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    Bulletin 02-13-2019

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    ARC 4305CDental Board[650]Notice of Intended Action

    Proposing rule making related to prescribing standards, continuing education, and disciplinary standards and providing an opportunity for public comment

        The Dental Board hereby proposes to amend Chapter 16, “Prescribing, Administering, and Dispensing Drugs,” Chapter 25, “Continuing Education,” and Chapter 30, “Discipline,” Iowa Administrative Code.Legal Authority for Rule Making    This rule making is proposed under the authority provided in Iowa Code sections 147.76, 153.33 and 272C.3.State or Federal Law Implemented    This rule making implements, in whole or in part, Iowa Code sections 147.10, 147.11, 153.15A, 153.33, 153.39 and 272C.2.Purpose and Summary    The primary purpose of these proposed amendments is to make updates in accordance with 2018 Iowa Acts, House File 2377. Additional amendments make updates to and clarify existing rules.     The proposed amendments to Chapter 16 update requirements for prescribing controlled substances pursuant to House File 2377 and update prescribing standards in general.        The proposed amendments to Chapter 25 add requirements for continuing education on opioids, pursuant to House File 2377, and add a provision relating to the number of hours permitted to be claimed for an advanced cardiac life support course.     The proposed amendment to Chapter 30 replaces rule 650—30.4(147,153,272C) with a new rule pertaining to updated disciplinary standards. The proposed amendment clarifies and reorganizes disciplinary standards, adds an opioid-related disciplinary standard as required by House File 2377, and reduces duplicative disciplinary standards. Fiscal Impact     This rule making has no fiscal impact to the State of Iowa. Jobs Impact    After analysis and review of this rule making, no impact on jobs has been found.Waivers    Any person who believes that the application of the discretionary provisions of this rule making would result in hardship or injustice to that person may petition the Board for a waiver of the discretionary provisions, if any, pursuant to 650—Chapter 7. Public Comment     Any interested person may submit written or oral comments concerning this proposed rule making. Written or oral comments in response to this rule making must be received by the Board no later than 4:30 p.m. on April 1, 2019. Comments should be directed to: Steve Garrison Iowa Dental Board 400 S.W. Eighth Street, Suite D Des Moines, Iowa 50309 Phone: 515.281.3248 Fax: 515.281.7969 Email: steven.garrison@iowa.govPublic Hearing     No public hearing is scheduled at this time. As provided in Iowa Code section 17A.4(1)“b,” an oral presentation regarding this rule making may be demanded by 25 interested persons, a governmental subdivision, the Administrative Rules Review Committee, an agency, or an association having 25 or more members. Review by Administrative Rules Review Committee    The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making at its regular monthly meeting or at a special meeting. The Committee’s meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).    The following rule-making actions are proposed:

        ITEM 1.    Amend rule 650—16.1(124,153,155A) as follows:

    650—16.1(124,153,155A) Definitions.          "Authorized delegate" means a licensed or registered health care professional such as a dental hygienist, dental assistant or registered nurse who has obtained PMP log-in credentials. A dental assistant trainee may not serve as an authorized delegate.        "Controlled substance" means a drug or other substance listed in division II of Iowa Code chapter 124.        "Electronic signature" means a confidential personalized digital key, code, or number used for secure electronic data transmissions which identifies and authenticates the signatory.        "Electronic transmission" means the transmission of information in electronic form or the transmission of the exact visual image of a document by way of electronic equipment. Electronic transmission includes but is not limited to transmission by facsimile machine and transmission by computer link, modem, or other computer communication device.        "Opioid" means a drug that produces an agonist effect on opioid receptors and is indicated or used for the treatment of pain.        "Prescription drug" means any of the following: (a) a substance for which federal or state law requires a prescription before it may be legally dispensed to the public; (b) a drug or device that under federal law is required, prior to being dispensed or delivered, to be labeled with either of the following statements: (1) Caution: Federal law prohibits dispensing without a prescription or (2) Caution: Federal law restricts this drug to use by or on the order of a licensed veterinarian; or (c) a drug or device that is required by any applicable federal or state law or regulation to be dispensed on prescription only, or is restricted to use by a practitioner onlymeans a drug, as classified by the United States Food and Drug Administration, that is required to be prescribed or administered to a patient by a practitioner prior to dispensation.        "Prescription monitoring program" "PMP" means the information program for drug prescribing and dispensing administered by the Iowa board of pharmacy.

        ITEM 2.    Amend rule 650—16.2(153) as follows:

    650—16.2(153) Scope of authorityand prescribing requirements.      16.2(1)   A license to practice dentistry issued by this board permits the licensee to prescribe, administer, or dispense prescription drugs if the use is directly related to the practice of dentistryand is within the scope of the dentist-patient relationship. Registration with the Federal Drug Enforcement Administration and the Iowa board of pharmacy examiners further extends this privilege to controlled substances.    16.2(2)   A dental examination must be conducted and a medical history taken before a dentist initially prescribes, administers, or dispenses medication to a patient, except for patients who receive fluoride or silver diamine fluoride dispensed under protocols approved by the bureau of oral and health delivery systems of the department of public health. The examination must focus on the patient’s dental problems, and the resulting diagnosis must relate to the patient’s specific complaint. The patient’s dental record must contain written evidence of the examination and medical history.Prescribing by a licensed dentist must be directly related to the practice of dentistry. A dental examination and medical history must be taken before a dentist initially prescribes, administers, or dispenses a prescription drug to a patient, except for patients who receive fluoride dispensed under protocols approved by the bureau of oral and health delivery systems of the department of public health. A prescription drug prescribed, administered, or dispensed by a licensed dentist must be for a diagnosed condition and be included in a dental treatment plan. The patient’s dental record must contain written evidence of the examination and medical history.    16.2(3)   On each occasion when a medicationprescription drug is prescribed, administered, or dispensed to a patient, an entry must be made in the patient’s dental record containing the following information: the name, quantity, and strength of the medicationprescription drug; the directions for its use; the date of issuance; and the condition for which the medicationprescription drug was used.    16.2(4)   A patient’s dental record that contains an entry pertaining to the issuance of medications must be retained in accordance with 650—27.11(153,272C).    16.(5) 16.2(4)   The prescribing, administering, and dispensing of prescription drugs shall be done in accordance with all applicable state and federal laws.    16.2(5)   When controlled substances are purchased, administered, or dispensed, a dentist shall maintain records and accountability in accordance with 657—Chapter 10.    16.2(6)   A dentist shall not self-prescribe or self-administer controlled substances.    16.2(7)   Prescribing, administering, or dispensing controlled substances to members of the licensee’s immediate family is prohibited, except for an acute dental condition or on an emergency basis for a dental condition when the licensee conducts an examination, establishes a patient record, and maintains proper documentation.

        ITEM 3.    Rescind rule 650—16.3(153).

        ITEM 4.    Renumber rules 650—16.4(153) to 650—16.6(153) as 650—16.3(153) to 650—16.5(153).

        ITEM 5.    Amend renumbered rule 650—16.3(153) as follows:

    650—16.3(153) Dispensing—requirements for containers and labeling.      16.3(1)   Containers. A prescription drug shall be dispensed in asuitable container which meets the requirements of the Poison Prevention Packaging Act of 1970, 15 U.S.C. §§ 1471-1476 which relates to childproof closure, unless otherwise required by the patient. Containers must also meet the requirements of Section 502G of the Federal Food Drug and Cosmetic Act, 21 U.S.C. §301 et seq. which pertains to light resistance and moisture-resistance needs of the drug being dispenseddesigned to protect its integrity in accordance with all applicable federal and state laws.    16.3(2)   Labeling. A label shall be affixed to the container in which a prescription drug is dispensed bearing the following information:
    1. Name and address of the dentist.
    2. Name of the patient.
    3. Date dispensed.
    4. Directions for use.
    5. Name, quantity, and strength of medication.
    6. If it is Schedule II, III, or IV controlled substance, the federal transfer warning statement must appear on the label as follows: “Caution: Federal law prohibits the transfer of this drug to any person other than the patient for whom it was prescribed.”
    7. Cautionary statements, if any.
        16.3(3)   Prescription sample drugs dispensed in the original container or package and provided without charge shall be deemed to conform to labeling and packaging requirements.

        ITEM 6.    Amend renumbered rule 650—16.4(153) as follows:

    650—16.4(153) Identifying information on prescriptionsPrescription requirements.      16.4(1)   Prescriptions for Schedule II, III, IV, and V controlled substances must include the name and address of the prescribing dentist and the dentist’s federal DEA number. The name and address of the prescribing dentist may be preprinted. Proper security shall be maintained if prescription forms are preprinted.Prior to January 1, 2020, a prescription drug order may be written or transmitted to a pharmacy orally, by fax, or through electronic prescribing in accordance with applicable federal and state laws. A dentist shall take adequate measures to prevent prescription forgery from occurring. Beginning January 1, 2020, all prescription drug orders, including prescriptions for controlled substances, must be electronically prescribed unless otherwise exempted. Beginning January 1, 2020, a dentist who fails to comply with the electronic prescribing mandate may be subject to a nondisciplinary administrative penalty of $250 per violation, up to a maximum of $5,000 per calendar year.    16.4(2)   The dentist’s signature on a prescription must be original or an electronic signature, not a copy or stamp, except as the use of electronic signatures may be limited by federal or state law.A dentist may delegate to a licensed dental hygienist or registered dental assistant the preparation of a prescription for the review, authorization, and manual or electronic signature of the dentist, but the dentist is responsible for the accuracy, completeness, and validity of the prescription.    16.4(3)   On each occasion when medication is prescribed to a patient, the prescription issued to the patient shall contain the following information: the name of the patient for whom the prescription is intended; the name, quantity, and strength of the medication; the directions for its use; the date of issuance; and the name, address, and signature of the dentist issuing the prescription.A dentist shall securely maintain the unique authentication credentials issued to the dentist for utilization of the electronic prescription application and authentication of the dentist’s electronic signature. Unique authentication credentials issued to any individual shall not be shared with or disclosed to any other individual.

        ITEM 7.    Amend renumbered rule 650—16.5(153) as follows:

    650—16.5(153) Transmission of prescriptionsRequired use of the PMP.  A prescription drug order may be transmitted to a pharmacy in written form, orally including telephone voice communication, or by electronic transmission in accordance with applicable federal and state laws and rules. A dentist shall take adequate measures to guard against the diversion of prescription drugs and controlled substances through prescription forgeries. The dentist may authorize an employee to transmit to the pharmacy a prescription drug order orally or by electronic transmission provided that the identity of the transmitting employee is included in the order.    16.5(1) Computer-to-computer transmission of a prescription.  Prescription drug orders, excluding orders for controlled substances, may be communicated directly from a dentist’s computer to a pharmacy’s computer by electronic transmission.    a.    Orders shall be sent only to the pharmacy of the patient’s choice with no unauthorized intervening person or other entity controlling, screening, or otherwise manipulating the prescription drug order or having access to it.    b.    The electronically transmitted order shall identify the dentist’s telephone number for verbal confirmation, the time and date of transmission, and the pharmacy intended to receive the transmission as well as any other information required by federal or state law or rules.    c.    Orders shall be transmitted only by the dentist or the dentist’s employee and shall include the dentist’s electronic signature.    d.    The electronic transmission shall be deemed the original prescription drug order provided it meets the requirements of this rule.    16.5(1)   Before a dentist issues an opioid prescription or dispenses an opioid, a dentist or authorized delegate shall query the PMP. The query shall be performed within 48 hours of a prescription being issued or dispensed and shall be done for each patient, each time an opioid prescription is authorized or dispensed.     16.5(2) Facsimile transmission of a prescription.  A dentist may request that a pharmacist dispense noncontrolled and controlled drugs, excluding Schedule II controlled substances, pursuant to a prescription transmitted to the pharmacy by the dentist or the dentist’s employee. A dentist shall maintain the original prescription, if printed, in the patient’s record.A dentist who dispenses a controlled substance is required to report the dispensing to the PMP within one business day in accordance with 657—Chapter 37.

        ITEM 8.    Rescind rule 650—16.7(153).

        ITEM 9.    Adopt the following new definition of “Opioid” in rule 650—25.1(153):        "Opioid" means a drug that produces an agonist effect on opioid receptors and is indicated or used for the treatment of pain.

        ITEM 10.    Amend rule 650—25.4(153) as follows:

    650—25.4(153) Required continuing education courses.      25.4(1)   The following courses are required forall licensees and registrants:    a.    Mandatory reporter training for child abuse and dependent adult abuse.    b.    Cardiopulmonary resuscitation.    c.    Infection control.    d.    Jurisprudence.    25.4(2)   Mandatory reporter training for child abuse and dependent adult abuse.    a.    Licensees or registrants who regularly examine, attend, counsel or treat children in Iowa shall indicate on the renewal application completion of two hours of training in child abuse identification and reporting in the previous five years or conditions for exemptions as identified in paragraph “f” of this subrule,25.4(2)“f,” pursuant to Iowa Code chapter 232. Completion of training in this course shall result in two hours of continuing education credit.    b.    Licensees or registrants who regularly examine, attend, counsel or treat adults in Iowa shall indicate on the renewal application completion of two hours of training in dependent adult abuse identification and reporting in the previous five years or conditions for exemptions as identified in paragraph “f” of this subrule,25.4(2)“f,” pursuant to Iowa Code chapter 235B.    c.    Licensees or registrants who regularly examine, attend, counsel or treat both children and adults in Iowa shall indicate on the renewal application completion of at least two hours of training on the identification and reporting of abuse in children and dependent adults in the previous five years or conditions for exemptions as identified in paragraph “f” of this subrule,25.4(2)“f,” pursuant to Iowa Code chapters 232 and 235B. Training may be completed through separate courses or in one combined course that includes curricula for identifying and reporting child abuse and dependent adult abuse. Completion of training in this combined course shall result in three hours of continuing education credit.    d.    The licensee or registrant shall maintain written documentation for five years after completion of the mandatory training, including program date(s), content, duration, and proof of participation. The board may audit this information at any time within the five-year period.    e.    Training programs in child and dependent adult abuse identification and reporting that are approved by the board are those that use a curriculum approved by the abuse education review panel of the department of public health or a training program offered by the department of human services, the department of education, an area education agency, a school district, the Iowa law enforcement academy, an Iowa college or university, or a similar state agency.    f.    Exemptions. Licensees and registrants shall be exempt from the requirement for mandatory training for identifying and reporting child and dependent adult abuse if the board determines that it is in the public interest or that at the time of the renewal the licensee or registrant is issued an extension or exemption pursuant to rule 650—25.10(153).    25.4(3)   Cardiopulmonary resuscitation (CPR). Licensees and registrants shall furnish evidence of valid certification for CPR, which shall be credited toward the continuing education requirement for renewal of the license, faculty permit or registration. Such evidence shall be filed at the time of renewal of the license, faculty permit or registration. Valid certification means certification by an organization on an annual basis or, if that certifying organization requires certification on a less frequent basis, evidence that the licensee or registrant has been properly certified for each year covered by the renewal period. In addition, the course must include a clinical component. Credit hours awarded for certification in CPR shall not exceed three hours of required continuing education hours per biennium.Credit hours awarded for certification in pediatric advanced life support (PALS) or advanced cardiac life support (ACLS) may be claimed hour for hour.     25.4(4)   Infection control. Beginning September 1, 2018, licensees and registrants shall complete continuing education in the area of infection control. Licensees and registrants shall furnish evidence of continuing education completed within the previous biennium in the area of infection control standards, as required by the Centers for Disease Control and Prevention of the United States Department of Health and Human Services. Completion of continuing education in the area of infection control shall be credited toward the required continuing education requirement in the renewal period during which it was completed. A minimum of one hour shall be submitted.    25.4(5)   Jurisprudence. Beginning September 1, 2018, licensees and registrants shall complete continuing education in the area of Iowa jurisprudence related to the practice of dentistry, dental hygiene and dental assisting. Licensees and registrants shall furnish evidence of continuing education completed within the previous biennium in the area of Iowa jurisprudence. Completion of continuing education in the area of Iowa jurisprudence shall be credited toward the required continuing education requirement in the renewal period during which it was completed. A minimum of one hour shall be submitted.    25.4(6)   The following is required for dentists only.    a.    As a condition of license renewal, a licensed dentist who has prescribed opioids to a patient during the biennium renewal period shall obtain a minimum of one hour of continuing education credit on opioids. This training shall include guidelines for prescribing opioids, including recommendations on limitations of dosages and the length of prescriptions, risk factors for abuse, and nonopioid and nonpharmacological therapy options. This hour may count toward the 30 hours of continuing education required for license renewal. The licensee shall maintain documentation of this hour, which may be subject to audit. If the continuing education did not cover the U.S. Centers for Disease Control and Prevention guideline for prescribing opioids for chronic pain, the licensee shall read the guideline prior to license renewal.    b.    A licensed dentist who did not prescribe opioids during the biennium renewal period may attest that the dentist is not subject to this requirement due to the fact that the dentist did not prescribe opioids during the time period.

        ITEM 11.    Rescind rule 650—30.4(147,153,272C) and adopt the following new rule in lieu thereof:

    650—30.4(147,153,272C) Grounds for discipline.  The following shall constitute grounds for the imposition by the board of one or more of the disciplinary sanctions set forth in rule 650—30.2(153), specifically including the imposition of civil penalties not to exceed $10,000. This rule is not subject to waiver pursuant to 650—Chapter 7 or any other provision of law.    30.4(1)   The board may impose discipline for the following violations related to licensure and registration:    a.    Fraud or deceit in procuring or renewing any license, permit, or registration, including any false or misleading statement of a material fact or omission of information required to be disclosed;    b.    Engaging in the practice of dentistry, dental hygiene, or dental assisting with a lapsed or inactive license, permit, or registration, or engaging in dental radiography with a lapsed or inactive dental radiography qualification;     c.    Engaging in the practice of dentistry, dental hygiene, or dental assisting without a license, permit, or registration, or engaging in dental radiography without a dental radiography qualification;    d.    Employing or permitting an unlicensed or unregistered person or a person with a lapsed or inactive license, permit, or registration to practice dentistry, dental hygiene, or dental assisting;    e.    Encouraging, assisting, or enabling the unauthorized practice of dentistry, dental hygiene, or dental assisting in any manner; or    f.    Failure to prominently display the names of all persons who are practicing dentistry, dental hygiene, or dental assisting within an office.    30.4(2)   The board may impose discipline for the following violations related to ethics:    a.    Fraud in representation as to skill or ability, whether by words or conduct or concealment of that which should have been disclosed, including but not limited to violations of 650—Chapter 26;    b.    Knowingly making misleading, deceptive, untrue, or fraudulent representations in the practice of the licensee’s or registrant’s profession;    c.    Practicing dentistry, dental hygiene, or dental assisting in a manner that is harmful or detrimental to the public. Proof of actual injury need not be established;    d.    Conviction of a felony or misdemeanor crime if the conviction relates to the practice of the profession;    e.    Improper sexual contact with or making suggestive, lewd, lascivious or improper remarks or advances to a patient or a coworker;    f.    Actions which are abusive, coercive, intimidating, harassing, untruthful, or threatening in the practice of dentistry;    g.    Obtaining any fee by fraud or misrepresentation;    h.    Giving or receiving cash or cash equivalents, or giving or receiving any gifts exceeding nominal value, for referral of patients;    i.    Failure to transfer patient records to another licensee upon request; or    j.    Unprofessional or unethical conduct including, but not limited to, those acts defined by Iowa Code section 153.32 or any violation of 650—Chapter 27.    30.4(3)   The board may impose discipline for the following violations related to the ability to practice:    a.    Habitual use of drugs or intoxicants rendering the licensee or registrant unfit for practice; or    b.    Practicing dentistry, dental hygiene, or dental assisting while in a state of advanced physical or mental disability where such disability renders the licensee or registrant incapable of performing professional services or impairs functions of judgment necessary to the practice.    30.4(4)   The board may impose discipline for the following violations related to patient care:    a.    Willful and gross malpractice;    b.    Willful and gross neglect;    c.    Failure to maintain a satisfactory standard of competency;    d.    Failure to preserve the confidentiality of patient information or accessing any confidential patient information without authorization;    e.    Practicing beyond training; or    f.    Delegating any acts to any licensee or registrant that are beyond the training or education of the licensee or registrant, or that are otherwise prohibited by rule.     30.4(5)   The board may impose discipline for the following violations related to prescribing:    a.    Violating the rules governing prescribing, including any violation of 650—Chapter 16;    b.    Improperly delegating access to the Iowa prescription monitoring program (PMP) to an unauthorized individual;    c.    Indiscriminately or promiscuously prescribing, administering, or dispensing any drug;     d.    Failure to check the PMP prior to prescribing an opioid; or    e.    Prescribing opioids in dosage amounts exceeding what would be prescribed by a reasonably prudent prescribing practitioner engaged in a similar practice.    30.4(6)   The board may impose discipline for the following violations related to infection control:    a.    Failure to maintain adequate safety and sanitary conditions for a dental office; or    b.    Failure to comply with standard precautions for preventing and controlling infectious diseases and managing personnel health and safety concerns related to infection control, as “required” or “recommended” for dentistry by the Centers for Disease Control and Prevention of the United States Department of Health and Human Services and the Iowa occupational safety and health administration.     30.4(7)   The board may impose discipline for the following violations related to reporting, compliance, and other state laws:    a.    Failure to notify the board of change of address within 60 days;     b.    Failure to report disciplinary action taken by a licensing authority of another state, territory or country, or another licensing authority in this state, within 30 days of the final action by the licensing authority. A stay by an appellate court shall not negate this requirement; however, if the disciplinary action is overturned or reversed by a court of last resort, the report shall be expunged from the records of the board when the board is so notified;    c.    Having a license or registration revoked, suspended, or otherwise disciplined by a licensing authority in any state, territory, or country;    d.    Failure to report any adverse judgment in a professional malpractice action to which the licensee or registrant was a party or any settlement of a claim against the licensee or registrant alleging malpractice;    e.    Failure to comply with an order of the board;    f.    Violating any provision of Iowa law or rule of the board, or being a party to or assisting in any violation of any provision of Iowa law or rule of the board;    g.    Failure to report any restriction of practice imposed by a hospital, clinic, or other practicing setting;    h.    Failure to report any misdemeanor or felony conviction within 60 days;    i.    Failure to comply with an Iowa practitioner review committee (IPRC) initial agreement or contract;     j.    Failure to report to the board any acts or omissions made by other licensees or registrants of the board that may constitute a basis for disciplinary action under the rules of statutory provisions governing the practice of dentistry, dental hygiene, or dental assisting in Iowa; or    k.    Failure to report adverse occurrences related to sedation, nitrous oxide inhalation analgesia, and antianxiety premedication pursuant to 650—Chapter 29.     30.4(8)   The board may impose discipline for the following violations related to board investigations:    a.    Knowingly providing false information to the board or an agent of the board during the course of an inspection or investigation or interfering with an inspection or investigation;    b.    Failure to comply with a subpoena issued by the board;     c.    Failure to fully and promptly comply with office inspections conducted at the request of the board to determine compliance with sanitation and infection control standards or sedation permit requirements;    d.    Failure to cooperate with a board investigation; or     e.    Retaliating against, threatening, or coercing any person for filing a complaint with the board or cooperating with a board inspection or investigation.     30.4(9)   The board may impose discipline for the following violations related to continuing education:     a.    Failure to respond to the board during a continuing education audit, or failure to submit verification of continuing education requirements within the time period provided;     b.    Knowingly submitting a false report of continuing education; or     c.    Failure to meet the required continuing education hours per biennium.     ARC 4281CEconomic Development Authority[261]Notice of Intended Action

    Proposing rule making related to the brownfield and grayfield redevelopment tax credit and providing an opportunity for public comment

        The Economic Development Authority hereby proposes to amend Chapter 65, “Brownfield and Grayfield Redevelopment,” Iowa Administrative Code.Legal Authority for Rule Making    This rule making is proposed under the authority provided in Iowa Code section 15.106A.State or Federal Law Implemented    This rule making implements, in whole or in part, Iowa Code sections 15.293B(4) and 15.295.Purpose and Summary    The proposed rule making makes the following changes. First, it removes the application scoring criterion which gives projects an additional 25 points if the project was registered under the program in a prior year. Although this criterion may have been desirable when the credit first became competitive, the Authority has experienced an influx of applications for projects that are not ready to move forward but rather are applying only for the purpose of receiving the additional 25 points in a future application round. Second, the rule making removes the 12-month maximum extension for project completion. The removal of this language brings the rules into agreement with language in Iowa Code section 15.293B(4).Fiscal Impact     This rule making has no fiscal impact to the State of Iowa. Jobs Impact    After analysis and review of this rule making, no impact on jobs has been found.Waivers    Any person who believes that the application of the discretionary provisions of this rule making would result in hardship or injustice to that person may petition the Authority for a waiver of the discretionary provisions, if any, pursuant to 261—Chapter 199. Public Comment     Any interested person may submit written or oral comments concerning this proposed rule making. Written or oral comments in response to this rule making must be received by the Authority no later than 4:30 p.m. on March 5, 2019. Comments should be directed to: Jennifer Klein Economic Development Authority 200 East Grand Avenue Des Moines, Iowa 50309 Phone: 515.348.6144 Email: jennifer.klein@iowaeda.comPublic Hearing    No public hearing is scheduled at this time. As provided in Iowa Code section 17A.4(1)“b,” an oral presentation regarding this rule making may be demanded by 25 interested persons, a governmental subdivision, the Administrative Rules Review Committee, an agency, or an association having 25 or more members. Review by Administrative Rules Review Committee    The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making at its regular monthly meeting or at a special meeting. The Committee’s meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).    The following rule-making actions are proposed:

        ITEM 1.    Amend paragraph 65.8(2)"a" as follows:    a.    Each application for tax credits during each established application period will be scored according to criteria set forth in this paragraph. Points will be added together and the resulting score averaged with the scores of applications evaluated by all council members. Scoring criteria include:    (1)   The project’s feasibility: 25 points.    (2)   The project’s financial need: 25 points.    (3)   The project’s quality: 25 points.    (4)   Whether the project was formerly registered under the program but did not receive an award: 25 points.

        ITEM 2.    Amend paragraph 65.11(7)"b" as follows:    b.    A registered project shall be completed within 30 months of the project’s approval unless the authority, with the approval of the board, provides additional time to complete the project. A project shall not be provided more than 12 months of additional time. If the registered project is not completed within the time required, the project is not eligible to claim a tax credit.    ARC 4276CEducation Department[281]Notice of Intended Action

    Proposing rule making related to corporal punishment and providing an opportunity for public comment

        The State Board of Education hereby proposes to rescind Chapter 103, “Corporal Punishment Ban; Restraint; Physical Confinement and Detention,” and to adopt a new Chapter 103, “Corporal Punishment, Physical Restraint, Seclusion, and Other Physical Contact with Students,” Iowa Administrative Code.Legal Authority for Rule Making    This rule making is proposed under the authority provided in Iowa Code section 256.7(5).State or Federal Law Implemented    This rule making implements, in whole or in part, Iowa Code sections 256B.3 and 280.21.Purpose and Summary    The Iowa Department of Education received an amended petition for rule making, which was submitted on September 18, 2018, and filed pursuant to Iowa Code section 17A.7.  That petition seeks revisions to Chapter 103, the Department’s administrative rules on corporal punishment, physical restraint, and physical confinement and detention, commonly known as the Department’s “seclusion and restraint” rules.  The amended petition was received after several meetings between the petitioners, other interested parties, and key Department staff regarding the content of the original petition.  After reviewing the proposed rules, the Department recommended that the rules be submitted to the State Board of Education as a Notice of Intended Action to update the current rules to allow all interested parties an opportunity for public comment. Fiscal Impact     This rule making has no fiscal impact to the State of Iowa. Jobs Impact    After analysis and review of this rule making, no impact on jobs has been found.Waivers    An agencywide waiver provision is provided for in 281—Chapter 4. Public Comment     Any interested person may submit written or oral comments concerning this proposed rule making. Written or oral comments in response to this rule making must be received by the Department no later than 4:30 p.m. on March 5, 2019. Comments should be directed to: Nicole Proesch Department of Education Grimes State Office Building, Second Floor East 14th and Grand Avenue Des Moines, Iowa 50319-0416 Phone: 515.281.8661 Email: nicole.proesch@iowa.govPublic Hearing     A public hearing at which persons may present their views orally or in writing will be held as follows: March 5, 2019 9 to 10 a.m. State Board Room, Second Floor Grimes State Office Building East 14th Street and Grand Avenue Des Moines, Iowa     Persons who wish to make oral comments at the public hearing may be asked to state their names for the record and to confine their remarks to the subject of this proposed rule making.     Any persons who intend to attend the public hearing and have special requirements, such as those related to hearing or mobility impairments, should contact the Department and advise of specific needs by calling 515.281.5295. Review by Administrative Rules Review Committee    The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making at its regular monthly meeting or at a special meeting. The Committee’s meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).    The following rule-making action is proposed:

        ITEM 1.    Rescind 281—Chapter 103 and adopt the following new chapter in lieu thereof: CHAPTER 103CORPORAL PUNISHMENT, PHYSICAL RESTRAINT, SECLUSION, AND OTHER PHYSICAL CONTACT WITH STUDENTS

    281—103.1(256B,280) Purpose and objectives.  The purpose of this chapter is to provide uniform definitions and policies for public school districts, accredited nonpublic schools, and area education agencies regarding the application of physical contact or force to enrolled students. These rules clarify that corporal punishment, prone restraint, and mechanical restraint are prohibited; explain the parameters and protocols for the use of physical restraint and seclusion; and describe other limits on physical contact with students. The applicability of this chapter to physical restraint, seclusion, or behavior management interventions does not depend on the terminology employed by the organization to describe the activity or space. These rules are intended to promote the dignity, care, safety, welfare, and security of each child and the school community; encourage the use of proactive, effective, and evidence- and research-based strategies and best practices to reduce the occurrence of challenging behaviors; increase meaningful instructional time for all students; ensure that seclusion and physical restraint are used only in specified circumstances and are subject to assessment, monitoring, documentation, and reporting by trained employees; and give clear guidance on whether a disciplinary or behavioral management technique is prohibited or may be used.

    281—103.2(256B,280) Definitions.  For the purposes of this chapter:        "Corporal punishment" means the intentional physical punishment of a student. “Corporal punishment” includes the use of unreasonable or unnecessary physical force, or physical contact made with the intent to harm or cause pain.        "Debriefings" are meetings to collaboratively examine and determine what caused an incident resulting in the use of physical restraints or seclusion, how the incident or the use of physical restraints or seclusion or both could have been avoided and how future incidents could be avoided, and to plan for and implement positive and preventative supports. The debriefing process is intended to improve future outcomes by reducing the likelihood of future problem behavior and the subsequent use of physical restraint or seclusion.        "Mechanical restraint" means the use of a device as a means of restricting a student’s freedom of movement. “Mechanical restraint” does not mean a device used by trained school personnel, or used by a student, for the specific and approved therapeutic or safety purposes for which such a device was designed and, if applicable, prescribed, including restraints for medical immobilization, adaptive devices or mechanical supports used to allow greater freedom of mobility than would be possible without the use of such devices or mechanical supports, and vehicle safety restraints when used as intended during the transport of a student in a moving vehicle.        "Parent" means an individual included in the definition of “parent” in rule 281—41.30(256B,34CFR300), and also includes an individual authorized to make decisions for the child pursuant to a power of attorney for temporary delegation of custody or for making educational decisions.        "Physical restraint" means a personal restriction that immobilizes or reduces the ability of a child to move the child’s arms, legs, body, or head freely.         "Prone restraint" means any restraint in which the child is held face down on the floor.        "Reasonable and necessary force" is that force, and no more, which a reasonable person would judge to be necessary under the circumstances that existed at the time, that is not intended to cause pain, and that does not exceed the degree or duration required to accomplish the purposes set forth in rule 281—103.5(256B,280).        "School" includes public school districts, accredited nonpublic schools, and area education agencies.        "Seclusion" means the involuntary confinement of a child in a room or area from which the child is prevented or prohibited from leaving.         "Seclusion room" means a room, area, or enclosure, whether within or outside the classroom, used for seclusion.

    281—103.3(256B,280) Ban on corporal punishment and prone and mechanical restraints.  An employee shall not inflict, or cause to be inflicted, corporal punishment upon a student or use prone restraints or mechanical restraints upon a student.

    281—103.4(256B,280) Activities that are not considered corporal punishment.  Corporal punishment does not include the following:
    1. Verbal recrimination or chastisement directed toward a student;
    2. Reasonable requests or requirements of a student engaged in activities associated with physical education class or extracurricular athletics;
    3. Actions consistent with and included in an individualized education program (IEP) developed under the Individuals with Disabilities Education Act, as reauthorized, Iowa Code chapter 256B, and 281––Chapter 41, a behavior intervention plan (BIP), individual health plan (IHP), or safety plan; however, under no circumstance shall an IEP, BIP, IHP, or safety plan violate the provisions of this chapter;
    4. Reasonable periods of detention, not in excess of school hours, or brief periods of detention before or after school, in a seat, classroom, or other part of a school facility;
    5. Actions by an employee subject to these rules toward a person who is not a student of the school or receiving the services of a school employing or utilizing the services of the employee.

    281—103.5(256B,280) Use of reasonable and necessary force.      103.5(1)   Notwithstanding the ban on corporal punishment in rule 281—103.3(256B,280), no employee subject to these rules is prohibited from:    a.    Using reasonable and necessary force, not designed or intended to cause pain, in order to accomplish any of the following:    (1)   To quell a disturbance or prevent an act that threatens physical harm to any person.    (2)   To obtain possession of a weapon or other dangerous object within a student’s control.    (3)   For the purposes of self-defense or defense of others as provided for in Iowa Code section 704.3.    (4)   To remove a disruptive student from class or any area of the school’s premises or from school-sponsored activities off school premises.    (5)   To prevent a student from the self-infliction of harm.    (6)   To protect the safety of others.    (7)   To protect property as provided for in Iowa Code section 704.4 or 704.5.    b.    Using incidental, minor, or reasonable physical contact to maintain order and control.    103.5(2)   An employee subject to these rules is not privileged to use unreasonable force to accomplish any of the purposes listed above.

    281—103.6(256B,280) Reasonable force.      103.6(1)   In determining the reasonableness of the physical force used by a school employee, the following factors shall be applied:    a.    The size and physical, mental, and psychological condition of the student;    b.    The nature of the student’s behavior or misconduct provoking the use of physical force;    c.    The instrumentality used in applying the physical force;    d.    The extent and nature of resulting injury to the student, if any, including mental and psychological injury;    e.    The motivation of the school employee using the physical force.    103.6(2)   Reasonable physical force, privileged at its inception, does not lose its privileged status by reasons of an injury to the student, not reasonably foreseeable or otherwise caused by intervening acts of another, including the student.

    281—103.7(256B,280) Reasonable and necessary force—use of physical restraint or seclusion.      103.7(1)   Physical restraint or seclusion is reasonable and necessary only:    a.    To prevent or terminate an imminent threat of serious physical injury to the student or others; or     b.    To prevent serious damage to property of significant monetary value or significant nonmonetary value or importance, when the student’s actions seriously disrupt the learning environment, and when physical restraint or seclusion is necessary to ensure the safety of the student and others; and     c.    Less restrictive alternatives to seclusion or physical restraint would not be effective, would not be feasible under the circumstances, or have failed in preventing or terminating the imminent threat or behavior; and    d.    The physical restraint or seclusion complies with all the rules of this chapter.    103.7(2)   If seclusion or physical restraint is utilized, the following provisions shall apply:    a.    The seclusion or physical restraint must be imposed by an employee who:    (1)   Is trained in accordance with rule 281—103.8(256B,280); or    (2)   Is otherwise available and a trained employee is not immediately available due to the unforeseeable nature of the occurrence.    b.    A school must attempt to notify the student’s parent using the school’s emergency contact system upon both the commencement and conclusion of the seclusion or physical restraint.    c.    The seclusion or physical restraint must only be used for as long as is necessary, based on research and evidence, to allow the student to regain control of the student’s behavior to the point that the threat or behavior necessitating the use of the seclusion or physical restraint has ended. Unless otherwise provided for in the student’s written, approved IEP, BIP, IHP, or safety plan, if the seclusion or physical restraint continues for more than 15 minutes:    (1)   The student shall be provided with a break to attend to personal and bodily needs.     (2)   An employee shall obtain written approval from an administrator or administrator’s designee to continue the seclusion or physical restraint. An employee must obtain such written approval every 30 minutes thereafter for the continuation of the seclusion or physical restraint. Approval must be based on current evidence-based practices and standards and be documented in accordance with rule 281—103.8(256B,280).    (3)   The student’s parent must be notified every 30 minutes thereafter for as long as the seclusion or physical restraint continues unless the parent and the school agree to a different notification schedule for that occurrence.     (4)   Schools and employees must document and explain in writing the reasons why it was not possible for them to obtain written approval, notify parents, or take action under paragraphs 103.7(2)“b” and “c” within the prescribed time limits.     (5)   Schools and employees who initiate and then end the use of nonapproved restraints must document and explain in writing the reasons why they had no other option but to use this type of behavioral intervention. This subparagraph is not intended to excuse or condone the use of nonapproved restraints.    d.    The area of seclusion shall be a designated seclusion room that complies with the seclusion room requirements of rule 281—103.9(256B,280), unless the nature of the occurrence makes the use of the designated seclusion room impossible; in that event, the school must document and explain in writing the reasons why a designated seclusion room was not used.    e.    An employee must continually visually monitor the student for the duration of the seclusion or physical restraint.    f.    An employee shall not use any physical restraint that obstructs the airway of the student.    g.    If an employee restrains a student who uses sign language or an augmentative mode of communication as the student’s primary mode of communication, the student shall be permitted to have the student’s hands free of physical restraint, unless doing so is not feasible in view of the threat posed.    103.7(3)   An employee must document the use of the seclusion or physical restraint in accordance with rule 281—103.8(256B,280).    103.7(4)   Nothing in this rule shall be construed as limiting or eliminating any immunity conferred by Iowa Code section 280.21 or any other provision of law.    103.7(5)   An agency covered by this chapter shall investigate any complaint or allegation that one or more of its employees violated one or more provisions of this chapter. If an agency covered by this chapter determines that one or more of its employees violated one or more of the provisions of this chapter, the agency shall take appropriate corrective action. If any allegation involves a specific student, the agency shall transmit to the parents of the student the results of its investigation, including, to the extent permitted by law, any required corrective action.    103.7(6)   If a child’s IEP, BIP, IHP, or safety plan includes either or both physical restraint or seclusion measures, those measures must be individualized to the child; described with specificity in the child’s IEP, BIP, IHP, or safety plan; and be reasonably calculated to enable the child to make progress appropriate in light of the child’s circumstances.    103.7(7)   These rules must be complied with whether or not a parent consents to the use of physical restraint or seclusion for the child.    103.7(8)   If any alleged violation of this chapter is also an allegation of “abuse” as defined in rule 281—102.2(280), the procedures in 281—Chapter 102 shall be applicable.    103.7(9)   Schools must provide a copy of Chapter 103 and its related policies, procedures and training materials to any individual who is not an employee but whose duties could require the individual to participate in or be present when physical restraints or seclusion are being used. Schools must invite these individuals to participate in training offered to employees pursuant to this chapter.

    281—103.8(256B,280) Training, documentation, debriefing, and reporting requirements.      103.8(1)   Training. An employee must receive training prior to using any form of physical restraint or seclusion. Training shall cover the following topics:    a.    The rules of this chapter;    b.    The school’s specific policies and procedures regarding the rules of this chapter;    c.    Student and staff debriefing requirements;    d.    Positive behavior interventions and supports;    e.    Research-based disciplinary alternatives to physical restraint and seclusion;    f.    Crisis prevention, crisis intervention, and crisis de-escalation techniques;     g.    Duties and responsibilities of school resource officers and other responders, and the techniques, strategies and procedures used by responders; and    h.    Safe and effective use of physical restraint and seclusion.    103.8(2)   Documentation and reporting. Schools must maintain documentation for each occurrence of physical restraint and seclusion. An employee who implemented or observed the use of physical restraint or seclusion must complete a written report that must contain at least the following information:    a.    The name of the student;    b.    The names and job titles of employees who observed, implemented, or were involved in administering or monitoring the use of seclusion or physical restraints, including the administrator or individual who approved continuation of the seclusion or physical restraint pursuant to subparagraph 103.7(2)“c”(2);    c.    The date of the occurrence;    d.    The beginning and ending times of the occurrence;    e.    The date the employees who observed, implemented, or were involved in administering or monitoring the use of seclusion or physical restraints last completed training required by subrule 103.8(1);    f.    A description of the actions of the student before, during, and after the seclusion or physical restraint;    g.    A description of the actions of the employee(s) involved before, during, and after the seclusion or physical restraint;    h.    Copies of all written approvals for continuation of the seclusion or physical restraint period generated in accordance with subrule 103.7(2);    i.    A description of the less restrictive means attempted as alternatives to seclusion or physical restraint;    j.    A description of any injuries, whether to the student or others, and any property damage;    k.    A description of future approaches to address the student’s behavior, including any consequences or disciplinary actions that may be imposed on the student; and    l.    The time and manner by which the school notified the student’s parent of the use of physical restraint or seclusion.Schools must provide the student’s parent with a written copy of the report by the end of the next school day following the occurrence. The report shall be accompanied by a letter inviting the parent to participate in a debriefing meeting to be held within five school days of the day the report and letter are mailed to or provided to the parent. The letter must include the date, time and place of the meeting and the name and title of employees and other individuals who will attend the meeting. The parent may elect to receive the report and the letter via electronic mail or facsimile or by obtaining a copy at the school. If the parent does not provide instructions to the school or enter into an agreement with the school for alternate dates and methods of delivery, the school must mail the letter and report to the parent by first-class mail, postage prepaid, postmarked by end of the next school day after the occurrence.     103.8(3)   Debriefing. Schools must hold a debriefing meeting as soon as practicable, but within five school days of the day the report and letter are mailed or provided to the parent, unless a parent who wants to participate personally or through a representative asks for an extension of time, or the parent and school agree to an alternate date and time. The student may attend the meeting with the parent’s consent. The parent may elect to be accompanied by other individuals or representatives. The meeting must include employees who administered the physical restraint or seclusion, an administrator or employee who was not involved in the occurrence, the individual or administrator who approved continuation of the physical restraint or seclusion, and other relevant personnel designated by the school (such as principal, counselor, classroom teacher, special education teacher). The meeting, and the debriefing report that is to be provided to the parent after the meeting, must include the following information and subjects:    a.    The date and location of the meeting, and the names and titles of the participants;    b.    The documentation and report completed in compliance with subrule 103.8(2);     c.    A review of the student’s BIP, IHP, safety plan, and IEP as applicable;     d.    Identification of patterns of behavior and proportionate response, if any, in the student and the employees involved;    e.    Determination of possible alternative responses to the incident/less restrictive means, if any;    f.    Identification of additional resources that could facilitate those alternative responses in the future;    g.    Planning for follow-up actions, such as behavior assessments, revisions of school intervention plans, medical consultations, and reintroduction plans.Schools must complete the debriefing report and provide a copy of the report to the parent of the student within three school days of the debriefing meeting. The parent may elect to receive the report via electronic mail, or facsimile, or by obtaining a copy at the school. If the parent does not provide instructions to the school or enter into an agreement with the school for alternate dates and methods of delivery, the school must mail the debriefing report to the parent by first-class mail, postage prepaid, postmarked no later than three schools days after the debriefing meeting.    103.8(4)   When a student exhibits a pattern of behavior that results in multiple instances of physical restraint or seclusion in the same school year, the school must convene a meeting consisting of employees designated by the school, the student’s parent(s), and an expert in behavioral health, mental health, or another appropriate discipline for the purposes of evaluating the causes of the student’s behavior, reviewing and revising the student’s BIP, IHP, IEP, safety plan, or behavioral plan or developing a plan for the student if none exists, and ensuring the provision of any necessary behavioral supports in order to improve the student’s safety and continued access to education.     103.8(5)   Schools must comply with the requirements of the Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99), Iowa Code chapter 22, “Examination of Public Records” (Open Records), and other applicable federal and state laws, when taking action pursuant to this rule.

    281—103.9(256B,280) Seclusion room requirements.  Schools must meet the following standards for the structural and physical requirements for rooms used for seclusion:    103.9(1)   The room must meet and comply with all applicable building, fire, safety, and health codes and standards and with the other requirements of this rule.     103.9(2)   The dimensions of the room shall be of adequate width, length, and height to allow the student to move about and recline safely and comfortably, considering the age, size, and physical and mental condition of the student being secluded. The interior of the room must be no less than 70 square feet, and the distance between opposing walls must be no less than 7 feet across.    103.9(3)   The room must not be isolated from school employees or the facility.    103.9(4)   Any wall that is part of the room must be part of the structural integrity of the room (not free-standing cells or portable units attached to the existing wall or floor).    103.9(5)   The room must provide a means of continuous visual and auditory monitoring of the student.    103.9(6)   The room must be adequately lighted with switches to control lighting located outside the room.    103.9(7)   The room must be adequately ventilated with switches to control fans or other ventilation devices located outside the room.    103.9(8)   The room must maintain a temperature within the normal human comfort range and consistent with the rest of the building with temperature controls located outside of the room.    103.9(9)   The room must be clean and free of objects and fixtures that could be potentially dangerous to a student, including protruding, exposed, or sharp objects, exposed pipes, electrical wiring, or other objects in the room that could be used by students to harm themselves or to climb up a wall.    103.9(10)   The room must contain no free-standing furniture.    103.9(11)   The room must be constructed of materials safe for its intended use, including wall and floor coverings designed to prevent injury to the student. Interior finish of the seclusion room shall comply with the state and local building and fire codes and standards.     103.9(12)   Doors must open outward. The door shall not be fitted with a lock unless it releases automatically when not physically held in the locked position by personnel on the outside of the door and permits the door to be opened from the inside. Doors, when fully open, shall not reduce the required corridor width by more than 7 inches. Doors in any position shall not reduce the required width by more than one-half.    103.9(13)   The room must be able to be opened from the inside immediately upon the release of a security mechanism held in place by constant human contact.    103.9(14)   Windows must be transparent and made of unbreakable or shatterproof glass or plastic.     103.9(15)   Schools must consult with appropriate state and local building, fire, safety, and health officials to ensure the room complies with all applicable codes and standards (for example, heating, ventilation, lighting, accessibility, dimensions, access, entry, and exit, fire suppression, etc.) prior to its use.       These rules are intended to implement Iowa Code section 280.21.    ARC 4278CEnergy and Geological Resources Division[565]Notice of Intended Action

    Proposing rule making related to transfer of geological programs and providing an opportunity for public comment

        The Department of Natural Resources (Department) hereby proposes to rescind Chapter 50, “General,” and Chapter 51, “Oil, Gas, and Metallic Minerals,” Iowa Administrative Code.Legal Authority for Rule Making    This rule making is proposed under the authority provided in Iowa Code section 458A.11.State or Federal Law Implemented    This rule making implements, in whole or in part, Iowa Code chapter 458A.Purpose and Summary    This proposed rule making is necessary to conform Department rules with 2018 Iowa Acts, House File 2303, signed by Governor Reynolds on March 21, 2018. House File 2303 transferred the State Geologist and the Iowa Geological Survey to the University of Iowa. Therefore, existing Chapter 50 needs to be rescinded since that chapter applies to the Iowa Geological Survey. Chapter 51 is also being proposed for rescission. The content of Chapter 51, oil, gas, and mineral drilling, can be moved into the Department’s main administrative rules location: agency identification number 561. Therefore, Chapter 51 is being proposed for rescission and a new 561—Chapter 17 is being created in a companion rule making (ARC 4279C, IAB 2/13/19). The proposed rule making creating 561—Chapter 17 makes no substantive changes from Chapter 51, with the exception of replacing references to the State Geologist in Chapter 51 with references to the Director of the Department and making other minor clarifying revisions to the chapter consistent with 2018 Iowa Acts, House File 2303.    This rule making is related to Natural Resources Department[561] rule making ARC 4279C, IAB 2/13/19, and Environmental Protection Commission[567] rule making ARC 4277C, IAB 2/13/19.Fiscal Impact     This rule making has no fiscal impact to the State of Iowa. A copy of the impact statement is available upon request from the Department. Jobs Impact    After analysis and review of this rule making, no impact on jobs has been found. A copy of the jobs impact statement is available from the Department upon request.Waivers    This rule making is subject to the waiver provisions of 561—Chapter 10. Any person who believes that the application of the discretionary provisions of this rule making would result in hardship or injustice to that person may petition the Department for a waiver of the discretionary provisions, if any. Public Comment     Any interested person may submit written comments concerning this proposed rule making. Written comments in response to this rule making must be received by the Department no later than 4:30 p.m. on March 5, 2019. Comments should be directed to: David Scott Iowa Department of Natural Resources Wallace State Office Building 502 East Ninth Street Des Moines, Iowa 50319 Phone: 515.725.8239 Email: david.scott@dnr.iowa.govPublic Hearing     A public hearing at which persons may present their views orally or in writing will be held as follows. Upon arrival, attendees should proceed to the fourth floor to check in at the Department reception desk to sign in and be directed to the appropriate hearing location. March 5, 2019 10 a.m. to 12 noon Conference Room 4 West Wallace State Office Building Des Moines, Iowa     Persons who wish to make oral comments at the public hearing will be asked to state their names for the record and to confine their remarks to the subject of this proposed rule making.     Any persons who intend to attend the public hearing and have special requirements, such as those related to hearing or mobility impairments, should contact the Department and advise of specific needs. Review by Administrative Rules Review Committee    The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making at its regular monthly meeting or at a special meeting. The Committee’s meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).    The following rule-making actions are proposed:

        ITEM 1.    Rescind and reserve 565—Chapter 50.

        ITEM 2.    Rescind and reserve 565—Chapter 51.    ARC 4277CEnvironmental Protection Commission[567]Notice of Intended Action

    Proposing rule making related to geological survey, small fish animal unit, and land recycling program and providing an opportunity for public comment

        The Environmental Protection Commission (Commission) hereby proposes to amend Chapter 50, “Scope of Division—Definitions—Forms—Rules of Practice,” Chapter 51, “Water Permit or Registration—When Required,” Chapter 52, “Criteria and Conditions for Authorizing Withdrawal, Diversion and Storage of Water,” Chapter 53, “Protected Water Sources—Purposes—Designation Procedures—Information in Withdrawal Applications—Limitations—List of Protected Sources,” Chapter 65, “Animal Feeding Operations,” Chapter 72, “Criteria for Approval,” Chapter 82, “Well Contractor Certification,” and Chapter 137, “Iowa Land Recycling Program and Response Action Standards,” Iowa Administrative Code.Legal Authority for Rule Making    This rule making is proposed under the authority provided in Iowa Code sections 455B.173, 455B.263, 455H.105 and 459.103.State or Federal Law Implemented    This rule making implements, in whole or in part, Iowa Code sections 455B.173, 455B.263, 455H.107 and 459.102.Purpose and Summary    2018 Iowa Acts, House File 2303: Transfer of State Geologist and Iowa Geological Survey to the University of Iowa. The proposed amendments are being made in order to conform Chapters 50 to 53, 72, and 82 with 2018 Iowa Acts, House File 2303, signed by Governor Reynolds on March 21, 2018. House File 2303 transferred the State Geologist and the Iowa Geological Survey to the University of Iowa. Prior to the enactment of this legislation, the State Geologist was employed by, and the Iowa Geological Survey was contained within, the Department of Natural Resources (Department). There are multiple references to the Iowa Geological Survey that need to be updated to clarify that the Iowa Geological Survey is no longer part of the Department. As such, this proposed rule making amends Chapters 50 to 53, 72, and 82.    2018 Iowa Acts, House File 2281: Addition of animal unit for small fish. The proposed amendments are being made in order to conform Chapter 65 with amendments from 2018 Iowa Acts, House File 2281, signed by Governor Reynolds on April 4, 2018. House File 2281 added an animal unit capacity for fish weighing less than 25 grams to the definitions in the animal feeding operation statute, and this proposed rule making amends the definitions in Chapter 65 to make the same change.    2018 Iowa Acts, House File 2464: An increase in the reimbursement cap for the Land Recycling Program (LRP). The proposed amendments are being made in order to conform Chapter 137 with amendments from 2018 Iowa Acts, House File 2464, signed by Governor Reynolds on April 10, 2018. House File 2464 amended the Iowa Code chapter related to the LRP, Iowa Code chapter 455H. The General Assembly created the LRP in 1997 with a goal to promote the voluntary investigation and cleanup of contaminated sites under a cooperative, regulatory-friendly framework. Voluntary cleanups reduce risk to human health and the environment while working to remove the stigma attached to contaminated sites. Incentives for voluntary participation include Department verification of site assessment and cleanup plans, as well as state “sign-off” on site cleanup completion, known as a No Further Action Certificate (Certificate).    All LRP participants must enter into an agreement with the Department for reimbursement of costs incurred by the Department for oversight review associated with enrollment of the site. Prior to the enactment of House File 2464, reimbursement to the Department was capped at $7,500 per site. For sites that have received a Certificate, participant reimbursements covered 70 percent of oversight costs and other funding sources were used to subsidize a participant’s costs that exceeded $7,500. However, those funding sources have become increasingly overburdened. To encourage continued use of the LRP, it was determined that the $7,500 reimbursement cap needed to be increased. House File 2464 increased the cap to $25,000 for new sites enrolled in the program on or after July 1, 2018. This proposed rule making implements this change from House File 2464.Fiscal Impact     This rule making has no fiscal impact to the State of Iowa. A copy of the fiscal impact statement is available from the Department upon request. Jobs Impact    After analysis and review of this rule making, no impact on jobs has been found. A copy of the jobs impact statement is available from the Department upon request. Waivers    Any person who believes that the application of the discretionary provisions of this rule making would result in hardship or injustice to that person may petition the Department for a waiver of the discretionary provisions, if any, pursuant to 561—Chapter 10. Public Comment     Any interested person may submit written comments concerning this proposed rule making. Written comments in response to this rule making must be received by the Department no later than 4:30 p.m. on March 5, 2019. Comments should be directed to: Kelli Book Iowa Department of Natural Resources Wallace State Office Building 502 East Ninth Street, Fourth Floor Des Moines, Iowa 50319 Email: kelli.book@dnr.iowa.govPublic Hearing     A public hearing at which persons may present their views orally or in writing will be held as follows. Upon arrival, attendees should proceed to the fourth floor to check in at the Department reception desk to sign in and be directed to the appropriate hearing location. March 5, 2019 10 a.m. to 12 noon Conference Room 4 West Wallace State Office Building Des Moines, Iowa     Persons who wish to make oral comments at the public hearing will be asked to state their names for the record and to confine their remarks to the subject of this proposed rule making.     Any persons who intend to attend the public hearing and have special requirements, such as those related to hearing or mobility impairments, should contact the Department and advise of specific needs. Review by Administrative Rules Review Committee    The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making at its regular monthly meeting or at a special meeting. The Committee’s meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).    The following rule-making actions are proposed:

        ITEM 1.    Amend subparagraph 50.6(1)"a" as follows:    (1)   Test drilling. In cases where test drilling is needed for geological information relevant to the application, the applicant is responsible for employing a driller who will collect, bag and properly label cutting samples at each five-foot interval and at each apparent change in geological formation from a test hole or production well hole at least the approximate depth of the proposed production well. The cutting samples must be saved for collection by the department in sample bags provided by the department’s Iowa geological survey (IGS). The samples shall besubmitted to IGS and be accompanied by a driller’s log showing the location and total depth of the hole and a description of the materials encountered at successive intervals.

        ITEM 2.    Amend subrule 51.6(3) as follows:    51.6(3) Test pumping.  The department may authorize by registration, as described in 51.6(5), test pumping of sources of water to determine adequacy of the source and effects of such withdrawals. The department may require the applicant to conduct the test pumping under the supervision of or acquire technical assistance from the department’s Iowa geological survey (IGS) or its designeesubmit the results to the department. No such registration for test pumping shall be for a period of more than one year. A registration must be obtained from the department for any pumping test in which more than 25,000 gallons of water will be withdrawn in a period of 24 hours or less.

        ITEM 3.    Amend subrule 51.6(6) as follows:    51.6(6) Research contracts.  The withdrawal of water for research purposes by the department’s IGSIowa geological survey through its agents, employees, or contractees may be authorized by registration under 51.6(5) and may be subject to conditions set by the department.

        ITEM 4.    Amend paragraphs 52.4(4)"b" and 52.4(4)"c" as follows:    b.    Observation wells.In addition to the requirement of 52.6(3) for construction of an access port to allow measurement of water levels in each production well, an applicant or permittee may also be required to construct, maintain, and monitor observation wells as a condition of obtaining or keeping a water permit if the department, after consultation with the department’s IGS, finds observation wells necessary to monitor the effects of the proposed or authorized withdrawals of water. Observation wells must be properly constructed and responsive to water level fluctuations in the aquifer. Plans for and monitoring of the observation wells must be approved by the department.    c.    Prohibition of excessive water level declines.If the department, after consultation with the department’s IGS, determines that withdrawals of water from the Dakota Sandstone formation of the Cretaceous system within a designated geographical area are causing water level declines which constitute a significant threat to the public interest in the availability of water for sustained beneficial use of the aquifer, renewals of permits shall be denied, and permits shall be modified or canceled in accordance with procedures in Iowa Code section 455B.271, as necessary to protect the aquifer for sustained use.

        ITEM 5.    Amend subrule 52.6(4) as follows:    52.6(4) Aquifer tests and observation wells.  A permittee may be required to conduct a controlled aquifer test as a condition of keeping a water permit if the department, after consultation with the department’s IGS, finds an aquifer test to be necessary to determine the effects which the authorized withdrawals have on other water uses. A controlled aquifer test, authorized by the department and supervised by a certified well contractor, licensed professional engineer or other designee of the department, may be required for an administrative resolution of a well interference conflict pursuant to 567—Chapter 54. The permittee may be required to construct, develop, and maintain adequate observation wells for use in an aquifer test and for subsequent water level measurements or water quality monitoring.

        ITEM 6.    Amend rule 567—53.2(455B), introductory paragraph, as follows:

    567—53.2(455B) Designation of protected sources.  The department, after consultation with the department’s Iowa geological survey (IGS) and other authorities, may designate a surface water or groundwater source within a defined geographical area as a protected source.

        ITEM 7.    Amend subrule 53.7(1) as follows:    53.7(1) Ralston Site, Linn County.  The area within a one-mile radius of a point which is 600 feet south of the midpoint of the northern edge of Section 2, Township 83 North, Range 7 West in Linn County is a protected water source. Any new application for a permit to withdraw groundwater or to increase an existing permitted withdrawal of groundwater from within the protected water source area will be restricted or denied, if necessary to preserve public health and welfare or to minimize movement of groundwater contaminants from the Ralston Site. The Ralston Site is identified in the Registry of Hazardous Waste or Hazardous Substance Disposal Sites pursuant to Iowa Code section 455B.426.Withdrawal of groundwater from within the protected water source area may also be restricted or denied from what would otherwise be nonregulated wells, if necessary to preserve public health and welfare or to minimize movement of groundwater contaminants from the Ralston Site. The Linn County health department will refer any application for a construction permit for a private well within the protected water source area to the department’s water supply section that will, after consultation with the department’s IGS, determine whether the proposed well will be allowed.

        ITEM 8.    Amend subrule 65.1(1), definition of “Animal unit,” as follows:        "Animal unit" means a unit of measurement based upon the product of multiplying the number of animals of each category by a special equivalency factor, as follows: 1. Slaughter and feeder cattle 1.000 2. Immature dairy cattle 1.000 3. Mature dairy cattle 1.400 4. Butcher or breeding swine weighing more than 55 pounds 0.400 5. Swine weighing 15 pounds or more but not more than 55 pounds 0.100 6. Sheep or lambs 0.100 7. Goats 0.100 8. Horses 2.000 9. Turkeys weighing 7 pounds or more 0.018 10. Turkeys weighing less than 7 pounds 0.0085 11. Broiler or layer chickens weighing 3 pounds or more 0.010 12. Broiler or layer chickens weighing less than 3 pounds 0.0025 13. Ducks 0.040 14. Fishweighing 25 grams or more 0.001 15. Fish weighing less than 25 grams 0.00006

        ITEM 9.    Amend paragraph 72.51(4)"c" as follows:    c.    Interested agency notification.Notify regional planning commissions, county boards of supervisors, city councils, soil conservation districts through which the nominated stream runs, the fish and wildlife divisionbureaus of the department, the soil conservation division of the department of agriculture and land stewardship, the department of agriculture and land stewardship and theIowa geological survey bureau of the department.

        ITEM 10.    Amend paragraph 72.51(5)"c" as follows:    c.    Interagency coordination.Invite the fish and wildlife divisionbureaus of the department, theIowa geological survey bureau, and any other agency or governmental subdivision expressing an interest in the proceeding to participate in the field investigation and preparation of the report, and request their assessment of whether extension of department jurisdiction over the nominated stream would have either an adverse or beneficial impact on their agency’s water resource programs.

        ITEM 11.    Amend subrule 82.12(1) as follows:    82.12(1) Submission of records and samples.  Each certified well contractor shall submit drilling records and drill cutting samples, when required, to the Iowa Geological Survey, Department of Natural Resources, Oakdale Campus, University of Iowa, Iowa City, Iowa 52242, telephone (319)338-1575, or as otherwise directed by the department,department and to the Iowa geological survey as follows:    a.    Within 30 days of completion of any water well used as part of a public water supply, a well used for withdrawal of water for which a permit is required by rule 567—50.1(455B), or wells used to monitor groundwater quantity or quality required by the department if so directed by the Iowa geological survey (IGS), department of natural resourcesdepartment. The certified well contractor must submitto the department the drilling records and samples required by subrules 82.12(2) and 82.12(3)and must submit to the Iowa geological survey the samples required by subrule 82.12(4).    b.    Within 30 days of the completion of any water well used as part of a nonpublic water supply or other water wells used to access groundwater. The certified well contractor must submitto the department the drilling records and samples required by subrules 82.12(2) and 82.12(3).    c.    Prior to constructing a water well to be used as part of a nonpublic water supply or other water well used to access groundwater, the certified well contractor must contact the local health department in the county in which the water well is to be located to determine if submittal of drill cutting samples is required.

        ITEM 12.    Amend subrule 82.12(2) as follows:    82.12(2) Drilling records.  Drilling records must be submitted on theIowa water well driller’s log form provided by the Iowa geological survey, department of natural resourcesavailable on the department’s website.

        ITEM 13.    Amend subrule 82.12(4) as follows:    82.12(4) Cutting samples.  Drill cutting samples shall be collected at intervals of 5 feet and at each pronounced change in geological formation. The Iowa geological survey, department of natural resources, will provide drill cutting bags.

        ITEM 14.    Amend subrule 137.3(3), introductory paragraph, as follows:    137.3(3) Enrollment fees and oversight costs.  A nonrefundable enrollment fee of $750 must be submitted with the program application. This fee is intended to cover the department’s cost of reviewing the program application and a minimum amount of subsequent oversight costs. Subsequent fees in excess of the minimum $750 may be assessed for actual oversight costs incurred by the department as provided in this chapter. Department oversight activities may include, but are not limited to: review of documents, meetings with the participant(s), site visits, sampling, and laboratory costs related to verification of submitted materials. The total fees for oversight costs shall not exceed $7,500 per enrolled siteenrolled prior to July 1, 2018. For sites enrolled on or after July 1, 2018, the fee shall not exceed $25,000 per enrolled site. Fees shall be assessed and collected as follows:    ARC 4287CHuman Services Department[441]Notice of Intended Action

    Proposing rule making related to assessment levels for nursing facilities and providing an opportunity for public comment

        The Human Services Department hereby proposes to amend Chapter 36, “Facility Assessments,” and Chapter 81, “Nursing Facilities,” Iowa Administrative Code.Legal Authority for Rule Making    This rule making is proposed under the authority provided in Iowa Code section 249A.4 and 2018 Iowa Acts, Senate File 2418.State or Federal Law Implemented    This rule making implements, in whole or in part, Iowa Code section 249A.4 and 2018 Iowa Acts, Senate File 2418.Purpose and Summary    These proposed amendments change the assessment levels for nursing facilities effective July 1, 2019.  The assessment level cap was removed during the 2018 Legislative Session by 2018 Iowa Acts, Senate File 2418.  The Department, in collaboration with stakeholders, developed new assessment levels and requested an effective date of July 1, 2019.  Fiscal Impact    This rule making has a fiscal impact to the State of Iowa of $100,000 annually or $500,000 over five years. Assumptions for this fiscal impact include:

  • Annual non-Medicare revenue: $1,499,417,079
  • Non-Medicare patient days: 7,016,276
  • Estimates were based on changes expected for state fiscal year (SFY) 2020 and not on current revenue levels.
    •     A model was developed to estimate the impact of this change. Based on this model, it is estimated that annual assessment fee revenues will increase from $32,726,360 under the current policy to $58,570,397 under the proposed policy, an increase of $25,844,037. These expenditures will be 100 percent state funds. Jobs Impact    After analysis and review of this rule making, no impact on jobs has been found.Waivers    Any person who believes that the application of the discretionary provisions of this rule making would result in hardship or injustice to that person may petition the Department for a waiver of the discretionary provisions, if any, pursuant to rule 441—1.8(17A,217). Public Comment     Any interested person may submit written comments concerning this proposed rule making. Written comments in response to this rule making must be received by the Department no later than 4:30 p.m. on March 5, 2019. Comments should be directed to: Harry Rossander Bureau of Policy Coordination Department of Human Services Hoover State Office Building, Fifth Floor 1305 East Walnut Street Des Moines, Iowa 50319-0114 Email: policyanalysis@dhs.state.ia.usPublic Hearing     No public hearing is scheduled at this time. As provided in Iowa Code section 17A.4(1)“b,” an oral presentation regarding this rule making may be demanded by 25 interested persons, a governmental subdivision, the Administrative Rules Review Committee, an agency, or an association having 25 or more members. Review by Administrative Rules Review Committee    The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making at its regular monthly meeting or at a special meeting. The Committee’s meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).    The following rule-making actions are proposed:

        ITEM 1.    Amend subrule 36.6(2) as follows:    36.6(2) Assessment level.  Effective July 1, 2012, the assessment level for each nursing facility shall be determined on an annual basis and shall be effective for the state fiscal year.    a.    Effective July 1, 20152019, nursing facilities with 46 or fewer licensed beds are required to pay a quality assurance assessment of $1.36$2.45 per non-Medicare patient day. Effective with assessment for the state fiscal year beginning July 1, 2012, the number of licensed beds on file with the department of inspections and appeals as of May 1 of each year shall be used to determine the assessment level for the following state fiscal year.    b.    Effective July 1, 20152019, nursing facilities designated as continuing care retirement centers (CCRCs) by the insurance division of the Iowa department of commerce are required to pay a quality assurance assessment of $1.36$2.45 per non-Medicare patient day. Effective with assessment for the state fiscal year beginning July 1, 2012, continuing care retirement center designations as of May 1 of each year shall be used to determine the assessment level for the following state fiscal year.    c.    Effective July 1, 20152019, nursing facilities with annual Iowa Medicaid patient days of 26,50021,000 or more are required to pay a quality assurance assessment of $1.36$2.45 per non-Medicare patient day. Effective with assessment for the state fiscal year beginning July 1, 2012, the annual number of Iowa Medicaid patient days reported in the most current cost report submitted to the Iowa Medicaid enterprise as of May 1 of each year shall be used to determine the assessment level for the following state fiscal year.    d.    Effective July 1, 20152019, all other nursing facilities are required to pay a quality assurance assessment of $7.13$12.75 per non-Medicare patient day.

        ITEM 2.    Amend paragraph 81.6(21)"b" as follows:    b.    Quality assurance assessment rate add-on.Effective with the implementation of the quality assurance assessment paid pursuant to 441—Chapter 36, Division II, a quality assurance add-on of $10$15 per patient day shall be added to the Medicaid per diem reimbursement rate as otherwise calculated pursuant to this rule.    ARC 4289CHuman Services Department[441]Notice of Intended Action

    Proposing rule making related to a passive managed care enrollment process and providing an opportunity for public comment

        The Human Services Department hereby proposes to amend Chapter 73, “Managed Care,” Iowa Administrative Code.Legal Authority for Rule Making    This rule making is proposed under the authority provided in Iowa Code section 249A.4.State or Federal Law Implemented    This rule making implements, in whole or in part, Iowa Code section 249A.4.Purpose and Summary    These proposed amendments revise language to reflect the Department’s implementation of a passive managed care enrollment process. For Medicaid eligibility groups subject to mandatory managed care enrollment, members will be passively enrolled with a managed care plan no earlier than the first day of the month of the member’s application to Medicaid, with no initial fee-for-service (FFS) period. Additionally, outdated language is being removed in order to appropriately reflect the responsibility that managed care organizations (MCOs) have for retroactive eligibility periods.Fiscal Impact     This rule making has a fiscal impact to the State of Iowa of less than $100,000 annually or $500,000 over five years. The Medicaid actuary has communicated that no material fiscal impact is anticipated. The cost would be shifted from FFS claims payments to MCO cap payments. Theoretically, in the aggregate, there should not be a substantial difference in the cost. However, home- and community-based services (HCBS) members would not have received any HCBS services for that first one to two months (or longer). With passive managed care enrollment, the MCO will immediately receive the HCBS cap rate, so in those instances the MCO may perhaps receive a higher payment than would have otherwise been paid out in FFS. There will be a capitation payment sooner for HCBS members, but member expenditures are typically less while awaiting MCO assignment, which will be reflected in capitation rate development (increasing member months with a small decrease in expenditures evens out any difference). Jobs Impact    After analysis and review of this rule making, no impact on jobs has been found.Waivers    Any person who believes that the application of the discretionary provisions of this rule making would result in hardship or injustice to that person may petition the Department for a waiver of the discretionary provisions, if any, pursuant to rule 441—1.8(17A,217). Public Comment     Any interested person may submit written comments concerning this proposed rule making. Written comments in response to this rule making must be received by the Department no later than 4:30 p.m. on March 5, 2019. Comments should be directed to: Harry Rossander Bureau of Policy Coordination Department of Human Services Hoover State Office Building, Fifth Floor 1305 East Walnut Street Des Moines, Iowa 50319-0114 Email: policyanalysis@dhs.state.ia.usPublic Hearing     No public hearing is scheduled at this time. As provided in Iowa Code section 17A.4(1)“b,” an oral presentation regarding this rule making may be demanded by 25 interested persons, a governmental subdivision, the Administrative Rules Review Committee, an agency, or an association having 25 or more members. Review by Administrative Rules Review Committee    The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making at its regular monthly meeting or at a special meeting. The Committee’s meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).    The following rule-making actions are proposed:

        ITEM 1.    Adopt the following new definition of “Passive enrollment process” in rule 441—73.1(249A):        "Passive enrollment process" means the process by which the department assigns a member to a managed care organization and which, in accordance with 42 CFR 438.54, seeks to preserve existing provider-member relationships and relationships with providers that have traditionally served Medicaid members, if possible. In the absence of existing relationships, the process ensures that members are equally distributed among all available managed care organizations.

