Health Facilities Division Goal

Through education, regulation and enforcement, protect and enhance the health, safety, welfare and quality of life of people receiving care and services from licensed and/or certified entities.






If you are a Certified Nursing Assistant and would like to help out during the COVID-19 response, please click the link above.


Welcome to the home page for the Health Facilities Division of the Iowa Department of Inspections and Appeals.  The Division is the designated state survey and certification agency responsible for inspecting and licensing/certifying various health care entities, as well as health care providers and suppliers operating in the State of Iowa. Entities subject to the Department's oversight and regulation include nursing facilities, skilled nursing facilities, residential care facilities, intermediate care facilities for the intellectually disabled, hospitals, hospices, home health agencies, programs and facilities caring for children, assisted living programs and elder group homes.  Health Facilities Division personnel also investigate complaints alleging improper care or treatment of patients, residents, and tenants in licensed and certified entities.


Visitors to this web site will find a variety of useful information to assist them in the selection of a long-term health care provider, such as the directory of long-term care facilities and the Department's Report Cards web page.  Visitors are encouraged to review the materials found on this web site as it contains many tools to help them become better consumers. Providers, too, will find valuable information such as the latest rules and regulations governing their operations. Links to other useful web sites are also provided for easy access to relevant information.


Affordable Care Act Section 6103

The following links are provided to consumers in accordance with section 6103 of the Affordable Care Act:


If you have a technical issue with this Health Facilities Division website, please contact the State of Iowa Office of the Chief Information Officer (OCIO) at 515-281-5703 or 800-532-1174. You may also complete a request for assistance online with this form.


For additional information, you can contact us at:


Iowa Department of Inspections and Appeals

Health Facilities Division

Lucas State Office Building

321 East 12th Street

Des Moines, Iowa 50319-0083

Phone: (515) 281-4115

Fax: (515) 242-5022


Assistance with Account IDs and Passwords

Account IDs and passwords used by Health Care Entities and Direct Care Workers to access this website are maintained by the Health Facilities Division of the Iowa Department of Inspections and Appeals.


New Accounts and Resets

For facilities that need assistance with new accounts, or resetting passwords or identity baselines, please contact Dawn Fisk at (515) 281-4233 (


Direct Care Workers
If you are a Direct Care Worker (Certified Nursing Assistant) and need assistance, please contact Stephen Montalvo at (515) 281-4077 or Stacey Siepmann at (515) 281-0108 (





TB Testing

As of Sept. 3, 2019, DIA has been made aware that there is no longer a shortage of TB skin testing (TST) antigen.


The Department of Inspections and Appeals (DIA) had previously been made aware that the CDC had issued information regarding a shortage of TB skin testing (TST) antigen. DIA received several questions from providers regarding what they should do if they are not able to obtain product for the TST testing procedure. The Department consulted with the Department of Public Health on this issue.

The TB screening and testing requirements contained within 481 Iowa Admin. Code chapter 59 represent industry best practice. The Iowa Department of Public Health recommends that health care facilities and hospitals continue baseline TB screening and testing as outlined in Chapter 59. In the absence of available TST antigen, health care facilities and hospitals should use the IGRA procedure rather than the TST procedure. See Rule 59.5(1). However, the Department of Inspection and Appeals acknowledges the costs of IGRAs may be prohibitive in some settings. Accordingly, the Department of Inspections and Appeals offers the following guidance and exemption:

- If a health care facility or hospital is unable to test new HCWs and residents as required by Chapter 59 using the TST procedure due to the antigen shortage, it should consider using the IGRA procedure to test.

- If the IGRA procedure is not feasible for the health care facility or hospital, it should continue to perform and document sign/symptom review of new HCWs and residents as described in Chapter 59. It should also document the reason why a new HCW or resident was not tested and place the HCW or resident on a callback list to test as soon as possible (in order of date of hire or admission, respectively). HCWs in this category are allowed to work normal duties. HCWs and residents placed on a callback list must be tested as soon as the TST product is available.

- Health care facilities and hospitals should not test HCWs as part of a serial testing program (Chapter 59 does not require serial testing for health care facilities or hospitals classified as low risk, and all Iowa facilities and hospitals are currently classified as low risk).


