House
File
803
-
Introduced
HOUSE
FILE
803
BY
COMMITTEE
ON
HUMAN
RESOURCES
(SUCCESSOR
TO
HSB
255)
A
BILL
FOR
An
Act
relating
to
duties
performed
by
physician
assistants.
1
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
2
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Section
1.
Section
90A.1,
Code
2021,
is
amended
by
adding
1
the
following
new
subsections:
2
NEW
SUBSECTION
.
5A.
“Physician”
means
a
person
licensed
as
3
a
physician
pursuant
to
chapter
148.
4
NEW
SUBSECTION
.
5B.
“Physician
assistant”
means
a
person
5
licensed
as
a
physician
assistant
pursuant
to
chapter
148C.
6
Sec.
2.
Section
90A.8,
Code
2021,
is
amended
to
read
as
7
follows:
8
90A.8
Required
conditions
for
boxing
matches.
9
1.
A
boxing
match
shall
be
not
more
than
fifteen
rounds
in
10
length
and
the
contestants
shall
wear
gloves
weighing
at
least
11
eight
ounces
during
such
contests.
The
commissioner
may
adopt
12
rules
requiring
more
stringent
procedures
for
specific
types
13
of
boxing.
14
2.
A
contestant
shall
not
take
part
in
a
boxing
match
15
unless
the
contestant
has
presented
a
valid
registration
16
identification
card
issued
pursuant
to
section
90A.3
to
the
17
commissioner
prior
to
the
weigh-in
for
the
boxing
match.
18
The
contestant
shall
pass
a
rigorous
physical
examination
19
to
determine
the
contestant’s
fitness
to
engage
in
any
such
20
match
within
twenty-four
hours
of
the
start
of
the
match.
21
The
examination
shall
be
conducted
by
a
licensed
practicing
22
physician
or
physician
assistant
designated
or
authorized
by
23
the
commissioner.
24
Sec.
3.
Section
135.109,
subsection
3,
paragraph
b,
Code
25
2021,
is
amended
to
read
as
follows:
26
b.
A
licensed
physician
,
physician
assistant,
or
nurse
who
27
is
knowledgeable
concerning
domestic
abuse
injuries
and
deaths,
28
including
suicides.
29
Sec.
4.
Section
135.146,
subsection
2,
Code
2021,
is
amended
30
to
read
as
follows:
31
2.
Participation
in
the
vaccination
program
shall
be
32
voluntary,
except
for
first
responders
who
are
classified
33
as
having
occupational
exposure
to
blood-borne
pathogens
as
34
defined
by
the
occupational
safety
and
health
administration
35
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standard
contained
in
29
C.F.R.
§1910.1030
.
First
responders
1
who
are
so
classified
shall
be
required
to
receive
the
2
vaccinations
as
described
in
subsection
1
.
A
first
responder
3
shall
be
exempt
from
this
requirement,
however,
when
a
4
written
statement
from
a
licensed
physician
or
physician
5
assistant
is
presented
indicating
that
a
vaccine
is
medically
6
contraindicated
for
that
person
or
the
first
responder
signs
7
a
written
statement
that
the
administration
of
a
vaccination
8
conflicts
with
religious
tenets.
9
Sec.
5.
Section
135J.1,
Code
2021,
is
amended
by
adding
the
10
following
new
subsection:
11
NEW
SUBSECTION
.
01.
“Attending
physician”
means
a
physician
12
licensed
pursuant
to
chapter
148
or
a
physician
assistant
13
licensed
pursuant
to
chapter
148C.
14
Sec.
6.
Section
135J.1,
subsection
6,
paragraph
e,
Code
15
2021,
is
amended
to
read
as
follows:
16
e.
As
deemed
appropriate
by
the
hospice,
physician
17
assistants,
providers
of
special
services
including
but
18
not
limited
to
a
spiritual
counselor,
a
pharmacist,
or
19
professionals
in
the
fields
of
mental
health
may
be
included
20
on
the
interdisciplinary
team.
21
Sec.
7.
Section
135J.3,
subsections
1
and
4,
Code
2021,
are
22
amended
to
read
as
follows:
23
1.
A
planned
program
of
hospice
care,
the
medical
components
24
of
which
shall
be
under
the
direction
of
a
licensed
an
25
attending
physician.
26
4.
Palliative
care
provided
to
a
hospice
patient
and
family
27
under
the
direction
of
a
licensed
an
attending
physician.
28
Sec.
8.
Section
141A.5,
subsection
2,
paragraph
c,
Code
29
2021,
is
amended
to
read
as
follows:
30
c.
(1)
Devise
a
procedure,
as
a
part
of
the
partner
31
notification
program,
to
provide
for
the
notification
of
an
32
identifiable
third
party
who
is
a
sexual
partner
of
or
who
33
shares
drug
injecting
equipment
with
a
person
who
has
tested
34
positive
for
HIV,
by
the
department
or
a
physician
or
physician
35
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assistant
,
when
all
of
the
following
situations
exist:
1
(a)
A
physician
or
physician
assistant
for
the
infected
2
person
is
of
the
good
faith
opinion
that
the
nature
of
the
3
continuing
contact
poses
an
imminent
danger
of
HIV
transmission
4
to
the
third
party.
5
(b)
When
the
physician
or
physician
assistant
believes
6
in
good
faith
that
the
infected
person,
despite
strong
7
encouragement,
has
not
and
will
not
warn
the
third
party
and
8
will
not
participate
in
the
voluntary
partner
notification
9
program.
10
(2)
Notwithstanding
subsection
3
,
the
department
or
a
11
physician
or
physician
assistant
may
reveal
the
identity
of
a
12
person
who
has
tested
positive
for
HIV
infection
pursuant
to
13
this
subsection
only
to
the
extent
necessary
to
protect
a
third
14
party
from
the
direct
threat
of
transmission.
This
subsection
15
shall
not
be
interpreted
to
create
a
duty
to
warn
third
parties
16
of
the
danger
of
exposure
to
HIV
through
contact
with
a
person
17
who
tests
positive
for
HIV
infection.
18
(3)
The
department
shall
adopt
rules
pursuant
to
chapter
19
17A
to
implement
this
paragraph
“c”
.
The
rules
shall
provide
a
20
detailed
procedure
by
which
the
department
or
a
physician
or
21
physician
assistant
may
directly
notify
an
endangered
third
22
party.
23
Sec.
9.
Section
141A.6,
subsections
3
and
4,
Code
2021,
are
24
amended
to
read
as
follows:
25
3.
Within
seven
days
of
diagnosing
a
person
as
having
AIDS
26
or
an
AIDS-related
condition,
the
diagnosing
physician
or
27
physician
assistant
shall
make
a
report
to
the
department
on
a
28
form
provided
by
the
department.
29
4.
Within
seven
days
of
the
death
of
a
person
with
HIV
30
infection,
the
attending
physician
or
attending
physician
31
assistant
shall
make
a
report
to
the
department
on
a
form
32
provided
by
the
department.
33
Sec.
10.
Section
141A.7,
subsection
3,
Code
2021,
is
amended
34
to
read
as
follows:
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3.
A
person
may
apply
for
voluntary
treatment,
1
contraceptive
services,
or
screening
or
treatment
for
HIV
2
infection
and
other
sexually
transmitted
diseases
directly
to
a
3
licensed
physician
and
surgeon,
an
osteopathic
physician
and
4
surgeon,
a
physician
assistant,
or
a
family
planning
clinic.
5
Notwithstanding
any
other
provision
of
law,
however,
a
minor
6
shall
be
informed
prior
to
testing
that,
upon
confirmation
7
according
to
prevailing
medical
technology
of
a
positive
8
HIV-related
test
result,
the
minor’s
legal
guardian
is
required
9
to
be
informed
by
the
testing
facility.
Testing
facilities
10
where
minors
are
tested
shall
have
available
a
program
to
11
assist
minors
and
legal
guardians
with
the
notification
process
12
which
emphasizes
the
need
for
family
support
and
assists
in
13
making
available
the
resources
necessary
to
accomplish
that
14
goal.
However,
a
testing
facility
which
is
precluded
by
15
federal
statute,
regulation,
or
centers
for
disease
control
16
and
prevention
guidelines
from
informing
the
legal
guardian
17
is
exempt
from
the
notification
requirement.
The
minor
shall
18
give
written
consent
to
these
procedures
and
to
receive
the
19
services,
screening,
or
treatment.
Such
consent
is
not
subject
20
to
later
disaffirmance
by
reason
of
minority.
21
Sec.
11.
Section
144A.2,
Code
2021,
is
amended
by
adding
the
22
following
new
subsections:
23
NEW
SUBSECTION
.
2A.
“Attending
physician
assistant”
means
24
the
physician
assistant
selected
by,
or
assigned
to,
the
25
patient
who
has
primary
responsibility
for
the
treatment
and
26
care
of
the
patient.
27
NEW
SUBSECTION
.
10A.
“Physician
assistant”
means
a
person
28
licensed
to
practice
as
a
physician
assistant
in
this
state.
29
Sec.
12.
Section
144A.4,
Code
2021,
is
amended
to
read
as
30
follows:
31
144A.4
Revocation
of
declaration.
32
1.
A
declaration
may
be
revoked
at
any
time
and
in
any
33
manner
by
which
the
declarant
is
able
to
communicate
the
34
declarant’s
intent
to
revoke,
without
regard
to
mental
or
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physical
condition.
A
revocation
is
only
effective
as
to
1
the
attending
physician
or
attending
physician
assistant
2
upon
communication
to
such
physician
or
physician
assistant
3
by
the
declarant
or
by
another
to
whom
the
revocation
was
4
communicated.
5
2.
The
attending
physician
or
attending
physician
assistant
6
shall
make
the
revocation
a
part
of
the
declarant’s
medical
7
record.
8
Sec.
13.
Section
144A.7A,
subsection
1,
Code
2021,
is
9
amended
to
read
as
follows:
10
1.
If
an
attending
physician
or
attending
physician
11
assistant
issues
an
out-of-hospital
do-not-resuscitate
order
12
for
an
adult
patient
under
this
section
,
the
physician
shall
13
use
the
form
prescribed
pursuant
to
subsection
2
,
include
a
14
copy
of
the
order
in
the
patient’s
medical
record,
and
provide
15
a
copy
to
the
patient
or
an
individual
authorized
to
act
on
the
16
patient’s
behalf.
17
Sec.
14.
Section
144A.7A,
subsection
3,
paragraph
e,
Code
18
2021,
is
amended
to
read
as
follows:
19
e.
The
physician’s
or
physician
assistant’s
signature.
20
Sec.
15.
Section
144B.1,
subsection
3,
Code
2021,
is
amended
21
to
read
as
follows:
22
3.
“Durable
power
of
attorney
for
health
care”
means
a
23
document
authorizing
an
attorney
in
fact
to
make
health
care
24
decisions
for
the
principal
if
the
principal
is
unable,
in
the
25
judgment
of
the
attending
physician
or
attending
physician
26
assistant
,
to
make
health
care
decisions.
27
Sec.
16.
Section
144B.5,
subsection
1,
Code
2021,
is
amended
28
to
read
as
follows:
29
1.
A
durable
power
of
attorney
for
health
care
executed
30
pursuant
to
this
chapter
may,
but
need
not,
be
in
the
following
31
form:
32
I
hereby
designate
........
as
my
attorney
in
fact
(my
33
agent)
and
give
to
my
agent
the
power
to
make
health
care
34
decisions
for
me.
This
power
exists
only
when
I
am
unable,
in
35
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the
judgment
of
my
attending
physician
or
attending
physician
1
assistant
,
to
make
those
health
care
decisions.
The
attorney
2
in
fact
must
act
consistently
with
my
desires
as
stated
in
this
3
document
or
otherwise
made
known.
4
Except
as
otherwise
specified
in
this
document,
this
document
5
gives
my
agent
the
power,
where
otherwise
consistent
with
the
6
law
of
this
state,
to
consent
to
my
physician
or
physician
7
assistant
not
giving
health
care
or
stopping
health
care
which
8
is
necessary
to
keep
me
alive.
9
This
document
gives
my
agent
power
to
make
health
care
10
decisions
on
my
behalf,
including
to
consent,
to
refuse
to
11
consent,
or
to
withdraw
consent
to
the
provision
of
any
care,
12
treatment,
service,
or
procedure
to
maintain,
diagnose,
or
13
treat
a
physical
or
mental
condition.
This
power
is
subject
14
to
any
statement
of
my
desires
and
any
limitations
included
in
15
this
document.
16
My
agent
has
the
right
to
examine
my
medical
records
and
to
17
consent
to
disclosure
of
such
records.
18
Sec.
17.
Section
144B.6,
subsection
1,
Code
2021,
is
amended
19
to
read
as
follows:
20
1.
Unless
the
district
court
sitting
in
equity
specifically
21
finds
that
the
attorney
in
fact
is
acting
in
a
manner
contrary
22
to
the
wishes
of
the
principal
or
the
durable
power
of
attorney
23
for
health
care
provides
otherwise,
an
attorney
in
fact
who
24
is
known
to
the
health
care
provider
to
be
available
and
25
willing
to
make
health
care
decisions
has
priority
over
any
26
other
person,
including
a
guardian
appointed
pursuant
to
27
chapter
633
,
to
act
for
the
principal
in
all
matters
of
health
28
care
decisions.
The
attorney
in
fact
has
authority
to
make
29
a
particular
health
care
decision
only
if
the
principal
is
30
unable,
in
the
judgment
of
the
attending
physician
or
attending
31
physician
assistant
,
to
make
the
health
care
decision.
If
the
32
principal
objects
to
a
decision
to
withhold
or
withdraw
health
33
care,
the
principal
shall
be
presumed
to
be
able
to
make
a
34
decision.
35
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Sec.
18.
Section
144D.4,
subsection
3,
Code
2021,
is
amended
1
to
read
as
follows:
2
3.
If
the
individual’s
physician
or
physician
assistant
has
3
issued
an
out-of-hospital
do-not-resuscitate
order
pursuant
4
to
section
144A.7A
,
the
POST
form
shall
not
supersede
the
5
out-of-hospital
do-not-resuscitate
order.
6
Sec.
19.
Section
144F.2,
subsection
1,
paragraph
b,
Code
7
2021,
is
amended
to
read
as
follows:
8
b.
A
legal
representative
who
is
an
agent
under
a
durable
9
power
of
attorney
for
health
care
pursuant
to
chapter
144B
10
shall
be
given
the
opportunity
to
designate
a
lay
caregiver
11
in
lieu
of
the
patient’s
designation
of
a
lay
caregiver
only
12
if,
consistent
with
chapter
144B
,
in
the
judgment
of
the
13
attending
physician
or
attending
physician
assistant
,
the
14
patient
is
unable
to
make
the
health
care
decision.
A
legal
15
representative
who
is
a
guardian
shall
be
given
the
opportunity
16
to
designate
a
lay
caregiver
in
lieu
of
the
patient’s
17
designation
of
a
lay
caregiver
to
the
extent
consistent
with
18
the
powers
and
duties
granted
the
guardian
pursuant
to
section
19
633.635
.
20
Sec.
20.
Section
189A.6,
Code
2021,
is
amended
to
read
as
21
follows:
22
189A.6
Health
examination
of
employees.
23
The
operator
of
any
establishment
shall
require
all
24
employees
of
such
establishment
to
have
a
health
examination
25
by
a
physician
or
physician
assistant
and
a
certified
health
26
certificate
for
each
employee
shall
be
kept
on
file
by
the
27
operator.
The
secretary
may
at
any
time
require
an
employee
28
of
an
establishment
to
submit
to
a
health
examination
by
a
29
physician
or
physician
assistant
.
No
person
suffering
from
30
any
communicable
disease,
including
any
communicable
skin
31
disease,
and
no
person
with
infected
wounds,
and
no
person
who
32
is
a
“carrier”
of
a
communicable
disease
shall
be
employed
in
33
any
capacity
in
an
establishment.
No
person
shall
work
or
34
be
employed
in
or
about
any
establishment
during
the
time
in
35
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which
a
communicable
disease
exists
in
the
home
in
which
such
1
person
resides
unless
such
person
has
obtained
a
certificate
2
from
a
physician
or
physician
assistant
to
the
effect
that
3
no
danger
of
public
contagion
or
infection
will
result
from
4
the
employment
of
such
person
in
such
establishment.
