RESPIRATORY CARE PRACTITIONERS

chapter 261	licensure of respiratory care practitioners, polysomnographic technologists, and respiratory care and polysomnography practitioners	
chapter 262	continuing education for respiratory care practitioners and polysomnographic technologists	
chapter 263	discipline for respiratory care practitioners and polysomnographic technologists	
chapter 264	reserved	
chapter 265	practice of respiratory care practitioners and polysomnographic technologists	
CHAPTER 261
LICENSURE OF RESPIRATORY CARE PRACTITIONERS, POLYSOMNOGRAPHIC TECHNOLOGISTS, AND RESPIRATORY CARE AND POLYSOMNOGRAPHY PRACTITIONERS
[Prior to 4/17/02, see 645—Chapter 260]
645—261.1(148G,152B) Definitions. For purposes of these rules, the following definitions shall apply:
“Active license” means a license that is current and has not expired.
“Board” means the board of respiratory care and polysomnography.
“BRPT” means the Board of Registered Polysomnographic Technologists.
“CAAHEP” means the Commission on Accreditation of Allied Health Education Programs.
“CoARC” means the Commission on Accreditation for Respiratory Care.
“Grace period” means the 30-day period following expiration of a license when the license is still considered to be active. In order to renew a license during the grace period, a licensee is required to pay a late fee.
“Licensee” means any person licensed to practice as a respiratory care practitioner, polysomnographic technologist, or respiratory care and polysomnography practitioner in the state of Iowa.
“License expiration date” means March 31 of even-numbered years.
“NBRC” means the National Board for Respiratory Care.
“Polysomnographic technologist” means a person licensed by the board to engage in the practice of polysomnography under the general supervision of a physician or a qualified health care professional prescriber.
“Reactivate” or “reactivation” means the process as outlined in rule 645—261.14(17A,147,272C) by which an inactive license is restored to active status.
“Reciprocal license” means the issuance of an Iowa license to practice as a respiratory care practitioner, polysomnographic technologist, or respiratory care and polysomnography practitioner to an applicant who is currently licensed in another state that has a mutual agreement with the Iowa board of respiratory care and polysomnography to license persons who have the same or similar qualifications to those required in Iowa.
“Reinstatement” means the process as outlined in 645—11.31(272C) by which a licensee who has had a license suspended or revoked or who has voluntarily surrendered a license may apply to have the license reinstated, with or without conditions. Once the license is reinstated, the licensee may apply for active status.
[ARC 8348B, IAB 12/2/09, effective 1/6/10; ARC 2323C, IAB 12/23/15, effective 1/27/16; ARC 3932C, IAB 8/1/18, effective 9/5/18]
645—261.2(148G,152B) General requirements for licensure.
	261.2(1) The following general criteria shall apply to all applications for licensure:
	a. 	The applicant shall complete an application.
	b. 	The applicant shall complete the application form according to the instructions contained in the application. If the application is not completed according to the instructions, the application will not be reviewed by the board until properly completed.
	c. 	Each application shall be accompanied by the appropriate fees specified in 645—subrule 5.17(1).
	d. 	The applicant shall submit two completed sets of fingerprint cards to facilitate a national criminal history background check. The cost for the evaluation of the fingerprint cards and the criminal history background checks by the Iowa division of criminal investigation (DCI) and the Federal Bureau of Investigation (FBI) criminal history background checks shall be assessed to the applicant. The board may withhold issuing a license pending receipt of a report from the DCI and FBI.
	e. 	The applicant shall submit a release authorizing the background check.
	f. 	Licensees who were issued their licenses within six months prior to the renewal shall not be required to renew their licenses until the renewal month two years later.
	g. 	An applicant who has been a licensed respiratory care practitioner, polysomnographic technologist, or respiratory care and polysomnography practitioner under the laws of another jurisdiction shall provide verification of license from the jurisdiction in which the applicant has most recently been licensed. Verification shall be sent directly from the jurisdiction to the board office. The applicant must also disclose any public or pending complaints against the applicant in any other jurisdiction. Web-based verification may be substituted for verification direct from the jurisdiction’s board office if the verification provides:
	(1)	Licensee’s name;
	(2)	Date of initial licensure;
	(3)	Current licensure status; and
	(4)	All disciplinary action taken against the license.