CBD Oil in Licensed and Certified Healthcare Facilities

The Department has received many inquiries regarding the use of cannabidiol in regulated healthcare facilities. Department staff met with staff from the Iowa Department of Public Health (IDPH) and the Iowa Board of Pharmacy to gather information on some of the questions that we've received regarding the storage, handling, and administration of medical cannabidiol in health care facilities. Information received included:

- There is currently no provision in state law for a "facility caregiver". Only the patient and/or a designated caregiver would be able to pick up the medication from the dispensary.

- Only the patient or designated caregiver can administer cannabidiol. NOTE: Since cannabidiol is a Schedule I substance, the applicable storage and handling requirements apply. That is, only the resident and the designated caregiver are able to store, access and administer the drug. Facility staff cannot do so.

- Federal law prohibits a physician from writing an order for a Schedule I substance.

- The use of medical cannabidiol in regulated entities would be extremely difficult to implement within the current law. Changes will possibly occur that will change the landscape in the future. (Posted 02/18/2019)



New TB Screening Rules Take Effect September 5, 2018

The Department of Inspections and Appeals (DIA) has adopted new rules dealing with tuberculosis (TB) screening in health care facilities and hospitals.  The rules, which are contained in Iowa Administrative Code chapter 481—59, also provide clarification regarding the applicability of the TB screening process in a variety of circumstances, such as when health care workers transfer between facilities. 


The adopted rules, which take effect September 5, 2018, incorporate several suggestions from the Department’s stakeholders, including clarifying the baseline TB screening process and what the TB risk assessment shall include.  The rewritten rules also clarify and expand the definitions of “two-step tuberculin skin test,” “health care worker,” and “transfer” as the term relates to health care workers changing employment between health care facilities or hospitals.  The change in the definitions will reduce the instances of over-testing by including students in the definition of health care worker.  (Posted 08/31/2018)



Dual Certification Required for Some Dementia-Specific Assisted Living Programs

Beginning with their next certification, dementia-specific assisted living programs (ALP/Ds) that serve both a general population as well as tenants residing in a memory care unit may be required to file a separate application for each unit in the program.  The change is a result of conversations between the Department of Inspections and Appeals (DIA) and representatives from the Iowa Center for Assisted Living (ICAL) and LeadingAge Iowa regarding a door alarm requirement pertaining to dementia-specific programs.


The associations had requested that the Department grant a variance or draft a change to Iowa Administrative Code section 481—69.32(2), which requires “an operating alarm system shall be connected to each exit door in a dementia-specific program”.  It has come to the Department’s attention that several assisted living programs that serve residents in both memory care units and general population units do not have operating alarm systems connected to exit doors in their general population units.  These programs have operating alarm systems connected to exit doors in only the memory care units.


After reviewing data on elopements occurring in dementia-specific programs, it was determined that half of the elopements were by tenants residing in general population units.  Of the 50 percent of the elopements by tenants residing in memory care units, 19 percent traversed through the general population unit before exiting the programs.


In an effort to provide balance between the interests of safety and autonomy in assisted living programs, any dementia-specific assisted living program that does not wish to install an alarm system on exit doors in the general population unit may dually certify the program.  The program may certify its memory care unit as a dementia-specific program and the general population unit as a traditional assisted living program.  Dual certification will require the program to file two full application packets – one for each unit.  Dually-certified programs should be aware that any time a tenant leaves the memory care unit of the building, even if it is just into the general population part of the building that will be considered an elopement.


If a dementia-specific assisted living program chooses the dual certification option, it must notify the Department of its decision by September 1, 2018.  The notification to DIA applies only to those programs with a certification renewal period of September 1, 2018, or later.  These programs will be required to apply for dual certification at the time of its next certification.  A dementia-specific assisted living program that does not wish to be dually certified must have an operating alarm system connected to each exit door in the program, including those doors in the general population unit, by no later than September 1, 2018. (Posted 08/08/2018)


