S.F. _____ Section 1. Section 147.1, subsections 3 and 6, Code 2016, 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, respiratory 13 care and polysomnography practitioner, polysomnographic 14 technologist, social worker, massage therapist, athletic 15 trainer, acupuncturist, nursing home administrator, hearing 16 aid specialist, or sign language interpreter or transliterator 17 means a person licensed under this subtitle . 18 6. “Profession” means medicine and surgery, podiatry, 19 osteopathic medicine and surgery, anesthesiologist assisting, 20 practice as a physician assistant, psychology, chiropractic, 21 nursing, dentistry, dental hygiene, dental assisting, 22 optometry, speech pathology, audiology, pharmacy, physical 23 therapy, physical therapist assisting, occupational therapy, 24 occupational therapy assisting, respiratory care, cosmetology 25 arts and sciences, barbering, mortuary science, marital and 26 family therapy, mental health counseling, polysomnography, 27 social work, dietetics, massage therapy, athletic training, 28 acupuncture, nursing home administration, practice as a hearing 29 aid specialist, sign language interpreting or transliterating, 30 orthotics, prosthetics, or pedorthics. 31 Sec. 2. Section 147.2, subsection 1, Code 2016, is amended 32 to read as follows: 33 1. A person shall not engage in the practice of medicine 34 and surgery, podiatry, osteopathic medicine and surgery, 35 -1- LSB 5675SC (2) 86 tr/nh 1/ 13

S.F. _____ anesthesiologist assisting, psychology, chiropractic, physical 1 therapy, physical therapist assisting, nursing, dentistry, 2 dental hygiene, dental assisting, optometry, speech pathology, 3 audiology, occupational therapy, occupational therapy 4 assisting, orthotics, prosthetics, pedorthics, respiratory 5 care, pharmacy, cosmetology arts and sciences, barbering, 6 social work, dietetics, marital and family therapy or mental 7 health counseling, massage therapy, mortuary science, athletic 8 training, acupuncture, nursing home administration, or sign 9 language interpreting or transliterating, or shall not practice 10 as a physician assistant or a hearing aid specialist, unless 11 the person has obtained a license for that purpose from the 12 board for the profession. 13 Sec. 3. Section 147.13, subsection 1, Code 2016, is amended 14 to read as follows: 15 1. For medicine and surgery, osteopathic medicine and 16 surgery, anesthesiologist assisting, and acupuncture, the board 17 of medicine. 18 Sec. 4. Section 147.74, Code 2016, is amended by adding the 19 following new subsection: 20 NEW SUBSECTION . 23A. An anesthesiologist assistant 21 licensed under chapter 148H may use the words “anesthesiologist 22 assistant” after the person’s name. 23 Sec. 5. NEW SECTION . 148H.1 Definitions. 24 1. “Anesthesiologist” means a physician who has completed 25 a residency in anesthesiology approved by the American 26 board of anesthesiology or the American osteopathic board of 27 anesthesiology. 28 2. “Anesthesiologist assistant” means a person who meets all 29 of the following conditions: 30 a. Has graduated from an anesthesiologist assistant program 31 accredited by the American medical association’s committee on 32 allied health education and accreditation or by its successor 33 agency. 34 b. Has passed the certifying examination administered by 35 -2- LSB 5675SC (2) 86 tr/nh 2/ 13

S.F. _____ the national commission for certification of anesthesiologist 1 assistants. 2 c. Has active certification by the national commission for 3 certification of anesthesiologist assistants. 4 d. Provides health care services delegated by a licensed 5 anesthesiologist. 6 3. “Applicant” means an individual who seeks to become 7 licensed as an anesthesiologist assistant. 8 4. “Board” means the board of medicine created in section 9 147.13. 10 5. “Continuing education” means the offering of instruction 11 or information to license holders for the purpose of 12 maintaining or increasing skills necessary for the safe and 13 competent practice of anesthetic care. 14 6. “Immediately available” means in the same physical 15 location or facility in which the services are provided. 16 7. “Physician” means an individual licensed pursuant to 17 chapter 148 to practice medicine and surgery or osteopathic 18 medicine and surgery. 19 Sec. 6. NEW SECTION . 148H.2 License required to practice. 20 1. Except as provided in subsection 2, a person shall not 21 practice as an anesthesiologist assistant unless the person 22 holds a current, valid license issued pursuant to this chapter 23 to practice as an anesthesiologist assistant. 24 2. Subsection 1 shall not apply to any of the following: 25 a. A person participating in a training program leading 26 toward certification by the national commission for 27 certification of anesthesiologist assistants, as long as the 28 person is supervised by an anesthesiologist. 29 b. An individual participating in a hospital residency 30 program in preparation to practice as an anesthesiologist. 31 c. Any person who is otherwise authorized by section 148H.13 32 to perform any of the activities that an anesthesiologist 33 assistant is authorized to perform. 34 Sec. 7. NEW SECTION . 148H.3 License application 35 -3- LSB 5675SC (2) 86 tr/nh 3/ 13

