244 Respiratory care practitioner

STATE BOARD
OF MEDICINE
AND
STATE BOARD OF OSTEOPATHIC MEDICINE

[49 PA. CODE CHS. 18 AND 25]

Respiratory Care Practitioners

[26 Pa.B. 757]

   By this combined proposal, the State Board of Medicine and State Board of Osteopathic Medicine (the Boards) propose to amend Chapters 18 and 25, as set forth in Annex A. These proposed regulations will add new subchapters pertaining to the certification and practice of respiratory care practitioners in this Commonwealth.

   In 1993, the Legislature amended both medical practice acts to create a new certification class of practitioners regulated by the Boards to be known as respiratory care practitioners. Under the amendatory acts, respiratory care practitioners may obtain certifications from either Board.

   The Boards have elected to promulgate the proposed new Subchapters F and I (relating to respiratory care practitioners) jointly inasmuch as the amendments to both Boards' practice acts regarding respiratory care certification are substantially identical.

Statutory Authority

   The regulations are proposed under the authority of sections 13.1(c) and 36.1 of the Medical Practice Act of 1985 (MPA) (63 P. S. §§ 422.13a(c) and 422.36a) and sections 10.1(c) and 10.2 of the Osteopathic Medical Practice Act (OMPA) (63 P. S. §§ 271.10a(c) and 271.10b), added by the act of July 2, 1993 (P. L. 424, No. 60) and the act of July 2, 1993 (P. L. 418, No. 519) respectively. These sections require that the Boards issue certificates and temporary permits to individuals meeting the qualifications set forth in the MPA and the OMPA to practice or offer to practice respiratory care in this Commonwealth. Under section 13.1(a) of the MPA and section 10.1(a) of the OMPA, on and after June 30, 1995, an individual may not practice, hold himself out to the public to practice or offer to practice as a respiratory care practitioner unless that individual holds a valid, current temporary permit or certificate issued by either Board. See section 3 of the act of July 2, 1993, section 13.1(a) of the MPA, section 3 of the act of July 2, 1993 and section 10.1(a) of the OMPA.

   Under section 13.1(c) of the MPA and section 10.1(c) of the OMPA, the Boards are authorized to promulgate regulations to establish procedures for application, credentials, verification, examination, certification and fees.

Persons Affected

   Persons who practice or who seek to practice respiratory care in this Commonwealth on and after June 30, 1995, must obtain a permit or a certificate in accordance with the provisions of this proposal.

Summary of Provisions

   Major features of the new subchapters as proposed are summarized as follows.

§§ 18.302 and 25.293.  Definitions.

   These proposed sections would define words and phrases used in the subchapters. The National uniform examination adopted by the Boards is the CRTT, the entry level respiratory care examination of the National Board for Respiratory Care (NBRC). The Boards also recognize as the accrediting agency for acceptable respiratory care educational programs the Joint Review Committee on Respiratory Therapy Education (JRCRTE).

§§ 18.303 and 25.924.  Fees.

   These proposed sections establish fees for obtaining a temporary permit, certification, examination and biennial renewal of certifications. Each of the fees for the issuance of a temporary permit and initial certification and for examination is based upon the costs of providing the service. The biennial renewal fee represents the estimation of the Boards of the costs of administering the certification program over a biennial period.

§§ 18.304 and 25.295.  Certification of respiratory care practitioners; practice; exceptions.

   Subsection (a) of each section would notify persons intending to practice respiratory care of the requirements of certification unless exempted by statute.

   Subsections (b) of each section as proposed would notify persons that the words ''respiratory care practitioner,'' the letters ''R.C.P.'' or similar words and abbreviations, may not be used in connection with the provision of respiratory care services unless provided by a certified respiratory care practitioner under the supervision of a licensed physician.

§§ 18.305 and 25.296.  Functions of respiratory care practitioners.

   Proposed subsection (a) of each section states the functions that have been legislatively reserved to respiratory care practitioners. Proposed subsection (b) of each section restates the limitation of the MPA and the OMPA that respiratory care functions may only be performed upon a physician prescription, a referral or under medical direction under standing orders or protocols in a health care facility or other health care site.

§§ 18.306 and 25.297.  Temporary permits.

   The MPA and the OMPA require the Boards to issue temporary permits to persons who are qualified by education to take the examination for certification. Proposed subsection (a) of each section provides that a temporary permit will be issued to applicants who submit evidence of: (1) having graduated from a respiratory care program while awaiting the results of the Board-approved examination; (2) expecting to graduate within 30 days of the date of application for temporary permit; or (3) having provided respiratory care services for at least 12-consecutive months prior to December 28, 1993, and awaiting results of the examination. Proposed subsection (b) of each section provides that a temporary permit expire in the case of failure of the examination or at the end of 12 months, whichever occurs first. Only those applicants who have not fulfilled the requirements for certification need obtain a temporary permit.

