Senate Study Bill 1093 - Introduced SENATE FILE _____ BY (PROPOSED COMMITTEE ON HUMAN RESOURCES BILL BY CHAIRPERSON MATHIS) A BILL FOR An Act relating to prescription authority for certain 1 psychologists and making penalties applicable. 2 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 3 TLSB 1910SC (2) 86 rh/nh
S.F. _____ Section 1. Section 123.3, subsection 35, Code 2015, is 1 amended to read as follows: 2 35. “Pharmacy” means a drug store in which drugs and 3 medicines are exposed for sale and sold at retail, or in which 4 prescriptions of licensed physicians and surgeons, dentists, 5 prescribing psychologists, or veterinarians are compounded and 6 sold by a registered pharmacist. 7 Sec. 2. Section 124.101, subsection 26, paragraph a, Code 8 2015, is amended to read as follows: 9 a. A physician, dentist, podiatric physician, prescribing 10 psychologist, veterinarian, scientific investigator or 11 other person licensed, registered , or otherwise permitted to 12 distribute, dispense, conduct research with respect to , or to 13 administer a controlled substance in the course of professional 14 practice or research in this state. 15 Sec. 3. Section 147.107, subsections 1 and 2, Code 2015, are 16 amended to read as follows: 17 1. A person, other than a pharmacist, physician, 18 dentist, podiatric physician, prescribing psychologist, or 19 veterinarian who dispenses as an incident to the practice of 20 the practitioner’s profession, shall not dispense prescription 21 drugs or controlled substances. 22 2. a. A pharmacist, physician, dentist, or podiatric 23 physician , or prescribing psychologist who dispenses 24 prescription drugs, including but not limited to controlled 25 substances, for human use, may delegate nonjudgmental 26 dispensing functions to staff assistants only when verification 27 of the accuracy and completeness of the dispensing is 28 determined by the pharmacist or practitioner in the 29 pharmacist’s or practitioner’s physical presence. However, the 30 physical presence requirement does not apply when a pharmacist 31 or practitioner is utilizing an automated dispensing system or 32 when a pharmacist is utilizing a tech-check-tech program, as 33 defined in section 155A.3 . When using an automated dispensing 34 system the pharmacist or practitioner shall utilize an 35 -1- LSB 1910SC (2) 86 rh/nh 1/ 11
S.F. _____ internal quality control assurance plan that ensures accuracy 1 for dispensing. When using a tech-check-tech program the 2 pharmacist shall utilize an internal quality control assurance 3 plan, in accordance with rules adopted by the board of 4 pharmacy, that ensures accuracy for dispensing. Verification 5 of automated dispensing and tech-check-tech accuracy and 6 completeness remains the responsibility of the pharmacist or 7 practitioner and shall be determined in accordance with rules 8 adopted by the board of pharmacy, the board of medicine, the 9 dental board, and the board of podiatry , and the board of 10 psychology for their respective licensees. 11 b. A dentist, physician, or podiatric physician , or 12 prescribing psychologist who dispenses prescription drugs, 13 other than drug samples, pursuant to this subsection , shall 14 report the fact that they dispense prescription drugs with the 15 practitioner’s respective board at least biennially. 16 c. A physician, dentist, or podiatric physician , or 17 prescribing psychologist who dispenses prescription drugs, 18 other than drug samples, pursuant to this subsection , shall 19 offer to provide the patient with a written prescription that 20 may be dispensed from a pharmacy of the patient’s choice or 21 offer to transmit the prescription orally, electronically, or 22 by facsimile in accordance with section 155A.27 to a pharmacy 23 of the patient’s choice. 24 Sec. 4. NEW SECTION . 148.13A Authority of board as to 25 supervising physicians under chapter 154B. 26 The board of medicine shall establish by rule specific 27 procedures for consulting with and considering the advice of 28 the board of psychology in determining whether to initiate 29 a disciplinary proceeding under chapter 17A against a 30 licensed physician in a matter involving the supervision of a 31 psychologist prescribing medication pursuant to a conditional 32 prescription certificate under chapter 154B. 33 Sec. 5. Section 154B.1, Code 2015, is amended to read as 34 follows: 35 -2- LSB 1910SC (2) 86 rh/nh 2/ 11
