ARC 1909C
PROFESSIONAL LICENSURE DIVISION[645]
Adopted and Filed
Pursuant to the authority of Iowa Code section 148C.3, the Board of Physician Assistants hereby amends Chapter 327, “Practice of Physician Assistants,” Iowa Administrative Code.
This rule making removes the requirement that a physician assistant (PA) who is practicing in a remote medical site must have a supervising physician physically visit and practice at the remote medical site at least every two weeks.
The current requirement that physicians leave their practice and travel to remote medical sites creates a financial burden. With advances in technology, the need for supervising physicians to be physically present has changed. With enhancements in medical care, including electronic medical records, cell phones, fax, and real-time audiovisual interaction via electronic means, appropriate supervision can occur effectively when the physician is not physically present at the practice location. In addition, effective July 11, 2014, the federal requirement that a physician be physically on site in a rural health clinic every two weeks was removed. Compared to the site visitation requirements of surrounding states, Iowa’s site visitation requirement is the most restrictive. This rule making seeks to bring Iowa’s requirements up to date with advances in technology and current national practice standards.
Notice of Intended Action was published in the Iowa Administrative Bulletin on November 26, 2014, as ARC 1741C. A public hearing was held on December 16, 2014.
The Board received 12 written comments. Comments received at the public hearing mirrored submitted written comments. Comments in support of the rule making were received from the Iowa Physician Assistant Society; the American Academy of Physician Assistants; Iowa Specialty Hospital; individual PAs and a physician. Comments in support of the rule making noted that the federal requirement for on-site visits every two weeks has been removed; that PAs in the surrounding states of Minnesota, Wisconsin, Illinois, and South Dakota practice without the on-site requirement; that technology has advanced sufficiently to allow for appropriate supervision and consultation; and that removal of a one-size-fits-all requirement would allow the physician/physician assistant team greater flexibility to meet the health care needs of Iowans. Comments in opposition to the rule making were received from the Polk County Medical Society, Iowa Board of Medicine, Iowa Academy of Family Physicians, Iowa Osteopathic Medical Association, Cedar Rapids Physician Hospital Organization, and Iowa Medical Society. Comments in opposition noted that one visit every two weeks was an absolute minimum; that telehealth alone is insufficient to ensure a PA’s competency and to provide appropriate oversight; that the on-site visit does not create a financial burden; and that the rule making does not set clear minimum expectations so that the public is assured that supervision is occurring.
The Board reviewed all public comment at its meeting on January 21, 2015. After discussion, the Board determined that the supervision requirements of subrules 326.8(4) and 327.1(1) clearly set out supervision expectations. The Board voted to adopt the amendment without making any changes to the Noticed rule making.
This amendment is identical to that published under Notice.
The amendment is subject to the waiver provisions at 645—Chapter 18.
The Iowa Board of Physician Assistants adopted this amendment on January 21, 2015.
After analysis and review of this rule making, there is a potential for a positive impact on jobs with increased utilization of physician assistants in rural health clinics.
This amendment is intended to implement Iowa Code section 148C.3.
This amendment will become effective April 22, 2015.
The following amendment is adopted.
	Amend subrule 327.4(2) as follows:
	327.4(2) A supervising physician must visit a remote site to provide additional medical direction, medical services and consultation at least every two weeks or less frequently as specified in special circumstances in accordance with the requirements in 645—subrule 326.8(4) and subrule 327.1(1). When visits are less frequent than every two weeks in unusual or emergency circumstances, the board shall be notified in writing of these circumstances.
[Filed 2/16/15, effective 4/22/15]
[Published 3/18/15]
Editor’s Note: For replacement pages for IAC, see IAC Supplement 3/18/15.