Iowa 2019-2020 Regular Session Status: Enacted

SF 2357 — 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.

Last action — Signed by Governor.

  1. ✓
    Introduced
  2. ✓
    In Committee
  3. ✓
    Passed Senate
  4. ✓
    Passed House
  5. ✓
    To Executive
  6. 6
    Enacted

This bill has been enacted into law. Introduced February 20, 2020. Enacted.

Prognosis

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Where this bill stands today.

Odds of enactment

High

How often bills like it became law.

Not enough signal yet to read this bill's trajectory — we surface a likelihood only once there's real movement (stage, sponsorship, committee, or votes) to point to.

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Bill Text

What changed in the latest version

34 added · 158 removed

34 line(s) added, 158 removed.

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Senate File 2357 - Introduced SENATE FILE 2357 BY COMMITTEE ON STATE GOVERNMENT (SUCCESSOR TO SSB 3071) A BILL FOR An Act relating to the practice and licensure of physician assistants, and including effective date provisions.
Senate File 2357 - Enrolled Senate File 2357 AN ACT RELATING TO THE PRACTICE AND LICENSURE OF PHYSICIAN ASSISTANTS, AND INCLUDING EFFECTIVE DATE PROVISIONS.
TLSB 5646SV (3) 88 pf/rh S.F.
Section 1.
2357 Section 1.
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 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.
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.
If prescription drug supplying authority is delegated by a supervising physician to a physician assistant, a nurse or LSB 5646SV (3) 88 -1- pf/rh 1/19 S.F.
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.
2357 staff assistant may assist the physician assistant in providing that service.
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.
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 .
However, the rules shall prohibit the prescribing of schedule II controlled substances which are listed as depressants pursuant to chapter 124.
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.
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 LSB 5646SV (3) 88 -2- pf/rh 2/19 S.F.
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.
2357 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.
“Approved program” means a program for the education 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 .
“Approved program” means a program for the education Senate File 2357, p.
LSB 5646SV (3) 88 -3- pf/rh 3/19 S.F.
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 .
2357 2.
2.
7.
Senate File 2357, p.
5 7.
“Supervising physician” means a physician who supervises the medical services provided by a physician assistant consistent with the physician assistant’s education, training, LSB 5646SV (3) 88 -4- pf/rh 4/19 S.F.
“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.
2357 or experience and who accepts ultimate responsibility for the medical care provided by the supervising physician-physician assistant team.
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 to perform .
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.
For the purposes of this section, “medical LSB 5646SV (3) 88 -5- pf/rh 5/19 S.F.
6 to perform .
2357 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 .
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.
This paragraph shall not be construed to expand the scope of practice of an advanced registered nurse practitioner LSB 5646SV (3) 88 -6- pf/rh 6/19 S.F.
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.
2357 pursuant to chapter 152 or physician assistants pursuant to chapter 148C .
1.
Senate File 2357, p.
7 1.
(d) “Physician assistant” or “P.A.” means a person licensed LSB 5646SV (3) 88 -7- pf/rh 7/19 S.F.
(d) “Physician assistant” or “P.A.” means a person licensed as a physician assistant by the board.
2357 as a physician assistant by the board.
“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.
“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.
(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 LSB 5646SV (3) 88 -8- pf/rh 8/19 S.F.
(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.
2357 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.
The ultimate role of the physician assistant cannot be rigidly defined because of the variations in practice requirements due to geographic, economic, and sociologic factors.
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.
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 LSB 5646SV (3) 88 -9- pf/rh 9/19 S.F.
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.
2357 care, hospice, and physical and occupational therapy.
(ii) The physician assistant must comply with appropriate federal and state regulations.
Senate File 2357, p.
10 (ii) The physician assistant must comply with appropriate federal and state regulations.
(vi) The physician assistant may prescribe, supply, and administer drugs and medical devices in all settings including LSB 5646SV (3) 88 -10- pf/rh 10/19 S.F.
(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.
2357 but not limited to hospitals, health care facilities, health care institutions, clinics, offices, health maintenance organizations, and outpatient and emergency care settings.
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(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 assistant.
(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.
LSB 5646SV (3) 88 -11- pf/rh 11/19 S.F.
(7) Remote medical site requirements pursuant to 645 IAC 327.4(1) and (2), including all of the following:
2357 (7) Remote medical site requirements pursuant to 645 IAC 327.4(1) and (2), including all of the following:
(iii) The physician assistant and supervising physician 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.
(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.
(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 LSB 5646SV (3) 88 -12- pf/rh 12/19 S.F.
(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.
2357 every two weeks.
A sample supervisory agreement form is available from the board.
A sample supervisory Senate File 2357, p.
13 agreement form is available from the board.
The supervising physician shall maintain a copy of LSB 5646SV (3) 88 -13- pf/rh 13/19 S.F.
The supervising physician shall maintain a copy of the supervisory agreement and provide a copy of the agreement to the board upon request.
2357 the supervisory agreement and provide a copy of the agreement to the board upon request.
(b) Methods for communication between the physician assistant and the physician and whether the physician assistant practices at the same site or a remote site.
