Schedule for rule making 1504

Publication procedures 1505

Agency identification numbers 1512

ATTORNEY GENERAL[61]

Notice and Notice Terminated, Forfeited property,
ch 33 ARC 7825A 1516

CITATION OF ADMINISTRATIVE RULES 1511

DENTAL EXAMINERS BOARD[650]

PUBLIC HEALTH DEPARTMENT[641]"umbrella"

Deep sedation/general anesthesia, conscious
sedation and nitrous oxide inhalation
analgesia, 29.1 to 29.13 ARC 7809A 1517

ECONOMIC DEVELOPMENT, IOWA
DEPARTMENT OF[261]

Filed, CDBG--housing set-aside program,
23.11 ARC 7811A 1561

Filed, Housing fund, ch 25 ARC 7812A 1561

EDUCATIONAL EXAMINERS BOARD[282]

EDUCATION DEPARTMENT[281]"umbrella"

Notice, Issuance of practitioners' licenses,
ch 14 ARC 7802A 1520

Notice, Substitute teacher's license, 14.17
ARC 7801A 1524

EDUCATION DEPARTMENT[281]

Notice, Open enrollment, 17.9(1) ARC 7797A 1524

Notice, Physical examinations for bus drivers,
43.15 ARC 7796A 1525

ENVIRONMENTAL PROTECTION
COMMISSION[567]

NATURAL RESOURCES DEPARTMENT[561]"umbrella"

Notice, Wastewater treatment loans, 92.3 to 92.8,
92.10 ARC 7824A 1525

HUMAN SERVICES DEPARTMENT[441]

Notice, Statewide average cost, 75.15(2),
75.24(3) ARC 7789A 1527

Notice, HCBS MR and brain injury waiver
programs, 77.37, 77.39, 79.1, 83.67(9)"d"
ARC 7806A 1528

Notice, Dental procedures, 78.4, 78.28(2)
ARC 7807A 1533

Notice, Home health agency policy, 78.9
ARC 7790A 1535

Managed health care providers, 88.1, 88.3, 88.4,
88.6, 88.10(1), 88.12, 88.41, 88.42(1),
88.46, 88.47(1), 88.48, 88.49, 88.51, 88.52
ARC 7829A 1536

Notice, Abuse of children, rescind ch 175,
division I; amend 175.21 to 174.27, 175.31 to
175.33, 175.35 to 175.42 ARC 7808A 1542

Filed Emergency After Notice, FIP and FMAP,
40.27(1), 41.27, 75.52(1), 75.57 ARC 7791A 1557

Filed, Medicaid reimbursement policies for
chiropractors; FQHCs and RHCs, 78.8,
79.1(2), 88.14 ARC 7792A 1561

Filed, Child care centers, ch 109 ARC 7793A 1564

INSURANCE DIVISION[191]

COMMERCE DEPARTMENT[181]"umbrella"

Notice, HMOs--mental health, emergency services,
35.30, 40.20 ARC 7798A 1549

Filed, Securities, 50.31, 50.32, 50.36 to 50.38,
50.42, 50.57 ARC 7805A 1579

LABOR SERVICES DIVISION[347]

Notice, General industry safety and health,
10.20 ARC 7826A 1550

Notice, Construction safety--respiratory protection
and scaffolds, 26.1 ARC 7827A 1550

NATURAL RESOURCE COMMISSION[571]

NATURAL RESOURCES DEPARTMENT[561]"umbrella"

Small business regulatory
flexibility analysis, Mussels, 87.1 1618

PERSONNEL DEPARTMENT[581]

Amended Notice, Deferred compensation, 15.6,
15.13 ARC 7810A 1551

PROFESSIONAL LICENSURE DIVISION[645]

PUBLIC HEALTH DEPARTMENT[641]"umbrella"

Notice, Physical therapist assistants, 202.3(5),
202.4(7), 202.6, 202.9 to 202.11,
202.13, 202.19 to 202.26 ARC 7820A 1551

Filed, Physical therapy examiners, 200.1,
200.3(3), 200.4(3), 200.5, 200.8, 200.9,
200.10(3), 200.12, 200.18 to 200.26
ARC 7821A 1580

Filed, Physician assistants, 325.2, 325.15, 325.17
ARC 7822A 1586

PUBLIC FUNDS--AVAILABILITY

Public Health Department[641]
Loan repayment 1514
PRIMECARRE community scholarship 1515

PUBLIC HEALTH DEPARTMENT[641]

Notice of public funds availability 1514

Notice, AIDS, 1.2(1) ARC 7818A 1554

Filed, Renovation, remodeling, and repainting--
lead hazard notification process, ch 69
ARC 7814A 1587

Filed, Lead professional certification, 70.1 to
70.8 ARC 7813A 1589

Filed Emergency, Emergency medical services,
132.1, 132.16 ARC 7817A 1558

Filed Emergency, Law enforcement emergency
care provider--defibrillation, 139.1, 139.2,
139.6 ARC 7816A 1559

Filed, Love our kids grant, ch 141 ARC 7815A 1604

Filed, Gambling treatment program, ch 162
ARC 7819A 1606

PUBLIC HEARINGS

Summarized list 1506

RACING AND GAMING COMMISSION[491]

INSPECTIONS AND APPEALS DEPARTMENT[481]"umbrella"

Filed, Occupational and vendor licensing,
rescind 13.6(6) ARC 7794A 1606

REGENTS BOARD[681]

Notice, Application fees at state universities,
1.1, 1.2 ARC 7800A 1555

SUBSTANCE ABUSE COMMISSION[643]

PUBLIC HEALTH DEPARTMENT[641]"umbrella"

Filed, Standards for programs and the operating
a motor vehicle while intoxicated (OWI) law,
ch 8 ARC 7823A 1606

SUPREME COURT

Decisions summarized 1620

TRANSPORTATION DEPARTMENT[761]

Notice, Motor vehicle records--privacy
protection, 415.3, 415.4 ARC 7795A 1556

Filed, General, 415.2, 415.4(6), 600.4, 600.16,
601.1(6), 604.40(1), 605.5, 605.7, 605.11(2),
605.26(2), 611.2, 611.4(4), 615.1, 615.9,
615.15, 615.23, 615.25, 615.38(1), 615.40,
615.45, 620.3(3), 620.4(4), 620.10, 630.2
ARC 7799A 1608

TREASURER OF STATE[781]

Filed, Deposit and security of public funds in
credit unions, ch 14 ARC 7828A 1611

USURY

Notice 1556

UTILITIES DIVISION[199]

COMMERCE DEPARTMENT[181]"umbrella"

Filed, Rb factor, 19.10(1) ARC 7804A 1614

Filed, Quality of service--telephone, 22.1(3),
22.2(6), 22.3, 22.6 ARC 7803A 1614

It also contains Proclamations and Executive Orders of the Governor which are general and permanent in nature; Economic Impact Statements to proposed rules and filed emergency rules; Objections filed by Administrative Rules Review Committee, Governor or the Attorney General; and Delay by the Committee of the effective date of filed rules; Regulatory Flexibility Analyses and Agenda for monthly Administrative Rules Review Committee meetings. Other "materials deemed fitting and proper by the Administrative Rules Review Committee" include summaries of Public Hearings, Attorney General Opinions and Supreme Court Decisions.

The Bulletin may also contain Public Funds Interest Rates [12C.6]; Workers' Compensation Rate Filings [515A.6(7)]; Usury [535.2(3)"a"]; Agricultural Credit Corporation Maximum Loan Rates [535.12]; and Regional Banking--Notice of Application and Hearing [524.1905(2)].

PLEASE NOTE: Italics indicate new material added to existing rules; strike through letters indicate deleted material.

KATHLEEN K. BATES, Administrative Code Editor Telephone: (515)281-3355

ROSEMARY DRAKE, Assistant Editor (515)281-7252

First quarter July 1, 1997, to June 30, 1998 $237.00 plus $11.85 sales tax

Second quarter October 1, 1997, to June 30, 1998 $178.00 plus $8.90 sales tax

Third quarter January 1, 1998, to June 30, 1998 $118.00 plus $5.90 sales tax

Fourth quarter April 1, 1998, to June 30, 1998 $ 60.00 plus $3.00 sales tax

Single copies may be purchased for $17.50 plus $0.88 tax. Back issues may be purchased if the issues are available.

Prices for the Iowa Administrative Code and its Supplements are as follows:

Iowa Administrative Code - $1,086.00 plus $54.30 sales tax

(Price includes 22 volumes of rules and index, plus a one-year subscription to the Code Supplement and the Iowa Administrative Bulletin. Additional or replacement binders can be purchased for $10.55 plus $0.53 tax.)

Iowa Administrative Code Supplement - $382.00 plus $19.10 sales tax

(Subscription expires June 30, 1998)

All checks should be made payable to the Iowa State Printing Division. Send all inquiries and subscription orders to:

Customer Service Center

Department of General Services

Hoover State Office Building, Level A

Des Moines, IA 50319

Telephone: (515)242-5120

PRINTING SCHEDULE FOR IAB
ISSUE NUMBER	SUBMISSION DEADLINE	ISSUE DATE
19	Friday, February 20, 1998	March 11, 1998
20	Friday, March 6, 1998	March 25, 1998
21	Friday, March 20, 1998	April 8, 1998

PLEASE NOTE:

Rules will not be accepted after 12 o'clock noon on the Friday filing deadline days unless prior approval has been received from the Administrative Rules Coordinator's office.

If the filing deadline falls on a legal holiday, submissions made on the following Monday will be accepted.

TO: Administrative Rules Coordinators and Text Processors of State Agencies

FROM: Kathleen K. Bates, Iowa Administrative Code Editor

SUBJECT: Publication of Rules in Iowa Administrative Bulletin

The Administrative Code Division uses Interleaf 6 to publish the Iowa Administrative Bulletin and can import documents directly from most other word processing systems, including Ami Pro, Microsoft Word, Professional Write, Word for Windows (Word 7 or earlier), and WordPerfect.

1. To facilitate the processing of rule-making documents, we request a 3.5" High Density (not Double Density) IBM PC-compatible diskette of the rule making. Please indicate on each diskette the following information: agency name, file name, format used for exporting, and chapter(s) amended. Diskettes may be delivered to the Administrative Code Division, 4th Floor, Lucas State Office Building or included with the documents submitted to the Governor's Administrative Rules Coordinator.

2. Alternatively, if you have Internet E-mail access, you may send your document as an attachment to an E-mail message, addressed to both of the following:

bcarr@legis.state.ia.us

kbates@legis.state.ia.us

Please note that changes made prior to publication of the rule-making documents are reflected on the hard copy returned to agencies by the Governor's office; diskettes are returned unchanged.

Your cooperation helps us print the Bulletin more quickly and cost-effectively than was previously possible and is greatly appreciated.

The Administrative Rules Review Committee voted to request that Agencies comply with Iowa Code section 17A.4(1)"b" by allowing the opportunity for oral presentation (hearing) to be held at least twenty days after publication of Notice in the Iowa Administrative Bulletin.

DENTAL EXAMINERS BOARD[650]
Deep sedation/general anesthesia, conscious sedation and nitrous oxide inhalation analgesia, 29.1 to 29.13 IAB 2/11/98 ARC 7809A	Conference Room--2nd Floor Executive Hills West 1209 E. Court Des Moines, Iowa	March 18, 1998 2:30 p.m.
EDUCATIONAL EXAMINERS BOARD[282]
Issuance of practitioners' licenses, ch 14 IAB 2/11/98 ARC 7802A	Conference Room--2nd Floor Grimes State Office Bldg. Des Moines, Iowa	March 6, 1998 10 a.m.
(ICN Network)	ICN Room--2nd Floor Grimes State Office Bldg. Des Moines, Iowa	March 10, 1998 7 to 8:30 p.m.
	Air National Guard ICN Classroom, Bldg. 250 Harbor Dr. Sioux City, Iowa	March 10, 1998 7 to 8:30 p.m.
	Harris-Lake Park High School ICN Room 1 105 Ave. A West Lake Park, Iowa	March 10, 1998 7 to 8:30 p.m.
	Waterloo Armory ICN Classroom 3306 Airport Blvd. Waterloo, Iowa	March 10, 1998 7 to 8:30 p.m.
	Green Valley AEA 14 Turner Room 1405 N. Lincoln Creston, Iowa	March 10, 1998 7 to 8:30 p.m.
	North High School 626 W. 53rd St. Davenport, Iowa (west parking lot, gymnasium entrance)	March 10, 1998 7 to 8:30 p.m.
	National Guard Armory ICN Room 1501 W. Stone Ave. Fairfield, Iowa	March 10, 1998 7 to 8:30 p.m.
EDUCATIONAL EXAMINERS BOARD[282] (Cont'd) (ICN Network)	Iowa City High School Industrial Technology Bldg. 1900 Morningside Dr. Iowa City, Iowa (north of the high school)	March 10, 1998 7 to 8:30 p.m.
	North Iowa Area Community College Activity Center, Room 106 500 College Dr. Mason City, Iowa	March 10, 1998 7 to 8:30 p.m.
	Dubuque Armory ICN Classroom 195 Radford Rd. Dubuque, Iowa	March 10, 1998 7 to 8:30 p.m.
	Loess Hills AEA--ICN Room Fire Number 24997 Council Bluffs, Iowa (on Hwy. 92, 6 miles east of Council Bluffs)	March 10, 1998 7 to 8:30 p.m.
	National Guard Armory 1659 Nelson Ave. Fort Dodge, Iowa (adjacent to airport)	March 10, 1998 7 to 8:30 p.m.
Substitute teacher's license, 14.17 IAB 2/11/98 ARC 7801A	Conference Room 3 North Third Floor Grimes State Office Bldg. Des Moines, Iowa	March 5, 1998 10 a.m.
EDUCATION DEPARTMENT[281]
Open enrollment, 17.9(1) IAB 2/11/98 ARC 7797A	State Board Room Grimes State Office Bldg. Des Moines, Iowa	March 11, 1998 2 p.m.
Pupil transportation, 43.15 IAB 2/11/98 ARC 7796A	State Board Room Grimes State Office Bldg. Des Moines, Iowa	March 11, 1998 1 p.m.
ENVIRONMENTAL PROTECTION COMMISSION[567]
Air quality, 20.2, 20.3, amendments to ch 22, 23.1 to 23.4, 24.1(2), 25.1, 25.2, 28.1, 29.1, 31.2 IAB 1/14/98 ARC 7762A	East Conference Room Air Quality Bureau 7900 Hickman Rd., Suite 1 Urbandale, Iowa	February 13, 1998 1 p.m.
State revolving fund loans for wastewater treatment, 92.3 to 92.8, 92.10 IAB 2/11/98 ARC 7824A	Conference Room--4th Floor Wallace State Office Bldg. Des Moines, Iowa	March 3, 1998 10 a.m.
HUMAN SERVICES DEPARTMENT[441]
Home- and community-based (HCBS) MR and brain injury waiver programs, 77.37(12), 77.39(10), 79.1, 83.67(9) IAB 2/11/98 ARC 7806A	Conference Room--6th Floor Iowa Bldg., Suite 600 411 Third St. S.E. Cedar Rapids, Iowa	March 6, 1998 1 p.m.
	Lower Level 417 E. Kanesville Blvd. Council Bluffs, Iowa	March 4, 1998 9 a.m.
	Conference Room 3--5th Floor Bicentennial Bldg. 428 Western Davenport, Iowa	March 5, 1998 12:30 p.m.
	Conference Room 104 City View Plaza 1200 University Des Moines, Iowa	March 4, 1998 10 a.m.
	Liberty Room Mohawk Square 22 N. Georgia Ave. Mason City, Iowa	March 5, 1998 11:30 a.m.
	Conference Room 2 120 E. Main Ottumwa, Iowa	March 4, 1998 1 p.m.
	Fifth Floor 520 Nebraska St. Sioux City, Iowa	March 5, 1998 10 a.m.
	Conference Room 220 Pinecrest Office Bldg. 1407 Independence Ave. Waterloo, Iowa	March 4, 1998 11 a.m.
Managed health care providers, 88.1, 88.3, 88.4, 88.6, 88.10(1), 88.12, 88.41, 88.42(1), 88.46, 88.47(1), 88.48, 88.49, 88.51(3), 88.52 IAB 2/11/98 ARC 7829A	Conference Room--6th Floor Iowa Bldg., Suite 600 411 Third St. S.E. Cedar Rapids, Iowa	March 6, 1998 3 p.m.
	Lower Level 417 E. Kanesville Blvd. Council Bluffs, Iowa	March 4, 1998 11:30 a.m.
	Conference Room 4--5th Floor Bicentennial Bldg. 428 Western Davenport, Iowa	March 5, 1998 8 a.m.
	Conference Room 104 City View Plaza 1200 University Des Moines, Iowa	March 4, 1998 1 p.m.
HUMAN SERVICES DEPARTMENT[441] (Cont'd)	Liberty Room Mohawk Square 22 N. Georgia Ave. Mason City, Iowa	March 4, 1998 10 a.m.
	Conference Room 2 120 E. Main Ottumwa, Iowa	March 4, 1998 9 a.m.
	Fifth Floor 520 Nebraska St. Sioux City, Iowa	March 4, 1998 2 p.m.
	Conference Room 403 Pinecrest Office Bldg. 1407 Independence Ave. Waterloo, Iowa	March 4, 1998 10 a.m.
Abuse of children, rescind ch 175, division I; amend 175.21 to 175.27, 175.31 to 175.33, 175.35 to 175.42 IAB 2/11/98 ARC 7808A	Conference Room--6th Floor Iowa Bldg., Suite 600 411 Third St. S.E. Cedar Rapids, Iowa	March 6, 1998 10 a.m.
	Lower Level 417 E. Kanesville Blvd. Council Bluffs, Iowa	March 4, 1998 10 a.m.
	Conference Room 3--5th Floor Bicentennial Bldg. 428 Western Davenport, Iowa	March 5, 1998 10 a.m.
	Conference Room 100 City View Plaza 1200 University Des Moines, Iowa	March 4, 1998 9 a.m.
	Liberty Room Mohawk Square 22 N. Georgia Ave. Mason City, Iowa	March 5, 1998 11 a.m.
	Conference Room 2 120 E. Main Ottumwa, Iowa	March 4, 1998 11 a.m.
	Fifth Floor 520 Nebraska St. Sioux City, Iowa	March 4, 1998 1 p.m.
	Conference Room 220 Pinecrest Office Bldg. 1407 Independence Ave. Waterloo, Iowa	March 4, 1998 10:30 a.m.
LABOR SERVICES DIVISION[347]
General industry safety and health, 10.20 IAB 2/11/98 ARC 7826A	Division of Labor Services 1000 E. Grand Ave. Des Moines, Iowa	March 5, 1998 9 a.m. (If requested)
Construction safety and health, 26.1 IAB 2/11/98 ARC 7827A	Division of Labor Services 1000 E. Grand Ave. Des Moines, Iowa	March 5, 1998 9 a.m. (If requested)
PERSONNEL DEPARTMENT[581]
Benefits--deferred compensation, 15.6, 15.13 IAB 2/11/98 ARC 7810A	South Conference Room--1st Floor Grimes State Office Bldg. Des Moines, Iowa	March 4, 1998 1 p.m.
PROFESSIONAL LICENSURE DIVISION[645]
Physical therapist assistants, 202.3(5), 202.4(7), 202.6, 202.9 to 202.11, 202.13, 202.19 to 202.26 IAB 2/11/98 ARC 7820A	Conference Room--4th Floor Lucas State Office Bldg. Des Moines, Iowa	March 3, 1998 11 a.m. to 1 p.m.
PUBLIC HEALTH DEPARTMENT[641]
AIDS, 1.2(1) IAB 2/11/98 ARC 7818A (ICN Network)	Scott Community College Room 210 500 Belmont Rd. Bettendorf, Iowa	March 9, 1998 10 a.m.
	University of Northern Iowa Schindler Hall, Room 130C Hudson Rd. and 23rd St. Cedar Falls, Iowa	March 9, 1998 10 a.m.
	Trinity Hospital Mobile Classroom 802 Kenyon Rd. Fort Dodge, Iowa	March 9, 1998 10 a.m.
	Public Health Department--3rd Floor Lucas State Office Bldg. Des Moines, Iowa	March 9, 1998 10 a.m.
Swimming pools and spas, ch 15 IAB 1/28/98 ARC 7787A	Conference Room--3rd Floor Side 1 Lucas State Office Bldg. Des Moines, Iowa	February 24, 1998 1 p.m.
Variances and waivers of public health administrative rules, ch 178 IAB 1/28/98 ARC 7786A	Conference Room--4th Floor Lucas State Office Bldg. Des Moines, Iowa	February 17, 1998 2 p.m.
REGENTS BOARD[681]
Admission fees at state universities, 1.1, 1.2 IAB 2/11/98 ARC 7800A	Conference Room--1st Floor West Old Historical Bldg. E. 12th and Grand Ave. Des Moines, Iowa	March 3, 1998 4 p.m.
TRANSPORTATION DEPARTMENT[761]
Placement of validation sticker-- motorcycle and small trailer plates, 400.53(1) IAB 1/28/98 ARC 7779A	Conference Room--Lower Level Park Fair Mall 100 Euclid Ave. Des Moines, Iowa	February 19, 1998 11 a.m. (If requested)
Motor vehicle records-- privacy protection, 415.3, 415.4 IAB 2/11/98 ARC 7795A	Conference Room--Lower Level Park Fair Mall 100 Euclid Ave. Des Moines, Iowa	March 5, 1998 10 a.m. (If requested)
Abandoned vehicles, 480.3 IAB 1/28/98 ARC 7778A	Conference Room--Lower Level Park Fair Mall 100 Euclid Ave. Des Moines, Iowa	February 19, 1998 10 a.m. (If requested)
VETERANS AFFAIRS COMMISSION[801]
Organization and procedures, 1.2(3)"a" IAB 1/28/98 ARC 7780A	Bldg. A6A Camp Dodge 7700 N.W. Beaver Dr. Johnston, Iowa	February 17, 1998 1 p.m.

CITATION of Administrative Rules

The Iowa Administrative Code shall be cited as (agency identification number) IAC
(chapter, rule, subrule, lettered paragraph, or numbered subparagraph).

441 IAC 79 (Chapter)

441 IAC 79.1(249A) (Rule)

441 IAC 79.1(1) (Subrule)

441 IAC 79.1(1)"a" (Paragraph)

441 IAC 79.1(1)"a"(1) (Subparagraph)

The Iowa Administrative Bulletin shall be cited as IAB (volume), (number), (publication
date), (page number), (ARC number).

IAB Vol. XII, No. 23 (5/16/90) p. 2050, ARC 872A

"Umbrella" agencies and elected officials are set out below at the left-hand margin in CAPITAL letters.

Divisions (boards, commissions, etc.) are indented and set out in lowercase type under their statutory "umbrellas."

Other autonomous agencies which were not included in the original reorganization legislation as "umbrella" agencies are included alphabetically in small capitals at the left-hand margin, e.g., BEEF INDUSTRY COUNCIL, IOWA[101].

The following list will be updated as changes occur:

AGRICULTURE AND LAND STEWARDSHIP DEPARTMENT[21]

Agricultural Development Authority[25]

Soil Conservation Division[27]

ATTORNEY GENERAL[61]

AUDITOR OF STATE[81]

BEEF INDUSTRY COUNCIL, IOWA[101]

BLIND, DEPARTMENT FOR THE[111]

CITIZENS' AIDE[141]

CIVIL RIGHTS COMMISSION[161]

COMMERCE DEPARTMENT[181]

Alcoholic Beverages Division[185]

Banking Division[187]

Credit Union Division[189]

Insurance Division[191]

Professional Licensing and Regulation Division[193]

Accountancy Examining Board[193A]

Architectural Examining Board[193B]

Engineering and Land Surveying Examining Board[193C]

Landscape Architectural Examining Board[193D]

Real Estate Commission[193E]

Real Estate Appraiser Examining Board[193F]

Savings and Loan Division[197]

Utilities Division[199]

CORRECTIONS DEPARTMENT[201]

Parole Board[205]

CULTURAL AFFAIRS DEPARTMENT[221]

Arts Division[222]

Historical Division[223]

ECONOMIC DEVELOPMENT, IOWA DEPARTMENT OF[261]

City Development Board[263]

Iowa Finance Authority[265]

EDUCATION DEPARTMENT[281]

Educational Examiners Board[282]

College Student Aid Commission[283]

Higher Education Loan Authority[284]

Iowa Advance Funding Authority[285]

Libraries and Information Services Division[286]

Public Broadcasting Division[288]

School Budget Review Committee[289]

EGG COUNCIL[301]

ELDER AFFAIRS DEPARTMENT[321]

EMPLOYMENT SERVICES DEPARTMENT[341]

Job Service Division[345]

Labor Services Division[347]

ETHICS AND CAMPAIGN DISCLOSURE BOARD, IOWA[351]

EXECUTIVE COUNCIL[361]

FAIR BOARD[371]

GENERAL SERVICES DEPARTMENT[401]

HUMAN INVESTMENT COUNCIL[417]

HUMAN RIGHTS DEPARTMENT[421]

Community Action Agencies Division[427]

Criminal and Juvenile Justice Planning Division[428]

Deaf Services Division[429]

Persons With Disabilities Division[431]

Latino Affairs Division[433]

Status of Blacks Division[434]

Status of Women Division[435]

HUMAN SERVICES DEPARTMENT[441]

INSPECTIONS AND APPEALS DEPARTMENT[481]

Employment Appeal Board[486]

Foster Care Review Board[489]

Racing and Gaming Commission[491]

State Public Defender[493]

INTERNATIONAL NETWORK ON TRADE (INTERNET)[497]

LAW ENFORCEMENT ACADEMY[501]

LIVESTOCK HEALTH ADVISORY COUNCIL[521]

MANAGEMENT DEPARTMENT[541]

Appeal Board, State[543]

City Finance Committee[545]

County Finance Committee[547]

NARCOTICS ENFORCEMENT ADVISORY COUNCIL[551]

NATIONAL AND COMMUNITY SERVICE, IOWA COMMISSION ON[555]

NATURAL RESOURCES DEPARTMENT[561]

Energy and Geological Resources Division[565]

Environmental Protection Commission[567]

Natural Resource Commission[571]

Preserves, State Advisory Board[575]

PERSONNEL DEPARTMENT[581]

PETROLEUM UNDERGROUND STORAGE TANK FUND
BOARD, IOWA COMPREHENSIVE[591]

PREVENTION OF DISABILITIES POLICY COUNCIL[597]

PUBLIC DEFENSE DEPARTMENT[601]

Emergency Management Division[605]

Military Division[611]

PUBLIC EMPLOYMENT RELATIONS BOARD[621]

PUBLIC HEALTH DEPARTMENT[641]

Substance Abuse Commission[643]

Professional Licensure Division[645]

Dental Examiners Board[650]

Medical Examiners Board[653]

Nursing Board[655]

Pharmacy Examiners Board[657]

PUBLIC SAFETY DEPARTMENT[661]

RECORDS COMMISSION[671]

REGENTS BOARD[681]

Archaeologist[685]

REVENUE AND FINANCE DEPARTMENT[701]

Lottery Division[705]

SECRETARY OF STATE[721]

SEED CAPITAL CORPORATION, IOWA[727]

SESQUICENTENNIAL COMMISSION, IOWA STATEHOOD[731]

SHEEP AND WOOL PROMOTION BOARD, IOWA[741]

TELECOMMUNICATIONS AND TECHNOLOGY COMMISSION, IOWA[751]

TRANSPORTATION DEPARTMENT[761]

Railway Finance Authority[765]

TREASURER OF STATE[781]

UNIFORM STATE LAWS COMMISSION[791]

VETERANS AFFAIRS COMMISSION[801]

VETERINARY MEDICINE BOARD[811]

VOTER REGISTRATION COMMISSION[821]

WALLACE TECHNOLOGY TRANSFER FOUNDATION[851]

WORKFORCE DEVELOPMENT DEPARTMENT[871]

Industrial Services Division[873]

Labor Services Division[875]

Workforce Development Board and
Workforce Development Center Administration Division[877]

Pursuant to the authority of Iowa Code sections 13C.2(6) and 809A.25, the Attorney General hereby gives Notice of Intended Action to adopt Chapter 33, "Forfeited Property," Iowa Administrative Code.

Notice of Intended Action was originally published March 12, 1997, as ARC 7106A. The noticed rules were not adopted within the 180-day period allowed by law; therefore, the Department is terminating the rule making commenced in ARC 7106A and is renoticing Chapter 33.

The proposed rules in this Notice of Intended Action reflect changes made in response to public comment in three areas. First, proposed subrule 33.2(3) is amended to provide law enforcement agencies greater flexibility in determining what steps are appropriate for the safeguarding of real property seized for forfeiture. Second, proposed subrule 33.5(2) is amended to provide that seizing agencies may retain 90 percent of forfeited cash for their use or for division among law enforcement agencies and prosecutors pursuant to agreement. Third, new proposed rule 61--33.10 (809A) clarifies that mortgagees are included within the definition of lien holder, and that lien holders may be appointed to act as agents in disposing of forfeited property.

The proposed rules will not necessitate additional expenditures by political subdivisions or agencies and entities that contract with political subdivisions.

Any interested person may make written suggestions or comments on these rules on or before March 3, 1998. Written materials should be directed to Doug Marek, Deputy Attorney General, Department of Justice, Hoover State Office Building, Des Moines, Iowa 50319.

Interested persons may request an oral presentation pursuant to Iowa Code section 17A.4(1)"b" by contacting Doug Marek at (515)281-3349 by 4 p.m. March 3, 1998.

These rules are intended to implement Iowa Code section 809A.25.

The following new chapter is proposed.

Adopt 61--Chapter 33 as follows:

61--33.2(809A) Maintenance and storage of property during pendency of proceedings. The seizing agency that initiates a seizure for forfeiture must arrange for and pay costs associated with the proper care of property seized for forfeiture within the following guidelines:

33.2(1) Motor vehicles.

a. Motor vehicles must be stored in a manner which will minimize deterioration due to lack of operation and maintenance.

b. The use of commercial towing and storage facilities is at the expense of the seizing agency. The department will not assume responsibility for such fees, whether before or after forfeiture, unless the department decides to retain ownership of the vehicle for its use instead of transferring title to the seizing agency.

33.2(2) Cash. Where possible, a seizing agency should, in cooperation with the prosecuting attorney, secure a court order authorizing cash to be deposited in an interest-bearing account. The department will not claim any interest in income derived from such account, but the interest must be accounted for as provided by these rules.

33.2(3) Real property.

a. Unoccupied structures of value must be equipped with alarm systems or otherwise safeguarded to protect them from unlawful entry and damage by fire. The seizing agency should consider the value of the property, the condition of existing gates and locks, and the potential threat to public safety when determining whether alarm systems or other safeguards are appropriate.

b. Real property that complies with local and state building and housing code standards at the time of seizure must be maintained to local and state building and housing code standards as well as to the standard of neighboring properties, including mowing and removal of snow as necessary. Seized property that does not comply with code standards at the time of seizure must not be allowed to degrade and should be maintained in a condition that does not present a threat to public safety.

33.2(4) Other property. Property other than listed above shall be cared for as appropriate, giving due consideration to the nature of the property.

61--33.3(809A) Notice to department of forfeited property.

33.3(1) An agency which seizes real property for forfeiture must notify the department within ten days of the seizure.

33.3(2) A prosecuting attorney who obtains a declaration of forfeiture or an order forfeiting property must provide the department with a copy of the declaration or the order forfeiting the property within ten working days of receiving the order.

61--33.4(809A) Disposition of forfeited property.

33.4(1) Controlled substances. An agency in possession of a controlled substance which has been forfeited shall dispose of it as required by Iowa Code section 124.506.

33.4(2) Obscene materials. Materials which violate the provisions of Iowa Code chapter 728 shall be destroyed. An inventory and a record of the destruction of obscene materials shall be maintained by the agency.

33.4(3) Firearms and ammunition. Forfeited firearms and ammunition must be disposed of pursuant to the rules of the department of public safety.

33.4(4) Real property. An agency seizing real property for forfeiture must do the following:

a. Accept transfer of title from the department.

b. Pay all costs associated with transfer of title, including abstracting costs, property taxes and assessments.

c. Indemnify the state for any expenses it might become liable for by being the owner of the property during the forfeiture and transfer process, including but not limited to environmental clean-up costs, abstracting costs, and any expenses the department incurs to comply with reasonable community standards of maintenance.

d. Indemnify the state for any expenditures incurred as a result of liability to a third party for any injury associated with the property which occurs during the period from seizure through transfer of ownership to the agency.

33.4(5) Alcoholic beverages and beer. Alcoholic beverages and beer shall be destroyed. An inventory and a record of the destruction of forfeited alcoholic beverages and beer shall be maintained by the agency.

33.4(6) Motor vehicles.

a. Orders forfeiting motor vehicles must include a physical description of the vehicle, as well as the vehicle identification number.

b. Motor vehicles must be titled to the department prior to being transferred to the seizing agency or its designee.

c. The department requires payment of a fee of $100 for processing the transfer of title to a vehicle.

61--33.5(809A) Use by the department.

33.5(1) The department will review each item of forfeited property to determine if it is of a nature that would be useful to the department in enforcement of the law. If such a use exists, the department may take possession of the property and retain ownership instead of transferring it to the seizing agency.

33.5(2) The department will retain 10 percent of forfeited cash. The balance of forfeited cash, 90 percent, will be given to the seizing agency for its use or for division among law enforcement agencies and prosecutors pursuant to agreement.

33.5(3) In the event of a very large forfeiture, or series of forfeitures, the department may give a lesser percentage of property to the seizing agency.

61--33.6(809A) Gifts to other law enforcement agencies.

33.6(1) If the department determines that it does not have use for an item of forfeited property, the seizing agency must accept ownership of the property and use or dispose of it under these guidelines.

33.6(2) If the department determines that property is available for gift to agencies involved in the investigation or prosecution of a case but is presented with conflicting requests for its gift, the department may refuse to give the property to any of the agencies.

33.6(3) Forfeited property, including cash, must be used to enhance the enforcement of the criminal law and cannot be used to supplant or otherwise replace normally budgeted items. Questions regarding the propriety of the disposition of forfeited assets should be directed to the department.

61--33.7(809A) Record keeping. An agency which seizes property for forfeiture shall maintain records showing the disposition, including destruction, of forfeited property for a period of three years from the date of forfeiture. The records shall comply with any recommendations of the state auditor but must, at a minimum, include the following:

1. The date of forfeiture, a description of the property and the name(s), if available, of the person(s) who owned the property and person(s) in possession of the property at the time of seizure.

2. The manner in which all forfeited property has been used by the agency.

3. The disposition of all forfeited property which has been sold or otherwise disposed of, and of the proceeds derived therefrom.

4. The manner of use of all forfeited funds and proceeds from the sale of forfeited property.

61--33.8(809A) Failure to comply. If the department determines that an agency is not in compliance with these rules, the department may suspend, temporarily or permanently, the agency's privilege of receiving gifts of forfeited property.

61--33.9(809A) Appeal. An agency may appeal a decision to suspend its privilege to receive gifts of forfeited property under rule 61--33.8(809A) or other departmental action upon the basis that it has not been done according to these rules as follows:

33.9(1) Appeal to deputy attorney general for criminal justice. An applicant may file a notice of appeal to the deputy attorney general within 30 days of the departmental action that forms the basis of appeal. The deputy attorney general shall review the matter, taking testimony if necessary, and issue a written decision.

33.9(2) Appeal to attorney general. An agency may further appeal from a denial of appeal by the supervising deputy to the attorney general within 30 days of the date the supervising deputy's written decision was mailed.

33.9(3) Appeal to district court. An agency which disagrees with the decision of the attorney general has the right to appeal to the district court within 30 days of receipt of the attorney general's final decision.

61--33.10(809A) Interest holders.

33.10(1) The term "interest holder" shall include an entity which owns or holds a properly perfected mortgage, security interest, or other interest in real or personal property.

33.10(2) An interest holder with an exempt interest in forfeited property may be appointed as an agent to act in disposing of forfeited property. An interest holder acting as an agent in disposing of forfeited property shall be relieved of any and all duties that would be imposed on the lien holder if it were acting in its capacity as a lien holder.

ARC 7809A

Pursuant to the authority of Iowa Code section 147.76, the Iowa Board of Dental Examiners gives Notice of Intended Action to amend Chapter 29, "Deep Sedation/General Anesthesia, Parenteral Conscious Sedation and Nitrous Oxide Inhalation Analgesia," Iowa Administrative Code.

Chapter 29 is being amended to include rules on anti-anxiety premedication, to change the term "parenteral conscious sedation" to "conscious sedation" and to clarify that dental hygienists and dental assistants may under direct supervision assist the dentist with the monitoring of nitrous oxide inhalation analgesia.

Any interested person may make written suggestions or comments on these proposed amendments on or before March 3, 1998. Such written comments should be directed to Constance L. Price, Executive Director, Iowa Board of Dental Examiners, Executive Hills West, 1209 East Court, Des Moines, Iowa 50319.

There will be a public hearing on March 18, 1998, at 2:30 p.m. in the Second Floor Conference Room, Executive Hills West, 1209 East Court, Des Moines, Iowa. At the hearing, persons will be asked to give their names and addresses for the record and to confine their remarks to the subject of the amendments.

These amendments are intended to implement Iowa Code sections 153.33 and 153.34.

The following amendments are proposed.

ITEM 1. Amend the title of 650--Chapter 29 as follows:

650--29.1(153) Definitions. For the purpose of these rules relative to the administration of deep sedation/general anesthesia, parenteral conscious sedation, and nitrous oxide inhalation analgesia by licensed dentists the following definitions shall apply:

"Antianxiety premedication" is the prescription/administration of pharmacologic substances for the relief of anxiety and apprehension which does not result in a depressed level of consciousness.

"Parenteral conscious Conscious sedation" is a depressed level of consciousness produced by the parenteral administration of pharmacologic substances, that retains the patient's ability to independently and continuously maintain an airway and respond appropriately to physical stimulation or verbal command.

ITEM 3. Amend subrules 29.2(2) and 29.2(3) as follows and add new subrule 29.2(4) as follows:

29.2(2) Parenteral conscious Conscious sedation. Dentists licensed in this state shall not administer parenteral conscious sedation in the practice of dentistry until they have obtained a permit as required by the provisions of this chapter.

29.2(3) Nitrous oxide inhalation analgesia. Commencing 12 months after the effective date of this rule, dentists Dentists licensed in this state shall not administer nitrous oxide inhalation analgesia in the practice of dentistry until they have complied with the provisions of 29.6(153).

29.2(4) Antianxiety premedication. Dentists licensed in this state shall not administer antianxiety premedication in the practice of dentistry until they have complied with the provisions of 29.7(153).

ITEM 4. Amend subrule 29.3(6) as follows:

29.3(6) A dentist qualified to administer deep sedation/general anesthesia under this rule may administer parenteral conscious sedation and nitrous oxide inhalation analgesia provided the dentist meets the requirements of 29.6(153).

ITEM 5. Amend rule 650--29.4(153) as follows:

650--29.4(153) Requirements for the issuance of parenteral conscious sedation permits.

29.4(1) A permit may be issued to a licensed dentist to use parenteral conscious sedation on an outpatient basis for dental patients provided the dentist meets the requirements set forth by the board which may include the following:

a. Has successfully completed Parts I and III of the American Dental Association Council on Dental Education Guidelines; and

b. Has formal training in airway management; or

c. Has submitted evidence of successful completion of parenteral conscious sedation experience at the graduate level, which is approved by the board. The applicant shall document this experience by specifying the type of experience; the number of hours; the length of training; and the number of patient contact hours including documentation of the number of supervised parenteral conscious sedation cases.

d. Has successfully completed a formal training program, approved by the board, which included physical evaluation, IV sedation, airway management, monitoring, basic life support and emergency management.

29.4(2) When an applicant has not met the above requirements, the applicant must complete a remedial training program in parenteral conscious sedation and related academic subjects beyond the undergraduate dental school level. The remedial training program shall be prior approved by the board. The applicant may be subject to professional evaluation as part of the application process. The professional evaluation shall be conducted by the Anesthesia Credentials Committee and include at a minimum the evaluation of the applicant's knowledge of case management and airway management.

29.4(3) A dentist utilizing parenteral conscious sedation shall maintain a properly equipped facility. The facility shall maintain and the dentist shall be trained on the following equipment: anesthesia or analgesia machine, EKG monitor, positive pressure oxygen, suction, laryngoscope and blades, endotracheal tubes, magill forceps, oral airways, stethoscope, blood pressure monitoring device, pulse oximeter, emergency drugs, defibrillator. The facility shall be staffed with trained auxiliary personnel capable of reasonably handling procedures, problems, and emergencies incident to the administration of parenteral conscious sedation. A licensee may submit a request to the board for waiver of any of the provisions of this subrule. Waiver requests will be considered by the board on an individual basis and shall be granted only if the board determines that there is a reasonable basis for the waiver.

29.4(4) A dentist administering parenteral conscious sedation must document and maintain current, successful completion of an Advanced Cardiac Life Support (ACLS) course, and the auxiliary personnel shall maintain certification in basic life support and be capable of administering basic life support.

29.4(5) A dentist who is performing a procedure for which parenteral conscious sedation is being employed shall not administer the pharmacologic agents and monitor the patient without the presence and assistance of at least one qualified auxiliary personnel in the room who is qualified under subrule 29.4(4).

29.4(6) A licensed dentist who has been utilizing parenteral conscious sedation on an outpatient basis in a competent manner for five years preceding the effective date of this rule, but has not had the benefit of formal training as outlined in this rule, may apply for a permit provided the dentist fulfills the provisions set forth in subrules 29.4(3), 29.4(4) and 29.4(5).

29.4(7) Dentists qualified to administer parenteral conscious sedation may administer nitrous oxide inhalation analgesia provided they meet the requirement of 29.6(153).

29.4(8) If parenteral conscious sedation results in a general anesthetic state, the rules for deep sedation/general anesthesia apply.

ITEM 6. Amend subrules 29.5(1) and 29.5(3) as follows:

29.5(1) No dentist shall use or permit the use of deepsedation/general anesthesia or parenteral conscious sedation in a dental office for dental patients, unless the dentist possesses a then currently valid current permit issued by the Iowa board of dental examiners. The dentists A dentist holding a permit shall be subject to review and their facilities subject to facility inspection as deemed appropriate by the board.

29.5(3) An application for a parenteral conscious sedation permit must include the appropriate fee as specified in 650--Chapter 15, as well as evidence indicating compliance with rule 29.4(153).

ITEM 7. Amend subrule 29.6(3) as follows:

29.6(3) A licensed dentist who has been utilizing nitrous oxide inhalation analgesia in a dental office in a competent manner for the 12-month period preceding the effective date of this rule, but has not had the benefit of formal training outlined in paragraph 29.6(1)"a" or 29.6(1)"b," may continue the use provided the dentist fulfills the requirements of paragraph paragraphs 29.6(1)"c" and "d" and subrule 29.6(2).

ITEM 8. Adopt the following new subrules:

29.6(4) Dental hygienists and dental assistants may under direct supervision assist the dentist with the monitoring of nitrous oxide inhalation analgesia provided they meet the requirements set forth in 29.6(2) and 29.6(5).

29.6(5) The dental hygienist and the dental assistant shall satisfactorily complete a course of instruction which includes both didactic and clinical instruction at a teaching institution accredited by the American Dental Association. The course of study shall include instruction in the theory of pain control, anatomy, medical history, pharmacology and emergencies and complications.

29.6(6) If a state of conscious sedation results from the administration of nitrous oxide inhalation analgesia, the rules for conscious sedation apply.

ITEM 9. Adopt new rule 650--29.7(153) as follows:

650--29.7(153) Antianxiety premedication.

29.7(1) Antianxiety premedication is the prescription or administration of pharmacologic substances for the relief of anxiety and apprehension.

29.7(2) The regulation and monitoring of this modality of treatment is the responsibility of the ordering dentist.

29.7(3) If the antianxiety premedication results in a state of conscious sedation, the rules for conscious sedation shall apply.

29.7(4) A dentist utilizing antianxiety premedication and auxiliary personnel shall be trained in and capable of administering basic life support.

ITEM 10. Amend rules 650--29.7(153) to 650-- 29.12(153) as follows:

650--29.7(153) 650--29.8(153) Noncompliance. Violations of the provisions of this chapter may result in revocation or suspension of the dentist's permit or other disciplinary measures as deemed appropriate by the board.

650--29.8(153) 650--29.9(153) Reporting of adverse occurrences related to deep sedation/general anesthesia,parenteral conscious sedation, and nitrous oxide inhalation analgesia. , and antianxiety premedication.

29.8(1) 29.9(1) Reporting. All licensed dentists in the practice of dentistry in this state must submit a report within a period of 30 days to the board of any mortality or other incident which results in temporary or permanent physical or mental injury requiring hospitalization of the patient during, or as a result of antianxiety premedication, nitrous oxide inhalation analgesia, parenteral conscious sedation or deep sedation/general anesthesia related thereto. The report shall include responses to at least the following:

a. Description of dental procedure.

b. Description of preoperative physical condition of patient.

c. List of drugs and dosage administered.

d. Description, in detail, of techniques utilized in administering the drugs utilized.

e. Description of adverse occurrence:

1. Describe in detail symptoms of any complications, to include but not be limited to onset, and type of symptoms in patient.

2. Treatment instituted on the patient.

3. Response of the patient to the treatment.

f. Describe the patient's condition on termination of any procedures undertaken.

29.8(2) 29.9(2) Failure to report. Failure to comply with subrule 29.8(1) 29.9(1), when the occurrence is related to the use of deep sedation/general anesthesia, parenteral conscious sedation, or nitrous oxide inhalation analgesia, or antianxiety premedication, may result in the dentist's loss of authorization to administer deep sedation/general anesthesia, parenteral conscious sedation, or nitrous oxide inhalation analgesia, or antianxiety premedication or in other sanctions provided by law.

650--29.9(153) 650--29.10(153) Anesthesia credentials committee.

29.9(1) 29.10(1) The anesthesia credentials committee is a peer review committee appointed by the board to assist the board in the administration of this chapter. This committee shall be chaired by a member of the board and shall include at least six additional members who are licensed to practice dentistry in Iowa. At least four members of the committee shall hold deep sedation/general anesthesia or parenteral conscious sedation permits issued under this chapter.

29.9(2) 29.10(2) The anesthesia credentials committee shall perform the following duties at the request of the board:

a. to c. No change.

650--29.10(153) 650--29.11(153) Renewal. Beginning 12 months from the effective date of these rules and for each renewal thereafter, permit holders are required to maintain evidence of renewal of ACLS certification.

Beginning 12 months from the effective date of these rules and for each renewal thereafter, permit holders are required to submit a minimum of six hours of continuing education in the area of sedation. These hours may also be submitted as part of license renewal requirements.