        ITEM 2.    Amend rule 441—73.3(249A) as follows:

    441—73.3(249A) Enrollment.      73.3(1) Enrollment area.  The coverage area for enrollment shall be statewide.    73.3(2) Members subject to enrollment.  All HAWK-I program and Iowa Health and Wellness Plan members shall be subject to mandatory enrollment in a managed care organization. All Medicaid members, with the exception of the following, shall be subject to mandatory enrollment in a managed care organization:     a.    Members who are medically needy as defined at 441—subrule 75.1(35).    b.    Individuals eligible only for emergency medical services because the individuals do not meet citizenship or alienage requirements, pursuant to 441—subrule 75.11(4).    c.    Persons who are currently presumptively eligible as defined in 441—subrules 75.1(30), 75.1(40), and 75.1(44).    d.    Persons eligible for the program of all-inclusive care for the elderly (PACE) who voluntarily elect PACE coverage as defined in 441—subrule 88.24(1).    e.    Persons enrolled in the health insurance premium payment program (HIPP) pursuant to rule 441—75.21(249A).     f.    Persons eligible only for the Medicare savings program as defined in rules 441—75.1(249A) and 441—76.1(249A).    g.    American Indian and Alaska Native populations who are exempt from mandatory enrollment pursuant to 42 CFR 438.50(d)(2) but who may enroll voluntarily.    73.3(3) Enrollment process.  The department shall notify members who must be enrolled in a managed care organization of enrollment and the effective date of enrollment. The department will implement an enrollment process in accordance with federal funding requirements, including 42 CFR 438 as amended to October 16, 2015May 6, 2016.    a.    General.Members may receive managed care organization choice counseling from the enrollment broker. The enrollment broker will provide information about individual managed care organization benefit structures, services and network providers, as well as information about other Medicaid programs as requested by the Medicaid member to assist the member in making an informed selection.    b.    TentativePassive assignment.MembersEffective no earlier than the first day of the month of the member’s application to Medicaid, the member shall be tentatively assigned to a managed care organizationusing the department’s passive enrollment process and offered the opportunity to choose from the available managed care organizations within a time frame specified in the tentativepassive assignment letter.    c.    Request to change enrollment.An enrollee may, within 90 days of initial enrollment, request to change enrollment from one managed care organization and enroll in another managed care organization. The request may be made on a form designated by the department, in writing, or by telephone call to the enrollment broker’s toll-free member telephone line. Enrollment changes are effective no later than the first day of the second month beginning after the date on which the enrollment broker receives the enrollee’s written or verbal request.    (1)   A member shall have a minimum of ten days from the date of the tentative assignment letter to request enrollment with a different managed care organization. The request may be made on a form designated by the department, in writing, or by telephone call to the enrollment broker’s toll-free member telephone line. Changes are subject to the effective date provisions of subrule 73.3(4).    (2)   An enrollee may, within 90 days of initial enrollment, request to change enrollment from one managed care organization and enroll in another managed care organization. The request may be made on a form designated by the department, in writing, or by telephone call to the enrollment broker’s toll-free member telephone line. Changes are subject to the effective date provisions of subrule 73.3(4).    d.    Ongoing enrollment.Enrollees shall remain enrolled with the chosen managed care organization for a total of 12 months.    e.    Enrollment cycle.Prior to the end of the enrollee’s annual enrollment period, the enrollee shall be notified of the option to maintain enrollment with the current managed care organization or to enroll with a different managed care organization.    73.3(4) Effective date of enrollment.  The effective date of enrollment shall be no later than the first day of the second month beginning after the date on which the managed care organization receives the designated managed health care choice form or written or verbal request.     73.(5) 73.3(4) Benefit reimbursement prior to enrollment.      a.    Prior to the effective date of managed care enrollment, except as provided in paragraph 73.3(5)“b,”73.3(4)“b,” the Medicaid program shall reimburse providers for covered program benefits pursuant to 441—Chapters 74 to 91, as applicable for eligible members.    b.    The managed care organization shall be responsible for covering newly retroactive Medicaid eligibility periods, prior to the effective date of enrollment, in the following cases:(1)   Babiesfor babies born to Medicaid-enrolled women who are retroactively eligible to the month of birth; and.    (2)   Children enrolled in the HAWK-I program retroactive to the date of application. For purposes of this requirement, a retroactive Medicaid eligibility period is defined as a period of time up to three months prior to the Medicaid determination month.    ARC 4288CHuman Services Department[441]Notice of Intended Action

    Proposing rule making related to consumer choices option and providing an opportunity for public comment

        The Human Services Department hereby proposes to amend Chapter 78, “Amount, Duration and Scope of Medical and Remedial Services,” and Chapter 79, “Other Policies Relating to Providers of Medical and Remedial Care,” Iowa Administrative Code.Legal Authority for Rule Making    This rule making is proposed under the authority provided in Iowa Code section 249A.4.State or Federal Law Implemented    This rule making implements, in whole or in part, Iowa Code section 249A.4.Purpose and Summary    The proposed amendments make several changes to the Consumer Choices Option (CCO) program available within the AIDS/HIV, brain injury, elderly, health and disability, intellectual disability, and physical disability waivers. The amendments consolidate the CCO service description rules into one subrule, 78.34(13).  The amendments change the monthly budget billing methodology for the Financial Management Services (FMS) provider from a prepay method to a postpay method.  The amendments clarify who may self-direct services.  The amendments also clarify the budget and employer authority responsibilities and define how the monthly CCO budget may be used by a member self-directing services.  The amendments make technical changes to remove the references to the Department service workers who are no longer involved in the CCO program. Finally, the amendments add new member and employee responsibilities to ensure proper payments for CCO services are made.Fiscal Impact     This rule making has no fiscal impact to the State of Iowa. Jobs Impact    After analysis and review of this rule making, no impact on jobs has been found.Waivers    Any person who believes that the application of the discretionary provisions of this rule making would result in hardship or injustice to that person may petition the Department for a waiver of the discretionary provisions, if any, pursuant to rule 441—1.8(17A,217). Public Comment     Any interested person may submit written comments concerning this proposed rule making. Written comments in response to this rule making must be received by the Department no later than 4:30 p.m. on March 5, 2019. Comments should be directed to: Harry Rossander Bureau of Policy Coordination Department of Human Services Hoover State Office Building, Fifth Floor 1305 East Walnut Street Des Moines, Iowa 50319-0114 Email: policyanalysis@dhs.state.ia.usPublic Hearing     No public hearing is scheduled at this time. As provided in Iowa Code section 17A.4(1)“b,” an oral presentation regarding this rule making may be demanded by 25 interested persons, a governmental subdivision, the Administrative Rules Review Committee, an agency, or an association having 25 or more members. Review by Administrative Rules Review Committee    The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making at its regular monthly meeting or at a special meeting. The Committee’s meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).    The following rule-making actions are proposed:

        ITEM 1.    Amend subrule 78.34(13) as follows:    78.34(13) Consumer choices option.  The consumer choices option provides a member with a flexible monthly individual budget that is based on the member’s service needs. With the individual budget, the member shall have the authority to purchase goods and services to meet the member’s assessed needs and may choose to employ providers of services and supports. The services, supports, and items that are purchased with an individual budget must be directly related to a member’s assessed need or goal established in the member’s service plan.The consumer choices option is available to any member receiving the AIDS/HIV, brain injury, elderly, health and disability, intellectual disability, or physical disability waiver programs who has the ability and desire to perform all budget authority tasks identified in paragraph 78.34(13)“g” and employer authority tasks identified in paragraph 78.34(13)“h,” or who delegates the budget or employer authority tasks identified in paragraph 78.34(13)“i.” Components of this service are set forth below.    a.    Agreement.As a condition of participating in the consumer choices option, a member shall sign Form 470-4289, HCBS Consumer Choices Informed Consent and Risk Agreement, to document that the member has been informed of the responsibilities and risks of electing the consumer choices option.    b.    Individual budget amount.A monthly individual budget amount shall be established for each member based on the assessed needs of the member and based on the services and supports authorized in the member’s service plan. The member shall be informed of the individual budget amount during the development of the service plan.    (1)   Services that may be included in determining the individual budget amount for a member in the HCBS health and disability waiver are:
    1. Consumer-directed attendant care (unskilled).
    2. Home and vehicle modification.
    3. Home-delivered meals.
    4. Homemaker service.
    5. Basic individual respite care.
        (2)   The department shall determine an average unit cost for each service listed in subparagraph 78.34(13)“b”(1) based on actual unit costs from the previous fiscal year plus a cost-of-living adjustment.Services that may be included in determining the individual budget amount for a member in the HCBS elderly waiver are:    1.   Assistive devices.    2.   Chore service.    3.   Consumer-directed attendant care (unskilled).    4.   Home and vehicle modification.    5.   Home-delivered meals.    6.   Homemaker service.    7.   Basic individual respite care.    8.   Senior companion.    9.   Transportation.    (3)   In aggregate, costs for individual budget services shall not exceed the current costs of waiver program services. In order to maintain cost neutrality, the department shall apply a utilization adjustment factor to the amount of service authorized in the member’s service plan before calculating the value of that service to be included in the individual budget amount.Services that may be included in determining the individual budget amount for a member in the HCBS AIDS/HIV waiver are:    1.   Consumer-directed attendant care (unskilled).    2.   Home-delivered meals.    3.   Homemaker service.    4.   Basic individual respite care.    (4)   The department shall compute the utilization adjustment factor for each service by dividing the net costs of all claims paid for the service by the total of the authorized costs for that service, using at least 12 consecutive months of aggregate service data. The utilization adjustment factor shall be no lower than 60 percent. The department shall analyze and adjust the utilization adjustment factor at least annually in order to maintain cost neutrality.Services that may be included in determining the individual budget amount for a member in the HCBS intellectual disability waiver are:    1.   Consumer-directed attendant care (unskilled).    2.   Day habilitation.    3.   Home and vehicle modification.    4.   Prevocational services.    5.   Basic individual respite care.    6.   Supported community living.    7.   Supported employment.    8.   Transportation.    (5)   Individual budgets for respite services shall be computed based on the average cost for services identified in subparagraph 78.34(13)“b”(2). Respite services are not subject to the utilization adjustment factor in subparagraph 78.34(13)“b”(3).Services that may be included in determining the individual budget amount for a member in the HCBS brain injury waiver are:    1.   Consumer-directed attendant care (unskilled).    2.   Home and vehicle modification.    3.   Prevocational services.    4.   Basic individual respite care.    5.   Specialized medical equipment.    6.   Supported community living.    7.   Supported employment.    8.   Transportation.    (6)   Anticipated costs for home and vehicle modification are not subject to the average cost in subparagraph 78.34(13)“b”(2) or the utilization adjustment factor in subparagraph 78.34(13)“b”(3). Anticipated costs for home and vehicle modification shall not include the costs of the financial management services or the independent support broker. Before becoming part of the individual budget, all home and vehicle modifications shall be identified in the member’s service plan and approved by the case manager or service worker. Costs for home and vehicle modification may be paid to the financial management services provider in a one-time payment.Services that may be included in determining the individual budget amount for a member in the HCBS physical disability waiver are:    1.   Consumer-directed attendant care (unskilled).    2.   Home and vehicle modification.    3.   Specialized medical equipment.    4.   Transportation.    (7)   The individual budget amount may be changed only at the first of the month and shall remain fixed for the entire month.    (7)   The department shall determine an average unit cost for each service listed in subparagraphs 78.34(13)“b”(1) to (6) based on actual unit costs from the previous fiscal year plus a cost-of-living adjustment.    (8)   In aggregate, costs for individual budget services shall not exceed the current costs of waiver program services. In order to maintain cost neutrality, the department shall apply a utilization adjustment factor to the amount of service authorized in the member’s service plan before calculating the value of that service to be included in the individual budget amount.    (9)   The department shall compute the utilization adjustment factor for each service by dividing the net costs of all claims paid for the service by the total of the authorized costs for that service, using at least 12 consecutive months of aggregate service data. The utilization adjustment factor shall be no lower than 60 percent.     (10)   Individual budgets for respite services shall be computed based on the average cost for services identified in subparagraph 78.34(13)“b”(7). Respite services are not subject to the utilization adjustment factor in subparagraph 78.34(13)“b”(8).    (11)   Anticipated costs for home and vehicle modification, assistive devices, and specialized medical equipment are not subject to the average cost in subparagraph 78.34(13)“b”(7) or the utilization adjustment factor in subparagraph 78.34(13)“b”(8). The anticipated costs may include the costs of the financial management services and the independent support broker when the home and vehicle modification, assistive device, or specialized medical equipment is the only service included in the CCO monthly budget and the total cost for the home and vehicle modification, assistive device, or specialized medical equipment, including the cost of the financial management services and the independent support broker, is approved by the Iowa Medicaid Enterprise or managed care organization as the least costly option to meet the member’s need. Costs for the home and vehicle modification, assistive device, or specialized medical equipment may be paid to the financial management services provider in a one-time payment. Before becoming part of the CCO monthly budget, all home and vehicle modifications, assistive device, and specialized medical equipment shall be identified in the member’s service plan and authorized by the case manager or community-based case manager.    (12)   The individual budget amount may be changed only at the first of the month and shall remain fixed for the entire month.        c.    Required service components.To participate in the consumer choices option, a member must hire an independent support broker and must work with a financial management service that is enrolled as a Medicaid provider. Before hiring the independent support broker, the member shall receive the results of the background check conducted pursuant to 441—Chapter 119.    d.    Optional service components.A member who elects the consumer choices option may purchase the following goods, services and supports, which shall be provided in the member’s home or at an integrated community setting:    (1)   Self-directed personal care services. Self-directed personal care services are services or goods that provide a range of assistance in activities of daily living and incidental activities of daily living that help the member remain in the home and community. These services must be identified in the member’s service plan developed by the member’s case manager or service workercommunity-based case manager.    (2)   Self-directed community supports and employment. Self-directed community supports and employment are services that support the member in developing and maintaining independence and community integration. These services must be identified in the member’s service plan developed by the member’s case manager or service workercommunity-based case manager.    (3)   Individual-directed goods and services. Individual-directed goods and services are services, equipment, or supplies not otherwise provided through the Medicaid program that address an assessed need or goal identified in the member’s service plan. The item or service shall meet the following requirements:
    1. Promote opportunities for community living and inclusion.
    2. Increase independence or substitute for human assistance, to the extent the expenditures would otherwise be made for that human assistance.
    3. Be accommodated within the member’s budget without compromising the member’s health and safety.
    4. Be provided to the member or directed exclusively toward the benefit of the member.
    5. Be the least costly to meet the member’s needs.
    6. Not be available through another source.
        e.    Development of the individual budget.The independent support broker shall assist the member in developing and implementing the member’s individual budget. The individual budget shall include:    (1)   The costs of the financial management service.    (2)   The costs of the independent support broker. The independent support broker may be compensated for up to 6 hours of service for assisting with the implementation of the initial individual budget. The independent support broker shall not be paid for more than 30 hours of service for an individual member during a 12-month period without prior approval by the department.    (3)   The costs of any optional service component chosen by the member as described in paragraph 78.34(13)“d.”At a minimum, the CCO monthly budget must include the purchase of self-directed personal care, individual-directed goods and services, or self-directed community supports and services needed to meet the amount of service authorized for use in CCO identified in the member’s service plan. After funds have been budgeted to meet the identified needs, remaining funds from the monthly budget amount may be used to purchase additional self-directed personal care, individual-directed goods and services, or self-directed community supports and services as allowed by the monthly budget. The additional self-directed personal care, individual-directed goods and services, or self-directed community supports and services may exceed the amount of service or supports authorized in the member’s service plan. Costs of the following items and services shall not be covered by the individual budget:
    1. Child care services.
    2. Clothing not related to an assessed medical need.
    3. Conference, meeting or similar venue expenses other than the costs of approved services the member needs while attending the conference, meeting or similar venue.
    4. Costs associated with shipping items to the member.
    5. Experimental and non-FDA-approved medications, therapies, or treatments.
    6. Goods or services covered by other Medicaid programs.
    7. Home furnishings.
    8. Home repairs or home maintenance.
    9. Homeopathic treatments.
    10. Insurance premiums or copayments.
    11. Items purchased on installment payments.
    12. Motorized vehicles.
    13. Nutritional supplements.
    14. Personal entertainment items.
    15. Repairs and maintenance of motor vehicles.
    16. Room and board, including rent or mortgage payments.
    17. School tuition.
    18. Service animals.
    19. Services covered by third parties or services that are the responsibility of a non-Medicaid program.
    20. Sheltered workshop services.
    21. Social or recreational purchases not related to an assessed need or goal identified in the member’s service plan.
    22. Vacation expenses, other than the costs of approved services the member needs while on vacation.
    1. Services provided in the family home by a parent, stepparent, legal representative, sibling, or stepsibling during overnight sleeping hours unless the parent, stepparent, legal representative, sibling, or stepsibling is awake and actively providing direct services as authorized in the member’s service plan.
    2. Residential services provided to three or more members living in the same residential setting.
        (4)   The costs of any approved home or vehicle modification, assistive device, or specialized medical equipment. When authorized, the budget may include an amount allocated for a home or vehicle modification, an assistive device, or specialized medical equipment. Before becoming part of the individual budget, all home and vehicle modifications, assistive devices, and specialized medical equipment shall be identified in the member’s service plan and approved by the case manager or service workercommunity-based case manager. The authorized amount shall not be used for anything other than the specific modification, assistive device, or specialized medical equipment, as identified in subparagraph 78.34(13)“b”(11).    (5)   Any amount set aside in a savings plan to reserve funds for the future purchase of self-directed personal care, individual-directed goods and services, or self-directed community supports and services as defined in paragraph 78.34(13)“d.” The savings plan shall meet the requirements in paragraph 78.34(13)“f.”        f.    Savings plan.A member savings plan must be in writing and be approvedbefore the start of the savings plan by the department before the start of the savings planfor fee-for-service members or by the member’s managed care organization for members in managed care. AmountsBudget amounts allocated to the savings plan must result from efficiencies in meeting identifiedthe member’s service needs of the memberidentified in the member’s service plan.    (1)   The savings plan shall identify:
    1. The specific goods, services, supports or supplies to be purchased through the savings plan.
    2. The amount of the individual budget allocated each month to the savings plan.
    3. The amount of the individual budget allocated each month to meet the member’s identified service needs.
    4. How the member’s assessed needs will continue to be met through the individual budget when funds are placed in savings.
    1. Specific time spans for accumulating the savings allocation, not to exceed the member’s current service plan year end date.
        (2)   With the exception of funds allocated for respite care, the savings plan shall not include funds budgeted for direct servicesor supports that were not received. The budgeted amount associated with unused direct services other than respite care shall revert to the Medicaid program at the end of each month. Funds from unused respite services may be allocated to the savings plan but shall not be used for anything other than future respite care.    (3)   Funds accumulated under a savings plan shall be used only to purchase items that increase independence or substitute for human assistance to the extent that expenditures would otherwise be made for human assistance, including additional goods, supports, services or supplies.Funds allocated to a savings plan may be used to purchase additional self-directed personal care, individual-directed goods and services, or self-directed community supports and services. The additional self-directed personal care, individual-directed goods and services, or self-directed community supports and services included in the monthly budget may exceed the amount of service or supports authorized in the member’s service plan. The self-directed personal care, individual-directed goods and services, or self-directed community supports and services purchased with funds from a savings plan must:
    1. Be used to meet a member’s identified need,
    2. Be medically necessary, and
    3. Be approved by the member’s case manager or service workeror community-based case manager.
        (4)   All funds allocated to a savings plan that are not expended by December 31 of each year shall revert to the Medicaid programto purchase additional self-directed personal care, individual-directed goods and services, or self-directed community supports and services must be used during the member’s waiver year in which the saving occurred.    (5)   The annual reassessment of a member’s needs must take into account the purchases of goods and services that substitute for human assistance. Adjustments shall be made to the services used to determine the individual budget based on the reassessment.        g.    Budget authority.The member shall have authority over the individual budget authorized by the departmentor managed care organization to perform the following tasks:    (1)   Contract with entities to provide services and supports as described in this subrule.    (2)   Determine the amount to be paid for services. Reimbursement ratesfor employees shall be consistent withemployee reimbursement ratesor the prevailing wages paid by others in the community for the same or substantially similar services. Reimbursement rates for the independent support broker and the financial management service are subject to the limits in 441—subrule 79.1(2). The reimbursement rate for a member’s legal representative who provides services to the member as allowed by 441—paragraph 79.9(7)“b” must be based on the skill level of the legal representative and may not exceed the median statewide reimbursement rate for the service unless the higher rate receives prior approval from the department.    (3)   Schedule the provision of services. Whenever a member’s legal representative provides services to the member as allowed by 441—paragraph 79.9(7)“b,” the legal representative may not be paid for more than 40 hours of service per week and aA contingency plan must be established in the member’s service plan to ensure service delivery in the event the legal representativemember’s employee is unable to provide services due to illness or other unexpected event.    (4)   Authorize payment for optional service components identified in the individual budget.When the member’s guardian or legal representative is a paid employee, payment authorization for optional service components must be delegated to a representative pursuant to paragraph 78.34(13)“i.”    (5)   Reallocate funds among services included in the budget. Every purchase of a good or service must be identified and approved in the individual budget before the purchase is made.    h.    Delegation of budget authority.The member may delegate responsibility for the individual budget to a representative in addition to the independent support broker.    (1)   The representative must be at least 18 years old.    (2)   The representative shall not be a current provider of service to the member.    (3)   The member shall sign a consent form that designates who the member has chosen as a representative and what responsibilities the representative shall have.    (4)   The representative shall not be paid for this service.     h.    Employer authority.The member shall have the authority to be the common-law employer of employees providing services and support under the CCO. A common-law employer has the right to direct and control the performance of the services. If the member is a child, the parent or the legal representative shall be responsible for completing all employer authority tasks. Adult members who do not have the ability to complete all employer authority tasks shall have a representative delegated to complete the employer authority tasks identified in this paragraph. Documentation of the person responsible for the employer authority tasks, whether the member or another entity, shall be included in the member’s service plan. The member or the delegated employer authority may perform the following functions:    (1)   Recruit and hire employees.    (2)   Verify employee qualifications.    (3)   Specify additional employee qualifications.    (4)   Determine employee duties.    (5)   Determine employee wages and benefits.    (6)   Schedule employees.    (7)   Train and supervise employees.     i.    Employer authority.The member shall have the authority to be the common-law employer of employees providing services and support under the consumer choices option. A common-law employer has the right to direct and control the performance of the services. The member may perform the following functions:    (1)   Recruit employees.    (2)   Select employees from a worker registry.    (3)   Verify employee qualifications.    (4)   Specify additional employee qualifications.    (5)   Determine employee duties.    (6)   Determine employee wages and benefits.    (7)   Schedule employees.    (8)   Train and supervise employees.    i.    Delegation of budget and employer authority. The member may delegate responsibilities for the individual budget or employer authority functions to a representative. If the member is a child, the parent or the legal representative shall be delegated all budget and employer authority tasks. Adult members aged 18 and older who do not have the ability to complete all budget or employer authority tasks shall have a representative delegated to complete the applicable budget authority tasks identified in paragraph 78.34(13)“g” and employer authority tasks identified in paragraph 78.34(13)“h.” Documentation of the person responsible for the budget and employer authority tasks, whether the member or a representative, shall be included in the member’s service plan.     (1)   The representative must be at least 18 years old.    (2)   The representative shall not be a current provider of service to the member.    (3)   The member shall sign a consent form that designates who the member has chosen as a representative and the responsibilities of the representative.    (4)   The representative shall not be paid for this service.    j.    Employment agreement.Any person employed by the member to provide services under the consumer choices option shall sign an employment agreement with the member that outlines the employee’s and member’s responsibilities.    k.    Responsibilities of the independent support broker.The independent support broker shall perform the following services as directed by the member or the member’s representative:    (1)   Assist the member with developing the member’s initial and subsequent individual budgets and with making any changes to the individual budget.    (2)   Have monthly contact with the member for the first four months of implementation of the initial individual budget and have, at a minimum, quarterly contact thereafter.    (3)   Complete the required employment packet with the financial management service.    (4)   Assist with interviewing potential employees and entities providing services and supports if requested by the member.    (5)   Assist the member with determining whether a potential employee meets the qualifications necessary to perform the job.    (6)   Assist the member with obtaining a signed consent from a potential employee to conduct background checks if requested by the member.    (7)   Assist the member with negotiating with entities providing services and supports if requested by the member.    (8)   Assist the member with contracts and payment methods for services and supports if requested by the member.    (9)   Assist the member with developing an emergency backup plan. The emergency backup plan shall address any health and safety concerns.    (10)   Review expenditure reports from the financial management service to ensure that services and supports in the individual budget are being provided.    (11)   Document in writing on the independent support broker timecard every contact the broker has with the member. Contact documentation shall include information on the extent to which the member’s individual budget has addressed the member’s needs and the satisfaction of the member.    l.    Responsibilities of the financial management service.The financial management service shall perform all of the following services:    (1)   Receive Medicaid funds in an electronic transfer.    (2)   Process and pay invoices for approved goods and services included in the individual budget.    (3)   EnterMonitor and track theapproved individual budget into the web-based tracking system chosen by the departmentamount authorized each month and enterdocument all expenditures as they are paid.    (4)   Provide real-time individual budget account balances for the member, the independent support broker, and the department, available at a minimum during normal business hours (9 a.m. to 5 p.m., Monday through Friday).    (5)   Conduct criminal background checks on potential employees pursuant to 441—Chapter 119.    (6)   Verify for the member an employee’s citizenship or alien status.    (7)   Assist the member with fiscal and payroll-related responsibilities including, but not limited to:
    1. Verifying that hourly wages comply with federal and state labor rules.
    2. Collecting and processing timecards.
    3. Withholding, filing, and paying federal, state and local income taxes, Medicare and Social Security (FICA) taxes, and federal (FUTA) and state (SUTA) unemployment and disability insurance taxes, as applicable.
    4. Computing and processing other withholdings, as applicable.
    5. Processing all judgments, garnishments, tax levies, or other withholding on an employee’s pay as may be required by federal, state, or local laws.
    6. Preparing and issuing employee payroll checks.
    7. Preparing and disbursing IRS Forms W-2 and W-3 annually.
    8. Processing federal advance earned income tax credit for eligible employees.
    9. Refunding over-collected FICA, when appropriate.
    10. Refunding over-collected FUTA, when appropriate.
        (8)   Assist the member in completing required federal, state, and local tax and insurance forms.    (9)   Establish and manage documents and files for the member and the member’s employees.    (10)   Monitor timecards, receipts, and invoices to ensure that they are consistent with the individual budget. Keep records of all timecards and invoices for each member for a total of five years.    (11)   Provide to the department, the independent support broker, and the member monthly and quarterly status reports that include a summary of expenditures paid and amount of budget unused.    (12)   Establish an accessible customer service system and a method of communication for the member and the independent support broker that includes alternative communication formats.    (13)   Establish a customer services complaint reporting system.    (14)   Develop a policy and procedures manual that is current with state and federal regulations and update as necessary.    (15)   Develop a business continuity plan in the case of emergencies and natural disasters.    (16)   Provide to the department an annual independent audit of the financial management service.    (17)   Assist in implementing the state’s quality management strategy related to the financial management service.    (18)   The department may request that the financial management service provider withhold payment to any member or member’s employee to offset any overpayment or enforce any sanction placed on the service provider pursuant to rule 441—79.3(249A).        m.    Responsibilities of the member and the employee.A member participating in the CCO and the member’s employee(s) are responsible for the following:    (1)   A member participating in the CCO shall be jointly and severally liable with any of the member’s employees for any overpayment of medical assistance funds used through a CCO budget.    (2)   A member may not employ any person who has been sanctioned, or who is affiliated with a person or an entity that has been sanctioned, under 441—Chapter 79. For purposes of this subparagraph, “sanction” also includes anyone who has been temporarily suspended for a credible allegation of fraud under 42 CFR Part 455. Any CCO funds paid to any employee who or which has been sanctioned is an overpayment that the department shall recoup under 441—Chapter 79.    (3)   A member may not employ any person who has been excluded by the Office of the Inspector General of the Department of Health and Human Services under Sections 1128 or 1156 of the Social Security Act and is not eligible to receive federal funds.    (4)   Employees shall complete, sign and date Form 470-4429, Consumer Choices Option Semi-Monthly Time Sheet, for each date of service provided to a member. Documentation shall comport with 441—subparagraph 79.3(2)“c”(3), “Service documentation.”     (5)   Members shall sign, and certify under penalty of perjury, each employee timecard identified in subparagraph 78.34(13)“m”(5) prior to the timecard’s submission to the financial management service provider for payment in order to verify that all information on the submitted timecard accurately describes the amount, duration, and scope of services provided. When timecard information is submitted to the financial management service provider in an electronic format, the member shall retain the signed employee timecard for five years from the date of service.

        ITEM 2.    Rescind subrule 78.37(16) and adopt the following new subrule in lieu thereof:    78.37(16) Consumer choices option.  The consumer choices option is service activities provided pursuant to subrule 78.34(13).

        ITEM 3.    Rescind subrule 78.38(9) and adopt the following new subrule in lieu thereof:    78.38(9) Consumer choices option.  The consumer choices option is service activities provided pursuant to subrule 78.34(13).

        ITEM 4.    Rescind subrule 78.41(15) and adopt the following new subrule in lieu thereof:    78.41(15) Consumer choices option.  The consumer choices option is service activities provided pursuant to subrule 78.34(13).

        ITEM 5.    Rescind subrule 78.43(15) and adopt the following new subrule in lieu thereof:    78.43(15) Consumer choices option.  The consumer choices option is service activities provided pursuant to subrule 78.34(13).

        ITEM 6.    Rescind subrule 78.46(6) and adopt the following new subrule in lieu thereof:    78.46(6) Consumer choices option.  The consumer choices option is service activities provided pursuant to subrule 78.34(13).

        ITEM 7.    Amend subrule 79.1(2), provider category “HCBS waiver service providers,” paragraphs “32,” “33,” and “34,” as follows:    79.1(2) Basis of reimbursement of specific provider categories.      Provider category    Basis of reimbursement    Upper limit32. Self-directed personal careRate negotiated by member    Determined by member’sindividual budget. When an individual who serves as a member’s legal representative provides services to the member as allowed by 79.9(7)“b,” the payment rate must be based on the skill level of the legal representative and may not exceed the median statewide reimbursement rate for the service unless the higher rate receives prior approval from the department441—subparagraph 78.34(13)“g”(2).    33. Self-directed communitysupports and employmentRate negotiated by member    Determined by member’sindividual budget. When an individual who serves as a member’s legal representative provides services to the member as allowed by 79.9(7)“b,” the payment rate must be based on the skill level of the legal representative and may not exceed the median statewide reimbursement rate for the service unless the higher rate receives prior approval from the department441—subparagraph 78.34(13)“g”(2).    34. Individual-directed goodsand servicesRate negotiated by member    Determined by member’sindividual budget. When an individual who serves as a member’s legal representative provides services to the member as allowed by 79.9(7)“b,” the payment rate must be based on the skill level of the legal representative and may not exceed the median statewide reimbursement rate for the service unless the higher rate receives prior approval from the department441—subparagraph 78.34(13)“g”(2).

        ITEM 8.    Rescind and reserve subrule 79.1(9).    ARC 4282CInsurance Division[191]Notice of Intended Action

    Proposing rule making related to Medicare supplement policies and providing an opportunity for public comment

        The Insurance Division hereby proposes to rescind Chapter 37, “Medicare Supplement Insurance,” Iowa Administrative Code, and to adopt a new Chapter 37 with the same title.Legal Authority for Rule Making    This rule making is proposed under the authority provided in Iowa Code chapter 514D.State or Federal Law Implemented    This rule making implements, in whole or in part, Iowa Code chapter 514D.Purpose and Summary    The Insurance Division proposes to rescind the current Chapter 37 and replace it with a new version.  The new chapter is based on the Model Regulation to Implement the NAIC Medicare Supplement Insurance Minimum Standards Model Act, 2017, and the model regulation for advertising adopted by the National Association of Insurance Commissioners (NAIC). The new chapter includes new requirements for Medicare Supplement policies to be offered and issued on or after January 1, 2020. This rule making also serves as furtherance of the Insurance Division’s compliance with Iowa Code section 17A.7(2).Fiscal Impact    This rule making has no fiscal impact to the State of Iowa.Jobs Impact    After analysis and review of this rule making, no impact on jobs has been found.Waivers    The Division’s general waiver provisions of 191—Chapter 4 apply to these rules. Public Comment    Any interested person may submit written comments concerning this proposed rule making. Written comments in response to this rule making must be received by the Insurance Division no later than 4:30 p.m. on March 8, 2019. Comments should be directed to: Ann Outka Insurance Division Two Ruan Center 601 Locust Street, Fourth Floor Des Moines, Iowa 50309 Fax: 515.281.3059 Email: ann.outka@iid.iowa.govPublic Hearing    A public hearing at which persons may present their views orally or in writing will be held as follows: March 8, 2019 10 to 11 a.m. Division Offices, Fourth Floor Two Ruan Center 601 Locust Street Des Moines, Iowa     Persons attending the public hearing will be asked to provide their names. Persons may submit written comments. If persons wish to make oral comments in person or by telephone, they will be asked to state their names and whom they represent for the record and to confine their remarks to the subject of the proposed rule making.    Any persons who intend to attend the public hearing and have special requirements, such as those related to hearing or mobility impairments, should contact the Division and advise of specific needs. Review by Administrative Rules Review Committee    The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making at its regular monthly meeting or at a special meeting. The Committee’s meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).    The following rule-making action is proposed:

        ITEM 1.    Rescind 191—Chapter 37 and adopt the following new chapter in lieu thereof: CHAPTER 37MEDICARE SUPPLEMENT INSURANCE

    191—37.1(514D) Purpose and authority.  The purpose of this chapter is to provide for the reasonable standardization of coverage and simplification of terms and benefits of Medicare supplement policies; to facilitate public understanding and comparison of such policies; to eliminate provisions contained in such policies which may be misleading or confusing in connection with the purchase of such policies or with the settlement of claims; and to provide for full disclosures in the sale of accident and sickness insurance coverages to persons eligible for Medicare. This chapter is issued pursuant to the authority vested in the commissioner under Iowa Code chapter 514D.

    191—37.2(514D) Applicability, scope, and appendices.      37.2(1) Applicability and scope.      a.    Except as otherwise specifically provided in rules 191—37.6(514D), 191—37.22(514D), 191—37.23(514D), 191—37.28(514D) and 191—37.32(514D), this chapter shall apply to:    (1)   All Medicare supplement individual or group policies delivered or issued for delivery in this state on or after [the effective date of this chapter], unless otherwise stated; and    (2)   All certificates issued under group Medicare supplement policies, which certificates have been delivered or issued for delivery in this state on or after [the effective date of this chapter], unless otherwise stated.    b.    This chapter shall not apply to a policy or contract of one or more employers or labor organizations, or of the trustees of a fund established by one or more employers or labor organizations, or combination thereof; for employees or former employees, or a combination thereof; or for members or former members, or a combination thereof, of the labor organizations.    37.2(2) Appendices.  The following appendices can be found at the end of this chapter:    a.    Appendix A: Medicare Supplement Refund Calculation Form. This form is to be completed pursuant to subrule 37.23(3).    b.    Appendix B: Disclosure Statements. The applicable notice from the choices in Appendix B shall be used on Medicare supplement applications, pursuant to subrule 37.26(2).    c.    Appendix C: Statements and Questions for Application Forms Related to Duplicate or Replacement Coverage. The statements and questions in Appendix C shall be included with the outline of coverage and delivered with any application form for Medicare supplement policies or certificates to an applicant, as required by subrules 37.27(1) and 37.27(2).    d.    Appendix D: Notice to Applicant Regarding Replacement of Medicare Supplement Insurance or Medicare Advantage. The notice form of Appendix D shall be provided as required by subrules 37.27(4) and 37.27(5).    e.    Appendix E: Outline of Coverage: Benefit Charts. The items in the applicable tables in this Appendix E, displaying the features of each benefit plan offered by the issuer, shall be included in the outline of coverage in the order prescribed, pursuant to subrule 37.28(4).    f.    Appendix F: Form for Reporting Medicare Supplement Policies or Certificates. This form is to be completed pursuant to subrule 37.32(1).

    191—37.3(514D) Definitions.  For purposes of this chapter, in addition to the definitions in Iowa Code section 514D.2, the following definitions shall apply, unless otherwise specified:        "1990 standardized Medicare supplement benefit plan" "1990 plan" means a group or individual Medicare supplement policy issued on or after January 1, 1992, and with an effective date for coverage prior to June 1, 2010, and includes Medicare supplement insurance policies and certificates renewed on or after June 1, 2010, which are not replaced by the issuer at the request of the insured.        "2010 standardized Medicare supplement benefit plan" "2010 plan" means a group or individual Medicare supplement policy issued with an effective date for coverage on or after June 1, 2010, and with an effective date for coverage prior to January 1, 2020.        "2020 standardized Medicare supplement benefit plan" "2020 plan" means a group or individual Medicare supplement policy issued with an effective date for coverage on or after January 1, 2020.        "Applicant" means:
    1. In the case of an individual Medicare supplement policy, the person who seeks to contract for insurance benefits; and
    2. In the case of a group Medicare supplement policy, the proposed covered individual, unless stated otherwise.
            "Basic core benefits" are benefits defined in subrule 37.7(2) for 1990 plans and in subrule 37.8(2) for 2010 plans and 2020 plans (pursuant to subrule 37.9(1)).        "Certificate" means any certificate of coverage delivered or issued for delivery in this state to a covered individual under a group Medicare supplement policy.        "Certificate form" means the form (as defined in Iowa Code section 514D.2(2)) on which the certificate is delivered or issued for delivery by the issuer.        "Certificate holder" means the named individual to whom the certificate of coverage under a group policy is issued, or a spouse, if applicable.        "CMS" means the Centers for Medicare and Medicaid Services of the U.S. Department of Health and Human Services.        "Commissioner" means the Iowa insurance commissioner, and includes the insurance division as delegated.        "Covered individual" means an individual who may receive benefits under an individual or group Medicare supplement policy because the individual is one of the following: the named insured under an individual Medicare supplement policy; the named certificate holder under a group Medicare supplement policy; or an individual such as a spouse covered by way of the named certificate holder’s group Medicare supplement policy. For purposes of rule 191—37.20(514D), “covered individual” means an individual who may receive benefits under an individual or group Medicare Select policy because the individual is one of the following: the named insured under an individual Medicare Select policy; the named certificate holder under a group Medicare Select policy; or an individual such as a spouse covered by way of the named certificate holder’s group Medicare Select policy.        "Creditable coverage."
    1. “Creditable coverage” means, with respect to an individual, health coverage of the individual provided under any of the following:
  • A group health plan;
  • Health insurance coverage;
  • Part A or Part B of Title XVIII of the Social Security Act (Medicare);
  • Title XIX of the Social Security Act (Medicaid), other than coverage consisting solely of benefits under Section 1928;
  • Chapter 55 of Title 10, United States Code (CHAMPUS);
  • A medical care program of the Indian Health Service or of a tribal organization;
  • A state health benefits risk pool;
  • A health plan offered under Chapter 89 of Title 5, United States Code (Federal Employees Health Benefits Program);
  • A public health plan as defined in federal regulation; and
  • A health benefit plan under Section 5(e) of the Peace Corps Act (22 United States Code 2504(e)).
    1. “Creditable coverage” shall not include one or more of, or any combination of, the following:
  • Coverage only for accident or disability income insurance, or any combination thereof;
  • Coverage issued as a supplement to liability insurance;
  • Liability insurance, including general liability insurance and automobile liability insurance;
  • Workers’ compensation or similar insurance;
  • Automobile medical payment insurance;
  • Credit-only insurance;
  • Coverage for on-site medical clinics; and
  • Other similar insurance coverage, specified in federal regulations, under which benefits for medical care are secondary or incidental to other insurance benefits.
    1. “Creditable coverage” shall not include the following benefits if they are provided under a separate policy, certificate or contract of insurance or are otherwise not an integral part of the plan:
  • Limited scope dental or vision benefits;
  • Benefits for long-term care, nursing home care, home health care, community-based care, or any combination thereof; and
  • Such other similar limited benefits as are specified in federal regulations.
    1. “Creditable coverage” shall not include the following benefits if offered as independent, noncoordinated benefits:
  • Coverage only for a specified disease or illness; and
  • Hospital indemnity or other fixed indemnity insurance.
    1. “Creditable coverage” shall not include the following if it is offered as a separate policy, certificate or contract of insurance:
  • Medicare supplemental health insurance as defined under Section 1882(g)(1) of the Social Security Act;
  • Coverage supplemental to the coverage provided under Chapter 55 of Title 10, United States Code; and
  • Similar supplemental coverage provided to the coverage under a group health plan.
    •         "File" "filing," when used in reference to filing information with the commissioner or with the insurance division, means submitting information as set forth in these rules through the System for Electronic Rate and Form Filing (SERFF), www.serff.com, or as otherwise directed by the insurance division through its website, iid.iowa.gov.         "Group member" means the individual who is a member of the group entity to which the group policy is issued.        "Group policyholder" means the group entity to which a group Medicare supplement policy is issued.        "Insolvency" means that an issuer, licensed to transact the business of insurance in this state, has had a final order of liquidation entered against it with a finding of insolvency by a court of competent jurisdiction in the issuer’s state of domicile.        "Insurance division" means the Iowa insurance division.        "Issuer" includes insurance companies, fraternal benefit societies, health care service plans, health maintenance organizations, and any other entity delivering or issuing for delivery in this state Medicare supplement policies or certificates.        "Medicare" means the Health Insurance for the Aged Act, Title XVIII of the Social Security Amendments of 1965, as then constituted or later amended.        "Medicare Advantage plan" means a plan of coverage for health benefits under Medicare Part C (as defined in 42 U.S.C. 1395w-28(b)(1)), and includes:
    1. Coordinated care plans which provide health care services, including but not limited to health maintenance organization plans (with or without a point-of-service option), plans offered by provider-sponsored organizations, and preferred provider organization plans;
    2. Medical savings account plans coupled with a contribution into a Medicare Advantage medical savings account; and
    3. Medicare Advantage private fee-for-service plans.
            "Medicare Select policy," “Medicare Select certificate,”“Medicare Select issuer,” and “Medicare Select network provider” are defined in subrule 37.20(2).        "Medicare supplement policy" means a group or individual policy of accident and sickness insurance or a subscriber contract of hospital and medical service associations or health maintenance organizations, other than a policy issued pursuant to a contract under Section 1876 of the federal Social Security Act (42 U.S.C. Section 1395 et seq.) or an issued policy under a demonstration project specified in 42 U.S.C. Section 1395ss(g)(1), which is advertised, marketed or designed primarily as a supplement to reimbursements under Medicare for the hospital, medical or surgical expenses of persons eligible for Medicare. “Medicare supplement policy” does not include Medicare Advantage plans, outpatient prescription drug plans established under Medicare Part D, or any health care prepayment plan (HCPP) that provides benefits pursuant to an agreement under Section 1833(a)(1)(A) of the Social Security Act.        "MMA" means the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Pub. L. No. 108-173, 117 Stat. 2066.        "PACE program" means a program of all-inclusive care for the elderly, operated by an approved PACE organization (an entity that is approved as a PACE program by the Iowa department of human services and that has in effect a PACE program agreement between the entity, CMS, and the Iowa department of human services to operate a PACE program) that provides comprehensive health care services to enrollees in Iowa, pursuant to Section 1894 of the Social Security Act (42 U.S.C. 1395eee) and Iowa Administrative Code rules 441—88.21(249A) through 441—88.28(249A).        "Person" means any individual, corporation, association, or partnership.        "Policy form" means the form (as defined by Iowa Code section 514D.2(2)) on which the policy (as defined by Iowa Code section 514D.2(4)) is delivered or issued for delivery by the issuer.        "Policyholder" means the individual person to whom or group entity to which an individual or group Medicare supplement policy is issued.        "PPS" means prospective payment system.        "Prestandardized Medicare supplement benefit plan" "prestandardized plan" means a group or individual Medicare supplement policy issued prior to January 1, 1992.        "Producer" means a person licensed in this state pursuant to Iowa Code chapter 522B and Iowa Administrative Code 191—Chapter 10 to sell, solicit, negotiate, effect, procure, deliver, renew, continue or bind policies of insurance for persons residing or located, or for policies to be performed, in this state.        "Secretary" means the Secretary of the U.S. Department of Health and Human Services.        "SMSBP" "standard Medicare supplement benefit plan" means a 1990 plan, a 2010 plan, or a 2020 plan.

    191—37.4(514D) Policy definitions and terms.  No policy or certificate may be advertised, solicited or issued for delivery in this state as a Medicare supplement policy or certificate unless such policy or certificate contains definitions or terms which conform to the requirements of this rule.        "Accident," “accidental injury,” or “accidental means” shall be defined to employ “result” language and shall not include words which establish an accidental means test or use words such as “external, violent, visible wounds” or similar words of description or characterization.
    1. The definition shall not be more restrictive than the following: “Injury or injuries for which benefits are provided means accidental bodily injury sustained by the covered individual which is the direct result of an accident, independent of disease or bodily infirmity or any other cause, and occurs while insurance coverage is in force.”
    2. Such definition may provide that injuries shall not include injuries for which benefits are provided or available under any workers’ compensation, employer’s liability or similar law, or motor vehicle no-fault plan, unless prohibited by law.
            "Benefit period" "Medicare benefit period" shall not be defined more restrictively than as defined by Medicare.        "Convalescent nursing home," “extended care facility,” or “skilled nursing facility” shall not be defined more restrictively than as defined by Medicare.        "Hospital" may be defined in relation to its status, facilities and available services or to reflect its accreditation by the Joint Commission on Accreditation of Hospitals, but not more restrictively than as defined by Medicare.        "Medicare" shall be defined in the policy and certificate. Medicare may be substantially defined as “The Health Insurance for the Aged Act, Title XVIII of the Social Security Amendments of 1965 as then constituted or later amended,” or “Title I, Part I of Pub. L. No. 89-97, as Enacted by the Eighty-Ninth Congress of the United States of America and popularly known as the Health Insurance for the Aged Act, as then constituted and any later amendments or substitutes thereof,” or words of similar import.        "Medicare-eligible expenses" shall mean expenses of the kinds covered by Medicare Parts A and B, to the extent recognized as reasonable and medically necessary by Medicare.        "Physician" shall not be defined more restrictively than as defined by Medicare.        "Sickness" shall not be defined to be more restrictive than the following: “Sickness means illness or disease of a covered individual which first manifests itself after the effective date of insurance and while the insurance is in force.” The definition may be further modified to exclude sicknesses or diseases for which benefits are provided under any workers’ compensation, occupational disease, employer’s liability or similar law.

    191—37.5(514D) Policy provisions.      37.5(1) Coverage restrictions related to Medicare.  Except for permitted preexisting condition clauses as described in paragraphs 37.6(1)“a,” 37.7(1)“d,” and 37.8(1)“d,” no policy or certificate may be advertised, solicited or issued for delivery in this state as a Medicare supplement policy or certificate if such Medicare supplement policy or certificate contains limitations or exclusions on coverage that are more restrictive than those permitted by Medicare.    37.5(2) Waivers of preexisting conditions.  No Medicare supplement policy or certificate may use waivers to exclude, limit or reduce coverage or benefits for specifically named or described preexisting diseases or physical conditions.    37.5(3) Duplicate benefits.  No Medicare supplement policy or certificate in force in the state shall contain benefits which duplicate benefits provided by Medicare insurance.    37.5(4) Renewal of pre-2006 coverage.  Subject to paragraphs 37.6(1)“d,” “e,” and “g” and 37.7(1)“d” and “e,” a Medicare supplement policy or certificate with benefits for outpatient prescription drugs in existence prior to January 1, 2006, shall, at the option of a currently covered individual who does not enroll in Medicare Part D, be renewed for that covered individual.    37.5(5) Coverage of prescription drugs after 2005.  A Medicare supplement policy or certificate with benefits for outpatient prescription drugs shall not be issued after December 31, 2005.    37.5(6) Renewal of coverage of prescription drugs after 2005 for enrollees of Part D.  After December 31, 2005, a Medicare supplement policy or certificate with benefits for outpatient prescription drugs may not be renewed after the covered individual enrolls in Medicare Part D unless:    a.    The policy or certificate is modified to eliminate outpatient prescription coverage for expenses of outpatient prescription drugs incurred after the effective date of the covered individual’s coverage under a Medicare Part D plan; and    b.    Premiums are adjusted to reflect the elimination of outpatient prescription drug coverage at the time of Medicare Part D enrollment, accounting for any claims paid, if applicable.

    191—37.6(514D) Minimum benefit standards for prestandardized Medicare supplement benefit plan policies or certificates issued for delivery prior to January 1, 1992 (prestandardized plans).  No policy or certificate may be advertised, solicited or issued for delivery in this state as a prestandardized plan policy or certificate unless it meets or exceeds the following minimum standards. These are minimum standards and do not preclude the inclusion of other provisions or benefits which are not inconsistent with these standards.    37.6(1) General standards.  The following standards apply to prestandardized plans and are in addition to all other requirements of this chapter.    a.    A prestandardized plan shall not exclude or limit benefits for losses incurred more than six months from the effective date of coverage because it involved a preexisting condition. The prestandardized plan shall not define a preexisting condition more restrictively than a condition for which medical advice was given or treatment was recommended by or received from a physician within six months before the effective date of coverage.    b.    A prestandardized plan shall not indemnify against losses resulting from sickness on a different basis than losses resulting from accidents.    c.    A prestandardized plan shall provide that benefits designed to cover cost-sharing amounts under Medicare will be changed automatically to coincide with any changes in the applicable Medicare deductible, copayment, or coinsurance amounts. Premiums may be modified to correspond with such changes.    d.    A “noncancelable,” “guaranteed renewable,” or “noncancelable and guaranteed renewable” prestandardized plan shall not:    (1)   Provide for termination of coverage of a spouse of a group member solely because of the occurrence of an event specified for termination of coverage of the group member, other than the nonpayment of premium; or    (2)   Be canceled or nonrenewed by the issuer solely on the grounds of deterioration of health.    e.    Except as authorized by the commissioner, an issuer shall neither cancel nor nonrenew a prestandardized plan policy or certificate for any reason other than nonpayment of premium or material misrepresentation.    f.    Group Medicare supplement policies.    (1)   If a group prestandardized plan is terminated by the group policyholder and not replaced as provided in subparagraph 37.6(1)“f”(3), the issuer shall offer to each of the covered individuals under the group prestandardized plan an individual Medicare supplement policy. The issuer shall offer each of the group prestandardized plan’s covered individuals at least the following choices:    1.   An individual Medicare supplement policy currently offered by the issuer having comparable benefits to those contained in the terminated group prestandardized plan; and    2.   An individual Medicare supplement policy which provides only such benefits as are required to meet the basic core benefits minimum standards as defined in subrule 37.7(2).    (2)   If a covered individual’s membership with the group entity that is the group policyholder is terminated, the issuer shall:    1.   Offer the covered individual such conversion opportunities as are described in subparagraph 37.6(1)“f”(1); or    2.   At the option of the group policyholder, offer the covered individual continuation of coverage under the group prestandardized plan.    (3)   If a group prestandardized plan is replaced by another group Medicare supplement policy purchased by the same group policyholder, the issuer of the replacement group Medicare supplement policy shall offer coverage to all covered individuals under the replaced group prestandardized plan on its date of termination. Coverage under the new replacement group Medicare supplement policy shall not result in any exclusion for preexisting conditions that would have been covered under the replaced group prestandardized plan.    (4)   If a prestandardized plan eliminates an outpatient prescription drug benefit as a result of requirements imposed by the MMA, the modified policy shall be deemed to satisfy the guaranteed renewal requirements of this subrule.    g.    Termination of a prestandardized plan policy or certificate shall be without prejudice to any continuous loss which commenced while the prestandardized plan policy or certificate was in force, but the extension of benefits beyond the period during which the prestandardized plan policy or certificate was in force may be predicated upon the continuous total disability of the covered individual, limited to the duration of the prestandardized plan policy or certificate benefit period, if any, or to payment of the maximum benefits. Receipt of Medicare Part D benefits will not be considered in determining a continuous loss.    37.6(2) Minimum benefit standards.  The following are minimum benefit standards for prestandardized plans:    a.    Coverage of Part A Medicare-eligible expenses for hospitalization to the extent not covered by Medicare from the sixty-first day through the ninetieth day in any Medicare benefit period;    b.    Coverage for either all or none of the Medicare Part A inpatient hospital deductible amount;    c.    Coverage of Part A Medicare-eligible expenses which are incurred as daily hospital charges during the covered individual’s use of Medicare’s lifetime hospital inpatient reserve days;    d.    Upon exhaustion of all Medicare hospital inpatient coverage including the lifetime reserve days, coverage of 90 percent of all Medicare Part A eligible expenses for hospitalization not covered by Medicare subject to a lifetime maximum benefit of an additional 365 days;    e.    Coverage under Medicare Part A for the reasonable cost of the first three pints of blood (or equivalent quantities of packed red blood cells, as defined under federal regulations) unless replaced in accordance with federal regulations or already paid for under Part B;    f.    Coverage for the coinsurance amount, or in the case of hospital outpatient department services paid under a PPS, the copayment amount, of Medicare-eligible expenses under Part B regardless of hospital confinement, subject to a maximum calendar year out-of-pocket amount equal to the Medicare Part B deductible;    g.    Effective January 1, 1990, coverage under Medicare Part B for the reasonable cost of the first three pints of blood (or equivalent quantities of packed red blood cells, as defined under federal regulations), unless replaced in accordance with federal regulations or already paid for under Part A, subject to the Medicare deductible amount.

    191—37.7(514D) Benefit standards for 1990 standardized Medicare supplement benefit plan policies or certificates issued for delivery on or after January 1, 1992, and with an effective date for coverage prior to June 1, 2010 (1990 plans).  The following standards are applicable to all Medicare supplement policies or certificates delivered or issued for delivery in this state on or after January 1, 1992, and with an effective date for coverage prior to June 1, 2010. No policy or certificate may be advertised, solicited, delivered or issued for delivery in this state as a Medicare supplement policy or certificate unless it complies with these benefit standards. No issuer may offer any prestandardized Medicare supplement benefit plan for sale on or after January 1, 1992. Benefit standards applicable to Medicare supplement policies and certificates issued before January 1, 1992, remain subject to the requirements of rule 191—37.6(514D).    37.7(1) General standards.  The following standards apply to 1990 plans and are in addition to all other requirements of this chapter.    a.    Combinations of benefits other than standard not allowed.No groups, packages or combinations of Medicare supplement benefits other than those listed in this rule shall be offered for sale in this state, except as may be permitted in subrule 37.7(6) and in rule 191—37.20(514D).    b.    Uniformity and conformity.All 1990 plans shall be uniform in structure, language, designation and format to the standardized Medicare supplement benefit plans A through L listed in subrule 37.7(4) and shall conform to the definitions in rules 191—37.3(514D) and 191—37.4(514D). Each benefit shall be structured in accordance with the format provided in this rule and list the benefits in the order shown in this rule. For purposes of this rule, “structure, language, and format” means style, arrangement and overall content of a benefit.    c.    Other designations may be used.An issuer may use, in addition to the benefit plan designations required in paragraph 37.7(1)“b,” other designations to the extent permitted by law.    d.    Preexisting conditions.A 1990 plan shall not exclude or limit benefits for losses incurred more than six months from the effective date of coverage because the claim involved a preexisting condition. The 1990 plan may not define a preexisting condition more restrictively than a condition for which medical advice was given or treatment was recommended by or received from a physician within six months before the effective date of coverage.    e.    Sickness same as accident.A 1990 plan shall not indemnify against losses resulting from sickness on a different basis than losses resulting from accidents.    f.    Automatic change of cost sharing.A 1990 plan shall provide that benefits designed to cover cost-sharing amounts under Medicare will be changed automatically to coincide with any changes in the applicable deductible, copayment, or coinsurance amounts set by Medicare. Premiums may be modified to correspond with such changes.    g.    Termination of coverage of spouse.No 1990 plan shall provide for termination of coverage of a spouse solely because of the occurrence of an event specified for termination of coverage of the insured, other than the nonpayment of premium.    h.    Guaranteed renewability.Each 1990 plan shall be guaranteed renewable.    (1)   The issuer shall not cancel or nonrenew a 1990 plan solely on the ground of health status of the covered individual.    (2)   The issuer shall not cancel or nonrenew a 1990 plan for any reason other than nonpayment of premium or material misrepresentation.    (3)   If the 1990 plan is terminated by the group policyholder and is not replaced as provided under subparagraph 37.7(1)“h”(5), the issuer shall offer to the covered individual a conversion opportunity of an individual Medicare supplement policy which, at the option of the covered individual, either:    1.   Provides for continuation of the benefits contained in the group 1990 plan; or    2.   Provides for such benefits as otherwise meet the requirements of this subrule.    (4)   If a covered individual under a group 1990 plan terminates membership in the group, the issuer shall either:    1.   Offer the covered individual the conversion opportunity described in subparagraph 37.7(1)“h”(3); or    2.   At the option of the group policyholder, offer the covered individual continuation of coverage under the group Medicare supplement policy.    (5)   If a group 1990 plan is replaced by another group Medicare supplement policy purchased by the same group policyholder, the issuer of the replacement group Medicare supplement policy shall offer coverage under the replacement group Medicare supplement policy to all covered individuals of the replaced group 1990 plan effective on the date of termination of the replaced group 1990 plan. Coverage under the replacement group Medicare supplement policy shall not result in any exclusion of any covered individual’s preexisting conditions that would have been covered under the replaced group 1990 plan.    (6)   If a 1990 plan eliminates an outpatient prescription drug benefit as a result of requirements imposed by the MMA, the modified 1990 plan shall be deemed to satisfy the guaranteed renewal requirements of this paragraph.    i.    Termination involving continuous loss.Termination of a 1990 plan shall be without prejudice to any continuous loss which commenced while the 1990 plan was in force, but the extension of benefits beyond the period during which the 1990 plan was in force may be conditioned upon the continuous total disability of the covered individual, limited to the duration of the 1990 plan benefit period, if any, or payment of the maximum benefits. Receipt of Medicare Part D benefits will not be considered in determining a continuous loss.    j.    Suspension for Title XIX coverage.    (1)   A 1990 plan shall provide that benefits and premiums under the 1990 plan shall be suspended at the request of the covered individual for the period (not to exceed 24 months) in which the covered individual has applied for and is determined to be entitled to medical assistance under Title XIX of the Social Security Act, but only if the covered individual notifies the issuer of such 1990 plan within 90 days after the date the covered individual becomes entitled to such assistance.    (2)   If such suspension occurs and if the covered individual loses entitlement to such medical assistance, such 1990 plan shall be automatically reinstituted (effective as of the date of termination of such entitlement) if the covered individual provides notice of loss of such entitlement within 90 days after the date of such loss and pays the premium attributable to the period, effective as of the date of termination of such entitlement.    (3)   Each 1990 plan shall provide that benefits and premiums under the 1990 plan shall be suspended for the period provided by federal regulation at the request of the covered individual if the covered individual is entitled to benefits under Section 226(b) of the Social Security Act and is covered under a group health plan as defined in Section 1862(b)(1)(A)(v) of the Social Security Act. If suspension occurs and if the covered individual loses coverage under the group health plan, the 1990 plan shall be automatically reinstituted effective as of the date of loss of coverage if the covered individual provides notice to the issuer of loss of coverage within 90 days after the date of such loss and pays the premium attributable to the period, effective as of the date of termination of enrollment in the group health plan.    (4)   Reinstitution of coverage as described in subparagraphs 37.7(1)“j”(2) and (3):    1.   Shall not provide for any waiting period with respect to treatment of preexisting conditions;    2.   Shall provide for resumption of coverage that is substantially equivalent to coverage in effect before the date of suspension. If the suspended 1990 plan provided coverage for outpatient prescription drugs, reinstitution of the 1990 plan for Medicare Part D enrollees shall be without coverage for outpatient prescription drugs and shall otherwise provide substantially equivalent coverage to the coverage in effect before the date of suspension; and    3.   Shall provide for classification of premiums on terms at least as favorable to the covered individual as the premium classification terms that would have applied to the covered individual had the coverage not been suspended.    k.    Exchange of 1990 plan to 2010 plan.If an issuer makes a written offer to a covered individual covered by one or more of the issuer’s 1990 plans (as described in this rule) to allow, during a specified period, the covered individual to exchange coverage from the covered individual’s 1990 plan (as described in this rule) to a 2010 plan (as described in rule 191—37.8(514D)), the offer and subsequent exchange shall comply with the following requirements:    (1)   An issuer need not provide justification to the commissioner or comply with 191—Chapter 16 or rule 191—37.27(514D) if the covered individual exchanges a 1990 plan policy or certificate for an issue-age-rated 2010 plan policy or certificate using the same issue age and duration as was used for the covered individual’s 1990 plan policy or certificate to be exchanged. If a covered individual’s 1990 plan policy or certificate to be exchanged is priced on an issue-age-rate schedule at the time of such offer, the rate charged to the covered individual for the exchanged 2010 plan policy or certificate shall recognize the policy reserve buildup, due to the prefunding inherent in the use of an issue-age-rate basis, for the benefit of the covered individual. The rating method proposed to be used by an issuer must be filed with the commissioner pursuant to rule 191—37.24(514D).    (2)   The rating class of the new exchanged 2010 plan policy or certificate shall be the class closest to the covered individual’s rating class of the exchanged 1990 plan.    (3)   An issuer may not apply new preexisting condition limitations or a new incontestability period to the covered individual’s exchanged 2010 plan for those benefits contained in the exchanged 1990 plan, but may apply preexisting condition limitations of no more than six months to any added benefits contained in the exchanged 2010 plan that were not contained in the exchanged 1990 plan.    (4)   The exchanged 2010 plan shall be offered to all covered individuals within a given 1990 plan, except where the offer or issue would be in violation of state or federal law.    37.7(2) Standards for basic core benefits common to 1990 standardized Medicare supplement benefit plans A through J (1990 plans).  Every issuer shall make available a 1990 plan including only the following basic core benefits to each prospective covered individual. An issuer may make available to prospective covered individuals any of the issuer’s other standardized Medicare supplement benefit plans in addition to the basic core benefits, but not in lieu thereof. The 1990 basic core benefits are the following:    a.    Coverage of Part A Medicare-eligible expenses for hospitalization, to the extent not covered by Medicare, from the sixty-first day through the ninetieth day in any Medicare benefit period;    b.    Coverage of Part A Medicare-eligible expenses incurred for hospitalization, to the extent not covered by Medicare, for each Medicare lifetime inpatient reserve day used;    c.    Upon exhaustion of the Medicare hospital inpatient coverage including the lifetime reserve days, coverage of 100 percent of the Medicare Part A eligible expenses for hospitalization, paid at the applicable PPS rate or other appropriate Medicare standard of payment, subject to a lifetime maximum benefit of an additional 365 days. Medicare requires that the provider shall accept the issuer’s payment as payment in full and that the provider may not bill the covered individual for any balance;    d.    Coverage under Medicare Parts A and B for the reasonable cost of the first three pints of blood (or equivalent quantities of packed red blood cells, as defined under federal regulations) unless replaced in accordance with federal regulations;    e.    Coverage for the coinsurance amount or, in the case of hospital outpatient department services paid under a PPS, the copayment amount of Medicare Part B eligible expenses regardless of hospital confinement, subject to the Medicare Part B deductible.    37.7(3) Standards for additional benefits for plans B through J.  The following benefit descriptions apply to the additional benefits specified for 1990 plans B through J in subrule 37.7(4):    a.    Medicare Part A deductible: coverage for all of the Medicare Part A inpatient hospital deductible amount per benefit period.    b.    Skilled nursing facility care: coverage for the actual billed charges up to the coinsurance amount from the twenty-first day through the one hundredth day in a Medicare benefit period for post-hospital skilled nursing facility care eligible under Medicare Part A.    c.    Medicare Part B deductible: coverage for all of the Medicare Part B deductible amount per calendar year regardless of hospital confinement.    d.    Eighty percent of the Medicare Part B excess charges: coverage for 80 percent of the difference between the actual Medicare Part B charge as billed, not to exceed any charge limitation established by Medicare or by state law, and the Medicare-approved Part B charge.    e.    One hundred percent of the Medicare Part B excess charges: coverage for all of the difference between the actual Medicare Part B charge as billed, not to exceed any charge limitation established by Medicare or by state law, and the Medicare-approved Part B charge.    f.    Basic outpatient prescription drug benefit: coverage for 50 percent of outpatient prescription drug charges, after a $250 calendar year deductible, to a maximum of $1,250 in benefits received by the covered individual per calendar year, to the extent not covered by Medicare. The outpatient prescription drug benefit may be included for sale or issuance in a Medicare 1990 plan until January 1, 2006.    g.    Extended outpatient prescription drug benefit: coverage for 50 percent of outpatient prescription drug charges, after a $250 calendar year deductible to a maximum of $3,000 in benefits received by the covered individual per calendar year, to the extent not covered by Medicare. The outpatient prescription drug benefit may be included for sale or issuance in a Medicare 1990 plan until January 1, 2006.    h.    Medically necessary emergency care in a foreign country: coverage to the extent not covered by Medicare for 80 percent of the billed charges for Medicare-eligible expenses for medically necessary emergency hospital, physician and medical care received in a foreign country, which care would have been covered by Medicare if provided in the United States and which care began during the first 60 consecutive days of each trip outside the United States, subject to a calendar year deductible of $250 and a lifetime maximum benefit of $50,000. For purposes of this benefit, “emergency care” shall mean care needed immediately because of an injury or an illness of sudden and unexpected onset.    i.    Preventive medical care benefit:    (1)   Coverage for the following preventive health services not covered by Medicare:    1.   An annual clinical preventive medical history and physical examination that may include tests and services from numbered paragraph “2” and patient education to address preventive health care measures.    2.   Preventive screening tests or preventive services, the selection and frequency of which is determined to be medically appropriate by the attending physician.    (2)   Reimbursement shall be for the actual charges up to 100 percent of the Medicare-approved amount for each service, as if Medicare were to cover the service as identified in American Medical Association current procedural terminology (AMA CPT) codes, to a maximum of $120 annually under this benefit. This benefit shall not include payment for any procedure covered by Medicare.    j.    At-home recovery benefit: coverage for services to provide short-term, at-home assistance with activities of daily living for those recovering from an illness, injury or surgery.    (1)   For purposes of this benefit, the following definitions shall apply:“Activities of daily living” includes, but is not limited to, bathing, dressing, personal hygiene, transferring, eating, ambulating, assistance with drugs that are normally self-administered, and changing bandages or other dressings.“At-home recovery visit” means the period of a visit required to provide at-home recovery care, without limit on the duration of the visit, except each consecutive four hours in a 24-hour period of services provided by a care provider is one visit.“Care provider” means a duly qualified or licensed home health aide or homemaker, personal care aide or nurse provided through a licensed home health care agency or referred by a licensed referral agency or licensed nurses registry.“Home” shall mean any place used by the covered individual as a place of residence, provided that such place would qualify as a residence for home health care services covered by Medicare. A hospital or skilled nursing facility shall not be considered the covered individual’s place of residence.    (2)   Coverage requirements and limitations.    1.   At-home recovery services provided must be primarily services which assist in activities of daily living.    2.   The covered individual’s attending physician must certify that the specific type and frequency of at-home recovery services are necessary because of a condition for which a home care plan of treatment was approved by Medicare.    3.   Coverage is limited to:
  • No more than the number and type of at-home recovery visits certified as necessary by the covered individual’s attending physician. The total number of at-home recovery visits shall not exceed the number of Medicare-approved home health care visits under a Medicare-approved home care plan of treatment.
  • The actual charges for each visit up to a maximum reimbursement of $40 per visit.
  • One thousand six hundred dollars per calendar year.
  • Seven visits in any one week.
  • Care furnished on a visiting basis in the covered individual’s home.
  • Services provided by a care provider as defined in this paragraph 37.7(3)“j.”
  • At-home recovery visits while the covered individual is covered under the policy or certificate and not otherwise excluded.
  • At-home recovery visits received during the period the covered individual is receiving Medicare-approved home care services or no more than eight weeks after the service date of the last Medicare-approved home health care visit.
    •     (3)   Coverage is excluded for:    1.   Home care visits paid for by Medicare or other government programs; and    2.   Care provided by family members, unpaid volunteers or providers who are not care providers.        37.7(4) Elements required in standardized 1990 Medicare supplement benefit plans.  The additional benefits described in subrule 37.7(3) shall be included in 1990 Medicare supplement benefit plans as specified for each 1990 plan as follows:    a.    Plan A shall be limited to the basic core benefits, as defined in subrule 37.7(2).    b.    Plan B shall include only the following: basic core benefits as set forth in subrule 37.7(2), plus the Medicare Part A deductible as defined in paragraph 37.7(3)“a.”    c.    Plan C shall include only the following: basic core benefits as set forth in subrule 37.7(2), plus the Medicare Part A deductible, skilled nursing facility care, Medicare Part B deductible, and medically necessary emergency care in a foreign country as defined in paragraphs 37.7(3)“a,”“b,”“c,” and “h,” respectively.    d.    Plan D shall include only the following: basic core benefits as set forth in subrule 37.7(2), plus the Medicare Part A deductible, skilled nursing facility care, medically necessary emergency care in a foreign country, and the at-home recovery benefit as defined in paragraphs 37.7(3)“a,”“b,”“h,” and “j,” respectively.    e.    Plan E shall include only the following: basic core benefits as set forth in subrule 37.7(2), plus the Medicare Part A deductible, skilled nursing facility care, medically necessary emergency care in a foreign country, and preventive medical care as defined in paragraphs 37.7(3)“a,”“b,”“h,” and “i,” respectively.    f.    Plan F shall include only the following: basic core benefits as set forth in subrule 37.7(2), plus the Medicare Part A deductible, skilled nursing facility care, the Medicare Part B deductible, 100 percent of the Medicare Part B excess charges, and medically necessary emergency care in a foreign country as defined in paragraphs 37.7(3)“a,”“b,”“c,”“e,” and “h,” respectively.    g.    Plan G shall include only the following: basic core benefits as set forth in subrule 37.7(2), plus the Medicare Part A deductible, skilled nursing facility care, 80 percent of the Medicare Part B excess charges, medically necessary emergency care in a foreign country, and the at-home recovery benefit as defined in paragraphs 37.7(3)“a,”“b,”“d,”“h,” and “j,” respectively.    h.    Plan H shall consist of only the following: basic core benefits as set forth in subrule 37.7(2), plus the Medicare Part A deductible, skilled nursing facility care, basic prescription drug benefit, and medically necessary emergency care in a foreign country as defined in paragraphs 37.7(3)“a,”“b,”“f,” and “h,” respectively. The outpatient prescription drug benefit shall not be included in a 1990 plan sold after December 31, 2005.    i.    Plan I shall consist of only the following: basic core benefits as set forth in subrule 37.7(2), plus the Medicare Part A deductible, skilled nursing facility care, 100 percent of the Medicare Part B excess charges, basic prescription drug benefit, medically necessary emergency care in a foreign country, and at-home recovery benefit as defined in paragraphs 37.7(3)“a,”“b,”“e,”“f,”“h,” and “j,” respectively. The outpatient prescription drug benefit shall not be included in a 1990 plan sold after December 31, 2005.    j.    Plan J shall consist of only the following: basic core benefits as set forth in subrule 37.7(2), plus the Medicare Part A deductible, skilled nursing facility care, Medicare Part B deductible, 100 percent of the Medicare Part B excess charges, extended prescription drug benefit, medically necessary emergency care in a foreign country, preventive medical care, and at-home recovery benefit as defined in paragraphs 37.7(3)“a,”“b,”“c,”“e,”“g,”“h,”“i,” and “j,” respectively. The outpatient prescription drug benefit shall not be included in a 1990 plan sold after December 31, 2005.    k.    High deductible Plan F shall include only the following: 100 percent of covered expenses following the payment of the annual high deductible Plan F deductible. The covered expenses include the basic core benefits as set forth in subrule 37.7(2), plus the Medicare Part A deductible, skilled nursing facility care, the Medicare Part B deductible, 100 percent of the Medicare Part B excess charges, and medically necessary emergency care in a foreign country as defined in paragraphs 37.7(3)“a,”“b,”“c,”“e,” and “h,” respectively. The annual high deductible Plan F deductible shall consist of out-of-pocket expenses, other than premiums, for services covered by the Plan F policy, and shall be in addition to any other specific benefit deductibles. The annual high deductible Plan F deductible shall be $1,500 for 1998 and 1999, and shall be based on the calendar year. It shall be adjusted annually thereafter by the Secretary to reflect the change in the consumer price index for all urban consumers for the 12-month period ending with August of the preceding year, and rounded to the nearest multiple of $10.    l.    High deductible Plan J shall consist of only the following: 100 percent of covered expenses following the payment of the annual high deductible Plan J deductible. The covered expenses include the basic core benefits as set forth in subrule 37.7(2), plus the Medicare Part A deductible, skilled nursing facility care, Medicare Part B deductible, 100 percent of the Medicare Part B excess charges, extended outpatient prescription drug benefit, medically necessary emergency care in a foreign country, preventive medical care benefit, and at-home recovery benefit as defined in paragraphs 37.7(3)“a,”“b,”“c,”“e,”“g,”“h,”“i,” and “j,” respectively. The annual high deductible Plan J deductible shall consist of out-of-pocket expenses, other than premiums, for services covered by the Medicare supplement Plan J policy, and shall be in addition to any other specific benefit deductibles. The annual deductible shall be $1,500 for 1998 and 1999, and shall be based on a calendar year. It shall be adjusted annually thereafter by the Secretary to reflect the change in the consumer price index for all urban consumers for the 12-month period ending with August of the preceding year, and rounded to the nearest multiple of $10. The outpatient prescription drug benefit shall not be included in a 1990 plan sold after December 31, 2005.    m.    Plan K shall consist of the following:    (1)   Coverage of 100 percent of the Part A hospital coinsurance amount for each day used from the sixty-first day through the ninetieth day in any Medicare benefit period;    (2)   Coverage of 100 percent of the Part A hospital coinsurance amount for each Medicare lifetime inpatient reserve day used from the ninety-first day through the one hundred fiftieth day in any Medicare benefit period;    (3)   Upon exhaustion of the Medicare hospital inpatient coverage, including the lifetime reserve days, coverage of 100 percent of the Medicare Part A eligible expenses for hospitalization paid at the applicable PPS rate, or other appropriate Medicare standard of payment, subject to a lifetime maximum benefit of an additional 365 days. The provider shall accept the issuer’s payment in full and may not bill the covered individual for any balance;    (4)   Medicare Part A deductible: coverage for 50 percent of the Medicare Part A inpatient hospital deductible amount per benefit period until the out-of-pocket limitation is met as described in subparagraph 37.7(4)“m”(10);    (5)   Skilled nursing facility care: coverage for 50 percent of the coinsurance amount for each day used from the twenty-first day through the one hundredth day in a Medicare benefit period for post-hospital skilled nursing facility care eligible under Medicare Part A until the out-of-pocket limitation is met as described in subparagraph 37.7(4)“m”(10);    (6)   Hospice care: coverage for 50 percent of cost sharing for all Part A Medicare-eligible expenses and respite care until the out-of-pocket limitation is met as described in subparagraph 37.7(4)“m”(10);    (7)   Coverage for 50 percent, under Medicare Part A or B, of the reasonable cost of the first three pints of blood (or equivalent quantities of packed red blood cells, as defined under federal regulations) unless replaced in accordance with federal regulations until the out-of-pocket limitation is met as described in subparagraph 37.7(4)“m”(10);    (8)   Except for coverage provided in subparagraph 37.7(4)“m”(9), coverage for 50 percent of the cost sharing otherwise applicable under Medicare Part B after the covered individual pays the Part B deductible until the out-of-pocket limitation is met as described in subparagraph 37.7(4)“m”(10);    (9)   Coverage of 100 percent of the cost sharing for Medicare Part B preventive services after the covered individual pays the Part B deductible; and    (10)   Coverage of 100 percent of all cost sharing under Medicare Parts A and B for the balance of the calendar year after the individual has reached the out-of-pocket limitation on annual expenditures under Medicare Parts A and B of $4,000 in 2006, indexed each year by the appropriate inflation adjustment specified by the Secretary.    n.    Plan L shall consist of the following:    (1)   The benefits described in subparagraphs 37.7(4)“m”(1), (2), (3), and (9);    (2)   The benefits described in subparagraphs 37.7(4)“m”(4), (5), (6), (7) and (8), but substituting 75 percent for 50 percent in each subparagraph; and    (3)   The benefit described in paragraph 37.7(4)“m”(10), but substituting $2,000 for $4,000.    37.7(5)   Elements required in Medicare supplement plans mandated by the MMA. The 1990 plans mandated by the MMA, Plans K and L, shall include the benefits described for each plan, as follows:    a.    Plan K mandated by the MMA shall consist of only those benefits described in paragraph 37.7(4)“m.”    b.    Plan L mandated by the MMA shall consist of only those benefits described in paragraph 37.7(4)“n.”    37.7(6)   New or innovative benefits. An issuer may, with the prior approval of the commissioner, offer policies or certificates with new or innovative benefits in addition to the benefits provided in a policy or certificate that otherwise complies with the applicable standards. The new or innovative benefits may include benefits that are appropriate to Medicare supplement insurance, new or innovative, not otherwise available, cost-effective, and offered in a manner which is consistent with the goal of simplification of Medicare supplement policies. After December 31, 2005, the innovative benefit shall not include an outpatient prescription drug benefit.

