What changed in HF 803

64 passages reworded, 118 added and 153 removed; 96 of 431 unchanged.

Removed AddedIntroduced textText as passedAmendments

DIVISION I DUTIES OF PHYSICIAN ASSISTANTS

Section 1. Section 90A.1, Code 2021, 2022, is amended by adding the following new subsections:

NEW SUBSECTION. 5A. “Physician” means a person licensed as a physician pursuant to chapter 148.

NEW SUBSECTION. 5B. “Physician assistant” means a person licensed as a physician assistant pursuant to chapter 148C.

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2. Section 90A.8, subsection 2, Code 2021, 2022, is amended to read as follows: 90A.8 Required conditions for boxing matches.

1. A boxing match shall be not more than fifteen rounds in length and the contestants shall wear gloves weighing at least eight ounces during such contests. The commissioner may adopt rules requiring more stringent procedures for specific types of boxing.

2. A contestant shall not take part in a boxing match unless the contestant has presented a valid registration identification card issued pursuant to section 90A.3 to the commissioner prior to the weigh-in for the boxing match. The contestant shall pass a rigorous physical examination to determine the contestant’s fitness to engage in any such match within twenty-four hours of the start of the match. The examination shall be conducted by a licensed practicing physician or physician assistant designated or authorized by the commissioner.

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3. Section 135.109, 96.5, subsection 3, paragraph b, 1, paragraphs d and e, Code 2021, is 2022, are amended to read as follows:

d. The individual left employment because of illness, injury, or pregnancy upon the advice of a licensed and practicing physician or physician assistant, and upon knowledge of the necessity for absence immediately notified the employer, or the employer consented to the absence, and after recovering from the illness, injury, or pregnancy, when recovery was certified by a licensed and practicing physician or physician assistant, the individual returned to the employer and offered to perform services and the individual’s regular work or comparable suitable work was not available, if so found by the department, provided the individual is otherwise eligible.

e. The individual left employment upon the advice of a licensed and practicing physician or physician assistant, for the sole purpose of taking a member of the individual’s family to a place having a different climate, during which time the individual shall be deemed unavailable for work, and notwithstanding during such absence the individual secures temporary employment, and returned to the individual’s regular employer and offered the individual’s services and the individual’s regular work or comparable work was not available, provided the individual is otherwise eligible.

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4. Section 135.109, subsection 3, paragraph b, Code 2022, is amended to read as follows:

b. A licensed physician, physician assistant, or nurse who is knowledgeable concerning domestic abuse injuries and deaths, including suicides.

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4. 5. Section 135.146, subsection 2, Code 2021, 2022, is amended to read as follows:

2. Participation in the vaccination program shall be voluntary, except for first responders who are classified as having occupational exposure to blood-borne pathogens as defined by the occupational safety and health administration standard contained in 29 C.F.R. §1910.1030. First responders who are so classified shall be required to receive the vaccinations as described in subsection 1. A first responder shall be exempt from this requirement, however, when a written statement from a licensed physician or physician assistant is presented indicating that a vaccine is medically contraindicated for that person or the first responder signs a written statement that the administration of a vaccination conflicts with religious tenets.

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5. 6. Section 135J.1, Code 2021, 2022, is amended by adding the following new subsection:

NEW SUBSECTION.

01. “Attending physician” means a physician licensed pursuant to chapter 148 or a physician assistant licensed pursuant to chapter 148C.

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6. 7. Section 135J.1, subsection 6, paragraph e, Code 2021, 2022, is amended to read as follows:

e. As deemed appropriate by the hospice, physician assistants, providers of special services including but not limited to a spiritual counselor, a pharmacist, or professionals in the fields of mental health may be included on the interdisciplinary team.

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7. 8. Section 135J.3, subsections 1 and 4, Code 2021, 2022, are amended to read as follows:

1. A planned program of hospice care, the medical components of which shall be under the direction of a licensed an attending physician.

4. Palliative care provided to a hospice patient and family under the direction of a licensed an attending physician.

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8. 9. Section 141A.5, subsection 2, paragraph c, Code 2021, 2022, is amended to read as follows:

c.

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9. 10. Section 141A.6, subsections 3 and 4, Code 2021, 2022, are amended to read as follows:

3. Within seven days of diagnosing a person as having AIDS or an AIDS-related condition, the diagnosing physician or physician assistant shall make a report to the department on a form provided by the department.

4. Within seven days of the death of a person with HIV infection, the attending physician or attending physician assistant shall make a report to the department on a form provided by the department.

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10. 11. Section 141A.7, subsection 3, Code 2021, 2022, is amended to read as follows:

3. A person may apply for voluntary treatment, contraceptive services, or screening or treatment for HIV infection and other sexually transmitted diseases directly to a licensed physician and surgeon, an osteopathic physician and surgeon, a physician assistant, or a family planning clinic. Notwithstanding any other provision of law, however, a minor shall be informed prior to testing that, upon confirmation according to prevailing medical technology of a positive HIV-related test result, the minor’s legal guardian is required to be informed by the testing facility. Testing facilities where minors are tested shall have available a program to assist minors and legal guardians with the notification process which emphasizes the need for family support and assists in making available the resources necessary to accomplish that goal. However, a testing facility which is precluded by federal statute, regulation, or centers for disease control and prevention guidelines from informing the legal guardian is exempt from the notification requirement. The minor shall give written consent to these procedures and to receive the services, screening, or treatment. Such consent is not subject to later disaffirmance by reason of minority.

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11. 12. Section 144A.2, Code 2021, 2022, is amended by adding the following new subsections:

NEW SUBSECTION. 2A. “Attending physician assistant” means the physician assistant selected by, or assigned to, the patient who has primary responsibility for the treatment and care of the patient.

NEW SUBSECTION. 10A. “Physician assistant” means a person licensed to practice as a physician assistant in this state.

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12. 13. Section 144A.4, Code 2021, 2022, is amended to read as follows: 144A.4 Revocation of declaration.

1. A declaration may be revoked at any time and in any manner by which the declarant is able to communicate the declarant’s intent to revoke, without regard to mental or physical condition. A revocation is only effective as to the attending physician or attending physician assistant upon communication to such physician or physician assistant by the declarant or by another to whom the revocation was communicated.

2. The attending physician or attending physician assistant shall make the revocation a part of the declarant’s medical record.

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13. 14. Section 144A.7A, subsection 1, Code 2021, 2022, is amended to read as follows:

1. If an attending physician or attending physician assistant issues an out-of-hospital do-not-resuscitate order for an adult patient under this section, the physician shall use the form prescribed pursuant to subsection 2, include a copy of the order in the patient’s medical record, and provide a copy to the patient or an individual authorized to act on the patient’s behalf.

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14. 15. Section 144A.7A, subsection 3, paragraph e, Code 2021, 2022, is amended to read as follows:

e. The physician’s or physician assistant’s signature.

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15. 16. Section 144B.1, subsection 3, Code 2021, 2022, is amended to read as follows:

3. “Durable power of attorney for health care” means a document authorizing an attorney in fact to make health care decisions for the principal if the principal is unable, in the judgment of the attending physician or attending physician assistant, to make health care decisions.

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16. 17. Section 144B.5, subsection 1, Code 2021, 2022, is amended to read as follows:

1. A durable power of attorney for health care executed pursuant to this chapter may, but need not, be in the following form: I hereby designate........ as my attorney in fact (my agent) and give to my agent the power to make health care decisions for me. This power exists only when I am unable, in the judgment of my attending physician or attending physician assistant, to make those health care decisions. The attorney in fact must act consistently with my desires as stated in this document or otherwise made known. Except as otherwise specified in this document, this document gives my agent the power, where otherwise consistent with the law of this state, to consent to my physician or physician assistant not giving health care or stopping health care which is necessary to keep me alive. This document gives my agent power to make health care decisions on my behalf, including to consent, to refuse to consent, or to withdraw consent to the provision of any care, treatment, service, or procedure to maintain, diagnose, or treat a physical or mental condition. This power is subject to any statement of my desires and any limitations included in this document. My agent has the right to examine my medical records and to consent to disclosure of such records.

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17. 18. Section 144B.6, subsection 1, Code 2021, 2022, is amended to read as follows:

1. Unless the district court sitting in equity specifically finds that the attorney in fact is acting in a manner contrary to the wishes of the principal or the durable power of attorney for health care provides otherwise, an attorney in fact who is known to the health care provider to be available and willing to make health care decisions has priority over any other person, including a guardian appointed pursuant to chapter 633, to act for the principal in all matters of health care decisions. The attorney in fact has authority to make a particular health care decision only if the principal is unable, in the judgment of the attending physician or attending physician assistant, to make the health care decision. If the principal objects to a decision to withhold or withdraw health care, the principal shall be presumed to be able to make a decision.

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18. 19. Section 144D.4, subsection 3, Code 2021, 2022, is amended to read as follows:

3. If the individual’s physician or physician assistant has issued an out-of-hospital do-not-resuscitate order pursuant to section 144A.7A, the POST form shall not supersede the out-of-hospital do-not-resuscitate order.

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19. 20. Section 144F.2, subsection 1, paragraph b, Code 2021, 2022, is amended to read as follows:

b. A legal representative who is an agent under a durable power of attorney for health care pursuant to chapter 144B shall be given the opportunity to designate a lay caregiver in lieu of the patient’s designation of a lay caregiver only if, consistent with chapter 144B, in the judgment of the attending physician or attending physician assistant, the patient is unable to make the health care decision. A legal representative who is a guardian shall be given the opportunity to designate a lay caregiver in lieu of the patient’s designation of a lay caregiver to the extent consistent with the powers and duties granted the guardian pursuant to sections 232D.401 and 232D.402 or section 633.635.

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20. 21. Section 189A.6, Code 2021, 2022, is amended to read as follows: 189A.6 Health examination of employees. The operator of any establishment shall require all employees of such establishment to have a health examination by a physician or physician assistant and a certified health certificate for each employee shall be kept on file by the operator. The secretary may at any time require an employee of an establishment to submit to a health examination by a physician or physician assistant. No person suffering from any communicable disease, including any communicable skin disease, and no person with infected wounds, and no person who is a “carrier” of a communicable disease shall be employed in any capacity in an establishment. No person shall work or be employed in or about any establishment during the time in which a communicable disease exists in the home in which such person resides unless such person has obtained a certificate from a physician or physician assistant to the effect that no danger of public contagion or infection will result from the employment of such person in such establishment. Every person employed by an establishment and engaged in direct physical contact with meat or poultry products during its preparation, processing, or storage, shall be clean in person, wear clean washable outer garments and a suitable cap or other head covering used exclusively in such work. Only persons specifically designated by the operator of an establishment shall be permitted to touch meat or poultry products with their hands, and the persons so designated shall keep their hands scrupulously clean.

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21. 22. Section 225.9, Code 2021, 2022, is amended to read as follows: 225.9 Voluntary private patients. Voluntary private patients may be admitted in accordance with the regulations to be established by the state board of regents, and their care, nursing, observation, treatment, medicine, and maintenance shall be without expense to the state. However, the charge for such care, nursing, observation, treatment, medicine, and maintenance shall not exceed the cost of the same to the state. The physicians or physician assistants who meet the qualifications set forth in the definition of a mental health professional in section 228.1 on the hospital staff may charge such patients for their medical services under such rules, regulations and plan therefor as approved by the state board of regents.

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22. 23. Section 225.10, unnumbered paragraph 1, Code 2021, 2022, is amended to read as follows: Persons suffering from mental diseases may be admitted to the state psychiatric hospital as voluntary public patients if a physician authorized to practice medicine or osteopathic medicine in the state of Iowa or a physician assistant who meets the qualifications set forth in the definition of a mental health professional in section 228.1 files information with the regional administrator for the person’s county of residence, stating all of the following:

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23. 24. Section 225.10, subsections 1 and 2, Code 2021, 2022, are amended to read as follows:

1. That the physician or physician assistant who meets the qualifications set forth in the definition of a mental health professional in section 228.1 has examined the person and finds that the person is suffering from some abnormal mental condition that can probably be remedied by observation, treatment, and hospital care.

2. That the physician or physician assistant who meets the qualifications set forth in the definition of a mental health professional in section 228.1 believes it would be appropriate for the person to enter the state psychiatric hospital for that purpose and that the person is willing to do so.

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24. 25. Section 225.12, Code 2021, 2022, is amended to read as follows: 225.12 Voluntary public patient —— physician’s report. A physician or a physician assistant who meets the qualifications set forth in the definition of a mental health professional in section 228.1 filing information under section 225.10 shall include a written report to the regional administrator for the county of residence of the person named in the information, giving a history of the case as will be likely to aid in the observation, treatment, and hospital care of the person and describing the history in detail.

