SENATE FILE _____

BY  (PROPOSED COMMITTEE ON STATE GOVERNMENT BILL BY CHAIRPERSON DANIELSON)

A BILL FOR

An Act providing for the licensing of polysomnographic technologists and providing for a penalty.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  Section 147.1, subsections 3 and 6, Code 2011, are amended to read as follows:
   3.  “Licensed” or “certified”, when applied to a physician and surgeon, podiatric physician, osteopathic physician and surgeon, physician assistant, psychologist, chiropractor, nurse, dentist, dental hygienist, dental assistant, optometrist, speech pathologist, audiologist, pharmacist, physical therapist, physical therapist assistant, occupational therapist, occupational therapy assistant, respiratory care practitioner, practitioner of cosmetology arts and sciences, practitioner of barbering, funeral director, dietitian, marital and family therapist, mental health counselor,
 
polysomnographic technologist, social worker, massage therapist, athletic trainer, acupuncturist, nursing home administrator, hearing aid dispenser, or sign language interpreter or transliterator means a person licensed under this subtitle.
   6.  “Profession” means medicine and surgery, podiatry, osteopathic medicine and surgery, practice as a physician assistant, psychology, chiropractic, nursing, dentistry, dental hygiene, dental assisting, optometry, speech pathology, audiology, pharmacy, physical therapy, physical therapist assisting, occupational therapy, occupational therapy assisting, respiratory care, cosmetology arts and sciences, barbering, mortuary science, marital and family therapy, mental health counseling,
 
polysomnography, social work, dietetics, massage therapy, athletic training, acupuncture, nursing home administration, hearing aid dispensing, or sign language interpreting or transliterating.
    Sec. 2.  Section 147.2, subsection 1, Code 2011, is amended to read as follows:
   1.  A person shall not engage in the practice of medicine and surgery, podiatry, osteopathic medicine and surgery, psychology, chiropractic, physical therapy, physical therapist assisting, nursing, dentistry, dental hygiene, dental assisting, optometry, speech pathology, audiology, occupational therapy, occupational therapy assisting, respiratory care, pharmacy, cosmetology arts and sciences, barbering, social work, dietetics, marital and family therapy or mental health counseling, massage therapy, mortuary science,
 
polysomnography, athletic training, acupuncture, nursing home administration, hearing aid dispensing, or sign language interpreting or transliterating, or shall not practice as a physician assistant, unless the person has obtained a license for that purpose from the board for the profession.
    Sec. 3.  Section 147.13, subsection 1, Code 2011, is amended to read as follows:
   1.  For medicine and surgery, osteopathic medicine and surgery, and acupuncture,
 
and polysomnography, the board of medicine.
    Sec. 4.  Section 147.74, Code 2011, is amended by adding the following new subsection:
   NEW SUBSECTION.  22A.  A person who is licensed to engage in the practice of polysomnography shall have the right to use the title “polysomnographic technologist” or the abbreviation “P.S.G.T.”.
    Sec. 5.  NEW SECTION.  148F.1  Definitions.
   As used in this chapter, unless the context otherwise requires:
   1.  “Board” means the board of medicine established in chapter 147.
   2.  “Committee” means the polysomnography professional standards committee established in section 148F.5.
   3.  “Direct supervision” means that the polysomnographic technologist providing supervision must be present in the area where the polysomnographic procedure is being performed and immediately available to furnish assistance and direction throughout the performance of the procedure.
   4.  “General supervision” means that the polysomnographic procedure is provided under a physician’s overall direction and control, but the physician’s presence is not required during the performance of the procedure.
   5.  “Physician” means a person who is currently licensed in Iowa to practice medicine and surgery or osteopathic medicine and surgery.
   6.  “Polysomnographic student” means a person who is enrolled in a commission on accreditation of allied health education program or an equivalent program as determined by the board, and who may provide sleep-related services under the direct supervision of a polysomnographic technologist as a part of the person’s educational program.
   7.  “Polysomnographic technician” means a person who has graduated from a commission on accreditation of allied health education program or an equivalent program as determined by the board but has not yet passed an accepted national credentialing examination given by an approved certifying agency, who has obtained a temporary permit from the board, and who may provide sleep-related services under the general supervision of a licensed physician.
   8.  “Polysomnographic technologist” means a person who is credentialed by an approved certifying agency and is licensed by the board to engage in the practice of polysomnography under the general supervision of a physician.
   9.  “Polysomnographic trainee” means a person who is enrolled in an accredited sleep technologist educational program that is accredited by the American academy of sleep medicine and who may provide sleep-related services under the direct supervision of a polysomnographic technologist as a part of the person’s educational program.
   10.  “Practice of polysomnography” means as described in section 148F.2.
   11.  “Sleep-related services” means acts performed by polysomnographic technicians, polysomnographic trainees, polysomnographic students, and other persons permitted to perform those services under this chapter, in a setting described in this chapter that would be considered the practice of polysomnography if performed by a polysomnographic technologist.
    Sec. 6.  NEW SECTION.  148F.2  Practice of polysomnography.
   The practice of polysomnography consists of the following tasks, under the general supervision of a licensed physician:
   1.  Monitoring, recording, and evaluating physiologic data during the evaluation of sleep-related disorders, including sleep-related respiratory disturbances, by applying any of the following techniques, equipment, or procedures:
   a.  Noninvasive continuous, bilevel positive airway pressure, or adaptive servo-ventilation titration on spontaneously breathing patients using a mask or oral appliance; provided, that the mask or oral appliance does not extend into the trachea or attach to an artificial airway.
   b.  Supplemental low-flow oxygen therapy of less than six liters per minute, utilizing a nasal cannula or incorporated into a positive airway pressure device during a polysomnogram.
   c.  Capnography during a polysomnogram.
   d.  Cardiopulmonary resuscitation.
   e.  Pulse oximetry.
   f.  Gastroesophageal pH monitoring.
   g.  Esophageal pressure monitoring.
   h.  Sleep stage recording using surface electroencephalography, surface electrooculography, and surface submental electromyography.
   i.  Surface electromyography.
   j.  Electrocardiography.
   k.  Respiratory effort monitoring, including thoracic and abdominal movement.
   l.  Plethysmography blood flow monitoring.
   m.  Snore monitoring.
   n.  Audio and video monitoring.
   o.  Body movement monitoring.
   p.  Nocturnal penile tumescence monitoring.
   q.  Nasal and oral airflow monitoring.

