Louisiana Administrative Code
Title 46
PROFESSIONAL AND OCCUPATIONAL STANDARDS
Part LXIII. Psychologists
Note: Updates to the
LAC my be obtained from
http://doa.louisiana.gov/osr/lac/46v63/46v63.doc
Chapter 4.
Certificate of Prescriptive Authority
§401. Preface
A. Pursuant to R.S. 37:2371
through 2378 enacted on August 31, 2004, this document provides for rules
and regulations regarding prescriptive authority for medical
psychologists, including the application process, limits of practice,
documentation requirements and physician consultative relationship,
prescribing practices, continuing education requirements, renewal process
and complaint procedure.
AUTHORITY NOTE: Promulgated in accordance
with R.S.37:2371-2378
HISTORICAL NOTE: Promulgated by the
Department of Health and Hospitals, Board of Examiners of Psychologists,
LR 31:70 (January 2005)
§403. Application for Certificate
of Prescriptive Authority
A. A “Certificate of
Prescriptive Authority” will be issued by the board granting a
psychologist the authority to prescribe medications when the psychologist
has met the following requirements:
1. The
psychologist has filed an application for a Certificate of Prescriptive
Authority and paid the administrative application fee established by the
board. The application fee for a “Certificate of Prescriptive
Authority” shall be assessed as established for re-specialization
registration after licensure.
2. The
psychologist holds a current Louisiana license to practice psychology
with an applied clinical specialty. For the purposes of these rules, an
applied clinical specialty is defined as a board approved specialty in
Clinical Psychology, Counseling Psychology, School Psychology, Clinical
Neuropsychology or other applied clinical specialty as may be approved
by the board.
3.
The psychologist has successfully graduated with an approved
post-doctoral master’s degree in clinical psychopharmacology from an
institution accredited by a regional body recognized by the U.S.
Department of Education. For the purposes of these rules, an equivalent
to the post-doctoral master’s degree under the provisions of R.S.37:2373
(2) is defined as the successful completion of the Department of Defense
Psychopharmacology Demonstration Project (DOD-PDP), or similar program
developed and operated under the auspices of any branch of the United
States armed services.
a.
The education program shall provide post-doctoral didactic
instruction in the following content areas:
i.
Anatomy and physiology;
ii.
Biochemistry;
iii.
Neurosciences;
iv.
Pharmacology;
v.
Psychopharmacology;
vi.
Clinical Medicine/Pathophysiology; and,
vii.
Health Assessment, including relevant physical and laboratory
assessment.
b.
The training of a medical psychologist shall provide
opportunities for the psychologist to review, present and discuss case
examples representing a broad range of clinical psychopathologies;
medical conditions presenting as psychiatric illness; and treatment
complexities, including complicating medical conditions; diagnostic
questions; choice of medications; untoward side effects; compliance
problems; alternative treatments and treatment failures.
c.
Course work and/or training undertaken at a pre-doctoral level
cannot be substituted for any educational or training requirement
necessary to obtain a Certificate of Prescriptive Authority.
4. The
psychologist
has passed a national proficiency examination in psychopharmacology
approved by the board.
a. The
Psychopharmacology
Examination for Psychologists (PEP), developed by the American
Psychological Association practice organization’s College of
Professional Psychology and its contractor, the Professional
Examination Service, is an approved proficiency examination.
b. The
PEP or other national exam approved by the board shall be taken after
the successful completion of a postdoctoral program of education in
psychopharmacology and within three (3) years of completing an
application for a Certificate of Prescriptive Authority.
c. The
passing score shall be established by the board with consideration of
the recommendations of the College of Professional Psychology or other
national exam sponsoring organization and as approved by the board.
d. If
the applicant’s score falls below the passing score, the applicant may
take the examination a second time after a mandatory 90-day waiting
period.
e. If
the applicant’s score falls below the passing score on the second
attempt, the applicant shall be required to wait six (6) months before
repeating the examination.
f. If
the applicant fails three attempts, the applicant shall be required to
undergo and successfully complete remedial education and training as
determined by the board before being permitted to repeat the
examination.
g.
If the applicant fails on the fourth attempt, the applicant
will be required to repeat the educational program as outlined in
Paragraph A. 3. of this part before repeating the PEP examination and
re-applying for prescriptive authority.
B. Upon successful completion of
all requirements in §403.A. 1–4, the board will review the application and
notify the applicant of his or her approval status.
1.
