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F I S C A L I M P A C T R E P O R T

SPONSOR Lopez

DATE TYPED 3/15/05

HB

SHORT TITLE Polysomnography Licensure Exemptions

SB 1051/aSPAC

ANALYST McSherry

REVENUE

Estimated Revenue

Subsequent

Years Impact

Recurring

or Non-Rec

Fund

Affected

FY05

FY06

NFI

$3.0-$5.0

$5.0-$6.0 Recurring

Respiratory Care

Fund

(Parenthesis ( ) Indicate Revenue Decreases)

SOURCES OF INFORMATION

LFC Files

Responses Received From

Regulations and Licensing Department (RLD)

SUMMARY

Synopsis of SPAC Amendments

Senate Public Affairs Committee Amendments made to SB 1051 would replace the proposed

definition for Polysonography-related respiratory services, add an additional “exemption” from

licensure requirements, and would add a provision allowing RLD and the Respiratory Car Board

to issue temporary permits for students and graduates of approved polysomnography training

programs.

The newly proposed definition of polysomnographic related respiratory care services to be: the

limited practice of respiratory care by a pohysomnographic technologist under medical direction,

a technician or trainee under physician or technologist supervision, or a licensed respiratory car

practitioner. The services would be limited to “diagnostic and therapeutic” use of oxygen and

noninvasive ventilatory assistance for patients who spontaneously breathe when awake, applica-

tion and monitoring of oximetry and capnography, and educating patients.

The new exemption would allow a polysomnographic technologist to transcribe and implement

the orders of a NM physician or other authorized prescribing entity pertaining to polysomnogra-

phy.

Senate Bill 1051/aSPAC -- Page 2

Synopsis of the Original Bill

Senate Bill 1051 proposes to amend the Respiratory Care Act to include three new types of li-

censure (polysomnography, polysonmographic technitions and polysomnography trainees), in-

crease the number of members on the board from five to six, and change restrictions of practice

accordingly.

Specifically, the bill would:

Amend the definition section of the Respiratory Care Act (the Act) to include polysomnogra-

phy, polysomography-related respiratory care services, polysomnograpic (PSG) technicians,

PSG technologists, and PSG trainees. Polysomnography would be defined as: the process of

analyzing, monitoring and recording physiologic data during sleep and wakefulness to assist in

the assessment and diagnosis of sleep-wake disorders and other disorders, syndromes and dys-

functions that are sleep-related, manifest during sleep or that disrupt normal sleep-wake cycles

and activities.

Include educational, training, and examination requirements for PSG technologists to qualify

for issuance of a limited license to provide polysomnography-related respiratory care services to

patients in sleep disorder centers, sleep clinics, or sleep laboratories under the supervision of a

New Mexico licensed physician at a sleep disorder center or laboratory.

Include education and training requirements for PSG technicians and trainees to qualify for

limited permits to provide polysomnography-related respiratory care services as defined in the

legislation, to patients in sleep disorder centers, sleep clinics, or sleep laboratories under the su-

pervision of a New Mexico licensed physician at a sleep disorder center or laboratory.

Authorize the Regulation and Licensing Department (RLD) promulgate rules for issuance

and renewal of limited licenses to PSG technologists, and limited permits to PSG technicians or

trainees.

Add a PSG technologist member to the Respiratory Care board, and sets forth the require-

ments for appointment to the board.

Allow the Department to waive the education and examination requirements for a PSG tech-

nologist applicant for limited license who presents proof of current licensure, registration, or

permit in good standing in another jurisdiction that has licensure/permitting standards at least

equal to or better than those required in the Act.

Establish title use provisions for PSG technologists who have been issued a limited license or

PSG technicians and trainees who have been issued limited permits by the Department.

Amend Section 61-12B-12 to include PSG technologists, technicians, and trainees in the dis-

ciplinary provisions of the Act.

Authorize the Department to assess licensure and renewal fees for licensing and permitting of

PSG technologists, technicians, and trainees.

Senate Bill 1051/aSPAC -- Page 3

Significant Issues

The proposed licensures have not been reviewed through the sunrise process. A new board is not

being proposed, however a new types of professional licensure is proposed.

It is not known whether individuals currently practicing polysomnography would meet the li-

censing requirements proposed in the bill.

The proposed bill would require PSG technicians to have completed a formal polysomnography

training program associated with a state-licensed or nationally accredited educational facility or

successfully completed 480 hours of experience as a trainee. It is not known what portion of

care providers would be eligible for licensing if the proposed bill went into effect on July 1,

2005. It is possible that a large portion of providers would not be eligible.

According to RLD, many PSG technologists and technicians are trained on the job (OJT) and the

OJT varies from employer to employer resulting in great variability. RLD asserts that the vari-

ability places patients in sleep centers, sleep clinics and sleep laboratories at risk and that the

state has no mechanism in place to monitor the quality of care provided or the ethical behavior of

PSG staff.

RLD reports that tests performed by PSG staff require contact with a patient’s body, watch-

ing/videotaping patients sleep, knowledge of protected health information, patient education, and

manipulation of modality devices if certain treatments are utilized.

According to RLD, respiratory care related modalities affect the patient’s ability to breathe, and

are sensitive. The Department believes personnel should be trained and competent to provide

these services

.

This legislation would require that PSG personnel who provide PSG-related respiratory care ser-

vices have documented training, continuing education, and regulation consistent with the re-

quirements for respiratory care practitioners providing the same PSG-related respiratory care

services to patients.

FISCAL IMPLICATIONS

The bill provides for increased revenues to the Respiratory Care Board garnered through three

new licensures.

ADMINISTRATIVE IMPLICATIONS

The additional three levels of licensure would result in additional administrative workload for the

board administrators at RLD and additional workload for the Respiratory Care Board.

TECHNICAL ISSUES

There is a technical error on Line 4, page 4. “of” should be deleted at the beginning of the line.

OTHER SUBSTANTIVE ISSUES

RLD asserts that the proposed changes in SB1051 were developed by members of the New Mex-

Senate Bill 1051/aSPAC -- Page 4

ico Society for Respiratory Care who operate sleep centers/clinics/labs in Albuquerque, Santa Fe,

Gallup and Clovis and that the bill incorporates language recently enacted by the Oregon state

legislature.

RLD predicts there may be opposition to the legislation from the Association of Polysomno-

graphic Technologists. It is not clear what role, if any, polysomnographic technologists, techni-

cians, and trainees have played in developing the proposed language.

Despite the new licensure being proposed to be included under an already existing board; it

seems that the same process of public and professional hearing and involvement should be con-

sidered when regulating a new profession as is provided for when creating a new licensing board

through the Sunrise Act.

WHAT WILL BE THE CONSEQUENCES OF NOT ENACTING THIS BILL.

Sleep centers/clinics/laboratories will continue to train and employ polysomnography profes-

sionals and the profession would not be licensed.

According to RLD, patients would be at risk.

POSSIBLE QUESTIONS

1.

What role have polysomnographic professionals taken in proposing this bill.

2.

Have public hearing been held regarding the proposed licensures.

3.

Have any “grandfathering” mechanisms been proposed to provisionally license those pro-

fessionals currently practicing polysomnography.

EM/lg:yr