ARC 8699C

ARC 8699C

Proposing rulemaking related to licensure and providing an opportunity for public comment

A Regulatory Analysis for this rulemaking was published in the Iowa Administrative Bulletin on October 16, 2024. A public hearing was held on the following date(s):

●November 5, 2024

The Department of Inspections, Appeals, and Licensing received no public comments.

Persons who wish to make oral comments at a 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 a public hearing and have special requirements, such as those related to hearing or mobility impairments, should contact the Department and advise of specific needs.

ITEM 1.Rescind 653—Chapter 9 and adopt the following new chapter in lieu thereof:

CHAPTER 9

PERMANENT AND ADMINISTRATIVE MEDICINE PHYSICIAN LICENSURE

653—9.1(147,148) Definitions.

“ABMS” means the American Board of Medical Specialties.

“ACGME” means the Accreditation Council for Graduate Medical Education.

“AMA” means the American Medical Association.

“Any jurisdiction” means any state, the District of Columbia or territory of the United States of America or any other nation.

“Any United States jurisdiction” means any state, the District of Columbia or territory of the United States of America.

“AOA” means the American Osteopathic Association.

“Applicant” means a person who seeks authorization to practice medicine and surgery, osteopathic medicine and surgery, or administrative medicine in this state by making application to the board, or a physician who seeks licensure through the IMLC.

“Approved abuse education training program” means a training program using a curriculum approved by the abuse education review panel of the department of health and human services or a training program offered by a hospital, a professional organization for physicians, the department of education, an area education agency, a school district, the Iowa law enforcement academy, an Iowa college or university, or a similar state agency.

“Board” means the board of medicine.

“Board-approved resident training program” means a hospital-affiliated graduate medical education program accredited by ACGME, AOA, RCPSC, or CFPC at the time the applicant is enrolled in the program.

“Candidate” means a person who applies to sit for an examination administered by the board or its designated testing service.

“Category 1 credit” means any formal education program that is sponsored or jointly sponsored by an organization accredited for continuing medical education by the Accreditation Council for Continuing Medical Education, the Iowa Medical Society, or the Council on Continuing Medical Education of AOA. Credits designated as formal cognates by the American College of Obstetricians and Gynecologists or as prescribed credits by the American Academy of Family Physicians are accepted as equivalent to category 1 credits.

“CFPC” means the College of Family Physicians of Canada.

“COCA” means the Commission on Osteopathic College Accreditation.

“COMLEX” means the Comprehensive Osteopathic Medical Licensing Examination.

“Committee” means the licensure committee of the board.

“COMVEX-USA” means the Comprehensive Osteopathic Medical Variable-Purpose Examination for the United States of America.

“Core credentials” means those documents that demonstrate the applicant’s identity, medical training and practice history.

“Current, active status” means a license that is in effect and grants the privilege of practicing administrative medicine, medicine and surgery or osteopathic medicine and surgery, as applicable.

“ECFMG” means the Educational Commission for Foreign Medical Graduates.

“Expedited license” means a full and unrestricted medical license granted by a member state to an eligible physician through the process set forth in the IMLC.

“FCVS” means the Federation Credentials Verification Service.

“FLEX” means the Federation Licensing Examination.

“Foreign medical school,” also known as an “international medical school,” means a medical school that is located outside of any United States jurisdiction or Canada.

“FSMB” means the Federation of State Medical Boards.

“IMLC” means the Interstate Medical Licensure Compact enacted in Iowa Code chapter 147B.

“Inactive license” means any license that is not in current, active status.

“Incidentally called into this state in consultation with a physician and surgeon licensed in this state” as set forth in Iowa Code section 148.2(5) means all of the following shall be true:

1.The consulting physician shall be involved in the care of patients in Iowa only at the request of an Iowa-licensed physician.

2.The consulting physician has a license in good standing in another United States jurisdiction.

3.The consulting physician provides expertise and acts in an advisory capacity to an Iowa-licensed physician. The consulting physician may examine the patient and advise an Iowa-licensed physician as to the care that should be provided, but the consulting physician may not personally perform procedures, write orders, or prescribe for the patient.

4.The consulting physician practices in Iowa for a period not greater than 10 consecutive days and not more than 20 total days in any calendar year. Any portion of a day counts as one day.

5.The Iowa-licensed physician requesting the consultation retains the primary responsibility for the management of the patient’s care.

“Initial license” means the first permanent or administrative medicine license granted to a qualified individual.

“International medical school,” also known as a “foreign medical school,” means a medical school that is located outside of any United States jurisdiction or Canada.

“Interstate commission” means the interstate commission created pursuant to Iowa Code chapter 147B.

“LCME” means Liaison Committee on Medical Education.

“LMCC” means enrollment in the Canadian Medical Register as Licentiate of Medical Council of Canada with a certificate of registration as proof.

“MCCEE” means the Medical Council of Canada Evaluating Examination.

“Medical degree” means a degree of doctor of medicine and surgery or osteopathic medicine and surgery or comparable education from a foreign medical school.

“National Practitioner Data Bank” is a national data bank of disciplinary actions taken against health professionals, including physicians.

“NBME” means the National Board of Medical Examiners.

“NBOME” means the National Board of Osteopathic Medical Examiners.

“Observer” means a person who is not enrolled in an LCME- or COCA-accredited medical school or osteopathic medical school, who observes care to patients in Iowa for a defined period of time and for a noncredit experience, and who is supervised and accompanied by an Iowa-licensed physician as defined in subrule 9.2(3). An observer shall not provide or direct hands-on patient care, regardless of the observer’s level of training or supervision. The supervising physician may authorize an observer to read a chart, observe a patient interview or examination, or witness procedures, including surgery. An observer shall not chart; touch a patient as part of an examination; conduct an interview; order, prescribe or administer medications; make decisions that affect patient care; direct others in providing patient care; or conduct procedures, including surgery. Any of these activities requires licensure to practice in Iowa. An unlicensed physician observer or a medical student observer who is not enrolled in an LCME- or COCA-accredited medical school may touch a patient to verify a physical finding in the immediate presence of a physician but shall not conduct a more inclusive physical examination.

An unlicensed physician observer may:

1.Participate in discussions regarding the care of individual patients, including offering suggestions about diagnosis or treatment, provided the unlicensed physician observer does not direct the care; and

2.Elicit information from a patient provided the unlicensed physician observer does not actually perform a physical examination or otherwise touch the patient.

“Permanent licensure” means licensure granted after review of the application and core credentials to determine that the individual is qualified to enter into clinical practice.

“Practice” means the practice of medicine and surgery or osteopathic medicine and surgery.

“Primary source verification” means:

1.Verification of the authenticity of documents with the original source that issued the document.

