Amend House File 198, as passed by the House, as follows:
   1.  Page 1, before line 1 by inserting: 

<DIVISION I

HOME AND COMMUNITY-BASED SERVICES PROVIDERS —— TRAINING COSTS>
   2.  Page 1, after line 10 by inserting: 

<DIVISION II

DIRECT CARE PROFESSIONALS VOLUNTARY CERTIFICATION
   Sec. ___.  NEW SECTION.  152F.1  Definitions.
   As used in this chapter, unless the context otherwise requires:
   1.  “Board” means the board of direct care professionals created under chapter 147.
   2.  “Community living professional” means a direct care associate who has completed advanced training and is certified to provide home and community living, instrumental activities of daily living, and personal support services.
   3.  “Core training” means training specified by the board to provide basic foundational knowledge and an introduction to the direct care profession.
   4.  “Direct care associate” means any of the following:
   a.  An individual who has completed core training and is certified to provide direct care services in the state.
   b.  An individual who has completed a nurse aide training and competency evaluation program approved by the state as required pursuant to 42 C.F.R. § 483.152, is registered on the Iowa direct care worker registry established by the department of inspections and appeals, complies with the requirements of section 152F.3, and is certified to provide direct care services in the state.
   5.  “Direct care instructor” means an individual approved by the board to provide direct care instruction to direct care professionals.
   6.  “Direct care professional” means an individual who provides direct care services for compensation and is certified as a direct care associate, a community living professional, a health support professional, or a personal support professional.
   7.  “Direct care services” means the services provided to individuals who have health conditions, are ill, or are individuals with disabilities as specified in the individual’s service plan or in documented goals, including but not limited to home and community living services, instrumental activities of daily living services, personal activities of daily living services, personal support services, and health monitoring and maintenance services. 
   8.  “Direct care trainer” means a direct care instructor who is approved by the board to train instructors.
   9.  “Health monitoring and maintenance services” means services provided to support and maintain an individual’s health, including observation and reporting of behaviors or conditions; understanding the causes and symptoms of conditions including but not limited to muscular/skeletal, skin, respiratory system, and neurologic conditions, and diabetes, mental illness, pain, cancer, and intellectual and developmental disabilities; and providing functional support specific to certain conditions.
   10.  “Health support professional” means any of the following:
   a.  A direct care associate who has completed advanced training and is certified to provide personal activities of daily living and health monitoring and maintenance services.
   b.  An individual who has completed a nurse aide training and competency evaluation program approved by the state as required pursuant to 42 C.F.R. § 483.152, is registered on the Iowa direct care worker registry established by the department of inspections and appeals, complies with the requirements of section 152F.3, and is certified to provide personal activities of daily living and health monitoring and maintenance services.
   11.  “Home and community living services” means services to enhance or maintain independence of individuals including such activities as helping individuals develop and meet personal goals, providing direct physical and emotional support and assistance for persons with disabilities, utilizing crisis intervention and positive behavior supports, and using and following individual service plans.
   12.  “Instrumental activities of daily living services” means services provided to assist individuals with daily living tasks to allow them to function independently in a home or community setting, including but not limited to assistance with managing money, transportation, light housekeeping, and shopping and cooking.
   13.  “Personal activities of daily living services” means services to assist individuals in meeting basic needs, including but not limited to bathing, back rubs, and skin care; grooming activities; assistance with dressing and undressing; assistance with eating and feeding; assistance with toileting; and assistance with mobility, including transfers, walking, and turning in bed.
   14.  “Personal support professional” means a direct care associate who has completed advanced training and is certified to provide instrumental activities of daily living, personal activities of daily living, and personal support services.
   15.  “Personal support services” means support services provided to an individual as the individual performs personal activities of daily living including but not limited to coaching and prompting, and teaching skills and behaviors.
   16.  “Service plan” means a written, consumer-centered, outcome-based plan of services.
   17.  “Specialty endorsement” means an advanced level of certification based on requirements developed by experts in a particular discipline or professional area and approved by the board.
   Sec. ___.  NEW SECTION.  152F.2  Voluntary certification —— use of title.
   1.  The board of direct care professionals shall establish and publicize a program for voluntary certification of direct care professionals who meet the requirements for certification under this chapter.
