S.F. 2273 Section 1. Section 147.1, subsections 3 and 6, Code 2011, 1 are amended to read as follows: 2 3. “Licensed” or “certified” , when applied to a physician 3 and surgeon, podiatric physician, osteopathic physician and 4 surgeon, physician assistant, psychologist, chiropractor, 5 nurse, dentist, dental hygienist, dental assistant, 6 optometrist, speech pathologist, audiologist, pharmacist, 7 physical therapist, physical therapist assistant, occupational 8 therapist, occupational therapy assistant, respiratory care 9 practitioner, practitioner of cosmetology arts and sciences, 10 practitioner of barbering, funeral director, dietitian, marital 11 and family therapist, mental health counselor, polysomnographic 12 technologist, social worker, massage therapist, athletic 13 trainer, acupuncturist, nursing home administrator, hearing aid 14 dispenser, or sign language interpreter or transliterator means 15 a person licensed under this subtitle. 16 6. “Profession” means medicine and surgery, podiatry, 17 osteopathic medicine and surgery, practice as a physician 18 assistant, psychology, chiropractic, nursing, dentistry, 19 dental hygiene, dental assisting, optometry, speech pathology, 20 audiology, pharmacy, physical therapy, physical therapist 21 assisting, occupational therapy, occupational therapy 22 assisting, respiratory care, cosmetology arts and sciences, 23 barbering, mortuary science, marital and family therapy, mental 24 health counseling, polysomnography, social work, dietetics, 25 massage therapy, athletic training, acupuncture, nursing home 26 administration, hearing aid dispensing, or sign language 27 interpreting or transliterating. 28 Sec. 2. Section 147.2, subsection 1, Code 2011, is amended 29 to read as follows: 30 1. A person shall not engage in the practice of medicine 31 and surgery, podiatry, osteopathic medicine and surgery, 32 psychology, chiropractic, physical therapy, physical therapist 33 assisting, nursing, dentistry, dental hygiene, dental 34 assisting, optometry, speech pathology, audiology, occupational 35 -1- LSB 5551SV (4) 84 jr/nh 1/ 11

S.F. 2273 therapy, occupational therapy assisting, respiratory care, 1 pharmacy, cosmetology arts and sciences, barbering, social 2 work, dietetics, marital and family therapy or mental health 3 counseling, massage therapy, mortuary science, polysomnography, 4 athletic training, acupuncture, nursing home administration, 5 hearing aid dispensing, or sign language interpreting 6 or transliterating, or shall not practice as a physician 7 assistant, unless the person has obtained a license for that 8 purpose from the board for the profession. 9 Sec. 3. Section 147.13, subsection 18, Code 2011, is amended 10 to read as follows: 11 18. For respiratory care and polysomnographic technology , 12 the board of respiratory care. 13 Sec. 4. Section 147.14, subsection 1, paragraph o, Code 14 2011, is amended to read as follows: 15 o. For respiratory care, one licensed physician with 16 training in respiratory care, three respiratory care 17 practitioners who have practiced respiratory care for a 18 minimum of six years immediately preceding their appointment 19 to the board and who are recommended by the society for 20 respiratory care, three members who are licensed to practice 21 polysomnographic technology, and one member two members 22 not licensed to practice medicine, osteopathic medicine, 23 polysomnographic technology, or respiratory care who shall 24 represent the general public. 25 Sec. 5. Section 147.74, Code 2011, is amended by adding the 26 following new subsection: 27 NEW SUBSECTION . 22A. A person who is licensed to engage 28 in the practice of polysomnography shall have the right to use 29 the title “polysomnographic technologist” or the abbreviation 30 “PSGT”. 31 Sec. 6. NEW SECTION . 148F.1 Definitions. 32 As used in this chapter, unless the context otherwise 33 requires: 34 1. “Board” means the board of respiratory care established 35 -2- LSB 5551SV (4) 84 jr/nh 2/ 11

S.F. 2273 in chapter 147. 1 2. “Direct supervision” means that the polysomnographic 2 technologist providing supervision must be present where the 3 polysomnographic procedure is being performed and immediately 4 available to furnish assistance and direction throughout the 5 performance of the procedure. 6 3. “General supervision” means that the polysomnographic 7 procedure is provided under a physician’s overall direction and 8 control, but the physician’s presence is not required during 9 the performance of the procedure. 10 4. “Physician” means a person who is currently licensed in 11 Iowa to practice medicine and surgery or osteopathic medicine 12 and surgery and who is board certified in sleep medicine and 13 who is actively involved in the sleep medicine center or 14 laboratory. 15 5. “Polysomnographic student” means a person who is enrolled 16 in a commission on accreditation of allied health education 17 program or an equivalent program accredited by a nationally 18 recognized accrediting agency and who may provide sleep-related 19 services under the direct supervision of a polysomnographic 20 technologist as a part of the person’s educational program. 21 6. “Polysomnographic technician” means a person who has 22 graduated from a commission on accreditation of allied health 23 education program or equivalent program accredited by a 24 nationally recognized accrediting agency, but has not yet 25 passed an accepted national credentialing examination given by 26 a testing body that is accredited by a nationally recognized 27 accrediting agency, credentialed in one of the health-related 28 fields accepted by the board of registered polysomnographic 29 technologists, may provide sleep-related services under the 30 direct supervision of a licensed polysomnographic technologist 31 for a period of up to thirty days postgraduation while awaiting 32 credentialing examination scheduling and results. 33 7. “Polysomnographic technologist” means a person who is 34 credentialed by a nationally recognized accrediting agency 35 -3- LSB 5551SV (4) 84 jr/nh 3/ 11