S.F. _____ 154B.1 Definition Definitions . 1 As used in this chapter, unless the context otherwise 2 requires: 3 1. “Board” means the board of psychology created under 4 chapter 147. 5 2. “Collaborative relationship” means a cooperative 6 working relationship between a prescribing psychologist or a 7 psychologist with a conditional prescription certificate and a 8 licensed physician in the provision of patient care, including 9 diagnosis and cooperation in the management and delivery of 10 physical and mental health care. 11 3. “Conditional prescription certificate” means a document 12 issued by the board to a licensed psychologist that permits 13 the holder to prescribe psychotropic medication under the 14 supervision of a licensed physician pursuant to this chapter. 15 4. “Practice of psychology” means the application of 16 established principles of learning, motivation, perception, 17 thinking, and emotional relations to problems of behavior 18 adjustment, group relations, and behavior modification, 19 by persons trained in psychology for compensation or other 20 personal gain. The application of principles includes , but 21 is not limited to: Counseling and the use of psychological 22 remedial measures with persons, in groups or individually, 23 with adjustment or emotional problems in the areas of work, 24 family, school , and personal relationships; measuring and 25 testing personality, intelligence, aptitudes, public opinion, 26 attitudes, and skills; and the teaching of such subject matter, 27 and the conducting of research on the problems relating to 28 human behavior. 29 5. “Prescribing psychologist” means a licensed psychologist 30 who holds a valid prescription certificate. 31 6. “Prescription certificate” means a document issued by the 32 board to a licensed psychologist that permits the holder to 33 prescribe psychotropic medication pursuant to this chapter. 34 7. “Psychotropic medication” means a controlled substance 35 -3- LSB 1910SC (2) 86 rh/nh 3/ 11
S.F. _____ or dangerous drug that may not be dispensed or administered 1 without a prescription and whose primary indication for use 2 has been approved by the federal food and drug administration 3 for the treatment of mental disorders and is listed as a 4 psychotherapeutic agent in drug facts and comparisons or in the 5 American hospital formulary service. 6 Sec. 6. NEW SECTION . 154B.9 Drugs —— medicines. 7 1. Except as provided in subsections 2 and 3, a psychologist 8 shall not administer or prescribe drugs or medicine. 9 2. A licensed psychologist holding a conditional 10 prescription certificate may prescribe psychotropic medication 11 under the supervision of a licensed physician pursuant to this 12 chapter. 13 3. A prescribing psychologist may prescribe psychotropic 14 medication pursuant to this chapter. 15 Sec. 7. NEW SECTION . 154B.10 Conditional prescription 16 certificate. 17 1. An applicant for a conditional prescription certificate 18 shall be granted a certificate by the board if the applicant 19 satisfies all of the following requirements: 20 a. Holds a current license to practice psychology in this 21 state. 22 b. Completed pharmacological training from an institution 23 approved by the board or from a provider of continuing 24 education approved by the board. 25 c. Passed a national certification examination approved by 26 the board that tested the applicant’s knowledge of pharmacology 27 in the diagnosis, care, and treatment of mental disorders. 28 d. Within five years immediately preceding the date of 29 application, successfully completed an organized program of 30 education consisting of intensive didactic instruction of no 31 fewer than four hundred fifty classroom hours in at least the 32 following core areas of instruction: 33 (1) Neuroscience. 34 (2) Pharmacology. 35 -4- LSB 1910SC (2) 86 rh/nh 4/ 11
S.F. _____ (3) Psychopharmacology. 1 (4) Physiology. 2 (5) Appropriate and relevant physical and laboratory 3 assessment. 4 e. Within five years immediately preceding the date of 5 application, has been certified by the applicant’s supervising 6 psychiatrist or physician as having successfully completed 7 a supervised and relevant clinical experience of no less 8 than an eighty-hour practicum in clinical assessment and 9 pathophysiology and an additional supervised practicum of at 10 least four hundred hours treating no fewer than one hundred 11 patients with mental disorders. The practica shall have been 12 supervised by a psychiatrist or other appropriately trained 13 physician. The board shall determine whether the practica is 14 sufficient to competently train the applicant in the treatment 15 of a diverse patient population. 16 f. Possesses malpractice insurance in place that will cover 17 the applicant during the period the conditional prescription 18 certificate is in effect. 19 g. Meets all other requirements, as determined by rules 20 adopted by the board, for obtaining a conditional prescription 21 certificate. 22 2. A conditional prescription certificate is valid for two 23 years, at the end of which the holder may apply again pursuant 24 to the provisions of subsection 1. 25 3. A psychologist with a conditional prescription 26 certificate may prescribe psychotropic medication under the 27 supervision of a licensed physician subject to all of the 28 following conditions: 29 a. The psychologist shall continue to hold a current license 30 to practice psychology in this state and continue to maintain 31 malpractice insurance. 32 b. The psychologist shall inform the board of the name of 33 the physician under whose supervision the psychologist will 34 prescribe psychotropic medication and promptly inform the board 35 -5- LSB 1910SC (2) 86 rh/nh 5/ 11
