CHAPTER 9
PERMANENT PHYSICIAN LICENSURE
[Prior to 5/30/01, see 653—Chapter 11]
653—9.1(147,148) Definitions.
“ABMS” means the American Board of Medical Specialties, which is an umbrella organization for at least 24 medical specialty boards in the United States that assists the specialty boards in developing and implementing educational and professional standards to evaluate and certify physician specialists in the United States. The board recognizes specialty board certification by ABMS.
“ACGME” means the Accreditation Council for Graduate Medical Education, an accreditation body that is responsible for accreditation of post-medical school training programs in medicine and surgery in the United States of America. The board approves resident training programs accredited by ACGME.
“AMA” means the American Medical Association, a professional organization of physicians and surgeons.
“Any jurisdiction” means any state, the District of Columbia or territory of the United States of America or any other nation.
“Any United States jurisdiction” means any state, the District of Columbia or territory of the United States of America.
“AOA” means the American Osteopathic Association, which is the representative organization for osteopathic physicians (D.O.s) in the United States. The board approves osteopathic medical education programs with AOA accreditation; the board approves AOA-accredited resident training programs in osteopathic medicine and surgery at hospitals for graduates of accredited osteopathic medical schools. The board recognizes specialty board certification by AOA. The board recognizes continuing medical education accredited by the Council on Continuing Medical Education of AOA.
“Applicant” means a person who seeks authorization to practice medicine and surgery or osteopathic medicine and surgery in this state by making application to the board.
“Approved abuse education training program” means a training program using a curriculum approved by the abuse education review panel of the department of public health or a training program offered by a hospital, a professional organization for physicians, or the department of human services, the department of education, an area education agency, a school district, the Iowa law enforcement academy, an Iowa college or university, or a similar state agency.
“Board” means Iowa board of medicine.
“Board-approved resident training program” means a hospital-affiliated graduate medical education program accredited by ACGME, AOA, RCPSC, or CFPC at the time the applicant is enrolled in the program.
“Candidate” means a person who applies to sit for an examination administered by the board or its designated testing service.
“Category 1 activity” means any formal education program which is sponsored or jointly sponsored by an organization accredited for continuing medical education by the Accreditation Council for Continuing Medical Education, the Iowa Medical Society, or the Council on Continuing Medical Education of AOA that is of sufficient scope and depth of coverage of a subject area or theme to form an educational unit and is planned, administered and evaluated in terms of educational objectives that define a level of knowledge or a specific performance skill to be attained by the physician completing the program. Activities designated as formal cognates by the American College of Obstetricians and Gynecologists or as prescribed credit by the American Academy of Family Physicians are accepted as equivalent to category 1 activities.
“CFPC” means the College of Family Physicians of Canada, an organization that accredits graduate medical education in family practice in Canada.
“COMLEX” means the Comprehensive Osteopathic Medical Licensing Examination that is recognized by the board as the licensure examination that replaced the NBOME examination for graduates of osteopathic medical schools or colleges.
“Committee” means the licensure and examination committee of the board.
“COMVEX-USA” means the Comprehensive Osteopathic Medical Variable-Purpose Examination for the United States of America. The National Board of Osteopathic Medical Examiners prepares the examination and determines its passing score. A licensing authority in any jurisdiction administers the examination. COMVEX-USA is the current evaluative instrument offered to osteopathic physicians who need to demonstrate current osteopathic medical knowledge.
“Current, active status” means a license that is in effect and grants the privilege of practicing medicine and surgery or osteopathic medicine and surgery, as applicable.
“ECFMG” means the Educational Commission for Foreign Medical Graduates, an organization that assesses the readiness of foreign medical school graduates to enter ACGME-approved residency programs in the United States of America.
“FCVS” means the Federation Credentials Verification Service, a service under the Federation of State Medical Boards that verifies and stores core credentials for retrieval whenever needed.
“FLEX” means the Federation Licensing Examination, a licensure examination used in the past that was approved by the board for graduates with a medical degree.
“Foreign medical school,” also known as an “international medical school,” means a medical school that is located outside of any United States jurisdiction.
“FSMB” means the Federation of State Medical Boards, the organization of medical boards of the United States of America.
“Inactive license” means any license that is not in current, active status. Inactive license may include licenses formerly known as delinquent, lapsed, or retired. A physician whose license is inactive continues to hold the privilege of licensure in Iowa but may not practice medicine under an Iowa license until the license is reinstated to current, active status.
“Incidentally called into this state in consultation with a physician and surgeon licensed in this state” as set forth in Iowa Code section 148.2(5) means all of the following shall be true:
	1.	The consulting physician shall be involved in the care of patients in Iowa only at the request of an Iowa-licensed physician.
	2.	The consulting physician has a license in good standing in another United States jurisdiction.
	3.	The consulting physician provides expertise and acts in an advisory capacity to an Iowa-licensed physician. The consulting physician may examine the patient and advise an Iowa-licensed physician as to the care that should be provided, but the consulting physician may not personally perform procedures, write orders, or prescribe for the patient.
	4.	The consulting physician practices in Iowa for a period not greater than 10 consecutive days and not more than 20 total days in any calendar year. Any portion of a day counts as one day.
	5.	The Iowa-licensed physician requesting the consultation retains the primary responsibility for the management of the patient’s care.
“Initial license” means the first permanent license granted to a qualified individual.
“International medical school,” also known as a “foreign medical school,” means a medical school that is located outside of any United States jurisdiction.
“LCME” means Liaison Committee on Medical Education, an organization that accredits educational institutions granting degrees in medicine and surgery. The board approves programs that are accredited by LCME.
“LMCC” means enrollment in the Canadian Medical Register as Licentiate of Medical Council of Canada with a certificate of registration as proof. LMCC requires passing the Medical Council of Canada Examination.
“Mandatory training for identifying and reporting abuse” means training on identifying and reporting child abuse or dependent adult abuse required of physicians who regularly provide primary health care to children or adults, respectively. The full requirements on mandatory reporting of child abuse and the training requirements are found in Iowa Code section 232.69; the full requirements on mandatory reporting of dependent adult abuse and the training requirements are found in Iowa Code section 235B.16.
