Bill Text: IA HF424 | 2023-2024 | 90th General Assembly | Enrolled
Bill Title: A bill for an act providing for the collaborative practice of physician assistants by allowing for the practice of certain physician assistants without supervision by a physician. (Formerly HSB 115.) Effective date: 07/01/2023.
Spectrum: Committee Bill
Status: (Passed) 2023-05-10 - Signed by Governor. H.J. 1040. [HF424 Detail]
Download: Iowa-2023-HF424-Enrolled.html
House
File
424
-
Enrolled
House
File
424
AN
ACT
PROVIDING
FOR
THE
COLLABORATIVE
PRACTICE
OF
PHYSICIAN
ASSISTANTS
BY
ALLOWING
FOR
THE
PRACTICE
OF
CERTAIN
PHYSICIAN
ASSISTANTS
WITHOUT
SUPERVISION
BY
A
PHYSICIAN.
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
Section
1.
Section
135.24,
subsection
7,
paragraph
d,
Code
2023,
is
amended
to
read
as
follows:
d.
“Health
care
provider”
means
a
physician
licensed
under
chapter
148
;
a
chiropractor
licensed
under
chapter
151
;
a
physical
therapist
licensed
pursuant
to
chapter
148A
;
an
occupational
therapist
licensed
pursuant
to
chapter
148B
;
a
podiatrist
licensed
pursuant
to
chapter
149
;
a
physician
assistant
licensed
and
practicing
under
a
supervising
physician
pursuant
to
chapter
148C
;
a
licensed
practical
nurse,
a
registered
nurse,
or
an
advanced
registered
nurse
practitioner
licensed
pursuant
to
chapter
152
or
152E
;
a
respiratory
therapist
licensed
pursuant
to
chapter
152B
;
a
dentist,
dental
hygienist,
or
dental
assistant
registered
or
licensed
to
practice
under
chapter
153
;
an
optometrist
licensed
pursuant
to
chapter
154
;
a
psychologist
licensed
pursuant
to
chapter
154B
;
a
social
worker
licensed
pursuant
to
chapter
154C
;
a
mental
health
counselor,
marital
and
family
therapist,
behavior
analyst,
or
assistant
behavior
analyst
licensed
pursuant
to
chapter
154D
;
a
speech
pathologist
or
audiologist
licensed
pursuant
to
chapter
154F
;
a
pharmacist
licensed
pursuant
to
chapter
155A
;
or
an
emergency
medical
care
provider
certified
House
File
424,
p.
2
pursuant
to
chapter
147A
.
Sec.
2.
Section
135G.1,
subsection
8,
Code
2023,
is
amended
to
read
as
follows:
8.
“Physician
assistant”
means
a
person
licensed
to
practice
under
the
supervision
of
a
physician
as
authorized
in
chapters
147
and
chapter
148C
.
Sec.
3.
Section
135P.1,
subsection
2,
Code
2023,
is
amended
to
read
as
follows:
2.
“Health
care
provider”
means
a
physician
or
osteopathic
physician
licensed
under
chapter
148
,
a
physician
assistant
licensed
and
practicing
under
a
supervising
physician
pursuant
to
chapter
148C
,
a
podiatrist
licensed
under
chapter
149
,
a
chiropractor
licensed
under
chapter
151
,
a
licensed
practical
nurse,
a
registered
nurse,
or
an
advanced
registered
nurse
practitioner
licensed
under
chapter
152
or
152E
,
a
dentist
licensed
under
chapter
153
,
an
optometrist
licensed
under
chapter
154
,
a
pharmacist
licensed
under
chapter
155A
,
or
any
other
person
who
is
licensed,
certified,
or
otherwise
authorized
or
permitted
by
the
law
of
this
state
to
administer
health
care
in
the
ordinary
course
of
business
or
in
the
practice
of
a
profession.
Sec.
4.
Section
147.14,
subsection
1,
paragraph
l,
Code
2023,
is
amended
to
read
as
follows:
l.
