ADVOCACY and LEGISLATION -Updates

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posted May 12, 2009

Legislation to revise the Medical Practice Act, HB 509, passed the Senate and House and was sent to the Governor for his signature on April 15. HB 509 includes language that exempts anyone performing polysomnography acts under the supervision of a physician from the necessity of licensure. The language was drafted by the Governor's Counsel and is meant as a temporary fix to the problem that was identified by the Attorney General with delegation of these acts to an unlicensed healthcare professional. They will need to come back in a future session of the legislature to pass a licensure bill for the profession. (SEE ARTICLE 6)

This will preserve the status quo in the job market until there is enough time to pass a well thought out and properly vetted licensure bill.

To view the full version of HB 509, you can visit the GA Legislature website at http://www.legis.state.ga.us/ and plug the appropriate bill number in the upper right hand corner of the home page (HB ___).

posted April 21, 2009

Legislation to revise the Medical Practice Act, HB 509, passed the Senate and House and was sent to the Governor for his signature on April 15. HB 509 includes language that exempts anyone performing polysomnography acts under the supervision of a physician from the necessity of licensure. The language was drafted by the Governor's Counsel and is meant as a temporary fix to the problem that was identified by the Attorney General with delegation of these acts to an unlicensed healthcare professional. They will need to come back in a future session of the legislature to pass a licensure bill for the profession. (SEE ARTICLE 6)

This will preserve the status quo in the job market until there is enough time to pass a well thought out and properly vetted licensure bill.

To view the full version of HB 509, you can visit the GA Legislature website at http://www.legis.state.ga.us/ and plug the appropriate bill number in the upper right hand corner of the home page (HB ___).

posted March 30, 2009

Message from the GASP Organizing Board: We have been assured by the lobbyist assisting us, that the Health Practices Act made it through the legislative process and that the governor will sign the bill.  For your information, this is the language that is in the bill as we best we could determine from the legislative website. Since it still has some “strike throughs”, it is most certainly not the final copy of the bill.  We will keep you posted as information becomes available. 

This means our bill did not make it through this session and we have until January to work on a new improved version.  Our next step will be to elect officers and to plan a meeting and sigh of relief party!

Message from the lobbyist assisting GASP: We are in the final stretch.  The General Assembly is expected to conclude next week.  There is a rumor they will adjourn after Day 39 on Wednesday and wait until the revenue estimates come in for March before coming back for the final day to adopt a budget.

Legislation to revise the Medical Practice Act, HB 509, passed the Senate Health & Human Services Committee yesterday (Thursday March 26) .  It includes language that exempts anyone performing polysomnography acts under the supervision of a physician from the  necessity of licensure.  The language was drafted by the Governor's Counsel and is meant as a temporary fix to the problem that was identified by the Attorney General with delegation of these acts to an unlicensed healthcare professional.  They will need to come back in a future session of the legislature to pass a licensure bill for the profession.

While this is a disappointment to all -- especially the polysomnographers -- it will preserve the status quo in the job market until there is enough time to pass a well thought out and properly vetted licensure bill.

HB 509 is expected to be on the Senate floor Wednesday (Day 39) and if it is not amended further, the bill sponsor Rep. Sharon Cooper, will ask the House to accept the Senate changes in the bill and it will be its way to the Governor with these changes in tact.  This bill should pass without going to aconference committee.  

It also contains changes to the RCP practice act to update it as requested by the Respiratory Care Advisory Committee.   I will send all the language that affects RCP and the polysom exemption as soon as it is posted on the web.  

The bill is 110 pages and the meeting was completed late yesterday afternoon so it may be a day or two before the new committee substitute is posted. 

43-34-45. HB 509

(a) As used in this Code section, the term:

(1) 'Polysomnography' means the treatment, management, diagnostic testing, control, education, and care of patients with sleep and wake disorders. Polysomnography includes, but is not limited to, the process of analysis, monitoring, and recording of physiologic data during sleep and wakefulness to assist in the treatment of disorders, syndromes, and dysfunctions that are sleep related, manifest during sleep, or disrupt normal sleep activities. Polysomnography also includes, but is not limited to, the therapeutic and diagnostic use of low-flow oxygen, the use of positive airway pressure including continuous positive airway pressure (CPAP) and bi-level modalities, adaptive servo-ventilation, and maintenance of nasal and oral airways that do not extend into the trachea.