“Medical degree” means a degree of doctor of medicine and surgery or osteopathic medicine and surgery or comparable education from a foreign medical school.
“National Practitioner Data Bank” is a national data bank of disciplinary actions taken against health professionals, including physicians.
“NBME” means the National Board of Medical Examiners, an organization that prepares and administers qualifying examinations, either independently or jointly with other organizations.
“NBOME” means the National Board of Osteopathic Medical Examiners, an organization that prepares and administers qualifying examinations for osteopathic physicians.
“Observer” means a person who is not enrolled in an Iowa medical school or osteopathic medical school, who observes care to patients in Iowa for a defined period of time and for a noncredit experience, and who is supervised and accompanied by an Iowa-licensed physician as defined in 9.2(3). An observer shall not provide or direct hands-on patient care, regardless of the observer’s level of training or supervision. The supervising physician may authorize an observer to read a chart, observe a patient interview or examination, or witness procedures, including surgery. An observer shall not chart; touch a patient as part of an examination; conduct an interview; order, prescribe or administer medications; make decisions that affect patient care; direct others in providing patient care; or conduct procedures, including surgery. Any of these activities requires licensure to practice in Iowa. An unlicensed physician observer or a medical student observer may touch a patient to verify a physical finding in the immediate presence of a physician but shall not conduct a more inclusive physical examination.
An unlicensed physician observer may:
	1.	Participate in discussions regarding the care of individual patients, including offering suggestions about diagnosis or treatment, provided the unlicensed physician observer does not direct the care; and
	2.	Elicit information from a patient provided the unlicensed physician observer does not actually perform a physical examination or otherwise touch the patient.
“Permanent licensure” means licensure granted after review of the application and credentials to determine that the individual is qualified to enter into practice. The individual may only practice when the license is in current, active status.
“Practice” means the practice of medicine and surgery or osteopathic medicine and surgery.
“RCPSC” means the Royal College of Physicians and Surgeons of Canada, an organization that accredits graduate medical education in Canada.
“Reinstatement” means the process for returning an inactive license to current, active status.
“Resident physician” means a physician enrolled in an internship, residency or fellowship.
“Resident training program” means a hospital-affiliated graduate medical education program that enrolls interns, residents or fellows and may be referred to as a postgraduate training program for purposes of licensure.
“Service charge” means the amount charged for making a service available on line and is in addition to the actual fee for a service itself. For example, one who renews a license on line will pay the license renewal fee and a service charge.
“SPEX” means Special Licensure Examination prepared by the Federation of State Medical Boards and administered by a licensing authority in any jurisdiction. The passing score on SPEX is 75.
“USMLE” means the United States Medical Licensing Examination.
653—9.2(147,148) General licensure provisions.
	9.2(1) Licensure required. Licensure is required for practice in Iowa as identified in Iowa Code section 148.1; the exceptions are identified in subrule 9.2(2). Provisions for permanent physician licensure are found in this chapter; provisions for resident, special and temporary physician licensure are found in 653—Chapter 10.
	9.2(2) Licensure not required. The following persons are not required to obtain a license to practice in Iowa:
	a. 	Those persons described in Iowa Code sections 148.2(1) to 148.2(5).
	(1)	A medical student or osteopathic medical student in an international medical school may not take on the role of a medical student in the patient care setting unless enrolling in the University of Iowa’s Carver College of Medicine or in Des Moines University’s College of Osteopathic Medicine; however, an international medical student not enrolled at either of these institutions may be an observer as defined in rule 9.1(147,148).
	(2)	A graduate of an international medical school shall not practice medicine without an Iowa medical license; however, the graduate may be an observer as defined in rule 9.1(147,148).
	b. 	Those persons who are incidentally called into this state in consultation with a physician or surgeon licensed in this state as described in Iowa Code section 148.2(5) and as defined in rule 9.1(147,148).
	c. 	Physicians and surgeons who hold a current, active license in good standing in another United States jurisdiction and who come into Iowa on a temporary basis to aid disaster victims at the time of a disaster in accordance with Iowa Code section 29C.6.
	d. 	Physicians and surgeons who hold a current, active license in good standing in another United States jurisdiction and who come to Iowa to participate in further medical education may participate in patient care under the request and supervision of the patient’s Iowa-licensed physician in charge of the education. The Iowa-licensed physician shall retain the primary responsibility for management of the patient’s care.
	e. 	Physicians and surgeons who hold a current, active license in good standing in another United States jurisdiction and who come into Iowa to serve as expert witnesses as long as they do not provide treatment.
	f. 	Physicians and surgeons from out of state who hold a current, active license in good standing in another United States jurisdiction and who accompany one or more individuals into Iowa for the purpose of providing medical care to these individuals on a short-term basis, e.g., a team physician for an out-of-state college football team that comes into Iowa for a game.
	g. 	Physicians and surgeons who come to Iowa to observe patient care and who do not provide or direct hands-on patient care.
	h. 	Visiting resident physicians who come to Iowa to practice as part of their resident training program if under the supervision of an Iowa-licensed physician. An Iowa physician license is not required of a physician in training if the physician has a resident or permanent license in good standing in the home state of the resident training program. An Iowa temporary license is required of a physician in training if the physician does not hold a resident or permanent physician license in good standing in the home state of the resident training program (see rule 653—10.5(147,148)).
	9.2(3) Supervision of an observer. An Iowa-licensed physician who supervises an observer shall accompany the observer and solicit consent from each patient, where feasible, for the observation. The physician shall inform the patient of the observer’s background, e.g., high school student considering a medical career, a medical graduate who is working on licensure. The supervising physician shall ensure that the observer remains within the scope of an observer as defined in rule 9.1(147,148).
653—9.3(147,148) Eligibility for permanent licensure.