The board shall have the right to modify, restrict or otherwise
limit the prescriptive authority being granted a medical psychologist,
based on his or her training, experience, practice history or other
factors as might be necessary to ensure the health, safety and welfare
of the public. Such modifications, restrictions or other limitations
may include, but are not necessarily limited to, restrictions on the age
range of patients treated, the prescription of controlled substances,
off-label prescribing, medication classes prescribed and types of
disorders treated. The board shall have the right to change, modify or
remove any such restriction or other limitations when appropriate.
2.
If the application is approved, a valid Certificate of
Prescription Authority with an assigned number will be issued to the
psychologist, and the psychologist will be listed with the board as a
medical psychologist.
a.
The Certificate of Prescriptive Authority will be visibly
displayed in the medical psychologist’s primary practice location.
b.
All documents produced by a medical psychologist relevant to
prescribing activities, including prescriptions, must include a
signature block with the abbreviation of M.P. following the
designation of his or her doctorate degree.
c. The medical psychologist shall not issue a
prescription for a controlled substance until the board has received
verification that the medical psychologist has received a valid
Controlled and Dangerous Substance (CDS) license from the State of
Louisiana and valid federal DEA number. In order to continue
prescribing controlled substances, the medical psychologist is also
required to maintain and renew the CDS license and DEA number in
accordance with all applicable state and federal laws.
d. The board shall submit to the Louisiana State
Board of Pharmacy the name and address of the medical psychologist
approved for a certificate of prescription authority, the certificate
number, and effective date of the certificate.
3. If the
application for a certificate
of prescription authority is not approved, the psychologist will be
notified and provided an explanation for denial and information
pertaining to potential guidelines for remediation of any identified
deficiencies.
4. If
the license of a psychologist who has applied for a certificate of
prescriptive authority is under disciplinary restriction or under
investigation due to a complaint having been filed with this board,
granting of the certificate of prescriptive authority may be withheld
until such time as the restriction or the investigation has come to
conclusion and the license is in good standing status.
AUTHORITY NOTE: Promulgated in
accordance with R.S. 37:2371-2378.
HISTORICAL NOTE: Promulgated by
the Department of Health and Hospitals, Board of Examiners of
Psychologists, LR 31:70 (January 2005), amended LR 32:1228 (July 2006);
amended LR 33:458 (March 2007).
§405. Limits of Practice
A. Medical psychologists shall
pharmacologically treat only those disorders listed in the most recent
edition of the Diagnostic and Statistical Manual of Mental Disorders
published by the American Psychiatric Association or those mental and
emotional disorders listed in the most recent edition of the International
Classification of Diseases (ICD).
1.
Medical psychologists shall prescribe only medications recognized and
customarily used for the management of mental and emotional disorders.
2. A
medical psychologist may order and interpret routine laboratory
procedures, as necessary for adequate pretreatment health screening and
treatment maintenance, including monitoring potential side-effects
associated with medications prescribed by the medical psychologist.
3. A
medical psychologist shall not prescribe medications outside his or her
areas of competency consistent with his or her training and experience
as defined by the board.
B. Under no circumstances shall
a medical psychologist order, prescribe or distribute narcotics, defined
as natural and synthetic opioid analgesics and their derivatives used to
relieve pain.
C. Nothing in these regulations
shall be interpreted or construed as to permit a medical psychologist to
pharmacologically treat patients for primary endocrine, cardiovascular,
orthopedic, neurologic, gynecologic, metabolic, hematologic, respiratory,
renal, gastrointestinal, hepatic, dermatologic, oncologic, infectious,
opthalmalogic, or rheumatologic illness or disorders.
D. Medical psychologists may
prescribe medications for mental and emotional disorders that arise
secondary to a primary physical illness, so long as the primary physical
illness is being managed the patient’s primary or attending physician.
AUTHORITY NOTE: Promulgated in accordance
with R.S.37:2371-2378
HISTORICAL NOTE: Promulgated by the
Department of Health and Hospitals, Board of Examiners of Psychologists,
LR 31:71 (January 2005)
§407. Documentation of Physician
Consultation
A. When psychopharmacologic
management of a patient is indicated, the initial plan shall include
consultation with the patient’s primary care or attending physician.
B. The medical psychologist
shall document the consultation with the primary or attending physician in
the patient’s medical record. This documentation shall include, but is
not necessarily limited to, the patient’s name; the physician’s name; date
of consultation; purpose of consultation (e.g., new medication, change in
medication, discontinuance of medication, adverse treatment effects,
treatment failure, change in medical status, etc.); the results of the
consultation (e.g., medications ordered, generic or trade; starting dosage
and titration plan, if any; number of refills; etc.) and any other
information that might be necessary for the appropriate coordination of
care for the patient (e.g., review of prior labs or diagnostic procedures;
new labs or diagnostic procedures requested by the physician, if any;
etc.).