§§ 18.307 and 25.298.  Criteria for certification as a respiratory care practitioner.

   These proposed sections provide the criteria which the Boards will apply in the initial certification of applicants. Proposed subsection (a) of each section requires that the applicant submit evidence of: (1) having graduated from a respiratory care program and passed the Boards' examination; (2) having been credentialed as a Certified Respiratory Therapy Technician or a Registered Respiratory Therapist by the National Board for Respiratory Care; (3) holding a valid license, certificate or registration as a respiratory care practitioner in another state, territory or the District of Columbia issued based upon requirements substantially similar to those required in the Commonwealth; or (4) having provided respiratory care services for at least 12-consecutive months prior to December 23, 1993, and passed the CRTT. Proposed subsection (b) of each section requires the payment of the appropriate fee as a precondition to Board certification.

§§ 18.308 and 25.299.  Renewal of certification.

   As proposed, these sections establish the procedure for certificateholders to biennially renew their certifications as required under the MPA and the OMPA. Biennial review forms will be provided to certificateholders at their last mailing address on record with the appropriate Board. Certificateholders are required to inform the appropriate Board within 10 days of address changes. Certificateholders are further notified of the statutorily imposed $5 late penalty fee required by the Bureau of Professional and Occupational Affairs Fee Act (63 P. S. §§ 1401-101--1401-501) Subsections (e)--(h) of each section will notify certificateholders of procedures to request inactive status and to return to active status as a respiratory care practitioner in this Commonwealth.

Fiscal Impact

Commonwealth

   The proposed regulations establish fees for the issuance of temporary permits, certifications and biennial renewal for respiratory care practitioners. Revenue generated from these fees will be used to cover the costs of administration of the certification program. The proposed regulations would not otherwise impose additional costs on the Commonwealth.

Political Subdivisions

   The proposed regulations should not have any direct fiscal impact upon political subdivisions in this Commonwealth.

Private Sector

   The proposed regulations may impose additional costs upon the private sector. In particular, entities who provide respiratory care services may incur additional costs in bringing their facilities into compliance by employing or utilizing certified practitioners. Persons wishing to obtain certification from the Boards will incur those costs associated with the administration of the certification program, as well as costs associated with the qualifying examination.

General Public

   The proposed regulations should impose no additional costs upon the general public.

Paperwork Requirements

   Persons seeking temporary permits or certifications will be required to obtain application forms from the Boards in order to obtain certification.

Regulatory Review

   Under section 5(a) of the Regulatory Review Act (71 P. S. § 745.5(a)), the Boards submitted a copy of these proposed regulations on February 9, 1996, to the Independent Regulatory Review Commission (IRRC) and to the Chairpersons of the Senate Committee on Consumer Protection and Professional Licensure and the House Committee on Professional Licensure. In addition to submitting the proposal, the Boards have provided IRRC and the Committees with a copy of a detailed Regulatory Analysis Form prepared by the Boards in compliance with Executive Order 1982-2, ''Improving Government Regulations.'' A copy of this material is available to the public upon request.

   If IRRC has objections to any portion of the proposal, it will notify the Boards within 30 days of the close of the public comment period. The notification shall specify the regulatory review criteria which are not met by that portion. The Regulatory Review Act specifies detailed procedures for review of objections raised, prior to final publication of the regulations, by the Boards, the General Assembly and the Governor.

Contact Persons

   Interested persons are invited to submit written comments, suggestions or objections regarding the proposal to either the State Board of Medicine or the State Board of Osteopathic Medicine at the following address: P. O. Box 2649, Harrisburg, PA 17105-2649, within 30 days following publication of the proposal in the Pennsylvania Bulletin. Procedures for filing written comments or requests for documents and additional information may be obtained by contacting Cindy Warner, Administrative Assistant for the State Board of Medicine, at [phone], or Gina Bittner, Administrative Assistant for the State Board of Osteopathic Medicine, at [phone].

MORRIS A. FISHMAN, D.O.,   
Chairperson

VICTOR F. GRECO, M.D.,   
Chairperson

   Fiscal Note:  16A-532. No fiscal impact; (8) recommends adoption.

