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Text: SF00268                           Text: SF00270
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Senate File 269

Partial Bill History

Bill Text

PAG LIN
  1  1    Section 1.  Section 135B.7, unnumbered paragraph 2, Code
  1  2 1995, is amended to read as follows:
  1  3    The rules shall state that a hospital shall not deny
  1  4 clinical privileges to physicians and surgeons, podiatrists,
  1  5 osteopaths, osteopathic surgeons, dentists, or certified
  1  6 health service providers in psychology, physician assistants,
  1  7 or advanced registered nurse practitioners licensed under
  1  8 chapter 148, 148C, 149, 150, 150A, 152, or 153, or section
  1  9 154B.7 solely by reason of the license held by the
  1 10 practitioner or solely by reason of the school or institution
  1 11 in which the practitioner received medical schooling or
  1 12 postgraduate training if the medical schooling or postgraduate
  1 13 training was accredited by an organization recognized by the
  1 14 council on postsecondary accreditation or an accrediting group
  1 15 recognized by the United States department of education.  A
  1 16 hospital may establish procedures for interaction between a
  1 17 patient and a practitioner.  Nothing in the rules shall
  1 18 prohibit a hospital from limiting, restricting, or revoking
  1 19 clinical privileges of a practitioner for violation of
  1 20 hospital rules, regulations, or procedures established under
  1 21 this paragraph, when applied in good faith and in a
  1 22 nondiscriminatory manner.  Nothing in this paragraph shall
  1 23 require a hospital to expand the hospital's current scope of
  1 24 service delivery solely to offer the services of a class of
  1 25 providers not currently providing services at the hospital.
  1 26 Nothing in this section shall be construed to require a
  1 27 hospital to establish rules which are inconsistent with the
  1 28 scope of practice established for licensure of practitioners
  1 29 to whom this paragraph applies.  This section shall not be
  1 30 construed to authorize the denial of clinical privileges to a
  1 31 practitioner or class of practitioners solely because a
  1 32 hospital has as employees of the hospital identically licensed
  1 33 practitioners providing the same or similar services.
  1 34    Sec. 2.  Section 147.14, subsection 12, Code 1995, is
  1 35 amended to read as follows:
  2  1    12.  For the board of physician assistant examiners, three
  2  2 five members licensed to practice as physician assistants, at
  2  3 least two three of whom practice in counties with a population
  2  4 of less than fifty thousand, one member licensed to practice
  2  5 medicine and surgery who supervises a physician assistant, one
  2  6 member licensed to practice osteopathic medicine and surgery
  2  7 who supervises a physician assistant, and two members who are
  2  8 not licensed to practice either medicine and surgery or
  2  9 osteopathic medicine and surgery or licensed as a physician
  2 10 assistant and who shall represent the general public.  At
  2 11 least one of the physician members shall be in practice in a
  2 12 county with a population of less than fifty thousand.  A
  2 13 majority of members of the board constitutes a quorum.
  2 14    Sec. 3.  Section 147.107, subsection 5, Code 1995, is
  2 15 amended to read as follows:
  2 16    5.  Notwithstanding subsection 1 and any other provision of
  2 17 this section to the contrary, a physician may delegate the
  2 18 function of prescribing drugs, controlled substances, and
  2 19 medical devices to a physician assistant licensed pursuant to
  2 20 chapter 148C.  When delegated prescribing occurs, the
  2 21 supervising physician's name shall be used, recorded, or
  2 22 otherwise indicated in connection with each individual
  2 23 prescription so that the individual who dispenses or
  2 24 administers the prescription knows under whose delegated
  2 25 authority the physician assistant is prescribing.  Rules
  2 26 relating to the authority of physician assistants to prescribe
  2 27 drugs, controlled substances, and medical devices pursuant to
  2 28 this subsection shall be adopted by the board of physician
  2 29 assistant examiners, after consultation with the board of
  2 30 medical examiners and the board of pharmacy examiners, as soon
  2 31 as possible after July 1, 1991.  The rules shall be reviewed
  2 32 and approved by the physician assistant rules review group
  2 33 created under subsection 7 and shall be adopted in final form
  2 34 by January 1, 1993.  However, the rules shall prohibit the
  2 35 prescribing of schedule II controlled substances which are
  3  1 listed as stimulants or depressants pursuant to chapter 124.
  3  2 If rules are not reviewed and approved by the physician
  3  3 assistant rules review group created under subsection 7 and
  3  4 adopted in final form by January 1, 1993, a physician
  3  5 assistant may prescribe drugs as a delegated act of a
  3  6 supervising physician under rules adopted by the board of
  3  7 physician assistant examiners and subject to the rules review
  3  8 process established in section 148C.7.  The board of physician
  3  9 assistant examiners shall be the only board to regulate the
  3 10 practice of physician assistants relating to prescribing and
  3 11 supplying prescription drugs, controlled substances and
  3 12 medical devices, notwithstanding section 148C.6A.
