Iowa Admin. Code r. 653-19.3 - Standards of practice-collaboration with a prescribing psychologist
A collaborating physician shall be a person who is licensed to practice medicine and surgery or osteopathic medicine in Iowa, who regularly prescribes psychotropic medications for the treatment of mental disorders as part of the physician's normal course of practice, and who serves as a resource for a prescribing psychologist pursuant to a collaborative practice agreement. A collaborating physician shall be board-certified in family medicine, internal medicine, neurology, pediatrics, or psychiatry. A collaborating physician shall fully comply with the following standards of practice:
(1)
Collaboration. A
collaborating physician shall provide appropriate collaboration with a
prescribing psychologist to achieve patient safety and optimal clinical
outcomes. A collaborating physician shall ensure that appropriate clinical
examinations and necessary testing are performed and that all
psychopharmacology services provided are appropriate for the patient's
condition. Collaboration may be in person or via electronic communications in
accordance with these rules. A prescribing psychologist may have more than one
collaborating physician.
(2)
Maximum number of prescribing psychologists. A physician shall
not serve as a collaborating physician for more than two prescribing
psychologists at one time.
(3)
Initial assessment. Prior to serving as a collaborating
physician, a physician shall assess a prescribing psychologist's relevant
education, training, experience, and competence.
(4)
Scope of practice. A
collaborating physician shall ensure that all psychopharmacology services
provided by a prescribing psychologist are within the competence and scope of
practice of the collaborating physician and the prescribing
psychologist.
(5)
Prescriptive authority. A collaborating physician shall ensure
that a prescribing psychologist only prescribes psychotropic medications for
the treatment of mental disorders.
(6)
Delegation. A
collaborating physician shall ensure that a prescribing psychologist does not
delegate prescriptive authority to any other person.
(7)
Narcotics. A
collaborating physician shall ensure that a prescribing psychologist does not
prescribe narcotics.
(8)
Active DEA and CSA registration. A collaborating physician
shall ensure that a prescribing psychologist has an active DEA registration and
CSA registration at all times during the period of collaboration.
(9)
Patient populations. A
collaborating physician shall ensure that a prescribing psychologist only
provides psychopharmacology services to patient populations within the
prescribing psychologist's education, training, experience, and competence. A
collaborating physician may establish limitations on the types of populations
to whom a prescribing psychologist may provide psychopharmacology services
based on the prescribing psychologist's education, training, experience, and
competence.
(10)
Psychotropic medications. A collaborating physician shall
ensure that a prescribing psychologist only prescribes psychotropic medications
that are within the prescribing psychologist's education, training, experience,
and competence. A collaborating physician may establish limitations on the
types of psychotropic medications that a prescribing psychologist may prescribe
based on the prescribing psychologist's education, training, experience, and
competence.
(11)
Specialization. A collaborating physician shall ensure that a
prescribing psychologist has completed at least one year of the required two
years of supervised practice with the respective population in accordance with
rule 481-883.4(148,154B) before the prescribing psychologist provides
psychopharmacology services to children (less than 17 years of age), elderly
persons (over 65 years of age), or patients with serious medical conditions,
including but not limited to, heart disease, cancer, stroke, seizures, or
comorbid psychological conditions, or patients with developmental disabilities
and intellectual disabilities.
(12)
Informed consent. A collaborating physician shall ensure that
a prescribing psychologist obtains appropriate informed consent before a
prescribing psychologist provides psychopharmacology services to a
patient.
(13)
Release of
information. A collaborating physician shall ensure that a prescribing
psychologist obtains a release of information authorizing the prescribing
psychologist to share information with the collaborating physician before the
prescribing psychologist provides psychopharmacology services to a
patient.
(14)
Primary care
physician. A collaborating physician shall ensure that each patient
has a designated primary care physician before a prescribing psychologist
provides psychopharmacology services to a patient. A collaborating physician
shall ensure that a prescribing psychologist maintains a cooperative
relationship with the primary care physician who oversees a patient's general
medical care to ensure that necessary medical examinations are conducted, the
psychotropic medication is appropriate for the patient's medical condition, and
significant changes in the patient's medical or psychological condition are
discussed. A collaborating physician shall ensure that a prescribing
psychologist engages in appropriate consultation with a patient's designated
primary care physician while the prescribing psychologist is providing
psychopharmacology services to a patient.
(15)
Chart reviews. A
collaborating physician shall personally review a representative sample of the
prescribing psychologist's patient charts.
(16)
Performance
evaluations. A collaborating physician shall regularly evaluate the
clinical judgment, skills and performance of a prescribing psychologist to
safely provide psychopharmacology services to patients and provide appropriate
feedback to the prescribing psychologist.