   r.  Body temperature monitoring.
   2.  Monitoring the effects that a mask or oral appliance used to treat sleep disorders has on sleep patterns; provided, however, that the mask or oral appliance shall not extend into the trachea or attach to an artificial airway.
   3.  Observing and monitoring physical signs and symptoms, general behavior, and general physical response to polysomnographic evaluation and determining whether initiation, modification, or discontinuation of a treatment regimen is warranted.
   4.  Analyzing and scoring data collected during the monitoring described in this section for the purpose of assisting a physician in the diagnosis and treatment of sleep and wake disorders that result from developmental defects, the aging process, physical injury, disease, or actual or anticipated somatic dysfunction.
   5.  Implementation of a written or verbal order from a licensed physician to perform polysomnography.
   6.  Education of a patient regarding the treatment regimen that assists the patient in improving the patient’s sleep.
   7.  Use of any oral appliance used to treat sleep-disordered breathing while under the care of a licensed polysomnographic technologist during the performance of a sleep study, as directed by a licensed dentist.
    Sec. 7.  NEW SECTION.  148F.3  Location of services.
   The practice of polysomnography shall take place only in a hospital, a stand-alone sleep laboratory or sleep center, or in the patient’s residence in accordance with a physician’s order; provided, however, that the scoring of data and the education of patients may take place in settings other than in a hospital, sleep laboratory, sleep center, or the patient’s residence.
    Sec. 8.  NEW SECTION.  148F.4  Scope of chapter.
   Nothing in this chapter shall be construed to limit or restrict a health care practitioner licensed in this state from engaging in the full scope of practice of the individual’s profession.
    Sec. 9.  NEW SECTION.  148F.5  Polysomnography professional standards committee.
   1.  A polysomnography professional standards committee is established to advise the board in the performance of its duties under this chapter. The committee consists of the following members, appointed by the governor:
   a.  Two licensed polysomnographic technologists.
   b.  One physician who is certified in sleep medicine by a national certifying body recognized by the American academy of sleep medicine.
   c.  One respiratory therapist who is also a licensed polysomnographic technologist.
   d.  One electroneurodiagnostic technologist who is also a licensed polysomnographic technologist.
   e.  One consumer member who is not commercially or professionally associated with the health care field.
   2.  Members shall receive expense payments and per diem as provided in section 147.24.
   3.  Members shall serve four-year terms, and shall serve until their successors have been appointed.
   4.  The committee shall select a chairperson from its membership.
   5.  A majority of the committee shall constitute a quorum.
   6.  The board shall provide administrative, investigatory, and clerical services to the committee as necessary to implement and enforce this chapter.
   7.  Any vacant term shall be filled by the governor for the balance of the four-year term.
    Sec. 10.  NEW SECTION.  148F.6  Duties of the committee.
   The polysomnography professional standards committee shall do all of the following:
   1.  Advise the board regarding standards for licensed polysomnographic technologists.

