S.F. 539 Section 1. NEW SECTION . 10A.904 Definitions. 1 As used in this subchapter, unless the context otherwise 2 requires: 3 1. “Assisted living program” or “program” means the same as 4 defined in section 231C.2. 5 2. “Health care facility” means the same as defined in 6 section 135C.1. 7 3. “Long-term care facility” means a health care facility 8 or an assisted living program. 9 4. “Long-term care facility safety council” or “safety 10 council” means the long-term care facility safety council 11 created in section 10A.905. 12 5. “Resident” means the same as defined in section 135C.1. 13 6. “Tenant” means the same as defined in section 231C.2. 14 Sec. 2. NEW SECTION . 10A.905 Long-term care facility safety 15 council —— membership —— duties —— meetings. 16 1. A long-term care facility safety council is created. 17 a. The safety council shall include the following voting 18 members: 19 (1) The director of health and human services, or the 20 director’s designee. 21 (2) The state long-term care ombudsman, or the state 22 long-term care ombudsman’s designee. 23 (3) The director of an area agency on aging, or the 24 director’s designee. 25 (4) The state director of AARP, or the state director’s 26 designee. 27 (5) Three public members appointed by the governor, and 28 subject to confirmation by the senate, who are consumers or 29 members of consumer groups or consumer organizations. 30 (6) Two health care professionals appointed by the 31 governor, and subject to confirmation by the senate, who do not 32 have a conflict of interest in performing the duties of the 33 safety council. 34 b. The safety council shall also include the director or the 35 -1- LSB 1526XS (3) 91 lh/ko 1/ 8

S.F. 539 director’s designee as a nonvoting member. 1 2. The long-term care facility safety council shall do all 2 of the following: 3 a. Determine and approve standards, including those relating 4 to health and safety, for long-term care facilities. 5 b. Conduct informal conferences and reviews of health care 6 facility applicants and licensees, and assisted living program 7 applicants and certificate holders, and make recommendations 8 for departmental action pursuant to sections 135C.10A and 9 231C.11B. 10 c. Review and make recommendations to the department 11 regarding violations and penalties under chapters 135C and 12 231C. 13 d. Make recommendations to the department regarding the 14 adoption or amendment of administrative rules. 15 e. Review the operation of long-term care facilities for 16 which the department has referred a complaint received by the 17 department to the office of long-term care ombudsman. 18 f. Receive recommendations from the state long-term care 19 ombudsman regarding inspections of specific long-term care 20 facilities, and changes in administrative rules regarding the 21 health, safety, welfare, and rights of residents and tenants. 22 g. Submit an annual report to the general assembly by 23 October 31 for the immediately preceding fiscal year, including 24 any recommendations for changes in law to better protect 25 residents and tenants, and a summary of all recommendations 26 made by long-term care facilities during informal conferences. 27 h. Review a change of ownership application of a previously 28 licensed nursing facility pursuant to section 135C.7A, taking 29 into consideration whether the new ownership will improve the 30 financial status or health status of the nursing facility. The 31 department shall only grant a change of ownership application 32 upon the approval of the application by the safety council. 33 3. The members shall elect a public member as the 34 chairperson of the safety council annually. 35 -2- LSB 1526XS (3) 91 lh/ko 2/ 8

S.F. 539 4. The safety council shall hold an organizational meeting 1 in July each year, and meetings shall be held as necessary 2 to enable the safety council to expeditiously discharge its 3 duties. Meeting dates shall be set upon adjournment or by call 4 of the chairperson upon five days’ notice to the other members. 5 Sec. 3. Section 135C.1, Code 2025, is amended by adding the 6 following new subsection: 7 NEW SUBSECTION . 12A. “Long-term care facility safety 8 council” or “safety council” means the long-term care facility 9 safety council created pursuant to section 10A.905. 10 Sec. 4. Section 135C.10, unnumbered paragraph 1, Code 2025, 11 is amended to read as follows: 12 The department shall have the authority to deny, suspend, or 13 revoke a license in any case where the department finds that 14 there has been repeated failure on the part of the a facility 15 to comply with the provisions of this chapter or the rules or 16 minimum standards promulgated hereunder under this chapter , or 17 for any of the following reasons: 18 Sec. 5. NEW SECTION . 135C.10A Multiple violations 19 within a twelve-month period —— informal conference and review 20 by long-term care facility safety council —— recommended 21 departmental actions. 22 1. At the time the department effects delivery of notice 23 on an applicant or licensee under section 135C.11 to deny, 24 suspend, or revoke a license, the department shall also notify 25 the long-term care facility safety council. 26 2. a. The safety council shall hold an informal conference 27 with the applicant or licensee within ten working days of 28 the mailing or service of notice to review the applicant’s 29 or licensee’s history of violations for which a penalty was 30 assessed under this chapter, and the response by the applicant 31 or licensee in correcting such violations. 32 b. Following the informal conference and review, the safety 33 council shall report its findings to the department, including 34 any recommendations for departmental action as authorized under 35 -3- LSB 1526XS (3) 91 lh/ko 3/ 8

