Bill Text: IA HSB702 | 2019-2020 | 88th General Assembly | Introduced
Bill Title: A bill for an act relating to the practice and licensure of physician assistants.
Spectrum: Committee Bill
Status: (N/A - Dead) 2020-02-20 - Committee report, recommending amendment and passage. H.J. 320. [HSB702 Detail]
Download: Iowa-2019-HSB702-Introduced.html
House
Study
Bill
702
-
Introduced
HOUSE
FILE
_____
BY
(PROPOSED
COMMITTEE
ON
HUMAN
RESOURCES
BILL
BY
CHAIRPERSON
LUNDGREN)
A
BILL
FOR
An
Act
relating
to
the
practice
and
licensure
of
physician
1
assistants.
2
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
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Section
1.
Section
147.107,
subsections
3,
4,
and
5,
Code
1
2020,
are
amended
to
read
as
follows:
2
3.
A
physician
assistant
or
registered
nurse
may
supply,
3
when
pharmacist
services
are
not
reasonably
available
or
when
4
it
is
in
the
best
interests
of
the
patient,
on
the
direct
5
order
of
the
supervising
physician,
a
quantity
of
properly
6
packaged
and
labeled
prescription
drugs,
controlled
substances,
7
or
contraceptive
devices
necessary
to
complete
a
course
of
8
therapy.
However,
a
remote
clinic,
staffed
by
a
physician
9
assistant
or
registered
nurse,
where
pharmacy
services
are
10
not
reasonably
available,
shall
secure
the
regular
advice
11
and
consultation
of
a
pharmacist
regarding
the
distribution,
12
storage,
and
appropriate
use
of
such
drugs,
substances,
and
13
devices.
14
4.
Notwithstanding
subsection
3
,
a
A
physician
assistant
15
shall
not
may
prescribe,
dispense
,
order,
administer,
or
16
procure
prescription
drugs
as
an
incident
to
the
practice
17
of
the
supervising
physician
or
the
physician
assistant,
18
but
may
supply,
when
pharmacist
services
are
not
reasonably
19
available,
or
when
it
is
in
the
best
interests
of
the
patient,
20
a
quantity
of
properly
packaged
and
labeled
prescription
drugs,
21
controlled
substances,
or
medical
devices
necessary
to
complete
22
a
course
of
therapy.
However,
a
remote
clinic,
staffed
by
a
23
physician
assistant,
where
pharmacy
services
are
not
reasonably
24
available,
shall
secure
the
regular
advice
and
consultation
25
of
a
pharmacist
regarding
the
distribution,
storage,
and
26
appropriate
use
of
such
drugs,
substances,
and
devices.
27
Prescription
drugs
supplied
under
the
provisions
of
this
28
subsection
shall
be
supplied
for
the
purpose
of
accommodating
29
the
patient
and
shall
not
be
sold
for
more
than
the
cost
of
the
30
drug
and
reasonable
overhead
costs,
as
they
relate
to
supplying
31
prescription
drugs
to
the
patient,
and
not
at
a
profit
to
the
32
physician
or
the
physician
assistant.
If
prescription
drug
33
supplying
authority
is
delegated
by
a
supervising
physician
to
34
a
physician
assistant,
a
nurse
or
staff
assistant
may
assist
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the
physician
assistant
in
providing
that
service.
Rules
1
shall
be
adopted
by
the
board
of
physician
assistants,
after
2
consultation
with
the
board
of
pharmacy,
to
implement
this
3
subsection
pursuant
to
section
148C.4
.
4
5.
Notwithstanding
subsection
1
and
any
other
provision
5
of
this
section
to
the
contrary,
a
physician
may
delegate
6
the
function
of
prescribing
drugs,
controlled
substances,
7
and
medical
devices
for
which
the
supervising
physician
has
8
sufficient
training
or
experience
to
a
physician
assistant
9
licensed
pursuant
to
chapter
148C
after
the
supervising
10
physician
determines
the
physician
assistant’s
proficiency
11
and
competence
.
When
delegated
prescribing
occurs,
the
12
supervising
physician’s
name
shall
be
used,
recorded,
or
13
otherwise
indicated
in
connection
with
each
individual
14
prescription
so
that
the
individual
who
dispenses
or
15
administers
the
prescription
knows
under
whose
delegated
16
authority
the
physician
assistant
is
prescribing.
Rules
17
relating
to
the
authority
of
physician
assistants
to
prescribe
18
drugs,
controlled
substances,
and
medical
devices
pursuant
to
19
this
subsection
shall
be
adopted
by
the
board
of
physician
20
assistants,
after
consultation
with
the
board
of
medicine
and
21
the
board
of
pharmacy.
However,
the
rules
shall
prohibit
the
22
prescribing
of
schedule
II
controlled
substances
which
are
23
listed
as
depressants
pursuant
to
chapter
124
.
