H.F. 2358 Section 1. Section 135.24, subsection 2, paragraph a, Code 1 2014, is amended to read as follows: 2 a. Procedures for registration of health care providers 3 deemed qualified by the board of medicine, the board of 4 physician assistants, the dental board, the board of nursing, 5 the board of chiropractic, the board of psychology, the board 6 of social work, the board of behavioral science, the board 7 of pharmacy, the board of optometry, the board of podiatry, 8 the board of physical and occupational therapy, the board of 9 respiratory care and polysomnography , and the Iowa department 10 of public health, as applicable. 11 Sec. 2. Section 147.1, subsections 3 and 6, Code 2014, are 12 amended to read as follows: 13 3. “Licensed” or “certified” , when applied to a physician 14 and surgeon, podiatric physician, osteopathic physician and 15 surgeon, physician assistant, psychologist, chiropractor, 16 nurse, dentist, dental hygienist, dental assistant, 17 optometrist, speech pathologist, audiologist, pharmacist, 18 physical therapist, physical therapist assistant, occupational 19 therapist, occupational therapy assistant, orthotist, 20 prosthetist, pedorthist, respiratory care practitioner, 21 practitioner of cosmetology arts and sciences, practitioner 22 of barbering, funeral director, dietitian, marital and 23 family therapist, mental health counselor, polysomnographic 24 technologist, social worker, massage therapist, athletic 25 trainer, acupuncturist, nursing home administrator, hearing aid 26 dispenser, or sign language interpreter or transliterator means 27 a person licensed under this subtitle . 28 6. “Profession” means medicine and surgery, podiatry, 29 osteopathic medicine and surgery, practice as a physician 30 assistant, psychology, chiropractic, nursing, dentistry, 31 dental hygiene, dental assisting, optometry, speech pathology, 32 audiology, pharmacy, physical therapy, physical therapist 33 assisting, occupational therapy, occupational therapy 34 assisting, respiratory care, cosmetology arts and sciences, 35 -1- LSB 5277HV (4) 85 jr/nh 1/ 11

H.F. 2358 barbering, mortuary science, marital and family therapy, mental 1 health counseling, polysomnography, social work, dietetics, 2 massage therapy, athletic training, acupuncture, nursing 3 home administration, hearing aid dispensing, sign language 4 interpreting or transliterating, orthotics, prosthetics, or 5 pedorthics. 6 Sec. 3. Section 147.2, subsection 1, Code 2014, is amended 7 to read as follows: 8 1. A person shall not engage in the practice of medicine 9 and surgery, podiatry, osteopathic medicine and surgery, 10 psychology, chiropractic, physical therapy, physical 11 therapist assisting, nursing, dentistry, dental hygiene, 12 dental assisting, optometry, speech pathology, audiology, 13 occupational therapy, occupational therapy assisting, 14 orthotics, prosthetics, pedorthics, respiratory care, 15 pharmacy, cosmetology arts and sciences, barbering, social 16 work, dietetics, marital and family therapy or mental health 17 counseling, massage therapy, mortuary science, polysomnography, 18 athletic training, acupuncture, nursing home administration, 19 hearing aid dispensing, or sign language interpreting 20 or transliterating, or shall not practice as a physician 21 assistant, unless the person has obtained a license for that 22 purpose from the board for the profession. 23 Sec. 4. Section 147.13, subsection 18, Code 2014, is amended 24 to read as follows: 25 18. For respiratory care and polysomnography , the board of 26 respiratory care and polysomnography . 27 Sec. 5. Section 147.14, subsection 1, paragraph o, Code 28 2014, is amended to read as follows: 29 o. For respiratory care, one licensed physician with 30 training in respiratory care, three two respiratory care 31 practitioners who have practiced respiratory care for a minimum 32 of six years immediately preceding their appointment to the 33 board and who are recommended by the society for respiratory 34 care, one polysomnographic technologist who has practiced 35 -2- LSB 5277HV (4) 85 jr/nh 2/ 11

