Notice of Intended Action
Registered nurse certifying organizations/utilization and cost control review, ch 12
ARC 8794C
NURSING BOARD[655]
Notice of Intended Action
Proposing rulemaking related to certifying organizations and review committees
and providing an opportunity for public comment
The Board of Nursing hereby proposes to rescind Chapter 12, “Registered Nurse Certifying Organizations/Utilization and Cost Control Review,” Iowa Administrative Code, and to adopt a new chapter with the same title.
Legal Authority for Rulemaking
This rulemaking is proposed under the authority provided in Iowa Code chapters 509, 514, 514B and 514F and Executive Order 10.
State or Federal Law Implemented
This rulemaking implements, in whole or in part, Iowa Code sections 509.3(1)“g,” 514.7(4), 514B.1(5)“d” and 514F.1.
Purpose and Summary
Iowa Code sections 509.3(1)“g,” 514.7(4), and 514B.1(5)“d” all reference payment of covered services determined to be medically necessary that is, as specified in Iowa Code section 509.3(1)“g,” “provided by registered nurses certified by a national certifying organization, which organization shall be identified by the Iowa board of nursing pursuant to rules adopted by the board, if the services are within the practice of the profession of a registered nurse as that practice is defined in section 152.1.” Iowa Code section 514F.1 provides that the Board “shall establish utilization and cost control review committees of licensees under the respective chapters, selected from licensees who have practiced in Iowa for at least the previous five years, or shall accredit and designate other utilization and cost control organizations as utilization and cost control committees under this section, for the purposes of utilization review of the appropriateness of levels of treatment and of giving opinions as to the reasonableness of charges for diagnostic or treatment services of licensees,” and “shall adopt rules necessary and proper for the administration of this section pursuant to chapter 17A.” Iowa Code section 514F.1 further describes that “conduct of the utilization and cost control review committees authorized under this section shall be exempt from challenge under federal or state antitrust laws or other similar laws in regulation of trade or commerce.” The overall intended benefits of this chapter are to identify pertinent national certifying organizations in accordance with the requirements set forth herein, provide for the establishment of a utilization and cost control review (U.C.C.R.) committee, and describe the procedures by which such a U.C.C.R. committee would operate.
Regulatory Analysis
A Regulatory Analysis for this rulemaking was published in the Iowa Administrative Bulletin on October 30, 2024. A public hearing was held on the following date(s):
●November 19, 2024
The Department of Inspections, Appeals, and Licensing received no public comments for this chapter.
Fiscal Impact
This rulemaking has no fiscal impact to the State of Iowa.
Jobs Impact
After analysis and review of this rulemaking, no impact on jobs has been found.
Waivers
Any person who believes that the application of the discretionary provisions of this rulemaking would result in hardship or injustice to that person may petition the Board for a waiver of the discretionary provisions, if any, pursuant to 481—Chapter 6.
Public Comment
Any interested person may submit written or oral comments concerning this proposed rulemaking, which must be received by the Department no later than 4:30 p.m. on February 11, 2025. Comments should be directed to:
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Emily DeRonde |
Public Hearing
Public hearings at which persons may present their views orally or in writing will be held as follows:
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February 11, 2025 |
6200 Park Avenue |
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February 12, 2025 |
6200 Park Avenue |
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 hearing and have special requirements, such as those related to hearing or mobility impairments, should contact the Department and advise of specific needs.
Review by Administrative Rules Review Committee
The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rulemaking by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rulemaking at its regular monthly meeting or at a special meeting. The Committee’s meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).
The following rulemaking action is proposed:
ITEM 1.Rescind 655—Chapter 12 and adopt the following new chapter in lieu thereof:
CHAPTER 12
REGISTERED NURSE CERTIFYING ORGANIZATIONS/
UTILIZATION AND COST CONTROL REVIEW
655—12.1(509,514,514B,514F) Purpose. This chapter is promulgated for the purpose of administering the provisions of Iowa Code sections 509.3, 514.7, 514B.1 and 514F.1.
655—12.2Reserved.
655—12.3(509,514,514B) National certifying organizations. Eligibility requirements for certification are established by the individual national certifying organization. National certifying organizations identified by the board pursuant to Iowa Code sections 509.3, 514.7, 514B.1, and 514F.1 are as follows:
Addictions Nursing Certification Board
American Academy of Nurse Practitioners
American Association of Critical Care Nurses Certification Corporation
American Association for Marriage and Family Therapy
American Board of Medical Genetics
American Board of Neuroscience Nursing
American Board for Occupational Health Nurses, Inc.
American Board of Post Anesthesia Nursing Certification, Inc.
American Board of Urology
American Urological Association
American College of Nurse-Midwives
American Holistic Nurses’ Credentialing Corporation
American Nurses’ Credentialing Center
American Society of Plastic Surgical Nurses
Association of Perioperative Registered Nurses
Association for Professionals in Infection Control and Epidemiology
Association of Rehabilitation Nurses, Certification Board
Board of Certification for Emergency Nursing
Board of Nephrology Examiners Nursing and Technology
Certifying Council for Gastroenterology Clinicians, Inc.
