Administrative Code Bulletin: July 11, 2001

IOWA ADMINISTRATIVE

BULLETIN

Published Biweekly VOLUME XXIV NUMBER 1 July 11, 2001 Pages 1 to 100

CONTENTS IN THIS ISSUE

Pages 12 to 98 include ARC 0768B to ARC 0826B

ALL AGENCIES

Schedule for rule making 4

Publication procedures 5

Administrative rules on CD–ROM 5

Agency identification numbers 10

CITATION OF ADMINISTRATIVE RULES 9

CIVIL RIGHTS COMMISSION[161]

Filed, Waiver of requirements imposed
by commission rule, 15.3 ARC 0822B 68

CREDIT UNION DIVISION[189]

COMMERCE DEPARTMENT[181]“umbrella”

Filed, Uniform waiver and variance rules,
ch 23 ARC 0820B 69

DELAY

Public Safety Department[661]
Fire safety for bed and breakfast inns,
5.800 to 5.810, 5.820 Delay 99

ELDER AFFAIRS DEPARTMENT[321]

Notice, Long–term care coordinating unit,
16.1 to 16.5 ARC 0800B 12

Notice, Elder group homes, 26.1 to 26.3,
26.6(1), 26.7, 26.8(3), 26.10 to 26.17
ARC 0826B 13

ENVIRONMENTAL PROTECTION
COMMISSION[567]

NATURAL RESOURCES DEPARTMENT[561]“umbrella”

Notice, Concentrated animal feeding operation
registration program, 65.6(12) ARC 0818B 15

Filed, Title V periodic monitoring guidance;
compliance assurance monitoring (CAM),
22.108(3) ARC 0816B 69

Filed Emergency After Notice, Manure
applicators—certification and related
fees, 65.1, 65.2(3), 65.15, 65.19 ARC 0815B 33

Filed, Financial assurance requirements for
municipal solid waste landfills, ch 111
ARC 0812B 70

HUMAN SERVICES DEPARTMENT[441]

Notice, Transitional child care assistance program,
rescind ch 49 ARC 0807B 16

Notice, Exceeding income limits—suspension
of food stamp benefits, 65.1 ARC 0808B 16

Notice, Women who have been screened and
found to need treatment for breast or
cervical cancer, 75.1(40) ARC 0771B 16

Notice, Statewide average costs—nursing
facilities, 75.23(3), 75.24(3) ARC 0774B 17

Notice, Child welfare targeted case management
services, 77.29, 78.33, 80.2(2), ch 186
ARC 0777B 18

Notice, Medicaid provider reimbursement,
79.1 ARC 0781B 19

Notice, Home– and community–based waiver—
persons with a brain injury, 83.82, 83.90
ARC 0783B 19

Notice, Managed health care providers,
amendments to ch 88 ARC 0809B 20

Notice, PROMISE JOBS—mileage rate
reimbursement, 93.110(6), 93.114(15)
ARC 0785B 22

Notice, Joint registered group child care homes;
four–level child care home pilots, 110.1,
110.5(5), 110.35 ARC 0810B 22

Notice, Child care services, 130.3(1), 130.4(3)
ARC 0788B 23

Notice, Adoption, independent living, and family
planning services, 150.3(5) ARC 0790B 23

Notice, Payment increases to foster family homes
and adoptive homes, 156.6(1) ARC 0792B 24

Notice, Nursing facility conversion and
long–term care services development
grant applicants, 162.1 to 162.9 ARC 0794B 24

Notice, Access to dependent adult abuse
information, 176.4, 176.6(1), 176.10(3),
177.4, 177.5(2), 177.9(3) ARC 0811B 24

Notice, Wrap–around funding program,
rescind ch 179 ARC 0796B 26

Notice, RTSS rates frozen, 185.112(1)
ARC 0798B 26

HUMAN SERVICES DEPARTMENT[441] (Cont’d)

Filed, Reimbursement rates—state supplementary
assistance (SSA) residential care facility (RCF)
and in–home health related care (IHHRC),
52.1(3), 177.4 ARC 0769B 85

Filed Emergency After Notice, Emergency food
assistance program—increase in eligibility
guidelines, 73.4(3) ARC 0770B 33

Filed Emergency, Women who have been
screened and found to need treatment
for breast or cervical cancer, 75.1(40)
ARC 0772B 34

Filed, Medicaid—sanctions for persons who
do not cooperate, 75.14, 75.52, 75.56(2), 75.57,
75.58(2), 75.59, 76.1(5) ARC 0773B 86

Filed Emergency, Statewide average costs—
nursing facilities, 75.23(3), 75.24(3)
ARC 0775B 36

Filed, Medicaid reimbursement—ambulatory
surgical centers, 77.24, 78.26, 79.1(3)
ARC 0776B 87

Filed Emergency, Child welfare targeted case
management services, 77.29, 78.33, 80.2(2),
ch 186 ARC 0778B 37

Filed Emergency After Notice, HCBS MR waiver—
residential–based supported community living,
77.37, 78.41(10), 79.1, 83.60, 83.61(1),
83.62(3), 83.70(3) ARC 0779B 39

Filed Emergency, Modified price–based case–mix
system—non–state–owned nursing facilities for
Medicaid recipients, amendments to chs 78 to 81
ARC 0780B 41

Filed Emergency, Medicaid provider
reimbursement, 79.1 ARC 0782B 53

Filed Emergency, Home– and community–based
waiver—persons with a brain injury, 83.82,
83.90 ARC 0784B 58

Filed Emergency, PROMISE JOBS—mileage rate
reimbursement, 93.110(6), 93.114(15)
ARC 0786B 59

Filed, Record check evaluations for health
care programs, ch 119, 176.10(3)
ARC 0787B 87

Filed Emergency, Child care services, 130.3(1),
130.4(3) ARC 0789B 59

Filed Emergency, Adoption, independent living,
and family planning services, 150.3(5)
ARC 0791B 61

Filed Emergency, Payment increases to foster
family homes and adoptive homes, 156.6(1)
ARC 0793B 62

Filed Emergency, Nursing facility conversion
and long–term care services development
grant applicants, 162.1 to 162.9 ARC 0795B 62

Filed Emergency, Wrap–around funding
program, rescind ch 179 ARC 0797B 63

Filed Emergency, RTSS rates frozen,
185.112(1) ARC 0799B 63

INSURANCE DIVISION[191]

COMMERCE DEPARTMENT[181]“umbrella”

Notice, Multiple employer welfare arrangements,
77.2(1), 77.3(1), 77.4(3), 77.5(1), 77.11
ARC 0823B 26

LIBRARIES AND INFORMATION SERVICES
DIVISION[286]

EDUCATION DEPARTMENT[281]“umbrella”

Notice, Appointment process for library
service area boards of trustees, ch 9
ARC 0819B 27

Filed Emergency, Appointment process for
library service area boards of trustees, ch 9
ARC 0804B 64

NATURAL RESOURCE COMMISSION[571]

NATURAL RESOURCES DEPARTMENT[561]“umbrella”

Filed, Electronic license sales, 15.1
ARC 0813B 89

Filed, Game management areas, 51.3(1),
51.5(3), 51.9, 51.10 ARC 0814B 90

Filed, Unprotected nongame—garter snake
and timber rattlesnake, 76.1(2) ARC 0817B 90

PERSONNEL DEPARTMENT[581]

Filed Emergency After Notice, Reduction in
force—processes and procedures, 10.2,
11.3, 14.2(2), 14.3(10) ARC 0805B 66

PHARMACY EXAMINERS BOARD[657]

PUBLIC HEALTH DEPARTMENT[641]“umbrella”

Notice, Automated medication distribution
systems, ch 9 ARC 0801B 27

Notice Terminated, Controlled substances—
registration and reregistration fee, 10.3
ARC 0802B 30

PROFESSIONAL LICENSURE DIVISION[645]

PUBLIC HEALTH DEPARTMENT[641]“umbrella”

Filed, Psychologists, chs 239, 240; 241.2(1),
241.5, 241.9(1); chs 242, 243 ARC 0806B 90

PUBLIC HEARINGS

Summarized list 6

PUBLIC SAFETY DEPARTMENT[661]

Delay, Fire safety for bed and breakfast inns,
5.800 to 5.810, 5.820 99

RACING AND GAMING COMMISSION[491]

INSPECTIONS AND APPEALS DEPARTMENT[481]“umbrella”

Notice, Organization, meetings, and procedure,
1.2 ARC 0821B 30

REVENUE AND FINANCE DEPARTMENT[701]

Notice, Taxation—income from sale of obligations
issued by state or political subdivisions,
53.6, 59.6 ARC 0825B 31

SUBSTANCE ABUSE COMMISSION[643]

PUBLIC HEALTH DEPARTMENT[641]“umbrella”

Filed, Waivers or variances from administrative
rules, 3.17, ch 10 ARC 0824B 98

USURY

Notice 32

WORKERS’ COMPENSATION DIVISION[876]

WORKFORCE DEVELOPMENT DEPARTMENT[871]“umbrella”

Filed Emergency, Update of payroll tax tables,
8.8 ARC 0803B 67

PUBLISHED UNDER AUTHORITY OF IOWA CODE SECTIONS 2B.5 AND 17A.6

__________________________________

PREFACE

The Iowa Administrative Bulletin is published biweekly in pamphlet form pursuant to Iowa Code chapters 2B and 17A and contains Notices of Intended Action on rules, Filed and Filed Emergency rules by state agencies.

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.

Subscriptions and Distribution Telephone: (515)242–5120
Fax: (515)242–5974

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

STEPHANIE A. HOFF, Assistant Editor (515)281–8157

Fax: (515)281–4424

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Iowa Administrative Bulletin

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Single copies may be purchased for $20.50 plus $1.23 sales tax.

Iowa Administrative Code

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Schedule for Rule Making
2001

NOTICE SUBMISSION DEADLINE	NOTICE PUB. DATE	HEARING OR COMMENTS 20 DAYS	FIRST POSSIBLE ADOPTION DATE 35 DAYS	ADOPTED FILING DEADLINE	ADOPTED PUB. DATE	FIRST POSSIBLE EFFECTIVE DATE	POSSIBLE EXPIRATION OF NOTICE 180 DAYS
Dec. 22 ’00	Jan. 10 ’01	Jan. 30 ’01	Feb. 14 ’01	Feb. 16 ’01	Mar. 7 ’01	Apr. 11 ’01	July 9 ’01
Jan. 5	Jan. 24	Feb. 13	Feb. 28	Mar. 2	Mar. 21	Apr. 25	July 23
Jan. 19	Feb. 7	Feb. 27	Mar. 14	Mar. 16	Apr. 4	May 9	Aug. 6
Feb. 2	Feb. 21	Mar. 13	Mar. 28	Mar. 30	Apr. 18	May 23	Aug. 20
Feb. 16	Mar. 7	Mar. 27	Apr. 11	Apr. 13	May 2	June 6	Sept. 3
Mar. 2	Mar. 21	Apr. 10	Apr. 25	Apr. 27	May 16	June 20	Sept. 17
Mar. 16	Apr. 4	Apr. 24	May 9	May 11	May 30	July 4	Oct. 1
Mar. 30	Apr. 18	May 8	May 23	May 25	June 13	July 18	Oct. 15
Apr. 13	May 2	May 22	June 6	June 8	June 27	Aug. 1	Oct. 29
Apr. 27	May 16	June 5	June 20	June 22	July 11	Aug. 15	Nov. 12
May 11	May 30	June 19	July 4	July 6	July 25	Aug. 29	Nov. 26
May 25	June 13	July 3	July 18	July 20	Aug. 8	Sept. 12	Dec. 10
June 8	June 27	July 17	Aug. 1	Aug. 3	Aug. 22	Sept. 26	Dec. 24
June 22	July 11	July 31	Aug. 15	Aug. 17	Sept. 5	Oct. 10	Jan. 7 ’02
July 6	July 25	Aug. 14	Aug. 29	Aug. 31	Sept. 19	Oct. 24	Jan. 21 ’02
July 20	Aug. 8	Aug. 28	Sept. 12	Sept. 14	Oct. 3	Nov. 7	Feb. 4 ’02
Aug. 3	Aug. 22	Sept. 11	Sept. 26	Sept. 28	Oct. 17	Nov. 21	Feb. 18 ’02
Aug. 17	Sept. 5	Sept. 25	Oct. 10	Oct. 12	Oct. 31	Dec. 5	Mar. 4 ’02
Aug. 31	Sept. 19	Oct. 9	Oct. 24	Oct. 26	Nov. 14	Dec. 19	Mar. 18 ’02
Sept. 14	Oct. 3	Oct. 23	Nov. 7	Nov. 9	Nov. 28	Jan. 2 ’02	Apr. 1 ’02
Sept. 28	Oct. 17	Nov. 6	Nov. 21	Nov. 23	Dec. 12	Jan. 16 ’02	Apr. 15 ’02
Oct. 12	Oct. 31	Nov. 20	Dec. 5	Dec. 7	Dec. 26	Jan. 30 ’02	Apr. 29 ’02
Oct. 26	Nov. 14	Dec. 4	Dec. 19	Dec. 21	Jan. 9 ’02	Feb. 13 ’02	May 13 ’02
Nov. 9	Nov. 28	Dec. 18	Jan. 2 ’02	Jan. 4 ’02	Jan. 23 ’02	Feb. 27 ’02	May 27 ’02
Nov. 23	Dec. 12	Jan. 1 ’02	Jan. 16 ’02	Jan. 18 ’02	Feb. 6 ’02	Mar. 13 ’02	June 10 ’02
Dec. 7	Dec. 26	Jan. 15 ’02	Jan. 30 ’02	Feb. 1 ’02	Feb. 20 ’02	Mar. 27 ’02	June 24 ’02
Dec. 21	Jan. 9 ’02	Jan. 29 ’02	Feb. 13 ’02	Feb. 15 ’02	Mar. 6 ’02	Apr. 10 ’02	July 8 ’02
Jan. 4 ’02	Jan. 23 ’02	Feb. 12 ’02	Feb. 27 ’02	Mar. 1 ’02	Mar. 20 ’02	Apr. 24 ’02	July 22 ’02

PRINTING SCHEDULE FOR IAB
ISSUE NUMBER	SUBMISSION DEADLINE	ISSUE DATE
3	Friday, July 20, 2001	August 8, 2001
4	Friday, August 3, 2001	August 22, 2001
5	Friday, August 17, 2001	September 5, 2001

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.

PUBLICATION PROCEDURES

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 Microsoft Word, 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, First Floor South, Grimes 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, but not on the diskettes; diskettes are returned unchanged.

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

______________________

IOWA ADMINISTRATIVE RULES and IOWA COURT RULES on CD–ROM

2000 WINTER EDITION

Containing: Iowa Administrative Code (updated through December 2000)
Iowa Administrative Bulletins (July 2000 through December 2000)
Iowa Court Rules (updated through December 2000)

For free brochures and order forms contact:

Legislative Service Bureau
Attn: Ms. Stephanie Cox
State Capitol
Des Moines, Iowa 50319
Telephone: (515)281–3566 Fax: (515)281–8027
lsbinfo@legis.state.ia.us

PUBLIC HEARINGS

To All Agencies:

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.

AGENCY	HEARING LOCATION	DATE AND TIME OF HEARING
EDUCATION DEPARTMENT[281]
Beginning teacher mentoring and induction program, 83.1 to 83.8 IAB 6/27/01 ARC 0760B (ICN Network)	Keystone AEA 1400 Second St. NW Elkader, Iowa	July 18, 2001 10 to 11 a.m.
	Green Valley AEA 1405 N. Lincoln Creston, Iowa	July 18, 2001 10 to 11 a.m.
	Garner–Hayfield High School 605 Lyon Garner, Iowa	July 18, 2001 10 to 11 a.m.
	Denison High School 819 N. 16th St. Denison, Iowa	July 18, 2001 10 to 11 a.m.
	Iowa Lakes Community College 2111 Hwy. 169 N Algona, Iowa	July 18, 2001 10 to 11 a.m.
	Graphic Arts Technology Center 1951 Manufacturing Dr. Clinton, Iowa	July 18, 2001 10 to 11 a.m.
	Grinnell Community Senior High School 1333 Sunset St. Grinnell, Iowa	July 18, 2001 10 to 11 a.m.
	Keokuk High School 2285 Middle Rd. Keokuk, Iowa	July 18, 2001 10 to 11 a.m.
	Allison–Bristow Community High School 513 Birch St. Allison, Iowa	July 18, 2001 10 to 11 a.m.
	Prairie High School 401 76th Avenue SW Cedar Rapids, Iowa	July 18, 2001 10 to 11 a.m.
	Davis County High School 106 N. East St. Bloomfield, Iowa	July 18, 2001 10 to 11 a.m.
	Unity Christian High School 216 Michigan SW Orange City, Iowa	July 18, 2001 10 to 11 a.m.
	Hoover High School 4800 Aurora Ave. Des Moines, Iowa	July 18, 2001 10 to 11 a.m.
EDUCATION DEPARTMENT[281] (Cont’d) (ICN Network)
	Laurens–Marathon High School 300 W. Garfield Laurens, Iowa	July 18, 2001 10 to 11 a.m.
	Department of Education Grimes State Office Bldg. Des Moines, Iowa	July 18, 2001 10 to 11 a.m.
	Anita Jr.–Sr. High School Victory Park Rd. Anita, Iowa	July 18, 2001 10 to 11 a.m.
ELDER AFFAIRS DEPARTMENT[321]
Senior living coordinating unit, 16.1 to 16.5 IAB 7/11/01 ARC 0800B	Room 316, Hotel Fort Des Moines Tenth and Walnut Des Moines, Iowa	July 31, 2001 10 a.m.
Elder group homes, 26.1, 26.2, 26.3(6), 26.6(1), 26.7, 26.8(3), 26.10 to 26.17 IAB 7/11/01 ARC 0826B	Room 316, Hotel Fort Des Moines Tenth and Walnut Des Moines, Iowa	July 31, 2001 10 a.m.
ENVIRONMENTAL PROTECTION COMMISSION[567]
Concentrated animal feeding operation registration program, 65.6(12) IAB 7/11/01 ARC 0818B	Fifth Floor Conference Room Wallace State Office Bldg. Des Moines, Iowa	July 31, 2001 10 a.m.
INSURANCE DIVISION[191]
Multiple employer welfare arrangements, 77.2(1), 77.3(1), 77.4(3), 77.5(1), 77.11 IAB 7/11/01 ARC 0823B	330 Maple St. Des Moines, Iowa	August 1, 2001 10 a.m.
IOWA FINANCE AUTHORITY[265]
Low–income housing tax credits, 12.1, 12.2 IAB 6/27/01 ARC 0764B (ICN Network)	Department of Economic Development 200 East Grand Ave. Des Moines, Iowa	August 22, 2001 10 a.m.
	Room 208, Metro High School 1212 Seventh St. SE Cedar Rapids, Iowa	August 22, 2001 10 a.m.
	Media Center, Lewis Central H.S. 3601 Hwy. 275 Council Bluffs, Iowa	August 22, 2001 10 a.m.
	Room 107, Technical Center 1501 W. Townline Rd. Creston, Iowa	August 22, 2001 10 a.m.
	Annex Bldg., Central High School 1120 Main St. Davenport, Iowa	August 22, 2001 10 a.m.
IOWA FINANCE AUTHORITY[265] (Cont’d) (ICN Network)
	Carnegie–Stout Public Library 360 W. 11th St. Dubuque, Iowa	August 22, 2001 10 a.m.
	Room 12, Fort Dodge High School 819 N. 25th St. Fort Dodge, Iowa	August 22, 2001 10 a.m.
	Room 128, Careers Bldg. 500 College Dr. Mason City, Iowa	August 22, 2001 10 a.m.
	Room 107, Advanced Technology Ctr. 525 Grandview Ave. Ottumwa, Iowa	August 22, 2001 10 a.m.
	Room 127B, Bldg. B 4647 Stone Ave. Sioux City, Iowa	August 22, 2001 10 a.m.
	Room 110, Tama Hall 1501 E. Orange Rd. Waterloo, Iowa	August 22, 2001 10 a.m.
LIBRARIES AND INFORMATION SERVICES DIVISION[286]
Appointment process for library service area boards of trustees, ch 9 IAB 7/11/01 ARC 0819B (See also ARC 0804B herein)	First Floor Conference Room State Library of Iowa East 12th and Grand Des Moines, Iowa	August 1, 2001 10 a.m.
NURSING BOARD[655]
Nursing education programs, ch 2 IAB 6/27/01 ARC 0758B	Ballroom Kirkwood Civic Center Hotel Fourth and Walnut Des Moines, Iowa	September 19, 2001 5 p.m.
Nursing practice for LPNs, 6.6(5) IAB 6/27/01 ARC 0763B	Ballroom Kirkwood Civic Center Hotel Fourth and Walnut Des Moines, Iowa	September 19, 2001 5 p.m.
Prescriptive authority of ARNPs, 7.1 IAB 6/27/01 ARC 0762B	Ballroom Kirkwood Civic Center Hotel Fourth and Walnut Des Moines, Iowa	September 19, 2001 5 p.m.
National certifying organizations; utilization and cost control review process, 12.2, 12.3, 12.5, 12.7 IAB 6/27/01 ARC 0761B	Ballroom Kirkwood Civic Center Hotel Fourth and Walnut Des Moines, Iowa	September 19, 2001 5 p.m.
RACING AND GAMING COMMISSION[491]
Organization, meetings, and procedure, 1.2 IAB 7/11/01 ARC 0821B	Suite B 717 E. Court Des Moines, Iowa	July 31, 2001 9 a.m.
Vacation; stewards; licensing, 4.45(3), 5.5(9), 6.2(1), 6.26 IAB 6/27/01 ARC 0743B	Suite B 717 E. Court Des Moines, Iowa	July 17, 2001 9 a.m.
SECRETARY OF STATE[721]
Uniform commercial code, 1.3, 2.1, 4.4, 5.14(1), ch 6, ch 30 IAB 6/27/01 ARC 0766B (See also ARC 0767B)	First Floor Lucas State Office Bldg. Des Moines, Iowa	July 17, 2001 1:30 p.m.
SOIL CONSERVATION DIVISION[27]
Water protection practices— water protection fund, 12.76, 12.82(8), 12.83, 12.84(1) IAB 6/27/01 ARC 0751B	Second Floor Conference Room Wallace State Office Bldg. Des Moines, Iowa	July 18, 2001 2 p.m.
TRANSPORTATION DEPARTMENT[761]
General requirements and covenants for highway and bridge construction; contracts set aside for DBEs, chs 125, 126 IAB 6/27/01 ARC 0744B	Commission Conference Room 800 Lincoln Way Ames, Iowa	July 19, 2001 10 a.m. (If requested)

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

AGENCY IDENTIFICATION NUMBERS

Due to reorganization of state government by 1986 Iowa Acts, chapter 1245, it was necessary to revise the agency identification numbering system, i.e., the bracketed number following the agency name.

“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]

EMPOWERMENT BOARD, IOWA[349]

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 African–Americans, Division on the[434]

Status of Women Division[435]

HUMAN SERVICES DEPARTMENT[441]

INFORMATION TECHNOLOGY DEPARTMENT[471]

INSPECTIONS AND APPEALS DEPARTMENT[481]

Employment Appeal Board[486]

Foster Care Review Board[489]

Racing and Gaming Commission[491]

State Public Defender[493]

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]

SHEEP AND WOOL PROMOTION BOARD, IOWA[741]

TELECOMMUNICATIONS AND TECHNOLOGY COMMISSION, IOWA[751]

TRANSPORTATION DEPARTMENT[761]

Railway Finance Authority[765]

TREASURER OF STATE[781]

TURKEY MARKETING COUNCIL, IOWA[787]

UNIFORM STATE LAWS COMMISSION[791]

VETERANS AFFAIRS COMMISSION[801]

VETERINARY MEDICINE BOARD[811]

VOTER REGISTRATION COMMISSION[821]

WORKFORCE DEVELOPMENT DEPARTMENT[871]

Labor Services Division[875]

Workers’ Compensation Division[876]

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

NOTICES

ARC 0800B

ELDER AFFAIRS DEPARTMENT[321]

Notice of Intended Action

Twenty–five interested persons, a governmental subdivision, an agency or association of 25 or more persons may demand an oral presentation hereon as provided in Iowa Code section 17A.4(1)“b.”

Notice is also given to the public that the Administrative Rules Review Committee may, on its own motion or on written request by any individual or group, review this proposed action under section 17A.8(6) at a regular or special meeting where the public or interested persons may be heard.

Pursuant to the authority of Iowa Code section 231.58, the Department of Elder Affairs hereby gives Notice of Intended Action to amend Chapter 16, “Long–Term Care Coordinating Unit,” Iowa Administrative Code.

These amendments incorporate the “senior living coordinating unit” name change and provide for the addition of four legislative members and inclusion of responsibilities relating to the Senior Living Trust Fund Act as passed by the 78th General Assembly in 2000 Iowa Acts, chapter 1004 [Iowa Code chapter 249H].

Any interested person may make written suggestions or comments on the proposed amendments on or before July 31, 2001. Written comments should be directed to Dr. Judith A. Conlin, Director, Department of Elder Affairs, 200 Tenth Street, Suite 300, Des Moines, Iowa 50309–3609.

Oral or written comments may be submitted at a public hearing to be held at 10 a.m. on Tuesday, July 31, 2001, in Room 316, Hotel Fort Des Moines, 10th and Walnut, 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 these amendments.

Anyone who wishes to attend the hearing and has special requirements such as hearing, vision, or mobility impairments or other special needs should notify the Department of Elder Affairs no later than 4 p.m. on Friday, July 27, 2001. Notice may be in writing or by telephone to (515)242–3338.

These amendments are intended to implement Iowa Code chapter 249H.

The following amendments are proposed.

Amend 321—Chapter 16 as follows:

CHAPTER 16
~~LONG–TERM CARE~~ SENIOR LIVING
COORDINATING UNIT

321—16.1(~~249D~~ 231) Purpose. The ~~long–term care~~ senior living coordinating unit shall develop mechanisms and procedures to improve long–term care in Iowa. In furthering this purpose the ~~long–term care~~ senior living coordinating unit shall develop procedures, plans, rules and reports as identified in Iowa Code section ~~249D.58~~ 231.58 and shall provide direction and oversight for disbursement of moneys from the senior living trust fund established by Iowa Code section 249H.4.

321—16.2(~~249D~~ 231) Organization. The ~~long–term care~~ senior living coordinating unit is created within the department of elder affairs.

16.2(1) Membership. The membership of the coordinating unit consists of:

a. The director of the department of human services;

b. The ~~executive~~ director of the department of elder affairs;

c. The director of the department of public health;

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

e. Two members appointed by the governor to terms of three years beginning July 1 and ending June 30; and

f. Four members of the general assembly, as ex officio, nonvoting members.

16.2(2) Legislative members. The legislative members of the unit shall be appointed by the majority leader of the senate, after consultation with the president of the senate and the minority leader of the senate, and by the speaker of the house, after consultation with the majority leader and the minority leader of the house of representatives.

16.2(3) Expenses. Nonlegislative members shall receive actual expenses incurred while serving in their official capacity and, if the holder of the position has an income level of 150 percent or less of the United States poverty level as defined in the most recently revised poverty income guidelines published by the United States Department of Health and Human Services, may also request to receive compensation of $50 per diem as provided in Iowa Code section 7E.6. Legislative members shall receive compensation pursuant to Iowa Code section 2.12.

16.2(2 4) Chairperson and vice–chairperson duties. The chairperson of the unit is chosen from among the voting members on an annual, rotating basis.

a. Rotation is alphabetical by department name.

b. The chairperson’s duties include:

(1) Convening and chairing unit meetings;

(2) Ensuring that unit proceedings are recorded;

(3) Ensuring that minutes of meetings are prepared and distributed;

(4) Ensuring that tentative meeting agendas are prepared and distributed; and

(5) Ensuring that all notices required by Iowa Code section ~~28A.4~~ 21.4 are given.

c. The vice–chairperson of the unit is chosen from the voting members on an annual basis. The vice–chairperson shall assume the chairperson’s duties in the chairperson’s absence.

16.2(3 5) Quorum and action.

a. A majority of the voting members of the unit constitutes a quorum.

b. Action of the unit is not taken except upon the affirmative vote of a majority of the members of the unit. Other materials considered are made a part of the unit’s minutes by reference.

c. In cases not covered by these rules, Robert’s Rules of Order, as amended, shall govern.

321—16.3(~~249D~~ 231) Meetings. The unit shall meet at least once during each calendar quarter. Meeting dates shall be set by members of the unit at the end of each meeting or by call of the chairperson upon five days’ notice.

321—16.4(~~249D~~ 231) Operation.

16.4(1) The technical and administrative functions of the unit shall be apportioned among the departments of elder affairs, human services, public health, and inspections and appeals and other entities included in the CBAS committee by memorandum of agreement.

16.4(2) The unit shall establish an advisory work group to review and make recommendations to the unit regarding the awarding of grants under Iowa Code section 249H.6.

a. The advisory work group shall consist of representatives from the member departments and other individuals with the knowledge and skills necessary to review grant applications, including a representative from the state fire marshal’s office and the securities bureau of the department of commerce.

b. The advisory work group shall review all complete applications as provided in 441—Chapter 162 and make recommendations to the unit regarding the awarding of grants.

16.4(3) The unit shall consider the recommendations of the advisory work group in relation to the purpose of the Senior Living Trust Fund Act and make recommendations to the department of human services regarding the awarding of grants under Iowa Code chapter 249H.

321—16.5(~~249D~~ 231) Communications. Communications to the unit shall be addressed to the department of elder affairs at the address identified in 321—subrule 2.1(2) of these rules unless otherwise specified.

These rules are intended to implement Iowa Code ~~chapter~~ chapters 231 and 249H.

ARC 0826B

ELDER AFFAIRS DEPARTMENT[321]

Notice of Intended Action

Pursuant to the authority of Iowa Code sections 17A.3 and 231.14 and chapter 231B, the Department of Elder Affairs hereby gives Notice of Intended Action to amend Chapter 26, “Elder Group Homes,” Iowa Administrative Code.

The proposed amendments are intended to more clearly delineate the exceptions and appeals processes for elder group homes and update language to be consistent with the Iowa Code and other departmental rules and processes in accordance with Executive Order Number 11 and Iowa Code section 17A.9A.

The proposed amendments to Chapter 26 will be subject to waiver.

Any interested person may make written suggestions or comments on the proposed amendments on or before July 31, 2001. Written comments should be directed to Beth Bahnson, HCBS Division Administrator, Iowa Department of Elder Affairs, 200 Tenth Street, Suite 300, Des Moines, Iowa 50309–3609.

Oral or written comments may be submitted at a public hearing on these amendments to be held at 10 a.m. on Tuesday, July 31, 2001, in Room 316, Hotel Fort Des Moines, 10th and Walnut, 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 these amendments.

Anyone who wishes to attend the hearing and has special requirements such as hearing, vision, or mobility impairments or other special needs should notify the Department of Elder Affairs no later than 4 p.m. on Thursday, July 26, 2001. Notice may be in writing or by telephone to (515)242–3338.

These amendments are intended to implement Iowa Code chapter 231B and section 17A.9A.

The following amendments are proposed.

ITEM 1. Amend rule 321—26.1(231B), definition of “committee,” as follows:

“Committee” means a ~~care review~~ resident advocate committee established under 321 IAC 9.

ITEM 2. Amend rule 321—26.2(231B) as follows:

321—26.2(231B) Application process.

26.2(1) Application materials may be obtained from the Iowa department of elder affairs.

26.2(2) An eligible applicant:

a. Is ~~Any~~ any person or nonprofit corporation owning a single–family residence. ~~has the right to apply to the Iowa department of elder affairs for EGH certification for that resi–dence.~~

b. Shall submit one copy of the completed application and the certification fee to the Iowa department of elder affairs.

ITEM 3. Amend rule 321—26.3(231B) by adopting the following new subrule:

26.3(6) Renewal of certification. A certificate for an elder group home, unless suspended or revoked, shall expire at the end of the time period specified in the certificate and shall be renewed upon application by the owner or operator in accordance with this subrule. In order to obtain a renewal of the elder group home certification, the applicant must submit:

a. The completed application form at least 30 days prior to the expiration of such certificate;

b. The required certification fee for an elder group home with the application for renewal;

c. Documentation by a qualified professional that the following systems have been inspected and are found to be maintained in conformance with manufacturer’s recommendations and nationally recognized standards: heating, cooling, water heater, electricity, plumbing, sewage, artificial light, and ventilation; and, if applicable, garbage disposal equipment, cooking appliances, laundry equipment and elevators;

d. If the elder group home is contracting personal care from a certified home health agency or a licensed health care facility, a copy of that entity’s current license or monitoring report;

e. Documentation that all employees have received the two–hour training on dependent adult abuse for mandatory reporters;

f. Appropriate changes in the documentation submitted for certification to reflect any changes in the elder group home; and

g. An assurance that all other elements of the elder group home’s operation remain the same as previously submitted.

ITEM 4. Amend subrule 26.6(1) as follows:

26.6(1) Level of care ~~exceptions~~ waivers. Requests for waiver of the level of care limitations for occupants of an elder group home shall comply with the requirements of 321—subrule 1.2(3) in addition to the following standards. The department shall: ~~shall establish a process:~~

~~a. To grant on a time–limited basis an exception to this chapter for a tenant who temporarily needs additional service or hospice care;~~

~~b. To monitor the appropriateness of the exception; and~~

~~c. To keep exceptions to a minimum.~~

a. Accept from an elder group home a written request for waiver of an individual tenant’s service limit, for a specified period of time of no more than 21 days, as soon as it becomes apparent to the elder group home’s staff that the tenant is going to need licensed nursing activities or hospice care;

b. Respond in writing to such requests within two working days of receipt of necessary documentation;

c. Monitor regularly for the duration of the waiver the tenant medical and functional information for continued appropriateness of the exception;

d. Keep waivers to a minimum.

ITEM 5. Amend rule 321—26.7(231B) as follows:

321—26.7(231B) ~~Care review~~ Resident advocate committees. ~~Care review~~ Resident advocate committees for EGHs shall be governed by 321—Chapter 9 unless otherwise required in this chapter.

26.7(1) Committee placement. A ~~care review~~ resident advocate committee shall be established by the department within each city or county with EGH(s) certified in accordance with this chapter.

26.7(2) Committee ratio. The department shall establish ~~care review~~ resident advocate committees at the ratio of one committee for no more than five EGHs.

26.7(3) Committee visitations. The committee shall visit each EGH assigned to it at a minimum of once a year and within one month following the admission of the first tenant to the EGH.

ITEM 6. Amend subrule 26.8(3) as follows:

26.8(3) Resident manager.

a. The resident manager shall:

(1) be Be 18 years of age or older, of sound mind, essentially capable of physical self–care, and shall reside in the EGH as a primary residence; and

b. (2) ~~The resident manager shall sign an affidavit attesting to not being a substance abuser or to having a record of dependent adult or domestic abuse.~~ Sign a statement affirming that the resident manager has not been convicted of a felony or found to be in violation of the dependent adult abuse laws in any state;

(3) Sign a statement disclosing whether the resident manager has or has had an ownership interest in an elder group home, assisted living program, home health agency, residential care facility or licensed nursing facility in any state which has been closed due to removal of program, agency, or facility licensure or certification or involuntary termination from participation in either the Medicaid or Medicare programs; or has been found to have failed to provide adequate protection or services for tenants to prevent abuse or neglect;

b. The elder group home shall conduct a criminal background check on each employee hired after July 1, 1998, in accordance with Iowa Code section 135C.33.

c. Any person refusing to sign ~~such an affidavit~~ the statements required in 26.8(3)“a”(2) and (3) or subsequently found to have ~~lied~~ provided false information on said ~~affidavit~~ statements shall not serve as a resident manager.

ITEM 7. Rescind rule 321—26.10(231B) and renumber rule 321—26.11(231B) as 321—26.10(231B).

ITEM 8. Amend rule 321—26.12(231B) as follows:

321—26.1211(231B) Certification required. Any ~~facility~~ entity that meets the definition of an EGH as defined in Iowa Code ~~Supplement~~ section 231B.1(4) must be certified by the department, excepting those facilities that are certified or licensed under Iowa Code chapter 135C.

ITEM 9. Amend 321—Chapter 26 by adopting the following new rules:

321—26.12(231B) Complaint procedure. Any person with concerns regarding the operations and service delivery of an elder group home may file a complaint with the home– and community–based services division of the department of elder affairs at the address provided in 321—subrule 2.1(2).

26.12(1) The complaint shall include the complainant’s name, address, and telephone number and the complainant’s relationship to the elder group home. The department may elect to act on anonymous complaints if the department, upon preliminary review, determines that the complaint has reasonable basis and is not intended to harass the elder group home.

26.12(2) The complaint shall identify the elder group home and shall include the complainant’s concerns regarding the home.

26.12(3) Upon receipt of a complaint made in accordance with this rule, the department shall make a preliminary review of the complaint. If the department, upon preliminary review, determines that the complaint is intended to harass the elder group home or is without reasonable basis, the department may dismiss the complaint.

26.12(4) Within 20 working days of receipt of a reasonable complaint regarding quality of care, the department shall make or cause to be made an on–site review of the elder group home. If the complaint involves a situation that can reasonably be expected to result in imminent harm, the department shall make or cause to be made an on–site review of the elder group home within 24 hours.

26.12(5) The department shall apply a preponderance of the evidence standard in determining whether or not a complaint is substantiated. Upon conclusion of the investigation, the department shall notify the complainant and elder group home promptly of the results. Notice of results shall include a summary of the complaint(s), the finding(s), and the plan for resolution.

26.12(6) The department’s decision to dismiss a complaint or its determination that a complaint is not substantiated is a final agency action not subject to contested case proceedings, appeal, or judicial review provisions of Iowa Code chapter 17A.

26.12(7) When the nature of a complaint falls outside the department’s authority, the department shall forward or refer complainants to the appropriate investigatory entity.

321—26.13(231C) Denial, suspension, or revocation. The department shall have the authority to deny, suspend or revoke a certificate in any case where the department finds there has been a substantial or repeated failure on the part of the elder group home to comply with the requirements of 321—Chapter 26 or for any of the following reasons:

26.13(1) Cruelty or indifference to elder group home tenants.

26.13(2) Appropriation or conversion of the property of an elder group home tenant without the tenant’s written consent or the written consent of the tenant’s legal guardian.

26.13(3) Permitting, aiding, or abetting the commission of any illegal act in the program.

26.13(4) Obtaining or attempting to obtain or retain a certificate by fraudulent means, misrepresentation, or by submitting false information.

26.13(5) Habitual intoxication or addiction to the use of drugs by the applicant, manager or supervisor of the elder group home.

26.13(6) Securing the devise or bequest of the property of a tenant of an elder group home by undue influence.

26.13(7) Any individual has or has had an ownership interest in an elder group home, assisted living program, home health agency, residential care facility or licensed nursing facility in any state which has been closed due to removal of program, agency, or facility licensure or certification or involuntary termination from participation in either the Medicaid or Medicare programs; or has been found to have failed to provide adequate protection or services for tenants to prevent abuse or neglect.

26.13(8) In the case of a certificate applicant or an existing certified owner or operator which is an entity other than an individual, the department may deny, suspend, or revoke a certificate if any individual who is in a position of control or is an officer of the entity engages in any act or omission proscribed by this chapter.

321—26.14(231C) Notice—hearings.

26.14(1) The denial, suspension, or revocation of a certificate shall be effected by delivery to the applicant or certificate holder by certified mail, return receipt requested, or by personal service of a notice setting forth the particular reasons for such action. Such denial, suspension, or revocation shall become effective 30 days after the mailing or service of the notice, unless the applicant or certificate holder, within such 30–day period, gives written notice to the department requesting a hearing, in which case the notice shall be deemed to be suspended.

26.14(2) If the applicant or certificate holder requests a hearing, the department shall transmit the request to the department of inspections and appeals pursuant to 481 IAC 10.4(10A).

26.14(3) The hearing shall be conducted by the department of inspections and appeals pursuant to 481 IAC 10.1(10A) to 10.24(10A,17A).

26.14(4) At any time at or prior to the hearing, the department may rescind the notice of the denial, suspension, or revocation upon receipt of satisfactory evidence that the reasons for the denial, suspension, or revocation have been or will be removed.

321—26.15(231C) Appeals. All appeals shall be conducted pursuant to 321 IAC 2.7(4).

321—26.16(231C) Judicial review. Procedures for judicial review shall be conducted pursuant to 321 IAC 2.7(6).

321—26.17(231C) Records. The department collects and stores a variety of records in the course of certifying and monitoring elder group homes. Some information stored may be personally identifiable. None is retrievable by personal identifier unless a business uses an individual’s name in the title. Each elder group home record maintained by the department contains both open and confidential information.

26.17(1) Open information includes the following:

a. Certificate application and status;

b. Final findings of state and Medicaid surveys;

c. Records of complaints;

d. Reports from the fire marshal;

e. Plans of correction submitted by the program;

f. Official notices of certificate sanctions; and

g. Findings of fact, conclusions of law, decisions and orders issued pursuant to rules 26.13(231C), 26.14(231C) and 26.15(231C).

26.17(2) Confidential information includes:

a. Monitoring or investigation information which does not comprise a final finding. Monitoring information which does not comprise a final finding may be made public in a proceeding concerning the citation of a program, or denial, suspension or revocation of a certificate;

b. Names of all complainants;

c. Names of tenants of all elder group homes, identifying medical information and the address of anyone other than an owner.

ARC 0818B

ENVIRONMENTAL PROTECTION COMMISSION[567]

Notice of Intended Action

Pursuant to the authority of Iowa Code section 455B.200, the Environmental Protection Commission hereby gives Notice of Intended Action to amend Chapter 65, “Animal Feeding Operations,” Iowa Administrative Code.

This amendment would incorporate by reference the Concentrated Animal Feeding Operation Registration Program as set forth in Environmental Protection Division Policy Procedure Number 5–b–15.

Any interested person may make written suggestions or comments on the proposed amendment on or before July 31, 2001. Written comments should be directed to WayneGeiselman, Department of Natural Resources, Wallace State Office Building, 502 East 9th Street, Des Moines, Iowa 50319–0034; fax (515)281–8895.

Also, there will be a public hearing on July 31, 2001, at10 a.m. in the Fifth 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 people will be asked to give their names and addresses for the record and to confine their remarks to the subject of the amendment.

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

This amendment is intended to implement Iowa Code section 455B.200.

The following amendment is proposed.

Amend rule 567—65.6(455B) by adopting the following new subrule:

65.6(12) Concentrated animal feeding operation registration program. A producer feeding animals in an open feedlot existing prior to April 1, 2001, may participate in the concentrated animal feeding operation registration program as provided in Environmental Protection Division Policy Procedure Number 5–b–15, dated March 22, 2001.

ARC 0807B

HUMAN SERVICES DEPARTMENT[441]

Notice of Intended Action

Pursuant to the authority of Iowa Code sections 234.6 and 239B.4(4), the Department of Human Services proposes to rescind Chapter 49, “Transitional Child Care Assistance Program,” appearing in the Iowa Administrative Code.

The Transitional Child Care Assistance Program was implemented effective April 1, 1990, to extend child care eligibility to Family Investment Program (at that time, Aid to Dependent Children) recipients who lost their FIP (ADC) eligibility due to an increase in earned income or due to the loss of the $30 or the $30 plus one–third earned income disregards. The Seventy–seventh General Assembly repealed 1997 Iowa Code Supplement section 239B.23 that implemented the Transitional Child Care Assistance Program in 1998 Iowa Acts, chapter 1218, section 82. The Seventy–eighth General Assembly, in 1999 Iowa Acts, chapter 192, section 36, directed the Department to continue transitional child care eligibility for persons receiving transitional child care as of July 1, 1999. No new applications were to be taken or approved after June 30, 1999.

Elimination of the Transitional Child Care Assistance Program was one of a number of changes to state requirements for publicly funded child day care benefits intended to establish a seamless child day care system.

This amendment rescinds the Transitional Child Care Assistance Program as the two–year period of eligibility for those persons who were receiving transitional child care assistance as of July 1, 1999, has now expired.

This amendment does not provide for waivers in specified situations because the program is being eliminated at the direction of the legislature.

Consideration will be given to all written data, views, and arguments thereto received by the Office of Policy Analysis, Department of Human Services, Hoover State Office Building, 1305 East Walnut, Des Moines, Iowa 50319–0114, on or before August 1, 2001.

This amendment is intended to implement Iowa Code section 234.6.

The following amendment is proposed.

Rescind and reserve 441—Chapter 49.

ARC 0808B

HUMAN SERVICES DEPARTMENT[441]

Notice of Intended Action

Pursuant to the authority of Iowa Code section 234.6, the Department of Human Services proposes to amend Chapter 65, “Administration,” appearing in the Iowa Administrative Code.

This amendment provides that retrospectively budgeted food stamp households who have retrospective income that exceeds food stamp gross or net income limits for only one month will have their food stamp benefits suspended. This amendment does not apply to households who do not have to meet income limits. One–, two–, and some three–member households currently receive food stamp benefits even though their retrospective income is over gross or net income limits. These households will now be suspended for one month and will not receive any benefits.

This change is required by federal regulation. The United States Department of Agriculture (USDA) notified Iowa that it is out of compliance with regulation requirements for suspension. Iowa previously had a federally approved waiver for suspension, but USDA rescinded the waiver.

This amendment does not provide for waiver in specified situations because federal food stamp law does not allow for any waivers.

This amendment is intended to implement Iowa Code section 234.12.

The following amendment is proposed.

Amend rule 441—65.1(234), definition of “suspension,” as follows:

“Suspension” means a month in which a benefit issuance is not made due to retrospective gross or net income ~~which~~ that exceeds program limits, when eligibility for benefit issuance is expected to exist for the following month.

ARC 0771B

HUMAN SERVICES DEPARTMENT[441]

Notice of Intended Action

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.

This amendment implements a new Medicaid coverage group for women who have been screened for breast or cervical cancer under the Centers for Disease Control and Prevention Breast and Cervical Cancer Early Detection Program established under Title XV of the Public Health Service Act and have been found to need treatment for either breast or cervical cancer (including a precancerous condition) if the women do not have creditable health insurance coverage.

Women aged 50 to 64 with incomes under 250 percent of the federal poverty level who are without health insurance to pay for breast and cervical cancer screenings have been able to obtain free screenings since Congress passed the Breast and Cervical Cancer Mortality Prevention Act in 1990. However, those women whose screenings were positive for the disease have had to struggle to fund and pay for treatment. Full Medicaid covered services shall be available under this new optional coverage group as long as treatment is being received for breast or cervical cancer.

A woman having creditable coverage under the Health Insurance Portability and Accountability Act (HIPAA) would have coverage under any of the following:

• A group health care plan.

• Health insurance coverage—benefits consisting of medical care (provided directly, through insurance or reimbursement, or otherwise and including items and services paid for as medical care) under any hospital or medical service policy or certificate, hospital or medical service plan contract, or health maintenance organization contract offered by a health insurance issuer.

• Medicare.

• Medicaid.

• Armed forces insurance.

• A medical care program of the Indian Health Service or of a tribal organization.

• A state health risk pool.

This amendment also includes provisions for presumptive eligibility determination to allow access to treatment before a formal Medicaid eligibility determination can be completed.

This amendment does not provide for waivers because it confers a benefit and was mandated by the Seventy–ninth General Assembly.

The substance of this amendment is also Adopted and Filed Emergency and is published herein as ARC 0772B. The purpose of this Notice is to solicit comment on that submission, the subject matter of which is incorporated by reference.

This amendment is intended to implement Iowa Code section 249A.3(2) as amended by 2001 Iowa Acts, Senate File 537, section 9.

ARC 0774B

HUMAN SERVICES DEPARTMENT[441]

Notice of Intended Action

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 facility services in Iowa, revise the average charges for nursing facility care, hospital–based skilled nursing care, non–hospital–based skilled nursing care, mental health institute (MHI) care, and psychiatric medical institution for children (PMIC) care, and state the maximum Medicaid rate for intermediate care facility for the mentally retarded (ICF/MR) 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 average charge (or maximum Medicaid rate) is used to determine whether a person who has established a medical assistance income trust qualifies for Medicaid.

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

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 $1,590) but whose income is below the statewide average charge (or the maximum Medicaid reimbursement rate in the case of intermediate care facilities for the mentally retarded) for nursing facility services or for a higher level of care if the person so requires, a medical assistance income trust may be used to establish Medicaid eligibility.

In the past the rules required that an average of the maximum Medicaid reimbursement rates for the two state–owned intermediate care facilities for the mentally retarded and the community–based intermediate care facilities for the mentally retarded be used. These rule changes allow the maximum Medicaid reimbursement rate for care at any ICF/MR, as required by Iowa Code 633.709(3)“a.”

The average charges and maximum Medicaid reimbursement rate are relevant to disposition of income and principal in a medical assistance income (Miller–type) trust, which affects the Medicaid eligibility of individuals with Miller Trusts.

The Department alternates the updating of the statewide average cost for nursing facility services and the statewide average charge for nursing facilities and for hospital– and non–hospital–based skilled nursing facilities by conducting an annual survey one year and applying actual and projected increases the next year. An actual survey was done in 2000. This year the average cost of nursing facility services and charges for nursing facility care, hospital–based skilled nursing care, and non–hospital–based skilled nursing care are based on the Health Care Financing Administration Skilled Nursing Facility (HCFA/SNF) Total Market Basket Index annual inflation factor ending June 30, 2002, which projects an increase of 3.1 percent. The average charges for PMIC care are based on Medicaid rates because Medicaid is the primary payer of these services. The Department provided the average charge for care in an MHI and the maximum Medicaid reimbursement rate for ICF/MR care based on rule 441— 82.5(249A).

On this basis, the average private pay cost for nursing facility services increased from $2,933 per month to $3,024. The average charge to a private pay resident for nursing facility care increased from $2,758 per month to $2,844. The average charge for hospital–based skilled care increased from $9,836 per month to $10,141. The average charge for non–hospital–based skilled care increased from $4,523 per month to $4,663. The maximum Medicaid reimbursement rate for ICF/MR care is $10,365 per month (the previously used average of the maximums for state–owned and community–based facilities was $8,510). The average charge for PMIC care increased from $4,359 to $4,477 per month. The average statewide charge to a resident of a mental health institute decreased from $9,962 to $9,646 per month.

These amendments do not provide for waivers in specified situations because the increases confer a benefit and everyone should be subject to the same amounts set by these amendments. Individuals may request a waiver under the Department’s general rule on exceptions at 441— 1.8(17A,217).

The substance of these amendments is also Adopted and Filed Emergency and is published herein as ARC 0775. The purpose of this Notice is to solicit comment on that submission, the subject matter of which is incorporated by reference.

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

ARC 0777B

HUMAN SERVICES DEPARTMENT[441]

Notice of Intended Action

Pursuant to the authority of Iowa Code section 249A.4 and 2001 Iowa Acts, House File 732, section 28, subsections 4 and 6, and section 49, the Department of Human Services proposes to amend Chapter 77, “Conditions of Participation for Providers of Medical and Remedial Care,” Chapter 78, “Amount, Duration and Scope of Medical and Remedial Services,” and Chapter 80, “Procedure and Method of Payment,” appearing in the Iowa Administrative Code, and to adopt Chapter 186, “Child Welfare Targeted Case Management Services.”