(17)
Collaborative practice
agreement. Prior to serving as a collaborating physician for a
prescribing psychologist, the collaborating physician shall ensure that the
prescribing psychologist has a written collaborative practice agreement in
place. A template may be obtained from the boards of medicine and psychology.
The collaborative practice agreement shall define the nature and extent of the
collaborative relationship and outline specific parameters for review of the
collaborative relationship. The collaborative practice agreement shall take
into account the collaborating physician's and prescribing psychologist's
relevant education, training, experience, and competence and the nature and
scope of the psychopharmacology services to be provided. The collaborating
physician shall review the terms of the collaborative practice agreement with
the prescribing psychologist at least once each year. The collaborating
physician and prescribing psychologist shall each maintain a copy of the
collaborative practice agreement and provide a copy of the agreement to the
boards of medicine and psychology upon request. The collaborative practice
agreement shall include the following:
a.
Prescribing psychologist's information. The name, license
number, DEA registration number, CSA registration number, address, telephone
number, email address, and practice locations of the prescribing
psychologist.
b.
Collaborating physician's information. The name, license number, DEA
registration number, CSA registration number, address, telephone number, email
address, and practice locations of the collaborating physician.
c.
Period of collaboration.
The time period covered by the collaborative practice agreement.
d.
Locations and settings. A
description of the locations and settings where and with whom collaborative
practice will occur.
e.
Scope of practice. A description of the scope of practice of the
collaborating physician and the prescribing psychologist.
f.
Methods of communication.
A description of how the collaborating physician and prescribing psychologist
may communicate for appropriate collaboration.
g.
Initial assessment. A
description of the steps the collaborating physician has taken to assess a
prescribing psychologist's relevant education, training, experience, and
competence prior to collaborating with a prescribing psychologist.
h.
Limitations on psychotropic
medications. A description of any limitations on the types of
psychotropic medications the prescribing psychologist may prescribe consistent
with the collaborating physician's and prescribing psychologist's relevant
education, training, experience, and competence.
i.
Limitations on patient
populations. A description of any limitations on the types of
populations the prescribing psychologist may treat with psychotropic
medications consistent with the collaborating physician's and prescribing
psychologist's relevant education, training, experience, and
competence.
j.
Expectations and responsibilities. A description of the expectations
and responsibilities of the collaborative relationship.
k.
Specialization. A
description of the specialized training the prescribing psychologist has
completed in order to provide psychopharmacology services to children (less
than 17 years of age), elderly persons (over 65 years of age), or patients with
serious medical conditions, including but not limited to, heart disease,
cancer, stroke, seizures, or comorbid psychological conditions, or patients
with developmental disabilities and intellectual disabilities in accordance
with rule 481-883.4(148,154B).
l.
Chart reviews. A description of the steps the collaborating
physician has taken to personally review a representative sample of the
prescribing psychologist's patient charts.
m.
Consultation between the
collaborating physician and the primary care provider. A requirement
that the collaborating physician consult with the patient's primary care
physician on a regular basis regarding the patient's psychotropic treatment
plan and any potential complications.
n.
Performance evaluations.
A description of the steps the collaborating physician has taken to regularly
evaluate the clinical judgment, skills and performance of the prescribing
psychologist to safely provide psychopharmacology services to patients and
provide appropriate feedback to the prescribing psychologist.
o.
Termination of the collaborative
practice agreement. A provision describing how the collaborative
practice agreement may be terminated and the process for notifying affected
patients.
p.
Signatures. Signatures of the collaborating physician and the
prescribing psychologist.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
A
(1) Supervision plan. Prior to issuing a conditional prescription certificate , the board shall review and approve the proposed supervision plan.
a. The proposed supervision plan must include the following:
(1) Conditional prescribing psychologist information. The plan must include the name, license number, address, telephone number, and email address of the supervisee.
(2) Supervising physician information. The plan must include the name, license number, date of licensure, area of specialization, address, telephone number, and email address of each supervising physician .
(3) Primary supervising physician . The plan must include a designation of the primary supervising physician .
(4) Period of supervision. The plan must include the beginning date of the supervision plan and estimated date of completion.
(5) Locations and settings. The plan must include a description of the locations and settings where and with whom supervision will occur.
(6) Scope of practice. The plan must include a description of the scope of practice of the conditional prescribing psychologist , including any limitations on the types of psychotropic medications that may be prescribed and the patient populations to which a prescription may be issued and including the expectations and responsibilities of the supervising physician .
