S.F. 232 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 choices option” means a service delivery 6 option under the medical assistance home and community-based 7 services waiver program that allows eligible waiver recipients 8 to self-direct personal care, community and employment 9 supports, and individual directed goods and services necessary 10 to remain in the recipient’s home or community. 11 3. “Community living professional” means a direct care 12 associate who has completed advanced training and is certified 13 to provide home and community living, instrumental activities 14 of daily living, and personal support services. 15 4. “Consumer-directed attendant care” means a service 16 delivery option under the medical assistance home and 17 community-based services waiver program that allows eligible 18 waiver recipients to direct and manage the recipient’s own 19 skilled and nonskilled attendant care services necessary to 20 remain in the recipient’s home or community. 21 5. “Core training” means training specified by the board to 22 provide basic foundational knowledge and an introduction to the 23 direct care profession. 24 6. “Direct care associate” means any of the following: 25 a. An individual who has completed core training and is 26 certified to provide direct care services in the state. 27 b. An individual who has completed a nurse aide training 28 and competency evaluation program approved by the state as 29 required pursuant to 42 C.F.R. § 483.152, is registered on the 30 Iowa direct care worker registry established by the department 31 of inspections and appeals, complies with the requirements 32 of section 152F.3, and is certified to provide direct care 33 services in the state. 34 7. “Direct care instructor” means an individual approved 35 -1- LSB 1449XS (14) 85 pf/nh 1/ 18

S.F. 232 by the board to provide direct care instruction to direct care 1 professionals. 2 8. “Direct care professional” means an individual who 3 provides direct care services for compensation and is a direct 4 care associate, a community living professional, a health 5 support professional, or a personal support professional. 6 9. “Direct care services” means the services provided 7 to individuals who have health conditions, are ill, or are 8 individuals with disabilities as specified in the individual’s 9 service plan or in documented goals, including but not limited 10 to home and community living services, instrumental activities 11 of daily living services, personal activities of daily living 12 services, personal support services, and health monitoring and 13 maintenance services. 14 10. “Direct care trainer” means a direct care instructor who 15 is approved by the board to train instructors. 16 11. “Health monitoring and maintenance services” means 17 services provided to support and maintain an individual’s 18 health, including observation and reporting of behaviors 19 or conditions; understanding the causes and symptoms of 20 conditions including but not limited to muscular/skeletal, 21 skin, respiratory system, and neurologic conditions, and 22 diabetes, mental illness, pain, cancer, and intellectual and 23 developmental disabilities; and providing functional support 24 specific to certain conditions. 25 12. “Health support professional” means any of the 26 following: 27 a. A direct care associate who has completed advanced 28 training and is certified to provide personal activities of 29 daily living and health monitoring and maintenance services. 30 b. An individual who has completed a nurse aide training 31 and competency evaluation program approved by the state as 32 required pursuant to 42 C.F.R. § 483.152, is registered on the 33 Iowa direct care worker registry established by the department 34 of inspections and appeals, complies with the requirements of 35 -2- LSB 1449XS (14) 85 pf/nh 2/ 18

S.F. 232 section 152F.3, and is certified to provide personal activities 1 of daily living and health monitoring and maintenance services. 2 13. “Home and community living services” means services to 3 enhance or maintain independence of individuals including such 4 activities as helping individuals develop and meet personal 5 goals, providing direct physical and emotional support and 6 assistance for persons with disabilities, utilizing crisis 7 intervention and positive behavior supports, and using and 8 following individual support plans. 9 14. “Instrumental activities of daily living services” means 10 services provided to assist individuals with daily living tasks 11 to allow them to function independently in a home or community 12 setting, including but not limited to assistance with managing 13 money, transportation, light housekeeping, and shopping and 14 cooking. 15 15. “Personal activities of daily living services” means 16 services to assist individuals in meeting basic needs, 17 including but not limited to bathing, back rubs, and skin care; 18 grooming activities; assistance with dressing and undressing; 19 assistance with eating and feeding; assistance with toileting; 20 and assistance with mobility, including transfers, walking, and 21 turning in bed. 22 16. “Personal support professional” means a direct care 23 associate who has completed advanced training and is certified 24 to provide instrumental activities of daily living, personal 25 activities of daily living, and personal support services. 26 17. “Personal support services” means support services 27 provided to an individual as the individual performs personal 28 activities of daily living including but not limited to 29 coaching and prompting, and teaching skills and behaviors. 30 18. “Service plan” means a written, consumer-centered, 31 outcome-based plan of services. 32 19. “Specialty endorsement” means an advanced level of 33 certification based on requirements developed by experts in a 34 particular discipline or professional area and approved by the 35 -3- LSB 1449XS (14) 85 pf/nh 3/ 18

