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.

 

 

 

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:

 

The Health Facilities Division's web site is constantly evolving to include new and expanded information. We welcome public comments on ways to improve this web site, and encourage visitors to e-mail their thoughts and suggestions to webmaster@dia.iowa.gov.

 

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.

 

Health Care Entities that experience problems logging into the website should contact either Terry Ventling at (515) 281-6968 (terry.ventling@dia.iowa.gov) or Geri Paul at (515) 281-4548 (geri.paul@dia.iowa.gov).

 

Direct Care Workers who experience problems accessing the website should contact either Greg DeMoss at (515) 281-4077 (greg.demoss@dia.iowa.gov) or Stacey Siepmann at (515) 281-0108 (stacey.siepmann@dia.iowa.gov).

 

 

 

 

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, the Department of Inspections and Appeals’ 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.

 

Website:  https://dia-hfd.iowa.gov/DIA_HFD/Home.do

Fax:  (515) 281-7106

Email:  HFD_Complaint@dia.iowa.gov

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:

 

Rita Crane

Executive Assistant, Office of the Regional Administrator

Centers for Medicare and Medicaid Services

601 East 12th Street, Suite 355

Kansas City, MO 64106

Rita.crane@mcs.hhs.gov  

 

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.

 

New Chapter 57 Rules Take Effect Today (1/14/15)

New administrative rules governing the operation of residential care facilities became effective today.  The newly rewritten chapter [481 IAC 57] eliminates obsolete language and updates other provisions where necessary.  Input from various stakeholder groups was sought throughout the months-long process.  A copy of the new Chapter 57, “Residential Care Facilities,” is available from the legislative website at https://www.legis.iowa.gov/docs/ACO/chapter/01-07-2015.481.57.pdf

 

Power Strip Usage in Patient Care Areas

The Centers for Medicare & Medicaid Services (CMS) issued S&C Letter 14-46-LSC, “Categorical Waiver for Power Strips Use in Patient Care Areas,” on September 26, 2014.  Staff in the State Fire Marshal’s Office has reviewed the letter and offer the following clarification:  (1) The S&C Letter will only apply to long-term care facilities that provide life support services and all hospitals.  The Fire Marshal’s Office believes the S&C Letter exempts long-term care facilities and residential care facility if they don’t use the line-operated electrical appliances. (2) The previous surge protector policy provided by the Fire Marshal’s Office will remain in effect and applies to all health care facilities.  Facilities with questions should contact either the State Fire Marshal’s Office or the Health Facilities Division.

 

New License Application Developed for Health Care Facilities

Beginning August 1st, all health care facilities licensed under Iowa Code Chapter 135C should begin using the new license application developed by the Health Facilities Division of the Iowa Department of Inspections and Appeals (DIA).  135C-licensed providers include nursing facilities, skilled nursing facilities, intermediate care facilities, and residential care facilities.  The application has been revised to better collect relevant and accurate information about the facility for which a license is being sought.  Staff in the Health Facilities Division will be sending the new license application to all facilities prior to the expiration of their current licenses.

 

Elopement Reminder

The Department of Inspections and Appeals would like to remind providers of the importance of ensuring the safety of wandering residents, especially during the harsh winter months.  It is vitally important to remind staff of the need to check the wander guard system as directed by the manufacturers and as facility policy requires, to ensure mechanical problems are promptly identified, reported, and repaired.  Remember, if a construction project requires the disengagement of the wander guard system, or you are completing repair work on the locking system/wander guard system, it is critical to ensure that wandering residents are adequately supervised during the outage to prevent an elopement. 

 

Additionally, in some instances, it has been reported that a wandering resident left a facility when a visitor exited.  It is especially important in the winter months to ensure that visitors and family members are educated regarding the importance of not assisting a resident out the door without staff knowledge.  While alarms can help to monitor a resident’s activities, staff must be vigilant in order to respond to the alarms in a timely manner.  Alarms do not replace necessary supervision.

