H.F. 803 DIVISION I 1 DUTIES OF PHYSICIAN ASSISTANTS 2 Section 1. Section 90A.1, Code 2021, is amended by adding 3 the following new subsections: 4 NEW SUBSECTION . 5A. “Physician” means a person licensed as 5 a physician pursuant to chapter 148. 6 NEW SUBSECTION . 5B. “Physician assistant” means a person 7 licensed as a physician assistant pursuant to chapter 148C. 8 Sec. 2. Section 90A.8, Code 2021, is amended to read as 9 follows: 10 90A.8 Required conditions for boxing matches. 11 1. A boxing match shall be not more than fifteen rounds in 12 length and the contestants shall wear gloves weighing at least 13 eight ounces during such contests. The commissioner may adopt 14 rules requiring more stringent procedures for specific types 15 of boxing. 16 2. A contestant shall not take part in a boxing match 17 unless the contestant has presented a valid registration 18 identification card issued pursuant to section 90A.3 to the 19 commissioner prior to the weigh-in for the boxing match. 20 The contestant shall pass a rigorous physical examination 21 to determine the contestant’s fitness to engage in any such 22 match within twenty-four hours of the start of the match. 23 The examination shall be conducted by a licensed practicing 24 physician or physician assistant designated or authorized by 25 the commissioner. 26 Sec. 3. Section 96.5, subsection 1, paragraphs d and e, Code 27 2021, are amended to read as follows: 28 d. The individual left employment because of illness, 29 injury, or pregnancy upon the advice of a licensed and 30 practicing physician or physician assistant , and upon knowledge 31 of the necessity for absence immediately notified the employer, 32 or the employer consented to the absence, and after recovering 33 from the illness, injury, or pregnancy, when recovery was 34 certified by a licensed and practicing physician or physician 35 -1- HF 803 (2) 89 ss/rh/md 1/ 37

H.F. 803 assistant , the individual returned to the employer and offered 1 to perform services and the individual’s regular work or 2 comparable suitable work was not available, if so found by the 3 department, provided the individual is otherwise eligible. 4 e. The individual left employment upon the advice of a 5 licensed and practicing physician or physician assistant , 6 for the sole purpose of taking a member of the individual’s 7 family to a place having a different climate, during which 8 time the individual shall be deemed unavailable for work, and 9 notwithstanding during such absence the individual secures 10 temporary employment, and returned to the individual’s 11 regular employer and offered the individual’s services and the 12 individual’s regular work or comparable work was not available, 13 provided the individual is otherwise eligible. 14 Sec. 4. Section 135.109, subsection 3, paragraph b, Code 15 2021, is amended to read as follows: 16 b. A licensed physician , physician assistant, or nurse who 17 is knowledgeable concerning domestic abuse injuries and deaths, 18 including suicides. 19 Sec. 5. Section 135.146, subsection 2, Code 2021, is amended 20 to read as follows: 21 2. Participation in the vaccination program shall be 22 voluntary, except for first responders who are classified 23 as having occupational exposure to blood-borne pathogens as 24 defined by the occupational safety and health administration 25 standard contained in 29 C.F.R. §1910.1030 . First responders 26 who are so classified shall be required to receive the 27 vaccinations as described in subsection 1 . A first responder 28 shall be exempt from this requirement, however, when a 29 written statement from a licensed physician or physician 30 assistant is presented indicating that a vaccine is medically 31 contraindicated for that person or the first responder signs 32 a written statement that the administration of a vaccination 33 conflicts with religious tenets. 34 Sec. 6. Section 135J.1, Code 2021, is amended by adding the 35 -2- HF 803 (2) 89 ss/rh/md 2/ 37

H.F. 803 following new subsection: 1 NEW SUBSECTION . 01. “Attending physician” means a physician 2 licensed pursuant to chapter 148 or a physician assistant 3 licensed pursuant to chapter 148C. 4 Sec. 7. Section 135J.1, subsection 6, paragraph e, Code 5 2021, is amended to read as follows: 6 e. As deemed appropriate by the hospice, physician 7 assistants, providers of special services including but 8 not limited to a spiritual counselor, a pharmacist, or 9 professionals in the fields of mental health may be included 10 on the interdisciplinary team. 11 Sec. 8. Section 135J.3, subsections 1 and 4, Code 2021, are 12 amended to read as follows: 13 1. A planned program of hospice care, the medical components 14 of which shall be under the direction of a licensed an 15 attending physician. 16 4. Palliative care provided to a hospice patient and family 17 under the direction of a licensed an attending physician. 18 Sec. 9. Section 141A.5, subsection 2, paragraph c, Code 19 2021, is amended to read as follows: 20 c. (1) Devise a procedure, as a part of the partner 21 notification program, to provide for the notification of an 22 identifiable third party who is a sexual partner of or who 23 shares drug injecting equipment with a person who has tested 24 positive for HIV, by the department or a physician or physician 25 assistant , when all of the following situations exist: 26 (a) A physician or physician assistant for the infected 27 person is of the good faith opinion that the nature of the 28 continuing contact poses an imminent danger of HIV transmission 29 to the third party. 30 (b) When the physician or physician assistant believes 31 in good faith that the infected person, despite strong 32 encouragement, has not and will not warn the third party and 33 will not participate in the voluntary partner notification 34 program. 35 -3- HF 803 (2) 89 ss/rh/md 3/ 37

H.F. 803 (2) Notwithstanding subsection 3 , the department or a 1 physician or physician assistant may reveal the identity of a 2 person who has tested positive for HIV infection pursuant to 3 this subsection only to the extent necessary to protect a third 4 party from the direct threat of transmission. This subsection 5 shall not be interpreted to create a duty to warn third parties 6 of the danger of exposure to HIV through contact with a person 7 who tests positive for HIV infection. 8 (3) The department shall adopt rules pursuant to chapter 9 17A to implement this paragraph “c” . The rules shall provide a 10 detailed procedure by which the department or a physician or 11 physician assistant may directly notify an endangered third 12 party. 13 Sec. 10. Section 141A.6, subsections 3 and 4, Code 2021, are 14 amended to read as follows: 15 3. Within seven days of diagnosing a person as having AIDS 16 or an AIDS-related condition, the diagnosing physician or 17 physician assistant shall make a report to the department on a 18 form provided by the department. 19 4. Within seven days of the death of a person with HIV 20 infection, the attending physician or attending physician 21 assistant shall make a report to the department on a form 22 provided by the department. 23 Sec. 11. Section 141A.7, subsection 3, Code 2021, is amended 24 to read as follows: 25 3. A person may apply for voluntary treatment, 26 contraceptive services, or screening or treatment for HIV 27 infection and other sexually transmitted diseases directly to a 28 licensed physician and surgeon, an osteopathic physician and 29 surgeon, a physician assistant, or a family planning clinic. 30 Notwithstanding any other provision of law, however, a minor 31 shall be informed prior to testing that, upon confirmation 32 according to prevailing medical technology of a positive 33 HIV-related test result, the minor’s legal guardian is required 34 to be informed by the testing facility. Testing facilities 35 -4- HF 803 (2) 89 ss/rh/md 4/ 37

H.F. 803 where minors are tested shall have available a program to 1 assist minors and legal guardians with the notification process 2 which emphasizes the need for family support and assists in 3 making available the resources necessary to accomplish that 4 goal. However, a testing facility which is precluded by 5 federal statute, regulation, or centers for disease control 6 and prevention guidelines from informing the legal guardian 7 is exempt from the notification requirement. The minor shall 8 give written consent to these procedures and to receive the 9 services, screening, or treatment. Such consent is not subject 10 to later disaffirmance by reason of minority. 11 Sec. 12. Section 144A.2, Code 2021, is amended by adding the 12 following new subsections: 13 NEW SUBSECTION . 2A. “Attending physician assistant” means 14 the physician assistant selected by, or assigned to, the 15 patient who has primary responsibility for the treatment and 16 care of the patient. 17 NEW SUBSECTION . 10A. “Physician assistant” means a person 18 licensed to practice as a physician assistant in this state. 19 Sec. 13. Section 144A.4, Code 2021, is amended to read as 20 follows: 21 144A.4 Revocation of declaration. 22 1. A declaration may be revoked at any time and in any 23 manner by which the declarant is able to communicate the 24 declarant’s intent to revoke, without regard to mental or 25 physical condition. A revocation is only effective as to 26 the attending physician or attending physician assistant 27 upon communication to such physician or physician assistant 28 by the declarant or by another to whom the revocation was 29 communicated. 30 2. The attending physician or attending physician assistant 31 shall make the revocation a part of the declarant’s medical 32 record. 33 Sec. 14. Section 144A.7A, subsection 1, Code 2021, is 34 amended to read as follows: 35 -5- HF 803 (2) 89 ss/rh/md 5/ 37

