VOLUME 47, ISSUE 13
September 8, 2015 Rule Proposals
Law and Public Safety
Division of Consumer Affairs New Jersey State Board of Polysomnography
Proposed Amendments: N.J.A.C. 13:44L-1.2, 2.2, 2.3, 2.4, 3.3, 5.1, 5.2, and 5.3
Proposed Repeal: N.J.A.C. 13:44L-5.10
Definitions; Application for a Temporary License as a Polysomnographic Technician; Application for License as a Polysomnographic Technologist; Application for Licensure by Out-of-State Licensed Polysomnographic Technologist; Renewal of Polysomnographic Technician License; Scope of Practice: Licensed Polysomnographic Technician; Scope of Practice: Licensed Polysomnographic Trainee; Recordkeeping: Qualified Medical Director
Authorized By: New Jersey State Board of Polysomnography, Dorcas O'Neal, Executive Director.
Authority: N.J.S.A. 45:14G-7.
Calendar Reference: See Summary below for explanation of exception to calendar requirement.
Proposal Number: PRN 2015-109.
Submit comments by November 7, 2015, to:
Dorcas O'Neal, Executive Director
New Jersey State Board of Polysomnography
124 Halsey Street
PO Box 45051
Newark, New Jersey 07101
The agency proposal follows:
Summary
N.J.S.A. 45:14G-3 defines "polysomnography" as the allied health specialty involving the treatment, management, diagnostic testing, research, control, education, and care of patients with sleep and wake disorders under a qualified medical director (QMD). The statute defines "polysomnographic technologist" as a person licensed by the Board of Polysomnography (Board) to practice polysomnography under the direction of any licensed physician. Although the statute permits technologists to work under the direction of any licensed physician, the existing rules require that technologists work under the direction of a QMD. In order to harmonize the statutory requirement that polysomnography be practiced under a QMD with the statutory provision that requires technologists to work under the direction of a licensed physician, the Board is proposing to clarify that polysomnographic technologists may provide all services within their scope of practice, if such services are pursuant to a written or verbal order from a licensed physician based on a sleep study of the patient conducted under the authority of a qualified medical director, so long as the technologist documents all services provided to the patient in the patient record for review by the licensed physician who issued the prescription. Under the amended rules, the diagnosis of a patient's sleep disorder would still have to be made under the authority of a QMD; however the amended rule would permit technologists to perform their services pursuant to a prescription by a licensed physician. For example, under the proposed rules, if the patient had a sleep study conducted under a QMD, a technologist would be permitted to provide services in a patient's home, so long as the services are being provided pursuant to a physician's prescription based on that sleep study, and the technologist documents all services provided to the patient in the patient record for review by the licensed physician that issued the prescription. The technologist could be an employee of a durable medical equipment (DME) company providing continuous positive airway pressure equipment to the patient. Under the existing rules, a technologist could work for a DME company only if a QMD also works for the DME company. Generally, QMDs do not work for DME companies because of state and Federal conflict of interest laws.
The Board is also proposing to permit trainees and technicians to practice in sleep centers that are State-licensed, as well as those that are accredited by the American Academy of Sleep Medicine (AASM), as permitted by N.J.S.A. 45:14G-3. The Board, therefore, proposes to redefine the terms "trainee" and "technician" to be consistent with the statutory definitions. Additionally, the Board is proposing to permit technicians who are either renewing their technician's license or applying for a technologist's license, to count experience gained in State-licensed facilities towards the minimum number of sleep studies required for licensure.
Additionally, the Board is proposing to amend its rules, so that an applicant for a technician's license who is not a trainee may substitute for successful completion of a Commission on the Accreditation of Allied Health Education Programs (CAAHEP) course of study, successful completion of the A-STEP Introductory Course and A-STEP modules, so long as the applicant has also completed the Certified Polysomnographic Technician's (CPSGT) examination administered by the Board of Registered Polysomnographic Technologists (BRPT).