S.F. _____ of any change of the supervising physician. 1 c. A physician supervising a psychologist prescribing 2 psychotropic medication pursuant to a conditional prescription 3 certificate shall be subject to disciplinary action pursuant to 4 section 148.13A for the acts and omissions of the psychologist 5 while under the physician’s supervision. This provision 6 does not relieve the psychologist from liability for the 7 psychologist’s acts and omissions. 8 Sec. 8. NEW SECTION . 154B.11 Prescription certificate. 9 1. An applicant for a prescription certificate shall be 10 granted a certificate by the board if the applicant satisfies 11 all of the following requirements: 12 a. Possesses a conditional prescription certificate and has 13 successfully completed one year of prescribing psychotropic 14 medication as certified by the supervising licensed physician. 15 b. Holds a current license to practice psychology in this 16 state. 17 c. Possesses malpractice insurance that will cover the 18 applicant as a prescribing psychologist. 19 d. Meets all other requirements, as determined by rules 20 adopted by the board, for obtaining a prescription certificate. 21 2. A psychologist with a prescription certificate may 22 prescribe psychotropic medication pursuant to the provisions of 23 this chapter subject to the following conditions: 24 a. The psychologist continues to hold a current license to 25 practice psychology in this state and maintains malpractice 26 insurance. 27 b. The psychologist annually satisfies the continuing 28 education requirements for prescribing psychologists, as 29 determined by the board, which shall be no fewer than twenty 30 hours each year. 31 Sec. 9. NEW SECTION . 154B.12 Prescribing practices. 32 1. A prescribing psychologist or a psychologist with 33 a conditional prescription certificate may administer and 34 prescribe psychotropic medication within the scope of the 35 -6- LSB 1910SC (2) 86 rh/nh 6/ 11
S.F. _____ psychologist’s profession, including the ordering and review of 1 laboratory tests in conjunction with the prescription, for the 2 treatment of mental disorders. 3 2. When prescribing psychotropic medication for a 4 patient, the prescribing psychologist or the psychologist 5 with a conditional prescription certificate shall maintain 6 an ongoing collaborative relationship with the licensed 7 physician who oversees the patient’s general medical care to 8 ensure that necessary medical examinations are conducted, 9 the psychotropic medication is appropriate for the patient’s 10 medical condition, and significant changes in the patient’s 11 medical or psychological condition are discussed. 12 3. A prescription written by a prescribing psychologist or a 13 psychologist with a conditional prescription certificate shall 14 meet all of the following requirements: 15 a. Comply with applicable state and federal laws. 16 b. Be identified as issued by the psychologist as 17 “psychologist certified to prescribe”. 18 c. Include the psychologist’s board-assigned identification 19 number. 20 4. A prescribing psychologist or a psychologist with 21 a conditional prescription certificate shall not delegate 22 prescriptive authority to any other person. Records of all 23 prescriptions shall be maintained in patient records. 24 5. When authorized to prescribe controlled substances, a 25 prescribing psychologist or a psychologist with a conditional 26 prescription certificate shall file with the board in a 27 timely manner all individual federal drug enforcement agency 28 registration and numbers. The board shall maintain current 29 records on every psychologist, including federal registration 30 and numbers. 31 Sec. 10. NEW SECTION . 154B.13 Board duties regarding 32 prescription certificates and conditional prescription 33 certificates. 34 1. The board shall adopt rules providing for the 35 -7- LSB 1910SC (2) 86 rh/nh 7/ 11
S.F. _____ procedures to obtain a conditional prescription certificate, 1 a prescription certificate, and renewals of a prescription 2 certificate. The board may set reasonable application and 3 renewal fees. 4 2. The board shall adopt rules establishing the grounds for 5 denial, suspension, or revocation of conditional prescription 6 certificates and prescription certificates, including a 7 provision for suspension or revocation of a license to practice 8 psychology upon suspension or revocation of a certificate. 9 3. The board shall provide to the board of pharmacy an 10 annual list of prescribing psychologists and psychologists 11 with conditional prescription certificates that contains 12 the information agreed upon between the board and the board 13 of pharmacy. The board shall promptly notify the board of 14 pharmacy of psychologists who are added to or removed from the 15 list. 16 4. The board shall adopt other rules as necessary to 17 administer this chapter. 