Pages 943 to 1007 include ARC 1193B to ARC 1222B

Administrative rules review committee 934

Notice, Warehouse receipts, 90.12
ARC 1211B 943

Filed Emergency, Warehouse receipts,
90.12 ARC 1212B 992

Schedule for rule making 932

Publication procedures 933

Administrative rules on CD–ROM 933

Agency identification numbers 941

CITATION OF ADMINISTRATIVE RULES 931

Filed Emergency After Notice, Housing
fund, 25.2, 25.4 to 25.6, 25.8 to 25.10
ARC 1195B 992

Filed, Community development fund,
41.1 to 41.9 ARC 1193B 995

Notice, Conservation education, 68.1 to 68.4,
68.6, 68.8 to 68.11 ARC 1194B 943

Notice, Accreditation of providers of services
to persons with mental illness, mental
retardation, and developmental disabilities,
ch 24 ARC 1204B 945

Notice, Food stamp program,
65.1 to 65.4, 65.8(9), 65.16, 65.19,
65.20, 65.21(3), 65.28(9), 65.37,
65.42, 65.45 ARC 1202B 959

Notice, Health insurance premium
payment program, 75.21 ARC 1198B 961

Notice, Interstate compact on juveniles,
143.1, 143.2, 143.4(5) ARC 1199B 962

Notice, Juvenile court services directed
programs, 151.1, 151.2, 151.30(5),
151.31(5) ARC 1200B 962

Notice, Mental illness, mental retardation, and
developmental disabilities—local services,
rescind 153.31 to 153.42 ARC 1203B 963

Notice, Adult day care; sheltered work/
work activity services; transportation services;
community supervised apartment living
arrangements services program; residential
services for adults, rescind chs 171,
172, 174, 206, 207 ARC 1201B 964

Filed, Code of administrative judicial conduct,
10.29 ARC 1205B 996

Filed, Viatical and life settlements, ch 48
ARC 1210B 997

Notice, Delinquent license fee; license
under sanction; continuing education
to reactivate/reinstate license, 3.1,
3.3(1), 3.5(2), 3.7 ARC 1218B 964

Filed, Request for inactive status, 3.7(6)“a”(3)
ARC 1222B 997

Filed, Discipline, 4.2(2), 4.6, 4.9, 4.11, 4.13,
4.14, 4.36(2) ARC 1221B 997

Filed, Child support noncompliance, ch 17
ARC 1220B 998

Filed, Student loan default or noncompliance, ch 18
ARC 1219B 998

Notice, Waiver rules, ch 7 ARC 1208B 965

Filed, Marital and family therapists and
mental health counselors, rescind ch 30;
renumber ch 31 as ch 33; adopt ch 31;
32.6, 32.10; adopt ch 34 ARC 1206B 998

Summarized list 937

Notice of electric and natural gas delivery
tax rates and municipal electric and natural
gas transfer replacement tax rates for each
competitive service area 966

Notice, Adjustments to computed tax,
42.2(10), 42.13 ARC 1214B 970

Filed, Interest rate—calendar year 2002,
10.2(21) ARC 1216B 1005

Filed, Ethanol blended gasoline tax credit,
42.16, 52.19 ARC 1215B 1006

Filed, Investment tax credit, 52.10
ARC 1213B 1006

Notice, Administration; confidentiality of
attorney work product; personally identifiable
information; waivers; definitions; eligibility
guidelines for court–appointed counsel;
attorney fee contracts; claims for indigent
defense services, amend chs 1, 2, 4;
adopt chs 6, 7, 10, 11, 12; rescind ch 13
ARC 1209B 971

Notice, Waiver rules, ch 7 ARC 1196B 985

Notice, Project cost reporting requirements for
cities and counties, ch 178 ARC 1207B 987

Notice, Application for license; license
issuance; sanctions, 601.1, 605.12,
605.26, 615.37, 615.38 ARC 1197B 989

Notice—Public funds interest rates 991

Filed, Waiver and variance rules, ch 19
ARC 1217B 1007

Notice 991

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

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

__________________________________

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

The Iowa Administrative Bulletin is sold as a separate publication and may be purchased by subscription or single copy. All subscriptions will expire on June 30 of each year. Subscriptions must be paid in advance and are prorated quarterly.

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

The Iowa Administrative Code and Supplements are sold in complete sets and subscription basis only. All subscriptions for the Supplement (replacement pages) must be for the complete year and will expire on June 30 of each year.

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

Iowa Administrative Code - $1,252.75 plus $75.17 sales tax

(Price includes 22 volumes of rules and index, plus a one–year subscription to the Code Supplement and the Iowa Administrative Bulletin. Additional binders may be purchased for $11.75 plus $.71 sales tax.)

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

Department of General Services

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

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

TO: Administrative Rules Coordinators and Text Processors of State Agencies

FROM: Kathleen K. Bates, Iowa Administrative Code Editor

SUBJECT: Publication of Rules in Iowa Administrative Bulletin

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

1. To facilitate the publication of rule–making documents, we request that you send your document(s) as an attachment(s) to an E–mail message, addressed to both of the following:

bruce.carr@legis.state.ia.us and

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2. Alternatively, you may send a 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.

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.

Containing: Iowa Administrative Code (updated through June 2001)
Iowa Administrative Bulletins (January 2001 through June 2001)
Iowa Court Rules (updated through June 2001)

For free brochures and order forms contact:

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

The Administrative Rules Review Committee will hold its regular, statutory meeting on Tuesday, January 8, 2002, at 9 a.m. in Room 116, State Capitol, Des Moines, Iowa. The following rules will be reviewed:

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.

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]

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]

ELDER AFFAIRS DEPARTMENT[321]

EXECUTIVE COUNCIL[361]

GENERAL SERVICES DEPARTMENT[401]

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]

MANAGEMENT DEPARTMENT[541]

Appeal Board, State[543]

City Finance Committee[545]

County Finance Committee[547]

NATURAL RESOURCES DEPARTMENT[561]

Energy and Geological Resources Division[565]

Environmental Protection Commission[567]

Natural Resource Commission[571]

Preserves, State Advisory Board for[575]

PERSONNEL DEPARTMENT[581]

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]

REGENTS BOARD[681]

Archaeologist[685]

REVENUE AND FINANCE DEPARTMENT[701]

Lottery Division[705]

SECRETARY OF STATE[721]

TRANSPORTATION DEPARTMENT[761]

Railway Finance Authority[765]

TREASURER OF STATE[781]

WORKFORCE DEVELOPMENT DEPARTMENT[871]

Labor Services Division[875]

Workers’ Compensation Division[876]

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

Pursuant to the authority of Iowa Code sections 159.5(11) and 203C.5, the Department of Agriculture and Land Stewardship hereby gives Notice of Intended Action to amend Chapter 90, “State Licensed Warehouses and Warehouse Operators,” Iowa Administrative Code.

This proposed amendment to rule 90.12(203C) eliminates the requirement that warehouse operators file with the Grain Warehouse Bureau the Department’s copy (pink copy) of the warehouse receipt. Due to layoffs within the Department, the Bureau does not have time or staff to enter the information from warehouse receipts and file the thousands of warehouse receipts that the Bureau receives from licensed warehouse operators.

Any interested persons may make written commentsor suggestions concerning this proposed amendment onor before 4:30 p.m. on January 15, 2002. Such written materials should be directed to Donna Gwinn, Bureau Chief, Grain Warehouse Bureau, Department of Agriculture and Land Stewardship, Wallace State Office Building, 502 East Ninth Street, Des Moines, Iowa 50319; or faxed to (515) 281–6800. E–mail may be sent to Donna.Gwinn@idals. state.ia.us.

No waiver provision is included in this amendment because an existing rule allows for waivers in appropriate cases. That waiver rule applies to the amendment proposed in this filing.

This proposed amendment is being simultaneously Adopted and Filed Emergency and is published herein as ARC 1212B. The content of that submission is incorporated by reference.

This amendment is intended to implement Iowa Code sections 203C.16, 203C.17, 203C.18, 203C.34 and 203C.35.

Pursuant to the authority of Iowa Code section 256.7(5), the State Board of Education hereby proposes to amend Chapter 68, “Conservation Education,” Iowa Administrative Code.

These amendments update the Department’s administration of the conservation education program established in Iowa Code section 256.34. These rules were last amended in 1991. A regulatory review of this chapter by the Conservation Education Board found that several areas in the chapter required updating.

A waiver provision is not included. The Department has adopted a uniform waiver rule.

Any interested person may make written suggestions or comments on the proposed amendments on or before January 15, 2002. Written materials should be directed to Kathy McKee, Environmental Education Consultant, Department of Education, Grimes State Office Building, Des Moines, Iowa 50319–0146, by fax to (515)281–4122 or by E–mail to kathy.mckee@ed.state.ia.us. Persons who wish to convey their views orally should contact Kathy McKee by telephone at (515)281–3146.

Persons may also present their views either orally or in writing at a public hearing to be held on Friday, January 15, 2002, at 10 a.m. in the State Board Room, Grimes State Office Building, 400 East 14th Street and Grand Avenue, Des Moines, Iowa. Any person who plans to attend the public hearing and requires special accommodations for specific needs should contact Kathy McKee at (515)281–3146.

These amendments are intended to implement Iowa Code section 256.34.

The following amendments are proposed.

ITEM 1. Amend rule 281—68.1(256) as follows:

281—68.1(256) Purpose. The purpose of these rules is to define procedures for the administration of the cost sharing funds within the conservation education program board account for production and revision of conservation education materials and to specify stipends to Iowa educators who participate in innovative conservation education programs approved by the board. The conservation education program shall serve Iowa citizens by providing effective curriculum curricula, program materials and educator stipends to increase environmental awareness, and enhance understanding of environmental problems, and promote the resolution of environmental issues stewardship and natural resources. Expenditure of funds from the conservation education program board account shall be in accordance with this policy.

ITEM 2. Amend rule 281—68.2(256) as follows:

281—68.2(256) Conservation education program policy. The conservation education program board shall constitute a long–term integrated effort to support funding of conservation education materials and to provide stipends to Iowa educators who participate in innovative conservation education programs conservation education for Iowa educators and students. To support this policy, the board may establish guidelines to direct applicants to priority areas for funding and shall give preference to grants that meet these guidelines. The board may provide funding for activities that expand the impact of the project and provide accessibility for widespread adoption of programs for implementation by others. The board may provide funding for tracking of project implementation and evaluation.

ITEM 3. Amend rule 281—68.3(256) as follows:

281—68.3(256) Conservation education board. A conservation education program board is created in the department. The board shall have three five members appointed as follows:

1. One member appointed by the director of the department of education.

2. One member appointed by the director of the department of natural resources.

3. One member appointed by the president of the Iowa association of county conservation boards.

ITEM 4. Amend the following definitions in rule 281— 68.4(256):

“Board” means REAP conservation education program board.

“Conservation education programs (CEP)” means programs developed for formal (K–12 students), informal (preschool, adult and continuing education) and higher education (postsecondary and adult) programs, developed with consideration of, but not limited to, environmental education priorities established at the Governor’s Environmental Education Conference January 12 and 13, 1990. The “Governor’s Environmental Education Priorities for the 90’s” is available through the Bureau of Instruction and Curriculum, Department of Education, Grimes State Office Building, Des Moines, Iowa. Also “conservation education programs” means the lifelong education process dealing with people’s relationships with each other and with their natural and altered surroundings and includes the relation of population, pollution, resource allocation and depletion, conservation, transportation, technology and planning to the total human environment within the subject areas of natural resource conservation and environmental protection.

“Educator” is defined as means any person who teaches environmental/conservation education as a result of this training or experience and as part of an occupation or volunteer service. This may apply to certified teachers, governmental or private naturalists or education specialists, or others so determined by the board.

“Environmental/conservation education materials” is defined as a holistic approach to the educational process that incorporates the principles of carrying capacity, sustainability, interdependence, diversity, change, adaptation, competition/cooperation, cycles and energy flow. Environmental/conservation education materials promote numerous skills including critical thinking, problem solving, analysis, clarification, communication, observation, measuring, listing, mapping, predicting, computing, writing, reading, estimating and applying knowledge and skills, including critical thinking, problem solving, analysis, clarification, communication, observation, measuring, listing, mapping, predicting, computing, writing, reading, estimating, and applying knowledge and skills. means materials that are developed or produced that provide knowledge, skills, processes and strategies that enhance Iowa citizens’ understanding of natural resources conservation and environmental issues.

“Stipends for Iowa educators who participate in innovative conservation education programs” means may include tuition cost, acceptable food and lodging costs, substitute teacher costs, mileage expenses and or stipends separateallowances when applicable for educators to attend board–approved environmental/conservation education workshops, in–service programs and conferences, and other costs as approved by the board.

ITEM 5. Amend subrule 68.6(2) as follows:

68.6(2) Applications shall be made in sufficient detail as to clearly describe the scope of the project including the following:

a. No change.

b. Project summary and demonstration of need.

c. No change.

d. Any documentation Documentation of assurances and letters of from community support, including cooperating agencies.

e. to g. No change.

Any application which is not complete at the time of project review and scoring, or for which additional pertinent information has been requested and not received, shall not be considered for funding. Proposals not containing the specified information or not received by the specified date may not be considered. All applications shall be submitted in accordance with instructions in the requests for proposals the specified submittal deadline shall not be considered for funding. The proposals shall be submitted to the department.

ITEM 6. Amend subrule 68.6(3) as follows:

68.6(3) Applications shall be postmarked on or before the April 1, 1990, deadline for FY90 grants, and May 15 and November 1 for subsequent fiscal years in which funds are provided. Upon arrival, the proposals proposal will be reviewed to determine whether all required materials have been included and whether the proposal falls within the department of education’s guidelines. Failure to meet these criteria will result in disqualification of the proposal.

ITEM 7. Rescind rule 281—68.8(256) and adopt the following new rule in lieu thereof:

281—68.8(256) Criteria. Preference will be given, in formal and informal education programs, to materials capable of being infused in multiple curricular areas. Also, preference will be given to projects that encourage conservation stewardship. Proposals shall include but not be limited to the following information:

68.8(1) Statement of need. This part of the proposal identifies the target audience and describes how this audience will be served. The statement of need contains evidence or research that a need for such a project exists, explains how stated needs relate to REAP/CEP priorities and guidelines, and shows interdisciplinary components.

