CHAPTER 131
EMERGENCY MEDICAL SERVICES—PROVIDERS—INITIAL CERTIFICATION—RENEWAL AND REACTIVATION—AUTHORITY—COMPLAINTS AND INVESTIGATIONS
641—131.1(147A) Purpose. This chapter establishes the regulations and requirements for emergency medical provider initial certification for individuals who have been trained to provide emergency and nonemergency medical care at the EMR, EMT, AEMT, paramedic or other certification level recognized by the department before 2011; describes the authority, permission to practice and scope of practice for certified emergency medical care providers in the state of Iowa; and establishes the regulations and requirements for renewal, extension and reactivation of an emergency medical care provider certification in the state of Iowa.
[ARC 5143C, IAB 8/12/20, effective 9/16/20]
641—131.2(147A,147D) Definitions. For the purpose of these rules, the following definitions shall apply:
“Advanced emergency medical technician” or “AEMT” means an individual who has successfully completed a course of study based on the United States Department of Transportation’s Advanced Emergency Medical Technician Instructional Guidelines (January 2009), has passed the psychomotor and cognitive examinations for the AEMT, and is currently certified by the department as an AEMT.
“Bureau” or “BETS” means the bureau of emergency and trauma services, the bureau designated by the department as the lead agency for coordinating and implementing the provision of emergency medical services in this state.
“CAPCE” means the Commission on Accreditation for Prehospital Continuing Education. CAPCE is an accrediting body charged with the review and accreditation of EMS continuing education.
“CEH” means continuing education hour, which is based upon a minimum of 50 minutes of training per hour.
“Certification” or “certificate” means a document issued by the department authorizing a person to practice as an emergency medical care provider in Iowa.
“Certification period” means the length of time an emergency medical care provider certificate is valid. The certification period shall be for two years from initial issuance or from renewal, unless otherwise specified on the certificate or unless sooner suspended or revoked.
“Certification status” means the status of an individual EMS certificate holder.
	1.	“Active” means the holder of the certification has the authority to function as an emergency medical care provider at the level certified in accordance with subrule 131.5(1).
	2.	“Probation,” which is an active certification, means the holder of the certification has the authority to function as an emergency medical care provider at the level certified in accordance with subrule 131.5(1) and under the conditions of probation.
	3.	“Denied” means the certificate is inactive and the holder of the certification has no authority to function as an emergency medical care provider.
	4.	“Inactive” means the certificate is inactive and the holder of the certification has no authority to function as an emergency medical care provider.
	5.	“Revoked” means the certification is inactive and the holder of the certification has no authority to function as an emergency medical care provider.
	6.	“Surrendered” means the certification is inactive and the holder of the certification has no authority to function as an emergency medical care provider.
	7.	“Suspended” means the certification is inactive and the holder of the certification has no authority to function as an emergency medical care provider.
“Certified” means being officially recognized as meeting department-approved testing and training standards and being issued a certificate by the department in accordance with Iowa Code chapters 272C and 147A to practice as an emergency medical care provider in the state of Iowa.
“Cognitive examination” or “written examination” means the portion of the NREMT certification examination process evaluating the candidate’s level of EMS knowledge.
“Compact” means the emergency medical services personnel licensure interstate compact according to Iowa Code chapter 147D. The compact facilitates the day-to-day movement of emergency medical services personnel across state boundaries in the performance of emergency medical services duties and authorizes the department to afford immediate permission to practice to emergency medical services personnel licensed in a member state.
“Core continuing education” means education obtained during a certification period to renew certification. Core continuing education shall have an assigned sponsor number from CAPCE, an authorized EMS training program, the board of nursing, the board of medicine or the department.
“Critical care paramedic” or “CCP” means a currently certified paramedic who has successfully completed a critical care course of instruction approved by the department and has received endorsement from the department as a critical care paramedic.
“Department” means the Iowa department of public health.
“Director” means the director of the Iowa department of public health.
“Emergency medical care” means any medical procedure authorized by Iowa Code chapter 147A and these rules.
“Emergency medical care provider” means an individual who has been trained to provide emergency and nonemergency medical care at the EMR, EMT, AEMT, paramedic, or other certification level recognized by the department before 2011 and has been issued a certificate by the department, or a person practicing in accordance with Iowa Code chapter 147D.
“Emergency medical care student” means an individual registered with the department and enrolled in an EMS training program with an active EMS student registration.
“Emergency medical responder” or “EMR” means an individual who has successfully completed a course of study based on the United States Department of Transportation’s Emergency Medical Responder Instructional Guidelines (January 2009), has passed the psychomotor and cognitive examinations for the EMR, and is currently certified by the department as an EMR.
“Emergency medical services” or “EMS” means an integrated medical care delivery system to provide emergency and nonemergency medical care at the scene or during out-of-hospital patient transportation in an ambulance.
“Emergency medical technician” or “EMT” means an individual who has successfully completed a course of study based on the United States Department of Transportation’s Emergency Medical Technician Instructional Guidelines (January 2009), has passed the psychomotor and cognitive examinations for the EMT, and is currently certified by the department as an EMT.
