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Senate Study Bill 1142 - IntroducedA Bill ForAn Act 1relating to the practice of physician assistants without
2supervision by a physician.
3BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1 Section 1. Section 135.24, subsection 7, paragraph d, Code
22023, is amended to read as follows:
3d. “Health care provider” means a physician licensed under
4chapter 148; a chiropractor licensed under chapter 151; a
5physical therapist licensed pursuant to chapter 148A; an
6occupational therapist licensed pursuant to chapter 148B;
7a podiatrist licensed pursuant to chapter 149; a physician
8assistant licensed and practicing under a supervising physician
9pursuant to chapter 148C; a licensed practical nurse, a
10registered nurse, or an advanced registered nurse practitioner
11licensed pursuant to chapter 152 or 152E; a respiratory
12therapist licensed pursuant to chapter 152B; a dentist, dental
13hygienist, or dental assistant registered or licensed to
14practice under chapter 153; an optometrist licensed pursuant
15to chapter 154; a psychologist licensed pursuant to chapter
16154B; a social worker licensed pursuant to chapter 154C; a
17mental health counselor, marital and family therapist, behavior
18analyst, or assistant behavior analyst licensed pursuant to
19chapter 154D; a speech pathologist or audiologist licensed
20pursuant to chapter 154F; a pharmacist licensed pursuant to
21chapter 155A; or an emergency medical care provider certified
22pursuant to chapter 147A.
23 Sec. 2. Section 135G.1, subsection 8, Code 2023, is amended
24to read as follows:
258. “Physician assistant” means a person licensed to practice
26 under the supervision of a physician as authorized in chapters
27147 and chapter 148C.
28 Sec. 3. Section 135P.1, subsection 2, Code 2023, is amended
29to read as follows:
302. “Health care provider” means a physician or osteopathic
31physician licensed under chapter 148, a physician assistant
32licensed and practicing under a supervising physician pursuant
33to chapter 148C, a podiatrist licensed under chapter 149, a
34chiropractor licensed under chapter 151, a licensed practical
35nurse, a registered nurse, or an advanced registered nurse
-1-1practitioner licensed under chapter 152 or 152E, a dentist
2licensed under chapter 153, an optometrist licensed under
3chapter 154, a pharmacist licensed under chapter 155A, or
4any other person who is licensed, certified, or otherwise
5authorized or permitted by the law of this state to administer
6health care in the ordinary course of business or in the
7practice of a profession.
8 Sec. 4. Section 147.14, subsection 1, paragraph l, Code
92023, is amended to read as follows:
10l. For the board of physician assistants, five members
11licensed to practice as physician assistants, at least two of
12whom practice in counties with a population of less than fifty
13thousand, one member licensed to practice medicine and surgery
14who supervises collaborates with a physician assistant, one
15member licensed to practice osteopathic medicine and surgery
16who supervises collaborates with a physician assistant, and two
17members who are not licensed to practice either medicine and
18surgery or osteopathic medicine and surgery or licensed as a
19physician assistant and who shall represent the general public.
20At least one of the physician or osteopathic physician members
21shall be in practice in a county with a population of less than
22fifty thousand.
23 Sec. 5. Section 147.107, subsection 4, Code 2023, is amended
24to read as follows:
254. A Notwithstanding subsection 1 and any other provision
26of this section to the contrary, a physician assistant may
27prescribe, dispense, order, administer, or procure prescription
28drugs, controlled substances, or medical devices necessary to
29complete a course of therapy pursuant to section 148C.4. Rules
30relating to the authority of physician assistants to prescribe
31drugs, controlled substances, and medical devices pursuant to
32this subsection shall be adopted by the board of physician
33assistants after consultation with the board of medicine and
34board of pharmacy.
35 Sec. 6. Section 147.107, subsections 5 and 6, Code 2023, are
-2-1amended by striking the subsections.