  3 13    Sec. 4.  Section 148.13, subsections 1 and 4, Code 1995,
  3 14 are amended by striking the subsections.
  3 15    Sec. 5.  Section 148C.1, subsection 7, Code 1995, is
  3 16 amended by striking the subsection.
  3 17    Sec. 6.  Section 148C.3, subsections 1 and 9, Code 1995,
  3 18 are amended to read as follows:
  3 19    1.  The board shall formulate guidelines and adopt rules,
  3 20 pursuant to section 148C.7, to govern the registration
  3 21 licensure of persons who qualify as physician assistants.  An
  3 22 applicant for registration licensure shall submit the fee
  3 23 prescribed by the board and shall meet the requirements
  3 24 established by the board with respect to all of the following:
  3 25    a.  Academic qualifications, including evidence of
  3 26 graduation from an approved program.  However, if the board
  3 27 determines that a person has sufficient knowledge and
  3 28 experience to qualify as a physician assistant, the board may
  3 29 approve an application for registration licensure without
  3 30 requiring the completion of an approved program.  On or after
  3 31 July 1, 1996, a physician assistant who is not licensed
  3 32 pursuant to this chapter prior to that date shall be required
  3 33 to graduate from an approved program.
  3 34    b.  Examination grades and evidence of passing the national
  3 35 commission on certification of physician assistants
  4  1 examination or an equivalent examination which the board
  4  2 approves.
  4  3    c.  Hours of continuing medical education necessary to
  4  4 remain licensed or eligible for licensure.
  4  5    9.  Rules shall be adopted by the board pursuant to this
  4  6 chapter which will permit qualified practicing licensed
  4  7 physicians to supervise licensed physician assistants at a
  4  8 free medical clinic on a temporary basis.
  4  9    Sec. 7.  Section 148C.3, subsections 2, 3, 4, 6, and 7,
  4 10 Code 1995, are amended by striking the subsections.
  4 11    Sec. 8.  Section 148C.3, Code 1995, is amended by adding
  4 12 the following new subsection:
  4 13    NEW SUBSECTION.  5A.  The board may issue an inactive
  4 14 license under conditions as prescribed by the rules of the
  4 15 board.
  4 16    Sec. 9.  Section 148C.4, Code 1995, is amended to read as
  4 17 follows:
  4 18    148C.4  SERVICES PERFORMED BY ASSISTANTS.
  4 19    A physician assistant may perform medical services when the
  4 20 services are rendered under the supervision of the a physician
  4 21 or physicians specified in the physician assistant license
  4 22 approved by the board.  A trainee may perform medical services
  4 23 when the services are rendered within the scope of an approved
  4 24 program.
  4 25    Sec. 10.  Section 148C.7, Code 1995, is amended to read as
  4 26 follows:
  4 27    148C.7  RULES &endash; REVIEW GROUP.
  4 28    1.  A physician assistant rules review group is established
  4 29 consisting of one physician assistant member, one supervising
  4 30 physician member, and one public member from the board of
  4 31 physician assistant examiners and two members from the board
  4 32 of medical examiners who are licensed to practice medicine and
  4 33 surgery or osteopathic medicine and surgery.  The respective
  4 34 boards shall select their members to serve on the physician
  4 35 assistant rules review group.  The review group shall select
  5  1 its own chairperson.
  5  2    The review group shall review and approve or disapprove
  5  3 rules proposed for adoption by the board of physician
  5  4 assistant examiners.  Approval shall be a simple majority of
  5  5 the members of the group.  A rule shall not become effective
  5  6 without the approval of the review group.
  5  7    2.  The board may adopt rules reasonably necessary to carry
  5  8 out the purposes of this chapter.  Proposed rules must be
  5  9 submitted to the review group for prior review and approval.
  5 10 The rules shall be designed to encourage the utilization of
  5 11 physician assistants in a manner that is consistent with the
  5 12 provision of quality health care and medical services for the
  5 13 citizens of Iowa through better utilization of available
  5 14 physicians and the development of sound programs for the
  5 15 education and training of skilled physician assistants well
  5 16 qualified to assist physicians in providing health care and
  5 17 medical services.
  5 18    Sec. 11.  Section 148C.11, Code 1995, is amended to read as
  5 19 follows:
  5 20    148C.11  PROHIBITION &endash; CRIME.
  5 21    A person not registered and licensed as required by this
  5 22 chapter who practices as a physician assistant without having
  5 23 obtained the appropriate approval under this chapter, is
  5 24 guilty of a serious misdemeanor.
