481-67.7 Waiver of Criteria for Retention of a Tenant in the Program

The next assisted living rule review includes information on obtaining waivers when a tenant no longer meets criteria for retention in an assisted living program. An outline of the rules is below:

A tenant that is already admitted to your program may exceed criteria for retention in your program. In order to apply for a waiver to retention criteria rules:

• The tenant or their legal representative have made an informed decision that it is their desire to remain in assisted living.
• The program must provide the staff necessary to meet the tenant’s service needs in addition to the service needs of the other tenants in the program.
• The waiver will only be approved if the department believes that the waiver will not jeopardize the health, safety, security, or welfare of the tenant, other tenants, and program staff.
• The tenant must have a terminal illness diagnosis and has been admitted to hospice. In addition, it is believed that the tenant will only exceed criteria for a temporary period of less than six months.

A couple important notes related to the above criteria for a waiver:

• The program providing the staff necessary cannot include the hospice staff that are providing services. For example, if the tenant routinely requires a two-person assist with transfers, the program must have at least two staff on duty at all times to meet the need of the tenant.
• The tenant must be admitted to a hospice program. If the tenant is not in hospice care, then a waiver cannot be approved by the department.

Guidelines for submitting a waiver:

• The waiver must be submitted by the program on a form and in a manner that is approved by the department (department indicating Department of Inspections, Appeals, and Licensing). There is a copy of the waiver form on the Assisted Living Resources page on the LeadingAge Iowa website.
• DIAL must respond in writing to the waiver request within 15 working days of receipt of all required documentation. Note that DIAL is not always able to respond to waiver requests within the 15 working days, however, programs must maintain documentation/evidence that a waiver request was submitted to ensure compliance when surveyors are reviewing tenant’s records.
• The program must provide written notification of any changes in the tenant’s condition within five working days.
• If the tenant has exceeded the six-month time period that is allowed in the rule, DIAL must complete a monitoring visit to ensure that the tenant meets criteria to remain in the program on a waiver.
• DIAL may seek additional information not outlined in the rules to determine if the waiver should be granted.

The program is allowed to appeal a decision when a waiver is denied.

Common insufficiencies cited under these rules include when tenants exceeded criteria for retention and a waiver was not submitted.