Senate File 2298 - Reprinted SENATE FILE 2298 BY COMMITTEE ON STATE GOVERNMENT (SUCCESSOR TO SSB 3078) (As Amended and Passed by the Senate March 12, 2012 ) A BILL FOR An Act relating to direct care professionals including the 1 establishment of a board of direct care professionals, 2 providing for implementation, making penalties applicable, 3 and including effective date provisions. 4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 5 SF 2298 (6) 84 pf/nh

S.F. 2298 Section 1. NEW SECTION . 152F.1 Definitions. 1 As used in this chapter, unless the context otherwise 2 requires: 3 1. “Board” means the board of direct care professionals 4 created under chapter 147. 5 2. “Community living professional” means a direct care 6 associate who has completed advanced training and is certified 7 to provide home and community living, instrumental activities 8 of daily living, and personal support services. 9 3. “Direct care associate” means an individual who has 10 completed core training and is certified to provide direct care 11 services in the state. 12 4. “Direct care instructor” means an individual approved 13 by the board to provide direct care instruction to direct care 14 professionals. 15 5. “Direct care professional” means an individual who 16 provides direct care services for compensation and is a direct 17 care associate, a community living professional, a health 18 support professional, or a personal support professional. 19 6. “Direct care services” means the services provided to 20 individuals who are ill or individuals with disabilities as 21 specified in the individual’s service plan or in documented 22 goals, including but not limited to home and community living 23 services, instrumental activities of daily living services, 24 personal activities of daily living services, personal support 25 services, and health monitoring and maintenance services. 26 7. “Direct care trainer” means a direct care instructor who 27 is approved by the board to train instructors. 28 8. “Health monitoring and maintenance services” means 29 medically-oriented services that assist an individual in 30 maintaining the individual’s health including measuring intake 31 and output; providing catheter and ostomy care; collecting 32 specimens; checking vital signs, including temperature, pulse, 33 respiration, and blood pressure; measuring height and weight; 34 performing range of motion exercises; providing assistance with 35 -1- SF 2298 (6) 84 pf/nh 1/ 10

S.F. 2298 urinary care; and application of thrombo embolic deterrent hose 1 or hot and cold packs. 2 9. “Health support professional” means a direct care 3 associate who has completed advanced training and is certified 4 to provide personal activities of daily living and health 5 monitoring and maintenance services or a direct care associate 6 who has met the federal nurse aide requirements pursuant to 42 7 C.F.R. § 483.152. 8 10. “Home and community living services” means services to 9 enhance or maintain independence of individuals including such 10 activities as helping individuals develop and meet personal 11 goals, providing direct physical and emotional support and 12 assistance for persons with disabilities, utilizing crisis 13 intervention and positive behavior supports, and using and 14 following individual support plans. 15 11. “Instrumental activities of daily living services” means 16 services provided to assist individuals with daily living tasks 17 to allow them to function independently in a home or community 18 setting, including but not limited to assistance with managing 19 money, transportation, light housekeeping, and shopping and 20 cooking. 21 12. “Personal activities of daily living services” means 22 services to assist individuals in meeting basic needs, 23 including but not limited to bathing, back rubs, and skin care; 24 grooming activities; assistance with dressing and undressing; 25 assistance with eating and feeding; assistance with toileting; 26 and assistance with mobility, including transfers, walking, and 27 turning in bed. 28 13. “Personal support professional” means a direct care 29 associate who has completed advanced training and is certified 30 to provide instrumental activities of daily living, personal 31 activities of daily living, and personal support services. 32 14. “Personal support services” means support services 33 provided to an individual as the individual performs personal 34 activities of daily living including but not limited to 35 -2- SF 2298 (6) 84 pf/nh 2/ 10

