Pursuant to the authority of Iowa Code sections 307.12, 307A.2 and 1985 Iowa Acts, chapter 265, the Iowa Department of Transportation hereby gives Notice of Intended Action to amend Chapter 923, “Capital Match Revolving Loan Fund,” Iowa Administrative Code.    The Department is proposing amendments to Chapter 923 to update the chapter. The following explains each proposed amendment:

1. Include the name, address, and telephone number of the person or agency authoring the comments or request.
2. Reference the number and title of the proposed rule, as given in this Notice, that is the subject of the comments or request.
3. Indicate the general content of a requested oral presentation.
4. Be addressed to Tracy George, Rules Administrator, Iowa Department of Transportation, Strategic Communications and Policy, 800 Lincoln Way, Ames, Iowa 50010; email: tracy.george@iowadot.us.
5. Be received by the Department’s rules administrator no later than January 23, 2018.

    Pursuant to Iowa Code chapter 476 and section 17A.4, the Utilities Board (Board) gives notice that on December 8, 2017, the Board issued an order in Docket No. RMU-2016-0006, In re: Review of Cogeneration and Small Power Production Rules [199 IAC Chapter 15], “Order Commencing Rule Making,” proposing to amend the Board’s chapter 15 cogeneration and small power production rules. Chapter 15 regulates interactions between utilities and qualifying facilities and alternative energy production (AEP) facilities, provides guidelines for alternative energy purchase programs, provides guidance regarding renewable energy and wind energy production tax credits, and regulates small wind innovation zones.    The Board is proposing to amend rule 199—15.10(476) to be consistent with recent amendments to rule 199—45.3(476), which were adopted by the Board on December 28, 2016, in Docket No. RMU-2016-0003. Those amendments were adopted in response to newly enacted Iowa Code section 476.58. The Board is also proposing to adopt new definitions in rule 199—15.1(476) to help clarify some of the new language in rule 199—15.10(476). These definitions can also be found in rule 199—45.1(476).    The order approving this Notice of Intended Action can be found on the Board’s Electronic Filing System (EFS) website, efs.iowa.gov, in Docket No. RMU-2016-0006.    Pursuant to Iowa Code section 17A.4(1)“a” and “b,” any interested person may file a written statement of position pertaining to the proposed amendments. The statement must be filed on or before January 23, 2018. The statement should be filed electronically through the Board’s EFS. Instructions for making an electronic filing can be found on the EFS website at efs.iowa.gov. Filings shall comply with the format requirements in 199 IAC 2.2(2) and clearly state the author’s name and address and make specific reference to Docket No. RMU-2016-0006. Paper comments may only be filed with approval of the Board.    No oral presentation is scheduled at this time. Pursuant to section 17A.4(1)“b,” an oral presentation may be requested or the Board on its own motion after reviewing the comments may determine an oral presentation should be scheduled. Requests for an oral presentation should be filed by January 23, 2018.    After analysis and review of this rule making, the Board tentatively concludes that the proposed amendments, if adopted, will not have a detrimental effect on employment in Iowa.    These amendments are intended to implement Iowa Code chapter 476 and section 17A.4.    The following amendments are proposed.

    Pursuant to the authority of Iowa Code sections 249A.4 and 249N.2, the Department of Human Services hereby amends Chapter 74, “Iowa Health and Wellness Plan,” Iowa Administrative Code.    These amendments change the definition of “medical home” and add definitions of “personal provider,” “primary care provider” and “primary medical provider” to rules pertaining to the Iowa Health and Wellness Program (IHAWP). The clarification of these terms will allow Iowa Health and Wellness members to access a personal provider who will be able to coordinate care to meet the member’s medical needs.    Notice of Intended Action was published in the Iowa Administrative Bulletin as ARC 3375C on October 11, 2017. The Department received no comments during the public comment period. These amendments are identical to those published under Notice of Intended Action.    The Council on Human Services adopted these amendments on December 13, 2017.    These amendments do not provide for waivers in specified situations because requests for the waiver of any rule may be submitted under the Department’s general rule on exceptions at 441—1.8(17A,217).    After analysis and review of this rule making, no impact on jobs has been found.    These amendments are intended to implement Iowa Code sections 249A.4 and 249N.2.    These amendments will become effective February 7, 2018.    The following amendments are adopted.