These amendments implement a new service under the Medicaid State Plan, child welfare targeted case management services. The Seventy–ninth General Assembly directed the Department to pursue federal approval of a state plan amendment to use medical assistance funding for targeted case management services. The population to be served through targeted case management services is children who are at risk of maltreatment or who are in need of protective services.

Section 1915(g)(1) and (2) of the Social Security Act state that:

“(1) A State may provide, as medical assistance, case management services under the plan without regard tothe requirements of section 1902(a)(1) and section 1902(a)(10)(B). The provision of case management services under this subsection shall not restrict the choice of the individual to receive medical assistance in violation of section 1902(a)(23)....”

“(2) For purposes of this subsection, the term “case management services” means services which will assist individuals eligible under the plan in gaining access to needed medical, social, educational, and other services.”

These amendments define and structure the department of human services child welfare targeted case management program. Child welfare targeted case management services assist children in gaining and coordinating access to necessary care and services appropriate to their individual needs. Qualified case managers employed by certified public providers perform case management services.

These amendments establish child eligibility, covered child welfare targeted case management services, provider certification standards and requirements, case manager qualifications, and children’s rights.

The Department will not certify providers as child welfare targeted case management service providers until approval for federal funding of child welfare targeted case management services under the Medicaid program is received from the federal Health Care Financing Administration.

Child welfare targeted case management services, which are provided at the choice of the child and family, will most frequently be provided in conjunction with other child welfare services, as a result of protective services concerns. During the intake process, providers of child welfare services must offer children and families the option of having child welfare targeted case management services funded by Medicaid, but the receipt of child welfare services including the targeted case management functions is not optional when ordered by the juvenile court. Providers will not be required to have separate and distinct criteria for accessing targeted case management services provided in conjunction with other child welfare services. Separate and distinct criteria for accessing targeted case management services will be required when child welfare targeted case management services are provided as a “stand alone” service.

These amendments do not provide for waivers, as these changes will enhance coordination of child welfare services to children and families and were mandated by the General Assembly.

The substance of these amendments is also Adopted and Filed Emergency and is published herein as ARC 0778B. The purpose of this Notice is to solicit comment on that submission, the subject matter of which is incorporated by reference.

These amendments are intended to implement Iowa Code section 249A.4 and 2001 Iowa Acts, House File 732, section 28, subsection 4.

ARC 0781B

HUMAN SERVICES DEPARTMENT[441]

Notice of Intended Action

Pursuant to the authority of Iowa Code section 249A.4 and 2001 Iowa Acts, House File 732, section 31, subsection 1, paragraphs “b,” “c,” “e,” “g,” “h,” “j,” and “k,” and subsections 8 and 10, and section 49, the Department of Human Services proposes to amend Chapter 79, “Other Policies Relating to Providers of Medical and Remedial Care,” appearing in the Iowa Administrative Code.

These amendments implement changes to Medicaid provider reimbursement as mandated by the Seventy–ninth General Assembly. Specifically, these amendments:

• Reimburse pharmacy dispensing fees using a single rate of $5.17 per prescription or the pharmacist’s usual and customary fee, whichever is lower. This aligns the dispensing fees for both Maximum–Allowable–Cost–established and –nonestablished drugs.

• Implement a 3 percent reduction in reimbursement rates from the rates in effect on June 30, 2001, for the following noninstitutional providers: ambulance; ambulatory surgical centers; audiologists; birth centers; case management providers; certified registered nurse anesthetists; chiropractors; community mental health centers; dentists; durable medical equipment, prosthetic devices and medical supply dealers; family or pediatric nurse practitioners; family planning clinics; hearing aid dealers; home health agencies; hospitals (critical access, inpatient, and outpatient); lead inspection agencies; maternal health centers; nurse–midwives; opticians; optometrists; orthopedic shoe dealers; physical therapists; physicians; podiatrists; psychiatric medical institutions for children (outpatient day treatment); psychologists; rehabilitation agencies; rehabilitation services for adults with a chronic mental illness providers; and screening centers.

• Calculate the reimbursement rates for intermediate care facilities for persons with mental retardation at the 80th percentile as calculated from the December 31, 2000, cost reports.

In addition, these amendments add a prospective payment or alternative reimbursement methodology option for federally qualified health centers and rural health clinics. This change is mandated by the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000.

These amendments do not provide for waivers to the reimbursement rates because all providers of the same category should be reimbursed on the same basis as mandated by the General Assembly.

The substance of these amendments is also Adopted and Filed Emergency and is published herein as ARC 0782B. The purpose of this Notice is to solicit comment on that submission, the subject matter of which is incorporated by reference.

These amendments are intended to implement Iowa Code section 249A.4 and 2001 Iowa Acts, House File 732, section 31, subsection 1, paragraphs “b,” “c,” “e,” “g,” “h,” “j,” and “k,” and subsections 8 and 10.

ARC 0783B

HUMAN SERVICES DEPARTMENT[441]

Notice of Intended Action

Pursuant to the authority of Iowa Code section 249A.4, the Department of Human Services proposes to amend Chapter 83, “Medicaid Waiver Services,” appearing in the Iowa Administrative Code.

As mandated by the Seventy–ninth General Assembly, these amendments revise the provisions of the home– and community–based waiver for persons with a brain injury by removing the eligibility requirement that the person must have been a resident of a medical institution for at least 30 days at the time of initial application.

In addition, these amendments also clarify the responsibility of the county of legal settlement for payment, and eliminate the requirement that a county payment slot be available. The General Assembly mandated that the state shall pay the nonfederal share of the costs of an eligible person’s services under the waiver unless a county has paid or is paying for the nonfederal share of the cost of the person’s waiver services or ICF/MR placement or unless the county would become liable for the costs of services at the ICF/MR level of care due to the person’s reaching the age of majority. This mandate clarifies when the county is responsible for payment and the rule on county responsibility is revised accordingly. The federal Health Care Financing Administration (HCFA) has also clarified that counties cannot limit the eligibility for the BI waiver of people for whom counties have financial responsibility by limiting county payment slots.

Pursuant to the clarification of county responsibility and the federal direction, the requirement that there be county payment slots for adults with legal settlement in a county and the county option to provide no payment slots is eliminated.

These amendments do not provide for waivers because they are mandated by the General Assembly and HCFA with no provision for exceptions, and they confer a benefit on persons applying for the brain injury waiver by removing a restrictive eligibility requirement.

The substance of these amendments is also Adopted and Filed Emergency and is published herein as ARC 0784B. The purpose of this Notice is to solicit comment on that submission, the subject matter of which is incorporated by reference.

These amendments are intended to implement Iowa Code section 249A.4 and 2001 Iowa Acts, House File 732, section 7, subsection 3, paragraph “e.”

ARC 0809B

HUMAN SERVICES DEPARTMENT[441]

Notice of Intended Action

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 revisions to policy governing managed health care providers:

• A requirement is added that Health Maintenance Organizations (HMOs) contracting with the Department to provide services to enrolled Medicaid recipients must be accredited by the National Committee on Quality Assurance (NCQA) or the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

This change will ensure that all contracting HMOs will have to meet standards for quality improvement and assurance that are consistent across HMOs by July 1, 2002. Consistent and coordinated services should improve the quality of services being provided. This change will have no effect on the benefit package for Medicaid recipients or the enrollment process or the scope of services required to be covered.

• The default assignment when a recipient fails to choose a managed care entity is modified to include theMediPASS option. This change is required by the Balanced Budget Act of 1997 in order for the managed health care program to operate without an ongoing waiver of federal freedom of choice requirements. Operating the managed health care program without a waiver allows greater flexibility in the management and operations of the managed care program and saves staff time spent to develop and submit the waiver request every two years. Recipients who are assigned to a managed care entity have at least ten days in which to request enrollment in a different available entity.

• Native American Indians, Alaskan natives, and recipients who are receiving services from a Title V provider are excluded from participating in the managed care programs. This change is also required by the Balanced Budget Act of 1997 in order for the managed health care program to operate without an ongoing waiver of federal freedom of choice requirements.

• A provision requiring that a federal waiver be approved prior to implementation of mandatory enrollment is removed as obsolete.

• The time an HMO on–call physician has to respond to each call that requires a medical decision is changed from 60 to 30 minutes. The Prepaid Health Program (PHP) already uses the 30–minute standard. The Managed Health Care Advisory Committee of Physicians has approved the 30–minute standard.

• An expansion incentive enhanced capitation payment based on the counties in a region included in the HMO’s enrollment area is deleted as this incentive payment has never been used and is now an obsolete concept.

• Various outdated references and typographical errors identified in the Department’s rules review process are corrected.

These amendments do not provide for waivers in specified situations because all contracting HMOs should be required to be accredited and the default assignment and exclusion of Native American Indians, Alaskan natives, and recipients who are receiving services from a Title V provider are required by the Balanced Budget Act. The default assignment affects only those who fail to exercise a choice of managed care providers.

Consideration will be given to all written data, views, and arguments thereto received by the Office of Policy Analysis, Department of Human Services, Hoover State Office Building, Des Moines, Iowa 50319–0114, on or before August 1, 2001.

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

The following amendments are proposed.

ITEM 1. Amend rule 441—88.1(249A), definition of “contract,” as follows:

“Contract” shall mean a contract between the department and an HMO for the provision of medical and health services to Medicaid recipients in which the HMO assumes a risk as defined in the contract. These contracts shall meet the requirements of the Code of Federal Regulations, Title 42, Part 434 as amended to ~~March 6, 1992~~ December 31, 1996.

ITEM 2. Amend rule 441—88.2(249A) as follows:

Amend subrule 88.2(1), paragraph “a,” by adopting the following new subparagraph (3):

(3) For any contract executed or extended to be in effect on or after July 1, 2002, an HMO must have accreditation by the National Committee on Quality Assurance (NCQA) or the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

Amend subrule 88.2(4) as follows:

Amend paragraph “a” as follows:

a. Recipients who are medically needy as defined at ~~441—Chapter 86~~ 441—subrule 75.1(35).

Rescind and reserve paragraph “d.”

Adopt the following new paragraphs “i” and “j”:

i. Recipients who are Native American Indians or Alaskan natives.

j. Recipients who are receiving services from a Title V provider.

ITEM 3. Amend subrule 88.3(7), introductory paragraph, as follows:

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 or to a MediPASS patient manager on a rotating basis to ensure an equitable distribution between the HMO and MediPASS programs based on the number of managed health care options (MediPASS and HMOs) available in the county. 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.

ITEM 4. Amend subrule 88.7(4), paragraph “b,” as follows:

b. If a physician does not respond to the initial telephone call there must be a written protocol specifying when a physician must be consulted. Calls requiring a medical decision shall be forwarded to the on–call physician and a response to each call which requires a medical decision must be provided by the physician within 60 30 minutes.

ITEM 5. Amend subrule 88.12(2) as follows:

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 a base fiscal year. 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 6. Amend rule 441—88.13(249A) as follows:

441—88.13(249A) Quality assurance. The HMO shall have in effect an internal quality assurance system ~~which~~ that meets the requirements of 42 CFR 434.44 as amended to December 31, 1996, and a system of periodic medical audits meeting the requirements of 42 CFR 434.53~~, both~~ as amended to ~~October 1, 1987~~ December 13, 1990.

ITEM 7. Amend rule 441—88.21(249A), definitions of “contract” and “prepaid health plan (PHP),” as follows:

“Contract” shall mean a contract between the department and a PHP for the provision of medical services to enrolled Medicaid recipients for whom the PHP assumes a risk as defined in the contract. These contracts shall meet the requirements of the Code of Federal Regulations, Title 42, Part 434 as amended to ~~March 6, 1992~~ December 31, 1996.

“Prepaid health plan (PHP)” shall mean an entity defined in Section 1903(m)(2)(B)(iii) of the Social Security Act and considered to be a PHP by the department based upon criteria set forth in the Code of Federal Regulations at Title 42, Part 434.20(a)(3) as amended to ~~October 1, 1987~~ March 31, 1991.

ITEM 8. Amend subrule 88.22(4) as follows:

Amend the introductory paragraph as follows:

88.22(4) Recipients eligible to enroll. Any Medicaid–eligible recipient is eligible to enroll in a contracting ~~HMO~~ PHP except for the following:

Amend paragraph “a” as follows:

a. Recipients who are medically needy as defined at ~~441—Chapter 86~~ 441—subrule 75.1(35).

Rescind and reserve paragraph “d.”

Adopt the following new paragraphs “i” and “j”:

i. Recipients who are Native American Indians or Alaskan natives.

j. Recipients who are receiving services from a Title V provider.

ITEM 9. Amend subrules 88.23(1) and 88.23(3) as follows:

88.23(1) Enrollment area. Counties in a PHP enrollment area shall be designated as voluntary or mandatory. In voluntary counties, enrollment is not required but eligible recipients may choose to join the PHP. Recipients not excluded in rule 441—88.21(249A) may volunteer to enroll in the PHP. In mandatory counties, enrollment in managed health care is required for eligible recipients.

Prior to implementation of mandatory enrollment, a federal waiver must be approved allowing that freedom of choice exists among any participating HMOs, PHPs, or other managed health care plan in the enrollment area.

88.23(3) Mandatory enrollment. In a county where the department has a contract with more than one PHP, HMO, or other managed health care provider, the department shall require whenever it is administratively feasible that all eligible recipients enroll with a managed health care provider of their own choosing. Administrative feasibility is determined by ~~whether a freedom of choice waiver has been received from HCFA and~~ whether the managed health care providers have the capacity to adequately serve all potential enrolled recipients. Recipients may enroll by completing the choice form designated by the managed health care contractor, in writing to or through verbal request to the managed health care offices. Recipients may also contact the managed health care contractor by the publicized toll–free telephone number for enrollment assistance.

ITEM 10. Amend rule 441—88.33(249A) as follows:

441—88.33(249A) Quality assurance. The PHP shall have in effect an internal quality assurance system ~~which~~ that meets the requirements of 42 CFR 434.44 as amended to December 31, 1996, and a system of periodic medical audits meeting the requirements of 42 CFR 434.53~~, both~~ as amended to ~~October 1, 1987~~ December 13, 1990.

ITEM 11. Amend subrule 88.42(2) as follows:

Amend paragraph “a” as follows:

a. Medically needy recipients as defined in ~~441—Chapter 86~~ 441—subrule 75.1(35).

Rescind and reserve paragraph “d.”

Adopt the following new paragraphs “i” and “j”:

i. Recipients who are Native American Indians or Alaskan natives.

j. Recipients who are receiving services from a Title V provider.

ITEM 12. Amend subrule 88.46(2), introductory paragraph, 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 or to a MediPASS patient manager on a rotating basis to ensure an equitable distribution between the HMO and MediPASS programs based on the number of managed health care options (MediPASS and HMOs) available in the county. 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.

ITEM 13. Amend subrule 88.48(1) 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~~ Iowa Plan program and do not require authorization (see ~~rules~~ rule 441—88.61(249A) ~~and 88.81(249A)~~):

ITEM 14. Amend rule 441—88.61(249A), definition of “contract,” as follows:

“Contract” shall mean a contract between the department and the entity or entities selected by the department to implement the Iowa Plan. Contract sections related to Medicaid–funded services shall be interpreted to meet the requirements of the Code of Federal Regulations, Title 42, Part 434 as amended to ~~March 27, 1996~~ December 31, 1996. The department of public health also shall be party to the contracts in relationship to the provision of substance abuse services to non–Medicaid persons served through the Iowa Plan.

ARC 0785B

HUMAN SERVICES DEPARTMENT[441]

Notice of Intended Action

Pursuant to the authority of Iowa Code section 239B.4(4) and 2001 Iowa Acts, House File 732, section 3, subsections 9 and 10, and section 49, the Department of Human Services proposes to amend Chapter 93, “PROMISE JOBS Program,” appearing in the Iowa Administrative Code.

These amendments increase the mileage rate reimbursement for required PROMISE JOBS activities from $.16per mile to $.21 per mile and extend the time limit onPROMISE JOBS funding for approvable postsecondary classroom training from 24 months within a 36–consecutive–month period of time to 24 months of funding within a48–consecutive–month period of time as mandated by the Seventy–ninth General Assembly.

These amendments do not provide for waivers because they confer a benefit and were mandated by the Seventy–ninth General Assembly.

The substance of these amendments is also Adopted and Filed Emergency and is published herein as ARC 0786B. The purpose of this Notice is to solicit comment on that submission, the subject matter of which is incorporated by reference.

These amendments are intended to implement Iowa Code section 239B.8 as amended by 2001 Iowa Acts, Senate File 198, section 1, sections 239B.17 to 239B.19 and 2001 Iowa Acts, House File 732, section 3, subsections 9 and 10.

ARC 0810B

HUMAN SERVICES DEPARTMENT[441]

Notice of Intended Action

Pursuant to the authority of Iowa Code section 237A.12, the Department of Human Services proposes to amend Chapter 110, “Family and Group Child Care Homes,” appearing in the Iowa Administrative Code.

These amendments revise policy governing joint registered group child care homes and policy governing four–level child care home pilots to agree with changes made by the Seventy–ninth General Assembly in 2001 Iowa Acts, Senate File 458, sections 3 and 4.

Current policy governing joint registered group child care homes provides that these homes shall only care for 10 children between the ages of 24 months and school age. These amendments provide that joint registered group child care homes may now care for 11 children between the ages of 24 months and school age. The limit of four infants, who are now included in the total of 11 children, remains unchanged. “School” is defined as kindergarten or a higher grade level. Policy governing group child care homes that are not joint registered also remains unchanged. Those homes may only care for 6 children under school age.

Current policy provides that the pilot project for four–level registration shall be implemented in a maximum of two counties per Department region. These amendments provide that the Department may implement the pilot project in any county where there is an interest in implementing the pilot. A two–year transition period is provided for counties new to the pilot.

These amendments do not provide for waivers in specified situations because the changes are necessary to reflect the direction given by the General Assembly. Individuals may request a waiver of child care licensing requirements under the Department’s general rule on exceptions at rule 441—1.8(17A,217).

These amendments are intended to implement Iowa Code sections 237A.3(2)“b” and 237A.3A(1) as amended by 2001 Iowa Acts, Senate File 458, sections 3 and 4.

The following amendments are proposed.

ITEM 1. Amend rule 441—110.1(237A) as follows:

Amend the definition of “group child care home–joint registration,” introductory paragraph, as follows:

“Group child care home–joint registration” means a program ~~which~~ that provides child care for more than 6 but less than 12 children, of whom no more than 4 children present may be less than 24 months of age, and not more than 10 children present shall be 24 months of age or older but not attending school in kindergarten or a higher grade level. The combined total number of these two categories of children shall not exceed 11. In a joint registration group child care home, the joint holder of the certificate of registration must be an adult, and must meet the same requirements as those listed for the provider. In addition to the above numbers, a joint registration group child care home may provide care for more than 11 but less than 16 children for a period of less than two hours at any time, and more than two hours when the inclement weather exception conditions are met.

Adopt the following new definition in alphabetical order:

“School” means kindergarten or a higher grade level.

ITEM 2. Amend subrule 110.5(5), paragraph “d,” as follows:

d. The total number of children not attending kindergarten or a higher grade level, including the provider’s own infants and children not attending ~~kindergarten or a higher grade level,~~ school in a joint registration group child care home at any one time shall never exceed 11. The providers may care for up to 4 additional children attending ~~kindergarten or a higher grade level~~ school, not including the provider’s own school–age children, for less than two hours at any one time. If there are more than 6 children present for a period of two hours or more, the joint registration group child care home must have the second adult of the joint registration present. There shall never be more than 4 children less than 24 months of age present, there shall never be more than 10 children present who are 24 months of age or older but not attending school in kindergarten or a higher grade level, and the total of these two groups of children shall never exceed 11.

ITEM 3. Amend 441—Chapter 110, Division II, Four–Level Child Care Home Registration, Preamble, as follows:

The purpose of this division is to establish a pilot project for a four–level approach to child care home registration as mandated by the general assembly in Iowa Code section 237A.3A as amended by ~~1999 Iowa Acts, chapter 192, section 4~~ 2001 Iowa Acts, Senate File 458, section 4. ~~The pilot project shall include a maximum of two counties in each department region where there is interest.~~ The department may implement the pilot project in counties where there is an interest in implementing the pilot project. The provisions of this division do not apply to unregistered family child care homes located in those counties. ~~A report shall be submitted to the general assembly in January 2000 regarding the feasibility of implementing the pilot project statewide.~~

ITEM 4. Amend rule 441—110.35(237A), introductory paragraph, as follows:

441—110.35(237A) Transition exception. The exception provisions of this rule are applicable to child care homes ~~in Scott and Delaware counties~~ registering under Iowa Code section 237A.3A during a two–year transition period ~~beginning April 20, 1998, and ending April 19, 2000~~ from the date the county in which the home is located began the pilot. ~~The transition period for other pilot counties selected shall be a period from July 1, 1999, to January 1, 2002.~~ During the transition period, the following provisions shall apply, notwithstanding the previous specific rules:

ARC 0788B

HUMAN SERVICES DEPARTMENT[441]

Notice of Intended Action

Pursuant to the authority of Iowa Code section 217.6, the Department of Human Services proposes to amend Chapter 130, “General Provisions,” appearing in the Iowa Administrative Code.

These amendments update income guidelines and the fees parents pay for child care services based on their monthly gross income to be consistent with the federal poverty guidelines for 2001 as mandated by the Seventy–eighth General Assembly.

These amendments do not provide for any waivers in specific situations because these changes confer a benefit on consumers by providing an increase in the income eligibility guidelines. In addition, these changes were mandated by the legislature with no provisions for exceptions.

The substance of these amendments is also Adopted and Filed Emergency and is published herein as ARC 0789B. The purpose of this Notice is to solicit comment on that submission, the subject matter of which is incorporated by reference.

These amendments are intended to implement Iowa Code section 237A.13.

ARC 0790B

HUMAN SERVICES DEPARTMENT[441]

Notice of Intended Action

Pursuant to the authority of Iowa Code section 234.6 and 2001 Iowa Acts, House File 732, section 31, subsection 6, and section 49, the Department of Human Services proposes to amend Chapter 150, “Purchase of Service,” appearing in the Iowa Administrative Code.

These amendments update fiscal year changes and freeze the rates for adoption, independent living, and family planning services purchased by the Department under a purchase of social services contract at the level in effect on June 30, 2001.

These amendments do not provide for a waiver to the rate freeze because the changes were mandated by the General Assembly. All adoption, independent living, and family planning service providers should be reimbursed on the same basis.

The substance of these amendments is also Adopted and Filed Emergency and is published herein as ARC 0791B. The purpose of this Notice is to solicit comment on that submission, the subject matter of which is incorporated by reference.

These amendments are intended to implement Iowa Code section 234.6 and 2001 Iowa Acts, House File 732, section 31, subsection 6.

ARC 0792B

HUMAN SERVICES DEPARTMENT[441]

Notice of Intended Action

Pursuant to the authority of Iowa Code section 234.6 and 2001 Iowa Acts, House File 732, section 31, subsection 5, and section 49, the Department of Human Services proposes to amend Chapter 156, “Payments for Foster Care and Foster Parent Training,” and Chapter 201, “Subsidized Adoptions,” appearing in the Iowa Administrative Code.

These amendments implement the increases to foster family homes and adoptive homes mandated by the Seventy–ninth General Assembly.

The daily foster family care and adoption payment rates are increased as follows: for a child aged 0 through 5 from $14.00 to $14.28, for a child aged 6 through 11 from $14.78 to $15.07, for a child aged 12 through 15 from $16.53 to $16.83, and for a child aged 16 and over from $16.53 to $16.83.

The maximum foster family basic monthly maintenance rate and the maximum adoption subsidy rate for children remain at 70 percent of the United States Department of Agriculture’s estimate of the cost to raise a child in the Midwest with a cost–of–living increase added for Fiscal Year 2002.

These amendments do not provide for any waivers in specified situations because these changes confer a benefit on foster parents and adoptive parents by increasing the foster family daily maintenance rate and the maximum adoption subsidy rate.

The substance of these amendments is also Adopted and Filed Emergency and is published herein as ARC 0793B. The purpose of this Notice is to solicit comment on that submission, the subject matter of which is incorporated by reference.

These amendments are intended to implement Iowa Code section 234.6 and 2001 Iowa Acts, House File 732, section 31, subsection 5.

ARC 0794B

HUMAN SERVICES DEPARTMENT[441]

Notice of Intended Action

Pursuant to the authority of Iowa Code subsection 249H.6(3), the Department of Human Services proposes to amend Chapter 162, “Nursing Facility Conversion and Long–Term Care Services Development Grants,” appearing in the Iowa Administrative Code.

These amendments change the period of time that a Nursing Facility Conversion and Long–Term Care Services Development Grant applicant must be a licensed nursing facility approved under the Medicaid program or a provider of long–term care services from three years to two years as mandated by the Seventy–ninth General Assembly.

These amendments do not provide for waivers because this change was mandated by the Seventy–ninth General Assembly with no provision for exceptions. All grant applicants and recipients should be subject to the same rules.

The substance of these amendments is also Adopted and Filed Emergency and is published herein as ARC 0795B. The purpose of this Notice is to solicit comment on that submission, the subject matter of which is incorporated by reference.

These amendments are intended to implement Iowa Code section 249H.6 as amended by 2001 Iowa Acts, House File 740, section 7.

ARC 0811B

HUMAN SERVICES DEPARTMENT[441]

Notice of Intended Action

Pursuant to the authority of Iowa Code sections 217.6 and 234.6, the Department of Human Services proposes to amend Chapter 176, “Dependent Adult Abuse,” and Chapter 177, “In–Home Health Related Care,” appearing in the Iowa Administrative Code.

These amendments revise the list of who may have access to dependent adult abuse information other than unfounded adult abuse information to add employees of the Department of Inspections and Appeals who are operating the Internet information system and administrators of agencies providing mental health, mental retardation, or developmental disability services under a county management plan, if the information concerns a person employed by or being considered by the agency for employment. These changes bring rules into conformance with Iowa Code section 235B.6 as amended by 2001 Iowa Acts, House File 228, section 4.

In addition, these amendments correct various outdated references and form names and numbers identified in the Department’s rules review process throughout 441—Chapters 176 and 177.

These amendments do not provide for waivers in specified situations because the amendments merely conform rules to statute and correct outdated references.

These amendments are intended to implement Iowa Code chapter 235B and section 249.3(2)“a”(2).

The following amendments are proposed.

ITEM 1. Amend rule 441—176.4(235B) as follows:

441—176.4(235B) Reporters. The central abuse registry and ~~local~~ county office shall accept reports from mandatory reporters or any other person who believes dependent adult abuse has occurred. Mandatory reporters shall make a written report within 48 hours after an oral report. The reporter may use the department’s Form 470–2441, Suspected Dependent Adult Abuse Reporting Form, or may use a form developed by the reporter ~~which~~ that meets the requirements of Iowa Code section 232.70.

ITEM 2. Amend subrule 176.6(1) as follows:

176.6(1) When a report is received, the department shall promptly commence an appropriate evaluation or assessment, except that the ~~state~~ department of inspections and appeals is responsible for the evaluation and disposition of a case of adult abuse in a health care facility, including hospitals as defined in Iowa Code section 135B.1~~, subsection 1,~~ and facilities as defined in Iowa Code section 135C.1~~, subsection 5~~. The department shall forward all reports and other information concerning adult abuse in a health care facility to the ~~state~~ department of inspections and appeals on the first working day following the submitting of the report. The ~~state~~ department of inspections and appeals shall inform the registry of all actions taken or contemplated concerning the evaluation or disposition of a case of adult abuse in a health care facility. The primary purpose of the evaluation or assessment by the department shall be the protection of the dependent adult named in the report.

ITEM 3. Amend subrule 176.10(3) as follows:

Amend paragraph “b,” subparagraph (2), as follows:

(2) An employee of the department of human services or department of inspections and appeals responsible for the evaluation or assessment of an adult abuse report or for the purpose of performing record checks as required under Iowa Code section 135C.33.

Amend paragraph “c” by adopting the following new subparagraph (6):

(6) To an administrator of an agency providing mental health, mental retardation, or developmental disability services under a county management plan developed pursuant to Iowa Code section 331.439, if the information concerns a person employed by or being considered by the agency for employment.

Amend paragraph “d,” subparagraphs (3) and (4), as follows:

(3) A court or administrative agency hearing an appeal for correction of dependent adult abuse information as provided in Iowa Code chapter 235B ~~as amended by 1991 Iowa Acts, Senate File 455, section 10~~.

(4) An expert witness at any stage of an appeal necessary for correction of dependent adult abuse information as provided in Iowa Code chapter 235B ~~as amended by 1991 Iowa Acts, Senate File 455, section 10~~.

ITEM 4. Amend the implementation clause following 441—Chapter 176 as follows:

These rules are intended to implement Iowa Code chapter 235B ~~as amended by 2000 Iowa Acts, chapter 1067~~.

ITEM 5. Amend rule 441—177.4(249) as follows:

Amend subrule 177.4(1), paragraph “b,” as follows:

b. The physician’s certification shall include a statement of the specific health care services and that the services can be provided in the individual’s own home. The certification shall be given on Form ~~SS–1719–0~~ 470–0673, ~~Assessment of Functional Capacity of Client and Recommendation for Services~~ Physician’s Report, or on a similar plan of care form presently used by public health agencies.

Amend subrule 177.4(10), introductory paragraph and paragraph “d,” as follows:

177.4(10) Application. Application for in–home health related care shall be made on Form ~~PA–1107–0~~ 470–0442, Application for Medical Assistance or State Supplementary Assistance. An eligibility determination shall be completed within 30 days from the date of the application, unless one or more of the following conditions exist:

d. The application is pending because ~~the SS–1511–0~~ Form 470–0636, Provider Agreement, has not been completed and completion is beyond control of the client. When ~~a Provider Agreement~~ Form 470–0636 cannot be completed due to the client’s failure to locate a provider, applications shall not be held pending beyond 60 days from the date of application.

ITEM 6. Amend subrule 177.5(2) as follows:

177.5(2) Physician’s report. The provider shall obtain a physician’s report at the time service is initiated and annually thereafter. The report shall be on Form ~~SS–1718–0~~ 470–0672, Provider Health Assessment ~~Form~~.

ITEM 7. Amend subrule 177.9(3) as follows:

177.9(3) Provider agreement. The client and the provider shall enter into an agreement, using Form ~~SS–1511–0~~ 470–0636, Provider Agreement, prior to the provision of service. Any reduction to the state supplemental assistance program shall be applied to the maximum amount paid by the department of human services as stated in the Provider Agreement by using Form 470–1999, Amendment to Provider Agreement.

ITEM 8. Rescind the implementation clauses following rules 441—177.4(249) to 177.11(239) and adopt thefollowing new implementation clause following 441— Chapter 177:

These rules are intended to implement Iowa Code section 249.3(2)“a”(2).

ARC 0796B

HUMAN SERVICES DEPARTMENT[441]

Notice of Intended Action

Pursuant to the authority of Iowa Code section 234.6 and 2001 Iowa Acts, House File 732, section 14, subsection 14, paragraph “b,” and section 49, the Department of Human Services proposes to rescind Chapter 179, “Wrap–Around Funding Program,” appearing in the Iowa Administrative Code.

This amendment eliminates the Wrap–around Funding Program at the direction of the Seventy–ninth General Assembly. Funding for this program was eliminated in the Department’s appropriation bill.

This amendment does not provide for any waivers to receive the program because this change was mandated by the legislature, with no provisions for exceptions.

The substance of this amendment is also Adopted and Filed Emergency and is published herein as ARC 0797B. The purpose of this Notice is to solicit comment on that submission, the subject matter of which is incorporated by reference.

This amendment is intended to implement Iowa Code section 234.6 and 2001 Iowa Acts, House File 732, section 14, subsection 14, paragraph “b.”

ARC 0798B

HUMAN SERVICES DEPARTMENT[441]

Notice of Intended Action

Pursuant to the authority of Iowa Code section 217.6 and 2001 Iowa Acts, House File 732, section 31, subsection 8, and section 49, the Department of Human Services proposes to amend Chapter 185, “Rehabilitative Treatment Services,” appearing in the Iowa Administrative Code.

This amendment freezes rehabilitative treatment and supportive service (RTSS) rates at their June 30, 2001, level as mandated by the Seventy–ninth General Assembly. This amendment also continues the suspension of the regional administrator’s and provider’s ability to renegotiate rates for existing services during state fiscal year 2002.

This amendment does not provide for any waivers to the rate freeze because this change was mandated by the legislature, with no provisions for exceptions.

The substance of this amendment is also Adopted and Filed Emergency and is published herein as ARC 0799B. The purpose of this Notice is to solicit comment on that submission, the subject matter of which is incorporated by reference.

This amendment is intended to implement Iowa Code section 234.6 and 2001 Iowa Acts, House File 732, section 31, subsection 8.

ARC 0823B

INSURANCE DIVISION[191]

Notice of Intended Action

Pursuant to the authority of Iowa Code section 505.8 and 507A.4, subsection 10, paragraph “b,” the Insurance Division gives Notice of Intended Action to amend Chapter 77, “Multiple Employer Welfare Arrangements,” Iowa Administrative Code.

The proposed amendments provide for changes due to the passage of 2001 Iowa Acts, House File 325, which was passed by the General Assembly during the 2001 legislative session and went into effect upon enactment on March 14. The proposed amendments include the deletion of references to the Iowa Individual Health Benefit Reinsurance Association and the payment of premium tax. In addition, language has been removed concerning the requirement of a joint and several liability agreement between employers. However, the rules do require a multiple employer welfare arrangement (MEWA) to provide a mechanism subject to approval by the commissioner for the payment of claims in the event an employer member is unable to comply with the MEWA contribution requirements.

Any person may make written comments on the proposed amendments on or before July 31, 2001. Comments should be directed to Susan E. Voss, Deputy Insurance Commissioner, Insurance Division, 330 Maple Street, Des Moines, Iowa 50319. Comments may also be transmitted by E–mail to susan.voss@comm6.state.ia.us or by fax to (515) 281–5692.

A public hearing will be held at 10 a.m. on August 1, 2001, at the offices of the Insurance Division, 330 Maple Street, Des Moines, Iowa 50319. Persons wishing to provide oral comments should contact Susan Voss no later than July 31, 2001, to be placed on the agenda.

These amendments are intended to implement Iowa Code section 507A.4, subsection 10, as amended by 2001 Iowa Acts, House File 325.

The following amendments are proposed.

ITEM 1. Amend subrule 77.2(1) by rescinding paragraph “i” and adopting the following new paragraph in lieu thereof:

i. A mechanism approved by the commissioner to ensure that claims shall be paid in the event a member of the MEWA is unable to comply with the MEWA’s contribution requirements.

ITEM 2. Amend subrule 77.3(1), paragraph “a,” as follows:

a. Unless otherwise provided below or pursuant to the discretion of the commissioner, each MEWA shall deposit with an organization or trustee meeting the requirements of 191—32.4(508) cash, securities or any combination of these that is acceptable in the amount set forth below. In addition to the requirements set forth below, the commissioner may increase the amount required to be deposited based on the commissioner’s written determination that such an increase is necessary to adequately secure any potential liability of the MEWA to its enrollees, subject to Iowa Code chapter 17A proceedings.

ITEM 3. Rescind and reserve subrule 77.4(3).

ITEM 4. Amend subrule 77.5(1) as follows:

77.5(1) The following disclosure shall be made to each employer member of the MEWA: The benefits and coverages described herein are provided through a self–insured trust fund established and funded in full or in part by a group of employers. It is not a licensed insurance company and it is not protected by a guaranty fund in the event of insolvency. ~~Participating employers are jointly and severally liable for any losses incurred or as determined by the trust or as directed by the division.~~

ITEM 5. Amend rule 191—77.11(507A) by rescinding numbered paragraph “8.”

ARC 0819B

LIBRARIES AND INFORMATION SERVICES DIVISION[286]

Notice of Intended Action

Pursuant to the authority of Iowa Code section 256.52, the Commission of Libraries hereby gives Notice of Intended Action to adopt new Chapter 9, “Appointment Process for Library Service Area Boards of Trustees,” Iowa Administrative Code.

This proposed chapter implements 2001 Iowa Acts, House File 637, section 14(7), and outlines the process for appointing members to library service area boards.

Any interested person may make written comments on the proposed rules on or before August 1, 2001. Such written comments should be directed to Sharman B. Smith, State Librarian, State Library of Iowa, East 12th Street and Grand Avenue, Des Moines, Iowa 50319.

A public hearing will be held on August 1, 2001, at 10 a.m. at the State Library of Iowa, First Floor Conference Room, East 12th Street and Grand Avenue, Des Moines, Iowa, at which time persons may present their views orally. At the hearing, persons will be asked to give their names and addresses for the record, to confine their remarks to the subject of the rules and to limit their remarks to five minutes.

The Commission approved these proposed rules on June 11, 2001.

These rules were also Adopted and Filed Emergency and are published herein as ARC 0804B. The content of that submission is incorporated by reference.

These rules are intended to implement 2001 Iowa Acts, House File 637, section 14(7).

ARC 0801B

PHARMACY EXAMINERS BOARD[657]

Notice of Intended Action

Pursuant to the authority of Iowa Code sections 124.301 and 147.76, the Board of Pharmacy Examiners hereby gives Notice of Intended Action to adopt new Chapter 9, “Automated Medication Distribution Systems,” Iowa Administrative Code.

The proposed rules were approved at the June 12, 2001, regular meeting of the Board of Pharmacy Examiners.

The new chapter establishes standards for the verification and accuracy of automated medication distribution systems (AMDS) in the practice of pharmacy as required by 2001 Iowa Acts, House File 726, section 10, paragraph “i,” enacted by the Seventy–ninth General Assembly. The rules define various terms relating to AMDS and assign responsibility for medication distribution and other functions relating to AMDS. The rules establish requirements for policies and procedures and for record keeping regarding utilization of AMDS and establish continuous quality control assurance requirements to be implemented by any pharmacy utilizing AMDS in pharmacy practice.

Requests for waiver or variance of the discretionary provisions of these rules will be considered pursuant to 657— Chapter 34.

Any interested person may present written comments, data, views, and arguments on the proposed rules not later than 4:30 p.m. on July 31, 2001. Such written materials should be sent to Lloyd K. Jessen, Executive Secretary/Director, Board of Pharmacy Examiners, 400 S.W. Eighth Street, Suite E, Des Moines, Iowa 50309–4688, or by E–mail to lloyd.jessen@ibpe.state.ia.us.

These rules are intended to implement Iowa Code sections 124.301, 147.107, and 155A.33 and 2001 Iowa Acts, House File 726, section 10, paragraph “i.”

The following new chapter is proposed.

CHAPTER 9
AUTOMATED MEDICATION
DISTRIBUTION SYSTEMS

657—9.1(124,147,155A) Definitions. For the purposes of this chapter, the following definitions shall apply:

“Automated medication distribution system” or “AMDS” includes, but is not limited to, mechanical or electronic systems that perform operations or activities relative to thestoring, packaging, compounding, labeling, dispensing, ad– ministering, or distributing of medications and which collect, control, and maintain all transaction information.

“Board” means the board of pharmacy examiners.

“Centralized unit dose AMDS” means an AMDS located in the pharmacy where automated technology is utilized in the dispensing of patient–specific unit dose medications.

“Component” means any single physical or electronic storage or access device that, in combination with other devices, makes up the AMDS.

“Decentralized unit dose AMDS” means an AMDS where automated technology is utilized in the dispensing of patient–specific unit dose medications and medication–dispensing components are maintained in remote locations such as patient care areas or medication rooms in a hospital.

“Information access” means the entry into a record–keeping component of the AMDS, by electronic or other means, for the purpose of adding, updating, or retrieving any patient or medication record or data.

“Medication access” means the physical entry into any component of the AMDS for the purpose of stocking or removing medications.

“Outpatient AMDS” means an AMDS where automated technology is utilized in the dispensing of prescriptions for ambulatory patients.

“Qualified personnel” means pharmacists, pharmacy technicians, or other health care professionals trained for the specific duty.

“Remote location” means any location outside the licensed pharmacy where any component of an AMDS is located and includes the following:

• Patient care areas or medication rooms in a hospital, skilled nursing facility, or long–term care facility.

• Ambulatory care or surgery centers.

• Clinics and health practitioners’ offices.

• Other locations approved by the board.

657—9.2(155A,79GA,HF726) Pharmacist in charge responsibilities. The pharmacist in charge shall be responsible for the following:

1. Assigning, discontinuing, or changing medication and information access to the AMDS.

2. Ensuring that medication access, including access to controlled substances, complies with state and federal regulations.

3. Ensuring that each AMDS is filled or stocked accurately and in accordance with established, written policies and procedures.

4. Ensuring that each AMDS is in good working order and performs its designated tasks, including ensuring the correct strength, dosage form, and quantity of the prescribed medication.

5. Ensuring that the AMDS has adequate security safeguards regarding medication access and information access.

6. Ensuring that confidentiality of patient–specific information is maintained.

7. Implementing an ongoing quality assurance program that monitors and strives to improve performance of each AMDS.

8. Establishing and ensuring compliance with all policies and procedures relating to the AMDS.

9. Ensuring that all personnel utilizing or accessing the AMDS have been appropriately trained.

10. Ensuring that the board is provided with written notice at least 90 days prior to an installation, removal, or upgrade that significantly changes the operation of an AMDS. The notice shall include:

• The name, address, and license number of the pharmacy;

• The location of the automated equipment;

• Identification of the pharmacist in charge;

• The name, manufacturer, and model of the system;

• A description of the change or upgrade, if applicable; and

• If installing a new or significantly changed AMDS, a copy of the quality assurance plan.

657—9.3(147,155A,79GA,HF726) System, site, and process requirements. An AMDS may be utilized on site by licensed pharmacies or in remote locations as defined in rule 9.1(124,147,155A). Each AMDS shall comply with the following minimum requirements:

9.3(1) System access.

a. The AMDS shall automatically and electronically re–cord medication access.

b. Medication access and information access records shall include, at a minimum, the date the AMDS was accessed, the identity of the individual who accessed the system, the type of transaction completed, and the identity of the accessed component.

c. Information access for the purpose of retrieving or reviewing any patient or medication record or data, when the access does not permit change or addition to the record or data, shall be exempt from the access record requirements of paragraph “b” of this subrule.

d. The AMDS shall include the ability to assign, discontinue, and change medication access and information access to the AMDS.

e. A licensed pharmacist or qualified personnel under the oversight of a licensed pharmacist shall fill and stock medications in the AMDS.

f. A record of medications filled or stocked into an AMDS shall be maintained and shall include identification of the person filling or stocking the system and, if applicable, the person checking for accuracy.

9.3(2) Dispensing and distributing.

a. All containers of medications stored in each AMDS shall be packaged and labeled in compliance with federal and state laws and regulations.

b. All aspects of handling controlled substances shall comply with the requirements of all state and federal laws and regulations.

c. Each AMDS shall provide a mechanism for securing and accounting for medications removed from and subsequently returned to the system. Medications removed from a system component but not administered to a patient shall be returned to the component in a manner that would prevent medication access except for the purpose of returning the medication to the pharmacy.

d. Each AMDS shall provide a mechanism for securing and accounting for wasted or discarded medications in compliance with federal and state laws and regulations.

9.3(3) Security and confidentiality. An AMDS shall include system safeguards designed to prevent and detect unauthorized medication access, including access to controlled substances. System safeguards shall also be designed to prevent and detect unauthorized information access for the purpose of modification or manipulation of patient records and prescription drug orders.

a. An AMDS shall maintain confidential patient records and information in compliance with 657—21.1(124,155A) and 21.2(124,155A).

b. An AMDS shall be capable of generating reports of all medication access activity. Reports shall include, at a minimum for each medication access record, the following:

(1) Identification of the person.

(2) The date and, preferably, the time.

(3) Identification of the medication.

(4) Whether the medication access involved stocking, dispensing, wasting, or returning the medication.

(5) The quantity of the medication.

(6) The accessed component.

657—9.4(147,155A,79GA,HF726) Quality assurance and improvement. The goal of AMDS is the accurate dispensing of medications. In all dispensing activities, the pharmacy shall strive for 100 percent accuracy. All identified errors shall be logged, the reasons for the errors shall be determined, procedures shall be reviewed, and problems contributing to the errors shall be resolved. Errors shall be categorized as:

1. Computer order entry error,

2. Incorrect medication,

3. Incorrect dose,

4. Incorrect quantity—extra dose(s),

5. Incorrect quantity—short dose(s),

6. Incorrect dosage form, and

7. Other errors. All errors categorized as “other errors” shall include additional notation identifying the error.

657—9.5(147,155A,79GA,HF726) Centralized unit dose AMDS. The quality assurance plan shall provide for pharmacist verification of all medication doses dispensed for a minimum of 90 days following implementation of the AMDS. All identified errors shall be logged as provided in rule 9.4(147,155A,79GA,HF726).

9.5(1) Initial report to the board. The first report to the board shall summarize identified errors by category and shall include the total number of errors identified, the reasons for the errors, the corrective actions taken to prevent the recurrence of those errors, and the average accuracy (correct doses over total doses) for all AMDS–dispensed medications during the first 90 days following implementation.

9.5(2) Random verification. If the average accuracy of the AMDS during the initial 90–day period is at least 99.7 percent for all medication doses dispensed, the quality assurance plan shall provide for random verification by a pharmacist. The plan shall provide that 5 percent of all medication doses daily dispensed utilizing the AMDS be verified by a pharmacist or it shall provide that 100 percent of all medication doses dispensed on a specific day each month be verified by a pharmacist; or a pharmacy may request prior approval from the board for an alternate pharmacist verification process. Errors shall continue to be identified and logged as provided in rule 9.4(147,155A,79GA,HF726).

If the average accuracy of the AMDS during the initial 90–day period is not at least 99.7 percent for all medication doses dispensed, the pharmacy shall continue pharmacist verification of all medication doses dispensed utilizing the AMDS until the average accuracy for 90 consecutive days is at least 99.7 percent.

9.5(3) Reports during first year. For a minimum of one year following implementation of the AMDS, written quarterly reports shall be submitted to the board. Reports shall summarize identified errors by category and shall include the total number of errors identified, the reasons for the errors, the corrective actions taken to prevent the recurrence of those errors, and the average accuracy (correct doses over total verified doses) for all medication doses verified during the preceding quarter.

9.5(4) Accuracy. Any random verification disclosing accuracy of less than 99.7 percent for all medication doses verified shall require that a pharmacist again verify all medication doses dispensed utilizing the AMDS until the average accuracy meets or exceeds 99.7 percent for all medication doses dispensed for three consecutive days.

9.5(5) Continued verification. The quality assurance plan shall provide for continuation of random verification by the pharmacist of AMDS–dispensed medication doses as provided in subrules 9.5(2) and 9.5(4).

9.5(6) Reports after one year. Following the one–year period and within 30 days of determining by random verification that the accuracy of AMDS medication fills is less than 99.7 percent for all medication doses verified, a written report shall be submitted to the board. The report shall summarize the identified errors by category and shall include the reasons for the errors, the corrective actions taken to prevent the recurrence of those errors, and the low accuracy rate prompting the report.

657—9.6(147,155A,79GA,HF726) Decentralized unit dose AMDS. When bar coding or other technology–based verification is not utilized to check the accuracy of medication doses stocked in dispensing components, a pharmacist shall verify that all medication doses are accurately placed in each compartment of each dispensing component. All identified errors shall be logged as provided in rule 9.4(147,155A,79GA,HF726).

When bar coding or other technology–based verification is utilized and a pharmacist is not filling the dispensing component, the quality assurance plan shall provide for random verification by a pharmacist. The plan shall provide that, one day each month, all medication doses contained in 10 percent of the components utilized within the system be verified by a pharmacist. Or the plan shall provide that, one day each month, 10 percent of the medication doses contained in each component utilized within the system be verified by a pharmacist. If, however, the system includes less than five components, a pharmacist shall, one day each month, verify all medication doses contained in one component utilized within the system. A pharmacy may request prior approval from the board for an alternate pharmacist verification process. All identified errors shall be logged as provided in rule 9.4(147,155A,79GA,HF726).

9.6(1) Report to the board. Reasons for errors resulting in accuracy (correct doses over doses verified) of less than 99.7 percent for all medication doses verified shall be identified, procedures shall be reviewed, and problems contributing to errors shall be resolved. A written report shall be submitted, within 30 days, to the board. The report shall summarize the identified errors by category and shall include the reasons for the errors, the corrective actions taken to prevent the recurrence of those errors, and the low accuracy rate prompting the report.

9.6(2) Accuracy. Anytime the average accuracy falls below 99.7 percent for all medication doses verified, the frequency of pharmacist verification shall be increased to one day each week until the average accuracy meets or exceeds 99.7 percent for four consecutive weeks.

657—9.7(147,155A,79GA,HF726) Outpatient AMDS.

9.7(1) Verification. Prior to dispensing, all outpatient prescriptions dispensed utilizing an AMDS shall be verified by a pharmacist in the pharmacist’s physical presence unless a waiver is approved pursuant to subrule 9.7(2).

9.7(2) Waiver. A pharmacy may request waiver or variance from subrule 9.7(1) pursuant to the procedures and requirements of 657—Chapter 34. In addition, applications for waiver shall specify and include justification for the requested waiver, the methods to be used to ensure patient counseling is provided on new prescriptions pursuant to 657—8.20(155A), a quality assurance plan, and written policies and procedures for utilization of the AMDS.

a. Quarterly reports. The quality assurance plan shall provide for submission of written quarterly reports to the board. All reports shall summarize identified errors by category and shall include reasons for the errors, the corrective actions taken to resolve and prevent recurrence of the errors, and average accuracy for the specified period.

b. Verification. The quality assurance plan shall provide for verification processes for all AMDS–dispensed prescriptions.

c. Identification of errors. The plan shall require that all identified errors be categorized and logged as provided in rule 9.4(147,155A,79GA,HF726).

d. Accuracy. The plan shall identify actions to be taken in the event that any medication error is identified.

657—9.8(124,155A) Records. All records required pursuant to these rules shall be available to the board or its authorized agents for two years following the recorded activity.

657—9.9(124,155A) Policies and procedures. All policies and procedures shall be maintained in the pharmacy responsible for the AMDS. All pharmacies utilizing AMDS shall develop, implement, and adhere to policies and procedures that address, at a minimum, the following:

1. Type of equipment, system components, and location including:

• Name and address of the pharmacy or remote location where any component of the AMDS is being used, and

• Manufacturer’s name and model of each system component.

2. Medication access and information access procedures.

3. Security and confidentiality of records in compliance with 657—21.1(124,155A) and 21.2(124,155A).

4. Description of how the component is being utilized including processes for dispensing and distributing medications.

5. Staff education and training.

6. Review, including prospective drug use review, of medication orders and prescriptions in accordance with federal and state laws and regulations.

