ARC 8700C

ARC 8700C

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 10 and adopt the following new chapter in lieu thereof:

CHAPTER 10

RESIDENT, SPECIAL AND TEMPORARY PHYSICIAN LICENSURE

653—10.1(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 or osteopathic medicine and surgery in this state by making application to the board.

“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 health and human services, 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 board of medicine.

“Board-approved activity” means one of the following activities:

1.Covering for an Iowa-licensed physician who unexpectedly is unavailable to provide medical care to the physician’s patients;

2.Demonstrating or proctoring that involves providing hands-on patient care to patients in Iowa;

3.Conducting a procedure on a patient in Iowa when the consultant’s expertise in the procedure is greater than that of the Iowa-licensed physician who requested the procedure;

4.Providing medical care to patients in Iowa, if the physician is enrolled in an out-of-state resident training program and does not hold a resident or permanent license in the home state of the resident training program;

5.Serving as a camp physician;

6.Participating as a learner in a program of further medical education that allows hands-on patient care when the physician does not currently hold a license in good standing in any United States jurisdiction; or

7.Any other activity approved by the board.

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

“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 that is of sufficient scope and depth of coverage of a subject area or theme to form an educational unit and is planned, administered and evaluated in terms of educational objectives that define a level of knowledge or a specific performance skill to be attained by the physician completing the program. 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.

“Committee” means the licensure committee of the board.

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

“FCVS” means the Federation Credentials Verification Service.

“FSMB” means the Federation of State Medical Boards.

“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 will 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.

“LCME” means Liaison Committee on Medical Education.

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

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

“Postgraduate training” means graduate medical education, e.g., an internship, residency or fellowship, in a hospital-affiliated training program approved by the board at the time the applicant was enrolled in the program.

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

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

“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. For example, one who renews a license online will pay the license renewal fee and a service charge.

“Training for chronic pain management” means required training on chronic pain management identified in 653—Chapter 11.

“Training for end-of-life care” means required training on end-of-life care identified in 653—Chapter 11.

“Training for identifying and reporting abuse” means training on identifying and reporting child abuse or dependent adult abuse required of physicians who regularly provide primary health care to children or adults, respectively.

“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.

653—10.2(148) Licensure required. Licensure is required for practice in Iowa as identified in Iowa Code section 148.1; the exceptions are identified in 653—subrule 9.2(2).

653—10.3(147,148) Resident physician licensure.

10.3(1) General provisions.

a.The resident physician license authorizes the licensee to practice as an intern, resident or fellow while under the supervision of a licensed practitioner of medicine and surgery or osteopathic medicine and surgery in a board-approved resident training program in Iowa. When the ACGME, AOA, RCPSC, or CFPC fails to offer accreditation for a fellowship or the fellowship fails to seek accreditation, the board will approve the program if the parent program is accredited by one of the aforementioned accrediting bodies. Completion of one or more years of a program that itself lacks such accreditation does not fulfill the one-year resident training requirement for permanent licensure.

b.An Iowa resident physician license or an Iowa permanent physician license is required of any resident physician enrolled in an Iowa resident training program and practicing in Iowa.

c.A resident physician license will expire on the expected date of completion of the resident training program as indicated on the licensure application.

d.A resident physician license is valid only for practice in the program designated in the application. When the physician leaves that program, the license will immediately become inactive. The director of the resident training program must notify the board within 30 days of the licensee’s terminating from the program.

e.A resident physician licensee who changes resident training programs must apply for a new resident physician license as described in subrule 10.3(3). Such changes include a transfer to a different program in the same institution, a move to a program in another institution, or becoming a fellow after completing a residency in the same core program. An individual who contracts with an institution to be in two programs from the time of application for the resident license shall not be required to apply for another resident license for the second program.

f.A visiting resident physician may come to Iowa to practice as a part of the physician’s resident training program if the physician is 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 physician 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)).

g.An Iowa license is not required for residents when they are training in a federal facility in Iowa. An Iowa license is not required for faculty who are teaching in and employed by a federal facility in Iowa and who are licensed in another state.

h.The director of a resident training program that enrolls a resident with an Iowa resident physician license shall report annually on October 1 on the resident’s progress and whether any warnings have been issued, investigations conducted, or disciplinary actions taken, whether by voluntary agreement or formal action.

i.A resident physician licensee must 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.

j.A resident physician licensee’s file shall be closed and labeled “deceased” when the board receives a copy of the physician’s death certificate.