Sharing of Staff

Recently, the Department has received questions regarding the sharing of staff between a certified nursing facility and another licensure type operated by the same provider (e.g. a Residential Care Facility or Assisted Living Program).  IF a certified SNF/NF facility can maintain sufficient coverage, it would be acceptable for a nurse or certified nurse aide to "clock out" from the SNF/NF, go assist in the RCF or AL, and then return to the SNF/NF, clocking back in.  While working in the non-certified entity, the nurse or certified nurse aide would NOT be counted for purposes of PBJ nor would they be considered when assessing required nurse coverage or sufficiency of staff during the time they were working in the non-certified entity.  (Posted 07/27/2018)


Use of Electronic Cigarettes in Nursing Facilities

In November 2011, the Centers for Medicare & Medicaid Services (CMS) issued a policy memo (S&C 12-04) that states that vapor pens are not considered smoking devices and their heating element does not pose the same dangers of ignition as regular cigarettes.  While the risk of direct ignition is not the same with vapor pens, a review of recent literature by the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and the Federal Emergency Management Agency (FEMA) shows that as vapor pen use has increased, other risks associated with their use have also increased.  These risks include: health effects for the smoker and second-hand smoke related to the vapor; nicotine overdose by ingestion or contact with the skin; and explosion or fire caused by the battery.  Because these devices are not without risk and have accidents associated with them, facilities have a responsibility to oversee their use and provide supervision to maintain an accident-free environment.


Nursing facilities should revise smoking policies to specifically address the unique characteristics and risks that vapor pens/electronic cigarettes pose, such as where they can be used, supervision and handling (and charging) of batteries, and refilling cartridges.  The FDA has published recommendations for safe handling at the following link:  


With regard to indoor use, there are several factors to be considered.  Facility responsibility to provide supervision and maintain an accident-free environment, would generally preclude allowing residents to use vapor pens in their rooms.  Also, consideration would have to be given to whether the resident shared a room and the effects of second-hand vapor.  In August 2016, the World Health Organization (WHO) recommended that electronic cigarettes be banned indoors or where smoking is prohibited because of the second-hand exposure to potentially toxic chemicals, and many local and state jurisdictions have begun enacting laws that prohibit vapor pen use everywhere that smoking is banned.


To summarize, CMS has not revised its policy on vapor pens/electronic cigarettes, but expects that because these devices have inherent risks associated with their use, surveyors will carefully consider how the facility provides for resident safety, and balances resident rights to use these devices with the rights of residents (and staff) who do not want to be exposed to second-hand vapor.  (Posted 05/21/2018)


Nurse Aide Training Program Instructors

The Department has received clarification from the Centers for Medicare and Medicaid Services (CMS) related to the instructor qualifications for nurse aide training programs.  CMS has agreed that as long as the training program coordinator has the requisite long-term care experience, the instructors in the nurse aide program who are under the supervision of the program coordinator would NOT be required to have the one year of long-term care experience.  Hopefully this will help facilitate the hiring of qualified instructors for the nurse aide training programs.  (Posted 02/12/2018)


Elopement Reminder

The Department of Inspections and Appeals (DIA) reminds providers of the importance of ensuring the safety of wandering residents, especially during winter months.  It is vitally important to remind staff of the need to check the Wander Guard or other alarm system according to the manufacturer’s recommendations and as facility policy requires to ensure that mechanical problems are promptly identified, reported, and repaired.


Also, if a construction project requires the disengagement of the facility’s alarm system, or if repairs are being made to the facility’s locking or alarm systems, it is crucial to ensure that wandering residents are adequately supervised during the outage to prevent an elopement. 


Additionally, it has been reported that wandering residents sometimes leave a facility when visitors exit. Therefore, it is especially important during the winter months to ensure that visitors and family members are educated regarding the importance of not assisting a resident in exiting the facility without staff knowledge.  While alarms can help monitor a resident’s activities, staff must be vigilant in order to respond to an alarm in a timely manner. Remember – alarms do not replace adequate supervision.


