Iowa Passes Psychologist Rx Law

In May, Iowa became the fourth state to enact legislation permitting specially trained psychologists to prescribe psychotropic medications. However, implementation of the law will be delayed until specific education and training standards are determined by representatives from Iowa’s boards of medicine and psychology.

APA, joined by other medical professional societies, opposes prescribing rights for psychologists, citing patient safety concerns.

New Mexico’s prescribing law passed in 2002 and Louisiana’s in 2004. Similar legislation passed in 2014 in Illinois, although details of the training requirements for psychologists there are still being working out. More than 30 states have considered such bills over the past two decades, but only four have become law.

“I was surprised at the outcome,” said Jerome Greenfield, M.D., director of mental health services for the Iowa Department of Corrections and president of the Iowa Psychiatric Society (IPS), in an interview. “We presented good, organized, accurate information to legislators, but the issue became a pawn in a larger political chess game behind the scenes.”

Iowa psychiatrists and other physicians can still influence implementation of the new law. The boards of medicine and psychology must agree on the precise wording for the psychopharmacological training of psychologists before they are permitted to prescribe.

“The IPS will work closely with this process to ensure that our concerns and suggestions are incorporated into the final rule,” Joyce Vista-Wayne, M.D., of Mercy Medical Center in Des Moines and the immediate past president of the IPS, told Psychiatric News.

Pharmacological training isn’t the only requirement psychologists will be asked to complete, according to language in the law. To receive a conditional prescription certificate, a psychologist must pass a certification examination, complete a postdoctoral master’s degree in clinical psychopharmacology, and complete a “supervised and relevant clinical experience,” including a practicum of unspecified length.

Holders of the conditional prescription certificate must practice under the supervision of a physician, who need not be a psychiatrist. They cannot treat persons under the age of 17 or older than 65, pregnant women, or people with “serious medical conditions.” After two years, the holder of a conditional prescription certificate can apply for an unconditional prescription certificate.

The entire legislative process took place in a period of turmoil for Iowa’s mental health payment system, said Greenfield. Two of the four mental health facilities in the state have closed, and recent changes in the mental health portion of the Medicaid program have led to further cuts in services. Psychologists claimed that prescribing rights would help to increase access to mental health services, especially in rural areas.

However, psychologists are predominantly concentrated around cities in Iowa, as they are in New Mexico and Louisiana, said Greenfield. “They may have added more prescribers but not more access.”

To expand access to psychiatric services in the state, the IPS is seeking legislative support for parity payment for telepsychiatry and telemedicine services and is continuing a push to expand psychiatric training of primary care providers in rural and underserved areas, said Vista-Wayne.

In addition, Mercy Medical Center-Des Moines and Unity Point/Broadlawns Medical Center announced in March the start of two new psychiatry residency training programs in 2018, supplementing Iowa’s sole existing program at the University of Iowa, she said.

Timing of work by the boards of medicine and psychology on the training rules is unclear at the moment, but proposed rules are unlikely to be drafted and open for public comment before December. ■