844 IAC 2.2 — ARTICLE 2.2. PHYSICIAN ASSISTANTS

TITLE 844 MEDICAL LICENSING BOARD OF INDIANA

ARTICLE 2.2. PHYSICIAN ASSISTANTS

844 IAC 2.2-1 Rule 1. Definitions (Repealed)

Rule 1. Definitions (Repealed)

(Repealed by Medical Licensing Board of Indiana; filed Apr 6, 2010, 2:52 p.m.: 20100505-IR-844090164FRA)

Rule 1.1

844 IAC 2.2-1.1-1 844 IAC 2.2-1.1-1 Applicability

Rule 1.1. Definitions

844 IAC 2.2-1.1-1 Applicability

Authority: IC 25-22.5-2-7

Affected: IC 25-22.5-1

Sec. 1. The definitions in this rule apply throughout this title.

(Medical Licensing Board of Indiana; 844 IAC 2.2-1.1-1; filed Apr 6, 2010, 2:52 p.m.: 20100505-IR-844090164FRA; readopted filed Nov 22, 2016, 12:11 p.m.: 20161221-IR-844160317RFA; readopted filed Nov 22, 2022, 12:22 p.m.: 20221221-IR-844220255RFA; readopted filed Feb 27, 2024, 10:19 a.m.: 20240327-IR-844230772RFA)

844 IAC 2.2-1.1-2 844 IAC 2.2-1.1-2 "Anesthesia" defined

844 IAC 2.2-1.1-2 "Anesthesia" defined

Authority: IC 25-22.5-2-7

Affected: IC 25-22.5; IC 25-27.5

Sec. 2. For purposes of IC 25-27.5, "anesthesia" includes the following:

(1) Moderate sedation/analgesia.

(2) Deep sedation/analgesia.

(3) General anesthesia.

(4) Regional anesthesia.

(Medical Licensing Board of Indiana; 844 IAC 2.2-1.1-2; filed Apr 6, 2010, 2:52 p.m.: 20100505-IR-844090164FRA; readopted filed Nov 22, 2016, 12:11 p.m.: 20161221-IR-844160317RFA; readopted filed Nov 22, 2022, 12:22 p.m.: 20221221-IR-844220255RFA; readopted filed Feb 27, 2024, 10:19 a.m.: 20240327-IR-844230772RFA)

844 IAC 2.2-1.1-3 844 IAC 2.2-1.1-3 "Board" defined

844 IAC 2.2-1.1-3 "Board" defined

Authority: IC 25-22.5-2-7

Affected: IC 25-22.5-1; IC 25-27.5-2-3

Sec. 3. "Board" has the meaning set forth in IC 25-27.5-2-3.

(Medical Licensing Board of Indiana; 844 IAC 2.2-1.1-3; filed Apr 6, 2010, 2:52 p.m.: 20100505-IR-844090164FRA; readopted filed Nov 22, 2016, 12:11 p.m.: 20161221-IR-844160317RFA; readopted filed Nov 22, 2022, 12:22 p.m.: 20221221-IR-844220255RFA; readopted filed Feb 27, 2024, 10:19 a.m.: 20240327-IR-844230772RFA; filed Jun 20, 2025, 3:41 p.m.: 20250716-IR-844240435FRA)

844 IAC 2.2-1.1-3.1 844 IAC 2.2-1.1-3.1 "Collaborating physician" defined

844 IAC 2.2-1.1-3.1 "Collaborating physician" defined

Authority: IC 25-22.5-2-7

Affected: IC 25-22.5; IC 25-27.5-2-4.7

Sec 3.1. "Collaborating physician" has the meaning set forth in IC 25-27.5-2-4.7.

(Medical Licensing Board of Indiana; 844 IAC 2.2-1.1-3.1; filed Jun 20, 2025, 3:41 p.m.: 20250716-IR-844240435FRA)

844 IAC 2.2-1.1-3.2 844 IAC 2.2-1.1-3.2 "Collaboration" defined

844 IAC 2.2-1.1-3.2 "Collaboration" defined

Authority: IC 25-22.5-2-7

Affected: IC 25-22.5; IC 25-27.5-2-4.9

Sec. 3.2. "Collaboration" has the meaning set forth in IC 25-27.5-2-4.9.

(Medical Licensing Board of Indiana; 844 IAC 2.2-1.1-3.2; filed Jun 20, 2025, 3:41 p.m.: 20250716-IR-844240435FRA)

844 IAC 2.2-1.1-3.5 844 IAC 2.2-1.1-3.5 "Collaboration agreement" defined

844 IAC 2.2-1.1-3.5 "Collaboration agreement" defined

Authority: IC 25-22.5-2-7

Affected: IC 25-22.5

Sec. 3.5. " Collaboration agreement" means a written document signed by the collaborating physician or physicians and the physician assistant that:

(1) includes the tasks delegated to the physician assistant;

(2) describes the collaborative plan for the physician assistant, including emergency procedures the physician assistant shall follow;

(3) specifies the protocol the physician assistant shall follow in prescribing a drug;

(4) specifies the names of medical devices the physician is delegated to prescribe;

(5) includes the:

(A) name;

(B) address; and

(C) phone number;

of the physician or physicians who will be collaborating with the physician assistant; and

(6) includes a description of the setting or settings in which the physician assistant will be working.

(Medical Licensing Board of Indiana; 844 IAC 2.2-1.1-3.5; filed Jun 20, 2025, 3:41 p.m.: 20250716-IR-844240435FRA)

844 IAC 2.2-1.1-4 844 IAC 2.2-1.1-4 "Committee" defined

844 IAC 2.2-1.1-4 "Committee" defined

Authority: IC 25-22.5-2-7

Affected: IC 25-22.5-1; IC 25-27.5-2-5

Sec. 4. "Committee" has the meaning set forth in IC 25-27.5-2-5.

(Medical Licensing Board of Indiana; 844 IAC 2.2-1.1-4; filed Apr 6, 2010, 2:52 p.m.: 20100505-IR-844090164FRA; readopted filed Nov 22, 2016, 12:11 p.m.: 20161221-IR-844160317RFA; readopted filed Nov 22, 2022, 12:22 p.m.: 20221221-IR-844220255RFA; readopted filed Feb 27, 2024, 10:19 a.m.: 20240327-IR-844230772RFA; filed Jun 20, 2025, 3:41 p.m.: 20250716-IR-844240435FRA)

844 IAC 2.2-1.1-5 844 IAC 2.2-1.1-5 "Contact hour" defined (Repealed)

844 IAC 2.2-1.1-5 "Contact hour" defined (Repealed)

(Repealed by Medical Licensing Board of Indiana; filed Jun 20, 2025, 3:41 p.m.: 20250716-IR-844240435FRA)

844 IAC 2.2-1.1-6 844 IAC 2.2-1.1-6 "Deep sedation/analgesia" defined

844 IAC 2.2-1.1-6 "Deep sedation/analgesia" defined

Authority: IC 25-22.5-2-7

Affected: IC 25-22.5; IC 25-27.5

Sec. 6. (a) For purposes of IC 25-27.5, "deep sedation/analgesia" means a drug-induced depression of consciousness during which patients cannot be easily aroused, but respond purposefully after repeated or painful stimulation. For purposes of this rule, reflex withdrawal from a painful stimulus is not considered a purposeful response.

(b) The following are conditions that a patient under deep sedation/analgesia may experience:

(1) The ability to independently maintain ventilatory function may be impaired.

(2) Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate.

(3) Cardiovascular function is usually maintained.

