SF 467 (LSB 2299XS (3) 91)

SENATE FILE 467

BY  WARME

A BILL FOR

An Act relating to the licensure of anesthesiologist assistants, and making penalties applicable.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  Section 147.1, subsections 3 and 6, Code 2025, are amended to read as follows:
   3.  “Licensed” or “certified”, when applied to a physician and surgeon, podiatric physician, osteopathic physician and surgeon, genetic counselor, physician assistant, anesthesiologist assistant, psychologist, chiropractor, nurse, dentist, dental hygienist, dental assistant, optometrist, speech pathologist, audiologist, pharmacist, physical therapist, physical therapist assistant, occupational therapist, occupational therapy assistant, orthotist, prosthetist, pedorthist, respiratory care practitioner, practitioner of cosmetology arts and sciences, practitioner of barbering, funeral director, dietitian, behavior analyst, assistant behavior analyst, marital and family therapist, mental health counselor, midwife, respiratory care and polysomnography practitioner, polysomnographic technologist, social worker, massage therapist, athletic trainer, acupuncturist, nursing home administrator, hearing aid specialist, or sign language interpreter or transliterator means a person licensed under this subtitle.
   6.  “Profession” means medicine and surgery, podiatry, osteopathic medicine and surgery, genetic counseling, practice as a physician assistant, anesthesiologist assistant, psychology, chiropractic, nursing, dentistry, dental hygiene, dental assisting, optometry, speech pathology, audiology, pharmacy, physical therapy, physical therapist assisting, occupational therapy, occupational therapy assisting, respiratory care, cosmetology arts and sciences, barbering, mortuary science, applied behavior analysis, marital and family therapy, mental health counseling, midwifery, polysomnography, social work, dietetics, massage therapy, athletic training, acupuncture, nursing home administration, practice as a hearing aid specialist, sign language interpreting or transliterating, orthotics, prosthetics, or pedorthics.
    Sec. 2.  Section 147.2, subsection 1, Code 2025, is amended to read as follows:
   1.  A person shall not engage in the practice of medicine and surgery, podiatry, osteopathic medicine and surgery, anesthesiologist assisting, genetic counseling, psychology, chiropractic, physical therapy, physical therapist assisting, nursing, dentistry, dental hygiene, dental assisting, optometry, speech pathology, audiology, occupational therapy, occupational therapy assisting, orthotics, prosthetics, pedorthics, respiratory care, pharmacy, cosmetology arts and sciences, barbering, social work, dietetics, applied behavior analysis, marital and family therapy or mental health counseling, massage therapy, mortuary science, polysomnography, athletic training, acupuncture, nursing home administration, or sign language interpreting or transliterating, or shall not practice as a physician assistant or a hearing aid specialist, unless the person has obtained a license for that purpose from the board for the profession.
    Sec. 3.  Section 147.13, subsection 1, Code 2025, is amended to read as follows:
   1.  For medicine and surgery, osteopathic medicine and surgery, anesthesiologist assistant, acupuncture, and genetic counseling, the board of medicine.
    Sec. 4.  Section 147.74, Code 2025, is amended by adding the following new subsection:
   NEW SUBSECTION.  29.  An anesthesiologist assistant licensed pursuant to chapter 148K may use the words “anesthesiologist assistant” or “certified anesthesiologist assistant” or the initials “A.A.” or “C.A.A.” after the person’s name.
    Sec. 5.  Section 148.2, subsection 4, Code 2025, is amended to read as follows:
   4.  Licensed podiatric physicians, chiropractors, physical therapists, nurses, dentists, optometrists, anesthesiologist assistants, and pharmacists who are exclusively engaged in the practice of their respective professions.
    Sec. 6.  NEW SECTION.  148K.1  Definitions.
   As used in this chapter, unless the context otherwise requires:
   1.  “Anesthesiologist” means a physician and surgeon or osteopathic physician and surgeon licensed pursuant to chapter 148 who has successfully completed a training program in anesthesiology accredited by the accreditation council for graduate medical education, the American osteopathic association, or an equivalent organization.