H.F. 2358 polysomnography for a minimum of six years immediately 1 preceding appointment to the board and who is recommended by 2 the Iowa sleep society , and one member not licensed to practice 3 medicine, osteopathic medicine, polysomnography, or respiratory 4 care who shall represent the general public. 5 Sec. 6. Section 147.74, Code 2014, is amended by adding the 6 following new subsection: 7 NEW SUBSECTION . 22A. A person who is licensed to engage in 8 the practice of polysomnography shall have the right to use the 9 title “polysomnographic technologist” or the letters “P.S.G.T.” 10 after the person’s name. No other person may use that title 11 or letters or any other words or letters indicating that the 12 person is a polysomnographic technologist. 13 Sec. 7. NEW SECTION . 148G.1 Definitions. 14 As used in this chapter, unless the context otherwise 15 requires: 16 1. “Board” means the board of respiratory care and 17 polysomnography established in chapter 147. 18 2. “Direct supervision” means that the polysomnographic 19 technologist providing supervision must be present where the 20 polysomnographic procedure is being performed and immediately 21 available to furnish assistance and direction throughout the 22 performance of the procedure. 23 3. “General supervision” means that the polysomnographic 24 procedure is provided under a physician’s or qualified health 25 care professional prescriber’s overall direction and control, 26 but the physician’s or qualified health care professional 27 prescriber’s presence is not required during the performance 28 of the procedure. 29 4. “Physician” means a person who is currently licensed in 30 Iowa to practice medicine and surgery or osteopathic medicine 31 and surgery and who is board certified in sleep medicine and 32 who is actively involved in the sleep medicine center or 33 laboratory. 34 5. “Polysomnographic student” means a person who is enrolled 35 -3- LSB 5277HV (4) 85 jr/nh 3/ 11

H.F. 2358 in a commission on accreditation of allied health education 1 program or an equivalent program accredited by a nationally 2 recognized accrediting agency and who may provide sleep-related 3 services under the direct supervision of a polysomnographic 4 technologist as a part of the person’s educational program. 5 6. “Polysomnographic technician” means a person who 6 has graduated from a commission on accreditation of allied 7 health education program or equivalent program accredited 8 by a nationally recognized accrediting agency, but has not 9 yet received an accepted national credential awarded from 10 an examination program that is accredited by a nationally 11 recognized examination accrediting organization but who may 12 provide sleep-related services under the direct supervision of 13 a licensed polysomnographic technologist for a period of up to 14 thirty days following graduation while awaiting credentialing 15 examination scheduling and results. 16 7. “Polysomnographic technologist” means a person licensed 17 by the board to engage in the practice of polysomnography under 18 the general supervision of a physician or a qualified health 19 care professional prescriber. 20 8. “Practice of polysomnography” means as described in 21 section 148G.2. 22 9. “Qualified health care practitioner” means an individual 23 who is licensed under section 147.2, and who holds a 24 credential listed on the board of registered polysomnographic 25 technologists list of accepted allied health credentials. 26 10. “Qualified health care professional prescriber” means a 27 physician assistant operating under the prescribing authority 28 granted in section 147.107 or an advanced registered nurse 29 practitioner operating under the prescribing authority granted 30 in section 147.107. 31 11. “Sleep-related services” means acts performed by 32 polysomnographic technicians, polysomnographic students, and 33 other persons permitted to perform those services under this 34 chapter, in a setting described in this chapter that would be 35 -4- LSB 5277HV (4) 85 jr/nh 4/ 11

H.F. 2358 considered the practice of polysomnography if performed by a 1 polysomnographic technologist. 2 Sec. 8. NEW SECTION . 148G.2 Practice of polysomnography. 3 The practice of polysomnography consists of but is not 4 limited to the following tasks as performed for the purpose of 5 polysomnography, under the general supervision of a licensed 6 physician or qualified health care professional prescriber: 7 1. Monitoring, recording, and evaluating physiologic 8 data during polysomnographic testing and review during the 9 evaluation of sleep-related disorders, including sleep-related 10 respiratory disturbances, by applying any of the following 11 techniques, equipment, or procedures: 12 a. Noninvasive continuous, bilevel positive airway pressure, 13 or adaptive servo-ventilation titration on spontaneously 14 breathing patients using a mask or oral appliance; provided, 15 that the mask or oral appliance does not extend into the 16 trachea or attach to an artificial airway. 17 b. Supplemental low-flow oxygen therapy of less than six 18 liters per minute, utilizing a nasal cannula or incorporated 19 into a positive airway pressure device during a polysomnogram. 20 c. Capnography during a polysomnogram. 21 d. Cardiopulmonary resuscitation. 22 e. Pulse oximetry. 23 f. Gastroesophageal pH monitoring. 24 g. Esophageal pressure monitoring. 25 h. Sleep stage recording using surface 26 electroencephalography, surface electrooculography, and surface 27 submental electromyography. 28 i. Surface electromyography. 29 j. Electrocardiography. 30 k. Respiratory effort monitoring, including thoracic and 31 abdominal movement. 32 l. Plethysmography blood flow monitoring. 33 m. Snore monitoring. 34 n. Audio and video monitoring. 35 -5- LSB 5277HV (4) 85 jr/nh 5/ 11