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25. 26. Section 225.15, subsection 1, Code 2021, 2022, is amended to read as follows:

1. When a respondent arrives at the state psychiatric hospital, the admitting physician, or a physician assistant who meets the qualifications set forth in the definition of a mental health professional in section 228.1, shall examine the respondent and determine whether or not, in the physician’s or physician assistant’s judgment, the respondent is a fit subject for observation, treatment, and hospital care. If, upon examination, the physician or physician assistant who meets the qualifications set forth in the definition of a mental health professional in section 228.1 decides that the respondent should be admitted to the hospital, the respondent shall be provided a proper bed in the hospital. The physician or physician assistant who meets the qualifications set forth in the definition of a mental health professional in section 228.1 who has charge of the respondent shall proceed with observation, medical treatment, and hospital care as in the physician’s or physician assistant’s judgment are proper and necessary, in compliance with sections 229.13 to 229.13, 229.14, this section, and section 229.16. After the respondent’s admission, the observation, medical treatment, and hospital care of the respondent may be provided by a mental health professional, as defined in section 228.1, who is licensed as a physician, advanced registered nurse practitioner, or physician assistant.

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26. 27. Section 225.16, subsection 1, Code 2021, 2022, is amended to read as follows:

1. If the regional administrator for a person’s county of residence finds from the physician’s information or from the information of a physician assistant who meets the qualifications set forth in the definition of a mental health professional in section 228.1 which was filed under the provisions of section 225.10 that it would be appropriate for the person to be admitted to the state psychiatric hospital, and the report of the regional administrator made pursuant to section 225.13 shows that the person and those who are legally responsible for the person are not able to pay the expenses incurred at the hospital, or are able to pay only a part of the expenses, the person shall be considered to be a voluntary public patient and the regional administrator shall direct that the person shall be sent to the state psychiatric hospital at the state university of Iowa for observation, treatment, and hospital care.

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27. 28. Section 225C.14, subsection 2, Code 2021, 2022, is amended to read as follows:

2. As used in this section and sections 225C.15, 225C.16, and 225C.17, the term “medical emergency” means a situation in which a prospective patient is received at a state mental health institute in a condition which, in the opinion of the chief medical officer, or that officer’s physician or physician assistant designee, provided that a physician assistant designee meets the qualifications set forth in the definition of a mental health professional in section 228.1, requires the immediate admission of the person notwithstanding the policy stated in subsection 1.

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28. 29. Section 225C.16, subsection 1, Code 2021, 2022, is amended to read as follows:

1. The chief medical officer of a state mental health institute, or that officer’s physician or physician assistant designee, provided that a physician assistant designee meets the qualifications set forth in the definition of a mental health professional in section 228.1, shall advise a person residing in that county who applies for voluntary admission, or a person applying for the voluntary admission of another person who resides in that county, in accordance with section 229.41, that the regional administrator for the county has implemented the policy stated in section 225C.14, and shall advise that a preliminary diagnostic evaluation of the prospective patient be sought, if that has not already been done. This subsection does not apply when voluntary admission is sought in accordance with section 229.41 under circumstances which, in the opinion of the chief medical officer or that officer’s physician designee, constitute a medical emergency.

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29. 30. Section 232.71B, subsection 10, Code 2021, 2022, is amended to read as follows:

10. Physical examination. If the department refers a child to a physician or physician assistant for a physical examination, the department shall contact the physician or physician assistant regarding the examination within twenty-four hours of making the referral. If the physician or physician assistant who performs the examination upon referral by the department reasonably believes the child has been abused, the physician or physician assistant shall report to the department within twenty-four hours of performing the examination.

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30. 31. Section 232.78, subsection 4, unnumbered paragraph 1, Code 2021, 2022, is amended to read as follows: The juvenile court may enter an order authorizing a physician or physician assistant or hospital to provide emergency medical or surgical procedures before the filing of a petition under this chapter provided:

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31. 32. Section 232.78, subsection 5, unnumbered paragraph 1, Code 2021, 2022, is amended to read as follows: The juvenile court, before or after the filing of a petition under this chapter, may enter an ex parte order authorizing a physician or physician assistant or hospital to conduct an outpatient physical examination or authorizing a physician or physician assistant, a psychologist certified under section 154B.7, or a community mental health center accredited pursuant to chapter 230A to conduct an outpatient mental examination of a child if necessary to identify the nature, extent, and cause of injuries to the child as required by section 232.71B, provided all of the following apply:

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32. 33. Section 232.79, subsection 1, unnumbered paragraph 1, Code 2021, 2022, is amended to read as follows: A peace officer or juvenile court officer may take a child into custody, a physician or physician assistant treating a child may keep the child in custody, or a juvenile court officer may authorize a peace officer, physician or physician assistant, or medical security personnel to take a child into custody, without a court order as required under section 232.78 and without the consent of a parent, guardian, or custodian provided that both of the following apply:

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33. 34. Section 232.79, subsection 2, paragraph a, Code 2021, 2022, is amended to read as follows:

a. Bring the child immediately to a place designated by the rules of the court for this purpose, unless the person is a physician or physician assistant treating the child and the child is or will presently be admitted to a hospital.

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34. 35. Section 232.83, subsection 2, unnumbered paragraph 1, Code 2021, 2022, is amended to read as follows: Anyone authorized to conduct a preliminary investigation in response to a complaint may apply for, or the court on its own motion may enter an ex parte order authorizing a physician or physician assistant or hospital to conduct an outpatient physical examination or authorizing a physician or physician assistant, a psychologist certified under section 154B.7, or a community mental health center accredited pursuant to chapter 230A to conduct an outpatient mental examination of a child if necessary to identify the nature, extent, and causes of any injuries, emotional damage, or other such needs of a child as specified in section 232.2, subsection 6, paragraph “c”, “e”, or “f”, provided that all of the following apply:

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35. 36. Section 232.95, subsection 2, paragraph c, Code 2021, 2022, is amended to read as follows:

c. Authorize a physician, physician assistant, or hospital to provide medical or surgical procedures if such procedures are necessary to safeguard the child’s life or health.

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36. 37. Section 234.22, Code 2021, 2022, is amended to read as follows: 234.22 Extent of services. Such family planning and birth control services may include interview with trained personnel; distribution of literature; referral to a licensed physician or physician assistant for consultation, examination, tests, medical treatment and prescription; and, to the extent so prescribed, the distribution of rhythm charts, drugs, medical preparations, contraceptive devices and similar products.

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37. 38. Section 235A.13, subsection 9, Code 2021, 2022, is amended to read as follows:

9. “Near fatality” means an injury to a child that, as certified by a physician or physician assistant, placed the child in serious or critical condition.

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38. 39. Section 237A.5, subsection 1, Code 2021, 2022, is amended to read as follows:

1. All personnel in licensed or registered facilities shall have good health as evidenced by a report following a preemployment physical examination taken within six months prior to beginning employment. The examination shall include communicable disease tests by a licensed physician as defined in section 135C.1 or a licensed physician assistant as defined in section 148C.1 and shall be repeated every three years after initial employment. Controlled medical conditions which would not affect the performance of the employee in the capacity employed shall not prohibit employment.

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39. 40. Section 237A.13, subsection 1, paragraph d, Code 2021, 2022, is amended to read as follows:

d. The child’s parent, guardian, or custodian is absent for a limited period of time due to hospitalization, physical illness, or mental illness, or is present but is unable to care for the child for a limited period as verified by a physician or physician assistant.

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40. 41. Section 249.3, subsection 2, paragraph a, subparagraph (2), Code 2021, 2022, is amended to read as follows:

(2) Nursing care in the person’s own home, certified by a physician or physician assistant as being required, so long as the cost of the nursing care does not exceed standards established by the department.

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41. 42. Section 321.375, subsection 4, paragraph b, subparagraph (4), Code 2021, 2022, is amended to read as follows:

(4) Maintaining a daily log of all glucose test results for the previous six-month period and providing copies to the school district or school, the examining physician or examining physician assistant, and the department of education upon request.

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42. 43. Section 321.446, subsection 3, paragraph c, Code 2021, 2022, is amended to read as follows:

c. The transportation of a child who has been certified by a physician licensed under chapter 148 or a physician assistant licensed under chapter 148C as having a medical, physical, or mental condition that prevents or makes inadvisable securing the child in a child restraint system, safety belt, or safety harness.

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43. 44. Section 347B.5, Code 2021, 2022, is amended to read as follows: 347B.5 Admission —— labor required. The county care facility shall maintain a record of the name and age of each person admitted and the date of admission. The board may require of any resident of the county care facility, with approval of a physician or physician assistant, reasonable and moderate labor suited to the resident’s age and bodily strength. Any income realized through the labor of residents, together with the receipts from operation of the county farm if one is maintained, shall be appropriated for use by the county care facility as the board of supervisors directs.

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44. Section 347B.6, Code 2021, is amended to read as follows: 347B.6 Order for admission. No person shall be admitted into the county care facility as a resident except upon order of the board of supervisors, which shall be issued only after the person seeking admission has received a preadmission physical examination by a physician or physician assistant. However, if the need for admission of the person to the county care facility is immediate and no physician or physician assistant is readily available to perform the examination, the board may order the person’s admission pending an examination by a physician or physician assistant, any provisions of sections 135C.3 and 135C.4 to the contrary notwithstanding. When an admission is so ordered, the physical examination shall be completed within three days after the person’s admission to the county care facility.

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45. Section 411.5, subsection 8, Code 2021, is amended to read as follows:

8. Medical board. The board of trustees shall designate a single medical provider network as the medical board for the system. The medical board shall arrange for and pass upon all medical examinations required under the provisions of chapter 400 and this chapter and shall assist the system in all aspects of the comprehensive disability program described in section 411.1A. For examinations required because of disability, a physician or physician assistant from the medical board specializing in occupational medicine, and a second physician or physician assistant specializing in an appropriate field of medicine as determined by the occupational medicine physician or physician assistant, shall pass upon the medical examinations required for disability retirements and shall report to the system in writing their conclusions and recommendations upon all matters referred to the medical board. Each report of a medical examination under section 411.6, subsections 3 and 5, shall include the medical board’s findings in accordance with section 411.6 as to the extent of the member’s physical impairment.

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46. Section 411.6, subsection 5, paragraph b, Code 2021, is amended to read as follows:

b. If a member in service or the chief of the police or fire departments becomes incapacitated for duty as a natural or proximate result of an injury or disease incurred in or aggravated by the actual performance of duty at some definite time or place or while acting, pursuant to order, outside the city by which the member is regularly employed, the member, upon being found to be temporarily incapacitated following a medical examination as directed by the city, is entitled to receive the member’s full pay and allowances from the city’s general fund or trust and agency fund until reexamined as directed by the city and found to be fully recovered or until the city determines that the member is likely to be permanently disabled. If the temporary incapacity of a member continues more than sixty days, or if the city expects the incapacity to continue more than sixty days, the city shall notify the system of the temporary incapacity. Upon notification by a city, the system may refer the matter to the medical board for review and consultation with the member’s treating physician or treating physician assistant during the temporary incapacity. Except as provided by this paragraph, the board of trustees of the statewide system has no jurisdiction over these matters until the city determines that the disability is likely to be permanent.

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47. Section 411.6, subsection 7, unnumbered paragraph 1, Code 2021, is amended to read as follows: The system may, and upon the member’s application shall, require any disability beneficiary who has not yet attained age fifty-five to undergo a medical examination at a place designated by the medical board. The examination shall be made by the medical board or, in special cases, by an additional physician, or physicians, physician assistant, or physician assistants designated by such board. If any disability beneficiary who has not attained the age of fifty-five refuses to submit to the medical examination, the member’s allowance may be discontinued until withdrawal of such refusal, and if the refusal continues for one year all rights in and to the member’s pension may be revoked by the system. For a disability beneficiary who has not attained the age of fifty-five and whose entitlement to a disability retirement commenced on or after July 1, 2000, the medical board may, as part of the examination required by this subsection, suggest appropriate medical treatment or rehabilitation if, in the opinion of the medical board, the recommended treatment or rehabilitation would likely restore the disability beneficiary to duty.

45. Section 347B.6, Code 2022, is amended to read as follows: 347B.6 Order for admission. No person shall be admitted into the county care facility as a resident except upon order of the board of supervisors, which shall be issued only after the person seeking admission has received a preadmission physical examination by a physician or physician assistant. However, if the need for admission of the person to the county care facility is immediate and no physician or physician assistant is readily available to perform the examination, the board may order the person’s admission pending an examination by a physician or physician assistant, any provisions of sections 135C.3 and 135C.4 to the contrary notwithstanding. When an admission is so ordered, the physical examination shall be completed within three days after the person’s admission to the county care facility.

