Bill Text: IA SF2357 | 2019-2020 | 88th General Assembly | Enrolled
Bill Title: A bill for an act relating to the practice and licensure of physician assistants, and including effective date provisions. (Formerly SSB 3071.) Effective date: 03/18/2020.
Spectrum: Committee Bill
Status: (Passed) 2020-03-18 - Signed by Governor. S.J. 658. [SF2357 Detail]
Download: Iowa-2019-SF2357-Enrolled.html
Senate
File
2357
-
Enrolled
Senate
File
2357
AN
ACT
RELATING
TO
THE
PRACTICE
AND
LICENSURE
OF
PHYSICIAN
ASSISTANTS,
AND
INCLUDING
EFFECTIVE
DATE
PROVISIONS.
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
Section
1.
Section
147.107,
subsections
3,
4,
and
5,
Code
2020,
are
amended
to
read
as
follows:
3.
A
physician
assistant
or
registered
nurse
may
supply,
when
pharmacist
services
are
not
reasonably
available
or
when
it
is
in
the
best
interests
of
the
patient,
on
the
direct
order
of
the
supervising
physician,
a
quantity
of
properly
packaged
and
labeled
prescription
drugs,
controlled
substances,
or
contraceptive
devices
necessary
to
complete
a
course
of
therapy.
However,
a
remote
clinic,
staffed
by
a
physician
assistant
or
registered
nurse,
where
pharmacy
services
are
not
reasonably
available,
shall
secure
the
regular
advice
and
consultation
of
a
pharmacist
regarding
the
distribution,
storage,
and
appropriate
use
of
such
drugs,
substances,
and
devices.
4.
Notwithstanding
subsection
3
,
a
A
physician
assistant
shall
not
may
prescribe,
dispense
,
order,
administer,
or
procure
prescription
drugs
as
an
incident
to
the
practice
of
the
supervising
physician
or
the
physician
assistant,
but
may
supply,
when
pharmacist
services
are
not
reasonably
Senate
File
2357,
p.
2
available,
or
when
it
is
in
the
best
interests
of
the
patient,
a
quantity
of
properly
packaged
and
labeled
prescription
drugs
,
controlled
substances,
or
medical
devices
necessary
to
complete
a
course
of
therapy
.
However,
a
remote
clinic,
staffed
by
a
physician
assistant,
where
pharmacy
services
are
not
reasonably
available,
shall
secure
the
regular
advice
and
consultation
of
a
pharmacist
regarding
the
distribution,
storage,
and
appropriate
use
of
such
drugs,
substances,
and
devices.
Prescription
drugs
supplied
under
the
provisions
of
this
subsection
shall
be
supplied
for
the
purpose
of
accommodating
the
patient
and
shall
not
be
sold
for
more
than
the
cost
of
the
drug
and
reasonable
overhead
costs,
as
they
relate
to
supplying
prescription
drugs
to
the
patient,
and
not
at
a
profit
to
the
physician
or
the
physician
assistant.
If
prescription
drug
supplying
authority
is
delegated
by
a
supervising
physician
to
a
physician
assistant,
a
nurse
or
staff
assistant
may
assist
the
physician
assistant
in
providing
that
service.
Rules
shall
be
adopted
by
the
board
of
physician
assistants,
after
consultation
with
the
board
of
pharmacy,
to
implement
this
subsection
pursuant
to
section
148C.4
.
5.
Notwithstanding
subsection
1
and
any
other
provision
of
this
section
to
the
contrary,
a
physician
may
delegate
the
function
of
prescribing
drugs,
controlled
substances,
and
medical
devices
for
which
the
supervising
physician
has
sufficient
training
or
experience
to
a
physician
assistant
licensed
pursuant
to
chapter
148C
after
the
supervising
physician
determines
the
physician
assistant’s
proficiency
and
competence
.
When
delegated
prescribing
occurs,
the
supervising
physician’s
name
shall
be
used,
recorded,
or
otherwise
indicated
in
connection
with
each
individual
prescription
so
that
the
individual
who
dispenses
or
administers
the
prescription
knows
under
whose
delegated
authority
the
physician
assistant
is
prescribing.
Rules
relating
to
the
authority
of
physician
assistants
to
prescribe
drugs,
controlled
substances,
and
medical
devices
pursuant
to
this
subsection
shall
be
adopted
by
the
board
of
physician
assistants,
after
consultation
with
the
board
of
medicine
and
the
board
of
pharmacy.
However,
the
rules
shall
prohibit
the
Senate
File
2357,
p.
