H.F. _____ Section 1. Section 147.1, subsections 3 and 6, Code 2015, 1 are amended to read as follows: 2 3. “Licensed” or “certified” , when applied to a physician 3 and surgeon, podiatric physician, osteopathic physician and 4 surgeon, anesthesiologist assistant, physician assistant, 5 psychologist, chiropractor, nurse, dentist, dental hygienist, 6 dental assistant, optometrist, speech pathologist, audiologist, 7 pharmacist, physical therapist, physical therapist assistant, 8 occupational therapist, occupational therapy assistant, 9 orthotist, prosthetist, pedorthist, respiratory care 10 practitioner, practitioner of cosmetology arts and sciences, 11 practitioner of barbering, funeral director, dietitian, marital 12 and family therapist, mental health counselor, social worker, 13 massage therapist, athletic trainer, acupuncturist, nursing 14 home administrator, hearing aid dispenser, or sign language 15 interpreter or transliterator means a person licensed under 16 this subtitle . 17 6. “Profession” means medicine and surgery, podiatry, 18 osteopathic medicine and surgery, anesthesiologist assisting, 19 practice as a physician assistant, psychology, chiropractic, 20 nursing, dentistry, dental hygiene, dental assisting, 21 optometry, speech pathology, audiology, pharmacy, physical 22 therapy, physical therapist assisting, occupational therapy, 23 occupational therapy assisting, respiratory care, cosmetology 24 arts and sciences, barbering, mortuary science, marital 25 and family therapy, mental health counseling, social work, 26 dietetics, massage therapy, athletic training, acupuncture, 27 nursing home administration, hearing aid dispensing, sign 28 language interpreting or transliterating, orthotics, 29 prosthetics, or pedorthics. 30 Sec. 2. Section 147.2, subsection 1, Code 2015, is amended 31 to read as follows: 32 1. A person shall not engage in the practice of medicine 33 and surgery, podiatry, osteopathic medicine and surgery, 34 anesthesiologist assisting, psychology, chiropractic, physical 35 -1- LSB 1609YC (5) 86 tr/nh 1/ 13

H.F. _____ therapy, physical therapist assisting, nursing, dentistry, 1 dental hygiene, dental assisting, optometry, speech pathology, 2 audiology, occupational therapy, occupational therapy 3 assisting, orthotics, prosthetics, pedorthics, respiratory 4 care, pharmacy, cosmetology arts and sciences, barbering, 5 social work, dietetics, marital and family therapy or mental 6 health counseling, massage therapy, mortuary science, athletic 7 training, acupuncture, nursing home administration, hearing aid 8 dispensing, or sign language interpreting or transliterating, 9 or shall not practice as a physician assistant, unless the 10 person has obtained a license for that purpose from the board 11 for the profession. 12 Sec. 3. Section 147.13, subsection 1, Code 2015, is amended 13 to read as follows: 14 1. For medicine and surgery, osteopathic medicine and 15 surgery, anesthesiologist assisting, and acupuncture, the board 16 of medicine. 17 Sec. 4. Section 147.74, Code 2015, is amended by adding the 18 following new subsection: 19 NEW SUBSECTION . 23A. An anesthesiologist assistant 20 licensed under chapter 148G may use the words “anesthesiologist 21 assistant” after the person’s name. 22 Sec. 5. NEW SECTION . 148G.1 Definitions. 23 1. “Anesthesiologist” means a physician who has completed 24 a residency in anesthesiology approved by the American 25 board of anesthesiology or the American osteopathic board of 26 anesthesiology. 27 2. “Anesthesiologist assistant” means a person who meets all 28 of the following conditions: 29 a. Has graduated from an anesthesiologist assistant program 30 accredited by the American medical association’s committee on 31 allied health education and accreditation or by its successor 32 agency. 33 b. Has passed the certifying examination administered by 34 the national commission for certification of anesthesiologist 35 -2- LSB 1609YC (5) 86 tr/nh 2/ 13