S.F. _____ requirements. 1 1. A person shall apply to the board for a license under 2 this chapter upon such forms and in such manner as may be 3 prescribed by the board by rule and shall pay the application 4 fee set by the board by rule. The application fee shall cover 5 the costs of issuing the license and shall not be refundable. 6 2. The application shall contain a statement that it is 7 made under oath or affirmation and that its representations 8 are true and correct to the best knowledge and belief of 9 the person signing the application. The application shall 10 include proof of certification after passing the certifying 11 examination administered by the national commission for 12 certification of anesthesiologist assistants or its successor, 13 the date of the certification, any identification numbers, and 14 any other information necessary for the board to verify the 15 certification. 16 3. The board, upon approval of the application, shall issue 17 a license to the applicant. 18 Sec. 8. NEW SECTION . 148H.4 Temporary license. 19 Notwithstanding any provision of this chapter to the 20 contrary, the board may issue a temporary license to practice 21 as an anesthesiologist assistant to an applicant who has 22 taken the certifying examination described in section 148H.1, 23 subsection 2, and is awaiting the results. A temporary license 24 may be issued upon the payment of a temporary license fee, the 25 submission of all required documents, and the applicant meeting 26 the necessary qualifications as defined by the board by rule. 27 The temporary license shall be valid until the results of the 28 certifying examination are available. The temporary license 29 may be renewed at the discretion of the board and upon payment 30 of the temporary license fee. 31 Sec. 9. NEW SECTION . 148H.5 Licensure in another state —— 32 reciprocity. 33 1. Upon application and payment of a fee set by the board by 34 rule, the board shall issue a license to an anesthesiologist 35 -4- LSB 5675SC (2) 86 tr/nh 4/ 13

S.F. _____ assistant who is licensed in another jurisdiction and who 1 has had no violations, suspensions, or revocations of a 2 license to practice as an anesthesiologist assistant in any 3 jurisdiction, provided that such person is licensed in a 4 jurisdiction with licensure requirements that are substantially 5 equal to, or greater than, the requirements for licensure of 6 anesthesiologist assistants pursuant to this chapter. 7 2. The board may negotiate reciprocal compacts with 8 licensing boards of other states for the admission of licensed 9 anesthesiologist assistants from this state to practice in 10 other states. 11 Sec. 10. NEW SECTION . 148H.6 License renewal —— void 12 licenses —— duplicate licenses. 13 1. A license is valid for two years from the date it is 14 issued and may be renewed biennially by filing an application 15 for renewal with the board upon such forms and in such manner 16 as may be prescribed by the board by rule and paying the 17 required renewal fee as set by the board by rule. 18 2. The application shall include but not be limited to all 19 of the following: 20 a. The date and number of the applicant’s license. 21 b. A description of any disciplinary action taken against 22 the applicant by any professional association or society, 23 licensed hospital or medical staff, state, or country. 24 c. Information concerning the applicant’s current physical 25 and mental fitness to practice as an anesthesiologist 26 assistant. 27 3. The board shall mail a blank form for application for 28 renewal of a license to each person licensed in this state at 29 the person’s last known office or residence address. 30 4. If an application for renewal is filed and the fee paid 31 after the licensure renewal date, a delinquent fee shall be 32 paid. The delinquent fee may be waived by the board based on 33 extenuating circumstances as defined by the board by rule. 34 5. If a person licensed by the board does not renew such 35 -5- LSB 5675SC (2) 86 tr/nh 5/ 13

