653—19.11(17A,124,147,148,154B,272C) Standards of practice—collaboration with a prescribing psychologist. A collaborating physician shall be a person who is licensed to practice medicine and surgery or osteopathic medicine in Iowa, who regularly prescribes psychotropic medications for the treatment of mental disorders as part of the physician’s normal course of practice, and who serves as a resource for a prescribing psychologist pursuant to a collaborative practice agreement. A collaborating physician shall be board-certified in family medicine, internal medicine, neurology, pediatrics, or psychiatry. A collaborating physician shall fully comply with the following standards of practice:
	19.11(1) Collaboration. A collaborating physician shall provide appropriate collaboration with a prescribing psychologist to achieve patient safety and optimal clinical outcomes. A collaborating physician shall ensure that appropriate clinical examinations and necessary testing are performed and that all psychopharmacology services provided are appropriate for the patient’s condition. Collaboration may be in person or via electronic communications in accordance with these rules. A prescribing psychologist may have more than one collaborating physician.
	19.11(2) Maximum number of prescribing psychologists. A physician shall not serve as a collaborating physician for more than two prescribing psychologists at one time.
	19.11(3) Initial assessment. Prior to serving as a collaborating physician, a physician shall assess a prescribing psychologist’s relevant education, training, experience, and competence.
	19.11(4) Scope of practice. A collaborating physician shall ensure that all psychopharmacology services provided by a prescribing psychologist are within the competence and scope of practice of the collaborating physician and the prescribing psychologist.
	19.11(5) Prescriptive authority. A collaborating physician shall ensure that a prescribing psychologist only prescribes psychotropic medications for the treatment of mental disorders.
	19.11(6) Delegation. A collaborating physician shall ensure that a prescribing psychologist does not delegate prescriptive authority to any other person.
	19.11(7) Narcotics. A collaborating physician shall ensure that a prescribing psychologist does not prescribe narcotics.
	19.11(8) Active DEA and CSA registration. A collaborating physician shall ensure that a prescribing psychologist has an active DEA registration and CSA registration at all times during the period of collaboration.
	19.11(9) Patient populations. A collaborating physician shall ensure that a prescribing psychologist only provides psychopharmacology services to patient populations within the prescribing psychologist’s education, training, experience, and competence. A collaborating physician may establish limitations on the types of populations to whom a prescribing psychologist may provide psychopharmacology services based on the prescribing psychologist’s education, training, experience, and competence.
	19.11(10) Psychotropic medications. A collaborating physician shall ensure that a prescribing psychologist only prescribes psychotropic medications that are within the prescribing psychologist’s education, training, experience, and competence. A collaborating physician may establish limitations on the types of psychotropic medications that a prescribing psychologist may prescribe based on the prescribing psychologist’s education, training, experience, and competence.
	19.11(11) Specialization. A collaborating physician shall ensure that a prescribing psychologist has completed at least one year of the required two years of supervised practice with the respective population in accordance with subrule 19.3(4) before the prescribing psychologist provides psychopharmacology services to children (less than 17 years of age), elderly persons (over 65 years of age), or patients with serious medical conditions, including but not limited to, heart disease, cancer, stroke, seizures, or comorbid psychological conditions, or patients with developmental disabilities and intellectual disabilities.
	19.11(12) Informed consent. A collaborating physician shall ensure that a prescribing psychologist obtains appropriate informed consent before a prescribing psychologist provides psychopharmacology services to a patient.
	19.11(13) Release of information. A collaborating physician shall ensure that a prescribing psychologist obtains a release of information authorizing the prescribing psychologist to share information with the collaborating physician before the prescribing psychologist provides psychopharmacology services to a patient.
	19.11(14) Primary care physician. A collaborating physician shall ensure that each patient has a designated primary care physician before a prescribing psychologist provides psychopharmacology services to a patient. A collaborating physician shall ensure that a prescribing psychologist maintains a cooperative relationship with the primary care physician who oversees a patient’s general medical care to ensure that necessary medical examinations are conducted, the psychotropic medication is appropriate for the patient’s medical condition, and significant changes in the patient’s medical or psychological condition are discussed. A collaborating physician shall ensure that a prescribing psychologist engages in appropriate consultation with a patient’s designated primary care physician while the prescribing psychologist is providing psychopharmacology services to a patient.