	9.3(1) Requirements. To be eligible for permanent licensure, an applicant shall meet all of the following requirements:
	a. 	Fulfill the application requirements specified in rule 9.5(147,148).
	b. 	Be at least 21 years of age.
	c. 	Hold a medical degree from an educational institution approved by the board at the time the applicant graduated and was awarded the degree.
	(1)	Educational institutions approved by the board shall be fully accredited by an accrediting agency recognized by the board as schools of instruction in medicine and surgery or osteopathic medicine and surgery and empowered to grant academic degrees in medicine.
	(2)	The accrediting bodies currently recognized by the board are:
	1.	LCME for the educational institutions granting degrees in medicine and surgery; and
	2.	AOA for educational institutions granting degrees in osteopathic medicine and surgery.
	(3)	If the applicant holds a medical degree from an educational institution not approved by the board at the time the applicant graduated and was awarded the degree, the applicant shall meet one of the following requirements:
	1.	Hold a valid certificate issued by ECFMG;
	2.	Have successfully completed a fifth pathway program established in accordance with AMA criteria;
	3.	Have successfully passed either a basic science examination administered by a United States or Canadian medical licensing authority or SPEX; and have successfully completed three years of resident training in a program approved by the board; and have submitted evidence of five years of active practice without restriction as a licensee of any United States or Canadian jurisdiction; or
	4.	Have successfully passed either a basic science examination administered by a United States or Canadian medical licensing authority or SPEX; and hold board certification by a specialty board approved by ABMS or AOA; and submit evidence of five years of active practice without restriction as a licensee of any United States or Canadian jurisdiction.
	d. 	Have successfully completed one year of resident training in a hospital-affiliated program approved by the board at the time the applicant was enrolled in the program. Beginning July 1, 2006, an applicant who is a graduate of an international medical school shall have successfully completed 24 months of such training.
	(1)	For those required to have 12 months of training, the program shall have been 12 months of progressive training in not more than two specialties and in not more than two programs approved for resident training by the board. Beginning July 1, 2006, for those required to have 24 months of training, the program shall have been 24 months of progressive training in not more than two specialties and in not more than two programs approved for resident training by the board.
	(2)	Resident training approved by the board shall be accredited by an accrediting agency recognized by the board for the purpose of accrediting resident training programs.
	(3)	The board approves resident training programs accredited by:
	1.	ACGME;
	2.	AOA;
	3.	RCPSC; and
	4.	CFPC.
	(4)	The board shall accept each 12 months of practice as a special licensee as equivalent to one year of resident training in a hospital-affiliated program approved by the board.
	e. 	Pass one of the licensure examinations or combinations as prescribed in rule 9.4(147,148).
	9.3(2) Reserved.
653—9.4(147,148) Licensure examinations.
	9.4(1) Requirements. To be eligible for permanent licensure, an applicant shall meet one of the following requirements:
	a. 	An applicant who has never been licensed in any United States jurisdiction shall pass the USMLE, COMLEX, or Medical Council of Canada Examination as prescribed in this rule and authorize the testing authority to verify scores.
	b. 	An M.D. applicant who has been licensed in any United States jurisdiction shall meet the licensure examination requirements in effect in Iowa at the time of original licensure if the examination precedes USMLE. An M.D. applicant who has been licensed in any United States jurisdiction based on USMLE shall meet the requirements in subrule 9.4(2). The applicant shall authorize the appropriate testing authority to verify scores obtained on the examination as specified in this rule.
	c. 	A D.O. applicant who has been licensed in any United States jurisdiction shall meet the licensure examination requirements in effect in Iowa at the time of original licensure if the examination precedes USMLE or COMLEX, whichever is applicable. A D.O. applicant who has been licensed in any United States jurisdiction based on USMLE or COMLEX shall meet the requirements in subrule 9.4(2) or paragraph 9.4(6)“a,” respectively.
	9.4(2) USMLE.
	a. 	The USMLE is a joint program of FSMB and the NBME. The USMLE is a multipart examination consisting of Step 1, Step 2, and Step 3. Steps 1 and 2 are administered by NBME and ECFMG. The board contracts with FSMB for the administration of Step 3. USMLE Steps 1 and 2 were implemented in 1992; Step 3 was implemented in 1994.
	b. 	Since 1999, Step 3 is a computerized examination offered at testing centers in the Des Moines area and other Iowa locations.
	c. 	Applications are available at Department of Examination Services, FSMB, 400 Fuller Wiser Road, Suite 300, Euless, Texas 76039 or www.fsmb.org.
	d. 	Candidates who meet the following requirements are eligible to take USMLE Step 3:
	(1)	Submit a completed application form and pay the required examination fee as specified in 653—subrule 8.3(1).
	(2)	Document successful completion of USMLE Steps 1 and 2 in accordance with the requirements of NBME. Graduates of a foreign medical school shall meet the requirements of ECFMG.
	(3)	Document holding a medical degree from a board-approved educational institution. If a candidate holds a medical degree from an educational institution not approved by the board at the time the applicant graduated and was awarded the degree, the candidate shall meet the requirements specified in 9.3(1)“c”(3).
	(4)	Document successful completion of a minimum of seven calendar months of resident training in a program approved by the board at the time of the application for Step 3 or enrollment in a resident training program approved by the board at the time of the application for Step 3.
	e. 	The following conditions shall apply to applicants for licensure in Iowa who utilize USMLE as the licensure examination.
	(1)	Passing Steps 1, 2, and 3 is required within a ten-year period beginning with the date of passing either Step 1 or Step 2, whichever occurred first. Board certification by the ABMS or AOA is required if the applicant was not able to pass Steps 1, 2, and 3 within the required time as specified in this paragraph.
	(2)	Step 3 may be taken and passed only after Steps 1 and 2 are passed.
	(3)	A score of 75 or better on each step shall constitute a passing score on that step.
	(4)	Each USMLE step must be passed individually and individual step scores shall not be averaged to compute an overall score.
	(5)	A failure of any USMLE step, regardless of the jurisdiction for which it was taken, shall be considered a failure of that step for the purposes of Iowa licensure.