S.F. _____ license for two consecutive renewal periods, such license shall 1 be deemed void. 2 6. A duplicate license to replace any license lost, 3 destroyed, or mutilated may be issued to an applicant, subject 4 to rules adopted by the board, upon the payment of a reasonable 5 fee. 6 Sec. 11. NEW SECTION . 148H.7 Anesthesiologist assistant 7 functions —— supervision —— prohibited activities. 8 1. An anesthesiologist assistant may assist the supervising 9 anesthesiologist in developing and implementing an anesthesia 10 care plan for a patient. In providing assistance to the 11 supervising anesthesiologist, an anesthesiologist assistant may 12 do any of the following: 13 a. Obtain a comprehensive patient history, perform relevant 14 elements of a physical exam, and present the history to the 15 supervising anesthesiologist. 16 b. Pretest and calibrate anesthesia delivery systems and 17 obtain and interpret information from the systems and monitors, 18 in consultation with an anesthesiologist. 19 c. Assist the supervising anesthesiologist with the 20 implementation of medically accepted monitoring techniques. 21 d. Establish basic and advanced airway interventions, 22 including intubation of the trachea and performing ventilatory 23 support. 24 e. Administer intermittent vasoactive drugs and start and 25 adjust vasoactive infusions. 26 f. Administer anesthetic drugs, adjuvant drugs, and 27 accessory drugs. 28 g. Assist the supervising anesthesiologist with the 29 performance of epidural anesthetic procedures, spinal 30 anesthetic procedures, and other regional anesthetic 31 techniques. 32 h. Administer blood, blood products, and supportive fluids. 33 i. Provide assistance to a cardiopulmonary resuscitation 34 team in response to a life-threatening situation. 35 -6- LSB 5675SC (2) 86 tr/nh 6/ 13

S.F. _____ j. Participate in administrative, research, and clinical 1 teaching activities as authorized by the supervising 2 anesthesiologist. 3 k. Perform such other tasks not prohibited by law under 4 the supervision of a licensed anesthesiologist that the 5 anesthesiologist assistant has been trained and is proficient 6 to perform. 7 2. An anesthesiologist shall at all times accept and be 8 responsible for the oversight of the health care services 9 rendered by an anesthesiologist assistant as provided in 10 section 148H.8. 11 3. An anesthesiologist assistant shall not perform any of 12 the following functions: 13 a. Prescribe any medications or controlled substances. 14 b. Administer any drugs, medicines, devices, or therapies 15 the supervising anesthesiologist is not qualified or authorized 16 to prescribe. 17 c. Practice or attempt to practice without the supervision 18 of a licensed anesthesiologist or in any location where the 19 supervising anesthesiologist is not immediately available for 20 consultation, assistance, and intervention. 21 4. A student in an anesthesiologist assistant training 22 program shall be identified as a student anesthesiologist 23 assistant or an anesthesiologist assistant student. Under no 24 circumstances shall such a student use or permit to be used 25 on the student’s behalf, the terms “intern”, “resident”, or 26 “fellow” or be identified in any way as a physician or surgeon. 27 5. The anesthesiologist members of the faculty of an 28 anesthesiologist assistant program established in this state 29 shall be comprised of anesthesiologists certified by the 30 American board of anesthesiology. A faculty member of an 31 anesthesiologist assistant program shall not concurrently 32 supervise more than two anesthesiologist assistant students 33 who are delivering anesthesia. A certified registered nurse 34 anesthetist shall be excluded from the clinical education of 35 -7- LSB 5675SC (2) 86 tr/nh 7/ 13