S.F. 2273 and is licensed by the board to engage in the practice of 1 polysomnography under the general supervision of a physician. 2 8. “Practice of polysomnography” means as described in 3 section 148F.2. 4 9. “Sleep-related services” means acts performed by 5 polysomnographic technicians, polysomnographic students, and 6 other persons permitted to perform those services under this 7 chapter, in a setting described in this chapter that would be 8 considered the practice of polysomnography if performed by a 9 polysomnographic technologist. 10 Sec. 7. NEW SECTION . 148F.2 Practice of polysomnography. 11 The practice of polysomnography consists of but is not 12 limited to the following tasks as performed for the purpose of 13 polysomnography, under the general supervision of a licensed 14 physician: 15 1. Monitoring, recording, and evaluating physiologic 16 data during polysomnographic testing and review during the 17 evaluation of sleep-related disorders, including sleep-related 18 respiratory disturbances, by applying any of the following 19 techniques, equipment, or procedures: 20 a. Noninvasive continuous, bilevel positive airway pressure, 21 or adaptive servo-ventilation titration on spontaneously 22 breathing patients using a mask or oral appliance; provided, 23 that the mask or oral appliance does not extend into the 24 trachea or attach to an artificial airway. 25 b. Supplemental low-flow oxygen therapy of less than six 26 liters per minute, utilizing a nasal cannula or incorporated 27 into a positive airway pressure device during a polysomnogram. 28 c. Capnography during a polysomnogram. 29 d. Cardiopulmonary resuscitation. 30 e. Pulse oximetry. 31 f. Gastroesophageal pH monitoring. 32 g. Esophageal pressure monitoring. 33 h. Sleep stage recording using surface 34 electroencephalography, surface electrooculography, and surface 35 -4- LSB 5551SV (4) 84 jr/nh 4/ 11

S.F. 2273 submental electromyography. 1 i. Surface electromyography. 2 j. Electrocardiography. 3 k. Respiratory effort monitoring, including thoracic and 4 abdominal movement. 5 l. Plethysmography blood flow monitoring. 6 m. Snore monitoring. 7 n. Audio and video monitoring. 8 o. Body movement monitoring. 9 p. Nocturnal penile tumescence monitoring. 10 q. Nasal and oral airflow monitoring. 11 r. Body temperature monitoring. 12 2. Monitoring the effects that a mask or oral appliance 13 used to treat sleep disorders has on sleep patterns; provided, 14 however, that the mask or oral appliance shall not extend into 15 the trachea or attach to an artificial airway. 16 3. Observing and monitoring physical signs and symptoms, 17 general behavior, and general physical response to 18 polysomnographic evaluation and determining whether initiation, 19 modification, or discontinuation of a treatment regimen is 20 warranted. 21 4. Analyzing and scoring data collected during the 22 monitoring described in this section for the purpose of 23 assisting a physician in the diagnosis and treatment of sleep 24 and wake disorders that result from developmental defects, 25 the aging process, physical injury, disease, or actual or 26 anticipated somatic dysfunction. 27 5. Implementation of a written or verbal order from a 28 licensed physician to perform polysomnography. 29 6. Education of a patient regarding the treatment regimen 30 that assists the patient in improving the patient’s sleep. 31 7. Use of any oral appliance used to treat sleep-disordered 32 breathing while under the care of a licensed polysomnographic 33 technologist during the performance of a sleep study, as 34 directed by a licensed dentist. 35 -5- LSB 5551SV (4) 84 jr/nh 5/ 11

