House Study Bill 574 - Introduced HOUSE FILE _____ BY (PROPOSED COMMITTEE ON STATE GOVERNMENT BILL BY CHAIRPERSON VANDER LINDEN) A BILL FOR An Act providing for the licensing of polysomnographic 1 technologists, making penalties applicable, and including 2 effective date provisions. 3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 4 TLSB 5277YC (8) 85 jr/nh
H.F. _____ 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 5277YC (8) 85 jr/nh 1/ 10
H.F. _____ 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 member who is recommended by the Iowa sleep society 35 -2- LSB 5277YC (8) 85 jr/nh 2/ 10
H.F. _____ and is licensed to practice polysomnography, and one member 1 not licensed to practice medicine, osteopathic medicine, 2 polysomnography, or respiratory care who shall represent the 3 general public. 4 Sec. 6. Section 147.74, Code 2014, is amended by adding the 5 following new subsection: 6 NEW SUBSECTION . 22A. A person who is licensed to engage in 7 the practice of polysomnography shall have the right to use the 8 title “polysomnographic technologist” or the letters “P.S.G.T.” 9 after the person’s name. No other person may use that title 10 or letters or any other words or letters indicating that the 11 person is a polysomnographic technologist. 12 Sec. 7. NEW SECTION . 148G.1 Definitions. 13 As used in this chapter, unless the context otherwise 14 requires: 15 1. “Board” means the board of respiratory care and 16 polysomnography established in chapter 147. 17 2. “Direct supervision” means that the polysomnographic 18 technologist providing supervision must be present where the 19 polysomnographic procedure is being performed and immediately 20 available to furnish assistance and direction throughout the 21 performance of the procedure. 22 3. “General supervision” means that the polysomnographic 23 procedure is provided under a physician’s or physician 24 assistant’s overall direction and control, but the physician’s 25 or physician assistant’s presence is not required during the 26 performance of the procedure. 27 4. “Physician” means a person who is currently licensed in 28 Iowa to practice medicine and surgery or osteopathic medicine 29 and surgery and who is board certified in sleep medicine and 30 who is actively involved in the sleep medicine center or 31 laboratory. 32 5. “Physician assistant” means a person licensed as a 33 physician assistant under chapter 148C who performs medical 34 services under the supervision of a physician. 35 -3- LSB 5277YC (8) 85 jr/nh 3/ 10
H.F. _____ 6. “Polysomnographic student” means a person who is enrolled 1 in a commission on accreditation of allied health education 2 program or an equivalent program accredited by a nationally 3 recognized accrediting agency and who may provide sleep-related 4 services under the direct supervision of a polysomnographic 5 technologist as a part of the person’s educational program. 6 7. “Polysomnographic technician” means a person who has 7 graduated from a commission on accreditation of allied health 8 education program or equivalent program accredited by a 9 nationally recognized accrediting agency, but has not yet 10 passed an accepted national credentialing examination given by 11 a testing body that is accredited by a nationally recognized 12 accrediting agency, credentialed in one of the health-related 13 fields accepted by the board of registered polysomnographic 14 technologists, may provide sleep-related services under the 15 direct supervision of a licensed polysomnographic technologist 16 for a period of up to thirty days postgraduation while awaiting 17 credentialing examination scheduling and results. 18 8. “Polysomnographic technologist” means a person who is 19 credentialed by a nationally recognized accrediting agency 20 and is licensed by the board to engage in the practice of 21 polysomnography under the general supervision of a physician 22 or physician assistant. 23 9. “Practice of polysomnography” means as described in 24 section 148G.2. 25 10. “Qualified health care practitioner” means an individual 26 licensed as described in section 147.2 who is determined by the 27 board to be qualified to perform polysomnography. 28 11. “Sleep-related services” means acts performed by 29 polysomnographic technicians, polysomnographic students, and 30 other persons permitted to perform those services under this 31 chapter, in a setting described in this chapter that would be 32 considered the practice of polysomnography if performed by a 33 polysomnographic technologist. 34 Sec. 8. NEW SECTION . 148G.2 Practice of polysomnography. 35 -4- LSB 5277YC (8) 85 jr/nh 4/ 10
H.F. _____ The practice of polysomnography consists of but is not 1 limited to the following tasks as performed for the purpose of 2 polysomnography, under the general supervision of a licensed 3 physician or physician assistant: 4 1. Monitoring, recording, and evaluating physiologic 5 data during polysomnographic testing and review during the 6 evaluation of sleep-related disorders, including sleep-related 7 respiratory disturbances, by applying any of the following 8 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 -5- LSB 5277YC (8) 85 jr/nh 5/ 10
H.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 physician or physician assistant 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. 9. NEW SECTION . 148G.3 Location of services. 25 The practice of polysomnography shall take place only in a 26 facility that is accredited by a nationally recognized sleep 27 medicine laboratory or center accrediting agency, in a hospital 28 licensed under chapter 135B, or in a patient’s home pursuant to 29 rules adopted by the board; provided, however, that the scoring 30 of data and the education of patients may take place in another 31 setting. 32 Sec. 10. NEW SECTION . 148G.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 -6- LSB 5277YC (8) 85 jr/nh 6/ 10
