Revision: March 7, 2013, midnight
SB 135-FN – AS AMENDED BY THE SENATE
03/07/13 0356s
2013 SESSION
10/01
SENATE BILL 135-FN
AN ACT relative to the regulation of the practice of genetic counseling.
SPONSORS: Sen. Carson, Dist 14; Sen. Lasky, Dist 13; Sen. Gilmour, Dist 12; Rep. Rosenwald, Hills 30; Rep. Harding, Graf 13
COMMITTEE: Executive Departments and Administration
This bill establishes the genetic counselors governing board in the office of licensed allied health professionals for the regulation of the practice of genetic counseling in this state.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
03/07/13 0356s
13-0874
10/01
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Thirteen
AN ACT relative to the regulation of the practice of genetic counseling.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 New Chapter; Genetic Counselors. Amend RSA by inserting after chapter 326-J the following new chapter:
CHAPTER 326-K
326-K:1 Definitions. In this chapter and RSA 328-F:
I. “ABGC” means the American Board of Genetic Counseling, its equivalent, or successor.
II. “ABMG” means the American Board of Medical Genetics, its equivalent, or successor.
III. “Board” means the genetic counselors governing board established in RSA 328-F.
IV. “Genetic counselor” means an individual, who is licensed by the board under this chapter, to engage in the competent practice of genetic counseling.
V. “NSGC” means the National Society of Genetic Counselors, its equivalent, or successor.
VI. “Practice of genetic counseling” means, but shall not be limited to:
(a) Obtaining and evaluating individual, family, and medical histories to determine genetic risk for genetic or medical conditions and diseases in a patient, his or her offspring, and other family members;
(b) Discussing the features, natural history, means of diagnosis, genetic and environmental factors, and management of risk for genetic or medical conditions and diseases;
(c) Identifying and coordinating genetic laboratory tests and other diagnostic studies as appropriate for the genetic assessment;
(d) Integrating genetic laboratory test results and other diagnostic studies with personal and family medical history to assess and communicate risk factors for genetic or medical conditions and diseases;
(e) Explaining the clinical implications of genetic laboratory tests and other diagnostic studies and their results;
(f) Evaluating the client’s or family’s responses to the condition or risk of recurrence and provide client-centered counseling and anticipatory guidance;
(g) Identifying and utilizing community resources that provide medical, educational, financial, and psychosocial support and advocacy; and
(h) Providing written documentation of medical, genetic, and counseling information for families and health care professionals.
326-K:2 Exemptions from Licensure. The requirements for licensure under this chapter shall not apply to:
I. Any person licensed by the state to practice in a profession other than that of genetic counseling when acting within the scope of the person’s profession and doing work of a nature consistent with the person’s training. Such person shall not hold himself or herself out to the public as a genetic counselor.
II. Any person employed as a genetic counselor by the federal government or an agency thereof if such person provides genetic counseling services solely under the direction and control of the organization by which he or she is employed.
III. A student, if the following conditions apply:
(a) The student is enrolled in an ABGC accredited genetic counseling educational program;
(b) The genetic counseling services performed by the student are an integral part of the student’s course of study;
(c) The genetic counseling services are performed under the direct supervision of a licensed genetic counselor; and
(d) The student is designated by the title, “genetic counseling intern.”
IV. A genetic counselor working for an out-of-state employer or organization providing occasional genetic counseling services in this state who is not licensed in the state of New Hampshire, and:
(a) Is licensed as a genetic counselor in the state where he or she is employed; or
(b) If licensure is not available in the genetic counselor’s state of employment, the genetic counselor shall be certified or have active candidate status conferred by the ABGC or the ABMG.
326-K:3 Eligibility for Initial Licensure. In addition to requirements under RSA 328-F, the board shall require the following as a minimum to qualify for licensure. Each applicant shall:
I. Comply with the NSGC Code of Ethics.
II. Provide satisfactory evidence of having fulfilled the following criteria:
(a) Genetic counselor certified by ABGC or ABMG; or
(b) Medical geneticist certified by ABMG; or
(c) An individual who has worked as a genetic counselor for a minimum of 10 years preceding the effective date of this chapter and who provides the following documentation:
(1) A master’s or higher degree in genetics or related field of study; and
(2) Proof of having never failed the ABMG/ABGC certification examination; and
(3) Three letters of recommendation from at least one genetic counselor who qualifies for licensure under this chapter, and either a clinical geneticist certified by ABMG or medical geneticist certified by ABMG. The board shall consider a letter from a supervising physician if clinical or medical geneticist is not available. All individuals submitting letters of recommendation shall have worked with the applicant in an employment setting during the last 10 years and can attest to the applicant’s competency in providing genetic counseling services; and
(4) Proof of attending ABGC approved continuing education programs within the last 5 years.
