231.1 Short title.

This chapter, entitled the "Elder Iowans Act", sets forth the state's commitment to its elders, their dignity, independence, and rights.

231.11 Commission established.

The commission of elder affairs is established which shall consist of eleven members. Two members shall be appointed by the president of the senate, after consultation with the majority leader and the minority leader of the senate, from the members of the senate to serve as ex officio nonvoting members with no more than one member being appointed from the same political party. Two members shall be appointed by the speaker of the house of representatives from the members of the house to serve as ex officio nonvoting members with no more than one member being appointed from the same political party. Seven members shall be appointed by the governor subject to confirmation by the senate. Not more than a simple majority of the governor's appointees shall belong to the same political party. At least four of the seven members appointed by the governor shall be fifty-five years of age or older when appointed.

231.12 Terms.

All members of the commission shall be appointed for terms of four years, with staggered expiration dates. The terms of office shall commence and end as provided by section 69.19. A vacancy on the commission shall be filled for the unexpired term of the vacancy in the same manner as the original appointment was made. If a legislative member ceases to be a member of the general assembly the legislative member may continue to serve until a successor is appointed.

231.13 Meetings--officers.

Members of the commission shall elect from the commission's membership a chairperson, and other officers as commission members deem necessary, who shall serve for a period of two years. The commission shall meet at regular intervals at least six times each year and may hold special meetings at the call of the chairperson or at the request of a majority of the commission membership. The commission shall meet at the seat of government or such other place as the commission may designate. Members shall be paid a per diem as specified in section 7E.6 and shall receive reimbursement for actual expenses for their official duties.

231.14 Commission duties and authority.

The commission is the policymaking

1. Approve state and area plans on aging.

2. Adopt policies to coordinate state activities related to the purposes of this chapter.

3. Serve as an effective and visible advocate for elders by establishing policies for reviewing and commenting upon all state plans, budgets, and policies which affect elders and for providing technical assistance to any agency, organization, association, or individual representing the needs of elders.

4. Divide the state into distinct planning and service areas after considering the geographical distribution of elders in the state, the incidence of the need for supportive services, nutrition services, multipurpose senior centers, and legal services, the distribution of elders who have low incomes residing in such areas, the distribution of resources available to provide such services or centers, the boundaries of existing areas within the state which are drawn for the planning or administration of supportive services programs, the location of units of general purpose, local government within the state, and any other relevant factors.

5. Designate for each planning and service area a public or private nonprofit agency or organization as the area agency on aging for that area.

6. Adopt policies to assure that the department will take into account the views of recipients of supportive services or nutrition services, or elders using multipurpose senior centers in the development of policy.

7. Adopt a formula for the distribution of federal Older Americans Act funds taking into account, to the maximum extent feasible, the best available data on the geographic distribution of elders in the state, and publish the formula for review and comment.

8. Adopt policies to assure that preference will be given to providing services to elders with the greatest economic or social needs, with particular attention to low-income minority elders, and include methods of carrying out the preference in the state plan.

9. Adopt policies to administer state programs authorized by this chapter.

The commission shall adopt administrative rules pursuant to chapter 17A to implement the duties specified in this chapter.

10. Adopt policies by which eligibility for federal, state, and local funding is established at age sixty, with preference in service delivery given to elders age seventy-five or older.

231.15 through 231.20

Reserved.

231.2 Legislative findings and declaration.

The general assembly finds and declares that:

1. Iowa's elders constitute a fundamental resource which has been undervalued, and the means must be found to recognize and use the competence, wisdom, and experience of our elders for the benefit of all Iowans.

2. The number of persons in this state age sixty and older is increasing rapidly, and of these elders, the number of women, minorities, and persons eighty-five years of age or older is increasing at an even greater rate.

3. The social and health problems of older people are compounded by a lack of access to existing services and by the unavailability of a complete range of services in all areas of the state.

4. The ability of older people to maintain self- sufficiency and to live their lives with dignity, productivity, and creativity is a matter of profound importance and concern for this state.

