Senate Study Bill 3078 - Introduced SENATE FILE _____ BY (PROPOSED COMMITTEE ON STATE GOVERNMENT BILL BY CHAIRPERSON DANIELSON) A BILL FOR An Act relating to direct care professionals including the 1 establishment of a board of direct care professionals, 2 providing for implementation, making penalties applicable, 3 and including effective date provisions. 4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 5 TLSB 5449SC (1) 84 pf/nh

S.F. _____ Section 1. NEW SECTION . 152F.1 Definitions. 1 As used in this chapter, unless the context otherwise 2 requires: 3 1. “Board” means the board of direct care professionals 4 created under chapter 147. 5 2. “Community living professional” means a direct care 6 associate who has completed advanced training and is certified 7 to provide home and community living, instrumental activities 8 of daily living, and personal support services. 9 3. “Direct care associate” means a direct care provider who 10 has completed core training and is certified to provide direct 11 care services in the state. 12 4. “Direct care instructor” means an individual approved 13 by the board to provide direct care instruction to direct care 14 providers and direct care professionals. 15 5. “Direct care professional” means a direct care associate, 16 a community living professional, a health support professional, 17 a personal support professional, or a direct care associate who 18 has received a specialty endorsement. 19 6. “Direct care provider” means an individual who provides 20 direct care services for compensation. 21 7. “Direct care services” means services provided to 22 individuals who are ill or individuals with disabilities, 23 including but not limited to home and community living 24 services, instrumental activities of daily living services, 25 personal activities of daily living services, personal support 26 services, and health monitoring and maintenance services. 27 8. “Direct care trainer” means a direct care instructor who 28 is approved by the board to train instructors. 29 9. “Health monitoring and maintenance services” means 30 medically-oriented services that assist an individual in 31 maintaining the individual’s health including measuring intake 32 and output; providing catheter and ostomy care; collecting 33 specimens; checking vital signs, including temperature, pulse, 34 respiration, and blood pressure; measuring height and weight; 35 -1- LSB 5449SC (1) 84 pf/nh 1/ 10

S.F. _____ performing range of motion exercises; providing assistance with 1 urinary care; and application of thrombo embolic deterrent hose 2 or hot and cold packs. 3 10. “Health support professional” means a direct care 4 associate who has completed advanced training and is certified 5 to provide personal activities of daily living and health 6 monitoring and maintenance services. 7 11. “Home and community living services” means services to 8 enhance or maintain independence of individuals including such 9 activities as helping individuals develop and meet personal 10 goals, providing direct physical and emotional support and 11 assistance for persons with disabilities, utilizing crisis 12 intervention and positive behavior supports, and using and 13 following individual support plans. 14 12. “Instrumental activities of daily living services” means 15 services provided to assist individuals with daily living tasks 16 to allow them to function independently in a home or community 17 setting, including but not limited to assistance with managing 18 money, transportation, light housekeeping, and shopping and 19 cooking. 20 13. “Personal activities of daily living services” means 21 services to assist individuals in meeting basic needs, 22 including but not limited to bathing, back rubs, and skin care; 23 grooming activities; assistance with dressing and undressing; 24 assistance with eating and feeding; assistance with toileting; 25 and assistance with mobility, including transfers, walking, and 26 turning in bed. 27 14. “Personal support professional” means a direct care 28 associate who has completed advanced training and is certified 29 to provide instrumental activities of daily living, personal 30 activities of daily living, and personal support services. 31 15. “Personal support services” means support services 32 provided to an individual as the individual performs personal 33 activities of daily living including but not limited to 34 coaching and prompting, and teaching skills and behaviors. 35 -2- LSB 5449SC (1) 84 pf/nh 2/ 10