S.F. 232 board. 1 Sec. 2. NEW SECTION . 152F.2 Certification required —— 2 exceptions —— use of title. 3 1. Unless otherwise exempt under section 152F.4, beginning 4 January 1, 2015, an individual shall not provide direct care 5 services in this state without being certified as a direct care 6 associate. 7 2. An individual who is not certified pursuant to this 8 chapter shall not use words or titles which imply or represent 9 that the individual is certified as a direct care professional 10 under this chapter. 11 3. A direct care associate shall not act as or represent 12 that the individual is a direct care professional with advanced 13 training certification or a specialty endorsement, unless the 14 direct care associate is first certified at the appropriate 15 level of certification under this chapter. 16 4. An individual may voluntarily pursue advanced training 17 or a specialty endorsement under this chapter. Notwithstanding 18 any provision to the contrary, an individual who completes 19 advanced training or satisfies the requirements for a specialty 20 endorsement is not required to be certified at that level if 21 the individual does not act as or represent that the individual 22 is certified at that level. Section 147.83 does not apply 23 to a direct care associate who is not certified as a direct 24 care professional with advanced training certification or a 25 specialty endorsement if the direct care associate does not act 26 as or represent that the individual is certified at that level. 27 Sec. 3. NEW SECTION . 152F.3 Requirements to obtain 28 certification —— renewal —— continuing education —— reciprocity. 29 1. An applicant for certification as a direct care associate 30 shall present evidence satisfactory to the board that the 31 applicant satisfies all of the following requirements: 32 a. The applicant has successfully completed the required 33 education for the certification from a board-approved direct 34 care instructor or direct care trainer; or the individual has 35 -4- LSB 1449XS (14) 85 pf/nh 4/ 18

S.F. 232 completed a nurse aide training and competency evaluation 1 program approved by the state as required pursuant to 42 C.F.R. 2 § 483.152 and is registered on the Iowa direct care worker 3 registry established by the department of inspections and 4 appeals. 5 b. The applicant has paid all fees required by the board. 6 c. The applicant certifies that the applicant will conduct 7 all professional activities in accordance with standards for 8 professional conduct established by the board. 9 2. An applicant for certification as a direct care 10 professional with advanced training or a specialty endorsement 11 shall present evidence satisfactory to the board that the 12 applicant satisfies all of the following requirements: 13 a. The applicant has successfully completed the required 14 education for the certification from a board-approved direct 15 care instructor or direct care trainer. 16 b. The applicant has paid all fees required by the board. 17 c. The applicant has passed a state examination approved by 18 the board. 19 d. The applicant certifies that the applicant will conduct 20 all professional activities in accordance with standards for 21 professional conduct established by the board. 22 3. Notwithstanding subsection 2, an applicant for 23 certification as a health support professional shall present 24 evidence satisfactory to the board that the applicant satisfies 25 all of the following requirements: 26 a. The applicant has complied with one of the following: 27 (1) Successful completion of the required education for 28 the certification from a board-approved direct care instructor 29 or direct care trainer and successful passage of a state 30 examination approved by the board. 31 (2) Successful completion of a nurse aide training and 32 competency evaluation program approved by the state as required 33 pursuant to 42 C.F.R. § 483.152 and registration on the Iowa 34 direct care worker registry established by the department of 35 -5- LSB 1449XS (14) 85 pf/nh 5/ 18