Similarly, the Board is proposing to amend N.J.A.C. 13:44L-2.3(b) to permit an individual who does not hold a temporary license as a technician to become licensed as a polysomnographic technologist if the individual has completed either (1) a CAAHEP accredited polysomnographic course; or (2) the A-STEP Introductory Course and the A-STEP Self-Study Modules. The applicant would also be required to complete at least 50 sleep studies in one or more facilities that are State-licensed or are provisionally or fully accredited by AASM and successfully complete either the Sleep Technologist Registry (RST) examination administered by the American Board of Sleep Medicine, or the Registered Polysomnographic Technologist (RPSGT) examination administered by the Board of Registered Polysomnographic Technologists.
The proposed amendments described above would permit experienced technicians and technologists who move into the State from states that do [page=2240] not license the practice of polysomnography to begin working immediately, without first having to complete the trainee and/or technician pathway, as the case may be, or complete a CAAHEP course.
The Board is proposing to define the terms, "ABSM," "RPSGT," "RST," "CPSGT," "State-licensed," and "under the direction." The Board is also proposing to amend the definition of "direction" to clarify, as discussed above, that technologists are required to provide their services pursuant to a written or verbal order from a licensed physician. Additionally, the Board is proposing to amend the phrase "Department of Health and Senior Services" to "Department of Health" wherever it occurs throughout the chapter because the Department of Health and Senior Services was reorganized and renamed effective June 29, 2012 (P.L. 2012, c. 17).
The Board is also proposing to repeal N.J.A.C. 13:44L-5.10, the rule requiring a technologist to obtain documentation from the QMD with whom the technologist is working proving that the QMD has the qualifications necessary to meet the rule's definition of QMD. The Board proposes to repeal this requirement because under the proposed amendments, technologists will no longer be required to work under the direct supervision of a QMD, and they may not be able to obtain this type of information for QMDs with whom they do not directly work.
N.J.A.C. 13:44L-1.2 is the definitions section. The Board proposes to redefine the terms, "polysomnographic technician" and "polysomnographic trainee," to provide that while working under the supervision of a licensed polysomnographic technologist or licensed physician, technicians and trainees may practice in either State-licensed facilities or in sleep centers or laboratories that are provisionally accredited or fully accredited by the AASM. N.J.S.A. 45:14G-3 provides that technicians and trainees may practice in either State-licensed facilities or nationally accredited sleep centers or laboratories. N.J.A.C. 13:44L-1.2 defines these terms more narrowly, however, permitting them to work only in sleep centers or laboratories accredited or provisionally accredited by the AASM. The Board proposes to amend the definitions to permit trainees and technicians to work in more types of facilities, as contemplated by the statute.
Under the existing rules, an applicant for a technician's license must submit proof that he or she has successfully completed the certification examination administered by the BRPT. At the time that the existing rules were promulgated, the RPSGT examination was the only examination offered that met this description. Because the BRPT now offers both the RPSGT and the CPSGT, the Board is proposing to add these definitions to the rules for clarity. The Board is also proposing adding the definitions of RST and ABSM, because the Board has determined that this examination is equivalent to the RPSGT, and successful completion of this examination is being proposed as an equivalent alternative to successful completion of the RPSGT. As discussed above, the Board also proposes to define "State-licensed" to mean licensed by the Department of Health because both terms are used interchangeably in the current rules.
N.J.A.C. 13:44L-2.2 sets forth the criteria that an applicant must meet when applying for a license to become a polysomnographic technician. The Board proposes to amend N.J.A.C. 13:44L-2.2(b)5 to permit an applicant for licensure who is not a trainee to present proof that he or she has successfully completed either (1) a CAAHEP accredited polysomnographic course or (2) the A-Step Introductory Course and the A-STEP modules and the CPGST examination. The Board is proposing similar changes to N.J.A.C. 13:44L-2.3 for the licensure of technologists who do not hold a current technician's license and have not completed a CAAHEP course.