    Pursuant to the authority of Iowa Code section 249A.4 and 2017 Iowa Acts, House File 653, section 12(15)(c), the Department of Human Services amends Chapter 74, “Iowa Health and Wellness Plan,” Chapter 75, “Conditions of Eligibility,” and Chapter 76, “Enrollment and Reenrollment,” Iowa Administrative Code.    These amendments eliminate the three-month retroactive Medicaid coverage benefit provisions for initial applications and applications to add new household members. Pursuant to 2017 Iowa Acts, House File 653, as passed during the 87th Session of the General Assembly, the Department requested a waiver from the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services to eliminate the retroactivity provisions. Upon federal approval, elimination of three-month retroactive eligibility for Medicaid applicants began on November 1, 2017.    Notice of Intended Action was published in the Iowa Administrative Bulletin as ARC 3355C on October 11, 2017. The proposed amendments were also Adopted and Filed Emergency and published as ARC 3353C on the same date and became effective October 1, 2017.    The Department received comments from four respondents during the public comment period. A summary of the respondents’ comments and the Department’s responses is as follows:    Comment 1: Two respondents expressed vehement opposition to the emergency rules. All respondents requested that the Department suspend or delay implementation of the policy to eliminate retroactive Medicaid. Three respondents requested a delay until after the 2018 Legislative Session, and a fourth respondent requested a delay until after the Department has determined the true impact of the policy and explored exceptions to policy for patient populations receiving care at Iowa’s hospitals. One respondent requested that the rules be modified to allow retroactive Medicaid for patients who face an unexpected and undue hardship and are truly prevented from applying for Medicaid within the three-month time period.    Department response 1: The Department needs legislative authority and CMS approval to suspend or delay implementation of the policy to eliminate retroactive Medicaid or to make an exception for a specific population, except as authorized by CMS for pregnant women and infants (see Department response 2).    Comment 2: Three respondents stated that they were aware of the provision to eliminate retroactive Medicaid included in House File 653 but believed that the provision to eliminate retroactive Medicaid applied only to the Medicaid expansion population.    Department response 2: Conversations with all providers and advocacy groups occurred with as much transparency as possible as the legislation was developing.    The provision in House File 653 related to elimination of retroactive coverage does not specify populations, such as the Medicaid expansion population. The legislation mandates that the Department seek a waiver from CMS to implement the strategy to eliminate retroactive coverage for Medicaid applicants.    Iowa Medicaid Enterprise sent an Informational Letter (1808-MC-FFS-D) to all Medicaid providers on June 30, 2017. The letter explained that House File 653 contained a number of legislatively mandated cost-containment initiatives and specified that one such initiative was to eliminate retroactive benefits for all Iowa Medicaid eligibility groups.    In accordance with the legislative mandate in House File 653, the Department filed for a waiver to eliminate retroactive benefits for all Iowa Medicaid eligibility groups. CMS approved the waiver to eliminate the three-month retroactive period for all Medicaid applicants with the exception that Iowa must continue to provide three months of retroactive Medicaid to pregnant women and infants (under the age of one) who otherwise qualify.    In the Adopted and Filed Emergency rule making, the amendments revised, renumbered or amended the rules to remove the retroactive benefit for Medicaid for all populations. After publication of the Adopted and Filed Emergency rule making, CMS instructed the Department to reinstate retroactive Medicaid benefits for pregnant women and infants (under the age of one). Therefore, the amendments in this rule making reinstate retroactive Medicaid eligibility for pregnant women and infants (under the age of one).    Comment 3: All respondents expressed concerns regarding the populations that their organizations serve and the ability of their organizations to continue to serve Medicaid patients. Specifically, respondents’ comments are as follows:    • Elderly and disabled persons needing postacute and chronic care: The Department included its rationale for this amendment request which is founded on the fact that the commercial market does not allow for retroactive coverage. However, Medicaid is the payor for an entirely separate and unique population than the commercial market. Many aged and disabled will be left without coverage even though they meet the eligibility requirements.    This change will have a large impact on the amount of money seniors or their families pay for a hospital stay, residence in a skilled nursing facility, etc. For many aging individuals, the need for nursing facility care can come on suddenly. For example, a fall may result in a broken hip from which a frail senior may never fully recover. A sudden need does not allow for preplanning. Retroactive Medicaid coverage would allow a window of opportunity to get one’s Medicaid coverage in order. With nursing home care costing $5,000 to $8,000/month, a 90-day bill can run $15,000 to $25,000. If a senior in such a situation is determined Medicaid-eligible in the application month, the senior is not in the financial situation to be able pay for the health care services received prior to the application month, creating a significant financial hardship for the senior and increased uncompensated care costs for the provider.    If this rule advances, Iowa health care system members will have to carefully consider whether they can continue to admit Medicaid-eligible Iowans into their nursing facilities.    • Persons with catastrophic injuries and traumatic brain injuries: Special consideration should be made for those individuals who experience a catastrophic injury or event such as a traumatic brain injury or stroke. For these individuals and their families, eliminating the retroactive period would be devastating. Survivors of catastrophic injury are first and foremost focused on survival, and then on rehabilitation. Such individuals are now unable to work, are likely to lose their jobs, and must apply for social security disability, which takes six months for approval. With no job and no income, many will lose their insurance and be at high risk of having a gap in health coverage. Nevertheless, they have to be treated.    Persons with catastrophic injury may not be able to apply for Medicaid on their own and may not have a legal representative to assist. This would lead to gaps in health coverage if there is no retroactive Medicaid period.    This organization has served persons whose insurance premiums were not paid while they were in acute care settings. Insurance may lapse retroactively, and the lapse may not be discovered immediately. Again, without retroactive Medicaid benefits, there would be a lapse in coverage. Currently, if an injured individual misses a deadline in providing information to the Department, the Medicaid application is closed and a new application has to be started. This is often the case when essential documents, such as 401(k) statements, are not able to be secured on Medicaid’s timeline. Again, this would cause a lapse in coverage for the individual if there are not retroactive Medicaid benefits.    • Patients receiving hospital care, including emergency care: The rule change will bring extreme financial strain and liability on Medicaid beneficiaries for their cost of care prior to enrollment. Medicaid patients often have significant financial needs; therefore, this rule will place an additional financial burden on hospitals and safety-net providers and will reduce their ability to serve Medicaid patients.    Hospitals are already struggling to cope with Medicaid changes and additional cost-containment strategies implemented in the last Legislative Session. Hospitals are seeing an increase in administrative expense, increased difficulty finding long-term placement options and an increase in charity care and bad debt that affects the financial stability of Iowa’s hospitals, especially in rural communities.    Iowa’s hospitals care for all patients in need of emergency care, at all hours of the day, regardless of ability to pay and cannot deny emergency services to those without an insurance card. Hospitals are required by federal law to provide emergency care. The Iowa Hospital Association’s members have expressed concern regarding the financial liability of Medicaid eligible patients, whether behavioral health patients whose illness impacts their ability to move forward with a Medicaid application or a trauma patient who has lost the ability to communicate and needs additional time to work through the application process. While these cases may not happen every day, when they do, these are cases of a high level of care at extraordinary expense. Iowa’s hospitals will no longer be able to rely on retroactive enrollment to ensure payment for care in these situations. The results of this policy decision are possibly catastrophic to these patients and the hospitals that assist them.    • Persons with behavioral health needs (substance use disorders/addictions, mental health): Patients who qualify for Medicaid, in addition to having significant financial needs, also commonly have behavioral health needs. Their needs prevent them from being able to fully comprehend the need for and timelines to apply for coverage. Additionally, the Department’s rationale for the change is to align Medicaid more closely with the commercial insurance market, but Medicaid is the payor for an entirely separate and unique population than the commercial market. This shift will remove an important safety net and directly shifts the financial burden to providers and medical facilities and ultimately reduces their ability to serve Medicaid patients.    Department response 3: The Department needs legislative authority and CMS approval to make an exception and continue to allow the three-month retroactive period for a specific population, except as authorized by CMS for pregnant women and infants (see Department response 2).    There are other ways an applicant can get Medicaid coverage retrospectively without applying the three-month retroactive period:    • Eligibility for applicants who are determined eligible for Medicaid will continue to be effective as of the first of the month of application, regardless of when the decision is made. For example, if an application is filed on December 29 and in March, the Department determines that the applicant is Medicaid-eligible for the months of December through March and ongoing, Medicaid is approved effective December 1. Any unpaid medical bills incurred on or after December 1 will be covered as long as the service is a Medicaid-covered service.    • The 90-day reconsideration period allows a former Medicaid member to submit a Medicaid review up to 90 days past the expiration of the member’s 12-month eligibility period without needing to submit a new application. If the person is determined eligible, the effective date of the new eligibility period goes back to the first of the month after the previous eligibility period ended and there is no lapse in coverage.    Comment 4: If facilities become hesitant to admit individuals who have suffered a catastrophic injury since there would no longer be “presumptive Medicaid,” individuals would be forced to stay in the hospital and acute care settings until their Medicaid was active and verified or until they receive approval for disability, which takes six months to determine. Acute hospital stays are considerably more expensive than the next level of service.    Department response 4: These rule changes do not impact presumptive Medicaid. Hospitals and other providers that are designated as a “presumptive provider organization” can make a presumptive Medicaid eligibility determination for persons seeking services. “Presumptive Medicaid” is available to applicants who are children, pregnant women, parents and caretakers, persons aged 19 to under age 65, persons in need of treatment for breast or cervical cancer, and certain former foster care children.    If the provider determines an applicant eligible for presumptive Medicaid, eligibility begins as of the date the presumptive provider makes the eligibility determination and enters the data into the Department’s system. Presumptive Medicaid eligibility continues until the last day of the month following the month of the presumptive determination or until the Department makes a formal Medicaid decision, whichever occurs earlier.     Comment 5: Without the retroactive period, there will likely be more individuals forced to stay in acute care until Medicaid coverage can be verified instead of transitioning to a lower level of care. This will result in significantly higher costs and less effective care. Additionally, because of the process of applying for Medicaid, there will be a lapse between private insurance and Medicaid benefits in many cases. This could result in:    • Uninsured individuals with medically complex situations who have nowhere to turn for treatment, which is putting extreme undue hardships on the individuals and their families.    • Limited admissions to rehabilitation providers who are unable to take on the risk of uninsured individuals without the retroactive coverage.    • Delaying individuals the right to crucial rehabilitation at the time that recovery and successful outcomes are most likely.    Department response 5: The Department needs legislative authority and CMS approval to make an exception and continue to allow the three-month retroactive period for a specific population, except as authorized by CMS for pregnant women and infants (see Department response 2).    The Department believes many in this situation may be eligible under presumptive Medicaid and eligible for retroactive benefits as of the first of the month of application (see Department responses 3 and 4).    Comment 6: Iowa will be the first state in the nation to eliminate retroactive coverage for the traditional Medicaid population (non-expansion population, including the disabled).    Another respondent commented similarly saying “no other state is advancing this type of cost-shift to private-pay residents.”    Department response 6: The Department proposed these amendments to align Medicaid policy with that of the commercial market, which does not allow for an individual to apply for retroactive insurance coverage.     The Department needs legislative authority and CMS approval to suspend or delay implementation of the policy to eliminate retroactive Medicaid or to make an exception and allow the three-month retroactive period for a specific population, except as authorized by CMS for pregnant women and infants (see Department response 2).    Comment 7: With a lack of consistent reporting from the Iowa jails to Iowa Medicaid Enterprise, it is often impossible to know if a Medicaid patient has lost coverage due to being incarcerated for over 30 days. Providers rely upon the state’s eligibility line for verification, and unfortunately, it is not real time. Thus, treatment is provided based upon inaccurate eligibility data, and in the end, the provider is stuck with the cost and repayment of any funds received for this service.    Department response 7: The Department acknowledges this comment and that there are issues with the Department’s receipt of timely and accurate incarceration data. However, the Department does not see this issue as relevant to the elimination of the three-month retroactive period.    Comment 8: All the respondents expressed concerns about costs shifting to providers and Medicaid members, and some respondents believe that the Department underestimated the fiscal impact of the rule change.    Department response 8: There continues to be strong opposition to and disagreement with the Department’s assessment of the overall fiscal impact of these amendments and the impact as it relates to the long-term care data.    The Department received an approval from CMS to implement elimination of retroactive coverage strategy for all Medicaid applicants, except for pregnant women and infants under the age of one, and as a result, the Department recalculated the fiscal impact to exclude the two populations:     o Total annual Medicaid savings = $26,956,724. Reduced from $37,086,260.     o Annual State savings = $5,586,234. Reduced from $9,835,575.     o Savings for the following eligibility groups remain unchanged from the September calculations:     ■ Elderly: Total = $262,791; State = $110,241     ■ Disabled: Total = $4,368,799; State = $1,832,711     ■ Long-term care facility: Total = $334,478; State = $140,314    As previously stated, there are other ways for an applicant to obtain Medicaid coverage retrospectively without application of the three-month retroactive period (see Department response 3). The Department thinks there may be a misunderstanding of the situations that actually meet the criteria of the three-month retroactive coverage as opposed to retroactive benefits applied for other reasons. The Department is willing to meet with the providers individually to discuss the situations that meet the definition of the three-month retroactive period in order to understand the discrepancies.    As explained in Department response 2, these adopted amendments have been changed from those published under Notice of Intended Action and Adopted and Filed Emergency to reinstate retroactive eligibility for pregnant women and infants (under the age of one).    The Council on Human Services adopted these amendments on December 13, 2017.    These amendments do not provide for waivers in specified situations because requests for the waiver of any rule may be submitted under the Department’s general rule on exceptions at 441—1.8(17A,217).    After analysis and review of this rule making, it was determined that Medicaid providers may experience financial loss due to nonpayment of unpaid medical bills incurred in the three months prior to a Medicaid applicant’s filing of an application.    These amendments are intended to implement Iowa Code section 249A.4 and 2017 Iowa Acts, House File 653, section 12(15)(a)(7).    These amendments will become effective February 7, 2018.    The following amendments are adopted.