68.8(2) Goals, objectives, activities. This part of the proposal describes how the project will address the environmental education goals identified by the writer, how workable or appropriate the project is to the audience, and activity timelines. This part also describes how the project incorporates collaboration and networking, the potential of the project to be implemented elsewhere, and how the project demonstrates innovative and creative ideas and strategies.

68.8(3) Funding and budget considerations. This part of the proposal describes a realistic and cost–effective budget, shows ratio of total budget to number of people directly served, and shows that the project budget meets expense eligibility stated in subrule 68.9(6).

68.8(4) Evaluation. This part of the proposal describes evaluation tools that show how well the project’s goals and objectives have been met and how well the audience meets objectives. This part identifies strategies, milestones and tools that will be used to monitor the project, describes how monitoring will be used to strengthen the project, and how information will be disseminated.

ITEM 8. Amend subrule 68.9(1) as follows:

68.9(1) Timely completion of projects. Grants are expected to be completed in a 12–month time period; however, up to 18 months will be considered for board approval for grants difficult to accomplish in 12 months. The board may consider extending the time period of a grant upon request.

ITEM 9. Amend subrule 68.9(2) as follows:

68.9(2) Record keeping and retention. Grant recipients shall keep adequate records relating to the administration of a project, particularly relating to all incurred expenses. These records shall be available for audit by representatives of the department and the state auditor’s office. All records shall be retained in accordance with state laws.

ITEM 10. Amend subrule 68.9(3) as follows:

68.9(3) Quarterly Midterm and final reports. Grantees shall provide quarterly midterm and final reports that include information detailing progress toward goals and objectives, expenditures, and services provided on forms provided for those reports. The report shall clearly identify the status of fundraising relevant to the approved projects and identify problems that may cause a delay in completing the project within the approved project period. Failure to submit reports by the due date shall result in suspension of financial payments to the grantee until the time that the report is received. Grants are considered active until the board notifies the grantee that the grant has been terminated or completed by the terms of the grant. At the completion of the project and prior to the final payment, a final written report shall be submitted by the grantee to the board. The final 10 percent payment shall be withheld pending this report, which shall include a 75–word to 100–word summary of project results. This summary will be posted on the state environmental education Web site. No new awards shall be made for continuation programs where there are delinquent reports from prior grants.

ITEM 11. Amend subrule 68.9(6) as follows:

68.9(6) Restrictions. Funds allocated under this chapter shall not be used for out–of–state travel or equipment, such as typewriters, computers, and hardware, or for construction, renovation or remodeling costs unless specifically approved by the board.

ITEM 12. Amend rule 281—68.10(256) as follows:

281—68.10(256) Board review and approval. The board or its designee shall review score, and rank projects for funding, and funds shall be awarded on a competitive basis. If delegated, the reviewing, scoring and ranking of projects will be presented to the board as recommendations. The board may approve or disapprove deny funding for any project or part thereof. Reasons for rejection of any recommended project or any part thereof shall be included in the motion to approve, modify, or reject any project.

68.10(2 1) In each year following FY90 that funds Funds are made available by the Iowa legislature, payments. Payments shall be as follows:

a. For grant periods in excess of 90 days, up to 50 percent shall be paid at the beginning of the grant period, up to 40 percent at the midpoint of the grant period, and the balance at successful completion as determined by the board.

b. For grant periods of fewer than 90 days, 75 percent shall be paid at the beginning of the grant period and the balance at successful completion as determined by the board.

68.10(3 2) The board shall notify successful applicants and shall provide to each of them a contract for signature. This contract shall be signed by an official with authority to bind the applicant and shall be returned to the department prior to the award of any funds under this program.

ITEM 13. Amend rule 281—68.11(256) as follows:

281—68.11(256) Waivers of retroactivity. Normally, grant program developments completed prior to application scoring will not be approved. However, an applicant may make written request for a waiver of retroactivity to allow project elements to be considered for grant assistance. Waivers will be granted in writing by the board. and receipt Receipt of a waiver does not ensure funding, but only ensures that the project will be considered for funding along with all other applications. Waiver of retroactivity provisions will be assumed to exist for any project initiated after July 1, 1989, until the first cycle of application scoring and grant allocations has been completed. For subsequent cycles, waivers must be requested and issued in writing prior to July 1, 1990.

Pursuant to the authority of Iowa Code section 225C.6, the Department of Human Services proposes to rescind Chapter 24, “Accreditation of Providers of Services to Persons with Mental Illness, Mental Retardation, and Developmental Disabilities,” Iowa Administrative Code, and to adopt a new Chapter 24 with the same title.

This new chapter rewrites policy governing accreditation of providers of services to persons with mental illness, mental retardation, and developmental disabilities to clarify the accreditation process, make the appeal process consistent with the process used by the rest of the Department, and revise the method of deciding the term of accreditation of an organization. Specifically, these new rules:

• Add and revise definitions to more clearly define language in the standards. The person served is now referred to as an “individual” instead of “consumer” to coincide with the most current accepted practice. Definitions of “goal achieving,” “goal keeping,” “readiness assessment,” and “readiness development” relating to intensive psychiatric rehabilitative services are added to clearly show how this chapter is based on the model developed by the Boston Center for Psychiatric Rehabilitation. A definition is added for “new organization” and the definition of “organization” is revised to clearly indicate which providers come under this chapter.

• Add requirements for reporting and tracking incident reports to set up a total quality improvement system forcommunity–based placements to help ensure safety of the individuals served and to bring Iowa into compliance with federal regulations.

• More clearly define the survey process. Organizations will be required to submit any documentation relevant to a survey to the survey team before the close of the on–site review.

• Move the standards for organization of service systems and consumer rights from standards for organizational activities to standards for services. These standards are reviewed using the files of the individuals served. The indicators remaining under the standards for organizational activities will either be found in or out of compliance depending on whether there is documentation to show the indicator has been implemented.

• Revise standards for services as follows:

• Require verification of a service description to be in the individual’s file.

• Reorder the steps to developing a performance improvement system.

• Add guidelines for electronic files.

• More clearly define what needs to be present in the personnel files of the organization.

• Require handling of medications to meet state and federal regulations.

• Add a clearer description of what needs to be included in a social history, assessment, and service plan.

• Require documentation of the individual’s treatment for emergency services to be contained in the narrative.

• Add case management requirements for quarterly face–to–face meetings, annual documentation of the need for case management, an average caseload of 45, and quarterly reviews to match the state plan and federal requirements.

• Revise the subrule on intense psychiatric rehabilitation to more clearly define the components required in the Boston Psychiatric Rehabilitation Model.

• Require supported community living to include provisions for skill training.

• Require emergency services to be documented in a narrative format and coordination of contacts to be made with relevant professionals.

• Clarify the application process and approval process for deemed status.

• Revise the policies governing the period of accreditation to provide that the term of accreditation is now determined by counting a percentage of all applicable performance indicators found to be in compliance in each of the three major sections using 15 percent of the total from policies and procedures, 15 percent of the total from organizational activities, and 70 percent of the total from specific services.

• Require an organization whose accreditation has been denied or revoked to wait at least six months from the notice of decision before it can apply as a new provider.

• Provide that when an organization is deemed, it will no longer be required to be responsible for meeting all requirements under this chapter. The organization will be held to the corrective action plan of the national accrediting body or the HCBS certification report. The organization shall also be required to meet the requirements for incident reports and the complaint process.

These rules do not provide for waivers of accreditation standards because organizations may request a waiver of these requirements under the Department’s general rule on exceptions at rule 441—1.8(17A,217).

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 January 16, 2002.

Oral presentations may be made by persons appearing at the following meeting. Written comments will also be accepted at that time.

Des Moines – January 18, 2002 10 a.m.

Hoover State Office Building

First Floor, Conference Rooms 1 and 2

1305 East Walnut

Des Moines, Iowa 50309

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

These rules are intended to implement Iowa Code chapter 225C.

The following amendment is proposed.

Rescind 441—Chapter 24 and adopt the following new 441—Chapter 24 in lieu thereof:

CHAPTER 24
ACCREDITATION OF PROVIDERS OF SERVICES
TO PERSONS WITH MENTAL ILLNESS,
MENTAL RETARDATION, AND
DEVELOPMENTAL DISABILITIES

PREAMBLE

The mental health and developmental disabilities commission has established this set of standards to be met by all providers of services to persons with mental illness, mental retardation, and developmental disabilities that are not required to be licensed by the department of inspections and appeals and that are required to meet specific standards for the organizations and services under the authority of the commission.

The mental health and developmental disabilities commission has established this set of standards to be met by community mental health centers, mental health services providers, case management providers and supported community living providers in accordance with Iowa Code chapter 225C. The commission’s intent is to establish standards that are based on the principles of quality improvement, that are designed to facilitate the provision of excellent quality services that lead to positive outcomes, that make organizations providing services responsible for effecting efficient and effective management and operational systems that enhance the involvement of individuals and that establish a best practices level of performance by which to measure provider organizations. The standards are to serve as the foundation of a performance–based review of those organizations for which the commission holds accreditation responsibility as set forth in Iowa Code chapters 225C and 230A.

The mission of accreditation is to assure individuals and the general public of organizational accountability for meeting best practices performance levels, for efficient and effective management and for the provision of quality services that result in quality outcomes for individuals.

“Accreditation” means the decision made by the commission that the organization has met the applicable standards.

“Advanced registered nurse practitioner” means a nurse with current licensure as a registered nurse in Iowa or who is licensed in another state and recognized for licensure in this state pursuant to Iowa Code chapter 152E and who is also registered in Iowa to practice in an advanced role.

“Advisory board” means the board that reviews and makes recommendations to the organization’s board of directors on the program being accredited. The advisory board shall meet at least three times a year and shall have at least three members, at least 51 percent of whom are not providers. The advisory board shall include representatives who have disabilities or family members of persons with disabilities. The advisory board’s duties include review and recommendation of policies, development and review of the organization plan for the program being accredited, review and recommendation of the budget for the program being accredited, and review and recommendation of the total quality improvement program of the program being accredited.

“Anticipated discharge plan” means the statement of the condition or circumstances by which the individual would no longer need each of the specific services accredited under this chapter.

“Appropriate” means the degree to which the services or supports or activities provided or undertaken by the organization are suitable and desirable for the individual’s needs, situation, or problems.

“Assessment” means the review of the individual’s current functioning in regard to the individual’s situation, needs, strengths, abilities, desires and goals.

“Benchmarks” are defined as processes of an organization that lead to implementation of the indicators.

“Board of directors” means the board that provides oversight, guidance, and policy direction for the operation of the program being accredited. The board shall have at least three members. Organization staff shall not constitute the majority of members of the board.

“Case management services” means those services established pursuant to Iowa Code chapter 225C.

“Chronic mental illness” means the condition present in persons aged 18 and over who have a persistent mental or emotional disorder that seriously impairs their functioning relative to such primary aspects of daily living as personal relations, living arrangements, or employment. Persons with chronic mental illness typically meet at least one of the following criteria:

1. Have undergone psychiatric treatment more intensive than outpatient care more than once in a lifetime (e.g., emergency services, alternative home care, partial hospitalization or inpatient hospitalization).

2. Have experienced at least one episode of continuous, structured, supportive residential care other than hospitalization.

In addition, these persons typically meet at least two of the following criteria, on a continuing or intermittent basis, for at least two years:

• Are unemployed or employed in a sheltered setting or have markedly limited skills and a poor work history.

• Require financial assistance for out–of–hospital maintenance and may be unable to procure this assistance without help.

• Show severe inability to establish or maintain a personal social support system.

• Require help in basic living skills.

• Exhibit inappropriate social behavior that results in demand for intervention by the mental health or judicial system.

In atypical instances, a person who varies from the above criteria could still be considered to be a person with chronic mental illness.

“Commission” means the mental health and developmental disabilities commission (MH/DD commission) as established and defined in Iowa Code chapter 225C.

“Community” means a natural setting where individuals live, learn, work, and socialize.

“Community mental health center” means an organization providing mental health services that is established pursuant to Iowa Code chapters 225C and 230A.

“Consultation services” means case, program and community levels of professional assistance and information to increase the skill level and effectiveness of services being provided by other service organizations or groups.

“Credentialed staff” or “staff who have been credentialed” means staff who have completed the organization credential verification process.

“Credential verification process” means the process used by the organization to verify the qualifications of education, training and experience required for each staff position, and the procedures for verifying that staff assigned to the positions meet those qualifications.

“Crisis intervention plan” means a personalized, individualized plan developed with the individual that identifies potential personal psychiatric, environmental and medical emergencies. This plan shall also include those life situations identified as problematic and the identified strategies and natural supports developed with the individual to enable the individual to self–manage, alleviate or end the crises. This plan shall also include how the individual can access emergency services that may be needed.

“Deemed status” means acceptance by the commission of accreditation or licensure of a program or service by another accrediting body in lieu of accreditation based on review and evaluation by the division.

“Department” means the Iowa department of human services.

“Developmental disability” means a severe, chronic disability of an individual that:

1. Is attributable to a mental or physical impairment or combination of mental and physical impairments;

2. Is manifested before the individual attains the age of 22;

3. Is likely to continue indefinitely;

4. Results in substantial functional limitations in three or more of the following areas of major life activity: self–care, receptive and expressive language, learning, mobility, self–direction, capacity for independent living, and economic self–sufficiency; and

5. Reflects the individual’s need for a combination and sequence of special, interdisciplinary, or generic services, individualized supports, or other forms of assistance that are of lifelong or extended duration and are individually planned and coordinated.

An individual from birth to the age of nine, inclusive, who has a substantial developmental delay or specific congenital or acquired condition, may be considered to have a developmental disability without meeting three or more of the criteria described above if the individual, without services and supports, has a high probability of meeting those criteria later in life.

“Direct services” means services involving direct interaction with an individual such as transporting an individual or providing therapy, habilitation, or rehabilitation activities.

“Division” means the division of mental health and developmental disabilities of the department of human services.

“Doctor of medicine or osteopathic medicine” means a person who is licensed in the state of Iowa under Iowa Code chapter 148 as a physician and surgeon or under Iowa Code chapter 150A as an osteopathic physician and surgeon.