2.Original source verification by another jurisdiction’s physician licensing organization.

3.Original source verification by the FSMB’s Federation Credentials Verification Service.

“RCPSC” means the Royal College of Physicians and Surgeons of Canada.

“Reactivation” means the process for returning an inactive license to current, active status.

“Relinquishment” means that a person’s permanent license to practice medicine and surgery, osteopathic medicine and surgery, or administrative medicine is deemed abandoned if the person fails to renew or reactivate the license within five years after its expiration. A license that has been relinquished is no longer valid or renewable. Relinquishment is not disciplinary in nature.

“Resident physician” means a physician enrolled in an internship, residency or fellowship.

“Resident training program” means a hospital-affiliated graduate medical education program that enrolls interns, residents or fellows and may be referred to as a postgraduate training program for purposes of licensure.

“Service charge” means the amount charged for making a service available online and is in addition to the actual fee for a service itself.

“SPEX” means Special Licensure Examination prepared by the Federation of State Medical Boards and administered by a licensing authority in any jurisdiction.

“Terminated license” means a nondisciplinary process by which an Iowa license issued through the Interstate Medical Licensure Compact is no longer eligible for renewal. A compact license is terminated when a licensee no longer meets the IMLC qualifications. A terminated IMLC license may not be reinstated.

“Uniform application for physician state licensure” means a web-based application that is intended to standardize and simplify the licensure application process for state medical licensure.

“USMLE” means the United States Medical Licensing Examination.

653—9.2(147,148) General licensure provisions.

9.2(1) Licensure required. Licensure is required for practice in Iowa as identified in Iowa Code section 148.1; the exceptions are identified in subrule 9.2(2).

9.2(2) Licensure not required. The following persons are not required to obtain a license to practice in Iowa:

a.Those persons described in Iowa Code section 148.2(1) through 148.2(5). A medical student or osteopathic medical student in an international medical school may not take on the role of a medical student in the patient care setting unless the student is enrolled in the University of Iowa’s Carver College of Medicine or in Des Moines University’s College of Osteopathic Medicine; however, an international medical student or graduate of an international medical school not enrolled at either of these institutions may be an observer as defined in rule 653—9.1(147,148).

b.Those persons who are incidentally called into this state in consultation with a physician or surgeon licensed in this state as described in Iowa Code section 148.2(5) and as defined in rule 653—9.1(147,148).

c.Physicians and surgeons who hold a current, active license in good standing in another United States jurisdiction and who come into Iowa on a temporary basis to aid disaster victims at the time of a disaster in accordance with Iowa Code section 29C.6.

d.Physicians and surgeons who hold a current, active license in good standing in another United States jurisdiction and who come to Iowa to participate in further medical education may participate in patient care under the request and supervision of the patient’s Iowa-licensed physician in charge of the education. The Iowa-licensed physician shall retain the primary responsibility for management of the patient’s care.

e.Physicians and surgeons who hold a current, active license in good standing in another United States jurisdiction and who come into Iowa to serve as expert witnesses as long as they do not provide treatment.

f.Physicians and surgeons from out of state who hold a current, active license in good standing in another United States jurisdiction and who accompany one or more individuals into Iowa for the purpose of providing medical care to these individuals on a short-term basis; e.g., a team physician for an out-of-state college football team that comes into Iowa for a game.

g.Physicians and surgeons who come to Iowa to observe patient care and who do not provide or direct hands-on patient care.

h.Visiting resident physicians who come to Iowa to practice as part of their resident training program if under the supervision of an Iowa-licensed physician. An Iowa physician license is not required of a physician in training if the physician has a resident or permanent license in good standing in the home state of the resident training program. An Iowa temporary license is required of a physician in training if the physician does not hold a resident or permanent physician license in good standing in the home state of the resident training program (more information can be found in rule 653—10.5(147,148)).

9.2(3) Supervision of an observer. An Iowa-licensed physician who supervises an observer shall accompany the observer and solicit consent from each patient, where feasible, for the observation. The physician shall inform the patient of the observer’s background; e.g., a high school student considering a medical career or a medical graduate who is working on licensure. The supervising physician ensures that the observer remains within the scope of an observer as defined in rule 653—9.1(147,148).

653—9.3(147,148) Eligibility for licensure.

9.3(1) Requirements. To be eligible for permanent or administrative medicine licensure, an applicant shall:

a.Fulfill the application requirements specified in rule 653—9.4(147,148).

b.Hold a medical degree from an educational institution approved by the board at the time the applicant graduated and was awarded the degree.

(1)Educational institutions approved by the board shall be fully accredited by an accrediting agency recognized by the board as schools of instruction in medicine and surgery or osteopathic medicine and surgery and empowered to grant academic degrees in medicine.

(2)The accrediting bodies currently recognized by the board are:

1.LCME for the educational institutions granting degrees in medicine and surgery; and

2.AOA for educational institutions granting degrees in osteopathic medicine and surgery.

(3)If the applicant holds a medical degree from an educational institution not approved by the board at the time the applicant graduated and was awarded the degree, the applicant shall meet one of the following requirements:

1.Hold a valid certificate issued by ECFMG;

2.Pass the MCCEE;

3.Have successfully completed a fifth pathway program established in accordance with AMA criteria;

4.Have successfully passed either a basic science examination administered by a United States or Canadian medical licensing authority or SPEX; and have successfully completed three years of resident training in a program approved by the board; and have submitted evidence of five years of active practice without restriction as a licensee of any United States or Canadian jurisdiction; or

5.Have successfully passed either a basic science examination administered by a United States or Canadian medical licensing authority or SPEX; and hold board certification by a specialty board approved by ABMS or AOA; and submit evidence of five years of active practice without restriction as a licensee of any United States or Canadian jurisdiction.

c.Have successfully completed one year of resident training in a hospital-affiliated program approved by the board at the time the applicant was enrolled in the program. An applicant who is a graduate of an international medical school must have successfully completed 24 months of such training.

(1)For those required to have 12 months of training, the program shall have been 12 months of progressive training in not more than two specialties and in not more than two programs approved for resident training by the board. For those required to have 24 months of training, the program shall have been 24 continuous months of progressive training in not more than two specialties and in not more than two programs approved for resident training by the board.

(2)Resident training approved by the board must be accredited by an accrediting agency recognized by the board for the purpose of accrediting resident training programs.

(3)The board approves resident training programs accredited by:

1.ACGME;

2.AOA;

3.RCPSC; and

4.CFPC.