H.F. 2358 o. Body movement monitoring. 1 p. Nocturnal penile tumescence monitoring. 2 q. Nasal and oral airflow monitoring. 3 r. Body temperature monitoring. 4 2. Monitoring the effects that a mask or oral appliance 5 used to treat sleep disorders has on sleep patterns; provided, 6 however, that the mask or oral appliance shall not extend into 7 the trachea or attach to an artificial airway. 8 3. Observing and monitoring physical signs and symptoms, 9 general behavior, and general physical response to 10 polysomnographic evaluation and determining whether initiation, 11 modification, or discontinuation of a treatment regimen is 12 warranted. 13 4. Analyzing and scoring data collected during the 14 monitoring described in this section for the purpose of 15 assisting a physician in the diagnosis and treatment of sleep 16 and wake disorders that result from developmental defects, 17 the aging process, physical injury, disease, or actual or 18 anticipated somatic dysfunction. 19 5. Implementation of a written or verbal order from a 20 physician or qualified health care professional prescriber to 21 perform polysomnography. 22 6. Education of a patient regarding the treatment regimen 23 that assists the patient in improving the patient’s sleep. 24 7. Use of any oral appliance used to treat sleep-disordered 25 breathing while under the care of a licensed polysomnographic 26 technologist during the performance of a sleep study, as 27 directed by a licensed dentist. 28 Sec. 9. NEW SECTION . 148G.3 Location of services. 29 The practice of polysomnography shall take place only in a 30 facility that is accredited by a nationally recognized sleep 31 medicine laboratory or center accrediting agency, in a hospital 32 licensed under chapter 135B, or in a patient’s home pursuant to 33 rules adopted by the board; provided, however, that the scoring 34 of data and the education of patients may take place in another 35 -6- LSB 5277HV (4) 85 jr/nh 6/ 11

H.F. 2358 setting. 1 Sec. 10. NEW SECTION . 148G.4 Scope of chapter. 2 Nothing in this chapter shall be construed to limit or 3 restrict a health care practitioner licensed in this state from 4 engaging in the full scope of practice of the individual’s 5 profession. 6 Sec. 11. NEW SECTION . 148G.5 Rulemaking. 7 The board shall adopt rules necessary for the implementation 8 and administration of this chapter and the applicable 9 provisions of chapters 147 and 272C. 10 Sec. 12. NEW SECTION . 148G.6 Licensing requirements. 11 1. Beginning January 1, 2016, a qualified health care 12 practitioner, as determined by the board by rule, may apply to 13 the board for a license to perform polysomnography. The board 14 shall issue a license to the health care practitioner, without 15 examination, provided the application contains verification 16 that the health care practitioner has completed five hundred 17 hours of paid clinical or nonclinical polysomnographic work 18 experience within the three years prior to submission of the 19 application. The application shall also contain verification 20 from the health care practitioner’s supervisor that the health 21 care practitioner is competent to perform polysomnography. 22 2. Beginning January 1, 2016, a person seeking licensure 23 as a polysomnographic technologist shall be of good moral 24 character, be at least eighteen years of age, pay the fees 25 established by the board for licensure, and present proof that 26 the person has satisfied one of the following educational 27 requirements: 28 a. Graduation from a polysomnographic educational program 29 that is accredited by the committee on accreditation for 30 polysomnographic technologist education or an equivalent 31 program as determined by the board. 32 b. Graduation from a respiratory care educational program 33 that is accredited by the commission on accreditation 34 for respiratory care or by a committee on accreditation 35 -7- LSB 5277HV (4) 85 jr/nh 7/ 11

H.F. 2358 for the commission on accreditation of allied health 1 education programs, and completion of the curriculum for a 2 polysomnographic certificate established and accredited by the 3 commission on accreditation of allied health education programs 4 as an extension of the respiratory care program. 5 c. Graduation from an electroneurodiagnostic technologist 6 educational program that is accredited by the committee 7 on accreditation for education in electroneurodiagnostic 8 technology or by a committee on accreditation for the 9 commission on accreditation of allied health education 10 programs, and completion of the curriculum for a 11 polysomnographic certificate established and accredited by the 12 commission on accreditation of allied health education programs 13 as an extension of the electroneurodiagnostic educational 14 program. 15 d. An individual who is licensed under section 147.2 16 who holds an active license in good standing may practice 17 polysomnography without holding a polysomnographic license upon 18 approval of the board. Individuals shall submit verification 19 to the board of either of the following: 20 (1) Successful completion of an educational program in 21 polysomnography approved by the board. 22 (2) Successful completion of an examination in 23 polysomnography approved by the board. 24 Sec. 13. NEW SECTION . 148G.7 Persons exempt from licensing 25 requirement. 26 1. The following persons may provide sleep-related services 27 without being licensed as a polysomnographic technologist under 28 this chapter: 29 a. A qualified health care practitioner may provide 30 sleep-related services under the direct supervision of a 31 licensed polysomnographic technologist for a period of up to 32 six months while gaining the clinical experience necessary 33 to meet the admission requirements for a polysomnographic 34 credentialing examination. The board may grant a one-time 35 -8- LSB 5277HV (4) 85 jr/nh 8/ 11