(Medical Licensing Board of Indiana; 844 IAC 2.2-1.1-6; filed Apr 6, 2010, 2:52 p.m.: 20100505-IR-844090164FRA; readopted filed Nov 22, 2016, 12:11 p.m.: 20161221-IR-844160317RFA; readopted filed Nov 22, 2022, 12:22 p.m.: 20221221-IR-844220255RFA; readopted filed Feb 27, 2024, 10:19 a.m.: 20240327-IR-844230772RFA; filed Jun 20, 2025, 3:41 p.m.: 20250716-IR-844240435FRA)

844 IAC 2.2-1.1-7 844 IAC 2.2-1.1-7 "Drug classification" defined (Repealed)

844 IAC 2.2-1.1-7 "Drug classification" defined (Repealed)

(Repealed by Medical Licensing Board of Indiana; filed Jun 20, 2025, 3:41 p.m.: 20250716-IR-844240435FRA)

844 IAC 2.2-1.1-8 844 IAC 2.2-1.1-8 "General anesthesia" defined

844 IAC 2.2-1.1-8 "General anesthesia" defined

Authority: IC 25-22.5-2-7

Affected: IC 25-22.5; IC 25-27.5

Sec. 8. (a) For purposes of IC 25-27.5, "general anesthesia" means a drug-induced loss of consciousness during which patients are not arousable, even by pain stimulation.

(b) The following are conditions that a patient under general anesthesia may experience:

(1) The ability to independently maintain ventilatory function is often impaired.

(2) Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required due to depressed spontaneous ventilation or drug-induced depression of neuromuscular function.

(3) Cardiovascular function may be impaired.

(Medical Licensing Board of Indiana; 844 IAC 2.2-1.1-8; filed Apr 6, 2010, 2:52 p.m.: 20100505-IR-844090164FRA; readopted filed Nov 22, 2016, 12:11 p.m.: 20161221-IR-844160317RFA; readopted filed Nov 22, 2022, 12:22 p.m.: 20221221-IR-844220255RFA; readopted filed Feb 27, 2024, 10:19 a.m.: 20240327-IR-844230772RFA)

844 IAC 2.2-1.1-9 844 IAC 2.2-1.1-9 "Local anesthesia" defined

844 IAC 2.2-1.1-9 "Local anesthesia" defined

Authority: IC 25-22.5-2-7

Affected: IC 25-22.5; IC 25-27.5

Sec. 9. For purposes of IC 25-27.5, "local anesthesia" means a transient and reversible loss of sensation in a circumscribed portion of the body produced by a local anesthetic agent or by cooling a circumscribed area of the skin. The term includes subcutaneous infiltration of an agent.

(Medical Licensing Board of Indiana; 844 IAC 2.2-1.1-9; filed Apr 6, 2010, 2:52 p.m.: 20100505-IR-844090164FRA; readopted filed Nov 22, 2016, 12:11 p.m.: 20161221-IR-844160317RFA; readopted filed Nov 22, 2022, 12:22 p.m.: 20221221-IR-844220255RFA; readopted filed Feb 27, 2024, 10:19 a.m.: 20240327-IR-844230772RFA)

844 IAC 2.2-1.1-10 844 IAC 2.2-1.1-10 "Minimal sedation/anxiolysis" defined

844 IAC 2.2-1.1-10 "Minimal sedation/anxiolysis" defined

Authority: IC 25-22.5-2-7

Affected: IC 25-22.5; IC 25-27.5

Sec. 10. For purposes of IC 25-27.5, "minimal sedation/anxiolysis" means a drug-induced state during which a patient responds normally to verbal commands. Although cognitive function and coordination may be impaired, ventilatory and cardiovascular functions are usually not affected.

(Medical Licensing Board of Indiana; 844 IAC 2.2-1.1-10; filed Apr 6, 2010, 2:52 p.m.: 20100505-IR-844090164FRA; readopted filed Nov 22, 2016, 12:11 p.m.: 20161221-IR-844160317RFA; readopted filed Nov 22, 2022, 12:22 p.m.: 20221221-IR-844220255RFA; readopted filed Feb 27, 2024, 10:19 a.m.: 20240327-IR-844230772RFA)

844 IAC 2.2-1.1-11 844 IAC 2.2-1.1-11 "Moderate sedation/analgesia" defined

844 IAC 2.2-1.1-11 "Moderate sedation/analgesia" defined

Authority: IC 25-22.5-2-7

Affected: IC 25-22.5; IC 25-27.5

Sec. 11. (a) For purposes of IC 25-27.5, "moderate sedation/analgesia" (also referred to as "conscious sedation") means a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation.

(b) The following are conditions that a patient under moderate sedation/analgesia may experience:

(1) No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate.

(2) Cardiovascular function is usually maintained.

(Medical Licensing Board of Indiana; 844 IAC 2.2-1.1-11; filed Apr 6, 2010, 2:52 p.m.: 20100505-IR-844090164FRA; readopted filed Nov 22, 2016, 12:11 p.m.: 20161221-IR-844160317RFA; readopted filed Nov 22, 2022, 12:22 p.m.: 20221221-IR-844220255RFA; readopted filed Feb 27, 2024, 10:19 a.m.: 20240327-IR-844230772RFA)

844 IAC 2.2-1.1-12 844 IAC 2.2-1.1-12 "NCCPA" defined

844 IAC 2.2-1.1-12 "NCCPA" defined

Authority: IC 25-22.5-2-7

Affected: IC 25-22.5-1; IC 25-27.5-2-8

Sec. 12. "NCCPA" has the meaning set forth in IC 25-27.5-2-8.

(Medical Licensing Board of Indiana; 844 IAC 2.2-1.1-12; filed Apr 6, 2010, 2:52 p.m.: 20100505-IR-844090164FRA; readopted filed Nov 22, 2016, 12:11 p.m.: 20161221-IR-844160317RFA; readopted filed Nov 22, 2022, 12:22 p.m.: 20221221-IR-844220255RFA; readopted filed Feb 27, 2024, 10:19 a.m.: 20240327-IR-844230772RFA; filed Jun 20, 2025, 3:41 p.m.: 20250716-IR-844240435FRA)

844 IAC 2.2-1.1-13 844 IAC 2.2-1.1-13 "Physician assistant" defined

844 IAC 2.2-1.1-13 "Physician assistant" defined

Authority: IC 25-22.5-2-7

Affected: IC 25-22.5-1; IC 25-27.5-2-10

Sec. 13. "Physician assistant" has the meaning set forth in IC 25-27.5-2-10.

(Medical Licensing Board of Indiana; 844 IAC 2.2-1.1-13; filed Apr 6, 2010, 2:52 p.m.: 20100505-IR-844090164FRA; readopted filed Nov 22, 2016, 12:11 p.m.: 20161221-IR-844160317RFA; readopted filed Nov 22, 2022, 12:22 p.m.: 20221221-IR-844220255RFA; readopted filed Feb 27, 2024, 10:19 a.m.: 20240327-IR-844230772RFA; filed Jun 20, 2025, 3:41 p.m.: 20250716-IR-844240435FRA)

844 IAC 2.2-1.1-14 844 IAC 2.2-1.1-14 "Protocol" defined

844 IAC 2.2-1.1-14 "Protocol" defined

Authority: IC 25-22.5-2-7

Affected: IC 25-22.5-1

Sec. 14. "Protocol" means general directions under standard practice for prescribing a drug or medical device. The term includes clinical practice guidelines and reference texts or other sources.

