House File 198 S-3185 Amend House File 198, as passed by the House, as 1 follows: 2 1. Page 1, before line 1 by inserting: 3 < DIVISION I 4 HOME AND COMMUNITY-BASED SERVICES PROVIDERS —— TRAINING 5 COSTS > 6 2. Page 1, after line 10 by inserting: 7 < DIVISION II 8 DIRECT CARE PROFESSIONALS VOLUNTARY CERTIFICATION 9 Sec. ___. NEW SECTION . 152F.1 Definitions. 10 As used in this chapter, unless the context 11 otherwise requires: 12 1. “Board” means the board of direct care 13 professionals created under chapter 147. 14 2. “Community living professional” means a direct 15 care associate who has completed advanced training and 16 is certified to provide home and community living, 17 instrumental activities of daily living, and personal 18 support services. 19 3. “Core training” means training specified by the 20 board to provide basic foundational knowledge and an 21 introduction to the direct care profession. 22 4. “Direct care associate” means any of the 23 following: 24 a. An individual who has completed core training 25 and is certified to provide direct care services in the 26 state. 27 b. An individual who has completed a nurse aide 28 training and competency evaluation program approved 29 by the state as required pursuant to 42 C.F.R. § 30 483.152, is registered on the Iowa direct care worker 31 registry established by the department of inspections 32 and appeals, complies with the requirements of section 33 152F.3, and is certified to provide direct care 34 services in the state. 35 5. “Direct care instructor” means an individual 36 approved by the board to provide direct care 37 instruction to direct care professionals. 38 6. “Direct care professional” means an individual 39 who provides direct care services for compensation and 40 is certified as a direct care associate, a community 41 living professional, a health support professional, or 42 a personal support professional. 43 7. “Direct care services” means the services 44 provided to individuals who have health conditions, 45 are ill, or are individuals with disabilities as 46 specified in the individual’s service plan or in 47 documented goals, including but not limited to home and 48 community living services, instrumental activities of 49 daily living services, personal activities of daily 50 -1- HF198.1902 (2) 85 pf/nh 1/ 12 #1. #2.

living services, personal support services, and health 1 monitoring and maintenance services. 2 8. “Direct care trainer” means a direct care 3 instructor who is approved by the board to train 4 instructors. 5 9. “Health monitoring and maintenance services” 6 means services provided to support and maintain 7 an individual’s health, including observation and 8 reporting of behaviors or conditions; understanding 9 the causes and symptoms of conditions including but 10 not limited to muscular/skeletal, skin, respiratory 11 system, and neurologic conditions, and diabetes, 12 mental illness, pain, cancer, and intellectual and 13 developmental disabilities; and providing functional 14 support specific to certain conditions. 15 10. “Health support professional” means any of the 16 following: 17 a. A direct care associate who has completed 18 advanced training and is certified to provide personal 19 activities of daily living and health monitoring and 20 maintenance services. 21 b. An individual who has completed a nurse aide 22 training and competency evaluation program approved 23 by the state as required pursuant to 42 C.F.R. § 24 483.152, is registered on the Iowa direct care worker 25 registry established by the department of inspections 26 and appeals, complies with the requirements of section 27 152F.3, and is certified to provide personal activities 28 of daily living and health monitoring and maintenance 29 services. 30 11. “Home and community living services” means 31 services to enhance or maintain independence of 32 individuals including such activities as helping 33 individuals develop and meet personal goals, providing 34 direct physical and emotional support and assistance 35 for persons with disabilities, utilizing crisis 36 intervention and positive behavior supports, and using 37 and following individual service plans. 38 12. “Instrumental activities of daily living 39 services” means services provided to assist individuals 40 with daily living tasks to allow them to function 41 independently in a home or community setting, including 42 but not limited to assistance with managing money, 43 transportation, light housekeeping, and shopping and 44 cooking. 45 13. “Personal activities of daily living services” 46 means services to assist individuals in meeting basic 47 needs, including but not limited to bathing, back rubs, 48 and skin care; grooming activities; assistance with 49 dressing and undressing; assistance with eating and 50 -2- HF198.1902 (2) 85 pf/nh 2/ 12

