House File 424 - Introduced HOUSE FILE 424 BY COMMITTEE ON HEALTH AND HUMAN SERVICES (SUCCESSOR TO HSB 115) A BILL FOR An Act providing for the collaborative practice of physician 1 assistants by allowing for the practice of physician 2 assistants without supervision by a physician. 3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 4 TLSB 1624HV (1) 90 ss/rh
H.F. 424 Section 1. Section 135.24, subsection 7, paragraph d, Code 1 2023, is amended to read as follows: 2 d. Health care provider means a physician licensed under 3 chapter 148 ; a chiropractor licensed under chapter 151 ; a 4 physical therapist licensed pursuant to chapter 148A ; an 5 occupational therapist licensed pursuant to chapter 148B ; 6 a podiatrist licensed pursuant to chapter 149 ; a physician 7 assistant licensed and practicing under a supervising physician 8 pursuant to chapter 148C ; a licensed practical nurse, a 9 registered nurse, or an advanced registered nurse practitioner 10 licensed pursuant to chapter 152 or 152E ; a respiratory 11 therapist licensed pursuant to chapter 152B ; a dentist, dental 12 hygienist, or dental assistant registered or licensed to 13 practice under chapter 153 ; an optometrist licensed pursuant 14 to chapter 154 ; a psychologist licensed pursuant to chapter 15 154B ; a social worker licensed pursuant to chapter 154C ; a 16 mental health counselor, marital and family therapist, behavior 17 analyst, or assistant behavior analyst licensed pursuant to 18 chapter 154D ; a speech pathologist or audiologist licensed 19 pursuant to chapter 154F ; a pharmacist licensed pursuant to 20 chapter 155A ; or an emergency medical care provider certified 21 pursuant to chapter 147A . 22 Sec. 2. Section 135G.1, subsection 8, Code 2023, is amended 23 to read as follows: 24 8. Physician assistant means a person licensed to practice 25 under the supervision of a physician as authorized in chapters 26 147 and chapter 148C . 27 Sec. 3. Section 135P.1, subsection 2, Code 2023, is amended 28 to read as follows: 29 2. Health care provider means a physician or osteopathic 30 physician licensed under chapter 148 , a physician assistant 31 licensed and practicing under a supervising physician pursuant 32 to chapter 148C , a podiatrist licensed under chapter 149 , a 33 chiropractor licensed under chapter 151 , a licensed practical 34 nurse, a registered nurse, or an advanced registered nurse 35 -1- LSB 1624HV (1) 90 ss/rh 1/ 8
H.F. 424 practitioner licensed under chapter 152 or 152E , a dentist 1 licensed under chapter 153 , an optometrist licensed under 2 chapter 154 , a pharmacist licensed under chapter 155A , or 3 any other person who is licensed, certified, or otherwise 4 authorized or permitted by the law of this state to administer 5 health care in the ordinary course of business or in the 6 practice of a profession. 7 Sec. 4. Section 147.14, subsection 1, paragraph l, Code 8 2023, is amended to read as follows: 9 l. For the board of physician assistants, five members 10 licensed to practice as physician assistants, at least two of 11 whom practice in counties with a population of less than fifty 12 thousand, one member licensed to practice medicine and surgery 13 who supervises collaborates with a physician assistant, one 14 member licensed to practice osteopathic medicine and surgery 15 who supervises collaborates with a physician assistant, and two 16 members who are not licensed to practice either medicine and 17 surgery or osteopathic medicine and surgery or licensed as a 18 physician assistant and who shall represent the general public. 19 At least one of the physician or osteopathic physician members 20 shall be in practice in a county with a population of less than 21 fifty thousand. 22 Sec. 5. Section 147.107, subsection 4, Code 2023, is amended 23 to read as follows: 24 4. A Notwithstanding subsection 1 and any other provision 25 of this section to the contrary, a physician assistant may 26 prescribe, dispense, order, administer, or procure prescription 27 drugs, controlled substances, or medical devices necessary to 28 complete a course of therapy pursuant to section 148C.4 . Rules 29 relating to the authority of physician assistants to prescribe 30 drugs, controlled substances, and medical devices pursuant to 31 this subsection shall be adopted by the board of physician 32 assistants after consultation with the board of medicine and 33 board of pharmacy. 34 Sec. 6. Section 147.107, subsections 5 and 6, Code 2023, are 35 -2- LSB 1624HV (1) 90 ss/rh 2/ 8
H.F. 424 amended by striking the subsections. 1 Sec. 7. Section 147.136A, subsection 1, paragraph a, Code 2 2023, is amended to read as follows: 3 a. Health care provider means a hospital as defined in 4 section 135B.1 , a health care facility as defined in section 5 135C.1 , a health facility as defined in section 135P.1 , a 6 physician or an osteopathic physician licensed under chapter 7 148 , a physician assistant licensed and practicing under a 8 supervising physician under chapter 148C , a podiatrist licensed 9 under chapter 149 , a chiropractor licensed under chapter 151 , a 10 licensed practical nurse, a registered nurse, or an advanced 11 registered nurse practitioner licensed under chapter 152 or 12 152E , a dentist licensed under chapter 153 , an optometrist 13 licensed under chapter 154 , a pharmacist licensed under chapter 14 155A , a professional corporation under chapter 496C that is 15 owned by persons licensed to practice a profession listed in 16 this paragraph, or any other person or entity who is licensed, 17 certified, or otherwise authorized or permitted by the law of 18 this state to administer health care in the ordinary course of 19 business or in the practice of a profession. 