(Medical Licensing Board of Indiana; 844 IAC 2.2-1.1-14; filed Apr 6, 2010, 2:52 p.m.: 20100505-IR-844090164FRA; readopted filed Nov 22, 2016, 12:11 p.m.: 20161221-IR-844160317RFA; readopted filed Nov 22, 2022, 12:22 p.m.: 20221221-IR-844220255RFA; readopted filed Feb 27, 2024, 10:19 a.m.: 20240327-IR-844230772RFA)

844 IAC 2.2-1.1-15 844 IAC 2.2-1.1-15 "Regional anesthesia" defined

844 IAC 2.2-1.1-15 "Regional anesthesia" defined

Authority: IC 25-22.5-2-7

Affected: IC 25-22.5; IC 25-27.5

Sec. 15. (a) For purposes of IC 25-27.5, "regional anesthesia" means the administration of anesthetic agents to a patient to interrupt nerve impulses without the loss of consciousness and includes the following:

(1) Major conduction blocks, such as:

(A) epidural;

(B) spinal; and

(C) caudal;

blocks.

(2) Peripheral nerve blocks, such as:

(A) brachial;

(B) lumbar plexus;

(C) peribulbar; and

(D) retrobulbar;

blocks.

(3) Intravenous regional anesthesia, such as Bier blocks.

(b) A superficial nerve block or application of a local anesthetic agent where the total dosage administered exceeds the recommended maximum dosage per body weight described in the manufacturer's package insert is considered regional anesthesia for purposes of this rule.

(Medical Licensing Board of Indiana; 844 IAC 2.2-1.1-15; filed Apr 6, 2010, 2:52 p.m.: 20100505-IR-844090164FRA; readopted filed Nov 22, 2016, 12:11 p.m.: 20161221-IR-844160317RFA; readopted filed Nov 22, 2022, 12:22 p.m.: 20221221-IR-844220255RFA; readopted filed Feb 27, 2024, 10:19 a.m.: 20240327-IR-844230772RFA; filed Jun 20, 2025, 3:41 p.m.: 20250716-IR-844240435FRA)

844 IAC 2.2-1.1-16 844 IAC 2.2-1.1-16 "Supervisory agreement" defined

844 IAC 2.2-1.1-16 "Supervisory agreement" defined

Authority: IC 25-22.5-2-7

Affected: IC 25-22.5

Sec. 16. "Supervisory agreement" means a written document signed by the supervising physician or physicians and the physician assistant that:

(1) includes the tasks delegated to the physician assistant;

(2) describes the supervisory plan for the physician assistant, including emergency procedures that the physician assistant must follow;

(3) specifies the names of the drug or drug classification the physician assistant is delegated to prescribe and the protocol the physician assistant shall follow in prescribing a drug;

(4) specifies the names of medical devices the physician is delegated to prescribe;

(5) includes the:

(A) name;

(B) address; and

(C) phone number;

of the physician or physicians who will be supervising the physician assistant; and

(6) includes a description of the setting or settings in which the physician assistant will be working.

(Medical Licensing Board of Indiana; 844 IAC 2.2-1.1-16; filed Apr 6, 2010, 2:52 p.m.: 20100505-IR-844090164FRA; readopted filed Nov 22, 2016, 12:11 p.m.: 20161221-IR-844160317RFA; readopted filed Nov 22, 2022, 12:22 p.m.: 20221221-IR-844220255RFA; readopted filed Feb 27, 2024, 10:19 a.m.: 20240327-IR-844230772RFA)

Rule 2

844 IAC 2.2-2-1 844 IAC 2.2-2-1 Applications

Rule 2. General Provisions

844 IAC 2.2-2-1 Applications

Authority: IC 25-22.5-2-7; IC 25-27.5-3-5

Affected: IC 25-22.5-1-2; IC 25-27.5

Sec. 1. (a) The application for licensure of a physician assistant must be made on forms supplied by the committee.

(b) An application for licensure as a physician assistant or a temporary permit must include all the following information:

(1) Complete name, address, and telephone number of the physician assistant.

(2) Satisfactory evidence of the following:

(A) Completion of required pharmacology training from a physician assistant program accredited by the Accreditation Review Commission on Education for the Physician Assistant.

(B) Passage of the Physician Assistant National Certifying Examination administered by the NCCPA.

(C) A current NCCPA certificate.

(D) A current Indiana physician assistant license or a submitted application in conjunction with prescribing authority application.

(3) The names used by the physician assistant, explaining the reason for a name change or use.

(4) The date and place of birth of the physician assistant and their age at the time of application.

(5) Citizenship and visa status, if applicable.

(6) Whether the physician assistant has been licensed, certified, or registered in any other jurisdiction and, if so, the dates they were licensed, certified, or registered.

(7) Whether the physician assistant has had disciplinary action taken against the license, certificate, or registration by the licensing or regulatory agency of any other state or jurisdiction, and the details and dates of the disciplinary action.

(8) A complete listing of each place of employment, including:

(A) the name and address of the employers;

(B) the dates of each employment; and

(C) employment responsibilities held or performed;

that the applicant has had since becoming a physician assistant in any state or jurisdiction.

(9) Whether the physician assistant is or has been addicted to, or chemically dependent on narcotic drugs, alcohol, or other drugs and, if so, the details of the addiction.

(10) Whether the applicant has been denied licensure, certification, approval, or registration as a physician assistant by any other state or jurisdiction and, if so, the details of the denial, including the following:

(A) The name and location of the state or jurisdiction denying:

(i) licensure;

(ii) certification;

(iii) approval; or

(iv) registration.

(B) The date of the denial.

(C) The reasons relating to the denial.

(11) Whether the physician assistant has been convicted of, or pleaded guilty to, any violation of federal, state, or local law relating to the:

(A) use;

(B) manufacturing;

(C) distributing;

(D) sale;

(E) dispensing; or

(F) possession;

of controlled substances or drug addiction and, if so, the details relating thereto.

(12) Whether the physician assistant has been convicted of, or pleaded guilty to, a federal or state criminal offense, felony, or misdemeanor, except for traffic violations that resulted only in fines and, if so, the details thereto.

(13) Whether the physician assistant was denied privileges in any hospital or health care facility, or had those privileges revoked, suspended, or subjected to any restriction, probation, or other type of discipline or limitation, and, if so, the details relating to the denial, including the:

(A) name and address of the hospital or health care facility;

(B) date of the action; and

(C) reasons for the denial.

(14) Whether the physician assistant has ever been admonished, censured, reprimanded, or requested to withdraw, resign, or retire from any hospital or health care facility where the physician assistant was employed, worked, or held privileges.

(15) Whether the physician assistant has had any malpractice judgments entered against them or settled any malpractice action or cause of action and, if so, a complete, detailed description of the facts and circumstances relating to the judgments or actions.

(c) The information in an application shall be submitted under oath or affirmation, subject to the penalties of perjury.

(d) An applicant for licensure as a physician assistant shall submit an executed authorization and release form provided by the committee that:

(1) authorizes the committee or any of its authorized representatives to inspect, receive, and review the documents, records, or other information pertaining to the applicant;

(2) authorizes and directs any:

(A) person;

(B) corporation;

(C) partnership;

(D) association;

(E) organization;

(F) institute;

(G) forum; or

(H) officer thereof;

to give the committee the relevant documents, records, or other information pertaining to the applicant; and

(3) releases the committee, or any of its authorized representatives, and any:

(A) person;

(B) corporation;

(C) partnership;

(D) association;

(E) organization;

(F) institute;

(G) forum; or

(H) officer thereof;

from all liability regarding inspecting, reviewing, receiving, or supplying that information.