Every
5
person
employed
by
an
establishment
and
engaged
in
direct
6
physical
contact
with
meat
or
poultry
products
during
its
7
preparation,
processing,
or
storage,
shall
be
clean
in
person,
8
wear
clean
washable
outer
garments
and
a
suitable
cap
or
other
9
head
covering
used
exclusively
in
such
work.
Only
persons
10
specifically
designated
by
the
operator
of
an
establishment
11
shall
be
permitted
to
touch
meat
or
poultry
products
with
their
12
hands,
and
the
persons
so
designated
shall
keep
their
hands
13
scrupulously
clean.
14
Sec.
21.
Section
225.9,
Code
2021,
is
amended
to
read
as
15
follows:
16
225.9
Voluntary
private
patients.
17
Voluntary
private
patients
may
be
admitted
in
accordance
18
with
the
regulations
to
be
established
by
the
state
board
of
19
regents,
and
their
care,
nursing,
observation,
treatment,
20
medicine,
and
maintenance
shall
be
without
expense
to
21
the
state.
However,
the
charge
for
such
care,
nursing,
22
observation,
treatment,
medicine,
and
maintenance
shall
not
23
exceed
the
cost
of
the
same
to
the
state.
The
physicians
or
24
physician
assistants
who
meet
the
qualifications
set
forth
25
in
the
definition
of
a
mental
health
professional
in
section
26
228.1
on
the
hospital
staff
may
charge
such
patients
for
27
their
medical
services
under
such
rules,
regulations
and
plan
28
therefor
as
approved
by
the
state
board
of
regents.
29
Sec.
22.
Section
225.10,
unnumbered
paragraph
1,
Code
2021,
30
is
amended
to
read
as
follows:
31
Persons
suffering
from
mental
diseases
may
be
admitted
to
32
the
state
psychiatric
hospital
as
voluntary
public
patients
33
if
a
physician
authorized
to
practice
medicine
or
osteopathic
34
medicine
in
the
state
of
Iowa
or
a
physician
assistant
who
35
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803
meets
the
qualifications
set
forth
in
the
definition
of
a
1
mental
health
professional
in
section
228.1
files
information
2
with
the
regional
administrator
for
the
person’s
county
of
3
residence,
stating
all
of
the
following:
4
Sec.
23.
Section
225.10,
subsections
1
and
2,
Code
2021,
are
5
amended
to
read
as
follows:
6
1.
That
the
physician
or
physician
assistant
has
examined
7
the
person
and
finds
that
the
person
is
suffering
from
some
8
abnormal
mental
condition
that
can
probably
be
remedied
by
9
observation,
treatment,
and
hospital
care.
10
2.
That
the
physician
or
physician
assistant
believes
11
it
would
be
appropriate
for
the
person
to
enter
the
state
12
psychiatric
hospital
for
that
purpose
and
that
the
person
is
13
willing
to
do
so.
14
Sec.
24.
Section
225.12,
Code
2021,
is
amended
to
read
as
15
follows:
16
225.12
Voluntary
public
patient
——
physician’s
report.
17
A
physician
or
a
physician
assistant
who
meets
the
18
qualifications
set
forth
in
the
definition
of
a
mental
health
19
professional
in
section
228.1
filing
information
under
20
section
225.10
shall
include
a
written
report
to
the
regional
21
administrator
for
the
county
of
residence
of
the
person
named
22
in
the
information,
giving
a
history
of
the
case
as
will
be
23
likely
to
aid
in
the
observation,
treatment,
and
hospital
care
24
of
the
person
and
describing
the
history
in
detail.
25
Sec.
25.
Section
225.15,
subsection
1,
Code
2021,
is
amended
26
to
read
as
follows:
27
1.
When
a
respondent
arrives
at
the
state
psychiatric
28
hospital,
the
admitting
physician
,
or
a
physician
assistant
29
who
meets
the
qualifications
set
forth
in
the
definition
30
of
a
mental
health
professional
in
section
228.1,
shall
31
examine
the
respondent
and
determine
whether
or
not,
in
the
32
physician’s
or
physician
assistant’s
judgment,
the
respondent
33
is
a
fit
subject
for
observation,
treatment,
and
hospital
34
care.
If,
upon
examination,
the
physician
or
physician
35
-9-
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803
assistant
decides
that
the
respondent
should
be
admitted
to
the
1
hospital,
the
respondent
shall
be
provided
a
proper
bed
in
the
2
hospital.
The
physician
or
physician
assistant
who
has
charge
3
of
the
respondent
shall
proceed
with
observation,
medical
4
treatment,
and
hospital
care
as
in
the
physician’s
or
physician
5
assistant’s
judgment
are
proper
and
necessary,
in
compliance
6
with
sections
229.13
to
229.16
.
After
the
respondent’s
7
admission,
the
observation,
medical
treatment,
and
hospital
8
care
of
the
respondent
may
be
provided
by
a
mental
health
9
professional,
as
defined
in
section
228.1
,
who
is
licensed
as
a
10
physician,
advanced
registered
nurse
practitioner,
or
physician
11
assistant.
12
Sec.
26.
Section
225.16,
subsection
1,
Code
2021,
is
amended
13
to
read
as
follows:
14
1.
If
the
regional
administrator
for
a
person’s
county
15
of
residence
finds
from
the
physician’s
information
or
16
from
the
information
of
a
physician
assistant
who
meets
the
17
qualifications
set
forth
in
the
definition
of
a
mental
health
18
professional
in
section
228.1
which
was
filed
under
the
19
provisions
of
section
225.10
that
it
would
be
appropriate
for
20
the
person
to
be
admitted
to
the
state
psychiatric
hospital,
21
and
the
report
of
the
regional
administrator
made
pursuant
to
22
section
225.13
shows
that
the
person
and
those
who
are
legally
23
responsible
for
the
person
are
not
able
to
pay
the
expenses
24
incurred
at
the
hospital,
or
are
able
to
pay
only
a
part
of
25
the
expenses,
the
person
shall
be
considered
to
be
a
voluntary
26
public
patient
and
the
regional
administrator
shall
direct
that
27
the
person
shall
be
sent
to
the
state
psychiatric
hospital
at
28
the
state
university
of
Iowa
for
observation,
treatment,
and
29
hospital
care.
30
Sec.
27.
Section
225C.14,
subsection
2,
Code
2021,
is
31
amended
to
read
as
follows:
32
2.
As
used
in
this
section
and
sections
225C.15
,
225C.16
,
33
and
225C.17
,
the
term
“medical
emergency”
means
a
situation
34
in
which
a
prospective
patient
is
received
at
a
state
mental
35
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803
health
institute
in
a
condition
which,
in
the
opinion
of
the
1
chief
medical
officer,
or
that
officer’s
physician
or
physician
2
assistant
designee,
provided
that
a
physician
assistant
3
designee
meets
the
qualifications
set
forth
in
the
definition
4
of
a
mental
health
professional
in
section
228.1,
requires
the
5
immediate
admission
of
the
person
notwithstanding
the
policy
6
stated
in
subsection
1
.
7
Sec.
28.
Section
225C.16,
subsection
1,
Code
2021,
is
8
amended
to
read
as
follows:
9
1.
The
chief
medical
officer
of
a
state
mental
health
10
institute,
or
that
officer’s
physician
or
physician
assistant
11
designee,
provided
that
a
physician
assistant
designee
meets
12
the
qualifications
set
forth
in
the
definition
of
a
mental
13
health
professional
in
section
228.1,
shall
advise
a
person
14
residing
in
that
county
who
applies
for
voluntary
admission,
or
15
a
person
applying
for
the
voluntary
admission
of
another
person
16
who
resides
in
that
county,
in
accordance
with
section
229.41
,
17
that
the
regional
administrator
for
the
county
has
implemented
18
the
policy
stated
in
section
225C.14
,
and
shall
advise
that
a
19
preliminary
diagnostic
evaluation
of
the
prospective
patient
20
be
sought,
if
that
has
not
already
been
done.
This
subsection
21
does
not
apply
when
voluntary
admission
is
sought
in
accordance
22
with
section
229.41
under
circumstances
which,
in
the
opinion
23
of
the
chief
medical
officer
or
that
officer’s
physician
24
designee,
constitute
a
medical
emergency.
25
Sec.
29.
Section
232.71B,
subsection
10,
Code
2021,
is
26
amended
to
read
as
follows:
27
10.
Physical
examination.
If
the
department
refers
a
28
child
to
a
physician
or
physician
assistant
for
a
physical
29
examination,
the
department
shall
contact
the
physician
30
or
physician
assistant
regarding
the
examination
within
31
twenty-four
hours
of
making
the
referral.
If
the
physician
32
or
physician
assistant
who
performs
the
examination
upon
33
referral
by
the
department
reasonably
believes
the
child
has
34
been
abused,
the
physician
or
physician
assistant
shall
report
35
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1921HV
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89
ss/rh
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57
H.F.
803
to
the
department
within
twenty-four
hours
of
performing
the
1
examination.
2
Sec.
30.
Section
232.78,
subsection
4,
unnumbered
paragraph
3
1,
Code
2021,
is
amended
to
read
as
follows:
4
The
juvenile
court
may
enter
an
order
authorizing
a
5
physician
or
physician
assistant
or
hospital
to
provide
6
emergency
medical
or
surgical
procedures
before
the
filing
of
a
7
petition
under
this
chapter
provided:
8
Sec.
31.
Section
232.78,
subsection
5,
unnumbered
paragraph
9
1,
Code
2021,
is
amended
to
read
as
follows:
10
The
juvenile
court,
before
or
after
the
filing
of
a
petition
11
under
this
chapter
,
may
enter
an
ex
parte
order
authorizing
12
a
physician
or
physician
assistant
or
hospital
to
conduct
an
13
outpatient
physical
examination
or
authorizing
a
physician
or
14
physician
assistant
,
a
psychologist
certified
under
section
15
154B.7
,
or
a
community
mental
health
center
accredited
pursuant
16
to
chapter
230A
to
conduct
an
outpatient
mental
examination
17
of
a
child
if
necessary
to
identify
the
nature,
extent,
and
18
cause
of
injuries
to
the
child
as
required
by
section
232.71B
,
19
provided
all
of
the
following
apply:
20
Sec.
32.
Section
232.79,
subsection
1,
unnumbered
paragraph
21
1,
Code
2021,
is
amended
to
read
as
follows:
22
A
peace
officer
or
juvenile
court
officer
may
take
a
child
23
into
custody,
a
physician
or
physician
assistant
treating
24
a
child
may
keep
the
child
in
custody,
or
a
juvenile
court
25
officer
may
authorize
a
peace
officer,
physician
or
physician
26
assistant
,
or
medical
security
personnel
to
take
a
child
into
27
custody,
without
a
court
order
as
required
under
section
232.78
28
and
without
the
consent
of
a
parent,
guardian,
or
custodian
29
provided
that
both
of
the
following
apply:
30
Sec.
33.
Section
232.79,
subsection
2,
paragraph
a,
Code
31
2021,
is
amended
to
read
as
follows:
32
a.
Bring
the
child
immediately
to
a
place
designated
by
33
the
rules
of
the
court
for
this
purpose,
unless
the
person
is
34
a
physician
or
physician
assistant
treating
the
child
and
the
35
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57
H.F.
803
child
is
or
will
presently
be
admitted
to
a
hospital.
1
Sec.
34.
Section
232.83,
subsection
2,
unnumbered
paragraph
2
1,
Code
2021,
is
amended
to
read
as
follows:
3
Anyone
authorized
to
conduct
a
preliminary
investigation
4
in
response
to
a
complaint
may
apply
for,
or
the
court
on
its
5
own
motion
may
enter
an
ex
parte
order
authorizing
a
physician
6
or
physician
assistant
or
hospital
to
conduct
an
outpatient
7
physical
examination
or
authorizing
a
physician
or
physician
8
assistant
,
a
psychologist
certified
under
section
154B.7
,
or
a
9
community
mental
health
center
accredited
pursuant
to
chapter
10
230A
to
conduct
an
outpatient
mental
examination
of
a
child
if
11
necessary
to
identify
the
nature,
extent,
and
causes
of
any
12
injuries,
emotional
damage,
or
other
such
needs
of
a
child
as
13
specified
in
section
232.2,
subsection
6
,
paragraph
“c”
,
“e”
,
or
14
“f”
,
provided
that
all
of
the
following
apply:
15
Sec.
35.
Section
232.95,
subsection
2,
paragraph
c,
Code
16
2021,
is
amended
to
read
as
follows:
17
c.
Authorize
a
physician
,
physician
assistant,
or
hospital
18
to
provide
medical
or
surgical
procedures
if
such
procedures
19
are
necessary
to
safeguard
the
child’s
life
or
health.
20
Sec.
36.
Section
234.22,
Code
2021,
is
amended
to
read
as
21
follows:
22
234.22
Extent
of
services.
23
Such
family
planning
and
birth
control
services
may
include
24
interview
with
trained
personnel;
distribution
of
literature;
25
referral
to
a
licensed
physician
or
physician
assistant
26
for
consultation,
examination,
tests,
medical
treatment
27
and
prescription;
and,
to
the
extent
so
prescribed,
the
28
distribution
of
rhythm
charts,
drugs,
medical
preparations,
29
contraceptive
devices
and
similar
products.
30
Sec.
37.
Section
235A.13,
subsection
9,
Code
2021,
is
31
amended
to
read
as
follows:
32
9.
“Near
fatality”
means
an
injury
to
a
child
that,
as
33
certified
by
a
physician
or
physician
assistant
,
placed
the
34
child
in
serious
or
critical
condition.
35
-13-
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1921HV
(1)
89
ss/rh
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H.F.
803
Sec.
38.
Section
237A.5,
subsection
1,
Code
2021,
is
amended
1
to
read
as
follows:
2
1.
All
personnel
in
licensed
or
registered
facilities
3
shall
have
good
health
as
evidenced
by
a
report
following
a
4
preemployment
physical
examination
taken
within
six
months
5
prior
to
beginning
employment.
The
examination
shall
include
6
communicable
disease
tests
by
a
licensed
physician
as
defined
7
in
section
135C.1
or
a
licensed
physician
assistant
as
defined
8
in
section
148C.1
and
shall
be
repeated
every
three
years
after
9
initial
employment.
Controlled
medical
conditions
which
would
10
not
affect
the
performance
of
the
employee
in
the
capacity
11
employed
shall
not
prohibit
employment.
12
Sec.
39.
Section
237A.13,
subsection
1,
paragraph
d,
Code
13
2021,
is
amended
to
read
as
follows:
14
d.
The
child’s
parent,
guardian,
or
custodian
is
absent
15
for
a
limited
period
of
time
due
to
hospitalization,
physical
16
illness,
or
mental
illness,
or
is
present
but
is
unable
to
care
17
for
the
child
for
a
limited
period
as
verified
by
a
physician
18
or
physician
assistant
.
19
Sec.
40.
Section
249.3,
subsection
2,
paragraph
a,
20
subparagraph
(2),
Code
2021,
is
amended
to
read
as
follows:
21
(2)
Nursing
care
in
the
person’s
own
home,
certified
by
a
22
physician
or
physician
assistant
as
being
required,
so
long
23
as
the
cost
of
the
nursing
care
does
not
exceed
standards
24
established
by
the
department.
25
Sec.
41.
Section
321.375,
subsection
4,
paragraph
b,
26
subparagraph
(4),
Code
2021,
is
amended
to
read
as
follows:
27
(4)
Maintaining
a
daily
log
of
all
glucose
test
results
28
for
the
previous
six-month
period
and
providing
copies
to
the
29
school
district
or
school,
the
examining
physician
or
examining
30
physician
assistant
,
and
the
department
of
education
upon
31
request.
32
Sec.
42.
Section
321.446,
subsection
3,
paragraph
c,
Code
33
2021,
is
amended
to
read
as
follows:
34
c.
The
transportation
of
a
child
who
has
been
certified
by
35
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a
physician
licensed
under
chapter
148
or
a
physician
assistant
1
licensed
under
chapter
148C
as
having
a
medical,
physical,
or
2
mental
condition
that
prevents
or
makes
inadvisable
securing
3
the
child
in
a
child
restraint
system,
safety
belt,
or
safety
4
harness.
5
Sec.
43.
Section
347B.5,
Code
2021,
is
amended
to
read
as
6
follows:
7
347B.5
Admission
——
labor
required.
8
The
county
care
facility
shall
maintain
a
record
of
the
name
9
and
age
of
each
person
admitted
and
the
date
of
admission.
