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Senate
File
467
-
Introduced
SENATE
FILE
467
BY
WARME
A
BILL
FOR
An
Act
relating
to
the
licensure
of
anesthesiologist
1
assistants,
and
making
penalties
applicable.
2
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
3
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Section
1.
Section
147.1,
subsections
3
and
6,
Code
2025,
1
are
amended
to
read
as
follows:
2
3.
“Licensed”
or
“certified”
,
when
applied
to
a
physician
3
and
surgeon,
podiatric
physician,
osteopathic
physician
4
and
surgeon,
genetic
counselor,
physician
assistant,
5
anesthesiologist
assistant,
psychologist,
chiropractor,
nurse,
6
dentist,
dental
hygienist,
dental
assistant,
optometrist,
7
speech
pathologist,
audiologist,
pharmacist,
physical
8
therapist,
physical
therapist
assistant,
occupational
9
therapist,
occupational
therapy
assistant,
orthotist,
10
prosthetist,
pedorthist,
respiratory
care
practitioner,
11
practitioner
of
cosmetology
arts
and
sciences,
practitioner
12
of
barbering,
funeral
director,
dietitian,
behavior
13
analyst,
assistant
behavior
analyst,
marital
and
family
14
therapist,
mental
health
counselor,
midwife,
respiratory
15
care
and
polysomnography
practitioner,
polysomnographic
16
technologist,
social
worker,
massage
therapist,
athletic
17
trainer,
acupuncturist,
nursing
home
administrator,
hearing
18
aid
specialist,
or
sign
language
interpreter
or
transliterator
19
means
a
person
licensed
under
this
subtitle
.
20
6.
“Profession”
means
medicine
and
surgery,
podiatry,
21
osteopathic
medicine
and
surgery,
genetic
counseling,
22
practice
as
a
physician
assistant,
anesthesiologist
assistant,
23
psychology,
chiropractic,
nursing,
dentistry,
dental
hygiene,
24
dental
assisting,
optometry,
speech
pathology,
audiology,
25
pharmacy,
physical
therapy,
physical
therapist
assisting,
26
occupational
therapy,
occupational
therapy
assisting,
27
respiratory
care,
cosmetology
arts
and
sciences,
barbering,
28
mortuary
science,
applied
behavior
analysis,
marital
and
family
29
therapy,
mental
health
counseling,
midwifery,
polysomnography,
30
social
work,
dietetics,
massage
therapy,
athletic
training,
31
acupuncture,
nursing
home
administration,
practice
as
a
hearing
32
aid
specialist,
sign
language
interpreting
or
transliterating,
33
orthotics,
prosthetics,
or
pedorthics.
34
Sec.
2.
Section
147.2,
subsection
1,
Code
2025,
is
amended
35
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to
read
as
follows:
1
1.
A
person
shall
not
engage
in
the
practice
of
medicine
2
and
surgery,
podiatry,
osteopathic
medicine
and
surgery,
3
anesthesiologist
assisting,
genetic
counseling,
psychology,
4
chiropractic,
physical
therapy,
physical
therapist
assisting,
5
nursing,
dentistry,
dental
hygiene,
dental
assisting,
6
optometry,
speech
pathology,
audiology,
occupational
therapy,
7
occupational
therapy
assisting,
orthotics,
prosthetics,
8
pedorthics,
respiratory
care,
pharmacy,
cosmetology
arts
9
and
sciences,
barbering,
social
work,
dietetics,
applied
10
behavior
analysis,
marital
and
family
therapy
or
mental
health
11
counseling,
massage
therapy,
mortuary
science,
polysomnography,
12
athletic
training,
acupuncture,
nursing
home
administration,
13
or
sign
language
interpreting
or
transliterating,
or
shall
not
14
practice
as
a
physician
assistant
or
a
hearing
aid
specialist,
15
unless
the
person
has
obtained
a
license
for
that
purpose
from
16
the
board
for
the
profession.