H.F. 803 1. If an attending physician or attending physician 1 assistant issues an out-of-hospital do-not-resuscitate order 2 for an adult patient under this section , the physician shall 3 use the form prescribed pursuant to subsection 2 , include a 4 copy of the order in the patient’s medical record, and provide 5 a copy to the patient or an individual authorized to act on the 6 patient’s behalf. 7 Sec. 15. Section 144A.7A, subsection 3, paragraph e, Code 8 2021, is amended to read as follows: 9 e. The physician’s or physician assistant’s signature. 10 Sec. 16. Section 144B.1, subsection 3, Code 2021, is amended 11 to read as follows: 12 3. “Durable power of attorney for health care” means a 13 document authorizing an attorney in fact to make health care 14 decisions for the principal if the principal is unable, in the 15 judgment of the attending physician or attending physician 16 assistant , to make health care decisions. 17 Sec. 17. Section 144B.5, subsection 1, Code 2021, is amended 18 to read as follows: 19 1. A durable power of attorney for health care executed 20 pursuant to this chapter may, but need not, be in the following 21 form: 22 I hereby designate ........ as my attorney in fact (my 23 agent) and give to my agent the power to make health care 24 decisions for me. This power exists only when I am unable, in 25 the judgment of my attending physician or attending physician 26 assistant , to make those health care decisions. The attorney 27 in fact must act consistently with my desires as stated in this 28 document or otherwise made known. 29 Except as otherwise specified in this document, this document 30 gives my agent the power, where otherwise consistent with the 31 law of this state, to consent to my physician or physician 32 assistant not giving health care or stopping health care which 33 is necessary to keep me alive. 34 This document gives my agent power to make health care 35 -6- HF 803 (2) 89 ss/rh/md 6/ 37

H.F. 803 decisions on my behalf, including to consent, to refuse to 1 consent, or to withdraw consent to the provision of any care, 2 treatment, service, or procedure to maintain, diagnose, or 3 treat a physical or mental condition. This power is subject 4 to any statement of my desires and any limitations included in 5 this document. 6 My agent has the right to examine my medical records and to 7 consent to disclosure of such records. 8 Sec. 18. Section 144B.6, subsection 1, Code 2021, is amended 9 to read as follows: 10 1. Unless the district court sitting in equity specifically 11 finds that the attorney in fact is acting in a manner contrary 12 to the wishes of the principal or the durable power of attorney 13 for health care provides otherwise, an attorney in fact who 14 is known to the health care provider to be available and 15 willing to make health care decisions has priority over any 16 other person, including a guardian appointed pursuant to 17 chapter 633 , to act for the principal in all matters of health 18 care decisions. The attorney in fact has authority to make 19 a particular health care decision only if the principal is 20 unable, in the judgment of the attending physician or attending 21 physician assistant , to make the health care decision. If the 22 principal objects to a decision to withhold or withdraw health 23 care, the principal shall be presumed to be able to make a 24 decision. 25 Sec. 19. Section 144D.4, subsection 3, Code 2021, is amended 26 to read as follows: 27 3. If the individual’s physician or physician assistant has 28 issued an out-of-hospital do-not-resuscitate order pursuant 29 to section 144A.7A , the POST form shall not supersede the 30 out-of-hospital do-not-resuscitate order. 31 Sec. 20. Section 144F.2, subsection 1, paragraph b, Code 32 2021, is amended to read as follows: 33 b. A legal representative who is an agent under a durable 34 power of attorney for health care pursuant to chapter 144B 35 -7- HF 803 (2) 89 ss/rh/md 7/ 37

H.F. 803 shall be given the opportunity to designate a lay caregiver 1 in lieu of the patient’s designation of a lay caregiver only 2 if, consistent with chapter 144B , in the judgment of the 3 attending physician or attending physician assistant , the 4 patient is unable to make the health care decision. A legal 5 representative who is a guardian shall be given the opportunity 6 to designate a lay caregiver in lieu of the patient’s 7 designation of a lay caregiver to the extent consistent with 8 the powers and duties granted the guardian pursuant to section 9 633.635 . 10 Sec. 21. Section 189A.6, Code 2021, is amended to read as 11 follows: 12 189A.6 Health examination of employees. 13 The operator of any establishment shall require all 14 employees of such establishment to have a health examination 15 by a physician or physician assistant and a certified health 16 certificate for each employee shall be kept on file by the 17 operator. The secretary may at any time require an employee 18 of an establishment to submit to a health examination by a 19 physician or physician assistant . No person suffering from 20 any communicable disease, including any communicable skin 21 disease, and no person with infected wounds, and no person who 22 is a “carrier” of a communicable disease shall be employed in 23 any capacity in an establishment. No person shall work or 24 be employed in or about any establishment during the time in 25 which a communicable disease exists in the home in which such 26 person resides unless such person has obtained a certificate 27 from a physician or physician assistant to the effect that 28 no danger of public contagion or infection will result from 29 the employment of such person in such establishment. Every 30 person employed by an establishment and engaged in direct 31 physical contact with meat or poultry products during its 32 preparation, processing, or storage, shall be clean in person, 33 wear clean washable outer garments and a suitable cap or other 34 head covering used exclusively in such work. Only persons 35 -8- HF 803 (2) 89 ss/rh/md 8/ 37

H.F. 803 specifically designated by the operator of an establishment 1 shall be permitted to touch meat or poultry products with their 2 hands, and the persons so designated shall keep their hands 3 scrupulously clean. 4 Sec. 22. Section 225.9, Code 2021, is amended to read as 5 follows: 6 225.9 Voluntary private patients. 7 Voluntary private patients may be admitted in accordance 8 with the regulations to be established by the state board of 9 regents, and their care, nursing, observation, treatment, 10 medicine, and maintenance shall be without expense to 11 the state. However, the charge for such care, nursing, 12 observation, treatment, medicine, and maintenance shall not 13 exceed the cost of the same to the state. The physicians or 14 physician assistants who meet the qualifications set forth 15 in the definition of a mental health professional in section 16 228.1 on the hospital staff may charge such patients for 17 their medical services under such rules, regulations and plan 18 therefor as approved by the state board of regents. 19 Sec. 23. Section 225.10, unnumbered paragraph 1, Code 2021, 20 is amended to read as follows: 21 Persons suffering from mental diseases may be admitted to 22 the state psychiatric hospital as voluntary public patients 23 if a physician authorized to practice medicine or osteopathic 24 medicine in the state of Iowa or a physician assistant who 25 meets the qualifications set forth in the definition of a 26 mental health professional in section 228.1 files information 27 with the regional administrator for the person’s county of 28 residence, stating all of the following: 29 Sec. 24. Section 225.10, subsections 1 and 2, Code 2021, are 30 amended to read as follows: 31 1. That the physician or physician assistant who meets 32 the qualifications set forth in the definition of a mental 33 health professional in section 228.1 has examined the person 34 and finds that the person is suffering from some abnormal 35 -9- HF 803 (2) 89 ss/rh/md 9/ 37

