S.F. 337 Section 1. Section 135.24, subsection 2, paragraph a, Code 1 2015, 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 2015, 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 1669SV (3) 86 tr/nh 1/ 12

S.F. 337 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 2015, 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 2015, 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 2015, is amended to read as follows: 29 o. For respiratory care and polysomnography , one licensed 30 physician with training in respiratory care, three two 31 respiratory care practitioners who have practiced respiratory 32 care for a minimum of six years immediately preceding their 33 appointment to the board and who are recommended by the society 34 for respiratory care, one polysomnographic technologist who 35 -2- LSB 1669SV (3) 86 tr/nh 2/ 12

S.F. 337 has practiced polysomnography for a minimum of six years 1 immediately preceding appointment to the board and who 2 is recommended by the Iowa sleep society, and one member 3 not licensed to practice medicine, osteopathic medicine, 4 polysomnography, or respiratory care who shall represent the 5 general public. 6 Sec. 6. Section 147.74, Code 2015, is amended by adding the 7 following new subsection: 8 NEW SUBSECTION . 23A. A person who is licensed to engage in 9 the practice of polysomnography shall have the right to use the 10 title “polysomnographic technologist” or the letters “P.S.G.T.” 11 after the person’s name. No other person may use that title 12 or letters or any other words or letters indicating that the 13 person is a polysomnographic technologist. 14 Sec. 7. NEW SECTION . 148G.1 Definitions. 15 As used in this chapter, unless the context otherwise 16 requires: 17 1. “Board” means the board of respiratory care and 18 polysomnography established in chapter 147. 19 2. “Direct supervision” means that the polysomnographic 20 technologist providing supervision must be present where the 21 polysomnographic procedure is being performed and immediately 22 available to furnish assistance and direction throughout the 23 performance of the procedure. 24 3. “General supervision” means that the polysomnographic 25 procedure is provided under a physician’s or qualified health 26 care professional prescriber’s overall direction and control, 27 but the physician’s or qualified health care professional 28 prescriber’s presence is not required during the performance 29 of the procedure. 30 4. “Physician” means a person who is currently licensed in 31 Iowa to practice medicine and surgery or osteopathic medicine 32 and surgery and who is board certified and who is actively 33 involved in the sleep medicine center or laboratory. 34 5. “Polysomnographic student” means a person who is 35 -3- LSB 1669SV (3) 86 tr/nh 3/ 12

S.F. 337 enrolled in a program approved by the board and who may 1 provide sleep-related services under the direct supervision 2 of a polysomnographic technologist as a part of the person’s 3 educational program. 4 6. “Polysomnographic technician” means a person who has 5 graduated from a program approved by the board, but has not 6 yet received an accepted national credential awarded from an 7 examination program approved by the board and who may provide 8 sleep-related services under the direct supervision of a 9 licensed polysomnographic technologist for a period of up to 10 thirty days following graduation while awaiting credentialing 11 examination scheduling and results. 12 7. “Polysomnographic technologist” means a person licensed 13 by the board to engage in the practice of polysomnography under 14 the general supervision of a physician or a qualified health 15 care professional prescriber. 16 8. “Practice of polysomnography” means as described in 17 section 148G.2. 18 9. “Qualified health care practitioner” means an individual 19 who is licensed under section 147.2, and who holds a 20 credential listed on the board of registered polysomnographic 21 technologists list of accepted allied health credentials. 22 10. “Qualified health care professional prescriber” means a 23 physician assistant operating under the prescribing authority 24 granted in section 147.107 or an advanced registered nurse 25 practitioner operating under the prescribing authority granted 26 in section 147.107. 27 11. “Sleep-related services” means acts performed by 28 polysomnographic technicians, polysomnographic students, and 29 other persons permitted to perform those services under this 30 chapter, in a setting described in this chapter that would be 31 considered the practice of polysomnography if performed by a 32 polysomnographic technologist. 33 Sec. 8. NEW SECTION . 148G.2 Practice of polysomnography. 34 The practice of polysomnography consists of but is not 35 -4- LSB 1669SV (3) 86 tr/nh 4/ 12

