Proposing rule making related to five-year review of rules and providing an opportunity for public comment
The Corrections Department hereby proposes to amend Chapter 1, “Departmental Organization and Procedures,” and Chapter 20, “Institutions Administration,” Iowa Administrative Code.Legal Authority for Rule Making This rule making is proposed under the authority provided in Iowa Code section 904.108.State or Federal Law Implemented This rule making implements, in whole or in part, Iowa Code section 904.108.Purpose and Summary All of the Department’s rules were reviewed as part of the comprehensive five-year review required under Iowa Code section 17A.7. These proposed amendments are designed to eliminate outdated or redundant rules, update Iowa Administrative Code language and eliminate any rules that are inconsistent or incompatible with statutes or other rules. The proposed amendments to Chapter 1 reflect updates to the Department’s internal structure, such as prison telephone numbers and staff job responsibilities. The proposed amendments to Chapter 20 include:
Proposing rule making related to declaratory orders and providing an opportunity for public comment
The Human Services Department hereby proposes to amend Chapter 5, “Declaratory Orders,” Iowa Administrative Code.Legal Authority for Rule Making This rule making is proposed under the authority provided in Iowa Code section 17A.9.State or Federal Law Implemented This rule making implements, in whole or in part, Iowa Code section 17A.9.Purpose and Summary This proposed rule making is part of the Department’s five-year rules review process. This rule making makes changes to contact information and nonsubstantive changes to verbiage for consistency throughout the agency’s rules.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 June 7, 2022. Comments should be directed to: Nancy Freudenberg Department of Human Services Hoover State Office Building, Fifth Floor 1305 East Walnut Street Des Moines, Iowa 50319-0114 Email: appeals@dhs.state.ia.us Public 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 441—5.1(17A) as follows:441—5.1(17A) Petition for declaratory order. Any person may file a petition with the department for a declaratory order as to the applicability to specified circumstances of a statute, rule, or order within the primary jurisdiction of the department at the OfficeBureau of Policy AnalysisCoordination, Department of Human Services, Hoover State Office Building,Fifth Floor, 1305 East Walnut, Des Moines, Iowa 50319-0114, or at appeals@dhs.state.ia.us. A petition is deemed filed when it is received by that office.The date of receipt of a petition is the day it reaches the department’s rules administrator. The department shall provide the petitioner with a file-stamped copy of the petition if the petitioner provides the department an extra copy for this purpose. The petition mustshall be typewritten or legibly handwritten in ink and shouldshall substantially conform to the following form:BEFORE THE DEPARTMENT OF HUMAN SERVICES Petition by (Name of Petitioner) for aDeclaratory Order on (Cite provisions oflaw involved). } PETITION FORDECLARATORY ORDERThe petition mustshall provide the following information:- A clear and concise statement of all relevant facts on which the order is requested. For public assistance policy rulings, the request should state facts such as the amount of income and resources of a person who may be affected by the policy.
- A citation and the relevant language of the specific statutes, rules, or orders, whose applicability is questioned, and any other relevant law.
- The questions petitioner wants answered, stated clearly and concisely.
- The answers to the questions desired by the petitioner and a summary of the reasons urged by the petitioner in support of those answers. A request which seeks to change rather than to declare or determine policy will be denied.
- The reasons for requesting the declaratory order and disclosure of the petitioner’s interest in the outcome.
- A statement indicating whether the petitioner is currently a party to another proceeding involving the questions at issue and whether, to the petitioner’s knowledge, those questions have been decided by, are pending determination by, or are under investigation by, any governmental entity.
- The names and addresses of other persons, or a description of any class of persons, known by the petitioner to be affected by, or interested in, the questions presented in the petition.
- Any request by the petitioner for a meeting provided for by rule 441—5.7(17A).
- The petitioner’s state identification number, if applicable.
- Facts supporting the intervenor’s standing and qualifications for intervention.
- The answers urged by the intervenor to the question or questions presented and a summary of the reasons urged in support of those answers.
- Reasons for requesting intervention and disclosure of the intervenor’s interest in the outcome.
- A statement indicating whether the intervenor is currently a party to any proceeding involving the questions at issue and whether, to the intervenor’s knowledge, those questions have been decided by, are pending determination by, or are under investigation by, any governmental entity.
- The names and addresses of any additional persons, or a description of any additional class of persons, known by the intervenor to be affected by, or interested in, the questions presented.
- Whether the intervenor consents to be bound by the determination of the matters presented by the declaratory order proceeding.
Proposing rule making related to food program terminology and family self-sufficiency grants program and providing an opportunity for public comment
The Human Services Department hereby proposes to amend Chapter 47, “Diversion Initiatives,” Iowa Administrative Code.Legal Authority for Rule Making This rule making is proposed under the authority provided in Iowa Code chapter 239B and section 234.6.State or Federal Law Implemented This rule making implements, in whole or in part, Iowa Code chapter 239B and section 234.6 and 7 CFR Part 273.Purpose and Summary As part of the Department’s five-year rules review process, this proposed rule making updates the name of Iowa’s food assistance program in Division I of Chapter 47. The formal name of Iowa’s program has been changed from the Food Assistance Program to the Supplemental Nutrition Assistance Program (SNAP) to be consistent with the name of the federal program and to alleviate confusion around food benefits that are available. Division II of Chapter 47 relates to the Family Self-Sufficiency Grants Program. This proposed rule making clarifies that the Bureau of Refugee Services can provide PROMISE JOBS services to refugees who have not yet obtained United States citizenship. A family self-sufficiency grant shall be authorized for removing an identified barrier to self-sufficiency that will enable a PROMISE JOBS participant to either obtain new employment or retain existing employment. This proposed rule making also clarifies the duties of the Department’s division administrator relating to issuing payments and approving local plans for family self-sufficiency grants.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 June 7, 2022. Comments should be directed to: Nancy Freudenberg Department of Human Services Hoover State Office Building, Fifth Floor 1305 East Walnut Street Des Moines, Iowa 50319-0114 Email: appeals@dhs.state.ia.us Public 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 441—Chapter 47, Division I preamble, as follows:PreambleThese rules implement the Iowa promoting awareness of the benefits of a healthy marriage program. This program uses federal funds from the Temporary Assistance to Needy Families (TANF) block grant to provide information to certain households about the benefits of a healthy and stable marriage. Eligibility for this program also establishes categorical eligibility for the Iowa food assistance programsupplemental nutrition assistance program (SNAP) under 441—Chapter 65. ITEM 2. Amend rule 441—47.1(234), introductory paragraph, as follows:441—47.1(234) Eligibility criteria. Eligibility for the promoting awareness of the benefits of a healthy marriage program is always determined in conjunction with determination of eligibility for food assistanceSNAP under 441—Chapter 65. ITEM 3. Amend subrule 47.1(1) as follows: 47.1(1) Application. There is no separate application for the program. Eligibility for the program is determined whenever the department determines a household’s eligibility for food assistanceSNAP. ITEM 4. Amend subrules 47.1(4) and 47.1(5) as follows: 47 47.1 1(4) Otherwise eligible for food assistanceSNAP. The household must meet all eligibility criteria for food assistanceSNAP except as provided in this rule. A household that includes a member who is currently disqualified from food assistanceSNAP due to an intentional program violation is not eligible for the program. 47 47.1 1(5) Minimum food assistanceSNAP benefit. The household must be eligible for a monthly food assistanceSNAP benefit greater than zero. Households with a monthly food assistanceSNAP benefit of zero are not eligible for the program. ITEM 5. Amend paragraph 47.2(2)"b" as follows: b. The household’s food assistanceSNAP certification period under 441—Chapter 65 ends. ITEM 6. Amend rule 441—47.21(239B), definition of “Bureau of refugee services,” as follows: "Bureau of refugee services" or “BRS” means a unit of the department of human services that provides PROMISE JOBS services to refugeeswho have not obtained United States citizenship. ITEM 7. Amend subrule 47.22(2) as follows: 47.22(2) The program shall be available for use by the bureau of refugee services (BRS) for PROMISE JOBS participants who are refugeeswho have not obtained United States citizenship, as delineated in the PROMISE JOBS agreement. ITEM 8. Amend rule 441—47.24(239B), introductory paragraph, as follows:441—47.24(239B) Assistance available in family self-sufficiency grants. Family self-sufficiency grants shall be authorized for removing an identified barrier to self-sufficiency when it can be reasonably anticipated that the assistance will enable PROMISE JOBS participant families toobtain or retain employment or obtain employment in the two full calendar months following the date of authorization of payment. For example, if a payment is authorized on August 20, it should be anticipated that the participant can find employment in September or October. ITEM 9. Amend subrule 47.24(2) as follows: 47.24(2) Types of assistance. The department, in conjunction with IWD and BRS, shall determine those barriers to self-sufficiency which can be considered for family self-sufficiency grants such as, but not limited to, auto maintenance or repair, licensing fees, child care, and referral to other resources, including those necessary to address questions of domestic violence. The IWD service delivery areas and BRS shall have the opportunity to adjust the list of approvable barriers to self-sufficiency based on local resources and circumstances. These adjustments shall be approved by thedepartment division administrator and the appropriate responsible administrator prior to implementation. ITEM 10. Amend subrule 47.24(5) as follows: 47.24(5) Supplanting. Family self-sufficiency grants shall not be used for services already available throughthe department, PROMISE JOBS, or other local resources at no cost. ITEM 11. Amend subrule 47.24(7) as follows: 47.24(7) Issuing payments. Family self-sufficiency grants are PROMISE JOBS benefits and shall be authorized through the PROMISE JOBS expense allowance system. WarrantsPayments may be issued to the participants or to a vendor for support services provided to the family. Thedepartment division administrator in