	261.2(2) Incomplete applications that have been on file in the board office for more than two years shall be considered invalid and shall be destroyed.
[ARC 2323C, IAB 12/23/15, effective 1/27/16; ARC 3932C, IAB 8/1/18, effective 9/5/18; ARC 5770C, IAB 7/14/21, effective 8/18/21; ARC 6993C, IAB 4/19/23, effective 5/24/23]
645—261.3(152B) Additional requirements for respiratory care practitioner licensure. The following are additional specific criteria for licensure as a respiratory care practitioner:
	261.3(1) The applicant shall have successfully completed a respiratory care education program accredited by, or under a letter of review from, CoARC or CAAHEP.
	261.3(2) Foreign-trained respiratory care practitioners shall:
	a. 	Provide an equivalency evaluation of their educational credentials by one of the following: International Educational Research Foundations, Inc., Credentials Evaluation Service, P.O. Box 3665, Culver City, CA 90231-3665, telephone (310)258-9451, website www.ierf.org or email at info@ierf.org; or International Credentialing Associates, Inc., 7245 Bryan Dairy Road, Bryan Dairy Business Park II, Largo, FL 33777, telephone (727)549-8555. The professional curriculum must be equivalent to that stated in these rules. A candidate shall bear the expense of the curriculum evaluation.
	b. 	Provide a copy of the certificate or diploma awarded to the applicant from a respiratory care program in the country in which the applicant was educated.
	c. 	Receive a final determination from the board regarding the application for licensure.
	261.3(3) The examination required by the board shall be the Therapist Multiple-Choice Examination or the Certified Respiratory Therapist Examination administered by the NBRC. The applicant shall have achieved a score on the examination which meets or exceeds the minimum passing score established by the NBRC.
	261.3(4) The applicant shall apply directly to the NBRC to attempt the examination.
	261.3(5) Results of the examination must be received by the board of respiratory care and polysomnography by one of the following methods:
	a. 	Scores are sent directly from the examination service to the board;
	b. 	A copy of a certificate showing proof of the successful achievement of the certified respiratory therapist (CRT) or registered respiratory therapist (RRT) credential awarded by the NBRC is submitted to the board; or
	c. 	A copy of the score report or an electronic web-based confirmation by the NBRC showing proof of successful completion is submitted to the board.
[ARC 8348B, IAB 12/2/09, effective 1/6/10; ARC 2323C, IAB 12/23/15, effective 1/27/16; ARC 6993C, IAB 4/19/23, effective 5/24/23]
645—261.4(148G,152B) Additional requirements for polysomnographic technologist licensure. The following are additional specific criteria for licensure as a polysomnographic technologist:
	261.4(1) Graduation from a polysomnographic educational program accredited by CAAHEP. A transcript shall be submitted to the board office directly from the college or university; or
	261.4(2) Graduation from an entry into respiratory care professional practice program accredited by CoARC or CAAHEP for which a transcript shall be submitted to the board office directly from the college or university; and direct-source verification of one of the following:
	a. 	Completion of a sleep specialist program option accredited by CoARC or CAAHEP, or
	b. 	Obtaining the sleep disorder specialist credential from the NBRC, or
	c. 	Obtaining the registered polysomnographic technologist credential from the BRPT; or
	261.4(3) Graduation from an electroneurodiagnostic technologist program with a polysomnographic technology track that is accredited by CAAHEP. A transcript shall be submitted to the board office directly from the college or university; or
	261.4(4) Requirements for current Iowa licensees holding a license in a profession other than polysomnography. An individual who holds an active license under Iowa Code section 147.2 in a profession other than polysomnography and whose license is in good standing with the board for that profession may receive licensure upon verification from the medical director of the individual’s current employer or the medical director’s designee that the individual has completed on-the-job training in the field of polysomnography and is competent to perform polysomnography.