   2.  “Anesthesiologist assistant” means a person licensed pursuant to section 148K.3 who is approved by the board to assist in the practice of medicine under delegation of an anesthesiologist.
   3.  “Assist” means the performance of duties delegated to an anesthesiologist assistant by an anesthesiologist.
   4.  “Board” means the board of medicine established in chapter 147.
   5.  “Certification examination” means the initial certifying examination approved by the board for the certification of an anesthesiologist assistant, including the examination administered by the national commission for the certification of anesthesiologist assistants or another national anesthesiologist assistant certifying agency that has been reviewed and approved by the board.
   6.  “Supervising anesthesiologist” means an anesthesiologist engaging in the supervision of an anesthesiologist assistant.
   7.  “Supervision” means the supervision by an anesthesiologist who can delegate, coordinate, direct, or consult an anesthesiologist assistant and oversee the implementation of the anesthesiologist’s instructions.
    Sec. 7.  NEW SECTION.  148K.2  Board —— powers and duties.
   The board shall do all of the following:
   1.  Grant, deny, revoke, and reinstate a license to practice anesthesiology assisting.
   2.  Investigate claims that an anesthesiologist assistant or supervising anesthesiologist has engaged in conduct prohibited by this chapter.
   3.  Adopt rules pursuant to chapter 17A for the practice of anesthesiologist assistants.
    Sec. 8.  NEW SECTION.  148K.3  Anesthesiologist assistants —— licensing.
   1.  A person shall not practice as an anesthesiologist assistant in this state, use the title or abbreviations “anesthesiologist assistant”, “A.A.”, or “C.A.A.”, or represent that the person is an anesthesiologist assistant unless the person is licensed pursuant to this section.
   2.  The board shall grant an anesthesiologist assistant license to an applicant who does all of the following:
   a.  Graduates from an anesthesiologist assistant program accredited by the commission on accreditation of allied health education programs or its successor organization.
   b.  Successfully completes a certification examination administered by the national commission for the certification of anesthesiologist assistants or another national certifying agency that has been reviewed and approved by the board.
   c.  Submits an application on a form prescribed by the board.
   d.  Submits an application fee in an amount determined by the board by rule.
   3.  A license issued pursuant to this section is valid for a period of two years. A licensee may renew a license issued pursuant to this section by submitting a renewal application in a form prescribed, and an application fee in an amount determined, by the board by rule by January 31 of the year of expiration. The board shall provide renewal notices to licensees at least one month prior to expiration.
   4.  a.  The board shall issue a temporary license to a person who does all of the following:
   (1)  Submits a temporary license application on a form prescribed by the board by rule.
   (2)  Submits an application fee in an amount determined by the board by rule.
   (3)  Successfully completes a program approved by the commission on accreditation of allied health education or another program approved by the board for the education and training of anesthesiologist assistants.
   (4)  Certifies that the person intends to take the next available certification examination after the receipt of the temporary license.
   b.  A temporary license shall not be issued for a period of more than one year and is not eligible for renewal. The board may adopt rules pursuant to chapter 17A for additional restrictions on a temporary license.
   5.  The board may revoke, suspend, restrict, or refuse to renew a license issued pursuant to this section if the board determines that a person has violated a provision of this chapter, or rules adopted by the board pursuant to this chapter.
   6.  a.  The board may issue a new license to an anesthesiologist assistant whose license was previously revoked by the board if the former anesthesiologist assistant submits an application in a form prescribed by the board and the board finds all of the following:
   (1)  That the applicant is completely rehabilitated with respect to the conduct that was the basis for revocation.
   (2)  That the applicant has not engaged in any conduct during the revocation period that would constitute a basis for revocation of an anesthesiologist assistant license.
   (3)  If the basis of the revocation was a criminal conviction, that the applicant’s civil rights have been fully restored.