“Emergency medical technician-defibrillation” or “EMT-D” means an individual who has successfully completed an approved program and is currently certified by the department as an EMT-D.
“EMS clinical guidelines” or “minimum EMS clinical guidelines” means a minimum clinical standard approved by the department upon which a service program’s medical director shall base service program protocols.
“EMS instructor” or “EMS-I” means an individual who has successfully completed an EMS instructor curriculum approved by the department and is currently endorsed by the department as an EMS-I.
“Endorsement” or “endorsed” means an approval granted by the department authorizing an individual to serve as an EMS-I or CCP.
“Fees” means those fees received pursuant to Iowa Code chapters 147A and 147D.
“First responder” or “FR” means an individual who has successfully completed an approved program and is currently certified by the department as an FR.
“First responder-defibrillation” or “FR-G” means an individual who has successfully completed an approved program and is currently certified by the department as a FR-G.
“NREMT” means the National Registry of Emergency Medical Technicians. The NREMT provides a valid, uniform process to assess the knowledge and skills required for competent practice by EMS professionals.
“Paramedic” or “PM” means an individual who has successfully completed a course of study based on the United States Department of Transportation’s Paramedic Instructional Guidelines (January 2009), has passed the psychomotor and cognitive examinations for the paramedic, and is currently certified by the department as a paramedic.
“Patient” means an individual who is sick, injured, or otherwise incapacitated and has been evaluated or provided treatment by an emergency medical care provider.
“Patient abandonment” means a termination of the provider/patient relationship at a time when a continuous level of care is needed. Patient abandonment does not occur when a scene is unsecured, deteriorates or becomes too dangerous for the emergency medical care provider to safely function. Patient abandonment does not occur when patient care is transferred to another emergency medical care provider following assessment or triage.
“Physician” means an individual licensed under Iowa Code chapter 148.
“Physician assistant” or “PA” means an individual licensed pursuant to Iowa Code chapter 148C.
“Protocols” means written directions and orders approved by a service program’s medical director utilizing the EMS clinical guidelines.
“Psychomotor examination” or “practical examination” means the portion of the department-approved or NREMT certification examination process that evaluates the skill and procedure capabilities of the candidate.
“Registered nurse” or “RN” means an individual licensed pursuant to Iowa Code chapter 152.
“Service program” or “service” means any transport service or nontransport service, inclusive of associated satellites and service program affiliates, that has received full or conditional authorization from the department.
[ARC 5143C, IAB 8/12/20, effective 9/16/20]
641—131.3(147A) Initial certification.
	131.3(1) An individual who has successfully completed the training program requirements at the EMR, EMT, AEMT or paramedic level and has a valid certification with NREMT shall submit the following to the department for initial Iowa emergency medical care provider certification:
	a. 	A completed EMS certification application.
	b. 	An NREMT active certification number.
	c. 	Payment of the initial application fee.
	d. 	Two completed fingerprint cards for background checks.
	e. 	Payment of the background check fee.
	131.3(2) Once the above items are received and approved, the department may issue an initial emergency medical care provider certification.
	131.3(3) Initial Iowa certification dates shall be consistent with the NREMT certification dates.
	131.3(4) The individual seeking an Iowa emergency medical provider care certification shall submit all application materials within two years from the Iowa training program course completion date.
	131.3(5) If the individual is unable to complete the requirements within two years due to medical reasons or military obligation, an extension may be granted upon submission of a signed statement from an appropriate medical or military authority and approval by the department.
[ARC 5143C, IAB 8/12/20, effective 9/16/20]
641—131.4(147A) Background check results.
	131.4(1) Negative information on the criminal history will not necessarily preclude an individual from certification. The department will directly communicate with the individual to carefully consider the results of the background check. The following will be taken into consideration during the evaluation and analysis:
	a. 	The nature and gravity of the conviction.
	b. 	The length of time between the conviction and the application for certification.
	c. 	Frequency and severity of the criminal activity and child or dependent adult abuse activity included in the background check results.
	d. 	Mitigating factors at the time the activity occurred.
	e. 	Cooperation with federal or state officials in the investigation and treatment/rehabilitation plan.
	f. 	The maturity of the individual at the time of any criminal activity or child or dependent adult abuse activity.
	131.4(2) The department will take reasonable steps to ensure the accuracy of the information contained in the background checks. An individual who believes the background checks contain inaccurate information will be informed of the steps the individual may wish to pursue to correct the information.
	131.4(3) All criminal history records are confidential and will only be used in accordance with this policy to determine eligibility. All background check records will be stored in a secure location. Background check records shall not be redisseminated by the department.
[ARC 5143C, IAB 8/12/20, effective 9/16/20]
641—131.5(147A) Authority.