3
prescribing
of
schedule
II
controlled
substances
which
are
listed
as
depressants
pursuant
to
chapter
124
.
Sec.
2.
Section
147.136,
subsection
1,
Code
2020,
is
amended
to
read
as
follows:
1.
Except
as
otherwise
provided
in
subsection
2
,
in
an
action
for
damages
for
personal
injury
against
a
physician
and
surgeon,
osteopathic
physician
and
surgeon,
dentist,
podiatric
physician,
optometrist,
pharmacist,
chiropractor,
physician
assistant,
or
nurse
licensed
to
practice
that
profession
in
this
state,
or
against
a
hospital
licensed
for
operation
in
this
state,
based
on
the
alleged
negligence
of
the
practitioner
in
the
practice
of
the
profession
or
occupation,
or
upon
the
alleged
negligence
of
the
hospital
in
patient
care,
in
which
liability
is
admitted
or
established,
the
damages
awarded
shall
not
include
actual
economic
losses
incurred
or
to
be
incurred
in
the
future
by
the
claimant
by
reason
of
the
personal
injury,
including
but
not
limited
to
the
cost
of
reasonable
and
necessary
medical
care,
rehabilitation
services,
and
custodial
care,
and
the
loss
of
services
and
loss
of
earned
income,
to
the
extent
that
those
losses
are
replaced
or
are
indemnified
by
insurance,
or
by
governmental,
employment,
or
service
benefit
programs
or
from
any
other
source.
Sec.
3.
Section
147.138,
Code
2020,
is
amended
to
read
as
follows:
147.138
Contingent
fee
of
attorney
reviewed
by
court.
In
any
action
for
personal
injury
or
wrongful
death
against
any
physician
and
surgeon,
osteopathic
physician
and
surgeon,
dentist,
podiatric
physician,
optometrist,
pharmacist,
chiropractor
,
physician
assistant,
or
nurse
licensed
under
this
chapter
or
against
any
hospital
licensed
under
chapter
135B
,
based
upon
the
alleged
negligence
of
the
licensee
in
the
practice
of
that
profession
or
occupation,
or
upon
the
alleged
negligence
of
the
hospital
in
patient
care,
the
court
shall
determine
the
reasonableness
of
any
contingent
fee
arrangement
between
the
plaintiff
and
the
plaintiff’s
attorney.
Sec.
4.
Section
148C.1,
Code
2020,
is
amended
to
read
as
follows:
148C.1
Definitions.
1.
“Approved
program”
means
a
program
for
the
education
Senate
File
2357,
p.
4
of
physician
assistants
which
has
been
accredited
by
the
American
medical
association’s
committee
on
allied
health
education
and
accreditation
or
its
successor,
by
the
commission
on
accreditation
of
allied
health
educational
programs
or
its
successor,
or
by
the
accreditation
review
commission
on
education
for
the
physician
assistant
or
its
successor
,
or,
if
accredited
prior
to
2001,
either
by
the
committee
on
allied
health
education
and
accreditation,
or
the
commission
on
accreditation
of
allied
health
education
programs
.
2.
“Board”
means
the
board
of
physician
assistants
created
under
chapter
147
.
3.
“Collaboration”
means
consultation
with
or
referral
to
the
appropriate
physician
or
other
health
care
professional
by
a
physician
assistant
as
indicated
by
the
patient’s
condition;
the
education,
competencies,
and
experience
of
the
physician
assistant;
and
the
standard
of
care.
3.
4.
“Department”
means
the
Iowa
department
of
public
health.
4.
5.
“Licensed
physician
assistant”
or
“licensed
P.A.”
means
a
person
who
is
licensed
by
the
board
to
practice
as
a
physician
assistant
under
the
supervision
of
one
or
more
physicians.
“Supervision”
does
not
require
the
personal
presence
of
the
supervising
physician
at
the
place
where
medical
services
are
rendered
except
insofar
as
the
personal
presence
is
expressly
required
by
this
chapter
or
required
by
rules
of
the
board
adopted
pursuant
to
this
chapter
.
5.
6.
“Physician”
means
a
person
who
is
currently
licensed
in
Iowa
to
practice
medicine
and
surgery
or
osteopathic
medicine
and
surgery.
Notwithstanding
this
subsection
,
a
physician
supervising
a
physician
assistant
practicing
in
a
federal
facility
or
under
federal
authority
shall
not
be
required
to
obtain
licensure
beyond
licensure
requirements
mandated
by
the
federal
government
for
supervising
physicians.
6.
7.
