House Study Bill 255 - Introduced HOUSE FILE _____ BY (PROPOSED COMMITTEE ON HUMAN RESOURCES BILL BY CHAIRPERSON MEYER) 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 TLSB 1921YC (2) 89 ss/rh
H.F. _____ 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 -1- LSB 1921YC (2) 89 ss/rh 1/ 57
H.F. _____ 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 -2- LSB 1921YC (2) 89 ss/rh 2/ 57
H.F. _____ 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: 35 -3- LSB 1921YC (2) 89 ss/rh 3/ 57
H.F. _____ 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 35 -4- LSB 1921YC (2) 89 ss/rh 4/ 57
H.F. _____ 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 -5- LSB 1921YC (2) 89 ss/rh 5/ 57
H.F. _____ 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 -6- LSB 1921YC (2) 89 ss/rh 6/ 57
H.F. _____ 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 -7- LSB 1921YC (2) 89 ss/rh 7/ 57
H.F. _____ 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 -8- LSB 1921YC (2) 89 ss/rh 8/ 57
H.F. _____ 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- LSB 1921YC (2) 89 ss/rh 9/ 57
H.F. _____ 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 -10- LSB 1921YC (2) 89 ss/rh 10/ 57
H.F. _____ 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 -11- LSB 1921YC (2) 89 ss/rh 11/ 57
H.F. _____ 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 -12- LSB 1921YC (2) 89 ss/rh 12/ 57
H.F. _____ 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- LSB 1921YC (2) 89 ss/rh 13/ 57
H.F. _____ 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 -14- LSB 1921YC (2) 89 ss/rh 14/ 57
H.F. _____ 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: 35 -15- LSB 1921YC (2) 89 ss/rh 15/ 57
H.F. _____ 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 35 -16- LSB 1921YC (2) 89 ss/rh 16/ 57
H.F. _____ 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 -17- LSB 1921YC (2) 89 ss/rh 17/ 57
H.F. _____ 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: 35 -18- LSB 1921YC (2) 89 ss/rh 18/ 57
H.F. _____ 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 35 -19- LSB 1921YC (2) 89 ss/rh 19/ 57
H.F. _____ 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 35 -20- LSB 1921YC (2) 89 ss/rh 20/ 57
H.F. _____ 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 -21- LSB 1921YC (2) 89 ss/rh 21/ 57
H.F. _____ 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 -22- LSB 1921YC (2) 89 ss/rh 22/ 57
H.F. _____ 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 -23- LSB 1921YC (2) 89 ss/rh 23/ 57
H.F. _____ 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 -24- LSB 1921YC (2) 89 ss/rh 24/ 57
H.F. _____ 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 -25- LSB 1921YC (2) 89 ss/rh 25/ 57
H.F. _____ 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 -26- LSB 1921YC (2) 89 ss/rh 26/ 57
H.F. _____ 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 -27- LSB 1921YC (2) 89 ss/rh 27/ 57
H.F. _____ 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- LSB 1921YC (2) 89 ss/rh 28/ 57
H.F. _____ 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- LSB 1921YC (2) 89 ss/rh 29/ 57
H.F. _____ 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- LSB 1921YC (2) 89 ss/rh 30/ 57
H.F. _____ 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 -31- LSB 1921YC (2) 89 ss/rh 31/ 57
H.F. _____ 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 -32- LSB 1921YC (2) 89 ss/rh 32/ 57
H.F. _____ 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 -33- LSB 1921YC (2) 89 ss/rh 33/ 57
H.F. _____ 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 -34- LSB 1921YC (2) 89 ss/rh 34/ 57
H.F. _____ 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 35 -35- LSB 1921YC (2) 89 ss/rh 35/ 57
H.F. _____ 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. 35 -36- LSB 1921YC (2) 89 ss/rh 36/ 57
H.F. _____ (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 -37- LSB 1921YC (2) 89 ss/rh 37/ 57
H.F. _____ (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 -38- LSB 1921YC (2) 89 ss/rh 38/ 57
H.F. _____ (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. 35 -39- LSB 1921YC (2) 89 ss/rh 39/ 57
H.F. _____ (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 -40- LSB 1921YC (2) 89 ss/rh 40/ 57
H.F. _____ 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 35 -41- LSB 1921YC (2) 89 ss/rh 41/ 57
H.F. _____ 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 35 -42- LSB 1921YC (2) 89 ss/rh 42/ 57
H.F. _____ 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 -43- LSB 1921YC (2) 89 ss/rh 43/ 57
H.F. _____ 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 35 -44- LSB 1921YC (2) 89 ss/rh 44/ 57
H.F. _____ 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 35 -45- LSB 1921YC (2) 89 ss/rh 45/ 57
H.F. _____ 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 -46- LSB 1921YC (2) 89 ss/rh 46/ 57
H.F. _____ 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 -47- LSB 1921YC (2) 89 ss/rh 47/ 57
H.F. _____ 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 -48- LSB 1921YC (2) 89 ss/rh 48/ 57
H.F. _____ (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 -49- LSB 1921YC (2) 89 ss/rh 49/ 57
H.F. _____ 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 -50- LSB 1921YC (2) 89 ss/rh 50/ 57
H.F. _____ 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 -51- LSB 1921YC (2) 89 ss/rh 51/ 57
H.F. _____ 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 -52- LSB 1921YC (2) 89 ss/rh 52/ 57
H.F. _____ (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