H.F. _____ assistants. 1 c. Has active certification by the national commission for 2 certification of anesthesiologist assistants. 3 d. Provides health care services delegated by a licensed 4 anesthesiologist. 5 3. “Applicant” means an individual who seeks to become 6 licensed as an anesthesiologist assistant. 7 4. “Board” means the board of medicine created in section 8 147.13. 9 5. “Continuing education” means the offering of instruction 10 or information to license holders for the purpose of 11 maintaining or increasing skills necessary for the safe and 12 competent practice of anesthetic care. 13 6. “Immediately available” means in the same physical 14 location or facility in which the services are provided. 15 7. “Physician” means an individual licensed pursuant to 16 chapter 148 to practice medicine and surgery or osteopathic 17 medicine and surgery. 18 Sec. 6. NEW SECTION . 148G.2 License required to practice. 19 1. Except as provided in subsection 2, a person shall not 20 practice as an anesthesiologist assistant unless the person 21 holds a current, valid license issued pursuant to this chapter 22 to practice as an anesthesiologist assistant. 23 2. Subsection 1 shall not apply to any of the following: 24 a. A person participating in a training program leading 25 toward certification by the national commission for 26 certification of anesthesiologist assistants, as long as the 27 person is supervised by an anesthesiologist. 28 b. An individual participating in a hospital residency 29 program in preparation to practice as an anesthesiologist. 30 c. Any person who is otherwise authorized by section 148G.13 31 to perform any of the activities that an anesthesiologist 32 assistant is authorized to perform. 33 Sec. 7. NEW SECTION . 148G.3 License application 34 requirements. 35 -3- LSB 1609YC (5) 86 tr/nh 3/ 13

H.F. _____ 1. A person shall apply to the board for a license under 1 this chapter upon such forms and in such manner as may be 2 prescribed by the board by rule and shall pay the application 3 fee set by the board by rule. The application fee shall cover 4 the costs of issuing the license and shall not be refundable. 5 2. The application shall contain a statement that it is 6 made under oath or affirmation and that its representations 7 are true and correct to the best knowledge and belief of 8 the person signing the application. The application shall 9 include proof of certification after passing the certifying 10 examination administered by the national commission for 11 certification of anesthesiologist assistants or its successor, 12 the date of the certification, any identification numbers, and 13 any other information necessary for the board to verify the 14 certification. 15 3. The board, upon approval of the application, shall issue 16 a license to the applicant. 17 Sec. 8. NEW SECTION . 148G.4 Temporary license. 18 Notwithstanding any provision of this chapter to the 19 contrary, the board may issue a temporary license to practice 20 as an anesthesiologist assistant to an applicant who has 21 taken the certifying examination described in section 148G.1, 22 subsection 2, and is awaiting the results. A temporary license 23 may be issued upon the payment of a temporary license fee, the 24 submission of all required documents, and the applicant meeting 25 the necessary qualifications as defined by the board by rule. 26 The temporary license shall be valid until the results of the 27 certifying examination are available. The temporary license 28 may be renewed at the discretion of the board and upon payment 29 of the temporary license fee. 30 Sec. 9. NEW SECTION . 148G.5 Licensure in another state —— 31 reciprocity. 32 1. Upon application and payment of a fee set by the board by 33 rule, the board shall issue a license to an anesthesiologist 34 assistant who is licensed in another jurisdiction and who 35 -4- LSB 1609YC (5) 86 tr/nh 4/ 13

H.F. _____ has had no violations, suspensions, or revocations of a 1 license to practice as an anesthesiologist assistant in any 2 jurisdiction, provided that such person is licensed in a 3 jurisdiction with licensure requirements that are substantially 4 equal to, or greater than, the requirements for licensure of 5 anesthesiologist assistants pursuant to this chapter. 6 2. The board may negotiate reciprocal compacts with 7 licensing boards of other states for the admission of licensed 8 anesthesiologist assistants from this state to practice in 9 other states. 10 Sec. 10. NEW SECTION . 148G.6 License renewal —— void 11 licenses —— duplicate licenses. 12 1. A license is valid for two years from the date it is 13 issued and may be renewed biennially by filing an application 14 for renewal with the board upon such forms and in such manner 15 as may be prescribed by the board by rule and paying the 16 required renewal fee as set by the board by rule. 17 2. The application shall include but not be limited to all 18 of the following: 19 a. The date and number of the applicant’s license. 20 b. A description of any disciplinary action taken against 21 the applicant by any professional association or society, 22 licensed hospital or medical staff, state, or country. 23 c. Information concerning the applicant’s current physical 24 and mental fitness to practice as an anesthesiologist 25 assistant. 26 3. The board shall mail a blank form for application for 27 renewal of a license to each person licensed in this state at 28 the person’s last known office or residence address. 29 4. If an application for renewal is filed and the fee paid 30 after the licensure renewal date, a delinquent fee shall be 31 paid. The delinquent fee may be waived by the board based on 32 extenuating circumstances as defined by the board by rule. 33 5. If a person licensed by the board does not renew such 34 license for two consecutive renewal periods, such license shall 35 -5- LSB 1609YC (5) 86 tr/nh 5/ 13