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48. 46. Section 514C.17, subsections 1 and 2, Code 2021, 2022, are amended to read as follows:

1. Except as provided under subsection 2 or 3, if a carrier, as defined in section 513B.2, or a plan established pursuant to chapter 509A for public employees, terminates its contract with a participating health care provider, a covered individual who is undergoing a specified course of treatment for a terminal illness or a related condition, with the recommendation of the covered individual’s treating physician licensed under chapter 148 or treating physician assistant licensed under chapter 148C may continue to receive coverage for treatment received from the covered individual’s physician or physician assistant for the terminal illness or a related condition, for a period of up to ninety days. Payment for covered benefits and benefit levels shall be according to the terms and conditions of the contract.

2. A covered person who makes a change in health plans involuntarily may request that the new health plan cover services of the covered person’s treating physician licensed under chapter 148 or treating physician assistant licensed under chapter 148C who is not a participating health care provider under the new health plan, if the covered person is undergoing a specified course of treatment for a terminal illness or a related condition. Continuation of such coverage shall continue for up to ninety days. Payment for covered benefits and benefit levels shall be according to the terms and conditions of the contract.

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49. 47. Section 514C.18, subsection 1, unnumbered paragraph 1, Code 2021, 2022, is amended to read as follows: Notwithstanding the uniformity of treatment requirements of section 514C.6, a policy or contract providing for third-party payment or prepayment of health or medical expenses shall provide coverage benefits for the cost associated with equipment, supplies, and self-management training and education for the treatment of all types of diabetes mellitus when prescribed by a physician licensed under chapter 148 or a physician assistant licensed under chapter 148C. Coverage benefits shall include coverage for the cost associated with all of the following:

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50. 48. Section 514C.18, subsection 1, paragraph b, subparagraphs (1) and (2), Code 2021, 2022, are amended to read as follows:

(1) The physician or physician assistant managing the individual’s diabetic condition certifies that such services are needed under a comprehensive plan of care related to the individual’s diabetic condition to ensure therapy compliance or to provide the individual with necessary skills and knowledge to participate in the management of the individual’s condition.

(2) The diabetes self-management training and education program is certified by the Iowa department of public health. The department shall consult with the American diabetes association, Iowa affiliate, in developing the standards for certification of diabetes education programs that cover at least ten hours of initial outpatient diabetes self-management training within a continuous twelve-month period and up to two hours of follow-up training for each subsequent year for each individual diagnosed by a physician or physician assistant with any type of diabetes mellitus.

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51. 49. Section 514C.20, subsection 1, paragraphs a and b, Code 2021, 2022, are amended to read as follows:

a. A child under five years of age upon a determination by a licensed dentist and the child’s treating physician licensed pursuant to chapter 148 or treating physician assistant licensed pursuant to chapter 148C, that such child requires necessary dental treatment in a hospital or ambulatory surgical center due to a dental condition or a developmental disability for which patient management in the dental office has proved to be ineffective.

b. Any individual upon a determination by a licensed dentist and the individual’s treating physician licensed pursuant to chapter 148 or treating physician assistant licensed pursuant to chapter 148C, that such individual has one or more medical conditions that would create significant or undue medical risk for the individual in the course of delivery of any necessary dental treatment or surgery if not rendered in a hospital or ambulatory surgical center.

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52. 50. Section 514C.25, subsection 1, paragraph a, Code 2021, 2022, is amended to read as follows:

a. Notwithstanding the uniformity of treatment requirements of section 514C.6, a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses shall provide coverage benefits for medically necessary prosthetic devices when prescribed by a physician licensed under chapter 148 or physician assistant licensed under chapter 148C. Such coverage benefits for medically necessary prosthetic devices shall provide coverage for medically necessary prosthetic devices that, at a minimum, equals the coverage and payment for medically necessary prosthetic devices provided under the most recent federal laws for health insurance for the aged and disabled pursuant to 42 U.S.C. §1395k, 13951, and 1395m, and 42 C.F.R. §410.100, 414.202, 414.210, and 414.228, as applicable. DIVISION II DUTIES OF PHYSICIAN ASSISTANTS —— RULES

Sec.

53. ADMINISTRATIVE RULEMAKING.

1. The department of administrative services, department on aging, department of corrections, economic development authority, department of education, department of human services, department of inspections and appeals, racing and gaming commission, Iowa law enforcement academy, natural resource commission, Iowa department of public health, department of public safety, department of transportation, Iowa department of veterans affairs, and the department of workforce development including the division of labor services, in accordance with chapter 17A and this section, and consistent with this Act, shall each amend, rescind, or adopt rules which address all of the following:

a. For the department of administrative services, rules relating to and in substantial conformance with all of the following:

(1) For the retroactive conversion of vacation time to sick leave under 11 IAC 63.2(2)(h), including that in the event of an illness or disability while on vacation, that portion of the vacation spent under the care of a physician or physician assistant shall be switched retroactively to and charged against the employee’s accrued sick leave upon satisfactory proof from the physician or physician assistant of the illness or disability and its duration.

(2) Definitions pursuant to 11 IAC 63.19, including that “catastrophic illness” means a physical or mental illness or injury of the employee, as certified by a licensed physician or physician assistant, that will result in the inability of the employee to work for more than thirty workdays on a consecutive or intermittent basis; or that will result in the inability of the employee to report to work for more than thirty workdays due to the need to attend to an immediate family member on a consecutive or intermittent basis.

(3) For certification requirements pursuant to 11 IAC 63.19(4), including that the employee shall submit an application for donated leave on forms developed by the department. Appointing authorities may, at their department’s expense, seek second medical opinions or updates from physicians or physician assistants regarding the status of an employee’s or employee’s immediate family member’s illness or injury. If the employee is receiving family medical leave Act leave, a second opinion must be obtained from a physician or physician assistant who is not regularly employed by the state.

b. For the department on aging, rules for special dietary needs pursuant to 17 IAC 7.18(3), including that a written order from a physician or physician assistant for each older individual requesting a therapeutic diet shall be obtained prior to the older individual’s receipt of the meal and kept on file where the meal is prepared and served. The order shall be interpreted by a licensed dietitian and the individual’s physician or physician assistant.

c. For the department of corrections, rules relating to and in substantial conformance with all of the following:

(1) For substance abuse and conditions of parole pursuant to 201 IAC 45.2(1)(e), including that the parolee shall not use, purchase, or possess alcoholic beverages and shall submit to alcohol tests and drug tests when directed by the parolee’s supervising officer. The parolee shall not enter taverns or liquor stores or other establishments where the primary activity is the sale of alcoholic beverages. The parolee will not use, ingest, inject, huff, possess, or smoke any illegal or synthetic substances. The parolee shall not use, purchase, possess, or transfer any drugs unless they are prescribed by a physician or physician assistant.

(2) For medical services pursuant to 201 IAC 50.15, unnumbered paragraph 1, including that the jail administrator shall establish a written policy and procedure to ensure that prisoners have the opportunity to receive necessary medical attention for the prisoners’ objectively serious medical and dental needs which are known to the jail staff. A serious medical need is one that has been diagnosed by a physician or physician assistant as requiring treatment or is one that is so obvious that even a lay person would easily recognize the necessity for a physician’s or physician assistant’s attention. The plan shall include a procedure for emergency care. Responsibility for the costs of medical services and products remains that of the prisoner. However, no prisoner will be denied necessary medical services, dental service, medicine, or prostheses because of a lack of ability to pay. Medical and dental prostheses shall be provided only for the serious medical needs of the prisoner, as determined by a licensed health care professional. Cosmetic or elective procedures need not be provided.

(3) For medical resources pursuant to 201 IAC 50.15(1), including that each jail shall have a designated licensed physician, licensed osteopathic physician, physician assistant, or medical resource, such as a hospital or clinic staffed by licensed physicians, physician assistants, or licensed osteopathic physicians, designated for the medical supervision, care, and treatment of prisoners as deemed necessary and appropriate. Medical resources shall be available on a twenty-four-hour basis.

(4) For medication procedures pursuant to 201 IAC 50.15(7)(d), including that prescription medication, as ordered by a licensed physician, licensed osteopathic physician, licensed physician assistant, or licensed dentist, shall be provided in accordance with the directions of the prescribing physician, physician assistant, or dentist. Prisoners with medication from a personal physician, osteopathic physician, physician assistant, or dentist may be evaluated by a physician, osteopathic physician, physician assistant, or dentist selected by the jail administrator to determine if the present medication is appropriate.

(5) For medication storage pursuant to 201 IAC 50.15(9)(c), including that expired drugs or drugs not in unit dose packaging, whose administration had been discontinued by the attending physician or physician assistant, shall be destroyed by the jail administrator or designee in the presence of a witness. A record of drug destruction shall be made in each prisoner’s medical record. The record shall include the name, the strength, and the quantity of the drug destroyed, and the record shall be signed by the jail administrator or designee and by the witness.

(6) For medical diets pursuant to 201 IAC 50.16(5), including special diets as prescribed by a physician or physician assistant shall be followed and documented. The physician or physician assistant who prescribes the special diet shall specify a date on which the diet will be reviewed for renewal or discontinuation. Unless specified by the prescribing physician or physician assistant, a certified dietitian shall develop the menu.

(7) For the care and treatment of juveniles in nonsecure hold pursuant to 201 IAC 50.24(5)(a)(10), including special diets as prescribed by a physician or physician assistant shall be followed and documented.

(8) For medical services in temporary holding facilities pursuant to 201 IAC 51.13, unnumbered paragraph 1, including that the facility administrator shall establish a written policy and procedure to ensure that detainees have the opportunity to receive necessary medical attention for the detainee’s objectively serious medical and dental needs which are known to the facility staff. A serious medical need is one that has been diagnosed by a physician or physician assistant as requiring treatment, or one that is so obvious that even a lay person would easily recognize the necessity for a physician’s or physician assistant’s attention. The plan shall include a procedure for emergency services day or night and a procedure for regular medical attention. Responsibility for the costs of medical services remains that of the detainee. However, no detainee will be denied necessary medical services, dental service, or medicine because of a lack of ability to pay. Medical and dental prostheses shall be provided only for the serious medical needs of the detainee, as determined by a licensed health care professional. Cosmetic or elective procedures need not be provided.

(9) For medical resources in temporary holding facilities pursuant to 201 IAC 51.13(1), each facility shall have a designated licensed physician, licensed physician assistant, licensed osteopathic physician or medical resource, such as a hospital or clinic staffed by licensed physicians, licensed physician assistants, or licensed osteopathic physicians, designated for the medical supervision, care, and treatment of detainees as deemed necessary and appropriate. Medical resources shall be available on a twenty-four-hour basis.

(10) For medication procedures in temporary holding facilities pursuant to 201 IAC 51.13(7)(d), including prescription medication, as ordered by a licensed physician, licensed physician assistant, licensed osteopathic physician, or licensed dentist shall be provided in accordance with the directions of the prescribing physician, physician assistant, or dentist. Detainees with medication from a personal physician, physician assistant, osteopathic physician, or dentist may be evaluated by a physician, physician assistant, osteopathic physician, or dentist selected by the facility administrator to determine if the present medication is appropriate.

(11) For medication storage in temporary holding facilities pursuant to 201 IAC 51.13(9)(c), including expired drugs or drugs not in unit dose packaging, whose administration had been discontinued by the attending physician or physician assistant, shall be destroyed by the facility administrator or designee in the presence of a witness. A record of drug destruction shall be made in each detainee’s medical record. The record shall include the name, the strength, and the quantity of the drug destroyed; and the record shall be signed by the facility administrator or designee and by the witness.

(12) For medical diets in temporary holding facilities pursuant to 201 IAC 51.14(4), including that special diets as prescribed by a physician or physician assistant shall be followed and documented.

(13) For medical care and treatment for juveniles in nonsecure holds in temporary holding facilities pursuant to 201 IAC 51.20(5)(a)(10), special diets as prescribed by a physician or physician assistant shall be followed and documented.

d. For the economic development authority, rules for the certification of a person with a disability for the purpose of the targeted small business program pursuant to 261 IAC 52.2(7)(a), including that in order to be considered a person with a disability for the purpose of the targeted small business program, the person must qualify and receive certification as having a disability from a licensed medical physician or physician assistant or must have been found eligible for vocational rehabilitation services by the department of education, division of vocational rehabilitation services, or by the department for the blind.

e. For the department of education, rules relating to and in substantial conformance with all of the following:

(1) For statements relating to medication administration policies pursuant to 281 IAC 14.1(3), including that a statement that persons administering medication shall include authorized practitioners, such as licensed registered nurses, physician assistants, and physicians, and persons to whom authorized practitioners have delegated the administration of prescription and nonprescription drugs (who shall have successfully completed a medication administration course). Individuals who have demonstrated competency in administering their own medications may self-administer their medication. Individuals shall self-administer asthma or other airway constricting disease medication or possess and have use of an epinephrine auto-injector with parent and physician or physician assistant consent on file, without the necessity of demonstrating competency to self-administer these medications.

(2) For medication administration courses relating to medication administration policies pursuant to 281 IAC 14.1(4), including that a provision for a medication administration course provided by the department that is completed every five years with an annual medication administration procedural skills check completed with a registered nurse, physician assistant, or pharmacist. A registered nurse, physician assistant, or licensed pharmacist shall conduct the course. A record of course completion shall be maintained by the school.