   2.  An individual who is not certified pursuant to this chapter shall not use words or titles which imply or represent that the individual is certified as a direct care professional under this chapter.
   3.  A direct care associate shall not represent that the individual is certified as a direct care professional with advanced training certification or a specialty endorsement, unless the direct care associate is first certified at the appropriate level of certification under this chapter.
   Sec. ___.  NEW SECTION.  152F.3  Requirements to obtain certification —— renewal —— continuing education —— reciprocity.
   1.  An applicant for certification as a direct care associate shall present evidence satisfactory to the board that the applicant satisfies all of the following requirements:
   a.  The applicant has successfully completed the required education for the certification from a board-approved direct care instructor or direct care trainer; or the individual has completed a nurse aide training and competency evaluation program approved by the state as required pursuant to 42 C.F.R. § 483.152 and is registered on the Iowa direct care worker registry established by the department of inspections and appeals.
   b.  The applicant has paid all fees required by the board.
   c.  The applicant certifies that the applicant will conduct all professional activities in accordance with standards for professional conduct established by the board.
   2.  An applicant for certification as a direct care professional with advanced training or a specialty endorsement shall present evidence satisfactory to the board that the applicant satisfies all of the following requirements:
   a.  The applicant has successfully completed the required education for the certification from a board-approved direct care instructor or direct care trainer.
   b.  The applicant has paid all fees required by the board.
   c.  The applicant has passed a state examination approved by the board.
   d.  The applicant certifies that the applicant will conduct all professional activities in accordance with standards for professional conduct established by the board.
   3.  Notwithstanding subsection 2, an applicant for certification as a health support professional shall present evidence satisfactory to the board that the applicant satisfies all of the following requirements:
   a.  The applicant has complied with one of the following:
   (1)  Successful completion of the required education for the certification from a board-approved direct care instructor or direct care trainer and successful passage of a state examination approved by the board.
   (2)  Successful completion of a nurse aide training and competency evaluation program approved by the state as required pursuant to 42 C.F.R. § 483.152 and registration on the Iowa direct care worker registry established by the department of inspections and appeals.
   b.  The applicant has paid all fees required by the board.
   c.  The applicant certifies that the applicant will conduct all professional activities in accordance with standards for professional conduct established by the board.
   4.  An individual shall renew the individual’s certification biennially. Prior to such renewal, the individual shall present evidence that the individual has satisfied continuing education requirements and shall pay a renewal fee as determined by the board.
   5.  The board shall issue the appropriate certification to an applicant who demonstrates experience in direct care services in another state and satisfies the requirements established by the board for the specific certification.
   Sec. ___.  NEW SECTION.  152F.4  Duties of the board.
   The board shall do all of the following:
   1.  Adopt rules consistent with this chapter, chapter 147, chapter 272, and the recommendations of the direct care worker advisory council established pursuant to 2008 Iowa Acts, chapter 1188, section 69, including the recommendations in the final report submitted by the advisory council to the governor and the general assembly in March 2012, which are necessary for the performance of its duties.
   2.  Establish standards and guidelines for direct care professionals, including establishing or approving, as applicable, training and curriculum requirements for direct care associates and each advanced training credential and specialty endorsement.
   a.  The curriculum for core training shall provide for its incorporation into and completion through a flexible delivery system, utilizing a variety of settings and methods, as approved by the board, including but not limited to employer-provided training, community college courses, and online training including but not limited to the college of direct support.
   b.  The curriculum requirements for health support professionals shall satisfy the curriculum requirements specified for nurse aides pursuant to 42 C.F.R. § 483.152.
   c.  The training and curriculum requirements approved by the board shall provide for adaptations, accommodations, modifications, and individualization for applicants, based on their needs, abilities, and personal learning styles.
   3.  Require an individual to undergo criminal history and child and dependent adult abuse record checks prior to certification, and establish record checks requirements applicable to direct care professionals consistent with section 135C.33. The requirement shall provide for acceptance of prior record checks completed by the individual’s current employer in lieu of new record checks, if the individual has had no gap in employment since completion of the checks.
   4.  Require compliance with child abuse and dependent adult abuse reporting and training requirements in accordance with section 232.69 and chapters 235B and 235E, as applicable.