“Physician
assistant”
or
“P.A.”
means
a
person
who
has
successfully
completed
an
approved
program
and
passed
an
examination
approved
by
the
board
or
is
otherwise
found
by
the
board
to
be
qualified
to
perform
medical
services
under
the
supervision
of
a
physician
meets
the
qualifications
under
this
chapter
and
is
licensed
to
practice
medicine
by
the
board
.
Senate
File
2357,
p.
5
7.
“Trainee”
means
a
person
who
is
currently
enrolled
in
an
approved
program.
8.
“Supervising
physician”
means
a
physician
who
supervises
the
medical
services
provided
by
a
physician
assistant
consistent
with
the
physician
assistant’s
education,
training,
or
experience
and
who
accepts
ultimate
responsibility
for
the
medical
care
provided
by
the
supervising
physician-physician
assistant
team.
Sec.
5.
Section
148C.3,
subsections
1
and
3,
Code
2020,
are
amended
to
read
as
follows:
1.
The
board
shall
adopt
rules
to
govern
the
licensure
of
physician
assistants.
An
applicant
for
licensure
shall
submit
the
fee
prescribed
by
the
board
and
shall
meet
the
requirements
established
by
the
board
with
respect
to
each
of
the
following:
a.
Academic
qualifications,
including
evidence
of
graduation
from
an
approved
program.
A
physician
assistant
who
is
not
a
graduate
of
an
approved
program,
but
who
passed
the
national
commission
on
certification
of
physician
assistants’
physician
assistant
national
certifying
examination
prior
to
1986,
is
exempt
from
this
graduation
requirement.
b.
Evidence
of
passing
the
national
commission
on
the
certification
of
physician
assistants’
physician
assistant
national
certifying
examination
or
an
equivalent
examination
approved
by
the
board.
c.
Hours
of
continuing
medical
education
necessary
to
become
or
remain
licensed.
3.
A
licensed
physician
assistant
shall
perform
only
those
services
for
which
the
licensed
physician
assistant
is
qualified
by
training
or
education
and
which
are
not
prohibited
by
the
board.
Sec.
6.
Section
148C.4,
subsection
1,
Code
2020,
is
amended
to
read
as
follows:
1.
A
physician
assistant
may
perform
medical
services
when
the
services
are
rendered
under
the
supervision
of
a
physician.
A
physician
assistant
student
may
perform
medical
services
when
the
services
are
rendered
within
the
scope
of
an
approved
program
provide
any
legal
medical
service
for
which
the
physician
assistant
has
been
prepared
by
the
physician
assistant’s
education,
training,
or
experience
and
is
competent
Senate
File
2357,
p.
6
to
perform
.
For
the
purposes
of
this
section
,
“medical
services
when
the
services
are
rendered
under
the
supervision
of
a
physician”
“legal
medical
service
for
which
the
physician
assistant
has
been
prepared
by
the
physician
assistant’s
education,
training,
or
experience
and
is
competent
to
perform”
includes
making
a
pronouncement
of
death
for
a
patient
whose
death
is
anticipated
if
the
death
occurs
in
a
licensed
hospital,
a
licensed
health
care
facility,
a
correctional
institution
listed
in
section
904.102
,
a
Medicare-certified
home
health
agency,
or
a
Medicare-certified
hospice
program
or
facility
,
with
notice
of
the
death
to
a
physician
and
in
accordance
with
the
directions
of
a
physician
.
Sec.
7.
Section
148C.4,
Code
2020,
is
amended
by
adding
the
following
new
subsection:
NEW
SUBSECTION
.
3.
The
degree
of
collaboration
between
a
physician
assistant
and
the
appropriate
member
of
a
health
care
team
shall
be
determined
at
the
practice
level,
and
may
involve
decisions
made
by
the
medical
group,
hospital
service,
supervising
physician,
or
employer
of
the
physician
assistant,
or
the
credentialing
and
privileging
system
of
a
licensed
health
care
facility.
A
physician
shall
be
accessible
at
all
times
for
consultation
with
a
physician
assistant
unless
the
physician
assistant
is
providing
emergency
medical
services
pursuant
to
645
IAC
327.1(1)(n).
The
supervising
physician
shall
have
ultimate
responsibility
for
determining
the
medical
care
provided
by
the
supervising
physician-physician
assistant
team.
Sec.
8.
Section
249A.4,
subsection
7,
paragraph
b,
Code
2020,
is
amended
to
read
as
follows:
b.