	131.5(1) Authority of emergency medical care provider. An emergency medical care provider who holds an active Iowa certification issued by the department or has permission to practice in Iowa pursuant to Iowa Code chapter 147D may:
	a. 	As a member of a responding authorized service program, render emergency medical care and perform emergency medical care without contacting medical direction if written protocols have been approved by the service program medical director.
	b. 	Function in any hospital or any other entity in which health care is ordinarily provided only when:
	(1)	Employed by or assigned to a hospital or other entity in which health care is ordinarily provided when under the direct supervision of a physician as a member of an authorized service program, or in an individual capacity, by rendering lifesaving services in the facility in which employed or assigned pursuant to the emergency medical care provider’s certification and under direct supervision of a physician, physician assistant, or registered nurse. An emergency medical care provider shall not routinely function without the direct supervision of a physician, physician assistant, or registered nurse. However, when the physician, physician assistant, or registered nurse cannot directly assume emergency care of the patient, the emergency medical care provider may perform, without direct supervision, emergency medical care procedures for which certified, if the life of the patient is in immediate danger and such care is required to preserve the patient’s life;
	(2)	Employed by or assigned to a hospital or other entity in which health care is ordinarily provided when under the direct supervision of a physician, as a member of an authorized service program, or in an individual capacity, to perform nonlifesaving procedures for which certified and designated in a written job description. Such procedures may be performed after the patient is observed by and when the emergency medical care provider is under the supervision of the physician, physician assistant, or registered nurse and where the procedure may be immediately abandoned without risk to the patient.
	131.5(2) Scope of practice.
	a. 	Emergency medical care providers shall perform only those skills and procedures that are authorized within the scope of practice for which certified.
	b. 	The Iowa Emergency Medical Care Provider Scope of Practice (September 2019) is hereby incorporated and adopted by reference for emergency medical care providers. For any differences that may occur between the scope of practice adopted by reference and these rules, the rules shall prevail.
	c. 	The Iowa Emergency Medical Care Provider Scope of Practice (September 2019) is available on the BETS website (www.idph.iowa.gov/BETS/EMS/provider-information).
	d. 	The department may grant a waiver for changes to the scope of practice that have not yet been adopted by reference in these rules pursuant to 641—Chapter 178.
[ARC 5143C, IAB 8/12/20, effective 9/16/20; Editorial change: IAC Supplement 11/18/20; ARC 5528C, IAB 3/24/21, effective 4/28/21]
641—131.6(147A) Renewal standards, reactivation procedures, fees, and continuing education.
	131.6(1) Renewal of certification.
	a. 	An emergency medical care provider shall submit an application for renewal of an active Iowa EMS certification within 90 days prior to the certification expiration date.
	b. 	The renewal application and process are completed online via an individual Iowa EMS provider account. The electronic portal to access individual accounts is located at: dphregprograms.iowa.gov/PublicPortal/Iowa/IDPH/common/index.jsp.
	c. 	Renewal notifications will be sent to Iowa emergency medical care providers who have an active certification set to expire in 90 days. The notification will be sent by email to the address on file in the emergency medical care provider’s electronic profile.
	d. 	It is the emergency medical care provider’s responsibility to ensure the electronic profile information, including the email address, is updated and correct within 30 days of any change.
	e. 	A renewal certificate shall be valid for two years from the current expiration date unless sooner surrendered, suspended or revoked.
	f. 	A lower-level certificate may be renewed if the individual voluntarily chooses to move from a higher level to a lower level by completing all applicable continuing education requirements for the lower level during the certification period and submitting a change of status request, available on the BETS website (www.idph.iowa.gov/BETS/EMS/provider-information).
	g. 	A certification status shall become inactive if the certificate has not been renewed by the certification expiration date unless the emergency medical care provider is granted an extension as described in subrule 131.6(3).
	h. 	An emergency medical care provider may request an inactive status. The request must be made by submitting a change of status request, available on the BETS website (www.idph.iowa.gov/BETS/EMS/provider-information). A request for inactive status, when accepted in connection with a disciplinary investigation or proceeding, has the same effect as an order of revocation.
	131.6(2) Late renewal of certification.
	a. 	An emergency medical care provider who has completed the required continuing education during the certification period but fails to submit the EMS renewal of certification application and applicable fees prior to the certification expiration date is eligible for late renewal of the inactive certification.
	b. 	The emergency medical care provider shall complete the EMS renewal of certification application, submit a late fee in addition to the applicable renewal fee and submit an audit report form provided by the department. The fee and audit report form shall be submitted before the last day of the month following the certification expiration date. If the late renewal submission is not completed by the last day of the month following the certification expiration date, the certification remains inactive.
	c. 	An emergency medical care provider who has not completed the required continuing education during the certification period is not eligible for late renewal. The certification is inactive.
	131.6(3) Extension of certification.
	a. 	An emergency medical care provider who is unable to attain all continuing education requirements within the certification period may request a 45-day extension. To complete the extension process, the provider shall:
	(1)	Submit a request for extension application, available on the BETS website (www.idph.iowa.gov/BETS/EMS/provider-information), at least 7 days prior to the certification expiration date, but no more than 90 days prior to the certification expiration date, and payment of the extension fee.
	(2)	Complete the continuing education requirements.