    191—37.8(514D) Benefit standards for 2010 standardized Medicare supplement benefit plan policies or certificates issued for delivery with an effective date for coverage on or after June 1, 2010, and with an effective date for coverage prior to January 1, 2020 (2010 plans).  The following standards are applicable to all Medicare supplement policies or certificates delivered or issued for delivery in this state with an effective date for coverage on or after June 1, 2010, and effective for coverage prior to January 1, 2020. No policy or certificate was to be advertised, solicited, delivered, or issued for delivery in this state as a Medicare supplement policy or certificate during that time period unless it complied with the benefit standards set forth in this rule. No issuer may offer any 1990 standardized Medicare supplement benefit plan for sale on or after June 1, 2010. Benefit standards applicable to Medicare supplement policies and certificates issued before June 1, 2010, remain subject to the requirements of rule 191—37.6(514D) or 191—37.7(514D).    37.8(1) General standards.  The following standards apply to 2010 plans and are in addition to all other requirements of this chapter.    a.    Combinations of benefits other than standard not allowed.No groups, packages or combinations of Medicare supplement benefits other than those listed in this rule shall be offered for sale in this state, except as may be permitted in subrule 37.8(5) and rule 191—37.20(514D).    b.    Uniformity and conformity.All 2010 plans shall be uniform in structure, language, designation and format to the standard benefit plans listed in subrule 37.8(4), and shall conform to the definitions in rules 191—37.3(514D) and 191—37.4(514D). Each benefit plan shall be structured in accordance with the format provided in subrules 37.8(2), 37.8(3) and 37.8(4), or in the case of Plan K or L, each benefit plan shall be structured in accordance with the format provided in paragraph 37.8(4)“h” or “i.” Each plan shall list the benefits in the order shown. For purposes of this rule, “structure, language, and format” means style, arrangement and overall content of a benefit.    c.    Other designations may be used.An issuer may use, in addition to the benefit plan designations required in paragraph 37.8(1)“b,” other designations to the extent permitted by law.    d.    Preexisting conditions.A 2010 plan shall not exclude or limit benefits for losses incurred more than six months from the effective date of coverage because the losses involved a preexisting condition. The 2010 plan may not define a preexisting condition more restrictively than a condition for which medical advice was given or treatment was recommended by or received from a physician within six months before the effective date of coverage.    e.    Sickness same as accident.A 2010 plan shall not indemnify against losses resulting from sickness on a different basis than losses resulting from accidents.    f.    Automatic change of cost sharing.A 2010 plan shall provide that benefits designed to cover cost-sharing amounts under Medicare will be changed automatically to coincide with any changes in the applicable Medicare deductible, copayment, or coinsurance amounts. Premiums may be modified to correspond with such changes.    g.    Termination of coverage of spouse.No 2010 plan shall provide for termination of coverage of a spouse solely because of the occurrence of an event specified for termination of coverage of the named insured or group member, other than the nonpayment of premium.    h.    Guaranteed renewability.Each 2010 plan shall be guaranteed renewable.    (1)   The issuer shall not cancel or nonrenew the policy or certificate solely on the ground of health status of the covered individual.    (2)   The issuer shall not cancel or nonrenew the 2010 plan for any reason other than nonpayment of premium or material misrepresentation.    (3)   If a group 2010 plan is terminated by the group policyholder and is not replaced as provided under subparagraph 37.8(1)“h”(5), the issuer shall offer covered individuals a conversion opportunity to an individual 2010 plan which, at the option of the covered individual, either:    1.   Provides for continuation of the benefits contained in the group 2010 plan; or    2.   Provides for benefits that otherwise meet the requirements of this subrule.    (4)   If a covered individual under a group 2010 plan terminates membership in the group, the issuer shall:    1.   Offer the covered individual the conversion opportunity described in subparagraph 37.8(1)“h”(3); or    2.   At the option of the group policyholder, offer the covered individual continuation of coverage under the group 2010 plan.    (5)   If a group 2010 plan is replaced by another group Medicare supplement policy purchased by the same group policyholder, the issuer of the replacement group Medicare supplement policy shall offer coverage under the replacement group Medicare supplement policy to all covered individuals of the replaced group 2010 plan on the effective date of termination of the replaced group 2010 plan. Coverage under the replacement group Medicare supplement policy shall not result in any exclusion for any covered individual’s preexisting conditions that would have been covered under the replaced group 2010 plan.    i.    Termination involving continuous loss.Termination of a 2010 plan policy or certificate shall be without prejudice to any continuous loss which commenced while the policy or certificate was in force, but the extension of benefits beyond the period during which the policy or certificate was in force may be conditioned upon the continuous total disability of the covered individual, limited to the duration of the policy or certificate benefit period, if any, or payment of the maximum benefits. Receipt of Medicare Part D benefits will not be considered in determining a continuous loss.    j.    Suspension for Title XIX coverage.    (1)   A 2010 plan shall provide that benefits and premiums under the policy or certificate shall be suspended at the request of the covered individual for the period (not to exceed 24 months) in which the covered individual has applied for and is determined to be entitled to medical assistance under Title XIX of the Social Security Act, but only if the covered individual notifies the issuer of the policy or certificate within 90 days after the date the covered individual becomes entitled to assistance.    (2)   If such suspension occurs and if the covered individual loses entitlement to medical assistance, the policy or certificate shall be automatically reinstituted effective as of the date of termination of entitlement if the covered individual provides notice of loss of entitlement within 90 days after the date of loss and pays the premium attributable to the period, effective as of the date of termination of entitlement.    (3)   Each 2010 plan shall provide that benefits and premiums under the 2010 plan shall be suspended (for any period that may be provided by federal regulation) at the request of the covered individual if the covered individual is entitled to benefits under Section 226(b) of the Social Security Act and is covered under a group health plan as defined in Section 1862(b)(1)(A)(v) of the Social Security Act. If suspension occurs and if the covered individual loses coverage under the group health plan, the 2010 plan policy or certificate shall be automatically reinstituted effective as of the date of loss of coverage if the covered individual provides notice to the issuer of loss of coverage within 90 days after the date of the loss and pays the premium attributable to the period, effective as of the date of termination of such entitlement.    (4)   Reinstitution of coverage as described in subparagraphs 37.8(1)“j”(2) and (3):    1.   Shall not provide for any waiting period with respect to treatment of preexisting conditions;    2.   Shall provide for resumption of coverage that is substantially equivalent to coverage in effect before the date of suspension; and    3.   Shall provide for classification of premiums on terms at least as favorable to the covered individual as the premium classification terms that would have applied to the covered individual had the coverage not been suspended.    37.8(2) Standards for basic core benefits common to 2010 standardized Medicare supplement benefit Plans A, B, C, D, F, F with high deductible, G, M, and N (2010 basic core benefits).      a.    Availability of basic core benefits required.Every issuer of 2010 plans shall make available to each prospective covered individual a 2010 plan including only the following 2010 basic core benefits. An issuer may make available to a prospective covered individual any of the issuer’s other Medicare supplement benefit plans in addition to the 2010 plan of basic core benefits, but not in lieu thereof.    b.    When issuer must make certain plans available.If an issuer makes available any of the additional benefits described in subrule 37.8(3) or offers standardized benefit Plans K or L (as described in paragraphs 37.8(4)“h” and “i”), then the issuer shall make available to each prospective covered individual, in addition to a policy form or certificate form with only the 2010 plan basic core benefits as set forth in paragraph 37.8(2)“c,” a policy form or certificate form containing either standardized benefit Plan C (as described in paragraph 37.8(4)“c”) or a standardized benefit Plan F (as described in paragraph 37.8(4)“e”).    c.    2010 plan basic core benefits.The 2010 plan basic core benefits shall include the following:    (1)   Hospitalization days 61 through 90: coverage of Part A Medicare-eligible expenses for hospitalization, to the extent not covered by Medicare, from the sixty-first day through the ninetieth day in any Medicare benefit period;    (2)   Hospitalization for reserve days: coverage of Part A Medicare-eligible expenses incurred for hospitalization to the extent not covered by Medicare for each Medicare lifetime inpatient reserve day used;    (3)   Hospitalization for additional 365 days: upon exhaustion of the Medicare hospital inpatient coverage, including the lifetime reserve days, coverage of 100 percent of the Medicare Part A eligible expenses for hospitalization paid at the applicable PPS rate, or other appropriate Medicare standard of payment, subject to a lifetime maximum benefit of an additional 365 days. Medicare requires that the provider shall accept the issuer’s payment as payment in full and that the provider may not bill the covered individual for any balance;    (4)   Blood: coverage under Medicare Parts A and B for the reasonable cost of the first three pints of blood (or equivalent quantities of packed red blood cells, as defined under federal regulations) unless replaced in accordance with federal regulations;    (5)   Coinsurance: coverage for the coinsurance amount or, in the case of hospital outpatient department services paid under a PPS, the copayment amount of Medicare-eligible expenses under Part B regardless of hospital confinement, subject to the Medicare Part B deductible; and    (6)   Hospice care: coverage of cost sharing for all Part A Medicare-eligible hospice care and respite care expenses.    37.8(3) Standards for 2010 plan additional benefits.  The following additional benefits shall be included in 2010 plan Plans B, C, D, F, F with high deductible, G, M, and N as provided by subrule 37.8(4):    a.    Medicare Part A deductible: coverage for 100 percent of the Medicare Part A inpatient hospital deductible amount per benefit period;    b.    Medicare Part A deductible: coverage for 50 percent of the Medicare Part A inpatient hospital deductible amount per benefit period;    c.    Skilled nursing facility care: coverage for the actual billed charges up to the coinsurance amount from the twenty-first day through the one hundredth day in a Medicare benefit period for post-hospital skilled nursing facility care eligible under Medicare Part A;    d.    Medicare Part B deductible: coverage for 100 percent of the Medicare Part B deductible amount per calendar year regardless of hospital confinement;    e.    One hundred percent of the Medicare Part B excess charges: coverage for all of the difference between the actual Medicare Part B charges as billed, not to exceed any charge limitation established by the Medicare program or state law, and the Medicare-approved Part B charge; and    f.    Medically necessary emergency care in a foreign country: coverage to the extent not covered by Medicare for 80 percent of the billed charges for Medicare-eligible expenses for medically necessary emergency hospital, physician and medical care received in a foreign country, which care would have been covered by Medicare if provided in the United States and which care began during the first 60 consecutive days of each trip outside the United States, subject to a calendar year deductible of $250 and a lifetime maximum benefit of $50,000. For purposes of this benefit, “emergency care” shall mean care needed immediately because of an injury or an illness of sudden and unexpected onset.    37.8(4) Elements required in standardized 2010 Medicare supplement benefit plans.  The 2010 plans shall include the benefits, as described for each plan, as follows:    a.    Plan A shall include only the following: the basic core benefits as set forth in subrule 37.8(2).    b.    Plan B shall include only the following: the basic core benefits as set forth in subrule 37.8(2), plus 100 percent of the Medicare Part A deductible as defined in paragraph 37.8(3)“a.”    c.    Plan C shall include only the following: the basic core benefits as set forth in subrule 37.8(2), plus 100 percent of the Medicare Part A deductible, skilled nursing facility care, 100 percent of the Medicare Part B deductible, and medically necessary emergency care in a foreign country as defined in paragraphs 37.8(3)“a,”“c,”“d,” and “f,” respectively.    d.    Plan D shall include only the following: the basic core benefits as set forth in subrule 37.8(2), plus 100 percent of the Medicare Part A deductible, skilled nursing facility care, and medically necessary emergency care in a foreign country as defined in paragraphs 37.8(3)“a,”“c,” and “f,” respectively.    e.    Plan F shall include only the following: the basic core benefits as set forth in subrule 37.8(2), plus 100 percent of the Medicare Part A deductible, skilled nursing facility care, 100 percent of the Medicare Part B deductible, 100 percent of the Medicare Part B excess charges, and medically necessary emergency care in a foreign country as defined in paragraphs 37.8(3)“a,”“c,”“d,”“e,” and “f,” respectively.    f.    Plan F with high deductible.    (1)   Plan F with high deductible shall include only the following:    1.   One hundred percent of covered expenses following the payment of the annual deductible set forth in subparagraph 37.8(4)“f”(2).    2.   The basic core benefits as set forth in subrule 37.8(2), plus 100 percent of the Medicare Part A deductible, skilled nursing facility care, 100 percent of the Medicare Part B deductible, 100 percent of the Medicare Part B excess charges, and medically necessary emergency care in a foreign country as defined in paragraphs 37.8(3)“a,”“c,”“d,”“e,” and “f,” respectively.    (2)   The annual deductible in Plan F with high deductible shall consist of out-of-pocket expenses, other than premiums, for services covered by (regular) Plan F, and shall be in addition to any other specific benefit deductibles. The basis for the deductible shall be $1,500 and shall be adjusted annually from 1999 by the Secretary to reflect the change in the consumer price index for all urban consumers for the 12-month period ending with August of the preceding year, and rounded to the nearest multiple of $10.    g.    Plan G shall include only the following: the core benefits as set forth in subrule 37.8(2), plus 100 percent of the Medicare Part A deductible, skilled nursing facility care, 100 percent of the Medicare Part B excess charges, and medically necessary emergency care in a foreign country as defined in paragraphs 37.8(3)“a,”“c,”“e,” and “f,” respectively.     h.    Plan K is mandated by the MMA and shall include only the following:    (1)   Medicare Part A hospital coinsurance from the sixty-first day through the ninetieth day: coverage of 100 percent of the Part A hospital coinsurance amount for each day used from the sixty-first day through the ninetieth day in any Medicare benefit period;    (2)   Medicare Part A hospital coinsurance from the ninety-first day through the one hundred fiftieth day: coverage of 100 percent of the Part A hospital coinsurance amount for each Medicare lifetime inpatient reserve day used from the ninety-first day through the one hundred fiftieth day in any Medicare benefit period;    (3)   Medicare Part A hospitalization after lifetime reserve days are exhausted: upon exhaustion of the Medicare hospital inpatient coverage, including the lifetime reserve days, coverage of 100 percent of the Medicare Part A eligible expenses for hospitalization paid at the applicable PPS rate, or other appropriate Medicare standard of payment, subject to a lifetime maximum benefit of an additional 365 days. The provider shall accept the issuer’s payment as payment in full and may not bill the covered individual for any balance;    (4)   Medicare Part A deductible: coverage for 50 percent of the Medicare Part A inpatient hospital deductible amount per benefit period until the out-of-pocket limitation is met as described in subparagraph 37.8(4)“h”(10);    (5)   Skilled nursing facility care: coverage for 50 percent of the coinsurance amount for each day used from the twenty-first day through the one hundredth day in a Medicare benefit period for post-hospital skilled nursing facility care eligible under Medicare Part A until the out-of-pocket limitation is met as described in subparagraph 37.8(4)“h”(10);    (6)   Hospice care: coverage for 50 percent of cost sharing for all Medicare Part A eligible expenses and respite care until the out-of-pocket limitation is met as described in subparagraph 37.8(4)“h”(10);    (7)   Blood: coverage for 50 percent, under Medicare Part A or B, of the reasonable cost of the first three pints of blood (or equivalent quantities of packed red blood cells, as defined under federal regulations) unless replaced in accordance with federal regulations until the out-of-pocket limitation is met as described in subparagraph 37.8(4)“h”(10);    (8)   Medicare Part B cost sharing: except for coverage provided in subparagraph 37.8(4)“h”(9), coverage for 50 percent of the cost sharing otherwise applicable under Medicare Part B after the covered individual pays the Part B deductible until the out-of-pocket limitation is met as described in subparagraph 37.8(4)“h”(10);    (9)   Medicare Part B preventive services: coverage of 100 percent of the cost sharing for Medicare Part B preventive services after the covered individual pays the Medicare Part B deductible; and    (10)   Cost sharing after out-of-pocket limits reached: coverage of 100 percent of all cost sharing under Medicare Parts A and B for the balance of the calendar year after the individual has reached the out-of-pocket limitation on annual expenditures under Medicare Parts A and B of $4,000 in 2006, indexed each year by the appropriate inflation adjustment specified by the Secretary.    i.    Plan L is mandated by the MMA and shall include only the following:    (1)   The benefits described in subparagraphs 37.8(4)“h”(1), (2), (3) and (9);    (2)   The benefits described in subparagraphs 37.8(4)“h”(4), (5), (6), (7) and (8), but substituting 75 percent for 50 percent; and    (3)   The benefit described in subparagraph 37.8(4)“h”(10), but substituting $2,000 for $4,000.    j.    Plan M shall include only the following: the basic core benefits as set forth in subrule 37.8(2), plus 50 percent of the Medicare Part A deductible, skilled nursing facility care, and medically necessary emergency care in a foreign country as defined in paragraphs 37.8(3)“b,”“c,” and “f,” respectively.    k.    Plan N shall include only the following: the basic core benefits as set forth in subrule 37.8(2), plus 100 percent of the Medicare Part A deductible, skilled nursing facility care, and medically necessary emergency care in a foreign country as defined in paragraphs 37.8(3)“a,”“c,” and “f,” respectively, with copayments in the following amounts:    (1)   The lesser of $20 or the Medicare Part B coinsurance or copayment for each covered provider office visit (including visits to medical specialists); and    (2)   The lesser of $50 or the Medicare Part B coinsurance or copayment for each covered emergency room visit; however, this copayment shall be waived if the covered individual is admitted to any hospital and the emergency visit is subsequently covered as a Medicare Part A expense.    37.8(5) New or innovative benefits.  An issuer may, with the prior approval of the commissioner, offer policies or certificates with new or innovative benefits, in addition to the standardized benefits provided in a policy or certificate that otherwise complies with the applicable standards. The new or innovative benefits shall include only benefits that are appropriate to Medicare supplement insurance, are new or innovative, are not otherwise available, and are cost-effective. Approval of new or innovative benefits must not adversely impact the goal of Medicare supplement simplification. New or innovative benefits shall not include an outpatient prescription drug benefit. New or innovative benefits shall not be used to change or reduce benefits, including a change of any cost-sharing provision, in any standardized plan.

    191—37.9(514D) Standard Medicare supplement benefit plans for 2020 standardized Medicare supplement benefit plan policies or certificates issued for delivery to individuals newly eligible for Medicare on or after January 1, 2020.  The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires that the following standards are applicable to all Medicare supplement policies or certificates delivered or issued for delivery in this state to individuals newly eligible for Medicare on or after January 1, 2020. No policy or certificate that provides coverage of the Medicare Part B deductible may be advertised, solicited, delivered or issued for delivery in this state as a Medicare supplement policy or certificate to individuals newly eligible for Medicare on or after January 1, 2020. All policies must comply with the following benefit standards. Benefit plan standards applicable to Medicare supplement policies and certificates issued to individuals eligible for Medicare before January 1, 2020, remain subject to the requirements of rules 191—37.6(514D), 191—37.7(514D) and 191—37.8(514D).    37.9(1) Benefit requirements.  The standards and requirements of rule 191—37.8(514D) shall apply to all Medicare supplement policies or certificates delivered or issued for delivery to individuals newly eligible for Medicare on or after January 1, 2020, with the following exceptions:    a.    Plan C is redesignated as Plan D and shall provide the benefits contained in paragraph 37.8(4)“c” but shall not provide coverage for 100 percent or any portion of the Medicare Part B deductible.    b.    Plan F is redesignated as Plan G and shall provide the benefits contained in paragraph 37.8(4)“e” but shall not provide coverage for 100 percent or any portion of the Medicare Part B deductible.    c.    Plans C, F, and F with high deductible may not be offered to individuals newly eligible for Medicare on or after January 1, 2020.     d.    Plan F with high deductible is redesignated as Plan G with high deductible and shall provide the benefits contained in paragraph 37.8(4)“f,” but shall not provide coverage for 100 percent or any portion of the Medicare Part B deductible; provided further that the Medicare Part B deductible paid by the covered individual shall be considered an out-of-pocket expense in meeting the annual high deductible.    e.    The reference to Plan C or F contained in paragraph 37.8(2)“b” is deemed a reference to Plan D or G for purposes of this rule.    37.9(2) Applicability to certain individuals.  This rule applies only to individuals who are newly eligible for Medicare on or after January 1, 2020, by reason of:    a.    Attaining age 65 on or after January 1, 2020; or    b.    Entitlement to benefits under Medicare Part A pursuant to Section 226(b) or 226A of the Social Security Act, or who are deemed to be eligible for benefits under Section 226(a) of the Social Security Act on or after January 1, 2020.    37.9(3) Guaranteed issue for eligible persons.  For purposes of rule 191—37.36(514D), in the case of any individual newly eligible for Medicare on or after January 1, 2020, any reference to a Medicare supplement Plan C or F (including Plan F with high deductible) shall be deemed to be a reference to Medicare supplement Plan D or G (including Plan G with high deductible), respectively, that meets the requirements of this rule.    37.9(4) Offer of redesignated plans to individuals other than newly eligible.  On or after January 1, 2020, the standardized benefit plans described in paragraph 37.9(1)“d” may be offered to any individual who was eligible for Medicare prior to January 1, 2020, in addition to the standardized plans described in subrule 37.8(4).

    191—37.10()    Reserved.

    191—37.11()    Reserved.

    191—37.12()    Reserved.

    191—37.13()    Reserved.

    191—37.14()    Reserved.

    191—37.15()    Reserved.

    191—37.16()    Reserved.

    191—37.17()    Reserved.

    191—37.18()    Reserved.

    191—37.19()    Reserved.

    191—37.20(514D) Medicare Select policies and certificates.      37.20(1) Applicability of this rule.      a.    Rule 191—37.20(514D) shall apply to Medicare Select policies and certificates, as defined in this rule.    b.    No policy or certificate may be advertised as a Medicare Select policy or certificate unless it meets the requirements of this rule.    37.20(2) Definitions.  For the purposes of this rule, in addition to the definitions of Iowa Code section 514D.2, and of rules 191—37.3(514D) and 191—37.4(514D), the following definitions shall apply:        "Complaint" means any dissatisfaction expressed by a covered individual concerning a Medicare Select issuer or a Medicare Select network provider.        "Grievance" means dissatisfaction expressed in writing by a covered individual under a Medicare Select policy or certificate with the administration, claims practices, or provision of services concerning a Medicare Select issuer or its Medicare Select network providers.        "Medicare Select issuer" means an issuer offering, or seeking to offer, a Medicare Select policy or certificate.        "Medicare Select network provider" means a provider of health care, or a group of providers of health care, which has entered into a written agreement with a Medicare Select issuer to provide benefits insured under a Medicare Select policy or certificate.        "Medicare Select policy" means a Medicare supplement individual policy that contains a restricted network provision; “Medicare Select certificate” means an individual’s certificate of coverage under a group Medicare supplement policy that contains restricted network provisions; and “Medicare Select policy or certificate” means either a Medicare Select policy or a Medicare Select certificate.        "Restricted network provision" means any provision in a Medicare Select policy or certificate which conditions the payment of benefits, in whole or in part, on the use of Medicare Select network providers belonging to a network specified by the Medicare Select policy or certificate.        "Service area" means the geographic area, approved by the commissioner as part of the Medicare Select issuer’s plan of operation, within which the Medicare Select issuer is authorized to offer a Medicare Select policy or certificate.    37.20(3) Authorization to offer Medicare Select policies or certificates.  The commissioner may authorize an issuer to offer a Medicare Select policy or certificate, pursuant to this rule and Section 4358 of the Omnibus Budget Reconciliation Act (OBRA) of 1990, if the commissioner finds, upon review and approval of the plan of operation filed in accordance with subrule 37.20(5), that the issuer has satisfied all of the requirements of this chapter.    37.20(4) Prohibition against offering Medicare Select policies or certificates without approved plan of operation.  A Medicare Select issuer shall not issue a Medicare Select policy or certificate in this state until its plan of operation has been approved by the commissioner, and the commissioner has authorized the issuer to offer Medicare Select policies or certificates, pursuant to subrule 37.20(3).    37.20(5) Medicare Select issuer shall file a proposed plan of operation.  An issuer shall file a proposed plan of operation with the commissioner in a format prescribed by the commissioner and receive approval of the proposed plan from the commissioner prior to offering Medicare Select policies or certificates. The plan of operation shall contain at a minimum all of the information required by paragraphs 37.20(5)“a” through “g” as follows:    a.    Evidence that all services covered under the Medicare Select policies or certificates that are subject to restricted network provisions are available and accessible through Medicare Select network providers, including a demonstration that the issuer has met all of the conditions in subparagraphs 37.20(5)“a”(1) through (5) as follows:    (1)   Such services can be provided by Medicare Select network providers with reasonable promptness with respect to geographic location, hours of operation and after-hours care. The hours of operation and availability of after-hours care shall reflect usual practice in the local area. Geographic availability shall reflect the usual travel times within the community.    (2)   The number of Medicare Select network providers in the service area is sufficient, with respect to current and expected covered individuals, either:    1.   To adequately deliver all services that are subject to a restricted network provision; or    2.   To make appropriate referrals.    (3)   There are written agreements with Medicare Select network providers describing specific responsibilities.    (4)   Emergency care is available 24 hours per day and seven days per week.    (5)   In the case of covered services that are subject to a restricted network provision and are provided on a prepaid basis, there are written agreements with Medicare Select network providers prohibiting such Medicare Select network providers from billing or otherwise seeking reimbursement from or recourse against any covered individual under a Medicare Select policy or certificate. This paragraph shall not apply to supplemental charges or coinsurance amounts as stated in the Medicare Select policy or certificate.    b.    A statement or map providing a clear description of the service area.    c.    A description of the grievance procedure to be utilized, that is compliant with subrule 37.20(11).    d.    A description of the quality assurance program, including:    (1)   The formal organizational structure;    (2)   The written criteria for selection, retention and removal of Medicare Select network providers; and    (3)   The procedures for evaluating quality of care provided by Medicare Select network providers, and the process to initiate corrective action when warranted.    e.    A list and description, by specialty, of the Medicare Select network providers.    f.    Copies of the written information proposed to be used by the Medicare Select issuer to comply with subrule 37.20(9).    g.    Any other information requested by the commissioner.    37.20(6) Filing of changes and updates to Medicare Select issuer’s plan of operations.      a.    A Medicare Select issuer shall file any proposed changes to the plan of operation, except for changes to the list of Medicare Select network providers, with the commissioner prior to implementing such changes. Such changes shall be considered approved by the commissioner after 30 days unless specifically disapproved.    b.    An updated list of Medicare Select network providers shall be filed with the commissioner at least quarterly.    37.20(7) Use of restricted network provision prohibited under certain circumstances.  A Medicare Select policy or certificate issuer shall not apply a restricted network provision to limit a payment amount for covered services provided by providers that are not restricted network providers if:    a.    The services are for symptoms requiring emergency care or are immediately required for an unforeseen illness, injury or a condition; and    b.    It is not reasonable to obtain such services through a Medicare Select network provider.    37.20(8) Full coverage for services required under certain circumstances.  A Medicare Select policy or certificate shall provide payment for full coverage under the Medicare Select policy for covered services that are not available through Medicare Select network providers.    37.20(9) Content of required disclosure.  A Medicare Select issuer shall make full and fair disclosure in writing of the provisions, restrictions, and limitations of the Medicare Select policy or certificate to each applicant. This disclosure shall include at a minimum all of the information described in paragraphs 37.20(9)“a” through “g” as follows:    a.    An outline of coverage sufficient to permit the applicant to compare the coverage and premiums of the Medicare Select policy or certificate with:    (1)   Other Medicare supplement policies or certificates offered by the Medicare Select issuer; and    (2)   Other Medicare Select policies or certificates.    b.    A description (including address, telephone number and hours of operation) of the Medicare Select network providers, including primary care physicians, specialty physicians, hospitals and other providers.    c.    A description of the restricted network provisions, including payments for coinsurance and deductibles when providers other than Medicare Select network providers are utilized. Except to the extent specified in the Medicare Select policy or certificate, expenses incurred when using out-of-network providers do not count toward the out-of-pocket annual limit contained in Medicare Select Plans K and L.    d.    A description of coverage for emergency and urgently needed care and other out-of-service area coverage.    e.    A description of limitations on referrals to Medicare Select network providers and to other providers.    f.    A description of the covered individual’s rights to purchase any other Medicare supplement policy or certificate otherwise offered by the Medicare Select issuer.    g.    A description of the Medicare Select issuer’s quality assurance program and grievance procedure.    37.20(10) Acknowledgment.  Prior to the sale of a Medicare Select policy or certificate, a Medicare Select issuer shall obtain from the applicant a signed and dated form stating that the applicant has received the information provided pursuant to subrule 37.20(9) and that the applicant understands the restrictions of the Medicare Select policy or certificate.    37.20(11) Complaint and grievance procedures.  A Medicare Select issuer shall have and use procedures for hearing complaints and resolving written grievances from the covered individuals. Such procedures shall be aimed at mutual agreement for settlement and may include arbitration procedures.    a.    The grievance procedure shall be described in the Medicare Select policy or certificate and in the outline of coverage.    b.    At the time the Medicare Select policy or certificate is issued, the Medicare Select issuer shall provide detailed information to the covered individual describing how a grievance may be registered with the Medicare Select issuer.    c.    The Medicare Select issuer shall consider grievances in a timely manner and shall transmit them to appropriate decision makers who have authority to fully investigate the issue and take corrective action.    d.    If a grievance is found to be valid, corrective action shall be taken promptly.    e.    All concerned parties shall be notified by the Medicare Select issuer about the results of a grievance.    f.    The Medicare Select issuer shall report no later than each March 31 to the commissioner regarding its grievance procedure. The report shall be in a format prescribed by the commissioner and shall contain the number of grievances filed in the prior calendar year and a summary of the subject, nature and resolution of such grievances.    37.20(12) Opportunity to purchase another policy at time of purchase.  At the time of initial purchase, a Medicare Select issuer shall make available to each applicant for a Medicare Select policy or certificate the opportunity to purchase any Medicare supplement policy or certificate otherwise offered by the Medicare Select issuer.    37.20(13) Opportunity to purchase another policy after issue.      a.    At the request of a covered individual under a Medicare Select policy or certificate, a Medicare Select issuer shall make available to the covered individual the opportunity to purchase a Medicare supplement policy or certificate offered by the Medicare Select issuer which has comparable or lesser benefits and which does not contain a restricted network provision. The Medicare Select issuer shall make such policies or certificates available without requiring evidence of insurability after the Medicare Select policy or certificate has been in force for six months.    b.    For the purposes of this subrule, a Medicare supplement policy or certificate will be considered to have comparable or lesser benefits unless it contains one or more significant benefits not included in the Medicare Select policy or certificate being replaced. For the purposes of this paragraph, a significant benefit means coverage for the Medicare Part A deductible, coverage for at-home recovery services or coverage for Medicare Part B excess charges.    37.20(14) Continuation of coverage.  Medicare Select policies and certificates shall provide for continuation of coverage in the event the Secretary determines that Medicare Select policies and certificates issued pursuant to this rule should be discontinued due to either the failure of the Medicare Select program to be reauthorized under law or the substantial amendment of the Medicare Select program.    a.    Each Medicare Select issuer shall make available to each insured individual under a Medicare Select policy or certificate the opportunity to purchase any Medicare supplement policy or certificate offered by the Medicare Select issuer which has comparable or lesser benefits and which does not contain a restricted network provision. The Medicare Select issuer shall make such policies and certificates available without requiring evidence of insurability.    b.    For the purposes of this subrule, a Medicare supplement policy or certificate will be considered to have comparable or lesser benefits unless it contains one or more significant benefits not included in the Medicare Select policy or certificate being replaced. For the purposes of this paragraph, a significant benefit means coverage for the Medicare Part A deductible, coverage for at-home recovery services or coverage for Medicare Part B excess charges.    37.20(15) Compliance with data requests.  A Medicare Select issuer shall comply with reasonable requests for data made by state or federal agencies, including the U.S. Department of Health and Human Services, for the purpose of evaluating the Medicare Select program.

    191—37.21(514D) Open enrollment.      37.21(1) Denial of policy for health reason prohibited.  No issuer shall deny or condition the issuance or effectiveness of any Medicare supplement policy or certificate available for sale in this state, or discriminate in the pricing of such a Medicare supplement policy or certificate, because of the health status, claims experience, receipt of health care, or medical condition of an applicant in the case of an application for a Medicare supplement policy or certificate that is submitted prior to or during the six-month period beginning with the first day of the first month in which an individual is both 65 years of age or older and is enrolled for benefits under Medicare Part B. Each Medicare supplement policy and certificate currently available from an issuer shall be made available to all applicants who qualify under this subrule without regard to age.    37.21(2) When preexisting condition exclusion cannot be applied.      a.    Definition of “continuous period of creditable coverage.”For purposes of this subrule, “continuous period of creditable coverage” means the period during which a covered individual was covered by creditable coverage, if during the period of the coverage the covered individual had no breaks in coverage greater than 63 days.    b.    No preexisting condition exclusion.If an applicant under subrule 37.21(1) submits an application during the time period referenced in subrule 37.21(1) and, as of the date of application, has had a continuous period of creditable coverage of at least six months, the issuer shall not exclude benefits based on a preexisting condition.    c.    Reduced time of preexisting condition exclusion.If the applicant qualifies under subrule 37.21(1) and submits an application during the time period referenced in subrule 37.21(1) and, as of the date of application, has had a continuous period of creditable coverage that is less than six months, the Medicare Select issuer shall reduce the period of any preexisting condition exclusion by the aggregate of the period of creditable coverage applicable to the applicant as of the enrollment date. The Secretary shall specify the manner of the reduction under this subrule.    37.21(3) When benefits can be excluded because of preexisting condition.  Subrule 37.21(1) shall not be construed, except as provided in rule 191—37.33(514D) or 191—37.36(514D), as preventing the exclusion of benefits under a policy, during the first six months, based on a preexisting condition for which the covered individual received treatment or was otherwise diagnosed during the six months before the coverage became effective.

    191—37.22(514D) Standards for claims payment.      37.22(1) Compliance with OBRA.  An issuer shall comply with Section 1882(c)(3) of the Social Security Act (as enacted by Section 4081(b)(2)(C) of the Omnibus Budget Reconciliation Act of 1987 (OBRA) 1987, Pub. L. No. 100-203) by:    a.    Accepting a notice from an issuer on dually assigned claims submitted by participating providers and suppliers as a claim for benefits in place of any other claim form otherwise required and making a payment determination on the basis of the information contained in that notice;    b.    Notifying the participating provider or supplier and the beneficiary of the payment determination;    c.    Paying the participating provider or supplier directly;    d.    Furnishing, at the time of enrollment, each covered individual with a card listing the policy name, number and a central mailing address to which notices from an issuer may be sent;    e.    Paying user fees for claim notices that are transmitted electronically or otherwise; and    f.    Providing to the Secretary, at least annually, the issuer’s central mailing address to which all claims may be sent by other issuers.    37.22(2) Certification of compliance with OBRA.  Compliance with the requirements set forth in 37.22(1) shall be certified on the Medicare supplement insurance experience reporting form.

    191—37.23(514D) Loss ratio standards and refund or credit of premium.      37.23(1) Definitions.  For the purposes of this rule:        "Health care expenses" means expenses of health maintenance organizations associated with the delivery of health care services, which expenses are analogous to incurred losses of issuers.        "Type" means one of the following: an individual policy, a group policy, an individual Medicare Select policy, or a group Medicare Select policy.    37.23(2) Loss ratio standards.      a.    Calculations.    (1)   A Medicare supplement policy form or certificate form shall not be delivered or issued for delivery unless the Medicare supplement policy form or certificate form can be expected, as estimated for the entire period for which rates are computed to provide coverage, to return to covered individuals one of the following amounts in the form of aggregate benefits (not including anticipated refunds or credits) provided under the policy form or certificate form:    1.   At least 75 percent of the aggregate amount of premiums earned in the case of group Medicare supplement policies, or    2.   At least 65 percent of the aggregate amount of premiums earned in the case of individual Medicare supplement policies.    (2)   The percentages in subparagraph 37.23(2)“a”(1) are to be calculated on the basis of incurred claims experience or incurred health care expenses where coverage is provided by a health maintenance organization on a service rather than reimbursement basis and earned premiums for such period and in accordance with accepted actuarial principles and practices.    (3)   For purposes of subparagraph 37.23(2)“a”(2), “incurred health care expenses where coverage is provided by a health maintenance organization” shall not include:    1.   Home office and overhead costs;    2.   Advertising costs;    3.   Commissions and other acquisition costs;    4.   Taxes;    5.   Capital costs;    6.   Administrative costs; and    7.   Claims processing costs.    b.    Filing demonstration of compliance.All filings of rates and rating schedules shall demonstrate that expected claims in relation to premiums comply with the requirements of this rule when combined with actual experience to date. Filings of rate revisions shall also demonstrate that the anticipated loss ratio over the entire future period for which the revised rates are computed to provide coverage can be expected to meet the appropriate loss ratio standards.    c.    Certain direct sales.For purposes of applying paragraph 37.23(2)“a” only, policies issued as a result of solicitations of individuals through the mails or by mass media advertising (including both print and broadcast advertising) shall be deemed to be individual policies.    d.    Prestandardized plans.For all policies issued prior to January 1, 1992, expected claims in relation to premiums shall meet:    (1)   The originally filed anticipated loss ratio when combined with the actual experience from inception;    (2)   The appropriate loss ratio requirement from paragraphs “1” and “2” of subparagraph 37.23(1)“a”(1) when combined with actual experience beginning with January 1, 1996, to date; and    (3)   The appropriate loss ratio requirement from paragraphs “1” and “2” of subparagraph 37.23(1)“a”(1) over the entire future period for which rates are computed to provide coverage.    37.23(3) Refund or credit calculation.      a.    An issuer shall collect and file with the commissioner by May 31 of each year the data contained in the reporting form contained in Appendix A for each type in a standard Medicare supplement benefit plan (SMSBP).    b.    If, on the basis of the experience as reported, the benchmark ratio since inception (Appendix A, ratio 1) exceeds the adjusted experience ratio since inception (Appendix A, ratio 3), then a refund or credit calculation is required. The refund calculation shall be done on a statewide basis for each type in an SMSBP. For purposes of the refund or credit calculation, experience on SMSBP policies issued within the reporting year shall be excluded.    c.    For purposes of this rule, for SMSBP policies or certificates issued prior to January 1, 1992, the issuer shall make the refund or credit calculation separately for all individual SMSBP policies (including all group SMSBP policies subject to an individual loss ratio standard when issued) combined and all other group SMSBP policies combined for experience after January 1, 1996. The first report shall be due May 31, 1998.    d.    A refund or credit shall be made only when the benchmark loss ratio exceeds the adjusted experience loss ratio and the amount to be refunded or credited exceeds a de minimis level. Such refund shall include interest from the end of the calendar year to the date of the refund or credit at a rate specified by the Secretary, but in no event shall it be less than the average rate of interest for 13-week Treasury notes. A refund or credit against premiums due shall be made by September 30 following the experience year upon which the refund or credit is based.    37.23(4) Annual filing of premium rates.  An issuer of Medicare supplement policies and certificates issued before or after the effective date of January 1, 1992, in this state shall file annually its rates, rating schedule and supporting documentation including ratios of incurred losses to earned premiums by SMSBP policy duration for approval by the commissioner in accordance with the filing requirements and procedures prescribed by the commissioner.     a.    The supporting documentation shall also demonstrate in accordance with actuarial standards of practice using reasonable assumptions that the appropriate loss ratio standards can be expected to be met over the entire period for which rates are computed.    (1)   Such demonstration shall exclude active life reserves.    (2)   An expected third-year loss ratio which is greater than or equal to the applicable percentage shall be demonstrated for SMSBP policies or certificates in force less than three years.    b.    As soon as practicable, but prior to the effective date of enhancements in Medicare benefits, every issuer of Medicare supplement policies or certificates in this state shall file with the commissioner, in accordance with the applicable filing procedures of this state, the following:    (1)   Such supporting documents as necessary to justify that the adjustments are appropriate.    1.   Appropriate premium adjustments shall be those which:
  • Are necessary to produce loss ratios as anticipated for the current premium for the applicable SMSBP policies or certificates;
  • Are necessary to produce an expected loss ratio under such SMSBP policies or certificates as will conform with minimum loss ratio standards for SMSBP policies or certificates; and
  • Are expected to result in a loss ratio at least as great as that originally anticipated in the rates used to produce current premiums by the issuer for such SMSBP policies or certificates.
    •     2.   No premium adjustment which would modify the loss ratio experience under the SMSBP policy other than the adjustments described herein shall be made with respect to an SMSBP policy at any time other than upon its renewal date or anniversary date.    3.   If an issuer fails to make premium adjustments acceptable to the commissioner, the commissioner may order premium adjustments, refunds or premium credits deemed necessary to achieve the loss ratio required by this rule.        (2)   Any appropriate riders, endorsements or policy forms needed to accomplish the SMSBP policy or certificate modifications necessary to eliminate benefit duplications with Medicare. Such riders, endorsements or policy forms shall provide a clear description of the Medicare supplement benefits provided by the SMSBP policy or certificate.        37.23(5) Public hearings.  The commissioner may conduct a public hearing to gather information concerning a request by an issuer for an increase in a rate for an SMSBP policy form or certificate form issued before or after the effective date of January 1, 1992, if the experience of the form for the previous reporting period is not in compliance with the applicable loss ratio standard. The determination of compliance is to be made without consideration of any refund or credit for such reporting period. Public notice of such hearing shall be furnished in a manner deemed appropriate by the commissioner.

    191—37.24(514D) Filing and approval of policies and certificates and premium rates.      37.24(1) Definition.  For the purposes of this rule:        "Type" means one of the following: an individual policy, a group policy, an individual Medicare Select policy, or a group Medicare Select policy.    37.24(2) Form filing and approval required.  An issuer shall not deliver or issue for delivery a policy or certificate to a resident of this state unless the SMSBP policy form or certificate form has been filed pursuant to rule 191—20.1(505,509,514A,515,515A,515F) and approved by the commissioner.    37.24(3) MMA requirements to be filed with state of issue.  An issuer shall file any riders or amendments to SMSBP policy or certificate forms to delete outpatient prescription drug benefits as required by the MMA only with the commissioner in the state in which the policy or certificate was issued.    37.24(4) Rate filing and approval required.  An issuer shall not use or change premium rates for a Medicare supplement policy or certificate unless the rates, rating schedule and supporting documentation have been filed with and approved by the commissioner in accordance with the filing requirements and procedures prescribed by the commissioner.    37.24(5) One form per type.      a.    Except as provided in paragraph 37.24(5)“b,” an issuer shall not file for approval more than one form of a policy or certificate of each type for each SMSBP.    b.    An issuer may offer, with the approval of the commissioner, up to four additional policy forms or certificate forms of the same type for the same SMSBP, one for each of the following cases:    (1)   The inclusion of new or innovative benefits;    (2)   The addition of either direct response or producer marketing methods;    (3)   The addition of either guaranteed issue or underwritten coverage;    (4)   The offering of coverage to individuals eligible for Medicare by reason of disability.    37.24(6) Forms to be kept available once approved.      a.    Except as provided in subparagraph 37.24(6)“a”(1), an issuer shall continue to make available for purchase any SMSBP policy form or certificate form issued after January 1, 1992, that has been approved by the commissioner. An SMSBP policy form or certificate form shall not be considered to be available for purchase unless the issuer has actively offered it for sale in the previous 12 months.    (1)   An issuer may discontinue the availability of an SMSBP policy form or certificate form if the issuer provides to the commissioner in writing its decision at least 30 days prior to discontinuing the availability of the form of the SMSBP policy or certificate. After receipt of the notice by the commissioner, the issuer shall no longer offer for sale the SMSBP policy form or certificate form in this state.    (2)   An issuer that discontinues the availability of an SMSBP policy form or certificate form pursuant to subparagraph 37.24(6)“a”(1) shall not file for approval of a new SMSBP policy form or certificate form of the same type for the same SMSBP as the discontinued form for a period of five years after the issuer provides notice to the commissioner of the discontinuance. The period of discontinuance may be reduced if the commissioner determines that a shorter period is appropriate.    b.    The sale or other transfer of Medicare supplement business to another issuer shall be considered a discontinuance for the purposes of this subrule.    c.    A change in the rating structure or methodology shall be considered a discontinuance under paragraph 37.24(6)“a” unless the issuer complies with the following requirements:    (1)   The issuer provides an actuarial memorandum, in a form and manner prescribed by the commissioner, describing the manner in which the revised rating methodology and resultant rates differ from the existing rating methodology and resultant rates.    (2)   The issuer does not subsequently put into effect a change of rates or rating factors that would cause the percentage differential between the discontinued and subsequent rates as described in the actuarial memorandum to change. The commissioner may approve a change to the differential which is in the public interest.    37.24(7) Experience under forms of same type to be combined for calculations.      a.    Except as provided in paragraph 37.24(7)“b,” the experience under all SMSBP policy forms or certificate forms of the same type in an SMSBP shall be combined for purposes of the refund or credit calculation prescribed in rule 191—37.23(514D).    b.    Forms assumed under an assumption reinsurance agreement shall not be combined with the experience of other policy or certificate forms for purposes of the refund or credit calculation.

    191—37.25(514D) Permitted compensation arrangements.      37.25(1) Definition of “compensation.”  For purposes of this rule:        "Compensation" includes pecuniary or nonpecuniary remuneration of any kind relating to the sale or renewal of the Medicare supplement or Medicare Select policy or certificate including, but not limited to, bonuses, gifts, prizes, awards and finder’s fees.    37.25(2) Compensation to producer for sales.  An issuer or other entity may provide a commission or other compensation to a producer or other representative for the sale of a Medicare supplement policy or certificate only if the first-year commission or other first-year compensation is no more than 200 percent of the commission or other compensation paid for selling or servicing the Medicare supplement policy or certificate in the second year or period.    37.25(3) Compensation to producer for renewals.  The commission or other compensation provided in subsequent (renewal) years must be the same as that provided in the second year or period and must be provided for no fewer than five renewal years.    37.25(4) Compensation for renewals involving replacement.  No issuer or other entity shall provide compensation to its producers and no producer shall receive compensation greater than the renewal compensation payable by the replacing issuer on renewal Medicare supplement policies or certificates if an existing Medicare supplement policy or certificate is replaced.

    191—37.26(514D) Required notice regarding policies or certificates which are not Medicare supplement policies or certificates.      37.26(1) Issuer required to disclose that a policy is not a Medicare supplement policy.  An issuer of any accident and sickness insurance policy or certificate issued for delivery in this state to a person eligible for Medicare shall notify the insured under the policy that the policy is not a Medicare supplement policy or certificate, if the policy or certificate is not a Medicare supplement policy or certificate.     a.    The notice shall either be printed or attached to the first page of the outline of coverage delivered to the insured under the accident and sickness policy or, if no outline of coverage is delivered, to the first page of the policy or certificate delivered to the insured.    b.    The notice shall be in no less than 12-point type and shall contain the following language:“THIS [POLICY OR CERTIFICATE] IS NOT A MEDICARE SUPPLEMENT [POLICY OR CONTRACT]. If you are eligible for Medicare, review the Guide to Health Insurance for People with Medicare available from the company.”    c.    The notice requirement of this subrule 37.26(1) shall not apply to an accident and sickness insurance policy or certificate that is a Medicare supplement policy or certificate, a policy issued pursuant to a contract under Section 1876 of the federal Social Security Act (42 U.S.C. Section 1395 et seq.), a disability income policy, or any other policy excepted by rule 191—37.2(514D).    37.26(2) Issuer required to disclose extent of duplication of Medicare.  When providing an application to persons eligible for Medicare for the health insurance policies or certificates described in paragraph 37.17(4)“a,” issuers shall disclose the extent to which a policy duplicates Medicare. The disclosure shall use the applicable statement in Appendix B and shall be provided as a part of, or together with, the application for the policy or certificate.

    191—37.27(514D) Requirements for application forms and replacement coverage.      37.27(1) Application to include Appendix C.  Application forms for Medicare supplement policies or certificates shall include in the outline of coverage the “statements and questions for application forms related to duplicate or replacement coverage” set forth in Appendix C, in the order prescribed in Appendix C, designed to elicit the following information, as of the date of the application: whether the applicant currently has a Medicare supplement policy or certificate, a Medicare Advantage policy or certificate, or other Medicaid coverage; whether the applicant has another health insurance policy or certificate in force; or whether the applicant intends a Medicare supplement policy or certificate to replace any other accident and sickness policy or certificate presently in force. An additional page or form containing such questions and statements and the applicant’s responses may be used, but it must be signed by the applicant and producer, attached to the application, and kept together with the issuer’s records.    37.27(2) List of policies sold to applicant.  Producers shall list on the form or on an attachment to the form of Appendix C any other health insurance policies they have sold to the applicant, including the following:    a.    Policies sold which are still in force.    b.    Policies sold in the prior five years which are no longer in force.    37.27(3) Direct response sales.  In the case of a direct response issuer, a copy of the application or additional page or form, signed by the applicant and acknowledged by the issuer, shall be returned to the applicant by the issuer upon delivery of the policy and shall include the notice regarding replacement of Medicare supplement coverage required of direct response issuers by subrule 37.27(4).    37.27(4) Required notice regarding replacement.  Upon determining that a sale will involve replacement of Medicare supplement coverage, any issuer, other than a direct response issuer, or its producer, shall furnish the applicant, prior to issuance or delivery of the Medicare supplement policy or certificate, a notice regarding replacement of Medicare supplement coverage. The notice shall be provided in the format described in subrule 37.27(5). One copy of such notice signed by the applicant and the producer, except where the coverage is sold without a producer, shall be provided to the applicant, and an additional signed copy shall be retained by the issuer. A direct response issuer shall deliver to the applicant at the time of the issuance of the policy the notice regarding replacement of Medicare supplement coverage.    37.27(5) Required format of notice regarding replacement.  The notice required by subrule 37.27(4) for an issuer shall be provided in substantially the form and language of the Notice to Applicant regarding Replacement of Medicare Supplement Insurance or Medicare Advantage, as set forth in Appendix D, in no less than 12-point type. Statements 1 and 2 of the replacement notice of Appendix D (applicable to preexisting conditions) may be deleted by an issuer if the replacement does not involve application of a new preexisting condition limitation.

    191—37.28(514D) Required disclosure provisions.      37.28(1) General rules.      a.    A Medicare supplement policy or certificate shall include renewal or continuation provisions. The language or specifications of such provisions shall be consistent with the type of Medicare supplement policy issued. Such provisions shall be appropriately captioned and shall appear on the first page of the Medicare supplement policy or certificate, and shall include any reservations by the issuer of the right to change premiums and any automatic renewal premium increases based on the covered individual’s age.    b.    Except for a rider or an endorsement by which the issuer effectuates a request made in writing by the covered individual, exercises a specifically reserved right under a Medicare supplement policy or certificate, or is required to reduce or eliminate benefits to avoid duplication of Medicare benefits, any rider or endorsement added to a Medicare supplement policy or certificate after the date the policy or certificate is issued, or at reinstatement or renewal, which reduces or eliminates benefits or coverage in the policy or certificate shall require a signed acceptance by the covered individual. After the date of issue of a Medicare supplement policy or certificate, any rider or endorsement which increases benefits or coverage with a concomitant increase in premium during the policy term shall be agreed to in writing signed by the covered individual, unless the benefits are required by the minimum standards for Medicare supplement policies or certificates, or if the increased benefits or coverage is required by law. Where a separate additional premium is charged for benefits provided in connection with a rider or endorsement, such premium charge shall be set forth in the Medicare supplement policy or certificate.    c.    Medicare supplement policies or certificates shall not provide for the payment of benefits based on standards described as “usual and customary,” “reasonable and customary” or words of similar import.    d.    If a Medicare supplement policy or certificate contains any limitations with respect to preexisting conditions, such limitations shall appear as a separate paragraph of the Medicare supplement policy or certificate and be labeled as “Preexisting Condition Limitations.”    e.    A Medicare supplement policy or certificate shall have a notice prominently printed on the first page of the policy or certificate, or attached thereto, stating in substance that the covered individual shall have the right to return the Medicare supplement policy or certificate within 30 days of its delivery and to have the premium refunded if, after examination of the Medicare supplement policy or certificate, the covered individual is not satisfied for any reason.    f.    An issuer of an accident or sickness policy or certificate which provides hospital or medical expense coverage on an expense-incurred or indemnity basis to an individual eligible for Medicare shall provide to any applicant for such policy or certificate the most recent version of A Guide to Health Insurance for People with Medicare (“guide”), developed jointly by the National Association of Insurance Commissioners and CMS, using the same language, format, type size (no less than 12 point), type-proportional spacing, bold characters and line spacing. Delivery of the guide shall be made whether or not such policy or certificate was advertised, solicited or issued as a Medicare supplement policy or certificate as defined in this chapter. Except in the case of a direct response issuer, delivery of the guide shall be made to the applicant at the time of application and acknowledgment of receipt of the guide shall be obtained by the issuer. A direct response issuer shall deliver the guide to the applicant upon request but not later than at the time the Medicare supplement policy is delivered.    37.28(2) Notice requirements.      a.    As soon as practicable, but no later than 30 days prior to the annual effective date of any Medicare benefit changes, an issuer shall notify its covered individuals of modifications it has made to Medicare supplement policies or certificates in a format acceptable to the commissioner. The notice shall:    (1)   Include a description of revisions to the Medicare program and a description of each modification made to the coverage provided under the Medicare supplement policy or certificate; and    (2)   Inform each covered individual as to when any premium adjustment is to be made due to changes in Medicare.    b.    The notice of benefit modifications and any premium adjustments shall be in outline form and in clear and simple terms so as to facilitate comprehension.    c.    Such notices shall not contain or be accompanied by any solicitation.    37.28(3) MMA notice requirements.  Issuers shall comply with any notice requirements of the MMA.    37.28(4) Outline of coverage requirements for Medicare supplement policies.      a.    An issuer shall provide an outline of coverage to any applicant for a Medicare supplement policy or certificate at the time application is presented to the prospective applicant and, except for a direct response policy, shall obtain an acknowledgment of receipt of such outline of coverage from the applicant.    b.    If an outline of coverage is provided at the time of application and the Medicare supplement policy or certificate is issued on a basis which would require revision of the outline, the issuer shall provide a substitute outline of coverage properly describing the Medicare supplement policy or certificate to accompany such Medicare supplement policy or certificate when it is delivered to the covered individual, and the substitute outline of coverage shall contain the following statement, in no less than 12-point type, immediately above the issuer’s company name:“NOTICE: Read this outline of coverage carefully. It is not identical to the outline of coverage provided upon application and the coverage originally applied for has not been issued.”    c.    The outline of coverage provided to an applicant pursuant to this rule shall consist of the following four parts: a cover page; premium information; disclosure pages; and charts displaying the features of each Medicare supplement benefit plan offered by the issuer. The outline of coverage shall be in the language and format prescribed in this rule and in Appendix E in no less than 12-point type. All plans shall be shown on the cover page, and the plans that are offered by the issuer shall be prominently identified. Premium information for plans that are offered by the issuer shall be shown on the cover page or immediately following the cover page and shall be prominently displayed. The premium and mode shall be stated for all plans that are offered to the prospective applicant. All possible premiums for the prospective applicant shall be illustrated.    d.    The items in Appendix E shall be included in the outline of coverage in the order prescribed in Appendix E.

    191—37.29()    Reserved.

    191—37.30(514D) Standards for marketing.      37.30(1) Requirements for marketing.  An issuer, directly or through its producers, shall:    a.    Establish marketing procedures to ensure that any comparison of policies or certificates by its producers will be fair and accurate.    b.    Establish marketing procedures to ensure excessive insurance is not sold or issued.    c.    Display prominently by type, stamp or other appropriate means, on the first page of the policy or certificate, the following:“Notice to buyer: This policy may not cover all of your medical expenses.”    d.    Inquire and otherwise make every reasonable effort to identify whether a prospective covered individual for Medicare supplement policy or certificate already has accident and sickness insurance and the types and amounts of any such insurance.    e.    Establish auditable procedures for certifying compliance with this subrule.    f.    At solicitation, provide written notice to the prospective covered individual of the name, address, and telephone number of the senior health insurance information program, part of the insurance division. The written notice shall be in a form prescribed by the commissioner.    37.30(2) Prohibitions in marketing.  In addition to the practices prohibited in Iowa Code chapter 507B, 191—Chapter 15 and other rules promulgated under Iowa Code chapter 507B, and rule 191—37.50(514D), the following acts and practices are prohibited:    a.    Twisting.Knowingly making any misleading representation or incomplete or fraudulent comparison of any insurance policies or certificates, or of any issuers, for the purpose of inducing, or tending to induce, any person to lapse, forfeit, surrender, terminate, retain, pledge, assign, borrow on, or convert any insurance policy or certificate or to take out a policy or certificate of insurance with another issuer.    b.    High-pressure tactics.Employing any method of marketing having the effect of or tending to induce the purchase of insurance through force, fright, threat, whether explicit or implied, or undue pressure to purchase or recommend the purchase of insurance.    c.    Cold-lead advertising.Making use directly or indirectly of any method of marketing which fails to disclose in a conspicuous manner that a purpose of the method of marketing is solicitation of insurance and that contact will be made by an insurance producer or insurance company.    37.30(3) Prohibited terms in noncompliant policies or certificates.  The terms “Medicare supplement,” “Medigap,” “Medicare wrap-around” and words of similar import shall not be used unless the policy or certificate is issued in compliance with this chapter.

    191—37.31(514D) Appropriateness of recommended purchase and excessive insurance.      37.31(1) Appropriateness.  In recommending the purchase or replacement of any Medicare supplement policy or certificate, a producer shall make reasonable efforts to determine the appropriateness of a recommended purchase or replacement.    37.31(2) No duplication.  Any sale of a Medicare supplement policy or certificate that will provide an individual more than one Medicare supplement policy or certificate is prohibited.    37.31(3) No Medicare supplement for enrollee in Part C.  An issuer shall not issue a Medicare supplement policy or certificate to an individual enrolled in Medicare Part C unless the effective date of the coverage is after the termination date of the individual’s Medicare Part C coverage.

    191—37.32(514D) Reporting of multiple policies.      37.32(1) Report of in-force Medicare supplement covered individuals.  On or before March 1 of each year, an issuer shall report, using the format of Appendix F, the following information for every covered individual resident of this state for which the issuer has in force more than one Medicare supplement policy or certificate:    a.    Policy and certificate number; and    b.    Date of issuance.    37.32(2) Grouping of items.  The items set forth in subrule 37.21(1) must be grouped by covered individual.

    191—37.33(514D) Prohibition against preexisting conditions, waiting periods, elimination periods and probationary periods in replacement policies or certificates.      37.33(1) Time credited from prior policy or certificate.  If a Medicare supplement policy or certificate replaces another Medicare supplement policy or certificate, the replacing issuer shall waive any time periods applicable to preexisting conditions, waiting periods, elimination periods and probationary periods in the new replacing Medicare supplement policy or certificate to the extent such time was spent under the replaced policy.    37.33(2) Similar benefits credited from prior policy or certificate.  If a Medicare supplement policy or certificate replaces another Medicare supplement policy or certificate which has been in effect for at least six months, the replacing Medicare supplement policy or certificate shall not provide any time period applicable to preexisting conditions, waiting periods, elimination periods and probationary periods for benefits similar to those contained in the replaced policy or certificate.

    191—37.34(514D) Prohibitions against use of genetic information and against requests for genetic testing.  This rule applies to all Medicare supplement policies or certificates with policy years beginning on or after May 21, 2009.    37.34(1) Definitions.  For the purposes of this rule, the following definitions shall apply:        "Family member" means, with respect to an individual, any other individual who is a first-degree, second-degree, third-degree, or fourth-degree relative of such individual.        "Genetic information" means, with respect to any individual, information about such individual’s genetic tests, the genetic tests of family members of such individual, and the manifestation of a disease or disorder in family members of such individual. “Genetic information” includes, with respect to any individual, any request for, or receipt of, genetic services, or participation in clinical research which includes genetic services, by such individual or any family member of such individual. Any reference to genetic information concerning an individual or family member of an individual who is a pregnant woman includes genetic information of any fetus carried by such pregnant woman or, with respect to an individual or family member utilizing reproductive technology, includes genetic information of any embryo legally held by an individual or family member. The term “genetic information” does not include information about the sex or age of any individual.        "Genetic services" means a genetic test, genetic counseling (including obtaining, interpreting, or assessing genetic information), or genetic education.        "Genetic test" means an analysis of human DNA, RNA, chromosomes, proteins, or metabolites that detects genotypes, mutations, or chromosomal changes. The term “genetic test” does not mean:
    1. An analysis of proteins or metabolites that does not detect genotypes, mutations, or chromosomal changes; or
    2. An analysis of proteins or metabolites that is directly related to a manifested disease, disorder, or pathological condition that could reasonably be detected by a health care professional with appropriate training and expertise in the field of medicine involved.
            "Issuer of a Medicare supplement policy or certificate" means the same as “issuer” as defined in rule 191—37.3(514D) and includes a third-party administrator, or other person acting for or on behalf of such issuer.        "Underwriting purposes" means:
    1. Rules for or determination of eligibility (including enrollment and continued eligibility) for benefits under the Medicare supplement policy or certificate;
    2. The computation of premium or contribution amounts under the Medicare supplement policy or certificate;
    3. The application of any preexisting condition exclusion under the Medicare supplement policy or certificate; and
    4. Other activities related to the creation, renewal, or replacement of a contract of health insurance or health benefits.
        37.34(2) Use of genetic information by issuer prohibited.  An issuer of a Medicare supplement policy or certificate:    a.    Shall not deny or condition the issuance or effectiveness of the Medicare supplement policy or certificate (including the imposition of any exclusion of benefits under the policy based on a preexisting condition) of an individual on the basis of the genetic information with respect to such individual; and    b.    Shall not discriminate in the pricing of the Medicare supplement policy or certificate (including the adjustment of premium rates) of an individual on the basis of the genetic information with respect to such individual.    37.34(3) What prohibition does not include.  Nothing in subrule 37.34(2) shall be construed to limit the ability of an issuer of a Medicare supplement policy or certificate, to the extent otherwise permitted by law, from:    a.    Denying or conditioning the issuance or effectiveness of the Medicare supplement policy or certificate or increasing the premium for a group plan based on the manifestation of a disease or disorder of a covered individual or applicant; or    b.    Increasing the premium for any Medicare supplement policy or certificate issued to an individual based on the manifestation of a disease or disorder of another individual who is covered under the Medicare supplement policy. In such case, the manifestation of a disease or disorder in one individual cannot also be used as genetic information about other group members and to further increase the premium for the insured group.    37.34(4) Issuer prohibited from requiring genetic testing.  An issuer of a Medicare supplement policy or certificate shall not request or require an individual or a family member of such individual to undergo a genetic test.    37.34(5) Obtaining and using test results to determine payment.  Subrule 37.34(4) shall not be construed to preclude an issuer of a Medicare supplement policy or certificate from obtaining and using the results of a genetic test in making a determination regarding payment (as defined for the purposes of applying the regulations promulgated under Medicare Part C of Title XI and Section 264 of the Health Insurance Portability and Accountability Act of 1996, as may be revised from time to time) and consistent with subrule 37.34(2). However, for purposes of carrying out this subrule, an issuer of a Medicare supplement policy or certificate may request only the minimum amount of information necessary to accomplish the intended purpose.    37.34(6) Conditions when issuer may request a genetic test.  Notwithstanding subrule 37.34(4), an issuer of a Medicare supplement policy or certificate may request, but not require, that an individual or a family member of such individual undergo a genetic test if each of the following conditions is met:    a.    The request is made pursuant to research that complies with Part 46 of Title 45, Code of Federal Regulations, or equivalent federal regulations, and any applicable state or local law or regulations for the protection of human subjects in research.    b.    The issuer of a Medicare supplement policy or certificate clearly indicates to each individual, or in the case of a minor child, to the legal guardian of such child, to whom the request is made that:    (1)   Compliance with the request is voluntary; and    (2)   Noncompliance will have no effect on enrollment status or premium or contribution amounts.    c.    No genetic information collected or acquired under this subrule shall be used for underwriting, determination of eligibility to enroll or maintain enrollment status, premium rates, or the issuance, renewal, or replacement of a Medicare supplement policy or certificate.    d.    The issuer of a Medicare supplement policy or certificate notifies the Secretary in writing that the issuer of a Medicare supplement policy or certificate is conducting activities pursuant to the exception provided for under this subrule, including a description of the activities conducted.    e.    The issuer of a Medicare supplement policy or certificate complies with such other conditions as the Secretary may by regulation require for activities conducted under this subrule.    37.34(7) Issuer prohibited from actively obtaining genetic information for underwriting.  An issuer of a Medicare supplement policy or certificate shall not request, require, or purchase genetic information for underwriting purposes.    37.34(8) Issuer prohibited from actively obtaining genetic information for enrollment.  An issuer of a Medicare supplement policy or certificate shall not request, require, or purchase genetic information with respect to any individual prior to such individual’s enrollment under the policy in connection with such enrollment.    37.34(9) Obtaining information incidentally not a violation.  If an issuer of a Medicare supplement policy or certificate obtains genetic information incidental to the requesting, requiring, or purchasing of other information concerning any individual, such request, requirement, or purchase shall not be considered a violation of subrule 37.34(8) if such request, requirement, or purchase is not in violation of subrule 37.34(7).

    191—37.35(514D) Prohibition against using materials prepared by SHIIP.  The Senior Health Insurance Information Program (SHIIP) may prepare a consumer Medicare supplement insurance premium guide and benefits comparison guide. This guide and the SHIIP name or logo shall not be used in the solicitation or sale of health insurance products. Violation of this rule shall be deemed an unfair trade practice under Iowa Code chapter 507B.