650--29.11(153) 650--29.12(153) Rules for denial or nonrenewal. A dentist who has been denied a deep sedation/general anesthesia or parenteral conscious sedation permit or renewal may appeal the denial and request a hearing on the issues related to the permit or renewal denial by serving a notice of appeal and request for hearing upon the executive director not more than 30 days following the date of the mailing of the notification of the permit or renewal denial, or not more than 30 days following the date upon which the dentist was served notice if notification was made in the manner of service of an original notice. The hearing shall be considered a contested case proceeding and shall be governed by the procedures set forth in 650 IAC 51.

650--29.12(153) 650--29.13(153) Record keeping. The patient chart must include preoperative and postoperative vital signs, drugs administered, dosage administered, anesthesia time in minutes, and monitors used. Intermittent vital signs shall be taken and recorded in patient chart during procedures and until the patient is fully ambulatory. The chart should contain the name of the person to whom the patient was discharged.

ARC 7802A

Pursuant to the authority of Iowa Code section 272.2, the Board of Educational Examiners hereby gives Notice of Intended Action to rescind Chapter 14, "Issuance of Practitioner's Licenses and Endorsements," Iowa Administrative Code, and to adopt a new Chapter 14, "Issuance of Practitioners' Licenses," Iowa Administrative Code.

The new chapter is expected to become effective on August 31, 2001, the same date on which the current Chapter 14 is rescinded. This new chapter defines the basic framework for Iowa practitioner licensure setting out the basic requirements and procedures for the issuance of all practitioners' licenses. These requirements include the type of licenses to be issued, including new licenses, the basic requirements and terms for each license, the new professional education core requirements, the human relations requirement, and the fee for the issuance of each type of license.

The endorsement requirements included in the current Chapter 14 will be transferred to a new Chapter 15 to be filed prior to August 31, 2001, as part of a complete revision in the endorsement structure and requirements.

Any interested person may make written suggestions or comments on the proposed rules by 4:30 p.m. on March 18, 1998. Written comments should be sent to Dr. Anne Kruse, Executive Director, Board of Educational Examiners, Grimes State Office Building, E. 14th and Grand Avenue, Des Moines, Iowa 50319-0147; fax (515)281-7669.

A public hearing will be conducted on March 6, 1998, at 10 a.m. in the State Board Conference Room, Second Floor, Grimes State Office Building, E. 14th and Grand Avenue, Des Moines, Iowa, in conjunction with the March 1998 meeting of the Board of Educational Examiners. Persons may present their views at this hearing either orally or in writing.

Also, there will be a public hearing on March 10, 1998, from 7 p.m. to 8:30 p.m. over the Iowa Communications Network (ICN) at which time persons may present their views. The sites for the public hearing on March 10, 1998, are:

Department of Education, ICN Room, 2nd Floor, Grimes State Office Building, E. 14th and Grand Avenue, Des Moines, Iowa;

Sioux City Air National Guard, ICN Classroom, Harbor Drive, Building 250, Sioux City, Iowa;

Harris-Lake Park High School, ICN Room 1, 105 Avenue A West, Lake Park, Iowa;

Waterloo Armory, ICN Classroom, 3306 Airport Boulevard, Waterloo, Iowa;

Green Valley Area Education Agency 14, Turner Room, 1405 North Lincoln, Creston, Iowa;

North High School, 626 West 53rd Street, (W. Parking Lot, gymnasium entrance), Davenport, Iowa;

National Guard Armory, ICN Room, 1501 W. Stone Avenue, Fairfield, Iowa;

Iowa City High School, Industrial Tech Building north of high school, 1900 Morningside Drive, Iowa City, Iowa;

North Iowa Area Community College, Activity Center Room 106, 500 College Drive, Mason City, Iowa;

Dubuque Armory, ICN Classroom, 195 Radford Road, Dubuque, Iowa;

Loess Hills Area Education Agency, ICN Room, East of Council Bluffs 6 miles on Highway 92, Fire Number 24997, Council Bluffs, Iowa;

Fort Dodge National Guard Armory, 1659 Nelson Avenue (adjacent to airport), Fort Dodge, Iowa.

These rules are intended to implement Iowa Code section 272.2.

The following chapter is proposed.

Rescind 282--Chapter 14, effective August 31, 2001, and adopt the following new chapter in lieu thereof.

282--14.2(272) Applicants from recognized Iowa institutions. An applicant for initial licensure who completes the teacher, administrator, or school service personnel preparation program from a recognized Iowa institution shall have the recommendation for the specific license and endorsement(s) or the specific endorsement(s) from the designated recommending official at the recognized education institution where the preparation was completed. A recognized Iowa institution is one which has its program of preparation approved by the state board of education according to standards established by said board, or an alternative program recognized by the state board of educational examiners.

282--14.3(272) Applicants from recognized non-Iowa institutions. An applicant for initial licensure who completes the teacher, administrator, or school service personnel preparation program from a recognized non-Iowa institution shall have the recommendation for the specific license and endorsement(s) or the specific endorsement(s) from the designated recommending official at the recognized institution where the preparation was completed, provided all requirements for Iowa licensure have been met.

Applicants who hold a valid license from another state and whose preparation was completed through a nontraditional program, through an accumulation of credits from several institutions, shall file all transcripts with the practitioner preparation and licensure bureau for a determination of eligibility for licensure.

A recognized non-Iowa institution is one which is accredited by the regional accrediting agency for the territory in which the institution is located.

282--14.4(272) Applicants from foreign institutions. An applicant for initial licensure whose preparation was completed in a foreign institution will be required to have all rec-ords translated into English and then file these records with the board of educational examiners for a determination of eligibility for licensure.

282--14.5(272) Issue date on original license. A license is valid only from and after the date of issuance.

282--14.6(272) Adding endorsements to licenses. After the issuance of a teaching, administrative, or school service personnel license, an individual may add other endorsements to that license upon proper application provided current requirements for that endorsement have been met. An updated license with expiration date unchanged from the original or renewed license will be prepared.

14.6(1) To add an endorsement, the applicant shall comply with one of the following options:

Option 1. Identify with a recognized Iowa teacher preparing institution, meet that institution's current requirements for the endorsement desired, and receive that institution's recommendation.

Option 2. Identify with a recognized Iowa teacher education institution and receive a statement that the applicant has completed the equivalent of the institution's approved program for the endorsement sought.

Option 3. Identify with a recognized teacher education institution and receive a statement that based on the institution's evaluation of the individual's preparation the applicant has completed all of the Iowa requirements for the endorsement sought.

14.6(2) Appeal. If an applicant believes the Iowa requirements have been met but cannot obtain an equivalent statement from an institution, the applicant may file the transcripts for review. The rejection from the institution must be in writing. In this situation, the staff in the board of educational examiners shall review the preparation in terms of the Iowa requirements.

282--14.7(272) Correcting licenses. If at the time of the original issuance or renewal of a license, a person does not receive an endorsement for which the individual is eligible, a corrected license shall be issued. Also, a corrected license shall be issued if a person receives an endorsement for which the person is not eligible.

282--14.8(272) Duplicate licenses. Upon application and payment of the fee set out in subrule 14.21(3), duplicate licenses shall be issued.

282--14.9(272) Fraud in procurement or renewal of licenses. Fraud in procurement or renewal of a license or falsifying records for licensure purposes will constitute grounds for filing a complaint with the board of educational examiners.

282--14.10(272) Licenses. The following licenses will be issued effective August 31, 2001:

1. Initial.

2. Continuing.

3. Advanced.

4. Professional Administrator.

5. Conditional.

6. Substitute.

7. Area Education Agency Administrator.

282--14.11(272) Requirements for an initial license. An initial license valid for two years may be issued to an applicant who:

1. Has a baccalaureate degree from a regionally accredited institution.

2. Has completed a state-approved teacher education program which meets the requirements of the professional education core.

3. Has completed an approved human relations component.

4. Has completed the exceptional learner component.

5. Has completed the requirements for one of the basic teaching endorsements, the special education teaching endorsements, or the secondary level occupational endorsements.

6. Meets the recency requirement of 14.15"3."

Renewal requirements for this license will be developed.

282--14.12(272) Requirements for a continuing license. A continuing license valid for five years may be issued to an applicant who:

1. Completes items "1" to "5" listed under 282-- 14.11(272).

2. Shows evidence of successful completion of a state-approved induction program or an approved alternative option or two years' successful teaching experience based on a local evaluation process.

3. Meets the recency requirement of 14.15"3."

Renewal requirements for this license will be developed.

282--14.13(272) Requirements for an advanced teacher's license. An advanced teacher's license valid for eight years may be issued to an applicant who:

1. Is the holder of or eligible for a continuing license.

2. Verifies seven years of successful teaching experience, or six years if the applicant has completed an approved induction program.

3. Completes one of the following options:

* Master's degree in a recognized endorsement area, or

* Master's degree in curriculum, effective teaching, or a similar degree program which has a focus on school curriculum or instruction, or

* A planned 32-semester-hour graduate level program in an endorsement area or in instructional improvement, or

* A planned sequence of graduate level coursework tied to an endorsement earned through the National Board for Professional Teaching Standards.

Renewal requirements for this license will be developed.

282--14.14(272) Requirements for a professional administrator's license. A professional administrator's license valid for five years may be issued to an applicant who:

1. Is the holder of or eligible for a continuing license.

2. Has five years of teaching experience.

3. Has completed the requirements for an administrative endorsement.

Renewal requirements for this license will be developed.

282--14.15(272) Requirements for a one-year conditional license. A nonrenewable conditional license valid for one year may be issued to an individual under any one of the following conditions:

1. Professional core requirements. The individual has not completed all the required courses in the professional core, 14.23(4), "a" to "j."

2. Human relations component. The individual has not completed an approved human relations component.

3. Recency. The individual meets requirement(s) for a valid license, but has had fewer than 160 days of teaching experience during the five-year period immediately preceding the date of application or has not completed six semester hours of college credit from a recognized institution within the five-year period. To obtain the desired license, the applicant must complete recent credit and, where recent credits are required, these credits shall be taken in professional education or in the applicant's endorsement area(s).

4. Degree not granted until next regular commencement. An applicant who meets the requirements for a license with the exception of the degree, but whose degree will not be granted until the next regular commencement, may be issued a one-year conditional license.

5. Based on an expired Iowa certificate or license, exclusive of a conditional license. The holder of an expired license, exclusive of a conditional license or a temporary certificate, shall be eligible to receive a conditional license upon application. This license shall be endorsed for the type of service authorized by the expired license on which it is based.

6. Based on an administrative decision. The bureau of practitioner preparation and licensure is authorized to issue a conditional license to applicants whose services are needed to fill positions in unique need circumstances.

282--14.16(272) Requirements for a two-year conditional license. A nonrenewable conditional license valid for two years may be issued to an individual under the following conditions: If a person is the holder of a valid license and is the holder of one or more endorsements, but is seeking to obtain some other endorsement, a two-year conditional license may be issued if requested by an employer and the individual seeking this endorsement has completed at least two-thirds of the requirements leading to completion of all requirements for that endorsement.

282--14.17(272) Conditional special education license. Based on the amount of preparation needed to complete the requirements for the endorsement, a conditional special education license may be issued to an individual for a term of up to three years under the following conditions:

1. The individual is the holder of a valid license.

2. The individual has completed at least one-half of the credits necessary for a special education endorsement.

3. The employing school official makes written request supported by the respective area education agency special education officials.

4. The college/university outlines the coursework to be completed for the endorsement.

282--14.18(272) Conditional occupational and postsecondary licenses.

14.18(1) Conditional occupational license. A two-year conditional occupational license may be issued to an applicant who has not met all of the experience requirements for the provisional occupational license.

14.18(2) Conditional postsecondary license. A two-year conditional postsecondary license may be issued to an applicant who has not met all of the initial requirements for a provisional postsecondary license or holds the provisional or regular postsecondary license with an endorsement and is seeking an endorsement in another teaching field.

282--14.19(272) Requirements for a substitute teacher's license.

14.19(1) A substitute teacher's license may be issued to an individual who:

a. Has been the holder of, or presently holds, a license in Iowa; or holds or held a regular teacher's license or certificate in another state, exclusive of temporary, emergency, substitute certificate or license, or a certificate based on an alternative certification program.

b. Has successfully completed all requirements of an approved teacher education program and is eligible for the provisional license, but has not applied for and been issued this license, or who meets all requirements for the provisional license with the exception of the degree but whose degree will be granted at the next regular commencement.

14.19(2) A substitute license is valid for five years and for not more than 90 days of teaching during any one school year.

14.19(3) The holder of a substitute license is authorized to teach in any school system in any position in which a regularly licensed teacher was employed to begin the school year.

14.19(4) Renewal requirements for this license will be developed.

282--14.20(272) Two-year exchange license.

14.20(1) A two-year nonrenewable exchange license may be issued to an individual under the following conditions:

a. The individual has completed a state-approved teacher education program in a college or university approved by the state board of education or the state board of educational examiners in the home state which is party to the exchange certification agreement.

b. The individual holds a valid regular certificate or license in the home state party to the exchange certification agreement.

c. The individual is not subject to any pending disciplinary proceedings in the home state.

d. The applicant for the exchange license complies with all requirements with regard to application processes and payments of licensure fees.

14.20(2) Each exchange license shall be limited to the area(s) and level(s) of instruction as determined by an analysis of the application, the transcripts and the license or certificate held in the state in which the basic preparation for licensure was completed.

14.20(3) Each individual receiving the two-year exchange license will have to complete any identified licensure deficiencies in order to be eligible for an initial regular license in Iowa.

282--14.21(272) Licensure and authorization fee.

14.21(1) Issuance and renewal of licenses, authorizations, and statements of professional recognition. The fee for the issuance of each initial practitioner's license, evaluator license, statement of professional recognition, and coaching authorization and the renewal of each license, evaluator approval license, statement of professional recognition, and coaching authorization shall be $25.

14.21(2) Adding endorsements. The fee for the addition of each endorsement to a license, following the issuance of the initial license and endorsement(s), shall be $25.

14.21(3) Duplicate licenses, authorizations, and statements of professional recognition. The fee for the issuance of a duplicate practitioner's license, evaluator license, statement of professional recognition, or coaching authorization shall be $5.

14.21(4) Evaluation fee. Each application from an out-of-state institution for initial licensure shall include, in addition to the basic fee for the issuance of a license, a one-time nonrefundable $25 evaluation fee.

Each application or request for a statement of professional recognition shall include a one-time nonrefundable $25 evaluation fee.

14.21(5) One-year emergency license. The fee for the issuance of a one-year emergency license based on an expired conditional license or an expired administrative decision license shall be $50.

282--14.22(272) NCATE accredited programs. The requirements of the professional education core at subrule 14.23(4) notwithstanding, an applicant from an out-of-state institution who has completed a program accredited by the National Council for the Accreditation of Teacher Education on or after October 1, 1988, shall be recognized as having completed the professional education core set out in 14.23(4), with the exception of paragraph "m."

282--14.23(272) Requirements for an original teaching subject area endorsement. Following are the basic requirements for the issuance of a license with an endorsement.

14.23(1) Baccalaureate degree from a regionally accredited institution.

14.23(2) Completion of an approved human relations component.

14.23(3) Completion of the exceptional learner program, which must include preparation that contributes to the education of the handicapped and the gifted and talented.

14.23(4) Professional education core. Completed coursework or evidence of competency in:

a. Student learning. The practitioner understands how students learn and develop and provides learning opportunities that support intellectual, career, social and personal development.

b. Diverse learners. The practitioner understands how students differ in their approaches to learning and creates instructional opportunities that are equitable and are adaptable to diverse learners.

c. Instructional planning. The practitioner plans instruction based upon knowledge of subject matter, students, the community, curriculum goals, and state curriculum models.

d. Instructional strategies. The practitioner understands and uses a variety of instructional strategies to encourage students' development of critical thinking, problem solving, and performance skills.

e. Learning environment/classroom management. The practitioner uses an understanding of individual and group motivation and behavior to create a learning environment that encourages positive social interaction, active engagement in learning, and self-motivation.

f. Communication. The practitioner uses knowledge of effective verbal, nonverbal, and media communication techniques, and other forms of symbolic representation, to foster active inquiry, collaboration, and support interaction in the classroom.

g. Assessment. The practitioner understands and uses formal and informal assessment strategies to evaluate the continuous intellectual, social, and physical development of the learner.

h. Foundations, reflection and professional development. The practitioner continually evaluates the effects of the practitioner's choices and actions on students, parents, and other professionals in the learning community and actively seeks out opportunities to grow professionally.

i. Collaboration, ethics and relationships. The practitioner fosters relationships with parents, school colleagues, and organizations in the larger community to support students' learning and development.

j. Computer technology related to instruction.

k. Completion of prestudent teaching field-based experiences.

l. Methods of teaching with an emphasis on the subject and grade level endorsement desired.

m. Student teaching in the subject area and grade level endorsement desired.

14.23(5) Content/subject matter specialization. The practitioner understands the central concepts, tools of inquiry, and structure of the discipline(s) the practitioner teaches and creates learning experiences that make these aspects of subject matter meaningful for students.

This is evidenced by completion of a 30-semester-hour teaching major which must minimally include the requirements for at least one of the basic endorsement areas, special education teaching endorsements, or secondary level occupational endorsements.

282--14.24(272) Human relations requirements for practitioner licensure. Preparation in human relations shall be included in programs leading to teacher licensure. Human relations study shall include interpersonal and intergroup relations and shall contribute to the development of sensitivity to and understanding of the values, beliefs, life styles and attitudes of individuals and the diverse groups found in a pluralistic society.

14.24(1) Beginning on or after August 31, 1980, each applicant for an initial practitioner's license shall have completed the human relations requirement.

14.24(2) On or after August 31, 1980, each applicant for the renewal of a practitioner's license shall have completed an approved human relations requirement.

14.24(3) Credit for the human relations requirement shall be given for licensed persons who can give evidence that they have completed a human relations program which meets board of educational examiners criteria (see 282-- 14.27(272)).

282--14.25(272) Development of human relations components. Human relations components shall be developed by teacher preparation institutions. In-service human relations components may also be developed by educational agencies other than teacher preparation institutions, as approved by the board of educational examiners.

282--14.26(272) Advisory committee. Education agencies developing human relations components shall give evidence that in the development of their programs they were assisted by an advisory committee. The advisory committee shall consist of equal representation of various minority and majority groups.

282--14.27(272) Standards for approved components. Human relations components will be approved by the board of educational examiners upon submission of evidence that they are designed to develop the ability of participants to:

14.27(1) Be aware of and understand the values, life styles, history, and contributions of various identifiable subgroups in our society.

14.27(2) Recognize and deal with dehumanizing biases such as sexism, racism, prejudice, and discrimination and become aware of the impact that such biases have on interpersonal relations.

14.27(3) Translate knowledge of human relations into attitudes, skills, and techniques which will result in favorable learning experiences for students.

14.27(4) Recognize the ways in which dehumanizing biases may be reflected in instructional materials.

14.27(5) Respect human diversity and the rights of each individual.

14.27(6) Relate effectively to other individuals and various subgroups other than one's own.

282--14.28(272) Evaluation. Educational agencies providing the human relations components shall indicate the means to be utilized for evaluation.

These rules are intended to implement Iowa Code chapter 272.

ARC 7801A

Pursuant to the authority of Iowa Code section 272.2, the Board of Educational Examiners hereby gives Notice of Intended Action to amend Chapter 14, "Issuance of Practitioner's Licenses and Endorsements," Iowa Administrative Code.

The proposed amendment clarifies the authority for the substitute license, provides an option to assist local districts with special instructional needs, and broadens the authority for the holder of a regular license to serve as a substitute teacher.

There will be a public hearing on the proposed amendment on March 5, 1998, beginning at 10 a.m., in Conference Room 3 North, Third Floor, Grimes State Office Building, E. 14th and Grand Avenue, Des Moines, Iowa.

Persons may present their views at the public hearingorally or in writing. Persons who wish to make oralpresentation at the public hearing may contact the Executive Director, Board of Educational Examiners, Grimes StateOffice Building, E. 14th and Grand Avenue, Des Moines, Iowa 50319-0147, or at (515)281-5849. Fax communi-cation may be sent to (515)281-7669, or E-mail atakruse@ed.state.ia.us.

Any interested person may make written comments or suggestions on the proposed amendment through March 18, 1998. Written comments and suggestions should be addressed to Dr. Anne Kruse, Executive Director, Board of Educational Examiners, at the address above.

This amendment is intended to implement Iowa Code chapter 272.

The following amendment is proposed.

Amend rule 282--14.17(272) to read as follows:

282--14.17(272) Requirements for a substitute teacher's license.

14.17(1) A substitute teacher's license may be issued to an individual who has met the following:

a. Has been the holder of, or presently holds, a license in Iowa; or holds or held a regular teacher's license or certificate in another state, exclusive of temporary, emergency, substitute certificate or license, or a certificate based on an alternative certification program.

b. Has successfully completed all requirements of an approved teacher education program and is eligible for the provisional license, but has not applied for and been issued this license, or who meets all requirements for the provisional license with the exception of the degree but whose degree will be granted at the next regular commencement.

14.17(2) A substitute license is valid for five years and for not more than 90 days of teaching in any one assignment during any one school year.

A school district administrator may file a written request with the board for an extension of the 90-day limit in one assignment on the basis of documented need and benefit to the instructional program. The board will review the request and provide a written decision either approving or denying the request.

14.17(3) The holder of a substitute license is authorized to teach in any school system in any position in which a regularly licensed teacher was employed to begin the school year.

In addition to the authority inherent in the provisional, educational, professional teacher, and permanent professional licenses and the endorsement(s) held, the holder of one of these regular licenses may substitute on the same basis as the holder of a substitute license while the regular license is in effect.

This license may be renewed by meeting requirements listed in 282--17.9(272).

ARC 7797A

Pursuant to the authority of Iowa Code section 256.7(5), the Iowa State Board of Education hereby gives Notice of Intended Action to amend Chapter 17, "Open Enrollment," Iowa Administrative Code.

This amendment is being proposed to incorporate statutory intent which requires the permission of the sending district before a bus from a receiving district can come into its boundaries for open enrolled students.

Any interested person may submit oral or written suggestions or comments on or before March 11, 1998, by addressing them to Jim Tyson, Consultant, Department of Education, Grimes State Office Building, Des Moines, Iowa 50319-0146, telephone (515)281-5001.

There will be a public hearing on March 11, 1998, at 2 p.m. in the State Board Room, Grimes State Office Building, Des Moines, Iowa, at which persons may present their views orally and in writing.

This amendment is intended to implement Iowa Code section 282.18(11).

The following amendment is proposed.

Amend subrule 17.9(1) as follows:

17.9(1) Parent responsibilities. The parent/guardian of a pupil who has been accepted for open enrollment shall be responsible to transport the pupil without reimbursement, except as provided in subrule 17.9(2), to and from a point on a regular school bus route of the receiving district. This point shall be a designated stop on the bus route of the receiving district. If this point--designated stop--is within the distances established by Iowa Code section 285.1 from the school designated for attendance by the receiving district, that district may, but is not required to, provide transportation for an open enrollment pupil. A receiving district may send buses into a resident district solely for the purpose of transporting an open enrollment pupil if the boards of both the sending and receiving districts agree to this arrangement. Bus routes that are outside the boundary of the receiving district that have been authorized by an area education agency board of directors, as provided by Iowa Code subsection 285.9(3), may be used to transport open enrollment pupils if the boards of directors of the resident and receiving districts have both taken action to approve such an arrangement. Bus routes that have been established by the receiving district for the purpose of transporting nonpublic school or special education pupils that operate in the resident district of an open enrollment pupil shall not be utilized for the transportation of such pupil for the portion of the route that is within the resident district unless the boards of directors of the resident and receiving districts have both taken action to approve such an arrangement. Bus routes transporting pupils for the purpose of whole-grade sharing shall not be used to transport open enrollment pupils for the portion of the route that is within the resident district unless the boards of directors of the resident and receiving districts have both taken action to approve such an arrangement.

ARC 7796A

Pursuant to the authority of Iowa Code section 256.7(5), the Iowa State Board of Education hereby gives Notice of Intended Action to amend Chapter 43, "Pupil Transportation," Iowa Administrative Code.

This amendment is being proposed to allow bus drivers to obtain physical examinations from the same group of professionals as other district employees by adding licensed physician assistants and advanced registered nurse practitioners.

Any interested person may submit oral or written suggestions or comments on or before March 11, 1998, by addressing them to Terry Voy, Consultant, Department of Education, Grimes State Office Building, Des Moines, Iowa 50319-0146, telephone (515)281-5001.

There will be a public hearing on March 11, 1998, at 1 p.m. in the State Board Room, Grimes State Office Building, Des Moines, Iowa, at which persons may present their views orally and in writing.

This amendment is intended to implement Iowa Code section 285.8.

The following amendment is proposed.

Amend rule 281--43.15(285), introductory paragraph, as follows:

281--43.15(285) Physical fitness. Applicants for the school bus driver's permit must submit each year to the school administration and accreditation bureau, a signed report (Form TR-F-6-497B) of a physical examination by a licensed physician and surgeon, osteopathic physician and surgeon, osteopath, or qualified doctor of chiropractic, licensed physician assistant, or advanced registered nurse practitioner, indicating physical fitness as follows:

ARC 7824A

Pursuant to the authority of Iowa Code section 455B.299, the Environmental Protection Commission hereby gives Notice of Intended Action to amend Chapter 92, "State Revolving Fund Loans for Wastewater Treatment," Iowa Administrative Code.

These amendments update the rules for the administration of the state revolving fund loans for wastewater treatment. They include deletions of requirements for loan recipients no longer required by the federal Clean Water Act and implementing regulations. These amendments will ease the burden on applicants for loan assistance. The "first use" references are no longer necessary as the state has previously met the federal "first use" requirement. References to the program requirements made in the rules pertaining to the capitalization grant and the intended use plan are deleted as they are no longer requirements for the grant and the plan. The rule on project requirements lists those items that apply to loans made prior to and following the date these amendments go into effect. The subrule on fundable categories is rescinded also because it is based on federal requirements no longer applicable.

Interested persons may make written comments on these proposed amendments on or before March 13, 1998. Written comments should be directed to Wayne Farrand, Wastewater Section, Iowa Department of Natural Resources, Wallace State Office Building, 502 East 9th Street, Des Moines, Iowa 50319; fax (515)281-8895.

There will be a public hearing on March 3, 1998, at 10 a.m. in the Fourth Floor Conference Room of the Wallace State Office Building at which time persons may present their views either orally or in writing. At the hearing, persons will be asked to give their names and addresses for the record and to confine their remarks to the subject of the rule.

Any persons who intend to attend a public hearing and have special requirements such as hearing or mobility impairments should contact the Department of Natural Resources and advise of specific needs.

These amendments are intended to implement Iowa Code sections 455B.291 through 455B.299.

The following amendments are proposed.

ITEM 1. Amend rule 567--92.3(455B), definition of "Fiscal year," as follows:

"Fiscal year" means the federal state fiscal year starting October July 1 and ending September June 30.

ITEM 2. Rescind and reserve subrule 92.4(3).

ITEM 3. Amend subrules 92.4(6) and 92.4(7) as follows:

92.4(6) Eligible recipient determination. Municipalities projected to be able to qualify for SRF assistance will be identified in an annual intended use plan. Only those proj-ects on the current fiscal year state project priority list developed pursuant to 567--Chapter 91 may be considered as an eligible recipient. SRF assistance will be available to proj-ects in priority order with first consideration given to the "first use" criteria of subrule 92.4(3).

92.4(7) State capitalization grant. The Clean Water Act authorizes the Environmental Protection Agency (EPA) to offer capitalization grants to states for use in a revolving fund loan program through fiscal year 1994. All wastewater treatment projects defined in Section 212 of the Clean Water Act which receive loan assistance from the fund before fiscal year 1995 will meet the requirements of Sections 201(b), 201(g)(1), 201(g)(2), 201(g)(3), 201(g)(5), 201(g)(6), 201(n)(1), 201(o), 204(a)(1), 204(a)(2), 204(b)(1), 204(d)(2), 211, 218, 511(c)(1), and 513 of the Clean Water Act, as described in rule 92.10(455B). A portion of the capitalization grant, as allowed by Title VI of the Clean Water Act, will be used to administer the SRF program.

ITEM 4. Amend subrule 92.5(1) as follows:

92.5(1) Forms. The department will provide an application package to apply for SRF loan assistance and to provide documentation in the program. Forms can be obtained from the Environmental Protection Division, Iowa Department of Natural Resources, Henry A. Wallace Building, 900 502 E. Grand Ninth Street, Des Moines, Iowa 50319-0034.

ITEM 5. Amend subrule 92.5(2), paragraph "a," as follows:

a. Two copies of the facility plan certified by a professional engineer registered licensed to practice in Iowa;

ITEM 6. Amend subrule 92.5(3) as follows:

92.5(3) Timing. Applications received for eligible proj-ects by the department on or before July 1 preceding the fiscal year will be given first assigned a priority for loan assistance in the development of the IUP for that fiscal year. Applications received after that date will be considered for addition to the list of eligible recipients in the IUP in priority order following applicants which had applied by July 1.

ITEM 7. Rescind and reserve subrule 92.6(2), paragraph "a," subparagraph (1).

ITEM 8. Rescind and reserve subrule 92.6(2), paragraph "d," subparagraphs (4) and (5).

ITEM 9. Amend subrule 92.7(2), paragraph "e," as follows:

e. The applicant has demonstrated its ability to provide the necessary legal, institutional, managerial and financial capability to complete the project ensure adequate construction, operation and maintenance. If the director has reasonable grounds to believe that an applicant's disposal system is not viable, the department may require the applicant to submit management and financial plans as prescribed in Iowa Code section 455B.174.

ITEM 10. Amend subrule 92.8(7) as follows:

92.8(7) Project bypass. Any project identified in the intended use plan for funding in a fiscal year that has not signed a binding commitment by August 31 of following the fiscal year will in which a fundable priority was assigned may be bypassed by projects of a lower priority that are in a state of readiness.

ITEM 11. Amend rule 567--92.10(455B), introductory paragraph and subrule 92.10(1), as follows:

567--92.10(455B) Project requirements. The following requirements of this rule apply to all wastewater treatment projects defined in Section 212 of the Clean Water Act receiving assistance from the SRF and identified in an intended use plan prior to fiscal year 1998. They are identified here with references to sections of the Clean Water Act and federal regulations, where appropriate. All wastewater treatment projects receiving assistance from the SRF and identified in an intended use plan in fiscal year 1998 or after need only meet the requirements of paragraphs 92.10(1)"a," 92.10(1)"h," 92.10(2)"b," 92.10(2)"c," 92.10(2)"f" to 92.10(2)"i," and subrule 92.10(3).

92.10(1) Planning. The planning phase of a project includes those necessary plans and studies which directly relate to facilities needed to comply with enforceable requirements of the Clean Water Act and state statutes. It consists of a systematic evaluation of alternatives that are feasible considering the unique demographic, topographic, hydrologic, and institutional characteristics of the planning area. Facilities planning will determine which alternative is cost effective must support selection of the proposed alternative.

The planning phase must include the following:

a. A description of the proposed project and the complete system of which it is a part. The facility plan must be prepared in accordance with chapter 11 of the "Iowa Wastewater Facilities Design Standards," and meet the applicable provisions of this subrule.

b. to h. No change.

ITEM 12. Amend subrule 92.10(2), paragraphs "b" and "c," as follows:

b. User charge system -- Section 204(b)(1) requires that a A system of user charges must be developed and enacted to assure ensure that users will pay their proportionate share of the costs of operation and maintenance (including replacement) of any waste treatment services provided by the recipient. A user charge system may also include methods of revenue collection for loan repayments.

c. Recipient capability. The recipient must demonstrate to the department that it has the legal, institutional, managerial and financial capability to ensure adequate construction, operation and maintenance of treatment works, as required by Section 204(b)(1) of the Clean Water Act.

ITEM 13. Amend subrule 92.10(3) as follows:

92.10(3) Qualifying requirements. The Clean Water Act includes several conditions Other information not identified in any particular phase of a project but which are includes basic qualifying factors necessary to qualify any project for SRF assistance must be provided. These consist of the following:

a. Fundable categories, of projects are as defined in 567--91.6(2), including: .

(1) Treatment--Section 201(g)(1) limits assistance to projects for secondary treatment, advanced treatment, or any cost-effective alternative, new interceptors and appurtenances, and infiltration/inflow correction. This section retains the governor's discretionary set aside by which a state can use up to 20 percent of its allotment for other projects within the definition of treatment works in Section 212(2), and for certain nonpoint source control and groundwater protection purposes, as defined in Section 319 of the Clean Water Act and subsequent agency regulations (40 CFR 35.2015(b)(2)(ii-iv): State Priority System and Project Priority List).

(2) Sewers--governor's discretionary fund--Section 211 provides that major rehabilitation or replacement of collectors is not eligible under the governor's 20 percent discretionary authority of 201(g)(1) unless the collector is needed to assure the total integrity of the treatment works, or that, for a new collector, adequate capacity exists at the facilities (40 CFR 35.2116 Collection System).

(3) Combined sewer overflows--Section 201(n)(1) provides that funds under Section 205 may be used for water quality problems due to discharges of combined sewer overflows which are not otherwise eligible, if such discharges are a major priority in a state (40 CFR 35.2015(b)(2)(iv): State Priority Systems--categories of need and 35.2024(a): Combined Sewer Overflows).

b. Capital financing plans. Section 201(o) calls on the state to assist eligible Eligible recipients in the development of must develop a capital financing plan which, at a minimum:

(1) Projects the future requirements for waste treatment services within the applicant's jurisdiction for a period of no less than ten years;

(2) Projects the nature, extent, timing, and costs of future expansion and reconstruction of treatment works which will be necessary to satisfy the applicant's projected future requirements for waste treatment services; and

(3) Sets forth with specificity the manner in which the applicant intends to finance such future expansion and reconstruction.

The recipient must submit the plan to the department for any comments deemed necessary.

c. Cost information. Cost estimates for the total project and costs allowable for loan financing shall be provided to the department by an eligible recipient.

d. NPDES compliance. To qualify for an SRF loan, a recipient must demonstrate to the satisfaction of the director that the project receiving loan assistance is a part of the recipient's overall plan that addresses all wastewater treatment needs and that describes how compliance with NPDES permit limitations will be achieved and maintained.

ITEM 14. Rescind subrule 92.10(4).

ARC 7789A

Pursuant to the authority of Iowa Code section 249A.4, the Department of Human Services proposes to amend Chapter 75, "Conditions of Eligibility," appearing in the Iowa Administrative Code.

These amendments revise the statewide average cost to a private pay person for nursing care in Iowa and the average charges for nursing facility care, hospital-based skilled nursing care, non-hospital-based skilled nursing care, intermediate care facility for the mentally retarded (ICF/MR) care, mental health institute (MHI) care, and psychiatric medical institution for children (PMIC) care. The statewide average cost is used to determine the period of ineligibility when an applicant or recipient has transferred assets for less than fair market value. The statewide charge is used to determine whether a person who has established a medical assistance income trust qualifies for Medicaid.

A person in a nursing facility who transfers assets for less than fair market value to become eligible for Medicaid becomes ineligible for Medicaid for a period of time determined by dividing the uncompensated value of the transferred assets by the statewide average cost to a private pay person in order to arrive at the number of months of ineligibility for nursing facility services or home- and community-based waiver services.

Any person is allowed to establish a medical assistance income trust under Iowa Code section 633.709. For persons whose income exceeds 300 percent of the Supplemental Security Income (SSI) benefit for one person (currently $1,482) but whose income is below the statewide average charge or the average Medicaid reimbursement rate for the type of medical facility care the person needs, a medical assistance income trust may be used to establish Medicaid eligibility.

The Department is required to update these average statewide costs and charges annually. The statewide average cost used to determine the period of ineligibility for a person who transfers assets for less than fair market value is a costdetermined using all types of nursing facilities, including hospital- and non-hospital-based skilled care.

The Department alternates updating the costs by conducting an actual survey one year and applying actual and projected increases the next year. A survey was conducted for fiscal year 1997. Actual and projected increases were applied for fiscal year 1998.

The average private pay cost increased from $2,415.08 to $2,567.77. The average charge to a private pay resident of nursing facility care increased from $2,255 to $2,397. The average charge for hospital-based skilled care increased from $7,232 per month to $7,471. The average charge for non-hospital-based skilled care increased from $3,554 to $3,671. The average charge for ICF/MR care increased from $8,030 to $8,319. The average statewide charge to a resident of a mental health institute increased from $9,704 to $9,975. The average charge of a psychiatric medical institution for children increased from $4,015 to $4,135.

Consideration will be given to all written data, views, and arguments thereto received by the Bureau of Policy Analysis, Department of Human Services, Hoover State Office Building, Des Moines, Iowa 50319-0114, on or before March 4, 1998.

These amendments are intended to implement Iowa Code section 249A.4.

The following amendments are proposed.

ITEM 1. Amend subrule 75.15(2), paragraph "b," as follows:

b. The average statewide cost to a private pay resident shall be determined by the department and updated annually for nursing facilities.

For the period from July 1, 1997 1998, through June 30, 1998 1999, this average statewide cost shall be $2,415.08 $2,567.77 per month or $79.40 $84.42 per day.

ITEM 2. Amend subrule 75.24(3), paragraph "b," introductory paragraphs and subparagraphs (1) to (6), as follows:

b. A trust established for the benefit of an individual if the trust is composed only of pension, social security, and other income to the individual (and accumulated income of the trust), and the state will receive all amounts remaining in the trust upon the death of the individual up to the amount equal to the total medical assistance paid on behalf of the individual.

For disposition of trust amounts pursuant to Iowa Code sections 633.707 to 633.711, the average statewide charges and Medicaid rates for the period from July 1, 1997 1998, to June 30, 1998 1999, shall be as follows:

(1) The average statewide charge to a private pay resident of a nursing facility is $2,255 $2,397 per month.

(2) The average statewide charge to a private pay resident of a hospital-based skilled nursing facility is $7,232 $7,471 per month.

(3) The average statewide charge to a private pay resident of a non-hospital-based skilled nursing facility is $3,554 $3,671 per month.

(4) The average statewide Medicaid rate for a resident of an intermediate care facility for the mentally retarded is $8,030 $8,319 per month.

(5) The average statewide charge to a resident of a mental health institute is $9,704 $9,975 per month.

(6) The average statewide charge to a private pay resident of a psychiatric medical institution for children is $4,015 $4,135 per month.

ARC 7806A

Pursuant to the authority of Iowa Code section 249A.4, the Department of Human Services proposes to amend Chapter 77, "Conditions of Participation for Providers of Medical and Remedial Care," Chapter 79, "Other Policies Relating to Providers of Medical and Remedial Care," and Chapter 83, "Medicaid Waiver Services," appearing in the Iowa Administrative Code.

These amendments implement the following changes in policy to the Home- and Community-Based (HCBS) MR and Brain Injury Waiver programs.

Policy governing both waiver programs is revised to:

* Clarify that in order for accreditation from another accrediting body to be used in lieu of an on-site review by the Department, the accreditation must be for a similar service.

* Clarify that interviews with consumers and significant people in the consumer's life are used only in on-site reviews for supported community living and supported employment services.

* Require only that respite providers meet the Organization Standard outcome and participate in satisfaction surveys for recertification. Respite services are a basic service that requires some oversight, but conducting a full,outcome-based survey is not an efficient use of the provider's or surveyor's time. Overseeing the providers' governance and participant satisfaction surveys would provide the necessary oversight.

* Allow corrective actions to be required when issuing a three-year certification with excellence.

Policy for the HCBS MR waiver program is revised to provide that if a notice of decision is not received from a county within 30 days from the date of request for services for an adult with a county of legal settlement, the request shall be sent to the Department of Human Services with documentation verifying the original submission of the request to the county. A letter from the Department shall then be sent to the county central point of coordination and county board of supervisors requesting a response within ten days. If no response is received within ten days, the Division of Medical Services designee will decide whether or not to approve the services and service costs or request modification of the service plan or ICP.

Policy governing reimbursement for HCBS MR and brain injury providers of supported community living, nonfacility respite, and supported employment (except instructional activities to obtain a job and follow-along) waiver services is revised to clarify how rates will be set and to have a retrospective adjustment based on actual costs.

* Providers are reimbursed on the basis of a rate for a unit of service calculated prospectively for each participating provider (and, for supported community living daily rates, for each consumer or site) based on projected or historical costs of operation, subject to maximums and to retrospective adjustment based on actual, current costs of operation so as not to exceed reasonable and proper costs by more than 2.5 percent.

* Providers are required to submit cost reports for each waiver service provided using the Financial and Statistical Report for Purchase of Service and Supplemental Schedule. Costs reported under the waiver shall not be reported as reimbursable costs under any other funding source and costs incurred for other services shall not be reported as reimbursable costs under the waiver. Failure to maintain records to support the Financial and Statistical Report and Supplemental Schedule may result in termination of the provider's HCBS certification. Failure to submit the Financial and Statistical Report and Supplemental Schedule by September 30 or an extended deadline of up to 30 days granted by the Division of Medical Services shall reduce payment to the provider to 76 percent of the provider's current rate.

* General rate criteria which were inadvertently omitted in an earlier rule revision are reinstated, including a limit of 20 percent of other costs for indirect administrative costs and a limitation on consumer travel and transportation, consumer consulting, consumer instruction, consumer environmental modification and repairs and consumer environmental furnishing to $1,570 per consumer per year.

* The prospective rates for new providers who have not submitted six months of cost reports will be based on a projection of the provider's reasonable and proper costs of operation until the provider has submitted an annual cost report that includes a minimum of six months of actual costs. The prospective rates paid established providers who have submitted an annual report with a minimum of a six-month history will be based on reasonable and proper costs in a base period and are adjusted annually for inflation. The base period shall be the period covered by the first Financial and Statistical Report and Supplemental Schedule submitted to the Department after 1997 that includes at least six months of actual, historical costs. The annual adjustment shall be equal to the increase in the consumer price index for all urban consumers for the preceding 12-month period ending June 30.

* Retrospective adjustments shall be made based on reconciliation of provider's actual service costs with the revenues received for those services as reported on the Financial and Statistical Report and Supplemental Schedule. Revenues exceeding adjusted actual costs by more than 2.5 percent shall be remitted to the Division of Medical Services. Payment will be due upon notice of the new rates and retrospective adjustment. Providers who do not reimburse revenues exceeding 2.5 percent of actual costs 30 days after notice is given by the Department will have the revenues over 2.5 percent of the actual costs deducted from future payments.

* For purposes of determining the daily rate for supported community living services, providers are treated as new providers until they have submitted an annual report including at least six months of actual costs for the same consumers at the same site with no significant change in any consumer's needs. Individual prospective daily rates are determined for each consumer. These rates may be adjusted no more than once every three months if there is a vacancy at the site for over 30 days or a consumer's needs have significantly changed. Rates adjusted on this basis will become effective the month a new cost report is submitted. Retrospective adjustments of the prospective daily rates are based on each site's average costs.

These rate policies were developed by a committee consisting of representatives of county CPCs, providers, and Department staff. Revisions will enhance the accountability of providers as requested by counties. Making the rules consistent will assist consumers, providers, counties, and the state in planning for services.

Consideration will be given to all written data, views, and arguments thereto received by the Bureau of Policy Analysis, Department of Human Services, Hoover State Office Building, Des Moines, Iowa 50319-0114, on or before March 4, 1998.

Oral presentations may be made by persons appearing at the following meetings. Written comments will also be accepted at these times.

Cedar Rapids - March 6, 1998 Cedar Rapids Regional Office Iowa Building - Suite 600 Sixth Floor Conference Room 411 Third St. S. E. Cedar Rapids, Iowa 52401	1 p.m.
Council Bluffs - March 4, 1998 Lower Level Council Bluffs Regional Office 417 E. Kanesville Boulevard Council Bluffs, Iowa 51501	9 a.m.
Davenport - March 5, 1998 Davenport Area Office Bicentennial Building - Fifth Floor Conference Room 3428 Western Davenport, Iowa 52801	12:30 p.m.
Des Moines - March 4, 1998 Des Moines Regional Office City View Plaza Conference Room 104 1200 University Des Moines, Iowa 50314	10 a.m.
Mason City - March 5, 1998 Mason City Area Office Mohawk Square, Liberty Room 22 North Georgia Avenue Mason City, Iowa 50401	11:30 a.m.
Ottumwa - March 4, 1998 Ottumwa Area Office Conference Room 2 120 East Main Ottumwa, Iowa 52501	1 p.m.
Sioux City - March 5, 1998 Sioux City Regional Office Fifth Floor 520 Nebraska St. Sioux City, Iowa 51101	10 a.m.
Waterloo - March 4, 1998 Waterloo Regional Office Pinecrest Office Building Conference Room 220 1407 Independence Avenue Waterloo, Iowa 50703	11 a.m.

Any persons who intend to attend a public hearing and have special requirements such as hearing or vision impairments should contact the Bureau of Policy Analysis at (515)281-8440 and advise of special needs.

These amendments are intended to implement Iowa Code section 249A.4.

The following amendments are proposed.

ITEM 1. Amend subrule 77.37(12) as follows:

Amend paragraph "b," introductory paragraph, as follows:

b. Recertification. After the initial certification, the level of certification shall be based on an on-site review unless the provider has been accredited for similar services by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the Council on Accreditation of Rehabilitation Facilities (CARF), the Council on Quality and Leadership in Supports for People with Disabilities (The Council), or the Council on Accreditation of Services for Families and Children (COA). The on-site reviews for supported community living and supported employment use interviews with consumers and significant people in the consumer's life to determine whether or not the 20 individual value-based outcomes set forth in subrules 77.37(1) and 77.37(2) and corresponding processes are present for the consumer. Respite services are required to meet Outcome 1 and participate in satisfaction surveys.

Amend paragraph "c," subparagraph (1), as follows:

(1) Three-year certification with excellence. An organization is eligible for certification with excellence if the number of processes present is 18 or higher and the number of outcomes and corresponding processes present together are is 12 or higher. Both criteria need to be met to receive three-year certification with excellence. No corrective action plan or follow-up monitoring is required. Corrective actions may be required which may be monitored through the assignment of follow-up monitoring either by written report, a plan of corrective actions and improvements, an on-site review, or the provision of technical assistance.

ITEM 2. Amend subrule 77.39(10) as follows:

Amend paragraph "b," introductory paragraph, as follows:

b. Recertification. After the initial certification, the level of certification shall be based on an on-site review unless the provider has been accredited for similar services by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the Council on Accreditation of Rehabilitation Facilities (CARF), the Council on Quality and Leadership in Supports for People with Disabilities (The Council), or the Council on Accreditation of Services for Families and Children (COA). The on-site reviews for supported community living and supported employment use interviews with consumers and significant people in the consumer's life to determine whether or not the 20 individual value-based outcomes set forth in subrules 77.39(1) and 77.39(2) and corresponding processes are present for the consumer. Respite services are required to meet Outcome 1 and participate in satisfaction surveys.

Amend paragraph "c," subparagraph (1), as follows:

(1) Three-year certification with excellence. An organization is eligible for certification with excellence if the number of processes present is 18 or higher and the number of outcomes and corresponding processes present together are is 12 or higher. Both criteria need to be met to receive three-year certification with excellence. No corrective action plan or follow-up monitoring is required. Corrective actions may be required which may be monitored through the assignment of follow-up monitoring either by written report, a plan of corrective actions and improvements, an on-site review, or the provision of technical assistance.