H.F. 803 mental condition that can probably be remedied by observation, 1 treatment, and hospital care. 2 2. That the physician or physician assistant who meets the 3 qualifications set forth in the definition of a mental health 4 professional in section 228.1 believes it would be appropriate 5 for the person to enter the state psychiatric hospital for that 6 purpose and that the person is willing to do so. 7 Sec. 25. Section 225.12, Code 2021, is amended to read as 8 follows: 9 225.12 Voluntary public patient —— physician’s report. 10 A physician or a physician assistant who meets the 11 qualifications set forth in the definition of a mental health 12 professional in section 228.1 filing information under 13 section 225.10 shall include a written report to the regional 14 administrator for the county of residence of the person named 15 in the information, giving a history of the case as will be 16 likely to aid in the observation, treatment, and hospital care 17 of the person and describing the history in detail. 18 Sec. 26. Section 225.15, subsection 1, Code 2021, is amended 19 to read as follows: 20 1. When a respondent arrives at the state psychiatric 21 hospital, the admitting physician , or a physician assistant 22 who meets the qualifications set forth in the definition of a 23 mental health professional in section 228.1, shall examine the 24 respondent and determine whether or not, in the physician’s 25 or physician assistant’s judgment, the respondent is a fit 26 subject for observation, treatment, and hospital care. If, 27 upon examination, the physician or physician assistant who 28 meets the qualifications set forth in the definition of a 29 mental health professional in section 228.1 decides that the 30 respondent should be admitted to the hospital, the respondent 31 shall be provided a proper bed in the hospital. The physician 32 or physician assistant who meets the qualifications set forth 33 in the definition of a mental health professional in section 34 228.1 who has charge of the respondent shall proceed with 35 -10- HF 803 (2) 89 ss/rh/md 10/ 37

H.F. 803 observation, medical treatment, and hospital care as in the 1 physician’s or physician assistant’s judgment are proper and 2 necessary, in compliance with sections 229.13 to 229.16 . 3 After the respondent’s admission, the observation, medical 4 treatment, and hospital care of the respondent may be provided 5 by a mental health professional, as defined in section 228.1 , 6 who is licensed as a physician, advanced registered nurse 7 practitioner, or physician assistant. 8 Sec. 27. Section 225.16, subsection 1, Code 2021, is amended 9 to read as follows: 10 1. If the regional administrator for a person’s county 11 of residence finds from the physician’s information or 12 from the information of a physician assistant who meets the 13 qualifications set forth in the definition of a mental health 14 professional in section 228.1 which was filed under the 15 provisions of section 225.10 that it would be appropriate for 16 the person to be admitted to the state psychiatric hospital, 17 and the report of the regional administrator made pursuant to 18 section 225.13 shows that the person and those who are legally 19 responsible for the person are not able to pay the expenses 20 incurred at the hospital, or are able to pay only a part of 21 the expenses, the person shall be considered to be a voluntary 22 public patient and the regional administrator shall direct that 23 the person shall be sent to the state psychiatric hospital at 24 the state university of Iowa for observation, treatment, and 25 hospital care. 26 Sec. 28. Section 225C.14, subsection 2, Code 2021, is 27 amended to read as follows: 28 2. As used in this section and sections 225C.15 , 225C.16 , 29 and 225C.17 , the term “medical emergency” means a situation 30 in which a prospective patient is received at a state mental 31 health institute in a condition which, in the opinion of the 32 chief medical officer, or that officer’s physician or physician 33 assistant designee, provided that a physician assistant 34 designee meets the qualifications set forth in the definition 35 -11- HF 803 (2) 89 ss/rh/md 11/ 37

H.F. 803 of a mental health professional in section 228.1, requires the 1 immediate admission of the person notwithstanding the policy 2 stated in subsection 1 . 3 Sec. 29. Section 225C.16, subsection 1, Code 2021, is 4 amended to read as follows: 5 1. The chief medical officer of a state mental health 6 institute, or that officer’s physician or physician assistant 7 designee, provided that a physician assistant designee meets 8 the qualifications set forth in the definition of a mental 9 health professional in section 228.1, shall advise a person 10 residing in that county who applies for voluntary admission, or 11 a person applying for the voluntary admission of another person 12 who resides in that county, in accordance with section 229.41 , 13 that the regional administrator for the county has implemented 14 the policy stated in section 225C.14 , and shall advise that a 15 preliminary diagnostic evaluation of the prospective patient 16 be sought, if that has not already been done. This subsection 17 does not apply when voluntary admission is sought in accordance 18 with section 229.41 under circumstances which, in the opinion 19 of the chief medical officer or that officer’s physician 20 designee, constitute a medical emergency. 21 Sec. 30. Section 232.71B, subsection 10, Code 2021, is 22 amended to read as follows: 23 10. Physical examination. If the department refers a 24 child to a physician or physician assistant for a physical 25 examination, the department shall contact the physician 26 or physician assistant regarding the examination within 27 twenty-four hours of making the referral. If the physician 28 or physician assistant who performs the examination upon 29 referral by the department reasonably believes the child has 30 been abused, the physician or physician assistant shall report 31 to the department within twenty-four hours of performing the 32 examination. 33 Sec. 31. Section 232.78, subsection 4, unnumbered paragraph 34 1, Code 2021, is amended to read as follows: 35 -12- HF 803 (2) 89 ss/rh/md 12/ 37

H.F. 803 The juvenile court may enter an order authorizing a 1 physician or physician assistant or hospital to provide 2 emergency medical or surgical procedures before the filing of a 3 petition under this chapter provided: 4 Sec. 32. Section 232.78, subsection 5, unnumbered paragraph 5 1, Code 2021, is amended to read as follows: 6 The juvenile court, before or after the filing of a petition 7 under this chapter , may enter an ex parte order authorizing 8 a physician or physician assistant or hospital to conduct an 9 outpatient physical examination or authorizing a physician or 10 physician assistant , a psychologist certified under section 11 154B.7 , or a community mental health center accredited pursuant 12 to chapter 230A to conduct an outpatient mental examination 13 of a child if necessary to identify the nature, extent, and 14 cause of injuries to the child as required by section 232.71B , 15 provided all of the following apply: 16 Sec. 33. Section 232.79, subsection 1, unnumbered paragraph 17 1, Code 2021, is amended to read as follows: 18 A peace officer or juvenile court officer may take a child 19 into custody, a physician or physician assistant treating 20 a child may keep the child in custody, or a juvenile court 21 officer may authorize a peace officer, physician or physician 22 assistant , or medical security personnel to take a child into 23 custody, without a court order as required under section 232.78 24 and without the consent of a parent, guardian, or custodian 25 provided that both of the following apply: 26 Sec. 34. Section 232.79, subsection 2, paragraph a, Code 27 2021, is amended to read as follows: 28 a. Bring the child immediately to a place designated by 29 the rules of the court for this purpose, unless the person is 30 a physician or physician assistant treating the child and the 31 child is or will presently be admitted to a hospital. 32 Sec. 35. Section 232.83, subsection 2, unnumbered paragraph 33 1, Code 2021, is amended to read as follows: 34 Anyone authorized to conduct a preliminary investigation 35 -13- HF 803 (2) 89 ss/rh/md 13/ 37

H.F. 803 in response to a complaint may apply for, or the court on its 1 own motion may enter an ex parte order authorizing a physician 2 or physician assistant or hospital to conduct an outpatient 3 physical examination or authorizing a physician or physician 4 assistant , a psychologist certified under section 154B.7 , or a 5 community mental health center accredited pursuant to chapter 6 230A to conduct an outpatient mental examination of a child if 7 necessary to identify the nature, extent, and causes of any 8 injuries, emotional damage, or other such needs of a child as 9 specified in section 232.2, subsection 6 , paragraph “c” , “e” , or 10 “f” , provided that all of the following apply: 11 Sec. 36. Section 232.95, subsection 2, paragraph c, Code 12 2021, is amended to read as follows: 13 c. Authorize a physician , physician assistant, or hospital 14 to provide medical or surgical procedures if such procedures 15 are necessary to safeguard the child’s life or health. 16 Sec. 37. Section 234.22, Code 2021, is amended to read as 17 follows: 18 234.22 Extent of services. 19 Such family planning and birth control services may include 20 interview with trained personnel; distribution of literature; 21 referral to a licensed physician or physician assistant 22 for consultation, examination, tests, medical treatment 23 and prescription; and, to the extent so prescribed, the 24 distribution of rhythm charts, drugs, medical preparations, 25 contraceptive devices and similar products. 26 Sec. 38. Section 235A.13, subsection 9, Code 2021, is 27 amended to read as follows: 28 9. “Near fatality” means an injury to a child that, as 29 certified by a physician or physician assistant , placed the 30 child in serious or critical condition. 31 Sec. 39. Section 237A.5, subsection 1, Code 2021, is amended 32 to read as follows: 33 1. All personnel in licensed or registered facilities 34 shall have good health as evidenced by a report following a 35 -14- HF 803 (2) 89 ss/rh/md 14/ 37