S.F. 232 inspections and appeals. 1 b. The applicant has paid all fees required by the board. 2 c. The applicant certifies that the applicant will conduct 3 all professional activities in accordance with standards for 4 professional conduct established by the board. 5 4. An individual shall renew the individual’s certification 6 biennially. Prior to such renewal, the individual shall 7 present evidence that the individual has satisfied continuing 8 education requirements and shall pay a renewal fee as 9 determined by the board. 10 5. The board shall issue the appropriate certification to an 11 applicant who demonstrates experience in direct care services 12 in another state and satisfies the requirements established by 13 the board for the specific certification. 14 Sec. 4. NEW SECTION . 152F.4 Scope of chapter. 15 1. The provisions of this chapter do not apply to any of the 16 following: 17 a. An individual who is providing direct care services 18 and is governed by a collective bargaining agreement in place 19 before July 1, 2017, until the expiration of such agreement. 20 b. An individual providing direct care services to a family 21 member. However, if public funds are used to provide payment 22 for the direct care services provided by the family member, 23 the family member shall comply with the requirements of this 24 chapter unless otherwise exempt. 25 c. An individual otherwise licensed who is operating within 26 the scope of that license and who does not represent to the 27 public that the individual is a direct care professional. 28 2. a. Notwithstanding any provision of this chapter to the 29 contrary, beginning January 1, 2015, an individual providing 30 direct care services under the medical assistance consumer 31 choices option or the consumer-directed attendant care program 32 is subject to the following: 33 (1) If the provider will provide services to only one 34 medical assistance recipient, the certification requirements of 35 -6- LSB 1449XS (14) 85 pf/nh 6/ 18

S.F. 232 this chapter shall not apply to the provider. 1 (2) If the provider will provide services to more than one 2 medical assistance recipient, the provisions of this chapter 3 shall apply unless all of the following requirements are met: 4 (a) The provider has the necessary competencies and 5 training to deliver the services included in the consumer 6 choices option employment agreement or consumer-directed 7 attendant care agreement. Competencies shall be demonstrated 8 through documentation of prior training and experience or a 9 certificate of formal training as required by rule of the 10 department of human services for the specific program. 11 (b) The medical assistance recipient and the provider 12 sign and submit to the department of human services, with 13 the agreement, a separate written acknowledgment that the 14 recipient acknowledges that the provider has the necessary 15 competencies and training to provide the services specified in 16 the agreement. The written acknowledgment shall be accompanied 17 by documents verifying that the necessary competencies and 18 training requirements have been met. 19 b. This subsection shall not be interpreted as supplanting 20 the medical assistance recipient’s choice to train a provider 21 in a manner that comports with the medical assistance 22 recipient’s personal preferences and needs or to establish 23 additional provider qualifications based on the medical 24 assistance recipient’s needs and preferences. 25 3. This chapter shall not be interpreted to preclude 26 an individual who provides direct care services but is not 27 otherwise required to be certified under this chapter from 28 being certified under this chapter on a voluntary basis. 29 Sec. 5. NEW SECTION . 152F.5 Duties of the board. 30 The board shall do all of the following: 31 1. Adopt rules consistent with this chapter, chapter 147, 32 chapter 272, and the recommendations of the direct care worker 33 advisory council established pursuant to 2008 Iowa Acts, 34 chapter 1188, section 69, including the recommendations in the 35 -7- LSB 1449XS (14) 85 pf/nh 7/ 18

S.F. 232 final report submitted by the advisory council to the governor 1 and the general assembly in March 2012, which are necessary for 2 the performance of its duties. 3 2. Adopt rules to provide a transition process that allows 4 individuals providing direct care services on or before January 5 1, 2015, who are subject to the certification requirements 6 of this chapter, to continue providing direct care services 7 while completing certification under this chapter. The rules 8 shall provide that certification requirements for an individual 9 subject to the transition process are based on consideration 10 of previous training, employment history, and experience. An 11 individual subject to the transition process shall complete the 12 requirements for direct care associate certification within a 13 time frame determined by rule of the board. The rules shall 14 provide for acceptance of prior record checks completed by the 15 individual’s current employer in lieu of new record checks, if 16 the individual has had no gap in employment since completion 17 of the checks. 18 3. Establish standards and guidelines for direct care 19 professionals, including establishing or approving, as 20 applicable, training and curriculum requirements for direct 21 care associates and each advanced training credential and 22 specialty endorsement. 23 a. The curriculum for core training shall provide for 24 its incorporation into and completion through a flexible 25 delivery system, utilizing a variety of settings and methods, 26 as approved by the board, including but not limited to 27 employer-provided training, community college courses, and 28 online training including but not limited to the college of 29 direct support. 30 b. The curriculum requirements for health support 31 professionals shall satisfy the curriculum requirements 32 specified for nurse aides pursuant to 42 C.F.R. § 483.152. 33 c. The training and curriculum requirements approved by 34 the board shall provide for adaptations, accommodations, 35 -8- LSB 1449XS (14) 85 pf/nh 8/ 18

