By: Guerra H.B. No. 2274

A BILL TO BE ENTITLED

AN ACT

relating to the licensing and regulation of anesthesiologist assistants; requiring an occupational license; providing an administrative penalty; authorizing fees.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Subtitle C, Title 3, Occupations Code, is amended by adding Chapter 207 to read as follows:

CHAPTER 207. ANESTHESIOLOGIST ASSISTANTS

SUBCHAPTER A. GENERAL PROVISIONS

Sec. 207.001. SHORT TITLE. This chapter may be cited as the Anesthesiologist Assistant Licensing Act.

Sec. 207.002. DEFINITIONS. In this chapter:

(1) "Anesthesiologist" means a physician who:

(A) holds a license in good standing issued by the medical board under Subtitle B; and

(B) is certified in anesthesiology by:

(i) the American Board of Physician Specialties;

(ii) the American Osteopathic Board of Anesthesiology; or

(iii) a certifying board recognized by the medical board.

(2) "Anesthesiologist assistant" means a person who holds a license issued under this chapter.

(3) "Anesthesiologist assistant board" means the Texas Anesthesiologist Assistant Board.

(4) "Medical board" means the Texas Medical Board.

(5) "Practice as an anesthesiologist assistant" means personally performing a medical task delegated to the person by a supervising anesthesiologist.

Sec. 207.003. APPLICABILITY. (a) A person is not required to hold a license issued under this chapter to practice as:

(1) a technician, assistant, or employee of a physician who performs delegated tasks but does not act as an anesthesiologist assistant or represent that the person is an anesthesiologist assistant; or

(2) any other licensed health care worker acting within the scope of that person's license if the person:

(A) does not use the title "anesthesiologist assistant" or the initials "C.A.A." or "A.A."; or

(B) is not represented or designated as an anesthesiologist assistant.

(b) This chapter does not limit the employment arrangement of an anesthesiologist assistant licensed under this chapter.

SUBCHAPTER B. TEXAS ANESTHESIOLOGIST ASSISTANT BOARD

Sec. 207.051. ANESTHESIOLOGIST ASSISTANT BOARD. (a) The Texas Anesthesiologist Assistant Board is an advisory board to the medical board.

(b) Chapter 2110, Government Code, does not apply to the anesthesiologist assistant board.

Sec. 207.052. APPOINTMENT OF BOARD. (a) The anesthesiologist assistant board consists of five members appointed by the president of the medical board as follows:

(1) two anesthesiologist assistants;

(2) two anesthesiologists; and

(3) one member who represents the public and is not licensed or trained in a health care profession.

(b) Appointments to the anesthesiologist assistant board shall be made without regard to the race, color, disability, sex, religion, age, or national origin of the appointee.

Sec. 207.053. TERMS; VACANCIES. (a) Members of the anesthesiologist assistant board are appointed for staggered six-year terms. The terms of one or two members, as appropriate, expire on February 1 of each odd-numbered year.

(b) A member may not serve more than:

(1) two consecutive full terms; or

(2) a total of three full terms.

(c) If a vacancy occurs during a member's term, the president of the medical board shall appoint a new member to serve the unexpired term.

Sec. 207.054. OFFICERS. The president of the medical board shall designate an anesthesiologist assistant member of the anesthesiologist assistant board as the presiding officer of the board to serve in that capacity at the will of the president. The anesthesiologist assistant board shall select from its membership a secretary to serve a one-year term.

Sec. 207.055. GROUNDS FOR REMOVAL. (a) It is a ground for removal from the anesthesiologist assistant board that a member:

(1) does not have at the time of taking office the qualifications required by Section 207.052;

(2) does not maintain during service on the assistant board the qualifications required by Section 207.052;

(3) cannot, because of illness or disability, discharge the member's duties for a substantial part of the member's term; or

(4) is absent from more than half of the regularly scheduled anesthesiologist assistant board meetings that the member is eligible to attend during a calendar year without an excuse approved by a majority vote of the board.

(b) The validity of an action of the anesthesiologist assistant board is not affected by the fact that it is taken when a ground for removal of a board member exists.