H.F. 803 preemployment physical examination taken within six months 1 prior to beginning employment. The examination shall include 2 communicable disease tests by a licensed physician as defined 3 in section 135C.1 or a licensed physician assistant as defined 4 in section 148C.1 and shall be repeated every three years after 5 initial employment. Controlled medical conditions which would 6 not affect the performance of the employee in the capacity 7 employed shall not prohibit employment. 8 Sec. 40. Section 237A.13, subsection 1, paragraph d, Code 9 2021, is amended to read as follows: 10 d. The child’s parent, guardian, or custodian is absent 11 for a limited period of time due to hospitalization, physical 12 illness, or mental illness, or is present but is unable to care 13 for the child for a limited period as verified by a physician 14 or physician assistant . 15 Sec. 41. Section 249.3, subsection 2, paragraph a, 16 subparagraph (2), Code 2021, is amended to read as follows: 17 (2) Nursing care in the person’s own home, certified by a 18 physician or physician assistant as being required, so long 19 as the cost of the nursing care does not exceed standards 20 established by the department. 21 Sec. 42. Section 321.375, subsection 4, paragraph b, 22 subparagraph (4), Code 2021, is amended to read as follows: 23 (4) Maintaining a daily log of all glucose test results 24 for the previous six-month period and providing copies to the 25 school district or school, the examining physician or examining 26 physician assistant , and the department of education upon 27 request. 28 Sec. 43. Section 321.446, subsection 3, paragraph c, Code 29 2021, is amended to read as follows: 30 c. The transportation of a child who has been certified by 31 a physician licensed under chapter 148 or a physician assistant 32 licensed under chapter 148C as having a medical, physical, or 33 mental condition that prevents or makes inadvisable securing 34 the child in a child restraint system, safety belt, or safety 35 -15- HF 803 (2) 89 ss/rh/md 15/ 37

H.F. 803 harness. 1 Sec. 44. Section 347B.5, Code 2021, is amended to read as 2 follows: 3 347B.5 Admission —— labor required. 4 The county care facility shall maintain a record of the name 5 and age of each person admitted and the date of admission. The 6 board may require of any resident of the county care facility, 7 with approval of a physician or physician assistant , reasonable 8 and moderate labor suited to the resident’s age and bodily 9 strength. Any income realized through the labor of residents, 10 together with the receipts from operation of the county farm if 11 one is maintained, shall be appropriated for use by the county 12 care facility as the board of supervisors directs. 13 Sec. 45. Section 347B.6, Code 2021, is amended to read as 14 follows: 15 347B.6 Order for admission. 16 No person shall be admitted into the county care facility 17 as a resident except upon order of the board of supervisors, 18 which shall be issued only after the person seeking admission 19 has received a preadmission physical examination by a physician 20 or physician assistant . However, if the need for admission 21 of the person to the county care facility is immediate and 22 no physician or physician assistant is readily available to 23 perform the examination, the board may order the person’s 24 admission pending an examination by a physician or physician 25 assistant , any provisions of sections 135C.3 and 135C.4 to the 26 contrary notwithstanding. When an admission is so ordered, the 27 physical examination shall be completed within three days after 28 the person’s admission to the county care facility. 29 Sec. 46. Section 514C.17, subsections 1 and 2, Code 2021, 30 are amended to read as follows: 31 1. Except as provided under subsection 2 or 3 , if a carrier, 32 as defined in section 513B.2 , or a plan established pursuant to 33 chapter 509A for public employees, terminates its contract with 34 a participating health care provider, a covered individual who 35 -16- HF 803 (2) 89 ss/rh/md 16/ 37

H.F. 803 is undergoing a specified course of treatment for a terminal 1 illness or a related condition, with the recommendation of the 2 covered individual’s treating physician licensed under chapter 3 148 or treating physician assistant licensed under chapter 148C 4 may continue to receive coverage for treatment received from 5 the covered individual’s physician or physician assistant for 6 the terminal illness or a related condition, for a period of 7 up to ninety days. Payment for covered benefits and benefit 8 levels shall be according to the terms and conditions of the 9 contract. 10 2. A covered person who makes a change in health plans 11 involuntarily may request that the new health plan cover 12 services of the covered person’s treating physician licensed 13 under chapter 148 or treating physician assistant licensed 14 under chapter 148C who is not a participating health care 15 provider under the new health plan, if the covered person is 16 undergoing a specified course of treatment for a terminal 17 illness or a related condition. Continuation of such coverage 18 shall continue for up to ninety days. Payment for covered 19 benefits and benefit levels shall be according to the terms and 20 conditions of the contract. 21 Sec. 47. Section 514C.18, subsection 1, unnumbered 22 paragraph 1, Code 2021, is amended to read as follows: 23 Notwithstanding the uniformity of treatment requirements of 24 section 514C.6 , a policy or contract providing for third-party 25 payment or prepayment of health or medical expenses shall 26 provide coverage benefits for the cost associated with 27 equipment, supplies, and self-management training and education 28 for the treatment of all types of diabetes mellitus when 29 prescribed by a physician licensed under chapter 148 or a 30 physician assistant licensed under chapter 148C . Coverage 31 benefits shall include coverage for the cost associated with 32 all of the following: 33 Sec. 48. Section 514C.18, subsection 1, paragraph b, 34 subparagraphs (1) and (2), Code 2021, are amended to read as 35 -17- HF 803 (2) 89 ss/rh/md 17/ 37

H.F. 803 follows: 1 (1) The physician or physician assistant managing the 2 individual’s diabetic condition certifies that such services 3 are needed under a comprehensive plan of care related to the 4 individual’s diabetic condition to ensure therapy compliance or 5 to provide the individual with necessary skills and knowledge 6 to participate in the management of the individual’s condition. 7 (2) The diabetes self-management training and education 8 program is certified by the Iowa department of public health. 9 The department shall consult with the American diabetes 10 association, Iowa affiliate, in developing the standards for 11 certification of diabetes education programs that cover at 12 least ten hours of initial outpatient diabetes self-management 13 training within a continuous twelve-month period and up to two 14 hours of follow-up training for each subsequent year for each 15 individual diagnosed by a physician or physician assistant with 16 any type of diabetes mellitus. 17 Sec. 49. Section 514C.20, subsection 1, paragraphs a and b, 18 Code 2021, are amended to read as follows: 19 a. A child under five years of age upon a determination by 20 a licensed dentist and the child’s treating physician licensed 21 pursuant to chapter 148 or treating physician assistant 22 licensed pursuant to chapter 148C , that such child requires 23 necessary dental treatment in a hospital or ambulatory surgical 24 center due to a dental condition or a developmental disability 25 for which patient management in the dental office has proved 26 to be ineffective. 27 b. Any individual upon a determination by a licensed dentist 28 and the individual’s treating physician licensed pursuant to 29 chapter 148 or treating physician assistant licensed pursuant 30 to chapter 148C , that such individual has one or more medical 31 conditions that would create significant or undue medical risk 32 for the individual in the course of delivery of any necessary 33 dental treatment or surgery if not rendered in a hospital or 34 ambulatory surgical center. 35 -18- HF 803 (2) 89 ss/rh/md 18/ 37