feeding; assistance with toileting; and assistance with 1 mobility, including transfers, walking, and turning in 2 bed. 3 14. “Personal support professional” means a direct 4 care associate who has completed advanced training and 5 is certified to provide instrumental activities of 6 daily living, personal activities of daily living, and 7 personal support services. 8 15. “Personal support services” means support 9 services provided to an individual as the individual 10 performs personal activities of daily living including 11 but not limited to coaching and prompting, and teaching 12 skills and behaviors. 13 16. “Service plan” means a written, 14 consumer-centered, outcome-based plan of services. 15 17. “Specialty endorsement” means an advanced level 16 of certification based on requirements developed by 17 experts in a particular discipline or professional area 18 and approved by the board. 19 Sec. ___. NEW SECTION . 152F.2 Voluntary 20 certification —— use of title. 21 1. The board of direct care professionals shall 22 establish and publicize a program for voluntary 23 certification of direct care professionals who meet the 24 requirements for certification under this chapter. 25 2. An individual who is not certified pursuant to 26 this chapter shall not use words or titles which imply 27 or represent that the individual is certified as a 28 direct care professional under this chapter. 29 3. A direct care associate shall not represent 30 that the individual is certified as a direct care 31 professional with advanced training certification 32 or a specialty endorsement, unless the direct care 33 associate is first certified at the appropriate level 34 of certification under this chapter. 35 Sec. ___. NEW SECTION . 152F.3 Requirements to 36 obtain certification —— renewal —— continuing education 37 —— reciprocity. 38 1. An applicant for certification as a direct care 39 associate shall present evidence satisfactory to the 40 board that the applicant satisfies all of the following 41 requirements: 42 a. The applicant has successfully completed the 43 required education for the certification from a 44 board-approved direct care instructor or direct care 45 trainer; or the individual has completed a nurse aide 46 training and competency evaluation program approved by 47 the state as required pursuant to 42 C.F.R. § 483.152 48 and is registered on the Iowa direct care worker 49 registry established by the department of inspections 50 -3- HF198.1902 (2) 85 pf/nh 3/ 12

and appeals. 1 b. The applicant has paid all fees required by the 2 board. 3 c. The applicant certifies that the applicant will 4 conduct all professional activities in accordance with 5 standards for professional conduct established by the 6 board. 7 2. An applicant for certification as a direct care 8 professional with advanced training or a specialty 9 endorsement shall present evidence satisfactory to the 10 board that the applicant satisfies all of the following 11 requirements: 12 a. The applicant has successfully completed the 13 required education for the certification from a 14 board-approved direct care instructor or direct care 15 trainer. 16 b. The applicant has paid all fees required by the 17 board. 18 c. The applicant has passed a state examination 19 approved by the board. 20 d. The applicant certifies that the applicant will 21 conduct all professional activities in accordance with 22 standards for professional conduct established by the 23 board. 24 3. Notwithstanding subsection 2, an applicant for 25 certification as a health support professional shall 26 present evidence satisfactory to the board that the 27 applicant satisfies all of the following requirements: 28 a. The applicant has complied with one of the 29 following: 30 (1) Successful completion of the required education 31 for the certification from a board-approved direct 32 care instructor or direct care trainer and successful 33 passage of a state examination approved by the board. 34 (2) Successful completion of a nurse aide training 35 and competency evaluation program approved by the 36 state as required pursuant to 42 C.F.R. § 483.152 and 37 registration on the Iowa direct care worker registry 38 established by the department of inspections and 39 appeals. 40 b. The applicant has paid all fees required by the 41 board. 42 c. The applicant certifies that the applicant will 43 conduct all professional activities in accordance with 44 standards for professional conduct established by the 45 board. 46 4. An individual shall renew the individual’s 47 certification biennially. Prior to such renewal, the 48 individual shall present evidence that the individual 49 has satisfied continuing education requirements and 50 -4- HF198.1902 (2) 85 pf/nh 4/ 12