S.F. _____ 16. “Specialty endorsement” means an advanced level of 1 certification based on requirements developed by experts in a 2 particular discipline or professional area and approved by the 3 board. 4 Sec. 2. NEW SECTION . 152F.2 Certification required —— 5 exceptions —— use of title. 6 1. Unless otherwise exempt under section 152F.4, beginning 7 January 1, 2014, a direct care provider shall not provide 8 direct care services in this state without being certified as a 9 direct care associate. 10 2. A direct care provider who is not certified pursuant 11 to this chapter shall not use words or titles which imply 12 or represent that the person is certified as a direct care 13 professional under this chapter. 14 3. A direct care associate shall not act as or represent 15 that the person is a direct care professional with advanced 16 training certification or a specialty endorsement, unless the 17 direct care associate is first certified at the appropriate 18 level of certification under this chapter. 19 4. Notwithstanding any provision to the contrary, a person 20 who completes advanced training or meets the requirements for 21 a specialty endorsement is not required to be certified at 22 that level if the person does not act as or represent that the 23 person is certified at that level. Section 147.83 does not 24 apply to a direct care associate who is not certified as a 25 direct care professional with advanced training certification 26 or a specialty endorsement if the direct care associate does 27 not act as or represent that the person is certified at that 28 level. 29 Sec. 3. NEW SECTION . 152F.3 Requirements to obtain 30 certification —— renewal —— continuing education —— reciprocity. 31 1. An applicant for certification as a direct care associate 32 shall present evidence satisfactory to the board that the 33 applicant meets all of the following requirements: 34 a. The applicant has successfully completed the required 35 -3- LSB 5449SC (1) 84 pf/nh 3/ 10

S.F. _____ education for the certification from a board-approved direct 1 care instructor or direct care trainer. 2 b. The applicant has paid all fees required by the board. 3 c. The applicant certifies that the applicant will conduct 4 all professional activities in accordance with standards for 5 professional conduct established by the board. 6 2. An applicant for certification as a direct care 7 professional with advanced training or a specialty endorsement 8 shall present evidence satisfactory to the board that the 9 applicant meets all of the following requirements: 10 a. The applicant has successfully completed the required 11 education for the certification from a board-approved direct 12 care instructor or direct care trainer. 13 b. The applicant has paid all fees required by the board. 14 c. The applicant has passed a state examination approved by 15 the board. 16 d. The applicant certifies that the applicant will conduct 17 all professional activities in accordance with standards for 18 professional conduct established by the board. 19 3. A person shall renew the person’s certification 20 biennially. Prior to such renewal, the person shall present 21 evidence that the person has satisfied continuing education 22 requirements and shall pay a renewal fee as determined by the 23 board. 24 4. The board shall issue the appropriate certification to an 25 applicant who demonstrates experience in direct care services 26 in another state and meets the requirements established by the 27 board for the specific certification. 28 Sec. 4. NEW SECTION . 152F.4 Scope of chapter. 29 The provisions of this chapter do not apply to any of the 30 following: 31 1. A person who is providing direct care services to a 32 family member with or without compensation or through the 33 medical assistance consumer choice option program. 34 2. A person otherwise licensed who is operating within the 35 -4- LSB 5449SC (1) 84 pf/nh 4/ 10

S.F. _____ scope of that license and does not represent to the public that 1 the person is a direct care professional. 2 Sec. 5. NEW SECTION . 152F.5 Duties of the board. 3 The board shall do all of the following: 4 1. Adopt rules consistent with this chapter, chapter 147, 5 and chapter 272C which are necessary for the performance of its 6 duties. 7 2. Adopt rules to provide a transition process that allows 8 direct care providers providing direct care services on or 9 before July 1, 2014, to continue providing direct care services 10 while completing certification under this chapter. A direct 11 care provider subject to the transition process shall complete 12 the requirements for direct care associate certification no 13 later than June 30, 2015. 14 3. Establish standards and guidelines for certification 15 reciprocity. 16 4. Establish standards and guidelines for direct care 17 associates, including minimum curriculum requirements. 18 5. Prepare and conduct, or prescribe, an examination for 19 applicants for certification. 20 6. Establish standards and guidelines for direct care 21 instructors and direct care trainers, including minimum 22 curriculum requirements and continuing education requirements. 23 7. Define educational activities which fulfill continuing 24 education requirements for renewal of certification. 25 8. Establish guidelines for inactive certification status 26 and inactive certification reentry. 27 Sec. 6. NEW SECTION . 152F.6 Certification suspension and 28 revocation. 29 A certification issued by the board under this chapter may be 30 suspended or revoked, or renewal of certification may be denied 31 by the board, for violation of any provision of this chapter, 32 section 147.55 or 272C.10, or rules adopted by the board. 33 Sec. 7. Section 147.1, subsections 3 and 6, Code 2011, are 34 amended to read as follows: 35 -5- LSB 5449SC (1) 84 pf/nh 5/ 10