2 Sec. 7. Section 147.136A, subsection 1, paragraph a, Code
32023, is amended to read as follows:
4a. “Health care provider” means a hospital as defined in
5section 135B.1, a health care facility as defined in section
6135C.1, a health facility as defined in section 135P.1, a
7physician or an osteopathic physician licensed under chapter
8148, a physician assistant licensed and practicing under a
9supervising physician under chapter 148C, a podiatrist licensed
10under chapter 149, a chiropractor licensed under chapter 151, a
11licensed practical nurse, a registered nurse, or an advanced
12registered nurse practitioner licensed under chapter 152 or
13152E, a dentist licensed under chapter 153, an optometrist
14licensed under chapter 154, a pharmacist licensed under chapter
15155A, a professional corporation under chapter 496C that is
16owned by persons licensed to practice a profession listed in
17this paragraph, or any other person or entity who is licensed,
18certified, or otherwise authorized or permitted by the law of
19this state to administer health care in the ordinary course of
20business or in the practice of a profession.
21 Sec. 8. Section 147A.10, subsection 3, Code 2023, is amended
22to read as follows:
233. An act of commission or omission of any appropriately
24certified emergency medical care provider, registered nurse,
25or licensed practical nurse, or physician assistant, while
26rendering emergency medical care under the responsible
27supervision and control of a physician to a person who is
28deemed by them to be in immediate danger of serious injury or
29loss of life, shall not impose any liability upon the certified
30emergency medical care provider, registered nurse, licensed
31practical nurse, or physician assistant, the supervising
32physician, physician designee, advanced registered nurse
33practitioner, or any hospital, or upon the state, or any
34county, city or other political subdivision, or the employees
35of any of these entities; provided that this section shall not
-3-1relieve any person of liability for civil damages for any act
2of commission or omission which constitutes recklessness.
3 Sec. 9. Section 148C.1, subsections 5 and 8, Code 2023, are
4amended by striking the subsections.
5 Sec. 10. Section 148C.1, subsection 6, Code 2023, is amended
6to read as follows:
76. “Physician” means a person who is currently licensed in
8Iowa to practice medicine and surgery or osteopathic medicine
9and surgery. Notwithstanding this subsection, a physician
10supervising a physician assistant practicing in a federal
11facility or under federal authority shall not be required to
12obtain licensure beyond licensure requirements mandated by the
13federal government for supervising physicians.
14 Sec. 11. Section 148C.3, subsection 2, Code 2023, is amended
15by striking the subsection.
16 Sec. 12. Section 148C.4, subsections 2 and 3, Code 2023, are
17amended to read as follows:
182. a. Notwithstanding subsection 1, a physician assistant
19licensed pursuant to this chapter or authorized to practice
20in any other state or federal jurisdiction who voluntarily
21and gratuitously, and other than in the ordinary course of
22the physician assistant’s employment or practice, responds to
23a need for medical care created by an emergency or a state
24or local disaster may render such care that the physician
25assistant is able to provide without supervision as described
26in this section or with such supervision as is available.
27b. A physician who supervises a physician assistant
28providing medical care pursuant to this subsection shall not
29be required to meet the requirements of rules adopted pursuant
30to section 148C.3, subsection 2, relating to supervision
31by physicians. A physician providing physician assistant
32supervision pursuant to this subsection or a physician
33assistant, who voluntarily and gratuitously, and other than in
34the ordinary course of the physician assistant’s employment or
35practice, responds to a need for medical care created by an
-4-1emergency or a state or local disaster shall not be subject
2to criminal liability by reason of having issued or executed
3the orders for provided such care, and shall not be liable for
4civil damages for acts or omissions relating to the issuance or
5execution of the orders such care unless the acts or omissions
6constitute recklessness.
73. The degree of collaboration between a physician
8assistant and the appropriate member of a health care team
9shall be determined at the practice level, and may involve
10decisions made by the medical group, hospital service,
11supervising physician, or employer of the physician assistant,
12or the credentialing and privileging system of a licensed
13health care facility. A physician shall be accessible at all
14times for consultation with a physician assistant unless the
15physician assistant is providing emergency medical services
16pursuant to 645 IAC 327.1(1)(n). The supervising physician
17shall have ultimate responsibility for determining the medical
18care provided by the supervising physician-physician assistant
19team. A physician assistant shall be responsible for the
20services performed by the physician assistant.
21 Sec. 13. Section 148F.7, Code 2023, is amended to read as
22follows:
23148F.7 Limitation on provision of care and services.
