California

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California Senate Bill 132, a bill to establish
educational and training requirements for sleep
technologists, was introduced into the General
Assembly on February 9. SB 132 is the same as
the measure Governor Schwarzenegger vetoed last
year in response to a protracted and contentious
debate over the California state budget. The
Governor chose to veto SB 1526 along with 137
other bills in order to send a message to the
state legislature. The Governors veto was
completely unrelated to the merits of the bill,
which had passed the legislature with a
significant bipartisan majority.
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Hawaii On January 28, 2009, nine bills pertaining
to licensing requirements for respiratory care
practitioners were introduced in the Hawaii State
Legislature. Iowa On January 7, the BRPT
submitted a letter to the IRBC requesting that
the Board approve the BRPT as a testing body in
the state of Iowa. On February 16, the IRBC sent
a letter to the BRPT informing them that the
Board approves the BRPT as a testing body
offering the examination for awarding the
credential of Registered Polysomnographic
Technologist. Maryland Senate Bill 433 would
postpone the initial licensure deadline for sleep
technologists from October 1, 2009 until 2012, in
response to a letter from the Maryland Board of
Physicians that implementation of the October 1,
2009 licensure deadline would lead to either a
significant decrease in the availability of sleep
studies in Maryland, or to a large pool of
unlicensed personnel practicing in spite of the
law.
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Minnesota Recently Senate Bill 685 (SF 685) was
introduced into the Minnesota Legislature. The
bill amends the Respiratory Care Practice Act by
changing the conditions for respiratory
therapists from registered to licensed.
However, the legislation also modifies the
exemption language for sleep technologists. sleep
technologists would be required to first pass the
BRPT exam before they are allowed to work in a
sleep facility. Tennessee The American
Association for Respiratory Care has introduced
Senate Bill 726, to amend the Polysomnographic
Practice Act by requiring that licensed sleep
technologists and technicians work under the
direct supervision of a licensed physician
eliminating the Accredited Sleep Technologist
Programs (A-STEP) in the state and by
eliminating the ability of a sleep technologist
to provide education of a patient regarding the
treatment regimen that assists the patient in
improving the patients sleep.
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MEDICAL BOARD NEWSLETTER APRIL
2008 Clarification to the CPAP
Language Individuals must be licensed in order
to provide care planning, provide education to
the patient or family or to size an interface
device for a CPAP or BiPap device with or without
oxygen. GEORGIA COMPOSITE STATE BOARD OF MEDICAL
EXAMINERS MINUTES NOVEMBER 1, 2007 Regarding a
question concerning CPAP-Does an individual need
to hold licensure in the state to perform
education, to patients, concerning applying a
nasal mask or interface for a CPAP device?
Approved to refer back to the Committee to review
at the December Committee Meeting, and request
Larry Arnson to draft letter for Committees
review.
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MEDICAL BOARD NEWSLETTER -- November
2008 Respiratory Care Advisory
Committee
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AASM Letter December 2, 2008 Jean Sumner, M.D.,
President Georgia Composite State Board of
Medical Examiners2 Peachtree Street, N.W. 36th
FloorAtlanta, Georgia 30303-3465 Re Status
of Registered Polysomnographic Technologists and
the Practice of Respiratory Care   Dear Dr.
Sumner   The American Academy of Sleep Medicine
(AASM) views with great alarm the steps being
taken by your Advisory Committee on Respiratory
Care that will have the effect of arbitrarily
expanding the scope of respiratory care practice
in a manner that will inhibit the ability of
polysomnographic technologists to continue their
well-established patient care work. As we have
seen from the minutes from the Boards November 1
meeting and the November issue of the Medical
Board Newsletter, actions are underway to expand
the regulatory language set out in Board Rule
360.13.12(2)(g) in a manner that will unduly
define the work of sleep technologists as
respiratory care. While a qualified respiratory
care therapist (RT) who has completed additional
schooling/training may be qualified to sit for
the BRPT examination, the fact is that the vast
majority of the 13,000 individuals who have taken
this examination and who work in sleep centers in
Georgia and throughout the country do not have a
respiratory care background.  
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Even an advanced respiratory therapist who holds
the RRT credential must have additional education
or training to sit for the new examination being
offered for the first time next January by the
National Board for Respiratory Care (NBRC) to
qualify as a sleep disorder specialist.
However, few educational programs, including the
baccalaureate and masters RT programs at the
Georgia State University College of Health and
Human Sciences School of Health Professions,
currently offer the add-on courses necessary for
a RT to be eligible to take the NBRC sleep
disorder specialist examination. The AASM urges
you to take the time necessary to fully
understand the implications of any action to
formalize a position that could result is
significant access to care roadblocks for
patients seeking care from a Georgia sleep center
by arbitrarily determining that sleep
technologists who are not also qualified as RTs
are violating the law in every instance where
they are providing quality care involving CPAP or
related therapy. In light of this and the
reality of hundreds of qualified personnel who
have been providing Georgians with this care for
decades as well as currently, we urge you to
delay any determinations on this issue until
there has been an open and complete airing of the
information scheduled to be presented in response
to the Other Business identified at the
November meeting. The AASM hopes that time will
be allowed at a future meeting to provide
detailed information on the work and care
routinely provided by sleep technologists. If
anything, the fact that sleep technologists are
not currently licensed in Georgia speaks to the
need to follow the lead taken in Louisiana,
Maryland, New Jersey, New Mexico and Tennessee
where sleep technologist licensure has been
established.
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SB 252 - Polysomnography Practice Act A BILL to
amend Chapter 34 of Title 43 of the Official Code
of Georgia Annotated, relating to physicians,
physician's assistants, and others, so as to
provide for the certification of polysomnographic
technologists to provide a short title to
provide legislative findings to provide for
definitions to provide for applications to be
made to the Composite State Board of Medical
Examiners to obtain certification to practice
polysomnography to provide for powers and duties
of the board to provide for certification
standards and requirements to provide for the
issuance and renewal of certification to provide
for permitted and prohibited activities to
provide for related matters to provide for an
effective date to repeal conflicting laws and
for other purposes.
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Funding for Fraud and Abuse Enforcement 2010
Budget Proposal Scheduled Medicare spending
cuts of about 21 in 2010 and about 5 in each of
the next few years will be eliminated.
Additional 311 million in spending will be added
for efforts to reduce Medicare and Medicaid
fraud. STIMULUS - OIG The HHS Office of the
Inspector General receives 17,000,000 which
shall remain available until September 30, 2012.
2009 OIG Work Plan We will examine the
factors contributing to the rise in Medicare
payments for sleep studies and assess provider
compliance with Federal program requirements.
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• OIG Compliance Program for Individual and Small
  Group Physician Practices (Published in Federal
  Register, October 5, 2000)
• Seven components of a voluntary compliance
  program
• Conducting internal monitoring and auditing
• Implementing compliance and practice standards
• Designating a compliance officer or contact
• Conducting appropriate training and education
• Responding appropriately to detected offenses and
  developing corrective action
• Developing open lines of communication and
• Enforcing disciplinary standards through
  well-publicized guidelines.

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State Society Update The purpose of the sleep
society initiative is to strengthen the sleep
care community in the state, and to provide a
forum that will serve to educate members and
protect the profession from any issues that may
affect their practice. At the start of this
initiative there were 18 state sleep societies,
including Georgia. Currently there are 28
societies. AASM currently is working with 10 new
states.