231.21 Department of elder affairs.

An Iowa department of elder affairs is established which shall administer this chapter under the policy direction of the commission of elder affairs. The department of elder affairs shall be administered by a director.

231.22 Director.

The governor, subject to confirmation by the senate, shall appoint a director of the department of elder affairs who shall, subject to chapter 19A, employ and direct staff as necessary to carry out the powers and duties created by this chapter. The director shall serve at the pleasure of the governor. However, the director is subject to reconfirmation by the senate as provided in section 2.32, subsection 8. The governor shall set the salary for the director within the range set by the general assembly.

The director shall have the following qualifications and training:

1. Training in the field of gerontology, social work, public health, public administration, or other related fields.

2. Direct experience or extensive knowledge of programs and services related to elders.

3. Demonstrated understanding and concern for the welfare of elders.

4. Demonstrated competency and recent working experience in an administrative, supervisory, or management position.

231.23 Department of elder affairs--duties and authority.

The department of elder affairs director shall:

1. Develop and administer a state plan on aging.

2. Assist the commission in the review and approval of area plans.

3. Pursuant to commission policy, coordinate state activities related to the purposes of this chapter.

4. Advocate for elders by reviewing and commenting upon all state plans, budgets, and policies which affect elders and by providing technical assistance to any agency, organization, association, or individual representing the needs of the elders.

5. Assist the commission in dividing the state into distinct planning and service areas.

6. Assist the commission in designating for each area a public or private nonprofit agency or organization as the area agency on aging for that area.

7. Pursuant to commission policy, take into account the views of elder Iowans.

8. Assist the commission in adopting a formula for the distribution of funds available from the federal Act.

9. Assist the commission in assuring that preference will be given to providing services to elders with the greatest economic or social needs, with particular attention to low- income minority elders.

10. Assist the commission in developing, adopting, and enforcing administrative rules, by issuing necessary forms and procedures.

11. Apply for, receive, and administer grants and gifts to conduct projects consistent with the purposes of this chapter.

12. Administer state authorized programs.

231.24 Information on acceptance of medicare assignments.

1. The department, in cooperation with the appropriate professional medical organizations, shall collect and analyze information on the number of physicians in Iowa in each of the following categories, including breakdowns by geographic region and by medical specialization:

a. Physicians who accept medicare assignments as payment in full for all medicare patients.

b. Physicians who accept medicare assignments as payment in full for all medicare patients with income and resources below the level established by the department.

c. Physicians who participate in a voluntary medicare assignment program.

2. The department shall identify any areas of the state and physician specialty areas in which physician participation in any of the categories under subsection 1 is not sufficient to meet the access to care needs of medicare patients in Iowa and shall recommend activities to improve access in those areas.

3. The information developed by the department shall be provided at least annually to the governor and the general assembly and to other interested persons upon request.

4. As used in this section:

a. "Medicare" means the program of health insurance established under Title XVIII of the federal Social Security Act.

b. "Medicare assignment" means payment by medicare of charges for health care services provided to medicare patients.

c. "Medicare patient" means a patient who is a beneficiary under medicare.

231.25 through 231.30

Reserved.

231.3 State policy and objectives.

The general assembly declares that it is the policy of the state to work toward attainment of the following objectives for Iowa's elders:

1. An adequate income in retirement.

2. Access to physical and mental health care without regard to economic status.

3. Suitable housing, appropriate to the special needs of older people.

4. Full restorative services for those who require institutional care, and a comprehensive array of community- based, long-term care services adequate to sustain older people in their communities and, whenever possible, in their homes.

5. Pursuit of meaningful activity within the widest range of civic, cultural, educational, recreational, and employment opportunities.

6. Suitable community transportation systems to assist in the attainment of independent movement.

7. Freedom, independence, and the free exercise of individual initiative in planning and managing their own lives.

231.31 State plan on aging.

The department of elder affairs shall develop, and submit to the commission of elder affairs for approval, a multiyear state plan on aging. The state plan on aging shall meet all applicable federal requirements and shall:

1. Be based upon area plans developed by area agencies on aging and submitted in a uniform format prepared and distributed by the department.