H.F. _____ be deemed void. 1 6. A duplicate license to replace any license lost, 2 destroyed, or mutilated may be issued to an applicant, subject 3 to rules adopted by the board, upon the payment of a reasonable 4 fee. 5 Sec. 11. NEW SECTION . 148G.7 Anesthesiologist assistant 6 functions —— supervision —— prohibited activities. 7 1. An anesthesiologist assistant may assist the supervising 8 anesthesiologist in developing and implementing an anesthesia 9 care plan for a patient. In providing assistance to the 10 supervising anesthesiologist, an anesthesiologist assistant may 11 do any of the following: 12 a. Obtain a comprehensive patient history, perform relevant 13 elements of a physical exam, and present the history to the 14 supervising anesthesiologist. 15 b. Pretest and calibrate anesthesia delivery systems and 16 obtain and interpret information from the systems and monitors, 17 in consultation with an anesthesiologist. 18 c. Assist the supervising anesthesiologist with the 19 implementation of medically accepted monitoring techniques. 20 d. Establish basic and advanced airway interventions, 21 including intubation of the trachea and performing ventilatory 22 support. 23 e. Administer intermittent vasoactive drugs and start and 24 adjust vasoactive infusions. 25 f. Administer anesthetic drugs, adjuvant drugs, and 26 accessory drugs. 27 g. Assist the supervising anesthesiologist with the 28 performance of epidural anesthetic procedures, spinal 29 anesthetic procedures, and other regional anesthetic 30 techniques. 31 h. Administer blood, blood products, and supportive fluids. 32 i. Provide assistance to a cardiopulmonary resuscitation 33 team in response to a life-threatening situation. 34 j. Participate in administrative, research, and clinical 35 -6- LSB 1609YC (5) 86 tr/nh 6/ 13

H.F. _____ teaching activities as authorized by the supervising 1 anesthesiologist. 2 k. Perform such other tasks not prohibited by law under 3 the supervision of a licensed anesthesiologist that the 4 anesthesiologist assistant has been trained and is proficient 5 to perform. 6 2. An anesthesiologist shall at all times accept and be 7 responsible for the oversight of the health care services 8 rendered by an anesthesiologist assistant as provided in 9 section 148G.8. 10 3. An anesthesiologist assistant shall not perform any of 11 the following functions: 12 a. Prescribe any medications or controlled substances. 13 b. Administer any drugs, medicines, devices, or therapies 14 the supervising anesthesiologist is not qualified or authorized 15 to prescribe. 16 c. Practice or attempt to practice without the supervision 17 of a licensed anesthesiologist or in any location where the 18 supervising anesthesiologist is not immediately available for 19 consultation, assistance, and intervention. 20 4. A student in an anesthesiologist assistant training 21 program shall be identified as a student anesthesiologist 22 assistant or an anesthesiologist assistant student. Under no 23 circumstances shall such a student use or permit to be used 24 on the student’s behalf, the terms “intern”, “resident”, or 25 “fellow” or be identified in any way as a physician or surgeon. 26 5. The anesthesiologist members of the faculty of an 27 anesthesiologist assistant program established in this state 28 shall be comprised of anesthesiologists certified by the 29 American board of anesthesiology. A faculty member of an 30 anesthesiologist assistant program shall not concurrently 31 supervise more than two anesthesiologist assistant students 32 who are delivering anesthesia. A certified registered nurse 33 anesthetist shall be excluded from the clinical education of 34 anesthesiologist assistants. 35 -7- LSB 1609YC (5) 86 tr/nh 7/ 13