ITEM 3. Amend rule 441--79.1(249A) as follows:

Amend subrule 79.1(1) by inserting the following new paragraphs "e" and "f":

e. Retrospectively limited prospective rates. Providers are reimbursed on the basis of a rate for a unit of service calculated prospectively for each participating provider (and, for supported community living daily rates, for each consumer or site) based on projected or historical costs of operation, subject to the maximums listed in subrule 79.1(2) and to retrospective adjustment based on actual, current costs of operation so as not to exceed reasonable and proper costs by more than 2.5 percent.

The prospective rates for new providers who have not submitted six months of cost reports will be based on a projection of the provider's reasonable and proper costs of operation until the provider has submitted an annual cost report that includes a minimum of six months of actual costs. The prospective rates paid established providers who have submitted an annual report with a minimum of a six-month history are based on reasonable and proper costs in a base period and are adjusted annually for inflation. The prospective rates paid to both new and established providers are subject to the maximums listed in subrule 79.1(2) and to retrospective adjustment based on the provider's actual, current costs of operation as shown by financial and statistical reports submitted by the provider, so as not to exceed reasonable and proper costs actually incurred by more than 2.5 percent.

f. Contractual rate. Providers are reimbursed on a basis of costs incurred pursuant to a contract between the provider and subcontractor.

Amend subrule 79.1(2), provider category of HCBS brain injury waiver service providers--supported community living, respite care, and supported employment providers, as follows:

Provider category	Basis of reimbursement	Upper limit
HCBS brain injury waiver service providers, including:
1. Supported community living	Fee schedule determined per day per month. See 79.1(17) Retrospectively limited prospective rates. See 79.1(15)	$32 per hour, $72.17 per day. Variance may be granted when cost-effective and in accordance with the ICP.
	Fee schedule determined per hour. See 79.1(17)	$32 per hour.
2. Respite care providers, including:
Nonfacility care:	Fee schedule Retrospectively limited prospective rates. See 79.1(15)	$12 per hour, $104 per 4- to 8-hour day
Facility care:
Hospital or skilled nursing facility	Prospective reimbursement	Limit for skilled nursing facility level of care
Nursing facility or intermediate care facility for the mentally retarded	Prospective reimbursement	Limit for nursing facility level of care
Foster group care	Prospective reimbursement	P.O.S. contract rate

5. Supported employment:
a. Instructional activities to obtain a job	Fee schedule See 79.1(17)	$34.02 per day
b. Initial instructional activities on the job	Fee schedule See 79.1(17) Retrospectively limited prospective rates. See 79.1(15)	$15.46 per hour
c. Enclave	Fee schedule See 79.1(17) Retrospectively limited prospective rates. See 79.1(15)	$5.67 per hour
d. Follow-along	Fee schedule. See 79.1(17)	$257.75 per month

Further amend subrule 79.1(2), provider category of HCBS MR waiver service providers--supported community living, respite care, supported employment, and home and vehicle modifications providers, as follows:

Provider category	Basis of reimbursement	Upper limit
HCBS MR waiver service providers, including:
1. Supported community living	Prospective cost-related reimbursement determined per day per month. Retrospectively limited prospective rates. See 79.1(15)	$32 per hour, not to exceed a total per month of $72.17 times the number of days in the month. $72.17 per day. Variations to the upper limit may be granted by the division of medical services when cost- effective and in accordance with the ICP or service plan as long as the statewide average remains at or below $72.17 per day.
	Prospective cost-related reimbursement determined per hour. See 79.1(15)	$32 per hour not to exceed a total per month of $72.17 times the number of days in the month. Variations may be granted by the division of medical services when cost-effective and in accordance with the ICP or service plan as long as the statewide average remains at or below $72.17 per day.
2. Respite care providers, including:
Nonfacility care:	Prospective cost-related reimbursement Retrospectively limited prospective rates. See 79.1(15)	$12 per hour
Facility care:
Hospital or skilled nursing facility	Prospective reimbursement	Limit for skilled nursing facility level of care
Nursing facility or intermediate care facility for the mentally retarded	Prospective reimbursement	Limit for nursing facility level of care
Foster group care	Prospective reimbursement	P.O.S. contract rate
3. Supported employment:
a. Instructional activities to obtain a job	Fee schedule See 79.1(15)	$34.02 per day. Maximum of 80 units, 5 per week, limit 16 weeks
b. Initial instructional activities on the job	Prospective cost- related reimbursement Retrospectively limited prospective rates. See 79.1(15)	$15.46 per hour. Maximum of 40 units per week, limit 16 weeks, 640 units
c. Enclave	Prospective cost- related reimbursement Retrospectively limited prospective rates. See 79.1(15)	$5.67 per hour. Maximum of 40 units per week
d. Follow-along	Fee schedule. See 79.1(15)	$257.75 per month. Maximum of 12 units per fiscal year or $8.45 per day for a partial month
7. Home and vehicle modifications	Fee schedule Contractual rate. See 79.1(15)	Maximum amount of $5,000 per consumer through 2/28/95 lifetime

Rescind subrules 79.1(15) and 79.1(17) and insert the following new subrules in lieu thereof:

79.1(15) Reimbursement for HCBS MR and BI supported community living, respite, and supported employment.

a. Reporting requirements.

(1) Providers shall submit cost reports for each waiver service provided using Form SS-1703-0, Financial and Statistical Report for Purchase of Service, and Form 470-3449, Supplemental Schedule. The cost reporting period is from July 1 to June 30. The completed cost reports shall be submitted to the department, division of medical services, by September 30 of each year.

(2) If a provider chooses to leave the HCBS program or terminates a service, a final cost report shall be submitted within 60 days of termination for retrospective adjustment.

(3) Costs reported under the waiver shall not be reported as reimbursable costs under any other funding source. Costs incurred for other services shall not be reported as reimbursable costs under the waiver.

(4) Financial information shall be based on the agency's financial records. When the records are not kept on an accrual basis of accounting, the provider shall make the adjustments necessary to convert the information to an accrual basis for reporting. Providers which are multiple program agencies shall submit a cost allocation schedule, prepared in accordance with generally accepted accounting principles.

(5) Failure to maintain records to support the cost reports may result in termination of the provider's HCBS certification.

(6) The department may require that an opinion of a certified public accountant or public accountant accompany the report when adjustments made to prior reports indicate noncompliance with reporting instructions.

(7) A 30-day extension for submitting the cost reports due by September 30 may be obtained by submitting a letter to the division of medical services by September 30. No extensions will be granted beyond 30 days.

(8) Failure to submit a report that meets the requirements of this paragraph by September 30 or an extended deadline granted per subparagraph (7) shall reduce payment to 76 percent of the current rate. The reduced rate shall be paid for not longer than three months, after which time no further payments will be made.

b. Home- and community-based general rate criteria.

(1) To receive reimbursement for services, a certified provider shall enter into an agreement with the department on Form 470-2918, HCBS Waiver Agreement, and have an approved individual comprehensive plan for the consumer.

(2) The rates a provider may charge are subject to limits established in subrule 79.1(2).

(3) Indirect administrative costs shall be limited to 20 percent of other costs.

(4) Mileage costs shall be reimbursed according to state employees rate.

(5) Consumer travel and transportation, consumer consulting, consumer instruction, consumer environmental modification and repairs and consumer environmental furnishings shall not exceed $1,570 per consumer per year.

c. Prospective rates for new providers.

(1) Providers who have not submitted an annual report including at least 6 months of actual, historical costs shall be paid prospective rates based on projected reasonable and proper costs of operation for a 12-month period reported in Form SS-1703-0, Financial and Statistical Report, and Form 470-3449, Supplemental Schedule.

(2) Prospective rates shall be subject to retrospective adjustment as provided in paragraph "e."

(3) After a provider has submitted an annual report including at least six months of actual, historical costs, prospective rates shall be determined as provided in paragraph "d."

d. Prospective rates for established providers.

(1) Providers who have submitted an annual report including at least six months of actual, historical costs shall be paid prospective rates based on reasonable and proper costs in a base period, as adjusted for inflation.

(2) The base period shall be the period covered by the first Form SS-1703-0, Financial and Statistical Report, and Form 470-3449, Supplemental Schedule, submitted to the department after 1997 that includes at least six months of actual, historical costs.

(3) Reasonable and proper costs in the base period shall be inflated by a percentage of the increase in the consumer price index for all urban consumers for the preceding 12-month period ending June 30, based on the months included in the base period, to establish the initial prospective rate for an established provider.

(4) After establishment of the initial prospective rate for an established provider, the rate will be adjusted annually, effective for the third month after the month during which the annual cost report is submitted to the department. The annual adjustment shall be equal to the increase in the consumer price index for all urban consumers for the preceding 12-month period ending June 30.

(5) Prospective rates shall be subject to retrospective adjustment as provided in paragraph "e."

e. Retrospective adjustments.

(1) Retrospective adjustments shall be made based on reconciliation of provider's reasonable and proper actual service costs with the revenues received for those services as reported on Form 470-4330, Supplemental Schedule, accompanying Form SS-1703-0, Financial and Statistical Report for Purchase of Service.

(2) Revenues exceeding adjusted actual costs by more than 2.5 percent shall be remitted to the division of medical services. Payment will be due upon notice of the new rates and retrospective adjustment.

(3) Providers who do not reimburse revenues exceeding 2.5 percent of actual costs 30 days after notice is given by the department will have the revenues over 2.5 percent of the actual costs deducted from future payments.

f. Supported community living daily rate. For purposes of determining the daily rate for supported community living services, providers are treated as new providers until they have submitted an annual report including at least six months of actual costs for the same consumers at the same site with no significant change in any consumer's needs. Individual prospective daily rates are determined for each consumer. These rates may be adjusted no more than once every three months if there is a vacancy at the site for over 30 days or the consumer's needs have significantly changed. Rates adjusted on this basis will become effective the month a new cost report is submitted. Retrospective adjustments of the prospective daily rates are based on each site's average costs.

79.1(17) Reimbursement for home- and community-based services home and vehicle modification. Payment is made for home and vehicle modifications at the amount of payment to the subcontractor provided in the contract between the supported community living provider and subcontractor. All contracts shall be awarded through competitive bidding, shall be approved by the department, and shall be justified by the consumer's service plan. Payment for completed work shall be made to the supported community living provider.

ITEM 4. Amend subrule 83.67(9) by adding the following new paragraph "d":

d. If a notice of decision is not received from a county within 30 days from the date of request for services, the request shall be sent to the department of human services with documentation verifying the original submission of the request to the county. A letter from the department of human services shall be sent to the county central point of coordination and county board of supervisors requesting a response within 10 days. If no response is received within 10 days, the division of medical services designee will make the decision as stated in paragraph "b."

ARC 7807A

Pursuant to the authority of Iowa Code section 249A.4, the Department of Human Services proposes to amend Chapter 78, "Amount, Duration and Scope of Medical and Remedial Services," appearing in the Iowa Administrative Code.

These amendments remove the prior authorization requirement for Medicaid approval for two dental procedures, oral prophylaxis and post supports, and remove the lower age limit for payment of pit and fissure sealants for first and second permanent molars for children through the age of 15. In addition, language is revised to be more precise.

Prior approval is no longer needed where the oral prophylaxis, including necessary scaling and polishing, is to be performed more frequently than every six months. Cast post and core, steel post and composite or amalgam in addition to a crown is payable when a tooth is functional and the integrity of the tooth would be jeopardized by no post support. Policy is being revised as the prior authorizations are no longer cost-effective and a court ruling declared the prosthetic services rule to be arbitrary and capricious.

Current policy limits payment for sealants to children aged 5 through 15. This policy is being revised in response to a petition for rule making from the Iowa Dental Association.

Consideration will be given to all written data, views, and arguments thereto received by the Bureau of Policy Analysis, Department of Human Services, Hoover State Office Building, Des Moines, Iowa 50319-0114, on or before March 4, 1998.

These amendments are intended to implement Iowa Code section 249A.4.

The following amendments are proposed.

ITEM 1. Amend rule 441--78.4(249A) as follows:

Amend subrule 78.4(1), paragraphs "a" and "c," as follows:

a. Oral prophylaxis, including necessary scaling and polishing, is payable only once in a six-month period except for persons who, because of physical or mental disability, need more frequent care. Prior approval is required in all cases where the oral prophylaxis is to be performed morefrequently than every six months. (Cross-reference 78.28(2)"a") Documentation supporting the need for oral prophylaxis performed more than once in a six-month period must accompany the claim.

c. Pit and fissure sealants are payable for placement on first and second permanent molars only. Reimbursement for sealants is restricted to work performed on children aged 5 through 15 years of age for first and second permanent molars. Payment will be approved for only one application per tooth in a child's lifetime.

Amend subrule 78.4(3), paragraph "e," as follows:

e. Cast post and core, steel post and composite or amalgam in addition to a crown require prior approval. Approval will be given is payable when a tooth is functional and the integrity of the tooth would be jeopardized by no post support. (Cross-reference 78.28(2)"b")

Amend subrule 78.4(4), paragraph "d," as follows:

d. Periodontal maintenance therapy which includes oral prophylaxis, oral examinations, measurement of pocket depths and limited root planing and scaling is a payable service when prior approval has been received. A request for approval must be accompanied by a plan for treatment periodontal treatment plan, a completed copy of a periodontal probe chart which exhibits pocket depths, periodontal history and radiograph(s). Payment for periodontal maintenance therapy will may be approved when after periodontal scaling and root planing and or periodontal surgical procedures have been provided. Periodontal maintenance therapy will may be approved for three visits at once per three-month intervals following treatment interval for moderate to advanced cases. Periodontal maintenance therapy may then be approved once per six-month interval if the patient's condition is getting worse or, if not maintained, conditions would deteriorate without treatment. (Cross-reference 78.28(2)"c""a"(3))

Amend subrule 78.4(7) as follows:

78.4(7) Prosthetic services. Payment will may be made for the following prosthetic services:

a. Immediate dentures An immediate denture and a first-time complete dentures denture including six months' postdelivery care. An immediate denture and a first-time complete denture are payable when the dentures are denture is provided to establish masticatory function. An immediate denture or a first-time complete denture is payable only once following the removal of teeth it replaces. Complete dentures are A complete denture is payable only once in a five-year period except when the dentures are denture is broken beyond repair, lost or stolen, or no longer fit fits due to growth in a child or changes in jaw structure and is required to prevent significant dental problems.

b. Partial dentures A removable partial denture replacing anterior teeth, including six months' postdelivery care. Partial dentures A removable partial denture replacing anterior teeth are is only payable once in a five-year period unless the dentures are removable partial denture is broken beyond repair, lost or stolen, or no longer fit fits due to growth in a child, or changes in jaw structure and are is required to prevent significant dental problems.

c. Partial dentures A removable partial denture replacing posterior teeth including six months' postdelivery care when prior approval has been received. Prior approval requests will A removable partial denture replacing posterior teeth shall be approved when the patient recipient has less than eight posterior teeth in occlusion; or when the patient's missing teeth could cause shifting or supra eruption of the remaining dentition; or the patient recipient has a full denture in one arch, and a partial denture replacing posterior teeth is required in the opposing arch in order to balance occlusion; or a partial denture replacing anterior teeth is being approved, and posterior teeth can be replaced with little additional cost. When one removable partial denture brings eight posterior teeth in occlusion, no additional removable partial denture will be approved. Partial dentures A removable partial denture replacing posterior teeth are is payable only once in a five-year period unless the dentures are removable partial denture is broken beyond repair, lost or stolen, or no longer fit fits due to growth in a child, or changes in jaw structure and are is required to prevent significant dental problems. (Cross-reference 78.28(2)"e""c"(1))

d. Fixed bridgework A fixed partial denture (including an acid etch bridgework fixed partial denture) for missing replacing anterior teeth when prior approval has been received. Fixed bridgework A fixed partial denture (including an acid etch fixed partial denture) for missing replacing anterior teeth shall be approved for recipients whose medical condition precludes the use of a removable prostheses partial denture. High noble or noble metals shall be approved only when the recipient is allergic to all other restorative materials. A fixed partial denture replacing anterior teeth is payable only once in a five-year period unless the fixed partial denture is broken beyond repair. (Cross-reference 78.28(2)"e""c"(2))

e. A fixed partial denture (including an acid etch fixed partial denture) replacing posterior teeth when prior approval has been received. A fixed partial denture (including an acid etch fixed partial denture) replacing posterior teeth shall be approved for the recipient whose medical condition precludes the use of a removable partial denture and who has less than eight posterior teeth in occlusion or if the recipient has a full denture in one arch and a partial denture replacing posterior teeth is required in the opposing arch to balance occlusion. When one fixed partial denture brings eight posterior teeth in occlusion, no additional fixed partial denture will be approved. High noble or noble metals will be approved only when the recipient is allergic to all other restorative materials. A fixed partial denture replacing posterior teeth is payable only once in a five-year period unless the fixed partial denture is broken beyond repair. (Cross-reference 78.28(2)"c"(3))

e f. Obturator for surgically excised palatal tissue or deficient velopharyngeal function of cleft palate patients.

f g. Chairside relines are payable only once per appliance prosthesis every 12 months.

g h. Laboratory processed relines are payable only once per appliance prosthesis every 12 months.

h i. Tissue conditioning is a payable service twice per appliance prosthesis in a 12-month period.

i j. Two repairs per appliance prosthesis in a 12-month period are payable.

j k. Adjustments to dentures a complete or removable partial denture are payable when medically necessary after six months' postdelivery care.

Amend subrule 78.4(8), paragraph "a," last paragraph, as follows:

Approval may be made for eight units of a three-month active treatment period. Additional units may be approved by the fiscal agent's orthodontic consultant if found to be medically necessary. (Cross-reference 78.28(2)"f""d")

ITEM 2. Amend subrule 78.28(2) as follows:

78.28(2) Dental services. Dental services which require prior approval are as follows:

a. Oral prophylaxis, including necessary scaling and polishing, is payable only once in a six-month period except for persons who because of physical or mental disability need more frequent care. Prior authorization is required in all cases where the oral prophylaxis is to be performed more frequently than every six months. (Cross-reference 78.4(1)"a")

b. Cast post and core, steel post and composite or amalgam in addition to a crown will be approved when a tooth is functional and the integrity of the tooth would be jeopardized by no post support. (Cross-reference 78.4(3)"e")

c a. The following periodontal services:

(1) Payment for periodontal scaling and root planing will be approved when interproximal and subgingival calculus is evident in X-rays or when justified and documented that curettage, scaling or root planing is required in addition to routine prophylaxis. (Cross-reference 78.4(4)"b")

(2) Payment for periodontal surgical procedures will be approved after periodontal scaling and root planing has been provided, a reevaluation examination has been completed, and the patient has demonstrated reasonable oral hygiene, unless the patient is unable to demonstrate reasonable oral hygiene because of physical or mental disability or in cases which demonstrate gingival hyperplasia resulting from drug therapy. (Cross-reference 78.4(4)"c")

(3) Payment for periodontal maintenance therapy will may be approved when after periodontal scaling and root planing and or periodontal surgical procedures have been provided. Periodontal maintenance therapy will may be approved for three visits at once per three-month intervals interval following treatment for moderate to advanced cases. Periodontal maintenance therapy may then be approved once per six-month interval if the patient's condition is getting worse or, if not maintained, conditions would deteriorate without treatment. (Cross-reference 78.4(4)"d")

d b. Surgical endodontic treatment which includes an apicoectomy, performed as a separate surgical procedure; an apicoectomy, performed in conjunction with endodontic procedure; an apical curettage; a root resection; or excision of hyperplastic tissue will be approved when nonsurgical treatment has been attempted and a reasonable time has elapsed after which failure has been demonstrated. Surgical endodontic procedures may be indicated when:

(1) Conventional root canal treatment cannot be successfully completed because canals cannot be negotiated, debrided or obturated due to calcifications, blockages, broken instruments, severe curvatures, and dilacerated roots.

(2) Correction of problems resulting from conventional treatment including gross underfilling, perforations, and canal blockages with restorative materials. (Cross-reference 78.4(5)"c")

e c. The following prosthetic services:

(1) Partial dentures A removable partial denture replacing posterior teeth will be approved when the patient recipient has less than eight posterior teeth in occlusion; or when the patient's missing teeth could cause shifting or supra eruption of the remaining dentition; or the patient recipient has a full denture in one arch, and a partial denture replacing posterior teeth is required in the opposing arch in order to balance occlusion; or a partial denture replacing anterior teeth is being approved, and posterior teeth can be replaced with little additional cost. When one removable partial denture brings eight posterior teeth in occlusion, no additional removable partial denture will be approved. Partial dentures A removable partial denture replacing posterior teeth are is payable only once in a five-year period unless the dentures are removable partial denture is broken beyond repair, lost or stolen, or no longer fit fits due to growth in a child or changes in jaw structure, and are is required to prevent significant dental problems. (Cross-reference 78.4(7)"d" "c")

(2) Fixed bridgework A fixed partial denture (including an acid etch bridgework fixed partial denture) for missing replacing anterior teeth will be approved for recipients whose medical condition precludes the use of a removable prostheses partial denture. High noble or noble metals will be approved only when the recipient is allergic to all other restorative materials. A fixed partial denture replacing anterior teeth is payable only once in a five-year period unless the fixed partial denture is broken beyond repair. (Cross-reference 78.4(7)"e""d")

(3) A fixed partial denture (including an acid etch fixed partial denture) replacing posterior teeth will be approved for recipients whose medical condition precludes the use of a removable partial denture and who have less than eight posterior teeth in occlusion or if the recipient has a full denture in one arch and a partial denture replacing posterior teeth is required in the opposing arch to balance occlusion. When one fixed partial denture brings eight posterior teeth in occlusion, no additional fixed partial denture will be approved. High noble or noble metals will be approved only when the recipient is allergic to all other restorative materials. A fixed partial denture replacing posterior teeth is payable only once in a five-year period unless the fixed partial denture is broken beyond repair. (Cross-reference 78.4(7)"e")

f d. Orthodontic services will be approved when it is determined that a patient has the most handicapping malocclusion. This determination is made in a manner consistent with the "Handicapping Malocclusion Assessment to Establish Treatment Priority," by J. A. Salzmann, D.D.S., American Journal of Orthodontics, October 1968.

A handicapping malocclusion is a condition that constitutes a hazard to the maintenance of oral health and interferes with the well-being of the patient by causing impaired mastication, dysfunction of the temporomandibular articulation, susceptibility to periodontal disease, susceptibility to dental caries, and impaired speech due to malpositions of the teeth. Treatment of handicapping malocclusions will be approved only for the severe and the most handicapping. Assessment of the most handicapping malocclusion is determined by the magnitude of the following variables: degree of malalignment, missing teeth, angle classification, overjet and overbite, openbite, and crossbite.

A request to perform an orthodontic procedure must be accompanied by an interpreted cephalometric radiograph and study models trimmed so that the models simulate centric occlusion of the patient. A written plan of treatment must accompany the diagnostic aids. Posttreatment records must be furnished upon request of the fiscal agent.

Approval may be made for eight units of a three-month active treatment period. Additional units may be approved by the fiscal agent's orthodontic consultant if found to be medically necessary. (Cross-reference 78.4(8)"a")

ARC 7790A

Pursuant to the authority of Iowa Code section 249A.4, the Department of Human Services proposes to amend Chapter 78, "Amount, Duration and Scope of Medical and Remedial Services," appearing in the Iowa Administrative Code.

These amendments modify Medicaid home health agency policy as follows:

* The maximum time for review of the treatment plan and certification period is increased from 60 to 62 days to be consistent with Medicare.

* Policy is added to clarify the definition of technology-dependent children. Children who are technology dependent are those who are ventilator dependent or whose medical condition is so unstable as to otherwise require intensive care in a hospital. Providers were confused at which level children met the medical necessity of technology dependent for the enhanced payment which is available.

* Policy is clarified that transportation and homework assistance are not home health services.

Consideration will be given to all written data, views, and arguments thereto received by the Bureau of Policy Analysis, Department of Human Services, Hoover State Office Building, Des Moines, Iowa 50319-0114, on or before March 4, 1998.

These amendments are intended to implement Iowa Code section 249A.4.

The following amendments are proposed.

ITEM 1. Amend subrule 78.9(1), introductory paragraph and paragraph "j," as follows:

78.9(1) Treatment plan. A plan of treatment shall be completed prior to the start of care and at a minimum reviewed every 60 62 days thereafter. The plan of care shall support the medical necessity and intensity of services to be provided by reflecting the following information:

j. Certification period (no more than 60 62 days).

ITEM 2. Amend subrule 78.9(10), paragraph "a," subparagraph (1), as follows:

(1) Private duty nursing services are those services which are provided by a registered nurse or a licensed practical nurse under the direction of the recipient's physician to a recipient in the recipient's place of residence or outside the recipient's residence, when normal life activities take the recipient outside the place of residence. Place of residence does not include nursing facilities, skilled nursing facilities, intermediate care facilities for the mentally retarded, or hospitals.

Services shall be provided according to a written plan of care authorized by a licensed physician. The home health agency is encouraged to collaborate with the recipient, or in the case of a child with the child's caregiver, in the development and implementation of the plan of treatment. These services shall exceed intermittent guidelines as defined in subrule 78.9(3). Private duty nursing and personal care services shall be inclusive of all home health agency services personally provided to the recipient. Enhanced payment under the interim fee schedule shall be made available for services to children who are technology dependent, i.e., ventilator dependent or whose medical condition is so unstable as to otherwise require intensive care in a hospital.

Private duty nursing or personal care services do not include:

1. Respite care, which is a temporary intermission or period of rest for the caregiver.

2. Nurse supervision services including chart review, case discussion or scheduling by a registered nurse.

3. Services provided to other members of the recipient's household.

4. Services requiring prior authorization that are provided without regard to the prior authorization process.

5. Transportation services.

6. Homework assistance.

ARC 7829A

Pursuant to the authority of Iowa Code section 249A.4, the Department of Human Services proposes to amend Chapter 88, "Managed Health Care Providers," appearing in the Iowa Administrative Code.

These amendments make the following changes to operation of the Medicaid managed care program required by the Balanced Budget Act (BBA) of 1997:

* The definition of emergency care is revised to mean those medical services rendered for an emergent medical condition or protection of the public health. "Emergent medical condition" is defined to mean a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect it to result in:

1. Placing the health of the person (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy,

2. Serious impairment to bodily functions, or

3. Serious dysfunction of any bodily organ or part.

The determination of whether an emergent medical condition exists shall be decided by a medical professional and shall be based on the patient's medical condition, including presenting symptoms and medical history (as related to severe pain) prior to treatment.

In cases where the above criteria are satisfied, no prior authorization procedures are allowed.

* A change in existing marketing rules was made to match the requirements of the BBA.

* Policy requiring the total number of enrolled Medicaid recipients and Part A and Part B Medicare beneficiaries not to exceed 75 percent of the nonfederally qualified HMO's total enrollment is deleted.

* The following definitions have been adapted from the BBA: "extended plan participation," "managed care entity," "mandatory enrollment," and "mandatory project county."

In addition, these amendments make the following changes to operation of the Medicaid managed care program which are not required by the Balanced Budget Act (BBA) of 1997:

* Due to increased frequency of managed care provider's developing proprietary definitions of "urgent care," the need arose for the Department to develop a standard definition to ensure that recipients' best interests are protected across all managed care programs. The definition of urgent care is revised to mean those medical services rendered for an urgent medical condition or protection of the public health. "Urgent medical condition" shall mean a medical condition manifesting itself by acute symptoms that are of lesser severity (including severe pain) than that recognized for an emergent medical condition, such that a prudent lay-person, who possesses an average knowledge of health and medicine, could reasonably expect the illness or injury to result in:

1. Placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in jeopardy,

2. Impairment to bodily functions, or

3. Dysfunction of any bodily organ or part.

In urgent medical care cases, prior authorization procedures must be followed, but the HMO or patient manager is required to arrange for necessary urgent medical care within 24 hours by either providing it or referring to and authorizing another appropriate provider to provide care.

* Policy regarding enrollment periods is revised. Under current policy, if a recipient in a mandatory project county (a county where the Department has contracts with more than one managed care entity) does not select an entity in ten days, the Department will automatically enroll the recipient in the entity. The recipient may then request to be disenrolled at any time and the disenrollment is effective no later than the first day of the second month subsequent to the date the Department receives the request.

The Balanced Budget Act of 1997 gives states the option of requiring that the recipient remain in managed care for a period of 12 months if the recipient is given a 90-day period to request disenrollment after being notified of placement in managed care and if the recipient does not have good cause to terminate enrollment. The Department has chosen to require recipients who do not request disenrollment in the 90-day period to remain in managed care for a period of six months. At the end of this nine-month cycle, a new notice is sent to the recipient, and the process repeats itself.

* In order to achieve statewide coverage by HMOs, current rules specify that an HMO must serve all counties in a region. Due to unforeseeable issues (such as statewide licensing requirements or provider availability) this requirement could not be fulfilled. Therefore, the Department is amending the requirements to delete the mandatory coverage of all counties in a region by redefining the enrollment area. To continue encouraging wide geographic coverage, these rules allow incentive reimbursement payments based on the percentage of counties in a region covered by an HMO.

Consideration will be given to all written data, views, and arguments thereto received by the Bureau of Policy Analysis, Department of Human Services, Hoover State Office Building, Des Moines, Iowa 50319-0114, on or before March 4, 1998.

Oral presentations may be made by persons appearing at the following meetings. Written comments will also be accepted at these times.

Cedar Rapids - March 6, 1998 3 p.m.

Cedar Rapids Regional Office

Iowa Building - Suite 600

Sixth Floor Conference Room

411 Third St. S. E.

Cedar Rapids, Iowa 52401

Council Bluffs - March 4, 1998 11:30 a.m.

Lower Level

Council Bluffs Regional Office

417 E. Kanesville Boulevard

Council Bluffs, Iowa 51501

Davenport - March 5, 1998 8 a.m.

Davenport Area Office

Bicentennial Building - Fifth Floor

Conference Room 4

428 Western

Davenport, Iowa 52801

Des Moines - March 4, 1998 1 p.m.

Des Moines Regional Office

City View Plaza

Conference Room 104

1200 University

Des Moines, Iowa 50314

Mason City - March 4, 1998 10 a.m.

Mason City Area Office

Mohawk Square, Liberty Room

22 North Georgia Avenue

Mason City, Iowa 50401

Ottumwa - March 4, 1998 9 a.m.

Ottumwa Area Office

Conference Room 2

120 East Main

Ottumwa, Iowa 52501

Sioux City - March 4, 1998 2 p.m.

Sioux City Regional Office

Fifth Floor

520 Nebraska St.

Sioux City, Iowa 51101

Waterloo - March 4, 1998 10 a.m.

Waterloo Regional Office

Pinecrest Office Building

Conference Room 403

1407 Independence Avenue

Waterloo, Iowa 50703

Any persons who intend to attend a public hearing and have special requirements such as hearing or vision impairments should contact the Bureau of Policy Analysis at (515)281-8440 and advise of special needs.

These amendments are intended to implement Iowa Code section 249A.4.

The following amendments are proposed.

ITEM 1. Amend rule 441--88.1(249A), definitions of "Emergency care," "Enrollment area," and "Urgent care," as follows:

"Emergency care" shall mean those medical services rendered under unforeseen conditions which require hospitalization or the treatment of accidental injury, relief of acute pain, for an emergent medical condition or protection of the public health or a condition which must be immediately diagnosed and treated to avoid risk of permanent damage to the patient's health.

"Enrollment area" shall mean the county or counties or region or regions in which an HMO is licensed to operate by the state of Iowa and in which service capability exists as defined by the department and set forth in the contract. An enrollment area shall not be less than an entire county or but may be less than a region. Effective July 1, 1998, an enrollment area shall be no less than a region or regions. Regions shall be established by the department and outlined in the contract with the HMO.

"Urgent care" shall mean those medical services necessary for conditions that are not life threatening but which require treatment which cannot wait for a regularly scheduled clinical appointment because of the prospect of the conditions worsening without timely medical intervention rendered for an urgent medical condition or protection of the public health.

Further amend rule 441--88.1(249A) by adding the following new definitions in alphabetical order:

"Emergent medical condition" shall mean a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect it to result in:

1. Placing the health of the person (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy,

2. Serious impairment to bodily functions, or

3. Serious dysfunction of any bodily organ or part.

The determination of whether an emergent medical condition exists shall be decided by a medical professional and shall be based on the patient's medical condition, including presenting symptoms and medical history (as related to severe pain) prior to treatment.

In cases where the above criteria are satisfied, no prior authorization procedures are allowed.

"Extended-participation program" shall mean a mandatory six-month enrollment period with a managed care entity.

"Managed care entity" shall mean either a managed care organization licensed by the department of insurance (e.g., HMO or PHP) or a primary care case management program (i.e., MediPASS).

"Mandatory enrollment" shall mean a mandatory participation in managed health care as specified in subrule 88.3(3).

"Mandatory project county" shall mean a county where the department has contracts with more than one managed care entity, one of which may be primary care case management (MediPASS) in cases where the number of MediPASS providers willing to serve as patient managers is sufficient to meet the needs and makeup of the recipient population in the county.

"Urgent medical condition" shall mean a medical condition manifesting itself by acute symptoms that are of lesser severity (including severe pain) than that recognized for an emergent medical condition, such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the illness or injury to result in:

1. Placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in jeopardy,

2. Impairment to bodily functions, or

3. Dysfunction of any bodily organ or part.

ITEM 2. Amend rule 441--88.3(249A) as follows:

Rescind subrule 88.3(3) and insert the following new subrule in lieu thereof:

88.3(3) Mandatory enrollment. Participation in managed health care, if available, is required as specified in this subrule for covered eligibles who reside in a mandatory project county. The department shall require, whenever administratively feasible, that all eligible recipients enroll with a managed care entity. Administrative feasibility is determined by whether a freedom-of-choice waiver or state plan amendment has been approved by the Health Care Financing Administration and whether the managed care entities demonstrate sufficient access to and quality of services.

Rescind subrule 88.3(6) and insert the following new subrule in lieu thereof:

88.3(6) Limitations on enrollment. Contracting managed care entities may specify in a contract a limit to the number of recipients who can be assigned under subrule 88.3(7). If a limit is specified, the contracting entity must still provide services to all enrolled recipients who voluntarily select enrollment in that option. If a specified limitation is reached, the remaining assignment needs in that county shall be met by the other managed care entities who are contracting with the department in that county.

Rescind subrule 88.3(7) and insert the following new subrule in lieu thereof:

88.3(7) Enrollment procedures. In mandatory enrollment counties, recipients shall be required to choose their managed care entity. When no choice is made by the recipient, the recipient shall be assigned to a contracting health maintenance organization (HMO) serving the recipient's county of residence, when an HMO is available. In the event there is no contracting HMO serving the recipient's county of residence in a mandatory enrollment county, the recipient shall be assigned to a MediPASS patient manager.

Within the MediPASS option, recipients shall be assigned according to age appropriateness. Whenever possible, family units shall be assigned to the same provider that an enrolled family member has selected, if that provider is appropriate according to age parameters. If not, the household shall be assigned to another physician. MediPASS patient managers shall not be assigned more recipients than their self-imposed maximum or the maximum described in subrule 88.46(5), whichever is lower.

Recipients who are assigned a managed care entity as described in this subrule shall have at least ten days in which to request enrollment in a different available entity. The change is subject to provisions in subrule 88.4(2) dealing with the effective date.

a. Timely notice. Recipients shall be sent timely notice of the managed care entity assignment. The recipient shall have a minimum of ten days in which a change to the assigned managed care entity can be made. The notice shall include the name of the managed care entity to whom the recipient shall be assigned if the recipient does not make a different selection by the date specified in the notice. If the covered eligible does not make a selection before the due date, the recipient shall be enrolled with the managed care entity listed on the notice.

b. Enrollment. Enrollment in managed health care shall be discussed during the face-to-face interview with all applicants for Medicaid under covered categories of assistance in mandatory or voluntary enrollment areas. The applicant shall be shown an informational videotape and encouraged to make a selection of a managed care entity. Applicants in mandatory enrollment areas shall be informed that should the applicant become eligible for a managed health care selection, one shall be assigned. Covered eligibles who are not enrolled shall be sent a notice of their managed health care assignment when the recipient:

(1) Attains initial eligibility for a covered category of service in a mandatory project county.

(2) Changes from an excluded category of assistance to a covered category of assistance in a mandatory project county.

(3) Is receiving a covered category of assistance and moves from a county where no managed health care is available or a voluntary project county to a mandatory project county.

(4) Reattains eligibility.

(5) Has a new member of the household receiving a covered category of assistance.

c. Selection of a managed health care provider. A list of health care providers participating in managed care entities serving the county shall be available to recipients for use in selecting a provider. If the recipient wishes to request an exception to the list of available managed health care providers, the managed health care review committee shall make a determination on the exception request. While the determination is being made, the recipient's enrollment shall be placed in a pending status.

d. Request to change enrollment. An enrolled recipient may, within 90 days from timely notice, request to change enrollment from one managed health care provider to another or one managed care entity to another. The request may be made on a choice form designated by the department, in writing, or by telephone call to the toll-free recipient managed health care telephone line maintained by the department. Changes are subject to the provisions of subrule 88.4(2) dealing with effective date.

e. Managed care entity extended-participation program (EPP). After the initial 90 days from timely notice, recipients will remain enrolled with the chosen entity for the following six months, with three exceptions:

(1) A request for disenrollment by recipient for good cause pursuant to paragraph 88.4(3)"a."

(2) A request for disenrollment by provider for good cause pursuant to paragraph 88.4(3)"b."

(3) Availability of a new, previously unavailable, managed care entity. In this instance recipients will be allowed to select that entity for the remainder of the current EPP period.

f. Enrollment cycle. Prior to the end of any EPP period, recipients shall be notified of their ability to enroll with a different managed care option. A change in enrollment or failure to change enrollment will begin a new EPP enrollment period at the end of the current EPP.

ITEM 3. Amend rule 441--88.4(249A) as follows:

Rescind and reserve subrule 88.4(1).

Amend subrule 88.4(3), paragraph "a," as follows:

a. Request for disenrollment by the recipient. The enrolled recipient may request disenrollment by completing a choice form designated by the managed health care contractor, in writing or by telephone call to the toll-free recipient managed health care telephone line maintained by the department at any time prior to enrollment with a managed health care entity and within the 90 days from timely notice date. With prior approval of the review committee After this time period, a recipient may be disenrolled for good cause when the recipient can demonstrate that services were untimely, inaccessible, of insufficient quality, or inadequately provided, or that the recipient was enrolled automatically because no choice regarding the HMO was made as described in subrule 88.3(2). In a mandatory county, a disenrollment request must be accompanied by a choice for another managed health care provider.

ITEM 4. Amend rule 441--88.6(249A), catchwords, as follows:

441--88.6(249A) Emergency and urgent care services.

Add the following new subrule 88.6(4).

88.6(4) Provision of urgent care. If the recipient is assigned to a patient manager by the HMO, the patient manager shall arrange for urgent care within 24 hours by either providing it or referring to and authorizing another appropriate provider to provide care.

ITEM 5. Rescind subrule 88.10(1) and insert the following new subrule in lieu thereof:

88.10(1) General requirements. An HMO may not distribute directly or through any agent or independent contractor any marketing materials, without the prior approval of the department, and may not distribute marketing materials that contain false or materially misleading information.

a. Service market. An HMO shall distribute any marketing materials to its entire service area or region.

b. Prohibition of tie-ins. An HMO, or any agency of the entity, may not seek to influence an individual's enrollment with the HMO in conjunction with the sale of any other insurance.

c. Prohibiting marketing fraud. Each HMO shall comply with the procedures and conditions the department prescribes in the contract in order to ensure that, before an individual is enrolled with the HMO, the individual is provided accurate oral and written information sufficient to make an informed decision whether or not to enroll.

d. Prohibition of "cold-call" marketing. HMOs shall not, directly or indirectly, conduct door-to-door, telephonic, or other "cold-call" marketing of enrollment.

ITEM 6. Amend subrules 88.12(1) and 88.12(2) as follows:

88.12(1) Capitation rate. In consideration for all services rendered by an HMO under a contract with the department, the HMO will receive a payment each month for each enrolled recipient. This capitation rate represents the total obligation of the department with respect to the costs of medical care and services provided to enrolled recipients under the contract.

A portion of any increase in capitation payments may be reserved for an incentive payment to be paid based on the percentage of counties in a region included in an HMO's enrollment area. Incentive payments shall be made retroactively to the beginning of a state fiscal year if an HMO increases the percentage of counties in a region included in its enrollment area.

88.12(2) Determination of rate. The capitation rate is actuarially determined for the beginning of each new fiscal year using statistics and data about Medicaid fee-for-service expenses for HMO-covered services to a similar population during the preceding a base fiscal year. (For example, fiscal year 1994 rates are predicted with fiscal year 1992 dates of service for Medicaid fee-for-service expenditures.) The capitation rate, including the expansion incentive enhanced capitation payment based on the counties in a region included in the HMO's enrollment area, shall not exceed the cost to the department of providing the same services on a fee-for-service basis to an actuarially equivalent nonenrolled population group. HMOs electing to share risk with the department shall have their payment rates reduced by an amount reflecting the department's experience for high cost fee-for-service recipients.

ITEM 7. Amend rule 441--88.41(249A), definitions of "Emergency care" and "Urgent care," as follows:

"Emergency care" shall mean care of a medical condition, as defined in 441--subrule 78.3(12), that is provided under unforeseen circumstances and presents a substantial risk to the patient's health unless immediate medical treatment is given those medical services rendered for an emergent medical condition or protection of the public health.

"Urgent care" shall mean care of a medical condition that is not severe enough to be considered an emergency, but cannot wait until a normally scheduled doctor appointment those medical services rendered for an urgent medical condition or protection of the public health.

Further amend rule 441--88.41(249A) by adding the following new definitions in alphabetical order:

"Emergent medical condition" shall mean a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect it to result in:

1. Placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy,

2. Serious impairment to bodily functions, or

3. Serious dysfunction of any bodily organ or part.

The determination of whether an emergent medical condition exists shall be decided by a medical professional and shall be based on the patient's medical condition including presenting symptoms and medical history (as related to severe pain) prior to treatment.

In cases where the above criteria are satisfied, no prior authorization procedures are allowed.

"Extended-participation program" shall mean mandatory six-month enrollment period with a managed care entity.

"Managed care entity" shall mean either a managed care organization licensed by the department of insurance (e.g., HMO or PHP) or a primary care case management program (i.e., MediPASS).

"Mandatory enrollment" shall mean a mandatory participation in managed health care as specified in subrule 88.46(1).

"Mandatory project county" shall mean a county where the department has contracts with more than one managed care entity, one of which may be primary care case management (MediPASS) in cases where the number of MediPASS providers willing to serve as patient managers is sufficient to meet the needs and makeup of the recipient population in the county.

"Medical service area" means a geographic area within which recipients must reside in order to enroll in the managed health care MediPASS option.

"Urgent medical condition" shall mean a medical condition manifesting itself by acute symptoms that are of lesser severity (including severe pain) than that recognized for an emergent medical condition, such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the illness or injury to result in:

1. Placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in jeopardy,

2. Impairment to bodily functions, or

3. Dysfunction of any bodily organ or part.

If the recipient is assigned to a patient manager (e.g.,MediPASS or HMO), the patient manager shall arrange for necessary care within 24 hours by either providing it or referring and authorizing another appropriate provider to provide care.

ITEM 8. Amend subrule 88.42(1) as follows:

88.42(1) Included categories of assistance. All categories of Medicaid-eligible recipients except those specified as excluded in subrule 88.42(2) are required to participate in Medicaid patient management managed health care if they reside in a mandatory project county as described in subrule 88.43(1). Recipients who reside in a voluntary project county as described in subrule 88.43(2) may participate if they so choose.

A choice to enroll in any other form of Medicaid managed health care available in the recipient's county of residence shall fulfill the requirements to participate in mandatory project counties.

ITEM 9. Amend rule 441--88.46(249A) as follows:

Amend subrule 88.46(1) as follows:

88.46(1) Mandatory enrollment. Participation in patient management or another form of managed health care, if available, is required for covered eligibles as specified in subrule 88.42(1) who reside in a mandatory project county. The department shall require, whenever administratively feasible, that all eligible recipients enroll with a managed care entity. Administrative feasibility is determined by whether a freedom-of-choice waiver or state plan amendment has been approved by the Health Care Financing Administration and whether the managed care entities demonstrate sufficient access to and quality of services. Recipients shall designate their choice of managed health care provider on a choice form designated by the managed health care contractor, in writing or by telephone call to the toll-free recipient managed health care telephone line. The department or its designee shall assign a patient manager or other managed health care provider for those recipients who fail to make their own selection.

Amend subrule 88.46(2) as follows:

88.46(2) Enrollment procedures. In mandatory enrollment counties, recipients shall be required to choose their managed health care provider. When no choice is made by the recipient, the recipient will be assigned to a contracting health maintenance organization (HMO) serving the recipient's county of residence, when an HMO is available. In the event there is no contracting HMO serving the recipient's county of residence in a mandatory enrollment county, the recipient shall be assigned to a Medicaid MediPASS patient management provider manager.

Within the patient management MediPASS option, recipients shall be assigned according to age appropriateness. Whenever possible, family units shall be assigned to the same provider that an already enrolled family member has selected, if that provider is appropriate according to age parameters. If not, the system shall assign the household to another physician. Patient MediPASS patient managers shall not be assigned more recipients than their self-imposed maximum or the maximum described in subrule 88.46(5), whichever is lower.

Recipients who are assigned a managed health care provider entity as described in this rule subrule shall have at least ten days in which to request enrollment in a different available managed health care plan entity. The change of plan is subject to provisions in subrules subrule 88.46(4) and 88.47(2) dealing with the effective date.

a. Timely notice. Recipients shall be sent timely notice of the managed health care assignment. The recipient shall have a minimum of ten days in which a change to the assigned managed health care provider entity can be made. The notice shall include the name of the managed health care provider entity to whom the recipient shall be assigned if the recipient does not make a different selection by the date specified in the notice. If the covered eligible does not make a selection before the due date, the recipient shall be enrolled with the managed health care provider entity listed on the notice.

b. Enrollment. Enrollment in managed health care shall be discussed during the face-to-face interview with all applicants for Medicaid under covered categories of assistance in mandatory or voluntary enrollment areas. The applicant shall be shown an informational videotape and encouraged to make a selection of a managed health care provider entity. Applicants in mandatory enrollment areas shall be informed that should the applicant become eligible for a managed health care selection, one shall be assigned. Covered eligibles who are not enrolled shall be sent a notice of their managed health care assignment when the recipient:

(1) Attains initial eligibility for a covered category of service in a mandatory project county.

(2) Changes from an excluded category of assistance to a covered category of assistance in a mandatory project county.

(3) Is receiving a covered category of assistance and moves from a nonproject county where no managed health care is available or voluntary project county to a mandatory project county.

(4) Reattains eligibility except as described in subrule 88.46(6) for a covered category of assistance.