2. Require that each area agency on aging develop and submit to the commission for approval an area plan which complies with federal law.

3. Evaluate the need for supportive services, including legal assistance, nutrition services, and multipurpose senior centers within the state, and determine the extent to which existing public or private programs meet those needs.

4. Adopt methods for effective and efficient administration of the state and area plans.

5. Adopt methods for periodic evaluation of activities and projects carried out under the state plan.

6. Prohibit the direct provision of supportive services or nutrition services by the department of elder affairs or an area agency on aging unless necessary to assure an adequate supply of such services, or unless the services are directly related to the department of elder affairs or area agency on aging's administrative functions, or unless services of comparable quality can be provided more economically by the department of elder affairs or area agency on aging.

231.32 Criteria for designation of area agencies on aging.

1. The commission shall designate thirteen area agencies on aging, the same of which existed on July 1, 1985. The commission shall continue the designation until an area agency on aging's designation is removed for cause as determined by the commission or until the agency voluntarily withdraws as an area agency on aging. In that event, the commission shall then proceed with subsections 2 and 3.

2. The commission shall designate an area agency to serve each planning and service area, after consideration of the views offered by the political subdivisions in the area. An area agency may be:

a. An established office of aging which is operating within a planning and service area designated by the commission.

b. Any office or agency of a unit of a political subdivision, which is designated for the purpose of serving as an area agency by the chief elected official of such unit.

c. Any office or agency designated by the appropriate chief elected officials of any combination of political subdivisions to act on behalf of the combination for such purpose.

d. Any public or nonprofit private agency in a planning and service area which is under the supervision or direction for this purpose of the department of elder affairs and which can engage in the planning or provision of a broad range of supportive services or nutrition services within the planning and service area.

Each area agency shall provide assurance, determined adequate by the commission, that the area agency has the ability to develop an area plan and to carry out, directly or through contractual or other arrangements, a program in accordance with the plan within the planning and service area. In designating an area agency on aging within the planning and service area, the commission shall give preference to an established office of aging, unless the commission finds that no such office within the planning and service area has the capacity to carry out the area plan.

3. When the commission designates a new area agency on aging the commission shall give the right of first refusal to a political subdivision if:

a. Such unit can meet the requirements of subsection 1.

b. The boundaries of such a unit and the boundaries of the area are reasonably contiguous.

231.33 Area agencies on aging duties.

Each area agency on aging shall:

1. Develop and administer an area plan on aging.

2. Assess the types and levels of services needed by older persons in the planning and service area, and the effectiveness of other public or private programs serving those needs.

3. Enter into subgrants or contracts to provide all services under the plan.

4. Provide technical assistance as needed, prepare written monitoring reports at least quarterly, and provide a written report of an annual on-site assessment of all service providers funded by the area agency.

5. Coordinate the administration of its plan with federal programs and with other federal, state, and local resources in order to develop a comprehensive and coordinated service system.

6. Establish an advisory council.

7. Give preference in the delivery of services under the area plan to elders with the greatest economic or social need.

8. Assure that elders in the planning and service area have reasonably convenient access to information and referral services.

9. Provide adequate and effective opportunities for elders to express their views to the area agency on policy development and program implementation under the area plan.

10. Designate community focal points.

11. Contact outreach efforts, with special emphasis on the rural elderly, to identify elders with greatest economic or social needs and inform them of the availability of services under the area plan.

12. Develop and publish the methods that the agency uses to establish preferences and priorities for services.

13. Attempt to involve the area lawyers in legal assistance activities.

14. Submit all fiscal and performance reports in accordance with the policies of the commission.

15. Monitor, evaluate, and comment on policies, programs, hearings, levies, and community actions which significantly affect the lives of elders.

16. Conduct public hearings on the needs of elders.

17. Represent the interests of elders to public officials, public and private agencies, or organizations.

18. Coordinate activities in support of the statewide long-term care resident's advocate program.

19. Coordinate planning with other agencies and organizations to promote new or expanded benefits and opportunities for elders.

