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


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 ( or Margo Ryan at (515) 281-4548 ( 

Direct Care Workers who experience problems accessing the website should contact either Greg DeMoss at (515) 281-4077 ( or Stacey Siepmann at (515) 281-0108 (





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 HFD Bureau Chief

Effective June 24, 2016, Linda Kellen will assume the duties of chief for the Special Services and Adult Services bureaus.  She replaces James Friberg, who retired from state government last month.  Linda is a Registered Nurse and holds a Bachelor’s of Science in Nursing, as well as a Master’s of Science in Administrative Studies.  She has been with the Health Facilities Division since 2008, and has been one of several leader workers in the Intermediate Care Facilities/Intellectually Disabled (ICF/ID) program and a surveyor in ICF/ID and assisted living program areas.  Linda can be reached by telephone at (515) 281-7624 or by email at


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”.  Providers who have questions about the new rules and their impact should contact Rose Boccella at (515) 281-7039 or by email at   (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 03/02/16)


Door Alarms in Nursing Facilities

Nursing facilities should be aware of the following information related to requirements for door alarms as described in IAC 481-61.  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 03/02/16)


Tuberculosis Testing Reminder

The rules regarding TB testing [481 IAC 59] outline the requirements and procedures to conduct TB screenings for health care workers, as well as residents of health care facilities. Additionally, the chapter details the screening process to be used, the risk classifications, and who may conduct TB screenings.


This chapter was substantially written by the Iowa Department of Public Health (IDPH) and was designed to bring Iowa into compliance with TB testing recommendations from the Centers for Disease Control and Prevention (CDC). The rules also provide uniformity in the requirements and procedures to conduct TB screening.


Nominations Sought for 2016 Governor's Award for Quality Care

Nominations are now being accepted for the 2016 Governor’s Award for Quality Care in Health Care Facilities. The Governor's Award recognizes Iowa health care facilities that offer unique or innovative activities to enhance the quality of care or quality of life for their residents.  Nominations are open to all health care facilities licensed under Iowa Code chapter 135C, which include nursing facilities, residential care facilities, and intermediate care facilities, including those facilities specializing in the care of persons with mental illness or intellectual disabilities.  Nomination forms may be obtained by calling the Iowa Department of Inspections and Appeals (DIA) at 515-281-7102 or downloaded from the Department's web site at


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 may be downloaded here.


Two New Independent Reviewers to Begin Work Later This Summer

Ellen Akst Jones of Fairfield and Ciara L. Vesey of Bettendorf have been awarded contracts by the Iowa Department of Inspections and Appeals (DIA) to serve as independent reviewers. Jones and Vesey replace two of the three previously hired attorneys who resigned because they were moving out of state.  They will join Jeffrey A. Boehlert of Des Moines, who continues as an independent reviewer.  As an independent reviewer, the attorneys will conduct federal informal dispute resolution and state informal conferences with health care facilities and assisted living programs that contest penalties imposed by the Department. 


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:


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  


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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