10.3(2) Resident license eligibility. To be eligible for a resident license, an applicant must meet all of the following requirements:

a.Fulfill the application requirements specified in subrule 10.3(3).

b.Be at least 20 years of age.

c.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 must 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 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 must:

1.Hold a valid certificate issued by ECFMG, or

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

d.The applicant’s license is not denied by the board due to the commission of a disqualifying offense, as provided in 653—subrule 9.3(3).

10.3(3) Resident physician licensure application.

a.Requirements. To apply for resident physician licensure, an applicant shall:

(1)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(2)“a”; and

(2)Complete and submit forms provided by the board, including required credentials, documents, a completed fingerprint packet, and a sworn statement by the applicant attesting to the truth of all information provided by the applicant.

b.Application. The application shall require the following information:

(1)Full legal name, date and place of birth, home address, and mailing address;

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

(3)A chronology accounting for all time periods from the date the applicant entered medical school to the date of the application;

(4)A photocopy of the applicant’s medical degree issued by an educational institution.

1.A complete translation shall be submitted for any diploma not written in English. An official transcript, written in English and received directly from the school, verifying graduation from medical school is a suitable alternative. An official FCVS Physician Information Profile is a suitable alternative.

2.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;

(5)If the educational institution awarding the applicant the degree has not been approved by the board, the applicant shall provide a valid ECFMG certificate or evidence of successful completion of a fifth pathway program in accordance with criteria established by the AMA. An official FCVS Physician Information Profile is a suitable alternative;

(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 care 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; 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.

10.3(4) Resident license application review process. The process below shall be utilized to review each application for a resident license.

a.An application shall be considered open from the date the application form is received in the board office with the nonrefundable resident licensure fee.

b.After reviewing each application, staff shall notify the applicant or designee about how to resolve any problems identified by the reviewer.

c.If the final review indicates no questions or concerns regarding the applicant’s qualifications for licensure, staff may grant administratively a resident license.

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

(1)If there is no current concern, staff shall grant administratively a resident license.

(2)If any concern exists, the application shall be referred to the committee.

e.Staff shall refer to the committee for review matters that include but are not limited to falsification of information on the application, criminal record, substance abuse, competency, physical or mental illness, or educational disciplinary history.

f.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 administratively a resident license.

g.If the committee is not able to eliminate questions or concerns without dissension from staff or a committee member, the committee shall recommend that the board:

(1)Request an investigation;

(2)Request that the applicant appear for an interview;

(3)Grant a resident physician license for a particular residency program;

(4)Grant a license under certain terms and conditions or with certain restrictions;

(5)Request that the applicant withdraw the licensure application; or

(6)Deny a license.

h.The board shall consider applications and recommendations from the committee and shall:

(1)Request an investigation;

(2)Request that the applicant appear for an interview;

(3)Grant a resident physician license for a particular residency program;

(4)Grant a license under certain terms and conditions or with certain restrictions;

(5)Request that the applicant withdraw the licensure application; or

(6)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—9.15(147,148).

10.3(5) Resident license application cycle. If the applicant does not submit all materials within 90 days of the board’s initial request for further information, the application shall be considered inactive. An applicant must reapply and submit a new nonrefundable application fee and a new application, documents and credentials.

10.3(6) Extension of a resident physician license.

a.If the licensee fails to complete the program by the expiration date on the license, the licensee has a one-month grace period in which to complete the program or secure an extension from the board.

b.The resident physician licensee must apply for an extension if the licensee has not been granted permanent physician licensure and the licensee will not complete the program within the grace period. The following extension application materials are due in the board office prior to the expiration of the license:

(1)A letter requesting an extension and providing an explanation of the need for an extension;

(2)The extension fee as specified in 653—paragraph 8.4(2)“b”; and

(3)A statement from the director of the resident training program attesting to the new expected date of completion of the program and the individual’s progress in the program and whether any warnings have been issued, investigations conducted, or disciplinary actions taken, whether by voluntary agreement or formal action.

c.Failure of the licensee to extend a license within one month following the expiration date will cause the license to become inactive and invalid.

d.To extend an inactive resident license within one year of becoming inactive, an applicant shall submit the following:

(1)A letter requesting an extension and providing an explanation of the need for an extension;

(2)The extension fee as specified in 653—paragraph 8.4(2)“b”; and

(3)A late fee as specified in 653—paragraph 8.4(2)“c”; and

(4)A statement from the director of the resident training program attesting to the new expected date of completion of the program and the individual’s progress in the program and whether any warnings have been issued, investigations conducted, or disciplinary actions taken, whether by voluntary agreement or formal action.

e.If more than one year has passed since the resident license became inactive, the applicant shall apply for a new resident license as described in subrule 10.3(3).

