House Study Bill 59 - 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 and providing for a penalty. 2 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 3 TLSB 1671YC (2) 85 jr/nh
H.F. _____ Section 1. Section 147.1, subsections 3 and 6, Code 2013, 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, orthotist, 9 prosthetist, pedorthist, respiratory care practitioner, 10 practitioner of cosmetology arts and sciences, practitioner 11 of barbering, funeral director, dietitian, marital and 12 family therapist, mental health counselor, polysomnographic 13 technologist, social worker, massage therapist, athletic 14 trainer, acupuncturist, nursing home administrator, hearing aid 15 dispenser, or sign language interpreter or transliterator means 16 a person licensed under this subtitle . 17 6. “Profession” means medicine and surgery, podiatry, 18 osteopathic medicine and surgery, practice as a physician 19 assistant, psychology, chiropractic, nursing, dentistry, 20 dental hygiene, dental assisting, optometry, speech pathology, 21 audiology, pharmacy, physical therapy, physical therapist 22 assisting, occupational therapy, occupational therapy 23 assisting, respiratory care, cosmetology arts and sciences, 24 barbering, mortuary science, marital and family therapy, mental 25 health counseling, polysomnography, social work, dietetics, 26 massage therapy, athletic training, acupuncture, nursing 27 home administration, hearing aid dispensing, sign language 28 interpreting or transliterating, orthotics, prosthetics, or 29 pedorthics. 30 Sec. 2. Section 147.2, subsection 1, Code 2013, is amended 31 to read as follows: 32 1. A person shall not engage in the practice of medicine 33 and surgery, podiatry, osteopathic medicine and surgery, 34 psychology, chiropractic, physical therapy, physical 35 -1- LSB 1671YC (2) 85 jr/nh 1/ 12
H.F. _____ therapist assisting, nursing, dentistry, dental hygiene, 1 dental assisting, optometry, speech pathology, audiology, 2 occupational therapy, occupational therapy assisting, 3 orthotics, prosthetics, pedorthics, respiratory care, 4 pharmacy, cosmetology arts and sciences, barbering, social 5 work, dietetics, marital and family therapy or mental health 6 counseling, massage therapy, mortuary science, polysomnography, 7 athletic training, acupuncture, nursing home administration, 8 hearing aid dispensing, or sign language interpreting 9 or transliterating, or shall not practice as a physician 10 assistant, unless the person has obtained a license for that 11 purpose from the board for the profession. 12 Sec. 3. Section 147.13, subsection 18, Code 2013, is amended 13 to read as follows: 14 18. For respiratory care and polysomnography , the board of 15 respiratory care. 16 Sec. 4. Section 147.14, subsection 1, paragraph o, Code 17 2013, is amended to read as follows: 18 o. For respiratory care, one licensed physician with 19 training in respiratory care, three respiratory care 20 practitioners who have practiced respiratory care for a 21 minimum of six years immediately preceding their appointment 22 to the board and who are recommended by the society for 23 respiratory care, three members who are licensed to practice 24 polysomnography, and one member two members not licensed to 25 practice medicine, osteopathic medicine, polysomnography, or 26 respiratory care who shall represent the general public. 27 Sec. 5. Section 147.74, Code 2013, is amended by adding the 28 following new subsection: 29 NEW SUBSECTION . 23A. A person who is licensed to engage 30 in the practice of polysomnography shall have the right to use 31 the title “polysomnographic technologist” or the abbreviation 32 “PSGT”. No other person may use that title or abbreviation 33 or any other words or letters indicating that the person is a 34 polysomnographic technologist. 35 -2- LSB 1671YC (2) 85 jr/nh 2/ 12