   (4)  That the applicant has made restitution to any aggrieved person as ordered by a court of competent jurisdiction.
   (5)  That the applicant satisfies any other standard of rehabilitation as determined by the board by rule.
   b.  A person shall not apply for the reinstatement of a license for at least two years from the date of revocation, except that a person whose license was revoked due to a conviction for a crime that was later reversed on repeal may apply for reinstatement immediately upon the entry of reversal by the court.
   c.  An applicant for reinstatement shall comply with all requirements for initial licensure as an anesthesiologist assistant.
    Sec. 9.  NEW SECTION.  148K.4  Anesthesiologist assistant —— scope of practice.
   1.  An anesthesiologist assistant shall assist in the practice of medicine only under the supervision of an anesthesiologist and shall perform only those duties delegated to the anesthesiologist assistant by the supervising anesthesiologist.
   2.  A supervising anesthesiologist shall supervise an anesthesiologist assistant in a manner consistent with federal rules and regulations for reimbursement for anesthesia services.
   3.  A supervising anesthesiologist shall be immediately available to the anesthesiologist assistant who assists in the delivery of medical care such that the supervising anesthesiologist is available to intervene if needed.
   4.  The practice of an anesthesiologist assistant shall not exceed the education and training of the anesthesiologist assistant. A medical care task assigned to an anesthesiologist assistant by a supervising anesthesiologist shall not be delegated by the anesthesiologist assistant to another person.
   5.  A supervising anesthesiologist may delegate any of the following duties to an anesthesiologist assistant:
   a.  Developing and implementing an anesthesia care plan for a patient.
   b.  Obtaining a comprehensive patient history and performing relevant elements of a physical exam.
   c.  Performing preoperative and postoperative anesthetic evaluations and maintaining patient progress notes.
   d.  Ordering and performing preoperative patient consultations.
   e.  Ordering preoperative medications, including controlled substances, which may be administered before the supervising anesthesiologist cosigns.
   f.  Changing or discontinuing a medical treatment plan after consulting with a supervising anesthesiologist.
   g.  Obtaining informed consent for anesthesia or related procedures.
   h.  Ordering the perioperative continuation of current medications, which may be administered before the supervising anesthesiologist cosigns.
   i.  Pretesting and calibrating anesthesia delivery systems and obtaining and interpreting information from the systems and monitors.
   j.  Implementing medically accepted monitoring techniques.
   k.  Performing basic and advanced airway interventions, including but not limited to endotracheal intubation, laryngeal mask insertion, and other advanced airway techniques.
   l.  Establishing peripheral intravenous lines, including subcutaneous lidocaine use.
   m.  Performing invasive procedures, including but not limited to arterial lines, central lines, and Swanz Ganz catheters.
   n.  Performing general anesthesia, including induction, maintenance, and emergence, and procedures associated with general anesthesia, such as gastric intubation.
   o.  Administering anesthetic drugs, adjuvant drugs, and accessory drugs.
   p.  Administering vasoactive drugs and starting and titrating vasoactive infusions to treat patient responses to anesthesia.
   q.  Performing, maintaining, evaluating, and managing epidural, spinal, and regional anesthesia, including catheters.
   r.  Performing monitored anesthesia care.
   s.  Obtaining venous and arterial blood samples.
   t.  Administering blood, blood products, and supportive fluids.
   u.  Performing, ordering, and interpreting appropriate preoperative, point-of-care, intraoeprative, or postoperative diagnostic tests or procedures.
   v.  Obtaining and administering perioperative anesthesia and related pharmaceutical agents, including intravenous fluids and blood products.
   w.  Managing the patient while in the preoperative suite, recovery area, or labor suite.
   x.  Ordering postoperative sedation, anxiolysis or analgesia, postoperative respiratory therapy and medicines to treat patient responses to anesthesia, and postoperative oxygen therapy, including initial ventilator therapy, which may be administered before the supervising anesthesiologist cosigns.
   y.  Initiating and managing cardiopulmonary resuscitation in response to a life-threatening situation.
   z.  Participating in administrative, research, and clinical teaching activities, including supervising student anesthesiologist assistants and other students involved in anesthesia education.
   aa.  Performing other tasks not prohibited by law that an anesthesiologist assistant has been trained in and is proficient to perform.