10.3(7) Review process for extending a resident license. The process below shall be utilized to review each request for an extension of a resident license.

a.An extension request shall be considered open from the date the required letters and nonrefundable extension fee are received in the board office.

b.After reviewing each request for extension, staff shall notify the licensee or designee about how to resolve any problems identified by the reviewer. The applicant for license extension shall provide additional information when requested by staff or the board.

c.If the final review indicates no questions or concerns regarding the applicant’s qualifications for continued licensure, staff may grant administratively an extension to a resident license.

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

(1)If there is no current concern, staff shall grant administratively an extension to a resident license.

(2)If any concern exists, the application shall be referred to the committee.

e.Staff shall refer to the committee for review matters that include but are not limited to falsification of information in the request, criminal record, substance abuse, competency, physical or mental illness, or educational disciplinary history.

f.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 administratively an extension to a resident license.

g.If the committee is not able to eliminate questions or concerns without dissension from staff or a committee member, the committee shall recommend that the board:

(1)Request an investigation;

(2)Request that the licensee appear for an interview;

(3)Grant a license under certain terms and conditions or with certain restrictions;

(4)Request that the licensee withdraw the request for an extension; or

(5)Deny a request for an extension of the license.

h.The board shall consider applications and recommendations from the committee and shall:

(1)Request an investigation;

(2)Request that the licensee appear for an interview;

(3)Grant an extension to the resident physician license;

(4)Grant an extension to the resident physician license under certain terms and conditions or with certain restrictions;

(5)Request that the licensee withdraw the request for an extension; or

(6)Deny a request for an extension of the license. The board may deny an extension of a license for any grounds on which the board may discipline a license. The procedure for appealing a license denial of an extension is set forth in rule 653—9.15(147,148).

10.3(8) Discipline of a resident license. The board may discipline a license for any of the grounds for which licensure may be revoked or suspended as specified in Iowa Code section 147.55 or 148.6, Iowa Code chapter 272C, and 653—Chapter 23.

10.3(9) Transition from a resident license to a permanent license. When a resident physician receives a permanent Iowa license, the resident physician license shall immediately become inactive.

653—10.4(147,148) Special licensure.

10.4(1) General provisions.

a.The board may grant a special license to a physician who is an academic staff member of a college of medicine or osteopathic medicine if that physician does not meet the qualifications for permanent licensure but is held in high esteem for unique contributions the individual has made to medicine and will make by practicing in Iowa. The license is not designed for physicians in regular faculty positions that could be filled by a physician qualified for permanent licensure in Iowa or for the purpose of training the physician who receives the license. The board will consider granting and renewing a special license on a case-by-case basis.

b.A special license may be issued for a period of not more than one year and may be renewed annually prior to expiration.

c.A special license will specifically limit the licensee to practice at the medical college and at any health care facility affiliated with the medical college.

d.A special license will automatically be placed on inactive status when the licensee discontinues service on the academic medical staff for which the special license was granted.

e.The board may cancel a special license if the licensee has practiced outside the scope of this license or for any of the grounds for which licensure may be revoked or suspended as specified in Iowa Code sections 147.55, 148.6, and 272C.10 and 653—Chapter 23. When cancellation of such a license is proposed, the board shall promptly notify the licensee by sending a statement of charges and notice of hearing by certified mail to the last-known address of the licensee. This contested case proceeding shall be governed by the provisions of 653—Chapter 25.

f.A special physician licensee must notify the board of any change in home address or the address of the place of practice within one month of making an address change.

g.A special physician licensee must 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.

h.A special physician licensee file will be closed and labeled “deceased” when the board receives a copy of the physician’s death certificate.

i.The board may accept each 12 months of practice as a special licensee as equivalent to one year of postgraduate training in a hospital-affiliated program approved by the board for the purposes of permanent licensure.

