Revision: June 6, 2013, midnight
SB 135-FN – AS AMENDED BY THE HOUSE
03/07/13 0356s
5June2013… 1718h
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. The bill also requires that professionals exempted from licensure but engaged in genetic counseling comply with the disclosure requirements applicable to genetic counselors.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.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
5June2013… 1718h
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 practice of genetic counseling.
V. “NSGC” means the National Society of Genetic Counselors, its equivalent, or successor.
VI. “Practice of genetic counseling” means, for the purposes of advising an individual client, a client’s family, or other licensed health care professionals:
(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; and
(g) Providing written documentation of medical, genetic, and counseling information for families and health care professionals.
326-K:2 Exemptions from Licensure. Except for the requirements under RSA 326-K:8, 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.”
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 currently certified by ABGC or ABMG; or
(b) Medical geneticist currently certified by ABMG.
III. Be at least 18 years of age.
IV. Be of good moral character.
V. Demonstrate sufficient evidence of good professional character and reliability to satisfy the board that the applicant shall faithfully and conscientiously avoid professional misconduct and adhere to this chapter, RSA 328-F, and the board’s rules.
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) Two years from the issuance of a provisional license.
III. A provisional license may only be extended upon approval of the board for good cause shown.
IV. 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 the supervising licensed genetic counselor or supervising licensed physician.
V. The board is authorized to issue conditional provisional licenses in accordance with rules adopted pursuant to RSA 541-A.
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.
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. The board may, in its discretion, grant a license under this chapter to an individual certified or licensed in another state if it determines that the requirements or standards for certification or licensure in that state are equivalent to, or greater than, those established by 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.
326-K:8 Privileged Communications. In addition to RSA 328-F:28:
I. No person shall disclose any information or results related to a genetic evaluation, assessment, laboratory test, diagnostic study, or written documentation of genetic counseling, to any person other than the client without prior written consent.
II. Information and results may be made available to the board for use in an investigation or disciplinary proceeding under RSA 328-F concerning a licensed genetic counselor only if the results are coded to maintain confidentiality of the client.
III. A violation of this section shall be subject to a civil action by an aggrieved individual and, if successful, the aggrieved individual shall be awarded special or general damages of not less than $10,000 for each violation, and costs and reasonable legal fees.
326-K:9 Rulemaking.
I. In addition to rules adopted pursuant to RSA 328-F:11, the board shall adopt rules pursuant to RSA 541-A relative to:
(a) Eligibility requirements for provisional licenses.
(b) Application procedures for provisional licenses.
(c) The requirements for direction and supervision of those practicing under provisional licenses.
(d) The limitations on practice imposed on those practicing under provisional licenses.
326-K:10 Eligibility for Renewal of Licenses. Licensees are eligible for renewal of their licenses if they:
I. Have completed 50 hours of continuing education which meet the requirements established by the board through rulemaking pursuant to RSA 541-A and at least 50 percent of which are directly related to the practice of genetic counseling.
II. Have not violated this chapter or RSA 328-F nor demonstrated poor professional character.
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:1.
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 3 licensed genetic counselors, who have actively engaged in the practice of genetic counseling in this state for at least 2 years, one practicing physician with experience in working with genetic counselors, 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 Genetic Testing; Disclosure; Medical Practice or Hospital. Amend RSA 141-H:2, III to read as follows:
III. Except as provided in paragraph II, or authorized by RSA 141-J, no person shall disclose to any other person that an individual has undergone genetic testing, and no person shall disclose the results of such testing to any other person, without the prior written and informed consent of the individual, the parent, guardian, or custodian if the individual is a minor under the age of 18, or the legal guardian or conservator if the individual is an incompetent person. [Discussion and disclosure of genetic testing for a patient, requested of a physician by a patient, by appropriate professionals within a physician's medical practice or hospital shall not be a violation of this chapter.]
8 Effective Date. This act shall take effect July 1, 2013.
LBAO
13-0874
Revised 04/03/13 Amended 03/18/13
SB 135 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 amended by the Senate (Amendment #2013-0356s), 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 $2,550 in FY 2014, $340 in FY 2015, $2,160 in FY 2016, and $1,170 in FY 2017. There will be no fiscal impact on county or local revenue, or local expenditures.
METHODOLOGY:
This bill would establish a Genetic Counselors Governing Board within the Office of Licensed Allied Health Professionals. The Office of Allied Health Professionals assumes there would initially be fifteen 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 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 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. In addition, the Office assumes there will be approximately 15 individuals licensed in FY 2014, two in FY 2015, and three in subsequent years. 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 ($170 each) |
$2,550 |
$340 |
$510 |
$510 |
Renewals ($110 each, every other year) |
0 |
0 |
$1,650 |
$220 |
Reinstatement ($220 each) |
0 |
0 |
0 |
$440 |
Total Revenue |
$2,550 |
$340 |
$2,160 |
$1,170 |
Expenditures: |
||||
Current Expenses |
$150 |
$150 |
$175 |
$175 |
Telecommunications |
$50 |
$50 |
$50 |
$75 |
Personal Services Temporary Appointment |
$2,000 |
$2,000 |
$2,000 |
$2,000 |
Benefits |
$153 |
$153 |
$153 |
$153 |
Total Expenditures |
$2,353 |
$2,353 |
$2,378 |
$2,403 |
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.