State Overview: Iowa

State law or statute prohibits or limits the use of prior authorization for buprenorphine containing products by either the state Medicaid plan or private insurance companies.

Medicaid fee-for-service and Medicaid managed care must cover at least one form of methadone, buprenorphine, naloxone, buprenorphine/ naloxone, and naltrexone without prior authorization. Iowa Code Ann. §441.78.28(2)

Iowa credentials three types of addiction counselors. A Certified Alcohol and Drug Counselor can attain the credential in two ways. The education track requires the individual complete specific relevant education classes and 1,000 hours of experience. The experience track requires a high school diploma, 150 hours of relevant training and 3,000 hours of experience.

An International Alcohol and Drug Counselor requires a high school degree, 270 hours of training and 6,000 hours of work experience. A higher-level degree can substitute the number of hours (i.e. a person with a bachelor's degree needs 4,000 hours). An International Advanced Alcohol and Drug Counselors requires a master's degree, 180 hours of relevant education and supervised experience in ten domains. Iowa Board of Certification

Licensed mental health counselors 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. Iowa Code §154D.1(6)

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.

NMs have full independent practice and prescriptive authority.

An advanced registered NP, including NMs, shall have the authority to practice to the full extent of the their license, education, and experience in the their respective population foci.

An advanced registered NP licensed by the board may prescribe, administer, or dispense prescription drugs or devices, including controlled substances, within their role and population foci and consistent with applicable state and federal laws. 655 Iowa Admin. Code §7.4

NPs have full independent practice and prescriptive authority.

An advanced registered NP shall have the authority to practice to the full extent of the their license, education, and experience in their respective population foci.

An advanced registered NP licensed by the board may prescribe, administer, or dispense prescription drugs or devices, including controlled substances, within the their role and population foci and consistent with applicable state and federal laws.  655 Iowa Admin. Code §7.4

NPs are authorized to sign physician orders for scope of treatment forms and to provide end-of-life treatment in clinical and home health agency settings. Iowa Code Ann. §144D.1 – 4

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. §249N.2

Optometrists may only perform procedures related to foreign body removal and the examination, evaluation, diagnosis and treatment of the human eye. Additional allowable procedures may be authorized by statute and/or rule. Iowa Code §154.1(3)(a)

Optometrists may administer all pharmaceutical agents for the diagnosis and treatment of eye diseases, including epinephrine auto-injections to counter anaphylaxis. Iowa Code §154.1(3)(b)

Optometrists may prescribe Schedule III-V controlled substances and also Schedule II hydrocodone or hydrocodone combination medications. Iowa Code §154.1(3)(b)(3)

Public health supervision of dental hygienists 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 Code Title IV §153.15. 

Statute does not identify dental therapists as an oral health provider.

Iowa does not explicitly allow for the practice of teledentistry.

Pharmacists may order and administer the COVID-19 vaccine to patients ages eighteen years and older. Iowa Code §155A.46

Iowa does not allow pharmacists to modify prescriptions.

Iowa does not allow pharmacists to prescribe hormonal contraceptives.

Pharmacists may prescribe nicotine replacement tobacco cessation products pursuant to the statewide protocol developed by the Board of Pharmacy. Iowa Code §155A.46

Supervision or collaboration not required for practice or prescriptive authority.

Joint rules shall be adopted by the board and the board of medicine requiring a licensed physician 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 with the appropriate physician or other health care professional for a period of at least two years. The rules shall 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 degree of collaboration between a physician assistant and the appropriate member of a health care team shall be determined at the practice level. Iowa Admin. Code § 148C.4 

A physician assistant may prescribe, dispense, order, administer or procure prescription drugs, controlled substances or medical devices necessary to complete a course of therapy. 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. Iowa Admin. Code § 147.107

Statute limits the number of PAs a physician may supervise.

Rules shall be adopted by the board pursuant to this chapter requiring a licensed PA to be supervised by physicians. The rules shall provide that not more than five PAs shall be supervised by a physician at one time. Iowa Code § 148C.3(2)

Chart co-signatures may be determined at the practice level.

The plan for completing and documenting chart reviews: A licensed physician within the same facility or health care system as the PA shall conduct an ongoing review of a representative sample of the PA's patient charts encompassing the scope of the PA's practice. Iowa Admin. Code 653-21.4(2)(b)(1)-(2)

Statute allows adaptable proximity.

"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 the rules of the board. Iowa Admin. Code § 148C.3

The supervising physician delegates medical services to the physician assistant. All delegated medical services shall be within the scope of practice of the supervising physician and the physician assistant. 653 Iowa Admin. Code §21.4(2)(f)