	(6)	Successful completion of a progressive three-year resident training program is required if the applicant passes the examination after more than six attempts on Step 1 or six attempts on Step 2 or three attempts on Step 3.
	f. 	Any candidate deemed eligible to sit for USMLE Step 3 is required to adhere to the examination procedures and protocol established by FSMB and NBME in the following publications: USMLE Test Administration Standards and Policies and Procedures Regarding Indeterminate Scores and Irregular Behavior, FSMB, 400 Fuller Wiser Road, Suite 300, Euless, Texas 76039.
	9.4(3) NBME.
	a. 	NBME Part Examinations (Parts I, II, and III) were first administered in 1916. The last regular administration of Part I occurred in 1991, Part II in April 1992, and Part III in May 1994.
	b. 	Successful completion of NBME Parts I, II, and III was a requirement for NBME certification.
	c. 	A score of 75 or better on each part shall constitute a passing score on that part.
	9.4(4) FLEX.
	a. 	From 1968 to 1985, (Old) FLEX was a three-day examination. Day 1 covered basic science; Day 2 covered clinical science; and Day 3 covered clinical competency. Applicants who took Old FLEX shall provide evidence of successful achievement of at least two of the following:
	(1)	Certification under seal that the applicant passed FLEX with a FLEX-weighted average of 75 percent or better, as determined by the state medical licensing authority, in no more than two sittings.
	(2)	Verification under seal of medical licensure in the state that administered the examination.
	(3)	Evidence of current certification by an American specialty board approved or recognized by the Council of Medical Education of AMA, ABMS, or AOA.
	b. 	From 1985 to 1994, (New) FLEX replaced the Old FLEX. New FLEX was a three-day nationally standardized examination consisting of two, one and one-half day components referred to as Component I (basic and clinical science principles and mechanisms underlying disease and modes of therapy) and Component II (knowledge and cognitive abilities required of a physician assuming independent responsibility for the general delivery of medical care to patients). The last regular administration of both components of New FLEX occurred in 1993. Two special administrations of New FLEX Component I were offered in 1994 to examinees who passed Component II but not Component I prior to 1994. To be eligible for permanent licensure, the candidate must have passed both components in Iowa with a FLEX score of 75 or better within a seven-year period beginning with the date of initial examination.
	(1)	Candidates who took the FLEX for the first time were required to take both components during the initial sitting. A candidate who failed either or both components must have repeated and passed the component failed, though Component II could only be repeated if the candidate had received a passing score of 75 percent or better on Component I.
	(2)	Eligible candidates were permitted to sit for the initial examination and reapply to the board to repeat a failed component or complete the entire examination two additional times. However, candidates who failed either or both components three times were required to wait one year, during which time the candidate was encouraged to obtain additional training, before being permitted to sit two additional times for either or both components of the FLEX.
	9.4(5) Combination examination sequences. To accommodate individuals who had already passed some part of the NBME Parts or FLEX before implementation of the USMLE, the USMLE program recommended and the board approved the following licensing combinations of examinations for licensure only if completed prior to January 1, 2000. These combinations are now only acceptable from an applicant who already holds a license from any United States jurisdiction.
	a. 	FLEX Component I plus USMLE Step 3 with a passing score of 75 or better on each examination;
	b. 	NBME Part I or USMLE Step 1 plus NBME Part II or USMLE Step 2 plus FLEX Component II with a passing score of 75 or better on each examination; or
	c. 	NBME Part I or USMLE Step 1 plus NBME Part II or USMLE Step 2 plus NBME Part III or USMLE Step 3 with a passing score of 75 or better on each examination.
	9.4(6) Examinations for graduates of board-approved colleges of osteopathic medicine and surgery.
	a. 	COMLEX.
	(1)	COMLEX is a three-level examination that replaced the three-part NBOME examination. COMLEX Level 3 was first administered in February 1995; Level 2 was first administered in March 1997; and Level 1 was first administered in June 1998. All three examinations must be successfully completed in sequential order within ten years of the successful completion of COMLEX Level 1. Board certification by the ABMS or AOA is required if the applicant was not able to pass Steps 1, 2, and 3 within the required time as specified in this paragraph.
	(2)	A standard score of 400 on Level 1 or Level 2 is required to pass the examination. A standard score of 350 on Level 3 is required to pass the examination.
	(3)	A candidate shall have successfully completed a minimum of seven calendar months of resident training in a program approved by the board at the time of the application for Level 3 or enrollment in a resident training program approved by the board at the time of the application for Level 3.
	(4)	Successful completion of a progressive three-year resident training program is required if the applicant passes the examination after more than six attempts on Level 1 or six attempts on Level 2 or three attempts on Level 3.
	(5)	Each COMLEX level must be passed individually, and individual level scores shall not be averaged to compute an overall score.
	(6)	Level 3 may be taken and passed only after Levels 1 and 2 are passed.
	(7)	A failure of any COMLEX level, regardless of the jurisdiction for which it was taken, shall be considered a failure of that level for the purposes of Iowa licensure.
	b. 	NBOME. The board accepts a passing score on the NBOME licensure examination for graduates of colleges of osteopathic medicine and surgery in any United States jurisdiction.
	(1)	NBOME was a three-part examination. All three parts must have been successfully completed in sequential order within seven years of the successful completion of NBOME Part 1.
	(2)	A passing score is required on each part of the examination.
	(3)	A candidate shall have successfully completed a minimum of seven calendar months of resident training in a program approved by the board at the time of the application for NBOME Part 3. Candidates shall have completed their resident training by the last day of the month in which the examination was taken.
	(4)	Successful completion of a three-year resident training program is required if the applicant passes the examination after more than six attempts on Part 1 or six attempts on Part 2 or three attempts on Part 3.
	(5)	Each NBOME part must have been passed individually, and individual part scores shall not be averaged to compute an overall score.
	(6)	Part 3 must have been taken and passed only after Parts 1 and 2 were passed.
	(7)	A failure of any NBOME part, regardless of the jurisdiction for which it was taken, shall be considered a failure of that part for the purposes of Iowa licensure.