    Pursuant to the authority of Iowa Code section 249A.4 and 2017 Iowa Acts, House File 653, section 91, the Department of Human Services hereby amends Chapter 75, “Conditions of Eligibility,” and Chapter 76, “Enrollment and Reenrollment,” Iowa Administrative Code.    These amendments remove references to medical assistance for family planning services which refer to Medicaid under the Family Planning Network waiver. The state of Iowa will no longer provide Medicaid under the Family Planning Network waiver. The state of Iowa will continue to provide family planning services through the new state-funded Family Planning Program (FPP) pursuant to 2017 Iowa Acts, House File 653, section 90, as passed during the 87th Session of the General Assembly. Administrative rules for the new FPP are located at 441—Chapter 87.    Notice of Intended Action was published in the Iowa Administrative Bulletin as ARC 3356C on October 11, 2017. These amendments were also Adopted and Filed Emergency and published as ARC 3354C on the same date and became effective October 1, 2017. The Department received no comments during the public comment period. These amendments are identical to those published under Notice of Intended Action and Adopted and Filed Emergency.    The Council on Human Services adopted these amendments on December 13, 2017.    These amendments do not provide for waivers in specified situations because requests for the waiver of any rule may be submitted under the Department’s general rule on exceptions at 441—1.8(17A,217).    After analysis and review of this rule making, providers of family planning services may see an increase or decrease in staffing needs based on the number of individuals seeking family planning services from the providers’ agencies.    These amendments are intended to implement Iowa Code chapter 249A and section 217.41B.    These amendments will become effective February 7, 2018, at which time the Adopted and Filed Emergency amendments are hereby rescinded.    The following amendments are adopted.