The Department’s administrative rules [481 IAC 50.7(4)] require that a facility notify the director or the director’s designee within 24 hours, or the next business day, by the most expeditious means available:


50.7(4) When a resident elopes from a facility. For the purposes of this subrule, "elopes" means when a resident who has impaired decision-making ability leaves the facility without the knowledge or authorization of staff. (Posted 12/06/2017)


Emergency Preparedness Final Rule To Be Implemented Nov. 15, 2017

The Centers for Medicare & Medicaid Services (CMS) has released a new Appendix Z of the State Operations Manual (SOM), which contains the interpretive guidelines and survey procedures for the Emergency Preparedness Final Rule.  Appendix Z applies to all health care providers and supplier eligible for participation in the Medicare Program.  The rule, which became effective Nov. 15, 2016, will be implemented on Nov. 15, 2017.  A copy of Appendix Z and the final rule on Emergency Preparedness for Medicare and Medicaid Participating Providers and Suppliers can be found in the “Documents” section of this website under the Emergency Preparedness heading or on the CMS website.  (Posted 10/13/2017)


Exit Doors in Dementia-Specific Assisted Living Programs

The Department of Inspections and Appeals (DIA) has recently identified issues regarding alarm systems on exit doors in dementia-specific assisted living programs.  Iowa Administrative Code chapter 481—69.32(2) requires “(A)n operating alarm system shall be connected to each exit door in a dementia-specific program.”  The Department’s interpretation of this rule is that all exit doors will be equipped with an alarm system.


Surveyors in the Adult Services Bureau have identified situations in which programs use a personal alarm system, such as WanderGuard, in lieu of alarms on exit doors.  These types of personal alarm systems should be used only as a secondary alarm system and not relied upon as the primary or sole alarm system in a dementia-specific program. (Posted 08/03/2017)


Dangerous Counterfeit Pain Pills Found in Iowa

The Iowa Department of Public Health, Department of Public Safety, Poison Control Center and Office of Drug Control Policy issued an advisory Monday, July 24, to warn Iowans of a new synthetic opioid drug threat recently discovered in Iowa.  Recent cases of counterfeit pain pills have been confirmed by the Iowa Division of Criminal Investigation’s (DCI) laboratory. Upon analysis in each case, pills made to resemble the prescription pain reliever oxycodone were found to contain more powerful and illicit synthetic opioids fentanyl and U-47700.


Effective Date for Home Health Agency CoP Rule Delayed

The Centers for Medicare & Medicaid Services (CMS) has extended the effective date of the final home health agency (HHA) Conditions of Participation (CoP) rule by an additional 6 months beyond the original July 13, 2017 effective date. The new HHA CoPs are now effective on January 13, 2018. This rule does not make any changes to the policies that were set forth in the final HHA CoP rule. The final rule to extend the effective date (CMS-3819-F2) is available on the Federal Register website. Questions regarding the requirements of the January 13, 2017 final HHA rule may be sent to  


“CMS-3819-F2” is hyperlink to:


“January 13, 2017 final HHA rule” is hyperlink to the following web address:


Challenging the Length of a Federally-Imposed CMP

The Department of Inspections and Appeals (DIA) has been informed by Centers for Medicare & Medicaid Services (CMS) that the number of days for which a civil monetary penalty (CMP) is imposed is NOT subject to review or adjustment during either the informal dispute resolution (IDR) or independent informal dispute resolution (IIDR) process.  If a facility chooses to provide information to challenge the dates for which a federal CMP has been imposed, the facility should submit that information directly to the Department, which will make a recommendation to CMS based on the information submitted.  Information to challenge the dates of a federally-imposed CMP should be submitted to the Program Coordinator who supervises the facility’s survey and certification process.


Corrective Action & CMPs

Facilities are reminded that the longer it takes to correct an identified deficient practice directly impacts the number of days a daily Civil Monetary Penalty (CMP) will be imposed.  It’s important to correct the deficient practice as soon as possible and maintain the correction at the time of the first revisit.  When a facility fails to meet the first revisit, the CMP continues until compliance is established at a later revisit. (Posted 04/17/2017)


Post-Certification Revisit Report

On March 24, 2017, the Department was notified by the federal Centers for Medicare & Medicaid Services (CMS) that Form CMS 2567B, Post-Certification Revisit Report, has been determined to be an internal document between state survey agencies and the regional offices.  As a result of the CMS directive, Form CMS 2567B will no longer be sent to providers with the revisit letter.  This change became effective April 10, 2017.  (Posted 04/17/2017)


