hb 1388

CHAPTER 275

HB 1388 - FINAL VERSION

AN ACT relative to respiratory care.

SPONSORS: Rep. P. Bradley, Coos 6; Rep. Horton, Coos 3; Sen. Hollingworth, Dist 23

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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

AN ACT relative to respiratory care.

Be it Enacted by the Senate and House of Representatives in General Court convened:

275:1 Purpose. The purpose of this act is to protect the public health, safety, and welfare, and to provide for the state administrative control, supervision, licensure, and regulation of the practice of respiratory care. It is intended that individuals who meet and maintain prescribed standards of competence and conduct may engage in the practice of respiratory care as authorized by this act. This act shall be liberally construed to promote the public interest and to accomplish the purposes stated herein.

275:2 Respiratory Care Practice Act. RSA 326-E is repealed and reenacted to read as follows:

I. "Board" means the governing board of respiratory care practitioners established under RSA 328-F:3, I.

II. "Consultation by telecommunication'' means that a respiratory care practitioner renders professional or expert opinion or advice via telecommunications or computer technology from another location. It includes the transfer of data or exchange of educational or related information by any means of audio, video, or data communications.

III. "Direct supervision" means a respiratory care practitioner licensed in this state who is physically present and is immediately available to direct and supervise tasks related to patient management.

IV. "Indirect supervision" means a respiratory care practitioner licensed in this state who is immediately available for consultation, direction, or supervision regarding the practice or performance of respiratory care.

V. "Performance of respiratory care" means respiratory care in accordance with the prescription of a licensed physician, licensed osteopath, certified physician assistant or nurse practitioner, including but not limited to, the diagnostic and therapeutic use of the following:

(a) Administration of medical gases (except for the purpose of anesthesia), aerosols, and humidification.

(g) Specific diagnostic and testing techniques employed in the medical management of patients to assist in diagnosis, monitoring, treatment, and research of pulmonary abnormalities, including measurements of ventilatory volumes, pressures and flows, collection and analysis of specimens of blood and blood gases and specimens from the respiratory tract, expired and inspired gas samples, respiratory secretions, and pulmonary function testing and hemodynamic and other related physiologic measurements of the cardiopulmonary system.

VI. "Physician" means a person licensed to practice medicine in this state pursuant to RSA 329.

VII. "Physician assistant" means a person licensed to practice as a physician's assistant pursuant to RSA 328-D.

(a) Direct and indirect respiratory care services, including but not limited to the administration of pharmacological, diagnostic, and therapeutic agents necessary to implement a treatment, disease prevention, pulmonary rehabilitative, or diagnostic regimen by a physician, physician assistant, or nurse practitioner.

(b) Transcription and implementation of written or verbal orders of a physician, physician assistant, or nurse practitioner which pertains to the practice of respiratory care.

(c) Observing and monitoring signs and symptoms, general behavior, general physical response to respiratory care treatment and diagnostic testing, including determination of whether such signs, symptoms, reactions, behavior or general response exhibits abnormal characteristics.

(d) Implementing report, referral, and respiratory care protocols or changes in treatment, based on observed abnormalities, pursuant to a physician, physician assistant, or nurse practitioner's prescription.

(e) Initiating emergency procedures pursuant to this board's rules or as otherwise provided under this chapter. Respiratory care may be practiced in any clinic, hospital, skilled nursing facility, private dwelling, or other place deemed appropriate or necessary by the board and in accordance with the prescription or verbal order of a physician, physician assistant or nurse practitioner.

IX. "Nurse practitioner" means a person licensed to practice as a nurse practitioner in this state pursuant to RSA 326-B:10.

treatment, management, diagnostic testing, control, and care of patients with deficiencies and abnormalities associated with cardiopulmonary systems under the direction of a physician, physician's assistant, or nurse practitioner. Respiratory care also includes inhalation therapy and respiratory therapy.

the American Medical Association's Committee on Allied Health Education and Accreditation (CAHEA) in collaboration with the Joint Review Committee for Respiratory Therapy Education (JRCRTE), or the Committee on Accreditation for Respiratory Care (CoARC), or by the Commission on Accreditation of Allied Health Education Programs (CAAHEP), or their successor organizations.

(a) Employed in the practice or performance of respiratory care who has the knowledge and skill necessary to administer the functions defined in paragraphs III and IV of this section.

(b) Capable of serving as a resource in relation to the clinical and technical aspects of respiratory care as to the safe and effective methods for administering respiratory care modalities.