17
Sec.
3.
Section
147.13,
subsection
1,
Code
2025,
is
amended
18
to
read
as
follows:
19
1.
For
medicine
and
surgery,
osteopathic
medicine
and
20
surgery,
anesthesiologist
assistant,
acupuncture,
and
genetic
21
counseling,
the
board
of
medicine.
22
Sec.
4.
Section
147.74,
Code
2025,
is
amended
by
adding
the
23
following
new
subsection:
24
NEW
SUBSECTION
.
29.
An
anesthesiologist
assistant
licensed
25
pursuant
to
chapter
148K
may
use
the
words
“anesthesiologist
26
assistant”
or
“certified
anesthesiologist
assistant”
or
the
27
initials
“A.A.”
or
“C.A.A.”
after
the
person’s
name.
28
Sec.
5.
Section
148.2,
subsection
4,
Code
2025,
is
amended
29
to
read
as
follows:
30
4.
Licensed
podiatric
physicians,
chiropractors,
physical
31
therapists,
nurses,
dentists,
optometrists,
anesthesiologist
32
assistants,
and
pharmacists
who
are
exclusively
engaged
in
the
33
practice
of
their
respective
professions.
34
Sec.
6.
NEW
SECTION
.
148K.1
Definitions.
35
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As
used
in
this
chapter,
unless
the
context
otherwise
1
requires:
2
1.
“Anesthesiologist”
means
a
physician
and
surgeon
3
or
osteopathic
physician
and
surgeon
licensed
pursuant
to
4
chapter
148
who
has
successfully
completed
a
training
program
5
in
anesthesiology
accredited
by
the
accreditation
council
6
for
graduate
medical
education,
the
American
osteopathic
7
association,
or
an
equivalent
organization.
8
2.
“Anesthesiologist
assistant”
means
a
person
licensed
9
pursuant
to
section
148K.3
who
is
approved
by
the
board
to
10
assist
in
the
practice
of
medicine
under
delegation
of
an
11
anesthesiologist.
12
3.
“Assist”
means
the
performance
of
duties
delegated
to
an
13
anesthesiologist
assistant
by
an
anesthesiologist.
14
4.
“Board”
means
the
board
of
medicine
established
in
15
chapter
147.
16
5.
“Certification
examination”
means
the
initial
certifying
17
examination
approved
by
the
board
for
the
certification
of
18
an
anesthesiologist
assistant,
including
the
examination
19
administered
by
the
national
commission
for
the
certification
20
of
anesthesiologist
assistants
or
another
national
21
anesthesiologist
assistant
certifying
agency
that
has
been
22
reviewed
and
approved
by
the
board.
23
6.
“Supervising
anesthesiologist”
means
an
anesthesiologist
24
engaging
in
the
supervision
of
an
anesthesiologist
assistant.
25
7.
“Supervision”
means
the
supervision
by
an
26
anesthesiologist
who
can
delegate,
coordinate,
direct,
27
or
consult
an
anesthesiologist
assistant
and
oversee
the
28
implementation
of
the
anesthesiologist’s
instructions.
29
Sec.
7.
NEW
SECTION
.
148K.2
Board
——
powers
and
duties.
30
The
board
shall
do
all
of
the
following:
31
1.
Grant,
deny,
revoke,
and
reinstate
a
license
to
practice
32
anesthesiology
assisting.
33
2.
Investigate
claims
that
an
anesthesiologist
assistant
or
34
supervising
anesthesiologist
has
engaged
in
conduct
prohibited
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by
this
chapter.
1
3.
Adopt
rules
pursuant
to
chapter
17A
for
the
practice
of
2
anesthesiologist
assistants.
3
Sec.
8.
NEW
SECTION
.
148K.3
Anesthesiologist
assistants
——
4
licensing.
5
1.