	261.4(5) Persons practicing sleep medicine on January 1, 2017.
	a. 	A person who is working in the field of sleep medicine on January 1, 2017, may receive a license to perform polysomnography upon verification of the following:
	(1)	Verification that the person has completed 500 hours of clinical polysomnographic work experience within the three years immediately prior to January 1, 2017; and
	(2)	Verification from the medical director of the person’s current employer or the medical director’s designee that the person is competent to perform polysomnography.
	b. 	A person who is not otherwise eligible to obtain a license pursuant to this subrule shall have until January 1, 2018, to:
	(1)	Achieve a passing score on the Registered Polysomnographic Technologist Examination administered by the BRPT. The passing score shall be the recommended passing score set by the BRPT; or
	(2)	Achieve a passing score on the Sleep Disorders Specialist Examination (SDS) administered by the NBRC. The passing score shall be the minimum passing score established by the NBRC.
	261.4(6) Foreign-trained polysomnographic technologists shall:
	a. 	Provide an equivalency evaluation of their educational credentials by either of the following:
	(1)	International Educational Research Foundations, Inc., Credentials Evaluation Service, P.O. Box 3665, Culver City, CA 90231-3665; telephone (310)258-9451; website www.ierf.org or email at info@ierf.org; or
	(2)	International Credentialing Associates, Inc., 7245 Bryan Dairy Road, Bryan Dairy Business Park II, Largo, FL 33777; telephone (727)549-8555.
The professional curriculum must be equivalent to that stated in these rules. A candidate shall bear the expense of the curriculum evaluation.
	b. 	Provide a copy of the certificate or diploma awarded to the applicant from a respiratory care program in the country in which the applicant was educated.
	c. 	Receive a final determination from the board regarding the application for licensure.
	261.4(7) Licensure by proof of work experience. An applicant who has relocated to Iowa from a state that did not require licensure to practice the profession may submit proof of work experience in lieu of educational and training requirements, if eligible, in accordance with rule 645—19.2(272C).
	261.4(8) Licensure by verification. A person who is licensed in another jurisdiction but who is unable to satisfy the requirements for licensure by endorsement may apply for licensure by verification, if eligible, in accordance with rule 645—19.1(272C).
[ARC 2323C, IAB 12/23/15, effective 1/27/16; ARC 3932C, IAB 8/1/18, effective 9/5/18; ARC 5770C, IAB 7/14/21, effective 8/18/21; ARC 6993C, IAB 4/19/23, effective 5/24/23]
645—261.5(148G,152B) Requirements for dual licensure. The following are additional specific criteria for licensure as a respiratory care and polysomnography practitioner. An applicant for licensure as a respiratory care and polysomnography practitioner shall meet the requirements of 261.5(1) and 261.5(2).
	261.5(1) The applicant shall have successfully completed a respiratory care education program accredited by, or under a letter of review from, CoARC or CAAHEP.
	a. 	Foreign-trained practitioners shall:
	(1)	Provide an equivalency evaluation of their educational credentials by either of the following:
	1.	International Educational Research Foundations, Inc., Credentials Evaluation Service, P.O. Box 3665, Culver City, CA 90231-3665; telephone (310)258-9451; website www.ierf.org or email at info@ierf.org; or
	2.	International Credentialing Associates, Inc., 7245 Bryan Dairy Road, Bryan Dairy Business Park II, Largo, FL 33777; telephone (727)549-8555.
The professional curriculum must be equivalent to that stated in these rules. A candidate shall bear the expense of the curriculum evaluation.
	(2)	Provide a copy of the certificate or diploma awarded to the applicant from the program in the country in which the applicant was educated.
	(3)	Receive a final determination from the board regarding the application for licensure.
	b. 	Examination requirements. The examinations required by the board shall be the Therapist Multiple-Choice Examination administered by the NBRC and either the Sleep Disorders Specialist Examination (SDS) administered by the NBRC or the Registered Polysomnographic Technologist Examination administered by the BRPT. The passing score shall be the minimum passing score established by the NBRC or BRPT.
	(1)	The applicant shall apply directly to the examination service to attempt the examination.