Email Notifications

Effective January 1, 2017, all communications between the Department of Inspections and Appeals (DIA) and licensed or certified entities resulting from a survey or investigation will be transmitted electronically. Such communications will include fining and citation documents, statements of deficiencies, regulatory insufficiencies and related correspondence. In order to ensure timely receipt of these documents, entities are asked to provide a contact name and corresponding email address. The email address should be for an individual authorized to receive the documents and be an email address that is checked on a regular basis. When there is a change in the authorized individual or email address, entities should notify their program coordinator and provide updated contact information.  (Posted 12/16/2016)


New Rules Ease Restrictions on CMA Training for Some

DES MOINES (November 4, 2016) -- New rules adopted recently by the Iowa Department of Inspections and Appeals (DIA) will make it easier for residential care facility (RCFs) employees to become certified medication aides (CMAs).  The rules, which take effect November 16, remove the requirement that individuals must first be certified nursing assistants (CNA) before taking classes to become a CMA.


“Eliminating this requirement will permit an individual employed in a residential care facility to become trained as a CMA without first being a CNA,” Health Facilities Division Administrator Dawn Fisk explained.  “The Department has heard from many smaller, rural facilities that it is difficult to hire individuals to work as certified medication aides due to the CNA requirement.  Hopefully this change will lessen the burden on these facilities when hiring staff to care for their residents.”


In order to become a certified medication aide, the individual must complete a 60-hour course consisting of classroom study and clinical experience.  The course, available at Iowa community colleges, prepares individuals to safely administer nonparenteral medications in nursing facilities and other settings.  Prior to registering for the course, the employing facility must provide the individual with a letter of recommendation for admission to the course. 


The new rules apply only to individuals employed in residential care facilities licensed for more than 15 beds.  Residential care facilities licensed for 15 or fewer beds may continue to use medication managers to administer nonparenteral medications.  “The requirement that CMAs working in nursing facilities or skilled nursing facilities must first be a certified nursing assistant remains unchanged as this is a federal requirement,” Fisk added.


Provider Training for New Nursing Home Regulations

The Centers for Medicare & Medicaid Services (CMS) is developing an online training for providers and other stakeholders on the new Nursing Home Regulations.  Provider access to the training will be located at, and will be available until July 2017. At this time, provider training will not be tracked, and there is no completion test or certificate provided.  The online training will include information about Phase 1 of the new Nursing Home Regulations, and will be available starting November 18, 2016. (Posted 10/25/2016)


Subacute Mental Health Care Services Licenses

Facilities wishing to provide subacute mental health care services may begin making application for the special licensure status effective Sept. 7, 2016.  Applications received prior to Sept. 7th will not be processed until after the effective date of the Department of Human Services’ (DHS) administrative rules.  The Iowa General Assembly created Iowa Code Chapter 135G for facilities to provide short-term, intensive, recovery-oriented services designed to stabilize an individual who is experiencing a decreased level of functioning due to a mental health condition.  In order to obtain the license, facilities will need to complete an application for license from the Department’s Health Facilities Division.  The application must be made at least 30 days prior to the proposed licensure date.


Requirements for licensure can be found in the Department’s administrative rules [481 IAC 71].  Final approval for a license will be granted by the DHS based upon criteria to identify the best-qualified providers.


Resident Privacy and Mental Abuse

The Centers for Medicare & Medicaid Services (CMS) has just issued a memorandum dealing with protecting resident privacy and prohibiting mental abuse related to photographs and audio/video recordings by nursing staff.  The memo (S&C: 16-33-NH) is available from the CMS website. (Posted 08/05/2016)


New ALP, ADS Rules Take Effect April 20, 2016

New rules primarily affecting assisted living programs and adult day service programs take effect Wednesday, April 20, 2016.  The new rules are the result of a five-year review conducted by the Department of Inspections and Appeals (DIA), which produced significant changes to Iowa Administrative Code chapters 481—67, “General Provisions for Elder Group Homes, Assisted Living Programs, and Adult Day Services,” 481—69, “Assisted Living Programs,” and 481—70, “Adult Day Services”. (Posted 04/05/2016)


Implementation of Required Staffing Data Submissions

Effective July 1, 2016 long-term care facilities must submit to the Centers for Medicare & Medicaid Services (CMS) complete and accurate direct care staffing information, including information for agency and contract staff, based on payroll and other verifiable and auditable data in a uniform format.  CMS may use its enforcement authority for noncompliance with the requirement to submit data.  A copy of the revised and final payroll-based journal (PBJ) policy manual and related information is available through CMS’s Staffing Data Submission PBJ website.  A copy of the Survey & Certification memorandum also is available on the CMS website.  (Posted 03/25/2016)


Protections during Abuse Investigations

When a nursing facility receives an allegation of abuse, they must report immediately (as soon as possible, but not to exceed 24 hours), separate the alleged perpetrator from ALL potential victims, and begin their investigation.