“Education services” means professional information, training, assistance, and referral services provided to the general public, individual persons and to organizations about mental illness and mental health, the promotion of prevention services, and skill training for organizations.

“Functional assessment” means the task analysis of daily living skills. The functional assessment also takes into consideration an individual’s strengths, stated needs and level and kind of disability.

“Goal achieving” means to gain the required skills and supports to obtain the goal of choice. For purposes of this chapter, the definition and explanation are taken from the Psychiatric Rehabilitation Practitioner Tools as developed by the Boston Center for Psychiatric Rehabilitation.

“Goal keeping” means assisting the individual in maintaining successful and satisfying role performance to prevent the emergence of symptoms associated with role deterioration. For purposes of this chapter, the definition and explanation are taken from the Psychiatric Rehabilitation Practitioner Tools as developed by the Boston Center for Psychiatric Rehabilitation.

“Human services field” means a post–high school course of study resulting in a degree from an accredited four–year college in a field of study which includes, but is not limited to, psychiatry, psychology, social work, mental health counseling, marriage and family therapy, nursing, education, occupational therapy, and recreational therapy.

“Incident” means an occurrence which includes personal injury or illness requiring treatment or admission to a hospital or other inpatient facility, injury to staff or to others that requires emergency treatment or admission to a hospital or to another inpatient facility, and medication errors.

“Indicators” means conditions that will exist when the activity is done competently and benchmarks are achieved. Indicators also provide a means to assess the activity’s effect on outcomes of services.

“Individual,” for the purposes of this chapter, means a person who uses the services of the organization.

“Informed consent” refers to time–limited, voluntary consent. The individual or legal guardian may withdraw consent at any time without risk of punitive action. Informed consent includes a description of the treatment and specific procedures to be followed, the intended outcome or anticipated benefits, the rationale for use, the risks of use and nonuse, and the less restrictive alternatives considered. The individual or legal guardian has the opportunity to ask and have questions satisfactorily answered.

“Intensive psychiatric rehabilitation services” means services designed to restore, improve, or maximize level of functioning, self–care, responsibility, independence, and quality of life and to minimize impairments, disabilities, and disadvantages of persons with a disabling mental illness. Services focus on improving personal capabilities while reducing the harmful effects of psychiatric disability, resulting in an individual’s recovering the ability to perform a valued role in society.

“Leadership” means the governing board, the chief administrative officer or executive director, managers, supervisors, and clinical leaders who participate in developing and implementing organizational policies, plans and systems.

“Marital and family therapist” means a person who is licensed under Iowa Code chapter 154D in the application of counseling techniques in the assessment and resolution of emotional conditions. This includes the alteration and establishment of attitudes and patterns of interaction relative to marriage, family life, and interpersonal relationships.

“Mental health counselor” means a person who is licensed under Iowa Code chapter 154D in counseling services involving assessment, referral, consultation, and the application of counseling, human development principles, learning theory, group dynamics, and the etiology of maladjustment and dysfunctional behavior to individuals, families, and groups.

“Mental health professional” means a person who meets all of the following conditions:

1. Holds at least a master’s degree in a mental health field, including, but not limited to, psychology, counseling and guidance, psychiatric nursing and social work; or is a doctor of medicine or osteopathic medicine; and

2. Holds a current Iowa license when required by the Iowa professional licensure laws; and

3. Has at least two years of postdegree experience supervised by a mental health professional in assessing mental health problems, mental illness and needs of persons and in providing appropriate mental health services for those persons.

“Mental health service provider” means an organization whose services are established to specifically address mental health services to individuals or the administration of facilities in which these services are provided. Organizations included are those contracting with a county board of supervisors to provide mental health services in lieu of that county’s affiliation with a community mental health center (Iowa Code chapter 230A) and those that may contract with a county board of supervisors for special services to the general public or special segments of the general public and that are not accredited by any other accrediting body. These standards do not apply to individual practitioners or partnerships of practitioners covered under Iowa’s professional licensure laws.

“Mental retardation” means a diagnosis of mental retardation under these rules which shall be made only when the onset of the person’s condition was prior to the age of 18 years and shall be based on an assessment of the person’s intellectual functioning and level of adaptive skills. A psychologist or psychiatrist who is professionally trained to administer the tests required to assess intellectual functioning and to evaluate a person’s adaptive skills shall make the diagnosis. A diagnosis of mental retardation shall be made in accordance with the criteria provided in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, published by the American Psychiatric Association.

“Natural supports” means those services and supports an individual identifies as wanted or needed that are provided at no cost by family, friends, neighbors, and others in the community, or by organizations or entities that serve the general public.

“New organization” means an entity that has never been accredited under 441—Chapter 24 or an accredited entity under 441—Chapter 24 that makes a significant change in its ownership, structure, management, or service delivery.

“Organization” means:

1. A governmental entity or an entity that meets Iowa Code requirements for a business organization as a for–profit or not–for–profit business including, but not limited to, a business corporation under Iowa Code chapter 490 or a nonprofit corporation under Iowa Code chapter 504A that provides a service accredited pursuant to the rules in this chapter.

2. A county, consortium of counties, or the department of human services that provides or subcontracts for the provision of case management.

3. A division or unit of a larger entity, such as a unit within a hospital or parent organization.

“Organization” does not include: an individual for whom a license to engage in a profession is required under Iowa Code section 147.2, any person providing a service if the person is not organized as a corporation or other business entity recognized under Iowa Code, or an entity that provides only financial, administrative, or employment services and that does not directly provide the services accredited under this chapter.

“Outcome” means the result of the performance or nonperformance of a function or process or activity.

“Policies” means the principles and statements of intent of the organization.

“Procedures” means the steps taken to implement the policies of the organization.

“Program” means a set of related resources and services directed to the accomplishment of a fixed set of goals for the population of a specified geographic area or for special target populations.

“Psychiatric nurse” means a person who meets the requirements of a certified psychiatric nurse and is eligible for certification by the American Nursing Association and licensed by the state of Iowa to practice nursing as defined in Iowa Code chapter 152.

“Psychiatric rehabilitation practitioner” means a person who holds a graduate degree in rehabilitation counseling, mental health counseling, psychology, social work, nursing, or medicine and has at least two years’ experience working in a psychiatric rehabilitation program or has at least 60 contact hours of training in psychiatric rehabilitation; or a person who holds a bachelor’s degree in one of the above areas and has both at least two years of experience working in a psychiatric rehabilitation program and at least 60 contact hours of training in psychiatric rehabilitation.

“Psychiatrist” means a doctor of medicine or osteopathic medicine who is certified by the American Board of Psychiatry and Neurology or who is eligible for certification and who is fully licensed to practice medicine in the state of Iowa.

“Psychologist” means a person who is licensed to practice psychology in the state of Iowa, or who is certified by the Iowa department of education as a school psychologist, or is eligible for certification by the Iowa department of education, or meets the requirements of eligibility for a license to practice psychology in the state of Iowa as defined in Iowa Code chapter 154B.

“Qualified case managers and supervisors” means persons who have the following qualifications: (1) a bachelor’s degree with 30 semester hours or equivalent quarter hours in a human services field and at least one year of experience in the delivery of services to the population groups the person is hired as a case manager or case management supervisor to serve, or (2) an Iowa license to practice as a registered nurse and at least three years of experience in the delivery of services to the population group the person is hired as a case manager or case management supervisor to serve. Persons employed as case management supervisors on or before August 1, 1993, who do not meet these requirements shall be considered to meet these requirements as long as they are continuously employed by the same case management provider.

“Qualified in a human–services field” means holding at least a bachelor’s degree from an accredited four–year college with a major or at least 30 semester hours or its equivalent in human services. Fields of study which qualify as“human–service–related fields” include, but are not limited to: psychiatry, psychology, social work, mental health counseling, marriage and family therapy, nursing, education, occupational therapy, and recreational therapy.

“Readiness assessment” means a process of involving the consumer in clarifying motivational readiness to participate in the recovery process. For purposes of this chapter the definition and explanation are taken from the Psychiatric Reha–bilitation Practitioner Tools as developed by the Boston Center for Psychiatric Rehabilitation.

“Readiness development” means services designed to develop or increase a consumer’s interest, motivation and resolve to engage in the rehabilitation services process, as a means of enhancing independent functioning and quality of life. For purposes of this chapter the definition and explanation are taken from the Psychiatric Rehabilitation Practitioner Tools as developed by the Boston Center for Psychiatric Rehabilitation.

“Registered nurse” means a person who is licensed to practice nursing in the state of Iowa as defined in Iowa Code chapter 152.

“Rehabilitation services” means services designed to restore, improve, or maximize the individual’s optimal level of functioning, self–care, self–responsibility, independence and quality of life and to minimize impairments, disabilities and dysfunction caused by a serious and persistent mental or emotional disability.

“Rights restriction” means limitations not imposed on the general public in the areas of communication, mobility, finances, medical or mental health treatment, intimacy, privacy, type of work, religion, place of residence, and persons with whom the individual may share a residence.

“Service plan” means an individualized goal–oriented plan of services written in language understandable by the individual and developed for the individual by the individual and the organization.

“Staff” means persons paid by the organization to perform duties and responsibilities defined in the organization’s policies and procedures.

“Supported community living services” means those services provided to individuals with a mental illness, mental retardation, or developmental disability to enable them to develop supports and learn skills that will allow them to live, learn, work and socialize in the community. These services include the provision of or arrangement for personal and environmental supports, the facilitation of the individual’s identification and development of a natural support system, assistance and referral in meeting basic human needs, the provision of or arrangement for family and community support, and education, coordination and development of local support systems. These services are intended to be provided in the individual’s home or other natural community environment where the skills are learned or used.

24.2(1) Performance benchmark. The organization has written policy direction for the organization and each service being accredited.

24.2(2) Performance indicators.

a. The organization has a policies and procedures manual with policy guidelines and administrative procedures for all organizational activities and services specific to its organization that addresses the standards in effect at the time of review.

b. The policies and procedures cover each benchmark and indicator in this chapter.

c. The policies and procedures manual is made available to all staff.

24.3(1) Performance improvement system.

a. Performance benchmark. The organization has a systematic, organizationwide, planned approach to designing, measuring, evaluating, and improving the level of its performance.

b. Performance indicators. The organization:

(1) Measures and assesses organizational activities and services accredited in this chapter annually.

(2) Gathers information from individuals, staff, and family members.

(3) Implements an internal review of individual records of those services accredited under this chapter.

(4) Reviews the organization’s response to situations that may pose a danger or threat to staff or individuals for necessity, appropriateness, effectiveness and prevention.

(5) Identifies areas in need of improvement.

(6) Has a plan to address the areas in need of improvement.

(7) Implements the plan and documents the results.

24.3(2) Leadership.

a. Performance benchmark. Organization leaders provide the framework for the planning, designing, directing, coordination, provision and improvement of services that are responsive to the individuals and the community served by the organization.

b. Performance indicators.

(1) There are clearly articulated mission and values statements that are reflected in the long–range organizational plans and in organization policies.

(2) The annual and long–range budgeting process involves appropriate governing and managing levels of leadership and reflects the organization’s mission and values. An independent auditor or other person as provided by law does an annual financial audit.

(3) The organization establishes a board of directors. The board has individuals or family members of an individual on the board or establishes and implements an advisory board.

(4) The organization’s decision–making process, including policy decisions affecting the organization, reflects involvement of the various levels of leadership and responsiveness to staff.

(5) Organization leaders solicit input from leaders of the various community groups representing individuals served by the organization in designing responsive service delivery systems.

(6) The organization leaders develop and implement a service system appropriate to the needs of the individuals served by the organization.

(7) Organization leaders make educational information, resources, and service consultation available to community groups.

24.3(3) Management information system.

a. Performance benchmark. Information is obtained, managed and used in an efficient and effective method to document, enhance and improve organizational performance and service delivery to the individuals.

b. Performance indicators.

(1) The organization keeps mail, correspondence, and all data information, including individual records, in a secured locked area. The organization keeps access to electronic files secure.

(2) The organization has a system to maintain, on a current basis, the organization, compilation, documentation, and maintenance of all individual–specific information related to the provision and outcomes of services and treatments provided to the individual.

24.3(4) Human resources.

a. Performance benchmark. The organization provides credentialed staff in order to support the organization’s mission and facilitate the provision of quality services to individuals.

b. Performance indicators. The organization:

(1) Has a job description in the personnel file of each staff member that clearly defines responsibilities, distribution of duties, and qualifications. The organization establishes a credentialing review process to verify qualifications of staff including degrees, licenses, medication management training, and certification as required by the position.

(2) Evaluates staff and management annually. The annual evaluation includes a plan for staff development for each staff member.

(3) Provides training and education to all staff relevant to their position.

(4) Provides for training on child and dependent adult abuse reporter requirements to all organization staff. The organization documents in personnel records training on child and dependent adult abuse reporter requirements.

(5) Documents in the personnel file that organization staff are aware of the organization’s policy on confidentiality and has the organization staff sign a document indicating that they are aware.

(6) Provides initial orientation to new organization staff.

(7) Has mechanisms in place that afford staff the right to express concerns about an individual care issue or to file a grievance concerning a specific employment situation.

(8) Completes a criminal and dependent adult abuse rec–ord check as required in Iowa Code section 135C.33(5) prior to employment for any employee who provides direct services to individuals in the individual’s home.

(9) Does not employ a person if the department of human services determines that the person has committed a crime or has a record of founded child or dependent adult abuse which warrants prohibition of employment.

(10) Includes the following question in all applications for staff that provide direct services to individuals in the individual’s home: “Do you have a record of founded child or dependent adult abuse or have you ever been convicted of a crime in this state or any other state?”

(11) Establishes and implements a code of ethics for all staff and documents in the personnel records that the code of ethics in effect at the time of review has been reviewed with each staff member. The organization ensures that the following issues are addressed: confidentiality, individual rights, professional and legal issues and statutory obligations in providing services to individuals.

24.3(5) Organizational environment.

a. Performance benchmark. The organization provides services in an organizational environment that is safe and supportive for the individuals being served and the staff providing services.

b. Performance indicators.