A
person
shall
not
practice
as
an
anesthesiologist
6
assistant
in
this
state,
use
the
title
or
abbreviations
7
“anesthesiologist
assistant”,
“A.A.”,
or
“C.A.A.”,
or
represent
8
that
the
person
is
an
anesthesiologist
assistant
unless
the
9
person
is
licensed
pursuant
to
this
section.
10
2.
The
board
shall
grant
an
anesthesiologist
assistant
11
license
to
an
applicant
who
does
all
of
the
following:
12
a.
Graduates
from
an
anesthesiologist
assistant
program
13
accredited
by
the
commission
on
accreditation
of
allied
health
14
education
programs
or
its
successor
organization.
15
b.
Successfully
completes
a
certification
examination
16
administered
by
the
national
commission
for
the
certification
17
of
anesthesiologist
assistants
or
another
national
certifying
18
agency
that
has
been
reviewed
and
approved
by
the
board.
19
c.
Submits
an
application
on
a
form
prescribed
by
the
board.
20
d.
Submits
an
application
fee
in
an
amount
determined
by
the
21
board
by
rule.
22
3.
A
license
issued
pursuant
to
this
section
is
valid
for
23
a
period
of
two
years.
A
licensee
may
renew
a
license
issued
24
pursuant
to
this
section
by
submitting
a
renewal
application
25
in
a
form
prescribed,
and
an
application
fee
in
an
amount
26
determined,
by
the
board
by
rule
by
January
31
of
the
year
27
of
expiration.
The
board
shall
provide
renewal
notices
to
28
licensees
at
least
one
month
prior
to
expiration.
29
4.
a.
The
board
shall
issue
a
temporary
license
to
a
person
30
who
does
all
of
the
following:
31
(1)
Submits
a
temporary
license
application
on
a
form
32
prescribed
by
the
board
by
rule.
33
(2)
Submits
an
application
fee
in
an
amount
determined
by
34
the
board
by
rule.
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(3)
Successfully
completes
a
program
approved
by
the
1
commission
on
accreditation
of
allied
health
education
or
2
another
program
approved
by
the
board
for
the
education
and
3
training
of
anesthesiologist
assistants.
4
(4)
Certifies
that
the
person
intends
to
take
the
next
5
available
certification
examination
after
the
receipt
of
the
6
temporary
license.
7
b.
A
temporary
license
shall
not
be
issued
for
a
period
8
of
more
than
one
year
and
is
not
eligible
for
renewal.
The
9
board
may
adopt
rules
pursuant
to
chapter
17A
for
additional
10
restrictions
on
a
temporary
license.
11
5.
The
board
may
revoke,
suspend,
restrict,
or
refuse
12
to
renew
a
license
issued
pursuant
to
this
section
if
the
13
board
determines
that
a
person
has
violated
a
provision
of
14
this
chapter,
or
rules
adopted
by
the
board
pursuant
to
this
15
chapter.
16
6.
a.
The
board
may
issue
a
new
license
to
an
17
anesthesiologist
assistant
whose
license
was
previously
revoked
18
by
the
board
if
the
former
anesthesiologist
assistant
submits
19
an
application
in
a
form
prescribed
by
the
board
and
the
board
20
finds
all
of
the
following:
21
(1)
That
the
applicant
is
completely
rehabilitated
with
22
respect
to
the
conduct
that
was
the
basis
for
revocation.
23
(2)
That
the
applicant
has
not
engaged
in
any
conduct
24
during
the
revocation
period
that
would
constitute
a
basis
for
25
revocation
of
an
anesthesiologist
assistant
license.
26
(3)
If
the
basis
of
the
revocation
was
a
criminal
27
conviction,
that
the
applicant’s
civil
rights
have
been
fully
28
restored.
29
(4)
That
the
applicant
has
made
restitution
to
any
aggrieved
30
person
as
ordered
by
a
court
of
competent
jurisdiction.
31
(5)
That
the
applicant
satisfies
any
other
standard
of
32
rehabilitation
as
determined
by
the
board
by
rule.
