S.F. 364 Section 1. Section 147.1, subsections 3 and 6, Code 2011, 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, physician assistant, psychologist, chiropractor, 5 nurse, dentist, dental hygienist, dental assistant, 6 optometrist, speech pathologist, audiologist, pharmacist, 7 physical therapist, physical therapist assistant, occupational 8 therapist, occupational therapy assistant, orthotist, 9 prosthetist, pedorthist, respiratory care practitioner, 10 practitioner of cosmetology arts and sciences, practitioner 11 of barbering, funeral director, dietitian, marital and 12 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, practice as a physician 19 assistant, psychology, chiropractic, nursing, dentistry, 20 dental hygiene, dental assisting, optometry, speech pathology, 21 audiology, pharmacy, physical therapy, physical therapist 22 assisting, occupational therapy, occupational therapy 23 assisting, respiratory care, cosmetology arts and sciences, 24 barbering, mortuary science, marital and family therapy, mental 25 health counseling, social work, dietetics, massage therapy, 26 athletic training, acupuncture, nursing home administration, 27 hearing aid dispensing, or sign language interpreting or 28 transliterating , orthotics, prosthetics, or pedorthics . 29 Sec. 2. Section 147.2, subsection 1, Code 2011, is amended 30 to read as follows: 31 1. A person shall not engage in the practice of medicine 32 and surgery, podiatry, osteopathic medicine and surgery, 33 psychology, chiropractic, physical therapy, physical 34 therapist assisting, nursing, dentistry, dental hygiene, 35 -1- LSB 2240SV (2) 84 jr/nh 1/ 12

S.F. 364 dental assisting, optometry, speech pathology, audiology, 1 occupational therapy, occupational therapy assisting, 2 orthotics, prosthetics, pedorthics, respiratory care, 3 pharmacy, cosmetology arts and sciences, barbering, social 4 work, dietetics, marital and family therapy or mental health 5 counseling, massage therapy, mortuary science, athletic 6 training, acupuncture, nursing home administration, hearing aid 7 dispensing, or sign language interpreting or transliterating, 8 or shall not practice as a physician assistant, unless the 9 person has obtained a license for that purpose from the board 10 for the profession. 11 Sec. 3. Section 147.13, Code 2011, is amended by adding the 12 following new subsection: 13 NEW SUBSECTION . 24. For orthotics, prosthetics, and 14 pedorthics, the board of orthotics, prosthetics, and 15 pedorthics. 16 Sec. 4. Section 147.14, subsection 1, Code 2011, is amended 17 by adding the following new paragraph: 18 NEW PARAGRAPH . x. For the board of orthotics, prosthetics, 19 and pedorthics, three persons licensed to practice orthotics, 20 prosthetics, or pedorthics who have engaged in the practice 21 of orthotics, prosthetics, or pedorthics in Iowa for at least 22 three years immediately preceding their appointment to the 23 board and two members who are not licensed to practice and who 24 shall represent the general public. 25 Sec. 5. Section 147.74, Code 2011, is amended by adding the 26 following new subsection: 27 NEW SUBSECTION . 24. a. An orthotist licensed under chapter 28 148F may use the words “licensed orthotist” after the person’s 29 name or signify the same by the use of the letters “L.O.” after 30 the person’s name. 31 b. A pedorthist licensed under chapter 148F may use the 32 words “licensed pedorthist” after the person’s name or signify 33 the same by the use of the letters “L.ped.” after the person’s 34 name. 35 -2- LSB 2240SV (2) 84 jr/nh 2/ 12