(4)The board may accept resident training that is not accredited as specified in subparagraph 9.3(1)“c”(3) on a case-by-case basis. In making this determination, the board may consider any relevant factors, including but not limited to the following:

1.The length of time the program has been in existence;

2.The location of the program;

3.The institution or organization that administers the program;

4.The reason that the program is not accredited; and

5.Whether the program is accredited or recognized by any agency other than those listed in subparagraph 9.3(1)“c”(3).

(5)The board may accept each 12 months of practice as a special licensee as equivalent to one year of resident training in a hospital-affiliated program approved by the board.

(6)The board may accept a current, active ABMS or AOA board certification obtained through an alternate pathway as equivalent to resident training in a hospital-affiliated program approved by the board. The alternate pathway must be a minimum of 24 months completed at an institution with a program approved by the board as specified in subparagraph 9.3(1)“c”(3).

d.Pass one of the licensure examinations or combinations as prescribed in rule 653—9.7(147,148).

9.3(2) Exceptions to the eligibility requirements.

a.A military service applicant or a veteran may apply for credit for verified military education, training, or service toward any experience or educational requirement for permanent licensure under this subrule or may be eligible for permanent licensure through reciprocity as specified in 653—Chapter 18.

b.A physician who holds a valid Letter of Qualification asserting eligibility for licensure through the IMLC is eligible for a permanent Iowa medical license.

653—9.4(147,148) Licensure application.

9.4(1) Requirements. To apply for licensure, an applicant shall:

a.Pay a nonrefundable initial application fee and fee for the evaluation of the fingerprint packet and the criminal history background checks by the division of criminal investigation (DCI) and the Federal Bureau of Investigation (FBI) as specified in 653—paragraph 8.4(1)“a”; and

b.Complete and submit the application and forms provided by the board, including required core credentials, documents, a completed fingerprint packet, and a sworn statement by the applicant attesting to the truth of all information provided by the applicant that has been signed by the applicant in the physical presence of a notary public.

c.Pass one of the examinations as prescribed in rule 653—9.7(147,148) and authorize the testing authority to verify scores.

9.4(2) Application. The application shall require the following information:

a.Full legal name, date and place of birth, home address, mailing address, principal business address, and personal email address regularly used by the applicant or licensee for correspondence with the board.

b.A statement listing every jurisdiction in which the applicant is or has been authorized to practice, including license numbers and dates of issuance.

c.A chronology accounting for all time periods from the date the applicant entered medical school to the date of the application.

d.A certified statement of scores on any licensure examination required in rule 653—9.7(147,148) that the applicant has taken in any jurisdiction. An official FCVS Physician Information Profile that supplies this information for the applicant is a suitable alternative.

e.A photocopy of the applicant’s medical degree issued by an educational institution.

(1)A complete translation of any diploma not written in English shall be submitted. An official transcript, written in English and received directly from the school, showing graduation from medical school is a suitable alternative.

(2)An official FCVS Physician Information Profile that supplies this information for the applicant is a suitable alternative.

(3)If a copy of the medical degree cannot be provided because of extraordinary circumstances, the board may accept other reliable evidence that the applicant obtained a medical degree from a specific educational institution.

f.A sworn statement from an official of the educational institution certifying the date the applicant received the medical degree and acknowledging what, if any, derogatory comments exist in the institution’s record about the applicant. If a sworn statement from an official of the educational institution cannot be provided because of extraordinary circumstances, the board may accept other reliable evidence that the applicant obtained a medical degree from a specific educational institution.

g.An official transcript, or its equivalent, received directly from the school for every medical school attended if requested by the board. A complete translation of any transcript not written in English shall be submitted if requested by the board. An official FCVS Physician Information Profile that supplies this information for the applicant is a suitable alternative.

h.If the educational institution awarding the applicant the degree has not been approved by the board, a current ECFMG status report or evidence of successful completion of a fifth pathway program in accordance with criteria established by AMA. An official FCVS Physician Information Profile that supplies this information for the applicant is a suitable alternative.

i.Documentation of successful completion of resident training approved by the board as specified in paragraph 9.3(1)“c.” An official FCVS Physician Information Profile that supplies this information for the applicant is a suitable alternative.

j.Verification of an applicant’s hospital and clinical staff privileges and other professional experience for the past five years if requested by the board.

k.A statement disclosing and explaining any informal or nonpublic actions, warnings issued, investigations conducted, or disciplinary actions taken, whether by voluntary agreement or formal action, by a medical or professional regulatory authority, an educational institution, a training or research program, or a health facility in any jurisdiction.

l.A statement disclosing and explaining the applicant’s involvement in civil litigation related to practice in any jurisdiction. Copies of the legal documents may be requested if needed during the review process.

m.A statement disclosing and explaining any charge of a misdemeanor or felony involving the applicant filed in any jurisdiction, whether or not any appeal or other proceeding to have the conviction or plea set aside is pending. Copies of the legal documents may be requested if needed during the review process.

n.A completed fingerprint packet to facilitate a national criminal history background check. The fee for the evaluation of the fingerprint packet and the DCI and FBI criminal history background checks will be assessed to the applicant.

653—9.5(272C) Licensure by verification. Licensure by verification is available in accordance with the following:

9.5(1) Eligibility. A person may seek licensure by verification if the person is currently licensed as a physician in at least one other jurisdiction that has a scope of practice substantially similar to that of Iowa.

9.5(2) Board application. The applicant must submit the following:

a.A completed application for licensure by verification.

b.A nonrefundable initial application fee and fee for the evaluation of the fingerprint packet and the criminal history background checks by the DCI and the FBI as specified in 653—paragraph 8.4(1)“a.”

c.A completed fingerprint packet to facilitate a criminal history background check by the DCI and FBI.

d.A verification form, completed by the licensing authority in the jurisdiction that issued the applicant’s license, verifying that the applicant’s license in that jurisdiction complies with the requirements of Iowa Code section 272C.12. The completed verification form must be sent directly from the licensing authority to the board.

e.Proof of passing an examination as required by rule 653—9.7(147,148).

f.A copy of the complete criminal record, if the applicant has a criminal history.

g.A copy of the relevant disciplinary documents, if another jurisdiction has taken disciplinary action against the applicant.

h.A written statement from the applicant detailing the scope of practice in the other state.

i.Copies of relevant laws setting forth the scope of practice in the other state.

9.5(3) Applicants with prior discipline. If another jurisdiction has taken disciplinary action against an applicant, the board will determine whether the cause for the disciplinary action has been corrected and the matter has been resolved. If the board determines the disciplinary matter has not been resolved, the board will neither issue a license nor deny the application for licensure until the matter is resolved. A person who has had a license revoked, or who has voluntarily surrendered a license, in another jurisdiction is ineligible for licensure by verification.