C. The
medical psychologist shall forward documentation of all
psychopharmacologic consultations to the patient’s primary or attending
physician for that physician’s records.
D. With the permission of the
patient, the medical psychologist shall forward any other relevant medical
documentation requested by the patient’s primary care or attending
physician.
AUTHORITY NOTE: Promulgated in accordance
with R.S.37:2371-2378
HISTORICAL NOTE: Promulgated by the Department of Health and Hospitals,
Board of Examiners of Psychologists, LR 31:71 (January 2005)
§409. Prescribing Practices of a
Medical Psychologist
A. In order to permit the
necessary coordination of care for the patient, the medical psychologist
shall obtain a release of information from the patient and/or the
patient’s legal guardian to contact the
patient’s primary or attending physician in all cases in which
psychopharmacologic management is planned.
1. If a
patient or the patient’s legal guardian declines to sign a release of
information authorizing coordination of care with his or her primary or
attending physician, the medical psychologist shall inform the patient
and/or the patient’s legal guardian that he or she cannot treat the
patient pharmacologically without such consultation.
2. If the
patient wishes to have his or her primary or attending physician
prescribe any recommended psychotropic medications, the medical
psychologist shall forward to the attending physician, with a proper
release from the patient, a summary of the medical psychologist’s
findings and treatment recommendations.
B. The
medical psychologist shall contact the primary or attending physician
prior to prescribing medications or making changes to an established
psychopharmacological regimen, such as dosage adjustments, or adding and
discontinuing a medication as described in Section 407.B of these rules.
1. The
medical psychologist shall inform the primary or attending physician of
the medication(s) he or she intends to prescribe and any laboratory
tests that he or she has ordered or reviewed.
2. The
medical psychologist shall discuss with the primary or attending
physician any relevant indications and contraindications of the proposed
medications.
3. In the
event that the primary or attending physician does not concur with the
psychopharmacologic treatment protocol planned by the medical
psychologist, the medical psychologists shall defer to the medical
judgment of the physician.
C. In all cases in which the
patient does not have a primary or attending physician, the medical
psychologist shall inform the patient that he or she cannot prescribe
medication for that patient until such time as the patient has secured a
primary care or attending physician and has been established as an active
patient of that physician.
D. In the event an established
patient changes his or her primary or attending physician with whom the
medical psychologist has established a consultative relationship, the
medical psychologist shall establish a consultative and collaborative
relationship with the new physician in order to continue
psychopharmacological treatment of the patient.
E. In the event a patient
terminates his or her relationship with his or her primary or attending
physician, with whom the medical psychologist has established a
consultative relationship and declines to secure a new primary care or
attending physician, the medical psychologist cannot continue to
psychopharmacologically manage the patient and shall so advise the
patient.
1. In
such instances, the medical psychologist shall document that he or she
has made every reasonable effort to encourage the patient to maintain
and/or establish a relationship with a primary care or attending
physician.
2. In
those cases in which an abrupt discontinuation of a psychopharmacologic
medication could represent a health risk or result in adverse effects,
the medical psychologist, with concurrence from the previously
established primary or attending physician of record, is authorized to
prescribe the medication(s) in a manner that is customarily recognized
as a discontinuation regimen until the medication has been completely
discontinued. This regimen shall be documented in the patient’s medical
chart.
F. Providing sample
medications.
1. If a
medical psychologist provides sample medications to a patient,
dispensations of these medications shall be governed by the same rules
as those governing the prescribing of medications as defined in these
rules.
2.
Medication samples maintained in the medical psychologist’s office shall
be secured in accordance with all relevant state and federal regulations
and/or laws.
G. The medical psychologist shall maintain a duplicate or
photostatic copy of all written prescriptions in the patient’s medical
record. When prescriptions are ordered by telephone, the medical
psychologist shall document the date and prescriptions ordered in the
patient’s medical record.
H. The medical psychologist shall not delegate the prescribing
of a drug to any individual.