conjunction with the appropriate responsible administrator shall have discretion in determining method of payment. The IWD service delivery area or BRS shall have the opportunity to adjust these payment options in an individual case based on circumstances and needs of the family with the approval of thedepartment division administrator and the appropriate responsible administrator prior to implementation. ITEM 12. Amend paragraph 47.25(1)"d" as follows: d. Demonstration of how removing the barrier is related toobtaining or retaining or obtaining employment, meeting the criteria from rule 441—47.24(239B). ITEM 13. Amend rule 441—47.26(239B), introductory paragraph, as follows:441—47.26(239B) Approved local plans for family self-sufficiency grants. Each IWD service delivery area shall create and provide to IWD the written policies and procedures for administering family self-sufficiency grants. BRS shall create and provide to the department the written policy and procedures for administering family self-sufficiency grants. The plan shall be reviewed for required elements and quality of service to ensure that it meets the purpose of the program and approved by the department division administrator and the IWD divisionappropriate responsible administrator. The written policies and procedures shall be available to the public at county offices, PROMISE JOBS offices, and at IWD. At a minimum, these policies and procedures shall contain or address the following: ITEM 14. Amend paragraph 47.26(1)"b" as follows: b. How determinations will be made that the service or assistance requested meets the program’s objective of helping the familyobtain or retain employment or obtain employment.ARC 6329CHuman Services Department[441]Notice of Intended ActionProposing rule making related to the foster home insurance fund and providing an opportunity for public comment
The Human Services Department hereby proposes to amend Chapter 158, “Foster Home Insurance Fund,” Iowa Administrative Code.Legal Authority for Rule Making This rule making is proposed under the authority provided in Iowa Code section 237.3.State or Federal Law Implemented This rule making implements, in whole or in part, Iowa Code section 237.3.Purpose and Summary Chapter 158 was reviewed as part of the Department’s five-year rules review project. This proposed rule making updates the insurance coverage under the Foster Home Insurance Fund to include auto damage by foster children as a covered expense. This rule making does not change the premium or the total costs the Department currently pays.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 June 7, 2022. Comments should be directed to:Nancy Freudenberg Department of Human Services Hoover State Office Building, Fifth Floor 1305 East Walnut Street Des Moines, Iowa 50319-0114 Email: appeals@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 action is proposed:
ITEM 1. Amend paragraph 158.3(1)"b" as follows: b. Compensation to licensed foster families for personal or real property damageand auto physical damage as a result of the activities of the family foster care child. Coverage also extends to third-party property damages caused by actions of the foster child.ARC 6322CPublic Health Department[641]Notice of Intended ActionProposing rule making related to congenital and inherited disorders and providing an opportunity for public comment
The Public Health Department hereby proposes to amend Chapter 4, “Center for Congenital and Inherited Disorders,” Iowa Administrative Code.Legal Authority for Rule Making This rule making is proposed under the authority provided in Iowa Code section 136A.8 and 2022 Iowa Acts, Senate File 2345.State or Federal Law Implemented This rule making implements, in whole or in part, Iowa Code chapter 136A and 2022 Iowa Acts, Senate File 2345.Purpose and Summary The proposed amendments will accomplish the following:
Proposing rule making related to AIDS drug assistance program eligibility requirements and providing an opportunity for public comment
The Public Health Department hereby proposes to amend Chapter 11, “Human Immunodeficiency Virus (HIV) Infection and Acquired Immune Deficiency Syndrome (AIDS),” Iowa Administrative Code.Legal Authority for Rule Making This rule making is proposed under the authority provided in Iowa Code chapter 141A.State or Federal Law Implemented This rule making implements, in whole or in part, Iowa Code section 141A.3(1).Purpose and Summary The proposed amendments increase the eligibility for the AIDS Drug Assistance Program (ADAP) from 400 percent of the federal poverty level (FPL) to 500 percent of the FPL for medication and insurance assistance. The proposed amendments also modify the requirements for medication assistance to account for some health plans that do not allow the ADAP to assist with insurance costs or that are not cost effective for the ADAP to support.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 the Department’s waiver provisions contained in 641—Chapter 178.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 June 7, 2022. Comments should be directed to: Randy Mayer Department of Public Health Lucas State Office Building 321 East 12th Street Des Moines, Iowa 50319 Email: randall.mayer@idph.iowa.gov Public 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. Amend rule 641—11.43(141A) as follows:641—11.43(141A) Eligibility requirements. 11.43(1) An applicant is eligible to participate in the ADAP medication assistance program if the applicant: a. Applies for enrollment in ADAP on a form provided by the department; b. Has no health insurance to cover the cost of the drugs that are or may become available from ADAP, or has insurance that is determined by the department to be incompatible with or cost-ineffective for the ADAP insurance assistance program; c. Is currently being prescribed a drug on the ADAP formulary; d. Has an annual income that is less than or equal to 400500 percent of the poverty level as determined by the most recent federal poverty guidelines published annually by the U.S. Department of Health and Human Services for the size of the household; e. Has a medical diagnosis of HIV infection or AIDS or is an unborn infant or an infant under 18 months of age who has an HIV-infected mother; and f. Is a resident of Iowa. 11.43(2) An applicant is eligible to participate in the ADAP health insurance assistance program if the applicant: a. Applies for enrollment in ADAP on a form provided by the department; b. Has creditable health insurance coverageor meets the enrollment qualifications for an ADAP-sponsored health plan; c. Is currently being prescribed a drug on the ADAP formulary; d. Has an annual income that is less than or equal to 400500 percent of the poverty level as determined by the most recent federal poverty guidelines published annually by the U.S. Department of Health and Human Services for the size of the household; e. Has a medical diagnosis of HIV infection or AIDS or is an unborn infant or an infant under 18 months of age who has an HIV-infected mother; and f. Is a resident of Iowa.ARC 6325CPublic Health Department[641]Notice of Intended ActionProposing rule making related to certification examinations for limited radiologic technologists and continuing education requirements and providing an opportunity for public comment
The Public Health Department hereby proposes to amend Chapter 42, “Permit to Operate Ionizing Radiation Producing Machines or Administer Radioactive Materials,” Iowa Administrative Code.Legal Authority for Rule Making This rule making is proposed under the authority provided in Iowa Code sections 136C.3 and 136C.12.State or Federal Law Implemented This rule making implements, in whole or in part, Iowa Code chapter 136C.Purpose and Summary The proposed amendments address changes made in the American Registry of Radiologic Technologists (ARRT) policies and procedures. The ARRT is recognized by national accreditation entities and regulatory bodies, including the Department, as the national certification entity for radiologic technologists, nuclear medicine technologists, radiation therapists, and radiologist assistants. The ARRT also provides the examination for limited radiologic technologists approved by the Department as eligible to take the examination. The Department tries to align rules with ARRT requirements whenever possible to reduce duplication, conflicting requirements, and burden on the regulated community. The amendment to subparagraph 42.9(2)“e”(3) removes the requirement for limited radiologic technologists to pay a fee to the Department for the limited radiography examination administered by the ARRT through an agreement with the Department. The ARRT is now charging this fee directly to the applicant; consequently, applicants will not need to pay the Department a fee for this service. The amendments to paragraphs 42.18(2)“b” and 42.18(2)“c” change the continuing education (CE) limitation for repeating certain CE courses. The ARRT made the change to allow a CE course to be repeated in future biennia; therefore, the Department is removing its restriction because of the conflict with ARRT requirements.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 the Department’s waiver provisions contained in 641—Chapter 178.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 June 7, 2022. Comments should be directed to:Angela Leek Department of Public Health Bureau of Radiological Health Lucas State Office Building 321 East 12th Street Des Moines, Iowa 50319 Email: radhealthia@idph.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 subparagraph 42.9(2)"e" as follows: (3) Each individual making application to take an examination as a limited radiologic technologist in 42.9(2)“e”(1)“1” or “3” must submit an application and nonrefundableto the department each time the individual takes the examination. The individual must also submit the examination fee of $200 to the departmentdirectly to the ARRT each time the individual takes the examination. ITEM 2. Amend paragraph 42.18(2)"b" as follows: b. Continuing education activities that are lecture presentations may not be repeated for credit in the same bienniumbut may be repeated across different biennia. ITEM 3. Rescind paragraph 42.18(2)"c".ARC 6326CPublic Health Department[641]Notice of Intended ActionProposing rule making related to WIC online ordering project and providing an opportunity for public comment
The Public Health Department hereby proposes to amend Chapter 73, “Special Supplemental Nutrition Program for Women, Infants, and Children (WIC),” Iowa Administrative Code.Legal Authority for Rule Making This rule making is proposed under the authority provided in Iowa Code section 135.11.State or Federal Law Implemented This rule making implements, in whole or in part, 20 U.S.C. Section 1786 and Iowa Code section 135.11.Purpose and Summary This proposed amendment will ensure that Iowa can move forward with the federal WIC Online Ordering Pilot Project by allowing a WIC participant, vendor, or contract agency to participate in the project.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 the Department’s waiver provisions contained in 641—Chapter 178.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 June 7, 2022. Comments should be directed to: Jill Lange Department of Public Health Lucas State Office Building 321 East 12th Street Des Moines, Iowa 50319 Email: jill.lange@idph.iowa.gov Public 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. Adopt the following new rule 641—73.26(135):641—73.26(135) WIC online ordering project. Notwithstanding any conflicting provision of law to the contrary, a participant, vendor, or contract agency may participate in the WIC online ordering project, provided that such participation conforms to the terms and conditions of the Iowa WIC Policy and Procedure Manual as modified to incorporate the WIC online ordering project.ARC 6319CEconomic Development Authority[261]Adopted and FiledRule making related to program funding and requirements