    Pursuant to the authority of Iowa Code section 249A.4, the Department of Human Services hereby amends Chapter 77, “Conditions of Participation for Providers of Medical and Remedial Care,” Chapter 78, “Amount, Duration and Scope of Medical and Remedial Services,” and Chapter 79, “Other Policies Relating to Providers of Medical and Remedial Care,” Iowa Administrative Code.    These amendments reflect the new accreditation standards in rule 441—24.21(225C) for crisis response services. Iowa Medicaid currently covers crisis response services; however, these amendments will clarify services covered and provide standards for operation for Medicaid crisis response service providers.    These amendments also establish the process by which the Department of Human Services’ Iowa Medicaid Enterprise (IME) will enroll and reimburse qualified subacute mental health facility providers.    Notice of Intended Action was published in the Iowa Administrative Bulletin as ARC 3439C on November 8, 2017. The Department received no comments during the public comment period. These amendments are identical to those published under Notice of Intended Action, except that a sentence has been added at the end of each of the new rules to cite the Iowa Code section implemented by the rules.    The Council on Human Services adopted these amendments on December 13, 2017.    These amendments do not provide for waivers in specified situations because requests for the waiver of any rule may be submitted under the Department’s general rule on exceptions at 441—1.8(17A,217).    After analysis and review of this rule making, no impact on jobs has been found.    These amendments are intended to implement Iowa Code section 249A.4.    These amendments will become effective February 7, 2018.    The following amendments are adopted.