At the conclusion of the facility’s investigation, if the facility determines the allegation of abuse is not substantiated, the facility may allow the alleged perpetrator to resume working with residents OTHER THAN the resident the perpetrator is alleged to have abused.  The alleged perpetrator’s return to fully unrestricted work status will be dependent on the outcome of the DIA investigation.


Before returning an alleged perpetrator to working with residents, the facility should have a high degree of certainty that the alleged abuse did not occur.  If it is later determined by the DIA that abuse did occur, there will be consideration given to whether an immediate jeopardy situation occurred by allowing the perpetrator to work with residents. (Posted 03/02/2016)


Door Alarms in Nursing Facilities

Nursing facilities should be aware of the following information related to requirements for door alarms as described in 481 IAC 61.  Chapter 61.2(6) states, in part,  that existing nursing facilities (as of July 1, 2013) built in compliance with prior versions of this chapter will be deemed in compliance, with the exception of any renovations, additions, functional alterations, changes of space utilization, or conversions to existing facilities for which construction documents are submitted.  Therefore, facilities already in existence on July 1, 2013 would be deemed to meet Chapter 61.6(7) which states an exit door alarm system shall be installed on all exterior doors. 


The prior version of Chapter 61 required that all fire exit doors be alarmed.  The newer version of Chapter 61 requires that all exit doors be alarmed.  However, as stated above, facilities built prior to July 1, 2013 in compliance with prior versions, will be deemed in compliance.  It should be noted, where a door alarm is required, a bracelet alarm system would not meet the requirement unless all residents wore bracelets. (Posted 03/02/2016)


A Message on Medicaid Modernization

The Iowa Department of Human Services (DHS) is working to modernize the Iowa Medicaid program with a focus on better care coordination to improve Medicaid members’ health. We’re helping DHS share information about this important new initiative, called the IA Health Link, which will be implemented on January 1, 2016. More than a half a million Iowans are currently enrolled in Medicaid, and we want members and those involved in their care to understand this effort and the new choices they have regarding their health coverage. Information on the IA Health Link initiative can be found on the dedicated web page. A special informational toolkit is available to stakeholders. Please also see listings of community and enrollment events and webinars on the DHS website. Please feel free to share this information with others in your organization or your community. If you’d like to subscribe to Iowa Medicaid’s email notifications, please email “subscribe” along with your name, organization and contact information to 


Facility’s Obligation to Provide CPR

The Department of Inspections and Appeals (DIA) has recently identified a number of immediate jeopardy situations in long-term care facilities related to the failure to provide Cardiopulmonary Resuscitation (CPR) when appropriate.  Facilities are reminded of their obligation in certain circumstances to provide basic life support, including the initiation of CPR, to a resident who experiences cardiac arrest.  The Survey & Certification Letter dealing with Cardiopulmonary Resuscitation (CPR) in Nursing Homes is available here.


Staff Identifier Lists

Effective 6/15/15, the Department will no longer provide a staff identifier list subsequent to recertification surveys or complaint/incident investigations.  This change applies to all provider types licensed or certified by the Department.  The Department has been directed by the Centers for Medicare and Medicaid Services that staff identifier lists are not to be distributed at the conclusion of a survey.  The staff identifier list will generally be available in a contested case hearing.  Resident identifier lists will be made available to all facility and program types licensed under 135C or certified under 231B, 231C, or 231D, in conjunction with the Statement of Deficiencies (Form 2567) or other report, when issued.


When developing Plans of Correction for identified deficient practices, providers are encouraged to focus on systemic interventions that may be incorporated in an overall staff training and development program and consistently monitored via a robust quality assurance program.  Individual personnel actions are a separate matter from regulatory compliance.