S.F. 364 c. A prosthetist licensed under chapter 148F may use the 1 words “licensed prosthetist” after the person’s name or signify 2 the same by the use of the letters “L.P.” after the person’s 3 name. 4 Sec. 6. NEW SECTION . 148F.1 Title and purpose. 5 1. This chapter may be cited and referred to as the 6 “Orthotics, Prosthetics, and Pedorthics Practice Act” . 7 2. The purpose of this chapter is to provide for the 8 regulation of persons offering orthotic, prosthetic, and 9 pedorthic services to the public in order to safeguard the 10 public health, safety, and welfare. 11 Sec. 7. NEW SECTION . 148F.2 Definitions. 12 As used in this chapter: 13 1. “Board” means the board of orthotics, prosthetics, and 14 pedorthics. 15 2. “Orthosis” means a custom-fabricated or custom-fitted 16 brace or support designed to provide for alignment, correction, 17 or prevention of neuromuscular or musculoskeletal dysfunction, 18 disease, injury, or deformity. “Orthosis” does not include 19 fabric or elastic supports, corsets, arch supports, low 20 temperature plastic splints, trusses, elastic hoses, canes, 21 crutches, soft cervical collars, dental appliances, or other 22 similar devices carried in stock and sold as “over-the-counter” 23 items by a drug store, department store, corset shop, or 24 surgical supply facility. 25 3. “Orthotic and prosthetic education program” means a course 26 of instruction accredited by the commission on accreditation 27 of allied health education programs, consisting of both of the 28 following: 29 a. A basic curriculum of college level instruction in math, 30 physics, biology, chemistry, and psychology. 31 b. A specific curriculum in orthotic or prosthetic courses, 32 including but not limited to: 33 (1) Lectures covering pertinent anatomy, biomechanics, 34 pathomechanics, prosthetic-orthotic components and materials, 35 -3- LSB 2240SV (2) 84 jr/nh 3/ 12

S.F. 364 training and functional capabilities, prosthetic or orthotic 1 performance evaluation, prescription considerations, etiology 2 of amputations and disease processes necessitating prosthetic 3 or orthotic use, and medical management. 4 (2) Subject matter related to pediatric and geriatric 5 problems. 6 (3) Instruction in acute care techniques, such as immediate 7 and early post-surgical prosthetics and fracture bracing 8 techniques. 9 (4) Lectures, demonstrations, and laboratory experiences 10 related to the entire process of measuring, casting, fitting, 11 fabricating, aligning, and completing prostheses or orthoses. 12 4. “Orthotic and prosthetic scope of practice” means a 13 list of tasks, with relative weight given to such factors 14 as importance, criticality, and frequency, based on 15 internationally accepted standards of orthotic and prosthetic 16 care as outlined by the international society of prosthetics 17 and orthotics’ professional profile for category I and category 18 III orthotic and prosthetic personnel. 19 5. “Orthotics” means the science and practice of evaluating, 20 measuring, designing, fabricating, assembling, fitting, 21 adjusting, or servicing an orthosis under an order from a 22 licensed physician or podiatric physician for the correction or 23 alleviation of neuromuscular or musculoskeletal dysfunction, 24 disease, injury, or deformity. 25 6. “Orthotist” means a health care professional, 26 specifically educated and trained in orthotic patient care, 27 who measures, designs, fabricates, fits, or services orthoses 28 and may assist in the formulation of the order and treatment 29 plan of orthoses for the support or correction of disabilities 30 caused by neuromusculoskeletal diseases, injuries, or 31 deformities. 32 7. “Pedorthic device” means therapeutic shoes, such as 33 diabetic shoes and inserts, shoe modifications made for 34 therapeutic purposes, below-the-ankle partial foot prostheses, 35 -4- LSB 2240SV (2) 84 jr/nh 4/ 12

S.F. 364 and foot orthoses for use at the ankle or below. The term also 1 includes subtalar-control foot orthoses designed to manage the 2 function of the anatomy by controlling the range of motion of 3 the subtalar joint. Excluding pedorthic devices which are 4 footwear, the proximal height of a custom pedorthic device 5 does not extend beyond the junction of the gastrocnemius and 6 the Achilles tendon. “Pedorthic device” does not include 7 nontherapeutic inlays or footwear regardless of method of 8 manufacture; unmodified, nontherapeutic over-the-counter shoes; 9 or prefabricated foot care products. 10 8. “Pedorthic education program” means an educational 11 program accredited by the national commission on orthotic and 12 prosthetic education consisting of all of the following: 13 a. A basic curriculum of instruction in foot-related 14 pathology of diseases, anatomy, and biomechanics. 15 b. A specific curriculum in pedorthic courses, including 16 lectures covering shoes, foot orthoses, and shoe modifications, 17 pedorthic components and materials, training and functional 18 capabilities, pedorthic performance evaluation, prescription 19 considerations, etiology of disease processes necessitating 20 use of pedorthic devices, medical management, subject matter 21 related to pediatric and geriatric problems, and lectures, 22 demonstrations, and laboratory experiences related to the 23 entire process of measuring and casting, fitting, fabricating, 24 aligning, and completing pedorthic devices. 25 9. “Pedorthic scope of practice” means a list of tasks 26 with relative weight given to such factors as importance, 27 criticality, and frequency based on nationally accepted 28 standards of pedorthic care as outlined by the national 29 commission on orthotic and prosthetic education comprehensive 30 analysis with an empirical validation study of the profession 31 performed by an independent testing company. 32 10. “Pedorthics” means the science and practice of 33 evaluating, measuring, designing, fabricating, assembling, 34 fitting, adjusting, or servicing a pedorthic device under an 35 -5- LSB 2240SV (2) 84 jr/nh 5/ 12