(5) Has a new member of the household receiving a covered category of assistance.

If the covered eligible in a mandatory project county does not make another selection before the due date specified in the notice, the covered eligible shall be enrolled with the managed health care provider listed on the notice.

c. Selection of a patient manager managed health care provider. A list of patient managers managed health care providers participating in managed care entities serving the medical service area county shall be available to recipients in order to assist covered eligibles for use in selecting a patient manager provider. If the recipient wishes to request an exception to the list of available patient managers managed health care providers as described in subrule 88.44(3), the managed health care review committee shall make a determination on the exception request. While the determination is being made, the recipient's enrollment shall be placed in a pending status.

d. Rescinded IAB 5/7/97, effective 7/1/97.

e. Request to change enrollment. An enrolled recipient may, at any time within 90 days from timely notice, request to change enrollment from one managed health care provider to another or one managed health care option entity to another. The request shall be made on a choice form designated by the managed health care contractor department, in writing, or by telephone call to the toll-free recipient managed health care telephone line maintained by the department. Changes are subject to the provisions of subrules 88.46(3) and 88.47(2) dealing with effective date.

f. Managed care entity extended-participation program (EPP). After the initial 90 days from timely notice, recipients will remain enrolled with the chosen provider for the following six months, with three exceptions:

(1) A request for disenrollment by recipient for good cause pursuant to paragraph 88.4(3)"a."

(2) A request for disenrollment by provider for good cause pursuant to paragraph 88.4(3)"b."

(3) Availability of a new, previously unavailable, managed care entity. In this instance recipients will be allowed to select that entity for the remainder of the current EPP period.

g. Enrollment cycle. Prior to the end of any extended-participation program (EPP) period, recipients will be notified of their ability to enroll with a different managed care option. A change in enrollment or failure to change enrollment will begin a new EPP enrollment period at the end of the current EPP.

Amend subrule 88.46(3), introductory paragraph, as follows:

88.46(3) Voluntary enrollment procedures. The request to enroll in a voluntary county shall be contingent on the requested patient manager being available. Voluntary enrollment procedures shall be the same guidelines as mandatory enrollment procedures except:

Further amend subrule 88.46(3) by adding the following new paragraph "d":

d. A managed health care provider must be available for enrollment.

ITEM 10. Amend subrule 88.47(1), paragraph "a," as follows:

a. The enrolled recipient may request disenrollment by completing a choice form designated by the managed health care contractor department, in writing, or by telephone call to the toll-free recipient managed health care telephone line maintained by the department at any time prior to enrollment with a managed health care entity and within the 90 days from the date of the enrollment notice. After this time period, a recipient may be disenrolled for good cause when the recipient can demonstrate that services were untimely, inaccessible, of insufficient quality, or inadequately provided. If the recipient is a covered eligible specified in subrule 88.42(1) as a mandatory participant, the recipient's disen-rollment request shall not be approved until another patient manager or managed health care option is chosen.

ITEM 11. Amend rule 441--88.48(249A) as follows:

Amend subrule 88.48(1), introductory paragraph and paragraph "e," as follows:

88.48(1) Managed services. Provision of the following services by any provider other than the patient manager requires authorization from the patient manager in order to be payable by Medicaid except that mental health and substance abuse services for all managed health care recipients are provided under the MHAP and MSACP programs and do not require authorization; see rules 441--88.61(249A) and 88.81(249A):

e. Clinic (rural health clinic, federally qualified health center, maternal health center, ambulatory surgical center, genetic consultation center, birthing center).

Further amend subrule 88.48(1), last unnumbered paragraph, as follows:

These services require preauthorization authorization even if the need for the service is considered urgent as defined in rule 441--88.41(249A). However, in case of urgent medical conditions, the patient manager shall arrange for necessary care within 24 hours by either providing it or referring to and authorizing another appropriate provider to provide care.

Amend subrule 88.48(3), first unnumbered paragraph, as follows:

Emergency services are excluded from the preauthorization authorization requirement, even though these services may be ones customarily requiring prior authorization under patient management. Urgent care requires preauthorization unless the patient manager cannot be reached authorization in order for Medicaid services to be paid. In either urgent care situations where preauthorization was not possible or emergency care situations, the provider must obtain authorization after the fact from the patient manager in order to bill for the Medicaid service. The unauthorized use of a patient manager's authorization number shall be considered to be false or fraudulent claim submission and may subject the provider to recoupment or to sanctions described at 441--subrule 79.2(3).

ITEM 12. Amend rule 441--88.49(249A), introductory paragraph, as follows:

441--88.49(249A) Grievance procedure. The department shall establish a procedure whereby enrolled recipients or providers may express complaints or concerns either verbally or in writing specific to patient management managed health care services.

ITEM 13. Amend subrule 88.51(3) as follows:

88.51(3) Standards and procedures for utilization review and quality assessment Managed health care advisory committee. Participating patient managers managed health care providers will be invited to assist the department or its agent in establishing standards and procedures for utilization review and quality assessment and assessing goals of the state's Medicaid managed health care program. The department shall form an education and review committee a managed health care advisory committee made up of persons deemed appropriate by the department to review, advise and plan managed care goals with the department. Members may include representatives of MediPASS providers, HMO providers, FQHC providers, RHC providers, association representatives, and other public agencies as deemed appropriate by the department. The committee's functions may include, but are not limited to, the following:

a. Establish Assist the department in developing procedures and parameters for utilization review and conduct further review of the utilization of patient managers whose pattern of utilization falls outside established parameters.

b. Establish procedures for and conduct reviews of patient management records to evaluate quality of management services and access to service. Assist the department in establishing options for managed health care quality assessment.

c. Review and make Assist the department in reviewing and making recommendations for action on quality ofservice-related grievances under the grievance procedure outlined in rule 441--88.49(249A).

d. Establish procedures for Assist the department in developing corrective action steps and possible recommendations for sanctions of patient managers managed health care providers who have identifiable utilization or quality of management service deficiencies. The corrective action or sanctions may include suspension of management fees for a probationary period, termination of the patient management contract, peer education, or further review of utilization behavior or quality of service. The patient manager in question shall have the right to appear before the committee to address utilization or quality of management service concerns the committee is addressing.

e. Establish Assist the department in developing standards and procedures for patient managers managed health care providers to use in performing preadmission and preprocedure review functions.

f. Prepare or provide educational or informative articles about the committee's activities for publication in professional journals to be used for patient education and health promotion.

ITEM 14. Amend 441--Chapter 88, Division III, by adding the following new rule:

441--88.52(249A) Marketing. A MediPASS provider may not distribute directly or through any agent or independent contractor marketing materials without the prior approval of the department, and may not distribute marketing materials that contain false or materially misleading information.

88.52(1) Service market. A MediPASS provider shall distribute any marketing materials to the entire service area or region.

88.52(2) Prohibition of "cold-call" marketing. MediPASS providers shall not, directly or indirectly, conduct door-to-door, telephonic, or other "cold-call" marketing of enrollment.

ARC 7808A

Pursuant to the authority of Iowa Code section 234.6 and Iowa Code Supplement subsection 232.71A(1), the Department of Human Services proposes to amend Chapter 175, "Abuse of Children," appearing in the Iowa Administrative Code.

These amendments obsolete the Child Abuse Investigations Program and expand from seven to eight the tasksassociated with completion of the assessment. The child protection worker is required to determine service recommendations and referrals as part of the assessment process. In addition, language is revised to provide consistent terminology, and Iowa Code references are updated.

The Child Abuse Assessment Pilot Program was initiated on December 1, 1995. The General Assembly in 1996 debated the issue of whether to continue the Child Abuse Assessment Pilot Program or the Child Abuse Investigations Program. Although originally the plan was to have statewide implementation of the Child Abuse Assessment Program by July 1, 1996, the Pilot Program was continued until February 1997. In 1997, the General Assembly again debated the issue of implementing the Child Abuse Assessment Program statewide and eliminating the Child Abuse Investigations Program. The General Assembly determined that the Department of Human Services should incrementally expand the Child Abuse Assessment Program statewide and that full implementation should be completed by July 1, 1998.

These amendments rescind Division I of 441--Chapter 175, which was the Child Abuse Investigations Program. Rules governing access to child abuse information and persons conducting research which were originally in Division I are transferred to Division II.

Consideration will be given to all written data, views, and arguments thereto received by the Bureau of Policy Analysis, Department of Human Services, Hoover State Office Building, Des Moines, Iowa 50319-0114, on or before March 4, 1998.

Oral presentations may be made by persons appearing at the following meetings. Written comments will also be accepted at these times.

Cedar Rapids - March 6, 1998 10 a.m.

Cedar Rapids Regional Office

Iowa Building - Suite 600

Sixth Floor Conference Room

411 Third St. S.E.

Cedar Rapids, Iowa 52401

Council Bluffs - March 4, 1998 10 a.m.

Lower Level

Council Bluffs Regional Office

417 E. Kanesville Boulevard

Council Bluffs, Iowa 51501

Davenport - March 5, 1998 10 a.m.

Davenport Area Office

Bicentennial Building - Fifth Floor

Conference Room 3

428 Western

Davenport, Iowa 52801

Des Moines - March 4, 1998 9 a.m.

Des Moines Regional Office

City View Plaza

Conference Room 100

1200 University

Des Moines, Iowa 50314

Mason City - March 5, 1998 11 a.m.

Mason City Area Office

Mohawk Square, Liberty Room

22 North Georgia Avenue

Mason City, Iowa 50401

Ottumwa - March 4, 1998 11 a.m.

Ottumwa Area Office

Conference Room 2

120 East Main

Ottumwa, Iowa 52501

Sioux City - March 4, 1998 1 p.m.

Sioux City Regional Office

Fifth Floor

520 Nebraska St.

Sioux City, Iowa 51101

Waterloo - March 4, 1998 10:30 a.m.

Waterloo Regional Office

Pinecrest Office Building

Conference Room 220

1407 Independence Avenue

Waterloo, Iowa 50703

Any persons who intend to attend a public hearing and have special requirements such as hearing or vision impairments should contact the Bureau of Policy Analysis at (515)281-8440 and advise of special needs.

These amendments are intended to implement Iowa Code sections 232.67 and 232.72 to 232.77, Iowa Code Supplement sections 232.68 to 232.71 and Iowa Code Supplement chapter 235A.

The following amendments are proposed.

ITEM 1. Rescind and reserve 441--Chapter 175, Division I.

ITEM 2. Amend 441--Chapter 175, Division II, Preamble, as follows:

ITEM 3. Amend rule 441--175.21(232,235A) as follows:

Amend the definitions of "Assessment," "Assessment intake," "Harm," and "Subject of a report," as follows:

"Assessment" means the process by which the department carries out its legal mandate in the pilot areas of the state to ascertain if child abuse has occurred, to record findings, to develop conclusions based upon evidence, to address the safety of the child and family functioning, engage the family in services if needed, enhance family strengths and address needs in a culturally sensitive manner.

"Assessment intake" means the process by which the department receives and records reports of child abuse.

"Harm" means an emotional or nonphysical injury which has a deleterious damaging effect upon a child.

"Subject of a report of child abuse" means any of the following:

1. A child named in a report as having been abused, or the child's attorney or guardian ad litem.

2. A parent or the attorney for the parent of a child named in a report child abuse assessment summary as having been abused.

3. A guardian or legal custodian, or that person's attorney, of a child named in a report child abuse assessment summary as having been abused.

4. A person or the attorney for the person named in a report child abuse assessment summary as having abused a child.

Delete the definitions of "Assessment report" and "Pilot project sites."

Add the following new definitions in alphabetical order:

"Allegation" means a statement setting forth a condition or circumstance yet to be proven.

"Caretaker" means a person responsible for the care of a child as defined in Iowa Code section 232.68.

"Case" means a report of child abuse that has been accepted for assessment services.

"Rejected intake" means a report of child abuse that has not been accepted for assessment.

"Report of child abuse" means a verbal or written statement made to the department by a person who suspects that child abuse has occurred.

"Unduly" shall mean improper or unjust, or excessive.

ITEM 4. Amend rule 441--175.22(232) as follows:

441--175.22(232) Receipt of a report of child abuse. Reports of suspected child abuse shall be received by pilot assessment county departments department offices, or by the central abuse registry, or the Child Abuse Hotline. Any report made to the department which alleges child abuse as defined in Iowa Code section 232.68 shall be accepted for assessment. Intake information Reports of child abuse which does do not meet the legal definition of child abuse shall become rejected intakes. Rejected intakes may be referred for services. If a report does not meet the legal definition of child abuse, but a criminal act harming a child is alleged, the department shall immediately refer the matter to the appropriate law enforcement agency. If a report would be determined to constitute constitutes an allegation of child sexual abuse as defined under Iowa Code section 232.68, except that the suspected abuse resulted from the acts or omissions of a person who was not a caretaker, the department shall refer the report to law enforcement orally and, as soon as practicable, and follow up in writing within 72 hours of receiving the report.

ITEM 5. Amend rule 441--175.23(232), catchwords and subrules 175.23(1) and 175.23(2), as follows:

441--175.23(232) Sources of report of child abuse.

175.23(1) Mandatory reporters. Any person meeting the criteria of a mandatory reporter is required to make an oral report of the suspected child abuse to the department within 24 hours of becoming aware of the abusive incident and make a written report to the department within 48 hours following the oral report. If the person making the report has reason to believe that immediate protection for the child is advisable, that person shall also make an oral report to an appropriate law enforcement agency.

175.23(2) Others required to report. In addition to mandatory reporters which are so designated by the Iowa Code, there are other classifications of persons who are required, either by administrative rule or department policy, to report suspected child abuse when this is a duty identified through the person's employment. Others required to report include:

a. Income maintenance workers.

b. Certified adoption investigators.

ITEM 6. Amend rule 441--175.24(232) as follows:

441--175.24(232) Child abuse assessment intake process. The primary purpose of intake is to obtain available and pertinent information regarding an allegation of child abuse and determine whether a report of child abuse becomes a case or a rejected intake. In order for an intake call to To result in an assessment a case, the report of child abuse must include some information to indicate all of the following: The alleged:

1. Victim of child abuse is a child.

2. Perpetrator of child abuse is a caretaker.

3. Incident falls within the definition of child abuse.

Only mandatory reporters or the person making the report may be contacted during the intake process to expand upon or to clarify information in the report. Any contact with subjects of the report or with nonmandatory reporters, other than the original reporter, automatically causes the case report of child abuse to be opened accepted for child abuse assessment services. If it is believed When it is determined that the report of child abuse fails to constitute an allegation of child abuse, the report of child abuse shall be rejected for child abuse assessment become a rejected intake. Rejected intake information shall be maintained by the department for six months and then destroyed. The county attorney shall be notified of intakes reports of child abuse accepted for assessment. When a report of child abuse is received which does not meet the requirements to become a case, but has information about illegal activity, the department shall notify law enforcement of the report.

ITEM 7. Amend rule 441--175.25(232) as follows:

441--175.25(232) Child abuse assessment process. An assessment shall be initiated within 24 hours following receipt of a the report of child abuse becoming a case. The primary purpose in conducting an assessment is to protect the safety of the child named in the report. The secondary purpose of the assessment is to engage the child's family in services to enhance family strengths and to address needs, where this is necessary and desired. There are seven eight tasks associated with completion of the assessment. These are:

1. Ensuring Observing and evaluating the child's safety. In instances when there is an immediate threat to the child child's safety, reasonable efforts shall be made to observe the alleged child victim named in the report within one hour of receipt of the report. Professional judgment shall dictate assurance of safety for the child. Otherwise, reasonable efforts shall be made to observe the alleged child victim within 24 hours of the report of child abuse becoming a case. When the alleged perpetrator clearly does not have access to the alleged child victim, reasonable efforts shall be made to observe the alleged child victim within 96 hours of receipt of the report. When reasonable efforts have been made to observe the alleged child victim within the specified time frames and the worker has established that there is no risk to the alleged child victim, the observation of the alleged child victim may be waived with supervisory approval.

2. Observing or interviewing Interviewing the alleged child victim.

3. Interviewing subjects of the report and other sources. Attempts shall be made to conduct interviews with subjects of the report and persons who have relevant information to share regarding the allegations. This may include contact with physicians to assess the child's condition. The child's custodial parents or guardians and the alleged perpetrator (if different) shall be interviewed, or offered the opportunity to be interviewed. The court may waive the requirement of the interview for good cause.

4. Gathering of physical and documentary evidence. Evidence shall be gathered from, but not be limited to, interviews, observations, photographs, medical and psychological reports and records, reports from child protection centers, written reports, audiotapes and their transcripts or summaries, videotapes and their transcripts or summaries, or other electronic forms.

5. Assessing Evaluating the home environment and relationships of household members. The assessment evaluation may, with the consent of the parent or guardian, include a visit to the home where the child resides. If permission is refused, the juvenile court may authorize the worker to enter the home to interview or observe or interview the child. An assessment evaluation of the home environment shall be conducted during the course of the child abuse assessment. If protective concerns are identified, the child protection worker shall evaluate the child named in the report and any other children in the same home as the parents or other persons responsible for their care. Each assessment case shall include a full description of information gathered during the assessment process. This description shall provide information which evaluates the safety of the child named in the report. If the child protection worker has concerns about a child's safety or a family's functioning, the worker shall conduct a more intensive assessment until those concerns are addressed. When an assessment is conducted at an out-of-home setting, assessment an evaluation of the environment and relationships where the abuse allegedly occurred shall be conducted.

6. Evaluating the information. Evaluation of information shall include an assessment analysis, which considers the credibility of the physical evidence, observations, and interviews and shall result in a finding regarding conclusion of whether or not to confirm the allegation report of child abuse.

7. Determining placement on child central abuse registry. A determination if of whether the report data and disposition data of a confirmed case of child abuse is subject to placement on the child central abuse registry pursuant to 1997 Iowa Acts, House File 698, section 5, subsection 3, Iowa Code Supplement subsection 232.71D(3) shall be made on each report assessment.

8. Treatment service recommendations and referrals. There are four possible service recommendations during or at the conclusion of a child abuse assessment. These are:

* No treatment service needs are identified; the worker recommends no treatment service.

* Treatment service needs are identified; the worker recommends new or continuing treatment services to the family to be provided through informal supports.

* Treatment service needs are identified; the worker recommends new or continuing treatment services to the family to be provided through community agencies.

* Treatment service needs are identified; the worker recommends new or continuing treatment services to the family to be provided by the department, either directly or through contracted agencies. Except in cases involving court-ordered services, the department shall not compel the family to accept treatment services, and the child protection worker shall advise the family that acceptance of treatment services is voluntary. If it is believed that treatment services are necessary for the protection of the abused child or other children in the home, juvenile court intervention shall be sought.

ITEM 8. Amend rule 441--175.26(232) as follows:

441--175.26(232) Completion of a written child protective assessment summary. When an assessment is completed, the The child protection worker shall complete a written child protective assessment summary within 20 business days from the receipt date of the report of child abuse becoming a case. In most instances, the child protective assessment summary shall be developed in conjunction with the child and family being assessed. All summaries A child protective assessment summary shall include the following consist of two parts as follows:

175.26(1) Information about the report Child Protective Assessment Summary - Part A, Form 470-3240. All summaries The Part A summary shall include report and dispositional data information about as follows:

a. Allegations: the report of child abuse which caused the assessment to be initiated and an assessment additional allegations raised after the report of child abuse becomes a case that have not been previously investigated or assessed.

b. Evaluation of the child's safety.: evaluation of the child's safety and the risk for occurrence or reoccurrence of abuse. Criteria to be used in the evaluation of the child's safety include, but are not limited to, the severity of the incident or condition, chronicity of the incident or condition, age of the child, attitude of the person responsible, current treatment services or supports, access of the person responsible for the abuse to the child, and protectiveness of the parent or caretaker who is not responsible for the abuse.

c. Findings and contacts: The Part A summary shall include a description of the child's condition including identification of the nature, extent, and cause of the injuries, if any, to the child named in the report,; identification of the injury or risk to which the child was exposed,; the circumstances which led to the injury or risk to the child,; the identity of the person alleged to be responsible for the injury or risk to the child, and ; the name, age and condition of other children in the same home as the child named in the report if protective concerns are identified; a list of collateral contacts; and a history of confirmed or founded abuse.

d. Determination regarding the allegations of child abuse: a statement of determination of whether the allegation of child abuse was founded, confirmed but not placed on the central abuse registry, or not confirmed. The statement shall include a rationale for placing or not placing the case on the central abuse registry.

e. Recommendation for treatment services: a statement describing whether treatment services are necessary to ensure the safety of the child or to prevent or remedy other identified problems. The statement shall include the type of treatment services recommended, if any, and whether these treatment services are to be provided by the department, community agencies, informal supports, or another treatment source. If treatment services are already being provided, the statement shall include a recommendation whether these treatment services should continue.

f. Juvenile court recommendation: a statement describing whether juvenile court action is necessary to ensure the safety of the child; the type of action needed, if any; and the rationale for the recommendation.

g. Criminal court recommendation: a statement describing whether criminal court action is necessary and the rationale for the recommendation.

175.26(2) An assessment of the family's strengths and needs Child Protective Assessment Summary - Part B, Form 470-3241. The Part B summary shall include assessment information as follows:

a. An evaluation of the child and family functioning: an evaluation which identifies the strengths and needs of the child, parents, home environment, family, family support system, and community support system.

b. A history of services: a history of informal and formal treatment or support services offered or provided to the family and a suggested plan of action to meet identified needs and to build on existing strengths. The history shall include treatment services available from the department, informal and formal services, and other supports available in the community. A comprehensive assessment of the family's strengths and needs shall occur for every case in which ongoing treatment services through the department are initiated identified and for all cases in which a family requests this service. A comprehensive assessment of the family's strengths and needs shall be strongly encouraged whenever the family and child are not receiving the required or desired treatment services or supports or when there are circumstances which place the child at risk for abuse. The Part B summary shall include an assessment of the child's safety and the family's functioning. For assessment cases in which the child, family and child protection worker identify unmet needs, the summary shall identify the strengths and needs of the child and of the child's parent, home, family and community. It shall include a suggested plan of action to meet identified needs and to build on existing strengths and identify services available from the department and informal and formal services and other supports available in the community to address the strengths and needs identified in the assessment. This portion of the written summary may be used as part of the child's case permanency plan for assessment cases in which ongoing treatment services will be provided by the department. Part B is assessment data and shall not be submitted to the child central abuse registry.

ITEM 9. Amend rule 441--175.27(232) as follows:

441--175.27(232) Contact with juvenile court or the county attorney. The child protection worker may orally contact juvenile court or the county attorney, or both, as circumstances warrant. When a child abuse report of child abuse is accepted for assessment, the county attorney shall be provided Form 470-0607, Child Protective Service Intake, with information about the allegation of child abuse and with identifying information about the subjects of the report. The child protection worker shall provide the juvenile court and the county attorney with a copy of the written assessment summary Form 470-3240, Child Protective Assessment Sum-mary - Part A, which pertains to the evaluation of the abuse reported findings, determinations, and recommendations regarding the report of child abuse. The assessment child protection worker shall provide the county attorney and the juvenile court with a copy of the written assessment summary Form 470-3241, Child Protective Assessment Summary - Part B, which pertains to the evaluation of the child and family's strengths and needs and the development of a suggested plan of action when any of the following occur:

175.27(1) County attorney's or juvenile court's assistance necessary. The worker requires the court's or the county attorney's assistance to complete the assessment process.

175.27(2) Court's protection needed. The worker believes that the child requires the court's protection.

175.27(3) Child adjudicated. The child is currently adjudicated or pending adjudication under a child in need of assistance petition or a delinquency petition.

175.27(4) County attorney or juvenile court requests copy. The county attorney or juvenile court requests a copy of Form 470-3241, Child Protective Assessment Summary - Part B. The child protection worker shall document when the Child Protective Assessment Summary - Part B is provided to the county attorney or juvenile court and the rationale provided for the request.

ITEM 10. Amend rule 441--175.31(232) as follows:

441--175.31(232) Completion of required correspondence.

175.31(1) Notification to parents that an a child abuse assessment is taking place being conducted. Written notice shall be provided to the parents of a child who is the subject of an assessment within five working days of commencing an assessment unless the assessment is completed within that time frame the five working days. Both custodial and noncustodial parents shall be notified, if their whereabouts are known. If it is believed that notification will result in danger to the child or others, an emergency order to prohibit parental notification shall be sought from juvenile court.

175.31(2) Notification of completion of assessment and right to request correction. Written notice shall be provided to all subjects of a child abuse assessment and to the mandatory reporter who made the report of child abuse which indicates that the child abuse assessment is completed. Both custodial and noncustodial parents shall be notified if their whereabouts are known. The notice shall contain information concerning the subject's rights to request correction and appeal rights. The subject may request correction of the information contained within the written child protective assessment summary if the subject disagrees with the information. The subject may appeal the content of the written child protective assessment summary only if the request for correction of the written child protective assessment summary is denied. If the child protective assessment summary results in a determination that abuse has occurred is confirmed, the notice shall indicate the type of abuse, name of the child and name of the person responsible for the abuse and whether the report has been placed on the registry.

ITEM 11. Amend rule 441--175.32(232) as follows:

441--175.32(232,235A) Case records. The assessment case record shall contain the written child protective assessment summary and any related correspondence or information which pertains to the report assessment or to the child and family. The name of the person who made the report of child abuse shall not be disclosed to the subjects of the report or their attorneys. The written child protective assessment summary shall have two sections parts.

The first section, Part A, Form 470-3270, which is report and disposition data,. Part A shall contain information which pertains to the child abuse allegation report of child abuse, and a description of the child's condition, identification of the injury or risk to which the child was exposed and the identity of any person alleged to be responsible for the injury or risk to the child. Subjects of the report and their attorneys have access to that information which is contained within the first section of the written summary Part A of the child protective assessment summary, including, where applicable, confirmation of placement on the child central abuse registry for abuse reports meeting the criteria pursuant to 1997 Iowa Acts, House File 698, section 5, subsection 3 Iowa Code Supplement subsection 232.71D(3). Part A of the report shall be sent to the juvenile court having jurisdiction over the child and to the county attorney. Part A shall only be submitted to the central abuse registry if the abuse is confirmed and determined to meet the criteria pursuant to 1997 Iowa Acts, House File 698, section 5, subsection 3 Iowa Code Supplement subsection 232.71D(3).

The second section of the written summary, Part B, Form 470-3271, which is assessment data,. Part B shall contain information which identifies the strengths and needs of the child, of the child's parent, home, family and community and, where appropriate, a suggested plan of action which is developed in conjunction with the family. The second section of the written summary Part B shall be available to those family members who participated in the assessment of child and family function, strengths, needs, and the development of a suggested plan of action to meet identified needs, if applicable. Release of any information contained within the second section of the written summary Part B shall be accomplished only when the parent or guardian approves the release as provided through Iowa Code chapter 217, except for founded reports which are governed under Iowa Code section 235A.15. Part B is assessment data and shall not be submitted to the central abuse registry.

175.32(1) Reports not placed on the central registry Assessments where abuse was confirmed but not placed on the central abuse registry. Access to the report data and disposition data of an assessment report not placed on the child central abuse registry is authorized only to the subjects of the assessment report, the child protective protection worker, law enforcement officer responsible for assisting in the assessment, the multidisciplinary team if assisting the department in the assessment of the abuse, county attorney, juvenile court, a person or agency responsible for the care of the child if the department or juvenile court determines that access is necessary, the department or contract personnel necessary for official duties, the department of justice, and the attorney for the department. Records are The child abuse assessment summary is retained five years from date of intake or five years from the date of closure of the service record, whichever occurs later. The report child abuse assessment summary is subject to confidentiality provisions of Iowa Code chapter 217 and 441--Chapter 9. No confidential information shall be released without consent except where there is otherwise authorized access to information as specified in the provisions of Iowa Code Supplement section 235A.15 as amended by 1997 Iowa Acts, House File 698, section 9, subsection 3.

175.32(2) Reports Assessments not placed on the central abuse registry where abuse was not confirmed. Access to the report data on a report child abuse assessment summary where abuse was not determined to have occurred and, therefore, the report assessment was not placed on the child central abuse registry is authorized only to the subjects of the assessment report, the child protective protection worker, county attorney, juvenile court and department or contract personnel necessary for official duties. Records are retained five years from date of intake or five years from the date of closure of the service record, whichever occurs later. The report child abuse assessment summary is subject to confidentiality provisions of Iowa Code chapter 217 and 441--Chapter 9. No confidential information shall be released without consent except where there is otherwise authorized access to information as specified in the provisions of Iowa Code Supplement section 235A.15 as amended by 1997 Iowa Acts, House File 698, section 9, subsection 4.

ITEM 12. Amend rule 441--175.33(232,235A) as follows:

441--175.33(232,235A) Child protection centers. The department may contract with designated child protection centers for assistance in conducting child abuse assessments. When a child who is the subject of an assessment is interviewed by staff at a child protection center, that interview may be used in conjunction with an interview conducted by the assessment child protection worker. Written reports developed by the child protection center shall be provided to the assessment child protection worker and may be included in the assessment case file record. Video or audio records are considered to be part of the assessment process and shall be maintained by the child protection center under the same confidentiality provisions of Iowa Code chapter 217 and 441--Chapter 9.

ITEM 13. Amend rule 441--175.35(232,235A), intro-ductory paragraph, as follows:

441--175.35(232,235A) Jurisdiction of assessments. Assessment personnel Child protection workers serving the county in which the child's home is located have primary responsibility for completing the child abuse assessment except when the abuse occurs in an out-of-home placement. Circumstances in which the department shall conduct an assessment when another state is involved include the following:

ITEM 14. Amend rule 441--175.36(235A), introductory paragraph and subrule 175.36(4), as follows:

441--175.36(235A) Multidisciplinary teams. Multidisciplinary teams shall be developed in county or multicounty areas in which more than 50 child abuse reports cases are received annually. These teams may be used as an advisory group to assist the department in conducting assessments. Multidisciplinary teams consist of professionals practicing in the disciplines of medicine, public health, mental health, social work, child development, education, law, juvenile probation, law enforcement, nursing, and substance abuse counseling. Members of multidisciplinary teams shall maintain confidentiality of cases in which they provide consultation. Rejected intakes shall not be shared with multidisciplinary teams since they are not considered to be child abuse information. During the course of an assessment, information regarding the initial child abuse report of child abuse and information related to the child and family functioning may be shared with the multidisciplinary team. After a conclusion is made, only report data and disposition data on confirmed cases of child abuse may be shared with the team members. When the multidisciplinary team is created, all team members shall execute an agreement, filed with the central abuse registry, which specifies:

175.36(4) Confidentiality provisions. Any written report or document produced by the team pertaining to an assessment case shall be made a part of the file for the case and shall be subject to all confidentiality provisions of 441--Chapter 9, unless the assessment results in placement on the child central abuse registry in which case the written report or document shall be subject to all confidentiality provisions of Iowa Code chapter 235A.

ITEM 15. Amend rule 441--175.37(232) as follows:

441--175.37(232) Community education. The department shall conduct a continuing publicity and educational program for the personnel of the department, mandatory reporters, and the general public to encourage recognition and reporting of child abuse, to improve the quality of reports of child abuse made to the department, and to inform the community about the assessment-based approach to child abuse reports cases.

ITEM 16. Amend rule 441--175.38(235) as follows:

441--175.38(235) Written authorizations. Requests for information from members of the general public as to whether a person is named on the child central abuse registry as having abused a child shall be submitted on Form 470-3301, Authorization for Release of Child Abuse Information, to the county office of the department or the central child abuse registry. The form shall be completed and signed by the person requesting the information and the person authorizing the check for the release of child abuse information.

ITEM 17. Amend rule 441--175.39(232) as follows:

441--175.39(232) Founded child abuse. Reports of child abuse where abuse has been confirmed shall be placed on the central abuse registry as founded child abuse for ten years under any of the circumstances specified by 1997 Iowa Acts, House File 698, section 5, subsection 3 Iowa Code Supplement subsection 232.71D(3). Reports of denial of critical care by failure to provide adequate clothing or failure to provide adequate supervision and physical abuse where abuse has been confirmed and determined to be minor, isolated, and unlikely to reoccur shall not be placed in the central abuse registry as a case of founded child abuse as specified by 1997 Iowa Acts, House File 698, section 5, subsections 2 and 3 Iowa Code Supplement subsections 232.71D(2) and (3).

ITEM 18. Amend rule 441--175.40(235A) as follows:

Amend rule 441--175.40(235A), introductory paragraph and subrule 175.40(1), as follows:

441--175.40(235A) Retroactive reviews. Review of child abuse information which is on the child central abuse registry as of July 1, 1997, shall be performed using the requirements for child abuse reports cases to be placed on the central abuse registry as founded child abuse pursuant to 1997 Iowa Acts, House File 698, section 5, subsections 2 and 3 Iowa Code Supplement subsections 232.71D(2) and (3). If the review indicates the information should not be placed on the child central abuse registry, the information shall be expunged from the registry. The information shall be retained as a service record for five years from the date of intake. The time the report has been placed on the central abuse registry shall count toward the five years' total.

175.40(1) Eligibility for retroactive reviews. Eligibility for retroactive reviews is limited to reports which do not meet the criteria for placement in the central abuse registry as a case of founded child abuse specified in 1997 Iowa Acts, House File 698, section 5, subsection 3 Iowa Code Supplement subsection 232.71D(3). The reports eligible for review are reports where the confirmed abuse involved one of the following circumstances:

a. Physical abuse where the injury was minor and isolated and is unlikely to reoccur.

b. Denial of critical care by failure to provide adequate clothing or failure to provide adequate supervision, where the risk to the child's health and welfare was minor and isolated and is unlikely to reoccur.

Rescind and reserve subrule 175.40(2).

Amend subrule 175.40(3) as follows:

175.40(3) Reviews initiated by department. Reviews shall be performed when the department is reviewing a report case for the purpose of one of the following:

a. A record check evaluation is being completed for licensing, registration or employment or residence in a child care facility. If the department worker completing the record check evaluation determines the report case does not meet the criteria specified in 1997 Iowa Acts, House File 698, section 5, subsection 3, Iowa Code Supplement subsection 232.71D(3) and, therefore, should be expunged from the central abuse registry, the department worker shall provide copies of the child abuse written report and Form 470-2310, Record Check Evaluation, to the Department of Human Services, Chief, Bureau of Program Support and Protective Services, Retroactive Review, Hoover State Office Building, Des Moines, Iowa 50319-0114. Within 30 days the bureau chief shall determine if the report is to be expunged from the central abuse registry and shall notify the regional administrator or designee in writing of that decision and the time frame for retention or expungement of the report. The bureau chief or designee shall notify the person on whom the review was completed of the decision to expunge the report case from the central abuse registry. If the department determines that the report case is to be expunged from the central abuse registry, no record check evaluation is necessary and the department shall notify the requester. If the department determines that the report case does meet the criteria for placement on the central abuse registry, the department shall proceed with the record check evaluation procedure.

b. A central abuse registry review is being completed in response to a request for correction or expungement. After the department has completed a central abuse registry review and has determined the report case is a confirmed case of child abuse, the department shall determine if the report case is eligible for a retroactive review. If eligible for retroactive review, the department shall perform a review to determine if the report case should be listed on the child central abuse registry. Notification of the decision shall be sent with the central abuse registry review decision.

ITEM 19. Amend 441--Chapter 175 by adding the following new rules:

441--175.41(235A) Access to child abuse information. Requests for child abuse information shall include sufficient information to demonstrate that the requesting party has authorized access to the information.

175.41(1) Written requests. Requests for child abuse information shall be submitted on Form SS-1606-0, Request for Child Abuse Information, to the county office of the department, except requests made for the purpose of determining employability of a person in a department-operated facility shall be submitted to the central abuse registry. Subjects of a report, or their attorney, may submit a request for child abuse information on Form SS-1606-0 or on Form 470-0686, Child Abuse Notification, to the county office of the department. The county office is granted permission to release child abuse information to the subject of a report or that person's attorney immediately upon verification of the identity and subject status.

175.41(2) Oral requests. Oral requests for child abuse information may be made when a person making the request believes that the information is needed immediately and if the person is authorized to access the information. When an oral request to obtain child abuse information is granted, the person approving the request shall document the approval to the central abuse registry through use of Form SS-1606-0, Request for Child Abuse Information, or Form 470-0686, Child Abuse Notification.

Upon approval of any request for child abuse information authorized by this rule, the department shall withhold the name of the person who made the report of child abuse unless ordered by a juvenile court or district court after a finding that the person's name is needed to resolve an issue in any phase of a case involving child abuse. Written requests and oral requests do not apply to child abuse information that is disseminated to an employee of the department, to a juvenile court, or to the attorney representing the department as authorized by Iowa Code section 235A.15.

175.41(3) Written authorizations. Requests for information from members of the general public as to whether a person is named on the central abuse registry as having abused a child shall be submitted on Form 470-3301, Authorization for Release of Child Abuse Information, to the county office of the department or the central abuse registry. The form shall be completed and signed by the person requesting the information and the person authorizing the check for the release of child abuse information.

The department shall not provide requested information when the authorization form is incomplete. Incomplete authorization forms shall be returned to the requester.

441--175.42(235A) Person conducting research. The supervisor of the central abuse registry shall be responsible for determining whether a person requesting child abuse information is conducting bona fide research, whether the research will further the official duties and functions of the central abuse registry, and whether identified information is essential to the research design. A bona fide research design is one which shows evidence of a good-faith, academically objective and sincere intent to add to the body of knowledge about child abuse. To make this determination, the central abuse registry shall require the person to submit credentials and the research design. Additional criteria for approval of a research project may include whether the research involves contact with subjects of child abuse information and whether contact with department personnel is required to complete the research design. If it is determined that the research will involve use of identified information, the central abuse registry shall also determine under what circumstances and in what format the information is to be used and shall execute an agreement with the researcher which will enable the researcher to obtain access to identified information on subjects of child abuse investigations, as an agent of the central abuse registry. The department will require the researcher to assume costs incurred by the department in obtaining or providing information for research purposes. The department shall keep a public record of persons conducting this research.

175.42(1) Child abuse factors. For purposes of conducting research pursuant to Iowa Code sections 235A.15 and 235A.23, official duties and functions of the central abuse registry shall include analysis or identification of child abuse factors in at least one of the following areas:

a. Causes of abuse--victim, parent and perpetrator characteristics, types of abuse, and correlations to family and environmental factors.

b. Effects of abuse--immediate and long-term effects of abuse on the individual child victim, the child's family and the perpetrator, in areas such as family functioning, foster placement, emotional and medical problems, and criminal activity; and effects of abuse on the community and society in general.

c. Prevention of abuse--intervention, prevention and treatment strategies.

d. Treatment of abuse--impact of service delivery upon recidivism and maintenance of the family unit.

e. Reporting of abuse--mandatory and permissive reporter characteristics, training needs, and perception of the department's protective services to children and families.

f. Identification of strengths and weaknesses in statute, policy or practice concerning child abuse services.

175.42(2) Guidelines. To be accepted by the central abuse registry, a research proposal originating outside the department shall meet the following guidelines:

a. The proposal shall meet the criteria listed above as "official duties and functions" of the central abuse registry.

b. The research shall be conducted by a competent researcher, evidenced by affiliation with a recognized human services agency, government body, or academic, social work or medical facility. The researcher shall demonstrate an ability to conduct nonbiased research and present findings in a professional and responsible manner which will benefit the department in providing protective services to children and families.

c. The proposed research shall not unduly interfere with the ongoing duties and responsibilities of department staff.

d. When the proposed research includes contact with subjects of child abuse information, the research design shall reflect a plan for initial subject contact by the department, which includes the following:

(1) Subjects shall be informed in writing of their right to refuse to participate in the research.

(2) Subjects shall receive written assurance that their participation in the research will not affect eligibility for services.

(3) Department staff shall be advised of research goals and procedures prior to contact with subjects, in order to answer questions which may arise.

(4) Subjects shall receive written assurance that when identifying information is released by the central abuse registry to research staff, the information will remain confidential and that all child abuse information will be deidentified prior to publication of the research findings.

175.42(3) Approval procedures. Procedures for approval of a research proposal are conducted as follows:

a. The supervisor of the central abuse registry shall designate a person to be the single point of contact (SPOC) for all research proposals requesting child abuse information or involving department staff who provide child protective services. All proposals shall be routed to the SPOC at the Division of Adult, Children and Family Services, Department of Human Services, Hoover State Office Building, Des Moines, Iowa 50319-0114.

b. Having received a research proposal, the SPOC shall log the date the proposal was received and other identifying information about the researcher and the research design and shall convene a research advisory committee to review the proposal. This committee may consist of:

(1) The unit supervisor of the child and dependent adult abuse registry, when applicable.

(2) The unit managers for the programs addressed by the research proposal.

(3) The research specialist.

(4) Representatives from the field, including a regional administrator or designee and one representative from a region, appointed by the regional administrator, if a specific region is involved.

(5) A representative from the department's division of management information, when the proposal involves use of one of the department's computerized data systems.

(6) A representative of the attorney general's office, when the proposal involves legal questions or issues.

(7) Other persons whom the SPOC may designate to assist in the review.

c. The SPOC is responsible for ensuring that advisory committee members receive copies of the research proposal.

d. The advisory committee may meet in person or by teleconference.

e. The researcher may, at the discretion of the SPOC, be provided an opportunity to address the advisory committee concerning the research proposal and answer questions about the research design.

f. The committee shall determine the value of the proposed research and formulate recommendations for acceptance of the proposal (with conditions as necessary) or rejection of the proposal (with rationale for the rejection). These recommendations shall be submitted to the SPOC.

g. The SPOC shall transmit the committee's recommendations, with additional comments and recommendations, as needed, to the division administrators for the divisions involved.

h. The division administrators shall review committee recommendations and submit the research proposal to the director or designee for final approval.

i. After review by the director, the proposal shall be returned to the SPOC, who shall notify the researcher of the director's decision, which decision shall be final.

j. If the research proposal is approved, the SPOC shall prepare a written research agreement with the researcher which provides:

(1) The purpose of the research.

(2) The research design or methodology.

(3) The control of research findings and publication rights of all parties, including the deidentification of child abuse information prior to publication.

(4) The duties of all parties in conducting the research.

(5) The transfer of funds, if applicable.

k. The SPOC shall be responsible for securing written approval of the research agreement from the attorney general's office, applicable division administrators, and the researcher.

l. The SPOC shall be responsible for maintaining the research agreement throughout the research project and renewing or modifying the agreement when necessary.

ITEM 20. Amend 441--Chapter 175, implementation sentence, as follows:

These rules are intended to implement Iowa Code sections 232.67 and 232.72 to 232.77, Iowa Code Supplement chapter 235A as amended by 1997 Iowa Acts, Senate File 230 and House File 698, and Iowa Code Supplement sections 232.67 232.68 to 232.77 232.71 as amended by 1997 Iowa Acts, Senate File 176, Senate File 230 and House File 698.

ARC 7798A

Pursuant to the authority of Iowa Code sections 505.8 and 514B.23, the Insurance Commissioner proposes to amend Chapter 35, "Accident and Health Insurance," and Chapter 40, "Health Maintenance Organizations," Iowa Administrative Code.

The amendments relate to state conformance with federal legislation, the Mental Health Parity Act of 1996, coverage of emergency services, and the definition of emergency medical condition. The federal law provides for parity in the application of limits to certain mental health benefits. All states are required to conform with the mental health parity law beginning January 1, 1998. There is a disparity in the coverage of emergency services by managed care entities that requires a uniform rule. Medicare has adopted a rule requiring the coverage of an emergency medical condition under certain circumstances. For uniformity purposes, the state intends to adopt the same definition and coverage requirement.

Any interested person may make written suggestions or comments on these proposed rules by March 3, 1998. Written comments should be directed to Susan E. Voss, Iowa Insurance Division, Lucas State Office Building, Des Moines, Iowa 50309, or fax (515)281-3059.

These amendments are intended to implement the Mental Health Parity Act of 1996, Pub. L. 104-204, 110 State. 2944, Iowa Code section 514B.9 and chapter 509.

The following amendments are proposed.

ITEM 1. Amend 191--Chapter 35 by adding the following new rule:

191--35.30(509) Mental health benefits.

35.30(1) A carrier or organized delivery system offering mental health benefits shall not set annual or lifetime limits on mental health benefits that are lower than limits for medical and surgical benefits. Health insurance coverage that does not impose an annual or lifetime limit on medical and surgical benefits shall not impose a limit on mental health benefits.

35.30(2) This rule does not apply to benefits for substance abuse or chemical dependency. This rule does not apply to health insurance coverage if costs increase 1 percent or more due to the application of these requirements. The calculation and notification requirements of the 1 percent exemption shall be performed pursuant to 45 CFR Part 146.136.

35.30(3) This rule applies to health insurance coverage for plan years beginning on or after January 1, 1998, and will cease to apply to benefits for services furnished on or after September 31, 2001.

ITEM 2. Amend 191--40.20(514B) by adding the following new subrules:

40.20(1) The term "emergency services" means, with respect to an individual enrolled with an organization, covered inpatient and outpatient services that are furnished by a provider that is qualified to furnish such services and are needed to evaluate or stabilize an emergency medical condition.

40.20(2) The term "emergency medical condition" means a medical condition manifesting itself by acute symptoms of sufficient severity, including severe pain, that a prudent lay-person, who possesses an average knowledge of health and medicine, could reasonably expect that absence of immediate medical attention to result in one of the following:

a. Placing the health of the individual or, with respect to a pregnant woman, the health of the woman and her unborn child, in serious jeopardy;

b. Serious impairment to bodily function; or

c. Serious dysfunction of any bodily organ or part.

ARC 7826A

Pursuant to the authority of Iowa Code sections 88.5 and 17A.3(1), the Labor Commissioner hereby gives Notice of Intended Action to amend Chapter 10, "General Industry Safety and Health Rules," Iowa Administrative Code.

The amendment relates to methylene chloride amendment and extension of start-up dates; electrical power generation, transmission and distribution and electrical protective equipment and approval of information collection requirements; and methylene chloride, partial stay; and respiratory protection.

If requested by March 3, 1998, a public hearing will be held on March 5, 1998, at 9 a.m. in the office of the Division of Labor Services, 1000 East Grand Avenue, Des Moines, Iowa. Any interested person will be given the opportunity to make oral or written submissions concerning the proposed amendment. Written data or arguments to be considered in adoption may be submitted by interested persons no later than March 5, 1998, to the Deputy Labor Commissioner, Division of Labor Services, 1000 East Grand Avenue, Des Moines, Iowa 50319-0209.

The Division has determined that this Notice of Intended Action may have an impact on small business. This amendment will not necessitate additional annual expenditures exceeding $100,000 by any one political subdivision or agency or any contractor providing services to political subdivisions or agencies.

The Division will issue a regulatory flexibility analysis as provided by Iowa Code section 17A.31 if a written request is filed by delivery or by mailing postmarked no later than March 4, 1998, to the Deputy Labor Commissioner, Division of Labor Services, 1000 East Grand Avenue, Des Moines, Iowa 50319. The request may be made by the Administrative Rules Review Committee, the Governor, a political subdivision, at least 25 persons who qualify as a small business under the Act, or an organization of small businesses representing at least 25 persons which is registered with the Division of Labor Services under the Act.