H.F. _____ Sec. 6. NEW SECTION . 148G.1 Definitions. 1 As used in this chapter, unless the context otherwise 2 requires: 3 1. “Board” means the board of respiratory care established 4 in chapter 147. 5 2. “Direct supervision” means that the polysomnographic 6 technologist providing supervision must be present where the 7 polysomnographic procedure is being performed and immediately 8 available to furnish assistance and direction throughout the 9 performance of the procedure. 10 3. “General supervision” means that the polysomnographic 11 procedure is provided under a physician’s overall direction and 12 control, but the physician’s presence is not required during 13 the performance of the procedure. 14 4. “Physician” means a person who is currently licensed in 15 Iowa to practice medicine and surgery or osteopathic medicine 16 and surgery and who is board certified in sleep medicine and 17 who is actively involved in the sleep medicine center or 18 laboratory. 19 5. “Polysomnographic student” means a person who is enrolled 20 in a commission on accreditation of allied health education 21 program or an equivalent program accredited by a nationally 22 recognized accrediting agency and who may provide sleep-related 23 services under the direct supervision of a polysomnographic 24 technologist as a part of the person’s educational program. 25 6. “Polysomnographic technician” means a person who has 26 graduated from a commission on accreditation of allied health 27 education program or equivalent program accredited by a 28 nationally recognized accrediting agency, but has not yet 29 passed an accepted national credentialing examination given by 30 a testing body that is accredited by a nationally recognized 31 accrediting agency, credentialed in one of the health-related 32 fields accepted by the board of registered polysomnographic 33 technologists, may provide sleep-related services under the 34 direct supervision of a licensed polysomnographic technologist 35 -3- LSB 1671YC (2) 85 jr/nh 3/ 12
H.F. _____ for a period of up to thirty days postgraduation while awaiting 1 credentialing examination scheduling and results. 2 7. “Polysomnographic technologist” means a person who is 3 credentialed by a nationally recognized accrediting agency 4 and is licensed by the board to engage in the practice of 5 polysomnography under the general supervision of a physician. 6 8. “Practice of polysomnography” means as described in 7 section 148G.2. 8 9. “Sleep-related services” means acts performed by 9 polysomnographic technicians, polysomnographic students, and 10 other persons permitted to perform those services under this 11 chapter, in a setting described in this chapter that would be 12 considered the practice of polysomnography if performed by a 13 polysomnographic technologist. 14 Sec. 7. NEW SECTION . 148G.2 Practice of polysomnography. 15 The practice of polysomnography consists of but is not 16 limited to the following tasks as performed for the purpose of 17 polysomnography, under the general supervision of a licensed 18 physician: 19 1. Monitoring, recording, and evaluating physiologic 20 data during polysomnographic testing and review during the 21 evaluation of sleep-related disorders, including sleep-related 22 respiratory disturbances, by applying any of the following 23 techniques, equipment, or procedures: 24 a. Noninvasive continuous, bilevel positive airway pressure, 25 or adaptive servo-ventilation titration on spontaneously 26 breathing patients using a mask or oral appliance; provided, 27 that the mask or oral appliance does not extend into the 28 trachea or attach to an artificial airway. 29 b. Supplemental low-flow oxygen therapy of less than six 30 liters per minute, utilizing a nasal cannula or incorporated 31 into a positive airway pressure device during a polysomnogram. 32 c. Capnography during a polysomnogram. 33 d. Cardiopulmonary resuscitation. 34 e. Pulse oximetry. 35 -4- LSB 1671YC (2) 85 jr/nh 4/ 12
H.F. _____ f. Gastroesophageal pH monitoring. 1 g. Esophageal pressure monitoring. 2 h. Sleep stage recording using surface 3 electroencephalography, surface electrooculography, and surface 4 submental electromyography. 5 i. Surface electromyography. 6 j. Electrocardiography. 7 k. Respiratory effort monitoring, including thoracic and 8 abdominal movement. 9 l. Plethysmography blood flow monitoring. 10 m. Snore monitoring. 11 n. Audio and video monitoring. 12 o. Body movement monitoring. 13 p. Nocturnal penile tumescence monitoring. 14 q. Nasal and oral airflow monitoring. 15 r. Body temperature monitoring. 16 2. Monitoring the effects that a mask or oral appliance 17 used to treat sleep disorders has on sleep patterns; provided, 18 however, that the mask or oral appliance shall not extend into 19 the trachea or attach to an artificial airway. 