For
the
board
of
physician
assistants,
five
members
licensed
to
practice
as
physician
assistants,
at
least
two
of
whom
practice
in
counties
with
a
population
of
less
than
fifty
thousand,
one
member
licensed
to
practice
medicine
and
surgery
who
supervises
a
physician
assistant
engaged
in
independent
practice
or
collaborates
with
a
physician
assistant,
one
member
licensed
to
practice
osteopathic
medicine
and
surgery
who
supervises
a
physician
assistant
engaged
in
independent
practice
or
collaborates
with
a
physician
assistant,
and
two
members
who
are
not
licensed
to
practice
either
medicine
and
surgery
or
osteopathic
medicine
and
surgery
or
licensed
as
a
physician
assistant
and
who
shall
represent
the
general
public.
At
least
one
of
the
physician
or
osteopathic
physician
members
shall
be
in
practice
in
a
county
with
a
population
of
less
than
fifty
thousand.
Sec.
5.
Section
147.107,
subsection
4,
Code
2023,
is
amended
House
File
424,
p.
3
to
read
as
follows:
4.
A
Notwithstanding
subsection
1
and
any
other
provision
of
this
section
to
the
contrary,
a
physician
assistant
may
prescribe,
dispense,
order,
administer,
or
procure
prescription
drugs,
controlled
substances,
or
medical
devices
necessary
to
complete
a
course
of
therapy
pursuant
to
section
148C.4
.
Rules
relating
to
the
authority
of
physician
assistants
to
prescribe
drugs,
controlled
substances,
and
medical
devices
pursuant
to
this
subsection
shall
be
adopted
by
the
board
of
physician
assistants
after
consultation
with
the
board
of
medicine
and
board
of
pharmacy.
Sec.
6.
Section
147.107,
subsections
5
and
6,
Code
2023,
are
amended
by
striking
the
subsections.
Sec.
7.
Section
147.136A,
subsection
1,
paragraph
a,
Code
2023,
is
amended
to
read
as
follows:
a.
“Health
care
provider”
means
a
hospital
as
defined
in
section
135B.1
,
a
health
care
facility
as
defined
in
section
135C.1
,
a
health
facility
as
defined
in
section
135P.1
,
a
physician
or
an
osteopathic
physician
licensed
under
chapter
148
,
a
physician
assistant
licensed
and
practicing
under
a
supervising
physician
under
chapter
148C
,
a
podiatrist
licensed
under
chapter
149
,
a
chiropractor
licensed
under
chapter
151
,
a
licensed
practical
nurse,
a
registered
nurse,
or
an
advanced
registered
nurse
practitioner
licensed
under
chapter
152
or
152E
,
a
dentist
licensed
under
chapter
153
,
an
optometrist
licensed
under
chapter
154
,
a
pharmacist
licensed
under
chapter
155A
,
a
professional
corporation
under
chapter
496C
that
is
owned
by
persons
licensed
to
practice
a
profession
listed
in
this
paragraph,
or
any
other
person
or
entity
who
is
licensed,
certified,
or
otherwise
authorized
or
permitted
by
the
law
of
this
state
to
administer
health
care
in
the
ordinary
course
of
business
or
in
the
practice
of
a
profession.
Sec.
8.
Section
147A.10,
subsection
3,
Code
2023,
is
amended
to
read
as
follows:
3.
An
act
of
commission
or
omission
of
any
appropriately
certified
emergency
medical
care
provider,
registered
nurse,
or
licensed
practical
nurse,
or
physician
assistant,
while
rendering
emergency
medical
care
under
the
responsible
supervision
and
control
of
a
physician
to
a
person
who
is
House
File
424,
p.
4
deemed
by
them
to
be
in
immediate
danger
of
serious
injury
or
loss
of
life,
shall
not
impose
any
liability
upon
the
certified
emergency
medical
care
provider,
registered
nurse,
licensed
practical
nurse,
or
physician
assistant,
the
supervising
physician,
physician
designee,
advanced
registered
nurse
practitioner,
or
any
hospital,
or
upon
the
state,
or
any
county,
city
or
other
political
subdivision,
or
the
employees
of
any
of
these
entities;
provided
that
this
section
shall
not
relieve
any
person
of
liability
for
civil
damages
for
any
act
of
commission
or
omission
which
constitutes
recklessness.
Sec.
9.
Section
148C.1,
subsection
5,
Code
2023,
is
amended
by
striking
the
subsection
and
inserting
in
lieu
thereof
the
following:
5.