H.F. _____ Sec. 12. NEW SECTION . 148G.8 Supervision required —— 1 written practice protocol —— audit or inspection by board. 2 1. a. An anesthesiologist assistant shall practice only 3 under the direct supervision of an anesthesiologist who is 4 physically present or immediately available. 5 b. An anesthesiologist may supervise up to four 6 anesthesiologist assistants concurrently, consistent with 7 the provisions of 42 C.F.R. §415.110 relating to anesthesia 8 services reimbursable under Medicare. 9 2. An anesthesiologist who agrees to act as the supervising 10 anesthesiologist for an anesthesiologist assistant shall 11 adopt a written practice protocol that is consistent with 12 this chapter and that delineates the services that the 13 anesthesiologist assistant is authorized to provide and 14 the manner in which the anesthesiologist will supervise the 15 anesthesiologist assistant. The provisions of the protocol 16 shall be based on relevant quality assurance standards, 17 including regular review by the supervising anesthesiologist 18 of the medical records of the patients cared for by the 19 anesthesiologist assistant. 20 3. The supervising anesthesiologist shall oversee the 21 anesthesiologist assistant in accordance with the terms 22 of the protocol and any rules adopted by the board for the 23 supervision of an anesthesiologist assistant. The board may 24 audit or inspect any written practice protocol under which an 25 anesthesiologist assistant works. 26 Sec. 13. NEW SECTION . 148G.9 Inactive license. 27 1. A person licensed pursuant to this chapter may apply 28 to the board for inactive license status on a form furnished 29 by the board. Upon receipt of the completed inactive status 30 application and a determination by the board that the licensee 31 meets the requirements defined by the board by rule, the 32 board shall declare the licensee inactive and shall place 33 the licensee on an inactive status list. A person that has 34 an inactive license or has discontinued the practice of an 35 -8- LSB 1609YC (5) 86 tr/nh 8/ 13

H.F. _____ anesthesiologist assistant because of retirement shall not 1 practice as an anesthesiologist assistant within this state. 2 2. During the period of inactive status, the licensee shall 3 not be required to comply with the board’s minimum requirements 4 for continuing education pursuant to section 148G.11. 5 3. A licensee that allows the person’s license to become 6 inactive for a period of five years or less may return the 7 license to active status by notifying the board in advance of 8 such intention, paying the appropriate fees, and meeting all 9 established licensure requirements of the board as a condition 10 of reinstatement. 11 Sec. 14. NEW SECTION . 148G.10 Retirement —— resumption of 12 practice. 13 A person licensed to practice as an anesthesiologist 14 assistant in this state who retires from such practice shall 15 file with the board an affidavit, on a form to be furnished by 16 the board, which states the date of retirement and such other 17 facts to verify the retirement as defined by the board by rule. 18 Sec. 15. NEW SECTION . 148G.11 Continuing education 19 requirements. 20 The board shall not renew a license under this chapter 21 unless the licensee provides satisfactory evidence that the 22 board’s minimum requirements for continuing education have 23 been met. The board shall adopt minimum requirements for 24 continuing education by rule, which shall include but are not 25 limited to the successful completion of the examination for 26 continued demonstration of qualifications once every six years, 27 as authorized by the national commission for certification of 28 anesthesiologist assistants or its successor. 29 Sec. 16. NEW SECTION . 148G.12 License denial, suspension, 30 and revocation. 31 1. The board may refuse to issue or renew, suspend, or 32 revoke a license under this chapter for any of the following: 33 a. Use or unlawful possession of any controlled substance, 34 as defined in chapter 124, or alcoholic beverage to an extent 35 -9- LSB 1609YC (5) 86 tr/nh 9/ 13

H.F. _____ that such use impairs the person’s ability to perform the work 1 of an anesthesiologist assistant. 2 b. The person has been finally adjudicated and found 3 guilty, or entered a plea of guilty or nolo contendere, in 4 a criminal prosecution under the laws of any state or of 5 the United States, for any offense reasonably related to the 6 qualifications, functions, or duties of an anesthesiologist 7 assistant, for any offense for which an essential element is 8 fraud, dishonesty, or an act of violence, or for any offense 9 involving moral turpitude, whether or not a sentence is 10 imposed. 11 c. Use of fraud, deception, misrepresentation, or bribery 12 in securing a license issued pursuant to this chapter or in 13 obtaining permission to take an examination given or required 14 pursuant to this chapter. 15 d. Obtaining or attempting to obtain any fee, charge, 16 tuition, or other compensation by fraud, deception, or 17 misrepresentation. 18 e. Incompetency, misconduct, gross negligence, fraud, 19 misrepresentation, or dishonesty in the performance of the 20 functions or duties of an anesthesiologist assistant. 21 f. Violation of, or assisting or enabling any person to 22 violate, any provision of this chapter or any rule adopted 23 pursuant to this chapter. 24 g. Impersonation of any person holding a license. 25 h. Disciplinary action against the holder of a license or 26 other right relating to the practice of an anesthesiologist 27 assistant granted by another state, territory, federal agency, 28 or country upon grounds for which revocation or suspension is 29 authorized in this state. 30 i. A final adjudication of insanity or incompetency by a 31 court of competent jurisdiction. 32 j. Assisting or enabling any person to practice or offer to 33 practice as an anesthesiologist assistant who is not licensed 34 and eligible to practice pursuant to this chapter. 35 -10- LSB 1609YC (5) 86 tr/nh 10/ 13