shall pay a renewal fee as determined by the board. 1 5. The board shall issue the appropriate 2 certification to an applicant who demonstrates 3 experience in direct care services in another state and 4 satisfies the requirements established by the board for 5 the specific certification. 6 Sec. ___. NEW SECTION . 152F.4 Duties of the board. 7 The board shall do all of the following: 8 1. Adopt rules consistent with this chapter, 9 chapter 147, chapter 272, and the recommendations of 10 the direct care worker advisory council established 11 pursuant to 2008 Iowa Acts, chapter 1188, section 69, 12 including the recommendations in the final report 13 submitted by the advisory council to the governor and 14 the general assembly in March 2012, which are necessary 15 for the performance of its duties. 16 2. Establish standards and guidelines for direct 17 care professionals, including establishing or 18 approving, as applicable, training and curriculum 19 requirements for direct care associates and each 20 advanced training credential and specialty endorsement. 21 a. The curriculum for core training shall provide 22 for its incorporation into and completion through 23 a flexible delivery system, utilizing a variety 24 of settings and methods, as approved by the board, 25 including but not limited to employer-provided 26 training, community college courses, and online 27 training including but not limited to the college of 28 direct support. 29 b. The curriculum requirements for health support 30 professionals shall satisfy the curriculum requirements 31 specified for nurse aides pursuant to 42 C.F.R. § 32 483.152. 33 c. The training and curriculum requirements 34 approved by the board shall provide for adaptations, 35 accommodations, modifications, and individualization 36 for applicants, based on their needs, abilities, and 37 personal learning styles. 38 3. Require an individual to undergo criminal 39 history and child and dependent adult abuse record 40 checks prior to certification, and establish record 41 checks requirements applicable to direct care 42 professionals consistent with section 135C.33. 43 The requirement shall provide for acceptance of 44 prior record checks completed by the individual’s 45 current employer in lieu of new record checks, if 46 the individual has had no gap in employment since 47 completion of the checks. 48 4. Require compliance with child abuse and 49 dependent adult abuse reporting and training 50 -5- HF198.1902 (2) 85 pf/nh 5/ 12

requirements in accordance with section 232.69 and 1 chapters 235B and 235E, as applicable. 2 5. Establish standards and guidelines for 3 certification reciprocity. 4 6. Prepare and conduct, or prescribe, an 5 examination for applicants for certification. 6 7. Establish standards and guidelines for direct 7 care instructors and direct care trainers, including 8 minimum curriculum requirements and continuing 9 education requirements. Training and continuing 10 education guidelines shall provide diverse options for 11 completion of the training and continuing education, 12 as appropriate, including but not limited to online, 13 employer-based, or educational institution-based 14 opportunities. 15 8. Define educational activities which fulfill 16 continuing education requirements for renewal of 17 certification. 18 9. Establish guidelines for inactive certification 19 status and inactive certification reentry. 20 10. Adopt rules to provide for a fifty percent 21 reduction in the fee for direct care associate 22 certification for applicants for certification during 23 the period beginning January 1, 2015, and ending 24 December 31, 2016. 25 11. Adopt rules to provide for all of the following 26 during the period beginning January 1, 2015, and ending 27 December 31, 2016: 28 a. Initial voluntary certification of an individual 29 providing direct care services on or before January 30 1, 2015, as a direct care associate, community living 31 professional, personal support professional, or 32 health support professional, as appropriate, based 33 on an appraisal of documented previous training, 34 employment history, and experience, submitted with the 35 application, in lieu of completion of the education, 36 training, or examination requirements specified for the 37 specific certification pursuant to section 152F.3. 38 b. Initial voluntary certification of an individual 39 who was registered on or before January 1, 2015, and is 40 registered on the date of application for certification 41 on the Iowa direct care worker registry established by 42 the department of inspections and appeals, in lieu of 43 completion of the education, training, and examination 44 requirements specified for the specific certification 45 pursuant to section 152F.3, as a direct care associate 46 or a health support professional, as requested in the 47 application submitted by the individual. 48 12. In collaboration with the direct care worker 49 advisory council established pursuant to 2008 50 -6- HF198.1902 (2) 85 pf/nh 6/ 12