9.5(4) Applicants with pending licensing complaints or investigations. If an applicant is currently the subject of a complaint, allegation, or investigation relating to unprofessional conduct pending before any regulating entity in another jurisdiction, the board will neither issue a license nor deny the application for licensure until the complaint, allegation, or investigation is resolved.

9.5(5) Temporary licenses. Applicants who satisfy all requirements for a license under this section except for passing a required examination specific to the laws of this state may be issued a temporary license that is valid for a period of three months and may be renewed once for an additional period of three months. The applicant must submit proof of passing the required examination before the temporary license expires.

653—9.6(147,148) Licensure examinations.

9.6(1) USMLE.

a.The USMLE is a multipart examination consisting of Step 1, Step 2, and Step 3. Steps 1 and 2 are administered by NBME and ECFMG. The board contracts with FSMB for the administration of Step 3.

b.Applications are available at Department of Examination Services, FSMB, 400 Fuller Wiser Road, Suite 300, Euless, Texas 76039, or www.fsmb.org.

c.Candidates who meet the following requirements are eligible to take USMLE Step 3:

(1)Submit a completed application form and pay the required examination fee as specified in rule 653—8.3(147,148,272C).

(2)Document successful completion of USMLE Steps 1 and 2 in accordance with the requirements of NBME. Graduates of a foreign medical school shall meet the requirements of ECFMG.

(3)Document holding a medical degree from a board-approved educational institution. If a candidate holds a medical degree from an educational institution not approved by the board at the time the applicant graduated and was awarded the degree, the candidate shall meet the requirements specified in subparagraph 9.3(1)“b”(3).

(4)Document successful completion of a minimum of seven calendar months of resident training in a program approved by the board at the time of the application for Step 3 or enrollment in a resident training program approved by the board at the time of the application for Step 3.

d.The following conditions apply to applicants for licensure in Iowa who utilize USMLE as the licensure examination:

(1)Passing Steps 1, 2, and 3 is required within a ten-year period beginning with the date of passing either Step 1 or Step 2, whichever occurred first. If the applicant did not pass Steps 1, 2, and 3 within the required time frame, then the requirement will be satisfied by either proof of active board certification by the ABMS or AOA or proof the delay was caused by participation in a joint M.D./Ph.D. or D.O./Ph.D. program.

(2)Step 3 may be taken and passed only after Steps 1 and 2 are passed.

(3)A score of 75 or better on each step shall constitute a passing score on that step.

(4)Successful completion of a continuous, progressive three-year resident training program is required if the applicant passes the examination after more than six attempts on Step 1 or six attempts on Step 2 CK and Step 2 CS combined or three attempts on Step 3.

9.6(2) NBME. Successful completion of NBME Parts I, II and III with a passing score of 75 or better on each part is required for NBME certification.

9.6(3) FLEX.

a.(Old) FLEX is a three-day examination administered from 1968 to 1985. Applicants who took (Old) FLEX shall provide evidence of successful achievement of at least two of the following:

(1)Certification under seal that the applicant passed FLEX with a FLEX-weighted average of 75 percent or better, as determined by the state medical licensing authority, in no more than two sittings.

(2)Verification under seal of medical licensure in the state that administered the examination.

(3)Evidence of current certification by an American specialty board approved or recognized by the Council of Medical Education of AMA, ABMS, or AOA.

b.(New) FLEX is a three-day nationally standardized examination administered from 1985 to 1994. To be eligible for licensure, the candidate must have passed both components with a FLEX score of 75 or better within a seven-year period beginning with the date of initial examination.

9.6(4) Combination examination sequences. The board approved the following licensing combinations of examinations for licensure only if completed prior to January 1, 2000. These combinations are now only acceptable from an applicant who already holds a license from any United States jurisdiction.

a.FLEX Component I plus USMLE Step 3 with a passing score of 75 or better on each examination;

b.NBME Part I or USMLE Step 1 plus NBME Part II or USMLE Step 2 plus FLEX Component II with a passing score of 75 or better on each examination; or

c.NBME Part I or USMLE Step 1 plus NBME Part II or USMLE Step 2 plus NBME Part III or USMLE Step 3 with a passing score of 75 or better on each examination.

9.6(5) COMLEX. COMLEX is a three-level examination that replaced the three-part NBOME examination. All three examinations must be successfully completed in sequential order within ten years of the successful completion of COMLEX Level 1. If the applicant did not pass Levels 1, 2, and 3 within the required time frame, then the requirement will be satisfied by either proof of active board certification by the ABMS or AOA or proof the delay was caused by participation in a joint D.O./Ph.D. or M.D./Ph.D. program.

a.A standard score of 400 on Level 1 or Level 2 is required to pass the examination. A standard score of 350 on Level 3 is required to pass the examination.

b.A candidate shall have successfully completed a minimum of seven calendar months of resident training in a program approved by the board at the time of the application for Level 3 or enrollment in a resident training program approved by the board at the time of the application for Level 3.

c.Successful completion of a continuous, progressive three-year resident training program is required if the applicant passes the examination after more than six attempts on Level 1 or six attempts on Level 2 CE and Level 2 PF combined or three attempts on Level 3.

d.Each COMLEX level must be passed individually, and individual level scores shall not be averaged to compute an overall score.

e.Level 3 may be taken and passed only after Levels 1 and 2 are passed.

f.A failure of any COMLEX level, regardless of the jurisdiction for which it was taken, shall be considered a failure of that level for the purposes of Iowa licensure.

9.6(6) NBOME.

a.NBOME was a three-part examination. All three parts must have been successfully completed in sequential order within seven years of the successful completion of NBOME Part 1.

b.A passing score is required on each part of the examination.

c.A candidate shall have successfully completed a minimum of seven calendar months of resident training in a program approved by the board at the time of the application for NBOME Part 3. Candidates shall have completed their resident training by the last day of the month in which the examination was taken.

d.Successful completion of a three-year resident training program is required if the applicant passes the examination after more than six attempts on Part 1 or six attempts on Part 2 or three attempts on Part 3.

e.Each NBOME part must have been passed individually, and individual part scores shall not be averaged to compute an overall score.

f.Part 3 must have been taken and passed only after Parts 1 and 2 were passed.

g.A failure of any NBOME part, regardless of the jurisdiction for which it was taken, shall be considered a failure of that part for the purposes of Iowa licensure.

9.6(7) LMCC. The board accepts toward Iowa licensure a verification of a licensee’s registration with the Medical Council of Canada, based on passing both parts of the Medical Council of Canada Qualifying Examination.

9.6(8) State licensing examinations. Licensing examinations administered by the board of medicine or another U.S. jurisdiction prior to 1974 are accepted if the examination was passed according to criteria established by that state at the time and led to licensure in that state.