	(3)	Complete and submit the EMS affirmative renewal of certification application, with all applicable renewal fees, to the department prior to the extended expiration date.
	(4)	Submit an audit report form provided by the department.
	b. 	If an emergency medical care provider fails to submit any of the items required in subparagraphs 131.6(3)“a”(2) and (3) by the forty-fifth day of the extended certification period, the certification will be inactive.
	c. 	The emergency medical care provider may not use continuing education completed during the extension period in the subsequent renewal period.
	131.6(4) Reactivation of an inactive certification.
	a. 	Certification inactive up to 24 months. An emergency medical care provider may apply to reactivate an inactive certification up to 24 months after the certification became inactive.
	(1)	An individual will submit to the department an EMS certification reactivation application, which is available on the BETS website (www.idph.iowa.gov/BETS/EMS/provider-information).
	(2)	If the department approves the application, the individual must submit an audit report form with 36 core continuing education hours prorated per lapsed year by core topic area and the reactivation fee.
	(3)	Upon receipt and approval of the items required in subparagraphs 131.6(4)“a”(1) and (2), the department may issue a new certification.
	(4)	An emergency medical care provider who fails to complete the reactivation process within 12 months from the date of application approval must reapply for reactivation of the inactive certification.
	b. 	Certification inactive from 25 months to 48 months. An emergency medical care provider may apply to reactivate an inactive certification that has been inactive for 25 months but no more than 48 months.
	(1)	An individual will submit to the department an EMS certification reactivation application, which is available on the BETS website (www.idph.iowa.gov/BETS/EMS/provider-information).
	(2)	If the department approves the application, the individual must submit documentation of successful completion of an approved EMS refresher course that includes successful completion of psychomotor and cognitive certification examinations. In addition, the individual must:
	1.	Submit two fingerprint cards.
	2.	Submit reactivation and background check fees.
	3.	Upon receipt and approval of the items required in subparagraphs 131.6(4)“b”(1) and (2), the department may issue a new certification.
	4.	An emergency medical care provider who fails to complete the reactivation process within 12 months from the date of application approval must reapply for reactivation of the inactive certification.
	c. 	Certification inactive for more than 48 months. An emergency medical care provider may not apply to reactivate a certification that has been inactive for more than 48 months.
	131.6(5) Reactivation of revoked or suspended certification.
	a. 	Any person whose certification to practice has been revoked or suspended may apply to the department for reactivation in accordance with the terms and conditions of the order of revocation or suspension, unless the order of revocation provides that the certification is permanently revoked.
	b. 	If the order of revocation or suspension did not establish terms and conditions upon which reactivation might occur or if the certification was voluntarily surrendered, an initial application for reactivation may not be made until one year has elapsed from the date of the order or the date of the voluntary surrender.
	c. 	All proceedings for reactivation shall be initiated by the person whose certification has been revoked or suspended in accordance with subrule 131.6(4). An application for reactivation shall allege facts which, if established, will be sufficient to enable the department to determine that the basis for the revocation or suspension of the person’s certification no longer exists and that it will be in the public interest for the certification to be reinstated. The burden of proof to establish such facts shall be on the person whose certification has been suspended or revoked.
	d. 	An order denying or granting reactivation shall be based upon a decision which incorporates findings of facts and conclusions of law.
	131.6(6) Fees. The nonrefundable fees are as follows:
	a. 	Application for initial Iowa certification at all certification levels: $30.
	b. 	Reactivation of a certification to practice: $30.
	c. 	Renewal of a certification to practice as a first responder, EMR: no fee.
	d. 	Renewal of a certification to practice as an emergency medical technician: no fee.
	e. 	Renewal of a certification to practice as an advance emergency medical technician: $10.
	f. 	Renewal of a certification to practice as a paramedic: $25.
	g. 	Late renewal of a certification to practice: $30.
	h. 	Returned payment due to insufficient funds: $15.
	i. 	Extension of certification: $50.
	j. 	Criminal history background checks by the Iowa division of criminal investigation (DCI) and the Federal Bureau of Investigation (FBI) and fingerprint card evaluation: $50.
	131.6(7) Continuing education renewal.
	a. 	The table below illustrates the minimum number of core CEHs by topic area for each level of emergency medical care provider to renew an Iowa EMS certification.