(1) The environment enhances the self–image of the individual and preserves the individual’s dignity, privacy, and self–development.

(2) The environment is safe and accessible and meets all applicable local, state, and federal regulations.

(3) The processes that service and maintain the environment and the effectiveness of the environment are reviewed within the organization’s monitoring and improvement system.

(4) The organization establishes intervention procedures for behavior that presents significant risk of harm to the individual or others. The interventions also ensure that the individual’s rights are protected and that due process is afforded.

(5) The organization meets state and federal regulations in the way it implements the safe storage, provision, and administration of medication when used within the service.

441—24.4(225C) Standards for services. Providers shall meet the standards in subrules 24.4(1) through 24.4(8) for each specific service set forth in subrules 24.4(9) through 24.4(14) except for outpatient, emergency, and evaluation services. Providers of outpatient service shall meet indicators in subrules 24.4(1), 24.4(2), 24.4(4), 24.4(6), 24.4(7), and 24.4(8). Providers of emergency and evaluation services shall meet the benchmark for the services they provide.

24.4(1) Social history.

a. Performance benchmark. The organization completes a social history for each individual served.

b. Performance indicators.

(1) The organization collects and documents relevant historical information and organizes the information in one distinct document in a narrative format.

(2) Program staff write or review the social history and update it at least annually.

(3) The social history includes relevant information regarding the onset of disability of the individual served. The family, physical, psychosocial, behavioral, cultural, environmental and legal history is included.

24.4(2) Assessment.

a. Performance benchmark. The organization develops a written assessment for each individual served. The assessment is the basis for the services provided to the individuals.

b. Performance indicators.

(1) The assessment includes information about the individual’s current situation, diagnosis, needs, problems, wants, abilities and desired results.

(2) Program staff develop and complete the assessment in a narrative format.

(3) Staff base decisions regarding level, type and immediacy of services to be provided, or need for further assessment or evaluation, upon the analysis of the information gathered in the assessment with the individual’s involvement.

(4) Program staff solicit collateral provider information as appropriate to the individual situation in order to compile a comprehensive and full assessment.

(5) Program staff complete an annual reassessment for each individual and document the reassessment in a written format.

(6) Individuals with a diagnosis of chronic mental illness have this diagnosis supported by a psychiatric or psychological evaluation conducted by a qualified professional, and documentation of the diagnosis is contained in the individual’s record.

(7) Documentation supporting the diagnoses of a developmental disability by professionals is in the individual’s record.

(8) Individuals with a diagnosis of mental retardation have this diagnosis supported by a psychological evaluation conducted by a qualified professional, and documentation of the diagnosis is contained in the individual’s record.

24.4(3) Individual service plan.

a. Performance benchmark. Individualized, planned and appropriate services are guided by an individual–specific service plan developed in collaboration with the individual, significantly involved others as appropriate, and staff. Services are planned for and directed to where the individuals live, learn, work, and socialize.

b. Performance indicators.

(1) The service plan is based on the current assessment.

(2) The service plan identifies observable or measurable individual goals and action steps to meet the goals.

(3) The service plan includes interventions and supports needed to meet those goals with incremental action steps, as appropriate.

(4) The service plan includes the staff, persons, or organizations responsible for carrying out the interventions or supports.

(5) Services defined in the service plan are appropriate to the severity level of problems and specific needs or disabilities and are related to desired individual outcomes.

(6) The plan reflects individual desires and involves other organizations and persons as appropriate.

(7) The selection and wording of the goals and desired outcomes reflect the individual’s wants, needs, and desires.

(8) Activities identified in the service plan encourage the individual’s ability and right to make choices, to experience a sense of achievement, and to modify or continue the individual’s participation in the treatment process.

(9) Staff monitor the service plan with review occurring regularly. At least annually, staff assess and revise the service plan to determine achievement, continued need or change in goals or intervention methods. The review includes the individual with the involvement of significant others as appropriate.

(10) Staff develop a separate, individualized, anticipated discharge plan as part of the individualized service plan that is specific to each service the individual receives.

(11) The service plan includes documentation of any rights restrictions, why there is a need for the restriction, and a plan to restore those rights or a reason why a plan is not necessary or appropriate.

24.4(4) Documentation of service provision.

a. Performance benchmark. Individualized and appropriate intervention services and treatments are provided in ways that support the needs, desires, and goals identified in the service plan, and that respect the individual’s rights and choices.

b. Performance indicators.

(1) Staff document in the narrative the individual’s participation in the treatment process.

(2) Responsible staff document the individual’s progress toward goals, the provision of staff intervention, and the individual’s response to those interventions.

(3) Documentation of service provision is in a written, legible, narrative format in accordance with organizational policies and procedures.

24.4(5) Incident reports. An incident is defined as an occurrence that includes personal injury or illness requiring treatment or admission to a hospital or other inpatient facility, injury to staff or to others that requires emergency treatment or admission to a hospital or to another inpatient facility, and medication errors.

a. Performance benchmark. The organization maintains an incident record report for incidents that occur or are identified during times of direct contact by provider staff. Incidents include:

(1) Events requiring a doctor’s or nurse’s care and skills.

(2) Events requiring the services of a mental health professional other than services previously identified in the service plan.

(3) The death of an individual.

(4) Intervention of law enforcement.

(5) Medication errors.

(6) Lack of supervision by organizational staff that results in harm to individuals or others.

(7) Physical harm to the individual served, staff, or others.

(8) Any incident reported to protective services, the police or the department of inspections and appeals.

(9) Admission of the individual to a domestic violence shelter.

b. Performance indicators.

(1) The organization has printed incident report forms available that include the following detailed information:

1. The name of the individual served.

2. A description of the incident.

3. The name of the provider where the incident occurred.

4. Names of all organization staff and others who were present at the time of the incident.

5. Action taken by the organization staff to handle the situation.

6. Resolution of the incident.

7. The date and time the incident occurred.

(2) When law enforcement is involved or summoned, there is documentation of the names of the law enforcement agents.

(3) The person in charge at the time of the incident prepares and signs the incident report.

(4) Staff file one copy of the completed incident report in the individual’s file and maintain a copy in a central location.

(5) Staff send a copy of the incident report to the individual, the individual’s legal guardian, appropriate medical personnel, and the individual’s Medicaid targeted case manager or county case manager within 72 hours of the incident.

24.4(6) Confidentiality and legal status.

a. Performance benchmark. Staff release medical and mental health information only when properly authorized.

b. Performance indicators.

(1) The organization obtains written consent from the individual, the individual’s legal guardian, or other persons authorized by law prior to the release of personal identifying information, medical records, mental health records, or any other confidential information.

(2) Staff complete releases in accordance with existing federal and state laws, rules, and regulations and maintain them in each individual file.

24.4(7) Service systems.

a. Performance benchmark. The organization develops a clear description of each of the services offered. The organization develops an admission and discharge system of services. Staff coordinate services with other settings and providers.

b. Performance indicators.

(1) The organization has established and documented the necessary admission information to determine the individual’s eligibility for participation in the service.

(2) Staff include in the individual’s file verification that a service description is provided to the individual and, when appropriate, family or significant others.

(3) Continuity of services occurs through coordination among the staff and professionals providing services to the individual. Coordination of services through linkages with other settings and providers has occurred, as appropriate.

(4) Staff include a written discharge summary in each individual record at the time of discharge.

24.4(8) Respect for individual rights.

a. Performance benchmark. Each individual is recognized and respected in the provision of services, in accordance with basic human, civil and statutory rights.

b. Performance indicators.

(1) Staff provide services in ways that respect and enhance the individual’s sense of autonomy, privacy, dignity, self–esteem and involvement in the individual’s own treatment. Staff take language barriers, cultural differences, and cognitive deficits into consideration and make provisions to facilitate meaningful individual participation.

(2) Staff inform individuals and, when appropriate, family and significant others of their rights, choices, and responsibilities.

(3) The organization has a procedure established to protect the individuals during any activities, procedure or research that requires informed consent.

(4) The organization verifies that the individual is informed of the process to express questions, concerns, complaints or grievances about any aspect of the individual’s service.

(5) The organization provides the individuals and their guardians the right to appeal the application of policies, procedures, or any staff action that affects the individual. The organization has established written appeal procedures and a method to ensure that the procedures and appeal process are available to individuals.

(6) All individuals, their legal representatives, and other persons authorized by law have access to the records of the individual in accordance with state and federal laws and regulations.

24.4(9) Providers of case management.

a. Performance benchmark. Case management services link individuals to service agencies and support systems responsible for providing the necessary direct service activities, and coordinate and monitor those services.

b. Performance indicators.

(1) Staff clearly define the need for case management and document it annually.

(2) The team is composed of, at a minimum, the individual, the case manager, and providers or natural supports relevant to the individual’s service needs. In addition the team may include family at the discretion of the individual.

(3) The team works with the individual to establish the service plan which guides and coordinates the delivery of the services.

(4) The case manager advocates for the individual.

(5) The case manager coordinates the services.

(6) Documentation of contacts includes date, name of individual, name of the case manager, and place of service. Individual face–to–face meetings with the individual are held at least quarterly.

(7) The case manager monitors the services.

(8) Case managers do not provide direct services.

(9) Individuals are linked to appropriate resources, which provide necessary direct services and natural supports.

(10) Individuals participate in developing an individualized crisis intervention plan that includes natural supports and self–help methods.

(11) Documentation shows individual input on choosing goals.

(12) Documentation shows individuals are informed about their choice of providers as provided in the county management plan.

(13) Within an accredited case management program, the average caseload is no more than 45 individuals per each full–time case manager.

(14) The case manager communicates with the team and then documents in the individual’s file a quarterly review of the individual’s progress toward achieving the goals.

24.4(10) Day treatment. Day treatment is an individualized service emphasizing mental health treatment and intensive psychosocial rehabilitation activities designed to increase the individual’s ability to function independently or facilitate transition from residential placement. Staff use individual and group treatment and rehabilitation services based on individual needs and identified behavioral or mental health issues.

a. Performance benchmark. Individuals who are experiencing a significantly reduced ability to function in the community are stabilized and improved by the receipt of psycho–social rehabilitation, mental health treatment services and in–home support services, and the need for residential or inpatient placement is alleviated.

b. Performance indicators.

(1) Individuals participate with the organizational staff in identifying the problem areas to be addressed and the goals to be achieved that are based on the individual’s need for services.

(2) Individuals receive individualized services designed to focus on those identified mental health or behavioral issues that are causing the significant impairment in their day–to–day functioning.

(3) Individuals who receive intensive outpatient and day treatment services receive a comprehensive and integrated schedule of recognized individual and group treatment and rehabilitation services.

(4) Individuals and staff review their progress in resolving problems and achieving goals on a frequent and regular basis.

(5) Individuals receive services appropriate to defined needs and current risk factors.

(6) Individuals receive services from staff who are appropriately qualified and trained to provide the range and intensity of services required by the specific problems or disabilities of the individual. A mental health professional provides or directly supervises the provision of treatment services.

(7) Individuals participate in discharge planning which focuses on coordinating and integrating individual, family, and community and organization resources.

(8) Family members of individuals are involved in the planning and provision of services as appropriate and as desired by the individual.

24.4(11) Intensive psychiatric rehabilitation services. Intensive psychiatric rehabilitation services are individualized services designed to increase the individual’s ability to recover valued roles in the community and to prevent or reduce the need for services in a hospital or residential setting.

a. Performance benchmark. Individuals who are experiencing a significantly reduced ability to function in the community due to a disability are stabilized and experience role recovery by the receipt of intensive psychiatric rehabilitation services.

b. Performance indicators.

(1) Individuals participate with the psychiatric rehabilitation practitioner in identifying the specific rehabilitation issues, developing environmental rehabilitation goals, and specifying service objectives or interventions. A service plan as specified in subrule 24.4(3) is required after the readiness assessment has been completed.

(2) Individuals receive individualized services designed to focus on those identified mental health needs, functional needs and support needs that contribute to the person’s level of disability preventing their full participation in the life of the community.

(3) Whenever possible, intensive psychiatric rehabilitative services are provided in natural settings where individuals live, learn, work and socialize.

(4) Individuals and a psychiatric rehabilitation practitioner review the individual’s progress in accomplishing rehabil–itation objectives or interventions and attaining environmental rehabilitation goals on a frequent and regular basis.

(5) Individuals receive services appropriate to mutually determined disability–related challenges and current risk factors.

(6) Individuals receive services from staff who meet the requirements of a psychiatric practitioner. A mental health professional or psychiatric rehabilitation practitioner supervises the provision of psychiatric rehabilitation services.

(7) During goal keeping, individuals participate in discharge planning that focuses on coordinating and integrating individual, family, community and organization resources for successful community tenure and the anticipated end of psychiatric rehabilitation services.

(8) Significantly involved others are involved with the individual in the planning and provision of services as appropriate and as desired by the individual.

(9) Individuals receive four to ten hours per week of recognized psychiatric rehabilitation services. All services are provided for an identified period of time.

(10) Staff document changes in motivational readiness to choose valued roles and environments biweekly in each individual’s file during readiness assessment or readiness development.

(11) Staff document skill acquisition and skill competency weekly in each individual’s file during goal achieving or goal keeping.

(12) Staff document use of critical resources weekly in each individual’s file during goal achieving or goal keeping.

(13) Staff document the achievement of chosen rehabil–itation goals regularly in each individual’s file during goal keeping.

(14) Staff document the level of individual satisfaction with services at least quarterly in each individual’s file.

(15) Staff document satisfaction with chosen roles and environments regularly in each individual’s file during goal keeping.

(16) Individuals achieve positive changes in environmental status such as moving to a more independent living arrangement, enrolling in an education program, getting a job, or joining a community group. Staff document this achievement regularly in each individual’s file during goal keeping.

(17) Staff document the need for and use of psychiatric inpatient services quarterly in each individual’s file.

24.4(12) Supported community living services. Supported community living services are those skill–trainingservices and supports determined necessary to enable individuals with a mental illness, mental retardation, or a developmental disability to live, learn, work, and socialize in a community setting. Services are individualized, need– and abilities–focused, and organized according to the following components, which are to be provided by organizational staff or through linkages with other resources: outreach to appropriate support or treatment services; assistance and referral in meeting basic human needs; assistance in housing and living arrangements; crisis intervention and assistance; social and vocational assistance; support, assistance, and education to the individual’s family and to the community; protection and advocacy; coordination and development of natural support systems; and service coordination. Services are directed to enhancing the individual’s ability to regain or attain higher levels of independence, or to maximize current levels of functioning.

a. Performance benchmark. Individuals with disabilities live, learn, work, and socialize in the community.

b. Performance indicators.