S.F. 232 modifications, and individualization for applicants, based on 1 their needs, abilities, and personal learning styles. 2 4. Require an individual to undergo criminal history 3 and child and dependent adult abuse record checks prior 4 to certification, and establish record checks requirements 5 applicable to direct care professionals consistent with section 6 135C.33. The requirement shall provide for acceptance of prior 7 record checks completed by the individual’s current employer in 8 lieu of new record checks, if the individual has had no gap in 9 employment since completion of the checks. 10 5. Establish child abuse and dependent adult abuse 11 reporting and training requirements consistent with section 12 232.69 and chapters 235B and 235E, as applicable. 13 6. Establish standards and guidelines for certification 14 reciprocity. 15 7. Prepare and conduct, or prescribe, an examination for 16 applicants for certification. 17 8. Establish standards and guidelines for direct care 18 instructors and direct care trainers, including minimum 19 curriculum requirements and continuing education requirements. 20 Training and continuing education guidelines shall provide 21 diverse options for completion of the training and continuing 22 education, as appropriate, including but not limited to online, 23 employer-based, or educational institution-based opportunities. 24 9. Define educational activities which fulfill continuing 25 education requirements for renewal of certification. 26 10. Establish guidelines for inactive certification status 27 and inactive certification reentry. 28 11. Establish a grace period of no less than thirty days 29 during which a newly employed individual may provide direct 30 care services before being required to complete the appropriate 31 level of certification under this chapter. 32 12. Establish the parameters for an exemption from the 33 requirements of this chapter for an individual who provides 34 direct care services in an employment position for not more 35 -9- LSB 1449XS (14) 85 pf/nh 9/ 18

S.F. 232 than ninety days or seven hundred and twenty hours, annually. 1 13. Adopt rules to establish a process for requesting and 2 approving, as a part of the application for certification, a 3 financial hardship exemption from payment of the initial direct 4 care associate certification fee for individual applicants 5 whose income is one hundred percent or less of the federal 6 poverty level as defined by the most recently revised poverty 7 guidelines published by the United States department of health 8 and human services. 9 Sec. 6. NEW SECTION . 152F.6 Certification suspension and 10 revocation. 11 A certification issued by the board under this chapter may be 12 suspended or revoked, or renewal of certification may be denied 13 by the board, for violation of any provision of this chapter, 14 section 147.55 or 272C.10, or rules adopted by the board. 15 Sec. 7. Section 10A.402, subsection 1, Code 2013, is amended 16 to read as follows: 17 1. Investigations relative to the practice of regulated 18 professions and occupations, except those within the 19 jurisdiction of the board of medicine, the board of pharmacy, 20 the dental board, and the board of nursing , and the board of 21 direct care professionals . 22 Sec. 8. Section 135.11A, Code 2013, is amended to read as 23 follows: 24 135.11A Professional licensure division —— other licensing 25 boards —— expenses —— fees. 26 1. There shall be a professional licensure division within 27 the department of public health. Each board under chapter 147 28 or under the administrative authority of the department, except 29 the board of nursing, board of medicine, dental board, and 30 board of pharmacy, and board of direct care professionals shall 31 receive administrative and clerical support from the division 32 and may not employ its own support staff for administrative and 33 clerical duties. 34 2. The professional licensure division and the licensing 35 -10- LSB 1449XS (14) 85 pf/nh 10/ 18