24
Sec.
2.
Section
147.136,
subsection
1,
Code
2020,
is
amended
25
to
read
as
follows:
26
1.
Except
as
otherwise
provided
in
subsection
2
,
in
an
27
action
for
damages
for
personal
injury
against
a
physician
and
28
surgeon,
osteopathic
physician
and
surgeon,
dentist,
podiatric
29
physician,
optometrist,
pharmacist,
chiropractor,
physician
30
assistant,
or
nurse
licensed
to
practice
that
profession
in
31
this
state,
or
against
a
hospital
licensed
for
operation
in
32
this
state,
based
on
the
alleged
negligence
of
the
practitioner
33
in
the
practice
of
the
profession
or
occupation,
or
upon
the
34
alleged
negligence
of
the
hospital
in
patient
care,
in
which
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liability
is
admitted
or
established,
the
damages
awarded
shall
1
not
include
actual
economic
losses
incurred
or
to
be
incurred
2
in
the
future
by
the
claimant
by
reason
of
the
personal
3
injury,
including
but
not
limited
to
the
cost
of
reasonable
and
4
necessary
medical
care,
rehabilitation
services,
and
custodial
5
care,
and
the
loss
of
services
and
loss
of
earned
income,
to
6
the
extent
that
those
losses
are
replaced
or
are
indemnified
by
7
insurance,
or
by
governmental,
employment,
or
service
benefit
8
programs
or
from
any
other
source.
9
Sec.
3.
Section
147.138,
Code
2020,
is
amended
to
read
as
10
follows:
11
147.138
Contingent
fee
of
attorney
reviewed
by
court.
12
In
any
action
for
personal
injury
or
wrongful
death
against
13
any
physician
and
surgeon,
osteopathic
physician
and
surgeon,
14
dentist,
podiatric
physician,
optometrist,
pharmacist,
15
chiropractor
,
physician
assistant,
or
nurse
licensed
under
16
this
chapter
or
against
any
hospital
licensed
under
chapter
17
135B
,
based
upon
the
alleged
negligence
of
the
licensee
in
the
18
practice
of
that
profession
or
occupation,
or
upon
the
alleged
19
negligence
of
the
hospital
in
patient
care,
the
court
shall
20
determine
the
reasonableness
of
any
contingent
fee
arrangement
21
between
the
plaintiff
and
the
plaintiff’s
attorney.
22
Sec.
4.
Section
148C.1,
Code
2020,
is
amended
to
read
as
23
follows:
24
148C.1
Definitions.
25
1.
“Approved
program”
means
a
program
for
the
education
26
of
physician
assistants
which
has
been
accredited
by
the
27
American
medical
association’s
committee
on
allied
health
28
education
and
accreditation
or
its
successor,
by
the
commission
29
on
accreditation
of
allied
health
educational
programs
or
30
its
successor,
or
by
the
accreditation
review
commission
on
31
education
for
the
physician
assistant
or
its
successor
,
or,
if
32
accredited
prior
to
2001,
either
by
the
committee
on
allied
33
health
education
and
accreditation,
or
the
commission
on
34
accreditation
of
allied
health
education
programs
.
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2.
“Board”
means
the
board
of
physician
assistants
created
1
under
chapter
147
.
2
3.
“Collaboration”
means
consultation
with
or
referral
to
3
the
appropriate
physician
or
other
health
care
professional
by
4
a
physician
assistant
as
indicated
by
the
patient’s
condition;
5
the
education,
competencies,
and
experience
of
the
physician
6
assistant;
and
the
standard
of
care.
7
3.
4.
“Department”
means
the
Iowa
department
of
public
8
health.
9
4.
5.
“Licensed
physician
assistant”
or
“licensed
P.A.”
10
means
a
person
who
is
licensed
by
the
board
to
practice
as
11
a
physician
assistant
under
the
supervision
of
one
or
more
12
physicians.
“Supervision”
does
not
require
the
personal
13
presence
of
the
supervising
physician
at
the
place
where
14
medical
services
are
rendered
except
insofar
as
the
personal
15
presence
is
expressly
required
by
this
chapter
or
required
by
16
rules
of
the
board
adopted
pursuant
to
this
chapter
.
17
5.
6.
“Physician”
means
a
person
who
is
currently
licensed
18
in
Iowa
to
practice
medicine
and
surgery
or
osteopathic
19
medicine
and
surgery.
Notwithstanding
this
subsection
,
a
20
physician
supervising
a
physician
assistant
practicing
in
21
a
federal
facility
or
under
federal
authority
shall
not
be
22
required
to
obtain
licensure
beyond
licensure
requirements
23
mandated
by
the
federal
government
for
supervising
physicians.
24
6.
7.