(1) Individuals receive services within their home and community setting where the skills are learned or used.

(2) At intake the individuals participate in a functional assessment that includes a task analysis of daily living skills to assist in defining areas of service need and establishing a service plan. Staff summarize the findings of the functional assessment in a narrative that describes the individual’s current level of functioning in the areas of living, learning, working, and socialization. Staff review functional assessments on a regular basis to determine progress.

(3) Individuals receive skill training and support services directed to enabling them to regain or attain higher levels of functioning or to maximize functioning in the current goal areas.

(4) Services are delivered on an individualized basis in the place where the individual lives or works. Supported community living is not part of an organized mental health support or treatment group, drop–in center, or clubhouse. Skill training groups can be one of the activities in the service plan and part of supported community living. They cannot stand alone as a supported community living service.

(5) Documentation that steps have been taken to encourage the use of natural supports and develop new ones is in the individual file.

(6) Individuals participate in developing a detailed individualized crisis intervention plan that includes natural supports and self–help methods.

24.4(13) Partial hospitalization services. Partial hospitalization services is an active treatment program providing intensive group and individual clinical services within a structured therapeutic environment for those individuals who are exhibiting psychiatric symptoms of sufficient severity to cause significant impairment in day–to–day functioning. Short–term outpatient crisis stabilization and rehabilitation services are provided to avert hospitalization or to transition from an acute care setting. Services are supervised and managed by a mental health professional, and psychiatric consultation is routinely available. Clinical services are provided by a mental health professional.

a. Performance benchmark. Individuals who are experiencing serious impairment in day–to–day functioning due to severe psychiatric distress are enabled to remain in their community living situation through the receipt of therapeutically intensive milieu services.

b. Performance indicators.

(1) Individuals and staff mutually develop an individualized service plan that focuses on the behavioral and mental health issues and problems identified at admission. Goals are based on the individual’s need for services.

(2) Individuals receive clinical services that are provided and supervised by mental health professionals. A licensed and qualified psychiatrist provides psychiatric consultation and medication services.

(3) Individuals receive a comprehensive schedule of active, planned and integrated psychotherapeutic and rehabil–itation services provided by qualified professional staff.

(4) Individuals receive group and individual treatment services that are designed to increase their ability to function independently.

(5) Individuals are involved in the development of an anticipated discharge plan that includes linkages to family, provider, and community resources and services.

(6) Individuals have sufficient staff available to ensure their safety, to be responsive to crisis or individual need, and to provide active treatment services.

(7) Individuals receive services commensurate with current identified risk and need factors.

(8) Support systems identified by individuals are involved in the planning and provision of services and treatments as appropriate and desired by the individual.

24.4(14) Outpatient psychotherapy and counseling services. Outpatient psychotherapy and counseling services are a dynamic process in which the therapist uses professional skills, knowledge and training to enable individuals to realize and mobilize their strengths and abilities, take charge of their lives, and resolve their issues and problems. Psychotherapy services may be individual, group, or family, and are provided by a person meeting the criteria of a mental health professional or by a person with a master’s degree or an intern working on a master’s degree in a mental health field who is directly supervised by a mental health professional.

a. Performance benchmark. Individuals realize and mobilize their own strengths and abilities to take control of their lives in the areas where they live, learn, work, and socialize.

b. Performance indicators.

(1) Individuals are prepared for their role as a partner in the therapeutic process at intake where they define their situation, evaluate those factors that affect their situation, and establish desired problem resolution.

(2) Psychiatric and psychopharmacological services are available as needed by the individual.

(3) Staff document current and future treatment goals and interventions and supports mutually agreed to by the individual and the therapist in the initial assessment and after each intervention and treatment service. A distinct service plan document is not required.

(4) Staff document the individual’s status at each visit and the reasons for continuing or discontinuing of services in the progress notes. A distinct discharge summary document is not required.

(5) Individual records are subject to an internal quality assurance process and monitored by the organization. Quality assurance activities include:

1. A review of the individual’s involvement in and with treatment.

2. Verification that treatment activities are documented and are relevant to the diagnosis or presenting problem.

3. Verification that the organization follows up on individuals who miss appointments.

24.4(15) Emergency services. Emergency services are crisis services that provide a focused assessment and rapid stabilization of acute symptoms of mental illness or emotional distress, and are available and accessible, by telephone or face–to–face, to individuals on a 24–hour basis. The clinical assessment and psychotherapeutic services are provided by a person who has training in emergency services and who is a mental health professional or has access to a mental health professional at least by telephone. Services may be provided by a person who holds a master’s degree in a mental health field including, but not limited to, psychology, counseling and guidance, psychiatric nursing, psychiatric rehabilitation, or social work; or a person who holds a bachelor’s degree in a human service discipline and has five years’ experience providing mental health services or human services; or a psychiatric nurse who has three years of clinical experience in mental health. A comprehensive social history is not required for this treatment.

a. Performance benchmark. Individuals receive, when needed, emergency services that provide a focused assessment and rapid stabilization of acute symptoms of mental illness or emotional distress.

b. Performance indicators.

(1) Individuals can access 24–hour emergency services by telephone or in person.

(2) Information about how to access emergency services is publicized to facilitate availability of services to individuals, family members, and the public.

(3) Individuals receive assessments and services from either a mental health professional or from personnel who meet the requirements above and are supervised by a mental health professional. Psychiatric consultation is available, if needed.

(4) Individuals receive intervention services commensurate with current identified risk factors.

(5) Significantly involved others of individuals are involved as necessary and appropriate to the situation and as desired by the individual.

(6) Individuals are involved in the development of post–emergency service planning and resource identification and coordination.

(7) Staff document contacts in a narrative format and maintain them in a central location that will allow timely response to the problems presented by the individual.

(8) Timely coordination of contacts is made with relevant professionals.

24.4(16) Evaluation services. Evaluation services are screening, diagnosis and assessment of individual and family functioning needs, abilities, and disabilities, and determining current status and functioning in the areas of living, learning, working, and socializing.

a. Performance benchmark. Individuals receive comprehensive evaluation services that include screening, diagnosis, and assessment of individual or family functioning, needs and disabilities.

b. Performance indicators.

(1) Individuals receive comprehensive evaluation services by a mental health professional that include screening, diagnosis, and assessment of individual or family functioning, needs, abilities, and disabilities.

(2) Evaluations consider the emotional, behavioral, cognitive, psychosocial, and physical information as appropriate and necessary.

(3) The evaluation includes recommendations for services, and need for further evaluations.

(4) Mental health evaluations are completed by a person who meets the criteria of a mental health professional, or a person with a master’s degree who is license–eligible and supervised by a mental health professional, or an intern of a master’s or doctorate program who is supervised by a mental health professional.

441—24.5(225C) Accreditation. The commission shall make all decisions involving issuance, denial, or revocation of accreditation. This accreditation shall delineate all categories of service the organization is accredited to provide. Although an organization may have more than one facility or service site, only one accreditation notice shall be issued to the organization for those services accredited by the commission except as provided in paragraph 24.5(2)“d.” Services that have deemed status according to the guidelines in this chapter shall have the accreditation period for the specific services coincide with the time period awarded by the national accrediting body or the certification for home– and community–based services.

24.5(1) Organizations eligible for accreditation. The commission accredits the following organizations:

a. Providers of case management.

b. Community mental health centers.

c. Providers of supported community living.

d. Providers of other mental health services.

24.5(2) Performance outcome determinations.

a. There are three major sections contained in these standards: policies and procedures, organizational activities, and services. The major sections are divided into standards, with performance benchmark and performance indicators for each standard. Each of the standards for the three sections (policy and procedures, organizational activities, and services) as set forth in rules 441—24.2(225C), 24.3(225C), and 24.4(225C) shall be reviewed.

b. A performance compliance level shall be determined based on the number of indicators found to be in compliance.

(1) There are four indicators for standards for policy and procedures. Each indicator has a value of 3.75 out of a possible score of 15.

(2) There are 32 indicators for standards for organizational activities. Each indicator has a value of .47 out of a possible score of 15.

(3) Quality assurance staff shall determine a score for each service to be accredited. If 25 percent or more of the files reviewed do not comply with the requirements for a performance indicator, then that indicator is considered out of compliance and corrective action is required. Quality assurance staff shall determine the score for each service by dividing the number of indicators in compliance by the total number of indicators applicable for that service.

c. In order for a total overall rating to be established, the performance rating for policy and procedures shall be counted as 15 percent of the total, organizational activities as 15 percent of the total, and services as 70 percent of the total.

d. When the commission accredits an organization for more than one service under this chapter, staff will conduct one survey for the organization. There shall be one accreditation award for all the services that the commission accredits based upon the lowest score of the services surveyed. Services that have deemed status will have a term of accreditation that coincides with the term of certification granted by the home– and community–based waiver or the accreditation granted by the national accrediting agency. At the time of the recertification visit, staff shall review the services that did not receive three–year accreditation. New or add–on services that meet the requirements for accreditation shall receive an initial 270–day accreditation for that individual service. The term of accreditation shall be determined individually. At the time of recertification of the new add–on service, recommendation may be made to coincide with the term of accreditation for the other services of that organization that are accredited by the commission.

e. An organization whose accreditation has been denied or revoked shall not be approved for any service for at least six months from the notice of decision denying or revoking accreditation. When an organization subcontracts with agencies to provide services, on–site reviews shall determine if each agency meets all the requirements in this chapter. When an organization subcontracts with agencies to provide services, on–site reviews shall determine if each agency meets all the requirements in this chapter.

f. When an organization subcontracts with more than one agency, the length of accreditation shall be determined individually. On–site visits are done at each subcontracting agency with accreditation issued to the organization.

g. Organizations that have received an initial 270–day accreditation and have not provided services to individuals pursuant to that accreditation by the end of the 270 days shall have their accreditation lapse for that specific service. New applications may be submitted that include the waiting list of consumers to be served along with specific timelines of when the services will begin. This lapse of accreditation shall not be considered a denial.

24.5(3) Accreditation decisions.

a. Initial 270–day accreditation. This type of accreditation is granted to a new organization, or an organization not previously accredited by the division. Staff may conduct a desk audit or on–site visit to review the organization’s mission, policies, procedures, staff credentials, and program descriptions.

b. Add–on service accreditation. An organization in good standing may initially apply for an add–on service. When the on–site review of the add–on service results in a score comparable to the overall organization’s score at the time of the most recent accreditation, the organization shall have the add–on accreditation date coincide with the overall accreditation date of the organization. In the event the add–on service site review results in a lower score and lower accreditation decision, division staff shall conduct another on–site review for that add–on service when the add–on service accreditation expires.

c. Three–year accreditation. An organization or service is eligible for this type of accreditation if it has achieved an 80 percent or higher percent average performance compliance level. The organization may be required to develop and submit a plan of corrective action and improvement that may be monitored either by written report or an on–site review.

d. One–year accreditation. An organization is eligible for this type of accreditation when multiple and substantial deficiencies exist in specific areas causing compliance levels with performance benchmarks and indicators to fall between the averages of 70 percent to 79 percent, or when previously required corrective action plans have not been implemented or completed. The organization must submit a corrective action plan to correct and improve specific deficiencies and overall levels of functioning. Quality assurance staff shall monitor this plan through on–site reviews, written reports and the provision of technical assistance.

e. Probational 180–day accreditation. An organization is eligible for this type of accreditation in lieu of denial when the overall compliance level is from 60 to 69 percent, and pervasive and serious deficiencies exist; or when previously required corrective action plans as a result of a one–year accreditation have not been implemented or completed. All deficiencies must be corrected by the time of the follow–up on–site survey at the conclusion of the provisional time period. After this survey the organization shall meet the standards for accreditation for a one–year accreditation, or the commission shall deny accreditation. The commission may downgrade organizations with a one– or three–year accreditation to the probational 180–day accreditation when one or more complaints are founded.

f. Denial of accreditation.

(1) Accreditation shall be denied when there are pervasive and serious deficiencies that put individuals at immediate risk or when the overall compliance level falls to 59 percent or below. Under such circumstances no corrective action report shall be required. An emergency commission meeting may be called to consider denial or revocation of accreditation.

(2) The commission shall issue a notice of decision to deny accreditation to the organization. If the organization disagrees with any action or failure to act in regard to that notice, the organization has the right to appeal according to 441—Chapter 7.

(3) When one or more complaints are received, quality assurance staff shall complete an investigation and submit a report to the commission. If any of the complaints are substantiated and the commission determines there is a pervasive or serious deficiency, the commission may deny accreditation.

(4) If the commission votes to deny accreditation, the commission shall issue a notice of decision to the organization. If the organization disagrees with any action of the commission, the organization has the right to appeal according to 441—Chapter 7.

24.5(4) Nonassignability. Accreditation shall not be assignable to any other organization or provider.

24.5(5) Discontinuation.

a. A discontinued organization is one that has terminated the service for which it has been accredited.

b. Accreditation is not transferable. Any person or other legal entity acquiring an accredited facility for the purpose of operating a service shall make an application as provided herein for a new certificate of accreditation. Similarly, any organization having acquired accreditation and desiring to alter the service philosophy or transfer operations to different premises must notify the division 30 calendar days before taking action in order for the division to review the change.

c. An organization shall notify the division of any sale or change in the business status or transfer of ownership in the business or impending closure of the accredited or certified service at least 30 calendar days before closure. The organization shall be responsible for the referral and placementof individuals, as appropriate, and for the preservation of all records.

24.5(6) Application and renewal procedures. An organization whose certification has been denied or revoked shall not reapply for at least six months from the notice of decision denying or revoking accreditation. An applicant for accreditation shall submit Form 470–3005, Application for Accreditation, signed by the organization’s chief executive officer and the chairperson of the governing body, and the following information:

a. The name and address of the applicant organization.

b. The name and address of the chief executive officer of the applicant organization.

c. The type of organization and specific services for which the organization is applying for accreditation.

d. The targeted population groups for which services are to be provided, as applicable.

e. The number of individuals in each of the targeted population groups to be served, as applicable.

f. Other relative information related to the standards as requested by division staff.

