H.F. 2064 Section 1. NEW SECTION . 148F.1 Title. 1 This chapter shall be known and may be cited as the 2 “Interventional Pain Management and Treatment Patient Safety 3 Act” . 4 Sec. 2. NEW SECTION . 148F.2 Definitions. 5 For purposes of this chapter, unless the context otherwise 6 requires: 7 1. “Acute pain” means pain that is temporary and results 8 from something specific, such as a surgery, a broken bone, 9 labor and childbirth, dental work, a cut, or a burn. 10 2. “Chronic interventional pain medicine” means the 11 diagnosis and treatment of chronic pain-related disorders 12 primarily with the application of interventional techniques in 13 managing chronic, persistent, and intractable pain. “Chronic 14 interventional pain medicine” does not include treatment of 15 acute pain or the administration of anesthesia-related services 16 in the operating room or emergency room setting. 17 3. “Chronic pain” means pain of any etiology associated with 18 a chronic medical condition or extending in duration beyond 19 the expected temporal boundary of tissue injury and normal 20 healing and adversely affecting the function or well-being of 21 the individual. 22 4. “Fluoroscope” means a radiologic instrument equipped with 23 a fluorescent screen on which opaque internal structures can 24 be viewed as moving shadow images formed by the differential 25 transmission of X rays throughout the body. 26 5. “Interventional techniques” means through the skin needle 27 placement through which drugs are then placed in targeted 28 areas, nerves are ablated, or certain surgical procedures 29 involving injection of steroids, analgesics, or anesthetics 30 are performed. “Interventional techniques” includes but is not 31 limited to the following: 32 a. Lumbar, thoracic, and cervical spine injections, 33 intra-articular injection, intrathecal injections, and epidural 34 injections, both interlaminar and transforminal. 35 -1- LSB 5155YH (5) 84 jr/nh 1/ 4

H.F. 2064 b. Facet injections. 1 c. Discography. 2 d. Nerve destruction. 3 e. Occipital nerve blocks. 4 f. Cervical, thoracic, or lumbar sympathetic blocks. 5 g. Intradiscal electrothermal therapy. 6 h. Spinal cord stimulation or peripheral nerve stimulation. 7 i. Intrathecal pump placement. 8 j. Ablation of targeted nerves. 9 k. Vertebroplasty. 10 l. Kyphoplasty. 11 m. Utilization of fluoroscopy, computerized tomography, 12 or ultrasound when such devices are used to assess the cause 13 or location of a patient’s chronic pain or as a means of 14 accurately directing needles, catheters, or electrodes as part 15 of a therapeutic modality for chronic pain treatment. 16 n. Other interventional techniques approved by the board of 17 medicine. 18 Sec. 3. NEW SECTION . 148F.3 Prohibited practices —— 19 exemptions. 20 1. A person shall not practice or offer to practice chronic 21 interventional pain medicine in this state unless such person 22 meets at least one of the following requirements: 23 a. Completion of one of the following types of advanced 24 specialty training in interventional pain medicine: 25 (1) Successful completion of a pain medicine fellowship 26 training program recognized by the accreditation council 27 for graduate medical education or approved by the American 28 osteopathic association, evidenced by documentation verifying 29 such successful completion. 30 (2) Successful completion of an American osteopathic 31 association or American board of anesthesiology approved 32 residency in anesthesiology, or of another American board 33 of medical specialties residency and subspecialty training 34 in interventional pain medicine, evidenced by documentation 35 -2- LSB 5155YH (5) 84 jr/nh 2/ 4

H.F. 2064 verifying such successful completion. 1 b. Receipt of one of the following types of board 2 certification: 3 (1) Board certification in pain medicine from one of 4 the following certifying bodies: the American board of 5 anesthesiology, the American board of physical medicine 6 and rehabilitation, or the American board of psychiatry 7 and neurology, evidenced by documentation verifying such 8 certification. 9 (2) Board certification from the American board of 10 pain medicine, evidenced by documentation verifying such 11 certification. 12 2. Notwithstanding subsection 1, the designated licensees 13 may perform the specified procedures as follows: 14 a. Anesthesiologists who are medical or osteopathic 15 physicians licensed under chapter 148, with board certification 16 in their primary specialty and active credentials to practice 17 at a health care institution accredited by the state of 18 Iowa may perform interlaminar epidural steroid injections if 19 credentialed to do so at that health care institution. 20 b. Medical or osteopathic physicians licensed under chapter 21 148 may perform intra-articular injections in accordance with 22 standards of care as determined by the board of medicine in 23 rule. 24 c. Podiatrists licensed under chapter 149 or dentists 25 licensed under chapter 153 may perform chronic pain 26 interventional procedures solely within the limits of their 27 specialty in accordance with standards of care as determined by 28 the respective licensing boards in rule. 29 3. Any person who violates this section is guilty of 30 a serious misdemeanor as provided in section 147.86 and 31 is subject to the injunction, punishment, and enforcement 32 provisions set forth in chapter 147. 33 Sec. 4. NEW SECTION . 148F.4 Rules. 34 The board of medicine shall adopt rules to implement and 35 -3- LSB 5155YH (5) 84 jr/nh 3/ 4

H.F. 2064 administer this chapter. 1 EXPLANATION 2 This bill establishes training and certification standards 3 for a person who wishes to practice chronic interventional pain 4 medicine. The person must either complete advanced specialty 5 training in interventional pain medicine or be certified by 6 a national board. The bill specifies the requirements for 7 either option. The bill does not create a specific license or 8 certification for chronic interventional pain medicine. 9 The bill exempts the following licensed professionals from 10 these training requirements in certain circumstances within the 11 scope of their training: anesthesiologists who are medical 12 or osteopathic physicians, medical or osteopathic physicians, 13 podiatrists, and dentists. The various licensing boards are 14 empowered to adopt rules detailing the standards of care for 15 the professions. 16 The bill provides that the board of medicine shall adopt 17 rules to implement and administer the bill. 18 The bill makes a penalty in Code section 147.86 applicable, 19 making it a serious misdemeanor to violate any of the 20 provisions of the bill. 21 -4- LSB 5155YH (5) 84 jr/nh 4/ 4