H.F. 803 Sec. 50. Section 514C.25, subsection 1, paragraph a, Code 1 2021, is amended to read as follows: 2 a. Notwithstanding the uniformity of treatment requirements 3 of section 514C.6 , a policy, contract, or plan providing for 4 third-party payment or prepayment of health or medical expenses 5 shall provide coverage benefits for medically necessary 6 prosthetic devices when prescribed by a physician licensed 7 under chapter 148 or physician assistant licensed under 8 chapter 148C . Such coverage benefits for medically necessary 9 prosthetic devices shall provide coverage for medically 10 necessary prosthetic devices that, at a minimum, equals 11 the coverage and payment for medically necessary prosthetic 12 devices provided under the most recent federal laws for health 13 insurance for the aged and disabled pursuant to 42 U.S.C. 14 §1395k, 13951, and 1395m, and 42 C.F.R. §410.100 , 414.202 , 15 414.210, and 414.228 , as applicable. 16 DIVISION II 17 DUTIES OF PHYSICIAN ASSISTANTS —— RULES 18 Sec. 51. NEW SECTION . 147.77 Powers, privileges, rights, or 19 duties provided by rule —— applicability to physician assistants. 20 1. The following agencies that adopt rules pursuant to 21 chapter 17A providing a power, privilege, right, or duty to 22 a physician licensed under chapter 148 or other profession 23 licensed under this subtitle relating to the following subjects 24 shall, consistent with the scope of practice of physician 25 assistants licensed under chapter 148C, and unless otherwise 26 inconsistent with state or federal law, provide the same power, 27 privilege, right, or duty by rule to a physician assistant 28 licensed under chapter 148C: 29 a. The department of administrative services, with respect 30 to rules relating to the following: 31 (1) Retroactive conversion of vacation time to sick leave 32 for vacation time spent under the care of a physician. 33 (2) Certification of a catastrophic illness by a physician 34 for purposes of donation of leave and second medical 35 -19- HF 803 (2) 89 ss/rh/md 19/ 37

H.F. 803 opinions and updates sought from a physician relating to such 1 certifications. 2 b. The department on aging, with respect to rules relating 3 to a written order from a physician for an older individual 4 requesting a therapeutic diet, and the interpretation of such 5 orders. 6 c. The department of corrections, with respect to rules 7 relating to the following: 8 (1) That a parolee shall not use, purchase, possess, or 9 transfer any drugs unless prescribed by a physician. 10 (2) That a serious medical need is one that has been 11 diagnosed by a physician as requiring treatment or is one so 12 obvious that a lay person would easily recognize the necessity 13 for a physician’s attention. 14 (3) That each jail shall have a designated licensed 15 physician, licensed osteopathic physician, or medical resource 16 designated for the medical supervision, care, and treatment of 17 prisoners as deemed necessary and appropriate. 18 (4) That prescription medication, as ordered by a licensed 19 physician, licensed osteopathic physician, or licensed dentist 20 shall be provided in accordance with the directions of the 21 prescribing physician or dentist. Prisoners with medication 22 from a personal physician, osteopathic physician, or dentist 23 may be evaluated by a physician, osteopathic physician, or 24 dentist selected by the jail administrator to determine if the 25 present medication is appropriate. 26 (5) That expired drugs or drugs not in unit dose packaging, 27 whose administration had been discontinued by the attending 28 physician, shall be destroyed by the jail administrator or 29 designee in the presence of a witness. 30 (6) That special diets in jails prescribed by a physician 31 shall be followed and documented, that the physician who 32 prescribes the special diet shall specify a date on which the 33 diet will be reviewed for renewal or discontinuation, and that 34 unless specified by the prescribing physician, a certified 35 -20- HF 803 (2) 89 ss/rh/md 20/ 37

H.F. 803 dietitian shall develop the menu. 1 (7) That special diets prescribed by a physician for the 2 care and treatment of juveniles in nonsecure hold shall be 3 followed and documented. 4 (8) For medical services in temporary holding facilities, 5 that a serious medical need is one that has been diagnosed by 6 a physician as requiring treatment or one that is so obvious 7 that a lay person would easily recognize the necessity for a 8 physician’s attention. 9 (9) For medical resources in temporary holding facilities, 10 that each facility shall have a designated licensed physician, 11 licensed osteopathic physician, or medical resource designated 12 for the medical supervision, care, and treatment of detainees 13 as deemed necessary and appropriate. 14 (10) Medication procedures in temporary holding facilities, 15 that prescription medication, as ordered by a licensed 16 physician, licensed osteopathic physician, or licensed dentist 17 shall be provided in accordance with the directions of the 18 prescribing physician or dentist. Detainees with medication 19 from a personal physician, osteopathic physician, or dentist 20 may be evaluated by a physician, osteopathic physician, or 21 dentist selected by the facility administrator to determine if 22 the present medication is appropriate. 23 (11) For medication storage in temporary holding 24 facilities, that expired drugs or drugs not in unit dose 25 packaging, whose administration had been discontinued by 26 the attending physician, shall be destroyed by the facility 27 administrator or designee in the presence of a witness. 28 (12) For medical diets in temporary holding facilities, 29 that special diets as prescribed by a physician shall be 30 followed and documented. 31 (13) For medical care and treatment for juveniles in 32 nonsecure holds in temporary holding facilities, that special 33 diets as prescribed by a physician shall be followed and 34 documented. 35 -21- HF 803 (2) 89 ss/rh/md 21/ 37

H.F. 803 d. The economic development authority, with respect to rules 1 relating to the certification of a person with a disability 2 for the purpose of the targeted small business program, that 3 in order to be considered a person with a disability for the 4 purpose of the targeted small business program, the person must 5 qualify and receive certification as having a disability from 6 a licensed medical physician or must have been found eligible 7 for vocational rehabilitation services by the department of 8 education, division of vocational rehabilitation services, or 9 by the department for the blind. 10 e. The department of education, with respect to rules 11 relating to the following: 12 (1) For statements relating to medication administration 13 policies, that a statement that persons administering 14 medication shall include authorized practitioners, such as 15 licensed registered nurses and physicians, and persons to whom 16 authorized practitioners have delegated the administration 17 of prescription and nonprescription drugs. Individuals 18 shall self-administer asthma or other airway constricting 19 disease medication or possess and have use of an epinephrine 20 auto-injector with parent and physician consent on file, 21 without the necessity of demonstrating competency to 22 self-administer these medications. 23 (2) For medication administration courses relating 24 to medication administration policies, that a medication 25 administration course be conducted by a registered nurse 26 or licensed pharmacist and include an annual medication 27 administration procedural skills check completed with a 28 registered nurse or pharmacist. 29 (3) For school-based youth services programs, that 30 preventive and primary health care services shall be delivered 31 by specifically credentialed providers as specified. 32 f. The department of human services, with respect to rules 33 relating to the following: 34 (1) That an incident for purposes of accreditation 35 -22- HF 803 (2) 89 ss/rh/md 22/ 37

H.F. 803 of providers of services to persons with mental illness, 1 intellectual disabilities, or developmental disabilities 2 includes but is not limited to an occurrence involving the 3 individual using the service that results in a physical injury 4 to or by the individual that requires a physician’s treatment 5 or admission to a hospital. 6 (2) That a mental health professional, for purposes 7 of accreditation of providers of services to persons with 8 mental illness, intellectual disabilities, or developmental 9 disabilities, includes a medical professional licensed in this 10 state, provided that the professional otherwise meets all of 11 the conditions to qualify as a mental health professional. 12 (3) That home health aide services for purposes of 13 disability services management and regional services may 14 include medications specifically ordered by a physician. 15 (4) That payment relating to the state supplementary 16 assistance program for residential care shall only be made when 17 there is on file an order written by a physician certifying 18 that the applicant or recipient being admitted requires 19 residential care but does not require nursing services. 20 (5) That a case folder for a facility participating in 21 the state supplementary assistance program must include a 22 physician’s statement certifying that a resident does not 23 require nursing services. 24 (6) That personnel providing psychological evaluations 25 and counseling or psychotherapy services for area education 26 agencies under the medical assistance program include specified 27 professions endorsed, licensed, or registered in this state, 28 provided that the professional otherwise meets all of the 29 conditions to qualify as a mental health professional. 30 (7) That personnel providing psychological evaluations and 31 counseling or psychotherapy services for providers of infant 32 and toddler program services under the medical assistance 33 program include specified professions endorsed, licensed, 34 or registered in this state, provided that the professional 35 -23- HF 803 (2) 89 ss/rh/md 23/ 37