Core Topics	EMR/FR	EMT/EMT-D	AEMT	PM	
Airway, Respirations, Ventilations	1	1	2	3	
Cardiology	2	6	7	9	
Trauma	1	2	3	3	
Medical	3	6	8	9	
Operations	1	5	5	6	
Totals	8	20	25	30	
	b. 	All core continuing education hours used to renew an Iowa EMS certification must have a sponsor number by an authorized Iowa training program, the department, the board of nursing, the board of medicine, or CAPCE before the emergency medical care provider attends the offering.
	c. 	An emergency medical care provider who is registered with the NREMT may renew the provider’s Iowa EMS certification by meeting the NREMT’s requirements. The emergency medical care provider must submit the Iowa affirmative renewal of certification application and all appropriate fees.
	d. 	An emergency medical care provider shall be deemed to have complied with the continuing education requirements during periods in which the provider serves honorably on active duty in the military services or for periods in which the provider is a government employee working as an emergency medical care provider and assigned to duty outside the United States. The emergency medical care provider must submit the Iowa affirmative renewal of certification application, all appropriate fees and documentation of assignment.
	e. 	The emergency medical care provider shall maintain a file containing documentation of CEHs accrued during each certification period for four years from the end of each certification period.
	f. 	A group of emergency medical care providers will be audited for each certification period. Emergency medical care providers to be audited will be chosen in a random manner or at the discretion of BETS. Falsifying reports or failure to comply with the audit request may result in formal disciplinary action. Those audited will be required to submit a department-provided audit report form within 45 days of the request. If audited, the emergency medical care provider must provide the following information:
	(1)	Date of program.
	(2)	Program sponsor number.
	(3)	Title of program.
	(4)	Number of approved hours.
	131.6(8) Continuing education approval. The following standards shall be applied for approval of continuing education:
	a. 	CEHs shall have an assigned sponsor number from CAPCE, an authorized EMS training program, the board of nursing, the board of medicine or the department.
	b. 	Human health-related college courses may be approved in advance by BETS at one quarter credit equal to 10 CEHs, one semester credit equal to 15 CEHs.
	131.6(9) Out-of-state continuing education. Out-of-state continuing education courses shall be accepted for CEHs if all criteria in subrule 131.6(7) are met and if the courses have been approved for emergency medical care personnel in the state in which the courses were held. A copy of course completion certificates (or other verifying documentation) shall, upon request, be submitted to the department.
[ARC 5143C, IAB 8/12/20, effective 9/16/20; Editorial change: IAC Supplement 11/18/20]
641—131.7(147A,272C) Discipline—denial, citation and warning, probation, suspension, or revocation of certificates or renewal.
	131.7(1) This rule is not subject to waiver pursuant to 641—Chapter 178 or any other provision of law.
	131.7(2) Prohibited grounds for discipline. The department shall not suspend or revoke the certification of a person who is in default or is delinquent on repayment or a service obligation under federal or state postsecondary educational loans or public or private services-conditional postsecondary tuition assistance solely on the basis of such default or delinquency.
	131.7(3) Methods of discipline.
	a. 	The department has the authority to impose the following disciplinary sanctions against an emergency medical care provider:
	(1)	Issue a citation and warning.
	(2)	Impose a civil penalty not to exceed $1,000.
	(3)	Require reexamination.
	(4)	Require additional education or training.
	(5)	Impose a period of probation under specific conditions.
	(6)	Prohibit permanently, until further order of the department, or for a specific period, a provider’s ability to engage in specific procedures, methods, acts or activities incident to the practice of the profession.
	(7)	Suspend a certificate until further order of the department or for a specific period.
	(8)	Deny an application for certification.
	(9)	Revoke a certification.
	(10)	Impose such other sanctions as allowed by law and as may be appropriate.
	b. 	A request for inactive status in connection with a disciplinary investigation or proceeding has the same effect as an order of revocation.
	c. 	A citation and warning, denial, probation, restriction, suspension revocation, or civil penalty imposed upon an individual certificate holder by the department shall be considered applicable to all certificates and endorsements issued to that individual by the department.
	d. 	An emergency medical care provider who has knowledge of an emergency medical care provider, service program or training program that has violated Iowa Code chapter 147A or these rules shall report such information to the department within 30 days.
	131.7(4)  The department may deny an application for issuance or renewal of an emergency medical care provider certificate, including endorsement, or may impose any of the disciplinary sanctions provided in subrule 131.7(3) when it finds that the individual or certificate holder has committed any of the following acts or offenses:
	a. 	Negligence in performing emergency medical care.
	b. 	Failure to follow the directions of supervising physicians or their designees.
	c. 	Rendering treatment not authorized under Iowa Code chapter 147A.
	d. 	Patient abandonment.
	e. 	Fraud in procuring certification or renewal including, but not limited to:
	(1)	An intentional perversion of the truth in making application for a certification to practice in this state;
	(2)	False representations of a material fact, whether by word or by conduct, by false or misleading allegations, or by concealment of that which should have been disclosed when making application for a certification in this state; or
	(3)	Attempting to file or filing with the department or training program any false or forged diploma or certificate or affidavit or identification or qualification in making an application for a certification in this state.
	f. 	Professional incompetency. Professional incompetency includes, but is not limited to:
	(1)	A substantial lack of knowledge or ability to discharge professional obligations within the scope of practice.
	(2)	A substantial deviation from the standards of learning or skill ordinarily possessed and applied by other emergency medical care providers in the state of Iowa acting in the same or similar circumstances.
	(3)	A failure to exercise the degree of care which is ordinarily exercised by the average emergency medical care provider acting in the same or similar circumstances.
	(4)	Failure to conform to the minimal standard of acceptable and prevailing practice of certified emergency medical care providers in this state.