653—9.7(147,148) Permanent licensure application review process. The process below is utilized to review each application. Priority is be given to processing a licensure application when a written request is received in the board office from an applicant whose practice will primarily involve provision of services to underserved populations, including but not limited to persons who are minorities or low-income or who live in rural areas.

9.7(1) An application for initial licensure will be considered open from the date the application form is received in the board office with the nonrefundable initial licensure fee.

9.7(2) After reviewing each application, board staff will notify the applicant about how to resolve any problems. An applicant shall provide additional information when requested by staff or the board.

9.7(3) If the final review indicates no questions or concerns regarding the applicant’s qualifications for licensure, staff may administratively grant the license. The staff may grant the license without having received a report on the applicant from the FBI.

9.7(4) If the final review indicates questions or concerns that cannot be remedied by continued communication with the physician, the executive director, director of licensure and director of legal affairs will determine if the questions or concerns indicate any uncertainty about the applicant’s current qualifications for licensure.

a.If there is no current concern, staff will administratively grant the license.

b.If any concern exists, the application will be referred to the committee.

9.7(5) Staff will refer to the committee for review matters that include but are not limited to falsification of information on the application, criminal record, malpractice, substance abuse, competency, physical or mental illness, or professional disciplinary history.

9.7(6) If the committee is able to eliminate questions or concerns without dissension from staff or a committee member, the committee may direct staff to grant the license administratively.

9.7(7) If the committee is not able to eliminate questions or concerns without dissension from staff or a committee member, the committee will recommend that the board:

a.Request an investigation;

b.Request that the applicant appear for an interview;

c.If the physician has not engaged in active clinical practice or board-approved training in the past three years in any jurisdiction of the United States or Canada, require an applicant to:

(1)Successfully pass a competency evaluation approved by the board;

(2)Successfully pass SPEX, COMVEX-USA, or another examination approved by the board;

(3)Successfully complete a retraining program arranged by the physician and approved in advance by the board; or

(4)Successfully complete a reentry to practice program or monitoring program approved by the board.

d.Grant a license;

e.Grant a license under certain terms and conditions or with certain restrictions;

f.Request that the applicant withdraw the licensure application; or

g.Deny a license.

9.7(8) The board will consider applications and recommendations from the committee and will:

a.Request further investigation;

b.Require that the applicant appear for an interview;

c.If the physician has not engaged in active clinical practice or board-approved training in the past three years in any jurisdiction of the United States or Canada, require an applicant to:

(1)Successfully pass a competency evaluation approved by the board;

(2)Successfully pass SPEX, COMVEX-USA, or another examination approved by the board;

(3)Successfully complete a retraining program arranged by the physician and approved in advance by the board; or

(4)Successfully complete a reentry to practice program or monitoring program approved by the board.

d.Grant a license;

e.Grant a license under certain terms and conditions or with certain restrictions;

f.Request that the applicant withdraw the licensure application; or

g.Deny a license. The board may deny a license for any grounds on which the board may discipline a license. The procedure for appealing a license denial is set forth in rule 653—9.17(147,148).

653—9.8(147,148) Licensure application cycle.

9.8(1) Failure to submit application materials. If the applicant does not submit all materials, including a completed fingerprint packet, within 90 days of the board’s initial request for further information, the application will be considered inactive.

9.8(2) Reactivation of the application. To reactivate the application, an applicant shall submit a nonrefundable fee for reactivation of the application as specified in 653—paragraph 8.4(1)“b” within 30 days. If the application is not reactivated within 30 days, the application for licensure is withdrawn and the applicant must reapply and submit a new nonrefundable application fee and a new application, documents and core credentials.

9.8(3) Period of reactivation. The period for reactivation of application shall extend 90 days from the date the request and fee are received in the board office. During this period, the applicant shall update core credentials and submit the remaining requested materials. If the applicant does not update core credentials or submit all materials during the 90-day period of reactivation, the application for licensure is withdrawn and the applicant must reapply and submit a new nonrefundable application fee and a new application, documents and core credentials.

653—9.9(147,148) Discretionary board actions on licensure applications. As circumstances warrant, the board may determine that any applicant for licensure is subject to the following:

9.9(1) The board may impose limits or restrictions on the practice of any applicant in this state that are equal in force to the limits or restrictions imposed on the applicant by any jurisdiction.

9.9(2) The board may defer final action on an application for licensure if there is an investigation or disciplinary action pending against an applicant in any jurisdiction until such time as the board is satisfied that licensure of the applicant poses no risk to the health and safety of Iowans.

9.9(3) The board is not precluded from taking disciplinary action after licensure is granted related to issues that arose in the licensure application process.

653—9.10(147,148) Issuance of a license.

9.10(1) Issuance. Upon the granting of permanent or administrative medicine licensure, staff will issue a license to practice that will expire on the first day of the licensee’s birth month.

a.Licenses of persons born in even-numbered years shall expire in an even-numbered year, and licenses of persons born in odd-numbered years shall expire in an odd-numbered year.

b.The license shall not be issued for a period less than two months or greater than two years and two months, in accordance with the licensee’s month and year of birth.

c.When a resident physician receives a permanent Iowa license, the resident physician license will immediately become inactive.

d.When a physician with a special license receives a permanent Iowa license, the special license will immediately become inactive.

e.When a physician with a permanent Iowa license receives an Iowa administrative medicine license, the permanent Iowa license will immediately become inactive.

f.A physician with an active permanent Iowa license is ineligible for an Iowa resident license.

9.10(2) Display of license certificate. The license certificate shall be displayed in the licensee’s primary location of practice.

653—9.11(147,148) Notification required to change the board’s data system.

9.11(1) Change of contact information. A licensee shall notify the board of any change in the home address, the address of the place of practice, home or practice telephone number, or personal email address regularly used by the applicant or licensee for correspondence with the board within one month of the change.

9.11(2) Change of name. A licensee shall notify the board of any change in name within one month of making the name change. Notification requires a notarized copy of a marriage license or a notarized copy of court documents.

9.11(3) Deceased. A licensee file shall be closed and labeled “deceased” when the board receives a copy of the physician’s death certificate or other reliable information of the licensee’s death.

9.11(4) Practice name. A licensee shall practice under the licensee’s full legal name.

653—9.12(147,148) Renewal of a permanent or administrative medicine license.

9.12(1) Licensee obligation. The licensee is responsible for renewing the license prior to its expiration. Failure of the licensee to receive notice does not relieve the licensee of responsibility for renewing that license.

9.12(2) Renewal application requirements. A licensee seeking renewal shall submit a completed renewal application; information on continuing education, training on chronic pain management, training on end-of-life care, and training on identifying and reporting abuse; and the required fee prior to the expiration date on the current license.

a.Renewal fee.