(e) Application forms submitted to the committee must be complete. Supporting documents required by the application must be submitted with the application.

(f) Applicants for a temporary permit to practice as a physician assistant while waiting to take the examination or awaiting results of the examination shall submit the requirements of subsection (b), except for subsection (b)(2)(B) and (b)(2)(C), to apply for a temporary permit.

(g) A temporary permit becomes invalid if the temporary permit holder fails to sit or register for the next available examination.

(h) Before beginning practice as a physician assistant, the physician assistant shall submit a collaboration agreement to the committee, which must be approved by the board. The collaboration agreement must:

(1) be submitted on the employer's letterhead;

(2) be written specifically for the applicant; and

(3) contain the original signature of both the applicant and collaborating physician, and the date signed.

(Medical Licensing Board of Indiana; 844 IAC 2.2-2-1; filed May 26, 2000, 8:52 a.m.: 23 IR 2498; errata filed Sep 21, 2000, 3:21 p.m.: 24 IR 382; filed Jan 2, 2003, 10:38 a.m.: 26 IR 1558; readopted filed Dec 1, 2009, 9:13 a.m.: 20091223-IR-844090779RFA; filed Apr 6, 2010, 2:52 p.m.: 20100505-IR-844090164FRA; readopted filed Nov 22, 2016, 12:11 p.m.: 20161221-IR-844160317RFA; readopted filed Nov 22, 2022, 12:22 p.m.: 20221221-IR-844220255RFA; readopted filed Feb 27, 2024, 10:19 a.m.: 20240327-IR-844230772RFA; filed Jun 20, 2025, 3:41 p.m.: 20250716-IR-844240435FRA)

844 IAC 2.2-2-2 844 IAC 2.2-2-2 Registration of collaborating physician

844 IAC 2.2-2-2 Registration of collaborating physician

Authority: IC 25-22.5-2-7; IC 25-27.5-3-5

Affected: IC 25-22.5; IC 25-27.5-6-1; IC 25-27.5-6-2

Sec. 2. (a) A physician licensed under IC 25-22.5 who intends to collaborate with a physician assistant shall register their intent to do so with the board, on a form approved by the board, before collaboration begins with the physician assistant. The collaborating physician shall include the following information on the form provided by the board:

(1) The:

(A) name;

(B) business address; and

(C) telephone number;

of the collaborating physician.

(2) The:

(A) name;

(B) business address;

(C) telephone number; and

(D) certification number;

of the physician assistant.

(3) The current license number of the physician.

(4) A statement that the physician will collaborate with not more than the number of physician assistants permitted by IC 25-27.5-6-2, and the name and certificate numbers of the physician assistants the collaborating physician is currently collaborating with.

(5) A description of the setting in which the physician assistant will practice under the collaborating physician, including the specialty, if any, of the collaborating physician.

(6) A statement that the collaborating physician:

(A) will collaborate with the physician assistant in accordance with IC 25-27.5-6 and this article;

(B) shall review all patient encounters maintained by the physician assistant as required by IC 25-27.5-6-1; and

(C) at all times, retain professional and legal responsibility for the care rendered by the physician assistant.

(7) A detailed description of the process maintained by the physician for evaluation of the physician assistant's performance.

(b) The designated collaborating physician is to accept the responsibility of collaborating with the physician assistant in the absence of the primary collaborating physician of record. Protocol is to be established by the physician practice.

(c) The collaborating physician shall, within fifteen (15) days, notify both the board and committee that the collaborating relationship with the physician assistant is terminated. The notification must state the reason for the termination.

(Medical Licensing Board of Indiana; 844 IAC 2.2-2-2; filed May 26, 2000, 8:52 a.m.: 23 IR 2499; errata filed Sep 21, 2000, 3:21 p.m.: 24 IR 382; filed Jan 2, 2003, 10:38 a.m.: 26 IR 1559; readopted filed Dec 1, 2009, 9:13 a.m.: 20091223-IR-844090779RFA; filed Apr 6, 2010, 2:52 p.m.: 20100505-IR-844090164FRA; readopted filed Nov 22, 2016, 12:11 p.m.: 20161221-IR-844160317RFA; readopted filed Nov 22, 2022, 12:22 p.m.: 20221221-IR-844220255RFA; readopted filed Feb 27, 2024, 10:19 a.m.: 20240327-IR-844230772RFA; filed Jun 20, 2025, 3:41 p.m.: 20250716-IR-844240435FRA)

844 IAC 2.2-2-3 844 IAC 2.2-2-3 License renewal

844 IAC 2.2-2-3 License renewal

Authority: IC 25-22.5-2-7

Affected: IC 25-27.5-5-2

Sec. 3. (a) A physician assistant holding a license issued by the committee shall renew their license every two (2) years, in even-numbered years, and pay the fee required by section 8 of this rule.

(b) Before May 1 of a renewal year, the committee, or its duly authorized agent, shall notify each license holder that the license holder is required to renew with the committee. The committee, or its agent, shall provide the license holder with a form to be completed for renewal.

(c) Applications for renewals must be made under oath or affirmation.

(d) A license holder shall do the following:

(1) Submit the following:

(A) Evidence of current NCCPA certification.

(B) A fee as determined by the committee, in the form of:

(i) a check;

(ii) a certified check;

(iii) a cashier's check;

(iv) a postal money order; or

(v) an electronic payment;

payable to the order of the "Indiana Professional Licensing Agency".

(2) Inform the committee, in writing, of all changes in address or name within thirty (30) days after the change.

(e) A license holder's failure to receive notification of renewal because they failed to notify the committee of a change of address or name does not:

(1) constitute an error on the part of the committee or the Indiana professional licensing agency; or

(2) exonerate or otherwise excuse the license holder from renewing the license.

(f) A physician assistant who is less than three (3) years delinquent in renewing a license may be reinstated after the committee receives the:

(1) renewed application;

(2) renewal fees; and

(3) penalty fee.

(g) If more than three (3) years have elapsed since the expiration of a license to practice as a physician assistant, before reinstatement, the applicant may be required by the committee to take and pass the examination approved by the committee.

(Medical Licensing Board of Indiana; 844 IAC 2.2-2-3; filed May 26, 2000, 8:52 a.m.: 23 IR 2500; readopted filed Nov 16, 2006, 10:49 a.m.: 20061129-IR-844060239RFA; filed Apr 6, 2010, 2:52 p.m.: 20100505-IR-844090164FRA; readopted filed Nov 22, 2016, 12:11 p.m.: 20161221-IR-844160317RFA; readopted filed Nov 22, 2022, 12:22 p.m.: 20221221-IR-844220255RFA; readopted filed Feb 27, 2024, 10:19 a.m.: 20240327-IR-844230772RFA; filed Jun 20, 2025, 3:41 p.m.: 20250716-IR-844240435FRA)

844 IAC 2.2-2-4 844 IAC 2.2-2-4 Reporting requirements

844 IAC 2.2-2-4 Reporting requirements

Authority: IC 25-22.5-2-7

Affected: IC 25-22.5-1-2

Sec. 4. If for any reason a physician assistant discontinues working at the direction or under the collaboration, or both, of the physician under which the physician assistant is registered with the board, the physician assistant shall inform both the board and committee, in writing, within fifteen (15) days after the event. The physician assistant may not begin practice under a new collaborating physician until that physician registers their intent to collaborate with the physician assistant to the board under section 2 of this rule. The physician assistant, in the written report, shall state the specific reason for the discontinuation of collaboration.