Iowa Acts, chapter 1188, section 69, do all of the 1 following: 2 a. Develop and conduct necessary outreach and 3 education for individuals providing direct care 4 services, consumers, training providers including but 5 not limited to community college health occupation 6 and training centers, employers, and other interested 7 parties to provide information about and the process 8 for participation in direct care professional voluntary 9 certification. 10 b. Determine data collection needs, collect data, 11 and track and analyze data to determine the effect of 12 certification on recruitment and retention, turnover 13 rates, the cost of turnover, consumer and employer 14 satisfaction, and public protection. The analysis of 15 data collected shall also be used to inform changes 16 in the certification system to provide for continuous 17 improvement for direct care professionals, consumers 18 and employers, and the public. 19 13. Provide for maintenance of the information 20 management system to be utilized for application for 21 and renewal of certification, comprehensive workforce 22 data collection and tracking, and a public interface. 23 The public interface shall include but is not limited 24 to searchable information regarding the credential 25 status of each certified direct care professional. 26 Sec. ___. NEW SECTION . 152F.5 Certification 27 suspension and revocation. 28 A certification issued by the board under this 29 chapter may be suspended or revoked, or renewal of 30 certification may be denied by the board, for violation 31 of any provision of this chapter, section 147.55 or 32 272C.10, or rules adopted by the board. 33 Sec. ___. NEW SECTION . 152F.6 Individuals 34 providing direct care services —— disclosure. 35 Any individual providing direct care services in 36 this state shall disclose the individual’s level of 37 certification under this chapter to a consumer prior to 38 the initial provision of direct care services to that 39 consumer. 40 Sec. ___. Section 10A.402, subsection 1, Code 2013, 41 is amended to read as follows: 42 1. Investigations relative to the practice of 43 regulated professions and occupations, except those 44 within the jurisdiction of the board of medicine, the 45 board of pharmacy, the dental board, and the board of 46 nursing , and the board of direct care professionals . 47 Sec. ___. Section 135.11A, Code 2013, is amended to 48 read as follows: 49 135.11A Professional licensure division —— other 50 -7- HF198.1902 (2) 85 pf/nh 7/ 12

licensing boards —— expenses —— fees. 1 1. There shall be a professional licensure 2 division within the department of public health. Each 3 board under chapter 147 or under the administrative 4 authority of the department, except the board of 5 nursing, board of medicine, dental board, and board of 6 pharmacy, and board of direct care professionals shall 7 receive administrative and clerical support from the 8 division and may not employ its own support staff for 9 administrative and clerical duties. 10 2. The professional licensure division and the 11 licensing boards may expend funds in addition to 12 amounts budgeted, if those additional expenditures are 13 directly the result of actual examination and exceed 14 funds budgeted for examinations. Before the division 15 or a licensing board expends or encumbers an amount 16 in excess of the funds budgeted for examinations, the 17 director of the department of management shall approve 18 the expenditure or encumbrance. Before approval is 19 given, the department of management shall determine 20 that the examination expenses exceed the funds budgeted 21 by the general assembly to the division or board 22 and the division or board does not have other funds 23 from which examination expenses can be paid. Upon 24 approval of the department of management, the division 25 or licensing board may expend and encumber funds for 26 excess examination expenses. The amounts necessary to 27 fund the excess examination expenses shall be collected 28 as fees from additional examination applicants and 29 shall be treated as repayment receipts as defined in 30 section 8.2 . 31 Sec. ___. Section 135.31, Code 2013, is amended to 32 read as follows: 33 135.31 Location of boards —— rulemaking. 34 The offices for the board of medicine, the board 35 of pharmacy, the board of nursing, and the dental 36 board , and the board of direct care professionals shall 37 be located within the department of public health. 38 The individual boards shall have policymaking and 39 rulemaking authority. 40 Sec. ___. Section 147.1, subsections 3 and 6, Code 41 2013, are amended to read as follows: 42 3. “Licensed” or “certified” , when applied 43 to a physician and surgeon, podiatric physician, 44 osteopathic physician and surgeon, physician assistant, 45 psychologist, chiropractor, nurse, dentist, dental 46 hygienist, dental assistant, optometrist, speech 47 pathologist, audiologist, pharmacist, physical 48 therapist, physical therapist assistant, occupational 49 therapist, occupational therapy assistant, orthotist, 50 -8- HF198.1902 (2) 85 pf/nh 8/ 12