S.F. 364 order from a licensed physician or podiatric physician for the 1 correction or alleviation of neuromuscular or musculoskeletal 2 dysfunction, disease, injury, or deformity. 3 11. “Pedorthist” means a health care professional, 4 specifically educated and trained in pedorthic patient 5 care, who measures, designs, fabricates, fits, or services 6 pedorthic devices and may assist in the formulation of the 7 order and treatment plan of pedorthic devices for the support 8 or correction of disabilities caused by neuromusculoskeletal 9 diseases, injuries, or deformities. 10 12. “Prosthesis” means an artificial medical device that 11 is not surgically implanted and that is used to replace a 12 missing limb, appendage, or any other external human body part 13 including an artificial limb, hand, or foot. 14 13. “Prosthetics” means the science and practice of 15 evaluating, measuring, designing, fabricating, assembling, 16 fitting, adjusting, or servicing a prosthesis under an order 17 from a licensed physician. 18 14. “Prosthetist” means a health care professional, 19 specifically educated and trained in prosthetic patient care, 20 who measures, designs, fabricates, fits, or services prostheses 21 and may assist in the formulation of the order and treatment 22 plan of prostheses for the replacement of external parts of the 23 human body lost due to amputation or congenital deformities or 24 absences. 25 15. “Resident” means a person who has completed an education 26 program in either orthotics or prosthetics and is continuing 27 the person’s clinical education in a residency accredited by 28 the national commission on orthotic and prosthetic education. 29 16. “Residency” means an approved supervised program of 30 a minimum duration of one year to acquire practical clinical 31 training in orthotics or prosthetics in a patient care setting. 32 Sec. 8. NEW SECTION . 148F.3 Duties of the board. 33 The board shall administer this chapter. The board’s duties 34 shall include but are not limited to the following: 35 -6- LSB 2240SV (2) 84 jr/nh 6/ 12

S.F. 364 1. Adoption of rules to administer and interpret this 1 chapter, chapter 147, and chapter 272C with respect to the 2 education and licensing of orthotists, prosthetists, and 3 pedorthists. 4 2. Adoption of rules to establish accepted standards of 5 orthotic and prosthetic scope of practice, including the 6 classification of devices and supervision of nonlicensed 7 caregivers. 8 3. Adoption of rules relating to professional conduct and 9 licensing and the establishment of ethical and professional 10 standards of practice. 11 4. Acting on matters concerning licensure and the process 12 of applying for, granting, suspending, imposing supervisory 13 or probationary conditions upon, reinstating, revoking, or 14 renewing a license. 15 5. Establishing and collecting licensure fees as provided 16 in section 147.80. 17 6. Developing continuing education requirements as a 18 condition of license renewal. 19 7. Evaluating requirements for licensure in other states to 20 determine if reciprocity may be granted. 21 8. Adoption of rules providing temporary licensing for 22 persons providing orthotic, prosthetic, and pedorthic care 23 in this state prior to the effective date of this Act. A 24 temporary license is good for no more than one year. 25 Sec. 9. NEW SECTION . 148F.4 Persons and practices not 26 affected. 27 This chapter does not prevent or restrict the practice, 28 services, or activities of any of the following: 29 1. A person licensed in this state by any other law from 30 engaging in the profession or occupation for which the person 31 is licensed, including but not limited to persons set out in 32 section 147.1, subsections 3 and 6. 33 2. A person employed as an orthotics, prosthetics, or 34 pedorthics practitioner by the government of the United States 35 -7- LSB 2240SV (2) 84 jr/nh 7/ 12