	19.11(15) Chart reviews. A collaborating physician shall personally review a representative sample of the prescribing psychologist’s patient charts.
	19.11(16) Performance evaluations. A collaborating physician shall regularly evaluate the clinical judgment, skills and performance of a prescribing psychologist to safely provide psychopharmacology services to patients and provide appropriate feedback to the prescribing psychologist.
	19.11(17) Collaborative practice agreement. Prior to serving as a collaborating physician for a prescribing psychologist, the collaborating physician shall ensure that the prescribing psychologist has a written collaborative practice agreement in place. A template may be obtained from the boards of medicine and psychology. The collaborative practice agreement shall define the nature and extent of the collaborative relationship and outline specific parameters for review of the collaborative relationship. The collaborative practice agreement shall take into account the collaborating physician’s and prescribing psychologist’s relevant education, training, experience, and competence and the nature and scope of the psychopharmacology services to be provided. The collaborating physician shall review the terms of the collaborative practice agreement with the prescribing psychologist at least once each year. The collaborating physician and prescribing psychologist shall each maintain a copy of the collaborative practice agreement and provide a copy of the agreement to the boards of medicine and psychology upon request. The collaborative practice agreement shall include the following:
	a. 	Prescribing psychologist’s information. The name, license number, DEA registration number, CSA registration number, address, telephone number, email address, and practice locations of the prescribing psychologist.
	b. 	Collaborating physician’s information. The name, license number, DEA registration number, CSA registration number, address, telephone number, email address, and practice locations of the collaborating physician.
	c. 	Period of collaboration. The time period covered by the collaborative practice agreement.
	d. 	Locations and settings. A description of the locations and settings where and with whom collaborative practice will occur.
	e. 	Scope of practice. A description of the scope of practice of the collaborating physician and the prescribing psychologist.
	f. 	Methods of communication. A description of how the collaborating physician and prescribing psychologist may communicate for appropriate collaboration.
	g. 	Initial assessment. A description of the steps the collaborating physician has taken to assess a prescribing psychologist’s relevant education, training, experience, and competence prior to collaborating with a prescribing psychologist.
	h. 	Limitations on psychotropic medications. A description of any limitations on the types of psychotropic medications the prescribing psychologist may prescribe consistent with the collaborating physician’s and prescribing psychologist’s relevant education, training, experience, and competence.
	i. 	Limitations on patient populations. A description of any limitations on the types of populations the prescribing psychologist may treat with psychotropic medications consistent with the collaborating physician’s and prescribing psychologist’s relevant education, training, experience, and competence.
	j. 	Expectations and responsibilities. A description of the expectations and responsibilities of the collaborative relationship.
	k. 	Specialization. A description of the specialized training the prescribing psychologist has completed in order to provide psychopharmacology services to children (less than 17 years of age), elderly persons (over 65 years of age), or patients with serious medical conditions, including but not limited to, heart disease, cancer, stroke, seizures, or comorbid psychological conditions, or patients with developmental disabilities and intellectual disabilities in accordance with subrule 19.3(4).
	l. 	Chart reviews. A description of the steps the collaborating physician has taken to personally review a representative sample of the prescribing psychologist’s patient charts.
	m. 	Consultation between the collaborating physician and the primary care provider. A requirement that the collaborating physician consult with the patient’s primary care physician on a regular basis regarding the patient’s psychotropic treatment plan and any potential complications.
	n. 	Performance evaluations. A description of the steps the collaborating physician has taken to regularly evaluate the clinical judgment, skills and performance of the prescribing psychologist to safely provide psychopharmacology services to patients and provide appropriate feedback to the prescribing psychologist.
	o. 	Termination of the collaborative practice agreement. A provision describing how the collaborative practice agreement may be terminated and the process for notifying affected patients.
	p. 	Signatures. Signatures of the collaborating physician and the prescribing psychologist.
[ARC 4835C, IAB 12/18/19, effective 1/22/20]