S.F. 2298 coaching and prompting, and teaching skills and behaviors. 1 15. “Service plan” means a written, consumer-centered, 2 outcome-based plan of services. 3 16. “Specialty endorsement” means an advanced level of 4 certification based on requirements developed by experts in a 5 particular discipline or professional area and approved by the 6 board. 7 Sec. 2. NEW SECTION . 152F.2 Certification required —— 8 exceptions —— use of title. 9 1. Unless otherwise exempt under section 152F.4, beginning 10 January 1, 2014, an individual shall not provide direct care 11 services in this state without being certified as a direct care 12 associate. 13 2. An individual who is not certified pursuant to this 14 chapter shall not use words or titles which imply or represent 15 that the individual is certified as a direct care professional 16 under this chapter. 17 3. A direct care associate shall not act as or represent 18 that the individual is a direct care professional with advanced 19 training certification or a specialty endorsement, unless the 20 direct care associate is first certified at the appropriate 21 level of certification under this chapter. 22 4. Notwithstanding any provision to the contrary, an 23 individual who completes advanced training or meets the 24 requirements for a specialty endorsement is not required to 25 be certified at that level if the individual does not act as 26 or represent that the individual is certified at that level. 27 Section 147.83 does not apply to a direct care associate who 28 is not certified as a direct care professional with advanced 29 training certification or a specialty endorsement if the direct 30 care associate does not act as or represent that the individual 31 is certified at that level. 32 Sec. 3. NEW SECTION . 152F.3 Requirements to obtain 33 certification —— renewal —— continuing education —— reciprocity. 34 1. An applicant for certification as a direct care associate 35 -3- SF 2298 (6) 84 pf/nh 3/ 10

S.F. 2298 shall present evidence satisfactory to the board that the 1 applicant meets all of the following requirements: 2 a. The applicant has successfully completed the required 3 education for the certification from a board-approved direct 4 care instructor or direct care trainer. 5 b. The applicant has paid all fees required by the board. 6 c. The applicant certifies that the applicant will conduct 7 all professional activities in accordance with standards for 8 professional conduct established by the board. 9 2. An applicant for certification as a direct care 10 professional with advanced training or a specialty endorsement 11 shall present evidence satisfactory to the board that the 12 applicant meets all of the following requirements: 13 a. The applicant has successfully completed the required 14 education for the certification from a board-approved direct 15 care instructor or direct care trainer. 16 b. The applicant has paid all fees required by the board. 17 c. The applicant has passed a state examination approved by 18 the board. 19 d. The applicant certifies that the applicant will conduct 20 all professional activities in accordance with standards for 21 professional conduct established by the board. 22 3. An individual shall renew the individual’s certification 23 biennially. Prior to such renewal, the individual shall 24 present evidence that the individual has satisfied continuing 25 education requirements and shall pay a renewal fee as 26 determined by the board. 27 4. The board shall issue the appropriate certification to an 28 applicant who demonstrates experience in direct care services 29 in another state and meets the requirements established by the 30 board for the specific certification. 31 Sec. 4. NEW SECTION . 152F.4 Scope of chapter. 32 1. The provisions of this chapter do not apply to any of the 33 following: 34 a. An individual who is providing direct care services 35 -4- SF 2298 (6) 84 pf/nh 4/ 10

S.F. 2298 and is governed by a collective bargaining agreement in place 1 before July 1, 2017, until the expiration of such agreement. 2 b. An individual providing direct care services to a family 3 member. 4 c. An individual otherwise licensed who is operating within 5 the scope of that license and who does not represent to the 6 public that the individual is a direct care professional. 7 2. This chapter shall not be interpreted to preclude 8 an individual who provides direct care services but is not 9 otherwise required to be certified under this chapter from 10 being certified under this chapter on a voluntary basis. 11 Sec. 5. NEW SECTION . 152F.5 Duties of the board. 12 The board shall do all of the following: 13 1. Adopt rules consistent with this chapter, chapter 147, 14 chapter 272, and the recommendations of the direct care worker 15 advisory council established pursuant to 2008 Iowa Acts, 16 chapter 69, which are necessary for the performance of its 17 duties. 18 2. Adopt rules to provide a transition process that allows 19 individuals providing direct care services on or before January 20 1, 2014, who are subject to the certification requirements 21 of this chapter, to continue providing direct care services 22 while completing certification under this chapter. The rules 23 shall provide that certification requirements for an individual 24 subject to the transition process are based on consideration 25 of previous training, employment history, and experience. An 26 individual subject to the transition process shall complete the 27 requirements for direct care associate certification within a 28 time frame determined by rule of the board. 29 3. Establish curriculum requirements for health support 30 professionals. The curriculum requirements established shall 31 not exceed the curriculum requirements specified for nurse 32 aides pursuant to 42 C.F.R. § 483.152, without prior approval 33 of sixty percent of the members of the board and prior approval 34 of the department of inspections and appeals. 35 -5- SF 2298 (6) 84 pf/nh 5/ 10