S.F. 337 limited to the following tasks as performed for the purpose of 1 polysomnography, under the general supervision of a licensed 2 physician or qualified health care professional prescriber: 3 1. Monitoring, recording, and evaluating physiologic 4 data during polysomnographic testing and review during the 5 evaluation of sleep-related disorders, including sleep-related 6 respiratory disturbances, by applying any of the following 7 techniques, equipment, or procedures: 8 a. Noninvasive continuous, bilevel positive airway pressure, 9 or adaptive servo-ventilation titration on spontaneously 10 breathing patients using a mask or oral appliance; provided, 11 that the mask or oral appliance does not extend into the 12 trachea or attach to an artificial airway. 13 b. Supplemental low-flow oxygen therapy of less than six 14 liters per minute, utilizing a nasal cannula or incorporated 15 into a positive airway pressure device during a polysomnogram. 16 c. Capnography during a polysomnogram. 17 d. Cardiopulmonary resuscitation. 18 e. Pulse oximetry. 19 f. Gastroesophageal pH monitoring. 20 g. Esophageal pressure monitoring. 21 h. Sleep stage recording using surface 22 electroencephalography, surface electrooculography, and surface 23 submental electromyography. 24 i. Surface electromyography. 25 j. Electrocardiography. 26 k. Respiratory effort monitoring, including thoracic and 27 abdominal movement. 28 l. Plethysmography blood flow monitoring. 29 m. Snore monitoring. 30 n. Audio and video monitoring. 31 o. Body movement monitoring. 32 p. Nocturnal penile tumescence monitoring. 33 q. Nasal and oral airflow monitoring. 34 r. Body temperature monitoring. 35 -5- LSB 1669SV (3) 86 tr/nh 5/ 12

S.F. 337 2. Monitoring the effects that a mask or oral appliance 1 used to treat sleep disorders has on sleep patterns; provided, 2 however, that the mask or oral appliance shall not extend into 3 the trachea or attach to an artificial airway. 4 3. Observing and monitoring physical signs and symptoms, 5 general behavior, and general physical response to 6 polysomnographic evaluation and determining whether initiation, 7 modification, or discontinuation of a treatment regimen is 8 warranted. 9 4. Analyzing and scoring data collected during the 10 monitoring described in this section for the purpose of 11 assisting a physician in the diagnosis and treatment of sleep 12 and wake disorders that result from developmental defects, 13 the aging process, physical injury, disease, or actual or 14 anticipated somatic dysfunction. 15 5. Implementation of a written or verbal order from a 16 physician or qualified health care professional prescriber to 17 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 facility 28 operated by a hospital or a hospital licensed under chapter 29 135B, or in a patient’s home pursuant to rules adopted by the 30 board; provided, however, that the scoring of data and the 31 education of patients may take place in another 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 1669SV (3) 86 tr/nh 6/ 12

S.F. 337 engaging in the full scope of practice of the individual’s 1 profession. 2 Sec. 11. NEW SECTION . 148G.5 Rulemaking. 3 The board shall adopt rules necessary for the implementation 4 and administration of this chapter and the applicable 5 provisions of chapters 147 and 272C. 6 Sec. 12. NEW SECTION . 148G.6 Licensing requirements. 7 1. Beginning January 1, 2017, a person seeking licensure 8 as a polysomnographic technologist shall apply to the board 9 and pay the fees established by the board for licensure. 10 The application shall show that the applicant is of good 11 moral character and is at least eighteen years of age, and 12 shall include proof that the person has satisfied one of the 13 following educational requirements: 14 a. Graduation from a polysomnographic educational program 15 that is accredited by the committee on accreditation for 16 polysomnographic technologist education or an equivalent 17 program as determined by the board. 18 b. Graduation from a respiratory care educational program 19 that is accredited by the commission on accreditation for 20 respiratory care or by a committee on accreditation for 21 the commission on accreditation of allied health education 22 programs, and any of the following: 23 (1) Completion of the curriculum for a polysomnographic 24 certificate established and accredited by the commission 25 on accreditation of allied health education programs as an 26 extension of the respiratory care program. 27 (2) Obtaining the sleep disorder specialist credential from 28 the national board for respiratory care. 29 (3) Obtaining the registered polysomnographic technologist 30 credential from the board of registered polysomnographic 31 technologists. 32 (4) Completing or obtaining any other certificate or 33 credential program as recognized by the board. 34 c. Graduation from an electroneurodiagnostic technologist 35 -7- LSB 1669SV (3) 86 tr/nh 7/ 12

