By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
Illinois clinical psychologists can now obtain licenses to prescribe medications for mental conditions under new regulations passed by the state. The new regulations issued by the Illinois Department of Financial and Professional Regulation (IDFPR) took effect in October 2017.
Psychologists traditionally have not had the authority to write prescriptions for medications, except in a very few states. Therefore, their patients have been unable to obtain psychotropic medications to treat their mental illnesses without seeing a physician, or in some cases a nurse practitioner or physician assistant with prescribing authority. This makes such treatment of mental illness more cumbersome and more expensive for the patient, and creates another obstacle for needed mental health services. Also, it is questioned whether nurse practitioners and physician assistants have any greater expertise in such medical issues than properly trained psychologists. Mental health, substance abuse and child welfare agencies have faced challenges in serving clients and the new regulations come in hopes of expanding access to care.
The New Illinois Regulations.
Illinois is now allowing psychologists with specialized training to prescribe medications. This prescriptive authority will extend to a wide range of medications to treat mental health conditions for patients between ages 17 and 65.
An Illinois-licensed clinical psychologist will now be eligible to obtain a prescribing psychologist license upon the completion of seven biomedical undergraduate level courses; the completion of psychopharmacology-related course work typically culminating in a master’s degree in clinical psychopharmacology; obtaining at least 14 months of supervised clinical training in a program meeting regulatory criteria, with rotations in emergency medicine, family medicine, geriatrics, internal medicine, obstetrics and gynecology, pediatrics, psychiatry, surgery, and an elective area; and achieving a passing score on the Psychopharmacology Examination for Psychologists.
The Stipulations.
Before prescribing, a psychologist must enter into a written collaborative agreement with an Illinois-licensed physician who prescribes medications for mental health conditions. The collaborative physician is not required to be a psychiatrist. This is similar to what is currently required in most states for nurse practitioners and physicians assistants.
The statute and regulations set forth a number of issues that must be addressed in a written collaborative agreement between a psychologist and the collaborating physician, including provisions that:
1. Describe the working relationship between the psychologist and collaborative physician;
2. Delegate prescriptive authority;
3. Promote the exercise of professional judgment by the prescribing psychologist;
4. Provide methods and guidelines for communication between the collaborating physician and the prescribing psychologist;
5. Provide for collaboration between the physician and the prescribing psychologist, including joint formulation and approval of orders or guidelines, consultation and review of medication orders; and
6. Address termination or change of status.
With this Authority Also Comes Restrictions.
A psychologist prescribing in Illinois is subject not only to training, continuing education and collaborative agreement requirements, but also to significant limitations. In particular:
1. The delegation of prescriptive authority must be limited to medications that the collaborating physician generally provides in the normal course of clinical practice to treat mental conditions;
2. A psychologist is not allowed to prescribe for patients who (a) are under 17 years of age; (b) are over 65 years of age; (c) are pregnant and have disclosed their pregnancy or who the psychologist knows are pregnant; (d) have disclosed serious medical conditions, such as heart disease, cancer, stroke, or acute seizures; or (e) have developmental and intellectual disabilities;
3. Prescriptions are not allowed for (1) benzodiazepine Schedule III controlled substances, (2) any injected controlled substance, (3) any Schedule II substance, or (4) any narcotic drug; and
4. Any delegation of Schedule III through V controlled substances must identify the specific controlled substance by brand or generic name.
The expansion of psychologists’ prescribing authority will also present new opportunities and challenges not only for psychologists but also for patients, payers, physicians, agencies and other health care providers.
With the incorporation of psychologist prescribing into patient care models, health care professionals hope to increase access to effective mental health treatment. You can read the new regulations in full here.
To stay on top of laws and regulations for mental health care professionals, be sure to check our Mental Health Law Blog regularly.
Many Educational Programs Exist for Psychologists Interested in Prescribing.
There are many schools of psychology and universities that offer comprehensive courses and programs, some leading to a separate degree, for psychologists interested in prescribing. These programs may exist even in states which do not allow psychologists to prescribe, such as Florida. We believe it is time for each state to change its laws and regulations to allow properly educated and trained psychologists to prescribe medications associated with the treatment of mental illnesses.
States should be taking action to make it easier for mental health patients to access the medications that may very well help them control their mental illnesses. Psychologists, mental health professionals, and advocacy groups for persons with mental health issues should be lobbying hard to get their state legislatures to enact similar legislation. Unfortunately, this will probably denigrate to nothing more than a turf battle, as so often happens with progressive changes in medical regulation. The physicians , nurse practitioners, and physician assistants who currently have such prescribing authority will doubtless fight such change since they will see it as affecting their future income.
The Health Law Firm.
For more information on how The Health Law Firm can assist you with licensure and compliance issues, click here to read one of my prior blogs.
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Sources:
Hindman, Rick. AHLA. “Illinois Implements Licensing Process for Psychologist Prescribing.” Physician Organizations Practice Group and Behavioral Health Task Force. (January 30, 2018). Web.
“Illinois law allows psychologists to prescribe.” American Psychological Association. (January 30, 2018). Web.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.
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