    191—37.36(514D) Guaranteed issue for eligible persons.      37.36(1) Definition of “Medicare Advantage organization.”  For purposes of this rule:        "Medicare Advantage organization" means a private company that has a contract with Medicare to provide Medicare Advantage plans and benefits to individuals.    37.36(2) Guaranteed issue.      a.    Eligible persons for guaranteed issue of a Medicare supplement policy or certificate are those individuals described in subrule 37.36(3) who seek to enroll under the Medicare supplement policy during the period specified in subrule 37.36(4) and who submit evidence of the date of termination, disenrollment, or Medicare Part D enrollment with the application for a Medicare supplement policy or certificate.    b.    With respect to eligible individuals for guaranteed issue of a Medicare supplement policy or certificate, an issuer: shall not deny or condition the issuance or effectiveness of a Medicare supplement policy or certificate described in subrule 37.36(6) that is offered by the issuer and is available for issuance to new enrollees; shall not discriminate in the pricing of such Medicare supplement policy or certificate because of health status, claims experience, receipt of health care, or medical condition; and shall not impose an exclusion of benefits based on a preexisting condition under such Medicare supplement policy or certificate.    37.36(3) Eligible persons.  An eligible person is an individual described in any of the following paragraphs 37.36(3)“a” through “g”:    a.    The individual is enrolled under an employee welfare benefit plan that provides health benefits that supplement benefits under Medicare, and the plan terminates or the plan ceases to provide some or all such supplemental health benefits to the individual (for purposes of this paragraph, “employee welfare benefit plan” means a plan, fund or program of employee benefits as defined in 29 U.S.C. Section 1002 Employee Retirement Income Security Act).    b.    The individual is enrolled with a Medicare Advantage organization under a Medicare Advantage plan and any of the following circumstances apply, or the individual is 65 years of age or older and is enrolled with a PACE provider and circumstances exist similar to one of the circumstances described in subparagraphs 37.36(3)“b”(1) through (5) that would permit discontinuance of the individual’s enrollment with such a provider if such individual were enrolled in a Medicare Advantage plan:    (1)   The certification of the Medicare Advantage organization or Medicare Advantage plan has been terminated.    (2)   The Medicare Advantage organization has terminated or otherwise discontinued providing the Medicare Advantage plan in the area in which the individual resides.    (3)   The individual is no longer eligible to elect the Medicare Advantage plan because of a change in the individual’s place of residence or other change in circumstances specified by the Secretary, but not including termination of the individual’s enrollment on the basis described in Section 1851(g)(3)(B) of the federal Social Security Act (where the individual has not paid premiums on a timely basis or has engaged in disruptive behavior as specified in standards under Section 1856), or the Medicare Advantage plan is terminated for all individuals within a residence area.    (4)   The individual demonstrates, in accordance with guidelines established by the Secretary, that:    1.   The Medicare Advantage organization offering the Medicare Advantage plan substantially violated a material provision of the Medicare Advantage organization’s contract under this part in relation to the individual, including the failure to provide an enrollee on a timely basis medically necessary care for which benefits are available under the Medicare Advantage plan or the failure to provide such covered care in accordance with applicable quality standards; or    2.   The Medicare Advantage organization, or agent, producer or other entity acting on the Medicare Advantage organization’s behalf, materially misrepresented the Medicare Advantage plan’s provisions in marketing the Medicare Advantage plan to the individual.    (5)   The individual meets such other exceptional conditions as the Secretary may provide.    c.    The individual is one for whom both subparagraphs 37.36(3)“c”(1) and (2) are true:    (1)   The individual is enrolled with one of the following organizations:    1.   An eligible organization under a contract under Section 1876 of the Social Security Act (Medicare cost);    2.   A similar organization operating under demonstration project authority, effective for periods before April 1, 1999;    3.   An organization operating under an agreement under Section 1833(a)(1)(A) of the Social Security Act (Health Care Prepayment Plan (HCPP)); or    4.   An organization under a Medicare Select policy.    (2)   The enrollment ceases under the same circumstances that would permit discontinuance of an individual’s election of coverage under paragraph 37.36(3)“b.”    d.    The individual is enrolled under a Medicare supplement policy or certificate, and the enrollment ceases because:    (1)   Of the insolvency or rehabilitation of the issuer (pursuant to Iowa Code chapter 507C) or the bankruptcy of the Medicare Advantage organization; or of other involuntary termination of coverage or enrollment under the policy (for purposes of this subparagraph, “bankruptcy” means when a Medicare Advantage organization that is not an issuer has filed, or has had filed against it, a petition for declaration of bankruptcy, and has ceased doing business in the state); or    (2)   The issuer of the policy substantially violated a material provision of the policy; or    (3)   The issuer, or an agent, producer or other entity acting on the issuer’s behalf, materially misrepresented the policy’s provisions in marketing the policy to the individual.    e.    The individual was enrolled under a Medicare supplement policy or certificate and terminated enrollment and subsequently enrolls, for the first time, with any Medicare Advantage organization under a Medicare Advantage plan, any eligible organization under a contract under Section 1876 of the Social Security Act (Medicare cost), any similar organization operating under demonstration project authority, any PACE provider, or a Medicare Select policy; and the subsequent enrollment under this paragraph 37.36(3)“e” was terminated by the enrollee during any period within the first 12 months of such subsequent enrollment (during which the enrollee is permitted to terminate such subsequent enrollment under Section 1851(e) of the federal Social Security Act).    f.    The individual, upon first becoming enrolled for benefits under Medicare Part B at age 65 or older, enrolls in a Medicare Advantage plan under Medicare Part C, or with a PACE provider, and disenrolls from the plan or program by no later than 12 months after the effective date of enrollment.    g.    The individual enrolls in a Medicare Part D plan during the initial enrollment period and, at the time of enrollment in Medicare Part D, was enrolled under a Medicare supplement policy or certificate that covers outpatient prescription drugs and the individual terminates enrollment in the Medicare supplement policy or certificate and submits evidence of enrollment in Medicare Part D along with the application for a policy described in paragraph 37.36(6)“e.”    37.36(4) Guaranteed issue time periods.      a.    In the case of an individual described in paragraph 37.36(3)“a,” the guaranteed issue period:    (1)   Begins on the later of:     1.   The date the individual receives a notice of termination or cessation of some or all supplemental health benefits (or, if a notice is not received, notice that a claim has been denied because of such a termination or cessation); or    2.   The date that the applicable coverage terminates or ceases; and     (2)   Ends 63 days thereafter.    b.    In the case of an individual described in paragraph 37.36(3)“b,”“c,”“e” or “f” whose enrollment is terminated involuntarily, the guaranteed issue period begins on the date that the individual receives a notice of termination and ends 63 days after the date the applicable coverage is terminated.    c.    In the case of an individual described in subparagraph 37.36(3)“d”(1), the guaranteed issue period:    (1)   Begins on the earlier of:    1.   The date that the individual receives a notice of termination, a notice that the issuer is insolvent or in rehabilitation (pursuant to Iowa Code chapter 507C), or other such similar notice, if any; and    2.   The date that the applicable coverage is terminated; and     (2)   Ends on the date that is 63 days after the date the coverage is terminated.    d.    In the case of an individual described in paragraph 37.36(3)“b,” subparagraph 37.36(3)“d”(2) or (3), or paragraph 37.36(3)“e” or “f” who disenrolls voluntarily, the guaranteed issue period begins on the date that is 60 days before the effective date of the disenrollment and ends on the date that is 63 days after the effective date.    e.    In the case of an individual described in paragraph 37.36(3)“g,” the guaranteed issue period begins on the date the individual receives notice pursuant to Section 1882(v)(2)(B) of the Social Security Act from the Medicare supplement or certificate issuer during the 60-day period immediately preceding the initial Medicare Part D enrollment period and ends on the date that is 63 days after the effective date of the individual’s coverage under Medicare Part D.    f.    In the case of an individual described in subrule 37.36(3) but not described in the preceding paragraphs 37.36(4)“a” to “e,” the guaranteed issue period begins on the effective date of disenrollment and ends on the date that is 63 days after the effective date.    37.36(5) Extended Medigap access for interrupted trial periods.      a.    In the case of an individual described in subrule 37.36(3) (or deemed to be so described pursuant to this paragraph 37.36(5)“a”) whose enrollment with an organization or provider described in paragraph 37.36(3)“e” is involuntarily terminated within the first 12 months of enrollment and who, without an intervening enrollment, enrolls with another such organization or provider, the subsequent enrollment shall be deemed to be an initial enrollment as described in paragraph 37.36(3)“e.”    b.    In the case of an individual described in paragraph 37.36(3)“f” (or deemed to be so described pursuant to this paragraph 37.36(5)“b”) whose enrollment with a plan or in a program described in paragraph 37.36(3)“f” is involuntarily terminated within the first 12 months of enrollment and who, without an intervening enrollment, enrolls in another such plan or program, the subsequent enrollment shall be deemed to be an initial enrollment as described in paragraph 37.36(3)“f.”    c.    For purposes of paragraphs 37.36(3)“e” and “f,” no enrollment of an individual with an organization or provider described in paragraph 37.36(3)“e,” or with a plan or in a program described in paragraph 37.36(3)“f,” may be deemed to be an initial enrollment under this paragraph 37.36(5)“c” after the two-year period beginning on the date on which the individual first enrolled with such an organization, provider, plan or program.    37.36(6) Products to which eligible persons are entitled.      a.    If an individual meets the requirements of paragraph 37.36(3)“a,”“b,”“c,” or “d,” the individual may be issued a Medicare supplement policy or certificate which has a benefit package classified as Plan A, B, C, F (including F with a high deductible), K or L offered by any issuer.    b.    The Medicare supplement policies or certificates to which eligible persons are entitled under paragraph 37.36(3)“e,” subject to paragraph 37.36(6)“c,” is the same Medicare supplement policy or certificate in which the individual was most recently previously enrolled if available from the same issuer, or, if not so available, a policy described in paragraph 37.36(6)“a.”    c.    After December 31, 2005, if the individual was most recently enrolled in a Medicare supplement policy or certificate with an outpatient prescription drug benefit, a Medicare supplement policy or certificate described in this subrule is:    (1)   The policy available from the same issuer but modified to remove outpatient prescription drug coverage; or    (2)   At the election of the individual, an A, B, C, F (including F with a high deductible), K or L policy that is offered by any issuer.    d.    The Medicare supplement policy or certificate to which eligible persons are entitled under paragraph 37.36(3)“f” shall include any Medicare supplement policy or certificate offered by any issuer.    e.    The Medicare supplement policy or certificate to which eligible persons are entitled under paragraph 37.36(3)“g” is a Medicare supplement policy or certificate that has a benefit package classified as Plan A, B, C, F (including F with a high deductible), K or L, and that is offered and is available for issuance to new enrollees by the same issuer that issued the individual’s Medicare supplement policy or certificate with outpatient prescription drug coverage.     37.36(7) Notification of provisions.      a.    At the time of an event described in subrule 37.36(3) because of which an individual loses coverage or benefits due to the termination or change of a contract or agreement, policy, or plan, the organization that terminates or changes the contract or agreement, the issuer terminating or changing the policy, or the administrator of the plan being terminated or changed, respectively, shall notify the individual of the individual’s rights under this rule and of the obligations of issuers of Medicare supplement policies or certificates under subrule 37.36(2). Such notice shall be communicated contemporaneously with the notification of termination.    b.    At the time of an event described in subrule 37.36(3) because of which an individual ceases enrollment under a contract or agreement, policy, or plan, the organization that offers the contract or agreement, regardless of the basis for the cessation of enrollment, the issuer offering the policy, or the administrator of the plan, respectively, shall notify the individual of the individual’s rights under this rule and of the obligations of issuers of Medicare supplement policies or certificates under subrule 37.36(3). Such notice shall be communicated within ten working days of the issuer receiving notification of the disenrollment.

    191—37.37()    Reserved.

    191—37.38()    Reserved.

    191—37.39()    Reserved.

    191—37.40()    Reserved.

    191—37.41()    Reserved.

    191—37.42()    Reserved.

    191—37.43()    Reserved.

    191—37.44()    Reserved.

    191—37.45()    Reserved.

    191—37.46()    Reserved.

    191—37.47()    Reserved.

    191—37.48()    Reserved.

    191—37.49()    Reserved.

    191—37.50(507B,514D) Medicare supplement advertising.      37.50(1) Purpose.  The purpose of this rule is to provide prospective purchasers with clear and unambiguous statements in the advertisement of Medicare supplement insurance and to ensure the clear and truthful disclosure of the benefits, limitations and exclusions of policies sold as Medicare supplement insurance. This purpose is intended to be accomplished by the establishment of guidelines and permissible and impermissible standards of conduct in the advertising of Medicare supplement insurance in a manner which prevents unfair, deceptive and misleading advertising and which is conducive to accurate presentation and description to the insurance-buying public through the advertising media and material used by producers and companies.    37.50(2) Applicability.      a.    This rule shall apply to any “advertisement” of Medicare supplement insurance, as that term is defined in subrule 37.50(3), unless otherwise specified in this rule, that the issuer or producer knows or reasonably should know is intended for presentation, distribution or dissemination in this state when the presentation, distribution or dissemination is made either directly or indirectly by or on behalf of an issuer or producer.    b.    The requirements of Iowa Code chapter 507B and 191—Chapter 15 also shall apply to issuers and producers to which this rule 191—37.50(507B,514D) applies, unless specifically exempted therein.    37.50(3) Definitions.  In addition to the definitions in Iowa Code sections 507B.2 and 514D.2 and rules 191—15.2(507B) and 191—37.3(514D), the following definitions shall apply to this rule 191—37.50(507B,514D). When a term defined in this rule is also defined in Iowa Code section 507B.2 or 514D.2 or rule 191—15.2(507B) or 191—37.3(514D), the definition of the term in this rule shall take precedence.        "Advertisement"
    1. Includes the definition of “advertisement” in rule 191—15.2(507B).
    2. Includes advertising material included with a Medicare supplement policy or certificate when the Medicare supplement policy or certificate is delivered and the advertising material is used in the solicitation of Medicare supplement policy renewals and reinstatements.
    3. Does not include:
  • The items excluded in paragraph “2” of the definition of “advertisement” in rule 191—15.2(507B).
  • Material to be used solely for the training and education of an issuer’s employees, producers, agents or brokers.
  • Material used in-house by issuers.
  • Communications within an issuer’s own organization not intended for dissemination to the public.
  • Individual communications of a personal nature with current covered individuals other than material urging the covered individuals to increase or expand coverage.
  • Correspondence between a prospective group or blanket policyholder and an issuer in the course of negotiating a group or blanket Medicare supplement policy.
  • Court-approved material ordered by a court to be disseminated to covered individuals or group policyholders of Medicare supplement policies.
  • A general announcement from a group or blanket Medicare supplement policyholder to eligible individuals on an employment or membership list that a Medicare supplement policy has been written or arranged; provided the announcement clearly indicates that it is preliminary to the issuance of a booklet.
    •         "Certificate" means any certificate issued under a group Medicare supplement policy, which certificate has been delivered or issued for delivery in this state.        "Exception" means any provision in a Medicare supplement policy whereby coverage for a specified hazard is entirely eliminated; it is a statement of a risk not assumed under the Medicare supplement policy or certificate.        "Institutional advertisement" means an advertisement having as its sole purpose the promotion of the reader’s, viewer’s or listener’s interest in the concept of Medicare supplement insurance, or the promotion of the issuer as a seller of Medicare supplement insurance.        "Invitation to contract" means an advertisement that is neither an institutional advertisement nor an invitation to inquire (defined in paragraph 37.50(8)“d”).         "Issuer" shall include any entity which is defined as an “issuer” in rule 191—37.3(514D) and is engaged in the advertisement of itself, or of Medicare supplement insurance.        "Lead-generating device" means any communication directed to the public that, regardless of form, content or stated purpose, is intended to result in the compilation or qualification of a list containing names and other personal information to be used to solicit residents of this state for the purchase of Medicare supplement insurance.        "Limitation" means any provision other than an exception or a reduction that restricts coverage under a Medicare supplement policy.        "Medicare supplement insurance" means a group or individual policy of accident and sickness insurance or a contract of hospital and medical service associations or health maintenance organizations that is advertised, marketed or designed primarily as a supplement to reimbursements under Medicare for the hospital, medical, or surgical expenses of persons eligible for Medicare by reason of age.        "Person" means a natural person, association, organization, partnership, trust, group, discretionary group, corporation or any other entity.        "Reduction" means any provision that reduces the amount of the benefit; a risk of loss is assumed but payment upon the occurrence of the loss is limited to some amount or period less than would be otherwise payable had the reduction not been used.        37.50(4) Form and content of advertisements.      a.    An issuer shall clearly identify its Medicare supplement insurance as an insurance policy or certificate. A Medicare supplement policy or certificate trade name must be followed by the words “Insurance Policy” or similar words clearly identifying the fact that an insurance policy or certificate or health benefits product (in the case of health maintenance organizations, prepaid health plans and other direct service organizations) is being offered.    b.    Medicare supplement insurance advertising materials that are reproduced in quantity shall be identified by form numbers or other identifying means. The identification shall be sufficient to distinguish an advertisement from any other advertising materials, policies, applications or other materials used by the issuer.    37.50(5) Testimonials or endorsements by third parties.  In addition to complying with 191—subrule 15.3(7), when a testimonial refers to benefits received under a Medicare supplement policy or certificate, the issuer shall retain for examination by the commissioner the specific claim data, including claim number, date of loss, and other pertinent information, for a period of four years or until the filing of the next regular report of examination of the issuer, whichever is the longer period of time. The use of testimonials that do not correctly reflect the present practices of the issuer or that are not applicable to the Medicare supplement policy or certificate or benefit being advertised is not permissible.    37.50(6) Use of statistics; jurisdictional licensing; status of insurer.  Medicare supplement insurance advertisements shall be in compliance with 191—subrule 15.3(5) and with the following:    a.    A Medicare supplement insurance advertisement shall specifically identify the Medicare supplement policy or certificate to which statistics relate and, where statistics are given which are applicable to a different policy or certificate, the advertisement shall state clearly that the data do not relate to the Medicare supplement policy or certificate being advertised.    b.    A Medicare supplement insurance advertisement that is intended to be seen or heard beyond the limits of the jurisdiction in which the issuer is licensed shall not imply licensing beyond those limits.    c.    A Medicare supplement insurance advertisement shall not create the impression directly or indirectly that the issuer, the issuer’s financial condition or status, the issuer’s payment of its claims, or the merits, desirability or advisability of the issuer’s policy forms or kinds of plans of insurance are approved, endorsed or accredited by any division or agency of this state or of the United States government.    d.    A Medicare supplement insurance advertisement shall not imply that approval, endorsement or accreditation of policy forms or advertising has been granted by any division or agency of this state or of the United States government. “Approval” of either policy forms or advertising shall not be used by an issuer to imply or state that a governmental agency has endorsed or recommended the issuer, its policies, its advertising or its financial condition.    37.50(7) Identity of issuer.  Advertisements shall be in compliance with 191—subrule 15.3(9) and with the following:    a.    Advertisements, stationery or envelopes that employ words, letters, initials, symbols or other devices are not permitted if they are so similar to those used by governmental agencies or other issuers that they may lead the public to believe:    (1)   The advertised Medicare supplement insurance coverages are somehow provided by or are endorsed by the governmental agencies or the other issuers;    (2)   The Medicare supplement insurance advertiser is the same as, is connected with or is endorsed by the governmental agencies or the other issuers.    b.    No Medicare supplement insurance advertisement shall use the name of a state or political subdivision thereof in a policy name or description.    c.    No Medicare supplement insurance advertisement in the form of envelopes or stationery of any kind may use any name, service mark, slogan, symbol or any device in such a manner that implies that the issuer or the policy advertised, or that any producer who may call upon the consumer in response to the advertisement, is connected with a governmental agency, such as the Social Security Administration.    d.    No Medicare supplement insurance advertisement may incorporate the word “Medicare” in the title of the plan or policy being advertised unless, wherever it appears, the word is qualified by language differentiating the plan or policy from Medicare. Such an advertisement, however, shall not use the phrase “_____________ Medicare Department of the _________________ Insurance Company,” or language of similar import.    e.    No Medicare supplement insurance advertisement shall be used that fails to include a disclaimer to the effect of “Not connected with or endorsed by the U.S. government or the federal Medicare program.”    f.    No Medicare supplement insurance advertisement may imply that the reader may lose a right, privilege or benefit under federal, state or local law if the reader fails to respond to the advertisement.    g.    No issuer may use, in the trade name of its Medicare supplement insurance policy, any terminology or words so similar to the name of a governmental agency or governmental program as to have the tendency to confuse, deceive or mislead the prospective purchaser.    h.    All Medicare supplement insurance advertisements used by producers or solicitors of an issuer shall have prior written approval of the issuer before the advertisements may be used.    i.    A producer who makes contact with a consumer as a result of acquiring that consumer’s name from a lead-generating device shall disclose that fact in the initial contact with the consumer.    37.50(8) Introductory, initial or special offers.      a.    Enrollment periods.    (1)   An advertisement of an individual Medicare supplement insurance policy shall not directly or by implication represent that a contract or combination of contracts is an introductory, initial or special offer, or that applicants will receive substantial advantages not available at a later date, or that the offer is available only to a specified group of individuals, unless such representation is true. A Medicare supplement insurance advertisement shall not contain phrases describing an enrollment period as “special,” “limited,” or similar words or phrases when the issuer uses such enrollment periods as the usual method of advertising Medicare supplement insurance.    (2)   An enrollment period during which a particular Medicare supplement insurance product may be purchased on an individual basis shall not be offered within this state unless there has been a lapse of not less than six months between the close of the immediately preceding enrollment period for the same product and the opening of the new enrollment period. The Medicare supplement insurance advertisement shall indicate the date by which the applicant must mail the application, which shall be not fewer than 10 days and not more than 40 days from the date that the enrollment period is advertised for the first time. This rule applies to all advertising media, e.g., mail, newspapers, electronic mail, websites, radio, television, magazines and periodicals, used by any one issuer. This rule is not applicable to solicitations of employees or members of a particular group or association that otherwise would be eligible for group, blanket or franchise insurance. The phrase “any one issuer” in this subparagraph includes all the affiliated companies of a group of insurance companies under common management or control. The phrase “a particular Medicare supplement insurance product” in this subparagraph means an insurance policy that provides benefits substantially different from those contained in any other policy. Different terms of renewability, an increase or decrease in the dollar amounts of benefits, or an increase or decrease in any elimination period or waiting period from those available during an enrollment period for another policy shall not be sufficient to constitute the product’s being offered as a different product eligible for concurrent or overlapping enrollment periods.    (3)   This rule prohibits any statement or implication to the effect that only a specific number of Medicare supplement policies will be sold, or that a time is fixed for the discontinuance of the sale of the particular Medicare supplement policy advertised because of special advantages available in the policy, unless either representation is true.    b.    An advertisement shall not offer a Medicare supplement policy that utilizes a reduced initial premium rate in a manner that overemphasizes the availability and the amount of the initial reduced premium. When an issuer charges an initial premium that differs in amount from the amount of the renewal premium payable on the same mode, the advertisement shall not display the amount of the reduced initial premium either more frequently or more prominently than the renewal premium, and both the initial reduced premium and the renewal premium shall be stated in juxtaposition in each portion of the advertisement where the initial reduced premium appears. The term “juxtaposition” means side by side or immediately above or below.    c.    Special awards, such as a “safe driver’s award,” shall not be used in connection with advertisements of Medicare supplement insurance.    d.    An invitation to inquire, which means an advertisement having as its objective the creation of a desire to inquire further about Medicare supplement insurance that is limited to a brief description of coverage, shall contain a provision in the following or substantially similar form:“This policy has [exclusions] [limitations] [reductions of benefits] [terms under which the policy may be continued in force or discontinued]. For costs and complete details of the coverage, call [or write] your producer or the company [whichever is applicable].”    37.50(9) Enforcement procedures—certificate of compliance.  Each issuer required to file an annual statement which is now or which hereafter becomes subject to the provisions of this chapter must file with the insurance division, with the issuer’s annual statement, a certificate of compliance executed by an authorized officer of the issuer wherein it is stated that, to the best of the authorized officer’s knowledge, information and belief, the Medicare supplement insurance advertisements that were disseminated by the issuer during the preceding statement year complied with or were made to comply in all respects with the provisions of this chapter and the laws of this state as implemented and interpreted by this chapter.    37.50(10) Filing for prior review.  The commissioner may, at the commissioner’s discretion, require the filing with the insurance division, for review prior to use, of any Medicare supplement insurance advertising material.

    191—37.51(514D) Severability.  If any provisions of this chapter or the application thereof to any person or circumstance is for any reason held to be invalid, the remainder of the chapter and the application of such provision to other persons or circumstances shall not be affected thereby.       These rules are intended to implement Iowa Code chapters 507B and 514D.     APPENDIX AMEDICARE SUPPLEMENT REFUND CALCULATION FORMFOR CALENDAR YEAR ______TYPE1SMSBP2For the State ofCompany Name NAIC Group CodeNAIC Company CodeAddressPerson Completing This ExhibitTitleTelephone NumberLine    (a)Earned Premium3    (b)Incurred Claims41.Current Year’s Experience     a. Total (all policy years)     b. Current year’s issues5     c. Net (for reporting purposes = 1a – 1b)2.Past Years’ Experience (all policy years)3.    Total Experience(Net Current Year + Past Year)4.Refunds Last Year (excluding interest)5.Previous Since Inception (excluding interest)6.Refunds Since Inception (excluding interest)7.Benchmark Ratio Since Inception (see worksheet for Ratio 1)8.    Experienced Ratio Since Inception (Ratio 2)Total Actual Incurred Claims (line 3, col. b) Total Earned Prem. (line 3, col. a) – Refunds Since Inception (line 6)9.    Life Years Exposed Since InceptionIf the Experienced Ratio is less than the Benchmark Ratio, and there are more than 500 life years exposure, then proceed to calculation of refund.10.Tolerance Permitted (obtained from credibility table)1 Individual, Group, Individual Medicare Select, or Group Medicare Select only.2 “SMSBP” = Standardized Medicare Supplement Benefit Plan – Use “P” for prestandardized Medicare supplement benefit plans.3 Includes Modal Loadings and Fees Charged.4 Excludes Active Life Reserves.5 This is to be used as “Issue Year Earned Premium” for Year 1 of next year’s “Worksheet for Calculation of Benchmark Ratios.” Medicare Supplement Credibility TableLife Years Exposed    Since InceptionTolerance    10,000 +0.0%    5,000 - 9,9995.0%    2,500 - 4,9997.5%    1,000 - 2,49910.0%    500 - 99915.0%If less than 500, no credibility. MEDICARE SUPPLEMENT REFUND CALCULATION FORMFOR CALENDAR YEAR ______TYPE1 SMSBP2For the State ofCompany NameNAIC Group CodeNAIC Company CodeAddressPerson Completing This Exhibit TitleTelephone Number11.Adjustment to Incurred Claims for CredibilityRatio 3 = Ratio 2 + ToleranceIf Ratio 3 is more than Benchmark Ratio (Ratio 1), a refund or credit to premium is not required.If Ratio 3 is less than the Benchmark Ratio, then proceed.12.Adjusted Incurred Claims[Total Earned Premiums (line 3, col. a) – Refunds Since Inception (line 6)] × Ratio 3 (line 11)13.Refund =Total Earned Premiums (line 3, col. a) – Refunds Since Inception (line 6) – [Adjusted Incurred Claims (line 12) / Benchmark Ratio (Ratio 1)]If the amount on line 13 is less than .005 times the annualized premium in force as of December 31 of the reporting year, then no refund is made. Otherwise, the amount on line 13 is to be refunded or credited, and a description of the refund or credit against premiums to be used must be attached to this form.I certify that the above information and calculations are true and accurate to the best of my knowledge and belief.SignatureName (Please type.)Title (Please type.)Date1 Individual, Group, Individual Medicare Select, or Group Medicare Select only.2 “SMSBP” = Standardized Medicare Supplement Benefit Plan – Use “P” for prestandardized plans. REPORTING FORM FOR THE CALCULATION OFBENCHMARK RATIO SINCE INCEPTION FOR GROUP POLICIESFOR CALENDAR YEAR _____TYPE1 SMSBP2For the State ofCompany NameNAIC Group CodeNAIC Company CodeAddressPerson Completing This Exhibit TitleTelephone Number(a)3(b)4(c)(d)(e)(f)(g)(h)(i)(j)(o)5    Year    EarnedPremium    Factor    (b) × (c)    CumulativeLoss Ratio    (d) × (e)    Factor    (b) × (g)    CumulativeLoss Ratio    (h) × (i)    Policy YearLoss Ratio12.7700.5070.0000.0000.4624.1750.5670.0000.0000.6334.1750.5671.1940.7590.7544.1750.5672.2450.7710.7754.1750.5673.1700.7820.8064.1750.5673.9980.7920.8274.1750.5674.7540.8020.8484.1750.5675.4450.8110.8794.1750.5676.0750.8180.88104.1750.5676.6500.8240.88114.1750.5677.1760.8280.88124.1750.5677.6550.8310.88134.1750.5678.0930.8340.89144.1750.5678.4930.8370.8915+64.1750.5678.6840.8380.89Total:(k):(l):(m):(n):Benchmark Ratio Since Inception: (l + n)/(k + m): __________1 Individual, Group, Individual Medicare Select, or Group Medicare Select only.2 “SMSBP” = Standardized Medicare Supplement Benefit Plan – Use “P” for prestandardized Medicare supplement benefit plans.3 Year 1 is the current calendar year - 1. Year 2 is the current calendar year - 2 (etc.). (Example: If the current year is 1991, then: Year 1 is 1990; Year 2 is 1989, etc.)4 For the calendar year on the appropriate line in column (a), the premium earned during that year for policies issued in that year.5 These loss ratios are not explicitly used in computing the benchmark loss ratios. They are the loss ratios, on a policy year basis, which result in the cumulative loss ratios displayed on this worksheet. They are shown here for informational purposes only.6 To include the earned premium for all years prior to as well as the 15th year prior to the current year. REPORTING FORM FOR THE CALCULATION OFBENCHMARK RATIO SINCE INCEPTION FOR INDIVIDUAL POLICIESFOR CALENDAR YEAR _____TYPE1 SMSBP2For the State ofCompany NameNAIC Group CodeNAIC Company CodeAddress Person Completing This ExhibitTitleTelephone Number(a)3(b)4(c)(d)(e)(f)(g)(h)(i)(j)(o)5    Year    EarnedPremium    Factor    (b) × (c)    CumulativeLoss Ratio    (d) × (e)    Factor    (b) × (g)    CumulativeLoss Ratio    (h) × (i)    Policy YearLoss Ratio12.7700.4420.0000.0000.4024.1750.4930.0000.0000.5534.1750.4931.1940.6590.6544.1750.4932.2450.6690.6754.1750.4933.1700.6780.6964.1750.4933.9980.6860.7174.1750.4934.7540.6950.7384.1750.4935.4450.7020.7594.1750.4936.0750.7080.76104.1750.4936.6500.7130.76114.1750.4937.1760.7170.76124.1750.4937.6550.7200.77134.1750.4938.0930.7230.77144.1750.4938.4930.7250.7715+64.1750.4938.6840.7250.77Total:(k):(l):(m):(n):Benchmark Ratio Since Inception: (l + n)/(k + m): _______1 Individual, Group, Individual Medicare Select, or Group Medicare Select only.2 “SMSBP” = Standardized Medicare Supplement Benefit Plan – Use “P” for prestandardized Medicare supplement benefit plans.3 Year 1 is the current calendar year - 1. Year 2 is the current calendar year - 2 (etc.). (Example: If the current year is 1991, then: Year 1 is 1990; Year 2 is 1989, etc.)4 For the calendar year on the appropriate line in column (a), the premium earned during that year for policies issued in that year.5 These loss ratios are not explicitly used in computing the benchmark loss ratios. They are the loss ratios, on a policy year basis, which result in the cumulative loss ratios displayed on this worksheet. They are shown here for informational purposes.6 To include the earned premium for all years prior to as well as the 15th year prior to the current year.     APPENDIX BDISCLOSURE STATEMENTSInstructions for Use of the Disclosure Statements for Health Insurance PoliciesSold to Medicare Beneficiaries that Duplicate Medicare Benefits1. Section 1882(d) of the federal Social Security Act [42 U.S.C. 1395ss] prohibits the sale of a health insurance policy (the term policy includes certificate) to a Medicare beneficiary that duplicates Medicare benefits unless it will pay benefits without regard to a beneficiary’s other health coverage and it includes the prescribed disclosure statement on or together with the application for the policy.2. All types of health insurance policies that duplicate Medicare benefits shall include one of the attached disclosure statements, according to the particular policy type involved, on the application or together with the application. The disclosure statement may not significantly or materially vary from the attached statements in terms of language or format (using not less than 12-point type size, type-proportional spacing, bold characters, line spacing, and boxes around text).3. State and federal law prohibits issuers from selling a Medicare supplement policy or certificate to a person that already has a Medicare supplement policy or certificate except as a replacement policy.4. Property/casualty and life insurance policies are not considered health insurance.5. Disability income policies are not considered to provide benefits that duplicate Medicare.6. Long-term care insurance policies that coordinate with Medicare and other health insurance are not considered to provide benefits that duplicate Medicare.7. The federal law does not preempt state laws that are more stringent than the federal requirements.8. The federal law does not preempt existing state form filing requirements.9. Section 1882 of the federal Social Security Act was amended in Subsection (d)(3)(A) to allow for alternative disclosure statements. The disclosure statements already in Appendix B remain. An issuer may use either disclosure statement with the requisite insurance product. However, issuers should use either the original disclosure statements or the alternative disclosure statements and not use both simultaneously. [Original disclosure statement for policies that provide benefits for expenses incurred for an accidental injury only.]    IMPORTANT NOTICE TO PERSONS ON MEDICARETHIS INSURANCE DUPLICATES SOME MEDICARE BENEFITSThis is not Medicare Supplement InsuranceThis insurance provides limited benefits, if you meet the policy conditions, for hospital or medical expenses that result from accidental injury. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.This insurance duplicates Medicare benefits when it pays:
  • Hospital or medical expenses up to the maximum stated in the policy
    • Medicare generally pays for most or all of these expenses.Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:
  • Hospitalization
  • Physician services
  • Outpatient Prescription Drugs if you are enrolled in Medicare Part D
  • Other approved items and services
    • Before You Buy This Insurance
  • Check the coverage in all health insurance policies you already have.
  • For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.
  • For help in understanding your health insurance, contact the Senior Health Insurance Information Program (SHIIP) of the Iowa Insurance Division.
    • [Original disclosure statement for policies that provide benefits for specified limited services.]    IMPORTANT NOTICE TO PERSONS ON MEDICARETHIS INSURANCE DUPLICATES SOME MEDICARE BENEFITSThis is not Medicare Supplement InsuranceThis insurance provides limited benefits, if you meet the policy conditions, for expenses relating to the specific services listed in the policy. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance. This insurance duplicates Medicare benefits when:
  • Any of the services covered by the policy are also covered by Medicare
    • Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:
  • Hospitalization
  • Physician services
  • Outpatient Prescription Drugs if you are enrolled in Medicare Part D
  • Other approved items and services
    • Before You Buy This Insurance
  • Check the coverage in all health insurance policies you already have.
  • For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.
  • For help in understanding your health insurance, contact the Senior Health Insurance Information Program (SHIIP) of the Iowa Insurance Division.
    • [Original disclosure statement for policies that reimburse expenses incurred for specified diseases or other specified impairments. This includes expense-incurred cancer, specified disease and other types of health insurance policies that limit reimbursement to named medical conditions.]    IMPORTANT NOTICE TO PERSONS ON MEDICARETHIS INSURANCE DUPLICATES SOME MEDICARE BENEFITSThis is not Medicare Supplement InsuranceThis insurance provides limited benefits, if you meet the policy conditions, for hospital or medical expenses only when you are treated for one of the specific diseases or health conditions listed in the policy. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.This insurance duplicates Medicare benefits when it pays:
  • Hospital or medical expenses up to the maximum stated in the policy
    • Medicare generally pays for most or all of these expenses.Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:
  • Hospitalization
  • Physician services
  • Hospice
  • Outpatient Prescription Drugs if you are enrolled in Medicare Part D
  • Other approved items and services
    • Before You Buy This Insurance
  • Check the coverage in all health insurance policies you already have.
  • For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.
  • For help in understanding your health insurance, contact the Senior Health Insurance Information Program (SHIIP) of the Iowa Insurance Division.
    • [Original disclosure statement for policies that pay fixed dollar amounts for specified diseases or other specified impairments. This includes cancer, specified disease, and other health insurance policies that pay a scheduled benefit or specific payment based on diagnosis of the conditions named in the policy.]    IMPORTANT NOTICE TO PERSONS ON MEDICARETHIS INSURANCE DUPLICATES SOME MEDICARE BENEFITSThis is not Medicare Supplement InsuranceThis insurance pays a fixed amount, regardless of your expenses, if you meet the policy conditions, for one of the specific diseases or health conditions named in the policy. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.This insurance duplicates Medicare benefits because Medicare generally pays for most of the expenses for the diagnosis and treatment of the specific conditions or diagnoses named in the policy.Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:
  • Hospitalization
  • Physician services
  • Hospice
  • Outpatient Prescription Drugs if you are enrolled in Medicare Part D
  • Other approved items and services
    • Before You Buy This Insurance
  • Check the coverage in all health insurance policies you already have.
  • For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.
  • For help in understanding your health insurance, contact the Senior Health Insurance Information Program (SHIIP) of the Iowa Insurance Division.
    • [Original disclosure statement for indemnity policies and other policies that pay a fixed dollar amount per day, excluding long-term care policies.]    IMPORTANT NOTICE TO PERSONS ON MEDICARETHIS INSURANCE DUPLICATES SOME MEDICARE BENEFITSThis is not Medicare Supplement InsuranceThis insurance pays a fixed dollar amount, regardless of your expenses, for each day you meet the policy conditions. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.This insurance duplicates Medicare benefits when:
  • Any expenses or services covered by the policy are also covered by Medicare
    • Medicare generally pays for most or all of these expenses.Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:
  • Hospitalization
  • Physician services
  • Outpatient Prescription Drugs if you are enrolled in Medicare Part D
  • Hospice
  • Other approved items and services
    • Before You Buy This Insurance
  • Check the coverage in all health insurance policies you already have.
  • For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.
  • For help in understanding your health insurance, contact the Senior Health Insurance Information Program (SHIIP) of the Iowa Insurance Division.
    • [Original disclosure statement for policies that provide benefits upon both an expense-incurred and fixed indemnity basis.]    IMPORTANT NOTICE TO PERSONS ON MEDICARETHIS INSURANCE DUPLICATES SOME MEDICARE BENEFITSThis is not Medicare Supplement InsuranceThis insurance pays limited reimbursement for expenses if you meet the conditions listed in the policy. It also pays a fixed amount, regardless of your expenses, if you meet other policy conditions. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.This insurance duplicates Medicare benefits when:
  • Any expenses or services covered by the policy are also covered by Medicare; or
  • It pays the fixed dollar amount stated in the policy and Medicare covers the same event.
    • Medicare generally pays for most or all of these expenses.Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:
  • Hospitalization
  • Physician services
  • Hospice care
  • Outpatient Prescription Drugs if you are enrolled in Medicare Part D
  • Other approved items and services
    • Before You Buy This Insurance
  • Check the coverage in all health insurance policies you already have.
  • For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.
  • For help in understanding your health insurance, contact the Senior Health Insurance Information Program (SHIIP) of the Iowa Insurance Division.
    • [Original disclosure statement for other health insurance policies not specifically identified in the preceding statements.]    IMPORTANT NOTICE TO PERSONS ON MEDICARETHIS INSURANCE DUPLICATES SOME MEDICARE BENEFITSThis is not Medicare Supplement InsuranceThis insurance provides limited benefits if you meet the conditions listed in the policy. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.This insurance duplicates Medicare benefits when it pays:
  • The benefits stated in the policy and coverage for the same event is provided by Medicare
    • Medicare generally pays for most or all of these expenses.Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:
  • Hospitalization
  • Physician services
  • Hospice
  • Outpatient Prescription Drugs if you are enrolled in Medicare Part D
  • Other approved items and services
    • Before You Buy This Insurance
  • Check the coverage in all health insurance policies you already have.
  • For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.
  • For help in understanding your health insurance, contact the Senior Health Insurance Information Program (SHIIP) of the Iowa Insurance Division.
    • [Alternative disclosure statement for policies that provide benefits for expenses incurred for an accidental injury only.]    IMPORTANT NOTICE TO PERSONS ON MEDICARETHIS IS NOT MEDICARE SUPPLEMENT INSURANCESome health care services paid for by Medicare may also trigger the payment of benefits from this policy.This insurance provides limited benefits, if you meet the policy conditions, for hospital or medical expenses that result from accidental injury. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.Medicare generally pays for most or all of these expenses.Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:
  • Hospitalization
  • Physician services
  • Outpatient Prescription Drugs if you are enrolled in Medicare Part D
  • Other approved items and services
    • This policy must pay benefits without regard to other health benefit coverage to which you may be entitled under Medicare or other insurance.Before You Buy This Insurance
  • Check the coverage in all health insurance policies you already have.
  • For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.
  • For help in understanding your health insurance, contact the Senior Health Insurance Information Program (SHIIP) of the Iowa Insurance Division.
    • [Alternative disclosure statement for policies that provide benefits for specified limited services.]    IMPORTANT NOTICE TO PERSONS ON MEDICARETHIS IS NOT MEDICARE SUPPLEMENT INSURANCESome health care services paid for by Medicare may also trigger the payment of benefits under this policy.This insurance provides limited benefits, if you meet the policy conditions, for expenses relating to the specific services listed in the policy. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:
  • Hospitalization
  • Physician services
  • Outpatient Prescription Drugs if you are enrolled in Medicare Part D
  • Other approved items and services
    • This policy must pay benefits without regard to other health benefit coverage to which you may be entitled under Medicare or other insurance.Before You Buy This Insurance
  • Check the coverage in all health insurance policies you already have.
  • For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.
  • For help in understanding your health insurance, contact the Senior Health Insurance Information Program (SHIIP) of the Iowa Insurance Division.
    • [Alternative disclosure statement for policies that reimburse expenses incurred for specified diseases or other specified impairments. This includes expense-incurred cancer, specified disease and other types of health insurance policies that limit reimbursement to named medical conditions.]    IMPORTANT NOTICE TO PERSONS ON MEDICARETHIS IS NOT MEDICARE SUPPLEMENT INSURANCESome health care services paid for by Medicare may also trigger the payment of benefits from this policy. Medicare generally pays for most or all of these expenses.This insurance provides limited benefits, if you meet the policy conditions, for hospital or medical expenses only when you are treated for one of the specific diseases or health conditions listed in the policy. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.Medicare generally pays for most or all of these expenses.Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:
  • Hospitalization
  • Physician services
  • Hospice
  • Outpatient Prescription Drugs if you are enrolled in Medicare Part D
  • Other approved items and services
    • This policy must pay benefits without regard to other health benefit coverage to which you may be entitled under Medicare or other insurance.Before You Buy This Insurance
  • Check the coverage in all health insurance policies you already have.
  • For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.
  • For help in understanding your health insurance, contact the Senior Health Insurance Information Program (SHIIP) of the Iowa Insurance Division.
    • [Alternative disclosure statement for policies that pay fixed dollar amounts for specified diseases or other specified impairments. This includes cancer, specified disease, and other health insurance policies that pay a scheduled benefit or specific payment based on diagnosis of the conditions named in the policy.]    IMPORTANT NOTICE TO PERSONS ON MEDICARETHIS IS NOT MEDICARE SUPPLEMENT INSURANCESome health care services paid for by Medicare may also trigger the payment of benefits from this policy.This insurance pays a fixed amount, regardless of your expenses, if you meet the policy conditions, for one of the specific diseases or health conditions named in the policy. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:
  • Hospitalization
  • Physician services
  • Hospice
  • Outpatient Prescription Drugs if you are enrolled in Medicare Part D
  • Other approved items and services
    • This policy must pay benefits without regard to other health benefit coverage to which you may be entitled under Medicare or other insurance.Before You Buy This Insurance
  • Check the coverage in all health insurance policies you already have.
  • For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.
  • For help in understanding your health insurance, contact the Senior Health Insurance Information Program (SHIIP) of the Iowa Insurance Division.
    • [Alternative disclosure statement for indemnity policies and other policies that pay a fixed dollar amount per day, excluding long-term care policies.]    IMPORTANT NOTICE TO PERSONS ON MEDICARETHIS IS NOT MEDICARE SUPPLEMENT INSURANCESome health care services paid for by Medicare may also trigger the payment of benefits from this policy.This insurance pays a fixed dollar amount, regardless of your expenses, for each day you meet the policy conditions. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance. Medicare generally pays for most or all of these expenses.Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:
  • Hospitalization
  • Physician services
  • Hospice
  • Outpatient Prescription Drugs if you are enrolled in Medicare Part D
  • Other approved items and services
    • This policy must pay benefits without regard to other health benefit coverage to which you may be entitled under Medicare or other insurance.Before You Buy This Insurance
  • Check the coverage in all health insurance policies you already have.
  • For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.
  • For help in understanding your health insurance, contact the Senior Health Insurance Information Program (SHIIP) of the Iowa Insurance Division.
    • [Alternative disclosure statement for policies that provide benefits upon both an expense-incurred and fixed indemnity basis.]    IMPORTANT NOTICE TO PERSONS ON MEDICARETHIS IS NOT MEDICARE SUPPLEMENT INSURANCESome health care services paid for by Medicare may also trigger the payment of benefits from this policy.This insurance pays limited reimbursement for expenses if you meet the conditions listed in the policy. It also pays a fixed amount, regardless of your expenses, if you meet other policy conditions. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.Medicare generally pays for most or all of these expenses.Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:
  • Hospitalization
  • Physician services
  • Hospice care
  • Outpatient Prescription Drugs if you are enrolled in Medicare Part D
  • Other approved items and services
    • This policy must pay benefits without regard to other health benefit coverage to which you may be entitled under Medicare or other insurance.Before You Buy This Insurance
  • Check the coverage in all health insurance policies you already have.
  • For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.
  • For help in understanding your health insurance, contact the Senior Health Insurance Information Program (SHIIP) of the Iowa Insurance Division.
    • [Alternative disclosure statement for other health insurance policies not specifically identified in the preceding statements.]    IMPORTANT NOTICE TO PERSONS ON MEDICARETHIS IS NOT MEDICARE SUPPLEMENT INSURANCESome health care services paid for by Medicare may also trigger the payment of benefits from this policy.This insurance provides limited benefits if you meet the conditions listed in the policy. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.Medicare generally pays for most or all of these expenses.Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:
  • Hospitalization
  • Physician services
  • Hospice
  • Outpatient Prescription Drugs if you are enrolled in Medicare Part D
  • Other approved items and services
    • This policy must pay benefits without regard to other health benefit coverage to which you may be entitled under Medicare or other insurance.Before You Buy This Insurance
  • Check the coverage in all health insurance policies you already have.
  • For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.
  • For help in understanding your health insurance, contact the Senior Health Insurance Information Program (SHIIP) of the Iowa Insurance Division.
    •     APPENDIX CSTATEMENTS AND QUESTIONS FOR APPLICATION FORMS RELATED TO DUPLICATE OR REPLACEMENT COVERAGEStatements(1) You do not need more than one Medicare supplement policy.(2) If you purchase this [policy or certificate], you may want to evaluate your existing health coverage and decide if you need multiple coverages.(3) You may be eligible for benefits under Medicaid and may not need a Medicare supplement [policy or certificate].(4) If, after purchasing this [policy or certificate], you become eligible for Medicaid, the benefits and premiums under your Medicare supplement [policy or certificate] can be suspended, if requested, during your entitlement to benefits under Medicaid for 24 months. You must request this suspension within 90 days of becoming eligible for Medicaid. If you are no longer entitled to Medicaid, your suspended Medicare supplement [policy or certificate] (or, if that is no longer available, a substantially equivalent [policy or certificate]) will be reinstituted if requested within 90 days of losing your Medicaid eligibility. If the Medicare supplement [policy or certificate] provided coverage for outpatient prescription drugs and you enrolled in Medicare Part D while your [policy or certificate] was suspended, the reinstituted [policy or certificate] will not have outpatient prescription drug coverage, but will otherwise be substantially equivalent to your coverage before the date of the suspension.(5) If you are eligible for and have enrolled in a Medicare supplement [policy or certificate] by reason of disability and you later become covered by an employer or union-based group health plan, the benefits and premiums under your Medicare supplement [policy or certificate] can be suspended, if requested, while you are covered under the employer or union-based group health plan. If you suspend your Medicare supplement [policy or certificate] under these circumstances, and later lose your employer or union-based group health plan, your suspended Medicare supplement [policy or certificate] (or, if that is no longer available, a substantially equivalent [policy or certificate],) will be reinstituted if requested within 90 days of losing your employer or union-based group health plan. If the Medicare supplement [policy or certificate] provided coverage for outpatient prescription drugs and you enrolled in Medicare Part D while your [policy or certificate] was suspended, the reinstituted [policy or certificate] will not have outpatient prescription drug coverage, but will otherwise be substantially equivalent to your coverage before the date of the suspension.(6) Counseling services may be available in your state to provide advice concerning your purchase of Medicare supplement insurance and concerning medical assistance through the state Medicaid program, including benefits as a Qualified Medicare Beneficiary (QMB) and a Specified Low-Income Medicare Beneficiary (SLMB).QuestionsIf you lost or are losing other health insurance coverage and received a notice from your prior insurance company saying you were eligible for guaranteed issue of a Medicare supplement insurance [policy or certificate], or that you had certain rights to buy such a [policy or certificate], you may be guaranteed acceptance in one or more of our Medicare supplement plans. Please include a copy of the notice from your prior insurance company with your application.PLEASE ANSWER ALL QUESTIONS.(Please mark Yes or No below with an “X”.)To the best of your knowledge,(1) (a) Did you turn age 65 in the last 6 months?Yes____No____(b) Did you enroll in Medicare Part B in the last 6 months?Yes____No____(c) If yes, what is the effective date? ____________________________(2) Are you covered for medical assistance through the state Medicaid program?(NOTE TO APPLICANT: If you are participating in a “Spend-Down Program” and have notmet your “Share of Cost,” please answer NO to this question.)Yes____No____If yes,(a) Will Medicaid pay your premiums for this Medicare supplement [policy or certificate]?Yes____No____(b) Do you receive any benefits from Medicaid OTHER THAN payments toward your Medicare Part B premium?Yes____No____(3) (a) If you had coverage from any Medicare plan other than original Medicare within the past 63days (for example, a Medicare Advantage plan, or a Medicare HMO or PPO), fill in your start and end dates below. If you are still covered under this plan, leave “END” blank.START __/__/__ END __/__/__(b) If you are still covered under the Medicare plan, do you intend to replace your current coverage with this new Medicare supplement [policy or certificate]?Yes____No____(c) Was this your first time in this type of Medicare plan?Yes____No____(d) Did you drop a Medicare supplement policy or certificate to enroll in this plan?Yes____No____(4) (a) Do you have another Medicare supplement policy or certificate in force?Yes____No____(b) If so, with what company, and what plan do you have [optional for direct mailers]? ______________________________________________________________________(c) If so, do you intend to replace your current Medicare supplement policy or certificate with this [policy or certificate]?Yes____No____(5) Have you had coverage under any other health insurance within the past 63 days? (For example, an employer, union, or individual plan)Yes____No____(a) If so, with what company and what kind of policy or certificate?____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________(b) What are your dates of coverage under the other policy or certificate?START __/__/__ END __/__/__(If you are still covered under the other policy or certificate, leave “END” blank.)     APPENDIX DNOTICE TO APPLICANT REGARDING REPLACEMENT OF MEDICARE SUPPLEMENT INSURANCE OR MEDICARE ADVANTAGE[Insurance company’s name and address]SAVE THIS NOTICE! IT MAY BE IMPORTANT TO YOU IN THE FUTURE.According to [your application] [information you have furnished], you intend to terminate an existing Medicare supplement policy or certificate or Medicare Advantage policy or certificate and replace it with a policy to be issued by [Company Name] Insurance Company. Your new policy will provide thirty (30) days within which you may decide without cost whether you desire to keep the policy. You should review this new coverage carefully. Compare it with all accident and sickness coverage you now have. If, after due consideration, you find that purchase of this Medicare supplement [policy or certificate] is a wise decision, you should terminate your present Medicare supplement policy or certificate or Medicare Advantage policy or certificate. You should evaluate the need for other accident and sickness coverage you have that may duplicate this policy.STATEMENT TO APPLICANT BY ISSUER, PRODUCER [BROKER OR OTHER REPRESENTATIVE]:I have reviewed your current medical or health insurance coverage. To the best of my knowledge, this Medicare supplement policy or certificate will not duplicate your existing Medicare supplement policy or certificate or, if applicable, Medicare Advantage policy or certificate because you intend to terminate your existing Medicare supplement policy or certificate or Medicare Advantage policy or certificate. The replacement [policy or certificate] is being purchased for the following reason (check one):____ Additional benefits.____ No change in benefits, but lower premiums.____ Fewer benefits and lower premiums.____ My plan has outpatient prescription drug coverage and I am enrolling in Part D.____ Disenrollment from a Medicare Advantage policy or certificate. Please explain reason for disenrollment. [optional only for direct mailers]____ Other. (Please specify.)________________________________________________________
    1. Note: If the issuer of the Medicare supplement policy or certificate being applied for does not impose, or is otherwise prohibited from imposing, preexisting condition limitations, please skip to statement 2 below. Health conditions which you may presently have (preexisting conditions) may not be immediately or fully covered under the new policy. This could result in denial or delay of a claim for benefits under the new [policy or certificate], whereas a similar claim might have been payable under your present policy or certificate.
    2. State law provides that your replacement policy or certificate may not contain new preexisting conditions, waiting periods, elimination periods or probationary periods. The insurance company will waive any time periods applicable to preexisting conditions, waiting periods, elimination periods or probationary periods in the new policy or certificate (or coverage) for similar benefits to the extent such time was spent (depleted) under the original policy or certificate.
    3. If you still wish to terminate your present policy or certificate and replace it with new coverage, be certain to truthfully and completely answer all questions on the application concerning your medical and health history. Failure to include all material medical information on an application may provide a basis for the company to deny any future claims and to refund your premium as though your policy or certificate had never been in force. After the application has been completed and before you sign it, review it carefully to be certain that all information has been properly recorded. [If the policy or certificate is guaranteed issue, this paragraph need not appear.]
    Do not cancel your present policy or certificate until you have received your new [policy or certificate] and are sure that you want to keep it.____________________________________________________________________(Signature of Producer, Broker or Other Representative)*[Typed Name and Address of Issuer, and of Producer or Broker]____________________________________________________________________(Applicant’s Signature)______________________________(Date)*Signature not required for direct response sales.     APPENDIX EOUTLINE OF COVERAGE: BENEFIT CHARTS[Any amount in brackets in this Appendix E shall be changed to coincide with any change in amount made by the Secretary of the U.S. Department of Health and Human Services.]Benefit Chart of Medicare Supplement Plans Sold for Effective Dates On or After June 1, 2010This chart shows the benefits included in each of the standard Medicare Supplement plans. Every company must make Plan “A” available. Some plans may not be available in your state.Basic Benefits:
  • Hospitalization – Part A coinsurance plus coverage for 365 additional days after Medicare benefits end.
  • Medical Expenses – Part B coinsurance (generally 20% of Medicare-approved expenses) or copayments for hospital outpatient services. Plans K, L and N require insureds to pay a portion of Part B coinsurance or copayments.
  • Blood – First three pints of blood each year.
  • Hospice – Part A coinsurance.
    • ABCDFF*G KLMNBasic, including 100% Part B coinsuranceBasic, including 100% Part B coinsuranceBasic, including 100% Part B coinsuranceBasic, including 100% Part B coinsuranceBasic, including 100% Part B co- insurance*Basic, including 100% Part B coinsurance Hospitali- zation and preven- tive care paid at 100%; other basic benefits paid at 50%Hospitali- zation and preven- tive care paid at 100%; other basic benefits paid at 75%Basic, including 100% Part B coinsuranceBasic, including 100% Part B coinsurance, except up to $20 copayment for office visit, and up to $50 copay- ment for ERSkilled Nursing Facility CoinsuranceSkilled Nursing Facility CoinsuranceSkilled Nursing Facility CoinsuranceSkilled Nursing Facility Coinsurance 50% Skilled Nursing Facility Coinsurance75% Skilled Nursing Facility CoinsuranceSkilled Nursing Facility CoinsuranceSkilled Nursing Facility CoinsurancePart A DeductiblePart A DeductiblePart A DeductiblePart A DeductiblePart A Deductible 50% Part A Deductible75% Part A Deductible50% Part A DeductiblePart A DeductiblePart B DeductiblePart B Deductible     Part BExcess (100%)    Part BExcess(100%) Foreign Travel Emer- gencyForeign Travel Emer- gencyForeign Travel EmergencyForeign Travel Emer- gency Foreign Travel Emer- gencyForeign Travel Emer- gency Out-of- pocket limit $[5560]; paid at 100% after limit reached Out-of- pocket limit $[2780]; paid at 100% after limit reached * Plan F also has an option called a high deductible Plan F. This high deductible plan pays the same benefits as Plan F after one has paid a calendar year $[2300] deductible. Benefits from high deductible Plan F will not begin until out-of-pocket expenses exceed $[2300]. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. These expenses include the Medicare deductibles for Part A and Part B, but do not include the plan’s separate foreign travel emergency deductible. PREMIUM INFORMATION [Boldface Type]We, [insert issuer’s name], can only raise your premium if we raise the premium for all policies like yours in this state. [If the premium is based on the increasing age of the insured individual, include information specifying when premiums will change.]READ YOUR POLICY VERY CAREFULLY [Boldface Type]This is only an outline describing your policy’s most important features. The policy is your insurance contract. You must read the policy itself to understand all of the rights and duties of both you and your insurance company.RIGHT TO RETURN POLICY [Boldface Type]If you find that you are not satisfied with your policy, you may return it to [insert issuer’s address]. If you send the policy back to us within 30 days after you receive it, we will treat the policy as if it had never been issued and return all of your payments.POLICY REPLACEMENT [Boldface Type]If you are replacing another health insurance policy, do NOT cancel it until you have actually received your new policy and are sure you want to keep it.NOTICE [Boldface Type]This policy may not fully cover all of your medical costs.[for producers:]Neither [insert company’s name] nor its producers are connected with Medicare.[for direct response:][Insert company’s name] is not connected with Medicare.This outline of coverage does not give all the details of Medicare coverage. Contact your local Social Security office or consult “Medicare and You” for more details.COMPLETE ANSWERS ARE VERY IMPORTANT [Boldface Type]When you fill out the application for the new policy, be sure to answer truthfully and completely all questions about your medical and health history. The company may cancel your policy and refuse to pay any claims if you leave out or falsify important medical information. [If the policy or certificate is guaranteed issue, this paragraph need not appear.]Review the application carefully before you sign it. Be certain that all information has been properly recorded.[Include for each plan prominently identified in the cover page a chart showing the services, Medicare payments, plan payments and insured payments, using the same language, in the same order, using uniform layout and format as shown in the charts below. No more than four plans may be shown on one chart. For purposes of illustration, charts for each plan are included in this Appendix E: Outline of Coverage. An issuer may use additional benefit plan descriptions on these charts pursuant to paragraph 37.8(1)“c.”][Include an explanation of any innovative benefits on the cover page and in the chart, in a manner approved by the commissioner.] Benefit Chart of Medicare Supplement Plans Sold On or After January 1, 2020This chart shows the benefits included in each of the standard Medicare supplement plans. Some plans may not be available. Only applicants first eligible for Medicare before 2020 may purchase Plans C, F, and high deductible F.Note: A ü means 100% of the benefit is paid. Benefits Plans Available to All ApplicantsMedicare first eligible before 2020 A B D G1 K L M NCF 1 Medicare Part A coinsurance and hospital coverage (up to an additional 365 days after Medicare benefits are used up) ü ü ü ü ü ü ü ü ü ü Medicare Part B coinsurance or copayment ü ü ü ü 50%75% ü ü Copays apply3 ü ü Blood (first three pints) ü ü ü ü 50%75% ü ü ü ü Medicare Part A hospice care coinsurance or copayment ü ü ü ü 50%75% ü ü ü ü Skilled nursing facility coinsurance ü ü 50%75% ü ü ü ü Medicare Part A deductible ü ü ü 50%75%50% ü ü ü Medicare Part B deductible ü ü Medicare Part B excess charges ü ü ü Foreign travel emergency (up to plan limits) ü ü ü ü ü Out-of-pocket limit in [2017]2[$5560]2[$2780]21Medicare Plans F and G also have high deductible options which require first paying the plans’ deductibles of [$2300] before the plans begin to pay. Once the plans’ deductibles are met, the plans pay 100% of covered services for the rest of the calendar year. High deductible Plan G does not cover the Medicare Part B deductible. However, high deductible Plans F and G count your payments of the Medicare Part B deductible toward meeting the plan deductibles.2Plans K and L pay 100% of covered services for the rest of the calendar year once you meet the out-of-pocket yearly limits.3Plan N pays 100% of the Medicare Part B coinsurance, except for copayments of up to $20 for some office visits and up to $50 copayments for emergency room visits that do not result in inpatient admissions. PLAN AMEDICARE (PART A)—HOSPITAL SERVICES—PER BENEFIT PERIOD* A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.SERVICESMEDICARE PAYSPLAN PAYSYOU PAY    HOSPITALIZATION*Semiprivate room and board, general nursing and miscellaneous services and supplies   First 60 daysAll but $[1364]$0$[1364] (Part A deductible)   61st through 90th dayAll but $[341] a day$[341] a day$0   91st day and after:   —While using 60 lifetime reserve daysAll but $[682] a day$[682] a day$0   —Once lifetime reserve days are used:     —Additional 365 days$0100% of Medicare eligible expenses$0**     —Beyond the additional 365 days$0$0All costs    SKILLED NURSING FACILITY CARE*You must meet Medicare’s requirements, including having been in a hospital for at least 3 days and entered a Medicare-approved facility within 30 days after leaving the hospital.               First 20 daysAll approved amounts$0$0   21st through 100th dayAll but $[170.50] a day$0Up to $[170.50] a day   101st day and after$0$0All costsBLOODFirst 3 pints$03 pints$0Additional amounts100%$0$0    HOSPICE CAREYou must meet Medicare’s requirements, including a doctor’s certification of terminal illness.    All but very limited copayment/coinsurance for outpatient drugs and inpatient respite care    Medicare copayment/ coinsurance    $0** NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurance company stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy’s basic core benefits (“basic core benefits” are the equivalent of what is provided under Medicare Part A). During this time, the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid. PLAN AMEDICARE (PART B)—MEDICAL SERVICES—PER CALENDAR YEARSERVICESMEDICARE PAYSPLAN PAYSYOU PAY    MEDICAL EXPENSES—IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such as physician’s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment    First $[185] of Medicare-Approved Amounts*$0$0$[185] (Part B deductible)    Remainder of Medicare-Approved AmountsGenerally 80%Generally 20%$0    Part B Excess Charges(Above Medicare-Approved Amounts)    $0    $0    All costsBLOODFirst 3 pints$0All costs$0Next $[185] of Medicare-Approved Amounts*$0$0$[185] (Part B deductible)Remainder of Medicare-Approved Amounts80%20%$0CLINICAL LABORATORY SERVICES— TESTS FOR DIAGNOSTIC SERVICES    100%    $0    $0PLAN AMEDICARE PARTS A & BSERVICESMEDICARE PAYSPLAN PAYSYOU PAY    HOME HEALTH CAREMEDICARE-APPROVED SERVICES    —Medically necessary skilled care servicesand medical supplies100%$0$0—Durable medical equipment          First $[185] of Medicare-ApprovedAmounts*$0$0$[185] (Part B deductible)         Remainder of Medicare-ApprovedAmounts80%20%$0* Once you have been billed $[185] of Medicare-approved amounts for covered services, your Medicare Part B deductible will have been met for the calendar year. MEDICARE PLAN BMEDICARE PART A—HOSPITAL SERVICES—PER BENEFIT PERIOD* A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.SERVICESMEDICARE PAYSPLAN PAYSYOU PAY    HOSPITALIZATION*Semiprivate room and board, general nursing and miscellaneous services and supplies   First 60 daysAll but $[1364]$[1364] (Part A deductible)$0   61st through 90th dayAll but $[341] a day$[341] a day$0   91st day and after:   —While using 60 lifetime reserve daysAll but $[682] a day$[682] a day$0   —Once lifetime reserve days are used:     —Additional 365 days$0100% of Medicare eligible expenses$0**     —Beyond the additional 365 days$0$0All costs    SKILLED NURSING FACILITY CARE*You must meet Medicare’s requirements, including having been in a hospital for at least 3 days and entered a Medicare-approved facility within 30 days after leaving the hospital.   First 20 daysAll approved amounts$0$0   21st through 100th dayAll but $[170.50] a day$0Up to $[170.50] a day   101st day and after$0$0All costsBLOODFirst 3 pints$03 pints$0Additional amounts100%$0$0    HOSPICE CAREYou must meet Medicare’s requirements, including a doctor’s certification of terminal illness.    All but very limited copayment/ coinsurance for outpatient drugs and inpatient respite care    Medicare copayment/ coinsurance    $0** NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurance company stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy’s basic core benefits (“basic core benefits” are the equivalent of what is provided under Medicare Part A). During this time, the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid. PLAN BMEDICARE (PART B)—MEDICAL SERVICES—PER CALENDAR YEARSERVICESMEDICARE PAYSPLAN PAYSYOU PAY    MEDICAL EXPENSES—IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such as physician’s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment    First $[185] of Medicare-Approved Amounts*$0$0$[185] (Part B deductible)    Remainder of Medicare-Approved AmountsGenerally 80%Generally 20%$0    Part B Excess Charges(Above Medicare-Approved Amounts)    $0    $0    All costsBLOODFirst 3 pints$0All costs$0Next $[185] of Medicare-Approved Amounts*$0$0$[185] (Part B deductible)Remainder of Medicare-Approved Amounts80%20%$0CLINICAL LABORATORY SERVICES— TESTS FOR DIAGNOSTIC SERVICES    100%    $0    $0PLAN BPARTS A & BSERVICESMEDICARE PAYSPLAN PAYSYOU PAY    HOME HEALTH CAREMEDICARE-APPROVED SERVICES    —Medically necessary skilled care services andmedical supplies100%$0$0—Durable medical equipment          First $[185] of Medicare-ApprovedAmounts*$0$0$[185] (Part B deductible)         Remainder of Medicare-ApprovedAmounts80%20%$0* Once you have been billed $[185] of Medicare-approved amounts for covered services, your Part B deductible will have been met for the calendar year. PLAN CMEDICARE (PART A)—HOSPITAL SERVICES—PER BENEFIT PERIODSERVICESMEDICARE PAYSPLAN PAYSYOU PAY    HOSPITALIZATION*Semiprivate room and board, general nursing and miscellaneous services and supplies   First 60 daysAll but $[1364]$[1364] (Part A deductible)$0   61st through 90th dayAll but $[341] a day$[341] a day$0   91st day and after:   —While using 60 lifetime reserve daysAll but $[682] a day$[682] a day$0   —Once lifetime reserve days are used:     —Additional 365 days$0100% of Medicare eligible expenses$0**     —Beyond the additional 365 days$0$0All costs    SKILLED NURSING FACILITY CARE*You must meet Medicare’s requirements, including having been in a hospital for at least 3 days and entered a Medicare-approved facility within 30 days after leaving the hospital.   First 20 daysAll approved amounts$0$0   21st through 100th dayAll but $[170.50] a dayUp to $[170.50] a day$0   101st day and after$0$0All costsBLOODFirst 3 pints$03 pints$0Additional amounts100%$0$0    HOSPICE CAREYou must meet Medicare’s requirements, including a doctor’s certification of terminal illness.    All but very limited copayment/ coinsurance for outpatient drugs and inpatient respite care    Medicare copayment/ coinsurance    $0* A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.** NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurance company stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy’s basic core benefits (“basic core benefits” are the equivalent of what is provided under Medicare Part A). During this time, the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid. PLAN CMEDICARE (PART B)—MEDICAL SERVICES—PER CALENDAR YEARSERVICESMEDICARE PAYSPLAN PAYSYOU PAY    MEDICAL EXPENSES—IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such as physician’s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment    First $[185] of Medicare-Approved Amounts*$0$[185] (Part B deductible)$0    Remainder of Medicare-Approved AmountsGenerally 80%Generally 20%$0    Part B Excess Charges(Above Medicare-Approved Amounts)    $0    $0    All costsBLOODFirst 3 pints$0All costs$0Next $[185] of Medicare-Approved Amounts*$0$[185] (Part B deductible)$0Remainder of Medicare-Approved Amounts80%20%$0CLINICAL LABORATORY SERVICES— TESTS FOR DIAGNOSTIC SERVICES    100%    $0    $0PLAN CPARTS A & BSERVICESMEDICARE PAYSPLAN PAYSYOU PAY    HOME HEALTH CAREMEDICARE-APPROVED SERVICES    —Medically necessary skilled care services andmedical supplies100%$0$0—Durable medical equipment         First $[185] of Medicare-ApprovedAmounts*$0$[185] (Part B deductible)$0         Remainder of Medicare-ApprovedAmounts*80%20%$0* Once you have been billed $[185] of Medicare-approved amounts for covered services, your Part B deductible will have been met for the calendar year.PLAN COTHER BENEFITS—NOT COVERED BY MEDICARESERVICESMEDICARE PAYSPLAN PAYSYOU PAY    FOREIGN TRAVEL—NOT COVERED BY MEDICAREMedically necessary emergency care services beginning during the first 60 days of each trip outside the USA   First $250 each calendar year$0$0$250   Remainder of charges$080% to a lifetime maximum benefit of $50,00020% and amounts over the $50,000 lifetime maximum PLAN DMEDICARE (PART A)—HOSPITAL SERVICES—PER BENEFIT PERIODSERVICESMEDICARE PAYSPLAN PAYSYOU PAY    HOSPITALIZATION*Semiprivate room and board, general nursing and miscellaneous services and supplies   First 60 daysAll but $[1364]$[1364] (Part A deductible)$0   61st through 90th dayAll but $[341] a day$[341] a day$0   91st day and after:   —While using 60 lifetime reserve daysAll but $[682] a day$[682] a day$0   —Once lifetime reserve days are used:     —Additional 365 days$0100% of Medicare eligible expenses$0**     —Beyond the additional 365 days$0$0All costs    SKILLED NURSING FACILITY CARE*You must meet Medicare’s requirements, including having been in a hospital for at least 3 days and entered a Medicare-approved facility within 30 days after leaving the hospital.   First 20 daysAll approved amounts$0$0   21st through 100th dayAll but $[170.50] a dayUp to $[170.50] a day$0   101st day and after$0$0All costsBLOODFirst 3 pints$03 pints$0Additional amounts100%$0$0    HOSPICE CAREYou must meet Medicare’s requirements, including a doctor’s certification of terminal illness.    All but very limited copayment/ coinsurance for outpatient drugs and inpatient respite care    Medicare copayment/ coinsurance    $0* A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.** NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurance company stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy’s basic core benefits (“basic core benefits” are the equivalent of what is provided under Medicare Part A). During this time, the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid. PLAN DMEDICARE (PART B)—MEDICAL SERVICES—PER CALENDAR YEARSERVICESMEDICARE PAYSPLAN PAYSYOU PAY    MEDICAL EXPENSES—IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such as physician’s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment    First $[185] of Medicare-Approved Amounts*$0$0$[185] (Part B deductible)    Remainder of Medicare-Approved AmountsGenerally 80%Generally 20%$0    Part B Excess Charges(Above Medicare-Approved Amounts)    $0    $0    All costsBLOODFirst 3 pints$0All costs$0Next $[185] of Medicare-Approved Amounts*$0$0$[185] (Part B deductible)Remainder of Medicare-Approved Amounts80%20%$0CLINICAL LABORATORY SERVICES— TESTS FOR DIAGNOSTIC SERVICES    100%    $0    $0PLAN DPARTS A & BSERVICESMEDICARE PAYSPLAN PAYSYOU PAY    HOME HEALTH CAREMEDICARE-APPROVED SERVICES    —Medically necessary skilled care services andmedical supplies100%$0$0—Durable medical equipment         First $[185] of Medicare-ApprovedAmounts*$0$0$[185] (Part B deductible)         Remainder of Medicare-ApprovedAmounts80%20%$0* Once you have been billed $[185] of Medicare-approved amounts for covered services, your Part B deductible will have been met for the calendar year.PLAN DOTHER BENEFITS—NOT COVERED BY MEDICARESERVICESMEDICARE PAYSPLAN PAYSYOU PAY    FOREIGN TRAVEL—NOT COVEREDBY MEDICAREMedically necessary emergency care services beginning during the first 60 days of each trip outside the USA   First $250 each calendar year$0$0$250   Remainder of charges$080% to a lifetime maximum benefit of $50,00020% and amounts over the $50,000 lifetime maximum PLAN F or HIGH DEDUCTIBLE PLAN FMEDICARE (PART A)—HOSPITAL SERVICES—PER BENEFIT PERIOD    SERVICES    MEDICARE PAYS    [AFTER YOU PAY $[2300] DEDUCTIBLE,**]PLAN PAYS[IN ADDITION TO $[2300] DEDUCTIBLE,**] YOU PAY    HOSPITALIZATION*Semiprivate room and board, general nursing and miscellaneous services and supplies   First 60 daysAll but $[1364]$[1364] (Part A deductible)$0   61st through 90th dayAll but $[341] a day$[341] a day$0   91st day and after:   —While using 60 lifetime reserve daysAll but $[682] a day$[682] a day$0   —Once lifetime reserve days are used:     —Additional 365 days$0100% of Medicare eligible expenses$0***     —Beyond the additional 365 days$0$0All costs    SKILLED NURSING FACILITY CARE*You must meet Medicare’s requirements, including having been in a hospital for at least 3 days and entered a Medicare-approved facility within 30 days after leaving the hospital.   First 20 daysAll approved amounts$0$0   21st through 100th dayAll but $[170.50] a dayUp to $[170.50] a day$0   101st day and after$0$0All costsBLOODFirst 3 pints$03 pints$0Additional amounts100%$0$0    HOSPICE CAREYou must meet Medicare’s requirements, including a doctor’s certification of terminal illness.    All but very limited copayment/ coinsurance for outpatient drugs and inpatient respite care    Medicare copayment/ coinsurance    $0* A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.[** This high deductible plan pays the same benefits as Plan F after you have paid a calendar year $[2300] deductible. Benefits from the high deductible Plan F will not begin until out-of-pocket expenses are $[2300]. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. This includes the Medicare deductibles for Part A and Part B, but does not include the plan’s separate foreign travel emergency deductible.]*** NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurance company stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy’s basic core (“basic core benefits” are the equivalent of what is provided under Medicare Part A). During this time, the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid. PLAN F or HIGH DEDUCTIBLE PLAN FMEDICARE (PART B)—MEDICAL SERVICES—PER CALENDAR YEAR    SERVICES    MEDICARE PAYS[AFTER YOU PAY $[2300] DEDUCTIBLE,**] PLAN PAYS[IN ADDITION TO $[2300] DEDUCTIBLE,**] YOU PAY    MEDICAL EXPENSES—IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such as physician’s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment    First $[185] of Medicare-Approved Amounts*$0$[185] (Part B deductible)$0    Remainder of Medicare-Approved AmountsGenerally 80%Generally 20%$0    Part B Excess Charges(Above Medicare-Approved Amounts)    $0    100%    $0BLOODFirst 3 pints$0All costs$0Next $[185] of Medicare-Approved Amounts*$0$[185] (Part B deductible)$0Remainder of Medicare-Approved Amounts80%20%$0CLINICAL LABORATORY SERVICES— TESTS FOR DIAGNOSTIC SERVICES    100%    $0    $0* Once you have been billed $[185] of Medicare-approved amounts for covered services, your Part B deductible will have been met for the calendar year.[** This high deductible plan pays the same benefits as Plan F after you have paid a calendar year $[2300] deductible. Benefits from the high deductible Plan F will not begin until out-of-pocket expenses are $[2300]. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. This includes the Medicare deductibles for Part A and Part B, but does not include the plan’s separate foreign travel emergency deductible.] PLAN F or HIGH DEDUCTIBLE PLAN FPARTS A & B    SERVICES    MEDICARE PAYS[AFTER YOU PAY $[2300] DEDUCTIBLE,**] PLAN PAYS[IN ADDITION TO $[2300] DEDUCTIBLE,**] YOU PAY    HOME HEALTH CAREMEDICARE-APPROVED SERVICES    —Medically necessary skilled care servicesand medical supplies100%$0$0—Durable medical equipment         First $[185] of Medicare-ApprovedAmounts*$0$[185] (Part B deductible)$0         Remainder of Medicare-ApprovedAmounts80%20%$0PLAN F or HIGH DEDUCTIBLE PLAN FOTHER BENEFITS—NOT COVERED BY MEDICARE    SERVICES    MEDICARE PAYS[AFTER YOU PAY $[2300] DEDUCTIBLE,**] PLAN PAYS[IN ADDITION TO $[2300] DEDUCTIBLE,**] YOU PAY    FOREIGN TRAVEL—NOT COVERED BY MEDICAREMedically necessary emergency care services beginning during the first 60 days of each trip outside the USA   First $250 each calendar year$0$0$250   Remainder of charges$080% to a lifetime maximum benefit of $50,00020% and amounts over the $50,000 lifetime maximum* Once you have been billed $[185] of Medicare-approved amounts for covered services, your Part B deductible will have been met for the calendar year.[** This high deductible plan pays the same benefits as Plan F after you have paid a calendar year $[2300] deductible. Benefits from the high deductible Plan F will not begin until out-of-pocket expenses are $[2300]. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. This includes the Medicare deductibles for Part A and Part B, but does not include the plan’s separate foreign travel emergency deductible.] PLAN G or HIGH DEDUCTIBLE PLAN GMEDICARE (PART A)—HOSPITAL SERVICES—PER BENEFIT PERIODSERVICESMEDICARE PAYS[AFTER YOU PAY $[2300] DEDUCTIBLE,**] PLAN PAYS[IN ADDITION TO $[2300] DEDUCTIBLE,**] YOU PAY    HOSPITALIZATION*Semiprivate room and board, general nursing and miscellaneous services and supplies   First 60 daysAll but $[1364]$[1364] (Part A deductible)$0   61st through 90th dayAll but $[341] a day$[341] a day$0   91st day and after:   —While using 60 lifetime reserve daysAll but $[682] a day$[682] a day$0   —Once lifetime reserve days are used:     —Additional 365 days$0100% of Medicare eligible expenses$0***     —Beyond the additional 365 days$0$0All costs    SKILLED NURSING FACILITY CARE*You must meet Medicare’s requirements, including having been in a hospital for at least 3 days and entered a Medicare-approved facility within 30 days after leaving the hospital.   First 20 daysAll approved amounts$0$0   21st through 100th dayAll but $[170.50] a dayUp to $[170.50] a day$0   101st day and after$0$0All costsBLOODFirst 3 pints$03 pints$0Additional amounts100%$0$0    HOSPICE CAREYou must meet Medicare’s requirements, including a doctor’s certification of terminal illness.    All but very limited copayment/ coinsurance for outpatient drugs and inpatient respite care    Medicare copayment/ coinsurance    $0* A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.[** This high deductible plan pays the same benefits as Plan G after you have paid a calendar year [$2300] deductible. Benefits from the high deductible Plan G will not begin until out-of-pocket expenses are [$2300]. Out-of-pocket expenses for this deductible include expenses for the Medicare Part B deductible, and expenses that would ordinarily be paid by the policy. This does not include the plan’s separate foreign travel emergency deductible.]*** NOTICE: When your Medicare Part A hospital benefits are exhausted, the issuer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy’s basic core benefits (“basic core benefits” are the equivalent of what is provided under Medicare Part A). During this time, the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid. PLAN G or HIGH DEDUCTIBLE PLAN GMEDICARE (PART B)—MEDICAL SERVICES—PER CALENDAR YEARSERVICESMEDICARE PAYS[AFTER YOU PAY $[2300] DEDUCTIBLE,**] PLAN PAYS[IN ADDITION TO $[2300] DEDUCTIBLE,**] YOU PAY    MEDICAL EXPENSES—IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such as physician’s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment    First $[185] of Medicare-Approved Amounts*$0$0$[185] (Unless Part B deductible has been met)     Remainder of Medicare-Approved AmountsGenerally 80%Generally 20%$0    Part B Excess Charges(Above Medicare-Approved Amounts)    $0    100%    0%BLOODFirst 3 pints$0All costs$0Next $[185] of Medicare-Approved Amounts*$0$0$[185] (Unless Part B deductible has been met) Remainder of Medicare-Approved Amounts80%20%$0CLINICAL LABORATORY SERVICES— TESTS FOR DIAGNOSTIC SERVICES    100%    $0    $0* Once you have been billed $[185] of Medicare-approved amounts for covered services, your Part B deductible will have been met for the calendar year.[**This high deductible plan pays the same benefits as Plan G after you have paid a calendar year $[2300] deductible. Benefits from the high deductible Plan G will not begin until out-of-pocket expenses are $[2300]. Out-of-pocket expenses for this deductible include expenses for the Medicare Part B deductible, and expenses that would ordinarily be paid by the policy. This does not include the plan’s separate foreign travel emergency deductible.] PLAN G or HIGH DEDUCTIBLE PLAN GPARTS A & BSERVICESMEDICARE PAYS[AFTER YOU PAY $[2300] DEDUCTIBLE,**] PLAN PAYS[IN ADDITION TO $[2300] DEDUCTIBLE,**] YOU PAY    HOME HEALTH CAREMEDICARE-APPROVED SERVICES    —Medically necessary skilled care services andmedical supplies100%$0$0—Durable medical equipment    First $[185] of Medicare-Approved Amounts*$0$0$[185] (Unless Part B deductible has been met)     Remainder of Medicare-Approved Amounts80%20%$0PLAN G or HIGH DEDUCTIBLE PLAN GOTHER BENEFITS—NOT COVERED BY MEDICARESERVICESMEDICARE PAYS[AFTER YOU PAY $[2300] DEDUCTIBLE,**] PLAN PAYS[IN ADDITION TO $[2300] DEDUCTIBLE,**] YOU PAY    FOREIGN TRAVEL—NOT COVERED BY MEDICAREMedically necessary emergency care services beginning during the first 60 days of each trip outside the USA   First $250 each calendar year$0$0$250   Remainder of charges$080% to a lifetime maximum benefit of $50,00020% and amounts over the $50,000 lifetime maximum* Once you have been billed $[185] of Medicare-approved amounts for covered services, your Part B deductible will have been met for the calendar year.[**This high deductible plan pays the same benefits as Plan G after you have paid a calendar year $[2300] deductible. Benefits from the high deductible Plan G will not begin until out-of-pocket expenses are $[2300]. Out-of-pocket expenses for this deductible include expenses for the Medicare Part B deductible, and expenses that would ordinarily be paid by the policy. This does not include the plan’s separate foreign travel emergency deductible.] PLAN KMEDICARE (PART A)—HOSPITAL SERVICES—PER BENEFIT PERIODSERVICESMEDICARE PAYSPLAN PAYSYOU PAY*    HOSPITALIZATION**Semiprivate room and board, general nursing and miscellaneous services and supplies   First 60 daysAll but $[1364]$[682] (50% of Part A deductible)$[682] (50% of Part A deductible)♦   61st through 90th dayAll but $[341] a day$[341] a day $0   91st day and after:   —While using 60 lifetime reserve daysAll but $[682] a day$[682] a day $0   —Once lifetime reserve days are used:     —Additional 365 days$0100% of Medicare eligible expenses$0***     —Beyond the additional 365 days$0$0All costs    SKILLED NURSING FACILITY CARE**You must meet Medicare’s requirements, including having been in a hospital for at least 3 days and entered a Medicare-approved facility within 30 days after leaving the hospital.   First 20 daysAll approved amounts$0$0   21st through 100th dayAll but $[170.50] a dayUp to $[85.25] a dayUp to $[85.25] a day ♦   101st day and after$0$0All costsBLOODFirst 3 pints$050%50%♦Additional amounts100%$0$0    HOSPICE CAREYou must meet Medicare’s requirements, including a doctor’s certification of terminal illness.    All but very limited copayment/ coinsurance for outpatient drugs and inpatient respite care    50% of copayment/ coinsurance     50% of Medicare copayment/ coinsurance♦* You will pay half the cost sharing of some covered services until you reach the annual out-of-pocket maximum of $[5560] each calendar year. The amounts that count toward your annual limit are noted with diamonds (♦) in the chart below. Once you reach the annual maximum, the plan pays 100% of your Medicare copayment and coinsurance for the rest of the calendar year. However, this limit does NOT include charges from your provider that exceed Medicare-approved amounts (these are called “Excess Charges”), and you will be responsible for paying this difference in the amount charged by your provider and the amount paid by Medicare for the item or service.** A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.*** NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurance company stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy’s basic core benefits (“basic core benefits” are the equivalent of what is provided under Medicare Part A). During this time, the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid. PLAN KMEDICARE (PART B)—MEDICAL SERVICES—PER CALENDAR YEARSERVICESMEDICARE PAYSPLAN PAYSYOU PAY*    MEDICAL EXPENSES—IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such as physician’s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment    First $[185] of Medicare-Approved Amounts****$0$0$[185] (Part B deductible)**** ♦    Preventive Benefits for Medicare-Covered Services    Generally 80% or more of Medicare-Approved AmountsRemainder of Medicare-Approved Amounts All costs above Medicare-Approved Amounts    Remainder of Medicare-Approved AmountsGenerally 80%Generally 10%Generally 10% ♦    Part B Excess Charges(Above Medicare-Approved Amounts)$0$0All costs (and they do not count toward annual out-of-pocket limit of $[5560])*BLOODFirst 3 pints$050%50%♦Next $[185] of Medicare-Approved Amounts****$0$0$[185] (Part B deductible)**** ♦Remainder of Medicare-Approved AmountsGenerally 80%Generally 10%Generally 10% ♦CLINICAL LABORATORY SERVICES— TESTS FOR DIAGNOSTIC SERVICES    100%    $0    $0* You will pay half the cost sharing of some covered services until you reach the annual out-of-pocket maximum of $[5560] each calendar year. The amounts that count toward your annual limit are noted with diamonds (♦) in the chart below. Once you reach the annual maximum, the plan pays 100% of your Medicare copayment and coinsurance for the rest of the calendar year. However, this limit does NOT include charges from your provider that exceed Medicare-approved amounts (these are called “Excess Charges”), and you will be responsible for paying this difference in the amount charged by your provider and the amount paid by Medicare for the item or service.**** Once you have been billed $[185] of Medicare-approved amounts for covered services, your Part B deductible will have been met for the calendar year. PLAN KPARTS A & BSERVICESMEDICARE PAYSPLAN PAYSYOU PAY*    HOME HEALTH CAREMEDICARE-APPROVED SERVICES    —Medically necessary skilled care services andmedical supplies100%$0$0    —Durable medical equipment   First $[185] of Medicare-ApprovedAmounts*****    $0    $0    $[185] (Part B deductible) ♦   Remainder of Medicare-Approved Amounts80%10%10%♦Medicare benefits are subject to change. Please consult the latest Guide to Health Insurance for People with Medicare.* You will pay half the cost sharing of some covered services until you reach the annual out-of-pocket maximum of $[5560] each calendar year. The amounts that count toward your annual limit are noted with diamonds (♦) in the chart below. Once you reach the annual maximum, the plan pays 100% of your Medicare copayment and coinsurance for the rest of the calendar year. However, this limit does NOT include charges from your provider that exceed Medicare-approved amounts (these are called “Excess Charges”), and you will be responsible for paying this difference in the amount charged by your provider and the amount paid by Medicare for the item or service.***** This plan limits your annual out-of-pocket payments for Medicare-approved amounts to $[5560] per year. However, this limit does NOT include charges from your provider that exceed Medicare-approved amounts (these are called “Excess Charges”), and you will be responsible for paying this difference in the amount charged by your provider and the amount paid by Medicare for the item or service. PLAN LMEDICARE (PART A)—HOSPITAL SERVICES—PER BENEFIT PERIODSERVICESMEDICARE PAYSPLAN PAYSYOU PAY*    HOSPITALIZATION**Semiprivate room and board, general nursing and miscellaneous services and supplies   First 60 daysAll but $[1364]$[1023] (75% of Part A deductible)$[341] (25% of Part A deductible)♦   61st through 90th dayAll but $[341] a day$[341] a day$0   91st day and after:   —While using 60 lifetime reserve daysAll but $[682] a day$[682] a day$0   —Once lifetime reserve days are used:     —Additional 365 days$0100% of Medicare eligible expenses$0***     —Beyond the additional 365 days$0$0All costs    SKILLED NURSING FACILITY CARE**You must meet Medicare’s requirements, including having been in a hospital for at least 3 days and entered a Medicare-approved facility within 30 days after leaving the hospital.   First 20 daysAll approved amounts$0$0   21st through 100th dayAll but $[170.50] a dayUp to $[127.88] a day (75% of Part A Coinsurance)Up to $[42.63] a day (25% of Part A Coinsurance)♦   101st day and after$0$0All costsBLOODFirst 3 pints$075%25%♦Additional amounts100%$0$0    HOSPICE CAREYou must meet Medicare’s requirements, including a doctor’s certification of terminal illness.    All but very limited copayment/ coinsurance for outpatient drugs and inpatient respite care     75% of copayment/ coinsurance    25% of copayment/ coinsurance♦* You will pay one-fourth of the cost sharing of some covered services until you reach the annual out-of-pocket limit of $[2780] each calendar year. The amounts that count toward your annual limit are noted with diamonds (♦) in the chart below. Once you reach the annual limit, the plan pays 100% of your Medicare copayment and coinsurance for the rest of the calendar year. However, this limit does NOT include charges from your provider that exceed Medicare-approved amounts (these are called “Excess Charges”), and you will be responsible for paying this difference in the amount charged by your provider and the amount paid by Medicare for the item or service.** A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.*** NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurance company stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy’s basic core benefits (“basic core benefits” are the equivalent of what is provided under Medicare Part A). During this time, the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid. PLAN LMEDICARE (PART B)—MEDICAL SERVICES—PER CALENDAR YEARSERVICESMEDICARE PAYSPLAN PAYSYOU PAY*    MEDICAL EXPENSES—IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such as physician’s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment    First $[185] of Medicare-Approved Amounts****$0$0$[185] (Part B deductible)****♦    Preventive Benefits for Medicare-Covered Services    Generally 75% or more of Medicare-Approved AmountsRemainder of Medicare-Approved AmountsAll costs above Medicare-Approved Amounts    Remainder of Medicare-Approved AmountsGenerally 80%Generally 15%Generally 5%♦    Part B Excess Charges(Above Medicare-Approved Amounts)$0$0All costs (and they do not count toward annual out-of-pocket limit of $[2780])*BLOODFirst 3 pints$075%25%♦Next $[185] of Medicare-Approved Amounts****$0$0$[185] (Part B deductible)♦Remainder of Medicare-Approved AmountsGenerally 80%Generally 15%Generally 5%♦CLINICAL LABORATORY SERVICES— TESTS FOR DIAGNOSTIC SERVICES    100%    $0    $0* You will pay one-fourth of the cost sharing of some covered services until you reach the annual out-of-pocket limit of $[2780] each calendar year. The amounts that count toward your annual limit are noted with diamonds (♦) in the chart below. Once you reach the annual limit, the plan pays 100% of your Medicare copayment and coinsurance for the rest of the calendar year. However, this limit does NOT include charges from your provider that exceed Medicare-approved amounts (these are called “Excess Charges”), and you will be responsible for paying this difference in the amount charged by your provider and the amount paid by Medicare for the item or service.**** Once you have been billed $[185] of Medicare-approved amounts for covered services (which are noted with an asterisk), your Part B deductible will have been met for the calendar year. PLAN LPARTS A & BSERVICESMEDICARE PAYSPLAN PAYSYOU PAY*    HOME HEALTH CAREMEDICARE-APPROVED SERVICES    —Medically necessary skilled care services andmedical supplies 100%$0$0    —Durable medical equipment     First $[185] of Medicare-ApprovedAmounts****    $0    $0    $[185] (Part B deductible)♦         Remainder of Medicare-Approved Amounts80%15%5%♦Medicare benefits are subject to change. Please consult the latest Guide to Health Insurance for People with Medicare.* You will pay one-fourth of the cost sharing of some covered services until you reach the annual out-of-pocket limit of $[2780] each calendar year. The amounts that count toward your annual limit are noted with diamonds (♦) in the chart below. Once you reach the annual limit, the plan pays 100% of your Medicare copayment and coinsurance for the rest of the calendar year. However, this limit does NOT include charges from your provider that exceed Medicare-approved amounts (these are called “Excess Charges”), and you will be responsible for paying this difference in the amount charged by your provider and the amount paid by Medicare for the item or service.**** Once you have been billed $[185] of Medicare-approved amounts for covered services (which are noted with an asterisk), your Part B deductible will have been met for the calendar year. PLAN MMEDICARE (PART A)—HOSPITAL SERVICES—PER BENEFIT PERIODSERVICESMEDICARE PAYSPLAN PAYSYOU PAY    HOSPITALIZATION*Semiprivate room and board, general nursing and miscellaneous services and supplies   First 60 daysAll but $[1364]$[682] (50% of Part A deductible)$[682] (50% of Part A deductible)   61st through 90th dayAll but $[341] a day$[341] a day$0   91st day and after:   —While using 60 lifetime reserve daysAll but $[682] a day$[682] a day$0   —Once lifetime reserve days are used:     —Additional 365 days$0100% of Medicare eligible expenses$0**     —Beyond the additional 365 days$0$0All costs    SKILLED NURSING FACILITY CARE*You must meet Medicare’s requirements, including having been in a hospital for at least 3 days and entered a Medicare-approved facility within 30 days after leaving the hospital.   First 20 daysAll approved amounts$0$0   21st through 100th dayAll but $[170.50] a dayUp to $[170.50] a day$0   101st day and after$0$0All costsBLOODFirst 3 pints$03 pints$0Additional amounts100%$0$0    HOSPICE CAREYou must meet Medicare’s requirements, including a doctor’s certification of terminal illness.    All but very limited copayment/ coinsurance for outpatient drugs and inpatient respite care    Medicare copayment/ coinsurance    $0* A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.** NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurance company stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy’s basic core benefits (“basic core benefits” are the equivalent of what is provided under Medicare Part A). During this time, the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid. PLAN MMEDICARE (PART B)—MEDICAL SERVICES—PER CALENDAR YEARSERVICESMEDICARE PAYSPLAN PAYSYOU PAY    MEDICAL EXPENSES—IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such as physician’s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment    First $[185] of Medicare-Approved Amounts*$0$0$[185] (Part B deductible)    Remainder of Medicare-Approved AmountsGenerally 80%Generally 20%0%    Part B Excess Charges(Above Medicare-Approved Amounts)    $0    $0    All costsBLOODFirst 3 pints$0All costs$0Next $[185] of Medicare-Approved Amounts*$0$0$[185] (Part B deductible)Remainder of Medicare-Approved Amounts80%20%$0CLINICAL LABORATORY SERVICES— TESTS FOR DIAGNOSTIC SERVICES    100%    $0    $0* Once you have been billed $[185] of Medicare-approved amounts for covered services, your Part B deductible will have been met for the calendar year. PLAN MPARTS A & BSERVICESMEDICARE PAYSPLAN PAYSYOU PAY    HOME HEALTH CAREMEDICARE-APPROVED SERVICES    —Medically necessary skilled care services andmedical supplies 100%$0$0    —Durable medical equipmentFirst $[185] of Medicare-Approved Amounts*    $0    $0    $[185] (Part B deductible)   Remainder of Medicare-Approved Amounts80%20%$0* Once you have been billed $[185] of Medicare-approved amounts for covered services, your Part B deductible will have been met for the calendar year.PLAN MOTHER BENEFITS—NOT COVERED BY MEDICARESERVICESMEDICARE PAYSPLAN PAYSYOU PAY    FOREIGN TRAVEL—NOT COVEREDBY MEDICAREMedically necessary emergency care services beginning during the first 60 days of each trip outside the USA   First $250 each calendar year$0$0$250   Remainder of charges$080% to a lifetime maximum benefit of $50,00020% and amounts over the $50,000 lifetime maximum PLAN NMEDICARE (PART A)—HOSPITAL SERVICES—PER BENEFIT PERIODSERVICESMEDICARE PAYSPLAN PAYSYOU PAY    HOSPITALIZATION*Semiprivate room and board, general nursing and miscellaneous services and supplies   First 60 daysAll but $[1364]$[1364] (Part A deductible)$0   61st through 90th dayAll but $[341] a day$[341] a day$0   91st day and after:   —While using 60 lifetime reserve daysAll but $[682] a day$[682] a day$0   —Once lifetime reserve days are used:     —Additional 365 days$0100% of Medicare eligible expenses$0**     —Beyond the additional 365 days$0$0All costs    SKILLED NURSING FACILITY CARE*You must meet Medicare’s requirements, including having been in a hospital for at least 3 days and entered a Medicare-approved facility within 30 days after leaving the hospital.   First 20 daysAll approved amounts$0$0   21st through 100th dayAll but $[170.50] a dayUp to $[170.50] a day$0**   101st day and after$0$0All costsBLOODFirst 3 pints$03 pints$0Additional amounts100%$0$0    HOSPICE CAREYou must meet Medicare’s requirements, including a doctor’s certification of terminal illness.    All but very limited copayment/ coinsurance for outpatient drugs and inpatient respite care    Medicare copayment/ coinsurance    $0* A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.** NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurance company stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy’s basic core benefits (“basic core benefits” are the equivalent of what is provided under Medicare Part A). During this time, the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid. PLAN NMEDICARE (PART B)—MEDICAL SERVICES—PER CALENDAR YEARSERVICESMEDICARE PAYSPLAN PAYSYOU PAY    MEDICAL EXPENSES—IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such as physician’s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment    First $[185] of Medicare-Approved Amounts*$0$0$[185] (Part B deductible)    Remainder of Medicare-Approved AmountsGenerally 80%Balance, other than up to $[20] per office visit and up to $[50] per emergency room visit. The copayment of up to $[50] is waived if the insured individual is admitted to any hospital and the emergency visit is covered as a Medicare Part A expense.Up to $[20] per office visit and up to $[50] per emergency room visit. The copayment of up to $[50] is waived if the insured individual is admitted to any hospital and the emergency visit is covered as a Medicare Part A expense.    Part B Excess Charges(Above Medicare-Approved Amounts)    $0    $0    All costsBLOODFirst 3 pints$0All costs$0Next $[185] of Medicare-Approved Amounts*$0$0$[185] (Part B deductible)Remainder of Medicare-Approved Amounts80%20%$0CLINICAL LABORATORY SERVICES— TESTS FOR DIAGNOSTIC SERVICES    100%    $0    $0* Once you have been billed $[185] of Medicare-approved amounts for covered services, your Part B deductible will have been met for the calendar year. PLAN NPARTS A & BSERVICESMEDICARE PAYSPLAN PAYSYOU PAY    HOME HEALTH CAREMEDICARE-APPROVED SERVICES    —Medically necessary skilled care services andmedical supplies 100%$0$0    —Durable medical equipmentFirst $[185] of Medicare-Approved Amounts*    $0    $0    $[185] (Part B deductible)   Remainder of Medicare-Approved Amounts80%20%$0* Once you have been billed $[185] of Medicare-approved amounts for covered services, your Part B deductible will have been met for the calendar year.PLAN NOTHER BENEFITS—NOT COVERED BY MEDICARESERVICESMEDICARE PAYSPLAN PAYSYOU PAY    FOREIGN TRAVEL—NOT COVEREDBY MEDICAREMedically necessary emergency care services beginning during the first 60 days of each trip outside the USA   First $250 each calendar year$0$0$250   Remainder of charges$080% to a lifetime maximum benefit of $50,00020% and amounts over the $50,000 lifetime maximum     APPENDIX F FORM FOR REPORTINGMEDICARE SUPPLEMENT POLICIES OR CERTIFICATESPursuant to Iowa Administrative Code rule 191—37.32(514D)Company Name:Address:Phone Number: Due March 1, annuallyThe purpose of this form is to report the following information on each resident of this state who has in force more than one Medicare supplement policy or certificate. The information is to be grouped by covered individual.Policy and Certificate #Date of IssuanceSignatureName and Title (please type)Date    ARC 4279CNatural Resources Department[561]Notice of Intended Action