(d) Capable of supervising, directing, or teaching less skilled personnel in the provision of respiratory care services.

XIII. "Supervisor of record" means a licensed respiratory care practitioner in this state who has been actively practicing as an respiratory care practitioner for at least 2 years prior to becoming a supervisor of record and is employed by the same employer as the person being supervised.

326-E:2 Rulemaking. The board shall adopt rules, pursuant to RSA 541-A, relative to:

I. Renewal of licenses, including requirements for continuing professional education.

II. Educational and professional qualifications for licensure, including requirements for applicants currently licensed in other states, territories, countries.

I. An applicant for a license to practice respiratory care shall be of good moral character and shall obtain and submit to the board written evidence, under oath, that the applicant:

(a) Completed a 4-year high school course of study or its equivalent as determined by the appropriate agency.

(b) Completed a respiratory care educational program as defined in RSA 326-E:1, except where the applicant has passed the National Board for Respiratory Care (NBRC) entry level exam or higher prior to July 31, 1977.

II. The applicant, except as otherwise provided in this chapter or RSA 328-F, shall be required to pass a standardized national examination.

III. The board may issue a license to practice respiratory care by endorsement to an applicant that has an application on file with the board and is:

(a) An applicant who is currently licensed to practice respiratory care under the laws of another state, territory, or country if the qualifications of the applicant are deemed by the board to be at least equivalent to those required in this state.

(b) Applicants holding credentials conferred by the National Board for Respiratory Care, Inc., as a Certified Respiratory Therapy Technician (CRTT), Certified Respiratory Therapist (CRT), or as a Registered Respiratory Therapist (RRT), providing such credential has not expired, been revoked, or suspended.

IV. Applicants applying for license under paragraph III shall be required to certify under oath that they are not under investigation by any professional licensing board and that their credentials have not been suspended, revoked, or expired.

V. The applicant applying for license under paragraph III shall practice under the indirect supervision and responsibility of a licensed respiratory care practitioner in this state, providing the applicant obtains an interim license as defined in RSA 326-E:6 and a current supervisory form is on file with the board.

I. Examinations for licensure in respiratory care shall be in English, nationally standardized, and administered by the National Board of Respiratory Care, Inc. or its successor organization as approved by the board. Examinations shall be made available no fewer than 2 times a year and in such places as may be determined by the board.

II. An applicant applying for licensure shall pay a fee, not to exceed 125 percent of the administrative cost, to the board. A fee shall be required for each reexamination. If an applicant fails to complete the requirements within 18 months from the date of filing, the application shall be considered abandoned. The applicant shall be allowed 2 reexaminations without undergoing further education at the direction of the board.

I. A person holding a license to practice respiratory care in this state shall use the title "respiratory care practitioner" and the abbreviation, "R.C.P.".

III. A person matriculated in an accredited respiratory care or polysomnographic technology education program shall display appropriate identification.

IV. A person or business entity, its employees, agents, or representatives shall not use in conjunction with that person's name or activity of the business the words "respiratory care", "respiratory therapy", "respiratory care practitioner", or "respiratory therapist" or the letters "R.T." or "R.C.P" or any other words, abbreviations, or insignia indicating or implying directly or indirectly that respiratory care is provided or supplied, including the billing of services labeled as respiratory care, unless such services are provided by or under the direction of a respiratory care practitioner licensed under this chapter.

I. The board shall issue an interim license, upon payment to the board, to qualified applicants who have filed an application with the board and who:

(a) Have graduated from an approved respiratory care program and are awaiting examination and results of a national examination administered by the National Board of Respiratory Care, Inc., or its successor organization and as approved by the board; or

(b) Have been educated outside of the United States and are awaiting verification of credentials and education in English and examination and results of a national examination administered by the National Board of Respiratory Care, Inc., or its successor organization and as approved by the board; or

II. The interim license shall be valid for up to 6 months and shall not be renewable.

III. An interim license shall authorize its holder to engage in the practice of respiratory care under the supervision of a licensed respiratory care practitioner in this state, and:

(a) Applicants who do not have a current license in another state shall practice only under direct supervision.

(b) Applicants who have a current license in another state shall practice under indirect supervision.