The Economic Development Authority (IEDA) hereby amends Chapter 7, “Iowa Jobs Training Program,” Chapter 42, “Iowa Tourism Grant Program,” Chapter 81, “Renewable Chemical Production Tax Credit Program,” Chapter 220, “Rural Housing Needs Assessment Grant Program,” and Chapter 221, “Rural Innovation Grant 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 chapter 260F; Iowa Code sections 15.108 and 15.320; 2021 Iowa Acts, House File 699; and 2019 Iowa Acts, Senate File 608.Purpose and Summary The IEDA is adopting the following corrective and clarifying amendments:
Rule making related to discontinued programs
The Economic Development Authority (IEDA) hereby rescinds Chapter 9, “Workforce Training and Economic Development Funds,” Chapter 11, “Certified School to Career Program,” Chapter 25, “Housing Fund,” Chapter 28, “Local Housing Assistance Program,” Chapter 29, “Homeless Shelter Operation Grants Program,” Chapter 30, “Job Opportunities for Persons with Disabilities Program,” Chapter 33, “Iowa Wine and Beer Promotion Grant Program,” Chapter 53, “Community Economic Betterment Account (CEBA) Program,” Chapter 57, “Value-Added Agricultural Products and Processes Financial Assistance Program (VAAPFAP),” Chapter 58, “New Jobs and Income Program,” Chapter 61, “Physical Infrastructure Assistance Program (PIAP),” Chapter 62, “Cogeneration Pilot Program,” Chapter 63, “University-Based Research Utilization Program,” Chapter 64, “New Capital Investment Program,” Chapter 67, “Life Science Enterprises,” Chapter 69, “Loan and Credit Guarantee Program,” Chapter 74, “Grow Iowa Values Financial Assistance Program,” Chapter 80, “Iowa Small Business Loan Program,” Chapter 103, “Information Technology Training Program,” Chapter 107, “Targeted Industries Networking Fund,” Chapter 109, “Targeted Industries Career Awareness Fund,” Chapter 111, “Supply Chain Development Program,” Chapter 311, “Renewable Fuel Infrastructure Board—Organization,” Chapter 312, “Renewable Fuel Infrastructure Program for Retail Motor Fuel Sites,” Chapter 313, “Renewable Fuel Infrastructure Program for Biodiesel Terminal Grants,” Chapter 314, “Renewable Fuel Infrastructure Program Administration,” and Chapter 402, “Energy Efficiency Community Grant 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, 1998 Iowa Acts, Senate File 2296; 2003 Iowa Acts, House Files 391 and 692; 2005 Iowa Acts, House Files 868 and 882; 2008 Iowa Acts, Senate File 2136; 2009 Iowa Acts, Senate File 344; 2011 Iowa Acts, House Files 590 and 648; 2012 Iowa Acts, House File 2473; 2013 Iowa Acts, House File 604; and 2020 Iowa Acts, House File 2536.Purpose and Summary The IEDA is rescinding rule chapters relating to programs that have been repealed, transferred to other agencies, or otherwise discontinued.Public Comment and Changes to Rule Making Notice of Intended Action for this rule making was published in the Iowa Administrative Bulletin on February 23, 2022, as ARC 6203C. No public comments were received. No changes from the Notice have been made.Adoption of Rule Making This rule making was adopted by the Authority Board on April 22, 2022.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 IEDA 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 June 22, 2022. The following rule-making actions are adopted:
ITEM 1. Rescind and reserve 261—Chapter 9. ITEM 2. Rescind and reserve 261—Chapter 11. ITEM 3. Rescind and reserve 261—Chapter 25. ITEM 4. Rescind and reserve 261—Chapter 28. ITEM 5. Rescind and reserve 261—Chapter 29. ITEM 6. Rescind and reserve 261—Chapter 30. ITEM 7. Rescind and reserve 261—Chapter 33. ITEM 8. Rescind and reserve 261—Chapter 53. ITEM 9. Rescind and reserve 261—Chapter 57. ITEM 10. Rescind and reserve 261—Chapter 58. ITEM 11. Rescind and reserve 261—Chapter 61. ITEM 12. Rescind and reserve 261—Chapter 62. ITEM 13. Rescind and reserve 261—Chapter 63. ITEM 14. Rescind and reserve 261—Chapter 64. ITEM 15. Rescind and reserve 261—Chapter 67. ITEM 16. Rescind and reserve 261—Chapter 69. ITEM 17. Rescind and reserve 261—Chapter 74. ITEM 18. Rescind and reserve 261—Chapter 80. ITEM 19. Rescind and reserve 261—Chapter 103. ITEM 20. Rescind and reserve 261—Chapter 107. ITEM 21. Rescind and reserve 261—Chapter 109. ITEM 22. Rescind and reserve 261—Chapter 111. ITEM 23. Rescind and reserve 261—Chapter 311. ITEM 24. Rescind and reserve 261—Chapter 312. ITEM 25. Rescind and reserve 261—Chapter 313. ITEM 26. Rescind and reserve 261—Chapter 314. ITEM 27. Rescind and reserve 261—Chapter 402. [Filed 4/25/22, effective 6/22/22][Published 5/18/22]Editor’s Note: For replacement pages for IAC, see IAC Supplement 5/18/22.ARC 6321CHuman Services Department[441]Adopted and FiledRule making related to community mental health centers
The Human Services Department hereby amends Chapter 24, “Accreditation of Providers of Services to Persons with Mental Illness, Intellectual Disabilities, or Developmental Disabilities,” Iowa Administrative Code.Legal Authority for Rule Making This rule making is adopted under the authority provided in Iowa Code sections 230A.101 and 230A.105.State or Federal Law Implemented This rule making implements, in whole or in part, Iowa Code chapter 230A.Purpose and Summary The purpose of these amendments is to establish a set of standards to be met by all designated community mental health centers (CMHCs). These amendments also define the process that the Department will use to designate at least one CMHC for addressing the mental health needs of the county or counties comprising a catchment area in accordance with Iowa Code chapter 230A, identify the target populations and core services to be served by CMHCs, and identify a formal accreditation review process for CMHCs. These amendments update language in Division I to reflect current practices and add a new Division III specific to CMHCs.Public Comment and Changes to Rule Making Notice of Intended Action for this rule making was published in the Iowa Administrative Bulletin on February 23, 2022, as ARC 6211C. The Department received 14 comments from four respondents on the proposed amendments. The comments and corresponding responses from the Department are divided into five topic areas as follows: Standards for Services—Performance Indicators Comment 1: One respondent commented that paragraph 24.4(14)“b” should be revised to provide for better clarity and understanding of intent. Response 1: The Department’s intention in proposing these changes is to align with other accreditation, oversight, and funding entities that require a distinct treatment plan. No changes have been made based on this comment. Comment 2: Regarding performance indicators in paragraph 24.4(14)“b,” two respondents suggested that stricken subparagraph 24.4(14)“b”(5) should be reinstated. The respondents commented that retaining the subparagraph would clarify that a distinct service plan document is optional as service plan documentation, would enable flexibility as to where the contents are located or documented and in what form (whether a distinct separate document or incorporated otherwise), and would provide flexibility that would be particularly helpful for outpatient psychotherapy and counseling services for which this is a new requirement. Response 2: The Department’s intention in proposing these changes is to align with other accreditation, oversight, and funding entities that require a distinct treatment plan. No changes have been made based on this comment. Accreditation Comment 1: Two respondents commented that for the CMHC designation in subrule 24.51(3), applicants should not be restricted to those CMHCs with a three-year accreditation and, as such, subparagraph 24.51(3)“a”(2) should be removed. The respondents stated that it is unclear if the Department intends to exclude the CMHC designation for organizations on an initial 270-day accreditation, one-year accreditation, and probational 180-day accreditation as found in subrule 24.5(5) and stated that by limiting this designation to those who have a three-year accreditation, there could be major disruption to the State’s community mental health infrastructure. Response 1: It is the Department’s intention that an applicant for designation as a CMHC under subrule 24.51(3) shall have a three-year accreditation in outpatient psychotherapy and evaluation. A three-year accreditation ensures that the provider’s accreditation to deliver outpatient psychotherapy and evaluation services has been reviewed and is in substantial compliance with accreditation standards. No changes have been made based on this comment. Community Support Services (CSS) in General Comment 1: One respondent commented that in regard to subrule 24.54(5) pertaining to CSS, the service and standards outlined in subrule 24.54(5) may be provided by the agency through a variety of funding mechanisms and may or may not include the CSS as identified by Iowa Medicaid and related managed care organizations (MCOs), such as, but not limited to, federal grant moneys, such as certified community behavioral health clinics (CCBHC). Response 1: In accordance with Iowa Code section 230A.106(2)“e,” CSS is a required core service to be offered by a CMHC. The Iowa Code requires the Department to implement rules for the core services listed. No changes have been made based on this comment. Comment 2: Two respondents commented that subrule 24.54(5) sets forth requirements for CSS and requires clarifications, particularly clarifications for CSS educational requirements. Noting that numbered paragraph 24.54(5)“b”(1)“3” requires that qualifications for CSS staff include a “bachelor’s degree with 30 semester hours or equivalent quarter hours in a human services field, including but not limited to psychology, social work, mental health counseling, marriage and family therapy, nursing, education, occupational therapy, and recreational therapy,” the respondents stated that this educational requirement was not present for supported community living (SCL) providers and that it is unclear why CSS providers would have this heightened educational requirement. The respondents requested the proposed numbered paragraph 24.54(5)“b”(1)“3” setting forth heightened educational attainment for CSS be removed from the rules and stated that they question the “need to artificially increase minimum requirements for staff, which could exacerbate workforce shortages and further limit services available to the community.” Response 2: The advisory stakeholder group that assisted with drafting these CMHC rules recommended qualifications to include a bachelor’s degree to be consistent with MCO requirements. CSS and SCL are not equivalent services. No changes have been made based on this comment. CSS—Functional Impairment Language Comment 1: One respondent requested revisions to the definition of “community support services” in rule 441—24.50(230A). The respondent stated that the CSS worker goes into the homes and upon seeing evidence of functional deficiencies can integrate these deficiencies into the treatment plan and that, as such, the use of the word “impairment” is more restrictive upon this role and potentially could be argued to fall outside the scope of practice for a CSS. The respondent suggested the following change to the introductory paragraph of the definition and elsewhere within this rule when in reference to CSS: Replacement of the words “and functional impairment” with the words “based upon their functional assessment.” The definition’s introductory paragraph would then read: “‘Community support services’ or ‘CSS’ means services that support individuals with a mental illness based upon their