S.F. 539 this chapter. The department shall proceed in accordance with 1 the recommendations of the safety council. A health care 2 facility may subsequently request a formal hearing and proceed 3 under section 135C.11. 4 Sec. 6. Section 135C.14, unnumbered paragraph 1, Code 2025, 5 is amended to read as follows: 6 The department shall, in accordance with chapter 17A , 7 and with the approval of the long-term care facility safety 8 council, adopt and enforce rules setting minimum standards 9 for health care facilities. In so doing, the department , 10 with the approval of the long-term care facility safety 11 council, may adopt by reference, with or without amendment, 12 nationally recognized standards and rules, which shall be 13 specified by title and edition, date of publication, or similar 14 information. The rules and standards required by this section 15 shall be formulated in consultation with the director of 16 health and human services or the director of health and human 17 services’ designee, with the director, with the state long-term 18 care ombudsman, and with affected industry, professional, 19 and consumer groups, and shall be designed to further the 20 accomplishment of the purposes of this chapter and shall relate 21 to: 22 Sec. 7. Section 231.42, subsection 2, Code 2025, is amended 23 by adding the following new paragraph: 24 NEW PARAGRAPH . f. Make recommendations to the long-term 25 care facility safety council created in section 10A.905 26 regarding inspections of specific health care facilities and 27 assisted living programs, and changes in administrative rules 28 regarding the health, safety, welfare, and rights of residents 29 of health care facilities and tenants of assisted living 30 programs. 31 Sec. 8. Section 231C.2, Code 2025, is amended by adding the 32 following new subsection: 33 NEW SUBSECTION . 7A. “Long-term care facility safety council” 34 or “safety council” means the long-term care facility safety 35 -4- LSB 1526XS (3) 91 lh/ko 4/ 8

S.F. 539 council created in section 10A.905. 1 Sec. 9. NEW SECTION . 231C.11B Multiple violations 2 within a twelve-month period —— informal conference and review 3 by long-term care facility safety council —— recommended 4 departmental actions. 5 1. At the time the department effects delivery of notice 6 on an applicant or certificate holder under section 231C.11, 7 based on the assisted living program having been issued notice 8 of three violations in a twelve-month period which presented 9 imminent danger or a substantial probability of resultant 10 death or physical harm to a tenant and for which a penalty 11 was assessed under section 231C.14, the department shall also 12 notify the long-term care facility safety council. 13 2. a. The safety council shall hold an informal conference 14 with the applicant or certificate holder within ten working 15 days of the mailing or service of notice to review the 16 applicant’s or certificate holder’s history of violations 17 for which a penalty was assessed under this chapter, and the 18 response by the applicant or certificate holder in correcting 19 such violations. 20 b. Following the informal conference and review, the safety 21 council shall report its findings to the department, including 22 any recommendations for departmental action as authorized under 23 this chapter. The department shall proceed in accordance with 24 the recommendations of the safety council. An assisted living 25 program may subsequently request a contested case hearing and 26 proceed under section 231C.9A. 27 Sec. 10. STUDY AND RECOMMENDATIONS —— SPECIAL FOCUS LIST FOR 28 LONG-TERM CARE FACILITIES. The long-term care facility safety 29 council created in section 10A.905, as enacted in this Act, 30 shall study the feasibility of creating a special focus list 31 for long-term care facilities in the state based on a review 32 of special focus lists in other states. Following completion 33 of the study, the safety council shall submit a report to 34 the general assembly by February 1, 2026, including specific 35 -5- LSB 1526XS (3) 91 lh/ko 5/ 8