prosthetist, pedorthist, respiratory care practitioner, 1 practitioner of cosmetology arts and sciences, 2 practitioner of barbering, funeral director, dietitian, 3 marital and family therapist, mental health counselor, 4 social worker, massage therapist, athletic trainer, 5 acupuncturist, nursing home administrator, hearing 6 aid dispenser, or sign language interpreter or 7 transliterator , or direct care professional means a 8 person licensed under this subtitle . 9 6. “Profession” means medicine and surgery, 10 podiatry, osteopathic medicine and surgery, practice 11 as a physician assistant, psychology, chiropractic, 12 nursing, dentistry, dental hygiene, dental assisting, 13 optometry, speech pathology, audiology, pharmacy, 14 physical therapy, physical therapist assisting, 15 occupational therapy, occupational therapy assisting, 16 respiratory care, cosmetology arts and sciences, 17 barbering, mortuary science, marital and family 18 therapy, mental health counseling, social work, 19 dietetics, massage therapy, athletic training, 20 acupuncture, nursing home administration, hearing 21 aid dispensing, sign language interpreting or 22 transliterating, orthotics, prosthetics, or pedorthics , 23 or practice as a direct care professional . 24 Sec. ___. Section 147.2, subsection 1, Code 2013, 25 is amended to read as follows: 26 1. A person shall not engage in the practice of 27 medicine and surgery, podiatry, osteopathic medicine 28 and surgery, psychology, chiropractic, physical 29 therapy, physical therapist assisting, nursing, 30 dentistry, dental hygiene, dental assisting, optometry, 31 speech pathology, audiology, occupational therapy, 32 occupational therapy assisting, orthotics, prosthetics, 33 pedorthics, respiratory care, pharmacy, cosmetology 34 arts and sciences, barbering, social work, dietetics, 35 marital and family therapy or mental health counseling, 36 massage therapy, mortuary science, athletic training, 37 acupuncture, nursing home administration, hearing 38 aid dispensing, or sign language interpreting or 39 transliterating, or shall not practice as a physician 40 assistant or as a certified direct care professional , 41 unless the person has obtained a license for that 42 purpose from the board for the profession. 43 Sec. ___. Section 147.13, Code 2013, is amended by 44 adding the following new subsection: 45 NEW SUBSECTION . 25. For direct care professionals, 46 the board of direct care professionals. 47 Sec. ___. Section 147.14, subsection 1, Code 2013, 48 is amended by adding the following new paragraph: 49 NEW PARAGRAPH . x. For the board of direct care 50 -9- HF198.1902 (2) 85 pf/nh 9/ 12

professionals, a total of nine members, five of whom 1 are direct care professionals who represent diverse 2 settings and populations served, two members of the 3 public who are consumers or family members of consumers 4 of direct care services, one registered nurse who 5 serves as a direct care instructor, and one human 6 services professional who serves as a direct care 7 instructor. 8 Sec. ___. Section 147.74, Code 2013, is amended by 9 adding the following new subsection: 10 NEW SUBSECTION . 23A. A direct care professional 11 certified under chapter 152F and this chapter may use 12 the following: 13 a. A direct care professional certified as a 14 direct care associate may use the title “direct care 15 associate” or the letters “D.C.A.” after the person’s 16 name. 17 b. A direct care professional certified as a 18 community living professional may use the title 19 “community living professional” or the letters “C.L.P.” 20 after the person’s name. 21 c. A direct care professional certified as a 22 personal support professional may use the title 23 “personal support professional” or the letters “P.S.P.” 24 after the person’s name. 25 d. A direct care professional certified as a 26 health support professional may use the title “health 27 support professional” or the letters “H.S.P.” after the 28 person’s name. 29 e. A direct care professional certified with a 30 specialty endorsement may use the title or letters 31 determined by the specialty endorsement entity and 32 approved by the board of direct care professionals. 33 f. A direct care professional who completes a 34 nurse aide training and competency evaluation program 35 approved by the state as required pursuant to 42 36 C.F.R. § 483.152 may use the title “certified nursing 37 assistant” or the letters “C.N.A.” after the person’s 38 name. 39 Sec. ___. Section 147.80, subsection 3, Code 2013, 40 is amended to read as follows: 41 3. The board of medicine, the board of pharmacy, 42 the dental board, and the board of nursing , and 43 the board of direct care professionals shall retain 44 individual executive officers, but shall make 45 every effort to share administrative, clerical, and 46 investigative staff to the greatest extent possible. 47 Sec. ___. Section 147.88, Code 2013, is amended to 48 read as follows: 49 147.88 Inspections and investigations. 50 -10- HF198.1902 (2) 85 pf/nh 10/ 12