	9.4(7) LMCC.
	a. 	The board accepts toward Iowa licensure a verification of a Licentiate’s registration with the Medical Council of Canada, based on passing the Medical Council of Canada Examination.
	b. 	The Medical Council of Canada may be contacted at P.O. Box/CP 8234, Station `T’, Ottawa, Ontario, Canada K1G 3H7 or (613)521-9417.
653—9.5(147,148) Permanent licensure application.
	9.5(1) Requirements. To apply for permanent licensure an applicant shall:
	a. 	Pay a nonrefundable initial application fee of $450 plus the fee identified in 653—subrule 8.4(7) for the evaluation of the fingerprint packet and the criminal history background checks by the Iowa division of criminal investigation (DCI) and the Federal Bureau of Investigation (FBI); and
	b. 	Complete and submit forms provided by the board, including required credentials, documents, a completed fingerprint packet, and a sworn statement by the applicant attesting to the truth of all information provided by the applicant. A completed fingerprint packet is not required if the applicant has held active physician licensure in Iowa within 12 months of applying for permanent licensure and fingerprinting was done prior to the issuance of that license.
	9.5(2) Application. The application shall require the following information:
	a. 	Name, date and place of birth, home address, mailing address and principal business address.
	b. 	A photograph of the applicant suitable for positive identification.
	c. 	A statement listing every jurisdiction in which the applicant is or has been authorized to practice, including license numbers and dates of issuance.
	d. 	A chronology accounting for all time periods from the date the applicant entered medical school to the date of the application.
	e. 	A certified statement of scores on any examination required in rule 9.4(147,148) that the applicant has taken in any jurisdiction. An official FCVS Physician Information Profile that supplies this information for the applicant is a suitable alternative.
	f. 	A photocopy of the applicant’s medical degree issued by an educational institution.
	(1)	A complete translation of any diploma not written in English shall be submitted. An official transcript, written in English and received directly from the school, showing graduation from medical school is a suitable alternative.
	(2)	An official FCVS Physician Information Profile that supplies this information for the applicant is a suitable alternative.
	(3)	If a copy of the medical degree cannot be provided because of extraordinary circumstances, the board may accept other reliable evidence that the applicant obtained a medical degree from a specific educational institution.
	g. 	A sworn statement from an official of the educational institution certifying the date the applicant received the medical degree and acknowledging what, if any, derogatory comments exist in the institution’s record about the applicant. If a sworn statement from an official of the educational institution cannot be provided because of extraordinary circumstances, the board may accept other reliable evidence that the applicant obtained a medical degree from a specific educational institution.
	h. 	An official transcript, or its equivalent, received directly from the school for every medical school attended. A complete translation of any transcript not written in English shall be submitted. An official FCVS Physician Information Profile that supplies this information for the applicant is a suitable alternative.
	i. 	If the educational institution awarding the applicant the degree has not been approved by the board, the applicant shall provide a valid ECFMG certificate or evidence of successful completion of a fifth pathway program in accordance with criteria established by AMA. An official FCVS Physician Information Profile that supplies this information for the applicant is a suitable alternative.
	j. 	Documentation of successful completion of resident training approved by the board as specified in paragraph 9.3(1)“d.” An official FCVS Physician Information Profile that supplies this information for the applicant is a suitable alternative.
	k. 	Verification of an applicant’s hospital and clinical staff privileges and other professional experience for the past five years.
	l. 	A statement disclosing and explaining any informal or nonpublic actions, warnings issued, investigations conducted, or disciplinary actions taken, whether by voluntary agreement or formal action, by a medical or professional regulatory authority, an educational institution, training or research program, or health facility in any jurisdiction.
	m. 	A statement of the applicant’s physical and mental health, including full disclosure and a written explanation of any dysfunction or impairment which may affect the ability of the applicant to engage in practice and provide patients with safe and healthful care.
	n. 	A statement disclosing and explaining the applicant’s involvement in civil litigation related to practice in any jurisdiction. Copies of the legal documents may be requested if needed during the review process.
	o. 	A statement disclosing and explaining any charge of a misdemeanor or felony involving the applicant filed in any jurisdiction, whether or not any appeal or other proceeding is pending to have the conviction or plea set aside.
	p. 	A completed fingerprint packet to facilitate a national criminal history background check. The fee for the evaluation of the fingerprint packet and the DCI and FBI criminal history background checks will be assessed to the applicant.
653—9.6(147,148) Permanent licensure application review process. The process below shall be utilized to review each application. Priority shall be given to processing a licensure application when a written request is received in the board office from an applicant whose practice will primarily involve provision of services to underserved populations, including but not limited to persons who are minorities or low-income or who live in rural areas.
	9.6(1) An application for initial licensure shall be considered open from the date the application form is received in the board office with the nonrefundable initial licensure fee.
	9.6(2) After reviewing each application, staff shall notify the physician about how to resolve any problems identified by the reviewer.
	9.6(3) If the final review indicates no questions or concerns regarding the applicant’s qualifications for licensure, staff may administratively grant the license. The staff may grant the license without having received a report on the applicant from the FBI.
	9.6(4) If the final review indicates questions or concerns that cannot be remedied by continued communication with the physician, the executive director, director of licensure and administration and director of legal affairs shall determine if the questions or concerns indicate any uncertainty about the applicant’s current qualifications for licensure.
	a. 	If there is no current concern, staff shall administratively grant the license.
	b. 	If any concern exists, the application shall be referred to the committee.
	9.6(5) Staff shall refer to the committee for review matters which include but are not limited to: falsification of information on the application, criminal record, malpractice, substance abuse, competency, physical or mental illness, or professional disciplinary history.
	9.6(6) If the committee is able to eliminate questions or concerns without dissension from staff or a committee member, the committee may direct staff to grant the license administratively.