(c) If the executive director of the medical board has knowledge that a potential ground for removal exists, the executive director shall notify the presiding officer of the anesthesiologist assistant board of the potential ground. If the potential ground for removal involves the presiding officer, the executive director shall notify the next highest ranking officer of the anesthesiologist assistant board, who shall then notify the president of the medical board that a potential ground for removal exists.

Sec. 207.056. COMPENSATION; REIMBURSEMENT OF EXPENSES. A member of the anesthesiologist assistant board may not receive compensation but is entitled to reimbursement for actual and necessary expenses incurred in performing the functions of the board, subject to the General Appropriations Act.

Sec. 207.057. OPEN MEETINGS; ADMINISTRATIVE PROCEDURE LAW. Except as otherwise provided by this chapter, the anesthesiologist assistant board is subject to Chapters 551 and 2001, Government Code.

Sec. 207.058. TRAINING. (a) A person who is appointed to and qualifies for office as a member of the anesthesiologist assistant board may not vote, deliberate, or be counted as a member in attendance at a meeting of the board until the person completes a training program that complies with this section.

(b) The training program must provide the person with information regarding:

(1) the law governing anesthesiologist assistant board operations;

(2) the programs, functions, rules, and budget of the anesthesiologist assistant board;

(3) the scope of and limitations on the rulemaking authority of the anesthesiologist assistant board;

(4) the results of the most recent formal audit of the anesthesiologist assistant board;

(5) the requirements of:

(A) laws relating to open meetings, public information, administrative procedure, and disclosing conflicts of interest; and

(B) other laws applicable to members of the anesthesiologist assistant board in performing their duties; and

(6) any applicable ethics policies adopted by the anesthesiologist assistant board or the Texas Ethics Commission.

(c) A person appointed to the anesthesiologist assistant board is entitled to reimbursement, as provided by the General Appropriations Act, for the travel expenses incurred in attending the training program regardless of whether the attendance at the program occurs before or after the person qualifies for office.

(d) The executive director of the medical board shall create a training manual that includes the information required by Subsection (b). The executive director shall distribute a copy of the training manual annually to each anesthesiologist assistant board member. On receipt of the training manual, each board member shall sign and submit to the executive director a statement acknowledging receipt of the training manual.

SUBCHAPTER C. POWERS AND DUTIES OF ANESTHESIOLOGIST ASSISTANT

BOARD AND MEDICAL BOARD

Sec. 207.101. GENERAL POWERS AND DUTIES OF ANESTHESIOLOGIST ASSISTANT BOARD; MEDICAL BOARD APPROVAL. (a) The anesthesiologist assistant board shall adopt rules that are reasonable and necessary for the performance of the anesthesiologist assistant board's duties under this chapter, as provided by Chapter 2001, Government Code, including rules to establish:

(1) licensing, renewal, and other fees;

(2) license renewal dates; and

(3) procedures for disciplinary actions.

(b) The medical board, by a majority vote, shall approve or reject each rule adopted by the anesthesiologist assistant board. If approved, the rule may take effect. If the rule is rejected, the medical board shall return the rule to the anesthesiologist assistant board for revision.

Sec. 207.102. GUIDELINES FOR EARLY INVOLVEMENT IN RULEMAKING PROCESS. (a) The anesthesiologist assistant board shall adopt guidelines to establish procedures for receiving input during the rulemaking process from individuals and groups that have an interest in matters under the anesthesiologist assistant board's jurisdiction. The guidelines must provide an opportunity for those individuals and groups to provide input before the anesthesiologist assistant board submits the rule to the medical board for approval.

(b) A rule adopted or approved by the medical board may not be challenged on the grounds that the anesthesiologist assistant board did not comply with this section. If the anesthesiologist assistant board was unable to solicit a significant amount of input from the public or affected persons early in the rulemaking process, the anesthesiologist assistant board shall state in writing the reasons why the anesthesiologist assistant board was unable to do so.

Sec. 207.103. POWERS AND DUTIES OF MEDICAL BOARD RELATING TO ANESTHESIOLOGIST ASSISTANTS. (a) The medical board shall administer and enforce this chapter.

