ARC 4664C
PROFESSIONAL LICENSURE DIVISION[645]
Notice of Intended Action
Proposing rule making related to medical services provided by physician assistants and providing an opportunity for public comment
The Board of Physician Assistants hereby proposes to amend Chapter 326, “Licensure of Physician Assistants,” Iowa Administrative Code.
Legal Authority for Rule Making
This rule making is proposed under the authority provided in Iowa Code sections 17A.3 and 147.76.
State or Federal Law Implemented
This rule making implements, in whole or in part, Iowa Code chapter 148C.
Purpose and Summary
Subrule 327.1(1) of the Board’s rules discusses medical services that may be provided by a physician assistant. Subparagraph 327.1(1)“s”(2) instructs that a physician assistant may not prescribe Schedule II controlled substances which are listed as depressants in Iowa Code chapter 124. Physician assistants may, however, order Schedule II controlled substances listed as depressants in Iowa Code chapter 124 but only with the prior approval and direction of a supervising physician. The Board received a question about the distinction between ordering and prescribing with respect to subrule 327.1(1). This proposed rule making provides four definitions to clarify the distinction between ordering and prescribing Schedule II controlled substances which are listed as depressants in Iowa Code chapter 124.
Fiscal Impact
This rule making has no fiscal impact to the State of Iowa.
Jobs Impact
After analysis and review of this rule making, no impact on jobs has been found.
Waivers
A waiver provision is not included in this rule making because all administrative rules of the professional licensure boards in the Professional Licensure Division are subject to the waiver provisions accorded under 645—Chapter 18.
Public Comment
Any interested person may submit written comments concerning this proposed rule making. Written comments in response to this rule making must be received by the Division no later than 4:30 p.m. on October 15, 2019. Comments should be directed to:

Susan Reynolds
Professional Licensure Division
Iowa Department of Public Health
Lucas State Office Building
321 East 12th Street
Des Moines, Iowa 50319
Email: susan.reynolds@idph.iowa.gov	
Public Hearing
A public hearing at which persons may present their views orally or in writing will be held as follows:

October 15, 2019
8 to 8:30 a.m.	Fifth Floor Board Conference Room 526
Lucas State Office Building
Des Moines, Iowa	
Persons who wish to make oral comments at the public hearing may be asked to state their names for the record and to confine their remarks to the subject of this proposed rule making. In an effort to ensure accuracy in memorializing a person’s comments, a person may provide written comments in addition to or in lieu of oral comments at the hearing.
Any persons who intend to attend the public hearing and have special requirements, such as those related to hearing or mobility impairments, should contact the Board and advise of specific needs.
Review by Administrative Rules Review Committee
The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making at its regular monthly meeting or at a special meeting. The Committee’s meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).
The following rule-making action is proposed:
	Amend rule 645—326.1(148C) as follows:
645—326.1(148C) Definitions.
“Active license” means a license that is current and has not expired.
“Administer” means the direct application of a drug, whether by injection, inhalation, ingestion, or any other means, to the body of a patient or research subject.
“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, by its successor, the Commission on Accreditation of Allied Health Education Programs, or by its successor, the Accreditation Review Commission on Education for the Physician Assistant, or its successor.
“Board” means the board of physician assistants.
“CME” means continuing medical education.
“Department” means the department of public health.
“Direction” means authoritative policy or procedural guidance for the accomplishment of a function or activity.
“Dispense” means the delivery of a drug or device to an ultimate user or the ultimate user’s agent.
“Grace period” means the 30-day period following expiration of a license when the license is still considered to be active. In order to renew a license during the grace period, a licensee is required to pay a late fee.
“Inactive license” means a license that has expired because it was not renewed by the end of the grace period. The category of “inactive license” may include licenses formerly known as lapsed, inactive, delinquent, closed, or retired.
“Licensee” means a person licensed by the board as a physician assistant to provide medical services under the supervision of one or more physicians.
“Licensure by endorsement” means the issuance of an Iowa license to practice as a physician assistant to an applicant who is or has been licensed in another state.
“Locum tenens” means the temporary substitution of one licensed physician assistant for another.
“Mandatory training” means training on identifying and reporting child abuse or dependent adult abuse required of physician assistants who are mandatory reporters. The full requirements on mandatory reporting of child abuse and the training requirements are found in Iowa Code section 232.69. The full requirements on mandatory reporting of dependent adult abuse and the training requirements are found in Iowa Code section 235B.16.
“NCCPA” means the National Commission on Certification of Physician Assistants.
“Opioid” means a drug that produces an agonist effect on opioid receptors and is indicated or used for the treatment of pain.
“Order” means the issuance of a written, electronic, facsimile, or oral order for a drug to be administered.
“Physician” means a person who is currently licensed in Iowa to practice medicine and surgery, osteopathic medicine and surgery, or osteopathy. 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.
“Physician assistant” means a person licensed as a physician assistant by the board.
“Prescribe” means the issuance of a written, electronic, facsimile, or oral order for a drug to be dispensed.
“Prescription monitoring program database” or “PMP database” means the Iowa prescription monitoring program database administered by the Iowa board of pharmacy pursuant to Iowa Code chapter 124, subchapter VI, and 657—Chapter 37.
“Reactivate” or “reactivation” means the process as outlined in rule 645—326.19(17A,147,272C) by which an inactive license is restored to active status.
“Reinstatement” means the process as outlined in 645—11.31(272C) by which a licensee who has had a license suspended or revoked or who has voluntarily surrendered a license may apply to have the license reinstated, with or without conditions. Once the license is reinstated, the licensee may apply for active status.
“Remote medical site” means a medical clinic for ambulatory patients which is away from the main practice location of a supervising physician and in which a supervising physician is present less than 50 percent of the time the site is open. “Remote medical site” will not apply to nursing homes, patient homes, hospital outpatient departments, outreach clinics, or any location at which medical care is incidentally provided (e.g., diet center, free clinic, site for athletic physicals, jail facility).
“Supervising physician” means a physician who supervises the medical services provided by the physician assistant and who accepts ultimate responsibility for the medical care provided by the physician/physician assistant team.
“Supervision” means that a supervising physician retains ultimate responsibility for patient care, although a physician need not be physically present at each activity of the physician assistant or be specifically consulted before each delegated task is performed. Supervision shall not be construed as requiring the personal presence of a supervising physician at the place where such services are rendered except insofar as the personal presence is expressly required by these rules or by Iowa Code chapter 148C.
“Supply prescription drugs” means to deliver to a patient or the patient’s representative a quantity of prescription drugs or devices that are properly packaged and labeled.