   5.  Establish standards and guidelines for certification reciprocity.
   6.  Prepare and conduct, or prescribe, an examination for applicants for certification.
   7.  Establish standards and guidelines for direct care instructors and direct care trainers, including minimum curriculum requirements and continuing education requirements. Training and continuing education guidelines shall provide diverse options for completion of the training and continuing education, as appropriate, including but not limited to online, employer-based, or educational institution-based opportunities.
   8.  Define educational activities which fulfill continuing education requirements for renewal of certification.
   9.  Establish guidelines for inactive certification status and inactive certification reentry.
   10.  Adopt rules to provide for a fifty percent reduction in the fee for direct care associate certification for applicants for certification during the period beginning January 1, 2015, and ending December 31, 2016.
   11.  Adopt rules to provide for all of the following during the period beginning January 1, 2015, and ending December 31, 2016:
   a.  Initial voluntary certification of an individual providing direct care services on or before January 1, 2015, as a direct care associate, community living professional, personal support professional, or health support professional, as appropriate, based on an appraisal of documented previous training, employment history, and experience, submitted with the application, in lieu of completion of the education, training, or examination requirements specified for the specific certification pursuant to section 152F.3.
   b.  Initial voluntary certification of an individual who was registered on or before January 1, 2015, and is registered on the date of application for certification on the Iowa direct care worker registry established by the department of inspections and appeals, in lieu of completion of the education, training, and examination requirements specified for the specific certification pursuant to section 152F.3, as a direct care associate or a health support professional, as requested in the application submitted by the individual.
   12.  In collaboration with the direct care worker advisory council established pursuant to 2008 Iowa Acts, chapter 1188, section 69, do all of the following:
   a.  Develop and conduct necessary outreach and education for individuals providing direct care services, consumers, training providers including but not limited to community college health occupation and training centers, employers, and other interested parties to provide information about and the process for participation in direct care professional voluntary certification.
   b.  Determine data collection needs, collect data, and track and analyze data to determine the effect of certification on recruitment and retention, turnover rates, the cost of turnover, consumer and employer satisfaction, and public protection. The analysis of data collected shall also be used to inform changes in the certification system to provide for continuous improvement for direct care professionals, consumers and employers, and the public.
   13.  Provide for maintenance of the information management system to be utilized for application for and renewal of certification, comprehensive workforce data collection and tracking, and a public interface. The public interface shall include but is not limited to searchable information regarding the credential status of each certified direct care professional.
   Sec. ___.  NEW SECTION.  152F.5  Certification suspension and revocation.
   A certification issued by the board under this chapter may be suspended or revoked, or renewal of certification may be denied by the board, for violation of any provision of this chapter, section 147.55 or 272C.10, or rules adopted by the board.
   Sec. ___.  NEW SECTION.  152F.6  Individuals providing direct care services —— disclosure.
   Any individual providing direct care services in this state shall disclose the individual’s level of certification under this chapter to a consumer prior to the initial provision of direct care services to that consumer.
   Sec. ___.  Section 10A.402, subsection 1, Code 2013, is amended to read as follows:
   1.  Investigations relative to the practice of regulated professions and occupations, except those within the jurisdiction of the board of medicine, the board of pharmacy, the dental board, and the board of nursing, and the board of direct care professionals.
   Sec. ___.  Section 135.11A, Code 2013, is amended to read as follows:
   135.11A  Professional licensure division —— other licensing boards —— expenses —— fees.
   1.  There shall be a professional licensure division within the department of public health. Each board under chapter 147 or under the administrative authority of the department, except the board of nursing, board of medicine, dental board, and board of pharmacy,
 
and board of direct care professionals shall receive administrative and clerical support from the division and may not employ its own support staff for administrative and clerical duties.
   2.  The professional licensure division and the licensing boards may expend funds in addition to amounts budgeted, if those additional expenditures are directly the result of actual examination and exceed funds budgeted for examinations. Before the division or a licensing board expends or encumbers an amount in excess of the funds budgeted for examinations, the director of the department of management shall approve the expenditure or encumbrance. Before approval is given, the department of management shall determine that the examination expenses exceed the funds budgeted by the general assembly to the division or board and the division or board does not have other funds from which examination expenses can be paid. Upon approval of the department of management, the division or licensing board may expend and encumber funds for excess examination expenses. The amounts necessary to fund the excess examination expenses shall be collected as fees from additional examination applicants and shall be treated as repayment receipts as defined in section 8.2.