S.F. _____ 3. “Licensed” or “certified” , when applied to a physician 1 and surgeon, podiatric physician, osteopathic physician and 2 surgeon, physician assistant, psychologist, chiropractor, 3 nurse, dentist, dental hygienist, dental assistant, 4 optometrist, speech pathologist, audiologist, pharmacist, 5 physical therapist, physical therapist assistant, occupational 6 therapist, occupational therapy assistant, respiratory care 7 practitioner, practitioner of cosmetology arts and sciences, 8 practitioner of barbering, funeral director, dietitian, marital 9 and family therapist, mental health counselor, social worker, 10 massage therapist, athletic trainer, acupuncturist, nursing 11 home administrator, hearing aid dispenser, or sign language 12 interpreter or transliterator , or direct care professional 13 means a person licensed under this subtitle. 14 6. “Profession” means medicine and surgery, podiatry, 15 osteopathic medicine and surgery, practice as a physician 16 assistant, psychology, chiropractic, nursing, dentistry, 17 dental hygiene, dental assisting, optometry, speech pathology, 18 audiology, pharmacy, physical therapy, physical therapist 19 assisting, occupational therapy, occupational therapy 20 assisting, respiratory care, cosmetology arts and sciences, 21 barbering, mortuary science, marital and family therapy, mental 22 health counseling, social work, dietetics, massage therapy, 23 athletic training, acupuncture, nursing home administration, 24 hearing aid dispensing, or sign language interpreting or 25 transliterating , or practice as a direct care professional . 26 Sec. 8. Section 147.2, subsection 1, Code 2011, is amended 27 to read as follows: 28 1. A person shall not engage in the practice of medicine 29 and surgery, podiatry, osteopathic medicine and surgery, 30 psychology, chiropractic, physical therapy, physical therapist 31 assisting, nursing, dentistry, dental hygiene, dental 32 assisting, optometry, speech pathology, audiology, occupational 33 therapy, occupational therapy assisting, respiratory care, 34 pharmacy, cosmetology arts and sciences, barbering, social 35 -6- LSB 5449SC (1) 84 pf/nh 6/ 10

S.F. _____ work, dietetics, marital and family therapy or mental health 1 counseling, massage therapy, mortuary science, athletic 2 training, acupuncture, nursing home administration, hearing aid 3 dispensing, or sign language interpreting or transliterating, 4 or shall not practice as a physician assistant or as a direct 5 care professional , unless the person has obtained a license for 6 that purpose from the board for the profession. 7 Sec. 9. Section 147.13, Code 2011, is amended by adding the 8 following new subsection: 9 NEW SUBSECTION . 24. For direct care professionals, the 10 board of direct care professionals. 11 Sec. 10. Section 147.14, subsection 1, Code 2011, is amended 12 by adding the following new paragraph: 13 NEW PARAGRAPH . x. For the board of direct care 14 professionals, a total of nine members, five of whom are 15 direct care professionals who represent diverse settings and 16 populations served, two members of the public, one registered 17 nurse who serves as a direct care instructor, and one human 18 services professional who serves as a direct care instructor. 19 Sec. 11. Section 147.74, Code 2011, is amended by adding the 20 following new subsection: 21 NEW SUBSECTION . 24. A direct care professional certified 22 under chapter 152F and this chapter may use the following: 23 a. A direct care professional certified as a direct care 24 associate may use the title “direct care associate” or D.C.A. 25 after the person’s name. 26 b. A direct care professional certified as a community 27 living professional may use the title “community living 28 professional” or the letters C.L.P. after the person’s name. 29 c. A direct care professional certified as a personal 30 support professional may use the title “personal support 31 professional” or the letters P.S.P. after the person’s name. 32 d. A direct care professional certified as a health support 33 professional may use the title “health support professional” or 34 the letters H.S.P. after the person’s name. 35 -7- LSB 5449SC (1) 84 pf/nh 7/ 10