This amendment is intended to implement Iowa Code section 88.5.

The following amendment is proposed.

Amend rule 347--10.20(88) by inserting at the end thereof:

62 Fed. Reg. 54383 (October 20, 1997)

62 Fed. Reg. 65203 (December 11, 1997)

62 Fed. Reg. 66276 (December 18, 1997)

63 Fed. Reg. 1269 (January 8, 1998)

ARC 7827A

Pursuant to the authority of Iowa Code sections 88.5 and 17A.3(1), the Labor Commissioner hereby gives Notice of Intended Action to amend Chapter 26, "Construction Safety and Health Rules," Iowa Administrative Code.

The amendment relates to respiratory protection and scaffolds correction.

If requested by March 3, 1998, a public hearing will be held on March 5, 1998, at 9 a.m. in the office of the Division of Labor Services, 1000 East Grand Avenue, Des Moines, Iowa. Any interested person will be given the opportunity to make oral or written submissions concerning the proposed amendment. Written data or arguments to be considered in adoption may be submitted by interested persons no later than March 5, 1998, to the Deputy Labor Commissioner, Division of Labor Services, 1000 East Grand Avenue, Des Moines, Iowa 50319-0209.

The Division has determined that this Notice of Intended Action may have an impact on small business. This amendment will not necessitate additional annual expenditures exceeding $100,000 by any one political subdivision or agency or any contractor providing services to political subdivisions or agencies.

The Division will issue a regulatory flexibility analysis as provided by Iowa Code section 17A.31 if a written request is filed by delivery or by mailing postmarked no later than March 4, 1998, to the Deputy Labor Commissioner, Division of Labor Services, 1000 East Grand Avenue, Des Moines, Iowa 50319. The request may be made by the Administrative Rules Review Committee, the Governor, a political subdivision, at least 25 persons who qualify as a small business under the Act, or an organization of small businesses representing at least 25 persons which is registered with the Division of Labor Services under the Act.

This amendment is intended to implement Iowa Code section 88.5.

The following amendment is proposed.

Amend rule 347--26.1(88) by inserting at the end thereof:

63 Fed. Reg. 1295 (January 8, 1998)

63 Fed. Reg. 1919 (January 13, 1998)

ARC 7810A

These amendments include changes resulting from the Small Business Job Protection Act, Public Law 104-188, and legislation in 1997 Iowa Acts, chapter 185. Specifically, these are new and revised rules for deferred compensation, including the establishment of mutual funds as an investment alternative.

Consideration will be given to all written suggestions and comments on the proposed amendments on or before March 4, 1998. Such written materials should be sent to the Assistant to the Director, Department of Personnel, Grimes State Office Building, Des Moines, Iowa 50319-0150; fax (515)242-6450.

These amendments were published as a Notice of Intended Action on August 27, 1997, as ARC 7463A. A public hearing was held on September 16, 1997. A second public hearing on the proposed amendments will be held on March 4, 1998, at 1 p.m. in the South Conference Room, First Floor, Grimes State Office Building, Des Moines, Iowa, at which time persons may present their views.

ARC 7820A

Pursuant to the authority of Iowa Code section 147.76, the Board of Physical and Occupational Therapy Examiners hereby gives Notice of Intended Action to amend Chapter 202, "Physical Therapist Assistants," Iowa Administrative Code.

These proposed amendments clarify the process to request a hearing if a license has been denied, change the license renewal period and the continuing education compliance period, raise renewal fees and penalty fees, and clarify the process for investigation of complaints or malpractice claims, disciplinary procedures, supervision requirements and peer review committees.

Any interested person may make written comments on the proposed amendments not later than March 3, 1998, addressed to Judy Manning, Professional Licensure, Department of Public Health, Lucas State Office Building, Des Moines, Iowa 50319-0075.

There will be a public hearing on March 3, 1998, from 11 a.m. to 1 p.m. in the Fourth Floor Conference Room, Iowa Department of Public Health, Lucas State Office Building, Des Moines, Iowa 50319-0075. Persons may present their views at the public hearing either orally or in writing. At the hearing, persons will be asked to give their names and addresses for the record and to confine their remarks to the subject of the proposed amendments.

The Board has determined that the amendments will have no impact on small business within the meaning of Iowa Code section 17A.31.

The proposed amendments are intended to implement Iowa Code section 147.76 and chapters 148A and 272C.

The following amendments are proposed.

ITEM 1. Adopt new subrule 202.3(5) as follows:

202.3(5) An applicant physical therapist assistant is a person who has made application for licensure and is awaiting board action. The applicant may practice under the supervision of a licensed physical therapist for a period not to exceed six months in the case of licensure by examination. During this time the applicant may perform physical therapy procedures as delegated by the supervising physical therapist only under "on-site" supervision. Documentation made in physical therapy records by an applicant physical therapist assistant shall be cosigned by the supervising physical therapist.

ITEM 2. Adopt new subrule 202.4(7) as follows:

202.4(7) An applicant physical therapist assistant is a person who has made application for licensure and is awaiting board action. The applicant may practice under the supervision of a licensed physical therapist for a period not to exceed three months in the case of licensure by endorsement. During this time the applicant may perform physical therapy procedures as delegated by the supervising physical therapist only under "on-site" supervision. Documentation made in physical therapy records by an applicant physical therapist assistant shall be cosigned by the supervising physical therapist.

ITEM 3. Rescind rule 645--202.6(147) and adopt the following new rule in lieu thereof:

645--202.6(147) License renewal.

202.6(1) Beginning July 1, 1999, a license to practice as a physical therapist assistant shall expire every two years on the fifteenth day of the birth month. Continuing education requirements shall be completed within the same renewal period for each license holder.

An application and a continuing education report form for renewal of license to practice as a physical therapist assistant shall be mailed to the licensee at least 60 days prior to the expiration of the license. Failure to receive the renewal application shall not relieve the license holder of the obligation to pay biennial renewal fees on or before the renewal date.

202.6(2) Beginning July 1, 1999, the continuing education requirements will coincide with the renewal compliance period. The licensee shall submit to the board office, 30 days before licensure expiration, the application and continuing education report form with the renewal fee as specified in rule 202.10(147). Individuals who were issued their initial license within six months of their birth month will not be required to renew their license until the fifteenth day of their birth month two years later. The new licensee is exempt from meeting the continuing education requirement for the continuing education biennium in which the license is originally issued. Individuals will be required to report 20 hours of continuing education for the first renewal and every renewal thereafter.

202.6(3) Late renewal. If the renewal fees are received by the board within 30 days after the renewal expiration date, a penalty fee is charged. If renewal fees are received more than 30 days after the renewal expiration date, the license is lapsed. An application for reinstatement must be filed with the board with the reinstatement fee, the renewal fee and the penalty fee as outlined in rule 202.10(147). Individuals who fail to submit the renewal application and complete documentation of continuing education hours shall be required to pay a penalty fee and shall be subject to an audit of their continuing education report.

202.6(4) Physical therapist assistants who have not fulfilled the requirements for license renewal or an exemption in the required time frame will have a lapsed license and shall not practice as a physical therapist assistant.

ITEM 4. Rescind rule 645--202.9(147) and adopt the following new rule in lieu thereof:

645--202.9(147) Reinstatement of lapsed license. Individuals who have allowed their licenses to lapse, prior to practicing as physical therapist assistants in the state of Iowa, shall satisfy the following requirements for reinstatement:

202.9(1) Submit written application for reinstatement to the board on forms provided by the board, pay the current application fee, the reinstatement fee and applicable penalty fees; and

202.9(2) Furnish in the application evidence of one of the following:

a. Completion of a total number of hours of accredited continuing education computed by multiplying 20 for each renewal period the license has been inactive; or

b. Successful completion of the appropriate physical therapy professional examination required in subrule 202.2(2) within one year immediately prior to the submission of the application for reinstatement.

ITEM 5. Amend subrule 202.10(1) as follows:

202.10(1) The application fee for a license to practice as a physical therapist assistant issued upon the basis of examination or endorsement is $45 $90 in check or money order made payable to the Board of Physical and Occupational Therapy Examiners. The examination fee is an additional $185 made payable by cashier's check to the Professional Examination Service (PES) and submitted to the Board of Physical and Occupational Therapy Examiners with application.

ITEM 6. Amend subrule 202.10(2) as follows:

202.10(2) The renewal fee of a license to practice as a physical therapist assistant for a biennial period is $45. Biennial renewal fee for a license to practice as a physical therapist assistant for the 1999 renewal cycle only is as follows:

Birth Month Prorated Fee

July 1999 $45

August 1999 $47

September 1999 $49

October 1999 $51

November 1999 $53

December 1999 $54

January 2000 $56

February 2000 $58

March 2000 $60

April 2000 $62

May 2000 $64

June 2000 $66

ITEM 7. Amend subrule 202.10(3) as follows:

202.10(3) Penalty fee for failure to complete and return the physical therapist assistant renewal application by January 31 (odd-numbered year) before the renewal expiration date is $45.

ITEM 8. Amend subrule 202.10(4) as follows:

202.10(4) Penalty fee for failure to complete the required continuing education by December 31 of even-numbered years during the renewal period is $25 $50. Failure to complete and return the continuing education report (Form G) by January 31 (odd-numbered year) by the end of the renewal period is $25 $50.

ITEM 9. Adopt new subrule 202.10(10) as follows:

202.10(10) Fee for a returned check is $15.

ITEM 10. Amend subrule 202.11(3) as follows:

202.11(3) The continuing education compliance period shall be each biennium beginning January 1 of the odd-numbered year to December 31 of the next even-numbered year the fifteenth day of the birth month and ending two years later on the fifteenth day of the birth month. During the continuing education compliance period, attendance at approved continuing education programs may be used as evidence of fulfilling the continuing education requirements for the subsequent biennial license renewal period beginning July 1. The biennial license renewal period shall extend from July 1 of each odd-numbered year until June 30 of the next odd-numbered year. For the 1999 renewal cycle only, the continuing education hours will be prorated as follows:

Birth Month Prorated Continuing Education

July 1999 25 hours

August 1999 26 hours

September 1999 27 hours

October 1999 27 hours

November 1999 28 hours

December 1999 29 hours

January 2000 30 hours

February 2000 31 hours

March 2000 32 hours

April 2000 32 hours

May 2000 33 hours

June 2000 34 hours

Continuing education hours will return to 20 hours each biennium at the end of this prorated compliance period.

ITEM 11. Rescind and reserve subrule 202.11(6).

ITEM 12. Rescind subrule 202.11(7) and adopt new subrule 202.11(7) in lieu thereof:

202.11(7) Individuals who were issued their licenses by reinstatement or interstate endorsement within six months of their birth month are exempt from meeting the continuing education requirement for the continuing education biennium in which the license is reinstated or issued by endorsement. Individuals will be required to report 20 hours of continuing education for the first renewal and every renewal thereafter.

ITEM 13. Amend subrule 202.13(1) as follows:

202.13(1) A report of continuing education activities shall be submitted on a board-approved form with the renewal application for relicensure by January 31 of the odd-numbered years the end of the biennial license renewal period. All continuing education activities submitted must be completed by December 31 of the even-numbered year in the continuing education compliance period for which the license was issued as specified in subrule 202.11(3) or a late fee will be assessed. See subrule as outlined in 202.10(4).

ITEM 14. Amend subrule 202.13(2) as follows:

202.13(2) Failure to receive renewal application shall not relieve the physical therapist assistant of the responsibility of meeting continuing education requirements and submitting renewal the fee for relicensure renewal by January 31 of the odd-numbered year the end of the compliance period.

ITEM 15. Amend subrule 202.13(3), paragraph "b," as follows:

b. All renewal license applications that are submitted late (after January 31 of the odd-numbered year the end of the compliance period) shall be subject to audit of continuing education reports.

ITEM 16. Amend rule 645--202.19(272C), catchwords, as follows:

645--202.19(272C) Alternative procedures and Informal settlement and license denial.

ITEM 17. Rescind rule 645--202.20(272C) and adopt the following new rule in lieu thereof:

645--202.20(272C) Disciplinary procedure. The board adopts herein by reference rule 645--200.20(272C).

ITEM 18. Rescind rule 645--202.21(272C) and adopt the following new rule in lieu thereof:

645--202.21(272C) Method of discipline. The board adopts herein by reference rule 645--200.21(272C).

ITEM 19. Rescind rule 645--202.22(272C) and adopt the following new rule in lieu thereof:

645--202.22(272C) Discretion of board. The board adopts herein by reference rule 645--200.22(272C).

ITEM 20. Adopt new rule 645--202.23(272C) as follows:

645--202.23(272C) Grounds for discipline. The board may impose any of the disciplinary sanctions set forth in rule 645--200.21(272C), including civil penalties in an amount not to exceed $1000, when the board determines that a licensee is guilty of any of the following acts or offenses.

202.23(1) All grounds listed in Iowa Code section 147.55.

202.23(2) Violation of the rules promulgated by the board.

202.23(3) Personal disqualifications:

a. Mental or physical inability reasonably related to and adversely affecting the licensee's ability to practice in a safe and competent manner.

b. Involuntary commitment for treatment of mental illness, drug addiction or alcoholism.

202.23(4) Practicing the profession while the license is suspended or lapsed.

202.23(5) Revocation, suspension, or other disciplinary action taken by a licensing authority of another state, territory, or country; or failure by the licensee to report in writing to the Iowa board of physical and occupational therapy examiners revocation, suspension, or other disciplinary action taken by a licensing authority of another state, territory, or country; or both.

202.23(6) Negligence by the licensee in the practice of the profession, which is a failure to exercise due care including negligent delegation to or supervision of employees or other individuals, whether or not injury results; or any conduct, practice or conditions which impair the ability to safely and skillfully practice the profession.

202.23(7) Failure to comply with the following rules of ethical conduct and practice.

a. A physical therapist assistant shall not practice outside the scope of the license.

b. When the physical therapist assistant does not possess the skills or knowledge to perform the delegated tasks, the physical therapist assistant is obligated to inform the delegating physical therapist and refuse to perform the delegated tasks.

c. The physical therapist assistant shall not exercise undue influence on patients to purchase equipment produced or supplied by a company in which the physical therapist owns stock or has any other direct or indirect financial interest.

d. Physical therapist assistants shall not permit another person to use their licenses for any purpose.

e. A physical therapist assistant shall not obtain, possess, or attempt to obtain or possess a controlled substance without lawful authority or sell, prescribe, give away, or administer a controlled substance in the practice of physical therapy.

f. A physical therapist assistant shall not verbally or physically abuse a patient.

g. A physical therapist assistant shall not engage in sexual misconduct. Sexual misconduct includes the following:

(1) Engaging in or soliciting a sexual relationship, whether consensual or nonconsensual, with a patient.

(2) Making sexual advances, requesting sexual favors, or engaging in other verbal conduct or physical contact of a sexual nature with a patient.

h. The physical therapist assistant shall work only when supervised by a physical therapist and in accordance with rule 645--200.24(272C). If the available supervision does not meet the standards as set forth in rule 645-- 200.24(272C), the physical therapy assistant shall refuse to administer treatment.

i. The signature of the physical therapist assistant on a physical therapy treatment record indicates that the physical therapy services were provided in accordance with the rules and regulations for practicing as a physical therapist or physical therapist assistant.

202.23(8) Unethical business practices, consisting of any of the following:

a. False or misleading advertising.

b. Betrayal of a professional confidence.

c. Falsifying patient's records.

202.23(9) Failure to notify the board of a change of name or address within 30 days after it occurs.

202.23(10) Submission of a false report of continuing education, or failure to submit the required report of continuing education.

202.23(11) Failure to notify the board within 30 days after occurrence of any judgment or settlement of a malpractice claim or disciplinary action taken by another state.

202.23(12) Failure to comply with a subpoena issued by the board.

202.23(13) Failure to report to the board as provided in Iowa Code section 272C.9 any violation by another licensee of the reasons for disciplinary action as listed in this rule.

202.23(14) Failure to report to the board as provided in Iowa Code section 272C.9 any violation by a physical therapist of the reasons for disciplinary action as listed in rule 202.20(272C).

202.23(15) Obtaining a license by fraud or misrepresentation.

202.23(16) Conviction of a felony related to the practice of physical therapy or the conviction of any felony that would affect the licensee's ability to practice physical therapy. A copy of the record of conviction shall be conclusive evidence. Conviction shall include a finding or verdict of guilty, a plea of guilty, an admission of guilt, or a plea of nolo contendere.

202.23(17) Professional incompetency. Professional incompetency includes but is not limited to:

a. A substantial lack of knowledge or ability to discharge professional obligations within the physical therapist assistant's practice;

b. A substantial deviation by the physical therapist assistant from the standards of learning or skill ordinarily possessed and applied by other physical therapist assistants in the state of Iowa acting in the same or similar circumstances;

c. A failure by a physical therapist assistant to exercise that degree of care which is ordinarily exercised by the average physical therapist assistant in the state of Iowa acting in the same or similar circumstances;

d. A willful or repeated departure from or the failure to conform to the minimal standard of acceptable and prevailing practice of physical therapy in the state of Iowa.

202.23(18) Inability to practice physical therapy with reasonable skill and safety by reason of a mental or physical impairment or chemical abuse.

202.23(19) Violating a lawful order of the board, previously entered by the board in a disciplinary or licensure hearing, or violating the terms and provisions of a consent agreement or informal settlement between a licensee and the board.

202.23(20) Failure to respond, when requested, to communications of the board within 30 days of the mailing of such communication by registered or certified mail.

202.23(21) Obtaining third-party payment through fraudulent means. Third-party payers include, but are not limited to, insurance companies and government reimbursement programs. Obtaining payment through fraudulent means includes, but is not limited to:

a. Reporting incorrect treatment dates for the purpose of obtaining payment;

b. Reporting charges for services not rendered;

c. Incorrectly reporting services rendered for the purpose of obtaining payment which is greater than that to which the licensee is entitled; or

d. Aiding a patient in fraudulently obtaining payment from a third-party payer.

202.23(22) Practicing without a current license or practicing when a license is lapsed.

ITEM 21. Adopt new rule 645--202.24(272C) as follows:

645--202.24(272C) Supervision requirements. The board adopts herein by reference rule 645--200.24(272C).

ITEM 22. Adopt new rule 645--202.25(272C) as follows:

645--202.25(272C) Peer review committees. The board adopts herein by reference rule 645--200.25(272C).

ITEM 23. Adopt new rule 645--202.26(272C) as follows:

645--202.26(272C) Conduct of persons attending meetings. The board adopts herein by reference rule 645-- 200.26(21).

ARC 7818A

Pursuant to the authority of Iowa Code sections 135.11 and 139.2, the Department of Public Health hereby gives Notice of Intended Action to amend Chapter 1, "Notification and Surveillance of Reportable Diseases," Iowa Administrative Code.

The purpose of this amendment is to include certain levels of CD4 laboratory results as a reportable AIDS-defining condition. The Centers for Disease Control and Prevention expanded the case definition of AIDS on January 1, 1993, to include immunologic criteria defined as CD4 T-lymphocyte laboratory test results of less than 200 cells per microliter, or a CD4 T-lymphocyte percent of total lymphocytes less than 14. Laboratory-initiated CD4 reporting will enhance AIDS surveillance by identifying proportionately more AIDS cases earlier in the course of their disease and with less reporting delay. This method of AIDS case ascertainment will enhance the state's ability to more completely monitor the epidemic in Iowa.

Presently 27 states have mandated laboratory-based CD4 reporting. Laboratory reporting of the CD4 values will serve as a cue to contact attending physicians to obtain AIDS case reports. A small proportion of the low CD4 reports will be linked to immunosuppression in renal transplantation, hereditary disorders, and other non-HIV conditions. This information, however, will become evident upon physician contact so that no report will be generated. The clear benefit of CD4 reporting is more complete epidemiologic ascertainment and preventing the unnecessary loss of federal funds due to underreporting of AIDS cases.

Any interested person may make written suggestions or comments on the proposed amendment on or before March 3, 1998. Written comments may be sent to Carolyn Vogel, Bureau of Disease Prevention, Department of Public Health, Lucas State Office Building, Des Moines, Iowa 50319-0075; fax (515)281-4570.

Also, there will be a public hearing on March 9, 1998, at 10 a.m. at which time persons may present their views. Public hearings will be held over the Iowa Communications Network at the following sites: Bettendorf at the Scott Community College, Room 210, 500 Belmont Road; Cedar Falls at the University of Northern Iowa, Room 130 C, Schindler Hall, at the corner of Hudson Road and 23rd Street; Fort Dodge in the Mobile Classroom at Trinity Hospital, 802Kenyon Road; Des Moines at the Department of Public Health, Third Floor, Lucas State Office Building, East 14th and Grand Avenue.

Any persons who plan to attend the public hearing and have special requirements, such as hearing or mobility impairments, should contact the Department of Public Health and advise of special needs.

This amendment is intended to implement Iowa Code section 139.2.

The following amendment is proposed.

Amend 1.2(1)"a"(1), Acquired Immune Deficiency Syndrome (AIDS), as follows:

1.2(1) List of reportable diseases or conditions.

a. Specific infectious diseases:

(1) Common diseases:

Acquired Immune Deficiency Syndrome (AIDS) and AIDS-defining conditions including CD4 T-lymphocyte count less than 200/microliter, or CD4 T-lymphocyte percent of total lymphocytes less than 14.

ARC 7800A

Pursuant to the authority of Iowa Code section 262.9, the Board of Regents hereby gives Notice of Intended Action to amend Chapter 1, "Admission Rules Common to the Three State Universities," Iowa Administrative Code.

The University of Iowa requested to increase the application fee from $20 to $30 for U.S. citizens and permanent resident students. After consultation among the universities, the Board of Regents agreed with the recommendation to implement differential application fees for U.S. citizens and permanent resident students at the three universities. Iowa State University and the University of Northern Iowa will continue to have $20 application fees while the University of Iowa's application fee will increase to $30.

During the same consultation, the University of Iowa proposal to raise the application fee for foreign students from $30 to $50 was accepted by all three universities. The increase in application fee is necessary because the universities must ensure compliance with federal regulations related to students with visas and meet the challenges involved with analyzing the academic preparation of foreign students.

Any interested person may make written suggestions or comments on the proposed amendments by 12 noon on March 4, 1998. Written comments should be directed toR. Wayne Richey, Executive Director, State Board of Regents, Old Historical Building, Des Moines, Iowa 50319-0071; fax (515)281-6420.

A public hearing is scheduled for March 3, 1998, at 4 p.m. in the Board of Regents Conference Room, First Floor West, Old Historical Building, East Twelfth Street and Grand Avenue, Des Moines, Iowa.

The proposed amendments are intended to implement Iowa Code section 262.9(3).

The following amendments are proposed.

ITEM 1. Amend rule 681--1.1(262), first unnumbered paragraph, as follows:

Applicants must submit a formal application for admission, together with a $20 application fee for U.S. citizens or permanent residents for applicants to Iowa State University and the University of Northern Iowa or a $30 application fee for applicants to the University of Iowa and a $30 $50 application fee for foreign students, and have their secondary school provide a transcript of their academic record, including credits and grades, rank in class, and certification of graduation. Applicants must also submit scores from the American College Test (ACT) or the Scholastic Aptitude Test (SAT), or the equivalent, as determined by each university. The Test of English as a Foreign Language (TOEFL) is required of foreign students whose first language is not English. Applicants may be required to submit additional information or data to support their applications.

ITEM 2. Amend rule 681--1.2(262), first unnumbered paragraph, as follows:

Applicants must submit a formal application for admission, together with a $20 application fee for U.S. citizens or permanent residents for applicants to Iowa State University and the University of Northern Iowa or a $30 application fee for applicants to the University of Iowa and a $30 $50 application fee for foreign students, and request that each college they have attended send an official transcript of record to the admissions office. High school academic records and standardized test results may also be required. The Test of English as a Foreign Language (TOEFL) is required of foreign students whose first language is not English.

ARC 7795A

Pursuant to the authority of Iowa Code sections 307.10 and 307.12, the Department of Transportation hereby gives Notice of Intended Action to amend Chapter 415, "Driver's Privacy Protection--Certificates of Title and Vehicle Registration," Iowa Administrative Code.

Iowa Code Supplement section 321.11 prohibits the Department from releasing personal information, other than to law enforcement agencies, licensed private investigation agencies and licensed security services, when the request is made by plate number.

The first item amends the definition of law enforcement agency to include a division or unit of a government agency if the division's or unit's primary responsibility is to prevent, detect or enforce a criminal law of this state. This will allow these divisions or units to access a motor vehicle record via a plate number or validation sticker number.

A numbered year/month validation sticker is attached to and is considered part of a registration plate. The amendments in Item 2 make it clear that requests made by validation sticker number will be treated the same as requests made by plate number.

Any person or agency may submit written comments concerning these proposed amendments or may submit a written request to make an oral presentation. The comments or request shall:

1. Include the name, address, and telephone number of the person or agency authoring the comments or request.

2. Reference the number and title of the proposed rule, as given in this Notice, that is the subject of the comments or request.

3. Indicate the general content of a requested oral presentation.

4. Be addressed to the Department of Transportation,Director's Staff Division, 800 Lincoln Way, Ames, Iowa 50010; fax (515)239-1639; Internet E-mail address: rules@iadot.e-mail.com.

5. Be received by the Director's Staff Division no later than March 3, 1998.

A meeting to hear requested oral presentations is scheduled for Thursday, March 5, 1998, at 10 a.m. in the conference room of the Motor Vehicle Division, which is located on the lower level of Park Fair Mall, 100 Euclid Avenue, Des Moines.

The meeting will be canceled without further notice if no oral presentation is requested.

These amendments are intended to implement Iowa Code Supplement section 321.11.

Proposed rule-making actions:

ITEM 1. Amend rule 761--415.3(321), definition of "Law enforcement agency," as follows:

"Law enforcement agency" includes, but is not limited to, county attorneys, federal district attorneys, attorneys general, and state and federal departments of justice, and a division or unit of a governmental agency if the division's or unit's primary responsibility is to prevent or detect crime or enforce a criminal law of this state.

ITEM 2. Amend subrules 415.4(8) and 415.4(9) as follows:

415.4(8) The department shall not release any personal information regarding a motor vehicle record if the request is made by plate number or validation sticker number, except as provided in Iowa Code section 321.11.

415.4(9) If a request for personal information is made by something other than plate number or validation sticker number, the personal information shall be disclosed if the individual whose personal information is requested has not elected to prohibit disclosure of the information to the general public.

In accordance with the provisions of Iowa Code section 535.2, subsection 3, paragraph "a," the Superintendent of Banking has determined that the maximum lawful rate of interest shall be:

January 1, 1997 -- January 31, 1997 8.25%

February 1, 1997 -- February 28, 1997 8.25%

March 1, 1997 -- March 31, 1997 8.50%

April 1, 1997 -- April 30, 1997 8.50%

May 1, 1997 -- May 31, 1997 8.75%

June 1, 1997 -- June 30, 1997 9.00%

July 1, 1997 -- July 31, 1997 8.75%

August 1, 1997 -- August 31, 1997 8.50%

September 1, 1997 -- September 30, 1997 8.25%

October 1, 1997 -- October 31, 1997 8.25%

November 1, 1997 -- November 30, 1997 8.25%

December 1, 1997 -- December 31, 1997 8.00%

January 1, 1998 -- January 31, 1998 8.00%

February 1, 1998 -- February 28, 1998 7.75%

The Council on Human Services adopted these amendments January 14, 1998. Notice of Intended Action regarding these amendments was published in the Iowa Administrative Bulletin on November 19, 1997, as ARC 7656A.

These amendments exempt all educational funds as income and as a resource when determining Family Investment Program (FIP) eligibility or benefit amount and Family Medical Assistance Program (FMAP)-related Medicaid coverage group eligibility.

Currently, the Department only exempts educational funds obtained from programs administered by the U.S. Secretary of Education but counts educational funds from other programs. When a client has a combination of exempt and nonexempt educational funds, any allowable educational expenses the student may have are offset first against the educational income that is exempt. Any remaining expenses are then offset against the countable educational funds. As a result, even though the source of the educational funds in itself renders the funds exempt, by deducting educational expenses from these funds first, the exempt funds are, in fact, used in the eligibility and benefit determination. However, recent litigation in another program has raised an issue in the Family Investment Program and FMAP-related Medicaid Program. Amendments to the Higher Education Act of 1965 may prohibit the use of educational funds obtained from programs under the Secretary of Education in any calculation to determine FIP eligibility or benefit amount and FMAP-related Medicaid eligibility. The Department is proposing these amendments to eliminate any possibility of litigation or incorrect policy.

The Department has the option to still consider educational funds from programs other than those under the Secretary of Education to determine FIP eligibility and benefit amount and FMAP-related Medicaid eligibility. However, by eliminating the exempt educational funds from the eligibility and benefit calculation, little, if any, countable income will most likely remain. Determining countable educational income is a very complicated and error-prone process. Considering the very low number of FIP participants who are students with countable educational income, there seems to be little, if any, purpose in performing the required complex calculation. Also, better education will lead to better-paying jobs. Supporting clients' efforts at improving their marketable skills that will increase their opportunities for gainful employment is in line with the Department's philosophy on welfare reform.

The Department of Human Services finds that these amendments confer a benefit on FIP and Medicaid recipients by exempting educational income from consideration in determining the amount of the FIP grant and Medicaid eligibility. Therefore, these amendments are filed pursuant to Iowa Code section 17A.5(2)"b"(2).

The following revisions were made to the Notice of Intended Action:

Subrule 41.27(6), paragraph "r," and subrule 75.57(6), paragraph "r," were revised to clarify that the exemption of educational income also applies to persons in training. The subrules were further revised to clarify that additional social security or veterans benefits made available for the person's dependents in the eligible group are nonexempt income.

These amendments are intended to implement Iowa Code section 249A.4 and Iowa Code Supplement sections 239B.2 and 239B.8.

These amendments became effective February 1, 1998.

The following amendments are adopted.

ITEM 1. Amend subrule 40.27(1), paragraph "a," subparagraph (3), as follows:

(3) The assistance unit contains any member receiving nonexempt unearned income, the source or amount of which is expected to change more often than once annually, unless the income is from job insurance benefits, or interest oreducational income as described in 441--paragraph 41.27(1)"d"; or unless the assistance unit's adult members are 60 years old or older, or are receiving disability or blindness payments under Titles I, II, X, XIV, or XVI of the Social Security Act; or unless all adults, who would otherwise be members of the assistance unit, are receiving supplemental security income including state supplementary assistance.

ITEM 2. Amend rule 441--41.27(239) as follows:

Amend subrule 41.27(1) by rescinding and reserving paragraphs "d" and "e."

Amend subrule 41.27(6) by rescinding paragraph "r" and inserting the following new paragraph in lieu thereof:

r. All earned and unearned educational funds of an undergraduate or graduate student or a person in training. Any extended social security or veterans benefits received by a parent or nonparental relative as defined at subrule 41.22(3), conditional to school attendance, shall be exempt. However, any additional amount received for the person's dependents who are in the eligible group shall be counted as nonexempt income.

Further amend subrule 41.27(6) by rescinding and reserving paragraph "s."

Amend subrule 41.27(9) by rescinding and reserving paragraph "g."

ITEM 3. Amend subrule 75.52(1), paragraph "a," subparagraph (3), as follows:

(3) The assistance unit contains any member receiving nonexempt unearned income, the source or amount of which is expected to change more often than once annually, unless the income is from job insurance benefits, or interest or educational income as described in paragraph 75.57(1)"b,"; or unless the assistance unit's adult members are 60 years old or older, or are receiving disability or blindness payments under Titles I, II, X, XIV, or XVI of the Social Security Act; or unless all adults, who would otherwise be members of the assistance unit, are receiving Supplemental Security Income (SSI) including state supplementary assistance (SSA).

ITEM 4. Amend rule 441--75.57(249A) as follows:

Amend subrule 75.57(1) by rescinding and reserving paragraphs "b" and "c."

Amend subrule 75.57(6) by rescinding paragraph "r" and inserting the following new paragraph in lieu thereof:

r. All earned and unearned educational funds of an undergraduate or graduate student or a person in training. Any extended social security or veterans benefits received by a parent or nonparental relative as defined at subrule 75.55(1), conditional to school attendance, shall be exempt. However, any additional amount received for the person's dependents who are in the eligible group shall be counted as nonexempt income.

Further amend subrule 75.57(6) by rescinding and reserving paragraph "s."

Amend subrule 75.57(9) by rescinding and reserving paragraph "g."

ARC 7817A

These amendments will allow non-EMS agencies, public or private, to train their employees or associates in the use of an automatic external defibrillator and are intended to enhance and supplement the local EMS system with nontraditional early defibrillation groups/agencies.

Iowa's 22 EMS training programs and the Iowa EMS Advisory Council endorsed public access defibrillation (PAD) on October 7 and 8, 1997. All of Iowa's EMS service programs, medical directors, and hospitals were mailed draft copies of proposed PAD amendments for comment. Additionally, two informational meetings were broadcast over the Iowa Communications Network (ICN) on December 8, and December 17, 1997, to gather input on the issue of PAD. There has been widespread support.

In compliance with Iowa Code section 17A.4(2), the Department finds that notice and public participation are impracticable because of the immediate need for rule change to implement the law.

The Department also finds, pursuant to Iowa Code section 17A.5(2)"b"(2), that the normal effective date of these amendments should be waived and these amendments should be made effective January 23, 1998, upon filing with the Administrative Rules Coordinator, as they confer a benefit upon the citizens of Iowa.

The Iowa State Board of Health adopted these amendments on January 14, 1998.

These amendments were also published in the Iowa Administrative Bulletin under Notice of Intended Action as ARC 7771A on January 14, 1998, to allow for public comment. A public hearing was held on Tuesday, February 3, 1998, from 2 to 3 p.m. over the Iowa Communications Network.

These amendments are intended to implement Iowa Code section 147A.4.

These amendments became effective upon filing on January 23, 1998.

The following amendments are adopted.

ITEM 1. Amend rule 641--132.1(147A) by inserting the following new definitions in alphabetical order:

"AED" means automatic external defibrillator.

"PAD" means public access defibrillation.

"PAD service program" means a nonemergency response business agency, public or private, that has trained its employees or associates in the use of an automatic external defibrillator and is authorized by the department as a PAD service program.

"Public access defibrillation" means the operation of an automatic external defibrillator by a nontraditional provider of emergency medical care.

"Public access defibrillation provider" means someone who has completed the public access provider AED course approved by the department and who is currently certified by the department as a PAD provider.

ITEM 2. Adopt new rule 641--132.16(147A) as follows:

641--132.16(147A) Public access defibrillation. The purpose of this rule is to allow nonemergency response agencies, public or private, to train their employees or associates in the use of the automatic external defibrillator and to provide AED coverage when appropriately trained personnel are available. This rule is intended to enhance and supplement the local EMS system with nontraditional early defibrillation groups/agencies.

132.16(1) Authority of public access defibrillation provider. Public access defibrillation providers may perform those skills identified in the public access defibrillation provider curriculum approved by the department, as part of an authorized PAD service program.

132.16(2) Public access defibrillation provider--training requirements. Individuals seeking certification as a public access defibrillation provider shall:

a. Be an employee or associate of the public or private business agency applying for PAD service program authorization.

b. Obtain appropriate training approved by the department. PAD provider training shall include as a minimum:

(1) Successful course completion in adult CPR, including one rescuer CPR, foreign body airway obstruction, rescue breathing, recovery position, and activating the EMS system.

(2) Successful completion of an AED curriculum approved by the department.

132.16(3) PAD service program--application, guidelines, and standards. A public or private nonemergency response business agency may establish an affiliation with an EMS service program if wishing to provide AED coverage in an EMS service program's service area or may apply for authorization as an independent PAD service program. An application is required and may be obtained by contacting the Iowa Department of Public Health, Bureau of EMS, Lucas State Office Building, Des Moines, Iowa 50319-0075. PAD service programs shall:

a. Provide a medical director licensed under Iowa Code chapter 148, 150, or 150A, who shall be responsible for the overall medical direction of the PAD service program.

b. Use an AED approved by the department.

c. Use the defibrillation protocol approved by the department.

d. Make simultaneous voice/ECG recordings on each call where CPR is performed.

e. Submit a copy of the patient care report and the original voice/ECG recording to the department or department designee within 48 hours of the cardiac arrest.

f. Implement a policy for periodic maintenance of the AED.

g. Ensure PAD providers complete quarterly practice sessions in the use of the AED.

h. Identify which authorized Iowa ambulance service program(s) will provide patient transportation.

i. Ensure continuity of care, which may include, if necessary, that the PAD provider accompany the patient to a hospital.

j. Complete a renewal application every three years.

k. Ensure PAD providers maintain current course completion in CPR.

132.16(4) Complaints and investigations. Complaints and investigations shall be conducted as with any complaint received against an EMS service program, applying rule 641 IAC 132.10(147A).

ARC 7816A

These amendments will allow Iowa law enforcement agencies to train their peace officers in the use of an automatic external defibrillator (AED) and are intended to enhance and supplement the local EMS system with nontraditional early defibrillation groups/agencies.

Iowa's 22 EMS training programs and the Iowa EMS Advisory Council endorsed public access defibrillation (PAD) on October 7 and 8, 1997. All of Iowa's EMS service programs, medical directors, and hospitals were mailed draft copies of proposed AED amendments for comment. Additionally, two informational meetings were broadcast over the Iowa Communications Network (ICN) on December 8, and December 17, 1997, to gather input on the issue of AED and use by law enforcement personnel. There has been widespread support.

In compliance with Iowa Code section 17A.4(2), the Department finds that notice and public participation are impracticable because of the immediate need for rule change to implement the law.

The Department also finds, pursuant to Iowa Code section 17A.5(2)"b"(2), that the normal effective date of these amendments should be waived and these amendments should be made effective January 23, 1998, upon filing with the Administrative Rules Coordinator, as they confer a benefit upon the citizens of Iowa.

The Iowa State Board of Health adopted these amendments on January 14, 1998.

These amendments were also published in the Iowa Administrative Bulletin under Notice of Intended Action as ARC 7772A on January 14, 1998, to allow for public comment. A public hearing was held on Tuesday, February 3, 1998, from 2 to 3 p.m. over the Iowa Communications Network.

These amendments are intended to implement Iowa Code section 147A.4.

These amendments became effective upon filing January 23, 1998.

The following amendments are adopted.

ITEM 1. Amend rule 641--139.1(147A) by adding the following new definitions in alphabetical order:

"AED" means automatic external defibrillator.

"Law enforcement AED service program" means a recognized Iowa law enforcement agency that has trained its peace officers in the use of an AED and is authorized by the department as a law enforcement AED service program.

ITEM 2. Amend rule 641--139.2(147A) as follows:

641--139.2(147A) Authority of Iowa law enforcement emergency care provider. Iowa law enforcement emergency care provider may perform skills identified in the Iowa law enforcement emergency care provider curriculum approved by the department, plus the skill of automated defibrillation for which training can be documented.

ITEM 3. Adopt new rule 641--139.6(147A) and an implementation clause as follows:

641--139.6(147A) Law enforcement AED service program authorization. A recognized Iowa law enforcement agency that desires to allow its peace officers to use an AED shall apply to the department for authorization. Application for authorization shall be made on forms provided by the department. The purpose of this rule is to allow law enforcement agencies to train their peace officers in the use of the automatic external defibrillator and to provide AED coverage when appropriately trained personnel are available. This rule is intended to enhance and supplement the local EMS system with nontraditional early defibrillation agencies.

139.6(1) Training requirements. Law enforcement personnel wishing to provide AED coverage as part of an Iowa law enforcement agency shall:

a. Be an employee or associate of the law enforcement agency.

b. As a minimum, be currently certified as an Iowa law enforcement emergency care provider.

c. Obtain appropriate training approved by the department. AED training shall include, as a minimum, successful completion of an AED curriculum approved by the department.

139.6(2) Iowa law enforcement AED service program application, guidelines, and standards. An Iowa law enforcement agency may establish an affiliation with an EMS service program if wishing to provide AED coverage in an EMS service program's service area or may apply for authorization as an independent law enforcement AED service program. An application is required and may be obtained by contacting the Iowa Department of Public Health, Bureau of EMS, Lucas State Office Building, Des Moines, Iowa 50319-0075. Iowa law enforcement AED service programs shall:

a. Provide a medical director licensed under Iowa Code chapter 148, 150, or 150A, who shall be responsible for the overall medical direction of the law enforcement AED service program.

b. Use an AED approved by the department.

c. Use the defibrillation protocol approved by the department.

d. Make simultaneous voice/ECG recordings on each call where CPR is performed.

e. Submit a copy of the patient care report and the original voice/ECG recording to the department or departmentdesignee within 48 hours of the cardiac arrest.

f. Implement a policy for periodic maintenance of the AED.

g. Ensure that law enforcement personnel trained in the use of the AED complete quarterly practice sessions in the use of the AED.

h. Identify which authorized Iowa ambulance service program(s) will provide patient transportation.

i. Ensure continuity of care, which may include, if necessary, that the peace officer trained in the use of an AED accompany the patient to a hospital.

j. Complete a renewal application every three years.

139.6(3) Complaints and investigations shall be conducted as with any complaint received against an EMS service program, applying rule 641 IAC 132.10(147A).

These rules are intended to implement Iowa Code chapter 147A.

Notice of Intended Action was published in the Iowa Administrative Bulletin as ARC 7704A on December 17, 1997. The IDED Board adopted the amendments on January 22, 1998.

The amendments remove from the rules specific requirements for the housing set-aside program and refer instead to a new Chapter 25 for the housing fund. The new Chapter 25, "Housing Fund," is published herein as ARC 7812A.

A public hearing was held on January 6, 1998. No comments concerning the proposed rules were received from the public. The final rules are identical to those published under Notice of Intended Action.

These amendments are intended to implement Iowa Code section 15.108(1)"a."

These amendments will become effective March 18, 1998.

The following amendments are adopted.

ITEM 1. Amend rule 261--23.11(15), introductory paragraph, as follows:

261--23.11(15) Requirements for the housing set-aside program. Specific requirements for the housing set-aside program are listed separately at 261--Chapter 25, Housing Fund.

ITEM 2. Rescind subrules 23.11(1) to 23.11(8).

ARC 7812A

Notice of Intended Action was published in the Iowa Administrative Bulletin as ARC 7705A on December 17, 1997. The IDED Board adopted the new chapter on January 22, 1998.

The rules consolidate housing fund requirements into one chapter to make it easier for housing fund applicants to locate housing fund information.

A public hearing was held on January 6, 1998. No comments concerning the proposed rules were received from the public. The final rules are identical to those published under Notice of Intended Action.

These rules are intended to implement Iowa Code section 15.108(1)"a."

These rules will become effective on March 18, 1998.

EDITOR'S NOTE: Pursuant to recommendation of the Administrative Rules Review Committee published in the Iowa Administrative Bulletin, September 10, 1986, the text of these rules [Ch 25] is being omitted. These rules are identical to those published under Notice as ARC 7705A, IAB 12/17/97.

ARC 7792A

These amendments combine two Notices of Intended Action. The Council on Human Services adopted these amendments January 14, 1998. Notices of Intended Action regarding these amendments were published in the Iowa Administrative Bulletin on November 19, 1997, as ARC 7657A, and on December 3, 1997, as ARC 7678A. ARC 7678A was previously Adopted and Filed Emergency and published in the December 3, 1997, Iowa Administrative Bulletin as ARC 7679A.

The amendments noticed as ARC 7657A revise Medicaid reimbursement policies for chiropractors.

Under current policy, Medicaid only pays chiropractors for manual manipulation of the spine. In 1997, the American Medical Association expanded the procedural code for chiropractors for manual manipulation of the spine from one to three codes, based on the number of regions of the spine being manipulated. An additional chiropractic manipulative therapy code for extra spinal manipulation was established but it is not currently recognized by Medicare as eligible for reimbursement. Medicare has predicted a 15 percent increase in chiropractic reimbursement with implementation of the new codes. These amendments adopt the new procedural codes.

In order to maintain budget neutrality, these amendments also restrict payment for manual manipulation of the spine to manipulations done for the purpose of correcting a subluxation demonstrated by X-ray which has resulted in a neuromusculoskeletal condition as defined below. Subluxation means an incomplete dislocation, off-centering, misalignment, fixation, or abnormal spacing of the vertebrae. No other diagnostic or therapeutic service furnished by a chiropractor is covered under the Medicaid program.

The subluxation must have resulted in a neuromusculo-skeletal condition for which chiropractic manipulative therapy (CMT) is appropriate treatment. The symptoms must be directly related to the subluxation that has been diagnosed. The mere statement or diagnosis of "pain" is not sufficient to support the medical necessity of CMT. CMT must have a direct therapeutic relationship to the patient's condition. The neuromusculoskeletal conditions generally require short-term, moderate-term, or long-term CMT depending on the category of the neuromusculoskeletal condition. If the CMT utilization guidelines are exceeded, documentation supporting the medical necessity of additional CMT must be submitted with the Medicaid claim form or the claim will be denied for failure to provide information.

The Iowa Chiropractic Society has been involved in the development of these rules.

The amendments noticed as ARC 7678A revise Medicaid reimbursement policies for federally qualified health centers (FQHCs) and rural health clinics (RHCs).

State Medicaid programs are required to cover ambulatory services that are furnished by FQHCs and RHCs. Medicaid payments for these services must be equal to 100 percent of the facilities' reasonable costs for providing the services. If an FQHC enters into a contract with a health maintenance organization (HMO) that contracts with a state Medicaid program, the HMO must pay the FQHC 100 percent of reasonable costs and the state's capitation payment to the HMO must reflect the 100 percent rate that is due the FQHC.

Section 4714 of the Balanced Budget Act of 1997 phases out the 100 percent requirement. Instead, states must pay at least 95 percent of reasonable costs for services furnished during federal fiscal year (FFY) 2000, at least 90 percent for FFY 2001, at least 85 percent for FFY 2002, and at least 70 percent for FFY 2003.

Section 4712 of the Act established two transitional provisions with an effective date of October 1, 1997. These amendments implement those transitional provisions.

1. In the case of services furnished by an FQHC or RHC pursuant to a contract with a managed care organization, states must make a supplemental payment to the center or clinic at least quarterly in an amount equal to the difference between the contracted amount and the cost-based amount. The first quarterly payment will be made by the Department in January 1998.

2. In the case of a contract between an FQHC or RHC and a managed care organization, the organization shall provide payment that is not less than the amount of payment that it would make for the services if furnished by a provider other than an FQHC or RHC. This provision shall be implemented retroactively for any services furnished on or after October 1, 1997.

There are currently 5 HMOs contracting with Iowa Medicaid. There are 3 FQHCs and 126 RHCs. Up to this point in time, the tendency has been for the HMOs to contract with the physicians in the FQHCs and RHCs, rather than with the FQHCs and RHCs themselves.

The following revisions were made to ARC 7657A:

Rule 441--78.8(249A) was revised to add a sentence which was in the rule which is being rescinded to clarify that payment will be made for the same chiropractic procedures payable under Medicare at the request of the Iowa Chiropractic Society.