functional assessment to live and work in the community of their choice through assisting with:” Response 1: The rules do not require the CSS provider to determine the individual’s functional impairment or complete a functional assessment. The scope of the CSS provider’s role is identified in subparagraph 24.54(5)“b”(2) and includes monitoring of mental health symptoms and communication with other providers. Determination of diagnosis and functional impairments is completed by a qualified mental health professional. The Department has added a definition of “functional impairment” to rule 441—24.50(230A). No other changes have been made based on this comment. Comment 2: One respondent commented that the introductory paragraph of subrule 24.54(5) should be changed to read as follows (the words “and functional impairments” are replaced with “based upon their functional impairment”): “24.54(5) Community support services (CSS). The purpose of CSS is to support individuals as they live and work in the community and address mental health symptoms based upon their functional assessment that negatively affect integration and stability in the community.” Response 2: To be eligible for CSS, an individual is required to have a diagnosis of a mental illness and identified functional impairment completed by a qualified mental health professional. The Department has added a definition of “functional impairment.” No other changes have been made based on this comment. Comment 3: One respondent commented that the performance benchmark in subparagraph 24.54(5)“a”(2) should be changed to read as follows (the words “and functional impairment” are removed): “(2) CSS is provided to individuals in the target population with mental illness.” Response 3: To be eligible for CSS, an individual is required to have a diagnosis of a mental illness and identified functional impairment completed by a qualified mental health professional. The Department has added a definition for “functional impairment.” No other changes have been made based on this comment. Comment 4: Two respondents commented that subrule 24.54(5) sets forth requirements for CSS and requires clarification regarding functional impairment determination. The respondents stated that “functional impairment” is an undefined term, which creates uncertainty in interpretation. They recommended that functional impairments referenced in subrule 24.54(5) either be defined or included within a clarifying statement to authorize trained CSS staff to make this determination as opposed to requiring an assessment done by another provider, which they said may limit services available to the community. Response 4: The Department agrees and has added a definition of “functional impairment” to rule 441—24.50(230A). The definition reads as follows: “‘Functional impairment,’ for the purpose of this division, means difficulties that substantially interfere with or limit functioning in one or more major life activities, such as basic daily living (including but not limited to eating, bathing, dressing); instrumental living skills (including but not limited to maintaining a household, managing money, community involvement, taking prescribed medication); and functioning in social, family, vocational and educational contexts.” CMHC Core Services—Unfunded Mandate Comment 1: One respondent commented that admission screening for voluntary patients to a state mental health institute in subrule 24.54(4), consultation services in subrule 24.54(6), education services in subrule 24.54(7), and coordination with unaffiliated agencies in subrule 24.54(8) are important services that could be performed by the CMHCs, but that each service also represents an unfunded mandate. The respondent stated that the inclusion as required core services and supports without funding or a payor source for the services adds an additional financial burden upon the CMHCs and that such a mandate should also include a source of payment for the services. Response 1: The services are included in Iowa Code chapter 230A, and the Department was directed to adopt rules to implement Iowa Code chapter 230A. No changes have been made based on this comment. Comment 2: Two respondents commented that subrule 24.54(4) requires “admission screening for voluntary patients to a state mental health institute.” The respondents stated that this includes both screening and evaluation to individuals requesting admission as well as the adoption of policies and procedures that define this process and includes referrals to other services pending placement if not immediately available. The respondents indicated that while they agree that admission screening activities in subrule 24.54(4) are prudent, they urge the Department to develop accompanying payment mechanisms for the provision of such services under the Iowa Medicaid fee schedule. The respondents stated that without reimbursement, these represent an unfunded mandate that would be impossible to implement and contribute to the unsustainability of CMHCs as a whole. Response 2: The services are included in Iowa Code chapter 230A, and the Department was directed to adopt rules to implement Iowa Code chapter 230A. No changes have been made based on this comment. Comment 3: Two respondents commented that subrule 24.54(6) requires that “consultation services shall be provided in accordance with Iowa Code section 230A.106(2)‘f.’” The respondents indicated that while they agree that consultation services activities in subrule 24.54(6) are prudent, they urge the Department to develop accompanying payment mechanisms for the provision of such services under the Iowa Medicaid fee schedule. The respondents stated that without reimbursement, these represent an unfunded mandate that would be impossible to implement and contribute to the unsustainability of CMHCs as a whole. Response 3: The services are included in Iowa Code chapter 230A, and the Department was directed to adopt rules to implement Iowa Code chapter 230A. No changes have been made based on this comment. Comment 4: Two respondents commented that subrule 24.54(7) requires that “education services shall be provided in accordance with Iowa Code section 230A.106(2)‘g.’” The respondents indicated that while they agree that education services activities in subrule 24.54(7) are prudent, they urge the Department to develop accompanying payment mechanisms for the provision of such services under the Iowa Medicaid fee schedule. The respondents stated that without reimbursement, these represent an unfunded mandate that would be impossible to implement and contribute to the unsustainability of CMHCs as a whole. Response 4: The services are included in Iowa Code chapter 230A, and the Department was directed to adopt rules to implement Iowa Code chapter 230A. No changes have been made based on this comment. Comment 5: Two respondents commented that subrule 24.54(8) regarding coordination with unaffiliated agencies requires that “coordination shall be provided in accordance with Iowa Code section 230A.106(3).” The respondents indicated that while they agree that these coordination activities in subrule 24.54(8) are prudent, they urge the Department to develop accompanying payment mechanisms for the provision of such services under the Iowa Medicaid fee schedule. The respondents stated that without reimbursement, these represent an unfunded mandate that would be impossible to implement and contribute to the unsustainability of CMHCs as a whole. Response 5: The services are included in Iowa Code chapter 230A, and the Department was directed to adopt rules to implement Iowa Code chapter 230A. No changes have been made based on this comment.Adoption of Rule Making This rule making was adopted by the Mental Health and Disability Services Commission on April 21, 2022.Fiscal Impact Some CMHCs may have increased expenditures in adding required services, but the extent to which that may occur is unknown. It is possible that, as a result of this rule making, some providers currently designated as CMHCs may not continue to be designated, either by choice or due to inability to meet the CMHC requirements. It is also possible that new providers will apply and be designated for areas of the state currently not served by a CMHC and be allowed to bill using the CMHC fee schedule for fee-for-service clients. Although this could potentially change the amount CMHCs are reimbursed through the Medicaid program, the overall impact is not expected to be significant. 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). 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 July 1, 2022. The following rule-making actions are adopted:
ITEM 1. Amend rule 441—24.1(225C), definitions of “Accreditation,” “Commission,” “Community mental health center,” “Deemed status” and “Division,” as follows: "Accreditation" means the decision made by the commissiondivision that the organization has met the applicable standards. "Commission" means the mental health and disability services commission (MH/DSMHDS commission) as established and defined in Iowa Code section 225C.5. "Community mental health center" "CMHC" means an organization providing mental health services that is established pursuant to Iowa Code chapters 225C and 230Aand accredited in accordance with Division III of this chapter. "Deemed status" means acceptance by the commissiondivision of accreditation or licensure of a program or service by another accrediting body in lieu of accreditation based on review and evaluation by the division. "Division" means the division of behavioral, developmental, and protective services for families, adults, and childrenmental health and disability services, community, of the department of human services. ITEM 2. Amend subparagraph 24.3(2)"b" as follows: (2) The annual and long-range budgeting process involves appropriate governing and managing levels of leadership and reflects the organization’s mission and values. An independent auditor or other person as provided by law performs an annual financial audit.Designated CMHCs shall submit their annual financial audit to the department. ITEM 3. Amend paragraph 24.4(14)"b" as follows: b. Performance indicators. (1) Individuals using the service are prepared for their role as partners in the therapeutic process at intake where they define their situations and evaluate those factors that affect their situations. (2) Individuals using the service establish desired problem resolution at intake during the initial assessment. (3) Psychiatric services other than psychopharmacological services are available from the organization as needed by the individual using the service. (4) Psychopharmacological services are available from the organization as needed. (5) Staff document mutually agreed-upon treatment goals during or after each session. A distinct service plan document is not required. (6) Staff document mutually agreed-upon supports and interventions during or after each session. A distinct service plan document is not required. (7) Staff document in the progress notes the individual’s status at each visit and the reasons for continuing or discontinuing services. A distinct discharge summary document is not required. (8) (5) Any assignment of activities to occur between sessions is documented in the following session’s documentation. (9) (6) Individuals using the service who have a chronic mental illness participate in developing a detailed psychiatric crisis intervention plan that includes natural supports and self-help methods. (10) (7) The record documents that the organization follows up on individuals who miss appointments. (8) Treatment planning is based on the assessment. (9) Individuals using the service participate with the organizational staff in identifying the assessed needs to be addressed. (10) The treatment plan identifies measurable goals, desired outcomes and time frames for achieving them. (11) The treatment plan includes interventions and supports to be provided. (12) Individuals using the service review their progress in resolving problems and achieving goals on a frequent and regular basis with organizational staff. The treatment plan is revised as appropriate to the individual’s needs and priorities. (13) Individuals using the service participate in transition/discharge planning that includes linkages to family, provider, and community resources and services. (14) Significantly involved others of individuals using the service are involved in the planning and provision of services, as appropriate and as desired by the individual. ITEM 4. Amend rule 441—24.5(225C) as follows:441—24.5(225C) Accreditation. The commissiondivision administrator shall make all decisions involving issuance, denial, or revocation of accreditation. This accreditation shall delineate all categories of service the organization is accredited to provide. Although an organization may have more than one facility or service site, the commissiondivision administrator shall issue only one accreditation notice to the organization, except as provided in paragraph 24.5(5)“f.” 24.5(1) Organizations eligible for accreditation. The commissiondivision administrator accredits the following organizations: a. Case management providers. b. Community mental health centers. c. Supported community living providers. d. Mental health service providers. e. Crisis response providers. 