SSB 3071 (LSB 5646XC (5) 88)

SENATE FILE _____ 

BY  (PROPOSED COMMITTEE ON STATE GOVERNMENT BILL BY CHAIRPERSON SMITH)

A BILL FOR

An Act relating to the practice and licensure of physician assistants.
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 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 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 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 health care professional 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.
   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 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.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill relates to the practice and licensure of physician assistants. 
   With regard to drug dispensing, supplying, and prescribing, the bill provides that a physician assistant may prescribe, dispense, order, administer, or procure prescription drugs 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. 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 provider apply. 
   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 health care professional 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 immediate evaluation, treatment, and institution of procedures essential to providing an appropriate response to emergency medical problems. 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 the Medicaid program and provides that the provision shall not be construed to expand the scope of practice of a physician assistant.