General Assembly: 81 (2005 Regular GA) - Chapter 60 - Assisted living programs


Published: 2005-04-27

Subscribe to a Global-Regulation Premium Membership Today!

Key Benefits:

Subscribe Now for only USD$20 per month, or Get a Day Pass for only USD$4.99.

155 LAWS OF THE EIGHTY-FIRST G.A., 2005 SESSION CH. 60

CH. 60CH. 60

CHAPTER 60

ASSISTED LIVING PROGRAMS

H.F. 585

ANACT relating to assisted living programs, providing for a fee, providing penalties, and pro- viding an effective date.

Be It Enacted by the General Assembly of the State of Iowa:

Section 1. Section 231C.1, subsection 1, Code 2005, is amended to read as follows: 1. The general assembly finds that assisted living is an important part of the long-term care

system continua in this state. Assisted living emphasizes the independence and dignity of the individual while providing services in a cost-effective manner.

Sec. 2. Section 231C.1, subsection 2, paragraphs b and c, Code 2005, are amended to read as follows: b. To establish standards for assisted living programs that allow flexibility in design which

promotes a social model of service delivery by focusing on individual independence, individu- al needs and desires, and consumer-driven quality of service. c. To encourage general public participation in the development of assisted living programs

for individuals of all income levels.

Sec. 3. Section 231C.2, subsections 2, 5, and 9, Code 2005, are amended to read as follows: 2. “Assisted living”means provision of housingwith serviceswhichmay include but are not

limited tohealth-related care, personal care, and assistancewith instrumental activities of dai- ly living to three or more tenants in a physical structure which provides a homelike environ- ment. “Assisted living” also includes encouragement of family involvement, tenant self-direc- tion, and tenant participation in decisions that emphasize choice, dignity, privacy, individ- uality, shared risk, and independence. “Assisted living” includes the provision of housing and assistance with instrumental activities of daily living only if personal care or health-related care is also included. “Assisted living” includes twenty-four-hours per day response staff to meet scheduled and unscheduled or unpredictable needs in a manner that promotes maxi- mum dignity and independence and provides supervision, safety, and security. 5. “Health-related care” means services provided by a registered nurse or a licensed practi-

cal nurse, on a part-time or intermittent basis, and services provided by other licensed health care professionals, on a part-time or intermittent basis, as defined by rule. 9. “Personal care” means assistance with the essential activities of daily living, which may

include but are not limited to transferring, bathing, personal hygiene, dressing, grooming, and housekeeping, that are essential to thehealthandwelfare of the tenant, andsupervisingof self- administered medications, but does not include the administration of medications.1

Sec. 4. Section 231C.2, subsection 7, Code 2005, is amended by striking the subsection and inserting in lieu thereof the following: 7. “Medication setup” means assistance with various steps of medication administration to

support a tenant’s autonomy, which may include but is not limited to routine prompting, cue- ing and reminding, opening containers or packaging at the direction of the tenant, reading in- structions or other label information, or transferring medications from the original container into suitable medication dispensing containers, reminder containers, or medication cups.

Sec. 5. Section 231C.2, subsection 13, Code 2005, is amended by striking the subsection and inserting in lieu thereof the following: 13. “Tenant’s legal representative” means a person appointed by the court to act on behalf

of a tenant or a person acting pursuant to a power of attorney.

___________________

1 See chapter 179, §121 herein

156LAWS OF THE EIGHTY-FIRST G.A., 2005 SESSIONCH. 60

Sec. 6. Section 231C.3, subsection 1, unnumbered paragraph 1, Code 2005, is amended to read as follows: Thedepartment shall establish by rule in accordancewith chapter 17A, a programminimum

standards for certification and monitoring of assisted living programs. The department may adopt by referencewith or without amendment, nationally recognized standards and rules for assisted living programs. The rules shall include specification of recognized accrediting enti- ties and provisions related to dementia-specific programs. The standards and rules shall be formulated in consultation with the department of inspections and appeals, and affected in- dustry, professional, and consumer groups and shall be designed to accomplish the purposes of this chapter and shall include but are not limited to rules relating to all of the following:

Sec. 7. Section 231C.3, subsection 1, paragraph b, Code 2005, is amended to read as fol- lows: b. Requirements that assisted living programs furnish the department of elder affairs and

the department of inspections and appeals with specified information necessary to administer this chapter. All information related to a provider application for an assisted living program submitted to either the department of elder affairs or the department of inspections and ap- peals shall be considered a public record pursuant to chapter 22.

Sec. 8. Section 231C.3, subsection 2, Code 2005, is amended by striking the subsection.