N.J.A.C. 13:44L-2.3 and 2.4 set forth the criteria that an applicant must meet when applying for a license to become a polysomnographic technologist. Because the Board has determined that the RST examination is substantially equivalent to RPSGT examination, the Board is proposing to amend N.J.A.C. 13:44L-2.3(a)5 and (b)5 and 2.4(a)5 to permit an applicant for a technologist's license to successfully complete either the RST or RPSGT examination to satisfy the examination requirement for licensure.
Because the Board is proposing that technicians be permitted to work at State-licensed facilities, the Board has determined that technicians should also be permitted to count sleep studies performed in State-licensed facilities towards the minimum number of sleep studies required for either licensure as a technologist or renewal of their technician's license. Accordingly, the Board proposes to amend N.J.A.C. 13:44L-2.3(a)4 to permit a licensed technician applying for licensure as a technologist, to offer documentary proof that he or she has completed at least 50 sleep studies in one or more facilities either licensed by the State or provisionally or fully accredited by AASM. The Board also proposes to amend N.J.A.C. 13:44L-3.3(c)4 to permit technicians to complete sleep studies required for renewal at State-licensed or AASM-accredited facilities. The Board also proposes to amend N.J.A.C. 13:44L-5.2(c) and 5.3(b), so that trainees and technicians may provide services within their scope of practice at facilities that are either State-licensed or provisionally or fully accredited by AASM.
The Board proposes to amend N.J.A.C. 13:44L-5.1(a)2 to delete the term "diagnosing" from the technologists scope of practice; while technologists analyze data that may assist a physician in performing a diagnosis, technologists themselves do not perform diagnoses. The Board also proposes to amend N.J.A.C. 13:44L-5.1(b) to permit technologists to provide all services within their scope of practice if such services are pursuant to a written or verbal order from a licensed physician based on a sleep study of the patient conducted under the authority of a qualified medical director, so long as the technologist documents all services provided to the patient in the patient record for review by the licensed physician who issued the prescription. These amendments would permit licensees to provide services in more types of facilities than under the current rules. Accordingly, the Board proposes to delete N.J.A.C. 13:44L-5.1(c) because subsection (b) as proposed expands the settings at which polysomnographic technologists may perform their scope of practice.
N.J.A.C. 13:44L-5.10 is a recordkeeping section. It requires that a licensed technologist obtain documentation each year from the QMD with whom he or she is working that indicates that the QMD meets the criteria set forth in the definitions section of the chapter. The Board proposes to repeal this section because under the proposed amendments, technologists are no longer required to work directly under a QMD, so it may be difficult for technolgists to procure the documentation that this section requires.
The Board has provided a 60-day comment period for this notice of proposal. Therefore, this notice is excepted from the rulemaking calendar requirement pursuant to N.J.A.C. 1:30-3.3(a)5.
Social Impact
The Board believes that the proposed amendments and repeal will have a positive social impact on polysomnographic trainees, technicians, and technologists. The proposed amendments will expand licensees' employment opportunities because they permit them to work in more types of facilities. The proposed amendments will also benefit technicians by allowing them to count sleep studies performed either in State-licensed facilities or in AASM provisionally or fully accredited facilities, towards the minimum number required for renewal of their technician's license or to qualify for their technologist's license.
The Board believes that the proposed amendments will have a positive social impact by permitting qualified individuals to practice sooner. The proposed amendments would allow an individual who is not a trainee and who has not taken a CAAHEP course to become licensed as a technician if the individual has successfully completed the A-STEP Introductory Course and modules and has successfully completed the CPSGT examination. The proposed amendments would also permit an individual who is not a technician and who has not successfully completed a CAAHEP course to become a technologist if the individual has successfully completed the A-STEP Introductory Course and modules, has successfully completed either the RST or RPSGT examination, and has completed at least 50 sleep studies in one or more facilities that are State-licensed or are provisionally or fully accredited by AASM. This would be especially helpful for individuals who have been practicing in another state that does not license the practice of polysomnography, and are, therefore, ineligible for licensure through comity. The Board also believes that expanding the definitions section of the chapter will have a positive social impact on licensees because it will promote clarity.
