S.F. _____ 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 1669XC (6) 86 tr/nh 1/ 11

S.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 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 1669XC (6) 86 tr/nh 2/ 11

S.F. _____ 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 in sleep medicine and 33 who is actively involved in the sleep medicine center or 34 laboratory. 35 -3- LSB 1669XC (6) 86 tr/nh 3/ 11

S.F. _____ 5. “Polysomnographic student” means a person who is 1 enrolled in a program approved by the board and who may 2 provide sleep-related services under the direct supervision 3 of a polysomnographic technologist as a part of the person’s 4 educational program. 5 6. “Polysomnographic technician” means a person who has 6 graduated from a program approved by the board, but has not 7 yet received an accepted national credential awarded from an 8 examination program approved by the board and who may provide 9 sleep-related services under the direct supervision of a 10 licensed polysomnographic technologist for a period of up to 11 thirty days following graduation while awaiting credentialing 12 examination scheduling and results. 13 7. “Polysomnographic technologist” means a person licensed 14 by the board to engage in the practice of polysomnography under 15 the general supervision of a physician or a qualified health 16 care professional prescriber. 17 8. “Practice of polysomnography” means as described in 18 section 148G.2. 19 9. “Qualified health care practitioner” means an individual 20 who is licensed under section 147.2, and who holds a 21 credential listed on the board of registered polysomnographic 22 technologists list of accepted allied health credentials. 23 10. “Qualified health care professional prescriber” means a 24 physician assistant operating under the prescribing authority 25 granted in section 147.107 or an advanced registered nurse 26 practitioner operating under the prescribing authority granted 27 in section 147.107. 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 1669XC (6) 86 tr/nh 4/ 11

S.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 qualified health care professional prescriber: 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 1669XC (6) 86 tr/nh 5/ 11

S.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 qualified health care professional prescriber to 18 perform polysomnography. 19 6. Education of a patient regarding the treatment regimen 20 that assists the patient in improving the patient’s sleep. 21 7. Use of any oral appliance used to treat sleep-disordered 22 breathing while under the care of a licensed polysomnographic 23 technologist during the performance of a sleep study, as 24 directed by a licensed dentist. 25 Sec. 9. NEW SECTION . 148G.3 Location of services. 26 The practice of polysomnography shall take place only in a 27 facility that is accredited by a nationally recognized sleep 28 medicine laboratory or center accrediting agency, in a hospital 29 licensed under chapter 135B, or in a patient’s home pursuant to 30 rules adopted by the board; provided, however, that the scoring 31 of data and the education of patients may take place in another 32 setting. 33 Sec. 10. NEW SECTION . 148G.4 Scope of chapter. 34 Nothing in this chapter shall be construed to limit or 35 -6- LSB 1669XC (6) 86 tr/nh 6/ 11

S.F. _____ restrict a health care practitioner licensed in this state from 1 engaging in the full scope of practice of the individual’s 2 profession. 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, 2017, a person seeking licensure 9 as a polysomnographic technologist shall apply to the board 10 and pay the fees established by the board for licensure. 11 The application shall show that the applicant is of good 12 moral character and is at least eighteen years of age, and 13 shall include proof that the person has satisfied one of the 14 following educational requirements: 15 a. Graduation from a polysomnographic educational program 16 that is accredited by the committee on accreditation for 17 polysomnographic technologist education or an equivalent 18 program as determined by the board. 19 b. Graduation from a respiratory care educational program 20 that is accredited by the commission on accreditation 21 for respiratory care or by a committee on accreditation 22 for the commission on accreditation of allied health 23 education programs, and completion of the curriculum for a 24 polysomnographic certificate established and accredited by the 25 commission on accreditation of allied health education programs 26 as an extension of the respiratory care program. 27 c. Graduation from an electroneurodiagnostic technologist 28 educational program that is accredited by the committee 29 on accreditation for education in electroneurodiagnostic 30 technology or by a committee on accreditation for the 31 commission on accreditation of allied health education 32 programs, and completion of the curriculum for a 33 polysomnographic certificate established and accredited by the 34 commission on accreditation of allied health education programs 35 -7- LSB 1669XC (6) 86 tr/nh 7/ 11

S.F. _____ as an extension of the electroneurodiagnostic educational 1 program. 2 2. a. Notwithstanding subsection 1, beginning January 1, 3 2017, the board may issue a license to perform polysomnography 4 to a health care practitioner who holds an active license under 5 section 147.2 in a profession other than polysomnography and 6 who is in good standing with the board for that profession upon 7 application to the board demonstrating either of the following: 8 (1) Successful completion of an educational program in 9 polysomnography approved by the board. 10 (2) Successful completion of an examination in 11 polysomnography approved by the board. 12 b. The board shall not collect a licensing or application 13 fee from a health care practitioner who receives a license 14 pursuant to this subsection. 15 3. Notwithstanding subsection 1, beginning January 1, 16 2017, a person who is working in the field of sleep medicine 17 on January 1, 2017, may apply to the board for a license to 18 perform polysomnography. The board may issue a license to the 19 person, without examination, provided the application contains 20 verification that the person has completed five hundred 21 hours of paid clinical or nonclinical polysomnographic work 22 experience within the three years prior to submission of the 23 application. The application shall also contain verification 24 from the person’s supervisor that the person is competent to 25 perform polysomnography. 26 4. A person who is working in the field of sleep medicine 27 on January 1, 2017, who is not otherwise eligible to obtain 28 a license pursuant to this section shall have until January 29 1, 2018, to achieve a passing score on an examination as 30 designated by the board. The board shall allow the person 31 to attempt the examination and be awarded a license as a 32 polysomnographic technologist by meeting or exceeding the 33 passing point established by the board. After January 1, 34 2018, only persons licensed as polysomnographic technologists 35 -8- LSB 1669XC (6) 86 tr/nh 8/ 11