S.F. _____ e. A direct care professional certified with a specialty 1 endorsement may use the title or letters determined by the 2 specialty endorsement entity and approved by the board of 3 direct care professionals. 4 Sec. 12. Section 272C.1, subsection 6, Code 2011, is amended 5 by adding the following new paragraph: 6 NEW PARAGRAPH . ag. The board of direct care professionals, 7 created pursuant to chapter 147. 8 Sec. 13. TRANSITION PROVISIONS. 9 1. A direct care provider providing direct care services 10 on or before January 1, 2014, may continue providing direct 11 care services while completing certification as required under 12 this Act. The board of direct care professionals shall adopt 13 rules to provide a transition process that allows such direct 14 care providers to complete the requirements for direct care 15 associate certification no later than June 30, 2015. 16 2. Notwithstanding sections 147.14 and 147.16, for the 17 initial board of direct care professionals, the governor may 18 appoint, subject to confirmation by the senate, in lieu of the 19 five members required to be direct care associates and the two 20 members required to be direct care instructors, members with 21 experience and expertise that is substantially equivalent to 22 the professional requirements for a direct care associate or 23 direct care instructor, as applicable. 24 Sec. 14. IMPLEMENTATION. The provisions of this Act shall 25 be implemented as follows: 26 1. The sections of this Act relating to the board of direct 27 care professionals including sections 152F.1 and 152F.5, as 28 enacted in this Act; sections 147.13, 147.14, and 272C.1, 29 as amended in this Act, and as specified in the transition 30 provisions; and the section of this Act providing transition 31 provisions relating to the board shall be implemented so that a 32 board of direct care professionals is appointed no later than 33 December 15, 2012. 34 2. The sections of this Act relating to requirements for 35 -8- LSB 5449SC (1) 84 pf/nh 8/ 10

S.F. _____ certification of direct care professionals including sections 1 152F.2, 152F.3, 152F.4, and 152F.6, as enacted in this Act; 2 and sections 147.1, 147.2, and 147.74, as amended in this Act, 3 shall be implemented so that the requirements are applicable 4 beginning no later than January 1, 2014. 5 Sec. 15. EFFECTIVE UPON ENACTMENT. This Act, being deemed 6 of immediate importance, takes effect upon enactment. 7 EXPLANATION 8 This bill provides for the certification of direct care 9 professionals under new Code chapter 152F. The bill provides 10 definitions relating to levels of certification and services 11 provided, and defines the “board” as the board of direct care 12 professionals. 13 The bill requires individuals who provide direct care 14 services for compensation (direct care providers) to be 15 certified as direct care associates. 16 The bill also provides for advanced training and specialty 17 endorsements as the bases for higher levels of certification. 18 The bill provides requirements for certification, renewal 19 of certification, continuing education, and reciprocity 20 of certification. The bill provides for exemptions 21 from certification and for suspension or revocation of 22 certification. The bill specifies the duties of the board of 23 direct care professionals. 24 The bill makes conforming changes in the Code under 25 Code chapter 147 (general provisions for health-related 26 professions), and Code chapter 272C (regulation of licensed 27 professions and occupations). 28 The bill provides transition provisions for the initial 29 appointment of the board and for application of requirements 30 to direct care providers providing direct care services prior 31 to implementation of direct care professional requirements on 32 January 1, 2014. The bill takes effect upon enactment, but 33 provides for phased-in implementation. 34 The provisions of Code chapters 147 and 272C, including 35 -9- LSB 5449SC (1) 84 pf/nh 9/ 10