(Medical Licensing Board of Indiana; 844 IAC 2.2-2-4; filed May 26, 2000, 8:52 a.m.: 23 IR 2500; readopted filed Nov 16, 2006, 10:49 a.m.: 20061129-IR-844060239RFA; filed Apr 6, 2010, 2:52 p.m.: 20100505-IR-844090164FRA; readopted filed Nov 22, 2016, 12:11 p.m.: 20161221-IR-844160317RFA; readopted filed Nov 22, 2022, 12:22 p.m.: 20221221-IR-844220255RFA; readopted filed Feb 27, 2024, 10:19 a.m.: 20240327-IR-844230772RFA; filed Jun 20, 2025, 3:41 p.m.: 20250716-IR-844240435FRA)

844 IAC 2.2-2-5 844 IAC 2.2-2-5 Privileges and duties

844 IAC 2.2-2-5 Privileges and duties

Authority: IC 25-22.5-2-7; IC 25-27.5-3-5

Affected: IC 25-22.5-1-2; IC 25-27.5

Sec. 5. (a) When engaged in the physician assistant's professional activities, a physician assistant shall:

(1) wear a name tag identifying the individual as a physician assistant; and

(2) inform patients that they are a physician assistant.

A physician assistant may not portray themselves as a licensed physician.

(b) A physician assistant shall make available for inspection at their primary place of business:

(1) the physician assistant's license issued by the committee; and

(2) a statement from the collaborating physician that the physician assistant is, or will be, collaborating with that physician.

(c) The physician assistant may perform, under the supervision of the collaborating physician, those duties and responsibilities that are:

(1) delegated by the collaborating physician; and

(2) within the collaborating physician's scope of practice.

(Medical Licensing Board of Indiana; 844 IAC 2.2-2-5; filed May 26, 2000, 8:52 a.m.: 23 IR 2500; filed Jan 2, 2003, 10:38 a.m.: 26 IR 1560; readopted filed Dec 1, 2009, 9:13 a.m.: 20091223-IR-844090779RFA; filed Apr 6, 2010, 2:52 p.m.: 20100505-IR-844090164FRA; readopted filed Nov 22, 2016, 12:11 p.m.: 20161221-IR-844160317RFA; readopted filed Nov 22, 2022, 12:22 p.m.: 20221221-IR-844220255RFA; readopted filed Feb 27, 2024, 10:19 a.m.: 20240327-IR-844230772RFA; filed Jun 20, 2025, 3:41 p.m.: 20250716-IR-844240435FRA)

844 IAC 2.2-2-6 844 IAC 2.2-2-6 Competent practice of physician assistants

844 IAC 2.2-2-6 Competent practice of physician assistants

Authority: IC 25-22.5-2-7

Affected: IC 25-22.5-1-2; IC 25-27.5-5-4; IC 25-27.5-6-1; IC 35-48-2

Sec. 6. It is considered willful misconduct or the incompetent practice as a physician assistant under IC 25-27.5 if a physician assistant licensed by the committee has committed any of the following acts:

(1) Held themselves out or permitted another to represent them as a licensed physician.

(2) Performed a task other than under the direction or collaboration of a physician licensed by the board.

(3) Been delegated or performed a task beyond their competence unless under mitigating circumstances, such as the physician assistant attending to a patient in a life-threatening emergency with no physician immediately available.

(4) Used intoxicants or drugs to an extent that they cannot perform competently and with safety as a physician assistant.

(5) Been convicted of a felony or other criminal offense involving moral turpitude in this state or any other state, territory, or country. As used in this subdivision, "conviction" includes:

(A) a conviction of an offense that, if committed in this state, would be considered a felony or other criminal offense without regard to its designation elsewhere; or

(B) a criminal proceeding in which a finding or verdict of guilty is made or returned, but the adjudication of guilt is either withheld or not entered thereon.

(6) Been adjudicated as mentally or physically incompetent or because of their condition they cannot safely perform as a physician assistant, or both.

(7) Failed to:

(A) while on duty, wear a name tag with a designation of physician assistant thereon;

(B) make available for inspection their license as a physician assistant in the office of their primary employment as a physician assistant; or

(C) be of good moral character and abide by ethical standards.

(8) Engaged in independent practice or received remuneration for medical services directly from the patient or a third party, except as provided by federal or state law.

(9) Failed to collaborate with the collaborating physician designee.

(10) Advertised themselves in any way that would mislead the public generally or the patients of the collaborating physician as to the physician assistant's role and status.

(11) Failed to maintain certification issued by the NCCPA.

(12) Neglected or failed to keep adequate patient records of services performed by the physician assistant or did not submit those encounters for review by the collaborating physician as required by IC 25-27.5-6-1.

(13) Failed to follow the request of a patient to be seen, examined, or treated by a physician. If a patient makes that request, the physician assistant and collaborating physician shall take the necessary and appropriate actions to comply with the patient's request.

(14) Prescribed the use of a drug or medicine outside of those drugs included in the prescribing authority delegated by the collaborating physician, as identified in the collaboration agreement and prohibited under IC 25-27.5-5-4.

(15) Made a diagnosis or instituted a treatment without the authorization of the collaborating physician or physician designee.

(Medical Licensing Board of Indiana; 844 IAC 2.2-2-6; filed May 26, 2000, 8:52 a.m.: 23 IR 2501; readopted filed Nov 16, 2006, 10:49 a.m.: 20061129-IR-844060239RFA; filed Apr 6, 2010, 2:52 p.m.: 20100505-IR-844090164FRA; readopted filed Nov 22, 2016, 12:11 p.m.: 20161221-IR-844160317RFA; readopted filed Nov 22, 2022, 12:22 p.m.: 20221221-IR-844220255RFA; readopted filed Feb 27, 2024, 10:19 a.m.: 20240327-IR-844230772RFA; filed Jun 20, 2025, 3:41 p.m.: 20250716-IR-844240435FRA)

844 IAC 2.2-2-6.1 844 IAC 2.2-2-6.1 Fines and penalties

844 IAC 2.2-2-6.1 Fines and penalties

Authority: IC 25-1-9-9; IC 25-27.5-3-6

Affected: IC 25-27.5

Sec. 6.1. (a) Unless otherwise established in this title, fines and civil penalties levied by the board are set at fifty percent (50%) of the statutory maximum. If no statutory maximum is set, the fine or civil penalty is set at one thousand dollars ($1,000).

(b) A fine or civil penalty levied under subsection (a) may be reduced or increased after consideration of the mitigating factors identified in subsection (c) and aggravating factors identified in subsection (d). No fine or civil penalty may be set at less than one hundred dollars ($100).

(c) Mitigating factors include the following:

(1) Inability to pay.

(2) Acknowledging responsibility for underlying conduct.

(3) Acts prior to the underlying conduct to prevent or reduce damage to the public.

(4) Likelihood that the underlying conduct will not recur.

(5) The underlying conduct resulted from provocation, stress, emotional problems, or other circumstances that might offer an explanation.

(6) Timely and voluntary disclosure of the conduct underlying the fine or penalty.

(7) Subsequent remedial acts deemed appropriate by the board.

(d) Aggravating factors include the following:

(1) The underlying conduct resulted in moderate damage to the public.

(2) The underlying conduct resulted in severe damage to the public.

(3) The underlying conduct involved dishonesty or deception.

(4) The underlying conduct occurred as part of an overall pattern of improper conduct.

(5) The underlying conduct was motivated by bias against a protected class.

(6) Previous board discipline.