24.5(2) Application and renewal procedures. An applicant for accreditation shall submit Form 470-3005, Application for Accreditation, to the Division of Behavioral, Developmental, and Protective ServicesDivision of Mental Health and Disability Services, Community, Department of Human Services, Fifth Floor, Hoover State Office Building, 1305 East Walnut, Des Moines, Iowa 50319-0114. a. The application shall be signed by the organization’s chief executive officer and the chairperson of the governing body and shall include the following information: (1) The name and address of the applicant organization. (2) The name and address of the chief executive officer of the applicant organization. (3) The type of organization and specific services for which the organization is applying for accreditation. (4) The targeted population groups for which services are to be provided, as applicable. (5) The number of individuals in each of the targeted population groups to be served, as applicable. (6) Other information related to the standards as requested by division staff. b. Organizations that have received an initial 270-day accreditation and have not provided services by the end of the 270 days shall have their accreditation lapse for that specific service. This lapse of accreditation shall not be considered a denial. New applications may be submitted that include the waiting list of individuals to be served along with specific timelines of when the services will begin. c. An organization in good standing may apply for an add-on service. 24.5(3) Application review. Upon receipt of an application, Form 470-3005, the division shall review the materials submitted to determine whether the application is complete and request any additional material as needed. Survey reviews shall commence only after the organization has submitted all application material. a. For a new organization, staff may initially conduct a desk audit or on-site visit to review the organization’s mission, policies, procedures, staff credentials, and program descriptions. b. The division shall review organizational services and activities as determined by the accreditation category. This review may include audits of case records, administrative procedures, clinical practices, personnel records, performance improvement systems and documentation, and interviews with staff, individuals, boards of directors, or others deemed appropriate, consistent with the confidentiality safeguards of state and federal laws. c. A team shall make an on-site visit to the organization. The division shall not be required to provide advance notice to the provider of the on-site visit for accreditation. d. The on-site team shall consist of designated members of the division staff. At the division’s discretion, the team may include provider staff of other providers, individuals, and others deemed appropriate. e. The team shall survey the organization and the services indicated on the accreditation application in order to verify information contained in the application and ensure compliance with all applicable laws, rules, and regulations. At the time of a one-year recertification visit, the team shall review the services that did not receive three-year accreditation. f. The team shall review case records and personnel records to see how the organization implements each of the indicators in the standards. If the documentation is not found in the records, the organization shall show, at the time the division staff is on site, documentation of how the indicator was accomplished. g. When an organization subcontracts with agencies to provide services, on-site reviews shall be done at each subcontracting agency to determine if each agency meets all the requirements in this chapter. The accreditation is issued to the organization. h. At the end of the survey, the team leader shall lend an exit review. Before the close of the on-site review, the organization must provide the team leader any documentation that demonstrates how the organization has met these standards for services. i. The accreditation team leader shall send a written report of the findings to the organization within 30 working days after completion of the accreditation survey. j. Organizations required to develop a corrective action and improvement plan pursuant to subrule 24.5(4)“a” shall submit the plan to the division within 30 working days after the receipt of a report issued as a result of the division’s survey review. The action plan shall include specific problem areas cited, corrective actions to be implemented by the organization, dates by which each corrective measure shall be completed, and quality assurance and improvement activities to measure and ensure continued compliance. k. Quality assurance staff shall review and approve the corrective action and improvement plan before making an accreditation recommendation to the commissiondivision administrator. l. The division shall offer technical assistance to organizations applying for first-time accreditation. Following accreditation, any organization may request technical assistance from the division to bring into conformity those areas found in noncompliance with this chapter’s requirements. If multiple deficiencies are noted during a survey, the commission may also require that technical assistancemay be provided to an organization, as staff time permits, to assist in implementation of an organization’s corrective action plan. Renewal applicants may be provided technical assistance as needed, if staff time permits. 24.5(4) Performance outcome determinations. There are three major areas addressed in these standards: policies and procedures, organizational activities, and services, as set forth in rules 441—24.2(225C), 441—24.3(225C), and 441—24.4(225C). Each rule contains standards, with a performance benchmark and performance indicators for each standard. Each of the applicable standards for the three areas (policy and procedures, organizational activities, and services) shall be reviewed. a. Quality assurance staff shall determine a performance compliance level based on the number of indicators found to be in compliance. (1) For service indicators, if 25 percent or more of the files reviewed do not comply with the requirements for a performance indicator, then that indicator is considered out of compliance and corrective action is required. (2) Corrective action is required when any indicator under policies and procedures or organizational activities is not met. b. In the overall rating, the performance rating for policy and procedures shall count as 15 percent of the total, organizational activities as 15 percent of the total, and services as 70 percent of the total. (1) Each of the three indicators for policy and procedures has a value of 5 out of a possible score of 15. (2) Each of the 34 indicators for organizational activities has a value of .44 out of a possible score of 15. (3) Each service has a separate weighting according to the total number of indicators applicable for that service, with a possible score of 70, as follows:ServiceNumber of indicatorsValue of each indicatorCase management51501.371.4Day treatment48471.461.49Intensive psychiatric rehabilitation51501.371.4Supported community living45441.551.59Partial hospitalization48471.461.49Outpatient psychotherapy and counseling35382.001.84Emergency88.75Evaluation417.50 c. Quality assurance staff shall determine a separate score for each service to be accredited. When an organization offers more than one service under this chapter, there shall be one accreditation award for all the services based upon the lowest score of the services surveyed. 24.5(5) Accreditation decisions. The division shall prepare all documents with a final recommendation regarding accreditation to be presented at the commission meetingthe division administrator. The division shall mail to all commission members summary reports of the on-site service review or desk review and a final recommendation concerning accreditation on each application to be processed at the next commission meeting.If the commissiondivision administrator approves accreditation, Form 470-3006, Notice of Action-Approval, shall be issued which states the duration of the accreditation and the services that the organization is accredited to provide. If the commissiondivision administrator denies or revokes accreditation, Form 470-3008, Notice of Action-Denial, shall be issued which states the reasons for the denial. a. Initial 270-day accreditation.This type of accreditation may be granted to a new organization. The commissiondivision administrator shall base the accreditation decision on a report by the division that: (1) The organization has an approved policies and procedures manual that includes job descriptions. (2) Staff assigned to the positions meet the qualifications in the standards and the policies and procedures of the organization. b. Three-year accreditation.An organization or service is eligible for this type of accreditation if it has achieved an 80 percent or higher performance compliance level. The organization may be required to develop and submit a plan of corrective action and improvement that may be monitored either by written report or an on-site review. c. One-year accreditation.An organization is eligible for this type of accreditation when multiple and substantial deficiencies exist in specific areas causing compliance levels with performance benchmarks and indicators to fall between 70 percent and 79 percent, or when previously required corrective action plans have not been implemented or completed. The organization must submit a corrective action plan to correct and improve specific deficiencies and overall levels of functioning. Quality assurance staff shall monitor this plan through on-site reviews, written reports and the provision of technical assistance. d. Probational 180-day accreditation.An organization is eligible for probational 180-day accreditation instead of denial when the overall compliance level is from 60 to 69 percent, and pervasive and serious deficiencies exist; or when corrective action plans previously required as a result of a one-year accreditation have not been implemented or completed. The commissiondivision administrator may downgrade