20. Coordinate planning with other agencies for assuring the safety of elders in a natural disaster or other safety threatening situation.

21. Submit a report to the department of elder affairs every six months, of the name of each health care facility in its area for which the resident advocate committee has failed to submit the report required by rules adopted pursuant to section 231.44.

231.34 through 231.40

Reserved.

231.4 Definitions.

For purposes of this chapter, unless the context otherwise requires:

1. "Administrative action" means an action or decision made by an owner, employee, or agent of a long-term care facility, or by a governmental agency, which affects the service provided to residents covered in this chapter.

2. "Commission" means the commission of elder affairs.

3. "Comprehensive and coordinated system" means a system for providing all necessary supportive services, including nutrition services, in a manner designed to:

a. Facilitate accessibility to, and utilization of, all supportive services and nutrition services provided within the geographic area served by the system by any public or private agency or organization.

b. Develop and make the most efficient use of supportive services and nutrition services in meeting the needs of elders.

c. Use available resources efficiently and with a minimum of duplication.

4. "Department" means the department of elder affairs.

5. "Director" means the director of the department of elder affairs.

6. "Elder" means an individual who is sixty years of age or older. "Elderly" means individuals sixty years of age or older.

7. "Equivalent support" means in-kind contributions of services, goods, volunteer support time, administrative support, or other support reasonably determined by the commission as equivalent to a dollar amount.

8. "Federal Act" means the Older Americans Act of 1965, 42 U.S.C. § 3001 et seq., as amended to and including February 1, 1986.

9. "Focal point" means a facility established to encourage the maximum collocation and coordination of services for elders.

10. "Greatest economic need" means the need resulting from an income level at or below the poverty threshold established by the bureau of the census.

11. "Greatest social need" means the need caused by noneconomic factors which include physical and mental disabilities, language barriers, and cultural or social isolation including that caused by racial or ethnic status which restricts an individual's ability to perform normal daily tasks or which threatens the elder's capacity to live independently.

12. "Information and referral source" means a location where a department of elder affairs or any public or private agency or organization:

a. Maintains current information with respect to the opportunities and services available to elders, and develops current lists of elders in need of services and opportunities.

b. Employs, where feasible, a specially trained staff to assess the needs and capacities of elders, and to inform elders of the opportunities and services.

13. "Legal assistance" means legal advice and representation by an attorney including, but not limited to, counseling or other appropriate assistance by a paralegal or law student under the supervision of an attorney, and includes counseling or representation by a person who does not possess a juris doctorate, where permitted by law, of elders with economic or social needs.

14. "Long-term care facility" means a long-term care unit of a hospital, a licensed hospice program, a foster group home, a group living arrangement, or a facility licensed under section 135C.1 whether the facility is public or private.

15. "Multipurpose senior center" means a community facility for the organization and provision of a broad spectrum of services, which shall include, but not be limited to, health, social, nutritional, and educational services and the provision of facilities for recreational activities for elders.

16. "Resident's advocate program" means the state long- term care resident's advocate program operated by the commission of elder affairs and administered by the long-term care resident's advocate.

231.41 Purpose.

The purpose of this subchapter is to establish the long-term care resident's advocate program operated by the Iowa commission of elder affairs in accordance with the requirements of the Older Americans Act of 1965, and to adopt the supporting federal regulations and guidelines for its implementation. In accordance with chapter 17A, the commission of elder affairs shall adopt and enforce rules for the implementation of this subchapter.

231.42 Long-term care resident's advocate--duties.

The Iowa commission of elder affairs, in accordance with section 3027(a)(12) of the federal Act, shall establish the office of long-term care resident's advocate within the commission. The long-term care resident's advocate shall:

1. Investigate and resolve complaints about administrative actions that may adversely affect the health, safety, welfare, or rights of elderly in long-term care facilities.

2. Monitor the development and implementation of federal, state, and local laws, regulations, and policies that relate to long-term care facilities in Iowa.

