Revision: Jan. 15, 2019, 12:57 p.m.
HB 547-FN - AS INTRODUCED
2019 SESSION
19-0411
10/04
HOUSE BILL 547-FN
AN ACT relative to licensure of polysomnographers.
SPONSORS: Rep. P. Schmidt, Straf. 19
COMMITTEE: Executive Departments and Administration
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ANALYSIS
This bill requires persons practicing polysomnography to be licensed and establishes the governing board of polysomnographers under allied health professionals.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
19-0411
10/04
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Nineteen
AN ACT relative to licensure of polysomnographers.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 New Chapter; Polysomnographers. Amend RSA by inserting after chapter 326-L the following new chapter:
CHAPTER 326-M
POLYSOMNOGRAPHERS
326-M:1 Definitions. In this chapter and RSA 328-F:
I. Board" means the board of polysomnographers.
II. "Polysomnographer" or "polysomnographic technologist" means a person licensed by the board to practice polysomnography.
III. “Practice of polysomnography” or "polysomnography" means monitoring and recording physiologic data during the evaluation of sleep-related disorders, including sleep-related respiratory disturbances by a polysomnographic technologist performing the following tasks under direct or indirect supervision of a licensed physician:
(a) Supplemental low flow oxygen therapy, less than 6 liters per minute utilizing nasal cannula or positive airway pressure (PAP) during a polysomnogram;
(b) Capnography during a polysomnogram;
(c) Cardiopulmonary resuscitation;
(d) Pulse oximetry;
(e) Gastroesophageal pH monitoring;
(f) Esophageal pressure monitoring;
(g) Sleep staging, including surface electroencephalography, surface electrooculography, and surface submental electromyography;
(h) Surface electromyography;
(i) Electrocardiography;
(j) Respiratory effort monitoring, including thoracic and abdominal movement;
(k) Plethysmography blood flow;
(l) Snore monitoring;
(m) Audio or video monitoring of movement and behavior during sleep;
(n) Nasal and oral airflow monitoring;
(o) Body temperature monitoring;
(p) Monitoring the effects that a mask or oral appliance used to treat sleep disorders has on sleep patterns, provided that the mask or oral appliance does not extend into the trachea or attach to an artificial airway;
(q) 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;
(r) Analyzing and scoring data collected during the monitoring described in subparagraphs (p) and (q) for the purpose of assisting a licensed physician in the diagnosis and treatment of sleep and wake disorders which result from developmental defects, the aging process, physical injury, disease, or actual or anticipated somatic dysfunction;
(s) Implementation of a written or verbal order from a licensed physician in a sleep lab or sleep center which requires the practice of polysomnography; and
(t) Education of a patient regarding the treatment regimen which assists the patient in improving the patient’s sleep.
326-M:2 Rulemaking. The board shall adopt rules pursuant to RSA 541-A:
I. Specifying the application procedures and eligibility requirements to be met by persons or entities seeking approval as providers of continuing education programs.
II. Specifying the standards to be met by continuing education programs.
III. Specifying the professional organizations, or the standards to be met by professional organizations, whose approval of education programs qualifies the programs as board-approved continuing education.
326-M:3 Requirements for Initial Licensure.
I. An applicant for an initial polysomnographer license for a person engaged in the practice of polysomnography shall be of good professional character and shall have completed a polysomnographic technologist educational program approved by the board and shall have successfully completed and achieved a passing score on the comprehensive registry examination for polysomnographic technologists administered by the Board of Registered Polysomnographic Technologists or its successor organization.
II. An applicant for initial licensure shall be required to certify under oath that the applicant is not under investigation by any professional licensing board and that the applicant's credentials have not been suspended or revoked by any professional licensing board.
III. An applicant for initial licensure who has not practiced as a polysomnographer for at least 500 hours per year during the 4 years prior to filing the application shall be required to successfully complete continuing education and continuing competency requirements set forth in rules adopted by the board pursuant to RSA 541-A.
326-M:4 Professional Identification.
