Iowa Scope of Practice Policy: State Profile
Under Iowa scope of practice law, dental hygienists may provide educational services, assessment, screening and collect data for evaluation by a dentist under general supervision and without prior patient examination by the dentists. All other services, including the administration of local anesthesia or nitrous oxide, must be provided under the direct supervision of a dentist unless they are provided under public health supervision. Public health supervision may occur in a public health setting and requires the dentist and dental hygienist to enter into a written supervision agreement. A dental hygienist under public health supervision may provide services without an initial patient examination by the dentist and for certain procedures, the dentist is not required to provide future treatment. Iowa scope of practice laws do not allow dental hygienists to prescribe medication and currently do not provide for the licensing of dental therapists.
In Iowa, licensed mental health counselor’s may provide services involving assessment, referral, consultation, and the application of counseling, human development, principles, learning theory, group dynamics, and the etiology of maladjustment and dysfunctional behavior to individuals, families and groups. Diagnostic ability is not outlined in statute.
Nurse practitioners (NPs) in Iowa may have a collaborative agreement with a physician or practice independently without physician oversight or supervision. NPs may provide nursing assessment, intervention and management, as well as prescribe drugs, devices and medical gases. Iowa NPs are required to practice within their educational background and the standards established by national certifying bodies. NPs are recognized as primary care providers in Iowa.
An NP in Iowa may independently prescribe Schedule II-V controlled substances. With proper training or experience an NP in Iowa may obtain a federal waiver to dispense buprenorphine-containing products.
In Iowa, there are currently no statutory or regulatory standards for the certification of mental health peer support specialists and peer recovery specialists. The standards and requirements for the certification of mental health peer support specialists and peer recovery specialists are developed and administered by third-party, nonprofit certification providers.
Iowa physician assistants (PAs) may provide medical services as delegated by a supervising physician and as outlined by state law. The supervision requirements for a PA are established by state regulation and include face-to-face meetings and chart reviews. A supervising physician is not required to be personally present to ensure supervision.
A PA in Iowa may prescribe Schedule III-V controlled substances as delegated by a supervising physician. PAs, however, are prohibited from prescribing Schedule II depressants. With proper training or appropriate experience a PA in Iowa can receive a federal waiver to dispense buprenorphine-containing products, as long as the supervising physician is certified, trained or permitted to treat and manage patients with opioid use disorder.
Iowa SOP Legislation
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- Licensed Professional Counselor Ability to Diagnose
A licensed mental health counselor’s diagnostic ability is not outlined in statute. Iowa Code §154D.1(6)
- Number of Nurse Practitioners Prescribing Buprenorphine
As of August 2018, 36 NPs in Iowa have received a federal waiver to treat opioid dependency with buprenorphine-containing products. Consistent with their prescriptive authority and with proper training or experience an NP may obtain a federal waiver to dispense buprenorphine-containing products. Iowa Admin. Code r. 655-7.1
- Number of Physician Assistants Prescribing Buprenorphine
As of August 2018, 4 PAs in Iowa have received a federal waiver to treat opioid dependency with buprenorphine-containing products. A PA in Iowa may prescribe Schedule III-V controlled substances as delegated by a supervising physician. With proper training or appropriate experience a PA in Iowa can receive a federal waiver to dispense buprenorphine-containing products, as long as the supervising physician is certified, trained, or permitted to treat and manage patients with opioid use disorder. Iowa Admin. Code r. 645-327.1(1)(s)
- Peer Support Specialist Certification or Credentialing Authority
The standards and requirements for the certification of mental health peer support specialists and peer recovery specialists are developed and administered by third-party, non-profit certification providers.
- Practice Authority
NPs have full independent practice authority. An NP means a nurse with current licensure as a registered nurse in Iowa or who is licensed in another state and recognized for licensure in this state pursuant to the nurse licensure compact, and is also registered in Iowa to practice in an advanced role. The ARNP is prepared for an advanced role by virtue of additional knowledge and skills gained through a formal advanced practice education program of nursing in a specialty area approved by the board. In the advanced role, the nurse practices nursing assessment, intervention and management within the boundaries of the nurse-client relationship. Advanced nursing practice occurs in a variety of settings, within an interdisciplinary health care team, which provide for consultation, collaborative management, or referral. 655 IAC §7.1(152)
- Prescriptive Authority
NPs may prescribe drugs, devices and medical gases and are authorized to prescribe controlled substances after they register with the U.S. Drug Enforcement Administration and the Iowa Board of Pharmacy. 655 IAC §7.1(152)
- Nurse Practitioner as a Primary Care Provider
NPs are recognized in state policy as primary care providers. A primary care provider means any of the following who provide primary care and meet certification standards: a physician who is a family or general practitioner, a pediatrician, an internist, an obstetrician or a gynecologist; an advanced registered nurse practitioner; a physician assistant; or a chiropractor. Iowa Code Ann. §135.157(9)
- Dental Hygienists with Direct Access
A dental hygienist may perform educational, therapeutic and preventive services in schools, public health agencies, hospitals and the armed forces. All services except those deemed educational must be performed under the supervision of a dentist. Iowa Code Title IV §153.15.
- Dental Hygienists with Prescriptive Authority
Dental hygienists do not have prescriptive authority.
- Dental Therapists
Statute does not identify dental therapists as an oral health provider.
- Supervision Requirements
The law outlines the exact means of responsible supervision. Requirements include types of supervision, amount of and purpose of face-to-face meetings with the PA, among others. Direct supervision is not required, but the supervising physician must be easily available in person or via telecommunication for consultation. 653 IAC §21.4(1)
- Prescriptive Authority for Physician Assistants
A PA may prescribe drugs, medical devices and Schedules III-V controlled substances if delegated by the supervising physician. A PA may not prescribe Schedule II controlled substances that are listed as depressants in law. 645 IAC §327.1(1)(s)
- Scope of Practice Determination
The law outlines the duties that may be performed by the PA. The delegated medical services must be within the scope of practice of the supervising physician and the PA. 653 IAC §21.4(2)(f), 645 IAC §327.1(1)