The
10
board
may
require
of
any
resident
of
the
county
care
facility,
11
with
approval
of
a
physician
or
physician
assistant
,
reasonable
12
and
moderate
labor
suited
to
the
resident’s
age
and
bodily
13
strength.
Any
income
realized
through
the
labor
of
residents,
14
together
with
the
receipts
from
operation
of
the
county
farm
if
15
one
is
maintained,
shall
be
appropriated
for
use
by
the
county
16
care
facility
as
the
board
of
supervisors
directs.
17
Sec.
44.
Section
347B.6,
Code
2021,
is
amended
to
read
as
18
follows:
19
347B.6
Order
for
admission.
20
No
person
shall
be
admitted
into
the
county
care
facility
21
as
a
resident
except
upon
order
of
the
board
of
supervisors,
22
which
shall
be
issued
only
after
the
person
seeking
admission
23
has
received
a
preadmission
physical
examination
by
a
physician
24
or
physician
assistant
.
However,
if
the
need
for
admission
25
of
the
person
to
the
county
care
facility
is
immediate
and
26
no
physician
or
physician
assistant
is
readily
available
to
27
perform
the
examination,
the
board
may
order
the
person’s
28
admission
pending
an
examination
by
a
physician
or
physician
29
assistant
,
any
provisions
of
sections
135C.3
and
135C.4
to
the
30
contrary
notwithstanding.
When
an
admission
is
so
ordered,
the
31
physical
examination
shall
be
completed
within
three
days
after
32
the
person’s
admission
to
the
county
care
facility.
33
Sec.
45.
Section
411.5,
subsection
8,
Code
2021,
is
amended
34
to
read
as
follows:
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8.
Medical
board.
The
board
of
trustees
shall
designate
a
1
single
medical
provider
network
as
the
medical
board
for
the
2
system.
The
medical
board
shall
arrange
for
and
pass
upon
3
all
medical
examinations
required
under
the
provisions
of
4
chapter
400
and
this
chapter
and
shall
assist
the
system
in
5
all
aspects
of
the
comprehensive
disability
program
described
6
in
section
411.1A
.
For
examinations
required
because
of
7
disability,
a
physician
or
physician
assistant
from
the
8
medical
board
specializing
in
occupational
medicine,
and
a
9
second
physician
or
physician
assistant
specializing
in
an
10
appropriate
field
of
medicine
as
determined
by
the
occupational
11
medicine
physician
or
physician
assistant
,
shall
pass
upon
12
the
medical
examinations
required
for
disability
retirements
13
and
shall
report
to
the
system
in
writing
their
conclusions
14
and
recommendations
upon
all
matters
referred
to
the
medical
15
board.
Each
report
of
a
medical
examination
under
section
16
411.6,
subsections
3
and
5
,
shall
include
the
medical
board’s
17
findings
in
accordance
with
section
411.6
as
to
the
extent
of
18
the
member’s
physical
impairment.
19
Sec.
46.
Section
411.6,
subsection
5,
paragraph
b,
Code
20
2021,
is
amended
to
read
as
follows:
21
b.
If
a
member
in
service
or
the
chief
of
the
police
or
22
fire
departments
becomes
incapacitated
for
duty
as
a
natural
23
or
proximate
result
of
an
injury
or
disease
incurred
in
or
24
aggravated
by
the
actual
performance
of
duty
at
some
definite
25
time
or
place
or
while
acting,
pursuant
to
order,
outside
the
26
city
by
which
the
member
is
regularly
employed,
the
member,
27
upon
being
found
to
be
temporarily
incapacitated
following
a
28
medical
examination
as
directed
by
the
city,
is
entitled
to
29
receive
the
member’s
full
pay
and
allowances
from
the
city’s
30
general
fund
or
trust
and
agency
fund
until
reexamined
as
31
directed
by
the
city
and
found
to
be
fully
recovered
or
until
32
the
city
determines
that
the
member
is
likely
to
be
permanently
33
disabled.
If
the
temporary
incapacity
of
a
member
continues
34
more
than
sixty
days,
or
if
the
city
expects
the
incapacity
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to
continue
more
than
sixty
days,
the
city
shall
notify
the
1
system
of
the
temporary
incapacity.
Upon
notification
by
a
2
city,
the
system
may
refer
the
matter
to
the
medical
board
for
3
review
and
consultation
with
the
member’s
treating
physician
or
4
treating
physician
assistant
during
the
temporary
incapacity.
5
Except
as
provided
by
this
paragraph,
the
board
of
trustees
of
6
the
statewide
system
has
no
jurisdiction
over
these
matters
7
until
the
city
determines
that
the
disability
is
likely
to
be
8
permanent.
9
Sec.
47.
Section
411.6,
subsection
7,
unnumbered
paragraph
10
1,
Code
2021,
is
amended
to
read
as
follows:
11
The
system
may,
and
upon
the
member’s
application
shall,
12
require
any
disability
beneficiary
who
has
not
yet
attained
13
age
fifty-five
to
undergo
a
medical
examination
at
a
place
14
designated
by
the
medical
board.
The
examination
shall
be
made
15
by
the
medical
board
or,
in
special
cases,
by
an
additional
16
physician
,
or
physicians
,
physician
assistant,
or
physician
17
assistants
designated
by
such
board.
If
any
disability
18
beneficiary
who
has
not
attained
the
age
of
fifty-five
refuses
19
to
submit
to
the
medical
examination,
the
member’s
allowance
20
may
be
discontinued
until
withdrawal
of
such
refusal,
and
21
if
the
refusal
continues
for
one
year
all
rights
in
and
22
to
the
member’s
pension
may
be
revoked
by
the
system.
For
23
a
disability
beneficiary
who
has
not
attained
the
age
of
24
fifty-five
and
whose
entitlement
to
a
disability
retirement
25
commenced
on
or
after
July
1,
2000,
the
medical
board
may,
as
26
part
of
the
examination
required
by
this
subsection
,
suggest
27
appropriate
medical
treatment
or
rehabilitation
if,
in
the
28
opinion
of
the
medical
board,
the
recommended
treatment
or
29
rehabilitation
would
likely
restore
the
disability
beneficiary
30
to
duty.
31
Sec.
48.
Section
514C.17,
subsections
1
and
2,
Code
2021,
32
are
amended
to
read
as
follows:
33
1.
Except
as
provided
under
subsection
2
or
3
,
if
a
carrier,
34
as
defined
in
section
513B.2
,
or
a
plan
established
pursuant
to
35
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chapter
509A
for
public
employees,
terminates
its
contract
with
1
a
participating
health
care
provider,
a
covered
individual
who
2
is
undergoing
a
specified
course
of
treatment
for
a
terminal
3
illness
or
a
related
condition,
with
the
recommendation
of
the
4
covered
individual’s
treating
physician
licensed
under
chapter
5
148
or
treating
physician
assistant
licensed
under
chapter
148C
6
may
continue
to
receive
coverage
for
treatment
received
from
7
the
covered
individual’s
physician
or
physician
assistant
for
8
the
terminal
illness
or
a
related
condition,
for
a
period
of
9
up
to
ninety
days.
Payment
for
covered
benefits
and
benefit
10
levels
shall
be
according
to
the
terms
and
conditions
of
the
11
contract.
12
2.
A
covered
person
who
makes
a
change
in
health
plans
13
involuntarily
may
request
that
the
new
health
plan
cover
14
services
of
the
covered
person’s
treating
physician
licensed
15
under
chapter
148
or
treating
physician
assistant
licensed
16
under
chapter
148C
who
is
not
a
participating
health
care
17
provider
under
the
new
health
plan,
if
the
covered
person
is
18
undergoing
a
specified
course
of
treatment
for
a
terminal
19
illness
or
a
related
condition.
Continuation
of
such
coverage
20
shall
continue
for
up
to
ninety
days.
Payment
for
covered
21
benefits
and
benefit
levels
shall
be
according
to
the
terms
and
22
conditions
of
the
contract.
23
Sec.
49.
Section
514C.18,
subsection
1,
unnumbered
24
paragraph
1,
Code
2021,
is
amended
to
read
as
follows:
25
Notwithstanding
the
uniformity
of
treatment
requirements
of
26
section
514C.6
,
a
policy
or
contract
providing
for
third-party
27
payment
or
prepayment
of
health
or
medical
expenses
shall
28
provide
coverage
benefits
for
the
cost
associated
with
29
equipment,
supplies,
and
self-management
training
and
education
30
for
the
treatment
of
all
types
of
diabetes
mellitus
when
31
prescribed
by
a
physician
licensed
under
chapter
148
or
a
32
physician
assistant
licensed
under
chapter
148C
.
Coverage
33
benefits
shall
include
coverage
for
the
cost
associated
with
34
all
of
the
following:
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Sec.
50.
Section
514C.18,
subsection
1,
paragraph
b,
1
subparagraphs
(1)
and
(2),
Code
2021,
are
amended
to
read
as
2
follows:
3
(1)
The
physician
or
physician
assistant
managing
the
4
individual’s
diabetic
condition
certifies
that
such
services
5
are
needed
under
a
comprehensive
plan
of
care
related
to
the
6
individual’s
diabetic
condition
to
ensure
therapy
compliance
or
7
to
provide
the
individual
with
necessary
skills
and
knowledge
8
to
participate
in
the
management
of
the
individual’s
condition.
9
(2)
The
diabetes
self-management
training
and
education
10
program
is
certified
by
the
Iowa
department
of
public
health.
11
The
department
shall
consult
with
the
American
diabetes
12
association,
Iowa
affiliate,
in
developing
the
standards
for
13
certification
of
diabetes
education
programs
that
cover
at
14
least
ten
hours
of
initial
outpatient
diabetes
self-management
15
training
within
a
continuous
twelve-month
period
and
up
to
two
16
hours
of
follow-up
training
for
each
subsequent
year
for
each
17
individual
diagnosed
by
a
physician
or
physician
assistant
with
18
any
type
of
diabetes
mellitus.
19
Sec.
51.
Section
514C.20,
subsection
1,
paragraphs
a
and
b,
20
Code
2021,
are
amended
to
read
as
follows:
21
a.
A
child
under
five
years
of
age
upon
a
determination
by
22
a
licensed
dentist
and
the
child’s
treating
physician
licensed
23
pursuant
to
chapter
148
or
treating
physician
assistant
24
licensed
pursuant
to
chapter
148C
,
that
such
child
requires
25
necessary
dental
treatment
in
a
hospital
or
ambulatory
surgical
26
center
due
to
a
dental
condition
or
a
developmental
disability
27
for
which
patient
management
in
the
dental
office
has
proved
28
to
be
ineffective.
29
b.
Any
individual
upon
a
determination
by
a
licensed
dentist
30
and
the
individual’s
treating
physician
licensed
pursuant
to
31
chapter
148
or
treating
physician
assistant
licensed
pursuant
32
to
chapter
148C
,
that
such
individual
has
one
or
more
medical
33
conditions
that
would
create
significant
or
undue
medical
risk
34
for
the
individual
in
the
course
of
delivery
of
any
necessary
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dental
treatment
or
surgery
if
not
rendered
in
a
hospital
or
1
ambulatory
surgical
center.
2
Sec.
52.
Section
514C.25,
subsection
1,
paragraph
a,
Code
3
2021,
is
amended
to
read
as
follows:
4
a.
Notwithstanding
the
uniformity
of
treatment
requirements
5
of
section
514C.6
,
a
policy,
contract,
or
plan
providing
for
6
third-party
payment
or
prepayment
of
health
or
medical
expenses
7
shall
provide
coverage
benefits
for
medically
necessary
8
prosthetic
devices
when
prescribed
by
a
physician
licensed
9
under
chapter
148
or
physician
assistant
licensed
under
10
chapter
148C
.
Such
coverage
benefits
for
medically
necessary
11
prosthetic
devices
shall
provide
coverage
for
medically
12
necessary
prosthetic
devices
that,
at
a
minimum,
equals
13
the
coverage
and
payment
for
medically
necessary
prosthetic
14
devices
provided
under
the
most
recent
federal
laws
for
health
15
insurance
for
the
aged
and
disabled
pursuant
to
42
U.S.C.
16
§1395k,
13951,
and
1395m,
and
42
C.F.R.
§410.100
,
414.202
,
17
414.210,
and
414.228
,
as
applicable.
18
Sec.
53.
ADMINISTRATIVE
RULEMAKING.
19
1.
The
department
of
administrative
services,
department
20
on
aging,
department
of
corrections,
economic
development
21
authority,
department
of
education,
department
of
human
22
services,
department
of
inspections
and
appeals,
racing
and
23
gaming
commission,
Iowa
law
enforcement
academy,
natural
24
resource
commission,
Iowa
department
of
public
health,
25
department
of
public
safety,
department
of
transportation,
26
Iowa
department
of
veterans
affairs,
and
the
department
of
27
workforce
development
including
the
division
of
labor
services,
28
in
accordance
with
chapter
17A
and
this
section,
and
consistent
29
with
this
Act,
shall
each
amend,
rescind,
or
adopt
rules
which
30
address
all
of
the
following:
31
a.
For
the
department
of
administrative
services,
rules
32
relating
to
and
in
substantial
conformance
with
all
of
the
33
following:
34
(1)
For
the
retroactive
conversion
of
vacation
time
to
sick
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leave
under
11
IAC
63.2(2)(h),
including
that
in
the
event
of
1
an
illness
or
disability
while
on
vacation,
that
portion
of
2
the
vacation
spent
under
the
care
of
a
physician
or
physician
3
assistant
shall
be
switched
retroactively
to
and
charged
4
against
the
employee’s
accrued
sick
leave
upon
satisfactory
5
proof
from
the
physician
or
physician
assistant
of
the
illness
6
or
disability
and
its
duration.
7
(2)
Definitions
pursuant
to
11
IAC
63.19,
including
that
8
“catastrophic
illness”
means
a
physical
or
mental
illness
or
9
injury
of
the
employee,
as
certified
by
a
licensed
physician
or
10
physician
assistant,
that
will
result
in
the
inability
of
the
11
employee
to
work
for
more
than
thirty
workdays
on
a
consecutive
12
or
intermittent
basis;
or
that
will
result
in
the
inability
of
13
the
employee
to
report
to
work
for
more
than
thirty
workdays
14
due
to
the
need
to
attend
to
an
immediate
family
member
on
a
15
consecutive
or
intermittent
basis.
16
(3)
For
certification
requirements
pursuant
to
11
IAC
17
63.19(4),
including
that
the
employee
shall
submit
an
18
application
for
donated
leave
on
forms
developed
by
the
19
department.
Appointing
authorities
may,
at
their
department’s
20
expense,
seek
second
medical
opinions
or
updates
from
21
physicians
or
physician
assistants
regarding
the
status
of
an
22
employee’s
or
employee’s
immediate
family
member’s
illness
or
23
injury.
If
the
employee
is
receiving
family
medical
leave
Act
24
leave,
a
second
opinion
must
be
obtained
from
a
physician
or
25
physician
assistant
who
is
not
regularly
employed
by
the
state.
26
b.
For
the
department
on
aging,
rules
for
special
dietary
27
needs
pursuant
to
17
IAC
7.18(3),
including
that
a
written
28
order
from
a
physician
or
physician
assistant
for
each
older
29
individual
requesting
a
therapeutic
diet
shall
be
obtained
30
prior
to
the
older
individual’s
receipt
of
the
meal
and
kept
31
on
file
where
the
meal
is
prepared
and
served.
The
order
shall
32
be
interpreted
by
a
licensed
dietitian
and
the
individual’s
33
physician
or
physician
assistant.
34
c.
For
the
department
of
corrections,
rules
relating
to
and
35
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in
substantial
conformance
with
all
of
the
following:
1
(1)
For
substance
abuse
and
conditions
of
parole
pursuant
2
to
201
IAC
45.2(1)(e),
including
that
the
parolee
shall
not
3
use,
purchase,
or
possess
alcoholic
beverages
and
shall
submit
4
to
alcohol
tests
and
drug
tests
when
directed
by
the
parolee’s
5
supervising
officer.
The
parolee
shall
not
enter
taverns
6
or
liquor
stores
or
other
establishments
where
the
primary
7
activity
is
the
sale
of
alcoholic
beverages.
The
parolee
will
8
not
use,
ingest,
inject,
huff,
possess,
or
smoke
any
illegal
9
or
synthetic
substances.
The
parolee
shall
not
use,
purchase,
10
possess,
or
transfer
any
drugs
unless
they
are
prescribed
by
a
11
physician
or
physician
assistant.