H.F. _____ engaging in the full scope of practice of the individual’s 1 profession. This chapter shall not apply to licensed 2 respiratory therapists. 3 Sec. 11. NEW SECTION . 148G.5 Rulemaking. 4 The board shall adopt rules necessary for the implementation 5 and administration of this chapter and the applicable 6 provisions of chapters 147 and 272C. 7 Sec. 12. NEW SECTION . 148G.6 Licensing requirements. 8 1. Beginning January 1, 2015, a qualified health care 9 practitioner, as determined by the board by rule, may apply to 10 the board for a license to perform polysomnography. The board 11 shall issue a license to the health care practitioner, without 12 examination, provided the application contains verification 13 that the health care practitioner has completed five hundred 14 hours of paid clinical or nonclinical polysomnographic work 15 experience within the three years prior to submission of the 16 application. The application shall also contain verification 17 from the health care practitioner’s supervisor that the health 18 care practitioner is competent to perform polysomnography. 19 An individual licensed to practice polysomnography pursuant 20 to this subsection shall not use the title “polysomnographic 21 technologist” or the letters “P.S.G.T.” 22 2. Beginning January 1, 2015, 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 by a committee 31 on accreditation for the commission on accreditation of 32 allied health education programs, or an equivalent program as 33 determined by the board. 34 b. Graduation from a respiratory care educational program 35 -7- LSB 5277YC (8) 85 jr/nh 7/ 10
H.F. _____ that is accredited by the commission on accreditation 1 for respiratory care or by a committee on accreditation 2 for the commission on accreditation of allied health 3 education programs, and completion of the curriculum for a 4 polysomnographic certificate established and accredited by the 5 commission on accreditation of allied health education programs 6 as an extension of the respiratory care program. 7 c. Graduation from an electroneurodiagnostic technologist 8 educational program that is accredited by the committee 9 on accreditation for education in electroneurodiagnostic 10 technology or by a committee on accreditation for the 11 commission on accreditation of allied health education 12 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 electroneurodiagnostic educational 16 program. 17 Sec. 13. NEW SECTION . 148G.7 Persons exempt from licensing 18 requirement. 19 1. The following persons may provide sleep-related services 20 without being licensed as a polysomnographic technologist under 21 this chapter: 22 a. A polysomnographic technician may provide sleep-related 23 services under the general supervision of a physician or 24 physician assistant for a period of up to six months from the 25 date of the technician’s graduation from one of the accredited 26 programs described in section 148G.6. The board may in its 27 sole discretion grant a one-time extension of up to three 28 months beyond this one-year period. 29 b. A polysomnographic student may provide sleep-related 30 services under the direct supervision of a polysomnographic 31 technologist as a part of the student’s educational program 32 while actively enrolled in a polysomnographic educational 33 program that is accredited by the commission on accreditation 34 of allied health education programs or an equivalent program as 35 -8- LSB 5277YC (8) 85 jr/nh 8/ 10
H.F. _____ determined by the board. 1 2. Before providing any sleep-related services, a 2 polysomnographic technician or polysomnographic student who is 3 obtaining clinical experience shall give notice to the board 4 that the person is working under the direct supervision of a 5 polysomnographic technologist in order to gain the experience 6 to be eligible to sit for a national certification examination. 7 The person shall wear a badge that appropriately identifies the 8 person while providing such services. 9 Sec. 14. NEW SECTION . 148G.8 Licensing sanctions. 10 The board may impose sanctions for violations of this 11 chapter as provided in chapters 147 and 272C. 12 Sec. 15. Section 152B.1, subsection 1, Code 2014, is amended 13 to read as follows: 14 1. “Board” means the board of respiratory care and 15 polysomnography created under chapter 147 . 16 Sec. 16. Section 272C.1, subsection 6, paragraph z, Code 17 2014, is amended to read as follows: 18 z. The board of respiratory care and polysomnography in 19 licensing respiratory care practitioners pursuant to chapter 20 152B and polysomnographic technologists pursuant to chapter 21 148G . 22 Sec. 17. INITIAL APPOINTMENT OF POLYSOMNOGRAPHIC 23 TECHNOLOGIST TO BOARD. For the initial appointment of the 24 polysomnographic member to the board of respiratory care and 25 polysomnography pursuant to section 147.14, as amended in this 26 Act, such appointee must be eligible for licensure pursuant to 27 this Act. The appointment shall be effective upon the first 28 expiration of the term of an existing respiratory care board 29 member. 30 Sec. 18. EFFECTIVE DATE. The following provision or 31 provisions of this Act take effect January 1, 2015: 32 1. The section of this Act amending section 147.2, 33 subsection 1. 34 EXPLANATION 35 -9- LSB 5277YC (8) 85 jr/nh 9/ 10
H.F. _____ The inclusion of this explanation does not constitute agreement with 1 the explanation’s substance by the members of the general assembly. 2 This bill requires the licensing of polysomnographic 3 technologists beginning January 1, 2015, and makes the 4 provisions of Code chapters 147 and 272C, including penalty 5 and other regulatory provisions, applicable to other health 6 professions applicable to the practice of polysomnography. 7 Code section 147.86 provides that it is a serious misdemeanor 8 to violate a provision of the licensing laws. A serious 9 misdemeanor is punishable by confinement for no more than one 10 year and a fine of at least $315 but not more than $1,875. The 11 licensing program is administered and regulated by the board 12 of respiratory care and polysomnography, with one respiratory 13 care practitioner replaced by a person licensed to practice 14 polysomnography. 15 A licensed polysomnographic technologist practices under 16 the general supervision of a licensed physician or physician 17 assistant, providing specifically enumerated services related 18 to sleep disorders. A polysomnographic student enrolled in an 19 approved educational program provides services under the direct 20 supervision of a polysomnographic technologist. 21 The bill sets out educational standards and testing 22 requirements, and provides for disciplinary actions. 23 -10- LSB 5277YC (8) 85 jr/nh 10/ 10