S.F. 364 if that person practices solely under the direction or control 1 of the organization by which the person is employed. 2 3. A person pursuing a course of study leading to a degree 3 or certificate in orthotics, prosthetics, or pedorthics in an 4 educational program accredited or approved according to rules 5 adopted by the board, if the activities and services constitute 6 a part of a supervised course of study and the person is 7 designated by a title which clearly indicates the person’s 8 status as a student, resident, or trainee. 9 Sec. 10. NEW SECTION . 148F.5 Qualifications for licensure 10 as orthotist, prosthetist, or pedorthist. 11 1. To qualify for a license to practice orthotics or 12 prosthetics, a person shall meet the following requirements: 13 a. Possess a baccalaureate degree from a college or 14 university. 15 b. Have completed the amount of formal training, including 16 but not limited to an orthotic and prosthetic education 17 program, and clinical practice established and approved by the 18 board. 19 c. Complete a clinical residency in the professional area 20 for which a license is sought in accordance with standards, 21 guidelines, or procedures for residencies established and 22 approved by the board. The majority of training must be 23 devoted to services performed under the supervision of a 24 licensed practitioner of orthotics or prosthetics or a person 25 certified as a certified orthotist, certified prosthetist, 26 or certified prosthetist orthotist whose practice is located 27 outside the state. 28 d. Pass all written, practical, and oral examinations that 29 are required and approved by the board. 30 e. Be qualified to practice in accordance with accepted 31 standards of orthotic and prosthetic care as established by the 32 board. 33 2. To qualify for a license to practice pedorthics, a person 34 shall meet the following requirements: 35 -8- LSB 2240SV (2) 84 jr/nh 8/ 12

S.F. 364 a. Submit proof of a high school diploma or its equivalent. 1 b. Have completed the amount of formal training, including 2 but not limited to a pedorthic education program, and clinical 3 practice established and approved by the board. 4 c. Complete a qualified work experience program or 5 internship in pedorthics that has a minimum of one thousand 6 hours of pedorthic patient care experience in accordance 7 with any standards, guidelines, or procedures established 8 and approved by the board. The majority of training must 9 be devoted to services performed under the supervision of a 10 licensed practitioner of pedorthics or a person certified as 11 a certified pedorthist whose practice is located outside the 12 state. 13 d. Pass all examinations that are required and approved by 14 the board. 15 e. Be qualified to practice in accordance with accepted 16 standards of pedorthic care as established by the board. 17 3. The standards and requirements for licensure established 18 by the board shall be substantially equal to or in excess of 19 standards commonly accepted in the professions of orthotics, 20 prosthetics, or pedorthics, as applicable. The board shall 21 adopt rules as necessary to set the standards and requirements. 22 4. A person may be licensed in more than one discipline. 23 Sec. 11. NEW SECTION . 148F.6 Assistants and technicians. 24 1. a. A person shall not work as an assistant to an 25 orthotist or prosthetist or provide patient care services or 26 fabrication of orthoses or prostheses, unless the work is 27 performed under the supervision of a licensed orthotist or 28 prosthetist. 29 b. An assistant may perform orthotic or prosthetic 30 procedures and related tasks in the management of patient care. 31 An assistant may also fabricate, repair, and maintain orthoses 32 and prostheses. 33 2. a. A person shall not work as a technician unless 34 the work is performed under the supervision of a licensed 35 -9- LSB 2240SV (2) 84 jr/nh 9/ 12

S.F. 364 orthotist, prosthetist, or pedorthist. 1 b. A technician may assist a person licensed under this 2 chapter with fabrication of orthoses, prostheses, or pedorthic 3 devices but shall not provide direct patient care. 4 Sec. 12. NEW SECTION . 148F.7 Limitation on provision of 5 care and services. 6 A licensed orthotist, prosthetist, or pedorthist may provide 7 care or services only if the care or services are provided 8 pursuant to an order from a licensed physician, a licensed 9 podiatric physician, an advanced registered nurse practitioner 10 who has a written collaborative agreement with a collaborating 11 physician or podiatric physician that specifically authorizes 12 ordering the services of an orthotist, prosthetist, or 13 pedorthist, an advanced registered nurse practitioner who 14 practices in a hospital or ambulatory surgical treatment center 15 and possesses clinical privileges to order services of an 16 orthotist, prosthetist, or pedorthist, or a physician assistant 17 who has been delegated the authority to order the services of 18 an orthotist, prosthetist, or pedorthist by the assistant’s 19 supervising physician. A licensed podiatric physician or an 20 advanced registered nurse practitioner collaborating with a 21 podiatric physician may only order care or services concerning 22 the foot from a licensed pedorthist or orthotist. 23 Sec. 13. NEW SECTION . 148F.8 Penalties. 24 1. If any person, company, or other entity violates a 25 provision of this chapter, the attorney general may petition 26 for an order enjoining the violation or for an order enforcing 27 compliance with this chapter. Upon the filing of a verified 28 petition in court, the court may issue a temporary restraining 29 order, without notice or bond, and may preliminarily and 30 permanently enjoin the violation. If it is established 31 that the person, company, or other entity has violated or is 32 violating the injunction, the court may punish the offender 33 for contempt of court. Proceedings under this section shall 34 be in addition to, and not in lieu of, all other remedies and 35 -10- LSB 2240SV (2) 84 jr/nh 10/ 12

