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 an active license in Iowa or who is currently licensed in another state and recognized for licensure in Iowa, pursuant to the nurse licensure compact contained in Iowa Code chapter 152E, and who possesses evidence of certification by a national certification organization or successor agency as recognized by the board in 655—12.3(509,514,514B).
655—12.3(509,514,514B) National certifying organizations. Eligibility requirements for certification are established by the individual national certifying organization. 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:
Addictions Nursing Certification Board
American Academy of Nurse Practitioners
American Association of Critical Care Nurses Certification Corporation
American Association for Marriage and Family Therapy
American Board of Medical Genetics
American Board of Neuroscience Nursing
American Board for Occupational Health Nurses, Inc.
American Board of Post Anesthesia Nursing Certification, Inc.
American Board of Urologic Allied Health Professionals, Inc.
American College of Nurse-Midwives, ACNM Certification Council
American Holistic Nurses’ Certification Corporation
American Nurses’ Credentialing Center
American Society of Plastic and Reconstructive Surgical Nurses, Inc.
Association of Operating Room Nurses
Association for Practitioners in Infection Control
Association of Rehabilitation Nursing, Certification Board
Board of Certification for Emergency Nursing
Board of Nephrology Examiners, Nursing and Technology
Certification Board of Perioperative Nursing
Certifying Council for Gastroenterology Clinicians, Inc.
Clinical Nutrition Certification Board
Council on Certification of Nurse Anesthetists
Council on Recertification of Nurse Anesthetists
Dermatology Nurses Association
Enterostomal Therapy Nursing Certification Board
HIV/AIDS Nursing Certification Board
International Association of Infant Massage Instructors
International Board of Lactation Consultant Examiners
International Nurses Society on Addictions
Intravenous Nurses Society Certification Corporation
Lamaze International
National Board for Certification of School Nurses
National Certification Board of Diabetes Educators
National Certification Board of Pediatric Nurse Practitioners and Nurses
National Certification Corporation for the Obstetric, Gynecologic and Neonatal Nursing Specialties
National Certifying Board for Ophthalmic Registered Nurses
National Consortium of Chemical Dependency Nurses
Oncology Nursing Certification Corporation
Orthopaedic Nurses Certification Board
Plastic Surgical Nursing Certification Board
Radiological Nursing Certification Board
Society of Gastroenterology Nurses and Associates
Society of Otorhinolaryngology and Head-Neck Nurses
Society of Urological Nurses and Associates
Society of Vascular Nursing
Wound, Ostomy and Continence Nurses Society
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 five licensed registered nurses, three of whom shall be certified registered nurses. A quorum of the U.C.C.R. committee is three members. When a quorum is present, a position is carried by a majority of the committee members.
	12.5(2) The chairperson of the board of nursing, upon receipt of a request for review, shall appoint committee members and designate a chairperson and a secretary.
	12.5(3) 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 an active Iowa registered nurse license or hold a current license in another state and be recognized for licensure in Iowa pursuant to the nurse licensure compact contained in Iowa Code chapter 152E.
	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 board 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 board by addressing the request to the Iowa Board of Nursing, RiverPoint Business Park, 400 S.W. Eighth Street, Suite B, Des Moines, Iowa 50309-4685. 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.
	12.7(4) The office of the board of nursing shall provide administrative services to the U.C.C.R. committee. The U.C.C.R. committee shall present its findings and recommendations in writing to the chairperson of the board within 90 days of the committee appointment. The executive director of the board of nursing shall notify the parties of the committee findings.
	12.7(5) 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(6) 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]
[Filed 9/28/01, Notice 6/27/01—published 10/17/01, effective 11/21/01]