24A licensed orthotist, prosthetist, or pedorthist may provide
25care or services only if the care or services are provided
26pursuant to an order from a licensed physician, a licensed
27podiatric physician, an advanced registered nurse practitioner
28licensed pursuant to chapter 152 or 152E, or a physician
29assistant who has been delegated the authority to order the
30services of an orthotist, prosthetist, or pedorthist by the
31assistant’s supervising physician licensed under chapter 148C.
32 Sec. 14. Section 154F.2, subsection 1, paragraph a, Code
332023, is amended to read as follows:
34a. Licensed physicians and surgeons, licensed osteopathic
35physicians and surgeons, and licensed physician assistants,
-5-1 and registered nurses acting under the supervision of a
2physician or osteopathic physician, persons conducting hearing
3tests under the direct supervision of a licensed physician
4and surgeon or licensed osteopathic physician and surgeon,
5or students of medicine or surgery or osteopathic medicine
6and surgery pursuing a course of study in a medical school or
7college of osteopathic medicine and surgery approved by the
8board of medicine while performing functions incidental to
9their course of study.
10 Sec. 15. Section 225C.6, subsection 4, paragraph c,
11subparagraph (1), Code 2023, is amended to read as follows:
12(1) A comprehensive set of wraparound services for persons
13who have had or are at imminent risk of having acute or
14crisis mental health symptoms that do not permit the persons
15to remain in or threatens removal of the persons from their
16home and community, but who have been determined by a mental
17health professional and a licensed health care professional,
18subject to the professional’s scope of practice, not to need
19inpatient acute hospital services. For the purposes of this
20subparagraph, “mental health professional” means the same as
21defined in section 228.1 and “licensed health care professional”
22means a person licensed under chapter 148 to practice medicine
23and surgery or osteopathic medicine and surgery, an advanced
24registered nurse practitioner licensed under chapter 152 or
25152E, or a physician assistant licensed to practice under the
26supervision of a physician as authorized in chapters 147 and
27 chapter 148C.
28 Sec. 16. Section 280.16, subsection 1, paragraph d, Code
292023, is amended to read as follows:
30d. “Licensed health care professional” means a person
31licensed under chapter 148 to practice medicine and surgery or
32osteopathic medicine and surgery, an advanced registered nurse
33practitioner licensed under chapter 152 or 152E and registered
34with the board of nursing, or a physician assistant licensed to
35practice under the supervision of a physician as authorized in
-6-1chapters 147 and chapter148C.
2 Sec. 17. Section 489.1102, subsection 2, paragraph b, Code
32023, is amended to read as follows:
4b. Nothing in this section shall be construed to expand
5the scope of practice of a physician assistant or modify the
6requirement in section 148C.4 that a physician assistant
7perform medical services under the supervision of a licensed
8physician.
9 Sec. 18. Section 489.1105, subsection 2, paragraph b, Code
102023, is amended to read as follows:
11b. Nothing in this section shall be construed to expand
12the scope of practice of a physician assistant or modify the
13requirement in section 148C.4 that a physician assistant
14perform medical services under the supervision of a licensed
15physician.
16 Sec. 19. Section 496C.4, subsection 2, paragraph b, Code
172023, is amended to read as follows:
18b. Nothing in this section shall be construed to expand
19the scope of practice of a physician assistant or modify the
20requirement in section 148C.4 that a physician assistant
21perform medical services under the supervision of a licensed
22physician.
23 Sec. 20. Section 496C.7, subsection 3, paragraph b, Code
242023, is amended to read as follows:
25b. Nothing in this section shall be construed to expand
26the scope of practice of a physician assistant or modify the
27requirement in section 148C.4 that a physician assistant
28perform medical services under the supervision of a licensed
29physician.
30 Sec. 21. REPEAL. Sections 148.13, 148C.5, and 148.12, Code
312023, are repealed.
32EXPLANATION
33The inclusion of this explanation does not constitute agreement with
34the explanation’s substance by the members of the general assembly.
35This bill relates to the practice of physician assistants.
-7-1The bill repeals requirements that physician assistants
2practice under the supervision of a licensed physician and
3surgeon or osteopathic physician and surgeon. The bill
4repeals provisions requiring rulemaking for the supervision
5of physician assistants and requiring the board of physician
6assistants and board of medicine to submit an annual report
7regarding collaborative efforts, and makes other conforming
8changes.