	9.6(7) If the committee is not able to eliminate questions or concerns without dissension from staff or a committee member, the committee shall recommend that the board:
	a. 	Request an investigation;
	b. 	Request that the applicant appear for an interview;
	c. 	If the physician has not engaged in active practice in the past three years in any jurisdiction of the United States or Canada, require an applicant to:
	(1)	Successfully pass a competency evaluation approved by the board;
	(2)	Successfully pass SPEX, COMVEX-USA, or another examination approved by the board; or
	(3)	Successfully complete a retraining program arranged by the physician and approved in advance by the board;
	d. 	Grant a license;
	e. 	Grant a license under certain terms and conditions or with certain restrictions;
	f. 	Request that the applicant withdraw the licensure application; or
	g. 	Deny a license.
	9.6(8) The board shall consider applications and recommendations from the committee and shall:
	a. 	Request further investigation;
	b. 	Require that the applicant appear for an interview;
	c. 	If the physician has not engaged in active practice in the past three years in any jurisdiction of the United States or Canada, require an applicant to:
	(1)	Successfully pass a competency evaluation approved by the board;
	(2)	Successfully pass SPEX, COMVEX-USA, or another examination approved by the board; or
	(3)	Successfully complete a retraining program arranged by the physician and approved in advance by the board;
	d. 	Grant a license;
	e. 	Grant a license under certain terms and conditions or with certain restrictions;
	f. 	Request that the applicant withdraw the licensure application; or
	g. 	Deny a license. The board may deny a license for any grounds on which the board may discipline a license. The procedure for appealing a license denial is set forth in rule 9.15(147,148).
653—9.7(147,148) Licensure application cycle.
	9.7(1) Failure to submit application materials. If the applicant does not submit all materials, including a completed fingerprint packet, within 90 days of the board office’s last documented request for further information, the application shall be considered inactive. The board office shall notify the applicant of this change in status.
	9.7(2) Reactivation of the application. To reactivate the application, an applicant shall submit a nonrefundable reactivation of application fee of $150 and shall update credentials.
	a. 	The period for requesting reactivation is limited to 90 days from the date the applicant is notified that the application is inactive, unless the applicant is granted an extension in writing by the committee or the board.
	b. 	The period for reactivation of application shall extend 90 days from the date the request and fee are received in the board office. During this period, the applicant shall update credentials and submit the remaining requested materials unless granted an extension in writing by the committee or the board.
	c. 	Once the reactivation period expires, an applicant must reapply and submit a new nonrefundable application fee and a new application, documents and credentials. Beginning July 1, 2006, an applicant who holds a valid ECFMG certificate and who reapplies shall submit evidence of having successfully completed two years of postgraduate training as specified in paragraph 9.3(1)“d.”
653—9.8(147,148) Discretionary board actions on licensure applications. As circumstances warrant, the board may determine that any applicant for licensure is subject to the following:
	9.8(1) The board may impose limits or restrictions on the practice of any applicant once licensed in this state that are equal in force to the limits or restrictions imposed on the applicant by any jurisdiction.
	9.8(2) The board may defer final action on an application for licensure if there is an investigation or disciplinary action pending against an applicant in any jurisdiction until such time as the board is satisfied that licensure of the applicant poses no risk to the health and safety of Iowans.
	9.8(3) The board is not precluded from taking disciplinary action after licensure is granted related to issues that arose in the licensure application process.
653—9.9(147,148) Issuance of a permanent license.
	9.9(1) Issuance. Upon the granting of permanent licensure, staff shall issue an original license to practice that shall expire on the first day of the licensee’s birth month.
	a. 	Licenses of persons born in even-numbered years shall expire in an even-numbered year, and licenses of persons born in odd-numbered years shall expire in an odd-numbered year.
	b. 	The license shall not be issued for a period less than two months or greater than two years and two months, in accordance with the licensee’s month and year of birth.
	c. 	When a resident physician receives a permanent Iowa license, the resident physician license shall immediately become inactive.
	9.9(2) Display of license. The original permanent license shall be displayed in the licensee’s primary location of practice.
653—9.10(147,148) Notification required to change the board’s data system.
	9.10(1) Change of address. A licensee shall notify the board of any change in the home address or the address of the place of practice within one month of making an address change.
	9.10(2) Change of name. A licensee shall notify the board of any change in name within one month of making the name change. Notification requires a notarized copy of a marriage license or a notarized copy of court documents.
	9.10(3) Deceased. A licensee file shall be closed and labeled “deceased” when the board receives a copy of the physician’s death certificate.
653—9.11(147,148) Renewal of a permanent license.
	9.11(1) Renewal notice. Staff shall send a renewal notice by regular mail to each licensee at the licensee’s last-known address at least 60 days prior to the expiration of the license.
	9.11(2) Licensee obligation. The licensee is responsible for renewing the license prior to its expiration. Failure of the licensee to receive the notice does not relieve the licensee of responsibility for renewing that license.
	9.11(3) Renewal application requirements. A licensee seeking renewal shall submit a completed renewal application, including information on continuing education and mandatory training on identifying and reporting abuse, and the required fee, not later than the expiration date on the current license.
	a. 	The renewal fee is $550 if the renewal is made via paper application or $450 if the renewal is made via on-line application, per biennial period or a prorated portion thereof if the current license was issued for a period of less than 24 months.
	b. 	The requirements for continuing education and mandatory training on identifying and reporting abuse are found in 653—Chapter 11.
	c. 	The first renewal fee shall be prorated on a monthly basis according to the date of issuance and the physician’s month and year of birth, if the original permanent license was issued for a period of less than 24 months.
	9.11(4) Issuance of a renewal. Upon receiving the completed renewal application, staff shall administratively issue a two-year license that expires on the first day of the licensee’s birth month. In the event the board receives adverse information on the renewal application, the board shall issue the renewal license but may refer the adverse information for further consideration.
	9.11(5) Renewal penalties. If the licensee fails to submit the renewal application and fee by the expiration date on the current license, the licensee shall be charged a penalty fee of $50 for each month the renewal is in arrears, up to two months, or $100. For example, if the license expires on January 1, a penalty of $50 will be charged for renewal in January and an additional $50 or a total of $100 shall be charged for renewal in February.