(3) For definitions pursuant to 281 IAC 66.2, including that “preventive and primary health care services” means services which include but are not limited to physical examinations, immunizations, hearing and vision screening, preventive care, maintenance services, diagnosis, treatment, referral, case management, health supervision, and health teaching. These services shall be delivered by specifically credentialed providers such as licensed physicians, dentists, physician assistants, registered nurses, nutritionists, social workers, psychologists, dental hygienists, physical or occupational therapists, and respiratory therapists. Youth with complex health needs may require referral to specially trained and skilled health care providers.

f. For the department of human services, rules relating to and in substantial conformance with all of the following:

(1) Definitions pursuant to 441 IAC 24.1, including all of the following:

(a) “Incident” includes but is not limited to an occurrence involving the individual using the service that results in a physical injury to or by the individual that requires a physician’s or physician assistant’s treatment or admission to a hospital, provided that the physician assistant meets the requirements of a mental health professional pursuant to section 228.1 and this section.

(b) “Mental health professional” means a person who meets all of the following conditions:

(i) Holds at least a master’s degree in a mental health field including but not limited to psychology, counseling and guidance, psychiatric nursing, and social work; or is a doctor of medicine or osteopathic medicine.

(ii) Holds a current Iowa license when required by the Iowa professional licensure laws (such as a psychiatrist, a psychologist, a marital and family therapist, a mental health counselor, an advanced registered nurse practitioner, a physician assistant, a psychiatric nurse, or a social worker). (iii) Has at least two years of postdegree experience supervised by a mental health professional in assessing mental health problems, mental illness, and service needs and in providing mental health services.

51.

(c) “Physician assistant” means a person who is licensed to practice as a physician assistant in the state of Iowa under chapter 148C.

NEW SECTION. 147.77 Powers, privileges, rights, or duties provided by rule —— applicability to physician assistants.

(2) Definitions pursuant to 441 IAC 25.1, including that “home health aide services” means unskilled medical services which provide direct personal care. This service may include assistance with activities of daily living, such as helping the recipient to bathe, get in and out of bed, care for hair and teeth, exercise, and take medications specifically ordered by the physician or physician assistant.

1. The following agencies that adopt rules pursuant to chapter 17A providing a power, privilege, right, or duty to a physician licensed under chapter 148 or other profession licensed under this subtitle relating to the following subjects shall, consistent with the scope of practice of physician assistants licensed under chapter 148C, and unless otherwise inconsistent with state or federal law, provide the same power, privilege, right, or duty by rule to a physician assistant licensed under chapter 148C:

(3) For physician’s statements relating to eligibility for residential care pursuant to 441 IAC 51.3(2), including that payment for residential care shall be made only when there is on file an order written by a physician or physician assistant certifying that the applicant or recipient being admitted requires residential care but does not require nursing services. The certification shall be updated whenever a change in the recipient’s physical condition warrants reevaluation, but no less than every twelve months.

a. The department of administrative services, with respect to rules relating to the following:

(4) For the maintenance of case records by a facility desiring to participate in the state supplementary assistance program pursuant to 441 IAC 54.2, requiring that a case folder for each individual residing in the facility contain a physician’s or physician assistant’s statement certifying that the resident does not require nursing services.

(1) Retroactive conversion of vacation time to sick leave for vacation time spent under the care of a physician.

(5) For the provision of psychological evaluations and counseling or psychotherapy services by area education agencies pursuant to 441 IAC 77.28(4), including that personnel providing psychological evaluations and counseling or psychotherapy services may include a person licensed by the Iowa board of physician assistants as a physician assistant pursuant to 645 IAC chapters 326 to 349 and who meets the requirements of a “mental health professional” pursuant to 441 IAC 24.1.

(2) Certification of a catastrophic illness by a physician for purposes of donation of leave and second medical opinions and updates sought from a physician relating to such certifications.

(6) For the provision of psychological evaluations and counseling or psychotherapy services by an agency participating in the medical assistance program as a provider of infant and toddler program services pursuant to 441 IAC 77.43(1)(d), including that personnel providing psychological evaluations and counseling or psychotherapy services may include a person licensed by the Iowa board of physician assistants as a physician assistant pursuant to 645 IAC chapters 326 to 349 and who meets the requirements of a “mental health professional” pursuant to 441 IAC 24.1.

b. The department on aging, with respect to rules relating to a written order from a physician for an older individual requesting a therapeutic diet, and the interpretation of such orders.

(7) For the provision of other services by an agency participating in the medical assistance program as a provider of infant and toddler program services pursuant to 441 IAC 77.43(1)(i), including that personnel providing other services may include a person licensed by the Iowa board of physician assistants as a physician assistant pursuant to 645 IAC chapters 326 to 349 and who meets the requirements of a “mental health professional” pursuant to 441 IAC 24.1.

c. The department of corrections, with respect to rules relating to the following:

(8) For the provision of psychological evaluations and counseling or psychotherapy services by providers of local education agency services pursuant to 441 IAC 77.44(1)(d), including that personnel providing psychological evaluations and counseling or psychotherapy services may include a person registered by the Iowa board of physician assistants as a physician assistant pursuant to 645 IAC chapters 326 to 349 and who meets the requirements of a “mental health professional” pursuant to 441 IAC 24.1.

(1) That a parolee shall not use, purchase, possess, or transfer any drugs unless prescribed by a physician.

(9) For the provision of other services by providers of local education agency services pursuant to 441 IAC 77.44(1)(i), including that personnel providing other services may include a person licensed by the Iowa board of physician assistants as a physician assistant pursuant to 645 IAC chapters 326 to 349 and who meets the requirements of a “mental health professional” pursuant to 441 IAC 24.1.

(2) That a serious medical need is one that has been diagnosed by a physician as requiring treatment or is one so obvious that a lay person would easily recognize the necessity for a physician’s attention.

(10) For payment for medically necessary home health agency services pursuant to 441 IAC 78.9, unnumbered paragraph 1, including that payment shall be approved for medically necessary home health agency services prescribed by a physician or physician assistant in a plan of home health care provided by a Medicare-certified home health agency.

(3) That each jail shall have a designated licensed physician, licensed osteopathic physician, or medical resource designated for the medical supervision, care, and treatment of prisoners as deemed necessary and appropriate.

(11) For authorization for medically necessary home health agency services pursuant to 441 IAC 78.9, including that services shall be authorized by a physician or physician assistant, evidenced by the physician’s or physician assistant’s signature and date on a plan of treatment.

(4) That prescription medication, as ordered by a licensed physician, licensed osteopathic physician, or licensed dentist shall be provided in accordance with the directions of the prescribing physician or dentist. Prisoners with medication from a personal physician, osteopathic physician, or dentist may be evaluated by a physician, osteopathic physician, or dentist selected by the jail administrator to determine if the present medication is appropriate.

(12) For treatment plans of home health agencies pursuant to 441 IAC 78.9(1)(h)(3), including that a member’s medical condition shall be reflected by the date last seen by a physician or physician assistant, if available.

(5) That expired drugs or drugs not in unit dose packaging, whose administration had been discontinued by the attending physician, shall be destroyed by the jail administrator or designee in the presence of a witness.

(13) For items included in treatment plans of home health agencies pursuant to 441 IAC 78.9(1)(l), including that a plan of care shall include a physician’s or physician assistant’s signature and date. The plan of care must be signed and dated by the physician or physician assistant before the claim for service is submitted for reimbursement.

(6) That special diets in jails prescribed by a physician shall be followed and documented, that the physician who prescribes the special diet shall specify a date on which the diet will be reviewed for renewal or discontinuation, and that unless specified by the prescribing physician, a certified dietitian shall develop the menu.

(14) For skilled nursing services provided by a home health agency pursuant to 441 IAC 78.9(3), unnumbered paragraph 1, including that skilled nursing services are services that when performed by a home health agency require a licensed registered nurse or licensed practical nurse to perform. Situations when a service can be safely performed by the member or other nonskilled person who has received the proper training or instruction or when there is no one else to perform the service are not considered a “skilled nursing service”. Skilled nursing services shall be available only on an intermittent basis. Intermittent services for skilled nursing services shall be defined as a medically predictable recurring need requiring a skilled nursing service at least once every sixty days, not to exceed five days per week (except as provided below), with an attempt to have a predictable end. Daily visits (six or seven days per week) that are reasonable and necessary and show an attempt to have a predictable end shall be covered for up to three weeks. Coverage of additional daily visits beyond the initial anticipated time frame may be appropriate for a short period of time, based on the medical necessity of service. Medical documentation shall be submitted justifying the need for continued visits, including the physician’s or physician assistant’s estimate of the length of time that additional visits will be necessary. Daily skilled nursing visits or multiple daily visits for wound care or insulin injections shall be covered when ordered by a physician or physician assistant and included in the plan of care. Other daily skilled nursing visits which are ordered for an indefinite period of time and designated as daily skilled nursing care do not meet the intermittent definition and shall be denied.

(7) That special diets prescribed by a physician for the care and treatment of juveniles in nonsecure hold shall be followed and documented.

(15) For physical therapy services provided by a home health agency pursuant to 441 IAC 78.9(4), unnumbered paragraph 1, including that payment shall be made for physical therapy services when the services relate directly to an active written treatment plan, follow a treatment plan established by the physician or physician assistant after any needed consultation with the qualified physical therapist, are reasonable and necessary to the treatment of the patient’s illness or injury, and meet the guidelines defined for restorative, maintenance, or trial therapy as set forth in subrule 78.19(1)(a,b).

(8) For medical services in temporary holding facilities, that a serious medical need is one that has been diagnosed by a physician as requiring treatment or one that is so obvious that a lay person would easily recognize the necessity for a physician’s attention.

(16) For occupational therapy services provided by a home health agency pursuant to 441 IAC 78.9(5), unnumbered paragraph 1, including that payment shall be made for occupational therapy services when the services relate directly to an active written treatment plan, follow a treatment plan established by the physician or physician assistant, are reasonable and necessary to the treatment of the patient’s illness or injury, and meet the guidelines defined for restorative, maintenance, or trial therapy as set forth in subrule 78.19(1)(a,c).

(9) For medical resources in temporary holding facilities, that each facility shall have a designated licensed physician, licensed osteopathic physician, or medical resource designated for the medical supervision, care, and treatment of detainees as deemed necessary and appropriate.

(17) For speech therapy services provided by a home health agency pursuant to 441 IAC 78.9(6), unnumbered paragraph 1, including that payment shall be made for speech therapy services when the services relate directly to an active written treatment plan, follow a treatment plan established by the physician or physician assistant, are reasonable and necessary to the treatment of the patient’s illness or injury, and meet the guidelines defined for restorative, maintenance, or trial therapy as set forth in subrule 78.19(1)(a,d).

(10) Medication procedures in temporary holding facilities, that prescription medication, as ordered by a licensed physician, licensed osteopathic physician, or licensed dentist shall be provided in accordance with the directions of the prescribing physician or dentist. Detainees with medication from a personal physician, osteopathic physician, or dentist may be evaluated by a physician, osteopathic physician, or dentist selected by the facility administrator to determine if the present medication is appropriate.

(18) For home health aide services provided by a home health agency pursuant to 441 IAC 78.9(7)(a), including that the service as well as the frequency and duration are stated in a written plan of treatment established by a physician or physician assistant. The home health agency is encouraged to collaborate with the member, or in the case of a child with the child’s caregiver, in the development and implementation of the plan of treatment.

(11) For medication storage in temporary holding facilities, that expired drugs or drugs not in unit dose packaging, whose administration had been discontinued by the attending physician, shall be destroyed by the facility administrator or designee in the presence of a witness.

(19) For home health aide services provided by a home health agency pursuant to 441 IAC 78.9(7)(c), unnumbered paragraph 1, including that services shall be provided on an intermittent basis. “Intermittent basis” for home health agency services is defined as services that are usually two to three times a week for two to three hours at a time. Services provided for four to seven days per week, not to exceed twenty-eight hours per week, when ordered by a physician or physician assistant and included in a plan of care shall be allowed as intermittent services. Increased services provided when medically necessary due to unusual circumstances on a short-term basis of two to three weeks may also be allowed as intermittent services when the home health agency documents the need for the excessive time required for home health aide services.

(12) For medical diets in temporary holding facilities, that special diets as prescribed by a physician shall be followed and documented.

(20) For home health aide services provided by a home health agency pursuant to 441 IAC 78.9(7)(c), unnumbered paragraph 3, including that personal care services include the activities of daily living, e.g., helping the member to bathe, get in and out of bed, care for hair and teeth, exercise, and take medications specifically ordered by the physician or physician assistant, but ordinarily self-administered, and retraining the member in necessary self-help skills.