The Board believes that the public would be adequately protected, because successful completion of the A-STEP Introductory Course [page=2241] insures that the candidates receive didactic training. Additionally, in order to qualify to sit for the examinations, candidates must meet certain educational and experiential criteria to prove that they are qualified to practice polysomnography.
Economic Impact
The Board believes that the proposed amendments and repeal would have a positive economic impact on licensees because the amendments and repeal are designed to expand employment opportunities for licensees.
The Board also believes that the proposed amendments will have a positive economic impact on non-trainees who wish to be licensed as technicians, by permitting them to substitute, for completion of a CAAHEP course program, the successful completion of the A-STEP Introductory Course and the A-STEP modules and the CPSGT examination. The proposed amendments would confer a similar benefit on individuals who are not technologists but who have successfully completed the A-STEP Introductory Course and the A-STEP modules, the requisite examinations, and the required experience, when applying for technologist licenses. The CAAHEP program is designed to take anywhere from six months to two years and costs several thousands of dollars. The alternate route, involving successful completion of the A-STEP programs, is less expensive and can be completed more quickly. The Board believes that individuals who are not eligible for endorsement but who have already been practicing in the field, and who may have received their training prior to the introduction of CAAHEP, should be able to work within the State and not have to restart their careers as trainees, or spend time and money on a CAAHEP program in order to practice in New Jersey.
The Board does not believe that the proposed amendments will have any economic impact on the public.
Federal Standards Statement
A Federal standards analysis is not required because the proposed amendments and repeal are governed by N.J.S.A. 45:14G-1 et seq., and are not subject to any Federal requirements or standards.
Jobs Impact
The Board believes that the proposed amendments and repeal may result in the creation of jobs because licensees would be able to provide their services in more employment settings. The Board does not believe that the proposed amendments will result in the loss of jobs in the State.
Agriculture Industry Impact
The proposed amendments and repeal will have no impact on the agriculture industry in the State.
Regulatory Flexibility Statement
Since the nine polysomnographic trainees, 230 polysomnographic technicians, and 297 polysomnographic technologists are individually licensed by the Board, they may be considered "small businesses" under the Regulatory Flexibility Act (Act), N.J.S.A. 52:14B-16 et seq. The proposed amendments and repeal do not impose any new reporting, recordkeeping, or compliance requirements; rather, they redefine where licensees may work and permit candidates for licensure to satisfy the requirements in different ways. The proposed repeal also eliminates a recordkeeping requirement for technologists. Therefore, no regulatory flexibility analysis is required.
Housing Affordability Impact Analysis
The proposed amendments and repeal will have an insignificant impact on the affordability of housing in New Jersey and there is an extreme unlikelihood that the rulemaking would evoke a change in the average costs associated with housing because the proposed amendments and repeal expand licensees' employment opportunities, permitting them to work in more types of facilities or settings, and permits them to meet alternative education, experience, and examination standards.
Smart Growth Development Impact Analysis
The proposed amendments and repeal will have an insignificant impact on smart growth and there is an extreme unlikelihood that the rulemaking would evoke a change in housing production in Planning Areas 1 or 2, or within designated centers, under the State Development and Redevelopment Plan in New Jersey because the proposed amendments and repeal expand licensees' employment opportunities, permitting them to work in more types of facilities or settings, and permits them to meet alternative education, experience, and examination standards.
Full text of the proposal follows (additions indicated in boldface thus; deletions indicated in brackets [thus]):
SUBCHAPTER 1. GENERAL PROVISIONS
13:44L-1.2 Definitions
The following words and terms, when used in this chapter, shall have the following meanings, unless the context clearly indicates otherwise:
. . .
"ABSM" means the American Board of Sleep Medicine.
. . .
"CPSGT" means the Certified Polysomnographic Technician examination administered by the Board of Registered Polysomnographic Technologists.
. . .