3. Provide information to other agencies and to the public about the problems of elderly in long-term care facilities.

4. Train volunteers and assist in the development of citizens' organizations to participate in the long-term care resident's advocate program.

5. Carry out other activities consistent with the resident's advocate provisions of the federal Act.

6. Administer the resident advocate committee program.

7. Report annually to the general assembly on the activities of the resident's advocate office.

The resident's advocate shall have access to long-term care facilities, private access to residents, access to residents' personal and medical records, and access to other records maintained by the facilities or governmental agencies pertaining only to the person on whose behalf a complaint is being investigated.

231.43 Authority and responsibilities of the commission.

To ensure compliance with the federal Act the commission of elder affairs shall establish the following:

1. Procedures to protect the confidentiality of a resident's records and files.

2. A statewide uniform reporting system.

3. Procedures to enable the long-term care resident's advocate to elicit, receive, and process complaints regarding administrative actions which may adversely affect the health, safety, welfare, or rights of elderly in long-term care facilities.

231.44 Resident advocate committee--duties--disclosure--liability.

1. The resident advocate committee program is administered by the long-term care resident's advocate program.

2. The responsibilities of the resident advocate committee are in accordance with the rules adopted by the commission pursuant to chapter 17A. When adopting the rules, the commission shall consider the needs of residents of each category of licensed health care facility as defined in section 135C.1, subsection 6, and the services each facility may render. The commission shall coordinate the development of rules with the mental health and developmental disabilities commission created in section 225C.5 to the extent the rules would apply to a facility primarily serving persons with mental illness, mental retardation, or a developmental disability. The commission shall coordinate the development of appropriate rules with other state agencies.

3. A health care facility shall disclose the names, addresses, and phone numbers of a resident's family members, if requested, to a resident advocate committee member, unless permission for this disclosure is refused in writing by a family member.

4. Neither the state nor any resident advocate committee member is liable for an action undertaken by a resident advocate committee member in the performance of duty, if the action is undertaken and carried out in good faith.

231.45 through 231.50

Reserved.

231.5 through 231.10

Reserved.

231.51 Senior community service employment program (SCSEP), Title V of the Older Americans Act.

The department will direct and administer the senior community service employment program (SCSEP) as authorized by the federal Act in coordination with the department of workforce development and the department of economic development.

The purpose of the senior community service employment program is to foster and promote useful part-time opportunities in community service activities for unemployed, low-income persons who are fifty-five years old or older.

Funds appropriated to the department from the United States department of labor shall be distributed to local projects in accordance with federal requirements.

The department shall require such uniform reporting and financial accounting by area agencies on aging and local projects as may be necessary to fulfill the purposes of this section.

231.52 Retired Iowans community employment program (RICEP).

The department shall establish the retired Iowans community employment program in coordination with the department of workforce development to encourage and promote the meaningful employment of older citizens in the state.

Funds appropriated to the department for this purpose shall be distributed statewide according to administrative rules by the commission.

The department shall require such uniform reporting and financial accounting by area agencies on aging and local projects as may be necessary to fulfill the purposes of this section.

231.53 Coordination with Job Training Partnership Act.

The employment and training program administered by the department shall be coordinated with the training program for older individuals administered by the department of workforce development under the Job Training Partnership Act.

A proposed annual plan for coordinating these programs shall be developed jointly by the department of elder affairs, the department of education, and the department of workforce development for submittal to the state job training coordinating council. The state job training coordinating council shall take the proposed plan under advisement in preparing a final annual plan for coordinating these programs which will be submitted to the governor.

After the end of each annual planning period, the department of elder affairs, the department of education, and the department of workforce development shall submit a joint report to the state job training coordinating council describing the services provided to elderly Iowans, assessing the extent to which coordination of programs was achieved, and making recommendations for improving coordination.

231.54 Elderlaw education program.

The department shall establish a program of financial support for law school clinic programs in Iowa to provide legal assistance to elders and to provide training and experience to law students in serving elders. Funds appropriated for this purpose shall be instituted based on administrative rules adopted by the commission. The department shall require such records as needed to implement this section.

