House File 424 - Enrolled
House File 424
AN ACT
PROVIDING FOR THE COLLABORATIVE PRACTICE OF PHYSICIAN
ASSISTANTS BY ALLOWING FOR THE PRACTICE OF CERTAIN PHYSICIAN
ASSISTANTS WITHOUT SUPERVISION BY A PHYSICIAN.
4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1 Section 1. Section 135.24, subsection 7, paragraph d, Code
2 2023, is amended to read as follows:
3 d. “Health care provider” means a physician licensed under
4 chapter 148; a chiropractor licensed under chapter 151; a
5 physical therapist licensed pursuant to chapter 148A; an
6 occupational therapist licensed pursuant to chapter 148B;
7 a podiatrist licensed pursuant to chapter 149; a physician
8 assistant licensed and practicing under a supervising physician
9 pursuant to chapter 148C; a licensed practical nurse, a
10 registered nurse, or an advanced registered nurse practitioner
11 licensed pursuant to chapter 152 or 152E; a respiratory
12 therapist licensed pursuant to chapter 152B; a dentist, dental
13 hygienist, or dental assistant registered or licensed to
14 practice under chapter 153; an optometrist licensed pursuant
15 to chapter 154; a psychologist licensed pursuant to chapter
16 154B; a social worker licensed pursuant to chapter 154C; a
17 mental health counselor, marital and family therapist, behavior
18 analyst, or assistant behavior analyst licensed pursuant to
19 chapter 154D; a speech pathologist or audiologist licensed
20 pursuant to chapter 154F; a pharmacist licensed pursuant to
21 chapter 155A; or an emergency medical care provider certified
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22 pursuant to chapter 147A.
23 Sec. 2. Section 135G.1, subsection 8, Code 2023, is amended
24 to read as follows:
25 8. “Physician assistant” means a person licensed to practice
26 under the supervision of a physician as authorized in chapters
27 147 and chapter 148C.
28 Sec. 3. Section 135P.1, subsection 2, Code 2023, is amended
29 to read as follows:
30 2. “Health care provider” means a physician or osteopathic
31 physician licensed under chapter 148, a physician assistant
32 licensed and practicing under a supervising physician pursuant
33 to chapter 148C, a podiatrist licensed under chapter 149, a
34 chiropractor licensed under chapter 151, a licensed practical
35 nurse, a registered nurse, or an advanced registered nurse
1 practitioner licensed under chapter 152 or 152E, a dentist
2 licensed under chapter 153, an optometrist licensed under
3 chapter 154, a pharmacist licensed under chapter 155A, or
4 any other person who is licensed, certified, or otherwise
5 authorized or permitted by the law of this state to administer
6 health care in the ordinary course of business or in the
7 practice of a profession.
8 Sec. 4. Section 147.14, subsection 1, paragraph l, Code
9 2023, is amended to read as follows:
10 l. For the board of physician assistants, five members
11 licensed to practice as physician assistants, at least two of
12 whom practice in counties with a population of less than fifty
13 thousand, one member licensed to practice medicine and surgery
14 who supervises a physician assistant engaged in independent
15 practice or collaborates with a physician assistant, one
16 member licensed to practice osteopathic medicine and surgery
17 who supervises a physician assistant engaged in independent
18 practice or collaborates with a physician assistant, and two
19 members who are not licensed to practice either medicine and
20 surgery or osteopathic medicine and surgery or licensed as a
21 physician assistant and who shall represent the general public.
22 At least one of the physician or osteopathic physician members
23 shall be in practice in a county with a population of less than
24 fifty thousand.
25 Sec. 5. Section 147.107, subsection 4, Code 2023, is amended
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26 to read as follows:
27 4. A Notwithstanding subsection 1 and any other provision
28 of this section to the contrary, a physician assistant may
29 prescribe, dispense, order, administer, or procure prescription
30 drugs, controlled substances, or medical devices necessary to
31 complete a course of therapy pursuant to section 148C.4. Rules
32 relating to the authority of physician assistants to prescribe
33 drugs, controlled substances, and medical devices pursuant to
34 this subsection shall be adopted by the board of physician
35 assistants after consultation with the board of medicine and
1 board of pharmacy.
2 Sec. 6. Section 147.107, subsections 5 and 6, Code 2023, are
3 amended by striking the subsections.
4 Sec. 7. Section 147.136A, subsection 1, paragraph a, Code
5 2023, is amended to read as follows:
6 a. “Health care provider” means a hospital as defined in
7 section 135B.1, a health care facility as defined in section
8 135C.1, a health facility as defined in section 135P.1, a
9 physician or an osteopathic physician licensed under chapter
10 148, a physician assistant licensed and practicing under a
11 supervising physician under chapter 148C, a podiatrist licensed
12 under chapter 149, a chiropractor licensed under chapter 151, a
13 licensed practical nurse, a registered nurse, or an advanced
14 registered nurse practitioner licensed under chapter 152 or
15 152E, a dentist licensed under chapter 153, an optometrist
16 licensed under chapter 154, a pharmacist licensed under chapter
17 155A, a professional corporation under chapter 496C that is
18 owned by persons licensed to practice a profession listed in
19 this paragraph, or any other person or entity who is licensed,
20 certified, or otherwise authorized or permitted by the law of
21 this state to administer health care in the ordinary course of
22 business or in the practice of a profession.