S.F. 232 boards may expend funds in addition to amounts budgeted, if 1 those additional expenditures are directly the result of actual 2 examination and exceed funds budgeted for examinations. Before 3 the division or a licensing board expends or encumbers an 4 amount in excess of the funds budgeted for examinations, the 5 director of the department of management shall approve the 6 expenditure or encumbrance. Before approval is given, the 7 department of management shall determine that the examination 8 expenses exceed the funds budgeted by the general assembly 9 to the division or board and the division or board does not 10 have other funds from which examination expenses can be paid. 11 Upon approval of the department of management, the division 12 or licensing board may expend and encumber funds for excess 13 examination expenses. The amounts necessary to fund the excess 14 examination expenses shall be collected as fees from additional 15 examination applicants and shall be treated as repayment 16 receipts as defined in section 8.2 . 17 Sec. 9. Section 135.31, Code 2013, is amended to read as 18 follows: 19 135.31 Location of boards —— rulemaking. 20 The offices for the board of medicine, the board of pharmacy, 21 the board of nursing, and the dental board , and the board 22 of direct care professionals shall be located within the 23 department of public health. The individual boards shall have 24 policymaking and rulemaking authority. 25 Sec. 10. Section 147.1, subsections 3 and 6, Code 2013, are 26 amended to read as follows: 27 3. “Licensed” or “certified” , when applied to a physician 28 and surgeon, podiatric physician, osteopathic physician and 29 surgeon, physician assistant, psychologist, chiropractor, 30 nurse, dentist, dental hygienist, dental assistant, 31 optometrist, speech pathologist, audiologist, pharmacist, 32 physical therapist, physical therapist assistant, occupational 33 therapist, occupational therapy assistant, orthotist, 34 prosthetist, pedorthist, respiratory care practitioner, 35 -11- LSB 1449XS (14) 85 pf/nh 11/ 18

S.F. 232 practitioner of cosmetology arts and sciences, practitioner 1 of barbering, funeral director, dietitian, marital and 2 family therapist, mental health counselor, social worker, 3 massage therapist, athletic trainer, acupuncturist, nursing 4 home administrator, hearing aid dispenser, or sign language 5 interpreter or transliterator , or direct care professional 6 means a person licensed under this subtitle . 7 6. “Profession” means medicine and surgery, podiatry, 8 osteopathic medicine and surgery, practice as a physician 9 assistant, psychology, chiropractic, nursing, dentistry, 10 dental hygiene, dental assisting, optometry, speech pathology, 11 audiology, pharmacy, physical therapy, physical therapist 12 assisting, occupational therapy, occupational therapy 13 assisting, respiratory care, cosmetology arts and sciences, 14 barbering, mortuary science, marital and family therapy, mental 15 health counseling, social work, dietetics, massage therapy, 16 athletic training, acupuncture, nursing home administration, 17 hearing aid dispensing, sign language interpreting or 18 transliterating, orthotics, prosthetics, or pedorthics , or 19 practice as a direct care professional . 20 Sec. 11. Section 147.2, subsection 1, Code 2013, is amended 21 to read as follows: 22 1. A person shall not engage in the practice of medicine 23 and surgery, podiatry, osteopathic medicine and surgery, 24 psychology, chiropractic, physical therapy, physical 25 therapist assisting, nursing, dentistry, dental hygiene, 26 dental assisting, optometry, speech pathology, audiology, 27 occupational therapy, occupational therapy assisting, 28 orthotics, prosthetics, pedorthics, respiratory care, 29 pharmacy, cosmetology arts and sciences, barbering, social 30 work, dietetics, marital and family therapy or mental health 31 counseling, massage therapy, mortuary science, athletic 32 training, acupuncture, nursing home administration, hearing aid 33 dispensing, or sign language interpreting or transliterating, 34 or shall not practice as a physician assistant or as a direct 35 -12- LSB 1449XS (14) 85 pf/nh 12/ 18

S.F. 232 care professional , unless the person has obtained a license for 1 that purpose from the board for the profession. 2 Sec. 12. Section 147.13, Code 2013, is amended by adding the 3 following new subsection: 4 NEW SUBSECTION . 25. For direct care professionals, the 5 board of direct care professionals. 6 Sec. 13. Section 147.14, subsection 1, Code 2013, is amended 7 by adding the following new paragraph: 8 NEW PARAGRAPH . x. For the board of direct care 9 professionals, a total of eleven members, six of whom are 10 direct care professionals who represent diverse settings and 11 populations served, two members of the public who are consumers 12 or family members of consumers of direct care services, one 13 registered nurse who serves as a direct care instructor, 14 one human services professional who serves as a direct care 15 instructor, and one licensed nursing home administrator. 16 Sec. 14. Section 147.74, Code 2013, is amended by adding the 17 following new subsection: 18 NEW SUBSECTION . 23A. A direct care professional certified 19 under chapter 152F and this chapter may use the following: 20 a. A direct care professional certified as a direct care 21 associate may use the title “direct care associate” or the 22 letters “D.C.A.” after the person’s name. 23 b. A direct care professional certified as a community 24 living professional may use the title “community living 25 professional” or the letters “C.L.P.” after the person’s name. 26 c. A direct care professional certified as a personal 27 support professional may use the title “personal support 28 professional” or the letters “P.S.P.” after the person’s name. 29 d. A direct care professional certified as a health support 30 professional may use the title “health support professional” or 31 the letters “H.S.P.” after the person’s name. 32 e. A direct care professional certified with a specialty 33 endorsement may use the title or letters determined by the 34 specialty endorsement entity and approved by the board of 35 -13- LSB 1449XS (14) 85 pf/nh 13/ 18

