ARC 9296C - Iowa Administrative Rules

Notice of Intended Action

Physician supervision of a physician assistant, ch 21

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ARC 9296C

MEDICINE BOARD[653]

Notice of Intended Action

Proposing rulemaking related to physician supervision of a physician assistant
and providing an opportunity for public comment

The Boardof Medicine (Board) hereby proposes to rescind Chapter 21, “Physician Supervision of a Physician Assistant,” Iowa Administrative Code, and to adopt a new chapter with the same title.

Legal Authority for Rulemaking

This rulemaking is proposed under the authority provided in Iowa Code chapters 17A, 147, 148C and 272C.

State or Federal Law Implemented

This rulemaking implements, in whole or in part, Iowa Code sections 148C.3 and 272C.3.

Purpose and Summary

This rulemaking proposes to rescind Chapter 21 and adopt a new chapter with the same title.This proposed rulemaking implements Iowa Code section 148C.5 as amended by 2023 Iowa Acts, House File 424, in accordance with the goals and directives of Executive Order 10.Iowa Code section 148C.3 requires the Board and Board of Physician Assistants to adopt joint rules requiring a licensed physician assistant to be supervised by a physician during the first two years of independent practice if the physician assistant has not previously practiced under a supervising physician or in collaboration therewith for a period of at least two years.

Regulatory Analysis

A Regulatory Analysis for this rulemaking was published in the Iowa Administrative Bulletin on October 16, 2024. A public hearing was held on the following date(s):

●November 5, 2024

The following public comments were received from the Iowa Physician Assistant Society (Sydney Gangestad):

●House File 424 passed in 2023 and was signed into law. This legislation required the Board to work with the Board of Physician Assistants on rulemaking related to the independent practice of physician assistants, which applies to brand-new physician assistants graduating from school and wanting to open their own practice.

●The Board of Physician Assistants has made numerous drafts of the rules, and the Board has not acknowledged the work of the Board of Physician Assistants. The Board continues to put forth rules that are beyond the scope of House File 424 and is usurping legislative authority.

●The Board no longer has the authority to put forth supervision rules.

●The fiscal impact of this rulemaking does not account for the incentives received by physicians who supervise physician assistants or the burden on the physician assistant to have supervision.

●The only people impacted by the stall in rules being adopted are Iowans who are not able to benefit from the intent of House File 424.

The following public comments were received from the Iowa Medical Society:

●The Legislature identified a strong desire to have physician assistant supervision.

●These rules are supposed to be joint rules, which requires the opinion of the Board and also allows the Board to have a voice in the rules.

●The Iowa Medical Society hopes that the Board of Physician Assistants will come to the table and work with the Board to draft joint rules.

The Board approved this Notice of Intended Action with proposed changes from the Regulatory Analysis. Changes were made to Chapter 21 to align with 481—Chapter 780, which represents the joint rules between the Board of Physician Assistants and the Board of Medicine.

Fiscal Impact

This rulemaking has no fiscal impact to the State of Iowa.

Jobs Impact

After analysis and review of this rulemaking, no impact on jobs has been found.

Waivers

Any person who believes that the application of the discretionary provisions of this rulemaking would result in hardship or injustice to that person may petition the Board for a waiver of the discretionary provisions, if any, pursuant to 481—Chapter 6.

Public Comment

Any interested person may submit written comments concerning this proposed rulemaking, which must be received by the Department of Inspections, Appeals, and Licensing no later than 4:30 p.m. on June 17, 2025. Comments should be directed to:

Emily DeRonde
Department of Inspections, Appeals, and Licensing
6200 Park Avenue
Des Moines, Iowa 50321
Email: emily.deronde@dia.iowa.gov

Public Hearing

Public hearings at which persons may present their views orally or in writing will be held as follows:

June 3, 2025 8 a.m.	6200 Park Avenue Des Moines, Iowa
June 4, 2025 8 a.m.	6200 Park Avenue Des Moines, Iowa

Information on virtual participation will be available on the Department’s website prior to the hearings.

Persons who wish to make oral comments at a public hearing may be asked to state their names for the record and to confine their remarks to the subject of this proposed rulemaking.

Any persons who intend to attend a public hearing and have special requirements, such as those related to hearing or mobility impairments, should contact the Department and advise of specific needs.

Review by Administrative Rules Review Committee

The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rulemaking by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rulemaking at its regular monthly meeting or at a special meeting. The Committee’s meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).

The following rulemaking action is proposed:

ITEM 1.Rescind 653—Chapter 21 and adopt the following new chapter in lieu thereof:

CHAPTER 21

PHYSICIAN SUPERVISION OF A PHYSICIAN ASSISTANT

653—21.1(148,272C) Ineligibility determinants. A physician with an active permanent, special, or temporary Iowa license who is actively engaged in the practice of medicine in Iowa may supervise a physician assistant. A physician is ineligible to supervise a physician assistant for any of the following reasons:

21.1(1) The physician does not hold an active, permanent, special or temporary Iowa medical license.

21.1(2) The physician is subject to a disciplinary order of the board that restricts or rescinds the physician’s authority to supervise a physician assistant. The physician may supervise a physician assistant to the extent that the order allows.

21.1(3) The physician is already supervising five physician assistants.

653—21.2(148,272C) Exemptions from this chapter. This chapter does not apply to the following:

21.2(1) A physician working in a federal facility or under federal authority when the provisions of this chapter conflict with federal regulations.

21.2(2) A physician who supervises a physician assistant providing medical care created by an emergency or a state or local disaster pursuant to Iowa Code section 148C.4.

653—21.3(148) Board notification. A physician who supervises a physician assistant shall notify the board of the supervisory relationship within 60 days of the provision of initial supervision and at the time of the physician’s license renewal.

653—21.4(148,272C) Requirements for supervising. More information regarding requirements for supervising can be found in rules 481—780.6(148C) and 481—780.8(148C).

653—21.5(148,272C) Grounds for discipline. A physician may be subject to disciplinary action for supervising a physician assistant in violation of these rules or 653—Chapter 23 or 481—Chapter 780, which relate to duties and responsibilities for physician supervision of physician assistants. Grounds for discipline also include:

21.5(1) The physician supervises a physician assistant when the physician does not have sufficient training or experience to supervise a physician assistant in the area of medical practice in which a physician assistant is to be utilized.

21.5(2) A physician supervises more than five physician assistants at the same time.

21.5(3) The physician fails to ensure that the physician assistant is adequately supervised, including being available in person or by telecommunication to respond to the physician assistant.

21.5(4) The physician fails to adequately direct and supervise a physician assistant or fails to comply with the minimum standards of supervision in accordance with this chapter, 481—Chapters 780 through 784, and Iowa Code chapters 148 and 148C.

653—21.6(148,272C) Disciplinary sanction. The board may restrict or rescind a physician’s authority to supervise a physician assistant as part of a disciplinary sanction following a contested case proceeding if the reason for the disciplinary action impacts the ability of the physician to supervise a physician assistant. The board shall notify the board of physician assistants when it takes a disciplinary action against a physician’s license that affects the physician’s authority to supervise a physician assistant.

653—21.7(148,272C) Communication with physician assistant supervisees. The physician shall notify all physician assistant supervisees within one workday upon receiving disciplinary action from the board or any other change in status that affects the physician’s eligibility to supervise a physician assistant.

These rules are intended to implement Iowa Code sections 148C.3 and 272C.3.