(7) The underlying conduct involved a vulnerable member of the public, including an individual:

(A) less than twelve (12) years of age;

(B) more than sixty-five (65) years of age;

(C) with a disability; or

(D) under the licensee's care, custody, or control.

(8) Failure to cooperate in a consumer complaint investigation or board proceeding.

(9) Dishonesty during board proceedings.

(Medical Licensing Board of Indiana, 844 IAC 2.2-2-6.1; filed Apr 21, 2025, 2:08 p.m.: 20250521-IR-844240594FRA)

844 IAC 2.2-2-7 844 IAC 2.2-2-7 Discipline of physician assistants (Repealed)

844 IAC 2.2-2-7 Discipline of physician assistants (Repealed)

(Repealed by Medical Licensing Board of Indiana; filed Apr 6, 2010, 2:52 p.m.: 20100505-IR-844090164FRA)

844 IAC 2.2-2-8 844 IAC 2.2-2-8 Certification of physician assistants; fees

844 IAC 2.2-2-8 Certification of physician assistants; fees

Authority: IC 25-22.5-2-7; IC 25-27.5-3-5

Affected: IC 25-22.5-1-1.1; IC 25-22.5-1-2; IC 25-27.5

Sec. 8. (a) A nonrefundable fee of one hundred dollars ($100) must accompany the initial application for certification .

(b) A nonrefundable fee of fifty dollars ($50 ) must accompany an application for changing collaborating physicians.

(c) A fee of fifty dollars ($50) must accompany each biennial application for renewal of the physician assistant certificate. A fee of fifty dollars ($50) must accompany each request for a temporary permit in addition to the fee for initial certification.

(d) A fee of ten dollars ($10) must accompany each request for verification of licensure to another state.

(e) The fees under this section are nonrefundable.

(Medical Licensing Board of Indiana; 844 IAC 2.2-2-8; filed May 26, 2000, 8:52 a.m.: 23 IR 2501; filed Jan 2, 2003, 10:38 a.m.: 26 IR 1560; readopted filed Dec 1, 2009, 9:13 a.m.: 20091223-IR-844090779RFA; readopted filed Jun 16, 2010, 12:14 p.m.: 20100630-IR-844090779RFA; readopted filed Nov 22, 2016, 12:11 p.m.: 20161221-IR-844160317RFA; readopted filed Nov 22, 2022, 12:22 p.m.: 20221221-IR-844220255RFA; readopted filed Feb 27, 2024, 10:19 a.m.: 20240327-IR-844230772RFA; filed Jun 20, 2025, 3:41 p.m.: 20250716-IR-844240435FRA)

Rule 3

844 IAC 2.2-3-1 844 IAC 2.2-3-1 Scope

Rule 3. Opioid Prescribing Requirements

844 IAC 2.2-3-1 Scope

Authority: IC 25-22.5-2-7; IC 25-22.5-13-3

Affected: IC 25-1-9; IC 25-27.5

Sec. 1. This rule establishes standards and protocols for physician assistants in the prescribing of opioid controlled substances for pain management treatment.

(Medical Licensing Board of Indiana; 844 IAC 2.2-3-1; filed Sep 2, 2016, 1:04 p.m.: 20160928-IR-844150420FRA; readopted filed Nov 22, 2016, 12:11 p.m.: 20161221-IR-844160317RFA; readopted filed Nov 22, 2022, 12:22 p.m.: 20221221-IR-844220255RFA; readopted filed Feb 27, 2024, 10:19 a.m.: 20240327-IR-844230772RFA)

844 IAC 2.2-3-2 844 IAC 2.2-3-2 Definitions

844 IAC 2.2-3-2 Definitions

Authority: IC 25-22.5-2-7; IC 25-22.5-13-3

Affected: IC 25-1-9; IC 25-27.5

Sec. 2. (a) The definitions in this section apply throughout this rule.

(b) "Abuse deterrent formulation" means an opioid formulation that has properties shown to meaningfully deter the intentional, nontherapeutic use, even once, to achieve a desirable psychological or physiological effect, even if the formulation does not fully prevent those intentional, nontherapeutic uses.

(c) "Chronic pain" means a state in which pain persists beyond the usual course of an acute disease or healing of an injury, or that may or may not be associated with an acute or chronic pathologic process that causes continuous or intermittent pain over months or years.

(d) "Controlled substances" has the meaning set forth in IC 35-48-1.1-7.

(e) "Morphine equivalent dose" means a conversion of various opioids to a standardized dose of morphine by the use of accepted conversion tables.

(f) "Opioid" means any various narcotics containing opium or at least one (1) of its natural or synthetic derivatives. However, if a narcotic is not a controlled substance, it is not an opioid for purposes of this rule.

(g) "Outset of an opioid treatment plan" means that a patient has been prescribed opioids as described in section 3(c) of this rule, and, therefore, the provisions stated in section 3(a) of this rule apply to that patient.

(h) "Terminal" means a condition caused by injury, disease, or illness from which, to a reasonable degree of medical certainty:

(1) there can be no recovery; and

(2) progression to death can be anticipated as an eventual consequence of that condition.

(Medical Licensing Board of Indiana; 844 IAC 2.2-3-2; filed Sep 2, 2016, 1:04 p.m.: 20160928-IR-844150420FRA; readopted filed Nov 22, 2016, 12:11 p.m.: 20161221-IR-844160317RFA; readopted filed Nov 22, 2022, 12:22 p.m.: 20221221-IR-844220255RFA; readopted filed Feb 27, 2024, 10:19 a.m.: 20240327-IR-844230772RFA; filed Jun 20, 2025, 3:41 p.m.: 20250716-IR-844240435FRA; errata filed Jul 17, 2025, 3:00 p.m.: 20250730-IR-844250376ACA)

844 IAC 2.2-3-3 844 IAC 2.2-3-3 Triggers for imposition of requirements; exemptions

844 IAC 2.2-3-3 Triggers for imposition of requirements; exemptions

Authority: IC 25-22.5-2-7; IC 25-22.5-13-3

Affected: IC 16-21; IC 16-25; IC 16-28; IC 25-1-9; IC 25-27.5

Sec. 3. (a) This section and sections 4 through 9 of this rule establish requirements concerning the use of opioids for chronic pain management for patients.

(b) Notwithstanding subsection (a), this section and sections 4 through 9 of this rule do not apply to the use of opioids for chronic pain management for the following:

(1) Patients with a terminal condition.

(2) Residents of a health facility licensed under IC 16-28.

(3) Patients enrolled in a hospice program licensed under IC 16-25.

(4) Patients enrolled in an inpatient or outpatient palliative care program of a hospital licensed under IC 16-21, or a hospice licensed under IC 16-25.

However, a period that a patient who was, but is no longer, a resident or patient as described in subdivisions (2) through (4) shall be included in the calculations under subsection (c).

(c) The requirements in the sections identified in subsection (a) only apply if a patient has been prescribed:

(1) more than sixty (60) opioid-containing pills a month for more than three (3) consecutive months;

(2) a morphine equivalent dose of more than fifteen (15) milligrams per day for more than three (3) consecutive months;

(3) a transdermal opioid patch for more than three (3) consecutive months;

(4) tramadol, but only if the patient's tramadol dose reaches a morphine equivalent dose of more than sixty (60) milligrams per day for more than three (3) consecutive months; or

(5) an extended release opioid medication that is not in an abuse deterrent form for which an FDA-approved abuse deterrent form is available.

Subdivisions (1) and (2) do not apply to the controlled substances addressed by subdivisions (3) through (5).