24.5(7) Application review. An organization seeking accreditation shall submit a completed application, Form 470–3005, to the division.

a. The division shall review the materials submitted to determine that the application is complete and request any additional material as needed. Reviews shall commence only after the organization has submitted all application material.

b. The commission may grant organizations applying for first–time accreditation initial accreditation for 270 days to operate until the division completes an on–site survey. The commission shall base the accreditation decision on a report by the division that the organization has an approved policy and procedure manual that includes job descriptions of the staff that show how the staff assigned to the positions meet the qualifications in the standards and policies and procedures of the organization.

24.5(8) Survey review of organizations. The division shall review organizational services and activities as determined by the accreditation category. This review may include on–site case record audits, administrative procedures, clinical practices, personnel records, performance improvement systems and documentation, and interviews with staff, individuals, boards of directors, or others deemed appropriate, consistent with the confidentiality safeguards of state and federal laws. The division shall review case records and personnel records to see how the organization implements each of the indicators in the standards. If the documentation is not found in the records, the organization shall show, at the time the division staff is on site, documentation of how the indicator was accomplished.

a. A team shall make an on–site visit to the organization. The division shall not be required to provide advance notice to the provider of the on–site visit for accreditation.

b. The on–site team shall consist of designated members of the division staff. At the division’s discretion, the team may include provider staff of other providers, individuals, and others deemed appropriate.

c. The team shall survey the organization that has applied for accreditation or that is being reviewed as determined by accreditation category and the services indicated on the accreditation application in order to verify information contained in the application and ensure compliance with all applicable laws, rules and regulations.

d. At the end of the survey, the team leader shall lead an exit review. Before the close of the on–site review, the organization must provide the team leader any documentation that demonstrates how the organization has met these standards for services.

e. The accreditation team leader shall send a written report of the findings to the organization within 30 working days after completion of the accreditation survey.

f. The division shall offer technical assistance to organizations applying for first–time accreditation. Following accreditation, any organization may request technical assistance from the division to bring into conformity those areas found in noncompliance with this chapter’s requirements. The commission may also require that technical assistance be provided to an organization as staff time permits, if multiple deficiencies are noted during a survey to assist in implementation of an organization’s corrective action plan. Renewal applicants may be provided technical assistance as needed, if staff time permits.

g. Organizations required to develop a corrective action and improvement plan shall submit it to the division within 30 working days after the receipt of a report issued as a result of the division’s survey review. The corrective action plan shall include specific problem areas cited, corrective actions to be implemented by the organization, dates by which each corrective measure shall be completed, and quality assurance and improvement activities to measure and ensure continued compliance.

h. The division shall prepare all documents with a final recommendation regarding accreditation to be presented at the commission meeting. The division shall mail to all commission members summary reports of the on–site service review or desk review and a final recommendation concerning accreditation on each application to be processed at the next commission meeting. If the commission approves accreditation, Form 470–3006, Notice of Action–Approval, shall be issued which states the duration of the accreditation and the services that the organization is accredited to provide. If the commission denies or revokes accreditation, Form 470–3008, Notice of Action–Denial, shall be issued which states the reasons for the denial.

i. The division may grant an extension to the period of accreditation for an organization if there has been a delay in the accreditation process that is beyond the control of the organization, division, or commission; or the organization has requested an extension to permit the organization to prepare and obtain approval of a corrective action plan. The division shall establish the length of the extension on a case–by–case basis.

441—24.6(225C) Deemed status. The commission may grant deemed status to organizations accredited by a recognized national, not–for–profit, accrediting body when the commission determines the accreditation is for similar services. The commission shall also grant deemed status for supported community living services to organizations that are certified under 441—subrule 77.37(14).

24.6(1) National accrediting bodies. The national accrediting bodies currently recognized as meeting division criteria for possible deeming are:

a. Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

b. The Commission on Accreditation of Rehabilitation Facilities (CARF).

c. The Council on Quality and Leadership in Supports for People with Disabilities (The Council).

d. Council on Accreditation of Services for Families and Children (COA).

The accreditation credentials of these national bodies must specify the type of organization, programs, and services that they accredit and include targeted population groups, if appropriate.

Deemed status means that the division is accepting an outside body’s review, assessment, and accreditation of an organization’s functioning and services. Therefore, the accrediting body doing the review must be assessing categories of organizations and types of programs and services corresponding to those described under this chapter.

When an organization that is nationally accredited requests deemed status for services not covered by the national body’s standards but covered under this chapter, the accreditation for those services shall be done by the division. Technical assistance by division staff shall be provided to deemed status organizations as time permits.

24.6(2) Reservations. When deemed status is granted, the commission and the division reserve the following:

a. To have division staff conduct on–site focused reviews for those organizations applying for deemed status which the division has not previously accredited.

b. To have division staff do joint site visits with the accrediting body, attend exit conferences, or conduct focused follow–behind visits as determined to be appropriate in consultation with the national accrediting organization and the provider organization.

c. To be informed of and to investigate all complaints that fall under this chapter’s jurisdiction and to make findings as a result of the investigation. Complaints and findings shall be reported to the national accrediting body. The complaint process outlined in this chapter shall be followed.

d. To review and act upon deemed status under the following circumstances: when complaints have been founded, when the national accreditation status of the provider expires without renewal, or when the organization’s status is downgraded or withdrawn by the national accrediting body.

24.6(3) Application for deemed status.

a. To apply for deemed status, the organization shall submit Form 470–3332, Application and Letter of Agreement, and copies of the latest survey report and accreditation certificate, documentation of specific programming policies and procedures for populations being served, and credentials for staff providing services to populations served.

b. Once the division has begun an on–site visit, the division shall not accept an application for deemed status. The organization shall complete the accreditation process.

24.6(4) Requirements for deemed status. To be eligible for deemed status, the organization shall:

a. Be currently accredited by a recognized national accrediting body for services that are defined in this chapter; or

b. Be currently accredited under 441—subrule 77.37(14) for supported community living under the home–and community–based waiver. If individuals with mental illness are served, the provider must submit verification of the training and credentials of the staff to show that the staff can meet the needs of the individuals they serve.

c. Require the supported community living staff to have the same supervisor as the HCBS/MR program.

d. Require staff for the program being deemed to have the training and credentials needed to meet the needs of the person served.

24.6(5) Granting of deemed status. When the commis–sion grants deemed status, the accreditation period shall co–incide with the time period awarded by the national accrediting body or the certification for home– and community–based services. Under no circumstances shall the commission award accreditation for longer than three years.

24.6(6) Continuation of deemed status.

a. The organization shall send a copy of Form 470–3332, Application and Letter of Agreement, along with a copy of the application for renewal to the national accrediting body at the same time as application is made to a national accrediting body.

b. HCBS staff shall furnish to the division copies of the letter notifying a provider of a forthcoming recertification for organizations deemed for supported community living under the home– and community–based services (HCBS) waiver.

c. Following the on–site review by a national accrediting body, the organization shall send the division a copy of the cover sheet and national accrediting body report within 30 calendar days from the date that the organization receives the documents. If a corrective action plan is required, the organization shall send the division a copy of all correspondence and documentation related to the corrective action.

d. HCBS staff shall furnish the division with copies of HCBS certification reports and any corrective action required by HCBS within 30 calendar days after HCBS staff complete the report or the organization completes required corrective action.

441—24.7(225C) Complaint process. The division shall receive and record complaints by individuals, employees, any interested persons, and the public relating to or alleging violations of applicable requirements of the Iowa Code or rules adopted pursuant to the Code.

24.7(1) Submittal of complaint. The complaint may be delivered personally or by mail to the MH/DD Division, Department of Human Services, Fifth Floor, Hoover State Office Building, 1305 East Walnut, Des Moines, Iowa 50319– 0114, or by telephone (515)281–5874. To the extent allowed by law the division shall keep the name of the complainant confidential.

a. As needed or requested, the division shall assist individuals in making a complaint.

b. The information received should specifically state the basis of the complaint.

24.7(2) Review of complaint. Upon receipt of a complaint, the division shall make a preliminary desk audit review of the complaint to determine an appropriate response. That response may include notifying the individual who issued the complaint that there is no basis for a review, referring the complaint to another investigative body, or making a determination to do a full investigation. If the division concludes that the complaint is reasonable, has merit, and is based on a violation of rules in this chapter, it may make an investigation of the organization. The on–site review does not require advance notice to the organization. The division may investigate some complaints by an office audit. The division shall give priority for on–site visits to instances when individuals given service are at immediate risk of jeopardy.

24.7(3) On–site investigation. If a decision is made to conduct an on–site investigation, the division shall notify the chief executive officer and board chairperson of the organization involved that the division has received a complaint before or at the commencement of the on–site investigation.

a. The division shall give the organization an opportunity to informally present a position regarding allegations in the complaint. The organization may submit the position in writing within five working days following the on–site visit or present it in a personal conference with division staff.

b. The division shall submit a written report by certified mail to the chief administrative officer of the organization and the chairperson of the board of directors within 20 working days after completion of the investigation.

c. The report shall indicate whether the complaint was or was not substantiated, the basis for the substantiation or nonsubstantiation, the specific rules violated, and a recommendation for corrective action with time lines specified in the report.

d. The date of delivery shown by the certified mail stub shall constitute the date of official notice.

24.7(4) Review by commission. To the extent allowed by Iowa Code section 21.5, the commission may review the complaint and investigation report in a closed meeting. When individuals receiving services are in immediate jeopardy, the commission may call an emergency meeting to make a decision on possible revocation or denial of accreditation.

a. If the complaint is substantiated, the commission may take actions deemed appropriate, which may include shortening the term of accreditation, requiring a corrective action plan, or suspending or revoking an organization’s accreditation status, depending on the severity of the substantiated complaint.

b. The action taken by the commission shall be voted upon in the reconvened public meeting and entered into the official record of commission minutes.

c. The division shall inform the complainant and the organization by certified mail of the findings and actions taken by the commission. The date of delivery shown by the certified mail stub shall constitute the date of official notice.

24.7(5) Corrective action plan. When the commission takes action to suspend or revoke accreditation, there will be no corrective action plan. In other instances, if the complaint is substantiated, the organization shall submit a corrective action plan to the division within 20 calendar days after receiving the commission’s decision. This plan must respond to violations cited and commission requirements and include time lines, internal monitoring systems, and performance improvement planning. Failure of the organization to respond within 20 calendar days with an acceptable corrective action plan that addresses the organization’s plan of correction following a substantiated investigation or complaint may of itself constitute the basis for revocation or suspension of accreditation. The commission shall determine the appropriate action based on the information submitted. The division shall notify the organization of any action the commission takes.

441—24.8(225C) Appeal procedure. An appeal may be filed using the procedure identified in 441—Chapter 7. Notice of an appeal shall be sent to Appeals Section, Department of Human Services, Hoover State Office Building, Fifth Floor, 1305 East Walnut, Des Moines, Iowa 50319–0114, within 30 calendar days of the written decision from the commission.

441—24.9(225C) Exceptions to policy. Exceptions to policy shall follow the policies and procedures in the department’s general rule on exceptions to policy at rule 441— 1.8(17A,217).

These rules are intended to implement Iowa Code chapter 225C.

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.

These amendments provide that all households eligible for expedited food stamp benefits will now receive their benefits through the mail rather than picking them up at the county office. This may mean that it may take these households longer to receive their food stamps. These households will still receive their food stamp benefits within the federally mandated time period of seven days from the date the application is received. This change is being implemented because of the reduction in staff and in the number of full–time offices.

These amendments also make the following technical revisions to policy:

• A preamble is added to the rules to clarify the purpose of the chapter.

• Rules that are mandated by federal regulations and are not a state option are rescinded.

• References and form numbers are updated.

These technical changes were made in response to public comments and staff review during the rule assessment mandated by Executive Order Number 8.

These amendments do not provide for waivers in specified situations because federal food stamp law does not allow for any waivers.

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 January 16, 2002.

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

Ames – January 16, 2002 10 a.m.

Story County DHS Office

Second Floor Conference Room

126 South Kellogg Street

Ames, Iowa 50010

Cedar Rapids – January 16, 2002 9 a.m.

Iowa Building

Seventh Floor Conference Room

411 Third St. S.E.

Cedar Rapids, Iowa 52401

Council Bluffs – January 16, 2002 9 a.m.

Administrative Conference Room

417 East Kanesville Boulevard

Council Bluffs, Iowa 51501

Davenport – January 16, 2002 10 a.m.

Bicentennial Building

Fifth Floor Conference Room

428 Western Avenue

Davenport, Iowa 52801

Des Moines – January 16, 2002 10 a.m.

City View Plaza

Conference Room 104

1200 University

Des Moines, Iowa 50314

Dubuque – January 16, 2002 9 a.m.

Dubuque County DHS Office

Town Clock Plaza

Nesler Center

Third Floor Conference Rooms A and B

Dubuque, Iowa 52001

Fort Dodge – January 17, 2002 1:30 p.m.

Webster County DHS Office

330 First Avenue North

Fort Dodge, Iowa 50501

Marshalltown – January 17, 2002 1 p.m.

Marshall County DHS Office

First Floor Conference Room

206 West State Street

Marshalltown, Iowa 50158

Mason City – January 16, 2002 10 a.m.

Cerro Gordo County DHS Office

Mohawk Square, Liberty Room

22 North Georgia Avenue

Mason City, Iowa 50401

Sioux City – January 17, 2002 1:30 p.m.

Suite 500

520 Nebraska Street

Sioux City, Iowa 51101

Waterloo – January 16, 2002 10 a.m.

Black Hawk County Office

Pinecrest Office Building

Conference Rooms 213/215

1407 Independence Avenue

Waterloo, Iowa 50703

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

These amendments are intended to implement Iowa Code section 234.12.

The following amendments are proposed.