	9.11(6) Failure to renew. Failure of the licensee to renew a license within two months following its expiration date shall cause the license to become inactive and invalid. A licensee whose license is invalid is prohibited from practice until the license is reinstated in accordance with rule 9.13(147,148).
	a. 	In order to ensure that the license will not become inactive when a paper renewal form is used, the completed renewal application and appropriate fees must be received in the board office by the fifteenth of the month prior to the month the license becomes inactive. For example, a licensee whose license expires on January 1 has until March 1 to renew the license or the license becomes inactive and invalid. The licensee must submit and the board office must receive the renewal materials prior to or on February 15 to ensure that the license will be renewed prior to becoming inactive and invalid on March 1.
	b. 	In order to ensure that the license will not become inactive when on-line renewal is used, the licensee must complete the on-line renewal prior to midnight of the last day of the month in the month after the expiration date on the license. For example, a licensee whose license expiration date is January 1 must complete the on-line renewal before midnight on the last day of February; the license becomes inactive and invalid at 12:01 a.m.	on March 1.
	9.11(7) Display of license. Renewal licenses shall be displayed along with the original permanent license in the primary location of practice.
653—9.12(147,148) Inactive status and reinstatement of a permanent license.
	9.12(1) Definition of inactive status. An inactive license is any license that is not a current, active license.
	a. 	“Inactive status” may include licenses formerly known as delinquent, lapsed, or retired.
	b. 	A physician with an inactive license may not practice medicine until the license is reinstated to current, active status.
	c. 	A physician whose license is inactive continues to hold the privilege of licensure in Iowa but may not practice medicine under an Iowa license until the license is reinstated to current, active status. A licensee who practices under an Iowa license when the license is inactive may be subject to disciplinary action by the board, injunctive action pursuant to Iowa Code section 147.83, criminal sanctions pursuant to Iowa Code section 147.86, or other available legal remedies.
	9.12(2) Mechanisms for becoming inactive. A licensee seeking to become inactive may do so by submitting a written request to the board office or by failing to renew a license by the first day of the third month after the expiration date. For example, a licensee whose license expires on January 1 will be considered inactive if the license is not renewed by March 1.
	9.12(3) Fee. There is no fee to become inactive.
653—9.13(147,148) Reinstatement of an unrestricted Iowa license.
	9.13(1) Reinstatement within one year of the license’s becoming inactive. An individual whose license is in inactive status for up to one year and who wishes to reinstate the license shall submit a completed renewal application, documentation of continuing education and mandatory training on identifying and reporting abuse, the renewal fee, and the reinstatement penalty. All of the information shall be received in the board office within one year of the license’s becoming inactive for the applicant to reinstate under this subrule. For example, a physician whose license became inactive on March 1 has until the last day of the following February to renew under this subrule.
	a. 	Fees for reinstatement within one year of the license’s becoming inactive. The reinstatement fee is $550 except when the license in the most recent license period had been granted for less than 24 months; in that case, the reinstatement fee is prorated according to the date of issuance and the physician’s month and year of birth.
	b. 	Continuing education and mandatory training requirements. The requirements for continuing education and mandatory training on identifying and reporting abuse are found in 653—Chapter 11. Applicants for reinstatement shall provide documentation of having completed:
	(1)	The number of hours of category 1 activity needed for renewal in the most recent license period. None of the hours obtained in the inactive period may be carried over to a future license period; and
	(2)	Mandatory training on identifying and reporting abuse, if applicable, within the previous five years.
	c. 	Issuance of a reinstated license. Upon receiving the completed application, staff shall administratively issue a license that expires on the renewal date that would have been in effect if the licensee had renewed the license before the license expired.
	d. 	Reinstatement application process. The applicant who fails to submit all reinstatement information required within 365 days of the license’s becoming inactive shall be required to meet the reinstatement requirements of 9.13(2). For example, if a physician’s license expires on January 1, the completed reinstatement application is due in the board office by December 31, in order to meet the requirements of this subrule.
	9.13(2) Reinstatement of an unrestricted Iowa license that has been inactive for one year or longer. An individual whose license is in inactive status and who has not submitted a reinstatement application that was received by the board within one year of the license’s becoming inactive shall follow the application cycle specified in this rule and shall satisfy the following requirements for reinstatement:
	a. 	Submit an application for reinstatement to the board upon forms provided by the board. The application shall require the following information:
	(1)	Name, date and place of birth, license number, home address, mailing address and principal business address;
	(2)	A chronology accounting for all time periods from the date of initial licensure;
	(3)	Every jurisdiction in which the applicant is or has been authorized to practice including license numbers and dates of issuance;
	(4)	Verification of the applicant’s hospital and clinical staff privileges, and other professional experience for the past five years;
	(5)	A statement disclosing and explaining any warnings issued, investigations conducted or disciplinary actions taken, whether by voluntary agreement or formal action, by a medical or professional regulatory authority, an educational institution, training or research program, or health facility in any jurisdiction;
	(6)	A statement of the applicant’s physical and mental health, including full disclosure and a written explanation of any dysfunction or impairment which may affect the ability of the applicant to engage in practice and provide patients with safe and healthful care;
	(7)	A statement disclosing and explaining the applicant’s involvement in civil litigation related to practice in any jurisdiction. Copies of the legal documents may be requested if needed during the review process;
	(8)	A statement disclosing and explaining any charge of a misdemeanor or felony involving the applicant filed in any jurisdiction, whether or not any appeal or other proceeding is pending to have the conviction or plea set aside; and
	(9)	A completed fingerprint packet to facilitate a national criminal history background check. The fee for the evaluation of the fingerprint packet and the DCI and FBI criminal history background checks will be assessed to the applicant.
	b. 	Pay the reinstatement fee of $500 plus the fee identified in 653—subrule 8.4(7) for the evaluation of the fingerprint packet and the DCI and FBI criminal history background checks. No fee is required for reinstatement for those whose licenses became inactive between December 8, 1999, and July 4, 2001; however, the fee for the evaluation of the fingerprint packet and the DCI and FBI criminal history background checks will be assessed.
	c. 	Provide documentation of completion of 80 hours of category 1 continuing education activity within the previous two years and documentation of mandatory training on identifying and reporting abuse as specified in 653—Chapter 11.
	d. 	If the physician has not engaged in active practice in the past three years in any jurisdiction of the United States or Canada, require an applicant to:
	(1)	Successfully pass a competency evaluation approved by the board;
	(2)	Successfully pass SPEX, COMVEX-USA, or another examination approved by the board; or
	(3)	Successfully complete a retraining program arranged by the physician and approved in advance by the board.
	e. 	An individual who is able to submit a letter from the board with different reinstatement or reactivation criteria is eligible for reinstatement based on those criteria.
