident’s room may be 8 conducted only after all of the following conditions are met: 9 a. (1) If the resident resides in a private room, the 10 resident, or the resident representative when acting on behalf 11 of the resident, completes a notification and consent form and 12 submits the signed and completed form to the nursing facility. 13 (2) If the resident resides in a shared room, the resident 14 or the resident representative when acting on behalf of 15 the resident, and any roommate or the roommate’s resident 16 representative, completes notification and consent forms and 17 submit the signed and completed forms to the nursing facility. 18 b. Any required waiting period prior to the initiating or 19 resuming of electronic monitoring has expired. 20 2. Upon receipt of any required, completed notification 21 and consent form, the nursing facility shall place a copy of 22 the form in the resident’s file and a copy of the form in any 23 roommate’s file. The nursing facility shall provide a copy 24 of any notification and consent form received to the resident 25 and the resident’s roommate, or to the resident’s resident 26 representative or the roommate’s resident representative, as 27 applicable. 28 3. If a resident or roommate, or the resident representative 29 or roommate’s resident representative if the representative 30 is consenting on behalf of the resident or roommate, chooses 31 to withdraw consent to electronic monitoring, the nursing 32 facility shall make available the original notification and 33 consent form so that the original form may be updated. Upon 34 receipt of the updated original form, the nursing facility 35 -5- LSB 1847XS (2) 91 lh/ko 5/ 12

S.F. 537 shall place a copy of the updated form in the resident’s file. 1 The nursing facility shall provide a copy of the updated form 2 to the resident and the resident’s roommate or to the resident 3 representative or roommate’s resident representative, as 4 applicable. 5 4. If a new roommate, or the new roommate’s resident 6 representative when consenting on behalf of the new roommate, 7 does not consent to electronic monitoring and submit a 8 completed notification and consent form to the nursing 9 facility, and the resident or resident representative 10 conducting the electronic monitoring does not remove or disable 11 an existing electronic monitoring device, the nursing facility 12 shall provide the resident or the resident representative, as 13 applicable, a twenty-four-hour notice to remove or disable the 14 electronic monitoring device. If the device is not removed 15 or disabled within twenty-four hours of notification to the 16 resident or resident representative, the nursing facility may 17 disable or remove the electronic monitoring device. 18 5. If an existing roommate, or the existing roommate’s 19 resident representative when withdrawing consent on behalf of 20 the existing roommate, submits an updated notification and 21 consent form withdrawing consent and the resident or resident 22 representative conducting electronic monitoring does not remove 23 or disable the electronic monitoring device, the nursing 24 facility shall provide the resident or resident representative 25 a twenty-four-hour notice to remove or disable the electronic 26 monitoring device. If the device is not removed or disabled 27 within twenty-four hours of notification to the resident or 28 resident representative, the nursing facility may disable or 29 remove the electronic monitoring device. 30 Sec. 7. NEW SECTION . 135C.55 Notification and consent form 31 requirements. 32 1. The notification and consent form completed by the 33 resident shall include, at a minimum, all of the following 34 information: 35 -6- LSB 1847XS (2) 91 lh/ko 6/ 12

S.F. 537 a. The resident’s signed consent to electronic monitoring or 1 the signature of the resident representative, if applicable. 2 If a resident representative signs the notification and consent 3 form, the form shall document all of the following: 4 (1) The date the resident was asked if the resident wants 5 electronic monitoring to be conducted. 6 (2) The name of any person present when the resident was 7 asked. 8 (3) An acknowledgment that the resident did not 9 affirmatively object. 10 (4) The source of authority allowing the resident 11 representative to sign the notification and consent form on the 12 resident’s behalf, including any court order, as applicable. 13 b. The resident’s roommate’s signed consent or the signature 14 of the roommate’s resident representative, if applicable. If a 15 roommate’s resident representative signs the notification and 16 consent form, the form shall document all of the following: 17 (1) The date the roommate was asked if the roommate wants 18 electronic monitoring to be conducted. 19 (2) The name of any person present when the roommate was 20 asked. 21 (3) An acknowledgment that the roommate did not 22 affirmatively object. 23 (4) The source of authority allowing the resident 24 representative to sign the notification and consent form on the 25 roommate’s behalf, including any court order, as applicable. 26 c. The type of electronic monitoring device to be used. 27 d. Any installation needs, such as mounting a device to a 28 wall or ceiling, and the costs associated with installation 29 and use, which are to be paid by the resident or the resident 30 representative, and the resident’s liability for potential 31 damage and repairs due to installation. 32 e. Fourteen days’ notice of the proposed date of 33 installation for scheduling purposes. 34 f. A copy of any contract for maintenance of the electronic 35 -7- LSB 1847XS (2) 91 lh/ko 7/ 12

