ARC 0662D

ARC 0662D

HUMAN SERVICES DEPARTMENT[441]

Notice of Intended Action

Proposing rulemaking related to nursing facilities
and providing an opportunity for public comment

    The Department of Health and Human Services hereby proposes to amend Chapter 81, “Nursing Facilities,” Iowa Administrative Code.

Legal Authority for Rulemaking

    This rulemaking is proposed under the authority provided in Iowa Code chapter 249A.

State or Federal Law Implemented

    This rulemaking implements, in whole or in part, Iowa Code chapter 249A and 42 CFR Sections 483.151, 483.152, 483.154, and 483.156.

Purpose and Summary

    This proposed rulemaking implements federal updates to the Nurse Aid Training and Competency Evaluation Programs (NATCEP) by amending Chapter 81 to update the date certain for internal references to 42 CFR Sections 483.151, 483.152, 483.154, and 483.156. This proposed rulemaking also restores a student-to-teacher ratio to help ensure the quality of clinical instruction provided to nurse aide trainees.

    The Centers for Medicare and Medicaid Services (CMS) issued a policy clarification memo in April 2026 updating training, supervision, and instructor qualifications for NATCEP. Because NATCEP is State-approved under federal law (42 CFR Part 483, Subpart D), each State must update its own NATCEP regulations and approval processes to align with CMS’s clarified requirements. States are responsible for implementing these changes in their own statutes, rules, and program approvals.

    Iowa addresses CMS’s NATCEP requirements in Chapter 81 by referencing the applicable federal regulations with a date certain. The current date certain used in Chapter 81 is August 1, 2024. As such, there is a need to update that date certain to ensure that the new federal requirements apply.

    This proposed rulemaking also reinstates a student-to-teacher ratio of one registered nurse or licensed practical nurse assistant to every 15 students within a clinical training setting. This requirement was inadvertently removed during the 2024 Red Tape Review since it was thought to be covered by referencing the federal regulation. Reestablishing this student-to-teacher ratio will help ensure the quality of the clinical portion of nurse aide training.

Regulatory Analysis

    A Regulatory Analysis for this rulemaking was published in the Iowa Administrative Bulletin on September 2, 2026. A public hearing was held on the following date(s):

     ?   September 23, 2026

Fiscal Impact

    This rulemaking has no fiscal impact to the State of Iowa.

Jobs Impact

    After analysis and review of this rulemaking, no impact on jobs has been found.

Waivers

    Any person who believes that the application of the discretionary provisions of this rulemaking would result in hardship or injustice to that person may petition the Department for a waiver of the discretionary provisions, if any, pursuant to 441—Chapter 2504.

Public Comment

    Any interested person may submit written or oral comments concerning this proposed rulemaking, which must be received by the Department no later than 4:30 p.m. on November 3, 2026. Comments should be directed to:

Public Hearing

    A public hearing at which persons may present their views orally or in writing will be held as follows:

    Persons who wish to make oral comments at the public hearing may be asked to state their names for the record and to confine their remarks to the subject of this proposed rulemaking.

    Any persons who intend to attend the public hearing and have special requirements, such as those related to hearing or mobility impairments, should contact the Department and advise of specific needs.

Review by Administrative Rules Review Committee

    The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rulemaking by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rulemaking at its regular monthly meeting or at a special meeting. The Committee’s meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).

    The following rulemaking action is proposed:

    ITEM 1.  Amend paragraph 81.13(2)“e” as follows:

    e.  Withdrawal of approval. The department of inspection, appeals, and licensing will follow the provision of 42 CFR 483.151(e) (as amended to August 1, 2024) 42 CFR 483.151(f) as amended to January 1, 2027, regarding withdrawals of approvals.

    ITEM 2.  Amend subrule 81.13(3) as follows:

    81.13(3) Requirements for approval of a nurse aide training and competency evaluation program. The department has designated the department of inspections, appeals, and licensing to approve required nurse aide training and competency evaluation programs. Policies and procedures governing approval of the programs are set forth in 42 CFR 483.152 (as amended to August 1, 2024) as amended to January 1, 2027.

    a. to c. No change.

    d.   Clinical setting student-to-teacher ratio. The ratio of department of inspections, appeals, and licensing-approved instructors to students shall not exceed one registered nurse, or licensed practical nurse functioning as an assistant to a registered nurse, who is in the proximate area in the clinical setting, for every 15 students in the clinical setting.

    ITEM 3.  Amend subrule 81.13(4) as follows:

    81.13(4) Nurse aide competency evaluation. Nurse aid competency evaluation program shall be administered in accordance with 42 CFR 483.154 (as amended to August 1, 2024) as amended to January 1, 2027.

    a. to d. No change.

    ITEM 4.  Amend paragraph 81.13(5)“a” as follows:

    a.  Establishment of registry. The department of inspections, appeals, and licensing shall establish and maintain a registry of nurse aides in accordance with 42 CFR 483.156 (as amended to August 1, 2024) as amended to January 1, 2027. In addition, the registry shall contain a record of known convictions by a court of law of a person convicted of abuse, neglect, mistreatment, or misappropriation of resident property.