   6.  This section shall not prohibit an anesthesiologist assistant from having access to and obtaining prescription drugs as directed by a supervising anesthesiologist.
   7.  This section shall not apply to a person enrolled in an anesthesiologist assistant education program approved by the board.
    Sec. 10.  NEW SECTION.  148K.5  Unauthorized practice —— penalties.
   1.  a.  A person who practices anesthesiologist assisting without a license issued pursuant to this chapter is guilty of a serious misdemeanor.
   b.  A person who represents that the person is an anesthesiologist assistant without a license issued pursuant to this chapter, or who employs a person to practice anesthesiology assisting who is not licensed pursuant to this chapter, is guilty of a serious misdemeanor.
   2.  Except for a person licensed pursuant to this chapter, this section does not apply to persons who are licensed to practice a health profession covered by chapter 147, when the licensee’s performance of anesthesiology assisting falls within the scope of practice of the licensee’s licensed profession.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill creates the licensed profession of anesthesiology assisting under the authority of the board of medicine (board). The bill allows an anesthesiologist, defined in the bill as a physician and surgeon or osteopathic physician and surgeon who is trained in the administration of anesthesia, to delegate certain duties, listed in the bill, to an anesthesiologist assistant who is licensed by the board and supervised by the anesthesiologist. The bill includes definitions for both “assist” and “supervision”.
   The bill requires the board to license a person as an anesthesiologist assistant if the person graduates from an accredited anesthesiologist assistant program, completes an appropriate certification examination, submits an application on a form prescribed by the board, and pays an application fee in an amount determined by the board by rule. An anesthesiologist assistant shall be valid for two years and may be renewed. The bill also requires the board to issue a temporary license to a person who successfully completes an accredited anesthesiologist assistant training program, certifies that person intends to take the next available certification examination after the receipt of the temporary license, submits an application in a form prescribed by the board, and pays an application fee in an amount determined by the board by rule. A temporary license shall not be issued for a term of more than one year and is not eligible for renewal.
   The bill allows the board to revoke, suspend, restrict, or refuse to renew an anesthesiologist assistant license if the board determines that a licensee has violated a provision of the bill or rules adopted by the board. The bill also allows a board to reinstate a revoked license if the board makes certain determinations regarding the former licensee’s fitness to practice anesthesiologist assisting and the former licensee applies for reinstatement. The bill prohibits a former licensee from applying for reinstatement less than two years from the date the license is revoked, except that a person whose license was revoked due to a conviction for a crime that was later reversed on repeal may apply for reinstatement immediately upon the entry of reversal by the court.
   The bill allows an anesthesiologist assistant to perform only those duties delegated to the anesthesiologist assistant by the supervising anesthesiologist that are within the education and training of the anesthesiologist assistant. The bill requires a supervising anesthesiologist to be immediately available to the anesthesiologist assistant such that the supervising anesthesiologist is available to intervene if needed. The bill does not prohibit an anesthesiologist assistant from having access to and obtaining prescription drugs as directed by a supervising anesthesiologist.
   The bill prohibits a person who is not licensed as provided in the bill from using the title “anesthesiologist assistant”, using the initials “A.A.” or “C.A.A.”, or otherwise representing that the person is an anesthesiologist assistant. The bill also prohibits a person from practicing anesthesiology assisting without a license issued pursuant to the bill unless the person is licensed to practice a health profession and the performance of anesthesiology assisting is within the scope of practice of the person’s license. A person who violates either of these provisions is guilty of a serious misdemeanor. A serious misdemeanor is punishable by confinement for no more than one year and a fine of at least $430 but not more than $2,560.