S.F. _____ 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 5551XC (2) 84 jr/nh 1/ 13

S.F. _____ 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 1, Code 2011, is amended 10 to read as follows: 11 1. For medicine and surgery, osteopathic medicine and 12 surgery, and acupuncture, and polysomnography, the board of 13 medicine. 14 Sec. 4. Section 147.74, Code 2011, is amended by adding the 15 following new subsection: 16 NEW SUBSECTION . 22A. A person who is licensed to engage 17 in the practice of polysomnography shall have the right to use 18 the title “polysomnographic technologist” or the abbreviation 19 “P.S.G.T.”. 20 Sec. 5. NEW SECTION . 148F.1 Definitions. 21 As used in this chapter, unless the context otherwise 22 requires: 23 1. “Board” means the board of medicine established in 24 chapter 147. 25 2. “Committee” means the polysomnography professional 26 standards committee established in section 148F.5. 27 3. “Direct supervision” means that the polysomnographic 28 technologist providing supervision must be present in the 29 area where the polysomnographic procedure is being performed 30 and immediately available to furnish assistance and direction 31 throughout the performance of the procedure. 32 4. “General supervision” means that the polysomnographic 33 procedure is provided under a physician’s overall direction and 34 control, but the physician’s presence is not required during 35 -2- LSB 5551XC (2) 84 jr/nh 2/ 13

S.F. _____ the performance of the procedure. 1 5. “Physician” means a person who is currently licensed in 2 Iowa to practice medicine and surgery or osteopathic medicine 3 and surgery. 4 6. “Polysomnographic student” means a person who is enrolled 5 in a commission on accreditation of allied health education 6 program or an equivalent program as determined by the board, 7 and who may provide sleep-related services under the direct 8 supervision of a polysomnographic technologist as a part of the 9 person’s educational program. 10 7. “Polysomnographic technician” means a person who has 11 graduated from a commission on accreditation of allied health 12 education program or an equivalent program as determined by the 13 board but has not yet passed an accepted national credentialing 14 examination given by an approved certifying agency, who has 15 obtained a temporary permit from the board, and who may provide 16 sleep-related services under the general supervision of a 17 licensed physician. 18 8. “Polysomnographic technologist” means a person who is 19 credentialed by an approved certifying agency and is licensed 20 by the board to engage in the practice of polysomnography under 21 the general supervision of a physician. 22 9. “Polysomnographic trainee” means a person who is enrolled 23 in an accredited sleep technologist educational program that is 24 accredited by the American academy of sleep medicine and who 25 may provide sleep-related services under the direct supervision 26 of a polysomnographic technologist as a part of the person’s 27 educational program. 28 10. “Practice of polysomnography” means as described in 29 section 148F.2. 30 11. “Sleep-related services” means acts performed by 31 polysomnographic technicians, polysomnographic trainees, 32 polysomnographic students, and other persons permitted to 33 perform those services under this chapter, in a setting 34 described in this chapter that would be considered the 35 -3- LSB 5551XC (2) 84 jr/nh 3/ 13

S.F. _____ practice of polysomnography if performed by a polysomnographic 1 technologist. 2 Sec. 6. NEW SECTION . 148F.2 Practice of polysomnography. 3 The practice of polysomnography consists of the following 4 tasks, under the general supervision of a licensed physician: 5 1. Monitoring, recording, and evaluating physiologic data 6 during the evaluation of sleep-related disorders, including 7 sleep-related respiratory disturbances, by applying any of the 8 following techniques, equipment, or procedures: 9 a. Noninvasive continuous, bilevel positive airway pressure, 10 or adaptive servo-ventilation titration on spontaneously 11 breathing patients using a mask or oral appliance; provided, 12 that the mask or oral appliance does not extend into the 13 trachea or attach to an artificial airway. 14 b. Supplemental low-flow oxygen therapy of less than six 15 liters per minute, utilizing a nasal cannula or incorporated 16 into a positive airway pressure device during a polysomnogram. 17 c. Capnography during a polysomnogram. 18 d. Cardiopulmonary resuscitation. 19 e. Pulse oximetry. 20 f. Gastroesophageal pH monitoring. 21 g. Esophageal pressure monitoring. 22 h. Sleep stage recording using surface 23 electroencephalography, surface electrooculography, and surface 24 submental electromyography. 25 i. Surface electromyography. 26 j. Electrocardiography. 27 k. Respiratory effort monitoring, including thoracic and 28 abdominal movement. 29 l. Plethysmography blood flow monitoring. 30 m. Snore monitoring. 31 n. Audio and video monitoring. 32 o. Body movement monitoring. 33 p. Nocturnal penile tumescence monitoring. 34 q. Nasal and oral airflow monitoring. 35 -4- LSB 5551XC (2) 84 jr/nh 4/ 13