“Physician
assistant”
or
“P.A.”
means
a
person
health
25
care
professional
who
has
successfully
completed
an
approved
26
program
and
passed
an
examination
approved
by
the
board
or
27
is
otherwise
found
by
the
board
to
be
qualified
to
perform
28
medical
services
under
the
supervision
of
a
physician
meets
the
29
qualifications
under
this
chapter
and
is
licensed
to
practice
30
medicine
by
the
board
.
31
7.
“Trainee”
means
a
person
who
is
currently
enrolled
in
an
32
approved
program.
33
8.
“Supervising
physician”
means
a
physician
who
supervises
34
the
medical
services
provided
by
a
physician
assistant
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consistent
with
the
physician
assistant’s
education,
training,
1
or
experience
and
who
accepts
ultimate
responsibility
for
the
2
medical
care
provided
by
the
supervising
physician-physician
3
assistant
team.
4
Sec.
5.
Section
148C.3,
subsections
1
and
3,
Code
2020,
are
5
amended
to
read
as
follows:
6
1.
The
board
shall
adopt
rules
to
govern
the
licensure
of
7
physician
assistants.
An
applicant
for
licensure
shall
submit
8
the
fee
prescribed
by
the
board
and
shall
meet
the
requirements
9
established
by
the
board
with
respect
to
each
of
the
following:
10
a.
Academic
qualifications,
including
evidence
of
graduation
11
from
an
approved
program.
A
physician
assistant
who
is
not
a
12
graduate
of
an
approved
program,
but
who
passed
the
national
13
commission
on
certification
of
physician
assistants’
physician
14
assistant
national
certifying
examination
prior
to
1986,
is
15
exempt
from
this
graduation
requirement.
16
b.
Evidence
of
passing
the
national
commission
on
the
17
certification
of
physician
assistants’
physician
assistant
18
national
certifying
examination
or
an
equivalent
examination
19
approved
by
the
board.
20
c.
Hours
of
continuing
medical
education
necessary
to
become
21
or
remain
licensed.
22
3.
A
licensed
physician
assistant
shall
perform
only
23
those
services
for
which
the
licensed
physician
assistant
is
24
qualified
by
training
or
education
and
which
are
not
prohibited
25
by
the
board.
26
Sec.
6.
Section
148C.4,
subsection
1,
Code
2020,
is
amended
27
to
read
as
follows:
28
1.
A
physician
assistant
may
perform
medical
services
29
when
the
services
are
rendered
under
the
supervision
of
a
30
physician.
A
physician
assistant
student
may
perform
medical
31
services
when
the
services
are
rendered
within
the
scope
of
an
32
approved
program
provide
any
legal
medical
service
for
which
33
the
physician
assistant
has
been
prepared
by
the
physician
34
assistant’s
education,
training,
or
experience
and
is
competent
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to
perform
.
For
the
purposes
of
this
section
,
“medical
1
services
when
the
services
are
rendered
under
the
supervision
2
of
a
physician”
“legal
medical
service
for
which
the
physician
3
assistant
has
been
prepared
by
the
physician
assistant’s
4
education,
training,
or
experience
and
is
competent
to
perform”
5
includes
making
a
pronouncement
of
death
for
a
patient
6
whose
death
is
anticipated
if
the
death
occurs
in
a
licensed
7
hospital,
a
licensed
health
care
facility,
a
correctional
8
institution
listed
in
section
904.102
,
a
Medicare-certified
9
home
health
agency,
or
a
Medicare-certified
hospice
program
10
or
facility
,
with
notice
of
the
death
to
a
physician
and
in
11
accordance
with
the
directions
of
a
physician
.
12
Sec.
7.
Section
148C.4,
Code
2020,
is
amended
by
adding
the
13
following
new
subsection:
14
NEW
SUBSECTION
.
3.
The
degree
of
collaboration
between
15
a
physician
assistant
and
the
appropriate
member
of
a
health
16
care
team
shall
be
determined
at
the
practice
level,
and
may
17
involve
decisions
made
by
the
medical
group,
hospital
service,
18
supervising
physician,
or
employer
of
the
physician
assistant,
19
or
the
credentialing
and
privileging
system
of
a
licensed
20
health
care
facility.
A
physician
shall
be
accessible
at
all
21
times
for
consultation
with
a
physician
assistant
unless
the
22
physician
assistant
is
providing
emergency
medical
services
23
pursuant
to
645
IAC
327.1(1)(n).
The
supervising
physician
24
shall
have
ultimate
responsibility
for
determining
the
medical
25
care
provided
by
the
supervising
physician-physician
assistant
26
team.
27
Sec.
8.
Section
249A.4,
subsection
7,
paragraph
b,
Code
28
2020,
is
amended
to
read
as
follows:
29
b.