    Proposing rule making related to oil, gas, and metallic minerals and providing an opportunity for public comment

        The Natural Resources Department (Department) hereby proposes to adopt new Chapter 17, “Oil, Gas, and Metallic Minerals,” Iowa Administrative Code.Legal Authority for Rule Making    This rule making is proposed under the authority provided in Iowa Code section 458A.11.State or Federal Law Implemented    This rule making implements, in whole or in part, Iowa Code chapter 458A.Purpose and Summary    The Department is charged by the legislature with responsibility for the oil, gas, and mineral drilling program in Iowa Code chapter 458A. Prior to this year, the State Geologist, who was at the time an employee of the Department, received and reviewed these oil, gas, and mineral drilling permit applications. The details of the State Geologist’s review are set out in 565—Chapter 51. Last year, pursuant to 2018 Iowa Acts, House File 2303, signed by Governor Reynolds on March 21, 2018, the Legislature transferred the State Geologist and the Iowa Geological Survey to the University of Iowa. The oil, gas, and mineral permitting program remained with the Department. Because of the transfer of the State Geologist to the University of Iowa, the Department is now required to update its rules governing the oil, gas, and mineral permitting program. The Department is proposing to rescind 565—Chapter 51 (see ARC 4278C, IAB 2/13/19) and to move the contents of that chapter into new Chapter 17 proposed herein.    No substantive changes are being proposed in Chapter 17, but wording has been updated to make Chapter 17 consistent with 2018 Iowa Acts, House File 2303. For example, proposed revisions replace the references in 565—Chapter 51 to the State Geologist with references to the Director of the Department and include other minor clarifications to the chapter consistent with House File 2303. The revisions clarify that applications for permits to drill oil and gas wells or to drill for minerals in Iowa will be submitted to, and be reviewed by, the Director of the Department and that the Department maintains jurisdiction over the permitting program.     Other minor revisions are included as part of the Department’s five-year review process. This rule making is related to Energy and Geological Resources Division[565] rule making ARC 4278C, IAB 2/13/19, and Environmental Protection Commission[567] rule making ARC 4277C, IAB 2/13/19.Fiscal Impact     This rule making has no fiscal impact to the State of Iowa. A copy of the fiscal impact statement is available from the Department upon request. Jobs Impact    After analysis and review of this rule making, no impact on jobs has been found. A copy of the jobs impact statement is available from the Department upon request.Waivers    This rule is subject to the waiver provision of 561—Chapter 10. Any person who believes that the application of the discretionary provisions of this rule making would result in hardship or injustice to that person may petition the Department for a waiver of the discretionary provisions, if any. Public Comment     Any interested person may submit written comments concerning this proposed rule making. Written comments in response to this rule making must be received by the Department no later than 4:30 p.m. on March 5, 2019. Comments should be directed to: David Scott Department of Natural Resources Wallace State Office Building 502 East Ninth Street, Fourth Floor Des Moines, Iowa 50319 Phone: 515.725.8239 Email: david.scott@dnr.iowa.govPublic Hearing     A public hearing at which persons may present their views orally or in writing will be held as follows. Upon arrival, attendees should proceed to the fourth floor to check in at the Department reception desk to sign in and be directed to the appropriate hearing location. March 5, 2019 10 a.m. to 12 noon Conference Room 4 West Wallace State Office Building Des Moines, Iowa     Persons who wish to make oral comments at the public hearing will be asked to state their names for the record and to confine their remarks to the subject of this proposed rule making.     Any persons who intend to attend the public hearing and have special requirements, such as those related to hearing or mobility impairments, should contact the Department and advise of specific needs. Review by Administrative Rules Review Committee    The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making at its regular monthly meeting or at a special meeting. The Committee’s meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).    The following rule-making action is proposed:

        ITEM 1.    Adopt the following new 561—Chapter 17: CHAPTER 17OIL, GAS, AND METALLIC MINERALS

    561—17.1(458A) Definitions.  Unless the context otherwise requires, the words defined in this rule shall have the indicated meaning when found elsewhere in these rules.        "Allowable period" means the period as designated in which an allowable may be produced.        "Artesian water" means underground water that is confined by impervious material under pressure sufficient to raise it above the upper level of the saturated material in which it lies if this is penetrated by wells or natural fissures.        "Barrel" means 42 United States gallons measured at 60 degrees Fahrenheit and atmospheric pressure at sea level.        "Barrel of oil" means 42 United States gallons of oil after deductions for the full amount of basic sediment, water, and other impurities present, ascertained by centrifugal or other recognized and customary test.        "Blowout" means a sudden or violent escape of oil or natural gas, as from a drilling well when high formational pressure is encountered.        "Blowout preventer" means a heavy casinghead control fitted with special gates or rams which can be closed around the drill pipe, or which completely closes the top of the casing.        "Casing pressure" means the pressure built up between the casing and tubing when the casing and tubing are packed off at the top of the well.        "Casinghead gas" means any gas or vapor, or both gas and vapor, indigenous to an oil stratum and produced from such stratum with oil.        "Certificate of compliance and authorization to transport oil or gas from lease" means a form prescribed by the department, which, when executed by an operator or producer, certifies that the operation of the wells involved, and the production of oil or gas therefrom, has been in compliance with the orders and rules of the department. This certificate also authorizes a purchaser of oil or gas to transport same from the lease. Thereby, the department is informed of the purchaser, and the purchaser is informed that the oil or gas purchased has been produced legally. The certificate of clearance by the department is included on the bottom of the producer’s compliance form.        "Common source of supply" is synonymous with pool.        "Completed well" means a well that has (a) produced or is ready to produce formation hydrocarbons through the permanent wellhead facilities, or (b) been declared a dry hole and temporarily abandoned or plugged and abandoned, or (c) been otherwise readied for operations as in the case of injection and service wells.        "Condensate" means liquid hydrocarbons that were originally in the gaseous phase in the reservoir.        "Cubic foot of gas" means the volume of gas contained in one cubic foot of space at a standard pressure base and a standard temperature base. The standard pressure base shall be 14.65 pounds per square inch absolute, and the standard temperature base shall be 60 degrees Fahrenheit.        "Day" means a period of 24 consecutive hours from 7 a.m. one day to 7 a.m. the following day.        "Department" means the Iowa department of natural resources.        "Developed area" means a spacing unit on which a well has been completed that is capable of producing oil or gas, or the acreage that is otherwise attributed to a well by the department for allowable purposes.        "Development" means any work which actively looks toward bringing in production.        "Director" means the director of the Iowa department of natural resources or the director’s designee.        "Gas allowable" means the amount of natural gas authorized to be produced by order of the department.        "Gas-oil ratio" means the ratio of the gas produced in cubic feet to the number of barrels of oil concurrently produced during any stated period.        "Just and equitable share of the production" means, as to each person, that part of the authorized production from the pool that is substantially in the proportion that the amount of recoverable oil or gas or both in the developed area of the person’s tract or tracts in the pool bears to the recoverable oil or gas or both in the total developed area in the pool.        "Lease" means a tract or tracts of land which, by virtue of an oil, gas, or metallic minerals lease, fee or mineral ownership, a drilling, pooling, or other agreement, a rule, or order of governmental authority, or otherwise, constitutes a single tract or leasehold estate for the purpose of the development or operation thereof for oil or gas or both, or for the exploration for or production of metallic minerals.        "Nomination" means the statement made by a purchaser indicating the amount of oil or gas the purchaser has a definite and bona fide need to purchase during a given period.        "Oil allowable" means the amount of oil authorized to be produced by order of the department.        "Oil and gas" means oil or gas or both.        "Oil well" means any well capable of producing oil in paying quantities.        "Operator" means any person who, duly authorized, is in charge of the development of a lease, or the operation of a producing well.        "Overage" "overproduction" means the oil or gas produced in excess of the allowable fixed by the department.        "Pipeline oil" means oil free from water and basic sediment to the degree that is acceptable for pipeline transportation and refinery use.        "Potential" means the actual or properly computed daily ability of a well to produce oil as determined by a test made in conformity with rules prescribed by the department.        "Pressure maintenance" means the injection of gas, water or other fluids into oil or gas reservoirs to maintain pressure or retard pressure decline in the reservoir for the purpose of increasing the recovery of oil or other hydrocarbons therefrom.        "Protect correlative rights" means that the action or regulation by the department should afford a reasonable opportunity to each person entitled therein to recover or receive the oil or gas in the person’s tract, or tracts, or the equivalent thereof, without being required to drill unnecessary wells or to incur other unnecessary expense to recover or receive such oil or gas or its equivalent.        "Proven oil or gas land" means that area which has been shown by development or geological information to be such that additional wells drilled thereon are reasonably certain to be commercially productive of oil or gas or both.        "Purchaser" means any person who directly or indirectly purchases, transports, takes, or otherwise removes production to the person’s account from a well, wells, or pool.        "Run" means oil or gas, measured at standard conditions, moved off the lease or unit for sale.        "Storer" means every person as herein defined who stores, terminals, retains in custody under warehouse or storage agreements or contracts, oil which comes to rest in the person’s tank or other receptacle under control of said storer, but excluding the ordinary lease stocks of producers.        "Transporter" means and includes any common carrier by pipeline, barge, boat, or other water conveyance or truck or other conveyance except railroads, and any other person transporting oil by pipeline, barge, boat or other water conveyance, or truck and other conveyance.        "Water flooding" means the injection into a reservoir through one or several wells of volumes of water, either currently or cumulatively in excess of the volumes of oil and water produced, for the purpose of increasing the recovery of oil therefrom.        "Well log" means the written record progressively describing the strata, water, oil, gas or metallic minerals encountered in drilling a well with such additional information as to give volumes, pressures, rate of fill-up, water depths, caving strata, casing record, etc., as is usually recorded in normal procedure of drilling. The well log shall include any electrical or other geophysical logging, detail of all cores, and all drill-stem tests, including depth tested, cushion used, time pool open, flowing and shut-in pressures and recoveries.        "Wildcat well" means a well drilled to discover a previously unknown pool.

    561—17.2(458A) Application and permit.      17.2(1) Production of oil, gas, or metallic minerals.  Prior to commencement of operations, including the drilling of any well, an application on a form prescribed by the department shall be delivered to the director for a permit to drill, deepen, or plug back any well for oil, or gas or metallic mineral production. The application for each well shall be accompanied by a fee of $50, and an organization report and a bond must be on file in the department or must accompany the application.An accurate plat, map, or sketch prepared by a licensed surveyor or engineer must accompany the application. The plat shall be drawn neatly and to scale and shall show the distance from the two nearest lease lines and from the two nearest section lines, and from the nearest completed or drilling wells on the same lease.The department shall not issue a permit to drill if the application is not properly completed or if a well drilled at the location applied for would cause or tend to cause waste or violate correlative rights. The applicant may appeal the decision of the department to the environmental protection commission in accordance with 567—Chapter 7.Unless extended in writing by the department, the permit shall expire six months from the date of issue if the work for which the permit was issued is not being actively pursued.    17.2(2) Stratigraphic test wells.  Before commencing exploratory drilling for geological information relating to oil, gas, or metallic mineral production, or the underground storage of natural gas, an application for a drilling permit shall be filed with the director. One application may be filed for a group or series of exploratory wells within a designated area. The application shall be accompanied by a plat of the general area to be covered by township and range listing the approximate number and depth of the holes, and outlining the parcels where drilling is contemplated. The plat shall indicate the nature of the applicant’s property interest in each parcel where drilling is contemplated. The application shall be accompanied by a fee of $200. The applicant shall comply with the requirements in rules 561—17.4(458A) and 561—17.5(458A) concerning organization reports and bonding.

    561—17.3(458A) Transfer of drilling permits.  No person to whom a permit has been issued shall transfer the permit to any other location or to any other person until the following requirements have been complied with and the transfer has been approved by the department.    17.3(1) Transfer to another location.  If, prior to the drilling of a well, the person to whom the permit was originally issued desires to change the location, the person shall submit a letter so stating and another application properly filled out showing the new location. No additional fee is necessary, but drilling shall not be started until the transfer has been approved and the new permit posted at the new location.    17.3(2) Transfer to another person.  If, while a well is drilling, or after it has been completed, the person to whom the permit was originally issued disposes of the person’s interest in the well, the person shall submit a written statement to the department setting forth the facts and requesting that the permit be transferred to the person who has acquired the well.    17.3(3) Statement of responsibility and bond.  Before the transfer of a drilling permit shall be approved, the person who has acquired the well must submit a written statement setting forth that the person has acquired such well and assumes the full responsibility for its operation and abandonment in conformity with the laws of Iowa and the rules and orders of the department. The bond required to guarantee compliance therewith shall be furnished by the person acquiring such well.

    561—17.4(458A) Organization reports.  Unless accepted by an order of the department, every person acting as a principal or agent for another or independently engaged in the production, storage, transportation (except railroad), refining, reclaiming, treating, marketing, or processing of oil or gas, or engaged in the exploration for or production of metallic minerals, shall file with the department on a form prescribed by the department: the name under which the business is being operated or conducted; the name and post office address of the person, the business or businesses in which engaged; the plan of organization, and in case of a corporation, the law under which it is chartered; and the names and post office addresses of any persons acting as trustees together with the names of the manager, agent or executive thereof, and the names and post office addresses of officers thereof. In the event that business is conducted under an assumed name, the report shall show the names and post office addresses of all owners in addition to the other information required.Immediately after any change occurs as to facts stated in the report filed, a supplementary report shall be filed with the department with respect to the change.

    561—17.5(458A) Bond.  The department shall, except as hereinafter provided, require from the owner or operator a good and sufficient bond in the sum of $15,000 in favor of the state of Iowa, conditioned that the well shall be operated and repaired and, upon abandonment, shall be plugged in accordance with the laws of the state of Iowa and the rules and orders of the department. Said bond shall remain in force and effect until the plugging of said well is approved and the bond is released by the department. In lieu of the bond relating to individual wells, any owner or operator may file with the department a good and sufficient blanket bond in the sum of $30,000 covering all wells drilled or to be drilled in the state of Iowa by the principal in said bond, and the acceptance and approval by the department of the blanket bond shall be in full compliance with the above provisions requiring an individual well bond. Bond or bonds shall be by a corporate surety authorized to do business in the state of Iowa or in cash.

    561—17.6(458A) Drilling.  Unless altered, modified, or changed for particular common sources of supply, upon notice and hearing before the department, the following rules shall apply to all wells drilled.    17.6(1) Sealing off strata.  During the drilling of any well for production of or exploration for oil, gas, or metallic minerals, all oil, gas, and water strata above and below the producing horizon shall be sealed or separated where necessary in order to prevent their contents from passing into other strata.All fresh waters and waters of present or probable value for domestic, public, commercial or livestock purposes shall be confined to their respective strata and shall be adequately protected by methods approved by the department. Special precautions shall be taken in drilling and abandoning wells to guard against any loss of artesian water from the strata in which it occurs, and the contamination of artesian water by objectionable water, oil, or gas.All water shall be shut off and excluded from the various oil and gas bearing strata which are penetrated. Water shutoffs shall ordinarily be made by cementing casing with or without the use of mud-laden fluid.    17.6(2) Casing and tubing requirements.  All wells drilled for oil, gas or production of metallic minerals shall be completed with strings of casing which shall be properly cemented at sufficient depths to protect all water, oil, or gas bearing strata.Sufficient cement shall be used on surface to fill the annular space back of the casing to the bottom of the cellar or to the surface of the ground. All strings of casing shall stand cemented under pressure for at least 12 hours before drilling plug or initiating tests. The term “under pressure” as used herein will be complied with if one float valve is used or if pressure is otherwise held. Cementing shall be by the pump and plug method, or other method approved by the director.All flowing wells shall be tubed. The tubing shall be set as near the bottom as practicable, but tubing perforations shall not be above the top of pay unless authorized by the department.    17.6(3) Defective casing or cementing.  In any well that appears to have defective, faultily cemented, or corroded casing which will permit or may create underground waste, the operator shall proceed with diligence to use the appropriate method and means to eliminate such hazard of underground waste. If such hazard of waste cannot be eliminated, the well shall be properly plugged and abandoned.    17.6(4) Blowout prevention.  In all drilling operations, proper and necessary precautions shall be taken for keeping the well under control, including the use of a blowout preventer and high-pressure fittings attached to properly cemented casing strings, where indicated by geologic conditions.    17.6(5) Pulling outside string of casing.  In pulling outside strings of casing from any oil or gas well, the space outside the casing left in the hole shall be kept and left full of mud-laden fluid or cement of adequate specific gravity to seal off all fresh and salt water strata and any strata bearing oil or gas not producing. No casing shall be removed without the prior approval of the department.    17.6(6) Safety rules.  All oil wells shall be cleaned into a pit or tank, not less than 40 feet from the derrick floor and 150 feet from any fire hazard. All flowing oil wells must be produced through an approved oil and gas separator or emulsion treater of ample capacity and in good working order. No boiler or portable electric lighting generator shall be placed or remain nearer than 150 feet from any producing well or oil tank. Any rubbish or debris that might constitute a fire hazard shall be removed to a distance of at least 150 feet from the vicinity of wells and tanks. All waste shall be disposed of in such manner as to avoid creating a fire hazard and to comply with the rules of the environmental protection commission. The drilling fluid level shall be maintained continuously at a height sufficient to control subsurface pressures. During the course of drilling, blowout preventers shall be tested at least once each 24-hour period, and results of the test shall be noted in the driller’s record.    17.6(7) Preservation of cores and samples.  Sample cuttings shall be taken at 5-foot intervals and at each change of formation, if less than 5 feet thick, in all wells drilled for oil, gas, or metallic mineral exploration or production, for the storage of dry natural gas, or casinghead gas, and for the development of reservoirs for the storage of liquid petroleum gas in the state of Iowa, unless a geophysical log is to be taken for the entire depth of the well. Where a geophysical log is to be taken for the entire depth of the well, sample cuttings shall be taken at 10-foot intervals and at each formation change if less than 10 feet thick. The director may grant a variance from the 10-foot sample interval under special conditions. Each sample shall be carefully identified as to well name and depth of sample, and all samples shall be shipped at the operator’s expense to the department.The operator of any well drilled as provided in the foregoing paragraph shall, during the drilling of, or immediately following the completion of, any given well, advise the director of all intervals that are to be cored, or have been cored, and such cores as are taken shall be preserved and forwarded to the department at the operator’s expense.This rule shall not be construed as prohibiting the operator from taking samples of the core for identification and tests pertaining to oil and gas or metallic minerals. In the event that it is necessary for the operator to utilize all or any portion of the core to the extent that representative samples, sufficiently large to analyze, are not available for the state, the operator shall furnish the director with the results of identification or testing procedures.    17.6(8) Well completion or recompletion report and well log.  Within ten days after completion of a well drilled for oil or gas or production of metallic minerals or for the storage of dry natural gas, or casinghead gas, or for the development of reservoirs for the storage of liquid petroleum gas, the operator or the operator’s agent shall file with the director a complete log or record of the well, duly signed, on forms prescribed by the department. This record shall be filed even though samples of the drill cuttings have been taken and preserved for subsequent delivery to the department. The logs on the wells shall be forwarded to the department and shall be confidential for a period of six months when so requested by the operator in writing. A proper log on any well shall include all normally recorded information on the following:    a.    Depth to and thickness of water-bearing beds, including, where measured, the static water level and volume of such water.    b.    Lithology of formations penetrated, including color, hardness, and character of the rock, and particularly showing the position and thickness of coal beds and deposits of mineral materials of economic value.    c.    Any caverns, large voids, losses of circulation, and sudden appreciable changes in water level.    d.    A record of all oil, gas, and highly mineralized water encountered, including fill-up, volumes, and pressures.    e.    A record of all casing and liner used, including the size, weight, amount, and depth set, the amount of cement used on each casing string, and the amount of casing stripped from the hole on completion or abandonment of the well.    f.    Data on drill stem tests.    g.    Generalized description of any core taken during drilling.    h.    Data on perforating acidizing, fracturing, shooting, and testing.    i.    Data on bridge plugs set, make and type of plug, depth set, whether left in place or removed, and details of plug back operation below the bridge.    j.    Electrical or other geophysical logging.    17.6(9) Stratigraphic test wells.  All stratigraphic test wells shall be plugged in accordance with the provisions of rule 561—17.15(458A).Any mechanical logs taken must be filed with the director within the time limits set forth below. Lithologic samples must be collected during the drilling of all stratigraphic test wells in accordance with the provisions of subrule 17.6(7).All records, samples, and logs required under this rule must be filed with the director six months after completion of the program set forth in the original application. If the company so requests in writing, these records, samples, and logs shall be kept confidential for an additional period of one year after filing.    17.6(10) Wells for storage of liquid petroleum gas.  Only one fee shall be required for the drilling of wells for the development of each reservoir for the storage of liquid petroleum gas, but an application for a permit to drill shall be filed with the department and a permit issued prior to the drilling of each well. The application for a permit to drill a single well or the first in a series of wells for this purpose shall be accompanied by a complete set of plans for the development of the reservoir and by a plat of the reservoir area with all contemplated wells and the reservoir limits indicated thereon.A blanket bond of $30,000 must be filed with the department on a form prescribed by the department conditioned on compliance with the laws of the state of Iowa and the rules and orders of the department. Each bond shall be executed by an acceptable corporate surety authorized to do business in the state of Iowa. Compliance with the blanket bond requirement of rule 561—17.5(458A) shall satisfy the blanket bond requirement herein.All records, samples and logs required under this rule must be filed with the director in accordance with the provisions of subrule 17.6(8).When any well is no longer used for the purpose for which it was drilled, the well shall be plugged in accordance with the provisions of rule 561—17.15(458A).    17.6(11) Wells for storage of dry natural gas.  No application, fee, organization report, bond or permit shall be required for the drilling of wells for the storage of dry natural gas in underground basins or watercourses for which a permit is required and has been obtained under the provisions of Iowa Code chapter 455B. In lieu of a formal application and permit for wells otherwise required under the provisions of Iowa Code chapter 458A, and these rules adopted pursuant thereto, the owner or operator thereof shall give notice to the director of intent to drill at least 5 days prior to initiation of drilling of each well. The owner or operator of the wells shall submit monthly to the director a report of activities during the preceding 30 days as well as contemplated action during the following 30-day period, providing thereby at least 5 days’ prior notice of any contemplated action. Wells may not be drilled at points more than one-quarter mile from the points indicated in the forecasts without at least 5 days’ prior notice to the director its specific approval thereof. The owner or operator shall drill, operate, maintain, abandon and plug the wells and shall file reports, records, samples, cores, and logs, in accordance with these rules and the orders and requirements of the department.

    561—17.7(458A) Identification of wells.  Every producible well shall be identified by a sign, posted on the derrick or not more than 20 feet from the well. Such signs shall be of durable construction and the lettering thereon shall be kept in a legible condition and shall be large enough to be legible under normal conditions at a distance of 50 feet. The wells on each lease or property shall be numbered in nonrepetitive, logical, and distinctive sequence, unless some other system of numbering was adopted by the owner prior to the adoption of these rules. Each sign shall show the number of the well, the name of the lease (which shall be different or distinctive for each lease), the name of the lessee, owner, or operator, the permit number, and the location by quarter, section, township, and range. The signs shall be displayed for each drilling well when so required by the department.

    561—17.8(458A) Surface equipment.      17.8(1) Meter fittings.  Meter fittings of adequate size to measure the gas efficiently for the purpose of obtaining gas-oil ratios shall be installed on the gas vent line of every separator or proper connections made for orifice well tester. Wellhead equipment shall be installed and maintained in first-class condition so that static bottom hole pressures may be obtained at any time by the duly authorized agents of the department after notification of the operator. Valves shall be installed so that pressures can be readily obtained on both casing and tubing.    17.8(2) Chokes or beans.  All flowing wells shall be equipped with adequate chokes or beans, to properly control the flow thereof.    17.8(3) Oil and gas separators.  All flowing oil wells must be produced through an approved oil and gas separator.    17.8(4) Dikes.  When it is deemed necessary by the director to protect life, health, or property, the department may require any lease or oil storage tanks to be surrounded by an earthen dike which shall have a capacity of one and one-half times the capacity of the tank or tanks it surrounds, which dike shall be continually maintained; and the reservoir within shall be kept free from vegetation, water, or oil.

    561—17.9(458A) Deviation.  No well may be intentionally directionally deviated from the vertical without the written approval of the department. Deviation is permitted without special permission for short distances, to straighten the hole, sidetrack junk, or correct other mechanical difficulties. The maximum point at which a well penetrates the producing formation shall not vary unreasonably from the vertical drawn from the center of the hole at the surface. Directional surveys may be required by the department whenever the location of the bottom of the well is in doubt. When necessary to protect correlative rights, the department shall require that the well be straightened.

    561—17.10(458A) Vacuum pumps prohibited.  The use of vacuum pumps or other devices for the purpose of putting a vacuum on any gas or oil-bearing stratum is prohibited unless authorized by an order of the department upon notice and hearing.

    561—17.11(458A) Notification of fire, breaks, leaks, or blowouts.  All persons controlling or operating any oil and gas wells or pipelines, or receiving tanks, storage tanks, or receiving and storage receptacles into which crude oil is produced, received, or stored, or through which oil or gas is piped or transported, shall notify the department of fire, breaks, leaks or blowouts as soon as possible but not later than six hours after the incident occurs or is discovered, in accordance with Iowa Code section 455B.386. A written report, giving full details concerning all fires which occur at such oil or gas wells or tanks or receptacles on their property, all tanks or receptacles struck by lightning and any other fire which destroys oil or gas, and any breaks or leaks in or from tanks or receptacles and pipelines from which oil or gas is escaping or has escaped shall be submitted to the department within 30 days. In all reports of fires, breaks, leaks, or escapes, or other accidents of this nature, the location of the well, tank, receptacle, or line break shall be given by section, township, range, and property so that the exact location thereof can be readily located on the ground. The report shall likewise specify what steps have been taken or are in progress to remedy the situation reported, and shall detail the quantity of oil or gas lost, destroyed, or permitted to escape. In case any tank or receptacle is permitted to run over, the escape thus occurring shall be reported as in the case of a leak.

    561—17.12(458A) Producing from different pools through the same casing string or multiple completion of wells.   No well shall be permitted to produce either oil or gas from different pools through the same string of casing. The multiple-zone completion of any well may be authorized only by special order of the department upon notice and hearing.

    561—17.13(458A) Commingling of production prohibited.  The production from one pool shall not be commingled with that from another pool in the same field before delivery to a purchaser, unless otherwise ordered by the department.

    561—17.14(458A) Reports by producers, transporters or storers.      17.14(1) Producers.  The producer or operator of each and every lease shall on or before the fifteenth day of each month succeeding the month in which the production occurs, submit to the department on a form prescribed by the department, a statement showing the amount of production made by each such lease during the preceding month.    17.14(2) Transporters or storers.  Each transporter or storer of any oil or gas from any well, lease, pool, or developed unit shall, on or before the fifteenth day of each month succeeding the month in which the purchasing or taking occurs, file with the department, on forms prescribed by the department, a statement of oil or gas purchased or taken from any such well, lease, pool, or developed unit during the preceding month.

    561—17.15(458A) Abandonment and plugging of wells.  Any well drilled in connection with oil or gas operations or metallic mineral exploration or production shall be properly plugged when the well is no longer used for the purpose for which it was drilled. In instances where no completion or recompletion reports are filed, the well(s) in question must be properly abandoned and plugged within 30 days after the permit authorizing the drilling expires.    17.15(1) Notice of intent to abandon and plug.  Notice of the proposed method of abandoning and plugging any well drilled in connection with oil or gas operations or metallic mineral exploration or production must be filed on a form prescribed by the department. Approval must be obtained from the director prior to commencing operations. Time must be allowed for a department representative to be present at the plugging operations, if so desired by the director. Where the time required to file notice and obtain approval in writing would constitute an undue hardship, verbal permission to proceed may be granted, but in any case the form must be filed.    17.15(2) Method of plugging.  Before any well is abandoned, it shall be plugged in a manner which will confine permanently all oil, gas, and water in the separate strata in which they occur. This operation shall be accomplished by the use of mud-laden fluid, cement, and plugs, used singly or in combination as may be approved by the director. In the event that no log or an unsatisfactory log of the well is supplied, the well shall be completely plugged with cement from bottom to top. Casing shall be cut off below plow depth. Seismic, core, or other exploratory holes drilled to or below strata containing fresh water shall be plugged and abandoned in accordance with the applicable provisions recited above.    17.15(3) Extension of time to plug well.  Upon written application to defer the abandonment and plugging of any unplugged well, the department may grant an extension for a reasonable period of time when good cause therefor is shown and providing all of the casing is left in the well and is in sound condition. The bond covering such well shall remain in full force and effect until the well is plugged and the other requirements of final abandonment have been completed.

    561—17.16(458A) Well spacing.  In the absence of an order by the department setting spacing units for a pool, the following shall apply.    17.16(1) Oil wells.  No more than one well drilled for oil shall be drilled upon any tract of land other than a governmental quarter-quarter section or governmental lot corresponding thereto, or, in areas not covered by U.S. public land surveys, an arbitrarily designated 40-acre tract. The well shall not be located closer than 330 feet to any boundary line of the governmental quarter-quarter section, governmental lot corresponding thereto, or arbitrarily designated 40-acre tract, nor closer than 660 feet to the nearest well drilling to or capable of producing from the same pool on the same lease or unit. Should the governmental quarter-quarter section, governmental lot, or arbitrarily designated tract contain less than 36 acres, no well shall be drilled thereon except by special order of the department.    17.16(2) Gas wells.  Not more than one well shall be drilled for gas upon any tract of land other than a governmental section, or, in areas not covered by U.S. public land surveys, an arbitrarily designated 640-acre tract. The wells shall not be located closer than 1,320 feet to any boundary line of the governmental section or arbitrarily designated 640-acre tract, nor closer than 3,750 feet to the nearest well drilling to or capable of producing from the same pool on the same lease or unit. Should the governmental section or arbitrarily designated tract contain less than 600 acres, no well shall be drilled thereon except by special order of the department.       These rules are intended to implement Iowa Code chapter 458A.    ARC 4286CNursing Board[655]Notice of Intended Action

    Proposing rule making related to licensure to practice and providing an opportunity for public comment

        The Nursing Board hereby proposes to amend Chapter 3, “Licensure to Practice—Registered Nurse/Licensed Practical Nurse,” Iowa Administrative Code.Legal Authority for Rule Making    This rule making is proposed under the authority provided in Iowa Code section 147.73.State or Federal Law Implemented    This rule making implements, in whole or in part, Iowa Code section 147.3.Purpose and Summary    The proposed amendments to Chapter 3:

  • Amend definitions and add definitions for clarity and strike the special license fee in the definition of “fees” since special licensure for those who are licensed in another country is no longer included in rule 655—3.6(17A,147,152,272C).
  • Strike references to Chapter 16, “Nurse Licensure Compact,” since the chapter was recently rescinded.
  • Strike subrule 3.3(2), which lists the exceptions for licensure by examination.
  • Rescind rule 655—3.4(17A,147,152,272C) relating to licensure by examination and adopt in its place a new rule whose content is condensed due to removal of certain application procedures and language related to licensure requirements for an examination applicant.
  • Rescind rule 655—3.5(17A,147,152,272C) relating to licensure by endorsement and adopt in its place a new rule whose content is condensed due to removal of certain application procedures and language related to licensure requirements for an endorsement applicant.
  • Remove some references to “wallet card” in anticipation of a future paperless licensure process.
  • Rescind rule 655—3.6(17A,147,152,272C) relating to foreign-educated applicants and adopt in its place a new rule whose content is condensed to outline the requirements for the evaluation of the education of an applicant educated in a foreign country or in a U.S. territory that is not a member of the National Council of State Boards of Nursing (NCSBN), add additional accepted documents in lieu of a transcript in paragraphs 3.6(1)“b” and “c,” and include Test of English as a Foreign Language (TOEFL) and International English Language Testing System (IELTS) academic scores to align with NCSBN’s recommendations.
  • Mandate a nurse refresher course for a licensee who has not held an active license in any jurisdiction for the previous five years within the 12 months prior to reactivation and outline the requirements for the nurse refresher course.
    • Fiscal Impact    This rule making has no fiscal impact to the State of Iowa. Jobs Impact    After analysis and review of this rule making, no impact on jobs has been found.Waivers    Any person who believes that the application of the discretionary provisions of this rule making would result in hardship or injustice to that person may petition the Board for a waiver of the discretionary provisions, if any, pursuant to 655—Chapter 15. Public Comment    Any interested person may submit written comments concerning this proposed rule making. Written comments in response to this rule making must be received by the Board no later than 4:30 p.m. on March 8, 2019. Comments should be directed to: Kathy Weinberg Iowa Board of Nursing 400 S.W. Eighth Street, Suite B Des Moines, Iowa 50309 Email: kathy.weinberg@iowa.govPublic Hearing    A public hearing at which persons may present their views orally or in writing will be held as follows: March 8, 2019 9 to 10 a.m. Board Office, Suite B 400 S.W. Eighth Street Des Moines, Iowa     Persons who wish to make oral comments at the public hearing may be asked to state their names for the record and to confine their remarks to the subject of this proposed rule making.     Any persons who intend to attend the public hearing and have special requirements, such as those related to hearing or mobility impairments, should contact the Board and advise of specific needs. Review by Administrative Rules Review Committee    The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making at its regular monthly meeting or at a special meeting. The Committee’s meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).    The following rule-making actions are proposed:

        ITEM 1.    Amend rule 655—3.1(17A,147,152,272C) as follows:

    655—3.1(17A,147,152,272C) Definitions.          "Accredited or approvedApproved nursing program" means a nursing education program whose status has been recognized by the board or by a similar board in another jurisdiction that prepares individuals for licensure as a licensed practical nurse, registered nurse, or advanced registered nurse practitioner; or grants a baccalaureate, master’s or doctorate degree with a major in nursing.        "Address" means a street address in any state when a street address is available or a rural route address when a street address is not available.        "Applicant" means a person who is qualified to take the examination or apply for licensure by endorsement.        "CGFNS" means the Commission on Graduates of Foreign Nursing Schools.        "Endorsement" means the process by which a registered nurse/licensed practical nurse licensed in another jurisdiction becomes licensed in Iowa.        "Examination" means the tests used to determine minimum competency prior to the issuance of a registered nurse/licensed practical nurse license.        "Fees" means those fees collected which are based upon the cost of sustaining the board’s mission to protect the public health, safety and welfare. The nonrefundable fees set by the board are as follows:
    1. Application for original license based on the registered nurse examination, $93 (plus the fee for evaluation of the fingerprint cards and the criminal history background checks by the Iowa division of criminal investigation (DCI) and the Federal Bureau of Investigation (FBI)).
    2. Application for original license based on the practical nurse examination, $93 (plus the fee for evaluation of the fingerprint cards and the criminal history background checks by the DCI and the FBI).
    3. Application for registered nurse/licensed practical nurse license by endorsement, $119 (plus the fee for evaluation of the fingerprint cards and the criminal history background checks by the DCI and the FBI).
    4. Application for original license or renewal as an advanced registered nurse practitioner, $81 for any period of licensure up to three years.
    5. For a certified statement that a registered nurse/licensed practical nurse is licensed in this state or registered as an advanced registered nurse practitioner, $25.
    6. For written verification of licensure status, not requiring certified statements, $3 per license.
    7. For reactivation of a license to practice as a registered nurse/licensed practical nurse, $175 for a license lasting more than 24 months up to 36 months (plus the fee for evaluation of the fingerprint cards and the criminal history background checks by the DCI and the FBI).
    8. For reactivation of a license to practice as an advanced registered nurse practitioner, $81 for any period of licensure up to three years.
    9. For the renewal of a license to practice as a registered nurse/licensed practical nurse, $99 for a three-year period.
    10. For a duplicate or reissued wallet card or original certificate to practice as a registered nurse, licensed practical nurse, or advanced registered nurse practitioner, $20.
    11. For late renewal of a registered nurse/licensed practical nurse license, $50, plus the renewal fee as specified in paragraph “9” of this definition.
    12. For a check returned for any reason, $15. If licensure/registration has been issued by the board office based on a check for the payment of fees and the check is later returned by the bank, the board shall request payment by certified check or money order.
    13. For a certified copy of an original document, $20.
    14. For special licensure, $62.
    1. 15For the evaluation of the fingerprint cards and the DCI and FBI criminal history background checks, $50.
            "IELTS™" means International English Language Testing System.        "Inactive license" means a registered nurse or licensed practical nurse license that has been placed on inactive status because it was not renewed by the fifteenth day of the month following the expiration date, or the board has received notification that a licensee has declared another compact state as primary state of residency. Pursuant to 655—subrule 16.2(8), the former home state license shall no longer be valid upon the issuance of a new home state license.        "Late license" means a registered nurse or licensed practical nurse license that has not been renewed by the expiration date on the wallet card. The time between the expiration date and the fifteenth day of the month following the expiration date is considered a grace period.        "Licensee" means a person who has been issued a license to practice as a registered nurse, licensed practical nurse or advanced registered nurse practitioner under the laws of this state.        "NCLEX®" means National Council Licensure Examination for registered nurse/licensed practical nurse licensure.        "NCSBN" means the National Council of State Boards of Nursing, Inc.        "Nurse licensure compact" means an agreement between member states that allows mutual recognition of a nursing license. The definitions in the nurse licensure compact rules are incorporated for purposes of this chapter.        "Overpayment" means payment in excess of the required fee. Overpayment less than $10 received by the board shall not be refunded.        "Reactivation" means the process whereby an inactive licensee obtains a current license.        "Reinstatement," pursuant to rule 655—20.36(17A,147,152,272C), means the process by which any person whose license to practice nursing has been suspended, revoked or voluntarily surrendered by order of the board may apply for license consideration.        "Temporary license" means a license issued on a short-term basis for a specified time pursuant to subrule 3.5(4).        "TOEFL®" means Test of English as a Foreign Language.        "Unlicensed student" means a person enrolled in a nursing education program who has never been licensed as a registered nurse or licensed practical/vocational nurse in any U.S. jurisdiction.        "Verification" means the process whereby the board provides a certified statement that the license of a registered nurse/licensed practical nurse/advanced registered nurse practitioner is active, inactive, or encumbered/disciplined.       This rule is intended to implement Iowa Code sections 147.80 and 147.82.

        ITEM 2.    Amend rule 655—3.2(17A,147,152,272C) as follows:

    655—3.2(17A,147,152,272C) Mandatory licensure.      3.2(1)   A person who practices nursing in the state of Iowa as defined in Iowa Code section 152.1, outside of one’s family, shall have a current Iowa license, whether or not the employer is in Iowa and whether or not the person receives compensation. Any nurse who participates in the care of a patient situated in Iowa, whether that care is provided through telephonic, electronic or in-person means, and regardless of the location of the nurse, must obtain Iowa licensure unless specifically exempted by the licensure compact agreement. The nurse shall maintain verification of licensure and shall have it available for inspection when engaged in the practice of nursing in Iowa.    3.2(2)   Current Iowa licensure is not mandatory when:    a.    A nurse who resides in another party state is recognized for licensure in this state pursuant to the nurse licensure compact contained in Iowa Code chapter 152E. The nurse shall maintain verification of licensure and shall have it available for inspection when engaged in the practice of nursing in Iowa.The nurse licensure compact rules are available on the board’s website.     b.    A nurse who holds an active license in another state provides services to patients in Iowa only during interstate transit.    c.    A nurse who holds an active license in another state provides emergency services in an area in which the governor of Iowa has declared a state of emergency.    3.2(3)   A nurse who is enrolled in an approved nursing program shall hold an active license in the U.S. jurisdiction(s) in which the nurse provides patient care.       This rule is intended to implement Iowa Code section 147.2.

        ITEM 3.    Amend rule 655—3.3(17A,147,152,272C) as follows:

    655—3.3(17A,147,152,272C) Licensure qualifications for registered nurse and licensed practical nurse.  Applicants shall meet the requirements set forth in Iowa Code sections 147.3 and 152.7. Requirements include:
    1. a.    Graduation from an approved nursing program preparing registered nurses as defined in Iowa Code section 152.5(1) for registered nurse applicants or graduation from an approved nursing program preparing practical nurses as defined in Iowa Code section 152.5(1) for licensed practical nurse applicants.
    2. b.    Passing NCLEX® or the State Board Test Pool Examination, the national examination used prior to 1982.
    3. c.    Board approval of an applicant with a criminal history or a record of prior disciplinary action, regardless of jurisdiction.
        3.3(2)   The requirement listed in paragraph 3.3(1)“b” is subject to the following exceptions:    a.    A practical nurse applicant must have written the same examination as that administered in Iowa and achieved a score established as passing for that test by the board unless the applicant graduated and was licensed prior to July 1951.    b.    An applicant whose national examination scores do not meet the Iowa requirements in effect at the time of the examination and who wishes to become licensed in Iowa may appeal to the board. The board may require the applicant to pass the current examination.       This rule is intended to implement Iowa Code sections 147.2 and 152.7(3).

        ITEM 4.    Rescind rule 655—3.4(17A,147,152,272C) and adopt the following new rule in lieu thereof:

    655—3.4(17A,147,152,272C) Licensure by examination.      3.4(1) Board application.  A graduate of an approved nursing program seeking initial licensure shall submit the following:    a.    A completed application for licensure by examination.    b.    Payment of the application fee.    c.    Two completed fingerprint cards and a signed waiver form to facilitate a national criminal history background check.    d.    Copies of relevant court documents if the applicant has a criminal history.    e.    Official transcript denoting the date of graduation and diploma or degree conferred sent directly to the board from the nursing program.    3.4(2) Test registration.  The applicant shall complete NCLEX® registration, including payment of applicable fees through the national test service agency.    3.4(3) ADA accommodations.  An applicant with a disability may submit a request to the board for testing accommodations. The request should include the nature of the disability and the specific testing accommodations being requested. A request must be accompanied by written documentation from the applicant’s health care provider describing the disability and the recommended accommodations, and documentation from the applicant’s nursing education program if testing accommodations were provided to the applicant during school. Approved accommodation requests will be communicated to the national test service agency.    3.4(4) Authorization to test.  An applicant will not receive authorization to test until all of the requirements in subrules 3.4(1) and 3.4(2) are met. An applicant shall self-schedule the examination with an approved testing center and must test within 91 days of receiving authorization to test. An applicant who does not test within 91 days of receiving authorization to test is required to submit a new completed application for licensure by examination and fee to the board. An applicant who does not appear for a testing appointment or does not complete the examination must follow the requirements for reexamination.    3.4(5) Reexamination.  An applicant who fails the examination and reapplies within 12 months of submitting a prior application to the board shall be required to complete the requirements in paragraphs 3.4(1)“a” and “b” and subrule 3.4(2). An applicant who fails the examination and reapplies after 12 months of submitting a prior application to the board shall be required to complete all requirements in subrules 3.4(1) and 3.4(2).    3.4(6) Licensure.  Upon satisfactory review of the documentation described in subrule 3.4(1) and proof of successful completion of the examination, the applicant will be issued a certificate of license by examination and a current license to practice as a registered nurse or licensed practical nurse.    3.4(7) Failure to complete the licensure process.  Once an application is initiated, the applicant has 12 months to complete the licensure process. The board reserves the right to destroy any applications and supporting documents after 12 months if the applicant has not completed the licensure process. Applicants who fail to complete the licensure process within 12 months are required to start the application process anew.

        ITEM 5.    Rescind rule 655—3.5(17A,147,152,272C) and adopt the following new rule in lieu thereof:

    655—3.5(17A,147,152,272C) Licensure by endorsement.      3.5(1) Board application.  A graduate of an approved nursing program seeking licensure in Iowa who has been licensed in another state shall submit the following:    a.    A completed application for licensure by endorsement.    b.    Payment of the application fee.    c.    Two completed fingerprint cards and a signed waiver form to facilitate a national criminal history background check.    d.    Copies of relevant court documents if the applicant has a criminal history.    e.    Copies of relevant disciplinary documents if the applicant has had disciplinary action taken by another state.    f.    Verification of the license from the original state of licensure, which may be done through www.nursys.com or using the verification form, depending on the requirements of the original state of licensure.     g.    Proof of active licensure in any jurisdiction within the previous five years from the date of application or proof of completion of a nurse refresher course in accordance with rule 655—3.10(152) taken within the 12 months prior to the date of application.    h.    Official transcript denoting the date of graduation and diploma or degree conferred sent directly to the board from the nursing program. An applicant may be excused from this requirement if the nursing program is closed and records are no longer available.    3.5(2) Temporary license.  An applicant who has submitted all documentation described in paragraphs 3.5(1)“a” to “g” may request a temporary license for up to 30 days to practice in Iowa pending receipt of official transcripts from the nursing program.    3.5(3) Licensure.  Upon satisfactory review of the documentation described in subrule 3.5(1), the applicant will be issued a certificate of license by endorsement and a current license to practice as a registered nurse or licensed practical nurse.    3.5(4) Failure to complete the licensure process.  Once an application is initiated, the applicant has 12 months to complete the licensure process. The board reserves the right to destroy any applications and supporting documents after 12 months if the applicant has not completed the licensure process. Applicants who fail to complete the licensure process within 12 months are required to start the application process anew.

        ITEM 6.    Rescind rule 655—3.6(17A,147,152,272C) and adopt the following new rule in lieu thereof:

    655—3.6(17A,147,152,272C) Applicants educated in a foreign country or in a U.S. territory that is not a member of NCSBN.      3.6(1) Applicant for licensure.  An applicant seeking licensure in Iowa who was educated in a foreign country or in a U.S. territory that is not a member of NCSBN shall apply for licensure by examination pursuant to rule 655—3.4(17A,147,152,272C) or licensure by endorsement pursuant to rule 655—3.5(17A,147,152,272C), as applicable, but instead of submitting an official transcript, shall submit one of the following documents issued by CGFNS:    a.    Credentials evaluation service professional report.    b.    VisaScreen certificate or certificate verification letter verifying that a VisaScreen certificate was issued.    c.    Certification program CGFNS certificate or certificate verification letter verifying that a certification program CGFNS certificate was issued.    3.6(2) CGFNS documentation.  The documentation issued by CGFNS shall verify all of the following:    a.    Completion of education equivalent to approved nursing programs for licensed practical nurse and registered nurse applicants.    b.    The applicant’s licensure or registration as a nurse in the applicant’s country or U.S. territory of origin, current country or U.S. territory of residence, or country or U.S. territory where educated.    c.    The ability to read, write, speak, and understand the English language as determined by passing the TOEFL® or IELTS™ test. A passing score is as follows: 560 for the TOEFL® paper-based test; 220 for the TOEFL® computer-based test; 84 for the TOEFL® internet-based test; and an overall score of 6.5 and a speaking score of 7.0 for the IELTS™ test. An applicant shall be exempt from taking either the TOEFL® or IELTS™ test when all of the following are met: (1) the nursing education was completed in a college, university, or professional school located in Australia, Barbados, Canada (except Quebec), Ireland, Jamaica, New Zealand, South Africa, Trinidad and Tobago, or the United Kingdom; (2) the language of instruction in the nursing program was English; and (3) the language of the textbooks in the nursing program was English.    3.6(3) Social security number.  To be eligible for a multistate license, an applicant must have a social security number. An applicant who does not have a social security number shall submit documentation of lawful presence and will only be eligible for a single state license.