Sec. 9. Section 231C.3, subsection 7, Code 2005, is amended to read as follows: 7. The departmentmay also establish by rule in accordancewith chapter 17A a special clas-

sification minimum standards for affordable subsidized and dementia-specific assisted living programs. The rules shall be formulated in consultation with the department of inspections and appeals and affected industry, professional, and consumer groups.

Sec. 10. Section 231C.3, Code 2005, is amended by adding the following new subsections: NEWSUBSECTION. 11. Thedepartment of elder affairs and thedepartment of inspections

and appeals shall conduct joint training sessions for personnel responsible for conducting monitoring evaluations and complaint investigations of assisted living programs. NEW SUBSECTION. 12. Certification of an assisted living program shall be for two years

unless certification is revoked for good cause by the department of inspections and appeals.

Sec. 11. Section 231C.5, Code 2005, is amended to read as follows: 231C.5 WRITTEN OCCUPANCY AGREEMENT REQUIRED. 1. An assisted living program shall not operate in this state unless a written occupancy

agreement, as prescribed in subsection 2, is executed between the assisted living programand each tenant or the tenant’s legal representative, prior to the tenant’s occupancy, and unless the assisted living program operates in accordance with the terms of the occupancy agree- ment. The assisted living program shall deliver to the tenant or the tenant’s legal representa- tive a complete copy of the occupancy agreement and all supporting documents and attach- ments and shall deliver, at least thirty days prior to any changes, a written copy of changes to the occupancy agreement if any changes to the copy originally delivered are subsequently made. 2. An assisted living program occupancy agreement shall clearly describe the rights and re-

sponsibilities of the tenant and the program. The occupancy agreement shall also include but is not limited to inclusion of all of the following information in the body of the agreement or in the supporting documents and attachments: a. A description of all fees, charges, and rates describing tenancy and basic services cov-

ered, and any additional and optional services and their related costs. b. A statement regarding the impact of the fee structure on third-party payments, and

whether third-party payments and resources are accepted by the assisted living program.

157 LAWS OF THE EIGHTY-FIRST G.A., 2005 SESSION CH. 60

c. The procedure followed for nonpayment of fees. d. Identification of the party responsible for payment of fees and identification of the ten-

ant’s legal representative, if any. e. The term of the occupancy agreement. f. A statement that the assisted living program shall notify the tenant or the tenant’s legal

representative, as applicable, in writing at least thirty days prior to any change being made in the occupancy agreement with the following exceptions: (1) When the tenant’s health status or behavior constitutes a substantial threat to the health

or safety of the tenant, other tenants, or others, including when the tenant refuses to consent to relocation. (2) When an emergency or a significant change in the tenant’s condition results in the need

for the provision of services that exceed the type or level of services included in the occupancy agreement and the necessary services cannot be safely provided by the assisted living pro- gram. g. A statement that all tenant information shall be maintained in a confidential manner to

the extent required under state and federal law. h. Occupancy, involuntary transfer, and transfer criteria and procedures, which ensure a

safe and orderly transfer. i. The internal appeals process provided relative to an involuntary transfer. i. j. The program’s policies and procedures for addressing grievances between the assisted

living program and the tenants, including grievances relating to transfer and occupancy. j. k. A statement of the prohibition against retaliation as prescribed in section 231C.13. k. l. The emergency response policy. l. m. The staffing policy which specifies if the staff is available twenty-four hours per day,

if nurse delegation will be used, and how staffing will be adapted to meet changing tenant needs. m. n. In dementia-specific assisted living programs, a description of the services and pro-

gramming provided to meet the life skills and social activities of tenants. n. o. The refund policy. o. p. A statement regarding billing and payment procedures. 3. Occupancy agreements and related documents executed by each tenant or the tenant’s

legal representative shall be maintained by the assisted living program in program files from the date of execution until three years from the date the occupancy agreement is terminated. A copy of themost current occupancy agreement shall be provided tomembers of the general public, upon request. Occupancy agreements and related documents shall be made available for on-site inspection to the department of inspections and appeals upon request and at rea- sonable times.

Sec. 12. Section 231C.6, subsection 1, Code 2005, is amended to read as follows: 1. If an assisted living program initiates the involuntary transfer of a tenant and the action

is not a result of a monitoring evaluation or complaint investigation by the department of in- spections and appeals, and if the tenant or the tenant’s legal representative contests the trans- fer, the following procedure shall apply: a. The assisted living program shall notify the tenant or the tenant’s legal representative,

in accordancewith the occupancy agreement, of the need to transfer, the reason for the trans- fer, and the contact information of the tenant advocate. b. The assisted living program shall provide the tenant advocate with a copy of the notifica-

tion to the tenant. c. The tenant advocate shall offer the notified tenant or the tenant’s legal representative as-

sistance with the program’s internal appeals process. The tenant is not required to accept the assistance of the tenant advocate. d. If, following the internal appeals process, the assisted living program upholds the trans-

fer decision, the tenant or the tenant’s legal representative may utilize other remedies autho- rized by law to contest the transfer.

