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 TLSB 2299XS (3) 91 ss/ko
S.F. 467 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 -1- LSB 2299XS (3) 91 ss/ko 1/ 11
S.F. 467 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 persons 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 -2- LSB 2299XS (3) 91 ss/ko 2/ 11
S.F. 467 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 anesthesiologists 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 35 -3- LSB 2299XS (3) 91 ss/ko 3/ 11
S.F. 467 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. 35 -4- LSB 2299XS (3) 91 ss/ko 4/ 11
S.F. 467 (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 applicants 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, 35 -5- LSB 2299XS (3) 91 ss/ko 5/ 11
S.F. 467 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. 35 -6- LSB 2299XS (3) 91 ss/ko 6/ 11
S.F. 467 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 35 -7- LSB 2299XS (3) 91 ss/ko 7/ 11
S.F. 467 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 35 -8- LSB 2299XS (3) 91 ss/ko 8/ 11
S.F. 467 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 licensees performance of anesthesiology assisting falls within 8 the scope of practice of the licensees licensed profession. 9 EXPLANATION 10 The inclusion of this explanation does not constitute agreement with 11 the explanations 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 35 -9- LSB 2299XS (3) 91 ss/ko 9/ 11
S.F. 467 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 licensees 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 persons license. A person who violates 34 either of these provisions is guilty of a serious misdemeanor. 35 -10- LSB 2299XS (3) 91 ss/ko 10/ 11
S.F. 467 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. 3 -11- LSB 2299XS (3) 91 ss/ko 11/ 11