H.F. 803 otherwise meets all of the conditions to qualify as a mental 1 health professional. 2 (8) That personnel providing other services for providers 3 of infant and toddler program services under the medical 4 assistance program include specified professions recognized, 5 endorsed, or licensed in this state, provided that the 6 professional otherwise meets all of the conditions to qualify 7 as a mental health professional. 8 (9) That personnel providing psychological evaluations 9 and counseling or psychotherapy services for providers of 10 local education agency services under the medical assistance 11 program include specified professions endorsed, licensed, 12 or registered in this state, provided that the professional 13 otherwise meets all of the conditions to qualify as a mental 14 health professional. 15 (10) That personnel providing other services for providers 16 of local education agency services under the medical assistance 17 program include specified professions recognized, endorsed, 18 or licensed in this state, provided that the professional 19 otherwise meets all of the conditions to qualify as a mental 20 health professional. 21 (11) For payment for medically necessary home health agency 22 services under the medical assistance program, that payment 23 shall be approved for medically necessary home health agency 24 services prescribed by a physician in a plan of home health 25 care provided by a Medicare-certified home health agency. 26 (12) For authorization for medically necessary home health 27 agency services under the medical assistance program, that 28 services shall be authorized by a physician, evidenced by the 29 physician’s signature and date on a plan of treatment. 30 (13) For treatment plans of home health agencies under the 31 medical assistance program, that a member’s medical condition 32 shall be reflected by the date last seen by a physician, if 33 available. 34 (14) For items included in treatment plans of home health 35 -24- HF 803 (2) 89 ss/rh/md 24/ 37

H.F. 803 agencies under the medical assistance program, that a plan of 1 care shall include a physician’s signature and date and that 2 the plan of care must be signed and dated by the physician 3 before the claim for service is submitted for reimbursement. 4 (15) For skilled nursing services provided by a home health 5 agency under the medical assistance program, that medical 6 documentation shall be submitted justifying the need for 7 continued visits, including the physician’s estimate of the 8 length of time that additional visits will be necessary, and 9 that daily skilled nursing visits or multiple daily visits for 10 wound care or insulin injections shall be covered when ordered 11 by a physician and included in the plan of care. 12 (16) For physical therapy services provided by a home health 13 agency under the medical assistance program, that payment shall 14 be made for physical therapy services when the services follow 15 a treatment plan established by the physician after any needed 16 consultation with the qualified physical therapist. 17 (17) For occupational therapy services provided by a 18 home health agency under the medical assistance program, 19 that payment shall be made for occupational therapy services 20 when the services follow a treatment plan established by the 21 physician. 22 (18) For speech therapy services provided by a home health 23 agency under the medical assistance program, that payment shall 24 be made for speech therapy services when the services follow a 25 treatment plan established by the physician. 26 (19) For home health aide services provided by a home health 27 agency under the medical assistance program, that the service 28 as well as the frequency and duration are stated in a written 29 plan of treatment established by a physician. 30 (20) For home health aide services provided by a home health 31 agency under the medical assistance program, that services 32 provided for specified durations when ordered by a physician 33 and included in a plan of care shall be allowed as intermittent 34 services. 35 -25- HF 803 (2) 89 ss/rh/md 25/ 37

H.F. 803 (21) For home health aide services provided by a home health 1 agency under the medical assistance program, that personal 2 care services include helping the member take medications 3 specifically ordered by a physician. 4 (22) For private duty nursing or personal care services for 5 persons aged twenty and under, under the medical assistance 6 program, that private duty nursing services are those services 7 which are provided by a registered nurse or a licensed 8 practical nurse under the direction of the member’s physician 9 to a member in the member’s place of residence or outside the 10 member’s residence, when normal life activities take the member 11 outside the place of residence. 12 (23) For private duty nursing or personal care services for 13 persons aged twenty and under, under the medical assistance 14 program, that services shall be provided according to a written 15 plan of care authorized by a licensed physician. 16 (24) For private duty nursing or personal care services for 17 persons aged twenty and under, under the medical assistance 18 program, that personal care services are those services 19 provided by a home health aide or certified nurse’s aide and 20 which are delegated and supervised by a registered nurse under 21 the direction of the member’s physician to a member in the 22 member’s place of residence or outside the member’s residence, 23 when normal life activities take the member outside the place 24 of residence, and that these services shall be in accordance 25 with the member’s plan of care and authorized by a physician. 26 (25) For requirements for private duty nursing or personal 27 care services for persons aged twenty and under, under the 28 medical assistance program, that private duty nursing or 29 personal care services shall be ordered in writing by a 30 physician as evidenced by the physician’s signature on the plan 31 of care. 32 (26) For obtaining prescription medications for children in 33 juvenile detention and shelter care homes, that prescription 34 medication provided to residents shall be dispensed only from a 35 -26- HF 803 (2) 89 ss/rh/md 26/ 37

H.F. 803 licensed pharmacy in this state in accordance with state law, 1 from a licensed pharmacy in another state according to the laws 2 of that state, or by a licensed physician. 3 (27) For health and dental programs provided by agencies 4 providing foster care services, that a child’s physical 5 examination shall be performed by a licensed physician or 6 licensed nurse practitioner. 7 (28) For health and dental programs provided by agencies 8 providing foster care services, that if documentation of prior 9 immunization is unavailable, immunizations required by the 10 department of public health shall begin within thirty days of 11 placement, unless contraindicated and unless a statement from 12 a physician to that effect is included in the child’s medical 13 record, and that a statement from a physician, referring 14 agency, parent, or guardian indicating immunizations are 15 current is sufficient documentation of immunizations. 16 (29) For the dispensing, storage, authorization, and 17 recording of medications in child care centers, that all 18 medications shall be stored in their original containers, with 19 accompanying physician or pharmacist’s directions and label 20 intact and stored so they are inaccessible to children and the 21 public. 22 (30) For an infants’ area in a child care center, that 23 upon the recommendation of a child’s physician or the area 24 education agency serving the child, a child who is two years 25 of age or older with a disability that results in significant 26 developmental delays in physical and cognitive functioning who 27 does not pose a threat to the safety of the infants may, if 28 appropriate and for a limited time approved by the department, 29 remain in the infant area. 30 (31) For facility requirements for a child development 31 home, that the telephone number for each child’s physician 32 shall be written on paper and readily accessible by the 33 telephone. 34 (32) For medications and hazardous materials in a child 35 -27- HF 803 (2) 89 ss/rh/md 27/ 37

H.F. 803 development home, that medications shall be given only with 1 the parent’s or doctor’s written authorization, and that each 2 prescribed medication shall be accompanied by a physician’s or 3 pharmacist’s direction. 4 (33) For medical reports regarding the health of a family 5 in a family life home, that a medical report shall provide 6 significant findings of a physician, such as the presence or 7 absence of any communicable disease. 8 (34) For medical reexaminations of a family in a family 9 life home, that medical reexaminations may be required at the 10 discretion of a physician. 11 (35) For medical examinations of a client in a family life 12 home, that a physician shall certify that the client is free 13 from any communicable disease and does not require a higher 14 level of care than that provided by a family life home. 15 (36) For the records of a client in a family life home, 16 that the family shall have available at all times, the name, 17 address, and telephone number of the client’s physician. 18 (37) For the facility requirements for a child care home, 19 that the telephone number for each child’s physician shall be 20 written on paper and readily accessible by the telephone. 21 (38) For the administration of medications at a child care 22 home, that medications shall be given only with the parent’s or 23 doctor’s written authorization and each prescribed medication 24 shall be accompanied by a physician’s or pharmacist’s 25 direction. 26 (39) For payments for foster care, that an intellectual 27 disabilities professional includes specified professions, 28 provided that the professional otherwise meets all of 29 the conditions to qualify as an intellectual disabilities 30 professional. 31 (40) For payments for foster care, that a mental health 32 professional includes specified professions, provided that the 33 professional otherwise meets all of the conditions to qualify 34 as a mental health professional. 35 -28- HF 803 (2) 89 ss/rh/md 28/ 37