158LAWS OF THE EIGHTY-FIRST G.A., 2005 SESSIONCH. 60

Sec. 13. Section 231C.8, Code 2005, is amended to read as follows: 231C.8 INFORMAL REVIEW. 1. If an assisted livingprogramcontests the regulatory insufficiencies of amonitoringevalu-

ation or complaint investigation, the program shall submit written information, demonstrat- ing that the program was in compliance with the applicable requirement at the time of the monitoring evaluation or complaint investigation, in support of the contesting of the regulato- ry insufficiencies, to the department of inspections and appeals for review. 2. The department of inspections and appeals shall review the written information sub-

mitted within ten working days of the receipt of the information. At the conclusion of the re- view, the department of inspections and appealsmay affirm,modify, or dismiss the regulatory insufficiencies. The department of inspections and appeals shall notify the program inwriting of the decision to affirm, modify, or dismiss the regulatory insufficiencies, and the reasons for the decision. 3. In the case of a complaint investigation, the department of inspections and appeals shall

also notify the complainant, if known, of the decision and the reasons for the decision.

Sec. 14. Section 231C.9, Code 2005, is amended to read as follows: 231C.9 PUBLIC DISCLOSURE OF FINDINGS. Following Upon completion of a monitoring evaluation or complaint investigation of an as-

sisted living program by the department of inspections and appeals pursuant to this chapter, including the conclusion of all administrative appeals processes, the department of inspec- tions andappeals’ final findingswith respect to complianceby the assisted livingprogramwith requirements for certification shall be made available to the public in a readily available form and place. Other information relating to an assisted living program that is obtained by the de- partment of inspections and appeals which does not constitute the department of inspections and appeals’ final findings from a monitoring evaluation or complaint investigation of the as- sisted living program shall be made available to the department of elder affairs upon request in order to facilitate policy decisions, but shall not be made available to the public except in proceedings involving the denial, suspension, or revocation of a certificate under this chapter.

Sec. 15. Section 231C.10, subsection 1, Code 2005, is amended to read as follows: 1. The department of inspections and appeals may deny, suspend, or revoke a certificate in

any casewhere the department of inspections and appeals finds that there has been a substan- tial or repeated failure on the part of the assisted living program to comply with this chapter or the rules, orminimum standards adopted under this chapter, or for any of the following rea- sons: a. Cruelty or indifference to assisted living program tenants. b. a. Appropriation or conversion of the property of an assisted living program tenantwith-

out the tenant’s written consent or thewritten consent of the tenant’s legal guardian represen- tative. c. b. Permitting, aiding, or abetting the commission of any illegal act in the assisted living

program. d. c. Obtaining or attempting to obtain or retain a certificate by fraudulent means, misrep-

resentation, or by submitting false information. e. d. Habitual intoxication or addiction to the use of drugs by the applicant, administrator,

executive director, manager, or supervisor of the assisted living program. f. e. Securing the devise or bequest of the property of a tenant of an assisted living program

by undue influence. g. f. Founded dependent adult abuse as defined in section 235B.2. h. g. In the caseof anyofficer,memberof theboardof directors, trustee, or designatedman-

ager of the program or any stockholder, partner, or individual who has greater than a ten five percent equity interest in the program,whohas or has had an ownership interest in an assisted living program, adult day services program, elder group home, home health agency, residen- tial care facility, or licensed nursing facility in any state which has been closed due to removal

159 LAWS OF THE EIGHTY-FIRST G.A., 2005 SESSION CH. 60

of program, agency, or facility licensure or certification or involuntary termination from par- ticipation in either the medical assistance or Medicare programs, or who has been found to have failed to provide adequate protection or services for tenants to prevent abuse or neglect. i. h. In the case of a certificate applicant or an existing certified owner or operator who is

an entity other than an individual, the person is in a position of control or is an officer of the entity and engages in any act or omission proscribed by this chapter. j. i. For any other reason as provided by law or administrative rule.

Sec. 16. Section 231C.14, Code 2005, is amended by adding the following new subsection: NEWSUBSECTION. 3. Preventing or interfering with or attempting to impede in any way

any duly authorized representative of the department of inspections and appeals in the lawful enforcement of this chapter or of the rules adopted pursuant to this chapter. As used in this subsection, “lawful enforcement” includes but is not limited to: a. Contacting or interviewing any tenant of an assisted living program in private at any rea-

sonable hour and without advance notice. b. Examining any relevant records of an assisted living program. c. Preserving evidence of any violation of this chapter or of the rules adopted pursuant to

this chapter.