        ITEM 7.    Amend rule 655—3.7(17A,147,152,272C) as follows:

    655—3.7(17A,147,152,272C) License cycle.      3.7(1) Name and address changes.  Written notification to the board of name and address changes is required within 30 days of the event. Licensure documents are mailed to the licensee at the address on file in the board office. There is no fee for a change of name or address in board records.    3.7(2) New licenses.  The board shall issue licenses by endorsement and examination for a 24- to 36-month period. When the license is renewed, it will be placed on a three-year renewal cycle. Expiration shall be on the fifteenth day of thelicensee’s birth month.    3.7(3) Renewal.  The licensee may renew the license beginning 60 days prior to license expiration. Renewal is available online at the board’s website or by mail upon request. When the licensee has satisfactorily completed the requirements for renewal, a wallet card shall be mailed to the licensee.    a.    The licensee shall:    (1)   Attest that Iowa is the primary state of residence as outlined in rule 655—16.2(152E) or that the primary state of residence is a noncompact state. The board may request evidence of residency.    (2)   Submit the renewal application and the renewal fee as specified in rule 655—3.1(17A,147,152, 272C).    (3)   Meet the continuing education requirement as set forth in 655—Chapter 5, prior to license renewal.    (4)   Complete the required mandatory reporter training set forth in paragraph 3.7(3)“b.”    b.    Mandatory reporter training.    (1)   The course shall be a curriculum approved by the Iowa department of public health.    (2)   A licensee who regularly examines, attends, counsels or treats children in Iowa shall indicate on the renewal application completion of two hours of training in child abuse identification and reporting in the previous five years or condition(s) for rule suspension as identified in subparagraph 3.7(3)“b”(6).    (3)   A licensee who regularly examines, attends, counsels or treats adults in Iowa shall indicate on the renewal application completion of two hours of training in dependent adult abuse identification and reporting in the previous five years or condition(s) for rule suspension as identified in subparagraph 3.7(3)“b”(6).    (4)   A licensee who regularly examines, attends, counsels or treats both adults and children in Iowa shall indicate on the renewal application completion of training on abuse identification and reporting in dependent adults and children or condition(s) for rule suspension as identified in subparagraph 3.7(3)“b”(6). Training may be completed through separate courses as identified in subparagraphs 3.7(3)“b”(2) and (3) or in one combined two-hour course that includes curricula for identifying and reporting child abuse and dependent adult abuse.    (5)   The licensee shall maintain written documentation for five years after mandatory training as identified in subparagraphs 3.7(3)“b”(2) to (4), including program date(s), content, duration, and proof of participation.    (6)   The requirement for mandatory training for identifying and reporting child and dependent adult abuse shall be suspended if the board determines that suspension is in the public interest or that a person at the time of license renewal:
    1. Is engaged in active duty in the military service of this state or the United States.
    2. Holds a current waiver by the boardexemption based on evidence of significant hardship in complying with training requirements, including waiveran exemption of continuing education requirements or extension of time in which to fulfill requirements due to a physical or mental disability or illness as identified in 655—Chapter 5 .
        (7)   The board may select licensees for audit of compliance with the requirements in subparagraphs 3.7(3)“b”(1) to (6).        3.7(4) Late renewal.  The license shall become late when the license has not been renewed by the expiration date on the wallet card. The licensee shall be assessed a late fee as specified in rule 655—3.1(17A,147,152,272C).To renew a late license, the licensee shall complete the renewal requirements and submit the late fee before the fifteenth day of the month following the expiration date on the wallet card.    3.7(5) Inactive status.  The license shall become inactive when the license has not been renewed by the fifteenth day of the month following the expiration date on the wallet card or the board office has been notified by another compact state that a licensee has declared a new primary state. Pursuant to 655—subrule 16.2(8), theThe former home state license shall no longer be valid upon the issuance of a new home state license.    a.    If the inactive license is not reactivated, it shall remain inactive.    b.    If the licensee resides in Iowa or a noncompact state, the licensee shall not practice nursing in Iowa until the license is reactivated to active status. If the licensee is identified as practicing nursing with an inactive license, disciplinary proceedings shallmay be initiated.    c.    The licensee is not required to obtain continuing education credit or pay fees while the license is inactive.    d.    To reactivate the license, the licensee shall complete the reactivation requirements.    (1)   The licensee shall be provided an application, a continuing education report form, two fingerprint cards, a waiver form, and statement of the fees. The reactivation fee and criminal history background check fee are specified in the definition of “fees” in rule 655—3.1(17A,147,152,272C).    (2)   The licensee shall have obtained 36 contact hours of continuing education, as specified in 655—Chapter 5, within the 36 months prior to reactivation.    (3)   A licensee who has not held an active license in any jurisdiction for the previous five years shall be required to complete a nurse refresher course in accordance with rule 655—3.10(152) within the 12 months prior to reactivation.    (3)   (4)   Upon receipt of the completed reactivation application, required continuing education materials,certificate of completion of a nurse refresher course (if applicable), two completed fingerprint cards and a signed waiver form to facilitate a national criminal history background check, fees for both the reactivation and the criminal history background check and verification that the primary state of residence is Iowa or a noncompact state, the licensee shall be issued a license for a 24- to 36-month period. At the time of the next renewal, the license will be placed on a three-year renewal cycle. Expiration shall be on the fifteenth day of the licensee’s birth month. The board staff may issue a certificate of license prior to receipt of a report on the applicant from the DCI/FBI.    (4)   (5)   An applicant who fails to complete the reactivation of licensure process within 12 months from the date of initial application must reapply. All fees are nonrefundable.    3.7(6) Duplicate wallet card or certificate.  A duplicate wallet card or certificate shall be required if the current card or certificate is lost, stolen, destroyed or not received by the licensee within 60 days from the date the license is issued. The licensee shall be issued a duplicate wallet card or certificate upon receipt of an application for a duplicate wallet card or certificate and receipt of the fee as specified in rule 655—3.1(17A,147,152,272C). If the licensee notifies the board that the wallet card or certificate has not been received within 60 days after being issued, no fee shall be required. A fee is applicable when the licensee fails to notify the board of a name or address change.    3.7(7) Reissue of a certificate or wallet card.  The board shall reissue a certificate or current wallet card upon receipt of a written request from the licensee, return of the original document and payment of the fee as specified in rule 655—3.1(17A,147,152,272C). No fee shall be required if an error was made by the board on the original document.       This rule is intended to implement Iowa Code sections 147.2, 147.10, 147.11, 272C.2, and 272C.3 and chapter 152.

        ITEM 8.    Amend rule 655—3.8(17A,147,152,272C) as follows:

    655—3.8(17A,147,152,272C) Verification.  Upon written request from the licensee or another jurisdiction and payment of the verification fee as specified in rule 655—3.1(17A,147,152,272C), the board shall provide a certified statement to another jurisdiction or entity that the license of a registered nurse, licensed practical nurse or advanced registered nurse practitioner is active, inactive or encumbered/disciplined in Iowa.       This rule is intended to implement Iowa Code sections 147.2 and 147.8.

        ITEM 9.    Amend rule 655—3.9(17A,272C) as follows:

    655—3.9(17A,272C) License denial.      3.9(1)   Prior to the denial of licensure to an applicant, the board shall issue a preliminary notice of denial that cites the factual and legal basis for denying the application, notifies the applicant of the appeal process and specifies the date upon which the denial will become final if not appealed.    3.9(2)   An applicant who has been issued a preliminary notice of denial may appeal the notice and request a hearing on the issues related to the preliminary notice of denial by serving a request for hearing upon the executive director within 30 days following the date the preliminary notice of denial was mailed. The request for hearing shall specify the factual or legal errors in the preliminary notice of denial and provide any additional written information or documents in support of the licensure.    3.9(3)   All hearings held pursuant to this rule shall be held in accordance with the process outlined in 655—Chapter 20.    3.9(4)   If an applicant does not appeal a preliminary notice of denial, the preliminary notice of denial automatically becomes final and a notice of denial will be issued.       This rule is intended to implement Iowa Code chapters 17A and 272C.

        ITEM 10.    Adopt the following new rule 655—3.10(152):

    655—3.10(152) Nurse refresher course.      3.10(1)   A nurse refresher course shall meet the following requirements:    a.    A minimum of 80 hours of theory, with content in basic nursing skills, pharmacology, physical assessment, IV therapy (RN only), and legal and ethical considerations in healthcare; and    b.    A minimum of 80 hours of hands-on supervised clinical learning experiences.    3.10(2)   To participate in the clinical component of a nurse refresher course in Iowa, a licensee must have an active license to practice nursing in Iowa or a limited authorization issued by the board. A licensee shall request the limited authorization from the board prior to beginning the clinical component of a nurse refresher course.    3.10(3)   To receive a certificate of completion from the nurse refresher course, a licensee must complete all requirements of the nurse refresher course to the satisfaction of the course provider. The course provider shall submit proof of completion of the nurse refresher course directly to the board.

        ITEM 11.    Adopt the following new implementation sentence in 655—Chapter 3:       These rules are intended to implement Iowa Code chapters 17A, 147, 152, and 272C.    ARC 4290CPharmacy Board[657]Notice of Intended Action

    Proposing rule making related to controlled substances and providing an opportunity for public comment

        The Board of Pharmacy hereby proposes to amend Chapter 10, “Controlled Substances,” Iowa Administrative Code.Legal Authority for Rule Making    This rule making is proposed under the authority provided in Iowa Code sections 124.201, 124.203 and 124.301.State or Federal Law Implemented    This rule making implements, in whole or in part, Iowa Code sections 124.203, 124.301 to 124.305, 124.551A, 124.557 and 147.80.Purpose and Summary    During the 2018 Legislative Session, changes were made to the Iowa Code that require prescribing practitioners to register for the Iowa Prescription Monitoring Program (PMP) at the same time as the prescribing practitioners apply for Iowa Uniform Controlled Substances Act (CSA) registration; allow the Board to assess a surcharge of up to 25 percent of a registration fee to be deposited into the PMP fund; and align language relating to disciplinary action against CSA registrants with disciplinary actions against other licensees and registrants. The proposed amendments reflect these changes. The proposed amendments also:

  • Temporarily place into Schedule I of the CSA six substances so scheduled by the federal Drug Enforcement Administration (DEA),
  • Add a late penalty fee for applications for registration modification which are submitted untimely,
  • Add a $15 fee for written verification of a registration,
  • Add a certified paramedic to the list of individuals who may dispose of a controlled substance as a result of administrative waste,
  • Provide a correction to a referenced rule,
  • Carve out butalbital products from the current list of “exempted prescription products” so that such products are not exempted from the CSA for purposes of reporting to the PMP, and
  • Allow for the disposal of controlled substances of a hospice patient by employees of a qualified hospice program, pursuant to the 2018-enacted federal SUPPORT Act.
    • Fiscal Impact     While there are proposed rules to impose a late penalty fee on untimely registration change applications and a fee for written verification of a registration, the Board anticipates that registrants will timely apply for registration changes and utilize the Board’s online verification system at no charge. Further, the Board does not intend to implement the surcharge at this time due to adequate grant funding secured. Jobs Impact    After analysis and review of this rule making, no impact on jobs has been found.Waivers    Any person who believes that the application of the discretionary provisions of this rule making would result in hardship or injustice to that person may petition the Board for a waiver of the discretionary provisions, if any, pursuant to 657—Chapter 34. Public Comment     Any interested person may submit written comments concerning this proposed rule making. Written comments in response to this rule making must be received by the Board no later than 4:30 p.m. on March 5, 2019. Comments should be directed to: Sue Mears Board of Pharmacy 400 S.W. 8th Street, Suite E Des Moines, Iowa 50309 Email: sue.mears@iowa.govPublic Hearing     No public hearing is scheduled at this time. As provided in Iowa Code section 17A.4(1)“b,” an oral presentation regarding this rule making may be demanded by 25 interested persons, a governmental subdivision, the Administrative Rules Review Committee, an agency, or an association having 25 or more members. Review by Administrative Rules Review Committee    The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making at its regular monthly meeting or at a special meeting. The Committee’s meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).    The following rule-making actions are proposed:

        ITEM 1.    Adopt the following new definition of “Prescription Monitoring Program” in rule 657—10.2(124):        "Prescription monitoring program,” “PMP," "program" means the program established pursuant to 657—Chapter 37 for the collection and maintenance of PMP information and for the provision of PMP information to authorized individuals.

        ITEM 2.    Amend rule 657—10.5(124) as follows:

    657—10.5(124) Application.  Applicants for initial registration, registration renewal pursuant to rule 657—10.6(124), or modifications pursuant to rule 657—10.9(124) shall complete the appropriate application and shall include all required information and attachments. Each registration application shall require submission of a $90 registration fee except as provided in subrule 10.5(3).    10.5(1) Signature requirements.  Each application, attachment, or other document filed as part of an application shall be signed by the applicant as follows:    a.    If the applicant is an individual practitioner, the practitioner shall sign the application and supporting documents.    b.    If the applicant is a business, the application and supporting documents shall be signed by the person ultimately responsible for the security and maintenance of controlled substances at the registered location.If the applicant is a pharmacy, the responsible individual shall be the pharmacist in charge, unless the applicant petitions the board for an alternate responsible individual.    10.5(2) Submission of multiple applicationsPrescribing practitioner PMP registration required.  Any person or business required to obtain more than one registration pursuant to rule 657—10.7(124) or 657—10.8(124) may submit all applications in one package. Each application shall be complete and shall not refer to any accompanying application or any attachment to an accompanying application for required information.A prescribing practitioner, except for a licensed veterinarian, shall register for the PMP at the same time the prescribing practitioner applies for registration.    10.5(3) Registration fee exemptions.  The registration fee is waived for federal, state, and local law enforcement agencies and for the following federal and state institutions: hospitals, health care or teaching institutions, and analytical laboratories authorized to possess, manufacture, distribute, and dispense controlled substances in the course of official duties. In order to enable law enforcement agency laboratories to obtain and transfer controlled substances for use as standards in chemical analysis, such laboratories shall maintain a registration to conduct chemical analysis (analytical laboratory). Such laboratories shall be exempt from any registration fee. Exemption from payment of any fees as provided in this subrule does not relieve the entity of registration or of any other requirements or duties prescribed by law.    10.5(4) Fees.  Each application shall include a nonrefundable registration fee, except as provided in subrule 10.5(3), of $90 per biennium, which may be prorated to the expiration date of the applicant’s underlying professional license or other board license if applicable, and may include a nonrefundable surcharge of not more than 25 percent of the registration fee for deposit into the program fund.

        ITEM 3.    Amend rule 657—10.6(124) as follows:

    657—10.6(124) Registration renewal.  Each registration shall be renewed prior to its biennial expiration. A registrant may renew its registration up to 60 days prior to the registration expiration. Thenonrefundable fee for registration renewal shall be $90per biennium and may include a nonrefundable surcharge of not more than 25 percent of the registration fee for deposit into the program fund.    10.6(1) Delinquent registration grace period.  A registrationrenewal application that is not renewed prior to the first day of the month following expirationsubmitted after expiration but within 30 days following expiration shall beconsidered delinquentand shall require the nonrefundable payment of the application fee plus a nonrefundable late penalty fee of $90 and may require payment of a surcharge of not more than 25 percent of the applicable fees for deposit into the program fund. A registrant may continue operations within the first 30 days following expiration while the license is delinquent if the registrant is in the process of renewing the registration. Failure to renew a registration prior to the first day of the month following expiration, but when submitting a completed renewal application within the 30 days following expiration, shall require payment of the renewal fee and a penalty fee of $90.A registrant that submits a completed registration renewal application, nonrefundable late application fee, and nonrefundable late penalty fee within 30 days following expiration shall not be subject to disciplinary action for continuing to operate in the 30 days following expiration.    10.6(2) Delinquent registration reactivation beyond grace period.  If a registration renewal application is not postmarked or hand-delivered to the board office within 30 days following itsthe registration’s expiration date, the registrant may not conduct operations that involve controlled substances until the registrant reactivates the registration. A registrant may apply for reactivation by submitting a registration application for reactivation and a $360 fee.The nonrefundable fee for reactivation shall be $360 and may include a nonrefundable surcharge of not more than 25 percent of the applicable fee for deposit into the program fund. As part of the reactivation application, the registrant shall disclose the activities conducted with respect to controlled substances while the registration was expired. A registrant that continues to conduct activities with respect to controlled substances without an active registration may be subject to disciplinary sanctions.

        ITEM 4.    Amend rule 657—10.9(124) as follows:

    657—10.9(124) Modification or termination of registration.  A registered individual or business shall apply to modify a current registration as provided by this rule.When submission of an application and fee is required, such application and fee shall be timely submitted pursuant to rule 657—10.5(124). A registrant which has timely submitted an application for registration modification and fee may continue to service Iowa patients while the registration modification is pending final approval. A registrant which has submitted an application for registration modification after the required date of submission pursuant to this rule but within 30 days of the required date of submission shall be assessed a nonrefundable late penalty fee of $90 in addition to the application fee. A registrant which has submitted an application for registration modification 31 days or later following the required date of submission pursuant to this rule shall be assessed a nonrefundable late penalty fee of $360.    10.9(1) Change of substances authorized.  Any registrant shall apply to modify the substances authorized by the registration by submitting a written request to the board. The request shall include the registrant’s name, address, telephone number, registration number, and the substances or schedules to be added to or removed from the registration and shall be signed by the same person who signed the most recent application for registration or registration renewal. No fee shall be required for the modification.    10.9(2) Change of address of registered location.      a.    Individual practitioner or researcher.An entity registered as an individual practitioner or researcher shall apply to change the address of the registered location by submitting a written request to the board. The request shall include the registrant’s name, current address, new address, telephone number, effective date of the address change, and registration number, and shall be signed by the registered individual practitioner or the same person who signed the most recent application for registration or registration renewal. No fee shall be required for the modification.    b.    Pharmacy, hospital, care facility, service program, manufacturer, distributor, analytical laboratory, teaching institution, importer, or exporter.An entity registered as a pharmacy, hospital, care facility, service program, manufacturer, distributor, analytical laboratory, teaching institution, importer, or exporter shall apply to change the address of the registered location by submitting a completed application and fee for registration as provided in rule 657—10.5(124). The registrant shall submit a completed application and fee for change in registration simultaneously with any other required application pursuant to the board’s rules for the applicable license or registration. In the absence of a simultaneous license or registration application, the registrant shall submit a completed application and fee for change in registration no less than 30 days in advance of the change of address.    10.9(3) Change of registrant’s name.      a.    Individual practitioner or researcher.An entity registered as an individual practitioner or researcher shall apply to change the registrant’s name by submitting a written request to the board. The request shall include the registrant’s current name, new name, address, telephone number, effective date of the name change, and registration number, and shall be signed by the registered individual practitioner or the same person who signed the most recent application for registration or registration renewal. No fee shall be required for the modification. Change of name, as used in this paragraph, refers to a change of the legal name of the registrant and does not authorize the transfer of a registration issued to an individual practitioner or researcher to another individual practitioner or researcher.    b.    Pharmacy, hospital, care facility, service program, manufacturer, distributor, analytical laboratory, teaching institution, importer, or exporter.An entity registered as a pharmacy, hospital, care facility, service program, manufacturer, distributor, analytical laboratory, teaching institution, importer, or exporter shall apply to change the registrant name by submitting a completed application and fee for registration as provided in rule 657—10.5(124).The registrant shall submit a completed application and fee for change in registration simultaneously with any other required application pursuant to the board’s rules for the applicable license or registration. In the absence of a simultaneous license or registration application, the registrant shall submit a completed application and fee for change in registration no less than 30 days in advance of the change of registrant’s name.    10.9(4) Change of ownership of registered business entity.  A change of immediate ownership of a pharmacy, hospital, care facility, service program, manufacturer, distributor, analytical laboratory, teaching institution, importer, or exporter shall require the submission of a completed application and fee for registration as provided in rule 657—10.5(124).The registrant shall submit a completed application and fee for change in registration simultaneously with any other required application pursuant to the board’s rules for the applicable license or registration. In the absence of a simultaneous license or registration application, the registrant shall submit a completed application and fee for change in registration no less than 30 days in advance of the change of registrant’s ownership.    10.9(5) Change of responsible individual.  Any registrant, except an individual practitioner or researcher or a pharmacy or hospital, shall apply to change the responsible individual authorized by the registration by submitting a written request to the board. The request shall include the registrant’s name, address, and telephone number; the name and title of the current responsible individual and of the new responsible individual; the effective date of the change; and the registration number and shall be signed by the new responsible individual. No fee shall be required for the modification.    a.    Individual practitioners and researchers.Responsibility under a registration issued to an individual practitioner or researcher shall remain with the named individual practitioner or researcher. The responsible individual under such registration may not be changed or transferred.    b.    Pharmacies and hospitalsPharmacy, hospital, care facility, service program, manufacturer, distributor, analytical laboratory, teaching institution, importer, or exporter.The responsible pharmacist may execute a power of attorney for DEA order forms to change responsibility under the registration issued to the pharmacy or hospital. The power of attorney shall include the name, address, DEA registration number, and CSA registration number of the registrant. The power of attorney shall identify the current and new responsible individuals and shall authorize the new responsible individual to execute applications and official DEA order forms to requisition Schedule II controlled substances. The power of attorney shall be signed by both individuals, shall be witnessed by two adults, and shall be maintained by the registrant and available for inspection or copying by representatives of the board or other state or federal authorities. The responsible individual may be changed on the CSA registration by submission of a completed application and fee for registration as provided in rule 657—10.5(124).The registrant shall submit a completed application and fee for change in registration simultaneously with any other required application pursuant to the board’s rules for the applicable license or registration. In the absence of a simultaneous license or registration application, the registrant shall submit a completed application and fee for change in registration within 10 days of the identification of a new responsible individual.    10.9(6) Termination of registration.  A registration issued to an individual or business shall terminate when the registered individual or business ceases legal existence, discontinues business, or discontinues professional practice. A registration issued to an individual shall terminate upon the death of the individual.

        ITEM 5.    Rescind rule 657—10.10(124) and adopt the following new rule in lieu thereof:

    657—10.10(124) Denial of application or discipline of registration.      10.10(1) Grounds for denial or discipline.  The board may deny any application or discipline any registration upon a finding that the applicant or registrant:     a.    Has furnished false or fraudulent material information.    b.    Has had the applicant’s or registrant’s federal registration to manufacture, distribute, or dispense controlled substances suspended, revoked, or otherwise sanctioned.    c.    Has been convicted of a public offense under any state or federal law relating to any controlled substance. For the purpose of this rule only, a conviction shall include a plea of guilty, a forfeiture of bail or collateral deposited to secure a defendant’s appearance in court which forfeiture has not been vacated, or a finding of guilt in a criminal action even if entry of the judgment or sentence has been withheld and the applicant or registrant has been placed on probation.     d.    Has committed such acts as would render the applicant’s or registrant’s registration under Iowa Code section 124.303 inconsistent with the public interest as determined by that section.    e.    Has been subject to discipline by the applicant’s or registrant’s respective professional licensing board and the discipline revokes or suspends the applicant’s or registrant’s professional license or otherwise disciplines the applicant’s or registrant’s professional license in a way that restricts the applicant’s or registrant’s authority to handle or prescribe controlled substances. A copy of the record of licensee discipline or a copy of the licensee’s surrender of the professional license shall be conclusive evidence.    f.    Has failed to obtain or maintain active registration while engaged in activities which require registration.    10.10(2) Considerations in denial of application or discipline of registration.  In determining the public interest, the board shall consider all the following factors:    a.    Maintenance of effective controls against diversion of controlled substances into channels other than legitimate medical, scientific, or industrial channels.    b.    Compliance with applicable state and local law.    c.    Any convictions of the applicant or registrant under any federal and state laws relating to any controlled substance.    d.    Past experience in the manufacture or distribution of controlled substances, and the existence in the applicant’s or registrant’s establishment of effective controls against diversion.    e.    Furnishing by the applicant of false or fraudulent material in any application filed under this chapter.    f.    Suspension or revocation of the applicant’s or registrant’s federal registration to manufacture, distribute, or dispense controlled substances as authorized by federal law.    g.    Any other factors relevant to and consistent with the public health and safety.    h.    Failure of a prescribing practitioner, except a licensed veterinarian, to register with the PMP pursuant to subrule 10.5(2).    10.10(3) Proceedings.      a.    Prior to denying an application for registration, the board shall serve upon the applicant a notice of intent to deny the application. An applicant has 30 days to appeal a notice of intent to deny the application. If the notice of intent to deny the application is timely appealed, a notice of hearing shall be issued, initiating a contested case proceeding governed by 657—Chapter 35. Proceedings to refuse renewal of a registration shall not abate the existing registration, which shall remain in effect pending the outcome of the contested case proceeding. A registration may be disciplined in accordance with 657—Chapters 35 and 36.     b.    Prior to sanctioning a registration, the board shall serve upon the registrant a notice of hearing and statement of charges. The notice shall contain a statement of the basis therefore and shall call upon the registrant to appear before an administrative law judge or the board at a time and place not less than 30 days after the date of service of the notice. The notice shall also contain a statement of the legal basis for such hearing and for the sanction of registration and a summary of the matters of fact and law asserted. Proceedings to refuse renewal of registration shall not abate the existing registration, which shall remain in effect pending the outcome of the administrative hearing unless the board issues an order of immediate suspension. A registration may be disciplined in accordance with 657—Chapters 35 and 36.    10.10(4) Disposition of controlled substances.  Upon service of an order of the board suspending or revoking a registration, the registrant shall deliver all affected controlled substances in the registrant’s possession to the board or authorized agent of the board. Upon receiving the affected controlled substances from the registrant, the board or its authorized agent shall place all such substances under seal and retain the sealed controlled substances pending final resolution of any appeals or until a court of competent jurisdiction directs otherwise. No disposition may be made of the substances under seal until the time for filing an appeal has elapsed or until all appeals have been concluded unless a court, upon application, orders the sale of perishable substances and the deposit of proceeds of the sale with the court. Upon a revocation order’s becoming final, all such controlled substances may be forfeited to the state.

        ITEM 6.    Adopt the following new rule 657—10.11(124,147,155A):

    657—10.11(124,147,155A) Registration verification.  The board may require a nonrefundable fee of $15 for completion of a request for written verification of any registration.

        ITEM 7.    Amend subrule 10.22(2) as follows:    10.22(2) Waste resulting from administration or compounding.  Except as otherwise specifically provided by federal or state law or rules of the board, the unused portion of a controlled substance resulting from administration to a patient from a registrant’s stock or emergency supply or resulting from drug compounding operations may be destroyed or otherwise disposed of by the registrant, a certified paramedic, or a pharmacist in witness of one other licensed health care provider or a registered pharmacy technician 18 years of age or older pursuant to this subrule. A written record of the wastage shall be made and maintained by the registrant for a minimum of two years following the wastage. The record shall include the following:    a.    The controlled substance wasted.    b.    The date of wastage.    c.    The quantity or estimated quantity of the wasted controlled substance.    d.    The source of the controlled substance, including identification of the patient to whom the substance was administered or the drug compounding process utilizing the controlled substance.    e.    The reason for the waste.    f.    The signatures of both individuals involved in the wastage.

        ITEM 8.    Amend rule 657—10.23(124) as follows:

    657—10.23(124) Disposal of previously dispensed controlled substances.      10.23(1) Registrant disposal.  Except as provided in 657—Chapter 23 for care facilities, a registrant may not dispose of previously dispensed controlled substances unless the registrant has modified its registration with DEA to administer an authorized collection program. A registrant shall not take possession of a previously dispensed controlled substance except for reuse for the same patient.or except as provided in paragraph 10.23(2)“b.”    10.23(2) Hospice disposal.      a.    An employee of a hospice program, acting within the scope of employment, may dispose of a controlled substance of a hospice program patient following the death of the patient or the expiration of the controlled substance pursuant to and in compliance with federal law.    b.    A physician of a hospice program patient may dispose of a patient’s controlled substance which is no longer required due to a change in the patient’s care plan.

        ITEM 9.    Amend subrule 10.27(2) as follows:    10.27(2) Long-term care or terminally ill patient.  A prescription for a Schedule II controlled substance written for a patient in a long-term care facility (LTCF) or for a patient with a medical diagnosis documenting a terminal illness may be filled in partial quantities to include individual dosage units as provided by this subrule.    a.    If there is any question whether a patient may be classified as having a terminal illness, the pharmacist shall contact the practitioner prior to partially filling the prescription. Both the pharmacist and the practitioner have a corresponding responsibility to ensure that the controlled substance is for a terminally ill patient.    b.    The pharmacist shall record on the prescription whether the patient is “terminally ill” or an “LTCF patient.” For each partial filling, the dispensing pharmacist shall record on the back of the prescription or on another appropriate uniformly maintained and readily retrievable record, the date of the partial filling, the quantity dispensed, the remaining quantity authorized to be dispensed, and the identification of the dispensing pharmacist.    c.    The total quantity of Schedule II controlled substances dispensed in all partial fillings shall not exceed the total quantity prescribed. Schedule II prescriptions for patients in an LTCF or for patients with a medical diagnosis documenting a terminal illness shall be valid for a period not to exceed 60 days from the issue date unless sooner terminated by the discontinuance of the drug.    d.    Information pertaining to current Schedule II prescriptions for patients in an LTCF or for patients with a medical diagnosis documenting a terminal illness may be maintained in a computerized system pursuant to rule 657—21.4(124,155A)657—21.5(124,155A).

        ITEM 10.    Adopt the following new paragraphs 10.39(2)"ao" to 10.39(2)"as":    ao.    Naphthalen-1-yl 1-(5-fluoropentyl)-1H-indole-3-carboxylate. Other names: NM2201 or CBL2201.    ap.    N-(1-amino-3-methyl-1-oxobutan-2-yl)-1-(5-fluoropentyl)-1H-indazole-3-carboxamide. Other name: 5F-AB-PINACA.    aq.    1-(4-cyanobutyl)-N-(2-phenylpropan-2-yl)-1H-indazole-3-carboxamide. Other names: 4-CN-CUMYL-BUTINACA, 4-cyano-CUMYL-BUTINACA, 4-CN-CUMYL BINACA, CUMYL-4CN-BINACA, or SGT-78.    ar.    Methyl 2-(1-(cyclohexylmethyl)-1H-indole-3-carboxamido)-3-methylbutanoate. Other names: MMB-CHMICA or AMB-CHMICA.    as.    1-(5-fluoropentyl)-N-(2-phenylpropan-2-yl)-1H-pyrrolo[2,3-b]pyridine-3-carboxamide. Other name: 5F-CUMYL-P7AICA.

        ITEM 11.    Adopt the following new subrule 10.39(5):    10.39(5)   Amend Iowa Code section 124.204(6)“i” by adding the following new subparagraph:    (27)   1-(1,3-benzodioxol-5-yl)-2-(ethylamino)-pentan-1-one. Other names: N-ethylpentylone or ephylone.

        ITEM 12.    Amend rule 657—10.40(124) as follows:

    657—10.40(124) Excluded and exempt substances.  The Iowa board of pharmacy hereby excludes from all schedules the current list of “Excluded Nonnarcotic Products” identified in Title 21, CFR Part 1308, Section 22, and. With the exception of listed butalbital products, the board hereby excludes from all schedules thecurrent list of “Exempted Prescription Products” described in Title 21, CFR Part 1308, Section 32. Copies of such lists may be obtained by written request to the board office at 400 S.W. Eighth Street, Suite E, Des Moines, Iowa 50309-4688.    ARC 4291CPharmacy Board[657]Notice of Intended Action

    Proposing rule making related to technician product verification programs and providing an opportunity for public comment

        The Board of Pharmacy hereby proposes to rescind Chapter 40, “Tech-Check-Tech Programs,” and adopt new Chapter 40, “Technology-Assisted Technician Product Verification Programs,” Iowa Administrative Code.Legal Authority for Rule Making    This rule making is proposed under the authority provided in Iowa Code sections 147.76 and 155A.33A.State or Federal Law Implemented    This rule making implements, in whole or in part, Iowa Code sections 155A.6A, 155A.33 and 155A.33A.Purpose and Summary    During the 2018 Legislative Session, changes were made to the Iowa Code which amended a program by which a certified pharmacy technician may be authorized to provide the final product verification of a prescription filled by another pharmacy employee. What were formerly known as “tech-check-tech” programs are now “technician product verification” (TPV) programs. The proposed chapter reflects this change. The Board also completed an overall review of the chapter of administrative rules relating to “tech-check-tech” programs as required by Iowa Code section 17A.7(2) and incorporated the changes made to the Iowa Code to create a new chapter relating to TPV programs.    The proposed rules:

  • Establish the minimum standards for a pharmacy to initiate a TPV program, including a pharmacist-to-technician ratio and program quality assurance;
  • Set requirements for a certified pharmacy technician to be authorized to participate in product verification activities;
  • Identify the minimum scanning technology required in a TPV program;
  • Set requirements for policies and procedures; and
  • Set requirements for record keeping.
    •     In advance of this Notice, the Board provided a draft version of the revised chapter to all pharmacy professionals licensed in Iowa to solicit feedback and comment. The Board received approximately 30 comments from pharmacists, technicians, and the Iowa Pharmacy Association, which had conducted a multiyear pilot project to study the safety and outcomes for community-based technician product verification programs. Several comments expressed opposition to such programs, while others offered suggestions to ensure the programs would not result in reduced pharmacist staffing. Several comments sought additional clarification for certain terms or topics. All comments were considered, and suggestions were incorporated into this proposed chapter as determined appropriate.Fiscal Impact     This rule making has no fiscal impact to the State of Iowa.Jobs Impact    After analysis and review of this rule making, no impact on jobs can be determined.Waivers    Any person who believes that the application of the discretionary provisions of this rule making would result in hardship or injustice to that person may petition the Board for a waiver of the discretionary provisions, if any, pursuant to 657—Chapter 34.Public Comment    Any interested person may submit written comments concerning this proposed rule making. Written comments in response to this rule making must be received by the Board no later than 4:30 p.m. on March 5, 2019. Comments should be directed to: Sue Mears Board of Pharmacy 400 S.W. 8th Street, Suite E Des Moines, Iowa 50309 Email: sue.mears@iowa.govPublic Hearing     No public hearing is scheduled at this time. As provided in Iowa Code section 17A.4(1)“b,” an oral presentation regarding this rule making may be demanded by 25 interested persons, a governmental subdivision, the Administrative Rules Review Committee, an agency, or an association having 25 or more members. Review by Administrative Rules Review Committee    The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making at its regular monthly meeting or at a special meeting. The Committee’s meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).    The following rule-making action is proposed:

        ITEM 1.    Rescind 657—Chapter 40 and adopt the following new chapter in lieu thereof: CHAPTER 40TECHNOLOGY-ASSISTED TECHNICIAN PRODUCT VERIFICATION PROGRAMS

    657—40.1(155A) Purpose and scope.  A pharmacy located in Iowa which provides clinical pharmaceutical services may, but shall not be required to, develop and implement a technician product verification (TPV) program in accordance with these rules. For the purpose of this chapter, clinical pharmaceutical services shall mean services that exceed the minimum requirements of the practice of pharmacy. Clinical pharmaceutical services include, but are not limited to, medication therapy management, collaborative practice, statewide protocols, and immunizations. In a TPV program, certified pharmacy technicians provide technology-assisted final drug product verification during the prescription filling process. The pharmacist shall still be responsible for verification of the accuracy of data entry, drug utilization review, ensuring rational drug therapy, and counseling. The onsite practice hours for a pharmacist shall not be reduced but shall be redistributed directly to clinical pharmaceutical services to improve patient care and health outcomes.

    657—40.2(155A) Definitions.  For the purposes of this chapter, the following definitions shall apply:        "Board" means the board of pharmacy.        "Certified pharmacy technician" means an individual who holds a valid current national certification and who has registered with the board as a certified pharmacy technician pursuant to 657—Chapter 3.        "Checking technician" means a certified pharmacy technician who has been authorized pursuant to rule 657—40.4(155A) by the responsible pharmacist to provide drug product verification in a TPV program.        "Representative sample" means a subset of prescriptions that must be verified by a pharmacist for each checking technician involved in a TPV program. A subset consists of a minimum of 1 percent of prescriptions verified by each checking technician or 25 prescriptions per checking technician, whichever is greater.        "Responsible pharmacist" means the pharmacist who is designated by the pharmacy or pharmacist in charge to oversee a TPV program and who is responsible for ensuring the TPV program complies with these rules.        "Technician product verification program" "TPV" means a program formally established and implemented pursuant to these rules which permits a checking technician to provide technology-assisted drug product verification during the prescription filling process. “TPV” includes programs previously approved by the board as “tech-check-tech” or “TCT” programs.

    657—40.3(155A) TPV program requirements.      40.3(1) Site-specific.  A TPV program shall be specific to the site at which technician product verification is utilized.    40.3(2) TPV program oversight.  A pharmacy shall, at all times, have one designated responsible pharmacist who is responsible for meeting TPV program requirements. The responsible pharmacist is not required to be on duty at all times when the TPV program is in use and may designate one or more pharmacists on duty to supervise the activities of checking technicians.     40.3(3) Checking technician qualifications.  Prior to authorizing a technician to conduct TPV program checking technician activities, the responsible pharmacist shall ensure the certified pharmacy technician has met the minimum requirements of rule 657—40.4(155A).    40.3(4) Staff responsibilities.  Within a TPV program, each pharmacist shall optimize clinical pharmaceutical services and ensure consistent and safe implementation of the program. A pharmacist shall be on site and available to checking technicians during any period when TPV is utilized. Each individual involved in the TPV program shall be responsible for the activities performed by that individual, ensuring the activities adhere to TPV program policies and procedures and board rules.    40.3(5) Technology required.  The pharmacy’s prescription processing system shall have appropriate scanning technology to ensure each product is accurately filled and verified. Scanning technology shall include barcode scanning or superior electronic scanning to verify that the National Drug Code (NDC) of the container of product being used to fill the prescription matches the NDC of the product entered into the pharmacy’s prescription processing system to fill the prescription. Only a pharmacist shall be authorized to override a scanning technology error or exception. When scanning technology does not function properly, only a pharmacist shall be authorized to visually verify the product or manually enter the drug product into the pharmacy’s prescription processing system. The pharmacy’s prescription processing system shall be capable of documenting each step of the dispensing process and identifying which pharmacy employee was responsible for each step of the dispensing process.    40.3(6) Pharmacist-to-technician ratio.  In any pharmacy which utilizes a TPV program, the ratio of pharmacists to technicians physically present in the pharmacy shall not exceed 1:2 at any time, including when TPV is not in use.    40.3(7) Board notification and inspection.  Prior to implementing a TPV program, a pharmacy shall provide advance notice to the board, on forms provided by the board, of its intention to implement a TPV program. The board may require an onsite inspection prior to program commencement.     40.3(8) Program discontinuation.  A pharmacy shall provide notice to the board when it discontinues a TPV program. A pharmacy intending to implement a previously discontinued TPV program shall provide advance notice to the board, on forms provided by the board, of its intent to implement a TPV program pursuant to subrule 40.3(7).

    657—40.4(155A) Checking technician requirements.  A certified pharmacy technician shall comply with the requirements of this rule prior to being authorized to engage in checking technician activities in a TPV program. Prior to authorizing the technician to engage in TPV activities, the responsible pharmacist shall ensure the technician is proficient in all aspects of the TPV program and the responsibilities of a checking technician.    40.4(1) Minimum qualifications.      a.    National certification.The certified pharmacy technician’s national certification as required pursuant to rule 657—3.5(155A) shall be current.    b.    Iowa registration.The certified pharmacy technician’s registration with the board as required pursuant to rule 657—3.3(155A) shall be current and not currently subject to disciplinary charges or sanctions.    c.    Prior experience.The certified pharmacy technician shall have completed a minimum of 2,000 hours as a technician and be trained pursuant to subrule 40.4(2).    40.4(2) Training.  Pursuant to the pharmacy’s policies and procedures, the technician shall satisfactorily complete a training program prior to being authorized to engage in TPV activities. The elements of the pharmacy’s training program shall be described in the advance notice provided to the board pursuant to subrule 40.3(7).

    657—40.5()   Reserved.

    657—40.6()   Reserved.

    657—40.7(155A) Policies and procedures.  Policies and procedures shall be developed and adhered to in a TPV program. Policies and procedures for a TPV program shall include, at a minimum, the following:
    1. A program to train certified pharmacy technicians to be checking technicians pursuant to subrule 40.4(2), including but not limited to training in the scanning technology to be utilized in the TPV program, limitations of the scanning technology, and strategies to compensate for these limitations.
    2. A procedure to identify a representative sample to complete a quarterly quality assurance double check of prescriptions verified by each checking technician.
    3. Redirection of pharmacist hours to clinical pharmaceutical services.
    4. Identification of drug products for which authorized checking technicians will be prohibited from performing final drug product verification during the prescription filling process.

    657—40.8(155A) TPV program quality assurance.      40.8(1) Quality assurance program—quarterly verification.  The responsible pharmacist shall establish and implement a quality assurance program to evaluate TPV program activities. Each quarter, a pharmacist shall verify a representative sample of prescriptions verified by each checking technician. The quarterly verification shall be documented, and such documentation shall be maintained pursuant to subrule 40.11(2).    40.8(2) Review of errors.  Any error resulting from TPV shall be documented and evaluated via the pharmacy’s continuous quality improvement program (CQI) program pursuant to rule 657—8.26(155A) and shall require the technician responsible for the error to be retrained through the pharmacy’s established training program.    40.8(3) Quarterly reports.  The responsible pharmacist shall ensure the completion of a quarterly report on forms provided by the board. The quarterly report shall be maintained in the pharmacy pursuant to subrule 40.11(3).

    657—40.9()   Reserved.

    657—40.10()   Reserved.

    657—40.11(155A) TPV program records.  The records required in this rule, in addition to any other required records of the pharmacy, shall be available for inspection and copying by the board, its authorized agent, or another authorized agency for a minimum of two years following the date of the record.    40.11(1) Checking technician training and authorization.  TPV program records shall include all records documenting the successful completion of the pharmacy’s training program for each checking technician in the TPV program. The record for each checking technician shall include the following:    a.    The name of the technician.    b.    The date on which the technician completed the system-specific training for participation in the TPV program.    c.    The date on which the technician was authorized to participate in the TPV program.    40.11(2) Quality assurance program.  TPV program records shall include all records associated with the quality assurance program to evaluate each checking technician in the TPV program, including the dates and results of each quarterly verification; the dates of and reasons for any suspension or revocation of a checking technician’s TPV program authorization, identification of corrective action or retraining completed, and the date of the subsequent reinstatement of a checking technician’s TPV program authorization; and the dates of and reasons for any disciplinary action taken against a checking technician in connection with the TPV program.    40.11(3) Quarterly reports.  TPV program records shall include quarterly reports as required pursuant to subrule 40.8(3).       These rules are intended to implement Iowa Code sections 155A.6A, 155A.33, and 155A.33A.    ARC 4275CProfessional Licensure Division[645]Amended Notice of Intended Action

    Proposing rule making related to endorsement applicants and license reactivation for chiropractic physicians and providing an opportunity for public comment

        The Board of Chiropractic hereby proposes to amend Chapter 41, “Licensure of Chiropractic Physicians,” Iowa Administrative Code. Legal Authority for Rule Making    This rule making is proposed under the authority provided in Iowa Code sections 147.76 and 272C.3.State or Federal Law Implemented    This rule making implements, in whole or in part, Iowa Code chapters 147 and 272C.Purpose and Summary    The proposed amendments reduce the required number of continuing education (CE) hours from 60 to 40 for endorsement and reactivation applicants in order to be consistent with the Board’s recent rule making amending Chapter 44.Reason for Amendment of Notice of Intended Action    Notice of Intended Action for this rule making was published in the Iowa Administrative Bulletin on November 21, 2018, as ARC 4129C. No public comments were received. The proposed amendments have been changed to make continuing education requirements for endorsement applicants consistent with changes in the prerequisite CE hours in Chapter 44.Fiscal Impact     This rule making has no fiscal impact to the State of Iowa. Jobs Impact    After analysis and review of this rule making, no impact on jobs has been found.Waivers    A waiver provision is not included in this rule making because all administrative rules of the professional licensure boards in the Professional Licensure Division are subject to the waiver provisions accorded under 645—Chapter 18.Public Comment    Any interested person may submit written comments concerning this proposed rule making. Written comments in response to this rule making must be received by the Board no later than 4:30 p.m. on March 5, 2019. Comments should be directed to: Susan Reynolds Professional Licensure Division Iowa Department of Public Health Lucas State Office Building Des Moines, Iowa 50319-0075 Email: susan.reynolds@idph.state.ia.usPublic Hearing     No public hearing is scheduled at this time. As provided in Iowa Code section 17A.4(1)“b,” an oral presentation regarding this rule making may be demanded by 25 interested persons, a governmental subdivision, the Administrative Rules Review Committee, an agency, or an association having 25 or more members. Review by Administrative Rules Review Committee    The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making at its regular monthly meeting or at a special meeting. The Committee’s meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).    The following rule-making actions are proposed:

        ITEM 1.    Amend subparagraph 41.6(2)"f" as follows:    (1)   Completion of 6040 hours of board-approved continuing education during the immediately preceding two-year period as long as the applicant had an active practicelicense within the last five years; or

        ITEM 2.    Amend subparagraph 41.6(2)"g" as follows:    (1)   Evidence of satisfactory completion of 6040 hours of board-approved continuing education during the immediately preceding two-year period; and

        ITEM 3.    Amend subparagraph 41.14(3)"a" as follows:    (2)   Verification of completion of 6040 hours of continuing education that comply with standards defined in rule 645—44.3(151,272C) within two years of the application for reactivation.

        ITEM 4.    Amend subparagraph 41.14(3)"b" as follows:    (2)   Verification of completion of 6040 hours of continuing education that comply with standards defined in rule 645—44.3(151,272C) within two years of application for reactivation; and    ARC 4306CProfessional Licensure Division[645]Notice of Intended Action

    Proposing rule making related to disinterment and providing an opportunity for public comment

        The Board of Mortuary Science hereby proposes to amend Chapter 100, “Practice of Funeral Directors, Funeral Establishments, and Cremation Establishments,” Iowa Administrative Code.Legal Authority for Rule Making    This rule making is proposed under the authority provided in Iowa Code chapter 156 and section 147.76.State or Federal Law Implemented    This rule making implements, in whole or in part, Iowa Code chapters 144C, 147, 156 and 272C.Purpose and Summary    The proposed amendment makes rule 645—100.9(144) consistent with rules of the Department of Public Health related to the purpose of issuing disinterment permits in accordance with Iowa Code section 144.34.Fiscal Impact     This rule making has no fiscal impact to the State of Iowa. Jobs Impact    After analysis and review of this rule making, no impact on jobs has been found.Waivers    A waiver provision is not included in this rule making because all administrative rules of the professional licensure boards in the Professional Licensure Division are subject to the waiver provisions accorded under 645—Chapter 18.Public Comment     Any interested person may submit written comments concerning this proposed rule making. Written comments in response to this rule making must be received by the Board no later than 4:30 p.m. on March 5, 2019. Comments should be directed to: Susan Reynolds Professional Licensure Division Department of Public Health Lucas State Office Building Des Moines, Iowa 50319 Fax: 515.281.3121 Email: susan.reynolds@idph.iowa.govPublic Hearing     A public hearing at which persons may present their views orally or in writing will be held as follows: March 5, 2019 7:30 to 8 a.m. Fifth Floor Board Conference Room 526 Lucas State Office Building Des Moines, Iowa     Persons who wish to make oral comments at the public hearing may be asked to state their names for the record and to confine their remarks to the subject of this proposed rule making. In an effort to ensure accuracy in memorializing a person’s comments, a person may provide written comments in addition to or in lieu of oral comments at the hearing.     Any persons who intend to attend the public hearing and have special requirements, such as those related to hearing or mobility impairments, should contact the Board and advise of specific needs. Review by Administrative Rules Review Committee    The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making at its regular monthly meeting or at a special meeting. The Committee’s meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).    The following rule-making action is proposed:

        ITEM 1.    Amend subrule 100.9(6) as follows:    100.9(6)   Disinterment permits shall be required for any relocation of a human remains or cremated remains from the original site of interment or entombmentif the purpose is for autopsy or reburial.    ARC 4292CRevenue Department[701]Notice of Intended Action

    Proposing rule making related to remote sales and marketplace sales and providing an opportunity for public comment

        The Revenue Department hereby proposes to adopt new Chapter 215, “Remote Sales and Marketplace Sales,” Iowa Administrative Code.Legal Authority for Rule Making    This rule making is proposed under the authority provided in Iowa Code section 421.17.State or Federal Law Implemented    This rule making implements, in whole or in part, Iowa Code section 423.14A as enacted by 2018 Iowa Acts, Senate File 2417.Purpose and Summary    The Department proposes to adopt the following new chapter of rules to implement sales tax collection requirements imposed on marketplace facilitators and remote sellers by 2018 Iowa Acts, Senate File 2417. These proposed rules provide information about how and when remote sellers and marketplace facilitators are required to register, collect, and remit sales tax in Iowa. Fiscal Impact     This rule making has no fiscal impact to the State of Iowa beyond the impact of the provisions of 2018 Iowa Acts, Senate File 2417, that it seeks to implement. Table 7 of the Legislative Services Agency Fiscal Note for Senate File 2417 estimated that collection on sales by “online sellers” and “online marketplaces” would increase General Fund revenues by $27.6 million in fiscal year (FY) 2019, $66.4 million in FY 2020, $69.3 million in FY 2021, $71.7 million in FY 2022, $74.2 million in FY 2023, and $76.5 million in FY 2024. Jobs Impact    After analysis and review of this rule making, no impact on jobs has been found.Waivers    Any person who believes that the application of the discretionary provisions of this rule making would result in hardship or injustice to that person may petition the Department for a waiver of the discretionary provisions, if any, pursuant to rule 701—7.28(17A). Public Comment     Any interested person may submit written or oral comments concerning this proposed rule making. Written or oral comments in response to this rule making must be received by the Department no later than 4:30 p.m. on March 5, 2019. Comments should be directed to: Tim Reilly Department of Revenue Hoover State Office Building P.O. Box 10457 Des Moines, Iowa 50306 Phone: 515.725.2294 Email: tim.reilly@iowa.govPublic Hearing     A public hearing at which persons may present their views orally or in writing will be held as follows: March 5, 2019 9 to 10 a.m. Room 430, Fourth Floor Hoover State Office Building Des Moines, Iowa     Persons who wish to make oral comments at the public hearing may be asked to state their names for the record and to confine their remarks to the subject of this proposed rule making.     Any persons who intend to attend the public hearing and have special requirements, such as those related to hearing or mobility impairments, should contact the Department and advise of specific needs. Review by Administrative Rules Review Committee    The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making at its regular monthly meeting or at a special meeting. The Committee’s meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).    The following rule-making action is proposed:

        ITEM 1.    Adopt the following new 701—Chapter 215: CHAPTER 215REMOTE SALES AND MARKETPLACE SALES

    701—215.1(423) Definitions.      215.1(1) Incorporation of definitions.  To the extent it is consistent with Iowa Code chapter 423 and this chapter, all other words and phrases used in this chapter shall mean the same as defined in Iowa Code sections 423.1 and 423.14A and rule 701—211.1(423).    215.1(2) Chapter-specific definitions.  For purposes of this chapter, unless the context otherwise requires:        "Gross revenue from sales" means all revenue from Iowa sales.        "Iowa sales" means the same as defined in Iowa Code section 423.14A(1)“a.” “Iowa sales” includes all retail sales, whether taxable or exempt, and other sales of tangible personal property, specified digital products, or services otherwise sold into Iowa or for delivery into Iowa, including wholesale or sale for resale. “Iowa sales” includes sales made through a marketplace.        "Marketplace" means any physical or electronic place, including but not limited to a store, booth, Internet website, catalog, television or radio broadcast, or a dedicated sales software application, where a marketplace seller sells or offers for sale tangible personal property, or specified digital products, or where services are offered for sale into Iowa regardless of whether the tangible personal property, specified digital product, marketplace seller, or marketplace has a physical presence in Iowa.        "Physical presence in Iowa" means the activities described in Iowa Code section 423.1(48)“a”(1).        "Remote seller" means a retailer that does not have a physical presence in Iowa but which makes sales of tangible personal property, specified digital products, or services that are sourced to Iowa.        "Retailer" means the same as defined in Iowa Code section 423.1(47). “Retailer” includes a marketplace facilitator that meets or exceeds the sales threshold and includes a remote seller.        "Sales threshold" means the revenue or transaction levels that trigger collection and remittance obligations for Iowa sales tax and local option sales tax as described in Iowa Code section 423.14A(3): $100,000 or more in gross revenue from Iowa sales or 200 or more separate sales transactions into Iowa in either the current or immediately prior calendar year.        "Separate transaction" means each invoice that is generated from an Iowa sale, including a single invoice that accounts for multiple products or services. For leases, rentals, and subscriptions, each required periodic payment is a separate transaction. “Separate transaction” does not include any deposits made in advance of a sale.

    701—215.2(423) Retailers with physical presence in Iowa.      215.2(1) Sales threshold inapplicable.  The sales threshold does not apply to any seller, marketplace facilitator, or other retailer that has physical presence in Iowa. A seller, marketplace facilitator, or other retailer with physical presence in Iowa must collect and remit Iowa sales tax and any applicable local option sales tax pursuant to Iowa Code section 423.14 even if the sales threshold is not met.    215.2(2) Mixed marketplace and nonmarketplace sales.  A retailer with physical presence in Iowa who makes both marketplace and nonmarketplace sales must do the following:    a.    Collect sales tax on any taxable sales on which the marketplace does not collect sales tax.    b.    Report on its Iowa sales tax return its gross revenue from all Iowa sales, including any marketplace sales on which the marketplace facilitator collected Iowa sales tax, regardless of whether the sales threshold is met.Example: Seller X is an Iowa-based business, with property and personnel located in Iowa. Seller X has $80,000 in gross revenue from Iowa sales. Seller X makes $10,000 of gross revenue from Iowa sales through a marketplace facilitator that collects Iowa sales tax and applicable local option sales tax. The remaining $70,000 in gross revenue comes from Iowa sales made at Seller X’s storefront in Iowa. Seller X must collect and remit Iowa sales tax and applicable local option sales tax on the $70,000 in nonmarketplace sales. On its Iowa sales tax return, Seller X should report $80,000 in gross revenue from sales. Seller X may take a deduction on its Iowa sales tax return of $10,000 for sales on which the marketplace collected Iowa sales tax and applicable local option sales tax.

    701—215.3(423) Remote sellers—registration and collection obligations.      215.3(1) Combined Iowa sales from all sources.  Remote sellers must determine whether they meet the sales threshold based on the total of their Iowa sales through marketplaces combined with their nonmarketplace Iowa sales.    215.3(2) Remote sellers with Iowa sales solely through marketplaces.  If a remote seller meets the sales threshold but only makes retail sales in Iowa through marketplaces, the remote seller’s registration and collection obligations depend on whether all of the marketplace facilitators through which the remote seller makes Iowa sales are registered to collect Iowa tax.    a.    Registered marketplace facilitators.If all the marketplace facilitators used by the remote seller to make taxable Iowa sales collect Iowa sales tax and applicable local option sales tax, the remote seller does not have to collect sales or local option sales tax. The marketplace facilitator will report and pay Iowa sales tax and applicable local option sales tax on a sales tax return filed by the marketplace facilitator.Example: Seller X has $200,000 in gross revenue from Iowa sales. Seller X makes all of its Iowa sales through a marketplace facilitator that collects Iowa sales tax and applicable local option sales tax on sales. Seller X does not need to register for an Iowa sales tax permit or file an Iowa sales tax return. The marketplace facilitator will report the sales tax on the marketplace facilitator’s Iowa sales tax return.    b.    Nonregistered marketplace facilitators.If a marketplace facilitator is not required to or fails to register and collect tax in Iowa, remote sellers who exceed the sales threshold must obtain an Iowa sales tax permit, collect Iowa sales tax and local option sales tax, and file Iowa sales tax returns for sales made on that marketplace.Example: Seller X has $200,000 in gross revenue from Iowa sales. Seller X has $2,000 gross revenue from sales on Marketplace Y and $198,000 in gross revenue from sales on Marketplace Z. Marketplace Y meets the sales threshold and is registered to collect and remit sales tax and local option sales tax in Iowa. Marketplace Z, however, has very few, low-cost Iowa sales, and meets neither the gross revenue nor volume of sales threshold, and is therefore not required to and does not collect tax on Iowa sales. Seller X must collect Iowa sales tax and applicable local option sales tax on retail sales sourced to Iowa that are made on Marketplace Z.    215.3(3) Remote sellers making both marketplace and nonmarketplace sales.  A remote seller that exceeds the sales threshold and makes nonmarketplace Iowa sales, such as through the remote seller’s own website, must obtain an Iowa sales tax permit. The remote seller must report on its Iowa sales tax return its gross revenue from all Iowa sales. The remote seller would be able to deduct the amount of gross sales made through any marketplaces registered to collect tax in Iowa on the remote seller’s sales tax return. A remote seller making Iowa sales through a marketplace operated by an unregistered marketplace facilitator must collect and remit Iowa sales tax and applicable local option sales tax on those sales.

    701—215.4(423) Marketplace facilitators—registration and collection obligations.  Marketplace facilitators that meet the sales threshold must collect and remit Iowa sales tax and applicable local option sales tax on all taxable sales made through their marketplace that are sourced to Iowa. Marketplace facilitators must collect Iowa sales tax on all taxable Iowa sales, regardless of the location or sales volume of the marketplace sellers who make sales on marketplace facilitator’s marketplaces.Example: M is a marketplace facilitator that meets the sales threshold and therefore collects Iowa sales tax and applicable local option sales tax on Iowa sales facilitated through M’s marketplace. Seller S lists soccer balls for sale on M’s marketplace. A purchaser in Iowa buys a soccer ball listed by S on M’s marketplace. The soccer ball is delivered to the purchaser’s home address in Iowa. M must collect Iowa sales tax and applicable local option sales tax on the sale of the soccer ball. The outcome is the same regardless of whether S is located in Iowa and regardless of S’s Iowa sales volume.

    701—215.5(423) Commencement of collection obligation and sales tax liability.      215.5(1) Commencement of collection obligation.  If a remote seller or marketplace facilitator without physical presence in Iowa did not exceed the sales threshold for the prior year, and therefore does not collect sales tax in the current year, and exceeds the sales threshold in the current year, the remote seller or marketplace facilitator must collect Iowa sales tax and applicable local option sales tax starting on the first day of the next calendar month that starts at least 30 days from the day the remote seller or marketplace facilitator first exceeded the sales threshold. The remote seller or marketplace facilitator must collect tax through the end of the calendar year in which the sales threshold was met or exceeded as well as the entire next calendar year.Example: Company S, a remote seller, did not exceed the sales threshold in 2018. On September 15, 2019, S exceeds the sales threshold for the first time. S must register to collect Iowa sales tax and must begin collecting Iowa sales tax on November 1, 2019. S must continue to collect through at least December 31, 2020. S’s sales volume in 2020 and later years will determine whether S must collect Iowa sales tax after December 31, 2020.     215.5(2) Commencement of sales tax liability.  If a remote seller or marketplace facilitator without physical presence in Iowa exceeds the sales threshold as described in subrule 215.5(1), the remote seller or marketplace facilitator without physical presence in Iowa shall not be liable for any sales tax not collected beginning on January 1 of the current year through the day prior to the date the remote seller or marketplace facilitator without physical presence in Iowa is obligated to collect sales tax as described in subrule 215.5(1). Purchasers will be liable for any use tax that accrues prior to the date the remote seller or marketplace facilitator without physical presence in Iowa is obligated to collect sales tax as described in subrule 215.5(1).    215.5(3) Permit registration.  If a remote seller or marketplace facilitator without physical presence in Iowa that makes taxable sales exceeds the sales threshold, the remote seller or marketplace facilitator without physical presence in Iowa must register for a sales tax permit under 701—Chapter 13 prior to the date the remote seller or marketplace facilitator without physical presence in Iowa is obligated to collect sales tax as described in subrule 215.5(1).

    701—215.6(423) Retailers registered and collecting who fail to meet or exceed sales threshold.  If a retailer is registered to collect Iowa sales tax and collects in year 1 and fails to meet or exceed the sales threshold in year 2, the retailer must still collect all applicable sales taxes in year 2. If the retailer does not meet or exceed the sales threshold at any point in year 2, the retailer is not required to collect and remit Iowa sales tax or applicable local option sales tax in year 3. However, if a retailer is registered to collect, the retailer must continue collecting regardless of the impact of the sales threshold. A retailer that falls under the sales threshold may either submit sales tax returns demonstrating it did not collect tax until a time in the future when the retailer meets or exceeds the sales threshold or cancel its sales tax permit if it wishes to cease collecting. If the retailer meets or exceeds the sales thresholds at any point thereafter, the retailer would need to register again in accordance with 701—Chapter 13 and begin collecting in accordance with this chapter.Example: Company S, a remote seller, exceeds the sales threshold on June 25, 2019. S must collect Iowa sales tax and applicable local option sales tax beginning August 1, 2019, and must collect for all of 2020. S does not meet or exceed the sales threshold in 2020. S is not obligated to collect sales tax on January 1, 2021. S may cease collection and cancel its sales tax permit effective January 1, 2021.

    701—215.7(423) Coupons; incorporation of rule 701—212.3(423).  The requirements of rule 701—212.3(423) shall apply to marketplace facilitators and remote sellers in the same manner that those requirements apply to retailers. Coupons and other discounts offered by marketplace facilitators and remote sellers are retailer’s discounts, which reduce the sales price and thus the taxable amount of a sale, in accordance with Iowa Code section 423.1(51).

    701—215.8(423) Customer returns marketplace purchase directly to marketplace seller.  If a marketplace facilitator collects Iowa sales tax and applicable local option sales tax on the sale and the customer returns the item directly to the marketplace seller, the marketplace seller shall refund the full price paid by the customer including all tax collected by the marketplace facilitator. The marketplace seller shall seek reimbursement of state and local option sales tax from the marketplace facilitator. The marketplace facilitator shall reimburse the returned state and local option sales tax to the marketplace seller once the marketplace seller has adequately demonstrated that the marketplace seller returned the tax in conjunction with a return made directly to the marketplace seller. The marketplace facilitator may claim a credit for the return of state and local sales tax on its Iowa sales tax return. Nothing in this rule requires a marketplace seller to accept a return as described in this rule. Nothing in this rule requires a marketplace facilitator to allow returns to be made directly to a marketplace seller.

    701—215.9(423) Exempt and nontaxable sales.      215.9(1) Exempt sales.  A retailer required to collect and remit Iowa sales tax and applicable local option sales tax in accordance with Iowa Code section 423.14A and this chapter is responsible for correctly applying exemptions for tangible personal property, specified digital products, and services. As a member of the streamlined sales tax governing board, the department maintains a taxability matrix to describe whether various items are taxable or exempt. See rule 701—240.6(423) for an explanation of the liability relief provided to retailers who rely on the taxability matrix in determining whether to collect tax on an item.    215.9(2) Nontaxable sales.  A retailer, including an Iowa retailer with a physical presence in Iowa, a remote seller, or a marketplace facilitator, that makes or facilitates only nontaxable sales, such as sale for resale or wholesale transactions, is not required to register for a sales tax permit.

    701—215.10(423) Other taxes for marketplace sales and items not subject to sales/use tax.   A marketplace facilitator is not obligated to collect tax on a product sold through a marketplace it operates that is not subject to Iowa sales and use tax. Example: A marketplace facilitator allows marketplace sellers to list for sale vehicles subject to registration under Iowa Code chapter 321, including the fee for new registration imposed in accordance with Iowa Code section 321.105A. Because the fee for new registration is not imposed under Iowa Code chapter 423, the marketplace facilitator is not obligated to collect the fee for new registration.

    701—215.11(423) Administration; incorporation of 701—Chapter 11.  Except as otherwise stated in this chapter, the requirements of 701—Chapter 11 shall apply to all retailers, including remote sellers and marketplace facilitators, required to collect and remit sales tax under this chapter.

    701—215.12(423) Filing returns; payment of tax; penalty and interest; incorporation of 701—Chapter 12.  Except as otherwise stated in this chapter, the filing requirements of 701—Chapter 12 shall apply to all retailers, including remote sellers and marketplace facilitators, required to collect and remit sales tax under this chapter.

    701—215.13(423) Permits; incorporation of 701—Chapter 13.  Except as otherwise stated in this chapter, the permit requirements of 701—Chapter 13 shall apply to all retailers, including remote sellers and marketplace facilitators, required to collect and remit sales tax under this chapter.        These rules are intended to implement Iowa Code section 423.14A.    ARC 4283CUtilities Division[199]Notice of Intended Action

    Proposing rule making related to procedure for determining competitiveness and providing an opportunity for public comment

        The Utilities Board hereby proposes to amend Chapter 5, “Procedure for Determining the Competitiveness of a Communications Service or Facility,” Iowa Administrative Code.Legal Authority for Rule Making    This rule making is proposed under the authority provided in Iowa Code sections 474.5 and 476.2.State or Federal Law Implemented    This rule making implements, in whole or in part, Iowa Code sections 476.1D, 476.2 and 546.7.Purpose and Summary    The Board is conducting a comprehensive review of its administrative rules in accordance with Iowa Code section 17A.7(2). The purpose of this proposed rule making is to update and amend Chapter 5 of the Board’s rules establishing procedures for determining the competitiveness of a communications service or facility pursuant to Iowa Code section 476.1D.    The Board issued an order commencing rule making on January 23, 2019. The order is available on the Board’s electronic filing system, efs.iowa.gov, under Docket No. RMU-2016-0021.Fiscal Impact     After analysis and review, the Board tentatively concludes that the amendments will have no effect on the expenditure of public moneys within the state of Iowa. Jobs Impact    After analysis and review, the Board tentatively concludes that the amendments will not have a detrimental effect on employment in Iowa.Waivers    No waiver provision is included in the proposed amendments since the Board has a general waiver provision in rule 199—1.3(17A,474,476) that provides procedures for requesting a waiver of the rules in this chapter. Public Comment     Any interested person may submit written comments concerning this proposed rule making. Written comments in response to this rule making must be received by the Board no later than 4:30 p.m. on March 5, 2019. Comments should be directed to: Iowa Utilities Board Electronic Filing System (EFS) at efs.iowa.gov Phone: 515.725.7337 Email: efshelpdesk@iub.iowa.govPublic Hearing     No public hearing is scheduled at this time. As provided in Iowa Code section 17A.4(1)“b,” an oral presentation regarding this rule making may be demanded by 25 interested persons, a governmental subdivision, the Administrative Rules Review Committee, an agency, or an association having 25 or more members. Review by Administrative Rules Review Committee    The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making at its regular monthly meeting or at a special meeting. The Committee’s meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).    The following rule-making actions are proposed:

        ITEM 1.    Amend rule 199—5.1(476) as follows:

    199—5.1(476) Purpose.  These rules govern the procedure for investigating and determining the applicable level of regulation under Iowa Code Supplement section 476.1D for a communications service or facilitypursuant to Iowa Code section 476.1D.

        ITEM 2.    Amend subrule 5.2(1), introductory paragraph, as follows:    5.2(1)  Petitioner.  Any interested person may petition the board for a determination of the following under Iowa Code Supplement section 476.1D.

        ITEM 3.    Amend subrule 5.2(2), introductory paragraph, as follows:    5.2(2)  Contents of petition.  A petition for a determination under subrule 5.2(1) shall substantially comply with the form prescribed in 199—subrule 2.2(1), except that references to rule making shall be replaced by references to the service or facility sought to be evaluated. In addition, the petition must contain or be submitted with the following information:

        ITEM 4.    Rescind subrule 5.2(3).

        ITEM 5.    Amend subrule 5.3(1) as follows:    5.3(1)  Order.  If the petitioner has complied with subrule 5.2(2), the board mayshall issue an order docketing the matter as a formal notice and comment proceeding. At any time the board may initiate a formal notice and comment proceeding on its own motion. At any time, the board may also on its own motion initiate evidentiary hearings to develop a reliable record of facts related to the issues raised and to allow discovery to the extent the board deems necessary. The petition will not be deemed to be an application for new or changed rates, charges, schedules or regulationsand setting a procedural schedule.

        ITEM 6.    Rescind subrule 5.3(2) and adopt the following new subrule in lieu thereof:    5.3(2) Responses.  Any person, including the consumer advocate, wanting to file a response to a petition must do so within 30 days of the filing of the petition or as otherwise directed by the board in its order docketing the matter.

        ITEM 7.    Rescind subrule 5.3(4).

        ITEM 8.    Rescind rule 199—5.4(476) and adopt the following new rule in lieu thereof:

    199—5.4(476) Comments.  All comments shall be sworn and shall be filed within 30 days after publication of notice of the proceeding in the Iowa Administrative Bulletin unless otherwise directed by the board. Reply comments may be allowed at the discretion of the board. Comments shall be filed electronically unless otherwise allowed by the board.

        ITEM 9.    Rescind rule 199—5.5(476) and adopt the following new rule in lieu thereof:

    199—5.5(476) Formal proceeding.  The board may schedule an oral argument, evidentiary hearing, or other formal proceeding as appropriate to allow all interested persons the opportunity to address the issues raised in the petition and any comments filed with the board. All persons filing comments will be required to appear at any formal proceeding that may be held. If the board holds an evidentiary hearing, all persons filing comments shall have at least one witness available who may be cross-examined about the subject matter of the comments.

        ITEM 10.    Rescind rule 199—5.8(476).    ARC 4285CUtilities Division[199]Notice of Intended Action

    Proposing rule making related to planning and reporting for rate-regulated utilities and providing an opportunity for public comment

        The Utilities Board hereby proposes to rescind Chapter 35, “Energy Efficiency Planning and Cost Review,” and to adopt a new Chapter 35, “Energy Efficiency and Demand Response Planning and Reporting for Natural Gas and Electric Utilities Required to Be Rate-Regulated,” Iowa Administrative Code.Legal Authority for Rule Making    This rule making is proposed under the authority provided in Iowa Code section 476.2.State or Federal Law Implemented    This rule making implements, in whole or in part, Iowa Code sections 476.2 and 476.6.Purpose and Summary    The Board reviewed Chapter 35 as part of its five-year comprehensive review in accordance with Iowa Code section 17A.7(2).  The purpose of the comprehensive review is to identify and update rules that are outdated, redundant, or inconsistent with statutes and other administrative rules.  On August 8, 2016, the Board issued an order requesting stakeholder comments concerning amendments to Chapter 35 and received comments from the Office of Consumer Advocate, Interstate Power and Light Company, Black Hills Energy, MidAmerican Energy Company, the Environmental Law and Policy Center, and the Iowa Environmental Council.  On March 9, 2017, the Board held a workshop to discuss the comments received and potential revisions to Chapter 35.  Prior to the completion of the Board’s comprehensive review, the Iowa Legislature passed and the Governor signed 2018 Iowa Acts, Senate File 2311, (2018 Iowa Acts, chapter 1135) amending the energy efficiency provisions of Iowa Code chapter 476.  After reviewing the stakeholder comments and Senate File 2311, the Board proposes to rescind Chapter 35 and adopt a new Chapter 35, ensuring consistency between Iowa Code chapter 476 as amended by 2018 Iowa Acts, Senate File 2311, and the Board’s other administrative rules.    The Board issued an order commencing rule making on January 23, 2019. The order is available on the Board’s electronic filing system, efs.iowa.gov, under Docket No. RMU-2016-0018.Fiscal Impact     Because the rule making updates and revises existing rules in light of statutory changes, it is anticipated the rule making will have no fiscal impact. Jobs Impact    After analysis and review of this rule making, no impact on jobs has been found.Waivers    Any person who believes that the application of the discretionary provisions of this rule making would result in hardship or injustice to that person may petition the Board for a waiver of the discretionary provisions, if any. Public Comment     Any interested person may submit written comments concerning this proposed rule making. Written comments in response to this rule making must be received by the Board no later than 4:30 p.m. on March 5, 2019. Comments should be directed to: Iowa Utilities Board Electronic Filing System (EFS) at efs.iowa.gov Phone: 515.725.7337 Email: efshelpdesk@iub.iowa.govPublic Hearing     An oral presentation at which persons may present their views orally or in writing will be held as follows: March 13, 2019 9 to 11 a.m. Board Hearing Room 1375 East Court Avenue Des Moines, Iowa     Persons who wish to make oral comments at the public hearing may be asked to state their names for the record and to confine their remarks to the subject of this proposed rule making.     Any persons who intend to attend the oral presentation and have special requirements, such as those related to hearing or mobility impairments, should contact the Board and advise of specific needs. Review by Administrative Rules Review Committee    The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making at its regular monthly meeting or at a special meeting. The Committee’s meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).    The following rule-making action is proposed:

        ITEM 1.    Rescind 199—Chapter 35 and adopt the following new chapter in lieu thereof: CHAPTER 35ENERGY EFFICIENCY AND DEMAND RESPONSE PLANNING AND REPORTING FOR NATURAL GAS AND ELECTRIC UTILITIES REQUIRED TO BE RATE-REGULATED

    199—35.1(476) Authority and purpose.  These rules are intended to implement Iowa Code sections 476.6(13) and 476.6(15) relating to the energy efficiency and demand response plans and reports filed by the natural gas and electric utilities required by statute to be rate-regulated. The purpose of these rules is to establish requirements for energy efficiency and demand response plans, modifications, prudence reviews, and cost-recovery tariffs.