(1)The fees for renewal are specified in 653—subparagraph 8.4(1)“c”(1).

(2)There is no renewal fee due for a physician who was on active duty in the U.S. armed forces, reserves or national guard during the renewal period.

(3)A physician who fails to renew before the expiration of the license is charged a penalty fee as set forth in 653—paragraph 8.4(1)“d.”

b.The requirements for continuing education and training on identifying and reporting abuse are found in 653—Chapter 11.

9.12(3) Issuance of a renewal. Upon receipt of the completed renewal application, staff will administratively issue a two-year license that expires on the first day of the licensee’s birth month. In the event the board receives adverse information on the renewal application, the board will issue the renewal license but may refer the adverse information for further consideration.

9.12(4) Failure to renew. The license will become inactive and invalid if the licensee fails to renew a license within two months following its expiration date. A licensee whose license is invalid or inactive is prohibited from practice until the license is reactivated in accordance with rule 653—9.15(147,148).

9.12(5) Display of license. Renewal licenses shall be displayed along with the license certificate in the primary location of practice.

653—9.13(147,148) Inactive status of a license.

9.13(1) Definition of inactive status. An inactive license is any license that is not a current, active license.

a.“Inactive status” may include licenses formerly known as delinquent, lapsed, or retired.

b.A physician whose license is inactive continues to hold the privilege of licensure in Iowa but may not practice medicine under an Iowa license until the license is reactivated to current, active status. A licensee who practices under an Iowa license when the license is inactive may be subject to disciplinary action by the board, injunctive action pursuant to Iowa Code section 147.83, criminal sanctions pursuant to Iowa Code section 147.86, or other available legal remedies.

9.13(2) Mechanisms for becoming inactive. A licensee seeking to become inactive may submit a written request to the board office, or a license may become inactive by failing to renew a license by the first day of the third month after the expiration date.

653—9.14(147,148) Reactivation of an unrestricted Iowa license.

9.14(1) Reactivation within one year of the license’s becoming inactive. An individual whose license is in inactive status for up to one year and who wishes to reinstate the license shall submit a completed renewal application; the reinstatement fee; documentation of continuing education; and, if applicable, documentation on training on chronic pain management, end-of-life care, and identifying and reporting abuse. All of the information shall be received in the board office within one year of the license’s becoming inactive for the applicant to reinstate under this subrule.

a.Fee for reactivation of an unrestricted Iowa license within one year of the license’s becoming inactive. The reactivation fee is specified in 653—paragraph 8.4(1)“g.”

b.Continuing education and training requirements. Applicants for reactivation shall provide documentation of having completed:

(1)The number of hours of category 1 credit needed for renewal in the most recent license period. None of the credits obtained in the inactive period may be carried over to a future license period; and

(2)Training on chronic pain management, end-of-life care, and identifying and reporting abuse, if applicable, within the previous five years.

c.Issuance of a reactivated license. Upon receiving the completed application, staff will administratively issue a license that expires on the renewal date that would have been in effect if the licensee had renewed the license before the license expired.

d.Reinstatement application process. The applicant who fails to submit all reinstatement information required within 365 days of the license’s becoming inactive shall be required to meet the reinstatement requirements of subrule 9.15(2). For example, if a physician’s license expires on January 1, the completed reinstatement application is due in the board office by December 31, in order to meet the requirements of this subrule.

9.14(2) Reactivation of an unrestricted Iowa license that has been inactive for one year or longer. An individual whose license is in inactive status and who has not submitted a reactivation application that was received by the board within one year of the license’s becoming inactive shall follow the application cycle specified in this rule and shall satisfy the following requirements for reactivation:

a.Submit an application for reactivation to the board. The application shall require the following information:

(1)Full legal name, date and place of birth, license number, home address, mailing address, principal business address, and personal email address regularly used by the applicant or licensee for correspondence with the board;

(2)A chronology accounting for all time periods from the date of initial licensure;

(3)Every jurisdiction in which the applicant is or has been authorized to practice including license numbers and dates of issuance;

(4)Documentation of successful completion of resident training approved by the board as specified in paragraph 9.3(1)“c” that was completed since the time of initial licensure. An official FCVS Physician Information Profile that supplies this information for the applicant is a suitable alternative;

(5)Verification of the applicant’s hospital and clinical staff privileges, and other professional experience for the past five years if requested by the board;

(6)A statement disclosing and explaining any warnings issued, investigations conducted or disciplinary actions taken, whether by voluntary agreement or formal action, by a medical or professional regulatory authority, an educational institution, training or research program, or health facility in any jurisdiction;

(7)A statement disclosing and explaining the applicant’s involvement in civil litigation related to practice in any jurisdiction. Copies of the legal documents may be requested if needed during the review process;

(8)A statement disclosing and explaining any charge of a misdemeanor or felony involving the applicant filed in any jurisdiction, whether or not any appeal or other proceeding is pending to have the conviction or plea set aside. Copies of the legal documents may be requested if needed during the review process; and

(9)A completed fingerprint packet to facilitate a national criminal history background check. The fee for the evaluation of the fingerprint packet and the DCI and FBI criminal history background checks will be assessed to the applicant.

b.Pay the reactivation fee plus the fee for the evaluation of the fingerprint packet and the DCI and FBI criminal history background checks specified in 653—paragraph 8.4(1)“f.”

c.Provide documentation of completion of 40 hours of category 1 credit within the previous two years and documentation of training on chronic pain management, end-of-life care, and identifying and reporting abuse as specified in 653—Chapter 11.

d.If the physician has not engaged in active clinical practice or board-approved training in the past three years in any jurisdiction of the United States or Canada:

(1)Successfully pass a competency evaluation approved by the board;

(2)Successfully pass SPEX, COMVEX-USA, or another examination approved by the board;

(3)Successfully complete a retraining program arranged by the physician and approved in advance by the board; or

(4)Successfully complete a reentry to practice program or monitoring program approved by the board.

e.An individual who is able to submit a letter from the board with different reactivation criteria is eligible for reactivation based on those criteria.

653—9.15(147,148) Reinstatement of a restricted Iowa license. A physician whose license has been suspended or revoked following a disciplinary proceeding is required to seek reinstatement pursuant to 653—Chapter 26.

653—9.16(147,148) Relinquishment of license to practice. A person’s permanent license to practice medicine and surgery, osteopathic medicine and surgery, or administrative medicine shall be deemed relinquished if the person fails to apply for renewal or reactivation of the license within five years after its expiration.

9.16(1) A license will not be reinstated, reissued, or restored once it is relinquished. The person may apply for a new license pursuant to Iowa Code sections 148.3 and 148.11 and 653—Chapters 9 and 10.