20 3. Observing and monitoring physical signs and symptoms, 21 general behavior, and general physical response to 22 polysomnographic evaluation and determining whether initiation, 23 modification, or discontinuation of a treatment regimen is 24 warranted. 25 4. Analyzing and scoring data collected during the 26 monitoring described in this section for the purpose of 27 assisting a physician in the diagnosis and treatment of sleep 28 and wake disorders that result from developmental defects, 29 the aging process, physical injury, disease, or actual or 30 anticipated somatic dysfunction. 31 5. Implementation of a written or verbal order from a 32 licensed physician to perform polysomnography. 33 6. Education of a patient regarding the treatment regimen 34 that assists the patient in improving the patient’s sleep. 35 -5- LSB 1671YC (2) 85 jr/nh 5/ 12
H.F. _____ 7. Use of any oral appliance used to treat sleep-disordered 1 breathing while under the care of a licensed polysomnographic 2 technologist during the performance of a sleep study, as 3 directed by a licensed dentist. 4 Sec. 8. NEW SECTION . 148G.3 Location of services. 5 The practice of polysomnography shall take place only in a 6 facility that is accredited by a nationally recognized sleep 7 medicine laboratory or center accrediting agency; provided, 8 however, that the scoring of data and the education of patients 9 may take place in settings other than in a facility that is 10 accredited by a nationally recognized sleep medicine laboratory 11 or center accrediting agency. 12 Sec. 9. NEW SECTION . 148G.4 Scope of chapter. 13 Nothing in this chapter shall be construed to limit or 14 restrict a health care practitioner licensed in this state from 15 engaging in the full scope of practice of the individual’s 16 profession. Respiratory therapists licensed in Iowa and 17 working within the scope of practice of their license as 18 provided in chapter 152B are exempt from this chapter. 19 Sec. 10. NEW SECTION . 148G.5 Powers of the board. 20 The board may do any of the following: 21 1. Promulgate rules necessary for the implementation and 22 administration of this chapter and the applicable provisions 23 of chapter 147. 24 2. Establish fees as provided in section 147.80. 25 3. Review and approve or reject the application of each 26 person who applies for licensure as a polysomnographic 27 technologist. 28 4. Issue all temporary permits and all approved licenses and 29 renewals of licenses. 30 5. Deny, suspend, revoke, restrict, or impose conditions 31 on a license, as the board deems necessary or appropriate at 32 the time a license is issued, renewed, or reinstated, or as a 33 sanction imposed at the conclusion of a disciplinary hearing. 34 6. Issue private advisory letter rulings to any person 35 -6- LSB 1671YC (2) 85 jr/nh 6/ 12
H.F. _____ licensed under this chapter who makes a request for a ruling 1 regarding any matter within the board’s jurisdiction; provided, 2 however, that the ruling shall affect only the licensee making 3 the inquiry and shall have no precedential value for any other 4 contested case or inquiry before the board or the committee. 5 7. Develop a code of ethics for the practice of 6 polysomnography. 7 8. Develop standards of care for the practice of 8 polysomnography. 9 9. Develop standards for the educational and clinical 10 training of polysomnographic technologists, including the 11 evaluation of the accreditation status of educational programs 12 in polysomnography. 13 10. Develop criteria for the evaluation of applications for 14 licensure submitted by polysomnographic technologists who are 15 licensed in other states. 16 11. Develop continuing education requirements for licensed 17 polysomnographic technologists. 18 Sec. 11. NEW SECTION . 148G.6 Licensing requirement. 19 1. a. Commencing January 1, 2014, a person who is engaged 20 in the practice of polysomnography shall be licensed as 21 provided in this chapter and it shall be unlawful for any 22 person to engage in the practice of polysomnography without 23 such license. 24 b. (1) Prior to January 1, 2014, a person who is engaged in 25 the practice of polysomnography without being licensed under 26 this chapter shall not be deemed to be in violation of this 27 chapter. 28 (2) A person who is engaged in the practice of 29 polysomnography on January 1, 2014, shall be eligible for 30 licensure under this chapter without meeting the educational 31 requirements of this section provided that the person meets 32 the requirements set out in this chapter. This person shall 33 meet or exceed the passing point of a nationally accepted 34 credentialing exam in polysomnographic technology by January 35 -7- LSB 1671YC (2) 85 jr/nh 7/ 12