S.F. _____ anesthesiologist assistants. 1 Sec. 12. NEW SECTION . 148H.8 Supervision required —— 2 written practice protocol —— audit or inspection by board. 3 1. a. An anesthesiologist assistant shall practice only 4 under the direct supervision of an anesthesiologist who is 5 physically present or immediately available. 6 b. An anesthesiologist may supervise up to four 7 anesthesiologist assistants concurrently, consistent with 8 the provisions of 42 C.F.R. §415.110 relating to anesthesia 9 services reimbursable under Medicare. 10 2. An anesthesiologist who agrees to act as the supervising 11 anesthesiologist for an anesthesiologist assistant shall 12 adopt a written practice protocol that is consistent with 13 this chapter and that delineates the services that the 14 anesthesiologist assistant is authorized to provide and 15 the manner in which the anesthesiologist will supervise the 16 anesthesiologist assistant. The provisions of the protocol 17 shall be based on relevant quality assurance standards, 18 including regular review by the supervising anesthesiologist 19 of the medical records of the patients cared for by the 20 anesthesiologist assistant. 21 3. The supervising anesthesiologist shall oversee the 22 anesthesiologist assistant in accordance with the terms 23 of the protocol and any rules adopted by the board for the 24 supervision of an anesthesiologist assistant. The board may 25 audit or inspect any written practice protocol under which an 26 anesthesiologist assistant works. 27 Sec. 13. NEW SECTION . 148H.9 Inactive license. 28 1. A person licensed pursuant to this chapter may apply 29 to the board for inactive license status on a form furnished 30 by the board. Upon receipt of the completed inactive status 31 application and a determination by the board that the licensee 32 meets the requirements defined by the board by rule, the 33 board shall declare the licensee inactive and shall place 34 the licensee on an inactive status list. A person that has 35 -8- LSB 5675SC (2) 86 tr/nh 8/ 13

S.F. _____ an inactive license or has discontinued the practice of an 1 anesthesiologist assistant because of retirement shall not 2 practice as an anesthesiologist assistant within this state. 3 2. During the period of inactive status, the licensee shall 4 not be required to comply with the board’s minimum requirements 5 for continuing education pursuant to section 148H.11. 6 3. A licensee that allows the person’s license to become 7 inactive for a period of five years or less may return the 8 license to active status by notifying the board in advance of 9 such intention, paying the appropriate fees, and meeting all 10 established licensure requirements of the board as a condition 11 of reinstatement. 12 Sec. 14. NEW SECTION . 148H.10 Retirement —— resumption of 13 practice. 14 A person licensed to practice as an anesthesiologist 15 assistant in this state who retires from such practice shall 16 file with the board an affidavit, on a form to be furnished by 17 the board, which states the date of retirement and such other 18 facts to verify the retirement as defined by the board by rule. 19 Sec. 15. NEW SECTION . 148H.11 Continuing education 20 requirements. 21 The board shall not renew a license under this chapter 22 unless the licensee provides satisfactory evidence that the 23 board’s minimum requirements for continuing education have 24 been met. The board shall adopt minimum requirements for 25 continuing education by rule, which shall include but are not 26 limited to the successful completion of the examination for 27 continued demonstration of qualifications once every six years, 28 as authorized by the national commission for certification of 29 anesthesiologist assistants or its successor. 30 Sec. 16. NEW SECTION . 148H.12 License denial, suspension, 31 and revocation. 32 1. The board may refuse to issue or renew, suspend, or 33 revoke a license under this chapter for any of the following: 34 a. Use or unlawful possession of any controlled substance, 35 -9- LSB 5675SC (2) 86 tr/nh 9/ 13

S.F. _____ as defined in chapter 124, or alcoholic beverage to an extent 1 that such use impairs the person’s ability to perform the work 2 of an anesthesiologist assistant. 3 b. The person has been finally adjudicated and found 4 guilty, or entered a plea of guilty or nolo contendere, in 5 a criminal prosecution under the laws of any state or of 6 the United States, for any offense reasonably related to the 7 qualifications, functions, or duties of an anesthesiologist 8 assistant, for any offense for which an essential element is 9 fraud, dishonesty, or an act of violence, or for any offense 10 involving moral turpitude, whether or not a sentence is 11 imposed. 12 c. Use of fraud, deception, misrepresentation, or bribery 13 in securing a license issued pursuant to this chapter or in 14 obtaining permission to take an examination given or required 15 pursuant to this chapter. 16 d. Obtaining or attempting to obtain any fee, charge, 17 tuition, or other compensation by fraud, deception, or 18 misrepresentation. 19 e. Incompetency, misconduct, gross negligence, fraud, 20 misrepresentation, or dishonesty in the performance of the 21 functions or duties of an anesthesiologist assistant. 22 f. Violation of, or assisting or enabling any person to 23 violate, any provision of this chapter or any rule adopted 24 pursuant to this chapter. 25 g. Impersonation of any person holding a license. 26 h. Disciplinary action against the holder of a license or 27 other right relating to the practice of an anesthesiologist 28 assistant granted by another state, territory, federal agency, 29 or country upon grounds for which revocation or suspension is 30 authorized in this state. 31 i. A final adjudication of insanity or incompetency by a 32 court of competent jurisdiction. 33 j. Assisting or enabling any person to practice or offer to 34 practice as an anesthesiologist assistant who is not licensed 35 -10- LSB 5675SC (2) 86 tr/nh 10/ 13