10.4(2) Special license eligibility. To be eligible for a special license, an applicant shall meet all of the following requirements:

a.Fulfill the application requirements specified in subrule 10.4(3);

b.Be at least 21 years of age;

c.Be a physician in a medical specialty;

d.Present evidence of holding a medical degree from an educational institution that is located in a jurisdiction outside the United States or Canada and that is listed in the Directory of Medical Schools published by the International Medical Education Directory;

e.Have completed at least two years of postgraduate education in any jurisdiction;

f.Have practiced for five years after postgraduate education;

g.Demonstrate proficiency in English by providing a valid ECFMG certificate or verification of a passing score on the Test of Spoken English (TSE) or the Test of English as a Foreign Language (TOEFL) examination administered by the Educational Testing Service;

h.Be licensed in a jurisdiction outside the United States or Canada and present evidence that any licenses held in any jurisdiction are unrestricted; and

i.The applicant’s license is not denied by the board due to the commission of a disqualifying offense, as provided in 653—subrule 9.3(3).

10.4(3) Special license application.

a.Requirements. To apply for a special license, an applicant must:

(1)Pay a nonrefundable special license fee and a 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(3)“a”;

(2)Complete and submit forms provided by the board, including required credentials, documents, a completed fingerprint packet, and a sworn statement by the applicant attesting to the truth of all information provided by the applicant;

(3)Provide verification of successful completion of a medical degree;

(4)Provide a valid ECFMG certificate or verification of a passing score on the TSE or TOEFL examination administered by the Educational Testing Service;

(5)Present a letter from the dean of the medical college in which the applicant will be practicing that indicates all of the following:

1.The applicant has been invited to serve on the academic staff of the medical school and in what capacity;

2.The applicant’s qualifications and the unique contributions the applicant has made to the practice of medicine;

3.The unique contributions the applicant is expected to make by practicing in Iowa and how these contributions will serve the public interest of Iowans; and

(6)Present at least two letters of recommendation from universities, other educational institutions, or research facilities that indicate the applicant’s noteworthy professional attainment.

b.Application. The application shall request the following information:

(1)Name, date and place of birth, home address, and mailing address;

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

(3)A chronology accounting for all time periods from the date the applicant entered medical school to the date of the application;

(4)A photocopy of the applicant’s medical degree issued by an educational institution and 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. A complete translation of any diploma not written in English shall be submitted;

(5)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;

(6)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;

(7)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; and

(8)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.

10.4(4) Special license application review process. The process below shall be utilized to review each application for a special license.

a.An application shall be considered open from the date the application form is received in the board office with the nonrefundable special licensure fee.

b.After reviewing each application, staff shall notify the applicant or the applicant’s academic institution about how to resolve any problems identified by the reviewer. The applicant shall provide additional information when requested by staff or the board.

c.If the final review indicates no questions or concerns regarding the applicant’s qualifications for licensure, staff may administratively grant a special license.

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

(1)If there is no current concern, staff shall administratively grant a special license.

(2)If any concern exists, the application shall be referred to the committee.

e.Staff shall refer to the committee for review matters that include but are not limited to falsification of information on the application, criminal record, substance abuse, questionable competency, physical or mental illness, or educational disciplinary history.

f.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 administratively a special license.

g.If the committee is not able to eliminate questions or concerns without dissension from staff or a committee member, the committee shall recommend that the board:

(1)Request that the applicant appear for an interview;

(2)Grant a special license for practice at the medical college designated in the application;

(3)Grant a license under certain terms and conditions or with certain restrictions;

(4)Request that the applicant withdraw the licensure application; or

(5)Deny a license.

h.The board shall consider applications and recommendations from the committee and shall:

(1)Request that the applicant appear for an interview;

(2)Grant a special license for practice at the medical college designated in the application;

(3)Grant a license under certain terms and conditions or with certain restrictions;

(4)Request that the applicant withdraw the licensure application; or

(5)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—9.15(147,148).

10.4(5) Special license application cycle. If the applicant does not submit all materials within 90 days of the board’s initial request for further information, the application will be considered inactive. An applicant must reapply and submit a new nonrefundable application fee and a new application, documents and credentials.

10.4(6) Renewal of a special license.

a.If the special physician licensee has not qualified for and received a permanent license, the licensee must renew prior to expiration.

b.A special physician licensee may apply for a one-year renewal by submitting the following:

(1)A completed renewal application;

(2)The renewal fee as specified in 653—paragraph 8.4(3)“b”;

(3)Evidence of continuing education and training on chronic pain management, end-of-life care, and identifying and reporting abuse as specified in 653—Chapter 11; and

(4)A letter from the dean of the medical college that addresses the individual’s unique contribution to the practice of medicine in Iowa, how the anticipated contribution will serve the public interest of Iowans, and the need for renewal of this license. For a licensee who received the initial special license prior to July 1, 2001, the only statement needed from the dean is verification of the academic appointment the licensee continues to hold.

c.Failure of the licensee to renew a license within one month of the expiration date will cause the license to become inactive. A licensee whose license is inactive is prohibited from practice until a new special license is granted according to subrules 10.4(3) and 10.4(4).