“Independent
practice”
means
the
practice
of
a
physician
assistant
that
is
organized
as
a
professional
corporation
under
chapter
496C
or
a
professional
limited
liability
company
under
chapter
489.
Sec.
10.
Section
148C.1,
subsection
8,
Code
2023,
is
amended
by
striking
the
subsection
and
inserting
in
lieu
thereof
the
following:
8.
“Supervising
physician”
means
a
physician
who
supervises
the
medical
services
provided
by
a
physician
assistant
engaged
in
independent
practice
consistent
with
the
physician
assistant’s
education,
training,
and
experience.
Sec.
11.
Section
148C.1,
subsection
6,
Code
2023,
is
amended
to
read
as
follows:
6.
“Physician”
means
a
person
who
is
currently
licensed
in
Iowa
to
practice
medicine
and
surgery
or
osteopathic
medicine
and
surgery.
Notwithstanding
this
subsection
,
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.
Sec.
12.
Section
148C.3,
subsection
2,
Code
2023,
is
amended
to
read
as
follows:
2.
a.
Rules
Joint
rules
shall
be
adopted
by
the
board
and
the
board
of
medicine
pursuant
to
this
chapter
requiring
a
licensed
physician
assistant
to
be
supervised
by
physicians
a
physician
during
the
first
two
years
of
independent
practice
if
House
File
424,
p.
5
the
physician
assistant
has
not
previously
practiced
under
a
supervising
physician
or
in
collaboration
with
the
appropriate
physician
or
other
health
care
professional
for
a
period
of
at
least
two
years
.
The
rules
shall
provide
that
not
more
than
five
physician
assistants
shall
be
supervised
by
a
physician
at
one
time
determine
the
terms
of
collaboration
for
a
physician
assistant
engaged
in
independent
practice
after
the
conclusion
of
two
years
of
practice
under
a
supervising
physician
.
The
rules
shall
also
provide
that
a
physician
assistant
shall
notify
the
board
of
the
identity
of
the
physician
assistant’s
supervising
physician
and
of
any
change
in
the
status
of
the
supervisory
relationship.
b.
For
purposes
of
this
chapter,
“supervision”
does
not
require
the
personal
presence
of
the
physician
at
the
place
where
medical
services
are
rendered
except
insofar
as
the
personal
presence
is
expressly
required
by
this
chapter
or
by
rules
of
the
board
adopted
pursuant
to
chapter
17A.
Sec.
13.
Section
148C.4,
subsections
2
and
3,
Code
2023,
are
amended
to
read
as
follows:
2.
a.
Notwithstanding
subsection
1
,
a
physician
assistant
licensed
pursuant
to
this
chapter
or
authorized
to
practice
in
any
other
state
or
federal
jurisdiction
who
voluntarily
and
gratuitously,
and
other
than
in
the
ordinary
course
of
the
physician
assistant’s
employment
or
practice,
responds
to
a
need
for
medical
care
created
by
an
emergency
or
a
state
or
local
disaster
may
render
such
care
that
the
physician
assistant
is
able
to
provide
without
supervision
as
described
in
this
section
or
with
such
supervision
as
is
available
.
b.
A
physician
who
supervises
a
physician
assistant
providing
medical
care
pursuant
to
this
subsection
shall
not
be
required
to
meet
the
requirements
of
rules
adopted
pursuant
to
section
148C.3,
subsection
2
,
relating
to
supervision
by
physicians.
A
physician
providing
physician
assistant
supervision
pursuant
to
this
subsection
or
a
physician
assistant,
who
voluntarily
and
gratuitously,
and
other
than
in
the
ordinary
course
of
the
physician
assistant’s
employment
or
practice,
responds
to
a
need
for
medical
care
created
by
an
emergency
or
a
state
or
local
disaster
shall
not
be
subject
to
criminal
liability
by
reason
of
having
issued
or
executed
House
File
424,
p.
6
the
orders
for
provided
such
care,
and
shall
not
be
liable
for
civil
damages
for
acts
or
omissions
relating
to
the
issuance
or
execution
of
the
orders
such
care
unless
the
acts
or
omissions
constitute
recklessness.
3.
The
degree
of
collaboration
between
a
physician
assistant
and
the
appropriate
member
of
a
health
care
team
shall
be
determined
at
the
practice
level,
and
may
involve
decisions
made
by
the
medical
group,
hospital
service,
supervising
physician,
or
employer
of
the
physician
assistant,
or
the
credentialing
and
privileging
system
of
a
licensed
health
care
facility.