Advanced
registered
nurse
practitioners
licensed
pursuant
to
chapter
152
and
physician
assistants
licensed
pursuant
to
chapter
148C
shall
be
regarded
as
approved
providers
of
health
care
services,
including
primary
care,
for
purposes
of
managed
care
or
prepaid
services
contracts
under
the
medical
assistance
program.
This
paragraph
shall
not
be
construed
to
expand
the
scope
of
practice
of
an
advanced
registered
nurse
practitioner
pursuant
to
chapter
152
or
physician
assistants
pursuant
to
chapter
148C
.
Sec.
9.
ADMINISTRATIVE
RULEMAKING.
Senate
File
2357,
p.
7
1.
The
board
of
medicine
and
the
board
of
physician
assistants
shall
each,
at
the
next
meeting
of
the
respective
boards
held
one
calendar
week
or
more
after
the
enactment
of
this
Act,
approve
a
notice
of
intended
action
to
adopt
rules
to
implement
this
Act
for
submission
to
the
administrative
rules
coordinator
and
the
Iowa
administrative
code
editor
pursuant
to
section
17A.4,
subsection
1,
paragraph
“a”.
2.
Notwithstanding
section
148C.5,
the
board
of
medicine
and
the
board
of
physician
assistants,
in
accordance
with
chapter
17A
and
this
section,
and
consistent
with
this
Act,
shall
each
amend,
rescind,
or
adopt
rules
which
address
all
of
the
following:
a.
For
the
board
of
physician
assistants,
rules
relating
to
and
in
substantial
conformance
with
all
of
the
following:
(1)
Definitions
pursuant
to
645
IAC
326.1
including
all
of
the
following:
(a)
“Approved
program”
means
a
program
for
the
education
of
physician
assistants
which
has
been
accredited
by
the
accreditation
review
commission
on
education
for
the
physician
assistant
or
its
successor,
or
if
accredited
prior
to
2001,
either
by
the
committee
on
allied
health
education
and
accreditation,
or
the
commission
on
accreditation
of
allied
health
education
programs.
(b)
“Collaboration”
means
consultation
with
or
referral
to
the
appropriate
physician
or
other
health
care
professional
by
a
physician
assistant
as
indicated
by
the
patient’s
condition;
the
education,
competencies,
and
experience
of
the
physician
assistant;
and
the
standard
of
care.
(c)
“Opioid”
means
a
drug
that
produces
an
agonist
effect
on
opioid
receptors
and
is
indicated
or
used
for
the
treatment
of
pain
or
opioid
use
disorder.
(d)
“Physician
assistant”
or
“P.A.”
means
a
person
licensed
as
a
physician
assistant
by
the
board.
(e)
“Remote
medical
site”
means
a
medical
clinic
for
ambulatory
patients
which
is
more
than
thirty
miles
away
from
the
main
practice
location
of
a
supervising
physician
and
in
which
a
supervising
physician
is
present
less
than
fifty
percent
of
the
time
the
site
is
open.
“Remote
medical
site”
does
not
apply
to
nursing
homes,
patient
homes,
hospital
Senate
File
2357,
p.
8
outpatient
departments,
outreach
clinics,
or
any
location
at
which
medical
care
is
incidentally
provided
such
as
a
diet
center,
free
clinic,
site
for
athletic
physicals,
or
a
jail
facility.
(f)
“Supervising
physician”
means
a
physician
who
supervises
the
medical
services
provided
by
the
physician
assistant
consistent
with
the
physician
assistant’s
education,
training,
or
experience
and
who
accepts
ultimate
responsibility
for
the
medical
care
provided
by
the
physician-physician
assistant
team.
(2)
Examination
requirements
pursuant
to
645
IAC
326.6
including
that
the
applicant
for
licensure
as
a
physician
assistant
shall
successfully
pass
the
certifying
examination
conducted
by
the
national
commission
on
certification
of
physician
assistants
or
a
successor
examination
approved
by
the
board
of
physician
assistants.
(3)
Use
of
title
requirements
pursuant
to
645
IAC
326.15
including
that
a
physician
assistant
licensed
under
chapter
148C
may
use
the
words
“physician
assistant”
after
the
person’s
name
or
signify
the
same
by
the
use
of
the
letters
“P.A.”
A
person
who
meets
the
qualifications
for
licensure
under
chapter
148C
but
does
not
possess
a
current
license
may
use
the
title
“P.A.”
or
“physician
assistant”
but
may
not
act
or
practice
as
a
physician
assistant
unless
licensed
under
chapter
148C.