7. Patient counseling on outpatient prescriptions.

8. Quality assurance and quality improvement.

9. Downtime procedures.

10. Periodic system maintenance.

11. Medication security and control including:

• Medication loading, storage, and records.

• Medications removed but not used.

• Inventory.

• Cross contamination.

• Lot number control.

• Wasted or discarded medications.

• Controlled substances.

These rules are intended to implement Iowa Code sections 124.301, 147.107, and 155A.33 and 2001 Iowa Acts, House File 726, section 10, paragraph “i.”

ARC 0802B

PHARMACY EXAMINERS BOARD[657]

Notice of Termination

Pursuant to the authority of Iowa Code section 124.301, the Board of Pharmacy Examiners terminates the rule making initiated by its Notice of Intended Action published in the Iowa Administrative Bulletin on November 29, 2000, as ARC 0298B, proposing to amend Chapter 10, “Controlled Substances (Drugs),” Iowa Administrative Code.

The Notice proposed to increase the fee for registration and registration renewal under the Iowa Controlled Substances Act and increase the penalty for late registration or registration renewal.

The Board is terminating the rule making commenced in ARC 0298B. Rule making was commenced in anticipation of increased appropriation for additional enforcement staff. The appropriation increase was not approved; therefore the fee increase is not required.

ARC 0821B

RACING AND GAMING COMMISSION[491]

Notice of Intended Action

Pursuant to the authority of Iowa Code sections 99D.7 and 99F.4, the Racing and Gaming Commission hereby gives Notice of Intended Action to amend Chapter 1, “Organization and Operation,” Iowa Administrative Code.

This rule change puts in place a procedure the Commission will follow for reconsideration of a motion.

Any person may make written suggestions or comments on the proposed amendment on or before July 31, 2001. Written material should be directed to the Racing and Gaming Commission, 717 E. Court, Suite B, Des Moines, Iowa 50309. Persons who wish to convey their views orally should contact the Commission office at (515)281–7352.

Also, there will be a public hearing on July 31, 2001, at 9 a.m. in the office of the Racing and Gaming Commission, 717 E. Court, Suite B, Des Moines, Iowa. Persons may pre–sent their views at the public hearing either orally or in writing.

This amendment is intended to implement Iowa Code chapters 99D and 99F.

The following amendment is proposed.

Rescind rule 491—1.2(99D,99F) and adopt in lieu thereof the following new rule:

491—1.2(99D,99F) Organization, meetings, and procedure.

1.2(1) Organization.

a. The racing and gaming commission is located at 717 E. Court, Suite B, Des Moines, Iowa 50309; telephone (515)281–7352. Office hours are 8 a.m. to 4:30 p.m., Monday through Friday.

b. The racing and gaming commission consists of five members. The membership shall elect a chairperson and vice–chairperson in July of each year. No chairperson shall serve more than two consecutive one–year full terms.

1.2(2) Meetings.

a. The commission meets periodically throughout the year and shall meet in July of each year. Notice of a meeting is published on the commission’s Web site at www3.state.ia.us/irgc/ at least five days in advance of the meeting or will be mailed to interested persons upon request. The notice shall contain the specific date, time, and place of the meeting. Agendas are available to any interested persons not less than five days in advance of the meeting.

b. Persons wishing to appear before the commission should submit a written request to the commission office not less than ten working days prior to the meeting. The administrator or commission may place a time limit on presentations after taking into consideration the number of presentations requested.

c. Special or electronic meetings may be called by the chairperson only upon a finding of good cause and shall be held in strict accordance with Iowa Code section 21.4 or 21.8.

1.2(3) Procedure. All meetings shall be open to the public unless a closed session is voted by four members or all members present for the reasons specified in Iowa Code section 21.5. The operation of commission meetings shall be governed by the following rules of procedure:

a. A quorum shall consist of three members.

b. When a quorum is present, a position is carried by an affirmative vote of the majority of the entire membership of the commission.

c. A commissioner, who is present at a meeting of the commission when action is taken, shall be presumed to have assented to the action unless the commissioner’s dissent was requested to be entered in the minutes. A roll call vote on any motion may be recorded in the minutes. Reconsideration of any action may only be initiated by a commissioner who voted with the prevailing side. The motion to reconsider any action may be made and seconded before the conclusion of the meeting when the action was approved, or it may be made in writing and submitted to the commission office within two business days following the meeting. Only the mover has the option to request that the motion be held in abeyance, when the motion to reconsider is offered during the same meeting. Any commissioner is eligible to call up the motion to reconsider at the next meeting of the commission. The official minutes shall record the offering of any motion to reconsider, whether placed during the meeting or by timely written submission.

d. The presiding officer may exclude any person from the meeting for behavior that disrupts or obstructs the meeting.

e. Cases not covered by this rule shall be governed by the 1990 edition of Robert’s Rules of Order Newly Revised.

ARC 0825B

REVENUE AND FINANCE DEPARTMENT[701]

Notice of Intended Action

Pursuant to the authority of Iowa Code sections 421.17(19) and 422.68, the Department of Revenue and Finance hereby gives Notice of Intended Action to amend Chapter 53, “Determination of Net Income,” and Chapter 59, “Determination of Net Income,” Iowa Administrative Code.

Item 1 provides that income from the sale of obligations issued by the state of Iowa or its political subdivisions shall be taxable for corporation income tax purposes unless the law authorizing these obligations specifically exempts the income from the sale from Iowa corporation income tax.

Item 2 updates an implementation clause.

Item 3 provides that income from the sale of obligations issued by the state of Iowa or its political subdivisions, along with interest and dividend income from these obligations, shall be taxable for franchise tax purposes. An exception exists if the law authorizing these obligations specifically exempts the income from the sale and interest and dividend income from Iowa franchise tax.

Item 4 updates an implementation clause.

These proposed amendments will not necessitate additional expenditures by political subdivisions or agencies and entities which contract with political subdivisions.

Any person who believes that the application of the discretionary provisions of these amendments would result in hardship or injustice to that person may petition the Department for a waiver of the discretionary provisions, if any.

The Department has determined that these proposed amendments may have an impact on small business. The Department has considered the factors listed in Iowa Code section 17A.4A. The Department will issue a regulatory analysis as provided in Iowa Code section 17A.4A if a written request is filed by delivery or by mailing postmarked no later than August 13, 2001, to the Policy Section, Compliance Division, Department of Revenue and Finance, Hoover State Office Building, P.O. Box 10457, Des Moines, Iowa 50306. The request may be made by the Administrative Rules Review Committee, the Administrative Rules Coordinator, at least 25 persons signing that request who each qualify as a small business, or an organization representing at least 25 such persons.

Any interested person may make written suggestions or comments on these proposed amendments on or before August 10, 2001. Such written comments should be directed to the Policy Section, Compliance Division, Department of Revenue and Finance, Hoover State Office Building, P.O. Box 10457, Des Moines, Iowa 50306.

Persons who want to convey their views orally should contact the Policy Section, Compliance Division, Department of Revenue and Finance, at (515)281–4250 or at the Department of Revenue and Finance offices on the fourth floor of the Hoover State Office Building.

Requests for a public hearing must be received by August 3, 2001.

These amendments are intended to implement Iowa Code chapter 422 as amended by 2001 Iowa Acts, House File 715.

The following amendments are proposed.

ITEM 1. Amend rule 701—53.6(422) by adopting the following new second unnumbered paragraph:

For tax years beginning on or after January 1, 2001, add, to the extent not already included, income from the sale of obligations of the state of Iowa and its political subdivisions. Gains or losses from the sale or other disposition of bonds issued by the state of Iowa or its political subdivisions shall be included in Iowa taxable income unless the law authorizing these obligations specifically exempts the income from the sale or other disposition from Iowa corporation income tax.

ITEM 2. Amend rule 701—53.6(422), implementation clause, as follows:

This rule is intended to implement Iowa Code section 422.35 as amended by 2001 Iowa Acts, House File 715.

ITEM 3. Amend rule 701—59.6(422) by adopting the following new second unnumbered paragraph:

For tax years beginning on or after January 1, 2001, add, to the extent not already included, income from the sale of obligations of the state of Iowa and its political subdivisions and interest and dividend income from these obligations. Gains or losses from the sale or other disposition of bonds issued by the state of Iowa or its political subdivisions, along with interest and dividend income from these bonds, shall be included in Iowa taxable income unless the law authorizing these obligations specifically exempts the income from the sale and interest and dividend income from Iowa franchise tax.

ITEM 4. Amend rule 701—59.6(422), implementation clause, as follows:

This rule is intended to implement Iowa Code sections 422.35 and 422.61 as amended by 2001 Iowa Acts, House File 715.

NOTICE—USURY

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:

June 1, 2000 — June 30, 2000 8.00%

July 1, 2000 — July 31, 2000 8.50%

August 1, 2000 — August 31, 2000 8.00%

September 1, 2000 — September 30, 2000 8.00%

October 1, 2000 — October 31, 2000 7.75%

November 1, 2000 — November 30, 2000 7.75%

December 1, 2000 — December 31, 2000 7.75%

January 1, 2001 — January 31, 2001 7.75%

February 1, 2001 — February 28, 2001 8.00%

March 1, 2001 — March 31, 2001 7.25%

April 1, 2001 — April 30, 2001 7.00%

May 1, 2001 — May 31, 2001 7.00%

June 1, 2001 — June 30, 2001 7.25%

July 1, 2001 — July 31, 2001 7.50%

FILED EMERGENCY

ARC 0815B

ENVIRONMENTAL PROTECTION COMMISSION[567]

Adopted and Filed Emergency After Notice

Pursuant to the authority of Iowa Code section 455B.200, the Environmental Protection Commission hereby amends Chapter 65, “Animal Feeding Operations,” Iowa Administrative Code.

The amendments add several provisions pertaining to certification and related fees for manure applicators, including implementation of statutory provisions which exempt certain family members from payment of the confinement site manure applicator certification fee. The amendments also convert differential expiration dates for manure applicator certificates to a uniform date, add four lakes as major water sources and make editorial corrections.

The amendments also change the definition of “freeboard” to allow for the gravity unloading of an aboveground manure storage tank provided the tank is equipped with redundant valves and barricades, and an emergency response plan is available on site.

These amendments have been reviewed by the Animal Agriculture Consulting Organization.

Notice of Intended Action was published in the Iowa Administrative Bulletin on March 21, 2001, as ARC 0569B. No written comments were received, and no oral comments were made at the April 24, 2001, public hearing.

These amendments are identical to those published under Notice of Intended Action.

In compliance with Iowa Code section 17A.5(2)“b”(2), the Commission finds these amendments confer a benefit on the public by making the family fee exemption effective and by simplifying the applicator training and certification program and that the normal effective date of these amendments should be waived and these amendments should be made effective July 1, 2001. The major impact of these rules is that the certified manure applicator program will be changed so that the certificates of all applicators will expire uniformly on December 31, 2001. A 60–day “grace” period will then be allowed for training by Iowa State University before the applicators will have to be officially signed up for the program. These amendments also implement the “family farm” exemption to the fee for the certificates if applicators are members of the same family. The July 1, 2001, effective date is necessary because the Commission has already announced at various training programs around the state that this change would be occurring on July 1, 2001.

These amendments are intended to implement Iowa Code section 455B.203A.

These amendments became effective July 1, 2001.

65.19, Appendices A and B] is being omitted. These amendments are identical to those published under Notice as ARC 0569B, IAB 3/21/01.

[Filed Emergency After Notice 6/21/01, effective 7/1/01]
[Published 7/11/01]

[For replacement pages for IAC, see IAC Supplement 7/11/01.]

ARC 0770B

HUMAN SERVICES DEPARTMENT[441]

Adopted and Filed Emergency After Notice

Pursuant to the authority of Iowa Code section 234.6, the Department of Human Services hereby amends Chapter 73, “Commodity Distribution Programs,” appearing in the Iowa Administrative Code.

The Council on Human Services adopted this amendment June 13, 2001. Notice of Intended Action regarding this amendment was published in the Iowa Administrative Bulletin on May 2, 2001, as ARC 0640B.

This amendment increases the income eligibility guidelines for the Emergency Food Assistance Program.

Income eligibility guidelines for the Emergency Food Assistance Program in Iowa are based on the income guidelines for the reduced price meals in the National School Lunch Program. These guidelines are set at 185 percent of the federal poverty guidelines and are normally revised effective July 1 of each year. Revised federal poverty guidelines have been received by the Department.

This amendment does not provide for waiver in specified situations because it confers a benefit by allowing the Department to serve a greater number of needy individuals under the Emergency Food Assistance Program.

This amendment is identical to that published under Notice of Intended Action.

The Department finds that this amendment confers a benefit to persons eligible for the Emergency Food Assistance Program by increasing the number of persons who can be served. Therefore, this amendment is filed pursuant to Iowa Code section 17A.5(2)“b”(2).

This amendment is intended to implement Iowa Code section 234.12.

This amendment became effective July 1, 2001.

The following amendment is adopted.

Amend subrule 73.4(3), paragraph “d,” subparagraph (2), as follows:

(2) Income eligible status. The gross income according to family size is no more than the following amounts:

Household Size	Yearly Income	Monthly Income	Weekly Income
1	~~$15,448~~ $15,892	~~$1,288~~ $1,325	~~$ 298~~ $ 306
2	~~20,813~~ 21,479	~~1,735~~ 1,790	~~401~~ 414
3	~~26,178~~ 27,066	~~2,182~~ 2,256	~~504~~ 521
4	~~31,543~~ 32,653	~~2,629~~ 2,722	~~607~~ 628
5	~~36,908~~ 38,240	~~3,076~~ 3,187	~~710~~ 736
6	~~42,273~~ 43,827	~~3,523~~ 3,653	~~813~~ 843
7	~~47,638~~ 49,414	~~3,970~~ 4,118	~~917~~ 951
8	~~53,003~~ 55,001	~~4,417~~ 4,584	~~1,020~~ 1,058
For each additionalhousehold member add:	~~$ 5,365~~ $ 5,587	~~$ 448~~ $ 466	~~$ 104~~ $ 108

[Filed Emergency After Notice 6/13/01, effective 7/1/01]

[Published 7/11/01]

EDITOR’S NOTE: For replacement pages for IAC, see IAC Supplement 7/11/01.

ARC 0772B

HUMAN SERVICES DEPARTMENT[441]

Adopted and Filed Emergency

Pursuant to the authority of Iowa Code section 249A.4, the Department of Human Services hereby amends Chapter 75, “Conditions of Eligibility,” appearing in the Iowa Administrative Code.

A woman having creditable coverage under the Health Insurance Portability and Accountability Act (HIPAA) would have coverage under any of the following:

• A group health care plan.

• Medicare.

• Medicaid.

• Armed forces insurance.

• A medical care program of the Indian Health Service or of a tribal organization.

• A state health risk pool.

This amendment also includes provisions for presumptive eligibility determination to allow access to treatment before a formal Medicaid eligibility determination can be completed.

This amendment does not provide for waivers because it confers a benefit and was mandated by the Seventy–ninth General Assembly.

The Department finds that notice and public participation are impracticable because there is not time to allow for notice and public comment by the legislatively mandated effective date of July 1, 2001. Therefore, this amendment is filed pursuant to Iowa Code section 17A.4(2).

The Department finds that this amendment confers a benefit on women who have been screened for breast or cervical cancer under the Centers for Disease Control and Prevention Breast and Cervical Cancer Early Detection Program established under Title XV of the Public Health Service Act and have been found to need treatment for either breast or cervical cancer by making those women eligible for Medicaid if they do not have creditable health insurance. Therefore, this amendment is filed pursuant to Iowa Code section 17A.5(2)“b”(2).

This amendment is also published herein under Notice of Intended Action as ARC 0771B to allow for public comment.

The Council on Human Services adopted this amendment June 13, 2001.

This amendment is intended to implement Iowa Code section 249A.3(2) as amended by 2001 Iowa Acts, Senate File 537, section 9.

This amendment became effective July 1, 2001.

The following amendment is adopted.

Amend rule 441—75.1(249A) by adopting the following new subrule 75.1(40):

75.1(40) Women who have been screened and found to need treatment for breast or cervical cancer.

a. Medical assistance shall be available to women who:

(1) Have been screened for breast or cervical cancer under the Centers for Disease Control and Prevention Breast and Cervical Cancer Early Detection Program established under Title XV of the Public Health Service Act and have been found to need treatment for either breast or cervical cancer (including a precancerous condition);

(2) Do not otherwise have creditable coverage, as that term is defined by the Health Insurance Portability and Accountability Act (HIPAA) (42 U.S.C. Section 300gg(c)(1)), and are not eligible for medical assistance under Iowa Code section 249A.3(1); and

(3) Are under the age of 65.

b. Eligibility established under paragraph “a” continues until the woman is:

(1) No longer receiving treatment for breast or cervical cancer;

(2) No longer under the age of 65; or

(3) Covered by creditable coverage or eligible for medical assistance under Iowa Code section 249A.3(1).

c. Presumptive eligibility. A woman who has been screened for breast or cervical cancer under the Centers for Disease Control and Prevention Breast and Cervical Cancer Early Detection Program established under Title XV of the Public Health Service Act, who has been found to need treatment for either breast or cervical cancer (including a precancerous condition), and who is determined by a qualified provider to be presumptively eligible for medical assistance under paragraph “a” shall be eligible for medical assistance until the last day of the month following the month of the presumptive eligibility determination if no Medicaid application is filed in accordance with rule 441—76.1(249A) by that day or until the date of a decision on a Medicaid application filed in accordance with rule 441—76.1(249A) by the last day of the month following the month of the presumptive eligibility determination, whichever is earlier.

The woman shall complete Form 470–2927, Health Services Application, in order for the qualified provider to make the presumptive eligibility determination. Presumptive eligibility shall begin no earlier than the date the qualified Medicaid provider determines eligibility.

Payment of claims for services provided to a woman under this paragraph is not dependent upon a finding of Medicaid eligibility for the woman.

(1) A provider who is qualified to determine presumptive eligibility is defined as a provider who:

1. Is eligible for payment under the Medicaid program; and

2. Either:

• Has been named lead agency for a county or regional local breast and cervical cancer early detection program under a contract with the department of public health; or

• Has a cooperative agreement with the department of public health under the Centers for Disease Control and Prevention Breast and Cervical Cancer Early Detection Program established under Title XV of the Public Health Service Act to receive reimbursement for providing breast or cervical cancer screening or diagnostic services to participants in the Care for Yourself Breast and Cervical Cancer Early Detection Program; and

3. Has made application and has been specifically designated by the department in writing as a qualified provider for the purpose of determining presumptive eligibility under this rule.

(2) The provider shall complete Form 470–3684, Application for Authorization to Make Presumptive Medicaid Eligibility Determinations (BCCT), and submit it to the department for approval in order to be designated as a provider qualified to make presumptive eligibility determinations. Once the department has approved the provider’s application, the provider and the department shall sign Form 470–3865, Memorandum of Understanding with a Qualified Provider for Women with Breast or Cervical Cancer Treatment. When both parties have signed the memorandum, the department shall designate the provider as a qualified provider and notify the provider.

(3) When a qualified provider has made a presumptive eligibility determination for a woman, the provider shall:

1. Contact the department to obtain a state identification number for the woman who has been determined presumptively eligible.

2. Notify the department in writing of the determination within five working days after the date the presumptive eligibility determination is made. The provider shall use a copy of Form 470–2580, Presumptive Medicaid Eligibility Notice of Decision, for this purpose.

3. Inform the woman in writing, at the time the determination is made, that if she has not applied for Medicaid on Form 470–2927, Health Services Application, she has until the last day of the month following the month of the preliminary determination to file the application with the department. The qualified provider shall use Form 470–2580, Presumptive Medicaid Eligibility Notice of Decision, for this purpose.

4. Forward copies of Form 470–2927, Health Services Application, to the appropriate department office for eligibility determination if the woman indicated on the application that she was applying for any of the other programs. The provider shall forward these copies and proof of screening for breast or cervical cancer under the Centers for Disease Control and Prevention Breast and Cervical Cancer Early Detection Program within two working days from the date of the presumptive eligibility determination.

(4) In the event that a woman needing care does not appear to be presumptively eligible, the qualified provider shall inform the woman that she may file an application at the county department office if she wishes to have an eligibility determination made by the department.

(5) Presumptive eligibility shall end under either of the following conditions:

1. The woman fails to file an application for Medicaid in accordance with rule 441—76.1(249A) by the last day of the month following the month of the presumptive eligibility determination.

2. The woman files a Medicaid application by the last day of the month following the month of the presumptive eligibility determination and is found ineligible for Medicaid.

(6) Adequate and timely notice requirements and appeal rights shall apply to an eligibility determination made on a Medicaid application filed pursuant to rule 441— 76.1(249A). However, notice requirements and appeal rights of the Medicaid program shall not apply to a woman who is:

1. Denied presumptive eligibility by a qualified provider.

2. Determined to be presumptively eligible by a qualified provider and whose presumptive eligibility ends because the woman fails to file an application by the last day of the month following the month of the presumptive eligibility determination.

(7) A new period of presumptive eligibility shall begin each time a woman is screened for breast or cervical cancer under the Centers for Disease Control and Prevention Breast and Cervical Cancer Early Detection Program established under Title XV of the Public Health Service Act, is found to need treatment for breast or cervical cancer, and files Form 470–2927, Health Services Application, with a qualified provider.

[Filed Emergency 6/13/01, effective 7/1/01]

[Published 7/11/01]

EDITOR’S NOTE: For replacement pages for IAC, see IAC Supplement 7/11/01.

ARC 0775B

HUMAN SERVICES DEPARTMENT[441]

Adopted and Filed Emergency

Pursuant to the authority of Iowa Code section 249A.4, the Department of Human Services hereby amends Chapter 75, “Conditions of Eligibility,” appearing in the Iowa Administrative Code.

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

On this basis, the average private pay cost for nursing facility services increased from $2,933 per month to $3,024. The average charge to a private pay resident for nursing facility care increased from $2,758 per month to $2,844. The average charge for hospital–based skilled care increased from $9,836 per month to $10,141. The average chargefor non–hospital–based skilled care increased from $4,523 per month to $4,663. The maximum Medicaid reimbursement rate for ICF/MR care is $10,365 per month (the previously used average of the maximums for state–owned and community–based facilities was $8,510). The average charge for PMIC care increased from $4,359 to $4,477 per month. The average statewide charge to a resident of an MHI decreased from $9,962 to $9,646 per month.

The Department finds that notice and public participation are unnecessary because the amendments simply update existing rules pursuant to established policy based on mathematical calculations. Therefore, these amendments are filed pursuant to Iowa Code section 17A.4(2).

The Department finds that these amendments confer a benefit on persons applying for Medicaid by establishing a more equitable period of ineligibility and raising the income level for persons needing to establish a Medicaid–qualifying trust to become eligible for some type of facility care. Therefore, these amendments are filed pursuant to Iowa Code section 17A.5(2)“b”(2).

These amendments are also published herein under Notice of Intended Action as ARC 0774B to allow for public comment.

The Council on Human Services adopted these amendments June 13, 2001.

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

These amendments became effective July 1, 2001.

The following amendments are adopted.

ITEM 1. Amend subrule 75.23(3) as follows:

75.23(3) Period of ineligibility. The number of months of ineligibility shall be equal to the total cumulative uncompensated value of all assets transferred by the individual (or the individual’s spouse) on or after the look–back date specified in 75.23(2), divided by the statewide average private pay rate for nursing facility services at the time of application. 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, ~~2000~~ 2001, through June 30, ~~2001~~ 2002, this average statewide cost shall be ~~$2,933~~ $3,024 per month or ~~$96.43~~ $99.42 per day.

ITEM 2. Amend subrule 75.24(3), paragraph “b,” 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, ~~2000~~ 2001, to June 30, ~~2001~~ 2002, shall be as follows:

(1) The average statewide charge to a private pay resident of a nursing facility is ~~$2,758~~ $2,844 per month.

(2) The average statewide charge to a private pay resident of a hospital–based skilled nursing facility is ~~$9,836~~ $10,141 per month.

(3) The average statewide charge to a private pay resident of a non–hospital–based skilled nursing facility is ~~$4,523~~ $4,663 per month.

(4) The ~~average~~ maximum statewide Medicaid rate for a resident of an intermediate care facility for the mentally retarded is ~~$8,510~~ $10,365 per month.

(5) The average statewide charge to a resident of a mental health institute is ~~$9,962~~ $9,646 per month.

(6) The average statewide charge to a private pay resident of a psychiatric medical institution for children is ~~$4,359~~ $4,477 per month.

(7) No change.

[Filed Emergency 6/13/01, effective 7/1/01]

[Published 7/11/01]

EDITOR’S NOTE: For replacement pages for IAC, see IAC Supplement 7/11/01.

ARC 0778B

HUMAN SERVICES DEPARTMENT[441]

Adopted and Filed Emergency

Pursuant to the authority of Iowa Code section 249A.4 and 2001 Iowa Acts, House File 732, section 28, subsections 4 and 6, and section 49, the Department of Human Services hereby amends Chapter 77, “Conditions of Participation for Providers of Medical and Remedial Care,” Chapter 78, “Amount, Duration and Scope of Medical and Remedial Services,” and Chapter 80, “Procedure and Method of Payment,” appearing in the Iowa Administrative Code, and adopts Chapter 186, “Child Welfare Targeted Case Management Services.”

Section 1915(g)(1) and (2) of the Social Security Act state that:

“(1) A State may provide, as medical assistance,case management services under the plan without regardto the requirements of section 1902(a)(1) and section 1902(a)(10)(B). The provision of case management services under this subsection shall not restrict the choice of the individual to receive medical assistance in violation of section 1902(a)(23)....”

These amendments do not provide for waivers, as these changes will enhance coordination of child welfare services to children and families and were mandated by the General Assembly.

In compliance with Iowa Code section 17A.4(2), the Department finds that notice and public participation are unnecessary because these amendments implement 2001 Iowa Acts, House File 732, section 28, subsections 4 and 6, and section 49, that authorize the Department to adopt rules without notice and public participation.

The Department also finds, pursuant to Iowa Code section 17A.5(2)“b”(1), that the normal effective date of these amendments should be waived and these amendments made effective July 1, 2001, as authorized by 2001 Iowa Acts, House File 732, section 28, subsections 4 and 6, and section 49.

These amendments are also published herein under Notice of Intended Action as ARC 0777B to allow for public comment.

The Council on Human Services adopted these amendments June 13, 2001.

These amendments are intended to implement Iowa Code section 249A.4 and 2001 Iowa Acts, House File 732, section 28, subsection 4.

These amendments became effective July 1, 2001.

The following amendments are adopted.

ITEM 1. Amend rule 441—77.29(249A) as follows:

441—77.29(249A) Case management provider organizations. Case management provider organizations are eligible to participate in the Medicaid program provided that they meet the standards for the populations being served. Providers shall meet the following standards:

77.29(1) Standards in 441—Chapter 24. Providers shall meet the standards in 441—Chapter 24 ~~and~~ when they are the department of human services, a county or consortium of counties, or an agency or provider under subcontract to the department or a county or consortium of counties providing case management services to persons with mental retardation, developmental disabilities or chronic mental illness.

77.29(2) Standards in 441—Chapter 186. Providers shall meet the standards in 441—Chapter 186 when providing child welfare targeted case management services as defined in 441—Chapter 186.

ITEM 2. Amend rule 441—78.33(249A) as follows:

Amend the introductory paragraph as follows:

441—78.33(249A) Case management services. Payment on a monthly payment per enrollee basis will be approved for the case management functions required in 441—Chapter 24 or 441—Chapter 186.

Amend subrules 78.33(1) and 78.33(2), introductory paragraphs, as follows:

78.33(1) Payment will be approved for case management services pursuant to 441—Chapter 24 to:

78.33(2) Payment for services pursuant to 441—Chapter 24 to recipients under age 18 residing in a child welfare decategorization county shall be made when the following conditions are met:

Adopt the following new subrule 78.33(3):

78.33(3) Payment will be approved for case management services pursuant to 441—Chapter 186 to recipients under 18 years of age who are receiving or are in need of child welfare services as defined in 441—Chapter 186.

ITEM 3. Amend subrule 80.2(2), paragraph “ad,” as follows:

ad. Case management providers shall submit claims on Form 470–2486, Claim for Targeted Medical Care, for services provided pursuant to 441—Chapter 24 and on FACS–generated claims for services provided pursuant to 441— Chapter 186.

ITEM 4. Adopt the following new 441—Chapter 186:

CHAPTER 186
CHILD WELFARE TARGETED CASEMANAGEMENT SERVICES

PREAMBLE

These rules define and structure the department of human services child welfare targeted case management program. Child welfare targeted case management services assist children in gaining and coordinating access to necessary care and services appropriate to their individual needs. Qualified case managers employed by certified providers perform case management services.

This chapter sets out child eligibility, covered child welfare targeted case management services, provider certification standards and requirements, case manager qualifications, and children’s rights.

441—186.1(249A) Definitions.

“Child” means a person under 18 years of age.

“Child welfare services” means public social services provided under Title IV–B of the Social Security Act (42 U.S.C. Sections 620 – 629e), as defined in 42 CFR 1357.10, as amended to May 31, 2001.

“Child welfare targeted case management services” means activities designed to plan, coordinate, link, monitor, and evaluate access to necessary medical, educational and other services, including child welfare services, for an eligible individual child. Child welfare targeted case management services do not include direct services. The services are directed toward ensuring the safety, health, well–being, and permanency of the eligible individual child.

“Department” means the department of human services.

“Division” means the division of adult, children and family services of the department.

441—186.2(249A) Eligibility. A child shall be eligible for child welfare targeted case management if the child is:

1. Medicaid–eligible or if the child has another payment source;

2. Under 18 years of age; and

3. Receiving or is in need of child welfare services.

441—186.3(249A) Services.

186.3(1) Covered services. Covered child welfare targeted case management services shall include all of the following:

a. Assessing the child’s need for case management services.

b. Developing, completing, and regularly reviewing a written individual service plan with the assistance of and input from the child and parents or legal guardians, and other relevant persons.

c. Communicating with the child and parents or legal guardian, and other relevant persons identified as necessary to the development or implementation of the goals of the individual service plan for the child.

d. Coordinating referrals for service with appropriate service providers.

e. Coordinating and monitoring service delivery to ensure quality and effectiveness of services.

f. Monitoring and evaluating services on a regular basis to ensure appropriateness and continued need.

g. Completing and maintaining necessary documentation to support and verify the provision of child welfare targeted case management services.

186.3(2) Service contacts. Providers of child welfare targeted case management services shall document all contacts between the case manager and the child, child’s parents, primary caregiver, legal representative, or other relevant persons identified as necessary for the safety, health, well–being, and permanency of the child. At a minimum, these contacts shall include:

a. Face–to–face contact with the child once every three months; and

b. Contact with the child, parent or legal guardian, or another person, as necessary to develop or monitor the child’s service plan in any month in which there is no face–to–face contact with the child.

441—186.4(249A) Provider certification. Certification is the process by which the department shall ensure that providers meet the requirements for provision of child welfare targeted case management services. Each provider of child welfare targeted case management services shall meet the following criteria for certification:

186.4(1) Legal authority. The provider shall have legal authority to provide child welfare services under Title IV–B of the Social Security Act (42 U.S.C. Sections 620 – 629e), as defined in 42 CFR 1357.10, as amended to May 31, 2001, directed to any of the following:

a. Protecting or promoting the welfare and safety of children.

b. Preventing or remedying or coordinating the development of solutions to problems which may result in the neglect, abuse, or exploitation of children.

c. Preventing the unnecessary separation of children from their families.

d. Restoring IV–E–eligible or non–IV–E–eligible children who have been removed to their families.

e. Ensuring adequate care of IV–E–eligible or non–IV–E–eligible children in out–of–home placements other than those for delinquents, Medicaid–funded facilities, or those receiving Medicaid–funded targeted case management for persons with mental retardation, developmental disabilities or chronic mental illness.

186.4(2) Staff qualifications. The provider shall document the education and experience of the case managers employed to provide case management services under this chapter. A case manager shall have:

a. A degree from an accredited four–year college or university; and

b. The equivalent of four years of full–time work experience involving direct contact with people who are overcoming social, economic, psychological, or health problems; or

c. An equivalent combination of education and experience substituting the equivalent of one year of full–time qualifying work experience for one year (30 semester hours or equivalent hours) of the required education.

186.4(3) Capacity and experience. The provider shall demonstrate the capacity and experience to provide child welfare targeted case management services. The provider shall have:

a. The administrative capacity and experience to serve the target population and to ensure the quality of services delivered under state and federal requirements.

b. The capacity to provide accurate documentation of services and costs and to document and maintain children’s records under state and federal requirements.

c. Policies and procedures in place to ensure that:

(1) Eligible children and parents or legal guardians are permitted to choose any certified provider of child welfare targeted case management services and are permitted to choose not to receive child welfare targeted case management services.

(2) Each child receiving services under this chapter shall be treated with respect. Each contact and activity by the provider shall support the child’s abilities and dignity, and shall enhance the child’s safety, health, well–being, and permanency to the extent possible. Case managers shall monitor provision of services by others pursuant to the child’s service plan to ensure similarly respectful delivery of services.

(3) Criteria for accessing child welfare targeted case management services and criteria for determining need for child welfare targeted case management services are established.

(4) Adverse actions are handled pursuant to rule 441— 130.5(234) or pursuant to policies and procedures of the same scope.

d. A process for addressing the concerns or complaints of a child, parent or legal guardian, or other persons aggrieved by the actions of a case manager or provider pursuant to this chapter.

441—186.5(249A) Certification. The division shall certify providers as child welfare targeted case management service providers pursuant to this chapter after receiving approval for federal funding of child welfare targeted case management services under the Medicaid program from the federal Health Care Financing Administration. Providers shall initiate the certification process by submitting an application for certification to the division. The division shall certify each provider that meets standards. The certification process shall examine the provider’s ability to meet certification standards as set forth in this chapter and other federal and state requirements for this service.

186.5(1) Period of certification. Providers that meet these standards shall be fully certified for a period of three years.

186.5(2) Provisional certification. Providers that fail to meet one or more of these standards shall be provisionally certified if the failure does not cause serious risk of harm to a child or compromise the fiscal integrity of the service. To gain full certification, a provisionally certified provider must submit a corrective action plan for approval by the division and satisfy all requirements of an approved corrective action plan, all within six months of the issuance of provisional certification. Failure to present and satisfy an approved corrective plan within six months of provisional certification shall result in withdrawal of provisional certification.

186.5(3) Denial of certification. Certification shall be denied to any provider whose services under this chapter are of such quality that children are put at serious risk of harm.

186.5(4) Nonassignability of certification. Certification is not transferable or assignable to another provider.

186.5(5) Appeal procedure. A provider aggrieved by a certification decision may file a complaint with the division within 30 days of receipt of the notice of decision. Providers not satisfied with the decision of the division may file an appeal pursuant to 441—Chapter 7. Complaints not resolved with the division within 45 days of submittal of the complaint may proceed to administrative appeal pursuant to 441—Chapter 7.

These rules are intended to implement Iowa Code section 249A.4 and 2001 Iowa Acts, House File 732, section 28, subsection 4.

[Filed Emergency 6/13/01, effective 7/1/01]

[Published 7/11/01]

EDITOR’S NOTE: For replacement pages for IAC, see IAC Supplement 7/11/01.

ARC 0779B

HUMAN SERVICES DEPARTMENT[441]

Adopted and Filed Emergency After Notice

Pursuant to the authority of Iowa Code section 249A.4, the Department of Human Services hereby amends Chapter 77, “Conditions of Participation for Providers of Medical and Remedial Care,” Chapter 78, “Amount, Duration and Scope of Medical and Remedial Services,” Chapter 79, “Other Policies Relating to Providers of Medical and Remedial Care,” and Chapter 83, “Medicaid Waiver Services,” appearing in the Iowa Administrative Code.

The Council on Human Services adopted these amendments June 13, 2001. Notice of Intended Action regarding these amendments was published in the Iowa Administrative Bulletin on April 18, 2001, as ARC 0616B.

These amendments add a new service, residential–based supported community living, to the Home– and Community–Based Services Mental Retardation (HCBS MR) waiver. These amendments specify who may provide the services, certification procedures, services to be provided and service requirements, and eligibility criteria for the services.

This service was developed to provide placement outside the home for children with mental retardation or related conditions in a residential setting. Initially, only children under the age of 18 who are currently in Rehabilitative Treatment and Supportive Services group home placements will be eligible for the service. The Department’s intent is to expand this service to other children in the future as funding becomes available.

The Department will contract only with public or private agencies to provide this service. Providers must be licensed as group living foster care facilities under 441—Chapter 114 or as residential facilities for mentally retarded children under 441—Chapter 116 or meet other specified conditions.

Living units are limited to four beds unless the Division of Medical Services gives approval for living units of up to eight beds. The Division of Medical Services shall approve five– to eight–bed living units only if all of the following conditions are met:

• The living unit is an existing residential facility structure owned or operated by the service provider as of July 1, 1998.

• There is a need for the service to be provided in a five– to eight–person living unit instead of a smaller living unit, considering the location of the programs in an area.

• The provider supplies the Division of Medical Services with a written plan acceptable to the Department that addresses how the provider will reduce its living units to four–bed units within a two–year period of time.

Allowable service components are the following:

• Daily living skills development. These are services to develop the child’s ability to function independently in the community on a daily basis, including training in food preparation, maintenance of living environment, time and money management, personal hygiene, and self–care.

• Social skills development. These are services to develop a child’s communication and socialization skills, including interventions to develop a child’s ability to solve problems, resolve conflicts, develop appropriate relationships with others, and develop techniques for controlling behavior.

• Family support development. These are services necessary to allow a child to return to the child’s family or another less restrictive service environment. These services must include counseling and therapy sessions that involve both the child and the child’s family at least 50 percent of the time and that focus on techniques for dealing with the special care needs of the child and interventions needed to alleviate behaviors that are disruptive to the family or other group living unit.

• Counseling and behavior intervention services. These are services to halt, control, or reverse stress and social, emotional, or behavioral problems that threaten or have negatively affected the child’s stability. Activities under these services include counseling and behavior intervention with the child, including interventions to ameliorate problem behaviors.

To be eligible for the residential–based community supported living service, a child must have a diagnosis of mental retardation or have a related condition as defined in the rules, be under the age of 18, have been placed on June 30, 2001, in a group care program that the Department contracted withto provide rehabilitative treatment and supportive services for children with mental retardation or a related con–dition and that is licensed under 441—Chapter 116, and reside in a residential–based living environment furnished by a residential–based supported community living provider.

The Seventy–seventh General Assembly in 1997 Iowa Acts, chapter 208, section 33, directed the Department to convene a work group to make recommendations for a combined funding pool (Mental Retardation—Most Appropriate Groupcare Initiative for Children or MR–MAGIC) for children with mental retardation. Based on the results from this work group, the Seventy–eighth General Assembly in 2000 Iowa Acts, chapter 1228, section 8, subsection 9, directed the Department to pursue federal approval of a medical assistance home– and community–based services waiver to allow children with mental retardation who would otherwise require ICF/MR care to be served in out–of–home settings of up to eight beds which meet the standards established by the Department.

Rather than seek approval of an additional waiver, the Department is seeking approval of an additional service to the HCBS MR waiver. This service is seen as an efficient use of funds and will allow flexibility in funding. This service will allow federal participation to be claimed for services that are currently either being paid with 100 percent state dollars or that are subject to dispute with the Health Care Financing Administration under the Rehabilitative Treatment and Supportive Services program.

This service could reduce the need for ICF/MR placement of children and reduce the cost of serving these children. Children in placement could be closer to home. The Department will grandfather the existing group foster care beds and will require the provider to transition down to four beds over the next two years.

These amendments also remove the requirement for the county to maintain continuity of services for an ill and handicapped waiver consumer on the MR waiver when the consumer turns 18. The county has responsibility for services, but does not necessarily have to provide those services through the MR waiver.

These amendments do not provide for waivers in specified situations because this service is a benefit and an alternative to institutional care.

Eight public hearings were held around the state. Two persons attended and one person submitted written comments. The following revision was made to the Notice of Intended Action in response to the public comments:

Subrule 77.37(23), paragraph “b,” subparagraph (3), numbered paragraph “2,” introductory paragraph, was revised to reflect that the agency’s standards for the rights and dignity of children shall be age appropriate. The introductory paragraph of numbered paragraph “2” now reads as follows:

“2. The agency must have standards for the rights and dignity of children that are age appropriate. These standards shall include the following:”.

The Department finds that these amendments confer a benefit on persons needing residential care by providing an alternative to institutional care and giving these persons additional choices in living arrangements. These amendments also provide a cost saving to the state. Therefore, these amendments are filed pursuant to Iowa Code section 17A.5(2)“b”(2).

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

These amendments became effective July 1, 2001.

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 amendments [77.37, 78.41(10), 79.1, 83.60, 83.61(1), 83.62(3), 83.70(3)] is being omitted. With the exception of the change noted above, these amendments are identical to those published under Notice as ARC 0616B, IAB 4/18/01.

[Filed Emergency After Notice 6/13/01, effective 7/1/01]
[Published 7/11/01]

[For replacement pages for IAC, see IAC Supplement 7/11/01.]

ARC 0780B

HUMAN SERVICES DEPARTMENT[441]

Adopted and Filed Emergency

Pursuant to the authority of Iowa Code section 249A.4 and 2001 Iowa Acts, House File 740, section 4, subsection 6, the Department of Human Services hereby amends Chapter 78, “Amount, Duration and Scope of Medical and Remedial Services,” Chapter 79, “Other Policies Relating to Providers of Medical and Remedial Care,” Chapter 80, “Procedure and Method of Payment,” and Chapter 81, “Nursing Facilities,” appearing in the Iowa Administrative Code.

These amendments adopt a modified price–based case–mix system for reimbursing non–state–owned nursing facilities for Medicaid recipients based on a recognition of the provider’s allowable costs for two components, a direct care and non–direct care component, plus a potential excess payment allowance. The case–mix system reflects the relative acuity or need for care of the Medicaid recipients in the nursing facility. Nursing facilities will submit cost reports to the Department on an annual, rather than semiannual, basis. The Department will make case–mix adjustments to the nursing facilities’ rates on a quarterly basis.

As mandated by the General Assembly, the Department began to phase in a case–mix system of reimbursement to nursing facilities on July 1, 2000. The purpose of the phase–in was to reduce the impact that a facility may experience from changing from the former system of reimbursement to the new system. During this first year, providers continuedto receive, without reduction, 100 percent of their former system rate. Additionally, if a nursing facility had above–average case mix, an additional payment was provided.

Over the next two years the modified price–based case–mix reimbursement system will continue to be gradually phased in, allowing nursing facilities additional time to adapt to the new reimbursement system. Facilities will be held harmless through June 30, 2003, from any reduction of their June 30, 2001, Medicaid rate excluding the case–mix transition add–on payment.

Beginning July 1, 2001, a portion of each facility’s total Medicaid rate will be based on a percent of the current system rate plus a percent of the modified price–based case–mix rate. The following table illustrates how the phase–in rates are calculated:

Phase–In Period	Current System Rate	Modified Price–Based Case–Mix Rate
July 1, 2000 – June 30, 2001	100 percent	0 percent
July 1, 2001 – June 30, 2002	66.67 percent	33.33 percent
July 1, 2002 – June 30, 2003	33.33 percent	66.67 percent
July 1, 2003, and thereafter	0 percent	100 percent

The current system rate to be used effective July 1, 2001, will be the nursing facility’s Medicaid rate effective on June 30, 2001, excluding the case–mix transition add–on amount, plus a 6.21 percent inflation factor, not to exceed $94. The current system rate to be used effective July 1, 2002, will be the nursing facility’s Medicaid rate effective on June 30, 2001, excluding the case–mix transition add–on amount, plus an inflation allowance of 6.21 percent, and an additional inflation factor based on the HCFA/SNF Total Market Basket Index. However, the current system rate to be used effective July 1, 2002, shall not exceed $94 times an inflation factor pursuant to subrule 81.6(18).

In no case shall the total Medicaid rate for July 1, 2001, through June 30, 2002, be less than the current system rate effective on June 30, 2001, excluding the case–mix transition add–on payment, and increased by a 6.21 percent inflation allowance. In no case shall the total Medicaid rate for July 1, 2002, through June 30, 2003, be less than the reimbursement rate effective on June 30, 2002, plus an inflation factor pursuant to subrule 81.6(18) projected for the following 12 months.

Direct care and non–direct care rate components. Medicaid payment for services provided to eligible nursing facility recipients under the modified price–based case–mix system will be based on a provider’s allowable costs plus a potential excess payment allowance, not to exceed the rate component limits. The direct care and non–direct care component rates will be determined using actual allowable costs taken from the cost reports submitted by the nursing facilities. These costs will be subject to several expense exclusions and limitations that exist within current policy (e.g., exclusion of advertising expenses and limits on owners and management compensation) as well as adjustments for inflation, utilization incentive, and cost normalization, as discussed below.

Average per diem allowable costs for each cost component will be calculated for each nursing facility, arrayed from lowest to highest and weighted based on each facility’s total patient days. The per diem cost of the nursing facility that falls at the median of all patient days, multiplied by a percentage, becomes the basis for the potential excess payment allowance and the rate component limits.

For purposes of determining the direct care and non–direct care component rates applicable to Medicare–certified hospital–based facilities, a separate peer group of Medicare–certified hospital–based facilities will be used to calculate the patient–day–weighted medians.

A wage adjustment for nursing facilities located in Metropolitan Statistical Areas will also be applied to nursing salaries and benefits to account for wage differentials.

Medicaid rates will be updated July 1, 2001, and every second year thereafter with new cost report data, and quarterly for changes in the case mix of the Medicaid residents in each facility.

Based on legislation passed by the Seventy–ninth General Assembly, the direct care component is set at 120 percent of the median of direct care costs and the non–direct care component is set at 110 percent of the median of non–direct care costs, as in 441—subrule 79.1(2). At these percentages of the medians proposed, this reimbursement methodology provides aggregate cost coverage for nursing facilities of 100 percent of Medicaid costs, in comparison to the reimbursement system prior to case mix, in which 92 percent of Medicaid costs were covered. These rates will be adequate to allow for quality care and enlist sufficient providers to meet the need for nursing care of Iowa Medicaid residents.

Case mix. Case mix measures the relative resources required to care for a given population of nursing facility residents. Within and between nursing facilities, resident needs may vary widely, from residents requiring near full–time skilled nursing assistance to residents requiring only minimal assistance.

The Resource Utilization Groups, Version III (RUG–III) classification system will be used to classify residents and objectively determine a facility’s case mix. RUG–III was developed by the Health Care Financing Administration (HCFA) and is the basis for resident classification for the Medicare prospective payment system and numerous other states’ Medicaid systems. There are two basic RUG–III options for classification. Iowa will use the 34–group version that collapses the special rehabilitation category into four groups. HCFA recommends this version for use with Medicaid nursing facility resident populations when, as with the Iowa system, only nursing salaries are case–mix adjusted.

HCFA has also developed standard case–mix indices based on time studies performed during the middle to late 1990s, and these indices will be the basis for calculating the average case–mix index, or score, for each nursing facility under Iowa’s new case–mix system. The Department will calculate a facility’s average case–mix index four times per year for residents in the facility on the last day of each calendar quarter. A separate calculation will be made to determine the average case–mix index for all residents and Medicaid residents only. The case–mix index for Medicaid residents will be used to adjust Medicaid rates beginning with the second calendar quarter following the quarter of assessment.

Inflation factor. The new payment system will use historical costs as a basis for reimbursement. Historical costs will be increased to recognize an estimate of future cost inflation to develop a prospective rate for each nursing facility. Historical costs will be adjusted for inflation using the HCFA/SNF index published by Data Resources Incorporated. The HCFA/SNF index measures and predicts price level changes occurring in Medicare skilled nursing facilities and is the best available predictor of nursing facility cost inflation.

Utilization incentive. As an ongoing incentive to encourage providers to use resources prudently, a utilization standard (or occupancy factor) of 80 percent of licensed bed capacity has been applied to nursing facility costs. In applying a utilization standard, per patient day cost is calculated using the greater of actual patient days or a percentage of licensed bed capacity. On July 1, 2000, this 80 percent factor was modified to apply only to non–direct administrative, environmental and property costs. A utilization standard of 85 percent of licensed bed capacity will be phased in over the first three years of the new reimbursement system. As in 441— subparagraph 81.6(16)“a”(1), the standard for determining the Medicaid rate is 80 percent beginning July 1, 2001. Beginning July 1, 2003, and thereafter, the standard is 85 percent of licensed bed capacity. These utilization incentive percentages are based on legislation passed by theSeventy–ninth General Assembly. The utilization standard does not apply to hospital–based nursing facilities because Medicaid utilization is nominal.

Cost normalization. Cost normalization refers to the process of removing cost variations associated with different levels of resident case mix. Each provider’s average direct nursing care costs will be recalculated so that, to the extent possible, cost variations that are caused by different levels of case mix are removed. Cost normalization is accomplished simply by dividing a facility’s average allowable direct nursing care costs by the facility’s average case–mix index.

Accountability measures. Effective July 1, 2002, a portion of the Medicaid rates under the new case–mix system will be based on each facility’s achieving certain accountability measures that will link payment to quality of care. Rules governing the framework for these measures as well as the specific criteria that will be applied have yet to be finalized. A subgroup of the task force that developed these amendments has been convened to develop the measures. The Department envisions that these measures will include standard surveys and complaint investigations from the Department of Inspections and Appeals, customer satisfaction, employee retention rates, provision of cognitive loss and dementia care, and other objective measures of quality and accountability. Payments for achieving these measures will be made following the performance of the accountability measures by the nursing facility during each prior year. The measures developed will be evaluated for effectiveness.

The following is a hypothetical example of the steps used to calculate a facility’s Medicaid payment rate:

Step 1. Determination of Cost Components

Direct Care Costs
Direct Care Costs (inflation adjusted)	$440,000
Actual Patient Days	÷10,000
Average Direct Care Costs	$ 44.00
Facility Average Case–Mix Index (CMI)	÷ 0.9800
A. Normalized Direct Care Costs	$ 44.90
Non–Direct Care Costs
Administrative, Environmental and Property Costs	$245,000
Greater of Actual Patient Days or Patient Days at 80 Percent Occupancy	÷ 10,500
B. Average Administrative, Environmental and Property Costs	$ 23.33
Support Care Costs	$140,000
Actual Patient Days	÷ 10,000
C. Average Support Care Costs	$ 14.00
D. Average Non–Direct Care Costs (B + C)	$ 37.33
Cost Components
Direct Care Cost Component = A	$ 44.90
Non–Direct Care Cost Component = D	$ 37.33

This step is performed for each Medicaid–certified nursing facility. The direct care cost component and non–direct care cost component per patient day costs for each facility from Step 1 are separately arrayed from low to high to determine the patient–day–weighted median for each cost component, based on the number of patient days provided by facilities. The direct care and non–direct care patient–day–weighted medians are adjusted by the percentages specified in 441— subrule 79.1(2) in determining the rate component limits and the potential excess payment allowance.