I. A person holding a license issued by the board to practice as a polysomnographic technologist in this state shall use the title “licensed polysomnographic technologist.”
II. The licensee shall show his or her license when requested.
326-M:5 Duties and Powers of the Board.
I. The board shall have the authorities, powers, and duties set forth in RSA 328-F.
II. In addition, the board shall:
(a) Elect officers from among its members for terms of one year.
(b) Provide information to the public and its licensees regarding the complaint process.
(c) Provide timely orientation of new professional and public appointees to the board regarding duties, powers, and procedures of the board.
(d) Advise the board of directors of the office of licensed allied health professionals of matters regarding polysomnography.
(e) Keep information confidential in accordance with the confidentiality requirements of RSA 328-F.
(f) Keep confidential patient records, patient files, reports relating to patients, oral statements relating to diagnostic findings or treatment of patients, information from which a patient or his or her family may be identified and information received and records kept by the board as a result of an investigation, except when these become part of a disciplinary hearing or are required to be disclosed by the order of a court.
III. The board may refer the unlawful practice of polysomnography to the attorney general's office for prosecution regardless of whether the person or entity ceases the unlawful practice.
326-M:6 Exemptions From Licensure.
I. This chapter shall not prohibit:
(a) A person matriculated in an education program approved by the board who is pursuing a degree in polysomnography from satisfying supervised clinical education requirements related to the person's education while under direct supervision of a licensed practitioner or physician.
(b) A polysomnographer from practicing in the armed forces, federal public health services, or the Department of Veterans Affairs, pursuant to federal regulations of health care providers.
(c) A polysomnographer who is licensed in another jurisdiction of the United States from providing consultation by telecommunication.
(d) A polysomnographer who is licensed in another jurisdiction of the United States or foreign educated practitioner credentialed in another country from practicing polysomnography in conjunction with teaching or participating in an educational seminar of no more than 60 days in a calendar year.
II. This chapter shall not restrict a person licensed under any other law of this state from engaging in the profession or practice for which that person is licensed if that person does not represent, imply, or claim that he or she is a polysomnographer or a provider of polysomnography.
326-M:7 Rights of Consumers.
I. The public shall have access to:
(a) A list of licensees and conditional license holders that includes place of practice, license number, date of license or date of conditional license expiration, and status of license.
(b) A list of official actions taken by the board.
(c) A copy of public records of all hearings.
(d) A copy of minutes from all public meetings of the board.
II. A polysomnographer shall inform each patient that the patient has the freedom of choice in services and products.
III. Any person may submit a complaint in writing to the board regarding any licensee, entity, or other person potentially in violation of this chapter or of RSA 328-F. Confidentiality shall be maintained subject to state and federal law.
IV.(a) Information relating to practitioner-patient relationship is confidential and shall not be related to a third party who is not involved with the patient's care without the prior written consent of the patient.
(b) Confidential communications between licensees and their patients are placed on the same legal basis as those between physician and patient, and, except as otherwise provided by law, no licensee shall be required to disclose such privileged communications. Confidential communications between a patient of a licensee and any person working under the supervision of such licensee to provide services that are customary and necessary for diagnosis and treatment are privileged to the same extent as would be the same communications between the supervising licensee and the patient.
(c) The privilege established in subparagraph (b) shall not apply to investigations and disciplinary proceedings conducted by any agency regulating health professions in this state.
326-M:8 Responsibilities of the Polysomnographer.
I. The polysomnographer is responsible for managing all aspects of the polysomnographic care of each patient under the orders of a physician, physician assistant, or nurse practitioner. The practitioner shall provide:
(a) Written documentation of therapeutic effectiveness of care provided.
(b) Periodic written evaluation of each patient.
(c) Written documentation of diagnostic studies performed.
II. The polysomnographer shall be aware of and abide by this chapter, RSA 328-F, and the rules adopted by the board.
III. Each licensee shall provide his or her employer with a copy of his or her license, conditional license, current renewal verification, or proof of reinstatement of license. This copy shall be available for public review upon request. The employer shall maintain a list of all persons providing polysomnography at his or her facility for review by the board upon request.