ITEM 1. Amend 441—Chapter 65 by adopting the following new preamble:

PREAMBLE

The basis for the food stamp program is as provided in Title 7 of the Code of Federal Regulations. The purpose of this chapter is to provide for adoption of new and amended federal regulations as they are published, to establish a legal basis for Iowa’s choice of administrative options when administrative options are given to the state in federal regulations, to implement the policy changes that the United States Department of Agriculture (USDA) directs states to implement that are required by law but not yet included in federal regulations, and to implement USDA–approved demonstration projects and waivers of federal regulations.

ITEM 2. Amend rule 441—65.1(234) as follows:

Amend the definition of “notice of expiration” as follows:

“Notice of expiration” means either a message printed on an application for continued program participation, Review/Recertification Eligibility Document (RRED), Form 470– 2881, which is automatically issued to the household, or a hand–issued Form FP–2310–0 470–0325, Notice of Expiration.

Rescind the definitions of “intentional failure to comply” and “X–PERT.”

ITEM 3. Amend rule 441—65.2(234), introductory paragraph and first unnumbered paragraph, as follows:

441—65.2(234) Application. Persons in need of food stamps may file an application at an office in the administrative area in which they reside. An application is filed the day an appropriate food stamp office receives an application for food stamps on Form 470–3112 or 470–3122 (Spanish), Application for Assistance, Part 1; Form FP–2101–0 470–0306 or FP–2101–1 470–0307 (Spanish), Application for Food Stamps; or Form PA–2207–0 470–0462 or Form PA–2230–0 470–0466 (Spanish), Public Assistance Application, containing the applicant’s name and address which is signed by either a responsible member of the household or the household’s authorized representative. A household shall complete a Public Assistance Application when any person in the household is applying for or receiving aid through the family investment program, related medical programs or the refugee resettlement assistance programs. For cases not selected for the X–PERT system, the The application is complete when a completed Form FP–2101–0 470–0306, or FP–2101–1 470–0307, 470–0462, or 470–0466 Application for Food Stamps, is submitted, . when the An application form is necessary when it is for a month the household is not certified for food stamps or the application is for a when the household whose previous participation was in another applies in a new administrative area, except when any person in the household is applying for aid through the family investment program or related medical programs, the refugee resettlement assistance programs, or the child medical assistance program. These persons shall complete Form PA–2207–0 or Form PA–2230–0 (Spanish), Public Assistance Application, no later than at the time of the required interview.

ITEM 4. Amend rule 441—65.3(234) as follows:

441—65.3(234) Administration of program. The food stamp program shall be administered in accordance with the Food Stamp Act of 1977, 7 U.S.C. 2011 et seq., and in accordance with federal regulation, Title 7, Parts 270 through 282 283 as amended to June 1, 2001.

A copy of the federal law and regulations may be obtained at no more than the actual cost of reproduction by contacting the Division of Economic Assistance, Department of Human Services, 1305 East Walnut, Hoover State Office Building, Des Moines, Iowa 50319–0114, (515)281–3133.

This rule is intended to implement Iowa Code section 234.12.

ITEM 5. Amend rule 441—65.4(234), introductory paragraph, as follows:

441—65.4(234) Issuance. All food stamp coupons are issued by direct mail except for expedited food stamp benefits, exchange for improperly manufactured or mutilated coupons, and exchange of old series coupons for new series coupons. Expedited food stamp coupons shall be issued over the counter by local or area offices. Persons residing in counties in which a local or area office is not located shall have their expedited food stamp coupons mailed unless the interview is conducted in person at a local or area office in the administrative area in which they reside and benefits are picked up on the day of the interview. Exchanged coupons are issued over the counter by local or area offices. Food stamp recipients may chose to receive and use their benefits by electronic benefit transfer (EBT) instead of food stamp coupons in counties where this option is available. Where the option of EBT issuance is available and the household chooses this option, expedited food stamp benefits may shall be issued by EBT if expedited time frames can be met. Food stamp benefits for ongoing certifications are mailed or are otherwise made available to the household on a staggered basis during the first 15 days of each month.

ITEM 6. Rescind and reserve subrule 65.8(9).

ITEM 7. Amend rule 441—65.16(234) as follows:

441—65.16(234) Complaint system. Clients wishing to file a formal written complaint concerning the food stamp program may submit Form FP–2238–0 470–0323, or FP–2238–1 470–0327 (Spanish), Food Stamp Complaint, to the office of field support. Department staff shall encourage clients to use the form.

ITEM 8. Amend rule 441—65.19(234) as follows:

Amend subrule 65.19(2), paragraphs “a” and “c,” as follows:

a. The department will supply the Public Assistance Eligibility Report, Form PA–2140–0 470–0454 (computer issued), 470–0455 (manually issued), or 470–3719 (Spanish, manually issued) will be supplied to the recipient, by the department, as needed or requested. The department shall provide a postage–paid envelope for return of Form PA–2140–0, the Public Assistance Eligibility Report.

c. Failure to return a completed form shall result in cancellation of assistance. A completed form is a form with all items answered, accompanied by verification as required in 65.19(14), and signed and dated by a responsible household member on or after the last day of the budget month. When the PA–2140–0 Public Assistance Eligibility Report is used and a person in the household is also required to report monthly for another public assistance program, the form shall also be signed by all individuals required to sign for that program to be considered complete.

Amend subrule 65.19(4) as follows:

65.19(4) Public assistance income. The aid to dependent children department shall consider family investment program and refugee cash assistance grant(s) grants authorized for the issuance month will be considered in determination of the household’s eligibility and benefit level. Adjustive The department shall count adjustive or corrective public assistance payments shall be counted retrospectively.

Amend subrule 65.19(6), paragraph “a,” as follows:

a. Households required to submit aid to dependent children family investment program monthly reports.

Amend subrule 65.19(8) as follows:

65.19(8) Prospective beginning months. All The department shall calculate benefits for eligible households will have benefits calculated prospectively for the two beginning months. When a household has applied for assistance from the family investment program or related medical programs, the child medical assistance program or the refugee resettlement cash assistance program, and for food stamp benefits using a Form 470–3112, Application for Assistance, Part 1, or a Form PA–2207–0 470–0462 or PA–2230–0 470–0466 (Spanish), Public Assistance Application, the department shall allow a third food stamps’ stamp beginning month will be allowed. The department shall allow a third beginning month when the public assistance program’s first “initial month” is the same calendar month as the second food stamps’ stamp beginning month, and the third beginning month permits a simultaneous transition to retrospective budgeting.

ITEM 9. Amend subrules 65.20(1) and 65.20(2) as follows:

65.20(1) Issuance of the automated Notice of Expiration will occur with the mailing of Form 470–2881, Review/Recertification Eligibility Document, or a hand–issued Form FP 2310–0 470–0325, Notice of Expiration.

65.20(2) Issuance of the Notice of Expiration, Form FP–2310–0 470–0325, will occur at the time of certification if the household is certified for one month, or for two months, and will not receive the automated Notice of Expiration.

ITEM 10. Rescind and reserve subrule 65.21(3).

ITEM 11. Rescind and reserve subrule 65.28(9), paragraph “h.”

ITEM 12. Rescind and reserve rule 441—65.37(234).

ITEM 13. Rescind and reserve rule 441—65.42(234).

ITEM 14. Rescind and reserve rule 441—65.45(234).

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 clarify the policy governing the Health Insurance Premium Payment Program as follows:

• The Department shall request all information in writing and shall give the policyholder ten calendar days in which to provide it.

• When an employer will not agree to accept premium payment from the Department in lieu of a payroll deduction to the employee’s wages, the Department shall issue reimbursement to the policyholder five working days prior to the policyholder’s pay date.

• Timely and adequate notice shall be as defined in the Department’s rules on appeals at 441—subrule 7.7(1).

These clarifications were added in response to public comments submitted during the rule assessment mandated by Executive Order Number 8.

These amendments do not provide for waivers because the amendments are merely technical in nature.

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 January 16, 2002.

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

The following amendments are proposed.

ITEM 1. Amend rule 441—75.21(249A), introductory paragraph, as follows:

441—75.21(249A) Health insurance premium payment program. The department shall pay for the cost of enrolling an eligible Medicaid recipient in a health insurance plan when the department determines it is cost–effective to do so. Under the health insurance premium payment program, the department shall pay for the cost of premiums, coinsurance and deductibles for Medicaid–eligible individuals when the department determines that those costs will be less than the cost of paying for the individual’s care directly.

ITEM 2. Amend subrule 75.21(7), paragraph “c,” as follows:

c. If the household fails to cooperate in providing information necessary to establish ongoing eligibility, the department shall discontinue premium payment shall be discontinued pending after timely and adequate notice. The department shall request all information in writing and allow the policyholder ten calendar days in which to provide it.

ITEM 3. Amend subrule 75.21(9), paragraph “b,” as follows:

b. When the employer will not agree to accept premium payments from the department in lieu of a payroll deduction to the employee’s wages, the department shall reimburse the policyholder directly for payroll deductions or for payments made directly to the employer for the payment of healthinsurance premiums. The department shall issue reimbursement to the policyholder five working days prior to thepolicyholder’s pay date.

ITEM 4. Amend subrule 75.21(13) as follows:

75.21(13) Notices. An adequate notice shall be provided to the household under the following circumstances:

a. to c. No change.

A The department shall provide a timely and adequate notice as defined in 441—subrule 7.7(1) shall be provided to the household informing them of a decision to discontinue payment of the health insurance premium because thedepartment has determined the policy is no longer cost–effective or because the recipient has failed to cooperate in providing information necessary to establish continued eligibility for the program.

Pursuant to the authority of Iowa Code section 234.6, the Department of Human Services proposes to amend Chapter 143, “Interstate Compact on Juveniles,” appearing in the Iowa Administrative Code.

These amendments revise policy governing the Interstate Compact on Juveniles to:

• Add a preamble to the chapter to explain that articles adopted by each of the participating states govern the Interstate Compact and to explain Iowa’s obligations as a party to the Compact.

• Revise policy regarding processing of parolees and probationers from another state who commit a felony while in Iowa to be consistent with the Interstate Compact.

• Correct Iowa Code references.

These needed corrections were identified while the Department was completing the rules assessment mandated by Executive Order Number 8.

These amendments do not provide for waivers as waivers would be inconsistent with the interstate nature of the Compact.

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 January 16, 2002.

These amendments are intended to implement Iowa Code section 232.171.

The following amendments are proposed.

ITEM 1. Amend 441—Chapter 143 by adopting the following new preamble:

PREAMBLE

Iowa Code section 232.171 authorizes the state of Iowa to enter into the interstate compact on juveniles and incorporates into the Iowa Code the 15 basic articles and optional amendments that govern the interstate compact for all participating parties. The department implements the interstate compact on juveniles and participates in the contractual agreement with the other 49 states, the District of Columbia, the Virgin Islands, and Guam. The contractual agreement allows the parties to cooperate on the interstate aspects of juvenile delinquency as well as the return from one state to another of nondelinquent children who have run away from home.

ITEM 2. Rescind the implementation clauses following rules 441—143.1(232) and 441—143.2(232) and adopt the following new implementation clause at the end of the chapter:

These rules are intended to implement Iowa Code section 232.171.

ITEM 3. Amend subrule 143.4(5) as follows:

143.4(5) A parolee or probationer from another state held or placed in Iowa under the provisions of article VII and who commits a felony while in Iowa, shall be processed:

b. Processed according to the Iowa statutes and not returned to the sending state for violation.

Pursuant to the authority of Iowa Code section 234.6, the Department of Human Services proposes to amend Chapter 151, “Juvenile Court Services Directed Programs,” appearing in the Iowa Administrative Code.

These amendments revise policy governing juvenile court services directed programs to:

• Allow an amount up to 5 percent of the total allocation of the graduated sanction services to be set aside for juvenile court services administrative costs for the graduated sanction programs and require the state court administrator to establish a pay schedule for the accountant or audit position established in each judicial district.

• Allow an individual or a group rate as an option for the life skills service.

• Provide that juvenile court school liaisons and schools are not required to maintain or submit lists of children served for those months covered by a school employee contract and for which the salary is prorated, school is not in session, and no service is provided.

• Change references from “Department region” to “Department service area” and from “Department regional administrator” to “Department service area manager,” consistent with the restructuring of the Department.

These revisions are being proposed in response to public comment received during the rules review process mandated by Executive Order Number 8 and in response to the restructuring of the Department.

These amendments do not provide for waivers because these programs are governed by rules or court orders and the rules provide enough administrative flexibility that waivers are unnecessary.

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 January 16, 2002.

These amendments are intended to implement Iowa Code section 232.141.

The following amendments are proposed.

ITEM 1. Amend rule 441—151.1(232), definitions of “child” and “child welfare and juvenile justice plan,” as follows:

“Child” means a person under 18 years of age and also includes the following: A “child” means a person up to 19½ years of age when the child (1) is adjudicated delinquent and is under the jurisdiction of juvenile court services or (2) voluntarily accepts graduated sanction services when being released from the state training school, a highly structured juvenile program, or group care and a chief juvenile court officer or a chief juvenile court officer and a department regional administrator service area manager extend eligibility for the services.

“Child welfare and juvenile justice plan” means the annual plan for using decategorized funds within each department region service area.

ITEM 2. Amend rule 441—151.2(232) as follows:

Amend subrule 151.2(2), paragraph “a,” as follows:

a. An amount up to 3 5 percent, or as needed, of the total allocation of the graduated sanction services shall be set aside for juvenile court services administrative costs for the graduated sanction programs. The administrative costs shall include the costs of an accountant or audit position established in each judicial district. The state court administrator shall establish a written job classification and pay schedule for the accountant or audit position established in each judicial district and shall administer the set–aside for the eight judicial districts.

Amend subrule 151.2(3), paragraph “d,” as follows:

d. The chief juvenile court officer shall participate in developing an annual child welfare and juvenile justice plan for using decategorized funds within each department region service area. The respective chief juvenile court officers and department regional administrator service area manager shall sign the child welfare and juvenile justice plan.

ITEM 3. Amend subrule 151.30(5), paragraph “b,” as follows:

b. The life skills instruction may be provided on an individual or group basis. A An individual rate or a group rate shall be established for life skills instruction provided to more than one individual at a time.