12
(2)
For
medical
services
pursuant
to
201
IAC
50.15,
13
unnumbered
paragraph
1,
including
that
the
jail
administrator
14
shall
establish
a
written
policy
and
procedure
to
ensure
that
15
prisoners
have
the
opportunity
to
receive
necessary
medical
16
attention
for
the
prisoners’
objectively
serious
medical
and
17
dental
needs
which
are
known
to
the
jail
staff.
A
serious
18
medical
need
is
one
that
has
been
diagnosed
by
a
physician
or
19
physician
assistant
as
requiring
treatment
or
is
one
that
is
20
so
obvious
that
even
a
lay
person
would
easily
recognize
the
21
necessity
for
a
physician’s
or
physician
assistant’s
attention.
22
The
plan
shall
include
a
procedure
for
emergency
care.
23
Responsibility
for
the
costs
of
medical
services
and
products
24
remains
that
of
the
prisoner.
However,
no
prisoner
will
be
25
denied
necessary
medical
services,
dental
service,
medicine,
26
or
prostheses
because
of
a
lack
of
ability
to
pay.
Medical
27
and
dental
prostheses
shall
be
provided
only
for
the
serious
28
medical
needs
of
the
prisoner,
as
determined
by
a
licensed
29
health
care
professional.
Cosmetic
or
elective
procedures
need
30
not
be
provided.
31
(3)
For
medical
resources
pursuant
to
201
IAC
50.15(1),
32
including
that
each
jail
shall
have
a
designated
licensed
33
physician,
licensed
osteopathic
physician,
physician
assistant,
34
or
medical
resource,
such
as
a
hospital
or
clinic
staffed
35
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803
by
licensed
physicians,
physician
assistants,
or
licensed
1
osteopathic
physicians,
designated
for
the
medical
supervision,
2
care,
and
treatment
of
prisoners
as
deemed
necessary
and
3
appropriate.
Medical
resources
shall
be
available
on
a
4
twenty-four-hour
basis.
5
(4)
For
medication
procedures
pursuant
to
201
IAC
6
50.15(7)(d),
including
that
prescription
medication,
as
ordered
7
by
a
licensed
physician,
licensed
osteopathic
physician,
8
licensed
physician
assistant,
or
licensed
dentist,
shall
be
9
provided
in
accordance
with
the
directions
of
the
prescribing
10
physician,
physician
assistant,
or
dentist.
Prisoners
with
11
medication
from
a
personal
physician,
osteopathic
physician,
12
physician
assistant,
or
dentist
may
be
evaluated
by
a
13
physician,
osteopathic
physician,
physician
assistant,
or
14
dentist
selected
by
the
jail
administrator
to
determine
if
the
15
present
medication
is
appropriate.
16
(5)
For
medication
storage
pursuant
to
201
IAC
50.15(9)(c),
17
including
that
expired
drugs
or
drugs
not
in
unit
dose
18
packaging,
whose
administration
had
been
discontinued
by
the
19
attending
physician
or
physician
assistant,
shall
be
destroyed
20
by
the
jail
administrator
or
designee
in
the
presence
of
a
21
witness.
A
record
of
drug
destruction
shall
be
made
in
each
22
prisoner’s
medical
record.
The
record
shall
include
the
name,
23
the
strength,
and
the
quantity
of
the
drug
destroyed,
and
the
24
record
shall
be
signed
by
the
jail
administrator
or
designee
25
and
by
the
witness.
26
(6)
For
medical
diets
pursuant
to
201
IAC
50.16(5),
27
including
special
diets
as
prescribed
by
a
physician
or
28
physician
assistant
shall
be
followed
and
documented.
The
29
physician
or
physician
assistant
who
prescribes
the
special
30
diet
shall
specify
a
date
on
which
the
diet
will
be
reviewed
31
for
renewal
or
discontinuation.
Unless
specified
by
the
32
prescribing
physician
or
physician
assistant,
a
certified
33
dietitian
shall
develop
the
menu.
34
(7)
For
the
care
and
treatment
of
juveniles
in
nonsecure
35
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803
hold
pursuant
to
201
IAC
50.24(5)(a)(10),
including
special
1
diets
as
prescribed
by
a
physician
or
physician
assistant
shall
2
be
followed
and
documented.
3
(8)
For
medical
services
in
temporary
holding
facilities
4
pursuant
to
201
IAC
51.13,
unnumbered
paragraph
1,
including
5
that
the
facility
administrator
shall
establish
a
written
6
policy
and
procedure
to
ensure
that
detainees
have
the
7
opportunity
to
receive
necessary
medical
attention
for
the
8
detainee’s
objectively
serious
medical
and
dental
needs
which
9
are
known
to
the
facility
staff.
A
serious
medical
need
10
is
one
that
has
been
diagnosed
by
a
physician
or
physician
11
assistant
as
requiring
treatment,
or
one
that
is
so
obvious
12
that
even
a
lay
person
would
easily
recognize
the
necessity
for
13
a
physician’s
or
physician
assistant’s
attention.
The
plan
14
shall
include
a
procedure
for
emergency
services
day
or
night
15
and
a
procedure
for
regular
medical
attention.
Responsibility
16
for
the
costs
of
medical
services
remains
that
of
the
detainee.
17
However,
no
detainee
will
be
denied
necessary
medical
services,
18
dental
service,
or
medicine
because
of
a
lack
of
ability
to
19
pay.
Medical
and
dental
prostheses
shall
be
provided
only
20
for
the
serious
medical
needs
of
the
detainee,
as
determined
21
by
a
licensed
health
care
professional.
Cosmetic
or
elective
22
procedures
need
not
be
provided.
23
(9)
For
medical
resources
in
temporary
holding
facilities
24
pursuant
to
201
IAC
51.13(1),
each
facility
shall
have
a
25
designated
licensed
physician,
licensed
physician
assistant,
26
licensed
osteopathic
physician
or
medical
resource,
such
as
a
27
hospital
or
clinic
staffed
by
licensed
physicians,
licensed
28
physician
assistants,
or
licensed
osteopathic
physicians,
29
designated
for
the
medical
supervision,
care,
and
treatment
30
of
detainees
as
deemed
necessary
and
appropriate.
Medical
31
resources
shall
be
available
on
a
twenty-four-hour
basis.
32
(10)
For
medication
procedures
in
temporary
holding
33
facilities
pursuant
to
201
IAC
51.13(7)(d),
including
34
prescription
medication,
as
ordered
by
a
licensed
physician,
35
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803
licensed
physician
assistant,
licensed
osteopathic
physician,
1
or
licensed
dentist
shall
be
provided
in
accordance
with
the
2
directions
of
the
prescribing
physician,
physician
assistant,
3
or
dentist.
Detainees
with
medication
from
a
personal
4
physician,
physician
assistant,
osteopathic
physician,
or
5
dentist
may
be
evaluated
by
a
physician,
physician
assistant,
6
osteopathic
physician,
or
dentist
selected
by
the
facility
7
administrator
to
determine
if
the
present
medication
is
8
appropriate.
9
(11)
For
medication
storage
in
temporary
holding
facilities
10
pursuant
to
201
IAC
51.13(9)(c),
including
expired
drugs
or
11
drugs
not
in
unit
dose
packaging,
whose
administration
had
been
12
discontinued
by
the
attending
physician
or
physician
assistant,
13
shall
be
destroyed
by
the
facility
administrator
or
designee
14
in
the
presence
of
a
witness.
A
record
of
drug
destruction
15
shall
be
made
in
each
detainee’s
medical
record.
The
record
16
shall
include
the
name,
the
strength,
and
the
quantity
of
the
17
drug
destroyed;
and
the
record
shall
be
signed
by
the
facility
18
administrator
or
designee
and
by
the
witness.
19
(12)
For
medical
diets
in
temporary
holding
facilities
20
pursuant
to
201
IAC
51.14(4),
including
that
special
diets
21
as
prescribed
by
a
physician
or
physician
assistant
shall
be
22
followed
and
documented.
23
(13)
For
medical
care
and
treatment
for
juveniles
in
24
nonsecure
holds
in
temporary
holding
facilities
pursuant
to
201
25
IAC
51.20(5)(a)(10),
special
diets
as
prescribed
by
a
physician
26
or
physician
assistant
shall
be
followed
and
documented.
27
d.
For
the
economic
development
authority,
rules
for
28
the
certification
of
a
person
with
a
disability
for
the
29
purpose
of
the
targeted
small
business
program
pursuant
to
30
261
IAC
52.2(7)(a),
including
that
in
order
to
be
considered
31
a
person
with
a
disability
for
the
purpose
of
the
targeted
32
small
business
program,
the
person
must
qualify
and
receive
33
certification
as
having
a
disability
from
a
licensed
medical
34
physician
or
physician
assistant
or
must
have
been
found
35
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803
eligible
for
vocational
rehabilitation
services
by
the
1
department
of
education,
division
of
vocational
rehabilitation
2
services,
or
by
the
department
for
the
blind.
3
e.
For
the
department
of
education,
rules
relating
to
and
in
4
substantial
conformance
with
all
of
the
following:
5
(1)
For
statements
relating
to
medication
administration
6
policies
pursuant
to
281
IAC
14.1(3),
including
that
a
7
statement
that
persons
administering
medication
shall
include
8
authorized
practitioners,
such
as
licensed
registered
nurses,
9
physician
assistants,
and
physicians,
and
persons
to
whom
10
authorized
practitioners
have
delegated
the
administration
11
of
prescription
and
nonprescription
drugs
(who
shall
have
12
successfully
completed
a
medication
administration
course).
13
Individuals
who
have
demonstrated
competency
in
administering
14
their
own
medications
may
self-administer
their
medication.
15
Individuals
shall
self-administer
asthma
or
other
airway
16
constricting
disease
medication
or
possess
and
have
use
of
17
an
epinephrine
auto-injector
with
parent
and
physician
or
18
physician
assistant
consent
on
file,
without
the
necessity
of
19
demonstrating
competency
to
self-administer
these
medications.
20
(2)
For
medication
administration
courses
relating
to
21
medication
administration
policies
pursuant
to
281
IAC
14.1(4),
22
including
that
a
provision
for
a
medication
administration
23
course
provided
by
the
department
that
is
completed
every
five
24
years
with
an
annual
medication
administration
procedural
25
skills
check
completed
with
a
registered
nurse,
physician
26
assistant,
or
pharmacist.
A
registered
nurse,
physician
27
assistant,
or
licensed
pharmacist
shall
conduct
the
course.
A
28
record
of
course
completion
shall
be
maintained
by
the
school.
29
(3)
For
definitions
pursuant
to
281
IAC
66.2,
including
that
30
“preventive
and
primary
health
care
services”
means
services
31
which
include
but
are
not
limited
to
physical
examinations,
32
immunizations,
hearing
and
vision
screening,
preventive
care,
33
maintenance
services,
diagnosis,
treatment,
referral,
case
34
management,
health
supervision,
and
health
teaching.
These
35
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803
services
shall
be
delivered
by
specifically
credentialed
1
providers
such
as
licensed
physicians,
dentists,
physician
2
assistants,
registered
nurses,
nutritionists,
social
workers,
3
psychologists,
dental
hygienists,
physical
or
occupational
4
therapists,
and
respiratory
therapists.
Youth
with
complex
5
health
needs
may
require
referral
to
specially
trained
and
6
skilled
health
care
providers.
7
f.
For
the
department
of
human
services,
rules
relating
to
8
and
in
substantial
conformance
with
all
of
the
following:
9
(1)
Definitions
pursuant
to
441
IAC
24.1,
including
all
of
10
the
following:
11
(a)
“Incident”
includes
but
is
not
limited
to
an
occurrence
12
involving
the
individual
using
the
service
that
results
in
13
a
physical
injury
to
or
by
the
individual
that
requires
a
14
physician’s
or
physician
assistant’s
treatment
or
admission
15
to
a
hospital,
provided
that
the
physician
assistant
meets
16
the
requirements
of
a
mental
health
professional
pursuant
to
17
section
228.1
and
this
section.
18
(b)
“Mental
health
professional”
means
a
person
who
meets
19
all
of
the
following
conditions:
20
(i)
Holds
at
least
a
master’s
degree
in
a
mental
health
21
field
including
but
not
limited
to
psychology,
counseling
and
22
guidance,
psychiatric
nursing,
and
social
work;
or
is
a
doctor
23
of
medicine
or
osteopathic
medicine.
24
(ii)
Holds
a
current
Iowa
license
when
required
by
the
25
Iowa
professional
licensure
laws
(such
as
a
psychiatrist,
26
a
psychologist,
a
marital
and
family
therapist,
a
mental
27
health
counselor,
an
advanced
registered
nurse
practitioner,
a
28
physician
assistant,
a
psychiatric
nurse,
or
a
social
worker).
29
(iii)
Has
at
least
two
years
of
postdegree
experience
30
supervised
by
a
mental
health
professional
in
assessing
mental
31
health
problems,
mental
illness,
and
service
needs
and
in
32
providing
mental
health
services.
33
(c)
“Physician
assistant”
means
a
person
who
is
licensed
to
34
practice
as
a
physician
assistant
in
the
state
of
Iowa
under
35
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803
chapter
148C.
1
(2)
Definitions
pursuant
to
441
IAC
25.1,
including
that
2
“home
health
aide
services”
means
unskilled
medical
services
3
which
provide
direct
personal
care.
This
service
may
include
4
assistance
with
activities
of
daily
living,
such
as
helping
the
5
recipient
to
bathe,
get
in
and
out
of
bed,
care
for
hair
and
6
teeth,
exercise,
and
take
medications
specifically
ordered
by
7
the
physician
or
physician
assistant.
8
(3)
For
physician’s
statements
relating
to
eligibility
9
for
residential
care
pursuant
to
441
IAC
51.3(2),
including
10
that
payment
for
residential
care
shall
be
made
only
when
11
there
is
on
file
an
order
written
by
a
physician
or
physician
12
assistant
certifying
that
the
applicant
or
recipient
being
13
admitted
requires
residential
care
but
does
not
require
nursing
14
services.
The
certification
shall
be
updated
whenever
a
change
15
in
the
recipient’s
physical
condition
warrants
reevaluation,
16
but
no
less
than
every
twelve
months.
17
(4)
For
the
maintenance
of
case
records
by
a
facility
18
desiring
to
participate
in
the
state
supplementary
assistance
19
program
pursuant
to
441
IAC
54.2,
requiring
that
a
case
20
folder
for
each
individual
residing
in
the
facility
contain
a
21
physician’s
or
physician
assistant’s
statement
certifying
that
22
the
resident
does
not
require
nursing
services.
23
(5)
For
the
provision
of
psychological
evaluations
and
24
counseling
or
psychotherapy
services
by
area
education
25
agencies
pursuant
to
441
IAC
77.28(4),
including
that
26
personnel
providing
psychological
evaluations
and
counseling
27
or
psychotherapy
services
may
include
a
person
licensed
by
the
28
Iowa
board
of
physician
assistants
as
a
physician
assistant
29
pursuant
to
645
IAC
chapters
326
to
349
and
who
meets
the
30
requirements
of
a
“mental
health
professional”
pursuant
to
441
31
IAC
24.1.
32
(6)
For
the
provision
of
psychological
evaluations
and
33
counseling
or
psychotherapy
services
by
an
agency
participating
34
in
the
medical
assistance
program
as
a
provider
of
infant
and
35
-28-
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(1)
89
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57
H.F.
803
toddler
program
services
pursuant
to
441
IAC
77.43(1)(d),
1
including
that
personnel
providing
psychological
evaluations
2
and
counseling
or
psychotherapy
services
may
include
a
person
3
licensed
by
the
Iowa
board
of
physician
assistants
as
a
4
physician
assistant
pursuant
to
645
IAC
chapters
326
to
349
and
5
who
meets
the
requirements
of
a
“mental
health
professional”
6
pursuant
to
441
IAC
24.1.
7
(7)
For
the
provision
of
other
services
by
an
agency
8
participating
in
the
medical
assistance
program
as
a
provider
9
of
infant
and
toddler
program
services
pursuant
to
441
IAC
10
77.43(1)(i),
including
that
personnel
providing
other
services
11
may
include
a
person
licensed
by
the
Iowa
board
of
physician
12
assistants
as
a
physician
assistant
pursuant
to
645
IAC
13
chapters
326
to
349
and
who
meets
the
requirements
of
a
“mental
14
health
professional”
pursuant
to
441
IAC
24.1.