New Application Form and Administrative Rules

Effective May 6, 2015, a new application for certification form will be used by the Department of Inspections and Appeals (DIA) for all assisted living programs, elder group homes, and adult day service programs.  The use of the new application form coincides with changes to the Department’s administrative rules that clarify the content of an application and the process for notifying DIA of changes in ownership.  The new rules also require certified entities to notify DIA when changes occur to the program manager.  A copy of the new Application for Certification, as well as updated copies of the administrative rules [481—68, 481—69, and 481—70], can be found in the Documents section of this website.


Food Establishment Licenses

The Department of Inspections and Appeals (DIA) has been made aware that certain health care facilities in Iowa should have a food establishment license but have not obtained one.  The Iowa Health Care Association/Iowa Center for Assisted Living (IHCA/ICAL), in consultation with DIA, has developed flow charts to assist nursing facilities and assisted living programs in determining whether a food establishment license is required for their operations.  The Department encourages nursing facilities and assisted living programs with questions about food establishment licensure to review the flow charts, which can be found in the “documents” section of this website. Facilities requiring a food establishment license have until Friday, May 29, 2015 to apply for a license without penalty.  Licensing information may be obtained from DIA’s Food & Consumer Safety Bureau at 515-281-6538.


Timely Reporting of Resident Abuse

As the State Survey Agency, DIA’s Health Facilities Division (DIA/HFD) is periodically reviewed by the Kansas City Regional Office of the Centers for Medicare & Medicaid Services (KCRO/CMS).  Following a recent review, the KCRO informed the Health Facilities Division that the performance standard for the quality of complaint/incident investigations for nursing homes was “NOT MET”.  The most frequently cited example that caused the standard to be “NOT MET”, was that HFD surveyors were not citing a deficient practice when a facility report of abuse to the HFD did not occur immediately, and the time the report was made exceeded 24 hours from the time of the allegation.


After reviewing the specific details of the examples cited as deficient, HFD staff noted that in most cases, the facility had reported the abuse to DIA/HFD within the next business day, but NOT within 24 hours.  DIA/HFD had not consistently cited a deficient practice in these cases. KCRO has informed DIA/HFD that all allegations of abuse must be reported immediately, but in no case should the timeframe for reporting exceed 24 hours.  This is the case even when the 24-hour window for reporting the allegation falls on a weekend or holiday.


Long-term care facilities should be aware that all allegations of abuse must be reported to DIA/HFD immediately, and in no case should the time for reporting exceed 24 hours from the time the allegation is made.  Our surveyors have been retrained regarding this expectation and will cite a deficient practice when the time a report of abuse is made exceeds 24 hours from when the allegation of abuse is made.  Long-term care providers should review their policies to ensure compliance with federal requirements and revise as necessary to meet requirements.  Appropriate training should be provided to facility staff.


Additionally, LTC facilities should review the federal guidelines regarding the definitions of resident abuse.  You’ll note that federal guidelines define resident abuse without regard to who the perpetrator of the abuse may be.  Resident abuse may be committed by another resident, a family member, visitor or staff person of the facility.  Allegations of resident abuse must be reported to the State Survey Agency.  There are differences in the federal and state abuse reporting requirements, and facilities should be mindful of the requirements of each.


Reports of allegations of abuse can be made to DIA/HFD after regular business hours via web application, fax, email, or voicemail.



Fax:  (515) 281-7106


Phone:  (877) 686-0027


Pre-Decisional Documentation

The Department has been advised by the Centers for Medicare and Medicaid Services (CMS) that pre-decisional documentation gathered in the course of federal certification survey activity cannot be directly released by the State Survey Agency for the purposes of Informal Dispute Resolution, including Independent Informal Dispute Resolution.  All requests for these survey records require a valid Freedom of Information Act (FOIA) request.  FOIA requests for records may be directed to:


Rori Leeks

Office of the Regional Administrator

Centers for Medicare & Medicaid Services

601 East 12th Street, Suite 355

Kansas City, MO 64106

Email Address:  


Effective immediately, if requests for these federal records are received, the Department will provide the above contact information to the requestor so that they may make the request directly to the appropriate party.

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