Annex A

TITLE 49.  PROFESSIONAL AND
VOCATIONAL STANDARDS

PART I.  DEPARTMENT OF STATE

Subpart A.  PROFESSIONAL AND
VOCATIONAL AFFAIRS

CHAPTER 18.  STATE BOARD OF MEDICINE

Subchapter F.  RESPIRATORY CARE PRACTITIONERS

   (Editor's Note:  The following subchapter is proposed to be added. It is printed in regular type to enhance readability.)

Sec.

18.301.	Purpose.
18.302.	Definitions.
18.303.	Fees.
18.304.	Certification of respiratory care practitioners; practice; exemptions.
18.305.	Functions of respiratory care practitioners.
18.306.	Temporary permits.
18.307.	Criteria for certification as a respiratory care practitioner.
18.308.	Change of name or address.
18.309.	Renewal of certification.
18.310.	Inactive status.

§ 18.301.  Purpose.

   This subchapter implements sections 13.1 and 36.1 of the act (63 P. S. §§ 422.13a and 422.36a), which were added by section 3 of the act of July 2, 1993 (P. L. 424, No. 60) to provide for the certification of respiratory care practitioners.

§ 18.302.  Definitions.

   The following words and terms, when used in this subchapter have the following meanings, unless the context clearly indicates otherwise:

   CRTT--The entry level respiratory care examination, a National uniform examination developed and administered by the NBRC for certified respiratory care therapy technicians.

   JRCRTE--The Joint Review Committee on Respiratory Therapy Education, which accredits respiratory care programs.

   NBRC--The National Board for Respiratory Care, the agency recognized by the Board to credential respiratory care practitioners.

   Respiratory care practitioner--A person who has been certified in accordance with the act and this subchapter.

§ 18.303.  Fees.

   The following is the schedule of fees charged by the Board:

(1)  Temporary permit	$15
(2)  Initial certification	$15
(3)  Certification examination	$90 (Effective 7-96)	$100
(4)  Reexamination	$60
(5)  Biennial renewal of certification	$25

§ 18.304.  Certification of respiratory care practitioners; practice; exemptions.

   (a)  A person may not practice or hold himself out as being able to practice as a respiratory care practitioner in this Commonwealth unless the person holds a valid, current temporary permit or certificate issued by the Board, or the State Board of Osteopathic Medicine under Chapter 25 (relating to State Board of Osteopathic Medicine), or is exempted under section 13.1(e) of the act (63 P. S. § 422.13a(e)) or section 10.1(e) of the Osteopathic Medical Practice Act (63 P. S. § 271.10a(e)).

   (b)  A person may not use the words ''respiratory care practitioner,'' the letters ''R.C.P.'' or similar words and related abbreviations to imply that respiratory care services are being provided, unless the services are provided by a respiratory care practitioner who holds a valid, current temporary permit or certificate issued by the Board or the State Board of Osteopathic Medicine and only while working under the supervision of a licensed physician.

§ 18.305.  Functions of respiratory care practitioners.

   (a)  Under section 13.1(d) of the act (63 P. S. § 422.13a(d)), a respiratory care practitioner may perform activities that include the following:

   (1)  Administration of medical gases.

   (2)  Humidity and aerosol therapy.

   (3)  Administration of aerosolized medications.

   (4)  Intermittent positive pressure breathing.

   (5)  Incentive spirometry.

   (6)  Bronchopulmonary hygiene.

   (7)  Management and maintenance of natural airways.

   (8)  Maintenance and insertion of artificial airways.

   (9)  Cardiopulmonary rehabilitation.

   (10)  Management and maintenance of mechanical ventilation.

   (11)  Measurement of ventilatory flows, volumes and pressures.

   (12)  Analysis of ventilatory gases and blood gases.

   (b)  Under section 13.1(d) of the act, a respiratory care practitioner may perform the activities listed in subsection (a) only upon physician prescription or referral or while under medical direction consistent with standing orders or protocols in an institution or health care facility.

§ 18.306.  Temporary permits.

   (a)  A temporary permit will be issued to an applicant who submits evidence satisfactory to the Board, on forms supplied by the Board, that the applicant has met one or more of the following criteria:

   (1)  Has graduated from a respiratory care program approved by the JRCRTE, and is awaiting results of the CRTT.

   (2)  Is enrolled in a respiratory care program approved by the JRCRTE, expects to graduate within 30 days of the date of application, and has applied to sit for the next scheduled examination.

   (3)  Has provided respiratory care services for at least 12-consecutive months prior to December 28, 1993.

   (b)  A temporary permit shall expire upon notification of failure of the examination or 12 months from the date of issuance, whichever occurs first.

§ 18.307.  Criteria for certification as a respiratory care practitioner.