231.55 Retired senior volunteer programs.

The department shall establish a program of financial support for local retired senior volunteer programs to provide basic administrative support through block grants and to provide for program expansion through discretionary grants. Funds appropriated for this purpose shall be distributed in accordance with administrative rules adopted by the commission. The department shall require such records of local projects as needed to implement this section.

231.56 Elderly services program.

The department shall establish an elderly services program to reduce institutionalization and encourage community involvement to help the elderly remain in their own homes. Funds appropriated for this purpose shall be instituted based on administrative rules adopted by the commission. The department shall require such records as needed to implement this section.

231.57 Coordination of advocacy.

The department shall establish a program for the coordination of information and assistance provided within the state to assist elders in obtaining and protecting their rights and benefits. The insurance division of the department of commerce, office of the attorney general, the citizens' aide, and other state and local agencies providing information and assistance to elders in seeking their rights and benefits shall cooperate with the department in developing and implementing this program. The program shall include review of health insurance policies marketed to elders and other health-related written material distributed to elders for marketing purposes.

231.58 Long-term care coordinating unit.

1. A long-term care coordinating unit is created within the department of elder affairs. The membership of the coordinating unit consists of:

a. The director of human services.

b. The director of the department of elder affairs.

c. The director of public health.

d. The director of the department of inspections and appeals.

e. Two members appointed by the governor.

2. The long-term care coordinating unit shall:

a. Develop, for legislative review, the mechanisms and procedures necessary to implement, utilizing current personnel, a case-managed system of long-term care based on a uniform comprehensive assessment tool.

b. Develop common intake and release procedures for the purpose of determining eligibility at one point of intake and determining eligibility for programs administered by the departments of human services, public health, and elder affairs, such as the medical assistance program, federal food stamp program, and homemaker-home health aide programs.

c. Develop common definitions for long-term care services.

d. Develop procedures for coordination at the local and state level among the providers of long-term care, including when possible co-campusing of services. The director of the department of general services shall give particular attention to this section when arranging for office space pursuant to section 18.12 for these three departments.

e. Prepare a long-range plan for the provision of long- term care services within the state.

f. Propose rules and procedures for the development of a comprehensive long-term care and community-based services program.

g. Submit a report of its activities to the governor and general assembly on January 15 of each year.

231.59 Insurance information.

The department, with information provided by the insurance division of the department of commerce, shall develop and disseminate annually information regarding insurance policies available to supplement medicare, as defined in section 514D.2. The information shall permit a prospective insured to review the extent of coverage of various policies in order of most comprehensive to least, and shall include but is not limited to, the following:

1. The number of policies issued in Iowa by each corporation issuing contracts or policies relating to medicare supplement coverage.

2. The number of unresolved complaints against a corporation filed with the commissioner of insurance.

3. The percentage of complaints resolved satisfactorily for subscribers.

231.60 Representative payee project.

1. The department of elder affairs shall provide appropriate public and private organizations with written notice of the department's intent to serve as sponsor of the representative payee project in Iowa. The director shall designate a departmental staff person to serve as the project staff coordinator.

2. The department shall provide logistical support for the project including office space, telephone communications, office supplies, and postage.

3. The department shall provide for the training of representative payees.

4. The department shall establish and maintain an advisory council for the project which shall hold meetings quarterly. The department shall determine the council's membership by rule.

5. The department shall assist representative payees, and shall negotiate banking services for the project.

6. The department shall designate a volunteer, who may be a representative payee, as the public liaison to inform interested agencies and persons about the project, and to undertake to increase public awareness and referral of potential clients.

7. A person acting as a representative payee shall be considered acting in a fiduciary capacity, and shall be liable for acts or omissions of the representative payee constituting a breach of the fiduciary duty imposed by chapter 633.

8. For purposes of this section, "representative payee" means a person appointed by the social security administration to provide financial management services, without compensation, to individuals receiving social security administration or other government benefits, who are medically incapable of making responsible financial decisions.