(b) The expiration date on the interim license as set by the board has been reached;

(d) Upon notification to the board that the applicant has failed the national examination;

(f) The holder has failed to file a new supervisory form within 5 days when there has been a change in the supervisor of record;

(g) An out of state license validation reveals information that would cause the board not to issue a license; or

(a) Undertake misconduct investigations, the settlement of misconduct investigations, or undertake disciplinary hearings pursuant to RSA 328-F and this chapter in response to any information which reasonably suggests that a licensee has engaged in professional misconduct or an entity or other person has engaged in the delivery, performance, or practice of respiratory care.

(b) Regulate the performance and practice of respiratory care by interpreting and enforcing this chapter.

(c) Elect officers from its members for the operation and obligation of this chapter. Terms of office shall be for one year.

(d) Provide information to the public and its licensees regarding the complaint process.

(e) Provide timely orientation of new professional and public appointees to the board regarding duties, powers, and procedures of the board.

(f) Advise the board of directors of the office of allied health professionals of matters regarding respiratory care.

(g) Keep all information confidential relating to receiving and investigating complaints filed against licensees, entities, or other persons, until the information becomes public record or as otherwise required by law. Patient records, files, other reports, or oral statements relating to diagnostic findings, or treatment of patients, any information from which a patient or his or her family may be identified, or information received and records kept by the board as a result of an investigation made pursuant to this chapter or of RSA 328-F shall not be available to the public and shall be kept confidential by the board.

II. The board may refer the unlawful practice of respiratory care to the attorney general's office for prosecution regardless of whether the person or entity ceases the unlawful practice.

I. No person shall practice respiratory care or represent themselves to be a respiratory care practitioner unless they are licensed under this chapter, except that this chapter shall not prohibit:

(a) A person matriculated in an education program approved by the board who is pursuing a degree in respiratory care or respiratory therapy from satisfying supervised clinical education requirements related to the person's respiratory care education while under direct supervision of a respiratory care practitioner or physician.

(b) A respiratory care practitioner from practicing in the United States Armed Services, United States Public Health Services, or the Department of Veterans Affairs, pursuant to federal regulations of health care providers.

(c) A respiratory care practitioner who is licensed in another jurisdiction of the United States from providing consultation by telecommunication.

(d) A respiratory care practitioner who is licensed in another jurisdiction of the United States or foreign educated respiratory care practitioner credentialed in another country from practicing respiratory care in conjunction with teaching or participating in an educational seminar of no more than 60 days in a calendar year.

(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) in a diagnostic laboratory or research setting.

(g) Self care by a patient or gratuitous care by family members or friends who do not represent themselves as respiratory care practitioners.

(h) A respiratory care practitioner who is licensed in another jurisdiction of the United States or foreign educated respiratory care practitioner credentialed in another country from practicing respiratory care in conjunction with the interfacility transport of a critically ill patient.

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 respiratory care practitioner or a provider of respiratory care.

(a) A list of licensees and interim license holders that includes place of practice, license number, date of license or date of interim license expiration, and status of license.

II. A respiratory care practitioner 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. Information relating to the respiratory care practitioner-patient relationship is confidential and shall not be related to a third party who is not involved with that patient's care without the prior written consent of the patient. This privilege shall not extend to cases in which the respiratory care practitioner has a duty to report information as required by law.

V. Each licensee shall provide the director of respiratory care at their place of employment with a true copy of their license, interim license, or current renewal verification. This copy shall be available for public review upon request. The director of respiratory care shall maintain a list of all persons providing respiratory care at their facility for review by the board upon request.

I. The respiratory care practitioner is responsible for managing all aspects of the respiratory care of each patient under the orders of a physician, physician's assistant or nurse practitioner. The respiratory care practitioner shall provide:

II. The respiratory care practitioner shall be aware of and abide by the laws of this chapter and related chapters and the regulations concerning the performance and practice of respiratory care.

326-E:11 Training; Assistive Personnel. The assembly, delivery, maintenance, repair, and testing of respiratory care equipment and supplies shall be performed by respiratory care practitioners and other personnel in conformity with rules adopted by the board under RSA 541-A and RSA 326-E:2.

326-E:12 Penalties. An individual, corporation, or unincorporated association that violates any part of this chapter shall be guilty of a misdemeanor.

275:3 Allied Health Professionals; Respiratory Care. Amend RSA 328-F:2, VII to read as follows:

VII. "Respiratory care" means "respiratory care' as defined in RSA 326-E:1, [VI] V.

275:4 Allied Health Professionals; Governing Boards; Rulemaking. Amend RSA 328-F:11, IV to read as follows:

IV. The governing board of respiratory care practitioners shall adopt rules as provided in RSA [~~326-E:3~~] 326-E:2.