S.F. 2298 4. Require an individual to undergo criminal history 1 and child and dependent adult abuse record checks prior 2 to certification, and establish record checks requirements 3 applicable to direct care professionals consistent with section 4 135C.33. 5 5. Establish dependent adult abuse reporting and training 6 requirements consistent with chapters 235B and 235E, as 7 applicable. 8 6. Establish standards and guidelines for certification 9 reciprocity. 10 7. Establish standards and guidelines for direct care 11 professionals, including minimum curriculum requirements. 12 8. Prepare and conduct, or prescribe, an examination for 13 applicants for certification. 14 9. Establish standards and guidelines for direct care 15 instructors and direct care trainers, including minimum 16 curriculum requirements and continuing education requirements. 17 Training and continuing education guidelines shall provide 18 diverse options for completion of the training and continuing 19 education, as appropriate, including but not limited to online, 20 employer-based, or educational institution-based opportunities. 21 10. Define educational activities which fulfill continuing 22 education requirements for renewal of certification. 23 11. Establish guidelines for inactive certification status 24 and inactive certification reentry. 25 Sec. 6. NEW SECTION . 152F.6 Certification suspension and 26 revocation. 27 A certification issued by the board under this chapter may be 28 suspended or revoked, or renewal of certification may be denied 29 by the board, for violation of any provision of this chapter, 30 section 147.55 or 272C.10, or rules adopted by the board. 31 Sec. 7. Section 147.1, subsections 3 and 6, Code 2011, are 32 amended to read as follows: 33 3. “Licensed” or “certified” , when applied to a physician 34 and surgeon, podiatric physician, osteopathic physician and 35 -6- SF 2298 (6) 84 pf/nh 6/ 10

S.F. 2298 surgeon, physician assistant, psychologist, chiropractor, 1 nurse, dentist, dental hygienist, dental assistant, 2 optometrist, speech pathologist, audiologist, pharmacist, 3 physical therapist, physical therapist assistant, occupational 4 therapist, occupational therapy assistant, respiratory care 5 practitioner, practitioner of cosmetology arts and sciences, 6 practitioner of barbering, funeral director, dietitian, marital 7 and family therapist, mental health counselor, social worker, 8 massage therapist, athletic trainer, acupuncturist, nursing 9 home administrator, hearing aid dispenser, or sign language 10 interpreter or transliterator , or direct care professional 11 means a person licensed under this subtitle. 12 6. “Profession” means medicine and surgery, podiatry, 13 osteopathic medicine and surgery, practice as a physician 14 assistant, psychology, chiropractic, nursing, dentistry, 15 dental hygiene, dental assisting, optometry, speech pathology, 16 audiology, pharmacy, physical therapy, physical therapist 17 assisting, occupational therapy, occupational therapy 18 assisting, respiratory care, cosmetology arts and sciences, 19 barbering, mortuary science, marital and family therapy, mental 20 health counseling, social work, dietetics, massage therapy, 21 athletic training, acupuncture, nursing home administration, 22 hearing aid dispensing, or sign language interpreting or 23 transliterating , or practice as a direct care professional . 24 Sec. 8. Section 147.2, subsection 1, Code 2011, is amended 25 to read as follows: 26 1. A person shall not engage in the practice of medicine 27 and surgery, podiatry, osteopathic medicine and surgery, 28 psychology, chiropractic, physical therapy, physical therapist 29 assisting, nursing, dentistry, dental hygiene, dental 30 assisting, optometry, speech pathology, audiology, occupational 31 therapy, occupational therapy assisting, respiratory care, 32 pharmacy, cosmetology arts and sciences, barbering, social 33 work, dietetics, marital and family therapy or mental health 34 counseling, massage therapy, mortuary science, athletic 35 -7- SF 2298 (6) 84 pf/nh 7/ 10