 

A reminder of Iowa Administrative Code chapter 481—50.7(10A, 135C) Additional notification. The director or the director’s designee shall be notified 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.

 

Background Checks FAQ

The Department routinely receives questions related to record checks.  A list of the most commonly asked questions and their answers has been posted to the Documents section of this website. 

 

Hot Water Temperatures in Nursing Facilities

The Department recently received questions about hot water temperatures in nursing facilities. Previously, Iowa Administrative Code 481—chapter 61 generally required hot water temperatures of between 110 (resident areas) and 120 (dietary). However, on July 3, 2013, a new chapter 61 became effective, which incorporates by reference the Facility Guidelines Institute’s (FGI) Guidelines for Design and Construction of Health Care Facilities, 2010 edition. [rule 61.2(3)]. The FGI Guidelines require temperatures of 95 to 110 degrees Fahrenheit (35-43 degrees Centigrade) in resident care areas and a minimum of 140 degrees Fahrenheit (60 degrees Centigrade) in dietary and laundry. (See Table 4.1-2) Please find the document located in the Documents tab at the left side of the page.

 

MDS 3.0 Discharge Assessments

The Centers for Medicare & Medicaid Services (CMS) is clarifying steps to take to address Minimum Data Set (MDS) 3.0 discharge assessments that have not been completed and/or submitted as required under 42 CFR §483.20(g) and 42 CFR §483.20(f)(1). The Survey & Certification memo (S&C:13-56-NH) is intended to help surveyors understand both (a) what nursing homes should do to address inactive residents remaining on their resident roster due to incomplete and/or unsubmitted discharge assessments and (b) how nursing homes can ensure compliance with discharge assessment requirements.  The memo can be found in the documents section of this website.

 

Restraint Alternative Guide

Federal and state laws require nursing homes attempt alternative methods or interventions prior to the use of physical restraints.  Telligen has produced a seven-page Restraint Alternative Guide to help facilities identify appropriate restraint alternatives for residents who have restraints.  The Guide is available in the 'Documents' section of this website.  (12/19/12)

 

Minimum Data Set (MDS) 3.0 Quality Measures (QM) version 6

The MDS 3.0 QM User's Manual V6.0 and QM ID by CMS Reporting Module V1.0 for User's Manual V6.0 were posted by the Centers for Medicare & Medicaid Services (CMS) at http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/NHQIQualityMeasures.html   The new QM User's Manual V6 is effective immediately.

 

New Long-term Care Survey Regions

Effective November 2, 2012, Health Facilities Surveyors will no longer be assigned to specific long-term care areas.  Rather, Surveyors will be subject to assignment in any of five new geographic regions, which allows them to be utilized in the most efficient manner depending upon workloads.  Each geographic region (Northwest, Northeast, East Central, Southeast, and Southwest) has an assigned Program Coordinator who is responsible for nursing facilities in their respective region.  Polk County nursing facilities are divided among four of the Program Coordinators.  The new geographic areas are defined in the "Contacts" document found on this page.

 

Improving Antipsychotic Appropriateness in Dementia Patients (IA-ADAPT) Website

Developed by the University of Iowa with the support of the Agency for Healthcare Research and Quality, the IA-ADAPT website helps clinicians, providers, and consumers better understand, assess and address challenging behaviors in people with dementia using evidence-based approaches.  It includes user-friendly resources such as brief videos, written content, quick reference guides for clinicians and providers, and information for families or patients on the risks and benefits of antipsychtic for people with dementia.  The University of Iowa is offering continuing educaton credit for prescribers, nurses, and pharmacists.  You can also request laminated quick reference guides to use in your practice, which can help you put the strategies you learn about into practice. https://www.healthcare.uiowa.edu/igec/IAADAPT

 

"Under Appeal" Designation on the Report Card Website

In the past, pending appeals have been indicated on the Health Facilities Division's Report Card website by a red asterisk (*).  Beginning this month, the "under appeal" designation will be noted only when a facility has requested a formal administrative hearing pursuant to Iowa Code chapter 17A.  This change is necessitated by budgetary constraints and the availability of personnel to monitor and update the "under appeal" designation.  Appeal information is still available upon request from Division staff.