H.F. _____ 1, 2015. 1 2. A person seeking licensure as a polysomnographic 2 technologist shall be of good moral character, shall be at 3 least eighteen years of age, shall pay the fees established 4 by the board for licensure, and shall present proof that the 5 person meets one of the following educational requirements: 6 a. Graduation from a polysomnographic educational program 7 that is accredited by the committee on accreditation for 8 polysomnographic technologist education or by a committee 9 on accreditation for the commission on accreditation of 10 allied health education programs, or an equivalent program as 11 determined by the board. 12 b. Graduation from a respiratory care educational program 13 that is accredited by the commission on accreditation 14 for respiratory care or by a committee on accreditation 15 for the commission on accreditation of allied health 16 education programs, and completion of the curriculum for a 17 polysomnographic certificate established and accredited by the 18 commission on accreditation of allied health education programs 19 as an extension of the respiratory care program. 20 c. Graduation from an electroneurodiagnostic technologist 21 educational program that is accredited by the committee 22 on accreditation for education in electroneurodiagnostic 23 technology or by a committee on accreditation for the 24 commission on accreditation of allied health education 25 programs, and completion of the curriculum for a 26 polysomnography certificate established and accredited by the 27 commission on accreditation of allied health education programs 28 as an extension of the electroneurodiagnostic education 29 program. 30 3. To be eligible for renewal of a license to engage in the 31 practice of polysomnography, a polysomnographic technologist 32 shall maintain that person’s credential in compliance with 33 rules set forth by a national accredited certifying agency, as 34 adopted by the board in rule. 35 -8- LSB 1671YC (2) 85 jr/nh 8/ 12
H.F. _____ Sec. 12. NEW SECTION . 148G.7 Persons exempt from licensing 1 requirement —— temporary permit. 2 1. The following persons may provide sleep-related services 3 without being licensed as a polysomnographic technologist under 4 this chapter: 5 a. A polysomnographic technician may provide sleep-related 6 services under the general supervision of a physician for 7 a period of up to six months from the date of the person’s 8 graduation from one of the accredited programs described in 9 section 148G.6. The board may in its sole discretion grant a 10 one-time extension of up to three months beyond this one-year 11 period. 12 b. A polysomnographic student may provide sleep-related 13 services under the direct supervision of a polysomnographic 14 technologist as a part of the person’s educational program 15 while actively enrolled in a polysomnographic educational 16 program that is accredited by the commission on accreditation 17 of allied health education programs or an equivalent program as 18 determined by the board. 19 c. A person, other than a respiratory care practitioner 20 licensed under this chapter, credentialed in one of the 21 health-related fields accepted by the board of registered 22 polysomnographic technologists or another nationally 23 recognized accrediting agency, or a graduate of a commission on 24 accreditation of allied health educational program may provide 25 sleep-related services under direct supervision of a licensed 26 polysomnographic technologist for a period up to thirty 27 days postgraduation while awaiting credentialing examination 28 scheduling and results. 29 2. Before providing any sleep-related services, a 30 polysomnographic technician shall obtain a temporary permit 31 from the board. While providing sleep-related services, the 32 technician shall wear a badge that appropriately identifies the 33 person as a polysomnographic technician. 34 3. Before providing any sleep-related services, a person 35 -9- LSB 1671YC (2) 85 jr/nh 9/ 12