S.F. 2273 Sec. 8. NEW SECTION . 148F.3 Location of services. 1 The practice of polysomnography shall take place only in a 2 facility that is accredited by a nationally recognized sleep 3 medicine laboratory or center accrediting agency; provided, 4 however, that the scoring of data and the education of patients 5 may take place in settings other than in a facility that is 6 accredited by a nationally recognized sleep medicine laboratory 7 or center accrediting agency. 8 Sec. 9. NEW SECTION . 148F.4 Scope of chapter. 9 Nothing in this chapter shall be construed to limit or 10 restrict a health care practitioner licensed in this state from 11 engaging in the full scope of practice of the individual’s 12 profession. Respiratory therapists licensed in Iowa and 13 working within the scope of practice of their license as 14 provided in chapter 152B are exempt from this chapter. 15 Sec. 10. NEW SECTION . 148F.5 Powers of the board. 16 The board may do any of the following: 17 1. Promulgate rules necessary for the implementation and 18 administration of this chapter and the applicable provisions 19 of chapter 147. 20 2. Establish fees as provided in section 147.80. 21 3. Review and approve or reject the application of each 22 person who applies for licensure as a polysomnographic 23 technologist. 24 4. Issue all temporary permits and all approved licenses and 25 renewals of licenses. 26 5. Deny, suspend, revoke, restrict, or impose conditions 27 on a license, as the board deems necessary or appropriate at 28 the time a license is issued, renewed, or reinstated, or as a 29 sanction imposed at the conclusion of a disciplinary hearing. 30 6. Issue private advisory letter rulings to any person 31 licensed under this chapter who makes a request for a ruling 32 regarding any matter within the board’s jurisdiction; provided, 33 however, that the ruling shall affect only the licensee making 34 the inquiry and shall have no precedential value for any other 35 -6- LSB 5551SV (4) 84 jr/nh 6/ 11

S.F. 2273 contested case or inquiry before the board or the committee. 1 7. Develop a code of ethics for the practice of 2 polysomnography. 3 8. Develop standards of care for the practice of 4 polysomnography. 5 9. Develop standards for the educational and clinical 6 training of polysomnographic technologists, including the 7 evaluation of the accreditation status of educational programs 8 in polysomnography. 9 10. Develop criteria for the evaluation of applications for 10 licensure submitted by polysomnographic technologists who are 11 licensed in other states. 12 11. Develop continuing education requirements for licensed 13 polysomnographic technologists. 14 Sec. 11. NEW SECTION . 148F.6 Licensing requirement. 15 1. a. Commencing January 1, 2013, a person who is engaged 16 in the practice of polysomnography shall be licensed as 17 provided in this chapter and it shall be unlawful for any 18 person to engage in the practice of polysomnography without 19 such license. 20 b. (1) Prior to January 1, 2013, a person who is engaged in 21 the practice of polysomnography without being licensed under 22 this chapter shall not be deemed to be in violation of this 23 chapter. 24 (2) A person who is engaged in the practice of 25 polysomnography on January 1, 2013, shall be eligible for 26 licensure under this chapter without meeting the educational 27 requirements of this section provided that the person meets 28 the requirements set out in this chapter. This person shall 29 meet or exceed the passing point of a nationally accepted 30 credentialing exam in polysomnographic technology by January 31 1, 2014. 32 2. A person seeking licensure as a polysomnographic 33 technologist shall be of good moral character, shall be at 34 least eighteen years of age, shall pay the fees established 35 -7- LSB 5551SV (4) 84 jr/nh 7/ 11

S.F. 2273 by the board for licensure, and shall present proof that the 1 person meets one of the following educational requirements: 2 a. Graduation from a polysomnographic educational program 3 that is accredited by the committee on accreditation of 4 polysomnographic technologist education or by a committee 5 on accreditation for the commission on accreditation of 6 allied health education programs, or an equivalent program as 7 determined by the board. 8 b. Graduation from a respiratory care educational program 9 that is accredited by the commission on accreditation 10 for respiratory care or by a committee on accreditation 11 for the commission on accreditation of allied health 12 education programs, and completion of the curriculum for a 13 polysomnographic certificate established and accredited by the 14 commission on accreditation of allied health education programs 15 as an extension of the respiratory care program. 16 c. Graduation from an electroneurodiagnostic technologist 17 educational program that is accredited by the committee 18 on accreditation for education in electroneurodiagnostic 19 technology or by a committee on accreditation for the 20 commission on accreditation of allied health education 21 programs, and completion of the curriculum for a 22 polysomnography certificate established and accredited by the 23 commission on accreditation of allied health education programs 24 as an extension of the electroneurodiagnostic education 25 program. 26 3. To be eligible for renewal of a license to engage in the 27 practice of polysomnography, a polysomnographic technologist 28 shall maintain that person’s credential in compliance with 29 rules set forth by a national accredited certifying agency, as 30 adopted by the board in rule. 31 Sec. 12. NEW SECTION . 148F.7 Persons exempt from licensing 32 requirement —— temporary permit. 33 1. The following persons may provide sleep-related services 34 without being licensed as a polysomnographic technologist under 35 -8- LSB 5551SV (4) 84 jr/nh 8/ 11