	(5)	A substantial lack of knowledge or ability to discharge professional obligations within the minimum clinical standards approved by the department.
	g. 	Knowingly making misleading, deceptive, untrue or fraudulent representations in the practice of the profession or engaging in unethical conduct or practice harmful or detrimental to the public. Proof of actual injury need not be established. Acts which may constitute unethical conduct include, but are not limited to:
	(1)	Verbally or physically abusing a patient, coworker or any other individual encountered while a certified emergency medical care provider.
	(2)	Improper sexual contact with or making suggestive, lewd, lascivious or improper remarks or advances to a patient, coworker or any other individual encountered while certified as an emergency medical care provider in the state of Iowa.
	(3)	Betrayal of a professional confidence.
	(4)	Engaging in a professional conflict of interest.
	(5)	Falsification of medical records, official documents or other writings or records.
	h. 	Engaging in any conduct that subverts or attempts to subvert a department investigation.
	i. 	Failure to comply with a subpoena issued by the department or failure to cooperate with an investigation of the department.
	j. 	Failure to comply with the terms of a department order or the terms of a settlement agreement or consent order.
	k. 	Failure to report another emergency medical care provider to the department for any violations listed in these rules, pursuant to Iowa Code chapter 147A.
	l. 	Knowingly aiding, assisting or advising a person to unlawfully practice EMS.
	m. 	Representing oneself as an emergency medical care provider when one’s certification has been suspended or revoked or when one’s certification is lapsed or has been placed on inactive status.
	n. 	Permitting the use of a certification by a noncertified person for any purpose.
	o. 	Mental or physical inability reasonably related to and adversely affecting the emergency medical care provider’s ability to practice in a safe and competent manner as determined by an evaluation from a licensed evaluator of the provider’s mental or physical status.
	p. 	Being adjudged mentally incompetent by a court of competent jurisdiction.
	q. 	Sexual harassment of a patient, student, coworker or any other individual encountered while certified as an emergency medical care provider in the state of Iowa. Sexual harassment includes sexual advances, sexual solicitation, requests for sexual favors, and other verbal or physical conduct of a sexual nature communicated in person, in writing, via a third person or through electronic communication.
	r. 	Habitual intoxication or addiction to drugs.
	(1)	The inability of an emergency medical care provider to practice with reasonable skill and safety by reason of the excessive use of alcohol on a continuing basis.
	(2)	The excessive use of drugs which may impair an emergency medical care provider’s ability to practice with reasonable skill or safety.
	(3)	Obtaining, possessing, attempting to obtain or possess, or administering controlled substances without lawful authority.
	s. 	Fraud in representation as to skill, ability or certification.
	t. 	Willful or repeated violations of Iowa Code chapter 147A or these rules.
	u. 	Violating a statute of this state, another state, or the United States, without regard to its designation as either a felony or misdemeanor, which relates to the provision of emergency medical care, including but not limited to a crime involving dishonesty, fraud, theft, embezzlement, controlled substances, substance abuse, assault, sexual abuse, sexual misconduct, or homicide. A copy of the record of conviction or plea of guilty is conclusive evidence of the violation.
	v. 	Having certification to practice emergency medical care suspended or revoked or having other disciplinary action taken by a licensing or certifying authority of this state or another state, territory or country. A copy of the record or order of suspension, revocation or disciplinary action is conclusive or prima facie evidence.
	w. 	Falsifying certification renewal reports or failure to comply with the renewal audit request.
	x. 	Acceptance of any fee by fraud or misrepresentation.
	y. 	Repeated failure to comply with standard precautions for preventing transmission of infectious diseases as issued by the Centers for Disease Control and Prevention of the United States Department of Health and Human Services.
	z. 	Violating privacy and confidentiality. An emergency medical care provider shall not disclose or be compelled to disclose patient information unless disclosure is required or authorized by law.
	aa. 	Discrimination. An emergency medical care provider shall not practice, condone, or facilitate discrimination against a patient, student, or any other individual encountered while acting as certified as an emergency medical care provider in the state of Iowa on the basis of race, ethnicity, national origin, color, sex, sexual orientation, age, marital status, political belief, religion, mental or physical disability, diagnosis, or social or economic status.
	ab. 	Practicing emergency medical services or using a designation of certification or otherwise holding oneself out as practicing emergency medical services at a certain level of certification when the emergency medical care provider is not certified at such level.
	ac. 	Failure to respond within 30 days of receipt, unless otherwise specified, to communication from the department which was sent by registered or certified mail.
[ARC 5143C, IAB 8/12/20, effective 9/16/20; ARC 5528C, IAB 3/24/21, effective 4/28/21]
641—131.8(147A) Certification denial.
	131.8(1) An individual who has been denied certification by the department may appeal the denial and request a hearing on the issues related to the licensure denial by serving a notice of appeal and request for hearing upon the department not more than 20 days following the date of mailing of the notification of certification denial to the individual. The request for hearing shall specifically delineate the facts to be contested at hearing.