S.F. 537 monitoring device by a commercial entity. 1 g. A list of standard conditions or restrictions for the use 2 of the electronic monitoring device including but not limited 3 to all of the following: 4 (1) Prohibiting audio recording. 5 (2) Prohibiting video recording. 6 (3) Turning off the electronic monitoring device or 7 blocking the lens of the electronic monitoring device for the 8 duration of an exam or procedure by a health care professional. 9 (4) Turning off the electronic monitoring device or 10 blocking the lens of the electronic monitoring device while 11 dressing or bathing is performed. 12 (5) Turning off the electronic monitoring device for 13 the duration of a visit with a spiritual adviser, ombudsman, 14 attorney, financial planner, intimate partner, or other 15 visitor. 16 (6) Prohibiting drop-in video access. 17 (7) Requiring visual verification when the electronic 18 monitoring device is in use. 19 (8) Requiring conspicuously visible placement of the 20 electronic monitoring device inside the resident’s room. 21 (9) Prohibiting the electronic monitoring device from being 22 placed outside the resident’s living quarters. 23 h. A signature box to document if the resident or roommate 24 withdraws consent. 25 2. A nursing facility shall make the notification and 26 consent form available to residents and inform residents of the 27 option to conduct electronic monitoring of the resident’s room. 28 Sec. 8. NEW SECTION . 135C.56 Cost and installation. 29 1. A resident who chooses to conduct electronic monitoring 30 shall do so at the resident’s own expense, including payment 31 of any purchase, installation, maintenance, removal costs, and 32 costs for returning the resident’s room to preinstallation 33 condition. 34 2. If a resident chooses to place an electronic monitoring 35 -8- LSB 1847XS (2) 91 lh/ko 8/ 12

S.F. 537 device that uses internet technology for visual monitoring, the 1 resident shall be responsible for contracting with an internet 2 service provider. 3 3. The nursing facility shall make a reasonable attempt to 4 accommodate the resident’s installation needs. 5 4. All electronic monitoring device installations and 6 supporting services shall comply with all applicable building 7 codes. 8 5. A nursing facility shall not charge a resident a fee 9 for the costs of electricity used by the electronic monitoring 10 device. 11 Sec. 9. NEW SECTION . 135C.57 Notice to visitors. 12 1. If electronic monitoring is being conducted, a nursing 13 facility shall post a sign at each nursing facility entrance 14 accessible to visitors that states “Electronic monitoring 15 devices may be present in the rooms of residents to observe 16 persons and activities”. 17 2. A nursing facility shall post a sign clearly and 18 conspicuously at the entrance to a resident’s room where 19 electronic monitoring is being conducted. The notice shall 20 state “This room is electronically monitored”. 21 3. The nursing facility is responsible for installing and 22 maintaining the signage required in this section. 23 Sec. 10. NEW SECTION . 135C.58 Obstruction of electronic 24 monitoring devices. 25 A person shall not knowingly hamper, obstruct, tamper 26 with, or destroy an electronic monitoring device placed in 27 a resident’s room without the permission of the resident or 28 resident representative, as applicable. 29 Sec. 11. NEW SECTION . 135C.59 Immunity from liability —— 30 licensee discipline —— inadmissibility of recordings. 31 1. A nursing facility is not civilly or criminally liable 32 for the disclosure of an unlawful recording captured by an 33 electronic monitoring device. 34 2. A nursing facility is not civilly or criminally liable 35 -9- LSB 1847XS (2) 91 lh/ko 9/ 12