III. An individual who submits the documentation required in subparagraph II(c) not later than 180 days after licensure under this chapter is first available or no later than 180 days after accepting a position in New Hampshire may apply to the board for licensure without meeting the certification requirement.
326-K:4 Provisional License.
I. A provisional license may be issued by the board to an applicant who meets all of the requirements for licensure except for the certification component and has been granted active candidate status by ABGC.
II. A provisional license shall be valid for the ABGC examination cycle for which active candidate status by the ABGC has been granted. Such provisional license shall expire automatically upon the earliest of the following:
(a) Issuance of a full license;
(b) Thirty days after the applicant fails to pass the certification examination; or
(c) The date printed on the provisional license.
III. A provisional licensed genetic counselor shall work under the general supervision of a licensed genetic counselor or a licensed physician at all times during which the provisional licensed genetic counselor performs genetic counseling. An application for extension of the provisional license shall be signed by a supervisor.
326-K:5 Prohibition on Unlicensed Practice; Professional Identification.
I. No person shall practice or represent himself or herself as a genetic counselor in this state without first applying for and receiving a license or provisional license from the board to practice as a licensed genetic counselor.
II. A genetic counselor whose license is suspended or revoked or whose surrender of license with or without prejudice has been accepted by the board, shall promptly deliver the original license to the board.
III. Individuals holding currently valid licenses issued under this chapter may use the title “genetic counselor” and write the designation “licensed genetic counselor” following his or her written name.
IV. No person shall represent himself or herself or the services offered by using the term genetic counselor unless he or she is licensed in accordance with this chapter. No person, who is not so licensed may use in connection with his or her name or place of business, the title “genetic counselor,” “licensed genetic counselor,” “gene counselor,” “genetic consultant,” “genetic associate,” or any words, letters, abbreviations or insignia indicating or implying a person holds a genetic counseling license, or any similar words if the intent of such use is to imply that the person is licensed, unless licensed under this chapter.
V. Any person who states or implies by word or act that he or she is currently licensed to practice genetic counseling at a time when he or she does not hold a currently valid license shall be guilty of a misdemeanor.
326-K:6 Reciprocity. An applicant who satisfies the board that he or she is licensed under the laws of another state, territory, or jurisdiction of the United States, which in the opinion of the board imposes substantially the same licensing requirements as required by RSA 328-F, RSA 326-K:3, and the rules of the board, may be granted a license pursuant to this chapter.
326-K:7 Compensation. Notwithstanding RSA 328-F:6 and RSA 328-F:15, I(g), the members of genetic counselors governing board shall serve without compensation for attendance at meetings and shall not be reimbursed for travel expenses incurred in connection with the work of the board.
2 Allied Health Professionals; Definition; Governing Board. Amend RSA 328-F:2, II to read as follows:
II. “Governing boards” means individual licensing boards of athletic trainers, occupational therapy assistants, occupational therapists, recreational therapists, physical therapists, physical therapist assistants, respiratory care practitioners, [and] speech-language pathologists, and genetic counselors.
3 New Paragraph; Allied Health Professionals; Genetic Counseling. Amend RSA 328-F:2 by inserting after paragraph IX the following new paragraph:
X. “Genetic counseling” means genetic counseling as defined in RSA 326-K:2.
4 Governing Board; Establishment. Amend RSA 328-F:3, I to read as follows:
I. There shall be established governing boards of athletic trainers, occupational therapists, recreational therapists, respiratory care practitioners, physical therapists, [and] speech-language pathologists, and genetic counselors.
5 New Paragraph; Genetic Counselors; Governing Board; Appointment. Amend RSA 328-F:4 by inserting after paragraph IX the following new paragraph:
X. The genetic counselors governing board shall consist of 4 licensed genetic counselors, who have actively engaged in the practice of genetic counseling in this state for at least 2 years, and one public member. Initial appointment of professional members by the governor and council shall be qualified persons practicing genetic counseling in this state. All subsequent appointments or reappointments shall require licensure.
6 Renewals; Reference to Genetic Counselors Added. Amend RSA 328-F:19, I to read as follows:
I. Initial licenses and renewals shall be valid for 2 years, except that timely and complete application for license renewal by eligible applicants shall continue the validity of the licenses being renewed until the governing board has acted on the renewal application. Licenses issued pursuant to RSA 328-A, RSA 326-G, and RSA 326-J shall expire in even-numbered years and licenses issued pursuant to RSA 326-C, RSA 326-E, [and] RSA 326-F, and RSA 326-K shall expire in odd-numbered years.