    Pursuant to the authority of Iowa Code section 249A.4, the Department of Human Services hereby amends Chapter 78, “Amount, Duration and Scope of Medical and Remedial Services,” Iowa Administrative Code.    These amendments revise the language used to describe the home- and community-based services (HCBS) home-delivered meal benefit in order to provide greater clarity regarding how the benefit is to be administered.    These amendments will assist the Department in ensuring that delivery of excess meals is curtailed. These amendments provide a greater understanding to meal providers regarding the definition of service for HCBS home-delivered meals. This improved understanding will in turn assist in curtailing the delivery of meals considered to be outside of the benefit. A member will still have the ability to receive up to two meals per day if that number of meals is authorized in the member’s individualized service plan.    Notice of Intended Action was published in the Iowa Administrative Bulletin as ARC 3374C on October 11, 2017. The Department received no comments during the public comment period. These amendments are identical to those published under Notice of Intended Action.    The Council on Human Services adopted these amendments on December 13, 2017.    These amendments do not provide for waivers in specified situations because requests for the waiver of any rule may be submitted under the Department’s general rule on exceptions at 441—1.8(17A,217).    After analysis and review of this rule making, no impact on jobs has been found.    These amendments are intended to implement Iowa Code section 249A.4.    These amendments will become effective February 7, 2018.     The following amendments are adopted.

    Pursuant to the authority of Iowa Code section 249A.4, the Department of Human Services hereby amends Chapter 78, “Amount, Duration and Scope of Medical and Remedial Services,” Iowa Administrative Code.    This amendment will allow hospice agencies to use the Medicare election of hospice benefits as an alternative to using the election of Medicaid hospice benefits.    Medicaid members and hospice providers will benefit from this amendment. The Department will also be affected by a decrease in the number of exceptions to policy that are processed by the Department.    Notice of Intended Action was published in the Iowa Administrative Bulletin as ARC 3419C on October 25, 2017. The Department received no comments during the public comment period. This amendment is identical to that published under Notice of Intended Action.    The Council on Human Services adopted this amendment on December 13, 2017.    This amendment does not provide for waivers in specified situations because requests for the waiver of any rule may be submitted under the Department’s general rule on exceptions at 441—1.8(17A,217).    After analysis and review of this rule making, no impact on jobs has been found.    This amendment is intended to implement Iowa Code section 249A.4.    This amendment will become effective February 7, 2018.    The following amendment is adopted.

