State Government AffairsLegislative Update
Specific Respiratory Therapy Legislation
AZ- bill to roll independent RT Bd. into State Bd. of Nursing. Bill also deleted part of the scope of practice
ASRC and AARC worked in tandem to defeat.
WV amends student requirements for license and work permits
IA & UT tweaks RT Lic. Bd. responsibilities
OH (enacted) RTs subject to criminal background Cks.
CA RTs exempt during disasters (Good Sam)
Legislation Indirectly Impacting RTs
Report Vent Associated Pneumonia:
Al, HI, ID, MA, MS, MO, NH, NY, OK, UT, VA, WV
Asthma Mgt: FL, MS, MO, MS (kids screened for asthma) NY, TN, WA
COPD: IL (State Health Dept. to address), NM (part of quality indicators) VT
Legislation Indirectly Impacting RTs
Licensing DMEs: AZ Hospital Staffing: FL, HI, MN (RT
mention) Paramedics: FL (can provide non-
emergency services in ED) Enhanced retirement for those who
do “taxing work”, includes RTs: NY (also NY RTs not supposed to engage in torture)
Tobacco Related Legislation
Increased Taxes: Al, HI, ID, KS, ME, NE Smoke Free Environments: IA, MS,
OK, WV Smoking Cessation Programs: CO,
CT, MO, NE, NM, NV, RI, WA, WV No smoking in cars with kids: NE (age
16), WA (age 13) UT (“child”)
State RT Regulation
FL: Home study courses, reactivation of licenses, emergency response
KS: license fees NH: License renewal, disciplinary actions NJ: No longer renews a temporary
license NC: continuing ed requirements
Polysomnography Licensure Legislation
Licensure is enacted when it is determined that the health and safety of the public may in jeopardy if personnel providing the service have not met standards
Licensure demands standards: education/training and competency documentation be met
Polysomnography
AARC does not oppose the state regulation of those providing polysomnography/ sleep disorder services
AARC Board of Directors endorsed a Guidance Document on Polysomnography Licensure
Guidance Document
Does the legislation call for competency testing of the individual
Until competency has been documented are the personnel under the delegation of the physician
Are respiratory therapists exempt from having to be licensed, acquire further ed or obtain a credential
That is NOT what is happening in the states
That is NOT how the polysom model licensure legislation is written
Polysomnography Licensure
Model language permits: Individuals without accredited training or
valid competency testing to provide services- RT services
Limited supervision of these individuals Singles out the licensed RT to acquire
additional credential
No complaints or disciplinary actions every taken against an RT providing poor or incompetent sleep disorder services
Model Polysom Licensure Legislation singles out the RT to meet additional requirements i.e. obtain the RPSGT credential in order to keep providing the same services that have been permitted, with no complaints or issues for decades
With these new laws, if an RT provides the range of services defined as Polysomnography in these laws, without the additional credential the law requires the RT Licensure Board to take disciplinary action.
Nurses and other licensed health professionals NOT singled out, only RTs
Diminishes the RT scope of practice for no documentable or evidence based reason.
RTs required to pay for and pass and obtain an additional credential
Polysomnography
New Mexico enacted. Provision that would require RTs to become polysom technologists (RPSGT) eliminated.
California- 2 bills CRCB legislation licenses polysoms
under RC Bd. Sleep Stakeholders bill puts it under
Medical Bd.
NY ongoing moving towards licensure NY takes the view that licensure is for
professionals, defined as those with accredited education and competency testing
Will provide a grandfather pathway for the OJT to gain licensure for a limited time. Then 2 year associate degree required.
Iowa joint statement by RT, Nursing and Physician Bds.
MS Discussions with sleep stakeholders
LA polysom licensure law, required CAAHEP approved graduation. No schools established in years since. Proposed regs trying to insert OJT pathway to licensure
Federal Regulatory Issues
National Coverage Determination Policy for CPAP Therapy
National Coverage Decision (NCD) Memo for Continuous Positive Airway Pressure (CPAP) Therapy for Obstructive Sleep Apnea (OSA)
http://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=204
Coverage of CPAP is initially limited to a 12 week period for beneficiaries diagnosed with OSA
Coverage of CPAP based upon a diagnosis of OSA by home sleep testing (HST).
Major change:
Sleep testing to document OSA and need for C- PAP now can be done in the home AARC submitted 2 sets of comments
sleep testing should be under the conducted by an accredited facility or entity
Qualified personnel should be specifically identified including credentialed sleep technologists, ENDs, Nurses and RTs
Medicare Durable Medical Equipment Issues
36 month rent to own home O2 equipment
Started January 2006- clock is still ticking
CMS did issue regs to cover some concerns; servicing, replacement extra. But issues still exist.
Medicare Durable Medical Equipment Issues
Competitive Bid 10 MSAs chosen last fall Winners just announced 10 product categories including home
oxygen and O2 equipment supplies CMS says overall payments under CB
will save 26% of what Medicare currently pays
DME Accreditation
To compete in CB have to be accredited by one of 10 CMS approved accrediting bodies (Ex, JT. Commission).
All DMES participating in Medicare will have to be accredited by fall of 2009
CMS has Standards that Accrediting entities must follow when reviewing DMEs
Includes 3 specific AARC CPGs: Oxygen Therapy in the Home or
Alternate Site Health Care Facility; Long-Term Invasive Mechanical
Ventilation in the Home, and Intermittent Positive Pressure Breathing
Other Regulatory Issues
CMS CORF regs- meet to clarify terms respiratory therapists vs old RT technicians
Working with patient Stakeholders on CFC Free MDI/DPI transition
DOT working with Coalition to push for final regs: air carriers must permit (now an option) passengers to carry on approved portable O2 concentrators
CDC stop using inhalation therapists in MedWatch
Find out where RT Hospital Coverage policies went when CMS transitioned from paper to on line