H.F. 803 (41) For the subsidized adoption program, that a qualified 1 intellectual disability professional includes specified 2 professions, provided that the professional otherwise meets 3 all of the conditions to qualify as a qualified intellectual 4 disability professional. 5 (42) For the subsidized adoption program, that a qualified 6 mental health professional includes specified professions, 7 provided that the professional otherwise meets all of 8 the conditions to qualify as a qualified mental health 9 professional. 10 (43) For the information provided to a foster care provider 11 by a department worker at the time of placement, that the 12 information shall include the names, addresses, and telephone 13 numbers of the child’s physician and dentist. 14 g. The department of inspections and appeals, with respect 15 to rules relating to the following: 16 (1) For the qualifications of an attending physician at a 17 hospice, that the person shall have an active Iowa license to 18 practice medicine. 19 (2) For residential care facilities for persons with 20 intellectual disabilities, that a qualified intellectual 21 disability professional includes specified professions, 22 provided that the professional otherwise meets all of the 23 conditions to qualify as a qualified intellectual disability 24 professional. 25 (3) For nursing facilities, that a qualified intellectual 26 disabilities professional includes specified professions, 27 provided that the professional otherwise meets all of the 28 conditions to qualify as a qualified intellectual disabilities 29 professional. 30 (4) For intermediate care facilities for persons with 31 mental illness, that a qualified mental health professional 32 includes specified professions, provided that the professional 33 otherwise meets all of the conditions to qualify as a qualified 34 mental health professional. 35 -29- HF 803 (2) 89 ss/rh/md 29/ 37

H.F. 803 (5) For notifications submitted to the department from 1 a subacute mental health care facility in the event of an 2 accident causing a major injury, including as a major injury an 3 injury which requires consultation with the attending physician 4 or designee of the physician or advanced registered nurse 5 practitioner who determines that an injury is a major injury. 6 h. The racing and gaming commission, with respect to rules 7 relating to the following: 8 (1) For the grounds for denial, suspension, or revocation 9 of an occupational or vendor license, that a license shall be 10 denied if the applicant has a history of mental illness without 11 demonstrating successful treatment by a licensed medical 12 physician. 13 (2) For the qualifications for jockeys, that a jockey shall 14 pass a physical examination by a licensed physician affirming 15 fitness to participate as a jockey. 16 (3) For the regulation of licensees in restricted areas of 17 a racing facility, that licensees whose duties require them to 18 be in a restricted area of a racing facility shall not have 19 present within their systems any controlled substance as listed 20 in schedules I to V of U.S.C. Tit. 21 (Food and Drug Section 21 812), chapter 124, or any prescription drug unless it was 22 obtained directly or pursuant to valid prescription or order 23 from a duly licensed physician who is acting in the course of 24 professional practice. 25 i. The Iowa law enforcement academy, with respect to rules 26 relating to the following: 27 (1) For the minimum standards for law enforcement officers, 28 that an officer is examined by a licensed physician or surgeon. 29 (2) For hiring standards must be reverified if an individual 30 is not hired by an Iowa law enforcement agency during a 31 specified period of time following completion of the course 32 of study, that the individual must be examined by a licensed 33 physician or surgeon. 34 (3) For the selection or appointment of reserve peace 35 -30- HF 803 (2) 89 ss/rh/md 30/ 37

H.F. 803 officers, that the person shall be examined by a licensed 1 physician or surgeon. 2 j. The natural resource commission, with respect to rules 3 relating to the following: 4 (1) That the grounds for revoking or suspending an 5 instructor license include participation in a course while 6 ingesting prescription medication in a manner contrary to the 7 dosing directions given by the prescribing physician. 8 (2) For applications for use of a crossbow for deer and 9 turkey hunting by handicapped individuals, that an application 10 must include a statement signed by the applicant’s physician 11 declaring that the individual is not physically capable of 12 shooting a bow and arrow. 13 (3) For authorization for the use of a crossbow for deer 14 and turkey hunting by handicapped individuals, that if a 15 conservation officer has probable cause to believe the person’s 16 handicapped status has improved, making it possible for the 17 person to shoot a bow and arrow, the department of natural 18 resources may, upon the officer’s request, require the person 19 to obtain in writing a current physician’s statement. 20 (4) For licenses for nonresidents to participate in a 21 special deer hunting season for severely disabled persons, 22 that a nonresident applying for the license must have on file 23 with the department of natural resources either a copy of a 24 disabilities parking permit issued by a state department of 25 transportation or an Iowa department of natural resources form 26 signed by a physician that verifies their disability. 27 k. The Iowa department of public health, with respect to 28 rules relating to the following: 29 (1) That “impaired glucose tolerance” , for purposes of 30 outpatient diabetes education programs, means a condition in 31 which blood glucose levels are higher than normal, diagnosed by 32 a physician, and treated with a food plan, exercise, or weight 33 control. 34 (2) For instructors for programs not recognized by the 35 -31- HF 803 (2) 89 ss/rh/md 31/ 37

H.F. 803 American diabetes association or accredited by the American 1 association of diabetes educators, that the primary instructors 2 shall be one or more of specified health care professionals who 3 are knowledgeable about the disease process of diabetes and the 4 treatment of diabetes. 5 (3) For the written form for participation in the 6 prescription drug donation repository program, that the form 7 shall include the name and telephone number of the responsible 8 pharmacist, physician, or nurse practitioner who is employed 9 by or under contract with the pharmacy or medical facility, 10 and shall also include a statement, signed and dated by the 11 responsible pharmacist, physician, or nurse practitioner, 12 indicating that the pharmacy or medical facility meets the 13 eligibility requirements and shall comply with the requirements 14 established by rule. 15 (4) For the dispensing of donated prescription drugs and 16 supplies, that donated drugs and supplies may be dispensed 17 only if the drugs or supplies are prescribed by a health 18 care practitioner for use by an eligible individual and 19 are dispensed by a licensed pharmacist, physician, or nurse 20 practitioner. 21 l. The department of public safety, with respect to rules 22 relating to permits to carry weapons, that an unlawful user of 23 or addicted to any controlled substance includes any person who 24 is a current user of a controlled substance in a manner other 25 than as prescribed by a licensed physician. 26 m. The department of transportation, with respect to rules 27 relating to exemptions from motor vehicle window transparency 28 requirements, that a motor vehicle fitted with a front 29 windshield, a front side window, or a front sidewing with less 30 than seventy percent but not less than thirty-five percent 31 light transmittance before July 4, 2012, may continue to be 32 maintained and operated 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 on or 35 -32- HF 803 (2) 89 ss/rh/md 32/ 37