9.16(2) The relinquishment of license may be stayed if, at the date of relinquishment, there is an active:

a.Evaluation order pursuant to Iowa Code section 272C.9(1) and rule 653—24.4(272);

b.Combined statement of charges and settlement agreement pursuant to Iowa Code sections 17A.10(2) and 272C.3(4) and rule 653—25.3(17A);

c.Statement of charges pursuant to Iowa Code section 17A.12(2) and rule 653—25.4(17A);

d.Settlement agreement pursuant to Iowa Code sections 17A.10(2) and 272C.3(4) and rule 653—25.17(272C);

e.Final decision pursuant to Iowa Code sections 17A.12 and 272C.6 and rule 653—25.24(17A); or

f.Application for reactivation of the license pursuant to rule 653—9.15(147,148) or 653—9.16(147,148).

653—9.17(147,148) Administrative medicine licensure.

9.17(1) Application. An application for an administrative medicine license shall be made to the board of medicine pursuant to the requirements established in Iowa Code section 148.3 and this chapter. An applicant for an administrative medicine license shall be subject to all of the permanent licensure requirements established in Iowa Code section 148.3 and this chapter, except that the applicant will not be required to demonstrate that the applicant has engaged in active clinical practice in the past three years as outlined in paragraphs 9.8(7)“c” and 9.15(2)“d.”

The board may issue an administrative medicine license authorizing the licensee to practice administrative medicine only, as defined by this rule. The license shall be designated “administrative medicine license.”

9.17(2) Fees. All license and renewal fees shall be paid to the board in accordance with 653—Chapters 8 and 9.

9.17(3) Demonstration of competence.

a.If an applicant for initial licensure or reactivation of an administrative medicine license has not actively practiced administrative or clinical medicine in a jurisdiction of the United States or Canada in the past three years, the board may require the applicant to demonstrate competence in a method prescribed by the board in accordance with paragraphs 9.8(7)“c” and 9.15(2)“d.”

b.A physician who holds an administrative medicine license and has not engaged in active clinical practice in a jurisdiction of the United States or Canada for more than three years may be required to demonstrate competence to practice clinical medicine in a method prescribed by the board.

9.17(4) No exemptions to laws and rules. A physician with an administrative medicine license is subject to the same laws and rules governing the practice of medicine as a person holding a permanent Iowa medical license.

9.17(5) Interstate medical licensure compact. A physician who holds only an administrative medicine license may not be eligible for licensure under the interstate medical licensure compact.

653—9.18(147,147B,148) Licensure through IMLC.

9.18(1) Requirements for seeking a Letter of Qualification from the board of medicine. An applicant shall meet all of the following requirements:

a.Designate Iowa as state of principal license. To designate Iowa as state of principal license, the physician must possess a full, unrestricted, permanent Iowa medical license and meet one of the following requirements at the time the application for a Letter of Qualification is reviewed by board staff:

(1)Iowa is the physician’s primary residence, or

(2)At least 25 percent of the physician’s medical practice occurs in Iowa, or

(3)The physician’s employer is located in Iowa, or

(4)If the applicant does not meet any of the requirements under subparagraph 9.18(1)“a”(1), (2), or (3), the applicant can designate Iowa as the state of principal license if Iowa is the applicant’s state of residence for the purposes of federal income tax.

b.Provide evidence of the following qualifications:

(1)Graduation from a medical school accredited by the LCME, COCA, or a medical school listed in the International Medical Education Directory or its equivalent.

(2)Passage of each component of the USMLE or the COMLEX within three attempts, or any of its predecessor examinations accepted by the board as an equivalent examination for licensure purposes as prescribed in rule 653—9.7(147,148).

(3)Successful completion of graduate medical education approved by the ACGME or the AOA. “Successful completion” means participation in an ACGME or AOA postgraduate training program that achieves ABMS or AOA board eligibility status.

(4)At the time of application, hold specialty certification or a time-unlimited specialty certificate recognized by the ABMS or the AOA. The specialty certification or a time-unlimited specialty certificate does not have to be maintained once a physician is determined to be eligible for licensure through the IMLC.

(5)Has never been convicted of or received adjudication, deferred adjudication, community supervision, or deferred disposition for any criminal offense by a court of appropriate jurisdiction.

(6)Has never held a license authorizing the practice of medicine subjected to discipline by a licensing agency in any state, federal, or foreign jurisdiction, excluding any action related to nonpayment of fees related to a license.

(7)Has never had a controlled substance license or permit suspended or revoked by a state or the U.S. Drug Enforcement Administration (DEA).

(8)Is not under active investigation by a licensing agency or law enforcement authority in any state, federal, or foreign jurisdiction.

9.18(2) Application. A physician seeking licensure through the IMLC who is qualified to designate Iowa as state of principal license shall file an application for a Letter of Qualification with the interstate commission at www.imlcc.org and pay the nonrefundable service fee. The application shall require the following:

9.18(3) Letter of Qualification.

a.After evaluation of the applicant’s eligibility for licensure, the Board will issue a Letter of Qualification to the applicant verifying or denying the applicant’s eligibility. The applicant may appeal a determination of eligibility to the board of medicine within 30 days of issuance of the Letter of Qualification according to the processes outlined in rule 653—9.22(147,148).

b.The Letter of Qualification is valid for 365 days from its date of issuance to request licensure in a member state. The physician must maintain eligibility to claim Iowa as the state of principal license or designate a new state of principal license.

9.18(4) Expedited licensure. Physicians who have a valid Letter of Qualification may obtain licensure in Iowa through the IMLC. To obtain a permanent Iowa license through the IMLC, a qualified physician shall:

a.Complete the application process at the IMLC’s website, www.imlcc.org.

b.Pay the licensure fee specified in 653—subrule 8.3(2) and any service fees that are required by the IMLC.

c.Comply with the continuing medical education requirements of the board, including mandatory trainings specified in 653—Chapter 11.

9.18(5) Validity of a license issued through the IMLC. A license issued through the IMLC is valid for a period consistent with other permanent licenses issued by the board. An Iowa license issued through the IMLC shall be deemed terminated if the licensee fails to maintain a state of principal license.