The modified price–based case–mix rate is then based on the provider’s cost components, plus any allowed excess payment allowance, subject to the rate component limits. The following steps illustrate how the facility–specific modified price–based case–mix rates are calculated.

Step 2. Calculate Facility–Specific Medicaid Costs

Direct Care Component
A. Normalized Direct Care Costs	$ 44.90
B. Average Case–Mix Index for Medicaid Residents	× 1.0100
C. Case–Mix Adjusted Direct Care Costs (A × B)	$ 45.35
Non–Direct Care Component
D. Average Non–Direct Care Costs	$ 37.33

Step 3. Determine Allowed Excess Payment Allowance

Direct Care Component
A. Direct Care Patient–Day–Weighted Median	$ 50.00
B. Percentage of the Median to Apply	× 95%
C. (A x B)	$ 47.50
D. Average Case–Mix Index for Medicaid Residents	× 1.0100
E. (C × D)	$ 47.98
F. Case–Mix Adjusted Direct Care Costs	– 45.35
G. Difference if greater than zero (E – F)	$ 2.63
H. Profit Share	× 100%
I. Potential Excess Payment Allowance* (G × H)	$ 2.63
*Cannot be greater than 10 percent of the patient–day–weighted median ($5.00)
Non–Direct Care Component
J. Non–Direct Care Patient–Day– Weighted Median	$ 36.00
K. Percentage of the Median to Apply	× 96%
L. (J × K)	$ 34.56
M. Average Non–Direct Care Costs	- 37.33
N. Difference if greater than zero (L – M)	$ 0.00
O. Profit Share	× 65%
P. Potential Excess Payment Allowance* (N x O)	$ 0.00
*Cannot be greater than 8 percent of patient–day–weighted median ($2.88)

Step 4. Calculate Modified Price–Based Case–Mix Rate

Direct Care Component
A. Case–Mix Adjusted Direct Care Costs	$45.35
B. Allowed Excess Payment Allowance	+ 2.63
C. (A + B)	$ 47.98
D. Direct Care Limit (120 percent of patient–day–weighted median times the Medicaid case–mix index)	$ 60.60
E. Lesser of C or D	$ 47.98
Non–Direct Care Component
F. Average Non–Direct Care Costs	$ 37.33
G. Allowed Excess Payment Allowance	+ 0.00
H. (F + G)	$ 37.33
I. Non–Direct Care Limit (110 percent of patient–day–weighted median)	$ 39.60
J. Lesser of H or I	$ 37.33
K. Total Medicaid Rate (E + J)	$ 85.31

In developing this proposal, the current nursing facility reimbursement system was thoroughly reviewed and evaluated. This included a review of Iowa administrative rules, State Medicaid Plan documents, cost reports and instructions, and rate–setting compilations and worksheets. In addition, several meetings were conducted with the Case–Mix Reimbursement Task Force in order to obtain input from the nursing facility industry, consumer advocates and others about the current reimbursement system. Written comments were received from some of the Task Force representatives, which included useful perspectives on the strengths and weaknesses of the current system for consideration by the Department.

Members of the Task Force included representatives from the Department of Human Services, the Medicaid case–mix consultant (Myers and Stauffer LC), the Iowa Hospital Association, the Advocacy Network for Aging Iowans, the Long–Term Care Ombudsman of the Department of Elder Affairs, the Legislative Fiscal Bureau, partisan and nonpartisan legislative staff, the American Association of Retired Persons, the Iowa Council of Health Care Centers, the Iowa Health Care Association, the Iowa Association of Homes and Services for the Aging, Iowans for Nursing Home Reform, the Department of Inspections and Appeals, the Medicaid fiscal consultant (Ryun, Givens, Wenthe & Co.), the Medicaid fiscal agent (Consultec, Inc.), the Iowa Foundation for Medical Care, and the Department of Public Health.

The following summarizes the major findings from review of the current Medicaid payment system:

• System incentives. A review of the current system shows a clear bias toward institutional settings for long–term care services, which is not congruent with the objectives of Iowa’s Senior Living Program which was mandated by the General Assembly in 2000 Iowa Acts, chapter 1004, and seeks to improve access to care, increase consumer choice, contain costs, balance institutional and noninstitutional alternatives for long–term care, and improve the quality of lives of Iowans.

• No recognition of case–mix differences. Facility direct care resource needs are influenced heavily by the level of resident acuity and dependence. The current reimbursement system does not explicitly recognize variations in the level of acuity of nursing facility residents.

• Limited linkage to quality of care. The current system has no direct linkage between the quality of care delivered by the nursing facility and the level of Medicaid funding.

• Cost containment incentives. In order to achieve the objectives and goals of the Senior Living Program, cost containment for all health care services is essential. Inefficient use of taxpayer resources in any program will result in fewer dollars available to expand noninstitutional long–term care alternatives. State expenditures for nursing facility services have increased more than 37 percent since 1996, which far exceeds the 10 percent increases experienced by other health care providers (i.e., hospitals, skilled nursing facilities and home health agencies) for the same period. This rate of growth in Medicaid expenditures comes at a time when occupancy in nursing facilities for the same period declined by over 6 percent. These patterns strongly suggest that cost containment for the Medicaid nursing facility reimbursement system must be addressed.

• Inflation. The current system contains an overall reimbursement limitation established at the 70th percentile of rates. This feature is a relatively weak cost containment incentive for providers, since every provider with costs below the 70th percentile limit is reimbursed by Medicaid for the costs incurred, plus an adjustment for inflation. Providers that exceed the 70th percentile limit are capped at that level and do not receive an inflation adjustment. This methodology is inherently inflationary since the majority of providers have little incentive to contain their costs.

• Low occupancy. Occupancy levels in Iowa nursing facilities have declined significantly over the last several years and currently average approximately 85 percent. This level indicates that Iowa nursing facilities have approximately 5,000 empty beds. When a facility’s occupancy declines, Medicaid reimbursement tends to increase to cover the fixed costs of empty beds. Historically, the Iowa nursing facility reimbursement system has applied a cost factor when defining allowable costs that Medicaid would reimburse. Under this methodology, facilities with actual occupancy less than 80 percent would have their Medicaid rate established using a minimum of 80 percent occupancy and thereby reduce the cost to the state of less efficient nursing facilities. This provision encourages providers to maintain their occupancy level at 80 percent but no higher.

Based on the review of the current nursing facility reimbursement system, it is clear that there are inherent problems, discussed above, that need to be addressed by developing a new system in order for Iowa to move toward achieving the policy goals that have been enumerated by the General Assembly. In order to function in harmony with the Senior Living Program, the new nursing facility reimbursement system should reduce financial incentives for facilities to care for low–need, independent residents and increase the financial incentives to care for high–need, dependent residents. The new system should link payment to quality of care and be cost–effective. Without these changes, it will be difficult, if not impossible, for the state to achieve the goals of the Senior Living Program.

The Department and the Case–Mix Reimbursement Task Force evaluated several different case–mix reimbursement system options, including cost–based, price–based and modified price–based systems. Based on extensive evaluation of all options, the Department has determined that a modified price–based system will introduce new and desirable incentives into Iowa’s long–term care marketplace. These incentives are necessary to recognize the changes in the long–term care marketplace, including the significant decline in demand for nursing facility services by Iowans. In order to achieve the goals of the Senior Living Program over a reasonable period of time, the Department is proposing a modified price–based case–mix system.

The following summarizes the characteristics of a modified price–based system and presents a rationale for its adoption by the Department:

• Cost containment incentives and less inflationary system. Under a modified price–based system, the incentive for cost containment is greater than under a cost–based system. That is, facilities are encouraged to control costs to a greater extent since any costs incurred above the rate ceiling will not result in higher Medicaid reimbursement. In order to remain viable under a modified price–based system, nursing facilities must minimize their nursing costs in relation to their resident case mix, and they must also control their nonnursing costs in relation to the statewide median costs. Profits are made by facilities with costs below the established profit ceiling, while losses are experienced by facilities whose costs are greater than the established rate ceiling.

The Medicaid rate and weighted medians for direct and non–direct care costs will be rebased, or updated using more current costs, beginning with implementation on July 1, 2001, and every second year thereafter. This rebasing schedule strikes a reasonable balance between recognizing current costs and creating a structure that should achieve the nursing facility cost containment objectives which are a necessary component of success for the Senior Living Program.

• Long–term care market–driven changes and other funding options. The Department has observed that some nursing facilities incur costs that are out of line with the acuity level of residents they serve. These facilities have high nursing costs coupled with low resident acuity. Under the modified price–based system, these facilities will be encouraged to modify their cost structures or resident mix duringthe final two–year phase–in period and make efficiency–motivated operational changes that will lead to lower costs and higher case–mix and payment levels. Facilities will likely need to adapt their service mix to the changing marketplace.

The Department recognizes that some facilities will be better prepared than others to make these market–driven changes. Facilities that are not able to effectively adapt to these marketplace changes will be able to take advantage of other funding options such as the nursing facility conversion program. This program may include up to $80 million in state funding and represents the state’s commitment to facilitate, in the least disruptive manner possible, changes in long–term care delivery that are considered beneficial to Iowa’s elderly population.

The modified price–based system is expected to move the state toward achieving the objectives outlined by the General Assembly regarding a greater emphasis to be placed on alternatives to institutional long–term care services, cost containment, and access to appropriate consumer–driven long–term care services. It might not be possible to achieve these objectives using a cost–based reimbursement system, since there would be little incentive for facilities to adapt to marketplace changes if the Department continued with a system that ensures most facilities reimbursement at their full costs.

• The modified price–based system and quality of care. As the Department moves forward with changing the Medicaid nursing facility reimbursement system to better reflect the marketplace, it is very important for the state to monitor and evaluate the quality of care that is delivered in Iowa facilities. The Department fully appreciates the important role that the reimbursement system plays in ensuring high quality of care. It is important to note that a significant reimbursement feature of the new system provides for additional payments to facilities that achieve the quality–based accountability measures. Unlike a cost–based system that merely reimburses for costs incurred and offers little assurance of quality, the new modified price–based reimbursement system will reward facilities for actually delivering quality care.

However, despite having improved incentives to ensure high quality services, as stated previously, the Department recognizes that some facilities may not be able to achieve the necessary operational objectives that the modified price–based reimbursement system requires. The Department will, therefore, work closely with the Department of Inspections and Appeals (DIA) to monitor quality of care issues that are identified through the survey process. In the event undesirable quality of care trends are detected, the Department intends to work with DIA and other state agencies and contractors to assess the underlying cause. This will involve new processes of resident, financial, survey, and consumer data analysis and coordination. The Department also intends to work toward improving systems to locate alternative placements (e.g., home– and community–based services, assisted living, and other nursing facilities).

The development and design of the case–mix system of reimbursement has been carried out openly and with input from industry association representatives, consumer advocates, legislative representatives and numerous other interested parties. Information representing all aspects of theprocess has also been freely available to all parties, including cost and financial information, case–mix data, and budget appropriation statistics. An interactive computer model was developed that allowed users to readily perform numerous “what if” scenarios and evaluate the financial impact. This model was also shared with all interested Task Force participants. The wealth of available information to all parties was helpful in keeping the focus of the Task Force on the key elements of the design of the case–mix system. It was also essential for the purpose of educating the Task Force on many complex reimbursement concepts and methods.

The Department must seek a reasonable balance among the sometimes competing goals of providing adequate resources to Iowa nursing facilities to enable them to meet the needs of elderly Iowans entrusted to their care, prudently managing the state’s limited Medicaid budget resources, and ensuring that the intent of the General Assembly is accomplished through the development of sound public policies and programs. The Department believes that the modified price–based case–mix system reimbursement provides this balance.

As with any new reimbursement system, it will be critical to success to closely monitor trends and other aspects, and it is likely that refinements will be necessary in the future.

Through the 2001 General Assembly session, rate–setting parameters were debated among the Department, provider groups, and legislators. These debates resulted in increases to the rate ceiling and excess payment allowance that the Department had proposed as sufficient to adequately reimburse providers.

These amendments do not provide for waivers to the Medicaid nursing facility reimbursement system because all facilities should be subject to the same system.

In compliance with Iowa Code section 17A.4(2), the Department of Human Services finds that notice and public participation are unnecessary because these amendments implement 2001 Iowa Acts, House File 740, section 4, which authorizes the Department to adopt rules without notice and public participation.

These amendments were published under Notice of Intended Action in the May 16, 2001, Iowa Administrative Bulletin as ARC 0671B to allow for public comment.

The Council on Human Services adopted these amendments June 13, 2001.

These amendments are intended to implement Iowa Code sections 249A.2(6), 249A.3(2)“a,” 249A.4, and 249A.16 and 2001 Iowa Acts, House File 740, section 4.

These amendments became effective July 1, 2001.

The following amendments are adopted.

ITEM 1. Amend subrule 78.1(2), paragraph “b,” as follows:

b. Medical and sickroom supplies are payable when ordered by a legally qualified practitioner for a specific rather than incidental use. ~~No payment will be approved for medical and sickroom supplies for a recipient receiving care in a Medicare–certified skilled nursing facility.~~ When a recipient is receiving care in a nursing facility or residential care facility ~~which is not a Medicare–certified skilled nursing facility~~, payment will be approved only for the following supplies when prescribed by a legally qualified practitioner:

(1) to (7) No change.

ITEM 2. Amend subrules 78.3(13), 78.3(14), and 78.3(16) as follows:

78.3(13) Payment for patients in acute hospital bedswho are determined by IFMC to require the skilled nursing care level of care shall be made at ~~the average rate of all facilities participating in the skilled nursing program~~ an amount equal to the sum of the direct care rate component limitfor hospital–based Medicare–certified nursing facilitiespursuant to 441—subparagraph 81.6(16)“f”(3) plus the non–direct care rate component limit for hospital–based Medicare–certified nursing facilities pursuant to 441—subparagraph 81.6(16)“f”(3), with the rate component limits being ~~adjusted January 1 each year~~ revised July 1, 2001, and every second year thereafter. This rate is effective (a) as of the date of notice by IFMC that the lower level of care is required or (b) for the days IFMC determines in an outlier review that the lower level of care was required.

78.3(14) Payment for patients in acute hospital beds who are determined by IFMC to require nursing facility level of care shall be made at ~~the statewide average~~ an amount equal to the sum of the direct care rate component limit for Medicaid nursing facilities pursuant to 441—subparagraph 81.6(16)“f”(1) plus the non–direct care rate component limit for Medicaid nursing ~~facility rate~~ facilities pursuant to 441— subparagraph 81.6(16)“f”(1), with the rate component limits being ~~adjusted January 1 each year~~ revised July 1, 2001, and every second year thereafter. This rate is effective (a) as of the date of notice by IFMC that the lower level of care is required or (b) for the days IFMC determines in an outlier review that the lower level of care was required.

78.3(16) Payment will be made for medically necessary skilled nursing care when provided by a hospital participating in the swing–bed program certified by the department of inspections and appeals and approved by the U.S. Department of Health and Human Services. Payment shall be at ~~the~~ ~~the average rate per patient day paid during the previous calendar year for routine skilled nursing services furnishedby Iowa facilities participating in the Medicaid skilled payment program~~ an amount equal to the sum of the direct care rate component limit for hospital–based Medicare–certified nursing facilities pursuant to 441—subparagraph 81.6(16)“f”(3) and the non–direct care rate component limit for hospital–based Medicare–certified nursing facilities pursuant to 441—subparagraph 81.6(16)“f”(3), with the rate component limits being revised July 1, 2001, and every second year thereafter.

ITEM 3. Amend subrule 78.6(1), paragraphs “a” and “b,” as follows:

a. Eye examinations. The coverage of eye examinations depends on the purpose of the examination. Services are covered if the ~~exam~~ examination is the result of a complaint or symptom of an eye disease or injury. Routine eye examinations are covered once in a 12–month period. These services are rendered in the optometrist’s office or clinic, the home, a ~~skilled~~ nursing facility, ~~an intermediate care facility,~~ or other appropriate setting. Payment for mileage shall be subject to the same approval and payment criteria as those in effect for Medicare Part B. The following levels of service are recognized for optometric examinations:

(1) and (2) No change.

b. Medical services. Payment will be approved for medically necessary services and supplies within the scope of practice of the optometrist, including services rendered in the optometrist’s office or clinic, the home, a ~~skilled~~ nursing facility, ~~an intermediate care facility~~ or other appropriate setting. Payment for mileage shall be subject to the same approval and payment criteria as those in effect for Medicare Part B.

ITEM 4. Amend subrule 78.9(10), paragraph “a,” as follows:

Amend subparagraph (1), introductory paragraph, 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.

Amend subparagraph (2), introductory paragraph, as follows:

(2) Personal care services are those services provided by a home health aide or certified nurse’s aide and which are delegated and supervised by a registered 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. Payment for personal care services for persons aged 20 and under that exceed intermittent guidelines may be approved if determined to be medically necessary as defined in subrule 78.9(7). These services shall be in accordance with the recipient’s plan of care and authorized by a 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.

ITEM 5. Amend subrule 78.10(4), paragraph “b,” introductory paragraph, as follows:

b. ~~No payment will be made for sickroom supplies for a recipient receiving care in a skilled nursing facility.~~ Only the following types of sickroom supplies will be approved for payment for recipients receiving care in ~~an intermediate care~~ a nursing facility or an intermediate care facility for the mentally retarded when prescribed by the physician, physician assistant, or advanced registered nurse practitioner:

ITEM 6. Amend rule 441—78.11(249A), introductory paragraph, as follows:

441—78.11(249A) Ambulance service. Payment will be approved for ambulance service if it is required by the recipient’s condition and the recipient is transported to the nearest hospital with appropriate facilities or to one in the same locality, from one hospital to another, to the patient’s home or to a ~~skilled~~ nursing ~~home~~ facility. Payment for ambulance service to the nearest hospital for outpatient service will be approved only for emergency treatment. Ambulance service must be medically necessary and not merely for the convenience of the patient.

ITEM 7. Amend subrule 78.19(1), paragraph “a,” subparagraph (1), as follows:

(1) Services are provided in the recipient’s home or in a care facility (other than a hospital) by a speech therapist, physical therapist, or occupational therapist employed by or contracted by the agency. Services provided a recipient residing in a ~~skilled~~ nursing facility~~, intermediate care facility,~~ or residential care facility are payable when a statement is submitted signed by the facility that the facility does not have these services available. The statement need only be submitted at the start of care unless the situation changes. Payment will not be made to a rehabilitation agency for therapy provided to a recipient residing in an intermediate care facility for the mentally retarded since these facilities are responsible for providing or paying for services required by recipients.

ITEM 8. Amend rule 441—78.24(249A), introductory paragraph, as follows:

441—78.24(249A) Psychologists. Payment will be approved for services authorized by state law when they are provided by the psychologist in the psychologist’s office, a hospital, ~~or intermediate~~ nursing facility, or residential care facility.

ITEM 9. Amend subrule 78.28(9), paragraph “a,” as follows:

Amend subparagraph (1), introductory paragraph, as follows:

Amend subparagraph (2), introductory paragraph, as follows:

ITEM 10. Amend rule 441—79.1(249A) as follows:

Amend the introductory paragraph as follows:

441—79.1(249A) Principles governing reimbursement of providers of medical and health services. The basis of payment for services rendered by providers of services participating in the medical assistance program is either a system based on the provider’s allowable costs of operation or a fee schedule. Generally, institutional types of providers such as hospitals and ~~intermediate care~~ nursing facilities are reimbursed on a cost–related basis, and practitioners such as physicians, dentists, optometrists, and similar providers are reimbursed on the basis of a fee schedule. Providers of service must accept reimbursement based upon the department’s methodology without making any additional charge to the recipient.

Amend subrule 79.1(2), basis of reimbursement provider category of “nursing facilities,” as follows:

Provider category	Basis of reimbursement	Upper limit
Nursing facilities:
1. Nursing facility care	Prospective reimbursement. See 441—subrule 81.10(1) and 441—81.6(249A). The percentage of the median used to calculate the direct care excess payment allowance ceiling under 441— 81.6(16)“d”(1)“1”and (2)“1” is 95% of the patient–day–weighted median. The percentage of the difference used to calculate the direct care excess payment allowance is 100%. The percentage of the median used to calculate the direct care excess payment allowance limit is 10% of the patient–day– weighted median. The percentage of the median used to calculate the non–direct care excess payment allowance ceiling under 441—81.6(16)“d”(1)“2”and (2)“2” is 96% of the patient–day–weighted median. The percentage of the difference used to calculate the non–direct care excess payment allowance limit is 65%. The percentage of the median used to calculate the non–direct care excess payment allowance limit is 8%of the patient–day–weighted median.	~~Seventieth percentile of facility costs as calculated from all 6/30/00 cost reports~~ See 441—subrules 81.6(4) and 81.6(14) and paragraph 81.6(16)“f.” The direct care rate component limit under 441—81.6(16)“f”(1) and (2) is 120% of the patient–day–weighted median. The non–direct care rate component limit under 441— 81.6(16)“f”(1) and (2) is 110% of the patient–day–weighted median.
2. ~~Skilled nursing care provided in:~~ Hospital–based ~~facilities~~, Medicare–certified nursing care	Prospective reimbursement. See ~~79.1(9)~~ 441—subrule 81.10(1) and 441— 81.6(249A). The percentage of the median used to calculate the direct care excess payment allowance ceiling under 441— 81.6(16)“d”(3)“1” is 95% of the patient– day–weighted median. The percentage of the difference used to calculate the direct care excess payment allowance is 100%. The percentage of the median used to calculate the direct care excess payment allowance limit is 10% of the patient–day–weighted median. The percentage of the median used to calculate the non–direct care excess payment allowance ceiling under 441—81.6(16)“d”(3)“2” is 96% of the patient–day–weighted median. The percentage of the difference used to calculate the non–direct care excess payment allowance limit is 65%. The percentage of	~~Facility base rate per diems used on 6/30/99 inflated by 2% subject to a maximum allowable payment rate of $346.20 per day for hospital–based skilled facilities~~ See 441—subrules 81.6(4) and 81.6(14), and paragraph 81.6(16)“f.” The direct care rate component limit under 441— 81.6(16)“f”(3) is 120% of the patient–day–weighted median. The non–direct care rate component limit under 441—81.6(16)“f”(3) is 110% of the patient–day–weighted median.
	the median used to calculate the non–direct care excess payment allowance limit is 8% of the patient–day–weighted median.
~~Freestanding facilities~~	~~Prospective reimbursement. See 79.1(9)~~	~~Facility base rate per diems used on 6/30/99 inflated by 2% subject to a maximum allowable payment rate of $163.41 per day for freestanding skilled facilities~~

Rescind and reserve subrule 79.1(9).

ITEM 11. Amend subrule 80.2(2), paragraphs “u” and “am,” as follows:

u. Medicare–certified hospital–based nursing facilities ~~wishing to receive Medicaid skilled payment~~ shall submit claims on Form UB–82 92–HCFA–1450.

am. Nursing facilities ~~for persons with mental illness~~ shall submit claims on Form ~~UB–82–HCFA–1450~~ 470–0039.

ITEM 12. Amend rule 441—81.1(249A) as follows:

Amend the definitions of “department’s accounting firm,” “department’s fiscal agent,” “facility,” “facility–based,” “minimum data set,” and “non–facility–based,” as follows:

“Department’s accounting firm” means the firm on contract with the department to calculate nursing facility rates and provide other accounting services as requested. ~~The current accounting firm is Ryun, Givens, Wenthe & Company, 1601 48th Street, Suite 150, West Des Moines, Iowa 50266– 6756.~~

“Department’s fiscal agent” means the firm on contract with the department to enroll providers, process Medicaid claims, calculate skilled nursing facility rates, and perform other related functions. ~~The current fiscal agent is Consultec, 7755 Office Park Drive, West Des Moines, Iowa 50266.~~

“Facility” means a licensed nursing facility certified in accordance with the provisions of 42 CFR Part 483, as amended to September 23, 1992, to provide health services and includes ~~skilled~~ hospital–based nursing facilities that are Medicare–certified and provide only skilled level of care and swing–bed hospitals unless stated otherwise.

“Facility–based nurse aide training program” means a nurse aide training program ~~which~~ that is offered by a nursing facility and taught by facility employees or under the control of the licensee.

“Minimum data set” or “MDS” refers to a federally required resident assessment tool. Information from the MDS is used by the ~~federal Health Care Financing Administration~~ department to determine the facility’s case–mix index for purposes of ~~the case–mix add–on~~ normalizing per diem allowable direct care costs as provided by paragraph ~~81.6(16)“f.”~~ 81.6(16)“b,” for determining the Medicaid average case–mix index to adjust the direct care component pursuant to paragraphs 81.6(16)“c” and “e,” the excess payment allowance pursuant to paragraph 81.6(16)“d,” and the limits on reimbursement components pursuant to paragraph 81.6(16)“f.” MDS is described in subrule 81.13(9).

“Non–facility–based nurse aide training program” means a nurse aide training program ~~which~~ that is offered by an organization ~~which~~ that is not licensed to provide nursing facility services.

Rescind the definition of “case–mix add–on.”

Adopt the following new definitions in alphabetical order:

“Allowable costs” means the price a prudent, cost–conscious buyer would pay a willing seller for goods or services in an arm’s–length transaction, not to exceed the limitations set out in rules.

“Case mix” means a measure of the intensity of care and services used by similar residents in a facility.

“Case–mix index” means a numeric score within a specific range that identifies the relative resources used by similar residents and represents the average resource consumption across a population or sample.

“Cost normalization” refers to the process of removing cost variations associated with different levels of resident case mix. Normalized cost is determined by dividing a facility’s per diem direct care component costs by the facility cost report period case–mix index.

“Direct care component” means the portion of the Medicaid reimbursement rates that is attributable to the salaries and benefits of registered nurses, licensed practical nurses, certified nursing assistants, rehabilitation nurses, and contracted nursing services.

“Facility cost report period case–mix index” is the average of quarterly facilitywide average case–mix indices, carried to four decimal places. The quarters used in this average will be the quarters that most closely coincide with the financial and statistical reporting period. For example, a 01/01/2000 – 12/31/2000 financial and statistical reporting period would use the facilitywide average case–mix indices for quarters ending 03/31/00, 06/30/00, 09/30/00 and 12/31/00.

“Facilitywide average case–mix index” is the simple average, carried to four decimal places, of all resident case–mix indices based on the last day of each calendar quarter.

“Medicaid average case–mix index” is the simple average, carried to four decimal places, of all resident case–mix indices where Medicaid is known to be the per diem payor source on the last day of the calendar quarter.

“Non–direct care component” means the portion of Medicaid reimbursement rates attributable to administrative, environmental, property, and support care costs reported on the financial and statistical report.

“Patient–day–weighted median cost” means the per diem cost of the nursing facility that is at the median per diem cost of all nursing facilities based on patient days provided when per diem allowable costs are ranked from low to high. A separate patient–day–weighted median cost amount shall be determined for the direct care and non–direct care components.

“Special population nursing facility” refers to a nursing facility that serves the following populations:

1. One hundred percent of the residents served are aged 21 and under and require the skilled level of care.

2. Seventy percent of the residents served require the skilled level of care for neurological disorders.

ITEM 13. Rescind and reserve subrule 81.3(2).

ITEM 14. Amend rule 441—81.6(249A) as follows:

Amend the introductory paragraph as follows:

441—81.6(249A) Financial and statistical report anddetermination of payment rate. ~~All~~ With the exception of hospital–based nursing facilities that are Medicare–certified and provide only the skilled level of care, herein referred to as Medicare–certified hospital–based nursing facilities, all facilities in Iowa wishing to participate in the program shall submit a Financial and Statistical Report, Form 470–0030, to the department’s accounting firm. All Medicare–certified hospital–based nursing facilities shall submit a copy of their Medicare cost report to the department’s accounting firm. Costs for patient care services shall be reported, divided into the subcategories of “Direct Patient Care Costs” and “Support Care Costs.” Costs associated with food and dietary wages shall be included in the “Support Care Costs” subcategory. ~~An electronically submitted cost report shall be accepted if the format is approved by the accounting firm under contract with the department to audit nursing facility cost reports.~~ The financial and statistical report shall be submitted in an electronic format approved by the department. These reports shall be based on the following rules.

Amend subrule 81.6(3) as follows:

81.6(3) Submission of reports. The report shall be submitted to the department’s accounting firm no later than three months after the close of ~~each six months’ period of~~ the facility’s established fiscal year. Failure to submit a report that meets the requirements of this rule within this time shall reduce payment to 75 percent of the current rate. The reduced rate shall be paid for no longer than three months, after which time no further payments will be made.

A facility may change its fiscal year one time in any two–year period. If the facility changes its fiscal year, the facility shall notify the department’s accounting firm 60 days prior to the first date of the change.

Rescind subrule 81.6(4) and adopt the following new subrule in lieu thereof:

81.6(4) Payment at new rate.

a. Except for state–operated nursing facilities and special population nursing facilities, payment rates shall be updated July 1, 2001, and every second year thereafter with new cost report data, and adjusted quarterly to account for changes in the Medicaid average case–mix index. For nursing facilities receiving both an ICF and SNF Medicaid rate effective June 30, 2001, the June 30, 2001, Medicaid rate referenced in subparagraphs (1) and (2) below shall be the day–weighted average of the ICF and SNF Medicaid rates effective June 30, 2001, excluding the case–mix transition add–on amount.

(1) The Medicaid payment rates for services rendered from July 1, 2001, through June 30, 2002, shall be 66.67 percent of the facility’s Medicaid rate effective June 30, 2001, excluding the case–mix transition add–on amount, plus an inflation allowance of 6.21 percent, not to exceed $94, and 33.33 percent of the July 1, 2001, modified price–based rate pursuant to subrule 81.6(16). In no case shall the July 1, 2001, Medicaid rate be less than the Medicaid rate effective June 30, 2001, excluding the case–mix transition add–on amount, and increased by a 6.21 percent inflation allowance.

(2) Payment rates for services rendered from July 1, 2002, through June 30, 2003, shall be 33.33 percent of the facility’s Medicaid rate effective June 30, 2001, excluding the case–mix transition add–on amount, plus an inflation allowance of 6.21 percent, and an additional inflation factor based on the HCFA/SNF Total Market Basket Index. However, the current system rate to be used effective July 1, 2002, shall not exceed $94, times an inflation factor pursuant to subrule 81.6(18), and 66.67 percent of the July 1, 2002, modified price–based rate. In no case shall the July 1, 2002, Medicaid rate be less than the Medicaid rate effective June 30, 2002, plus an inflation factor pursuant to subrule 81.6(18) projected for the following 12 months.

(3) Payment rates for services rendered from July 1, 2003, and thereafter will be 100 percent of the modified price–based rate.

b. The Medicaid payment rate for special population nursing facilities shall be updated annually without a quarterly adjustment.

c. The Medicaid payment rate for state–operated nursing facilities shall be updated annually without a quarterly adjustment.

Amend subrule 81.6(5) as follows:

81.6(5) Accrual basis. Facilities not using the accrual basis of accounting shall adjust recorded amounts to the accrual basis. ~~Expenses which pertain to an entire year shall be included in each six–month report in equal amounts.~~ Records of cash receipts and disbursements shall be adjusted to reflect accruals of income and expense.

Amend subrule 81.6(9), paragraph “a,” as follows:

a. Census information shall be based on a ~~patient~~ patient’s status at midnight at the end of each day. ~~A patient whose status changes from one class to another shall be shown as discharged from the previous status and admitted to the new status on the same day.~~

Amend subrule 81.6(11), paragraph “h,” subparagraph (4), as follows:

(4) ~~The~~ Effective July 1, 2001, the base maximum allowed compensation for an administrator who is involved in ownership of the facility or who is an immediate relative of an owner of the facility is ~~$1,926~~ $3,296 per month plus ~~$20.53~~ $35.16 per month per licensed bed capacity for each bed over 60, not to exceed ~~$2,852~~ $4,884 per month. An administrator is considered to be involved in ownership of a facility when the administrator has ownership interest of 5 percent or more.

On ~~a semiannual~~ an annual basis, the maximum allowed compensation amounts for these administrators shall be increased or decreased by ~~the~~ an annual inflation factor ~~applied to facility rates~~ as ~~defined~~ specified by subrule ~~81.6(16)“a.”~~ 81.6(18).

Amend subrule 81.6(12), paragraph “e,” as follows:

e. A new owner or lessee wishing to claim a new rate of interest expense must submit documentation which verifies the amount of down payment made, the actual rate of interest, and the number of years required for repayment with the next ~~semiannual~~ annual cost report. In the absence of the necessary supportive documentation, interest and other property costs for all facilities ~~which~~ that have changed or will change ownership shall continue at the rate allowed the previous owner.

Rescind subrule 81.6(14) and adopt the following new subrule in lieu thereof:

81.6(14) Payment to new facility. The payment to a new facility shall be the sum of the patient–day–weighted median cost for the direct care and non–direct care components pursuant to paragraph 81.6(16)“c.” After the first full calendar quarter of operation, the patient–day–weighted median cost for the direct care component shall be adjusted by the facility’s average Medicaid case–mix index pursuant to subrule 81.6(19). A financial and statistical report shall be submitted from the beginning day of operation to the end of the fiscal year. Following the completion of the new facility’s first fiscal year, rates will be established in accordance with subrule 81.6(16). Subsequent financial and statistical reports shall be submitted annually for a 12–month period ending with the facility’s fiscal year.

Amend subrule 81.6(15) as follows:

81.6(15) Payment to new owner. An existing facility with a new owner shall continue ~~with~~ to be reimbursed using the previous owner’s per diem rate ~~until a new financial and statistical report has been submitted and a new rate established, not to exceed private pay charges~~ adjusted quarterly for changes in the Medicaid average case–mix index. The facility ~~may~~ shall submit a financial and statistical report for the period from beginning of actual operation under new ownership to the end of the facility’s fiscal year ~~or may submit two cost reports within the fiscal year provided the second report covers a period of six months ending on the last day of the fiscal year~~. Subsequent financial and statistical reports shall be submitted annually for a 12–month period ending with the facility’s fiscal year. The facility shall notify the department’s accounting firm of the date its fiscal year will end ~~and of the reporting option selected~~.

Rescind subrule 81.6(16) and adopt the following new subrule in lieu thereof:

81.6(16) Establishment of the direct care and non–direct care patient–day–weighted medians and modified price–based reimbursement rate. This subrule provides for the establishment of the modified price–based reimbursement rate. Paragraphs “a” through “f” describe the calculations presented in sequential order. The first step (paragraph “a”) determines the per diem direct care and non–direct care component costs. The second step (paragraph “b”) normalizes the per diem direct care component costs to remove cost variations associated with different levels of resident case mix. The third step (paragraph “c”) calculates the patient–day–weighted medians for the direct care and non–direct care components that are used in subsequent steps to establish rate component limits and excess payment allowances if any. The fourth step (paragraph “d”) calculates the potential excess payment allowance. The fifth step (paragraph “e”) calculates the reimbursement rate that is further subjected to the rate component limits in step six (paragraph “f”).

The Medicaid payment rate for services rendered from July 1, 2001, through June 30, 2003, includes a portion of the modified price–based reimbursement rate plus a portion of the Medicaid rate effective June 30, 2001, more fully described in 81.6(4)“a.” Payment rates for services rendered from July 1, 2003, and thereafter will be 100 percent of the modified price–based rate pursuant to subparagraph 81.6(4)“a”(3).

a. Calculation of per diem cost. For purposes of calculating the non–state–owned nursing facility Medicaid reimbursement rate and the Medicare–certified hospital–based nursing facility Medicaid reimbursement rate, the costs shall be divided into two components, the direct care component and non–direct care component as defined in rule 441— 81.1(249A). Each nursing facility’s per diem allowable direct care and non–direct care cost shall be established. Effective July 1, 2001, and every second year thereafter, the per diem allowable cost shall be arrived at by dividing total reported allowable costs by total inpatient days during the reporting period. Effective July 1, 2001, and every second year thereafter, total reported allowable costs shall be adjusted using the inflation factor specified in subrule 81.6(18) from the midpoint of the cost report period to the beginning of the state fiscal year rate period.

(1) Non–state–owned nursing facilities. Beginning July 1, 2001, patient days for purposes of the computation of administrative, environmental, and property expenses shall be inpatient days as specified in subrule 81.6(7) or 80 percent of the licensed capacity of the facility, whichever is greater.

Beginning July 1, 2002, and thereafter, patient days for purposes of the computation of administrative, environmental, and property expenses shall be inpatient days as determined in subrule 81.6(7) or 85 percent of the licensed capacity of the facility, whichever is greater.

Patient days for purposes of the computation of all other expenses shall be inpatient days as determined in subrule 81.6(7).

(2) Medicare–certified hospital–based nursing facilities. Patient days for purposes of the computation of all expenses shall be inpatient days as determined by subrule 81.6(7).

b. Cost normalization. The per diem allowable direct care costs are normalized by dividing a facility’s per diem direct care costs by the facility’s cost report period case–mix index as defined in rule 441—81.1(249A) and subrule 81.6(19).

c. Calculation of patient–day–weighted medians. For each of the rate components, a patient–day–weighted median shall be established for both the non–state–owned nursing facilities and the Medicare–certified hospital–based nursing facilities, hereinafter referred to as the non–state–owned nursing facility patient–day–weighted medians and the Medicare–certified hospital–based nursing facility patient–day–weighted medians.

The per diem normalized direct care cost for each facility is arrayed from low to high to determine the direct care component patient–day–weighted median cost based on the number of patient days provided by facilities. The per diem non–direct care cost for each facility is also arrayed from low to high to determine the non–direct care component patient–day–weighted median cost based on the number of patient days provided by facilities. An array and patient–day–weighted median for each cost component is determined separately for both non–state–owned nursing facilities and the Medicare–certified hospital–based nursing facilities.

(1) For the fiscal period beginning July 1, 2001, and ending June 30, 2003, the non–state–owned nursing facility direct care and non–direct care patient–day–weighted medians and the Medicare–certified hospital–based nursing facility direct care and non–direct care patient–day–weighted medians shall be calculated using the latest financial and statistical report with a fiscal year end of December 31, 2000, or earlier, inflated from the midpoint of the cost report period to July 1, 2001, using the inflation factor specified in subrule 81.6(18).

(2) Effective July 1, 2003, and each second year thereafter, the patient–day–weighted medians used in rate setting shall be recalculated. The non–state–owned nursing facility direct care and non–direct care patient–day–weighted medians and the Medicare–certified hospital–based nursing facility direct care and non–direct care patient–day–weighted medians shall be calculated using the latest completed cost report with a fiscal year end of the preceding December 31 or earlier. When patient–day–weighted medians are recalculated, inflation is applied from the midpoint of the cost report period to the first day of the state fiscal year rate period using the inflation factor specified in subrule 81.6(18).

d. Excess payment allowance.

(1) For non–state–operated nursing facilities not located in a Metropolitan Statistical Area as defined by the Health Care Financing Administration (not including Medicare–certified hospital–based nursing facilities), the excess payment allowance is calculated as follows:

1. For the direct care component, subject to the limit provided below, the excess payment allowance is equal to the percentage specified in 441—subrule 79.1(2) times the difference (if greater than zero) of the following: the direct care non–state–operated nursing facility patient–day–weighted median times the percentage specified in 441—subrule 79.1(2) times the Medicaid average case–mix index pursuant to subrule 81.6(19), minus a provider’s allowable normalized per patient day direct care costs pursuant to 81.6(16)“b” times the Medicaid average case–mix index pursuant to subrule 81.6(19). In no case shall theexcess payment allowance exceed the percentage specified in 441—subrule 79.1(2) times the direct care non–state–operated nursing facility patient–day–weighted median.

2. For the non–direct care component, subject to the limit provided below, the excess payment allowance is equal tothe percentage specified in 441—subrule 79.1(2) times the difference (if greater than zero) of the following: the non–direct care non–state–operated nursing facility patient–day–weighted median times the percentage specified in 441— subrule 79.1(2), minus a provider’s allowable per patient day non–direct care cost pursuant to paragraph 81.6(16)“a.” In no case shall the excess payment allowance exceed the percentage specified in 441—subrule 79.1(2) times the non–direct care non–state–operated nursing facility patient–day–weighted median.

(2) For non–state–operated nursing facilities located in a Metropolitan Statistical Area as defined by the Health Care Financing Administration (not including Medicare–certified hospital–based nursing facilities), the excess payment allowance is calculated as follows:

1. For the direct care component, subject to the limit provided below, the excess payment allowance is equal to the percentage specified in 441—subrule 79.1(2) times the difference (if greater than zero) of the following: the direct care non–state–operated nursing facility patient–day–weighted median times the percentage specified in 441—subrule 79.1(2) times the wage index factor specified below times the Medicaid average case–mix index pursuant to subrule 81.6(19), minus a provider’s allowable normalized per patient day direct care costs pursuant to paragraph 81.6(16)“b” times the Medicaid average case–mix index pursuant to subrule 81.6(19). In no case shall the excess payment allowance exceed the percentage specified in 441— subrule 79.1(2) times the direct care non–state–operated nursing facility patient–day–weighted median.

The wage index factor applied July 1, 2001, through June 30, 2002, shall be 11.46 percent. Beginning July 1, 2002, and thereafter, the wage index factor shall be determined annually by calculating the average difference between the Iowa hospital–based rural wage index and all Iowa hospital–based Metropolitan Statistical Area wage indices as published by the Health Care Financing Administration (HCFA) each July. The geographic wage index adjustment shall not exceed $8 per patient day.

A nursing facility may request an exception to application of the geographic wage index based upon a reasonable demonstration of wages, locations, and total cost. The nursing facility shall request the exception within 30 days of receipt of notification to the nursing facility of the new reimbursement rate using the department’s procedures for requesting exceptions at rule 441—1.8(17A,217).

2. For the non–direct care component, subject to the limit provided below, the excess payment allowance is equal to the percentage specified in 441—subrule 79.1(2) times the difference (if greater than zero) of the following: the non–direct care non–state–operated nursing facility patient–day–weighted median times the percentage specified in 441— subrule 79.1(2), minus a provider’s allowable per patient day non–direct care cost pursuant to paragraph 81.6(16)“a.” In no case shall the excess payment allowance exceed the percentage specified in 441—subrule 79.1(2) times the non–direct care non–state–operated nursing facility patient–day–weighted median.

(3) For Medicare–certified hospital–based nursing facilities, the excess payment allowance is calculated as follows:

1. For the direct care component, subject to the limit provided below, the excess payment allowance is equal to the percentage specified in 441—subrule 79.1(2) times the difference (if greater than zero) of the following: the direct care Medicare–certified hospital–based nursing facilitypatient–day–weighted median times the percentage specified in 441—subrule 79.1(2) times the Medicaid average case–mix index pursuant to subrule 81.6(19), minus a provider’s normalized allowable per patient day direct care costs pursuant to paragraph 81.6(16)“b” times the Medicaid average case–mix index pursuant to subrule 81.6(19). In no case shall the excess payment allowance exceed the percentage specified in 441—subrule 79.1(2) times the direct care Medicare–certified hospital–based nursing facility patient–day–weighted median.

2. For the non–direct care component, subject to the limit provided below, the excess payment allowance is equal to the percentage specified in 441—subrule 79.1(2) times the difference (if greater than zero) of the following: the non–direct care Medicare–certified hospital–based nursing facility patient–day–weighted median times the percentage specified in 441—subrule 79.1(2), minus a provider’s allowable per patient day non–direct care cost pursuant to paragraph 81.6(16)“a.” In no case shall the excess payment allowance exceed the percentage specified in 441—subrule 79.1(2) times the non–direct care Medicare–certified hospital–based nursing facility patient–day–weighted median.

e. Reimbursement rate. The Medicaid reimbursement rate is based on allowable costs, updated July 1, 2001, and every second year thereafter, as specified in subparagraphs (1) and (2) below, plus a potential excess payment allowance determined by the methodology in paragraph “d,” not to exceed the rate component limits determined by the methodology in paragraph “f.”

(1) For non–state–owned nursing facilities and Medicare–certified hospital–based nursing facilities, direct care and non–direct care rate components are calculated as follows:

1. The direct care component is equal to the provider’s normalized allowable per patient day costs times the Medi–caid average case–mix index pursuant to subrule 81.6(19), plus the allowed excess payment allowance as determined by the methodology in paragraph “d.”

2. The non–direct care component is equal to the provider’s allowable per patient day costs, plus the allowed excess payment allowance as determined by the methodology in paragraph “d.”

(2) The reimbursement rate for state–operated nursing facilities and special population nursing facilities shall be the facility’s average allowable per diem costs, adjusted for inflation pursuant to subrule 81.6(18), based on the most current financial and statistical report.

f. Notwithstanding paragraphs “d” and “e,” in no instance shall a rate component exceed the rate component limit defined as follows:

(1) For non–state–operated nursing facilities not located in a Metropolitan Statistical Area (not including Medicare–certified hospital–based nursing facilities), the direct care and non–direct care rate component limits are calculated as follows:

1. The direct care rate component limit is the direct care non–state–operated nursing facility patient–day–weighted median times the percentage of the median specified in 441—subrule 79.1(2) times the Medicaid average case–mix index pursuant to subrule 81.6(19).

2. The non–direct care rate component limit is the non–direct care non–state–operated nursing facility patient–day–weighted median times the percentage of the median specified in 441—subrule 79.1(2).

(2) For non–state–operated nursing facilities located ina Metropolitan Statistical Area (not including Medicare–certified hospital–based nursing facilities), the direct care and non–direct care rate component limits are calculated as follows:

1. The direct care rate component limit is the direct care non–state–operated nursing facility patient–day–weighted median times the percentage of the median specified in 441—subrule 79.1(2) times the wage factor specified in paragraph “d” times the Medicaid average case–mix index pursuant to subrule 81.6(19).

(3) For Medicare–certified hospital–based nursing facilities, the direct care and non–direct care rate component limits are calculated as follows:

1. The direct care rate component limit is the direct care Medicare–certified hospital–based nursing facility patient–day–weighted median times the percentage of the median specified in 441—subrule 79.1(2) times the Medicaid average case–mix index pursuant to subrule 81.6(19).

2. The non–direct care rate component limit is the non–direct care Medicare–certified hospital–based nursing facility patient–day–weighted median times the percentage of the median specified in 441—subrule 79.1(2).

(4) For special population nursing facilities enrolled on or after June 1, 1993, the upper limit on their rate is equal to the sum of the following:

1. The direct care Medicare–certified hospital–based nursing facility patient–day–weighted median times the percentage of the median specified in 441—subrule 79.1(2).

2. The non–direct care Medicare–certified hospital–based nursing facility patient–day–weighted median times the percentage of the median specified in 441—subrule 79.1(2).

g. Accountability measures. Additional reimbursement for non–state–owned nursing facilities, based on accountability measures, shall also be available beginning July 1, 2002, in amounts up to 3 percent of the sum of the non–state–operated nursing facility direct care patient–day–weighted median plus the non–state–operated nursing facility non–direct care patient–day–weighted median. These accountability measures may include areas such as standard surveys and complaint investigations from the department of inspections and appeals, customer satisfaction, employee retention rates, provision of cognitive loss and dementia care, and other objective measures of accountability and quality, with performance measured following identification of specific standards.

Amend subrule 81.6(17), introductory paragraph, as follows:

81.6(17) Cost report documentation. All nursing facilities shall submit ~~semiannual~~ an annual cost ~~reports~~ report based on the closing date of the facility’s fiscal year ~~and the midpoint of the facility’s fiscal year,~~ that ~~incorporate~~ incorporates documentation as set forth below. The documentation incorporated in the cost ~~reports~~ report shall include all of the following information:

Adopt the following new subrules:

81.6(18) Inflation factor. The department shall consider an inflation factor in determining the reimbursement rate. The inflation factor shall be based on the HCFA Total Skilled Nursing Facility (HCFA/SNF) Market Basket Index published by Data Resources, Inc. The HCFA/SNF index listed in the latest available quarterly publication prior to the July 1 rate setting shall be used to determine the inflation factor.

81.6(19) Case–mix index calculation.

a. The Resource Utilization Groups–III (RUG–III) Version 5.12b, 34 group, index maximizer model shall be used as the resident classification system to determine all case–mix indices, using data from the minimum data set (MDS) submitted by each facility pursuant to subrule 81.13(9). Standard Version 5.12b case–mix indices developed by HCFA shall be the basis for calculating the average case–mix index and shall be used to adjust the direct care costs in the determination of the direct care patient–day–weighted median and the reimbursement rate pursuant to subrule 81.6(16).

b. Each resident in the facility on the last day of each calendar quarter with a completed and submitted assessment shall be assigned a RUG–III 34 group calculated on the resident’s most current assessment available on the last day of each calendar quarter. This RUG–III group shall be translated to the appropriate case–mix index referenced in paragraph “a.” From the individual resident case–mix indices, two average case–mix indices for each Medicaid nursing facility shall be determined four times per year based on the last day of each calendar quarter.

The facilitywide average case–mix index is the simple average, carried to four decimal places, of all resident case–mix indices. The Medicaid–average case–mix index is the simple average, carried to four decimal places, of all indices for residents where Medicaid is known to be the per diem payor source on the last day of the calendar quarter. Assessments that cannot be classified to a RUG–III group due to errors shall be excluded from both average case–mix index calculations.

ITEM 15. Amend rule 441—81.10(249A) as follows:

Amend subrules 81.10(1) and 81.10(2) as follows:

81.10(1) Method of payment. ~~Facilities~~ Except for Medicaid accountability measures payment established in paragraph 81.6(16)“g,” facilities shall be reimbursed under a ~~cost–related~~ modified price–based vendor payment program. A per diem rate shall be established based on information submitted according to rule 441—81.6(249A). ~~The per diem rate shall be no greater than the maximum reasonable cost determined by the department.~~ Effective July 1, 2002, the per diem rate shall include an amount for Medicaid accountability measures.

81.10(2) Authorization of payment. The department shall authorize payment for care in a facility. The authorization shall be obtained prior to admission of the resident, whenever possible. For a nursing facility to be eligible for Medicaid payment for a resident, the facility must, when applicable, exhaust all Medicare benefits.

Amend subrule 81.10(4), paragraph “f,” as follows:

f. Payment for periods when residents are absent for visitation or hospitalization ~~will~~ shall be made at 75 percent of the ~~allowable audited costs for those beds, not to exceed the maximum reimbursement~~ nursing facility’s rate.

Further amend subrule 81.10(4) by adopting new paragraph “h” as follows:

h. In–state nursing facilities serving Medicaid eligible patients who require a ventilator at least six hours every day, are inappropriate for home care, and have medical needs that require skilled care as determined by the peer review organization shall receive reimbursement for the care of these patients equal to the sum of the Medicare–certified hospital–based nursing facility direct care rate component limit plus the Medicare–certified hospital–based nursing facility non–direct care rate component limit factor pursuant to subparagraph 81.6(16)“f”(3). Facilities may continue to receive reimbursement at this rate for 30 days for any person weaned from a respirator who continues to reside in the facility and continues to meet skilled care criteria for those 30 days.