653—10.5(147,148) Temporary licensure. The board may issue a temporary license authorizing a physician to participate in a board-approved activity in Iowa. Temporary licensure is granted on a case-by-case basis and depends upon the applicant’s education and training, experience and licensure status elsewhere and upon the intended use of the temporary license.

10.5(1) General provisions.

a.The temporary license to practice is intended for a physician to participate in a board-approved activity, as defined in rule 653—10.1(147,148), in Iowa that is short-term. Temporary licensure is not intended for locum tenens.

b.The license may be restricted to the board-approved activity, location(s) or time period of up to one year.

(1)A physician who is granted a temporary license for a board-approved activity may qualify for renewal of that license if the physician needs an extension of the license for the original purpose or to pursue more than one board-approved activity within a year.

(2)A physician who wishes to continue in a board-approved activity in Iowa for short intervals beyond one year is eligible for a temporary license each year after reapplying and qualifying on an annual basis.

c.A physician incidentally called into this state in consultation with a physician and surgeon licensed in this state, as defined in rule 653—10.1(147,148), is not required to obtain a temporary license in Iowa.

d.The board may take disciplinary action on a temporary license if the licensee has practiced outside the scope of the temporary license or for any of the grounds for which licensure may be revoked or suspended as specified in Iowa Code sections 147.55, 148.6, and 272C.10 and 653—Chapter 23. Contested case proceedings shall be governed by the provisions of 653—Chapter 25.

e.A physician who holds a temporary license must notify the board of any change in address within three days of making an address change.

f.A physician who holds a temporary license must 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.

g.The file of a physician who holds a temporary license will be closed and labeled “deceased” when the board receives a copy of the physician’s death certificate.

10.5(2) Temporary license eligibility. To be eligible for a temporary license, an applicant must meet all of the following requirements:

a.Fulfill the requirements specified in subrules 10.5(3) and 10.5(4);

b.Be at least 21 years of age;

c.Hold a medical degree from an educational institution approved by the board (if the applicant is an international medical graduate, the educational institution must be listed in the International Medical Education Directory);

d.Hold a current active, unrestricted license to practice medicine issued by any jurisdiction;

e.Be fluent in the English language;

f.Present a letter justifying the need for temporary licensure from the organization or individual seeking the applicant’s participation in a board-approved activity;

g.The applicant’s license is not denied by the board due to the commission of a disqualifying offense, as provided in 653—subrule 9.3(3).

10.5(3) Requirements for a temporary license. To apply for a temporary license, an applicant must:

a.Pay 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(4)“a.” A physician who is serving as a camp physician and who is not receiving payment other than expenses shall be exempt from the license application fee and the fee for the criminal history background check.

b.Complete and submit forms provided by the board, including required credentials, documents, a completed fingerprint packet and a sworn statement by the applicant attesting to the truth of all information provided by the applicant.

10.5(4) Application. The application shall require the following information:

a.The applicant’s full legal name, date and place of birth, home address, mailing address and principal business address;

b.A statement listing every jurisdiction in which the applicant is or has been authorized to practice, including the applicant’s license number and date of issuance of the license;

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

d.A statement by the applicant that discloses and explains 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;

e.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;

f.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;

g.A statement from the applicant that justifies the need for a temporary license, including where the applicant intends to practice and the type of practice involved;

h.A letter from the Iowa organization or individual seeking the applicant’s services that explains the need for the applicant’s participation in the board-approved activity in Iowa, the time period involved, the scope of practice, and the exact location and facilities where the board-approved activity will occur;

i.For an international medical graduate who does not hold a license in good standing in any United States jurisdiction, a statement, which shall be submitted by the Iowa organization or individual offering the board-approved activity, identifying who the applicant’s immediate supervisor will be;

j.For an international medical graduate who does not hold a license in good standing in any United States jurisdiction:

(1)Verification, which shall be submitted from the licensing authority of the country in which the physician is licensed, that the physician has a license in good standing;

(2)Evidence of fluency in the English language;

k.For a resident physician who does not hold a current, active resident or permanent license in the home state of the resident training program, a statement, which shall be submitted by the resident director or individual offering the board-approved activity, identifying who the applicant’s immediate supervisor will be; and

l.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.