15
(8)
For
the
provision
of
psychological
evaluations
and
16
counseling
or
psychotherapy
services
by
providers
of
local
17
education
agency
services
pursuant
to
441
IAC
77.44(1)(d),
18
including
that
personnel
providing
psychological
evaluations
19
and
counseling
or
psychotherapy
services
may
include
a
person
20
registered
by
the
Iowa
board
of
physician
assistants
as
a
21
physician
assistant
pursuant
to
645
IAC
chapters
326
to
349
and
22
who
meets
the
requirements
of
a
“mental
health
professional”
23
pursuant
to
441
IAC
24.1.
24
(9)
For
the
provision
of
other
services
by
providers
25
of
local
education
agency
services
pursuant
to
441
IAC
26
77.44(1)(i),
including
that
personnel
providing
other
services
27
may
include
a
person
licensed
by
the
Iowa
board
of
physician
28
assistants
as
a
physician
assistant
pursuant
to
645
IAC
29
chapters
326
to
349
and
who
meets
the
requirements
of
a
“mental
30
health
professional”
pursuant
to
441
IAC
24.1.
31
(10)
For
payment
for
medically
necessary
home
health
32
agency
services
pursuant
to
441
IAC
78.9,
unnumbered
paragraph
33
1,
including
that
payment
shall
be
approved
for
medically
34
necessary
home
health
agency
services
prescribed
by
a
physician
35
-29-
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57
H.F.
803
or
physician
assistant
in
a
plan
of
home
health
care
provided
1
by
a
Medicare-certified
home
health
agency.
2
(11)
For
authorization
for
medically
necessary
home
3
health
agency
services
pursuant
to
441
IAC
78.9,
including
4
that
services
shall
be
authorized
by
a
physician
or
physician
5
assistant,
evidenced
by
the
physician’s
or
physician
6
assistant’s
signature
and
date
on
a
plan
of
treatment.
7
(12)
For
treatment
plans
of
home
health
agencies
pursuant
8
to
441
IAC
78.9(1)(h)(3),
including
that
a
member’s
medical
9
condition
shall
be
reflected
by
the
date
last
seen
by
a
10
physician
or
physician
assistant,
if
available.
11
(13)
For
items
included
in
treatment
plans
of
home
health
12
agencies
pursuant
to
441
IAC
78.9(1)(l),
including
that
a
plan
13
of
care
shall
include
a
physician’s
or
physician
assistant’s
14
signature
and
date.
The
plan
of
care
must
be
signed
and
dated
15
by
the
physician
or
physician
assistant
before
the
claim
for
16
service
is
submitted
for
reimbursement.
17
(14)
For
skilled
nursing
services
provided
by
a
home
health
18
agency
pursuant
to
441
IAC
78.9(3),
unnumbered
paragraph
1,
19
including
that
skilled
nursing
services
are
services
that
when
20
performed
by
a
home
health
agency
require
a
licensed
registered
21
nurse
or
licensed
practical
nurse
to
perform.
Situations
22
when
a
service
can
be
safely
performed
by
the
member
or
other
23
nonskilled
person
who
has
received
the
proper
training
or
24
instruction
or
when
there
is
no
one
else
to
perform
the
service
25
are
not
considered
a
“skilled
nursing
service”.
Skilled
26
nursing
services
shall
be
available
only
on
an
intermittent
27
basis.
Intermittent
services
for
skilled
nursing
services
28
shall
be
defined
as
a
medically
predictable
recurring
need
29
requiring
a
skilled
nursing
service
at
least
once
every
sixty
30
days,
not
to
exceed
five
days
per
week
(except
as
provided
31
below),
with
an
attempt
to
have
a
predictable
end.
Daily
32
visits
(six
or
seven
days
per
week)
that
are
reasonable
and
33
necessary
and
show
an
attempt
to
have
a
predictable
end
shall
34
be
covered
for
up
to
three
weeks.
Coverage
of
additional
35
-30-
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89
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57
H.F.
803
daily
visits
beyond
the
initial
anticipated
time
frame
may
be
1
appropriate
for
a
short
period
of
time,
based
on
the
medical
2
necessity
of
service.
Medical
documentation
shall
be
submitted
3
justifying
the
need
for
continued
visits,
including
the
4
physician’s
or
physician
assistant’s
estimate
of
the
length
5
of
time
that
additional
visits
will
be
necessary.
Daily
6
skilled
nursing
visits
or
multiple
daily
visits
for
wound
7
care
or
insulin
injections
shall
be
covered
when
ordered
by
a
8
physician
or
physician
assistant
and
included
in
the
plan
of
9
care.
Other
daily
skilled
nursing
visits
which
are
ordered
for
10
an
indefinite
period
of
time
and
designated
as
daily
skilled
11
nursing
care
do
not
meet
the
intermittent
definition
and
shall
12
be
denied.
13
(15)
For
physical
therapy
services
provided
by
a
home
14
health
agency
pursuant
to
441
IAC
78.9(4),
unnumbered
paragraph
15
1,
including
that
payment
shall
be
made
for
physical
therapy
16
services
when
the
services
relate
directly
to
an
active
written
17
treatment
plan,
follow
a
treatment
plan
established
by
the
18
physician
or
physician
assistant
after
any
needed
consultation
19
with
the
qualified
physical
therapist,
are
reasonable
and
20
necessary
to
the
treatment
of
the
patient’s
illness
or
injury,
21
and
meet
the
guidelines
defined
for
restorative,
maintenance,
22
or
trial
therapy
as
set
forth
in
subrule
78.19(1)(a,b).
23
(16)
For
occupational
therapy
services
provided
by
a
home
24
health
agency
pursuant
to
441
IAC
78.9(5),
unnumbered
paragraph
25
1,
including
that
payment
shall
be
made
for
occupational
26
therapy
services
when
the
services
relate
directly
to
an
active
27
written
treatment
plan,
follow
a
treatment
plan
established
28
by
the
physician
or
physician
assistant,
are
reasonable
and
29
necessary
to
the
treatment
of
the
patient’s
illness
or
injury,
30
and
meet
the
guidelines
defined
for
restorative,
maintenance,
31
or
trial
therapy
as
set
forth
in
subrule
78.19(1)(a,c).
32
(17)
For
speech
therapy
services
provided
by
a
home
health
33
agency
pursuant
to
441
IAC
78.9(6),
unnumbered
paragraph
34
1,
including
that
payment
shall
be
made
for
speech
therapy
35
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H.F.
803
services
when
the
services
relate
directly
to
an
active
written
1
treatment
plan,
follow
a
treatment
plan
established
by
the
2
physician
or
physician
assistant,
are
reasonable
and
necessary
3
to
the
treatment
of
the
patient’s
illness
or
injury,
and
meet
4
the
guidelines
defined
for
restorative,
maintenance,
or
trial
5
therapy
as
set
forth
in
subrule
78.19(1)(a,d).
6
(18)
For
home
health
aide
services
provided
by
a
home
7
health
agency
pursuant
to
441
IAC
78.9(7)(a),
including
that
8
the
service
as
well
as
the
frequency
and
duration
are
stated
9
in
a
written
plan
of
treatment
established
by
a
physician
or
10
physician
assistant.
The
home
health
agency
is
encouraged
to
11
collaborate
with
the
member,
or
in
the
case
of
a
child
with
the
12
child’s
caregiver,
in
the
development
and
implementation
of
the
13
plan
of
treatment.
14
(19)
For
home
health
aide
services
provided
by
a
home
health
15
agency
pursuant
to
441
IAC
78.9(7)(c),
unnumbered
paragraph
1,
16
including
that
services
shall
be
provided
on
an
intermittent
17
basis.
“Intermittent
basis”
for
home
health
agency
services
18
is
defined
as
services
that
are
usually
two
to
three
times
a
19
week
for
two
to
three
hours
at
a
time.
Services
provided
for
20
four
to
seven
days
per
week,
not
to
exceed
twenty-eight
hours
21
per
week,
when
ordered
by
a
physician
or
physician
assistant
22
and
included
in
a
plan
of
care
shall
be
allowed
as
intermittent
23
services.
Increased
services
provided
when
medically
necessary
24
due
to
unusual
circumstances
on
a
short-term
basis
of
two
to
25
three
weeks
may
also
be
allowed
as
intermittent
services
when
26
the
home
health
agency
documents
the
need
for
the
excessive
27
time
required
for
home
health
aide
services.
28
(20)
For
home
health
aide
services
provided
by
a
home
health
29
agency
pursuant
to
441
IAC
78.9(7)(c),
unnumbered
paragraph
3,
30
including
that
personal
care
services
include
the
activities
of
31
daily
living,
e.g.,
helping
the
member
to
bathe,
get
in
and
out
32
of
bed,
care
for
hair
and
teeth,
exercise,
and
take
medications
33
specifically
ordered
by
the
physician
or
physician
assistant,
34
but
ordinarily
self-administered,
and
retraining
the
member
in
35
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89
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H.F.
803
necessary
self-help
skills.
1
(21)
For
private
duty
nursing
or
personal
care
services
2
for
persons
aged
twenty
and
under
pursuant
to
441
IAC
3
78.9(10)(a)(1),
unnumbered
paragraph
1,
including
that
private
4
duty
nursing
services
are
those
services
which
are
provided
5
by
a
registered
nurse
or
a
licensed
practical
nurse
under
the
6
direction
of
the
member’s
physician
or
physician
assistant
to
7
a
member
in
the
member’s
place
of
residence
or
outside
the
8
member’s
residence,
when
normal
life
activities
take
the
member
9
outside
the
place
of
residence.
Place
of
residence
does
not
10
include
nursing
facilities,
intermediate
care
facilities
for
11
the
mentally
retarded,
or
hospitals.
12
(22)
For
private
duty
nursing
or
personal
care
services
13
for
persons
aged
twenty
and
under
pursuant
to
441
IAC
14
78.9(10)(a)(1),
unnumbered
paragraph
2,
including
that
15
services
shall
be
provided
according
to
a
written
plan
of
care
16
authorized
by
a
licensed
physician
or
physician
assistant.
17
The
home
health
agency
is
encouraged
to
collaborate
with
the
18
member,
or
in
the
case
of
a
child
with
the
child’s
caregiver,
19
in
the
development
and
implementation
of
the
plan
of
treatment.
20
These
services
shall
exceed
intermittent
guidelines
as
defined
21
in
subrule
78.9(3).
Private
duty
nursing
and
personal
care
22
services
shall
be
inclusive
of
all
home
health
agency
services
23
personally
provided
to
the
member.
Enhanced
payment
under
24
the
interim
fee
schedule
shall
be
made
available
for
services
25
to
children
who
are
technology
dependent,
i.e.,
ventilator
26
dependent
or
whose
medical
condition
is
so
unstable
as
to
27
otherwise
require
intensive
care
in
a
hospital.
28
(23)
For
private
duty
nursing
or
personal
care
services
29
for
persons
aged
twenty
and
under
pursuant
to
441
IAC
30
78.9(10)(a)(2),
unnumbered
paragraph
1,
including
that
personal
31
care
services
are
those
services
provided
by
a
home
health
32
aide
or
certified
nurse’s
aide
and
which
are
delegated
and
33
supervised
by
a
registered
nurse
under
the
direction
of
the
34
member’s
physician
or
physician
assistant
to
a
member
in
the
35
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57
H.F.
803
member’s
place
of
residence
or
outside
the
member’s
residence,
1
when
normal
life
activities
take
the
member
outside
the
place
2
of
residence.
Place
of
residence
does
not
include
nursing
3
facilities,
intermediate
care
facilities
for
the
mentally
4
retarded,
or
hospitals.
Payment
for
personal
care
services
5
for
persons
aged
twenty
and
under
that
exceed
intermittent
6
guidelines
may
be
approved
if
determined
to
be
medically
7
necessary
as
defined
in
subrule
78.9(7).
These
services
shall
8
be
in
accordance
with
the
member’s
plan
of
care
and
authorized
9
by
a
physician.
The
home
health
agency
is
encouraged
to
10
collaborate
with
the
member,
or
in
the
case
of
a
child
with
the
11
child’s
caregiver,
in
the
development
and
implementation
of
the
12
plan
of
treatment.
13
(24)
For
requirements
for
private
duty
nursing
or
personal
14
care
services
for
persons
aged
twenty
and
under
pursuant
to
15
441
IAC
78.9(1)(b)(1),
including
that
private
duty
nursing
16
or
personal
care
services
shall
be
ordered
in
writing
by
17
a
physician
or
physician
assistant
as
evidenced
by
the
18
physician’s
or
physician
assistant’s
signature
on
the
plan
of
19
care.
20
(25)
For
obtaining
prescription
medications
for
children
21
in
juvenile
detention
and
shelter
care
homes
pursuant
to
441
22
IAC
105.9(1)(a),
including
that
prescription
medication
in
its
23
original
container,
clearly
labeled
and
prescribed
for
the
24
child,
may
be
accepted
as
legitimate
prescription
medication
25
for
the
child.
The
label
serves
as
verification
that
the
26
medication
was
ordered
by
an
authorized
prescriber.
Medication
27
shall
be
prescribed
by
a
provider
authorized
to
prescribe
28
the
medication.
Medication
provided
to
residents
shall
be
29
dispensed
only
from
a
licensed
pharmacy
in
the
state
of
Iowa
30
in
accordance
with
the
pharmacy
laws
in
the
Iowa
Code,
from
a
31
licensed
pharmacy
in
another
state
according
to
the
laws
of
32
that
state,
or
by
a
licensed
physician
or
physician
assistant.
33
(26)
For
health
and
dental
programs
provided
by
34
agencies
providing
foster
care
services
pursuant
to
441
IAC
35
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108.7(12)(b),
including
that
a
child
shall
have
a
physical
1
examination
at
least
annually.
This
shall
be
performed
by
a
2
licensed
physician,
physician
assistant,
or
licensed
nurse
3
practitioner.
4
(27)
For
health
and
dental
programs
provided
by
5
agencies
providing
foster
care
services
pursuant
to
441
6
IAC
108.7(12)(c),
including
that
a
child
shall
have
7
current
immunizations
as
required
by
the
department
of
8
public
health.
If
documentation
of
prior
immunization
is
9
unavailable,
immunizations
shall
begin
within
thirty
days
10
of
placement,
unless
contraindicated
and
unless
a
statement
11
from
a
physician
or
physician
assistant
to
that
effect
is
12
included
in
the
child’s
medical
record.
A
statement
from
a
13
physician,
physician
assistant,
referring
agency,
parent,
or
14
guardian
indicating
immunizations
are
current
is
sufficient
15
documentation
of
immunizations.
16
(28)
For
the
dispensing,
storage,
authorization,
and
17
recording
of
medications
in
child
care
centers
pursuant
to
18
441
IAC
109.10(3)(a),
including
that
all
medications
shall
19
be
stored
in
their
original
containers,
with
accompanying
20
physician,
physician
assistant,
or
pharmacist’s
directions
and
21
label
intact
and
stored
so
they
are
inaccessible
to
children
22
and
the
public.
Nonprescription
medications
shall
be
labeled
23
with
the
child’s
name.
24
(29)
For
an
infants’
area
in
a
child
care
center
pursuant
25
to
441
IAC
109.11(2),
including
that
an
area
shall
be
provided
26
properly
and
safely
equipped
for
the
use
of
infants
and
free
27
from
the
intrusion
of
children
two
years
of
age
and
older.
28
Children
over
eighteen
months
of
age
may
be
grouped
outside
29
this
area
if
appropriate
to
the
developmental
needs
of
the
30
child.
Upon
the
recommendation
of
a
child’s
physician
or
31
physician
assistant
or
the
area
education
agency
serving
32
the
child,
a
child
who
is
two
years
of
age
or
older
with
a
33
disability
that
results
in
significant
developmental
delays
in
34
physical
and
cognitive
functioning
who
does
not
pose
a
threat
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to
the
safety
of
the
infants
may,
if
appropriate
and
for
a
1
limited
time
approved
by
the
department,
remain
in
the
infant
2
area.
3
(30)
For
facility
requirements
for
a
child
development
4
home
pursuant
to
441
IAC
110.8(1)(a),
including
that
the
home
5
shall
have
a
nonpay,
working
landline
or
mobile
telephone
with
6
emergency
numbers
posted
for
police,
fire,
ambulance,
and
7
the
poison
information
center.
The
number
for
each
child’s
8
parent,
for
a
responsible
person
who
can
be
reached
when
the
9
parent
cannot,
and
for
the
child’s
physician
or
physician
10
assistant
shall
be
written
on
paper
and
readily
accessible
by
11
the
telephone.