    Pursuant to the authority of Iowa Code section 249A.4 and 2017 Iowa Acts, House File 653, section 93, the Department of Human Services hereby amends Chapter 79, “Other Policies Relating to Providers of Medical and Remedial Care,” Iowa Administrative Code.    These amendments allow Medicaid providers, in addition to providing narrative documentation, to provide narrative documentation of service in a checkbox form format. This change is being made to assist Medicaid providers to have a consistent interpretation of the documentation requirements for services provided.    Notice of Intended Action was published in the Iowa Administrative Bulletin as ARC 3357C on October 11, 2017. These amendments were also Adopted and Filed Emergency and published as ARC 3358C on the same date and became effective October 1, 2017. The Department received no comments during the public comment period. These amendments are identical to those published under Notice of Intended Action and Adopted and Filed Emergency.    The Council on Human Services adopted these amendments on December 13, 2017.    These amendments do not provide for waivers in specific situations because requests for the waiver of any rule may be submitted under the Department’s general rule on exceptions at 441—1.8(17A,217).    After analysis and review of this rule making, no impact on jobs has been found.    These amendments are intended to implement Iowa Code section 249A.4 and 2017 Iowa Acts, House File 653, section 93.     These amendments will become effective February 7, 2018, at which time the Adopted and Filed Emergency amendments are hereby rescinded.    The following amendments are adopted.

    Pursuant to the authority of Iowa Code section 237A.12, the Department of Human Services hereby amends Chapter 109, “Child Care Centers,” Iowa Administrative Code.    This amendment revises the definition of “child care” found in rule 441—109.1(237A) to provide allowable exemptions in accordance with 2017 Iowa Acts, House File 534. House File 534 modifies Iowa Code section 237A.1(3) to allow programs serving children who are at least three years of age and eligible for special education under Iowa Code chapter 256B to be exempt from child care facility licensing requirements.    Notice of Intended Action was published in the Iowa Administrative Bulletin as ARC 3438C on November 8, 2017. The Department received no comments during the public comment period. This amendment is identical to the amendment published under Notice of Intended Action.    The Council on Human Services adopted this amendment on December 13, 2017.    This amendment does not provide for waivers in specified situations because requests for the waiver of any rule may be submitted under the Department’s general rule on exceptions at 441—1.8(17A,217).    After analysis and review of this rule making, no impact on jobs has been found.    This amendment is intended to implement Iowa Code section 237A.1(3).    This amendment will become effective March 1, 2018.    The following amendment is adopted.

    Pursuant to the authority of Iowa Code section 237A.12, the Department of Human Services hereby amends Chapter 109, “Child Care Centers,” Chapter 110, “Child Development Homes,” and Chapter 120, “Child Care Homes,” Iowa Administrative Code.    The Department is required by federal legislation, CFR 45, Part 98, to implement professional development requirements for child care homes that are not registered but have a child care assistance provider agreement. Further, the Department is permitted to make exemptions for relatives that meet the federal definition of “relative.” These amendments provide consistency for requirements for professional development training entities and topics. These amendments also make enhancements to sleep practices to ensure that children who are sleeping in child care facilities are using items designed for sleeping which meet Consumer Product Safety Commission (CPSC) or American Society for Testing and Materials (ASTM) requirements.    Notice of Intended Action was published in the Iowa Administrative Bulletin as ARC 3436C on November 8, 2017. The Department received 19 comments from ten respondents on this rule making. A summary of the respondent’s comments and the Department’s responses are as follows:    Comment 1: Twelve comments were made in support of the recommended changes.     Department response 1: The Department appreciates the support of the respondents in this rule-making process.    Comment 2: Two comments were made suggesting that an approximate amount of time to check on children be added or that more guidance be provided regarding the expectation for sight and sound observation.     Department response 2: The Department recognizes the potential benefit of this addition. It is noted that expectations for observation times may vary for specific children, by age of child and location of sleeping. The Department and resource and referral agencies are available to provide feedback to child care providers on what may be appropriate expectations for their specific programs. At this time, the Department will not promulgate rules to require specific time frames.    Comment 3: Three comments were made that in-home day care providers should be required to follow the same requirements as child care centers and that they should receive training before the providers are able to keep children in their homes. It was requested that providers should have training regarding safe sleep practices.     Department response 3: The Department is responsible for promulgating administrative rules to implement Iowa Code section 237A.12. Iowa Code section 237A.3 permits child care homes to provide child care to five or fewer children without being required to register as a child development home. The provisions in the Iowa Code are enacted by the State Legislature, and any changes to the Iowa Code regarding an expansion of those who are required to abide by administrative rule requirements must go through the legislative process. Child development homes, child care homes with Child Care Assistance Provider Agreements and licensed child care center staff are currently required to complete preservice/orientation, which includes a module on safe sleep practices. No modifications to the rules will be made at this time.    Comment 4: Three comments were made to verify that children over one year of age would also be included in the prohibition from the use of restraint devices.     Department response 4: The rules are written to prohibit the allowance of restraint devices in cribs for any aged child. No change is needed to these amendments.    These amendments are identical to those published under Notice of Intended Action.    The Council on Human Services adopted these amendments on December 13, 2017.    These amendments do not provide for waivers in specified situations because requests for the waiver of any rule may be submitted under the Department’s general rule on exceptions at 441—1.8(17A,217).    After analysis and review of this rule making, no impact on jobs has been found.    These amendments are intended to implement Iowa Code section 237A.12.    These amendments will become effective March 1, 2018.    The following amendments are adopted.