	131.8(2) All hearings held pursuant to this rule shall be held pursuant to the process outlined in this chapter.
[ARC 5143C, IAB 8/12/20, effective 9/16/20]
641—131.9(147A) Emergency adjudicative proceedings. To the extent necessary to prevent or avoid immediate danger to the public health, safety or welfare and consistent with the Constitution and other provisions of law, the department may issue a written order in compliance with Iowa Code section 17A.18 to suspend a certificate in whole or in part, order the cessation of any continuing activity, order affirmative action, or take other action within the jurisdiction of the department by emergency adjudicative order.
	131.9(1) Before issuing an emergency adjudicative order, the department shall consider factors including, but not limited to, the following:
	a. 	Whether there has been a sufficient factual investigation to ensure that the department is proceeding on the basis of reliable information;
	b. 	Whether the specific circumstances which pose immediate danger to the public health, safety or welfare have been identified and determined to be continuing;
	c. 	Whether the individual required to comply with the emergency adjudicative order may continue to engage in other activities without posing immediate danger to the public health, safety or welfare;
	d. 	Whether imposition of monitoring requirements or other interim safeguards would be sufficient to protect the public health, safety or welfare; and
	e. 	Whether the specific action contemplated by the department is necessary to avoid the immediate danger.
	131.9(2) Issuance of order.
	a. 	An emergency adjudicative order shall contain findings of fact, conclusions of law, and policy reasons to justify the determination of an immediate danger in the department’s decision to take immediate action. The order is a public record.
	b. 	The written emergency adjudicative order shall be immediately delivered to the individual who is required to comply with the order. Delivery shall be made by one or more of the following procedures:
	(1)	Personal delivery.
	(2)	Certified mail, return receipt requested, to the last address on file with the department.
	(3)	Fax. Fax may be used as the sole method of delivery if the individual required to comply with the order has filed a written request that agency orders be sent by fax and has provided a fax number for that purpose.
	c. 	To the degree practicable, the department shall select the procedure for providing written notice that best ensures prompt, reliable delivery.
	d. 	Unless the written emergency adjudicative order is provided by personal delivery on the same day that the order issues, the department shall make reasonable immediate efforts to contact by telephone the individual who is required to comply with the order.
	e. 	After the issuance of an emergency adjudicative order, the department shall proceed as quickly as feasible to complete any proceedings that would be required if the matter did not involve an immediate danger.
	f. 	Issuance of a written emergency adjudicative order shall include notification of the date on which department proceedings are scheduled for completion. After issuance of an emergency adjudicative order, continuance of further department proceedings to a later date will be granted only in compelling circumstances upon application in writing unless the individual who is required to comply with the order is the party requesting the continuance.
[ARC 5143C, IAB 8/12/20, effective 9/16/20]
641—131.10(147A) Complaints, investigations and appeals.
	131.10(1) This rule is not subject to waiver pursuant to 641—Chapter 178 or any other provision of law.
	131.10(2) All complaints regarding emergency medical care personnel, training programs or continuing education providers, or those purporting to be or operating as the same, shall be reported to the department in writing. The address is Iowa Department of Public Health, Bureau of Emergency and Trauma Services, Lucas State Office Building, Des Moines, Iowa 50319-0075.
	131.10(3) An emergency medical care provider who has knowledge of an emergency medical care provider or service program that has violated Iowa Code chapter 147A, 641—Chapter 132 or these rules shall report such information to the department.
	131.10(4) Complaint investigations may result in the department’s issuance of a notice of denial, citation and warning, probation, suspension or revocation.
	131.10(5) A determination of mental incompetence by a court of competent jurisdiction automatically suspends a certificate for the duration of the certificate unless the department orders otherwise.
	131.10(6) Notice of denial, issuance of a citation and warning, probation, suspension or revocation shall be affected in accordance with the requirements of Iowa Code section 17A.12. Notice to the alleged violator of denial, probation, suspension or revocation shall be served by certified mail, return receipt requested, or by personal service.
	131.10(7) Any request for a hearing concerning the denial, citation and warning, probation, suspension or revocation shall be submitted by the aggrieved party in writing to the department by certified mail, return receipt requested, within 20 days of the receipt of the department’s notice to take action. The address is Iowa Department of Public Health, Bureau of Emergency and Trauma Services, Lucas State Office Building, Des Moines, Iowa 50319-0075. If the request is made within the 20-day time period, the notice to take action shall be deemed to be suspended pending the hearing. Prior to or at the hearing, the department may rescind the notice upon satisfaction that the reason for the denial, citation and warning, probation, suspension or revocation has been or will be removed. If no request for a hearing is received within the 20-day time period, the department’s notice of denial, citation and warning, probation, suspension or revocation shall become the department’s final agency action.
	131.10(8) Upon receipt of a request for hearing, the department shall forward the request within five working days to the department of inspections and appeals pursuant to the rules adopted by that agency regarding the transmission of contested cases. The information upon which the adverse action is based and any additional information which may be provided by the aggrieved party shall also be provided to the department of inspections and appeals.