(13) For medical care and treatment for juveniles in nonsecure holds in temporary holding facilities, that special diets as prescribed by a physician shall be followed and documented.

(21) For private duty nursing or personal care services for persons aged twenty and under pursuant to 441 IAC 78.9(10)(a)(1), unnumbered paragraph 1, including that private duty nursing services are those services which are provided by a registered nurse or a licensed practical nurse under the direction of the member’s physician or physician assistant to a member in the member’s place of residence or outside the member’s residence, when normal life activities take the member outside the place of residence. Place of residence does not include nursing facilities, intermediate care facilities for the mentally retarded, or hospitals.

d. The economic development authority, with respect to rules relating to the certification of a person with a disability for the purpose of the targeted small business program, that in order to be considered a person with a disability for the purpose of the targeted small business program, the person must qualify and receive certification as having a disability from a licensed medical physician or must have been found eligible for vocational rehabilitation services by the department of education, division of vocational rehabilitation services, or by the department for the blind.

(22) For private duty nursing or personal care services for persons aged twenty and under pursuant to 441 IAC 78.9(10)(a)(1), unnumbered paragraph 2, including that services shall be provided according to a written plan of care authorized by a licensed physician or physician assistant. The home health agency is encouraged to collaborate with the member, or in the case of a child with the child’s caregiver, in the development and implementation of the plan of treatment. These services shall exceed intermittent guidelines as defined in subrule 78.9(3). Private duty nursing and personal care services shall be inclusive of all home health agency services personally provided to the member. Enhanced payment under the interim fee schedule shall be made available for services to children who are technology dependent, i.e., ventilator dependent or whose medical condition is so unstable as to otherwise require intensive care in a hospital.

e. The department of education, with respect to rules relating to the following:

(23) For private duty nursing or personal care services for persons aged twenty and under pursuant to 441 IAC 78.9(10)(a)(2), unnumbered paragraph 1, including that personal care services are those services provided by a home health aide or certified nurse’s aide and which are delegated and supervised by a registered nurse under the direction of the member’s physician or physician assistant to a member in the member’s place of residence or outside the member’s residence, when normal life activities take the member outside the place of residence. Place of residence does not include nursing facilities, intermediate care facilities for the mentally retarded, or hospitals. Payment for personal care services for persons aged twenty and under that exceed intermittent guidelines may be approved if determined to be medically necessary as defined in subrule 78.9(7). These services shall be in accordance with the member’s plan of care and authorized by a physician. The home health agency is encouraged to collaborate with the member, or in the case of a child with the child’s caregiver, in the development and implementation of the plan of treatment.

(1) For statements relating to medication administration policies, that a statement that persons administering medication shall include authorized practitioners, such as licensed registered nurses and physicians, and persons to whom authorized practitioners have delegated the administration of prescription and nonprescription drugs. Individuals shall self-administer asthma or other airway constricting disease medication or possess and have use of an epinephrine auto-injector with parent and physician consent on file, without the necessity of demonstrating competency to self-administer these medications.

(24) For requirements for private duty nursing or personal care services for persons aged twenty and under pursuant to 441 IAC 78.9(1)(b)(1), including that private duty nursing or personal care services shall be ordered in writing by a physician or physician assistant as evidenced by the physician’s or physician assistant’s signature on the plan of care.

(2) For medication administration courses relating to medication administration policies, that a medication administration course be conducted by a registered nurse or licensed pharmacist and include an annual medication administration procedural skills check completed with a registered nurse or pharmacist.

(25) For obtaining prescription medications for children in juvenile detention and shelter care homes pursuant to 441 IAC 105.9(1)(a), including that prescription medication in its original container, clearly labeled and prescribed for the child, may be accepted as legitimate prescription medication for the child. The label serves as verification that the medication was ordered by an authorized prescriber. Medication shall be prescribed by a provider authorized to prescribe the medication. Medication provided to residents shall be dispensed only from a licensed pharmacy in the state of Iowa in accordance with the pharmacy laws in the Iowa Code, from a licensed pharmacy in another state according to the laws of that state, or by a licensed physician or physician assistant.

(3) For school-based youth services programs, that preventive and primary health care services shall be delivered by specifically credentialed providers as specified.

(26) For health and dental programs provided by agencies providing foster care services pursuant to 441 IAC 108.7(12)(b), including that a child shall have a physical examination at least annually. This shall be performed by a licensed physician, physician assistant, or licensed nurse practitioner.

f. The department of human services, with respect to rules relating to the following:

(27) For health and dental programs provided by agencies providing foster care services pursuant to 441 IAC 108.7(12)(c), including that a child shall have current immunizations as required by the department of public health. If documentation of prior immunization is unavailable, immunizations shall begin within thirty days of placement, unless contraindicated and unless a statement from a physician or physician assistant to that effect is included in the child’s medical record. A statement from a physician, physician assistant, referring agency, parent, or guardian indicating immunizations are current is sufficient documentation of immunizations.

(1) That an incident for purposes of accreditation of providers of services to persons with mental illness, intellectual disabilities, or developmental disabilities includes but is not limited to an occurrence involving the individual using the service that results in a physical injury to or by the individual that requires a physician’s treatment or admission to a hospital.

(28) For the dispensing, storage, authorization, and recording of medications in child care centers pursuant to 441 IAC 109.10(3)(a), including that all medications shall be stored in their original containers, with accompanying physician, physician assistant, or pharmacist’s directions and label intact and stored so they are inaccessible to children and the public. Nonprescription medications shall be labeled with the child’s name.

(2) That a mental health professional, for purposes of accreditation of providers of services to persons with mental illness, intellectual disabilities, or developmental disabilities, includes a medical professional licensed in this state, provided that the professional otherwise meets all of the conditions to qualify as a mental health professional.

(29) For an infants’ area in a child care center pursuant to 441 IAC 109.11(2), including that an area shall be provided properly and safely equipped for the use of infants and free from the intrusion of children two years of age and older. Children over eighteen months of age may be grouped outside this area if appropriate to the developmental needs of the child. Upon the recommendation of a child’s physician or physician assistant or the area education agency serving the child, a child who is two years of age or older with a disability that results in significant developmental delays in physical and cognitive functioning who does not pose a threat to the safety of the infants may, if appropriate and for a limited time approved by the department, remain in the infant area.

(3) That home health aide services for purposes of disability services management and regional services may include medications specifically ordered by a physician.

(30) For facility requirements for a child development home pursuant to 441 IAC 110.8(1)(a), including that the home shall have a nonpay, working landline or mobile telephone with emergency numbers posted for police, fire, ambulance, and the poison information center. The number for each child’s parent, for a responsible person who can be reached when the parent cannot, and for the child’s physician or physician assistant shall be written on paper and readily accessible by the telephone. The home must prominently display all emergency information, and all travel vehicles must have a paper copy of emergency parent contact information.

(4) That payment relating to the state supplementary assistance program for residential care shall only be made when there is on file an order written by a physician certifying that the applicant or recipient being admitted requires residential care but does not require nursing services.

(31) For medications and hazardous materials in a child development home pursuant to 441 IAC 110.8(3)(c), including that medications shall be given only with the parent’s or doctor’s written authorization. Each prescribed medication shall be accompanied by a physician’s, physician assistant’s, or pharmacist’s direction. Both nonprescription and prescription medications shall be in the original container with directions intact and labeled with the child’s name. All medications shall be stored properly and, when refrigeration is required, shall be stored in a separate, covered container so as to prevent contamination of food or other medications. All medications shall be stored so they are inaccessible to children. Any medication administered to a child shall be recorded, and the record shall indicate the name of the medication, the date and time of administration, and the amount administered.

(5) That a case folder for a facility participating in the state supplementary assistance program must include a physician’s statement certifying that a resident does not require nursing services.

(32) For medical reports regarding the health of a family in a family life home pursuant to 441 IAC 111.6(2), including that the medical report shall provide significant findings of a physician or physician assistant, such as the presence or absence of any communicable disease.

(6) That personnel providing psychological evaluations and counseling or psychotherapy services for area education agencies under the medical assistance program include specified professions endorsed, licensed, or registered in this state, provided that the professional otherwise meets all of the conditions to qualify as a mental health professional.

(33) For medical reexaminations of a family in a family life home pursuant to 441 IAC 111.6(3), including that medical reexaminations may be required at the discretion of a physician or physician assistant or the local department.

(7) That personnel providing psychological evaluations and counseling or psychotherapy services for providers of infant and toddler program services under the medical assistance program include specified professions endorsed, licensed, or registered in this state, provided that the professional otherwise meets all of the conditions to qualify as a mental health professional.

(34) For medical examinations of a client in a family life home pursuant to 441 IAC 111.9(1), including that a physician or physician assistant shall certify that the client is free from any communicable disease and does not require a higher level of care than that provided by a family life home. The certification shall be given prior to placement and following an annual medical review thereafter. The certification shall be given on Form 470-0673, Physician’s Report.

(8) That personnel providing other services for providers of infant and toddler program services under the medical assistance program include specified professions recognized, endorsed, or licensed in this state, provided that the professional otherwise meets all of the conditions to qualify as a mental health professional.

(35) For the records of a client in a family life home pursuant to 441 IAC 111.9(2), including that the family shall have available at all times, the name, address, and telephone number of the client’s physician or physician assistant.

(9) That personnel providing psychological evaluations and counseling or psychotherapy services for providers of local education agency services under the medical assistance program include specified professions endorsed, licensed, or registered in this state, provided that the professional otherwise meets all of the conditions to qualify as a mental health professional.

(36) For the administration of over-the-counter medications in a foster family home pursuant to 441 IAC 113.7(4)(b), including that all over-the-counter medications shall be administered according to label directions or as directed by a health care provider.

(10) That personnel providing other services for providers of local education agency services under the medical assistance program include specified professions recognized, endorsed, or licensed in this state, provided that the professional otherwise meets all of the conditions to qualify as a mental health professional.

(37) For the contents of reports of the health of a foster family pursuant to 441 IAC 113.11(2), including that this report shall include a statement from the health care provider that there are no physical or mental health problems which would be a hazard to foster children placed in the home and a statement that the foster parents’ health would not prevent needed care from being provided to the child.

(11) For payment for medically necessary home health agency services under the medical assistance program, that payment shall be approved for medically necessary home health agency services prescribed by a physician in a plan of home health care provided by a Medicare-certified home health agency.

(38) For a report of the capability of a foster family to care for a child pursuant to 441 IAC 113.11(4), including that if there is evidence that the foster parent is unable to provide necessary care for the child, the department licensing worker, the recruitment and retention contractor, or the health care provider may require additional medical and mental health reports, including a substance abuse evaluation.

(12) For authorization for medically necessary home health agency services under the medical assistance program, that services shall be authorized by a physician, evidenced by the physician’s signature and date on a plan of treatment.

(39) For the use of prescribed medications in group living foster care facilities pursuant to 441 IAC 114.12(7), including that all prescribed medications shall be clearly labeled indicating the resident’s full name, prescriber’s name, prescription number, name and strength of the drug, dosage, directions for use, and date of issuing the drug. Medications shall be packaged and labeled according to state and federal guidelines.

(13) For treatment plans of home health agencies under the medical assistance program, that a member’s medical condition shall be reflected by the date last seen by a physician, if available.

(40) For the facility requirements for a child care home pursuant to 441 IAC 120.8(1)(a), including that the home shall have a nonpay, working landline or mobile telephone with emergency numbers posted for police, fire, ambulance, and the poison information center. The number for each child’s parent, for a responsible person who can be reached when the parent cannot, and for the child’s physician or physician assistant shall be written on paper and readily accessible by the telephone. The home must prominently display all emergency information, and all travel vehicles must have a paper copy of emergency parent contact information.

(14) For items included in treatment plans of home health agencies under the medical assistance program, that a plan of care shall include a physician’s signature and date and that the plan of care must be signed and dated by the physician before the claim for service is submitted for reimbursement.

(41) For the administration of medications at a child care home pursuant to 441 IAC 120.8(3)(c), including that medications shall be given only with the parent’s or doctor’s written authorization. Each prescribed medication shall be accompanied by a physician’s, physician assistant’s, or pharmacist’s direction. Both nonprescription and prescription medications shall be in the original container with directions intact and labeled with the child’s name. All medications shall be stored properly and, when refrigeration is required, shall be stored in a separate, covered container so as to prevent contamination of food or other medications. All medications shall be stored so they are inaccessible to children. Any medication administered to a child shall be recorded, and the record shall indicate the name of the medication, the date and time of administration, and the amount administered.

(15) For skilled nursing services provided by a home health agency under the medical assistance program, that medical documentation shall be submitted justifying the need for continued visits, including the physician’s estimate of the length of time that additional visits will be necessary, and that daily skilled nursing visits or multiple daily visits for wound care or insulin injections shall be covered when ordered by a physician and included in the plan of care.