IV. In response to board inquires relevant to the status of their licenses or their practice of polysomnography, licensees shall provide complete and truthful information to the board.
V. Licensees shall notify the board if licenses, renewal verification cards, or other proofs of licensure are lost or stolen.
VI. Licensees shall maintain their current business and residential addresses on file with the licensing governing board. Changes in addresses shall be submitted no later than 30 days from the date of change.
VII. Each licensee shall notify the board of those acts or omissions that are violations of this chapter or are grounds for disciplinary action.
326-M:9 Materiel Management. The assembly, delivery, maintenance, repair, and testing of polysomnographic care equipment and supplies shall be performed by polysomnographers and other personnel in conformity with rules adopted by the board under RSA 541-A.
326-M:10 Eligibility for License Renewal. Licensees are eligible for renewal of their licenses if the licensees:
I. Have not violated this chapter or RSA 328-F nor demonstrated poor professional character.
II. Meet any continuing education and continuing competency requirements established by the board in rules adopted pursuant to RSA 541-A.
326-M:11 Approved Continuing Education Programs and Program Providers.
I. Education programs accepted by the board in fulfillment of the continuing education required for license renewal are:
(a) Education programs approved by other approved professional organizations.
(b) Education programs sponsored by continuing education providers approved by the board.
II. The board is authorized to approve, disapprove, or withdraw approval from providers of polysomnographic continuing education programs.
III. The board shall establish, through rules adopted pursuant to RSA 541-A, application procedures and eligibility requirements for the approval of persons and entities as providers of continuing education programs.
IV. The board shall set standards for the approval of continuing education programs and for the approval of providers of continuing education programs, including:
(a) Minimum qualifications of faculty.
(b) Curricular topics consistent with the knowledge and skills required for the practice of polysomnography, including biological, physical, social, behavioral, and respiratory care and medical sciences.
(c) Administrative aspects of the program or the provider.
2 Respiratory Care; Rulemaking; Reference Removed. Amend RSA 326-E:2, I to read as follows:
I. Specifying the limited scopes of practice permitted to certified pulmonary function technicians[,] and registered pulmonary function technologists[, and registered polysomnographic technologists].
3 Respiratory Care; Professional Identification; Reference Removed. Amend RSA 326-E:4, III to read as follows:
III. A person matriculated in an accredited respiratory care [or polysomnographic technology] education program shall display appropriate identification.
4 Respiratory Care; Exemptions from Licensure. Amend RSA 326-E:6, I(e) to read as follows:
(e) Respiratory care performed as part of a limited scope of practice, as defined by the board, by certified pulmonary function technicians (CPFT), registered pulmonary function technologists (RPFT) or [registered polysomnographic technologists (RPSGT)] licensed polysomnographers in a diagnostic laboratory or research setting.
5 Allied Health Professionals; Definitions. 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, polysomnographers, speech-language pathologists, and genetic counselors.
6 New Paragraph; Allied Health Professionals; Definitions. Amend RSA 328-F:2 by inserting after paragraph X the following new paragraph:
XI. "Polysomnography" means polysomnography as defined in RSA 326-M:1.
7 New Paragraph; Allied Health Professionals; Governing Boards. Amend RSA 328-F:4 by inserting after paragraph X the following new paragraph:
XI. The polysomnographers governing board shall consist of 3 licensed polysomnographers, who have actively engaged in the practice of polysomnography in this state for at least 2 years, one practicing physician with experience in working with polysomnographers, and one public member. Initial appointment of professional members by the governor and council may be qualified persons practicing as respiratory care practitioners under RSA 326-E. All subsequent appointments or reappointments shall require licensure as polysomnographers.
8 Allied Health Professionals; License Renewal. 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, and RSA 326-M shall expire in even-numbered years and licenses issued pursuant to RSA 326-C, RSA 326-E, RSA 326-F, and RSA 326-K shall expire in odd-numbered years.