	(2)	Results of the examinations must be received by the board of respiratory care and polysomnography by one of the following methods:
	1.	Scores are sent directly from the examination service to the board;
	2.	A copy of a certificate showing proof of the successful achievement of the certified respiratory therapist (CRT) or registered respiratory therapist (RRT) credential awarded by the NBRC is submitted to the board; or
	3.	A copy of the score report or an electronic web-based confirmation by the NBRC showing proof of successful completion of the Therapist Multiple-Choice Examination, State Clinical Examination, or Certified Respiratory Therapist Examination administered by the NBRC is submitted to the board.
	261.5(2) The applicant must also meet one of the following requirements:
	a. 	Graduation from a polysomnographic educational program accredited by CAAHEP. A transcript shall be submitted to the board office directly from the college or university; or
	b. 	Completion of a sleep specialist program option accredited by CoARC or CAAHEP for which a transcript shall be submitted to the board office directly from the college or university; and direct-source verification of one of the following:
	(1)	Completion of the curriculum for a polysomnographic certificate established and accredited by the CAAHEP as an extension of the respiratory care program, or
	(2)	Obtaining the sleep disorder specialist credential from the NBRC, or
	(3)	Obtaining the registered polysomnographic technologist credential from the BRPT; or
	c. 	Graduation from an electroneurodiagnostic technologist program with a polysomnographic technology track that is accredited by CAAHEP. A transcript shall be submitted to the board office directly from the college or university; or
	d. 	Hold an active license under Iowa Code section 147.2 in a profession other than polysomnography that is in good standing with the board for that profession and provide verification from the medical director of the applicant’s current employer or the medical director’s designee that the applicant has completed on-the-job training in the field of polysomnography and is competent to perform polysomnography; or
	e. 	Persons practicing sleep medicine on January 1, 2017.
	(1)	A person who is working in the field of sleep medicine on January 1, 2017, may receive a license upon verification of the following:
	1.	Verification that the person has completed 500 hours of clinical or nonclinical polysomnographic work experience within the three years immediately prior to January 1, 2017, and
	2.	Verification from the medical director of the person’s current employer or the medical director’s designee that the person is competent to perform polysomnography.
	(2)	A person who is not otherwise eligible to obtain a license pursuant to this subrule shall have until January 1, 2018, to achieve a passing score on the Registered Polysomnographic Technologist Examination administered by the BRPT or achieve a passing score on the Sleep Disorders Specialist Examination (SDS) administered by the NBRC. The passing score for the Registered Polysomnographic Technologist Examination shall be the recommended passing score set by the BRPT. The passing score for the SDS shall be the minimum passing score established by the NBRC.
[ARC 2323C, IAB 12/23/15, effective 1/27/16; ARC 3932C, IAB 8/1/18, effective 9/5/18; ARC 6993C, IAB 4/19/23, effective 5/24/23]
645—261.6 and 261.7  Reserved.
645—261.8(148G,152B) License renewal.
	261.8(1) The biennial license renewal period for a license shall begin on April 1 of an even-numbered year and end on March 31 of the next even-numbered year. The licensee is responsible for renewing the license prior to its expiration. Failure of the licensee to receive notice does not relieve the licensee of the responsibility for renewing the license.
	261.8(2) An individual who was issued an initial license within six months of the license renewal date will not be required to renew the license until the subsequent renewal two years later.
	261.8(3) A licensee seeking renewal shall:
	a. 	Meet the continuing education requirements of rule 645—262.2(148G,152B,272C) and the mandatory reporting requirements of subrule 261.8(4). A licensee whose license was reactivated during the current renewal compliance period may use continuing education credit earned during the compliance period for the first renewal following reactivation; and
	b. 	Submit the completed renewal application and renewal fee before the license expiration date.
	261.8(4) Mandatory reporter training requirements.
	a. 	A licensee who, in the scope of professional practice or in the licensee’s employment responsibilities, examines, attends, counsels or treats children in Iowa shall indicate on the renewal application completion of two hours of training in child abuse identification and reporting in the previous five years or condition(s) for waiver of this requirement as identified in paragraph “e.”
	b. 	A licensee who, in the course of employment, examines, attends, counsels or treats adults in Iowa shall indicate on the renewal application completion of two hours of training in dependent adult abuse identification and reporting in the previous five years or condition(s) for waiver of this requirement as identified in paragraph “e.”
	c. 	A licensee who, in the scope of professional practice or in the course of employment, examines, attends, counsels or treats both adults and children in Iowa shall indicate on the renewal application completion of training in abuse identification and reporting for dependent adults and children in the previous five years or condition(s) for waiver of this requirement as identified in paragraph “e.”