Subrule 78.8(3) was revised to remove two sentences regarding the X-ray requirement for treatment of additional areas of the spine following interpretation from Medicare staff.

Subrule 79.1(2) was revised to correct the upper payment limit for chiropractors to be the fee schedule in effect April 1, 1998, the effective date of these amendments.

No revisions were made to ARC 7678A.

These amendments are intended to implement Iowa Code section 249A.4.

These amendments shall become effective April 1, 1998, at which time the Adopted and Filed Emergency rules (ARC 7679A) are hereby rescinded.

The following amendments are adopted.

ITEM 1. Rescind rule 441--78.8(249A) and insert the following new rule in lieu thereof:

441--78.8(249A) Chiropractors. Payment will be made for the same chiropractic procedures payable under Title XVIII of the Social Security Act (Medicare).

78.8(1) Covered services. Chiropractic manipulative therapy (CMT) eligible for reimbursement is specifically limited by Medicaid to the manual manipulation (i.e., by use of the hands) of the spine for the purpose of correcting a subluxation demonstrated by X-ray. Subluxation means an incomplete dislocation, off-centering, misalignment, fixation, or abnormal spacing of the vertebrae.

78.8(2) Indications and limitations of coverage.

a. The subluxation must have resulted in a neuromusculoskeletal condition set forth in the table below for which CMT is appropriate treatment. The symptoms must be directly related to the subluxation that has been diagnosed. The mere statement or diagnosis of "pain" is not sufficient to support the medical necessity of CMT. CMT must have a direct therapeutic relationship to the patient's condition. No other diagnostic or therapeutic service furnished by a chiropractor is covered under the Medicaid program.

ICD-9	CATEGORY I	ICD-9	CATEGORY II	ICD-9	CATEGORY III
307.81	Tension headache	353.0	Brachial plexus lesions	721.7	Traumatic spondylopathy
721.0	Cervical spondylosis without myelopathy	353.1	Lumbosacral plexus lesions	722.0	Displacement of cervical intervertebral disc without myelopathy
721.2	Thoracic spondylosis without myelopathy	353.2	Cervical root lesions, NEC	722.10	Displacement of lumbar intervertebral disc without myelopathy
721.3	Lumbosacral spondylosis without myelopathy	353.3	Thoracic root lesions, NEC	722.11	Displacement of thoracic intervertebral disc without myelopathy
723.1	Cervicalgia	353.4	Lumbosacral root lesions, NEC	722.4	Degeneration of cervical intervertebral disc
724.1	Pain in thoracic spine	353.8	Other nerve root and plexus disorders	722.51	Degeneration of thoracic or thoracolumbar intervertebral disc
724.2	Lumbago	719.48	Pain in joint (other specified sites, must specify site)	722.52	Degeneration of lumbar or lumbosacral intervertebral disc
724.5	Backache, unspecified	720.1	Spinal enthesopathy	722.81	Post laminectomy syndrome, cervical region
784.0	Headache	722.91	Calcification of intervertebral cartilage or disc, cervical region	722.82	Post laminectomy syndrome, thoracic region
		722.92	Calcification of intervertebral cartilage or disc, thoracic region	722.83	Post laminectomy syndrome, lumbar region
		722.93	Calcification of intervertebral cartilage or disc, lumbar region	724.3	Sciatica
		723.0	Spinal stenosis in cervical region
		723.2	Cervicocranial syndrome
		723.3	Cervicobrachial syndrome
		723.4	Brachial neuritis or radiculitis, NOC
		723.5	Torticollis, unspecified
		724.01	Spinal stenosis, thoracic region
		724.02	Spinal stenosis, lumbar region
		724.4	Thoracic or lumbosacral neuritis or radiculitis
		724.6	Disorders of sacrum, ankylosis
		724.79	Disorders of coccyx, coccygodynia
		724.8	Other symptoms referable to back, facet syndrome
		729.1	Myalgia and myositis, unspecified
		729.4	Fascitis, unspecified
		738.40	Acquired spondylolisthesis
		756.12	Spondylolisthesis
		846.0	Sprains and strains of sacroiliac region, lumbosacral (joint; ligament)
		846.1	Sprains and strains of sacroiliac region, sacroiliac ligament
		846.2	Sprains and strains of sacroiliac region, sacrospinatus (ligament)
		846.3	Sprains and strains of sacroiliac region, sacrotuberous (ligament)
		846.8	Sprains and strains of sacroiliac region, other specified sites of sacroiliac region
		847.0	Sprains and strains, neck
		847.1	Sprains and strains, thoracic
		847.2	Sprains and strains, lumbar
		847.3	Sprains and strains, sacrum
		847.4	Sprains and strains, coccyx

b. The neuromusculoskeletal conditions listed in the table in paragraph "a" generally require short-, moderate-, or long-term CMT. A diagnosis or combination of diagnoses within Category I generally requires short-term CMT of 12 per 12-month period. A diagnosis or combination of diagnoses within Category II generally requires moderate-term CMT of 18 per 12-month period. A diagnosis or combination of diagnoses within Category III generally requires long-term CMT of 24 per 12-month period. For diagnostic combinations between categories, 28 CMTs are generally required per 12-month period. If the CMT utilization guidelines are exceeded, documentation supporting the medical necessity of additional CMT must be submitted with the Medicaid claim form or the claim will be denied for failure to provide information.

c. CMT is not a covered benefit when:

(1) The maximum therapeutic benefit has been achieved for a given condition.

(2) There is not a reasonable expectation that the continuation of CMT would result in improvement of the patient's condition.

(3) The CMT seeks to prevent disease, promote health and prolong and enhance the quality of life.

78.8(3) Documenting X-ray. An X-ray must document the primary regions of subluxation being treated by CMT.

The documenting X-ray must be taken at a time reasonably proximate to the initiation of CMT. An X-ray is considered to be reasonably proximate if it was taken no more than 12 months prior to or 3 months following the initiation of CMT. X-rays need not be repeated unless there is a new condition. No X-ray is required for pregnant women and for children aged 18 and under.

The X-ray films shall be labeled with the patient's name and date the X-rays were taken and shall be marked right or left. The X-ray shall be made available to the department or its duly authorized representative when requested. A written and dated X-ray report, including interpretation and diagnosis, shall be present in the patient's clinical record.

This rule is intended to implement Iowa Code section 249A.4.

ITEM 2. Amend subrule 79.1(2), provider categories of Chiropractors, Federally qualified health centers, and Rural health clinics, as follows:

Provider category	Basis of reimbursement	Upper limit
Chiropractors	Fee schedule	Fee schedule in effect 6/30/90 plus 2% 4/1/98
Federally qualified health centers (FQHC)	Retrospective cost-related	1. Reasonable cost as determined by Medicare cost reimbursement principles 2. In the case of services provided pursuant to a contract between an FQHC and a managed care organization (MCO), reimbursement from the MCO shall be supplemented to achieve "1" above
Rural health clinics (RHC)	Retrospective cost-related	Medicare upper limits 1. Reasonable cost as determined by Medicare cost reimbursement principles 2. In the case of services provided pursuant to a contract between an RHC and a managed care organization (MCO), reimbursement from the MCO shall be supplemented to achieve "1" above

ITEM 3. Amend 441--Chapter 88, Division I, by adding the following new rule:

441--88.14(249A) Contracts with federally qualified health centers (FQHCs) and rural health clinics (RHCs). In the case of services provided pursuant to a contract between an FQHC or RHC and a managed care organization, the organization shall provide payment to the FQHC or RHC that is not less than the amount of payment that it would make for the services if furnished by a provider other than an FQHC or RHC. The payment from the managed care organization to the FQHC or RHC shall be supplemented by a direct payment from the department to the FQHC or RHC to provide reasonable cost reimbursement as determined by Medicare cost reimbursement principles.

ARC 7793A

The Council on Human Services adopted these amendments January 14, 1998. Notice of Intended Action regarding these amendments was published in the Iowa Administrative Bulletin on September 10, 1997, as ARC 7478A.

These amendments implement the following changes to policy governing child day care centers:

* The chapter is revised for organizational clarity and to incorporate Iowa Code changes omitted in prior revisions.

* A requirement is added for an annual unannounced visit by the child care consultant.

* Standards that are more outcome-based are incorporated, where appropriate. These changes begin a process of shifting rules from a less prescriptive nature, keeping in step with the state's desire for more outcome-oriented processes and flexibility at the local level. Providers are allowed greater flexibility in meeting requirements, particularly in the areas of administration, records, facilities, and equipment. Rules that assist the provider in attending to the health and safety needs of children or that foster the overall well-being of preschool-age children, such as ratio, qualifications, and infant environment, remain prescriptive.

* Staff qualifications and requirements are revised. Categories of staff, namely center director and on-site supervisor, are distinguished for the purposes of outlining education, experience and training requirements that may be easier to achieve by all providers, urban and rural, and that ensure that staff in supervisory or lead roles are more experienced or better educated.

* Staff training requirements are expanded for center directors and on-site supervisors and training requirements are distinguished for staff that work more or less than 20 hours a week and those that work in centers that offersummer-only programs. Training in universal precautions and infectious disease control is added for all staff. The hours of training required to be received in self-study or in a group setting are outlined.

* The staff ratio requirements are revised although the staff-to-child ratio for all age groups will remain unchanged. The changes allow the ratio in combined age groups to be determined by the age of the majority of the children rather than the age of the youngest child unless children three years of age or under are included. Allowing staffing by majority of age in combined groups is consistent with preschool standards. The changes allow a reduced staff ratio at the beginning and end of the center's hours of operation when only a few children may remain in the center and allow the provider to be over the staff ratio for school-age children for less than four hours when inclement weather or structural damage results in a late start or early school dismissal.

* A parent satisfaction survey is added. Providers are required, if requested by the Department, to assist the Department in conducting an annual survey of parents. Incorporating a parent survey allows another quality assurance monitor, as parents are the only outside entity in a center on a daily basis. Use of the survey will assist in the public education of quality environments. As parents become more knowledgeable about developmentally appropriate and safe practices and in selecting quality providers, the market should respond, in part, as a matter of economic interest.

* Requirements for volunteers are adjusted. The criminal and child abuse record checks will be required on all volunteers included in the staff ratio (current policy requires checks when they volunteer more than ten hours).

* The requirements for submitting physical examinations are adjusted to require that school-age children submit an annual statement of health condition as verified by the parent. An annual physical examination submitted within 30 days of admission remains a requirement for preschool-age children.

* Requirements are added for facility testing and resolution for lead-based paint, radon, and carbon monoxide.

* Microwaves are reinstated in the program areas and as a means of warming infant food. This change is being made at the request of many providers and child care consultants.

* The bathtub requirement is removed for centers offering night care, as bathing is a parental responsibility.

Eight public hearings were held around the state. One hundred fifty persons attended the hearings and extensive written comments were received.

The following revisions were made to the Notice of Intended Action in response to public comments unless otherwise noted:

Subrule 109.4(2), paragraph "c," and subrule 109.12(1), introductory paragraph and paragraph "a," were revised by adding the words "or program structure" or "or program of activities" for clarification.

Subrule 109.4(2), paragraph "f," was revised to require a copy of the fee policies and financial agreements be given to the parents.

Subrule 109.4(3), paragraphs "a" and "b," were revised to change the grammatical structure. Paragraph "b" was further revised to cross-reference the subrule requiring the handbook.

Subrule 109.5(2) was revised to add language to clarify the intent of the parental evaluation.

Subrules 109.6(1) and 109.6(2), introductory paragraphs, were revised to clarify that final determination of whether the center director meets requirements rests with the Department.

Subrules 109.6(1), paragraph "d," and 109.6(2), paragraph "c," were revised to clarify the certification in CPR.

The experience charts in subrules 109.6(1), paragraph "e," and 109.6(2), paragraph "d," were revised to clarify that the experience listed in the chart is per week and to add the various types of home day care as qualifying experience. A nursing degree was also added as qualifying experience in centers serving children with disabilities.

The postsecondary education charts in subrules 109.6(1), paragraph "e," and 109.6(2), paragraph "d," were revised to add a bachelor's degree in a child-related field to be equivalent to an associate degree in determining points.

Subrule 109.6(2), introductory paragraph, was revised by adding the phrase "that children are present" to clarify when the on-site supervisor must be on site during the hours of operation.

Subrule 109.6(3) was revised to clarify temporary absence of an on-site supervisor.

Subrule 109.6(4) regarding requirements for child care lead teachers was deleted and subsequent subrules were renumbered. In general, people were supportive of requirements for lead teachers but there was some disagreement on the standards and confusion as to how they will be applied to the various programs. Further input will be sought and this area will be renoticed for further comments at a later date.

Renumbered subrule 109.6(4) was revised to make the transition period agree with the effective date of the rules.

Renumbered subrule 109.6(5), paragraph "b," subparagraph (3), was revised to clarify that mandatory training for volunteers included in the staff ratio must be completed within six months from the initial date the person served as a volunteer. In addition, an exemption was added for persons volunteering or substituting two times or less in a calendar year providing they sign a statement indicating they have been informed of their responsibilities as a mandatory reporter.

Renumbered subrule 109.6(6) was revised to correct a typographical error. A phrase was repeated twice.

Subrules 109.7(1), paragraph "b," and 109.7(4), paragraph "b," were revised to require only one hour of training in universal precautions to be consistent with OSHA requirements.

Subrules 109.7(2), paragraph "a," subparagraphs (1) and (2), and 109.7(4), paragraphs "c" and "d," were revised to eliminate a specified time frame for the required certificates.

Subrules 109.7(2), paragraph "a," subparagraph (2), and 109.7(4), paragraph "d," were revised to clarify that training for first-aid certification may be from other than the organizations listed as long as a nationally recognized curriculum is used.

Subrule 109.7(2), paragraph "a," subparagraphs (4) and (5), and paragraph "b," subparagraphs (2) and (3), were revised by removing the phrase "outside the center."

Subrule 109.7(2), paragraph "b," subparagraph (3), was revised to lower the number of contact hours required from ten to eight and specify a portion of the training which can be in self-study.

Subrule 109.8(2), paragraph "a," was revised to allow staff ratio to be determined only on the age of the majority of the children in the group for children four years of age and older instead of three years of age and older and to clarify that preschools may still include three-year-olds. Paragraph "b" was revised to clarify the staff ratio.

Subrule 109.8(2), paragraph "f," was revised to clarify that when a center contracts to provide transportation, an additional staff person is not required for the purpose of transporting school-age children to or from school. Paragraph "i" was revised to add preschools and to add staff ratio allowances for structural damage and inclement weather for late starts and early dismissals.

Subrule 109.9(1), paragraph "f," was revised to provide that a photocopy of a valid driver's license from any state may be included in the personnel record.

Subrule 109.10(1), paragraph "b," was revised to eliminate the annual physical requirement for school-age children and add an annual statement of health status submitted by the parents.

Subrule 109.10(5) was revised to clarify that universal precautions must also be used for blood and breast milk.

Subrule 109.10(7), paragraph "e," was revised to clarify that staff do not need to wash their hands before and after administering first aid if gloves are worn.

Subrule 109.10(8) was revised for grammatical clarity.

Subrule 109.10(10) was revised to add clarity to the reporting of incidents.

Subrule 109.10(12) was revised to provide that children under the age of 12, rather than under the age of 6, shall not be in the front seat of a vehicle; to require drivers of vehicles to possess any valid driver's license, rather than just an Iowa license; and to add nonprescription drugs to the list of substances that could impair a person's ability to drive.

Subrule 109.10(14) was revised to expand the list of prohibited pets and the areas where pets are not allowed.

Subrule 109.11(2) was revised to clarify the age of children who must remain outside the infant area.

Subrule 109.11(3), paragraph "e," was revised to clarify exemptions relating to facility requirements for centers operating in a school building.

Subrule 109.11(4) was revised in response to staff comments to require new construction after April 1, 1998, to have at least one sink provided in the program rooms for infants and toddlers.

Subrule 109.11(7), paragraph "b," was revised to specify the requirements for radon testing and mitigation procedures in response to comments from the Department of Public Health.

Subrule 109.11(7), paragraph "c," requiring assessment of asbestos and education on asbestos was deleted, paragraph "d" was relettered as paragraph "c," and a new paragraph "d" was added exempting centers operating before and after school programs and summer-only programs that serve only school-age children and that operate in a public school building from testing for lead, radon, and carbon monoxide.

Subrule 109.12(4) was revised to clarify that parental provision of items for oral hygiene is permitted and not mandatory.

Subrule 109.14(1), paragraph "b," was revised to clarify when a nurse is required to be on duty in get well centers and the supervision of an LPN in response to comments from the Board of Nursing.

Subrule 109.15(3), paragraph "b," was revised to clarify feeding requirements of children under six months of age. Paragraphs "c" and "d" were revised to correct milk requirements in response to comments from the Department of Public Health.

These amendments are intended to implement Iowa Code section 232.69 and chapter 237A.

These amendments shall become effective April 1, 1998.

The following amendments are adopted.

Rescind 441--Chapter 109 and adopt the following new chapter in lieu thereof:

The intent of this chapter is to specify minimum requirements for licensed child care centers and preschools and to define those child-caring environments that are governed by the licensing standards. The licensing standards govern licensing procedures, administration, parental participation, personnel, records, health and safety policies, physical facilities, activity programs, and food services.

441--109.1(237A) Definitions.

"Adult" means a person 18 years of age or older.

"Child" means a person under 18 years of age receiving care at a child care center.

"Child care center" or "center" means a facility providing child day care for seven or more children, except when the facility is registered as a family day care home or group day care home. For the purposes of this chapter, the word "center" shall apply to a child care center or preschool, unless otherwise specified.

"Child day care" or "child care" means the care, supervision, or guidance of a child by a person other than the parent, guardian, relative or custodian for periods of less than 24 hours per day per child on a regular basis in a place other than the child's home, but does not include care, supervision, or guidance of a child by any of the following:

1. An instructional program administered by a public or nonpublic school system accredited by the department of education or the state board of regents or a program provided under Iowa Code section 279.49 or 280.3A.

2. A church-related instructional program of not more than one day per week.

3. Short-term classes held between school terms.

4. A child care center for sick children operated as part of a pediatrics unit in a hospital licensed by the department of inspections and appeals pursuant to Iowa Code chapter 135B.

5. A nonprofit program operated by volunteers for no charge for not more than 2 hours during any 24-hour period.

6. A program provided by the state or a political subdivision, which provides recreational classes for a period of less than two hours per day.

7. A program administered by a political subdivision of the state which is primarily for recreational or social purposes and is limited to children who are five years of age or older and attending school.

8. An instructional program administered by a nonpublic school system which is not accredited by the department of education or the state board of regents.

"Department" means the department of human services.

"Extended evening care" means child care provided by a child care center between the hours of 9 p.m. and 5 a.m.

"Facility" means a building or physical plant established for the purpose of providing child day care.

"Get-well center" means a facility that cares for a child with an acute illness of short duration for short enrollment periods.

"National Health and Safety Performance Standards" means the National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs produced by the American Public Health Association and the American Academy of Pediatrics with the support of the Maternal and Child Health Bureau, Department of Health and Human Services.

"Parent" means parent or legal guardian.

"Preschool" means a child day care facility which provides care to children aged three through five, for periods of time not exceeding three hours per day. The preschool's program is designed to help the children develop intellectual, social and motor skills, and to extend their interest in and understanding of the world about them.

441--109.2(237A) Licensure procedures.

109.2(1) Application for license.

a. Any adult or agency has the right to make application for a license. The application for a license shall be made to the regional office of the department on Form 470-0722, Application for a License to Operate a Child Care Center, provided by the department.

b. Requested reports including the fire marshal's report and other information relevant to the licensing determination shall be furnished to the department upon application and renewal. A building owned or leased by a school district or accredited nonpublic school that complies with rules adopted by the state fire marshal for school buildings under 661--Chapter 5 is considered appropriate for use by a child care facility.

c. When a center makes a sufficient application for an initial or renewal license, it may operate for a period of up to 120 days, pending a final licensing decision. A sufficient application shall include the following:

(1) An application for a license has been submitted to the regional office.

(2) An approved fire marshal's report has been submitted to the regional office.

(3) A floor plan has been submitted to the regional office indicating room descriptions and dimensions, including the location of windows and doors.

(4) Information sufficient to determine that the center director meets minimum personnel qualifications shall be submitted to the regional office.

d. Applicants shall be notified of approval or denial within 120 days from the date the application is submitted.

109.2(2) License.

a. An applicant showing full compliance with center licensing laws and these rules, including department approval of center plans and procedures, shall be issued a license for one year. The department shall conduct at least one unannounced visit during each licensing year. In determining whether or not a center is in compliance with the intent of a licensing standard outlined in this chapter, the department shall make the final decision.

b. A new license shall be applied for when the center moves, expands, or the facility is remodeled to change licensed capacity.

c. A new license shall be applied for when another adult or agency assumes ownership or legal responsibility for the center.

109.2(3) Provisional license.

a. A provisional license may be issued for a period up to one year when the center does not meet all standards imposed by law or these rules.

b. A provisional license shall be renewable when written plans giving specific dates for completion to bring the center up to standards are submitted to and approved by the department.

c. When the center submits documentation or it can otherwise be verified that the center fully complies with all standards imposed by law or these rules, the license shall be upgraded to a full license.

109.2(4) Denial. Initial applications or renewals shall be denied when:

a. The center does not comply with center licensing laws and these rules in order to qualify for a full or provisional license.

b. The center is operating in a manner which the department determines impairs the safety, health, or well-being of children in care.

c. The owner, director, or a staff member with direct responsibility for child care or with access to a child when the child is alone, including staff who perform duties under a subcontract with the center, who will have access to a child, or anyone living in the child care center has one or more convictions of any crime in any state, or one or more founded abuse reports that merit prohibition of licensure as determined by the department.

d. Information provided either orally or in writing to the department or contained in the center's files is shown to have been falsified by the provider or with the provider's knowledge.

e. The center is not able to obtain an approved fire marshal's certificate as prescribed by the state fire marshal in 661--Chapter 5 or Iowa Code chapter 100 or fails to comply in correcting or repairing any deficiencies in the time determined by the fire marshal or the fire marshal determines the facility is not safe for occupancy.

109.2(5) Revocation and suspension. A license shall be revoked or suspended if corrective action has not been taken when:

a. The center does not comply with center licensing laws or these rules.

b. The center is operating in a manner which the department determines impairs the safety, health, or well-being of the children in care.

c. The owner, director, or a staff member with direct responsibility for child care or with access to a child when the child is alone, including staff who perform duties under a subcontract with the center, who will have access to a child, or anyone living in the child care center has one or more convictions of any crime in any state, or one or more founded abuse reports that merit prohibition of licensure as determined by the department.

d. Information provided to the department or contained in the center's files is shown to have been falsified by the provider or with the provider's knowledge.

e. The facility is not able to obtain an approved fire marshal's certificate as prescribed by the state fire marshal in 661--Chapter 5 or Iowa Code chapter 100 or fails to comply in correcting or repairing any deficiencies in the time determined by the fire marshal or the fire marshal determines the facility is not safe for occupancy.

109.2(6) Adverse actions.

a. Notice of adverse actions for a denial, revocation, or suspension and the right to appeal the licensing decision shall be given to applicants and licensees in accordance with 441--Chapter 7.

b. An applicant or licensee affected by an adverse action may request a hearing by means of a written request directed to the county office, regional office, or central office of the department within 30 days after the date the official notice was mailed containing the nature of the denial, revocation, or suspension.

c. A letter received by an owner or director of a licensed center initiating action to deny, suspend, or revoke the facility's license shall be conspicuously posted at the main entrance to the facility where it can be read by parents or any member of the public. The letter shall remain posted until resolution of the action to deny, suspend or revoke the license. If the action to deny, suspend, or revoke is upheld, the center shall return the license to the department.

d. If the center's license is denied, suspended or revoked, the department shall notify the parent, guardian, or legal custodian of each child for whom the facility provides child care. The center shall cooperate with the department in providing the names and address of the parent, guardian, or legal custodian of each child for whom the facility provides child care.

441--109.3(237A) Complaint file. A record of all unsubstantiated complaints received shall be kept by the department in a closed file, and there shall be documented resolutions of all complaints. Contents of this file shall be available to the owner or director of the center except that disclosure of the identity of the complainant shall be withheld unless expressly waived by the complainant. A record of all substantiated complaints and licensing violations shall be kept by the department in the licensing file and shall be available to the public upon request, except that disclosure of the identity of the complainant shall be withheld unless expressly waived by the complainant. Findings of any licensing violations shall be summarized in the licensing file.

441--109.4(237A) Administration.

109.4(1) Purpose and objectives. Incorporated and unincorporated centers shall submit a written statement of purpose and objectives. The plan and practices of operation shall be consistent with this statement.

109.4(2) Required written policies. The child care center owner, board or director shall:

a. Develop fee policies and financial agreements for the children served.

b. Develop and implement policies for enrollment and discharge of children, field trips and non-center activities, transportation, discipline, nutrition, and health and safety policies.

c. Develop a curriculum or program structure that uses developmentally appropriate practices and an activity program appropriate to the developmental level and needs of the children.

d. Develop and implement a written plan for staff orientation to the center's policies and to the provisions of 441--Chapter 109 where applicable to staff.

e. Develop and implement a written plan for ongoing training and staff development in compliance with professional growth and development requirements established by the department in rule 441--109.7(237A).

f. Make available for review a copy of the center policies and program to all staff at the time of employment and each parent at the time a child is admitted to the center. A copy of the fee policies and financial agreements shall be provided to each parent at the time a child is admitted to the center.

109.4(3) Required postings.

a. Postings are required for the certificate of license, notice of exposure of children to a communicable disease, and notice of actions to deny, suspend, or revoke the center's license and shall be conspicuously placed at the main entrance to the center. If the center is located in a building used for additional purposes and shares the main entrance to the building, the required postings shall be conspicuously placed in the center in an area that is frequented daily by parents or the public.

b. Postings are required for mandatory reporter requirements, the notice of availability of the handbook required in subrule 109.4(5), and the program activities and shall be placed in an area that is frequented daily by parents or the public.

109.4(4) Mandatory reporters. Requirements and procedures for mandatory reporting of suspected child abuse as defined in Iowa Code section 232.69 shall be posted where they can be read by staff and parents. Methods of identifying and reporting suspected child abuse and neglect shall be discussed with all staff within 30 days of employment.

109.4(5) Handbook. A copy of Form SS-0711, Child Care Centers and Preschools Licensing Standards and Procedures, shall be available in the center, and a notice stating that a copy is available for review upon request from the center director shall be conspicuously posted. The name, office mailing address and telephone number of the child care consultant shall be included in the notice.

109.4(6) Certificate of license. The child care license shall be posted in a conspicuous place and shall state the particular premises in which child care may be offered and the number of children who may be cared for at any one time. Notwithstanding the requirements in rule 441-- 109.8(237A), no greater number of children than is authorized by the license shall be cared for at any one time.

441--109.5(237A) Parental participation.

109.5(1) Unlimited access. Parents shall be afforded unlimited access to their children and to the provider caring for their children during the center's hours of operation or whenever their children are in the care of a provider, unless parental contact is prohibited by court order. The provider shall inform all parents of this policy in writing at the time the child is admitted to the center.

109.5(2) Parental evaluation. If requested by the department, centers shall assist the department in conducting an annual survey of parents being served by their center by providing to parents Form 470-3409, Parent Survey: Child Care Centers. The department shall notify centers of the time frames for distribution and completion of the survey and the procedures for returning the survey to the department. The purpose of the survey shall be to increase parents' understanding of developmentally appropriate and safe practice, solicit statewide information regarding parental satisfaction with the quality of care being provided to children and obtain the parents' perspective regarding the center's compliance with licensing requirements.

441--109.6(237A) Personnel. The board or director of the center shall develop policies for hiring and maintaining staff that demonstrate competence in working with children and that meet the following minimum requirements:

109.6(1) Center director requirements. Centers that have multiple sites shall have a center director or on-site supervisor in each center. The center director is responsible for the overall functions of the center, including supervising staff, designing curriculum and administering programs. The director shall ensure services are provided for the children within the framework of the licensing requirements and the center's statement of purpose and objectives. The center director shall have overall responsibility for carrying out the program and ensuring the safety and protection of the children. Information shall be submitted in writing to the child care consultant prior to the start of employment. Final determination shall be made by the department. Information shall be submitted sufficient to determine that the director meets the following minimum qualifications:

a. Is at least 21 years of age.

b. Has obtained a high school diploma or passed a general education development test.

c. Has completed at least one course in business administration or 12 contact hours in administrative-related training related to personnel, supervision, record keeping, or budgeting or has one year of administrative-related experience.

d. Has certification in infant, child, and adult cardiopulmonary resuscitation (CPR), first aid, and Iowa's training for the mandatory reporting of child abuse.

e. Has achieved a total of 100 points obtainedthrough a combination of education, experience, and childdevelopment-related training as outlined in the following chart:

EDUCATION		EXPERIENCE (Points multiplied by years of experience)		CHILD DEVELOPMENT- RELATED TRAINING
Bachelor's or higher degree in early childhood, child development, or elementary education	75	Full-time (20 hours or more per week) in a child care center or preschool setting	20	One point per contact hour of training
Associate's degree in child development or bachelor's degree in a child-related field	50	Part-time (less than 20 hours per week) in a child care center or preschool setting	10
Child development associate (CDA) or one-year diploma in child development from a community college or technical school	40	Full-time (20 hours or more per week) child development-related experience	10
Bachelor's degree in a non- child- related field	40	Part-time (less than 20 hours per week) child development-related experience	5
Associate's degree in a non- child-related field or completion of at least two years of a four-year degree	20	Registered family day care home, group day care home, or group day care home-joint registration provider	10
		Nonregistered family home provider	5

(1) In obtaining the total of 100 points, a minimum of two categories must be used, no more than 75 points may be achieved in any one category, and at least 20 points shall be obtained from the experience category.

(2) Points obtained in the child development-related training category shall have been taken within the past five years.

(3) For directors in centers predominantly serving children with special needs, the directors may substitute adisabilities-related or nursing degree for the bachelor's degree in early childhood, child development or elementary education in determining point totals. In addition, experience in working with children with special needs in an administrative or direct care capacity shall be equivalent to full-time experience in a child care center or preschool in determining point totals.

(4) For directors in centers serving predominantly school-age children, the directors may substitute a degree in secondary education, physical education, recreation or related fields for the bachelor's degree in early childhood, child development or elementary education in determining point totals. In addition, child-related experience working with school-age children shall be equivalent to full-time experience in a child care center or preschool in determining point totals.

109.6(2) On-site supervisor. The on-site supervisor is responsible for the daily supervision of the center and must be on site daily either during the hours of operation that children are present or a minimum of eight hours of the center's hours of operation. Information shall be submitted in writing to the child care consultant prior to the start of employment. Final determination shall be made by the department. Information shall be submitted sufficient to determine that the on-site supervisor meets the following minimum qualifications:

a. Is an adult.

b. Has obtained a high school diploma or passed a general education development test.

c. Has certification in infant, child, and adult cardiopulmonary resuscitation (CPR), first aid, and Iowa's mandatory reporting of child abuse.

d. Has achieved a total of 75 points obtained through a combination of education, experience, and childdevelopment-related training as outlined in the following chart:

EDUCATION		EXPERIENCE (Points multiplied by years of experience)		CHILD DEVELOPMENT- RELATED TRAINING
Bachelor's or higher degree in early childhood, child development, or elementary education	75	Full-time (20 hours or more per week) in a child care center or preschool setting	20	One point per contact hour of training
Associate's degree in child development or bachelor's degree in a child-related field	50	Part-time (less than 20 hours per week) in a child care center or preschool setting	10
Child development associate (CDA) or one-year diploma in child development from a community college or technical school	40	Full-time (20 hours or more per week) child development-related experience	10
Bachelor's degree in a non- child-related field	40	Part-time (less than 20 hours per week) child development-related experience	5
Associate's degree in a non-child- related field or completion of at least two years of a four-year degree	20	Registered family day care home, group day care home, or group day care home-joint registration provider	10
		Nonregistered family home provider	5

(1) In obtaining the total of 75 points, a minimum of two categories must be used, no more than 50 points may be achieved in any one category, and at least 10 points shall be obtained from the experience category.

(2) Points obtained in the child development-related training category shall have been taken within the past five years.

(3) For on-site supervisors in centers predominantly serving children with special needs, the on-site supervisor may substitute a disabilities-related or nursing degree for the bachelor's degree in early childhood, child development or elementary education in determining point totals. In addition, experience in working with children with special needs in an administrative or direct care capacity shall be equivalent to full-time experience in a child care center or preschool in determining point totals.

(4) For on-site supervisors in centers serving predominantly school-age children, the on-site supervisor may substitute a degree in secondary education, physical education, recreation or related fields for the bachelor's degree in early childhood, child development or elementary education in determining point totals. In addition, child-related experience working with school-age children shall be equivalent to full-time experience in a child care center or preschool in determining point totals.

109.6(3) Director and on-site supervisor functions combined. In a center where the functions of the center director and the on-site supervisor are accomplished by the same person, the educational and experience requirements for a center director shall apply. If the center director is serving in the role of the on-site supervisor, the director shall be on site daily either during the hours of operation or a minimum of at least eight hours of the center's hours of operation. If the staff person designated as the on-site supervisor is temporarily absent from the center, another responsible adult staff shall be designated as the interim on-site supervisor.

109.6(4) Transition period for staff. In achieving the qualifications outlined in rule 441--109.6(237A), staff hired prior to April 1, 1998, shall obtain the education, experience or child-developmental training sufficient to meet the required point totals by April 1, 1999.

109.6(5) Volunteers and substitutes.

a. All volunteers and substitutes shall sign a statement indicating whether or not they have one of the following:

(1) A conviction of any law in any state or any record of founded child abuse or dependent adult abuse in any state.

(2) A communicable disease or other health concern that could pose a threat to the health, safety, or well-being of the children.

b. When a volunteer or substitute is included in the staff ratio count, the center shall have the volunteer or substitute:

(1) Complete Form 595-1396, DHS Criminal HistoryRecord Check, Form B.

(2) Complete Form SS-1606-0, Request for Child Abuse Information.

(3) Obtain certification showing completion of a minimum of two hours of Iowa's training for mandatory reporting of child abuse within six months from the initial date the person served as a volunteer or substitute. Persons who volunteer or substitute two times or less in a calendar year shall be exempt from the two-hour training requirement and shall sign a statement indicating they have been informed of their responsibilities as a mandatory reporter.

109.6(6) Record checks and evaluations. The department shall submit record checks for each owner, director, or staff member with direct responsibility for child care or with access to a child when the child is alone, including staff who perform duties under a subcontract with the center, who will have access to a child, and anyone living in the child care facility who is 14 years of age or older to determine whether they have any founded child abuse reports or criminal convictions. Form SS-1606-0, Request for Child Abuse Information, and Form 595-1396, DHS Criminal History Record Check, Form B, shall be used for this purpose.

If there is a record of founded child abuse or a criminal conviction for the owner, director, staff member with direct responsibility for child care or with access to a child when the child is alone, including staff who perform duties under a subcontract with the center, who will have access to a child, or anyone living in the child care facility, the license shall be denied or revoked, unless an evaluation of the abuse or crime determines that the founded abuse or criminal conviction does not warrant prohibition of licensure or denial of employment. In an evaluation, the department and the employer of the person with the founded abuse or criminal conviction shall consider the nature and seriousness of the founded abuse or crime in relation to the position sought, the time elapsed since the commission of the founded abuse or crime, the circumstances under which the founded abuse or crime was committed, the degree of rehabilitation, the likelihood that the person will commit the abuse or crime again, and the number of founded abuses or crimes committed by the person. The person with the founded child abuse report or criminal conviction shall complete and return Form 470-2310, Record Check Evaluation, within ten calendar days of the date on the form to be used to assist in the evaluation. Failure of the person to complete and return the form within the specified time frame shall result in denial or revocation of the license or denial of employment.

a. If the owner, director, staff member with direct responsibility for child care or with access to a child when the child is alone, including staff who perform duties under a subcontract with the center, who will have access to a child, or anyone living in the child care facility has been convicted of a simple misdemeanor or of a serious misdemeanor that occurred five or more years prior to the application, the evaluation and decision may be made by the regional administrator or designee. The regional administrator or designee shall notify the employer and the person completing Form 470-2310, Record Check Evaluation, of the results of the evaluation using Form 470-2386, Record Check Decision.

b. If the owner, director, staff member with direct responsibility for child care or with access to a child when the child is alone, including staff who perform duties under a subcontract with the center, who will have access to a child, or anyone living in the child care facility has a founded abuse report, has been convicted of an aggravated misdemeanor or felony at any time, or has been convicted of a simple or serious misdemeanor that occurred within five years prior to application, the evaluation shall be initially conducted by the regional administrator or designee.

c. The department may permit a person who is evaluated to own, direct, be a staff member with direct responsibility for child care or with access to a child when the child is alone, or to perform duties under subcontract with the center, if the person will have access to a child, or to live in the child care facility, if the person complies with the department's conditions relating to the person's licensure, employment, or residence, which may include completion of additional training. For an employee of a center, these conditional requirements shall be developed with the center director. The department has final authority in determining whether prohibition of the person's licensure, employment, or residence is warranted and in developing any conditional requirements.

(1) If the regional administrator or designee determines that the founded abuse or crime does warrant prohibition of licensure or denial of employment, the regional administrator or designee shall notify the applicant of the results of the evaluation using Form 470-2386, Record Check Decision.

(2) If the regional administrator or designee believes that the founded abuse or criminal conviction should not warrant prohibition of licensure or denial of employment, the regional administrator or designee shall provide Form 470-2310, Record Check Evaluation, Form 470-2386, Record Check Decision, and copies of the child abuse report or criminal history record to the Department of Human Services, Administrator, Division of Adult, Children and Family Services, Hoover State Office Building, Des Moines, Iowa 50319-0114. Within 30 days the administrator shall determine whether the founded abuse or crime merits prohibition of licensure or denial of employment, and shall notify the regional administrator or designee in writing of that decision. The regional administrator or designee shall notify the owner or director of the child care center and the person on whom the evaluation and decision was completed using Form 470-2386, Record Check Decision.

d. The child abuse and criminal record checks shall be repeated a minimum of every five years or if the department or center becomes aware of any founded abuses or convictions of crimes. Any founded abuses or convictions of crimes since the last criminal record check or child abuserecord check shall be evaluated using the same process.

e. The department shall notify the parent, guardian, or legal custodian of each child for whom the person provides child care if there has been a substantiated child abuse case against an owner, director or staff of the child care center. The center shall cooperate with the department in providing the names and address of the parent, guardian, or legal custodian of each child for whom the facility provides child care.

441--109.7(237A) Professional growth and development. The center director, on-site supervisor, and staff counted as part of the staff ratio shall meet the following minimum staff training requirements:

109.7(1) Required training within the first six months of employment. During their first six months of employment, all staff shall receive the following training:

a. Two hours of Iowa's training for mandatory reporting of child abuse.

b. At least one hour of training regarding universal precautions and infectious disease control.

109.7(2) Staff employed 20 hours or more per week.

a. During their first year of employment, all staff employed 20 hours or more per week shall receive the following training:

(1) Certification in American Red Cross or American Heart Association infant, child, and adult cardiopulmonary resuscitation (CPR) or equivalent certification approved by the department. A valid certificate indicating the date of training and expiration date shall be maintained.

(2) Certification in infant, child, and adult first aid that uses a nationally recognized curriculum or is received from a nationally recognized training organization including the American Red Cross, American Heart Association, the National Safety Council, and Emergency Medical Planning (Medic First Aid) or an equivalent certification approved by the department. A valid certificate indicating the date of training and expiration date shall be maintained.

(3) Ten contact hours of training from one or more of the following topical areas: child development, guidance and discipline, developmentally appropriate practices, nutrition, health and safety, communication skills, professionalism, business practices, and cross-cultural competence. Training received for cardiopulmonary resuscitation (CPR), first aid, mandatory reporting of child abuse, and universal precautions shall not count toward the ten contact hours.

(4) At least four hours of the ten contact hours of training shall be received in a sponsored group setting. Six hours may be received in self-study using a training package approved by the department.

(5) Center directors and on-site supervisors shall receive all ten hours of training in a sponsored group setting.

(6) Staff who have completed a comprehensive training package of at least ten contact hours offered through a child care resource and referral agency or community college within six months prior to initial employment shall have the first year's ten contact hours of training waived.

b. Following their first year of employment, all staff who are employed 20 hours or more a week shall:

(1) Maintain current certification for Iowa's training for the mandatory reporting of child abuse; infant, child and adult CPR; and infant, child and adult first aid.

(2) Receive six contact hours of training annually from one or more of the following topical areas: child development, guidance and discipline, developmentally appropriate practices, nutrition, health and safety, communication skills, professionalism, business practices, and cross-cultural competence. At least two of the six contact hours shall be in a sponsored group setting.

(3) Center directors and on-site supervisors shall receive eight contact hours of training annually from the topical areas. At least four of the eight contact hours shall be in a sponsored group setting.

109.7(3) Staff employed less than 20 hours per week.

a. During their first year of employment, all staff who are employed less than 20 hours a week shall receive the following training:

(1) Five contact hours of training from one or more of the following topical areas: child development, guidance and discipline, developmentally appropriate practices, nutrition, health and safety, communication skills, professionalism, business practices, and cross-cultural competence.

(2) At least two of the five contact hours shall be in a sponsored group setting.

(3) Staff who have completed a comprehensive training package of at least ten contact hours offered through a child care resource and referral agency or community college within six months prior to initial employment shall have the five contact hours required in the first year waived.

b. Following their first year of employment, all staff who are employed less than 20 hours a week shall:

(1) Maintain current certification for Iowa's training for mandatory reporting of child abuse.

(2) Receive four contact hours of training annually from one or more of the following topical areas: child development, guidance and discipline, developmentally appropriate practices, nutrition, health and safety, communication skills, professionalism, business practices, and cross-cultural competence. At least two of the four contact hours shall be in a sponsored group setting.

109.7(4) Staff employed in centers that operate summer-only programs. Staff who are employed in centers that operate only in the summer months when school is not in session shall receive the following training:

a. Two hours of Iowa's training for mandatory reporting of child abuse.

b. At least one hour of training regarding universal precautions and infectious disease control.

c. At least one staff person on duty in the center and outdoor play area when children are present and on field trips shall have certification in American Red Cross or American Heart Association infant, child, and adult cardiopulmonary resuscitation (CPR) or equivalent certification approved by the department. A valid certificate indicating the date of training and expiration date shall be maintained.

d. At least one staff person on duty in the center and outdoor play area when children are present and on field trips shall receive certification in infant, child and adult first aid that uses a nationally recognized curriculum or is received from a nationally recognized training organization including the American Red Cross, American Heart Association, the National Safety Council, and Emergency Medical Planning (Medic First Aid) or an equivalent certification approved by the department. A valid certificate indicating the date of training and expiration date shall be maintained.

109.7(5) Training plans. Training shall supplement educational and experience requirements in rule 441-- 109.6(237A) and shall enhance the staff's skill in working with the developmental and cultural characteristics of the children served.

441--109.8(237A) Staff ratio requirements.

109.8(1) Staff requirements. Persons counted as part of the staff ratio shall meet the following requirements:

a. Be at least 16 years of age. If less than 18 years of age, the staff shall be under the direct supervision of an adult.

b. Be involved with children in programming activities.

c. At least one staff person on duty in the center and outdoor play area when children are present and present on field trips shall be over the age of 18 and hold current certification in first aid and cardiopulmonary resuscitation (CPR) as required in rule 441--109.7(237A).

109.8(2) Staff ratio. The staff-to-child ratio shall be as follows:

Age of children Minimum ratio of staff to children
Two weeks to two years	One to every four children
Two years	One to every six children
Three years	One to every eight children
Four years	One to every twelve children
Five years to ten years	One to every fifteen children
Ten years and over	One to every twenty children

a. Combinations of age groupings for children four years of age and older may be allowed and may have staff ratio determined on the age of the majority of the children in the group. If children three years of age and under are included in the combined age group, the staff ratio for children aged three and under shall be maintained for these children. Preschools shall have staff ratios determined on the age of the majority of the children, including children who are three years of age.

b. If a child between the ages of 18 and 24 months is placed outside the infant area, as defined at subrule 109.11(2), the staff ratio of 1 to 4 shall be maintained as would otherwise be required for the group until the child reaches the age of two.

c. Every child-occupied program room shall have adult supervision present in the room.

d. During nap time, at least one staff shall be present in every room where children are resting. Staff ratio requirements may be reduced to one staff per room where children are resting for a period of time not to exceed one hour provided staff ratio coverage can be maintained in the center. The staff ratio shall always be maintained in the infant area.

e. The minimum staff ratio shall be maintained at mealtimes and for any outdoor activities at the center.

f. When seven or more children over the age of three are present on the licensed premises or are being transported in one vehicle, at least two adult staff shall be present. Only one adult is required when a center is transporting children in a center-owned vehicle with parent authorization for the sole purpose of transporting children to and from school. When a center contracts with another entity to provide transportation other than for the purpose of transporting school-age children to or from school, at least one adult staff in addition to the driver shall be present if at least seven children provided care by the center are transported.

g. Any child care center-sponsored program activity involving five or more children conducted away from the licensed facility shall provide a minimum of one additional staff over the required staff ratio for the protection of the children.

h. For a period of two hours or less at the beginning or end of the center's hours of operation, one staff may care for six children or less, provided no more than two of the children are under the age of two years.

i. For centers or preschools serving school-age children, the ratio for school-age children may be exceeded for a period of no more than four hours during a day when school classes start late or are dismissed early due to inclement weather or structural damage provided the children are already enrolled at the center and the center does not exceed the licensed capacity.

441--109.9(237A) Records.

109.9(1) Personnel records. The center shall maintain personnel information sufficient to ensure that persons employed in the center meet minimum staff and training requirements and do not pose any threat to the health, safety, or well-being of the children. Each employee's file shall contain, at a minimum, the following:

a. A statement signed by each individual indicating whether or not the individual has any conviction by any law of any state or if the individual has any record of founded child abuse or dependent adult abuse.

b. A signed copy of Form 595-1396, DHS Criminal History Record Check, Form B. The form shall be completed by the center and forwarded to the department prior to the start of employment.

c. A copy of Form SS-1606-0, Request for Child Abuse Information.

d. A physical examination report. Personnel shall have good health as evidenced by a preemployment examination, including testing for communicable diseases which shall include testing for tuberculosis, performed within six months prior to beginning employment by a licensed medical doctor, doctor of osteopathy, physician's assistant or advanced registered nurse practitioner and repeated at least every three years after initial employment.

e. Documentation showing the minimum staff training requirements as outlined at rule 441--109.7(237A) are met, including current certifications in first aid and cardiopulmonary resuscitation (CPR) and Iowa's training for the mandatory reporting of child abuse.

f. A photocopy of a valid driver's license if the staff will be involved in the transportation of children.