20 Sec. 8. Section 147A.10, subsection 3, Code 2023, is amended 21 to read as follows: 22 3. An act of commission or omission of any appropriately 23 certified emergency medical care provider, registered nurse, 24 or licensed practical nurse, or physician assistant, while 25 rendering emergency medical care under the responsible 26 supervision and control of a physician to a person who is 27 deemed by them to be in immediate danger of serious injury or 28 loss of life, shall not impose any liability upon the certified 29 emergency medical care provider, registered nurse, licensed 30 practical nurse, or physician assistant, the supervising 31 physician, physician designee, advanced registered nurse 32 practitioner, or any hospital, or upon the state, or any 33 county, city or other political subdivision, or the employees 34 of any of these entities; provided that this section shall not 35 -3- LSB 1624HV (1) 90 ss/rh 3/ 8
H.F. 424 relieve any person of liability for civil damages for any act 1 of commission or omission which constitutes recklessness. 2 Sec. 9. Section 148C.1, subsections 5 and 8, Code 2023, are 3 amended by striking the subsections. 4 Sec. 10. Section 148C.1, subsection 6, Code 2023, is amended 5 to read as follows: 6 6. Physician means a person who is currently licensed in 7 Iowa to practice medicine and surgery or osteopathic medicine 8 and surgery. Notwithstanding this subsection , a physician 9 supervising a physician assistant practicing in a federal 10 facility or under federal authority shall not be required to 11 obtain licensure beyond licensure requirements mandated by the 12 federal government for supervising physicians. 13 Sec. 11. Section 148C.3, subsection 2, Code 2023, is amended 14 by striking the subsection. 15 Sec. 12. Section 148C.4, subsections 2 and 3, Code 2023, are 16 amended to read as follows: 17 2. a. Notwithstanding subsection 1 , a physician assistant 18 licensed pursuant to this chapter or authorized to practice 19 in any other state or federal jurisdiction who voluntarily 20 and gratuitously, and other than in the ordinary course of 21 the physician assistants employment or practice, responds to 22 a need for medical care created by an emergency or a state 23 or local disaster may render such care that the physician 24 assistant is able to provide without supervision as described 25 in this section or with such supervision as is available . 26 b. A physician who supervises a physician assistant 27 providing medical care pursuant to this subsection shall not 28 be required to meet the requirements of rules adopted pursuant 29 to section 148C.3, subsection 2 , relating to supervision 30 by physicians. A physician providing physician assistant 31 supervision pursuant to this subsection or a physician 32 assistant, who voluntarily and gratuitously, and other than in 33 the ordinary course of the physician assistants employment or 34 practice, responds to a need for medical care created by an 35 -4- LSB 1624HV (1) 90 ss/rh 4/ 8
H.F. 424 emergency or a state or local disaster shall not be subject 1 to criminal liability by reason of having issued or executed 2 the orders for provided such care, and shall not be liable for 3 civil damages for acts or omissions relating to the issuance or 4 execution of the orders such care unless the acts or omissions 5 constitute recklessness. 6 3. The degree of collaboration between a physician 7 assistant and the appropriate member of a health care team 8 shall be determined at the practice level, and may involve 9 decisions made by the medical group, hospital service, 10 supervising physician, or employer of the physician assistant, 11 or the credentialing and privileging system of a licensed 12 health care facility. A physician shall be accessible at all 13 times for consultation with a physician assistant unless the 14 physician assistant is providing emergency medical services 15 pursuant to 645 IAC 327.1(1)(n) . The supervising physician 16 shall have ultimate responsibility for determining the medical 17 care provided by the supervising physician-physician assistant 18 team. A physician assistant shall be responsible for the 19 services performed by the physician assistant. 20 Sec. 13. Section 148F.7, Code 2023, is amended to read as 21 follows: 22 148F.7 Limitation on provision of care and services. 23 A licensed orthotist, prosthetist, or pedorthist may provide 24 care or services only if the care or services are provided 25 pursuant to an order from a licensed physician, a licensed 26 podiatric physician, an advanced registered nurse practitioner 27 licensed pursuant to chapter 152 or 152E , or a physician 28 assistant who has been delegated the authority to order the 29 services of an orthotist, prosthetist, or pedorthist by the 30 assistants supervising physician licensed under chapter 148C . 31 Sec. 14. Section 154F.2, subsection 1, paragraph a, Code 32 2023, is amended to read as follows: 33 a. Licensed physicians and surgeons, licensed osteopathic 34 physicians and surgeons, and licensed physician assistants , 35 -5- LSB 1624HV (1) 90 ss/rh 5/ 8