S.F. 232 direct care professionals. 1 f. A direct care professional who completes a nurse aide 2 training and competency evaluation program approved by the 3 state as required pursuant to 42 C.F.R. § 483.152 may use the 4 title “certified nursing assistant” or the letters “C.N.A.” 5 after the person’s name. 6 Sec. 15. Section 147.80, subsection 3, Code 2013, is amended 7 to read as follows: 8 3. The board of medicine, the board of pharmacy, the dental 9 board, and the board of nursing , and the board of direct care 10 professionals shall retain individual executive officers, but 11 shall make every effort to share administrative, clerical, and 12 investigative staff to the greatest extent possible. 13 Sec. 16. Section 147.88, Code 2013, is amended to read as 14 follows: 15 147.88 Inspections and investigations. 16 The department of inspections and appeals may perform 17 inspections and investigations as required by this subtitle, 18 except inspections and investigations for the board of 19 medicine, board of pharmacy, board of nursing, and the dental 20 board , and the board of direct care professionals . The 21 department of inspections and appeals shall employ personnel 22 related to the inspection and investigative functions. 23 Sec. 17. Section 272C.1, subsection 6, Code 2013, is amended 24 by adding the following new paragraph: 25 NEW PARAGRAPH . ag. The board of direct care professionals, 26 created pursuant to chapter 147. 27 Sec. 18. MEDICAL ASSISTANCE CONSUMER-DIRECTED ATTENDANT 28 CARE PROGRAM AND CONSUMER CHOICES OPTION —— RULES. The 29 department of human services shall adopt rules for the medical 30 assistance consumer-directed attendant care and consumer 31 choices options programs as follows: 32 1. To specify the necessary competencies and training that 33 a provider is required to demonstrate to deliver the specific 34 services included in a consumer choices option employment 35 -14- LSB 1449XS (14) 85 pf/nh 14/ 18

S.F. 232 agreement or consumer-directed attendant care agreement, 1 and the documentation necessary to demonstrate the required 2 competencies or training. The competencies shall be consistent 3 with those specified for direct care professionals under 4 chapter 152F, as enacted in this Act, relative to the types of 5 services to be provided. 6 2. To require that the medical assistance recipient and 7 the provider sign and submit to the department of human 8 services, with the consumer choices option employment agreement 9 or consumer-directed attendant care agreement, a separate 10 written acknowledgment that the recipient acknowledges that the 11 provider has the necessary competencies and training to provide 12 the services specified in the agreement. 13 Sec. 19. DEPARTMENT OF INSPECTIONS AND APPEALS —— NURSE AIDE 14 CURRICULUM. The department of inspections and appeals shall 15 collaborate with the direct care workforce initiative workgroup 16 to ensure that the training curriculum requirements developed 17 for a health support professional credential satisfy the 18 requirements for a nurse aide pursuant to 42 C.F.R. § 483.152. 19 If the training curriculum requirements developed satisfy 20 this standard, beginning January 1, 2015, the department of 21 inspections and appeals shall approve the health support 22 professional training as the approved training curriculum for 23 nurse aides pursuant to 42 C.F.R. § 483.152. 24 Sec. 20. TRANSITION PROVISIONS. 25 1. An individual providing direct care services on or 26 before January 1, 2015, who is subject to the certification 27 requirements of this Act, may continue providing direct care 28 services while completing certification as required under this 29 Act. The board of direct care professionals shall adopt rules 30 to provide that certification requirements for an individual 31 subject to the transition process are based on consideration 32 of previous training, employment history, and experience, and 33 require such individuals to complete the requirements for 34 direct care associate certification within the time frame 35 -15- LSB 1449XS (14) 85 pf/nh 15/ 18