(b) The medical board shall adopt rules consistent with this chapter to regulate anesthesiologist assistants and anesthesiologists who supervise anesthesiologist assistants.

(c) The rules adopted by the medical board must include:

(1) a requirement that an anesthesiologist assistant assist only an anesthesiologist who is available to supervise the anesthesiologist assistant for the medical tasks delegated by that anesthesiologist; and

(2) a requirement that an anesthesiologist assistant shall maintain compliance with all certification requirements, including continuing education requirements, adopted by the National Commission for Certification of Anesthesiologist Assistants or its successor organization.

Sec. 207.104. FEES. The anesthesiologist assistant board shall set fees in amounts that are reasonable and necessary to cover the costs of administering and enforcing this chapter without the use of any other funds generated by the medical board.

Sec. 207.105. RULES ON CONSEQUENCES OF CRIMINAL CONVICTION. The anesthesiologist assistant board shall adopt rules and guidelines as necessary to comply with Chapter 53, except to the extent the requirements of this chapter are stricter than the requirements of Chapter 53.

Sec. 207.106. COMPLAINTS. The medical board shall maintain a system to promptly and efficiently act on complaints filed with the medical board regarding anesthesiologist assistants. The medical board shall maintain:

(1) information about the parties to the complaint and the subject matter of the complaint;

(2) a summary of the results of the review or investigation of the complaint; and

(3) information about the disposition of the complaint.

SUBCHAPTER D. LICENSE REQUIREMENTS, EXEMPTIONS, AND RENEWAL

Sec. 207.151. LICENSE REQUIRED. (a) A person may not practice as an anesthesiologist assistant in this state unless the person holds an anesthesiologist assistant license issued under this chapter.

(b) A person may not use the title "anesthesiologist assistant" or "certified anesthesiologist assistant" or the initials "C.A.A." or "A.A." or represent that the person is an anesthesiologist assistant unless the person holds a license issued under this chapter.

Sec. 207.152. ISSUANCE OF LICENSE. The medical board shall issue a license to an applicant who:

(1) meets the eligibility requirements of Section 207.153;

(2) submits an application on a form prescribed by the board;

(3) pays the required application and licensing fees; and

(4) submits to the board any other information the board considers necessary to evaluate the applicant's qualifications.

Sec. 207.153. ELIGIBILITY REQUIREMENTS. To be eligible for a license under this chapter, an applicant must:

(1) submit proof of completion of a graduate level training program accredited by the Commission on Accreditation of Allied Health Education Programs or its successor organization;

(2) pass a certifying examination administered by the National Commission for Certification of Anesthesiologist Assistants or its successor organization;

(3) submit proof of current certification from the National Commission for Certification of Anesthesiologist Assistants or its successor organization; and

(4) meet any additional qualifications adopted by rule by the anesthesiologist assistant board.

Sec. 207.154. CRIMINAL HISTORY RECORD INFORMATION REQUIREMENT FOR LICENSE ISSUANCE. (a) The medical board shall require that an applicant for a license submit a complete and legible set of fingerprints, on a form prescribed by the board, to the board or to the Department of Public Safety for the purpose of obtaining criminal history record information from the Department of Public Safety and the Federal Bureau of Investigation.

(b) The medical board may not issue a license to a person who does not comply with the requirement of Subsection (a).

(c) The medical board shall conduct a criminal history record information check of each applicant for a license using information:

(1) provided by the individual under this section; and

(2) made available to the board by the Department of Public Safety, the Federal Bureau of Investigation, and any other criminal justice agency under Chapter 411, Government Code.

(d) The medical board may:

(1) enter into an agreement with the Department of Public Safety to administer a criminal history record information check required under this section; and

(2) authorize the Department of Public Safety to collect from each applicant the costs incurred by the Department of Public Safety in conducting the criminal history record information check.

Sec. 207.155. EXEMPTIONS FROM LICENSING REQUIREMENT FOR CERTAIN ANESTHESIOLOGIST ASSISTANTS. A person is not required to hold a license issued under this chapter to practice as an anesthesiologist assistant student enrolled in an anesthesiologist assistant educational program accredited by the Commission on Accreditation of Allied Health Education Programs or its successor organization.