Clinical Nutrition Certification Board
National Board of Certification and Recertification for Nurse Anesthetists
Dermatology Nurses Association
Enterostomal Therapy Nursing Certification Board
Association of Nurses in AIDS Care, HIV/AIDS Nursing Certification Board
International Association of Infant Massage
International Board of Lactation Consultant Examiners
International Nurses Society on Addictions
Infusion Nurses Certification Corporation
Lamaze International
National Board for Certification of School Nurses
Certification Board for Diabetes Care and Education
Pediatric Nurse Certification Board
National Certification Corporation for the Obstetric, Gynecologic and Neonatal Nursing Specialties
National Certifying Board for Ophthalmic Registered Nurses
National Association of Chemical Dependency Nurses
Oncology Nursing Certification Corporation
Orthopaedic Nurses Certification Board
Plastic Surgical Nursing Certification Board
Radiologic Nursing Certification Board
Society of Gastroenterology Nurses and Associates
Society of Otorhinolaryngology and Head-Neck Nurses
Society of Urological Nurses and Associates
Society for Vascular Nursing
Wound, Ostomy and Continence Nursing Certification Board
655—12.4(514F) Utilization and cost control review (U.C.C.R.) committee. The board may establish a U.C.C.R. committee for the purpose set forth in Iowa Code section 514F.1, including questions regarding:
1.Appropriateness of levels of nursing care.
2.Documentation of the credentials of the nurse(s) offering the service(s).
3.Documentation of the care provided.
4.Documentation of the costs of nursing services provided by credentialed nurses as requested by users and payers of such services.
655—12.5(514F) Selection and composition of the U.C.C.R. committee.
12.5(1) A U.C.C.R. committee will consist of five licensed registered nurses, three of whom shall be certified by the above. A quorum of the U.C.C.R. committee is three members. When a quorum is present, a position is carried by a majority of the committee members.
12.5(2) The chairperson of the board of nursing, upon receipt of a request for review, will appoint committee members and designate a chairperson and a secretary.
12.5(3) Members of the U.C.C.R. committee will:
a.Have been actively practicing nursing in Iowa for a period of five years immediately prior to their appointment.
b.Hold an active Iowa registered nurse license or hold a current license in another state and be recognized for licensure in Iowa pursuant to the nurse licensure compact contained in Iowa Code chapter 152E.
c.Be actively involved in nursing practice during the term of appointment.
d.Not be exempt from mandatory disclosure requirements of Iowa Code section 272C.9.
e.Not be civilly liable when functioning in their capacity of committee members in compliance with Iowa Code section 272C.8.
f.Observe the requirements of confidentiality imposed by Iowa Code section 272C.6(4).
655—12.6(514F) Scope of review.
12.6(1) Factors to determine appropriateness of nursing care deemed medically necessary may include but are not limited to:
a.Utilization of the nursing process in establishing a nursing diagnosis.
b.Development of a nursing care plan based on documentation of client needs and standards of care for that particular clinical specialty.
c.Adequate completion of recommended nursing care plan.
d.Quality of care as measured by outcome.
e.Proper referral to specialists or physicians when conditions indicate.
12.6(2) Cost review will result in an opinion as to the fairness of charges for nursing care services based on criteria including but not be limited to:
a.The nurse’s usual charge for the service.
b.The customary charge for the service based on a review of peer group charges.
c.Reasonable variance due to degree of difficulty, skill, or judgment.
655—12.7(514F) Procedures for utilization and cost control review.
12.7(1) A request for review may be made to the board by a patient, licensee, or third-party payer of health care benefits.
12.7(2) The fee for a utilization and cost control review is $50 per individual patient review, made payable to the department of inspections, appeals, and licensing.
12.7(3) A request for review may be submitted to the board by addressing the request to the board of nursing as provided in 481—Chapter 1 and on the website of the department of inspections, appeals, and licensing: dial.iowa.gov. Requests may be made on forms provided by the department. All references to identification and location of the licensee shall be deleted prior to submission.
12.7(4) The U.C.C.R. committee will present its findings and recommendations in writing to the chairperson of the board within 90 days of the committee appointment, with the parties notified of the findings thereafter.
12.7(5) If during its review the U.C.C.R. committee identifies a possible violation of Iowa Code chapter 152 or rules promulgated thereunder, the board may take further action, as appropriate.
12.7(6) Action of the U.C.C.R. committee does not constitute an action of the board.
These rules are intended to implement Iowa Code sections 509.3, 514.7, 514B.1, and 514F.1.
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Closed For Comments
This notice is now closed for comments. Collection of comments closed on 2/11/2025.
Official Document
- Registered nurse certifying organizations/utilization and cost control review, ch 12
- Published on 1/22/2025
- 54 Views , 0 Comments
- Notice of Intended Action
The official published PDF of this document is available from the Iowa General Assembly’s Administrative Rules page.
View the Iowa Administrative Bulletin for 1/22/2025.
Administrative Rule References
The following administrative rule references were added to this document. You may click a reference to view related notices.
Rule 655-12.1 Rule 655-12.2 Rule 655-12.3 Rule 655-12.4 Rule 655-12.5 Rule 655-12.6 Rule 655-12.7Iowa Code References
The following Iowa code references were added to this document. You may click a reference to view related notices.
Iowa Code 152 Iowa Code 152E Iowa Code 272C.6(4) Iowa Code 272C.8 Iowa Code 272C.9 Iowa Code 509.3 Iowa Code 514.7 Iowa Code 514B.1 Iowa Code 514F.1Keywords
The following keywords and tags were added to this document. You may click a keyword to view related notices.
National certifying organizations Procedures for utilization and cost control review Purpose Scope of review Selection and composition of the UCCR committee Utilization and cost control review (UCCR) committeeAbout
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