Sec. 17. Section 231C.15, Code 2005, is amended to read as follows: 231C.15 CRIMINAL PENALTIES AND INJUNCTIVE RELIEF. 1. A person establishing, conducting, managing, or operating any assisted living program

without a certificate is guilty of a seriousmisdemeanor. Each day of continuing violation after conviction or notice from the department of inspections and appeals by certified mail of a violation shall be considered a separate offense or chargeable offense. A person establishing, conducting, managing, or operating an assisted living program without a certificate may be temporarily or permanently restrained by a court of competent jurisdiction from such activity in an action brought by the state. 2. A person who prevents or interferes with or attempts to impede in any way any duly au-

thorized representative of the department of inspections and appeals in the lawful enforce- ment of this chapter or of the rules adopted pursuant to this chapter is guilty of a simplemisde- meanor. As used in this subsection, lawful enforcement includes but is not limited to: a. Contacting or interviewing any tenant of an assisted living program in private at any rea-

sonable hour and without advance notice. b. Examining any relevant records of an assisted living program. c. Preserving evidence of any violation of this chapter or of the rules adopted pursuant to

this chapter.

Sec. 18. NEW SECTION. 231C.16A MEDICATION SETUP — ADMINISTRATION AND STORAGE OF MEDICATIONS. 1. An assisted living programmay provide for medication setup if requested by a tenant or

the tenant’s legal representative. If medication setup is provided following such request, the programshall be responsible for the specific task requested and the tenant shall retain respon- sibility for those tasks not requested to be provided. 2. If medications are administered or stored by an assisted living program, or if the assisted

living program provides for medication setup, all of the following shall apply: a. If administration of medications is delegated to the program by the tenant or tenant’s le-

gal representative, themedications shall be administered by a registered nurse, licensed prac- tical nurse, or advanced registered nurse practitioner licensed or registered in Iowa or by the individual to whom such licensed or registered individualsmay properly delegate administra- tion of medications. b. Medications, other than those self-administered by the tenant or provided throughmedi-

cation setup, shall be stored in locked storage that is not accessible to persons other than em- ployees responsible for administration or storage of medications.

160LAWS OF THE EIGHTY-FIRST G.A., 2005 SESSIONCH. 60

c. Medications shall be labeled and maintained in compliance with label instructions and state and federal law. d. A person, other than a person authorized to prescribe prescription drugs under state and

federal law, shall not alter the prescription of a tenant. e. Medications shall be stored in their originally received containers. f. Ifmedication setup is providedby theprogramat the request of the tenant or tenant’s legal

representative, or if medication administration is delegated to the program by the tenant or tenant’s legal representative, appropriate staff of the program may transfer the medications in the tenant’s presence from the original prescription container to medication dispensing containers, reminder containers, or medication cups. g. Program assistance withmedication administration as specified in the occupancy agree-

ment shall not require the program to provide assistance with the storage of medications.

Sec. 19. Section 231C.17, subsections 1 and 3, Code 2005, are amended to read as follows: 1. A hospital licensed pursuant to chapter 135B, or a health care facility licensed pursuant

to chapter 135C, or an adult day services program certified pursuant to chapter 231Dmay op- erate an assisted living program, located in a distinct part of or separate structure under the control of the hospital or health care facility, if the assisted living program is certified pursuant to this chapter. 3. A certified assisted living program that complies with the requirements of this chapter

shall not be required to be licensed or certified as a health care different type of facility pur- suant to chapter 135C, unless the facility is represented to the public as a licensed health care another type of facility.

Sec. 20. Section231C.18, subsection2,Code2005, is amendedbyadding the followingnew paragraph: NEWPARAGRAPH. e. For accreditation via a national body of accreditation, one hundred

twenty-five dollars.

Sec. 21. EFFECTIVE DATE. This Act, being deemed of immediate importance, takes ef- fect upon enactment.

Approved April 27, 2005

_________________________

CH. 61CH. 61

CHAPTER 61

REGULATION OF ADULT DAY SERVICES

H.F. 587

ANACT relating to adult day services regulation, providing penalties, and providing an effec- tive date.

Be It Enacted by the General Assembly of the State of Iowa:

Section 1. Section 231D.1, Code 2005, is amended to read as follows: 231D.1 DEFINITIONS. For the purposes of this chapter, unless the context otherwise requires: 1. “Adult day services”, “adult day services program”, or “program” means an organized