H.F. 2358 extension of up to six months. 1 b. A polysomnographic student may provide sleep-related 2 services under the direct supervision of a polysomnographic 3 technologist as a part of the student’s educational program 4 while actively enrolled in a polysomnographic educational 5 program that is accredited by the commission on accreditation 6 of allied health education programs or an equivalent program as 7 determined by the board. 8 2. Before providing any sleep-related services, a 9 polysomnographic technician or polysomnographic student who is 10 obtaining clinical experience shall give notice to the board 11 that the person is working under the direct supervision of a 12 polysomnographic technologist in order to gain the experience 13 to be eligible to sit for a national certification examination. 14 The person shall wear a badge that appropriately identifies the 15 person while providing such services. 16 Sec. 14. NEW SECTION . 148G.8 Licensing sanctions. 17 The board may impose sanctions for violations of this 18 chapter as provided in chapters 147 and 272C. 19 Sec. 15. Section 152B.1, subsection 1, Code 2014, is amended 20 to read as follows: 21 1. “Board” means the board of respiratory care and 22 polysomnography created under chapter 147 . 23 Sec. 16. Section 272C.1, subsection 6, paragraph z, Code 24 2014, is amended to read as follows: 25 z. The board of respiratory care and polysomnography in 26 licensing respiratory care practitioners pursuant to chapter 27 152B and polysomnographic technologists pursuant to chapter 28 148G . 29 Sec. 17. INITIAL APPOINTMENT OF POLYSOMNOGRAPHIC 30 TECHNOLOGIST TO BOARD. For the initial appointment of the 31 polysomnographic member to the board of respiratory care and 32 polysomnography pursuant to section 147.14, as amended in this 33 Act, such appointee must be eligible for licensure pursuant to 34 this Act. The appointment shall be effective upon the first 35 -9- LSB 5277HV (4) 85 jr/nh 9/ 11

H.F. 2358 expiration of the term of an existing respiratory care board 1 member. 2 Sec. 18. EFFECTIVE DATE. The following provision or 3 provisions of this Act take effect January 1, 2015: 4 1. The section of this Act amending section 147.2, 5 subsection 1. 6 Sec. 19. IMPLEMENTATION PERIOD. A person who is working 7 in the field of sleep medicine on January 1, 2016, who is 8 not eligible to obtain the registered polysomnographic 9 credential shall have until January 1, 2017, to achieve a 10 passing score on the registered polysomnographic technologist 11 examination for licensure only. The individual shall be 12 allowed to attempt the examination and be awarded a license as 13 a polysomnographic technologist by meeting or exceeding the 14 passing point established by the board of respiratory care and 15 polysomnography. After January 1, 2017, only persons licensed 16 as polysomnographic technologists or excepted from this chapter 17 may perform sleep-related services. 18 EXPLANATION 19 The inclusion of this explanation does not constitute agreement with 20 the explanation’s substance by the members of the general assembly. 21 This bill requires the licensing of polysomnographic 22 technologists beginning January 1, 2016, and makes the 23 provisions of Code chapters 147 and 272C, including penalty 24 and other regulatory provisions, applicable to other health 25 professions applicable to the practice of polysomnography. 26 Code section 147.86 provides that it is a serious misdemeanor 27 to violate a provision of the licensing laws. A serious 28 misdemeanor is punishable by confinement for no more than one 29 year and a fine of at least $315 but not more than $1,875. The 30 licensing program is administered and regulated by the board of 31 respiratory care and polysomnography, with one respiratory care 32 practitioner replaced by a polysomnographic technologist. 33 The board may license other licensed health care 34 professionals, without examination, to perform polysomnography. 35 -10- LSB 5277HV (4) 85 jr/nh 10/ 11

H.F. 2358 The applicant must provide evidence that the applicant 1 has completed 500 hours of paid clinical or nonclinical 2 polysomnographic work experience within the three years prior 3 to submission of the application. The application shall also 4 contain verification from the applicant’s supervisor that the 5 applicant is competent to perform polysomnography. 6 A licensed polysomnographic technologist practices under 7 the general supervision of a physician, a physician assistant, 8 or an advanced registered nurse practitioner, providing 9 specifically enumerated services related to sleep disorders. A 10 polysomnographic student enrolled in an approved educational 11 program provides services under the direct supervision of a 12 polysomnographic technologist. 13 The bill sets out educational standards and testing 14 requirements, and provides for disciplinary actions. 15 -11- LSB 5277HV (4) 85 jr/nh 11/ 11