   The Board will approve for certification as a respiratory care practitioner an applicant who:

   (1)  Submits evidence satisfactory to the Board, on forms supplied by the Board, that the applicant has met one or more of the following criteria:

   (i)  Has graduated from a respiratory care program approved by the JRCRTE and passed the CRTT as determined by the NBRC.

   (ii)  Has been credentialed as a Certified Respiratory Therapy Technician or Registered Respiratory Therapist by the NBRC.

   (iii)  Holds a valid license, certificate or registration as a respiratory care practitioner in another state, territory or the District of Columbia which has been issued based on requirements substantially the same as those required by the Commonwealth, including the examination requirement.

   (iv)  Has provided respiratory care services for at least 12 consecutive months prior to December 28, 1993, and has passed the CRTT as determined by the NBRC.

   (2)  Has paid the appropriate fee in the form of a check or money order.

§ 18.308.  Change of name or address.

   A certificateholder shall inform the Board in writing within 10 days of a change of name or mailing address.

§ 18.309.  Renewal of certification.

   (a)  A certification issued under this subchapter expires on December 31 of every even-numbered year unless renewed for the next biennium.

   (b)  Biennial renewal forms and other forms and literature to be distributed by the Board will be forwarded to the last mailing address given to the Board.

   (c)  To retain the right to engage in practice, the certificateholder shall renew certification in the manner prescribed by the Board and pay the required fee prior to the expiration of the next biennium.

   (d)  When a certification is renewed after December 31 of an even-numbered year, a penalty fee of $5 for each month or part of a month of practice beyond the renewal date will be charged in addition to the renewal fee.

§ 18.310.  Inactive status.

   (a)  A certificateholder who does not intend to practice in this Commonwealth and who does not desire to renew certification shall inform the Board in writing. Written confirmation of inactive status will be forwarded to the certificateholder.

   (b)  A certificateholder shall notify the Board, in writing, of his desire to reactivate the registration.

   (c)  A certificateholder who is applying to return to active status is required to pay fees which are due, submit a sworn statement stating the period of time during which the certificateholder was not engaged in practice in this Commonwealth, submit a resume of professional activities since the most recent registration and submit a letter of good standing from another state or territory where the certificateholder is currently licensed or registered to practice.

   (d)  The applicant for reactivation will not be assessed a fee or penalty for preceding biennial periods in which the applicant did not engage in practice in this Commonwealth.

CHAPTER 25.  STATE BOARD OF
OSTEOPATHIC MEDICINE

Subchapter I.  RESPIRATORY CARE PRACTITIONERS

   (Editor's Note:  The following subchapter is proposed to be added. It is printed in regular type to enhance readability.)

Sec.

25.292.	Purpose.
25.293.	Definitions.
25.294.	Fees.
25.295.	Certification of respiratory care practitioners; practice; exemptions.
25.296.	Functions of respiratory care practitioners.
25.297.	Temporary permits.
25.298.	Criteria for certification as a respiratory care practitioner.
25.299.	Change of name or address.
25.300.	Renewal of certification.
25.301.	Inactive status.

§ 25.292.  Purpose.

   This subchapter implements sections 10.1 and 10.2 of the act (63 P. S. §§ 271.10a and 271.10b), which were added by section 3 of the act of July 2, 1993 (P. L. 418, No. 59) to provide for the certification of respiratory care practitioners.

§ 25.293.  Definitions.

   The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise:

   CRTT--The entry level respiratory care examination, a National uniform examination developed and administered by the NBRC for certification of respiratory therapy technicians.

   JRCRTE--The Joint Review Committee on Respiratory Therapy Education, which accredits respiratory care programs.

   NBRC--The National Board for Respiratory Care, the agency recognized by the Board to certify respiratory care practitioners.

   Respiratory care practitioner--A person who has been certified in accordance with the act and this subchapter.

§ 25.294.  Fees.

   The following is the schedule of fees charged by the Board:

(1)  Temporary permit	$15
(2)  Initial certification	$15
(3)  Certification examination	$90 (Effective 7-96)	$100
(4)  Reexamination	$60
(5)  Biennial renewal of certification	$25

§ 25.295.  Certification of respiratory care practitioners; practice; exemptions.

   (a)  A person may not practice or hold himself out as being able to practice as a respiratory care practitioner in this Commonwealth unless the person holds a valid, current temporary permit or certificate issued by the Board, or the State Board of Medicine under Chapter 18 (relating to State Board of Medicine) or is exempted under section 10.1(e) of the act (63 P. S. §§ 271.10a(e)) or section 13.1(e) of the Medical Practice Act of 1985 (63 P. S. § 422.13a(e)).