    199—35.2(476) Definitions.  The following words and terms, when used in this chapter, shall have the meanings shown below:        "Assessment of potential" means development of energy and capacity savings available from actual and projected customer usage by cost-effectively applying commercially available technology and improved operating practices to energy-using equipment and buildings and considering market factors including, but not limited to, the effects of rate impacts, the need to capture lost opportunities, the non-energy benefits of measures, uncertainty associated with industry restructuring, the strategic value of energy efficiency and demand response to the utility, and other market factors.        "Avoided cost" means the cost the utility would have to pay to provide energy and capacity from alternative sources of supply available to utilities as calculated pursuant to paragraph 35.5(4)“l.”        "Cost-effectiveness tests" means one of the five acceptable economic tests used to compare the present value of applicable benefits to the present value of applicable costs of an energy efficiency or demand response program or plan. The tests are the participant test, the ratepayer impact test, the societal test, the total resource cost test and the utility cost test. A program or plan passes a benefit/cost test if the benefit/cost ratio is equal to or greater than one.        "Customer incentive" means an amount or amounts provided to or on behalf of customers for the purpose of having customers participate in energy efficiency programs. Incentives include, but are not limited to, rebates, loan subsidies, payments to dealers, rate credits, bill credits, the cost of energy audits, the cost of equipment given to customers, and the cost of installing such equipment. Customer incentives do not include the cost of information provided by the utility, nor do they include customers’ bill reductions associated with reduced energy usage due to the implementation of energy efficiency programs. For the purposes of energy efficiency pricing strategies, incentive means the difference between a customer’s bill on an energy efficiency customized rate and the customer’s bill on a traditional rate considering factors such as the elasticity of demand.        "Demand response" means changes in a customer’s normal consumption patterns in response to changes in the price of electricity over time, or to incentive payments designed to induce lower electricity use at times of high wholesale market prices or when system reliability is jeopardized.        "Energy efficiency measures" means activities on the customers’ side of the meter which reduce customers’ energy use or demand including, but not limited to, end-use efficiency improvements or pricing strategies.        "Energy savings performance standards" means those standards which shall be cost-effectively achieved, with the exception of low-income weatherization and tree-planting programs, and includes the annual capacity savings stated in either kilowatt (kW) or dekatherm per day (dth/day) or thousand cubic feet per day (Mcf/day) and the annual energy savings stated in either kilowatt hour (kWh) or dth or Mcf.        "Free riders" means those program participants who would have implemented energy efficiency measures or practices even without the program.        "Marginal energy cost" means the cost associated with supplying the next Mcf or dth of natural gas for a natural gas utility and the energy or fuel cost associated with generating or purchasing the next kWh of electricity for an electric utility.        "Market effects" means a change in the structure of a market or the behavior of participants in a market that is reflective of an increase (or decrease) in the adoption of energy-efficient products, services, or practices and is related to market intervention(s) (e.g., programs).        "Net benefits" means the present value of benefits less the present value of costs as defined in the cost-effectiveness test.        "Participant test" means an economic test used to compare the present value of benefits to the present value of costs over the useful life of an energy efficiency or demand response measure or program from the participant’s perspective. Present values are calculated using a discount rate appropriate to the class of customers to which the energy efficiency or demand response measure or program is targeted. Benefits are the sum of the present values of the customers’ bill reductions, tax credits, and customer incentives for each year of the useful life of an energy efficient or demand response measure or program. Costs are the sum of present values of the customer participation costs (including initial capital costs, ongoing operations and maintenance costs, removal costs less a salvage value of existing equipment, and the value of the customer’s time in arranging installation, if significant) and any resulting bill increases for each year of the useful life of the measure or program. The calculation of bill increases and decreases must account for any time-differentiated rates to the customer or class of customers being analyzed.        "Persistence of energy savings" means the savings due to changed operating hours, human behavior, interactive factors, and the degradation in equipment efficiency over the life of the measure compared to the baseline.        "Process-oriented industrial assessment" means an analysis which promotes the adoption of energy efficiency measures by examining the facilities, operations and equipment of an industrial customer in which energy efficiency opportunities may be embedded.        "Ratepayer impact measure test" means an economic test used to compare the present value of the benefits to the present value of the costs over the useful life of an energy efficiency or demand response measure or program from a rate level or utility bill perspective. Present values are calculated using the utility’s discount rate. Benefits are the sum of the present values of utility avoided capacity and energy costs (excluding the externality factor) and any revenue gains due to the energy efficiency or demand response measures for each year of the useful life of the measure or program. Costs are the sum of the present values of utility increased supply costs, revenue losses due to the energy efficiency or demand response measures, utility program costs, and customer incentives for each year of the useful life of the measure or program. The calculation of utility avoided capacity and energy, increased utility supply costs, and revenue gains and losses must use the utility costing periods.        "Societal test" means an economic test used to compare the present value of the benefits to the present value of the costs over the useful life of an energy efficiency or demand response measure or program from a societal perspective. Present values are calculated using a 12-month average of the 10-year and 30-year Treasury Bond rate as the discount rate. The average shall be calculated using the most recent 12 months at the time the utility calculates its benefit/cost tests for its energy efficiency or demand response plan. Benefits are the sum of the present values of the utility avoided supply and energy costs including the effects of externalities. Costs are the sum of the present values of utility program costs (excluding customer incentives), participant costs, and any increased utility supply costs for each year of the useful life of the measure or program. The calculation of utility avoided capacity and energy and increased utility supply costs must use the utility costing periods.        "Spillover (free drivers)" means the reduction in energy consumption or demand, or the reduction in both, caused by the presence of an energy efficiency or demand response program, beyond the program-related gross savings of the participants and without financial or technical assistance from the program. The term “free drivers” may be used for those who have spillover effects.        "Take-back effect" means a tendency to increase energy use in a facility, or of an appliance, as a result of increased efficiency of energy use. For example, a customer’s installation of high efficiency light bulbs and then operating the lights longer, constitutes “taking back” some of the energy otherwise saved by the efficient lighting.        "Total resource cost test" means an economic test used to compare the present value of the benefits to the present value of the costs over the useful life of an energy efficiency or demand response measure or program from a resource perspective. Present values are calculated using a 12-month average of the 10-year and 30-year Treasury Bond rate as the discount rate. The average shall be calculated using the most recent 12 months at the time the utility calculates its cost-effectiveness tests for its energy efficiency or demand response plan. Benefits are the sum of the present values of the utility avoided supply, energy costs, and federal tax credits. Costs are the sum of the present values of utility program costs (excluding customer incentives), participant costs, and any increased utility supply costs for each year of the useful life of the measure or program. The calculation of utility avoided capacity and energy and increased utility supply costs must use the utility costing periods.        "Useful life" means the number of years an energy efficiency measure will produce benefits.        "Utility cost test" means an economic test used to compare the present value of the benefits to the present value of the costs over the useful life of an energy efficiency or demand response measure or program from the utility revenue requirement perspective. Present values are calculated using the utility’s discount rate. Benefits are the sum of the present values of each year’s utility avoided capacity and energy costs (excluding the externality factor) over the useful life of the measure or program. Costs are the sum of the present values of the utility’s program costs, customer incentives, and any increased utility supply costs for each year of the useful life of the measure or program. The calculation of utility avoided capacity and energy and increased utility supply costs must use the utility costing periods.

    199—35.3(476) Energy efficiency and demand response plan filing.      35.3(1)   Each electric and natural gas utility shall file a five-year energy efficiency plan. Each electric utility shall file a five-year demand response plan. Combination electric and natural gas utilities may file combined assessments of potential and energy efficiency and demand response plans. Combined plans shall specify which energy efficiency programs are attributable to the electric operation, which are attributable to the natural gas operation, and which are attributable to both. If a combination utility files separate plans, the board may consolidate the plans for purposes of review and hearing.    35.3(2)   Written notice of the energy efficiency and demand response plans. No more than 62 days prior to filing its energy efficiency and demand response plans, a utility shall deliver a written notice of its filing to all affected customers. The notice shall be submitted to the board for approval not less than 45 days prior to proposed notification of customers. Additional information not related to the energy efficiency and demand response plans shall be kept to a minimum and shall not distract from the required content. The notice shall, at a minimum, include the following elements:    a.    A statement that the utility will be filing energy efficiency and demand response plans with the board.    b.    A brief identification of the proposed energy efficiency and demand response programs, a description of benefits and savings associated with the energy efficiency and demand response plans, and the estimated annual cost of the proposed energy efficiency and demand response programs during the five-year budget time frame.    c.    The estimated annual rate and bill impacts of the proposed energy efficiency and demand response programs on each class of customer; and the estimated annual jurisdictional rate impact for each major customer grouping in dollars and as a percentage, with the proposed actual increases to be filed at the time of notice to customers.    d.    A statement that the board will be conducting a contested case proceeding to review the application and that a customer may file comments in the board’s electronic filing system.    e.    The telephone numbers, websites, email addresses, and mailing addresses of the utility, the board and the consumer advocate, for the customer to contact with questions.    f.    Blank spaces for estimated annual rate and bill impact dollars and percentages; however, the board may require the utility to submit additional information necessary for review of the proposed form of notice.    g.    A copy of the notice with the final annual rate and bill impact dollars and percentages shall be provided to the board at the time of customer notification.The form of the notice, once approved by the board, may not be altered except to include the rate and bill impact dollars and percentages. The type size and quality shall be easily legible.

    199—35.4(476) Assessment of potential and collaboration.      35.4(1) Assessment of potential.  The utility shall conduct an assessment of the potential study to determine the energy and capacity savings available from actual and projected customer usage by applying commercially available technology and improved operating practices to energy-using equipment and buildings. The utility’s assessment shall address the potential energy and capacity savings in each of ten years subsequent to the year the assessment is filed. Economic and impact analyses of measures shall address benefits and costs over the entire estimated lives of energy efficiency measures.    35.4(2) Collaboration.  A utility shall offer interested persons the opportunity to participate in the development of its energy efficiency and demand response plans. At a minimum, a utility shall provide the opportunity to offer suggestions for programs and for the assessment of potential and to review and comment on a draft of the assessment of potential and energy efficiency and demand response plans proposed to be submitted by the utility. The utility may analyze proposals from participants to help determine the effects of the proposals on its plan. A participant shall have the responsibility to provide sufficient supporting information to enable the utility to analyze the participant’s proposal. The opportunity to participate shall commence at least 180 days prior to the date the utility submits its energy efficiency and demand response plans and assessment of potential to the board.

    199—35.5(476) Energy efficiency and demand response plan requirements.      35.5(1)   The utility shall file with the board an energy efficiency plan listing all proposed energy efficiency programs. An electric utility shall file a demand response plan listing all proposed demand response programs.     35.5(2)   The utility’s energy efficiency and demand response plans shall be supported by testimony, exhibits, and work papers including Microsoft Excel or similar software versions of exhibits and work papers. The testimony and exhibits shall be filed in compliance with the board’s filing standards located on the board’s electronic filing website.    35.5(3)   A utility’s plan shall include a range of programs which address all customer classes across its Iowa jurisdictional territory. At a minimum, the plan shall include a program for qualified lower-income residential customers, including a cooperative program with any community action agency within the utility’s service area. The utility shall consider including in its plan a program for tree planting.     35.5(4)   The following information shall be provided by the utility with its plan:    a.    A summary of the energy efficiency and demand response plans and results of the assessment of potential written in a nontechnical style for the benefit of the general public.    b.    The assessment of potential study.    c.    Cost-effectiveness test analysis.    (1)   The utility shall analyze cost-effectiveness for the plan as a whole and for each proposed program, using the total resource cost, societal, utility cost, ratepayer impact measure and participant tests.     (2)   The utility’s analyses shall use inputs or factors realistically expected to influence cost-effective implementation of programs and escalation rates for each cost and benefit component of the cost-effectiveness test that reflect changes over the lives of the programs.    (3)   The utility shall provide the analyses and results of cost-effectiveness tests, including the benefit/cost ratios and net benefits, for the plans as a whole and for each program. Low-income and tree-planting programs shall not be tested for cost-effectiveness, unless the utility wishes to present the results of cost-effectiveness tests for informational purposes.    d.    Descriptions of each program. If a proposed program is identical to an existing program, the utility may reference the program description currently in effect. A description of each proposed program shall include:    (1)   The name of the program.    (2)   The customers the program targets.    (3)   The energy efficiency or demand response measures promoted by the program.    (4)   The proposed utility promotional techniques, including the rebates or incentives offered through the program.    (5)   The proposed rates of program participation or implementation of measures, including both eligible and estimated actual participants.    e.    The estimated annual energy and demand savings for the plan and each program for each year the program is promoted by the plan. The utility shall estimate gross and net capacity and energy savings, accounting for free riders, take-back effects, spillover (free drivers), market effects, and persistence of energy savings.     f.    The budget for the plan and for each program for each year of implementation or for each of the next five years of implementation, whichever is less, itemized by proposed costs. The budget shall be consistent with the accounting plan required pursuant to subrule 35.9(1). The budget may include amounts collected pursuant to Iowa Code section 476.10A.    g.    Advertising which is part of an approved energy efficiency or demand response program is deemed to be advertising required by the board for purposes of Iowa Code section 476.18(3).     h.    The plan and program budgets shall be categorized into:    (1)   Planning and design costs.    (2)   Administrative costs.    (3)   Advertising and promotional costs.    (4)   Customer incentive costs.    (5)   Equipment costs.    (6)   Installation costs.    (7)   Monitoring and evaluation costs.    (8)   Miscellaneous costs.Cost categories shall be further described by the following subcategories: classifications of persons to be working on energy efficiency and demand response programs, full-time equivalents, dollar amounts of labor costs, and the name of outside firm(s) employed and a description of service(s) to be provided.    i.    The rate impacts and average bill impacts, by customer class, resulting from the plan.    j.    The utility’s forecasted electric and/or natural gas annual Iowa retail rate revenue for each of the five plan years by customer class.    k.    A monitoring and evaluation plan. The utility shall describe how it proposes to monitor and evaluate the implementation of its proposed programs and plan and shall show how it will accumulate and validate the information needed to measure the plan’s performance against the standards. The utility shall include a timeline that outlines each phase of the monitoring and evaluation plan. The utility shall propose a format for monitoring reports and describe how annual results will be reported to the board on a detailed, accurate and timely basis.    l.    Avoided cost calculations and inputs.    (1)   Electric avoided capacity and energy costs. The electric avoided capacity and energy costs shall be based on the utility’s board-approved tariff for cogeneration and small power production facilities. An externality factor of 10 percent is applied to avoided capacity and energy costs to account for societal costs of supplying energy. A party may submit, and the board shall consider, alternative avoided capacity and energy costs derived by an alternative method. A party submitting an alternative avoided cost methodology shall also submit an explanation of the alternative method.    (2)   Natural gas avoided capacity and energy costs. Information regarding avoided costs shall specify the days and weeks which constitute the utility’s peak and off-peak periods. Avoided costs shall be calculated for the peak and off-peak periods and adjusted for inflation to derive an annual avoided cost over a 20-year period. In addition, all parties may submit information specifying the hours, days, and weeks which constitute alternative costing periods. A party may submit, and the board shall consider, alternative avoided capacity and energy costs derived by an alternative method. A party submitting alternative avoided cost methodology shall also submit an explanation of the alternative method.    1.   Avoided capacity costs. Calculations of avoided capacity costs in the peak and off-peak periods shall be based on the following formula:AVOIDED CAPACITY COSTS = [(D + OC) × (1 + RM)] × (1 + EF)D (demand) is the greater of CD or FD.CD (current demand cost) is the utility’s average demand cost expressed in dollars per dth or Mcf during peak and off-peak periods.FD (future demand costs) is the utility’s average future demand cost over the 20-year period expressed in dollars per dth or Mcf when supplying natural gas during peak and off-peak periods.RM (reserve margin) is the reserve margin adopted by the utility.OC (other cost) is the value of any other costs per dth or Mcf related to the acquisition of natural gas supply or transportation by the utility over the 20-year period in the peak and off-peak periods.EF (externality factor) is a 7.5 percent factor applied to avoided capacity costs in the peak and off-peak periods to account for societal costs of supplying energy. In addition, the utility may propose a different externality factor, but must submit documentation of its accuracy.    2.   Avoided energy costs. Calculations of avoided energy costs in the peak and off-peak periods on a seasonal basis shall be based on the following formula:AVOIDED ENERGY COSTS = (E + VOM) × (1 + EF)E (energy costs) is the greater of ME or FE.ME (current marginal energy costs) is the utility’s current marginal energy costs expressed in dollars per dth or Mcf during peak and off-peak periods.FE (future energy costs) is the utility’s average future energy costs over the 20-year period expressed in dollars per dth or Mcf during peak and off-peak periods.VOM (variable operations and maintenance costs) is the utility’s average variable operations and maintenance costs over the 20-year period expressed in dollars per dth or Mcf during peak and off-peak periods.EF (externality factor) is a 7.5 percent factor applied to avoided energy costs in the peak and off-peak periods to account for societal costs of supplying energy. In addition, the utility may propose a different externality factor, but must submit documentation of its accuracy.

    199—35.6(476) Contested case proceeding.      35.6(1)   The board shall conduct a contested case proceeding for review of energy efficiency and demand response plans and budgets filed by natural gas and electric utilities required to be rate-regulated.    35.6(2)   Within 30 days after filing, each application for approval of an energy efficiency and demand response plan which meets the requirements of this chapter shall be docketed as a contested case proceeding. The Iowa economic development authority shall be considered a party to the proceeding. The proceeding shall follow the applicable provisions of 199—Chapter 7.    35.6(3)   The board shall not require a natural gas utility to adopt an energy efficiency plan that results in projected cumulative average annual costs that exceed 1.5 percent of the natural gas utility’s expected annual Iowa retail rate revenue and shall not require an electric utility to adopt an energy efficiency plan or a demand response plan that results in projected cumulative average annual costs that exceed 2 percent of the electric utility’s expected annual Iowa retail rate revenue.

    199—35.7(476) Exemptions from participation.      35.7(1)   The utility shall allow customers to request exemption from participating in the utility’s electric energy efficiency plan if the combined ratepayer impact measure test for the utility’s approved five-year electric energy efficiency and demand response plan is less than 1.0. The utility shall file a draft customer notice within 20 days following the board’s approval of the utility’s five-year energy efficiency plan. The notice shall, at a minimum, provide the following elements:    a.    A brief statement informing all customers that they are eligible to request an exemption from participation in the utility’s electric energy efficiency programs.    b.    The estimated annual rate and bill impacts of the approved electric energy efficiency plan on each class of customers and an estimate of the annual jurisdictional rate impact for each major customer grouping in dollars and as a percentage.    c.    A statement that customers requesting to be exempt from participation in the electric energy efficiency plan will not be eligible to participate in any utility-sponsored electric energy efficiency programs and will not be eligible to receive rebates from the utility for electric energy efficiency programs during the five-year plan cycle, beginning January 1 of the following year.    d.    An explanation that customers requesting to be exempt from participation in the electric energy efficiency plan will no longer be assessed the energy efficiency cost recovery factor for the electric energy efficiency programs on their utility bill.    e.    An explanation that customers requesting to be exempt from participation in the electric energy efficiency plan will be eligible to participate in demand response and natural gas energy efficiency programs and will be assessed costs related to those programs on their utility bills.    f.    A statement that the exemption from participation in the electric energy efficiency plan is applicable for the five-year plan cycle. The ability to request an exemption from participation in future electric energy efficiency plans will depend on the specifics of the utility’s plan filing as approved by the board.    g.    The utility’s telephone number, website address, and email address the customer should use to request an exemption from participation in the electric energy efficiency plan.    h.    A deadline by which customers must request an exemption. The deadline shall not be less than 30 days from the date of the notice.    i.    Blank spaces for estimated annual rate and bill impact dollars and percentages; however, the board may require the utility to submit additional information necessary for review of the proposed form of notice.     j.    Final annual rate and bill impact dollars and percentages shall be provided to the board at the time of customer notification.    k.    Once approved by the board the form of the notice shall not be altered except to include the rate and bill impact dollars and percentages. The type size and quality shall be easily legible.    35.7(2)   The utility shall deliver the approved notice to all affected customers within 30 days of the board approving the notice.

    199—35.8(476) Annual reporting requirements.  Each utility shall file by May 1 of each year an energy efficiency annual report which shall include the utility’s energy efficiency and demand response spending compared to the approved budgets, actual demand and energy savings compared to the performance standards approved by the board, cost-effectiveness results for the prior calendar year, the results of any monitoring and verification activities, any additional information pertinent to the implementation or performance of the energy efficiency or demand response plan for the previous calendar year, and other information as required by board order.

    199—35.9(476) Energy efficiency and demand response cost recovery.  Each utility shall be allowed to recover the authorized energy efficiency and demand response plan expenditures adjusted for any over- or under-collections calculated on an annual basis. The utility may propose to recover the portion of the costs of process-oriented industrial assessments related to energy efficiency.    35.9(1) Accounting for costs.  Each utility shall maintain accounting plans and procedures to account for all energy efficiency and demand response costs.    a.    Each utility shall maintain a subaccount system, a work order system, or an accounting system which identifies individual costs by each program.    b.    Each utility shall maintain accurate employee, equipment, materials, and other records which identify all amounts related to each individual energy efficiency program.    35.9(2) Automatic adjustment mechanism.  Each utility shall file by June 1 of each year energy efficiency and demand response costs proposed to be recovered in rates for the 12-month recovery period beginning at the start of the first utility billing month at least 30 days following board approval.    35.9(3) Energy efficiency cost recovery (EECR) and demand response cost recovery (DRCR) factors.  Each utility shall calculate an EECR factor to recover the costs associated with the energy efficiency plan, and each electric utility shall also calculate a DRCR factor to recover costs associated with the demand response plan. The utility shall calculate EECR/DRCR factors separately for each customer classification or grouping previously approved by the board. A utility shall not use customer classifications or allocations of indirect or other related costs other than those previously approved by the board without filing for a modification of the energy efficiency and demand response plan and board approval.    a.    EECR/DRCR factors shall be calculated according to the following formula: EECR/DRCR factor=authorized recovery + over-/under-collectionsannual sales units    b.    EECR/DRCR factor is the energy efficiency or demand response recovery amount per unit of sales.    c.    Authorized recovery is the difference between the actual energy efficiency or demand response expenditures by customer class for the previous calendar year and the approved energy efficiency or demand response budget by customer class for the previous calendar year plus the approved energy efficiency or demand response budget by customer class for the current calendar year.    d.    Over-/under-collections is the actual amount recovered by customer class for the previous calendar year less the amount authorized to be recovered by customer class for the previous calendar year. This may also include adjustments ordered by the board in prudence reviews.    e.    Annual sales units is the estimated sales for the 12-month recovery period for customers who have not requested an exemption as allowed by rule 199—35.7(476).    35.9(4) Filing requirements.  Each utility proposing to recover energy efficiency or demand response costs through an automatic adjustment mechanism shall provide the following information:    a.    The filing shall restate the derivation of each EECR/DRCR factor previously approved by the board.    b.    The filing shall include new EECR/DRCR factors based on allocation methods and customer classifications and groupings approved by the board in previous proceedings.    c.    The filing shall include all worksheets and detailed supporting data used to determine new EECR/DRCR factors. Information already on file with the board may be incorporated by reference in the filing.    d.    The filing shall include a reconciliation comparing the amounts actually collected by the previous EECR/DRCR factors to the amounts expended. Over- or under-collections shall be used to compute adjustment factors.    e.    If in a prudence review, the board has determined that previously recovered energy efficiency or demand response costs were imprudently incurred, adjustment factors shall include reductions for these amounts.    35.9(5) Tariff sheets.  Upon approval of the new EECR/DRCR factors, the utility shall file separate tariff sheets for board approval to implement the EECR/DRCR factors in its rates.    35.9(6) Customers’ bills.      a.    Each electric and natural gas utility shall include the EECR factor, the customer’s usage, and the dollar amount charge on the customer’s bill as “Funding for energy efficiency programs.” Customers who receive one bill for electric and natural gas service shall have a separate line item on the bill for the electric EECR and the natural gas EECR.    b.    Each electric utility shall represent the DRCR factor, the customer’s usage, and the dollar amount charge on the customer’s bill as “Funding for demand response programs.”

    199—35.10(476) Modification of an approved plan.      35.10(1)   Approved energy efficiency and demand response plans and budgets may be modified if the modification is approved by the board.    a.    Electric utilities may request a modification to an approved energy efficiency plan due to changes in the funding as a result of customers requesting exemptions from the electric energy efficiency plan.    b.    Natural gas and electric utilities may request modification of an approved energy efficiency plan or demand response plan for any reason.    c.    The board, on its own motion, may consider modification of the energy efficiency or demand response plan and budget.    35.10(2)   All applications to modify shall be filed in the same docket in which the energy efficiency or demand response plan was approved. All parties to the docket in which the energy efficiency or demand response plan was approved shall be served copies of the application to modify and shall have 14 days to file an objection or agreement. Objections should be specifically related to the contents of the modification. Failure to file timely objection shall be deemed agreement.    35.10(3)   Each application to modify an approved energy efficiency or demand response plan shall include:    a.    A statement of the proposed modification and the party’s interest in the modification.    b.    An analysis supporting the requested modification.    c.    An estimated implementation schedule for the modification.    d.    A statement of the effect of the modification on attainment of the utility’s performance standards and on projected results of the utility’s implementation of its plan.    35.10(4)   If the board finds that any reasonable ground exist to investigate the proposed modification, a procedural schedule shall be set and the board shall take action within 90 days after the modification request is filed.    35.10(5)   If an application to modify is filed and the board finds that there is no reason to investigate, then the board shall issue an order stating the reasons for the board’s decision relating to the application.    35.10(6)   If the board rejects or modifies a utility’s plan, the board may require the utility to file a modified plan and may specify the minimum acceptable contents of the modified plan.

    199—35.11(476) Prudence review.      35.11(1)   The board shall periodically conduct a contested case proceeding to evaluate the reasonableness and prudence of the utility’s implementation of energy efficiency and demand response plans and budgets. The prudence review shall be based upon the information filed by a utility in the annual report required by rule 199—35.8(476).    35.11(2)   The consumer advocate or other person may request the board to conduct a prudence review based upon the information filed by a utility in the annual report required by rule 199—35.8(476). The request to initiate the prudence review shall identify specific issues to be evaluated and may include a proposed procedural schedule.    35.11(3)   The board shall determine whether a contested case proceeding is necessary to address the issues raised in a request for a prudence review.    35.11(4)   Disallowance of past costs. If the board finds the utility did not take all reasonable and prudent actions to cost-effectively implement its energy efficiency programs, the board shall determine the amount in excess of those costs that would have been incurred under reasonable and prudent implementation. That amount shall be deducted from the next EECR/DRCR factors calculated pursuant to subrule 35.9(3) until satisfied.

    199—35.12(476) New structure energy conservation standards.  A utility providing natural gas or electric service shall not provide service to any structure completed after April 1, 1984, unless the owner or builder of the structure has certified to the utility that the building conforms to the energy conservation requirements adopted under 661—Chapter 303. If this compliance is already being certified to a state or local agency, a copy of that certification shall be provided to the utility. If no state or local agency is monitoring compliance with these energy conservation standards, the owner or builder shall certify that the structure complies with the standards by signing a form provided by the utility. No certification will be required for structures that are not governed by 661—Chapter 303.        These rules are intended to implement Iowa Code section 476.6.    ARC 4284CUtilities Division[199]Notice of Intended Action

    Proposing rule making related to update of interconnection standards and providing an opportunity for public comment

        The Utilities Board hereby proposes to amend Chapter 45, “Electric Interconnection of Distributed Generation Facilities,” Iowa Administrative Code.Legal Authority for Rule Making    This rule making is proposed under the authority provided in Iowa Code sections 474.5, 476.2 and 476.58.State or Federal Law Implemented    This rule making implements, in whole or in part, Iowa Code sections 476.1, 476.8 and 476.58.Purpose and Summary    This proposed rule making updates the Board’s interconnection rules to be consistent with the new Institute of Electrical and Electronics Engineers, Inc. (IEEE) Standard 1547. The amendments update references to the new IEEE Standard 1547 and to sections of the standard that have been changed or deleted. The Board is not aware of any substantive requirements created by the new standard. The Board issued an order commencing rule making on January 23, 2019. The order is available on the Board’s electronic filing system, efs.iowa.gov, under Docket No. RMU-2018-0002.Fiscal Impact     After analysis and review, the Board tentatively concludes that the amendments will have no effect on the expenditure of public moneys within the state of Iowa. Jobs Impact    After analysis and review of this rule making, no impact on jobs has been found.Waivers    Any person who believes that the application of the discretionary provisions of this rule making would result in hardship or injustice to that person may petition the Board for a waiver of the discretionary provisions, if any. Public Comment     Any interested person may submit written comments concerning this proposed rule making. Written comments in response to this rule making must be received by the Board no later than 4:30 p.m. on March 5, 2019. Comments should be directed to: Iowa Utilities Board Electronic Filing System (EFS) at efs.iowa.gov Phone: 515.725.7337 Email: efshelpdesk@iub.iowa.govPublic Hearing     No public hearing is scheduled at this time. As provided in Iowa Code section 17A.4(1)“b,” an oral presentation regarding this rule making may be demanded by 25 interested persons, a governmental subdivision, the Administrative Rules Review Committee, an agency, or an association having 25 or more members. Review by Administrative Rules Review Committee    The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making at its regular monthly meeting or at a special meeting. The Committee’s meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).    The following rule-making actions are proposed:

        ITEM 1.    Amend rule 199—45.1(476) as follows:

    199—45.1(476) Definitions.  Terms defined in the Public Utility Regulatory Policies Act of 1978 (PURPA), 16 U.S.C. 2601 et seq., shall have the same meaning for purposes of these rules as they have under PURPA, unless further defined in this chapter.        "Adverse system impact" means a negative effect that compromises the safety or reliability of the electric distribution system or materially affects the quality of electric service provided by the utility to other customers.        "AEP facility" means an AEP facility, as defined in 199—Chapter 15, used by an interconnection customer to generate electricity that operates in parallel with the electric distribution system. An AEP facility typically includes an electric generator and the interconnection equipment required to interconnect safely with the electric distribution system or local electric power system.        "Affected system" means an electric system not owned or operated by the utility reviewing the interconnection request that could suffer an adverse system impact from the proposed interconnection.        "Applicant" means a person (or entity) who has submitted an interconnection request to interconnect a distributed generation facility to a utility’s electric distribution system.        "Area network" means a type of electric distribution system served by multiple transformers interconnected in an electrical network circuit, generally used in large, densely populated metropolitan areas.        "Board" means the Iowa utilities board.        "Business day" means Monday through Friday, excluding state and federal holidays.        "Calendar day" means any day, including Saturdays, Sundays, and state and federal holidays.        "Certificate of completion" means the Certificate of Completion form that contains information about the interconnection equipment to be used, its installation, and local inspections.        "Commissioning test" means a test applied to a distributed generation facility by the applicant after construction is completed to verify that the facility does not create adverse system impacts and performs to the submitted specifications. At a minimum, the scope of the commissioning tests performed shall include the commissioning test specified in Institute of Electrical and Electronics Engineers, Inc. (IEEE), Standard 1547, Section 5.4 “Commissioning tests.”11 “Test and Verification Requirements.”        "Disconnection device" means a lockable visual disconnect or other disconnection device capable of isolating, disconnecting, and de-energizing the residual voltage in a distributed generation facility.        "Distributed generation facility" means a qualifying facility, an AEP facility, or an energy storage facility.        "Distribution upgrade" means a required addition or modification to the electric distribution system to accommodate the interconnection of the distributed generation facility. Distribution upgrades do not include interconnection facilities.        "Electric distribution system" means the facilities and equipment owned and operated by the utility and used to transmit electricity to ultimate usage points such as homes and industries from interchanges with higher voltage transmission networks that transport bulk power over longer distances. The voltage levels at which electric distribution systems operate differ among areas but generally operate at less than 100 kilovolts of electricity. “Electric distribution system” has the same meaning as the term “Area EPS,” as defined in Section 3.1.6.1 of IEEE Standard 1547.        "Electric meter" means a device used by an electric utility that measures and registers the integral of an electrical quantity with respect to time.        "Fault current" is the electrical current that flows through a circuit during an electrical fault condition. A fault condition occurs when one or more electrical conductors contact ground or each other. Types of faults include phase to ground, double-phase to ground, three-phase to ground, phase-to-phase, and three-phase. Often, a fault current is several times larger in magnitude than the current that normally flows through a circuit.        "IEEE Standard 1547" is the Institute of Electrical and Electronics Engineers, Inc., 3 Park Avenue, New York, NY 10016-5997, Standard 1547 (2003) “Standard for Interconnecting Distributed Resources with Electric Power Systems.”(2018) “Standard for Interconnection and Interoperability of Distributed Energy Resources and Associated Electric Power System Interfaces.”        "IEEE Standard 1547.1" is the IEEE Standard 1547.1 (2005) “Conformance Test Procedures for Equipment Interconnecting Distributed Resources with Electric Power Systems.”        "Interconnection customer" means a person or entity that interconnects a distributed generation facility to an electric distribution system.        "Interconnection equipment" means a group of components or an integrated system owned and operated by the interconnection customer that connects an electric generator with a local electric power system, as that term is defined in Section 3.1.6.2 of IEEE Standard 1547, or with the electric distribution system. Interconnection equipment is all interface equipment including switchgear, protective devices, inverters, or other interface devices. Interconnection equipment may be installed as part of an integrated equipment package that includes a generator or other electric source.        "Interconnection facilities" means facilities and equipment required by the utility to accommodate the interconnection of a distributed generation facility. Collectively, interconnection facilities include all facilities and equipment between the distributed generation facility’s interconnection equipment and the point of interconnection, including any modifications, additions, or upgrades necessary to physically and electrically interconnect the distributed generation facility to the electric distribution system. Interconnection facilities are sole-use facilities and do not include distribution upgrades.        "Interconnection request" means an applicant’s request, in a form approved by the board, for interconnection of a new distributed generation facility or to change the capacity or other operating characteristics of an existing distributed generation facility already interconnected with the electric distribution system.        "Interconnection study" is any study described in rule 199—45.11(476).        "Lab-certified" means a designation that the interconnection equipment meets the requirements set forth in rule 199—45.6(476).        "Line section" is that portion of an electric distribution system connected to an interconnection customer’s site, bounded by automatic sectionalizing devices or the end of the distribution line, or both.        "Local electric power system" means facilities that deliver electric power to a load that is contained entirely within a single premises or group of premises. “Local electric power system” has the same meaning as that term as defined in Section 3.1.6.2 of IEEE Standard 1547.        "Nameplate capacity" is the maximum rated output of a generator, prime mover, or other electric power production equipment under specific conditions designated by the manufacturer and usually indicated on a nameplate physically attached to the power production equipment.        "Nationally recognized testing laboratory" "NRTL" means a qualified private organization that meets the requirements of the Occupational Safety and Health Administration’s (OSHA) regulations. See 29 CFR 1910.7 as amended through February 22, 2017. NRTLs perform independent safety testing and product certification. Each NRTL shall meet the requirements as set forth by OSHA in its NRTL program.        "Parallel operation" "parallel" means a distributed generation facility that is connected electrically to the electric distribution system for longer than 100 milliseconds continuously.        "Point of interconnection" has the same meaning as the term “point of common coupling” as defined in Section 3.1.13 of IEEE Standard 1547.        "Primary line" means an electric distribution system line operating at greater than 600 volts.        "Qualifying facility" means a cogeneration facility or a small power production facility that is a qualifying facility under 18 CFR Part 292, Subpart B, used by an interconnection customer to generate electricity that operates in parallel with the electric distribution system. A qualifying facility typically includes an electric generator and the interconnection equipment required to interconnect safely with the electric distribution system or local electric power system.        "Radial distribution circuit" means a circuit configuration in which independent feeders branch out radially from a common source of supply.        "Review order position" means, for each distribution circuit or line section, the order of a completed interconnection request relative to all other pending completed interconnection requests on that distribution circuit or line section. The review order position is established by the date that the utility receives the completed interconnection request.        "Scoping meeting" means a meeting between representatives of the applicant and utility conducted for the purpose of discussing interconnection issues and exchanging relevant information.        "Secondary line" means an electric distribution system line, or service line, operating at 600 volts or less.        "Shared transformer" means a transformer that supplies secondary voltage to more than one customer.        "Spot network" means a type of electric distribution system that uses two or more inter-tied transformers to supply an electrical network circuit. A spot network is generally used to supply power to a single customer or a small group of customers. “Spot network” has the same meaning as the term “spot network” as defined in Section 4.1.49 “DER on Distribution Secondary Grid/Area/Street (Grid) Networks and Spot Networks” of IEEE Standard 1547.        "UL Standard 1741" means the standard titled “Inverters, Converters, Controllers, and Interconnection System Equipment for Use with Distributed Energy Resources,” January 28, 2010, edition, Underwriters Laboratories Inc., 333 Pfingsten Road, Northbrook, IL 60062-2096.        "Utility" means an electric utility that is subject to rate regulation by the Iowa utilities board.        "Witness test" for lab-certified equipment means a verification either by an on-site observation or review of documents that the interconnection installation evaluation required by IEEE Standard 1547, Section 5.3 and the commissioning test required by IEEE Standard 1547, Section 5.411 have been adequately performed. For interconnection equipment that has not been lab-certified, the witness test shall also include verification of the on-site design tests as required by IEEE Standard 1547, Section 5.1 and verification of production tests required by IEEE Standard 1547, Section 5.211. All verified tests are to be performed in accordance with the test procedures specified by IEEE Standard 1547.1.

        ITEM 2.    Amend subrule 45.5(10) as follows:    45.5(10)   The utility may require a witness test after the distributed generation facility is constructed. The applicant shall provide the utility with at least 15 business days’ notice of the planned commissioning test for the distributed generation facility. The applicant and utility shall schedule the witness test at a mutually agreeable time. If the witness test results are not acceptable to the utility, the applicant shall be granted 30 business days to address and resolve any deficiencies. The time period for addressing and resolving any deficiencies may be extended upon the mutual agreement of the utility and the applicant prior to the end of the 30 business days. An initial request for extension shall not be denied by the utility; subsequent requests may be denied. If the applicant fails to address and resolve the deficiencies to the utility’s satisfaction, the interconnection request shall be deemed withdrawn. Even if the utility or an entity approved by the utility does not witness a commissioning test, the applicant remains obligated to satisfy the interconnection test specifications and requirements set forth in IEEE Standard 1547, Section 511. The applicant shall, if requested by the utility, provide a copy of all documentation in its possession regarding testing conducted pursuant to IEEE Standard 1547.1.

        ITEM 3.    Amend subrule 45.6(2) as follows:    45.6(2)   Lab-certified interconnection equipment shall not require further design testing or production testing, as specified by IEEE Standard 1547, Sections 5.1 and 5.2Section 11, or additional interconnection equipment modification to meet the requirements for expedited review; however, the applicant shall conduct all commissioning tests or periodic testing as specified by IEEE Standard 1547, Sections 5.3, 5.4, and 5.5Section 11. The utility may conduct additional witness tests, but no more frequently than annually.    ARC 4293CEducation Department[281]Filed Emergency After Notice

    Rule making related to summer college credit program

        The State Board of Education hereby amends Chapter 22, “Senior Year Plus Program,” Iowa Administrative Code. Legal Authority for Rule Making    This rule making is adopted under the authority provided in Iowa Code section 256.7(5).State or Federal Law Implemented    This rule making implements, in whole or in part, 2017 Iowa Acts, chapter 172, section 50, paragraph 12C, as enacted by 2018 Iowa Acts, Senate File 2415, section 4.Purpose and Summary    Rule 281—22.33(261E) implements 2017 Iowa Acts, chapter 172, section 50, paragraph 12C, as enacted by 2018 Iowa Acts, Senate File 2415, section 4, which appropriates $600,000 in the current fiscal year for the Department to create a summer college credit program to be made available to eligible high school students in grades 9 through 12 during the summer months under the Future Ready Iowa Initiative. Rule 281—22.33(261E) establishes a policy framework for these programs, including minimum components for a program; a department review process; a funding mechanism; and student, course, and institution eligibility criteria. The rule is also consistent with the requirements of Iowa Code section 261E.8(7A) as enacted by 2018 Iowa Acts, House File 2458, section 14, which will become effective on July 1, 2019.Public Comment and Changes to Rule Making    Notice of Intended Action for this rule making was published in the Iowa Administrative Bulletin on December 5, 2018, as ARC 4155C. A public hearing was held on January 8, 2019, at 3 p.m. in the State Board Room, Second Floor, Grimes State Office Building, Des Moines, Iowa. No one attended the public hearing. No public comments were received. No changes from the Notice have been made.Reason for Waiver of Normal Effective Date    Pursuant to Iowa Code section 17A.5(2)“b”(1)(b), the State Board finds that the normal effective date of this rule making, 35 days after publication, should be waived and the rule making made effective on January 17, 2019, because the disbursement of funds to community colleges in the current fiscal year confers a benefit to the public by enabling community colleges to have programs in place by the summer of 2019.Adoption of Rule Making    This rule making was adopted by the State Board on January 16, 2019.Fiscal Impact     This rule making has no fiscal impact to the State of Iowa. Jobs Impact    After analysis and review of this rule making, no impact on jobs has been found.Waivers    An agencywide waiver provision is provided for in 281—Chapter 4.Review by Administrative Rules Review Committee    The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making at its regular monthly meeting or at a special meeting. The Committee’s meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).Effective Date    This rule making became effective on January 17, 2019.    The following rule-making action is adopted:

        ITEM 1.    Adopt the following new rule 281—22.33(261E):

    281—22.33(261E) Summer college credit program.      22.33(1) Program established.  A summer college credit program is established to expand access for high school students to high-quality career and technical education experiences aligned with career pathways leading to postsecondary credentials and high-demand jobs. Programs approved under subrule 22.33(3) shall be offered during the summer term of an eligible postsecondary institution.    22.33(2) Type of coursework offered.  The following provisions apply to coursework delivered through an approved program under this rule.    a.    Coursework eligible to be offered through an approved program under this rule shall be technical core coursework within and prerequisite coursework for a career and technical education program approved under 281—subrule 21.4(3).     b.    The career and technical education program shall be aligned to in-demand occupations identified by the state workforce development board and community colleges pursuant to Iowa Code section 84A.1B(13A) as enacted by 2018 Iowa Acts, House File 2458.     c.    Coursework delivered under this rule shall comply with the course requirements established under Iowa Code section 257.11(3). The course shall be ineligible for supplementary weighting under that section.    d.    The credit earned by a student who successfully completes a course under this rule shall not apply toward full-time enrollment defined under rule 281—22.6(261E).    22.33(3) Program proposals.  The department shall establish an annual process for the submission and review of proposals for summer college credit programs. A postsecondary institution eligible to offer programming under Division IV of this chapter may submit program proposals to the department.    a.    Minimum components.The proposal shall detail the following components.    (1)   A program description, including the course or courses to be made available through the program; total number of credit hours; additional cocurricular experiences and activities including project-, problem-, and work-based learning opportunities; additional support services to be made available through the program; and any other pertinent program information.     (2)   All minimum and required costs associated with offering the program, including, but not limited to, instructor salary, materials and supplies, and overhead costs.    (3)   The total number of students that the program is capable of serving.    (4)   Any additional components and expenses built into the program, including but not limited to student transportation, academic supports, and extracurricular experiences.    (5)   The start date and duration of the program. Programs approved under this rule shall have a start date no later than the second Friday in June of each year.    b.    Enrollment threshold.The postsecondary institution will propose, and the department will approve, a minimum program enrollment threshold. Programs that surpass the minimum enrollment threshold shall be eligible for funding under paragraph 22.33(4)“b.”    c.    Review of proposals.The department shall establish a review process to evaluate all program proposals. In reviewing proposals, the department shall give priority consideration to program proposals that will ensure equitable geographic disbursement of approved programs. The department shall also give consideration to additional criteria including number of students served; cost per credit hour offered; alignment to in-demand occupations; the inclusion of extracurricular experiences with an emphasis on project-, problem-, and work-based learning opportunities; and the inclusion of provisions that address and remove barriers to participation for nontraditional students, underrepresented minority students, and low-income students.    d.    Funding of proposals.A program proposal approved under this rule shall be funded under paragraph 22.33(4)“a” for the amount described under paragraph 22.33(3)“a.”    22.33(4) Disbursement of funds.  Subject to the appropriation of funds, the department shall disburse funds to a postsecondary institution offering an approved program in the following manner. All funds received under this rule shall be used to support and sustain the approved program.    a.    Base funding.Not more than one-half of the total allocation shall be made available to fund proposals approved under subrule 22.33(3).    b.    Enrollment.Any funds not distributed under paragraph 22.33(4)“a” shall be distributed to postsecondary institutions offering an approved program with student enrollment greater than the minimum enrollment threshold.     (1)   An approved program shall gather a count of students enrolled in the program on the third day following the start date of the program. The count of students enrolled in the program shall be submitted to the department in a manner prescribed by the department.     (2)   Enrollment funding shall be calculated by the department for each program with enrollment greater than the minimum enrollment threshold. For purposes of this rule, the portion of enrollment funding to be received by a postsecondary institution offering an approved program shall be equal to the total number of credits for all student enrollment in the approved program divided by the total number of credits for all student enrollments statewide.    c.    Subsequent years.In each of the subsequent three years following the implementation year, the portion of the allocation distributed based on enrollment shall increase by 10 percent each year until the minimum amount awarded based on enrollment is equal to 80 percent of the total allocation.     22.33(5) Availability.  A postsecondary institution offering an approved program shall enter into a contract with a school district interested in making the program available to eligible students of the school district. The program shall be made available to any eligible student from a participating school district. An institution offering programming to a student under this rule shall comply with the requirements of Division IV of this chapter.    a.    Student eligibility.To participate in an approved program, a student shall comply with the criteria established under rule 281—22.2(261E).    b.    Teacher eligibility.A teacher assigned to provide instruction under this rule shall comply with the criteria established under rule 281—22.3(261E) and be a community college-employed instructor.    c.    Institutional eligibility.Institutions offering an approved program under this rule shall comply with the criteria established under rule 281—22.4(261E).         [Filed Emergency After Notice 1/17/19, effective 1/17/19][Published 2/13/19]Editor’s Note: For replacement pages for IAC, see IAC Supplement 2/13/19.    ARC 4307CEconomic Development Authority[261]Adopted and Filed

    Rule making related to building block chemicals

        The Economic Development Authority hereby amends Chapter 81, “Renewable Chemical Production Tax Credit Program,” Iowa Administrative Code.Legal Authority for Rule Making    This rule making is adopted under the authority provided in Iowa Code section 15.106A.State or Federal Law Implemented    This rule making implements, in whole or in part, Iowa Code section 15.316.Purpose and Summary    Under the renewable chemical production tax credit, Iowa Code section 15.316 provides that the term “building block chemical” includes a prescribed list of chemicals “or such additional molecules as may be included by the authority by rule after consultation with appropriate experts from Iowa state university, including but not limited to the Iowa state university center for biorenewable chemicals.” In accordance with Iowa Code section 15.316 and the procedures set forth in rule 261—81.8(15), the Authority is adding four chemicals to the definition of “building block chemical”: benzene, toluene, xylene, and ethylbenzene. Brent Shanks, Director for the Center for Biorenewable Chemicals (CBiRC) at Iowa State University, has recommended approval of all four chemicals, and the Authority concurs.Public Comment and Changes to Rule Making    Notice of Intended Action for this rule making was published in the Iowa Administrative Bulletin on October 10, 2018, as ARC 4043C. No public comments were received. No changes from the Notice have been made.Adoption of Rule Making    This rule making was adopted by the Economic Development Authority Board on December 21, 2018.Fiscal Impact     This rule making has no fiscal impact to the State of Iowa. Jobs Impact    After analysis and review of this rule making, no impact on jobs has been found.Waivers    Any person who believes that the application of the discretionary provisions of this rule making would result in hardship or injustice to that person may petition the Authority for a waiver of the discretionary provisions, if any, pursuant to 261—Chapter 199.Review by Administrative Rules Review Committee    The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making at its regular monthly meeting or at a special meeting. The Committee’s meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).Effective Date    This rule making will become effective on March 20, 2019.    The following rule-making action is adopted:

        ITEM 1.    Amend rule 261—81.2(15), definition of “Building block chemical,” as follows:        "Building block chemical" means a molecule converted from biomass feedstock as a first product or a secondarily derived product that can be further refined into a higher-value chemical, material, or consumer product. “Building block chemical” includes but is not limited to high-purity glycerol, oleic acid, lauric acid, methanoic or formic acid, arabonic acid, erythonic acid, glyceric acid, glycolic acid, lactic acid, 3-hydroxypropionate, propionic acid, malonic acid, serine, succinic acid, fumaric acid, malic acid, aspartic acid, 3-hydroxybutyrolactone, acetoin, threonine, itaconic acid, furfural, levulinic acid, glutamic acid, xylonic acid, xylaric acid, xylitol, arabitol, citric acid, aconitic acid, 5-hydroxymethylfurfural, lysine, gluconic acid, glucaric acid, sorbitol, gallic acid, ferulic acid, nonfuel butanol, nonfuel ethanol,benzene, toluene, xylene, ethylbenzene, or such additional molecules as may be included by the authority following the procedure in rule 261—81.8(15).    [Filed 1/14/19, effective 3/20/19][Published 2/13/19]Editor’s Note: For replacement pages for IAC, see IAC Supplement 2/13/19.    ARC 4302CEducational Examiners Board[282]Adopted and Filed

    Rule making related to practitioner contractual obligations

        The Educational Examiners Board hereby amends Chapter 25, “Code of Professional Conduct and Ethics,” Iowa Administrative Code.Legal Authority for Rule Making    This rule making is adopted under the authority provided in Iowa Code section 272.2.State or Federal Law Implemented    This rule making implements, in whole or in part, Iowa Code section 272.2(1).Purpose and Summary    This amendment is intended to clarify the section of the Board’s Code of Professional Conduct and Ethics pertaining to violation of contractual obligations. Under the amendment, the Board will not have a legal basis to sanction the license of a practitioner who provides notice requesting release from a contract prior to, in the vast majority of cases, June 30. The Board will also not have a legal basis to sanction an administrator who hires a practitioner under contract at another district or accredited nonpublic school as long as that practitioner provided the required notice within the timeline referred to above.Public Comment and Changes to Rule Making    Notice of Intended Action for this rule making was published in the Iowa Administrative Bulletin on December 5, 2018, as ARC 4147C. A public hearing was held on January 2, 2019, at 1 p.m. in Room 3 Southwest, Grimes State Office Building, Des Moines, Iowa. No one attended the public hearing. No public comments were received. No changes from the Notice have been made.Adoption of Rule Making    This rule making was adopted by the Board on January 17, 2019.Fiscal Impact     This rule making has no fiscal impact to the State of Iowa. Jobs Impact    After analysis and review of this rule making, no impact on jobs has been found.Waivers    Any person who believes that the application of the discretionary provisions of this rule making would result in hardship or injustice to that person may petition the Board for a waiver of the discretionary provisions, if any, pursuant to 282—Chapter 6. Review by Administrative Rules Review Committee    The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making at its regular monthly meeting or at a special meeting. The Committee’s meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).Effective Date    This rule making will become effective on March 20, 2019.    The following rule-making action is adopted:

        ITEM 1.    Amend subrule 25.3(5) as follows:    25.3(5) Standard V—violations of contractual obligations.      a.    Violation of this standard includes:    (1)   Signing a written professional employment contract while under contract with another school, school district, or area education agency.    (2)   (1)   Asking a practitioner to sign a written professional employment contract before the practitioner has been unconditionally released from a current contract, unless the practitioner provided notice to the practitioner’s employing board as set forth in subparagraph 25.3(5)“b”(2). An administrator shall make a good faith effort to determine whether the practitioner has been released from the current contract.    (3)   (2)   Abandoning a written professional employment contract without prior unconditional release by the employer.    (4)   (3)   As an employer, executing a written professional employment contract with a practitioner, which requires the performance of duties that the practitioner is not legally qualified to perform.    (5)   (4)   As a practitioner, executing a written professional employment contract, which requires the performance of duties that the practitioner is not legally qualified to perform.    b.    In addressing complaints based upon contractual obligations, the board shall consider factors beyond the practitioner’s control. For purposes of enforcement of this standard, a practitioner will not be found to have abandoned an existing contract if:    (1)   The practitioner obtained a release from the employing board before discontinuing services under the contract; or    (2)   The practitioner provided notice to the employing board no later than the latest of the following dates:
    1. The practitioner’s last work day of the school year;
    2. The date set for return of the contract as specified in statute; or
    3. June 30.
        [Filed 1/24/19, effective 3/20/19][Published 2/13/19]Editor’s Note: For replacement pages for IAC, see IAC Supplement 2/13/19.    ARC 4294CEducation Department[281]Adopted and Filed

    Rule making related to school health services

        The State Board of Education hereby amends Chapter 14, “School Health Services,” Iowa Administrative Code.Legal Authority for Rule Making    This rule making is adopted under the authority provided in Iowa Code section 256.7.State or Federal Law Implemented    This rule making implements, in whole or in part, Iowa Code chapter 279 and 2018 Iowa Acts, Senate File 2113.Purpose and Summary    2018 Iowa Acts, Senate File 2113, established that the State Board shall adopt rules requiring school districts to adopt protocols for suicide prevention and postvention and the identification of adverse childhood experiences and strategies to mitigate toxic stress response. This rule making implements Senate File 2113.Public Comment and Changes to Rule Making    Notice of Intended Action for this rule making was published in the Iowa Administrative Bulletin on December 5, 2018, as ARC 4157C. A public hearing was held on January 8, 2019, at 9 a.m. in the State Board Room, Second Floor, Grimes State Office Building, Des Moines, Iowa. No one attended the public hearing. No public comments were received. One change from the Notice has been made to replace a reference to 2018 Iowa Acts, Senate File 2113, with references to Iowa Code sections 256.7(33) and 279.70.Adoption of Rule Making    This rule making was adopted by the State Board on January 16, 2019.Fiscal Impact     This rule making has no fiscal impact to the State of Iowa. AEA PD Online is providing free training. Jobs Impact    There will be training requirements for schools, which may have a cost attached. However, there is a free training that is being provided by AEA PD Online.Waivers    An agencywide rule waiver is provided for in 281—Chapter 4.Review by Administrative Rules Review Committee    The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making at its regular monthly meeting or at a special meeting. The Committee’s meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).Effective Date    This rule making will become effective on March 20, 2019.    The following rule-making actions are adopted:

        ITEM 1.    Renumber rule 281—14.4(256,280) as 281—14.5(256,280).

        ITEM 2.    Adopt the following new rule 281—14.4(279):

    281—14.4(279) Suicide prevention, identification of adverse childhood experiences, and strategies to mitigate toxic stress response.      14.4(1) Definitions.          "Adverse childhood experience" means a potentially traumatic event occurring in childhood that can have negative, lasting effects on an individual’s health and well-being.        "Postvention" means the provision of crisis intervention, support, and assistance for those affected by a suicide or suicide attempt to prevent further risk of suicide.    14.4(2) Required protocols.  School districts shall adopt protocols for suicide prevention and postvention and the identification of adverse childhood experiences and strategies to mitigate toxic stress response. The protocols shall be based on nationally recognized best practices.    14.4(3) Required training.      a.    By July 1, 2019, the board of directors of a school district shall require annual, evidence-based training at least one hour in length on suicide prevention and postvention for all school personnel who hold a license, certificate, authorization, or statement of recognition issued by the board of educational examiners and who have regular contact with students in kindergarten through grade 12. The content of the training shall be based on nationally recognized best practices.    b.    By July 1, 2019, the board of directors of a school district shall require annual, evidence-based, evidence-supported training on the identification of adverse childhood experiences and strategies to mitigate toxic stress response for all school personnel who hold a license, certificate, authorization, or statement of recognition issued by the board of educational examiners and who have regular contact with students in kindergarten through grade 12. The content of the training shall be based on nationally recognized best practices.    14.4(4) Resources for implementation.  The Iowa department of education will publicly provide resources and technical assistance to assist districts in compliance with this rule.

        ITEM 3.    Amend 281—Chapter 14, implementation sentence, as follows:       These rules are intended to implement 2015 Iowa Acts, Senate File 462Iowa Code sections 135.185, 256.7(33), 279.70, and 280.16.    [Filed 1/17/19, effective 3/20/19][Published 2/13/19]Editor’s Note: For replacement pages for IAC, see IAC Supplement 2/13/19.    ARC 4295CEducation Department[281]Adopted and Filed

    Rule making related to online learning

        The State Board of Education hereby amends Chapter 15, “Use of Online Learning and Telecommunications for Instruction by Schools,” Iowa Administrative Code.Legal Authority for Rule Making    This rule making is adopted under the authority provided in Iowa Code section 256.7(32).State or Federal Law Implemented    This rule making implements, in whole or in part, Iowa Code sections 256.7(32) and 256.41 to 256.43 and 2018 Iowa Acts, Senate Files 2415 and 475.Purpose and Summary    2018 Iowa Acts, Senate Files 475, 2131 and 2415, established that the State Board shall adopt rules for online learning in accordance with Iowa Code sections 256.41 to 256.43. Several changes to the current rules are incorporated in this rule making, including removing the statewide cap on students enrolled in online schools, rearranging substantive requirements, and adding a requirement that the Director maintain a list of private providers that meet the standards and a requirement that providers apply to the Department as required. The amendments also allow school districts to provide coursework primarily online to open enrolled students. The amendments implement 2018 Iowa Acts, Senate Files 475 and 2415.Public Comment and Changes to Rule Making    Notice of Intended Action for this rule making was published in the Iowa Administrative Bulletin on December 5, 2018, as ARC 4158C. A public hearing was held on January 8, 2019, at 10 a.m. in the State Board Room, Second Floor, Grimes State Office Building, Des Moines, Iowa. One person attended the public hearing. One public comment was received. No changes from the Notice have been made.Adoption of Rule Making    This rule making was adopted by the State Board on January 16, 2019.Fiscal Impact     The fiscal impact of this rule making depends on which districts take advantage of the new opportunities to offer online learning. Online learning is an option but not required of districts. Jobs Impact    This rule making may increase job opportunities in the area of online learning.Waivers    An agencywide rule waiver is provided for in 281—Chapter 4.Review by Administrative Rules Review Committee    The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making at its regular monthly meeting or at a special meeting. The Committee’s meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).Effective Date    This rule making will become effective on March 20, 2019.    The following rule-making actions are adopted:

        ITEM 1.    Amend rule 281—15.7(256) as follows:

    281—15.7(256) School district responsibilities.  Subject to the prohibition in rule 281—15.8(256), any    15.7(1) General.  Any online coursework offered by a school district shall be offered solely to resident students of the school district, or students attending the school district through a sharing agreement with another school district,or students attending the school district pursuant to Iowa Code section 282.18. Online coursework shall be aligned with the Iowa core standards as applicable and shall be taught by a teacher appropriately licensed and endorsed for the educational level and content area being taught. The teacher may be employed directly by the school district or by a third-party provider of the online curricula used by the school district. Teachers employed by the school district shall be subject to the provisions of Iowa Code chapters 272, 279, and 284. Teachers employed by a third-party provider shall be subject to the provisions of Iowa Code chapter 272; these teachers must be given access to appropriate professional development by the school district, but otherwise are not subject to the provisions of Iowa Code chapters 279 and 284.    15.7(2) Monitoring and supervision.  A school district providing educational instruction and course content delivered primarily over the Internet shall do all of the following with regard to such instruction and content:    a.    Monitor and verify full-time student enrollment, timely completion of graduation requirements, course credit accrual, and course completion.    b.    Monitor and verify student progress and performance in each course through a school-based assessment plan that includes submission of coursework and security and validity of testing components.    c.    Conduct parent-teacher conferences.    d.    Administer assessments required by the state to all students in a proctored setting and pursuant to state law.

        ITEM 2.    Rescind rule 281—15.8(256) and adopt the following new rule in lieu thereof:

    281—15.8(256) Data reporting.      15.8(1) District responsibilities.  A school district providing educational instruction and course content that are delivered primarily over the Internet pursuant to this division shall annually submit to the department, in the manner prescribed by the department, data that includes but is not limited to the following:    a.    Student achievement and demographic characteristics.    b.    Retention rates.    c.    The percentage of enrolled students’ active participation in extracurricular activities.    d.    Academic proficiency levels, consistent with requirements applicable to all school districts and accredited nonpublic schools in this state.    e.    Academic growth measures, which shall include either of the following:    (1)   Entry and exit assessments in, at a minimum, math and English for elementary and middle school students, and additional subjects, including science, for high school students.    (2)   State-required assessments that track year-over-year improvements in academic proficiency.    f.    Academic mobility. To facilitate the tracking of academic mobility, school districts shall request the following information from the parent or guardian of a student enrolled in educational instruction and course content that are delivered primarily over the Internet pursuant to this division:    (1)   For a student newly enrolling, the reasons for choosing such enrollment.    (2)   For a student terminating enrollment, the reasons for terminating such enrollment.    g.    Student progress toward graduation. Measurement of such progress shall account for specific characteristics of each enrolled student, including but not limited to age and course credit accrued prior to enrollment in educational instruction and course content that are delivered primarily over the Internet pursuant to this division, and shall be consistent with evidence-based best practices.    15.8(2) Department responsibilities.  The department shall compile and review the data collected pursuant to this division and shall submit its findings and recommendations for the continued delivery of educational instruction and course content by school districts delivered primarily over the Internet, in a report to the general assembly by January 15 annually.

        ITEM 3.    Rescind rule 281—15.11(256) and adopt the following new rule in lieu thereof:

    281—15.11(256) Conditions under which ILO coursework may be used to satisfy general accreditation requirements.      15.11(1) General.  Subject to the exceptions contained in subrules 15.11(2) and 15.11(3), ILO coursework may not be used to meet the requirements of Iowa Code section 256.11(5), which require that specified subjects be offered and taught by a school district or accredited nonpublic school.    15.11(2) Use of ILO for up to two specified subjects.  The requirements of subrule 15.11(1) shall not apply if a school district or school demonstrates either of the following conditions:    a.    The school district or school makes every reasonable and good faith effort to employ a teacher licensed under Iowa Code chapter 272 for the specified subject and is unable to employ such a teacher.    b.    Fewer than ten students typically register for instruction in the specified subject at the school district or school.    15.11(3) Waiver for additional specified subjects.  The department may waive for one school year the applicability of Iowa Code section 256.11(5), at its discretion, to additional specified subjects for a school district or accredited nonpublic school that proves to the satisfaction of the department that the school district or school has made every reasonable effort but is unable to meet the requirements of Iowa Code section 256.11(5). A school district or accredited nonpublic school may apply for an annual waiver each year.    15.11(4) Use of private providers.  Any specified subject course to which Iowa Code section 256.11(5) does not apply under either subrule 15.11(2) or 15.11(3) shall be provided by ILO if ILO offers the course, unless the course offered by ILO lacks the capacity to accommodate additional students. In that case, the specified subject course may instead be provided by the school district or accredited nonpublic school:     a.    Through an online learning platform if the course is developed by the school district or accredited nonpublic school itself, provided the course is taught by an Iowa licensed teacher with online learning experience and the course content is aligned with the Iowa content standards and satisfies the requirements of subrule 15.13(1).    b.    Through a private provider utilized to provide the course that meets the standards of subrule 15.13(1) and is approved in accordance with rule 281—15.16(256).    15.11(5) Definition.  For purposes of this rule, “good faith effort” means the same as defined in Iowa Code section 279.19A(9).

        ITEM 4.    Amend rule 281—15.12(256) as follows:

    281—15.12(256) School and school district responsibilities.  Each participating school district and accredited nonpublic school shall submit its online curricula, excluding coursework provided by ILO, to the department for review. Each participating school district and accredited nonpublic school shall include in its comprehensive school improvement plan submitted pursuant to Iowa Code section 256.7(21) a list and description of the online coursework offered by the school or school district, excluding coursework provided by ILO. Each participating school district and accredited nonpublic school is responsible for recording grades received for ILO coursework in a student’s permanent record and for awarding graduation credit for ILO coursework. Each participating school district and accredited nonpublic school shall identify a site coordinator to serve as a student advocate and as a liaison between the initiative staff and teachers and the school district or accredited nonpublic school. Each participating school district and school shall pay the fees prescribed by subrule 15.13(2).A school district may provide courses developed by private providers and delivered primarily over the Internet to pupils who are participating in open enrollment under Iowa Code section 282.18. However, if a student’s participation in open enrollment to receive educational instruction and course content delivered primarily over the Internet results in the termination of enrollment in the receiving district, the receiving district shall, within 30 days of the termination, notify the district of residence of the termination and the date of the termination. A rebate for tuition or fees paid or any other dividend or bonus moneys for enrollment of a child shall not be offered or provided directly or indirectly by a school district, school, or private provider to the parent or guardian of a pupil who enrolls in a school district or school to receive educational instruction and course content delivered primarily over the Internet.

        ITEM 5.    Amend rule 281—15.13(256) as follows:

    281—15.13(256) Department responsibilities.      15.13(1) Course quality.  The department shall annually evaluate the quality of courses offered under ILO to ensure that coursework is rigorous and of high quality and is aligned with Iowa’s core curriculum and core content requirements and standards as well as with national standards of quality for online courses issued by an internationally recognized association for elementary and secondary online learning. The department shall ensure that all ILO coursework is taught by a teacher who is appropriately licensed and endorsed for the educational level and content area being taught and who has completed an online-learning-for-Iowa-educators professional development course offered by an area education agency, a teacher preservice program, or comparable coursework.The director of the department shall maintain a list of approved online providers that meet the standards of this subrule and provide course content through an online learning platform taught by a teacher licensed under Iowa Code chapter 272 who has specialized training or experience in online learning. This list shall be maintained pursuant to subrule 15.16(2). Providers shall apply for approval annually or as determined by the department.    15.13(2) Fiscal matters.  The department shall establish fees payable by school districts, accredited nonpublic schools, and individuals providing instruction to students under Iowa Code chapter 299A as described in rule 281—15.10(256), for ILO coursework. Fees collected pursuant to this subrule are appropriated to the department to be used only for the purpose of administering ILO and shall be established so as not to exceed the cost of administering ILO. Providing professional development necessary to prepare teachers to participate in the initiative shall be considered a cost of ILO administration. Notwithstanding Iowa Code section 8.33, fees collected by the department that remain unencumbered or unobligated at the close of the fiscal year shall not revert but shall remain available for expenditure for the purpose of expanding ILO coursework offered in subsequent fiscal years.

        ITEM 6.    Adopt the following new rule 281—15.16(256):

    281—15.16(256) Private providers of online coursework.      15.16(1) School district discretion.  At the discretion of a school board or authorities in charge of an accredited nonpublic school, after consideration of circumstances created by necessity, convenience, and cost-effectiveness, courses developed by private providers may be utilized by a school district or school in implementing a high-quality online learning program. Courses obtained from private providers shall be taught by teachers licensed under Iowa Code chapter 272.    15.16(2) Department approval of private providers.  Private providers utilized to provide courses by a school district or accredited nonpublic school in accordance with this chapter shall meet the standards of subrule 15.13(1) and be approved in accordance with this subrule. The department shall establish an application process and review process for courses developed by private providers, including establishing a schedule of opportunities for new course approval applications, which shall be available at least annually, and a review cycle of courses previously approved.

        ITEM 7.    Amend 281—Chapter 15, implementation sentence, as follows:       These rules are intended to implement Iowa Code sections 256.2, 256.7, 256.9, and 256.42256.41 to 256.43.    [Filed 1/17/19, effective 3/20/19][Published 2/13/19]Editor’s Note: For replacement pages for IAC, see IAC Supplement 2/13/19.    ARC 4296CEducation Department[281]Adopted and Filed

    Rule making related to open enrollment

        The State Board of Education hereby amends Chapter 17, “Open Enrollment,” Iowa Administrative Code.Legal Authority for Rule Making    This rule making is adopted under the authority provided in Iowa Code section 256.7.State or Federal Law Implemented    This rule making implements, in whole or in part, Iowa Code section 282.18.Purpose and Summary    2018 Iowa Acts, Senate Files 475 and 2415, made changes to Iowa Code section 282.18 allowing individual pupils who participate in open enrollment to online education to participate in up to two cocurricular or extracurricular activities at their resident districts. The changes also allow districts to deduct up to $200 per activity off of the open enrollment tuition out. These amendments implement Senate Files 475 and 2415.Public Comment and Changes to Rule Making    Notice of Intended Action for this rule making was published in the Iowa Administrative Bulletin on December 5, 2018, as ARC 4159C. A public hearing was held on January 8, 2019, at 11 a.m. in the State Board Room, Second Floor, Grimes State Office Building, Des Moines, Iowa. Two people attended the public hearing. No public comments were received. No changes from the Notice have been made.Adoption of Rule Making    This rule making was adopted by the State Board on January 16, 2019.Fiscal Impact     This rule making has no fiscal impact to the State of Iowa. Jobs Impact    After analysis and review of this rule making, no impact on jobs has been found.Waivers    An agencywide rule waiver is provided for in 281—Chapter 4.Review by Administrative Rules Review Committee    The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making at its regular monthly meeting or at a special meeting. The Committee’s meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).Effective Date    This rule making will become effective on March 20, 2019.    The following rule-making actions are adopted:

        ITEM 1.    Amend subrule 17.8(2), introductory paragraph, as follows:    17.8(2) Restrictions on participation in interscholastic athletic contests and competitions.  ASubject to rule 281—17.15(282), a pupil who changes school districts under open enrollment in any of the grades 9 through 12 shall not be eligible to participate in varsity interscholastic athletic contests and competitions during the first 90 school days of enrollment. This restriction also shall apply to enrollments resulting from an approved petition filed by a parent/guardian to open enroll to an alternative receiving district and when the pupil returns to the district of residence using the process outlined in subrule 17.8(4). This 90-school-day restriction does not prohibit the pupil from practicing with an athletic team during the 90 school days of ineligibility. This 90-school-day restriction is not applicable to a pupil who:

        ITEM 2.    Adopt the following new subrule 17.10(9):    17.10(9) Open enrollment pursuant to rule 281—17.15(282).  If a pupil participates in cocurricular or extracurricular activities in accordance with subrule 17.15(2), the district of residence may deduct up to $200 per activity, for up to two activities, from the amount calculated in this rule. For a cocurricular activity, one semester shall equal one activity. Extracurricular activities for which such a resident district may charge up to $200 per activity for up to two activities under this subrule include interscholastic athletics, music, drama, and any other activity with a general fund expenditure exceeding $5,000 annually. A pupil may participate in additional extracurricular activities at the discretion of the resident district. The school district of residence may charge the pupil a fee for participation in such cocurricular or extracurricular activities equivalent to the fee charged to and paid in the same manner by other resident pupils.

        ITEM 3.    Adopt the following new rule 281—17.15(282):

    281—17.15(282) Open enrollment and online coursework.      17.15(1) General.  A school district may provide courses developed by private providers and delivered primarily over the Internet to pupils who are participating in open enrollment under Iowa Code section 282.18. However, if a student’s participation in open enrollment to receive educational instruction and course content delivered primarily over the Internet results in the termination of enrollment in the receiving district, the receiving district shall, within 30 days of the termination, notify the district of residence of the termination and the date of the termination.    17.15(2) Participation in activities in resident district.  A pupil participating in open enrollment for purposes of receiving educational instruction and course content primarily over the Internet in accordance with Iowa Code section 256.7(32) may participate in any cocurricular or extracurricular activities offered to children in the pupil’s grade or group and sponsored by the district of residence under the same conditions and requirements as the pupils enrolled in the district of residence. The pupil may participate in not more than two cocurricular or extracurricular activities during a school year unless the resident district approves the student’s participation in additional activities. The student shall comply with the eligibility, conduct, and other requirements relating to the activity that are established by the district of residence for any student who applies to participate or who is participating in the activity.

        ITEM 4.    Amend 281—Chapter 17, implementation sentence, as follows:       These rules are intended to implement Iowa Code Supplement section 282.18.    [Filed 1/17/19, effective 3/20/19][Published 2/13/19]Editor’s Note: For replacement pages for IAC, see IAC Supplement 2/13/19.    ARC 4297CEducation Department[281]Adopted and Filed

    Rule making related to supplementary weighting

        The State Board of Education hereby amends Chapter 97, “Supplementary Weighting,” Iowa Administrative Code.Legal Authority for Rule Making    This rule making is adopted under the authority provided in Iowa Code section 256.7.State or Federal Law Implemented    This rule making implements, in whole or in part, 2018 Iowa Acts, Senate File 475 and House File 633.Purpose and Summary    Chapter 97 outlines supplementary weighting. The amendments to Chapter 97 reflect legislative changes to supplementary weighting for Iowa school districts brought about during the 2018 Legislative Session. Those changes include an addition to the shared operational functions eligible for supplementary weighting and expansion of the eligibility period for this weighting and a new type of district eligibility for additional weighting under concurrent enrollment for certain career and technical education courses.Public Comment and Changes to Rule Making    Notice of Intended Action for this rule making was published in the Iowa Administrative Bulletin on December 5, 2018, as ARC 4156C. A public hearing was held on January 8, 2019, at 1 p.m. in the State Board Room, Second Floor, Grimes State Office Building, Des Moines, Iowa. No one attended the public hearing. One party commented on the rule making. No changes from the Notice have been made.Adoption of Rule Making    This rule making was adopted by the State Board on January 16, 2019.Fiscal Impact    This rule making may impact jobs that have shared operational functions, and it may impact local districts’ budgets. Jobs Impact    This may impact jobs that have shared operational functions.Waivers    An agencywide waiver provision is provided in 281—Chapter 4.Review by Administrative Rules Review Committee    The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making at its regular monthly meeting or at a special meeting. The Committee’s meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).Effective Date    This rule making will become effective on March 20, 2019.    The following rule-making actions are adopted:

        ITEM 1.    Rescind the definitions of “Fraction of a school year at the elementary level” and “Fraction of a school year at the secondary level” in rule 281—97.1(257).

        ITEM 2.    Adopt the following new definition of “Fraction of a school year” in rule 281—97.1(257):        "Fraction of a school year" shall mean the product of the minutes per day of class multiplied by the number of days per year the class meets divided by the product of the total number of minutes in a school day multiplied by the total number of days in a school year. All minutes available in a normal day shall be used in the calculation.