9 Repeals. The following are repealed:
I. RSA 326-E:1, VIII, relative to the definition of polysomnography.
II. RSA 326-E:4, III, relative to the display of appropriate identification.
III. RSA 326-E:6, I(i) relative to exceptions for polysomnographer trainees for respiratory care practice.
10 Effective Date. This act shall take effect July 1, 2019.
19-0411
1/14/19
HB 547-FN- FISCAL NOTE
AS INTRODUCED
AN ACT relative to licensure of polysomnographers.
FISCAL IMPACT: [ X ] State [ ] County [ ] Local [ ] None
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| Estimated Increase / (Decrease) | |||
STATE: | FY 2020 | FY 2021 | FY 2022 | FY 2023 |
Appropriation | $0 | $0 | $0 | $0 |
Revenue | $5,500 | $0 | $5,500 | $0 |
Expenditures | Indeterminable Increase | Indeterminable Increase | Indeterminable Increase | Indeterminable Increase |
Funding Source: | [ X ] General [ ] Education [ ] Highway [ X ] Other - Office of Professional Licensure and Certification Fund (RSA 310-A:!-e, I(b)) | |||
METHODOLOGY:
This bill requires the licensure of persons practicing polysomnography and creates a separate governing board within the Office of Professional Licensure and Certification's (OPLC) Allied Health unit. The bill is effective July 1, 2019. Licensees issued pursuant to this legislation are governed by RSA 328-F:19 for Allied Health Professionals and shall expire in even-numbered years. The OPLC estimates a $110 license fee payable every other year and 50 licensees total, with no estimated growth in the number of licensees. Assuming all 50 potential licensees apply for a license after July 1, 2019 and before December 30, 2019, estimated revenue for FY 2020 is $5,500 ($110 x 50 = $5,500) and all 50 potential licensees apply for renewal of the license 24 months later, estimated revenue for FY 2022 is $5,500.
OPLC estimates total annual expenses of $34,620. Estimated expenses include the addition of a part-time licensing clerk for $22,620 (29 hours per week at $15.00 per hour) and board expenses of $12,000 per year consisting of a per diem rate ($50 x 5 members = $250 x 12 meetings per year = $3,000) plus mileage ($750 x 12 meetings per year = $9,000).
This bill contains penalties that may have an impact on the New Hampshire judicial and correctional systems. There is no method to determine how many charges would be brought as a result of the changes contained in this bill to determine the fiscal impact on expenditures. However, the entities impacted have provided the potential costs associated with these penalties below.
Judicial Branch | FY 2020 | FY 2021 |
Class B Misdemeanor | $53 | $54 |
Class A Misdemeanor | $76 | $77 |
Routine Criminal Felony Case | $481 | $486 |
Appeals | Varies | Varies |
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It should be noted that average case cost estimates for FY 2020 and FY 2021 are based on data that is more than ten years old and does not reflect changes to the courts over that same period of time or the impact these changes may have on processing the various case types. An unspecified misdemeanor can be either class A or class B, with the presumption being a class B misdemeanor. | ||
Department of Corrections |
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FY 2018 Average Cost of Incarcerating an Individual | $40,615 | $40,615 |
FY 2018 Annual Marginal Cost of a General Population Inmate | $4,620 | $4,620 |
FY 2018 Average Cost of Supervising an Individual on Parole/Probation | $571 | $571 |
NH Association of Counties |
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County Prosecution Costs | Indeterminable | Indeterminable |
Estimated Average Daily Cost of Incarcerating an Individual | $105 to $120 | $105 to $120 |
Many offenses are prosecuted by local and county prosecutors. When the Department of Justice has investigative and prosecutorial responsibility or is involved in an appeal, the Department would likely absorb the cost within its existing budget. If the Department needs to prosecute significantly more cases or handle more appeals, then costs may increase by an indeterminable amount.
AGENCIES CONTACTED:
Office of Professional Licensure and Certification, Judicial Branch, Department of Justice, New Hampshire Association of Counties, and Department of Corrections