(2) 'Polysomnographic technologist' means any person performing polysomnography services under the supervision of a person licensed under this article.

(3) 'Supervision' means that the supervising physician licensed under this article shall remain available, either in person or through telephonic or electronic means, at the time that polysomnography services are provided.

(b) A physician may delegate tasks involving polysomnography to a polysomnographic technologist without regard to whether such technologist is certified or licensed as a respiratory care therapist under Article 6 of this chapter.

(c) Nothing in this Code section shall be construed to:

(1) Permit the practice of medicine as defined in this article by polysomnographic technologists;

(2) Prohibit a health care provider licensed in this state from engaging in the practice for which he or she is licensed, including, but not limited to, respiratory care professionals certified under Article 6 of this chapter; or

(3) Authorize a polysomnographic technologist to treat, manage, control, educate, or care for patients other than those with sleep or wake disorders or to provide diagnostic testing for patients other than those with suspected sleep or wake disorders.

And from the RCP Act: (section of the same amended bill)

…43-34-151.

(a) Unless certified under this article or exempted under subsection (b) of this Code section, no person shall:

(1) Practice respiratory care; or

(2) Represent himself or herself to be a respiratory care professional who is certified under this article.

(b) The prohibition in subsection (a) of this Code section does not apply to:

(1) The delivery of respiratory care by health care personnel who have been formally trained in these modalities and who are duly licensed to provide that care under any other provision of this title;

(2) The practice of respiratory care which is an integral part of the program of study by students enrolled in a respiratory care education program recognized by the Joint Review Committee for Respiratory Therapy Education and the American Medical Association Committee on Allied Health Education and Accreditation (CAHEA) or the equivalent thereof as accepted by the board. Students enrolled in respiratory therapy education programs shall be identified as 'student-RCP' and shall only provide respiratory care under direct clinical supervision;

(3) Self-care by a patient or gratuitous care by a friend or family member who does not represent or hold himself or herself out to be a respiratory care professional;

(4) Respiratory care services rendered in the course of an emergency or disaster;

(5) Persons in the military services or working in federal facilities when functioning in the course of their assigned duties;

(6) The performance of respiratory care diagnostic testing by individuals who are certified or registered as pulmonary function technologist technologists by the National Board for Respiratory Care, or equivalent certifying agency, as recognized by the board;

(7) The delivery, assembly, setup, testing, and demonstration of oxygen and aerosol equipment upon the order of a physician licensed under Article 2 of this chapter; or

(8) Persons who perform limited respiratory care procedures under the supervision of a certified respiratory care professional in a hospital or nursing home when the board has defined the competencies required to perform such limited respiratory care procedures; or

(9) Persons who perform polysomnography under Code Section 43-34-45.

posted March 13, 2009

SB 252 PASSED! NOW ON TO THE HOUSE!

GREAT WORK GASP MEMBERS!

posted March 6, 2009

Below you will find the final House and Senate versions of the Polysomnography Practice Act (PPA) that now has the signatures of Rep. Wilkinson and Sen. Thomas as the top sponsors in their respective legislative bodies.

• SB 252

• HB 675

Rep. Benfield and Sen. Adelman will also add their names along with Rep. Cooper, who is also the house chair of health and human services.  The legislators will move to add this act as an amendment to the health care practice bill that is moving through the govt and expected to pass.

For updates on the progress of the bills (which we will update you as well), you can visit the GA Legislature website at http://www.legis.state.ga.us/ and plug the appropriate bill numbers in the upper right hand corner of the home page (HB ___, and use the drop down to switch to SB ___ ).

There is still an urgent need to contact your legislators to support SB 252 and HB 675 and the Health Care Bill (which is really the only way to get the PPA into law this year) to make them aware of how important it is to move this bill through in THIS SESSION. 