A
physician
shall
be
accessible
at
all
times
for
consultation
with
a
physician
assistant
unless
the
physician
assistant
is
providing
emergency
medical
services
pursuant
to
645
IAC
327.1(1)(n)
.
The
supervising
physician
shall
have
ultimate
responsibility
for
determining
the
medical
care
provided
by
the
supervising
physician-physician
assistant
team
A
physician
assistant
shall
be
responsible
for
the
services
performed
by
the
physician
assistant
that
are
not
performed
under
the
supervision
of
a
physician
.
Sec.
14.
Section
148C.5,
subsection
1,
Code
2023,
is
amended
to
read
as
follows:
1.
If
the
board
commences
a
contested
case
hearing
against
a
physician
assistant
by
delivering
a
statement
of
charges
and
notice
of
hearing
to
the
physician
assistant,
the
board
shall
deliver
a
copy
of
the
statement
of
charges
and
notice
of
hearing
to
the
physician
assistant’s
supervising
physician
,
if
applicable
.
Sec.
15.
Section
148C.5,
subsection
3,
Code
2023,
is
amended
by
striking
the
subsection.
Sec.
16.
Section
148C.9,
Code
2023,
is
amended
to
read
as
follows:
148C.9
Eye
examination
restricted.
A
physician
assistant
shall
not
be
permitted
to
prescribe
lenses,
prisms,
or
contact
lenses
for
the
aid,
relief,
or
correction
of
human
vision.
A
physician
assistant
engaged
in
independent
practice
shall
not
be
permitted
to
measure
the
visual
power
and
visual
efficiency
of
the
human
eye,
as
distinguished
from
routine
visual
screening,
except
in
the
personal
presence
of
a
supervising
physician
at
the
place
where
House
File
424,
p.
7
such
services
are
rendered.
Sec.
17.
Section
148F.7,
Code
2023,
is
amended
to
read
as
follows:
148F.7
Limitation
on
provision
of
care
and
services.
A
licensed
orthotist,
prosthetist,
or
pedorthist
may
provide
care
or
services
only
if
the
care
or
services
are
provided
pursuant
to
an
order
from
a
licensed
physician,
a
licensed
podiatric
physician,
an
advanced
registered
nurse
practitioner
licensed
pursuant
to
chapter
152
or
152E
,
or
a
physician
assistant
who
has
been
delegated
the
authority
to
order
the
services
of
an
orthotist,
prosthetist,
or
pedorthist
by
the
assistant’s
supervising
physician
licensed
under
chapter
148C
.
Sec.
18.
Section
154F.2,
subsection
1,
paragraph
a,
Code
2023,
is
amended
to
read
as
follows:
a.
Licensed
physicians
and
surgeons,
licensed
osteopathic
physicians
and
surgeons,
and
licensed
physician
assistants
,
and
registered
nurses
acting
under
the
supervision
of
a
physician
or
osteopathic
physician,
persons
conducting
hearing
tests
under
the
direct
supervision
of
a
licensed
physician
and
surgeon
or
licensed
osteopathic
physician
and
surgeon,
or
students
of
medicine
or
surgery
or
osteopathic
medicine
and
surgery
pursuing
a
course
of
study
in
a
medical
school
or
college
of
osteopathic
medicine
and
surgery
approved
by
the
board
of
medicine
while
performing
functions
incidental
to
their
course
of
study.
Sec.
19.
Section
225C.6,
subsection
4,
paragraph
c,
subparagraph
(1),
Code
2023,
is
amended
to
read
as
follows:
(1)
A
comprehensive
set
of
wraparound
services
for
persons
who
have
had
or
are
at
imminent
risk
of
having
acute
or
crisis
mental
health
symptoms
that
do
not
permit
the
persons
to
remain
in
or
threatens
removal
of
the
persons
from
their
home
and
community,
but
who
have
been
determined
by
a
mental
health
professional
and
a
licensed
health
care
professional,
subject
to
the
professional’s
scope
of
practice,
not
to
need
inpatient
acute
hospital
services.