ITEM 4. Amend subrule 151.31(5), paragraph “b,” as follows:

b. School–based supervision is generally not an ongoing service provided to children. To substantiate claims for reimbursement, the juvenile court school liaison shall maintain a list (roster) by month of the individual children referred for service and for whom the claim is made. For a claim to be valid, the school–based supervision staff shall have face–to–face or verbal contact with each child whose name appears on the roster. The list shall include the name of the child and the referral source. The school or juvenile court services shall maintain a copy of the list and the claim. The list and the claim are subject to audit.

The juvenile court school liaison is not required to list the names of children receiving group services. Juvenile court school liaisons and schools are not required to maintain or submit lists of children served for those months covered by a school employee contract for which the salary is prorated when school is not in session and no service is provided. The prorated salary arrangement shall be described in the contract.

Pursuant to the authority of Iowa Code section 225C.6, the Department of Human Services proposes to amend Chapter 153, “Social Services Block Grant and Funding for Local Services,” appearing in the Iowa Administrative Code.

This amendment rescinds Division III, “Mental Illness, Mental Retardation, and Developmental Disabilities—Local Services.” These rules are no longer needed given the changes that have taken place in the last five years in the disability services system. Establishing policy for accessing funding for services is now the responsibility of the counties, and the state does not have the authority to establish or to enforce the requirements in this division.

This needed rescission was identified while the Department was completing the rule assessment mandated by Executive Order Number 8.

This amendment does not provide for waivers because the amendment is merely meant to remove policy that is no longer used.

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 January 16, 2002.

This amendment is intended to implement Iowa Code section 225C.4.

The following amendment is proposed.

Amend 441—Chapter 153 by rescinding and reserving Division III.

Pursuant to the authority of Iowa Code section 234.6, the Department of Human Services proposes to rescind Chapter 171, “Adult Day Care,” Chapter 172, “Sheltered Work/Work Activity Services,” Chapter 174, “Transportation Services,” Chapter 206, “Community Supervised Apartment Living Arrangements Services Program,” and Chapter 207, “Residential Services for Adults,” appearing in the Iowa Administrative Code.

This amendment rescinds chapters dealing with the purchase of the following adult services: adult day care, sheltered work/work activity services, transportation services, community supervised apartment living arrangements services, and residential services for adults. These rules are no longer needed given the changes that have taken place in the last five years in the disability services system. Contracting for services is now the responsibility of the counties, and the Department does not have the authority to establish or to enforce the requirements in these chapters.

These needed deletions were identified while the Department was completing the rule assessment mandated by Executive Order Number 8.

This amendment does not provide for waivers because the amendment is merely meant to remove policy that is no longer used.

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 January 16, 2002.

This amendment is intended to implement Iowa Code section 234.6.

The following amendment is proposed.

Rescind and reserve 441—Chapter 171, 441—Chapter 172, 441—Chapter 174, 441—Chapter 206, and 441— Chapter 207.

Pursuant to the authority of Iowa Code sections 17A.3 and 147.76, the Board of Nursing hereby gives Notice of Intended Action to amend Chapter 3, “Licensure to Practice—Registered Nurse/Licensed Practical Nurse,” Iowa Administrative Code.

These amendments remove the delinquent license fee for individuals whose licenses became delinquent prior to July 4, 1963, require board approval for licensure of an individual who holds a license under sanction in any United States jurisdiction or another country, and reduce continuing education requirements to reactivate/reinstate the nursing license.

Any interested person may make written comments or suggestions on or before January 15, 2002. Such written materials should be directed to the Executive Director, Board of Nursing, RiverPoint Business Park, 400 S.W. 8th Street, Suite B, Des Moines, Iowa 50309–4685. Persons who want to convey their views orally should contact the Executive Director at (515)281–3256 or in the Board office at S.W. 8th Street, by appointment.

These amendments are intended to implement Iowa Code chapters 17A, 147, 152, and 272C.

The following amendments are proposed.

ITEM 1. Amend rule 655—3.1(17A,147,152,272C), definition of “fees,” numbered paragraph “11,” to read as follows:

11. For a registered nurse/licensed practical nurse delinquent license fee, $100, plus back renewal fees to date due, calculated at $25 per year or any part thereof. The total back renewal fees shall not exceed $250. The delinquent license fee shall not be assessed if the license became delinquent prior to July 4, 1963.

ITEM 2. Amend subrule 3.3(1), paragraph “c,” to read as follows:

c. Approval by the board of those with a past felony conviction or a record of prior disciplinary action, regardless of jurisdiction.

ITEM 3. Amend subrule 3.5(2) by rescinding paragraph “c” and relettering paragraphs “d” and “e” as “c” and “d.”

ITEM 4. Amend subrule 3.7(5), paragraph “c,” subparagraph (2), to read as follows:

(2) The licensee shall have completed 15 12 contact hours of continuing education as specified in 655—Chapter 5, earned within the 12 months prior to reinstatement.

ITEM 5. Amend subrule 3.7(6), paragraph “b,” subparagraph (2), to read as follows:

(2) The licensee shall have completed 15 12 contact hours of continuing education as specified in 655—Chapter 5, earned within the 12 months prior to reactivation.

Pursuant to the authority of Iowa Code sections 17A.3 and 216A.76, the Persons with Disabilities Division hereby gives Notice of Intended Action to adopt new Chapter 7, “Waiver Rules,” Iowa Administrative Code.

Executive Order Number 11 issued on September 14, 1999, requires each agency with authority to adopt rules, as defined in Iowa Code sections 17A.2(1) and 17A.2(11), to initiate rule–making proceedings to adopt the uniform waiver rule outlined in the Executive Order. Executive Order Number 11 was published in the Iowa Administrative Bulletin, Volume XXII, Number Seven, dated October 6, 1999. Adoption of this new chapter will provide the Division with waiver rules.

Any interested person may make written suggestions or comments on these proposed rules on or before January 15, 2002. Such written materials should be directed to the Administrator, Division of Persons with Disabilities, Department of Human Rights, Lucas State Office Building, Second Floor, Des Moines, Iowa 50319; fax (515)242–6119.

These rules are intended to implement Executive Order Number 11 and Iowa Code section 17A.9A.

The following new chapter is proposed.

CHAPTER 7
WAIVER RULES

431—7.1(17A) Definition. The term “waiver” as used in this chapter means a prescribed waiver or variance from a specific rule or set of rules of this division applicable only to an identified person on the basis of the particular circumstances of that person.

431—7.2(17A) Scope of chapter. This chapter creates generally applicable standards and a generally applicable proc–ess for granting individual waivers from rules adopted by the division in situations when no other more specifically applicable law provides for waivers. To the extent another more specific provision of law purports to govern the issuance of a waiver from a particular rule, the more specific waiver provision shall supersede this chapter with respect to any waiver from that rule.

431—7.3(17A) Applicability. This chapter applies only to waivers of those division rules that are within the exclusive rule–making authority of the division. This chapter shall not apply to rules that merely define the meaning of a statute, or other provisions of law or precedent, if the division does not possess statutory authority to bind a court, to any extent, with its definition.

431—7.4(17A) Compliance with law. The division may not issue a waiver under this chapter unless: (1) the legislature has delegated authority sufficient to justify the action; and (2) the waiver is consistent with statute and other provisions of law. No waiver may be granted under this chapter from any mandatory requirement imposed by statute.

431—7.5(17A) Criteria for a waiver. The division may issue an order, in response to a completed petition or on its own motion, granting a waiver from a rule adopted by the division, in whole or in part, as applied to the circumstances of a specified person, if the division finds that the waiver is consistent with rules 7.3(17A) and 7.4(17A) of this chapter, that the waiver would not prejudice the substantial legal rights of any person, and either that:

1. The application of the rule to the person at issue does not advance, to any extent, any of the purposes for the rule or set of rules; or

2. The following criteria have been met:

• The application of the rule or set of rules to the person at issue would result in an undue hardship or injustice to that person; and

• The waiver on the basis of the particular circumstances relative to the specified person would be consistent with the overall public interest.

In determining whether a waiver would be consistent with the public interest, the division administrator shall consider whether, if a waiver is granted, the public health, safety, and welfare will be adequately protected by other means that will ensure a result that is substantially equivalent to full compliance with the rule.

431—7.6(17A) Division discretion. The final decision to grant or deny a waiver shall be vested in the division administrator. This decision shall be made at the discretion of the division upon consideration of relevant facts.

431—7.7(17A) Burden of persuasion. The burden of persuasion shall be on the petitioner to demonstrate by clear and convincing evidence that the division should exercise its discretion to grant the petitioner a waiver based upon the criteria contained in rule 7.5(17A) of this chapter.

431—7.8(17A) Contents of petition. A petition for a waiver shall include the following information where applicable and known to the requester:

1. The name, address, and telephone number of the entity or person for whom a waiver is requested, and the case number of any related contested case.

2. A description and citation of the specific rule or set of rules from which a waiver is requested.

3. The specific waiver requested, including a description of the precise scope and operative period for which the petitioner wants the waiver to extend.

4. The relevant facts that the petitioner believes would justify a waiver. This statement shall include a signed statement from the petitioner attesting to the accuracy of the facts represented in the petition and a statement of reasons that the petitioner believes will justify a waiver.

5. A history of any prior contacts between the petitioner and the division relating to the activity affected by the proposed waiver, including any notices of violation, contested case hearings, or investigative reports relating to the activity within the last five years.

6. Any information known to the requester relating to the division’s treatment of similar cases.

7. The name, address, and telephone number of any public agency or political subdivision which also regulates the activity in question or which might be affected by the granting of a waiver.

8. The name, address, and telephone number of any person or entity that would be adversely affected by the granting of a petition.

9. The name, address, and telephone number of any person with knowledge of the relevant facts relating to the proposed waiver.

10. Signed releases of information authorizing persons with knowledge of the waiver request to furnish the division with information relevant to the waiver.

431—7.9(17A) Additional information. Prior to issuing an order granting or denying a waiver, the division may request additional information from the petitioner relative to the petition and surrounding circumstances. If the petition was not filed in a contested case, the division may, on its own motion or at the petitioner’s request, schedule a telephonic or in–person meeting between the petitioner and a representative from the division to discuss the petition and surrounding circumstances.

431—7.10(17A) Notice. The division shall acknowledge the petition upon receipt. The division shall ensure that, within 30 days of the receipt of the petition, notice of the pendency of the petition and a concise summary of its contents have been provided to all persons to whom notice is required by any provision of law. In addition, the division may give notice to other persons. To accomplish this notice provision, the division may require the petitioner to serve the notice on all persons to whom notice is required by any provision of law and provide a written statement to the division attesting to the fact that notice has been provided.

431—7.11(17A) Hearing procedures. The provisions of Iowa Code sections 17A.10 to 17A.18A regarding contested case hearings shall apply to any petition for waiver of a rule or set of rules filed within a contested case and shall otherwise apply to division proceedings for a waiver only when the division so provides by rule or order or is required to do so by statute or other binding law.

431—7.12(17A) Ruling. An order granting or denying a waiver shall be in writing and shall contain a reference to the particular person and rule or portion thereof to which the order pertains, a statement of the relevant facts and reasons upon which the action is based, and a description of the precise scope and operative time period of a waiver if one is issued.

431—7.13(17A) Conditions. The division may condition the granting of the waiver on such conditions that the division deems to be reasonable and appropriate in order to achieve the objectives of the particular rule in question through alternative means.

431—7.14(17A) Time for ruling. The division shall grant or deny a petition for a waiver as soon as practicable but, in any event, shall do so within 120 days of its receipt, unless the petitioner agrees to a later date. However, if a petition is filed in a contested case, then the division may grant or deny the petition at the time the final decision in that contested case is issued.

431—7.15(17A) When deemed denied. Failure of the division to grant or deny a petition within the required time period shall be deemed a denial of that petition by the division. However, the division shall remain responsible for issuing an order denying a waiver as required by rule 7.12(17A).

431—7.16(17A) Service of orders. Within seven days of its issuance, any order issued under this chapter shall be transmitted to the petitioner or the person to whom the order pertains and to any other person entitled to such notice by any provision of law.

431—7.17(17A) Record keeping. Subject to the provisions of Iowa Code section 17A.3(1)“e,” the division shall maintain a record of all orders granting and denying waivers under this chapter. All final rulings in response to requests for waivers shall be indexed and copies distributed to members of the administrative rules review committee upon request. All final rulings shall also be available for inspection by the public at the division office during regular business hours.

431—7.18(17A) Cancellation of a waiver. A waiver issued by the division pursuant to this chapter may be withdrawn, canceled, or modified if, after appropriate notice and hearing, the division issues an order finding any of the following:

1. The person who was the subject of the waiver order withheld from the division or knowingly misrepresented to the division material facts relevant to the propriety or desirability of the waiver; or

2. The alternative means of ensuring that the public health, safety, and welfare will be adequately protected after issuance of the waiver order has been demonstrated to be insufficient, and no other means exists to protect the substantial legal rights of any person; or

3. The subject of the waiver order has failed to comply with all of the conditions contained in the order.

431—7.19(17A) Violations. A violation of a condition in a waiver order shall be treated as a violation of the particular rule for which the waiver was granted. As a result, the recipient of a waiver under this chapter who violates a condition of the waiver may be subject to the same remedies or penalties as a person who violates the rule at issue.

431—7.20(17A) Defense. After the division issues an order granting a waiver, the order shall constitute a defense, within the terms and the specific facts indicated therein, for the person to whom the order pertains in any proceeding in which the rule in question is sought to be invoked.

431—7.21(17A) Appeals. Appeals within the division from a decision granting or denying a waiver shall be in accordance with Iowa Code chapter 17A and division rules. These appeals shall be taken within 30 days of the issuance of the ruling granting or denying the waiver request, unless a different time is provided by rule or statute.

These rules are intended to implement Iowa Code section 17A.9A and Executive Order Number 11.

Pursuant to the authority of Iowa Code sections 437A.4 and 437A.5, the Director of Revenue and Finance hereby gives notice of the electric delivery tax rate, the municipal electric transfer replacement tax rate, the natural gas delivery tax rate, and the municipal natural gas transfer replacement tax rate for each competitive service area in the state. These rates will be used in conjunction with the number of kilowatt hours of electricity and the number of therms of natural gas delivered to consumers in calendar year 2001 by each taxpayer to determine the tax due for each taxpayer in the 2002–2003 fiscal year.