-8-ss/rh
2supervision by a physician.
3BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1 Section 1. Section 135.24, subsection 7, paragraph d, Code
22023, is amended to read as follows:
3d. “Health care provider” means a physician licensed under
4chapter 148; a chiropractor licensed under chapter 151; a
5physical therapist licensed pursuant to chapter 148A; an
6occupational therapist licensed pursuant to chapter 148B;
7a podiatrist licensed pursuant to chapter 149; a physician
8assistant licensed and practicing under a supervising physician
9pursuant to chapter 148C; a licensed practical nurse, a
10registered nurse, or an advanced registered nurse practitioner
11licensed pursuant to chapter 152 or 152E; a respiratory
12therapist licensed pursuant to chapter 152B; a dentist, dental
13hygienist, or dental assistant registered or licensed to
14practice under chapter 153; an optometrist licensed pursuant
15to chapter 154; a psychologist licensed pursuant to chapter
16154B; a social worker licensed pursuant to chapter 154C; a
17mental health counselor, marital and family therapist, behavior
18analyst, or assistant behavior analyst licensed pursuant to
19chapter 154D; a speech pathologist or audiologist licensed
20pursuant to chapter 154F; a pharmacist licensed pursuant to
21chapter 155A; or an emergency medical care provider certified
22pursuant to chapter 147A.
23 Sec. 2. Section 135G.1, subsection 8, Code 2023, is amended
24to read as follows:
258. “Physician assistant” means a person licensed to practice
26 under the supervision of a physician as authorized in chapters
27147 and chapter 148C.
28 Sec. 3. Section 135P.1, subsection 2, Code 2023, is amended
29to read as follows:
302. “Health care provider” means a physician or osteopathic
31physician licensed under chapter 148, a physician assistant
32licensed and practicing under a supervising physician pursuant
33to chapter 148C, a podiatrist licensed under chapter 149, a
34chiropractor licensed under chapter 151, a licensed practical
35nurse, a registered nurse, or an advanced registered nurse
-1-1practitioner licensed under chapter 152 or 152E, a dentist
2licensed under chapter 153, an optometrist licensed under
3chapter 154, a pharmacist licensed under chapter 155A, or
4any other person who is licensed, certified, or otherwise
5authorized or permitted by the law of this state to administer
6health care in the ordinary course of business or in the
7practice of a profession.
8 Sec. 4. Section 147.14, subsection 1, paragraph l, Code
92023, is amended to read as follows:
10l. For the board of physician assistants, five members
11licensed to practice as physician assistants, at least two of
12whom practice in counties with a population of less than fifty
13thousand, one member licensed to practice medicine and surgery
14who supervises collaborates with a physician assistant, one
15member licensed to practice osteopathic medicine and surgery
16who supervises collaborates with a physician assistant, and two
17members who are not licensed to practice either medicine and
18surgery or osteopathic medicine and surgery or licensed as a
19physician assistant and who shall represent the general public.
20At least one of the physician or osteopathic physician members
21shall be in practice in a county with a population of less than
22fifty thousand.
23 Sec. 5. Section 147.107, subsection 4, Code 2023, is amended
24to read as follows:
254. A Notwithstanding subsection 1 and any other provision
26of this section to the contrary, a physician assistant may
27prescribe, dispense, order, administer, or procure prescription
28drugs, controlled substances, or medical devices necessary to
29complete a course of therapy pursuant to section 148C.4. Rules
30relating to the authority of physician assistants to prescribe
31drugs, controlled substances, and medical devices pursuant to
32this subsection shall be adopted by the board of physician
33assistants after consultation with the board of medicine and
34board of pharmacy.
35 Sec. 6. Section 147.107, subsections 5 and 6, Code 2023, are
-2-1amended by striking the subsections.