7 Effective Date. This act shall take effect July 1, 2013.
LBAO
13-0874
01/25/13
SB 135-FN - FISCAL NOTE
AN ACT relative to the regulation of the practice of genetic counseling.
FISCAL IMPACT:
The Office of Allied Health Professionals, Judicial Branch, Department of Justice and New Hampshire Association of Counties state this bill, as introduced, will increase state and county expenditures by an indeterminable amount in FY 2014 and each year thereafter. The Office of Allied Health Professionals states this bill will increase state revenue by $850 in FY 2014, $170 in FY 2015, $720 in FY 2016, and $390 in FY 2017. There will be no fiscal impact on county or local revenue or on local expenditures.
METHODOLOGY:
The Office of Allied Health Professionals assumes there would initially be five individuals licensed as genetic counselors, and the Board would operate as the other governing boards, hold monthly meetings and charge the same license fees as the other boards. The Office of Allied Health Professionals indicates, based on the existing fees as established for the other professions, the genetic board would not generate sufficient revenue to equal 125% of the Board’s expenditures. The Office of Allied Health Professionals states it would continue to budget and adhere to the 125% budget requirement the boards as a group. The Office assumes the bill would be effective on July 1, 2013 and no additional equipment would be needed. Based on these assumptions, the Office estimates the operating budget would be as follows:
FY 2014 |
FY 2015 |
FY 2016 |
FY 2017 | |
Revenue: |
||||
Initial Licensure (5 @ $170) |
$850 |
$170 |
$170 |
$170 |
Renewals (5 @ $110) (every other year) |
0 |
0 |
$550 |
0 |
Reinstatement (1@ $220) |
0 |
0 |
0 |
$220 |
Total Revenue |
$850 |
$170 |
$720 |
$390 |
Expenditures: |
||||
Current Expense |
$150 |
$150 |
$175 |
$175 |
Telecommunications |
$50 |
$50 |
$50 |
$75 |
Part-Time Salary |
$3,000 |
$3,000 |
$3,000 |
$3,000 |
Benefits |
$300 |
$300 |
$300 |
$300 |
In State Travel for Monthly Board Meetings |
$4,500 |
$4,500 |
$4,500 |
$4,500 |
Total Expenditures |
$8,000 |
$8,000 |
$8,025 |
$8,050 |
The Judicial Branch states this bill requires genetic counselors to obtain a license from the genetic counselors governing board in order to practice. The proposed legislation establishes a misdemeanor for any person practicing without a license. In addition, the bill creates the genetic counselors governing board with investigatory and disciplinary powers. The Branch states, while the chapter does not provide for administrative appeals to the Supreme Court, such appeals can be made by a writ of certiorari. The Branch has no information to estimate how many charges would be brought as a result of the changes contained in the bill to determine the fiscal impact on expenditures. The Branch estimates states the average cost of a class B misdemeanor case in the district division of the circuit court will be is $44.32 in FY 2014 and $45.84 in FY 2015 and each year thereafter. The Branch states the case cost estimates are based on data that is more than seven years old and does not reflect the changes to the courts over that same period of time or the impact these changes may have on the processing of these types of cases. The Branch has no information to estimate how many appeals may result from the changes contained in the bill to determine the fiscal impact on expenditures. However, if a single case were to be appealed to the New Hampshire Supreme Court, the fiscal impact would be in excess of $10,000.
The Department of Justice states the Administrative Prosecutions Unit (APU), which is part of the Consumer Protection and Antitrust Bureau, currently provides prosecution services to the Board of Allied Health Professionals. The Department assumes the addition of this new board may increase the work of the APU. The Department states a significant increase would require additional resources, but indicates licensing boards typically cover a portion of these costs through licensing fees. In addition, the Department assumes the Board would require assistance from the Civil Bureau with the promulgation of rules, administrative enforcement of violations and with general legal counsel to the Board. Finally, the Department states the bill provides a misdemeanor sanction for the unauthorized practice of genetic counseling and any prosecutions would likely be undertaken by the Department. The Department is unable able to estimate the additional service the Board will require and therefore cannot determine the fiscal impact.
The New Hampshire Association of Counties states to the extent more individuals are charged, convicted, and sentenced to incarceration in a county correctional facility, the counties may have increased expenditures. The Association is unable to determine the number of individuals who might be charged, convicted or incarcerated as a result of this bill to determine an exact fiscal impact. The average annual cost to incarcerate an individual in a county correctional facility is approximately $35,000. There is no impact on county revenue.
The Judicial Council assumes any violations of the proposed statute would take place within the context of someone’s employment and it would be unlikely that he or she would meet the eligibility standards for appointment of counsel. The Council estimates this bill would have no impact on general fund expenditures for the provision of counsel to the indigent accused.