33
b.
A
person
shall
not
apply
for
the
reinstatement
of
a
34
license
for
at
least
two
years
from
the
date
of
revocation,
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except
that
a
person
whose
license
was
revoked
due
to
a
1
conviction
for
a
crime
that
was
later
reversed
on
repeal
may
2
apply
for
reinstatement
immediately
upon
the
entry
of
reversal
3
by
the
court.
4
c.
An
applicant
for
reinstatement
shall
comply
with
all
5
requirements
for
initial
licensure
as
an
anesthesiologist
6
assistant.
7
Sec.
9.
NEW
SECTION
.
148K.4
Anesthesiologist
assistant
——
8
scope
of
practice.
9
1.
An
anesthesiologist
assistant
shall
assist
in
10
the
practice
of
medicine
only
under
the
supervision
of
11
an
anesthesiologist
and
shall
perform
only
those
duties
12
delegated
to
the
anesthesiologist
assistant
by
the
supervising
13
anesthesiologist.
14
2.
A
supervising
anesthesiologist
shall
supervise
an
15
anesthesiologist
assistant
in
a
manner
consistent
with
16
federal
rules
and
regulations
for
reimbursement
for
anesthesia
17
services.
18
3.
A
supervising
anesthesiologist
shall
be
immediately
19
available
to
the
anesthesiologist
assistant
who
assists
20
in
the
delivery
of
medical
care
such
that
the
supervising
21
anesthesiologist
is
available
to
intervene
if
needed.
22
4.
The
practice
of
an
anesthesiologist
assistant
shall
23
not
exceed
the
education
and
training
of
the
anesthesiologist
24
assistant.
A
medical
care
task
assigned
to
an
anesthesiologist
25
assistant
by
a
supervising
anesthesiologist
shall
not
be
26
delegated
by
the
anesthesiologist
assistant
to
another
person.
27
5.
A
supervising
anesthesiologist
may
delegate
any
of
the
28
following
duties
to
an
anesthesiologist
assistant:
29
a.
Developing
and
implementing
an
anesthesia
care
plan
for
30
a
patient.
31
b.
Obtaining
a
comprehensive
patient
history
and
performing
32
relevant
elements
of
a
physical
exam.
33
c.
Performing
preoperative
and
postoperative
anesthetic
34
evaluations
and
maintaining
patient
progress
notes.
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d.
Ordering
and
performing
preoperative
patient
1
consultations.
2
e.
Ordering
preoperative
medications,
including
controlled
3
substances,
which
may
be
administered
before
the
supervising
4
anesthesiologist
cosigns.
5
f.
Changing
or
discontinuing
a
medical
treatment
plan
after
6
consulting
with
a
supervising
anesthesiologist.
7
g.
Obtaining
informed
consent
for
anesthesia
or
related
8
procedures.
9
h.
Ordering
the
perioperative
continuation
of
current
10
medications,
which
may
be
administered
before
the
supervising
11
anesthesiologist
cosigns.
12
i.
Pretesting
and
calibrating
anesthesia
delivery
systems
13
and
obtaining
and
interpreting
information
from
the
systems
and
14
monitors.
15
j.
Implementing
medically
accepted
monitoring
techniques.
16
k.
Performing
basic
and
advanced
airway
interventions,
17
including
but
not
limited
to
endotracheal
intubation,
laryngeal
18
mask
insertion,
and
other
advanced
airway
techniques.
19
l.
Establishing
peripheral
intravenous
lines,
including
20
subcutaneous
lidocaine
use.
21
m.
Performing
invasive
procedures,
including
but
not
limited
22
to
arterial
lines,
central
lines,
and
Swanz
Ganz
catheters.
23
n.
Performing
general
anesthesia,
including
induction,
24
maintenance,
and
emergence,
and
procedures
associated
with
25
general
anesthesia,
such
as
gastric
intubation.
26
o.