10.5(5) Standard application review process for a temporary license. The standard review process shall be utilized to review each application for a temporary license, except that the process identified in subrule 10.5(6) shall be used for any international medical graduate who does not currently hold a license in good standing in any United States jurisdiction or for any physician who seeks temporary licensure for an activity not listed in paragraphs “1” through “6” of the definition of “board-approved activity” in rule 653—10.1(147,148). The standard application review process is as follows:

a.An application shall be considered open from the date the application form and the nonrefundable fees are received in the board office.

b.After reviewing each application, staff shall notify the applicant or designee about how to resolve any problems identified by the reviewer.

c.If the final review indicates no questions or concerns regarding the applicant’s qualifications for temporary licensure or the need for a temporary licensee, staff may administratively grant a temporary license to the applicant for a specific activity, location(s) or specified duration based on the nature of the board-approved activity. The license shall not be granted for a period longer than one year.

d.If the final review indicates questions or concerns that cannot be remedied by continued communication with the applicant, then the executive director, the director of licensure and administration, and the director of legal affairs shall determine if the questions or concerns indicate any uncertainty about the applicant’s current qualifications for temporary licensure or the organization’s or requesting individual’s need for a licensee with a temporary license.

(1)If there is no current concern, staff shall administratively grant a temporary license.

(2)If any concern exists, the application shall be referred to the committee.

e.Staff shall 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, educational disciplinary history, or questionable need on the part of the organization.

f.If the committee is able to eliminate questions or concerns without dissension from staff or a committee member, the committee may direct staff to administratively grant a temporary license for a specific activity, location(s) or specified duration based on the nature of the board-approved activity.

g.If the committee is not able to eliminate questions or concerns without dissension from staff or a committee member, the committee shall recommend that the board:

(1)Grant a temporary license for a specific activity, location(s) or specified duration based on the nature of the board-approved activity;

(2)Grant a temporary license under certain terms and conditions or with certain restrictions;

(3)Deny a temporary license; or

(4)Request that the applicant withdraw the temporary licensure application.

h.The board shall consider applications and recommendations from the committee and shall:

(1)Grant a temporary license for a specific activity, location(s) or specified duration based on the nature of the board-approved activity;

(2)Grant a temporary license under certain terms and conditions or with certain restrictions;

(3)Request that the applicant withdraw the temporary licensure application. The request shall not imply that the applicant is ineligible for permanent licensure if that application process is pursued; or

(4)Deny a temporary license. The board may deny a temporary license for any grounds on which the board may discipline a license or for lack of need for a physician’s services by the organization or individual. The procedure for appealing a license denial is set forth in 653—9.17(147,148).

10.5(6) Application review process for applicants with certain exceptions. This application process shall be used to review applications submitted by an international medical graduate who does not currently hold a license in good standing in any United States jurisdiction or by a physician seeking temporary licensure for an activity not listed in paragraphs “1” through “6” of the definition of “board-approved activity” in rule 653—10.1(147,148). Following is the application review process for applicants with exceptions:

a.An application shall be considered open from the date the application form and the nonrefundable fees are received in the board office.

b.After reviewing each application, staff shall notify the applicant or designee about how to resolve any problems identified by the reviewer.

c.If the final review indicates no questions or concerns regarding the applicant’s qualifications for temporary licensure or the need for a temporary license, staff shall submit the application to the committee for review and recommendation to the board about whether to grant a temporary license to the physician and whether the license should be granted for a specific activity, location(s) or specified duration based on the nature of the board-approved activity.

d.The board shall consider applications and recommendations from the committee and shall:

(1)Grant a temporary license for a specific activity, location(s) or specified duration based on the nature of the board-approved activity;

(2)Grant a temporary license under certain terms and conditions or with certain restrictions;

(3)Request that the applicant withdraw the temporary licensure application. The request shall not imply that the applicant is ineligible for permanent licensure if that application process is pursued; or

(4)Deny a temporary license. The board may deny a temporary license for any grounds on which the board may discipline a license or for lack of need for a physician’s services by the organization or individual. The procedure for appealing a license denial is set forth in 653—9.17(147,148).

10.5(7) Temporary license application cycle. If the applicant does not submit all materials within 90 days of the board’s initial request for further information, the application will be considered inactive. An applicant whose application is inactive must reapply and submit new nonrefundable fees and a new application, documents and credentials if the applicant wishes to pursue temporary licensure.