Advanced
registered
nurse
practitioners
licensed
pursuant
30
to
chapter
152
and
physician
assistants
licensed
pursuant
to
31
chapter
148C
shall
be
regarded
as
approved
providers
of
health
32
care
services,
including
primary
care,
for
purposes
of
managed
33
care
or
prepaid
services
contracts
under
the
medical
assistance
34
program.
This
paragraph
shall
not
be
construed
to
expand
the
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scope
of
practice
of
an
advanced
registered
nurse
practitioner
1
pursuant
to
chapter
152
or
physician
assistants
pursuant
to
2
chapter
148C
.
3
EXPLANATION
4
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
5
the
explanation’s
substance
by
the
members
of
the
general
assembly.
6
This
bill
relates
to
the
practice
and
licensure
of
physician
7
assistants.
8
With
regard
to
drug
dispensing,
supplying,
and
prescribing,
9
the
bill
provides
that
a
physician
assistant
may
prescribe,
10
dispense,
order,
administer,
or
procure
prescription
drugs
11
in
accordance
with
Code
section
148C.4
which
provides
that
12
the
physician
assistant
may
provide
any
legal
medical
service
13
for
which
the
physician
assistant
has
been
prepared
by
14
education,
training,
or
experience
and
is
competent
to
perform.
15
Additionally,
the
bill
provides
that
a
physician
may
delegate
16
the
function
of
prescribing
drugs,
controlled
substances,
17
and
medical
devices
for
which
the
supervising
physician
18
has
sufficient
training
or
experience
after
the
supervising
19
physician
determines
the
physician
assistant’s
proficiency
20
and
competence.
Rules
relating
to
the
authority
of
physician
21
assistants
to
prescribe
drugs,
controlled
substances,
and
22
medical
devices
shall
be
adopted
by
the
board
of
physician
23
assistants,
after
consultation
with
the
board
of
medicine
and
24
the
board
of
pharmacy.
25
The
bill
includes
physician
assistants
in
the
listing
of
26
health
care
providers
in
provisions
relating
to
the
scope
27
of
recovery
in
an
action
for
damages
for
personal
injury,
28
limitations
on
noneconomic
damage
awards
against
health
care
29
providers,
and
contingent
fees
for
attorneys
in
any
action
30
for
personal
injury
or
wrongful
death
against
a
health
care
31
provider
apply.
32
The
bill
includes
definitions
for
the
purposes
of
Code
33
chapter
148C
(physician
assistants).
The
bill
amends
the
34
definition
of
“approved
program”
for
the
education
of
physician
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H.F.
_____
assistants;
includes
a
definition
of
“collaboration”
and
1
“supervising
physician”,
and
defines
“physician
assistant”
2
or
“P.A.”
as
a
health
care
professional
who
meets
the
3
qualifications
under
Code
chapter
148C
and
is
licensed
to
4
practice
medicine
by
the
board
of
physician
assistants.
5
The
bill
amends
the
reference
to
a
physician
assistant
6
examination
that
may
be
completed
in
lieu
of
graduation
from
7
an
approved
program,
and
provides
that
a
licensed
physician
8
assistant
shall
perform
only
those
services
for
which
the
9
licensed
physician
assistant
is
qualified
by
training
or
10
education
and
which
are
not
prohibited
by
the
board.
11
The
bill
provides
with
regard
to
the
services
that
may
12
be
performed
by
a
physician
assistant,
that
a
physician
13
assistant
may
provide
any
legal
medical
service
for
which
14
the
physician
assistant
has
been
prepared
by
the
physician
15
assistant’s
education,
training,
or
experience
and
is
competent
16
to
perform.
The
degree
of
collaboration
between
a
physician
17
assistant
and
the
appropriate
member
of
a
health
care
team
18
shall
be
determined
at
the
practice
level,
and
may
involve
19
decisions
made
by
the
medical
group,
hospital
service,
20
supervising
physician,
or
employer
of
the
physician
assistant,
21
or
the
credentialing
and
privileging
system
of
a
licensed
22
health
care
facility.
A
physician
shall
be
accessible
at
23
all
times
for
consultation
with
a
physician
assistant
unless
24
the
physician
assistant
is
providing
immediate
evaluation,
25
treatment,
and
institution
of
procedures
essential
to
providing
26
an
appropriate
response
to
emergency
medical
problems.
The
27
supervising
physician
shall
have
ultimate
responsibility
for
28
determining
the
medical
care
provided
by
the
supervising
29
physician-physician
assistant
team.
30
The
bill
also
includes
physician
assistants
as
approved
31
providers
of
health
care
services,
including
primary
care
for
32
purposes
of
managed
care
or
prepaid
services
contracts
under
33
the
Medicaid
program
and
provides
that
the
provision
shall
not
34
be
construed
to
expand
the
scope
of
practice
of
a
physician
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