        ITEM 3.    Amend rule 281—97.1(257), definition of “Supplementary weighting plan for at-risk students,” as follows:        "Supplementary weighting plan for at-risk students" shall mean a plan as defined in this chapter to add a weighting for each resident student enrolled in the district and a weighting for each resident studentthe percentage of pupils enrolled in grades one through six, as reported by the school district on the basic educational data survey for the base year, who isare eligible for free and reduced price meals under the federal National School Lunch Act and the federal Child Nutrition Act of 1966, 42 U.S.C. Sections 1751-17851751-1769j, multiplied by the budget enrollment in the school districtto generate funding to be used to develop or maintain at-risk programs, which may include alternative school programsalternative programs and alternative school programs, and returning dropout and dropout prevention programs approved pursuant to Iowa Code section 257.40.

        ITEM 4.    Amend subparagraph 97.2(5)"a" as follows:    (2)   The course must not be used by the school district in order to meet the minimum accreditation standards in Iowa Code section 256.11.256.11(5)“a” to “j,” with an exception to the career and technical limitation applicable to Iowa Code section 256.11(5)“h.”

        ITEM 5.    Adopt the following new subparagraph 97.2(5)"a":    (3)   A school district with total basic educational data survey enrollment of not more than 600 that contracts with a community college to provide any of the three required sequential units in any of the four career and technical education service areas identified as the district’s career and technical program required in Iowa Code section 256.11(5)“h” may request supplementary weighting for any community college course within one of the four service areas if the district’s course enrollment exceeds five.

        ITEM 6.    Amend paragraph 97.3(2)"b" as follows:    b.    Adding a weighting of forty-eight ten-thousandths for each resident studentmultiplied by the percentage of pupils in the district enrolled in grades one through six, as reported by the school district on the basic educational data survey for the base year, who isare eligible for free and reduced price meals under the federal National School Lunch Act and the federal Child Nutrition Act of 1966, 42 U.S.C. Sections 1751-17851751-1769j, multiplied by the district’s budget enrollment.

        ITEM 7.    Amend subrule 97.7(2), introductory paragraph, as follows:    97.7(2) Operational function area eligibility.  “Operational function sharing” means sharing of managerial personnel in the discrete operational function areas of superintendent management, business management, human resources management, student transportation management, facility operation or maintenance management, curriculum director, master social worker, independent social worker, or school counselor. “Operational function sharing” does not mean sharing of clerical personnel or school principals. The operational function sharing arrangement does not need to be a newly implemented sharing arrangement in order to be eligible for supplementary weighting.

        ITEM 8.    Rescind subparagraph 97.7(2)"a".

        ITEM 9.    Renumber subparagraphs 97.7(2)"a" and 97.7(2)"a" as 97.7(2)"a" and 97.7(2)"a".

        ITEM 10.    Amend subparagraph 97.7(2)"b" as follows:    (1)   Shared personnel must perform the services of managing the business operations. Managing business operations would include personnel performing the duties of a business manager or school business official, or personnel performing the duties listed in the Iowa Code for a board secretary including, but not limited to, board secretary duties listed in Iowa Code chapter 291, or personnel performing the duties listed in the Iowa Code for a board treasurer including, but not limited to,those listed in Iowa Code chapter 291 for a board secretary or board treasurer duties listed in Iowa Code chapter 291.

        ITEM 11.    Amend subparagraph 97.7(2)"f" as follows:    (1)   Shared personnel must perform the services of a curriculum director. An individual performing the function of a curriculum director must be properly licensed for that position.

        ITEM 12.    Adopt the following new paragraph 97.7(2)"h":    h.    School social worker.    (1)   Shared personnel must perform the services of a school social worker. An individual performing the function of a school social worker must be properly licensed for that position.    (2)   Social workers providing services required to be provided by an area education agency shall not be considered a shared school social worker under this subrule.    (3)   Shared school social worker services shall not include contracting for services from a private provider even if another political subdivision is contracting for services from the same private provider.

        ITEM 13.    Amend subrule 97.7(3), introductory paragraph, as follows:    97.7(3) Years of eligibilityEligibility.  A school district participating in an operational function sharing arrangement shall be eligible for supplementary weighting under this rule for a maximum of five years. The five years of eligibility shall include each year in which any shared operational function is included for supplementary weighting. The supplementary weighting for eligible shared operational functions may be included beginning on October 1, 2013.

        ITEM 14.    Amend subrules 97.7(5) to 97.7(7) as follows:    .(5) Consecutive years.  A school district that is eligible to add a supplementary weighting for resident students for a shared operational function is not required to utilize consecutive years. However, the final year in which a supplementary weighting may be added on October 1 for this purpose shall not be later than the school year that begins July 1, 2018, and the total of all years in which a supplementary weighting may be added on October 1 for this purpose shall not exceed five yearsJuly 1, 2023.    .(6) Change in sharing partners.  A school district that is eligible to add a supplementary weighting for resident students for a shared operational function may enter into an operational function sharing arrangement with one or more different sharing partners for its second, third, fourth or fifth year of eligible weighting. Establishing a new operational function sharing arrangement in a substantially similar function does not extend the maximum number of years for which a school district is eligible.    .(7) Change in shared personnel.  A school district that is eligible to add a supplementary weighting for resident students for a shared operational function may enter into an operational function arrangement for a different individual in a substantially similar position. Implementing a change of the individual or individuals shared does not extend the maximum number of years for which a school district is eligible.

        ITEM 15.    Amend subrules 97.7(9) to 97.7(11) as follows:    .(9) Multiple shared individuals inwithin an operational function.  A school district that implements more than one sharing arrangement within any discrete operational function area, as both the contract holder and the purchaser of services, shall not be eligible for supplementary weighting if more than one shared individual is licensed and qualified for the same position. If the school district had utilized its own employees, the sharing arrangement or arrangements would not have been necessaryhad the district utilized its own properly licensed and qualified employee(s).    .(10) Weighting.  A school district that shares an operational function in the area of superintendent management shall be assigned a supplementary weighting of eight pupils for the function. A school district that shares an operational function in the area of business management, human resources management, transportation management, or operation and maintenance management shall be assigned a supplementary weighting of five pupils for the function. A school district that shares the operational functions of a curriculum director, master social worker, independent social worker, or a school counselor shall be assigned a supplementary weighting of three pupils for the function. The supplementary weighting shall be assigned to each discrete operational function shared. The maximum number of years for which a supplementary weighting shall be assigned for all operational functions shared is five years. The department shall reserve the authority to determine if an operational sharing arrangement constitutes a discrete arrangement or qualifying operational sharing arrangement if the circumstances have not been clearly described in the Iowa Code or the Iowa Administrative Code.    .(11) Sharing arrangement duties.  A school district may receive the additional weighting for the sharing of services of an individual with a political subdivisionthat is not a school corporation even if the type of operational function performed by the individual for the school district and the type of operational function performed by the individual for the political subdivision are not the same operational function, so long as both operational functions are eligible for weighting. In such case, the school district shall be assigned the additional weighting for the type of operational function that the individual performs for the school district, and the school district shall not receive additional weighting for any other function performed by the individual.

        ITEM 16.    Amend 281—Chapter 97, implementation sentence, as follows:       These rules are intended to implement Iowa Code sections 257.6, 257.11as amended by 2014 Iowa Acts, Senate File 2056 and House File 2271, and 257.12 and Iowa Code chapter 261E.    [Filed 1/17/19, effective 3/20/19][Published 2/13/19]Editor’s Note: For replacement pages for IAC, see IAC Supplement 2/13/19.    ARC 4298CEducation Department[281]Adopted and Filed

    Rule making related to financial management of categorical funding

        The State Board of Education hereby amends Chapter 98, “Financial Management of Categorical Funding,” Iowa Administrative Code.Legal Authority for Rule Making    This rule making is adopted under the authority provided in Iowa Code section 256.7.State or Federal Law Implemented    This rule making implements, in whole or in part, Iowa Code sections 257.41, 297.22, 298A.8 and 298A.12 and 2018 Iowa Acts, House Files 2441 and 2467.Purpose and Summary    Chapter 98 outlines the financial management of categorical funding. The amendments to Chapter 98 reflect significant legislative changes to categorical funding for Iowa school districts brought about during the 2018 Legislative Session. Those changes include clarification of allowed school district use of materials purchased for a home school assistance program; additional allowed uses of at-risk, returning dropout, and dropout prevention funds; major process changes regarding school district applications to the School Budget Review Committee for a modified supplemental amount for at-risk, returning dropout, and dropout prevention programs; a substantial change in allowed use of early intervention supplement funds, which is now any general fund-appropriate use; allowing a school district to transfer from the general fund to the school district’s student activity account an amount necessary for reconditioning of protective and safety equipment; allowing a school district to establish an unpaid student meals account within the school nutrition fund and deposit moneys from the flexibility account within the general fund to this account; and allowing school districts with a balance in the child care fund which exceeds the amount necessary to operate the before- and after-school program to transfer this excess to the general fund by resolution of the board of directors following a public hearing. A more detailed explanation of these amendments follows:    Item 1: 2018 Iowa Acts, House File 2441, amends Iowa Code section 299A.12 to allow a school district to use items and materials purchased for the Home School Assistance Program for other purposes so long as those purposes do not prevent or interfere with the material’s use by parents or students utilizing the program. The amendment to rule 281—98.12(257,299A) implements that policy change.    Items 2 and 3: Over the last few legislative sessions, changes in allowed uses of funds generated through the at-risk formula under Iowa Code section 257.11(4) and funds generated through a modified supplemental amount under Iowa Code section 257.38 have resulted in these uses being identical. New subrules 98.18(1) and 98.18(2) reflect these changes.    Item 4: 2018 Iowa Acts, House File 2441, amends Iowa Code section 257.41(2), regarding appropriate uses of categorical funding for at-risk students, alternative programs and alternative schools, and returning dropout and dropout prevention programs. The amendment to subrules 98.21(1) to 98.21(3) implements those changes.    Item 5: 2018 Iowa Acts, House File 2441, amends Iowa Code section 257.10(11)“d,” pertaining to the allowed use of early intervention supplement funds due to the repeal of Iowa Code chapter 256D. New rule 281—98.23(257) reflects that change in allowed use.    Item 6: This item reletters a paragraph under subrule 98.22(3).    Item 7: 2018 Iowa Acts, House File 2467, creates new Iowa Code section 283A.11, which allows a school district to establish an unpaid student meals account in its school nutrition fund, and adds Iowa Code section 298A.2(2)“c”(06) [codified at Iowa Code section 298A.2(2)“c”(6)], allowing funds transferred to the flexibility account under Iowa Code section 298A.2 to be deposited in the unpaid student meals account for purposes of paying student meal debt. New paragraph 98.27(3)“g” implements that change.    Item 8: This amendment to subrule 98.44(1) clarifies how a school district is to address textbooks previously purchased for a nonpublic school with funds appropriated for this purpose and how to account for unexpended funds provided for the purchase of textbooks for a nonpublic school in the event the nonpublic school ceases operation.    Item 9: 2018 Iowa Acts, House File 2441, amends Iowa Code section 298A.8(2) to allow an amount necessary for reconditioning of protective and safety equipment to be transferred from the general fund to the school district’s student activity account. The amendment to paragraph 98.61(2)“s” implements this change.    Item 10: 2018 Iowa Acts, House File 2467, creates new Iowa Code section 283A.11, under which a school district is allowed to establish an unpaid student meals account in the school nutrition fund. New subrule 98.74(4) implements that change.    Item 11: 2018 Iowa Acts, House File 2441, amends Iowa Code section 298A.12, allowing school districts with a balance in the child care fund which exceeds the amount necessary to operate the before- and after-school program to transfer the excess amount to the general fund by resolution of the board of directors following a public hearing as prescribed in Iowa Code section 298A.12. The amendment to subrule 98.75(2) implements this policy change.Public Comment and Changes to Rule Making    Notice of Intended Action for this rule making was published in the Iowa Administrative Bulletin on December 5, 2018, as ARC 4160C. A public hearing was held on January 8, 2019, at 2 p.m. in the State Board Room, Second Floor, Grimes State Office Building, Des Moines, Iowa. No one attended the public hearing.    One public comment was received. Slight changes were made from Item 4 in the Notice based on the public comment. In paragraph 98.21(2)“d,” the phrase “outside a student’s regular attendance center” was added. In subrule 98.21(3), the phrase “student transportation other than as allowed in subrule 98.21(2)” was stricken. Adoption of Rule Making    This rule making was adopted by the State Board on January 16, 2019.Fiscal Impact    The fiscal impact of this rule making is unknown. Jobs Impact    After analysis and review of this rule making, no impact on jobs has been found.Waivers    An agencywide waiver provision is provided for in 281—Chapter 4.Review by Administrative Rules Review Committee    The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making at its regular monthly meeting or at a special meeting. The Committee’s meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).Effective Date    This rule making will become effective on March 20, 2019.    The following rule-making actions are adopted:

        ITEM 1.    Amend rule 281—98.12(257,299A), introductory paragraph, as follows:

    281—98.12(257,299A) Home school assistance program.  The home school assistance program (HSAP) is a program for a specific category of students and is provided outside the basic educational program provided to regularly enrolled students by the school district. If a district offers a home school assistance program, the state foundation aid that the district receives pursuant to Iowa Code section 257.6(1)“a”(5), and any amount designated for this purpose from the flexibility account as described in rule 281—98.27(257,298A), shall be expended for purposes of providing the home school assistance program.However, a district may use items and materials purchased for the home school assistance program for other purposes so long as this use does not prevent or interfere with the item’s or material’s use by parents or students utilizing the program.

        ITEM 2.    Rescind subrule 98.18(1) and adopt the following new subrule in lieu thereof:    98.18(1) Appropriate uses of categorical funding.  Appropriate uses of at-risk formula supplementary weighting funding include costs to develop or maintain programs for at-risk pupils, alternative programs and alternative schools for secondary students, and returning dropout and dropout prevention programs. Appropriate uses include those identified in subrule 98.21(2).

        ITEM 3.    Rescind subrule 98.18(2) and adopt the following new subrule in lieu thereof:    98.18(2) Inappropriate uses of categorical funding.  Inappropriate uses of at-risk formula supplementary weighting program funding include those identified in subrule 98.21(3).

        ITEM 4.    Amend subrules 98.21(1) to 98.21(3) as follows:    .(1) Purpose of categorical funding.  The purpose of the modified supplemental amount is to provide funding to meet the needs of identified students for costs in excess of the amount received under rule 281—98.18(257) pursuant to Iowa Code section 257.11(4). The funding shall be used only for expenditures that are directly related to the district’s approvedboard-adopted program plan established pursuant to Iowa Code sections 257.38 through 257.41.    a.    Returning dropouts are resident pupils who have been enrolled in a school district in any of grades 7 through 12 who withdrew from school for a reason other than transfer to another school or school district and who subsequently reenrolled in a public school in the school district.    b.    Potential dropouts are resident pupils who are enrolled in a school district who demonstrate poor school adjustment as indicated by two or more of the following:    (1)   High rate of absenteeism, truancy, or frequent tardiness.    (2)   Limited or no extracurricular participation or lack of identification with school, including but not limited to expressed feelings of not belonging.    (3)   Poor grades, including but not limited to failing in one or more school subjects or grade levels.    (4)   Low achievement scores in reading or mathematics which reflect achievement at two years or more below grade level.    (5)   Children in grades kindergarten through 3 who meet the definition of at-risk children adopted by the department of education.    .(2) Appropriate uses of categorical funding.  Appropriate uses of the funding for an approveda board-adopted program include, but are not limited to:    a.    Salary and benefits forstaff, including but not limited to instructional staff, instructional support staff,administrative staff, and guidance counselors, and; salary and benefits or contract payments for psychologists licensed under Iowa Code chapter 154B, licensed independent social workers or master social workers under Iowa Code chapter 154C, licensed mental health counselors under Iowa Code chapter 154D; and salaries and benefits for school-based youth services staff dedicated to providing services directly and exclusively to the identified students participating in the approvedadopted program beyond the services provided by the school district to students who are not identified as at risk or as potential or returning dropouts. However, if the staff person or guidance counselor works part-timeor on a contract basis with students who are participating in the approved program and has another unrelated staff assignment, only the portion of the staff person’s or guidance counselor’s time that is related to the programor with such students may be charged to the program funding. The school district shall have the authority to designate and submit in thein its adopted program plan the portion of the staff member’s or guidance counselor’sperson’s time and related salary and benefitsor contract payment amount dedicated to this purpose.For purposes of this paragraph, an alternative setting may be necessary to provide for a program which is offered at a location off school grounds and which is intended to serve student needs by improving relationships and connections to school, decreasing truancy and tardiness, providing opportunities for course credit recovery, or helping students identified as at risk to accelerate through multiple grade levels of achievement within a shortened time frame.    b.    Professional development for all teachers, guidance counselors, and staffidentified in paragraph 98.21(2)“a” working with identified students under an approvedadopted program.    c.    Research-based resources, materials, software, supplies, equipment, and purchased services that meet all of the following criteria:    (1)   Meet the needs of K through grade 12 identified students,    (2)   Are beyond those provided by the regular school program,    (3)   Are necessary to provide the services listed in the school district’s approvedadopted at-risk or returning dropout and dropout prevention program plan, and    (4)   Will remain with the K through grade 12 at-risk program, alternative program or alternative school, or returning dropout and dropout prevention program.    d.    Transportation provided by the school district exclusively to transport identified students to an alternative school or alternative programoutside a student’s regular attendance center, located in and provided by another Iowa school district, or an extended school year program.    e.    The portion of the maximum tuition allowed by Iowa Code section 282.24 that corresponds to the portion exclusively providing direct additional instruction and services to an identified group of students above the costs of instruction of pupils in a regular curriculum.    f.    School-level administrator assigned exclusively to an off-site alternative school or alternative program within the district. If the principal is administering the school or program part-time, the portion of time that is exclusively and directly related to the program may be charged to the program funding, but the portion of time that is related to other purposes shall not.    g.    f.    Instructional costs necessary to address the behavior of a child during instructional time when those services are not otherwise provided to students who do not require special education and when the costs exceed the costs of instruction of pupils in a regular curriculum, the costs exceed the maximum tuition rate prescribed in Iowa Code section 282.24, the child has not been placed in a facility operated by the state, and all of the following apply:    (1)   The child does not require special education.    (2)   The child is not placed by the department of human services or a court in a residential or day treatment program where the treatment necessary to address the student’s behavior was included in the contract with the placement agency.    (3)   The child is not placed in a hospital unit, health care facility, psychiatric medical institution for children or other treatment facility where the cost of treatment necessary to address the student’s behavior is covered by insurance or Medicaid.    (4)   The board of directors of the district of residence has determined that the child is likely to inflict self-harm or likely to harm another student.    h.    g.    Costs incurred for a program intended to address high rates of absenteeism, truancy, or frequent tardiness.    i.    h.    Amounts that a school district receives as formula supplementary weighting pursuant to Iowa Code section 257.11(4)“a” or as a modified supplemental amount received under Iowa Code section 257.41 may be used in the budget year for purposes of providing districtwide, buildingwide, or grade-specific at-risk and dropout prevention programming targeted to nonidentified students.    i.    School security personnel costs.    j.    Any purpose determined by the board of directors that directly benefits students participating in the adopted program.    .(3) Inappropriate uses of categorical funding.  Inappropriate uses of the modified supplemental amount program funding include, but are not limited to, indirect costs or use charges, operational or maintenance costs, capital expenditures other than equipment, student transportation other than as allowed in subrule 98.21(2), administrative costs other than those allowed in subrule 98.21(2), expenses related to the routine duties of a school nurse, general support for a school guidance counselor including anyand activities performedby a staff member under paragraph 98.21(2)“a” with identified students that are also provided to all students, or any other expenditures not directly related to providing the approvedboard-adopted program beyond the scope of the regular classroom.

        ITEM 5.    Rescind rule 281—98.23(256D,257) and adopt the following new rule in lieu thereof:

    281—98.23(257) Early intervention supplement.      98.23(1) Appropriate uses of categorical funding.  Appropriate uses of the early intervention-supplement funding include any general fund-appropriate use described in rule 281—98.61(24,143,257,275,279,280,285,297,298,298A,301,473,670).    98.23(2) Inappropriate uses of categorical funding.  Inappropriate uses of the early intervention-supplement funding include those which are inappropriate to the general fund as described in rule 281—98.61(24,143,257,275,279,280,285,297,298,298A,301,473,670).    98.23(3) Deference.  Deference shall be given to the decisions of school districts’ boards of directors in accordance with Iowa Code section 257.10.       This rule is intended to implement Iowa Code section 257.9(8).

        ITEM 6.    Reletter paragraph 98.27(3)"g" as 98.27(3)"h".

        ITEM 7.    Adopt the following new paragraph 98.27(3)"g":    g.    Deposit into the unpaid student meals account as described in subrule 98.74(4).

        ITEM 8.    Amend subrule 98.44(1) as follows:    98.44(1) Appropriate uses of categorical funding.  The appropriate use of the nonpublic textbook services funding shall be for the public school district to purchase nonsectarian textbooks for the use of pupils attending accredited nonpublic schools located within the boundaries of the public school district. “Textbook”“Textbooks” means books and loose-leaf or bound manuals, systems of reusable instructional materials or combinations of books and supplementary instructional materials which convey information to the student or otherwise contribute to the learning process, or electronic textbooks, including but not limited to computer software, applications using computer-assisted instruction, interactive videodisc, other computer courseware and magnetic media, and laptop computers or other portable personal computing devices which are used for nonreligious instructional use only.In the event that a participating accredited nonpublic school physically relocates to another school district, textbooks purchased for the nonpublic school with funds appropriated for that purpose in accordance with the Iowa Code shall be transferred to the school district in which the accredited nonpublic school has relocated and may be made available to the accredited nonpublic school by the school district in which the nonpublic school has relocated. Funds distributed to a former school district for purposes of purchasing textbooks and that are unexpended shall also be transferred from the former school district to the school district in which the accredited nonpublic school has relocated.In the event that a participating accredited nonpublic school ceases operation, textbooks purchased for the nonpublic school with funds appropriated for that purpose in accordance with the Iowa Code shall be returned to the public school district in which the nonpublic school was located. Funds provided for the purpose of purchasing textbooks for the nonpublic school that are unexpended shall be reverted to the department of education.

        ITEM 9.    Amend paragraph 98.61(2)"s" as follows:    s.    Beginning with the budget year beginning July 1, 2016, transferring, by board resolution, to the student activity fund an amount necessary to purchaseor, beginning with the budget year beginning July 1, 2018, recondition protective and safety equipment required for any extracurricular interscholastic athletic contest or competition that is sponsored or administered by an organization as defined in Iowa Code section 280.13, as allowed under Iowa Code section 298A.2 pursuant to Iowa Code section 298A.8(2).

        ITEM 10.    Adopt the following new subrule 98.74(4):    98.74(4) Unpaid student meals account.  Beginning with the budget year beginning July 1, 2018, in accordance with Iowa Code section 283A.11, a school district may establish an unpaid student meals account in the school nutrition fund and may deposit in the account moneys received from private sources for purposes of paying student meal debt accrued by individual students as well as amounts designated for the account from the school district’s flexibility account as described in rule 281—98.27(257,298A). Moneys deposited in the unpaid student meals account shall be used by the school district only to pay individual student meal debt. The school district shall set fair and equitable procedures for such expenditures.

        ITEM 11.    Amend subrule 98.75(2) as follows:    98.75(2) Appropriate uses of the child care fund.  Appropriate expenditures in the child care fund include salaries and benefits for employees necessary to operate the child care program or before- and after-school program, purchased services, supplies, and equipment.Effective with the budget year beginning July 1, 2018, if the balance in the before- and after-school program exceeds the amount necessary to operate the before- and after-school program, the excess amount may, following a public hearing, be transferred to the general fund by a resolution of the board of directors of the school corporation which meets all requirements stipulated in Iowa Code section 298A.12. A transfer under this subrule does not increase a school district’s authorized expenditures as defined in Iowa Code section 257.7.

        ITEM 12.    Amend 281—Chapter 98, implementation sentence, as follows:       These rules are intended to implement Iowa Code chapters 24, 29C, 76, 143, 256, 256B, 257, 274, 275, 276, 279, 280, 282, 283A, 284, 284A, 285, 291, 294A, 296,298,298A,299A,300, 301, 423E, 423F, 565, and 670,and Iowa Code sections 11.6(1)“a”(1), 256C.4(1)“c,” 256D.4(3) and 284.13, and 2011 Iowa Code Supplement chapters 298 and 299A.    [Filed 1/17/19, effective 3/20/19][Published 2/13/19]Editor’s Note: For replacement pages for IAC, see IAC Supplement 2/13/19.    ARC 4303CLabor Services Division[875]Adopted and Filed

    Rule making related to regulated objects

        The Boiler and Pressure Vessel Board hereby amends Chapter 91, “General Requirements for All Objects,” Iowa Administrative Code.Legal Authority for Rule Making    This rule making is adopted under the authority provided in Iowa Code section 89.14.State or Federal Law Implemented    This rule making implements, in whole or in part, Iowa Code chapter 89.Purpose and Summary    This amendment adopts by reference four code cases of the American Society of Mechanical Engineers.  The amendment is the result of a petition for rule making filed by an equipment manufacturer. Adoption of the code cases will revise restrictions for construction materials and welding on certain boilers. Code Case 2668-1 authorizes the use of specific materials for seamless and welded ferritic stainless steel tubing in Section IV hot water heating boilers with specified conditions. Code Case 2764-1 sets forth conditions for specific materials previously allowed only in applications with 80 psi or less to be used in applications up to 160 psi. Code Case 2760 establishes certain conditions for the use of the laser beam welding process for welding tubes to tubesheets. Code Case 2869 establishes certain conditions for the use of stainless steel material with a minimum thickness of 0.0157 inches for the construction of Section IV hot water heating boilers.Public Comment and Changes to Rule Making    Notice of Intended Action for this rule making was published in the Iowa Administrative Bulletin on December 19, 2018, as ARC 4179C. No public comments were received. No changes from the Notice have been made.Adoption of Rule Making    This rule making was adopted by the Board on January 24, 2019.Fiscal Impact     This rule making has no fiscal impact to the State of Iowa. Jobs Impact    After analysis and review of this rule making, no impact on jobs has been found.Waivers    Any person who believes that the application of the discretionary provisions of this rule making would result in hardship or injustice to that person may petition the Board for a waiver of the discretionary provisions, if any, pursuant to 875—Chapter 81.Review by Administrative Rules Review Committee    The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making at its regular monthly meeting or at a special meeting. The Committee’s meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).Effective Date    This rule making will become effective on March 20, 2019.    The following rule-making action is adopted:

        ITEM 1.    Adopt the following new subrule 91.1(2):    91.1(2) ASME code cases.  If the manufacturer of an object listed ASME Code Case 2668-1, 2760, 2764-1, or 2869 on the manufacturer’s data report for the object and the object is otherwise in compliance with all applicable provisions, the object is in compliance with these rules.    [Filed 1/24/19, effective 3/20/19][Published 2/13/19]Editor’s Note: For replacement pages for IAC, see IAC Supplement 2/13/19.    ARC 4308CNursing Board[655]Adopted and Filed

    Rule making related to advanced registered nurse practitioners

        The Nursing Board hereby rescinds Chapter 7, “Advanced Registered Nurse Practitioners,” Iowa Administrative Code, and adopts a new Chapter 7 with the same title.Legal Authority for Rule Making    This rule making is adopted under the authority provided in Iowa Code sections 17A.3 and 147.76.State or Federal Law Implemented    This rule making implements, in whole or in part, Iowa Code chapter 152.Purpose and Summary    New Chapter 7 clarifies the definitions contained in the existing chapter, includes new definitions, streamlines the requirements and process for licensure as an advanced registered nurse practitioner (ARNP), clarifies the role and expectation of the ARNP per the Consensus Model and current standards of practice and includes new language on the standards of practice for treating patients and new language on the standards of practice for prescribing and administering opioids and other controlled substances.    Notice of Intended Action for this rule making was published in the Iowa Administrative Bulletin on November 21, 2018, as ARC 4132C.     The Board received a number of comments on this rule making. Seven comments expressed concern that the noticed prescription monitoring program (PMP) rule did not include the statutory exceptions for inpatient hospice care or long-term residential facility patient care. The Board agreed that the exceptions contained within 2018 Iowa Acts, House File 2377, should be in its PMP rule and revised the rule to include those exceptions. One comment requested that the Board include an additional exception for cancer patients. The Board considered this comment and declined to create, at this time, exceptions beyond those contained within 2018 Iowa Acts, House File 2377.     Six comments expressed concern with requiring ARNPs to check the PMP prior to prescribing any controlled substance, as opposed to only checking the PMP prior to prescribing opioids. The Board considered these comments and decided that the Board’s PMP rule should require that the PMP be checked only prior to the prescribing of an opioid. The Board found that while checking the PMP prior to prescribing any controlled substance is a good practice and should be encouraged, the Board’s current rules should be coextensive with 2018 Iowa Acts, House File 2377. As ARNPs become more accustomed to using the PMP, the Board may again consider requiring that the PMP be checked before the ARNP prescribes any controlled substance. Also, to further clarify the distinction between opioid standards and controlled substances standards, the Board divided noticed rule 655—7.6(152) into two rules: standards of practice for controlled substances (655—7.6(17A,124,147,152,272C) herein) and use of the PMP (655—7.7(124) herein).     The Board received four comments expressing confusion as to the function of the 48-hour window to check the PMP database prior to prescribing an opioid. The Board’s noticed subrule 7.6(4) stated “within 48 hours of a prescription being issued,” and thus in fact required ARNPs to check the PMP database prior to issuing a prescription. The purpose of the proposed 48-hour window was to ensure that ARNPs were checking the PMP within an appropriate time prior to issuing a prescription and not, for example, checking the PMP six months before issuing a prescription and then asserting compliance. However, the comments revealed that this requirement generated misunderstanding, and the Board decided to remove the 48-hour window requirement.     The Board received two comments expressing concern about the feasibility of obtaining patient histories relating to familial substance abuse or providing ongoing patient education for certain types of patients who may be unable to provide such information or retain the education. The Board considered the comments and revised rule 655—7.6(17A,124,147,152,272C) to permit the ARNP to exercise the ARNP’s professional judgment and document the rationale for not performing a personal and family substance abuse risk assessment or not providing ongoing patient education. The Board received several comments noting that patient needs and ARNP practices vary depending on the population and practice. In response, the Board revised rule 655—7.5(17A,147,152) to allow ARNPs to exercise their professional judgment when performing “pertinent” health histories and revised the disciplinary provision in rule 655—7.6(17A,124,147,152,272C) to clarify that the standard of care for opioid dosages is what would be prescribed by a reasonably prudent ARNP in a similar “practice.”     The Board received two comments that demonstrated confusion about the continuing education requirements for ARNPs who prescribe opioids. In response, the Board rephrased rule 655—7.6(17A,124,147,152,272C) to clarify when education is required pursuant to 2018 Iowa Acts, House File 2377. The Board received one comment which suggested that the proposed rules were unclear in regard to when a nurse would be required to obtain a Drug Enforcement Administration (DEA) registration. The Board considered this comment and rephrased the noticed subrule, now subrule 7.6(5) herein, to clarify that DEA and Controlled Substances Act (CSA) registration is required by the Board only when it is required by the DEA and the Board of Pharmacy. The Board also revised noticed subrule 7.6(5), now subrule 7.7(4) herein, to clarify that ARNPs must understand the Board of Pharmacy’s PMP rules.    The Board received four comments relating to the proposed definition of “collaboration,” which differed from the definition in existing Chapter 7. The Board considered the comments and found that the proposed definition could have inadvertently impacted the Board’s fluoroscopy rules, and the Board agreed to adopt the original definition instead of the proposed definition. The Board received two comments relating to the proposed definition of “advanced registered nurse practitioner.” The proposed definition was an alternative phrasing of the definition contained in Iowa Code chapter 152. However, the Board considered the comments and decided to revise the proposed definition and use the same language contained in Iowa Code section 152.1(1) for clarity. The Board received four comments expressing concern about the omission of the following sentence from the proposed definition of “advanced registered nurse practitioner”: “The ARNP may perform selected medically delegated functions when a collaborative practice agreement exists.” Neither the Iowa Code nor the Board’s existing rules require ARNPs to practice pursuant to a practice agreement. Moreover, this language is outdated and has led to confusion among ARNPs, as an ARNP should not be practicing medicine and must practice within the ARNP’s population focus. The Board therefore considered but declined the request to include the sentence. The Board also added a definition of “dispense” to clarify the term of art.     The Board received three comments expressing concern that the rules regarding the use of the ARNP title and abbreviation were omitted from proposed new Chapter 7. Provisions relating to use of the ARNP title and abbreviation already exist in Iowa Code chapters 147 and 152. The Board considered the comments and decided to add the requirements on this topic for clarity. The Board received one comment expressing concern with the inclusion of certification for certified nurse practitioners or certified nurse specialists in at least one of six population foci. The Board considered the comment and found that the rule not only retains the four recognized specialties but also ensures that nurses are practicing within their area of training and competence. Thus, the Board declined to revise the rule in response to the comment. The Board received a comment expressing concern about which procedures govern the denial of an application for an ARNP license. In response, the Board added new subrule 7.3(7) to clarify that rule 655—3.9(17A,272C) governs such denials.    The Board received comments relating to proposed rule 655—7.8(152) regarding supervision of pharmacists engaged in collaborative drug therapy management. The Board considered the comments and has also learned that the Board of Pharmacy has prefiled legislation that could impact the rule. The Board decided to refrain from moving forward with the rule until the legislation is resolved, so proposed rule 655—7.8(152) has been removed from new Chapter 7. As a consequence of the rule revisions described above, noticed rule 655—7.7(152) is numbered herein as 655—7.8(152).Adoption of Rule Making    This rule making was adopted by the Board on January 9, 2019.Fiscal Impact     This rule making has no fiscal impact to the State of Iowa. Jobs Impact    After analysis and review of this rule making, no impact on jobs has been found.Waivers    Any person who believes that the application of the discretionary provisions of this rule making would result in hardship or injustice to that person may petition the Board for a waiver of the discretionary provisions, if any, pursuant to 655—Chapter 15.Review by Administrative Rules Review Committee    The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making at its regular monthly meeting or at a special meeting. The Committee’s meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).Effective Date    This rule making will become effective on March 20, 2019.    The following rule-making action is adopted:

        ITEM 1.    Rescind 655—Chapter 7 and adopt the following new chapter in lieu thereof: CHAPTER 7ADVANCED REGISTERED NURSE PRACTITIONERS

    655—7.1(17A,124,147,152) Definitions.          "Advanced registered nurse practitioner" "ARNP" means a person who is currently licensed as a registered nurse under Iowa Code chapter 152 or chapter 152E who is licensed by the board as an advanced registered nurse practitioner.        "Board" as used in this chapter means the Iowa board of nursing.        "Collaboration" is the process whereby an ARNP and physician jointly manage the care of a client.         "Controlled substance" means a drug in Schedules II through V of subchapter II of Iowa Code chapter 124.        "Dispense" means to provide a prescription drug to a patient for self-use outside of the ARNP’s practice location. “Dispense” does not include administration.        "National professional certification organization" means the American Academy of Nurse Practitioners, the American Association of Critical Care Nurses, the American Midwifery Certification Board, the American Nurses Credentialing Center, the National Board of Certification and Recertification for Nurse Anesthetists, the National Certification Corporation, and the Pediatric Nursing Certification Board.         "Opioid" means a drug that produces an agonist effect on opioid receptors and is indicated or used for the treatment of pain.        "Prescription monitoring program database" "PMP database" means a centralized database of reportable controlled substance prescriptions dispensed to patients and includes data access logs, security tracking information, and records of each individual who requests prescription monitoring program (PMP) information as operated by the board of pharmacy.

    655—7.2(152) Requirements for licensure as an ARNP.      7.2(1) Qualifications.  An applicant for an ARNP license shall meet the following qualifications:    a.    Hold an active unrestricted license as a registered nurse in accordance with 655—Chapter 3.    b.    Graduation from an accredited graduate or postgraduate advanced practice educational program in one of the following roles, except as provided by subrule 7.2(2):    (1)   Certified nurse-midwife.    (2)   Certified registered nurse anesthetist.    (3)   Certified nurse practitioner.    (4)   Clinical nurse specialist.    c.    Current certification issued by a national professional certification organization as a certified nurse-midwife or certified registered nurse anesthetist, or as a certified nurse practitioner or clinical nurse specialist in at least one of the following population foci:    (1)   Women’s health/gender-related.    (2)   Family (individual across the lifespan).    (3)   Psychiatric mental health.    (4)   Adult/gerontology.    (5)   Pediatrics.    (6)   Neonatal.    7.2(2) Exception.  An applicant who has completed a formal advanced practice educational program but has not graduated from an accredited graduate or postgraduate advanced practice educational program may be licensed as an ARNP provided that the applicant possesses a current certification from a national professional certification organization as described in paragraph 7.2(1)“c.” This exception is intended to allow for the grandfathering of ARNPs who completed educational programs before the board required graduation from an accredited graduate or postgraduate advanced practice educational program.

    655—7.3(17A,147,152) Application process.      7.3(1)   An applicant who wishes to be licensed as an ARNP shall submit the following to the board:     a.    An ARNP application for each population focus.    b.    A dated copy of the applicant’s current advanced level certification issued by the appropriate national professional certification organization.    c.    If the applicant is not licensed as a registered nurse in Iowa, verification of an active registered nurse license in another state recognized for licensure in this state pursuant to the nurse licensure compact contained in Iowa Code chapter 152E.    d.    A nonrefundable license fee of $81.    7.3(2)   The applicant shall request that official transcripts be sent directly to the board from the educational program verifying the coursework, date of completion of the program, and the degree conferred.    7.3(3)   The executive director of the board or the executive director’s designee shall have the authority to determine if all requirements have been met for licensure of the applicant as an ARNP. If all requirements have been met:     a.    The applicant shall be issued a license and a certificate to practice as an ARNP which clearly denotes the applicant’s name, title, and population focus, and the expiration date of the license.     b.    The expiration date of the ARNP license shall be the same as the expiration date of the applicant’s license to practice as a registered nurse.    7.3(4)   Licensure completion. An applicant shall complete the ARNP licensure process within 12 months from the start of the application. The board reserves the right to destroy incomplete application materials after 12 months.    7.3(5)   Renewal of licensure. An ARNP license may be renewed beginning 60 days prior to the license expiration date and ending 30 days after the expiration date. To renew, a licensee shall submit the information required by subrule 7.3(1). The expiration date assigned to a renewed ARNP license shall be the same as the expiration date of the licensee’s license to practice as a registered nurse.     7.3(6)   Inactive status. Failure to renew an ARNP license within 30 days after its expiration shall result in an inactive ARNP license.     a.    Continuing to work as an ARNP with an inactive ARNP license may result in disciplinary action.    b.    To reactivate the license, the licensee must reactivate the underlying license to practice as a registered nurse, if required, and shall complete the license renewal process for the ARNP license.    7.3(7)   License denial. Rule 655—3.9(17A,272C) shall govern the denial of an application for an ARNP license.

    655—7.4(17A,147,152) Advanced nursing practice.      7.4(1)   An ARNP shall practice within the ARNP’s respective population foci. An ARNP shall practice in accordance with the applicable standard of care as described in guidelines published by national professional associations or other reputable sources.     7.4(2)   An ARNP must maintain current certification with a national professional certification organization at all times while the ARNP license is active.    7.4(3)   An ARNP licensed by the board may prescribe, administer, or dispense prescription drugs or devices, including controlled substances, within the ARNP’s role and population foci and consistent with applicable state and federal laws.    7.4(4)   An ARNP shall have the authority to practice to the full extent of the ARNP’s license, education, and experience in the ARNP’s respective population foci. An ARNP may:    a.    Assess health status;    b.    Obtain a relevant health and medical history;    c.    Perform physical examinations;    d.    Order preventive and diagnostic procedures;    e.    Formulate a differential diagnosis;    f.    Develop a treatment plan;    g.    Develop a patient education plan;    h.    Receive third-party reimbursement;    i.    Maintain hospital privileges; and    j.    Promote health maintenance.    7.4(5)   Supervision of fluoroscopy. An ARNP shall be permitted to provide direct supervision in the use of fluoroscopic X-ray equipment, as defined in rule 641—38.2(136C).    a.    The ARNP shall provide direct supervision of fluoroscopy pursuant to the following provisions:    (1)   Completion of an educational course including content in radiation physics, radiobiology, radiological safety and radiation management applicable to the use of fluoroscopy, and maintenance of documentation verifying successful completion.    (2)   Collaboration, as needed, as defined in rule 655—7.1(17A,124,147,152).    (3)   Compliance with facility policies and procedures.    b.    The ARNP shall complete an annual radiological safety course whose content includes, but is not limited to, the time, dose, distance, shielding and effects of radiation.    c.    The ARNP shall maintain documentation of the initial educational course and all annual radiological safety updates.    d.    The initial and annual education requirements are subject to audit by the board pursuant to 655—subrule 5.2(10).     7.4(6)   Only a person currently licensed as an advanced registered nurse practitioner may use that title and the letters “ARNP” after the person’s name. A person currently licensed as an ARNP shall utilize the title “advanced registered nurse practitioner” or the letters “ARNP” after the person’s name. Utilization of the title which denotes the ARNP’s certification or population foci is at the discretion of the ARNP.

    655—7.5(17A,147,152) Standards of practice for treating patients.  An ARNP shall follow the standards of practice for the ARNP’s respective population foci. Prior to treating a patient, an ARNP shall:    7.5(1)   Establish a patient-provider relationship.     7.5(2)   Perform and document the following, or have access to the patient’s health records where all of the following have been documented by other providers in the care team:    a.    Chief complaint;    b.    Pertinent health history;    c.    A focused assessment;    d.    Diagnosis; and    e.    Plan of treatment.

    655—7.6(17A,124,147,152,272C) Standards of practice for controlled substances.  In addition to following the standards of practice for treating a patient described in rule 655—7.5(17A,147,152), an ARNP who prescribes or administers a controlled substance shall practice in accordance with the following:    7.6(1)   The health history shall include a personal and family substance abuse risk assessment, or the documented rationale for not performing the assessment.    7.6(2)   The health record must include documentation of the presence of one or more recognized indications for the use of a controlled substance.    7.6(3)   An ARNP is encouraged to utilize a treatment agreement if continuously prescribing one or more controlled substances.     7.6(4)   Throughout the course of the patient’s treatment, the ARNP shall provide ongoing education that includes, but is not limited to, the risks of using a controlled substance, and information regarding addiction, physical dependence, substance abuse, and tolerance, or document the rationale for not providing the education.    7.6(5)   An ARNP shall maintain an active Drug Enforcement Administration (DEA) registration and an active controlled substances Act (CSA) registration to dispense, prescribe, or administer controlled substances, when required by the DEA and the board of pharmacy.    7.6(6)   An ARNP shall not prescribe a controlled substance to the ARNP’s self or to a family member unless the prescribing occurs in a clinical setting when an emergency situation arises and when there is no other qualified practitioner available to the patient.     7.6(7)   The board may discipline an ARNP for prescribing opioids in dosage amounts that exceed what would be prescribed by a reasonably prudent ARNP in a similar practice.    7.6(8)   An ARNP who has prescribed opioids to a patient during the renewal cycle is required to complete a minimum of two contact hours of continuing education regarding the U.S. Centers for Disease Control and Prevention guideline for prescribing opioids for chronic pain, including recommendations on limitations on dosages and the length of prescriptions, risk factors for abuse, and nonopioid and nonpharmacologic therapy options, as a condition of license renewal every three years. These hours may count towards the 36 contact hours required for license renewal. The ARNP shall maintain documentation of these hours, which may be subject to audit.

    655—7.7(124) Use of the prescription monitoring program.      7.7(1)   Prior to the prescribing or dispensing of an opioid by an ARNP, the ARNP or the ARNP’s authorized delegate shall query the PMP database and the ARNP shall review the patient’s information contained in the PMP database.    7.7(2)   This rule does not apply to an ARNP when treating a patient who is receiving inpatient hospice care or long-term residential facility care.    7.7(3)   This rule does not apply to an ARNP who issues a medication order for an opioid to be administered to a patient at a hospital or clinic, because the ARNP is neither prescribing nor dispensing in this scenario.    7.7(4)   An ARNP is responsible for understanding the board of pharmacy’s rules governing use of the prescription monitoring program in 657—Chapter 37.

    655—7.8(152) Prescribing epinephrine auto-injectors in the name of a facility.      7.8(1)   An ARNP may issue a prescription for one or more epinephrine auto-injectors in the name of a facility as defined in Iowa Code section 135.185(1), a school district, or an accredited nonpublic school.    7.8(2)   An ARNP who prescribes epinephrine auto-injectors in the name of an authorized facility as defined in Iowa Code section 135.185(1), a school district, or an accredited nonpublic school, to be maintained for use pursuant to Iowa Code sections 135.185, 260.16 and 260.16A, provided the ARNP has acted reasonably and in good faith, shall not be liable for any injury arising from the provision, administration, or assistance in the administration of an epinephrine auto-injector.       These rules are intended to implement Iowa Code sections 17A.3, 124.551A, 124.552, 147.2, 147.10, 147.11, 147.72, 147.74, 147.76, 147.80, 147.107, 152.1, 152.6, 152.7, and 272C.2C.        [Filed 1/23/19, effective 3/20/19][Published 2/13/19]Editor’s Note: For replacement pages for IAC, see IAC Supplement 2/13/19.    ARC 4299CProfessional Licensure Division[645]Adopted and Filed

    Rule making related to opioid prescribing practices of a physician assistant

        The Board of Physician Assistants hereby amends Chapter 326, “Licensure of Physician Assistants,” Chapter 327, “Practice of Physician Assistants,” Chapter 328, “Continuing Education for Physician Assistants,” and Chapter 329, “Discipline for Physician Assistants,” Iowa Administrative Code.Legal Authority for Rule Making    This rule making is adopted under the authority provided in Iowa Code sections 147.76 and 148C.5.State or Federal Law Implemented    This rule making implements, in whole or in part, Iowa Code chapters 124, 147, 148, 148C and 272C and 2018 Iowa Acts, House File 2377.Purpose and Summary    2018 Iowa Acts, House File 2377, created new Iowa Code section 124.551A, which requires the Board to adopt rules requiring prescribing practitioners to review patient information in the prescription monitoring program (PMP). New Iowa Code section 147.162 requires the Board to adopt rules to establish penalties for practitioners who overprescribe opioids. New Iowa Code section 272C.2C requires the Board to adopt rules requiring continuing education for opioid prescribers as a condition of license renewal. These amendments mandate physician assistants who prescribe opioids to check the PMP prior to prescribing opioids, require continuing education regarding opioid prescriptions, and permit Board discipline for physician assistants who overprescribe opioids.Public Comment and Changes to Rule Making    Notice of Intended Action for this rule making was published in the Iowa Administrative Bulletin on November 21, 2018, as ARC 4128C. A public hearing was held on December 11, 2018, at 8:30 a.m. in the Fifth Floor Conference Room 526, Lucas State Office Building, Des Moines, Iowa. No one attended the public hearing. No public comments were received. No changes from the Notice have been made.Adoption of Rule Making    This rule making was adopted by the Board on January 16, 2019.Fiscal Impact     This rule making has no fiscal impact to the State of Iowa. Jobs Impact    After analysis and review of this rule making, no impact on jobs has been found.Waivers    A waiver provision is not included in this rule making because all administrative rules of the professional licensure boards in the Professional Licensure Division are subject to the waiver provisions accorded under 645—Chapter 18.Review by Administrative Rules Review Committee    The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making at its regular monthly meeting or at a special meeting. The Committee’s meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).Effective Date    This rule making will become effective on March 20, 2019.    The following rule-making actions are adopted:

        ITEM 1.    Adopt the following new definitions of “Opioid” and “Prescription monitoring program database” in rule 645—326.1(148C):        "Opioid" means a drug that produces an agonist effect on opioid receptors and is indicated or used for the treatment of pain.        "Prescription monitoring program database" "PMP database" means the Iowa prescription monitoring program database administered by the Iowa board of pharmacy pursuant to Iowa Code chapter 124, subchapter VI, and 657—Chapter 37.

        ITEM 2.    Adopt the following new subrule 327.6(3):    327.6(3)   Prior to prescribing an opioid, a physician assistant shall review the patient’s information contained in the prescription monitoring program database, unless the patient is receiving inpatient hospice care or long-term residential facility patient care.

        ITEM 3.    Adopt the following new paragraph 328.3(2)"d":    d.    A licensee who has prescribed opioids to a patient during the renewal cycle shall complete a minimum of two hours of continuing education regarding the guidelines for prescribing opioids for chronic pain, as issued by the Centers for Disease Control and Prevention of the United States Department of Health and Human Services, including recommendations on limitations on dosages and the length of prescriptions, risk factors for abuse, and nonopioid and nonpharmacologic therapy options, as a condition of license renewal. These hours may count toward the 100 hours of continuing education required for license renewal. The licensee shall maintain documentation of these hours, which may be subject to audit.

        ITEM 4.    Adopt the following new subrule 329.2(32):    329.2(32)   Prescribing opioids in dosage amounts that exceed what would be prescribed by a reasonably prudent licensee.    [Filed 1/18/19, effective 3/20/19][Published 2/13/19]Editor’s Note: For replacement pages for IAC, see IAC Supplement 2/13/19.    ARC 4300CProfessional Licensure Division[645]Adopted and Filed

    Rule making related to remote medical sites

        The Board of Physician Assistants hereby amends Chapter 327, “Practice of Physician Assistants,” Iowa Administrative Code.Legal Authority for Rule Making    This rule making is adopted under the authority provided in Iowa Code sections 147.76 and 148C.5.State or Federal Law Implemented    This rule making implements, in whole or in part, Iowa Code chapters 147, 148, 148C and 272C.Purpose and Summary    The amendment changes the care coordination between the supervising physician and the physician assistant working at a remote medical site to include electronic communication that will provide real-time patient assessment and treatment. In accordance with Iowa Code section 148C.5, the Board of Physician Assistants is amending its administrative rules in conjunction with the Board of Medicine (ARC 4213C, IAB 1/2/2019). The amendment is intended to reduce the number of waiver requests to improve administrative efficiency. This rule making is required to comply with Iowa Code sections 147.80 and 148C.5.Public Comment and Changes to Rule Making    Notice of Intended Action for this rule making was published in the Iowa Administrative Bulletin on November 21, 2018, as ARC 4130C. A public hearing was held on December 11, 2018, at 7:30 a.m. in the Fifth Floor Conference Room 526, Lucas State Office Building, Des Moines, Iowa. No one attended the public hearing. Written comments expressed that the amendment creates less flexibility between the supervising physician and physician assistant to decide the appropriate level of communication to staff at a remote medical site. No changes from the Notice have been made.Adoption of Rule Making    This rule making was adopted by the Board on January 16, 2019.Fiscal Impact     This rule making has no fiscal impact to the State of Iowa. Jobs Impact    After analysis and review of this rule making, no impact on jobs has been found.Waivers    A waiver provision is not included in this rule making because all administrative rules of the professional licensure boards in the Professional Licensure Division are subject to the waiver provisions accorded under 645—Chapter 18.Review by Administrative Rules Review Committee    The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making at its regular monthly meeting or at a special meeting. The Committee’s meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).Effective Date    This rule making will become effective on March 20, 2019.    The following rule-making action is adopted:

        ITEM 1.    Amend subrule 327.4(2) as follows:    327.4(2)   AThe supervising physician must visit a remote siteor communicate with the physician assistant at the remote site via electronic communications to provide additional medical direction, medical services and consultation at least every two weeks or less frequently as specified in special circumstances. When visits are less frequent than every two weeks in unusual or emergency circumstances, the board shall be notified in writing of these circumstances.For purposes of this rule, communication may consist of, but shall not be limited to, in-person meetings, two-way interactive communication directly between the supervising physician and the physician assistant via the telephone, secure messaging, electronic mail, or chart review. At least one supervising physician must meet in person with the physician assistant at the remote medical site at least once every six months to evaluate and discuss the medical facilities, resources, and medical services provided at the remote medical site.    [Filed 1/18/19, effective 3/20/19][Published 2/13/19]Editor’s Note: For replacement pages for IAC, see IAC Supplement 2/13/19.    ARC 4309CRevenue Department[701]Adopted and Filed

    Rule making related to updating references to 911

        The Revenue Department hereby amends Chapter 18, “Taxable and Exempt Sales Determined by Method of Transaction or Usage,” Chapter 40, “Determination of Net Income,” and Chapter 224, “Telecommunication Services,” Iowa Administrative Code.Legal Authority for Rule Making    This rule making is adopted under the authority provided in Iowa Code section 421.17.State or Federal Law Implemented    This rule making implements, in whole or in part, 2017 Iowa Acts, Senate File 500.Purpose and Summary    These amendments implement 2017 Iowa Acts, Senate File 500, which in large part amended Iowa Code chapter 34A. Senate File 500 changed the terms “Enhanced 911” and “E911” to “911” in order to reflect the merging of E911 and Next Generation 911 services. The Department is updating references to those terms.Public Comment and Changes to Rule Making    Notice of Intended Action for this rule making was published in the Iowa Administrative Bulletin on December 19, 2018, as ARC 4176C. No public comments were received. No changes from the Notice have been made.Adoption of Rule Making    This rule making was adopted by the Department on January 23, 2019.Fiscal Impact     This rule making has no fiscal impact to the State of Iowa. Jobs Impact    After analysis and review of this rule making, no impact on jobs has been found.Waivers    Any person who believes that the application of the discretionary provisions of this rule making would result in hardship or injustice to that person may petition the Department for a waiver of the discretionary provisions, if any, pursuant to rule 701—7.28(17A).Review by Administrative Rules Review Committee    The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making at its regular monthly meeting or at a special meeting. The Committee’s meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).Effective Date    This rule making will become effective on March 20, 2019.    The following rule-making actions are adopted:

        ITEM 1.    Amend paragraph 18.20(1)"c" as follows:    c.    “Gross receipts” from the sale of communication service in this state shall mean all charges to any person which are necessary for the ultimate user to secure the service, except those charges which are in the nature of a sale for resale (see subrule 18.20(4)). Such charges shall be taxable if the charges are necessary to secure communication service in this state even though payment of the charge may also be necessary to secure other services. Any charge necessary to secure only interstate communication service shall not be subject to tax if the nature of the service is separately stated and the charge for the service separately billed. For the present, the charges imposed by the Federal Communications Commission and referred to as “access charges for interstate or foreign access services” to an “end user” shall not be subject to tax if separately stated and billed.Charges imposed or approved by the utilities division of the department of commerce which are necessary to secure long distance service in this state, for example, “end user intrastate access charges,” are taxable. Such charges are taxable whether they result from an expense incurred from operations or are imposed by the mandate of the utilities division and unrelated to any expense actually incurred in providing the service.If company A collects gross receipts from ultimate users for communication services performed in this state by company B, company A shall treat those gross receipts as its own, collect tax upon them, and remit the tax to the department. The situation is similar to a consignment sale of tangible personal property, and tax must be remitted by the company collecting the gross receipts from the users of the communication services.As of April 4, 1990, the amount of a surcharge for enhanced 911 emergency telephone service shall not be subject to sales tax if the amount is no more than $1 per month per telephone access line and the surcharge is separately identified and separately billed. An enhanced 911 emergency telephone service surcharge is one which routes a 911 call to the appropriate public safety answering point and automatically displays a name, address, and telephone number of an incoming 911 call at that answering point.

        ITEM 2.    Amend rule 701—40.3(422) as follows:

    701—40.3(422) Interest and dividends from foreign securities and securities of state and other political subdivisions.  Interest and dividends from foreign securities and from securities of state and other political subdivisions are to be included in Iowa net income. Certain types of interest and dividends, because of specific exemption, are not includable in income for federal tax purposes. To the extent such income has been excluded for federal income tax purposes, unless the item of income is specifically exempted from state taxation by the laws or constitution of Iowa or of the United States, it must be added to Iowa taxable income.The following is a noninclusive listing of bonds issued by the state of Iowa and its political subdivisions, interest on which is exempt from both federal and state income taxes.
    1. Board of regents: Bonds issued under Iowa Code sections 262.41, 262.51, 262.60, 262A.8, and 263A.6.
    2. Urban renewal: Bonds issued under Iowa Code section 403.9(2).
    3. Municipal housing law - low-income housing: Bonds issued under Iowa Code section 403A.12.
    4. Subdistricts of soil conservation districts, revenue bonds: Bonds issued under Iowa Code section 161A.22.
    5. Aviation authorities, revenue bonds: Bonds issued under Iowa Code section 330A.16.
    6. Rural water districts: Bonds and notes issued under Iowa Code section 357A.15.
    7. County health center: Bonds issued under Iowa Code section 331.441(2)“c”(7).
    8. Iowa finance authority, water pollution control works and drinking water facilities financing: Bonds issued under Iowa Code section 16.131(5).
    9. Iowa finance authority, beginning farmer loan program: Bonds issued under Iowa Code section 16.64.
    10. Iowa finance authority, Iowa comprehensive petroleum underground storage tank fund: Bonds issued under Iowa Code section 455G.6(14).
    11. Iowa finance authority, E911911 program notes and bonds: Bonds issued under Iowa Code section 34A.20(6).
    12. Quad Cities interstate metropolitan authority bonds: Bonds issued under Iowa Code section 28A.24.
    13. Prison infrastructure revenue bonds: Bonds issued under Iowa Code sections 12.80(3) and 16.177(8).
    14. Community college residence halls and dormitories bonds: Bonds issued under Iowa Code section 260C.61.
    15. Community college bond program bonds: Bonds issued under Iowa Code section 260C.71(6).
    16. Interstate bridges bonds: Bonds issued under Iowa Code section 313A.36.
    17. Iowa higher education loan authority: Obligations issued by the authority pursuant to Iowa Code section 261A.27.
    18. Vision Iowa program: Bonds issued pursuant to Iowa Code section 12.71(8).
    19. School infrastructure program bonds: Bonds issued under Iowa Code section 12.81(8).
    20. Honey Creek premier destination park bonds: Bonds issued under Iowa Code section 463C.12(8).
    21. Iowa utilities board and Iowa consumer advocate building project bonds: Bonds issued under Iowa Code section 12.91(9).
    22. Iowa jobs program revenue bonds: Bonds issued under Iowa Code section 12.87(8).
    Interest from repurchase agreements involving obligations of the type discussed in this rule is subject to Iowa income tax. Nebraska Department of Revenue v. John Loewenstein, 513 US 123 (1994). Everett v. State Dept. of Revenue and Finance, 470 N.W.2d 13 (Iowa 1991).For the treatment of interest or dividends from regulated investment companies (mutual funds) that invest in obligations of the type discussed in this rule, see rule 701—40.52(422).Gains and losses from the sale or other disposition of bonds issued by the state of Iowa or its political subdivisions, as distinguished from interest income, shall be taxable for state income tax purposes.       This rule is intended to implement Iowa Code section 422.7 as amended by 2014 Iowa Acts, House File 2438.

        ITEM 3.    Amend rule 701—40.39(422) as follows:

    701—40.39(422) Exemption of interest from bonds or notes issued to fund the E911911 emergency telephone system.  Interest received on or after May 4, 1990, from bonds or notes issued by the Iowa finance authority to fund the E911911 emergency telephone system is exempt from the state income tax.       This rule is intended to implement Iowa Code sections 422.7 and 477B.20.

        ITEM 4.    Amend subrule 224.4(7) as follows:    224.4(7)   Enhanced 911 surcharge. An enhancedA 911 emergency telephone service surcharge is a surcharge for a service which routes a 911 call to the appropriate public safety answering point and automatically displays a name, address, and telephone number of an incoming 911 call at that answering point. A surcharge for enhanced 911 emergency telephone service is not subject to sales tax if:    a.    The amount is no more than $1 per month per telephone access line; and    b.    The surcharge is separately identified and separately billed.

        ITEM 5.    Amend rule 701—224.8(34A), catchwords, as follows:

    701—224.8(34A) Prepaid wireless E911911 surcharge.  

        ITEM 6.    Amend subrule 224.8(1), definition of “Prepaid wireless E911 surcharge,” as follows:        "Prepaid wireless E911911 surcharge" means the surcharge that is required to be collected by a seller from a consumer in the amount established under this rule.

        ITEM 7.    Rescind the definition of “E911” in subrule 224.8(1).

        ITEM 8.    Amend paragraphs 224.8(3)"a", 224.8(3)"c", 224.8(3)"d", 224.8(3)"e" and 224.8(3)"g" as follows:    a.    Each seller is responsible for collecting the applicable E911911 surcharge from the consumer with respect to each retail transaction occurring in this state. A seller may determine whether the transaction occurs in this state by referring to the department rules on the sourcing of sales of prepaid wireless telecommunications service located in paragraph 224.6(2)“b.” See also Iowa Code sections 34A.7B(4), 423.20 and 423.15.    c.    The prepaid wireless E911911 surcharge is the liability of the consumer and not of the seller or any provider, except that the seller shall be liable to remit all prepaid wireless E911911 surcharges that the seller collects from consumers as provided in paragraph 224.8(3)“a,” including all such surcharges that the seller is deemed to collect where the amount of the surcharge has not been separately stated on an invoice, receipt, or similar document provided to the consumer by the seller.    d.    The amount of the prepaid wireless E911911 surcharge that is collected by a seller from a consumer, if such amount is separately stated on an invoice, receipt, or other similar document provided to the consumer by the seller, shall not be included in the base for measuring any tax, fee, other surcharge, or other charge that is imposed by this state, any political subdivision of this state, or any intergovernmental agency.    e.    The seller must complete an E911a 911 Surcharge Schedule and the surcharge portion of the Iowa Sales Tax and Surcharge Return or Iowa Retailer’s Use Tax and Surcharge Return and file the information with the department.    g.    The seller may deduct and retain 3 percent of prepaid wireless E911911 surcharges that are collected by the seller from consumers.

        ITEM 9.    Amend paragraph 224.8(4)"a" as follows:    a.    The audit and appeal procedures applicable to sales and use tax under Iowa Code chapter 423 shall apply to the prepaid wireless E911911 surcharge. See also Iowa Code sections 421.10 and 421.60.

        ITEM 10.    Amend subrule 224.8(6) as follows:    224.8(6) Procedures for remitting the surcharge to the treasurer.  The department shall transfer all remitted prepaid wireless E911911 surcharges to the treasurer of state for deposit in the E911911 emergency communications fund created under Iowa Code section 34A.7A, subsection 2,34A.7A(2) within 30 days of receipt of the E911911 surcharge from sellers. Prior to remitting the surcharges to the treasurer, the department shall deduct and retain an amount, not to exceed 2 percent of collected surcharges, to reimburse the department’s direct costs of administering the collection and remittance of prepaid wireless E911911 surcharges.    [Filed 1/24/19, effective 3/20/19][Published 2/13/19]Editor’s Note: For replacement pages for IAC, see IAC Supplement 2/13/19.    ARC 4310CRevenue Department[701]Adopted and Filed

    Rule making related to securing payment of deferred inheritance tax

        The Revenue Department hereby amends Chapter 86, “Inheritance Tax,” Iowa Administrative Code.Legal Authority for Rule Making    This rule making is adopted under the authority provided in Iowa Code section 421.17.State or Federal Law Implemented    This rule making implements, in whole or in part, Iowa Code section 450.48 as amended by 2018 Iowa Acts, Senate File 2303.Purpose and Summary    Prior to July 1, 2018, estates containing personal property, real property, or a mix of both were required to provide a bond security to secure payment of deferred inheritance tax. During the 2018 Legislative Session, the Legislature amended Iowa Code section 450.48 to add other options in lieu of a bond for securing deferred payment. These amendments reflect the statutory change.Public Comment and Changes to Rule Making    Notice of Intended Action for this rule making was published in the Iowa Administrative Bulletin on December 19, 2018, as ARC 4177C. No public comments were received. Minor grammatical changes from the Notice have been made.Adoption of Rule Making    This rule making was adopted by the Department on January 23, 2019.Fiscal Impact     This rule making has no fiscal impact to the State of Iowa. The Fiscal Note for 2018 Iowa Acts, Senate File 2303, also identified no fiscal impact. Jobs Impact    After analysis and review of this rule making, no impact on jobs has been found.Waivers    Any person who believes that the application of the discretionary provisions of this rule making would result in hardship or injustice to that person may petition the Department for a waiver of the discretionary provisions, if any, pursuant to rule 701—7.28(17A).Review by Administrative Rules Review Committee    The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making at its regular monthly meeting or at a special meeting. The Committee’s meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).Effective Date    This rule making will become effective on March 20, 2019.    The following rule-making actions are adopted:

        ITEM 1.    Amend subrule 86.14(9) as follows:    86.14(9) Deferred life estates and remainder interest.      a.    A deferred estate generally occurs as the result of a decedent granting a life estate in property to one person withthe remainder of the property to another. In such cases, the determination of the tax on the remainder interest to be received by the remainderman may be deferred until the determination of the previous life estate pursuant to Iowa Code section 450.46. Tax on a remainder interest that has been deferred is valued pursuant to Iowa Code section 450.37, with no reduction based on the previous life estate. Tax due on a deferred interest must be paid before the last day of the ninth month from the date of the death ofthe life tenant pursuant to Iowa Code section 450.46. PenaltyPenalties and interest isare not imposed if the tax is paid before the last day of the ninth month from the date of the death ofthe life tenant. If the death of the decedent occurred before July 1, 1981, the tax due on a deferred interest must be paid before the last day of the twelfth month from the date of the death ofthe life tenant. Deferment may be elected due to the fact that the remainder interest is contingent and because the value of the remainder interest may be significantly altered from the time of the decedent’s death until the death of the life tenant. A request for deferment may be made on a completed department form, and the completed form, with any required documentation, may be filed with the department on or before the due date of the inheritance tax return. Failure to file a completed department form requesting a deferral of tax on the remainder interest with the inheritance tax return will allow the department to provide an automatic deferral for qualifying remainder interests.    b.    If deferral is chosen, an inheritance tax clearance cannot be issued for the estate. Expenses cannot be used to offset the value of the deferred remainder interest. Based upon Iowa Code section 450.12, deductible expenses must be expenses paid by the estate. Expenses incurred by a deferred remainder interest would not qualify based on Iowa Code section 450.12 as deductible expenses. Pursuant to Iowa Code section 450.52, the owner of a deferred remainder interest may choose to pay the tax on the present value of the remainder interest and have the lien on such an interest removed prior to the termination of the previous life estate. If early termination of the deferred remainder interest occurs, the value of the remainder interest will be reduced by the value of remaining previous life estate.    c.    If the tax on an estate is deferred, a bond may have to be filed with the proper clerk of the district court. This bond must remain effective until the tax on the deferred estate is paid. Failure to maintain or properly renew the bond will result in the bond’s being declared forfeited, and the amount collected. For additional details regarding obtaining a bond, see Iowa Code sections 450.49 and 450.50.The estate may secure payment of the deferred tax by providing other security in lieu of a bond, including but not limited to securities named in Iowa Code section 450.48(2) and securities deemed satisfactory by the department.

        ITEM 2.    Amend rule 701—86.14(450), implementation sentence, as follows:       This rule is intended to implement Iowa Code chapterchapters450, Iowa Code Supplement chapterand633E, and 2005 Iowa Acts, chapter 38.    [Filed 1/24/19, effective 3/20/19][Published 2/13/19]Editor’s Note: For replacement pages for IAC, see IAC Supplement 2/13/19.    ARC 4311CRevenue Department[701]Adopted and Filed

    Rule making related to the flood mitigation program

        The Revenue Department hereby amends Chapter 238, “Flood Mitigation Program,” Iowa Administrative Code.Legal Authority for Rule Making    This rule making is adopted under the authority provided in Iowa Code section 421.17.State or Federal Law Implemented    This rule making implements, in whole or in part, Iowa Code section 418.13 as amended by 2018 Iowa Acts, House File 2258.Purpose and Summary    During the 2018 Legislative Session, the Legislature added language to Iowa Code section 418.13 to specify that a governmental entity may use moneys from an account for reimbursements for funds advanced internally or to help make payments on bonds incurred to pay for projects approved by the Flood Mitigation Board before, on, or after July 1, 2018. These amendments to rule 701—238.4(418) regarding the use of moneys from a flood mitigation fund reflect the statutory change.Public Comment and Changes to Rule Making    Notice of Intended Action for this rule making was published in the Iowa Administrative Bulletin on December 19, 2018, as ARC 4175C. No public comments were received. No changes from the Notice have been made.Adoption of Rule Making    This rule making was adopted by the Department on January 23, 2019.Fiscal Impact     This rule making has no fiscal impact to the State of Iowa. The Fiscal Note for House File 2258 estimates no impact to the General Fund and notes that the law change could have a positive fiscal impact for local governments. Jobs Impact    After analysis and review of this rule making, no impact on jobs has been found.Waivers    Any person who believes that the application of the discretionary provisions of this rule making would result in hardship or injustice to that person may petition the Department for a waiver of the discretionary provisions, if any, pursuant to rule 701—7.28(17A).Review by Administrative Rules Review Committee    The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making at its regular monthly meeting or at a special meeting. The Committee’s meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).Effective Date    This rule making will become effective on March 20, 2019.    The following rule-making actions are adopted:

        ITEM 1.    Amend paragraph 238.4(4)"c" as follows:    c.    Requests for remittance shall be made for the amount of moneys in the governmental entity’s account necessary to pay the governmental entity’s costs or obligations related to the project, according to the sales tax revenue funding needs specified in the approved project plan. A governmental entity shall not, however, during any fiscal year receive remittances under this rule exceeding $15 million or 70 percent of the total yearly amount of increased sales tax increment revenue in the governmental entity’s applicable area and deposited in the governmental entity’s account or the annual maximum amount established by the board pursuant to Iowa Code section 418.9(4), whichever is less.

        ITEM 2.    Renumber subrules 238.4(5) to 238.4(7) as 238.4(6) to 238.4(8).

        ITEM 3.    Adopt the following new subrule 238.4(5):    238.4(5) Authorized expenditures.      a.    Requests for remittance shall be made for the amount of moneys in the governmental entity’s account necessary to pay the governmental entity’s costs or obligations related to the project, according to the sales tax revenue funding needs specified in the approved project plan.     b.    Allowed costs or obligations under Iowa Code section 418.13(1) include the costs of the approved project, reimbursements for funds advanced internally or to help make payments on bonds incurred to pay for approved projects, and principal and interest on bonds issued under Iowa Code section 418.14.

        ITEM 4.    Amend rule 701—238.4(418), implementation sentence, as follows:       This rule is intended to implement Iowa Code sectionsections418.12and 418.13.    [Filed 1/24/19, effective 3/20/19][Published 2/13/19]Editor’s Note: For replacement pages for IAC, see IAC Supplement 2/13/19.    ARC 4301CWorkforce Development Department[871]Adopted and Filed

    Rule making related to vocational training eligibility requirements

        The Director of the Workforce Development Department hereby amends Chapter 24, “Claims and Benefits,” Iowa Administrative Code.Legal Authority for Rule Making    This rule making is adopted under the authority provided in Iowa Code section 96.11.State or Federal Law Implemented    This rule making implements, in whole or in part, Iowa Code chapter 96.Purpose and Summary    This amendment updates the Department’s eligibility criteria for a waiver of work search requirements for claimants attending approved training programs. The amendment clearly states the expectations that must be met in order for a claimant to be approved for the program. Public Comment and Changes to Rule Making    Notice of Intended Action for this rule making was published in the Iowa Administrative Bulletin on December 19, 2018, as ARC 4174C. No public comments were received. No changes from the Notice have been made.Adoption of Rule Making    This rule making was adopted by the Director of the Department on January 23, 2019.Fiscal Impact     This rule making has no fiscal impact to the State of Iowa. Jobs Impact    After analysis and review of this rule making, no impact on jobs has been found.Waivers    Any person who believes that the application of the discretionary provisions of this rule making would result in hardship or injustice to that person may petition the Department for a waiver of the discretionary provisions, if any. Review by Administrative Rules Review Committee    The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making at its regular monthly meeting or at a special meeting. The Committee’s meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).Effective Date    This rule making will become effective on March 20, 2019.    The following rule-making action is adopted:

        ITEM 1.    Amend subrule 24.39(2) as follows:    24.39(2)   A claimant may receive unemployment insurance while attending a training course approved by the department, under the following conditions:    a.    The educational establishment must be a college, university or technical training institution.    b.    The training must be completed 104 weeks or less from the start date.    c.    The individual must be enrolled and attending the training programin person as a full-time student.While attending the approved training course, the claimant need not be available for work or actively seeking work, except if the hours of the training are outside the regular hours worked in the base period employment. After completion of department-approved training, the claimant must, in order to continue to be eligible for unemployment insurance, place no restriction on employability. The claimant must be able to work, be available for work and be actively searching for work. In addition, the claimant may be subject to disqualification for any refusal of work without good cause after the claimant has completed the training.    [Filed 1/23/19, effective 3/20/19][Published 2/13/19]Editor’s Note: For replacement pages for IAC, see IAC Supplement 2/13/19.
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