   2.  Provide for distribution of information regarding licensed polysomnographic technologist standards.
   3.  Advise the board on enforcement issues.
   4.  Review applications for licensure and license renewal and recommend the granting or denial thereof.
   5.  Advise the board on issues related to receiving and investigating complaints, conducting hearings, and imposing disciplinary action in relation to complaints against licensed polysomnographic technologists.
   6.  Review polysomnographic technology education and training for and make specific recommendations to the board regarding the qualifications to practice.
   7.  Advise the board regarding approval of continuing education programs.
    Sec. 11.  NEW SECTION.  148F.7  Powers of the board.
   The board, with the advice of the polysomnography professional standards committee, may do any of the following:
   1.  Promulgate rules necessary for the implementation and administration of this chapter and the applicable provisions of chapter 147.
   2.  Establish fees as provided in section 147.80.
   3.  Review and approve or reject the application of each person who applies for licensure as a polysomnographic technologist.
   4.  Issue all temporary permits and all approved licenses and renewals of licenses.
   5.  Deny, suspend, revoke, restrict, or impose conditions on a license, as the board deems necessary or appropriate at the time a license is issued, renewed, or reinstated, or as a sanction imposed at the conclusion of a disciplinary hearing.
   6.  Issue private advisory letter rulings to any person licensed under this chapter who makes a request for a ruling regarding any matter within the committee’s jurisdiction; provided, however, that the ruling shall affect only the licensee making the inquiry and shall have no precedential value for any other contested case or inquiry before the board or the committee.
   7.  Develop a code of ethics for the practice of polysomnography.
   8.  Develop standards of care for the practice of polysomnography.
   9.  Develop standards for the educational and clinical training of polysomnographic technologists, including the evaluation of the accreditation status of educational programs in polysomnography.
   10.  Develop criteria for the evaluation of applications for licensure submitted by polysomnographic technologists who are licensed in other states.
   11.  Develop continuing education requirements for licensed polysomnographic technologists.
    Sec. 12.  NEW SECTION.  148F.8  Licensing requirement.
   1.
  a.  Commencing January 1, 2013, a person who is engaged in the practice of polysomnography shall be licensed as provided in this chapter and it shall be unlawful for any person to engage in the practice of polysomnography without such license.
   b.
  (1)  Prior to January 1, 2013, a person who is engaged in the practice of polysomnography without being licensed under this chapter shall not be deemed to be in violation of this chapter.
   (2)  A person who is engaged in the practice of polysomnography on January 1, 2013, shall be eligible for licensure under this chapter without meeting the educational requirements of this section provided that the person meets the requirements of subsection 2, paragraphs “b”, “c”, and “d”.
   2.  A person seeking licensure as a polysomnographic technologist shall be of good moral character, shall be at least eighteen years of age, shall pay the fees established by the board for licensure, and shall present proof that the person meets all of the following requirements:

   a.  Meet one of the following educational requirements:
   (1)  Graduation from a polysomnographic educational program that is accredited by the committee on accreditation of polysomnographic technologist education or by a committee on accreditation for the commission on accreditation of allied health education programs, or an equivalent program as determined by the board.
   (2)  Graduation from a respiratory care educational program that is accredited by the committee on accreditation for respiratory care or by a committee on accreditation for the commission on accreditation of allied health education programs, and completion of the curriculum for a polysomnographic certificate established and accredited by the commission on accreditation of allied health education programs as an extension of the respiratory care program.
   (3)  Graduation from an electroneurodiagnostic technologist educational program that is accredited by the committee on accreditation for education in electroneurodiagnostic technology or by a committee on accreditation for the commission on accreditation of allied health education programs, and completion of the curriculum for a polysomnography certificate established and accredited by the commission on accreditation of allied health education programs as an extension of the electroneurodiagnostic education program.
   (4)  Successful completion of an accredited sleep technologist educational program that is accredited by the American academy of sleep medicine.
   b.  Pass the national certifying examination given by the board of registered polysomnographic technologists or a nationally recognized accredited certifying agency.
   c.  Be credentialed by the board of registered polysomnographic technologists or a nationally recognized accredited certifying agency.
   d.  Meet any additional educational or clinical requirements established by the board, as recommended by the committee.
   3.  To be eligible for renewal of a license to engage in the practice of polysomnography, a polysomnographic technologist shall maintain that person’s credential in compliance with rules set forth by a national accredited certifying agency, as adopted by the board in rule.
    Sec. 13.  NEW SECTION.  148F.9  Persons exempt from licensing requirement —— temporary permit.
   1.  The following persons may provide sleep-related services without being licensed as a polysomnographic technologist under this chapter:
   a.  A polysomnographic technician may provide sleep-related services under the general supervision of a physician for a period of up to six months from the date of the person’s graduation from one of the accredited programs described in section 148F.8. The board may in its sole discretion grant a one-time extension of up to three months beyond this one-year period.
   b.  A polysomnographic trainee may provide sleep-related services under the direct supervision of a polysomnographic technologist as a part of the person’s educational program while actively enrolled in an accredited sleep technologist educational program.
   c.  A polysomnographic student may provide sleep-related services under the direct supervision of a polysomnographic technologist as a part of the person’s educational program while actively enrolled in a polysomnographic educational program that is accredited by the commission on accreditation of allied health education programs or an equivalent program as determined by the board.
   d.  A person, other than a respiratory care practitioner licensed under this chapter, credentialed in one of the health-related fields accepted by the board of registered polysomnographic technologists or another nationally recognized certifying agency, may provide sleep-related services under the direct supervision of a polysomnographic technologist for a period of up to one year while obtaining the clinical experience necessary to be eligible to take the examination.
   2.  Before providing any sleep-related services, a polysomnographic technician shall obtain a temporary permit from the board. While providing sleep-related services, the technician shall wear a badge that appropriately identifies the person as a polysomnographic technician.
   3.  Before providing any sleep-related services, a polysomnographic trainee shall give notice to the board that the trainee is enrolled in an approved educational program. Trainees shall wear a badge that appropriately identifies the trainee as a polysomnographic trainee while providing such services.
   4.  Before providing any sleep-related services, a person who is obtaining clinical experience shall give notice to the board that the person is working under the direct supervision of a polysomnographic technologist in order to gain the experience to be eligible to sit for a national certification examination. The person shall wear a badge that appropriately identifies the person while providing such services.
   5.  Polysomnographic students shall not receive compensation for the sleep-related services they provide and shall wear badges that appropriately identify them as students.
    Sec. 14.  NEW SECTION.  148F.10  Issuance, retirement, and renewal of licenses.
   1.  The board shall issue and renew licenses under this chapter as provided by the board in rule.
   2.  A person who has been issued a license to practice under this chapter who wishes to retire that license shall file with the committee an affidavit on a form to be furnished by the committee stating the date on which the person retired from practice and other facts that verify the retirement as the board deems necessary. Any such person who thereafter wishes to reenter practice shall request reinstatement of licensure.

   3.  A license issued by the board under this chapter shall contain the name and address of the person to whom it is issued, the date and number of the license, and other information that the board deems necessary.
   a.  The address contained on the license shall be the address where all correspondence and renewal forms from the board shall be sent.
   b.  Any person whose address changes shall, within thirty days after the change in address, notify the board of the address change. The most recent address contained in the board’s records for each license holder shall be the address deemed sufficient for purposes of service of process.
   4.  A license shall either be prominently displayed in the office or place in which the person practices or be stored in a place from which it can be immediately produced upon request of a patient or representative of the board.
   5.  A person whose license has been lost may make application to the committee for a replacement. The application shall be accompanied by an affidavit setting out the facts concerning the loss of the original license.
    Sec. 15.  NEW SECTION.  148F.11  Licensing sanctions.
   The board may impose sanctions for violations of this chapter as provided in chapters 147 and 272C.
    Sec. 16.  INITIAL APPOINTMENTS.
   1.  Initial appointments to the polysomnography professional standards committee shall be made as follows: two members shall be appointed to terms of four years, two members shall be appointed to terms of three years, and two members shall be appointed to a term of two years. Each regular appointment thereafter shall be for a term of four years.
   2.  The governor may consider for appointment to the committee the names of persons recommended by the professional organizations for each profession represented on the committee. The Iowa sleep society may submit a list of three names for each position to be filled by a polysomnographic technologist. The Iowa respiratory care society may submit a list of three names for the position to be filled by a respiratory therapist. The Iowa state medical association may submit a list of three names for the position to be filled by a physician.
EXPLANATION
   This bill requires the licensing of polysomnographic technologists and makes the provisions of Code chapters 147 and 272C, including penalty and other regulatory provisions, applicable to other health professions applicable to the practice of polysomnography. Code section 147.86 provides that it is a serious misdemeanor to violate a provision of the licensing laws. The licensing program is administered and regulated by the board of medicine, with the advice of a polysomnography professional standards committee.
   A licensed polysomnographic technologist practices under the general supervision of a licensed physician, providing specifically enumerated services related to sleep disorders. A polysomnographic student or trainee enrolled in an approved educational program provides services under the direct supervision of a polysomnographic technologist.
   The bill sets out educational standards and testing requirements, and provides for disciplinary actions.