Amend subrule 81.10(7), paragraphs “a,” “b,” and “c,” as follows:

a. The nursing facility shall recompute the average per diem rate on a facilitywide, private pay basis ~~twice~~ yearly. This computation shall coincide with the preparation of the Financial and Statistical Report, Form 470–0030, which is submitted to the department’s accounting firm.

b. An individual private pay resident’s rate shall be computed by accumulating the ~~six~~ 12 months’ total charges for the individual and dividing the total charges by the total number of days in which the bed was occupied by or was being held for the resident. The total monthly charges will include the basic charge per day plus any standard charges for extra care and service.

c. To compute the facilitywide average private pay per diem rate, the facility shall accumulate total monthly ~~changes~~ charges for all private pay residents for the ~~six~~ 12–month period and divide by the total patient days for all private pay residents for the same period to arrive at the private pay average per diem rate for the entire facility.

In no case shall the Medicaid rate calculated pursuant to subrule 81.6(16) be greater than the private pay average per diem rate determined on a facilitywide basis.

ITEM 16. Rescind subrule 81.20(1) and adopt the following new subrule in lieu thereof:

81.20(1) Out–of–state providers. Except for Medicare–certified hospital–based nursing facilities and special population nursing facilities, out–of–state providers shall be reimbursed at the same nursing facility rate they would receive from the Medicaid program in their state of residence or an amount equal to the sum of the Iowa non–state–operated nursing facility direct care rate component limit pursuant to subparagraph 81.6(16)“f”(1) plus the non–direct care rate limit pursuant to subparagraph 81.6(16)“f”(1), whichever is lower.

a. Medicare–certified hospital–based nursing facilities providing skilled care in other states shall be reimbursed atan amount equal to the sum of the Iowa Medicare–certified hospital–based nursing facility direct care rate component limit pursuant to subparagraph 81.6(16)“f”(3) plus the non–direct care rate component limit pursuant to subparagraph 81.6(16)“f”(3) if one of the following criteria is met:

(1) The placement is recommended because moving the resident back to Iowa would endanger the resident’s health, because services are not readily available in Iowa, or because the out–of–state placement is cost–effective.

(2) The placement is temporary until services are available to the resident in Iowa or until the program of treatment is completed.

b. Special population nursing facilities shall be reimbursed at the same nursing facility rate they would receive from Medicaid in their state of residence or, if not participating in the Medicaid program in their state, they shall be reimbursed pursuant to subparagraph 81.6(16)“e”(2), if one of the following criteria is met:

(2) The placement is temporary until services are available to the resident in Iowa or until the program of treatment is completed.

ITEM 17. Amend rule 441—81.31(249A), definition of “deficiency,” as follows:

“Deficiency” means a ~~skilled nursing facility’s or~~ nursing facility’s failure to meet a participation requirement.

[Filed Emergency 6/13/01, effective 7/1/01]

[Published 7/11/01]

EDITOR’S NOTE: For replacement pages for IAC, see IAC Supplement 7/11/01.

ARC 0782B

HUMAN SERVICES DEPARTMENT[441]

Adopted and Filed Emergency

Pursuant to the authority of Iowa Code section 249A.4 and 2001 Iowa Acts, House File 732, section 31, subsection 1, paragraphs “b,” “c,” “e,” “g,” “h,” “j,” and “k,” and subsections 8 and 10, and section 49, the Department of Human Services hereby amends Chapter 79, “Other Policies Relating to Providers of Medical and Remedial Care,” appearing in the Iowa Administrative Code.

These amendments implement changes to Medicaid provider reimbursement as mandated by the Seventy–ninth General Assembly. Specifically, these amendments:

• Calculate the reimbursement rates for intermediate care facilities for persons with mental retardation at the 80th percentile as calculated from the December 31, 2000, cost reports.

These amendments do not provide for waivers to the reimbursement rates because all providers of the same category should be reimbursed on the same basis as mandated by the General Assembly.

The Department of Human Services finds that notice and public participation for the revisions to the payment methodology for federally qualified health centers and rural health clinics are unnecessary because the Department has no choice but to implement these changes which are mandated by the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000. Therefore, these amendments are filed pursuant to Iowa Code section 17A.4(2).

The Department finds that the revisions to the payment methodology for federally qualified health centers and rural health clinics confer a benefit on federally qualified health centers and rural health clinics by giving them the option of prospective payment rates or use of an alternative payment methodology that would retain 100 percent cost–based reimbursement. Therefore, these amendments are filed pursuant to Iowa Code section 17A.5(2)“b”(2).

In compliance with Iowa Code section 17A.4(2), the Department of Human Services finds that notice and public participation are otherwise unnecessary because the other amendments implement 2001 Iowa Acts, House File 732, section 31, subsection 1, paragraphs “b,” “c,” “e,” “g,” “h,” “j,” and “k,” and subsections 8 and 10, and section 49, that authorize the Department to adopt rules without notice and public participation.

The Department also finds, pursuant to Iowa Code section 17A.5(2)“b”(1), that the normal effective date of the other amendments should be waived and these amendments made effective July 1, 2001, as authorized by 2001 Iowa Acts, House File 732, section 49.

These amendments are also published herein under Notice of Intended Action as ARC 0781B to allow for public comment.

The Council on Human Services adopted these amendments June 13, 2001.

These amendments became effective July 1, 2001.

The following amendments are adopted.

ITEM 1. Amend subrule 79.1(1), paragraph “d,” as follows:

d. *Monthly fee for service with cost settlement. Providers are reimbursed on the basis of a payment for a month’s provision of service for each client enrolled in a case management program for any portion of the month based on reasonable and proper costs for service provision. The fee will be determined by the department with advice and consultation from the appropriate professional group and will reflect the amount of resources involved in services provision.

Providers are reimbursed throughout each fiscal year on the basis of a projected monthly rate for each participating provider, based on reasonable and proper costs of operation, pursuant to federally accepted reimbursement principles (generally Medicare or OMB A–87 principles) with annual retrospective cost settlement based on submission of actual costs of operation and service utilization data by the provider on financial and statistical reports. The cost settlement represents the difference between the amount received by the provider during the year for covered services and the amount supported by the actual costs of doing business, determined in accordance with an accepted method of cost apportionment.

ITEM 2. Amend subrule 79.1(2), basis of reimbursement provider categories “Ambulance”; “Ambulatory surgical centers”; “Audiologists”; “Birth centers”; “Case management providers”; “Certified registered nurse anesthetists”; “Chiropractors”; “Community mental health centers”; “Dentists”; “Durable medical equipment, prosthetic devices and medical supply dealers”; “Family or pediatric nurse practitioner”; “Family planning clinics”; “Federally qualified health centers”; “Hearing aid dealers”; “Home health agencies”; “Hospitals (Critical access)”; “Hospitals (Inpatient)”; “Hospitals (Outpatient)”; “Intermediate care facilities for the mentally retarded”; “Lead inspection agency”; “Maternal health centers”; “Nurse–midwives”; “Opticians”; “Optometrists”; “Orthopedic shoe dealers”; “Physical therapists”; “Physicians”; “Podiatrists”; “Prescribed drugs”; “Psychiatric medical institutions for children (Outpatient day treatment)”; “Psychologists”; “Rehabilitation agencies”; “Rehabilitation services for adults with a chronic mental illness providers”; “Rehabilitative treatment services”; “Rural health clinics”; and “Screening centers,” as follows:

Provider category	Basis of reimbursement	Upper limit
Ambulance	Fee schedule	Ground ambulance: Fee schedule in effect ~~6/30/00 plus 0.7%~~ 6/30/01 less 3%. Air ambulance: A base rate of ~~$209.54~~ $203.25 plus ~~$7.85~~ $7.61 per mile for each mile the patient is carried.
Ambulatory surgical centers	Base rate fee schedule as determined by Medicare. See 79.1(3)	~~Rate determined by Medicare~~ Fee schedule in effect 6/30/01 less 3%
Audiologists	Fee schedule	~~Rate in effect on 1/1/00 under the fee schedule established for Iowa under the federal Medicare program, incorporating the resource–based relative value scale (RBRVS) methodology~~ Fee schedule in effect 6/30/01 less 3%
Birth centers	Fee schedule	Fee schedule in effect ~~6/30/00 plus 0.7%~~ 6/30/01 less 3%
Case management providers	~~Retrospective cost–related~~ Monthly fee for service with cost settlement	Retrospective cost–settled rate in effect 6/30/01 less 3%
Certified registered nurse anesthetists	Fee schedule	Fee schedule in effect ~~6/30/00 plus 0.7%~~ 6/30/01 less 3%
Chiropractors	Fee schedule	~~Rate in effect on 1/1/00 under the fee schedule established for Iowa under the federal Medicare program, incorporating the resource–based relative value scale (RBRVS) methodology~~ Fee schedule in effect 6/30/01 less 3%
Community mental health centers	Fee schedule	Reimbursement rate for center in effect ~~6/30/00 plus 17.33%~~ 6/30/01 less 3%
Dentists	Fee schedule	~~75% of usual and customary rate~~ Fee schedule in effect 6/30/01 less 3%
Durable medical equipment, prosthetic devices and medical supply dealers	Fee schedule. See 79.1(4)	Fee schedule in effect ~~6/30/00 plus 0.7%~~ 6/30/01 less 3%
Family or pediatric nurse ~~practitioner~~ practitioners	Fee schedule	~~Rate in effect on 1/1/00 under the fee schedule established for Iowa under the federal Medicare program, incorporating the resource–based relative value scale (RBRVS) methodology~~ Fee schedule in effect 6/30/01 less 3%
Family planning clinics	Fee schedule	Fees in effect ~~6/30/00 plus 0.7%~~ 6/30/01 less 3%
Federally qualified health centers (FQHC)	Retrospective cost–related See 441—88.14(249A)	1. Prospective payment rate as required by the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA 2000) or an alternative methodology allowed thereunder, as specified in “2” below 1 2. 100% of reasonable cost as determined by Medicare cost reimbursement principles 2 3. 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” or “2” above.
Hearing aid ~~dealers~~ dispensers	Fee schedule plus product acquisition cost	Fee schedule in effect ~~6/30/00 plus 0.7%~~ 6/30/01 less 3%
Home health agencies
(Encounter services– intermittent services)	Retrospective cost–related	~~Maximum Medicare rate~~ Rate in effect 6/30/01 less 3%
(Private duty nursing or personal care and VFC vaccine administration for persons aged 20 and under)	Interim fee schedule with retrospective cost settling based on ~~Medicare~~ Medicaid methodology	~~Retrospective cost settling according to Medicare~~ ~~methodology~~ Rate in effect 6/30/01 less 3%
Hospitals (Critical access)	Retrospectively adjusted prospective rates. See 79.1(1)“g” and 79.1(5)	The reasonable cost of covered services provided to medical assistance recipients or the upper limits for other hospitals, whichever is greater
Hospitals (Inpatient)	Prospective reimbursement. See 79.1(5)	Reimbursement rate in effect ~~6/30/00~~ 6/30/01 ~~increased by~~ less 3%
Hospitals (Outpatient)	Prospective reimbursement for providers listed at 441— paragraphs 78.31(1)“a” to “f.” See 79.1(16)	Ambulatory patient group rate (plus an evaluation rate) and assessment payment rate in effect on ~~6/30/00~~ 6/30/01 ~~increased by~~ less 3%
	Fee schedule for providers listed at 441—paragraphs 78.31(1)“g” to “n.” See 79.1(16)	Rates in effect on ~~6/30/00~~ 6/30/01~~increased by~~ less 3%
Intermediate care facilities for the mentally retarded	Prospective reimbursement. See 441—82.5(249A)	Eightieth percentile of facility costs as calculated from ~~12/31/99~~ 12/31/00 cost reports
Lead inspection agency	Fee schedule	Fee schedule in effect ~~6/30/00 plus 0.7%~~ 6/30/01 less 3%
Maternal health centers	Reasonable cost per procedure on a prospective basis as determined by the department based on financial and statistical data submitted annually by the provider group	Fee schedule in effect ~~6/30/00 plus 0.7%~~ 6/30/01 less 3%
Nurse–midwives	Fee schedule	~~Rate in effect on 1/1/00 under the fee schedule established for Iowa under the federal Medicare program, incorporating the resource–based relative value scale (RBRVS) methodology~~ Fee schedule in effect 6/30/01 less 3%
Opticians	Fee schedule. Fixed fee for lenses and frames; other optical materials at product acquisition cost	~~Reimbursement rate for provider in effect 6/30/00 plus 0.7%~~ Fee schedule in effect 6/30/01 less 3%
Optometrists	Fee schedule. Fixed fee for lenses and frames; other optical materials at product acquisition cost	~~Rate in effect on 1/1/00 under the fee schedule established for Iowa under the federal Medicare program, incorporating the resource–based relative value scale (RBRVS) methodology~~ Fee schedule in effect 6/30/01 less 3%
Orthopedic shoe dealers	Fee schedule	~~Reimbursement rate for provider in effect 6/30/00~~ ~~plus 0.7%~~ Fee schedule in effect 6/30/01 less 3%
Physical therapists	Fee schedule	~~Rate in effect on 1/1/00 under the fee schedule established for Iowa under the federal Medicare program, incorporating the resource–based relative value scale (RBRVS)~~ ~~methodology~~ Fee schedule in effect 6/30/01 less 3%
Physicians (doctors of medicine or osteopathy)	Fee schedule. See 79.1(7)	Rate in effect on 1/1/00 under the fee schedule established for Iowa under the federal Medicare program, incorporating the resource–based relative value scale (RBRVS) methodology, excluding anesthesia services. Anesthesia services will be reimbursed at the Iowa Medicaid fee schedule in effect 6/30/00 plus 0.7%. Fee schedule in effect 6/30/01 less 3%
Podiatrists	Fee schedule	~~Rate in effect on 1/1/00 under the fee schedule established for Iowa under the federal Medicare program, incorporating the resource–based relative value scale (RBRVS) methodology~~ Fee schedule in effect 6/30/01 less 3%
Prescribed drugs	See 79.1(8)	~~$4.13 or $6.42~~ $5.17 dispensing fee (See 79.1(8)“a” and “e”)
Psychiatric medical institutions for children
(Outpatient day treatment)	Fee schedule	Fee schedule in effect ~~6/30/00 plus 0.7%~~ 6/30/01 less 3%
Psychologists	Fee schedule	~~Rate in effect on 1/1/00 under the fee schedule established for Iowa under the federal Medicare program, incorporating the resource–based relative value scale (RBRVS) methodology~~ Fee schedule in effect 6/30/01 less 3%
Rehabilitation agencies	Retrospective cost–related	~~Reimbursement rate for agency in effect 6/30/00~~ ~~plus 0.7%~~ Fee schedule in effect 6/30/01 less 3%
Rehabilitation services for adults with a chronic mental illness providers, including:
1. Rehabilitation support services providers, including:
Community living skills training services providers	Retrospective cost–related. See 79.1(19)	Retrospective rate established pursuant to 79.1(19) less 3%
Employment–related services providers	Retrospective cost–related. See 79.1(19)	Retrospective rate established pursuant to 79.1(19) less 3%
2. Day program services providers, including:
Skills training providers	Retrospective cost–related. See 79.1(19)	Retrospective rate established pursuant to 79.1(19) less 3%
Skills development providers	Retrospective cost–related. See 79.1(19)	Retrospective rate established pursuant to 79.1(19) less 3%
Rehabilitative treatment services	Reasonable and necessary costs per unit of service based on data included on the Rehabilitative Treatment and Supportive Services Financial and Statistical Report, Form 470–3049. See 441—185.101(234) to ~~441—185.107(234)~~ 441— 185.112(234). A provider who is an individual may choose between the fee schedule in effect November 1, 1993 (See 441—subrule 185.103(7)) and reasonable and necessary costs.	~~No cap~~ Rate in effect on 6/30/01
Rural health clinics (RHC)	Retrospective cost–relatedSee 441—88.14(249A)	1. Prospective payment rate as required by the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA 2000) or an alternative methodology allowed thereunder, as specified in “2” below 1 2. 100% of reasonable cost as determined by Medicare cost reimbursement principles 2 3. 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” or “2” above.
Screening centers	Fee schedule	Reimbursement rate for center in effect ~~6/30/00 plus 0.7%~~ 6/30/01 less 3%

ITEM 3. Amend subrule 79.1(8), paragraph “a,” second and third unnumbered paragraphs, as follows:

The basis of payment for prescribed drugs for which the MAC has been established shall be the lesser of the MAC plus a professional dispensing fee of ~~$4.13~~ $5.17 or the pharmacist’s usual and customary charge to the general public.

The basis of payment for drugs for which the MAC has not been established shall be the lesser of the EAC plus a professional dispensing fee of ~~$6.42~~ $5.17 or the pharmacist’s usual and customary charge to the general public.

[Filed Emergency 6/13/01, effective 7/1/01]

[Published 7/11/01]

EDITOR’S NOTE: For replacement pages for IAC, see IAC Supplement 7/11/01.

ARC 0784B

HUMAN SERVICES DEPARTMENT[441]

Adopted and Filed Emergency

Pursuant to the authority of Iowa Code section 249A.4, the Department of Human Services hereby amends Chapter 83, “Medicaid Waiver Services,” appearing in the Iowa Administrative Code.

The Department of Human Services finds that notice and public participation are unnecessary and impracticable because the Department has no choice but to implement these changes which were mandated by the Seventy–ninth General Assembly and HCFA and there is not time to allow for notice and public comment before the statutory effective date of July 1, 2001. Therefore, these amendments are filed pursuant to Iowa Code section 17A.4(2).

The Department finds that these amendments confer a benefit on persons with a brain injury by removing the requirement that they be institutionalized in order to be eligible for the waiver and that there be a county payment slot available. The amendments also confer a benefit on the public by clarifying county responsibility, as mandated by the General Assembly. Therefore, these amendments are filed pursuant to Iowa Code section 17A.5(2)“b”(2).

These amendments are also published herein under Notice of Intended Action as ARC 0783B to allow for public comment.

The Council on Human Services adopted these amendments June 13, 2001.

These amendments are intended to implement Iowa Code section 249A.4 and 2001 Iowa Acts, House File 732, section 7, subsection 3, paragraph “e.”

These amendments became effective July 1, 2001.

The following amendments are adopted.

ITEM 1. Amend rule 441—83.82(249A) as follows:

Amend subrule 83.82(1) by rescinding and reserving paragraph “e.”

Further amend subrule 83.82(1) by amending paragraph “l” as follows:

l. Be assigned a state payment slot within the yearly total approved by the Health Care Financing Administration.

Rescind and reserve subrule 83.82(3).

Amend subrule 83.82(4) as follows:

83.82(4) Securing a state payment slot.

a. The county department office shall contact the division of medical services ~~for state cases and children of the county of legal settlement for adults~~ to determine if a payment slot is available for all new applications for the HCBS BI waiver program ~~which require the ICF/MR level of care~~. For new applications for people who require the ICF/MR level of care when the county of legal settlement has payment responsibility pursuant to rule 441—83.90(249A), the county department office shall inform the county of legal settlement of the application.

(1) For persons not currently receiving Medicaid, the county department office shall contact the division of medical services or and notify the county of those persons for whom the county has payment responsibility by the end of the second working day after receipt of a completed Form ~~PA–1107–0~~ 470–0442, Application for Medical Assistance or State Supplementary Assistance.

(2) For current Medicaid recipients, the county department office shall contact the division of medical services or and notify the county of those persons for whom the county has payment responsibility by the end of the second working day after receipt of a signed and dated Form ~~SS–1645–0~~ 470–0660, Home– and Community–Based Service Report.

b. On the third day after the receipt of the completed Form ~~PA–1107–0~~ 470–0442 or ~~SS–1645–0~~ 470–0660, if no payment slot is available, persons shall be entered on a waiting list by the division of medical services ~~or county~~ according to the following:

(1) Persons not currently eligible for Medicaid shall be entered on the waiting list on the basis of the date a completed Form ~~PA–1107–0~~ 470–0442, Application for Medical Assistance or State Supplementary Assistance, is date–stamped in the county department office. Consumers currently eligible for Medicaid shall be added to the waiting list on the basis of the date the consumer requests HCBS BI program services as documented by the date of the consumer’s signature on Form ~~SS–1645–0~~ 470–0660. In the event that more than one application is received at one time, persons shall be entered on the waiting list on the basis of the month of birth, January being month one and the lowest number.

(2) Persons who do not fall within the available slots shall have their applications rejected but their names shall be maintained on the waiting list. As slots become available, persons shall be selected from the waiting list to maintain the number of approved persons on the program based on their order on the waiting list.

The county shall have financial responsibility for the state share of the costs of services for these consumers as stated in rule 441—83.90(249A). The county shall include these ICF/MR level of care brain–injured consumers in their annual county management plan which is approved by the state.

ITEM 2. Amend rule 441—83.90(249A) as follows:

441—83.90(249A) County reimbursement. The county board of supervisors of the consumer’s county of legal settlement shall reimburse the department for all the nonfederal share of the cost of brain injury waiver services to persons at the ICF/MR level of care with legal settlement in the county who are coming onto the waiver from ~~a minimum 30–day residence in~~ an ICF/MR facility or who have been receiving other services for which the county has been financially responsible or would become liable due to the person’s reaching the age of majority. The county shall enter into a Medicaid Home and Community Based Payment Agreement, Form ~~MA–2171~~ 470–0379, with the department for reimbursement of the nonfederal share of the cost of services provided to HCBS brain injury waiver adults at the ICF/MR level of care who meet the criteria stated above. Waiver slots for these persons shall be identified in the county management plan submitted to the department pursuant to 441—Chapter 25.

The county shall enter into the agreement using the criteria in subrule 83.82(2).

[Filed Emergency 6/13/01, effective 7/1/01]

[Published 7/11/01]

EDITOR’S NOTE: For replacement pages for IAC, see IAC Supplement 7/11/01.

ARC 0786B

HUMAN SERVICES DEPARTMENT[441]

Adopted and Filed Emergency

Pursuant to the authority of Iowa Code section 239B.4(4) and 2001 Iowa Acts, House File 732, section 3, subsections 9 and 10, and section 49, the Department of Human Services hereby amends Chapter 93, “PROMISE JOBS Program,” appearing in the Iowa Administrative Code.

These amendments increase the mileage rate reimbursement for required PROMISE JOBS activities from $.16per mile to $.21 per mile and extend the time limit on PROMISE JOBS funding for approvable postsecondary classroom training from 24 months within a 36–consecutive–monthperiod of time to 24 months of funding within a 48–consecutive–month period of time as mandated by theSeventy–ninth General Assembly.

These amendments do not provide for waivers because they confer a benefit and were mandated by the Seventy–ninth General Assembly.

In compliance with Iowa Code section 17A.4(2), the Department of Human Services finds that notice and public participation are unnecessary because these amendments implement 2001 Iowa Acts, House File 732, section 3, subsections 9 and 10, and section 49, that authorize the Department to adopt rules without notice and public participation.

These amendments are also published herein under Notice of Intended Action as ARC 0785B to allow for public comment.

The Council on Human Services adopted these amendments June 13, 2001.

These amendments became effective July 1, 2001.

The following amendments are adopted.

ITEM 1. Amend subrule 93.110(6), paragraph “b,” as follows:

b. For participants who use a motor vehicle they operate themselves or who hire private transportation, the transportation allowance shall be based on a formula which uses the normally scheduled days of participation in the PROMISE JOBS activity for the period covered by the allowance times the participant’s anticipated daily round–trip miles times the mileage rate of ~~$.16~~ $.21 per mile.

ITEM 2. Amend subrule 93.114(15), introductory paragraph and paragraph “b,” as follows:

93.114(15) Maximum limit on PROMISE JOBS funding. Notwithstanding subrules 93.114(1) through 93.114(14), any participant who develops one or more FIAs on or after July 1, 1996, that include approvable postsecondary vocational classroom training shall be eligible for consideration for PROMISE JOBS expenses allowable under these rules for no more than 24 months within a 36 48–consecutive–month period. Except for this funding limit, all other policies at subrules 93.114(1) to 93.114(14) apply, including the established time frames described in 93.114(3) and 93.114(14)“g,” for including postsecondary vocational classroom training in the FIA, without requiring other FIA activities.

b. The period of 36 48 consecutive months begins with the first month that the participant is eligible for consideration for PROMISE JOBS expense allowances. It is not altered by breaks in FIP assistance or breaks from the postsecondary vocational classroom training activity.

[Filed Emergency 6/13/01, effective 7/1/01]

[Published 7/11/01]

EDITOR’S NOTE: For replacement pages for IAC, see IAC Supplement 7/11/01.

ARC 0789B

HUMAN SERVICES DEPARTMENT[441]

Adopted and Filed Emergency

Pursuant to the authority of Iowa Code section 217.6, the Department of Human Services hereby amends Chapter 130, “General Provisions,” appearing in the Iowa Administrative Code.

In compliance with Iowa Code section 17A.4(2), the Department of Human Services finds that notice and public participation on these amendments are unnecessary because these amendments implement Iowa Code section 237A.13, passed by the Seventy–eighth General Assembly, which requires the Department to use the federal poverty levels when determining eligibility for child care and placement of clients on waiting lists. The Department historically has updated the poverty guidelines for child care to be effective July 1, 2001.

The Department finds that the amendments updating the income guidelines and fee schedules confer a benefit on consumers by increasing the income guidelines and making more persons eligible for the services. Therefore, these amendments are filed pursuant to Iowa Code section 17A.5(2)“b”(2).

These amendments are also published herein under Notice of Intended Action as ARC 0788B to allow for public comment.

The Council on Human Services adopted these amendments June 13, 2001.

These amendments are intended to implement Iowa Code section 237A.13.

These amendments became effective July 1, 2001.

The following amendments are adopted.

ITEM 1. Amend subrule 130.3(1), paragraph “d,” subparagraph (2), as follows:

(2) Income eligible status. The monthly gross income according to family size is no more than the following amounts:

Family Size

For Child Care
Monthly
Gross Income

All Other Services Monthly Gross
Income Below

1 Member

~~$ 696~~

$ 716

~~$ 974~~

$1,002

~~$1,219~~

$1,253

$ 583

2 Members

~~938~~

968

~~1,313~~

1,355

~~1,641~~

1,693

762

3 Members

~~1,179~~

1,219

~~1,651~~

1,707

~~2,064~~

2,134

942

4 Members

~~1,421~~

1,471

~~1,989~~

2,059

~~2,486~~

2,574

1,121

5 Members

~~1,663~~

1,723

~~2,328~~

2,412

~~2,910~~

3,014

1,299

6 Members

~~1,904~~

1,974

~~2,666~~

2,764

~~3,332~~

3,455

1,478

7 Members

~~2,146~~

2,226

~~3,004~~

3,116

~~3,755~~

3,895

1,510

8 Members

~~2,388~~

2,478

~~3,343~~

3,469

~~4,178~~

4,336

1,546

9 Members

~~2,629~~

2,729

~~3,681~~

3,821

~~4,601~~

4,776

1,581

10 Members

~~2,871~~

2,981

~~4,019~~

4,173

~~4,701~~

5,216

1,612

For child care, Column A, add ~~$242~~ $252 for each additional person over 10 members. For child care, Column B, add ~~$338~~ $352 for each additional person over 10 members. For child care, Column C, add ~~$100~~ $123 for each additional person over 10 members. For other services, add $33 for each additional person over 10 members.

Column A is used to determine income eligibility when funds are insufficient to serve additional families beyond those already receiving services or requiring protective child care and applications are being taken from families who are at or below 100 percent of the federal poverty guidelines and in which the parents are employed at least 28 hours per week or are under the age of 21 and participating in an educational program leading to a high school diploma or equivalent or from parents under the age of 21 with a family income at or below 100 percent of the federal poverty guidelines who are participating, at a satisfactory level, in an approved training or education program. (See 441—paragraphs 170.2(3)“a” and “c.”)

Column B is used to determine income eligibility when funds are insufficient to serve additional families beyond those already receiving services or requiring protective child care and applications are being taken from families with an income of more than 100 percent but not more than 140 percent of the federal poverty level whose members are employed at least 28 hours per week (see 441—paragraph 170.2(3)“d”) or when there is adequate funding and no waiting lists and applications are being taken from families applying for services, with the exception of families with children with special needs.

Column C is used to determine income eligibility for families with children with special needs.

ITEM 2. Amend subrule 130.4(3), introductory paragraph and “Monthly Income Increment Levels According to Family Size” table, as follows:

130.4(3) Child care services. The monthly income chart and fee schedule for child care services in a licensed child care center, an exempt facility, a registered family or group child care home, a nonregistered family child care home, or in–home are shown in the following table:

Monthly Income Increment Levels According to Family Size

Income
Increment
Levels

Half–Day
Fee

~~661~~

680

~~891~~

919

~~1120~~

1158

~~1350~~

1397

~~1579~~

1636

~~1809~~

1875

~~2039~~

2115

~~2268~~

2354

~~2498~~

2593

~~2727~~

2832

.00

~~696~~

716

~~938~~

968

~~1179~~

1219

~~1421~~

1471

~~1663~~

1723

~~1904~~

1974

~~2146~~

2226

~~2388~~

2478

~~2629~~

2729

~~2871~~

2981

.50

~~735~~

756

~~990~~

1022

~~1245~~

1287

~~1500~~

1553

~~1756~~

1819

~~2011~~

2085

~~2266~~

2350

~~2521~~

2616

~~2776~~

2882

~~3032~~

3148

1.00

~~776~~

798

~~1045~~

1079

~~1315~~

1360

~~1584~~

1640

~~1854~~

1921

~~2123~~

2201

~~2393~~

2482

~~2662~~

2763

~~2932~~

3043

~~3201~~

3324

1.50

~~819~~

843

~~1104~~

1139

~~1389~~

1436

~~1673~~

1732

~~1958~~

2028

~~2242~~

2325

~~2527~~

2621

~~2811~~

2917

~~3096~~

3214

~~3381~~

3510

2.00

~~865~~

890

~~1166~~

1203

~~1466~~

1516

~~1767~~

1829

~~2067~~

2142

~~2368~~

2455

~~2668~~

2768

~~2969~~

3081

~~3269~~

3394

~~3570~~

3707

2.50

~~914~~

940

~~1231~~

1270

~~1548~~

1601

~~1866~~

1931

~~2183~~

2262

~~2500~~

2592

~~2818~~

2923

~~3135~~

3253

~~3453~~

3584

~~3770~~

3914

3.00

~~965~~

993

~~1300~~

1342

~~1635~~

1691

~~1970~~

2040

~~2305~~

2389

~~2641~~

2738

~~2976~~

3087

~~3311~~

3436

~~3646~~

3785

~~3981~~

4134

3.50

~~1019~~

1048

~~1373~~

1417

~~1727~~

1785

~~2081~~

2154

~~2434~~

2522

~~2788~~

2891

~~3142~~

3259

~~3496~~

3628

~~3850~~

3996

~~4204~~

4365

4.00

~~1076~~

1107

~~1450~~

1496

~~1823~~

1885

~~2197~~

2274

~~2571~~

2664

~~2945~~

3053

~~3318~~

3442

~~3692~~

3831

~~4066~~

4220

~~4439~~

4609

4.50

~~1136~~

1169

~~1531~~

1580

~~1926~~

1991

~~2320~~

2402

~~2715~~

2813

~~3109~~

3224

~~3504~~

3635

~~3899~~

4046

~~4293~~

4457

~~4688~~

4868

5.00

~~1200~~

1234

~~1617~~

1668

~~2033~~

2102

~~2450~~

2536

~~2867~~

2970

~~3284~~

3404

~~3700~~

3838

~~4117~~

4272

~~4534~~

4706

~~4950~~

5140

5.50

~~1267~~

1304

~~1707~~

1762

~~2147~~

2220

~~2587~~

2678

~~3027~~

3137

~~3467~~

3595

~~3908~~

4053

~~4348~~

4511

~~4788~~

4970

~~5228~~

5428

6.00

[Filed Emergency 6/13/01, effective 7/1/01]

[Published 7/11/01]

EDITOR’S NOTE: For replacement pages for IAC, see IAC Supplement 7/11/01.

ARC 0791B

HUMAN SERVICES DEPARTMENT[441]

Adopted and Filed Emergency

Pursuant to the authority of Iowa Code section 234.6 and 2001 Iowa Acts, House File 732, section 31, subsection 6, and section 49, the Department of Human Services hereby amends Chapter 150, “Purchase of Service,” appearing in the Iowa Administrative Code.

In compliance with Iowa Code section 17A.4(2), the Department of Human Services finds that notice and public participation are unnecessary because these amendments implement 2001 Iowa Acts, House File 732, section 31, subsection 6, and section 49 that authorize the Department to adopt rules without notice and public participation.

These amendments were also published under Notice of Intended Action in the Iowa Administrative Bulletin on July 11, 2001, as ARC 0790B to allow for public comment.

The Council on Human Services adopted these amendments June 13, 2001.

These amendments are intended to implement Iowa Code section 234.6 and 2001 Iowa Acts, House File 732, section 31, subsection 6.

These amendments became effective July 1, 2001.

The following amendments are adopted.

ITEM 1. Amend subrule 150.3(5), paragraph “p,” subparagraph (2), as follows:

Amend the introductory paragraph and numbered paragraph “1,” introductory paragraph, as follows:

(2) For the fiscal year beginning July 1, ~~2000~~ 2001, the maximum reimbursement rates for services provided under a purchase of social service agency contract (adoption; , shelter care; , family planning; , and independent living) shall be the same as the rates in effect on June 30, ~~2000~~ 2001, except under any of the following circumstances:

1. If a new service was added after June 30, ~~2000~~ 2001, the initial reimbursement rate for the service shall be based upon actual and allowable costs. A new service does not include a new building or location or other changes in method of service delivery for a service currently provided under the contract.

Amend numbered paragraph “3,” as follows:

3. For the fiscal year beginning July 1, ~~2000~~ 2001, the combined service and maintenance reimbursement rate paid to a shelter care provider shall be based on the financial and statistical report submitted to the department. The maximum reimbursement rate shall be $83.69 per day. If the department reimburses the provider at less than the maximum rate, but the provider’s cost report justifies a rate of at least $83.69, the department shall readjust the provider’s reimbursement rate to the actual and allowable cost plus the inflation factor or $83.69, whichever is less.

Rescind and reserve numbered paragraph “4.”

ITEM 2. Amend the implementation clause following 441—Chapter 150, Division I, to read as follows:

These rules are intended to implement Iowa Code section 234.6 and 2001 Iowa Acts, House File 732, section 31, subsection 6.

[Filed Emergency 6/13/01, effective 7/1/01]

[Published 7/11/01]

EDITOR’S NOTE: For replacement pages for IAC, see IAC Supplement 7/11/01.

ARC 0793B

HUMAN SERVICES DEPARTMENT[441]

Adopted and Filed Emergency

Pursuant to the authority of Iowa Code section 234.6 and 2001 Iowa Acts, House File 732, section 31, subsection 5, and section 49, the Department of Human Services hereby amends Chapter 156, “Payments for Foster Care and Foster Parent Training,” and Chapter 201, “Subsidized Adoptions,” appearing in the Iowa Administrative Code.

These amendments implement the increases to foster family homes and adoptive homes mandated by the Seventy–ninth General Assembly.

These amendments do not provide for any waivers inspecified situations because these changes confer a benefit on foster parents and adoptive parents by increasing the foster family daily maintenance rate and the maximum adoption subsidy rate.

In compliance with Iowa Code section 17A.4(2), the Department of Human Services finds that notice and public participation on these amendments are unnecessary because these amendments implement 2001 Iowa Acts, House File 732, section 31, subsection 5, and section 49, that authorizes the Department to adopt rules without notice and public participation.

These amendments were also published under Notice of Intended Action in the Iowa Administrative Bulletin on July 11, 2001, as ARC 0792B to allow for public comment.

The Council on Human Services adopted these amendments June 13, 2001.

These amendments are intended to implement Iowa Code section 234.6 and 2001 Iowa Acts, House File 732, section 31, subsection 5.

These amendments became effective July 1, 2001.

The following amendments are adopted.

ITEM 1. Amend rule 441—156.6(234) as follows:

Amend subrule 156.6(1) as follows:

156.6(1) Basic rate. A monthly payment for care in a foster family home licensed in Iowa shall be made to the foster family based on the following schedule:

Age of child	Daily rate
0 through 5	~~$14.00~~ $14.28
6 through 11	~~14.78~~ 15.07
12 through 15	~~16.53~~ 16.83
16 and over	~~16.53~~ 16.83

Further amend rule 441—156.6(234), implementation clause, to read as follows:

This rule is intended to implement Iowa Code section 234.38 and ~~2000 Iowa Acts, Senate File 2435, section 31, subsection 6~~ 2001 Iowa Acts, House File 732, section 31, subsection 5.

ITEM 2. Amend 441—Chapter 201, implementation clause, to read as follows:

These rules are intended to implement Iowa Code sections 600.17 to 600.21 and 600.23; and ~~2000 Iowa Acts, Senate File 2435, section 31, subsection 6~~ 2001 Iowa Acts, House File 732, section 31, subsection 5.

[Filed Emergency 6/13/01, effective 7/1/01]

[Published 7/11/01]

EDITOR’S NOTE: For replacement pages for IAC, see IAC Supplement 7/11/01.

ARC 0795B

HUMAN SERVICES DEPARTMENT[441]

Adopted and Filed Emergency

Pursuant to the authority of Iowa Code subsection 249H.6(3), the Department of Human Services hereby amends Chapter 162, “Nursing Facility Conversion and Long–Term Care Services Development Grants,” appearing in the Iowa Administrative Code.

The Department finds that notice and public participation are unnecessary and impracticable because the Department has no choice but to implement this change which was mandated by the Seventy–ninth General Assembly and there is not time to allow for notice and public comment before the statutory effective date of July 1, 2001. Therefore, these amendments are filed pursuant to Iowa Code section 17A.4(2).

The Department finds that these amendments confer a benefit on grant conversion applicants by lowering the period of time they must be providers before they can be eligible for a grant. Therefore, these amendments are filed pursuant to Iowa Code section 17A.5(2)“b”(2).

These amendments are also published herein under Notice of Intended Action as ARC 0794B to allow for public comment.

The Council on Human Services adopted these amendments June 13, 2001.

These amendments are intended to implement Iowa Code section 249H.6 as amended by 2001 Iowa Acts, House File 740, section 7.

These amendments became effective July 1, 2001.

The following amendments are adopted.

ITEM 1. Amend 441—Chapter 162 by amending the parenthetical statute reference (78GA,SF2193) as follows wherever it appears:

(~~78GA,SF2193~~ 249H)

ITEM 2. Amend subrule 162.3(1), paragraphs “a” and “b,” as follows:

a. A licensed nursing facility that has been an approved provider under the medical assistance program under the same ownership for the ~~three~~ two–year period prior to application for the grant.

b. A provider of long–term care services, including one not covered by the medical assistance program, that has been in business for at least ~~three~~ two years under the same owner.

ITEM 3. Amend the implementation clause following 441—Chapter 162 as follows:

These rules are intended to implement ~~2000 Iowa Acts, Senate File 2193, section 6~~ Iowa Code section 249H.6 as amended by 2001 Iowa Acts, House File 740, section 7.

[Filed Emergency 6/13/01, effective 7/1/01]

[Published 7/11/01]

EDITOR’S NOTE: For replacement pages for IAC, see IAC Supplement 7/11/01.

ARC 0797B

HUMAN SERVICES DEPARTMENT[441]

Adopted and Filed Emergency

Pursuant to the authority of Iowa Code section 234.6 and 2001 Iowa Acts, House File 732, section 14, subsection 14, paragraph “b,” and section 49, the Department of Human Services hereby rescinds Chapter 179, “Wrap–Around Funding Program,” appearing in the Iowa Administrative Code.

This amendment eliminates the Wrap–around Funding Program at the direction of the Seventy–ninth General Assembly. Funding for this program was eliminated in the Department’s appropriation bill.

This amendment does not provide for any waivers to receive the program because this change was mandated by the legislature, with no provisions for exceptions.

In compliance with Iowa Code section 17A.4(2), the Department finds that notice and public participation are unnecessary because this amendment implements 2001 Iowa Acts, House File 732, section 14, subsection 14, paragraph “b,” and section 49, that authorize the Department to adopt rules without notice and public participation.

The Department also finds, pursuant to Iowa Code section 17A.5(2)“b”(1), that the normal effective date of this amendment should be waived and this amendment made effective July 1, 2001, as authorized by 2001 Iowa Acts, House File 732, section 14, subsection 14, paragraph “b,” and section 49.

This amendment is also published herein under Notice of Intended Action as ARC 0796B to allow for public comment.

The Council on Human Services adopted this amendment June 13, 2001.

This amendment is intended to implement Iowa Code section 234.6 and 2001 Iowa Acts, House File 732, section 14, subsection 14, paragraph “b.”

This amendment became effective July 1, 2001.

The following amendment is adopted.

Rescind and reserve 441—Chapter 179.

[Filed Emergency 6/13/01, effective 7/1/01]

[Published 7/11/01]

EDITOR’S NOTE: For replacement pages for IAC, see IAC Supplement 7/11/01.

ARC 0799B

HUMAN SERVICES DEPARTMENT[441]

Adopted and Filed Emergency

Pursuant to the authority of Iowa Code section 217.6 and 2001 Iowa Acts, House File 732, section 31, subsection 8, and section 49, the Department of Human Services hereby amends Chapter 185, “Rehabilitative Treatment Services,” appearing in the Iowa Administrative Code.

This amendment does not provide for any waivers to the rate freeze because this change was mandated by the legislature, with no provisions for exceptions.

In compliance with Iowa Code section 17A.4(2), the Department of Human Services finds that notice and public participation are unnecessary because this amendment implements 2001 Iowa Acts, House File 732, section 31, subsection 8, and section 49, that authorize the Department to adopt rules without notice and public participation.

This amendment was also published under Notice of Intended Action in the Iowa Administrative Bulletin on July 11, 2001, as ARC 0798B to allow for public comment.

The Council on Human Services adopted this amendment June 13, 2001.

This amendment is intended to implement Iowa Code section 234.6 and 2001 Iowa Acts, House File 732, section 31, subsection 8.

This amendment became effective July 1, 2001.

The following amendment is adopted.

Amend subrule 185.112(1), paragraph “k,” as follows:

k. Once a negotiated rate is established based on the provisions of this subrule, it shall not be changed or renegotiated during the time period of this rule except in the following circumstances:

(1) By mutual consent of the provider and the regional administrator of the host region based upon the factors delineated at paragraph 185.112(1)“f,” except that rates shall not be changed or renegotiated for the period of July 1, 2000, through June 30, ~~2001~~ 2002.

(2) In accordance with paragraph 185.112(6)“b,” except that rates shall not be changed or renegotiated for services not assumed by a new provider for the period of July 1, 2000, through June 30, ~~2001~~ 2002.

(3) Rates may be changed when funds are appropriated for an across–the–board increase. ~~Effective July 1, 2000, a 5 percent across–the–board cost–of–living adjustment will be applied.~~

[Filed Emergency 6/13/01, effective 7/1/01]

[Published 7/11/01]

EDITOR’S NOTE: For replacement pages for IAC, see IAC Supplement 7/11/01.

ARC 0804B

LIBRARIES AND INFORMATION SERVICES DIVISION[286]

Adopted and Filed Emergency

Pursuant to the authority of Iowa Code section 256.52, the Commission of Libraries hereby adopts new Chapter 9, “Appointment Process for Library Service Area Boards of Trustees,” Iowa Administrative Code.

This chapter implements 2001 Iowa Acts, House File 637, section 14(7), and outlines the process for appointing members to library service area boards.

In compliance with Iowa Code section 17A.4(2), the Commission finds that notice and public participation are impracticable and contrary to the public interest due to the need to have the library service area boards in place on or soon after July 1, 2001, in order to conduct the business of the library service areas, which includes authorizing payroll and bill payments.

The Commission also finds, pursuant to Iowa Code section 17A.5(2)“b”(2), that the normal effective date of these rules should be waived and these rules should be made effective upon filing with the Administrative Rules Coordinator on June 20, 2001, as they confer an immediate benefit to library service areas.

The Commission adopted these rules on June 11, 2001.

These rules are also published herein under Notice of Intended Action as ARC 0819B to allow public comment. This emergency filing permits the State Library to implement the new provisions of the legislation.

These rules are intended to implement 2001 Iowa Acts, House File 637, section 14(7).

These rules became effective June 20, 2001.

The following new chapter is adopted.

CHAPTER 9
APPOINTMENT PROCESS FOR
LIBRARY SERVICE AREA
BOARDS OF TRUSTEES

286—9.1(256) Definitions. The definitions used in Iowa Code chapters 17A and 256 shall apply for terms used throughout this chapter. In addition, the following definitions shall apply:

“Area education agency media division representative” means an individual currently employed by an area education agency (AEA) media division located within the geographic boundaries of the library service area.

“At–large representative” means an individual residing within the geographic boundaries of the library service area.

“Board” means the seven–member governing board of trustees for each of the seven library service areas.

“Commission” means the Iowa commission of libraries, which serves as the governing board of the state library.

“Community college representative” means an employee or a trustee of a community college located within the geographic boundaries of the library service area and whose position, experience, and background are relevant to the responsibilities and duties of the library service area.

“Library patron representative” means a user of any type of library located within the geographic boundaries of the library service area.

“Library service area” means an intermediate service agency established to provide support services to libraries, including consulting, continuing education, and interlibrary loan and reference services, and to encourage local financial support for library services.

“Public library employee” means a person currently employed by a public library located within the geographic boundaries of the library service area.

“Public library trustee” means a current member of the governing board of trustees of a public library located within the geographic boundaries of the library service area.

286—9.2(256) Authority. The commission coordinates the appointments to the boards of trustees of the library service areas and ensures appointments are consistently made across the state and are in compliance with administrative rules.

286—9.3(256) Board overview. A library service area board of trustees, balanced by gender and political party (to be verified by state voter registration records), consists of seven members representing constituencies located within the library service area’s geographic boundaries. Each board shall include an AEA media division representative, a public library trustee, a public library employee, a community college representative, a library patron, and two at–large representatives.

9.3(1) Terms for library service area board members shall be four years, except for board members appointed in 2001 who shall serve staggered terms as follows:

AEA media division representative 2–year term

Public library trustee 3–year term

Public library employee 4–year term

Community college representative 2–year term

Library patron 3–year term

At–large representative 4–year term

At–large representative 2–year term

9.3(2) No library service area board member shall serve more than two consecutive terms.

9.3(3) The position of any board member shall be considered vacant if the member is absent from three consecutive regular meetings of the board, except in the case of illness or temporary absence, or if the member no longer fulfills the qualifications of the member’s appointment.

9.3(4) The state library shall be notified by the administrator of the library service area when a board vacancy occurs.

9.3(5) Each library service area board shall elect two members to serve on a library service area executive council.

286—9.4(256) Appointments. The board members shall be mutually appointed within each library service area in accordance with the following process.

9.4(1) Area education agency media division representative. Directors of the AEA media divisions located within the geographic service area of the library service area shall be contacted by the commission and asked to mutually agree on a representative and submit to the commission an appointment form signed by all AEA media division directors within the library service area.

The commission shall notify the administrator of the library service area of the appointment.

9.4(2) Public library trustee and public library employee. One statewide nominating committee for the seven library service area boards shall be convened by the commission. Voting members of the nominating committee shall include two members appointed by the commission and one representative appointed by each of the following library organizations: the Iowa Library Association, the Iowa Library Trustees Association, the Iowa Small Libraries Association, the Iowa Libraries of Medium Size, and the Iowa Urban Public Libraries. Each library organization shall be asked to consider size and location of community in making an appointment. State library staff shall assist in accomplishing the work of the nominating committee.

a. The nominating committee shall:

(1) Solicit nominations for public library trustees (must be a public library trustee at the time of appointment) and public library employees (must be a public library employee at time of appointment) in each of the library service areas through various means (i.e., newsletters, Web sites, electronic mailing lists).

(2) Receive nominations on standardized nomination forms that include information on political party and gender.

(3) Develop a slate of public library trustee candidates for each of the seven library service areas as vacancies occur. To ensure an adequate number of candidates to meet the political party and gender balance requirements and other considerations such as candidate qualifications and size and location of community represented, each slate must include at least two candidates.

(4) Develop a slate of public library employee candidates for each of the seven library service areas as vacancies occur. The nominating committee shall seek a broad cross section of library employees for the public library employee slates. To ensure an adequate number of candidates to meet the political party and gender balance requirements and other considerations such as candidate qualifications and size and location of community represented, each slate must include at least two candidates.

(5) Ensure that each public library board has an equal voice by distributing one public library trustee ballot to the president of each public library board of trustees located within the geographic boundaries of the library service area. It is the responsibility of the president of the local public library board to confer with other board members, to vote for one candidate, and to return the ballot to the nominating committee.

(6) Ensure that each public library has an equal voice by distributing one public library employee ballot to the director of each public library located within the geographic boundaries of the library service area. It is the responsibility of the public library director to confer with library staff, to vote for one candidate, and to return the ballot to the nominating committee.

(7) Collect and count the votes for public library trustee and public library employee candidates in each library service area. The candidates with the most votes shall be appointed to the library service area board provided that statutory requirements concerning political party and gender balance are fulfilled. If political party and gender balance is not achieved, the nominating committee shall select the candidate with the highest number of votes who meets political party and gender balance requirements.

(8) Submit to the commission election results for the public library trustee representative and the public library employee representative for each library service area board.

b. The commission certifies the election results and notifies the administrator of the library service area of the appointments.

c. In the event a public library trustee or public library employee vacancy occurs before the end of a term, the commission shall appoint a public library trustee or public library employee to serve the remainder of the term. When possible, appointees will be selected from the candidates voted upon on the most recent ballot.

9.4(3) Community college representative. The presidents of the community colleges located within the geographic boundaries of the library service area shall be contacted by the commission and asked to coordinate the selection of a representative mutually agreed upon by the community college boards of trustees. The community college presidents shall be asked to submit to the commission an appointment form signed by all of the community college presidents within the library service area. The representative whose position, experience, and background are relevant to the responsibilities and duties of the library service area must be an employee of a community college or be a community college board member within the library service area.

The commission shall notify the administrator of the library service area of the appointment.

9.4(4) Commission appointees. The commission shall appoint to each library service area board one individual to represent library users residing within the boundaries of the library service area. The commission shall also appoint to each library service area board two individuals to represent the public at large residing within the boundaries of the library service area.

a. For the library patron representatives, the commission shall:

(1) Solicit nominations from Iowa libraries of all types. Nomination forms are to be submitted to the commission.

(2) Consider candidate qualifications and current library service area board makeup (i.e., political party and gender balance, size and location of community, type of library) when making appointments.

(3) Notify the administrator of the library service area of the appointment.

b. For the at–large representatives, the commission shall:

(1) Solicit nominations from Iowa libraries of all types. A candidate may be a current or past employee of any type of library, a current or past library trustee, a library patron, or a member of the general public. Nomination forms shall be submitted to the commission.

(3) Notify the administrator of the library service area of the appointments.

286—9.5(256) Review process. Actions of the commission regarding appointments to library service area boards of trustees may be reviewed as follows:

9.5(1) Reviews shall be made on procedural grounds only. Such grounds include alleged conflicts of interest or procedures not uniformly applied to all library service areas.