23 Sec. 8. Section 147A.10, subsection 3, Code 2023, is amended
24 to read as follows:
25 3. An act of commission or omission of any appropriately
26 certified emergency medical care provider, registered nurse,
27 or licensed practical nurse, or physician assistant, while
28 rendering emergency medical care under the responsible
29 supervision and control of a physician to a person who is
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30 deemed by them to be in immediate danger of serious injury or
31 loss of life, shall not impose any liability upon the certified
32 emergency medical care provider, registered nurse, licensed
33 practical nurse, or physician assistant, the supervising
34 physician, physician designee, advanced registered nurse
35 practitioner, or any hospital, or upon the state, or any
1 county, city or other political subdivision, or the employees
2 of any of these entities; provided that this section shall not
3 relieve any person of liability for civil damages for any act
4 of commission or omission which constitutes recklessness.
5 Sec. 9. Section 148C.1, subsection 5, Code 2023, is amended
6 by striking the subsection and inserting in lieu thereof the
7 following:
8 5. “Independent practice” means the practice of a physician
9 assistant that is organized as a professional corporation under
10 chapter 496C or a professional limited liability company under
11 chapter 489.
12 Sec. 10. Section 148C.1, subsection 8, Code 2023, is amended
13 by striking the subsection and inserting in lieu thereof the
14 following:
15 8. “Supervising physician” means a physician who supervises
16 the medical services provided by a physician assistant
17 engaged in independent practice consistent with the physician
18 assistant’s education, training, and experience.
19 Sec. 11. Section 148C.1, subsection 6, Code 2023, is amended
20 to read as follows:
21 6. “Physician” means a person who is currently licensed in
22 Iowa to practice medicine and surgery or osteopathic medicine
23 and surgery. Notwithstanding this subsection, a physician
24 supervising a physician assistant practicing in a federal
25 facility or under federal authority shall not be required to
26 obtain licensure beyond licensure requirements mandated by the
27 federal government for supervising physicians.
28 Sec. 12. Section 148C.3, subsection 2, Code 2023, is amended
29 to read as follows:
30 2. a. Rules Joint rules shall be adopted by the board and
31 the board of medicine pursuant to this chapter requiring a
32 licensed physician assistant to be supervised by physicians a
33 physician during the first two years of independent practice if
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34 the physician assistant has not previously practiced under a
35 supervising physician or in collaboration with the appropriate
1 physician or other health care professional for a period of at
2 least two years. The rules shall provide that not more than
3 five physician assistants shall be supervised by a physician at
4 one time determine the terms of collaboration for a physician
5 assistant engaged in independent practice after the conclusion
6 of two years of practice under a supervising physician. The
7 rules shall also provide that a physician assistant shall
8 notify the board of the identity of the physician assistant’s
9 supervising physician and of any change in the status of the
10 supervisory relationship.
11 b. For purposes of this chapter, “supervision” does not
12 require the personal presence of the physician at the place
13 where medical services are rendered except insofar as the
14 personal presence is expressly required by this chapter or by
15 rules of the board adopted pursuant to chapter 17A.
16 Sec. 13. Section 148C.4, subsections 2 and 3, Code 2023, are
17 amended to read as follows:
18 2. a. Notwithstanding subsection 1, a physician assistant
19 licensed pursuant to this chapter or authorized to practice
20 in any other state or federal jurisdiction who voluntarily
21 and gratuitously, and other than in the ordinary course of
22 the physician assistant’s employment or practice, responds to
23 a need for medical care created by an emergency or a state
24 or local disaster may render such care that the physician
25 assistant is able to provide without supervision as described
26 in this section or with such supervision as is available.
27 b. A physician who supervises a physician assistant
28 providing medical care pursuant to this subsection shall not
29 be required to meet the requirements of rules adopted pursuant
30 to section 148C.3, subsection 2, relating to supervision
31 by physicians. A physician providing physician assistant
32 supervision pursuant to this subsection or a physician
33 assistant, who voluntarily and gratuitously, and other than in
34 the ordinary course of the physician assistant’s employment or
35 practice, responds to a need for medical care created by an
1 emergency or a state or local disaster shall not be subject
2 to criminal liability by reason of having issued or executed
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3 the orders for provided such care, and shall not be liable for
4 civil damages for acts or omissions relating to the issuance or
5 execution of the orders such care unless the acts or omissions
6 constitute recklessness.