(42) Definitions pursuant to 441 IAC 156.1 including all of the following:

(16) For physical therapy services provided by a home health agency under the medical assistance program, that payment shall be made for physical therapy services when the services follow a treatment plan established by the physician after any needed consultation with the qualified physical therapist.

(a) “Intellectual disabilities professional” means a psychologist, physician, physician assistant, registered nurse, educator, social worker, physical or occupational therapist, speech therapist, or audiologist who meets the educational requirements for the profession, as required in the state of Iowa, and has at least one year of experience working with persons with an intellectual disability.

(17) For occupational therapy services provided by a home health agency under the medical assistance program, that payment shall be made for occupational therapy services when the services follow a treatment plan established by the physician.

(b) “Mental health professional” means a person who meets all of the following conditions:

(18) For speech therapy services provided by a home health agency under the medical assistance program, that payment shall be made for speech therapy services when the services follow a treatment plan established by the physician.

(i) Holds at least a master’s degree in a mental health field including but not limited to psychology, counseling and guidance, psychiatric nursing, and social work; or is a doctor of medicine or osteopathic medicine or a physician assistant; and (ii) Holds a current Iowa license when required by the Iowa professional licensure laws (such as a psychiatrist, a psychologist, a marital and family therapist, a mental health counselor, an advanced registered nurse practitioner, a psychiatric nurse, a physician assistant, or a social worker); and (iii) Has at least two years of postdegree experience supervised by a mental health professional in assessing mental health problems, mental illness, and service needs and in providing mental health services.

(19) For home health aide services provided by a home health agency under the medical assistance program, that the service as well as the frequency and duration are stated in a written plan of treatment established by a physician.

(c) “Physician assistant” means a person licensed as a physician assistant as defined in chapter 148C.

(20) For home health aide services provided by a home health agency under the medical assistance program, that services provided for specified durations when ordered by a physician and included in a plan of care shall be allowed as intermittent services.

(43) Definitions pursuant to 441 IAC 201.2 including all of the following:

(21) For home health aide services provided by a home health agency under the medical assistance program, that personal care services include helping the member take medications specifically ordered by a physician.

(a) “Qualified intellectual disability professional” means a person who has at least one year of experience working directly with persons with an intellectual disability or other developmental disabilities and who is one of the following:

(22) For private duty nursing or personal care services for persons aged twenty and under, under the medical assistance program, that private duty nursing services are those services which are provided by a registered nurse or a licensed practical nurse under the direction of the member’s physician to a member in the member’s place of residence or outside the member’s residence, when normal life activities take the member outside the place of residence.

(i) A doctor of medicine or osteopathy.

(23) For private duty nursing or personal care services for persons aged twenty and under, under the medical assistance program, that services shall be provided according to a written plan of care authorized by a licensed physician.

(ii) A registered nurse. (iii) A physician assistant who meets the requirements of “qualified mental health professional” under this section and “mental health professional” under 441 IAC 24.1.

(24) For private duty nursing or personal care services for persons aged twenty and under, under the medical assistance program, that personal care services are those services provided by a home health aide or certified nurse’s aide and which are delegated and supervised by a registered nurse under the direction of the member’s physician to a member in the member’s place of residence or outside the member’s residence, when normal life activities take the member outside the place of residence, and that these services shall be in accordance with the member’s plan of care and authorized by a physician.

(iv) A person who holds at least a bachelor’s degree in a human services field including but not limited to social work, sociology, special education, rehabilitation counseling, or psychology.

(25) For requirements for private duty nursing or personal care services for persons aged twenty and under, under the medical assistance program, that private duty nursing or personal care services shall be ordered in writing by a physician as evidenced by the physician’s signature on the plan of care.

(b) “Qualified mental health professional” means a person who meets all of the following conditions:

(26) For obtaining prescription medications for children in juvenile detention and shelter care homes, that prescription medication provided to residents shall be dispensed only from a licensed pharmacy in this state in accordance with state law, from a licensed pharmacy in another state according to the laws of that state, or by a licensed physician.

(i) Holds a master’s degree in a mental health field including but not limited to psychology, counseling and guidance, or psychiatric nursing, and social work; or is a doctor of medicine or osteopathic medicine or a physician assistant; and (ii) Holds a current Iowa license when required by the Iowa professional licensure laws for persons practicing as a psychiatrist, a psychologist, a marital and family therapist, a mental health counselor, an advanced registered nurse practitioner, a physician assistant, a psychiatric nurse, or a social worker; and (iii) Has at least two years of postdegree experience supervised by a mental health professional in assessing mental health problems, mental illness, and services needs and in providing mental health services.

(27) For health and dental programs provided by agencies providing foster care services, that a child’s physical examination shall be performed by a licensed physician or licensed nurse practitioner.

(44) For the information provided to a foster care provider by a department worker pursuant to 441 IAC 202.6(1)(a)(3), including the names, addresses, and telephone numbers of the child’s physician or physician assistant and dentist.

(28) For health and dental programs provided by agencies providing foster care services, that if documentation of prior immunization is unavailable, immunizations required by the department of public health shall begin within thirty days of placement, unless contraindicated and unless a statement from a physician to that effect is included in the child’s medical record, and that a statement from a physician, referring agency, parent, or guardian indicating immunizations are current is sufficient documentation of immunizations.

g. For the department of inspections and appeals, rules relating to and in substantial conformance with all of the following:

(29) For the dispensing, storage, authorization, and recording of medications in child care centers, that all medications shall be stored in their original containers, with accompanying physician or pharmacist’s directions and label intact and stored so they are inaccessible to children and the public.

(1) For the qualifications of an attending physician at a hospice pursuant to 481 IAC 53.6(1), including that the person shall have an active Iowa license to practice medicine or as a physician assistant pursuant to chapter 148, 148C, 150, or 150A.

(30) For an infants’ area in a child care center, that upon the recommendation of a child’s physician or the area education agency serving the child, a child who is two years of age or older with a disability that results in significant developmental delays in physical and cognitive functioning who does not pose a threat to the safety of the infants may, if appropriate and for a limited time approved by the department, remain in the infant area.

(2) Definitions pursuant to 481 IAC 57.6(2)(a), unnumbered paragraph 1, including that “qualified intellectual disability professional” means a psychologist, physician, physician assistant, registered nurse, educator, social worker, physical or occupational therapist, speech therapist, or audiologist who meets the educational requirements for the profession, as required in the state of Iowa, and has one year’s experience working with persons with an intellectual disability.

(31) For facility requirements for a child development home, that the telephone number for each child’s physician shall be written on paper and readily accessible by the telephone.

(3) Definitions pursuant to 481 IAC 58.1, unnumbered paragraph 19, including that “qualified intellectual disabilities professional” means a psychologist, physician, physician assistant, registered nurse, educator, social worker, physical or occupational therapist, speech therapist, or audiologist who meets the educational requirements for the profession, as required in the state of Iowa, and having one year’s experience working with persons with an intellectual disability.

(32) For medications and hazardous materials in a child development home, that medications shall be given only with the parent’s or doctor’s written authorization, and that each prescribed medication shall be accompanied by a physician’s or pharmacist’s direction.

(4) Definitions pursuant to 481 IAC 65.1 including all of the following:

(33) For medical reports regarding the health of a family in a family life home, that a medical report shall provide significant findings of a physician, such as the presence or absence of any communicable disease.

(a) “Physician assistant” means a person licensed as a physician assistant pursuant to 645 IAC chapters 326 to 349.

(34) For medical reexaminations of a family in a family life home, that medical reexaminations may be required at the discretion of a physician.

(b) “Qualified mental health professional (QMHP)” means a person who:

(35) For medical examinations of a client in a family life home, that a physician shall certify that the client is free from any communicable disease and does not require a higher level of care than that provided by a family life home.

(i) Holds at least a master’s degree in a mental health field, including but not limited to psychology, counseling and guidance, nursing, and social work; or is a doctor of medicine (M.D.), a doctor of osteopathic medicine and surgery (D.O.), or a physician assistant; and (ii) Holds a current Iowa license when required by the Iowa licensure law; and (iii) Has at least two years of postdegree experience, supervised by a mental health professional, in assessing mental problems and needs of individuals and in providing appropriate mental health services for those individuals. See rule 481 IAC 65.4 for variance procedures.

(36) For the records of a client in a family life home, that the family shall have available at all times, the name, address, and telephone number of the client’s physician.

(5) For notifications submitted to the department of inspections and appeals from a subacute mental health care facility in the event of an accident causing a major injury pursuant to 481 IAC 71.8(3)(a)(3), including as a major injury an injury which requires consultation with the attending physician, or designee of the physician, advanced registered nurse practitioner, or physician assistant who determines, in writing, on a form designated by the department, that an injury is a “major injury” based upon the circumstances of the accident, the previous functional ability of the resident, and the resident’s prognosis.

(37) For the facility requirements for a child care home, that the telephone number for each child’s physician shall be written on paper and readily accessible by the telephone.

h. For the racing and gaming commission, rules relating to and in substantial conformance with all of the following:

(38) For the administration of medications at a child care home, that medications shall be given only with the parent’s or doctor’s written authorization and each prescribed medication shall be accompanied by a physician’s or pharmacist’s direction.

(1) For the grounds for denial, suspension, or revocation of a license pursuant to 491 IAC 6.5(1)(f), including that a license shall be denied if the applicant has an addiction to alcohol or a controlled substance without sufficient evidence of rehabilitation, has a history of mental illness without demonstrating successful treatment by a licensed medical physician or physician assistant meeting the requirements of a “mental health professional” pursuant to section 228.1, or has a history of repeated acts of violence without sufficient evidence of rehabilitation.

(39) For payments for foster care, that an intellectual disabilities professional includes specified professions, provided that the professional otherwise meets all of the conditions to qualify as an intellectual disabilities professional.

(2) For the qualifications for jockeys pursuant to 491 IAC 6.24(1)(b), including that a jockey shall pass a physical examination given within the previous twelve months by a licensed physician or physician assistant affirming fitness to participate as a jockey. The commission representatives may require that any jockey be reexamined and may refuse to allow any jockey to ride pending completion of such examination.

(40) For payments for foster care, that a mental health professional includes specified professions, provided that the professional otherwise meets all of the conditions to qualify as a mental health professional.

(3) For the regulation of licensees in restricted areas of a racing facility pursuant to 491 IAC 6.28(2), unnumbered paragraph 1, including that licensees whose duties require them to be in a restricted area, as defined in subrule 6.28(1), of a racing facility shall not have present within their systems any controlled substance as listed in schedules I to V of U.S.C. Tit. 21 (Food and Drug Section 812), chapter 124, or any prescription drug unless it was obtained directly or pursuant to valid prescription or order from a duly licensed physician or physician assistant who is acting in the course of professional practice. Acting with reasonable cause, a commission representative may direct the above licensees to deliver a specimen of urine or subject themselves to the taking of a blood sample or other body fluids at a collection site approved by the commission. In these cases, the commission representative may prohibit the licensee from participating in racing until the licensee evidences a negative test result. Sufficient sample should be collected to ensure a quantity for a split sample when possible. A licensee who refuses to provide the samples herein described shall be in violation of these rules and shall be immediately suspended and subject to disciplinary action by the board or commission representative. All confirmed positive test costs and any related expenses shall be paid for by the licensee. Negative tests shall be at the expense of the commission.

(41) For the subsidized adoption program, that a qualified intellectual disability professional includes specified professions, provided that the professional otherwise meets all of the conditions to qualify as a qualified intellectual disability professional.

i. For the law enforcement academy, rules relating to and in substantial conformance with all of the following:

(42) For the subsidized adoption program, that a qualified mental health professional includes specified professions, provided that the professional otherwise meets all of the conditions to qualify as a qualified mental health professional.

(1) For the minimum standards for Iowa law enforcement officers pursuant to 501 IAC 2.1(11), including that the officer is examined by a licensed physician or physician assistant or surgeon and meets the physical requirements necessary to fulfill the responsibilities of a law enforcement officer.

(43) For the information provided to a foster care provider by a department worker at the time of placement, that the information shall include the names, addresses, and telephone numbers of the child’s physician and dentist.

(2) For the certification of law enforcement officers pursuant to 501 IAC 3.12(5)(a)(3), including that the individual must be examined by a licensed physician or surgeon or physician assistant and meet the physical requirements necessary to fulfill the responsibilities of a law enforcement officer.

g. The department of inspections and appeals, with respect to rules relating to the following:

(3) For the selection or appointment of reserve peace officers pursuant to 501 IAC 10.100(10), including that the person shall be examined by a licensed physician or surgeon or physician assistant and meets the physical requirements as defined by the law enforcement agency necessary to fulfill the responsibilities of the reserve peace officer position being filled.

(1) For the qualifications of an attending physician at a hospice, that the person shall have an active Iowa license to practice medicine.

j. For the natural resource commission, rules relating to and in substantial conformance with all of the following:

(2) For residential care facilities for persons with intellectual disabilities, that a qualified intellectual disability professional includes specified professions, provided that the professional otherwise meets all of the conditions to qualify as a qualified intellectual disability professional.