(d) Because the requirements in the sections identified in subsection (a) do not apply until the time stated in subsection (c), the initial evaluation of the patient for purposes of sections 4, 7, and 8(a) of this rule is not required to take place until that time.

(e) Notwithstanding subsection (d), the physician assistant may undertake those actions earlier than required if the physician assistant [sic] it medically appropriate and, if those actions meet the requirements, a further initial evaluation is not required. If the physician assistant conducts actions earlier than required under this subsection, any subsequent requirements are determined by when the initial evaluation would have been required and not at the earlier date it actually was conducted.

(Medical Licensing Board of Indiana; 844 IAC 2.2-3-3; filed Sep 2, 2016, 1:04 p.m.: 20160928-IR-844150420FRA; readopted filed Nov 22, 2016, 12:11 p.m.: 20161221-IR-844160317RFA; readopted filed Nov 22, 2022, 12:22 p.m.: 20221221-IR-844220255RFA; readopted filed Feb 27, 2024, 10:19 a.m.: 20240327-IR-844230772RFA; filed Jun 20, 2025, 3:41 p.m.: 20250716-IR-844240435FRA)

844 IAC 2.2-3-4 844 IAC 2.2-3-4 Evaluation and risk stratification by physician assistant

844 IAC 2.2-3-4 Evaluation and risk stratification by physician assistant

Authority: IC 25-22.5-2-7; IC 25-22.5-13-3

Affected: IC 25-1-9; IC 25-27.5

Sec. 4. (a) A physician assistant shall do the physician assistant's own evaluation and risk stratification of a patient by doing the following in the initial evaluation of the patient:

(1) Performing an appropriately focused history and physical exam and obtain or order appropriate tests, as indicated.

(2) Making a diligent effort to obtain and review records from previous health care providers to supplement the physician assistant's understanding of the patient's chronic pain problem, including past treatments, and documenting this effort.

(3) Asking the patient to complete an objective pain assessment tool to document and better understand the patient's specific pain concerns.

(4) Assessing both the patient's mental health status and risk for substance abuse using available validated screening tools.

(5) After completing the initial evaluation, establishing a working diagnosis and tailoring a treatment plan to meaningful and functional goals, with the patient reviewing them from time to time.

(b) Where medically appropriate, the physician assistant shall use nonopioid options instead of, or in addition to, prescribing opioids.

(Medical Licensing Board of Indiana; 844 IAC 2.2-3-4; filed Sep 2, 2016, 1:04 p.m.: 20160928-IR-844150420FRA; readopted filed Nov 22, 2016, 12:11 p.m.: 20161221-IR-844160317RFA; readopted filed Nov 22, 2022, 12:22 p.m.: 20221221-IR-844220255RFA; readopted filed Feb 27, 2024, 10:19 a.m.: 20240327-IR-844230772RFA; filed Jun 20, 2025, 3:41 p.m.: 20250716-IR-844240435FRA)

844 IAC 2.2-3-5 844 IAC 2.2-3-5 Physician assistant discussion with patient; treatment agreement

844 IAC 2.2-3-5 Physician assistant discussion with patient; treatment agreement

Authority: IC 25-22.5-2-7; IC 25-22.5-13-3

Affected: IC 25-1-9; IC 25-27.5

Sec. 5. A physician assistant shall discuss with a patient the potential risks and benefits of opioid treatment for chronic pain, as well as expectations related to prescription requests and proper medication use. In doing so, the physician assistant shall do the following:

(1) Where alternative modalities to opioids for managing pain exist for a patient, discuss them with the patient.

(2) Provide a simple and clear explanation to help patients understand the key elements of their treatment plans.

(3) Counsel women between fourteen (14) and fifty-five (55) years of age with child bearing potential about the risks to the fetus when the mother has been taking opioids while pregnant. The described risks include fetal opioid dependency and neonatal abstinence syndrome (NAS).

(4) Discuss with the patient risks of dependency and addiction.

(5) Discuss with the patient safe storage practices for prescribed opioids.

(6) Provide a written warning to the patient disclosing the risks associated with taking extended release medications that are not in an abuse deterrent form, if the physician assistant prescribes for the patient a hydrocodone-only extended release medication that is not in an abuse deterrent form.

(7) Discuss with the patient the risks and benefits of using an abuse deterrent formulation, as opposed to a nonabuse deterrent formulation, if a formulation exists for the opioid product the physician assistant is prescribing to the patient. Nothing in this subdivision may be construed to require a physician assistant to prescribe an opioid in an abuse deterrent formulation.

(8) Together with the patient, review and sign a "Treatment Agreement", which must include at least the following:

(A) The goals of the treatment.

(B) The patient's consent to drug monitoring testing in circumstances where the physician assistant determines drug monitoring testing is medically necessary.

(C) The physician assistant's prescribing policies, which must include at least a:

(i) requirement that the patient take the medication as prescribed; and

(ii) prohibition of sharing medication with other individuals.

(D) A requirement that the patient inform the physician assistant:

(i) about any other controlled substances prescribed to or taken by the patient; and

(ii) if the patient drinks alcohol while taking opioids.

(E) The granting of permission to the physician assistant to conduct random pill counts.

(F) Reasons the opioid therapy may be changed or discontinued by the physician assistant.

A copy of the treatment agreement shall be retained in the patient's chart.

(Medical Licensing Board of Indiana; 844 IAC 2.2-3-5; filed Sep 2, 2016, 1:04 p.m.: 20160928-IR-844150420FRA; readopted filed Nov 22, 2016, 12:11 p.m.: 20161221-IR-844160317RFA; readopted filed Nov 22, 2022, 12:22 p.m.: 20221221-IR-844220255RFA; readopted filed Feb 27, 2024, 10:19 a.m.: 20240327-IR-844230772RFA; filed Jun 20, 2025, 3:41 p.m.: 20250716-IR-844240435FRA)

844 IAC 2.2-3-6 844 IAC 2.2-3-6 Patient visits to physician assistant

844 IAC 2.2-3-6 Patient visits to physician assistant

Authority: IC 25-22.5-2-7; IC 25-22.5-13-3

Affected: IC 25-1-9; IC 25-27.5

Sec. 6. (a) Physician assistants may not prescribe opioids for patients without periodic scheduled visits. Visits for patients with a stable medication regimen and treatment plan shall occur face-to-face at least once every four (4) months. More frequent visits may be appropriate for patients working with the physician assistant to achieve optimal management. For patients requiring changes to the medication and treatment plan, if changes are prescribed by the physician assistant, the visits required by this subsection are scheduled at least once every two (2) months until the medication and treatment has been stabilized.

(b) During the visits required by subsection (a), the physician assistant shall evaluate patient progress and compliance with the patient's treatment plan regularly and set clear expectations along the way, such as attending physical therapy, counseling, or other treatment options.

(Medical Licensing Board of Indiana; 844 IAC 2.2-3-6; filed Sep 2, 2016, 1:04 p.m.: 20160928-IR-844150420FRA; readopted filed Nov 22, 2016, 12:11 p.m.: 20161221-IR-844160317RFA; readopted filed Nov 22, 2022, 12:22 p.m.: 20221221-IR-844220255RFA; readopted filed Feb 27, 2024, 10:19 a.m.: 20240327-IR-844230772RFA; filed Jun 20, 2025, 3:41 p.m.: 20250716-IR-844240435FRA)

844 IAC 2.2-3-7 844 IAC 2.2-3-7 INSPECT report

844 IAC 2.2-3-7 INSPECT report

Authority: IC 25-22.5-2-7; IC 25-22.5-13-3

Affected: IC 25-1-9; IC 25-26-24-19; IC 25-27.5

Sec. 7. At the outset of an opioid treatment plan, and at least annually thereafter, a physician assistant prescribing opioids for a patient shall run an INSPECT report on that patient under IC 25-26-24-19 and document in the patient's chart whether the INSPECT report is consistent with the physician assistant's knowledge of the patient's controlled substance use history.