18 Sec. 11. Section 155A.3, subsection 35, Code 2015, is 19 amended to read as follows: 20 35. “Practitioner” means a physician, dentist, podiatric 21 physician, prescribing psychologist, veterinarian, or other 22 person licensed or registered to distribute or dispense a 23 prescription drug or device in the course of professional 24 practice in this state or a person licensed by another state 25 in a health field in which, under Iowa law, licensees in this 26 state may legally prescribe drugs. 27 Sec. 12. Section 155A.23, subsection 1, paragraph c, Code 28 2015, is amended to read as follows: 29 c. For the purpose of obtaining a prescription drug or 30 device, falsely assuming the title of or claiming to be 31 a manufacturer, wholesaler, pharmacist, pharmacy owner, 32 physician, dentist, podiatric physician, prescribing 33 psychologist, veterinarian, or other authorized person. 34 Sec. 13. Section 155A.24, subsection 14, Code 2015, is 35 -8- LSB 1910SC (2) 86 rh/nh 8/ 11
S.F. _____ amended to read as follows: 1 14. This section does not prevent a licensed practitioner of 2 medicine, dentistry, podiatry, nursing, psychology, veterinary 3 medicine, optometry, or pharmacy from acts necessary in the 4 ethical and legal performance of the practitioner’s profession. 5 EXPLANATION 6 The inclusion of this explanation does not constitute agreement with 7 the explanation’s substance by the members of the general assembly. 8 This bill grants prescription authority to certain licensed 9 psychologists under Code chapter 154B. 10 The bill adds definitions of “board”, “collaborative 11 relationship”, “conditional prescription certificate”, 12 “prescribing psychologist”, “prescription certificate”, and 13 “psychotropic medication” to the Code chapter. 14 The bill allows a licensed psychologist holding a 15 conditional prescription certificate and a prescribing 16 psychologist, defined as a licensed psychologist who holds 17 a valid prescription certificate, to prescribe psychotropic 18 medication. However, the psychologist holding a conditional 19 prescription certificate may only prescribe psychotropic 20 medication under the supervision of a licensed physician. 21 The bill sets the requirements for a psychologist to obtain 22 a conditional prescription certificate or a prescription 23 certificate. A conditional prescription certificate is 24 valid for two years and a psychologist may reapply for the 25 certificate. To receive a prescription certificate, a 26 psychologist must complete one year of prescribing psychotropic 27 medication as supervised by a licensed physician. The licensed 28 physician may be subject to disciplinary action for the 29 acts and omissions of the psychologist under the physician’s 30 supervision. A psychologist must maintain licensure as 31 a psychologist and malpractice insurance to retain the 32 prescription certificate or the conditional prescription 33 certificate. 34 The bill provides that a prescribing psychologist or 35 -9- LSB 1910SC (2) 86 rh/nh 9/ 11
S.F. _____ psychologist with a conditional prescription certificate may 1 administer and prescribe psychotropic medication within the 2 scope of the person’s profession. The prescribing psychologist 3 or psychologist with a conditional prescription certificate 4 must maintain a relationship with the patient’s licensed 5 physician when prescribing psychotropic medication for the 6 patient. 7 The bill states that a prescription written by a 8 prescribing psychologist or a psychologist with a conditional 9 prescription certificate must comply with state and federal 10 law, be identified as issued by a “psychologist certified to 11 prescribe”, and include the psychologist’s board-assigned 12 identification number. A prescribing psychologist or 13 psychologist with a conditional prescription certificate 14 may not delegate the prescriptive authority to any other 15 person, and records of the prescriptions must be maintained 16 in the patient’s records. The prescribing psychologist or 17 psychologist with a conditional prescription certificate must 18 also file federal drug enforcement agency registrations and 19 numbers with the board. 20 The bill instructs the board of psychology to adopt rules 21 providing for the procedures for obtaining a conditional 22 prescription certificate, a prescription certificate, and 23 renewal of the prescription certificate. The board may 24 also set a reasonable application and renewal fee. The 25 board must adopt rules regarding the denial, suspension, 26 or revocation of conditional prescription certificates and 27 prescription certificates. The board must provide the board of 28 pharmacy with an annual list of prescribing psychologists and 29 psychologists with conditional prescription certificates and 30 promptly notify the board of pharmacy of psychologists who are 31 added to or removed from the list. 32 A prescribing psychologist may be subject to criminal and 33 civil penalties and licensing sanctions under Code chapters 34 124, 147, 154B, and 155A. 35 -10- LSB 1910SC (2) 86 rh/nh 10/ 11
S.F. _____ The bill makes conforming changes in Code chapters 123, 124, 1 147, and 155A. 2 -11- LSB 1910SC (2) 86 rh/nh 11/ 11