(1) For the grounds for revoking or suspending an instructor license pursuant to 571 IAC 12.25(8), including the participation in a course while under the influence of alcohol or any illegal drug or while ingesting prescription medication in a manner contrary to the dosing directions given by the prescribing physician or physician assistant.

(3) For nursing facilities, that a qualified intellectual disabilities professional includes specified professions, provided that the professional otherwise meets all of the conditions to qualify as a qualified intellectual disabilities professional.

(2) For applications for use of a crossbow for deer and turkey hunting by handicapped individuals pursuant to 571 IAC 15.22(2), including that an individual requesting use of a crossbow for hunting deer or turkey must submit an application for an authorization card on forms provided by the department. The application must include a statement signed by the applicant’s physician or physician assistant declaring that the individual is not physically capable of shooting a bow and arrow. A first-time applicant must submit the authorization card application no later than ten days before the last day of the license application period for the season the person intends to hunt.

(4) For intermediate care facilities for persons with mental illness, that a qualified mental health professional includes specified professions, provided that the professional otherwise meets all of the conditions to qualify as a qualified mental health professional.

(3) For the validity of an authorization card for the use of a crossbow for deer and turkey hunting by handicapped individuals pursuant to 571 IAC 15.22(4), including that a card authorizing the use of a crossbow for hunting deer and turkey will be valid for as long as the person is incapable of shooting a bow and arrow. If a conservation officer has probable cause to believe the person’s handicapped status has improved, making it possible for the person to shoot a bow and arrow, the department may, upon the officer’s request, require the person to obtain in writing a current physician’s or physician assistant’s statement.

(5) For notifications submitted to the department from a subacute mental health care facility in the event of an accident causing a major injury, including as a major injury an injury which requires consultation with the attending physician or designee of the physician or advanced registered nurse practitioner who determines that an injury is a major injury.

(4) For licenses for nonresidents to participate in a special deer hunting season for severely disabled persons pursuant to 571 IAC 94.10(1), including that a nonresident meeting the requirements of section 321L.1(8) may apply for or purchase a nonresident deer hunting license to participate in a special deer hunting season for severely disabled persons. Nonresidents applying for this license must have on file with the department of natural resources either a copy of a disabilities parking permit issued by a state department of transportation or an Iowa department of natural resources form signed by a physician or physician assistant that verifies their disability.

h. The racing and gaming commission, with respect to rules relating to the following:

k. For the Iowa department of public health, rules relating to and in substantial conformance with all of the following:

(1) For the grounds for denial, suspension, or revocation of an occupational or vendor license, that a license shall be denied if the applicant has a history of mental illness without demonstrating successful treatment by a licensed medical physician.

(1) Definitions pursuant to 641 IAC 9.2 including all of the following:

(2) For the qualifications for jockeys, that a jockey shall pass a physical examination by a licensed physician affirming fitness to participate as a jockey.

(a) “Diabetes mellitus” includes the following:

(3) For the regulation of licensees in restricted areas of a racing facility, that licensees whose duties require them to be in a restricted area of a racing facility shall not have present within their systems any controlled substance as listed in schedules I to V of U.S.C. Tit. 21 (Food and Drug Section 812), chapter 124, or any prescription drug unless it was obtained directly or pursuant to valid prescription or order from a duly licensed physician who is acting in the course of professional practice.

(i) “Type I diabetes” means insulin-dependent diabetes (IDDM) requiring lifelong treatment with insulin.

i. The Iowa law enforcement academy, with respect to rules relating to the following:

(ii) “Type II diabetes” means noninsulin-dependent diabetes often managed by a food plan, exercise, weight control, and in some instances, oral medications or insulin. (iii) “Gestational diabetes” means diabetes diagnosed during pregnancy.

(1) For the minimum standards for law enforcement officers, that an officer is examined by a licensed physician or surgeon.

(iv) “Impaired glucose tolerance” means a condition in which blood glucose levels are higher than normal, diagnosed by a physician or physician assistant, and treated with a food plan, exercise, or weight control.

(2) For hiring standards must be reverified if an individual is not hired by an Iowa law enforcement agency during a specified period of time following completion of the course of study, that the individual must be examined by a licensed physician or surgeon.

(b) “Physician assistant” means a person licensed as a physician assistant under chapter 148C.

(3) For the selection or appointment of reserve peace officers, that the person shall be examined by a licensed physician or surgeon.

(2) For instructors for programs not recognized by the American diabetes association or accredited by the American association of diabetes educators pursuant to 641 IAC 9.8(3), including that the primary instructors shall be one or more of the following health care professionals: physicians, physician assistants, registered nurses, licensed dietitians, and pharmacists who are knowledgeable about the disease process of diabetes and the treatment of diabetes. If there is only one primary instructor, there shall be at least one supporting instructor. The supporting instructor shall be from one of the four professions listed as possible primary instructors, but a different profession from the single primary instructor.

j. The natural resource commission, with respect to rules relating to the following:

(3) For information required for participation in the prescription drug donation repository program by medical facilities and pharmacies pursuant to 641 IAC 109.3(3)(b), including the name and telephone number of the responsible pharmacist, physician, physician assistant, or nurse practitioner who is employed by or under contract with the pharmacy or medical facility.

(1) That the grounds for revoking or suspending an instructor license include participation in a course while ingesting prescription medication in a manner contrary to the dosing directions given by the prescribing physician.

(4) For information required for participation in the prescription drug donation repository program by medical facilities and pharmacies pursuant to 641 IAC 109.3(3)(c), including a statement, signed and dated by the responsible pharmacist, physician, physician assistant, or nurse practitioner, indicating that the pharmacy or medical facility meets the eligibility requirements under this rule and shall comply with the requirements of the chapter.

(2) For applications for use of a crossbow for deer and turkey hunting by handicapped individuals, that an application must include a statement signed by the applicant’s physician declaring that the individual is not physically capable of shooting a bow and arrow.

(5) For the dispensing of donated prescription drugs and supplies pursuant to 641 IAC 109.6(1), including that donated drugs and supplies may be dispensed only if the drugs or supplies are prescribed by a health care practitioner for use by an eligible individual and are dispensed by a licensed pharmacist, physician, physician assistant, or nurse practitioner.

(3) For authorization for the use of a crossbow for deer and turkey hunting by handicapped individuals, that if a conservation officer has probable cause to believe the person’s handicapped status has improved, making it possible for the person to shoot a bow and arrow, the department of natural resources may, upon the officer’s request, require the person to obtain in writing a current physician’s statement.

l. For the department of public safety, rules for definitions pursuant to 661 IAC 91.1, including that “unlawful user of or addicted to any controlled substance” means a person who uses a controlled substance and has lost the power of self-control with reference to the use of the controlled substance or any person who is a current user of a controlled substance in a manner other than as prescribed by a licensed physician or physician assistant. Such use is not limited to the use of drugs on a particular day, or within a matter of days or weeks before, but rather that the unlawful use has occurred recently enough to indicate that the individual is actively engaged in such conduct. A person may be an unlawful current user of a controlled substance even though the substance is not being used at the precise time the person applies for an Iowa permit to carry weapons or seeks to acquire a firearm or receives or possesses a firearm. An inference of current use may be drawn from evidence of a recent use or possession of a controlled substance or a pattern of use or possession that reasonably covers the present time, e.g., a conviction for use or possession of a controlled substance within the past year; multiple arrests for such offenses within the past five years if the most recent arrest occurred within the past year; or persons found through a drug test to use a controlled substance unlawfully, provided that the test was administered within the past year. For a current or former member of the armed forces, an inference of current use may be drawn from recent disciplinary or other administrative action based on confirmed drug use, e.g., court-martial conviction, nonjudicial punishment, or an administrative discharge based on drug use or drug rehabilitation failure.

(4) For licenses for nonresidents to participate in a special deer hunting season for severely disabled persons, that a nonresident applying for the license must have on file with the department of natural resources either a copy of a disabilities parking permit issued by a state department of transportation or an Iowa department of natural resources form signed by a physician that verifies their disability.

m. For the department of transportation, rules relating to and in substantial conformance with all of the following:

k. The Iowa department of public health, with respect to rules relating to the following:

(1) For exemptions from motor vehicle window transparency requirements pursuant to 761 IAC 450.7(3)(b), including that a motor vehicle fitted with a front windshield, a front side window, or a front sidewing with less than seventy percent but not less than thirty-five percent light transmittance before July 4, 2012, may continue to be maintained and operated with a front windshield, a front side window, or a front sidewing with less than seventy percent but not less than thirty-five percent light transmittance on or after July 4, 2012, so long as the vehicle continues to be used for the transport of a passenger or operator who obtained Form 432020, which documented a medical need for such reduced transparency, and was signed by the person’s physician or physician assistant before July 4, 2012. Form 432020 must be carried at all times in the vehicle to which the exemption applies. At such time as the vehicle is no longer used for the transport of the passenger or operator who is the subject of Form 432020, the exemption expires and may not be renewed. The owner of the vehicle to which the exemption applied must return the vehicle to conformance with the minimum standard of transparency set forth in subrule 450.7(2) within sixty days of expiration of the exemption.

(1) That “impaired glucose tolerance”, for purposes of outpatient diabetes education programs, means a condition in which blood glucose levels are higher than normal, diagnosed by a physician, and treated with a food plan, exercise, or weight control.

(2) Definitions pursuant to 761 IAC 450.7(3), including that “physician assistant” as used in this rule means a person licensed under chapter 148C.

(2) For instructors for programs not recognized by the American diabetes association or accredited by the American association of diabetes educators, that the primary instructors shall be one or more of specified health care professionals who are knowledgeable about the disease process of diabetes and the treatment of diabetes.

n. For the Iowa department of veterans affairs, rules relating to expenses relating to the purchase of certain equipment services pursuant to 801 IAC 14.4(5)(b), including that individuals requesting reimbursement under this subrule will be required to provide verification of the purchase and installation of the equipment and information relating to the need for the equipment. Individuals may also provide a product and installation cost estimate to the commission for approval, with the understanding that the commission will pay no more than the cost estimate to the supplier or installer. Applicants needing durable equipment as a medical necessity should provide information from a physician or physician assistant.

(3) For the written form for participation in the prescription drug donation repository program, that the form shall include the name and telephone number of the responsible pharmacist, physician, or nurse practitioner who is employed by or under contract with the pharmacy or medical facility, and shall also include a statement, signed and dated by the responsible pharmacist, physician, or nurse practitioner, indicating that the pharmacy or medical facility meets the eligibility requirements and shall comply with the requirements established by rule.

o. For the department of workforce development, rules relating to and in substantial conformance with all of the following:

(4) For the dispensing of donated prescription drugs and supplies, that donated drugs and supplies may be dispensed only if the drugs or supplies are prescribed by a health care practitioner for use by an eligible individual and are dispensed by a licensed pharmacist, physician, or nurse practitioner.

(1) For the definition of voluntary quit without good cause attributable to the employer pursuant to 871 IAC 24.25(35), including that the claimant left because of illness or injury which was not caused or aggravated by the employment or pregnancy and failed to:

l. The department of public safety, with respect to rules relating to permits to carry weapons, that an unlawful user of or addicted to any controlled substance includes any person who is a current user of a controlled substance in a manner other than as prescribed by a licensed physician.

(a) Obtain the advice of a licensed and practicing physician or physician assistant;

m. The department of transportation, with respect to rules relating to exemptions from motor vehicle window transparency requirements, that a motor vehicle fitted with a front windshield, a front side window, or a front sidewing with less than seventy percent but not less than thirty-five percent light transmittance before July 4, 2012, may continue to be maintained and operated with a front windshield, a front side window, or a front sidewing with less than seventy percent but not less than thirty-five percent light transmittance on or after July 4, 2012, so long as the vehicle continues to be used for the transport of a passenger or operator who documented in the manner specified by the department a medical need for such reduced transparency, which document was signed by the person’s physician before July 4, 2012.

(b) Obtain certification of release for work from a licensed and practicing physician or physician assistant;

n. The Iowa department of veterans affairs, with respect to rules relating to expenses relating to the purchase of durable equipment or services, that individuals requesting reimbursement who need durable equipment as a medical necessity should provide information from a physician.

(c) Return to the employer and offer services upon recovery and certification for work by a licensed and practicing physician or physician assistant; or (d) Fully recover so that the claimant could perform all of the duties of the job.

o. The department of workforce development, with respect to rules relating to the following:

(2) For the definition of a nonemployment related separation that is a voluntary quit with good cause attributable to the employer pursuant to 871 IAC 24.26(6)(a), including that the claimant left because of illness, injury, or pregnancy upon the advice of a licensed and practicing physician or physician assistant. Upon recovery, when recovery was certified by a licensed and practicing physician or physician assistant, the claimant returned and offered to perform services to the employer, but no suitable, comparable work was available. Recovery is defined as the ability of the claimant to perform all of the duties of the previous employment.