Training may be completed through separate courses as identified in paragraphs “a” and “b” or in one combined two-hour course that includes curricula for identifying and reporting child abuse and dependent adult abuse. The course shall be a curriculum approved by the Iowa department of public health abuse education review panel.
	d. 	The licensee shall maintain written documentation for five years after mandatory training as identified in paragraphs “a” to “c,” including program date(s), content, duration, and proof of participation.
	e. 	The requirement for mandatory training for identifying and reporting child and dependent adult abuse shall be suspended if the board determines that suspension is in the public interest or that a person at the time of license renewal:
	(1)	Is engaged in active duty in the military service of this state or the United States.
	(2)	Holds a current waiver by the board based on evidence of significant hardship in complying with training requirements, including an exemption of continuing education requirements or extension of time in which to fulfill requirements due to a physical or mental disability or illness as identified in 645—Chapter 262.
	f. 	The board may select licensees for audit of compliance with the requirements in paragraphs “a” to “e.”
	261.8(5) Upon receiving the information required by this rule and the required fee, board staff shall administratively issue a two-year license and shall send the licensee a wallet card by regular mail. In the event the board receives adverse information on the renewal application, the board shall issue the renewal license but may refer the adverse information for further consideration or disciplinary investigation.
	261.8(6) A person licensed to practice as a respiratory care practitioner, polysomnographic technologist, or respiratory care and polysomnography practitioner shall keep the person’s license certificate and renewal displayed in a conspicuous public place at the primary site of practice.
	261.8(7) Late renewal. The license shall become late when the license has not been renewed by the expiration date on the renewal. The licensee shall be assessed a late fee as specified in rule 645—5.17(147,152B). To renew a late license, the licensee shall complete the renewal requirements and submit the late fee within the grace period.
	261.8(8) Inactive license. A licensee who fails to renew the license by the end of the grace period has an inactive license. A licensee whose license is inactive continues to hold the privilege of licensure in Iowa, but may not practice respiratory care in Iowa until the license is reactivated. A licensee who practices respiratory care in the state of Iowa with an inactive license may be subject to disciplinary action by the board, injunctive action pursuant to Iowa Code section 147.83, criminal sanctions pursuant to Iowa Code section 147.86, and other available legal remedies.
[ARC 9933B, IAB 12/28/11, effective 2/1/12; ARC 2323C, IAB 12/23/15, effective 1/27/16; ARC 5770C, IAB 7/14/21, effective 8/18/21]
645—261.9 to 261.13  Reserved.
645—261.14(17A,147,272C) License reactivation. To apply for reactivation of an inactive license, a licensee shall:
	261.14(1) Submit a reactivation application on a form provided by the board.
	261.14(2) Pay the reactivation fee specified in rule 645—5.17(147,152B).
	261.14(3) If the license has been inactive for two or more years, the licensee shall submit two completed fingerprint cards to facilitate a national criminal history background check. The cost for the evaluation of the fingerprint packet and the DCI and FBI criminal history background checks shall be assessed to the applicant. The board may withhold issuing a license pending receipt of a report from the DCI and FBI.
	261.14(4) Provide verification of current competence to practice by satisfying one of the following criteria:
	a. 	If the license has been on inactive status for five years or less, an applicant must provide the following:
	(1)	Verification of the license from the jurisdiction in which the applicant has most recently been practicing during the time period the Iowa license was inactive, sent directly from the jurisdiction to the board office. The applicant must also disclose any public or pending complaints against the applicant in any other jurisdiction. Web-based verification may be substituted for verification from a jurisdiction’s board office if the verification includes:
	1.	Licensee’s name;
	2.	Date of initial licensure;
	3.	Current licensure status; and
	4.	Any disciplinary action taken against the license; and
	(2)	Verification of completion of continuing education that conforms to standards defined in 645—262.3(148G,152B,272C) within 24 months immediately preceding submission of the application for reactivation; or verification of active practice, consisting of a minimum of 2,080 hours, in another state or jurisdiction within 24 months immediately preceding an application for reactivation.