If you have friends, patients, or know anyone with influence in state/local government, please contact them for support as well.  In order to keep everyone on the same page throughout this rapid process, regular updates will be provided on the Georgia Association of Sleep Professionals website at www.gasleep.org.  (The GASP website will be updated this evening.)

To find your elected official navigate to:  http://www.legis.state.ga.us/legis/FindLegislator.htm

Below is an updated sample script for all to use when contacting legislators about this bill. Remember, your representatives and senators WANT to hear from you (their constituents). They WANT to represent YOU and YOUR issues, but you have to make the call, the visit, the EFFORT. Please help yourself and your patients by making the calls.

Dr. Jeffrey Durmer made a visit to the Medical Board Board this morning (Friday, 3/6) to update them on what's been accomplished so far, that an Act is now in the legislative process, and to respectfully request they hold off on any "prosecutory" actions. 

**********

SAMPLE SCRIPT

RE:      REQUEST TO SUPPORT SB 252 and HB 675
  

I would like to request your support for a bill that are moving through the house and senate this session called the POLYSOMONOGRAPHY PRACTICE ACT (SB 252 and HB 675). 

This bill establishes uniform statewide educational, training, and background check requirements for individuals who assist physicians in diagnosing and treating sleep disorders.  These uniform requirements will help ensure the safety and quality of care for patients in Georgia who are being diagnosed and treated for sleep disorders.

This bill is sponsored in the State House of Representatives by Representatives Benfield and Wilkinson and in the Senate by Senator Thomas.  Throughout the legislative process, the sponsors have worked in good faith with all the relevant stakeholders and state agencies to address any concerns raised.  As a result, there is no known opposition.  The bill has the support of the Georgia Association of Sleep Professionals and the American Academy of Sleep Medicine. These organizations represent the physicians, and technologists who provide sleep medicine care in our state for the thousands of patients impacted by sleep disorders.  This bill is also supported by the Georgia Society for Respiratory Care, and the American Association of Sleep Technologists.  

We urgently request your support for the Polysomnography Practice Act bill in this legislative session.

posted March 1, 2009

CPAP therapy in the State of GA will come to a GRINDING HALT without your IMMEDIATE Political Action!

In the next 3-4 business days, the Polysomnography Practice Act will be introduced in the Georgia Legislature. This Act will provide a license for Sleep Technologists which will allow them to continue to provide CPAP, bi-level, and ASV therapy to the patients of GA. It is being formally drafted by the Legislative counsel at this moment, and is planned for release Tuesday, March 3 or Wednesday, March 4.  There are less than 7 days to get this bill through this session. The next session is next year.

Over the past few weeks, many sleep professionals around our state have inquired about what they can do to help.  THIS is the time to act! Your help is needed NOW!   Please contact your local state house representative and state senator and ask them to support this bill.  The most efficient means of communicating with your legislator is by phone call or personal visit, given the rapidly approaching session end.

The organizing committee of the Georgia Association of Sleep Professionals has worked diligently with GA state officials and legislators to draft a bill that will pass without opposition. Because of the short time line before the end of this year’s session we need to make as many legislators aware of the urgent need for them to move this bill through in THIS SESSION. 

If you have friends, patients, or know anyone with influence in state/local government, please contact them for support as well.  In order to keep everyone on the same page throughout this rapid process, regular updates will be provided on the Georgia Association of Sleep Professionals website at www.gasleep.org.

To find your elected official navigate to:  http://www.legis.state.ga.us/legis/FindLegislator.htm

Below is a sample script for all to use when contacting legislators about this bill. Remember, your representatives and senators WANT to hear from you (their constituents). They WANT to represent YOU and YOUR issues, but you have to make the call, the visit, the EFFORT. Please help yourself and your patients by making the calls.

SAMPLE SCRIPT

RE:      SIGNATURE REQUEST FOR POLYSOMNOGRAPHY PRACTICE ACT

I would like to request your support for a bill that will be moving through the house and senate this session called the POLYSOMONOGRAPHY PRACTICE ACT. 

This bill establishes uniform statewide educational, training, and background check requirements for individuals who assist physicians in diagnosing and treating sleep disorders.  These uniform requirements will help ensure the safety and quality of care for patients in Georgia who are being diagnosed and treated for sleep disorders.