S.F. _____ and eligible to practice pursuant to this chapter. 1 k. Issuance of a license based upon a material mistake of 2 fact. 3 l. Violation of any professional trust or confidence. 4 m. Violation of the ethical standards for an 5 anesthesiologist assistant as defined by the board by rule. 6 n. Violation of a rule or regulation of this state, any 7 other state, or the federal government. 8 2. The board shall notify the applicant or licensee 9 in a complaint in writing of the reasons for the refusal, 10 suspension, or revocation and shall advise the applicant or 11 licensee of the right to file an objection to the complaint. 12 The board shall adopt rules of procedure for the filing 13 of complaints and objections thereto which conform to the 14 provisions of chapter 17A. 15 3. The board shall have the authority to issue subpoenas to 16 compel witnesses to testify or produce evidence in proceedings 17 to deny, suspend, or revoke a license. 18 4. After the filing of a complaint by the board, the 19 proceedings shall be conducted in accordance with the 20 provisions of chapter 17A. Upon a finding that the grounds for 21 disciplinary action provided in subsection 1 are met, the board 22 may take any of the following actions: 23 a. Deny initial issuance or renewal of a license to the 24 person named in the complaint. 25 b. Censure or place the person named in the complaint on 26 probation with such terms and conditions as the board deems 27 appropriate for a period not to exceed ten years. 28 c. Suspend the license of the person named in the complaint 29 for a period not to exceed seven years. 30 d. Revoke the license of the person named in the complaint. 31 5. An individual whose license has been revoked shall wait 32 at least one year from the date of revocation to apply for 33 relicensure and shall not be eligible for a temporary license. 34 Relicensure shall be at the discretion of the board after 35 -11- LSB 5675SC (2) 86 tr/nh 11/ 13

S.F. _____ compliance with all requirements of this chapter. 1 Sec. 17. NEW SECTION . 148H.13 Scope of chapter. 2 1. Notwithstanding the provisions of this chapter, the 3 governing body of a hospital may limit the functions and 4 activities that an anesthesiologist assistant performs in 5 such hospital. Nothing in this section shall be construed to 6 require any hospital to hire an anesthesiologist who is not 7 already employed as a physician prior to July 1, 2016. 8 2. Nothing in this chapter shall be construed as prohibiting 9 any individual, regardless of whether the individual is 10 licensed pursuant to this chapter, from providing the services 11 of anesthesiologist assistant, so long as those services are 12 lawfully performed pursuant to the individual’s scope of 13 practice as authorized by law. 14 EXPLANATION 15 The inclusion of this explanation does not constitute agreement with 16 the explanation’s substance by the members of the general assembly. 17 This bill provides for licensing of anesthesiologist 18 assistants and makes the provisions of Code chapters 147 and 19 272C, including penalty and other regulatory provisions, 20 applicable to the practice of anesthesiologist assisting. 21 The board of medicine is to be responsible for governing the 22 licensure process for anesthesiologist assistants. 23 The bill requires anesthesiologist assistants to perform all 24 duties under the immediate supervision of an anesthesiologist. 25 The bill does not prevent other persons from performing the 26 duties of an anesthesiologist assistant if the person is 27 legally authorized to perform such duties within their regular 28 scope of practice. 29 To become a licensed anesthesiologist assistant, a person 30 must graduate from an anesthesiologist assistant program 31 accredited by the American medical association’s committee 32 on allied health education and accreditation, pass the 33 certifying examination administered by the national commission 34 for certification of anesthesiologist assistants, and have 35 -12- LSB 5675SC (2) 86 tr/nh 12/ 13

S.F. _____ an active certification by the national commission for 1 certification of anesthesiologist assistants. The person must 2 then file the proper application and fees with the board of 3 medicine. The bill allows for licensure without examination 4 if an anesthesiologist assistant holds a similar license in 5 another jurisdiction. Licensees must complete continuing 6 education requirements. The bill sets forth provisions for 7 license renewal, temporary licensure, inactive or retired 8 license status, and license suspension, denial, or revocation. 9 -13- LSB 5675SC (2) 86 tr/nh 13/ 13