  5 25    Sec. 12.  Section 148E.8, Code 1995, is amended to read as
  5 26 follows:
  5 27    148E.8  SCOPE OF CHAPTER.
  5 28    This chapter does not apply to a person otherwise licensed
  5 29 to practice medicine and surgery, osteopathy, osteopathic
  5 30 medicine and surgery, chiropractic, podiatry, or dentistry, or
  5 31 licensed to practice as a physician assistant.
  5 32    Sec. 13.  Section 148E.10, Code 1995, is amended to read as
  5 33 follows:
  5 34    148E.10  EVALUATION OF CONDITION REQUIRED.
  5 35    A person registered under this chapter shall not engage in
  6  1 the performance of acupuncture upon another person until the
  6  2 person's condition has been evaluated by a person licensed to
  6  3 practice medicine and surgery, osteopathy, osteopathic
  6  4 medicine and surgery, chiropractic, podiatry, or dentistry, or
  6  5 licensed to practice as a physician assistant, and the person
  6  6 has been referred to the acupuncturist by the medical
  6  7 evaluator.
  6  8    Sec. 14.  Section 249A.4, subsection 8, unnumbered
  6  9 paragraph 1, Code 1995, is amended to read as follows:
  6 10    Shall advise and consult at least semiannually with a
  6 11 council composed of the presidents of the following
  6 12 organizations, or a president's representative who is a member
  6 13 of the organization represented by the president:  the Iowa
  6 14 medical society, the Iowa osteopathic medical association, the
  6 15 Iowa state dental society, the Iowa state nurses association,
  6 16 the Iowa pharmacists association, the Iowa podiatry society,
  6 17 the Iowa optometric association, the community mental health
  6 18 centers association of Iowa, the Iowa psychological
  6 19 association, the Iowa hospital association, the Iowa
  6 20 osteopathic hospital association, opticians' association of
  6 21 Iowa, inc., the Iowa hearing aid society, the Iowa speech,
  6 22 language, and hearing association, the Iowa health care
  6 23 association, the Iowa association for home care, the Iowa
  6 24 council of health care centers, the Iowa physician assistant
  6 25 society, the Iowa nurse practitioners association, and the
  6 26 Iowa association of homes for the aging, the Iowa psychiatric
  6 27 nurse managers network, the arc of Iowa which was formerly
  6 28 known as the association for retarded citizens of Iowa, the
  6 29 alliance for the mentally ill of Iowa, Iowa state association
  6 30 of counties, and the Iowa governor's planning council for
  6 31 developmental disabilities, together with one person
  6 32 designated by the Iowa state board of chiropractic examiners;
  6 33 one state representative from each of the two major political
  6 34 parties appointed by the speaker of the house, one state
  6 35 senator from each of the two major political parties appointed
  7  1 by the president of the senate, after consultation with the
  7  2 majority leader and the minority leader of the senate, each
  7  3 for a term of two years; four public representatives,
  7  4 appointed by the governor for staggered terms of two years
  7  5 each, none of whom shall be members of, or practitioners of,
  7  6 or have a pecuniary interest in any of the professions or
  7  7 businesses represented by any of the several professional
  7  8 groups and associations specifically represented on the
  7  9 council under this subsection, and at least one of whom shall
  7 10 be a recipient of medical assistance; the director of public
  7 11 health, or a representative designated by the director; and
  7 12 the dean of the college of medicine, university of Iowa, or a
  7 13 representative designated by the dean.  
  7 14    Sec. 15.  NEW SECTION.  514C.8  SERVICES PROVIDED BY
  7 15 LICENSED PHYSICIAN ASSISTANTS AND LICENSED ADVANCED REGISTERED
  7 16 NURSE PRACTITIONERS.
  7 17    Notwithstanding section 514C.6, a policy, contract, or plan
  7 18 providing for third-party payment or prepayment of health or
  7 19 medical expenses shall include a provision for the payment of
  7 20 necessary medical or surgical care and treatment provided by a
  7 21 physician assistant licensed pursuant to chapters 147 and
  7 22 148C, or provided by an advanced registered nurse practitioner
  7 23 licensed pursuant to chapters 147 and 152, if performed within
  7 24 the scope of the licensed physician assistant's license or the
  7 25 licensed advanced registered nurse practitioner's license and
  7 26 the policy, contract, or plan would pay for the care and
  7 27 treatment if the care and treatment were provided by a person
  7 28 engaged in the practice of medicine or surgery as licensed
  7 29 under chapter 148 or 150A.  The policy, contract, or plan
  7 30 shall provide that insureds or enrollees under the policy,
  7 31 contract, or plan may reject the coverage for services which
  7 32 may be provided by a licensed physician assistant or a
  7 33 licensed advanced registered nurse practitioner if the
  7 34 coverage is rejected for all providers of similar services.