S.F. _____ pursuant to this chapter, or excepted from the requirements of 1 this chapter may perform sleep-related services. 2 Sec. 13. NEW SECTION . 148G.7 Persons exempt from licensing 3 requirement. 4 1. The following persons may provide sleep-related services 5 without being licensed as a polysomnographic technologist under 6 this chapter: 7 a. A qualified health care practitioner may provide 8 sleep-related services under the direct supervision of a 9 licensed polysomnographic technologist for a period of up to 10 six months while gaining the clinical experience necessary 11 to meet the admission requirements for a polysomnographic 12 credentialing examination. The board may grant a one-time 13 extension of up to six months. 14 b. A polysomnographic student may provide sleep-related 15 services under the direct supervision of a polysomnographic 16 technologist as a part of the student’s educational program 17 while actively enrolled in a polysomnographic educational 18 program that is accredited by the commission on accreditation 19 of allied health education programs or an equivalent program as 20 determined by the board. 21 2. Before providing any sleep-related services, a 22 polysomnographic technician or polysomnographic student who is 23 obtaining clinical experience shall give notice to the board 24 that the person is working under the direct supervision of a 25 polysomnographic technologist in order to gain the experience 26 to be eligible to sit for a national certification examination. 27 The person shall wear a badge that appropriately identifies the 28 person while providing such services. 29 Sec. 14. NEW SECTION . 148G.8 Licensing sanctions. 30 The board may impose sanctions for violations of this 31 chapter as provided in chapters 147 and 272C. 32 Sec. 15. Section 152B.1, subsection 1, Code 2015, is amended 33 to read as follows: 34 1. “Board” means the board of respiratory care and 35 -9- LSB 1669XC (6) 86 tr/nh 9/ 11

S.F. _____ polysomnography created under chapter 147 . 1 Sec. 16. Section 272C.1, subsection 6, paragraph z, Code 2 2015, is amended to read as follows: 3 z. The board of respiratory care and polysomnography in 4 licensing respiratory care practitioners pursuant to chapter 5 152B and polysomnographic technologists pursuant to chapter 6 148G . 7 Sec. 17. INITIAL APPOINTMENT OF POLYSOMNOGRAPHIC 8 TECHNOLOGIST TO BOARD. For the initial appointment of the 9 polysomnographic member to the board of respiratory care and 10 polysomnography pursuant to section 147.14, as amended in this 11 Act, such appointee must be eligible for licensure pursuant to 12 this Act. The appointment shall be effective upon the first 13 expiration of the term of an existing respiratory care board 14 member which occurs after the effective date of this section 15 of this Act. 16 Sec. 18. EFFECTIVE DATE. The following provision or 17 provisions of this Act take effect January 1, 2017: 18 1. The section of this Act amending section 147.2, 19 subsection 1. 20 EXPLANATION 21 The inclusion of this explanation does not constitute agreement with 22 the explanation’s substance by the members of the general assembly. 23 This bill requires the licensing of polysomnographic 24 technologists beginning January 1, 2017, and makes the 25 provisions of Code chapters 147 and 272C, including penalty 26 and other regulatory provisions, applicable to other health 27 professions applicable to the practice of polysomnography. 28 Code section 147.86 provides that it is a serious misdemeanor 29 to violate a provision of the licensing laws. A serious 30 misdemeanor is punishable by confinement for no more than one 31 year and a fine of at least $315 but not more than $1,875. The 32 licensing program is administered and regulated by the board of 33 respiratory care and polysomnography, with one respiratory care 34 practitioner replaced by a polysomnographic technologist. 35 -10- LSB 1669XC (6) 86 tr/nh 10/ 11

S.F. _____ The bill provides that the board may issue a license to a 1 person who has graduated from one of three educational programs 2 approved by the board. The board may also issue a license to 3 any health care practitioner licensed under Code section 147.2 4 to practice polysomnography as long as the practitioner shows 5 the board that the practitioner has completed an educational 6 program or passed an examination approved by the board. The 7 board may license a person working in the field of sleep 8 medicine on January 1, 2017, without examination, to perform 9 polysomnography. The applicant must provide evidence that 10 the applicant has completed 500 hours of paid clinical or 11 nonclinical polysomnographic work experience within the three 12 years prior to submission of the application. The application 13 shall also contain verification from the applicant’s supervisor 14 that the applicant is competent to perform polysomnography. 15 A person currently practicing polysomnography who is not 16 otherwise eligible for licensure under the bill has until 17 January 1, 2018, to pass an examination approved by the board. 18 A licensed polysomnographic technologist practices under 19 the general supervision of a physician, a physician assistant, 20 or an advanced registered nurse practitioner, providing 21 specifically enumerated services related to sleep disorders. A 22 polysomnographic student enrolled in an approved educational 23 program provides services under the direct supervision of a 24 polysomnographic technologist. 25 -11- LSB 1669XC (6) 86 tr/nh 11/ 11