Presidents Meeting

March 2008

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

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

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