9.5(2) A written and signed explanation of the concern shall be sent to the chairperson of the commission. The letter of explanation shall include:

a. The facts of the concern;

b. Suggested remedy; and

c. An argument in favor of the remedy.

9.5(3) The commission shall consider the concerns and remedies expressed in the letter of explanation and will provide the individual with a written response within 30 calendar days.

These rules are intended to implement 2001 Iowa Acts, House File 637, section 14.

[Filed Emergency 6/20/01, effective 6/20/01]

[Published 7/11/01]

EDITOR’S NOTE: For replacement pages for IAC, see IAC Supplement 7/11/01.

ARC 0805B

PERSONNEL DEPARTMENT[581]

Adopted and Filed Emergency After Notice

Pursuant to the authority of Iowa Code section 19A.9, the Department of Personnel hereby amends Chapter 10, “Promotion, Transfer, Temporary Assignment, Reassignment and Voluntary Demotion,” Chapter 11, “Separations, Disciplinary Actions and Reduction in Force,” and Chapter 14, “Leave,” Iowa Administrative Code.

These amendments relate to the processes and procedures of a reduction in force.

Notice of Intended Action was published in the Iowa Administrative Bulletin on May 16, 2001, as ARC 0675B.

A public hearing concerning the noticed rules was held on June 5, 2001. Comments were received during the notice period, but no comments were received at the public hearing.

These amendments are identical to the Notice of Intended Action.

Pursuant to Iowa Code section 17A.5(2)“b”(2), these amendments shall become effective on June 22, 2001, and filing of this notice. The Department finds that these amendments confer a benefit upon the Executive Branch of Iowa state government, state employees and the public by correcting and clarifying the procedures and processes associated with reduction in force and reorganization and amending the rules to conform to the Department’s statutory authority. Adoption of these amendments benefits the Executive Branch of state government and state employees by ensuring legally sound, equitable treatment of affected employees, and benefits the public by facilitating budget savings through workforce reduction.

These amendments are intended to implement Iowa Code section 19A.9.

These amendments became effective June 22, 2001.

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 amendments [10.2, 11.3, 14.2(2), 14.3(10)] is being omitted. These amendments are identical to those published under Notice as ARC 0675B, IAB 5/16/01.

[Filed Emergency After Notice 6/21/01, effective 6/22/01]
[Published 7/11/01]

[For replacement pages for IAC, see IAC Supplement 7/11/01.]

ARC 0803B

WORKERS’ COMPENSATION DIVISION[876]

Adopted and Filed Emergency

Pursuant to the authority of Iowa Code section 86.8, the Workers’ Compensation Commissioner hereby amends Chapter 8, “Substantive and Interpretive Rules,” Iowa Administrative Code.

This amendment provides a reference to current tables which determine payroll taxes.

In compliance with Iowa Code section 17A.4(2), the Workers’ Compensation Commissioner finds that notice and public participation are unnecessary. Rule 8.8(85,17A) is noncontroversial and, further, Iowa Code section 85.61(6) requires adoption of current tables to determine payroll taxes by July 1 of each year. The Division must wait until the Internal Revenue Service and Iowa Department of Revenue and Finance determine whether there will be changes in their publications on July 1 of the current year.

The Division also finds, pursuant to Iowa Code section 17A.5(2)“b”(2), that the normal effective date of this amendment, 35 days after publication, should be waived and the amendment made effective July 1, 2001, as it confers a benefit upon the public to ensure speedy and uniform compliance with the Division’s legislative mandate.

The Division has determined that the amendment will have no impact on small business within the meaning of Iowa Code section 17A.31.

The amendment does not include a waiver provision because rule 876—12.4(17A) provides the specified situations for waiver of Workers’ Compensation Division rules.

This amendment is intended to implement Iowa Code section 85.61(6).

This amendment became effective on July 1, 2001.

The following amendment is adopted.

Amend rule 876—8.8(85,17A) to read as follows:

876—8.8(85,17A) Payroll tax tables. Tables for determining payroll taxes to be used for the period July 1, ~~2000~~ 2001, through June 30, ~~2001~~ 2002, are the tables in effect on July 1, ~~2000~~ 2001, for computation of:

1. Federal income tax withholding according to the percentage method of withholding for weekly payroll period. (Internal Revenue Service, Circular E, Employer’s Tax Guide, Publication 15 [Rev. January ~~2000~~ 2001].)

2. Iowa income tax withholding computer formula for weekly payroll period. (Iowa Department of Revenue and Finance Iowa Withholding Tax Guide, Publication 44–001 [Rev. January 1998], for all wages paid on or after January 1, 1998.)

3. Social Security and Medicare withholding (FICA) at the rate of 7.65 percent (Internal Revenue Service, ~~Employer’s Supplemental Tax Guide, Publication 15–A~~ Circular E, Employer’s Tax Guide, Publication 15 [Rev. January ~~2000~~ 2001].)

This rule is intended to implement Iowa Code section 85.61(6).

[Filed Emergency 6/20/01, effective 7/1/01]

[Published 7/11/01]

EDITOR’S NOTE: For replacement pages for IAC, see IAC Supplement 7/11/01.

FILED

ARC 0822B

CIVIL RIGHTS COMMISSION[161]

Adopted and Filed

Pursuant to the authority of Iowa Code subsection 216.5(10), the Civil Rights Commission hereby amends Chapter 15, “Miscellaneous Provisions,” Iowa Administrative Code.

This new rule describes the application procedures and criteria for issuing or denying waivers from Commission rules. The purpose of this rule is to comply with Iowa Code section 17A.9A and Executive Order Number 11, which require state agencies to adopt a uniform waiver rule. Notice of Intended Action was published in the May 2, 2001, Iowa Administrative Bulletin as ARC 0641B.

A public hearing was held on May 22, 2001. No one attended the hearing, and no written or oral comments were received.

The Civil Rights Commission board adopted this rule on June 20, 2001.

This rule is identical to the one published under Notice of Intended Action.

This rule will become effective August 15, 2001.

This rule is intended to implement Iowa Code section 17A.9 and Executive Order Number 11.

The following amendment is adopted.

Amend 161—Chapter 15 by adopting the following new rule:

161—15.3(17A,ExecOrd11) Waiver of requirements imposed by commission rule.

15.3(1) Filing of a request for waiver or variance. Any person may file a request for waiver or variance of an administrative rule of the civil rights commission by writing a proper request which is received by Executive Director, Civil Rights Commission, Second Floor, 211 East Maple Street, Des Moines, Iowa 50309–1858. All requests for waiver or variance of an administrative rule must be in writing and meet all requirements set out in paragraph 15.3(2)“a.” A request for a waiver is filed by any of the methods listed in rule 161—3.5(216). The date a request for waiver is filed is governed by rule 161—subrule 3.5(7). The commission shall provide the requester with a file–stamped copy of the request if the requester provides an extra copy for this purpose.

15.3(2) Form of request.

a. Required contents. A request for waiver or variance of a rule must:

(1) Prominently state on its face that it is a request for a waiver or variance of an administrative rule; and

(2) State the name and address of the entity or person for whom a waiver or variance is requested; and

(3) Describe or give the citation of the specific rule for which a waiver or variance is requested; and

(4) State the specific waiver or variance requested.

The commission shall not process a filing as a request for a waiver or variance if that filing does not conform to the requirements of this paragraph.

b. Suggested contents. In addition, a request for waiver or variance of a rule should also:

(1) State all relevant facts that the requester believes would justify a waiver or variance.

(2) State the reasons the requester believes will justify a waiver or variance.

(3) State the history of the commission’s action relative to the requester. If the request is in connection with a complaint of discrimination on file with the commission, the requester should identify the complaint at issue including, if possible, the complaint number.

(4) State any information regarding the commission’s treatment of similar cases, if known.

(5) State the name, address and telephone number of any person inside or outside state government who would be adversely affected by the grant of the request or who otherwise possesses knowledge of the matter with respect to the waiver or variance request.

15.3(3) Procedure for evaluating requests for waiver.

a. Service of request. Within 30 days after the receipt of a request for waiver or variance of an administrative rule, the commission shall provide a copy to all persons who are required to receive one by a provision of law. The commission may also provide a copy of the request to those individuals whom the requester has identified as being adversely affected by a grant of the request. In the case of a request made in connection with a complaint of discrimination on file with the commission, the commission shall provide a copy of the request to all other parties in the case. Service may occur by regular mail. If necessary for maintenance of the confidentiality of a commission investigation, information may be redacted from a request for variance before the request is provided to persons other than the requester.

b. Decision maker for request. The decision whether to grant a request for waiver or variance shall be made either by the executive director or upon a vote of the commissioners. If the request is made in connection with a complaint of discrimination on file with the commission, any discussion by the commissioners of the request for waiver may be in closed session.

c. Investigation of allegations. The decision maker or a designated member of the commission staff may conduct an investigation into any factual issue which is relevant to the request for a waiver or variance. A refusal by the requester to cooperate in this investigation may be grounds to deny the request for waiver or variance. In the case of a request made in connection with a complaint of discrimination, if any party to the complaint refuses to cooperate in the investigation, the decision maker may infer that the requested information would be adverse to the uncooperative party.

d. Time frame for decision on request. The commission shall render a decision on a request for waiver or variance of a rule within 120 days of receipt of the request. During this period the commission may extend the time for rendering a decision by notifying all persons who were notified of the request pursuant to paragraph 15.3(3)“a” that the time for rendering a decision has been extended. This notice shall include a new time frame for rendering the decision. Failure to render a decision or extend the time for rendering a decision within the required period shall be deemed a denial of the request.

e. Notification of decision. The commission shall send any decision rendered concerning the request for waiver or variance to all persons who were notified of the request pursuant to paragraph 15.3(3)“a.”

f. Form of grant of request. Any waiver or variance shall be the narrowest exception possible to the provisions of the rule. A waiver or variance shall not be permanent unless the requester has shown that a temporary waiver or variance is impracticable. The commission may renew a temporary waiver or variance without a request if the commission finds that the factors of paragraph 15.3(4)“b” remain valid.

15.3(4) Standard for evaluating request for waiver.

a. Burden of persuasion. The burden of persuasion rests with the person who requests from the commission a waiver or variance of a rule.

b. Standard. A request for a waiver or variance shall be evaluated based on the unique, individual circumstances set out in the request. A waiver or variance may be granted only if the decision maker finds clear and convincing evidence that:

(1) The application of the rule would pose an undue hardship on the person for whom the waiver or variance is requested; and

(2) The waiver or variance from the requirements of a rule in the specific case would not prejudice the substantial legal rights of any person; and

(3) The provisions of a rule subject to a request for a waiver or variance are not specifically mandated by statute or another provision of law; and

(4) Substantially equal protection of public health, safety, and welfare will be afforded by a means other than that prescribed in the particular rule for which the waiver or variance is requested; and

(5) Granting the request would not waive or vary any requirement created or duty imposed by statute.

15.3(5) Exceptions to waiver.

a. Waiver in contested cases. This rule does not apply to any request for a waiver or variance of a rule which is made in connection with a contested case before the commission. Waiver or variance requests made in connection with a contested case are governed by rule 161—4.29(17A).

b. Not applicable to this rule. No person may request a waiver or variance from the requirements of this rule.

c. Requests by commission officials. No commissioner, commission staff member or other commission official may file a request for a waiver of a requirement placed upon that individual as part of that individual’s official duties.

d. Time requirements. This rule does not authorize the commission to waive or vary any time requirement of an administrative rule.

e. No effect on case status. In the case of a request made in connection with a complaint of discrimination on file with the commission, the commission may not grant a request for waiver or variance if this would either close a case which was open at the time of the request or reopen a case which was closed at the time of the request. The reopening provisions of rule 161—3.16(216), however, shall apply.

15.3(6) Public inspection of waiver requests. All waiver or variance requests and responses shall be indexed by administrative rule number and available to members of the public for inspection at the offices of the Civil Rights Commission, Second Floor, 211 East Maple Street, Des Moines, Iowa. Identifying information concerning any person, including parties to complaints on file, may be withheld by the commission in order to protect the confidentiality of case–related information as required by Iowa Code section 216.15(4).

[Filed 6/21/01, effective 8/15/01]

[Published 7/11/01]

EDITOR’S NOTE: For replacement pages for IAC, see IAC Supplement 7/11/01.

ARC 0820B

CREDIT UNION DIVISION[189]

Adopted and Filed

Pursuant to the authority of Iowa Code sections 533.54 and 17A.9A and Executive Order Number 11, the Credit Union Review Board hereby adopts Chapter 23, “Uniform Waiver and Variance Rules,” Iowa Administrative Code.

Notice of Intended Action was published in the Iowa Administrative Bulletin on May 16, 2001, as ARC 0672B. No public comment was received on the rules. These rules are identical to those published under Notice.

The rules in Chapter 23 describe the procedures for applying for, issuing or denying waivers and variances from rules adopted by the Board or the Superintendent. The purpose of these rules is to comply with Iowa Code section 17A.9A and Executive Order Number 11 which relate to waivers and variances from the requirements of agency rules.

Consistent with Executive Order Number 9, the Board has considered the regulatory principles identified in the Order and finds that the proposed rules will serve an important public need in providing a fair and equitable procedure for requesting and granting waivers.

These rules were adopted by the Board on June 20, 2001.

These rules shall become effective August 15, 2001.

These rules are intended to implement Executive Order Number 11 and Iowa Code section 17A.9A.

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 23] is being omitted. These rules are identical to those published under Notice as ARC 0672B, IAB 5/16/01.

[Filed 6/21/01, effective 8/15/01]
[Published 7/11/01]

[For replacement pages for IAC, see IAC Supplement 7/11/01.]

ARC 0816B

ENVIRONMENTAL PROTECTION COMMISSION[567]

Adopted and Filed

Pursuant to the authority of Iowa Code section 455B.133, the Environmental Protection Commission hereby amends Chapter 22, “Controlling Pollution,” Iowa Administrative Code.

The purpose of this rule making is to incorporate the Department’s existing Periodic Monitoring Guidance into the rules. Also, this rule making adopts by reference Compliance Assurance Monitoring (CAM) that is required to be included in 40 CFR Part 70 or 71 operating permits. Periodic monitoring and CAM are needed to provide reasonable assurance of compliance with applicable requirements under the Clean Air Act (CAA).

Notice of Intended Action was published in the Iowa Administrative Bulletin on March 21, 2001, as ARC 0572B. An information meeting was held on January 25, 2001, and a public hearing was held on April 27, 2001, at the Air Quality Bureau in Urbandale. Written comments were provided by three organizations and incorporated by the Department.

Item 1 incorporates the Department’s existing Title V Periodic Monitoring Guidance into the rule. Periodic monitoring is required by 40 CFR Parts 70.6 and 71.6 where the applicable requirement does not require periodic testing or instrumental or noninstrumental monitoring.

Item 2 adopts by reference 40 CFR Part 64 Compliance Assurance Monitoring (CAM) for major stationary sources of air pollution that are required to obtain operating permits under Title V of the Clean Air Act. The fundamental requirements of CAM are to: (a) monitor compliance in a manner that is sufficient to yield data that provide a reasonable assurance of compliance and allow an owner or operator to make an informed certification of compliance; (b) take necessary corrective actions in response to the monitoring data; (c) report on the results of such monitoring; and (d) maintain records of such monitoring.

These amendments are intended to implement Iowa Code section 455B.133.

These amendments shall become effective on August 15, 2001.

The following amendments are adopted.

ITEM 1. Amend paragraph 22.108(3)“b” as follows:

b. Where the applicable requirement does not require periodic testing or instrumental or noninstrumental monitoring (which may consist of record keeping designed to serve as monitoring), periodic monitoring sufficient to yield reliable data from the relevant time period that are representative of the source’s compliance with the permit, as reported pursuant to subrule 22.108(5). Such monitoring ~~requirements~~ shall be determined by application of the “Periodic Monitoring Guidance” (June 18, 2001) available from the department ensure use of terms, test methods, units, averaging periods, and other statistical conventions consistent with the applicable requirement. Record–keeping provisions may be sufficient to meet the requirements of this rule and;

ITEM 2. Amend subrule 22.108(3), paragraph “c,” and adopt new paragraph “d” as follows:

c. As necessary, requirements concerning the use, maintenance, and, where appropriate, installation of monitoring equipment or methods.; and

d. As required, Compliance Assurance Monitoring (CAM) consistent with 40 CFR Part 64 (as amended through October 22, 1997).

[Filed 6/21/01, effective 8/15/01]

[Published 7/11/01]

EDITOR’S NOTE: For replacement pages for IAC, see IAC Supplement 7/11/01.

ARC 0812B

ENVIRONMENTAL PROTECTION COMMISSION[567]

Adopted and Filed

Pursuant to the authority of Iowa Code section 455B.304(8), the Environmental Protection Commission hereby rescinds Chapter 111, “Financial Assurance Requirements for Municipal Solid Waste Landfills,” Iowa Administrative Code, and adopts new Chapter 111 with the same title.

New Chapter 111 is a reorganization and amendment of the former chapter. The new chapter adopts procedures for review of financial assurance instruments by the Department. The new chapter also updates the allowable financial assurance mechanisms to more closely conform to current U.S. EPA requirements. The amendment is intended to satisfy the concerns raised in the Petition for Rule Making filed by the City of Henderson on May 31, 2000.

Notice of Intended Action was published in the Iowa Administrative Bulletin as ARC 0365B on December 27, 2000. A public hearing was held on January 19, 2001. Comments received have been addressed in a responsiveness summary. A copy of the responsiveness summary may be obtained from the Department of Natural Resources by contacting Jon Tack at (515)281–8889.

In response to public input, the proposed Chapter 111 has been revised. The proposed two–tiered financial assurance mechanism system will not be implemented. The adopted chapter returns to a system of multiple available financial assurance mechanisms.

A draft of the revised final chapter was distributed to interested parties for additional input. The proposed final Chapter 111 was presented to the Environmental Protection Commission on May 21, 2001, and public comment was received by the Commission. At the request of the Commission, additional revisions were made, and Chapter 111 was adopted by the Commission on June 18, 2001.

This amendment is intended to implement Iowa Code section 455B.304(8).

This amendment will become effective August 15, 2001.

The following amendment is adopted.

Rescind 567—Chapter 111 and adopt in lieu thereof the following new chapter:

CHAPTER 111
FINANCIAL ASSURANCE REQUIREMENTS FOR MUNICIPAL SOLID WASTE LANDFILLS

567—111.1(455B) Purpose. The purpose of this chapter is to implement Iowa Code sections 455B.304(8) and 455B.306(8) by providing the criteria for establishing financial assurance for closure, postclosure care and corrective action at municipal solid waste landfills.

567—111.2(455B) Applicability. The requirements of this chapter apply to all owners and operators of municipal solid waste landfills (MSWLF) except owners or operators who are state or federal government entities whose debts and liabilities are the debts and liabilities of a state or the United States.

567—111.3(455B) Financial assurance for closure.

111.3(1) The owner or operator must have a detailed written estimate, in current dollars, certified by an Iowa–licensed professional engineer, of the cost of hiring a third party to close the MSWLF in accordance with the closure plan as required by 567—subrules 103.2(13) and 102.12(10). Such estimate must be available at any time during the active life of the landfill. The owner or operator must submit to the department by April 1 of each year the estimate and financial assurance documentation.

a. The cost estimate must equal the cost of closing the MSWLF at any time during the active life of the facility when the extent and manner of its operation would make closure the most expensive.

b. During the active life of the MSWLF, the owner or operator must annually adjust the closure cost estimate for inflation.

c. The owner or operator must, annually or at the time of application for a permit amendment that increases closure costs, whichever occurs first, increase the closure cost estimate and the amount of financial assurance provided if changes to the closure plan or MSWLF conditions increase the maximum cost of closure at any time during the remaining active life of the facility.

d. The owner or operator may reduce the amount of financial assurance for closure if the most recent estimate of the maximum cost of closure at any time during the active life of the facility is less than the amount of financial assurance currently provided. Prior to the reduction, the owner or operator must submit to the department the justification for the reduction of the closure cost estimate and the updated documentation required by subrule 111.3(3) and receive department approval for the reduction. Approval or denial shall be issued within 30 days of receipt of the reduction request.

111.3(2) The owner or operator of an MSWLF must establish financial assurance for closure in accordance with the criteria in this chapter. The owner or operator must provide continuous coverage for closure until released from this requirement by demonstrating compliance with 567—subrules 103.2(13) and 102.12(10). A certification of compliance must be submitted by the owner or operator each year by April 1 and approved by the department.

111.3(3) The owner or operator of a sanitary landfill must verify that adequate financial assurance is in place in regard to closure. In order to comply with this rule, the owner or operator must comply with the following procedures:

a. The owner or operator shall submit a complete copy of the financial assurance instrument or the documents that establish the financial assurance instrument each year by April 1. The documents submitted shall contain, but are not limited to, the amount of the financial assurance, the annual financial statement and financial plan required by Iowa Code sections 455B.306(8)“e” and 455B.306(6)“c,” and the current balances of the closure and postclosure accounts required by Iowa Code section 455B.306(8)“b.” Nothing in this requirement shall require the duplicative submission of information otherwise submitted in order to comply with the requirements of this chapter.

b. The owner or operator shall submit, each year by April 1, a complete updated copy of the estimate, certified by an Iowa–licensed professional engineer, that forms the basis for the amount of financial assurance held by the owner or operator.

c. The owner or operator shall submit a copy of the documents establishing a financial assurance instrument in an amount equal to or greater than the third–party estimate.

d. The third–party estimate submitted to the department must account for at least the following factors determined by the department to be minimal necessary costs for closure:

(1) Closure and postclosure plan document revisions;

(2) Site preparation, earthwork and final grading;

(3) Drainage control culverts, piping and structures;

(4) Erosion control structures, sediment ponds and terraces;

(5) Final cap construction;

(6) Cap vegetation soil placement;

(7) Cap seeding, mulching and fertilizing;

(8) Monitoring well, piezometer and gas control modifications;

(9) Leachate system cleanout and extraction well modifications;

(10) Monitoring well installations and abandonments;

(11) Facility modifications to effect closed status;

(12) Engineering and technical services;

(13) Legal, financial and administrative services; and

(14) Closure compliance certifications and documentation.

e. The cost estimates contained in the third–party estimate of closure costs must be accurate and reasonable when compared to the cost estimates used by other similarly situated landfills in Iowa.

f. The owner or operator shall submit yearly, by April 1, proof of compliance with this chapter as follows:

(1) For publicly owned municipal solid waste landfills, the owner or operator shall submit to the department a copy of the owner or operator’s most recent annual audit report in the form prescribed by the office of the auditor of the state of Iowa.

(2) Privately held municipal solid waste landfills shall submit an affidavit from the owner or operator indicating that a yearly review has been performed by a certified public accountant to determine whether the privately owned landfill is in compliance with this chapter. The affidavit shall state the name of the certified public accountant, the dates and conclusions of the review, and the steps taken to rectify any deficiencies identified by the accountant.

567—111.4(455B) Financial assurance for postclosure care.

111.4(1) The owner or operator must have a detailed written estimate, in current dollars, certified by an Iowa–licensed professional engineer, of the cost of hiring a third party to conduct postclosure care for the MSWLF in compliance with the plan developed pursuant to 567—subrules 103.2(14) and 102.12(10). The cost estimate must account for the total cost of conducting postclosure care, as described in the plan, for the entire postclosure care period. The owner or operator must submit to the department by April 1 of each year the estimate and financial assurance documentation.

a. The cost estimate for postclosure care must be based on the most expensive costs of that care during the entire postclosure care period.

b. During the active life of the MSWLF and during the postclosure care period, the owner or operator must annually adjust the postclosure cost estimate for inflation.

c. The owner or operator must, annually or at the time of application for a permit amendment that increases postclosure costs, whichever occurs first, increase the estimate and the amount of financial assurance provided if changes in the postclosure plan or MSWLF conditions increase the maximum cost of postclosure care.

d. The owner or operator may reduce the amount of financial assurance for postclosure care if the most recent estimate of the maximum cost of postclosure care beginning at any time during the active life of the facility is less than the amount of financial assurance currently provided. Prior to the reduction, the owner or operator must submit to the department the justification for the reduction of the closure cost estimate and the updated documentation required by subrule 111.3(3) and receive department approval for the reduction. Approval or denial shall be issued within 30 days of receipt of the reduction request.

111.4(2) The owner or operator of an MSWLF must establish financial assurance for the costs of postclosure care required by 567—subrules 103.2(14) and 102.12(10). The owner or operator must provide continuous coverage for postclosure care until released from this requirement by demonstrating compliance with the postclosure plan and the closure permit. A certification of compliance must be submitted by the owner or operator annually by April 1 and approved by the department.

111.4(3) The owner or operator of a sanitary landfill must verify that adequate financial assurance is in place in regard to postclosure. In order to comply with this rule, the owner or operator must comply with the following procedures:

a. The documents submitted shall contain, but are not limited to, the amount of the financial assurance, the annual financial statement and financial plan required by Iowa Code sections 455B.306(8)“e” and 455B.306(6)“c,” and the current balances of the closure and postclosure accounts required by Iowa Code section 455B.306(8)“b.” Nothing in this requirement shall require the duplicative submission of information otherwise submitted in order to comply with the requirements of this chapter.

c. The owner or operator shall submit a copy of the documents establishing a financial assurance instrument in an amount equal to or greater than the third–party estimate.

d. The third–party estimate submitted to the department must account for at least the following factors determined by the department to be minimal necessary costs for closure:

(1) General site facilities, access roads and fencing maintenance;

(2) Cap and vegetative cover maintenance;

(3) Drainage and erosion control systems maintenance;

(4) Groundwater to waste separation systems maintenance;

(5) Gas control systems maintenance;

(6) Gas control systems monitoring and reports;

(7) Groundwater and surface water monitoring systems maintenance;

(8) Groundwater and surface water quality monitoring and reports;

(9) Groundwater monitoring systems performance evaluations and reports;

(10) Leachate control systems maintenance;

(11) Leachate management, transportation and disposal;

(12) Leachate control systems performance evaluations and reports;

(13) Facility inspections and reports;

(14) Engineering and technical services;

(15) Legal, financial and administrative services; and

(16) Financial assurance, accounting, audits and reports.

e. The cost estimates contained in the third–party estimate of postclosure care costs must be accurate and reasonable when compared to the cost estimates used by other similarly situated landfills in Iowa.

f. The owner or operator shall submit yearly, by April 1, proof of compliance with this chapter as follows:

(1) For publicly owned municipal solid waste landfills, the owner or operator shall submit to the department a copy of the owner’s or operator’s most recent annual audit report in the form prescribed by the office of the auditor of the state of Iowa.

567—111.5(455B) Financial assurance for corrective action.

111.5(1) An owner or operator required to undertake corrective action pursuant to 567—subrules 103.2(4) through 103.2(9), inclusive, must have a detailed written estimate prepared by an Iowa–licensed professional engineer, in current dollars, of the cost of hiring a third party to perform the required corrective action. The estimate must account for the total costs of the activities described in the approved corrective action plan for the entire corrective action period. The owner or operator must submit to the department the estimate and financial assurance documentation within 30 days of departmental approval of the corrective action plan.

a. The owner or operator must annually adjust the estimate for inflation until the corrective action program is completed.

b. The owner or operator must increase the cost estimate and the amount of financial assurance provided if changes in the corrective action program or MSWLF conditions increase the maximum cost of corrective action.

c. The owner or operator may reduce the amount of the cost estimate and the amount of financial assurance provided if the estimate exceeds the maximum remaining costs of the remaining corrective action. The owner or operator must submit to the department the justification for the reduction of the cost estimate and documentation of financial assurance.

111.5(2) The owner or operator of an MSWLF required to undertake a corrective action program must establish financial assurance for the most recent corrective action program by one of the mechanisms prescribed in 567—111.6(455B) and, if necessary, one of the mechanisms prescribed in 567— 111.7(455B). The owner or operator must provide continuous coverage for corrective action until released from financial assurance requirements by demonstrating compliance with the following:

a. Upon completion of the remedy, the owner or operator must submit to the department a certification of compliance with the approved corrective action plan. The certification must be signed by the owner or operator and by an Iowa–licensed professional engineer.

b. Upon departmental approval of completion of the corrective action remedy, the owner or operator shall be released from the requirements for financial assurance for corrective action.

567—111.6(455B) Allowable financial assurance mechanisms. The mechanisms used to demonstrate financial assurance as required by Iowa Code section 455B.306(8)“a” must ensure that the funds necessary to meet the costs of closure, postclosure care, and corrective action for known releases will be available whenever the funds are needed. Owners or operators must choose from options in subrules 111.6(1) to 111.6(9).

111.6(1) Trust fund.

a. An owner or operator may demonstrate financial assurance for closure, postclosure, and corrective action, whichever is applicable, by establishing a trust fund which conforms to the requirements of this subrule. The trustee must be an entity which has the authority to act as a trustee and whose trust operations are regulated and examined by a federal or state agency. A copy of the trust agreement must be submitted pursuant to subrules 111.3(3) and 111.4(3) and placed in the facility’s official files.

b. Payments into the trust fund must be made annually by the owner or operator over ten years or over the remaining life of the MSWLF, whichever is shorter, in the case of a trust fund for closure or postclosure care, or over one–half of the estimated length of the corrective action program in the case of response to a known release. This period is referred to as the pay–in period.

c. For a trust fund used to demonstrate financial assurance for closure and postclosure care, the first payment into the fund must be at least equal to the current cost estimate for closure or postclosure care divided by the number of years in the pay–in period as defined in 111.6(1)“b.” The amount of subsequent payments must be determined by the following formula:

Next Payment	=	CE	-	CV
			Y

where CE is the current cost estimate for closure or postclosure care (updated for inflation or other changes), CV is the current value of the trust fund, and Y is the number of years remaining in the pay–in period.

d. For a trust fund used to demonstrate financial assurance for corrective action, the first payment into the trust fund must be at least equal to one–half of the current cost estimate for corrective action divided by the number of years in the corrective action pay–in period as defined in 111.6(1)“b.” The amount of subsequent payments must be determined by the following formula:

Next Payment	=	RB	-	CV
			Y

where RB is the most recent estimate of the required trust fund balance for corrective action, which is the total cost that will be incurred during the second half of the corrective action period, CV is the current value of the trust fund, and Y is the number of years remaining in the pay–in period.

e. The initial payment into the trust fund must be made before the initial receipt of waste or before the cancellation of an alternative financial assurance mechanism, in the case of closure and postclosure care; or no later than 120 days after the corrective action remedy has been approved by the department.

f. The owner or operator, or other person authorized to conduct closure, postclosure care, or corrective action activities may request reimbursement from the trustee for these expenditures, including partial closure, as they are incurred. Requests for reimbursement will be granted by the trustee only if sufficient funds are remaining in the trust fund to cover the remaining costs of closure, postclosure care, or corrective action and if justification and documentation of the costs are placed in the operating record. The owner or operator must submit to the department documentation of the justification for reimbursement and verification that reimbursement has been received.

g. The trust fund may be terminated by the owner or operator only if the owner or operator substitutes alternate financial assurance as specified in this rule or if the owner or operator is no longer required to demonstrate financial responsibility in accordance with this chapter.

h. After the pay–in period has been completed, the trust fund shall be adjusted annually to correct any deficiency of the fund with respect to the adjusted cost estimates and may be adjusted annually should the balance in the fund exceed the adjusted cost estimate.

111.6(2) Surety bond guaranteeing payment or performance.

a. An owner or operator may demonstrate financial assurance for closure or postclosure care by obtaining a payment or performance surety bond which conforms to the requirements of this subrule. An owner or operator may demonstrate financial assurance for corrective action by obtaining a performance bond which conforms to the requirements of this subrule. The bond must be effective before the initial receipt of waste or before the cancellation of an alternative financial assurance mechanism, in the case of closure and postclosure care; or no later than 120 days after the corrective action remedy has been approved by the department. The owner or operator must submit a copy of the bond to the department and keep a copy in the facility’s official files. The surety company issuing the bond must, at a minimum, be among those listed as acceptable sureties on federal bonds in Circular 570 of the U.S. Department of the Treasury.

b. The penal sum of the bond must be in an amount at least equal to the current closure and postclosure or corrective action cost estimate, whichever is applicable.

c. Under the terms of the bond, the surety will become liable on the bond obligation when the owner or operator fails to perform as guaranteed by the bond and also upon notice from the department pursuant to 111.6(2)“f.”

d. The owner or operator must establish a standby trust fund. The standby trust fund must meet the requirements of subrule 111.6(1) except the requirements for initial payment and subsequent annual payments specified in 111.6(1)“b” through “e.”

e. Payments made under the terms of the bond will be deposited by the surety directly into the standby trust fund. Payments from the trust fund must be approved by the trustee and the department.

f. Under the terms of the bond, the surety may only cancel the bond by sending notice of cancellation by certified mail to the owner and operator and to the department 120 days in advance of cancellation. When such notice is provided, the owner or operator shall, within 60 days, provide to the department adequate proof of alternate financial assurance, notice from the surety of withdrawal of the cancellation, or proof of a deposit into the standby trust of a sum equal to the amount of the bond. If the owner or operator has not complied with this rule within the 60–day time period, this shall constitute a failure to perform and the department shall notify the surety, prior to the expiration of the 120–day notice period, that such a failure has occurred.

g. The bond must be conditioned upon faithful performance by the owner or operator of all closure, postclosure, or corrective action requirements of the Code of Iowa and this chapter. A failure to comply with 111.6(2)“f” shall also constitute a failure to perform under the terms of the bond.

h. Liability under the bond shall be for the duration of the operation, closure, and postclosure period.

i. The owner or operator may cancel the bond only if alternate financial assurance is substituted prior to cancellation or if the owner or operator is no longer required to demonstrate financial responsibility in accordance with this chapter.

111.6(3) Letter of credit.

a. An owner or operator may demonstrate financial assurance for closure, postclosure care, or corrective action, whichever is applicable, by obtaining an irrevocable standby letter of credit which conforms to the requirements of this subrule. The letter of credit must be effective before the initial receipt of waste or before the cancellation of an alternative financial assurance mechanism, in the case of closure and postclosure care; or no later than 120 days after the corrective action plan is approved by the department. The owner or operator must submit to the department a copy of the letter of credit and place a copy in the facility’s official files. The issuing institution must be an entity which has the authority to issue letters of credit and whose letter–of–credit operations are regulated and examined by a federal or state agency.

b. A letter from the owner or operator referring to the letter of credit by number, issuing institution, and date, and providing the name and address of the facility, and the amount of funds assured, must be included with the letter of credit submitted to the department and placed in the facility’s files.

c. The letter of credit must be irrevocable and issued for a period of at least one year in an amount at least equal to the current cost estimate for closure, postclosure care or corrective action, whichever is applicable. The letter of credit must provide that the expiration date will be automatically extended for a period of at least one year unless the issuing institution has cancelled the letter of credit by sending notice of cancellation by certified mail to the owner and operator and to the department 120 days in advance of cancellation. When such notice is provided, the owner or operator shall, within 60 days, provide to the department adequate proof of alternate financial assurance, notice of withdrawal of cancellation, or proof of a deposit of a sum equal to the amount of the letter of credit into the closure and postclosure accounts established pursuant to Iowa Code section 455B.306(8)“b.” If the owner or operator has not complied with this subrule within the 60–day time period, the issuer of the letter of credit shall deposit a sum equal to the amount of the letter of credit into the closure and postclosure accounts established by the owner or operator pursuant to Iowa Code section 455B.306(8)“b.” The provision of funds by the issuer of the letter of credit shall be considered an issuance of a loan to the owner and operator, and the terms of that loan shall be governed by the letter of credit or subsequent agreement between those parties. The state shall not be considered a party to this credit transaction.

d. The owner or operator may cancel the letter of credit only if alternate financial assurance is substituted prior to cancellation or if the owner or operator is no longer required to demonstrate financial responsibility in accordance with this chapter.

111.6(4) Insurance.

a. An owner or operator may demonstrate financial assurance for closure, postclosure care, or corrective action by obtaining insurance which conforms to the requirements of this subrule. The insurance must be effective before the initial receipt of waste or prior to cancellation of an alternative financial assurance, in the case of closure and postclosure care; or no later than 120 days after the corrective action plan has been approved by the department. At a minimum, the insurer must be licensed to transact the business of insurance, or be eligible to provide insurance as an excess or surplus lines insurer, in one or more states. The owner or operator must submit to the department a copy of the insurance policy and retain a copy in the facility’s official files.

b. The closure or postclosure care insurance policy must guarantee that funds will be available to close the MSWLF unit whenever final closure occurs or to provide postclosure care for the MSWLF unit whenever the postclosure care period begins, whichever is applicable. The policy must also guarantee that once closure or postclosure care begins, the insurer will be responsible for the paying out of funds to the owner or operator or other person authorized to conduct closure or postclosure care, up to an amount equal to the face amount of the policy.

c. The insurance policy must be issued for a face amount at least equal to the current cost estimate for closure or postclosure care, whichever is applicable. The term “face amount” means the total amount the insurer is obligated to pay under the policy. Actual payments by the insurer will not change the face amount, although the insurer’s future liability will be lowered by the amount of the payments.

d. An owner or operator, or any other person authorized to conduct closure or postclosure care, may receive reimbursements for closure or postclosure expenditures, including partial closure, whichever is applicable. Requests for reimbursement will be granted by the insurer only if the remaining value of the policy is sufficient to cover the remaining costs of closure or postclosure care, and if justification and documentation of the cost are placed in the operating record. The owner or operator must submit to the department documentation of the justification for reimbursement and verification that the reimbursement has been received.

e. Each policy must contain a provision allowing assignment of the policy to a successor owner or operator. Such assignment may be conditional upon consent of the insurer, provided that such consent is not unreasonably refused.

f. The insurance policy must provide that the insurer may not cancel, terminate or fail to renew the policy except for failure to pay the premium. The automatic renewal of the policy must, at a minimum, provide the insured with the option of renewal at the face amount of the expiring policy. If there is a failure to pay the premium, the insurer may cancel the policy by sending notice of cancellation by certified mail to the owner and operator and to the department 120 days in advance of cancellation. When such notice is provided, the owner or operator shall, within 60 days, provide to the department adequate proof of alternate financial assurance, notice from the insurer of withdrawal of cancellation, or proof of a deposit of a sum equal to the amount of the insurance coverage into the closure and postclosure accounts established pursuant to Iowa Code section 455B.306(8)“b.” If the owner or operator has not complied with this subrule within the 60–day time period, this shall constitute a failure to perform and shall be a covered event pursuant to the terms of the insurance policy. A failure by the owner or operator to comply with this subrule within the 60–day period shall make the insurer liable for the closure and postclosure care of the covered facility up to the amount of the policy limits, which shall be equal to the most recently submitted cost estimates.

g. For insurance policies providing coverage for postclosure care, commencing on the date that liability to make payments pursuant to the policy accrues, the insurer will thereafter annually increase the face amount of the policy. Such increase must be equivalent to the face amount of the policy, less any payments made, multiplied by an amount equivalent to 85 percent of the most recent investment rate or of the equivalent coupon–issue yield announced by the U.S. Treasury for 26–week treasury securities.

h. The owner or operator may cancel the insurance only if alternate financial assurance is substituted prior to cancellation or if the owner or operator is no longer required to demonstrate financial responsibility in accordance with this chapter.

111.6(5) Corporate financial test. An owner or operator that satisfies the requirements of this subrule may demonstrate financial assurance up to the amount specified below:

a. Financial component. The owner or operator must satisfy the requirements of 111.6(5)“a”(1), (2), and (3) to meet the financial component of the corporate financial test.

(1) The owner or operator must satisfy one of the following three conditions:

1. A current rating for its senior unsubordinated debt of AAA, AA, A, or BBB as issued by Standard & Poor’s or Aaa, Aa, A or Baa as issued by Moody’s; or

2. A ratio of less than 1.5 comparing total liabilities to net worth (net worth calculations may not include future permitted capacity of the subject landfill as an asset); or

3. A ratio of greater than 0.10 comparing the sum of net income plus depreciation, depletion and amortization, minus $10 million, to total liabilities;

(2) The tangible net worth, excluding future permitted capacity of the subject landfill, of the owner or operator must be greater than:

1. The sum of the current closure, postclosure care,and corrective action cost estimates and any other environmental obligations, including guarantees, covered by thisfinancial test plus $10 million except as provided in 111.6(5)“a”(2)“2”; or

2. Net worth of $10 million, excluding future permitted capacity of the subject landfill, plus the amount of any guarantees that have not been recognized as liabilities on the financial statements provided all of the current closure, postclosure care, and corrective action costs and any other environmental obligations covered by a financial test are recognized as liabilities on the owner’s or operator’s audited financial statements, and subject to the approval of the department; and

(3) The owner or operator must have, located in the United States, assets, excluding future permitted capacity of the subject landfill, amounting to at least the sum of current closure, postclosure care, and corrective action cost estimates and any other environmental obligations covered by a financial test as described in 111.6(5)“e.”

b. Record–keeping and reporting requirements. The owner or operator must submit the following records to the department and place a copy in the facility’s official files prior to the initial receipt of solid waste or cancellation of an alternative financial assurance instrument, in the case of closure and postclosure care; or no later than 120 days after the corrective action plan has been approved by the department:

(1) A letter signed by a certified public accountant and based upon a certified audit that:

1. Lists all the current cost estimates covered by a financial test including, but not limited to, cost estimates required by rules 567—111.3(455B) to 567—111.5(455B); cost estimates required for municipal solid waste management facilities pursuant to 40 CFR Part 258; cost estimates required for UIC facilities under 40 CFR Part 144, if applicable; cost estimates required for petroleum underground storage tank facilities under 40 CFR Part 280, if applicable; cost estimates required for PCB storage facilities under 40 CFR Part 761, if applicable; and cost estimates required for hazardous waste treatment, storage, and disposal facilities under 40 CFR Parts 264 and 265, if applicable; and

2. Provides evidence demonstrating that the firm meets the conditions of 111.6(5)“a.”

(2) A copy of the independent certified public accountant’s unqualified opinion of the owner’s or operator’s financial statements for the latest completed fiscal year. To be eligible to use the financial test, the owner’s or operator’s financial statements must receive an unqualified opinion from the independent certified public accountant. An adverse opinion or disclaimer of opinion shall be cause for disallowance of this mechanism. A qualified opinion related to the demonstration of financial assurance may, at the discretion of the department, be cause for disallowance. If the department does not allow use of the corporate financial test, the owner or operator must provide alternate financial assurance that meets the requirements of this chapter.

(3) If the certified public accountant’s letter providing evidence of financial assurance includes financial data showing that the owner or operator satisfies 111.6(5)“a” that differs from data in the audited financial statements referred to in 111.6(5)“b”(2), then a special report from the owner’s or operator’s independent certified public accountant to the owner or operator is required. The special report shall be based upon an agreed–upon procedures engagement in accordance with professional auditing standards and shall describe the procedures performed in comparing the data in the certified public accountant’s letter derived from the independently audited, year–end financial statements for the latest fiscal year with the amounts in such financial statements, the findings of that comparison, and the reasons for any differences.

(4) If the certified public accountant’s letter provides a demonstration that the firm has assured for environmental obligations as provided in 111.6(5)“a”(2)“2,” then the letter shall include a report from the independent certified public accountant that verifies that all of the environmental obligations covered by a financial test have been recognized as liabilities on the audited financial statements and how these obligations have been measured and reported, and that the tangible net worth of the firm is at least $10 million plus the amount of any guarantees provided.

c. The owner or operator may cease the submission of the information required by subrule 111.6(5) only if alternate financial assurance is substituted prior to cancellation or if the owner or operator is no longer required to demonstrate financial responsibility in accordance with this chapter.

d. The department may, based on a reasonable belief that the owner or operator may no longer meet the requirements of 111.6(5)“a,” at any time require the owner or operator to provide reports of its financial condition in addition to or including current financial test documentation as specified in 111.6(5)“b.” If the department finds that the owner or operator no longer meets the requirements of 111.6(5)“a,” the owner or operator must provide alternate financial assurance that meets the requirements of this chapter.

e. Calculation of costs to be assured. When calculating the current cost estimates for closure, postclosure care, corrective action, or the sum of the combination of such costs to be covered, and any other environmental obligations assured by a financial test referred to in subrule 111.6(5), the owner or operator must include cost estimates required for 567— 111.3(455B) to 567— 111.5(455B); cost estimates for municipal solid waste management facilities pursuant to 40 CFR Section 258.74; and cost estimates required for the following environmental obligations, if the owner or operator assures those environmental obligations through a financial test: obligations associated with UIC facilities under 40 CFR Part 144, petroleum underground storage tank facilities under 40 CFR Part 280, PCB storage facilities under 40 CFR Part 761, and hazardous waste treatment, storage, and disposal facilities under 40 CFR Parts 264 and 265.

111.6(6) Local government financial test. An owner or operator that satisfies the requirements of this subrule may demonstrate financial assurance up to the amount specified below:

a. Financial component.

(1) The owner or operator must satisfy one of the following requirements:

1. If the owner or operator has outstanding, rated, general obligation bonds that are not secured by insurance, a letter of credit, or other collateral or guarantee, the owner or operator must have a current rating of Aaa, Aa, A, or Baa, as issued by Moody’s, or AAA, AA, A, or BBB, as issued by Standard & Poor’s on all such general obligation bonds; or

2. The owner or operator must satisfy each of the following financial ratios based on the owner’s or operator’s most recent audited annual financial statement:

• A ratio of cash plus marketable securities to total expenditures greater than or equal to 0.05; and

• A ratio of annual debt service to total expenditures less than or equal to 0.20.

(2) The owner or operator must prepare its financial statements in conformity with Generally Accepted Accounting Principles or Other Comprehensive Basis of Accounting and have its financial statements audited by an independent certified public accountant or the office of the auditor of the state of Iowa. The financial statement shall be in the form prescribed by the office of the auditor of the state of Iowa.

(3) A local government is not eligible to assure its obligations in subrule 111.6(6) if it:

1. Is currently in default on any outstanding general obligation bonds; or

2. Has any outstanding general obligation bonds rated lower than Baa as issued by Moody’s or BBB as issued by Standard & Poor’s; or

3. Operated at a deficit equal to 5 percent or more of total annual revenue in each of the past two fiscal years; or

4. Receives an adverse opinion or disclaimer of opinion from the independent certified public accountant or office of the auditor of the state of Iowa auditing its financial statement as required under 111.6(6)“a”(2). A qualified opinion that is related to the demonstration of financial assurance may, at the discretion of the department, be cause for disallowance of this mechanism.

(4) The following terms used in this paragraph are defined as follows:

1. “Deficit” means total annual revenues minus total annual expenditures;

2. “Total revenues” means revenues from all taxes and fees but does not include the proceeds from borrowing or asset sales, excluding revenue from funds managed by local government on behalf of a specific third party;

3. “Total expenditures” means all expenditures excluding capital outlays and debt repayment;

4. “Cash plus marketable securities” means all the cash plus marketable securities held by the local government on the last day of a fiscal year, excluding cash and marketable securities designated to satisfy past obligations such as pensions; and

5. “Debt service” means the amount of principal and interest due on a loan in a given time period, typically the current year.

b. Public notice component. The local government owner or operator must include disclosure of the closure and postclosure care costs assured through the financial test into its next annual audit report prior to the initial receipt of waste at the facility or prior to cancellation of an alternative financial assurance mechanism, whichever is later. A reference to corrective action costs must be placed in the next annual audit report after the corrective action plan is approved by the department. For the first year the financial test is used to assure costs at a particular facility, the reference may instead be placed in the facility’s official files until issuance of the next available annual audit report if timing does not permit the reference to be incorporated into the most recently issued annual audit report or budget. For closure and postclosure costs, conformance with Government Accounting Standards Board Statement 18 ensures compliance with this public notice component.

c. Record–keeping and reporting requirements.

(1) The local government owner or operator must submit to the department the following items:

1. A letter signed by the local government’s chief financial officer that:

• Lists all the current cost estimates covered by a financial test, as described in 111.6(6)“d”;

• Provides evidence and certifies that the local government meets the conditions of 111.6(6)“a”(1), (2), and (3); and

• Certifies that the local government meets the conditions of 111.6(6)“b” and 111.6(6)“d”; and

2. The local government’s annual financial report indicating compliance with the financial ratios required by 111.6(6)“a”(1)“2,” if applicable, and the requirements of 111.6(6)“a”(2) and 111.6(6)“a”(3)“3” and “4” and also indicating that the requirements of Governmental Accounting Standards Board Statement 18 have been met.

(2) The items required in 111.6(6)“c”(1) must be submitted to the department and placed in the facility’s official files prior to the receipt of waste or prior to the cancellation of an alternative financial mechanism, in the case of closure and postclosure care; or, in the case of corrective action, not later than 120 days after the corrective action plan is approved by the department.

(3) After the initial submission of the items and placement in the facility’s official files, the local government owner or operator must update the information and place the updated information in the facility’s official files within 180 days following the close of the owner or operator’s fiscal year.

(4) The owner or operator may cease the submission of the information required by subrule 111.6(6) only if alternate financial assurance is substituted prior to cancellation or if the owner or operator is no longer required to demonstrate financial responsibility in accordance with this chapter.

(5) A local government must satisfy the requirements of the financial test at the close of each fiscal year. If the local government owner or operator no longer meets the requirements of the local government financial test, the local government must, within 180 days following the close of the owner’s or operator’s fiscal year, obtain alternative financial assurance that meets the requirements of this rule, place the required submissions for that assurance in the operating rec–ord, and notify the department that the owner or operator no longer meets the criteria of the financial test and that alternate assurance has been obtained.

(6) The department, based on a reasonable belief that the local government owner or operator may no longer meet the requirements of the local government financial test, may require additional reports of financial conditions from the local government at any time. If the department finds, on the basis of such reports or other information, that the owner or operator no longer meets the requirements of the local government financial test, the local government must provide alternate financial assurance in accordance with this rule.

d. Calculation of costs to be assured. The portion of the closure, postclosure care, and corrective action costs which an owner or operator may assure under this subrule is determined as follows:

(1) If the local government owner or operator does not assure other environmental obligations through a financial test, the owner or operator may assure closure, postclosure care, and corrective action costs that equal up to 43 percent of the local government’s total annual revenue.

(2) If the local government assures other environmental obligations through a financial test, including those associated with UIC facilities under 40 CFR Section 144.62, petroleum underground storage tank facilities under 40 CFR Part 280, PCB storage facilities under 40 CFR Part 761, and hazardous waste treatment, storage, and disposal facilities under 40 CFR Parts 264 and 265, the owner or operator must add those costs to the closure, postclosure care, and corrective action costs it seeks to assure under this subparagraph. The total that may be assured must not exceed 43 percent of the local government’s total annual revenue.

(3) The owner or operator must obtain an alternate financial assurance instrument for those costs that exceed the limits set in 111.6(6)“d”(1) and (2).