The department of inspections and appeals may 1 perform inspections and investigations as required by 2 this subtitle, except inspections and investigations 3 for the board of medicine, board of pharmacy, board of 4 nursing, and the dental board , and the board of direct 5 care professionals . The department of inspections 6 and appeals shall employ personnel related to the 7 inspection and investigative functions. 8 Sec. ___. Section 272C.1, subsection 6, Code 2013, 9 is amended by adding the following new paragraph: 10 NEW PARAGRAPH . ag. The board of direct care 11 professionals, created pursuant to chapter 147. 12 Sec. ___. DEPARTMENT OF INSPECTIONS AND APPEALS —— 13 NURSE AIDE CURRICULUM. The department of inspections 14 and appeals shall collaborate with the direct care 15 workforce initiative workgroup to ensure that the 16 training curriculum requirements developed for a 17 health support professional credential satisfy the 18 requirements for a nurse aide pursuant to 42 C.F.R. 19 § 483.152. If the training curriculum requirements 20 developed satisfy this standard, beginning January 1, 21 2015, the department of inspections and appeals shall 22 approve the health support professional training as the 23 approved training curriculum for nurse aides pursuant 24 to 42 C.F.R. § 483.152. 25 Sec. ___. TRANSITION PROVISIONS. Notwithstanding 26 sections 147.14 and 147.16, for the initial board 27 of direct care professionals, the governor may 28 appoint, subject to confirmation by the senate, in 29 lieu of the five members required to be direct care 30 professionals and the two members required to be 31 direct care instructors, members with employment 32 experience providing direct care services in diverse 33 settings or expertise that is substantially equivalent 34 to the professional requirements for a direct care 35 professional or direct care instructor, as applicable. 36 Sec. ___. IMPLEMENTATION. The provisions of this 37 division of this Act shall be implemented as follows: 38 1. The sections of this division of this Act 39 relating to the board of direct care professionals 40 including sections 152F.1 and 152F.4, as enacted in 41 this division of this Act; sections 10A.402, 135.11A, 42 135.31, 147.13, 147.14, 147.80, 147.88, and 272C.1, as 43 amended in this division of this Act; and the section 44 of this division of this Act providing transition 45 provisions relating to the board of direct care 46 professionals shall be implemented so that a board of 47 direct care professionals is appointed no later than 48 December 15, 2013. 49 2. The sections of this division of this Act 50 -11- HF198.1902 (2) 85 pf/nh 11/ 12

relating to certification of direct care professionals 1 including sections 152F.2, 152F.3, and 152F.5, as 2 enacted in this division of this Act; and sections 3 147.1, 147.2, and 147.74, as amended in this division 4 of this Act, shall be implemented so that certification 5 is available beginning no later than January 1, 2015. 6 Sec. ___. FUNDING PROVISIONS. 7 1. The department of public health shall limit the 8 indirect service charge for the board of direct care 9 professionals to not more than fifteen percent. 10 2. It is the intent of the general assembly 11 that the board of direct care professionals be 12 self-sustaining by January 1, 2018. 13 Sec. ___. MEDICAL ASSISTANCE —— PREFERENTIAL 14 RATE FOR CERTIFIED DIRECT CARE PROFESSIONALS. The 15 department of human services shall review and 16 make recommendations for providing a preferential 17 reimbursement rate under the medical assistance program 18 for services provided by direct care professionals 19 based upon the individual’s level of certification 20 under chapter 152F, as enacted in this division of 21 this Act. The department shall report findings and 22 recommendations to the chairpersons and ranking members 23 of the joint appropriations subcommittee on health and 24 human services by December 15, 2013. 25 Sec. ___. EFFECTIVE UPON ENACTMENT. This division 26 of this Act, being deemed of immediate importance, 27 takes effect upon enactment. > 28 3. Title page, line 1, after < to > by inserting 29 < direct care services, including > 30 4. Title page, line 3, after < programs > 31 by inserting < , certification of direct care 32 professionals, making penalties applicable, and 33 including effective date provisions > 34 5. By renumbering as necessary. 35 ______________________________ JACK HATCH -12- HF198.1902 (2) 85 pf/nh 12/ 12 #3. #4. #5.