HB 758

T his bill generally establishes the scope of practice, licensure, and regulation for anesthesiologist assistants . However, this bill only authorizes a person to engage in the practice of an anesthesiologist assistant in Blount, Bradley, Davidson, Hamilton, Knox, Madison, Mau ry, Montgomery, Rutherford, Sevier, Shelby, Sullivan, Sumner, Washington, Williamson, and Wilson count ies . BOARD OF MEDICAL EXAMINERS This bill requires the board of medical examiners ("board"") to review and determine the qualifications and fitness of applicants for a license to practice as an anesthesiologist assistant. The board is required to perform a number of duties, including g rant ing, deny ing, renew ing, revok ing, and reinstat ing licenses . BOARD MEMBERSHIP Present law requires the board to co nsist of 12 members, nine of whom must be licensed physicians meeting certain qualifications. Three members must be nonphysicians who are consumers of health care and who neither own nor have any financial or other interest in any health care facility or business or school of medicine or other allied health care practitioner educational program and who must represent the public at large. The bill adds that out of those three nonphysician members, two must meet the above-mentioned provision, while the thi rd member must be a licensed anesthesiologist assistant, whose initial term begins upon the first expiration of a term of office for a nonphysician member who is serving on the board on January 1, 2026. LICENSURE T his bill authorizes t he board to grant an anesthesiologist assistant license to an applicant who meets all of the following requirements:  Graduated from an anesthesiologist assistant program accredited by the Commission on Accreditation of Allied Health Education Programs or its predecessor or successor organization .  Satisfactorily completed 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 .  Completes an application form.  Pays the required application and licensure fees as prescribed by rule. T his bill provides that t he license issued, including a temporary license, is valid for a period of two years and must be renewed every other year on or before January 31 by completing a renewal application form and the prescribed renewal fee before the current license expires. The board is required to provide renewal notices to licensees at least one month before the expiration date. The bo a rd is also authorized to reinstate a lapsed license if the applicant pays a reinstatement fee and meets the requirements for initial licensure. This bill authorizes the board to also issue a temporary license to a person who meets all of the following criteria:  Completes a temporary license application .  Pays the required temporary license fee as prescribed by rule .  Successfully completes a Commission on Accreditation of Allied Health Education program or another board-approved program for educating and training anesthesiologist assistants but who has not passed. The person must take the next available certification examination after receiving a temporary license. A temporary license must not be issued for a period of more than one year and is subject to other requirements the board adopts by rule. Th is bill authorizes the board to refuse to renew and to revoke, suspend, or restrict a license or take any other disciplinary action, including imposing conditions or restrictions on a license pursuant to this bill and the rules adopted. If the board determines that a person is ineligible for licensure, that an application for licensure should be denied, that a license should be suspended, or that another action should be taken on a current license, th en the board must adopt and enter its written order and findings. If the board proposes to issue discipline on a current license, then a contested case hearing must be conducted pursuant to the rules for contested hearings under the Uniform Administrative Procedures Act . NEW LICENSE AFTER REVOCATION T his bill authorizes t he board to issue a new license to an assistant whose license was previously revoked by the board if the applicant applies in writing to the board and demonstrates to the board's satisf action that the applicant is completely rehabilitated with respect to the conduct that was the basis for the revocation. In making its decision, the board must determine all of the following matters:  That the applicant has not engaged in conduct during the revocation period that would constitute a basis for revocation pursuant to rules adopted by the board .  If a criminal conviction was a basis of the revocation, that the applicant's civil rights have been fully restored pursuant to statute or another applicable recognized judicial, gubernatorial, or presidential order .  That the applicant has made restitution to an aggrieved person as ordered by a court of competent jurisdiction .  