Administering
anesthetic
drugs,
adjuvant
drugs,
and
27
accessory
drugs.
28
p.
Administering
vasoactive
drugs
and
starting
and
titrating
29
vasoactive
infusions
to
treat
patient
responses
to
anesthesia.
30
q.
Performing,
maintaining,
evaluating,
and
managing
31
epidural,
spinal,
and
regional
anesthesia,
including
catheters.
32
r.
Performing
monitored
anesthesia
care.
33
s.
Obtaining
venous
and
arterial
blood
samples.
34
t.
Administering
blood,
blood
products,
and
supportive
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fluids.
1
u.
Performing,
ordering,
and
interpreting
appropriate
2
preoperative,
point-of-care,
intraoeprative,
or
postoperative
3
diagnostic
tests
or
procedures.
4
v.
Obtaining
and
administering
perioperative
anesthesia
and
5
related
pharmaceutical
agents,
including
intravenous
fluids
and
6
blood
products.
7
w.
Managing
the
patient
while
in
the
preoperative
suite,
8
recovery
area,
or
labor
suite.
9
x.
Ordering
postoperative
sedation,
anxiolysis
or
analgesia,
10
postoperative
respiratory
therapy
and
medicines
to
treat
11
patient
responses
to
anesthesia,
and
postoperative
oxygen
12
therapy,
including
initial
ventilator
therapy,
which
may
be
13
administered
before
the
supervising
anesthesiologist
cosigns.
14
y.
Initiating
and
managing
cardiopulmonary
resuscitation
in
15
response
to
a
life-threatening
situation.
16
z.
Participating
in
administrative,
research,
and
17
clinical
teaching
activities,
including
supervising
student
18
anesthesiologist
assistants
and
other
students
involved
in
19
anesthesia
education.
20
aa.
Performing
other
tasks
not
prohibited
by
law
that
21
an
anesthesiologist
assistant
has
been
trained
in
and
is
22
proficient
to
perform.
23
6.
This
section
shall
not
prohibit
an
anesthesiologist
24
assistant
from
having
access
to
and
obtaining
prescription
25
drugs
as
directed
by
a
supervising
anesthesiologist.
26
7.
This
section
shall
not
apply
to
a
person
enrolled
in
an
27
anesthesiologist
assistant
education
program
approved
by
the
28
board.
29
Sec.
10.
NEW
SECTION
.
148K.5
Unauthorized
practice
——
30
penalties.
31
1.
a.
A
person
who
practices
anesthesiologist
assisting
32
without
a
license
issued
pursuant
to
this
chapter
is
guilty
of
33
a
serious
misdemeanor.
34
b.
A
person
who
represents
that
the
person
is
an
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anesthesiologist
assistant
without
a
license
issued
pursuant
1
to
this
chapter,
or
who
employs
a
person
to
practice
2
anesthesiology
assisting
who
is
not
licensed
pursuant
to
this
3
chapter,
is
guilty
of
a
serious
misdemeanor.
4
2.
Except
for
a
person
licensed
pursuant
to
this
chapter,
5
this
section
does
not
apply
to
persons
who
are
licensed
to
6
practice
a
health
profession
covered
by
chapter
147,
when
the
7
licensee’s
performance
of
anesthesiology
assisting
falls
within
8
the
scope
of
practice
of
the
licensee’s
licensed
profession.
9
EXPLANATION
10
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
11
the
explanation’s
substance
by
the
members
of
the
general
assembly.
12
This
bill
creates
the
licensed
profession
of
anesthesiology
13
assisting
under
the
authority
of
the
board
of
medicine
(board).
14
The
bill
allows
an
anesthesiologist,
defined
in
the
bill
as
a
15
physician
and
surgeon
or
osteopathic
physician
and
surgeon
who
16
is
trained
in
the
administration
of
anesthesia,
to
delegate
17
certain
duties,
listed
in
the
bill,
to
an
anesthesiologist
18
assistant
who
is
licensed
by
the
board
and
supervised
by
the
19
anesthesiologist.