S.F. _____ r. Body temperature monitoring. 1 2. Monitoring the effects that a mask or oral appliance 2 used to treat sleep disorders has on sleep patterns; provided, 3 however, that the mask or oral appliance shall not extend into 4 the trachea or attach to an artificial airway. 5 3. Observing and monitoring physical signs and symptoms, 6 general behavior, and general physical response to 7 polysomnographic evaluation and determining whether initiation, 8 modification, or discontinuation of a treatment regimen is 9 warranted. 10 4. Analyzing and scoring data collected during the 11 monitoring described in this section for the purpose of 12 assisting a physician in the diagnosis and treatment of sleep 13 and wake disorders that result from developmental defects, 14 the aging process, physical injury, disease, or actual or 15 anticipated somatic dysfunction. 16 5. Implementation of a written or verbal order from a 17 licensed physician to perform polysomnography. 18 6. Education of a patient regarding the treatment regimen 19 that assists the patient in improving the patient’s sleep. 20 7. Use of any oral appliance used to treat sleep-disordered 21 breathing while under the care of a licensed polysomnographic 22 technologist during the performance of a sleep study, as 23 directed by a licensed dentist. 24 Sec. 7. NEW SECTION . 148F.3 Location of services. 25 The practice of polysomnography shall take place only in a 26 hospital, a stand-alone sleep laboratory or sleep center, or 27 in the patient’s residence in accordance with a physician’s 28 order; provided, however, that the scoring of data and the 29 education of patients may take place in settings other than in 30 a hospital, sleep laboratory, sleep center, or the patient’s 31 residence. 32 Sec. 8. NEW SECTION . 148F.4 Scope of chapter. 33 Nothing in this chapter shall be construed to limit or 34 restrict a health care practitioner licensed in this state from 35 -5- LSB 5551XC (2) 84 jr/nh 5/ 13

S.F. _____ engaging in the full scope of practice of the individual’s 1 profession. 2 Sec. 9. NEW SECTION . 148F.5 Polysomnography professional 3 standards committee. 4 1. A polysomnography professional standards committee is 5 established to advise the board in the performance of its 6 duties under this chapter. The committee consists of the 7 following members, appointed by the governor: 8 a. Two licensed polysomnographic technologists. 9 b. One physician who is certified in sleep medicine by a 10 national certifying body recognized by the American academy of 11 sleep medicine. 12 c. One respiratory therapist who is also a licensed 13 polysomnographic technologist. 14 d. One electroneurodiagnostic technologist who is also a 15 licensed polysomnographic technologist. 16 e. One consumer member who is not commercially or 17 professionally associated with the health care field. 18 2. Members shall receive expense payments and per diem as 19 provided in section 147.24. 20 3. Members shall serve four-year terms, and shall serve 21 until their successors have been appointed. 22 4. The committee shall select a chairperson from its 23 membership. 24 5. A majority of the committee shall constitute a quorum. 25 6. The board shall provide administrative, investigatory, 26 and clerical services to the committee as necessary to 27 implement and enforce this chapter. 28 7. Any vacant term shall be filled by the governor for the 29 balance of the four-year term. 30 Sec. 10. NEW SECTION . 148F.6 Duties of the committee. 31 The polysomnography professional standards committee shall 32 do all of the following: 33 1. Advise the board regarding standards for licensed 34 polysomnographic technologists. 35 -6- LSB 5551XC (2) 84 jr/nh 6/ 13