S.F. 2273 this chapter: 1 a. A polysomnographic technician may provide sleep-related 2 services under the general supervision of a physician for 3 a period of up to six months from the date of the person’s 4 graduation from one of the accredited programs described in 5 section 148F.6. The board may in its sole discretion grant a 6 one-time extension of up to three months beyond this one-year 7 period. 8 b. A polysomnographic student may provide sleep-related 9 services under the direct supervision of a polysomnographic 10 technologist as a part of the person’s educational program 11 while actively enrolled in a polysomnographic educational 12 program that is accredited by the commission on accreditation 13 of allied health education programs or an equivalent program as 14 determined by the board. 15 c. A person, other than a respiratory care practitioner 16 licensed under this chapter, credentialed in one of the 17 health-related fields accepted by the board of registered 18 polysomnographic technologists or another nationally 19 recognized accrediting agency, or a graduate of a commission on 20 accreditation of allied health educational program may provide 21 sleep-related services under direct supervision of a licensed 22 polysomnographic technologist for a period up to thirty 23 days postgraduation while awaiting credentialing examination 24 scheduling and results. 25 2. Before providing any sleep-related services, a 26 polysomnographic technician shall obtain a temporary permit 27 from the board. While providing sleep-related services, the 28 technician shall wear a badge that appropriately identifies the 29 person as a polysomnographic technician. 30 3. Before providing any sleep-related services, a person 31 who is obtaining clinical experience shall give notice to the 32 board that the person is working under the direct supervision 33 of a polysomnographic technologist in order to gain the 34 experience to be eligible to sit for a national certification 35 -9- LSB 5551SV (4) 84 jr/nh 9/ 11

S.F. 2273 examination. The person shall wear a badge that appropriately 1 identifies the person while providing such services. 2 4. Polysomnographic students shall not receive compensation 3 for the sleep-related services they provide and shall wear 4 badges that appropriately identify them as students. 5 Sec. 13. NEW SECTION . 148F.8 Issuance, retirement, and 6 renewal of licenses. 7 1. The board shall issue and renew licenses under this 8 chapter as provided by the board in rule. 9 2. A person who has been issued a license to practice under 10 this chapter who wishes to retire that license shall file with 11 the board an affidavit on a form to be furnished by the board 12 stating the date on which the person retired from practice 13 and other facts that verify the retirement as the board deems 14 necessary. Any such person who thereafter wishes to reenter 15 practice shall request reinstatement of licensure. 16 3. A license issued by the board under this chapter 17 shall contain the name and address of the person to whom it 18 is issued, the date and number of the license, and other 19 information that the board deems necessary. 20 a. The address contained on the license shall be the address 21 where all correspondence and renewal forms from the board shall 22 be sent. 23 b. Any person whose address changes shall, within thirty 24 days after the change in address, notify the board of the 25 address change. The most recent address contained in the 26 board’s records for each license holder shall be the address 27 deemed sufficient for purposes of service of process. 28 4. A license shall either be prominently displayed in the 29 office or place in which the person practices or be stored in a 30 place from which it can be immediately produced upon request of 31 a patient or representative of the board. 32 5. A person whose license has been lost may make application 33 to the board for a replacement. The application shall be 34 accompanied by an affidavit setting out the facts concerning 35 -10- LSB 5551SV (4) 84 jr/nh 10/ 11

S.F. 2273 the loss of the original license. 1 Sec. 14. NEW SECTION . 148F.9 Licensing sanctions. 2 The board may impose sanctions for violations of this 3 chapter as provided in chapters 147 and 272C. 4 Sec. 15. INITIAL APPOINTMENTS. 5 1. Initial appointments of polysomnographic technologists 6 to the board of respiratory care pursuant to this Act shall be 7 made as follows: two members shall be appointed to a term of 8 three years and one member shall be appointed to a term of one 9 year. Each regular appointment thereafter shall be for a term 10 of three years. 11 2. The Iowa sleep society may submit a list of three 12 names to the governor for each position to be filled by a 13 polysomnographic technologist. 14 EXPLANATION 15 This bill requires the licensing of polysomnographic 16 technologists and makes the provisions of Code chapters 147 17 and 272C, including penalty and other regulatory provisions, 18 applicable to other health professions applicable to the 19 practice of polysomnography. Code section 147.86 provides 20 that it is a serious misdemeanor to violate a provision of 21 the licensing laws. The licensing program is administered 22 and regulated by the board of respiratory care, with four new 23 members added; three polysomngraphic technologists and one 24 additional public member, for a total of nine members. 25 A licensed polysomnographic technologist practices under 26 the general supervision of a licensed physician, providing 27 specifically enumerated services related to sleep disorders. A 28 polysomnographic student enrolled in an approved educational 29 program provides services under the direct supervision of a 30 polysomnographic technologist. 31 The bill sets out educational standards and testing 32 requirements, and provides for disciplinary actions. 33 -11- LSB 5551SV (4) 84 jr/nh 11/ 11