S.F. 337 educational program that is accredited by the committee 1 on accreditation for education in electroneurodiagnostic 2 technology or by a committee on accreditation for the 3 commission on accreditation of allied health education 4 programs, and completion of the curriculum for a 5 polysomnographic certificate established and accredited by the 6 commission on accreditation of allied health education programs 7 as an extension of the electroneurodiagnostic educational 8 program. 9 2. a. Notwithstanding subsection 1, beginning January 10 1, 2017, the board shall issue a license to perform 11 polysomnography to an individual who holds an active license 12 under section 147.2 in a profession other than polysomnography 13 and who is in good standing with the board for that profession 14 upon application to the board demonstrating any of the 15 following: 16 (1) Successful completion of an educational program in 17 polysomnography approved by the board. 18 (2) Successful completion of an examination in 19 polysomnography approved by the board. 20 (3) Verification from the medical director of the 21 individual’s current employer or the medical director’s 22 designee that the individual has completed on-the-job 23 training in the field of polysomnography as approved by 24 the board, along with written verification from the medical 25 director of the individual’s current employer or the medical 26 director’s designee that the individual is competent to perform 27 polysomnography. 28 b. The board shall not collect a licensing or application 29 fee from a health care practitioner who receives a license 30 pursuant to this subsection. 31 3. Notwithstanding subsection 1, beginning January 1, 32 2017, a person who is working in the field of sleep medicine 33 on January 1, 2017, may apply to the board for a license to 34 perform polysomnography. The board shall issue a license to 35 -8- LSB 1669SV (3) 86 tr/nh 8/ 12

S.F. 337 the person, without examination, provided the application 1 contains verification that the person has completed five 2 hundred hours of paid clinical or nonclinical polysomnographic 3 work experience within the three years prior to submission 4 of the application. The application shall also contain 5 verification from the medical director of the person’s current 6 employer or the medical director’s designee that the person 7 is competent to perform polysomnography. An active license 8 holder under section 147.2 being issued a license under this 9 subsection is exempt from paying the licensure fee required for 10 a polysomnography license. 11 4. A person who is working in the field of sleep medicine 12 on January 1, 2017, who is not otherwise eligible to obtain 13 a license pursuant to this section shall have until January 14 1, 2018, to achieve a passing score on an examination as 15 designated by the board. The board shall allow the person 16 to attempt the examination and be awarded a license as a 17 polysomnographic technologist by meeting or exceeding the 18 passing point established by the board. After January 1, 19 2018, only persons licensed as polysomnographic technologists 20 pursuant to this chapter, or excepted from the requirements of 21 this chapter may perform sleep-related services. 22 5. The fees assessed by the board shall be sufficient to 23 cover all costs associated with the administration of this 24 chapter. 25 Sec. 13. NEW SECTION . 148G.7 Persons exempt from licensing 26 requirement. 27 1. The following persons may provide sleep-related services 28 without being licensed as a polysomnographic technologist under 29 this chapter: 30 a. A qualified health care practitioner may provide 31 sleep-related services under the direct supervision of a 32 licensed polysomnographic technologist for a period of up to 33 six months while gaining the clinical experience necessary 34 to meet the admission requirements for a polysomnographic 35 -9- LSB 1669SV (3) 86 tr/nh 9/ 12