   Sec. ___.  Section 135.31, Code 2013, is amended to read as follows:
   135.31  Location of boards —— rulemaking.
   The offices for the board of medicine, the board of pharmacy, the board of nursing, and the dental board, and the board of direct care professionals shall be located within the department of public health. The individual boards shall have policymaking and rulemaking authority.
   Sec. ___.  Section 147.1, subsections 3 and 6, Code 2013, are amended to read as follows:
   3.  “Licensed” or “certified”, when applied to a physician and surgeon, podiatric physician, osteopathic physician and surgeon, physician assistant, psychologist, chiropractor, nurse, dentist, dental hygienist, dental assistant, optometrist, speech pathologist, audiologist, pharmacist, physical therapist, physical therapist assistant, occupational therapist, occupational therapy assistant, orthotist, prosthetist, pedorthist, respiratory care practitioner, practitioner of cosmetology arts and sciences, practitioner of barbering, funeral director, dietitian, marital and family therapist, mental health counselor, social worker, massage therapist, athletic trainer, acupuncturist, nursing home administrator, hearing aid dispenser, or sign language interpreter or transliterator, or direct care professional means a person licensed under this subtitle.
   6.  “Profession” means medicine and surgery, podiatry, osteopathic medicine and surgery, practice as a physician assistant, psychology, chiropractic, nursing, dentistry, dental hygiene, dental assisting, optometry, speech pathology, audiology, pharmacy, physical therapy, physical therapist assisting, occupational therapy, occupational therapy assisting, respiratory care, cosmetology arts and sciences, barbering, mortuary science, marital and family therapy, mental health counseling, social work, dietetics, massage therapy, athletic training, acupuncture, nursing home administration, hearing aid dispensing, sign language interpreting or transliterating, orthotics, prosthetics, or pedorthics, or practice as a direct care professional.
   Sec. ___.  Section 147.2, subsection 1, Code 2013, is amended to read as follows:
   1.  A person shall not engage in the practice of medicine and surgery, podiatry, osteopathic medicine and surgery, psychology, chiropractic, physical therapy, physical therapist assisting, nursing, dentistry, dental hygiene, dental assisting, optometry, speech pathology, audiology, occupational therapy, occupational therapy assisting, orthotics, prosthetics, pedorthics, respiratory care, pharmacy, cosmetology arts and sciences, barbering, social work, dietetics, marital and family therapy or mental health counseling, massage therapy, mortuary science, athletic training, acupuncture, nursing home administration, hearing aid dispensing, or sign language interpreting or transliterating, or shall not practice as a physician assistant
 
or as a certified direct care professional, unless the person has obtained a license for that purpose from the board for the profession.
   Sec. ___.  Section 147.13, Code 2013, is amended by adding the following new subsection:
   NEW SUBSECTION.  25.  For direct care professionals, the board of direct care professionals.
   Sec. ___.  Section 147.14, subsection 1, Code 2013, is amended by adding the following new paragraph:
   NEW PARAGRAPH.  x.  For the board of direct care professionals, a total of nine members, five of whom are direct care professionals who represent diverse settings and populations served, two members of the public who are consumers or family members of consumers of direct care services, one registered nurse who serves as a direct care instructor, and one human services professional who serves as a direct care instructor.
   Sec. ___.  Section 147.74, Code 2013, is amended by adding the following new subsection:
   NEW SUBSECTION.  23A.  A direct care professional certified under chapter 152F and this chapter may use the following:
   a.  A direct care professional certified as a direct care associate may use the title “direct care associate” or the letters “D.C.A.” after the person’s name.
   b.  A direct care professional certified as a community living professional may use the title “community living professional” or the letters “C.L.P.” after the person’s name.
   c.  A direct care professional certified as a personal support professional may use the title “personal support professional” or the letters “P.S.P.” after the person’s name.
   d.  A direct care professional certified as a health support professional may use the title “health support professional” or the letters “H.S.P.” after the person’s name.
   e.  A direct care professional certified with a specialty endorsement may use the title or letters determined by the specialty endorsement entity and approved by the board of direct care professionals.
   f.  A direct care professional who completes a nurse aide training and competency evaluation program approved by the state as required pursuant to 42 C.F.R. § 483.152 may use the title “certified nursing assistant” or the letters “C.N.A.” after the person’s name.