Sec. 207.156. LICENSE RENEWAL. (a) A license issued under this chapter is valid for a term of two or more years, as determined by anesthesiologist assistant board rule.

(b) On notification from the medical board, a person who holds a license under this chapter may renew the license by:

(1) paying the required renewal fee;

(2) submitting the appropriate form; and

(3) meeting any other requirement established by anesthesiologist assistant board rule.

(c) The anesthesiologist assistant board by rule may adopt a system under which licenses expire on various dates during the year.

(d) A person who is otherwise eligible to renew a license may renew an unexpired license by paying the required renewal fee to the medical board before the expiration date of the license. A person whose license has expired may not engage in activities that require a license until the license has been renewed.

(e) A person whose license is expired may renew the license by paying to the medical board a fee that is equal to 1-1/2 times the renewal fee for the license.

SUBCHAPTER E. PRACTICE BY LICENSE HOLDER

Sec. 207.201. NOTICE OF INTENT TO PRACTICE. Before beginning practice, each anesthesiologist assistant licensed under this chapter must submit on a form prescribed by the anesthesiologist assistant board notice of the license holder's intent to practice. The notice must include the name, business address, license number, and telephone number of the anesthesiologist assistant.

Sec. 207.202. SCOPE OF PRACTICE. (a) An anesthesiologist assistant may assist the supervising anesthesiologist and perform duties delegated by the supervising anesthesiologist, including the development and implementation of a patient's anesthesia care plan that is consistent with the rules adopted under this chapter.

(b) An anesthesiologist assistant who assists an anesthesiologist is not considered to be engaged in the practice of medicine.

(c) This chapter does not limit or expand the scope of practice of a physician assistant.

Sec. 207.203. NAME TAG. A person acting within the scope of a license issued under this chapter shall wear a name tag identifying the person as an anesthesiologist assistant.

Sec. 207.204. IDENTIFICATION OF STUDENT. A student in an anesthesiologist assistant training program shall be identified as a student anesthesiologist assistant or an anesthesiologist assistant student. A student may not use or permit to be used on the student's behalf the term "intern," "resident," or "fellow," or another term that identifies the student as a physician or surgeon.

SUBCHAPTER F. ENFORCEMENT

Sec. 207.251. ADMINISTRATIVE PENALTY. (a) The medical board by order may impose an administrative penalty against a person who violates this chapter or a rule or order adopted under this chapter.

(b) The medical board shall impose the penalty in the same manner and using the same procedures as Subchapter A, Chapter 165.

SECTION 2. (a) As soon as practicable after the effective date of this Act, the president of the Texas Medical Board shall appoint five members to the Texas Anesthesiologist Assistant Board in accordance with Chapter 207, Occupations Code, as added by this Act. In making the initial appointments, the president of the Texas Medical Board shall designate two members for terms expiring January 31, 2025, two members for terms expiring January 31, 2027, and one member for a term expiring January 31, 2029.

(b) Notwithstanding Section 207.052(a), Occupations Code, as added by this Act, a person practicing as an anesthesiologist assistant is eligible for appointment as an initial member of the Texas Anesthesiologist Assistant Board regardless of whether the person holds an anesthesiologist assistant license issued under Chapter 207, Occupations Code, as added by this Act.

SECTION 3. Not later than June 1, 2024, the Texas Medical Board with the advice of the Texas Anesthesiologist Assistant Board shall adopt the rules, procedures, and fees necessary to administer Chapter 207, Occupations Code, as added by this Act.

SECTION 4. Notwithstanding Chapter 207, Occupations Code, as added by this Act, an anesthesiologist assistant is not required to hold a license under that chapter to practice as an anesthesiologist assistant in this state before September 1, 2024.

SECTION 5. (a) Except as provided by Subsection (b) of this section, this Act takes effect September 1, 2023.

(b) Section 207.151 and Subchapter F, Occupations Code, as added by this Act, take effect September 1, 2024.