organizations with a one-year or three-year accreditation to the probational 180-day accreditation when one or more complaints are founded.All deficiencies must be corrected by the time of the follow-up on-site survey at the conclusion of the provisional period. After this survey, the organization shall meet the standards for accreditation for a one-year accreditation, or the commissiondivision administrator shall deny accreditation. e. Add-on service accreditation.When the on-site review of the add-on service results in a score comparable to the overall organization’s score at the time of the most recent accreditation, the organization shall have the add-on accreditation date coincide with the overall accreditation date of the organization. If the add-on service on-site review results in a lower score and lower accreditation decision, division staff shall conduct another on-site review for that add-on service when the add-on service accreditation expires. f. Special terms. (1) When an organization subcontracts with more than one agency, the length of accreditation shall be determined individually. (2) The accreditation period for services that have deemed status according to rule 441—24.6(225C) shall coincide with the period awarded by the national accrediting body or the certification for home-andhome- and community-based services. (3) New or add-on services that meet the requirements for accreditation shall receive an initial 270-day accreditation for that individual service. The term of accreditation shall be determined individually. At the time of recertification of the new add-on service, recommendation may be made to coincide with the term of accreditation for the other services of that organization that are accredited by the commissiondivision administrator. (4) An organization must notify the division when there are changes in its ownership, structure, management, or service delivery. g. Extensions.The division may grant an extension to the period of accreditation if there has been a delay in the accreditation process that is beyond the control of the organization,or the division, or the commission; or the organization has requested an extension to permit the organization to prepare and obtain approval of a corrective action plan. The division shall establish the length of the extension on a case-by-case basis. h. Denial of accreditationor revocation.An emergency commission meeting may be called to consider denial or revocation of accreditation. (1) Accreditation shall be denied when there are pervasive and serious deficiencies that put individuals at immediate risk or when the overall compliance level falls to 59 percent or below. Under such circumstances no corrective action report shall be required. (2) When one or more complaints are received, quality assurance staff shall complete an investigation and submit a report to the commissiondivision administrator. If any of the complaints are substantiated and the commissiondivision administrator determines that there is a pervasive or serious deficiency, the commissiondivision administrator may deny accreditation. (3) An organization whose accreditation has been denied or revoked shall not be approved for any service for at least six months from the notice of decision denying or revoking accreditation. (4) If the organization disagrees with any action or failure to act in regard to the notice of decision to deny accreditation to the organization, the organization has the right to appeal in accordance with 441—Chapter 7. 24.5(6) Nonassignability. Accreditation shall not be assignable to any other organization or provider. Any person or other legal entity acquiring an accredited facility for the purpose of operating a service shall make an application as provided in subrule 24.5(2) for a new certificate of accreditation. Similarly, any organization having acquired accreditation and desiring to alter the service philosophy or transfer operations to different premises must notify the division in writing 30 calendar days before taking action in order for the division to review the change. 24.5(7) Discontinuation. a. Discontinued organization.A discontinued organization is one that has terminated all of the services for which it has been accredited. Accreditation is not transferable between organizations. (1) An organization shall notify the division in writing of any sale, change in business status, closure, or transfer of ownership of the business at least 30 calendar days before the action. (2) The organization shall be responsible for the referral and placement of individuals using the services, as appropriate, and for the preservation of all records. b. Discontinued service.An organization shall notify the division in writing of the discontinuation of an accredited or certified service at least 30 calendar days before the service is discontinued. (1) Notice of discontinuation of a service shall not be initiated during the 30 days before the start of a survey. Once a survey has begun, all services shall be considered in determining the organization’s accreditation score. (2) The organization shall be responsible for the referral and placement of individuals using the services, as appropriate, and for the preservation of all records. ITEM 5. Amend rule 441—24.6(225C) as follows:441—24.6(225C) Deemed status(all services). The commissiondivision shall grant deemed status to organizations accredited by a recognized national, not-for-profit, accrediting body when the commissiondivision determines the accreditation is for similar services. The commissiondivision may also grant deemed status for supported community living services to organizations that are certified under the Medicaid home- and community-based services (HCBS) mental retardationintellectual disability waiver. 24.6(1) National accrediting bodies. a. The national accrediting bodies currently recognized as meeting division criteria for possible deeming are: 1(1) TheJoint Commission on Accreditation of Healthcare Organizations (JCAHO)(TJC). 2(2) The Commission on Accreditation of Rehabilitation Facilities (CARF). 3(3) The Council on Quality and Leadership in Supports for People with Disabilities (The Council). 4(4) TheCouncil on Accreditation of Services for Families and Children (COA). b. The accreditation credentials of these national bodies must specify the type of organization, programs, and services that these bodies accredit and include targeted population groups, if appropriate. c. Deemed status means that the division is accepting an outside body’s review, assessment, and accreditation of an organization’s functioning and services. Therefore, the accrediting body doing the review must be assessing categories of organizations and types of programs and services corresponding to those described under this chapter. An organization that has deemed status must adhere to and be accountable for the rules in this chapter. d. When an organization that is nationally accredited requests deemed status for services not covered by the national body’s standards but covered under this chapter, the division shall accredit those services. Division staff shall provide technical assistance to organizations with deemed status as time permits. 24.6(2) Application for deemed status. a. To apply for deemed status, the organization shall submit Form 470-3332, Application and Letter of Agreement, and copies; copy of the latest survey report and; documentation related to any corrective action required; accreditation certificate,; documentation of specific programming policies and procedures for populations being served,; and credentials for staff providing services to populations served. b. The division shall not accept an application for deemed status once the division has begun an on-site visit. The organization shall complete the accreditation process. 24.6(3) Requirements for deemed status. To be eligible for deemed status, the organization shall: a. Be currently accredited: (1) byBy a recognized national accrediting body for services as defined in subrule 24.6(1); or b. (2) Be currently accredited forFor supported community living under the Medicaid HCBS mental retardationintellectual disability waiver pursuant to 441—subrule 77.37(14). If individuals with mental illness are served, the organization must submit verification of the training and credentialsexperience of the staff to show that its staff can meet the needs of the individuals served. c. Require the supported community living staff to have the same supervisor as the HCBS/MR program. d. b. Require staff for the program being deemed to have thenecessary training and credentials needed to meet the needs of the personexperience to meet the needs of the population served. e. c. Require staff to meet the incident reporting requirements in subrule 24.4(5). 24.6(4) Granting of deemed status. When the commissiondivision grants deemed status, the accreditation period shall coincide with the period awarded by the national accrediting body or the certification for home- and community-based services. However, under no circumstances shall the commissiondivision award accreditation for longer than threefive years. 24.6(5) Reservations. When deemed status is granted, the commission and the division reservedivision reserves rights to the following: a. To have division staff conduct on-site reviews for those organizations applying for deemed status which the division has not previously accredited. b. To have division staff do joint site visits with the accrediting body, attend exit conferences, or conduct focused follow-behind visits as determined to be appropriate in consultation with the national accrediting organization and the provider organization. c. To be informed of and to investigate all complaints that fall under this chapter’s jurisdiction according to the process in rule 441—24.7(225C). The division shall report findings to the national accrediting body. d. To review and act upon deemed status when: (1) Complaints have been founded, or (2) The organization’s national accreditation status expires without renewal, or (3) The national accrediting body downgrades or withdraws the organization’s status. 24.6(6) Continuation of deemed status. a. The organization shall send a copy of Form 470-3332, Application and Letter of Agreement, along with a copy of the application for renewal to the national accrediting body at the same time as application is made to a national accrediting body. b. HCBS staff shall furnish to the division copies of the letter notifying a provider of a forthcoming recertification for organizations deemed for supported community living under the HCBS mental retardationintellectual disability waiver. c. Following the on-site review by a national accrediting body, the organization shall send the division a copy of the cover sheet and the national accrediting body report within 30 calendar days from the date that the organization receives the documents. If a corrective action plan is required, the organization shall send the division a copy of all correspondence and documentation related to the corrective action. d. HCBS staff shall furnish the division with copies of HCBS certification reports and any corrective action required by HCBS within 30 calendar days after HCBS staff complete the report or the organization completes required corrective action. ITEM 6. Amend rule 441—24.7(225C) as follows:441—24.7(225C) Complaint process(all services). The division shall receive and record complaints by individuals using the services, employees, any interested people, and the public relating to or alleging violations of applicable requirements of the Iowa Code or administrative rules. 