(4)
Recognition
of
an
approved
program
pursuant
to
645
IAC
326.18
including
that
the
board
shall
recognize
a
program
for
education
and
training
of
physician
assistants
if
it
is
accredited
by
the
accreditation
review
commission
on
education
for
the
physician
assistant
or
its
successor,
or,
if
accredited
prior
to
2001,
either
by
the
committee
on
allied
health
education
and
accreditation
or
the
commission
on
accreditation
of
allied
health
educational
programs.
(5)
Duties
pursuant
to
645
IAC
327.1(1),
unnumbered
paragraph
1,
including
that
the
medical
services
to
be
provided
by
the
physician
assistant
are
those
for
which
the
physician
assistant
has
been
prepared
by
education,
training,
or
experience
and
is
competent
to
perform.
The
ultimate
role
of
the
physician
assistant
cannot
be
rigidly
defined
because
of
the
variations
in
practice
requirements
due
to
Senate
File
2357,
p.
9
geographic,
economic,
and
sociologic
factors.
The
high
degree
of
responsibility
a
physician
assistant
may
assume
requires
that,
at
the
conclusion
of
formal
education,
the
physician
assistant
possess
the
knowledge,
skills,
and
abilities
necessary
to
provide
those
services
appropriate
to
the
practice
setting.
The
physician
assistant’s
services
may
be
utilized
in
any
clinical
settings
including
but
not
limited
to
the
office,
the
ambulatory
clinic,
the
hospital,
the
patient’s
home,
extended
care
facilities,
and
nursing
homes.
Diagnostic
and
therapeutic
medical
tasks
for
which
the
supervising
physician
has
sufficient
training
or
experience
may
be
delegated
to
the
physician
assistant
after
a
supervising
physician
determines
the
physician
assistant’s
proficiency
and
competence.
(6)
Duties
pursuant
to
645
IAC
327.1
relating
to
prescribing,
dispensing,
ordering,
administering,
and
procuring
drugs
and
medical
devices
including
all
of
the
following:
(a)
A
physician
assistant
may
administer
any
drug.
(b)
A
physician
assistant
may
prescribe,
dispense,
order,
administer,
and
procure
drugs
and
medical
devices.
A
physician
assistant
may
plan
and
initiate
a
therapeutic
regimen
that
includes
ordering
and
prescribing
nonpharmacological
interventions,
including
but
not
limited
to
durable
medical
equipment,
nutrition,
blood
and
blood
products,
and
diagnostic
support
services
including
but
not
limited
to
home
health
care,
hospice,
and
physical
and
occupational
therapy.
The
prescribing
and
dispensing
of
drugs
may
include
schedule
II
through
V
substances
as
described
in
chapter
124
and
all
legend
drugs.
(c)
A
physician
assistant
may
prescribe
drugs
and
medical
devices
subject
to
all
the
following
conditions:
(i)
The
physician
assistant
shall
have
passed
the
national
certifying
examination
conducted
by
the
national
commission
on
the
certification
of
physician
assistants
or
its
successor
examination
approved
by
the
board.
Physician
assistants
with
a
temporary
license
may
order
drugs
and
medical
devices
only
with
the
prior
approval
and
direction
of
a
supervising
physician.
Prior
approval
may
include
discussion
of
the
specific
medical
problems
with
a
supervising
physician
prior
to
the
patient
being
seen
by
the
physician
assistant.
Senate
File
2357,
p.
10
(ii)
The
physician
assistant
must
comply
with
appropriate
federal
and
state
regulations.
(iii)
If
a
physician
assistant
prescribes
or
dispenses
controlled
substances,
the
physician
assistant
must
register
with
the
federal
drug
enforcement
administration.
(iv)
The
physician
assistant
may
prescribe
or
order
schedule
II
controlled
substances
which
are
listed
as
depressants
in
chapter
124
only
with
the
prior
approval
and
direction
of
a
supervising
physician
who
has
sufficient
training
or
experience.
Prior
approval
may
include
discussion
of
the
specific
medical
problems
with
a
supervising
physician
prior
to
the
patient
being
seen
by
the
physician
assistant.
(v)
A
physician
assistant
shall
not
prescribe
substances
that
the
supervising
physician
does
not
have
the
authority
to
prescribe
except
as
allowed
in
645
IAC
327.1(1)(n)
when
providing
immediate
evaluation,
treatment,
and
institution
of
procedures
essential
to
providing
an
appropriate
response
to
emergency
medical
problems.