For
the
purposes
of
this
subparagraph,
“mental
health
professional”
means
the
same
as
defined
in
section
228.1
and
“licensed
health
care
professional”
means
a
person
licensed
under
chapter
148
to
practice
medicine
and
surgery
or
osteopathic
medicine
and
surgery,
an
advanced
House
File
424,
p.
8
registered
nurse
practitioner
licensed
under
chapter
152
or
152E
,
or
a
physician
assistant
licensed
to
practice
under
the
supervision
of
a
physician
as
authorized
in
chapters
147
and
chapter
148C
.
Sec.
20.
Section
228.1,
subsection
7,
paragraph
b,
Code
2023,
is
amended
to
read
as
follows:
b.
The
individual
holds
a
current
Iowa
license
if
practicing
in
a
field
covered
by
an
Iowa
licensure
law
and
is
a
psychiatrist,
an
advanced
registered
nurse
practitioner
who
holds
a
national
certification
in
psychiatric
mental
health
care
and
is
licensed
by
the
board
of
nursing,
a
physician
assistant
practicing
under
the
supervision
of
or
in
collaboration
with
a
psychiatrist,
a
qualified
mental
health
professional
physician
assistant,
a
psychiatric
advanced
registered
nurse
practitioner
as
defined
in
section
125.2,
or
an
individual
who
holds
a
doctorate
degree
in
psychology
and
is
licensed
by
the
board
of
psychology.
For
the
purposes
of
this
paragraph,
“collaboration”
means
the
same
as
defined
in
section
148C.1.
Sec.
21.
Section
280.16,
subsection
1,
paragraph
d,
Code
2023,
is
amended
to
read
as
follows:
d.
“
Licensed
health
care
professional”
means
a
person
licensed
under
chapter
148
to
practice
medicine
and
surgery
or
osteopathic
medicine
and
surgery,
an
advanced
registered
nurse
practitioner
licensed
under
chapter
152
or
152E
and
registered
with
the
board
of
nursing,
or
a
physician
assistant
licensed
to
practice
under
the
supervision
of
a
physician
as
authorized
in
chapters
147
and
chapter
148C
.
Sec.
22.
Section
489.1102,
subsection
2,
paragraph
b,
Code
2023,
is
amended
to
read
as
follows:
b.
Nothing
in
this
section
shall
be
construed
to
expand
the
scope
of
practice
of
a
physician
assistant
or
modify
the
requirement
in
section
148C.4
that
a
physician
assistant
perform
medical
services
under
the
supervision
of
a
licensed
physician
.
Sec.
23.
Section
489.1105,
subsection
2,
paragraph
b,
Code
2023,
is
amended
to
read
as
follows:
b.
Nothing
in
this
section
shall
be
construed
to
expand
the
scope
of
practice
of
a
physician
assistant
or
modify
the
House
File
424,
p.
9
requirement
in
section
148C.4
that
a
physician
assistant
perform
medical
services
under
the
supervision
of
a
licensed
physician
.
Sec.
24.
Section
496C.4,
subsection
2,
paragraph
b,
Code
2023,
is
amended
to
read
as
follows:
b.
Nothing
in
this
section
shall
be
construed
to
expand
the
scope
of
practice
of
a
physician
assistant
or
modify
the
requirement
in
section
148C.4
that
a
physician
assistant
perform
medical
services
under
the
supervision
of
a
licensed
physician
.
Sec.
25.
Section
496C.7,
subsection
3,
paragraph
b,
Code
2023,
is
amended
to
read
as
follows:
b.
Nothing
in
this
section
shall
be
construed
to
expand
the
scope
of
practice
of
a
physician
assistant
or
modify
the
requirement
in
section
148C.4
that
a
physician
assistant
perform
medical
services
under
the
supervision
of
a
licensed
physician
.
Sec.
26.
REPEAL.
Sections
148.13
and
148C.12,
Code
2023,
are
repealed.
______________________________
PAT
GRASSLEY
Speaker
of
the
House
______________________________
AMY
SINCLAIR
President
of
the
Senate
I
hereby
certify
that
this
bill
originated
in
the
House
and
is
known
as
House
File
424,
Ninetieth
General
Assembly.
______________________________
MEGHAN
NELSON
Chief
Clerk
of
the
House
Approved
_______________,
2023
______________________________
KIM
REYNOLDS
Governor