That the applicant demonstrates another standard of rehabilitation the board determines is appropriate. Unless a license revocation was based on a conviction of a felony or an offense involving moral turpitude and that conviction has been reversed on ap peal, this bill prohibits a person whose license was revoked from app lying for a new license earlier than two years after the date of revocation. If, however, a license revocation was based on a conviction of a felony or an offense involving moral turpitu de and that conviction has been reversed on appeal, then the board must vacate its previous order to revoke the license and the anesthesiologist assistant may apply for a new license after the court enters the reversal. An applicant for a new license afte r revocation must comply with all initial licensure requirements prescribed by this bill. SCOPE OF PRACTICE This bill authorizes an anesthesiologist assistant to assist in the practice of medicine only under the supervision of an anesthesiologist. The anesthesiologist assistant may perform only those duties and responsibilities delegated by the supervising anesthesiologist. The duty of supervision owed refers to the availability of a n anesthesiologist who can delegate, coordinate, direct, consult, or o versee the implementation of the anesthesiologist ' s intentions. The supervision may be in a manner consistent with federal rules or regulations for reimbursement for anesthesia services. This bill requires the supervising anesthesiologist to be immedi ately available to the assistant who assists in the delivery of medical care such that the supervising anesthesiologist is able to intervene if needed. An assistant's practice must not exceed the assistant's education and training, and the scope of pract i ce of the supervising anesthesiologist. This bill prohibits a medical care task assigned by the supervising anesthesiologist to the assistant from being delegated by the assistant to another person. This bill authorizes the following as delegable dutie s:  Developing and implementing an anesthesia care plan for a patient .  Obtaining a comprehensive patient history and performing relevant elements of a physical exam .  Performing preoperative and postoperative anesthetic evaluations and maintaining patient progress notes.  Ordering and performing preoperative patient consultations .  Ordering preoperative medications, including controlled substances, which may be administered before the supervising anesthesiologist cosigns .  Changing or discontinuing a medical treatment plan after consulting with the supervising anesthesiologist.  Obtaining informed consent for anesthesia or related procedures.  Ordering the preoperative continuation of current medications, which may be administered before the supervising anesthesiologist cosigns .  Pretesting and calibrating anesthesia delivery systems and obtaining and interpreting information from the systems and from monitors .  Implementing medically accepted monitoring techniques .  Performing basic and advanced airway interventions.  Establishing peripheral intravenous lines, including subcutaneous lidocaine use.  Performing invasive procedures.  Performing general anesthesia .  Administering anesthetic drugs, adjuvant drugs, and accessory drugs .  Administering vasoactive drugs and starting and titrating vasoactive infusions to treat patient responses to anesthesia .  Performing, maintaining, evaluating, and managing epidural, spinal, and regional anesthesia .  Performing monitored anesthesia care .  Obtaining venous and arterial blood samples .  Administering blood, blood products, and supportive fluids .  Performing, ordering, and interpreting appropriate preoperative, point of care, intraoperative, or postoperative diagnostic tests or procedures .  Obtaining and administering preoperative anesthesia and related pharmaceutical agents .  Managing the patient while in the preoperative suite, recovery area, or labor suites .  Ordering postoperative sedation, anxiolysis or analgesia, postoperative respiratory therapy and medicines to treat patient responses to anesthesia and ordering postoperative oxygen therapy, which may be administered before the supervising anesthesiologist cosigns .  Initiating and managing cardiopulmonary resuscitation in response to a life-threatening situation .  Participating in administrative, research, and clinical teaching activities .  Performing such other tasks not prohibited by law that an anesthesiologist assistant has been trained and is proficient to perform. This bill, however, does not prevent an anesthesiologist assistant from having access to and being able to obtain prescription drugs as directed by the supervising anesthesiologist . PENALTIES This bill prohibits a person from practicing in this state as an anesthesiologist assistant or using the title or representing that the person is a certified anesthesiologist assistant, or using the abbreviations ""C.A.A."" or ""A.A."" without having a license granted by the board. A violation is a Class B misdemeanor, punishable by a fine of not more than $1, 000, a term of imprisonment for not more than one year, or both. Each violation constitutes a separate offense. This bill also prohibits a supervising anesthesiologist from employing a person to practice as an a nesthesiologist assistant who is not licensed pursuant to this bill. A violation is a Class B misdemeanor, punishable by a fine of not more than $1, 000, a term of imprisonment for not more than one year, or both. Each violation constitutes a separate off ense. AUTHORITY TO PROMULGATE RULES T he bill authorizes t he department of health and the board of medical examiners to promulgate rules to effectuate this bill ."