(vi)
The
physician
assistant
may
prescribe,
supply,
and
administer
drugs
and
medical
devices
in
all
settings
including
but
not
limited
to
hospitals,
health
care
facilities,
health
care
institutions,
clinics,
offices,
health
maintenance
organizations,
and
outpatient
and
emergency
care
settings.
(vii)
A
physician
assistant
may
request,
receive,
and
supply
sample
drugs
and
medical
devices.
(viii)
The
board
of
physician
assistants
shall
be
the
only
board
to
regulate
the
practice
of
physician
assistants
relating
to
prescribing
and
supplying
prescription
drugs,
controlled
substances,
and
medical
devices.
(d)
A
physician
assistant
may
supply
properly
packaged
and
labeled
prescription
drugs,
controlled
substances,
or
medical
devices
when
pharmacist
services
are
not
reasonably
available
or
when
it
is
in
the
best
interests
of
the
patient.
(i)
When
the
physician
assistant
is
the
prescriber
of
the
medications
supplied,
these
medications
shall
be
supplied
for
the
purpose
of
accommodating
the
patient
and
shall
not
be
sold
for
more
than
the
cost
of
the
drug
and
reasonable
overhead
costs
as
they
relate
to
supplying
prescription
drugs
to
the
patient
and
not
at
a
profit
to
the
physician
or
physician
Senate
File
2357,
p.
11
assistant.
(ii)
A
nurse
or
staff
assistant
may
assist
the
physician
assistant
in
supplying
medications.
(e)
A
physician
assistant
may,
at
the
request
of
the
peace
officer,
withdraw
a
specimen
of
blood
from
a
patient
for
the
purpose
of
determining
the
alcohol
concentration
or
the
presence
of
drugs.
(f)
A
physician
assistant
may
direct
medical
personnel,
health
professionals,
and
others
involved
in
caring
for
patients
and
the
execution
of
patient
care.
(g)
A
physician
assistant
may
authenticate
medical
forms
by
signing
the
form.
(h)
A
physician
assistant
may
perform
other
duties
as
appropriate
to
a
physician
assistant’s
practice.
(i)
Health
care
providers
shall
consider
the
instructions
of
a
physician
assistant
to
be
authoritative.
(7)
Remote
medical
site
requirements
pursuant
to
645
IAC
327.4(1)
and
(2),
including
all
of
the
following:
(a)
A
physician
assistant
may
provide
medical
services
in
a
remote
medical
site
if
any
of
the
following
conditions
is
met:
(i)
The
physician
assistant
has
a
permanent
license
and
at
least
one
year
of
practice
as
a
physician
assistant.
(ii)
The
physician
assistant
with
less
than
one
year
of
practice
has
a
permanent
license
and
meets
all
of
the
following
criteria:
(A)
The
physician
assistant
has
practiced
as
a
physician
assistant
for
at
least
six
months.
(B)
The
physician
assistant
and
supervising
physician
have
worked
together
at
the
same
location
for
a
period
of
at
least
three
months.
(C)
The
supervising
physician
reviews
patient
care
provided
by
the
physician
assistant
as
determined
to
be
appropriate
by
the
supervising
physician.
(D)
The
supervising
physician
reviews
a
representative
sample
of
patient
charts
unless
the
medical
record
documents
that
direct
consultation
with
the
supervising
physician
occurred
for
a
period
the
supervising
physician
determines
is
appropriate.
(iii)
The
physician
assistant
and
supervising
physician
Senate
File
2357,
p.
12
provide
a
written
statement
sent
directly
to
the
board
that
the
physician
assistant
is
qualified
to
provide
the
needed
medical
services
and
that
the
medical
care
will
be
unavailable
at
the
remote
site
unless
the
physician
assistant
is
allowed
to
practice
there.
In
addition,
for
three
months,
the
supervising
physician
must
review
a
representative
sample
of
patient
charts
for
patient
care
provided
by
the
physician
assistant
at
least
weekly.
(b)
The
supervising
physician
must
visit
a
remote
site
or
communicate
with
the
physician
assistant
at
the
remote
site
via
electronic
communications
to
provide
additional
medical
direction,
medical
services,
and
consultation
at
least
every
two
weeks.
For
purposes
of
this
rule,
communication
may
consist
of,
but
shall
not
be
limited
to,
in-person
meetings,
two-way
interactive
communication
directly
between
the
supervising
physician
and
the
physician
assistant
via
telephone,
secure
messaging,
electronic
mail,
or
chart
review.
(8)
Identification
as
a
physician
assistant
pursuant
to
645
IAC
327.5
including
that
the
physician
assistant
shall
be
identified
as
a
physician
assistant
to
patients
and
to
the
public,
regardless
of
their
educational
degree.
