Lawmakers review 2024 legislation on nursing home inspections

Amid questions over potential conflicts with federal law, an Iowa House of Representatives subcommittee advanced legislation Tuesday dealing with the state inspection of nursing homes.
In 2024, the Iowa Legislature approved House File 2698, which the governor later signed into law, a bill that was opposed by advocates for seniors.
Part of that bill requires the state agency that oversees nursing homes, the Iowa Department of Inspections, Appeals and Licensing, to establish a new process of allowing nursing homes to review, with DIAL, any potential citations for either substandard care or placing residents in immediate jeopardy of serious injury or death. During the review, the facilities can provide DIAL with additional “context and evidence” to consider before issuing the citation.
Prior to that change in the law, DIAL was required to give nursing homes that same opportunity, but only after citations were issued.
In addition, the 2024 law also requires state regulators at DIAL to create, with the industry’s involvement, “joint training sessions” for both nursing home inspectors and the care facilities they oversee. The training sessions must include a review of at least three of the 10 regulatory violations most frequently cited by the inspectors during the previous year.
As part of that same process, DIAL is also required to “identify regional citation patterns” related to nursing home complaints and inspection outcomes. The law also requires the state’s long-term care ombudsman’s office — which by federal law is required to operate independently of state nursing home regulators — to participate in DIAL’s planning for the joint training sessions with the industry.
At Tuesday’s meeting of the Iowa House Subcommittee on Health and Human Services, the panel considered House Study Bill 1. Although that bill and its explanation parrots the language of the 2024 law that took effect last July, DIAL officials say it’s intended to address the fact that the new law makes reference to state-regulated residential care facilities but also references “immediate jeopardy” violations, which apply only to nursing homes.
The new bill, a DIAL spokesperson said, is merely “highlighting this for the Legislature so they can review and clarify the changes that were made last legislative session.”
Prior to Tuesday’s subcommittee meeting, John Hale, a consultant and an advocate for Iowa seniors, submitted written comments to the panel and questioned the intent of HSB 1.

Hale said it’s his understanding that under federal law, a nursing home cited for “immediate jeopardy” must be informed of that fact and must correct the situation even before state inspectors leave the building. However, the new state law requires that care facility representatives be given a chance to provide additional context and evidence before a “final finding of immediate jeopardy” is issued by DIAL’s administrators — a process that typically takes place within the 10-day period after inspectors have conducted an exit interview with a home’s administrator and then left the building.
“It is unclear what purpose is served by having another discussion of what happened and why,” Hale stated in his comments to the subcommittee. “DIAL needs to ensure that the numerous opportunities for ‘context or evidence’ do not lead to accepting substandard care or for watering down the citations called for.”
The subcommittee’s three members — Ryan Weldon, a Republican who represents northern Ankeny; Rob Johnson, a Des Moines Democrat; and Thomas Jay Moore, a Republican from Griswold– didn’t address those comments and adjourned after sending the bill on to the full committee for its consideration.
After the meeting, former DIAL director Dean Lerner also questioned the bill, writing in his comments to the subcommittee that “federal procedures do not permit this industry-inspired change of protocol.”
DIAL officials did not immediately respond Tuesday to an Iowa Capital Dispatch inquiry about any potential conflicts between state and federal law.