This bill is sponsored in the State House of Representatives by Representatives Benfield and Wilkinson and in the Senate by Senator Thomas.  Throughout the legislative process, the sponsors have worked in good faith with all the relevant stakeholders and state agencies to address any concerns raised.  As a result, there is no known opposition.  The bill has the support of the Georgia Association of Sleep Professionals and the American Academy of Sleep Medicine. These organizations represent the physicians, and technologists who provide sleep medicine care in our state for the thousands of patients impacted by sleep disorders.  This bill is also supported by the Georgia Society for Respiratory Care, and the American Association of Sleep Technologists.  

We urgently request your support for the Polysomnography Practice Act bill in this legislative session.

URGENT CALL TO ACTION - Posted February 9, 2009

Dear Friends and Colleagues,

As you may have heard, The Respiratory Care Advisory Committee of the Georgia State Composite Board of Medical Examiners issued a Clarification Statement in their Spring 2008 newsletter stating that,

“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.”

The implication is that Registered Polysomnographic Technologists, who do not otherwise hold a respiratory therapy license, would no longer be allowed to perform any PAP related activities in Sleep Medicine Centers, Laboratories or Clinics in the state. 

In response to the Respiratory Care Committee statement, members of the American Academy of Sleep Medicine and the American Association of Sleep Technologists in GA, along with the backing of these national organizations, solicited the help of willing individuals to organize a grassroots statewide association for Georgia Sleep Professionals.  Thus, the Georgia Association of Sleep Professionals, or GASP, began in June of 2008. Since that time, the organizing members have developed a website, an organizing Board of Directors, an Interim President, bylaws, mission and vision statements, as well as contracted an Executive Director to coordinate the development of GASP.

Also in June 2008, the AASM sent a letter to the Composite Board requesting further clarification of “the clarification”.  No tangible response was given; however, efforts by the organizers of GASP began to present the Sleep Medicine “case” for exemption or separate licensure to the Composite Board. 

In the meantime, the Composite Board sought advice from the Attorney General’s office regarding the matter. Upon receiving the opinion from the Attorney General’s office (which was no different from the previous statement) the GASP organizing committee drafted a letter and several supporting documents outlining the significant differences between the training and scope of practice of RTs and RPGSTs, as well as educational literature regarding Sleep Medicine, the use of PAP in Sleep Medicine, and a request to delay any formal ruling until legislation for either exemption or licensure for RPGSTs could be considered at the GA state house (see Legislative Section for these documents.)

On Thursday, February 5, 2009, we were given time to address the Composite Board directly with letters from the AASM, GASP and the American Sleep Apnea Association. Although no ruling was made on Thursday, the discussions between board members, the RT lobbyist and our contingency indicated that in the state of GA, licensure for RPSGTs is the only option.

As you know, Sleep Technology is not currently a licensed profession in the State of Georgia. The current Georgia Legislative session has begun and will only continue for 40 days, ending in March 2009.  The new session will not begin again until January 2010 which gives us time to craft legislation with our state representatives and senators, but also leaves open the issue for at least another year. The possibility exists that with a ruling to support the need for licensure to provide PAP therapy in the state of Georgia, our current system of RPGST based laboratory and clinical PAP treatments is in jeopardy. Many dedicated RPGSTs may lose their jobs, Sleep Medicine patients will undoubtedly face severe access-to-therapy limitations, and the infrastructure which supports PAP treatment in GA Sleep Centers, Laboratories and Clinics will dissolve.

The GASP organizing committee has arranged a meeting on Wednesday February 11, to present our case for legal licensure to a number of Georgia State Representatives at their offices in the capitol. With templates from 3 of the other 5 states in the US who currently have licensure for Sleep Technologists, we seek to begin the process culminating in a Georgia Licensure Act.

We ask from you, that you get involved NOW to protect your profession, your job, your Center and your future.

1.       FINANCIAL SUPPORT:  After the official GASP launch reception, scheduled for March 20, we will VOTE for our Board members. Prior to this, we must secure members and revenue to support the legal efforts ahead.   Please join GASP today and contribute further to the GASP Legal Fund.