(7) Release of information. The plan must include a provision requiring the conditional prescribing psychologist to obtain a release of information from all patients who are considered for psychopharmacological intervention, authorizing the conditional prescribing psychologist to share the patient's health information with the supervising physician .
(8) Consultation between the conditional prescribing psychologist and the supervising physician . The plan must include a provision requiring that the conditional prescribing psychologist consult with the supervising physician on a regular basis regarding a patient's psychotropic treatment plan and any potential complications. A conditional prescribing psychologist shall not prescribe a new psychotropic medication , discontinue a psychotropic medication , or change the dosage of a psychotropic medication if the supervising physician objects on the basis of a contraindication.
(9) Consultation between the supervising physician and the primary care physician . The plan must include a provision requiring that the supervising physician consult with the patient's primary care physician on a regular basis regarding the patient's psychotropic treatment plan and any potential complications.
(10) Termination of the supervision plan. The plan must include a description of how the supervision plan may be terminated and the process for notifying affected patients.
(11) Signatures. The plan must include signatures of the psychologist and all supervising physicians.
b. A conditional prescribing psychologist shall inform the board of any amendments to the conditional prescribing psychologist 's supervision plan, including the addition of any supervising physicians, within 30 days of the change. Amendments to a supervision plan are subject to board approval.
c. The board shall transmit all approved supervision plans and approved amendments to the board of medicine .
(2) Responsibilities of a supervising physician . A supervising physician shall provide supervision in accordance with rules established by the board of medicine .
(3) Responsibilities of a conditional prescribing psychologist . At the initial contact, a conditional prescribing psychologist shall inform a patient, or a patient's legal guardian when appropriate, that the conditional prescribing psychologist is practicing under the supervision of a physician for purposes of prescribing psychotropic medication and shall provide the name of the supervising physician . A conditional prescribing psychologist shall provide sufficient information regarding the supervision requirements to obtain informed consent and appropriate releases. Upon request, a conditional prescribing psychologist shall provide additional information regarding the conditional prescribing psychologist 's education, training, or experience with respect to prescribing psychotropic medications.
(4) Specialization. A conditional prescribing psychologist shall complete the following training during the supervised practice period to be eligible to prescribe psychotropic medications to the respective population as a prescribing psychologist :
a. Children. To prescribe to patients who are less than 17 years of age, a conditional prescribing psychologist shall complete at least one year of the required two years of supervised practice in either:
(1) A pediatric practice,
(2) A child and adolescent practice, or
(3) A general practice provided the conditional prescribing psychologist treats a minimum of 50 patients who are less than 17 years of age.
b. Elderly patients. To prescribe to patients who are over 65 years of age, a conditional prescribing psychologist shall complete at least one year of the required two years of supervised practice in either:
(1) A geriatric practice, or
(2) A general practice with patients across the lifespan including patients who are over 65 years of age.
c. Serious medical conditions. To prescribe to patients with serious medical conditions including but not limited to heart disease, cancer, stroke, seizures, or comorbid psychological conditions, or patients with developmental disabilities and intellectual disabilities, a conditional prescribing psychologist shall complete at least one year prescribing psychotropic medications to patients with serious medical conditions.
(5) Completion of supervised practice. A conditional prescribing psychologist shall see a minimum of 300 patients over a minimum of two years to complete the supervised practice period, provided each of the 300 patients has a diagnosed mental disorder and pharmacological intervention is considered as a treatment option, even if a decision is made not to prescribe a psychotropic medication to the patient. A conditional prescribing psychologist shall treat a minimum of 100 patients with psychotropic medication throughout the supervised practice period.
a. At the conclusion of the supervised practice period, a primary supervising physician shall certify the following:
(1) Supervision was provided in accordance with rules established by the board of medicine .
(2) A conditional prescribing psychologist has successfully completed two years of supervised practice, considered at least 300 patients for psychopharmacological intervention, and treated at least 100 patients with psychotropic medications.
(3) A conditional prescribing psychologist intending to specialize in the psychological care of children or elderly persons, or persons with serious medical conditions, has completed the requirements of subrule 19.3(4).
(4) A conditional prescribing psychologist has successfully completed the supervised practice period and demonstrated competence in psychopharmacology by demonstrating competency in the milestones listed in paragraph 19.2(3)"f" sufficient to obtain a prescription certificate .
b. If a conditional prescribing psychologist is unable to successfully complete the supervised practice period prior to the expiration of the conditional prescription certificate , the conditional prescribing psychologist may request an extension of the conditional prescription certificate provided that the conditional prescribing psychologist can demonstrate that the conditional prescribing psychologist is likely to successfully complete the supervised practice within the extended time requested. Any requests for extension must be submitted to and approved by both the board and the board of medicine .