109.9(2) Child's file. Centers shall maintain sufficient information in a file for each child, which shall be updated at least annually or when the parent notifies the center of a change or the center becomes aware of a change, to ensure that:

a. A parent or an emergency contact authorized by the parent can be contacted at any time the child is in the care of the center.

b. Appropriate emergency medical and dental services can be secured for the child while in the center's care.

c. Information is available in the center regarding the specific health and medical needs of a child, including information regarding any professionally prescribed treatment. Information shall include a physical examination report as required at subrule 109.10(1). For a center serving school-age children that operates in the same school facility in which the child attends school, documentation shall include a statement signed by the parent that the immunization information is available in the school file.

d. A child is released only to authorized persons.

e. Documentation of injuries, accidents, or other incidents involving the child is maintained.

f. Parent authorization is obtained for a child to attend center-sponsored field trips and non-center activities. If parental authorization is obtained on an authorization form inclusive of all children participating in the activity, the authorization form shall be kept on file at the center.

109.9(3) Immunization certificates. Signed and dated Iowa immunization certificates, provided by the state department of public health, shall be on file for each child enrolled as prescribed by the department of public health at 641--Chapter 7.

109.9(4) Daily activities. For each child under two years of age, the center shall make a daily written record. At the end of the child's day at the center, the daily written record shall be provided verbally or in writing to the parent or the person who removes the child from the center. The record shall contain information on each of these areas:

a. The time periods in which the child has slept.

b. The amount of food consumed and the times at which the child has eaten.

c. The time of and any irregularities in the child's elimination patterns.

d. The general disposition of the child.

e. A general summary of the activities in which the child participated.

441--109.10(237A) Health and safety policies. The child care center shall establish definite health policies, including the criteria for excluding a sick child from the center. The policies shall be consistent with the recommendations of the National Health and Safety Performance Standards and shall include, but are not limited to:

109.10(1) Physical examination report.

a. Preschool-age children. For each child five years of age and younger not enrolled in kindergarten, the child care center shall require an admission physical examination report, submitted within 30 days from the date of admission, signed by a licensed medical doctor, doctor of osteopathy, physician's assistant or advanced registered nurse practitioner. The date of the physical examination shall be no more than 12 months prior to the first day of attendance at the center. The written report shall include past health history, status of present health including allergies, medications, and acute or chronic conditions, and recommendations for continued care when necessary. Annually thereafter, a statement of health condition, signed by a licensed medical doctor, doctor of osteopathy, physician's assistant or advanced registered nurse practitioner, shall be submitted that includes any change in functioning, allergies, medications, or acute or chronic conditions.

b. School-age children. For each child five years of age and older and enrolled in school, the child care center shall require, prior to admission, a statement of health status signed by the parent or legal guardian that certifies that the child is free of communicable disease and that specifies any allergies, medications, or acute or chronic conditions. The statement from the parent shall be submitted annually thereafter.

c. Religious exemption. Nothing in this rule shall be construed to require medical treatment or immunization for staff or the child of any person who is a member of a church or religious organization which has guidelines governing medical treatment for disease that are contrary to these rules. In these instances, an official statement from the organization shall be incorporated in the personnel or child's file.

109.10(2) Medical and dental emergencies. The center shall have sufficient information and authorization to meet the medical and dental emergencies of children. The center shall have written procedures for medical and dental emergencies and shall ensure, through orientation and training, that all staff are knowledgeable of and able to implement the procedures.

109.10(3) Medications. The center shall have written procedures for the dispensing, storage, authorization, and recording of all prescription and nonprescription medications, including the following:

a. All medications shall be stored in their original containers, with accompanying physician or pharmacist's directions and label intact and stored so they are inaccessible to children and the public. Nonprescription medications shall be labeled with the child's name.

b. For every day an authorization for medication is in effect and the child is in attendance, there shall be a notation of administration including the name of the medicine, date, time, dosage given or applied, and the initials of the person administering the medication or the reason the medication was not given.

c. In the case of medications that are administered on an ongoing, long-term basis, authorization shall be obtained for a period not to exceed the duration of the prescription.

109.10(4) Daily contact. Each child shall have direct contact with a staff person upon arrival for early detection of apparent illness, communicable disease, or unusual condition or behavior which may adversely affect the child or the group. The center shall post notice at the main entrance to the center where it is visible to parents and the public of exposure of a child receiving care by the center to a communicable disease, the symptoms, and the period of communicability. If the center is located in a building used for other purposes and shares the main entrance to the building, the notice shall be conspicuously posted in the center in an area that is frequented daily by parents or the public.

109.10(5) Infectious disease control. Centers shall establish policies and procedures related to infectious disease control and the use of universal precautions with the handling of any bodily excrement or discharge, including blood and breast milk. Soiled diapers shall be stored in containers separate from other waste.

109.10(6) Quiet area for ill or injured. The center shall provide a quiet area under supervision for a child who appears to be ill or injured. The parents or a designated person shall be notified of the child's status in the event of a serious illness or emergency.

109.10(7) Staff hand washing. The center shall ensure that staff demonstrate clean personal hygiene sufficient to prevent or minimize the transmission of illness or disease. All staff shall wash their hands at the following times:

a. Upon arrival at the center.

b. Immediately before eating or participating in any food service activity.

c. After diapering a child.

d. Before leaving the rest room either with a child or by themselves.

e. Before and after administering nonemergency first aid to a child if gloves are not worn.

f. After handling animals and cleaning cages.

109.10(8) Children's hand washing. The center shall ensure that staff assist children in personal hygiene sufficient to prevent or minimize the transmission of illness or disease. For each infant or child with a disability, a separate cloth for washing and one for rinsing may be used in place of running water. Children's hands shall be washed at the following times:

a. Immediately before eating or participating in any food service activity.

b. After using the rest room or being diapered.

c. After handling animals.

109.10(9) First-aid kit. The center shall ensure that a clearly labeled first-aid kit is available and easily accessible to staff at all times whenever children are in the center, in the outdoor play area, and on field trips. The kit shall be sufficient to address first aid related to minor injury or trauma and shall be stored in an area inaccessible to children.

109.10(10) Recording incidents. Incidents involving a child, including minor injuries, minor changes in health status, or behavioral concerns, shall be reported to the parent on the day of the incident. Incidents resulting in an injury to a child shall be reported to the parent on the day of the incident. Incidents resulting in a serious injury to a child or significant change in health status shall be reported immediately to the parent. A written report shall be provided to the parent or person authorized to remove the child from the center. The written report shall be prepared by the staff member who observed the incident and a copy shall be retained in the child's file.

109.10(11) Smoking. Smoking and the use of tobacco products shall be prohibited in the center, outdoor play area and in the center-operated vehicle during hours of operation of the center.

109.10(12) Transportation. As outlined in Iowa Code section 321.446, all children transported in a motor vehicle subject to registration and with a gross weight of 10,000 pounds or less, except a school bus, shall be individually secured by a safety belt, safety seat, or harness in accordance with federal motor vehicle safety standards and the manufacturer's instructions. Children under the age of 3 shall be secured in a federally approved child restraint system. Children under the age of 12 shall not be located in the front seating section of the vehicle. Drivers of vehicles shall possess a valid driver's license and shall not operate a vehicle under the influence of alcohol, illegal drugs, prescription or nonprescription drugs that could impair their ability to operate a motor vehicle.

109.10(13) Field trip emergency numbers. Emergency telephone numbers for each child shall be taken by staff when transporting children to and from school and on field trips and non-center-sponsored activities away from the premises.

109.10(14) Pets. Animals kept on site shall be in good health with no evidence of disease, be of such disposition as to not pose a safety threat to children, and be maintained in a clean and sanitary manner. Documentation of current vaccinations shall be available for all cats and dogs. No ferrets, reptiles, including turtles, or birds of the parrot family shall be kept on site. Pets shall not be allowed in kitchen or food preparation areas.

109.10(15) Emergency plans.

a. The center shall have written emergency plans for responding to fire, tornado, flood (if area is susceptible to flood), intruders within the center, intoxicated parents and lost or abducted children. In addition, the center shall have guidelines for responding or evacuating in case of blizzards, power failures, bomb threats, chemical spills, earthquakes, or other disasters that could create structural damage to the center or pose health hazards. If the center is located within a ten-mile radius of a nuclear power plant or research facility, the center shall also have plans for nuclear evacuations. Emergency plans shall include written procedures including plans for transporting children and notifying parents, emergency telephone numbers, diagrams, and specific considerations for immobile children.

b. Emergency instructions, telephone numbers, and diagrams for fire, tornado, and flood (if area is susceptible to floods) shall be visibly posted by all program and outdoor exits. Emergency plan procedures shall be practiced and documented at least once a month for fire and for tornado. Records on the practice of fire and tornado drills shall be maintained for the current and previous year.

c. The center shall develop procedures for annual staff training on these emergency plans and shall include information on responding to fire, tornadoes, intruders, intoxicated parents and lost or abducted children in the orientation provided to new employees.

d. The center shall conduct a daily check to ensure that all exits are unobstructed.

441--109.11(237A) Physical facilities.

109.11(1) Room size. The program room size shall be a minimum of 80 square feet of useable floor space or sufficient floor space to provide 35 square feet of useable floor space per child. In rooms where floor space occupied by cribs is counted as useable floor space, there shall be 40 square feet of floor space per child. Kitchens, bathrooms, halls, lobby areas, storage areas and other areas of the center not designed as activity space for children shall not be used as regular program space or counted as useable floor space.

109.11(2) Infants' area. An area shall be provided properly and safely equipped for the use of infants and free from the intrusion of children two years of age and older. Children over 18 months of age may be grouped outside this area if appropriate to the developmental needs of the child. Upon the recommendation of a child's physician or the area education agency serving the child, a child who is two years of age or older with a disability that results in significant developmental delays in physical and cognitive functioning who does not pose a threat to the safety of the infants may, if appropriate and for a limited time approved by the department, remain in the infant area.

109.11(3) Facility requirements.

a. The center shall ensure that:

(1) The facility and premises are sanitary, safe andhazard-free.

(2) Adequate indoor and outdoor program space that is adjacent to the center is provided. Centers shall have a safe outdoor program area with at least sufficient square footage to accommodate 30 percent of the enrollment capacity at any one time at 75 square feet per child. The outdoor area shall include safe play equipment and an area of shade.

(3) Sufficient program space is provided for dining to allow ease of movement and participation by children and to allow staff sufficient space to attend to the needs of the children during routine care and emergency procedures.

(4) Sufficient lighting shall be provided to allow children to adequately perform developmental tasks without eye strain.

(5) Sufficient ventilation is provided to maintain adequate indoor air quality.

(6) Sufficient heating is provided to allow children to perform tasks comfortably without excessive clothing.

(7) Sufficient cooling is provided to allow children to perform tasks without being excessively warm or subject to heat exposure.

(8) Sufficient bathroom and diapering facilities are provided to attend immediately to children's toileting needs and maintained to reduce the transmission of disease.

(9) Equipment, including kitchen appliances, placed in a program area is maintained so as not to result in burns, shock or injury to children.

(10) Sanitation and safety procedures for the center are developed and implemented to reduce the risk of injury or harm to children and reduce the transmission of disease.

b. Approval may be given by the department to waive the outdoor space requirement for programs of three hours or less, provided there is suitable substitute space and equipment available.

c. Approval may be given by the department for centers operating in a densely developed area to use alternative outdoor play areas in lieu of adjacent outdoor play areas.

d. The director or designated person shall complete and keep a record of at least monthly inspections of the outdoor recreation area and equipment for the purpose of assessing and rectifying potential safety hazards. If the outdoor play area is not used for a period of time due to inclement weather conditions, the center shall document the reasons why the monthly inspection did not occur and shall complete and document an inspection prior to resuming use of the area.

e. Centers that operate in a public school building, including before and after school programs and summer programs serving school-age children, may receive limited exemption from a facility requirement at subrule 109.11(3), particularly relating to ventilation and bathroom facilities, if complying with the requirement would require a structural or mechanical change to the school building. Centers shall ensure that the space occupied by the center is sanitary, safe, and hazard-free and shall conduct monthly playground inspections or provide documentation that one has been completed by the public school personnel.

109.11(4) Bathroom facilities. At least one functioning toilet and one sink for each 15 children shall be provided in a room with natural or artificial ventilation. Training seats or chairs may be used for children under two years of age. New construction after November 1, 1995, shall provide for at least one sink in the same area as the toilet and, for centers serving children two weeks to two years of age, shall provide for at least one sink in the central diapering area. At least one sink shall be provided in program rooms for infants and toddlers or in an adjacent area other than the kitchen. New construction after April 1, 1998, shall have at least one sink provided in the program rooms for infants and toddlers.

109.11(5) Telephone. A working nonpay telephone shall be available in the center with emergency telephone numbers for police or 911, fire, ambulance, and poison information center posted adjacent to the telephone. The street address and telephone number of the center shall be included in the posting. A separate file or listing of emergency telephone numbers for each child shall be maintained near the telephone.

109.11(6) Kitchen appliances and microwaves. Gas or electric ranges or ovens shall not be placed in the program area. If kitchen appliances are maintained in the program area for food preparation activities, the area shall be sectioned off and shall not be counted as useable floor space for room size. Centers using microwave ovens for warming infant bottles or infant food shall ensure that the formula or food item is not served immediately to the child after being removed from the microwave. The infant bottle shall be shaken or food stirred and the formula or food item tested by the caregiver before being fed to the infant. Breast milk shall not be warmed in a microwave.

109.11(7) Environmental hazards.

a. Within one year of being issued an initial or renewal license, centers operating in facilities built prior to 1960 shall conduct a visual assessment for lead hazards that exist in the form of peeling or chipping paint. If the presence of peeling or chipping paint is found, the paint shall be presumed to be lead-based paint unless a certified inspector as defined in department of public health rules at 641--Chapter 70 determines that it is not lead-based paint. If the presence of peeling or chipping paint is found, interim controls using safe work methods as defined by the state department of public health shall be accomplished prior to a full license being issued.

b. Within one year of being issued an initial or renewal license, centers operating in facilities that are at ground level, use a basement area as program space, or have a basement beneath the program area shall have radon testing performed as prescribed by the state department of public health at 641--Chapter 43. Testing shall be required if test kits are available from the local health department or the Iowa Radon Coalition. Retesting shall be accomplished at least every two years from the date of the initial measurement if test kits are available from the local health department or the Iowa Radon Coalition. If testing determines confirmed radon gas levels in excess of 4.0 picocurie per liter, a plan using radon mitigation procedures established by the state department of public health shall be developed with and approved by the state department of public health prior to a full license being issued.

c. To reduce the risk of carbon monoxide poisoning, all centers shall, on an annual basis prior to the heating season, have a professional inspect all fuel-burning appliances, including oil and gas furnaces, gas water heaters, gas ranges and ovens, and gas dryers, to ensure the appliances are in good working order with proper ventilation. All centers shall install one carbon monoxide detector on each floor of the center that is listed with Underwriters Laboratory (UL) as conforming to UL Standard 2034.

d. Centers that operate before and after school programs and summer-only programs that serve only school-age children and that operate in a public school building are exempted from testing for lead, radon, and carbon monoxide.

441--109.12(237A) Activity program requirements.

109.12(1) Activities. The center shall have a written curriculum or program structure that uses developmentally appropriate practices and a written program of activities planned according to the developmental level of the children. The center shall post a schedule of the program in a visible place. The child care program shall complement but not duplicate the school curriculum. The program shall be designed to provide children with:

a. A curriculum or program of activities that promotes self-esteem and positive self-image; social interaction; self-expression and communication skills; creative expression; and problem-solving skills.

b. A balance of active and quiet activities; individual and group activities; indoor and outdoor activities; and staff-initiated and child-initiated activities.

c. Activities which promote both gross and fine motor development.

d. Experiences in harmony with the ethnic and cultural backgrounds of the children.

e. A supervised nap or quiet time for all children under the age of six not enrolled in school who are present at the center for five or more hours.

109.12(2) Discipline. The center shall have a written policy on the discipline of children which provides for positive guidance, with direction for resolving conflict and the setting of well-defined limits. The written policy shall be provided to staff at the start of employment and to parents at time of admission. The center shall not use as a form of discipline:

a. Corporal punishment including spanking, shaking, and slapping.

b. Punishment which is humiliating or frightening or which causes pain or discomfort to the child. Children shall never be locked in a room, closet, box or other device. Mechanical restraints shall never be used as a form of discipline. When restraints are part of a treatment plan for a child with a disability authorized by the parent and a psychologist or psychiatrist, staff shall receive training on the safe and appropriate use of the restraint.

c. Punishment or threat of punishment associated with a child's illness, lack of progress in toilet training, or in connection with food or rest.

d. No child shall be subjected to verbal abuse, threats, or derogatory remarks about the child or the child's family.

109.12(3) Policies for children requiring special accommodations. Reasonable accommodations, based on the special needs of the child, shall be made in providing care to a child with a disability. Accommodation can be a specific treatment prescribed by a professional or a parent, or a modification of equipment, or removal of physical barriers. The accommodation shall be recorded in the child's file.

109.12(4) Play equipment, materials and furniture. The center shall provide sufficient and safe indoor play equipment, materials, and furniture that conform with the standards or recommendations of the Consumer Product Safety Commission or the American Society for Testing and Materials for juvenile products. Play equipment, materials, and furniture shall meet the developmental, activity, and special needs of the children.

Rooms shall be arranged so as not to obstruct the direct observation of children by staff. Individual covered mats, beds, or cots and appropriate bedding shall be provided for all children who nap. The center shall develop procedures to ensure that all equipment and materials are maintained in a sanitary manner. Sufficient spacing shall be maintained between equipment to reduce the transmission of disease, to allow ease of movement and participation by children and to allow staff sufficient space to attend to the needs of the children during routine care and emergency procedures. The center shall provide sufficient toilet articles for each child for hand washing. Parents may provide items for oral hygiene (if appropriate to the developmental age and needs of the child). The center shall ensure that sanitary procedures are followed for use and storage of the articles.

109.12(5) Infant environment. A child care center serving children two weeks to two years old must provide an environment which protects the children from physical harm, but is not so restrictive as to inhibit physical, intellectual, emotional, and social development.

a. Stimulation shall be provided to each child through being held, rocked, played with and talked with throughout the time care is provided. Insofar as possible, the same adult should provide complete care for the same child.

b. Each infant and toddler shall be diapered in a sanitary manner as frequently as needed at a central diapering area. Diapering, sanitation, and hand-washing procedures shall be posted and implemented in every diapering area. There shall be at least one changing table for every 15 infants.

c. Highchairs or hook-on seats shall be equipped with a safety strap which shall be engaged when the chair is in use and shall be constructed so the chair will not topple.

d. Safe, washable toys, large enough so they cannot be swallowed and with no removable parts, shall be provided. All hard-surface toys used by children shall be sanitized daily.

e. Children under the age of one year shall be placed on their backs when sleeping unless otherwise authorized by a parent or physician. A crib or criblike furniture which has a waterproof mattress covering and sufficient bedding to enable a child to rest comfortably and which meets the current standards or recommendations from the Consumer Product Safety Commission or the American Society for Testing and Materials for juvenile products shall be provided for each child under two years of age if developmentally appropriate. Crib railings shall be fully raised and secured when the child is in the crib. A crib or criblike furniture shall be provided for the number of children present at any one time. The center shall develop procedures for maintaining all cribs or criblike furniture and bedding in a clean and sanitary manner. There shall be no restraining devices of any type used in cribs.

f. When playpens are provided, no more than one child shall be placed in one at any time.

g. Infant walkers shall not be used.

h. For programs operating five hours or less on a daily basis, the center shall have a sufficient number of cribs or criblike furniture which has a waterproof mattress covering and sufficient bedding to enable a child to rest comfortably and which meets the current standards from the Consumer Product Safety Commission or the American Society for Testing and Materials for juvenile products for children who may nap during the time in attendance. Cribs or criblike furniture shall be used by only one child at a time and shall be maintained in a clean and sanitary manner.

441--109.13(237A) Extended evening care. A center providing extended evening care shall comply with the licensing requirements for centers contained in Iowa Code chapter 237A and this chapter, with the additional requirements set forth below.

109.13(1) Facility requirements.

a. The center shall ensure that sufficient cribs, beds, cots and bedding are provided appropriate to the child's age and that sufficient furniture, lighting, and activity materials are available for the children. Equipment and materials shall be maintained in a safe and sanitary manner.

b. The center shall ensure that a separate space is maintained for school-age boys and girls to provide privacy during bathroom and bedtime activities. Bathroom doors used by children shall be nonlockable.

c. The center shall ensure that parents have provided the personal effects needed to meet their child's personal hygiene and prepare for sleep. The center shall supplement those items needed for personal hygiene which the parent does not provide. The center shall obtain written information from the parent regarding the child's snacking, toileting, personal hygiene and bedtime routines.

109.13(2) Activities.

a. Evening activities shall be primarily self-selected by the child.

b. Every child-occupied room except those rooms used only by school-age children for sleeping shall have adult supervision present in the room. Staff counted for purposes of meeting child-to-staff ratios shall be present and awake at all times. In rooms where only school-age children are sleeping, visual monitoring equipment may be used. If a visual monitor is used, the monitoring must allow for all children to be visible at all times. Staff shall be present in the room with the monitor and shall enter the room used for sleeping to conduct a check of the children every 15 minutes.

441--109.14(237A) Get-well center. A get-well center shall comply with the licensing requirements for centers contained in Iowa Code chapter 237A and this chapter with the additional requirements and exceptions set forth below.

109.14(1) Staff requirements.

a. The center shall have a medical advisor for the center's health policy. The medical advisor shall be a medical doctor or a doctor of osteopathy currently in pediatrics or family practice.

b. A center shall have a licensed LPN or RN on duty at all times that children are present. If the nurse on duty is an LPN, the medical advisor or an RN shall be available in the proximate area as defined in state board of nursing rules at 655--6.1(152).

109.14(2) Health policies.

a. The center shall have a written health policy, consistent with the National Health and Safety Performance Standards, approved and signed by the owner or the chair of the board and by the medical advisor before the center can begin operations. Changes in the health policy shall be approved by the medical advisor and submitted in writing to the department. A written summary of the health policy shall be given to the parent when a child is enrolled in the center. The center's health policy at a minimum shall address procedures in the following areas:

(1) Medical consultation, medical emergencies, triage policies, storage and administration of medications, dietary considerations, sanitation and infection control, categorization of illness, length of enrollment periods, exclusion policy, and employee health policy.

(2) Reportable disease policies as required by the state department of public health.

b. The child shall be given a brief evaluation by an LPN or RN upon each arrival at the center.

c. The parent shall receive a brief written summary when the child is picked up at the end of the day. The summary must include:

(1) Admitting symptoms.

(2) Medications administered and time they were admin-istered.

(3) Nutritional intake.

(4) Rest periods.

(5) Output.

(6) Temperature.

109.14(3) Exceptions. The following exceptions to 441--Chapter 109 shall be applied to get-well centers:

a. A center shall maintain a minimum staff ratio of one-to-four for infants and one-to-five for children over the age of two.

b. All staff that have contact with children shall have a minimum of 17 clock hours of special training in caring for mildly ill children. Current certification of the training shall be contained in the personnel files. Special training shall be department-approved and include the following:

(1) Four hours' training in infant and child cardiopulmonary resuscitation (CPR), four hours' training in pediatric first aid, and one hour of training in infection control within the first month of employment.

(2) Six hours' training in care of ill children, and two hours' training in child abuse identification and reporting within the first six months of employment and every five years thereafter.

c. There shall be 40 square feet of program space per child.

d. There shall be a sink with hot and cold running water in every child-occupied room.

e. Outdoor space may be waived with the approval of the department if the program is in an area adjacent to the pediatrics unit of a hospital.

f. Grouping of children shall be allowed by categorization of illness or by transmission route without regard to age, and shall be in separate rooms with full walls and doors.

441--109.15(237A) Food services. Centers participating in the USDA Child and Adult Care Food Program (CACFP) may have requirements that differ from those outlined in this rule in obtaining CACFP reimbursement and shall consult with a state CACFP consultant.

109.15(1) Nutritionally balanced meals or snacks. The center shall serve each child a full, nutritionally balanced meal or snack as defined by the USDA Child and Adult Care Food Program (CACFP) guidelines and shall ensure that staff provide supervision at the table during snacks and meals. Children remaining at the center two hours or longer shall be offered food at intervals of not less than two hours or more than three hours apart unless the child is asleep.

109.15(2) Menu planning. The center shall follow the minimum CACFP menu patterns for meals and snacks and serving sizes for children aged infant to 13 years. Menus shall be planned at least one week in advance, made available to parents, and kept on file at the center. Substitutions in the menu, including substitutions made for infants, shall be noted and kept on file. Foods with a high incident rate of causing choking in young children shall be avoided or modified. Provisions of this subrule notwithstanding, exceptions shall be allowed for special diets because of medical reasons in accordance with the child's needs and written instructions of a licensed physician or health care provider.

109.15(3) Feeding of children under two years of age.

a. All children under 12 months of age shall be fed on demand, unless the parent provides other written instructions. Meals and snacks provided by the center shall follow the CACFP infant menu patterns. Foods shall be appropriate for the infant's nutritional requirements and eating abilities. Menu patterns may be modified according to written instructions from the parent, physician or health care provider. Special formulas prescribed by a physician or health care provider shall be given to a child who has a feeding problem.

b. All children under six months of age shall be held or placed in a sitting-up position sufficient to prevent aspiration during feeding. No bottles shall be propped for children of any age. A child shall not be placed in a crib with a bottle or left sleeping with a bottle. Spoon feeding shall be adapted to the developmental capabilities of the child.

c. Single-service, ready-to-feed formulas, concentrated or powdered formula following the manufacturer's instructions or breast milk shall be used for children 12 months of age and younger unless otherwise ordered by a parent or physician.

d. Whole milk for children under age two who are not on formula or breast milk unless otherwise directed by a physician.

e. Cleaned and sanitized bottles and nipples shall be used for bottles prepared on site. Prepared bottles shall be kept under refrigeration when not in use.

109.15(4) Food brought from home.

a. The center shall establish policies regarding food brought from home for children under five years of age who are not enrolled in school. A copy of the written policy shall be given to the parent at admission. Food brought from home for children under five years of age who are not enrolled in school shall be monitored and supplemented if necessary to ensure CACFP guidelines are maintained.

b. The center may not restrict a parent from providing meals brought from home for school-age children or apply nutritional standards to the meals.

c. Perishable foods brought from home shall be maintained to avoid contamination or spoilage.

d. Snacks that may not meet CACFP nutrition guidelines may be provided by parents for special occasions such as birthdays or holidays.

109.15(5) Food preparation, storage, and sanitation. Centers shall ensure that food preparation and storage procedures are consistent with the recommendations of the National Health and Safety Performance Standards and provide:

a. Sufficient refrigeration appropriate to the perishable food to prevent spoilage or the growth of bacteria.

b. Sanitary and safe methods in food preparation, serving, and storage sufficient to prevent the transmission of disease, infestation of insects and rodents, and the spoilage of food. Staff preparing food who have injuries on their hands shall wear protective gloves. Staff serving food shall have clean hands or wear protective gloves and use clean serving utensils.

c. Sanitary methods for dish-washing techniques sufficient to prevent the transmission of disease.

d. Sanitary methods for garbage disposal sufficient to prevent the transmission of disease and infestation of insects and rodents.

109.15(6) Water supply. The center shall ensure that suitable water and sanitary drinking facilities are available and accessible to children. Centers that serve infants and toddlers shall provide individual cups for drinking in addition to drinking fountains that may be available in the center.

a. Private water supplies shall be of satisfactory bacteriological quality as shown by an annual laboratory analysis. Water for the analysis shall be drawn between May 1 and June 30 of each year. When the center provides care for children under two years of age, a nitrate analysis shall also be obtained.

b. When public or private water supplies are determined unsuitable for drinking, commercially bottled water certified as chemically and bacteriologically potable or water treated through a process approved by the health department or designee shall be provided.

These rules are intended to implement Iowa Code section 232.69 and chapter 237A.

ARC 7805A

Notice of Intended Action was published in the Iowa Administrative Bulletin on December 17, 1997, as ARC 7710A. Although a public hearing was not held, written comments were accepted until January 6, 1998. No comments were received. The Insurance Division adopted these amendments on January 22, 1998.

The new subrules incorporate by reference North American Securities Administrators Association (NASAA) Statements of Policy which apply to (1) Real Estate Investment Trusts; (2) Corporate Securities Definitions; (3) Impoundment of Proceeds; (4) Loans and Other Material Affiliated Transactions; (5) Options and Warrants; (6) Preferred Stock; (7) Promotional Shares; (8) Underwriting Expenses, Underwriter's Warrants, Selling Expenses and Selling Security Holders; (9) Unsound Financial Condition; and (10) Use of Proceeds.

In response to the new subrules, six rules will be rescinded as their substance is covered in the newly adopted NASAA Statements of Policy.

These amendments are identical to those published under Notice of Intended Action.

These amendments are intended to implement Iowa Code section 502.607.

These amendments will become effective March 18, 1998.

The following amendments are adopted.

ITEM 1. Rescind and reserve rules 191--50.31(502), 50.32(502), 50.36(502) to 50.38(502), and 50.42(502).

ITEM 2. Amend rule 191--50.57(502) by adding the following new subrules:

50.57(10) Real estate investment trusts. The registration of a real estate investment trust may be disallowed if it does not substantially comply, as determined by the administrator, with the NASAA Statement of Policy Regarding Real Estate Investment Trusts as amended by the NASAA membership on September 29, 1993, and published in CCH NASAAREPORTS at paragraph 3401.

50.57(11) Corporate securities definitions. For securities registration purposes, the administrator adopts the various definitions set out in the NASAA Statement of Policy Regarding Corporate Securities Definitions as adopted by the NASAA membership on April 27, 1997, and published in CCH NASAA REPORTS at paragraph 3812.

50.57(12) Impoundment of proceeds. When an impoundment of proceeds is necessary it shall substantially comply, as determined by the administrator, with the NASAA Statement of Policy Regarding the Impoundment of Proceeds as amended by the NASAA membership on April 27, 1997, and published in CCH NASAA REPORTS at paragraph 2154.

50.57(13) Loans and other material affiliated transactions. When there have been or will be loans and other material affiliated transactions, they shall substantially comply, as determined by the administrator, with the NASAA Statement of Policy Regarding Loans and Other Material Affiliated Transactions as amended by the NASAA membership on April 27, 1997, and published in CCH NASAAREPORTS at paragraph 374.

50.57(14) Options and warrants. Options and warrants may be issued if they substantially comply, as determined by the administrator, with the NASAA Statement of Policy Regarding Options and Warrants as amended by the NASAA membership on April 27, 1997, and published in CCHNASAA REPORTS at paragraph 2806.

50.57(15) Preferred stock. A public offering of preferred stock may be allowed if it substantially complies, as determined by the administrator, with the NASAA Statement of Policy Regarding Preferred Stock as amended by theNASAA membership on April 27, 1997, and published in CCH NASAA REPORTS at paragraph 3006.

50.57(16) Promotional shares. The registration of a security may include promotional shares if it substantially complies, as determined by the administrator, with the NASAA Statement of Policy Regarding Promotional Shares as adopted by the NASAA membership on April 27, 1997, and published in CCH NASAA REPORTS at paragraph 3203.

50.57(17) Underwriting expenses, underwriter's warrants, selling expenses and selling security holders. The registration of a security may be disallowed if it does not substantially comply, as determined by the administrator, with the NASAA Statement of Policy Regarding Underwriting Expenses, Underwriter's Warrants, Selling Expenses and Selling Security Holders as adopted by the NASAA membership on April 27, 1997, and published in CCH NASAA REPORTS at paragraph 3671.

50.57(18) Unsound financial condition. An issuer may be deemed to be in an unsound financial condition if it substantially complies, as determined by the administrator, with the NASAA Statement of Policy Regarding Unsound Financial Condition as adopted by the NASAA membership on April 27, 1997, and published in CCH NASAA REPORTS at paragraph 3826.

50.57(19) Use of proceeds. The registration of a security may be disallowed if it does not substantially comply, as determined by the administrator, with the NASAA Statement of Policy Regarding Specificity in Use of Proceeds as adopted by the NASAA membership on April 27, 1997, and published in CCH NASAA REPORTS at paragraph 3835.

ARC 7821A

These rules establish language for requirements for licensure by endorsement, clarify the process to request a hearing if a license has been denied, change the license renewal period and the continuing education compliance period, raise renewal fee and penalty fees, and clarify the process for investigation of complaints or malpractice claims, disciplinary procedures, supervision requirements and peer review committees.

Notice of Intended Action was published in the Iowa Administrative Bulletin on December 17, 1997, as ARC 7714A. A public hearing was held on January 6, 1998, from 11 a.m. to 1 p.m. in the Fourth Floor Conference Room, Iowa Department of Public Health, Lucas State Office Building, Des Moines, Iowa 50319-0075. Two persons were present representing Mercy Hospital Medical Center Physical Therapy Department. The following revisions were made to the Notice:

In 200.3(3)"a," language was added stating a person failing the exam cannot practice as an applicant physical therapist.

In 200.3(3)"b," language was added stating a person failing the exam cannot practice as an applicant physical therapist assistant.

In 200.5(1), second paragraph, the word "notice" was changed to "renewal application."

In 200.5(2), end of paragraph, a sentence was added regarding license renewal when initial license is issued within six months of birth date.

In 200.5(3), the word "late" was changed to "penalty" and "of $55" was deleted and the words "late filing" were changed to "penalty."

Rule 645--200.8(147), Reinstatement of lapsed license, was rescinded and replaced with a new rule.

In 200.12(1), the word "relicensure" was changed to "renewal."

In 200.12(2), the words "for relicensure" were deleted.

In 200.24(5), the words "who are providing physical therapy" and the sentence "This includes physical therapist assistants being supervised by telecommunicative supervision" were added.

In 200.24(9), the words "on site" were changed to "in sight."

These amendments were adopted by the Board of Physical and Occupational Therapy Examiners at a Board meeting on January 9, 1998.

These amendments will become effective March 18, 1998.

These amendments are intended to implement Iowa Code chapters 147, 156 and 272C.

The following amendments are adopted.

ITEM 1. Amend rule 645--200.1(147) by striking the definition of "Cotreatment" as follows:

"Cotreatment" means a patient treatment, evaluation, or both, provided by the physical therapist assisted by or in the presence of the physical therapist assistant who generally assists in providing services to that physical therapist.

ITEM 2. Amend subrule 200.3(3) as follows:

200.3(3) An applicant, who will be working in the scope of physical therapy prior to licensure, shall include on the application form the name of the licensed physical therapist who will be providing supervision of the applicant until the applicant is licensed. The applicant will notify the board, within seven days, of any change in supervision.

a. Applicant physical therapist. A person who has made application for licensure and is awaiting board action may practice only under the supervision of a licensed physical therapist for a period not to exceed six months in the case of licensure by examination and three months for licensure by endorsement. During this time the applicant may evaluate, plan treatment programs, and provide periodic reevaluation only under "on-site" supervision of a licensed physical therapist who shall bear full responsibility for care provided under the physical therapist's supervision and cosign all physical therapy records. A person who has failed the examination in any state, territory, or country shall not practice as an applicant physical therapist.

b. Applicant physical therapist assistant. A person who has made application for licensure and is awaiting board action may practice under the supervision of a licensed physical therapist for a period not to exceed six months in the case of licensure by examination and three months for licensure by endorsement. During this time the applicant may perform physical therapy procedures as delegated by the supervising physical therapist only under "on-site" supervision. Documentation made in physical therapy records by an applicant physical therapist assistant shall be cosigned by the supervising physical therapist. A person who has failed the examination in any state, territory, or country shall not practice as an applicant physical therapist assistant.

ITEM 3. Amend subrule 200.4(3), introductory sentence, as follows:

200.4(3) An applicant for licensure by interstate endorsement shall have successfully completed a course of study for the physical therapist accredited by the commission on accreditation in education of the American Physical Therapy Association, or another appropriate accrediting body, and have passed the National Physical Therapy Examination (NPTE) or other nationally recognized equivalent examination as defined by the board of physical and occupational therapy examiners and:

ITEM 4. Rescind rule 645--200.5(147) and adopt the following new rule in lieu thereof:

645--200.5(147) License renewal.

200.5(1) Beginning July 1, 1999, a license to practice as a physical therapist shall expire every two years on the fifteenth day of the birth month. Continuing education requirements shall be completed within the same renewal period for each license holder.

An application and a continuing education report form for renewal of license to practice as a physical therapist shall be mailed to the licensee at least 60 days prior to the expiration of the license. Failure to receive the renewal application shall not relieve the license holder of the obligation to pay biennial renewal fees on or before the renewal date.

200.5(2) Beginning July 1, 1999, the continuing education requirements will coincide with the renewal compliance period. The licensee shall submit to the board office 30 days before licensure expiration the application and continuing education report form with the renewal fee as specified in rule 200.9(147). Individuals who were issued their initial license within six months of their birth month will not be required to renew their license until the fifteenth day of their birth month two years later. The new licensee is exempt from meeting the continuing education requirement for the continuing education biennium in which the license is originally issued. Individuals will be required to report 40 hours of continuing education for the first renewal and every renewal thereafter.

200.5(3) Late renewal. If the renewal fees are received by the board within 30 days after the renewal expiration date, a penalty fee is charged. If renewal fees are received more than 30 days after the renewal expiration date, the license is lapsed. An application for reinstatement must be filed with the board with the reinstatement fee, the renewal fee and the penalty fee as outlined in rule 200.9(147). Individuals who fail to submit the renewal application and complete documentation of continuing education hours shall be required to pay a penalty fee and shall be subject to an audit of their continuing education report.

200.5(4) Physical therapists who have not fulfilled the requirements for license renewal or an exemption in the required time frame will have a lapsed license and shall not engage in the practice of physical therapy.

ITEM 5. Rescind rule 645--200.8(147) and adopt the following new rule in lieu thereof:

645--200.8(147) Reinstatement of lapsed license. Individuals who have allowed their licenses to lapse, prior to practicing as a physical therapist in the state of Iowa, shall satisfy the following requirements for reinstatement:

200.8(1) Submit written application for reinstatement to the board on forms provided by the board, pay current application fee, the reinstatement fee and applicable penalty fees; and

200.8(2) Furnish in the application evidence of one of the following:

a. Completion of a total number of hours of accredited continuing education computed by multiplying 40 for each renewal period the license has been inactive; or

b. Successful completion of the appropriate physical therapy professional examination required in subrule 200.2(2) within one year immediately prior to the submission of the application for reinstatement.

ITEM 6. Amend subrule 200.9(1) as follows:

200.9(1) The application fee for a license to practice physical therapy issued upon the basis of examination or endorsement is $55 $100 in check or money order made payable to the Board of Physical and Occupational Therapy Examiners. The examination fee is an additional $185 made payable by cashier's check to the Professional Examination Service (PES) and submitted to the Board of Physical and Occupational Therapy Examiners with application.

ITEM 7. Amend subrule 200.9(2) as follows:

200.9(2) The renewal fee of a license to practice physical therapy for a biennial period is $55. Biennial renewal fee for a license to practice physical therapy for the 1999 renewal cycle only is as follows:

Birth Month Prorated Fee

July 1999 $55

August 1999 $57

September 1999 $60

October 1999 $62

November 1999 $64

December 1999 $66

January 2000 $69

February 2000 $71

March 2000 $73

April 2000 $76

May 2000 $78

June 2000 $80

ITEM 8. Amend subrule 200.9(3) as follows:

200.9(3) Penalty fee for failure to complete and return the physical therapy renewal application by January 31 (odd-numbered year) before the renewal expiration date is $55.

ITEM 9. Amend subrule 200.9(4) as follows:

200.9(4) Penalty fee for failure to complete the required continuing education by December 31 of even-numbered years during the renewal period is $25 $50. Failure to complete and return the continuing education report (Form G) by January 31 (odd-numbered year) by the end of the renewal period is $25 $50.

ITEM 10. Adopt new subrule 200.9(10) as follows:

200.9(10) Fee for a returned check is $15.

ITEM 11. Amend subrule 200.10(3) as follows:

200.10(3) The continuing education compliance period shall be each biennium beginning January 1 of the odd-numbered year to December 31 of the next even-numbered year the fifteenth day of the birth month and ending two years later on the fifteenth day of the birth month. During the continuing education compliance period, attendance at approved continuing education programs may be used as evidence of fulfilling the continuing education requirement for the subsequent biennial license renewal period beginning July 1. The biennial license renewal period shall extend from July 1 of each odd-numbered year until June 30 of the next odd-numbered year. For the 1999 renewal cycle only, the continuing education hours will be prorated as follows:

Birth Month Prorated Continuing Education

July 1999 50 hours

August 1999 52 hours

September 1999 53 hours

October 1999 55 hours

November 1999 57 hours

December 1999 58 hours

January 2000 60 hours

February 2000 62 hours

March 2000 63 hours

April 2000 65 hours

May 2000 67 hours

June 2000 68 hours

Continuing education hours will return to 40 hours each biennium at the end of this prorated compliance period.

ITEM 12. Amend subrule 200.12(1) as follows:

200.12(1) A report of continuing education activities shall be submitted on a board-approved form with the application for relicensure renewal by January 31 of the odd-numbered years the end of the biennial license renewal period. All continuing education activities submitted must be completed by December 31 of the even-numbered year in the continuing education compliance period for which the license was issued as specified in 200.10(3) or a late fee will be assessed as outlined in (200.9(4)).

ITEM 13. Amend subrule 200.12(2) as follows:

200.12(2) Failure to receive renewal application shall not relieve the physical therapist of the responsibility of meeting continuing education requirements and submitting renewal fee for relicensure by January 31 of the odd-numbered year the end of the compliance period.

ITEM 14. Amend subrule 200.12(3), paragraph "b," as follows:

b. All renewal license applications that are submitted late (after January 31 of the odd-numbered year the end of the compliance period) shall be subject to audit of continuing education reports.

ITEM 15. Amend rule 645--200.18(272C) as follows:

645--200.18(272C) Investigation of complaints or malpractice claims.

200.18(1) Investigation. The chair of the board of physical and occupational therapy examiners shall may assign an investigation of a complaint or malpractice claim to a member of the board who will be known as the investigating board member or may request the state department of inspections and appeals to investigate the complaint or malpractice claim. The investigating board member or employee of the department of inspections and appeals may request information from any peer review committee which may be established to assist the board. The investigating board member or employee of the department of inspections and appeals may consult with an officer or assistant attorney general concerning the investigation on or evidence produced from the investigation. The investigating board member, if the board member investigates the complaint, or an assistant attorney general if the department investigates the complaint, shall make a written determination whether there is probable cause for a disciplinary hearing. The investigating board member shall not take part in the decision of the board, but may appear as a witness.

200.18(2) Informal discussion. In the course of conducting or directing an investigation, the board may request the licensee to attend a voluntary informal discussion before the board or board committee. The licensee is not required to attend or participate in the informal discussion. An informal discussion constitutes a part of the board's investigation of a pending disciplinary case, and the facts discussed at the informal discussion may be considered by the board in the event the matter proceeds to a contested case hearing. A board member who participates in an informal discussion is not disqualified from participating in the contested case hearing.

ITEM 16. Amend rule 645--200.19(272C), catchwords, as follows:

645--200.19(272C) Alternative procedure and Informal settlement and license denial.

ITEM 17. Rescind and reserve subrule 200.19(1).

ITEM 18. Amend subrule 200.19(2), paragraph "b," as follows:

b. The full board is not shall not be involved in negotiation until presentation of a final, written, form signed informal settlement to the full board for approval.

ITEM 19. Rescind subrule 200.19(6) and adopt the following new subrule in lieu thereof:

200.19(6) License denial.

a. An applicant who has been denied licensure by the board may appeal the denial and request a hearing on the issues related to the licensure denial by serving a notice of appeal and request for hearing upon the board not more than 30 days following the date of mailing of the notification of licensure denial to the applicant. The request for hearing as outlined herein shall specifically delineate the facts to be contested and determined at hearing.

b. If an applicant who has been denied licensure by the board appeals the licensure denial and requests a hearing pursuant to this subrule, the hearing and subsequent procedures shall be held pursuant to the process outlined at rule 200.20(272C).

ITEM 20. Rescind and reserve subrules 200.19(7) through 200.19(12).

ITEM 21. Rescind rule 645--200.20(272C) and adopt the following new rule in lieu thereof:

645--200.20(272C) Disciplinary procedure.

200.20(1) Notice of hearing. If there is a finding of probable cause for a disciplinary hearing, the department of public health shall prepare the notice of hearing and transmit the notice of hearing to the respondent by certified mail, return receipt requested, at least 10 days before the date of the hearing. If licensees have absented or removed themselves from the state, the notice of hearing and statement of charges shall be so served at least 30 days before the date of the hearing, wherever the licensee may be found. If the whereabouts of the licensee are unknown, service may be had by publication as provided in the rules of civil procedure upon filing the affidavit required by the rules.

200.20(2) Statement of charges. The statement of charges shall set forth in ordinary and concise language the acts or omissions with which the respondent is charged. The statement of charges shall specify the statute(s) and rule(s) which are alleged to have been violated.

200.20(3) Legal representation. Every statement of charges and notice of hearing shall be reviewed by the office of the attorney general, which shall be responsible for the legal representation of the public interest in all contested case proceedings before the board.

200.20(4) Continuances. A party has no automatic right to a continuance or delay of the disciplinary hearing. A party may request a continuance of the board no later than seven days prior to the date set for hearing. Within seven days of the date set for hearing, no continuances shall be granted except for extraordinary, extenuating, or emergency circumstances. The board administrator shall have the authority to grant a continuance after consultation, if needed, with the chairperson of the board. A board member shall not be contacted in person, by mail, by telephone, or by any other means by a party seeking a continuance.

200.20(5) Prehearing conference. The presiding officer or hearing officer either on the officer's own motion or at the request of either party may hold a prehearing conference which shall be scheduled not less than two days prior to the hearing. Notice by ordinary mail shall be given to each party of the date, time, and place of the prehearing conference.

200.20(6) Failure by respondent to appear. If a respondent, upon whom proper notice of hearing has been served, fails to appear at the hearing, the board may proceed with the conduct of the hearing, and the respondent shall be bound by the results of such hearing to the same extent as if the respondent were present.

200.20(7) Hearing procedure. The board adopts the rules of the department of public health found in 641--Chapter 173, Iowa Administrative Code, as the procedure for hearing before the board. The board may authorize an administrative law judge to conduct the hearings, administer oaths, issue subpoenas, and prepare written findings of fact, conclusions of law and decision at the direction of the board. If a majority of the board does not hear the disciplinary proceeding, a recording or a transcript of the proceeding shall be made available to members of the board who did not hear the proceeding.

200.20(8) Application for rehearing. The filing of an application for rehearing is not necessary to exhaust administrative remedies. Within 20 days after the issuance of a final decision, any party may file an application for rehearing. The application shall state the specific grounds for rehearing and the relief sought and copies thereof shall be timely mailed to all other parties. The application shall be deemed denied if not granted within 20 days after service on the board. Upon rehearing, the board shall consider facts not presented in the original hearing only if:

a. Such facts arose subsequent to the original proceedings; or

b. The party offering such evidence could not reasonably have provided such evidence at the original proceedings; or

c. The party offering the additional evidence was misled by any party as to the necessity for offering such evidence at the original proceedings.