"Direction" means [a licensed polysomnographic technologist only provides polysomnographic services when he or she is working in a facility that has a qualified medical director and when a physician who has medical responsibility for a patient has referred the patient to the polysomnographic technologist or the sleep center or laboratory at which the polysomnographic technologist works] pursuant to the written or verbal order of a licensed physician.
. . .
"Polysomnographic technician" means a person who holds a temporary license issued by the Board and who practices polysomnography under the supervision of either a licensed polysomnographic technologist or a licensed physician in a sleep center or laboratory, which is either State-licensed or provisionally accredited or fully accredited by AASM.
"Polysomnographic trainee" means a person who holds a provisional license issued by the Board and performs polysomnography under the direct supervision of either a licensed polysomnographic technologist or a licensed physician in a sleep center or laboratory, which is either State-licensed or provisionally accredited or fully accredited by AASM.
"Qualified medical director" means a licensed physician who is either eligible for board certification or is board certified in sleep medicine by the American Board of Sleep Medicine, or a certification board recognized by the American Board of Medical Specialties, which bases its certification in sleep medicine upon the sleep medicine examination created by the American Board of Internal Medicine, and who acts as the medical director of any:
1. (No change.)
2. Ambulatory care facility or general acute care hospital licensed by the Department of Health [and Senior Services];
3. Home health agencies, assisted living residences, comprehensive personal care homes, assisted living programs, and alternate family care sponsor agencies licensed by the Department of Health [and Senior Services]; or
4. (No change.)
"RPSGT" means the Registered Polysomnographic Technologist examination administered by the Board of Registered Polysomnographic Technologists.
"RST" means the Sleep Technologist Registry examination administered by the American Board of Sleep Medicine.
"State-licensed" means licensed by the Department of Health.
. . .
"Under the direction" means pursuant to the written or verbal order of a licensed physician.
SUBCHAPTER 2. LICENSURE
13:44L-2.2 Application for a temporary license as a polysomnographic technician
(a) (No change.)
[page=2242] (b) An applicant for a temporary license as a polysomnographic technician who does not hold a provisional license as a polysomnographic trainee shall submit, or arrange to have submitted, to the Board:
1.-4. (No change.)
5. Proof that the applicant has successfully completed [a CAAHEP accredited] either:
i. A CAAHEP-accredited polysomnographic course; or
ii. The CPSGT and the A-STEP Introductory Course and the A-STEP Self-Study Modules;
6.-7. (No change.)
(c) (No change.)
13:44L-2.3 Application for license as a polysomnographic technologist
(a) A licensed polysomnographic technician applying for licensure as a polysomnographic technologist shall submit to the Board:
1.-3. (No change.)
4. Documentary proof signed by a supervising polysomnographic technologist or qualified medical director indicating that the applicant has completed at least 50 sleep studies in one or more facilities that are State-licensed or are provisionally or fully accredited by AASM;
5. Proof that the applicant has successfully completed either the [certification] RPSGT examination administered by the BRPT or the RST examination administered by the ABSM;
6. (No change.)
(b) An applicant for licensure as a polysomnographic technologist who does not hold a temporary license as a polysomnographic technician shall submit to the Board:
1.-2. (No change.)
3. Proof that the applicant:
i. Has successfully completed either a CAAHEP accredited polysomnographic course[;] or the A-STEP Introductory Course and the A-STEP Self-Study Modules and documentary proof signed by a supervising polysomnographic technologist or qualified medical director indicating that the applicant has completed at least 50 sleep studies in one or more facilities that are State-licensed or are provisionally or fully accredited by AASM; or
ii. Possesses a doctorate degree in a health-related field. For purposes of this subparagraph, a health-related field means any field in which services are rendered or research is conducted for the purpose of maintaining or restoring an individual's physical or mental health. Examples would include, but are not limited to, fields such as medicine, dentistry, optometry, nursing, physical therapy, respiratory therapy, and psychology[.];
4. (No change.)
5. Proof that the applicant has successfully completed either the [certification] RPSGT examination administered by the BRPT or the RST examination administered by the ABSM or, in the case of an individual possessing a doctorate degree in a health-related field, proof that the applicant has successfully completed:
i.-ii. (No change.)