   Sec. ___.  Section 147.80, subsection 3, Code 2013, is amended to read as follows:
   3.  The board of medicine, the board of pharmacy, the dental board, and the board of nursing, and the board of direct care professionals shall retain individual executive officers, but shall make every effort to share administrative, clerical, and investigative staff to the greatest extent possible.
   Sec. ___.  Section 147.88, Code 2013, is amended to read as follows:
   147.88  Inspections and investigations.
   The department of inspections and appeals may perform inspections and investigations as required by this subtitle, except inspections and investigations for the board of medicine, board of pharmacy, board of nursing, and the dental board, and the board of direct care professionals. The department of inspections and appeals shall employ personnel related to the inspection and investigative functions.
   Sec. ___.  Section 272C.1, subsection 6, Code 2013, is amended by adding the following new paragraph:
   NEW PARAGRAPH.  ag.  The board of direct care professionals, created pursuant to chapter 147.
   Sec. ___.  DEPARTMENT OF INSPECTIONS AND APPEALS —— NURSE AIDE CURRICULUM.  The department of inspections and appeals shall collaborate with the direct care workforce initiative workgroup to ensure that the training curriculum requirements developed for a health support professional credential satisfy the requirements for a nurse aide pursuant to 42 C.F.R. § 483.152. If the training curriculum requirements developed satisfy this standard, beginning January 1, 2015, the department of inspections and appeals shall approve the health support professional training as the approved training curriculum for nurse aides pursuant to 42 C.F.R. § 483.152.
   Sec. ___.  TRANSITION PROVISIONS.  Notwithstanding sections 147.14 and 147.16, for the initial board of direct care professionals, the governor may appoint, subject to confirmation by the senate, in lieu of the five members required to be direct care professionals and the two members required to be direct care instructors, members with employment experience providing direct care services in diverse settings or expertise that is substantially equivalent to the professional requirements for a direct care professional or direct care instructor, as applicable.
   Sec. ___.  IMPLEMENTATION.  The provisions of this division of this Act shall be implemented as follows:
   1.  The sections of this division of this Act relating to the board of direct care professionals including sections 152F.1 and 152F.4, as enacted in this division of this Act; sections 10A.402, 135.11A, 135.31, 147.13, 147.14, 147.80, 147.88, and 272C.1, as amended in this division of this Act; and the section of this division of this Act providing transition provisions relating to the board of direct care professionals shall be implemented so that a board of direct care professionals is appointed no later than December 15, 2013.
   2.  The sections of this division of this Act relating to certification of direct care professionals including sections 152F.2, 152F.3, and 152F.5, as enacted in this division of this Act; and sections 147.1, 147.2, and 147.74, as amended in this division of this Act, shall be implemented so that certification is available beginning no later than January 1, 2015.
   Sec. ___.  FUNDING PROVISIONS.
   1.  The department of public health shall limit the indirect service charge for the board of direct care professionals to not more than fifteen percent.
   2.  It is the intent of the general assembly that the board of direct care professionals be self-sustaining by January 1, 2018.
   Sec. ___.  MEDICAL ASSISTANCE —— PREFERENTIAL RATE FOR CERTIFIED DIRECT CARE PROFESSIONALS.  The department of human services shall review and make recommendations for providing a preferential reimbursement rate under the medical assistance program for services provided by direct care professionals based upon the individual’s level of certification under chapter 152F, as enacted in this division of this Act. The department shall report findings and recommendations to the chairpersons and ranking members of the joint appropriations subcommittee on health and human services by December 15, 2013.
   Sec. ___.  EFFECTIVE UPON ENACTMENT.  This division of this Act, being deemed of immediate importance, takes effect upon enactment.>
   3.  Title page, line 1, after <to> by inserting <direct care services, including>
   4.  Title page, line 3, after <programs> by inserting <, certification of direct care professionals, making penalties applicable, and including effective date provisions>
   5.  By renumbering as necessary.

______________________________
JACK HATCH