S.F. 232 determined by rule of the board. 1 2. An individual who is registered on or before January 2 1, 2015, on the Iowa direct care worker registry established 3 by the department of inspections and appeals, is deemed to 4 satisfy the certification requirements for a health support 5 professional under this Act and, notwithstanding any provision 6 of this Act to the contrary, shall, upon application, be issued 7 initial certification as a direct care associate or a health 8 support professional, as requested by the individual. 9 3. Notwithstanding sections 147.14 and 147.16, for the 10 initial board of direct care professionals, the governor may 11 appoint, subject to confirmation by the senate, in lieu of the 12 six members required to be direct care professionals and the 13 two members required to be direct care instructors, members 14 with employment experience providing direct care services in 15 diverse settings or expertise that is substantially equivalent 16 to the professional requirements for a direct care professional 17 or direct care instructor, as applicable. 18 Sec. 21. IMPLEMENTATION. The provisions of this Act shall 19 be implemented as follows: 20 1. The sections of this Act relating to the board of direct 21 care professionals including sections 152F.1 and 152F.5, as 22 enacted in this Act; sections 10A.402, 135.11A, 135.31, 147.13, 23 147.14, 147.80, 147.88, and 272C.1, as amended in this Act, 24 and as specified in the transition provisions; and the section 25 of this Act providing transition provisions relating to the 26 board shall be implemented so that a board of direct care 27 professionals is appointed no later than December 15, 2013. 28 2. The sections of this Act relating to requirements for 29 certification of direct care professionals including sections 30 152F.2, 152F.3, 152F.4, and 152F.6, as enacted in this Act; 31 and sections 147.1, 147.2, and 147.74, as amended in this Act, 32 shall be implemented so that the requirements are applicable 33 beginning no later than January 1, 2015. 34 Sec. 22. FUNDING PROVISIONS. 35 -16- LSB 1449XS (14) 85 pf/nh 16/ 18

S.F. 232 1. The department of public health shall limit the indirect 1 service charge for the board of direct care professionals to 2 not more than fifteen percent. 3 2. It is the intent of the general assembly that the board 4 of direct care professionals be self-sustaining by January 1, 5 2018. 6 Sec. 23. MEDICAL ASSISTANCE —— PREFERENTIAL RATE FOR 7 CERTIFIED DIRECT CARE PROFESSIONALS. The department 8 of human services shall review the feasibility of and 9 benefits to the medical assistance program in providing a 10 preferential reimbursement rate for services provided by 11 direct care professionals based upon the individual’s level 12 of certification. The department shall report findings and 13 recommendations to the chairpersons and ranking members of the 14 joint appropriations subcommittee on health and human services 15 by December 15, 2013. 16 Sec. 24. EFFECTIVE UPON ENACTMENT. This Act, being deemed 17 of immediate importance, takes effect upon enactment. 18 EXPLANATION 19 This bill provides for the certification of direct care 20 professionals under new Code chapter 152F. The bill provides 21 definitions relating to levels of certification and services 22 provided, and defines the “board” as the board of direct care 23 professionals. 24 The bill requires individuals who provide direct care 25 services for compensation (direct care professionals) to be 26 certified as direct care associates. 27 The bill also provides for advanced training and specialty 28 endorsements as the bases for higher levels of certification. 29 The bill provides requirements for certification, renewal 30 of certification, continuing education, and reciprocity 31 of certification. The bill provides for exemptions 32 from certification and for suspension or revocation of 33 certification. The bill specifies the duties of the board of 34 direct care professionals. 35 -17- LSB 1449XS (14) 85 pf/nh 17/ 18

S.F. 232 The bill makes conforming changes in the Code including 1 those under Code chapter 147 (general provisions for 2 health-related professions), and Code chapter 272C (regulation 3 of licensed professions and occupations). 4 The bill provides transition provisions for the initial 5 appointment of the board and for application of requirements to 6 direct care professionals providing direct care services prior 7 to implementation of direct care professional requirements on 8 January 1, 2015. The bill takes effect upon enactment, but 9 provides for phased-in implementation. 10 The provisions of Code chapters 147 and 272C, including 11 a provision in Code section 147.86 that a violation of Code 12 chapter 147 or new Code chapter 152F is a serious misdemeanor, 13 are applicable to new Code chapter 152F. 14 -18- LSB 1449XS (14) 85 pf/nh 18/ 18