Iowa Management Services Agreement Guide: Referral Rules and the Medical Director's On-Site Hours
Iowa has no fee-splitting statute that we found, but Board rules bar paying for referrals, and the med spa rule requires four hours a week of documented on-site supervision by the medical director.
Key Highlights
- Board rules say a physician shall not pay or receive compensation for patient referrals and adopt the AMA and AOA ethics codes as guiding principles.
- A reported 1992 Attorney General opinion judges corporate employment of professionals case by case on control and dominion and rejects reliance on labels.
- Rule 481-655.6 requires at least four hours a week of in-person on-site supervision, review of at least 10% of charts and staying within 60 miles.
- Records must be retained at least seven years from the last service.
How to Price the Management Fee
We found no Iowa fee-splitting statute and no rule on percentage-of-revenue management fees. Board rules bar paying or receiving compensation for referrals and make accepting remuneration for referral in violation of law or ethics a discipline ground, so we use a fixed fee for defined services and nothing tied to referrals.
What the Practice Must Keep
The practice keeps the medical director's supervision duties: personally assessing staff qualifications, documented direct on-site supervision at least four hours a week, chart review of at least 10%, emergency protocols, informed consent and posting the director's identity and licensure. The ethics codes say a physician should not provide services under terms that tend to interfere with free and complete exercise of medical judgment.
Terms to Avoid
Avoid labels that hide control, since the reported opinion rejects reliance on profit or nonprofit status, a recital of physician independence or the employee label, and avoid any referral-linked pay or director who does not meet the on-site and distance requirements.
Term, Records and Departing Clinicians
Records must be retained at least seven years and transferred to a custodian with patient notice on a sale or closure. Non-competes follow common-law reasonableness, and a 2026 law bars them only for University of Iowa Hospitals and Clinics health professionals.
Filings, Notices and Watch Items
We found no Iowa transaction notice law, and a 2026 market oversight snapshot says Iowa has no authority to approve, condition or reject consolidation. A 2026 bill to license med spas advanced from a House subcommittee and its final status is unknown.
Drafting Checklist
- Fee: fixed, no referral compensation.
- Director: four hours a week on site, within 60 miles, 10% chart review.
- Consent: documented informed consent.
- Posting: director and staff identity and licensure.
- Records: kept seven years.
- Control: no hidden control behind labels.
How We Draft It
Patients pay the physician-owned practice, the practice pays the management company a fixed monthly fee under the agreement, and the management company pays MedGrid a fixed monthly retainer for consulting. The management company never practices medicine, and the agreement never moves a clinical decision to it. Our template follows the same flat-fee design in every state, with the state-specific limits below layered on top.
Disclaimer
This article is general educational information, not legal advice. Management agreement rules change and differ by state, and this summary draws on our published state guide, parts of which rest on secondary sources, so have health care counsel in the state review any agreement before you sign.
MedGrid MSO provides management services to independently owned practices; it does not practise medicine and does not direct clinical decisions. Requirements vary by state and by service, and change over time — nothing on this page is legal or medical advice. Talk to us or your own counsel before making a structural decision for your clinic.