111.6(7) Corporate guarantee.

a. An owner or operator may meet the requirements of this rule by obtaining a written guarantee. The guarantor must be the direct or higher–tier parent corporation of the owner or operator, a firm whose parent corporation is also the parent corporation of the owner or operator, or a firm with a “substantial business relationship’’ with the owner or operator. The guarantor must meet the requirements for owners or operators in subrule 111.6(5) and must comply with the terms of the guarantee. A certified copy of the guarantee must be placed in the facility’s operating record along with copies of the letter from a certified public accountant and accountant’s opinions. If the guarantor’s parent corporation is also the parent corporation of the owner or operator, the letter from the certified public accountant must describe the value received in consideration of the guarantee. If the guarantor is a firm with a ‘‘substantial business relationship’’ with the owner or operator, this letter must describe this ‘‘substantial business relationship’’ and the value received in consideration of the guarantee.

b. The guarantee must be effective and all required submissions made to the department prior to the initial receipt of waste or before cancellation of an alternative financial mechanism, in the case of closure and postclosure care; or, in the case of corrective action, no later than 120 days after the corrective action plan has been approved by the department.

c. The terms of the guarantee must provide that:

(1) If the owner or operator fails to perform closure, postclosure care, or corrective action of a facility covered by the guarantee, or fails to obtain alternate financial assurance within 90 days of notice of intent to cancel pursuant to 111.6(7)“c”(2) and (3), the guarantor will:

1. Perform, or pay a third party to perform, closure, postclosure care, or corrective action as required (performance guarantee);

2. Establish a fully funded trust fund as specified in subrule 111.6(1) in the name of the owner or operator (payment guarantee); or

3. Obtain alternate financial assurance as required by 111.6(7)“c”(3).

(2) The guarantee will remain in force for as long as the owner or operator must comply with the applicable financial assurance requirements of this chapter unless the guarantor sends prior notice of cancellation by certified mail to the owner or operator and to the department. Cancellation may not occur, however, during the 120 days beginning on the date of receipt of the notice of cancellation by both the owner or operator and the department, as evidenced by the return receipts.

(3) If notice of cancellation is given, the owner or operator must, within 90 days following receipt of the cancellation notice by the owner or operator and the department, provide to the department adequate proof of alternative financial assurance, notice from the guarantor of withdrawal of the cancellation, or proof of the establishment of a fully funded trust fund pursuant to subrule 111.6(1). If the owner or operator fails to comply with the provisions of this subparagraph within the 90–day period, the guarantor must provide that alternate financial assurance prior to cancellation of the corporate guarantee.

d. If a corporate guarantor no longer meets the requirements of subrule 111.6(5), the owner or operator must, within 90 days, obtain alternate financial assurance and submit proof of alternative financial assurance to the department. If the owner or operator fails to provide alternate financial assurance within the 90–day period, the guarantor must provide that alternate financial assurance within the next 30 days.

e. The owner or operator is no longer required to meet the requirements of subrule 111.6(7) upon the submission to the department of proof of the substitution of alternative financial assurance or if the owner or operator is no longer required to demonstrate financial responsibility in accordance with this chapter.

111.6(8) Local government guarantee. An owner or operator may demonstrate financial assurance for closure, postclosure care, or corrective action by obtaining a written guarantee provided by a local government or jointly provided by the members of an agency established pursuant to Iowa Code chapter 28E. The guarantor must meet the requirements of the local government financial test in subrule 111.6(6) and must comply with the terms of a written guarantee.

a. Terms of the written guarantee. The guarantee must be effective before the initial receipt of waste or before the cancellation of alternative financial assurance, in the case of closure and postclosure care; or no later than 120 days after the corrective action plan is approved by the department. The guarantee must provide that:

(1) If the owner or operator fails to perform closure, postclosure care, or corrective action of a facility covered by the guarantee or fails to obtain alternate financial assurance within 90 days of notice of intent to cancel pursuant to 111.6(7)“c”(2) and (3), the guarantor will:

1. Perform, or pay a third party to perform, closure, postclosure care, or corrective action as required; or

2. Establish a fully funded trust fund as specified in subrule 111.6(1) in the name of the owner or operator; or

3. Obtain alternate financial assurance as required by 111.6(8)“a”(3).

(2) The guarantee will remain in force unless the guarantor sends notice of cancellation by certified mail to the owner or operator and to the department. Cancellation may not occur, however, during the 120 days beginning on the date of receipt of the notice of cancellation by both the owner or operator and the state director as evidenced by the return receipts.

b. Record–keeping and reporting requirements.

(1) The owner or operator must submit to the department a certified copy of the guarantee along with the items required under 111.6(6)“c” and place a copy in the facility’s official files record before the initial receipt of waste or before cancellation of alternative financial assurance, whichever is later, in the case of closure and postclosure care; or no later than 120 days after the corrective action plan has been approved by the department.

(2) The owner or operator shall no longer be required to submit the items specified in 111.6(8)“b”(1) when proof of alternate financial assurance has been submitted to the department or the owner or operator is no longer required to provide financial assurance pursuant to this chapter.

(3) If a local government guarantor no longer meets the requirements of subrule 111.6(6), the owner or operator must, within 90 days, submit to the department proof of alternate financial assurance. If the owner or operator fails to obtain alternate financial assurance within that 90–day period, the guarantor must provide that alternate financial assurance within the next 30 days.

111.6(9) Local government dedicated fund. The owner or operator of a publicly owned MSWLF or local government serving as a guarantor may demonstrate financial assurance for closure, postclosure care, or corrective action, whichever is applicable, by establishing a dedicated fund or account that conforms to the requirements of this subrule. A dedicated fund will be considered eligible if it complies with “a” or “b” below, and all other provisions of this subrule, and documentation of this compliance has been submitted to the department.

a. The fund is dedicated by state constitutional provision or local government statute, charter, ordinance, or order to pay for closure, postclosure care, or corrective action costs, whichever is applicable, arising from the operation of the MSWLF and is funded for the full amount of coverage or funded for part of the required amount of coverage and used in combination with another mechanism(s) that provides the remaining coverage; or

b. The fund is dedicated by state constitutional provision or local government statute, charter, ordinance, or order as a reserve fund and is funded for no less than the full amount of coverage or funded for part of the required amount of coverage and used in combination with another mechanism(s) that provides the remaining coverage.

c. Payments into the dedicated fund must be made annually by the owner or operator for ten years or over the remaining life of the MSWLF, whichever is shorter, in the case of a dedicated fund for closure or postclosure care, or over one–half of the estimated length of an approved corrective action program in the case of a response to a known release. This is referred to as the “pay–in period.” The initial payment into the dedicated fund must be made before the initial receipt of waste in the case of closure and postclosure care or no later than 120 days after the corrective action plan has been approved by the department.

d. For a dedicated fund used to demonstrate financial assurance for closure and postclosure care, the first payment into the fund must be at least equal to the current cost estimate, divided by the number of years in the pay–in period as defined in this subrule. The amount of subsequent payments must be determined by the following formula:

Payment	=	TF	-	CF
			Y

where TF is the total required financial assurance for the owner or operator, CF is the current amount in the fund, and Y is the number of years remaining in the pay–in period.

e. For a dedicated fund used to demonstrate financial assurance for corrective action, the first payment into the dedicated fund must be at least one–half of the current cost estimate, divided by the number of years in the corrective action pay–in period as defined in this subrule. The amount of subsequent payments must be determined by the following formula:

Payment	=	RB	-	CF
			Y

where RB is the most recent estimate of the required dedicated fund balance, which is the total cost that will be incurred during the second half of the corrective action period, CF is the current amount in the dedicated fund, and Y is the number of years remaining in the pay–in period.

567—111.7(455B) General requirements.

111.7(1) Use of multiple financial mechanisms. An owner or operator may satisfy the requirements of this rule by establishing more than one financial mechanism per facility. The mechanisms must be a combination of those mechanisms outlined in this chapter and must provide financial assurance for an amount at least equal to the current cost estimate for closure, postclosure care, or corrective action, whichever is applicable. The financial test and a guarantee provided by a corporate parent, sibling or grandparent may not be combined if the financial statements of the two firms are consolidated.

111.7(2) Use of one mechanism for multiple facilities. An owner or operator may satisfy the requirements of this rule for multiple MSWLFs by the use of one mechanism if the owner or operator ensures that the mechanism provides financial assurance for an amount at least equal to the current cost estimates for closure, postclosure care, or corrective action, whichever is applicable, for all MSWLFs covered.

111.7(3) Criteria. The language of the financial assurance mechanisms listed in this chapter must ensure that the instruments satisfy the following criteria:

a. The financial assurance mechanisms must ensure that the amount of funds assured is sufficient to cover the costs of closure, postclosure care, or corrective action for known releases, whichever is applicable;

b. The financial assurance mechanisms must ensure that funds will be available in a timely fashion when needed;

c. The financial assurance mechanisms must be obtained by the owner or operator or prior to the initial receipt of solid waste and no later than 120 days after the corrective action remedy has been approved by the department until the owner or operator is released from the financial assurance requirements; and

d. The financial assurance mechanisms must be legally valid, binding, and enforceable under Iowa law.

111.7(4) No permit shall be issued by the department pursuant to Iowa Code section 455B.305 unless the applicant has demonstrated compliance with 567—Chapter 111.

These rules are intended to implement Iowa Code sections 455B.304 and 455B.306.

[Filed 6/21/01, effective 8/15/01]

[Published 7/11/01]

EDITOR’S NOTE: For replacement pages for IAC, see IAC Supplement 7/11/01.

ARC 0768B

HUMAN SERVICES DEPARTMENT[441]

Adopted and Filed

Pursuant to the authority of Iowa Code subsection 239B.4(4), the Department of Human Services hereby amends Chapter 40, “Application for Aid,” Chapter 41, “Granting Assistance,” Chapter 46, “Overpayment Recovery,” and Chapter 93, “PROMISE JOBS Program,” appearing in the Iowa Administrative Code.

These amendments:

1. Implement hardship exemption criteria that allow for Family Investment Program (FIP) assistance beyond the 60–month lifetime limit for families with hardship circumstances. “Hardship” is defined as the circumstance that is preventing the family from being self–supporting. However, the family’s safety shall take precedence over the goal of self–sufficiency. Current rules regarding the 60–month FIP limit currently at 441—subrule 41.25(7) are rescinded and replaced with the new hardship exemption rule 441— 41.30(239B) to allow for a better understanding of the rules’ interrelationship.

On August 22, 1996, President Clinton signed into law Public Law 104–193, the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996. The new law replaced the Aid to Families with Dependent Children (AFDC) program with a new block grant program to states, called Temporary Assistance for Needy Families (TANF). TANF provides federal funding to states for a number of assistance programs, including Iowa’s Family Investment Program (FIP) and the PROMISE JOBS work and training program.

As a result of Public Law 104–193, all states must limit TANF–funded cash assistance to a 60–month lifetime limit beginning with the date that states implement TANF. However, federal law and regulations allow states the option of extending TANF–funded assistance beyond 60 months for families with hardship circumstances.

Only TANF funding for the Family Investment Program meets the federal definition of “assistance” subject to the 60–month limit. Therefore, in Iowa the 60–month limit applies only to assistance from the Family Investment Program (FIP).

When the adult or minor parent head of household has received FIP for the family for 60 months, the entire family is ineligible even if the parent is not included in the FIP grant. The same is true when the family includes a stepparent who is on the FIP grant.

EXCEPTIONS: The 60–month limit does not apply to families headed by parents who receive Supplemental Security Income (SSI). Also, FIP assistance received by a nonparental specified relative who is not on the grant with the child is not counted. When the child lives with a nonparental specified relative and the latter is on the FIP grant with the child, only the relative becomes ineligible at the end of the 60–month period. FIP may continue for the child.

Iowa implemented TANF in January 1997. Thus, families who have received FIP assistance continuously since January 1997 can no longer receive FIP after December 2001 unless they meet the criteria for a hardship exemption and are earnestly working toward becoming self–supporting as described in these rules.

The goal of TANF is that families become self–sufficient within the 60–month lifetime limit. Realizing that this goal is not attainable for all families, TANF allows states the option of providing cash assistance beyond 60 months to families in hardship conditions. This assistance is not intended as an automatic extension of the 60–month limit but is intended for families that are faced with barriers beyond their control that impact their ability to become self–sufficient.

In accordance with federal TANF regulations, a hardship exemption does not begin until after a family’s 60–month FIP period has ended. A hardship exemption is limited to six consecutive calendar months. Families may apply for and be granted more than one hardship exemption if so warranted by their circumstances.

A constant family support team appointed by the regional administrators or the director’s designees and consisting of income maintenance, PROMISE JOBS, service and, when indicated, Family Development and Self–Sufficiency (FaDSS) program staff is responsible for determining eligibility of a family’s request for a hardship exemption. Prior to approval of the request, the family is required to meet with the team and provide supporting evidence of the particular hardship.

Families granted a hardship exemption are required to participate in PROMISE JOBS and develop a six–month Family Investment Agreement (FIA) that directly addresses their particular hardship barriers. The six–month FIA will outline specific steps to enable the family to make incremental progress toward overcoming the particular barrier. The family must participate to its maximum potential in activities that are expected to result in self–sufficiency. When the family fails to follow the terms of the FIA, a limited benefit plan shall result as in any other situation when a family fails to follow the terms of a required FIA.

NOTE: The Department is precluded from using public funds for cash assistance or PROMISE JOBS services for nonqualified aliens whose classification is not listed at 8 United States Code (U.S.C.) Section 1641. As a result, nonqualified aliens cannot participate in PROMISE JOBS or in Family Investment Agreement activities. Therefore, families headed by parents whose alien classification is not listed at 8 U.S.C. Section 1641 are not eligible for FIP beyond the 60–month limit.

2. Remove language that makes FIP reinstatement without a new application optional when necessary information is not received by the third working day before the effective date of cancellation. These amendments require reinstatement of FIP assistance without a new application so long as all necessary information is provided before the effective date of cancellation and eligibility can be reestablished.

The FIP reinstatement rules are changed to match food stamp policy. This change will result in reduced program complexity, improved program error rates, and less confusion for assistance families. This change also prevents interruption in FIP assistance and eliminates cumbersome reapplication procedures for families who provide necessary eligibility information before the cancellation date.

3. Specify the date of application and the effective date of FIP assistance for qualified alien family members after their five–year period of ineligibility required by federal law has ended.

4. Remove obsolete references to Job Training Partnership Act (JTPA) and replace the references with Workforce Investment Act (WIA) as appropriate. As a result of the Workforce Investment Act which was signed into law August 7, 1998, JTPA was closed out and transitioned to WIA.

These amendments do not provide for waivers in specific situations. Eligibility for a hardship exemption is determined based on the individual family’s circumstances and the decision is appealable.

The following revisions were made to the Notice of Intended Action in response to public comments:

• Subrule 41.30(3), first unnumbered paragraph, was revised to clarify that families headed by a parent who is a nonqualified alien are prohibited from receiving FIP beyond the 60–month limit because the Department is precluded from using public funds to provide PROMISE JOBS or Family Investment Agreement services to nonqualified aliens.

• Subrule 41.30(3), paragraph “a,” was revised to add a definition for “domestic violence” to subparagraph (1). The definition is consistent with the definition in 45 Code of Federal Regulations 264.1(c)(2). Paragraph “a” was further revised to remove the word “catastrophic” from subparagraph (4) in recognition that an accident or disease may not need to be of catastrophic proportions to present a barrier to the affected family.

• Subrule 41.30(3), paragraph “c,” subparagraph (3), and paragraph “d,” subparagraph (1), were revised to delete the references to the Family Development and Self Sufficiency (FaDSS) office as one of the offices where a hardship exemption request form may be received. The deletion was requested by FaDSS staff to prevent any possible delay in the Department receiving or processing a hardship exemption request as FaDSS does not have staff presence in all counties.

• Subrule 41.30(3), paragraph “d,” subparagraph (3), was revised to state that the regional administrators or the director’s designees shall appoint the members of the family support team. This change allows for greater flexibility.

• Subrule 41.30(3), paragraph “d,” subparagraph (5), was revised to indicate that statements from friends and relatives alone may not be sufficient to grant hardship status, but may be used to support other evidence. The wording in the Notice provided that statements from friends or relatives alone are not sufficient to grant hardship status. The change in wording allows the Department to accept statements from friends and relatives that appear credible for determining hardship exemption eligibility when those statements are the only available evidence.

The following revisions were made to the Notice of Intended Action for clarification:

• Subrule 41.30(3), introductory paragraph, was revised to clarify that the family’s safety shall take precedence over the goal of self–sufficiency.

• Subrule 41.30(3), paragraph “c,” subparagraph (3), and paragraph “d,” subparagraph (1), were revised to clarify that the hardship exemption request form must contain a legible name and address and be signed to be considered valid.

• Subrule 41.30(3), paragraph “d,” subparagraph (3), was revised to clarify that, at local option, FaDSS staff may be part of the family support team. However, when FaDSS is involved with the family, then FaDSS staff shall be part of the team.

• Subrule 41.30(3), paragraph “d,” subparagraph (7), was revised to clarify that failure to attend the required face–to–face meeting with the family support team results in denial of the family’s hardship exemption request. The requirement for a face–to–face meeting and the resulting ineligibility for FIP for failure to attend the meeting are the same as when a FIP applicant or participant fails to attend the required face–to–face application or annual review interview.

• Subrule 41.30(3), paragraph “e,” was revised to clarify that failure to develop or sign the required six–month Family Investment Agreement (FIA) results in denial of the family’s hardship exemption request. The resulting ineligibility for FIP is the same consequence as for any FIP family that fails to develop or sign a required FIA. Also, language in subparagraph (3) is corrected to reflect that failure to follow the terms of a required FIA results in a Limited Benefit Plan.

These amendments are intended to implement Iowa Code chapter 239B and 45 CFR Section 264.1.

These amendments shall become effective September 1, 2001.

The following amendments are adopted.

ITEM 1. Amend subrule 40.22(5) as follows:

Amend paragraph “a” as follows:

a. Assistance shall be reinstated without a new application when all necessary information is provided ~~at least three working days~~ before the effective date of cancellation and eligibility can be reestablished, or the family meets the conditions described at 441—subparagraph 41.30(3)“d”(9).

Rescind and reserve paragraph “b.”

ITEM 2. Amend rule 441—40.23(239B) as follows:

441—40.23(239B) Date of application. The date of application is the date an identifiable Public Assistance Application, Form 470–0462 or Form 470–0466 (Spanish), is received in any local or area office or by an income maintenance worker in any satellite office or by a designated worker who is in any disproportionate share hospital, federally qualified health center or other facility in which outstationing activities are provided. The disproportionate share hospital, federally qualified health center or other facility will forward the application to the department office ~~which~~ that is responsible for the completion of the eligibility determination. An identifiable application is an application containing a legible name and address that has been signed.

A new application is not required when adding a person to an existing eligible group. This person is considered to be included in the application that established the existing eligible group. However, in these instances, the date of application to add a person is the date the change is reported. When it is reported that a person is anticipated to enter the home, the date of application to add the person shall be the date of the report.

In those instances where a person previously excluded from the eligible group as described at 441—subrule 41.27(11) is to be added to the eligible group, the date of application to add the person is the date the person indicated willingness to cooperate.

EXCEPTIONS: When adding a person who was previously excluded from the eligible group for failing to comply with 441—subrule 41.22(13), the date of application to add the person is the date the social security number or proof of application for a social security number is provided.

When adding a person who was previously excluded from the eligible group as described at 441—subrules 41.23(5), 41.25(5) and 46.28(2) and rule 441—46.29(239B), the date of application to add the person is the first day after the period of ineligibility has ended.

When adding a person who was previously excluded from the eligible group as described at 441—subrule 41.24(8), the date of application to add the person is the date the person signs a family investment agreement.

This rule is intended to implement Iowa Code section 239B.2.

ITEM 3. Amend rule 441—40.26(239B) as follows:

441—40.26(239B) Effective date of grant. New approvals shall be effective as of the date the applicant becomes eligible for assistance, but in no case shall the effective date be earlier than seven days following the date of application. When an individual is added to an existing eligible group, the individual shall be added effective as of the date the individual becomes eligible for assistance, but in no case shall the effective date be earlier than seven days following the date the change is reported. When it is reported that a person is anticipated to enter the home, the effective date of assistance shall be no earlier than the date of entry or seven days following the date of report, whichever is later.

When the change is timely reported as described at subrule 40.27(4), a payment adjustment shall be made when indicated. When the individual’s presence is not timely reported as described at subrule 40.27(4), excess assistance issued is subject to recovery.

In those instances where a person previously excluded from the eligible group as described at 441—subrule 41.27(11) is to be added to the eligible group, the effective date of eligibility shall be seven days following the date the person indicated willingness to cooperate. However, in no instance shall the person be added until cooperation has actually occurred.

EXCEPTIONS: When adding a person who was previously excluded from the eligible group for failing to comply with 441—subrule 41.22(13), the effective date of eligibility shall be seven days following the date that the social security number or proof of application for a social security number is provided.

When adding a person who was previously excluded from the eligible group as described at 441—subrules 41.23(5), 41.25(5) and 46.28(2) and rule 441—46.29(239B), the effective date of eligibility shall be seven days following the date that the period of ineligibility ended.

When adding a person who was previously excluded from the eligible group as described at 441—subrule 41.24(8), the effective date of eligibility shall be seven days following the date the person signs a family investment agreement. In no case shall the effective date be within the six–month ineligibility period of a subsequent limited benefit plan as described at 441—paragraph 41.24(8)“a.”

This rule is intended to implement Iowa Code section 239B.3.

ITEM 4. Amend rule 441—41.24(239B) as follows:

Amend subrule 41.24(4) by relettering paragraph “b” as paragraph “c,” and adopting the following new paragraph “b”:

b. While the eligibility decision is pending, applicants who must qualify for a hardship exemption before approval of FIP shall be treated in accordance with subrule 41.30(3).

Amend subrule 41.24(9), paragraph “b,” introductory paragraph, as follows:

b. ~~Conciliation for volunteers shall be provided by a~~ A conciliation unit established by the PROMISE JOBS local service delivery area shall provide conciliation for volunteers. ~~PROMISE JOBS staff from DWD shall conciliate in cases decided by JTPA workers and PROMISE JOBS staff from JTPA shall conciliate in cases decided by DWD workers.~~ The bureau of refugee services shall arrange with PROMISE JOBS staff of DWD ~~and JTPA~~ to provide conciliation services when the need arises. If the local service delivery area has developed interagency teams of PROMISE JOBS staff, teams shall be assigned to conciliate in cases decided by other teams.

ITEM 5. Rescind and reserve subrule 41.25(7).

ITEM 6. Amend subrule 41.27(9), paragraph “a,” subparagraph (4), as follows:

(4) Eligibility for the family investment program for any month or partial month before the month of decision shall be determined only when there is eligibility in the month of decision. The family composition for any month or partial month before the month of decision shall be considered the same as on the date of decision. In determining eligibility and the amount of the assistance payment for any month or partial month preceding the month of decision, income and all circumstances except family composition in that month shall be considered in the same manner as in the month of decision. When the eligibility determination is delayed until the third initial month or later and payment is being made for the preceding months, the payment for the month following the initial two months shall be based, retrospectively, on income and all circumstances except family composition in the corresponding budget month. When the applicant is eligible for some, but not all, months of the application period due to the time limit described at subrule 41.30(1), family investment program eligibility shall be determined for the month of decision first, then the immediately preceding month, and so on until the time limit has been reached.

ITEM 7. Adopt the following new rule 441— 41.30(239B):

441—41.30(239B) Time limits.

41.30(1) Sixty–month limit. Assistance shall not be provided to a FIP applicant or recipient family that includes an adult who has received assistance for 60 calendar months under any state program in Iowa or in another state that is funded by the Temporary Assistance for Needy Families (TANF) block grant. The 60–month period need not be consecutive. An “adult” is any person who is a parent of the FIP child in the home, or included as an optional member under subparagraphs 41.28(1)“b”(1), (2) and (3). In two–parent households, the 60–month limit is determined when either parent has received assistance for 60 months. “Assistance” shall include any month for which the adult receives a FIP grant. Assistance received for a partial month shall count as a full month.

41.30(2) Determining number of months.

a. In determining the number of months an adult received assistance, the department shall consider toward the 60–month limit:

(1) Assistance received even when the parent is excluded from the grant unless the parent, or both parents in a two–parent household, are supplemental security income (SSI) recipients.

(2) Assistance received by an optional member of the eligible group as described in subparagraphs 41.28(1)“b”(1) and (2). However, once the person has received assistance for 60 months, the person is ineligible but assistance may continue for other persons in the eligible group. The entire family is ineligible for assistance when the optional member who has received assistance for 60 months is the incapacitated stepparent on the grant as described at subparagraph 41.28(1)“b”(3).

b. When the parent, or both parents in a two–parent household, have received 60 months of FIP assistance and are subsequently approved for supplemental security income, FIP assistance for the children may be granted, if all other eligibility requirements are met.

c. When a minor parent and child receive FIP on the adult parent’s case and the adult parent is no longer eligible due to the 60–month limit on FIP assistance, the minor parent may reapply for FIP as a minor parent living with a self–supporting parent.

d. In determining the number of months an adult received assistance, the department shall not consider toward the 60–month limit any month for which FIP assistance was not issued for the family, such as:

(1) A month of suspension.

(2) A month for which no grant is issued due to the limitations described in rules 441—45.26(239B) and 441— 45.27(239B).

(3) When all assistance for the month is returned.

(4) When all assistance for the month is reimbursed via child support collection or overpayment recovery.

e. The department shall not consider toward the 60–month limit months of assistance a parent or pregnant person received as a minor child and not as the head of a household or married to the head of a household. This includes assistance received for a minor parent for any month in which the minor parent was a child on the adult parent’s or the specified relative’s FIP case.

f. The department shall not consider toward the 60–month limit months of assistance received by an adult while living in Indian country (as defined in 18 United States Code Section 1151) or a Native Alaskan village where at least 50 percent of the adults were not employed.

41.30(3) Exception to the 60–month limit. A family may receive FIP assistance for more than 60 months as defined in subrule 41.30(1) if the family qualifies for a hardship exemption as described in this subrule. “Hardship” is defined as a circumstance that is preventing the family from being self–supporting. However, the family’s safety shall take precedence over the goal of self–sufficiency.

Families with an adult as defined in subrule 41.30(1) who is not a U.S. citizen or is not a qualified alien under 8 United States Code Section 1641 as described in subrule 41.23(5) are prohibited from receiving more than 60 months of FIP assistance. The family of an adult who is a nonqualified alien cannot meet the requirements of paragraph “e” since the department is precluded from using public funds to provide a nonqualified alien with family investment agreement or PROMISE JOBS services by Iowa Code sections 239B.8 and 239B.18 and rule 441—41.24(239B).

Eligibility for the hardship exemption shall be determined on an individual family basis. A hardship exemption shall not begin until the adult in the family has received at least 60 months of FIP assistance.

a. Hardship exemption criteria. Circumstances that may lead to a hardship exemption may include, but are not limited to, the following:

(1) Domestic violence. “Domestic violence” means that the family includes someone who has been battered or subjected to extreme cruelty. It includes:

1. Physical acts that resulted in, or threatened to result in, physical injury to the individual.

2. Sexual abuse.

3. Sexual activity involving a dependent child.

4. Being forced as the caretaker relative of a dependent child to engage in nonconsensual sexual acts or activities.

5. Threats of, or attempts at, physical or sexual abuse.

6. Mental abuse.

7. Neglect or deprivation of medical care.

(2) Lack of employability.

(3) Lack of suitable child care as defined in 441—subrule 93.134(1).

(4) Chronic or recurring medical conditions or mental health issues, or an accident or disease, when verified by a professional. The applicant or recipient shall follow a treatment plan to address the condition or issue.

(5) Housing situations that make it difficult or impossible to work.

(6) Substance abuse issues. A family requesting a hardship exemption due to substance abuse shall be required to obtain clinical assessment and follow an intensive treatment plan.

(7) Having a child whose circumstances require the parent to be in the home. This may include, but is not limited to, a child as defined in rule 441—170.1(234) or a child receiving child welfare, juvenile court or juvenile justice services. The safety of the child shall take precedence over the goal of self–sufficiency.

(8) Actively pursuing verification of a disability through the Social Security Administration.

(9) Other circumstances which prevent the family from being self–supporting.

b. Eligibility for a hardship exemption.

(1) Families may be eligible for a hardship exemption when circumstances prevent the family from being self–supporting. The hardship condition shall be a result of a past or current experience that is affecting the family’s current functioning. Current experience may include fear of an event that is likely to occur in the future. The definition of the hardship barrier relies upon the impact of the circumstances upon the family’s ability to leave FIP rather than the type of circumstances.

(2) Families determined eligible for more than 60 months of FIP shall make incremental steps toward overcoming the hardship and participate to their maximum potential in activities reasonably expected to result in self–sufficiency.

c. Requesting a hardship exemption.

(1) Families with adults as defined in subrule 41.30(1) who have or are close to having received 60 months of FIP assistance may request a hardship exemption. Requests for the hardship exemption shall be made on Form 470–3826, Request for FIP Beyond 60 Months. In addition, families that have received FIP for 60 months shall complete Form 470–0462 or Form 470–0466 (Spanish), Public Assistance Application, as described at rule 441—40.22(239B) as a condition for regaining FIP eligibility. Failure to provide the required application within ten days from the date of the county office’s request shall result in denial of the hardship request.

(2) In families that request FIP beyond 60 months, all adults as defined in subrule 41.30(1) shall sign the request. When the adult is incompetent or incapacitated, someone acting responsibly on the adult’s behalf may sign the request.

(3) Requests for a hardship exemption shall not be accepted prior to the first day of the family’s fifty–ninth month of FIP assistance. The date of the request shall be the date an identifiable Form 470–3826 is received in any department of human services or PROMISE JOBS office. An identifiable form is one that contains a legible name and address and that has been signed.

(4) To receive more than 60 months of FIP assistance, families must be eligible for a hardship exemption and meet all other FIP eligibility requirements.

(5) When an adult as defined in subrule 41.30(1) who has received FIP for 60 months joins a recipient family that has not received 60 months of FIP assistance, eligibility shall continue only if the recipient family submits Form 470–3826 and is approved for a hardship exemption as described in subrule 41.30(3) and meets all other FIP eligibility requirements.

(6) When an adult as defined in subrule 41.30(1) joins a recipient family that is in an exemption period, the current exemption period shall continue, if the recipient family continues to meet all other eligibility requirements, regardless of whether the joining adult has received FIP for 60 months.

(7) When two parents who are in a hardship exemption period separate, the remainder of the exemption period, if there is a need, shall follow the parent who retains the current FIP case.

d. Determination of hardship exemption.

(1) A determination on the request shall be made as soon as possible, but no later than 30 days following the date an identifiable Form 470–3826 is received in any department of human services or PROMISE JOBS office. A written notice of decision shall be issued to the family the next working day following a determination of eligibility or ineligibility for a hardship exemption.

The 30–day time standard shall apply except in unusual circumstances, such as when the county office and the family have made every reasonable effort to secure necessary information which has not been supplied by the date the time limit expired; or because of emergency situations, such as fire, flood or other conditions beyond the administrative control of the county office.

(2) When a Public Assistance Application is required to regain FIP eligibility, the 30–day time frame in rule 441— 40.25(239B) shall apply.

(3) A family support team appointed by the regional administrators or the director’s designees shall determine eligibility for a hardship exemption. The members of the family support team shall be constant and shall consist of income maintenance, PROMISE JOBS, and service staff. At local option, FaDSS staff may also be part of the team. When the family is participating in the FaDSS program, then FaDSS staff shall be a part of the team.

(4) The family shall provide supporting evidence of the hardship barrier and the impact of the barrier upon the family’s ability to leave FIP. The county office shall advise the applicant or recipient about how to obtain necessary documents. Upon request, the county office shall provide reasonable assistance in obtaining supporting documents when the family is not reasonably able to obtain the documents. The type of supporting evidence is dependent upon the circumstance that creates the hardship barrier.

(5) Examples of types of supporting evidence may include:

1. Court, medical, criminal, child protective services, social services, psychological, or law enforcement records.

2. Statements from professionals or other individuals with knowledge of the hardship barrier.

3. Statements from vocational rehabilitation or other job training professionals.

4. Statements from individuals other than the applicant or recipient with knowledge of the hardship circumstances. Written statements from friends and relatives alone may not be sufficient to grant hardship status, but may be used to support other evidence.

5. Court, criminal, police records or statements from domestic violence counselors may be used to substantiate hardship. Living in a domestic violence shelter shall not automatically qualify an individual for a hardship exemption, but would be considered strong evidence.

(6) The county office shall notify the family in writing of additional information or verification that is required to verify the barrier and its impact upon the family’s abilityto leave FIP. The family shall be allowed ten days to supply the required information or verification. The ten–day period may be extended under the circumstances described in 441—subrule 40.24(1) or 441—paragraph 40.27(4)“c.” Failure to supply the required information or verification, or refusal by the family to authorize the county office to secure the information or verification from other sources, shall result in denial of the family’s request for a hardship exemption.

(7) Before approving a family’s hardship exemption request, the family support team shall meet face to face with the adult as defined in subrule 41.30(1). In two–parent families, both parents shall attend the meeting. When the adult is incompetent or incapacitated, someone acting responsibly on the adult’s behalf may attend for the adult. If the family has not already provided evidence supporting the hardship exemption request, the family shall bring the supporting evidence to the meeting. Failure to attend the face–to–face meeting as required shall result in denial of the family’s hardship exemption request.

(8) A decision on the hardship exemption shall be made when all supporting evidence is available and the team is able to reach consensus. If the team cannot reach consensus on the hardship exemption, income maintenance staff shall make the final decision.

(9) Recipients whose FIP assistance is canceled at the end of the sixtieth month shall be eligible for reinstatement as described at 441—subrule 40.22(5) when Form 470–3826 and all supporting evidence are received before the effective date of cancellation even if eligibility for a hardship exemption is not determined until after the effective date of cancellation.

(10) When Form 470–3826 and all supporting evidence are not received before the effective date of the FIP cancellation and a Public Assistance Application is required for the family to regain FIP eligibility, the effective date of assistance shall be no earlier than seven days from the date of application as described at rule 441—40.26(239B).

(11) Eligibility for a hardship exemption shall last forsix consecutive calendar months. EXCEPTION: The six–month hardship exemption ends when FIP for the family is canceled for any reason and a Public Assistance Application is required for the family to regain FIP eligibility. In addition, when FIP eligibility depends on receiving a hardship exemption, the family shall submit a new Form 470–3826. A new hardship exemption determination shall be required prior to FIP approval.

(12) FIP received for a partial month of the six–month hardship exemption period shall count as a full month.

(13) There is no limit on the number of hardship exemptions a family may receive over time.

e. Six–month family investment agreement (FIA). With the help of the family support team, families who request a hardship exemption shall develop and sign a six–month family investment agreement (FIA) as defined at rule 441— 93.109(239B) to address the circumstances that are creating the barrier. Whenever possible, the FIA shall be developed at the time of the required face–to–face meeting described at subparagraph 41.30(3)“d”(7). The six–month FIA shall contain specific steps to enable the family to make incremental progress toward overcoming the barrier. Each subsequent hardship exemption shall require a new six–month FIA. Failure to develop or sign a six–month FIA shall result in denial of the family’s hardship exemption request.

(1) PROMISE JOBS staff shall provide necessary supportive services as described in 441—Chapter 93 and shall monitor the six–month FIA. The family support team shall determine the methodology of monitoring the incremental steps toward progress. Periodic contacts by a member of the team shall be made with the family at least once a month. These contacts need not be in person. Time and attendance reports shall be required as specified at rule 441— 93.135(239B).

(2) The six–month FIA shall be renegotiated and amended under the circumstances described at 441—subrule 93.109(2).

(3) Any family that has been granted a hardship exemption and that does not follow the terms of the family’s six–month FIA will have chosen a limited benefit plan in accordance with 441—Chapters 41 and 93.

f. Any family that is denied a hardship exemption may appeal the decision as described in 441—Chapter 7.

This rule is intended to implement Iowa Code chapter 239B.

ITEM 8. Amend rule 441—46.21(239B), definition of “procedural error,” as follows:

“Procedural error” means a technical error ~~which~~ that does not in and of itself result in an overpayment. Procedural errors include:

Failure to secure a properly signed application at the time of initial application or reapplication.

Failure of the county office to conduct the face–to–face interviews described in 441—subrules 40.24(2), ~~and~~ 40.27(1), and 41.30(3).

Failure to request a Public Assistance Eligibility Report or a Review/Recertification Eligibility Document at the time of a monthly, semiannual, or annual review.

Failure of county office staff to cancel the family investment program when the client submits a Public Assistance Eligibility Report or a Review/Recertification Eligibility Document which is not complete as defined in 441—paragraph 40.27(4)“b.” However, overpayments of grants as defined above based on incomplete reports are subject to recoupment.

ITEM 9. Amend rule 441—93.103(239B) as follows:

441—93.103(239B) Contracts with provider agencies for provision of services. The department of human services shall contract with the department of workforce development to provide PROMISE JOBS and FIA services to FIP recipients. Services shall include orientation, assessment, job–seeking skills training, group and individual job search, job placement and job development, high school completion, adult basic education (ABE), general educational development (GED), and English as second language (ESL), vocational classroom training, postsecondary education including entrepreneurial training, PROMISE JOBS on–the–job training (OJT), work experience, unpaid community service, parenting skills training, life skills training, monitored employment, volunteer mentoring, FaDSS or other family development services, and referral for family planning counseling.

The bureau of refugee services shall provide the above services, to the extent compatible with resources available, to persons who entered the United States with refugee status.

Only persons applying for or receiving FIP assistance are eligible for PROMISE JOBS services. PROMISE JOBS staff shall accept Form 470–3826, Request for FIP Beyond 60 Months, as described at 441—subrule 41.30(3).

ITEM 10. Amend rule 441—93.104(239B) as follows:

Amend subrule 93.104(3) as follows:

93.104(3) Applicants in a limited benefit plan who must complete significant contact with or action in regard to PROMISE JOBS for FIP eligibility to be considered, as described at 441—paragraphs 41.24(8)“a” and “d,” are eligible for expense allowances for the 20 hours of activity. Applicants are eligible for PROMISE JOBS services and allowances under the circumstances described at 441—subrule 41.30(3). However, PROMISE JOBS services and allowances are only available when it appears the applicant will otherwise be eligible for FIP.

Rescind and reserve subrule 93.104(6).

ITEM 11. Amend subrule 93.105(2), introductory paragraph and first two unnumbered paragraphs, as follows:

93.105(2) Service upon referral. FIP applicants and participants who are referred to PROMISE JOBS shall initiate service for PROMISE JOBS orientation by contacting the appropriate PROMISE JOBS office within ten calendar days of the mailing date of the notice of FIP approval or withinten calendar days of notice that exempt status has been lost and FIA responsibility has begun, as required under 441— subrule 41.24(5).

PROMISE JOBS provider agencies shall schedule FIA orientation appointments at the earliest available times for FIP participants who contact the appropriate PROMISE JOBS office within the ten days except when the department exercises administrative authority to require prioritization of orientation services to ensure that specific groups receive services in order to achieve self–sufficiency in the shortest possible time, to meet federal minimum participation rate requirements and other TANF requirements. PROMISE JOBS staff may waive orientation services before writing an FIA when developing an FIA that meets the conditions of 441— paragraph 41.30(3)“e.”

Applicants who have chosen and are in a limited benefit plan are referred to PROMISE JOBS and must initiateservice by contacting the department or the appropriate PROMISE JOBS office as described at 441—subrule 41.24(1). The applicants who communicate the desire to engage in PROMISE JOBS activities shall be scheduled at the earliest available time to begin or resume the family investment agreement process.

ITEM 12. Amend rule 441—93.106(239B) as follows:

441—93.106(239B) Orientation for PROMISE JOBS and the FIA. Every ~~FIP participant~~ person who schedules and keeps an orientation appointment as described at subrule 93.105(2) shall receive orientation services.

93.106(1) Requirements of orientation. During orientation, each ~~participant~~ person shall receive a full explanation of the advantages of employment under the family investment program (FIP), services available under PROMISE JOBS, a review of participant rights and responsibilities under the FIA and PROMISE JOBS, a review of the LBP as described at 441—subrule 41.24(8), an explanation of the benefits of cooperation with the child support recovery unit, and an explanation of the other programs available through PROMISE JOBS, specifically the transitional Medicaid and child care assistance programs.

a. Each ~~participant~~ person shall sign Form WI–3305, Your Rights and Responsibilities, acknowledging that information described above has been provided.

b. ~~Participants~~ Orientation participants are required to complete a current workforce development registration, Form 60–0330, Application for Job Placement and/or Job Insurance, when requested by PROMISE JOBS staff.

c. No change.

d. The PROMISE JOBS worker shall meet with each orientation participant, or family if appropriate when two parents or children who are mandatory PROMISE JOBS participants are involved, to determine readiness to participate, establish expenses and a payment schedule and to discuss child care needs.

93.106(2) No change.

ITEM 13. Amend subrule 93.109(2), introductory paragraph, as follows:

93.109(2) FIA requirements. ~~The~~ Except when developing the six–month FIA described at 441—paragraph 41.30(3)“e,” the FIA shall be developed during the orientation and assessment process through discussion between the FIP participants and PROMISE JOBS staff of coordinating PROMISE JOBS provider agencies, using Form 470–3095, Family Investment Agreement, and Form 470–3096, FIA Steps to Achieve Self–Sufficiency. The FIAs described at 441—paragraph 41.30(3)“e” may include orientation and assessment services.

ITEM 14. Amend rule 441—93.110(239B), introductory paragraph and first unnumbered paragraph, as follows:

441—93.110(239B) Arranging for services. Staff is responsible for providing or helping the participant to arrange for employment–oriented services, as required, to facilitate the registrants’ successful participation, including client assessment or case management, employment education, transportation, child care, referral for medical examination, and supportive services under the family development and self–sufficiency program described in 441—Chapter 165 or other family development programs, described in rule 441— 93.119(239B). PROMISE JOBS funds shall be used to pay costs of obtaining a birth certificate when the birth certificate is needed in order for the registrant to complete the employment service registration process described in rule 441— 93.106(239B). PROMISE JOBS funds may also be used to pay expenses for clients enrolled in ~~JTPA~~ Workforce Investment Act (WIA)–funded components when those expenses are allowable under these rules. Clients shall submit Form 470–0510, Estimate of Cost, to initiate allowances or change the amount of payment for expenses other than child care. Clients shall submit Form 470–2959, Child Care Certificate, to initiate child care payments or change the amount of child care payments. The caretaker, the provider and the worker shall sign Form 470–2959 before the provider is paid.

Payment for child care, if required for participation in any PROMISE JOBS component other than orientation, not specifically prohibited elsewhere in these rules, and not available from any other source, shall be provided for participants after service has been received as described at 441—Chapter 170.

ITEM 15. Amend subrule 93.111(1), paragraph “a,” subparagraph (4), as follows:

(4) Participants shall have the option of substituting for assessment I assessment information which they have completed with another agency or person such as, but not limited to, ~~JTPA,~~ WIA, Head Start, public housing authorities, child welfare workers, and family development services. Participants shall authorize PROMISE JOBS to obtain these assessment results by signing Form ~~MH–2201–0~~ 470–0429, Consent to Release or Obtain Information. To be used in place of assessment I, the assessment results must contain all or nearly all of the items from paragraph “a” above and must have been completed within the past 12 months.

ITEM 16. Amend subrule 93.129(2), introductory paragraph, as follows:

93.129(2) Conciliation period for volunteers. The purpose of the conciliation period is to identify and remove or resolve barriers to participation, to ensure that volunteer participants do not unknowingly lose their right to priority service, and to identify the steps that the participant and the PROMISE JOBS staff will take to ensure successful participation. Conciliation for volunteers shall be provided by a conciliation unit established by the PROMISE JOBS provider agencies in each local service delivery area. PROMISE JOBS staff from DWD shall conciliate decisions made by JTPA workers. PROMISE JOBS staff from JTPA shall conciliate DWD decisions. The bureau of refugee services shall arrange with PROMISE JOBS staff of DWD and JTPA to provide conciliation services when the need arises. If the local service delivery area assigns interagency teams, decisions by a team shall be conciliated by the other teams.

[Filed 6/13/01, effective 9/1/01]

[Published 7/11/01]

EDITOR’S NOTE: For replacement pages for IAC, see IAC Supplement 7/11/01.

ARC 0769B

HUMAN SERVICES DEPARTMENT[441]

Adopted and Filed

Pursuant to the authority of Iowa Code section 217.6 and 2000 Iowa Acts, chapter 1228, section 13, subsection 2, paragraph “a,” and section 44, the Department of Human Services hereby amends Chapter 52, “Payment,” and Chapter 177, “In–Home Health Related Care,” appearing in the Iowa Administrative Code.

These amendments increase the maximum and flat State Supplementary Assistance (SSA) residential care facility (RCF) and in–home health related care (IHHRC) reimbursement rates. The maximum RCF reimbursement rate will be increased from $24.50 to $25.14 per day. The flat RCF reimbursement rate will be increased from $17.50 to $17.96 per day. The monthly IHHRC reimbursement rate will be increased from $471.06 to $483.31.

The Seventy–eighth General Assembly directed that the Department may take actions to meet the federal pass–along requirement mandated by Title XVI of the Social Security Act, Section 1618, if necessary. These rate increases are necessary to meet the federal pass–along requirements for calendar year 2001.

In order to comply with the federal pass–along requirement in calendar year 2001 and to make up a shortfall in meeting the federal pass–along requirement in calendar year 2000, Iowa’s total SSA expenditures must be at least $19,796,851. Based on current projections, the Department projects that calendar year 2001 may be short of this required spending level. Current projections indicate that a 3 percent increase in the RCF and IHHRC reimbursement rates is necessary to ensure compliance with the pass–along requirement in calendar year 2001. This spending shortfall is attributable to a decline in in–home health–related care and residential care facility usage.

These amendments do not provide for waiver in specified situations because they confer a benefit and are required to meet the federal pass–along requirement, as mandated by the legislature. Individuals may request a waiver of the monthly IHHRC reimbursement under the Department’s general rule on exceptions at rule 441—1.8(17A,217).

These amendments were previously Adopted and Filed Emergency and published in the May 2, 2001, Iowa Administrative Bulletin as ARC 0643B. Notice of Intended Action to solicit comments on that submission was published in the May 2, 2001, Iowa Administrative Bulletin as ARC 0642B.

These amendments are identical to those published under Notice of Intended Action.

The Council on Human Services adopted these amendments June 13, 2001.

These amendments are intended to implement Iowa Code sections 249.3(2) and 249.4 and 2000 Iowa Acts, chapter 1228, section 13, subsection 2, paragraph “a.”

These amendments shall become effective September 1, 2001, at which time the Adopted and Filed Emergency amendments are hereby rescinded.

The following amendments are adopted.

ITEM 1. Amend subrule 52.1(3), introductory paragraph, as follows:

52.1(3) Residential care. Payment to a recipient in a residential care facility shall be made on a flat per diem rate of ~~$17.50~~ $17.96 or on a cost–related reimbursement system with a maximum reimbursement per diem rate of ~~$24.50~~ $25.14. A cost–related per diem rate shall be established for each facility choosing this method of payment according to rule 441—54.3(249).

ITEM 2. Amend rule 441—177.4(249) as follows:

Amend subrule 177.4(3) as follows:

177.4(3) Maximum costs. The maximum cost of service shall be ~~$471.06~~ $483.31. The provider shall accept the payment made and shall make no additional charges to the recipient or others.

Amend subrule 177.4(7), introductory paragraph, as follows:

177.4(7) Income for adults. The gross income of the individual and spouse, living in the home, shall be limited to ~~$471.06~~ $483.31 per month if one needs care or ~~$942.12~~ $966.62 if both need care, with the following disregards:

Amend subrule 177.4(8), paragraph “b,” introductory paragraph, as follows:

b. The income of the child shall be limited to ~~$471.06~~ $483.31 per month with the following disregards:

[Filed 6/13/01, effective 9/1/01]

[Published 7/11/01]

EDITOR’S NOTE: For replacement pages for IAC, see IAC Supplement 7/11/01.

ARC 0773B

HUMAN SERVICES DEPARTMENT[441]

Adopted and Filed

Pursuant to the authority of Iowa Code section 249A.4, the Department of Human Services hereby amends Chapter 75, “Conditions of Eligibility,” and Chapter 76, “Application and Investigation,” appearing in the Iowa Administrative Code.

The Council on Human Services adopted these amendments on June 13, 2001. Notice of Intended Action regarding these amendments was published in the Iowa Administrative Bulletin on April 18, 2001, as ARC 0611B.

These amendments revise Medicaid policy regarding sanctions of persons who do not cooperate. The Health Care Financing Administration (HCFA) has informed the Department that the removal of a sanctioned individual from the household size is a Temporary Assistance for Needy Families (TANF) regulation and not a Medicaid regulation. These changes are necessary to bring the Department into compliance with HCFA regulations. The changes allow sanctioned individuals to remain a part of the Medicaid household for purposes of determining the eligibility of the other household members.

Currently, a client who does not cooperate with the Department (i.e., the Child Support Recovery Unit, Third Party Liability Unit, or HIPP Unit) is not eligible for Medicaid and is removed from the household size. However, the sanctioned individual’s income is still considered when determining eligibility of the remaining eligible group. This is also true for undocumented aliens and those individuals who do not have a social security number.

These amendments will allow the sanctioned adult, the undocumented adult alien and those adults who are ineligible because they do not have a social security number to remain a part of the household size for purposes of determining the eligibility of the other household members. Ineligible children will not be included in the household size and their income and resources will not be used in determining eligibility of the eligible group.

The word “voluntarily” is being inserted when referencing a person who is “voluntarily excluded” from the eligible group to clarify the meaning.

Currently, earnings of a full–time student are exempt only if that student is an applicant or recipient. There are times when a student is excluded from Medicaid, and therefore not an applicant or recipient when the Department has to count the student’s income in determining the eligibility of the student’s child. This can make the child ineligible. Therefore, the rule is being changed to not count earnings of any person 19 years of age or younger who is a full–time student.

These amendments do not provide for waivers in specified situations because the changes confer a benefit.

These amendments are identical to those published under Notice of Intended Action.

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

These amendments shall become effective September 1, 2001.

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 amendments [75.14, 75.52, 75.56 to 75.59, 76.1(5)] is being omitted. These amendments are identical to those published under Notice as ARC 0611B, IAB 4/18/01.

[Filed 6/13/01, effective 9/1/01]
[Published 7/11/01]

[For replacement pages for IAC, see IAC Supplement 7/11/01.]

ARC 0776B

HUMAN SERVICES DEPARTMENT[441]

Adopted and Filed

Pursuant to the authority of Iowa Code section 249A.4, the Department of Human Services hereby amends Chapter 77, “Conditions of Participation for Providers of Medical and Remedial Care,” Chapter 78, “Amount, Duration and Scope of Medical and Remedial Services,” and Chapter 79, “Other Policies Relating to Providers of Medical and Remedial Care,” appearing in the Iowa Administrative Code.