(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.
LSB 5646SV (3) 88 -14- pf/rh 14/19 S.F.
assessment of education, training, skills, and relevant experience;
2357 assessment of education, training, skills, and relevant experience;
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, LSB 5646SV (3) 88 -15- pf/rh 15/19 S.F.
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.
2357 electronic mail, or chart review.
15 electronic mail, or chart review.
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 LSB 5646SV (3) 88 -16- pf/rh 16/19 S.F.
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.
2357 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.
Sec.
16 Sec.
EXPLANATION The inclusion of this explanation does not constitute agreement with the explanation’s substance by the members of the general assembly.
______________________________ ______________________________ CHARLES SCHNEIDER PAT GRASSLEY President of the Senate 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.
This bill relates to the practice and licensure of physician assistants.
______________________________ W.
With regard to drug dispensing, supplying, and prescribing, the bill provides that a physician assistant may prescribe, dispense, order, administer, or procure prescription drugs, controlled substances, or medical devices necessary to complete a course of therapy in accordance with Code section 148C.4 which provides that the physician assistant may provide any legal medical service for which the physician assistant has been prepared by education, training, or experience and is competent to perform.
CHARLES SMITHSON Secretary of the Senate Approved _______________, 2020 ______________________________ KIM REYNOLDS Governor
Additionally, the bill provides that a physician may delegate the function of prescribing drugs, controlled substances, and medical devices for which the supervising physician has sufficient training or experience after the supervising physician determines the physician assistant’s proficiency and competence.
Rules relating to the authority of physician assistants to prescribe drugs, controlled substances, and medical devices shall be adopted by the board of physician assistants, after consultation with the board of medicine and the board of pharmacy.
The bill includes physician assistants in the listing of health care providers in provisions relating to the scope of recovery in an action for damages for personal injury, limitations on noneconomic damage awards against health care providers, and contingent fees for attorneys in any action for personal injury or wrongful death against a health care LSB 5646SV (3) 88 -17- pf/rh 17/19 S.F.
2357 provider.
The bill includes definitions for the purposes of Code chapter 148C (physician assistants).
The bill amends the definition of “approved program” for the education of physician assistants;
includes a definition of “collaboration” and “supervising physician”, and defines “physician assistant” or “P.A.” as a person who meets the qualifications under Code chapter 148C and is licensed to practice medicine by the board of physician assistants.
The bill amends the reference to a physician assistant examination that may be completed in lieu of graduation from an approved program, and provides that 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.
The bill provides with regard to the services that may be performed by a physician assistant, that a physician assistant may 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 to perform.
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.
The supervising physician shall have ultimate responsibility for determining the medical care provided by the supervising physician-physician assistant team.
The bill also includes physician assistants as approved providers of health care services, including primary care for purposes of managed care or prepaid services contracts under LSB 5646SV (3) 88 -18- pf/rh 18/19 S.F.
2357 the Medicaid program and provides that the provision shall not be construed to expand the scope of practice of a physician assistant.
The bill also requires the board of medicine and the board of physician assistants to each, at the next meeting of the respective boards held one calendar week or more after the enactment of the bill, to approve a notice of intended action to adopt rules to implement the bill.
The bill specifies the rules that the two boards are to address or rescind.
The bill provides that the board of medicine and the board of physician assistants, upon the adoption of rules pursuant to Code chapter 17A as required by the bill, shall not thereafter approve a notice of intended action for the amendment or rescission of such rules for a period of two years from the effective date of the bill.
With the exception of the two-year limitation, the rulemaking requirements provided in the bill 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 the provisions of the bill relating to rulemaking and to the subject matter of those provisions of the bill or to otherwise diminish the authority to engage in rulemaking provided to either board by Code section 147.76 (rules) or any other statute.
The bill takes effect upon enactment.
LSB 5646SV (3) 88 -19- pf/rh 19/19
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Amendments

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Action History

  1. Signed by Governor.

  2. Reported correctly enrolled, signed by President and Speaker, and sent to Governor.

  3. Message from House.

  4. Explanation of vote.

  5. Immediate message.

  6. Passed House, yeas 98, nays none.

  7. Amendment H-8140 withdrawn.

  8. Substituted for HF 2542.

  9. Amendment H-8140 filed.

  10. Read first time, passed on file.

  11. Message from Senate.

  12. Immediate message.

  13. Passed Senate, yeas 49, nays 0.

  14. Committee report, approving bill.

  15. Introduced, placed on calendar, under Rule 28.

Sponsorship breakdown

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0 sponsors · 0 co-sponsors · 150 not signed on

Sponsors (0)

None.

Co-sponsors (0)

None.

Not signed on (150)

150 members have not signed on to this bill.

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"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

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Subjects

healthcare health-insurance
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This bill has been enacted into law. Introduced February 20, 2020. Enacted.
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