S.F. 539 descriptions of successful special focus lists in other states, 1 and recommendations for the creation of a special focus list 2 in Iowa including necessary Code changes and the potential 3 framework for the special focus list. 4 Sec. 11. CODE EDITOR DIRECTIVE. The Code editor is directed 5 to create a new subchapter X in chapter 10A as follows: 6 subchapter X shall be entitled “Long-term Care Facility Safety 7 Council” and shall include sections 10A.904 and 10A.905. 8 EXPLANATION 9 The inclusion of this explanation does not constitute agreement with 10 the explanation’s substance by the members of the general assembly. 11 This bill provides for oversight for long-term care 12 facilities (facilities). 13 The bill creates a long-term care facility safety council 14 (safety council) under the department of inspections, appeals, 15 and licensing (DIAL) to: determine and approve standards 16 for long-term care facilities; conduct informal conferences 17 and reviews of health care facility applicants and licensees 18 that have been issued three or more class I violations (a 19 violation which presents an imminent danger or a substantial 20 probability of death or physical harm to the residents of the 21 facility in which the violation occurs) within a 12-month 22 period for which a penalty was assessed, and of assisted 23 living program applicants or certificate holders that have 24 been issued notice of three violations in a 12-month period 25 which presented imminent danger or a substantial probability 26 of resultant death or physical harm to a tenant and for which 27 a penalty was assessed, and make recommendations to DIAL for 28 departmental action; review and make recommendations to DIAL 29 regarding violations and penalties; make recommendations to 30 DIAL regarding the adoption or amendment of administrative 31 rules; review the operation of long-term care facilities for 32 which the department has referred a complaint received by 33 the department to the office of long-term care ombudsman; 34 receive recommendations from the state long-term care 35 -6- LSB 1526XS (3) 91 lh/ko 6/ 8

S.F. 539 ombudsman and submit an annual report to the general assembly 1 with recommendations for changes in law to better protect 2 residents and tenants, and a summary of recommendations made 3 by long-term care facilities in informal conferences; and 4 review change of ownership applications of previously licensed 5 nursing facilities. The voting members of the safety council 6 include the director of health and human services, or the 7 director’s designee; the state long-term care ombudsman, or the 8 ombudsman’s designee; the director of an area agency on aging, 9 or the director’s designee; the state director of AARP, or the 10 state director’s designee; three public members, appointed by 11 the governor, and subject to confirmation by the senate; and 12 two health care professions, appointed by the governor, and 13 subject to confirmation by the senate. The safety council also 14 includes the director of DIAL, or the director’s designee as a 15 nonvoting member. The members shall annually elect a public 16 member as the chairperson of the council. The safety council 17 shall hold an organizational meeting in July each year and hold 18 other meetings as necessary to enable the safety council to 19 expeditiously discharge its duties. 20 The bill provides that at the time DIAL serves notice on an 21 applicant or licensee of a health care facility for denial, 22 suspension, or revocation of a license, DIAL shall also 23 notify the safety council. The safety council shall hold an 24 informal conference with the applicant or licensee within 10 25 working days of the mailing or service of notice to review 26 the applicant’s or licensee’s history of violations for which 27 a penalty was assessed, and the response by the applicant or 28 licensee in correcting such violations. Following the informal 29 conference and review, the council shall report its findings 30 to DIAL including recommendations for departmental action, 31 in accordance with which DIAL shall proceed. A facility may 32 subsequently request a formal hearing. 33 The bill also requires that at the time DIAL effects 34 delivery of notice on an assisted living program applicant or 35 -7- LSB 1526XS (3) 91 lh/ko 7/ 8

S.F. 539 certificate holder, based on the assisted living program having 1 been issued notice of three violations in a 12-month period 2 which presented imminent danger or a substantial probability 3 of resultant death or physical harm to a tenant, and for which 4 a penalty was assessed, DIAL shall also notify the long-term 5 care facility safety council. As with health care facilities, 6 the safety council shall hold an informal conference with the 7 applicant or certificate holder within 10 working days of 8 the mailing or service of notice to review the applicant’s 9 or certificate holder’s history of violations for which a 10 penalty was assessed, and the response by the applicant or 11 certificate holder in correcting such violations. Following 12 the informal conference and review, the safety council shall 13 report its findings to DIAL, including any recommendations 14 for departmental action, with which DIAL shall proceed. An 15 assisted living program may subsequently request a contested 16 case hearing. 17 The bill also requires DIAL to adopt and enforce 18 administrative rules that set minimum standards for facilities 19 with the approval of the safety council, rather than the 20 approval of the council on health and human services. 21 Additionally, the rules and standards must be formulated in 22 consultation with the state long-term care ombudsman. 23 The bill includes, as a duty of the state long-term care 24 ombudsman, making recommendations to the long-term care 25 facility safety council. 26 The bill requires the long-term care facility safety council 27 to study the feasibility of creating a special focus list for 28 long-term care facilities in the state based on a review of 29 special focus lists in other states, and to submit a report to 30 the general assembly by February 1, 2026, including specific 31 descriptions of successful special focus lists in other states, 32 and recommendations for the creation of a special focus list 33 in Iowa including necessary Code changes and the potential 34 framework for the special focus list. 35 -8- LSB 1526XS (3) 91 lh/ko 8/ 8