	131.10(9) The hearing shall be conducted according to the procedural rules of the department of inspections and appeals found in 481—Chapter 10.
	131.10(10) When the administrative law judge makes a proposed decision and order, it shall be served by certified mail, return receipt requested, or delivered by personal service. That proposed decision and order then becomes the department’s final agency action without further proceedings ten days after it is received by the aggrieved party unless an appeal to the director is taken as provided in subrule 131.10(11).
	131.10(11) Any appeal to the director for review of the proposed decision and order of the administrative law judge shall be filed in writing and mailed to the director by certified mail, return receipt requested, or delivered by personal service within ten days after the receipt of the administrative law judge’s proposed decision and order by the aggrieved party. A copy of the appeal shall also be mailed to the administrative law judge. Any request for an appeal shall state the reason for appeal.
	131.10(12) Upon receipt of an appeal request, the administrative law judge shall prepare the record of the hearing for submission to the director. The record shall include the following:
	a. 	All pleadings, motions, and rules.
	b. 	All evidence received or considered and all other submissions by recording or transcript.
	c. 	A statement of all matters officially noticed.
	d. 	All questions and offers of proof, objections and rulings on them.
	e. 	All proposed findings and exceptions.
	f. 	The proposed decision and order of the administrative law judge.
	131.10(13) The decision and order of the director becomes the department’s final agency action upon receipt by the aggrieved party and shall be delivered by certified mail, return receipt requested, or by personal service.
	131.10(14) It is not necessary to file an application for a rehearing to exhaust administrative remedies when appealing to the director or the district court as provided in Iowa Code section 17A.19. The aggrieved party to the final agency action of the department who has exhausted all administrative remedies may petition for judicial review of that action pursuant to Iowa Code chapter 17A.
	131.10(15) Any petition for judicial review of a decision and order shall be filed in the district court within 30 days after the decision and order becomes final. A copy of the notice of appeal shall be sent to the department by certified mail, return receipt requested, or by personal service. The address is Iowa Department of Public Health, Bureau of Emergency and Trauma Services, Lucas State Office Building, Des Moines, Iowa 50319-0075.
	131.10(16) The party who appeals a final agency action to the district court shall pay the cost of the preparation of a transcript of the contested case hearing for the district court.
	131.10(17) Final decisions of the department relating to disciplinary proceedings may be transmitted to the appropriate professional associations, the news media or employer.
[ARC 5143C, IAB 8/12/20, effective 9/16/20; ARC 5528C, IAB 3/24/21, effective 4/28/21]
These rules are intended to implement Iowa Code chapters 147A and 147D and section 272C.4.
[Filed 1/20/00, Notice 12/1/99—published 2/9/00, effective 3/15/00]
[Filed emergency 9/14/00—published 10/4/00, effective 9/14/00]
[Filed 1/10/02, Notice 11/28/01—published 2/6/02, effective 3/13/02]
[Filed 1/13/05, Notice 11/24/04—published 2/2/05, effective 3/9/05]
[Filed emergency 7/13/05 after Notice 6/8/05—published 8/3/05, effective 7/13/05]
[Filed 7/12/06, Notice 5/24/06—published 8/2/06, effective 9/6/06]
[Filed emergency 11/8/06—published 12/6/06, effective 1/1/07]
[Filed 1/10/07, Notice 12/6/06—published 1/31/07, effective 3/7/07]
[Filed 7/13/07, Notice 5/23/07—published 8/1/07, effective 9/5/07]
[Filed 5/14/08, Notice 3/26/08—published 6/4/08, effective 7/9/08]
[Filed 11/12/08, Notice 9/24/08—published 12/3/08, effective 1/7/09]
[Filed ARC 8230B (Notice ARC 7969B, IAB 7/15/09), IAB 10/7/09, effective 11/11/09]
[Filed ARC 8660B (Notice ARC 8497B, IAB 1/27/10), IAB 4/7/10, effective 5/12/10]
[Filed ARC 9443B (Notice ARC 9342B, IAB 1/26/11), IAB 4/6/11, effective 8/1/11]
[Filed ARC 0062C (Notice ARC 0002C, IAB 2/8/12), IAB 4/4/12, effective 5/9/12]
[Filed ARC 0480C (Notice ARC 0377C, IAB 10/3/12), IAB 12/12/12, effective 1/16/13]
[Filed ARC 1404C (Notice ARC 1292C, IAB 1/22/14), IAB 4/2/14, effective 5/7/14]
[Filed ARC 2277C (Notice ARC 2150C, IAB 9/16/15), IAB 12/9/15, effective 1/13/16]
[Filed ARC 2767C (Notice ARC 2628C, IAB 7/20/16), IAB 10/12/16, effective 11/16/16]
[Filed ARC 5143C (Notice ARC 4857C, IAB 1/15/20), IAB 8/12/20, effective 9/16/20]
[Editorial change: IAC Supplement 11/18/20]
[Filed ARC 5528C (Notice ARC 5271C, IAB 11/18/20), IAB 3/24/21, effective 4/28/21]