CHAPTER 12
REGISTERED NURSE CERTIFYING ORGANIZATIONS/
UTILIZATION AND COST CONTROL REVIEW
655—12.1(509,514,514B,514F) Purpose. The following chapter is promulgated for the purpose of administering the provisions of Iowa Code sections 509.3, 514.7, 514B.1 and 514F.1.
655—12.2(509,514,514B,514F) Definition. A “certified registered nurse” is a registered nurse with current active licensure in Iowa who possesses evidence of certification by a national certification organization or successor agency as recognized by the board in this rule.
655—12.3(509,514,514B) National certifying organizations. The national certifying organizations identified by the board pursuant to Iowa Code sections 509.3, 514.7, 514B.1, and 514F.1 are as follows:
	1.	American Association of Critical Care Nurses Certification Corporation.
	2.	American Association for Marriage and Family Therapy.
	3.	American Association of Spinal Cord Injury Nursing.
	4.	American Board of Medical Genetics.
	5.	American Board of Neuroscience Nursing.
	6.	American Board for Occupational Health Nurses, Inc.
	7.	American Board of Post Anesthesia Nursing Certification, Inc.
	8.	American Board of Urologic Allied Health Professionals, Inc.
	9.	American College of Nurse-Midwives, ACNM Certification Council (ACC).
	10.	American Nurses’ Association, American Nurses’ Credentialing Center.
	11.	American Society for Psychoprophylaxis in Obstetrics.
	12.	American Society of Plastic and Reconstructive Surgical Nurses, Inc.
	13.	Association for Practitioners in Infection Control.
	14.	Rehabilitation Nursing, Certification Board.
	15.	Board of Certification for Emergency Nursing.
	16.	Board of Nephrology Examiners, Nursing and Technology.
	17.	Certifying Council for Gastroenterology Clinicians, Inc.
	18.	Council on Certification of Nurse Anesthetists.
	19.	Council on Recertification of Nurse Anesthetists.
	20.	Enterostomal Therapy Nursing Certification Board.
	21.	International Association of Infant Massage Instructors.
	22.	International Board of Lactation Consultant Examiners.
	23.	Intravenous Nurses Society Certification Corporation.
	24.	National Board for Certification of School Nurses.
	25.	National Board of Nutrition Support Certification.
	26.	National Certification Board of Pediatric Nurse Practitioners and Nurses.
	27.	National Certification Board, Perioperative Nursing, Inc.
	28.	National Certifying Board for Ophthalmic Registered Nurses.
	29.	National Consortium of Chemical Dependency Nurses.
	30.	National Education Committee of the Oncology Nursing Society. Rescinded IAB 1/6/93, effective 2/10/93.
	31.	National Nurses Society of Addictions.
	32.	Nephrology Nursing Certification Board.
	33.	National Certification Corporation for the Obstetric, Gynecologic and Neonatal Nursing Specialties.
	34.	Oncology Nursing Certification Corporation.
	35.	Orthopedic Nurses Certification Board.
	36.	Plastic Surgical Nursing Certification Board.
655—12.4(514F) Utilization and cost control review (U.C.C.R.) committee. The board shall establish a U.C.C.R. committee for the purpose of providing a mechanism for review of questions related to:
	1.	Appropriateness of levels of nursing care.
	2.	Documentation of the credentials of the nurse(s) offering the service(s).
	3.	Documentation of the care provided.
	4.	Documentation of the costs of nursing services provided by certified registered nurses as requested by users and payers of such services.
655—12.5(514F) Selection and composition of the U.C.C.R. committee.
	12.5(1) The U.C.C.R. committee shall consist of seven licensed registered nurses, four of whom shall be certified registered nurses. A quorum of the U.C.C.R. committee is two-thirds of the membership. When a quorum is present, a position is carried by a majority of the committee members.
	12.5(2) The members of the U.C.C.R. committee shall serve three-year terms; however, the initial committee will have staggered terms with two members appointed for one year, two members appointed for two years and three members appointed for three years.
	12.5(3) The chairperson of the Iowa board of nursing shall appoint the committee members, designate a chairperson and a secretary, subject to approval by the board, at the first meeting following the organizational meeting each year.