H.F. 424 and registered nurses acting under the supervision of a 1 physician or osteopathic physician, persons conducting hearing 2 tests under the direct supervision of a licensed physician 3 and surgeon or licensed osteopathic physician and surgeon, 4 or students of medicine or surgery or osteopathic medicine 5 and surgery pursuing a course of study in a medical school or 6 college of osteopathic medicine and surgery approved by the 7 board of medicine while performing functions incidental to 8 their course of study. 9 Sec. 15. Section 225C.6, subsection 4, paragraph c, 10 subparagraph (1), Code 2023, is amended to read as follows: 11 (1) A comprehensive set of wraparound services for persons 12 who have had or are at imminent risk of having acute or 13 crisis mental health symptoms that do not permit the persons 14 to remain in or threatens removal of the persons from their 15 home and community, but who have been determined by a mental 16 health professional and a licensed health care professional, 17 subject to the professionals scope of practice, not to need 18 inpatient acute hospital services. For the purposes of this 19 subparagraph, mental health professional means the same as 20 defined in section 228.1 and licensed health care professional 21 means a person licensed under chapter 148 to practice medicine 22 and surgery or osteopathic medicine and surgery, an advanced 23 registered nurse practitioner licensed under chapter 152 or 24 152E , or a physician assistant licensed to practice under the 25 supervision of a physician as authorized in chapters 147 and 26 chapter 148C . 27 Sec. 16. Section 228.1, subsection 7, paragraph b, Code 28 2023, is amended to read as follows: 29 b. The individual holds a current Iowa license if 30 practicing in a field covered by an Iowa licensure law and 31 is a psychiatrist, an advanced registered nurse practitioner 32 who holds a national certification in psychiatric mental 33 health care and is licensed by the board of nursing, a 34 physician assistant practicing under the supervision of in 35 -6- LSB 1624HV (1) 90 ss/rh 6/ 8
H.F. 424 collaboration with a psychiatrist, or an individual who holds a 1 doctorate degree in psychology and is licensed by the board of 2 psychology. For the purposes of this paragraph, collaboration 3 means the same as defined in section 148C.1. 4 Sec. 17. Section 280.16, subsection 1, paragraph d, Code 5 2023, is amended to read as follows: 6 d. Licensed health care professional means a person 7 licensed under chapter 148 to practice medicine and surgery or 8 osteopathic medicine and surgery, an advanced registered nurse 9 practitioner licensed under chapter 152 or 152E and registered 10 with the board of nursing, or a physician assistant licensed to 11 practice under the supervision of a physician as authorized in 12 chapters 147 and chapter 148C . 13 Sec. 18. Section 489.1102, subsection 2, paragraph b, Code 14 2023, is amended to read as follows: 15 b. Nothing in this section shall be construed to expand 16 the scope of practice of a physician assistant or modify the 17 requirement in section 148C.4 that a physician assistant 18 perform medical services under the supervision of a licensed 19 physician . 20 Sec. 19. Section 489.1105, subsection 2, paragraph b, Code 21 2023, is amended to read as follows: 22 b. Nothing in this section shall be construed to expand 23 the scope of practice of a physician assistant or modify the 24 requirement in section 148C.4 that a physician assistant 25 perform medical services under the supervision of a licensed 26 physician . 27 Sec. 20. Section 496C.4, subsection 2, paragraph b, Code 28 2023, is amended to read as follows: 29 b. Nothing in this section shall be construed to expand 30 the scope of practice of a physician assistant or modify the 31 requirement in section 148C.4 that a physician assistant 32 perform medical services under the supervision of a licensed 33 physician . 34 Sec. 21. Section 496C.7, subsection 3, paragraph b, Code 35 -7- LSB 1624HV (1) 90 ss/rh 7/ 8
H.F. 424 2023, is amended to read as follows: 1 b. Nothing in this section shall be construed to expand 2 the scope of practice of a physician assistant or modify the 3 requirement in section 148C.4 that a physician assistant 4 perform medical services under the supervision of a licensed 5 physician . 6 Sec. 22. REPEAL. Sections 148.13, 148C.5, 148C.9, and 7 148C.12, Code 2023, are repealed. 8 EXPLANATION 9 The inclusion of this explanation does not constitute agreement with 10 the explanations substance by the members of the general assembly. 11 This bill relates to the practice of physician assistants. 12 The bill repeals requirements that physician assistants 13 practice under the supervision of a licensed physician and 14 surgeon or osteopathic physician and surgeon. The bill 15 repeals provisions requiring rulemaking for the supervision 16 of physician assistants and requiring the board of physician 17 assistants and board of medicine to submit an annual report 18 regarding collaborative efforts, and makes other conforming 19 changes. 20 -8- LSB 1624HV (1) 90 ss/rh 8/ 8