S.F. _____ 2. Provide for distribution of information regarding 1 licensed polysomnographic technologist standards. 2 3. Advise the board on enforcement issues. 3 4. Review applications for licensure and license renewal 4 and recommend the granting or denial thereof. 5 5. Advise the board on issues related to receiving and 6 investigating complaints, conducting hearings, and imposing 7 disciplinary action in relation to complaints against licensed 8 polysomnographic technologists. 9 6. Review polysomnographic technology education and 10 training for and make specific recommendations to the board 11 regarding the qualifications to practice. 12 7. Advise the board regarding approval of continuing 13 education programs. 14 Sec. 11. NEW SECTION . 148F.7 Powers of the board. 15 The board, with the advice of the polysomnography 16 professional standards committee, 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 committee’s jurisdiction; 33 provided, however, that the ruling shall affect only the 34 licensee making the inquiry and shall have no precedential 35 -7- LSB 5551XC (2) 84 jr/nh 7/ 13

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

S.F. _____ a. Meet one of the following educational requirements: 1 (1) Graduation from a polysomnographic educational program 2 that is accredited by the committee on accreditation of 3 polysomnographic technologist education or by a committee 4 on accreditation for the commission on accreditation of 5 allied health education programs, or an equivalent program as 6 determined by the board. 7 (2) Graduation from a respiratory care educational 8 program that is accredited by the committee on accreditation 9 for respiratory care or by a committee on accreditation 10 for the commission on accreditation of allied health 11 education programs, and completion of the curriculum for a 12 polysomnographic certificate established and accredited by the 13 commission on accreditation of allied health education programs 14 as an extension of the respiratory care program. 15 (3) Graduation from an electroneurodiagnostic technologist 16 educational program that is accredited by the committee 17 on accreditation for education in electroneurodiagnostic 18 technology or by a committee on accreditation for the 19 commission on accreditation of allied health education 20 programs, and completion of the curriculum for a 21 polysomnography certificate established and accredited by the 22 commission on accreditation of allied health education programs 23 as an extension of the electroneurodiagnostic education 24 program. 25 (4) Successful completion of an accredited sleep 26 technologist educational program that is accredited by the 27 American academy of sleep medicine. 28 b. Pass the national certifying examination given by 29 the board of registered polysomnographic technologists or a 30 nationally recognized accredited certifying agency. 31 c. Be credentialed by the board of registered 32 polysomnographic technologists or a nationally recognized 33 accredited certifying agency. 34 d. Meet any additional educational or clinical requirements 35 -9- LSB 5551XC (2) 84 jr/nh 9/ 13

S.F. _____ established by the board, as recommended by the committee. 1 3. To be eligible for renewal of a license to engage in the 2 practice of polysomnography, a polysomnographic technologist 3 shall maintain that person’s credential in compliance with 4 rules set forth by a national accredited certifying agency, as 5 adopted by the board in rule. 6 Sec. 13. NEW SECTION . 148F.9 Persons exempt from licensing 7 requirement —— temporary permit. 8 1. The following persons may provide sleep-related services 9 without being licensed as a polysomnographic technologist under 10 this chapter: 11 a. A polysomnographic technician may provide sleep-related 12 services under the general supervision of a physician for 13 a period of up to six months from the date of the person’s 14 graduation from one of the accredited programs described in 15 section 148F.8. The board may in its sole discretion grant a 16 one-time extension of up to three months beyond this one-year 17 period. 18 b. A polysomnographic trainee 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 while actively enrolled in an accredited sleep technologist 22 educational program. 23 c. A polysomnographic student may provide sleep-related 24 services under the direct supervision of a polysomnographic 25 technologist as a part of the person’s educational program 26 while actively enrolled in a polysomnographic educational 27 program that is accredited by the commission on accreditation 28 of allied health education programs or an equivalent program as 29 determined by the board. 30 d. A person, other than a respiratory care practitioner 31 licensed under this chapter, credentialed in one of the 32 health-related fields accepted by the board of registered 33 polysomnographic technologists or another nationally recognized 34 certifying agency, may provide sleep-related services under 35 -10- LSB 5551XC (2) 84 jr/nh 10/ 13