9.18(6) Disciplinary actions against licenses issued through the IMLC.

a.Physicians holding an Iowa license issued through the IMLC are subject to the laws and rules governing the practice of medicine in Iowa.

b.Any disciplinary action taken by another member board of the IMLC against a physician licensed through IMLC shall be deemed unprofessional conduct that may be subject to discipline by the board in addition to any other violation of the board’s rules deemed appropriate by the board.

c.If a license issued through the IMLC to a physician is revoked, surrendered, or relinquished in lieu of discipline, or suspended by a member board of the IMLC, then the physician’s Iowa expedited license is automatically and immediately suspended, without further action needed, for a period of 90 days upon entry of an order by the board. The 90-day suspension may be terminated early by the board.

d.Disciplinary actions by out-of-state boards can be considered conclusive regarding legal and factual matters. The home board may impose similar or lesser sanctions, as long as the sanctions comply with the board’s laws, or pursue separate disciplinary action.

e.If the Iowa board, as the physician’s state of principal license, revokes or suspends the physician’s license, or accepts a license surrender in lieu of discipline, then all licenses issued to the physician through the IMLC shall automatically be placed, without further action necessary by any member board, on the same status. If the Iowa board subsequently reinstates the physician’s license, the licenses issued by the other member boards shall remain encumbered until the member boards take action to reinstate the licenses.

9.18(7) Renewal of license issued through the IMLC. To be eligible for renewal of a license issued through the IMLC, a licensee shall:

a.Complete an online renewal application on a form provided by the IMLC at www.imlcc.org.

b.Complete an attestation that the licensee:

(1)Maintains eligibility to designate a state as the state of principal license, pursuant to paragraph 9.21(1)“a”;

(2)Maintains a full and unrestricted license in the designated state of principal license;

(3)Has not been convicted of or received adjudication, deferred adjudication, community supervision, or deferred disposition for any offense by a court of appropriate jurisdiction;

(4)Has not had a license authorizing the practice of medicine subject to discipline by a licensing agency in any state, federal or foreign jurisdiction, excluding any action related to nonpayment of fees related to a license;

(5)Has not had a controlled substance license or permit suspended or revoked by a state or the U.S. DEA.

c.Pay licensure fee for the renewal of a license issued through the IMLC and pay any service fee assessed by the IMLC.

d.If audited, submit verification of completion of continuing medical education requirements set forth in 653—Chapter 11.

9.18(8) Waivers. The laws and rules relating to the IMLC cannot be waived.

9.18(9) Advisory opinions. The board will recognize advisory opinions issued by the interstate commission on the meaning or interpretation of the IMLC, its bylaws, rules and actions when determining an applicant’s eligibility for licensure through the IMLC.

653—9.19(147,148) Denial of licensure, determination of ineligibility for licensure through the IMLC, or termination of a license issued through the IMLC.

9.19(1) Preliminary notice of denial. Prior to the denial of licensure to an applicant, the board shall issue a preliminary notice of denial that shall be sent to the applicant by regular, first-class mail at the address provided by the applicant. The preliminary notice of denial is a public record and shall cite the factual and legal basis for denying the application, notify the applicant of the appeal process, and specify the date upon which the denial will become final if it is not appealed.

9.19(2) Appeal procedure. An applicant who has received a preliminary notice of licensure denial or a Letter of Qualification that asserts the board has determined that the applicant is ineligible for licensure through the IMLC, or a notice that a medical license is ineligible for renewal through the IMLC, may appeal and request a hearing on the issues related to the preliminary notice of licensure denial or ineligibility for licensure or licensure renewal through the IMLC by serving a request for hearing upon the executive director not more than 30 calendar days following the date when the notice was mailed. The applicant’s current address shall be provided in the request for hearing. The request is deemed filed on the date it is received in the board office. If the request is received with a USPS nonmetered postmark, the board shall consider the postmark date as the date the request is filed. The request shall specify the factual or legal errors and that the applicant desires an evidentiary hearing, and may provide additional written information or documents in support of licensure, or a Letter of Qualification that asserts the applicant is eligible for licensure through the IMLC, or the applicant is eligible for licensure renewal through the IMLC.

9.19(3) Hearing. If an applicant appeals the preliminary notice of licensure denial or a determination of ineligibility for licensure or licensure renewal through the IMLC and requests a hearing, the hearing shall be a contested case and subsequent proceedings shall be conducted in accordance with rule 653—25.30(17A).

a.Hearings for applicants denied licensure, or determined to be ineligible for licensure or licensure renewal through the IMLC are contested cases open to the public.

b.Either party may request issuance of a protective order in the event privileged or confidential information is submitted into evidence.

c.Evidence supporting the denial of the license or the determination of ineligibility for licensure or licensure renewal through the IMLC may be presented by an assistant attorney general.

d.While each party shall have the burden of establishing the affirmative of matters asserted, the applicant shall have the ultimate burden of persuasion as to the applicant’s qualification for licensure or licensure eligibility or licensure renewal through IMLC.

e.The board, after a hearing on license denial, may grant or deny the application for licensure. The board shall state the reasons for its decision and may grant the license, grant the license with restrictions or deny the license. The final decision is a public record. After a hearing on ineligibility for licensure renewal through the IMLC, the board may uphold the termination of the license or allow the licensee to renew. The board shall state the reasons for its decision, which is a public record. After a hearing on a Letter of Qualification determination, the board may uphold the ineligible determination or issue a Letter of Qualification asserting the applicant is eligible for licensure through the IMLC. The board shall state the reasons for its decision, which is a public record.

f.Judicial review of a final order of the board denying licensure, issuing a license with restrictions, terminating a license not eligible for renewal through the IMLC, or upholding a Letter of Qualification asserting that an applicant is ineligible for licensure through the IMLC may be sought in accordance with the provisions of Iowa Code section 17A.19, which are applicable to judicial review of any agency’s final decision in a contested case.

9.19(4) Finality. If an applicant does not appeal a preliminary notice of denial in accordance with subrule 9.17(2), the preliminary notice of denial automatically becomes final. A final denial of an application for licensure is a public record.

9.19(5) Failure to pursue appeal. If an applicant appeals a preliminary notice of licensure denial or a notice of ineligibility for licensure or licensure renewal through the IMLC, in accordance with subrule 9.17(2), but the applicant fails to pursue that appeal to a final decision within one year from the date of the preliminary notice of licensure denial or a notice of ineligibility for licensure or licensure renewal through the IMLC, the board may dismiss the appeal. The appeal may be dismissed only after the board sends a written notice by first-class mail to the applicant at the applicant’s last-known address. The notice shall state that the appeal will be dismissed and that the preliminary notice of licensure denial or a notice of ineligibility for licensure or licensure renewal through the IMLC will become final if the applicant does not contact the board to schedule the appeal hearing within 30 days of the date the letter is mailed from the board office. Upon dismissal of an appeal, the preliminary notice of licensure denial or a notice of ineligibility for licensure or licensure renewal through the IMLC becomes final. A final decision under this rule is a public record.

These rules are intended to implement Iowa Code chapters 17A, 147, 147B,148, and 272C.