10.5(8) Renewal of a temporary license.

a.To apply for renewal of a temporary license, the licensee shall submit the following:

(1)A request for renewal;

(2)The renewal fee as specified in 653—paragraph 8.4(4)“b”; and

(3)Written justification for the renewal from the organization or individual seeking the applicant.

b.Failure of the licensee to renew a license by the expiration date will cause the license to become inactive. The individual shall not practice in Iowa until securing a permanent medical license or until becoming eligible for a second temporary license.

653—10.6(147,148,148J) Provisional licensure for foreign medical graduates.

10.6(1) General provisions.

a.The board may grant a provisional license to a foreign medical graduate who meets the qualifications provided in Iowa Code chapter 148J and these rules.

b.A provisional license may be issued for a period of not more than one year and may be renewed annually prior to expiration.

c.A provisional license will specifically limit the licensee to practice at the health care facility that provided the foreign medical graduate with the offer of employment as required by Iowa Code chapter 148J to qualify for this license.

d.The board may cancel a provisional license if the licensee has practiced outside the scope of this license, the licensee’s employment is terminated with the health care facility who offered the licensee employment to qualify for the provisional license, or the licensee ceases to have an eligible immigration status for employment in the United States of America or for any of the grounds for which licensure may be revoked or suspended as specified in Iowa Code sections 147.55, 148.6, and 272C.10 and 653—Chapter 23. When cancellation of such license is proposed, the board will promptly notify the licensee by serving a statement of charges and notice of hearing upon the licensee pursuant to 481—Chapter 506. This contested case proceeding shall be governed by the provisions of 481—Chapter 506.

e.A provisional licensee must notify the board of any change in the licensee’s home address or the address of the place of practice within one month of making an address change.

f.A provisional licensee must 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.

g.A provisional licensee file will be closed and labeled “deceased” when the board receives a copy of the physician’s death certificate.

10.6(2) Provisional license eligibility. To be eligible for a provisional license, an applicant shall meet all of the following requirements:

a.Fulfill the application requirements specified in subrule 10.6(3);

b.Be at least 21 years of age;

c.Present evidence of holding a medical degree from an international medical program in good standing. This can be achieved in the following two ways:

(1)The international medical program the licensee successfully completed is approved by the ECFMG; or

(2)By presenting sufficient evidence to the board that the international medical program the applicant completed is substantially similar to the requirements of the LCME;

d.Be in good standing with and have no pending discipline before the licensing or regulatory institution in the foreign country;

e.Have practice in medicine and surgery or osteopathic medicine and surgery as a licensed physician for five years following the completion of a residency or substantially similar postgraduate medical training. The applicant can demonstrate the postgraduate medical training is substantially similar to a residency in the following two ways:

(1)The residency or postgraduate training is approved by the ACGME, AOA, RCPSC, or CFPC; or

(2)By presenting sufficient evidence to the board that the residency or postgraduate training is substantially similar to the requirements of one of the four agencies listed in subparagraph 10.6(2)“e”(1);

f.Demonstrate proficiency in English by providing a valid ECFMG certificate or verification of a passing score on the TSE or TOEFL examination administered by the Educational Testing Service;

g.Be licensed in a jurisdiction outside the United States or Canada and present evidence that any licenses held in any jurisdiction are unrestricted;

h.The applicant’s license is not denied by the board due to the commission of a disqualifying offense, as provided in 655—subrule 9.3(3); and

i.Have a passing score in all steps of the USMLE.

10.6(3) Provisional license application.

a.Requirements. To apply for a provisional license, an applicant must:

(1)Pay a nonrefundable special license fee and a 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(3)“a”;

(2)Complete and submit forms provided by the board, including required credentials, documents, a completed fingerprint packet, and a sworn statement by the applicant attesting to the truth of all the information provided by the applicant;

(3)Provide a sworn statement from the director or the director’s designee of the medical licensing or regulatory institution in the individual’s resident country that the applicant’s license is in good standing and is not subject to any pending discipline;

(4)Provide a certified record from the national policy agency in the individual’s resident country of a complete criminal history of the applicant;

(5)Provide verification of successful completion of a medical degree;

(6)Provide a valid ECFMG certificate or verification of a passing score on the TSE or TOEFL examination administered by the Educational Testing Service; and

(7)Provide a sworn statement and supporting documents from the health care facility offering employment to the provisional licensee applicant that the facility has had the applicant’s immigration status reviewed by a licensed attorney of this jurisdiction and a determination was made that the applicant has proper immigration status for employment in the United States of America.

b.Application. The application shall request the following information:

(1)Name, date and place of birth, home address, and mailing address;

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

(3)A chronology accounting for all time periods from the date the applicant entered medical school to the date of the application;

(4)A photocopy of the applicant’s medical degree issued by an educational institution and 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. A complete translation of any diploma not written in English shall be submitted;

(5)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, educational institution, training or research program, or health facility in any jurisdiction;

(6)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;

(7)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; and

(8)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.