	1.	For respiratory care practitioners: 24 hours of continuing education.
	2.	For polysomnographic technologists: 24 hours of continuing education.
	3.	For respiratory care and polysomnography practitioners: 24 hours of continuing education of which at least 8 hours but no more than 12 hours shall be on sleep-related topics.
	b. 	If the license has been on inactive status for more than five years, an applicant must provide the following:
	(1)	Verification of the license from the jurisdiction in which the applicant has most recently been practicing during the time period the Iowa license was inactive, sent directly from the jurisdiction to the board office. The applicant must also disclose any public or pending complaints against the applicant in any other jurisdiction. Web-based verification may be substituted for verification from a jurisdiction’s board office if the verification includes:
	1.	Licensee’s name;
	2.	Date of initial licensure;
	3.	Current licensure status; and
	4.	Any disciplinary action taken against the license; and
	(2)	Verification of completion of continuing education that conforms to standards defined in 645—262.3(148G,152B,272C) within 24 months immediately preceding submission of the application for reactivation; or verification of active practice, consisting of a minimum of 2,080 hours, in another state or jurisdiction within 24 months immediately preceding an application for reactivation.
	1.	For respiratory care practitioners: 48 hours of continuing education.
	2.	For polysomnographic technologists: 48 hours of continuing education.
	3.	For respiratory care and polysomnography practitioners: 48 hours of continuing education of which at least 16 hours but no more than 24 hours shall be on sleep-related topics.
	261.14(5) Submit a sworn statement of previous active practice from an employer or professional associate, detailing places and dates of employment and verifying that the applicant has practiced at least 2,080 hours or taught as the equivalent of a full-time faculty member for at least one of the immediately preceding years during the last two-year time period. Sole proprietors may submit the sworn statement on their own behalf.
[ARC 2323C, IAB 12/23/15, effective 1/27/16; ARC 3932C, IAB 8/1/18, effective 9/5/18; ARC 6993C, IAB 4/19/23, effective 5/24/23]
645—261.15(17A,147,272C) License reinstatement. A licensee whose license has been revoked, suspended, or voluntarily surrendered must apply for and receive reinstatement of the license in accordance with 645—11.31(272C) and must apply for and be granted reactivation of the license in accordance with 645—261.14(17A,147,272C) prior to practicing in this state.
[ARC 2323C, IAB 12/23/15, effective 1/27/16]
These rules are intended to implement Iowa Code chapters 17A, 147, 148G, 152B and 272C.
[Filed 3/29/02, Notice 1/23/02—published 4/17/02, effective 5/22/02]
[Filed 1/14/04, Notice 10/15/03—published 2/4/04, effective 3/10/04]
[Filed 10/8/04, Notice 7/7/04—published 10/27/04, effective 12/1/04]
[Filed 5/12/05, Notice 3/16/05—published 6/8/05, effective 7/13/05]
[Filed 11/19/05, Notice 9/14/05—published 12/21/05, effective 1/25/06]
[Filed 7/23/07, Notice 5/23/07—published 8/15/07, effective 9/19/07]
[Filed 10/30/08, Notice 8/27/08—published 11/19/08, effective 1/1/09]
[Filed ARC 8348B (Notice ARC 8100B, IAB 9/9/09), IAB 12/2/09, effective 1/6/10]
[Filed ARC 9933B (Notice ARC 9595B, IAB 7/13/11), IAB 12/28/11, effective 2/1/12]
[Filed ARC 2323C (Notice ARC 2224C, IAB 10/28/15), IAB 12/23/15, effective 1/27/16]
[Filed ARC 3932C (Notice ARC 3617C, IAB 2/14/18), IAB 8/1/18, effective 9/5/18]
[Filed ARC 5770C (Notice ARC 5446C, IAB 2/24/21), IAB 7/14/21, effective 8/18/21]
[Filed ARC 6993C (Notice ARC 6654C, IAB 11/16/22), IAB 4/19/23, effective 5/24/23]