S.F. 337 credentialing examination. The board may grant a one-time 1 extension of up to six months. 2 b. A polysomnographic student may provide sleep-related 3 services under the direct supervision of a polysomnographic 4 technologist as a part of the student’s educational program 5 while actively enrolled in a polysomnographic educational 6 program that is accredited by the commission on accreditation 7 of allied health education programs or an equivalent program as 8 determined by the board. 9 2. Before providing any sleep-related services, a 10 polysomnographic technician or polysomnographic student who is 11 obtaining clinical experience shall give notice to the board 12 that the person is working under the direct supervision of a 13 polysomnographic technologist in order to gain the experience 14 to be eligible to sit for a national certification examination. 15 The person shall wear a badge that appropriately identifies the 16 person while providing such services. 17 Sec. 14. NEW SECTION . 148G.8 Licensing sanctions. 18 The board may impose sanctions for violations of this 19 chapter as provided in chapters 147 and 272C. 20 Sec. 15. Section 152B.1, subsection 1, Code 2015, is amended 21 to read as follows: 22 1. “Board” means the board of respiratory care and 23 polysomnography created under chapter 147 . 24 Sec. 16. Section 272C.1, subsection 6, paragraph z, Code 25 2015, is amended to read as follows: 26 z. The board of respiratory care and polysomnography in 27 licensing respiratory care practitioners pursuant to chapter 28 152B and polysomnographic technologists pursuant to chapter 29 148G . 30 Sec. 17. INITIAL APPOINTMENT OF POLYSOMNOGRAPHIC 31 TECHNOLOGIST TO BOARD. For the initial appointment of the 32 polysomnographic member to the board of respiratory care and 33 polysomnography pursuant to section 147.14, as amended in this 34 Act, such appointee must be eligible for licensure pursuant to 35 -10- LSB 1669SV (3) 86 tr/nh 10/ 12

S.F. 337 this Act. The appointment shall be effective upon the first 1 expiration of the term of an existing respiratory care board 2 member which occurs after the effective date of this section 3 of this Act. 4 Sec. 18. EFFECTIVE DATE. The following provision or 5 provisions of this Act take effect January 1, 2017: 6 1. The section of this Act amending section 147.2, 7 subsection 1. 8 EXPLANATION 9 The inclusion of this explanation does not constitute agreement with 10 the explanation’s substance by the members of the general assembly. 11 This bill requires the licensing of polysomnographic 12 technologists beginning January 1, 2017, and makes the 13 provisions of Code chapters 147 and 272C, including penalty 14 and other regulatory provisions, applicable to other health 15 professions applicable to the practice of polysomnography. 16 Code section 147.86 provides that it is a serious misdemeanor 17 to violate a provision of the licensing laws. A serious 18 misdemeanor is punishable by confinement for no more than one 19 year and a fine of at least $315 but not more than $1,875. The 20 licensing program is administered and regulated by the board of 21 respiratory care and polysomnography, with one respiratory care 22 practitioner replaced by a polysomnographic technologist. 23 The bill provides that the board may issue a license to 24 a person who has graduated from one of three educational 25 programs approved by the board. If the educational program 26 was in respiratory care, the person must also have received a 27 certification or credential as a sleep disorder specialist, 28 a registered polysomnographic technologist, or other area as 29 designated by the board. The board shall also issue a license 30 to practice polysomnography to any individual licensed under 31 Code section 147.2 as long as the individual shows the board 32 that the individual has completed an educational program 33 or passed an examination approved by the board or receives 34 verification from the medical director of the individual’s 35 -11- LSB 1669SV (3) 86 tr/nh 11/ 12

S.F. 337 current employer that the individual has completed on-the-job 1 training and is competent to perform polysomnography. The 2 board shall license a person working in the field of sleep 3 medicine on January 1, 2017, without examination, to perform 4 polysomnography. The applicant must provide evidence that 5 the applicant has completed 500 hours of paid clinical or 6 nonclinical polysomnographic work experience within the 7 three years prior to submission of the application. The 8 application shall also contain verification from the medical 9 director of the person’s current employer that the applicant 10 is competent to perform polysomnography. A person currently 11 practicing polysomnography who is not otherwise eligible for 12 licensure under the bill has until January 1, 2018, to pass an 13 examination approved by the board. 14 An active license holder under Code section 147.2 being 15 issued a license under the bill is exempt from paying the 16 licensure fee required for a polysomnography license. The fees 17 assessed by the board shall be sufficient to cover all costs 18 associated with the administration of the bill. 19 A licensed polysomnographic technologist practices under 20 the general supervision of a physician, a physician assistant, 21 or an advanced registered nurse practitioner, providing 22 specifically enumerated services related to sleep disorders. A 23 polysomnographic student enrolled in an approved educational 24 program provides services under the direct supervision of a 25 polysomnographic technologist. 26 -12- LSB 1669SV (3) 86 tr/nh 12/ 12