H.F. _____ k. Issuance of a license based upon a material mistake of 1 fact. 2 l. Violation of any professional trust or confidence. 3 m. Violation of the ethical standards for an 4 anesthesiologist assistant as defined by the board by rule. 5 n. Violation of a rule or regulation of this state, any 6 other state, or the federal government. 7 2. The board shall notify the applicant or licensee 8 in a complaint in writing of the reasons for the refusal, 9 suspension, or revocation and shall advise the applicant or 10 licensee of the right to file an objection to the complaint. 11 The board shall adopt rules of procedure for the filing 12 of complaints and objections thereto which conform to the 13 provisions of chapter 17A. 14 3. The board shall have the authority to issue subpoenas to 15 compel witnesses to testify or produce evidence in proceedings 16 to deny, suspend, or revoke a license. 17 4. After the filing of a complaint by the board, the 18 proceedings shall be conducted in accordance with the 19 provisions of chapter 17A. Upon a finding that the grounds for 20 disciplinary action provided in subsection 1 are met, the board 21 may take any of the following actions: 22 a. Deny initial issuance or renewal of a license to the 23 person named in the complaint. 24 b. Censure or place the person named in the complaint on 25 probation with such terms and conditions as the board deems 26 appropriate for a period not to exceed ten years. 27 c. Suspend the license of the person named in the complaint 28 for a period not to exceed seven years. 29 d. Revoke the license of the person named in the complaint. 30 5. An individual whose license has been revoked shall wait 31 at least one year from the date of revocation to apply for 32 relicensure and shall not be eligible for a temporary license. 33 Relicensure shall be at the discretion of the board after 34 compliance with all requirements of this chapter. 35 -11- LSB 1609YC (5) 86 tr/nh 11/ 13

H.F. _____ Sec. 17. NEW SECTION . 148G.13 Scope of chapter. 1 1. Notwithstanding the provisions of this chapter, the 2 governing body of a hospital may limit the functions and 3 activities that an anesthesiologist assistant performs in 4 such hospital. Nothing in this section shall be construed to 5 require any hospital to hire an anesthesiologist who is not 6 already employed as a physician prior to July 1, 2015. 7 2. Nothing in this chapter shall be construed as prohibiting 8 any individual, regardless of whether the individual is 9 licensed pursuant to this chapter, from providing the services 10 of anesthesiologist assistant, so long as those services are 11 lawfully performed pursuant to the individual’s scope of 12 practice as authorized by law. 13 EXPLANATION 14 The inclusion of this explanation does not constitute agreement with 15 the explanation’s substance by the members of the general assembly. 16 This bill provides for licensing of anesthesiologist 17 assistants and makes the provisions of Code chapters 147 and 18 272C, including penalty and other regulatory provisions, 19 applicable to the practice of anesthesiologist assisting. 20 The board of medicine is to be responsible for governing the 21 licensure process for anesthesiologist assistants. 22 The bill requires anesthesiologist assistants to perform all 23 duties under the immediate supervision of an anesthesiologist. 24 The bill does not prevent other persons from performing the 25 duties of an anesthesiologist assistant if the person is 26 legally authorized to perform such duties within their regular 27 scope of practice. 28 To become a licensed anesthesiologist assistant, a person 29 must graduate from an anesthesiologist assistant program 30 accredited by the American medical association’s committee 31 on allied health education and accreditation, pass the 32 certifying examination administered by the national commission 33 for certification of anesthesiologist assistants, and have 34 an active certification by the national commission for 35 -12- LSB 1609YC (5) 86 tr/nh 12/ 13

H.F. _____ certification of anesthesiologist assistants. The person must 1 then file the proper application and fees with the board of 2 medicine. The bill allows for licensure without examination 3 if an anesthesiologist assistant holds a similar license in 4 another jurisdiction. Licensees must complete continuing 5 education requirements. The bill sets forth provisions for 6 license renewal, temporary licensure, inactive or retired 7 license status, and license suspension, denial, or revocation. 8 -13- LSB 1609YC (5) 86 tr/nh 13/ 13