The
home
must
prominently
display
all
emergency
12
information,
and
all
travel
vehicles
must
have
a
paper
copy
of
13
emergency
parent
contact
information.
14
(31)
For
medications
and
hazardous
materials
in
a
child
15
development
home
pursuant
to
441
IAC
110.8(3)(c),
including
16
that
medications
shall
be
given
only
with
the
parent’s
or
17
doctor’s
written
authorization.
Each
prescribed
medication
18
shall
be
accompanied
by
a
physician’s,
physician
assistant’s,
19
or
pharmacist’s
direction.
Both
nonprescription
and
20
prescription
medications
shall
be
in
the
original
container
21
with
directions
intact
and
labeled
with
the
child’s
name.
All
22
medications
shall
be
stored
properly
and,
when
refrigeration
23
is
required,
shall
be
stored
in
a
separate,
covered
container
24
so
as
to
prevent
contamination
of
food
or
other
medications.
25
All
medications
shall
be
stored
so
they
are
inaccessible
26
to
children.
Any
medication
administered
to
a
child
shall
27
be
recorded,
and
the
record
shall
indicate
the
name
of
the
28
medication,
the
date
and
time
of
administration,
and
the
amount
29
administered.
30
(32)
For
medical
reports
regarding
the
health
of
a
family
31
in
a
family
life
home
pursuant
to
441
IAC
111.6(2),
including
32
that
the
medical
report
shall
provide
significant
findings
of
33
a
physician
or
physician
assistant,
such
as
the
presence
or
34
absence
of
any
communicable
disease.
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(33)
For
medical
reexaminations
of
a
family
in
a
family
1
life
home
pursuant
to
441
IAC
111.6(3),
including
that
medical
2
reexaminations
may
be
required
at
the
discretion
of
a
physician
3
or
physician
assistant
or
the
local
department.
4
(34)
For
medical
examinations
of
a
client
in
a
family
life
5
home
pursuant
to
441
IAC
111.9(1),
including
that
a
physician
6
or
physician
assistant
shall
certify
that
the
client
is
free
7
from
any
communicable
disease
and
does
not
require
a
higher
8
level
of
care
than
that
provided
by
a
family
life
home.
The
9
certification
shall
be
given
prior
to
placement
and
following
10
an
annual
medical
review
thereafter.
The
certification
shall
11
be
given
on
Form
470-0673,
Physician’s
Report.
12
(35)
For
the
records
of
a
client
in
a
family
life
home
13
pursuant
to
441
IAC
111.9(2),
including
that
the
family
shall
14
have
available
at
all
times,
the
name,
address,
and
telephone
15
number
of
the
client’s
physician
or
physician
assistant.
16
(36)
For
the
administration
of
over-the-counter
medications
17
in
a
foster
family
home
pursuant
to
441
IAC
113.7(4)(b),
18
including
that
all
over-the-counter
medications
shall
be
19
administered
according
to
label
directions
or
as
directed
by
20
a
health
care
provider.
21
(37)
For
the
contents
of
reports
of
the
health
of
a
foster
22
family
pursuant
to
441
IAC
113.11(2),
including
that
this
23
report
shall
include
a
statement
from
the
health
care
provider
24
that
there
are
no
physical
or
mental
health
problems
which
25
would
be
a
hazard
to
foster
children
placed
in
the
home
and
a
26
statement
that
the
foster
parents’
health
would
not
prevent
27
needed
care
from
being
provided
to
the
child.
28
(38)
For
a
report
of
the
capability
of
a
foster
family
29
to
care
for
a
child
pursuant
to
441
IAC
113.11(4),
including
30
that
if
there
is
evidence
that
the
foster
parent
is
unable
to
31
provide
necessary
care
for
the
child,
the
department
licensing
32
worker,
the
recruitment
and
retention
contractor,
or
the
health
33
care
provider
may
require
additional
medical
and
mental
health
34
reports,
including
a
substance
abuse
evaluation.
35
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803
(39)
For
the
use
of
prescribed
medications
in
group
1
living
foster
care
facilities
pursuant
to
441
IAC
114.12(7),
2
including
that
all
prescribed
medications
shall
be
clearly
3
labeled
indicating
the
resident’s
full
name,
prescriber’s
name,
4
prescription
number,
name
and
strength
of
the
drug,
dosage,
5
directions
for
use,
and
date
of
issuing
the
drug.
Medications
6
shall
be
packaged
and
labeled
according
to
state
and
federal
7
guidelines.
8
(40)
For
the
facility
requirements
for
a
child
care
home
9
pursuant
to
441
IAC
120.8(1)(a),
including
that
the
home
shall
10
have
a
nonpay,
working
landline
or
mobile
telephone
with
11
emergency
numbers
posted
for
police,
fire,
ambulance,
and
12
the
poison
information
center.
The
number
for
each
child’s
13
parent,
for
a
responsible
person
who
can
be
reached
when
the
14
parent
cannot,
and
for
the
child’s
physician
or
physician
15
assistant
shall
be
written
on
paper
and
readily
accessible
by
16
the
telephone.
The
home
must
prominently
display
all
emergency
17
information,
and
all
travel
vehicles
must
have
a
paper
copy
of
18
emergency
parent
contact
information.
19
(41)
For
the
administration
of
medications
at
a
child
20
care
home
pursuant
to
441
IAC
120.8(3)(c),
including
that
21
medications
shall
be
given
only
with
the
parent’s
or
doctor’s
22
written
authorization.
Each
prescribed
medication
shall
23
be
accompanied
by
a
physician’s,
physician
assistant’s,
or
24
pharmacist’s
direction.
Both
nonprescription
and
prescription
25
medications
shall
be
in
the
original
container
with
directions
26
intact
and
labeled
with
the
child’s
name.
All
medications
27
shall
be
stored
properly
and,
when
refrigeration
is
required,
28
shall
be
stored
in
a
separate,
covered
container
so
as
to
29
prevent
contamination
of
food
or
other
medications.
All
30
medications
shall
be
stored
so
they
are
inaccessible
to
31
children.
Any
medication
administered
to
a
child
shall
32
be
recorded,
and
the
record
shall
indicate
the
name
of
the
33
medication,
the
date
and
time
of
administration,
and
the
amount
34
administered.
35
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803
(42)
Definitions
pursuant
to
441
IAC
156.1
including
all
of
1
the
following:
2
(a)
“Intellectual
disabilities
professional”
means
a
3
psychologist,
physician,
physician
assistant,
registered
nurse,
4
educator,
social
worker,
physical
or
occupational
therapist,
5
speech
therapist,
or
audiologist
who
meets
the
educational
6
requirements
for
the
profession,
as
required
in
the
state
of
7
Iowa,
and
has
at
least
one
year
of
experience
working
with
8
persons
with
an
intellectual
disability.
9
(b)
“Mental
health
professional”
means
a
person
who
meets
10
all
of
the
following
conditions:
11
(i)
Holds
at
least
a
master’s
degree
in
a
mental
health
12
field
including
but
not
limited
to
psychology,
counseling
and
13
guidance,
psychiatric
nursing,
and
social
work;
or
is
a
doctor
14
of
medicine
or
osteopathic
medicine
or
a
physician
assistant;
15
and
16
(ii)
Holds
a
current
Iowa
license
when
required
by
the
17
Iowa
professional
licensure
laws
(such
as
a
psychiatrist,
18
a
psychologist,
a
marital
and
family
therapist,
a
mental
19
health
counselor,
an
advanced
registered
nurse
practitioner,
a
20
psychiatric
nurse,
a
physician
assistant,
or
a
social
worker);
21
and
22
(iii)
Has
at
least
two
years
of
postdegree
experience
23
supervised
by
a
mental
health
professional
in
assessing
mental
24
health
problems,
mental
illness,
and
service
needs
and
in
25
providing
mental
health
services.
26
(c)
“Physician
assistant”
means
a
person
licensed
as
a
27
physician
assistant
as
defined
in
chapter
148C.
28
(43)
Definitions
pursuant
to
441
IAC
201.2
including
all
of
29
the
following:
30
(a)
“Qualified
intellectual
disability
professional”
means
31
a
person
who
has
at
least
one
year
of
experience
working
32
directly
with
persons
with
an
intellectual
disability
or
other
33
developmental
disabilities
and
who
is
one
of
the
following:
34
(i)
A
doctor
of
medicine
or
osteopathy.
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(ii)
A
registered
nurse.
1
(iii)
A
physician
assistant
who
meets
the
requirements
of
2
“qualified
mental
health
professional”
under
this
section
and
3
“mental
health
professional”
under
441
IAC
24.1.
4
(iv)
A
person
who
holds
at
least
a
bachelor’s
degree
in
a
5
human
services
field
including
but
not
limited
to
social
work,
6
sociology,
special
education,
rehabilitation
counseling,
or
7
psychology.
8
(b)
“Qualified
mental
health
professional”
means
a
person
9
who
meets
all
of
the
following
conditions:
10
(i)
Holds
a
master’s
degree
in
a
mental
health
field
11
including
but
not
limited
to
psychology,
counseling
and
12
guidance,
or
psychiatric
nursing,
and
social
work;
or
is
a
13
doctor
of
medicine
or
osteopathic
medicine
or
a
physician
14
assistant;
and
15
(ii)
Holds
a
current
Iowa
license
when
required
by
the
16
Iowa
professional
licensure
laws
for
persons
practicing
as
a
17
psychiatrist,
a
psychologist,
a
marital
and
family
therapist,
18
a
mental
health
counselor,
an
advanced
registered
nurse
19
practitioner,
a
physician
assistant,
a
psychiatric
nurse,
or
a
20
social
worker;
and
21
(iii)
Has
at
least
two
years
of
postdegree
experience
22
supervised
by
a
mental
health
professional
in
assessing
mental
23
health
problems,
mental
illness,
and
services
needs
and
in
24
providing
mental
health
services.
25
(44)
For
the
information
provided
to
a
foster
care
provider
26
by
a
department
worker
pursuant
to
441
IAC
202.6(1)(a)(3),
27
including
the
names,
addresses,
and
telephone
numbers
of
the
28
child’s
physician
or
physician
assistant
and
dentist.
29
g.
For
the
department
of
inspections
and
appeals,
rules
30
relating
to
and
in
substantial
conformance
with
all
of
the
31
following:
32
(1)
For
the
qualifications
of
an
attending
physician
at
a
33
hospice
pursuant
to
481
IAC
53.6(1),
including
that
the
person
34
shall
have
an
active
Iowa
license
to
practice
medicine
or
as
35
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57
H.F.
803
a
physician
assistant
pursuant
to
chapter
148,
148C,
150,
or
1
150A.
2
(2)
Definitions
pursuant
to
481
IAC
57.6(2)(a),
unnumbered
3
paragraph
1,
including
that
“qualified
intellectual
disability
4
professional”
means
a
psychologist,
physician,
physician
5
assistant,
registered
nurse,
educator,
social
worker,
physical
6
or
occupational
therapist,
speech
therapist,
or
audiologist
7
who
meets
the
educational
requirements
for
the
profession,
as
8
required
in
the
state
of
Iowa,
and
has
one
year’s
experience
9
working
with
persons
with
an
intellectual
disability.
10
(3)
Definitions
pursuant
to
481
IAC
58.1,
unnumbered
11
paragraph
19,
including
that
“qualified
intellectual
12
disabilities
professional”
means
a
psychologist,
physician,
13
physician
assistant,
registered
nurse,
educator,
social
worker,
14
physical
or
occupational
therapist,
speech
therapist,
or
15
audiologist
who
meets
the
educational
requirements
for
the
16
profession,
as
required
in
the
state
of
Iowa,
and
having
one
17
year’s
experience
working
with
persons
with
an
intellectual
18
disability.
19
(4)
Definitions
pursuant
to
481
IAC
65.1
including
all
of
20
the
following:
21
(a)
“Physician
assistant”
means
a
person
licensed
as
a
22
physician
assistant
pursuant
to
645
IAC
chapters
326
to
349.
23
(b)
“Qualified
mental
health
professional
(QMHP)”
means
a
24
person
who:
25
(i)
Holds
at
least
a
master’s
degree
in
a
mental
health
26
field,
including
but
not
limited
to
psychology,
counseling
and
27
guidance,
nursing,
and
social
work;
or
is
a
doctor
of
medicine
28
(M.D.),
a
doctor
of
osteopathic
medicine
and
surgery
(D.O.),
29
or
a
physician
assistant;
and
30
(ii)
Holds
a
current
Iowa
license
when
required
by
the
Iowa
31
licensure
law;
and
32
(iii)
Has
at
least
two
years
of
postdegree
experience,
33
supervised
by
a
mental
health
professional,
in
assessing
mental
34
problems
and
needs
of
individuals
and
in
providing
appropriate
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mental
health
services
for
those
individuals.
See
rule
481
IAC
1
65.4
for
variance
procedures.
2
(5)
For
notifications
submitted
to
the
department
of
3
inspections
and
appeals
from
a
subacute
mental
health
care
4
facility
in
the
event
of
an
accident
causing
a
major
injury
5
pursuant
to
481
IAC
71.8(3)(a)(3),
including
as
a
major
injury
6
an
injury
which
requires
consultation
with
the
attending
7
physician,
or
designee
of
the
physician,
advanced
registered
8
nurse
practitioner,
or
physician
assistant
who
determines,
9
in
writing,
on
a
form
designated
by
the
department,
that
an
10
injury
is
a
“major
injury”
based
upon
the
circumstances
of
the
11
accident,
the
previous
functional
ability
of
the
resident,
and
12
the
resident’s
prognosis.
13
h.
For
the
racing
and
gaming
commission,
rules
relating
to
14
and
in
substantial
conformance
with
all
of
the
following:
15
(1)
For
the
grounds
for
denial,
suspension,
or
revocation
16
of
a
license
pursuant
to
491
IAC
6.5(1)(f),
including
that
a
17
license
shall
be
denied
if
the
applicant
has
an
addiction
to
18
alcohol
or
a
controlled
substance
without
sufficient
evidence
19
of
rehabilitation,
has
a
history
of
mental
illness
without
20
demonstrating
successful
treatment
by
a
licensed
medical
21
physician
or
physician
assistant
meeting
the
requirements
of
22
a
“mental
health
professional”
pursuant
to
section
228.1,
or
23
has
a
history
of
repeated
acts
of
violence
without
sufficient
24
evidence
of
rehabilitation.
25
(2)
For
the
qualifications
for
jockeys
pursuant
to
491
26
IAC
6.24(1)(b),
including
that
a
jockey
shall
pass
a
physical
27
examination
given
within
the
previous
twelve
months
by
a
28
licensed
physician
or
physician
assistant
affirming
fitness
to
29
participate
as
a
jockey.
The
commission
representatives
may
30
require
that
any
jockey
be
reexamined
and
may
refuse
to
allow
31
any
jockey
to
ride
pending
completion
of
such
examination.
32
(3)
For
the
regulation
of
licensees
in
restricted
areas
33
of
a
racing
facility
pursuant
to
491
IAC
6.28(2),
unnumbered
34
paragraph
1,
including
that
licensees
whose
duties
require
them
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to
be
in
a
restricted
area,
as
defined
in
subrule
6.28(1),
1
of
a
racing
facility
shall
not
have
present
within
their
2
systems
any
controlled
substance
as
listed
in
schedules
I
to
3
V
of
U.S.C.
Tit.
21
(Food
and
Drug
Section
812),
chapter
124,
4
or
any
prescription
drug
unless
it
was
obtained
directly
or
5
pursuant
to
valid
prescription
or
order
from
a
duly
licensed
6
physician
or
physician
assistant
who
is
acting
in
the
course
7
of
professional
practice.
Acting
with
reasonable
cause,
a
8
commission
representative
may
direct
the
above
licensees
to
9
deliver
a
specimen
of
urine
or
subject
themselves
to
the
taking
10
of
a
blood
sample
or
other
body
fluids
at
a
collection
site
11
approved
by
the
commission.
In
these
cases,
the
commission
12
representative
may
prohibit
the
licensee
from
participating
in
13
racing
until
the
licensee
evidences
a
negative
test
result.
14
Sufficient
sample
should
be
collected
to
ensure
a
quantity
15
for
a
split
sample
when
possible.
A
licensee
who
refuses
to
16
provide
the
samples
herein
described
shall
be
in
violation
of
17
these
rules
and
shall
be
immediately
suspended
and
subject
to
18
disciplinary
action
by
the
board
or
commission
representative.