2 Sec. 7. Section 147.136A, subsection 1, paragraph a, Code
32023, is amended to read as follows:
4a. “Health care provider” means a hospital as defined in
5section 135B.1, a health care facility as defined in section
6135C.1, a health facility as defined in section 135P.1, a
7physician or an osteopathic physician licensed under chapter
8148, a physician assistant licensed and practicing under a
9supervising physician under chapter 148C, a podiatrist licensed
10under chapter 149, a chiropractor licensed under chapter 151, a
11licensed practical nurse, a registered nurse, or an advanced
12registered nurse practitioner licensed under chapter 152 or
13152E, a dentist licensed under chapter 153, an optometrist
14licensed under chapter 154, a pharmacist licensed under chapter
15155A, a professional corporation under chapter 496C that is
16owned by persons licensed to practice a profession listed in
17this paragraph, or any other person or entity who is licensed,
18certified, or otherwise authorized or permitted by the law of
19this state to administer health care in the ordinary course of
20business or in the practice of a profession.
21 Sec. 8. Section 147A.10, subsection 3, Code 2023, is amended
22to read as follows:
233. An act of commission or omission of any appropriately
24certified emergency medical care provider, registered nurse,
25or licensed practical nurse, or physician assistant, while
26rendering emergency medical care under the responsible
27supervision and control of a physician to a person who is
28deemed by them to be in immediate danger of serious injury or
29loss of life, shall not impose any liability upon the certified
30emergency medical care provider, registered nurse, licensed
31practical nurse, or physician assistant, the supervising
32physician, physician designee, advanced registered nurse
33practitioner, or any hospital, or upon the state, or any
34county, city or other political subdivision, or the employees
35of any of these entities; provided that this section shall not
-3-1relieve any person of liability for civil damages for any act
2of commission or omission which constitutes recklessness.
3 Sec. 9. Section 148C.1, subsections 5 and 8, Code 2023, are
4amended by striking the subsections.
5 Sec. 10. Section 148C.1, subsection 6, Code 2023, is amended
6to read as follows:
76. “Physician” means a person who is currently licensed in
8Iowa to practice medicine and surgery or osteopathic medicine
9and surgery. Notwithstanding this subsection, a physician
10supervising a physician assistant practicing in a federal
11facility or under federal authority shall not be required to
12obtain licensure beyond licensure requirements mandated by the
13federal government for supervising physicians.
14 Sec. 11. Section 148C.3, subsection 2, Code 2023, is amended
15by striking the subsection.
16 Sec. 12. Section 148C.4, subsections 2 and 3, Code 2023, are
17amended to read as follows:
182. a. Notwithstanding subsection 1, a physician assistant
19licensed pursuant to this chapter or authorized to practice
20in any other state or federal jurisdiction who voluntarily
21and gratuitously, and other than in the ordinary course of
22the physician assistant’s employment or practice, responds to
23a need for medical care created by an emergency or a state
24or local disaster may render such care that the physician
25assistant is able to provide without supervision as described
26in this section or with such supervision as is available.
27b. A physician who supervises a physician assistant
28providing medical care pursuant to this subsection shall not
29be required to meet the requirements of rules adopted pursuant
30to section 148C.3, subsection 2, relating to supervision
31by physicians. A physician providing physician assistant
32supervision pursuant to this subsection or a physician
33assistant, who voluntarily and gratuitously, and other than in
34the ordinary course of the physician assistant’s employment or
35practice, responds to a need for medical care created by an
-4-1emergency or a state or local disaster shall not be subject
2to criminal liability by reason of having issued or executed
3the orders for provided such care, and shall not be liable for
4civil damages for acts or omissions relating to the issuance or
5execution of the orders such care unless the acts or omissions
6constitute recklessness.
73. The degree of collaboration between a physician
8assistant and the appropriate member of a health care team
9shall be determined at the practice level, and may involve
10decisions made by the medical group, hospital service,
11supervising physician, or employer of the physician assistant,
12or the credentialing and privileging system of a licensed
13health care facility. A physician shall be accessible at all
14times for consultation with a physician assistant unless the
15physician assistant is providing emergency medical services
16pursuant to 645 IAC 327.1(1)(n). The supervising physician
17shall have ultimate responsibility for determining the medical
18care provided by the supervising physician-physician assistant
19team. A physician assistant shall be responsible for the
20services performed by the physician assistant.
21 Sec. 13. Section 148F.7, Code 2023, is amended to read as
22follows:
23148F.7 Limitation on provision of care and services.