 

Reporting Reasonable Suspicion of a Crime in a LTC Facility

June 30, 2011 - The federal Centers for Medicare & Medicaid Services (CMS) has issued a memorandum (S&C: 11-30) requiring specific individuals in applicable long-term care facilities to report any reasonable suspicion of crimes committed against a resident of that facility.  S&C: 11-30 is available in the Documents section of this website.

 

Surveyors Are to Have Unrestricted Access to Medical Records

April 19, 2011 - Medicare-certified health care providers and suppliers are reminded that surveyors are to be provided unrestricted access to medical records regardless of whether the facilities use paper-based records or Electronic Health Records (EHRs).  For providers and suppliers using EHRs, the survey team must request during the entrance conference that a terminal(s) be provided where surveyors may access records.  In the case of a hospital or other provider or supplier with terminals at multiple care locations, surveyors must be provided access to a terminal at each care location. Surveyors must be able to conduct the survey process in a consistent manner in all facilities regardless of whether the facility uses paper based or electronic records. In the August 2009 Survey and Certification Letter, CMS cautioned providers and suppliers that impeding the survey process by unnecessarily delaying or restricting access to medical records may lead to termination from the Medicare Program.

 

Reducing Restraint Use in Nursing Homes

November 17, 2010 - The Iowa Foundation for Medical Care (IFMS) has produced a guide for residents and families regarding the use of restraints in nursing homes, and how to reduce them.  The guide can be found in the Documents section of this website.

 

New MDS 3.0 Section Q Information

October 1, 2010 - The federal Centers for Medicare and Medicaid Services (CMS) will implement a new version of the Minimum Data Set (MDS) assessment required to be used by all Medicaid certified nursing facilities, beginning October 1, 2010. Included in the new MDS 3.0 are a series of questions known as "Section Q Return to Community Referral".  For more information see the CMS memo in the Documents section of this website.

 

DHS Clarifies Record Check Evaluations

September 1, 2010 - The Iowa Department of Human Services (DHS) has issued a clarification regarding the submission of employees' names for criminal history record evaluations.  See the clarification posted in the Documents section of this web site.

 

Status Change Requirements for Non-LTC Medicare-Certified Entities

April 22, 2010 - Recently, some Medicare-certified entities have failed to report status changes to the Department of Inspections and Appeals (DIA).  A new clarification has been issued by the Department regarding status change requirements for non-LTC Medicare-Certified Entities.  The clarification can be found in the Documents section of this website.

 

Life Safety Code (LSC) Documents

The Kansas City Regional Office of the federal Centers for Medicare and Medicaid Services (CMS) has asked that the following documents be posted to survey agency web sites:

 

Laundry Fire Prevention Suggestions

Federal LSC Survey Plans of Correction, Appeals and Alternatives

Waiver Request of Specific Life Safety Code Provisions

 

To access these documents, click the Documents button in the navigation bar.  Links to these documents should be at the top of the web page.  Questions related to these documents should be referred to the Iowa State Fire Marshal's Office at (515) 725-6168.

 

Major Injury Determination Form

If the resident’s injury does not require admission to a higher level of care for treatment, other than for observation and a facility is relying on a physician, a designee, or an extender to determine whether a major injury to a resident has occurred, then the facility must complete a portion of the Major Injury Determination Form and submit it to the physician for a determination.  If the physician, designee, or extender determines that a major injury has occurred, then notification must be made to the Department of Inspections and Appeals.  The Major Injury Determination Form is available from the Health Facilities Division's web site or from the Department's web site. The form is available in the Documents section of this website.

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