24.7(1) Submittal of complaint. The complaint may be delivered personallysubmitted in person; or by mail to the Division of Behavioral, Developmental, and Protective ServicesMental Health and Disability Services, Community, Department of Human Services, Hoover State Office Building, Fifth Floor, 1305 East Walnut, Des Moines, Iowa 50319-0114,; electronically through the department’s website; by email to division staff; or by telephone (515)281-5874. a. The division shall assist individuals in making a complaint as needed or requested. b. The information received should specifically state the basis of the complaint. The division shall keep the name of the complainant confidential to the extent allowed by law. 24.7(2) Review of complaint. Upon receipt of a complaint, the division shall make a preliminary desk review of the complaint to determine an appropriate response. That response may include notifying the person who submitted the complaint that there is no basis for a review, referring the complaint to another investigative body, or making a determination to do a full investigation.The complainant may submit a written request for a report of the findings and actions taken by the division as a result of the complaint. 24.7(3) Investigation of complaint. If the division concludes that the complaint is reasonable, has merit, and is based on a violation of rules in this chapter, it may make an investigation of the organization. The division may investigate complaints by an officedesk audit or by an on-site investigation. The division shall give priority for on-site investigations to instances when individuals using the service are in immediate jeopardy. a. If a decision is made to conduct an on-site investigation, the on-site review does not require advance notice to the organization. The division shall notify the chief executive officer and board chairperson of the organization involved before or at the commencement of the on-site investigation that the division has received a complaint. b. The division shall give the organization an opportunity to informally present a position regarding allegations in the complaint. The organization may submit the position in writing within five working days following the on-site visit or present it in a personal conference with division staff. c. The division shall submit a written report by certified mail to the chief administrativeexecutive officer of the organization and the chairperson of the board of directors within 20 working days after completion of the investigation. d. The report shall indicate whether the complaint was or was not substantiated, the basis for the substantiation or nonsubstantiation,decision and the specific rules violated, and a recommendation for corrective action with time lines specified in the report. e. If the complaint is substantiated, the division may take actions deemed appropriate, which may include requiring a corrective action plan, shortening the term of accreditation or suspending or revoking an organization’s accreditation, depending on the severity of the substantiated complaint. f. When the division suspends, shortens or revokes an organization’s accreditation as the result of a substantiated compliant, the organization will be notified by certified mail of the findings and actions taken by the division. e. g. The date of delivery shown by the certified mail stub shall constitute the date of official notice. 24.7(4) Review by commission. When individuals receiving services are in immediate jeopardy, the commission may call an emergency meeting to make a decision on possible revocation or denial of accreditation. a. To the extent allowed by Iowa Code section 21.5, the commission may review the complaint and investigation report in a closed meeting. The action taken by the commission shall be voted upon in the reconvened public meeting and entered into the official record of commission minutes. b. If the complaint is substantiated, the commission make take actions deemed appropriate, which may include shortening the term of accreditation, requiring a corrective action plan, or suspending or revoking an organization’s accreditation, depending on the severity of the substantiated complaint. c. The division shall inform the complainant and the organization by certified mail of the findings and actions taken by the commission. The date of delivery shown by the certified mail stub shall constitute the date of official notice. 24.(5) 24.7(4) Corrective action plan. When the commissiondivision acts to suspend or revoke accreditation, there will be no corrective action plan. In other instances, if the complaint is substantiated, the organization shall submit a corrective action plan to the division within 20 calendar days after receiving the commission’sdivision’s decision. This plan must respond to violations cited and commissionthe division’s requirements and include time lines, internal monitoring systems, and performance improvement planning.Failure of the organization to respond within 20 calendar days with an acceptable corrective action plan that addresses the organization’s plan of correction following a substantiated investigation or complaint may of itself constitute the basis for revocation or suspension of accreditation. The commissiondivision shall determine the appropriate action based on the information submitted. The division shall notify the organizationin writing of any action the commission takestaken. ITEM 7. Amend rule 441—24.40(225C), implementation sentence, as follows: These rules are intended to implement Iowa Code sectionsections 331.397 and 2014 Iowa Acts, House File 2379225C.19A and chapter 230A. ITEM 8. Reserve rules 441—24.41 to 441—24.49. ITEM 9. Adopt the following new 441—Chapter 24 Division III heading:DIVISION IIICOMMUNITY MENTAL HEALTH CENTERS ITEM 10. Adopt the following new 441—Chapter 24 Division III preamble:PreambleThe department of human services in consultation with the mental health and disability services commission has established this set of standards to be met by all designated community mental health centers (CMHCs). CMHCs are to provide an organized set of services to adequately meet the mental health needs of individuals in their catchment area. It is the department’s responsibility to designate at least one community mental health center for addressing the mental health needs of the county or counties comprising a catchment area in accordance with Iowa Code chapter 230A. ITEM 11. Adopt the following new rules 441—24.50(230A) to 441—24.55(230A):441—24.50(230A) Definitions. "Catchment area" means the same as defined in Iowa Code section 230A.102(2). "Community mental health center self-assessment" means the form completed and submitted to the department by a new organization as part of the initial application to be designated as a CMHC. Designated CMHCs complete the form annually and submit it to the department as part of the accreditation and CMHC monitoring process. "Community support services" "CSS" means services that support individuals with a mental illness and functional impairment to live and work in the community of their choice through assisting with:- Monitoring of mental health symptoms and functioning/reality orientation;
- Transportation;
- Supportive relationship;
- Communication with other providers;
- Ensuring individual attends appointments/obtains medications;
- Crisis intervention/developing crisis plan; and
- Coordination and development of natural support systems for mental health support.
- Core services and supports,
- Serving the target population with minimal to no service denials,
- Addressing the standards in rule 441—24.2(225), and
- Ensuring an individual’s ability to access services regardless of ability to pay. The CMHC shall assist individuals with applying for health insurance and MHDS regional assistance when necessary to ensure access to services.
Rule making related to standards of practice for telehealth for registered nurses (RNs) and licensed practical nurses (LPNs)
The Board of Nursing hereby amends Chapter 6, “Nursing Practice for Registered Nurses/Licensed Practical Nurses,” Iowa Administrative Code.Legal Authority for Rule Making This rule making is adopted under the authority provided in Iowa Code section 147.76.State or Federal Law Implemented This rule making implements, in whole or in part, Iowa Code chapter 152.Purpose and Summary In light of the proliferation of telehealth services, the Board is adopting new amendments governing minimum standards of practice for registered nurses (RNs) and licensed practical nurses (LPNs) who provide health care services through telehealth. These amendments provide when an Iowa license is required, instruct that the licensee will be held to the same standard of care as is applicable to in-person settings, instruct that RNs and LPNs may only provide services through telehealth that are within the licensee’s scope of practice, require the use of Health Insurance Portability and Accountability Act (HIPAA)-compliant technology, and require adequate recordkeeping of telehealth encounters.Public Comment and Changes to Rule Making Notice of Intended Action for this rule making was published in the Iowa Administrative Bulletin on February 23, 2022, as ARC 6208C. A public hearing was held on March 15, 2022, at 9 a.m. at the Board’s office, 400 S.W. Eighth Street, Suite B, 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 April 6, 2022.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 June 22, 2022. The following rule-making actions are adopted:
ITEM 1. Adopt the following new definitions of “Asynchronous store-and-forward transmission,” “Licensee” and “Telehealth” in rule 655—6.1(152): "Asynchronous store-and-forward transmission" means the collection of a patient’s relevant health information and the subsequent transmission of the data from an originating site to a health care provider at a distant site without the presence of the patient. "Licensee" means an individual licensed by the board as a registered nurse or licensed practical nurse. "Telehealth" means the practice of nursing using electronic audiovisual communications and information technologies or other means, including interactive audio with asynchronous store-and-forward transmission, between a licensee in one location and a patient in another location with or without an intervening health care provider. Telehealth includes asynchronous store-and-forward technologies, remote monitoring, and real-time interactive services, including teleradiology and telepathology. Telehealth, for the purposes of this rule, shall not include the provision of nursing services only through an audio-only telephone, email messages, facsimile transmissions, or U.S. mail or other parcel service, or any combination thereof. ITEM 2. Adopt the following new rule 655—6.4(152):655—6.4(152) Telehealth. 6.4(1) Telehealth permitted. A licensee may, in accordance with all applicable laws and rules, provide health care services to a patient through telehealth. 6.4(2) License required. A registered nurse or licensed practical nurse who provides services through telehealth to a patient physically located in Iowa must hold an active license issued by the board or have an active privilege to practice in Iowa pursuant to the nurse licensure compact. 6.4(3) Standard of care. A licensee who provides services through telehealth shall be held to the same standard of care as is applicable to in-person settings. A licensee shall not perform any service via telehealth unless the same standard of care can be achieved as if the service was performed in person. 6.4(4) Scope of practice. A licensee who provides services through telehealth shall ensure the services provided are consistent with the licensee’s scope of practice, education, training, and experience. 6.4(5) Technology. A licensee providing services through telehealth shall utilize technology that is secure and compliant with the Health Insurance Portability and Accountability Act (HIPAA). The technology must be of sufficient quality, size, resolution, and clarity such that the licensee can safely and effectively provide the telehealth services and abide by the applicable standard of care. 6.4(6) Records. A licensee who provides services through telehealth shall maintain a record of the care provided to the patient. Such records shall comply with all applicable laws, rules, and standards of care for recordkeeping, confidentiality, and disclosure of a patient’s medical record. [Filed 4/20/22, effective 6/22/22][Published 5/18/22]Editor’s Note: For replacement pages for IAC, see IAC Supplement 5/18/22.ARC 6317CNursing Board[655]Adopted and FiledRule making related to standards of practice for telehealth for advanced registered nurse practitioners (ARNPs)