(9)
Prescription
requirements
pursuant
to
645
IAC
327.6(2)
including
that
each
oral
prescription
drug
order
issued
by
a
physician
assistant
shall
include
the
same
information
required
for
a
written
prescription,
except
for
the
written
signature
of
the
physician
assistant
and
the
physician
assistant’s
practice
address.
(10)
Grounds
for
discipline
pursuant
to
645
IAC
329.2(25)
including
prohibiting
a
person
from
representing
the
person
as
a
physician
assistant
when
the
persons’s
license
has
been
suspended
or
revoked,
or
when
the
person’s
license
is
on
inactive
status
except
as
provided
by
645
IAC
326.15.
b.
For
the
board
of
medicine
rules
relating
to
and
in
substantial
conformance
with
the
following
relating
to
supervisory
agreements
pursuant
to
653
IAC
21.4
including
all
of
the
following:
(1)
A
physician
who
supervises
a
physician
assistant
shall
establish
a
written
supervisory
agreement
prior
to
supervising
a
physician
assistant.
A
sample
supervisory
Senate
File
2357,
p.
13
agreement
form
is
available
from
the
board.
The
purpose
of
the
supervisory
agreement
is
to
define
the
nature
and
extent
of
the
supervisory
relationship
and
the
expectations
of
each
party.
The
supervisory
agreement
shall
take
into
account
the
physician
assistant’s
demonstrated
skills,
training
and
experience,
proximity
of
the
supervising
physician
to
the
physician
assistant,
and
the
nature
and
scope
of
the
medical
practice.
The
supervising
physician
shall
maintain
a
copy
of
the
supervisory
agreement
and
provide
a
copy
of
the
agreement
to
the
board
upon
request.
The
supervisory
agreement
shall,
at
a
minimum,
address
all
of
the
following
provisions:
(a)
Review
of
requirements.
The
supervising
physician
and
the
physician
assistant
shall
review
all
of
the
requirements
of
physician
assistant
licensure,
practice,
supervision,
and
delegation
of
medical
services
as
set
forth
in
section
148.13
and
chapter
148C,
Iowa
administrative
code
chapter
653,
and
645
IAC
chapters
326
to
329.
(b)
Assessment
of
education,
training,
skills,
and
experience.
Each
supervising
physician
shall
assess
the
education,
training,
skills,
and
relevant
experience
of
the
physician
assistant
prior
to
providing
supervision.
Each
supervising
physician
and
physician
assistant
shall
ensure
that
the
other
party
has
the
appropriate
education,
training,
skills,
and
relevant
experience
necessary
to
successfully
collaborate
on
patient
care
delivered
by
the
team.
The
method
for
assessing
and
providing
feedback
regarding
the
physician
assistant’s
education,
training,
skills,
and
experience
shall
be
reflected
in
the
supervision
agreement.
(2)
The
supervision
agreement
between
the
physician
assistant
and
the
physician
shall
address
all
of
the
following:
(a)
The
medical
services
the
supervising
physician
delegates
to
the
physician
assistant.
The
medical
services
and
medical
tasks
delegated
to
and
provided
by
the
physician
assistant
shall
be
in
compliance
with
645
IAC
327.1(1).
All
delegated
medical
services
shall
be
within
the
scope
of
practice
of
the
supervising
physician
and
the
physician
assistant.
(b)
Methods
for
communication
between
the
physician
assistant
and
the
physician
and
whether
the
physician
assistant
Senate
File
2357,
p.
14
practices
at
the
same
site
or
a
remote
site.
Each
supervising
physician
and
physician
assistant
shall
conduct
ongoing
discussions
and
evaluation
of
the
supervisory
agreement,
including
supervision;
expectations
for
both
parties;
assessment
of
education,
training,
skills,
and
relevant
experience;
review
of
delegated
services;
review
of
the
medical
services
provided
by
the
physician
assistant;
and
the
types
of
cases
and
situations
when
the
supervising
physician
expects
to
be
consulted.
(i)
The
plan
for
completing
and
documenting
chart
reviews.
A
licensed
physician
within
the
same
facility
or
health
care
system
as
the
physician
assistant
shall
conduct
an
ongoing
review
of
a
representative
sample
of
the
physician
assistant’s
patient
charts
encompassing
the
scope
of
the
physician
assistant’s
practice.
The
findings
of
the
review
shall
be
discussed
with
the
physician
assistant
in
a
manner
determined
by
the
practice
in
consultation
with
the
physician
assistant’s
primary
supervising
physician.