AUTHORITY NOTE: Promulgated in accordance
with R.S.37:2371-2378
HISTORICAL NOTE: Promulgated by the
Department of Health and Hospitals, Board of Examiners of Psychologists,
LR 31:72 (January 2005)
§411. Continuing Professional
Education
A. In addition to the requirements for continuing professional
education as specified in the rules of the board (LAC 46:LXIII,
§801-§815), each medical psychologist shall annually complete 30 hours of
approved continuing medical education in psychopharmacology and/or
psychopharmacotherapy and/or other topics relevant to the practice of
medical psychology. When selecting continuing education activities, the
medical psychologist shall select those activities that are offered by
sponsors approved by the board, and contain information on subjects
relevant to the practice of medical psychology.
B. Acceptable sponsors of continuing education are listed in
LAC 46:LXIII, §805. These include accredited institutions of higher
education; national (e.g., APA, AMA), regional, or state professional
associations (e.g., LPA, LAMP, a state medical society), which
specifically offer graduate or post-doctoral continuing education
training. When choosing other continuing medical education (CME)
activities to fulfill continuing professional education requirements, the
medical psychologist shall select those category 1 activities that are
offered by sponsors accredited by the Accreditation Council for Continuing
Medical Education (ACCME).
C. Home study courses shall have
either APA or ACCME approval.
D. Each medical psychologist shall, as part of his/her
continuing education requirements, maintain Basic Life Support (BLS)
certification.
AUTHORITY NOTE: Promulgated in accordance
with R.S.37:2371-2378
HISTORICAL NOTE: Promulgated by the Department of Health and Hospitals,
Board of Examiners of Psychologists, LR 31:72 (January 2005)
§413. Annual Renewal of the
Certificate of Prescriptive Authority
A. Each medical psychologist shall report his/her 30 hours of
annual continuing education relevant to the pharmacological treatment of
mental and emotional disorders on a form provided by the board. This form
will be distributed with the license renewal form. By signing the report
form, the medical psychologist signifies that the report is true and
accurate. This report is submitted annually, at the time of license
renewal, while other continuing education requirements follow the biennial
reporting guidelines listed in LAC 46:LXIII, §809.
B. Each medical psychologist
prescribing controlled substances shall also submit documentation of a
valid CDS license and DEA number with the continuing education report.
C. Upon acceptance of required
continuing education credits and documentation of current BLS
certification, the board will issue a renewal of the medical
psychologist’s Certificate of Prescriptive Authority, providing that the
medical psychologist’s license to practice psychology within the State of
Louisiana is simultaneously renewed by the board.
AUTHORITY NOTE: Promulgated in accordance
with R.S.37:2371-2378
HISTORICAL NOTE: Promulgated by the
Department of Health and Hospitals, Board of Examiners of Psychologists,
LR 31:73 (January 2005)
§415. Complaint Procedure
A. Any complaint against a
medical psychologist shall be made, investigated and adjudicated according
to the complaint procedures outlined in Title 37, Ch. 28, §2359 and LAC
46:LXIII, §1501-§1543.
B. The board shall have the
right to restrict, modify, suspend or revoke, in whole or in part, the
prescriptive authority of a medical psychologist who is found in violation
of any part of R.S. 37:2371-2378 or these rules for such time as the board
determines necessary to protect the health, safety and welfare of the
public.
1. Any
medical psychologist who knowingly fails to adhere to any modifications, limitations or
restrictions of their prescriptive authority, as determined by the board, shall be subject to revocation of
their certificate to prescribe.
2. The
name and prescriptive authority number of any medical psychologist whose
prescriptive authority is restricted, modified, limited, suspended or
revoked for any reason stemming from violation of any part of R.S.
37:2371-2378 or these rules shall be forwarded to the Louisiana State
Board of Pharmacy, along with the nature of any such modification,
limitation, suspension or revocation.
3. In any
case involving the restriction, modification, limitation, suspension or
revocation of the authority to prescribe controlled substances, the
board shall forward to the Controlled Substances section of the
Louisiana Department of Health and Hospitals and the regional office of
the United States Drug Enforcement Agency, the name and address, DEA
number and Louisiana State CDS license of the medical psychologist whose
prescriptive authority for controlled substances has been so restricted,
suspended or revoked.
C. Any medical psychologist who
prescribes any medication while his or her certificate to prescribe is
suspended or revoked shall be subject to the additional revocation of his
or her license to practice psychology in Louisiana, and his or her name
shall be forwarded to the district attorney in the parish of their
practice.
AUTHORITY NOTE: Promulgated in accordance
with R.S.37:2371-2378
HISTORICAL NOTE: Promulgated by the
Department of Health and Hospitals, Board of Examiners of Psychologists,
LR 31:73 (January 2005)