	12.5(4) Members of the U.C.C.R. committee shall:
	a. 	Have been actively practicing nursing in Iowa for a period of five years immediately prior to their appointment.
	b. 	Hold a current Iowa registered nurse license.
	c. 	Be actively involved in nursing practice during the term of appointment.
	d. 	Not be exempt from mandatory disclosure requirements of Iowa Code section 272C.9.
	e. 	Not be civilly liable when functioning in their capacity of committee members in compliance with Iowa Code section 272C.8.
	f. 	Observe the requirements of confidentiality imposed by Iowa Code subsection 272C.6(4). For the purposes of this subsection, all information requested by or provided to the U.C.C.R. committee under this chapter shall be considered privileged and confidential complaint or investigative information. However, the final decision of the U.C.C.R. committee shall not be considered confidential.
655—12.6(514F) Scope of review.
	12.6(1) Factors to determine appropriateness of nursing care deemed medically necessary shall include, but not be limited to, the following:
	a. 	Utilization of the nursing process in establishing a nursing diagnosis.
	b. 	Development of a nursing care plan based on documentation of client needs and standards of care for that particular clinical specialty.
	c. 	Adequate completion of recommended nursing care plan.
	d. 	Quality of care as measured by outcome.
	e. 	Proper referral to specialists/physicians when conditions indicate.
	12.6(2) Cost review shall result in an opinion as to the fairness of charges for nursing care services based on criteria which shall include, but not be limited to, the following:
	a. 	The nurse’s usual charge for the service.
	b. 	The customary charge for the service based on a review of peer group charges.
	c. 	Reasonable variance due to degree of difficulty factors which require extraordinary skill and judgment.
655—12.7(514F) Procedures for utilization and cost control review.
	12.7(1) A request for review may be made to the committee by a patient, a licensee or any third party payer of health care benefits.
	12.7(2) The fee for a utilization and cost control review will be $50 per individual patient review, made payable to the secretary of the U.C.C.R. committee at the time of the request. Such funds are to be used to pay expenses as deemed appropriate by the U.C.C.R. committee.
	12.7(3) A request for review shall be submitted to the committee by addressing the request to the U.C.C.R. Committee, Iowa Board of Nursing, Executive Hills East, 1223 East Court Avenue, Des Moines, Iowa 50319. All requests shall be made on the approved forms. Forms will be made available upon request from the office of the board of nursing. All references to identification and location of the licensee shall be deleted prior to submission to the U.C.C.R. committee. The request will be forwarded by the office of the board to the chairperson of the U.C.C.R. committee who may assign a three-person subcommittee to review the case and issue an opinion. The subcommittee shall include at least one certified registered nurse.
	12.7(4) The office of the Iowa board of nursing shall provide administrative services to the U.C.C.R. committee. The U.C.C.R. subcommittee shall respond in writing with its findings and recommendations within 90 days of the request to the chairperson of the U.C.C.R. committee, who, in turn, shall submit to the executive director of the Iowa board of nursing the results of the review or opinion. The executive director of the Iowa board of nursing shall notify the parties of the committee findings.
	12.7(5) The chairperson of the U.C.C.R. committee shall issue a report to the board every six months summarizing the activities of the committee which shall include a signed report by the secretary indicating receipts and expenditures of the committee.
	12.7(6) If the U.C.C.R. committee, by way of its review of the matter, determines that the matter constitutes possible violation of the Iowa practice of nursing Act (Iowa Code chapter 152), the chairperson of the committee shall immediately notify the board of nursing and submit a copy of the review findings. The board has authority to further investigate and pursue disciplinary action based on any information submitted pursuant to these rules.
	12.7(7) Action of the U.C.C.R. committee does not constitute an action of the board.
These rules are intended to implement Iowa Code sections 509.3, 514.7, 514B.1, and 514F.1.
[Filed 4/11/90, Notice 1/10/90—published 5/2/90, effective 6/6/90]
[Filed 10/10/90, Notice 8/22/90—published 10/31/90, effective 12/5/90]
[Filed 12/9/92, Notice 10/14/92—published 1/6/93, effective 2/10/93]