19
All
confirmed
positive
test
costs
and
any
related
expenses
20
shall
be
paid
for
by
the
licensee.
Negative
tests
shall
be
at
21
the
expense
of
the
commission.
22
i.
For
the
law
enforcement
academy,
rules
relating
to
and
in
23
substantial
conformance
with
all
of
the
following:
24
(1)
For
the
minimum
standards
for
Iowa
law
enforcement
25
officers
pursuant
to
501
IAC
2.1(11),
including
that
the
26
officer
is
examined
by
a
licensed
physician
or
physician
27
assistant
or
surgeon
and
meets
the
physical
requirements
28
necessary
to
fulfill
the
responsibilities
of
a
law
enforcement
29
officer.
30
(2)
For
the
certification
of
law
enforcement
officers
31
pursuant
to
501
IAC
3.12(5)(a)(3),
including
that
the
32
individual
must
be
examined
by
a
licensed
physician
or
surgeon
33
or
physician
assistant
and
meet
the
physical
requirements
34
necessary
to
fulfill
the
responsibilities
of
a
law
enforcement
35
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officer.
1
(3)
For
the
selection
or
appointment
of
reserve
peace
2
officers
pursuant
to
501
IAC
10.100(10),
including
that
the
3
person
shall
be
examined
by
a
licensed
physician
or
surgeon
4
or
physician
assistant
and
meets
the
physical
requirements
as
5
defined
by
the
law
enforcement
agency
necessary
to
fulfill
the
6
responsibilities
of
the
reserve
peace
officer
position
being
7
filled.
8
j.
For
the
natural
resource
commission,
rules
relating
to
9
and
in
substantial
conformance
with
all
of
the
following:
10
(1)
For
the
grounds
for
revoking
or
suspending
an
11
instructor
license
pursuant
to
571
IAC
12.25(8),
including
the
12
participation
in
a
course
while
under
the
influence
of
alcohol
13
or
any
illegal
drug
or
while
ingesting
prescription
medication
14
in
a
manner
contrary
to
the
dosing
directions
given
by
the
15
prescribing
physician
or
physician
assistant.
16
(2)
For
applications
for
use
of
a
crossbow
for
deer
and
17
turkey
hunting
by
handicapped
individuals
pursuant
to
571
18
IAC
15.22(2),
including
that
an
individual
requesting
use
19
of
a
crossbow
for
hunting
deer
or
turkey
must
submit
an
20
application
for
an
authorization
card
on
forms
provided
by
the
21
department.
The
application
must
include
a
statement
signed
by
22
the
applicant’s
physician
or
physician
assistant
declaring
that
23
the
individual
is
not
physically
capable
of
shooting
a
bow
and
24
arrow.
A
first-time
applicant
must
submit
the
authorization
25
card
application
no
later
than
ten
days
before
the
last
day
26
of
the
license
application
period
for
the
season
the
person
27
intends
to
hunt.
28
(3)
For
the
validity
of
an
authorization
card
for
the
29
use
of
a
crossbow
for
deer
and
turkey
hunting
by
handicapped
30
individuals
pursuant
to
571
IAC
15.22(4),
including
that
a
31
card
authorizing
the
use
of
a
crossbow
for
hunting
deer
and
32
turkey
will
be
valid
for
as
long
as
the
person
is
incapable
33
of
shooting
a
bow
and
arrow.
If
a
conservation
officer
has
34
probable
cause
to
believe
the
person’s
handicapped
status
has
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improved,
making
it
possible
for
the
person
to
shoot
a
bow
1
and
arrow,
the
department
may,
upon
the
officer’s
request,
2
require
the
person
to
obtain
in
writing
a
current
physician’s
3
or
physician
assistant’s
statement.
4
(4)
For
licenses
for
nonresidents
to
participate
in
a
5
special
deer
hunting
season
for
severely
disabled
persons
6
pursuant
to
571
IAC
94.10(1),
including
that
a
nonresident
7
meeting
the
requirements
of
section
321L.1(8)
may
apply
for
or
8
purchase
a
nonresident
deer
hunting
license
to
participate
in
9
a
special
deer
hunting
season
for
severely
disabled
persons.
10
Nonresidents
applying
for
this
license
must
have
on
file
11
with
the
department
of
natural
resources
either
a
copy
of
a
12
disabilities
parking
permit
issued
by
a
state
department
of
13
transportation
or
an
Iowa
department
of
natural
resources
form
14
signed
by
a
physician
or
physician
assistant
that
verifies
15
their
disability.
16
k.
For
the
Iowa
department
of
public
health,
rules
relating
17
to
and
in
substantial
conformance
with
all
of
the
following:
18
(1)
Definitions
pursuant
to
641
IAC
9.2
including
all
of
the
19
following:
20
(a)
“Diabetes
mellitus”
includes
the
following:
21
(i)
“Type
I
diabetes”
means
insulin-dependent
diabetes
22
(IDDM)
requiring
lifelong
treatment
with
insulin.
23
(ii)
“Type
II
diabetes”
means
noninsulin-dependent
diabetes
24
often
managed
by
a
food
plan,
exercise,
weight
control,
and
in
25
some
instances,
oral
medications
or
insulin.
26
(iii)
“Gestational
diabetes”
means
diabetes
diagnosed
27
during
pregnancy.
28
(iv)
“Impaired
glucose
tolerance”
means
a
condition
in
29
which
blood
glucose
levels
are
higher
than
normal,
diagnosed
30
by
a
physician
or
physician
assistant,
and
treated
with
a
food
31
plan,
exercise,
or
weight
control.
32
(b)
“Physician
assistant”
means
a
person
licensed
as
a
33
physician
assistant
under
chapter
148C.
34
(2)
For
instructors
for
programs
not
recognized
by
the
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American
diabetes
association
or
accredited
by
the
American
1
association
of
diabetes
educators
pursuant
to
641
IAC
9.8(3),
2
including
that
the
primary
instructors
shall
be
one
or
more
3
of
the
following
health
care
professionals:
physicians,
4
physician
assistants,
registered
nurses,
licensed
dietitians,
5
and
pharmacists
who
are
knowledgeable
about
the
disease
process
6
of
diabetes
and
the
treatment
of
diabetes.
If
there
is
only
7
one
primary
instructor,
there
shall
be
at
least
one
supporting
8
instructor.
The
supporting
instructor
shall
be
from
one
of
the
9
four
professions
listed
as
possible
primary
instructors,
but
a
10
different
profession
from
the
single
primary
instructor.
11
(3)
For
information
required
for
participation
in
the
12
prescription
drug
donation
repository
program
by
medical
13
facilities
and
pharmacies
pursuant
to
641
IAC
109.3(3)(b),
14
including
the
name
and
telephone
number
of
the
responsible
15
pharmacist,
physician,
physician
assistant,
or
nurse
16
practitioner
who
is
employed
by
or
under
contract
with
the
17
pharmacy
or
medical
facility.
18
(4)
For
information
required
for
participation
in
the
19
prescription
drug
donation
repository
program
by
medical
20
facilities
and
pharmacies
pursuant
to
641
IAC
109.3(3)(c),
21
including
a
statement,
signed
and
dated
by
the
responsible
22
pharmacist,
physician,
physician
assistant,
or
nurse
23
practitioner,
indicating
that
the
pharmacy
or
medical
facility
24
meets
the
eligibility
requirements
under
this
rule
and
shall
25
comply
with
the
requirements
of
the
chapter.
26
(5)
For
the
dispensing
of
donated
prescription
drugs
27
and
supplies
pursuant
to
641
IAC
109.6(1),
including
that
28
donated
drugs
and
supplies
may
be
dispensed
only
if
the
drugs
29
or
supplies
are
prescribed
by
a
health
care
practitioner
30
for
use
by
an
eligible
individual
and
are
dispensed
by
a
31
licensed
pharmacist,
physician,
physician
assistant,
or
nurse
32
practitioner.
33
l.
For
the
department
of
public
safety,
rules
for
34
definitions
pursuant
to
661
IAC
91.1,
including
that
“unlawful
35
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user
of
or
addicted
to
any
controlled
substance”
means
a
1
person
who
uses
a
controlled
substance
and
has
lost
the
power
2
of
self-control
with
reference
to
the
use
of
the
controlled
3
substance
or
any
person
who
is
a
current
user
of
a
controlled
4
substance
in
a
manner
other
than
as
prescribed
by
a
licensed
5
physician
or
physician
assistant.
Such
use
is
not
limited
to
6
the
use
of
drugs
on
a
particular
day,
or
within
a
matter
of
days
7
or
weeks
before,
but
rather
that
the
unlawful
use
has
occurred
8
recently
enough
to
indicate
that
the
individual
is
actively
9
engaged
in
such
conduct.
A
person
may
be
an
unlawful
current
10
user
of
a
controlled
substance
even
though
the
substance
is
11
not
being
used
at
the
precise
time
the
person
applies
for
an
12
Iowa
permit
to
carry
weapons
or
seeks
to
acquire
a
firearm
13
or
receives
or
possesses
a
firearm.
An
inference
of
current
14
use
may
be
drawn
from
evidence
of
a
recent
use
or
possession
15
of
a
controlled
substance
or
a
pattern
of
use
or
possession
16
that
reasonably
covers
the
present
time,
e.g.,
a
conviction
17
for
use
or
possession
of
a
controlled
substance
within
the
18
past
year;
multiple
arrests
for
such
offenses
within
the
past
19
five
years
if
the
most
recent
arrest
occurred
within
the
past
20
year;
or
persons
found
through
a
drug
test
to
use
a
controlled
21
substance
unlawfully,
provided
that
the
test
was
administered
22
within
the
past
year.
For
a
current
or
former
member
of
the
23
armed
forces,
an
inference
of
current
use
may
be
drawn
from
24
recent
disciplinary
or
other
administrative
action
based
on
25
confirmed
drug
use,
e.g.,
court-martial
conviction,
nonjudicial
26
punishment,
or
an
administrative
discharge
based
on
drug
use
27
or
drug
rehabilitation
failure.
28
m.
For
the
department
of
transportation,
rules
relating
to
29
and
in
substantial
conformance
with
all
of
the
following:
30
(1)
For
exemptions
from
motor
vehicle
window
transparency
31
requirements
pursuant
to
761
IAC
450.7(3)(b),
including
that
32
a
motor
vehicle
fitted
with
a
front
windshield,
a
front
side
33
window,
or
a
front
sidewing
with
less
than
seventy
percent
but
34
not
less
than
thirty-five
percent
light
transmittance
before
35
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July
4,
2012,
may
continue
to
be
maintained
and
operated
with
a
1
front
windshield,
a
front
side
window,
or
a
front
sidewing
with
2
less
than
seventy
percent
but
not
less
than
thirty-five
percent
3
light
transmittance
on
or
after
July
4,
2012,
so
long
as
the
4
vehicle
continues
to
be
used
for
the
transport
of
a
passenger
5
or
operator
who
obtained
Form
432020,
which
documented
a
6
medical
need
for
such
reduced
transparency,
and
was
signed
by
7
the
person’s
physician
or
physician
assistant
before
July
4,
8
2012.
Form
432020
must
be
carried
at
all
times
in
the
vehicle
9
to
which
the
exemption
applies.
At
such
time
as
the
vehicle
is
10
no
longer
used
for
the
transport
of
the
passenger
or
operator
11
who
is
the
subject
of
Form
432020,
the
exemption
expires
and
12
may
not
be
renewed.
The
owner
of
the
vehicle
to
which
the
13
exemption
applied
must
return
the
vehicle
to
conformance
with
14
the
minimum
standard
of
transparency
set
forth
in
subrule
15
450.7(2)
within
sixty
days
of
expiration
of
the
exemption.
16
(2)
Definitions
pursuant
to
761
IAC
450.7(3),
including
17
that
“physician
assistant”
as
used
in
this
rule
means
a
person
18
licensed
under
chapter
148C.
19
n.
For
the
Iowa
department
of
veterans
affairs,
rules
20
relating
to
expenses
relating
to
the
purchase
of
certain
21
equipment
services
pursuant
to
801
IAC
14.4(5)(b),
including
22
that
individuals
requesting
reimbursement
under
this
subrule
23
will
be
required
to
provide
verification
of
the
purchase
and
24
installation
of
the
equipment
and
information
relating
to
25
the
need
for
the
equipment.
Individuals
may
also
provide
a
26
product
and
installation
cost
estimate
to
the
commission
for
27
approval,
with
the
understanding
that
the
commission
will
pay
28
no
more
than
the
cost
estimate
to
the
supplier
or
installer.
29
Applicants
needing
durable
equipment
as
a
medical
necessity
30
should
provide
information
from
a
physician
or
physician
31
assistant.
32
o.
For
the
department
of
workforce
development,
rules
33
relating
to
and
in
substantial
conformance
with
all
of
the
34
following:
35
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(1)
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803
(1)
For
the
definition
of
voluntary
quit
without
good
cause
1
attributable
to
the
employer
pursuant
to
871
IAC
24.25(35),
2
including
that
the
claimant
left
because
of
illness
or
injury
3
which
was
not
caused
or
aggravated
by
the
employment
or
4
pregnancy
and
failed
to:
5
(a)
Obtain
the
advice
of
a
licensed
and
practicing
physician
6
or
physician
assistant;
7
(b)
Obtain
certification
of
release
for
work
from
a
licensed
8
and
practicing
physician
or
physician
assistant;
9
(c)
Return
to
the
employer
and
offer
services
upon
recovery
10
and
certification
for
work
by
a
licensed
and
practicing
11
physician
or
physician
assistant;
or
12
(d)
Fully
recover
so
that
the
claimant
could
perform
all
of
13
the
duties
of
the
job.
14
(2)
For
the
definition
of
a
nonemployment
related
15
separation
that
is
a
voluntary
quit
with
good
cause
16
attributable
to
the
employer
pursuant
to
871
IAC
24.26(6)(a),
17
including
that
the
claimant
left
because
of
illness,
injury,
18
or
pregnancy
upon
the
advice
of
a
licensed
and
practicing
19
physician
or
physician
assistant.
Upon
recovery,
when
recovery
20
was
certified
by
a
licensed
and
practicing
physician
or
21
physician
assistant,
the
claimant
returned
and
offered
to
22
perform
services
to
the
employer,
but
no
suitable,
comparable
23
work
was
available.
Recovery
is
defined
as
the
ability
of
24
the
claimant
to
perform
all
of
the
duties
of
the
previous
25
employment.
26
(3)
For
the
definition
of
a
voluntary
quit
with
good
cause
27
attributable
to
the
employer
pursuant
to
871
IAC
24.26(9),
28
including
that
the
claimant
left
employment
upon
the
advice
of
29
a
licensed
and
practicing
physician
or
physician
assistant
for
30
the
sole
purpose
of
taking
a
family
member
to
a
place
having
a
31
different
climate
and
subsequently
returned
to
the
claimant’s
32
regular
employer
and
offered
to
perform
services,
but
the
33
claimant’s
regular
or
comparable
work
was
not
available.
34
However,
during
the
time
the
claimant
was
at
a
different
35
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climate
the
claimant
shall
be
deemed
to
be
unavailable
for
1
work
notwithstanding
that
during
the
absence
the
claimant
2
secured
temporary
employment.
(Family
is
defined
as
wife,
3
husband,
children,
parents,
grandparents,
grandchildren,
foster
4
children,
brothers,
brothers-in-law,
sisters,
sisters-in-law,
5
aunts,
uncles,
or
corresponding
relatives
of
the
classified
6
employee’s
spouse
or
other
relatives
of
the
classified
employee
7
or
spouse
residing
in
the
classified
employee’s
immediate
8
household.)
9
p.
For
the
department
of
workforce
development,
labor
10
services
division,
rules
relating
to
and
in
substantial
11
conformance
with
all
of
the
following:
12
(1)
For
the
disclosure
of
a
trade
secret
during
a
medical
13
emergency
pursuant
to
875
IAC
110.6(2),
including
that
where
a
14
treating
physician,
physician
assistant,
or
nurse
determines
15
that
a
medical
emergency
exists
and
the
specific
chemical
16
identity
of
a
hazardous
chemical
is
necessary
for
emergency
17
or
first-aid
treatment,
the
chemical
manufacturer,
importer,
18
or
employer
shall
immediately
disclose
the
specific
chemical
19
identity
of
a
trade
secret
chemical
to
that
treating
physician,
20
physician
assistant,
or
nurse,
regardless
of
the
existence
of
21
a
written
statement
of
need
or
a
confidentiality
agreement.