2.       Get Sleep Medicine friends involved: Call or email every colleague and vendor you know and direct them to the GASP website, www.gasleep.org, so they know as much as you do about this issue. Ask your colleagues to JOIN GASP.  Ask your vendors to SPONSOR GASP.  If we fail to address this through legislation it is not just going to affect Technologists – it affects everyone in Sleep Medicine, especially our patients. 

3.       Get the Word Out: Tell people about this. We may ask all of you to call your State Representative once we have a bill to support. Get ready to act on your own behalf.

Remember, if we all do nothing, we stand a chance that we will lose everything a little at a time.  Please get involved now, and keep an eye out for updates on the GASP website as we get closer to the GASP launch party on March 20, 2009.

Sincerely yours,

Paul Gouin, MD

President

Georgia Association of Sleep Professionals

PRESS RELEASE - Posted February 5, 2009

Fighting for Patient Rights in the State of Georgia

The Georgia Association of Sleep Professionals (GASP) met with the Composite State Board of Medical Examiners regarding a licensing proposal that could severely limit access to appropriate testing, treatment and education of Sleep Medicine patients.  Current regulatory entities assert that any licensed Respiratory Therapist, regardless of demonstrated competency, is allowed to test, treat and educate patients in Sleep Medicine.   This is in complete contradiction to the opinions of the Sleep Medicine community.

A clarification issued by the Composite Board regarding the governance of Sleep Technology and Sleep Technologists does not incorporate the expertise or opinion of the Sleep Medicine community in the State of Georgia or any national association such as the American Academy of Sleep Medicine or the American Academy of Sleep Technologists. This memorandum states that any licensed Respiratory Therapist is allowed to treat patients without regard to specialized training in the normal and abnormal physiology, specific disease states, and methodologies applied in the field of Sleep Medicine.

The clarification issued by the Board suggests that all licensed respiratory therapists are competent to provide patient education, diagnostic and therapeutic services that are dependent on training that is specific to Sleep Technologists and Sleep Medicine professionals. By this suggestion, GASP feels that Sleep Medicine related services to the patients of Georgia will be compromised.

If the decision is made that only Respiratory Therapists can provide PAP therapy in the State of Georgia, GASP predicts healthcare for Sleep Medicine patients in the State of Georgia will decline precipitously, access to appropriate testing, treatment and education for Sleep Medicine patents will be severely limited, and hundreds of hard-working career-minded Registered Polysomnographic Technologists and Technicians will lose their jobs across the State of Georgia in the midst of a major U.S. economic crisis.

Posted January 16, 2009

Respiratory Care Advisory Committee’s position statement on the performance of CPAP training, use and care by unlicensed personnel in sleep labs which appeared in the Board’s Nov. 2008 newsletter, is on the agenda at the February 5, 2009 meeting of the Georgia Composite State Board of Medical Examiners.  Members of GASP will be attending the February 5 meeting at 9:00 a.m., which is an open public forum, to present a letter and supporting materials disputing the Respiratory Committee's statement.  VIEW.

The American Sleep Apnea Association has also prepared a letter in support of GASP's position, that will be presented at the Board meeting on Thursday, February 5. VIEW

Posted December 8, 2008

The American Academy of Sleep Medicine has sent a letter to the Georgia Composite State Board of Medical Examiners to dispute the Respiratory Committee's statement in November 2008.  VIEW LETTER.

Posted December 5, 2008

The Georgia Composite State Board of Medical Examiners has delayed discussion of the Respiratory Care Advisory Committee’s position statement on the performance of CPAP training, use and care by unlicensed personnel in sleep labs which appeared in the Board’s Nov. 2008 newsletter. (the newsletter can be found at http://medicalboard.georgia.gov/vgn/images/portal/cit_1210/56/9/88927066MedBdNewsletter_Nov08.pdf) The Board has requested an opinion by the GA Attorney General on the Committee’s statement. The Board may put the issue on a future meeting agenda.

Mike Brennen, RPSGT
BRPT Governmental Affairs

To submit news, please email media@gasleep.org.