  7 35 The terms and conditions under which physician assistant
  8  1 services or advanced nurse practitioner services are
  8  2 compensated shall not contain practice or supervision
  8  3 restrictions in addition to those already imposed by law as of
  8  4 July 1, 1995.  This section applies to services provided under
  8  5 a policy, contract, or plan issued on or after July 1, 1995,
  8  6 and to an existing policy, contract, or plan on the policy's,
  8  7 contract's, or plan's anniversary or renewal date, or upon the
  8  8 expiration of the applicable collective bargaining contract,
  8  9 if any, whichever is later.  This section does not apply to
  8 10 enrollees eligible for coverage under Title XVIII of the
  8 11 federal Social Security Act or any other similar coverage
  8 12 under a state or federal government plan.
  8 13    Sec. 16.  Sections 148C.5A and 148C.6A, Code 1995, are
  8 14 repealed.  
  8 15                           EXPLANATION
  8 16    Section 135B.7 is amended to prohibit a hospital from
  8 17 denying clinical privileges to licensed physician assistants
  8 18 or licensed advanced registered nurse practitioners solely by
  8 19 reason of the license held by the physician assistant or
  8 20 advanced registered nurse practitioner or solely by reason of
  8 21 the school or institution where the physician assistant or
  8 22 advanced registered nurse practitioner was trained.
  8 23    Section 147.14, subsection 12, which designates the makeup
  8 24 of the board of physician assistant examiners, is amended to
  8 25 increase the number of physician assistants on the board from
  8 26 three to five members, and increasing the number from two to
  8 27 three of these members which must practice in counties with
  8 28 population of less than 50,000.
  8 29    Section 147.107, subsection 5, is amended to conform to the
  8 30 amendment of section 148C.7, and to strike language requiring
  8 31 that certain rules be adopted by January 1, 1993.
  8 32    Section 148.13 is amended by striking language that the
  8 33 board of medical examiners is to adopt rules setting forth the
  8 34 criteria for determining the ineligibility of a physician to
  8 35 serve as a supervising physician for a physician assistant,
  9  1 and language which provides that a decision of the board of
  9  2 physician assistant examiners in a contested case may be
  9  3 appealed to the board of medical examiners.
  9  4    Section 148C.1 is amended by striking the definition of
  9  5 "review group" to conform with the repeal of section 148C.7.
  9  6    Section 148C.3 is amended to strike language regarding the
  9  7 registration of physician assistants and provide that
  9  8 physician assistants are to be licensed.  A new subsection is
  9  9 added to provide that the board may issue an inactive license
  9 10 under conditions as prescribed by the board of physician
  9 11 assistant examiners.
  9 12    Section 148C.4 is amended to provide that a physician
  9 13 assistant may provide medical services under the supervision
  9 14 of any physician.  Currently, the supervising physician or
  9 15 physicians must be specified in the physician assistant's
  9 16 license.
  9 17    Section 148C.7 is amended to strike language establishing
  9 18 the physician assistant rules review group.
  9 19    Section 148C.11 is amended to strike a reference to
  9 20 registered physician assistants.
  9 21    Section 148E.8, which relates to the registration of
  9 22 persons engaged in the practice of acupuncture, is amended to
  9 23 exclude the application of that chapter to a licensed
  9 24 physician assistant.
  9 25    Section 148E.10 is amended to include licensed physician
  9 26 assistants as a professional which may evaluate another
  9 27 person's condition before that other person undergoes
  9 28 acupuncture.
  9 29    Section 249A.4, subsection 8, is amended to add
  9 30 representatives of the Iowa physician assistant society and
  9 31 the Iowa nurse practitioners association to the council with
  9 32 which the director of human services is to consult with
  9 33 respect to the administration of chapter 249A.
  9 34    New section 514C.8 is created and requires insurance
  9 35 companies and other third-party payors to provide
 10  1 reimbursement for services provided by a licensed physician
 10  2 assistant or licensed advanced registered nurse practitioner
 10  3 if reimbursement for such services would be provided by a
 10  4 person engaged in the practice of medicine or surgery as
 10  5 licensed under chapter 148 or 150A.
 10  6    Sections 148C.5A and 148C.6A are repealed.  Section 148C.5A
 10  7 provides for the consultation with and consideration of the
 10  8 advice of the board of medical examiners by the board of
 10  9 physician assistant examiners when determining whether or not
 10 10 to initiate a disciplinary proceeding.  Section 148C.6A
 10 11 provides for the appeal of a decision in a contested case
 10 12 proceeding before the board of physician assistant examiners
 10 13 to the board of medical examiners.  
 10 14 LSB 1907SS 76
 10 15 mj/cf/24.2
     
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