H.F. 803 after July 4, 2012, so long as the vehicle continues to be used 1 for the transport of a passenger or operator who documented in 2 the manner specified by the department a medical need for such 3 reduced transparency, which document was signed by the person’s 4 physician before July 4, 2012. 5 n. The Iowa department of veterans affairs, with respect 6 to rules relating to expenses relating to the purchase of 7 durable equipment or services, that individuals requesting 8 reimbursement who need durable equipment as a medical necessity 9 should provide information from a physician. 10 o. The department of workforce development, with respect to 11 rules relating to the following: 12 (1) That a voluntary quit shall be presumed to be without 13 good cause attributable to the employer for purposes of 14 unemployment compensation if a claimant left employment because 15 of illness or injury which was not caused or aggravated by the 16 employment or pregnancy and failed to obtain the advice of a 17 licensed and practicing physician, obtain certification of 18 release for work from a licensed and practicing physician, or 19 return to the employer and offer services upon recovery and 20 certification for work by a licensed and practicing physician. 21 (2) That for purposes of unemployment compensation, it is 22 a reason for a claimant leaving employment with good cause 23 attributable to the employer if the claimant left employment 24 because of illness, injury, or pregnancy upon the advice of 25 a licensed and practicing physician, and upon recovery, when 26 recovery was certified by a licensed and practicing physician, 27 the claimant returned and offered to perform services to the 28 employer, but no suitable, comparable work was available. 29 (3) That for purposes of unemployment compensation it is 30 a reason for a claimant leaving employment with good cause 31 attributable to the employer if the claimant left employment 32 upon the advice of a licensed and practicing physician for the 33 sole purpose of taking a family member to a place having a 34 different climate and subsequently returned to the claimant’s 35 -33- HF 803 (2) 89 ss/rh/md 33/ 37

H.F. 803 regular employer and offered to perform services, but the 1 claimant’s regular or comparable work was not available. 2 p. The labor services division of the department of 3 workforce development, with respect to rules relating to the 4 following: 5 (1) For the disclosure of a trade secret relating to a 6 hazardous chemical during a medical emergency, that where a 7 treating physician or nurse determines that a medical emergency 8 exists and the specific chemical identity of a hazardous 9 chemical is necessary for emergency or first-aid treatment, the 10 chemical manufacturer, importer, or employer shall immediately 11 disclose the specific chemical identity of a trade secret 12 chemical to that treating physician or nurse, regardless of the 13 existence of a written statement of need or a confidentiality 14 agreement. 15 (2) For the disclosure of a trade secret relating to 16 a hazardous chemical in a nonemergency situation, that in 17 nonemergency situations, a chemical manufacturer, importer, 18 or employer shall, upon request, disclose a specific chemical 19 identity, otherwise permitted to be withheld by rule, to a 20 specified health professional providing medical or other 21 occupational health services to exposed employees or designated 22 representatives in specified circumstances. 23 (3) For applications for a license to practice asbestos 24 removal, that except as noted in rule, only worker and 25 contractor/supervisor license applicants must submit a 26 respiratory protection and physician’s certification forms. 27 (4) For documentation held by persons licensed for asbestos 28 abatement in an area that is subject to a disaster emergency 29 proclamation, that the labor commissioner deems an individual 30 contractor, supervisor, or worker to be licensed and authorized 31 for asbestos abatement if the individual, in addition to other 32 specified conditions, makes immediately available on the 33 work site a copy of a physician’s statement indicating that, 34 consistent with federal law, a licensed physician has examined 35 -34- HF 803 (2) 89 ss/rh/md 34/ 37

H.F. 803 the individual within the past twelve months and approved the 1 individual to work while wearing a respirator. 2 (5) That the contents of an application for an event 3 license for a covered athletic event other than a professional 4 wrestling event shall contain, along with other requirements, 5 a copy of the medical license of the ringside physician and 6 the date, time, and location of the ringside physician’s 7 examination of the contestants. 8 (6) For the responsibilities of the promoter of an athletic 9 event, that the promoter submit test results to the ringside 10 physician no later than at the time of the physical showing 11 that each contestant scheduled for the event tested negative 12 for the human immunodeficiency, hepatitis B, and hepatitis C 13 viruses within the one-year period prior to the event, and that 14 the contestant shall not participate and the physician shall 15 notify the promoter that the contestant is prohibited from 16 participating for medical reasons if specified circumstances 17 occur. 18 (7) For injuries during a professional boxing match, that if 19 a contestant claims to be injured during the bout, the referee 20 shall stop the bout and request the attending physician to make 21 an examination. If the physician decides that the contestant 22 has been injured as the result of a foul, the physician shall 23 advise the referee of the injury. If the physician is of the 24 opinion that the injured contestant may be able to continue, 25 the physician shall order an intermission, after which the 26 physician shall make another examination and again advise 27 the referee of the injured contestant’s condition. It shall 28 be the duty of the promoter to have an approved physician in 29 attendance during the entire duration of all bouts. 30 (8) For persons allowed in a ring during a professional 31 boxing match, that no person other than the contestants and the 32 referee shall enter the ring during the bout, excepting the 33 seconds between the rounds or the attending physician if asked 34 by the referee to examine an injury to a contestant. 35 -35- HF 803 (2) 89 ss/rh/md 35/ 37

H.F. 803 (9) For the weighing of contestants in a professional boxing 1 match, that contestants shall be weighed and examined on the 2 day of the scheduled match by the attending ring physician at a 3 time and place to be determined by the commissioner. 4 (10) For attending ring physicians during a professional 5 boxing match, that when a boxer has been injured seriously, 6 knocked out, or technically knocked out, the referee shall 7 immediately summon the attending ring physician to aid the 8 stricken boxer, and that managers, handlers, and seconds shall 9 not attend to the stricken boxer, except at the request of the 10 physician. 11 (11) For the keeping of time during a professional boxing 12 match, that the timekeeper shall keep an exact record of time 13 taken out at the request of a referee for an examination of a 14 contestant by the physician. 15 (12) For the suspension of contestants during a 16 professional boxing match that is an elimination tournament, 17 that a contestant who for specified reasons is not permitted 18 to box in the state for a period of time shall be examined by a 19 physician approved by the commissioner before being permitted 20 to fight again. 21 (13) For the designation of officials for professional 22 kickboxing, that the designation of physicians is subject to 23 the approval of the commissioner or designee. 24 (14) For officials for a mixed martial arts event, that 25 officials shall include a physician. 26 (15) For the keeping of time for a mixed martial arts 27 event, that the timekeeper shall keep an exact record of time 28 taken out at the request of a referee for an examination of a 29 contestant by the physician. 30 (16) For persons allowed in the cage during a mixed martial 31 arts event, that a physician may enter the cage to examine a 32 contestant upon the request of the referee. 33 (17) For the decorum of persons involved in a mixed martial 34 arts event, that a contestant is exempt from prohibitions on 35 -36- HF 803 (2) 89 ss/rh/md 36/ 37

H.F. 803 specified conduct while interacting with the contestant’s 1 opponent during a round, but if the round is stopped by the 2 physician or referee for a time out, the prohibitions shall 3 apply to the contestant. 4 (18) For the examination of contestants in a mixed martial 5 arts event, that on the day of the event, at a time and place 6 to be approved by the commissioner, the ringside physician 7 shall conduct a rigorous physical examination to determine the 8 contestant’s fitness to participate in a mixed martial arts 9 match, and that a contestant deemed not fit by the physician 10 shall not participate in the event. 11 (19) For injuries during a mixed martial arts event, that if 12 a contestant claims to be injured or when a contestant has been 13 injured seriously or knocked out, the referee shall immediately 14 stop the fight and summon the attending ring physician to make 15 an examination of the stricken fighter. If the physician 16 decides that the contestant has been injured, the physician 17 shall advise the referee of the severity of the injury. If 18 the physician is of the opinion the injured contestant may be 19 able to continue, the physician shall order an intermission, 20 after which the physician shall make another examination and 21 again advise the referee of the injured contestant’s condition. 22 Managers, handlers, and seconds shall not attend to the 23 stricken fighter, except at the request of the physician. 24 2. This section shall not be construed to expand, diminish, 25 or otherwise modify the scope of practice of any profession 26 licensed under this subtitle. 27 3. The rulemaking requirements provided in this section 28 shall not be construed to prohibit the agencies listed in 29 subsection 1 from engaging in further rulemaking not in 30 conflict with this section or state or federal law relating to 31 the subject matter of this section or to otherwise diminish the 32 authority to engage in rulemaking provided to those agencies by 33 any other statute. 34 -37- HF 803 (2) 89 ss/rh/md 37/ 37