   (b)  A person may not use the words ''respiratory care practitioner,'' the letters ''R.C.P.'' or similar words and related abbreviations to imply that respiratory care services are being provided, unless the services are provided by a respiratory care practitioner who holds a valid, current temporary permit or certificate issued by the Board or the State Board of Medicine and only while working under the supervision of a licensed physician.

§ 25.296.  Functions of respiratory care practitioners.

   (a)  Under section 10.1(d) of the act (63 P. S. § 271.10a(d)), a respiratory care practitioner may perform activities that include the following:

   (1)  Administration of medical gases.

   (2)  Humidity and aerosol therapy.

   (3)  Administration of aerosolized medications.

   (4)  Intermittent positive pressure breathing.

   (5)  Incentive spirometry.

   (6)  Bronchopulmonary hygiene.

   (7)  Management and maintenance of natural airways.

   (8)  Maintenance and insertion of artificial airways.

   (9)  Cardiopulmonary rehabilitation.

   (10)  Management and maintenance of mechanical ventilation.

   (11)  Measurement of ventilatory flows, volumes and pressures.

   (12)  Analysis of ventilatory gases and blood gases.

   (b)  Under section 10.1(d) of the act, a respiratory care practitioner may perform the activities listed in subsection (a) only upon physician prescription or referral or while under medical direction consistent with standing orders or protocols in an institution or health care facility.

§ 25.297.  Temporary permits.

   (a)  A temporary permit will be issued to an applicant who submits evidence satisfactory to the Board, on forms supplied by the Board, that the applicant has met one or more of the following criteria;

   (1)  Has graduated from a respiratory care program approved by the JRCRTE, and is awaiting results of the CRTE.

   (2)  Is enrolled in a respiratory care program approved by the JRCRTE, expects to graduate within 30 days of the date of application, and has applied to sit for the next scheduled examination.

   (3)  Has provided respiratory care services for at least 12-consecutive months prior to December 28, 1993.

   (b)  A temporary permit shall expire upon notification of failure of the examination or 12 months from the date of issuance, whichever occurs first.

§ 25.298.  Criteria for certification as a respiratory care practitioner.

   The Board will approve for certification as a respiratory care practitioner an applicant who:

   (1)  Submits evidence satisfactory to the Board, on forms supplied by the Board, that the applicant has met one or more of the following criteria:

   (i)  Has graduated from a respiratory care program approved by the JRCRTE and passed the CRTT as determined by the NBRC.

   (ii)  Has been credentialed as a Certified Respiratory Therapy Technician or Registered Respiratory Therapist by the NBRC.

   (iii)  Holds a valid license, certificate or registration as a respiratory care practitioner in another state, territory or the District of Columbia which has been issued based on requirements substantially the same as those required by this Commonwealth, including the examination requirement.

   (iv)  Has provided respiratory care services for at least 12-consecutive months prior to December 28, 1993 and has passed the CRTT as determined by the NBRC.

   (2)  Has paid the appropriate fee in the form of a check or money order.

§ 25.299.  Change of name or address.

   A certificateholder shall inform the Board in writing within 10 days of a change of name or mailing address.

§ 25.300.  Renewal of certification.

   (a)  A certification issued under this subchapter expires on December 31 of every even-numbered year unless renewed for the next biennium.

   (b)  Biennial renewal forms and other forms and literature to be distributed by the Board will be forwarded to the last mailing address given to the Board.

   (c)  To retain the right to engage in practice, the certificateholder shall renew certification in the manner prescribed by the Board and pay the required fee prior to the expiration of the next biennium.

   (d)  When a certification is renewed after December 31 of an even-numbered year, a penalty fee of $5 for eachmonth or part of a month of practice beyond the renewal date will be charged in addition to the renewal fee.

§ 25.301.  Inactive status.

   (a)  A certificateholder who does not intend to practice in this Commonwealth and who does not desire to renew certification shall inform the Board in writing. Written confirmation of inactive status will be forwarded to the certificateholder.

   (b)  A certificateholder shall notify the Board, in writing, of his desire to reactivate the registration.

   (c)  A certificateholder who is applying to return to active status is required to pay fees which are due, submit a sworn statement stating the period of time during which the certificateholder was not engaged in practice in this Commonwealth, submit a resume of professional activities since the most recent registration and submit a letter of good standing from another state or territory where the certificateholder is currently licensed or registered to practice.

   (d)  The applicant for reactivation will not be assessed a fee or penalty for preceding biennial periods in which the applicant did not engage in practice in this Commonwealth.

[Pa.B. Doc. No. 96-244. Filed for public inspection February 23, 1996, 9:00 a.m.]