24A licensed orthotist, prosthetist, or pedorthist may provide
25care or services only if the care or services are provided
26pursuant to an order from a licensed physician, a licensed
27podiatric physician, an advanced registered nurse practitioner
28licensed pursuant to chapter 152 or 152E, or a physician
29assistant who has been delegated the authority to order the
30services of an orthotist, prosthetist, or pedorthist by the
31assistant’s supervising physician licensed under chapter 148C.
32 Sec. 14. Section 154F.2, subsection 1, paragraph a, Code
332023, is amended to read as follows:
34a. Licensed physicians and surgeons, licensed osteopathic
35physicians and surgeons, and licensed physician assistants,
-5-1 and registered nurses acting under the supervision of a
2physician or osteopathic physician, persons conducting hearing
3tests under the direct supervision of a licensed physician
4and surgeon or licensed osteopathic physician and surgeon,
5or students of medicine or surgery or osteopathic medicine
6and surgery pursuing a course of study in a medical school or
7college of osteopathic medicine and surgery approved by the
8board of medicine while performing functions incidental to
9their course of study.
10 Sec. 15. Section 225C.6, subsection 4, paragraph c,
11subparagraph (1), Code 2023, is amended to read as follows:
12(1) A comprehensive set of wraparound services for persons
13who have had or are at imminent risk of having acute or
14crisis mental health symptoms that do not permit the persons
15to remain in or threatens removal of the persons from their
16home and community, but who have been determined by a mental
17health professional and a licensed health care professional,
18subject to the professional’s scope of practice, not to need
19inpatient acute hospital services. For the purposes of this
20subparagraph, “mental health professional” means the same as
21defined in section 228.1 and “licensed health care professional”
22means a person licensed under chapter 148 to practice medicine
23and surgery or osteopathic medicine and surgery, an advanced
24registered nurse practitioner licensed under chapter 152 or
25152E, or a physician assistant licensed to practice under the
26supervision of a physician as authorized in chapters 147 and
27 chapter 148C.
28 Sec. 16. Section 280.16, subsection 1, paragraph d, Code
292023, is amended to read as follows:
30d. “Licensed health care professional” means a person
31licensed under chapter 148 to practice medicine and surgery or
32osteopathic medicine and surgery, an advanced registered nurse
33practitioner licensed under chapter 152 or 152E and registered
34with the board of nursing, or a physician assistant licensed to
35practice under the supervision of a physician as authorized in
-6-1chapters 147 and chapter148C.
2 Sec. 17. Section 489.1102, subsection 2, paragraph b, Code
32023, is amended to read as follows:
4b. Nothing in this section shall be construed to expand
5the scope of practice of a physician assistant or modify the
6requirement in section 148C.4 that a physician assistant
7perform medical services under the supervision of a licensed
8physician.
9 Sec. 18. Section 489.1105, subsection 2, paragraph b, Code
102023, is amended to read as follows:
11b. Nothing in this section shall be construed to expand
12the scope of practice of a physician assistant or modify the
13requirement in section 148C.4 that a physician assistant
14perform medical services under the supervision of a licensed
15physician.
16 Sec. 19. Section 496C.4, subsection 2, paragraph b, Code
172023, is amended to read as follows:
18b. Nothing in this section shall be construed to expand
19the scope of practice of a physician assistant or modify the
20requirement in section 148C.4 that a physician assistant
21perform medical services under the supervision of a licensed
22physician.
23 Sec. 20. Section 496C.7, subsection 3, paragraph b, Code
242023, is amended to read as follows:
25b. Nothing in this section shall be construed to expand
26the scope of practice of a physician assistant or modify the
27requirement in section 148C.4 that a physician assistant
28perform medical services under the supervision of a licensed
29physician.
30 Sec. 21. REPEAL. Sections 148.13, 148C.5, and 148.12, Code
312023, are repealed.
32EXPLANATION
33The inclusion of this explanation does not constitute agreement with
34the explanation’s substance by the members of the general assembly.
35This bill relates to the practice of physician assistants.
-7-1The bill repeals requirements that physician assistants
2practice under the supervision of a licensed physician and
3surgeon or osteopathic physician and surgeon. The bill
4repeals provisions requiring rulemaking for the supervision
5of physician assistants and requiring the board of physician
6assistants and board of medicine to submit an annual report
7regarding collaborative efforts, and makes other conforming
8changes.
-8-ss/rh