200.20(9) Appeal. Any appeal to the district court from disciplinary action of the board or denial of license shall be taken within 30 days from the issuance of the decision by the board. It is not necessary to request a rehearing before the board to appeal to the district court.

200.20(10) Transcript. The party who appeals a decision of the board to the district court shall pay the cost of the preparation of a transcript of the administrative hearing for the district court.

200.20(11) Publication of decisions. Final decisions of the board relating to disciplinary proceedings shall be transmitted to the appropriate association, the news media and employer.

200.20(12) Hearings open to the public. A hearing of a licensing board concerning a licensee shall be open to the public unless the licensee or the licensee's attorney requests in writing that the hearing be closed to the public.

200.20(13) Reinstatement. Any person whose license to practice has been revoked or suspended may apply to the board for reinstatement in accordance with the terms and conditions of the order of revocation or suspension, unless the order of revocation provides that the license is permanently revoked.

a. If the order of revocation or suspension did not establish terms and conditions upon which reinstatement might occur, or if the license was voluntarily surrendered, an initial application for reinstatement may not be made until one year has elapsed from the date of the order or the date of the voluntary surrender.

b. All proceedings for reinstatement shall be initiated by the respondent, who shall file with the board an application for reinstatement of the license. Such application shall be docketed in the original case in which the license was revoked, suspended, or relinquished. All proceedings upon the application for reinstatement shall be subject to the same rules of procedure as other cases before the board.

c. An application for reinstatement shall allege facts which, if established, will be sufficient to enable the board to determine that the basis for the revocation or suspension of the respondent's license no longer exists and that it will be in the public interest for the license to be reinstated. The burden of proof to establish such facts shall be on the respondent.

d. An order denying or granting reinstatement shall be based upon a decision which incorporates findings of facts and conclusions of law. The order shall be published as provided for in this rule.

200.20(14) Voluntary surrender. The board may accept the voluntary surrender of a license if accompanied by a written statement of intention. A voluntary surrender, when accepted in connection with a disciplinary proceeding, has the same force and effect as an order of revocation.

ITEM 22. Rescind rule 645--200.21(272C) and adopt the following new rule in lieu thereof:

645--200.21(272C) Method of discipline. The board has the authority to impose the following disciplinary sanctions:

1. Revocation of license.

2. Suspension of license until further order of the board or for a specific period.

3. Prohibiting permanently, until further order of the board or for a specific period, engaging in specified procedures, methods, or acts.

4. Probation.

5. Requiring additional education or training.

6. Requiring a reexamination.

7. Ordering a physical or mental evaluation, or ordering alcohol and drug screening within a time specified by the board.

8. Imposing civil penalties not to exceed $1000.

9. Issuing a citation and warning.

10. Imposing other sanctions allowed by law as may be appropriate.

ITEM 23. Rescind rule 645--200.22(272C) and adopt the following new rule in lieu thereof:

645--200.22(272C) Discretion of board. The following factors may be considered by the board in determining the nature and severity of the disciplinary sanction to be imposed:

200.22(1) The relative serious nature of the violation as it relates to assuring the citizens of this state a high standard of professional care.

200.22(2) The facts of the particular violation.

200.22(3) Any extenuating facts or other countervailing considerations.

200.22(4) The number of prior violations or complaints.

200.22(5) The seriousness of prior violations or complaints.

200.22(6) Whether remedial action has been taken.

200.22(7) Such other factors as may reflect upon the competency, ethical standards, and professional conduct of the licensee.

ITEM 24. Adopt new rule 645--200.23(272C) as follows:

645--200.23(272C) Grounds for discipline. The board may impose any of the disciplinary sanctions set forth in rule 200.21(272C), including civil penalties in an amount not to exceed $1000, when the board determines that a licensee is guilty of any of the following acts or offenses.

200.23(1) All grounds listed in Iowa Code section 147.55.

200.23(2) Violation of the rules promulgated by the board.

200.23(3) Personal disqualifications:

a. Mental or physical inability reasonably related to and adversely affecting the licensee's ability to practice in a safe and competent manner.

b. Involuntary commitment for treatment of mental illness, drug addiction or alcoholism.

200.23(4) Practicing the profession while the license is suspended or lapsed.

200.23(5) Revocation, suspension, or other disciplinary action taken by a licensing authority of another state, territory, or country; or failure by the licensee to report in writing to the Iowa board of physical and occupational therapy examiners revocation, suspension, or other disciplinary action taken by a licensing authority of another state, territory, or country; or both.

200.23(6) Negligence by the licensee in the practice of the profession, which is a failure to exercise due care including negligent delegation to or supervision of employees or other individuals whether or not injury results; or any conduct, practice or conditions which impair the ability to safely and skillfully practice the profession.

200.23(7) Failure to comply with the following rules of ethical conduct and practice.

a. A physical therapist shall not practice outside the scope of the license.

b. When the physical therapist does not possess the skill to evaluate a patient, plan the treatment program, or carry out the treatment, the physical therapist is obligated to assist in identifying a professionally qualified licensed practitioner to perform the service.

c. The practice of physical therapy shall minimally consist of:

(1) Interpreting all referrals.

(2) Evaluating each patient.

(3) Identifying and documenting individual patient's problems and goals.

(4) Establishing and documenting a plan of care.

(5) Providing appropriate treatment.

(6) Determining the appropriate portions of the treatment program to be delegated to assistive personnel.

(7) Appropriately supervising individuals as described in rule 200.24(272C).

(8) Providing timely patient reevaluation.

(9) Maintaining timely and adequate patient records of all physical therapy activity and patient response.

d. It is the responsibility of the physical therapist to inform the referring practitioner when any requested treatment procedure is inadvisable or contraindicated. The physical therapist shall refuse to carry out orders that are inadvisable or contraindicated and advise the referring practitioner of such orders.

e. Treatment shall not be continued beyond the point of possible benefit to the patient or by treating more frequently than necessary to obtain maximum therapeutic effect.

f. It is unethical for the physical therapist to directly or indirectly request, receive, or participate in the dividing, transferring, assigning, rebating, or refunding of an unearned fee or to profit by means of credit or other valuable consideration as an unearned commission, discount, or gratuity in connection with the furnishing of physical therapy services.

g. The physical therapist shall not exercise undue influence on patients to purchase equipment produced or supplied by a company in which the physical therapist owns stock or has any other direct or indirect financial interest.

h. Physical therapists shall not permit another person to use their licenses for any purpose.

i. A physical therapist shall not obtain, possess, or attempt to obtain or possess a controlled substance without lawful authority or sell, prescribe, give away, or administer a controlled substance in the practice of physical therapy.

j. A physical therapist shall not verbally or physically abuse a patient.

k. A physical therapist shall not engage in sexual misconduct. Sexual misconduct includes the following:

(1) Engaging in or soliciting a sexual relationship, whether consensual or nonconsensual, with a patient.

(2) Making sexual advances, requesting sexual favors, or engaging in other verbal conduct or physical contact of a sexual nature with a patient.

200.23(8) Failure to adequately supervise personnel in accordance with the standards for supervision set forth in rule 200.24(272C).

200.23(9) Unethical business practices, consisting of any of the following:

a. False or misleading advertising.

b. Betrayal of a professional confidence.

c. Falsifying patient's records.

200.23(10) Failure to notify the board of a change of name or address within 30 days after it occurs.

200.23(11) Submission of a false report of continuing education, or failure to submit the required report of continuing education.

200.23(12) Failure to notify the board within 30 days after occurrence of any judgment or settlement of a malpractice claim or disciplinary action taken by another state.

200.23(13) Failure to comply with a subpoena issued by the board.

200.23(14) Failure to report to the board as provided in Iowa Code section 272C.9 any violation by another licensee of the reasons for disciplinary action as listed in this rule.

200.23(15) Failure to report to the board as provided in Iowa Code section 272C.9 any violation by a physical therapist assistant of the reasons for disciplinary action as listed in rule 645--202.20(272C).

200.23(16) Obtaining a license by fraud or misrepresentation.

200.23(17) Conviction of a felony related to the practice of physical therapy or the conviction of any felony that would affect the licensee's ability to practice physical therapy. A copy of the record of conviction shall be conclusive evidence. Conviction shall include a finding or verdict of guilty, a plea of guilty, an admission of guilt, or a plea of nolo contendere.

200.23(18) Professional incompetency. Professional incompetency includes but is not limited to:

a. A substantial lack of knowledge or ability to discharge professional obligations within the physical therapist's practice;

b. A substantial deviation by the physical therapist from the standards of learning or skill ordinarily possessed and applied by other physical therapists in the state of Iowa acting in the same or similar circumstances;

c. A failure by a physical therapist to exercise in a substantial respect that degree of care which is ordinarily exercised by the average physical therapist in the state of Iowa acting in the same or similar circumstances;

d. A willful or repeated departure from or the failure to conform to the minimal standard of acceptable and prevailing practice of physical therapy in the state of Iowa.

200.23(19) Inability to practice physical therapy with reasonable skill and safety by reason of a mental or physical impairment or chemical abuse.

200.23(20) Violating a lawful order of the board, previously entered by the board in a disciplinary or licensure hearing, or violating the terms and provisions of a consent agreement or informal settlement between a licensee and the board.

200.23(21) Failure to respond, when requested, to communications of the board within 30 days of the mailing of such communication by registered or certified mail.

200.23(22) Obtaining third-party payment through fraudulent means. Third-party payers include, but are not limited to, insurance companies and government reimbursement programs. Obtaining payment through fraudulent means includes, but is not limited to:

a. Reporting incorrect treatment dates for the purpose of obtaining payment;

b. Reporting charges for services not rendered;

c. Incorrectly reporting services rendered for the purpose of obtaining payment which is greater than that to which the licensee is entitled; or

d. Aiding a patient in fraudulently obtaining payment from a third-party payer.

200.23(23) Practicing without a current license or practicing when a license is lapsed.

ITEM 25. Adopt new rule 645--200.24(272C) as follows:

645--200.24(272C) Supervision requirements.

200.24(1) Licensed physical therapist assistants may assist in providing physical therapy services under immediate telecommunicative supervision as long as the physical therapy services are rendered in accordance with the minimal frequency standards set forth in subrule 200.24(4).

200.24(2) Licensed physical therapist assistants may assist in providing physical therapy services as long as supervision and the physical therapy services are rendered in accordance with the minimal frequency standards set forth in subrule 200.24(4).

200.24(3) When providing physical therapy services under the supervision of a physical therapist, the physical therapist assistant shall:

a. Provide physical therapy services only under the supervision of the physical therapist.

b. Consult the supervising physical therapist if procedures are believed not to be in the best interest of the patient or if the assistant does not possess the skills necessary to provide the procedures.

c. Provide treatment only after evaluation and development of a treatment plan by the physical therapist.

d. Gather data relating to the patient's disability, but not interpret the data as it pertains to the plan of care.

e. Refer inquiries that require interpretation of patient information to the physical therapist.

f. Communicate any change, or lack of change, which occurs in the patient's condition which may need the assessment of the physical therapist.

200.24(4) The physical therapist must provide patient evaluation and participate in treatment based upon the health care admission or residency status of the patient being treated. The minimal frequency shall be:

Patient's Health Care Residency or Admission Status	Frequency of Physical Therapist Treatment
Hospital, acute care	Every 4th visit or 2nd calendar day
Hospital, non-CARF	Every 4th visit or 2nd calendar day
Hospital, CARF accredited beds	Every 5th visit or 5th calendar day
Skilled nursing	Every 5th visit or 5th calendar day
Home health	Every 5th visit or 10th calendar day
Nursing facility	Every 10th visit or 10th calendar day
Iowa educational agency	Every 5th visit or 30th calendar day
Other facility/ admissions status	Every 5th visit or 10th calendar day

200.24(5) A physical therapist may be responsible for supervising not more than two physical therapist assistants who are providing physical therapy per calendar day. This includes physical therapist assistants being supervised by telecommunicative supervision. However, a physical therapist assistant may be supervised by any number of physical therapists. The physical therapist is responsible for maintaining timely records which indicate the names of the physical therapist assistants for whom the physical therapist has supervisory responsibility.

200.24(6) The signature of a physical therapist assistant or physical therapist on a physical therapy treatment record indicates that the physical therapy services were provided in accordance with the rules and regulations for practicing as a physical therapist or physical therapist assistant.

200.24(7) The physical therapist assumes responsibility for all delegated tasks and shall not delegate a service which exceeds the expertise of the assistive personnel.

Following are activities which must be performed by the physical therapist and cannot be delegated to any assistive personnel including a physical therapist assistant:

1. Interpretation of referrals.

2. Initial physical therapy evaluation and reevaluations.

3. Identification, determination or modification of patient problems, goals, and care plans.

4. Final discharge evaluation and establishment of the discharge plan.

5. Assurance of the qualifications of all assistive personnel to perform assigned tasks through written documentation of their education or training that is maintained and available at all times.

6. Delegation and instruction of the services to be rendered by the physical therapist assistant or other assistive personnel, including, but not limited to, specific tasks or procedures, precautions, special problems, and contraindicated procedures.

7. Timely review of documentation, reexamination of the patient and revision of the plan when indicated.

200.24(8) Other assistive personnel: provision of patient care independently. Physical therapists are responsible for patient care provided by assistive personnel under their supervision. Physical therapy aides and other assistive personnel shall not provide independent patient care unless each of the following standards is satisfied:

a. The supervising physical therapist has physical participation in the patient's treatment or evaluation, or both, each treatment day.

b. The assistive personnel may provide independent patient care only while under the on-site supervision of the supervising physical therapist. On-site supervision means that the supervising physical therapist shall:

(1) Be continuously on site and present in the department or facility where the assistive personnel are performing services; and

(2) Be immediately available to assist the person being supervised in the services being performed; and

(3) Provide continued direction of appropriate aspects of each treatment session in which a component of treatment is delegated to assistive personnel.

c. Documentation made in physical therapy records by unlicensed assistive personnel shall be cosigned by the supervising physical therapist.

d. The physical therapist provides periodic reevaluation of assistive personnel's performance in relation to the patient.

200.24(9) Other assistive personnel. Physical therapy aides and other assistive personnel may assist a physical therapist assistant in providing patient care in the absence of a physical therapist only if the physical therapist assistant maintains in-sight supervision of the physical therapy aide or other assistive personnel and the physical therapist assistant is primarily and significantly involved in that patient's care.

ITEM 26. Adopt new rule 645--200.25(272C) as follows:

645--200.25(272C) Peer review committees.

200.25(1) A complaint may be assigned to a peer review committee for review, investigation, and report to the board.

200.25(2) The board shall determine which peer review committee will review a case and what complaints or other matters shall be referred to a peer review committee for investigation, review, and report to the board.

200.25(3) Members of the peer review committees shall not be liable for acts, omissions, or decisions made in connection with service on the peer review committee. However, such immunity from civil liability shall not apply if such act is done with malice.

200.25(4) The peer review committees shall observe the requirements of confidentiality imposed by Iowa Code section 272C.6.

ITEM 27. Adopt new rule 645--200.26(21) as follows:

645--200.26(21) Conduct of persons attending meetings.

200.26(1) The person presiding at a meeting for the board may exclude a person from an open meeting for behavior that obstructs the meeting.

200.26(2) Cameras and recording devices may be usedat open meetings provided they do not obstruct the meeting. If the user of a camera or recording device obstructs the meeting by the use of such device, the person presiding may request the person to discontinue use of the camera or device. If the person persists in use of the device or camera, that person shall be ordered excluded from the meeting by order of the board member presiding at the meeting.

ARC 7822A

These amendments provide that the Iowa Board of Physician Assistant Examiners will accept all programs accredited by the Council on Accreditation of Allied Health Educational Programs (CAAHEP) implementing Iowa Code section 148C.2.

No written or oral comments were received on these amendments. These amendments are identical to the Notice of Intended Action which was published in the Iowa Administrative Bulletin on October 22, 1997, as ARC 7607A.

These amendments were adopted by the Iowa Board of Physician Assistant Examiners at the January 21, 1998, board meeting.

These amendments will become effective on March 18, 1998.

These amendments are intended to implement Iowa Code chapter 148C.

The following amendments are adopted.

ITEM 1. Amend rule 645--325.2(148C), definition of "Approved program," as follows:

"Approved program" means a program for the education of physician assistants which has been formally evaluated and approved by the board or by the Accreditation Review Committee of Education for Physician Assistants of the American Medical Association or its successor agency. accredited by the Committee on Allied Health Education and Accreditation or its successor, the Council on Accreditation of Allied Health Educational Programs, or its successor.

ITEM 2. Amend rule 645--325.15(148C) as follows:

645--325.15(148C) Physician assistant trainee.

325.15(1) Any person who is enrolled as a trainee in any school offering an accredited physician assistant training program (student) in an approved program shall comply with the rules set forth in this chapter. A trainee (student) is exempted from licensure requirements.

325.15(2) Notwithstanding any other provisions of these rules, a trainee (student) may perform medical services when they are rendered within the scope of an approved program.

ITEM 3. Rescind rule 645--325.17(148C) and adopt the following new rule in lieu thereof:

645--325.17(148C) Essential requirements of an approved program. An educational program for the instruction of a physician assistant shall meet the essential requirements and criteria as established by the Committee on Allied Health Education and Accreditation or its successor, the Council on Accreditation of Allied Health Educational Programs, or its successor agency. Any educational program for

the instruction of a physician assistant which is not currently accredited by the Council on Accreditation of Allied Health Educational Programs, or its successor agency, does not meet the definition of an approved program.

ARC 7814A

This chapter implements a program to require individuals who perform renovation, remodeling, and repainting of target housing for compensation to provide an approved lead hazard information pamphlet to the owner and occupant of the housing prior to commencing the work.

These rules are based on the most current draft of U.S. Environmental Protection Agency requirements for notification regarding lead hazards prior to renovation, remodeling, and repainting.

The Department of Public Health intends to seek authorization from the U.S. Environmental Protection Agency to administer and enforce Section 406 of the federal Toxic Substance Control Act. In order to receive authorization from the U.S. EPA, the Department of Public Health's rules must be judged to be as protective as Section 406 of the federal Toxic Substance Control Act. Under 40 CFR Part 745, notification prior to renovation, remodeling, or repainting will become mandatory on August 31, 1999. The Department of Public Health must submit an application by March 1, 1998, asking for this program to be approved. The U.S. EPA must approve or disapprove this application by August 31, 1998. If this application is not approved, the U.S. EPA will enforce the federal regulations in Iowa beginning on August 31, 1998.

Notice of Intended Action was published in the Iowa Administrative Bulletin on October 22, 1997, as ARC 7602A. A public hearing was held on November 13, 1997. Three public comments were received. The first commenter asked that subrules 69.3(2) and 69.4(2) be changed to require clear and legible type rather than a specific size type. This change has been made. The second commenter asked for the notification requirement to be revised for emergency renovation, remodeling, and repainting needed to prevent significant property damage or threats to public safety or health. Rules 69.3(135) and 69.4(135) were amended and rule 69.5(135) was added to address this concern. The second commenter also asked that all references to "all occupants" be changed to "all known occupants." This change has been made. The third commenter made comments on four specific issues. The first comment was that this chapter refers to a pamphlet, "Lead Poisoning: How to Protect Iowa Families," that was not available for review with the rule. A notice that this pamphlet is available for comment was published in the Iowa Administrative Bulletin on December 17, 1997. This pamphlet must be approved by the U.S. EPA. In order to receive U.S. EPA approval, the Department must show that it has responded to public comments. The Department accepted comments on the pamphlet through January 7, 1998, and is addressing these comments prior to finalizing the pamphlet and submitting it to the U.S. EPA for approval. The second comment was a concern that the Department would not be able to respond to the large number of questions that will be generated by this regulation. The Department is prepared to respond to the large number of questions that will be generated. The third comment was that there did not appear to be a penalty for failing to comply with this chapter. The legislature did not establish a specific penalty for a violation of this chapter. However, Iowa Code chapter 135 states that anyone who knowingly violates any provision of chapter 135 or any administrative rule of the Department shall be guilty of a simple misdemeanor. The fourth comment was that the Department did not appear to have the staff to enforce this chapter. The Department does have the staff to enforce this chapter.

This chapter is intended to implement Iowa Code Supplement section 135.105C.

These rules shall become effective on March 19, 1998.

Adopt the following new chapter:

641--69.2(135) Definitions.

"Common area" means a portion of the building that is generally accessible to all occupants. This includes, but is not limited to, hallways, stairways, laundry and recreational rooms, playgrounds, community centers, garages, and boundary fences.

"Department" means the Iowa department of public health.

"Dwelling unit" means a single, unified combination of rooms designed for use as a dwelling by one family.

"Lead-based paint" means paint or other surface coatings that contain lead equal to or in excess of 1.0 milligram per square centimeter or more than 0.5 percent by weight.

"Lead-based paint hazard" means any condition that causes exposure to lead from lead-contaminated dust, lead-contaminated soil, or lead-based paint that is deteriorated or present in accessible surfaces, friction surfaces, and impact surfaces that would result in adverse human health effects.

"Living area" means any area of a residential dwelling used by at least one child six years of age or less including, but not limited to, living rooms, kitchen areas, dens, playrooms, and children's bedrooms.

"Multifamily dwelling" means a structure that contains more than one separate residential dwelling unit, which is used or occupied, or is intended to be used or occupied, in whole or in part, as the home or residence of one or more persons.

"Renovation, remodeling, repainting" means modifying any existing structure or portion of a structure where painted surfaces are disturbed, unless the activity fits the criteria of lead abatement as defined in 641--70.2(135) and is performed by a certified lead abatement contractor as defined in 641--70.2(135). This includes, but is not limited to, removing walls, ceilings, and other painted building components; window replacement; floor refinishing; and sanding, scraping, stripping, water blasting, or otherwise removing paint.

"Residential dwelling" means (1) a detached single-family dwelling unit, including the surrounding yard, attached structures such as porches and stoops, and detached buildings and structures including, but not limited to, garages, farm buildings, and fences, or (2) a single-family dwelling unit in a structure that contains more than one separate residential dwelling unit, which is used or occupied, or intended to be used or occupied, in whole or part, as the home or residence of one or more persons.

"Target housing" means housing constructed prior to 1978 with the exception of housing for the elderly or for persons with disabilities, unless at least one child six years of age or less, resides or is expected to reside in the housing, and housing which does not contain a bedroom.

641--69.3(135) Notification required. Beginning on August 1, 1999, individuals who perform renovation, remodeling, and repainting of target housing for compensation, except for emergency renovation, remodeling, and repainting of target housing for the purpose of preventing significant property damage or threats to public safety or health, must do the following prior to commencing the work:

69.3(1) Provide the pamphlet, Lead Poisoning: How to Protect Iowa Families, to the owner and occupant of each dwelling unit where renovation, remodeling, and repainting will be performed.

69.3(2) Obtain a signed, dated acknowledgment from the owner and known occupant of each dwelling unit where renovation, remodeling, and repainting will be performed affirming that they have received the pamphlet and are aware of the potential health hazards from remodeling, renovating, or repainting housing containing lead-based paint.

a. The acknowledgment shall include the following language:

I have received the pamphlet entitled Lead Poisoning: How to Protect Iowa Families and am aware of the potential health risk associated with remodeling, renovating, or repainting housing containing lead-based paint or lead-based paint hazards.

b. Below the statement, the acknowledgment shall require the signature of the owner and occupant, along with their dates of signature.

c. The type shall be clear and legible.

d. The acknowledgment may be included as a separate sheet or as a part of any written contract or service agreement. The acknowledgment must be completed prior to commencing the work.

e. If the parties use a written contract or agreement which is written in a language other than English, the acknowledgment text shall be written in the same language as the text of the contract or agreement.

69.3(3) If the general nature, location, and expected starting and ending dates of the planned renovation, remodeling, and repainting change after the initial notification has been conducted, the individual conducting the renovation, remodeling, and repainting shall provide further notification to the owners and occupants providing revised information on the ongoing or planned activities.

641--69.4(135) Notification required in multifamily housing. Beginning on August 1, 1999, individuals who perform renovation, remodeling, and repainting of common areas for compensation, except for emergency renovation, remodeling, and repainting of target housing for the purpose of preventing significant property damage or threats to public safety or health, must do the following prior to commencing the work:

69.4(1) Provide the pamphlet, Lead Poisoning: How to Protect Iowa Families, an approved lead hazard information pamphlet to the owner of the multifamily target housing where renovation, remodeling, and repainting will be performed.

69.4(2) Obtain a signed, dated acknowledgment from the owner of the multifamily target housing where renovation, remodeling, and repainting will be performed affirming that the owner has received the pamphlet and is aware of the potential health hazards from remodeling, renovating, or repainting housing containing lead-based paint.

a. The acknowledgment shall include the following language:

I have received the pamphlet entitled Lead Poisoning: How to Protect Iowa Families and am aware of the potential health risk associated with remodeling, renovating, or repainting housing containing lead-based paint or lead-based paint hazards.

b. Below the statement, the acknowledgment shall require the signature of the owner, along with the date of signature.

c. The type shall be clear and legible.

d. The acknowledgment may be included as a separate sheet or as a part of any written contract or service agreement. The acknowledgment must be completed prior to commencing the work.

e. If the parties use a written contract or agreement which is written in a language other than English, the acknowledgment text shall be written in the same language as the text of the contract or agreement.

f. Notify each owner and occupant of the multifamily housing, in writing, of the intended remodeling, repainting, or renovation, and make the pamphlet, Lead Poisoning: How to Protect Iowa Families, available upon request. At a minimum, this notification shall be accomplished by distributing written notice to each owner and occupant of the target housing. The notice shall describe:

(1) The general nature and location of the planned renovation, remodeling, and repainting activity.

(2) The expected starting and ending dates of the planned renovation, remodeling, and repainting activity.

(3) A statement of how the owners and occupants can obtain the pamphlet, Lead Poisoning: How to Protect Iowa Families, at no charge from the individual conducting the renovation, remodeling, and repainting activity.

g. These activities shall be conducted by the individual planning to perform the renovation, remodeling, and repainting, or by the owner on behalf of this individual.

h. If the owner performs the notification activities on behalf of the individual planning to perform the renovation, remodeling, and repainting, then the individual planning to perform the renovation, remodeling, and repainting must retain a statement signed and dated by the owner of the dwelling describing the steps performed to notify all occupants of the intended renovation, remodeling, and repainting, and to provide the pamphlet, Lead Poisoning: How to Protect Iowa Families, at no charge upon request. Regardless of who performs the notification activities required in this subrule, the individual planning to conduct the renovation, remodeling, and repainting shall be responsible for ensuring compliance with this subrule and shall be liable for any failures to comply with the notification requirements in this subrule.

69.4(3) If the general nature, location, and expected starting and ending dates of the planned renovation, remodeling, and repainting change after the initial notification has been conducted, the individual conducting the renovation, remodeling, and repainting shall provide further notification to the owners and occupants providing revised information on the ongoing or planned activities.

641--69.5(135) Emergency renovation, remodeling, and repainting. Beginning on August 1, 1999, individuals who perform emergency renovation, remodeling, and repainting of target housing for compensation for the purpose of preventing significant property damage or threats to public safety or health must do the following:

69.5(1) Provide the pamphlet, Lead Poisoning: How to Protect Iowa Families, an approved lead hazard information pamphlet to the owner of the target housing where renovation, remodeling, and repainting are performed.

69.5(2) Notify each owner and occupant of the target housing, in writing, of the remodeling, repainting, or renovation, and make the pamphlet, Lead Poisoning: How to Protect Iowa Families, available upon request. At a minimum, this notification shall be accomplished by distributing written notice to each owner and occupant of the target housing. The notice shall describe:

a. The general nature and location of the renovation, remodeling, and repainting activity.

b. The starting and ending dates of the renovation, remodeling, and repainting activity.

c. A statement of how the owners and occupants can obtain the pamphlet, Lead Poisoning: How to Protect Iowa Families, at no charge from the individual conducting the renovation, remodeling, and repainting activity.

69.5(3) These activities shall be conducted by the individual performing the renovation, remodeling, and repainting, or by the owner on behalf of this individual. If the owner performs the notification activities on behalf of the individual planning to perform the renovation, remodeling, and repainting, then the individual planning to perform the renovation, remodeling, and repainting must retain a statement signed and dated by the owner of the dwelling describing the steps performed to notify all occupants of the intended renovation, remodeling, and repainting, and to provide the pamphlet, Lead Poisoning: How to Protect Iowa Families, at no charge upon request. Regardless of who performs the notification activities required in this subrule, the individual conducting the renovation, remodeling, and repainting shall be responsible for ensuring compliance with this rule and shall be liable for any failures to comply with the notification requirements in this rule.

641--69.6(135) Record-keeping requirements. Beginning on August 1, 1999, individuals who conduct renovation, remodeling, and repainting for compensation in target housing shall retain all records necessary to demonstrate compliance with this chapter for a minimum of three years following completion of the renovation, remodeling, and repainting. The records shall include:

69.6(1) The address or location of the target housing where remodeling, renovation, or repainting was conducted.

69.6(2) A list of all known occupants of the dwelling units where renovation, remodeling, or repainting was conducted at the commencement of the work.

69.6(3) Copies of signed, dated acknowledgments as required by subrule 69.3(2) from each owner and occupant of a dwelling unit where renovation, remodeling, or repainting was conducted.

69.6(4) Copies of signed, dated acknowledgments as required by subrule 69.4(2) from each owner of multifamily target housing where renovation, remodeling, or repainting was conducted in common areas.

69.6(5) Copies of all signed, dated statements of notification, as well as copies of all notification materials to all owners and occupants as required by acknowledgments as required by subrule 69.4(2) from each owner and occupant of multifamily target housing where renovation, remodeling, or repainting was conducted in common areas.

641--69.7(135) Enforcement.

69.7(1) The department may enter the place of business of an individual who conducts renovation, remodeling, and repainting for the purpose of enforcing the notification required by this chapter.

69.7(2) The following are considered to be in violation of this chapter:

a. Failure or refusal to comply with any requirements of this chapter.

b. Failure or refusal to establish, maintain, provide, copy, or permit access to records or reports as required by this chapter.

c. Failure or refusal to permit entry or inspection as described in subrule 69.7(1).

These rules are intended to implement Iowa Code Supplement section 135.105C.

ARC 7813A

Iowa Code section 135.105A directs the Department of Public Health to establish a program for the training and certification of lead inspectors and lead abaters and states that a person shall not perform lead abatement or lead inspections unless the person has completed a training program approved by the Department and has obtained certification. Property owners are required to be certified only if the property in which they will perform lead inspections or lead abatement is occupied by a person other than the owner or a member of the owner's immediate family while the measures are being performed. A person may be certified as both a lead inspector and a lead abater. However, a person who is certified as both shall not provide both inspection and abatement services at the same site unless a written consent or waiver, following full disclosure by the person, is obtained from the owner or manager of the site. The legislation establishing this Iowa Code section stated that this section could take effect only after the Department of Public Health obtained certification from the U.S. Environmental Protection Agency (EPA) as an accredited program to train and certify lead inspectors and abaters. However, the legislation also stated that the Department could establish a temporary program for the voluntary certification of lead inspectors and lead abaters during the period prior to obtaining certification as an accredited program from the U.S. EPA.

In September 1996, the Department of Public Health adopted rules to implement a voluntary program to certify lead inspectors in response to the demand for lead inspectors that was created by the U.S. EPA rules that require disclosure regarding lead-based paint prior to the sale or rental of a pre-1978 dwelling.

In May 1997, the Department of Public Health amended the existing rules to implement a voluntary program to certify additional lead professionals, including lead inspectors, elevated blood lead (EBL) inspectors, lead abatement contractors, lead abatement workers, and visual risk assessors. These rules were adopted to meet the public demand for additional categories of certified lead inspectors and to ensure that certified lead abatement contractors and certified lead abatement workers were available to meet the requirements of a U.S. Department of Housing and Urban Development grant received by the city of Dubuque.

Since the Department of Public Health certification program has not yet received authorization from the U.S. EPA, certification of lead professionals is still voluntary.

In order to receive authorization from the U.S. EPA, the Department of Public Health must establish a program for the mandatory certification of lead professionals that will be considered as protective as the U.S. EPA rules contained in Subpart L and Subpart Q of 40 CFR Part 745 of the Code of Federal Regulations. Under 40 CFR Part 745, approval of training programs will become mandatory on March 1, 1999, and certification of lead professionals will become mandatory on August 31, 1999. The Department of Public Health must submit an application by March 1, 1998, asking for this program to be approved. The U.S. EPA must approve or disapprove this application by August 31, 1998. If this application is not approved, the U.S. EPA will enforce the federal regulations in Iowa beginning on August 31, 1998.

The amendments to Chapter 70 make changes to the current voluntary certification program for lead professionals. In addition, in order to meet the U.S. EPA requirements for authorization of this program, approval of training programs will become mandatory on March 1, 1999, and certification of lead professionals will become mandatory on August 1, 1999. While these amendments require lead professionals to be certified and establish specific requirements for how to perform lead-based paint activities if a property owner, manager or occupant chooses to undertake them, nothing in this chapter requires a property owner, manager, or occupant to undertake any particular lead-based paint activity.

These rules are based on the final U.S. Environmental Protection Agency requirements for certification of lead professionals.

Notice of Intended Action was published in the Iowa Administrative Bulletin on October 22, 1997, as ARC 7603A. A public hearing was held on November 13, 1997. Two public comments were received. The first commenter stated that the rules were appropriate and adequate. The second commenter commented on six separate issues.

The first comment was that this chapter would require lead inspectors to test more testing combinations than are required by the Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing (1995, U.S. Department of Housing and Urban Development). In response to this comment, subrule 70.6(2) and subrule 70.6(3) have been revised to remove requirements that conflicted with the Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing (1995, U.S. Department of Housing and Urban Development).

The second comment was that this chapter gives the Department of Public Health authority over child-occupied facilities in addition to target housing. Iowa Code section 135.105A does not restrict the Department of Public Health's authority to target housing. In addition, in order to be judged as protective as the corresponding U.S. EPA regulations, these rules must cover lead-based paint activities conducted in child-occupied facilities.

The third comment was that the 80 percent passing score required on tests given prior to certification is more stringent than many existing training programs. The Department of Public Health believes that an 80 percent passing score on certification tests is necessary for Iowa's program to be judged as protective as the corresponding U.S. EPA regulations. The Department of Public Health has used the 80 percent passing score in training programs for the past year, and 95 percent of the people taking the course have passed the test the first time.

The fourth comment was that it will be a hardship for lead abatement workers to meet any requirement for certification. These rules must require lead abatement workers to be certified if Iowa's program is to be judged to be as protective as the corresponding U.S. EPA regulations. However, in response to this comment, in subrule 70.4(6), the training hours required for a lead abatement worker to be certified have been reduced from 32 hours to 24 hours. All of the required topics can still be covered in a 24-hour training course. These topics will not be covered in as much detail as they would be in a 32-hour training course. However, since a certified lead abatement contractor must supervise the work of a certified lead abatement worker, the 24-hour training course will be adequate. In addition, the requirement that certified lead abatement contractors utilize only lead abatement workers has been changed from the Notice of Intended Action. The introductory paragraph of subrule 70.6(6) formerly read as follows: "A certified lead abatement contractor or lead abatement worker must conduct lead abatement according to the following standards and must utilize only certified lead abatement workers. Beginning on August 1, 1999, lead abatement shall be conducted only by a certified lead abatement contractor or a certified lead abatement worker." The phrase "and must utilize only certified lead abatement workers" has been deleted from the first sentence of the paragraph.

The fifth comment was that the Department of Public Health does not have the personnel necessary to enforce these regulations. The Department of Public Health has the personnel necessary to enforce these regulations and is working with the U.S. EPA to develop an enforcement plan.

The final comment was that reciprocity among states should have been addressed in this chapter. The Department of Public Health cannot address the issue of reciprocity among states until other states have programs that have been authorized by the U.S. EPA. The Department of Public Health will address the issue of reciprocity after Iowa's program and the programs in other states have been authorized by the U.S. EPA.

These amendments are intended to implement Iowa Code section 135.105A.

These amendments shall become effective on March 19, 1998.

The following amendments are adopted.

Amend 641--Chapter 70 as follows:

641--70.2(135) Definitions.

"Adequate quality control" means a plan or design which ensures the authenticity, integrity, and accuracy of samples, including dust, soil, and paint chip or paint film samples. Adequate quality control also includes provisions for representative sampling.

"Approved course" means a course that has been approved by the department for the training of lead professionals.

"Certified elevated blood lead (EBL) inspection agency" means an agency that has met the requirements of 641-- 70.5(135) and that has been certified by the department.

"Certified elevated blood lead (EBL) inspector" means a person who has met the requirements of 641--70.5(135) and who has been certified by the department.

"Certified lead abatement contractor" means a person who has met the requirements of 641--70.5(135) and who has been certified by the department.

"Certified lead abatement worker" means a person who has met the requirements of 641--70.5(135) and who has been certified by the department.

"Certified lead inspector" means a person who has met the requirements of 641--70.5(135) and who has been certified by the department.

"Certified lead professional" means a person who has been certified by the department as a lead inspector, elevated blood lead (EBL) inspector, lead abatement contractor, lead abatement worker, or visual risk assessor.

"Certified visual risk assessor" means a person who has met the requirements of 641--70.5(135) and who has been certified by the department.

"Child-occupied facility" means a building, or portion of a building, constructed prior to 1978, visited by the same child six years of age or under, on at least two different days within any week (Sunday through Saturday period, provided that each day's visit lasts at least three hours and the combined weekly visits last at least six hours). Child-occupied facilities may include, but are not limited to, day-care centers, preschools and kindergarten classrooms.

"Clearance levels" means values that indicate the maximum amount of lead permitted in dust on a surface following completion of an abatement activity. These values are 100 micrograms per square foot on floors, 500 micrograms per square foot on window sills, and 800 micrograms per square foot on window troughs.

"Common area" means a portion of the building that is generally accessible to all occupants. This includes, but is not limited to, hallways, stairways, laundry and recreational rooms, playgrounds, community centers, garages, and boundary fences.

"Component" or "building component" means specific design or structural elements or fixtures of a building, residential dwelling, or child-occupied facility that are distinguished from each other by form, function, and location. These include, but are not limited to, interior components such as ceilings, crown moldings, walls, chair rails, doors, door trim, floors, fireplaces, radiators and other heating units, shelves, shelf supports, stair treads, stair risers, stair stringers, newel posts, railing caps, balustrades, windows and trim (including sashes, window heads, jambs, sills or stools and troughs), built-in cabinets, columns, beams, bathroom vanities, countertops, and air conditioners; and exterior components such as painted roofing, chimneys, flashing, gutters and downspouts, ceilings, soffits, fascias, rake boards, cornerboards, bulkheads, doors and door trim, fences, floors, joists, latticework, railings and railing caps, siding, handrails, stair risers and treads, stair stringers, columns, balustrades, windowsills or stools and troughs, casing, sashes and wells, and air conditioners.

"Containment" means a process to protect workers and the environment by controlling exposures to the lead-contaminated dust and debris created during an abatement.

"Course agenda" means an outline of the key topics to be covered during a training course, including the time allotted to teach each topic.

"Course test" means an evaluation of the overall effectiveness of the training which shall test the trainees' knowledge and retention of the topics covered during the course.

"Course test blueprint" means written documentation identifying the proportion of course test questions devoted to each major topic in the course curriculum.

"Department" means the Iowa department of public health.

"Deteriorated paint" means paint that is cracking, flaking, chipping, peeling, or otherwise separating from the substrate of a building component.

"Discipline" means one of the specific types or categories of lead-based paint activities identified in this chapter for which individuals may receive training from approved courses and become certified by the department. For example, "lead inspector" is a discipline.

"Distinct painting history" means the application history, as indicated by its visual appearance or a record of application, over time, of paint or other surface coatings to a component or room.

"Documented methodologies" means methods or protocols used to sample for the presence of lead in paint, dust, and soil.

"Elevated blood lead (EBL) child" means any child who has had one venous blood lead level greater than 20 micrograms per deciliter or at least two venous blood lead levels of 15 to 19 micrograms per deciliter.

"Elevated blood lead (EBL) inspection" means an inspection to determine the sources of lead exposure for an elevated blood lead (EBL) child and the provision within ten working days of a written report explaining the results of the investigation to the owner and occupant of the residential dwelling or child-occupied facility being inspected and to the parents of the elevated blood lead (EBL) child.

"Encapsulant" means a substance that forms a barrier between lead-based paint and the environment using aliquid-applied coating (with or without reinforcement materials) or an adhesively bonded covering material.

"Encapsulation" means the application of an encapsulant.

"Enclosure" means the use of rigid, durable construction materials that are mechanically fastened to the substrate in order to act as a barrier between lead-based paint and the environment.

"Guest instructor" means an individual designated by the training program manager or principal instructor to provide instruction specific to the lecture, hands-on work activities, or work practice components of a course.

"Hands-on skills assessment" means an evaluation which tests the trainees' ability to satisfactorily perform the work practices and procedures identified in 641--70.6(135), as well as any other skill taught in a training course.

"Hazardous waste" means any waste as defined in 40 CFR 2561.3.

"Interim controls" means a set of measures designed to temporarily reduce human exposure or likely exposure to lead-based paint hazards, including repairing deteriorated lead-based paint, specialized cleaning, maintenance, painting, temporary containment, ongoing monitoring of lead-based paint hazards or potential hazards, and the establishment and operation of management and resident education programs.

"Lead abatement" means any measure or set of measures designed to permanently eliminate lead-based paint hazards in a residential dwelling or child-occupied facility. Abatement includes, but is not limited to, (1) the removal of lead-based paint and lead-contaminated dust, the permanent enclosure or encapsulation of lead-based paint, the replace-ment of lead-painted surfaces or fixtures, and the removal or covering of lead-contaminated soil and (2) all preparation, cleanup, disposal, and postabatement clearance testing activities associated with such measures.

Lead abatement specifically includes, but is not limited to, (1) projects for which there is a written contract or other documentation, which provides that an individual will be conducting activities in or to a residential dwelling or child-occupied facility that shall result in or are designed to permanently eliminate lead-based paint hazards, (2) projects resulting in the permanent elimination of lead-based paint hazards, (3) projects resulting in the permanent elimination of lead-based paint hazards that are conducted by firms or individuals who, through their company name or promotional literature, represent, advertise, or hold themselves out to be in the business of performing lead-based paint abatement, and (4) projects resulting in the permanent elimination of lead-based paint that are conducted in response to an abatement order. Abatement does not include renovation, remodeling, landscaping, or other activities, when such activities are not designed to permanently eliminate lead-based paint hazards, but, instead, are designed to repair, restore, or remodel a given structure or dwelling, even though these activities may incidentally result in a reduction or elimination of lead-based paint hazards. Furthermore, abatement does not include interim controls, operations and maintenance activities, or other measures and activities designed to temporarily, but not permanently, reduce lead-based paint hazards.

"Lead-based paint" means paint or other surface coatings that contain lead equal to or in excess of 1.0 milligram per square centimeter or more than 0.5 percent by weight.

"Lead-based paint activities" means, in the case of target housing and child-occupied facilities, lead inspection, elevated blood lead (EBL) inspection, lead hazard screen, risk assessment, lead abatement, and visual risk assessment.

"Lead-based paint hazard" means any condition that causes exposure to lead from lead-contaminated dust, lead-contaminated soil, or lead-based paint that is deteriorated or present in accessible surfaces, friction surfaces, and impact surfaces that would result in adverse human health effects.

"Lead-contaminated dust" means surface dust in residential dwellings or child-occupied facilities that contains in excess of 100 micrograms per square foot on floors, 500 micrograms per square foot on windowsills, and 800 micrograms per square foot on window troughs.

"Lead-contaminated soil" means bare soil on residential real property and on the property of a child-occupied facility that contains lead in excess of 400 parts per million for areas where child contact is likely and in excess of 2,000 parts per million if child contact is not likely.

"Lead hazard screen" means a limited risk assessment activity that involves limited paint and dust sampling.

"Lead inspection" means a surface-by-surface investigation to determine the presence of lead-based paint and a determination of the existence, nature, severity, and location of lead-based paint hazards in a residential dwelling or child-occupied facility and the provision of a written report explaining the results of the investigation and options for reducing lead-based paint hazards to the person requesting the lead inspection.

"Lead professional" means a person who conducts lead abatement, lead inspections, elevated blood lead (EBL) inspections, lead hazard screens, risk assessments, or visual risk assessments.

"Living area" means any area of a residential dwelling used by at least one child, six years of age or less, including, but not limited to, living rooms, kitchen areas, dens, playrooms, and children's bedrooms.

"Multifamily dwelling" means a structure that contains more than one separate residential dwelling unit, which is used or occupied, or intended to be used or occupied, in whole or in part, as the home or residence of one or more persons.

"Occupant protection plan" means a plan developed by a certified lead abatement contractor prior to the commencement of lead abatement in a residential dwelling or child-occupied facility that describes the measures and management procedures that will be taken during lead abatement to protect the building occupants from exposure to any lead-based paint hazards.

"Permanently covered soil" means soil which has been separated from human contact by the placement of a barrier consisting of solid, relatively impermeable materials, such as pavement or concrete. Grass, mulch, and other landscaping materials are not considered permanent covering.

"Principal instructor" means the individual who has the primary responsibility for organizing and teaching a particular course.

"Recognized laboratory" means an environmental laboratory recognized by the U.S. Environmental Protection Agency pursuant to Section 405(b) of the federal Toxic Substance Control Act as capable of performing an analysis for lead compounds in paint, soil, and dust.

"Reduction" means measures designed to reduce or eliminate human exposure to lead-based paint hazards through methods including interim controls and abatement.

"Refresher training course" means a course taken by a certified lead professional to maintain certification in a particular discipline.

"Residential dwelling" means (1) a detached single-family dwelling unit, including the surrounding yard, attached structures such as porches and stoops, and detached buildings and structures including, but not limited to, garages, farm buildings, and fences, or (2) a single-family dwelling unit in a structure that contains more than one separate residential dwelling unit, which is used or occupied, or intended to be used or occupied, in whole or part, as the home or residence of one or more persons.

"Risk assessment" means an investigation to determine the existence, nature, severity, and location of lead-based paint hazards in a residential dwelling or child-occupied facility and the provision of a written report explaining the results of the investigation and options for reducing lead-based paint hazards to the person requesting the risk assessment.

"State certification examination" means a discipline-specific examination administered by the department to test the knowledge of a person who has completed an approved training course and is applying for certification in a particular discipline.

"Target housing" means housing constructed prior to 1978 with the exception of housing for the elderly or for persons with disabilities, unless at least one child six years of age or less, resides or is expected to reside in the housing, and housing which does not contain a bedroom.

"Training hour" means at least 50 minutes of actual learning, including, but not limited to, time devoted to lecture, learning activities, small group activities, demonstrations, evaluations, or hands-on experience.

"Training manager" means the individual responsible for administering an approved course and monitoring the performance of principal instructors and guest instructors.