(ii)
Remote
medical
site.
“Remote
medical
site”
means
a
medical
clinic
for
ambulatory
patients
which
is
more
than
thirty
miles
away
from
the
main
practice
location
of
the
supervising
physician
and
in
which
the
supervising
physician
is
present
less
than
fifty
percent
of
the
time
when
the
remote
medical
site
is
open.
“Remote
medical
site”
does
not
apply
to
nursing
homes,
patient
homes,
hospital
outpatient
departments,
outreach
clinics,
or
any
location
at
which
medical
care
is
incidentally
provided,
such
as
a
diet
center,
free
clinic,
site
for
athletic
physicals,
or
a
jail
facility.
The
supervisory
agreement
shall
include
a
provision
which
ensures
that
the
supervising
physician
visits
the
remote
medical
site,
or
communicates
with
a
physician
assistant
at
the
remote
medical
site
via
electronic
communications,
at
least
every
two
weeks
to
provide
additional
medical
direction,
medical
services,
and
consultation
specific
to
the
medical
services
provided
at
the
remote
medical
site.
For
purposes
of
this
subparagraph
subdivision,
communication
may
consist
of,
but
shall
not
be
limited
to,
in-person
meetings
or
two-way,
interactive
communication
directly
between
the
supervising
physician
and
the
physician
assistant
via
telephone,
secure
messaging,
Senate
File
2357,
p.
15
electronic
mail,
or
chart
review.
The
board
shall
only
grant
a
waiver
or
variance
of
this
provision
if
substantially
equal
protection
of
public
health,
safety,
and
welfare
will
be
afforded
by
a
means
other
than
that
prescribed
in
this
subparagraph
subdivision.
(iii)
The
expectations
and
plan
for
alternate
supervision.
The
supervising
physician
shall
ensure
that
the
alternate
supervising
physician
is
available
for
a
timely
consultation
and
shall
ensure
that
the
physician
assistant
is
notified
of
the
means
by
which
to
reach
the
alternate
supervising
physician.
Sec.
10.
RESCISSION
OF
ADMINISTRATIVE
RULES.
1.
The
board
of
physician
assistants
shall
rescind
all
of
the
following:
a.
645
Iowa
administrative
code,
rule
326.19,
subrule
(3),
paragraph
“b”,
subparagraph
(3).
b.
645
Iowa
administrative
code,
rule
327.1,
subrule
(1),
paragraphs
“r”
through
“z”.
c.
645
Iowa
administrative
code,
rule
327.4,
subrules
(1)
and
(2).
2.
The
board
of
medicine
shall
rescind
653
Iowa
administrative
code,
rule
21.4,
subrules
(3)
through
(7).
Sec.
11.
RULEMAKING
——
LIMITATION
ON
AMENDMENTS
——
CONSTRUCTION.
1.
The
board
of
medicine
and
the
board
of
physician
assistants,
upon
the
adoption
of
rules
pursuant
to
chapter
17A
as
required
by
sections
9
and
10
of
this
Act,
shall
not
thereafter
approve
a
notice
of
intended
action
pursuant
to
section
17A.4,
subsection
1,
paragraph
“a”,
for
the
amendment
or
rescission
of
such
rules
for
a
period
of
two
years
from
the
effective
date
of
this
Act.
2.
Except
as
provided
in
subsection
1,
the
rulemaking
requirements
provided
in
sections
9
and
10
of
this
Act
shall
not
be
construed
to
prohibit
the
board
of
medicine
or
the
board
of
physician
assistants
from
engaging
in
further
rulemaking
not
in
conflict
with
sections
9
or
10
of
this
Act
relating
to
the
subject
matter
of
those
sections
or
to
otherwise
diminish
the
authority
to
engage
in
rulemaking
provided
to
either
board
by
section
147.76
or
any
other
statute.
Senate
File
2357,
p.
16
Sec.
12.
EFFECTIVE
DATE.
This
Act,
being
deemed
of
immediate
importance,
takes
effect
upon
enactment.
______________________________
CHARLES
SCHNEIDER
President
of
the
Senate
______________________________
PAT
GRASSLEY
Speaker
of
the
House
I
hereby
certify
that
this
bill
originated
in
the
Senate
and
is
known
as
Senate
File
2357,
Eighty-eighth
General
Assembly.
______________________________
W.
CHARLES
SMITHSON
Secretary
of
the
Senate
Approved
_______________,
2020
______________________________
KIM
REYNOLDS
Governor