	9.13(3) Reinstatement application process. The process is the same as that described in rule 9.6(147,148).
653—9.14(147,148) Reinstatement of a restricted Iowa license. A physician whose license has been suspended or revoked following a disciplinary proceeding is required to seek reinstatement pursuant to 653—Chapter 26.
653—9.15(147,148) Denial of licensure.
	9.15(1) Preliminary notice of denial. Prior to the denial of licensure to an applicant, the board shall issue a preliminary notice of denial that shall be sent to the applicant by regular, first-class mail at the address provided by the applicant. The preliminary notice of denial shall be in writing, cite the factual and legal basis for denying the application, notify the applicant of the time for appeal, and specify the date upon which the denial will become final if it is not appealed.
	9.15(2) Appeal procedure. An applicant who has received a preliminary notice of denial may appeal the denial and request a hearing on the issues related to the preliminary notice of denial by serving a request for hearing upon the executive director not more than 30 calendar days following the date when the preliminary notice of denial was mailed. The applicant’s current address shall be provided in the request for hearing. The request is deemed filed on the date it is received in the board office. If the request is received with a USPS nonmetered postmark, the board shall consider the postmark date as the date the request is filed. The request shall specify the factual or legal errors and that the applicant desires an evidentiary hearing, and may provide additional written information or documents in support of licensure.
	9.15(3) Hearing. If an applicant appeals the preliminary notice of denial and requests a hearing, the hearing shall be a contested case and subsequent proceedings shall be conducted in accordance with 653—25.30(17A).
	a. 	License denial hearings are contested cases open to the public.
	b. 	Either party may request issuance of a protective order in the event privileged or confidential information is submitted into evidence.
	c. 	Evidence supporting the denial of the license may be presented by an assistant attorney general.
	d. 	While each party shall have the burden of establishing the affirmative of matters asserted, the applicant shall have the ultimate burden of persuasion as to the applicant’s qualification for licensure.
	e. 	The board, after a hearing on license denial, may grant or deny the application for licensure. The board shall state the reasons for its decision and may grant the license, grant the license with restrictions or deny the license. The final decision is a public record.
	f. 	Judicial review of a final order of the board denying licensure, or issuing a license with restrictions, may be sought in accordance with the provisions of Iowa Code section 17A.19, which are applicable to judicial review of any agency’s final decision in a contested case.
	9.15(4) Finality. If an applicant does not appeal a preliminary notice of denial in accordance with 9.15(2), the preliminary notice of denial automatically becomes final. A final denial of an application for licensure is a public record.
	9.15(5) Failure to pursue appeal. If an applicant appeals a preliminary notice of denial in accordance with 9.15(2), but the applicant fails to pursue that appeal to a final decision within one year from the date of the preliminary notice of denial, the board may dismiss the appeal. The appeal may be dismissed only after the board sends a written notice by first-class mail to the applicant at the applicant’s last-known address. The notice shall state that the appeal will be dismissed and the preliminary notice of denial will become final if the applicant does not contact the board to schedule the appeal hearing within 30 days of the date the letter is mailed from the board office. Upon dismissal of an appeal, the preliminary notice of denial becomes final. A final denial of an application for licensure under this rule is a public record.
653—9.16(17A,147,148,272C) Waiver or variance requests. Waiver or variance requests shall be submitted in conformance with 653—Chapter 3.
These rules are intended to implement Iowa Code chapters 17A, 147, 148, and 272C.
[Filed 5/11/01, Notice 4/4/01—published 5/30/01, effective 7/4/01]
[Filed 2/14/02, Notice 11/28/01—published 3/6/02, effective 4/10/02]
[Filed emergency 4/12/02—published 5/1/02, effective 4/12/02]
[Filed 4/12/02, Notice 3/6/02—published 5/1/02, effective 6/5/02]
[Filed 6/6/02, Notice 5/1/02—published 6/26/02, effective 7/31/02]
[Filed emergency 10/9/02 after Notice 8/21/02—published 10/30/02, effective 10/9/02]
[Filed emergency 2/7/03 after Notice 1/8/03—published 3/5/03, effective 2/7/03]
[Filed emergency 8/28/03 after Notice 7/23/03—published 9/17/03, effective 9/1/03]
[Filed 7/16/04, Notice 6/9/04—published 8/4/04, effective 9/8/04]
[Filed 9/9/04, Notice 8/4/04—published 9/29/04, effective 11/3/04]◊
[Filed 12/30/04, Notice 11/24/04—published 1/19/05, effective 2/23/05]
[Filed 6/17/05, Notice 5/11/05—published 7/6/05, effective 8/10/05]
[Filed emergency 8/30/05 after Notice 7/6/05—published 9/28/05, effective 10/1/05]
[Filed 10/12/06, Notice 8/2/06—published 11/8/06, effective 1/1/07]
[Filed 12/14/06, Notice 11/8/06—published 1/17/07, effective 2/21/07]
[Filed emergency 2/8/07 after Notice 1/3/07—published 2/28/07, effective 3/1/07]
[Filed emergency 11/21/07 after Notice 10/10/07—published 12/19/07, effective 1/1/08]
[Filed 4/3/08, Notice 2/27/08—published 4/23/08, effective 5/28/08]
[Filed 9/18/08, Notice 8/13/08—published 10/8/08, effective 11/12/08]◊
◊	Two or more ARCs