S.F. _____ the direct supervision of a polysomnographic technologist 1 for a period of up to one year while obtaining the clinical 2 experience necessary to be eligible to take the examination. 3 2. Before providing any sleep-related services, a 4 polysomnographic technician shall obtain a temporary permit 5 from the board. While providing sleep-related services, the 6 technician shall wear a badge that appropriately identifies the 7 person as a polysomnographic technician. 8 3. Before providing any sleep-related services, a 9 polysomnographic trainee shall give notice to the board that 10 the trainee is enrolled in an approved educational program. 11 Trainees shall wear a badge that appropriately identifies the 12 trainee as a polysomnographic trainee while providing such 13 services. 14 4. Before providing any sleep-related services, a person 15 who is obtaining clinical experience shall give notice to the 16 board that the person is working under the direct supervision 17 of a polysomnographic technologist in order to gain the 18 experience to be eligible to sit for a national certification 19 examination. The person shall wear a badge that appropriately 20 identifies the person while providing such services. 21 5. Polysomnographic students shall not receive compensation 22 for the sleep-related services they provide and shall wear 23 badges that appropriately identify them as students. 24 Sec. 14. NEW SECTION . 148F.10 Issuance, retirement, and 25 renewal of licenses. 26 1. The board shall issue and renew licenses under this 27 chapter as provided by the board in rule. 28 2. A person who has been issued a license to practice under 29 this chapter who wishes to retire that license shall file with 30 the committee an affidavit on a form to be furnished by the 31 committee stating the date on which the person retired from 32 practice and other facts that verify the retirement as the 33 board deems necessary. Any such person who thereafter wishes 34 to reenter practice shall request reinstatement of licensure. 35 -11- LSB 5551XC (2) 84 jr/nh 11/ 13

S.F. _____ 3. A license issued by the board under this chapter 1 shall contain the name and address of the person to whom it 2 is issued, the date and number of the license, and other 3 information that the board deems necessary. 4 a. The address contained on the license shall be the address 5 where all correspondence and renewal forms from the board shall 6 be sent. 7 b. Any person whose address changes shall, within thirty 8 days after the change in address, notify the board of the 9 address change. The most recent address contained in the 10 board’s records for each license holder shall be the address 11 deemed sufficient for purposes of service of process. 12 4. A license shall either be prominently displayed in the 13 office or place in which the person practices or be stored in a 14 place from which it can be immediately produced upon request of 15 a patient or representative of the board. 16 5. A person whose license has been lost may make application 17 to the committee for a replacement. The application shall be 18 accompanied by an affidavit setting out the facts concerning 19 the loss of the original license. 20 Sec. 15. NEW SECTION . 148F.11 Licensing sanctions. 21 The board may impose sanctions for violations of this 22 chapter as provided in chapters 147 and 272C. 23 Sec. 16. INITIAL APPOINTMENTS. 24 1. Initial appointments to the polysomnography professional 25 standards committee shall be made as follows: two members 26 shall be appointed to terms of four years, two members shall 27 be appointed to terms of three years, and two members shall be 28 appointed to a term of two years. Each regular appointment 29 thereafter shall be for a term of four years. 30 2. The governor may consider for appointment to the 31 committee the names of persons recommended by the professional 32 organizations for each profession represented on the committee. 33 The Iowa sleep society may submit a list of three names for 34 each position to be filled by a polysomnographic technologist. 35 -12- LSB 5551XC (2) 84 jr/nh 12/ 13

S.F. _____ The Iowa respiratory care society may submit a list of three 1 names for the position to be filled by a respiratory therapist. 2 The Iowa state medical association may submit a list of three 3 names for the position to be filled by a physician. 4 EXPLANATION 5 This bill requires the licensing of polysomnographic 6 technologists and makes the provisions of Code chapters 147 7 and 272C, including penalty and other regulatory provisions, 8 applicable to other health professions applicable to the 9 practice of polysomnography. Code section 147.86 provides 10 that it is a serious misdemeanor to violate a provision of 11 the licensing laws. The licensing program is administered 12 and regulated by the board of medicine, with the advice of a 13 polysomnography professional standards committee. 14 A licensed polysomnographic technologist practices under 15 the general supervision of a licensed physician, providing 16 specifically enumerated services related to sleep disorders. 17 A polysomnographic student or trainee enrolled in an approved 18 educational program provides services under the direct 19 supervision of a polysomnographic technologist. 20 The bill sets out educational standards and testing 21 requirements, and provides for disciplinary actions. 22 -13- LSB 5551XC (2) 84 jr/nh 13/ 13