SSB 1091 (LSB 1671XC (2) 85)

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 2013, 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, orthotist, prosthetist, pedorthist, 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, sign language interpreting or transliterating, orthotics, prosthetics, or pedorthics.
    Sec. 2.  Section 147.2, subsection 1, Code 2013, 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, orthotics, prosthetics, pedorthics, 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 18, Code 2013, is amended to read as follows:
   18.  For respiratory care
 
and polysomnography, the board of respiratory care.
    Sec. 4.  Section 147.14, subsection 1, paragraph o, Code 2013, is amended to read as follows:
   o.  For respiratory care, one licensed physician with training in respiratory care, three respiratory care practitioners who have practiced respiratory care for a minimum of six years immediately preceding their appointment to the board and who are recommended by the society for respiratory care,
 
three members who are licensed to practice polysomnography, and one member
 
two members not licensed to practice medicine, osteopathic medicine,
 
polysomnography, or respiratory care who shall represent the general public.
    Sec. 5.  Section 147.74, Code 2013, is amended by adding the following new subsection:
   NEW SUBSECTION.  23A.  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 “PSGT”. No other person may use that title or abbreviation or any other words or letters indicating that the person is a polysomnographic technologist.
    Sec. 6.  NEW SECTION.  148G.1  Definitions.
   As used in this chapter, unless the context otherwise requires:
   1.  “Board” means the board of respiratory care established in chapter 147.
   2.  “Direct supervision” means that the polysomnographic technologist providing supervision must be present where the polysomnographic procedure is being performed and immediately available to furnish assistance and direction throughout the performance of the procedure.
   3.  “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.
   4.  “Physician” means a person who is currently licensed in Iowa to practice medicine and surgery or osteopathic medicine and surgery and who is board certified in sleep medicine and who is actively involved in the sleep medicine center or laboratory.
   5.  “Polysomnographic student” means a person who is enrolled in a commission on accreditation of allied health education program or an equivalent program accredited by a nationally recognized accrediting agency and who may provide sleep-related services under the direct supervision of a polysomnographic technologist as a part of the person’s educational program.
   6.  “Polysomnographic technician” means a person who has graduated from a commission on accreditation of allied health education program or equivalent program accredited by a nationally recognized accrediting agency, but has not yet passed an accepted national credentialing examination given by a testing body that is accredited by a nationally recognized accrediting agency, credentialed in one of the health-related fields accepted by the board of registered polysomnographic technologists, may provide sleep-related services under the direct supervision of a licensed polysomnographic technologist for a period of up to thirty days postgraduation while awaiting credentialing examination scheduling and results.
   7.  “Polysomnographic technologist” means a person who is credentialed by a nationally recognized accrediting agency and is licensed by the board to engage in the practice of polysomnography under the general supervision of a physician.
   8.  “Practice of polysomnography” means as described in section 148G.2.
   9.  “Sleep-related services” means acts performed by polysomnographic technicians, 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. 7.  NEW SECTION.  148G.2  Practice of polysomnography.
   The practice of polysomnography consists of but is not limited to the following tasks as performed for the purpose of polysomnography, under the general supervision of a licensed physician:
   1.  Monitoring, recording, and evaluating physiologic data during polysomnographic testing and review 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. 8.  NEW SECTION.  148G.3  Location of services.
   The practice of polysomnography shall take place only in a facility that is accredited by a nationally recognized sleep medicine laboratory or center accrediting agency; provided, however, that the scoring of data and the education of patients may take place in settings other than in a facility that is accredited by a nationally recognized sleep medicine laboratory or center accrediting agency.
    Sec. 9.  NEW SECTION.  148G.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. Respiratory therapists licensed in Iowa and working within the scope of practice of their license as provided in chapter 152B are exempt from this chapter.
    Sec. 10.  NEW SECTION.  148G.5  Powers of the board.
   The board 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 board’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. 11.  NEW SECTION.  148G.6  Licensing requirement.
   1.
  a.  Commencing January 1, 2014, 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, 2014, 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, 2014, shall be eligible for licensure under this chapter without meeting the educational requirements of this section provided that the person meets the requirements set out in this chapter. This person shall meet or exceed the passing point of a nationally accepted credentialing exam in polysomnographic technology by January 1, 2015.
   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 one of the following educational requirements:
   a.  Graduation from a polysomnographic educational program that is accredited by the committee on accreditation for 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.
   b.  Graduation from a respiratory care educational program that is accredited by the commission 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.
   c.  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.
   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. 12.  NEW SECTION.  148G.7  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 148G.6. 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 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.
   c.  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 accrediting agency, or a graduate of a commission on accreditation of allied health educational program may provide sleep-related services under direct supervision of a licensed polysomnographic technologist for a period up to thirty days postgraduation while awaiting credentialing examination scheduling and results.
   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 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.
   4.  Polysomnographic students shall not receive compensation for the sleep-related services they provide and shall wear badges that appropriately identify them as students.
    Sec. 13.  NEW SECTION.  148G.8  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 board an affidavit on a form to be furnished by the board 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 board for a replacement. The application shall be accompanied by an affidavit setting out the facts concerning the loss of the original license.
    Sec. 14.  NEW SECTION.  148G.9  Licensing sanctions.
   The board may impose sanctions for violations of this chapter as provided in chapters 147 and 272C.
    Sec. 15.  INITIAL APPOINTMENTS.
   1.  Initial appointments of polysomnographic technologists to the board of respiratory care pursuant to this Act shall be made as follows: two members shall be appointed to a term of three years and one member shall be appointed to a term of one year. Each regular appointment thereafter shall be for a term of three years.
   2.  The Iowa sleep society may submit a list of three names to the governor for each position to be filled by a polysomnographic technologist.
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. A serious misdemeanor is punishable by confinement for no more than one year and a fine of at least $315 but not more than $1,875. The licensing program is administered and regulated by the board of respiratory care, with four new members added; three polysomnographic technologists and one additional public member, for a total of nine members.
   A licensed polysomnographic technologist practices under the general supervision of a licensed physician, providing specifically enumerated services related to sleep disorders. A polysomnographic student 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.