    Pursuant to the authority of Iowa Code section 88.5 and 2017 Iowa Acts, House File 529, the Labor Commissioner hereby amends Chapter 3, “Inspections, Citations and Proposed Penalties,” Iowa Administrative Code.    The U.S. Department of Labor, Occupational Safety and Health Administration, implemented a federal law increasing the penalties for violations. In order to make Iowa’s occupational safety and health penalties consistent with federal law, 2017 Iowa Acts, House File 529, was enacted. The amendment in Item 4 of this rule making is a direct result of House File 529. Additional amendments contained in this rule making consist of conforming amendments, editorial changes, and the removal of obsolete language.    The principal reasons for these amendments are to implement legislative intent, protect the safety and health of Iowa workers, and make Iowa’s regulations current and consistent with federal regulations. Pursuant to Iowa Code section 88.14 as amended by 2017 Iowa Acts, House File 529, the Labor Commissioner shall adopt rules to align state and federal penalty amounts.    Notice of Intended Action was published in the October 25, 2017, Iowa Administrative Bulletin as ARC 3415C. No comments were received. The following changes from the Notice have been made. In Item 4, the date in subrule 3.11(1) was changed from January 27, 2018, to February 11, 2018. References to 2017 Iowa Acts, House File 529, have been removed because the legislation has been codified in Iowa Code chapter 88.    No variance procedures are included in this rule. Variance procedures are set forth in 875—Chapter 5.    After analysis and review of this rule making, jobs could be impacted. However, these amendments are implementing federally mandated regulations, and the State of Iowa is only implementing the federal regulations. The requirements imposed on Iowa businesses by these regulations do not exceed those imposed by federal law.    These amendments are intended to implement Iowa Code chapter 88 as amended by 2017 Iowa Acts, House File 529.    These amendments shall become effective on February 11, 2018.    The following amendments are adopted.

    Pursuant to the authority of Iowa Code sections 147.7, 147.76 and 157.14, the Board of Cosmetology Arts and Sciences hereby amends Chapter 60, “Licensure of Cosmetologists, Electrologists, Estheticians, Manicurists, Nail Technologists, and Instructors of Cosmetology Arts and Sciences,” Chapter 61, “Licensure of Salons and Schools of Cosmetology Arts and Sciences,” and Chapter 64, “Continuing Education for Cosmetology Arts and Sciences,” Iowa Administrative Code.     This rule making provides clarity on the licensure procedures for practitioners and establishments. These amendments update language to reflect provisions in the Iowa Code, clarify licensure requirements and remove temporary-permit requirements. The amendments align posting requirements for schools with those of salons and update curriculum requirements to include online coursework and allowable excused absences. These amendments update language to reflect provisions in the Iowa Code related to compliance with continuing education requirements for active duty military and extend continuing education protocols to the spouse of an active duty military service person. These amendments reduce the number of continuing education hours from eight hours biennially to reflect the minimum of six hours required by Iowa Code section 272C.2A to be earned during the two years immediately prior to a licensee’s license renewal. These amendments further update the required number of continuing education hours for consistency across chapters and remove outdated language.    Notice of Intended Action was published in the Iowa Administrative Bulletin as ARC 3372C on October 11, 2017. A public hearing was held on October 31, 2017. No public comment was received. These amendments are identical to those published under Notice.    A waiver provision is not included in this rule making because all administrative rules of the professional licensure boards in the Division of Professional Licensure are subject to the waiver provisions in 645—Chapter 18.    The Board of Cosmetology Arts and Sciences adopted these amendments on December 4, 2017.    After analysis and review of this rule making, no impact on jobs has been found.    These amendments are intended to implement Iowa Code chapters 147, 157, and 272C.    These amendments will become effective February 7, 2018.    The following amendments are adopted.

    Pursuant to the authority of Iowa Code section 147.76 and chapters 154A and 272C, the Board of Hearing Aid Specialists hereby amends Chapter 121, “Licensure of Hearing Aid Specialists,” Chapter 122, “Continuing Education for Hearing Aid Specialists,” Chapter 123, “Practice of Hearing Aid Dispensing,” and Chapter 124, “Discipline for Hearing Aid Specialists,” Iowa Administrative Code.    This rule making discusses licensure procedures for practitioners. These amendments are mainly technical in nature, including updates to contact information for the Board’s website, updates to definitions and clarification of references throughout the chapters.    Notice of Intended Action was published in the Iowa Administrative Bulletin as ARC 3409C on October 25, 2017. A public hearing was held on Wednesday, November 15, 2017. No public comment was received. These amendments are identical to those published under Notice.    A waiver provision is not included in this rule making because all administrative rules of the professional licensure boards in the Division of Professional Licensure are subject to the waiver provisions accorded under 645—Chapter 18.    After analysis and review of this rule making, no impact on jobs has been found.    These amendments are intended to implement Iowa Code chapters 147, 154A and 272C.    These amendments will become effective February 7, 2018.    The following amendments are adopted.