10.6(4) Provisional license application review process. The process below shall be utilized to review each application for a provisional license.

a.An application is considered open from the date the application form is received in the board office with the nonrefundable provisional licensure fee.

b.After reviewing each application, staff will notify the applicant or the health care facility offering the applicant employment about how to resolve any problems identified by the reviewer. The applicant shall provide additional information when requested by staff or the board.

c.If the final review indicates no questions or concerns regarding the applicant’s qualifications for licensure, staff may administratively grant a provisional license.

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

(1)If there is no current concern, staff will administratively grant a provisional license.

(2)If any concern exists, the application will be referred to the committee.

e.Staff will refer to the committee for review matters that include but are not limited to falsification of information on the application, criminal record, substance abuse, questionable competency, physical or mental illness, or educational disciplinary history.

f.If the committee is able to eliminate questions or concerns without dissension from staff or a committee member, the committee may direct staff to administratively grant a provisional license.

g.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:

(1)Request that the applicant appear for an interview;

(2)Grant a provisional license;

(3)Grant a license under certain terms and conditions or with certain restrictions;

(4)Request that the applicant withdraw the licensure application; or

(5)Deny a license.

h.The board will consider applications and recommendations from the committee and:

(1)Request that the applicant appear for an interview;

(2)Grant a provisional license for practice at the medical college designated in the application;

(3)Grant a license under certain terms and conditions or with certain restrictions;

(4)Request that the applicant withdraw the licensure application; or

(5)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—9.15(147,148).

10.6(5) Provisional license application cycle. If the applicant does not submit all materials within 90 days of the board’s initial request for further information, the application will be considered inactive. An applicant must reapply and submit a new nonrefundable application fee and a new application, new documents and new credentials.

10.6(6) Renewal of a provisional license.

a.If the provisional licensee has not qualified for and received a permanent license, the licensee must renew prior to expiration.

b.A provisional licensee may apply for a one-year renewal by submitting the following:

(1)A completed renewal application;

(2)The renewal fee as specified in 653—paragraph 8.4(3)“b”;

(3)Evidence of continuing education and training on chronic pain management, end-of-life care, and identifying and reporting abuse as specified in 653—Chapter 11; and

(4)A letter from the chief medical officer for the health care facility employing the licensee that addresses the individual’s fitness to the practice of medicine in Iowa, how the anticipated contribution will serve the public interest of Iowans, and the need for renewal of this license.

c.Failure of the licensee to renew a license within one month of the expiration date will cause the license to become inactive. A licensee whose license is inactive is prohibited from practice until a new provisional license is granted according to subrules 10.4(3) and 10.4(4).

10.6(7) Conversion of a provisional license to a full license.

a.After three consecutive years of holding a provisional license in good standing, the provisional licensee may apply to have the licensee’s license converted to a full license to practice medicine and surgery or osteopathic medicine and surgery, provided the license has not been revoked pursuant to Iowa Code section 148J.2. The provisional licensee may alternatively elect to continue to renew the licensee’s provisional license on a yearly basis.

b.The provisional licensee shall make application to the board for conversion of the licensee’s provisional license using the application form provided by the board. The application shall include the following:

(1)A completed application;

(2)The renewal fee as specified in 653—paragraph 8.4(3)“b”;

(3)Evidence of continuing education and training on chronic pain management, end-of-life care, and identifying and reporting abuse as specified in 653—Chapter 11.

(4)A letter, submitted by the chief medical officer for the health care facility employing the licensee, that addresses the individual’s fitness to practice medicine in Iowa, how the anticipated contribution will serve the public interest of Iowans, and the need for renewal of this license.

(5)An updated criminal background check as described in subrule 10.6(3).

(6)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.

(7)A statement disclosing and explaining the applicant’s involvement in civil litigation related to the 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 to have the conviction or plea set aside is pending. Copies of the legal documents may be requested if needed during the review process.

(9)The 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.

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

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