S.F. 364 penalties provided in this chapter. 1 2. If a person practices as an orthotist, prosthetist, 2 or pedorthist or represents the person as such without being 3 licensed under the provisions of this chapter, then any other 4 licensed orthotist, pedorthist, or prosthetist, any interested 5 party, or any person injured by the person may petition for 6 relief as provided in subsection 1. 7 3. If a company or other entity holds itself out to provide 8 orthotic, prosthetic, or pedorthic services without having 9 an orthotist, prosthetist, or pedorthist licensed under the 10 provisions of this chapter on its staff to provide those 11 services, then any other licensed orthotist, prosthetist, 12 or pedorthist or any interested party or injured person may 13 petition for relief as provided in subsection 1. 14 Sec. 14. Section 272C.1, subsection 6, Code 2011, is amended 15 by adding the following new paragraph: 16 NEW PARAGRAPH . ag. The board of orthotics, prosthetics, and 17 pedorthics, created pursuant to chapter 147. 18 Sec. 15. INITIAL BOARD. The initial members of the board of 19 orthotics, prosthetics, and pedorthics established pursuant to 20 this Act shall be appointed to the following terms: 21 1. Two professional members eligible for licensure and one 22 public member shall be appointed for a term of two years. 23 2. One professional member eligible for licensure and one 24 public member shall be appointed for a term of one year. 25 EXPLANATION 26 This bill creates new Code chapter 148F that requires 27 the licensure of persons offering orthotic, prosthetic, or 28 pedorthic services. The bill provides for the establishment of 29 a five-member licensing board consisting of three professional 30 members and two members who represent the general public. 31 The bill provides for fees to fund the board and provides 32 penalties for violation of the practice requirement. The 33 penalties, including criminal penalties, are set out for all 34 health-related boards in Code chapters 147 and 272C. In 35 -11- LSB 2240SV (2) 84 jr/nh 11/ 12

S.F. 364 addition to penalties, the bill sets out several procedures for 1 enforcing compliance with this licensing law. The attorney 2 general may seek a judicial ruling to stop violations. That 3 same standing for court action is extended to any licensed 4 orthotist, pedorthist, or prosthetist, any interested party, or 5 any person injured by the violation. The board is similar in 6 composition and responsibilities to the other health-related 7 licensing boards. 8 Orthotics is the science and practice of evaluating, 9 measuring, designing, fabricating, assembling, fitting, 10 adjusting, or servicing a custom-fabricated or custom-fitted 11 brace or support for the correction or alleviation of 12 neuromuscular or musculoskeletal dysfunction, disease, injury, 13 or deformity. 14 Pedorthics is the science and practice of evaluating, 15 measuring, designing, fabricating, assembling, fitting, 16 adjusting, or servicing a specially designed shoe or shoe 17 insert for the correction or alleviation of neuromuscular or 18 musculoskeletal dysfunction, disease, injury, or deformity. 19 Prosthetics is the science and practice of evaluating, 20 measuring, designing, fabricating, assembling, fitting, 21 adjusting, or servicing an artificial medical device that is 22 not surgically implanted and that is used to replace a missing 23 limb, appendage, or any other external human body part. 24 The bill provides qualifications for licensure as an 25 orthotist, prosthetist, or pedorthist and requirements for 26 assistants and technicians to be supervised by such licensees. 27 -12- LSB 2240SV (2) 84 jr/nh 12/ 12