22
The
chemical
manufacturer,
importer,
or
employer
may
require
23
a
written
statement
of
need
and
confidentiality
agreement,
24
in
accordance
with
the
provisions
of
subrules
110.6(3)
and
25
110.6(4),
as
soon
as
circumstances
permit.
26
(2)
For
the
disclosure
of
a
trade
secret
in
a
nonemergency
27
situation
pursuant
to
875
IAC
110.6(3),
unnumbered
paragraph
28
1,
including
that
in
nonemergency
situations,
a
chemical
29
manufacturer,
importer,
or
employer
shall,
upon
request,
30
disclose
a
specific
chemical
identity,
otherwise
permitted
to
31
be
withheld
under
subrule
110.6(1),
to
a
health
professional
32
(i.e.,
physician,
physician
assistant,
industrial
hygienist,
33
toxicologist,
epidemiologist,
or
occupational
health
nurse),
34
providing
medical
or
other
occupational
health
services
35
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to
exposed
employee(s),
and
to
employees
or
designated
1
representatives,
if:
2
(3)
For
applications
for
a
license
to
practice
asbestos
3
removal
pursuant
to
875
IAC
155.6(1),
including
that
except
as
4
noted
in
the
subrule,
the
applicant
must
complete
and
submit
5
the
entire
form
provided
by
the
division
with
the
necessary
6
attachments.
Respirator
fit
tests
and
medical
examinations
7
must
have
occurred
within
the
past
twelve
months.
Only
worker
8
and
contractor/supervisor
license
applicants
must
submit
the
9
respiratory
protection
and
physician’s
or
physician
assistant’s
10
certification
forms.
Photocopies
of
the
forms
shall
not
be
11
accepted.
12
(4)
For
documentation
held
by
persons
licensed
for
asbestos
13
abatement
in
an
area
that
is
subject
to
a
disaster
emergency
14
proclamation
pursuant
to
875
IAC
155.6(11)(a)(2),
including
15
a
copy
of
a
physician’s
or
physician
assistant’s
statement
16
indicating
that,
consistent
with
29
C.F.R.
§1910.134,
a
17
licensed
physician
or
physician
assistant
has
examined
the
18
individual
within
the
past
twelve
months
and
approved
the
19
individual
to
work
while
wearing
a
respirator.
20
(5)
For
the
contents
of
an
application
for
a
covered
event
21
other
than
a
professional
wrestling
event
pursuant
to
875
IAC
22
169.4(1)(b),
all
of
following:
23
(a)
A
copy
of
the
medical
license
of
the
ringside
physician
24
or
physician
assistant.
25
(b)
The
date,
time,
and
location
of
the
ringside
physician’s
26
or
physician
assistant’s
examination
of
the
contestants.
27
(6)
For
the
responsibilities
of
the
promoter
of
an
athletic
28
event
pursuant
to
875
IAC
169.5(16),
unnumbered
paragraph
1,
29
including
that
the
promoter
submit
to
the
ringside
physician
or
30
physician
assistant
no
later
than
at
the
time
of
the
physical
31
test
results
showing
that
each
contestant
scheduled
for
the
32
event
tested
negative
for
the
human
immunodeficiency,
hepatitis
33
B,
and
hepatitis
C
viruses
within
the
one-year
period
prior
34
to
the
event.
The
contestant
shall
not
participate
and
the
35
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physician
or
physician
assistant
shall
notify
the
promoter
that
1
the
contestant
is
prohibited
from
participating
for
medical
2
reasons
if
any
of
the
following
occurs:
3
(7)
For
injuries
during
a
professional
boxing
match
4
pursuant
to
875
IAC
173.4,
including
that
if
a
contestant
5
claims
to
be
injured
during
the
bout,
the
referee
shall
stop
6
the
bout
and
request
the
attending
physician
or
physician
7
assistant
to
make
an
examination.
If
the
physician
or
8
physician
assistant
decides
that
the
contestant
has
been
9
injured
as
the
result
of
a
foul,
the
physician
or
physician
10
assistant
shall
advise
the
referee
of
the
injury.
If
the
11
physician
or
physician
assistant
is
of
the
opinion
that
the
12
injured
contestant
may
be
able
to
continue,
the
physician
or
13
physician
assistant
shall
order
a
five-minute
intermission,
14
after
which
the
physician
or
physician
assistant
shall
make
15
another
examination
and
again
advise
the
referee
of
the
injured
16
contestant’s
condition.
It
shall
be
the
duty
of
the
promoter
17
to
have
an
approved
physician
or
physician
assistant
in
18
attendance
during
the
entire
duration
of
all
bouts.
19
(8)
For
persons
allowed
in
a
ring
during
a
professional
20
boxing
match
pursuant
to
875
IAC
173.8,
including
that
no
21
person
other
than
the
contestants
and
the
referee
shall
enter
22
the
ring
during
the
bout,
excepting
the
seconds
between
the
23
rounds
or
the
attending
physician
or
physician
assistant
if
24
asked
by
the
referee
to
examine
an
injury
to
a
contestant.
25
(9)
For
the
weighing
of
contestants
in
a
professional
boxing
26
match
pursuant
to
875
IAC
173.19,
including
that
contestants
27
shall
be
weighed
and
examined
on
the
day
of
the
scheduled
28
match
by
the
attending
ring
physician
or
physician
assistant,
29
at
a
time
and
place
to
be
determined
by
the
commissioner.
30
Preliminary
boxers
may
be
allowed
to
weigh
in
and
be
examined
31
not
later
than
one
hour
before
the
scheduled
time
of
the
first
32
match
on
the
card.
All
weigh-ins
will
be
conducted
with
the
33
boxer
stripped.
Accurate
scales
shall
be
furnished
by
the
34
promoter.
35
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803
(10)
For
attending
ring
physicians
during
a
professional
1
boxing
match
pursuant
to
875
IAC
173.45,
including
that
when
a
2
boxer
has
been
injured
seriously,
knocked
out,
or
technically
3
knocked
out,
the
referee
shall
immediately
summon
the
attending
4
ring
physician
or
physician
assistant
to
aid
the
stricken
5
boxer.
Managers,
handlers,
and
seconds
shall
not
attend
to
6
the
stricken
boxer,
except
at
the
request
of
the
physician
or
7
physician
assistant.
8
(11)
For
the
keeping
of
time
during
a
professional
boxing
9
match
pursuant
to
875
IAC
173.47,
including
that
the
timekeeper
10
shall
provide
a
stopwatch
and
shall
maintain
an
accurate
time
11
of
all
bouts.
The
timekeeper
shall
keep
an
exact
record
of
12
time
taken
out
at
the
request
of
a
referee
for
an
examination
13
of
a
contestant
by
the
physician
or
physician
assistant,
14
replacing
a
glove,
or
adjusting
any
equipment
during
a
round.
15
The
timekeeper
shall
provide
a
whistle
and
shall
sound
the
16
whistle
ten
seconds
before
the
start
of
each
round
of
boxing
17
bouts.
The
timekeeper
shall
be
impartial
and
shall
not
signal
18
interested
parties
at
any
time
during
a
bout.
19
(12)
For
the
suspension
of
contestants
during
an
20
elimination
tournament
pursuant
to
875
IAC
174.6,
including
21
that
a
contestant
who
suffers
a
knockout
or
where
the
referee
22
stops
a
fight
on
a
technical
knockout
shall
not
be
permitted
23
to
box
in
the
state
for
a
period
of
thirty
days.
Before
being
24
permitted
to
fight
again,
the
contestant
shall
be
examined
by
a
25
physician
or
physician
assistant
approved
by
the
commissioner.
26
(13)
For
the
designation
of
officials
for
professional
27
kickboxing
pursuant
to
875
IAC
176.4(1),
including
that
the
28
designation
of
officials,
referees,
physicians
or
physician
29
assistants,
timekeepers,
judges,
kick
counters,
scorekeepers,
30
contestants,
seconds,
and
managers
is
subject
to
the
approval
31
of
the
commissioner
or
designee.
32
(14)
For
officials
for
a
mixed
martial
arts
event
pursuant
33
to
875
IAC
177.4(1),
including
that
officials
shall
consist
34
of
three
judges,
two
referees,
the
physician
or
physician
35
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803
assistant,
and
the
timekeeper.
1
(15)
For
the
keeping
of
time
for
a
mixed
martial
arts
event
2
pursuant
to
875
IAC
177.4(3),
including
that
the
timekeeper
3
shall
keep
an
exact
record
of
time
taken
out
at
the
request
of
4
a
referee
for
an
examination
of
a
contestant
by
the
physician
5
or
physician
assistant,
replacing
a
glove,
or
adjusting
6
any
equipment
during
a
round.
The
timekeeper
shall
notify
7
contestants
at
the
beginning
and
end
of
each
round.
The
8
timekeeper
shall
be
impartial
and
shall
not
signal
interested
9
parties
at
any
time
during
a
match.
10
(16)
For
persons
allowed
in
the
cage
during
a
mixed
martial
11
arts
event
pursuant
to
875
IAC
177.4(8),
including
that
no
12
person
other
than
the
two
contestants
and
the
referee
shall
13
enter
the
cage
during
the
match.
However,
the
physician
or
14
physician
assistant
may
enter
the
cage
to
examine
a
contestant
15
upon
the
request
of
the
referee.
16
(17)
For
the
decorum
of
persons
involved
in
a
mixed
martial
17
arts
event
pursuant
to
875
IAC
177.4(10)(d),
including
that
a
18
contestant
is
exempt
from
875
IAC
177.4(10)(a)(1)
and
(2)
while
19
interacting
with
the
contestant’s
opponent
during
a
round.
20
However,
if
the
round
is
stopped
by
the
physician,
physician
21
assistant,
or
referee
for
a
time
out,
875
IAC
177.4(10)(a)(1)
22
and
(2)
shall
apply
to
a
contestant.
23
(18)
For
the
examination
of
contestants
in
a
mixed
martial
24
arts
event
pursuant
to
875
IAC
177.5(13),
including
that
on
the
25
day
of
the
event,
at
a
time
and
place
to
be
approved
by
the
26
commissioner,
the
ringside
physician
or
physician
assistant
27
shall
conduct
a
rigorous
physical
examination
to
determine
28
the
contestant’s
fitness
to
participate
in
an
mixed
martial
29
arts
match.
A
contestant
deemed
not
fit
by
the
physician
or
30
physician
assistant
shall
not
participate
in
the
event.
31
(19)
For
injuries
during
a
mixed
martial
arts
event
pursuant
32
to
875
IAC
177.6(7),
including
that
if
a
contestant
claims
to
33
be
injured
or
when
a
contestant
has
been
injured
seriously
or
34
knocked
out,
the
referee
shall
immediately
stop
the
fight
and
35
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summon
the
attending
ring
physician
or
physician
assistant
to
1
make
an
examination
of
the
stricken
fighter.
If
the
physician
2
or
physician
assistant
decides
that
the
contestant
has
been
3
injured,
the
physician
or
physician
assistant
shall
advise
the
4
referee
of
the
severity
of
the
injury.
If
the
physician
or
5
physician
assistant
is
of
the
opinion
the
injured
contestant
6
may
be
able
to
continue,
the
physician
or
physician
assistant
7
shall
order
a
five-minute
intermission,
after
which
the
8
physician
or
physician
assistant
shall
make
another
examination
9
and
again
advise
the
referee
of
the
injured
contestant’s
10
condition.
Managers,
handlers,
and
seconds
shall
not
attend
to
11
the
stricken
fighter,
except
at
the
request
of
the
physician
12
or
physician
assistant.
13
2.
The
boards
listed
in
subsection
1,
upon
adoption
of
14
rules
pursuant
to
chapter
17A
as
required
by
this
section
of
15
this
Act
shall
not
thereafter
approve
a
notice
of
intended
16
action
pursuant
to
section
17A.4(1)(a),
for
the
amendment
or
17
rescission
of
such
rules
for
a
period
of
two
years
from
the
18
effective
date
of
this
Act.
19
3.
Except
as
provided
in
subsection
2,
the
rulemaking
20
requirements
provided
in
this
section
of
this
Act
shall
not
21
be
construed
to
prohibit
the
boards
listed
in
subsection
1
22
from
engaging
in
further
rulemaking
not
in
conflict
with
this
23
section
of
this
Act
relating
to
the
subject
matter
of
this
24
section
or
to
otherwise
diminish
the
authority
to
engage
in
25
rulemaking
provided
to
those
boards
by
any
other
statute.
26
EXPLANATION
27
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
28
the
explanation’s
substance
by
the
members
of
the
general
assembly.
29
This
bill
relates
to
duties
that
may
be
performed
by
30
physician
assistants
in
Code
sections
90A.8
(required
31
conditions
for
boxing
matches),
135.109
(Iowa
domestic
abuse
32
death
review
team
membership),
135.146
(first
responder
33
vaccination
program),
135J.3
(licensed
hospice
program
——
34
basic
requirements),
141A.5
(partner
notification
program
——
35
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HIV),
141A.6
(HIV-related
conditions
——
consent,
testing,
and
1
reporting
——
penalty),
141A.7
(HIV
test
results
——
counseling
2
——
application
for
services),
144A.4
(life-sustaining
3
procedures
——
revocation
of
declaration),
144A.7A
4
(out-of-hospital
do-not-resuscitate
orders),
144B.5
(durable
5
power
of
attorney
for
health
care
——
form),
144B.6
(attorney
6
in
fact
——
priority
to
make
decisions),
144D.4
(physician
7
orders
for
scope
of
treatment
——
general
provisions),
144F.2
8
(discharge
policies
——
opportunity
to
designate
lay
caregiver),
9
189A.6
(meat
and
poultry
inspections
——
health
examination
of
10
employees),
225.9
(voluntary
private
psychiatric
patients),
11
225.10
(voluntary
public
psychiatric
patients),
225.12
12
(voluntary
public
psychiatric
patients
——
physician’s
report),
13
225.15
(examination
and
treatment
——
psychiatric
patients),
14
225.16
(voluntary
public
psychiatric
patients
——
admission),
15
225C.14
(preliminary
diagnostic
evaluation
——
state
mental
16
health
institutes),
225C.16
(referrals
for
evaluation
——
state
17
mental
health
institute),
232.71B
(duties
of
the
department
18
of
human
services
upon
receipt
of
child
abuse
report),
232.78
19
(temporary
custody
of
a
child
pursuant
to
ex
parte
court
20
order),
232.79
(custody
of
a
child
without
court
order),
232.83
21
(child
sexual
abuse
involving
a
person
not
responsible
for
22
the
care
of
the
child),
232.95
(hearing
concerning
temporary
23
removal
of
a
child),
234.22
(extent
of
family
planning
and
24
birth
control
services),
235A.13
(definitions
——
child
abuse),
25
237A.5
(child
care
facility
personnel),
237A.13
(state
child
26
care
assistance),
249.3
(state
supplementary
assistance
27
eligibility),
321.375
(school
bus
drivers
——
qualifications
——
28
grounds
for
suspension),
321.446
(child
restraint
devices),
29
347B.5
(county
care
facility
admission
——
labor
required),
30
347B.6
(county
care
facility
——
order
for
admission),
31
411.5
(peace
officer
and
fire
fighter
retirement
system
——
32
administration),
411.6
(benefits),
514C.17
(health
and
accident
33
insurance
——
continuity
of
care
——
terminal
illness),
514C.18
34
(diabetes
coverage),
514C.20
(mandated
coverage
for
dental
35
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care
——
anesthesia
and
certain
hospital
charges),
and
514C.25
1
(coverage
for
prosthetic
devices).
2
The
bill
also
directs
the
department
of
human
services,
3
department
on
aging,
department
of
corrections,
economic
4
development
authority,
department
of
education,
department
of
5
inspections
and
appeals,
racing
and
gaming
commission,
law
6
enforcement
academy,
natural
resource
commission,
department
7
of
public
health,
department
of
public
safety,
department
8
of
transportation,
Iowa
department
of
veterans
affairs,
and
9
department
of
workforce
development,
including
the
labor
10
services
division,
to
adopt
rules
adding
physician
assistants
11
to
lists
of
health
care
workers
that
may
perform
certain
12
duties.
The
bill
prohibits
those
boards
from
amending
or
13
rescinding
such
rules
for
a
period
of
two
years
from
the
14
effective
date
of
the
bill.
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