6. (No change.)
13:44L-2.4 Application for licensure by out-of-State licensed polysomnographic technologist
(a) An applicant for licensure as a licensed polysomnographic technologist who is licensed as a polysomnographic technologist in another state shall submit to the Board:
1.-4. (No change.)
5. Proof that the applicant has successfully completed either the [certification] RPSGT examination administered by the BRPT or the RST examination administered by the ABSM; and
6. (No change.)
SUBCHAPTER 3. RENEWAL
13:44L-3.3 Renewal of polysomnographic technician license
(a)-(b) (No change.)
(c) A licensed polysomnographic technician applying for renewal of a temporary license pursuant to (b) above shall submit to the Board:
1.-3. (No change.)
4. Documentary proof signed by a supervising polysomnographic technologist or qualified medical director indicating that, within the last year, the applicant has completed at least 100 sleep studies in a facility that is either State-licensed or provisionally or fully accredited by AASM;
5.-6. (No change.)
SUBCHAPTER 5. PRACTICE REQUIREMENTS
13:44L-5.1 Scope of practice: licensed polysomnographic technologist
(a) The following functions are within the scope of practice of a licensed polysomnographic technologist:
1. (No change.)
2. Assessing[, diagnosing] and assisting in the treatment and research of disorders, syndromes, and dysfunctions that are sleep related, manifest during sleep, or disrupt normal sleep and wake cycles and activities;
3.-9. (No change.)
(b) A licensed polysomnographic technologist shall provide the services [from] delineated at (a) above only [when a physician who has medical responsibility for the patient has referred the patient to the licensed polysomnographic technologist or to the sleep center or laboratory at which the licensed polysomnographic technologist works.] pursuant to a written or verbal order from a licensed physician based on a sleep study of the patient conducted under the authority of a qualified medical director, and the licensee documents all services provided to the patient in the patient record for review by the licensed physician who issued the order.
[(c) A licensed polysomnographic technologist may provide the services from (a) above only if he or she is working at a State-licensed facility that has a qualified medical director.]
13:44L-5.2 Scope of practice: licensed polysomnographic technician
(a)-(b) (No change.)
(c) A licensed polysomnographic technician may provide the services from (a) above only if he or she is working at a State-licensed facility that has a qualified medical director and is under the supervision of a licensed polysomnographic technologist or licensed physician or at a facility that is provisionally or fully accredited by AASM.
(d) (No change.)
13:44L-5.3 Scope of practice: licensed polysomnographic trainee
(a) (No change.)
(b) A licensed polysomnographic trainee may provide the services from (a) above only if he or she is working at a State-licensed facility that has a qualified medical director or at a facility that is provisionally or fully accredited by AASM and is under the direct supervision of a licensed polysomnographic technologist or licensed physician.
(c) (No change.)
[13:44L-5.10 Recordkeeping: qualified medical director
(a) Every licensed polysomnographic technologist shall obtain documentation from the qualified medical director with whom he or she is working that indicates that the qualified medical director is:
1. A licensed physician who is either eligible for board certification or is board certified in sleep medicine by either the American Board of Sleep Medicine or a certification board recognized by the American Board of Medical Specialties, which bases its certification in sleep medicine upon the sleep medicine examination created by the American Board of Internal Medicine; and
2. Acting as the medical director of an in-patient or out-patient:
i. Sleep center or laboratory provisionally or fully accredited by AASM; or
ii. Home health agencies, assisted living residences, comprehensive personal care homes, assisted living programs and alternate family care sponsor agencies licensed by the Department of Health and Senior Services; or
iii. Health care service firms licensed by the Division of Consumer Affairs.
(b) If a qualified medical director's board certification has an expiration date, the documentation required by (a) above shall include this expiration date.
[page=2243] (c) Every licensed polysomnographic technologist shall maintain the documentation required by (a) above as part of his or her records and shall submit this documentation to the Board upon request.] |