(1) That a voluntary quit shall be presumed to be without good cause attributable to the employer for purposes of unemployment compensation if a claimant left employment because of illness or injury which was not caused or aggravated by the employment or pregnancy and failed to obtain the advice of a licensed and practicing physician, obtain certification of release for work from a licensed and practicing physician, or return to the employer and offer services upon recovery and certification for work by a licensed and practicing physician.

(3) For the definition of a voluntary quit with good cause attributable to the employer pursuant to 871 IAC 24.26(9), including that the claimant left employment upon the advice of a licensed and practicing physician or physician assistant for the sole purpose of taking a family member to a place having a different climate and subsequently returned to the claimant’s regular employer and offered to perform services, but the claimant’s regular or comparable work was not available. However, during the time the claimant was at a different climate the claimant shall be deemed to be unavailable for work notwithstanding that during the absence the claimant secured temporary employment. (Family is defined as wife, husband, children, parents, grandparents, grandchildren, foster children, brothers, brothers-in-law, sisters, sisters-in-law, aunts, uncles, or corresponding relatives of the classified employee’s spouse or other relatives of the classified employee or spouse residing in the classified employee’s immediate household.) p. For the department of workforce development, labor services division, rules relating to and in substantial conformance with all of the following:

(2) That for purposes of unemployment compensation, it is a reason for a claimant leaving employment with good cause attributable to the employer if the claimant left employment because of illness, injury, or pregnancy upon the advice of a licensed and practicing physician, and upon recovery, when recovery was certified by a licensed and practicing physician, the claimant returned and offered to perform services to the employer, but no suitable, comparable work was available.

(1) For the disclosure of a trade secret during a medical emergency pursuant to 875 IAC 110.6(2), including that where a treating physician, physician assistant, or nurse determines that a medical emergency exists and the specific chemical identity of a hazardous chemical is necessary for emergency or first-aid treatment, the chemical manufacturer, importer, or employer shall immediately disclose the specific chemical identity of a trade secret chemical to that treating physician, physician assistant, or nurse, regardless of the existence of a written statement of need or a confidentiality agreement. The chemical manufacturer, importer, or employer may require a written statement of need and confidentiality agreement, in accordance with the provisions of subrules 110.6(3) and 110.6(4), as soon as circumstances permit.

(3) That for purposes of unemployment compensation it is a reason for a claimant leaving employment with good cause attributable to the employer if the claimant left employment upon the advice of a licensed and practicing physician for the sole purpose of taking a family member to a place having a different climate and subsequently returned to the claimant’s regular employer and offered to perform services, but the claimant’s regular or comparable work was not available.

(2) For the disclosure of a trade secret in a nonemergency situation pursuant to 875 IAC 110.6(3), unnumbered paragraph 1, including that in nonemergency situations, a chemical manufacturer, importer, or employer shall, upon request, disclose a specific chemical identity, otherwise permitted to be withheld under subrule 110.6(1), to a health professional (i.e., physician, physician assistant, industrial hygienist, toxicologist, epidemiologist, or occupational health nurse), providing medical or other occupational health services to exposed employee(s), and to employees or designated representatives, if:

p. The labor services division of the department of workforce development, with respect to rules relating to the following:

(3) For applications for a license to practice asbestos removal pursuant to 875 IAC 155.6(1), including that except as noted in the subrule, the applicant must complete and submit the entire form provided by the division with the necessary attachments. Respirator fit tests and medical examinations must have occurred within the past twelve months. Only worker and contractor/supervisor license applicants must submit the respiratory protection and physician’s or physician assistant’s certification forms. Photocopies of the forms shall not be accepted.

(1) For the disclosure of a trade secret relating to a hazardous chemical during a medical emergency, that where a treating physician or nurse determines that a medical emergency exists and the specific chemical identity of a hazardous chemical is necessary for emergency or first-aid treatment, the chemical manufacturer, importer, or employer shall immediately disclose the specific chemical identity of a trade secret chemical to that treating physician or nurse, regardless of the existence of a written statement of need or a confidentiality agreement.

(4) For documentation held by persons licensed for asbestos abatement in an area that is subject to a disaster emergency proclamation pursuant to 875 IAC 155.6(11)(a)(2), including a copy of a physician’s or physician assistant’s statement indicating that, consistent with 29 C.F.R. §1910.134, a licensed physician or physician assistant has examined the individual within the past twelve months and approved the individual to work while wearing a respirator.

(2) For the disclosure of a trade secret relating to a hazardous chemical in a nonemergency situation, that in nonemergency situations, a chemical manufacturer, importer, or employer shall, upon request, disclose a specific chemical identity, otherwise permitted to be withheld by rule, to a specified health professional providing medical or other occupational health services to exposed employees or designated representatives in specified circumstances.

(5) For the contents of an application for a covered event other than a professional wrestling event pursuant to 875 IAC 169.4(1)(b), all of following:

(3) For applications for a license to practice asbestos removal, that except as noted in rule, only worker and contractor/supervisor license applicants must submit a respiratory protection and physician’s certification forms.

(a) A copy of the medical license of the ringside physician or physician assistant.

(4) For documentation held by persons licensed for asbestos abatement in an area that is subject to a disaster emergency proclamation, that the labor commissioner deems an individual contractor, supervisor, or worker to be licensed and authorized for asbestos abatement if the individual, in addition to other specified conditions, makes immediately available on the work site a copy of a physician’s statement indicating that, consistent with federal law, a licensed physician has examined the individual within the past twelve months and approved the individual to work while wearing a respirator.

(b) The date, time, and location of the ringside physician’s or physician assistant’s examination of the contestants.

(5) That the contents of an application for an event license for a covered athletic event other than a professional wrestling event shall contain, along with other requirements, a copy of the medical license of the ringside physician and the date, time, and location of the ringside physician’s examination of the contestants.

(6) For the responsibilities of the promoter of an athletic event pursuant to 875 IAC 169.5(16), unnumbered paragraph 1, including event, that the promoter submit test results to the ringside physician or physician assistant no later than at the time of the physical test results showing that each contestant scheduled for the event tested negative for the human immunodeficiency, hepatitis B, and hepatitis C viruses within the one-year period prior to the event. The event, and that the contestant shall not participate and the physician or physician assistant shall notify the promoter that the contestant is prohibited from participating for medical reasons if any of the following occurs: specified circumstances occur.

(7) For injuries during a professional boxing match pursuant to 875 IAC 173.4, including match, that if a contestant claims to be injured during the bout, the referee shall stop the bout and request the attending physician or physician assistant to make an examination. If the physician or physician assistant decides that the contestant has been injured as the result of a foul, the physician or physician assistant shall advise the referee of the injury. If the physician or physician assistant is of the opinion that the injured contestant may be able to continue, the physician or physician assistant shall order a five-minute an intermission, after which the physician or physician assistant shall make another examination and again advise the referee of the injured contestant’s condition. It shall be the duty of the promoter to have an approved physician or physician assistant in attendance during the entire duration of all bouts.

(8) For persons allowed in a ring during a professional boxing match pursuant to 875 IAC 173.8, including match, that no person other than the contestants and the referee shall enter the ring during the bout, excepting the seconds between the rounds or the attending physician or physician assistant if asked by the referee to examine an injury to a contestant.

(9) For the weighing of contestants in a professional boxing match pursuant to 875 IAC 173.19, including match, that contestants shall be weighed and examined on the day of the scheduled match by the attending ring physician or physician assistant, at a time and place to be determined by the commissioner. Preliminary boxers may be allowed to weigh in and be examined not later than one hour before the scheduled time of the first match on the card. All weigh-ins will be conducted with the boxer stripped. Accurate scales shall be furnished by the promoter.

(10) For attending ring physicians during a professional boxing match pursuant to 875 IAC 173.45, including match, that when a boxer has been injured seriously, knocked out, or technically knocked out, the referee shall immediately summon the attending ring physician or physician assistant to aid the stricken boxer. Managers, boxer, and that managers, handlers, and seconds shall not attend to the stricken boxer, except at the request of the physician or physician assistant. physician.

(11) For the keeping of time during a professional boxing match pursuant to 875 IAC 173.47, including that the timekeeper shall provide a stopwatch and shall maintain an accurate time of all bouts. The timekeeper shall keep an exact record of time taken out at the request of a referee for an examination of a contestant by the physician or physician assistant, replacing a glove, or adjusting any equipment during a round. The timekeeper shall provide a whistle and shall sound the whistle ten seconds before the start of each round of boxing bouts. The timekeeper shall be impartial and shall not signal interested parties at any time during a bout.

(11) For the keeping of time during a professional boxing match, that the timekeeper shall keep an exact record of time taken out at the request of a referee for an examination of a contestant by the physician.

(12) For the suspension of contestants during a professional boxing match that is an elimination tournament pursuant to 875 IAC 174.6, including tournament, that a contestant who suffers a knockout or where the referee stops a fight on a technical knockout shall for specified reasons is not be permitted to box in the state for a period of thirty days. Before being permitted to fight again, the contestant time shall be examined by a physician or physician assistant approved by the commissioner. commissioner before being permitted to fight again.

(13) For the designation of officials for professional kickboxing pursuant to 875 IAC 176.4(1), including that the designation of officials, referees, physicians or physician assistants, timekeepers, judges, kick counters, scorekeepers, contestants, seconds, and managers is subject to the approval of the commissioner or designee.

(13) For the designation of officials for professional kickboxing, that the designation of physicians is subject to the approval of the commissioner or designee.

(14) For officials for a mixed martial arts event pursuant to 875 IAC 177.4(1), including that officials shall consist of three judges, two referees, the physician or physician assistant, and the timekeeper.

(14) For officials for a mixed martial arts event, that officials shall include a physician.

(15) For the keeping of time for a mixed martial arts event pursuant to 875 IAC 177.4(3), including that the timekeeper shall keep an exact record of time taken out at the request of a referee for an examination of a contestant by the physician or physician assistant, replacing a glove, or adjusting any equipment during a round. The timekeeper shall notify contestants at the beginning and end of each round. The timekeeper shall be impartial and shall not signal interested parties at any time during a match.

(15) For the keeping of time for a mixed martial arts event, that the timekeeper shall keep an exact record of time taken out at the request of a referee for an examination of a contestant by the physician.

(16) For persons allowed in the cage during a mixed martial arts event pursuant to 875 IAC 177.4(8), including event, that no person other than the two contestants and the referee shall enter the cage during the match. However, the physician or a physician assistant may enter the cage to examine a contestant upon the request of the referee.

(17) For the decorum of persons involved in a mixed martial arts event pursuant to 875 IAC 177.4(10)(d), including event, that a contestant is exempt from 875 IAC 177.4(10)(a)(1) and (2) prohibitions on specified conduct while interacting with the contestant’s opponent during a round. However, round, but if the round is stopped by the physician, physician assistant, or referee for a time out, 875 IAC 177.4(10)(a)(1) and (2) the prohibitions shall apply to a the contestant.

(18) For the examination of contestants in a mixed martial arts event pursuant to 875 IAC 177.5(13), including event, that on the day of the event, at a time and place to be approved by the commissioner, the ringside physician or physician assistant shall conduct a rigorous physical examination to determine the contestant’s fitness to participate in an a mixed martial arts match. A match, and that a contestant deemed not fit by the physician or physician assistant shall not participate in the event.

(19) For injuries during a mixed martial arts event pursuant to 875 IAC 177.6(7), including event, that if a contestant claims to be injured or when a contestant has been injured seriously or knocked out, the referee shall immediately stop the fight and summon the attending ring physician or physician assistant to make an examination of the stricken fighter. If the physician or physician assistant decides that the contestant has been injured, the physician or physician assistant shall advise the referee of the severity of the injury. If the physician or physician assistant is of the opinion the injured contestant may be able to continue, the physician or physician assistant shall order a five-minute an intermission, after which the physician or physician assistant shall make another examination and again advise the referee of the injured contestant’s condition. Managers, handlers, and seconds shall not attend to the stricken fighter, except at the request of the physician or physician assistant. physician.

2. The boards listed in subsection 1, upon adoption of rules pursuant to chapter 17A as required by this section of this Act shall not thereafter approve a notice of intended action pursuant to section 17A.4(1)(a), for the amendment or rescission of such rules for a period of two years from the effective date of this Act.

2. This section shall not be construed to expand, diminish, or otherwise modify the scope of practice of any profession licensed under this subtitle.

3. Except as provided in subsection 2, the The rulemaking requirements provided in this section of this Act shall not be construed to prohibit the boards agencies listed in subsection 1 from engaging in further rulemaking not in conflict with this section of this Act or state or federal law relating to the subject matter of this section or to otherwise diminish the authority to engage in rulemaking provided to those boards agencies by any other statute.