7 3. The degree of collaboration between a physician
8 assistant and the appropriate member of a health care team
9 shall be determined at the practice level, and may involve
10 decisions made by the medical group, hospital service,
11 supervising physician, or employer of the physician assistant,
12 or the credentialing and privileging system of a licensed
13 health care facility. A physician shall be accessible at all
14 times for consultation with a physician assistant unless the
15 physician assistant is providing emergency medical services
16 pursuant to 645 IAC 327.1(1)(n). The supervising physician
17 shall have ultimate responsibility for determining the medical
18 care provided by the supervising physician-physician assistant
19 team A physician assistant shall be responsible for the
20 services performed by the physician assistant that are not
21 performed under the supervision of a physician.
22 Sec. 14. Section 148C.5, subsection 1, Code 2023, is amended
23 to read as follows:
24 1. If the board commences a contested case hearing against
25 a physician assistant by delivering a statement of charges
26 and notice of hearing to the physician assistant, the board
27 shall deliver a copy of the statement of charges and notice of
28 hearing to the physician assistant’s supervising physician, if
29 applicable.
30 Sec. 15. Section 148C.5, subsection 3, Code 2023, is amended
31 by striking the subsection.
32 Sec. 16. Section 148C.9, Code 2023, is amended to read as
33 follows:
34 148C.9 Eye examination restricted.
35 A physician assistant shall not be permitted to prescribe
1 lenses, prisms, or contact lenses for the aid, relief, or
2 correction of human vision. A physician assistant engaged
3 in independent practice shall not be permitted to measure
4 the visual power and visual efficiency of the human eye, as
5 distinguished from routine visual screening, except in the
6 personal presence of a supervising physician at the place where
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7 such services are rendered.
8 Sec. 17. Section 148F.7, Code 2023, is amended to read as
9 follows:
10 148F.7 Limitation on provision of care and services.
11 A licensed orthotist, prosthetist, or pedorthist may provide
12 care or services only if the care or services are provided
13 pursuant to an order from a licensed physician, a licensed
14 podiatric physician, an advanced registered nurse practitioner
15 licensed pursuant to chapter 152 or 152E, or a physician
16 assistant who has been delegated the authority to order the
17 services of an orthotist, prosthetist, or pedorthist by the
18 assistant’s supervising physician licensed under chapter 148C.
19 Sec. 18. Section 154F.2, subsection 1, paragraph a, Code
20 2023, is amended to read as follows:
21 a. Licensed physicians and surgeons, licensed osteopathic
22 physicians and surgeons, and licensed physician assistants,
23 and registered nurses acting under the supervision of a
24 physician or osteopathic physician, persons conducting hearing
25 tests under the direct supervision of a licensed physician
26 and surgeon or licensed osteopathic physician and surgeon,
27 or students of medicine or surgery or osteopathic medicine
28 and surgery pursuing a course of study in a medical school or
29 college of osteopathic medicine and surgery approved by the
30 board of medicine while performing functions incidental to
31 their course of study.
32 Sec. 19. Section 225C.6, subsection 4, paragraph c,
33 subparagraph (1), Code 2023, is amended to read as follows:
34 (1) A comprehensive set of wraparound services for persons
35 who have had or are at imminent risk of having acute or
1 crisis mental health symptoms that do not permit the persons
2 to remain in or threatens removal of the persons from their
3 home and community, but who have been determined by a mental
4 health professional and a licensed health care professional,
5 subject to the professional’s scope of practice, not to need
6 inpatient acute hospital services. For the purposes of this
7 subparagraph, “mental health professional” means the same as
8 defined in section 228.1 and “licensed health care professional”
9 means a person licensed under chapter 148 to practice medicine
10 and surgery or osteopathic medicine and surgery, an advanced
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11 registered nurse practitioner licensed under chapter 152 or
12 152E, or a physician assistant licensed to practice under the
13 supervision of a physician as authorized in chapters 147 and
14 chapter 148C.
15 Sec. 20. Section 228.1, subsection 7, paragraph b, Code
16 2023, is amended to read as follows:
17 b. The individual holds a current Iowa license if
18 practicing in a field covered by an Iowa licensure law and
19 is a psychiatrist, an advanced registered nurse practitioner
20 who holds a national certification in psychiatric mental
21 health care and is licensed by the board of nursing, a
22 physician assistant practicing under the supervision of or in
23 collaboration with a psychiatrist, a qualified mental health
24 professional physician assistant, a psychiatric advanced
25 registered nurse practitioner as defined in section 125.2, or
26 an individual who holds a doctorate degree in psychology and is
27 licensed by the board of psychology. For the purposes of this
28 paragraph, “collaboration” means the same as defined in section
29 148C.1.
30 Sec. 21. Section 280.16, subsection 1, paragraph d, Code
31 2023, is amended to read as follows:
32 d. “Licensed health care professional” means a person
33 licensed under chapter 148 to practice medicine and surgery or
34 osteopathic medicine and surgery, an advanced registered nurse
35 practitioner licensed under chapter 152 or 152E and registered
1 with the board of nursing, or a physician assistant licensed to
2 practice under the supervision of a physician as authorized in
3 chapters 147 and chapter 148C.
4 Sec. 22. Section 489.1102, subsection 2, paragraph b, Code
5 2023, is amended to read as follows:
6