(Medical Licensing Board of Indiana; 844 IAC 2.2-3-7; filed Sep 2, 2016, 1:04 p.m.: 20160928-IR-844150420FRA; readopted filed Nov 22, 2016, 12:11 p.m.: 20161221-IR-844160317RFA; readopted filed Nov 22, 2022, 12:22 p.m.: 20221221-IR-844220255RFA; readopted filed Feb 27, 2024, 10:19 a.m.: 20240327-IR-844230772RFA; filed Jun 20, 2025, 3:41 p.m.: 20250716-IR-844240435FRA)

844 IAC 2.2-3-8 844 IAC 2.2-3-8 Drug monitoring testing

844 IAC 2.2-3-8 Drug monitoring testing

Authority: IC 25-22.5-2-7; IC 25-22.5-13-3

Affected: IC 25-1-9; IC 25-27.5

Sec. 8. (a) At any time the physician assistant determines that it is medically necessary, whether at the outset of an opioid treatment plan, or any time thereafter, a physician assistant prescribing opioids for a patient shall perform or order a drug monitoring test, which must include a confirmatory test using a method selective enough to differentiate individual drugs within a drug class, on the patient.

(b) In determining whether a drug monitoring test under subsection (a) is medically necessary, the physician assistant shall consider, subject to the provisions of subsection (c), each of the following factors where applicable and reasonably feasible:

(1) Whether there is reason to believe a patient is not taking the prescribed opioids or is diverting the opioids.

(2) Whether there has been no appreciable impact on the patient's chronic pain despite being prescribed opioids for a period that would generally have an impact.

(3) Whether there is reason to believe the patient is taking or using controlled substances other than opioids or other drugs or medications, including illicit street drugs that may produce significant polypharmacological effects or have other detrimental interaction effects.

(4) Whether there is reason to believe the patient is taking or using opioids in addition to the opioids being prescribed by the physician assistant and any other treating practitioner.

(5) Attempts by the patient to obtain early refills of opioid containing prescriptions.

(6) How many times the patient alleges their opioid containing prescription has been lost or stolen.

(7) When the patient's INSPECT report provides irregular or inconsistent information.

(8) When a previous drug monitoring test conducted on the patient raised concerns about the patient's usage of opioids.

(9) The need to verify that the patient no longer has substances in the patient's system that are not appropriate under the patient's treatment plan.

(10) When the patient engages in apparent aberrant behaviors or shows apparent intoxication.

(11) When the patient's opioid usage shows an unauthorized dose escalation.

(12) When the patient is reluctant to change medications or is demanding certain medications.

(13) When the patient refuses to participate in or cooperate with a full diagnostic workup or examination.

(14) Whether a patient has a history of substance abuse.

(15) When the patient has a health status change (e.g., pregnancy).

(16) Comorbid psychiatric diagnoses.

(17) Other evidence of chronic opioid use, controlled substance abuse or misuse, illegal drug use or addiction, or medication noncompliance.

(18) Any other factor the physician assistant believes is relevant to making an informed professional judgment about the medical necessity of a prescription.

(c) It is not considered a violation of this section for a physician assistant to fail to conduct a review of the eighteen (18) factors listed in subsection (b) if the physician assistant reasonably determines, after a review of less than all the factors listed in subsection (b), that a drug monitoring test is medically necessary.

(d) Nothing about subsection (b) may be construed to prohibit the physician assistant from performing or ordering a drug monitoring test at any other time the physician assistant considers appropriate.

(e) If a test performed under subsection (a), or conducted under subsection (d), reveals inconsistent medication use patterns or the presence of illicit substances, a review of the current treatment plan is required. Documentation of the revised treatment plan and discussion with the patient must be recorded in the patient's chart.

(Medical Licensing Board of Indiana; 844 IAC 2.2-3-8; filed Sep 2, 2016, 1:04 p.m.: 20160928-IR-844150420FRA; readopted filed Nov 22, 2016, 12:11 p.m.: 20161221-IR-844160317RFA; readopted filed Nov 22, 2022, 12:22 p.m.: 20221221-IR-844220255RFA; readopted filed Feb 27, 2024, 10:19 a.m.: 20240327-IR-844230772RFA; filed Jun 20, 2025, 3:41 p.m.: 20250716-IR-844240435FRA)

844 IAC 2.2-3-9 844 IAC 2.2-3-9 Morphine equivalent doses above 60; revising of assessments and treatment plans

844 IAC 2.2-3-9 Morphine equivalent doses above 60; revising of assessments and treatment plans

Authority: IC 25-22.5-2-7; IC 25-22.5-13-3

Affected: IC 25-1-9; IC 25-27.5

Sec. 9. When a patient's opioid dose reaches a morphine equivalent dose of more than sixty (60) milligrams per day, a face-to-face review of the treatment plan and patient evaluation must be scheduled, including consideration of referral to a specialist. If the physician assistant elects to continue providing opioid therapy at a morphine equivalent dose of more than sixty (60) milligrams per day, the physician assistant must develop a revised assessment and treatment plan for ongoing treatment. The revised assessment and treatment plan must be documented in the patient's chart, including an assessment of increased risk for adverse outcomes, including death, if the physician assistant elects to provide ongoing opioid treatment.

(Medical Licensing Board of Indiana; 844 IAC 2.2-3-9; filed Sep 2, 2016, 1:04 p.m.: 20160928-IR-844150420FRA; readopted filed Nov 22, 2016, 12:11 p.m.: 20161221-IR-844160317RFA; readopted filed Nov 22, 2022, 12:22 p.m.: 20221221-IR-844220255RFA; readopted filed Feb 27, 2024, 10:19 a.m.: 20240327-IR-844230772RFA)

844 IAC 2.2-3-10 844 IAC 2.2-3-10 Scope of practice in prescribing opioids

844 IAC 2.2-3-10 Scope of practice in prescribing opioids

Authority: IC 25-22.5-2-7; IC 25-22.5-13-3

Affected: IC 25-1-9; IC 25-22.5; IC 25-27.5-5; IC 25-27.5-6

Sec. 10. IC 25-27.5-5 addresses the scope of practice of physician assistants in their dependent practice under collaborating physicians, including limiting the duties and responsibilities of physician assistants to those that are delegated by the collaborating physician and are within the collaborating physician's scope of practice. IC 25-27.5-6 addresses supervisory responsibilities of the collaborating physician, or when applicable, a physician designee. Prescribing opioids for chronic pain management as regulated by this rule falls within the requirements on collaborating physicians, or when applicable, on physician designees, under IC 25-27.5-5 and IC 25-27.5-6, including appropriate delegating of duties and responsibilities to physician assistants and appropriate supervision of physician assistants.

(Medical Licensing Board of Indiana; 844 IAC 2.2-3-10; filed Sep 2, 2016, 1:04 p.m.: 20160928-IR-844150420FRA; readopted filed Nov 22, 2016, 12:11 p.m.: 20161221-IR-844160317RFA; readopted filed Nov 22, 2022, 12:22 p.m.: 20221221-IR-844220255RFA; readopted filed Feb 27, 2024, 10:19 a.m.: 20240327-IR-844230772RFA; filed Jun 20, 2025, 3:41 p.m.: 20250716-IR-844240435FRA)