Presidents Meeting March 2008

State Government Affairs Legislative 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)

 nmemo.asp?id=204 nmemo.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 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

More to Come  CMS issues PPS annual updates for various Providers (Hospital, LTC, Physician, etc).  RTs issues often buried within these regs  Waiting to see what is next