The Board of Nursing hereby amends Chapter 7, “Advanced Registered Nurse Practitioners,” Iowa Administrative Code.Legal Authority for Rule Making This rule making is adopted under the authority provided in Iowa Code section 147.76.State or Federal Law Implemented This rule making implements, in whole or in part, Iowa Code chapter 152.Purpose and Summary In light of the proliferation of telehealth services, the Board is adopting amendments governing minimum standards of practice for advanced registered nurse practitioners (ARNPs) who provide health care services through telehealth. These amendments provide when an Iowa license is required, instruct that the licensee will be held to the same standard of care as is applicable to in-person settings, instruct when a provider-patient relationship must first be established, require the use of Health Insurance Portability and Accountability Act (HIPAA)-compliant technology, authorize the issuance of prescriptions via telehealth provided such issuance is consistent with the standard of care, require adequate recordkeeping of telehealth encounters, and require referrals for follow-up care when required by the standard of care. These amendments have been reviewed and approved by the Board’s ARNP Advisory Committee, which is a committee comprised of 11 ARNPs who work in various settings throughout the state.Public Comment and Changes to Rule Making Notice of Intended Action for this rule making was published in the Iowa Administrative Bulletin on February 23, 2022, as ARC 6205C. A public hearing was held on March 15, 2022, at 10 a.m. at the Board’s Office, 400 S.W. Eighth Street, Suite B, 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 April 6, 2022.Fiscal Impact This rule making has no fiscal impact to the State of Iowa.Jobs Impact Although a precise jobs impact is unclear, these amendments have the potential for creating additional jobs, because the amendments clarify that ARNPs may provide health care services, consistent with ARNPs’ scopes of practice and population foci, through telehealth.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 June 22, 2022. The following rule-making actions are adopted:
ITEM 1. Adopt the following new definitions of “Asynchronous store-and-forward transmission,” “Cross-coverage,” “Licensee,” “On call” and “Telehealth” in rule 655—7.1(17A,124,147,152): "Asynchronous store-and-forward transmission" means the collection of a patient’s relevant health information and the subsequent transmission of the data from an originating site to a health care provider at a distant site without the presence of the patient. "Cross-coverage" means a licensee who engages in a remote evaluation of a patient, without in-person contact, at the request of another licensed health care provider who has established a proper practitioner-patient relationship with the patient. "Licensee" means an individual licensed by the board as an advanced registered nurse practitioner. "On call" means a licensee is available, where necessary, to attend to the urgent and follow-up needs of a patient for whom the licensee has temporarily assumed responsibility, as designated by the patient’s primary care licensee or other health care provider of record. "Telehealth" means the practice of nursing using electronic audiovisual communications and information technologies or other means, including interactive audio with asynchronous store-and-forward transmission, between a licensee in one location and a patient in another location with or without an intervening health care provider. Telehealth includes asynchronous store-and-forward technologies, remote monitoring, and real-time interactive services, including teleradiology and telepathology. Telehealth, for the purposes of this rule, shall not include the provision of nursing services only through an audio-only telephone, email messages, facsimile transmissions, or U.S. mail or other parcel service, or any combination thereof. ITEM 2. Adopt the following new rule 655—7.9(152):655—7.9(152) Standards of practice for telehealth. 7.9(1) Telehealth permitted. A licensee may, in accordance with all applicable laws and rules, provide health care services to a patient through telehealth. 7.9(2) License required. An advanced registered nurse practitioner who provides services through telehealth to a patient physically located in Iowa must be licensed by the board. A licensee who provides services through telehealth to a patient physically located in another state shall be subject to the laws and jurisdiction of the state where the patient is physically located. 7.9(3) Standard of care. a. A licensee who provides services through telehealth shall be held to the same standard of care as is applicable to in-person settings. A licensee shall not perform any service via telehealth unless the same standard of care can be achieved as if the service was performed in person. b. Prior to initiating contact with a patient for the purpose of providing services to the patient using telehealth, a licensee shall: (1) Review the patient’s history and all relevant medical records; and (2) Determine as to each unique patient encounter whether the licensee will be able to provide the same standard of care using telehealth as would be provided if the services were provided in person. 7.9(4) Scope of practice. A licensee who provides services through telehealth must practice within the licensee’s respective population foci and ensure the services provided are consistent with the licensee’s scope of practice, education, training, and experience. 7.9(5) Practitioner-patient relationship. a. Prior to providing services through telehealth, the licensee shall first establish a practitioner-patient relationship. A practitioner-patient relationship is established when: (1) The person with a health-related matter seeks assistance from the licensee; (2) The licensee agrees to provide services; and (3) The person agrees to be treated, or the person’s legal guardian or legal representative agrees to the person’s being treated, by the licensee regardless of whether there has been a previous in-person encounter between the licensee and the person. b. A practitioner-patient relationship can be established through an in-person encounter, consultation with another licensee or health care provider, or telehealth encounter. c. Notwithstanding paragraphs 7.9(5)“a” and “b,” services may be provided through telehealth without first establishing a practitioner-patient relationship in the following settings or circumstances: (1) Institutional settings; (2) Licensed or certified nursing facilities, residential care facilities, intermediate care facilities, assisted living facilities, and hospice settings; (3) In response to an emergency or disaster; (4) Informal consultations with another health care provider performed by a licensee outside of the context of a contractual relationship, or on an irregular or infrequent basis, without the expectation or exchange of direct or indirect compensation; (5) Episodic consultations by a specialist located in another jurisdiction who provides consultation services upon request to a licensee; (6) A substitute licensee acting on behalf and at the designation of an absent licensee or other health care provider in the same specialty on an on-call or cross-coverage basis; or (7) When a sexually transmitted disease has been diagnosed in a patient, a licensee prescribes or dispenses antibiotics to the patient’s named sexual partner(s) for the treatment of the sexually transmitted disease as recommended by the U.S. Centers for Disease Control and Prevention. 7.9(6) Consent to telehealth. Prior to providing services via telehealth, the licensee shall obtain consent from the patient, or the patient’s legal guardian or legal representative, to receive services via telehealth. 7.9(7) Technology. A licensee providing services through telehealth shall utilize technology that is secure and compliant with the Health Insurance Portability and Accountability Act (HIPAA). The technology must be of sufficient quality, size, resolution, and clarity such that the licensee can safely and effectively provide the telehealth services and abide by the applicable standard of care. 7.9(8) Prescriptions. A licensee providing services through telehealth may issue a prescription to a patient as long as the issuance of such prescription is consistent with the standard of care applicable to the in-person setting. 7.9(9) Records. A licensee who provides services through telehealth shall maintain a record of the care provided to the patient. Such records shall comply with all applicable laws, rules, standards of care for recordkeeping, confidentiality, and disclosure of a patient’s medical record. 7.9(10) Follow-up care. A licensee who provides services through telehealth shall refer a patient for follow-up care when required by the standard of care. [Filed 4/20/22, effective 6/22/22][Published 5/18/22]Editor’s Note: For replacement pages for IAC, see IAC Supplement 5/18/22.ARC 6318CWorkers’ Compensation Division[876]Adopted and FiledRule making related to payroll tax tables
The Workers’ Compensation Commissioner hereby amends Chapter 8, “Substantive and Interpretive Rules,” Iowa Administrative Code.Legal Authority for Rule Making This rule making is adopted under the authority provided in Iowa Code section 86.8.State or Federal Law Implemented This rule making implements, in whole or in part, Iowa Code section 85.61.Purpose and Summary The purpose of this rule making is to update references to the tables that determine payroll taxes.Public Comment and Changes to Rule Making Notice of Intended Action for this rule making was published in the Iowa Administrative Bulletin on March 9, 2022, as ARC 6221C. No public comments were received. No changes from the Notice have been made.Adoption of Rule Making This rule making was adopted by the Commissioner on April 13, 2022.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 This amendment does not include a waiver provision because rule 876—12.4(17A) provides the specific situations for waiver of Workers’ Compensation Division rules.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 June 22, 2022. The following rule-making action is adopted:
ITEM 1. Amend rule 876—8.8(85,17A) as follows:876—8.8(85,17A) Payroll tax tables. Tables for determining payroll taxes to be used for the period July 1, 20212022, through June 30, 20222023, are the tables in effect on July 1, 20212022, for computation of:- Federal income tax withholding according to the percentage method of withholding for weekly payroll period. (Federal Income Tax Withholding Methods, Publication 15-T [2021].)
- Iowa individual income tax withholding formula. (Iowa Department of Revenue [Effective January 1, 20212022].)
- Social Security and Medicare withholding (FICA) at the rate of 7.65 percent. (Internal Revenue Service, Circular E, Employer’s Tax Guide, Publication 15 [20202021].)