    Pursuant to the authority of Iowa Code sections 147.76 and 152D.5, the Board of Athletic Training hereby amends Chapter 351, “Licensure of Athletic Trainers,” Iowa Administrative Code.    These amendments are mainly technical in nature and are related to the updating of current websites and contact information for the Division of Professional Licensure and for Board of Certification (BOC) examination services. The amendments also remove out-of-date language to reflect current licensure processes.    Notice of Intended Action was published in the Iowa Administrative Bulletin as ARC 3363C on October 11, 2017. A public hearing was held on October 31, 2017. No public comment was received. These amendments are identical to those published under Notice.    A waiver provision is not included in this rule making because all administrative rules of the professional licensure boards in the Division of Professional Licensure are subject to the waiver provisions in 645—Chapter 18.    The Board of Athletic Training adopted these amendments on December 12, 2017.    After analysis and review of this rule making, no impact on jobs has been found.    These amendments are intended to implement Iowa Code chapters 147, 152D, and 272C.    These amendments will become effective February 7, 2018.    The following amendments are adopted.

    Pursuant to the authority of Iowa Code sections 307.12, 307A.2 and 314.27, the Iowa Department of Transportation, on December 12, 2017, adopted amendments to Chapter 105, “Holiday Rest Stops,” and Chapter 106, “Promotion of Iowa Agricultural Products at Rest Areas,” and rescinded Chapter 123, “Rest Area Sponsorship Program,” Iowa Administrative Code.     The amendments to Chapter 105 correct implementation statutes and the chapter’s implementation sentence, add the Department’s website, and eliminate unnecessary language.    The amendments to Chapter 106 add the Department’s website and eliminate unnecessary language.    The Department is rescinding Chapter 123. The Department developed this chapter based on the Federal Highway Administration’s allowing sponsorships of interstate rest areas. Once the rules were in place, the Department promoted the program and held a letting to secure sponsors. Only eight rest areas were adopted, resulting in only $55,000 of sponsorship funds per year. The Department conducted additional promotions, held a second letting and received no bidders. Once the three-year term expired, none of the current sponsors were interested in future sponsorships. Other states have experienced the same lack of interest. The restrictions put on the program by the Federal Highway Administration severely limited the benefits that potential sponsors would receive.    Notice of Intended Action for these amendments was published in the October 11, 2017, Iowa Administrative Bulletin as ARC 3366C. These amendments are identical to those published under Notice of Intended Action.     These rules do not provide for waivers. Any person who believes that the person’s circumstances meet the statutory criteria for a waiver may petition the Department for a waiver under 761—Chapter 11.    After analysis and review of this rule making, no impact on jobs has been found.     These amendments are intended to implement Iowa Code section 314.27 and 1995 Iowa Acts, chapter 18, section 2.    These amendments will become effective February 7, 2018.    The following amendments are adopted.

    Pursuant to the authority of Iowa Code section 96.11, the Director of the Department of Workforce Development hereby amends Chapter 23, “Employer’s Contribution and Charges,” and Chapter 24, “Claims and Benefits,” Iowa Administrative Code.    These amendments update, clarify and simplify the procedures by which claimants and employers interact with Iowa Workforce Development.     Notice of Intended Action was published in the Iowa Administrative Bulletin on August 30, 2017, as ARC 3280C. The Notice was on the Administrative Rules Review Committee (ARRC) agenda on September 12, 2017. Comment was received from labor and business representatives at the ARRC meeting. Labor representatives were generally opposed to the Department’s internal policy change and voiced opposition to that policy in connection with this rule making. An Amended Notice of Intended Action was published in the Iowa Administrative Bulletin on October 11, 2017, as ARC 3380C to set a public hearing. Another Amended Notice of Intended Action was published in the Iowa Administrative Bulletin on October 25, 2017, as ARC 3432C, which rescheduled the public hearing. Public comment was received in writing before the public hearing, and oral comment was received at the public hearing on November 21, 2017. Representatives from labor unions and trade organizations offered comment in opposition to rule 871—24.39(96) in Item 12 of the Notice of Intended Action. The Department determined that most of the comments in opposition to this rule were in fact in opposition to the internal policy for applying the rule and that no change from the Noticed rule was appropriate at this time. These amendments are identical to those published under Notice.    These amendments do not have any fiscal impact on the State of Iowa.    Waiver provisions do not apply to this rule making.    After analysis and review of this rule making, no impact on jobs has been found.    These amendments are intended to implement Iowa Code chapter 96.    These amendments will become effective February 7, 2018.    The following amendments are adopted.