S.F. 2298 training, acupuncture, nursing home administration, hearing aid 1 dispensing, or sign language interpreting or transliterating, 2 or shall not practice as a physician assistant or as a direct 3 care professional , unless the person has obtained a license for 4 that purpose from the board for the profession. 5 Sec. 9. Section 147.13, Code 2011, is amended by adding the 6 following new subsection: 7 NEW SUBSECTION . 24. For direct care professionals, the 8 board of direct care professionals. 9 Sec. 10. Section 147.14, subsection 1, Code 2011, is amended 10 by adding the following new paragraph: 11 NEW PARAGRAPH . x. For the board of direct care 12 professionals, a total of eleven members, six of whom are 13 direct care professionals who represent diverse settings and 14 populations served, two members of the public, one registered 15 nurse who serves as a direct care instructor, one human 16 services professional who serves as a direct care instructor, 17 and one licensed nursing home administrator. 18 Sec. 11. Section 147.74, Code 2011, is amended by adding the 19 following new subsection: 20 NEW SUBSECTION . 24. A direct care professional certified 21 under chapter 152F and this chapter may use the following: 22 a. A direct care professional certified as a direct care 23 associate may use the title “direct care associate” or the 24 letters “D.C.A.” after the person’s name. 25 b. A direct care professional certified as a community 26 living professional may use the title “community living 27 professional” or the letters “C.L.P.” after the person’s name. 28 c. A direct care professional certified as a personal 29 support professional may use the title “personal support 30 professional” or the letters “P.S.P.” after the person’s name. 31 d. A direct care professional certified as a health support 32 professional may use the title “health support professional” or 33 the letters “H.S.P.” after the person’s name. 34 e. A direct care professional certified with a specialty 35 -8- SF 2298 (6) 84 pf/nh 8/ 10

S.F. 2298 endorsement may use the title or letters determined by the 1 specialty endorsement entity and approved by the board of 2 direct care professionals. 3 f. A direct care professional who complies with federal 4 nurse aide requirements pursuant to 42 C.F.R. § 483.152 may use 5 the title “certified nursing assistant” or the letters “C.N.A.” 6 after the person’s name. 7 Sec. 12. Section 272C.1, subsection 6, Code 2011, is amended 8 by adding the following new paragraph: 9 NEW PARAGRAPH . ag. The board of direct care professionals, 10 created pursuant to chapter 147. 11 Sec. 13. TRANSITION PROVISIONS. 12 1. An individual providing direct care services on or 13 before January 1, 2014, who is subject to the certification 14 requirements of this Act, may continue providing direct care 15 services while completing certification as required under this 16 Act. The board of direct care professionals shall adopt rules 17 to provide that certification requirements for an individual 18 subject to the transition process are based on consideration 19 of previous training, employment history, and experience, and 20 require such individuals to complete the requirements for 21 direct care associate certification within the time frame 22 determined by rule of the board. 23 2. An individual who is registered on or before January 24 1, 2014, on the Iowa direct care worker registry established 25 by the department of inspections and appeals, is deemed to 26 meet the certification requirements for a health support 27 professional under this Act. 28 3. Notwithstanding sections 147.14 and 147.16, for the 29 initial board of direct care professionals, the governor may 30 appoint, subject to confirmation by the senate, in lieu of the 31 five members required to be direct care professionals and the 32 two members required to be direct care instructors, members 33 with experience and expertise that is substantially equivalent 34 to the professional requirements for a direct care professional 35 -9- SF 2298 (6) 84 pf/nh 9/ 10

S.F. 2298 or direct care instructor, as applicable. 1 Sec. 14. IMPLEMENTATION. The provisions of this Act shall 2 be implemented as follows: 3 1. The sections of this Act relating to the board of direct 4 care professionals including sections 152F.1 and 152F.5, as 5 enacted in this Act; sections 147.13, 147.14, and 272C.1, 6 as amended in this Act, and as specified in the transition 7 provisions; and the section of this Act providing transition 8 provisions relating to the board shall be implemented so that a 9 board of direct care professionals is appointed no later than 10 December 15, 2012. 11 2. The sections of this Act relating to requirements for 12 certification of direct care professionals including sections 13 152F.2, 152F.3, 152F.4, and 152F.6, as enacted in this Act; 14 and sections 147.1, 147.2, and 147.74, as amended in this Act, 15 shall be implemented so that the requirements are applicable 16 beginning no later than January 1, 2014. 17 Sec. 15. FUNDING PROVISIONS. 18 1. The department of public health shall limit the indirect 19 service charge for the board of direct care professionals to 20 not more than fifteen percent. 21 2. It is the intent of the general assembly that the board 22 of direct care professionals be self-sustaining by January 1, 23 2017. 24 Sec. 16. EFFECTIVE UPON ENACTMENT. This Act, being deemed 25 of immediate importance, takes effect upon enactment. 26 -10- SF 2298 (6) 84 pf/nh 10/ 10