H.F. _____ who is obtaining clinical experience shall give notice to the 1 board that the person is working under the direct supervision 2 of a polysomnographic technologist in order to gain the 3 experience to be eligible to sit for a national certification 4 examination. The person shall wear a badge that appropriately 5 identifies the person while providing such services. 6 4. Polysomnographic students shall not receive compensation 7 for the sleep-related services they provide and shall wear 8 badges that appropriately identify them as students. 9 Sec. 13. NEW SECTION . 148G.8 Issuance, retirement, and 10 renewal of licenses. 11 1. The board shall issue and renew licenses under this 12 chapter as provided by the board in rule. 13 2. A person who has been issued a license to practice under 14 this chapter who wishes to retire that license shall file with 15 the board an affidavit on a form to be furnished by the board 16 stating the date on which the person retired from practice 17 and other facts that verify the retirement as the board deems 18 necessary. Any such person who thereafter wishes to reenter 19 practice shall request reinstatement of licensure. 20 3. A license issued by the board under this chapter 21 shall contain the name and address of the person to whom it 22 is issued, the date and number of the license, and other 23 information that the board deems necessary. 24 a. The address contained on the license shall be the address 25 where all correspondence and renewal forms from the board shall 26 be sent. 27 b. Any person whose address changes shall, within thirty 28 days after the change in address, notify the board of the 29 address change. The most recent address contained in the 30 board’s records for each license holder shall be the address 31 deemed sufficient for purposes of service of process. 32 4. A license shall either be prominently displayed in the 33 office or place in which the person practices or be stored in a 34 place from which it can be immediately produced upon request of 35 -10- LSB 1671YC (2) 85 jr/nh 10/ 12
H.F. _____ a patient or representative of the board. 1 5. A person whose license has been lost may make application 2 to the board for a replacement. The application shall be 3 accompanied by an affidavit setting out the facts concerning 4 the loss of the original license. 5 Sec. 14. NEW SECTION . 148G.9 Licensing sanctions. 6 The board may impose sanctions for violations of this 7 chapter as provided in chapters 147 and 272C. 8 Sec. 15. INITIAL APPOINTMENTS. 9 1. Initial appointments of polysomnographic technologists 10 to the board of respiratory care pursuant to this Act shall be 11 made as follows: two members shall be appointed to a term of 12 three years and one member shall be appointed to a term of one 13 year. Each regular appointment thereafter shall be for a term 14 of three years. 15 2. The Iowa sleep society may submit a list of three 16 names to the governor for each position to be filled by a 17 polysomnographic technologist. 18 EXPLANATION 19 This bill requires the licensing of polysomnographic 20 technologists and makes the provisions of Code chapters 147 21 and 272C, including penalty and other regulatory provisions, 22 applicable to other health professions applicable to the 23 practice of polysomnography. Code section 147.86 provides 24 that it is a serious misdemeanor to violate a provision of 25 the licensing laws. A serious misdemeanor is punishable 26 by confinement for no more than one year and a fine of at 27 least $315 but not more than $1,875. The licensing program 28 is administered and regulated by the board of respiratory 29 care, with four new members added; three polysomnographic 30 technologists and one additional public member, for a total of 31 nine members. 32 A licensed polysomnographic technologist practices under 33 the general supervision of a licensed physician, providing 34 specifically enumerated services related to sleep disorders. A 35 -11- LSB 1671YC (2) 85 jr/nh 11/ 12
H.F. _____ polysomnographic student enrolled in an approved educational 1 program provides services under the direct supervision of a 2 polysomnographic technologist. 3 The bill sets out educational standards and testing 4 requirements, and provides for disciplinary actions. 5 -12- LSB 1671YC (2) 85 jr/nh 12/ 12