S.F. 537 for a violation of a resident’s right to privacy arising out 1 of any electronic monitoring conducted in accordance and in 2 compliance with this subchapter. 3 3. The resident and resident representative, as applicable, 4 are responsible for complying with local, state, and federal 5 privacy laws and for firewall protections to prevent images 6 that may violate obscenity laws from being inadvertently shown 7 on the internet via the electronic monitoring device. 8 4. A nursing facility that knowingly violates this 9 subchapter shall be subject to licensee discipline. 10 5. If a resident fails to comply with the nursing facility 11 policies and residency agreement relating to the use of an 12 electronic monitoring device, nursing facility staff may 13 report the failure to the office of long-term care ombudsman 14 and law enforcement, as applicable. Continued failure by a 15 resident to comply with such nursing facility policies and 16 residency agreement may constitute grounds for termination of a 17 resident’s residency agreement. 18 Sec. 12. NEW SECTION . 135C.60 Resident protections. 19 1. A nursing facility shall not do any of the following: 20 a. Refuse to admit a potential resident or remove a resident 21 because the nursing facility disagrees with the potential 22 resident’s or the resident’s decisions regarding electronic 23 monitoring, whether the decision is made by a resident or a 24 resident representative acting on behalf of the resident. 25 b. Retaliate or discriminate against any resident for 26 consenting or refusing to consent to electronic monitoring. 27 c. Prevent the placement or use of an electronic monitoring 28 device by a resident who has provided the nursing facility 29 with any notification and consent form as required under this 30 subchapter. 31 2. Any contractual provision prohibiting, limiting, 32 or otherwise modifying the rights and obligations in this 33 subchapter is contrary to public policy and is void and 34 unenforceable. 35 -10- LSB 1847XS (2) 91 lh/ko 10/ 12

S.F. 537 Sec. 13. NEW SECTION . 135C.61 Report to the department. 1 A nursing facility shall report to the department, during 2 the nursing facility’s recertification survey, the number of 3 electronic monitoring device notification and consent forms 4 received by the nursing facility. 5 Sec. 14. Section 633.635, subsection 3, Code 2025, is 6 amended by adding the following new paragraph: 7 NEW PARAGRAPH . d. Consenting to electronic monitoring 8 conducted in accordance with chapter 135C. 9 Sec. 15. DIRECTIVE TO DEPARTMENT OF INSPECTIONS, APPEALS, 10 AND LICENSING. The department of inspections, appeals, and 11 licensing shall prescribe by rule pursuant to chapter 17A the 12 notification and consent form described in this Act, and shall 13 make the form available on the department’s internet site. 14 Sec. 16. CODE EDITOR DIRECTIVE. The Code editor may codify 15 the provisions of this Act as a new subchapter of chapter 135C 16 entitled “Electronic Monitoring”. 17 EXPLANATION 18 The inclusion of this explanation does not constitute agreement with 19 the explanation’s substance by the members of the general assembly. 20 This bill provides for authorized electronic monitoring in 21 nursing facilities. 22 The bill provides that a nursing facility resident or a 23 resident representative, as applicable, may conduct electronic 24 monitoring of the resident’s room through the use of electronic 25 monitoring devices placed in the resident’s room pursuant 26 to the bill. The bill specifies the consents that must be 27 obtained for a resident to conduct electronic monitoring in the 28 resident’s room, including from any roommate; the process to 29 be followed if a roommate refuses to consent; the provision 30 of notification to the nursing facility; the notification and 31 consent form requirements; the responsibility for costs and 32 installation relating to the electronic monitoring; notice 33 to visitors; prohibited obstruction of electronic monitoring 34 devices; immunity from liability, and licensee discipline; 35 -11- LSB 1847XS (2) 91 lh/ko 11/ 12