These amendments allow Medicaid reimbursement to ambulatory surgical centers currently participating in the Medicaid program for providing dental services and clarify criteria governing covered surgical procedures. Freestanding ambulatory surgical centers providing only dental services are also made eligible to participate in the medical assistance program if the Board of Dental Examiners has issued a current permit pursuant to 650—Chapter 29 for any dentist to administer deep sedation or general anesthesia at the facility.

Medicare certification requirements for ambulatory surgical centers are excessive when only dental services are provided. These amendments will create a less costly alternative to hospital care for Medicaid recipients who require deep sedation or general anesthesia to receive dental care.

These amendments do not provide for waivers in specified situations because a waiver is not appropriate as these amendments confer a benefit by providing an additional dental service setting.

The following revision was made to the Notice of Intended Action: Rule 441—78.26(249A) was revised by replacing the “Iowa Foundation for Medical Care” with the “department’s utilization review and quality assurance firm.” IFMC may not always be the organization awarded the contract to act as the Department’s utilization review and quality assurance firm.

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

These amendments shall become effective September 1, 2001.

The following amendments are adopted.

ITEM 1. Amend rule 441—77.24(249A) as follows:

441—77.24(249A) Ambulatory surgical centers. Ambulatory surgical centers ~~which~~ that are not part of hospitals are eligible to participate in the medical assistance program if they are certified to participate in the Medicare program (Title XVIII of the Social Security Act). Freestanding ambulatory surgical centers providing only dental services are also eligible to participate in the medical assistance program if the board of dental examiners has issued a current permit pursuant to 650—Chapter 29 for any dentist to administer deep sedation or general anesthesia at the facility.

ITEM 2. Amend rule 441—78.26(249A), introductory paragraphs, as follows:

441—78.26(249A) Ambulatory surgical center services. Ambulatory surgical center services are those services furnished by an ambulatory surgical center in connection with a covered surgical procedure or a covered dental procedure.

The covered services provided by an ambulatory surgical center shall be those services covered by the Medicare program and those services which can be safely performed in an outpatient setting as determined by the department upon advice from the Iowa Foundation for Medical Care.

Covered surgical procedures shall be those medically necessary procedures that are eligible for payment ~~and under the same circumstances~~ as physicians’ services, under the circumstances specified in rule 441—78.1(249A) and performed on an eligible recipient, that can safely be performed in an outpatient setting as determined by the department upon advice from the department’s utilization review and quality assurance firm.

Covered dental procedures are those medically necessary procedures that are eligible for payment as dentists’ services, under the circumstances specified in rule 441— 78.4(249A) and performed on an eligible recipient, that can safely be performed in an outpatient setting for Medicaid recipients whose mental, physical, or emotional condition necessitates deep sedation or general anesthesia.

The covered services provided by the ambulatory surgical center in connection with a Medicaid–covered surgicalor dental procedure shall be those nonsurgical and non–dental services covered by the Medicare program as ambulatory surgical center services in connection with Medicare–covered surgical procedures.

ITEM 3. Amend subrule 79.1(3) as follows:

79.1(3) Ambulatory surgical centers. Payment is made for facility services on a fee schedule ~~which is~~ determined by Medicare. These fees are grouped into eight categories corresponding to the difficulty or complexity of the surgical procedure involved. Procedures not classified by Medicare shall be included in the category with comparable procedures.

Services of the physician or the dentist are reimbursed on the basis of a fee schedule (see ~~subrule~~ paragraph 79.1(1)“c”). This payment is made directly to the physician or dentist.

[Filed 6/13/01, effective 9/1/01]

[Published 7/11/01]

EDITOR’S NOTE: For replacement pages for IAC, see IAC Supplement 7/11/01.

ARC 0787B

HUMAN SERVICES DEPARTMENT[441]

Adopted and Filed

Pursuant to the authority of Iowa Code section 234.6, the Department of Human Services hereby adopts Chapter 119, “Record Check Evaluations for Health Care Programs,” and amends Chapter 176, “Dependent Adult Abuse,” appearing in the Iowa Administrative Code.

Iowa Code section 135C.33 requires health care facilities to request criminal and dependent adult abuse record checks on a person prior to employment of that person. The facilities may also request that the Department of Human Services perform child abuse record checks in the state. Health care facilities include residential care facilities, nursing facilities, intermediate care facilities for persons with mental illness, and intermediate care facilities for persons with mental retardation. These requirements also apply to the following providers if they are regulated by the state or receive any state or federal funding for prospective employees providing direct services to consumers:

• Homemaker, home–health aide, home–care aide, and adult day care providers, or other providers of in–home services.

• Hospices.

• Federal home– and community–based waiver providers.

• Elder group homes.

• Assisted living facilities.

If the Department of Public Safety determines that a person has committed a crime or the Department of Human Services determines that the person has a record of founded child or dependent adult abuse, the employer may request that the Department of Human Services conduct an evaluation to determine whether prohibition of the person’s employment is warranted.

These amendments establish the procedures for the record check evaluations by the Department and update policy regarding who may request an employment background check to conform policy with a change passed by the Seventy–ninth General Assembly in 2001 Iowa Acts, House File 192.

The Department completed approximately 3,500 evaluations in calendar year 2000 for current and prospective employees of health care facilities and other health care programs.

These amendments do not provide for waivers in specified situations because Iowa law does not provide for exceptions.

The following revisions were made to the Notice of Intended Action in response to public comments:

Rule 441—119.2(135C) was revised to:

• Allow, but not require, employers to request criminal background checks on current employees if the employer learns from any source that a current employee has a criminal or dependent adult or child abuse record.

• Clarify that there must be a current criminal and dependent adult abuse background check before an employer may request a record check evaluation.

These amendments are intended to implement Iowa Code section 135C.33 as amended by 2001 Iowa Acts, House File 192, section 1, and section 235B.6 as amended by 2001 Iowa Acts, House File 192, section 3.

These amendments shall become effective September 1, 2001.

The following amendments are adopted.

ITEM 1. Adopt the following new 441—Chapter 119:

CHAPTER 119
RECORD CHECK EVALUATIONS
FOR HEALTH CARE PROGRAMS

PREAMBLE

These rules establish procedures for the performance of record check evaluations by the department of human services for personnel employed by health care facilities and other health care programs listed in Iowa Code section 135C.33. Record check evaluations are performed, at the request of a prospective employer, on persons who have been found to have been convicted of a crime under a law of any state or have a record of founded child or dependent adult abuse, to determine whether the crimes or founded abuses warrant prohibition of employment.

441—119.1(135C) Definitions.

“Department” means the department of human services.

“Health care program” means any of the facilities and programs listed in Iowa Code chapter 135C that are subject to record check evaluations.

441—119.2(135C) When record check evaluations are requested.

119.2(1) Record check evaluations on prospective employees. Health care programs shall request a record check evaluation when they decide to consider for employment a person whose background check indicates a criminal or dependent adult abuse or child abuse record. Criminal and dependent adult abuse background checks are required on all prospective employees, including employees who have terminated employment for any reason or any length of time and wish to return to the same health care program.

119.2(2) Record check evaluations on current employees. Employers may request a record check evaluation on current employees when a current employee’s background check indicates a criminal or dependent adult or child abuse record. An employer may request a current criminal or dependent adult or child abuse record check when the employer learns from any source that a current employee has a criminal or dependent adult or child abuse record that has not been previously evaluated at the health care program.

119.2(3) Transfer of employment. If a person owns or operates more than one facility, and an employee of one of the facilities is transferred to another facility without a lapse in employment, the facility is not required to request additional criminal or abuse record checks of the employee or obtain a new record check evaluation.

441—119.3(135C) Request for evaluation.

119.3(1) Required documentation. The employer and the prospective employee shall complete and the employer shall submit Form 470–2310, Record Check Evaluation, to the department to request an evaluation. The employer shall submit the form and required documentation to the Department of Human Services, Central Abuse Registry, 1305 East Walnut, Des Moines, Iowa 50319–0114. The department shall not process evaluations that are not signed by the prospective employee. The position sought or held must be clearly written on the first page of Form 470–2310, Record Check Evaluation. Form 470–2310 shall be accompanied by the following documents:

a. A copy of the documentation of the applicant’s status on the DCI criminal history database generated within 30 days of the time that the request for evaluation is submitted to the department.

b. A copy of the Iowa Criminal History, if there is a history, as provided to the employer by the division of criminal investigations.

c. A copy of the documentation of the applicant’s status on the dependent adult abuse registry generated within 30 days of the time that the request for evaluation is submitted to the department.

119.3(2) Additional documentation.

a. The employer may provide or the department may request from the prospective employee or employer information to assist in performance of the evaluation that includes, but is not limited to, the following:

(1) Documentation of criminal justice proceedings.

(2) Documentation of rehabilitation.

(3) Written employment references or applications.

(4) Documentation of substance abuse education or treatment.

(5) Criminal history records, child abuse information, and dependent adult abuse information from other states.

(6) Documentation of the applicant’s prior residences.

b. Any person or agency that might have pertinent information regarding the criminal or abuse history and rehabilitation of a prospective employee may be contacted.

c. The department may check the child abuse registry during a record check evaluation. If there is a record of child abuse, the department shall consider the information in the child abuse record in reaching a decision regarding employability.

441—119.4(135C) Completion of evaluation.

119.4(1) Considerations. The department shall consider the following when conducting a record check evaluation:

a. The nature and seriousness of the crime or founded child or dependent adult abuse in relation to the position sought or held.

b. The time elapsed since the commission of the crime or founded child or dependent adult abuse.

c. The circumstances under which the crime or founded abuse was committed.

d. The degree of rehabilitation.

e. The likelihood that the person will commit a crime or founded child or dependent adult abuse again.

f. The number of crimes or instances of founded child or dependent adult abuse committed by the person involved.

119.4(2) Notice of decision. The department shall issue a notice of decision in writing to the employer that requested the record check evaluation. The department shall send a copy of the notice of decision to the person who has applied for employment, if the person’s address is available. If the address is not available, the department shall send the prospective employee’s copy of the notice to the employer.

a. The notice shall be valid only for employment with the employer that requested the record check evaluation.

b. The notice shall not be valid for employment with any other prospective employer.

c. Record check evaluations are valid for employment that commences within 30 days from the date of notice of decision.

d. The notice of decision shall contain the notice of right to appeal.

441—119.5(135C) Appeal rights. Any person or the person’s attorney may file a written statement with the department requesting an appeal of the record check evaluation decision within 30 days of the date of the notice of the resultsof the record check evaluation in accordance with 441— Chapter 7.

These rules are intended to implement Iowa Code section 135C.33.

ITEM 2. Amend subrule 176.10(3), paragraph “e,” by adopting the following new subparagraph (10):

(10) The department of inspections and appeals for purposes of record checks of applicants for employment with the department of inspections and appeals.

[Filed 6/13/01, effective 9/1/01]

[Published 7/11/01]

EDITOR’S NOTE: For replacement pages for IAC, see IAC Supplement 7/11/01.

ARC 0813B

NATURAL RESOURCE COMMISSION[571]

Adopted and Filed

Pursuant to the authority of Iowa Code section 455A.5(6)“e,” the Natural Resource Commission hereby amends Chapter 15, “General License Regulations,” Iowa Administrative Code.

These amendments establish the requirements for electronic license sales.

Notice of Intended Action was published in the Iowa Administrative Bulletin on March 7, 2001, as ARC 0542B. No comments were received during the comment period or at the public hearing held March 27, 2001. There are no changes from the Notice of Intended Action.

These amendments are intended to implement Iowa Code section 455A.5(6)“e.”

These amendments shall become effective August 15, 2001.

The following amendments are adopted.

ITEM 1. Amend subrule 15.1(1) by adopting the following new definition in alphabetical order:

Administration fee. Administration fee means the fee collected by the department to pay a portion of the cost of administering the sale of licenses through electronic means.

ITEM 2. Amend rule 571—15.1(483A) by adopting the following new subrule:

15.1(7) Administration fee. An administration fee of 50 cents per privilege purchased shall be collected from the purchaser at the time of purchase, except upon the issuance of free landowner deer and turkey licenses, free annual hunting and fishing licenses, free lifetime fishing licenses, and free group home fishing licenses.

[Filed 6/21/01, effective 8/15/01]

[Published 7/11/01]

EDITOR’S NOTE: For replacement pages for IAC, see IAC Supplement 7/11/01.

ARC 0814B

NATURAL RESOURCE COMMISSION[571]

Adopted and Filed

Pursuant to the authority of Iowa Code subsection 455A.5(6), the Natural Resource Commission hereby amends Chapter 51, “Game Management Areas,” Iowa Administrative Code.

These rules give the regulations for public use of state game management areas. These amendments address the issues of use of firearms, use of blinds and decoys, use of nontoxic shot, and rappelling and rock climbing in game management areas.

Notice of Intended Action was published in the Iowa Administrative Bulletin on May 2, 2001, as ARC 0651B.

There is one change from the Notice of Intended Action. The phrase “Boone Forks wildlife management area only on the abandoned railroad bridge piers” has been added to the first sentence of rule 571—51.10(481A). The sentence now reads as follows:

“Rock climbing and rappelling are prohibited at all game management areas except at Indian Bluffs and Pictured Rocks wildlife management areas, Boone Forks wildlife management area only on the abandoned railroad bridgepiers, and those authorized by 571—subrule 61.5(13).”

These amendments are intended to implement Iowa Code sections 456A.24 and 481A.6.

These amendments shall become effective August 15, 2001.

The following amendments are adopted.

ITEM 1. Amend subrule 51.3(1), paragraph “j,” by adopting the following new subparagraph (4) and renumbering current subparagraphs (4) to (9) as (5) to (10):

(4) Brushy Creek Area – Webster County.

ITEM 2. Amend subrule 51.5(3) as follows:

51.5(3) Use of waterfowl decoys. The use of waterfowl decoys on any game management area is restricted as follows: Decoys are prohibited from one–half hour after sunset until midnight each day, and decoys cannot be left unattended for over 30 minutes between midnight and one–half hour after sunset. Decoys shall be considered as removed from an area when they are picked up and placed in a boat, vehicle or other container at an approved access site.

ITEM 3. Amend rule 571—51.9(481A) by adding the following new entry in alphabetical order:

County Wildlife Area

Franklin Coulter Marsh

ITEM 4. Amend 571—Chapter 51 by adopting the following new rule:

571—51.10(481A) Rock climbing and rappelling. Rock climbing and rappelling are prohibited at all game management areas except at Indian Bluffs and Pictured Rocks wildlife management areas, Boone Forks wildlife management area only on the abandoned railroad bridge piers, and those authorized by 571—subrule 61.5(13). No one shall place bolts, pitons or similar anchoring devices at Indian Bluffs or

Pictured Rocks unless authorized to do so by the wildlife biologist in charge of the area.

[Filed 6/21/01, effective 8/15/01]

[Published 7/11/01]

EDITOR’S NOTE: For replacement pages for IAC, see IAC Supplement 7/11/01.

ARC 0817B

NATURAL RESOURCE COMMISSION[571]

Adopted and Filed

Pursuant to the authority of Iowa Code subsection 455A.5(6), the Natural Resource Commission hereby amends Chapter 76, “Unprotected Nongame,” Iowa Administrative Code.

This chapter gives the regulations for unprotected nongame bird and reptile species. This amendment addresses the issue of leaving garter snakes on the list of unprotected nongame species and removing the timber rattlesnake from the list of unprotected nongame species in certain specified counties.

Notice of Intended Action was published in the Iowa Administrative Bulletin on May 2, 2001, as ARC 0652B. There are no changes from the Notice of Intended Action.

This amendment is intended to implement Iowa Code sections 456A.24 and 481A.6.

This amendment shall become effective August 15, 2001.

The following amendment is adopted.

Amend rule 571—76.1(481A) by adopting the following new subrule:

76.1(2) Reptiles.

a. Garter snake.

b. Timber rattlesnake except in Allamakee, Appanoose, Clayton, Delaware, Des Moines, Dubuque, Fayette, Henry, Jackson, Jones, Lee, Madison, Van Buren, and Winneshiek Counties but not including an area of 50 yards around houses actively occupied by human beings in those counties.

[Filed 6/21/01, effective 8/15/01]

[Published 7/11/01]

EDITOR’S NOTE: For replacement pages for IAC, see IAC Supplement 7/11/01.

ARC 0806B

PROFESSIONAL LICENSURE DIVISION[645]

Adopted and Filed

Pursuant to the authority of Iowa Code section 147.76, the Board of Psychology Examiners hereby adopts new Chapter 239, “Board of Psychology Examiners”; rescinds Chapter 240, “Board of Psychology Examiners,” adopts new Chapter 240, “Licensure of Psychologists”; amends Chapter 241, “Continuing Education for Psychologists”; adopts new Chapter 242, “Discipline for Psychologists”; and adopts new Chapter 243, “Fees,” Iowa Administrative Code.

The proposed amendments rescind the current licensing rules and fees and adopt a new chapter for licensure, a new chapter for discipline and a new chapter for fees.

Notice of Intended Action was published in the Iowa Administrative Bulletin on March 7, 2001, as ARC 0533B. A public hearing was held on March 29, 2001, from 9 to 11 a.m. in the Professional Licensure Conference Room, Fifth Floor, Lucas State Office Building, Des Moines, Iowa. No public comments were received at the hearing.

The following changes were made to the Notice of Intended Action:

In rule 240.1(154B), definitions were added for “license expiration date,” “licensure by endorsement” and “reciprocal license.”

Paragraph 240.2(2)“g” was amended to read as follows:

“g. The EPPP examination may be taken a total of only four times in this state or in any other state or jurisdiction. If the applicant fails a fourth EPPP, education in areas established by the board must be obtained before another examination will be allowed.”

In rule 240.7(154B), the phrase “not to exceed” was added to the last sentence in the introductory paragraph to clarify the amount of time a psychologist not licensed in Iowa can practice in Iowa under Iowa Code section 154B.3(5).

In rule 240.12(272C), the following changes were made: subrule 240.12(3) was clarified regarding renewal at the next scheduled renewal cycle; subrule 240.12(4) was added to explain that a new licensee on inactive status in the first renewal cycle does not have to complete continuing education if the licensee reinstates in the first renewal cycle; subrule 240.12(5), requiring verifications of licensure for reinstatement, was added. The chart for subrule 240.12(6) was changed to reflect the Board’s decision to cap the renewal fees at two bienniums.

Subrule 240.13(5), requiring verifications of licensure, was added and subsequent subrules were renumbered.

An amendment to subrule 241.9(1) was included to reflect the Board’s decision to cap the renewal fees at two bienniums.

These amendments were adopted by the Board of Psychology Examiners on June 15, 2001.

These amendments will become effective August 15, 2001.

These amendments are intended to implement Iowa Code section 147.76 and chapters 154B and 272C.

The following amendments are adopted.

ITEM 1. Adopt new 645—Chapter 239 as follows:

CHAPTER 239
BOARD OF PSYCHOLOGY EXAMINERS

645—239.1(154B) General definitions.

“Board” means the board of psychology examiners.

“Law” means chapters 147 and 154B of the Code of Iowa.

645—239.2(154B) Availability of information.

239.2(1) All information regarding rules, forms, time and place of meetings, minutes of meetings, record of hearings, and examination results are available to the public between the hours of 8 a.m. and 4:30 p.m., Monday through Friday, except holidays.

239.2(2) Information may be obtained by writing to the Board of Psychology Examiners, Iowa Department of Public Health, Lucas State Office Building, Des Moines, Iowa 50319–0075. All official correspondence shall be in writing and directed to the board at this address.

645—239.3(154B) Organization and proceedings.

239.3(1) A chairperson, vice–chairperson, and secretary shall be elected at the first meeting of each fiscal year.

239.3(2) Four board members actually present constitute a quorum.

239.3(3) The board shall hold an annual meeting and at least three interim meetings and may hold additional meetings called by the chairperson or by a majority of the board’s members. The chairperson shall designate the date, place, and time prior to each meeting of the board. Notice of time and place of all meetings shall be given to board members by the secretary at least 14 days before the meeting is to be held. However, in case of emergency requiring the board to meet before such notice can be given, notification may be given no later than 24 hours before the meeting. The board shall follow the latest edition of Robert’s Rules of Order Revised at its meeting whenever any objection is made as to the manner in which it proceeds at a meeting.

239.3(4) All issues, requests, or submissions to the board will be considered. However, official action will be taken only in response to written requests.

239.3(5) The board shall have both formal and informal procedures for use when appropriate in conducting the business of the board. Procedures may involve, but are not limited to, hearings for individuals, questions of legal policy, inquiries concerning board policies or decisions, or other board business. Informal procedures shall be preferred unless either the board or requesting party requests a formal procedure. When a formal procedure is elected, a full transcript or audio tape recording of the procedure shall be made.

These rules are intended to implement Iowa Code chapters 17A, 147, and 154B.

ITEM 2. Rescind 645—Chapter 240 and adopt the following new chapter in lieu thereof:

CHAPTER 240
LICENSURE OF PSYCHOLOGISTS

645—240.1(154B) Definitions. For purposes of these rules, the following definitions shall apply:

“Board” means the board of psychology examiners.

“Certified health service provider in psychology” means a person who works in a clinical setting, is licensed to practice psychology and who has a doctoral degree in psychology. A person certified as a health service provider in psychology shall be deemed qualified to diagnose or evaluate mental illness and nervous disorders.

“Lapsed license” means a license that a person has failed to renew as required, or the license of a person who failed to meet stated obligations for renewal within a stated time.

“Licensee” means any person licensed to practice as a psychologist or health service provider in psychology in the state of Iowa.

“License expiration date” means June 30 of even–numbered years.

“Licensure by endorsement” means the issuance of an Iowa license to practice psychology to an applicant who is currently licensed in another state.

“Organized health service training program” means a training program designed to provide the intern with a planned, programmed sequence of training experiences. The primary focus and purpose is ensuring breadth and quality of training.

“Reciprocal license” means the issuance of an Iowa license to practice psychology to an applicant who is currently licensed in another state that has a mutual agreement with the Iowa board of psychology examiners to license persons who have the same or similar qualifications to those required in Iowa.

“Recognized health service setting” means a setting in which the delivery of direct preventive, assessment, and therapeutic intervention services are provided to individuals whose growth, adjustment or functioning is actually impaired or is demonstrably at high risk of impairment. The delivery of the aforementioned services includes, but is not limited to, the diagnosis or evaluation and treatment of mental illness and nervous disorders, excluding those mental illnesses and nervous disorders which are established as primarily of biological etiology with the exception of the treatment of the psychological and behavioral aspects of those mental illnesses and nervous disorders.

“Supervisor” means a licensed psychologist who meets the qualifications stated in these rules.

“Testing service” means Professional Examination Service (PES).

645—240.2(154B) Requirements for licensure.

240.2(1) The following criteria shall apply to licensure:

a. An applicant shall complete a board–approvedapplication packet. Application forms may be obtained from the board’s Web site (http://www.idph.state.ia.us/licensure) or directly from the board office. All applications shall be sent to Board of Psychology Examiners, Professional Licensure Division, Fifth Floor, Lucas State Office Building, Des Moines, Iowa 50319–0075.

b. An applicant shall complete the application form according to the instructions contained in the application. If the application is not completed according to the instructions, the application will not be reviewed by the board.

c. Each application shall be accompanied by the appropriate fees (exclusive of the test administration fee) payable by check or money order to the Board of Psychology Examiners. The fees are nonrefundable.

d. No application will be considered by the board until:

(1) Official copies of academic transcripts sent directly from the school to the board of psychology examiners have been received by the board;

(2) Satisfactory evidence of the candidate’s qualifications has been supplied in writing on the prescribed forms by the candidate’s supervisors;

(3) A Statement of Competency form, which may be obtained from the board of psychology examiners, has been submitted; and

(4) Verifications of licenses from other states have been sent directly from those states to the board office.

e. The candidate shall take written and oral examinations required by the board pursuant to these rules.

f. Licensees who were issued their licenses within six months prior to the renewal date shall not be required to renew their licenses until the renewal date two years later.

g. Incomplete applications that have been on file in the board office for more than two years shall be:

(1) Considered invalid and shall be destroyed; or

(2) Maintained upon written request of the candidate. The candidate is responsible for requesting that the file be maintained.

h. Notification of eligibility for licensure shall be sent to the licensee by the board.

240.2(2) The following criteria shall apply to the written examination:

a. The licensee shall complete an approved application form for the Examination for Professional Practice in Psychology (EPPP) available from the board’s Web site (http://www.idph.state.ia.us/licensure) or directly from the board office. All applications shall be sent to Board of Psychology Examiners, Professional Licensure Division, Fifth Floor, Lucas State Office Building, Des Moines, Iowa 50319–0075.

b. The application shall be accompanied by a check or money order for the Examination for Professional Practice in Psychology fee made payable to PES.

c. The board shall notify PES of eligible candidates for the EPPP.

d. An “authorization–to–test” letter containing a toll–free telephone number to call for scheduling the examination shall be sent to each eligible candidate by PES.

e. The board of psychology examiners shall mail examination results to the candidates.

f. If a retake is necessary, candidates must reapply to the board of psychology examiners and wait at least 60 days before an appointment to test may be scheduled.

g. The EPPP examination may be taken four times in this state or in any other state or jurisdiction. If the applicant fails a fourth EPPP, education in areas established by the board must be obtained before another examination will be allowed.

240.2(3) The following criteria shall apply to the oral examination:

a. A candidate shall be eligible to schedule the oral examination after:

(1) Passing the EPPP written examination;

(2) Completing the supervised professional experience pursuant to 645—240.5(154B); and

(3) Completing the Statement of Competency.

b. The board of psychology examiners shall notify the candidate by regular mail of eligibility to sit for the oral examination.

c. The oral examination shall be conducted by the licensed members of the board pursuant to Iowa Code section 147.21.

d. The applicant shall schedule the examination with the board of psychology examiners.

e. If a retake is necessary, the candidate must wait at least six months before an appointment to retest may be scheduled.

f. Candidates shall receive written notification of the results of the examination from the board of psychology examiners.

645—240.3(154B) Educational qualifications. A new applicant for licensure to practice as a psychologist shall possess a doctoral degree in psychology.

240.3(1) The degree in psychology shall be granted by an institution accredited by the North Central Association of Colleges and Secondary Schools or an equivalent accrediting association or entity in other regions of the United States; or

240.3(2) The doctoral degree in psychology shall be granted through a professional psychology program that is accredited by the North Central Association of Colleges and Secondary Schools or an equivalent accrediting association or entity in other regions of the United States; or

240.3(3) The program from which the doctoral degree in psychology is granted must meet the following requirements:

a. The program must be accredited by the American Psychological Association and recognized as meeting the requirements of a professional psychology program.

b. The program, wherever it may be administratively housed, must be clearly identified and labeled as a psychology program. A program must specify in pertinent institutional catalogues and brochures its intent to educate and train professional psychologists.

c. The psychology program must stand as a recognizable, coherent organizational entity within the institution.

d. There must be a clear authority and primary responsibility for the core and specialty areas whether or not the program cuts across administrative lines.

e. The program must be an integrated, organized sequence of study.

f. There must be an identifiable psychology faculty on site sufficient in size to ensure that the ratio of faculty to students is adequate for instruction. The faculty must also have sufficient breadth in order to ensure that the scope of knowledge in psychology provides for adequate instruction. There must be a psychologist responsible for the program.

g. The program must have an identifiable body of students who are matriculated in that program for a degree.

h. The program must include supervised practicum, internship, and field or laboratory training appropriate to the practice of psychology.

i. The curriculum shall encompass a minimum of three academic years of graduate study.

j. The program shall require a minimum of one year’s residency at the educational institution granting the doctoral degree.

k. In addition to instruction in scientific and professional ethics and standards, research design and methodology, statistics and psychometrics, the core program shall require each student to demonstrate competence in each of the following substantive content areas. This typically will be met by including a minimum of three or more graduate semester hours (five or more graduate quarter hours) in each of these four substantive content areas:

(1) Biological bases of behavior: physiological psychol–ogy, comparative psychology, neuropsychology, sensation and perception, psychopharmacology;

(2) Cognitive–affective bases of behavior: learning, thinking, motivation, and emotion;

(3) Social bases of behavior: social psychology, group processes, organizational and systems theory; and

(4) Individual differences: personality theory, human development, and abnormal psychology.

l. In addition, all professional education programs in psychology will include course requirements in specialty areas.

240.3(4) Foreign–trained psychologists shall:

a. Provide an equivalency evaluation of their educational credentials by one of the following: International Educational Research Foundations, Inc., Credentials Evaluation Service, P.O. Box 3665, Culver City, CA 90231–3665, telephone (310)258–9451, Web site www.ierf.org, or E–mail info@ierf.org; or International Credentialing Associates, Inc., 7245 Bryan Dairy Road, Bryan Dairy Business Park II, Largo, Florida 33777, telephone (727)549–8555. The professional curriculum must be equivalent to that stated in these rules. The candidate shall bear the expense of the curriculum evaluation.

b. Provide a notarized copy of the certificate or diploma awarded to the applicant from a psychology program in the country in which the applicant was educated.

c. Receive a final determination from the board regarding the application for licensure.

645—240.4(154B) Title designations.

240.4(1) Applicants for licensure who have met educational requirements but have not yet passed the EPPP may be designated “psychology associate” or “associate in psychology.” The title “psychology associate” or “associate in psychology” shall not be used except in the person’s employment and supervision that meet the requirements of subrule 240.5(2).

240.4(2) Applicants for licensure who have passed the EPPP and who are fulfilling the experience requirements specified herein for licensure may be designated “psychology resident” or “resident in psychology.” The designation of “resident” shall not be used except in the employment and supervised experience that meet the requirements of subrule 240.5(2).

240.4(3) Notwithstanding other provisions of these rules, applicants for licensure who are engaged in organized health service training programs as specified in rule 645— 240.6(154B) may be designated “psychology intern” or “intern in psychology” during their time in training.

240.4(4) Persons licensed in another state who are in the process of seeking licensure in Iowa and who are being supervised until obtaining an Iowa license may use the designation “Licensed Psychologist, (name of state)” for a period of up to one year from the date of application.

645—240.5(154B) Supervised professional experience.

240.5(1) The supervised professional experience shall:

a. Be 12 months full–time or a minimum of 1800 hours;

b. Apply the principles of psychology;

c. Be supervised by a licensed psychologist as specified in subrule 240.5(2) or rule 240.8(154B);

d. Be performed competently as attested to by the supervisor;

e. Have the fees and receipt of payment schedule remain the sole domain of the employing agency or supervising psychologist.

240.5(2) Requirements.

a. To meet the requirements of the supervised professional experience, the supervisee must:

(1) Meet a minimum of one hour per week, face to face and individually with the supervisor;

(2) Have training that is appropriate to the functions to be performed;

(3) Work in the same physical setting as the supervisor unless otherwise approved by the board;

(4) Offer work in the name of the supervising psychologist;

(5) Begin the experience after all academic requirements for the doctoral degree are met and when all degree requirements are verified in writing;

(6) Not apply professional employment that occurs prior to meeting the doctoral academic requirements to the supervised professional experience;

(7) Compute part–time employment on a prorated basis for the supervised professional experience; and

(8) Have the background, training, and experience that is appropriate to the functions performed.

b. To meet the requirements of the supervised professional experience, the supervisor must:

(1) Be a licensed psychologist as specified in rule 240.2(154B) or 240.8(154B);

(2) Complete the supervision form provided by the board;

(3) Meet a minimum of one hour per week, face to face and individually with the supervisee;

(4) Provide training that is appropriate to the functions to be performed;

(5) Work in the same physical setting as the supervisee unless otherwise approved by the board;

(6) Have work offered in the name of the supervising psychologist;

(7) Have no more than three full–time persons associated with the supervisor as listed on the supervisor report form obtained from the board;

(8) Not provide group supervision as part of this experience;

(9) Not supervise any psychological practice or permit the supervisor’s supervisee to engage in any psychological practice which the supervisor cannot perform competently; and

(10) Be responsible for determining competency of the work performed by the supervisee and the designation of the title of the supervisee.

240.5(3) Employment experience which is offered to satisfy one provision of the law may not be simultaneously offered to satisfy the educational provisions of the law. For example, employment experiences which are part of the required preparation for the doctoral degree will be applicable only to the doctoral degree requirements and may not be simultaneously offered to satisfy the supervised professional experience requirement.

240.5(4) Professional employment experience acquired by the applicant between the time all requirements were fulfilled for the doctoral degree and the time of the actual conferral of the degree may be credited toward the professional employment experience requirements for licensing, provided that the date of completion of all degree requirements is verified in writing by an appropriate academic official. Verification must come directly to the board from the academic official.

240.5(5) Persons providing psychological services who are not licensed by the board of psychology examiners shall be under the direct and continuing administrative and professional direction of a psychologist licensed by the board.

645—240.6(154B) Certified health service provider in psychology.

240.6(1) Requirements for the health service provider in psychology. The applicant shall:

a. Have at least two years of clinical experience in a recognized health service setting or meet the standards of the National Register of Health Service Providers in Psychology. Two years of clinical experience means two years of supervised experience in health service in psychology, of which at least one year is in an organized health service training program as defined in 240.6(2) and one year is postdoctoral.

b. Complete the application and provide all supporting documentation to the board.

c. Pay the health service provider fee payable by check or money order to the Board of Psychology Examiners.

The certificate shall be renewed biennially at the same time as the psychology license renewal fees are due.

240.6(2) Requirements of the health service training program. The organized health service training program shall:

a. Have a clearly designated staff psychologist who is responsible for the integrity and quality of the training program and who holds an active license from the state board of examiners in psychology in the state in which the program exists.

b. Have two or more psychologists on the staff as supervisors, at least one of whom holds an active license as a psychologist from the state board of examiners in psychology in the state in which the program exists.

c. Have supervision which is provided by a staff member of the organized health service training program or by an affiliate of the organized health service training program who carries clinical responsibility for the cases being supervised. At least half of the internship supervision shall be provided by one or more psychologists.

d. Provide training in a range of assessment and treatment activities conducted directly with patients seeking psychological services.

e. Have a minimum of 375 hours of trainees’ time in direct patient contact.

f. Include a minimum of two hours per week (regardless of whether the internship is completed in one year or two) of regularly scheduled, formal, face–to–face individual supervision with the specific intent of dealing with psychological services rendered directly by the intern. There must also be at least two additional hours per week in learning activities such as case conferences involving a case in which the intern is actively involved; seminars dealing with clinical issues; cotherapy with a staff person including discussion; group supervision; additional individual supervision.

g. Have training that is at the postclerkship, postpracti–cum, and postexternship level.

h. Have a minimum of two interns at the internship level of training during any period of training.

i. Designate for internship–level trainees titles such as “intern,” “resident,” “fellow,” or other designation of trainee status.

j. Have a written statement or brochure which describes the goals and content of the internship, states clear expectations for quantity and quality of trainees’ work and is made available to prospective interns.

k. Provide a minimum of 1800 hours of training experience that shall be completed within 24 consecutive months and no less than 12 months.

645—240.7(154B) Exemption to licensure. Psychologists residing outside the state of Iowa and intending to practice in Iowa under the provisions of Iowa Code section 154B.3(5) shall file a summary of intent to practice and provide verification of the license from the other jurisdiction. The summary shall be submitted to and approved by the board prior to practice in Iowa. The exemption shall be valid for 10 consecutive business days or not to exceed 15 business days in any 90–day period.

The summary and supporting documentation shall be accompanied by a check or money order for the processing fee for exemption to licensure pursuant to 645—Chapter 243. The fee is nonrefundable and shall be submitted payable to the Board of Psychology Examiners.

645—240.8(154B) Psychologists’ supervision of unlicensed persons in a practice setting. The supervising psychologist shall:

1. Be vested with administrative control over the functioning of assistants in order to maintain ultimate responsibility for the welfare of every client. When the employer is a person other than the supervising psychologist, the supervising psychologist must have direct input into administrative matters.

2. Have sufficient knowledge of all clients, including face–to–face contact when necessary, in order to plan effective service delivery procedures. The progress of the work shall be monitored through such means as will ensure that full legal and professional responsibility can be accepted by the supervisor for all services rendered. Supervisors shall also be available for emergency consultation and intervention.

3. Provide work assignments that shall be commensurate with the skills of the supervisee. All procedures shall be planned in consultation with the supervisor.

4. Work in the same physical setting as the supervisee, unless other individual arrangements are approved by the board of psychology examiners.

5. Make public announcement of services and fees; contact with laypersons or the professional community shall be offered only by or in the name of the supervising psychologist. Titles of unlicensed persons must clearly indicate their supervised status.

6. Provide specific information to clients when an unlicensed person delivers services to those clients, including disclosure of the unlicensed person’s status and information regarding the person’s qualifications and functions.

7. Inform clients of the possibility of periodic meetings with the supervising psychologist at the client’s, the supervisee’s or the supervisor’s request.

8. Provide for setting and receipt of payment that shall remain the sole domain of the employing agency or supervising psychologist.

9. Establish and maintain a level of supervisory contact consistent with established professional standards, and be fully accountable in the event that professional, ethical or legal issues are raised.

10. Provide a detailed job description in which functions are designated at varying levels of difficulty, requiring increasing levels of training, skill and experience. This job description shall be made available to representatives of the board and service recipients upon request.

11. Be responsible for the planning, course, and outcome of the work. The conduct of supervision shall ensure the professional, ethical, and legal protection of the client and of the unlicensed persons.

12. Maintain an ongoing record of supervision which details the types of activities in which the unlicensed person is engaged, the level of competence in each, and the type and outcome of all procedures.

13. Countersign all written reports and communications as “Reviewed and Approved” by the supervising psychologist.

645—240.9(154B) Licensure by endorsement. An applicant who has been a licensed psychologist under the laws of another jurisdiction shall file an application for licensure by endorsement with the board office. The board may receive by endorsement any applicant from the District of Columbia or another state, territory, province or foreign country who:

1. Submits to the board a completed application;

2. Pays the licensure fee;

3. Shows evidence of licensure requirements that are similar to those required in Iowa;

4. Provides official copies of academic transcripts and the EPPP score to the board;

5. Supplies satisfactory evidence of the candidate’s qualifications in writing on the prescribed forms by the candidate’s supervisors. If verification of professional experience is not available, the board may consider submission of documentation from the state in which the applicant is currently licensed or equivalent documentation of supervision;

6. Takes the oral examination required by the board; and

7. Provides verification of licenses from other states that have been sent directly from those states to the board office.

645—240.10(147) Licensure by reciprocal agreement. The board may enter into a reciprocal agreement with the District of Columbia or any state, territory, province or foreign country with equal or similar requirements for licensure in psychology. The applicant shall take the oral examination for the state of Iowa as administered by the board.

645—240.11(147) License renewal.

240.11(1) The biennial license renewal period for a license to practice psychology shall begin on July 1 of even–numbered years and end on June 30 of the next even–numbered year. All licensees shall renew on a biennial basis.

240.11(2) A renewal of license application and continuing education report form to practice psychology 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 the biennial renewal fee(s) on or before the renewal date.

a. The licensee shall submit the completed application and continuing education report form with the renewal fee(s) to the board office before the license expiration date.

b. Individuals who were issued their initial licenses within six months of the license renewal date will not be required to renew their licenses until the next renewal two years later.

c. Those persons licensed for the first time shall not be required to complete continuing education as a prerequisite for the first renewal of their licenses.

d. Persons licensed to practice psychology shall keep their renewal licenses displayed in a conspicuous public place at the primary site of practice.

240.11(3) Late renewal. If the renewal fee(s), continuing education report and renewal application are received within 30 days after the license renewal expiration date, the late fee for failure to renew before expiration shall be charged.

240.11(4) When all requirements for license renewal are met, the licensee shall be sent a license renewal card by regular mail.

645—240.12(272C) Exemptions for inactive practitioners.

240.12(1) A licensee who is not engaged in practice in the state of Iowa may be granted a waiver of compliance and obtain a certificate of exemption upon written application to the board. The application shall contain a statement that the applicant will not engage in practice in the state of Iowa without first complying with all regulations governing reinstatement after exemption. The application for a certificate of exemption shall be submitted upon the form provided by the board. A licensee must hold a current license in good standing in order to apply for exempt, inactive status, and must apply prior to the license expiration date.

240.12(2) Reinstatement of exempted, inactive practitioners. Inactive practitioners who have requested and been granted a waiver of compliance with the renewal requirements and who have obtained a certificate of exemption shall, prior to engaging in the practice of the profession in Iowa, satisfy the requirements for reinstatement as outlined in 645—241.9(272C).

240.12(3) Licensees shall renew at the next scheduled renewal. Licensees who were issued their reinstatement within six months prior to the renewal date shall not be required to renew their licenses until the renewal date two years later.

240.12(4) A new licensee who is on inactive status during the initial license renewal time period and reinstates before the first license expiration date will not be required to complete continuing education for that first license renewal time period only. Forty hours of continuing education will be required for every renewal thereafter.

240.12(5) Verifications of license(s) are required from any state in which the licensee has practiced since the Iowa license became inactive.

240.12(6) Reinstatement of inactive license after exemption. The following chart illustrates the requirements for reinstatement based on the length of time a license has been inactive.

An applicant shall satisfy the following requirements:	1 renewal	2 or more renewals
Submit written application for reinstatement to the board	Required	Required
Pay renewal fee(s)	$140	$280
Pay the reinstatement fee	$50	$50
Furnish evidence of full–time practice in another state of the U.S. or the District of Columbia and completion of continuing education OR	Current valid license and at least 40 hours of continuing education	Current valid license and at least 80 hours of continuing education
Furnish evidence of completion of approved continuing education. Continuing education hours must be completed within the two most recent bienniums prior to the date of application for reinstatement.	40 hours	80 hours
Total fees and continuing education hours required for reinstatement:	$190 and 40 hours	$330 and 80 hours

645—240.13(272C) Lapsed licenses.

240.13(1) If the renewal fee(s) and continuing education report are received more than 30 days after the license expiration date, the license shall be lapsed. An application for reinstatement must be filed with the board accompanied by the reinstatement fee, the renewal fee(s) for each biennium the license is lapsed and the late fee for failure to renew before expiration. The licensee may be subject to an audit of the licensee’s continuing education report.

240.13(2) Licensees who have not fulfilled the requirements for license renewal or for an exemption in the required time frame will have a lapsed license and shall not engage in the practice of psychology. Practicing without a license may be cause for disciplinary action.

240.13(3) In order to reinstate a lapsed license, licensees shall comply with all requirements for reinstatement of a lapsed license as outlined in 645—241.5(272C).

240.13(4) After reinstatement of a lapsed license, the licensee shall renew at the next scheduled renewal cycle and complete the continuing education required for the biennium.

240.13(5) Verifications of license(s) are required from any state in which the licensee has practiced since the Iowa license lapsed.

240.13(6) Reinstatement of a lapsed license. The following chart illustrates the requirements for reinstatement based on the length of time a license has lapsed.

An applicant shall satisfy the following requirements:	30 days after expiration date up to 1 renewal	2 renewals	3 renewals	4 renewals
Submit written application for reinstatement and statement of competence to the board	Required	Required	Required	Required
Pay renewal fee(s)	$140	$280	$420	$560
Pay late fee	$50	$50	$50	$50
Pay the reinstatement fee	$50	$50	$50	$50
Provide evidence of satisfactory completion of continuing education requirements during the period since the license lapsed	40 hours	80 hours	80 hours	80 hours
Total fees and continuing education hours required for reinstatement:	$240 and 40 hours	$380 and 80 hours	$520 and 80 hours	$660 and 80 hours

645—240.14(17A,147,272C) License denial.

240.14(1) 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 in these rules shall specifically describe the facts to be contested and determined at the hearing.

240.14(2) If an applicant who has been denied licensure by the board appeals the licensure denial and requests a hearing pursuant to this rule, the hearing and subsequent procedures shall be held pursuant to the process outlined in Iowa Code chapters 17A and 272C.

These rules are intended to implement Iowa Code chapters 17A, 147, and 272C.

ITEM 3. Amend subrule 241.2(1) as follows:

241.2(1) The biennial continuing education compliance period shall extend for a two–year period beginning on July 1 of even–numbered years and ending on June 30 of even–numbered years. Each biennium, each person who is licensed to practice as a licensee in this state shall be required to complete a minimum of 40 hours of continuing education approved by the board. For the ~~2001~~ 2002 renewal cycle only, 50 hours of continuing education will be due by June 30, 2002. Continuing education credit earned from December 31, ~~2000~~ 2001, through June 30, ~~2001~~ 2002, may be used for either the ~~2001~~ 2002 renewal cycle or the following biennium. The licensee may use the earned continuing education credit hours only once. Credit may not be duplicated for both compliance periods. This applies for the renewal biennium of ~~2001~~ 2002 and for the following renewal biennium. Continuing education hours will return to 40 hours each biennium at the end of this prorated compliance period.

ITEM 4. Amend rule 241.5(272C), numbered paragraph “3,” as follows:

3. Pays ~~all~~ the ~~penalty~~ late ~~fees~~ fee ~~which have been~~ assessed by the board for failure to renew;

ITEM 5. Amend paragraph 241.9(1)“b” as follows:

b. Pays ~~all~~ the renewal fees then due to a maximum of two renewals; and

ITEM 6. Adopt new 645—Chapter 242 as follows:

CHAPTER 242
DISCIPLINE FOR PSYCHOLOGISTS

645—242.1(272C) Grounds for discipline. The board may impose any of the disciplinary sanctions set forth in rule 645—13.1(272C), including civil penalties in an amount not to exceed $1,000, when the board determines that a licensee is guilty of any of the following acts or offenses:

242.1(1) All grounds listed in Iowa Code section 147.55 which are:

a. Fraud in procuring a license.

b. Professional incompetency.

c. Knowingly making misleading, deceptive, untrue or fraudulent representations in the practice of the profession, or engaging in unethical conduct or practice harmful or detrimental to the public. Proof of actual injury need not be established.

d. Habitual intoxication or addiction to the use of drugs.

e. Conviction of a felony related to the profession or occupation of the licensee, or the conviction of any felony that would affect that licensee’s ability to practice within the profession. A copy of the record of conviction or plea of guilty shall be conclusive evidence.

f. Fraud in representations as to skill or ability.

g. Use of untruthful or improbable statements in advertisements.

h. Willful or repeated violations of the provisions of Iowa Code chapter 147.

242.1(2) Violation of the rules promulgated by the board.

242.1(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.

242.1(4) Practicing the profession while the license is suspended.

242.1(5) Revocation, suspension, or other disciplinary action taken by a licensing authority of the District of Columbia or another state, territory, or country; or failure by the licensee to report in writing to the Iowa board of psychology examiners the revocation, suspension, or other disciplinary action taken by a licensing authority of another state, territory, or country; or both.

242.1(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.

242.1(7) Prohibited acts consisting of the following:

a. Permitting an unlicensed employee or person under the licensee’s control to perform activities requiring a license.

b. Permitting another person to use the licensee’s license for any purpose.

c. Practice outside the scope of a license.

d. Obtaining, possessing, or attempting to obtain or possess a controlled substance without lawful authority; or selling, prescribing, giving away, or administering controlled substances.

e. Verbally or physically abusing clients.

f. Any sexual intimidation or sexual relationship between a psychologist and a client.

242.1(8) Unethical business practices, consisting of any of the following:

a. False or misleading advertising.

b. Betrayal of a professional confidence.

c. Falsifying clients’ records.

242.1(9) Failure to report a change of name or address within 30 days after it occurs.

242.1(10) Submission of a false report of continuing education or failure to submit the annual report of continuing education.

242.1(11) Failure to notify the board within 30 days after occurrence of any judgment or settlement of a malpractice claim or action.

242.1(12) Failure to comply with a subpoena issued by the board.

242.1(13) Failure to report to the board as provided in 645—Chapter 13 any violation by another licensee of the reasons for disciplinary action as listed in this rule.

242.1(14) Failure to comply with the Ethical Principles of Psychologists and Code of Conduct of the American Psychological Association, as published in the December 1992 edition of American Psychologist, effective December 1, 1992, which are hereby adopted by reference. Later amendments or editions of the Ethical Principles of Psychologists and the Code of Conduct are not included in this rule. Copies of the Ethical Principles of Psychologists and the Code of Conduct may be obtained by contacting the Director, Office of Ethics, American Psychological Association, 750 First Street N.E., Washington, D.C. 20002–4242.

This rule is intended to implement Iowa Code sections 147.76, 147.55(3), 272C.4 and 272C.10.

ITEM 7. Adopt new 645—Chapter 243 as follows:

CHAPTER 243
FEES

645—243.1(147,154B) License fees. All fees are nonrefundable.

243.1(1) Licensure fee for license to practice psychology is $100.

243.1(2) Biennial license renewal fee is $140.

243.1(3) Late fee for failure to renew before expiration is $50.

243.1(4) Reinstatement fee for a lapsed license or an inactive license is $50.

243.1(5) Duplicate license fee is $10.

243.1(6) Verification of license fee is $10.

243.1(7) Returned check fee is $15.

243.1(8) Disciplinary hearing fee is a minimum of $75.

243.1(9) Processing fee for exemption to licensure is $50.

243.1(10) The fee for the Examination for Professional Practice in Psychology is $450.

243.1(11) Certification fee for a health service provider is $50.

243.1(12) Biennial renewal fee for certification as a certified health service provider in psychology is $50.

This rule is intended to implement Iowa Code section 147.8 and Iowa Code chapters 17A, 154B and 272C.

[Filed 6/21/01, effective 8/15/01]

[Published 7/11/01]

EDITOR’S NOTE: For replacement pages for IAC, see IAC Supplement 7/11/01.

ARC 0824B

SUBSTANCE ABUSE COMMISSION[643]

Adopted and Filed

Pursuant to the authority of Iowa Code subsection 125.7(4), the Substance Abuse Commission hereby amends Chapter 3, “Licensure Standards for Substance Abuse Treatment Programs,” and adopts new Chapter 10, “Waivers or Variances from Administrative Rules,” Iowa Administrative Code.

The purpose of this rule making is to implement Executive Order Number 11 executed and signed by the Governor on September 14, 1999. The Executive Order directs state rule–making authorities to adopt uniform rules regarding waivers from administrative rules. New Chapter 10 is in response to that order. The chapter is also intended to implement Iowa Code section 17A.9A, which establishes additional terms and conditions concerning the issuance of waivers.

Notice of Intended Action was published in the Iowa Administrative Bulletin on March 21, 2001, as ARC 0562B. A public hearing was held on April 11, 2001. No comments were received on the published Notice. There are no changes as a result of the public hearing. A correction was made in 643—10.6(17A,125), numbered paragraph “10.” The word “board” was replaced with “commission.”

The Substance Abuse Commission adopted these amendments on June 20, 2001.

These amendments are intended to implement Iowa Code section 17A.9A and chapter 125.

These amendments shall become effective August 15, 2001.

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 amendments [3.17, Ch 10] is being omitted. With the exception of the change noted above, these amendments are identical to those published under Notice as ARC 0562B, IAB 3/21/01.

[Filed 6/22/01, effective 8/15/01]
[Published 7/11/01]

[For replacement pages for IAC, see IAC Supplement 7/11/01.]

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