The
bill
includes
definitions
for
both
20
“assist”
and
“supervision”.
21
The
bill
requires
the
board
to
license
a
person
as
an
22
anesthesiologist
assistant
if
the
person
graduates
from
an
23
accredited
anesthesiologist
assistant
program,
completes
an
24
appropriate
certification
examination,
submits
an
application
25
on
a
form
prescribed
by
the
board,
and
pays
an
application
26
fee
in
an
amount
determined
by
the
board
by
rule.
An
27
anesthesiologist
assistant
shall
be
valid
for
two
years
and
28
may
be
renewed.
The
bill
also
requires
the
board
to
issue
29
a
temporary
license
to
a
person
who
successfully
completes
30
an
accredited
anesthesiologist
assistant
training
program,
31
certifies
that
person
intends
to
take
the
next
available
32
certification
examination
after
the
receipt
of
the
temporary
33
license,
submits
an
application
in
a
form
prescribed
by
the
34
board,
and
pays
an
application
fee
in
an
amount
determined
by
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the
board
by
rule.
A
temporary
license
shall
not
be
issued
for
1
a
term
of
more
than
one
year
and
is
not
eligible
for
renewal.
2
The
bill
allows
the
board
to
revoke,
suspend,
restrict,
or
3
refuse
to
renew
an
anesthesiologist
assistant
license
if
the
4
board
determines
that
a
licensee
has
violated
a
provision
of
5
the
bill
or
rules
adopted
by
the
board.
The
bill
also
allows
6
a
board
to
reinstate
a
revoked
license
if
the
board
makes
7
certain
determinations
regarding
the
former
licensee’s
fitness
8
to
practice
anesthesiologist
assisting
and
the
former
licensee
9
applies
for
reinstatement.
The
bill
prohibits
a
former
10
licensee
from
applying
for
reinstatement
less
than
two
years
11
from
the
date
the
license
is
revoked,
except
that
a
person
12
whose
license
was
revoked
due
to
a
conviction
for
a
crime
13
that
was
later
reversed
on
repeal
may
apply
for
reinstatement
14
immediately
upon
the
entry
of
reversal
by
the
court.
15
The
bill
allows
an
anesthesiologist
assistant
to
perform
16
only
those
duties
delegated
to
the
anesthesiologist
assistant
17
by
the
supervising
anesthesiologist
that
are
within
the
18
education
and
training
of
the
anesthesiologist
assistant.
The
19
bill
requires
a
supervising
anesthesiologist
to
be
immediately
20
available
to
the
anesthesiologist
assistant
such
that
the
21
supervising
anesthesiologist
is
available
to
intervene
if
22
needed.
The
bill
does
not
prohibit
an
anesthesiologist
23
assistant
from
having
access
to
and
obtaining
prescription
24
drugs
as
directed
by
a
supervising
anesthesiologist.
25
The
bill
prohibits
a
person
who
is
not
licensed
as
26
provided
in
the
bill
from
using
the
title
“anesthesiologist
27
assistant”,
using
the
initials
“A.A.”
or
“C.A.A.”,
or
otherwise
28
representing
that
the
person
is
an
anesthesiologist
assistant.
29
The
bill
also
prohibits
a
person
from
practicing
anesthesiology
30
assisting
without
a
license
issued
pursuant
to
the
bill
unless
31
the
person
is
licensed
to
practice
a
health
profession
and
the
32
performance
of
anesthesiology
assisting
is
within
the
scope
33
of
practice
of
the
person’s
license.
A
person
who
violates
34
either
of
these
provisions
is
guilty
of
a
serious
misdemeanor.
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A
serious
misdemeanor
is
punishable
by
confinement
for
no
more
1
than
one
year
and
a
fine
of
at
least
$430
but
not
more
than
2
$2,560.
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